Limited data exist regarding the real-world practices and clinical outcomes in patients with ischemic heart failure with reduced left ventricular ejection fractions (LVEFs).Using nationwide registry data from South Korea, we aimed to investigate long-term outcomes and clinical practices, especially implantable cardioverter defibrillators (ICDs) implantation, in patients with reduced LVEFs at least 40 days after acute myocardial infarction (AMI). Of 13,056 patients with AMI between 2011 and 2015, we analyzed 350 (median age, 66 years [interquartile range, 56-75]) who had LVEFs <40% on follow-up transthoracic echocardiogram 40 days after the index event. The primary outcome was cardiac-cause mortality at 3 years. Secondary outcomes comprised major cardiovascular events as well as outcomes defined by the use of ICDs, cardiac resynchronization therapy defibrillators (CRT-Ds), and electrophysiology studies. Among 350 patients, 39 (11.1%) died from cardiac causes during 3 years of follow-up. Eleven (3.1%) were hospitalized for ventricular tachycardia. The rate of ICD or CRT-D implantation up to 3 years was 5.7% (20/350). Cox time-to-event analysis revealed older age, LVEF <30%, diabetes mellitus, and previous MI or revascularization as positively associated with cardiac death, whereas the use of statins and body weight <67 kg were negatively associated. This nationwide Korean registry demonstrated that only 5.7% of patients who had reduced LVEFs after 40 days of AMI underwent ICD implantations over 3 years. Considering the high mortality, concerted efforts are needed to improve clinical outcomes for patients who may have been candidates for ICD implantation.

Background: In patients with coronary artery disease treated with permanent polymercoated drug-eluting stents (DES), the persistent presence of a less biocompatible polymer might delay arterial healing. Thin strut polymer-free DES have the potential to improve clinical outcomes and reduce the duration of dual antiplatelet therapy (DAPT). The purpose of this first-in-human study was to assess the safety and effectiveness of a novel polymer-free DES in patients with de novo coronary lesions. The TIGERevolutioN® stent (CG Bio Co., Ltd., Seoul, Korea) consists of a cobalt chromium platform with a strut thickness of 70 μm and a surface treated with titanium dioxide onto which everolimus-eluting stent (EES) is applied abluminally (6 µg/mm of stent length) without utilization of a polymer. Methods: A total of 20 patients were enrolled, with de novo coronary lesions (stable or unstable angina) and > 50% diameter stenosis in a vessel 2.25 to 4.00 mm in diameter and ≤ 40 mm in length for angiographic, optical coherence tomography (OCT), and clinical assessment at 8 months. All patients received DAPT after stent implantation. The primary endpoint was angiographic in-stent late lumen loss (LLL) at 8 months. Results: Twenty patients with 20 lesions were treated with TIGERevolutioN® . At 8 months, in-stent LLL was 0.7 ± 0.4 mm. On OCT, percent area stenosis was 29.2 ± 9.4% and stent strut coverage was complete in all lesions. No adverse cardiovascular event occurred at 8 months. Conclusion The new polymer-free EES was safe and effective with low LLL and excellent strut coverage at 8 months of follow-up.

BACKGROUND: Biodegradable poly (l-lactic acid) (PLLA), a bio safe polymer with a large elastic modulus, is widely used in biodegradable medical devices. However, because of its poor mechanical properties, a PLLA strut must be made twice as thick as a metal strut for adequate blood vessel support. Therefore, the mechanical properties of a drug-eluting metal-based stents (MBS) and a bioresorbable vascular scaffolds (BVS) were evaluated and their safety and efficacy were examined via a long-term rabbit iliac artery model. METHODS: The surface morphologies of the MBSs and BVSs were investigated via optical and scanning electron microscopy. An everolimus-eluting (EE) BVS or an EE-MBS was implanted into rabbit iliac arteries at a 1.1:1 stent-toartery ratio. Twelve months afterward, stented iliac arteries from each group were analyzed via X-ray angiography, optical coherence tomography (OCT), and histopathologic evaluation. RESULTS: Surface morphology analysis of the EE coating on the MBS confirmed that it was uniform and very thin (4.7 lm). Comparison of the mechanical properties of the EE-MBS and EE-BVS showed that the latter outperformed the former in all aspects (radial force (2.75 vs. 0.162 N/mm), foreshortening (0.24% vs. 1.9%), flexibility (0.52 vs. 0.19 N), and recoil (3.2% vs. 6.3%). At all time points, the percent area restenosis was increased in the EE-BVS group compared to the EE-MBS group. The OCT and histopathological analyses indicate no significant changes in strut thickness. CONCLUSION BVSs with thinner struts and shorter resorption times should be developed. A comparable long-term safety/efficacy evaluation after complete absorption of BVSs should be conducted.

BACKGROUND: Androgenetic alopecia (AGA) is characterized by the structural miniaturization of androgen-sensitive hair follicles in susceptible individuals and is anatomically defined within a given pattern of the scalp. Oral finasteride and topical minoxidil are the only drugs whose effect and safety were demonstrated and approved by the FDA. However, the treatment result of these medications are not always satisfactory. Here, we report the result of a clinical trial of the new topical agent, Scalp med(R) to patients with AGA. OBJECTIVE: The goal of this study was to test Scalp med(R), the solution including minoxidil, retinol, polysorbate 80 and phytosterol in the treatment of AGA. METHODS: Included in this study were males between the ages of 20 and 60 years, in good health, with mild to moderate AGA. Efficacy was evaluated by terminal hair count per 1 cm2 and hair thickness. RESULTS: The results of this clinical trial showed a highly positive response to treatment. After 24 weeks of treatment, a significant improvement in hair count and hair thickness was demonstrated in all the patients. CONCLUSION: This clinical study establishes the effectiveness and safety of Scalp med(R) in the treatment of AGA.
Alopecia ; Finasteride ; Hair ; Hair Follicle ; Humans ; Male ; Miniaturization ; Minoxidil ; Polysorbates ; Scalp ; Vitamin A

BACKGROUND: Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. METHODS: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. RESULTS: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. CONCLUSION: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices.
Aged ; Blood Glucose ; Chronic Disease ; Chungcheongnam-do ; Diabetes Complications ; Diabetes Mellitus ; Education ; Humans ; Mass Screening ; Patient Care Team ; Physicians, Family ; Primary Health Care* ; Self Care* ; Surveys and Questionnaires

Involvement of central nervous system is a well- known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.
Acidosis ; Ataxia ; Basal Ganglia* ; Brain ; Central Nervous System ; Dysarthria ; Follow-Up Studies ; Humans ; Hypoglycemia ; Hypokinesia ; Magnetic Resonance Imaging ; Middle Aged ; Myalgia ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis* ; Rhabdomyolysis ; Risk Factors ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the relationship between the electrophysiologic findings and the ultrasonographic findings of the ulnar neuropathy around the elbow. METHOD: We examed 20 elbows with the ulnar neuropathy around the elbow and 22 healthy elbows. We measured the cross-sectional area (CSA) and the diameters of the long, short axis of the ulnar nerve at the swollen portion and the compressed portion by ultrasonography. RESULTS: The CSA, diameters on the longitudinal and transverse view of the swollen portion of the ulnar nerve of the patients group was larger than that of the control group (p<0.05). The decrement of conduction velocity across the elbow was -0.54+/-5.74 m/s in the control group and 18.60+/-10.45 m/s in the patients group (p<0.05). There was no significant correlation between the decrement of the nerve conduction velocity across elbow and the decrement of CSA (r=0.346, p>0.05). There was significant correlation between the decrement of the nerve conduction velocity across elbow and the increment of the diameter on the swollen portion on the longitudinal and transverse view (r=0.541, 0.466, p<0.05, respectively). CONCLUSION: The difference of diameter between swollen and compressed portion of the ulnar nerve on the ultrasonography was correlated with the conduction velocity decrement on the electrophysiologic study.
Axis, Cervical Vertebra ; Elbow* ; Humans ; Neural Conduction ; Ulnar Nerve ; Ulnar Neuropathies* ; Ultrasonography

Endometriosis represents extrauterine nonneoplastic endometrial tissue. It is most commonly diagnosed in women of childbearing age, with a peak age of 40 to 44 years. The incidence of genitourinary involvement ranges from 1% to 2%. Ureteral endometriosis is a rare entity, and its diagnosis requires a high index of suspicion. We report a case of ureteral endometriosis in a 44-year-old multiparous woman with a brief review of literature.
Adult ; Diagnosis ; Endometriosis* ; Female ; Humans ; Hydronephrosis ; Incidence ; Ureter*

The occurrence of bladder tumors in the first 2 decades of life are rare neoplasias. Transitional cell tumors of the bladder are extremely a rare clinical disease entity. Here, a case of a papillary urothelial tumor in a 5-year-old girl is reported, with a brief review of the literature. Histologically, the tumor was a solitary and papillary urothelial tumor of low malignant potential (by WHO and the ISUP).
Child ; Child, Preschool* ; Female* ; Humans ; Urinary Bladder Neoplasms ; Urinary Bladder*

We reported a girl diagnosed Schinzel-Giedion syndrome with severe psychomotor retardation and malformation that was characterized by mid face retraction, scoliosis, skull anomaly, wide cranial fontanels, brain cortical atropy, atrial septal defect, and hydronephrosis. Urinary tract infection, respiratory tract infection, and seizure were common. The neurodevelopment therapy was not effective and developmental stage was not improved. Spasticity was the only findings which was improved.
Brain ; Cranial Fontanelles ; Female ; Heart Septal Defects, Atrial ; Humans ; Hydronephrosis ; Muscle Spasticity ; Respiratory Tract Infections ; Scoliosis ; Seizures ; Skull ; Urinary Tract Infections