No abstract available.
Thioctic Acid*

BACKGROUND/AIMS: As the optimal stereotactic body radiation therapy (SBRT) modality for hepatocellular carcinoma (HCC) has not been confirmed, we aimed herein to provide a practical guideline by our retrospective review. METHODS: Thirty-nine patients with primary HCC who underwent liver SBRT via 3 modalities (helical tomotherapy [HT]: 22, volumetric modulated arc therapy [VMAT]: 13, Cyberknife: 4) at our institution between July 2014 and July 2015 were included. Modalities were compared with regard to dose conformity index (CI), homogeneity index (HI), clinical results, and patient compliance. RESULTS: VMAT SBRT had favorable conformity (CI: 0.7±0.2), homogeneity (HI: 1.1±0.0), and shortest treatment time (100.2±26.1 seconds). HT SBRT yielded good dosimetric outcomes, especially in conformity (CI: 1.0±0.2). Although the Cyberknife SBRT synchrony system allowed real-time tumor targeting, the treatment time was longest (3,015.0±447.3 seconds), invasive pre-treatment procedures were required, and the HI (1.3±0.0) was lowest. CONCLUSIONS: All 3 modalities yielded competent dosimetric planning parameters. VMAT SBRT was most appropriate for tumors with residual lipiodol or patients with poor conditions. HT SBRT is available for multiple or irregular targets. Cyberknife SBRT is recommended for carefully selected patients and tumors indicated for sono-guided fiducial insertion.
Carcinoma, Hepatocellular* ; Ethiodized Oil ; Humans ; Liver ; Patient Compliance ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

PURPOSE: This study aimed to evaluate whether the deformable image registration (DIR) method is clinically applicable to the safe delivery of re-irradiation in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between August 2010 and March 2012, 12 eligible HCC patients received re-irradiation using helical tomotherapy. The median total prescribed radiation doses at first irradiation and re-irradiation were 50 Gy (range, 36-60 Gy) and 50 Gy (range, 36-58.42 Gy), respectively. Most re-irradiation therapies (11 of 12) were administered to previously irradiated or marginal areas. Dose summation results were reproduced using DIR by rigid and deformable registration methods, and doses of organs-at-risk (OARs) were evaluated. Treatment outcomes were also assessed. RESULTS: Thirty-six dose summation indices were obtained for three OARs (bowel, duodenum, and stomach doses in each patient). There was no statistical difference between the two different types of DIR methods (rigid and deformable) in terms of calculated summation operatorD (0.1 cc, 1 cc, 2 cc, and max) in each OAR. The median total mean remaining liver doses (M(RLD)) in rigid- and deformable-type registration were not statistically different for all cohorts (p=0.248), although a large difference in M(RLD) was observed when there was a significant difference in spatial liver volume change between radiation intervals. One duodenal ulcer perforation developed 20 months after re-irradiation. CONCLUSION: Although current dose summation algorithms and uncertainties do not warrant accurate dosimetric results, OARs-based DIR dose summation can be usefully utilized in the re-irradiation of HCC. Appropriate cohort selection, watchful interpretation, and selective use of DIR methods are crucial to enhance the radio-therapeutic ratio.
Adult ; Aged ; Algorithms ; Carcinoma, Hepatocellular/*radiotherapy ; Female ; Humans ; Liver Neoplasms/*radiotherapy ; Male ; Middle Aged ; Organs at Risk/*radiation effects ; *Radiation Dosage ; Radiometry/*methods ; Radiotherapy/methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated ; *Re-Irradiation ; Tomography, X-Ray Computed/methods ; Treatment Outcome

BACKGROUND: Activated fibrinolysis during cardiopulmonary bypass(CPB) is one of the causes of post CPB coagulopathy. Antifibirinolytics such as tranexamic acid have been administered prophylactically before CPB to decrease postCPB bleeding. However, their routinely application has been challenged as regarding it's thrombotic complication. This study was performed to evaluate the effect of tranexamic acid administered before CPB by thromboelastography. METHODS: 50 open heart surgical patients were randomly selected and devided into two groups, control(N=25) and tranexamic acid group(N=25). In tranexamic acid group. 125mg of tranexamic acid were singly infused before vena caval and aortic cannulation. All of parameters of thromboelastography (TEG) and fibrin degradation products measured before and after CPB were compared between two groups. RESULTS: There were no significant differences in fibrinolytic indexes of TEGs between control group and tranexamic group afte CPB. And there were also no changes in fibrinolysis index between before and after CPB in both groups. The concentration of FDP did not changed after CPB in both groups. CONCLUSIONS: It may be considered that prophylactic administration of tranexamic acid before CPB to reduce post-CPB bleeding would not be recommended routinely.
Catheterization ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis* ; Heart* ; Hemorrhage ; Humans ; Thoracic Surgery* ; Thrombelastography ; Tranexamic Acid*

OBJECTIVE: Plasma homocysteine (Hcy) is considered to be a marker of endothelial dysfunction and a predictor of cardiovascular disease (CVD). Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) is not only a marker of vascular damage but a significant predictor of CVD. Previous studies about the effect of high plasma Hcy levels on arterial stiffness have yielded inconsistent results. We therefore assessed the association between Hcy and baPWV in a relatively large number of subjects with type 2 diabetes mellitus (DM). METHODS: We retrospectively assessed plasma Hcy concentration and arterial stiffness in 1,477 Korean type 2 diabetic patients. Participants were also evaluated for plasma glucose, hemoglobin A1c (HbA1c), duration of DM, microvascular complications, lipid profile, and high sensitivity C-reactive protein (hsCRP). Arterial stiffness was measured noninvasively by baPWV. RESULTS: Correlation analysis indicated a significant positive association between serum Hcy levels and baPWV (r=0.245, p<0.001). In a multiple linear regression analysis, the association between serum Hcy levels and baPWV was independent of traditional cardiovascular risk factors (standardized beta=3.8, p=0.01). CONCLUSION: The results support the hypothesis that plasma Hcy levels are associated with arterial stiffness in patients with type 2 DM. Prospective studies are warranted to determine whether lowering serum Hcy level could reduce arterial stiffness and cardiovascular morbidity in type 2 DM.
C-Reactive Protein ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Glucose ; Hemoglobins ; Homocysteine ; Humans ; Linear Models ; Plasma ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) are novel anti-diabetic drugs whose glucose-lowering effect and cardiovascular and renal benefits were evidenced in clinical trials. We investigated the real-world efficacy and safety of the combination of SGLT2i and GLP-1RA in patients with type 2 diabetes mellitus in Korea. The medical records of 104 patients who maintained the combination for at least 1 year were retrospectively reviewed. The change in glycosylated hemoglobin (HbA1c) after 6 months and 1 year of treatment was evaluated. The mean age was 51 years, and 41% were female. The mean baseline HbA1c, body mass index, and duration of diabetes were 9.0%, 28.8 kg/m2, and 11.7 years, respectively. Compared with baseline, the HbA1c decreased by 1.5% (95% confidence interval [CI], 1.27 to 1.74; P<0.001) after 6 months and by 1.4% (95% CI, 1.19 to 1.70; P<0.001) after 1 year. Over 1 year, the bodyweight change was −2.8 kg (95% CI, −4.21 to −1.47; P<0.001). The combination of SGLT2i and GLP-1RA is effective and tolerable in type 2 diabetes mellitus patients in real-world practice.

Dulaglutide, a weekly injectable glucagon-like peptide-1 receptor agonist, has demonstrated effectiveness when combined with basal insulin. We examined whether the efficacy of dulaglutide is comparable to that of prandial insulin in kidney transplant (KT) recipients with type 2 diabetes mellitus (T2DM) undergoing multiple daily insulin injection (MDI) therapy. Thirty-seven patients, who switched from MDI therapy to basal insulin and dulaglutide, were retrospectively analyzed. Changes in glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels, body weight, and basal insulin dose were evaluated over 6 months. Dulaglutide was comparable to three injections of prandial insulin in terms of glycemic control (HbA1c 7.1% vs. 7.0%; 95% confidence interval [CI], –0.53 to 0.28; P=0.53). The basal insulin and dulaglutide combination resulted in a reduction in FPG levels by 9.7 mg/dL (95% CI, 2.09 to 41.54; P=0.03), in body weight by 4.9 kg (95% CI, 2.87 to 6.98; P<0.001), and in basal insulin dose by 9.52 IU (95% CI, 5.80 to 3.23; P<0.001). Once-weekly dulaglutide may be an effective alternative for thrice-daily prandial insulin in KT recipients with T2DM currently receiving MDI therapy.

BACKGROUND: Hypertension is common in patients with type 2 diabetes, affecting up to 60% of patients. The Korean Diabetes Association performed a nationwide survey about prevalence, awareness and control of hypertension among diabetic Koreans. METHODS: The current survey included 3,859 diabetic patients recruited from 43 hospitals in Korea. Age, gender, height, weight and blood pressure (BP) were measured by standard methods. Data on fasting plasma glucose, glycosylated hemoglobin (HbA1c), awareness of hypertension, and compliance of antihypertensive medication were collected via interview and reviewed using patient medical records. RESULTS: A total of 57.5% of all patients were >60 years old. Their mean HbA1c was 7.6+/-1.5%. Among antihypertensive medication users, 39.9% had <130 mm Hg and <80 mm Hg, whereas 60.1% had > or =130 mm Hg or > or =80 mm Hg. The answer "BP is under good control" was given by 75.1% of the antihypertensive medication users. Out of these patients, 26.4% had <130 mm Hg and <80 mm Hg, whereas 73.6% had > or =130 mm Hg or > or =80 mm Hg. A total of 75.5% of antihypertensive medication users answered that they had taken their antihypertensive medication every day for the past 2 weeks. "Forgetfulness" was most frequently the reason of non-compliance for patients that did not take their antihypertensive medication regularly. CONCLUSION: Approximately one third of the patients with diabetes were found to reach target blood pressure control in the 43 hospitals across Korea. Stricter control is needed to reduce severe complications of diabetes in Korea.
Blood Pressure ; Compliance ; Diabetes Mellitus ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Korea ; Plasma ; Prevalence

OBJECTIVES: High serum Lp(a) concentration is associated with a high risk of coronary artery disease(CAD). This study was initiated to determine whether increased Lp(a) levels are associated with diabetic vascular complications in Korean patients with NIDDM. METHODS: A total of 183 NDDM patients were studied cross-sectionally for the presence of various vascular complications. Lp(a) levels were measured by 1-step sandwich ELISA method. RESULTS: The patients with overt proteinuria had higher Lp(a) levels than the patients with mormoalbuminuria or microalbuminuria(26.8mg/dl vs 13.8 mg/dl and 17.3mg/dl, p<0.05), The patients with proliferative retinopathy and/or those treated by photocoagulation had higher Lp(a) levels than those without retinopathy or those with background retinopathy(34.1mg/dl vs 13.3mg/dl and 16,9mg/dl, p<0.05), The Lp(a) levels were also higher in the patients with CAD than those without CAD(30.9mg/ dl vs 16.3mg/dl, p<0.05). Multiple logistic regression analysis revealed that high Lp(a) levels were independantly associated with CAD and severe diabetic retinopath3. CONCLUSION: High Lp(a) levels are associated with CAD and proliferative retinopathy in Korean patients with NIDDM.
Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Nephropathies ; Diabetic Retinopathy ; Enzyme-Linked Immunosorbent Assay ; Humans ; Light Coagulation ; Lipoprotein(a)* ; Logistic Models ; Proteinuria

The civilization has given us a great comfort and convenience but also it has been threatening our life at the same time. Recently among these causes of death the traffic accident is the most dangerous thing to threat our life. Most traffic accidents happen on the road but are increasing on the sea and river recently. Accordingly this paper presents an accident example for a boat collision accident which was anlalyzed from the evidences drawn by forensic medical and scientific methods for a passenger death accident by a collision between two boats. The forensic medical accident interpretation was made up by autopsy and drug toxicology inspection. A person who has met an unnatural death at the accident time was drunken condition. The cause of death was judged by the multiple viscera injury, and presumed to be killed by applying an high external force. In order to perform a forensic scientific analysis, we investigated the passenger's life jacket that a person killed in the accident was wearing and also investigated the external appearance of two boats which have 150h.p and 130h.p. Through comparing the position of two boats with the direction of impact on the surface of the water, we could assume that the 130h.p boat impacted the tail on the right side of 150h.p boat with constant acceleration or constant velocity.
Acceleration ; Accidents, Traffic ; Autopsy ; Cause of Death ; Civilization ; Humans ; Rivers ; Ships* ; Toxicology ; Viscera ; Water