BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is often performed therapeutically, and antithrombotic treatment is required for at least 12 months after stent implantation. However, the development of post-PCI upper gastrointestinal bleeding (UGIB) increases morbidity and mortality. We investigated the incidence and risk factors for UGIB in Korean patients within 1 year after PCI. METHODS: The medical records of 3,541 patients who had undergone PCI between January 2006 and June 2012 were retrospectively reviewed. We identified 40 cases of UGIB. We analyzed the incidence and clinical risk factors associated with UGIB occurring within 1 year after PCI by comparing the results for each case to matched controls. The propensity score matching method using age and sex was utilized. RESULTS: UGIB occurred in 40 patients (1.1%). Two independent risk factors for UGIB were a history of peptic ulcer disease (odds ratio [OR], 12.68; 95% confidence interval [CI], 2.70 to 59.66; p=0.001) and the use of anticoagulants (OR, 7.76; 95% CI, 2.10 to 28.66; p=0.002). CONCLUSIONS: UGIB after PCI occurred at a rate of 1.1% in the study population. Clinicians must remain vigilant for the possibility of UGIB after PCI and should consider performing timely endoscopy in patients who have undergone PCI and are suspected of having an UGIB.
Aged ; Anticoagulants/adverse effects ; Case-Control Studies ; Female ; Gastrointestinal Hemorrhage/epidemiology/*etiology ; Humans ; Incidence ; Male ; Middle Aged ; Peptic Ulcer/complications ; Percutaneous Coronary Intervention/*adverse effects ; *Postoperative Complications ; Propensity Score ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors

PURPOSE: The purpose of this study was to investigate the dosimetric benefits and treatment efficiency of carotid-sparing TomoHelical 3-dimensional conformal radiotherapy (TH-3DCRT) for early glottic cancer. MATERIALS AND METHODS: Ten early-stage (T1N0M0) glottic squamous cell carcinoma patients were simulated, based on computed tomography scans. Two-field 3DCRT (2F-3DCRT), 3-field intensity-modulated radiation therapy (3F-IMRT), TomoHelical-IMRT (TH-IMRT), and TH-3DCRT plans were generated with a 67.5-Gy total prescription dose to the planning target volume (PTV) for each patient. In order to evaluate the plan quality, dosimetric characteristics were compared in terms of conformity index (CI) and homogeneity index (HI) for PTV, dose to the carotid arteries, and maximum dose to the spinal cord. Treatment planning and delivery times were compared to evaluate treatment efficiency. RESULTS: The median CI was substantially better for the 3F-IMRT (0.65), TH-IMRT (0.64), and TH-3DCRT (0.63) plans, compared to the 2F-3DCRT plan (0.32). PTV HI was slightly better for TH-3DCRT and TH-IMRT (1.05) compared to 2F-3DCRT (1.06) and 3F-IMRT (1.09). TH-3DCRT, 3F-IMRT, and TH-IMRT showed an excellent carotid sparing capability compared to 2F-3DCRT (p < 0.05). For all plans, the maximum dose to the spinal cord was < 45 Gy. The median treatment planning times for 2F-3DCRT (5.85 minutes) and TH-3DCRT (7.10 minutes) were much lower than those for 3F-IMRT (45.48 minutes) and TH-IMRT (35.30 minutes). The delivery times for 2F-3DCRT (2.06 minutes) and 3F-IMRT (2.48 minutes) were slightly lower than those for TH-IMRT (2.90 minutes) and TH-3DCRT (2.86 minutes). CONCLUSION: TH-3DCRT showed excellent carotid-sparing capability, while offering high efficiency and maintaining good PTV coverage.
Carcinoma, Squamous Cell ; Carotid Arteries ; Humans ; Prescriptions ; Radiotherapy, Conformal* ; Radiotherapy, Intensity-Modulated ; Spinal Cord

Phytochemical constituents were isolated from the fruits of Acanthopanax chiisanensis by repeated column chromatography. Their structures were identified as beta-sitosterol (1), daucosterol (2), sesamin (3), chiisanogenin (4), and 22alpha-hydroxy chiisanogenin (5) by spectroscopic analysis (MS, 1H-, and 13C-NMR). Compounds 1 - 5 were isolated for the first time from the fruits of A. chiisanensis.
Eleutherococcus* ; Araliaceae ; Chromatography ; Fruit* ; Terpenes*

BACKGROUND: Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. MAIN CONTENTS: This review covers the epidemiology, underlying mechanisms, and acute and preventive treatments for cancer-related stroke. First, the characteristics of stroke (clinical and radiological features) and systemic cancer (type and extent) in patients with cancer-specific stroke are discussed. Second, the role of laboratory tests in the early identification of patients with cancer-specific stroke is discussed. Specifically, serum D-dimer levels (as a marker of a hypercoagulable state) and embolic signals on transcranial Doppler (suggestive of embolic origin) may provide clues regarding changes in the levels of coagulopathy related to cancer and anticoagulation. Finally, strategies for stroke treatment in cancer patients are discussed, emphasizing the importance of preventive strategies (i.e., the use of anticoagulants) over acute revascularization therapy in cancer-related stroke. CONCLUSION: Recent studies have revealed that the characteristics of cancer-related stroke are distinct from those of conventional stroke. Our understanding of the characteristics of cancer-related stroke is essential to the correct management of these patients. The studies presented in this review highlight the importance of a personalized approach in treating stroke patients with cancer.
Aged ; Anticoagulants ; Cause of Death ; Embolism ; Fibrin Fibrinogen Degradation Products ; Humans ; Stroke

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 < or = 250), bilateral lung infiltration, and old age (> or = 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of > or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.
APACHE ; Adult ; Aged ; Antiviral Agents/therapeutic use ; Female ; Hospitalization ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/drug therapy/*epidemiology/mortality ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Predictive Value of Tests ; ROC Curve ; Respiration, Artificial ; Risk Factors ; Severity of Illness Index

Neurogenesis can be induced by pathological conditions such as cerebral ischemia. However the molecular mechanisms or modulating reagents of the reactive neurogenesis after the cerebral ischemia are poorly characterized. Retinoic acid (RA) has been shown to increase neurogenesis by enhancing the proliferation and neuronal differentiation of forebrain neuroblasts. Here, we examined whether RA can modulate the reactive neurogenesis after the cerebral ischemia. In contrast to our expectation, RA treatment decreased the reactive neurogenesis in subventricular zone (SVZ), subgranular zone (SGZ) and penumbral region. Furthermore, RA treatment also decreased the angiogenesis and gliosis in penumbral region.
Animals ; Brain/blood supply ; Cell Differentiation ; Cell Proliferation ; Ischemic Attack, Transient/metabolism/*pathology ; Male ; Neovascularization, Pathologic ; Neuroglia/pathology/physiology ; Neurons/pathology/*physiology ; Rats ; Rats, Sprague-Dawley ; Tretinoin/*pharmacology/physiology

BACKGROUND: Many patients with "cold hands/feet syndrome" have been taking herbal medicine or medicine to improve blood circulation without proven evidence. Raynaud's disease had been neglected in primary care. This study was conducted to investigate the recognition for Raynaud's disease and "cold hands/feet syndrome" by family doctors. METHODS: A questionnaire was posted to 905 family doctors who were in practice from January to July 2003. RESULTS: Among the 274 respondents, 58 (21%) reported that they have seen patients with "sensitive to cold" frequently and 208 (76%) doctors have seen such patients sometimes. Only 8 (3%) doctors answered that they have never seen patients with such symptoms. When such patients see a doctor and complain of "cold hands/feet syndrome", most doctors (60%) prescribed medicine that improved blood circulation (83%) or calcium channel blockers (9%). In case of questions like 'Do you suspect "cold hands/feet syndrome" or "sensitive to cold" contain Raynaud's disease?', 132 (48%) doctors answered 'yes'. And among the 132 doctors, only 15 (11.2%) doctors thought that those patients with "cold hands/feet syndrome" had Raynaud's disease. In addition when the doctors diagnosed the condition as Raynaud's disease, 54% prescribed medicine that improved blood circulation (52%) or calcium channel blockers (40%). CONCLUSION: Most doctors prescribe medicine that improves blood circulation for cold hands/feet syndrome. Many doctors also prescribe medicine to improve blood circulation for Raynaud's disease frequently. The result of our study suggests that there is a need to train doctors so that recognized and diagnosed Raynaud's disease can be correctly.
Blood Circulation ; Calcium Channel Blockers ; Surveys and Questionnaires ; Herbal Medicine ; Humans ; Primary Health Care ; Raynaud Disease*

BACKGROUND: Many patients with "cold hands/feet syndrome" have been taking herbal medicine or medicine to improve blood circulation without proven evidence. Raynaud's disease had been neglected in primary care. This study was conducted to investigate the recognition for Raynaud's disease and "cold hands/feet syndrome" by family doctors. METHODS: A questionnaire was posted to 905 family doctors who were in practice from January to July 2003. RESULTS: Among the 274 respondents, 58 (21%) reported that they have seen patients with "sensitive to cold" frequently and 208 (76%) doctors have seen such patients sometimes. Only 8 (3%) doctors answered that they have never seen patients with such symptoms. When such patients see a doctor and complain of "cold hands/feet syndrome", most doctors (60%) prescribed medicine that improved blood circulation (83%) or calcium channel blockers (9%). In case of questions like 'Do you suspect "cold hands/feet syndrome" or "sensitive to cold" contain Raynaud's disease?', 132 (48%) doctors answered 'yes'. And among the 132 doctors, only 15 (11.2%) doctors thought that those patients with "cold hands/feet syndrome" had Raynaud's disease. In addition when the doctors diagnosed the condition as Raynaud's disease, 54% prescribed medicine that improved blood circulation (52%) or calcium channel blockers (40%). CONCLUSION: Most doctors prescribe medicine that improves blood circulation for cold hands/feet syndrome. Many doctors also prescribe medicine to improve blood circulation for Raynaud's disease frequently. The result of our study suggests that there is a need to train doctors so that recognized and diagnosed Raynaud's disease can be correctly.
Blood Circulation ; Calcium Channel Blockers ; Surveys and Questionnaires ; Herbal Medicine ; Humans ; Primary Health Care ; Raynaud Disease*

BACKGROUND: The DYT1 dystonia is primary torsion dystonia (PTD) caused by a GAG deletion in DYT1 gene on chromosome 9 and transmits as autosomal dominant trait. It usually begins as limb-onset dystonia in childhood and tends to spread to other sites and has been reported as the most common cause of early onset PTD in Ashkenazi Jews. However, the frequency of DYT1 mutation in Korean patients with sporadic PTD has not been reported. METHODS: We examined dystonia patients who visited the Neurologic Clinic of Asan Medical Center between Jan 2001 and March 2002. The sporadic PTD patients of them were screened by genotyping with their peripheral blood samples. RESULTS: The 66 patients with sporadic PTD were recruited and two of them showed DYT1 mutation on Chromosome 9. One patient had segmental dystonia with cervical onset; the other had generalized dystonia with left leg onset. None of the patients with focal dystonia showed a DYT1 mutation. CONCLUSIONS: The DYT1 dystonia comprise a small portion of PTD without familial history in Korea. The DYT1 gene test should be considered in the early-onset or spreading type dystonia despite the absence of familial background in primary dystonia patient.
Chromosomes, Human, Pair 9 ; Chungcheongnam-do ; Dystonia ; Dystonia Musculorum Deformans* ; Dystonic Disorders ; Humans ; Jews ; Korea ; Leg

BACKGROUND: Resistance to the potent growth inhibitory effects of TGF- (transforming growth factor-) is a characteristic of many malignancies. TGF- insensitivity has been attributed to alterations in the number and function of the TGF- receptors as well as disturbances of downstream signal transduction. The aim of this study was to examine the expression of TGF-1 and its receptors in human colorectal cancer tissue and determine its relationship with cancer growth and with prognostic factors. METHODS: Immunohistochemical staining of TGF-1, TGF-RI, and TGF-RII was performed on 20 human colorectal adenomas, 30 carcinomas and 10 normal mucosas as a control. RESULTS: The staining indices of TGF-1, TGF-RI, and TGF-RII increased in adenomas and carcinomas compared with normal mucosas and adenomas, respectively. In adenomas the staining index of TGF-1 significantly increased with the severity of atypism. The staining index of TGF-RII increased in the carcinomas in the right colon and rectum, compared with those in the left colon. CONCLUSION: The enhanced expression of TGF-1, TGF-RI and II in the colorectal carcinoma suggests an important role of colorectal carcinogenesis and tumor progression.
Adenoma ; Carcinogenesis ; Colon ; Colorectal Neoplasms* ; Humans* ; Immunohistochemistry ; Mucous Membrane ; Rectum ; Signal Transduction ; Transforming Growth Factor beta