Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non-small cell lung cancer.

BACKGROUND: To evaluate the lung dose differences between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) techniques for lung stereotactic body radiation therapy (SBRT) and the correlations with tumor characteristics, such as size and location. METHODS: Dosimetric comparisons between the two SBRT techniques in high- and low- to intermediate-dose regions were retrospectively performed using four planning indices and lung-dose parameters in 31 lung tumors. The magnitude of differences in these parameters was analyzed with relation to the planning target volume (PTV) and location-related parameters. RESULTS: The absolute differences between the two techniques in lung-dose parameters were small in both ipsilateral and bilateral lungs. The dosimetric differences were mainly correlated with the PTV rather than location-related parameters, with positive and negative correlations with the high-dose and intermediate-dose parameters, respectively. The distances from the ipsilateral lung centroid to the PTV center were not correlated with the differences in any of the lung-dose parameters. Additionally, the negative correlations with the MLD and V20 differences disappeared after applying a more rapid dose fall-off in the IMRT plans for tumors with small PTVs of ≤15 cc. CONCLUSIONS: Lung dose differences between the 3D-CRT and IMRT techniques for lung SBRT were mainly correlated with the PTV rather than location-related parameters. Together with the dosimetric benefit in high-dose lung regions of IMRT for larger tumors, the relative increases in the MLD and V20 for small-sized tumors could be reduced by applying a more rapid dose fall-off outside the PTV.

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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Influence of tumor characteristics on correction differences between cone-beam computed tomography-guided patient setup strategies in stereotactic body radiation therapy for lung cancer.

BACKGROUND: To evaluate the correction differences between vertebra and tumor matching as cone-beam computed tomography (CBCT)-guided setup strategies in lung stereotactic body radiation therapy (SBRT), and the correlations with tumor characteristics such as size, mobility, and location. METHODS: The manual registrations for 33 lung tumors treated with SBRT were retrospectively performed by matching thoracic vertebrae for vertebra matching and then by matching CBCT-visualized tumors within the internal target volume obtained from a four-dimensional CT dataset for tumor matching. RESULTS: The mean correction difference between the two matching methods during the SBRT fractions was larger in the anterior-posterior direction (2.7 mm) than in the superior-inferior (2.1 mm) and left-right (1.4 mm) directions, with differences of less than 5 mm in 90% of the total 134 CBCT fractions. The X-axis and direct distances from the central axis to the tumor had significant correlations with the correction differences in all three directions, while the mobility-related parameters were correlated only in the superior-inferior direction. The absolute differences in lung-dose parameters after applying the margins (3.4-6.5 mm) required for the setup errors from vertebra matching relative to tumor matching were mild, with values of 1.95 Gy for the mean lung dose and 3.9% for V20. CONCLUSION: The setup differences between vertebra and tumor matching in the CBCT-guided setup without rotation correction were increased in tumors located long distances from the central axis. The additional safety margins of 3.4-6.5 mm were required for the setup errors from vertebra matching. KEY POINTS: Significant findings of the study The correction difference between the vertebra and tumor matching as CBCT-guided setup strategies was the largest in the anterior-posterior direction and significantly correlated with the X-axis and direct distances from the central axis to the tumor. What this study adds Setup differences between vertebra and tumor matching in the CBCT-guided setup were increased in tumors located long distances from the central axis. The additional safety margins of 3.4-6.5 mm were required for the setup errors from vertebra matching.

Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women's Chest Pain Registry.

BACKGROUND/AIMS: Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated. METHODS: The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated. RESULTS: Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD. CONCLUSION: This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient's medical history in pretest assessment for OCAD should be individualized considering gender.

Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women’s Chest Pain Registry

Background/Aims@#Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated. @*Methods@#The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated. @*Results@#Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD. @*Conclusions@#This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient’s medical history in pretest assessment for OCAD should be individualized considering gender.

Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women: data from the KoRean wOmen'S chest pain rEgistry (KoROSE).

OBJECTIVES: This study investigated the association between obesity type and obstructive coronary artery disease (CAD) in postmenopausal women. METHODS: Study data were obtained from a nation-wide registry, composed of 659 women older than 55 years with chest pain undergoing elective invasive coronary angiography in the suspicion of CAD. Obstructive CAD was defined as angiographic findings of ≥50% diameter stenosis with any major epicardial coronary artery. Overall obesity was defined as a body mass index of ≥25 kg/m, and central obesity was defined as a waist circumference of ≥85 cm. RESULTS: A total of 311 women (47.2%) had obstructive CAD. The incidence of overall obesity was not different between participants with and without obstructive CAD (P = 0.340), but the prevalence of obstructive CAD was significantly higher in participants with central obesity than those without (55.5% vs 41.0%, P < 0.001). There was no significant difference in body mass index between participants with and without obstructive CAD (P = 0.373). Multivariable analysis showed that central obesity was associated with obstructive CAD even after controlling for potential confounders (odds ratio, 1.61; 95% confidence interval, 1.10-2.34; P = 0.013). However, overall obesity was not associated with obstructive CAD in the same multivariable analysis (P = 0.228). CONCLUSIONS: Central obesity but not overall obesity is associated with obstructive CAD in postmenopausal women with stable chest pain undergoing invasive coronary angiography. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A440.

Efectos de la imaginería motora aplicada durante el periodo de inmovilización o posquirúrgico en miembro superior: una revisión sistemática / Effects of motor imagery applied during upper limb immobilisation and / or after surgery: A systematic review

Objetivo: El objetivo de esta revisión sistemática fue resumir toda la evidencia relativa a los efectos de la imaginería motora realizada durante el periodo de inmovilización después de una lesión o en el inmediato posquirúrgico y los efectos sobre el dolor, la fuerza, la función y el rango articular. Métodos: Se hicieron búsquedas sistemáticas en todos los idiomas y en 4 bases de datos: PubMed, OtSeeker, Cinhal, WOS y PEDro. Se seleccionaron los estudios elegibles publicados hasta noviembre de 2018. Se incluyeron ensayos clínicos aleatorizados que investigaron los efectos de la intervención de imaginería motora durante el periodo de inmovilización después de una lesión o en el inmediato posquirúrgico de miembro superior. Se utilizó la escala PEDro de calidad metodológica. Resultados: Se seleccionaron 4 ensayos clínicos aleatorizados, 2 con calidad metodológica buena y 2 con calidad metodológica insuficiente. El rango articular se evaluó en los 4ensayos, el dolor en 2, la fuerza en 3 y en uno la función. Se observaron cambios positivos en el grupo de imaginería motora en el rango articular en 3 estudios: 2 de calidad metodológica buena (n = 40 y n = 18) y uno de calidad insuficiente (n = 18); en el dolor, en un estudio de calidad buena (n = 40); en la fuerza en 2 estudios: uno de calidad buena (n = 40) y uno de insuficiente (n = 18) y en la función, en uno de calidad buena (n = 40). Conclusiones: Los resultados muestran beneficios positivos en el uso de imaginería motora aplicándola inmediatamente después del periodo posquirúrgico o en personas sanas simulando una inmovilización

Objective: The objective of this systematic review was to make a detailed examination of all the evidence concerning the effects of motor imagery (MI) performed during the immobilisation period after an injury, or in the immediate postoperative period, and the effects on pain, strength, function, and joint range. Methods: Systematic searches were conducted in all languages and in 4 electronic databases: PubMed, OTseeker, Cinahl, WOS and PEDro. Eligible studies published up to November 2018 were selected. Randomised controlled trials that investigated the effects of a motor imagery intervention performed during the period of immobilisation after an injury, or in the immediate postoperative upper limb were included. methodological quality was assessed using the PEDro scale. Results: Four randomised clinical trials were selected, 2 with good methodological quality and 2 with insufficient methodological quality. The joint range was evaluated in the 4 trials, pain in 2, strength in 3, and function in one. Positive changes were observed in the group of motor imagery in the joint mobility in 3 studies: 2 of good methodological quality (n = 40 and n = 18) and one insufficient (n= 18), in pain in one study of good quality (n = 40), in strength in 2 studies: one good quality (n = 40) and 1 insufficient (n = 18) and in function in 1 of good quality (n = 40). Conclusions: The results show positive benefits in the use of motor imagery applied immediately after the postoperative period or in healthy people simulating an immobilisation

Prognostic significance of acute hypertensive response in ischemic stroke or transient ischemic attack patients and its relationship with left ventricular myocardial function.

OBJECTIVES: Acute hypertensive response (AHR) in acute stroke is associated with adverse outcomes; however, the underlying pathophysiology of the association is poorly understood and its prognostic impact in ischemic stroke remains unclear. We aimed to investigate the prognostic significance of AHR in patients with ischemic stroke or transient ischemic attack (TIA), and further examined the relationship between AHR and myocardial function, using two-dimensional speckle-tracking echocardiography (2D-STE). METHODS: A total of 244 consecutive patients with acute ischemic stroke (AIS) (n = 192) or TIA (n = 52), who were evaluated with 2D-STE within 7 days from admission, were retrospectively analysed. The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infraction or recurrent ischemic stroke. RESULTS: Among the study population, AHR was observed in 161 (66%) patients. During a mean follow-up of 21.0 ±â€Š12.5 months, 29 patients (11.9%) [25 (15.5%) AHR vs. 4 (4.8%) No AHR, P = 0.014] reached the primary endpoint. A Kaplan-Meier curve revealed that patients with AHR had a significantly higher incidence of MACCE than those without AHR (log-rank P = 0.013). Multivariate Cox regression analysis demonstrated that AHR [adjusted hazard ratio 4.60, 95% confidence interval (95% CI) 1.31-16.15] was a strong predictor of MACCE. In multivariate logistic regression analysis, left ventricular global longitudinal strain (per 1% decrease) showed a significant relationship with AHR (adjusted odds ratio 1.17, 95% CI 1.02-1.35). CONCLUSION: AHR in patients with AIS or TIA may be an important poor prognostic marker related to myocardial dysfunction.

Sex Differences in Traditional and Nontraditional Risk Factors for Obstructive Coronary Artery Disease in Stable Symptomatic Patients.

BACKGROUND: There have been limited data on sex-specific risk factors for coronary artery disease (CAD) in patients with stable chest pain. This study was performed to investigate whether risk factors for CAD differ by sex in stable symptomatic patients. METHODS: Data were obtained from a nation-wide registry, enrolling 1025 patients (age, 62.0 ± 11.0 years, 587 women) with chest pain who underwent elective invasive coronary angiography under the suspicion of CAD. RESULTS: A total of 373 patients (36.4%) had obstructive CAD (≥50% stenosis) (men vs. women: 33.8% vs. 38.3%, p = 0.135). In men, univariate analyses showed that age, renal function, total cholesterol, low-density lipoprotein cholesterol, triglyceride, C-reactive protein (CRP), left ventricular (LV) systolic function, and septal annular velocity of LV (e') were significantly associated with the presence of obstructive CAD. Among these factors, a high CRP level (≥0.50 mg/dL) was an independent predictor of CAD in multivariable analysis (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.26-6.82; p = 0.012). In women, univariate analyses showed that age, waist circumference, heart rate, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, LV systolic function, LV mass index, e' velocity, E/e', and left atrial size were significantly associated with the presence of obstructive CAD. Among these factors, lower e' velocity (<6.35 cm/s) was an independent predictor of CAD in multivariable analysis (OR, 2.38; 95% CI, 1.21-4.70; p = 0.012). CONCLUSIONS: Among patients with stable chest pain, inflammation and LV diastolic dysfunction are independently associated with obstructive CAD in men and women, respectively.

Effects of multiparity on left ventricular diastolic dysfunction in women: cross-sectional study of the KoRean wOmen'S chest pain rEgistry (KoROSE).

OBJECTIVES: To investigate the association between left ventricular (LV) diastolic dysfunction and multiparity in patients with suspected coronary artery disease (CAD). DESIGN: Cross-sectional study. SETTING: Linked secondary and tertiary care records from 29 cardiac centres which participated in KoRean wOmen'S chest pain rEgistry. PARTICIPANTS: 960 women with suspected CAD who underwent invasive coronary angiography from February 2011 to May 2017. The patients were classified by parity number, as follows: low-parity, 0 to <3; multiparity, ≥3 pregnancies. MAIN OUTCOME MEASURE: Prevalence of LV diastolic dysfunction. RESULTS: There were 302 and 658 low-parity and multiparity patients, respectively. The prevalence of LV diastolic dysfunction was significantly higher in the multiparity than in the low-parity group. The multiparity group had significantly lower E and e´ septal velocities and E/A ratio, and had a significantly higher E/e´ ratio and right ventricular systolic pressure, which are parameters of LV diastolic dysfunction, than the low-parity group. The prevalence of CAD was significantly higher in the multiparity than in the low-parity group. Receiver operating characteristic curve analysis identified a parity of 2.5 as the cut-off for predicting LV diastolic dysfunction (area under the curve, 0.66; sensitivity, 74.1%; specificity, 52.0%; 95% CI 0.607 to 0.706; p<0.001). After adjustment for confounding factors, multivariate regression analysis showed that multiparity had a 1.80-fold increased risk for LV diastolic dysfunction (OR 1.80, 95% CI 1.053 to 3.081, p=0.032). CONCLUSIONS: The prevalence of LV diastolic dysfunction was higher in multiparity than in low-parity women with suspected CAD. Multiparity was an independent risk factor for LV diastolic dysfunction. LV diastolic dysfunction should be evaluated in multiparous women for the risk of subsequent cardiovascular disease and facilitate the initiation of appropriate treatment.

Relationships between blood pressure measurements and target organ damage: Data from the Korea women's chest pain registry.

This study was performed to investigate the association between four BP measurements (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], and pulse pressure [PP]) and four TOD parameters (left ventricular mass index [LVMI], E/e', estimated glomerular filtration rate [eGFR], and obstructive coronary artery disease [CAD]). Data were obtained from a nation-wide registry, composed of 652 patients (471 women, 58.4 ± 10.5 years) with suspected CAD who underwent elective invasive coronary angiography (CAG). A total of 217 patients (33.2%) had obstructive CAD (≥50%). In multivariable analyses, E/e' was associated with SBP, MAP and PP, and CAD was associated with SBP and PP (P < 0.05 for each). All four BP measurements were not associated with LVMI and eGFR (P > 0.05 for each). In patients undergoing elective invasive CAG, SBP, and PP had stronger relationships with E/e' and CAD than DBP and MAP.

Amputación bilateral en paciente diabética con ceguera, el uso de prótesis inadecuadas. Reporte de caso / Bilateral amputation in diabetic patient with blindness, the use of inadequate prosthesis. Case report

Resumen: Las complicaciones más frecuentes asociadas con la diabetes incluyen al pie diabético y al glaucoma, que suelen llevar a la amputación y a la pérdida de la visión, respectivamente. El desarrollo científico y tecnológico actual ha permitido el diseño e implementación de sistemas protésicos óptimos para estos pacientes, asegurando una reincorporación a las actividades de la vida diaria, así como una correcta adaptación al uso de las mismas. La falta de recursos económicos compromete la adquisición de las prótesis ideales, recurriendo al uso de sistemas «artesanales¼ o «rústicos¼ que afectan la adaptación. Se presenta el caso de un paciente femenino de 47 años de edad, ama de casa, quien presenta parestesias bilaterales y sensación de miembro fantasma asociado a neuromas de amputación por diabetes mellitus tipo II de ocho años de evolución. La paciente, con bajos recursos económicos, es evaluada postamputación con diagnóstico de dependencia grave en la ejecución de las actividades de la vida diaria, con desplazamiento en silla de ruedas asistido; esta presentación es una variante frecuente como consecuencia de la pérdida bilateral de miembros inferiores, concomitante a la ausencia total de la visión. Se presenta el tratamiento de rehabilitación en etapa preprotésica y protésica, acompañados por los resultados de las evaluaciones para mostrar la efectividad del proceso terapéutico, sin olvidar la participación del cuidador como ente coterapéutico fundamental en el proceso.

Abstract: The most frequent diabetes-related complications are diabetic foot and glaucoma, which lead to amputation and loss of vision, respectively. Current scientific and technologic developments have permitted the design and implementation of prosthetic systems that are optimal for these patients, as the latter adapt themselves to them and can resume activities of daily living. The lack of economic resources compromises the quality of the prostheses patients can afford, as they resort to «artisanal¼ or «rustic¼ systems that hamper their adaptation process. We present herein the case of a 47 year-old female patient, housewife, with bilateral paresthesias and phantom limb sensation associated with amputation neuromas resulting from type II diabetes mellitus that had affected the patient for eight years. This patient of a low socioeconomic stratum underwent a post-amputation assessment and was diagnosed as being heavily dependent when performing activities of daily living and required assisted wheelchair for ambulation. This is a frequent variant resulting from bilateral loss of lower limbs together with complete loss of vision. We describe the rehabilitation therapy during the pre- and post-prosthetic stages, together with the results of the assessments to show the effectiveness of the treatment process, without forgetting the participation of the caregiver as a fundamental co-therapeutic element in this process.

Repeated Oral Administration of Human Serum Albumin Protects from the Cerebral Ischemia in Rat Brain Following MCAO.

Albumin is known to have neuroprotective effects. The protein has a long half-life circulation, and its effects can therefore persist for a long time to aid in the recovery of brain ischemia. In the present study, we investigated the neuroprotective effects of human serum albumin (HSA) on brain hemodynamics. Albumin is administrated using repeated oral gavage to the rodents. Sprague-Dawley rats underwent middle cerebral artery occlusion procedures and served as a stroke model. Afterwards, 25% human serum albumin (1.25 g/kg) or saline (5 ml/kg) was orally administrated for 2 weeks in alternating days. After 2 weeks, the rodents were assessed for levels of brain ischemia. Our testing battery consists of behavioral tests and in vivo optical imaging sessions. Modified neurological severity scores (mNSS) were obtained to assess the levels of ischemia and the effects of HSA oral administration. We found that the experimental group demonstrated larger hemodynamic responses following sensory stimulation than controls that were administered with saline. HSA administration resulted in more significant changes in cerebral blood volume following direct cortical electric stimulation. In addition, the mNSS of the treatment group was lower than the control group. In particular, brain tissue staining revealed that the infarct size was also much smaller with HSA administration. This study provides support for the efficacy of HSA, and that long-term oral administration of HSA may induce neuroprotective effects against brain ischemia.

Sex Difference in the Association Between Brachial Pulse Pressure and Coronary Artery Disease: The Korean Women's Chest Pain Registry (KoROSE).

This study was performed to investigate the association between brachial pulse pressure (PP) and the presence/extent of obstructive coronary artery disease (CAD) in men and women. Study data were obtained from a nation-wide registry composed of 632 patients (173 men and 459 women, 58.1±10.5 years) with suspected CAD who underwent invasive coronary angiography. PP was higher in patients with obstructive CAD (≥50% stenosis) than those without CAD in both sexes (P=.032 in men; P<.001 in women). However, PP increased proportionally with the increasing number of obstructed coronary arteries in women (P<.001) but not in men (P=.070). Multiple logistic-regression analyses demonstrated that higher PP (≥50.5 mm Hg) was an independent factor for determining obstructive CAD even after controlling for potential confounders in women (odds ratio, 2.83; 95% confidence interval, 1.40-5.73; P=.004). These results were consistent in 173 selected women matched with 173 men based on age and CAD severity. In conclusion, the association between brachial PP and obstructive CAD was more pronounced in women than in men. Brachial PP can be a simple and useful indicator of CAD especially in women.

Repeated Oral Administration of Human Serum Albumin Protects from the Cerebral Ischemia in Rat Brain Following MCAO

Albumin is known to have neuroprotective effects. The protein has a long half-life circulation, and its effects can therefore persist for a long time to aid in the recovery of brain ischemia. In the present study, we investigated the neuroprotective effects of human serum albumin (HSA) on brain hemodynamics. Albumin is administrated using repeated oral gavage to the rodents. Sprague-Dawley rats underwent middle cerebral artery occlusion procedures and served as a stroke model. Afterwards, 25% human serum albumin (1.25 g/kg) or saline (5 ml/kg) was orally administrated for 2 weeks in alternating days. After 2 weeks, the rodents were assessed for levels of brain ischemia. Our testing battery consists of behavioral tests and in vivo optical imaging sessions. Modified neurological severity scores (mNSS) were obtained to assess the levels of ischemia and the effects of HSA oral administration. We found that the experimental group demonstrated larger hemodynamic responses following sensory stimulation than controls that were administered with saline. HSA administration resulted in more significant changes in cerebral blood volume following direct cortical electric stimulation. In addition, the mNSS of the treatment group was lower than the control group. In particular, brain tissue staining revealed that the infarct size was also much smaller with HSA administration. This study provides support for the efficacy of HSA, and that long-term oral administration of HSA may induce neuroprotective effects against brain ischemia.

Sex Difference in the Association Between Metabolic Syndrome and Left Ventricular Diastolic Dysfunction.

BACKGROUND: Sex-related differences in the influence of metabolic syndrome (MetS) on various cardiovascular diseases have been suggested. The aim of this study was to investigate the effect of sex on the association between MetS and left ventricular (LV) diastolic dysfunction in patients with suspected coronary artery disease (CAD). METHODS: Two hundred ten patients (105 men and age-matched 105 women; mean age: 56.5 ± 10.9 years) undergoing elective coronary angiography for the evaluation of CAD were studied. MetS was defined according to the International Diabetes Federation criteria. LV diastolic function was assessed using transthoracic echocardiography. RESULTS: The incidence of MetS was 23.8% in men and 14.3% in women (P = 0.079). The incidence of LV diastolic dysfunction was significantly different by MetS in women, but not in men. In multiple linear regression analyses, the number of MetS components was independently associated with septal e' velocity, E/e', and left atrial (LA) diameter in women (P < 0.05 for each). In men, the number of MetS components was associated with only LA size in this analysis. As the number of components of MetS increased, septal e' velocity decreased proportionally in women (P < 0.001), but not in men (P = 0.117). CONCLUSIONS: Among middle-aged and elderly Korean patients at high risk of CAD, the impact of MetS on LV diastolic dysfunction was more pronounced in women than in men. This suggests the important role of sex hormonal effects in the development of LV diastolic dysfunction in relation to MetS in this population.

Cerebral Hemodynamics and Vascular Reactivity in Mild and Severe Ischemic Rodent Middle Cerebral Artery Occlusion Stroke Models.

Ischemia can cause decreased cerebral neurovascular coupling, leading to a failure in the autoregulation of cerebral blood flow. This study aims to investigate the effect of varying degrees of ischemia on cerebral hemodynamic reactivity using in vivo real-time optical imaging. We utilized direct cortical stimulation to elicit hyper-excitable neuronal activation, which leads to induced hemodynamic changes in both the normal and middle cerebral artery occlusion (MCAO) ischemic stroke groups. Hemodynamic measurements from optical imaging accurately predict the severity of occlusion in mild and severe MCAO animals. There is neither an increase in cerebral blood volume nor in vessel reactivity in the ipsilateral hemisphere (I.H) of animals with severe MCAO. The pial artery in the contralateral hemisphere (C.H) of the severe MCAO group reacted more slowly than both hemispheres in the normal and mild MCAO groups. In addition, the arterial reactivity of the I.H in the mild MCAO animals was faster than the normal animals. Furthermore, artery reactivity is tightly correlated with histological and behavioral results in the MCAO ischemic group. Thus, in vivo optical imaging may offer a simple and useful tool to assess the degree of ischemia and to understand how cerebral hemodynamics and vascular reactivity are affected by ischemia.

Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women.

BACKGROUND: Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. METHODS: 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). RESULTS: The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. CONCLUSION: In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.

Normal Echocardiographic Measurements in a Korean Population Study: Part II. Doppler and Tissue Doppler Imaging.

BACKGROUND: Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS: Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS: Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION: Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.

Higher Blood Pressure Variability in White Coat Hypertension; from the Korean Ambulatory Blood Pressure Monitoring Registry.

BACKGROUND AND OBJECTIVES: Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. SUBJECTS AND METHODS: We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. RESULTS: Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). CONCLUSION: From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.