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Park IJ, Kim D, Yu HT, Kim T, Uhm J, Joung B, Lee M, Hwang C, Pak H. Association of extra-pulmonary vein triggers with low-voltage area and clinical recurrence in patients with atrial fibrillation undergoing catheter ablation. J Arrhythm 2024; 40:278-288. [PMID: 38586845 PMCID: PMC10995600 DOI: 10.1002/joa3.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background and Objectives Although extra-pulmonary vein (PV) triggers (ExPVTs) play a role in atrial fibrillation (AF) recurrence after catheter ablation (AFCA), the mechanism is unknown. We explored whether the locations of ExPVTs were associated with low-voltage scar areas (LVAs). Methods Among 2255 consecutive patients who underwent a de novo AFCA, 1696 (male 72.1%, median 60 years old, paroxysmal 64.7%) were included who underwent isoproterenol provocation and voltage mapping of the left atrium (LA) during their procedures. We investigated the associations between ExPVTs and their mean LA voltage and colocalization of ExPVTs within LVAs (<0.2 mV). Results We observed ExPVTs in 181 (10.7%) patients (60 in the LA, 99 in the right atrium [RA], 16 biatrial, and 6 unmappable). A lower mean LA voltage was independently associated with the existence of ExPVTs (OR 0.77 per 1 SD mV increase, 95% CI 0.60-0.99, p = .039). Among 76 patients who had ExPVTs[LA], 43 (56.6%) had ExPVTs within LVAs. During a median of a 42-month follow-up, patients with ExPVTs had a higher AF recurrence than those without (HR 1.87, 95% CI 1.48-2.37, Log-rank p < .001), but colocalization of ExPVTs and LVAs (Log-rank p = .544) and the anatomical location of ExPVTs (Log-rank p = .084) did not affect the rhythm outcome. Conclusions The presence of ExPVTs was associated with low LA voltage and poor rhythm outcome post-AFCA, but the colocalization of ExPVTs and LVA in LA did not affect rhythm outcome.
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Affiliation(s)
- In Jae Park
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Daehoon Kim
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Hee Tae Yu
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Boyoung Joung
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Chun Hwang
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
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Hwang T, Kwon O, Yu HT, Yang S, Kim D, Kim T, Uhm J, Joung B, Lee M, Hwang C, Pak H. Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: UTMOST AF. J Arrhythm 2024; 40:267-277. [PMID: 38586840 PMCID: PMC10995596 DOI: 10.1002/joa3.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/25/2024] [Accepted: 02/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background High-power short-duration (HPSD) ablation creates wide, shallow lesions using radiofrequency (RF) heating. It is uncertain if adjusting RF energy based on atrial wall thickness provides extra benefits. We studied the safety and effectiveness of tailored HPSD energy based on left atrial (LA) wall thickness (LAWT) for circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF). Methods We enrolled 212 patients (68.4% male, mean age: 59.5 ± 11.0 years) and randomly assigned them to two groups: LAWT-guided CPVI (WT, n = 108) and conventional CPVI (control, n = 104). Both groups used an open irrigated-tip deflectable catheter to apply 50 W for 10 s to the posterior LA, while controls used 60 W for 15 s on other LA regions. RF delivery time in WT was titrated (15 s at LAWT > 2.1 mm, 13 s at 1.4-2.1 mm, and 11 s at <1.4 mm) according to the computed tomogram-myocardial thickness color map. Results After a mean follow-up of 13.4 ± 7.0 months, the WT and control groups showed no significant difference regarding clinical recurrence rate (13.9% vs. 5.8%, respectively; p = .061) and major complication rate (4.6% vs. 3.8%, respectively; p > .999). The total procedure time, cardioversion rate, and post-procedural AAD prescription rates did not significantly differ between the groups. Conclusions The LAWT-guided energy titration strategy did not result in improved procedural safety and efficacy compared to the conventional 50-60 W-HPSD CPVI in patients with PAF.
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Affiliation(s)
- Taehyun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Oh‐Seok Kwon
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Song‐Yi Yang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - for UTMOST Investigators
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
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Kim M, Kim T, Hwang I, Park J, Yu HT, Uhm J, Joung B, Lee M, Hwang C, Pak H. Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation. J Am Heart Assoc 2024; 13:e030818. [PMID: 38293911 PMCID: PMC11056140 DOI: 10.1161/jaha.123.030818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Although successful atrial fibrillation (AF) ablation can maintain sinus rhythm and reduce the left atrial (LA) dimension, blunted LA reverse remodeling can be observed in patients with atrial myopathy. We explored the potential mechanisms and long-term outcomes in patients with blunted LA reverse remodeling after successful AF catheter ablation. METHODS AND RESULTS We included 1685 patients who underwent baseline and 1-year follow-up echocardiograms, had a baseline LA dimension ≥40 mm, and did not have a recurrence of AF within a year. The patients were divided into tertile groups according to the delta value of the change in LA dimension on the preprocedure and 1-year postprocedure echocardiography. After propensity score matching for age, sex, AF type, and LA dimension, 1272 patients were finally included in the analyses (424 in each group; the least/blunted, moderate, and the most reverse remodeling group). The patients in the T1 group (blunted LA reverse remodeling) were independently associated with higher left ventricular mass index (odds ratio [OR], 1.014 [95% CI, 1.005-1.022], P=0.001), change in ΔH2FPEF score (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score (OR, 1.445 [95% CI, 1.121-1.861], P=0.004), ventricular epicardial adipose tissue volume (OR, 1.010 [95% CI, 1.003-1.017], P=0.003), thinner LA wall thickness (OR, 0.461 [95% CI, 0.271-0.785], P=0.004), lower LA voltage (OR, 0.670 [95% CI, 0.499-0.899], P=0.008), and showed higher long-term AF recurrence (log-rank P<0.001) than other groups. CONCLUSIONS Blunted LA reverse remodeling after AF catheter ablation, which is suggestive of atrial myopathy, was independently associated with a larger ventricular epicardial adipose tissue volume and worsening of H2FPEF score. Blunted LA reverse remodeling after AF catheter ablation was also an independent predictor for higher recurrences of AF post-1-year AF catheter ablation.
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Affiliation(s)
- Moon‐Hyun Kim
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Inseok Hwang
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Je‐Wook Park
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Hee Tae Yu
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Boyoung Joung
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Chun Hwang
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Yonsei University College of Medicine, Yonsei University Health SystemSeoulRepublic of Korea
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Jin M, Yang P, Yu H, Kim T, Lee H, Pak H, Lee M, Joung B. Association of usual walking with mortality in oldest old adults aged 85 years and older: a nationwide senior cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current guidelines recommend moderate to vigorous intensity physical activity (MVPA) for health benefit in adults. However, it is difficult to meet the recommended minimum MVPA in “oldest old” aged over 85. Although walking is simple and easy exercise for oldest old, research on the association between walking and mortality in oldest old are lacking.
Purpose
To investigate the association between walking and the risk of all-cause and cardiovascular mortality among older adults aged 85 years and older.
Methods
7047 participants aged 85 or older underwent the Korean National Health Screening Program, including self-administered questionnaire for physical activity. Reported frequency per week of walking for at least 30 minutes increment was used to classify hours of walking per week. We computed multivariable-adjusted hazard ratios for walking and mutually adjusted for MVPA in relation to all-cause and cardiovascular mortality.
Results
The proportions of participants who engaged in walking, moderate- and vigorous-intensity physical activity were 42.5% (2996/7047), 14.7% (1037/7047) and 11.0% (773/7047), respectively. Only 7.6% (538/7047) of participants met the guidelines recommended minimum MVPA. Compared to inactive individuals, those who walked at least 1 hour per week had lower all-cause (HR 0.60 [95% CI, 0.50–0.74]) and cardiovascular mortality risk (HR 0.61 [95% CI, 0.42–0.89]). Walking 1 hour per week was still significant associated with reduction of risk for all-cause (HR 0.50 [95% CI, 0.40–0.61]) and cardiovascular mortality (HR 0.46 [95% CI, 0.30–0.70]) among participants who reported only walking without any MVPA.
Conclusions
1 hour a week of walking might be of benefit for all-cause and cardiovascular mortality in aged over 85 years, even without MVPA. Promoting walking may be a way to help oldest old avoid inactivity and encourage an active lifestyle for all-cause and cardiovascular mortality risk reduction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Jin
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - P Yang
- Cha Bundang Medical Center , Seongnam , Korea (Republic of)
| | - H Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H Lee
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - H Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Thind M, Zareba W, Atar D, Crijns HJGM, Zhu J, Pak H, Reiffel J, Ludwigs U, Wieloch M, Stewart J, Kowey P. Efficacy and safety of dronedarone versus placebo in patients with atrial fibrillation stratified according to renal function: Post hoc analyses of the EURIDIS-ADONIS trials. Clin Cardiol 2022; 45:101-109. [PMID: 35019175 PMCID: PMC8799050 DOI: 10.1002/clc.23765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The use of antiarrhythmic drugs (AADs) in patients with chronic kidney disease (CKD) is complex because impaired renal clearance can cause increased drug levels, and risk of intolerance or adverse events. Due to the propensity for CKD to occur alongside atrial fibrillation/atrial flutter (AF/AFL), it is essential that AAD safety and efficacy are assessed for patients with CKD. HYPOTHESIS Dronedarone, an approved AAD, may present a suitable therapeutic option for patients with AF/AFL and concomitant CKD. METHODS EURIDIS-ADONIS (EURIDIS, NCT00259428; ADONIS, NCT00259376) were identically designed, multicenter, double-blind, parallel-group trials investigating AF/AFL control with dronedarone 400 mg twice daily versus placebo (randomized 2:1). In this post hoc analysis, the primary endpoint was time to first AF/AFL. Patients were stratified according to renal function using the CKD-Epidemiology Collaboration equation and divided into estimated glomerular filtration rate (eGFR) subgroups of 30-44, 45-59, 60-89, and ≥90 ml/min. Time-to-events between treatment groups were compared using log-rank testing and Cox regression. RESULTS At baseline, most (86%) patients demonstrated a mild or mild-to-moderate eGFR decrease. Median time to first AF/AFL recurrence was significantly longer with dronedarone versus placebo for all eGFR subgroups except the 30 to 44 ml/min group, where the trend was similar but statistical power may have been limited by the small population. eGFR stratification had no significant effect on serious adverse events, deaths, or treatment discontinuations. CONCLUSIONS This analysis suggests that dronedarone could be an effective therapeutic option for AF with an acceptable safety profile in patients with impaired renal function.
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Affiliation(s)
- Munveer Thind
- Division of CardiologyLankenau Heart InstituteWynnewoodPennsylvaniaUSA
| | - Wojciech Zareba
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dan Atar
- Department of CardiologyOslo University Hospital UllevalOsloNorway
- Institute of Clinical MedicineUniversity of OsloNorway
| | - Harry J. G. M. Crijns
- Department of CardiologyMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Jun Zhu
- Fuwai HospitalCAMS & PUMCBeijingChina
| | - Hui‐Nam Pak
- Yonsei University College of MedicineYonsei University Health SystemSeoulRepublic of Korea
| | - James Reiffel
- Division of CardiologyColumbia University Medical CenterNew YorkNew YorkUSA
| | | | - Mattias Wieloch
- SanofiParisFrance
- Department of Clinical Sciences MalmöLund UniversityMalmöSweden
| | | | - Peter Kowey
- Division of CardiologyLankenau Heart InstituteWynnewoodPennsylvaniaUSA
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Hwang T, Yoon M, Kim M, Kim I, Yu H, Kim T, Uhm J, Kim J, Joung B, Lee M, Pak H. Clinical and electrophysiological characteristics of extra-pulmonary vein triggers in patients who underwent catheter ablation for atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Extra-pulmonary vein (PV) triggers play significant roles in atrial fibrillation (AF) recurrence after AF catheter ablation (AFCA).
Purpose
We explore the clinical and electrophysiological characteristics of extra-PV triggers in de novo and repeat-AFCA procedure.
Methods
We included 2,151 patients who had de novo AFCA and 319 repeat AFCA (female 28.0%, 59.1 ± 10.8 years old, paroxysmal AF 65.1%) those underwent post-procedural isoproterenol (ISO) provocation tests. We analysed the clinical, electrophysiological, and procedure-related factors associated with extra-PV triggers.
Results
Extra-PV triggers were documented in 11.9% (1.19 ± 0.42 foci) after de novo-AFCA and 27.0% (1.37 ± 0.65 foci) after repeat-AFCA (p = 0.004). LA volume index (OR 1.02 [1.01-1.03], p = 0.004), history of vascular disease (OR 0.55[0.31-0.91], p = 0.028) and Lead I amplitude of electrocardiogram (OR <0.01 [<0.01-0.62], p = 0.032) were independently associated with the existence of extra-PV triggers in de-novo procedure. Women (OR 1.84 [1.03-3.25], p = 0.037) and LA appendage volume (OR 1.04 [1.01-1.07] p = 0.027) were independently associated with extra-PV triggers during the redo-mapping procedure. Septum (28.4%), coronary sinus (24.0%), and superior vena cava (19.6%) were common extra-PV foci, and septal foci were more commonly found in repeat mapping (38.4% vs. 25.0%, p = 0.025). Among 65 patients who showed extra-PV at the repeat procedures, 19 (29.2%) matched with previous focal or empirical extra-PV ablation sites and 9 (13.8%) were multiple or unmappable sites. AF recurrence rates were significantly higher in both patients with extra-PV triggers after de novo procedures (Log-rank P <0.001; HR 1.93 [1.58-2.36], p= <0.001) and repeat procedures (Log-rank P <0.001, HR 1.87 [1.29-2.70], p= <0.001).
Conclusion
ISO provoked extra-PV triggers commonly found in AF patients with significant remodelling and previous empirical or focal extra-PV ablations. Existence of extra-PV triggers were independently associated with poorer rhythm outcome after both de novo and repeat AFCA. Denovo AF ablation outcome OverallExtra-PV triggers (-)Extra-PV triggers (+)p-value(n = 2151)(n = 1895)(n = 256)Age, yrs58.98 ± 10.9558.73 ± 11.0360.76 ± 10.200.006Male, (%)1550 ( 72.1)1389 ( 73.3)161 ( 62.9)0.001Follow up duration, month50.30 (37.71)51.65 (37.95)40.71 (34.58)<0.001Early recurrence (%)579 ( 27.8)455 ( 24.9)124 ( 48.4)<0.001Clinical recurrence (%)699 ( 33.6)584 ( 32.0)115 ( 44.9)<0.001Abstract Figure. AF free survival according to Extra PVT
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Affiliation(s)
- T Hwang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Yoon
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - I Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - T Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Hwang I, Park J, Kwon O, Lim B, Hong M, Kim M, Yu H, Kim T, Uhm J, Joung B, Lee M, Pak H. Computational modeling for antiarrhythmic drugs for atrial fibrillation according to the genotypes. Europace 2021. [DOI: 10.1093/europace/euab116.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant [HI19C0114] from the Ministry of Health and Welfare. Additionally, the work was funded by grants [NRF-2019R1C1C100907512], and [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) under the Ministry of Science, ICT & Future Planning (MSIP).
Background
The efficacy of antiarrhythmic drugs (AAD) can vary in patients with atrial fibrillation (AF) and the PITX2 gene affects the responsiveness of AADs. We explored the virtual AAD (V-AAD) responses between wild-type and PITX2+/- deficient AF conditions by realistic in-silico AF modeling.
Methods
We tested the V-AADs in AF modeling integrated with patients’ 3D-computed tomography and 3D-electroanatomical mapping, acquired in 25 patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal type). The ion currents for the PITX2+/- deficiency and each AAD (amiodarone, sotalol, dronedarone, flecainide, and propafenone) were defined based on previous publications.
Results
We compared the wild-type and PITX2+/- deficiency in terms of the action potential duration (APD90), conduction velocity (CV), maximal slope of restitution (Smax), and wave-dynamic parameters, such as the dominant frequency (DF), phase singularities (PS), and AF termination rates according to the V-AADs. The PITX2+/- deficient model exhibited a shorter APD90 (p < 0.001), a lower Smax (p < 0.001), mean DF (p = 0.012), PS number (p < 0.001), and a longer AF cycle length (AFCL, p = 0.011). Five V-AADs changed the electrophysiology in a dose dependent manner. AAD-induced AFCL lengthening (p < 0.001) and reductions in the CV (p = 0.033), peak DF (p < 0.001) and PS number (p < 0.001) were more significant in PITX2+/- deficient than wild-type AF. PITX2+/- deficient AF was easier to terminate with class IC AADs than the wild-type AF (p = 0.018).
Conclusions
The computational modeling-guided AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF. AF wave-dynamics and electrophysiological characteristics are different among the PITX2 deficient and the wild-type genotype models. BaselineChanges after AADClass ICClass IIIWild-typePITX2+/-p-valueWild-typePITX2+/-p-valueWild-typePITX2+/-p-valueWild-typePITX2+/-p-valueAPD90, (ms)243.7 ± 33.8184.4 ± 15.5<0.00138.2 ± 37.343.4 ± 56.20.223275.9 ± 43.5219.0 ± 39.2<0.001284.9 ± 32.8233.8 ± 71.4<0.001CV, (m/s)0.78 ± 0.320.70 ± 0.210.347-0.15 ± 0.18-0.20 ± 0.260.0330.63 ± 0.320.53 ± 0.300.0270.60 ± 0.360.43 ± 0.33<0.001Mean Smax0.787 ± 0.280.531 ± 0.18<0.0010.005 ± 0.260.115 ± 0.24<0.0010.828 ± 0.310.694 ± 0.320.0030.768 ± 0.320.608 ± 0.27<0.001Mean AFCL, (ms)146.96 ± 24.61164.78 ± 22.730.01122.62 ± 24.5537.92 ± 32.72<0.001165.44 ± 36.96190.85 ± 35.61<0.001169.05 ± 25.26203.35 ± 34.78<0.001Peak DF, (Hz)10.68 ± 2.9711.82 ± 3.340.211-2.98 ± 4.94-5.46 ± 4.66<0.00110.01 ± 4.397.23 ± 4.20<0.0016.30 ± 4.325.80 ± 4.070.301Mean DF, (Hz)6.80 ± 0.886.22 ± 0.710.012-1.95 ± 2.44-2.20 ± 1.990.2065.75 ± 1.784.53 ± 2.00<0.0014.14 ± 2.393.69 ± 2.000.077PS Number, (N)101086 ± 9608814150 ± 24778<0.001-59322 ± 99288-7409 ± 27856<0.00150579 ± 6523611568 ± 21868<0.00132951 ± 558643524 ± 8302<0.001PS Life Span, (ms)109.36 ± 113.90102.24 ± 226.640.889-24.87 ± 72.06-41.38 ± 126.350.073103.36 ± 180.6868.05 ± 162.790.14871.91 ± 141.8655.99 ± 217.970.454Table. Effects of AADs in the Wild-type and PITX2+/- Deficiency groupAbstract Figure. Wild-type vs. PITX2+/- baseline model
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Affiliation(s)
- I Hwang
- Yonsei University, Seoul, Korea (Republic of)
| | - J Park
- Yonsei University, Seoul, Korea (Republic of)
| | - O Kwon
- Yonsei University, Seoul, Korea (Republic of)
| | - B Lim
- Yonsei University, Seoul, Korea (Republic of)
| | - M Hong
- Yonsei University, Seoul, Korea (Republic of)
| | - M Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - H Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - T Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - J Uhm
- Yonsei University, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Seoul, Korea (Republic of)
| | - M Lee
- Yonsei University, Seoul, Korea (Republic of)
| | - H Pak
- Yonsei University, Seoul, Korea (Republic of)
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Hwang T, Kim M, Yu H, Kim T, Uhm J, Joung B, Lee M, Pak H. Long-term outcomes of empirical extra-pulmonary vein linear ablation in patients with persistent atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants [HI18C0070] and [HI19C0114] from the Korea Health 21 R&D Project, Ministry of Health and Welfare, and a grant [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF).
Background
Although extra-pulmonary vein (PV) left atrial (LA) linear ablation has been performed during catheter ablation (CA) of persistent atrial fibrillation (PeAF), the long-term efficacy and safety of this procedure have not yet been verified.
Purpose
We investigated whether an anterior line (AL) and posterior box ablation (POBA) in addition to circumferential PV isolation (CPVI) improves the rhythm without worsening the LA function in PeAF patients.
Methods
We retrospectively compared the additional AL + POBA and CPVI alone groups in 604 patients with PeAF who underwent regular rhythm follow-ups (16.9%; males 79.3%, 58.5 ± 10.7 years of age) after propensity score matching. The primary endpoint was AF recurrence after single procedures and secondary endpoints were the cardioversion rate, response to anti arrhythmic drugs, LA changes, and re-conduction rates of the de-novo ablation lesion set.
Results
After a mean follow-up of 45.2 ± 33.6 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank p = 0.554) despite longer procedure times in the AL + POBA group (p < 0.001). Atrial tachycardia recurrences (p = 0.001) and the cardioversion rates after ablation (p < 0.001) were higher in the AL + POBA group than CPVI group. AL + POBA was associated with better rhythm outcomes in patients with large anterior LA volume indices (p for interaction 0.037) and low mean LAA(left atrial appendage) voltages (p for interaction 0.019). In repeat procedures, the LA pulse pressure elevation was significant after the AL + POBA.
Conclusion
In patients with PeAF, an AL + POBA in addition to the CPVI did not improve the rhythm outcomes nor influence the long-term safety, and lead to more extended procedures. Procedure outcomes OverallAL + POBACPVIp-value(n = 604)(n = 302)(n = 302)Procedure time, min190.8 ± 62.6226.9 ± 49.4154.6 ± 52.8<0.001Ablation time, sec5079 ± 19566420 ± 13723738± 1475<0.001Overall complications24 (4.0)13 (4.3)11 (3.6)0.835Early recurrence, n (%)277 (45.9)129 (42.7)148 (49.0)0.142Recurrence type AT, n (% in early recur)77 (27.8)51 (39.5)26 (17.6)<0.001Clinical recurrence within 1-year, n(%)116 (19.2)52 (17.2)65 (21.5)0.256Recurrence type AT, n (% in clinical recur)60 (23.1)46 (30.7)14 (12.7)0.001Cardioversion, n (% in total recur/ % overall)105 (40.4/17.4)74 (49.3/24.5)31 (28.1/10.3)<0.001POBA, posterior box ablation; AL, anterior line; CPVI, circumferential pulmonary vein isolation; AT, atrial tachycardia;Abstract Figure. Long term ablation outcome
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Affiliation(s)
- T Hwang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - T Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Park H, Kim Y, Kim JS, Oh Y, Shin D, Pak H, Hwang G, Choi K, Oh S, Kim J, Lee M, Park H, Kim D, Jin E, Park J, Oh I, Shin D, Park H, Kim JH, Kim N, Ahn M, Seo B, Kim Y, Kang S, Lee J. Status of international normalized ratio control and treatment patterns in patients with nonvalvular atrial fibrillation taking vitamin K antagonist with or without antiplatelet therapy: Results from KORAFII registry. J Arrhythm 2019; 35:593-601. [PMID: 31410229 PMCID: PMC6686287 DOI: 10.1002/joa3.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/06/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies have shown that the concomitant use of a vitamin K antagonist (VKA) and an antiplatelet (APL) drug increased the bleeding risk and was less effective at preventing ischemic events. This study aimed to investigate the control status of international normalized ratio (INR) and the discontinuation rate of a VKA in patients taking VKA plus an APL drug compared with those taking a VKA alone. METHODS Data were extracted from the KORean Atrial Fibrillation Investigation II registry, a multicenter noninterventional prospective observational study. Nonvalvular atrial fibrillation (NVAF) patients with CHADS 2 scores ≥ 1 who newly started (within 3 months) a VKA were enrolled and followed up for 1 year. RESULTS A total of 866 NVAF patients (mean age, 67.7 years; 60.3% men) without a bleeding history were divided into the VKA+APL (n = 229) and VKA alone (n = 637) groups. During follow-up, mean INR level was lower in the VKA+APL group than in the VKA alone group (1.7 ± 0.8 vs 1.9 ± 0.9, P = 0.0005). INR levels were poorly controlled in both groups (66.1% and 64.7%, respectively). Patients in the VKA+APL group more frequently discontinued VKA than patients in the VKA alone group (28.8% vs 24.2%, P = 0.045). Major causes of VKA discontinuation were uncontrolled INR level and patient dissatisfaction or concerns. CONCLUSIONS The conditions of NVAF patients were inadequately controlled with VKA with or without an APL. These findings suggest that other antithrombotic treatment options are warranted in NVAF patients to achieve INR control.
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Affiliation(s)
- Hee‐Soon Park
- Internal MedicineKorea University College of MedicineSeoulKorea
| | - Young‐Hoon Kim
- Internal MedicineKorea University College of MedicineSeoulKorea
| | - June Soo Kim
- Internal MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Yong‐Seog Oh
- Internal MedicineSeoul St. Mary's HospitalThe Catholic University of KoreaSeoulKorea
| | - Dong‐Gu Shin
- Internal MedicineYeungnam University College of MedicineDaeguKorea
| | - Hui‐Nam Pak
- Internal MedicineSeverance HospitalYonsei University Health SystemSeoulKorea
| | | | - Kee‐Joon Choi
- Internal MedicineAsan Medical CenterUlsan UniversitySeoulKorea
| | - Seil Oh
- Internal MedicineSeoul National University HospitalSeoulKorea
| | - Jin‐Bae Kim
- Internal MedicineKyung Hee University Medical CenterSeoulKorea
| | - Man‐Young Lee
- Internal MedicineYeoyuido St. Mary's HospitalThe Catholic University of KoreaSeoulKorea
| | - Hyung‐Wook Park
- Internal MedicineChonnam National University HospitalGwangjuKorea
| | - Dae‐Kyeong Kim
- Internal MedicineInje University Busan Paik HospitalBusanKorea
| | - Eun‐Sun Jin
- Internal MedicineKyung Hee University Hospital at GangdongSeoulKorea
| | - Jae‐Seok Park
- Internal MedicineSejong General HospitalBucheonKorea
| | - Il‐Young Oh
- Internal MedicineSeoul National University Bundang HospitalSoengnam‐SiKorea
| | - Dae‐Hee Shin
- Internal MedicineGangneung Asan HospitalGangneungKorea
| | - Hyoung‐Seob Park
- Internal MedicineDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Jun Hyung Kim
- Internal MedicineChungnam National University College of MedicineChungnamKorea
| | - Nam‐Ho Kim
- Internal MedicineWonkwang University HospitalIksanKorea
| | - Min‐Soo Ahn
- Internal MedicineYonsei UniversityWonju Severance Christian HospitalWonjuKorea
| | - Bo‐Jeong Seo
- Outcomes Research/Real World Data, Corporate Affairs & Health and ValuePfizer Pharmaceuticals Korea Ltd.SeoulKorea
| | - Young‐Joo Kim
- Outcomes Research/Real World Data, Corporate Affairs & Health and ValuePfizer Pharmaceuticals Korea Ltd.SeoulKorea
| | - Seongsik Kang
- Internal Medicine ‐MedicalPfizer Pharmaceuticals Korea Ltd.SeoulKorea
| | - Juneyoung Lee
- Department of BiostatisticsCollege of MedicineKorea UniversitySeoulKorea
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10
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Uhm J, Kim J, Jin M, Kim I, Cho MS, Yang P, Yu HT, Kim T, Joung B, Pak H, Nam G, Choi K, Kim Y, Hwang C, Lee M. Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. J Arrhythm 2019; 35:645-653. [PMID: 31410235 PMCID: PMC6686296 DOI: 10.1002/joa3.12213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery (VS) remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs. METHODS Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior VS (total-VS group; age, 34.0 [24.5-45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of VS (no-VS group; age, 40.5 [23.0-54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined. RESULTS Accessory pathway exhibited decremental conduction in four of nine patients in the total-VS group. The number of RFCA attempts was significantly higher in the total-VS group than in the no-VS group (10.0 [4.5-14.5] vs 2.0 [1.0-3.0]; P < 0.001). In four patients who underwent mitral VS, successful RFCA was achieved using the transaortic approach, coronary sinus (CS) approach, or bipolar ablation. In three patients who underwent tricuspid VS, successful RFCA was achieved using the above-prosthetics or trans-prosthetics approach. In two patients, RFCA failed. The trans-prosthetics approach and bipolar ablation technique were effective. The transaortic and CS approaches were occasionally effective. The transseptal approach was ineffective. CONCLUSIONS Successful RFCA of APs at the site of prior VS can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.
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Affiliation(s)
- Jae‐Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Moo‐Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - In‐Soo Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Pil‐Sung Yang
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Gi‐Byoung Nam
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Kee‐Joon Choi
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - You‐Ho Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Department of CardiologyRevere HealthProvoUtah
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
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Kim K, Yang P, Jang E, Yu HT, Kim T, Uhm J, Kim J, Pak H, Lee M, Joung B, Lip GYH. P5143The increased risk of stroke, bleeding and mortality with new-onset atrial fibrillation in critically ill patients: a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Kim
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - P Yang
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - E Jang
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - H T Yu
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - T Kim
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - J Uhm
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - J Kim
- Gangnam Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - H Pak
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - M Lee
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - G Y H Lip
- University of Birmingham, Department of Cardiology, Birmingham, United Kingdom
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12
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Lee O, Kim K, Kim J, Kim YD, Pak H, Hong G, Chim CY, Uhm J, Cho I, Joung B, Yu C, Lee H, Kang W, Heo J, Jang Y. P3830Favorable neurological outcomes of left atrial appendage occlusion versus non-vitamin K antagonist oral anticoagulants after stroke in atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Lee
- Severance Hospital, Cardiology, Yongin, Korea Republic of
| | - K Kim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - J Kim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - Y D Kim
- Severance Hospital, Neurology, Seoul, Korea Republic of
| | - H Pak
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - G Hong
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - C Y Chim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - J Uhm
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - I Cho
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - B Joung
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - C Yu
- Korea University Anam Hospital, Cardiology, Seoul, Korea Republic of
| | - H Lee
- Sejong General Hospital, Cardiology, Seoul, Korea Republic of
| | - W Kang
- Gil Hospital, Cardiology, Incheon, Korea Republic of
| | - J Heo
- Severance Hospital, Neurology, Seoul, Korea Republic of
| | - Y Jang
- Severance Hospital, Cardiology, Seoul, Korea Republic of
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Phillips K, Santoso T, Sanders P, Alison J, Chan JLK, Pak H, Chandavimol M, Ghamdi MAL, Stein K, Shanker A, Omar R. Percutaneous Left Atrial Appendage Closure with the WATCHMAN Device: 12 Month Outcomes from the WASP Asia-Pacific Registry. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Goirigolzarri Artaza J, Gallego Delgado M, Jaimes Castellanos C, Cavero Gibanel M, Pastrana Ledesma M, Alonso Pulpon L, Gonzalez Mirelis J, Al Ansi RZ, Sokolovic S, Cerin G, Szychta W, Popa BA, Botezatu D, Benea D, Manganiello S, Corlan A, Jabour A, Igual Munoz B, Osaca Asensi J, Andres La Huerta A, Maceira Gonzalez A, Estornell Erill J, Cano Perez O, Sancho-Tello M, Alonso Fernandez P, Sepulveda Sanchez P, Montero Argudo A, Palombo C, Morizzo C, Baluci M, Kozakova M, Panajotu A, Karady J, Szeplaki G, Horvath T, Tarnoki D, Jermendy A, Geller L, Merkely B, Maurovich-Horvat P, Moustafa S, Mookadam F, Youssef M, Zuhairy H, Connelly M, Prieur T, Alvarez N, Ashikhmin Y, Drapkina O, Boutsikou M, Demerouti E, Leontiadis E, Petrou E, Karatasakis G, Kozakova M, Morizzo C, Bianchi V, Marchi B, Federico G, Palombo C, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Goto M, Uejima T, Itatani K, Pedrizzetti G, Mada R, Daraban A, Duchenne J, Voigt J, Chiu DYY, Green D, Johnstone L, Sinha S, Kalra P, Abidin N, Sikora-Frac M, Zaborska B, Maciejewski P, Bednarz B, Budaj A, Nemes A, Sasi V, Gavaller H, Kalapos A, Domsik P, Katona A, Szucsborus T, Ungi T, Forster T, Ungi I, Pluchinotta F, Arcidiacono C, Saracino A, Carminati M, Bussadori C, Dahlslett T, Karlsen S, Grenne B, Sjoli B, Bendz B, Skulstad H, Smiseth O, Edvardsen T, Brunvand H, Vereckei A, Szelenyi Z, Szenasi G, Santoro C, Galderisi M, Niglio T, Santoro M, Stabile E, Rapacciuolo A, Spinelli L, De Simone G, Esposito G, Trimarco B, Hubert S, Jacquier A, Fromonot J, Resseguier C, Tessier A, Guieu R, Renard S, Haentjiens J, Lavoute C, Habib G, Menting ME, Koopman L, Mcghie J, Rebel B, Gnanam D, Helbing W, Van Den Bosch A, Roos-Hesselink J, Shiino K, Yamada A, Sugimoto K, Takada K, Takakuwa Y, Miyagi M, Iwase M, Ozaki Y, Hayashi T, Itatani K, Inuzuka R, Shindo T, Hirata Y, Shimizu N, Miyaji K, Henri C, Dulgheru R, Magne J, Kou S, Davin L, Nchimi A, Oury C, Pierard L, Lancellotti P, Kovalyova O, Honchar O, Tengku W, Ketaren A, Mingo Santos S, Monivas Palomero V, Restrepo Cordoba A, Rodriguez Gonzalez E, Goirigolzarri Artaza J, Sayago Silva I, Garcia Lunar I, Mitroi C, Cavero Gibanel M, Segovia Cubero J, Ryu S, Park J, Kim S, Choi J, Goh C, Byun Y, Choi J, Westholm C, Johnson J, Jernberg T, Winter R, Rio P, Moura Branco L, Galrinho A, Pinto Teixeira P, Viveiros Monteiro A, Portugal G, Pereira-Da-Silva T, Afonso Nogueira M, Abreu J, Cruz Ferreira R, Mazzone A, Botto N, Paradossi U, Chabane A, Francini M, Cerone E, Baroni M, Maffei S, Berti S, Ghattas A, Shantsila E, Griffiths H, Lip G, Galli E, Guirette Y, Daudin M, Auffret V, Mabo P, Donal E, Fabiani I, Conte L, Scatena C, Barletta V, Pratali S, De Martino A, Bortolotti U, Naccarato A, Di Bello V, Falanga G, Alati E, Di Giannuario G, Zito C, Cusma' Piccione M, Carerj S, Oreto G, Dattilo G, Alfieri O, La Canna G, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Cengiz B, Sahin ST, Yurdakul S, Kahraman S, Bozkurt A, Aytekin S, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Venkateshvaran A, Sola S, Dash PK, Thapa P, Manouras A, Winter R, Brodin L, Govind SC, Mizariene V, Verseckaite R, Bieseviciene M, Karaliute R, Jonkaitiene R, Vaskelyte J, Arzanauskiene R, Janenaite J, Jurkevicius R, Rosner S, Orban M, Nadjiri J, Lesevic H, Hadamitzky M, Sonne C, Manganaro R, Carerj S, Cusma-Piccione M, Caprino A, Boretti I, Todaro M, Falanga G, Oreto L, D'angelo M, Zito C, Le Tourneau T, Cueff C, Richardson M, Hossein-Foucher C, Fayad G, Roussel J, Trochu J, Vincentelli A, Cavalli G, Muraru D, Miglioranza M, Addetia K, Veronesi F, Cucchini U, Mihaila S, Tadic M, Lang R, Badano L, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Chialastri C, Madeo A, Malouf J, Buffa V, Musumeci F, Gripari P, Tamborini G, Bottari V, Maffessanti F, Carminati C, Muratori M, Vignati C, Bartorelli A, Alamanni F, Pepi M, Polymeros S, Dimopoulos A, Spargias K, Karatasakis G, Athanasopoulos G, Pavlides G, Dagres N, Vavouranakis E, Stefanadis C, Cokkinos D, Pradel S, Mohty D, Magne J, Darodes N, Lavergne D, Damy T, Beaufort C, Aboyans V, Jaccard A, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Jovanova S, Arnaudova-Dezjulovic F, Correia CE, Cruz I, Marques N, Fernandes M, Bento D, Moreira D, Lopes L, Azevedo O, Keramida K, Kouris N, Kostopoulos V, Psarrou G, Giannaris V, Olympios C, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Roufas K, Papadaki H, Vardas P, Dominguez Rodriguez F, Monivas Palomero V, Mingo Santos S, Arribas Rivero B, Cuenca Parra S, Zegri Reiriz I, Vazquez Lopez-Ibor J, Garcia-Pavia P, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nemes A, Domsik P, Kalapos A, Forster T, Serra W, Lumetti F, Mozzani F, Del Sante G, Ariani A, Corros C, Colunga S, Garcia-Campos A, Diaz E, Martin M, Rodriguez-Suarez M, Leon V, Fidalgo A, Moris C, De La Hera J, Kylmala MM, Rosengard-Barlund M, Groop PH, Lommi J, Bruin De- Bon H, Bilt Van Der I, Wilde A, Brink Van Den R, Teske A, Rinkel G, Bouma B, Teixeira R, Monteiro R, Garcia J, Silva A, Graca M, Baptista R, Ribeiro M, Cardim N, Goncalves L, Duszanska A, Skoczylas I, Kukulski T, Polonski L, Kalarus Z, Choi JH, Park J, Ahn J, Lee J, Ryu S, Ahn J, Kim D, Lee H, Przewlocka-Kosmala M, Mlynarczyk J, Rojek A, Mysiak A, Kosmala W, Pellissier A, Larochelle E, Krsticevic L, Baron E, Le V, Roy A, Deragon A, Cote M, Garcia D, Tournoux F, Yiangou K, Azina C, Yiangou A, Zitti M, Ioannides M, Ricci F, Dipace G, Aquilani R, Radico F, Cicchitti V, Bianco F, Miniero E, Petrini F, De Caterina R, Gallina S, Jardim Prista Monteiro R, Teixeira R, Garcia J, Baptista R, Ribeiro M, Cardim N, Goncalves L, Chung H, Kim J, Joung B, Uhm J, Pak H, Lee M, Lee K, Ragab A, Abdelwahab A, Yazeed Y, El Naggar W, Spahiu K, Spahiu E, Doko A, Liesting C, Brugts J, Kofflard M, Kitzen J, Boersma E, Levin MD, Coppola C, Piscopo G, Rea D, Maurea C, Caronna A, Capasso I, Maurea N, Azevedo O, Tadeu I, Lourenco M, Portugues J, Pereira V, Lourenco A, Nesukay E, Kovalenko V, Cherniuk S, Danylenko O, Nemes A, Domsik P, Kalapos A, Lengyel C, Varkonyi T, Orosz A, Forster T, Castro M, Abecasis J, Dores H, Madeira S, Horta E, Ribeiras R, Canada M, Andrade M, Mendes M, Morosin M, Piazza R, Leonelli V, Leiballi E, Pecoraro R, Cinello M, Dell' Angela L, Cassin M, Sinagra G, Nicolosi G, Wierzbowska-Drabik K, Hamala P, Kasprzak J, O'driscoll J, Rossato C, Gargallo-Fernandez P, Araco M, Sharma S, Sharma R, Jakus N, Baricevic Z, Ljubas Macek J, Skoric B, Skorak I, Velagic V, Separovic Hanzevacki J, Milicic D, Cikes M, Deljanin Ilic M, Ilic S, Kocic G, Pavlovic R, Stoickov V, Ilic V, Nikolic L, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Labate V, Bandera F, Generati G, Pellegrino M, Donghi V, Alfonzetti E, Guazzi M, Zakarkaite D, Kramena R, Aidietiene S, Janusauskas V, Rucinskas K, Samalavicius R, Norkiene I, Speciali G, Aidietis A, Kemaloglu Oz T, Ozpamuk Karadeniz F, Akyuz S, Unal Dayi S, Esen Zencirci A, Atasoy I, Osken A, Eren M, Fazendas PR, Caldeira D, Stuart B, Cruz I, Rocha Lopes L, Almeida AR, Sousa P, Joao I, Cotrim C, Pereira H, Fazendas PR, Caldeira D, Stuart B, Cruz I, Rocha Lopes L, Almeida AR, Joao I, Cotrim C, Pereira H, Sinem Cakal S, Elif Eroglu E, Baydar O, Beytullah Cakal B, Mehmet Vefik Yazicioglu M, Mustafa Bulut M, Cihan Dundar C, Kursat Tigen K, Birol Ozkan B, Ali Metin Esen A, Yagasaki H, Kawasaki M, Tanaka R, Minatoguchi S, Houle H, Warita S, Ono K, Noda T, Watanabe S, Minatoguchi S, Cho EJ, Park SJ, Lim HJ, Chang SA, Lee SC, Park SW, Cho EJ, Park SJ, Lim HJ, Chang SA, Lee SC, Park SW, Mornos C, Cozma D, Ionac A, Mornos A, Popescu I, Ionescu G, Pescariu S, Melzer L, Faeh-Gunz A, Seifert B, Attenhofer Jost CH, Storve S, Haugen B, Dalen H, Grue J, Samstad S, Torp H, Ferrarotti L, Maggi E, Piccinino C, Sola D, Pastore F, Marino P, Ranjbar S, Karvandi M, Hassantash S, Karvandi M, Ranjbar S, Tierens S, Remory I, Bala G, Gillis K, Hernot S, Droogmans S, Cosyns B, Lahoutte T, Tran N, Poelaert J, Al-Mallah M, Alsaileek A, Nour K, Celeng C, Horvath T, Kolossvary M, Karolyi M, Panajotu A, Kitslaar P, Merkely B, Maurovich Horvat P, Aguiar Rosa S, Ramos R, Marques H, Portugal G, Pereira Da Silva T, Rio P, Afonso Nogueira M, Viveiros Monteiro A, Figueiredo L, Cruz Ferreira R. Poster session 6. Eur Heart J Cardiovasc Imaging 2014; 15:ii235-ii264. [PMCID: PMC4453635 DOI: 10.1093/ehjci/jeu271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
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Feechan A, Jermakow AM, Ivancevic A, Godfrey D, Pak H, Panstruga R, Dry IB. Host cell entry of powdery mildew is correlated with endosomal transport of antagonistically acting VvPEN1 and VvMLO to the papilla. Mol Plant Microbe Interact 2013; 26:1138-50. [PMID: 23819806 DOI: 10.1094/mpmi-04-13-0091-r] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Challenge by a nonadapted powdery mildew fungal pathogen leads to the formation of a local cell-wall apposition (papilla) beneath the point of attempted penetration. Several plasma membrane (PM) proteins with opposing roles in powdery mildew infection, including Arabidopsis thaliana PENETRATION1 (PEN1) and barley (Hordeum vulgare) MILDEW RESISTANCE LOCUS O (MLO), are localized to the site of powdery mildew attack. PEN1 contributes to penetration resistance to nonadapted powdery mildews, whereas MLO is a susceptibility factor required by adapted powdery mildew pathogens for host cell entry. Our previous studies have demonstrated that the vesicle and endosomal trafficking inhibitors, brefeldin A and wortmannin, have opposite effects on the penetration rates of adapted and nonadapted powdery mildews on grapevine. These findings prompted us to study the pathogen-induced intracellular trafficking of grapevine variants of MLO and PEN1. We first identified grapevine (Vitis vinifera) VvPEN1 and VvMLO orthologs that rescue Arabidopsis Atpen1 and Atmlo2 mlo6 mlo12 null mutants, respectively. By using endomembrane trafficking inhibitors in combination with fluorescence microscopy, we demonstrate that VvMLO3/VvMLO4 and VvPEN1 are co-trafficked together from the PM to the site of powdery mildew challenge. This focal accumulation of VvMLO3/VvMLO4 and VvPEN1 to the site of attack seems to be required for their opposing functions during powdery mildew attack, because their subcellular localization is correlated with the outcome of attempted powdery mildew penetration.
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Trindade-Filho A, Mendes C, Ferreira S, Oliveira S, Vasconcelos A, Maia F, Pak H, Paula K. DNA obtained from decomposed corpses cartilage: A comparison with skeleton muscle source. Forensic Science International: Genetics Supplement Series 2008. [DOI: 10.1016/j.fsigss.2007.10.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oliveira S, Trindade-Filho A, Mendes C, Paula K, Maia F, Pak H, Dalton G. Power of exclusion of 18 autossomic STR loci in a Brazilian Middle–West region population sample. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ics.2005.09.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pak H, Teixeira F, Punjabi S, Nicholson M, Van Rij A. Small bowel obstruction in a young woman. Gut 2005; 54:927, 1050. [PMID: 15951535 PMCID: PMC1774627 DOI: 10.1136/gut.2004.058032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- H Pak
- Department of Surgery, Dunedin Public Hospital, New Zealand
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Nikzat H, Pak H, Fuse T, Hu Y, Ogyu K, Kobayashi N, Hasatani M. Characteristics of Pulverized Coal Burner Using a High-Oxygen Partial Pressure. Chem Eng Res Des 2004. [DOI: 10.1205/026387604772803106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Holtkamp K, Mika C, Grzella I, Heer M, Pak H, Hebebrand J, Herpertz-Dahlmann B. Reproductive function during weight gain in anorexia nervosa. Leptin represents a metabolic gate to gonadotropin secretion. J Neural Transm (Vienna) 2003; 110:427-35. [PMID: 12658369 DOI: 10.1007/s00702-002-0800-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The adipocyte hormone leptin plays an important part in the reproductive function and in energy homeostasis. Only single studies have addressed the relationship between leptin and the hypothalamus-pituitary-gonadal axis (HPG) in anorexia nervosa (AN). In the present study 18 female adolescents with AN were investigated during weight gain. Leptin, LH, FSH, fT3, BMI and body composition were measured in the 1(st), 3(rd), 7(th) and 11(th) week of inpatient treatment. 18 eumenorrheic age- and gender-matched controls were examined once during the early follicular phase of their menstrual cycle. Our results demonstrate a critical leptin level of 1.2 ng/ml for an increase of FSH and confirmed a leptin threshold level of 1.85 ng/ml for LH. It may be concluded that leptin represents a metabolic gate to gonadotropin secretion. Once this is exceeded other biological mechanisms seem to be important for the complete recovery of the reproductive function and the resumption of menses.
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Affiliation(s)
- K Holtkamp
- Department of Child and Adolescent Psychiatry, Technical University of Aachen, Germany
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Abstract
BACKGROUND Solid tumors are angiogenesis dependent, and elevated levels of proangiogenic cytokines have been reported in a variety of histologies. Endostatin is an antiangiogenic fragment of the basement membrane protein, collagen XVIII. Because antiangiogenic protein fragments may be generated by tumor-derived proteases, the authors sought to determine whether circulating levels of endostatin were elevated in patients with localized soft tissue sarcoma. METHODS The authors analyzed preoperative serum levels of endostatin, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) in 25 patients (14 males and 11 females; mean age, 44 years) with soft tissue sarcoma. For each serum sample, two aliquots were assayed in duplicate using a competitive enzyme immunoassay. Serum levels were compared with levels from 34 age-matched and gender-matched volunteer blood donors. RESULTS Endostatin levels were significantly higher in sera from sarcoma patients than in sera from healthy controls (43.0 ng/mL vs. 25.8 ng/mL, respectively; P = 0.0002; Mann-Whitney U test). Significant elevations also were noted in VEGF and bFGF levels (P = 0.0002 and P = 0.0001, respectively). Furthermore, endostatin levels > 2 standard deviations above the control mean (55 ng/mL) were associated with an increased risk of tumor recurrence after resection (P = 0.047; log-rank test). CONCLUSIONS Serum endostatin, VEGF, and bFGF levels are elevated in patients with soft tissue sarcoma. Elevated endostatin levels appear to be associated with tumor aggressiveness. The role of these cytokines in sarcoma angiogenesis and as potential targets for therapy warrants further study.
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Affiliation(s)
- A L Feldman
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Oettingen G, Pak H, Schnetter K. Self-regulation of goal setting: turning free fantasies about the future into binding goals. J Pers Soc Psychol 2001; 80:736-53. [PMID: 11374746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Fantasy realization theory states that when people contrast their fantasies about a desired future with reflections on present reality, a necessity to act is induced that leads to the activation and use of relevant expectations. Strong goal commitment arises in light of favorable expectations, and weak goal commitment arises in light of unfavorable expectations. To the contrary, when people only fantasize about a desired future or only reflect on present reality, expectancy-independent moderate goal commitment emerges. Four experiments pertaining to various life domains supported these hypotheses. Strength of goal commitment was assessed in cognitive (e.g., making plans), affective (e.g., felt attachment), and behavioral terms (e.g., effort expenditure, quality of performance). Implications for theories on goal setting and goal striving are discussed.
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Affiliation(s)
- G Oettingen
- Department of Psychology, New York University, New York 10003, USA.
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Abstract
BACKGROUND Solid tumors are angiogenesis dependent, and elevated levels of proangiogenic cytokines have been reported in a variety of histologies. Endostatin is an antiangiogenic fragment of the basement membrane protein, collagen XVIII. Because antiangiogenic protein fragments may be generated by tumor-derived proteases, the authors sought to determine whether circulating levels of endostatin were elevated in patients with localized soft tissue sarcoma. METHODS The authors analyzed preoperative serum levels of endostatin, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) in 25 patients (14 males and 11 females; mean age, 44 years) with soft tissue sarcoma. For each serum sample, two aliquots were assayed in duplicate using a competitive enzyme immunoassay. Serum levels were compared with levels from 34 age-matched and gender-matched volunteer blood donors. RESULTS Endostatin levels were significantly higher in sera from sarcoma patients than in sera from healthy controls (43.0 ng/mL vs. 25.8 ng/mL, respectively; P = 0.0002; Mann-Whitney U test). Significant elevations also were noted in VEGF and bFGF levels (P = 0.0002 and P = 0.0001, respectively). Furthermore, endostatin levels > 2 standard deviations above the control mean (55 ng/mL) were associated with an increased risk of tumor recurrence after resection (P = 0.047; log-rank test). CONCLUSIONS Serum endostatin, VEGF, and bFGF levels are elevated in patients with soft tissue sarcoma. Elevated endostatin levels appear to be associated with tumor aggressiveness. The role of these cytokines in sarcoma angiogenesis and as potential targets for therapy warrants further study.
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Affiliation(s)
- A L Feldman
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Gotoh J, Kuang TY, Nakao Y, Cohen DM, Melzer P, Itoh Y, Pak H, Pettigrew K, Sokoloff L. Regional differences in mechanisms of cerebral circulatory response to neuronal activation. Am J Physiol Heart Circ Physiol 2001; 280:H821-9. [PMID: 11158982 DOI: 10.1152/ajpheart.2001.280.2.h821] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vibrissal stimulation raises cerebral blood flow (CBF) in the ipsilateral spinal and principal sensory trigeminal nuclei and contralateral ventroposteromedial (VPM) thalamic nucleus and barrel cortex. To investigate possible roles of adenosine and nitric oxide (NO) in these increases, local CBF was determined during unilateral vibrissal stimulation in unanesthetized rats after adenosine receptor blockade with caffeine or NO synthase inhibition with N(G)-nitro-L-arginine methyl ester (L-NAME) or 7-nitroindazole (7-NI). Caffeine lowered baseline CBF in all structures but reduced the percent increase during stimulation only in the two trigeminal nuclei. L-NAME and 7-NI lowered baseline CBF but reduced the percent increase during stimulation only in the higher stations of this sensory pathway, i.e., L-NAME in the VPM nucleus and 7-NI in both the VPM nucleus and barrel cortex. Combinations of caffeine with 7-NI or L-NAME did not have additive effects, and none alone or in combination completely eliminated functional activation of CBF. These results suggest that caffeine-sensitive and NO-dependent mechanisms are involved but with different regional distributions, and neither fully accounts for the functional activation of CBF.
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Affiliation(s)
- J Gotoh
- Laboratory of Cerebral Metabolism, National Institute of Mental Health, Bethesda, Maryland 20892-4030, USA
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Vidmar DA, Cruess D, Hsieh P, Dolecek Q, Pak H, Gwynn M, Maggio K, Montemorano A, Powers J, Richards D, Sperling L, Wong H, Yeager J. The effect of decreasing digital image resolution on teledermatology diagnosis. Telemed J 2000; 5:375-83. [PMID: 10908453 DOI: 10.1089/107830299311943] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the effect of degraded digital image resolution (as viewed on a monitor) on the accuracy and confidence of dermatologic interpretation. MATERIALS AND METHODS Eight dermatologists interpreted 180 clinical cases divided into three Logical Competitor Sets (LCS) (pigmented lesions, non-pigmented lesions, and inflammatory dermatoses). Each case was digitized at three different resolutions. The images were randomized and divided into (9) 60-image sessions. The physicians were completely blinded concerning the image resolution. After 60 seconds per image, the viewer recorded a diagnosis and level of confidence. The resultant ROC curves compared the effect of LCS, level of clinical difficulty, and resolution of the digital image. One-way analysis of variance (ANOVA) compared the curves. RESULTS The areas beneath the ROC curves did not demonstrate any consistently significant difference between the digital image resolutions for all LCS and levels of difficulty. The only significant effect observed was amongst pigmented lesions (LCS-A) where the ROC curve area was significantly smaller in the easy images at high resolution compared to low and medium resolutions. For all other ROC curve comparisons within LCS-A, at all other levels of difficulty, as well as within the other LCS at all levels of difficulty, none of the differences was significant. CONCLUSION A 720 x 500 pixel image can be considered equivalent to a 1490 x 1000 pixel image for most store-and-forward teledermatology consultations.
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Affiliation(s)
- D A Vidmar
- Department of Military and Emergency Medicine and Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Pak H, Montemarano AD, Berger T. Purpuric nodules and macules on the extremities of a young woman. Cutaneous polyarteritis nodosa. Arch Dermatol 1998; 134:231-2, 234-5. [PMID: 9487217 DOI: 10.1001/archderm.134.2.231-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- H Pak
- Walter Reed Army Medical Center, Washington, DC, USA
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Horinaka N, Kuang TY, Pak H, Wang R, Jehle J, Kennedy C, Sokoloff L. Blockade of cerebral blood flow response to insulin-induced hypoglycemia by caffeine and glibenclamide in conscious rats. J Cereb Blood Flow Metab 1997; 17:1309-18. [PMID: 9397030 DOI: 10.1097/00004647-199712000-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The possibility that adenosine and ATP-sensitive potassium channels (KATP) might be involved in the mechanisms of the increases in cerebral blood flow (CBF) that occur in insulin-induced hypoglycemia was examined. Cerebral blood flow was measured by the [14C]iodoantipyrine method in conscious rats during insulin-induced, moderate hypoglycemia (2 to 3 mmol/L glucose in arterial plasma) after intravenous injections of 10 to 20 mg/kg of caffeine, an adenosine receptor antagonist, or intracisternal infusion of 1 to 2 mumol/L glibenclamide, a KATP channel inhibitor. Cerebral blood flow was also measured in corresponding normoglycemic and drug-free control groups. Cerebral blood flow was 51% higher in untreated hypoglycemic than in untreated normoglycemic rats (P < 0.01). Caffeine had a small, statistically insignificant effect on CBF in normoglycemic rats, but reduced the CBF response to hypoglycemia in a dose-dependent manner, i.e., 27% increase with 10 mg/kg and complete elimination with 20 mg/kg. Chemical determinations by HPLC in extracts of freeze-blown brains showed significant increases in the levels of adenosine and its degradation products, inosine and hypoxanthine, during hypoglycemia (P < 0.05). Intracisternal glibenclamide had little effect on CBF in normoglycemia, but, like caffeine, produced dose-dependent reductions in the magnitude of the increases in CBF during hypoglycemia, i.e., +66% with glibenclamide-free artificial CSF administration, +25% with 1 mumol/L glibenclamide, and almost complete blockade (+5%) with 2 mumol/L glibenclamide. These results suggest that adenosine and KATP channels may play a role in the increases in CBF during hypoglycemia.
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Affiliation(s)
- N Horinaka
- Laboratory of Cerebral Metabolism, National Institute of Mental Health, Bethesda, Maryland 20892, USA
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Lee SH, Kim HS, Pak H. A molecular dynamics simulation study on nematic–isotropic phase transition of rod‐like molecules in NpT ensemble. J Chem Phys 1992. [DOI: 10.1063/1.463647] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial would infection (one case). There were no deaths. Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.
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Abstract
A young woman, who was initially treated for an Arnold-Chiari malformation, was found 7 years later to have a posterior third ventricular tumor. A superior cerebellar approach allowed total resection of the mass, which was an aggressive choroid plexus papilloma. The patient was treated with whole cerebrospinal axis radiation. There is no clinical or computed tomographic evidence of recurrence after 4 years. The literature is reviewed and a discussion of aggressive choroid plexus papilloma (carcinoma) is presented.
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Abstract
Successful canine lung cancer models have required repeated focal bronchial carcinogen exposure under general anesthesia. To simplify serial studies of the respiratory mucosa during carcinogenesis, bistomal autologous heterotopic tracheal pedicle grafts have been made. These grafts can readily be returned to the original orthotopic site, and this has been shown to be a method with which to study reversibility of mucosal changes. Polycyclic aromatic hydrocarbons were applied topically to the mucosa three times a week for 21 to 22 months in 21 grafts. Implants of Silastic polymer from which carcinogen was released in sustained-release fashion were then left in the grafts for 4 to 6 weeks. Serial cytological and histological examinations showed development of atypical squamous metaplasia in the graft mucosa. Mucosal papillomatosis was noted in 4 of 7 grafts surgically excised 17 to 18 months after completion of carcinogen exposure. The heterotopic bistomal tracheal graft provides a useful method for studying respiratory epithelial carcinogenesis without repeated general anesthesia.
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DeCaro LF, Paladugu R, Benfield JR, Lovisatti L, Pak H, Teplitz RL. Typical and atypical carcinoids within the pulmonary APUD tumor spectrum. J Thorac Cardiovasc Surg 1983; 86:528-36. [PMID: 6621081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The behavior of pulmonary APUD tumors is not constant; management is controversial, and morphology has reached its limit as a tool for prognostic assessment and therapeutic planning. We have studied 24 patients with carcinoids; 17 patients with typical carcinoids presented with Stage I disease, but one patient later died most probably of small cell undifferentiated lung cancer (SCLC). Seven patients with atypical carcinoids included three with Stage III cancers, one patient with simultaneous bilateral carcinoids, and one patient with simultaneous adenocarcinoma. Of 17 patients with typical carcinoids, 16 or 92% are disease free or died of unrelated causes. Of seven patients with atypical carcinoids, five or 71% are disease free. Tumor doubling time of atypical carcinoids, was 79.6 months (45 to 120) or six times shorter than that of typical carcinoids (p less than 0.05). Two of the three deaths from cancer were probably from SCLC and one from a synchronous adenocarcinoma. Review of diagnostic material from 12 patients with SCLC who survived a mean of 41 months (24 to 134) showed that diagnosis had rested on cytology alone in four patients and that, in seven patients, the quality or extent of the original diagnostic material was adequate to make the diagnosis of a malignant tumor but inadequate to permit reclassification. Tumor cells from 11 patients with carcinoids (seven typical and four atypical) and 28 patients with SCLC had DNA measurement by image analysis. The mean DNA content of typical and atypical carcinoids and SCLC is 1.17, 1.25, and 1.94 respectively (p less than 0.001). These findings strongly suggest a relationship between DNA content and atypia or malignancy in APUD lung tumors. We conclude that there are at least two levels of virulence among carcinoids represented by typical and atypical carcinoids. The prognosis for treated Stage I typical and atypical carcinoids is excellent. When deaths occur, they are from systemic cancer. Current evidence indicates that DNA measurements by image analysis may help to discriminate levels of malignancy among APUD pulmonary cancers and thereby help to clarify therapeutic controversies.
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de los Reyes RA, Ausman JI, Diaz FG, Pak H, Pearce JE, Dujovny M. The surgical management of vertebrobasilar insufficiency. Acta Neurochir (Wien) 1983; 68:203-16. [PMID: 6880877 DOI: 10.1007/bf01401179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Vertebrobasilar insufficiency may result from structural lesions anywhere along the vertebrobasilar system. Recently developed techniques in angiography and microsurgery have made the vertebrobasilar system more accessible to surgical therapy. The syndrome of vertebrobasilar insufficiency is discussed, and our experience with the surgical treatment of lesions from the vertebral origin to the distal basilar region is reviewed.
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Kitchen JC, Zaneveld JR, Pak H. Effect of particle size distribution and chlorophyll content on beam attenuation spectra. Appl Opt 1982; 21:3913-3918. [PMID: 20396339 DOI: 10.1364/ao.21.003913] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The relationships between beam attenuation spectra, chlorophyll and pheophytin pigment concentrations, and particle size distributions are examined for a coastal region (Monterey Bay area) believed to have negligible concentrations of terrestrially derived dissolved organic compounds (during May 1977) but large quantities of phytoplankton and resuspended sediments. It was found that the slope of the beam attenuation spectra increases when the hyperbolic slope of the size distribution increases. The magnitude of this increase in slope was consistent with calculations based on a range of particle diameters from 0.5 to 30 microm, so that it would be possible to predict the slope of the particle size distribution if the slope of the beam attenuation spectra is known. The ratio of chlorophyll and pheophytin pigments to suspended volume concentrations affected the beam attenuation spectra to a lesser degree and in a more complex manner. Because of the strong effect of slope, it was concluded that the chlorophyll and pheophytin pigment content of suspended particles could not be efficiently predicted by means of beam attenuation measurements.
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Affiliation(s)
- J C Kitchen
- Oregon State University, School of Oceanography, Corvallis, Oregon 97331, USA
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Ausman JI, Diaz FG, de los Reyes RA, Pak H, Patel S, Mehta B, Boulos R. Posterior circulation revascularization. Superficial temporal artery to superior cerebellar artery anastomosis. J Neurosurg 1982; 56:766-76. [PMID: 7077375 DOI: 10.3171/jns.1982.56.6.0766] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Eight patients were evaluated for severe vertebrobasilar insufficiency (VBI). There were five males and three females, with an average age of 60.2 years (range 42 to 67 years). Three were diabetic and five hypertensive, including two patients who had both diseases. Seven of the eight had ongoing episodes of VBI refractory to anticoagulant and/or antiplatelet agents. Symptoms included two or more of the following in all patients: dizziness, diplopia, hemiparesis, hemihypesthesia, perioral numbness, bilateral visual blurring, dysarthria, and ataxia. Angiography revealed severe atherosclerotic stenosis of the proximal or midsection of the basilar artery in all patients. A 10-cm segment of the anterior or posterior division of the superficial temporal artery (STA) was anastomosed to a proximal segment of the superior cerebellar artery (SCA) through a right subtemporal approach. Seven of eight (87%) postoperative angiograms demonstrated patency as evidenced by filling of the SCA and, in most cases, of the basilar artery. Six of the eight patients were improved or asymptomatic after the operation, one was unchanged, and one died. The average follow-up period was 14 months, with a range of 4 to 23 months. Transient morbidity included temporal lobe swelling in four patients and a subdural hematoma in one. Anastomosis of the STA to the SCA is a feasible therapeutic option in the patient with VBI secondary to stenosis of the proximal or midsection of the basilar artery.
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Ausman JI, Diaz FG, de los Reyes RA, Pak H, Patel S, Boulos R. Anastomosis of occipital artery to anterior inferior cerebellar artery for vertebrobasilar junction stenosis. Surg Neurol 1981; 16:99-102. [PMID: 7280991 DOI: 10.1016/0090-3019(81)90105-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A new approach to revascularization of the posterior fossa for vertebrobasilar insufficiency due to vertebrobasilar junction stenosis is reported. The procedure involves anastomosing the occipital artery to a branch of the anterior inferior cerebellar artery. Rationale for the procedure and surgical technique are discussed.
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Ausman JI, Diaz FG, de los Reyes RA, Pak H, Patel S, Boulos R. Superficial temporal to proximal superior cerebellar artery anastomosis for basilar artery stenosis. Neurosurgery 1981; 9:56-60. [PMID: 7279173 DOI: 10.1227/00006123-198107000-00009] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
abstract
A newly modified revascularization procedure for vertebrobasilar insufficiency due to midbasilar stenosis is reported. The approach involves anastomosing the superficial temporal artery to a proximal segment of the superior cerebellar artery. The rationale for the procedure and the surgical technique are discussed.
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Abstract
A middle-aged woman presented with progressive brainstem neurological deficits. Clinical manifestations and preoperative radiological examination were indicative of an expanding intrapontine mass. At operation, an intrapontine hematoma and a venous angioma adherent to the floor of the fourth ventricle were discovered. Successful evacuation of the hematoma was followed by an excellent recovery. Postoperative angiography demonstrated the venous angioma. To our knowledge, this is the first case of angiographically proved ruptured venous angioma of the pons treated successfully by an operation.
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Spinrad RW, Zaneveld JR, Pak H. Volume scattering function of suspended particulate matter at near-forward angles: a comparison of experimental and theoretical values. Appl Opt 1978; 17:1125-1130. [PMID: 20197945 DOI: 10.1364/ao.17.001125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Narrow angle light scattering measurements were made for various sizes of spherical particles suspended in water. These were compared to calculated theoretical scattering values as derived from the theory of Mie (1908). Through measurements with different particle concentrations at angles between 0.2 degrees and 0.7 degrees the effect of the unscattered main beam light was removed. Results agreed well with Mie theory for these angles.
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