Young Mee Choi

Fas, Fas-Associated Death Domain-Like Interleukin 1β-Converting Enzyme-Like Inhibitory Protein, and Apoptotic Features of Elderly Acute Myeloid Leukemia Based on Response to Induction Chemotherapy

A study was performed to examine the clinical outcome of triple-combination induction chemotherapy in 26 elderly Korean acute myeloid leukemia (AML) patients and to investigate apoptotic responses during and after treatment to determine whether the responses can be used as prognostic markers. Patients who had Western blot or polymerase chain reaction analysis findings of higher expression levels of Fas-associated death domain-like interleukin 1β-converting enzyme-like inhibitory protein (FLIP) on day 7 after chemotherapy were more likely to have complete remission, but there was less or no correlation with Fas or a proapoptosis/apoptosis reaction. Expression of FLIP molecules may be, at least in part, an early prognostic indicator in the treatment of elderly AML patients.

Computed Tomography Angiography Images of Coronary Artery Stenosis Provide a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic Individuals With Type 2 Diabetes: A Long-term Study of Clinical Outcomes

OBJECTIVE We investigated the efficacy of coronary computed tomography angiography (CCTA) in predicting the long-term risks in asymptomatic patients with type 2 diabetes and compared it with traditional risk factors. RESEARCH DESIGN AND METHODS We analyzed 933 patients with asymptomatic type 2 diabetes who underwent CCTA. Stenosis was considered obstructive (≥50%) in each coronary artery segment using CCTA. The extent and severity scores for coronary artery disease (CAD) were evaluated. The primary end point was major adverse cardiovascular events (MACE), including all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization during a mean follow-up period of 5.5 ± 2.1 years. RESULTS Ninety-four patients with MACE exhibited obstructive CAD with a greater extent and higher severity scores (P < 0.001 for all). After adjusting for confounding risk factors, obstructive CAD remained an independent predictor of MACE (hazard ratio 3.11 [95% CI 2.00–4.86]; P < 0.001]). The performance of a risk prediction model based on C-statistics was significantly improved (C-index 0.788 [95% CI 0.747–0.829]; P = 0.0349) upon the addition of a finding of obstructive CAD using CCTA to traditional risk factors, including age, male, hypertension, hyperlipidemia, smoking, estimated glomerular filtration rate, and HbA1c. Both integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analyses further supported this finding (IDI 0.046 [95% CI 0.020–0.072], P < 0.001, and NRI 0.55 [95% CI 0.343–0.757], P < 0.001). In contrast, the risk prediction power of the coronary artery calcium score remained unimproved (C-index 0.740, P = 0.547). CONCLUSIONS Based on our data, the addition of CCTA-detected obstructive CAD to models that include traditional risk factors improves the predictions of MACE in asymptomatic patients with type 2 diabetes.

Prehypertension is a comorbid state with autonomic and metabolic dysfunction

We aimed to elucidate the role of autonomic dysfunction in the context of complex metabolic and cardiovascular changes in subjects with prehypertension. We identified 556 asymptomatic subjects without hypertension who underwent comprehensive cardiovascular exams. We obtained heart rate recovery (HRR) after peak exercise to quantitatively measure autonomic dysfunction. Of the 556 participants, 279 individuals had prehypertension and the remaining 277 had optimal BP. HRR was significantly lower in the prehypertension group (36.0 ± 14.5 bpm) than in the optimal BP group (39.3 ± 14.7 bpm, P = .009). The prehypertension group more frequently demonstrated features of metabolic disturbances and subclinical target organ damage. Among the various baseline cardiovascular and metabolic factors assessed, resting systolic BP and high‐density lipoprotein cholesterol level were independent determinants of HRR (both P < .05). Autonomic dysfunction coexists with prehypertension and is closely linked to changes in systolic BP and lipid metabolism.

Giant Right Coronary Artery with Coronary Artery Fistula Complicated by Infective Endocarditis: Multimodality Imaging Approach

A 65-year-old woman presented to the emergency department feeling feverish and having dyspnea. A chest X-ray revealed multifocal nodular consolidation, indicating possible embolic infarction. Transthoracic echocardiography revealed vegetation attached to the aortic valve (Fig. 1A, arrow), resulting in moderate aortic regurgitation (see Supplementary Video 1, 2 in the onlineonly Data Supplement). Additionally, unusual flow originating from the right sinus of Valsalva was noted (Fig. 1B, asterisks and arrows, see Supplementary Video 3 in the online-only Data Supplement). The right ventricular (RV)-focused apical 4-chamber view revealed an oscillating echogenic mass attached to the RV inferoseptal wall (Fig. 1C, arrow). Color Doppler imaging revealed a turbulent flow draining to the RV from an uncertain dilated structure. The previously detected echogenic mass was found to be located at the point of fistulous drainage and considered vegetation (Fig. 1D: arrow head for fistula, asterisk for uncertain dilated structure, arrow for vegetation; Supplementary Video 4 in the online-only Data Supplement). A coronary computed tomographic angiography was immediately performed, revealing the presence of a giant right coronary artery (RCA, Fig. 1E) and combined coronary to RV fistula and vegetation (Fig. 1F: arrow heads for fistula, asterisk for giant RCA, arrow for vegetation). Final coronary angiography confirmed coronary to RV fistula, which originated from the distal RCA (Fig. 1G, arrowhead, see Supplementary Video 5 in the online-only Data Supplement). Surgery to remove the infected tissue and correct the coronary fistula, along with a concomitant aortic valve replacement, was recommended. The operative findings (Fig. 1H) were generally consistent with the preoperative diagnosis. The patient recovered from postoperative care without further clinical deterioration. Our case emphasizes the need for multimodality imaging in patients having infective endocarditis combined with complex structural heart disease.

Echocardiographic, Electrocardiographic Changes and Clinical Outcomes of Patients Who Respond to Cardiac Resynchronization Therapy after One Year

Background Response to cardiac resynchronization therapy (CRT) is commonly assessed after 6 or 12 months. We evaluated subsequent echocardiographic changes, serial QRS duration, and clinical outcomes in patients showing delayed responses to CRT after 12 months. Methods Among all patients who received CRT in Seoul St. Marys Hospital, 36 one-year survivors were enrolled. Indicators of a positive CRT response were ≥ 15% reduction in left ventricular end-systolic volume (LVESV) or ≥ 10% increase in left ventricular ejection fraction (LVEF) on any follow up echocardiogram. We defined the early responders as patients responding before one year, the late responders as patients responding after one year, and the non-responders as patients who did not respond on any follow-up echocardiogram. Results We identified 17 early responders, 10 late responders, and 9 non-responders. The late responders showed modest improvement in LVESV and LVEF at two years after CRT. QRS duration was shortened the day after CRT in all three groups. Narrowed QRS was maintained for two years in early and late responders, whereas it was continuously prolonged over time in non-responders. Incidence of all-cause death or heart failure hospitalization was comparable between early and late responders, while non-responders showed worst prognosis. Conclusion Patients responding to CRT after one year show modest echocardiographic improvement but clinical outcome is similar to early responders. Shorter baseline QRS duration and long-term maintenance of QRS duration shortening are important features of the late responders to CRT.

Effects of CPAP Therapy on Systemic Blood Pressure, Cardiac Rhythm and Catecholamines Concentration in Patients with Obstructive Sleep Apnea

연구배경 : 폐쇄성 수면 무호흡 증후군 환자는 수면중에 전신성 혈압의 상승과 심박동수의 현저한 변화를 보이며, 이러한 심혈관계 기능변화는 수면중 반복되는 무호흡에 의한 저산소증과 각성반응으로 인한 교감신경계 활성도 변화와 관련이 있을 것으로 생각되고 있다. 지속적 기도 양압 공급(CPAP) 치료는 폐쇄성 수면 무호흡을 가장 확실하게 치료할 수 있는 방법으로 알려져 있으나 이러한 치료법이 환자들의 심혈관계 교감신경계 활성도에 어떠한 영향을 미치는 지에 대해서는 명확히 알려져 있지 않다. 이에 저자들은 폐쇄성수면 무호흡 증후군 환지에서 CPAP 치료 적용시 나타나는 심혈관계 및 교감신경계 활성도 변화를 관찰하고자하였다. 방법 : 수면다원검사에서 폐쇄성 수면 무호흡 증후군으로 진단되어 CPAP 치료를 시행한 13명을 대상으로 치료 전과 후의 수면다원검사의 각 지표, 수면중 전신성 혈압, 수면중 심박동수와 부정맥, 그리고 혈장 catecholamines 농도 변화를 비교 분석하였다. 결과 : 수면다원검사의 각 지표중 CPAP 치료 후 무호흡-저호흡지수는 유의하게 감소하였고(p 【Background : Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. Methods : Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. Results: The apnea-hypopnea index (AHI) was significant1y decreased (p】

The Effect of glucocorticoid on the change of nitric oxide and cytokine levels in induced sputum from patients with bronchial asthma

Background : It has been well known that bronchia1 asthma is a chronic airway inflammatory disorder. Recently, sputum induced with hypertonic saline was introduced as a simple and useful nonivasive medium to investigate airway inflammation and symptom severity in patients with asthma. We examined the eosinophil, eosinophil cationic protein (ECP), interleukin(IL)-3, IL-5, granulocyte-macrophage colony-stimulating facta (GM-CSF), and nitric oxide (NO) derivatives in induced sputum from patients with bronchia1 asthma in order to determine the role of NO and various inflammatory cytokines as a useful markers of airway inflammation or changes in pulmonary function tests and symptoms. Methods : A total 30 patients with bronchia1 asthma received oral prednisolone 30 mg daily for 2 weeks. Forced expiratory volume in one second (), total blood eosinophil count and induced sputum eosinophil count, ECP, IL-3, IL-5, GM-CSF, and NO derivatives were determined before and after the administration of prednisolone. Results : Of the 30 patients, 13 (43.3%) were male and 17 (56.7%) were female. The mean age of patients was 41.8 years (range 19-64 years). Two patients could not produce sputum at the second study and 3 could not be followed up after their first visit. Two weeks after the prednisolone administration, there was a significant increase in (% of predicted value) from 78.120.6 % to 90.3 18.3 % (P27.2 % versus 29.621.3 % (P versus (P12.8 pg/ml to 21.78.7 pg/ml. There was a decreasing tendency but no significant differences in total blood eosinophil count (425.7265.9 vs 287.7294.7) and in the concentration of NO derivatives ( vs ) after the prednisolone treatments. IL-3, IL-5, GM-CSF were undetectable in the sputum of most subjects either before the prednisolone treatments or after the treatments. Before the prednisolone treatments, a significant inverse correlation was observed between FEV1 and sputum ECP (r=-D.364, P

A Case of lymphangitic carcinomatosis of lung presented as rapidly exacerbating reticulonodular infiltrates

A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis shoud should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial biopsy may be a useful tool to confirm the diagnosis.