The author has observed the effects of collagenase on the relapse phenomenon and the histochemical changes during the relapse period. 50 rats were used. : 3rats as a normal group, 15rats as control groups, and 32rats as experimental groups. Rat's teeth were moved for 10days with helical spring applied, followed by injection of "collagenase in Hank's sol." to the experimental groups and the "Hank's sol." to the control group in the interdental gingiva on the 10th day, and the spring was removed on the 11th day. After injection, the experimental animals were sacrificed on the 11th, 13th, 15th, 17th, 20th, and 24th day and perpared histochemically for the Hematoylin-Eosin, Van-Gieson, and Methyl Green-pyronin staining. The results are as follows: 1. Group I (11th day): In the control group the supracrestal fibers were stretched and the metabolic rate was high. Experimental group showed that supracrestal fibers were resor, bed, disarrayed, and the metabolic rate was low. 2. Group II (13th day): In the control group, the supracrestal fibers began to vhange from the vertical direction to tooth-axis to the parallel. Experimental group showed that supracrestal fibers were completely resorbed. 3. Group IV (17th day): The control group showed almost normal structure. Form this group the metabolic rates were low. Experimental group showed the most destructive pattern. 4. Group VI (24th day): Experimental group showed almost normal structure. It follows that experimental groups were relapsed less than the control groups, and collagenase was effective in the prebention of relapse after rat's experimental tooth movement.
Animals ; Collagenases* ; Gingiva ; Rats ; Recurrence* ; Tooth Movement* ; Tooth*

Protein-calorie malnutrition is common in CAPD patients and is associated with increase in morbidity and mortality in CAPD patients. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein losses through peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross- sectional study on clinically stable 115 patients (63 males and 52 females) who have been on CAPD for more than 2 years, and assessed nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Patients were divided into 4 groups according to the results of standard peritoneal equilibration test (PET). The results were as follows: 1) The patients were divided into 4 groups according to the PET results: high transporter (n=16, 14%), high average transporter (n=38, 33%), low average transporter (n=50, 43%), and low transporter (n=11, 10%). 2) The mean age of the patients was 50.1+/-11.6 years (range, 19-75) with sex ratio (M:F) 1.2:1 and mean duration of dialysis was 57.5+/-27.8 months (range, 24-135). The mean body weight (Bwt) was 59.2+/-8.9kg, percent ideal body weight (%IBW) was 104.7+/-15.6%, %lean body mass (LBM)/Bwt was 82.1+/-11.1%, and malnourished patients by subjective global assessment (SGA) were 32.2% (38/115). 3) The mean BUN, creatinine, total protein, and albumin level of the patients were 54.5+/-13.1mg/dL, 12.3+/-3.0mg/dL, 6.7+/-0.8g/dL, and 3.8+/-0.6g/dL, respectively. 4) There were no significant differences in age, sex ratio, CAPD duration, peritonitis rate, %LBM/ Bwt, and SGA among the 4 groups. 5) Total protein (g/dL) and albumin (g/dL) levels in high transporters were 6.4+/-0.5, 3.5+/-0.4, respectively, and they were significantly lower than those of low transporters (7.2+/-0.6, 4.2+/-0.5) (P<0.05). 6) 24 hour dialysate protein (g/day) and albumin (g/day) losses were significantly higher in high transporters (8.10+/-1.85, 4.19+/-1.23) compared to those of low transporters (5.07+/-1.85, 2.78+/-0.99) (P<0.05). 7) The level of IGF-1 (ng/mL) was significantly lower in high transporters (150.5+/-86.2) compared to that of low transporters (310.3+/-162.1) (P<0.05). 8) The level of BUN (mg/dL), Cr (mg/dL) were also lower in high transporters (45.4+/-13.1, 10.1+/-2.0) than those of low transporters (61.6+/-18, 14.7+/-2.7), but there were no significant differences in Hct, total cholesterol, prealbumin, and transferrin among the 4 groups. 9) There were no statistically significant differences in Kt/Vurea, RRF, NPCR, dietary calorie and protein intakes among the 4 groups. 10) Anthrometric parameters such as TSF, BSF, MAC and LBM measured by three different methods (LBMCr, LBMimp, LBManthro) didn't show any significant differences among the 4 groups. In conclusion, increased peritoneal permeability may not adversely affect SGA and anthropometric status of long-term CAPD patients, although it is associated with lower serum albumin, creatinine, and IGF-1 level. Clinical significance of these findings remains to be elucidated.
Body Weight ; Cholesterol ; Creatinine ; Dialysis ; Humans ; Ideal Body Weight ; Insulin-Like Growth Factor I ; Male ; Malnutrition ; Membranes ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Permeability ; Prealbumin ; Protein-Energy Malnutrition ; Serum Albumin ; Sex Ratio ; Transferrin ; Urea

Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. One factor that has so far received little attention, but which might contribute to morbidity and mortality, is the timing of referral to the nephrologist. We performed a retrospective analysis in 358 patients(male 275, female 151) who were initiated renal replacement therapy first at this hospital from Jan 1995 to Dec 1996. Patients were defined by the time of first nephrology as early referral(E, n=163) encountered after more than 8 weeks; late early referral(LE, n=19) encountered between 8 weeks and 4 weeks; late referral(L, n=55) encountered from 1 week to 4 weeks; urgent referral(U, n= 121) encountered less than 1 week. There were no differences in age, gender, primary renal disease, cause of dialysis, and renal replacement therapy modalities. However, there were significant differences in rnean arterial pressure and serum phosphate levels between these 4 groups. The mean arterial pressures (mmHg) were 109.15 +/- 17.16, 105.37+/-18.76, 117.24 +/- 27.24 and 116.98+/-24.26 for E, LE, L and U, respectively(p<0.05, compared E to U). In the U group, serum phosphate levels were elevated at initiation of dialysis compared to the E group(6.39+/-1.72 vs 7.29 +/- 3.54mg/dL, p<0.05). One year mortality in the U group had on increased tendency compared to the E group, especially earlier mortality(7.4% vs 14.9N, p>0.05). In the E group, there was more controlled blood pressure and serum phosphate levels compared to the U group at initiation of renal replacement therapy, but other parameters were not significantly different among the 4 groups. Delays in initiation of renal replacement therapy may result in patients entering dialysis in a compromised state, therefore adequate long-term predialysis care by a nephrologist is important. Socioeconomic - and medical factors respon-sible for late referral and late initiation of dialysis need to be evaluated and corrected to further improve the outcome of these patients.
Arterial Pressure ; Blood Pressure ; Dialysis* ; Female ; Humans ; Mortality ; Nephrology ; Referral and Consultation* ; Renal Replacement Therapy ; Retrospective Studies

Background and Objectives: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m 2 , mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm 2 ) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings. Conclusions An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS.Future randomized studies are required to validate and confirm our findings.

OBJECTIVE: The aim of this study was to validate the Glasgow-Blatchford score (GBS), Pre-Rockall score (PRS), and AIMS65 score to predict active bleeding in patients with normotension and upper gastrointestinal bleeding (UGIB), and analyze the variables that can predict active bleeding to help develop new predictive factors. METHODS: Data were collected retrospectively from January 2015 to December 2017. A systolic blood pressure ≥90 mmHg were defined as normotension, and the patients were divided into active bleeding and not-active bleeding groups based on an esophagogastroduodenoscopy and levin-tube irrigation. The GBS, PRS, and AIMS65 of each group were calculated. The receiver operator characteristic (ROC) curve and area under the curve (AUC) were also calculated to obtain the predictive power for active bleeding. Furthermore, the factors that can predict active bleeding were analyzed by multivariate logistic regression. The ROC curve and AUC were calculated using the variables that were adopted as useful factors. RESULTS: Of the 250 patients included, 85 were active bleeding and 165 were not-active bleeding. The ROC curve showed GBS (AUC, 0.54; 95% confidence interval [CI], 0.47–0.61), PRS (AUC, 0.58; 95% CI, 0.50–0.65), and AIMS65 (AUC, 0.51; 95% CI, 0.43–0.59) to have low predictive power for active bleeding. Multivariate logistic regression revealed the lactate (odds ratio [OR], 1.10; 95% CI, 1.01–1.20) and shock indices (OR, 4.15; 95% CI, 1.12–15.40) to be significant predictors of active bleeding. When calculating the probability of predicting active bleeding through these variables, AUC 0.64 (95% CI, 0.57–0.71) showed higher prediction power than the previous scores. CONCLUSION: The conventional scoring systems that predict the prognosis of UGIB showed low predictability in predicting active bleeding in UGIB patients with a systolic blood pressure ≥90 mmHg. Further study suggests the development of new score using factors, such as the lactate and shock indices.
Area Under Curve ; Blood Pressure ; Emergency Medicine ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Lactic Acid ; Logistic Models ; Prognosis ; Retrospective Studies ; ROC Curve ; Shock

Purpose: The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is often found during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A fusion of uncertain cause in the absence of tachycardia. Materials and Methods: We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between January 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion. Results: The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msec vs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%, p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002). Conclusion Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

PURPOSE: There has been many reports for the effect of attenuation correction on myocardial perfusion SPECT. We studied the effect of attenuation correction with CT (computed tomography) in patients with normal coronary angiography. MATERIALS AND METHODS: Fifteen patients with normal coronary artery on angiography and low likelihood of coronary artery disease were enrolled in this study (male: 6, female: 9, mean age: 58+/-8 year). Myocardial perfusion SPECT was done with Millennium VG with Hawkeye device (GE, SPECT/CT camera). A visual analysis and polar map quantification (Emory tool box) was performed. In quantitative analysis, percent uptake of each myocardial wall on polar map (percent of maximal uptake) was compared between non-corrected (NC) and corrected (AC) images. RESULTS: Visual analysis showed AC images led to an increase of uptake in the inferior wall, but decrease of uptake in the anterior wall, apex and septum. Liver activity is also increased in AC images. In quantitative analysis, the percent uptake is decreased in the anterior wall, apex and septum, but increased in the inferior wall. It is helpful to interpret the images in the inferior wall after AC, but difficult in the apex and anterior wall after AC. CONCLUSION: AC is helpful in the inferior wall. But in the apex or anterior wall, AC must be carefully applied to normal perfused myocardium.
Angiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Liver ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

Myxoma is the most common type of primary cardiac tumor and about 75% of myxomas occur in the left atrium of the heart. Most myxomas are diagnosed by echocardiography. The growth rate of myxoma is clearly unknown and newly developed myxoma is difficult to understand clearly the onset of growth. We describe the case of a newly developed huge left atrial myxoma (7x7 cm)which showed no echocardiographic evidence of the tumor four years ago. Four years later the patient underwent transthoracic echocardiography due to preoperative evaluation that was normal. Nine months later, she presented with dyspnea. Transthoracic echocardiography showed a large mass located in left atrium. Pathology showed a myxoma that measured 7x7 cm implying a growth rate of 0.15x0.15 cm/month.
Dyspnea ; Echocardiography ; Heart ; Heart Atria ; Heart Neoplasms ; Humans ; Myxoma

Background: Hypertrophic cardiomyopathy (HCM) needs careful differentiation from other cardiomyopathies. Current guidelines recommend genetic testing, but genetic data on differential diagnoses and their relation with clinical outcomes in HCM are still lacking.This study aimed to investigate the prevalence of genetic variants and the proportion of other cardiomyopathies in patients with suspected HCM in Korea and compare the outcomes of HCM according to the presence of sarcomere gene mutation. Methods: We enrolled 1,554 patients with suspected HCM having left ventricular hypertrophy on transthoracic echocardiography between April 2012 and February 2023. Patients who declined genetic testing or who had pure apical HCM without a familial history were excluded. Genetic testing was performed using a next-generation sequencing panel or wholeexome sequencing for cardiomyopathies. We performed cardiovascular magnetic resonance if the diagnosis was inconclusive. Genotype-positive HCM was defined as sarcomere gene mutations of pathogenic or likely pathogenic variants. Adverse clinical outcomes were defined as a composite of all-cause death, resuscitated cardiac arrest, heart failure-related admission, appropriate implantable cardioverter defibrillator shocks, and stroke. Results: Of 492 patients (mean age 49.6 ± 14.7 years, 29.4% women) who underwent genetic testing, 214 (43.5%) had disease-causing gene mutations. After combining gene tests, multi-imaging modality, and clinical information, 447 (90.9%) had HCM, and 27 (5.5%) had Fabry disease. Among the HCM patients, 182 (40.7%) were genotype-positive, and 265 (59.3%) were genotype-negative. Kaplan–Meier curve analysis showed that genotype-positive HCM patients experienced more composite outcomes (log-rank, P < 0.001). In multivariable Cox analysis, non-sustained ventricular tachycardia (NSVT) (hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.17–3.12; P = 0.010), left ventricular ejection fraction (LVEF) < 50% (HR, 5.50; 95% CI, 2.68–11.27; P < 0.001), LA reservoir strain (HR, 0.96; 95% CI, 0.93–0.99;P = 0.037), and positive sarcomere gene mutation (HR, 1.70; 95% CI, 1.04–2.78; P = 0.034) were significantly association with composite outcomes. Sarcomere gene mutation had incremental value for predicting adverse outcomes added on NSVT and LVEF < 50%. Conclusion Genetic testing is helpful in diagnosing HCM, and sarcomere gene mutations in HCM are significantly associated with clinical outcomes.