PURPOSE: This study sought to determine the 1-year clinical effectiveness and safety of a biodegradable, polymer-containing Biolimus A9™-eluting stent (BES) in Korean patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: A total of 1000 ACS patients with 1251 lesions who underwent implantation of BESs at 22 centers in Korea were enrolled between May 2011 and July 2013. We assessed major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinical-driven target vessel revascularization at 12 months. RESULTS: Patient mean age was 62.6±11.4 years. 72.8% of the patients were male, 28.5% had diabetes, 32.8% had multi-vessel disease (MVD), and 47.9% presented with acute MI (AMI). The mean global registry of acute coronary events risk score of all patients was 103.0±27.6. The number of stents per patient was 1.3±0.6. The incidences of MACE and definite stent thrombosis at 12 months were 3.9% and 0.2%, respectively. On multivariate Cox-regression analysis, age ≥65 years was identified as an independent predictors of 1-year MACE (hazard ratio=2.474; 95% confidence interval=1.202−5.091). Subgroup analyses revealed no significant differences in the incidence of MACE between patients with and without diabetes (4.3% vs. 3.7%, p=0.667), between those who presented with and without AMI (4.4% vs. 3.4%, p=0.403), and between those with and without MVD (4.6% vs. 3.5%, p=0.387). CONCLUSION: Our study demonstrated excellent 1-year clinical outcomes of BES implantation in patients at low-risk for ACS.
Acute Coronary Syndrome/drug therapy ; Aged ; Drug-Eluting Stents/adverse effects ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Republic of Korea ; Sirolimus/adverse effects ; Sirolimus/analogs & derivatives ; Sirolimus/therapeutic use ; Time Factors ; Treatment Outcome

OBJECTIVE: We investigated possible association between depressive disorders and BDNF Val66Met and 5-HTTLPR. Brain derived neurotrophic factor (BDNF) gene and serotonin transporter (SLC6A4) gene are promising candidate genes for depressive disorders. It has been suggested that BDNF promotes the survival and differentiation of serotonergic neurons and that serotonergic transmission exerts powerful control over BDNF gene expression. METHODS: Final analyses were performed on 186 patients with depressive disorders and 1032 controls. Val66Met polymorphism of BDNF gene and 5-HTTLPR polymorphism of serotonin transporter gene were genotyped and allele and genotypic associations on the diagnosis of depression and age at onset of depression were analyzed. RESULTS: The 5-HTTLPR was positively associated with depressive affected status in the total sample and in females (p=0.038 for allelewise, p=0.015 for genotype-wise associations), but, not in males. The BDNF Val66Met showed no association with depression. BDNF Val66Met and 5-HTTLPR alone were not associated with age at onset of depression. Additional analysis on the interaction between BDNF Val66Met and 5-HTTLPR found a significant association with age at onset of depression in the entire patient group. This association was also found in the female but not in the male patient group. None of the positive results survived Bonferroni correction for multiple testing. CONCLUSION: This result suggested that BDNF Val66Met and 5-HTTLPR may contribute to depressive disorders in a complex way and that the genetic effect could differ by gender. Further studies with large number of patients will be necessary.
Alleles ; Brain-Derived Neurotrophic Factor* ; Depression ; Depressive Disorder* ; Diagnosis ; Female ; Gene Expression ; Humans ; Male ; Polymorphism, Genetic ; Serotonergic Neurons ; Serotonin Plasma Membrane Transport Proteins

The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
Adolescent ; Consensus ; DNA ; Female ; Hospitals, University ; Humans ; Mass Screening ; Pregnant Women ; Societies ; Uterine Cervical Neoplasms

BACKGROUND/AIMS: Carvedilol is an antioxidant that inhibits smooth muscle cell proliferation and migration. The aim of this study was to investigate the beneficial effects of carvedilol-loaded stents on 2-year clinical outcomes after stent implantation in patients with coronary artery disease. METHODS: We performed a prospective trial with male subjects to compare the safety and effects of carvedilol-loaded BiodivYsio(R) stents implanted into 20 patients with those of bare-metal BiodivYsio(R) stents implanted into 21 patients for de novo coronary lesions. The primary end point was the degree of neointimal hyperplasia, which was measured by intravascular ultrasound (IVUS) 6 months after the procedure; the secondary end point was major adverse cardiac events (MACE) at 2 years after implantation. All carvedilol and control stents were deployed successfully. RESULTS: A 2-year follow-up was completed for 19 patients (95%) in the carvedilol stent group and 20 patients (95%) in the control stent group. IVUS showed a trend toward a larger luminal area (6.86 +/- 2.59 vs. 5.47 +/- 1.52 mm2, p = 0.267), smaller neointimal area (1.34 +/- 0.70 vs. 2.40 +/- 1.73 mm2, p = 0.18), and reduced net decrease in luminal area (-0.78 +/- 0.97 vs. -1.89 +/- 1.78 mm2, p = 0.106) in the carvedilol stent group compared with the control stent group, respectively. There were no significant differences in the incidence of MACE (10.5 vs. 30.0%, respectively, p = 0.132) between the groups at 2 years after stent implantation. Stent thrombosis did not occur in either group after 2 years. CONCLUSIONS: The carvedilol-loaded stents tended to inhibit neointimal hyperplasia without the occurrence of cardiac death, myocardial infarction, or stent thrombosis at 2-year follow-up.
Aged ; *Angioplasty, Balloon, Coronary ; Carbazoles/*administration & dosage ; Coronary Artery Disease/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Propanolamines/*administration & dosage ; Prospective Studies ; *Stents ; Treatment Outcome ; Ultrasonography, Interventional

The general anesthesia combined with epidural anesthesia have many advantages, which are including early recovery, postoperative analgesia, and less requirement of inhalation anesthetic. But the complications of epidural anesthesia such as total spinal anesthesia, respiratory depression, myocardial ischemia, and local anesthetic toxicity can lead to cardiac arrest. We report a case of acute myocardial infarction in a 74-year-old female patient receiving general anesthesia combined with epidural anesthesia. The profound hypotension without bradycardia and ST-segment elevation in lead II occurred 1 hour after local anesthetic injection and cardiac arrest followed. After the injection of atropine, epinephrine and dopamine, and external cardiac massage, sinus rhythm was restored. Postoperative serial examinations of ECG showed ST-segment elevation in leads II, III, aVF and serum enzymes such as CPK, CK-MB, and Troponin T were elevated. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.
Aged ; Analgesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Angioplasty, Balloon, Coronary ; Atropine ; Bradycardia ; Dopamine ; Electrocardiography ; Emergencies ; Epinephrine ; Female ; Heart Arrest ; Heart Massage ; Humans ; Hypotension ; Inhalation ; Myocardial Infarction ; Myocardial Ischemia ; Respiratory Insufficiency ; Troponin T

Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration.
Bradycardia ; Cardiopulmonary Bypass ; Funnel Chest* ; Heart Atria ; Hemothorax* ; Humans ; Hypotension ; Lacerations ; Lung ; Pericardial Effusion ; Pericardiectomy* ; Pericarditis, Constrictive* ; Pneumothorax

A 6-year-old-man with a severe pectus excavatum and marfanoid feature was admitted for the correction of pectus excavatum. Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view. This method is that convex steel bar is inserted under the sternum through small bilateral thoracic incisions, and when it is in position, the bar is turn over, thereby correction the deformity. We experienced a case of the cardiac arrest during the rotation of a stainless steel bar. After the injection of atropine, epinephrine and the closed cardiac massage, sinus rhythm was restored. A vasovagal reflex due to the operation could be considered the possible etiology.
Atropine ; Congenital Abnormalities ; Epinephrine ; Funnel Chest* ; Heart Arrest* ; Heart Massage ; Humans ; Reflex ; Stainless Steel* ; Steel ; Sternum

BACKGROUND AND OBJECTIVES: Acute myocardial infarction (AMI) at a young age less than 40 years is an uncommon condition and it is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of restenosis in AMI patients who underwent percutaneous coronary intervention (PCI), and these patients were under the age of 40 years. SUBJECTS AND METHODS: Between January 1997 and December 2006, 88 out of the 121 young AMI patients (mean age: 35.6+/-4.0 years, 115 males) who underwent follow-up coronary angiography after PCI were divided into two groups: the patients without restenosis (group I: n=62, mean age: 35.6+/-3.9 years, 60 males) and the patients with restenosis (group II: n=26, mean age: 36.3+/-3.8 years, 23 males). The clinical and coronary angiographic characteristics were compared between the two groups. RESULTS: Smoking (79.3%) was the most common risk factor in all the patients. The baseline clinical characteristics and baseline laboratory findings were not different between the two groups. There was no significant difference in the sex ratio (p=0.124). The Thrombolysis In Myocardial Infarction (TIMI) flows were not different between the two groups. The level of homocysteine (hcy) was significantly decreased from 12.4+/-8.8 micronmol/L to 9.3+/-3.8 micronmol/L in group I (p=0.011), but this was not changed significantly in group II (p=0.062). According to multiple logistic regression analysis, a high triglyceride level (>200 mg/dL) was an independent predictor of restenosis (p=0.046). CONCLUSION: A high level of serum triglyceride is a predictive factor of restenosis after PCI in young age patients with acute myocardial infarction.
Coronary Angiography ; Coronary Restenosis ; Follow-Up Studies ; Homocysteine ; Humans ; Logistic Models ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors ; Sex Ratio ; Smoke ; Smoking ; Triglycerides

BACKGROUND AND OBJECTIVES: Reactive oxygen species are known to be produced when atrial fibrillation develops. This study was performed to investigate the effects of hydrogen peroxide (H2O2) on the action potential parameters of the mouse atrium. SUBJECTS AND METHODS: Mouse (ICR) atrial fibers were excised and immersed in cold bicarbonate-containing Tyrode's solution. The preparations were then perfused with oxygenated (95% O2, 5% CO2) Tyrode's solution and driven by an electrical stimuli 1 ms in duration at a frequency of 1 Hz. The transmembrane potentials were recorded at 0, 2.5, 5, 10, 20 and 30 minute, and compared between groups I (control), II (H2O2 0.1 mM), III (H2O2 0.5 mM) and IV (H2O2 1 mM). RESULTS: In group I, the maximal diastolic potential (MDP), action potential amplitude (APA), maximal slope at phase 0 depolarization (Vmax), action potential duration until 50% and 90% of repolarization (APD50, APD90) were unchanged with increasing time. In group II, the MDP and APA were unchanged, but the Vmax was decreased, and the APD50 and APD90 prolonged. In group III, the MDP was increased and the Vmax decreased; the APD50 and APD90 were prolonged, but the APA unchanged. In group IV, the MDP was increased, the Vmax and APA decreased And the APD50 and APD90 prolonged. After-depolarization was observed in 40% (8/20) and 54.5% (12/22) of groups III and IV, respectively, and asystole occurred in 18.2% (4/22) of group IV. CONCLUSION: Hydrogen peroxide changed the action potential parameters in both time and dose dependent manner, and also elicited after-depolarization at higher concentrations. These results suggest reactive oxygen species are involved in the electrical remodeling and arrhythmogenesis in atrial myocardium.
Action Potentials* ; Animals ; Atrial Fibrillation ; Atrial Remodeling ; Free Radicals ; Heart Arrest ; Hydrogen Peroxide ; Membrane Potentials ; Mice* ; Myocardium* ; Oxygen* ; Reactive Oxygen Species

BACKGROUND AND OBJECTIVES: Systemic activation of the inflammatory system after aortic injury may play a role in the development of complications. The aim of this study was to determine the significance of the inflammatory markers for the mortality of patients suffering with medically treated type B acute aortic syndrome (AAS). SUBJECTS AND METHODS: We analyzed a total of 81 patients who were admitted with AAS within 24 hours from the onset of the symptoms and who were medically treated between January 2000 and December 2004. The patients were divided into two groups: the moribund patients who died within 2 weeks (group I: n=8, mean age: 64.0+/-11.0 years) and the patients who survived over 2 weeks (group II: n=73, mean age: 62.6+/-13.7 years). The serum high-sensitivity C-reactive protein (hsCRP) levels, the white blood cell (WBC) and monocyte counts, and the plasma D-dimer levels were measured on admission. RESULTS: The baseline clinical characteristics were not different between the two groups. The major causes of in-hospital death in group I were extensions or rupture of type B dissection (6 cases) and acute renal failure (2 cases). The multivariate analysis demonstrated that a high monocyte count (>1,250/mm3), and high levels of hsCRP (>11 mg/dL) and D-dimer (>1.2 mg/dL) were independent determinants of the short-term mortality (OR=6.39, 6.14 and 9.00; 95% CI=1.19 to 34.1, 1.14 to 32.9 and 1.20 to 67.4; p=0.02, 0.04 and 0.03, respectively). CONCLUSION: Systemic activation of the inflammatory system in type B AAS patients may be one of the important factors associated with the development of short-term mortality.
Acute Kidney Injury ; C-Reactive Protein ; Humans ; Inflammation ; Leukocytes ; Monocytes ; Mortality* ; Multivariate Analysis ; Plasma ; Prognosis ; Rupture