A study was undertaken to determine whether the specific change in the ratio of systolic to diastolic time (QS₂/DT) observed during prolonged exercise¹⁷⁾ is dependent on HR or elapsed time, and also to elucidate the possible relationship between change in QS₂/DT and distance-running performance. Twelve male distance runners were divided into two groups, a high- (HP Group) and a low-performance (LP Group) group, according to their 10, 000-meter running performance. They performed 60-min exercise on a bicycle ergometer at a work load controlled so as to keep the HR at 150 bpm. HR, systolic time intervals (STIs) and DT were calculated from electrocardiogram, phonocardiogram and the derivative of ear densitogram.
In the time course of QS₂/DT, two crests were formed at 2 and 15 min after the start of exercise, and also two troughs were formed at 10 and 20 min. Some of these troughs and crests formed even when HR was kept constant. Patterns of change in QS₂, DT, QS₂/DT and other parameters were similar in the two groups. However, the absolute values of the parameters differed. QS₂, left ventricular ejection time (LVET) and QS₂/DT in the HP Group were lower than those in the LP Group, whereas DT in the HP Group was longer than that in the LP Group.
From these findings, it was concluded that the specific change seen in QS₂/DT during prolonged exercise is dependent not on the HR level but on elapsed time. The changes in STIs and DT during prolonged exercise are thus influenced by the distance-running performance of the subjects.

OBJECTIVES: Of 339 patients with systemic lupus erythematosus(SLE) observed at Seoul National University Hospital in Seoul, 221 fulfilled criteria for lupus nephritis. We evaluated the clinicopathologic findings, outcomes and prognostic factors of patients' survival. METHODS: We searched computer system of our center using disease code for SLE from January 1973 to January 1995 and found 339 SLE patients among whom there were 221 definite lupus nephritis patients. We retrospectively reviewed medical records and investigated the influence of multiple prognostic factors on patients' survival using Cox hazard function analysis. RESULTS: Of 221 patients, 89.6% were female. The mean age of onset of SLE was 27.7+/-10.4 years and the mean follow-up duration was 42.5+/- 40.2 months. The most frequent symptoms at diagnosis were skin manifestations. Hypertension was diagnosed in 21.7% of patients and 21.6% had serum creatinine greater than 1.4mg/dL. Overall, 37.7% were nephrotic. Renal biopsy performed on 159 patients showed the following World Health Organization Class distribution : Class I 1.3%, class II 8.8%, class III 6.3%, class IV 65.4%, class V 13.2%, class IV+V 5.0%. Remission of nephritis was observed in 31.3% of patients. At the last follow-up period, there were 23 patients with deteriorated renal function among 168 patients and renal failure developed in 3.2%. Twenty eight patients died, primarily from infection, with 86.2% and 78.3% 5-year and 10-year survival rates, respectively. Initial presence of renal insufficiency(serum creatinine>or=1.4mg/dL) and treatment with prednisolone only were most important in predicting patients' survival. Combination treatment of high dose prednisolone and cytotoxic drug(azathioprine, oral cyclophosphamide, or iv cyclophosphamide) appeared to be beneficial for nephritis. Treatment modality was only independent risk factor associated with lower survival probability. CONCLUSION: The characteristics of our patients were not so different from those of others. Treatment modality and renal function were important predictors of fatality. Treatment with high dose prednisolone and cytotoxic drug improved the clinical outcome of lupus nephritis, as compared with prednisolone alone.
Age of Onset ; Biopsy ; Computer Systems ; Creatinine ; Cyclophosphamide ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Lupus Nephritis* ; Medical Records ; Nephritis ; Prednisolone ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Seoul ; Skin Manifestations ; Survival Rate ; World Health Organization

Spontaneous remission(SR) of acute leukemia is an extremely rare event. The precise incidence of SR in acute myeloid leukemia(AML) could not be assessed accurately because the majority of patients usually received induction chemotherapy within a few days after diagnosis. The mechanisms of SR are still not completely understood; therefore, the study of them is expected to contribute to the treatment of acute leukemia. We report a case of AML with SR, observed in a 23-year-old male who experienced severe infection and transfusions, with a brief review of the literature.
Diagnosis ; Humans ; Incidence ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute* ; Male ; Remission, Spontaneous* ; Young Adult

BACKGROUND AND PURPOSE: Wandering is one of the most common behavioral and psychological symptoms of dementia, and associated with some of the adverse outcomes in dementia, such as getting lost or even death. The etiology of wandering is not yet clearly known. As depression and wandering are both very common among the patients with dementia, this study examined the relationship between the depression and wandering among the community dwelling patients with dementia. METHODS: Fifty community dwelling patients diagnosed with dementia were included in this study if they had primary family caregiver, older than age 18 in Seoul, South Korea. The Geriatric Depression Scale, Korean Version (GDS-K), Korean Version of the Mini-Mental State Examination (K-MMSE) and Korean Version of Revised Algase Wandering Scale-Community Version (K-RAWS-CV) were used to measure the severity of depression, cognitive function and wandering. RESULTS: Thirty percents of the patients showed wandering. Mean score of GDS-K was significantly higher in wanderers than non-wanderers. Severity of depression was significantly correlated with the total score of K-RAWS-CV and subscales of persistent walking, repetitive walking, eloping behavior, and mealtime impulsivity in whole sample. K-MMSE score also was related to wandering behavior. The prevalence odds ratio for wandering in depressed patients compared with undepressed group was 8.386 (95% confidence interval: 1.978-35.561). CONCLUSIONS: This study implicates that not only cognitive impairment but also psychosocial aspects should be considered in wandering patients with dementia and suggests assessing the depression in patients would be helpful in identifying the causes of wandering.
Caregivers ; Dementia* ; Depression* ; Humans ; Impulsive Behavior ; Korea ; Meals ; Odds Ratio ; Prevalence ; Seoul ; Walking ; Wandering Behavior

With the field of neuroradiological procedures consistently expanding, breaking the border between the medical and surgical treatment, anesthetic involvement in those procedures is also increasing, which underscores the importance of related anesthesia management. The objective of this study is to review the closing or open endovascular procedures for intracranial aneurysm, arteriovenous malformation, acute ischemic stroke, and carotid stenosis and related anesthetic implications.
Anesthesia ; Arteriovenous Malformations ; Carotid Stenosis ; Endovascular Procedures ; Intracranial Aneurysm ; Stroke

BACKGROUND: Spinal anesthesia is a anesthetic technique that can be easily used and practically applied according to patient's preference and physiologic status, surgical procedures and so forth. The purpose of the present study is to analyze factors related to patient refusal of spinal anesthesia, arising from the previous spinal anesthesia experience associated with side effects or unsatisfactory senses after spinal anesthesia. METHODS: One hundred ninety four patients undergoing various surgical procedures under spinal anesthesia were enrolled. We made a questionnaire that consisted of examination items and question items, and checked it during spinal anesthesia and about 24 hours after spinal anesthesia. Factors related to patient refusal of spinal anesthesia were analyzed with multiple logistic regression. RESULTS: Thirty one out of 194 patients (16%) rejected to receive spinal anesthesia if they would have chance to have it again. Significant factors associated with refusal of spinal anesthesia were low back pain (P = 0.005), needle type (Quincke) (P = 0.025) and tingling sensation in the lower extremities immediately after spinal anesthesia induction (P = 0.003). Low back pain was significantly associated with the number of attempts of spinal block (P = 0.023). CONCLUSIONS: Factors related to patient refusal of spinal anesthesia are low back pain, needle type and tingling sensation. Low back pain is related to the number of attempts of spinal block. Practitioners should give patients appropriate information about spinal anesthesia preoperatively and consider using Whitacre needle and avoid multiple attempts of spinal block so as to increase patient's compliance with spinal anesthesia.
Anesthesia, Spinal ; Compliance ; Disulfiram ; Humans ; Logistic Models ; Low Back Pain ; Lower Extremity ; Needles ; Surveys and Questionnaires ; Sensation

Delirium is a serious complication that commonly occurs in critically ill patients in the intensive care unit (ICU). Delirium is frequently unrecognized or missed despite its high incidence and prevalence, and leads to poor clinical outcomes and an increased cost by increasing morbidity, mortality, and hospital and ICU length of stay. Although its pathophysiology is poorly understood, numerous risk factors for delirium have been suggested. To improve clinical outcomes, it is crucial to perform preventive measures against delirium, to detect delirium early using valid and reliable screening tools, and to treat the underlying causes or hazard symptoms of delirium in a timely manner.
Critical Illness ; Delirium ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Length of Stay ; Mass Screening ; Prevalence ; Risk Factors

Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

Cardiovascular disease (CVD) remains a global health challenge, primarily due to atherosclerosis, which leads to conditions such as coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Mitochondrial dysfunction initiates endothelial dysfunction, a key contributor to CVD pathogenesis, as well as triggers the accumulation of reactive oxygen species (ROS), energy stress, and cell death in endothelial cells, which are crucial for atherosclerosis development. This review explores the role of PTEN-induced protein kinase 1 (PINK1) in mitochondrial quality control, focusing on its significance in cardiovascular health. PINK1 plays a pivotal role in mitophagy (selective removal of damaged mitochondria), contributing to the prevention of CVD progression. PINK1-mediated mitophagy also affects the maintenance of cardiomyocyte homeostasis in ischemic heart disease, thus mitigating mitochondrial dysfunction and oxidative stress, as well as regulates endothelial health in atherosclerosis through influencing ROS levels and inflammatory response.We also investigated the role of PINK1 in vascular smooth muscle cells, emphasizing on its role in apoptosis and atherosclerosis. Dysfunctional mitophagy in these cells accelerates cellular senescence and contributes to adverse effects including plaque rupture and inflammation. Mitophagy has also been explored as a potential therapeutic target for vascular calcification, a representative lesion in atherosclerosis, with a focus on lactate-induced mechanisms. Finally, we highlight the current research and clinical trials targeting mitophagy as a therapeutic avenue for CVD.

An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists' point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as 'cannnot intubate' or 'cannot intubate and cannot ventilate' situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Bays ; Bronchoscopes ; Decompression ; Deglutition Disorders ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Lumbar Vertebrae ; Masks ; Ventilation