Objectives We performed this study to determine the optimal intravascular ultrasound (IVUS) criteria and to evaluate their accuracy for defining the functional significance of intermediate coronary ...stenoses in different locations of the coronary tree. Background Presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease and is determined by both the lesion severity and the amount of myocardium supplied. Methods IVUS and fractional flow reserve (FFR) measurements were performed in 267 intermediate lesions located at the proximal or mid part of major epicardial coronary arteries. Optimal IVUS criteria and their diagnostic accuracy for functionally significant stenoses (FFR <0.8) were assessed. Results FFR was <0.8 in 88 lesions (33%). The determinants of FFR were minimum lumen area (MLA) and lesion location. The diagnostic accuracy of MLA was highly variable according to the location of lesions. The best cutoff value of MLA to define the functional significance was 3.0 mm2 (area under the curve AUC: 0.81, 95% confidence interval CI: 0.68 to 0.91) for proximal left anterior descending artery (LAD) lesions and 2.75 mm2 for mid-LAD lesions located before the second diagonal branch (AUC: 0.76, 95% CI: 0.66 to 0.84). However, the appropriate MLA to predict the functional significance of lesions could not be found in other segments. Conclusions When IVUS parameters are used to determine the functional significance of lesions in patients with intermediate coronary artery stenoses, different criteria should be used according to lesion location. In segments or vessels with anatomic variations, IVUS cannot be used for functional assessment of a stenosis. (Comparison of Fractional Flow Reserve and Intravascular Ultrasound; NCT01133015 )
Exposure to allergens or irritants in the workplace may affect asthma control and the quality of life (QoL) of patients with asthma.
To examine the prevalence and characteristics of work-related ...asthma (WRA) in adult patients with severe asthma.
We analyzed data from the Korean Severe Asthma Registry (KoSAR), which is a nationwide multicenter observational study on severe asthma in Korea. Severe asthma was defined according to the American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. WRA was identified on the basis of asthma symptom aggravation at the workplace, as indicated by responses to a structured questionnaire. We compared the demographic and clinical characteristics and QoL between adult patients with severe asthma and WRA and those without WRA.
Among 364 patients with severe asthma who were employed at the time of enrollment, 65 (17.9%) had WRA. There were no significant differences in age, sex, obesity, or smoking history between the WRA and non-WRA groups. However, individuals with WRA exhibited a higher prevalence of anxiety (7.7% vs 2.4%, P = 0.046) and depression (12.3% vs 3.7%, P = 0.010) than those without. The levels of asthma control, lung function, and frequency of asthma exacerbations were similar between the two groups, but patients with WRA reported lower QoL, as determined by the Quality of Life Questionnaire for Adult Korean Asthmatics (56.6 ± 14.6 vs. 63.5 ± 13.9, P < 0.001).
Patients with severe asthma and WRA are more likely to experience anxiety and depression and have lower QoL than those without WRA.
Purpose Reconstruction of traumatic orbital wall defects has evolved to restore the original complex anatomy with the rapidly growing use of computer-aided design and prototyping. This study ...evaluated a mirror-imaged rapid prototype skull model and a pre-molded synthetic scaffold for traumatic orbital wall reconstruction. Patients and Methods A single-center retrospective review was performed of patients who underwent orbital wall reconstruction after trauma from 2012 to 2014. Patients were included by admission through the emergency department after facial trauma or by a tertiary referral for post-traumatic orbital deformity. Three-dimensional (3D) computed tomogram-based mirror-imaged reconstruction images of the orbit and an individually manufactured rapid prototype skull model by a 3D printing technique were obtained for each case. Synthetic scaffolds were anatomically pre-molded using the skull model as guide and inserted at the individual orbital defect. Postoperative complications were assessed and 3D volumetric measurements of the orbital cavity were performed. Paired samples t test was used for statistical analysis. Results One hundred four patients with immediate orbital defect reconstructions and 23 post-traumatic orbital deformity reconstructions were included in this study. All reconstructions were successful without immediate postoperative complications, although there were 10 cases with mild enophthalmos and 2 cases with persistent diplopia. Reoperations were performed for 2 cases of persistent diplopia and secondary touchup procedures were performed to contour soft tissue in 4 cases. Postoperative volumetric measurement of the orbital cavity showed nonsignificant volume differences between the damaged orbit and the reconstructed orbit (21.35 ± 1.93 vs 20.93 ± 2.07 cm2 ; P = .98). This protocol was extended to severe cases in which more than 40% of the orbital frame was lost and combined with extensive soft tissue defects. Conclusion Traumatic orbital reconstruction can be optimized and successful using an individually manufactured rapid prototype skull model and a pre-molded synthetic scaffold by computer-aid design and manufacturing.
Abstract Background This study evaluated the accuracy of blowout fracture reduction using 3D-printed rapid prototyping (RP) skull modeling. Patients and Methods Retrospective review was performed for ...82 patients who underwent post-traumatic orbital wall fracture reduction between 2012 and 2014. Patients were divided into two groups according to the use of 3D-printed RP skull model reproduced by mirroring technique, onto which a titanium mesh was anatomically molded. Using computed tomographic scans, the areas of pre- and post-operative orbital wall defect, the layout angles of the titanium mesh, and the gap lengths between the implant and fracture margin were compared between the two groups. Results Of the 82 patients identified, 46 and 36 were diagnosed with medial and inferior orbital wall fractures, respectively. Bone defect area of the RP group was significantly reduced in comparison with that of the conventional group (8.03±3.5% versus 18.7±15.41% for medial wall fractures, 7.14±5.74% versus 12.8±4.92% for inferior wall fractures, respectively, p <0.01). Satisfactory results were achieved regarding the layout angles and the gap lengths, presenting significantly reduced values in the RP group compared to that in the conventional group ( p <0.01). Conclusions More accurate restoration of traumatic orbital wall fractures can be achieved using patient-specific 3D-printed RP skull models.
Little is known about the characteristics of anaphylaxis in Korea or even in Asia.
To evaluate the incidence of anaphylaxis and the clinical features of patients with anaphylaxis in a Korean tertiary ...care hospital.
We performed a retrospective review from January 1, 2000, through July 31, 2006, of 138 patients with anaphylaxis, including inpatients, outpatients, and emergency department visitors, in the Seoul National University Hospital.
Among 978,146 patients, 138 (0.014%) had anaphylaxis. Two cardiopulmonary resuscitations were performed and 1 death occurred. The total mortality rate of anaphylactic patients was 0.0001%. The causes of anaphylaxes were drug (35.3%), food (21.3%), food-dependent exercise-induced (13.2%), idiopathic (13.2%), insect stings (11.8%), exercise induced (2.9%), blood products (1.5%), and latex (0.7%). Radiocontrast media and buckwheat were the leading causes of drug and food anaphylaxis, respectively. The organs most frequently involved in the anaphylaxis were cutaneous (95.7%), cardiovascular (76.8%), and respiratory (74.6%). The most common manifestations were dyspnea (71.3%), urticaria (81.9%), and angioedema (69.4%). Three of 138 patients (2.2%) had biphasic reactions.
The incidence, mortality rate, and clinical features of Korean patients with anaphylaxis were similar to rates for patients from other countries, despite some differences in causative agents.
Background While EES have proven superior to paclitaxel-eluting stents, it remains uncertain whether EES improve clinical outcomes compared to SES, which are the most efficacious among the ...first-generation drug-eluting stents. We performed a meta-analysis of randomized trials comparing the efficacy and safety of everolimus-eluting stents (EES) versus sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention. Methods From online and offline search until December 2011, we identified 11 randomized trials (total 12,869 patients). The primary endpoint was major adverse cardiac events. Results The risk of major adverse cardiac events did not differ significantly between the patients treated with EES versus SES OR, 0.90 (95% CI, 0.77-1.04); P = .162. However, we found a significant reduction in the risk of repeat revascularization in the EES arm OR, 0.85 (95% CI, 0.71-1.00); P = .047. There were no significant differences regarding the risk of cardiac death OR, 0.97 (95% CI, 0.74-1.27); P = .834, or myocardial infarction OR, 0.95 (95% CI, 0.75-1.20), P = .656. The risk of definite or probable stent thrombosis tended to be lower OR, 0.68 (95% CI, 0.45-1.02); P = .065, while definite ST was significantly lower OR, 0.44 (95% CI, 0.25-0.80); P = .007 with EES. Conclusions In a large systematic overview of comparative trials involving percutaneous revascularization with drug-eluting stents, treatment with EES significantly reduced the risk of repeat revascularization and definite ST compared to SES. We found no significant differences in the risk of cardiac death or myocardial infarction.
Abstract Background Flap survival is essential for the success of soft-tissue reconstruction. Accordingly, various surgical and medical methods aim to increase flap survival. Because flap survival is ...affected by the innate vascular supply, traditional preconditioning methods mainly target vasodilatation or vascular reorientation to increase blood flow to the tissue. External stress on the skin, such as an external volume expander or cupping, induces vascular remodeling, and these approaches have been used in the fat grafting field and in traditional Asian medicine. Materials and Methods In the present study, we used a rat random-pattern dorsal flap model to study the effectiveness of preconditioning with an externally applied device (cupping) at the flap site that directly applied negative pressure to the skin. The device, the pressure-controlled cupping, is connected to negative pressure vacuum device providing accurate pressure control from 0 mm Hg to −200 mm Hg. Flap surgery was performed after preconditioning under −25 mm Hg suction pressure for 30 min a day for 5 d, followed by 9 d of postoperative observation. Flap survival was assessed as the area of viable tissue and was compared between the preconditioned group and a control group. Results The preconditioned group showed absolute percentage increase of flap viability relative to the entire flap by 19.0± 7.6% (average 70.1% versus 51.0%). Tissue perfusion of entire flap, evaluated by laser Doppler imaging system, was improved with absolute percentage increase by 24.2± 10.4% (average 77.4% versus 53.1%). Histologic analysis of hematoxylin and eosin, CD31, and Masson-trichrome staining showed increased vascular density in the subdermal plexus and more organized collagen production with hypertrophy of the attached muscle. Conclusions Our study suggests that flap preconditioning caused by controlled noninvasive suction induces vascular remodeling that increases tissue perfusion and improves flap survival in a rat model.
Image analyses include computed tomography (CT), magnetic resonance imaging, and xenon ventilation CT, which is new modality to evaluate pulmonary functional imaging.
To examine the usefulness of ...dual-energy xenon ventilation CT in asthmatic patients.
A total of 43 patients 18 years or older who were nonsmokers were included in the study. Xenon CT images in wash-in and wash-out phases were obtained at baseline and after inhalation of methacholine and salbutamol. The degrees of ventilation defects and xenon trappings were evaluated through visual analysis.
Ventilation defects and xenon trapping were significantly increased and decreased after methacholine challenge and salbutamol inhalation, respectively (P < .005). The ventilation abnormalities were not significantly related to the percentage of forced expiratory volume in 1 second (FEV1) or the ratio of FEV1 to forced vital capacity. Xenon trappings after salbutamol inhalation were negatively related to the scores of the asthma control test, wheezing, or night symptoms, with statistical significance (P < .05), whereas, FEV1 showed no significant correlation with symptom scores. Baseline FEV1 was significantly lower and dyspnea and wheezing were more severe in the non-full reversal group than in the full reversal group after salbutamol inhalation in xenon CT (P < .05). The degree of ventilation defects were positively correlated with FEV1 improvement after 3 months of treatment (P = .02).
The results of this study suggest that xenon ventilation CT can be used as a new method to assess ventilation abnormalities in asthma, and these ventilation abnormalities can be used as novel parameters that reflect the status of asthma control and symptom severity.
Summary Background Compared with open resection, laparoscopic resection of rectal cancers is associated with improved short-term outcomes, but high-level evidence showing similar long-term outcomes ...is scarce. We aimed to compare survival outcomes of laparoscopic surgery with open surgery for patients with mid-rectal or low-rectal cancer. Methods The Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial was an open-label, non-inferiority, randomised controlled trial done between April 4, 2006, and Aug 26, 2009, at three centres in Korea. Patients (aged 18–80 years) with cT3N0–2M0 mid-rectal or low-rectal cancer who had received preoperative chemoradiotherapy were randomly assigned (1:1) to receive either open or laparoscopic surgery. Randomisation was stratified by sex and preoperative chemotherapy regimen. Investigators were masked to the randomisation sequence; patients and clinicians were not masked to the treatment assignments. The primary endpoint was 3 year disease-free survival, with a non-inferiority margin of 15%. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , number NCT00470951. Findings We randomly assigned 340 patients to receive either open surgery (n=170) or laparoscopic surgery (n=170). 3 year disease-free survival was 72·5% (95% CI 65·0–78·6) for the open surgery group and 79·2% (72·3–84·6) for the laparoscopic surgery group, with a difference that was lower than the prespecified non-inferiority margin (–6·7%, 95% CI −15·8 to 2·4; p<0·0001). 25 (15%) patients died in the open group and 20 (12%) died in the laparoscopic group. No deaths were treatment related. Interpretation Our results show that laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection, thus justifying its use. Funding National Cancer Center, South Korea.
This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with ...AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block.
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