Background and Objectives: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Methods: In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISEDAPT) score ≥25. The primary outcome was a 3–12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). Results: Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76– 4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92–4.98; p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Conclusions In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.Trial Registration: ClinicalTrials.gov Identifier: NCT02494895

BACKGROUND: Epithelial mesenchymal transition (EMT) has an important role in invasion and metastasis of tumor cells. The purpose of this study was to evaluate the roles of EMT-associated proteins on progression and metastasis as a prognostic/predictive factor in curatively-resected (R0) head and neck squamous cell carcinoma (HNSCC). METHODS: A total of 118 patients who received curative surgery for HNSCC at Inha University Hospital between January 1996 and December 2011 were included. We used protein immunohistochemistry to evaluate the expression of E-cadherin, vimentin, and EZH2 on tissue microarrays. Also, we reviewed all medical records and analyzed the relationship between the expression of EMT-associated proteins and prognosis. RESULTS: The E-cadherin-negative group showed more moderate/poor differentiation of cancer cell type than the higher E-cadherin-expressing group (p=.016) and high EZH2 expression was significantly correlated with nodal metastasis (p=.012). Our results demonstrate a significant association between high expression of EZH2 and vimentin and presence of distant progression (p=.026). However, expression of E-cadherin, vimentin, and EZH2 was not significantly associated with overall survival. CONCLUSIONS: These findings suggest that an EMT-associated protein expression profile is correlated with aggressiveness of disease and prognosis, and could be a useful marker for determination of additional treatment in curatively-resected HNSCC patients.
Cadherins ; Carcinoma, Squamous Cell* ; Epithelial-Mesenchymal Transition* ; Head* ; Humans ; Immunohistochemistry ; Medical Records ; Neck* ; Neoplasm Metastasis ; Prognosis ; Vimentin

PURPOSE: Systematic educational programs and genetic counseling certification courses for hereditary breast/ovarian cancer (HBOC) have not yet been introduced in Korea. We provided and evaluated the effects of genetic counseling education on Korean healthcare providers' knowledge, awareness, and counseling skills for patients at high risk of HBOC. METHODS: A 3-day educational program was conducted for healthcare providers who were interested in genetic counseling for patients at high risk of HBOC. Participants who completed a knowledge test and satisfaction questionnaire were included in the present sample. Pre-post comparisons were conducted to determine the effects of the intervention. RESULTS: Significant differences between preprogram and postprogram knowledge scores were observed (p=0.002). Awareness (p<0.001) and confidence (p<0.001) regarding genetic counseling significantly increased after the training. Doctors and participants with fewer years of work experience performed well on the knowledge test. Previous educational experience was correlated with increased confidence in knowledge and counseling skills. CONCLUSION: Genetic counseling education regarding HBOC improved knowledge and awareness of HBOC and enhanced confidence in the counseling process. The effects varied according to occupation and participants' previous education. The implementation of systematic educational programs that consider participant characteristics may improve the effects of such interventions.
Breast ; Breast Neoplasms ; Certification ; Counseling ; Delivery of Health Care ; Genetic Counseling ; Health Personnel ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Occupations ; Surveys and Questionnaires

BACKGOUND: Cobalt chloride (COCL) has hypoxia-mimetic effects by inhibiting degradation of HIF-1alpha, which is a master regulator of genes activated by low oxygen tension. Heme oxygenase-1 (HO-1), an inducible heat shock protein, is known to have cytoprotective effects against ischemic injury. This study evaluated the efficacy of COCL in a bilateral renal ischemia-reperfusion (I-R) injury model of male Sprague-Dawley rats. METHODS: I-R renal injury was induced by 45 min clamping of both renal arteries. Rats in the sham (n=6) and I-R control groups (n=8) had been drinking tap water, whereas rats in the COCL treated sham (n=6) and COCL treated I-R groups (n=9) had been drinking water containing 2 mM COCL from day -10 to day 1. RESULTS: The serum level of creatinine 24 hrs after surgery was 2.6+/-1.1 (mean+/-SD) mg/dL in I-R COCL treated group, significantly lower than that in I-R control group (4.8+/-1.6 mg/dL, p<0.05). The renal HO-1 gene expression and protein signal were significantly upregulated in the COCL treated sham group compared to sham operated control rats (all, p<0.05). The expressions of TGF-beta MCP-1, TNF-alpha endothelin-1 and Fas genes in COCL treated I-R rats were significantly lower than those of I-R control rats (all, p<0.05). The level of Bcl-2 gene expression of COCL treated I-R rats was significantly higher than the level of I-R control rats (p<0.05). CONCLUSION: It is speculated that the pretreatment of COCL in I-R rat model attenuates ischemic renal injury and at least in part, upregulation of renal HO-1 is involved in this mechanism.
Animals ; Cobalt* ; Constriction ; Creatinine ; Drinking ; Drinking Water ; Endothelin-1 ; Gene Expression ; Genes, bcl-2 ; Heat-Shock Proteins ; Heme Oxygenase-1 ; Humans ; Kidney ; Male ; Models, Animal ; Oxygen ; Rats ; Rats, Sprague-Dawley ; Renal Artery ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Up-Regulation ; Water

Light chain deposition disease (LCDD) is a systemic disorder characterized by the deposition of monoclonal immunoglobulin light chains (LCs) in various organs. As LCs are overproduced by an abnormal clone of B cells, LCDD is usually described in the course of plasma cell dyscrasias or other lymphoproliferative disorders. However, it can occur in the absence of any detectable hematological disorder even during prolonged follow-up. We experienced a case of 62-year-woman who presented generalized edema, massive proteinuria and renal insufficiency. The histologic findings showed nodular glomerular mesangial expansion and prominent ribbon like immunohistochemical staining for kappa-light chain in the glomerular capillary wall. There was no evidence of multiple myeloma in bone marrow biopsy specimen. Because she refused the intensive chemothrapy, low dose of prednisolone and cyclophosphamide were prescribed for 6 months. Her renal function was maintained relatively well without renal replacement therapy for 7 months. We report a case of idiopathic LCDD not associated with multiple myeloma or other plasma cell dysclasia.
B-Lymphocytes ; Biopsy ; Bone Marrow ; Capillaries ; Clone Cells ; Cyclophosphamide ; Edema ; Follow-Up Studies ; Immunoglobulin Light Chains ; Lymphoproliferative Disorders ; Multiple Myeloma ; Nephrotic Syndrome ; Paraproteinemias ; Plasma Cells ; Prednisolone ; Proteinuria ; Renal Insufficiency ; Renal Replacement Therapy

A 44-year-old woman diagnosed with idiopathic chronic kidney disease was subjected to living related renal transplantation from her brother. Immunosuppressant consisted of cyclosporine, mycophenolate mofetil, and prednisolone. On the day 2 after transplantation, her serum level of BUN and creatinine (Cr) were normalized to 13.4 mg/dL and 1.06 mg/dL respectively. Urine output was also well maintained. On day 9, her body temperature was 39degrees C, serum level of BUN and Cr were increased to 20.8 mg/dL and 1.54 mg/dL respectively and urine output was decreased with weight gain. Her serum cyclosporine trough level was 118 ng/dL. DTPA renal scan and Doppler sonography suggested acute rejection. So, antirejection treatment was started with methylprednisolone pulse therapy under the cover of empirical broad spectrum antibiotics. On day 11, graft biopsy was done and the biopsy was compatible with acute interstitial nephritis. The relationship between the time of renal dysfunction and drug medication was analyzed; trimethoprim-sulfamethoxazole (TMP-SMZ) and omeparzole were suspected as causative drugs. So, TMP-SMZ and omeprazole were discontinued. Her serum Cr was slowly increased to 2.32 mg/dL until day 15. And afterward, her serum Cr decreased and normalized We suggest that acute interstitial nephritis should be considered among the many causes of early renal allograft dysfunction when using TMP- SMZ and omeprazole.
Adult ; Allografts ; Anti-Bacterial Agents ; Biopsy ; Body Temperature ; Creatinine ; Cyclosporine ; Female ; Humans ; Kidney Transplantation* ; Methylprednisolone ; Nephritis, Interstitial* ; Omeprazole* ; Pentetic Acid ; Prednisolone ; Renal Insufficiency, Chronic ; Siblings ; Transplants ; Trimethoprim, Sulfamethoxazole Drug Combination* ; Weight Gain

A renal lesion of neoplasm-related nephrotic syndrome usually presents as membranous nephropathy. Neoplasm-related nephrotic syndrome exhibiting focal segmental glomerulosclerosis (FSGS) has been reported mainly in patients with hematological malignancies. But reports of an association between FSGS and neoplasm are extremely rare. We report a 66-year-old woman with FSGS who presented with nephrotic syndrome and was subsequently found to have carcinoid tumors in the duodenum, confirmed by tissue biopsy. After resection of carcinoid tumor, the patient received initial treatment with oral prednisolone for 2 months but her nephrotic syndrome persisted. The patient was then treated with oral cyclophosphamide. One month later, she was in complete remission of nephrotic syndrome as indicated by a normal serum albumin and no proteinuria. This case may be a coincidence or the lesions may be linked with each other but since little is known about the pathogenesis of FSGS and neoplasm, it is difficult to speculate on a pathogenetic link between these two lesions. We report a case of FSGS with nephrotic syndrome in a patient with carcinoid tumor.
Aged ; Biopsy ; Carcinoid Tumor* ; Cyclophosphamide ; Duodenum ; Female ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental* ; Hematologic Neoplasms ; Humans ; Nephrotic Syndrome ; Prednisolone ; Proteinuria ; Serum Albumin

A renin- or angiotensin-II responsive aldosterone producing tumor is a rare cause of primary hyperaldosteronism. This tumor can be identified by tests that show that the aldosterone producing adrenal tumor is not fully autonomous. In other words partially it is responsible for the stimulation of aldosterone secretion that results aldosterone levels in an increase in serum in response to the upright posture and spironolactone treatment. Furthermore, the urinary 18-hydroxycortisol level is within the normal range. Because of different responses to surgical removal, the differential diagnosis of the causes of primary aldosteronism can't be overemphasized even for rare causes of primary aldosteronism such as unilateral nodular hyperplasia or a renin-responsible aldosterone producing tumor. We should consider renin or angiotensin-II responsive adrenal adenoma in the differential diagnosis of primary aldosteronism when biochemical data shows atypical results. Here we present the first case in Korea of a renin-responsive aldosterone producing adrenal adenoma which was fully accessible and was successfully treated by surgical removal. Also, sampling for aldosterone secretion just above the insertion site in the left renal vein before surgery showed a suspiciously abberant left adrenal vein drainage into the IVC, This was very helpful information during adrenal vein ligation in laparoscopic adrenalectomy.
Adenoma ; Adrenalectomy* ; Aldosterone ; Cushing Syndrome* ; Diagnosis, Differential ; Drainage ; Female ; Humans ; Hyperaldosteronism ; Hyperplasia ; Korea ; Ligation ; Posture ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women* ; Reference Values ; Renal Veins ; Renin ; Spironolactone ; Veins

BACKGROUND: Phenol is the most commonly used neurolytic agent for the management of intractable somatic pain, but side effects such as motor dysfunction and potential loss of bladder or rectal sphincter function develop following their application. This study observed functional changes of hind limb and neuropathologic changes in the sciatic nerve after phenol application, highlighting the time of nerve regeneration. METHODS: Functional changes in hind limbs were observed for 6 weeks and the distal part of the phenol-injected or dripped sciatic nerve was severed in 3 rats of each group respectively at 10 minutes, 1 hour, 24 hours, 3 days, 1 week, 2 weeks, 4 weeks and 6 weeks. The pathologic changes in the severed nerves were observed under the electron microscope. RESULTS: The phenol-injected or-dripped hind limbs showed more pronounced motor weakness and more obvious gait changes. About 2 weeks after the phenol application, gradual improvement of gait changes began, and after 6 weeks, motor weakness and gait changes were no longer perceptible. In the group with phenol injection, at 10 minutes after injection, destructive lesions were confined to unmyelinated fibers and the myelin sheath of small myelinated fibers. On the 3rd day and at 1 week, pathologic changes on axonal fibers and Schwann cells were in progress with phagocytosis in spite of myelin restitution. From 2 to 4 weeks, axonal regeneration and remyelination appeared concurrent with myelin disintegration and axonolysis, and histologic findings at 6 weeks were similar to those of the control group. In the group with phenol drip, the histologic changes in the sciatic nerve were very similar to the injection group. CONCLUSIONS: These results suggest that histopathologic lesions after a phenol application on the peripheral nerves are not influenced by application methods. The progress of histopathologic changes is obvious according to the time interval following the phenol application. Accordingly, side effectsthat developed following the use of phenol may be improved around the time when the nerve regeneration occurs, between the second and fourth weeks after the injection. The course of histopathologic changes and clinical findings following the application of phenol is very similar to the previous experiment using alcohol.
Animals ; Axons ; Extremities ; Gait ; Myelin Sheath ; Nerve Regeneration ; Nociceptive Pain ; Peripheral Nerves ; Phagocytosis ; Phenol* ; Rats ; Regeneration ; Schwann Cells ; Sciatic Nerve* ; Urinary Bladder

Since the nose is the most prominent part in the face, the plastic surgeons are interested in the continued effort for rhinoplasty. Nasal tip projection is essential to optimal nasal for the patient's face. But, the nasal tips of Orientals are characterized by bulbous appearance due to thick and tense skin, flaring of nostril. and restriction of nasal tip projection due to underdevelopment of medial crus of alar cartilage and short columella. Most orientals want to correct their nasal tip as well as shape of nose. We present clinical cases of various nasal tip deformities which were corrected with various operative methods through either alar rim incision of open rhinoplasty incision depending upon the severity of tip deformity in order to achieve more natural tips and good nasal tip projection. And the clinical cases were categorized into causes of nasal tip deformity and methods of nasal tip augmentation. We are reporting these reporting these cases with review of literatures.
Cartilage ; Congenital Abnormalities ; Nose ; Rhinoplasty ; Skin ; Transcutaneous Electric Nerve Stimulation