St. Marys, South Korea
St. Marys, South Korea

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Lee S.-Y.,International St Marys Hospital | Hur S.-H.,Keimyung University | Lee S.-G.,University of Ulsan | Kim S.-W.,Chung - Ang University | And 7 more authors.
Circulation: Cardiovascular Interventions | Year: 2015

Background-Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. Methods and Results-A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a firstgeneration (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the presence of lipids or calcification. OCT-determined neoatherosclerosis was identified in 27.4% (58/212) of all DES-treated lesions. The frequency of neoatherosclerosis increased with the stent age. Stent age was shorter in the secondgeneration DES group (12.4 months versus 55.4 months, P<0.001), and neoatherosclerosis was less frequently observed in that group (10.8% versus 45.5%, P<0.001). However, after adjusting for cardiovascular risk factors, chronic kidney disease (odds ratio, 4.113; 95% confidence interval, 1.086-15.575; P=0.037), >70 mg/dL of low-density cholesterol at follow-up OCT (odds ratio, 2.532; 95% confidence interval, 1.054-6.084; P=0.038), and stent age (odds ratio, 1.710; 95% confidence interval, 1.403-2.084; P<0.001) were all independent predictors for neoatherosclerosis, whereas the type of DES (first-versus second-generation) was not. Patients with neoatherosclerosis showed a higher rate of acute coronary syndrome at follow-up OCT (19.0% versus 3.9%, respectively, P=0.001). Conclusions-The second-generation DES is not more protective against neoatherosclerosis compared with the firstgeneration DES. © 2015 American Heart Association, Inc.

Li L.,Texas A&M University | Li L.,Central Texas Veterans Health Care System | Wei C.,Texas A&M University | Wei C.,Central Texas Veterans Health Care System | And 6 more authors.
Hypertension | Year: 2014

Pulmonary arterial hypertension (PAH) is a devastating cardiopulmonary disorder with significant morbidity and mortality in patients with various lung and heart diseases. PAH is characterized by vascular obstruction which leads to a sustained increased pulmonary vascular resistance, vascular remodeling, and right ventricular hypertrophy and failure. Limited PAH therapies indicate that novel approaches are urgently needed for the treatment of PAH. Nuclear factor-κB (NF-κB) has been shown to play an important role in different cardiac pathologies; however, the role of NF-κB remains limited in the setting of PAH. Here, we investigated whether NF-κB inhibition in the lungs using Club (Clara) cell-10 promoter driving IκBα mutant had any effect in monocrotaline (MCT)-induced PAH mouse model. Our data revealed that MCT-induced PAH and right ventricular hypertrophy were associated with NF-κB activation, inflammatory response, and altered expression of bone morphogenetic protein receptor 2, inhibitor of differentiation, and Notch-3 signaling molecules in wild-type mice; and all these alterations were prevented in IκBα mutant mice treated with MCT. Moreover, endothelial cell apoptosis and endothelial-to-mesenchymal transition occurred in the lungs of MCT-treated wild-type mice and were restored in IκBα mutant+MCT mice, indicating an association with NF-κB signaling. In lung microvascular endothelial cells, IκBα (AA) mutant plasmid restored the decreased bone morphogenetic protein receptor 2 protein level and reversed the endothelialto-mesenchymal transition process induced by transforming growth factor-β1. We conclude that NF-κB regulates bone morphogenetic protein receptor 2-inhibitor of differentiation-Notch-3 axis genes and the subsequent endothelial cell apoptosis and endothelial-to-mesenchymal transition events in the lungs, providing new mechanistic information about MCT-induced PAH and right ventricular hypertrophy. © 2014 American Heart Association, Inc.

Lim J.-B.,Yonsei University | Kim D.-K.,Yonsei University | Chung H.W.,International St Marys Hospital
Cancer Science | Year: 2014

Thymus and activation-regulated chemokine (TARC) can stimulate cancer cell proliferation and migration. The present study evaluated the clinical significance of serum TARC in gastric cancer (GC). We measured serum TARC, macrophage-derived chemokine, monocyte chemotactic protein-1 and stem cell factor (SCF) levels using a chemiluminescent immunoassay along the GC carcinogenesis (normal, high-risk, early GC [EGC] and advanced GC [AGC]) in both training (N = 25 per group) and independent validation datasets (90 normal, 30 high-risk, 50 EGC and 50 AGC). Serum levels were compared among groups using one-way analysis of variance. To evaluate the diagnostic potential of serum TARC for GC, receiver operating characteristic curve and logistic regression analyses were performed. Correlations between serum TARC and GC clinicopathological features were analyzed using Spearman's correlation. In the training dataset, serum TARC correlated with serum MDC, MCP-1 and SCF. However, only serum TARC and SCF were significantly higher in cancer groups than non-cancer groups (P < 0.001). In the validation dataset, serum TARC also increased along the GC carcinogenesis; the AGC group (167.2 ± 111.1 ng/mL) had significantly higher levels than the EGC (109.1 ± 67.7 ng/mL), the high-risk (66.2 ± 47.7 ng/mL) and the normal (67.5 ± 36.2 ng/mL) groups (Bonferroni, all P < 0.001). Receiver operating characteristic curves and logistic regression demonstrated the remarkable diagnostic potential of serum TARC as a single marker (72.0% sensitivity and 71.1% specificity; cutoff point, 0.37; logistic regression) and in a multiple-marker panel (72.6% sensitivity and 88.2% specificity; cutoff point, 0.54). Spearman's correlation showed that serum TARC was closely correlated with tumor size (γs = 0.227, P = 0.028), T-stage (γs = 0.340, P = 0.001), N-stage (γs = 0.318, P = 0.002) and M-stage (γs = 0.346, P = 0.001). Serum TARC is a promising serum biomarker for GC. © 2014 The Authors.

Park S.O.,Konkuk University | Kim J.W.,Konkuk University | Na J.H.,International St Marys Hospital | Lee K.H.,International St Marys Hospital | And 3 more authors.
Resuscitation | Year: 2015

Aim: To compare the first-attempt success in endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) using direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope®) among novice emergency physicians (EPs). MethodsThis study is a historically controlled clinical design. From May 2011 to April 2013 out-of-hospital cardiac arrest patients were intubated during CPR by novice EPs. CPR data was automatically recorded by pre-installed video and subsequently analysed. The primary outcome was the success rate of the first-attempt at ETI. In addition, time to successful ETI from first-attempt (T-complete), duration of chest compression interruptions, and incidence of oesophageal intubation were compared. ResultsOf 305 patients undergoing ETI, 83 were intubated by novice EPs. The success rate of first-attempt ETI in the VL group (. n=. 49) was higher than that in the DL group (. n=. 34, 91.8% vs. 55.9%; p<. 0.001). The median T-complete was significantly shorter with VL than with DL (37 [29-55] vs. 62 [56-110] s; p<. 0.001). Oesophageal intubation was observed only in the DL group (. n=. 6, 17.6%). The median duration of chest compression interruptions was greater with DL (7 [3-6] s) than with VL (0 [0-0] s). Improvements in ETI during CPR were observed in the VL group after the first 3 months, but not the DL group during regular use for 1 year. ConclusionsFor novice EPs, the VL could significantly improve the first-attempt success in ETI during CPR while the DL couldn't improve it. © 2014 Elsevier Ireland Ltd.

Kang H.M.,Yonsei University | Kang H.M.,International St Marys Hospital | Kwon H.J.,Korea University | Yi J.H.,Jeil Eye Clinic | And 2 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To investigate the prognostic implication of subfoveal choroidal thickness on treatment outcome after intravitreal ranibizumab injections for typical exudative age-related macular degeneration (AMD). Design Retrospective study. Methods A total of 40 eyes of 37 patients who completed 6-month follow-up were analyzed. Patients' data were retrieved from medical records including best-corrected visual acuity (BCVA). Subfoveal choroidal thickness at baseline, 3 months, and 6 months was measured by enhanced depth imaging optical coherence tomography and adjusted for age and sex before statistical analysis. Treatment response was after 3 monthly intravitreal ranibizumab injections. Responders (responder group) were defined as a 100 μm or more decrease or complete resolution of subretinal fluid, whereas nonresponders (nonresponder group) were defined as changes less than 100 μm or more than 100 μm increase of subretinal fluid by optical coherence tomography. Results Mean age at diagnosis was 72.1 ± 8.1 years, and 22 eyes (55.0%) were responders. The responder group had thicker subfoveal choroid (257.2 ± 108.3 μm) and smaller lesions (1.3 ± 0.8 μm) at baseline than the nonresponder group (167.1 ± 62.4 μm, P =.003; and 2.0 ± 1.0 μm, P =.008). The responder group showed significantly better BCVA and thicker subfoveal choroid than the nonresponder group at 3 months (P =.002 and P =.023) and 6 months (P =.004 and P =.031). Stepwise and binary regression analysis demonstrated that subfoveal choroidal thickness was significantly correlated with visual outcome (B = -0.002, P =.003) and treatment response (B = 8.136, P =.018). Conclusion Subfoveal choroidal thickness may be a predictive factor for visual outcome and treatment response in typical exudative AMD after intravitreal ranibizumab injections. © 2014 by elsevier inc. all rights reserved.

Kim S.-W.,Emory University | Kim S.-W.,Catholic Kwandong University | Kim S.-W.,International St Marys Hospital | Kim S.-W.,Dong - A University | And 8 more authors.
Journal of the American College of Cardiology | Year: 2014

Background Cell therapy for cardiovascular disease has been limited by low engraftment of administered cellsand modest therapeutic effects. Bone marrow (BM) -derived CD31+ cells are a promising cell source owing to theirhigh angiovasculogenic and paracrine activities.Results The CD31+ cells cultured in endothelial cell medium (EC-CD31+ cells) showed the highest adhesion andangiogenic activities and lowest inflammatory properties in vitro compared with uncultured or other cultured CD31+ cells.When implanted into mouse MI or HLI models, EC-CD31+ cells improved cardiac function and repaired limb ischemiato a greater extent than uncultured CD31+ cells. Histologically, injected EC-CD31+ cells exhibited higher retention,neovascularization, and cardiomyocyte proliferation. Importantly, cell retention and endothelial transdifferentiationwas sustained up to 1 year.Objectives This study sought to identify culture conditions that could augment the cell adhesion, angiogenic, andanti-inflammatory activities of BM-derived CD31+ cells, and to determine whether these cultured CD31+ cells areeffective for cardiac and vascular repair.Methods CD31+ cells were isolated from human BM by magnetic-activated cell sorting and cultured for 10 daysunder hematopoietic stem cell, mesenchymal stem cell, or endothelial cell culture conditions. These cells werecharacterized by adhesion, angiogenesis, and inflammatory assays. The best of the cultured cells were implantedinto myocardial infarction (MI) and hindlimb ischemia (HLI) models to determine therapeutic effects and underlyingmechanisms.Conclusions Short-term cultured EC-CD31+ cells have higher cell engraftment, vessel-formation, cardiomyocyteproliferation, and anti-inflammatory potential, are highly effective for both cardiac and peripheral vascularrepair, and enhance survival of mice with heart failure. These cultured CD31+ cells may be a promising source fortreating ischemic cardiovascular diseases. (J Am Coll Cardiol 2014;64:168194) © 2014 American College of Cardiology Foundation. © 2014 American College of Cardiology Foundation.

Kang H.M.,Yonsei University | Kang H.M.,International St Marys Hospital | Lee S.C.,Yonsei University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2014

Background: To evaluate the long-time progression of retinal vasculitis in Behçet patients using the fluorescein angiography (FA) scoring system. Methods: Retrospective study was conducted for 71 eyes of 43 patients who met the study criteria. All patients completed at least 2 years of follow-up. FA was taken during the periods of active retinal vasculitis and the quiescent phase, and analyzed using a FA scoring system. Among nine categories, the four most prevalent FA signs were evaluated: optic disc hyperfluorescence (score 0-3), macular edema (score 0-4), retinal vascular staining and/or leakage (score 0-7), and capillary leakage (score 0-10). Results: Mean number of total active inflammations was 2.6±1.5 times during mean 55.0±20.0 months. Mean scores at the first active inflammation were 1.8±1.0 for optic disc hyperfluorescence, 2.4±1.0 for macular edema, 5.3±2.1 for retinal vascular staining and/or leakage, and 5.8±3.2 for capillary leakage. Mean total FA score was 17.4±6.8. Mean scores at the first quiescent phase were 0.6±0.4 for optic disc hyperfluorescence, 1.1±1.2 for macular edema, 3.8±1.9 for retinal vascular staining and/or leakage, and 3.5±3.5 for capillary leakage. Mean total FA score was 9.1±5.0. Mean scores for each active inflammation and quiescent phase were not significantly changed, and mean FA scores were significantly reduced in quiescent phase (P=0.003 for optic disc hyperfluorescence, P=0.005 for macular leakage, P=0.010 for retinal vascular staining and/or leakage, P=0.008 for capillary leakage, and P=0.018 for total FA score; paired t-test). Conclusions: Retinal vasculitis of Behçet patients did not significantly progress during long-term follow-up. © 2014 Springer-Verlag.

Kang J.W.,Incheon St Marys Hospital Incheon | Park S.K.,International St Marys Hospital
Korean Journal of Anesthesiology | Year: 2014

Background: The efficacy of palonosetron in preventing postoperative nausea and vomiting (PONV), as well as chemotherapy-induced nausea and vomiting, has already been demonstrated in multiple clinical studies. The purpose of this study was to determine whether continuous infusion of palonosetron following single injection could reduce PONV to a greater extent than single injection only of palonosetron.Methods: In total, 132 women were enrolled in the study. All subjects were over the age of 20 years and were scheduled to undergo gynecologic laparoscopic surgery. Patients were randomly allocated into two groups. In both groups, patients received 0.075 mg of palonosetron intravenously, immediately before induction of anesthesia. In the continuous palonosetron infusion group, 0.075 mg (1.5 ml) of palonosetron was added to the patient-controlled analgesia device. In the single-injection palonosetron group, 1.5 ml of normal saline was added.Results: The incidence of PONV 24 hours postoperatively was significantly lower in the continuous palonosetron infusion group than the single-injection palonosetron group (31.8 vs. 56.1%, P = 0.009).Conclusions: Continuous palonosetron infusion, following single injection, reduces the incidence of PONV compared with single injection only. © the Korean Society of Anesthesiologists, 2014.

Park J.,Chonbuk National University | Jeong S.Y.,International St Marys Hospital
Clinics in Orthopedic Surgery | Year: 2014

Background: The minimally invasive plate osteosynthesis (MIPO) technique using periarticular locking plates may be a good option for the repair of displaced proximal humeral fractures. However, axillary nerve complications related to this technique may be underestimated. The purpose of this study is to evaluate the outcomes of the minimally invasive plating, focusing on the complications. Methods: The records of 21 consecutive patients treated for proximal humerus fractures using the MIPO technique with locking plates were retrospectively reviewed. These patients were treated between March 2009 and March 2011 with a minimum one-year follow-up. The clinical function, complications, and radiological bony union were evaluated. Results: All of the patients, with one exception, showed at least 90 degrees of flexion and abduction at the shoulder joint six months postoperatively. The average Constant scores at three months, six months, and one year follow-ups were 74.0 (range, 62 to 90), 79.4 (range, 64 to 91), and 82.7 (range, 66 to 92), respectively. All of the patients achieved bony union within the average of 3.2 months (range, 2 to 6 months). There was one case of delayed union, one case of intra-articular screw penetration, and one case of axillary nerve paresis (incomplete injury), which did not completely recover during the one year of follow-up. Conclusions: The MIPO technique using periarticular locking plates is a useful option for the treatment of selected cases of displaced proximal humeral fractures. However, nerve complications such as axillary nerve paresis should be considered along with implant-related complications when choosing patients for minimally invasive plating. © 2014 by The Korean Orthopaedic Association.

Lim J.-B.,Yonsei University | Chung H.W.,Yonsei University | Chung H.W.,International St Marys Hospital
Cytokine | Year: 2015

Background: Chemokines play important roles in cancer development and progression. Epithelial-derived neutrophil-activating peptide-78 (ENA78/CXCL5) and stromal cell-derived factor (SDF-1/CXCL12) supposedly contribute to gastric cancer (GC) development and progression. This study aims to evaluate serum levels of ENA78/CXCL5 and SDF-1/CXCL12 along the GC carcinogenesis, and analyze their clinical significance, and diagnostic potentials through human serum samples. Methods: A total of 300 subjects were enrolled in this study. Serum levels of ENA78/CXCL5 and SDF-1/CXCL12, measured by chemiluminescent immunoassay, were compared among 4 disease groups; normal, high-risk (intestinal metaplasia and adenoma), early GC (EGC), and advanced GC (AGC) groups in both training (n=25 per group) and validation dataset (n=70, 30, 50, 50, respectively) by ANOVA test (post hoc Bonferroni). Correlations between serum ENA78/CXCL5 or SDF-1/CXCL12 levels and clinicopathological parameters of GC patients were evaluated (Spearman's correlation; γs). To validate the diagnostic accuracy, receiver operating characteristic (ROC) curve and logistic regression analysis was performed. Results: Serum ENA78/CXCL5 and SDF-1/CXCL12 levels were significantly higher in AGC groups than EGC, high-risk and normal groups in both training and validation dataset (Bonferroni, from p<0.01 to p<0.001). Clinicopathologically, serum ENA78/CXCL5 was correlated with T-stage (γs=0.231, p=0.021) and distant metastasis (γs=0.357, p<0.001), while serum SDF-1/CXCL12 was correlated with lymph node (γs=0.220, p=0.029) and distant (γs=0.425, p<0.001) metastasis. ROC curve and logistic regression demonstrated that serum ENA78/CXCL5 and SDF-1/CXCL12 showed higher diagnostic accuracy compared with carcinoembryonic antigen (CEA) in predicting GC. Serum ENA78/CXCL5 could predict both the presence of GC and distant metastasis, while serum SDF-1/CXCL12 could mainly predict its distant metastasis. All combination of serum ENA78/CXCL5, SDF-1/CXCL12, and CEA achieved 92.8% specificity at 75.0% sensitivity to predict distant metastasis of GC. Conclusions: Combinations of initial serum ENA78/CXCL5, SDF-1/CXCL12, and CEA before any treatment for GC can produce valuable serum biomarker panels to predict the presence and distant metastasis of GC. © 2015 Elsevier Ltd.

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