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1.
Ann Surg Oncol ; 27(3): 802-811, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31894481

RESUMO

BACKGROUND: This study aimed to compare the long-term survival of patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy for gastric adenocarcinoma (GA) in the United States and China. METHODS: Data on patients with GA who underwent gastrectomy without neoadjuvant therapy were retrieved from prospectively maintained databases at Memorial Sloan Kettering Cancer Center (MSKCC) and Fujian Medical University Union Hospital (FMUUH). Using propensity score-matching (PSM), equally sized cohorts of patients with similar clinical and pathologic characteristics who underwent minimally invasive versus open gastrectomy were selected. The primary end point of the study was 5-year overall survival (OS). RESULTS: The study identified 479 patients who underwent gastrectomy at MSKCC between 2000 and 2012 and 2935 patients who underwent gastrectomy at FMUUH between 2006 and 2014. Of the total 3432 patients, 1355 underwent minimally invasive gastrectomy, and 2059 underwent open gastrectomy. All the patients had at least 5 years of potential follow-up evaluation. Before PSM, most patient characteristics differed significantly between the patients undergoing the two types of surgery. After PSM, each cohort included 889 matched patients, and the actual 5-year OS did not differ significantly between the two cohorts, with an OS rate of 54% after minimally invasive gastrectomy and 50.4% after open gastrectomy (p = 0.205). Subgroup analysis confirmed that survival was similar between surgical cohorts among the patients for each stage of GA and for those undergoing distal versus total/proximal gastrectomy. In the multivariable analysis, surgical approach was not an independent prognostic factor. CONCLUSIONS: After PSM of U.S. and Chinese patients with GA undergoing gastrectomy, long-term survival did not differ significantly between the patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy.

2.
Cancer Lett ; 471: 38-48, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31811909

RESUMO

The biological functions of circular RNAs (circRNAs) in gastric cancer (GC) remain largely unexplored. Here, we identified that circ-RanGAP1 was significantly upregulated in both GC tissues and exosomes from the plasma of GC patients. High circ-RanGAP1 expression was closely associated with an advanced TNM stage, lymph node metastases, and worse survival. Inhibition of circ-RanGAP1 decreased GC cell invasion and migration in vitro. Overexpression of circ-RanGAP1 had the opposite effect. Additionally, circ-RanGAP1 silencing remarkably suppressed tumor growth and metastasis of GC in vivo. Mechanistically, circ-RanGAP1 sponged miR-877-3p to upregulate VEGFA expression. Overexpression of miR-877-3p reversed the biological functions mediated by circ-RanGAP1 in GC cells. Interestingly, we demonstrated that circ-RanGAP1 was upregulated in plasma exosomes from preoperative GC patients. More importantly, the plasma exosomes derived from these patients enhanced the migration and invasion potential of GC cells. Overall, the circ-RanGAP1-mediated miR-877-3p/VEGFA axis promotes GC progression. Our findings suggest that circ-RanGAP1 might act as a potential prognostic biomarker and therapeutic target for GC treatment.

3.
J Vasc Surg ; 71(1): 132-140.e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31285068

RESUMO

OBJECTIVE: Although chronic kidney disease (CKD) and diabetes are important prognostic factors in patients with peripheral artery disease, there are limited data regarding the outcomes of endovascular treatment (EVT) according to the severity of CKD, especially in the presence of diabetes. This study sought to compare clinical outcomes of lower limb EVT between patients with and patients without CKD according to the presence of diabetes. METHODS: Patients were enrolled from the Korean multicenter EVT registry and were divided according to the presence of diabetes, then further stratified by CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2). The primary outcome was major adverse limb events (MALEs; a composite of reintervention for target limb, reintervention for target vessel, and unplanned major amputation) at 2 years. RESULTS: A total of 3045 patients were eligible for analysis: 1277 nondiabetic patients (944 without CKD, 333 with CKD) and 1768 diabetic patients (951 without CKD, 817 with CKD). CKD was associated with a significantly increased risk of MALEs after EVT in diabetic patients (14.4% vs 9.9%; adjusted hazard ratio, 1.60; 95% confidence interval, 1.28-2.01; P < .001) but not in nondiabetic patients (7.6% vs 9.7%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.53-1.14; P = .203; interaction P = .018). In analysis stratified by the severity of CKD among diabetic patients, end-stage renal disease was significantly associated with an increased risk of MALE. CONCLUSIONS: CKD was associated with a significantly higher risk of MALEs after EVT in diabetic patients but not in nondiabetic patients. The increased risk of MALEs was mainly driven by patients with end-stage renal disease.

4.
Mayo Clin Proc ; 94(12): 2476-2487, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806101

RESUMO

OBJECTIVE: To evaluate the effect of ß-blockers according to heart rate in patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular systolic dysfunction (LVSD). PATIENTS AND METHODS: We enrolled patients with AMI without HF or LVSD between June 1, 2003, and February 28, 2015, from Seoul National University Hospital Acute Myocardial Infarction Registry. Patients were categorized according to discharge heart rate recorded on electrocardiographs and ß-blocker use. Low heart rate was defined as less than 75 beats/min. The primary end point was 5-year all-cause mortality according to discharge heart rate and ß-blocker use. RESULTS: Of 2271 patients, 1696 (74.7%) received ß-blockers and 1427 (62.8%) had low heart rates. At 5 years after discharge, 205 patients died. Overall, patients with low heart rates (P<.001) and those with ß-blocker treatment had lower mortality (P<.001). After adjustment for covariates, ß-blocker use was associated with 48% reduced risk for 5-year mortality in patients with high heart rates (hazard ratio, 0.52; 95% CI, 0.35-0.76), but not in those with low heart rates (P=.97). In an inverse-probability treatment-weighted cohort, ß-blocker use was also associated with improved mortality in those with a high heart rate. Findings were similar for 5-year cardiovascular mortality. CONCLUSION: Among survivors with AMI without HF or LVSD, ß-blocker use was associated with reduced 5-year all-cause mortality in patients who have high heart rates, but not in those with low heart rates.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Idoso , Estudos de Coortes , Feminino , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Taxa de Sobrevida , Disfunção Ventricular Esquerda
5.
Artigo em Inglês | MEDLINE | ID: mdl-31859438

RESUMO

AIMS: We compared long-term clinical outcomes between patients treated with Orsiro sirolimus-eluting stent (O-SES) and those treated with durable biocompatible polymer Resolute Integrity zotarolimus-eluting stent (R-ZES). METHODS AND RESULTS: The ORIENT trial was a randomized controlled noninferiority trial to compare angiographic outcomes between O-SES and R-ZES. We performed a post hoc analysis of 3-year clinical outcomes and included 372 patients who were prospectively enrolled and randomly assigned to O-SES (n = 250) and R-ZES (n = 122) groups in a 2:1 ratio. The primary endpoint was target lesion failure defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. At 3 years, target lesion failure occurred in 4.7% and 7.8% of O-SES and R-ZES groups, respectively (hazard ratio, 0.58; 95% confidence intervals, 0.24-1.41; p = .232 by log-rank test). Secondary endpoints including cardiac death, myocardial infarction, and target lesion revascularization showed no significant differences between the groups. Stent thrombosis occurred in two patients in R-ZES group (0.0% vs. 1.6%, p = .040). CONCLUSION: This study confirms long-term safety and efficacy of the two stents. We found a trend for lower target lesion failure with O-SES compared to R-ZES, although statistically insignificant.

6.
PLoS One ; 14(10): e0224486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31665159

RESUMO

Tobacco smoking causes cardiovascular diseases, lung disease, and various cancers. Understanding the population-based characteristics associated with smoking and the cause of death is important to improve survival. This study sought to evaluate the differential impact of smoking on cardiac or non-cardiac death according to age. Data from 514,866 healthy adults who underwent national health screening in South Korea were analyzed. The participants were divided into three groups: never-smoker, ex-smoker or current smoker according to the smoking status. The incidence rates and hazard ratios (HRs) of cardiac or non-cardiac deaths according to smoking status and age groups during the 10-year follow-up were calculated to evaluate the differential risk of smoking. Over the follow-up period, 6,192 and 24,443 cardiac and non-cardiac deaths had occurred, respectively. The estimated incidence rate of cardiac and non-cardiac death gradually increased in older age groups and was higher in current smokers and ex-smokers than that in never-smokers among all age groups. After adjustment of covariates, the HRs for cardiac death of current smokers compared to never-smokers were the highest in individuals in their 40's (1.82; 95% CI, 1.45-2.28); this gradually decreased to 0.96 (95% CI, 0.67-1.38) in individuals >80 years. In contrast, the HRs for non-cardiac death peaked in individuals in their 50's, (HR 1.69, 95% CI 1.57-1.82) and was sustained in those >80 years (HR 1.40, 95% CI 1.17-1.69). Ex-smokers did not show elevated risk of cardiac death compared to never-smokers in any age group, whereas they showed significantly higher risk of non-cardiac death in their 60's and 70's (HR, 1.29; 95% CI, 1.19-1.39; HR 1.22, 95% CI, 1.12-1.32, respectively). Acute myocardial infarction and lung cancer showed patterns similar to those of cardiac and non-cardiac death, respectively. Smoking was associated with higher relative risk of cardiac death in the middle-aged group and non-cardiac death in the older age group. Ex-smokers in the older age group had elevated risk of non-cardiac death. To prevent early cardiac death and late non-cardiac death, smoking cessation should be emphasized as early as possible.

7.
J Exp Clin Cancer Res ; 38(1): 410, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533855

RESUMO

BACKGROUND: UFM1 has been found to be involved in the regulation of tumor development. This study aims to clarify the role and potential molecular mechanisms of UFM1 in the invasion and metastasis of gastric cancer. METHODS: Expression of UFM1 in gastric tumor and paired adjacent noncancerous tissues from 437 patients was analyzed by Western blotting, immunohistochemistry, and realtime PCR. Its correlation with the clinicopathological characteristics and prognosis of gastric cancer patients was analyzed. The effects of UFM1 on the invasion and migration of gastric cancer cells were determined by the wound and trans-well assays, and the effect of UFM1 on subcutaneous tumor formation was verified in nude mice. The potential downstream targets of UFM1 and related molecular mechanisms were clarified by the human protein kinase assay and co-immunoprecipitation technique. RESULTS: Compared with the corresponding adjacent tissues, the transcription level and protein expression level of UFM1 in gastric cancer tissues were significantly downregulated (P < 0.05). The 5-year survival rate of gastric cancer patients with low UFM1 expression was significantly lower than the patients with high UFM1 expression (42.1% vs 63.0%, P < 0.05). The invasion and migration abilities of gastric cancer cells with stable UFM1 overexpression were significantly decreased, and the gastric cancer cells with UFM1 stable knockdown showed the opposite results; similar results were also obtained in the nude mouse model. Further studies have revealed that UFM1 could increase the ubiquitination level of PDK1 and decrease the expression of PDK1 at protein level, thereby inhibiting the phosphorylation level of AKT at Ser473. Additionally, the effect of UFM1 on gastric cancer cell function is dependent on the expression of PDK1. The expression level of UFM1 can improve the poor prognosis of PDK1 in patients with gastric cancer. CONCLUSION: UFM1 suppresses the invasion and metastasis of gastric cancer by increasing the ubiquitination of PDK1 through negatively regulating PI3K/AKT signaling.

8.
Eur Heart J ; 40(43): 3547-3555, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31504416

RESUMO

AIMS: Physical activity has been shown to reduce mortality in a dose-response fashion. Current guidelines recommend 500-1000 metabolic equivalent task (MET)-min per week of regular physical activity. This study aimed to compare the impact of leisure-time physical activity on mortality in primary versus secondary cardiovascular prevention. METHODS AND RESULTS: This study included a total of 131 558 and 310 240 subjects with and without cardiovascular disease (CVD), respectively, from a population-based cohort. Leisure-time physical activity was measured by self-report questionnaires. The study subjects were followed-up for a median of 5.9 years, and the main study outcome was all-cause mortality. There was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the secondary prevention group was shown to be greater than that in the primary prevention group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the secondary and primary prevention groups, respectively (interaction P < 0.001). In addition, while individuals without CVD benefited the most between 1 and 500 MET-min/week of physical activity, the benefit in those with CVD continued above 500 - 1000 MET-min/week. The adjusted mortality risk of individuals with CVD who performed a high level of physical activity (≥1000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without CVD. CONCLUSION: Individuals with CVD may benefit from physical activity to a greater extent than do healthy subjects without CVD.

9.
Mol Cancer Res ; 17(11): 2169-2183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416838

RESUMO

Intestinal-type gastric cancer often results from Helicobacter pylori infection through intestinal metaplasia, a transdifferentiated premalignant phenotype. Because H. pylori virulence factor CagA has been associated with aberrant expression of the transcription factor CDX1, which regulates intestinal differentiation, we explored its relationship with H. pylori infection and function during gastric carcinogenesis in normal gastric epithelial cells and gastric cancer cell lines. Infection of HFE 145 cells with CagA+ H. pylori increased expression of CDX1, as well as the epithelial-to-mesenchymal transition (EMT) markers Snail and Slug, increased invasion and migration, but those effects were not found in HFE 145 cells infected with CagA-deficient H. pylori. CDX1 overexpression increased expression of the intestinal markers Villin, sucrose isomaltase (SI), and MUC2, induced spheroid formation, and enhanced expression of the stem cell markers CD44, SOX2, Oct4, and Nanog, while CDX1 knockdown inhibited proliferation and intestinal stemness. Treatment of CDX1-expressing cells with metformin, an antidiabetic drug known to decrease the risk of gastric cancer, decreased expression of EMT and stemness markers, and reduced spheroid formation. In a murine xenograft model, combining metformin or shCDX1 with cisplatin reduced tumor growth, increased caspase-3 cleavage, and reduced expression of CD44 and MMP-9 to a greater degree than cisplatin alone. Patients with more advanced intestinal metaplasia staging exhibited higher CDX1 expression than those with earlier intestinal metaplasia staging (P = 0.039), and those with H. pylori tended to have more CDX1 expression than noninfected patients (P = 0.061). Finally, human tissue samples with higher CDX1 levels showed prominent CD44/SOX2 expression. Our findings indicate CagA+ H. pylori-induced CDX1 expression may enhance gastric cancer tumorigenesis and progression, and support therapeutic targeting of CDX1 in gastric cancer. IMPLICATIONS: This study shows that CDX1 contributes to the tumorigenesis and progression of gastric cancer and suggests the potential of targeting CDX1 to treat this malignancy.

10.
BMJ Open ; 9(7): e028741, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296510

RESUMO

OBJECTIVES: To date, no research has investigated the association between cardiac complication and electrical injury; hence, we aimed to assess the consequences and relating factors of cardiac complications from electrical injuries in South Korea. DESIGN: Retrospective single-centre study. PARTICIPANTS: 721 patients who had electrical injury-related admission during 2007-2017. An electronic medical record system was used to extract records of patients admitted for electrical injury treatment. RESULTS: Cardiac complications included abnormal parameters of myocardial damage, abnormal regional wall motion detected via echocardiogram, dysrhythmia (eg, bradycardia, atrial flutter/fibrillation) and ventricular tachycardia or fibrillation. Overall, 107 patients (14.8%) experienced cardiac complications. The average admission duration and intensive care unit stay duration were significantly longer in patients with cardiac complications than in those without them (75.0±45.3 vs 56.6±48.0 days and 19.3±24.1 vs 10.4±15.5 days, respectively, p<0.01 for both). Of the total cardiac cases, 72.9% had Troponin I elevation, 3.7% had regional wall motion abnormality, and 5.6% had atrial flutter/fibrillation. Overall, seven patients from the cardiac complication group and three patients from the control group died (p=0.01). All deaths occurred within 32 days, and the most common cause of death was septic shock. Total body surface area (TBSA) was only positively related factor to cardiac complications. CONCLUSION: This study is the first in South Korea to reveal that electrical accident patients with cardiac complications experience poorer in-hospital prognosis, and TBSA was the only risk factor of cardiac complications. And initial treatment for infection and inflammations could be important in electrical injury.

11.
Int Angiol ; 38(4): 305-311, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31345007

RESUMO

BACKGROUND: Self-expandable stents, Absolute Pro® (ABS) and Complete SE® (COM), demonstrated safety and efficacy in previous studies. We aimed to determine which stent is more effective for the endovascular treatment of femoropopliteal artery disease. METHODS: We enrolled patients who underwent endovascular intervention from 2010 to 2015 in our hospital. The primary endpoint was clinical primary patency, which is a composite of freedom from restenosis or clinically driven target lesion revascularization (TLR). RESULTS: A total of 197 patients and 210 limbs were analyzed, with 96 limbs of 88 patients assigned to the ABS group and 114 limbs of 109 patients assigned to the COM group. Baseline and lesion characteristics were similar between the two groups. The number of stents per limbs were 1.28±0.55 and 1.29±0.51 in the ABS and COM groups, respectively (P=0.92). The postprocedure ankle-brachial index was significantly improved in both groups compared with the preprocedural one (P<0.01), but there were no differences between the both groups at 6, 12, and 24 months after the index procedure. There were no significant differences in clinical primary patency rate (68.7% in ABS vs. 66.7% in COM, P=0.68) and TLR (9.4% in ABS vs. 14.0% in COM, P=0.41) between the two groups. There was no interaction of the clinical primary patency rate of the two stents and the patients' characteristics or lesion characteristics. CONCLUSIONS: In this retrospective single-center study, ABS and COM showed no difference in clinical efficacy. Both stents can be effectively used for the endovascular intervention of femoropopliteal artery disease when it is necessary.

12.
Sci Rep ; 9(1): 10970, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358791

RESUMO

The purpose of the present study was to describe the temporal trends in prevalence and management status of hypertension in Korea between 1998 and 2015. Data of adults who were aged 30 years or older were extracted from the Korea National Health and Nutrition Examination Survey, a nationwide representative population-based survey. Hypertension was prevalent in 30.5% of Korean adults. The age and sex standardized prevalence showed little change between 1998 and 2015. The elderly population and men showed higher prevalence. The rates of awareness, treatment, and control showed substantial improvements among hypertensive subjects between 1998 and the time period of 2007‒2009 (awareness, from 23.5 to 66.3%; treatment, from 20.4 to 60.3%; and control, from 4.9 to 42.1%), after which the numbers reached a plateau and no significant changes were observed subsequently (67.3%, 63.6%, and 46.2%, respectively, between 2013 and 2015). The management status remained poor especially among the young population and in men. In conclusion, the hypertension prevalence remained stable at approximately 30% in Korea between 1998 and 2015. While awareness, treatment, and control of hypertension improved remarkably, the young population and particularly men showed a suboptimal management status.

13.
Mol Cancer Res ; 17(9): 1945-1957, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31217166

RESUMO

Our previous work showed that in a mouse model of gastric adenocarcinoma with loss of p53 and Cdh1 that adding oncogenic Kras (a.k.a. Tcon mice) accelerates tumorigenesis and metastasis. Here, we sought to examine KRAS activation in epithelial-to-mesenchymal transition (EMT) and generation of cancer stem-like cells (CSC). Transduction of nontransformed HFE-145 gastric epithelial cells with oncogenic KRASG12V significantly decreased expression of the epithelial marker E-cadherin, increased expression of the mesenchymal marker vimentin and the EMT transcription factor Slug, and increased migration and invasion by 15- to 17-fold. KRASG12V also increased expression of self-renewal proteins such as Sox2 and increased spheroid formation by 2.6-fold. In tumor-derived organoids from Tcon mice, Kras knockdown decreased spheroid formation, expression of EMT-related proteins, migration, and invasion; similar effects, as well as reversal of chemoresistance, were observed following KRAS knockdown or MEK inhibition in patient tumor-derived gastric adenocarcinoma cell lines (AGS and KATOIII). KRAS inhibition in gastric adenocarcinoma spheroid cells led to reduced AGS flank xenograft growth, loss of the infiltrative tumor border, fewer lung metastases, and increased survival. In a tissue microarray of human gastric adenocarcinomas from 115 patients, high tumor levels of CD44 (a marker of CSCs) and KRAS activation were independent predictors of worse overall survival. In conclusion, KRAS activation in gastric adenocarcinoma cells stimulates EMT and transition to CSCs, thus promoting metastasis. IMPLICATIONS: This study provides rationale for examining inhibitors of KRAS to block metastasis and reverse chemotherapy resistance in gastric adenocarcinoma patients.

14.
EuroIntervention ; 15(11): e1014-e1021, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31085502

RESUMO

AIMS: The aim of this study was to compare the outcomes between multivessel and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), multivessel disease (MVD), and severe renal dysfunction (RD) using the nationwide AMI registry. METHODS AND RESULTS: Among 13,104 patients, 537 diagnosed with AMI and MVD who had severe RD at presentation (estimated glomerular filtration rate [GFR] <30 mL/min/1.73 m2, mean: 19.1±7.5 mL/min/1.73 m2) and underwent PCI during index hospitalisation were selected. The patients were classified according to treatment strategy, i.e., multivessel PCI (49.0%) or IRA-only PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction, re-hospitalisation for heart failure, and any repeat revascularisation at one year. The safety outcome was the worsening of renal function (WRF), defined as a 30% reduction in estimated GFR from baseline to 12-month follow-up. The adjusted MACE risks were similar in groups after Cox regression (41.8% vs 39.8%, hazard ratio [HR] 1.008 [0.743-1.367]) and propensity score-matching analysis (HR 0.974 [0.651-1.377]). Multivessel PCI showed a significant tendency of higher rates of WRF (24.8% vs 11.1%, adjusted odds ratio 2.134 [0.976-4.668]). CONCLUSIONS: Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.


Assuntos
Doença da Artéria Coronariana , Nefropatias , Infarto do Miocárdio , Intervenção Coronária Percutânea , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Humanos , Nefropatias/complicações , Pacientes , Resultado do Tratamento
15.
Eur Radiol Exp ; 3(1): 20, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144236

RESUMO

BACKGROUND: Vascular interventions imply radiation exposure to the operating physician (OP). To reduce radiation exposure, we propose a novel passive robotic device for fluoroscopy-guided arterial puncturing. METHODS: X-ray dose rates were measured for a total of 30 fluoroscopy-guided puncture femoral arteries in 15 pigs. Fifteen punctures were performed with the device while the other 15 were performed without the device by an interventional cardiologist with 10 years of experience. Parametric t test was used. RESULTS: The success rate with the device was 100%. Overall, the OP received more radiation (0.41 mSv/h) as compared to the assistant (0.06 mSv/h) (p <  0.001) and, amongst OP's body parts, hands received more radiation than other body parts (p <  0.001). The radiation dose rate to the OP's hands during arterial puncturing performed manually without the device was 0.95 ± 0.25 mSv/h whereas it was 0.14 ± 0.006 mSv/h using the device, resulting in an 85% reduction (p <  0.001). For the head, the dose was reduced from 0.16 mSv/h to 0.08 mSv/h (50% reduction, p <  0.001), and for the dominant arm, from 0.12 mSv/h to 0.07 mSv/h (42% reduction, p <  0.001). The fluoroscopy time was reduced from 4.5 ± 0.15 min to 4.3 ± 0.11 min device (p = 0.002). CONCLUSIONS: In a swine model, fluoroscopy time and radiation exposure for the OP puncturing femoral artery were significantly reduced by using the passive robotic device.

16.
Circ J ; 83(7): 1572-1580, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31130585

RESUMO

BACKGROUND: Some studies comparing minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) have reported MIDCAB's superiority, but they did not investigate contemporary PCI with newer generation drug-eluting stents (DES). We compared clinical outcomes after MIDCAB with previously reported outcomes after PCI with second-generation DES.Methods and Results:We retrospectively reviewed the records of patients treated with MIDCAB. Baseline characteristics and clinical outcomes after MIDCAB were compared with those for left anterior descending artery disease treated via PCI. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of cardiovascular death, non-fatal myocardial infarction, ischemic stroke, and target vessel revascularization (TVR). A propensity score-matching (PSM) analysis was conducted to adjust for between-group differences in baseline characteristics. We analyzed 77 patients treated with MIDCAB and 2,206 treated with PCI. The MIDCAB group was older and had more severe coronary disease and a higher incidence of left ventricular dysfunction. Over a 3-year follow-up, the PCI group had favorable MACCE outcomes. After PSM, there were no between-group differences in MACCE (MIDCAB, 15.6% vs. PCI, 23.4%; hazard ratio [HR], 0.80; 95% CI: 0.38-1.68, P=0.548) or TVR (MIDCAB, 2.6% vs. PCI, 5.2%; HR, 0.51; 95% CI: 0.10-3.09, P=0.509). CONCLUSIONS: Clinical outcomes were similar between MIDCAB and PCI using second-generation DES over 3 years of follow-up.

17.
J Clin Hypertens (Greenwich) ; 21(6): 774-785, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31012548

RESUMO

Pulse pressure (PP) is affected by arterial stiffness and is a predictor of cardiovascular events. However, value and utility of PP assessment in patients with acute myocardial infarction (AMI) remain less clear. We aimed to evaluate the association between PP and cardiovascular events in surviving patients with AMI at discharge. A total of 11 944 surviving patients with AMI at discharge from a Korean nationwide registry were included. Blood pressure was checked just before discharge. Noncardiac death and major adverse cardiovascular events (MACEs) including cardiac death, AMI, and stroke after discharge were analyzed. The median follow-up duration was 368 (IQR 339, 388) days. The rate of MACEs and cardiac death was higher in groups with the lowest PP (PP < 20 mm Hg) and highest PP (PP ≥ 71 mm Hg) and lowest in the group with PP of 31-40 mm Hg. With PP of 31-40 mm Hg as reference, univariate analysis showed a U-shaped association between the risk of MACEs (PP ≤ 20 mm Hg: hazard ratio [HR] 2.3; PP ≥ 71 mm Hg: HR 2.7) or cardiac death (PP ≤ 20 mm Hg: HR 2.6; PP ≥ 71 mm Hg: HR 3.1) and PP. In multivariate analysis, the curve changed from being U-shaped to J-shaped, and HR for PP ≥ 71 mm Hg (1.2 for MACEs and 1.4 cardiac death) decreased and HR for PP < 20 (2.1 for MACEs and 2.4 for cardiac death) did not significantly decrease after adjustment for cardiovascular risk factors. Our findings indicate that PP is a strong independent prognostic factor of MACEs and cardiac death in surviving patients with AMI. Low PP is a more significant independent predictor of MACEs and cardiac death than high PP in surviving patients after AMI.

18.
Eur J Prev Cardiol ; 26(11): 1208-1216, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30862234

RESUMO

BACKGROUND: Atrial fibrillation is a common cardiac arrhythmia and an important risk factor for stroke and cardiovascular morbidity. However, there is limited evidence regarding the association of air pollution with atrial fibrillation. This study aimed to compare the short-term and long-term effects of air pollution on atrial fibrillation. DESIGN: A nationwide cohort from the Korean general population. METHODS: Different analytical approaches were used for short-term and long-term effects. For the analysis of short-term effects, the daily incidence of emergency admissions for atrial fibrillation was identified. The relationship of atrial fibrillation with air pollutants, including PM2.5 (particulate matter ≤ 2.5 µm in aerodynamic diameter), PM10, carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone, was analysed using a time-series analysis. The long-term effects of air pollution were analysed for subjects aged ≥30 years who resided in Seoul between 2007 and 2015 and had no history of atrial fibrillation. RESULTS: During the study period, 1137 emergency visits were identified in Seoul as being associated with atrial fibrillation. A 10-µg/m3 increase in ambient PM2.5 was shown to significantly increase emergency admissions by 4.5% at lag day 3 (p = 0.038). No other pollutants showed a significant relationship with emergency atrial fibrillation admission. Among 124,010 residents in Seoul, 1903 developed atrial fibrillation at a median follow-up of 9.5 years (1.95 per 1000 person-years). Long-term exposure to air pollution had no significant impact on atrial fibrillation occurrence (p = 0.830 for PM2.5). CONCLUSION: This study suggests that short-term exposure to PM2.5 triggers atrial fibrillation. However, we found no evidence linking atrial fibrillation with long-term exposure to air pollution.

19.
JACC Cardiovasc Imaging ; 12(11 Pt 1): 2196-2206, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30772219

RESUMO

OBJECTIVES: This study aimed to investigate clinical and coronary computed tomographic angiography (CTA) characteristics of lesions that progressed to chronic total occlusion (CTO). BACKGROUND: CTO is one of the most common reasons for referral to coronary artery bypass surgery. Prediction and adequate early management for future CTO lesions may be beneficial. METHODS: The study evaluated patients with at least 1 vessel with a diameter stenosis of ≥70% on invasive coronary angiography (ICA) who underwent previous coronary CTA >12 months before ICA, from 2006 to 2015. The study compared the baseline clinical and coronary CTA characteristics of the patients with future CTO lesions with those of the patients with future non-CTO lesions (patient-level analysis) and compared coronary CTA findings between the future CTO lesion with the most stenotic non-CTO lesion in each CTO patient (lesion-level analysis). RESULTS: Among the 216 patients, 32 (14.8%) had a CTO lesion on ICA. In patient-level analysis, no significant differences in clinical characteristics were found, whereas the coronary CTA culprit lesions of the CTO group had a smaller minimal lumen diameter (MLD) with more adverse plaque characteristics. In lesion-level analysis, future CTO lesions had a smaller MLD, a smaller reference segment diameter (RD), and longer lesion length. These lesions were more likely to be noncalcified plaques with a noneccentric cross-sectional distribution, and had a higher remodeling index, lower mean plaque attenuation (MPA), and more napkin-ring signs. In multivariate analysis and receiver-operating characteristic curve analysis, MLD of <2.0 mm, RD of <3.2 mm, and MPA of <50 Hounsfield units were independent predictors of future CTO lesions. The risk of CTO development in lesions with triple risk factors was 14-fold higher than that of the lesions with no risk factors. CONCLUSIONS: Lesions that progressed to CTO had more severe baseline coronary CTA features than non-CTO lesions. A small MLD, small RD, and low MPA were independent predictors of progression to CTO.

20.
Int Heart J ; 60(2): 255-263, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799375

RESUMO

Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in ST-segment elevation myocardial infarction (STEMI). This study investigated whether directed intracoronary infusion of darbepoetin-α into ischemic myocardium before reperfusion would reduce infarct size or post-infarct remodeling in STEMI patients.Eighty STEMI patients received one of the following treatments simultaneously with the first balloon inflation: intracoronary darbepoetin-α 300 µg (n = 40) or saline (n = 40), administered via the over-the-wire balloon system. The primary endpoint was infarct size estimated by serial cardiac enzyme levels after procedure. The secondary endpoints were (1) infarct size and proportion of salvaged myocardium measured with cardiac magnetic resonance (CMR) at baseline; (2) post-infarct remodeling (PIR), defined as an increase in left ventricular end-diastolic volume more than 20% at 4 months compared to the baseline on CMR; and (3) composite cardiovascular endpoints assessed at 4 months.The peak CK-MB [median 270.0 (interquartile range 139.8-356.3) versus 231.5 (131.0-408.5) ng/mL, P = 0.55] and troponin-I [128.5 (63.5-227.8) versus 109.0 (43.8-220.0) ng/mL, P = 0.52) ] did not differ between the darbepoetin-α and control group. Fifty-seven patients completed the baseline and 4-month follow-up CMR. There were no differences in infarct size [30.6 (18.1-49.8) versus 31.5 (22.5-47.3) cm3, P = 0.91), proportion of salvaged myocardium [26.7% (15.9-42.6%) versus 35.8% (22.4-48.8%), P = 0.12) or PIR (8.0% versus 6.7%, P = 0.62) between the two groups. Composite cardiovascular outcomes did not differ between the two groups.In conclusion, administration of intracoronary darbepoetin-α before reperfusion did not reduce infarct size or post-infarct remodeling in STEMI patients.


Assuntos
Angioplastia Coronária com Balão/métodos , Darbepoetina alfa , Miocárdio/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Remodelação Ventricular/efeitos dos fármacos , Idoso , Vasos Coronários , Darbepoetina alfa/administração & dosagem , Darbepoetina alfa/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento
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