PURPOSE: This study examined the influence of the maximal aerobic capacity on the two-year cardiac-related re-hospitalization in patients with heart failure with a reduced ejection fraction (HFrEF) in Korean society.METHODS: The maximal aerobic capacity of the study population (n=95, male 63%) was evaluated using a cardiopulmonary exercise (CPX) testing system. Each patient was followed up for two years to divide the HFrEF patients into two groups according to cardiac-related re-hospitalization: re-hospitalization (RH) group (n=29, 30%) and no re-hospitalization (NRH) group (n=66, 70%).RESULTS: The relative peak VO₂ (mL/kg/min, p<0.001), exercise duration (p<0.001), respiratory exchange ratio (VCO₂/VO₂, p=0.001), systolic blood pressure (SBP) reserve (p=0.004), heart rate (HR) reserve (p=0.007), SBP max (p=0.02), and HR max (p=0.039) were significantly lower in the RH group than the NRH group during the CPX test. On the other hand, the ventilatory efficiency (VE/VCO₂ slope, p=0.02) and age (p=0.022) were significantly higher in the RH group than in the NRH group. In binary logistic regression analysis, the relative peak VO₂ (p=0.001, Wald Chi-square 10.137) was the strongest predictive factor on cardiac-related re-hospitalization, which was followed by VCO₂/VO₂ (p=0.019, Wald Chi-square 5.54). On the other hand, age (p=0.063, Wald Chi-square 3.445) did not have a significant influence on cardiac related re-hospitalization.CONCLUSION: The maximal aerobic capacity, especially the relative peak VO₂, is the strongest factor on cardiac-related re-hospitalization within two years in patients with HFrEF in Korean society.
Blood Pressure ; Exercise Test ; Hand ; Heart Failure ; Heart Rate ; Heart ; Humans ; Logistic Models ; Male

Müllerian duct aplasia-renal aplasia-cervicothoracic somite dysplasia (MURCS) association is a unique development disorder with four common types of malformations that include uterine aplasia or hypoplasia, renal ectopy or agenesis, vertebral anomalies, and short stature. The majority of MURCS patients are diagnosed with primary amenorrhea from late-adolescence. However, a few cases with MURCS association are not well diagnosed during childhood and long-term outcomes are not well reported. We report a case of an 8-year-old girl with MURCS association who presented with recurrent urinary tract infections and multiple congenital malformations, and who was followed for 10 years until adulthood. MURCS association should be considered as one of the differential diagnoses when evaluating prepubertal females with vertebral and renal malformations.
Amenorrhea ; Child ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Somites ; Urinary Tract Infections

Ultrasound-guided core needle biopsy (US-CNB) is an important step in the diagnosis of musculoskeletal soft-tissue lesions. To maximize efficacy and minimize the complications of US-CNB, it is critical to collaborate with a multidisciplinary team and to understand the particular considerations of US-CNB for these lesions. The purpose of this article is to provide a systematic review and step-by-step tips for using US-CNB to diagnose musculoskeletal soft-tissue lesions.
Biopsy, Large-Core Needle* ; Diagnosis ; Image-Guided Biopsy ; Soft Tissue Neoplasms ; Specialization* ; Ultrasonography

Angiogenesis, the formation of new blood vessels, is critical for tumor growth and metastasis. Notably, tumors themselves can lead to angiogenesis by inducing vascular endothelial growth factor (VEGF), which is one of the most potent angiogenic factors. Inhibition of angiogenesis is currently perceived as one of the most promising strategies for the blockage of tumor growth. In this study, we investigated the effects of Acer tegmentosum maxim water extract (ATME) on angiogenesis and its underlying signal mechanism. We studied the antiangiogenic activity of ATME by using human umbilical vein endothelial cells (HUVECs). ATME strongly inhibited VEGF-induced endothelial cell proliferation, migration, invasion, and tube formation, as well as vessel sprouting in a rat aortic ring sprouting assay. Moreover, we found that the p44/42 mitogen activated protein (MAP) kinase signaling pathway is involved in the inhibition of angiogenesis by ATME. Moreover, when we performed the in vivo matrigel plug assay, VEGF-induced angiogenesis was potently reduced when compared to that for the control group. Taken together, these results suggest that ATME exhibits potent antiangiogenic activity in vivo and in vitro and that these effects are regulated by the extracellular regulated kinase (ERK) pathway.
Acer/*metabolism ; Angiogenesis Inhibitors/*pharmacology ; Animals ; Cell Line, Tumor ; Cell Movement/drug effects ; Cell Proliferation/drug effects ; Cell Survival ; Extracellular Signal-Regulated MAP Kinases/*metabolism ; Hep G2 Cells ; Human Umbilical Vein Endothelial Cells/*drug effects ; Humans ; MAP Kinase Signaling System/drug effects ; Mice ; Mice, Inbred C57BL ; Mitogen-Activated Protein Kinase 1/metabolism ; Neoplasm Invasiveness/pathology ; Neovascularization, Pathologic/*drug therapy/prevention & control ; Nitric Oxide Synthase Type III/metabolism ; Phosphorylation/drug effects ; Plant Extracts/pharmacology ; Rats ; Rats, Sprague-Dawley ; Transcription Factors/metabolism ; Vascular Endothelial Growth Factor A/antagonists & inhibitors/metabolism

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.
Catheters ; Central Venous Catheters ; Humans ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy* ; Thrombosis ; Upper Extremity Deep Vein Thrombosis* ; Urokinase-Type Plasminogen Activator* ; Vena Cava, Superior

BACKGROUND AND OBJECTIVES: Turner syndrome (TS) is known to be caused by a total or partial deletion of one X-chromosome. Besides short stature and failure to enter puberty due to ovarian dysgenesis, auricular malformations, middle ear diseases and hearing impairment are also other clinical features of Turner syndrome. The goal of this study is to report otologic and audiologic characteristics in a group of children with Turner syndrome and correlate with these findings to karyotype. SUBJECTS AND METHOD: We retrospectively reviewed the outpatient charts of those who visited at our department for otologic and audiologic screening test between 2008 and 2011. All 23 TS children (46 ears) were enrolled under regular control of their pediatric endocrinologist for treatment with growth hormon and Estrogen. The mean age was 12.6 years (6-24 years). All children were evaluated by otologic history taking, otoscopy, pure tone audiometry and karyotyping. Furthermore, 16 children undertook auditory brain stem response (ABR) test and 10 children temporal bone computed tomography (CT). RESULTS: Abnormal otoscopic findings were found in 48% (22 ears), abnormal otologic history in 70% (16 children), and abnormal audiologic findings in 70% (32 ears). According to karyotyping, the total p-arm deletion group (74%) showed unfavorable audiologic results. ABR test and temporal bone CT did not show any unique findings, except five poor pneumatization of mastoid. CONCLUSION: Hearing impairment can be present at early age in Turner syndrome. Careful follow up during childhood is necessary to detect early ear and hearing problems for active intervention. Karyotype may be used as a predictor for future hearing impairment.
Audiology ; Audiometry ; Child ; Ear ; Ear Diseases ; Ear, Middle ; Estrogens ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Hearing Loss ; Humans ; Karyotype ; Karyotyping ; Mass Screening ; Otoscopy ; Outpatients ; Puberty ; Retrospective Studies ; Temporal Bone ; Turner Syndrome

The computational fluid dynamics methods for the limited flow rate and the small dimensions of an intracranial artery stenosis may help demonstrate the stroke mechanism in intracranial atherosclerosis. We have modeled the high wall shear stress (WSS) in a severe M1 stenosis. The high WSS in the systolic phase of the cardiac cycle was well-correlated with a thick fibrous cap atheroma with enhancement, as was determined using high-resolution plaque imaging techniques in a severe stenosis of the middle cerebral artery.
Blood Flow Velocity ; *Cerebral Angiography ; Cerebrovascular Circulation ; Computational Biology ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Intracranial Arteriosclerosis/*diagnosis ; *Magnetic Resonance Angiography ; Shear Strength ; Software ; Systole

PURPOSE: This study aimed to determine whether the standard clinical pathway based on evidence is applicable to pediatric asthma patients in the emergency room, and whether it is better for treatment effectiveness. METHODS: The clinical pathway was applied to children who visited our emergency room due to acute asthma between January 1 and December 31, 2009. Medical records of the emergency room were reviewed to see if the clinical pathway was correctly applied. The patients were divided into 2 groups: those who the pathway was correctly applied and those who the pathway was incorrectly applied to (group B, n=41). RESULTS: Acute asthma exacerbation occurred in 24 children (47%) in group A, while it occurred in 27 children (53%) in group B. The majority of patients in group B had moderate asthma exacerbation. The incorrect application of the clinical pathway and no use or insufficient use of inhaled anticholinergics was most frequently noted. The most common cause for the incorrect application of the clinical pathway was its misunderstanding of residents. The hospitalization rate was higher in group B than in group A. CONCLUSION: The application of the clinical pathway to pediatric asthma patients in the emergency room increased treatment effectiveness. However, training for the residents and intensive care for the patient with moderate asthma exacerbation are necessary for correct application of the clinical pathway.
Asthma ; Child ; Cholinergic Antagonists ; Critical Pathways ; Emergencies ; Hospitalization ; Humans ; Critical Care ; Medical Records ; Treatment Outcome

PURPOSE: Computational fluid dynamics (CFD) applications for atherosclerotic carotid stenosis have not been widely used due to limited resolution in the severely stenotic lumen as well as small flow dimension in the stenotic channel. MATERIALS AND METHODS: CT data in DICOM format was transformed into 3 dimensional (3D) CFD model of carotid bifurcation. For computational analysis of blood flow in stenosis, commercial finite element software (ADINA Ver. 8.5) was used. The blood flow was assumed to be laminar, viscous, Newtonian, and incompressible. The distribution of wall shear stress (WSS), peak velocity and pressure across the average systolic and diastolic blood pressures permitted construction of a contour map of the velocity in each cardiac cycle. RESULTS: Computer simulation of WSS, flow velocity and wall pressure could be demonstrated three dimensionally according to flow vs. time dimension. Such flow model was correlated with angiographic finding related to maximum degree of stenosis associated with ulceration. Combination of WSS map and catheter angiogram indicated that the highest WSS corresponded to the most severely stenotic segment at systolic phase, whereas ulceration, which is the weakest point of the plaque, appeared at the downstream side of the carotid bulb stenosis. CONCLUSION: Our preliminary study revealed that 3D CFD analysis in carotid stenosis was feasible from CT angiography source image and could reveal WSS, flow velocity and wall pressure in the severe carotid bulb stenosis with ulceration. Further CFD analysis is warranted to apply such hemodynamic information to the atherosclerotic lesion in the more practical way.
Angiography ; Carotid Arteries ; Carotid Stenosis ; Catheters ; Computer Simulation ; Constriction, Pathologic ; Hemodynamics ; Hydrodynamics ; Ulcer

PURPOSE:The purpose of this study was to assess the effect of long-term and differing frequency of on-line hemodiafiltration (OL-HDF) on changes in degree of hemoglobin, albumin level, serum small and middle molecules concentration in stable patients with undergoing high-flux hemodialysis (HF-HD). METHODS:Twenty five patients with more than 3 months of HF-HD were divided into two groups and followed for more than 36 months. Group 1 was treated once with OL-HDF and twice with HF-HD per week. Group 2 was treated three times with OL-HDF per week. Analysis was performed to compare hemoglobin, biochemical parameters, serum beta-microglobulin, leptin, alpha-microglobulin levels in both groups. RESULTS:There were significant improvements in hemoglobin and albumin level in group 2 compared to group 1. After receiving OL-HDF for a mean of 24 months, patients on both groups had the significantly reduced predialysis level of beta-microglobulin compared to baseline level. However, there is no significant difference in beta-microglobulin level between both groups. The predialysis level of leptin and alpha-microglobulin with relatively large molecular weight was not significantly reduced during observational period and was not significantly different between both groups. CONCLUSION:There were improvements in hemoglobin and albumin level according to the frequency of OL-HDF. The predialysis level of beta-microglobulin was significantly reduced after receiving even once with OL-HDF per week for long-term. Therefore, our study can suggest that there is no correlation between the frequency of OL-HDF and the predialysis level of beta-microglobulin.
Hemodiafiltration ; Hemoglobins ; Humans ; Leptin ; Molecular Weight ; Renal Dialysis