BACKGROUND: It is important to understand the distribution of 2-dimensional strain values in normal population. We performed a multicenter trial to measure normal echocardiographic values in the Korean population. METHODS: This was a substudy of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL) study. Echocardiographic specialists measured frequently used echocardiographic indices in healthy people according to a standardized method at 23 different university hospitals. The strain values were analyzed from digitally stored images. RESULTS: Of a total of 1003 healthy participants in NORMAL study, 2-dimensional strain values were measured in 501 subjects (265 females, mean age 47 ± 15 years old) with echocardiographic images only by GE echocardiographic machines. Interventricular septal thickness, left ventricular (LV) posterior wall thickness, systolic and diastolic LV dimensions, and LV ejection fraction were 7.5 ± 1.0 mm, 7.4 ± 1.0 mm, 29.9 ± 2.8 mm, 48.9 ± 3.6 mm, and 62 ± 4%, respectively. LV longitudinal systolic strain (LS) values of apical 4-chamber (A4C) view, apical 3-chamber (A3C) view, apical 2-chamber (A2C) view, and LV global LS (LVGLS) were −20.1 ± 2.3, −19.9 ± 2.7, −21.2 ± 2.6, and −20.4 ± 2.2%, respectively. LV longitudinal systolic strain rate (LVLSR) values of the A4C view, A3C view, A2C view, and LV global LSR (LVGLSR) were −1.18 ± 0.18, −1.20 ± 0.21, −1.25 ± 0.21, and −1.21 ± 0.21(−s), respectively. Females had lower LVGLS (−21.2 ± 2.2% vs. −19.5 ± 1.9%, p < 0.001) and LVGLSR (−1.25 ± 0.18(−s) vs. −1.17 ± 0.15(−s), p < 0.001) values than males. CONCLUSION: We measured LV longitudinal strain and strain rate values in the normal Korean population. Since considerable gender differences were observed, normal echocardiographic cutoff values should be differentially applied based on sex.
Echocardiography* ; Female ; Healthy Volunteers ; Heart Ventricles* ; Hospitals, University ; Humans ; Male ; Methods ; Multicenter Studies as Topic ; Reference Values ; Specialization

BACKGROUND: Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS: Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS: Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION: Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.
Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Reference Values

BACKGROUND AND PURPOSE: Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. METHODS: We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. RESULTS: AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.44-1.85) and SAP (OR 1.54, 95% CI 1.35-1.75). CONCLUSIONS: In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.
Arteries ; Atherosclerosis ; Brain ; Cerebral Small Vessel Diseases* ; Echocardiography, Transesophageal ; Humans ; Magnetic Resonance Imaging ; Plaque, Atherosclerotic* ; Stroke* ; Stroke, Lacunar ; White Matter

BACKGROUND: Measurement of the cardiac chamber is essential, and current guidelines recommend measuring and reporting values for both sides of the cardiac chamber during echocardiographic evaluation. Normal echocardiographic reference values have been suggested previously, but detailed information about right-sided chambers and values according to gender was not included. METHODS: This is a prospective multicenter (23 centers) study evaluating normal Korean adult subjects using comprehensive echocardiography. We included normal adult subjects (age; 20-79 years old) who had no significant cardiac disorders or illnesses, such as hypertension or diabetes, which could affect cardiac structure and function. We measured the cardiac chamber including both right and left ventricles as well as atria according to current echocardiography guidelines and compared values according to gender and age groups. RESULTS: A total of 1003 subjects were evaluated and the mean age was 48 +/- 16 years. Left ventricular (LV) dimensions increased, but LV volume decreased in older subjects. Right ventricular (RV) area decreased in women and older subjects, and the RV long-axis dimension showed a similar trend. Left atrial (LA) volume increased in men but there were no differences in LA volume index between men and women. The dimension of great arteries increased in men and older subjects. CONCLUSION: Since there were considerable differences between men and women and in the different age groups, and the trends differed significantly between different echo variables, normal echocardiographic cutoff values should be differentially applied based on age and gender.
Adult ; Arteries* ; Echocardiography* ; Female ; Heart Ventricles ; Humans ; Hypertension ; Male ; Prospective Studies ; Reference Values

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Metastasis of hepatocellular carcinoma (HCC) in the nasal septum is an extremely rare condition. The proper management and the role of surgical intervention are still controversial and there is no evidence-based guideline for this specific condition. The authors of the present study report a case of HCC with sinonasal metastasis, managed by surgery to relieve nasal obstruction and frequent epistaxis. Complete removal of the tumor via endoscopic surgery was performed and the pathology was reported to be consistent with metastatic HCC. No additional treatment modality was considered for the septal lesion. During the 8-month postoperative period, the patient remained alive and satisfied with comfortable nasal breathing. The present case report stresses the importance of interdisciplinary collaboration. Proper consultation between surgeon and oncologist may lead to improved quality of life, even when the patient is in the terminal stage of HCC.
Carcinoma, Hepatocellular ; Cooperative Behavior ; Epistaxis ; Humans ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum ; Neoplasm Metastasis ; Postoperative Period ; Quality of Life ; Respiration

OBJECTIVES: Bishphenol A (BPA) is a representative endocrine disruptor and is also known as a xenoestrogen. The objective of the present study is to investigate how many patients are exposed to BPA and to analyze the relationships between serum BPA concentration, bone mineral density (BMD) and biochemical bone markers in postmenopausal women with osteoporosis. METHODS: Total 51 patients were enrolled for measuring BPA and clinical variables including BMD and bone markers. The relationship between BPA and clinical variables were analyzed by the Pearson's correlation test and the Kruskal-Wallis test. Serum BPA concentration was measured by enzyme linked immunosorbent assay (ELISA). RESULTS: BPA was detected in all samples. The mean BPA concentration was 1.44 +/- 0.52 ng/mL. There was no statistically significant correlation between BPA and clinical variables. CONCLUSION: There was no statistical significance between serum BPA concentration and clinical variables related to bone metabolism. To clarify the effect of BPA on bone metabolism, further large scaled and high risk group investigation may be needed.
Benzhydryl Compounds ; Bone Density ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Osteoporosis ; Phenols

BACKGROUND: In an attempt to avoid the adverse effects of the cardiopulmonary bypass, off pump coronary artery bypass grafting(Off pump CABG) that has recently been rediscovered and refined. We compared the preoperative risk factors and in-hospital outcomes of patients done Off pump with those done On pump CABG. MATERIAL AND METHOD: One hundred seventy eight patients was underwent CABG between January 2001 and July 2001. 12 patients whom underwent associated valvular or left ventricular volume reduction surgery were excluded in this study. Data were collected for 52 Off pump CABG and 114 On pump CABG for patient and disease risk factors, extent of coronary disease, and in-hospital outcomes. RESULT: Off pump CABG and On pump CABG groups did not show any differences in their patient and disease risk factors, and extent of coronary disease. Off pump CABG group had significantly lower mean operation time(234 +/- 37 min vs 290 +/- 48 min, p < 0.001), lower mean CK-MB level(10.1 +/- 13.5 IU/L vs 33.1 +/- 18.2 IU/L, p < 0.001) and mean ventilation time(14.8 +/- 3.5 hours vs 16.2 +/- 4.9 hours, p=0.048) than On pump CABG groups. On pump CABG group had significantly more distal grafts(3.4 +/- 0.9 vs 2.6 +/- 0.8, p < 0.001) than Off pump CABG groups. There were no operative mortality in two groups. Off pump CABG and On pump CABG groups did not show any differences in their postoperative complications and outcomes including perioperative myocardial infarction, stroke, respiratory failure, renal failure, reoperation, the amount of bleeding, the need of intraaortic balloon pump, the need of inotropics, and the stay of intensive care unit and hospital. Two patients were converted to On pump CABG. CONCLUSION: This study showed that patients having Off pump CABG are not exposed to a greater risks of adverse outcomes and also provided evidence that patients having Off pump CABG have significantly lower operation time, CK-MB, ventilation time and less distal grafts. Although there may be potential benefits to Off pump CABG, further studies must be directed to determine those patients who would benefit from Off pump CABG.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; Hemorrhage ; Humans ; Intensive Care Units ; Mortality ; Myocardial Infarction ; Postoperative Complications ; Renal Insufficiency ; Reoperation ; Respiratory Insufficiency ; Risk Factors ; Stroke ; Surgical Procedures, Minimally Invasive ; Transplants ; Ventilation

BACKGROUND: Venous thromboembolism is a serious medical problem causing considerable morbidity and mortality. Risk factors of thrombosis are surgery, trauma, pregnancy, tumor, oral contraceptive as well as genetic risk factors (deficiencies of protein C, protein S, antithrombin III) though genetic risk factors were found in about 5 to 10% of cases. Recently, it is known that point mutations in the factor V gene and the prothrombin gene are common risk factors of idiopathic deep vein thrombosis (DVT) in Caucasian. But the frequency of these mutations in Asian population are reported lower than Caucasian's. We investigated the incidence of hereditary risk factors of venous thrombosis at single institution. METHOD: From April 1998 to June 1999, patients who were diagnosed as venous thromboembolism and under 50 years old were enrolled. All patients were requested for protein C, protein S (total, free), antithrombin III, APC resistance test, factor VIII activity, anticardiolipin antibody, lupus anticoagulant (LA), anti-beta2-glycoprotein-I (anti-beta2-GPI). Point mutations of factor V (Arg506->Gln, Arg306->Thr, Arg306->Gly, A4070G) and prothrombin G20210A allele mutation were checked by allele specific PCR amplification. RESULTS: Thirty-four patients (M:F=19:15, median age 38, 22-49) were diagnosed as DVT (7), pulmonary embolism with/without other site venous thrombosis (5/7), retinal vein occlusion (10), venous thrombosis of unusual site (5). Nine patients had past thrombosis history. One patient had familial DVT history. Thirteen patients had acquired risk factors of thrombosis. All the results of APC resistance test were within normal range. There was no single case of factor V mutations or prothrombin G20210A allele mutation. Three patients had positive anti-beta2-GPI and one patient had positive LA. We also found free protein S deficiency : 5/31, combined deficiency of free protein S and antithrombin III: 3/31. Twenty-five patients (73.5%) had elevated factor VIII (>150%). CONCLUSION: In this study, we couldn't detect factor V point mutations, prothrombin G20210A allele mutation in thromboembolic patients. But we found high prevalence of elevated factor VIII. Follow-up test for factor VIII and clinical observation for recurrent thrombosis are in progress.
Activated Protein C Resistance ; Alleles ; Antibodies, Anticardiolipin ; Antithrombin III ; Asian Continental Ancestry Group ; Factor V ; Factor VIII ; Follow-Up Studies ; Humans ; Incidence ; Lupus Coagulation Inhibitor ; Middle Aged ; Mortality ; Point Mutation ; Polymerase Chain Reaction ; Pregnancy ; Prevalence ; Protein C ; Protein S ; Protein S Deficiency ; Prothrombin ; Pulmonary Embolism ; Reference Values ; Retinal Vein Occlusion ; Risk Factors* ; Thromboembolism ; Thrombosis ; Venous Thromboembolism ; Venous Thrombosis*

OBJECTIVES: The aim of this study was to evaluate the psychiatric function and quality of life of the chemical workers who had been exposed to long-term, low-level organic solvents in the Y industrial complex. METHODS: A total of 144 male workers, of whom 82 were in the exposed group and 60 in the unexposed-control group, were evaluated by using Symptom Checklist-90-R(SCL-90-R), series of neuropsychological tests(critical flicker fusion threshold, CFFT); choice reaction time, CRT; compensatory tracking task, CTT); digit symbol substitution test, DSS), and the Korean version of the SmithKline Beecham Quality Of Life scale(KvSBQOL). For the statistical analyses, comparisons of the means of the two groups were performed for each variable with two-tailed t-test as well as ANCOVA including age and education as covariates. RESULTS: For the SCL-90-R, the nine symptom scales and the three global indices were clinically within normal range in both groups. However, the scores on the symptom scales of 'somatization', 'depression', 'hostility' and 'phobic anxiety', and those on the global indices of 'global severity index' and 'positive symptom total', were significantly higher in the exposed group than in the unexposed group. In terms of the neuropsychological function and the quality of life, there wes no significant difference between the two groups. CONCLUSIONS: These findings suggested that the long-term exposure to mixed organic solvents, even at the low level below the permissible exposure limit, might induce some psychiatric problems.
Education ; Flicker Fusion ; Humans ; Male ; Mental Health ; Quality of Life* ; Reaction Time ; Reference Values ; Solvents* ; Weights and Measures