Hyun Kuk Kim

Additional role of sarcopenia to waist circumference in predicting the odds of metabolic syndrome.

BACKGROUND & AIMS It is unclear whether sarcopenia contributes to the prediction of metabolic dysregulations in addition to that predicted by waist circumference. METHODS Subjects consisted of 6832 adult participants in the 2009 Korea National Health and Nutrition Examination Survey, grouped into categories of waist circumference (normal vs. high). Sarcopenia was assessed by appendicular skeletal muscle mass divided by weight. RESULTS In the normal waist circumference category, the risk of metabolic syndrome was nearly 3.5-fold higher in sarcopenic men (OR, 3.39; 95% CI, 1.67-6.90) than in those without sarcopenia. For the high waist circumference category, the risk of metabolic syndrome was 2.5-fold higher in sarcopenic women (OR, 2.37; 95% CI, 1.66-3.40) than in those without sarcopenia. The corresponding risk was also higher in sarcopenic men (OR, 1.81; 95% CI, 1.11-2.94) than in those without sarcopenia. With the exception in men with high waist circumference category, adjustments for other potential confounders did not substantially affect the results. Appendicular skeletal muscle mass divided by weight as a continuous variable was also associated with metabolic syndrome in men (OR, 0.39; 95% CI, 0.35-0.44) and women (OR, 0.53; 95% CI, 0.48-0.60). CONCLUSIONS Sarcopenia is associated with metabolic syndrome in men with normal waist circumference and women with high waist circumference. Our results emphasize that sarcopenia may contribute additionally to the risk of metabolic abnormalities beyond what is predicted by the abdominal obesity category.

Zabofloxacin versus moxifloxacin in patients with COPD exacerbation: a multicenter, double-blind, double-dummy, randomized, controlled, Phase III, non-inferiority trial.

A new quinolone, zabofloxacin, has now been developed; hence, a non-inferiority trial is needed to compare this new compound with another widely used quinolone to examine its efficacy and safety for the treatment of chronic obstructive pulmonary disease (COPD) exacerbations. This was a prospective, multicenter, double-blind, double-dummy, randomized, controlled, parallel-group, Phase III, non-inferiority clinical trial designed to compare oral zabofloxacin (367 mg once daily for 5 days) with moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation. In all, 345 COPD patients with a moderate COPD exacerbation were enrolled in the study via the outpatient clinics at 31 university hospitals. Clinical per protocol analysis revealed that the clinical cure rate for zabofloxacin was 86.7% and that for moxifloxacin was 86.3% (the rate difference, 0.4%; 95% confidence interval, −7.7%–8.6%). Intention-to-treat analysis revealed clinical cure rates of 77.1% and 77.3% (difference, −0.2%; 95% confidence interval, −9.0%–8.8%), respectively. These results confirm that zabofloxacin is not inferior to moxifloxacin. The favorable microbiological response rate for zabofloxacin was 67.4% and that for moxifloxacin was 79.5% (P=0.22). Patients in the zabofloxacin group showed better patient-oriented outcomes, as measured by EXAcerbations of Chronic Pulmonary Disease Tool-Patient-Reported Outcome and the COPD assessment test scores, than patients in the moxifloxacin group. Adverse drug reactions related to zabofloxacin occurred in 9.7% of cases and those related to moxifloxacin occurred in 9.6% of cases (P=0.97). The dropout rate due to adverse events was 0% (0/175) in the zabofloxacin group and 1.8% (3/167) in the moxifloxacin group (P=0.12). Oral zabofloxacin (367 mg once daily for 5 days) was not inferior to oral moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation.

Prevalence of Alcoholic Liver Disease Among Korean Adults: Results From the Fourth Korea National Health and Nutrition Examination Survey, 2009

Background/Aim: Alcohol consumption continues to be a common cause of acute and chronic liver disease. Methods: Data from a representative sample of 7,893 adults in the Korean National Health and Nutrition Examination Survey 2009 were analyzed. Alcoholic liver disease (ALD) was defined through heavy alcohol consumption (≥40 g/day for men or ≥20 g/day for women) and through elevated liver tests. Results: Approximately 6.7% (95% confidence interval [CI], 6.0–7.4) was at heavy alcohol consumption. Of these “heavy alcohol consumers,” one quarter also had ALD. The prevalence of ALD was 1.7% (95% CI, 1.3–2.1). Conclusion: ALD is still a burden in the Korean population.

Incidental Diagnosis of the Unicuspid Aortic Valve with Ascending Aortic Aneurysm in an Asymptomatic Adult

The unicuspid aortic valve is an extremely rare congenital anomaly. It usually presents with aortic stenosis and/or aortic regurgitation. Other cardiovascular complications, such as aortic dilatation and left ventricular hypertrophy can accompany it. Herein, we present a case report of a 50-year-old asymptomatic male patient with unicuspid aortic valve, complicated by ascending aortic aneurysm.

Stanford type A aortic dissection secondary to infectious aortitis: a case report.

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Potential Therapeutic Strategy in Chronic Obstructive Pulmonary Disease Using Pioglitazone-Augmented Wharton's Jelly-Derived Mesenchymal Stem Cells

Background A recent study reported that mesenchymal stem cells possess potential cellular therapeutic properties for treating patients with chronic obstructive pulmonary disease, which is characterized by emphysema. We examined the potential therapeutic effect of Whartons Jelly-derived mesenchymal stem cells (WJMSCs), following pretreatment with pioglitazone, in lung regeneration mouse emphysema models. Methods We used two mouse emphysema models, an elastase-induced model and a cigarette smoke-induced model. We intravenously injected WJMSCs (1×104/mouse) to mice, pretreated or not, with pioglitazone for 7 days. We measured the emphysema severity by mean linear intercepts (MLI) analysis using lung histology. Results Pioglitazone pretreated WJMSCs (pioWJMSCs) were associated with greater lung regeneration than non-augmented WJMSCs in the two mouse emphysema models. In the elastase-induced emphysema model, the MLIs were 59.02±2.42 µm (n=6), 72.80±2.87 µm (n=6), for pioWJMSCs injected mice, and non-augmented WJMSCs injected mice, respectively (p<0.01). Both pioWJMSCs and non-augmented WJMSCs showed regenerative effects in the cigarette smoke emphysema model (MLIs were 41.25±0.98 [n=6] for WJMSCs and38.97±0.61 µm [n=6] for pioWJMSCs) compared to smoking control mice (51.65±1.36 µm, n=6). The mean improvement of MLI appeared numerically better in pioWJMSCs than in non-augmented WJMSCs injected mice, but the difference did not reach the level of statistical significance (p=0.071). Conclusion PioWJMSCs may produce greater lung regeneration, compared to non-augmented WJMSCs, in a mouse emphysema model.

Development of a spirometry T-score in the general population

Background and objective Spirometry values may be expressed as T-scores in standard deviation units relative to a reference in a young, normal population as an analogy to the T-score for bone mineral density. This study was performed to develop the spirometry T-score. Methods T-scores were calculated from lambda-mu-sigma-derived Z-scores using a young, normal age reference. Three outcomes of all-cause death, respiratory death, and COPD death were evaluated in 9,101 US subjects followed for 10 years; an outcome of COPD-related health care utilization (COPD utilization) was evaluated in 1,894 Korean subjects followed for 4 years. Results The probability of all-cause death appeared to remain nearly zero until −1 of forced expiratory volume in 1 second (FEV1) T-score but increased steeply where FEV1 T-score reached below −2.5. Survival curves for all-cause death, respiratory death, COPD death, and COPD utilization differed significantly among the groups when stratified by FEV1 T-score (P<0.001). The adjusted hazard ratios of the FEV1 T-score for the four outcomes were 0.54 (95% confidence interval, 0.48–0.60), 0.43 (95% CI: 0.37–0.50), 0.30 (95% CI: 0.24–0.37), and 0.69 (95% CI: 0.59–0.81), respectively, adjusting for covariates (P<0.001). Conclusion The spirometry T-score could predict all-cause death, respiratory death, COPD death, and COPD utilization.

Cox-Maze III procedure with valvular surgery in an autopneumonectomized patient.

Destructive pulmonary inflammation can leave patients with only a single functional lung, resulting in anatomical and physiological changes that may interfere with subsequent cardiac surgeries. Such patients are vulnerable to perioperative cardiopulmonary complications. Herein, we report the first case, to our knowledge, of an autopneumonectomized patient who successfully underwent a modified Cox-Maze III procedure combined with valvular repairs. The three major findings in this case can be summarized as follows: (1) a median sternotomy with peripheral cannulations, such as femoral cannulations, can provide an optimal exposure and prevent the obstruction of vision that may occur as a result of multiple cannulations through a median sternotomy; (2) a modified septal incision combined with biatrial incisions facilitate adequate exposure of the mitral valve; and (3) the aggressive use of intraoperative ultrafiltration may be helpful for the perioperative managements as decreasing pulmonary water contents, thereby avoiding the pulmonary edema associated with secretion of inflammatory cytokines during a cardiopulmonary bypass. We also provide several suggestions for achieving similar satisfactory surgical outcomes in patients with a comparable condition.