Background:This study aimed to evaluate the early outcomes of Perceval sutureless valves in the Korean population and to introduce a modified technique of guiding suture placement during valve ...deployment.Methods and Results:From December 2014 to April 2019, 121 patients (mean age: 74.7±6.2 years; 53.7% female) received a Perceval sutureless aortic valve replacement. To prevent conduction system injury, the depth of guiding suture placement (1 mm below the nadir of the annulus) was modified. All patients underwent echocardiographic evaluation at discharge and 6–12 months postoperatively, with a mean follow up of 13.7±11.2 months. Concomitant surgeries, such as coronary artery bypass grafting, and other valvular surgeries, were performed in 45.5% of cases. The mean aortic cross-clamp times for isolated and minimal procedures were 32.8±7.9, and 41.2±8.0 min, respectively. The overall transvalvular mean gradients were 13.1±3.8 mmHg at discharge and 11.5±4.7 mmHg at the last follow up. After modifying the guiding suture placement, permanent pacemaker implantation risk decreased from 9.9% to 2.5%. Cardiac-related mortality was 0.8%, with no patient developing valvular or paravalvular aortic regurgitation, valve thrombosis, or endocarditis.Conclusions:Perceval valve implantation provided a significant cardiac-related survival benefit with excellent early hemodynamic and clinical outcomes. Further research is needed to determine whether adjusting the implantation depth, such as modification of the guiding suture technique, can reduce the risk of permanent pacemaker implantation.
Aim
Periodontitis is caused by dysbiosis of oral microbes and is associated with increased cognitive decline in Alzheimer's disease (AD), and recently, a potential functional link was proposed ...between oral microbes and AD. We compared the oral microbiomes of patients with or without AD to evaluate the association between oral microbes and AD in periodontitis.
Materials and Methods
Periodontitis patients with AD (n = 15) and cognitively unimpaired periodontitis patients (CU) (n = 14) were recruited for this study. Each patient underwent an oral examination and neuropsychological evaluation. Buccal, supragingival and subgingival plaque samples were collected, and microbiomes were analysed by next‐generation sequencing. Alpha diversity, beta diversity, linear discriminant analysis effect size, analysis of variance‐like differential expression analysis and network analysis were used to compare group oral microbiomes.
Results
All 29 participants had moderate to severe periodontitis. Group buccal and supragingival samples were indistinguishable, but subgingival samples demonstrated significant alpha and beta diversity differences. Differential analysis showed subgingival samples of the AD group had higher prevalence of Atopobium rimae, Dialister pneumosintes, Olsenella sp. HMT 807, Saccharibacteria (TM7) sp. HMT 348 and several species of Prevotella than the CU group. Furthermore, subgingival microbiome network analysis revealed a distinct, closely connected network in the AD group comprised of various Prevotella spp. and several anaerobic bacteria.
Conclusions
A unique microbial composition was discovered in the subgingival region in the AD group. Specifically, potential periodontal pathogens were found to be more prevalent in the subgingival plaque samples of the AD group. These bacteria may possess a potential to worsen periodontitis and other systemic diseases. We recommend that AD patients receive regular, careful dental check‐ups to ensure proper oral hygiene management.
Background and Objective
Interleukin (IL)‐1 and tumor necrosis factor (TNF)‐α are inflammatory cytokines that play an important role in periodontitis, and their genetic variations have been suggested ...to be associated with increased risk of periodontitis. Focusing on three single nucleotide polymorphisms (SNPs) of IL‐1α + 4845, IL‐1β + 3954, and TNF‐α −863, we aimed to investigate the relationship between periodontitis risk and the polymorphisms of IL‐1 α/β and TNF‐α in Koreans.
Material and Methods
Mouthwash samples from 548 subjects (135 controls without periodontitis, 387 generalized chronic periodontitis patients, and 26 generalized aggressive periodontitis patients) were collected for isolation of genomic DNA. Genotyping of selected SNPs was performed using real‐time PCR. Univariable associations between the polymorphisms and periodontitis were assessed by chi‐squared test or Fisher's exact test. To evaluate the association after controlling for confounding effects of various risk factors, we stratified the subjects according to the presence or absence of self‐reported diseases and employed multiple logistic regression model to adjust for age, smoking status, and oral hygiene indices and behaviors.
Results
Significant association of IL‐1β + 3954 and TNF‐α −863 polymorphisms with periodontitis was observed after adjusting for the confounding risk factors, but not in univariable association analysis. The significant association between genotype CT of IL‐1β + 3954 and increased risk of advanced periodontitis was consistently detected regardless of the status of self‐reported diseases. In the polymorphism of TNF‐α −863, the genotype with minor allele (CA + AA) was significantly associated with periodontitis susceptibility, which was observed only in the subjects with self‐reported diseases.
Conclusion
The results suggest that genetic variations of IL‐1β + 3954 and TNF‐α −863 are associated with increased risk of periodontitis in Koreans. In addition, our findings underscore the importance of controlling for confounding risk factors to detect significant association between genetic factors and risk of periodontitis. A further well‐designed large‐scale study is needed to warrant our results.
Many variables may affect the hemodynamic performance of the aortic valve prosthesis, and suture technique remains an important factor for determining maximum valve performance. The objective of this ...study was to determine the suture technique that produces better hemodynamic performance for aortic valve replacement (AVR).
Patients who underwent AVR between January 2015 and September 2018 in our institution were analyzed. We compared the preoperative clinical information and 1-year postoperative hemodynamic data of interrupted pledget mattress sutures (pledgeted group), interrupted nonpledget mattress sutures (nonpledgeted group), and figure-of-8 nonpledget sutures (figure-of-eight group). We compared the incidence of prosthesis-patient mismatch (PPM) and cardiac adverse events among the groups and subanalyzed the PPM rate in a small aortic annulus (18 to 21 mm).
A total of 439 patients underwent AVR (pledgeted, n = 212; nonpledgeted, n = 122; figure-of-eight, n = 105). The groups were similar in age (P = .359), sex (P = .055), underlying disease, and valve pathology. There was no difference in inhospital mortality or cardiac adverse events in each suture group (P = .282). The nonpledgeted suture had significantly lower moderate (P < .01) and severe PPM rates (P = .01) in patients with a small aortic annulus (18 to 21 mm).
The interrupted nonpledget mattress suture offers complete supraannular implantation, which reduces the incidence of PPM and results in better hemodynamic improvement after small-size AVR.
Background
Pediatric hemato-oncologic patients require central catheters for chemotherapy, and the junction of the superior vena cava and right atrium is considered the ideal location for catheter ...tips. Skin landmarks or fluoroscopic supports have been applied to identify the cavoatrial junction; however, none has been recognized as the gold standard. Therefore, we aim to develop a safe and accurate technique using augmented reality technology for the location of the cavoatrial junction in pediatric hemato-oncologic patients.
Methods
Fifteen oncology patients who underwent chest computed tomography were enrolled for Hickman catheter or chemoport insertion. With the aid of augmented reality technology, three-dimensional models of the internal jugular veins, external jugular veins, subclavian veins, superior vena cava, and right atrium were constructed. On inserting the central vein catheters, the cavoatrial junction identified using the three-dimensional models were marked on the body surface, the tip was positioned at the corresponding location, and the actual insertion location was confirmed using a portable x-ray machine. The proposed method was evaluated by comparing the distance from the cavoatrial junction to the augmented reality location with that to the conventional location on x-ray.
Results
The mean distance between the cavoatrial junction and augmented reality location on x-ray was 1.2 cm, which was significantly shorter than that between the cavoatrial junction and conventional location (1.9 cm;
P
= 0.027).
Conclusions
Central catheter insertion using augmented reality technology is more safe and accurate than that using conventional methods and can be performed at no additional cost in oncology patients.
Background and aims
Endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (UD EGC) has debate due to the risk of lymph node metastasis. We investigated the outcomes of ESD ...compared to those of surgery for the UD EGC within expanded indication.
Methods
We reviewed 971 UD EGC patients performed ESD across 18 hospitals in Korea and 1812 patients who underwent surgical resection in two hospitals between February 2005 and May 2015. Of these cases, we enrolled a curative resected ESD group of 328 patients and surgery group of 383 cases within an expanded indication. Overall outcomes and one-to-one propensity score-matched (218 ESD group vs 218 surgery group cases) outcomes for these two groups were analyzed.
Results
Over the 75.6 month median follow-up period for the 711 enrolled cases, recurrences occurred in 22 patients (6.7%) in the ESD group but not in the surgery group. Overall survival (OS) was higher in the surgery group (
p
= 0.0316) in all cases, but there was no significant difference after propensity score matching (
p
= 0.069). According to the histologic type in propensity score matching, the OS of signet ring cell carcinoma and poorly differentiated carcinoma patients did not differ between the ESD and surgery groups (
p
= 0.1189 and
p
= 0.3087, respectively). In the surgery group involving expanded criteria, lymph node metastasis was found in six cases (1.56%).
Conclusions
Although ESD shows comparable outcomes to surgery for the UD EGC within expanded indications, appropriate patient selection is needed for the ESD due to the possibility of lymph node metastasis.
There is an increasing demand and need for patients and caregivers to actively participate in the treatment process. However, when there are unexpected findings during pediatrics surgery, access ...restrictions in the operating room may lead to a lack of understanding of the medical condition, as the caregivers are forced to indirectly hear about it. To overcome this, we designed a tele-consent system that operates through a specially constructed mixed reality (MR) environment during surgery. We enrolled 11 patients with unilateral inguinal hernia and their caregivers among the patients undergoing laparoscopic inguinal herniorrhaphy between January through February 2021. The caregivers were informed of the intraoperative findings in real-time through MR glasses outside the operating room. After surgery, we conducted questionnaire surveys to evaluate the satisfaction and usefulness of tele-consent. We identified contralateral patent processus vaginalis in seven out of 11 patients, and then additionally performed surgery on the contralateral side with tele-consent from their caregivers. Most caregivers and surgeons answered positively about the satisfaction and usefulness of tele-consent. This study found that tele-consent with caregivers using MR glasses not only increased the satisfaction of caregivers and surgeons, but also helped to accommodate real-time findings by adapting surgical plan through the tele-consent.
Background
This study was performed to investigate the effects of cyclosporine A (CsA) on the osteogenic differentiation, osteoclastogenic‐supporting ability, and angiogenic potential of human ...periodontal ligament stem cells (hPDLSCs).
Methods
hPDLSCs were isolated from the extracted teeth of orthodontic patients. Cell proliferation was assessed using 3‐(4,5‐dimethylthiazol‐2‐yl)‐2, 5‐diphenyltetrazolium bromide assay, and osteogenic differentiation was evaluated by alkaline phosphatase (ALP) and alizarin red (ARS) staining. Real‐time polymerase chain reaction (PCR) was used to quantify transcripts. Tartrate‐resistant acid phosphatase staining of bone marrow‐derived macrophages (BMMs) and tube formation assays on human umbilical vein endothelial cells (HUVECs) were performed after treating cells with the conditioned media from CsA‐exposed or non‐exposed hPDLSCs. Signaling pathways mediating the angiogenic activity were investigated using western blotting.
Results
CsA suppressed the proliferation of hPDLSCs but enhanced osteogenic differentiation as determined by ALP and ARS staining and PCR of osteogenic transcripts. The expressions of osteoclastogenic transcripts in hPDLSCs and the differentiation of BMMs treated with conditioned medium from CsA‐exposed hPDLSCs were unaffected by CsA. However, the expressions of angiogenic transcripts and the transcripts known to support angiogenesis—phosphorylation of extracellular signal p‐regulated kinase (ERK) and p38, and c‐fos—were inhibited. Conditioned medium from CsA‐exposed hPDLSCs suppressed the tube forming abilities of HUVECs.
Conclusions
CsA enhanced the osteogenic differentiation and reduced angiogenesis by blocking the ERK and p38/c‐fos pathway in hPDLSCs. It is necessary to confirm whether this phenomenon is also observed in vivo in subsequent animal experiments.
Although epidemiologic studies have shown an association between the total mass of particulate matter <2.5μm in aerodynamic diameter (PM2.5) and cardiovascular disease, few studies have examined ...PM2.5 constituents associated with vascular and cardiac autonomic dysfunction.
In this longitudinal study, we investigated the relationship between PM2.5 constituents and blood pressure (BP), and markers of the autonomic nervous system. In 466 elderly subjects residing in communities in Seoul, Korea, we examined 16 constituents, seven sources, and total mass concentrations of PM2.5. We measured the BP, heart rate (HR), and indices of heart rate variability (HRV), such as the standard deviation of normal-to-normal intervals (SDNN), square root of the mean squared differences of successive NN intervals (rMSSD), and two frequency-domain variables (low frequency LF and high frequency HF). We used linear mixed effects models to assess the association of PM2.5 constituents and sources with cardiovascular markers.
BP, HR, and rMSSD were associated with concentration of total mass of PM2.5. For each increase of the interquartile range in PM2.5 constituents, systolic and diastolic BP, and HR increased by 2.1–3.3mmHg, 1.2–2.3mmHg, and 1.2–1.9bpm, respectively, while the rMSSD, LF, and HF decreased by 8.1–9.3%, 16.6%, and 20.4%, respectively. Particularly, elemental carbon, sulfate, ammonium, lead, and strontium in the PM2.5 constituents and emissions from oil combustion and incineration were associated with increased BP, HR, and decreased HRV.
Our results suggest an association between specific PM2.5 constituents and vascular and cardiac autonomic functions. These findings may provide supportive evidence for developing a pollution reduction plan to prevent cardiovascular diseases.
Display omitted
•PM2.5 constituents and vascular/cardiac autonomic function may have a relationship.•Increases in blood pressure and heart rate were associated with PM2.5 constituents.•Decreased heart rate variability indices were associated with PM2.5 constituents.•Oil combustion and incineration emissions were associated with autonomic function.
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