Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.

Background: The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. Methods: The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patientoriented composite outcome (POCO) at 2 years. Results: Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group.Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel.Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012,P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. Conclusion With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.

BACKGROUND/AIMS: This study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS). METHODS: A prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups. RESULTS: This study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P>0.05). The mean total BBPS score (7.95 vs. 8.11, P>0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P>0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008). CONCLUSIONS: Bowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS.
Adenoma ; Citric Acid ; Colonoscopy ; Compliance ; Humans ; Magnesium ; Nausea ; Patient Satisfaction ; Prospective Studies ; Sodium ; Visual Analog Scale ; Water

BACKGROUND/AIMS: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. METHODS: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. RESULTS: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. CONCLUSIONS: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
Christianity ; Humans ; Korea ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Ultrasonography

PURPOSE: Proper management of nutrition or health care for pregnant women is known to have better perinatal outcomes for maternal and neonatal health. In this study, we investigated the effect of regular medical and nutritional counseling provided to pregnant women for improved-results for mother and neonates. METHODS: Thirty-five pregnant women participated in the study and received information on nutrition management via telephone or e-mail every four weeks until childbirth. The nutrition management program comprised proper diet, low-salt diet, low-sugar diet, breast-feeding preparation, and provision of a healthy menu according to their pregnancy trimesters. We categorized them by their degree of participation into a “low participation group” that formed the control group, and a “high participation group” as the study group. RESULTS: No significant differences were found in maternal age, and body mass index between the two groups at the time of enrollment in the study. Post-natal exclusive breast feeding rate was significantly higher in the high participation group (62%) than in the low participation group (32%) (p<0.05). In the neonatal results, gestational age at birth and neonatal birth weight were significantly higher in the high participation group than in the low participation group (p<0.05). Neonatal complication rate, neonatal admission rate to intensive care unit, rate of low birth weight, Apgar score at 1 and 5 minutes, as well as the rate of transient tachypnea were higher in the low participation group, but lacked any statistically significant difference. CONCLUSION: Collaborative nutrition management with obstetricians and nutritionists is helpful in achieving better perinatal outcomes.
Apgar Score ; Birth Weight ; Body Mass Index ; Breast Feeding ; Counseling ; Delivery of Health Care ; Diet ; Diet, Sodium-Restricted ; Electronic Mail ; Female ; Gestational Age ; Gyeonggi-do* ; Humans ; Infant Health ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units ; Maternal Age ; Mothers ; Nutritionists ; Parturition ; Pregnancy Outcome ; Pregnancy Trimesters ; Pregnancy* ; Pregnant Women ; Tachypnea ; Telephone

PURPOSE: This study was done to clarify the effects of foot reflexology on peripheral neuropathy, symptom distress, anxiety and depression in cancer patients treated with oxaliplatin. METHODS: A quasi-experimental design was employed. Changes in the variables were evaluated to test the effects of foot reflexology. Participants were cancer patients treated with oxaliplatin (experimental group 14 and control group 17). Peripheral neuropathy, symptom distress, anxiety and depression were measured before and after reflexology. Data were collected from October, 2010 to April, 2011. chi2-test, Fisher's exact test, t-test, Wilcoxon signed rank test and the Mann-Whitney U test were used to analyze the data. RESULTS: The experimental group who received foot reflexology experienced less peripheral neuropathy and symptom distress than the control group. There was no difference in anxiety and depression between the experimental and control group. CONCLUSION: The foot reflexology program adopted in this study was found to be an effective method to reduce peripheral neuropathy and symptom distress. We recommend foot reflexology for patients with chemotherapy induced peripheral neuropathy.
Anxiety* ; Depression* ; Drug Therapy ; Foot* ; Humans ; Massage* ; Peripheral Nervous System Diseases*

PURPOSE: The purpose of management of the donor is to maintain a moist condition that promotes healing process and prevents pain, infection. We have performed a prospective study to compare the usefulness between Aquacel Ag(R) and Mepitel(R). METHODS: 36 consecutive patients, in whom STSG was performed, were included into the study. STSG are harvested as a usual manner and the donor site are dressed with Aquacel Ag(R) or Mepitel(R), alternatively. The usefulness are compared with re-epithelialization, pain, frequency to change the second dressing, and ease of application. RESULTS: There are no differences in the days of re-epithelialization, pain perception of patients, but significantly differences in frequency to change the second dressing, and ease of application. Aquacel Ag(R) is better than Mepitel(R). CONCLUSION: We concluded that Aquacel Ag(R) dressing is better than Mepitel(R) for STSG donor site just in the frequency to change the second dressing and ease of application.
Bandages ; Carboxymethylcellulose Sodium ; Humans ; Pain Perception ; Prospective Studies ; Re-Epithelialization ; Skin ; Tissue Donors ; Transplants

The purpose of this study was to investigate the effect of 3-month nutrition education (First Time Intervention, FI) + additional 3-month nutrition education (Repeated Intervention, RI) which was performed after the 8-month follow-up. FI was conducted during 0-3 months and RI for 11-14 months. Ninety-two subjects completed FI program, and 38 out of 92 subjects who received FI finished the RI. Anthropometric data, dietary assessment (24hr recall) and fasting blood analysis were measured at 0 month, 3 months, 11 months and 14 months time points. After FI (3 mo), waist circumference, triglycerides, total cholesterol were significantly decreased. At 11 month follow-up, body weight, BMI, hip circumference, SBP, DBP were significantly rebounced and HDL cholesterol was significantly decreased. Therefore, the effect of short-term nutrition education was not being sustained. After the secondary nutrition intervention (14 mo), waist circumference and hip circumference were again significantly decreased. Total diet quality index-international (DQI-I) score was significantly increased in both FI group and RI group. The changes in DQI-I scores were significantly correlated with the changes in body weight (r = -0.129, p < 0.05) and counts of nutrition education (r = 0.159, p < 0.05), indicating that effective nutrition education helps improve the diet quality leading to a possible role in CVD prevention among male workers. Although a short-term intervention seems to be a success, the effect was not retained in this study. Therefore, we suggest incorporating nutrition education as a routine program for male worker at worksite.
Body Weight ; Cholesterol ; Cholesterol, HDL ; Diet ; Fasting ; Follow-Up Studies ; Hip ; Humans ; Male ; Triglycerides ; Waist Circumference ; Workplace

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by endothelial cell damage, resulting in microangiopathic hemolytic anemia, thrombocytopenia, and various degrees of neurological and renal impairment caused by microvascular thrombi. It is rare in children and frequently follows a fatal course. TTP is divided into 2 types: one is inherited and associated with ADAMTS-13 gene mutations and the other is acquired and associated with anti-ADAMTS-13 autoantibodies. The measurement of ADAMTS-13 activity in plasma, identification of ADAMTS-13 circulating inhibitor, anti-ADAMTS-13 IgG, and ADAMTS-13 gene sequencing are crucial to the diagnosis of TTP. Plasma exchanges are the first-line treatment for acquired TTP, combined with steroids and immunosuppressive drugs. Here, we describe the case of an adolescent patient with TTP, confirmed by decreased level of ADAMTS-13 activity and an increased level of ADAMTS-13 inhibitor, who was successfully treated by plasma exchanges.
Adolescent ; Anemia, Hemolytic ; Autoantibodies ; Child ; Endothelial Cells ; Humans ; Immunoglobulin G ; Plasma ; Plasma Exchange ; Purpura ; Purpura, Thrombotic Thrombocytopenic ; Steroids ; Thrombocytopenia ; Thrombotic Microangiopathies ; Thymine Nucleotides

Effective nutrition educations for prevention of chronic diseases for the general population are of great importance these days. The purpose of this study was to evaluate the feasibility of nutrition education for cardiovascular risk factor reduction by e-mail education in male workers. The participants were divided into three groups by age; 28-39 age group, 40-49 age group, and 50-59 age group who got regular checkups for anthropometry and biochemistry. The 1 year program consisted of 15 topics containing information about metabolic syndrome (MS) and healthy eating behavior (intake of salt, fat and alcohol). Seven hundred thirty nine participants volunteered for the study [28-39 age group, n = 240; body mass index (BMI) = 24.9 +/- 2.7 kg/m2: 40' group, n = 276; BMI = 24.8 +/- 2.6 kg/m2: 50' group, n = 223; BMI = 24.9 +/- 2.7 kg/m2]. Percentage body fat (p<0.05) and percentage of abdominal fat (p<0.05), total cholesterol (p<0.05), systolic blood pressure (p<0.05), and diastolic blood pressure (p<0.05) were significantly decreased in all participants after the 1 year program. The total number of participants who had MS was decreased from 216 to 199 and especially the incidence of MS was decreased 27% in the group of subjects who were under the age 39. The e-mail worksite nutrition education program shows a substantial contribution to the development of effective CVD and chronic disease control and lifestyle nutrition educations that are applicable to and attractive for the large population at risk.
Abdominal Fat ; Adipose Tissue ; Anthropometry ; Biochemistry ; Blood Pressure ; Body Mass Index ; Cholesterol ; Chronic Disease ; Electronic Mail ; Feeding Behavior ; Humans ; Incidence ; Life Style ; Male ; Population Characteristics ; Risk Factors ; Workplace