Recent studies suggest that apolipoproteins may be better predictor of ischemic heart disease than are plasma lipids, such as total cholesterol and high density lipoprotein cholesterol(HDL-C). To examine this hypothesis, plasma levels of major lipids and major apolipo-proteins were measured and their derivatives were calculated in 30 male patients with ischemic heart disease(16 angina pectoris and 14 old myocardial infarction) and 30 age-matched male healthy controls. Plasma levels of lipids were obtained by conventional methods and apolipoproteins by Rocket immunoelectrophoresis. Levels of HDL-C, HDL2-cholesterol(HDL2-C), and apolipoprotein-AII, and ratios of HDL-C/total cholesterol, HDL2-C/total cholesterol, and apolipoprotein-AI/apolipoprotein-B were lower in the group of patients than in controls. Levels of low density lipoprotein cholesterol(LDL-C) and apolipoprotein-B, and ratios of lDL-C/HDL-C and apolipoprotein-AI/apolipoprotein-AII were higher in the group of patients. There were no statistically significant differences in the levels of total cholesterol and apolipoprotein-AI between the two groups. Stepwise discriminators analysis showed that apolipoprotein-B and apolipoprotein-AII were better discriminators than plasma lipids for identifying those with ischemic heart disease. One could correctly classify 78% of the cases by using the levels of the two apolipoproteins. By using the level of apolipoprotein-B, one could correctly classify 73% of the cases. There were no correlations between the levels of total cholesterol and HDL-C in the controls whereas there were positive correlations between the levels in the group of patients. In conclusion, this study showed that apolipoprotein-B was the best single discriminator for identifying the patients with ischemic heart disease, followed by apolipoprotein-AII.
Angina Pectoris ; Apolipoproteins A* ; Apolipoproteins* ; Cholesterol ; Heart ; Humans ; Immunoelectrophoresis ; Lipoproteins ; Male ; Myocardial Ischemia* ; Plasma* ; Risk Factors*

Treatment strategies for femoroacetabular impingement (FAI) syndrome have evolved in tandem with increased comprehension of FAI’s impact on hip joint health. Early intervention, including arthroscopic surgery, has gained popularity due to its potential to delay the progression of osteoarthritis. Arthroscopic surgery has demonstrated significant efficacy in treating FAI syndrome, with robust evidence from randomized controlled trials and systematic reviews supporting its use. Despite arthroscopic surgery’s success, complications and reoperations are not uncommon. The incidence ranges from 1% to 31% and 4% to 13%, respectively.Adjunctive biologic treatments, such as bone marrow aspirate concentrates and platelet-rich plasma, have shown promise in chondral lesion management. However, robust evidence supporting their routine use in FAI syndrome is currently lacking. Among conservative treatment methods, intra-articular injections offer diagnostic and therapeutic benefits for FAI patients. While they may provide pain relief and aid in prognosis, their long-term efficacy remains a subject of debate. Comparative studies between conservative and arthroscopic treatments highlight the importance of personalized approaches in managing FAI syndrome. In conclusion, recent advancements in FAI syndrome management have illuminated various treatment modalities. Arthroscopic surgery stands as a pivotal intervention, offering substantial benefits in pain relief, function, and quality of life. However, careful patient selection and postoperative monitoring are crucial for optimizing outcomes. Adjunctive biologics and intra-articular injections show promise but require further investigation. Tailoring treatment to individual patient characteristics remains paramount in optimizing FAI syndrome management.

Effect of diltiazem hydrochloride on cardiac performance with particular reference to the antianginal action was studied in 17 patients with ischemic heart disease, including 12 cases of effort angina, by means of clinical and mechanocardiographic evaluations. All patients were kept on the same medications from at least 2 weeks prior to diltiazem administration until the end of the study, and were prescribed no other antianginal drugs except for liberal use of sublingual nitroglycerin. Diltiazem was given 90mg a day in three divided doses for two weeks. Clinical and mechanocardiographic evaluations, including calculations of pressure rate product(PRP), triple product(TP) and tension time index(TTI), were made before and at a weekly interval after diltiazem administration. After the medication, heart rate, blood pressure and the pre-ejection period(PEP) with its ratio to the ejection time tended to decrease, and the decreases in heart rate and the PEP at the end of two weeks were significant. The PRP, TP and TTI were also significantly decreased at the end of the second week, and the decrease in the TTI was significant even a week after the medication. An antianginal effect, which appeared within few days, was excellent to good in over 90 percent of the cases. These facts suggest that diltiazem hydrochloride has no negative inotropic action and its antianginal effecti in its early stage of the drug administration is primarily due to coronary vasodilation and, as the drug is continued, is contributed to possibly by the decrease in the myocardial oxygen consumption as well.
Angina Pectoris* ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Myocardial Ischemia* ; Nitroglycerin ; Oxygen Consumption ; Vasodilation

BACKGROUND: Asymptomatic vancomycin-resistant enterococci (VRE) colonization precedes infection. VRE-colonized patients serve as silent reservoirs of enterococci that go on to colonize other patients. Rapidly identifying colonized patients is crucial to prevent the spread of VRE. The culture-based method of VRE screening is time-consuming. We evaluated the diagnostic performance of a recently developed multiplex real-time PCR for the detection of VRE. METHODS: We obtained 105 rectal swabs from patients who were being monitored for carriage of VRE. After 24 hour incubation of swabs in enterococcosel broth (EB) supplemented with 6 microg/mL vancomycin, multiplex real-time PCR was performed using the Anyplex(TM) VanR Real-time Detection (VanR) kit (Seegene, Inc., Seoul, Korea). The results of multiplex real-time PCR were compared to those of culture. We evaluated the specificity and detection limits of multiplex real-time PCR using VanR for VRE. RESULTS: A total of 96/105 (91.4%) samples were VRE positive according to multiplex real-time PCR with EB while 85/105 (80.9%) samples were positive in culture. Eleven discordant results (10.4%) (multiplex real-time PCR positive, culture negative) were noted. All non-enterococcal bacteria and vancomycin-susceptible enterococci were negative. The DNA detection limits of VanR were 0.035 pg per reaction (3 microL) for Enterococcus faecium and 0.35 pg for Enterococcus faecalis. CONCLUSION: The application of multiplex real-time PCR after EB incubation allows rapid and sensitive detection in 26-28 hours for VRE screening from rectal swabs. This method could facilitate the timely implementation of contact isolation to prevent the spread of VRE.
Bacteria ; Colon ; DNA ; Enterococcus ; Enterococcus faecium ; Humans ; Limit of Detection ; Mass Screening ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Vancomycin

Electrocardiographic findings in 18 cases of hypertrophic obstructive cardiomyopathy(HOCM) were compared with those in 20 hypertensives with disproportinate septal hypertrophy(DSH) and in 20 normal controls. In conventional 12 leads electrocardiograms, abmormal Q waves were seen only in 6 cases of HOCM and none in the remadinder. The R waves were tallest in leads V4 in 6 cases(33%) of HOCM, 3(15%) hypertensives with DSH, and 4(20%) of the controls. The correlations of the QRS voltages with echocardiographically measured left ventricular dimension, interventricular septal thickness and left ventricular mass were significant in the hypertensives with DST and normal controls, but insignificant in patients with HOCM. We conclude that these electrocardiographic differences in patients with HOCM from the others would be caused by uneven distribution of hypertrophied muscle mass in the left ventricule and/or by the altered depolarization in hypertrophied cardiac muscles.
Cardiomyopathy, Hypertrophic* ; Electrocardiography* ; Humans ; Hypertension* ; Myocardium

No abstract available.
Perfusion* ; Stomach Neoplasms* ; Stomach*

PURPOSE: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital. Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation. METHODS: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012. The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV). Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15). RESULTS: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, 'injury in two or more body regions' accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer. CONCLUSION: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of 'injury in two or more body regions' is needed.
Body Regions ; Cohort Studies ; Craniocerebral Trauma ; Emergency Service, Hospital* ; Humans ; Critical Care ; Retrospective Studies ; Triage

Background: Preoperative concerns of patients undergoing total hip arthroplasty (THA) and their complaints during the initial postoperative period are not well investigated. We evaluated preoperative concerns of patients and patient-perceived problems during the operation and initial 5 days after the operation. Methods: One hundred and thirty-two patients, who underwent primary THA at a tertiary referral hospital, were surveyed using a questionnaire and a face-to-face interview 1 day before the operation, operation day, and postoperative days 1, 2, 3, and 4. The severity of pain was assessed daily using a visual analog scale. Results: The most common preoperative concern was the severity of pain after the surgery (65.2%), followed by the need of transfusion (34.8%) and postoperative rehabilitation (32.6%). Among 29 patients who could recall the experience during the operation, 12 (41.4%) suffered from shoulder pain on the contralateral side, and 6 (20.7%) answered that hammering sound had been annoying. After returning to the ward, 29 patients (22.0%) suffered from nausea, 8 (6.1%) complained of back pain, and 7 (5.3%) had ipsilateral knee pain. On postoperative day 1, 7 patients (5.3%) had persistent back pain, 8 (6.1%) had headache, and 5 (3.8%) suffered from nausea. On postoperative day 2, nine patients (6.8%) complained of radiating pain due to aggravation of preexisting spinal stenosis, 7 (5.3%) complained of weakness of the hip flexor due to periarticular injection of ropivacaine during the operation, and 5 (3.8%) had dressing-related skin problem at the wound. On postoperative days 3 and 4, patients had no problem other than hip pain. The mean pain score was the highest (3.1 ± 1.0) on postoperative day 1. Conclusions The results of this study might provide information needed to solve problems and improve satisfaction of patients undergoing THA.

Background: Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden.The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery.This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared. Methods: This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery.The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality. Results: The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936;P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013). Conclusion A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.