We aimed to investigate whether thrombus aspiration could preserve the index of microcirculatory resistance (IMR) after primary percutaneous coronary intervention (PCI) in patients with ST-elevation ...myocardial infarction (STEMI).
Sixty-three patients with STEMI were randomised into two groups: primary PCI after thrombus aspiration (aspiration group, n=33) and primary PCI without thrombus aspiration (non-aspiration group, n=30). IMR was measured using a pressure-temperature sensor-tipped coronary wire. Echocardiography was performed at baseline and at six-month follow-up. No significant differences in baseline ejection fraction (EF, 47.3±8.5% vs. 49.5±7.8%, p=0.281) and baseline wall motion score index (WMSI, 1.45±0.31 vs. 1.37±0.27, p=0.299) were observed between the two groups. However, significant differences in IMR (23.5±10.2 U vs. 34.2±21.7 U, p=0.018), %E2%88%86EF (follow-up EF - baseline EF; 3.33±4.6% vs. 0.73±1.9%, p=0.005), and %E2%88%86WMSI (follow-up WMSI - baseline WMSI; -0.121±0.16 vs. -0.004±0.07, p=0.001) were observed between the two groups.
Thrombus aspiration as an adjunctive method to primary PCI for STEMI may preserve microvascular integrity and have beneficial effects on myocardial microcirculation.
Highlights • Direct access of stroke patients to hospitals offering intravenous thrombolytic therapy is compared to transfer of patients from non-thrombolysis centers. • Shorter onset-to-door time ...and better outcome in patients with acute ischemic stroke is demonstrated. • Implementation of regional stroke care programmings transporting stroke patients is recommended.
The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative ...effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated.
From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios (ORs) of preceding IVT.
Of the 639 patients (male, 61%; age 69 ± 12; National Institutes of Health Stroke Scale score of 15 11-19) who met the eligibility criteria, 458 received preceding IVT. These patients showed lower mRS scores (adjusted common OR, 1.38 95% CI 0.98-1.96). Preceding IVT was associated with successful recanalization (1.96 1.23-3.11) and reduced 3-month mortality (0.58 0.35-0.97) but not with SHT (0.96 0.48-1.93).
In patients treated with EVT within 8 of acute ischemic stroke onset, preceding IVT may enhance survival and successful recanalization without additional risk of SHT, and mitigate disability at 3 months.
The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, but it has several technical limitations for resection of the hepatic paracaval portion. We present a ...modified LHM that facilitates concurrent resection of the paracaval portion, a technique applicable to left liver resection for hilar bile duct (HBD) cancers. During 11 months from November 2006 to September 2007, 10 HBD cancer patients underwent left liver resection using the modified LHM. This method included initial partial transection of the caudal paracaval portion. Thus, subsequent blind tunneling over the retrohepatic inferior vena cava can become as short as 2–3 cm in length, resulting in effective prevention of short hepatic vein injury. The parenchyma transection plane was tailored to remove most of the paracaval portion. This modified LHM technique was safely and effectively applied to 10 consecutive patients, requiring a shorter time than conventional dissection method for caudate lobe dissection. No significant bleeding occurred during retrohepatic tunneling. The final parenchymal transection plane after left liver resection using modified LHM was the same as that following the conventional surgical technique for HBD cancers. In conclusion, we think that this modified LHM is an effective, technically simple procedure for resection of the left liver and caudate lobe in HBD patients.
Anticoagulant and antiplatelet therapy are widely used as preventive measures and treatment for cardiovascular and cerebrovascular diseases. Bleeding is a significant complication of anticoagulant ...and antiplatelet medications. With the growing use of acupuncture and the potential concomitant use of such medications, studies on the safety of acupuncture are necessary. The objective of this study was to evaluate the safety of acupuncture for patients taking warfarin or antiplatelet medications by comparing the rate of side effects for patients who did not take either of these medications.
The medical records were searched to identify patients who had received acupuncture treatments at the Department of Korean Internal Medicine of Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong between November 2010 and April 2012. Prescribed medications were identified from medical records and each patient was allocated to one of three groups based on the medication they were taking. Group A were taking warfarin, group B were taking antiplatelet medications but not warfarin, group C took neither warfarin nor antiplatelet medications and acted as a control group. Potential side effects that could be attributed to of acupuncture were identified.
A total of 242 patients and 4891 acupuncture treatments were identified. No patients experienced serious adverse events such as extensive bleeding. The occurrence rate of microbleeding (bleeding which stopped within 30s) was 4.8% for group A, 0.9% for group B and 3.0% for group C.
Acupuncture treatment appears safe even for patients taking warfarin or antiplatelet medications. Large-scale, well-designed studies are needed to confirm these results.
This article belongs to the Special Issue: ‘IG000019’.
Background: The incidence of facial palsy has been increasing. Many patients consult both Korean and Western physicians; however, no critical pathway (CP) for facial palsy has been established based ...on integrated medicine including Korean medicine, Western medicine, and complementary and alternative medicine. Thus, we developed and implemented an integrated CP for patients with acute facial palsy and investigated the satisfaction with CP. Methods: Overall, 20 patients who received treatment following the CP and 20 medical staff members involved in their care responded to a questionnaire survey. The questionnaire was developed based on a review of previous studies and focused on the satisfaction with the CP. Results: Patients' satisfaction score with the integrated CP was ≥ 4.4 for all items using a 5-point Likert-type scale. Smooth and cooperative treatment procedures, time-saving practices, and a clear explanation of the integrated treatment plan were satisfactory factors. Additionally, they preferred incorporating specialized facial massage and receiving education on self-exercise or massage techniques as complementary therapies. The medical staff members expressed a high level of satisfaction with the CP; however, the work division and treatment guidelines must be improved. Conclusion: An integrated CP program for acute facial palsy was implemented, and the satisfaction levels of patients and medical staff members were assessed. The results revealed high levels of satisfaction, and several improvements identified will be incorporated into clinical practice going forward.
Background The safety and efficacy of intravenous tissue plasminogen activator (IV-TPA) in the 3- to 4.5-hour window were largely driven from Western populations, but have not been systematically ...explored in Korean population. Methods We compared outcomes of acute ischemic stroke patients treated in the 3- to 4.5-hour window versus those in the 0- to 3-hour window, using a prospective multicenter registry database. Safety outcomes included symptomatic intracranial hemorrhage (SICH) and 3-month mortality and efficacy outcomes were the proportions of modified Rankin Scale (mRS) 0-1 and mRS 0-2 and the overall mRS distribution at 3 months. Results Among 723 patients consecutively treated with IV-TPA alone, 616 were treated within 3 hours and 107 treated between 3 and 4.5 hours. The median onset-to-treatment time was 115 minutes for 0- to 3-hour group and 217 minutes for 3- to 4.5-hour group. The SICH rate was higher in the 3- to 4.5-hour group than in the 0- to 3-hour group (4.7% vs. 3.1%), but the difference was not significant (adjusted odds ratio OR 95% confidence interval {CI}, .81 .20-3.35). There were no significant differences between the 3- to 4.5-hour and 0- to 3-hour groups in the 3-month mortality (19.6% vs. 12.0%), mRS 0-1 (39.3% vs. 42.9%), mRS 0-2 (48.6% vs. 55.7%), and the overall mRS distribution (adjusted proportional OR 95% CI, .94 .63-1.41) after adjusting for covariates. Conclusions IV-TPA treatment can be safely and efficaciously administered to eligible Korean patients up to the extended time window of 4.5 hours. However, efforts to expedite the treatment should not be neglected.
Recently, we are using explosion-proof elevators not only in industrial areas where there is a risk of gas leakage, but also in poor atmospheric conditions. Therefore, there is an increasing need for ...development an explosion-proof elevator with more safety. Therefore, this study developed an electric motor brake with high possibility of arc in the elevator parts as an explosion - proof type. For this purpose, we analyzed patented technology of elevator and patent of explosion proof technology. Based on the results, we developed an electric motor brake for an explosion-proof elevator. The technology also focuses on improving the housing and solenoid of the brakes and shows improved explosion protection compared to conventional brakes. As a result of analyzing the patent of the explosion proof technology, it was analyzed that the frame proof enclosure of the brake of the explosion type elevator is effective. The housing of the electromagnetic brake for the explosion-proof elevator was analyzed to be the most preferable structure with the explosion proof structure. Based on the above analysis, this paper defined the locking mechanism of the brakes and design the stable structure of the brakes. In this study, the optimum structure of the electromagnetic brake for the explosion proof elevator was found to be the explosion proof structure, and the existing elevator explosion proof technology focused only on the structure of the switch was extended to improve the explosion proofing function by improving the housing
The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who ...undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA).
We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinical outcome in patients who underwent EVAR or OSR of an AAA.
A total of 308 consecutive patients who underwent AAA repair were included; 178 received EVAR and 130 received OSR. There was no significant difference in the incidence of SIRS between EVAR patients and OSR patients. Regardless of treatment modality, SIRS was observed more frequently in patients treated with woven polyester grafts. Postoperative hospitalization was significantly prolonged in patients that experienced SIRS. In multivariate analyses, the initial white blood cell count (P = 0.001) and the use of woven polyester grafts (P = 0.005) were significantly associated with an increased risk of developing SIRS in patients who underwent EVAR. By contrast, the use of woven polyester grafts was the only factor associated with an increased risk of developing SIRS in patients who underwent OSR, although this was not statistically significant (P = 0.052).
The current study shows that the graft composition plays a primordial role in the development of SIRS, and it leads to prolonged hospitalization in both EVAR and OSR patients.
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