Purpose: This study aimed to identify clinical and radiologic characteristics that could predict response to atezolizumab-bevacizumab combination therapy in patients with advanced hepatocellular carcinoma (HCC). Materials and Methods: This single-center retrospective study included 108 advanced HCC patients with intrahepatic lesions who were treated with atezolizumab-bevacizumab. Two radiologists independently analyzed imaging characteristics of the index tumor on pretreatment computed tomography. Predictive factors associated with progressive disease (PD) at the best response based on Response Evaluation Criteria in Solid Tumors, ver. 1.1 were evaluated using logistic regression analysis. Progression-free survival (PFS) was estimated by the Kaplan-Meier method and compared with the log-rank test. Results: Of 108 patients with a median PFS of 15 weeks, 40 (37.0%) had PD during treatment. Factors associated with PD included the presence of extrahepatic metastases (adjusted odds ratio [aOR], 4.13; 95% confidence interval [CI], 1.19 to 14.35; p=0.03), the infiltrative appearance of the tumor (aOR, 3.07; 95% CI, 1.05 to 8.93; p=0.04), and the absence of arterial-phase hyperenhancement (APHE) (aOR, 6.34; 95% CI, 2.18 to 18.47; p < 0.001). Patients with two or more of these factors had a PD of 66.7% and a median PFS of 8 weeks, indicating a significantly worse outcome compared to the patients with one or no of these factors. Conclusion In patients with advanced HCC treated with atezolizumab-bevacizumab treatment, the absence of APHE, infiltrative appearance of the intrahepatic tumor, and presence of extrahepatic metastases were associated with poor response and survival. Evaluation of early response may be necessary in patients with these factors.

BACKGROUND/AIMS: The aim of this study was to examine the distribution of range of liver enzymes according to age and BMI in each gender using large-scale data. METHODS: Data were gathered from 65,715 subjects who underwent a routine health check-up and did not have HBsAg and anti-HCV. Boxplot analysis was used to examine the distribution of range of liver enzymes according to age and BMI in each gender. Multivariate linear regression analysis was performed for assessment of the association of liver enzymes with age and BMI, and to determine whether the range of liver enzymes was affected by risk factors for metabolic syndrome in each gender. RESULTS: ALT, AST, and GGT levels showed significant association with BMI in both male and female after adjusting for age. The range of ALT, AST, and GGT levels varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects. All risk factors for metabolic syndrome were shown to affect liver enzyme levels in male subjects. However, although most risk factors for metabolic syndrome affected liver enzyme levels, there might be weak or no effect of fasting hyperglycemia on AST, and low serum HDL-cholesterol level on GGT in female subjects. CONCLUSIONS: Age, BMI, and other risk factors for metabolic syndrome had a significant effect on the distribution of range of liver enzymes in each gender, even in this study conducted from Korean health checkup subjects.
Alanine Transaminase ; Aspartate Aminotransferases ; Body Mass Index* ; Fasting ; Female ; Hepatitis B Surface Antigens ; Humans ; Hyperglycemia ; Linear Models ; Liver* ; Male ; Metabolic Syndrome X ; Risk Factors

OBJECTIVES: This study was conducted to investigate the utilization and its determinants of rehabilitation services of people with disabilities in a rural area. METHODS: From March 2 to April 1, 2011, we interviewed 101 disabled people with either physical disabilities or brain lesions. The subjects completed questionnaires about the utilization of rehabilitation services, general characteristics (age, sex, marital status, education level, economic status, health insurance, housing, and employment) and disability characteristics (type, level, comorbidity, reason for the occurrence of the disability, self-rated degree of disability, and daily life care giver). Frequency, Pearson's chi-square test, and a multiple logistic regression were used for statistical analysis. RESULTS: This study showed that 70.3% of the people in this rural area with disabilities were using rehabilitation services. The two most common reasons for not using the services were "doubt about the effectiveness of the service" and "no facilities nearby." The facilities that the disabled people were currently using, in the order of most used to least, were general hospitals or clinics, rehabilitation centers, oriental medicine clinics, and public health centers. Only 19.7% of those who received rehabilitation responded that they were satisfied with the service. Significant factors in the utilization of rehabilitation services were sex, employment, self-rated economic status, and the reason for the occurrence of the disability. Women, people who were currently working, people who were of middle or higher economic status, or people who had acquired a disability were significantly more likely to use the services. CONCLUSIONS: A large number of people with disabilities in a rural area use rehabilitation services at present, but accessibility and satisfaction were low. Quantitatively and qualitatively, rehabilitation services for disabled people in a rural area should be centered around Community-based Rehabilitation (CBR). Effective strategies, for example reaching those who have not used the rehabilitation services, will be needed to improve services in rural areas.
Brain ; Comorbidity ; Disabled Persons ; Employment ; Female ; Hospitals, General ; Housing ; Humans ; Insurance, Health ; Logistic Models ; Marital Status ; Medicine, East Asian Traditional ; Public Health ; Rehabilitation Centers ; Surveys and Questionnaires

BACKGROUND: Adipose tissues include multipotent cells, the same as bone marrow-derived mesenchymal stem cells. The stromal vascular fractions (SVFs) from adipose tissues represent a heterogeneous cell population. The purpose of this study was to isolate and purify adipose-derived stem cells (ASCs) in SVFs by the density gradient method. METHODS: SVFs were extracted from the subcutaneous, epididymal, mesenteric and retroperitoneal adipose tissue of 8 weeks old male Sprague-Dawley rats (n = 15) and these were separated into 4 layers according to a Nycodenz gradient (Fx-1: < 11%, Fx-2: 11-13%, Fx-3: 13-19% and Fx-4: 19-30%). The post-confluent SVFs were cultured in adipogenic medium for 2 days, in insulin medium for 2 days and in 10% fetal bovine serum medium for 5 days. To observe lipid droplets in SVFs, we performed Oil Red O staining. RESLTS: The SVFs' cellular fractions (Fx-1, Fx-2, Fx-3 and Fx-4) were isolated by density gradient centrifugation from the adipose tissues of rats. The SVFs extracted to fraction 3 (Fx-3) had the most abundant cells compared to that of the other fractions. However fraction 1 (Fx-1) or 2 (Fx-2) had a superior ability to make lipid droplets. The adipogenic differentiation of Fx-1 or 2 was higher than that of the unfractionated cells. The SVFs extracted from retroperitoneal adipose tissue had the highest efficiency for adipogenic differentiation, whereas the SVFs from mesenteric adipose tissue did not differentiate. CONCLUSION: This density gradient fractionated method leads to efficient isolation and purification of cells with the characteristics of ASCs.
Adipose Tissue ; Animals ; Azo Compounds ; Centrifugation ; Centrifugation, Density Gradient ; Humans ; Insulin ; Intra-Abdominal Fat ; Iohexol ; Male ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Stem Cells

BACKGROUND AND OBJECTIVES: Heparin is crucial in the treatment of acute coronary syndrome. However, unfractionated heparin has pharmacokinetic, biophysical and biological limitations, but its low molecular weight has been used to overcome these limitations. The aim of this study was to find the optimal dose of dalteparin in Koreans. Instead, significant rises in the levels of aminotransferase were found in the liver during the study. SUBJECTS AND METHODS: A clinical investigation was conducted, at Seoul National University Hospital, between December 2000 and February 2001. The anti-Xa activity was checked just before the first, and 4 hours after, the second and ninth doses of dalteparin. Liver function tests were obtained on the first and follow-up day (day 6 or 7). RESULTS: Of the 17 patients who completed 10 doses of dalteparin, 13 showed significant rises in the levels of liver aminotransferase. In 5 cases, the levels of aminotransferase rose to 3 times, and in one case, to over 10 times the upper normal limit. All of the patients were asymptomatic, and the levels showed a decline one or two days later. The follow-up aminotransferase level was normalized in 8 out of 11 patients whose liver function tests were followed up. CONCLUSION: Previous studies have shown that 120 IU/kg of dalteparin was the optimal dose in Western countries. Whether this is the optimal dose for Koreans has not been proven, and there have been no studies to elucidate its adverse effects (e.g. hepatotoxicity) in Koreans. Therefore, large scale, randomized trials may be warranted to determine the pharmacodynamics and kinetics of dalteparin in Koreans.
Acute Coronary Syndrome* ; Coronary Disease ; Dalteparin* ; Drug-Related Side Effects and Adverse Reactions* ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Kinetics ; Liver ; Liver Function Tests ; Molecular Weight ; Seoul

BACKGROUND AND OBJECTIVES: In aortic dissection (AD), CT angiography (CTA) is useful both in initial diagnosis and long term follow-up. In this study, we used CTA to evaluate the morphologic changes of aorta after AD. SUBJECTS AND METHODS: We reviewed the initial and follow-up CTA images of 43 patients with AD. The diagnoses were double-lumen dissection (n=13), intramural hematoma (n=11), and residual dissection after surgery (n=19). The duration of CTA follow-up was 3.3+/-1.9 years (range 7 - 89 months). After reviewing the CTA images of the thoracic aorta level, and of the upper and lower abdominal aorta levels, we compared the areas of total lumen, true lumen and false lumen and the area ratio of true/total lumen. RESULTS: Changes in luminal areas were greatest in the thoracic aorta, where both the true lumen area and the ratio of true/total lumen area increased. Subgroup analysis revealed that although the total lumen area increased significantly in the classic AD group, no changes were noted in the ratio of true/total lumen area. Only the increase in false lumen area (from 5.8 cm 2 to 9.0 cm 2) was significant (p=0.036). In patients with intramural hematoma, a decrease in total lumen area and an increase in the ratio of true/total lumen area were noted. CONCLUSION: In classic AD, false lumen dilatation occurs with false lumen enlargement, whereas in intramural hematoma total aorta size decreases with any increase in the ratio of true/total lumen area.
Angiography* ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Diagnosis ; Dilatation ; Follow-Up Studies ; Hematoma ; Humans ; Phenobarbital ; Tomography, X-Ray Computed

BACKGROUND: Left ventricular remodeling after myocardial infarction is closely related to the prognosis of the patients with infarction and can be modified by angiotensin converting enzyme inhibitor. In experimental transmural infarction rat model, captopril decreases the ventricular compliance and simultaneously decrease the ventricular volume, but its effects on the nontransmurally infarcted heart are not elucidated. METHODS: Female Sprague-Dawley rats underwent 45-minute left coronary artery occlusion followed by reperfusion to produce nontransmural myocardial infarction. At 5 days after infarction, rats were randomized into two groups : untreated(n=8) and captopril-treated(captopril 2g/liter drinking water)(n=8). After 21 days of treatment, the hearts were arrested at diastole and excised. Passive pressure-volume curve of the left ventricle was plotted, and the stiffness modulus and mean compliance were calculated in the range of 5 to 30mmHg of pressure. Infarct size was also measured to confirm each group has similar size of lesion. The extent of fibrosis(relative area of fibrosis to randomly-selected peri-infarcted zone) was quantified on Masson's trichrome-stained ventricular slices by automatic image analysis software. RESULTS: Compared with untreated group, captopril-treated rats showed significantly decreased ventricular weight-to-body weight ratio(2.60+/-0.18mg/g vs. 2.84+/-0.20, p<0.05), decreased ventricular stiffness modulus(7.24+/-0.61 vs. 8.28+/-0.57, p<0.005), increased mean compliance(9.71+/-0.75 1/mmHg vs. 7.55+/-0.67, p<0.0001), and decreased fibrosis extent(0.82+/-1.49% vs. 5.53+/-5.33, p<0.01). CONCLUSION: These findings suggest that captopril increases the compliance of nontransmurally-infarcted left ventricle at least partly by the suppression of fibrosis, in contrast with previous findings that captopril decresed the passive compliance of transmurally-infarcted ventricle.
Animals ; Captopril ; Compliance ; Coronary Vessels ; Diastole ; Drinking ; Female ; Fibrosis ; Heart ; Heart Ventricles ; Humans ; Infarction ; Models, Animal ; Myocardial Infarction* ; Peptidyl-Dipeptidase A ; Prognosis ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Ventricular Remodeling*

BACKGROUND: Loss of myocardium due to acute myocardial infarction may cause acute heart failure and future left ventricular dysfunction. During heart failure, homeostatic mechanism will be activated and the renin-angiotensin system may play a role in congestive heart failure. Its primary components are angiotensinogen, renin, angiotensin converting enzyme, and angiotensin. According to the recent improvement of molecular biologic technique, it is possible to know the angiotensinogen nucleotidde sequence, amino acid sequence, and tertiary structure and to detect very small amount of material from tissue. The aim of the present study was to examine the change of expression of the liver angiotensinogen mRNA, a component of the circulation renin-angiotensin system in rats after myocardial infarction. METHODS: Female Sprague-Dawley rats(body weight 200-250g) were anesthetized and subjected either to left coronary artery occlusion or to sham operation. And the rats were sacrificed at 1 hours, 4 hours, 18 hours, 24 hours, 3 days, 7 days, 1 week, 2 weeks and 3 weeks. Northern blot analysis was performed. RESULTS: The liver angiotensinogen amRNA levels were elevated at 4 hours, 18 hours, 24 hours after myocardial infarction and reduced to control values at 3 days(max 5-fold). The liver angiotensinogen mRNA levels were lesser elevated at 4 hours, 18 hours, 24 hours after sham operation(max 1.8-fold). CONCLUSION: The renin-angiotensin system is one of the major regulators of blood pressure and fiuid and electrolyte homeostasis. It appears that the circulating renin-angiotensin system is activated acutely after myocardial infarction and is then turned off at cardiovascular compensation.
Amino Acid Sequence ; Angiotensinogen* ; Angiotensins ; Animals ; Blood Pressure ; Blotting, Northern ; Compensation and Redress ; Coronary Vessels ; Female ; Heart Failure ; Homeostasis ; Humans ; Liver* ; Myocardial Infarction* ; Myocardium ; Peptidyl-Dipeptidase A ; Rats* ; Rats, Sprague-Dawley ; Renin ; Renin-Angiotensin System ; RNA, Messenger* ; Ventricular Dysfunction, Left

BACKGROUND: CarboMedics and St.Jude Medical bileaflet valves are in widespread use but few noninvasive studies about the two types of valves were performedd. The aim of this study was to assess the characterisics of the normally functioning CarboMedics and St.Jude Medical prosthesis in the mitral position. METHODS: Patients with normally functioning CarboMedics and St.Jude Medical valve in the mitral position were included. They underwent transthoracic and transesophageal echocardiography 7 to 14days after mitral valve replacement. With the use of color flow Doppler transesophageal echocardiography, we measured the length, width, and area of maximal physiologic regurgitation and by using 2-D transesophageal echocardiography, we measured the opening and closing angles of the bileaflet valves and we tried to elucidate whether spontaneous echo contrast is present in the left atrium. RESULTS: 31 pateints underwent mitral valve replacement with CarboMedics and 10 patients with St.Jude Medical. The length of maximal physiologic regurgitation ranged from 11mm to 44mm in carboMedics mitral valve and from 12mm to 36mm in St.Jude Medical mitral valve. The area ranged from 0.19cm2to 3.48cm2in CarboMedcs and from 0.58cm2to 4.49cm2in CarboMedics and The mean opening and closing angles are 83.2(+/-1.1)degrees, 22.3(+/-1.3)degrees in CarboMedics and 86.5(+/-1.2)degrees 26.2(+/-3.2)degrees in St.Jude Medical. Spontaneous echo contrast was positive in 66% of patients, of whom patioents with atrial fibrillation showed nuch higher revalence of SEC than patients with sinus rhythm. CONCLUSION: These finding valve will give us a reference valvue for the evaluation of prosthetic valve function in mitral position.
Atrial Fibrillation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Mitral Valve* ; Prostheses and Implants

In a 52-year-old man who presented with acute myocardial infarction, dual coronary arteriovenous fistulas from the right coronary artery and left circumflex artery both which drained into the coronary sinus were detected on coronary arteriography.This is the first case of dual coronary arteriovenous fistulas draining into the coronary sinus.
Arteries ; Arteriovenous Fistula* ; Coronary Sinus* ; Coronary Vessels ; Humans ; Middle Aged ; Myocardial Infarction*