BACKGROUND AND PURPOSE: To compare the efficacy and safety of antiplatelet agents for the secondary prevention of ischemic stroke based on cytochrome P450 2C19 (CYP2C19) polymorphisms. METHODS: This study was a prospective, multicenter, randomized, parallel-group, open-label, blind genotype trial. First time non-cardiogenic ischemic stroke patients were enrolled and screened within 30 days. Participants were randomized to receive either triflusal or clopidogrel for secondary stroke prevention. The primary outcome was the time from randomization to first recurrent ischemic stroke or hemorrhagic stroke. RESULTS: The required sample size was 1,080 but only 784 (73%) participants were recruited. In patients with a poor CYP2C19 genotype for clopidogrel metabolism (n=484), the risk of recurrent stroke among those who received triflusal treatment was 2.9% per year, which was not significantly different from those who received clopidogrel treatment (2.2% per year; hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.60–2.53). In the clopidogrel treatment group (n=393), 38% had good genotypes and 62% poor genotypes for clopidogrel metabolism. The risk of recurrent stroke in patients with a good CYP2C19 genotype was 1.6% per year, which was not significantly different from those with a poor genotype (2.2% per year; HR, 0.69; 95% CI, 0.26–1.79). CONCLUSIONS: Whilst there were no significant differences between the treatment groups in the rates of stroke recurrence, major vascular events, or coronary revascularization, the efficacy of antiplatelet agents for the secondary prevention of stroke according to CYP2C19 genotype status remains unclear.
Cytochrome P-450 CYP2C19 ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Genotype ; Humans ; Metabolism ; Platelet Aggregation Inhibitors ; Prospective Studies ; Random Allocation ; Recurrence ; Sample Size ; Secondary Prevention* ; Stroke*

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of pulmonary valve replacement (PVR) on exercise capacity and determine cardiopulmonary exercise (CPEX) parameters associated with improvement in right ventricle (RV) function. SUBJECTS AND METHODS: We retrospectively analyzed CPEX and magnetic resonance imaging parameters in a total of 245 patients who underwent PVR from January 1998 to October 2015. In addition, we analyzed the characteristics of the patients who showed improved exercise capacity after PVR. RESULTS: Twenty-eight patients met the inclusion criteria for the study. CPEX parameters after PVR showed no significant changes in all patients. However, baseline predicted peak oxygen uptake (VO2(peak)) (%) value was significantly lower in patients with significant improvement in exercise capacity after PVR, as compared to patients who showed decreased exercise capacity after PVR (60.83±10.28 vs. 75.81±13.83) (p=0.003). In addition, patients with improved exercise capacity showed a positive correlation between the change of right ventricular ejection fraction (RVEF) (%) and the change of anaerobic threshold (r=0.733, p=0.007); whereas, patients with decreased exercise capacity showed a negative correlation between the change of RVEF (%) and the change of predicted VO2(peak) (%) (r=−0.575, p=0.020). CONCLUSION: The importance of predicted VO2(peak) (%) in evaluating exercise capacity differentiated from other CPEX variables. The change of anaerobic threshold and predicted VO2(peak) (%) might be a useful predictor of the change in RV function after PVR.
Anaerobic Threshold ; Exercise Test ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Oxygen ; Pulmonary Valve* ; Retrospective Studies ; Stroke Volume ; Tetralogy of Fallot*

BACKGROUND: Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare inherited disorder characterized by infantile-onset macrocephaly, slow neurologic deterioration, and seizures. Mutations in the causative gene, MLC1, are found in approximately 75% of patients and are inherited in an autosomal recessive manner. We analyzed MLC1 mutations in five unrelated Korean patients with MLC. METHODS: Direct Sanger sequencing was used to identify MLC1 mutations. A founder effect of the p.Ala275Asp variant was demonstrated by haplotype analysis using single-nucleotide polymorphic (SNP) markers. Multiple ligation-dependent probe amplification (MLPA) and comparative genomic hybridization plus SNP array were used to detect exonic deletions or uniparental disomy (UPD). RESULTS: The most prevalent pathogenic variant was c.824C>A (p.Ala275Asp) found in 7/10 (70%) alleles. Two pathogenic frameshift variants were found: c.135delC (p.Cys46Alafs*12) and c.337_353delinsG (p.Ile113Glyfs*4). Haplotype analysis suggested that the Korean patients with MLC harbored a founder mutation in p.Ala275Asp. The p.(Ile113Glyfs*4) was identified in a homozygous state, and a family study revealed that only the mother was heterozygous for this variant. Further analysis of MLPA and SNP arrays for this patient demonstrated loss of heterozygosity of chromosome 22 without any deletion, indicating UPD. The maternal origin of both chromosomes 22 was demonstrated by haplotype analysis. CONCLUSIONS: This study is the first to describe the mutational spectrum of Korean patients with MLC, demonstrating a founder effect of the p.Ala275Asp variant. This study also broadens our understanding of the mutational spectrum of MLC1 by demonstrating a homozygous p.(Ile113Glyfs*4) variant resulting from UPD of chromosome 22.
Alleles ; Chromosomes, Human, Pair 22* ; Comparative Genomic Hybridization ; Exons ; Founder Effect ; Haplotypes ; Humans ; Leukoencephalopathies* ; Loss of Heterozygosity ; Megalencephaly ; Mothers ; Seizures ; Uniparental Disomy*

PURPOSE: Generally, aspirin is used as a protective agent against thrombogenic phenomenon after pulmonary valve replacement (PVR) using a bioprosthetic valve. However, the appropriate duration of aspirin use is unclear. We analyzed the impact of postoperative duration of aspirin use on the longevity of bioprosthetic pulmonary valves in patients who underwent repair for congenital heart diseases. METHODS: We retrospectively reviewed the clinical data of 137 patients who underwent PVR using a bioprosthetic valve between January 2000 and December 2003. Among these patients, 89 were included in our study and divided into groups I (≤12 months) and II (>12 months) according to duration of aspirin use. We analyzed echocardiographic data from 9 to 11 years after PVR. Pulmonary vale stenosis and regurgitation were classified as mild, moderate, or severe. RESULTS: The 89 patients consisted of 53 males and 36 females. Their mean age was 14.3±8.9 years (range, 2.6–48 years) and body weight was 37.6±14.7 kg (range, 14–72 kg). The postoperative duration of aspirin use was 7.3±2.9 months in group I and 32.8±28.4 months in group II. However, no significant difference in sex ratio, age, body weight, type of bioprosthetic valve, and number of early redo-PVRs. In the comparison of echocardiographic data about 10 years later, no significant difference in pulmonary valve function was found. The overall freedom rate from redo-PVR at 10 years showed no significant difference (P=0.498). CONCLUSION: Our results indicated no benefit from long-term aspirin medication (>6 months) in patients who underwent PVR with a bioprosthetic valve.
Aspirin* ; Body Weight ; Constriction, Pathologic ; Echocardiography ; Female ; Freedom ; Heart Defects, Congenital* ; Heart Diseases ; Humans ; Longevity* ; Male ; Pulmonary Valve* ; Retrospective Studies ; Sex Ratio

Anti-inflammatory effects of Houttuynia cordata supercritical extract (HSE) were investigated in a carrageenan-air pouch model. HSE (200 mg/kg, oral) suppressed exudation and albumin leakage, as well as inflammatory cell infiltration. Dexamethasone (2 mg/kg, i.p.) only decreased exudation and cell infiltration, while indomethacin (2 mg/kg, i.p.) reduced exudate volume and albumin content. HSE lowered tumor-necrosis factor (TNF)-alpha and nitric oxide (NO), as well as prostaglandin E2 (PGE2). Dexamethasone only reduced TNF-alpha and NO, while indomethacin decreased TNF-alpha and PGE2. The suppressive activity of HSE on NO and PGE2 production was confirmed in RAW 264.7. These results demonstrate that HSE exerts anti-inflammatory effects by inhibiting both TNF-alpha-NO and cyclooxygenase II-PGE2 pathways.
Analysis of Variance ; Animals ; Anti-Inflammatory Agents/*pharmacology ; Carrageenan ; Cell Line, Tumor ; Dexamethasone/pharmacology ; Dinoprostone/metabolism ; Drugs, Chinese Herbal/*pharmacology ; Immunoenzyme Techniques ; Indomethacin/pharmacology ; Male ; Mice ; Mice, Inbred ICR ; Nitric Oxide/metabolism ; Signal Transduction/*drug effects ; Therapeutic Irrigation ; Tumor Necrosis Factor-alpha/metabolism

Rudimentary uterus with ipsilateral renal agenesis is a very rare Mullerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An appropriate and prompt diagnosis and treatment will prevent unnecessary procedures and offer relief of symptoms. We report one case of rudimentary uterine horn with ipsilateral renal agenesis with a brief review of concerned literatures.
Animals ; Diagnosis ; Dysmenorrhea ; Female ; Horns ; Menarche ; Pelvic Pain ; Unnecessary Procedures ; Uterus*

Choledocholithiasis caused by a foreign body is rare. The most common type of foreign body in the common bile duct is a residual object from previous surgery such as a metal clip or suture material. Foreign body may enter the biliary system after choledochointestinal anastomosis or endoscopic sphincterotomy. Rarely, penetrating missile fragment or gunshot shrapnel account for another type of foreign body. We experienced a case of common bile duct (CBD) stone caused by foreign meterial in 75-years-old women who had a plant foreign body in the common bile duct. She had no past history of abdominal surgery or penetrating trauma. The foreign body and stone were successfully extracted with Dormia basket after the endoscopic sphincterotomy.
Adenoma* ; Ampulla of Vater* ; Biliary Tract ; Choledocholithiasis ; Common Bile Duct* ; Female ; Foreign Bodies* ; Humans ; Plants ; Sphincterotomy, Endoscopic ; Sutures

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.
Cholesterol ; Cimicifuga* ; Female ; Hormone Replacement Therapy* ; Humans ; Prospective Studies ; Triglycerides

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.
Cholesterol ; Cimicifuga* ; Female ; Hormone Replacement Therapy* ; Humans ; Prospective Studies ; Triglycerides

OBJECTIVE: To evaluate the clinical significance and the optimal management of atypical squamous cells of undetermined significance (ASCUS) in Papanicolaou cervical smears. METHOD: This study included 25380 cases of cervical Pap smears received from January 1995 to June 2000 by the Department of Obstetrics & Gynecology, Inha Hospital, Medical College, the Inha University. Retrospective review was done on 384 cases of ASCUS. RESULT: ASCUS and squamous intraepithelial lesions (SIL) were diagnosed in 384 cases (1.5%), and 311 cases (1.1%), respectively. The ratio of ASCUS to SIL was 1.2. Colposcopic directed biopsies revealed 14 cases (14.1%) of low grade SIL (LSIL), 21 cases (21.2%) of high grade SIL (HSIL), and 2 cases (2.0%) of squamous cell carcinoma. CONCLUSION: The immediate colposcopy with biopsy in women with ASCUS may decrease follow-up visits for Pap testing, reduce patient anxiety, minimize the loss of high risk cases during follow-up and lower medicolegal litigation. The early colposcopy may be the method of choice for follow-up in women with ASCUS in Korea.
Anxiety ; Biopsy ; Carcinoma, Squamous Cell ; Colposcopy ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Jurisprudence ; Korea ; Obstetrics ; Retrospective Studies ; Vaginal Smears*