Background: Fractional flow reserve (FFR) based on computed tomography (CT) has been shown to better identify ischemia-causing coronary stenosis. However, this current technology requires high computational power, which inhibits its widespread implementation in clinical practice. This prospective, multicenter study aimed at validating the diagnostic performance of a novel simple CT based fractional flow reserve (CT-FFR) calculation method in patients with coronary artery disease. Methods: Patients who underwent coronary CT angiography (CCTA) within 90 days and invasive coronary angiography (ICA) were prospectively enrolled. A hemodynamically significant lesion was defined as an FFR ≤ 0.80, and the area under the receiver operating characteristic curve (AUC) was the primary measure. After the planned analysis for the initial algorithm A, we performed another set of exploratory analyses for an improved algorithm B. Results: Of 184 patients who agreed to participate in the study, 151 were finally analyzed.Hemodynamically significant lesions were observed in 79 patients (52.3%). The AUC was 0.71 (95% confidence interval [CI], 0.63–0.80) for CCTA, 0.65 (95% CI, 0.56–0.74) for CT-FFR algorithm A (P = 0.866), and 0.78 (95% CI, 0.70–0.86) for algorithm B (P = 0.112). Diagnostic accuracy was 0.63 (0.55–0.71) for CCTA alone, 0.66 (0.58–0.74) for algorithm A, and 0.76 (0.68–0.82) for algorithm B. Conclusion This study suggests the feasibility of automated CT-FFR, which can be performed on-site within several hours. However, the diagnostic performance of the current algorithm does not meet the a priori criteria for superiority. Future research is required to improve the accuracy.

BACKGROUND/AIMS: The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP. METHODS: In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching. RESULTS: The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality. CONCLUSIONS Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of soft tissue, and can lead to severe cervical kyphosis, presenting with a spectrum of physical complaints including dysphagia, hoarseness, stridor, aspiration pneumonia, and dyspnea due to airway compromise. Restrictive ventilatory impairment is very rare. We encountered a 73-year-old man with DISH presenting with progressive dysphagia and dyspnea over a few months. The symptoms were evaluated with a video fluoroscopy swallowing study and pulmonary function tests (PFT). The PFT revealed restrictive ventilatory impairment. A neck magnetic resonance imaging (MRI) study showed anterior cervical osteophytes causing upper airway compromise and compression of the esophagus. Osteophytes were removed surgically and the patient improved clinically. Here, we describe the case with a literature review.
Aged ; Deglutition ; Deglutition Disorders* ; Dyspnea ; Esophagus ; Fluoroscopy ; Hoarseness ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Kyphosis ; Magnetic Resonance Imaging ; Neck ; Osteophyte* ; Pneumonia, Aspiration ; Respiratory Function Tests ; Respiratory Sounds

BACKGROUND/AIMS: With the increasing incidence of cardiovascular disease, angiocardiography using contrast-enhancing media has become an essential diagnostic and therapeutic tool, despite the risk of contrast-medium-induced acute kidney injury (CIAKI). CIAKI may be exacerbated by renin-angiotensin-system (RAS) blockers, which are also used in a variety of cardiovascular disorders. This study evaluated the effects of RAS blockade on CIAKI after coronary angiography. METHODS: Patients who underwent coronary angiography in our hospital between May 2009 and July 2011 were reviewed. Serum creatinine levels before and after coronary angiography were recorded. CIAKI was diagnosed according to an increase in serum creatinine > 0.5 mg/dL or 25% above baseline. RESULTS: A total of 1,472 subjects were included in this study. Patients taking RAS blockers were older, had a higher baseline creatinine level, lower estimated glomerular filtration rate (eGFR), and had received a greater volume of contrast medium. After propensity score matching, no difference was observed between the RAS (+) and RAS (.) groups. Multiple logistic regression identified RAS blockade, age, severe heart failure, contrast volume used, hemoglobin level, and eGFR as predictors of CIAKI. Multiple logistic regression after propensity matching showed that RAS blockade was associated with CIAKI (odds ratio, 1.552; p = 0.026). CONCLUSIONS: This study showed that the incidence of CIAKI was increased in patients treated with RAS blockers.
Acute Kidney Injury/*chemically induced/diagnosis/epidemiology/physiopathology ; Aged ; Angiotensin II Type 1 Receptor Blockers/*adverse effects ; Angiotensin-Converting Enzyme Inhibitors/*adverse effects ; Biological Markers/blood ; Chi-Square Distribution ; Contrast Media/*adverse effects/diagnostic use ; Coronary Angiography/*adverse effects ; Creatinine/blood ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Incidence ; Kidney/*drug effects/physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Propensity Score ; Renin-Angiotensin System/*drug effects ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors

Infliximab, which is indicated for refractory rheumatoid arthritis (RA), ankylosing spondylitis (AS) and Crohn's disease, has cutaneous adverse events including skin rash, urticaria, pruritus, and lupus-like eruption. Psoriasis induced by infliximab is very rare. In Korea, it is infrequently reported in Crohn's disease or RA and never reported in AS. We encountered a case of psoriasis induced by infliximab treatment for AS, and report here on this case along with a review of the relevant literature.
Arthritis, Rheumatoid ; Crohn Disease ; Exanthema ; Korea ; Pruritus ; Psoriasis* ; Spondylitis, Ankylosing* ; Urticaria ; Infliximab

Apical ballooning syndrome (ABS), also referred to as stress cardiomyopathy, is characterized by acute left ventricular dysfunction following a stressful situation. Diagnosis of ABS is made in the following scenarios: transient hypokinesia or dyskinesia of the left ventricular segment, absence of obstructive coronary disease, new electrocardiogram abnormalities, absence of recent significant head trauma, pheochromocytoma, myocarditis, and hypertrophic cardiomyopathy. Prognosis is usually favorable since the wall motion abnormality returns to normal within days, and certainly within the first month. We encountered a case of SLE with apical ballooning on echocardiography in a 44-year-old woman. She was suffering from severe left ventricular dysfunction that has persisted on 5 year follow-up echocardiography. We report this case along with a review of the relevant literature.
Adult ; Cardiomyopathy, Hypertrophic ; Coronary Disease ; Craniocerebral Trauma ; Diagnosis ; Dyskinesias ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hypokinesia ; Lupus Erythematosus, Systemic ; Myocarditis ; Pheochromocytoma ; Prognosis ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left

OBJECTIVE: Although a series of trials support that rheumatoid arthritis (RA) is associated with increased atherosclerosis, the link between microvascular structural changes and the disease activity of RA has not been clarified. We measured changes in the retinal microvasculature using fundus fluorescein angiography (FAG) and investigated the association between the retinal vasculature and clinical parameters of RA. METHODS: Seventy-five RA patients and sixty healthy control were included. Morphometric and quantitative features in the capillary images including retinal vascular signs and vessel diameters were measured with fundus photography and FAG. RA activity was assessed based on high sensitivity C-reactive protein (hsCRP), disease activity score with 28 joints (DAS 28), and health assessment questionnaire (HAQ). RESULTS: Central retinal arteriolar equivalents (CRAE) was 118.1+/-31.3 microm in RA patients and 123.8+/-19.9 microm in control subjects, showing the tendency of retinal arteriolar narrowing in patients with RA but without statistical significance. The mean central retinal venular equivalents (CRVE) was 162.4+/-26.4 microm which was significantly higher than that of control group (144.1+/-23.1 microm, p<0.001). The prevalence of AVN was 34.7%, and significantly higher in RA group. Among retinal findings, the presence of early pinpoint hyperfluorescence and areas of delayed choroidal perfusion correlated with hsCRP. Age, disease duration, DAS 28, HAQ, and rheumatoid factor (RF) had no effect on CRAE and CRVE. In multivariate analysis, only hsCRP was found to be associated with wider venular caliber. CONCLUSION: Retinal venular widening was more common in RA patients. Retinal venular diameter had significant correlation with disease activity of RA. Retinal imaging is a comparative method for the assessment of microvascular findings of RA patients.
Arthritis, Rheumatoid ; Atherosclerosis ; C-Reactive Protein ; Capillaries ; Choroid ; Fluorescein ; Fluorescein Angiography ; Humans ; Joints ; Microvessels ; Multivariate Analysis ; Perfusion ; Photography ; Prevalence ; Rheumatoid Factor ; Surveys and Questionnaires

PURPOSE: To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture. MATERIALS AND METHODS: Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria. RESULTS: The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months. CONCLUSION: Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.
Accidents, Traffic ; Classification ; Femur* ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Humans ; Range of Motion, Articular ; Sex Distribution

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.
Angioplasty ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Heart Rate* ; Heart* ; Humans ; Oxygen ; Transplants

BACKGROUND AND OBJECTIVES: We hypothesized that simultaneous assessment of myocardial perfusion and a regional wall motion abnormality, using real-time myocardial contrast echocardiography (MCE), provides more useful information than routine two-dimensional echocardiography (2DE) in the diagnosis of acute coronary syndrome in patients with a non-diagnostic ECG. SUBJECTS AND METHODS: We prospectively enrolled 101 patients (age:61+/-10 years, 57 men) who presented with acute chest pain. A routine 2DE was performed to evaluate the regional wall motion abnormality, and a MCE to assess the perfusion defect. Coronary angiography was performed in all patients. The cardiac events (myocardial infarction, revascularization and death) were analyzed. RESULTS: Of the 101 patients studied, 64 had significant coronary artery disease (diameter stenosis >0%). Cardiac events occurred in 58 patients;21 myocardial infarction, 48 revascularization. The sensitivities of 2DE and MCE for significant coronary artery stenosis were 57.8 and 73.4%, and the specificities were 83.8 and 81.1%, respectively. Of the 58 patients with cardiac events, a regional wall motion abnormality was observed in 34 (59%), and a perfusion defect in 44 (76%). The specificities of 2DE and MCE for cardiac events were 79 and 77%, respectively. Cardiac events were more frequent in males, smokers and in those with an abnormal ECG (p<.05), but only a perfusion defect independently predicted cardiac events (p<.001, odds ratio=8.37). CONCLUSION: Real time MCE, in patients with acute chest pain, reasonably predicts significant coronary artery stenosis, and identifies those who will have cardiac events.
Acute Coronary Syndrome ; Chest Pain* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Diagnosis ; Echocardiography* ; Electrocardiography ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Prospective Studies ; Thorax*