BACKGROUND: Chronic infections, including Chlamydia pneumoniae, cytomegalovirus and Helicobacter pylori may be one of the risk factors for coronary artery disease (CAD). To document whether chronic infection may be associated with coronary artery disease, various inflammatory markers were analyzed in Korean patients with CAD. METHODS: The patients who underwent diagnostic coronary angiography (CAG) were divided into two groups according to the results of CAG: the patients with significant coronary lesions (Group I: n=126, M:F=99:27, 58.7+/-9.7 years) or the patients without coronary lesions (Group II: n=58, M:F=30:28, 55.5+/-8.9 years). Serologic assays for the immunoglobulin G (IgG) titers to C. pneumoniae, CMV, H. pylori, and for inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were performed. RESULTS: There were no significant differences in the sero-positivity of three infections between two groups, but titer of IgG antibody against H. pylori was significantly higher in Group I than that in Group II (859.3+/-342.2 vs. 474.2+/-113.2 U/mL, p=0.02). After adjustment for age, sex and other cardiovascular risk factors, high titer of IgG antibody aganist H. pylori was independently associated with coronary artery disease (p=0.05). CRP and ESR were significantly elevated in group I (2.7+/-5.1 vs. 0.6+/-0.9 mg/dL, p=0.003, 23.2+/-26.7 vs. 12.7+/-15 mm/hr, p=0.006). Angiographic parameters were not related with the titer of infectious agents or inflammatory markers. The value of CRP was significantly different according to clinical severity (3.8+/-6.0 in acute myocardial infarction, 1.5+/-3.6 in unstable angina pectoris, and 0.4+/-0.3 mg/dL in stable angina pectoris, p<0.01). The value of ESR was also significantly different according to clinical severity (29.0+/-30.2 in acute myocardial infarction, 17.1+/-19.0 in unstable angina pectoris, and 12.1+/-17.6 mm/hr in stable angina pectoris, p<0.01). CONCLUSIONS: Our results suggest that high titer of IgG antibody against H. pylori may be associated with CAD, and inflammation may play a significant role in the pathogenesis of acute coronary syndromes.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Blood Sedimentation ; C-Reactive Protein ; Chlamydophila pneumoniae ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Cytomegalovirus ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Inflammation* ; Myocardial Infarction ; Pneumonia ; Risk Factors

Melanoacanthoma is an extremely rare pigmented benign mixed epithelial tumor of both melanocytes and keratinocytes. A 52-year-old female presented an asymptomatic, slightly elevated, 1. 2 cm x 0. 8 cm, dark black-colored plaque on her right buttock of 2 years' duration. Histopathologic finding of the plaque shows hyperkeratosis, focal parakeratosis, follicular plugging, acanthosih, papillomatosis and pseudo-horn cyst in the epidermis. The tumor is composed of basaloid and squarnous cells with many foci of clusters and whorls of melanin pigment-laden cells. Electron microscopic finding reveals many scattered melanocytes in the entire epidermis. Melanin granules are found mostly in the melanocytes but can also be found in a few keratinocytes.
Buttocks ; Epidermis ; Female ; Humans ; Keratinocytes ; Melanins ; Melanocytes ; Middle Aged ; Papilloma ; Parakeratosis

Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

To reduce cardio-cerebro-vascular and renal morbidity and mortality, the current guidelines on the treatment of hypertension recommend evaluating and managing total cardiovascular risks of the patient with hypertension, not just focused on reducing blood pressure itself. In this point of view, the angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are considered to be ideal drugs in the treatment of hypertension, because the angiotensin II plays a pivotal role in every stage of cardiovascular disease continuum. Many studies have shown that the ARBs were not only effective in lowering blood pressure, but also had another role in reducing morbidity and mortality of heart failure, myocardial infarction, stroke, diabetic nephropathy, chronic kidney disease, and the recurrence of atrial fibrillation, so called beyond blood pressure lowering effects or pleiotropic effects. However, these favorable effects of ARBs are counter-balanced by some debating issues, myocardial infarction paradox or cancer risk. Furthermore, the issue whether ARBs could replace the role of ACEIs in the treatment of cardiovascular diseases is not resolved yet. Because there have been no randomized studies proving the ARBs are better than ACEIs in terms of cardiovascular morbidity or mortality, the current status of the role of ARBs are an reasonable alternative of ACEIs. In this review, the current issues and status of ARBs will be discussed.
Angiotensin II ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Atrial Fibrillation ; Blood Pressure ; Cardiovascular Diseases ; Diabetic Nephropathies ; Heart Failure ; Humans ; Hypertension ; Myocardial Infarction ; Receptors, Angiotensin ; Recurrence ; Renal Insufficiency, Chronic ; Stroke

It has been well known that ischemia reperfusion injury to skeletal muscle following an acute arterial occulusion causes significant morbidity and mortality. The skeletal muscle, which contains high energy phosphate compounds, has ischemic tolerance. During the ischemia, the ATP is catalyzed to hypoxanthine anaerobically and hypoxanthine dehydrogenase is converted to xanthine oxidase. During reperfusion, the hypoxanthine is catalyzed to xanthine by xanthine oxidase under O2 presence and that results in production of cytotoxic oxygen free radicals. The authors perform the present study to investigate the effects of allopurinol, the inhibitor of xanthine oxidase, on reperfused ischemic skeletal muscles by measuring of the immunoreactivities and exzyme activities of superoxide dismutase(SOD) and the formation of malondialdehyde(MDA). A total of 104 healthy Sprague-Dawley rats weighting from 200 gm to 250 gm were used as experimental animals. Under urethane(3.0mg/kg., IP) anesthesia with 3.0mg/kg of urethane, lower abdominal incision was made and the right and left common iliac artery were ligated by using vascular clamp for 2 hours. Both the quandriceps femoris muscles were obtained at 0 hour, half hour, 1 hour, 3 hours, 6 hours and 12 hours after the removal of vascular clamp. In the allopurinol pretreated group, 50mg/kg of allopurinol was administered once a day for 2 days and before 2 hours of ischemia. The specimens were sectioned in 14µm thickness with cryostat and homogenated ischemia. The specimens were sectioned in 14 µm thickness with cryostat and homegenated in the phosphate buffer. The immunoreactivities and enzyme activities of SOD were observed. The results were as follows: 1. The immunoreactivitiy and enzyme activity of SOD are decreased and the MDA level is increased in the 2 hours inchemic quadriceps femoris muscle of rats. 2. During the reperfusion of ischemic quadriceps femoris muscle of rats, the immunoreactivities of SOD in the half hour reperfused ischemic group and the enzyme activities of SOD in the 1 hour reperfused group are the highest and the immunoreactivities and enzyme activities of 6 hours reperfused ischemic group are the lowest. 3. Pertreatment of allopurionl decreased the immunoreactivities and enzyme activities of SOD during the ischemia and reperfusion of the quadriceps femoris muscles of rat. This results suggest that the allopurinol decreases the damages of skeletal muscles of rate during ischemia and reperfusion.
Adenosine Triphosphate ; Allopurinol ; Anesthesia ; Animals ; Free Radicals ; Hindlimb ; Hypoxanthine ; Iliac Artery ; Ischemia ; Mortality ; Muscle, Skeletal ; Muscles ; Oxygen ; Quadriceps Muscle ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase ; Superoxides ; Urethane ; Xanthine ; Xanthine Oxidase

Background: Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians. Methods: From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area. Results: The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%. Conclusion In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.

COVID-19 vaccination has played a pivotal role in coping with the COVID-19 pandemic by providing a powerful tool to curb the spread of the virus, reduce severe illness and hospitalizations, and ultimately save lives and facilitate a return to normal daily routines. As COVID-19 vaccination has become more widespread and more individuals have recovered from the infection, COVID-19 has entered an endemic disease phase. This phase is characterized by a less severe and more stable pattern of infection within certain regions, similar to the predictability of seasonal influenza. In this endemic era, COVID-19 vaccines may appear to be less important, and many people are reluctant to receive COVID-19 vaccination for various reasons, including the fear of adverse events. However, COVID-19 remains a major public health problem, in that the incidence rate of new COVID-19 infections is still high and the morbidity and mortality in high-risk populations are substantial.Therefore, the role of COVID-19 vaccines in protecting high-risk individuals is crucial, and ongoing research and surveillance are imperative to refine vaccination recommendations in the ever-changing landscape of the COVID-19 endemic era. This review explores the role of COVID-19 vaccination in the upcoming COVID-19 endemic era.

No abstract available.
Myxoma* ; Pulmonary Artery*

No abstract available.
Hypertension