Jinho Shin

Acute abdominal pain in systemic lupus erythematosus: focus on lupus enteritis (gastrointestinal vasculitis)

Objective: To determine the causes of acute abdominal pain in systemic lupus erythematosus (SLE) and to compare the clinical and laboratory data, especially antiphospholipid antibodies and the SLE Disease Activity Index (SLEDAI), between lupus enteritis (gastrointestinal vasculitis) and acute abdominal pain without lupus enteritis in patients with SLE. Methods: A retrospective study was carried out for all patients admitted with SLE from 1993 to March 2001. The SLEDAI and laboratory data were collected at the time of diagnosis of SLE and at the time of acute abdominal pain. Lupus enteritis (gastrointestinal vasculitis) was diagnosed by clinical investigation and abdominal computed tomographic findings. Results: Chart review identified 175 patients (20 male, 155 female) who had been admitted with SLE. Of these patients, 38 (22%) presented with acute abdominal pain. Lupus enteritis was the most common cause of acute abdominal pain. Patients were divided into three groups: group 1: lupus enteritis (n=17), group 2: acute abdominal pain without lupus enteritis (n=21), and group 3: SLE without acute abdominal pain (n=137). There was no difference in age and sex among the three groups. Antiphospholipid, anti-RNP, anti-Sm, anti-Ro, and anti-La antibodies did not differ among the three groups. There was no difference in the SLEDAI at the time of diagnosis and at the time of acute abdominal pain between groups 1 and 2. Complement, erythrocyte sedimentation rate, C reactive protein, and anti-dsDNA measured at the time of acute abdominal pain did not differ between groups 1 and 2. A drop in the white blood cell count at the time of abdominal pain was more prominent in group 1 than group 2. In lupus enteritis, the jejunum and ileum were the sites most commonly affected. Rectal involvement was rare. Even though four patients relapsed, all the patients with lupus enteritis, including those who relapsed, responded well to corticosteroid. Conclusion: Lupus enteritis is the most common cause of acute abdominal pain in SLE. All patients with lupus enteritis responded well to a high dose of a corticosteroid without surgical intervention. The SLEDAI and laboratory data, except leucopenia, do not correlate with the occurrence of lupus enteritis.

A potent opiate agonist protects against myocardial stunning during myocardial ischemia and reperfusion in rats

ObjectiveOpioids have a cardioprotective effect during ischemia. Previously, we showed in an ex-vivo model of myocardial ischemia and reperfusion that 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2, a highly potent and long-acting opioid peptide analgesic with fewer side effects than morphine, provides improved cardioprotection compared with morphine. The purpose of this study was to confirm, in an in-vivo model, the cardioprotective effect of 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2. MethodsRats (n=6/group) were randomized to 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2 therapy (intravenous 10 nmol bolus 30 min before ligation and 10 nmol/h continuous infusion), morphine (100 nmol bolus and 100 nmol/h infusion), or placebo, and underwent left anterior descending (LAD) ligation for 10 min followed by reperfusion for 30 min. Continuous transesophageal echocardiogram and electrocardiogram were monitored. Fractional shortening and systolic wall thickening of the ischemic area were calculated. Time to recovery of left ventricular function was the duration of time needed for fractional shortening to recover to 90% of baseline following reperfusion. Duration of reperfusion arrhythmia was the time to the cessation of salvo (at least three consecutive premature ventricular contractions (PVCs)) following reperfusion. ResultsTime to recovery of left ventricular function was significantly shorter in the 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2 (4.4±2.2 min) and morphine groups (6.0±2.5 min) than in the controls (10.5±2.2 min; p<0.01). The 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2 group showed significantly higher fractional shortening and systolic wall thickening of the ischemic area than the control group. Duration of reperfusion arrhythmia was also significantly shorter in the 2′,6′-dimethyltyrosine-D-Arg-Phe-Lys-NH2 (2.8±1.7 min) and morphine groups (5.8±3.9 min) than in the controls (11.8±2.0 min; p<0.05). Conclusion2′,6′-Dimethyltyrosine-D-Arg-Phe-Lys-NH2 provides a cardioprotective effect against myocardial ischemia and reperfusion in vivo.

Sex-Specific Characteristics of Anthropometry in Patients With Obstructive Sleep Apnea: Neck Circumference and Waist–Hip Ratio

Objective: This study aimed to investigate the sex-specific effects of anthropometric profiles on the occurrence and severity of obstructive sleep apnea (OSA). Methods: We evaluated 151 patients with suspected OSA undergoing polysomnography and anthropometric measurements such as body mass index (BMI), neck and waist circumference (NC and WC), and waist–hip ratio (WHR). Results: In men, NC (P = .006), WC (P = .035), and WHR (P = .003) were significantly increased in OSA and all were significantly correlated with apnea hypopnea index (AHI). However, in female OSA patients, BMI (P = .05), WC (P = .008), and WHR (P = .001) were elevated, but only WHR was significantly correlated with AHI. Correlation analyses showed significant correlations between NC and other anthropometric indexes in men but not in women. The receiver operating characteristic curves revealed that NC and WHR in men, and WHR in women, were significant in both model 1 (AHI ≥ 5) and model 2 (AHI ≥ 15). Conclusion: Waist–hip ratio is the most reliable correlate of OSA in both sexes. Neck circumference is an independent risk factor for male, but not for female, OSA patients. These different aspects of obesity may contribute to the pathogenesis of OSA and provide helpful guidance in the screening of OSA.

Body Fat Distribution After Menopause and Cardiovascular Disease Risk Factors: Korean National Health and Nutrition Examination Survey 2010

BACKGROUND The prevalence of cardiovascular disease in women increases sharply after menopause. The purpose of this study was to clarify the relationship between menopause and body fat distribution and to investigate their association with cardiovascular disease risk factors. METHODS We analyzed 2035 women 20-79 years of age using the National Health and Nutrition Examination Survey (KNHANES) 2010 database. Body fat was measured using dual-energy X-ray absorptiometry. RESULTS The percentage of total body fat and the body fat distribution (BFD) index (the ratio of the trunk fat mass to leg fat mass) are significantly higher in postmenopausal women than in premenopausal women (all p<0.001). When adjusted for age, menopause was associated with higher total body fat percentage (adjusted β=1.082, 95% confidence interval [CI] 0.074-2.090, p=0.035). In women with a body mass index<25 kg/m(2), the higher BFD index was also independently associated with menopause (adjusted β=14.408, 95% CI 1.672-27.145, p=0.027). After adjusting for age and body fat percentage, the BFD index showed significant and independent associations with systolic and diastolic blood pressure (adjusted β=0.060 and 0.042, all p<0.001, respectively), fasting glucose (adjusted β=0.007, p<0.001), total and high density lipoprotein cholesterol (adjusted β=0.001 and -0.002, p<0.05 and p<0.001, respectively), and triglyceride levels (adjusted β=0.007, p<0.001- except for low density lipoprotein cholesterol. CONCLUSIONS After menopause, women have not only higher total body fat percentage but also its different distribution, which independently correlates with cardiovascular disease risk factors. Therefore, this change in body fat may cause the sharp increase in cardiovascular disease incidence in middle-aged women, especially after menopause.

Arterial stiffness, fatty liver and the presence of coronary artery calcium in a large population cohort

BackgroundWe tested whether fatty liver, brachial-ankle pulse wave velocity (baPWV) and conventional cardiovascular risk factors were associated with a coronary artery calcium (CAC) score > 0 (as a marker of the presence of early atherosclerosis) in a cohort of healthy Korean adults.MethodThe study population consisted of individuals who underwent a comprehensive health examination in 2010 at Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University in South Korea. The 6009 subjects of total 7371 participants who had an assigned CAC score following coronary computed tomography (CT) scanning and baPWV were analyzed.ResultsAmong the study subjects, 39.2% of the population had evidence of fatty liver by ultrasound and 4.6% of the population had evidence of CAC score > 0. Among individuals with a CAC score = 0, 38% of the individuals had fatty liver compared with 58% of the individuals with a CAC score > 0. The individuals with a CAC score > 0 also had higher blood pressure and had more metabolic abnormalities. The prevalence of CAC score > 0 was increased according to baPWV quartiles and was higher in the fatty liver group in comparison with those without fatty liver. The odds ratio for CAC score > 0, after adjusting for clinical risk factors, showed a significant elevation with increasing quartiles of baPWV and the presence of fatty liver.ConclusionWe showed that both fatty liver and baPWV are independently associated with the presence of CAC, a marker of preclinical atherosclerosis. These associations are independent of conventional risk factors and medical history.

Effects of granulocyte-colony stimulating factor (G-CSF) on diabetic cardiomyopathy in Otsuka Long-Evans Tokushima Fatty rats

BackgroundDiabetic cardiomyopathy (CMP) is a common and disabling disease in diabetic patients, however no effective treatments have been developed. Although granulocyte-colony stimulating factor (G-CSF) improves heart function in myocardial infarction, its effect on non-ischemic CMP such as diabetic CMP is unknown. In the present study, we investigated the effects of G-CSF on diabetic CMP in a rat model of type II diabetes.MethodsTwenty 7-week-old male Otsuka Long-Evans Tokushima Fatty (OLETF: a rat model of diabetes) rats and 10 male Long-Evans Tokushima Otsuka (LETO: normal controls) rats were used. All of the LETO and 8 OLETF rats were fed on tap water while the rest were fed on sucrose-containing water. After 10 weeks, saline or recombinant human G-CSF (100 μg/kg/day) was injected intraperitoneally for 5 days. Blood levels of glucose, total cholesterol and triglyceride, and Doppler echocardiograms for diastolic dysfunction were obtained just before and 4 weeks after the saline or G-CSF treatment. Light microscopy, electron microscopy (EM) and immunohistochemistry for transforming growth factor-β were employed to examine myocardial histology 4 weeks after the saline or G-CSF treatment.ResultsDiastolic dysfunction developed at 17 weeks (before the saline or G-CSF treatment) in the OLETF rats whether or not they were fed sucrose water, but were more severe in those fed sucrose water. Four weeks after saline or G-CSF treatment, diastolic function had recovered in the G-CSF-treated group regardless of sucrose water feeding, and perivascular and/or interstitial fibrosis in the G-CSF-treated group had decreased significantly. TGF-β immunoreactivity in the interstitial and perivascular tissue was also reduced in the G-CSF-treated group, and EM studies revealed less severe disruption of myofilaments and mitochondrial cristae, and decreased collagen deposition.ConclusionsG-CSF can ameliorate cardiac diastolic dysfunction and morphological damage, especially fibrosis of the myocardium, in OLETF rats with diabetic CMP.

Relationship between sodium intake and blood pressure according to metabolic syndrome status in the Korean National Health and Nutrition Examination Survey.

ObjectivesThe relationship between sodium intake and blood pressure (BP) in population studies varies depending on the dietary habit and the characteristics of the population studied. Asian dietary patterns and salt sensitivity have been suggested to explain this association. Aging and metabolic syndrome (MS) are the most common reasons for salt sensitivity in populations. Participants and methodsWe therefore examined the dietary patterns in the Korean National Health and Nutrition Examination Survey. ResultsIn a multiple regression model for 3757 patients, age, antihypertensive medication, BMI, family history of hypertension, and MS were positively associated with systolic BP, whereas female sex, income, educational status, and fruit intake were negatively associated with systolic BP. Fruit intake was the only dietary factor that was negatively associated with systolic BP (P=0.017). In MS (n=712), sodium and fruit intake was independently positively and negatively associated with systolic BP, respectively, discounting age and medication. In contrast, in normal individuals (n=3045), diet was not related to systolic BP. The relationship between diet and systolic BP is more clear-cut in MS. ConclusionDietary pattern and salt sensitivity at the population level could be a cause of the relationship between sodium intake and BP.

2013 Korean Society of Hypertension guidelines for the management of hypertension. Part II—treatments of hypertension

Treatment strategies are provided in accordance with the level of global cardiovascular risk, from lifestyle modification in the lower risk group to more comprehensive treatment in the higher risk group. Considering the common trend of combination drug regimen, the choice of the first drug is suggested more liberally according to the physician’s discretion.

Harmful and beneficial relationships between alcohol consumption and subclinical atherosclerosis.

BACKGROUND AND AIMS Arterial stiffness and increased intima-media wall thickness are two of the main predictors of cardiovascular disease (CVD). We evaluated whether brachial-ankle pulse wave velocity (baPWV) and common carotid artery intima-media wall thickness (CCA-IMT) are correlated with alcohol consumption in a cross-sectional study among Korean men and women aged 40 years and over. METHODS AND RESULTS All 5539 subjects (2121 men and 3418 women) were participants in the Multi-Rural Communities cohort (MRcohort) study, a part of the Korean Genome Epidemiology Study (KoGES). The baPWV was positively correlated with alcohol consumption in men (p for trend <0.0001). Age (middle-aged versus elderly) modified the effect of alcohol consumption on PWV. On the other hand CCA-IMT decreased with alcohol consumption in men. There was no favorable zone of alcohol consumption in terms of baPWV and CCA-IMT. Adjustment for lipid profiles substantially attenuated the relationship between alcohol consumption and CCA-IMT. There was no clear relation between alcohol consumption and baPWV/CCA-IMT in women. CONCLUSIONS Along with a linear harmful relationship between alcohol consumption and arterial stiffness in men there may also be a beneficial relationship between alcohol consumption and carotid intima-wall thickness. The effect of alcohol on arterial stiffness may be slightly stronger in elderly men, and the effect of alcohol on CCA-IMT may be mediated by lipid factors.

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients

Background and Objectives Electrocardiography (ECG) is a cost-effective and useful method for diagnosing left ventricular hypertrophy (LVH) in a large-scale study or in clinical practice. Among ECG criteria, the Cornell product (Cor P) and Sokolow-Lyon criteria were adopted by the European Society of Hypertension-European Society of Cardiology Guidelines but have different performances among races. The aim of this study was to compare the diagnostic performance of two voltage criteria in Korean patients. Subjects and Methods Electrocardiography and echocardiographic LV mass of 332 (159 male, 173 female) consecutive patients were analyzed. Cornell voltage criteria and the Cor P were compared with Sokolow-Lyon voltage (Sok V) and the Sokolow-Lyon product (Sok P). The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the LVH diagnosis. The sensitivities and revised cut-off values were derived at specificity levels of 90, 95, and 100%. Results The Cornell-based criteria generally showed better performance than that of the Sok V criteria and Sok P in the area under the ROC curve analysis. The revised cut-off values for the Cornell voltage criteria (20 and 16 mm for males and females, respectively) showed an improved sensitivity (19.7 and 30.3% for males and females, respectively), with a high specificity of 95%. Conclusion The Cornell-based criteria had better performance than that of the Sokolow-Lyon criteria in both Korean men and women. However, revised cut-off values are needed to improve accuracy.