The correlation of left atrial volume index to the level of N-terminal pro-BNP in heart failure with a preserved ejection fraction

Background: Patients with heart failure with a preserved ejection fraction (HFPEF) have high N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP) level and a high ratio of early transmitral inflow to diastolic velocity of the mitral annulus (E/E′) derived from tissue Doppler imaging (TDI). Because left atrial volume indexed to body surface area (LAVI) is believed to reflect chronic diastolic dysfunction, we assessed the ability of LAVI and E/E′ ratio to predict NT‐pro‐BNP level in patients with HFPEF. Methods: One hundred forty‐eight patients with HFPEF (ejection fraction ≥ 50%, NT‐pro‐BNP ≥ 100 pg/ml) underwent conventional echocardiography including LAVI and E/E′ ratio, which were compared with NT‐pro‐BNP level. Results: In the overall patient population, modest correlations were found between NT‐pro‐BNP level and peak systolic TDI (S′) (P = 0.009), LAVI (P = 0.009), and E/E′ ratio (P = 0.017). However, in patients with E/E′ ratio ≥13, LAVI was the most important predictor of NT‐pro‐BNP level (P < 0.001), whereas in those with E/E′ ratio <13 it was S′ (P < 0.001) in multivariate analysis. Conclusion: In patients with HFPEF evidenced by high NT‐pro‐BNP level, LAVI correlates with NT‐pro‐BNP level in the setting of elevated E/E′ ratio. However, in the setting of low E/E′ ratio, LAVI does not seem to be associated with NT‐pro‐BNP level.     

Adeno-associated virus mediated endostatin gene therapy in combination with topoisomerase inhibitor effectively controls liver tumor in mouse model

AIM: rAAV mediated endostatin gene therapy has been examined as a new method for treating cancer. However, a sustained and high protein delivery is required to achieve the desired therapeutic effects. We evaluated the impact of topoisomerase inhibitors in rAAV delivered endostatin gene therapy in a liver tumor model. METHODS: rAAV containing endostatin expression cassettes were transduced into hepatoma cell lines. To test whether the topoisomerase inhibitor pretreatment increased the expression of endostatin, Western blotting and ELISA were performed. The biologic activity of endostatin was confirmed by endothelial cell proliferation and tube formation assays. The anti-tumor effects of the rAAV-endostatin vector combined with a topoisomerase inhibitor, etoposide, were evaluated in a mouse liver tumor model. RESULTS: Topoisomerase inhibitors, including camptothecin and etoposide, were found to increase the endostatin expression level in vitro. The over-expressed endostatin, as a result of pretreatment with a topoisomerase inhibitor, was also biologically active. In animal experiments, the combined therapy of topoisomerase inhibitor, etoposide with the rAAV-endostatin vector had the best tumor-suppressive effect and tumor foci were barely observed in livers of the treated mice. Pretreatment with an etoposide increased the level of endostatin in the liver and serum of rAAV-endostatin treated mice. Finally, the mice treated with rAAV-endostatin in combination with etoposide showed the longest survival among the experimental models. CONCLUSION: rAAV delivered endostatin gene therapy in combination with a topoisomerase inhibitor pretreatment is an effective modality for anticancer gene therapy.     

Kidney Function in Living Donors Undergoing Nephrectomy by Sevoflurane or Desflurane Anesthesia

Purpose

Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia.

Materials and Methods

From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR).

Results

The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR.

Conclusion

Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.     

The significance of tibial and common peroneal nerves in nerve blocks

Purpose

The aim of this study was to elucidate the anatomical location of tibial nerve (TN) and common peroneal nerve (CPN) in the popliteal crease for specific nerve block.

Methods

Fifty fresh specimens from 27 adult Korean cadavers (16 males and 11 females, age 35–87 years) were investigated. Five of the 27 cadavers were used to determine the depths of nerves in cross-section.

Results

Tibial nerve was located 50 % from the most lateral point of the popliteal crease and 1.4-cm deep to the surface. In 20 % of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26 % from the most lateral point of the popliteal crease and 0.7-cm deep from the surface. Furthermore, in 6 % of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease.

Conclusion

The results concerning the location of the TN and CPN at the popliteal crease offer a good guide to optimal nerve block.     

The Mediating Effect of Insomnia on the Relationship between Panic Symptoms and Depression in Patients with Panic Disorder

BackgroundThis study aimed to determine if sleep disturbances may mediate the relationship between panic symptoms and depression in patients with panic disorder (PD).MethodsElectronic medical records were retrospectively reviewed for 110 consecutive patients with diagnosed PD in an outpatient clinic between October 2018 and December 2019. Measurements include the PD Severity Scale, Beck Depression Inventory-II (BDI-II) and Insomnia Severity Index (ISI). Statistical analyses were performed to assess any potential relationship between PD, insomnia and depression.ResultsOf the PD patients, 88 (80%) and 89 (80.9%) had comorbid depression (BDI-II ≥ 14) and insomnia (Korean version of the ISI ≥ 8), respectively. In a mediation model using insomnia as the mediating variable, the total effect of panic symptom severity on depression was significant (t = 7.23, P < 0.001). There were significant effects of panic symptoms on insomnia (t = 4.62, P < 0.001) and of insomnia on depression (t = 6.69, P < 0.001). The main effect of panic symptom severity on depression was also significant, after controlling for the effect of insomnia (t = 5.10, P < 0.001), suggesting partial mediation.ConclusionBoth depressive symptoms and insomnia are common in patients with PD and depression was partially mediated by insomnia in these patients. These results suggest that an intervention for insomnia in patients with PD might help prevent the development of depression.     

The location and morphometry of the thyroid isthmus in adult Korean cadavers

The thyroid isthmus has different measurements in its width, height, and thickness, and its location with respect to the tracheal rings has been inconsistent, among the anatomical literature. This study was performed to clarify the location and morphometric characteristics of the thyroid isthmus. One hundred thyroid isthmuses of adult Korean cadavers (gender 58 males and 42 females, mean age 62.9 years, range 19–94 years) were used for this study. The distances from the inferior border of the cricoid cartilage to the superior and inferior margins of the isthmus were 4.9 ± 3.7 and 20.8 ± 5.8 mm, respectively. The width, height, and thickness of the thyroid isthmus were 11.1 ± 6.2, 15.9 ± 5.8 and 3.4 ± 1.7 mm, respectively. The thyroid isthmus was located on the 2nd to 4th, 1st to 3rd, and 1st to 4th tracheal rings, in 22, 18 and 18 % of the specimens, respectively. These results are expected to further the current knowledge of the location and morphometry of the thyroid isthmus and provide helpful information for surgical procedures in this region.     

The Prevalence of Os Acromiale in Korean Patients Visiting Shoulder Clinic

Background

The prevalence of os acromiale has been documented to be between 1% and 15% and is known to be clinically associated with subacromial impingement or rotator cuff tear. However, the prevalence of os acromiale in Korea has not yet been determined. The purpose of this study is to evaluate the prevalence of os acromiale in Korean patients who visited shoulder clinics and to investigate the correlations with rotator cuff tear.

Methods

We retrospectively reviewed the X-rays of patients visiting a shoulder clinic at a tertiary hospital in Korea from January 2011 to January 2012 to determine the frequency of os acromiale. X-ray findings were confirmed with magnetic resonance imaging (MRI) for patients who had these images available. MRI was also used to assess the status of the rotator cuff. The correlation between the presence of os acromiale either with gender, hand dominance or rotator cuff tear was analyzed statistically.

Results

A total of 2,946 shoulders from 1,568 patients were analyzed with X-rays. Thirteen cases out of 1,568 patients had an os acromiale; and there were five and eight cases of pre-acromiale and meso-acromiale, respectively. Thus, the prevalence of os acromiale in this study population was found to be 0.7 (7 cases per 1,000 patients). Bilaterality was found in two cases. Os acromiale was not more frequent according to gender (five males versus eight females, p = 0.525) and hand dominance was not associated with frequency of os acromiale (seven dominant arms versus six non-dominant arms, p = 0.631). A sub-analysis of shoulders with available MRIs (1,074 shoulders) revealed that there were two rotator cuff tears (40%) out of five cases of os acromiale, whereas 607 rotator cuff tears were observed (57%) among 1069 cases without os acromiale. This difference was not statistically significant (p = 0.656).

Conclusions

The identified prevalence of os acromiale in Korean patients who visited shoulder clinics is 0.7%, which is much lower as compared with the prevalence of general population from other ethnic groups. No correlation was observed between rotator cuff tears and os acromiale in this study population.     

Negligible Pharmacokinetic Interaction of Red Ginseng and Antihypertensive Agent Amlodipine in Sprague-Dawley Rats

Red ginseng (RG) is the top-selling functional food in Korea, but is not recommended for use in hypertensive patients. This study was performed to determine the pharmacokinetic (PK) interaction between RG and amlodipine, an antihypertensive drug. RG (0, 0.5, 1, or 2 g/kg/d) was administered orally for 2 wk, and then amlodipine (10 mg/kg) was given orally, to Sprague-Dawley (SD) rats. Blood was collected at 0.08, 0.25, 1, 1.5, 2, 3, 6, 12, and 24 h after amlodipine administration. In intravenous (iv) study, RG (0, 1, or 2 g/kg/d) was administered orally to SD rats for 2 wk, followed by amlodipine (2 mg/kg) intravenously (iv). Plasma concentrations of amlodipine were analyzed using a high-pressure liquid chromatography–tandem mass system (LC-MS/MS). Oral administration of amlodipine produced an increase of time to maximum plasma concentration (t_max: 2.6, 4.1, 8.3, and 8.9 h at 0, 0.5, 1, and 2 g/kg/d, respectively), and a decrease of maximum plasma concentration (C_max: 278.5, 212.4, 232.1, and 238.7 ng/ml at 0, 0.5, 1, and 2 g/kg/d, respectively.). However, the area under the concentration–time curve from time 0 to 24 h measurable concentration (AUC_{0-24 h} was 3487.4, 2895.4, 3158.2, and 3495 ng/h/ml at 0, 0.5, 1, and 2 g/kg/d respectively) was not significantly changed among the different dose groups. Administration of amlodipine iv produced no significant changes in the apparent terminal half-life, volume of distribution, and AUC_{0-24 hr} among the different dose groups. These results suggest that RG induced negligible influence on amlodipine pharmacokinetically in rats.