Background and Objectives: The aim of this study was to demonstrate the efficacy and safety of treatment with drug-coated balloon (DCB) in a large real-world population. Methods: Patients treated with DCBs were included in a multicenter observational registry that enrolled patients from 18 hospitals in Korea between January 2009 and December 2017. The primary outcome was target lesion failure (TLF) defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically indicated target lesion revascularization at 12 months. Results: The study included 2,509 patients with 2,666 DCB-treated coronary artery lesions (1,688 [63.3%] with in-stent restenosis [ISR] lesions vs. 978 [36.7%] with de novo lesions).The mean age with standard deviation was 65.7±11.3 years; 65.7% of the patients were men.At 12 months, the primary outcome, TLF, occurred in 179 (6.7%), 151 (8.9%), 28 (2.9%) patients among the total, ISR, and de novo lesion populations, respectively. A history of hypertension, diabetes, acute coronary syndrome, previous coronary artery bypass graft, reduced left ventricular ejection fraction, B2C lesion and ISR lesion were independent predictors of 12 months TLF in the overall study population. Conclusions This large multicenter DCB registry study revealed the favorable clinical outcome of DCB treatment in real-world practice in patient with ISR lesion as well as small de novo coronary lesion.

Ischemic stroke results from arterial occlusion and can cause irreversible brain injury. A non-human primate (NHP) model of ischemic stroke was previously developed to investigate its pathophysiology and for efficacy testing of therapeutic candidates; however, fine motor impairment remains to be well-characterized. We evaluated hand motor function in a cynomolgus monkey model of ischemic stroke. Endovascular transient middle cerebral artery occlusion (MCAO) with an angiographic microcatheter induced cerebral infarction. In vivo magnetic resonance imaging mapped and measured the ischemia-induced infarct lesion. In vivo diffusion tensor imaging (DTI) of the stroke lesion to assess the neuroplastic changes and fiber tractography demonstrated three-dimensional patterns in the corticospinal tract 12 weeks after MCAO. The hand dexterity task (HDT) was used to evaluate fine motor movement of upper extremity digits. The HDT was modified for a home cage-based training system, instead of conventional chair restraint training. The lesion was localized in the middle cerebral artery territory, including the sensorimotor cortex. Maximum infarct volume was exhibited over the first week after MCAO, which progressively inhibited ischemic core expansion, manifested by enhanced functional recovery of the affected hand over 12 weeks after MCAO. The total performance time decreased with increasing success rate for both hands on the HDT. Compensatory strategies and retrieval failure improved in the chronic phase after stroke. Our findings demonstrate the recovery of fine motor skill after stroke, and outline the behavioral characteristics and features of functional disorder of NHP stroke model, providing a basis for assessing hand motor function after stroke.

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found colocalized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206⁺ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68⁺ microglia/macrophages can therefore be used as a potential therapeutic target.
Brain ; Haplorhini ; Immunohistochemistry ; Infarction, Middle Cerebral Artery ; Inflammation ; Macaca mulatta ; Magnetic Resonance Imaging ; Microglia ; Middle Cerebral Artery ; Primates ; Stroke ; Transforming Growth Factor beta

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.
Humans ; Manometry ; Medical Records ; Motor Neurons ; Neurogenic Bowel ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urodynamics*

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.
Humans ; Manometry ; Medical Records ; Motor Neurons ; Neurogenic Bowel ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urodynamics*

OBJECTIVES: The aim of this study is to develop guideline for evaluation of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: Careful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression. CONCLUSION: The results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.
Comorbidity ; Depression* ; Depressive Disorder ; Diagnosis* ; Methods ; Peer Review ; Prognosis ; Weights and Measures

OBJECTIVES: The aim of this study is to develop guideline for use in diagnosis of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: There has been no evidence on strategies to improve the accuracy and rate of diagnosis of depression. The screening tools for depression were useful in diagnosis of depression in clinical practice. CONCLUSION: The results of this study may suggest the necessity of strategies to improve the validity and reliability of diagnosis of depression. In contrast, scales for screening depression can be useful in diagnosis of depression. This guideline did not include systematic reviews regarding useful scales for diagnosis of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.
Depression* ; Depressive Disorder ; Diagnosis* ; Mass Screening ; Methods ; Peer Review ; Reproducibility of Results ; Weights and Measures

BACKGROUND AND OBJECTIVES: The current guidelines recommend an early invasive strategy for patients suffering with non-ST segment elevation myocardial infarction (NSTEMI). However, there is still debate about the timing of revascularization in patients with NSTEMI. To analyze the clinical efficacy of the timing of revascularization, we compared the in-hospital clinical outcome of NSTEMI patients from the Korea Acute Myocardial Infarction Registry (KAMIR) between the early and selective invasive therapeutic groups. SUBJECTS AND METHODS: Between Nov. 2005 and Apr. 2007, 2762 acute NSTEMI patients (mean age=64.6+/-12.8 years, 1847 males) were enrolled in the KAMIR. The therapeutic strategy of NSTEMI was categorized into early invasive treatment (within 48 hours, Group I mean age: 63.1+/-13.1 years, 1085 males) and selective invasive treatment (Group II mean age: 66.5+/-12.1 years, 762 males). The initial clinical status and the in-hospital mortality and morbidity rate were compared between these two groups. The in-hospital outcomes were also compared between the two groups according to each level of the Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in the mortality and morbidity rate between the groups (6.5% vs. 10.3%, respectively, p<0.001). According to TIMI risk score, there were no significant differences of mortality and morbidity for the low to moderate risk patients (5.3% vs. 7.8%, respectively, p=0.123 for the risk score 0-2, 6.4% vs. 8.7%, p=0.139 for the risk score 3-4). CONCLUSION: Early invasive treatment improves the hospital outcome for the high-risk NSTEMI patients. The use of abciximab, a low ejection fraction, a high Killip class, a high TIMI risk score and old age are the predictive factors of in-hospital mortality and morbidity.
Angioplasty ; Hospital Mortality ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Prognosis ; Thrombolytic Therapy

Endometriosis is a relatively common disease, affecting 5-10% of women of reproductive age. But, endometriosis affecting the urinary tract is very rare entity. Involvement of urinary tract by endometriosis occurs in about 1% of women with pelvic endometriosis. Ureteral endometriosis is mostly asymptomatic for a long time, and associated with nonspecific symptoms at clinical presentation and difficult preoperative diagnosis. The involvement of the ureter is rarely intrinsic by implantation of endometrial tissue in the wall of the ureter, but rather due to external compression by adjacent endometriosis and its attendant inflammation and fibrosis. We have experienced a case of right severe hydroureteronephrosis due to ureteral stricture from endometriosis. Laparoscopic nephrectomy was done due to renal atrophy. At the same time, laparoscopic total hysterectomy with right salpingo-oophorectomy was performed because of the uterine adenomyosis and right ovarian endometrioma. So, we report that with a brief review of literatures.
Adenomyosis ; Atrophy ; Constriction, Pathologic* ; Diagnosis ; Endometriosis* ; Female ; Fibrosis ; Humans ; Hydronephrosis* ; Hysterectomy ; Inflammation ; Nephrectomy ; Ureter* ; Urinary Tract

BACKGROUND: Intrathecal (IT) magnesium has antinociceptive effects on animals and has been reported to prolong spinal opioid analgesia in humans. This study examined the effect of IT magnesium on spinal anesthesia and postoperative epidural analgesia. METHODS: Sixty patients undergoing total knee replacement were enrolled in this study. Before the IT injection of 0.5% isobaric tetracaine (10 mg), group C and group M received 0.9% saline or 50% magnesium sulfate 0.1 ml, respectively. The epidural solution for postoperative analgesia contained 0.2% ropivacaine (100 ml) only in group M, and 0.2% ropivacaine plus morphine (50microgram/ml) in group C. The verbal rating scale (VRS) scores for pain, sensory block level, intensity of motor block and side effects were recorded at 5, 60, and 120 minutes after the IT injection and at 1, 12 and 36 hours after surgery in the post-anesthesia care unit (PACU). RESULTS: The VRS score at 120 minutes after the IT injection were lower in group M than in group C (P< 0.05). There were no differences in the VRS scores and the use of supplemental analgesics at the postoperative period. The incidence of PONV, pruritus and urinary retention was significantly lower in group M than in group C at 12 and 36 hours after surgery. CONCLUSIONS: IT magnesium can be used as a local anesthetic adjuvant to strengthen the analgesic effect of spinal local anesthesia and to intensify the analgesic effect of epidural local anesthesia for postoperative pain control to the extent of 5 mg epidural morphine.
Analgesia ; Analgesia, Epidural ; Analgesics ; Anesthesia, Local ; Anesthesia, Spinal ; Animals ; Arthroplasty, Replacement, Knee ; Humans ; Incidence ; Magnesium Sulfate* ; Magnesium* ; Morphine ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Postoperative Period ; Pruritus ; Tetracaine ; Urinary Retention