Heart failure (HF) is a major cause of mortality and morbidity in South Korea, imposing substantial physical, emotional, and financial burdens on patients and society. Despite the high burden of symptom and complex care needs of HF patients, palliative care and hospice services remain underutilized in South Korea due to cultural, institutional, and knowledge-related barriers. This position statement from the Korean Society of Heart Failure emphasizes the need for integrating palliative and hospice care into HF management to improve quality of life and support holistic care for patients and their families. By clarifying the role of palliative care in HF and proposing practical referral criteria, this position statement aims to bridge the gap between HF and palliative care services in South Korea, ultimately improving patient-centered outcomes and aligning treatment with the goals and values of HF patients.

PURPOSE: Primary culture of the cavernous smooth muscle cells from corpus cavernous tissues is known to be difficult, mainly because of contamination with fibroblasts. We applied a new method for better isolation of rat penile smooth muscle cells (RPSMCs) from rat corpus cavernosum tissue for reliable ex vivo research on erectile dysfunction. MATERIALS AND METHODS: With the use of 8-week-old adult male Sprague-Dawley rats, ex vivo migrations of rat cavernous tissue were measured by penis and aortic ring assay by use of a Matrigel-based D-valine-modified culture method. The expression of alpha-smooth muscle actin (alpha-SMA) and platelet/endothelial cell adhesion molecule (PECAM)-1 in the RPSMCs was determined by standard immunofluorescent staining and immunoblotting. The expression patterns of phosphodiesterase (PDE) family mRNA in RPSMCs were compared with patterns in rat aortic smooth muscle cells (RASMCs) by use of quantitative real-time reverse transcription polymerase chain reaction. RESULTS: Immunocytochemical staining showed greater alpha-SMA-positive and PCAM-1-negative fluorescence. Moreover, whereas the expression of alpha-SMA was detected in the RPSMCs, that of PECAM-1 was not. The levels of PDE1A, PDE1B, PDE1C, PDE2A, PDE3A, PDE4A, PDE4B, PDE4C, PDE4D, and PDE5A mRNA in the RPSMCs were about 3.2-, 4.4-, 3.4-, 29.0-, 3.5-, 2.8-, 2.9-, 6.1-, 45.0-, and 6.0-fold the corresponding expression in RASMCs. CONCLUSIONS: We developed a two-stage tissue culture method utilizing a Matrigel-based sprouting culture system to facilitate stromal cell sprouting and an adherent culture system using D-valine to eliminate the contamination of fibroblasts into the smooth muscle cells.
Actins ; Adult ; Animals ; Antigens, CD31 ; Caves ; Cell Adhesion ; Collagen ; Drug Combinations ; Erectile Dysfunction ; Fibroblasts ; Fluorescence ; Humans ; Immunoblotting ; Laminin ; Male ; Muscle, Smooth ; Muscles ; Myocytes, Smooth Muscle ; Penile Erection ; Penis ; Primary Cell Culture ; Proteoglycans ; Rats ; Rats, Sprague-Dawley ; Reverse Transcription ; RNA, Messenger ; Stromal Cells

PURPOSE: The mechanism including changes of proteome within cavernosal tissue after cavernous nerve injury were not evaluated. We performed proteomics and functional analysis to identify proteins of penile corpus cavernosum whose expression was or was not altered by cavernous nerve resection (CNR). MATERIALS AND METHODS: Using 8-week-old male WKY rats, sham and CNR operation under microscope were performed. After 8 weeks, penile tissues of sham and CNR group were harvested. We used 2-DE and MALDI-TOF/TOF (AB 4700) to identify of differently expressed penile proteins. 2-DE gels were stained with silver nitrate and the gels were analyzed with PDQuest. RESULTS: We isolated more than 950 proteins on silver-stained gels of whole protein extracts from normal rat penile corpus cavernous. Of these proteins, 48 prominent proteins were identified using MALDI-TOF/TOF. Protein characterization revealed that the most prominent penile corpus cavernous proteins were those with antioxidant, chaperone, or cytoskeletal structure. Moreover, 11 proteins having levels elevated by CNR were annexin proteins, endoplasmic reticulum protein 29, glutathione s-transferase w-1, and others. In addition, Rho-GDP dissociation inhibitor (RhoGDI), a regulator of Rho proteins, was also increased in CNR rats compared with sham-operated control rats. CONCLUSIONS: The apoptotic signals observed in penile tissues was greatly increased in CNR rats than in sham-operated rats. These results suggest that RhoGDI is one of the proteins regulated by CNR in penile smooth muscle strips, and has a crucial role in the early stage of penile apoptosis.
Animals ; Apoptosis ; Caves ; Dissociative Disorders ; Endoplasmic Reticulum ; Erectile Dysfunction ; Gels ; Glutathione Transferase ; Humans ; Male ; Muscle, Smooth ; Proteins ; Proteome ; Proteomics ; Rats ; Rats, Inbred WKY ; rho-Specific Guanine Nucleotide Dissociation Inhibitors ; Salicylamides ; Silver Nitrate

Growth factor stimulation induces Y783 phosphorylation of phosphoinositide-specific PLC-gamma1, and the subsequent activation of this enzyme in a cellular signaling cascade. Previously, we showed that a double point mutation, Y509A/F510A, of PLC-gamma1, abolished interactions with translational elongation factor 1-alpha. Here, we report that the Y509A/F510A mutant PLC-gamma1 displayed extremely high levels of Y783 phosphorylation and enhanced catalytic activity, compared to wild-type PLC-gamma1, upon treatment of COS7 cells with EGF. In quiescent COS7 cells, the Y509A/F510A mutant PLC-gamma1 exhibited a constitutive hydrolytic activity, whereas the wild-type counterpart displayed a basal level of activity. Upon treatment of COS7 cells with EGF, the Y783F mutation in Y509A/F510A PLC-gamma1 (Y509A/F510A/Y783F triple mutant) cells also led to an enhanced catalytic activity, whereas Y783F mutation alone displayed a basal level of activity. Our results collectively suggest that the Y509A/F510A mutant is more susceptible to receptor tyrosine kinase-induced Y783 phosphorylation than is wild-type PLC-gamma1, but no longer requires Y783 phosphorylation step for the Y509A/F510A mutant PLC-gamma1 activation in vivo.
Amino Acid Substitution/drug effects/*genetics ; Animals ; COS Cells ; Cercopithecus aethiops ; Enzyme Activation/drug effects ; Epidermal Growth Factor/*pharmacology ; Hydrolysis/drug effects ; Mutant Proteins/metabolism ; Phosphatidylinositols/*metabolism ; Phospholipase C gamma/*genetics/metabolism ; Phosphorylation/drug effects ; Phosphotyrosine/*metabolism ; Point Mutation/*genetics ; Rats

BACKGROUND: A decreased lumbosacral subarachnoidal space volume is a major factor in the cephalad intrathecal spread of local anesthetics in term parturients and their subarachnoidal space is decreased due to the compressive effect of huge uteri. Therefore, they show a higher level of sensory block and hypotensive episodes. The purpose of this study is to investigate whether the symphysis-fundal height (SFH) correlates with the highest sensory level and the amount of ephedrine administered under spinal anesthesia. METHODS: Fifty-two uncomplicated parturients who consented to spinal anesthesia for elective cesarean section were studied. The SFH of all parturients had been measured just before the spinal anesthesia administered by one person. Hyperbaric bupivacaine with fentanyl 20 microgram, was administered for spinal anesthesia. The amount of 0.5% bupivacaine was adjusted according to the patient's height and weight. The level of sensory block and the amounts of ephedrine to treat hypotension, nausea and vomiting were assessed. Linear regression and correlation analysis were applied to analyze the data. RESULTS: According to the results of correlation analysis, there was no significant correlation between the level of sensory block and SFH. There were statistically significant positive correlations between the amount of ephedrine administered due to hypotension and SFH. CONCLUSIONS: In term parturients choosing elective cesarean section, the SFH is not correlated with the sensory level of spinal anesthesia, but is correlated with the amount of ephedrine administered during spinal anesthesia.
Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Humans ; Hypotension ; Linear Models ; Nausea ; Pregnancy ; Uterus ; Vomiting

BACKGROUND/AIMS: Osteopontin (OPN) is overexpressed in hepatocellular carcinoma (HCC) with postoperative recurrence or extrahepatic metastasis. However, its prognostic value in patients treated with transarterial chemoembolization (TACE) is unclear. We investigated the utility of serum OPN levels and changes therein as prognostic markers in HCC patients who have received TACE. METHODS: Forty-six patients with HCC were enrolled. Serum OPN levels were measured before and 4 weeks after TACE. Serum biochemistry and computed tomography (CT) scans were analyzed. We evaluated baseline serum OPN levels and subsequent changes therein in relation to tumor responses and cumulative survival rates following TACE. A decreasing pattern was defined as a decrease after TACE of more than 10% relative to baseline levels. A "responder" was defined as a patient who exhibited a tumor necrosis rate of higher than 50% on the follow-up CT scan. RESULTS: Higher initial serum OPN levels were associated with a large tumor, portal vein invasion, and an advanced tumor stage. Patients who had lower initial serum OPN levels and those who exhibited decreasing patterns after TACE tended to have more favorable tumor responses (P=0.043 and 0.055, respectively) and exhibited better cumulative survival rates (P=0.036 and 0.030, respectively). However, the initial serum OPN level and subsequent changes in serum OPN levels were not independent predictors for survival on multivariate analysis. CONCLUSIONS: Serum OPN levels were significantly higher in patients with advanced HCC. In addition, HCC patients with low pretreatment serum OPN levels and those for whom serum OPN declined following TACE exhibited better tumor responses and survived for longer.
Adult ; Aged ; Area Under Curve ; Carcinoma, Hepatocellular/metabolism/secondary/*therapy ; *Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms/metabolism/pathology/*therapy ; Male ; Middle Aged ; Neoplasm Staging ; Osteopontin/*blood ; Portal Vein/pathology ; Prognosis ; Severity of Illness Index ; Survival Rate ; Tomography, X-Ray Computed

Although prosthetic materials are commonly used to repair abdominal wall defects, they are also associated with postoperative complications. These complications could be prevented by the adoption of uniform guidelines on surgical methods and materials, but the best anatomical position for placement of prosthetic meshes is unclear. We report a case of an enterocutaneous fistula that developed after an abdominal wall defect was repaired by intraperitoneal application of a prosthetic mesh (Marlex(R)) to raise awareness of the consequences of improper use of prosthetic materials.
Abdominal Wall ; Adoption ; Fistula ; Intestinal Fistula ; Polypropylenes ; Postoperative Complications ; Surgical Mesh

PURPOSE: Cavernous nerve resection (CNR) in rats is a standard model of animal experiments on erectile dysfunction (ED) that occurs after radical prostatectomy (RP). Injured cavernous nerves after surgery can cause fibrosis and apoptosis that lead to penile structural changes that may be accompanied by alterations of protein expression. This study aimed to analyze the changes in protein after CNR in Wistar Kyoto rats. MATERIALS AND METHODS: Using 8-week-old male Wistar Kyoto rats, sham and CNR operation under a microscope were performed. Two and 8 weeks after surgery, we applied 2-DE and MALDI-TOF/TOF (AB 4700) to identify differently expressed penile proteins after CNR. 2-DE gels were stained with silver nitrate and were analyzed with PDQuest. After in-gel digestion, peptide mass spectra were obtained by MALDI-TOF/TOF mass spectrometry in the positive ion reflector mode. The obtained data were screened with a rat database from both the NCBI and the Swiss-Prot/TrFMBL home page. RESULTS: The proteins that were changed more than 1.5-fold compared with the sham group were annexin A4 and pyruvate kinase (PK). Annexin A4 was increased by 1.75-fold after 2 weeks, whereas PK was decreased by 4.16 after 8 weeks. These results were confirmed by immunohistochemistry. CONCLUSIONS: Annexin A4 in the CNR group was increased, which may be related to emiocytosis during apoptosis. The decrease in PK of the CNR group is assumed to be related to a decrease in efficacy during glycolysis. Further study will be needed to elucidate the molecular pathophysiology of ED after cavernous nerve injury.
Animal Experimentation ; Animals ; Annexin A4 ; Apoptosis ; Caves ; Digestion ; Erectile Dysfunction ; Fibrosis ; Gels ; Glycolysis ; Humans ; Immunohistochemistry ; Male ; Mass Spectrometry ; Prostatectomy ; Proteins ; Proteomics ; Pyruvate Kinase ; Rats ; Rats, Inbred WKY ; Salicylamides ; Silver Nitrate

The CD4+CD25+ T regulatory cells (Tregs) play an important role in immune tolerance in experimental transplantation but the clinical significance of circulating Tregs in the peripheral blood is undetermined. In 50 kidney transplant (KT) recipients, 29 healthy controls and 32 liver transplant (LT) recipients, the frequency of Tregs was measured with flow cytometry before and after transplantation. In the KT recipients, IL-10 secretion was measured with an enzyme-linked immunospot (ELISPOT) assay. The median frequency of circulating Tregs before KT was similar to that in healthy controls but significantly lower than that in LT patients before transplantation. The frequency of Tregs was significantly decreased in patients with subclinical acute rejection compared with those without subclinical acute rejection. Calcineurin inhibitors (CNIs) and anti-CD25 antibody decreased the frequency of Tregs but mTOR inhibitor did not. The frequency of donor-specific IL-10 secreting cells did not correlate with the number of Tregs. The frequency of circulating Tregs in KT recipients is strongly affected by CNIs and anti-CD25 antibody, and a low frequency of Tregs is associated with subclinical acute rejection during the early posttransplant period.
Adult ; CD4-Positive T-Lymphocytes/*immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Flow Cytometry ; Graft Rejection ; Humans ; Interleukin-10/metabolism ; Interleukin-2 Receptor alpha Subunit/*biosynthesis ; Kidney Failure, Chronic/blood/immunology/*therapy ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Nephrology/*methods ; T-Lymphocytes, Regulatory/*immunology

BACKGROUND: Vasoconstrictor-induced reduction in arterial graft diameter can cause significant flow deprivation. The aim of this study was to evaluate the effect of vasodilator pretreatment on vasoconstrictor-induced blood vessel spasm in vitro. MATERIAL AND METHOD: Rabbit brachial arteries (BA) and celiac arteries (CA) were cut into rings (3~4 mm) and suspended with a force displacement transducer (TSD 125C(R), Biopac Inc. USA) in a tissue bath filled with 5 mL modified Krebs solution bubbled with 5% CO2 and 95% O2 at 38degrees C. The rings were contracted with vasoconstrictors, and the developed tension changes were considered control values. The rings were then pretreated with 30micrometer nitroglycerin, nicardipine, verapamil, and papaverine, respectively, for 40 minutes and rinsed with the physiologic buffered salt solution three times every 15 min. The vasoconstrictor-induced tension changes after the previous procedure were considered experimental values. Data are expressed as the percentage tension induced by vasoconstrictors before and after pretreatment with vasodilators. RESULT: Nicardipine depressed vasoconstriction induced by norepinephrine, angiotensin II (AII), and U46619 in both the BA and the CA more significantly than did nitroglycerin (p<0.01) and verapamil (p<0.05). Verapamil depressed vasoconstriction induced by 5-hydroxytryptamine (5HT), AII, and U46619 in the BA and by 5HT in the CA more significantly than did nitroglycerin (p<0.01). CONCLUSION: These findings suggest that both nicardipine and verapamil effectively depressed vasoconstrictor action. Nicardipine is thought to be more effective than verapamil for the prevention of vasoconstrictor action.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Angiotensin II ; Baths ; Blood Vessels ; Brachial Artery ; Celiac Artery ; Contracts ; Displacement (Psychology) ; Glycosaminoglycans ; Isotonic Solutions ; Nicardipine ; Nitroglycerin ; Norepinephrine ; Papaverine ; Serotonin ; Spasm ; Transducers ; Transplants ; Vasoconstriction ; Vasoconstrictor Agents ; Vasodilator Agents ; Verapamil