Purpose of review
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are a class of lipid-lowering medications by inhibiting the enzyme HMG-CoA reductase. Statins are ...important drugs for the prevention of cardiovascular disease. The prominent value of statins is well established during the past three decades. The efficacy and safety of statins have been evaluated in many large randomized controlled trials.
Recent findings
Currently, emerging concerns with statin-induced liver toxicity (SILT) and muscle toxicity (SIMT) have been introduced. However, exact mechanisms of SILT and SIMT have not been well understood. Moreover, there is an increasing concern currently about their safety associated with genetic polymorphisms. Thus, this article reviews the mechanisms of statin-drug interactions and their adverse effects with a particular focus on SILT and SIMT. It is recommended that the specific pharmacology for the different statins should be understood to maximize their benefit and minimize statin-induced toxicity. Significant toxicity may be induced by statin-drug interactions, and understanding how certain drugs interact with statins will help physicians in safely prescribing these agents.
The purpose of this study was to explore the concurrent validity of the Acoustic Voice Quality Index (AVQI) in a Korean population. We investigated the feasibility of its cutoff values and diagnostic ...accuracy in discriminating between normal and dysphonic voices.
A total of 1,524 native Korean subjects with normal voices (n = 113) and with voice disorders (n = 1,411) were asked to speak and sustain the vowel “a” and to read the Korean text “Walk” aloud. A 2-second mid-speech portion of the sustained vowel sound and two sentences (with 26 syllables) were edited and concatenated, and the AVQI was calculated. Additionally, two auditory-perceptual assessments, namely the Grade, Roughness, Breathiness, Asthenia, Strain scale, and the Consensus Auditory-Perceptual Evaluation of Voice were used by five speech language pathologists to rate the severity of dysphonia.
Both auditory-perceptual assessments showed high confidence levels among the five speech language pathologists. The AVQI correlated with grade (G) and overall severity (OS). There were statistically significant differences in AVQI, G, and OS between normal and pathological speech groups. In the receiver operating characteristic curve analysis, AVQI, G, and OS cutoff values were <3.33, <0.00, and <22.00, respectively. The receiver operating characteristic curve analysis indicated that AVQI had excellent diagnostic accuracy for discriminating between normal and dysphonic voices (area under the curve: 0.970-0.977).
We demonstrated the concurrent validity of AVQI as a promising tool for assessing overall voice quality and quantifying dysphonia in a Korean-speaking population.
Particulate matter (PM) is a type of air pollutant that poses a risk to human health. In the ocular system, PM causes or aggravates dry eye syndrome (DES) by damaging the corneal and conjunctival ...epithelia. Liriope platyphylla has been used traditionally as an expectorant, antitussive agent, and tonic in Korea. However, the effects of Liriope platyphylla extract (LPE) on PM-induced ocular damage have not been elucidated. In this study, we evaluated the in vivo protective effect of LPE against PM-induced DES in rats. Topical administration of LPE attenuated the PM-induced decrease in tear volume and reduced corneal epithelial irregularity and damage. LPE also protected against PM-induced disruption of the corneal mucin-4 layer and reduction in the conjunctival goblet cell density. These findings suggest that LPE has protective effects against PM-induced DES.
Although the safety and efficacy of left atrial (LA) appendage (LAA) closure (LAAC) in nonvalvular atrial fibrillation (NVAF) patients have been well documented in randomized controlled trials and ...real-world experience, there are limited data in the literature about the impact of LAAC on cardiac remodeling. The aim of the study was to examine the impact of LAAC on cardiac functional and structural remodeling in NVAF patients.
Between March 2014 and November 2016, 47 NVAF patients who underwent LAAC were included in this study (LAAC group). A control group (non-LAAC group) was formed from 141 NVAF patients without LAAC using propensity score matching. The difference-in-difference analysis was used to evaluate the difference in cardiac remodeling between the two groups at baseline and follow-up evaluations.
The LAAC group had a larger increase in LA dimension, volume and volume index than the non-LAAC group (+3.9 mm, p = 0.001; +9.7 mL, p = 0.006 and +5.9 mL/m2, p = 0.011, respectively). Besides, a significant increase in E and E/e' ratio was also observed in the LAAC group (+14.6 cm/s, p = 0.002 and +2.3, p = 0.028, respectively). Compared with the non-LAAC group, left ventricular (LV) ejection fraction and fractional shortening decreased in LAAC patients, but were statistically insignificant (-3.5%, p = 0.109 and -2.0%, p = 0.167, respectively).
There were significant increases in LA size and LV filling pressure among NVAF patients after LAAC. These impacts of LAAC on cardiac functional and structural remodeling may have some clinical implications that need to be addressed in future studies.
•In cases when acute myocardial infarction (AMI) is complicated by cardiogenic shock (CS), patients with non-ST-segment elevation myocardial infarction (non–STEMI) generally have lower short-term ...mortality rates than patients with STEMI.•Generally, female gender is recognized as a prognostic factor associated with worse outcomes in AMI with CS; however, most of the research has been focused on male patients.•Over a 12-month follow-up period, no significant differences were observed in the risk of major adverse cardiac events between the STEMI and non–STEMI groups.•In female patients with CS, AMI clinical type might not influence mid-term prognosis.
There are limited data about mid-term prognosis according to acute myocardial infarction (AMI) type in female patients with AMI complicated by cardiogenic shock (CS). In this study, we evaluated the impact of AMI type on prognosis in female patients who underwent percutaneous coronary intervention (PCI) for AMI complicated by CS. A total of 184 female patients who underwent PCI for AMI complicated by CS were enrolled from 12 centers in the Republic of Korea. Patients were divided into 2 groups according to AMI type: the ST-segment elevation myocardial infarction (n = 114) and the non–ST-segment elevation myocardial infarction (n = 70) group. Primary outcome was a major adverse cardiac event (MACE) (defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity-score matching analysis was performed to reduce selection bias and potential confounding factors. During 12-month follow-up, a total of 73 MACEs occurred (ST-segment elevation myocardial infarction group, 47 41.2% vs non–ST-segment elevation myocardial infarction group, 26 37.1%, p = 0.643). Multivariate analysis revealed no significant difference in the incidence of MACE at 12 months between the 2 groups (adjusted hazard ratio 1.16, 95% confidence interval 0.70 to 2.37, p = 0.646). After propensity-score matching, the incidence of MACE at 12 months remained similar between the 2 groups (hazard ratio 1.31, 95% confidence interval 0.69 to 2.52, p = 0.413). The similarity in MACEs between the 2 groups was consistent across a variety of subgroups. In conclusion, after adjusting for baseline differences, AMI clinical type did not appear to increase the risk of MACEs at 12 months in female patients who underwent emergency PCI for AMI complicated by CS.
Objectives: Human mesenchymal stem cells (MSCs) are efficacious in various cellular therapeutic applications and have been isolated from several tissues. Recent studies have reported that human ...tonsil tissue contains a new source of progenitor cells, potentially applicable for cell-based therapies. Information about the effects of donor age, long-term passage and cryopreservation are essential for clinical applications and cell-based therapies. Therefore, the authors investigated how the morphology, cell-surface markers, proliferation potential and differentiation capacity of tonsil-derived MSCs (T-MSCs) were affected by donor age, long-term passage, and cryopreservation. Materials and Methods: T-MSCs were isolated from tonsillar tissue of 20 patients undergoing tonsillectomy. Authors evaluated the effects of donor-age, long-term passage, and cryopreservation on the morphology, surface markers, proliferation potential and differentiation capacities of T-MSCs. Results: T-MSCs exhibited a fibroblast-like, spindle-shaped appearance. There were no significant morphological differences according to donor age, long-term passage or cryopreservation. T-MSCs isolated from donors of various ages were positive for markers CD90, CD44, and CD73, but negative for CD45, CD31, and HLA-DR. There were no significant differences in the expression of positive and negative surface markers as a function of donor age, long-term passage and cryopreservation. T-MSCs from different donor age groups showed similar proliferation potentials after passage 2. After long-term passage and cryopreservation, there were no significant morphological differences. Cryopreservation did not affect the proliferation potential of T-MSCs, but there was a significant decrease in the proliferation potential in long-term passage T-MSCs (passage 15). The effect of donor age, long-term passage and cryopreservation on the in vitro adipogenic, osteogenic, and chondrogenic differentiation potential of T-MSCs was not significant. Conclusion: The effect of donor age, long-term passage culture, and cryopreservation on T-MSC properties are negligible, except for the proliferation capacity of long-term cultured T-MSCs. Therefore, T-MSCs are considered to be promising MSCs that can be used as future alternative sources for autologous or allogenic MSCs.
Background
Papillary thyroid cancer (PTC) metastasizes to central lymph node (CLN). CLN metastasis is associated with high risk of locoregional recurrence and distant metastasis. The significance of ...the number of metastatic CLN has not been addressed. This study was designed to evaluate the clinical implication of the number of metastatic CLN in PTC.
Methods
We reviewed the patients who underwent total thyroidectomy and CLN dissection with or without lateral neck dissection due to PTC, from March 2008 to June 2009. The relationships between the number of CLN and risk factors, including age, gender, tumor size, extrathyroidal extension, and lateral lymph node metastasis, were assessed. Patients were divided into three groups according to the number of CLN: group A = 0; group B = 1–2; and group C = ≥3.
Results
Of 258 patients enrolled in this study, 113 were in group A, 73 in group B, and 72 in group C. Extrathyroidal extension and lateral neck lymph node metastasis were related to increased rate of CLN metastasis (
P
< 0.05). Tumor size increased as the number of CLN increased; group C had the largest tumor size (
P
< 0.05). When evaluating the distribution of patients with extrathyroidal extension, group C had a significant odds ratio (4.213,
P
< 0.05). When evaluating the distribution of lateral neck lymph node metastasis, groups B and C had significant odds ratio (14.353, 75.403, respectively,
P
< 0.05).
Conclusions
The number of CLN metastasis correlated with the negative prognostic factors, including tumor size, extrathyroidal extension, and lateral neck lymph node metastasis. This suggests that the number of CLN has prognostic implication.
Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate ...the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability.
Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score-matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive.
Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification.
There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multi-vessel PCI in Cardiogenic Shock) trial, the optimal ...revascularization strategy for refractory cardiogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multivessel PCI strategies in patients with acute myocardial infarction complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. Methods and Results This study included patient-pooled data from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Devices for Korean Patients With Cardiogenic Shock) and SMC-ECMO (Samsung Medical Center-Extracorporeal Membrane Oxygenation) registries. A total of 315 patients with acute myocardial infarction with multivessel disease who underwent venoarterial-extracorporeal membrane oxygenation before revascularization attributable to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multivessel PCI according to nonculprit lesion treatment strategies. The primary end point was 30-day mortality or renal-replacement therapy, and the key secondary end point was 12-month follow-up mortality. Among the study population, 175 (55.6%) underwent culprit-only PCI and 140 (44.4%) underwent immediate multivessel PCI. Compared with culprit-only PCI, immediate multivessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (68.0% versus 54.3%;
=0.018) and all-cause mortality during 12 months of follow-up (59.5% versus 47.5%; hazard ratio HR, 0.689 95% CI, 0.506-0.939;
=0.018) in patients with acute myocardial infarction and CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. These results were also consistent in the 99 pairs of propensity score-matched population (60.6% versus 43.6%; HR, 0.622 95% CI, 0.420-0.922;
=0.018). Conclusions Among patients with acute myocardial infarction with multivessel disease complicated by advanced CS requiring venoarterial-extracorporeal membrane oxygenation before revascularization, immediate multivessel PCI was associated with lower incidences of 30-day mortality or renal replacement therapy and 12-month follow-up mortality, compared with culprit-only PCI. Registration Information clinicaltrials.gov. Identifier: NCT02985008.
Exposure to urban particulate matter (UPM) is a high-risk factor for various ocular surface diseases, including dry eye syndrome. However, the effects of UPM on corneal and conjunctival epithelium ...damage have not been fully elucidated. In this study, we investigated the toxicological effects of UPM exposure at high concentrations by using in vitro cultures. The cell viability, mucin expression, and the secreted inflammatory mediators of corneal and conjunctival epithelial cells was observed at 24 h after exposure to UPM. The progression of cell cycle was also examined by flow cytometry at 24 h after exposure to UPM. UPM reduced cell viability in a dose-dependent manner and increased cell population in S and G2 phase. The expression of mucin-1 was attenuated by UPM exposure, but that of mucin-4 was not. UPM increased interleukin (IL)-6 release and decreased IL-8 release. The intensity of 2′,7′-dichlorofluorescein diacetate (DCF-DA) was highest at 4 h of UPM exposure. In conclusion, these results suggest that UPM causes the disruption of corneal and conjunctival epithelium by decreasing cell viability, altering cell cycle, disrupting mucin, and regulating inflammatory mediators.
PDF
