Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease.

BACKGROUND AND PURPOSE: For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography. MATERIALS AND METHODS: Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups. RESULTS: The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (P = .418 and .424, respectively). The ΔTTP for the common carotid artery of >1.27 seconds and the ΔAUC ratio of >33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups. CONCLUSIONS: Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.

Assessment of CASP gene polymorphisms in periodontal disease.

Caspases (CASP) are intracellular proteases that play roles as mediators of apoptosis. Activation of caspase 3 is enhanced in chronic periodontitis. Thus, we hypothesized that single nucleotide polymorphisms (SNPs) of CASP genes might be associated with this condition in the Korean population. To investigate whether such polymorphisms might be involved in the development of periodontal disease, 51 patients and 33 control subjects were assessed. A total of 201 CASP gene SNPs were analyzed with genotypes being determined using and Axiom(TM) genome-wide human assay. SNPStats and SPSS 18.0 were used for the analysis of genetic data and logistic regression models were utilized to evaluate odds ratios, 95% confidence intervals, and P values. Of the 201 SNPs, only three (rs12108497, rs4647602, and rs113420705, all in the CASP3 gene) were significantly associated with chronic periodontitis (P < 0.05). The minor allele frequencies of these SNPs were higher in the patient group than in the control group. In addition, the TC and GT haplotypes formed by rs4647602 and rs113420705 were found to be associated with chronic this disease (TC haplotype, P = 0.0039; GT haplotype, P = 0.002). These results suggest that CASP3 gene polymorphisms may be associated with susceptibility to periodontal disease in the Korean population.

Chronic obstructive lung disease-related health care utilisation in Korean adults with obstructive lung disease.

OBJECTIVES: The numbers of nationwide epidemiological surveys about chronic obstructive pulmonary disease (COPD) prevalence and prospective cohort studies for health care utilisation are limited. We investigated COPD-related health care utilisation in adults with obstructive lung disease in the second Korean National Health and Nutritional Survey (KNHANES II) in 2001 using Korean national medical insurance claim data. METHODS: Among people aged >40 years, obstructive lung disease (OLD) is defined according to Global Initiative for Chronic Obstructive Lung Disease criteria. Data from a total of 1942 subjects were linked with Korean national medical insurance claims data, and we investigated their COPD-related out-patient visits from 2002 to 2005. RESULTS: Among the 1942 subjects, 256 (13.2%) had airflow obstruction. COPD-related out-patient visits were reported for 8.2% of patients without airway obstruction, 18.1% of those with mild airway obstruction, and 33.9% of those with moderate to very severe airway obstruction. Multivariate analysis revealed that previous COPD diagnosis by a physician (OR 2.54; P = 0.02) and lower socio-economic status (OR 0.45; P = 0.02) were independent predictors of COPD-related out-patient visits in subjects with OLD. CONCLUSIONS: Of the subjects with airway obstruction, those with poor financial status utilised COPD-related health care services less frequently, and those previously diagnosed as having COPD by a physician utilised the services more frequently.

Limited performance of quantitative assessment of myocardial function by thallium-201 gated myocardial single-photon emission tomography.

We investigated the reproducibility between thallium-201 and technetium-99m methoxyisobutylisonitrile (MIBI) gated single-photon emission tomography (SPET) for the assessment of indices of myocardial function such as end-diastolic and end-systolic volume (EDV, ESV), ejection fraction (EF) and wall motion. Rest 201Tl (111 MBq) gated SPET was sequentially performed twice in 20 patients. Rest 201Tl gated SPET and rest 99mTc-MIBI (370 MBq) gated SPET were performed 24 h apart in 40 patients. Wall motion was graded using the surface display of the Cedars quantitative gated SPET (QGS) software. EDV, ESV and EF were also measured using the QGS software. The reproducibility of functional assessment on rest 201Tl gated SPET was compared with that on 99mTc-MIBI gated SPET, and also with that between 201Tl gated SPET and 99mTc-MIBI gated SPET performed on the next day. The two standard deviation (2 SD) values for EDV, ESV and EF on the Bland-Altman plot were 29 ml, 19 ml and 12%, respectively, on repeated 201Tl gated SPET, compared with 14 ml, 11 ml and 5.3% on repeated 99mTc-MIBI gated SPET. The correlations were good (r=0.96, 0.97 and 0.87) between the two measurements of EDV, ESV and EF on repeated rest studies with 201Tl and 99mTc-MIBI gated SPET. However, Bland-Altman analysis revealed that the 2 SD values between the two measurements were 31 ml, 23 ml and 12%. We were able to score the wall motion in all cases using the 3D surface display of the QGS on 201Tl gated SPET. The kappa value of the wall motion grade on the repeated 201Tl study was 0.35, while that of the wall motion grade on the repeated 99mTc-MIBI study was 0.76. The kappa value was 0.49 for grading of wall motion on repeated rest studies with 201Tl and 99mTc-MIBI. In conclusion, QGS helped determine EDV, ESV, EF and wall motion on 201Tl gated SPET. Because the EDV, ESV and EF were less reproducible on repeated 201Tl gated SPET or on 201Tl gated SPET and 99mTc-MIBI gated SPET on the next day than on repeated 99mTc-MIBI gated SPET, functional measurement on 201Tl gated SPET did not seem to be interchangeable with that on 99mTc-MIBI gated SPET.

Effects of vasectomy on medical and psychosocial aspects.

PIP: To understand the effects of vasectomy on men, 1080 men were interviewed an average of 3.7 years after having had this operation. These men were grouped according to whether they privately paid for their operation or received it through a government program. The average age of these subjects was 37.8 years, and they had an average of 4.7 children. Reasons for vasectomy included economic considerations and the desire to limit their family. This type of operation was selected due to its permanance and reliability. Many men were motivated by family counselors or by the mass media. 68% had discussed the operation with their wives. 16% of the men had fears of impotence after the operation. Most were operated under a local anesthesia, and were not hospitalized. 57% did not bother to stay at home in recovery. Pain was encountered by 25% during the operation. Sexual activity was resumed in 3 weeks, with little change reported in eating or sleeping habits. Coital frequency decreased from 1.92-1.70 times/week. 90% of the men said they would recommend the operation to others.^ieng