BACKGROUND/AIMS: Quantification of hepatitis B surface antigen (HBsAg) is an emerging serologic test and may be useful for identifying treatment strategies for chronic hepatitis B (CHB). This study aimed to evaluate HBsAg titers during the natural course of CHB and identify correlations between HBsAg titers and hepatitis B virus (HBV) DNA concentrations across different CHB phases measured using an immunoradiometric assay (IRMA). METHODS: CHB phases were defined on the basis of HBV DNA concentrations, the presence of hepatitis B e antigen/antibody (HBeAg/Ab) and serum alanine aminotransferase levels. Serum HBsAg titers and paired HBV DNA concentrations in the different phases of CHB were compared using 627 serum samples. RESULTS: Mean HBsAg titers were significantly higher in the immunotolerant (IT) phase and immunoreactive (IR) HBeAg-positive phase than in the low-replicative (LR) and HBeAg-negative CHB (ENH) states. The correlation between HBsAg titers and HBV DNA concentrations was modest in the IT (n=36, r=0.804, p<0.001) and IR (n=48, r=0.773, p<0.001) phases, and it was poor in the LR state (n=116, r=0.289, p=0.002); however, no significant correlation was observed in the ENH state (n=67, r=0.146, p=0.237) or in the oral nucleos(t)ide analogue-treated group (n=267). CONCLUSIONS: HBsAg quantification using IRMA might be useful for discriminating different CHB phases and different stages of chronic liver disease.
Adult ; Alanine Transaminase/blood ; Biomarkers/blood ; DNA, Viral/*blood ; Disease Progression ; Female ; Hepatitis B Surface Antigens/*blood ; Hepatitis B e Antigens/blood ; Hepatitis B virus/*genetics/immunology ; Hepatitis B, Chronic/*immunology ; Humans ; *Immunoradiometric Assay ; Male ; Middle Aged ; Seoul ; Viral Load ; Virus Replication

PURPOSE: We describe 2 cases of bilateral acute myopia associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. CASE SUMMARY: A 24-year-old woman and a 25-year-old woman, both previously devoid of ocular problems, visited our hospital with blurry vision after taking topiramate for weight reduction. A thorough medical history review and ocular examinations, including a slit lamp examination, were performed. CONCLUSIONS: Slit-lamp examinations revealed forward displacement of the lens-iris diaphragm, which resulted in myopia and anterior chamber shallowing. Discontinuation of topiramate and the administration of cycloplegic agents successfully resolved the symptoms.
Adult ; Anterior Chamber ; Diaphragm ; Displacement (Psychology) ; Epilepsy ; Female ; Fructose ; Humans ; Myopia ; Vision, Ocular ; Weight Loss ; Young Adult

BACKGROUND AND OBJECTIVES: It is known that both hypercholesterolemia and aging cause endothelial dysfunction, but which has the greater effect is less well known. A useful, non-invasive method for the evaluation of endothelial function is flow-mediated dilation (FMD) of the brachial artery (BA) employing high-resolution ultrasound. This study was performed to evaluate the effect of serum cholesterol and age on endothelial function in women utilising the above method. SUBJECTS AND METHODS: 21 of the 37 women in this study (mean age 46+/-15 years, range 24-72), had hypercholesterolemia (>or=200 mg/dL) and 16 had normocholesterolemia (<200 mg/dL). None of the subjects suffered classic risk factors associated with atherosclerosis other than hypercholesterolemia. The inner diameter of the right BA was measured at the peak of ECG R wave, from a longitudinal section taken by an 8.0-MHz B-mode linear-array ultrasonic transducer. Scans were taken at rest, during reactive hyperaemia (endothelium-dependent dilation;EDD), again at rest, and following sublingual nitroglycerin (endothelium-independent dilation;EID). RESULTS: From simple linear regression analyses, the serum cholesterol levels were found to be negatively related to the EDD of the BA at an age <50 years (r=-0.63, p<0.01), and also >or=50 years (r=-0.54, p<0.05). Serum cholesterol levels were not significantly related to the EID, regardless of age. In contrast, age was not related to EDD or EID in either normocholesterolemic or hypercholesterolemic subjects. CONCLUSION: These results suggest hypercholesterolemia has a greater effect than age in impairing the endothelial function in women.
Age Factors ; Aging ; Atherosclerosis ; Brachial Artery ; Cholesterol ; Electrocardiography ; Endothelium ; Female ; Humans ; Hypercholesterolemia* ; Linear Models ; Nitroglycerin ; Risk Factors ; Transducers ; Ultrasonics ; Ultrasonography ; Vasodilation

BACKGROUND AND OBJECTIVES: G protein-coupled receptors were considered to be the only natural substrates of G protein-coupled receptor kinases (GRKs). However, it was recently demonstrated that GRKs can also bind to other signal molecules. The purpose of this study was to investigate new molecules that might interact with the GRK5 using a yeast two-hybrid system to screen the cDNA library. MATERIALS AND MEDTHODS: For the yeast two-hybrid system, the "bait" was constructed to generate a LexA-GRK5 fusion protein in the EGY48 yeast strain. Rat library cDNA was inserted into the "prey". The first step in the library screening was performed by a galactose dependent leucine orthotrophism. For the second step screening, a beta-galactosidase dependent discoloration of colonies was used. Sequencing and searching of the gene bank was undertaken to characterize the clones. RESULTS: We screened a total of 1.3X10 6 clones from the cDNA library. On the first screening, 162 clones were identified by leucine orhotrophism. Another 54 clones were identified on the second screening by beta-galactosidase activation. Seven clones were selected by PCR and restriction patterns. Sequencing of seven molecules revealed that four of the clones were emerin fragments, with 2 of the remaining 3 clones being: an ID2 protein and a mitochondrial cytochrome c oxidase subunit II, with the last one remaining an unknown molecule. For the emerin fragments, their interactions with the GRK5 were confirmed by immunoprecipitation. CONCLUSION: We describe the novel protein-protein interactions of the GRK5, specifically, with three molecules. At first, these proteins may modulate the activation of the GRK5 through this specific protein-protein interaction desensitizing the beta-adrenergic receptors. Conversely, the localization of these molecules inside the cell indicates a potential new physiological role for the GRK5.
Animals ; beta-Galactosidase ; Clone Cells ; DNA, Complementary ; Electron Transport Complex IV ; Galactose ; Gene Library ; GTP-Binding Proteins ; Heart ; Immunoprecipitation ; Leucine ; Mass Screening ; Phosphotransferases* ; Polymerase Chain Reaction ; Rats ; Receptors, Adrenergic, beta ; Two-Hybrid System Techniques* ; Yeasts*

PURPOSE: This study was done to determine whether maturatin alters endothelium- dependent responses in pulmonary arteries. METHODS: Vascular rings of pulmonary arteries, with and without endothelium, taken from rabbits of 3 and 30 days of age were suspended in organ chambers filled with Krebs-Henseleit solution, bubbled with 95% O2-5% CO2 and maintained at 37degrees C. Immediately after mounting, the rings were stretched progressively until a maximal response to KCl was achieved. The rings were incubated with indomethacin and allowed to equilibrate before contraction and relaxation study. RESULTS: When the endothelium was intact in arterial rings from 3-day-old rabbits, acetylcholine (ACH) (10-6 M) relaxed preconstricted rings with histamine (5x10-6 M) (98.1 4.7% relaxation, mean SD). In rings without endothelium, KCl (10-2 to 9x10-2 M) and histamine (5x10-8 to 10-5 M) caused concentration-dependent contractions. When normalized to maximal contractions achieved to each agonist, the concentration-effect curves to KCl and histamine in rings without endothelium were similar to both ages. Rings with endothelium showed a progressive shift to the right of the concentration- effect curve to histamine. Relaxation to sodium nitroprusside were unaffected by age. In preconstricted ring, ACH (10-8 to 5x10-6 M) caused relaxations in rings with endothelium which were greater at 30-day compared to 3-day-old rabbits. CONCLUSION: These study demonstrates that endothelium-dependent relaxation increase with age, possibly due to changes in the release and/or effect of endothelium-derived relaxing factor (EDRF or nitric oxide) from pulmonary arteries during the neonatal period.
Acetylcholine ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Histamine ; Humans ; Indomethacin ; Infant, Newborn* ; Nitroprusside ; Pulmonary Artery* ; Rabbits ; Relaxation*

BACKGROUND AND OBJECTIVES: The protective effect of angiotensin converting enzyme (ACE) inhibitor against ischemia/reperfusion injury has been demonstrated in animal models, however the effect of AT1 receptor antagonist is contradictory. The present study was designed to investigate the myocardial protective effects of the AT1 receptor antagonist irbesartan during myocardial ischemia/reperfusion in vivo. MATERIALS AND METHODS: Sprague-Dawley rats were subjected to a 45-minute left coronary artery ligation followed by a 2-hour re-perfusion. An inert vehicle (group I:n=14) or irbesartan (50 mg/kg/day:group II, n=12) was administered for 3 days before coronary occlusion. The ratio of the myocardial infarct area to the ischemic area at risk was assessed through triphenyltetrazolium chloride staining. Apoptosis was evaluated by analyzing DNA fragmentation and TdT-mediated dUDP nick end labeling staining. Western blot analysis was performed for MAP Kinases (ERK1/2 and p38) and Bcl-2 and Bax. RESULTS: The ratio of the infarct area to the ischemic area at risk of group II was smaller than that of group I (42.6+/-2.7% vs. 64.1+/-4.6%;p<0.005). Agarose gel electrophoresis revealed discrete DNA laddering in the ischemic zone of group I, however DNA ladder formation was attenuated in group II. The expressions of ERK1 MAPK and Bcl-2 were increased in the ischemic area of group II compared to that of group I. CONCLUSION: AT1 receptor antagonist was effective in reducing myocardial reperfusion injury in vivo. This effect can at least be partially attributed to the attenuation of cardiomyocyte apoptosis, and this anti-apoptotic effect appears to be related to the increased expression of Bcl-2 and alterations in MAP kinase signaling.
Angiotensin II* ; Angiotensins* ; Animals ; Apoptosis ; Blotting, Western ; Coronary Occlusion ; Coronary Vessels ; DNA ; DNA Fragmentation ; Electrophoresis, Agar Gel ; Ligation ; MAP Kinase Signaling System ; Models, Animal ; Myocardial Infarction ; Myocardial Ischemia* ; Myocardial Reperfusion Injury ; Myocytes, Cardiac ; Peptidyl-Dipeptidase A ; Phosphotransferases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Angiotensin ; Reperfusion Injury* ; Reperfusion*

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.
Hemorrhage ; Humans ; Incidence ; Kidney Failure, Chronic* ; Kidney Transplantation ; Mass Screening ; Medical Records ; Mortality ; Nasal Obstruction ; Nasal Polyps ; Otolaryngology ; Prevalence ; Retrospective Studies ; Sinusitis* ; Transplantation

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.
Hemorrhage ; Humans ; Incidence ; Kidney Failure, Chronic* ; Kidney Transplantation ; Mass Screening ; Medical Records ; Mortality ; Nasal Obstruction ; Nasal Polyps ; Otolaryngology ; Prevalence ; Retrospective Studies ; Sinusitis* ; Transplantation

BACKGROUND: Beta-adrenergic receptor Kinase 1(betaARK1) is a serine/threonine kinase attached, which inhibits the coupling of beta-adrenergic receptor with G-protein. Myocardial betaARK1 level is usually elevated in heart failure and hypertrophy, but it is not known whether the circulating betaARK1 level is related with the degree of cardiac hypertrophy. This study was performed to evaluate the association of the betaARK1 level in circulating mononuclear leukocytes(MNL) in untreated hypertension with left ventricular mass in hypertensive patients. Method: Nineteen non-treated hypertensive patients were included for this study. High blood pressure was confirmed when systolic BP is over 150 mmHg or diastoli BP is over 95 mmHg. Echocardiography was performed to evaluate the degree of hypertrophy by measuring the left ventricular mass index(LVMI) and relative wall thickness(RWT), and test the LV function by measuring the ejection fraction(EF) according to ASE guideline. At the same time, blood was collected from each patient and MNL were isolated by gradient centrifuge with Ficoll-400. Total RNA was purified from MNL and semi-quantitative RT-PCR was performed. After reverse transcription, PCR was done with primers for human betaARK1 and GAPDH as external control. betaARK1 levels were expressed by ratio to GAPDH level and estimated the relations with clinical and Echocardiographic parameters. Result: We studied confirmed 19 hypertensive patients(10 men and 9 women, mean age of 50.6 years). Echocardiographically measured indices(mean+/-SD) were as follows; LVMI(137.3+/-30.6g/m2), PWT(0.53+/-0.09) and EF(54.6+/-8.5%). Ratio of betaARK1 levels to GAPDH was from 0.10 to 0.96 (0.62+/-0.25). betaARK1 levels were correlated with LVMI(correlation coefficient: r=.502, p=.029) and RWT(r=.627, p=.004). But Systolic BP(r=0.009, p=.93), diastolic BP(r=.07, p=.85) or EF(r=.045, p=.84) were not related to level of betaARK1. CONCLUSIONS: The betaARK1 level of circulating MNL was correlated well with the degree of the cardiac hypertrophy estimated by LVMI and RWT. This data suggests that activation of sympatho-adrenal system would exert a major role in developing cardiac hypertrophy and we can expect the decreased responsiveness to catecholamine in the heart of hypertensive patients. betaARK1 in circulating MNL might be used as a predictor or marker for LV hypertrophy in hypertensive patients.
beta-Adrenergic Receptor Kinases ; Cardiomegaly ; Echocardiography ; Female ; GTP-Binding Proteins ; Heart ; Heart Failure ; Humans ; Hypertension ; Hypertrophy ; Leukocytes, Mononuclear* ; Male ; Phosphotransferases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA

BACKGROUND: To assess the myocardial perfusion state after myocardial infarction, Tl-201 SPECT (Thallium-201 Single Photon Emission Computed Tomography) with a repeated "booster" injection before the acquisition of delayed redistribution image is more sensitive and more effective than conventional 4 hour redistribution image. However, this protocol has several disadvantages such as patient inconvenience, additional Tl-201 dose and compromised quantitative analysis. In this study, we compared 4 hour nitrate-augmented redistribution protocol with standard 24 hour delayed redistribution protocol with reinjection to evaluate the usefulness of sublingual nitrate to augment myocardial perfusion and the effectiveness of myocardial assessment for each protocol. METHODS: In 20 myocardial infarction patients, stress-redistribution Tl-201 SPECT was performed. Immediately after resting redistribution image was taken, each patient was administered 0.6 mg of nitroglycerin sublingually without additional Tl-201 and nitrate-augmented SPECT was taken after 30 minutes. Each patient then returned the next day and was injected with a booster dose of Tl-201 30 minutes before the delayed redistribution SPECT acquisition. For the analysis of SPECT study, the myocardium was divided into 22 segments, and the perfusion to each segment was scored on a four-point scale by consensus. An overall cardiac perfusion score was derived by summing the perfusion score for each segment. RESULTS: Reduced stress perfusion was identified in 258 segment among total 440 segments: 61 (23.6%) had improved perfusion after rest redistribution; 145 (56.2%) had improved perfusion after nitrate-augmented redistribution; 140 (54.2%) had improved perfusion after 24 hour delayed redistribution after Tl-201 reinjection. The cardiac perfusion score after stress was 38.2+/-13.1. The score increased to 41.5+/-13.1 after rest redistribution. The perfusion score were improved to 46.3+/-10.4 (p< or =0.05 vs. rest redistribution) after nitrate augmentation. The cardiac perfusion score, 46.2+/-10.8, did not improve further after delayed redistribution. CONCLUSION: Tl-201 SPECT with sublingual nitrate-augmented redistribution is as same or better than 24-hour delayed redistribution with reinjection to detect viable myocardium. Therefore, Tl-201 SPECT with sublingual nitrate-augmented redistribution has economic and time sparing advantage over traditional 24 hour delayed redistribution with reinjection.
Consensus ; Humans ; Myocardial Infarction ; Myocardium* ; Nitroglycerin ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*