Laparoscopic surgery is rapidly evolving with technological advances, but there are several drawbacks. An articulating device, with freedom of a perfect 360°, is attractive as a solution to overcome the restriction of instrument movement caused by straight tools. Its usefulness or efficacy should be supported by relevant scientific evidence. However, it is sometimes difficult to prove it because the factors influencing the surgical outcomes are complex and closely related to each other.

OBJECTIVES: To compare the effect of three different cryoprotectants on basic stem cell characteristics for the possibility of using well defined, dimethyl sulfoxide (DMSO) and serum free freezing solutions to cryopreserve human Wharton's jelly-derived mesenchymal stem cells (WJMSCs) following controlled rate freezing protocol. METHODS: The mesenchymal stem cells isolated from human Wharton's jelly were cryopreserved using 10% DMSO, 10% polyvinylpyrrolidone (PVP) and a cocktail solution comprising of 0.05 M glucose, 0.05 M sucrose and 1.5 M ethylene glycol following controlled rate freezing protocol. We investigated the post-thaw cell viability, morphology, proliferation capacity, basic stem cell characteristics, in vitro differentiation potential and apoptosis-related gene expression profile before and after cryopreservation. RESULTS: The cryoprotectant 10% DMSO has shown higher post-thaw cell viability of 81.2+/-0.58% whereas 10% PVP and cocktail solution have shown 62.87+/-0.35% and 72.2+/-0.23%, respectively at 0 h immediately thawing. The cell viability was further reduced in all the cryopreserved groups at 24 h later post-thaw culture. Further, the complete elimination of FBS in cryoprotectants has resulted in drastic reduction in cell viability. Cryopreservation did not alter the basic stem cell characteristics, plasticity and multipotency except proliferation rate. The expression of pro-apoptotic BAX and p53 genes were higher whilst p21 was lower in all the cryopreserved groups when compare to the control group of WJMSCs. CONCLUSION: Although 10% DMSO has shown higher post-thaw cell viability compare to 10% PVP and cocktail solution, the present study indicates the feasibility of developing a well-defined DMSO free cryosolution which can improve storage and future broad range applications of WJMSCs in regenerative medicine without losing their basic stem cell characteristics.
Apoptosis ; Cell Survival ; Cryopreservation* ; Dimethyl Sulfoxide ; Ethylene Glycol ; Freezing* ; Genes, p53 ; Glucose ; Humans* ; Mesenchymal Stromal Cells* ; Plastics ; Povidone ; Regenerative Medicine ; Stem Cells ; Sucrose ; Transcriptome ; Wharton Jelly

BACKGROUND AND OBJECTIVES: While pulmonary vein isolation (PVI) is an effective curative procedure for patients with atrial fibrillation (AF), pulmonary vein (PV) stenosis is a potential complication which may lead to symptoms that are often unrecognized. The aim of this study was to compare differences between ablation sites in pulmonary venous flow (PVF) measured by transthoracic Doppler echocardiography (TTE) before and after PVI. SUBJECTS AND METHODS: One hundred five patients (M : F=64 : 41; mean age 56+/-10 years) with paroxysmal AF (n=78) or chronic, persistent AF (n=27) were enrolled. PVI strategies consisted of ostial ablation (n=75; OA group) and antral ablation using an electroanatomic mapping system (n=30; AA group). The ostial diameter was estimated by magnetic resonance imaging (MRI) in patients with PVF > or =110 cm/sec by TTE after PVI. RESULTS: No patient complained of PV stenosis-related symptoms. Changes in mean peak right PV systolic (-6.7+/-28.1 vs. 10.9+/-25.9 cm/sec, p=0.038) and diastolic (-4.1+/-17.0 vs. 9.9+/-25.9 cm/sec, p=0.021) flow velocities were lower in the AA group than in the OA group. Although the change in mean peak systolic flow velocity of the left PV before and after PVI in the AA group was significantly lower than the change in the OA group (-13.4+/-25.1 vs. 9.2+/-22.3 cm/sec, p=0.016), there was no difference in peak diastolic flow velocity. Two patients in the OA group had high PVF velocities (118 cm/sec and 133 cm/sec) on TTE, and their maximum PV stenoses measured by MRI were 62.5% and 50.0%, respectively. CONCLUSION: PV stenosis after PVI could be detected by TTE, and PVI by antral ablation using an electroanatomic mapping system might be safer and more useful for the prevention of PV stenosis.
Atrial Fibrillation ; Carbamates ; Catheter Ablation ; Catheters ; Constriction, Pathologic ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Organometallic Compounds ; Pulmonary Veins

BACKGROUND: The aim of the present study was to prepare hydroxyapatite (HA) and then characterize its effect on bone integration in a rabbit tibial defect model. The bone formation with different designs of HA was compared and the bony integration of several graft materials was investigated qualitatively by radiologic and histologic study. METHODS: Ten rabbits were included in this study; two holes were drilled bilaterally across the near cortex and the four holes in each rabbit were divided into four treatment groups (HAP, hydroxyapatite powder; HAC, hydroxyapatite cylinder; HA/TCP, hydroxyapatite/tri-calcium phosphate cylinder, and titanium cylinder). The volume of bone ingrowth and the change of bone mineral density were statistically calculated by computed tomography five times for each treatment group at 0, 2, 4, 6, and 8 weeks after grafting. Histologic analysis was performed at 8 weeks after grafting. RESULTS: The HAP group showed the most pronounced effect on the bone ingrowth surface area, which seen at 4, 6, and 8 weeks after graft (p < 0.05). On comparing the change of bone mineral density the bone ingrowth surface area among the 4 groups, there were no statistically significant differences among the groups found for any period (p > 0.05). On histological examination, the HAP group revealed well-recovered cortical bone, but the bone was irregularly thickened and haphazardly admixed with powder. The HAC group showed similar histological features to those of the HA/TCP group; the cortical surface of the newly developed bone was smooth and the bone matrix on the surface of the cylinder was regularly arranged. CONCLUSIONS: We concluded that both the hydroxyapatite powder and cylinder models investigated in our study may be suitable as a bone substitute in the rabbit tibial defect model, but their characteristic properties are quite different. In contrast to hydroxyapatite powder, which showed better results for the bone ingrowth surface, the hydroxyapatite cylinder showed better results for the sustained morphology.
Animals ; *Bone Substitutes ; *Durapatite ; *Osseointegration ; Rabbits ; Tibia/pathology/radiography/*surgery

BACKGROUND AND OBJECTIVES: It has been demonstrated that the concentration of plasma nerve growth factor (NGF) effects nerve sprouting. In addition, the relationship between plasma NGF concentration and the occurrence of ventricular tachyarrhythmia (VT) has been reported in animal models of myocardial infarction (MI). However, the causal relationship between NGF and VT remains unclear in humans. The aim of the current study was to determine whether NGF is increased in patients with MI. In addition, the relationship between the concentration of plasma NGF and the inducibility of VT was evaluated. SUBJECTS AND METHODS: We studied 15 patients with stable angina pectoris (SA) and 30 patients with an acute MI (AMI). The patients in the AMI group were divided into VT occurrence (n=14) and non-VT occurrence groups (n=16). Thirty-four patients suspected to have VT underwent programmed electrical stimulation (PES) and were divided into an idiopathic VT group (n=24) and an induced VT with PES {healthy control (C) group; n=10}. Plasma NGF concentrations were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The plasma concentrations of the AMI group were significantly increased compared to the C group {median (interquartile range), 18.9 (8.7) vs. 10.3 (12.5) pg/mL, p<0.05} and the patients with SA {18.9 (8.7) vs. 15.1 (6.7) pg/mL, p<0.05}, but not significantly different from those in the idiopathic VT group {median (interquartile range), 18.9 (8.7) vs. 18.7 (8.5) pg/mL, p=0.89}. There was no significant difference in the plasma NGF concentrations between the C and SA groups {10.3 (12.5) vs. 15.1 (6.7) pg/mL, p=0.18}. In the AMI patients, there was no significant difference in the plasma NGF concentrations between patients with VT and those without VT {18.5 (6.7) vs. 21.2 (10.2) pg/mL, p=0.25}. CONCLUSION: The plasma NGF concentrations were increased in patients with an AMI compared to patients with SA and Cs.
Angina, Stable ; Electric Stimulation ; Enzyme-Linked Immunosorbent Assay ; Humans ; Models, Animal ; Myocardial Infarction ; Nerve Growth Factor ; Plasma ; Tachycardia

PURPOSE: To evaluate the quality of prehospital CPR (cardiopulmonary resuscitation) performed by 119 rescue personnel and bystanders in Seoul and to recognize the present problems in the pre-hospital emergency medical service system (EMS). METHODS: We enrolled all patients in cardiac arrest visiting the emergency rooms of 9 university hospitals in Seoul via 119 rescue services from 16 October to 26 November 2006, prospectively investigating the environments in which arrest occurred and the factors associated with CPR. RESULTS: Among 73 patients, the most common place of arrest was in the home(45.2%), CPR by bystander was performed in 8 cases(10.7%), endotracheal intubation by EMS personnel was performed in 10 cases(14.1%). Average time from call to CPR was 11.9 minutes and the number of discharges alive was 3 cases(4.1%). CONCLUSION: To improve the rate of alive discharges, development of CPR education program for lay rescue, education in basic and advanced life support, and management of quality for EMS personnel are needed.
Cardiopulmonary Resuscitation ; Emergencies ; Emergency Medical Services ; Heart Arrest ; Hospitals, University ; Humans ; Hypogonadism ; Intubation, Intratracheal ; Mitochondrial Diseases ; Ophthalmoplegia ; Out-of-Hospital Cardiac Arrest ; Prospective Studies

The bone graft materials are grossly divided into autogenous bone, allogenic bone, xenogenic bone, and alloplastic material. Among the various allogenic graft materials, hydroxyapatite(Ca10(PO4)6(OH)2, HA), the main inorganic phase of human hard tissue, is widely used as a repair material for bones. When HA applied to bony defect, however, it may be encapsulated with fibrous tissue and floated in the implanted area by the lack of consolidation. Fluoridated hydroxyapatite(Ca10(PO4)6(OH)2, FHA), where F- partially replaces the OH- in the hydroxyapatite, is considered as an alternative material for bone repair due to its solubility and biocompatibility. This study was designed to find out the bone healing capacity of FHA newly produced as a nanoscale fiber in the laboratory. We implanted HA and FHA in the rabbit cranium defect and histologically analysed the specimen. The results were as follows. 1. In the 4 weeks, fibrous connective tissue and little bone formation around materials of the experimental group I implanted HA were observed. In the experimental group II implanted FHA, newly formed bone around materials were observed. 2. In the 8 weeks, the amount of newly formed and matured bone of the experimental group II was more than the experimental group I and control group. From the results obtained, we suggest that FHA, newly synthesized, is relatively favorable bone substitute with bioconpatibility and has better bone healing capacity than pure HA.
Bone Substitutes ; Connective Tissue ; Durapatite* ; Humans ; Osteogenesis ; Skull* ; Solubility ; Transplants

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Dyslipidemias ; Follow-Up Studies ; Heart* ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.
Body Weight ; Depression ; Depressive Disorder, Major ; Diagnosis ; Humans ; Outpatients ; Vital Signs ; Weights and Measures

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.
Female ; Humans ; Korea ; Prospective Studies ; Psychometrics* ; Surveys and Questionnaires* ; Translations ; Urinary Bladder ; Urinary Incontinence* ; Urination