BACKGROUND/AIMS: Several noninvasive methods have recently been developed for the evaluation of liver fibrosis. The accuracy of transient elastography (TE), acoustic-radiation-force impulse (ARFI) elastography, and real-time elastography (RTE) in predicting liver fibrosis were evaluated. METHODS: Seventy-four patients who had undergone a liver biopsy within the previous 6 months were submitted to evaluation with TE, ARFI, and RTE on the same day. RESULTS: There were significant correlations between fibrosis stage and liver stiffness measurement (LSM) using the three tested methods: TE, r2=0.272, P=0.0002; ARFI, r2=0.225, P=0.0017; and RTE, r2=0.228, P=0.0015. The areas under the receiver operating characteristic curves (AUROC) for the diagnosis of significant fibrosis (> or =F2, Metavir stage) by TE, ARFI, RTE, TE/platelet count (PLT), velocity of shear wave (Vs)/PLT, and elasticity score (Es)/PLT were 0.727, 0.715, 0.507, 0.876, 0.874, and 0.811, respectively. The AUROC for the diagnosis of cirrhosis by TE, ARFI, RTE, TE/PLT, Vs/PLT, and Es/PLT were 0.786, 0.807, 0.767, 0.836, 0.819, and 0.838, respectively. Comparisons of AUROC between all LSMs for predicting significant fibrosis (> or =F2) produced the following results: TE vs. RTE, P=0.0069; ARFI vs. RTE, P=0.0277; and TE vs. ARFI, P=0.8836. Applying PLT, the ability of each LSM to predict fibrosis stage significantly increased: TE/PLT vs. TE, P=0.0004; Vs/PLT vs. ARFI, P=0.0022; and Es/PLT vs. RTE, P<0.0001. However, the ability to predict cirrhosis was not enhanced, combining LSM and PLT. CONCLUSIONS: TE and ARFI may be better methods for predicting significant liver fibrosis than RTE. This predictive ability increased significantly when accounting for platelet count. However, all of the measures had comparable efficacies for predicting cirrhosis.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; *Elasticity Imaging Techniques ; Female ; Humans ; Liver/pathology ; Liver Cirrhosis/diagnosis/*physiopathology ; Male ; Middle Aged ; Odds Ratio ; Platelet Count ; Predictive Value of Tests ; ROC Curve ; Serum Albumin/analysis ; Severity of Illness Index

BACKGROUND/AIMS: There was a spiking incidence of acute hepatitis A (AHA) in 2009 summer, but it went down drastically after an outbreak of influenza A (H1N1). We assessed the relationship between 2009 H1N1 pandemic and AHA prevalence from August to December 2009. METHODS: We compared AHA cases nationwide and in our hospital for the period from the latter half of 2008 to the end of 2010. H1N1 cases in our hospital from August 2009 to December 2009 were included in the study and the correlation between 2009 H1N1 pandemic and AHA prevalence was assessed. RESULTS: The national surveillance system reported 2,233, 7,895, 15,231 and 7,660 AHA cases from 2007 to 2010, respectively. A similar trend was noted in our hospital in the same periods. Although the national total incidence was increased in 2009, it showed steep decreasing trend line in the final 21 weeks of 2009 (weeks 32-52), as compared with 2008 and 2010. The mean weekly incidence percentage (AHA cases in a week/total in a year) in weeks 32-52 of 2009 was 1.17+/-0.55%, significantly lower than that in 2008 and 2010 (1.61+/-0.43% and 1.56+/-0.51%; p<0.001). Furthermore, we found a significant negative correlation between 2009 H1N1 pandemic and AHA in our hospital for weeks 32-52 of 2009 (r=-0.597; p<0.001). CONCLUSIONS: The widespread occurrence of 2009 H1N1 pandemic highlighted the benefits of health care and good hygiene, such as effective hand washing and wearing of masks, which may have also interrupted hepatitis A virus transmission.
Acute Disease ; Hepatitis A/*epidemiology ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/*epidemiology/virology ; Pandemics ; Prevalence ; Republic of Korea/epidemiology ; Seasons

PURPOSE: The aim of this study was to investigate the effects of new herbal formula (KBMSI-1) on erectile dysfunction in streptozotocin-induced diabetic rat model. MATERIALS AND METHODS: We used male Sprague-Dawley rats aged 12 weeks and divided into three groups; control (n=8), diabetes (DM) (n=8), DM+KBMSI-1 200 mg/kg treatment (n=8) groups. The DM groups received a single intraperitoneal injection of streptozotocin (STZ). Distilled water was administered in the control and DM group. To investigate the penile erection, intracavernosal pressure (ICP) and intracavernosal pressure/mean arterial pressure (ICP/MAP) were recorded in all groups. Serial sections of the penis were used to perform Masson's trichrome stain. We analyzed the expression of nNOS and eNOS concentration in the isolated corpus cavernosum by western blotting. RESULTS: Peak ICP/MAP ratio was markedly increased in the treatment group with KBMSI-1 compared with DM group (p<0.05). Masson's trichrome staining of corpus cavernosum showed increase in smooth muscle volume and the regular arrangement of collagen fibers in KBMSI-1 treatment group compared with DM group. Western blot analysis revealed that the penile expressions of nNOS and eNOS protein were significantly higher in KBMSI-1-treated group than in DM group. CONCLUSIONS: This study showed that herbal formulation of KBMSI-1 enhances the penile erection and the level of eNOS and nNOS expression of penile corpus cavernosum in streptozotocin-induced diabetic rat model.
Aged ; Animals ; Arterial Pressure ; Azo Compounds ; Blotting, Western ; Collagen ; Diabetes Mellitus ; Eosine Yellowish-(YS) ; Erectile Dysfunction ; Humans ; Injections, Intraperitoneal ; Male ; Methyl Green ; Muscle, Smooth ; Penile Erection ; Penis ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Water

BACKGROUND/AIMS: Endoscopic variceal obliteration (EVO), endoscopic variceal ligation (EVL), and balloon-occluded retrograde transvenous obliteration (BRTO) are used to manage gastric variceal bleeding. We compared the re-bleeding rates and survival times of these modalities. METHODS: The study enrolled 103 patients with suspected gastric variceal bleeding between July 2001 and May 2009. For the management of gastric variceal bleeding, 52 patients underwent EVO; 36, EVL; and 15, BRTO. We evaluated their laboratory results and vital signs, and calculated the Child score, Child classification, and Model for End-stage Liver Disease score. Rebleeding was defined as new-onset hematemesis, hematochezia, melena, or endoscopically proven bleeding. Time-to-rebleeding and survival time were examined by Kaplan-Meyer analysis. A value of p<0.05 indicated statistical significance. RESULTS: There were no significant differences in baseline characteristics among the three groups. The overall follow-up period averaged 65.13 months. During follow-up, rebleeding occurred in 17 patients (11 EVO, 5 EVL, and 1 BRTO). The times-to-rebleeding were 63.59, 75.79, and 51.41 months for EVO, EVL, and BRTO, respectively, and did not differ significantly (p=0.515). The median survival times were 77.42, 70.14, and 42.79 months, respectively, and also were not different significantly (p=0.978). CONCLUSIONS: There were no significant differences in the time-to-rebleeding or survival time among EVO, EVL, and BRTO. Further prospective, large-scale studies are needed.
Adult ; Aged ; *Balloon Occlusion ; Enbucrilate/therapeutic use ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/complications/mortality/*therapy ; Humans ; Ligation ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Severity of Illness Index

PURPOSE: We screened more than 350 compounds with an endoperoxide ring structure in search of an anti-leukemic drug and found that compound 127 (c-127) could induce significant cytotoxicity in HL-60 cells. In this study, we investigated the molecular mechanisms of compound 127-induced antitumor activity on HL-60 cells. METHODS: HL-60 cells were cultured in Rosewell Park Memorial Institute 1640 and cell viability was measured by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide], a tetrazole assay. Apoptosis was assessed by a DNA fragmentation test. Apoptotic machineries were determined by Western blot analysis. RESULTS: C-127 could induce a cytotoxic effect at 24 h and apoptosis at 6 h, which was demonstrated with MTT assay and DNA fragmentation test, respectively. The apoptotic effect of this drug was caused by the activation of the intracellular caspase-8,3 activation, the cleavage of pro-apoptotic Bid, and the increase of c-Jun expression accompanied with JNK (Jun N-terminal kinases) phosphorylation. On the contrary, it increased the expression of anti-apoptotic Bcl-2 levels, leading to the induction of the induction of anti-apoptotic effect. Taken together, the present study demonstrated that c-127 was a potent inducer of cytotoxicity on HL-60 cells through apoptotic mechanisms, which included the activation of caspase family, the regulation of Bcl-2 family, and the activation of JNK signaling pathway. CONCLUSION: Our results suggest that c-127 has a strong antitumor activity through the regulation of various apoptotic machineries on HL-60 cells. The compound may be utilized as an effective and potentially therapeutic drug in leukemia.
Apoptosis ; Artemisinins ; Blotting, Western ; Cell Survival ; DNA Fragmentation ; HL-60 Cells ; Humans ; Leukemia ; MAP Kinase Signaling System ; Phosphorylation ; Tetrazoles

PURPOSE: Chlormadinone acetate (CMA) therapy for benign prostatic hyperplasia (BPH) may lower the serum prostate specific antigen (PSA) level. However, little is known about the effect of CMA on the total or free serum PSA levels of PSA. Such information would be important since PSA testing is useful for prostate cancer screening. Thus, we prospectively studied the effect of CMA therapy on the total and free serum PSA levels. MATERIALS AND METHODS: The patients with lower urinary tract symptoms (LUTS) and BPH who were aged over 50 years were treated with 50mg CMA for 6 months. Men with a PSA level greater than 10ng/ml were excluded to reduce the likelihood of including cases of occult prostate cancer. Those with suspicious findings on the digital rectal examination and serum PSA testing were biopsied to rule out prostate cancer. alpha- blocking agents were permitted to treat the men with LUTS. Serum levels of the total and free PSA were measured at the study baseline and after approximately 3 and 6 months. The prostate volume (PV) was assessed by transrectal ultrasonography. RESULTS: The analysis included 170 patients with a mean age of 67.9 years, a baseline PV of 47.3ml and a baseline total PSA of 4.1ng/ml. The total PSA levels declined from 4.1ng/ml at baseline to 2.0ng/ml after 6 months of treatment (50.7% decrease, p<0.01). The mean percent free PSA (21% to 22% at baseline) was not significantly altered by CMA treatment. The PSA levels and PV at baseline did not affect the rate of decline of PSA. CONCLUSIONS: The total PSA serum levels decreased by an average of 50% during CMA therapy, but the percent free PSA did not change significantly. This information is potentially useful in the interpretation of the PSA data that's used for early detection of prostate cancer in the men receiving CMA.
Chlormadinone Acetate* ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Mass Screening ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Ultrasonography

Phenobarbital is long acting barbiturate with low lipid solubility that act as central nervous system depressants and used as anticonvulsant, sedative, hypnotic drug. In acute severe barbiturate intoxication, through CNS depression, coma, respiratory arrest and hypotension may occur, which are the major causes of mortality. Mortality is 3% for blood levels over 80 mg/mL and the lethal dose in adult is estimated as 6 to 10 g. We report a case of phenobarbital intoxication in a 20 years old female, who was successfully treated by emergency hemoperfusion. She was in semicomatous state and had respiratory difficulty on the day of admission. It was estimated that she intakes 1.6 g of phenobarbital. She was treated with mechanical ventilation, urine alkalization and charcoal administration. Hemoperfusion was attempted to remove rapidly phenobarbital from blood. After hemoperfusion the blood phenobarbital level was decreased from 96 mg/mL to 67 mg/mL. On 2nd hospital day, the blood phenobarbital level was 56 mg/mL and she recovered her self respiration and mentality.
Adult ; Central Nervous System Depressants ; Charcoal ; Coma ; Depression ; Emergencies ; Female ; Hemoperfusion* ; Humans ; Hypotension ; Mortality ; Phenobarbital* ; Respiration ; Respiration, Artificial ; Solubility ; Young Adult

Amlodipine, a calcium channel blocker (CCB) belonging to the group of dihydropyridines, is characterized by a slower onset of action (6-8h), a longer duration of action (24-72h), a greater vascular, cardiac effect, and hyperglycemia. Case of intoxication with 300 mg of amlodipine in a 69-year-old female patient and with 450 mg of amlodipine and 120 mg of glimepride in a 64-year-old female patient caused severe hypotension and hyperglycemia. They were initially treated with fluids, dopamine and norepinephrine, but these therapy were ineffective. Then, the patients were given a bolus injection of insulin and continuous infusion of insulin. The former patient's hyperglycemia was not controlled. She expired in 47 hours. The latter one's hyperglycemia was controlled and then her hypotension improved. In conclusion, it is suggested that hyperinsulinemia-euglycemia therapy be considered as a first-line therapy in calcium channel blocker intoxication.
Aged ; Amlodipine* ; Calcium Channels ; Dihydropyridines ; Dopamine ; Female ; Humans ; Hyperglycemia* ; Hypotension ; Insulin ; Middle Aged ; Norepinephrine

BACKGROUND: The goal of this study is to evaluate the differences of the rate and the ratio of heart rate changes, which is well known to reflect the vagal reactivation, after peak exercise between ischemic heart disease and normal during treadmill exercise test. Additionally R-wave amplitude changes are evaluated to have the discriminal power between ischemic heart disease and normal. METHODS: We have studied 253 human (196 control, 57 patients) who took the symptom-limited exercise test using Marquette case 8000 model. The 57 patients who showed the positive result by exercise test have confirmed by coronary angiography. The rate of heart rate changes was defined as the absolute difference of the heart rate subtracted by the just-previous stage heart rate. The ratio of heart rate changes was defined as the percentile of the rate of heart rate changes comparing to the just-previous stage heart rate. The changes of R-wave amplitude at lead V5 and aVF were obtained by the subtraction of R-wave amplitude at the peak exercise stage from that at the standing rest stage respectively. Additively heart rate recovery was defined as the rate of heart rate change which was obtained at 1 minute later after peak exercise. RESULTS: In patients and control, the resting heart rate were 70 +/- 13 bpm and 69 +/- 11 bpm (p>0.05), and the peak heart rate were 136 +/- 22 bpm and 155 +/- 18 bpm respectively (p<0.001). The rate of heart rate changes in patients group were significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p<0.001, p=0.008, p=0.002). The ratio of heart rate changes in patients group were also significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p=0.017, p=0.027, p=0.002). With comparing both groups, the incidences of ventricular ectopy were not different during exercise and recovery stages, and the difference in the changes of R-wave amplitude at lead V5 and aVF were not observed respectively. CONCLUSION: The rate and ratio of heart rate changes are significantly lower in iscemic heart disease than in normal, and these are resulted from the depression of vagal reactivation. These findings are supplemental to make a diagnosis and a arrhythmic risk stratification of ischemic heart disease.
Coronary Angiography ; Depression ; Diagnosis ; Exercise Test ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Incidence ; Myocardial Ischemia*

Statin-induced rhabdomyolysis is a frequent complication in renal transplant recipients receiving cyclosporine, but incidences are different between different types of statins. Statins have different pharmacokinetic properties. Atorvsatatin, simvastatin, lovastatin, and cerivastatin are all metabolized by the cytochrome P450 isoenzyme 3A4 and co-administration of cyclosporine which may inhibit cytochrome P450 isoenzyme 3A4, increases statin levels and therefore increases the risk of rhabdomyolysis. Fluvastatin is metabolized by cytochrome P450 isoenzyme 2C9 and no clinically significant interactions with cyclosporine have been reported. Atorvastatin with co-administration of cyclosporine in renal transplant patients may induce drug interactions, therefore we recommend the routine monitoring of muscle enzymes, in these cases. Here, we reported a case of rhabdomyolysis in a patient who received atorvastatin and cyclosporine with the review of the literature.
Cyclosporine ; Cytochrome P-450 Enzyme System ; Drug Interactions ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Lovastatin ; Rhabdomyolysis* ; Simvastatin ; Transplantation* ; Atorvastatin Calcium