Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001).Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Purpose: The survival of organisms critically depends on avoidance responses to lifethreatening stimuli. Information about dangerous situations needs to be remembered to produce defensive behavior. To investigate underlying brain regions to process information of danger, manganese-enhanced MRI (MEMRI) was used in olfactory fear-conditioned rats. Materials and Methods: Fear conditioning was conducted in male Sprague-Dawley rats. The animals received nasal injections of manganese chloride solution to monitor brain activation for olfactory information processing. Twenty-four hours after manganese injection, rats were exposed to electric foot shocks with odor cue for one hour. Control rats were exposed to the same odor cue without foot shocks. Fortyeight hours after the conditioning, rats were anesthetized and their brains were scanned with 9.4T MRI. Acquired images were processed and statistical analyses were performed using AFNI. Results: Manganese injection enhanced brain areas involved in olfactory information pathways in T1 weighted images. Rats that received foot shocks showed higher brain activation in the central nucleus of the amygdala, septum, primary motor cortex, and preoptic area. In contrast, control rats displayed greater signals in the orbital cortex and nucleus accumbens. Conclusion Nasal delivery of manganese solution enhanced olfactory signal pathways in rats. Odor cue paired with foot shocks activated amygdala, the central brain region in fear, and related brain circuits. Use of MEMRI in fear conditioning provides a reliable monitoring technique of brain activation for fear learning.

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.
Menisci, Tibial ; Surgeons ; Suture Anchors* ; Sutures* ; Tears

PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. RESULTS: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. CONCLUSION: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
Femoral Neck Fractures ; Femur ; Fracture Fixation, Intramedullary ; Hip Fractures ; Humans ; Kidney ; Necrosis ; Odds Ratio ; Operative Time ; Partial Thromboplastin Time ; Rehabilitation ; Renal Dialysis*

BACKGROUND AND OBJECTIVES: We compared the efficacy and safety of valsartan and rosuvastatin combination therapy with each treatment alone in hypercholesterolemic hypertensive patients. SUBJECTS AND METHODS: Patients who met inclusion criteria were randomized to receive 1 of the following 2-month drug regimens: valsartan 160 mg plus rosuvastatin 20 mg, valsartan 160 mg plus placebo, or rosuvastatin 20 mg plus placebo. The primary efficacy variables were change in sitting diastolic blood pressure (sitDBP) and sitting systolic blood pressure (sitSBP), and percentage change in low-density lipoprotein-cholesterol (LDL-C) in the combination, valsartan, and rosuvastatin groups. Adverse events (AEs) during the study were analyzed. RESULTS: A total of 354 patients were screened and 123 of them were finally randomized. Changes of sitDBP by least squares mean (LSM) were -11.1, -7.2, and -3.6 mm Hg, respectively, and was greater in the combination, as compared to both valsartan (p=0.02) and rosuvastatin (p<0.001). Changes of sitSBP by LSM were -13.2, -10.8, and -4.9 mm Hg, and was greater in the combination, as compared to rosuvastatin (p=0.006) and not valsartan (p=0.42). Percentage changes of LDL-C by LSM were -52, -4, and -47% in each group, and was greater in the combination, as compared to valsartan (p<0.001), similar to rosuvastatin (p=0.16). Most AEs were mild and resolved by the end of the study. CONCLUSION: Combination treatment with valsartan and rosuvastatin exhibited an additive blood pressure-lowering effect with acceptable tolerability, as compared to valsartan monotherapy. Its lipid lowering effect was similar to rosuvatatin monotherapy.
Blood Pressure ; Drug Therapy, Combination ; Humans ; Least-Squares Analysis ; Rosuvastatin Calcium ; Valsartan

In this article, on page 230, Fig. 2A needs to be corrected.

BACKGROUND: Several studies have shown that the presence of cerebrovascular lesions may play an important role for determining the severity of the clinical symptoms of dementia. But no study to date has explored the clinical effect of cerebrovascular disease in Parkinson's disease with dementia (PDD), although cerebrovascular disease is common causes of dementia in elderly population. Therefore we conducted this study to evaluate the relationship between silent cerebrovascular lesions and cognitive decline in PDD. METHODS: Only 27 patients with PDD were chosen; 17 patients had PDD with silent cerebral ischemic lesions (PDDI) and 10 patients had PDD without silent cerebral ischemic lesions (pure PDD). These subjects received the global cognitive function testing and were all evaluated with detailed neuropsychological tests including attention, memory, language, and also the visuospatial and frontal function. RESULTS: There were no significant differences between pure PDD and PDDI group on general cognitive functions tests. Regard to mean time duration of suffering from Parkinson motor symptoms and motor function scale, pure PDD group showed more long duration than PDDI group but there was no significant difference between two groups. Furthermore, there were not any significant differences between the two groups on detailed neuropsychological tests. CONCLUSIONS: We concluded that silent cerebrovascular lesions do not contribute to neuropsychological severity of PDD, although vascular disease is a common cause of cognitive impairment in the elderly. Thus the results of the present study suggest that factors other than cerebrovascular disease contribute to severity of PDD.
Aged ; Cognition ; Dementia ; Humans ; Memory ; Neuropsychological Tests ; Parkinson Disease ; Stress, Psychological ; Vascular Diseases

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.
Acute Coronary Syndrome ; Angioplasty ; Coronary Artery Disease ; Hemophilia A ; Humans ; Life Expectancy ; Percutaneous Coronary Intervention ; Prevalence

OBJECTIVES: Lead exposure is known to be associated with high blood pressure, hypertension, coronary artery disease, peripheral arterial disease, left ventricular hypertropy, and electrocardiographic abnormalities. We investigated the association between blood lead and coronary artery calcification and stenosis. METHODS: Between April 2006 and July 2007, 502 adults (345 males and 157 females), who had no history of cardiovascular disease or occupational exposure to lead, were recruited as study subjects. All subjects underwent coronary CT angiography and blood lead measurement. RESULTS: Blood lead levels were distributed from 0.43 to 11.30 (microgram/dL with a geometric mean blood lead level of 2.98+/-1.5 (microgram/dL. The geometric mean blood lead levels were higher in men than women (3.31+/-1.5 (microgram/dL vs. 2.36+/-1.5 (microgram/dL, P < 0.01). Based on a multivariate analysis, a 1 unit ((microgram/dL) increase in blood lead level was associated with a 1.09 (95% confidence interval, 0.92~1.29) and a 1.01 fold (95% confidence interval, 0.63~1.63) greater risk for coronary artery calcification in men and women, respectively. Similarly, a 1 unit (microgram/dL) increase in blood lead level was associated with a 1.25 (95% confidence interval, 1.03~1.51) and a 1.42 fold (95% confidence interval, 0.73~2.75) greater risk for coronary artery stenosis in men and women, respectively. CONCLUSIONS: The results suggest that increased blood lead levels are associated with an increased risk of coronary artery stenosis.
Adult ; Angiography ; Cardiovascular Diseases ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Electrocardiography ; Female ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Occupational Exposure ; Peripheral Arterial Disease

OBJECTIVES: The purpose of this study was to estimate the normal blood lead (PbB) levels in a group of Korean subjects and to evaluate the association between PbB levels and habitual tobacco and alcohol use. METHODS: We recruited 532 adults (320 males and 212 females) with no history of occupational exposure to lead, as study subjects. RESULTS: PbB levels ranged between 0.43 microgram/dl and 9.45 microgram/dl. The adjusted geometric mean PbB in men was 3.19 microgram/dl, which was significantly higher than that seen in women: 2.66 microgram/dl (P=0.017). Geometric mean PbBs were not significantly different between urban and rural patients. The adjusted geometric mean PbB in smokers was 3.31 microgram/dl, which was significantly higher than that seen in nonsmokers: 2.64 microgram/dl (P=0.035). The adjusted geometric mean PbB in drinkers was 3.10 microgram/dl, which was significantly higher than that seen in non-drinkers: 2.75 microgram/dl (P=0.049). CONCLUSIONS: The PbB levels of some Korean adults seem to be comparable to those seen in foreign countries. Our results suggest that tobacco and alcohol cessation will be helpful in decreasing the harmful effect of lead.
Adult ; Drinking ; Humans ; Male ; Occupational Exposure ; Smoking ; Tobacco