BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI). METHODS: The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure. RESULTS: Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75–1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64–0.90; P = 0.002). CONCLUSION: The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682
Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Heart Failure ; Hospitalization ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stroke

OBJECTIVES: To investigate the possible role of mononuclear cells and their products in the pathogenesis of IgA nephropathy, in vitro expression of ICAM-1 on cultured mouse mesangial cell (MC) was examined after stimulation with mononuclear cell culture supernatant from patients with IgA nephropathy. METHODS: Peripheral blood mononuclear cells (PBMC) were isolated and cultured from 18 patients with primary IgA nephropathy, 8 normal controls and 5 patients with non-IgA nephropathy (FSGS 1, MGN 3, MPGN 1). ICAM-1 expression on cultured mouse MC by TNF-alpha, IL-1 beta and culture supernants of PBMC were analyzed using a cell ELISA method. The concentration of IL-1 beta and TNF-alpha in culture supernatants was measured by using a commercially available radioimmunoassay kit. RESULTS: Addition of human recombinant TNF-alpha induced an increased ICAM-1 expression in a dose-dependent manner. The expression of ICAM-1 was further increased after co-stimulation with TNF-alpha and IL-1 beta. Addition of PBMC culture supernatants into mouse MC induced significantly higher expression of ICAM-1 by supernatants from the patients with IgA nephropathy compared with that from normal controls. The concentration of TNF-alpha and IL-1 beta in supernatants from the patients with IgA nephropathy was significantly higher than that from those with non-IgA nephropathy. CONCLUSION: TNF-alpha and IL-1 released from mononuclear cells induced the up-regulation of ICAM-1 expression and this may be related to the immune pathogenesis of IgA nephropathy.
Animal ; Cells, Cultured ; Glomerular Mesangium/immunology ; Glomerular Mesangium/cytology ; Glomerulonephritis, IGA/immunology* ; Glomerulonephritis, IGA/etiology ; Human ; Intercellular Adhesion Molecule-1/metabolism* ; Interleukin-1/secretion ; Interleukin-1/pharmacology ; Leukocytes, Mononuclear/immunology ; Mice ; Tumor Necrosis Factor/secretion ; Tumor Necrosis Factor/pharmacology

OBJECTIVES: The purpose of the present study was to compare the general condition of peritonitis through a study of three connector systems : The Straight transfer set with Spike-and-Pork system(SPS), The Straight transfer set with Luer-Lock system(SLS), and The Y-set with Two Bag system(YS). METHODS: We reviewed our experience with 134 patients from 1988.1 to 1995.12. According to various kinds of connector system, we divided cases into 3 groups : The SPS(1988. 1-1991. 3) was used on 55 patients(mean age 47+/-2, M:F=30:25); The SLS(1991.4-1993.8) on 45 patients(mean age 55+/-1, M:F=30:15); and The YS(1993.9-1995.12) on 34 patients(mean age 49+/-5, M:F=15:19). RESULTS: 1) Total CAPD duration was 1.22 patient year in SPS, 1.08 in SLS, and 0.96 in YS. The incidence of peritonitis is 1.71 episodes per patient year in SPS, 1.03 in SLS, and 0.61 in YS. 2) Among the causative organisms of peritonitis, coagulase negative Staphylococcus was most common in the three groups(SPS:10.4%, SLS:10%, YS:20%). In SPS and SLS, S. aureus(7.7%, 8%), Pseudomonas(6.5%, 8%), E. coli(5.2%, 6%) were present in decreasing order. In YS, Pseudomonas (15%), S. aureus(15%), E. coli(10%) were present in decreasing order. There were no growth of organisms in 55.9% of SPS, 38% of SLS, and 30% of YS. 3) The probability of experiencing the first peritonitis at 1, 3, 6, and 12 months was 21.4%, 21.4%, 21.4%, and 23.9% respectively in SPS, 3.4%, 34.5%, 34.5%, and 10.3% respectively in SLS, and 0%, 28.5%, 35.7%, and 28.5% respectively in YS. 4) In the response to the treatment of peritonitis, 59.7% of the peritonitis episodes in SPS, 72% in SLS, and 85% in YS were cured with antibiotics. In 37.7% of the peritonitis episodes in SPS, 24% in SLS, and 10% in YS, the catheter was removed due to fungal, tubercolous, recurrent, or peritonitis not responding to antibiotics. 2 patients in SPS, 2 patients in SLS, and 1 patient in YS died due to peritonitis. 5) The catheter survival rate at 3, 6, 12 months was 72%, 63.6%, and 40% respectively in SPS, 89%, 78.3%, and 46.7% respectively in SLS, and 94%, 85.3%, and 76.6% respectively in YS. CONCLUSION: Our study suggests that there is a relationship between the development of connector system and a decrease of peritonitis in CAPD.
Anti-Bacterial Agents ; Catheters ; Coagulase ; Humans ; Incidence ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis* ; Pseudomonas ; Staphylococcus ; Survival Rate

OBJECTIVES: As one of the studies for the contribution of hyperlipidemia to the pathogenesis of glomerulosclerosis, this study was performed to evaluate the effects of low density lipoprotein(LDL) and oxidized LDL on mesangial cell proliferation and intercellular adhesion molecule-1 (ICAM-1) expression. METHODS: Oxidized-LDL and cell-treated LDL were prepared from LDL by incubation with copper sulfate and mesangial cells, respectively. They were each co-incubated with human mesangial cells. The effects of LDL, oxidized-LDL and cell-treated LDL on mesangial cell proliferation were estimated by measuring the uptake of [3H]-thymidine and counting the cell numbers under phase contrast microscopy. The expression of ICAM-1 on mesangial cells was examined by indirect immunofluorescence method. RESULTS: LDL increased the uptake of [3H]-thymidine by mesangial cells at 10 g/mL returning to control levels at 50 g/mL, and decreased [3H]-thymidine uptake at 100 g/mL of LDL concentration. Also, mesangial cell numbers decreased at 100 g/mL of LDL concentration. In contrast, oxidized LDL decreased [3H]-thymidine uptake starting at 1 g/mL, and decreased mesangial cell numbers starting at 10 g/mL of oxidized-LDL concentration, in a concentration-dependent manner. Cell-treated LDL above the concentration of 10 g/mL caused a concentration- dependent increase in [3H]-thymidine uptake. LDL at certain concentrations increased mesangial cell ICAM-1 expression. CONCLUSION: These results that low concentration of LDL stimulate and high concentration of LDL and oxidized LDL inhibit human mesangial cell proliferation may be the in vitro evidence of lipid mediated glomerulosclerotic injury.
Cell Count ; Copper Sulfate ; Fluorescent Antibody Technique, Indirect ; Humans ; Hyperlipidemias ; Intercellular Adhesion Molecule-1* ; Mesangial Cells* ; Microscopy, Phase-Contrast

OBJECTIVES: In order to evaluate the role of these cytokines in biological response induced by blood interaction with hemodialysis membranes. METHODS: We have investigated the IL-1, TNF and IL-6 concentrations in the supernatant of 24-hours cultured peripheral blood mononuclear cells (PBMC) without(spontaneous group) or with broken cuprophan or P1VMA membranes in 9 chronic hemodialyzed patients and 8 healthy controls. The blood samples were drawn before dialysis using following criteria: (a) in last dialytic treatment with PMMA membranes(HDEl), (b) after two weeks of dialytic treatment wih cuprophan membranes(HDE2). RESULTS: In the both of patient group(HDE1 and HDE2) and controls production of IL-l, TNF and IL-6 of PBMC stimulated with cuprophan or PMMA membrane particles was increased compared to those of spontaneous group. IL-1 production of HDE1 stimulated PMMA(99.31 +/- 30.15fmol/ml) was significantly higher compared to that of cuprophan(48.43 +/- 11.29fmol/ml), TNF production of HDE2 with cuprophan(114.86 +/- 38.5lfmoVml) was significantly high compared to that of spontaneous group(52.42 +/- 29.94fmol/ml). IL-6 production of HDE2(646.70 +/- 103.84fmol/ml) was significantly high compared to that of spontaneous group(385.88 +/- 87.03fmoVml). Comparing cytokine production of PBMC, there was a significant correlation between IL-1 and IL-6(r=0.78), IL-1 and TNF(r=0.78) and TNF and IL-6(r=0,76). CONCLUSION: Our results show that the interaction of cuprophan or PMMA membranes with blood increase the production of IL-1, TNF and IL-6. We suggest that in patients undergoing routine hemodialysis PBMC are primed by exposure to chronic stimulation.
Cytokines ; Dialysis ; Humans ; Interleukin-1* ; Interleukin-6* ; Membranes* ; Polymethyl Methacrylate ; Renal Dialysis

The effect of food consumption on blood pressure during hemodialysis was examined in relatively younger 10 nondiabetic patients with end stage renal disease who were free from autonomic dysfunction. A balanced diet(300 Cal) was given after 1 hour of hemodialysis. Fed and fasting treatments were randomly assigned, three times respectively, in each patient. Systolic(p=0.006), diastolic(p=0.08) and mean blood pressures fell faster in the 30-minute postprandial period in the fed treatments compared with those of equivalent times in the fasting treatments. For each of these changes, two-way repeated measures analysis of variance revealed neither significant time effect, nor significant treatment effect, nor significant interaction between time(before vs. after meal) and treatment(fed vs. fasting). These results suggest that food ingestion during hemodialysis dose not cause significant hypotension in relatively younger patients with end stage renal failure on chronic hemodialysis in the absence of autonomic dysfunction.
Blood Pressure* ; Eating ; Fasting ; Humans ; Hypotension ; Kidney Failure, Chronic ; Postprandial Period ; Renal Dialysis* ; Renal Insufficiency

No abstract available.
Adenoma* ; Humans ; Pyelonephritis*

No abstract available.
Humans ; Interleukin-1* ; Interleukin-6* ; Plasma* ; Tumor Necrosis Factor-alpha*

No abstract available.
Humans ; Nephrotic Syndrome* ; Renal Veins* ; Thrombosis*

No abstract available.
Apoproteins* ; Diabetic Nephropathies* ; Lipoproteins*