Changes in high-sensitivity C-reactive protein levels and metabolic indices according to grip strength in Korean postmenopausal women

OBJECTIVE

This study aimed to investigate the changes in high-sensitivity C-reactive protein (hs-CRP) level and metabolic indices such as blood pressure, serum lipid level and serum glucose level according to grip strength in postmenopausal women.

METHOD

Data from participants (postmenopausal women) in the Seventh Korea National Health and Nutrition Examination Survey 2018 were analyzed. Absolute handgrip strength was the sum of the maximal grip strength of both hands, and relative handgrip was calculated as absolute handgrip divided by the body mass index. We performed linear regression analysis after adjusting for confounders to assess the influence of grip strength on hs-CRP level and metabolic indices.

RESULTS

Linear regression analysis showed that after adjusting for confounders, with an increased absolute grip strength, systolic blood pressure and hs-CRP levels were decreased; however, the changes were not significant for the remaining indices. Relative grip strength was associated with hs-CRP levels and metabolic indices. With a high relative grip strength, hs-CRP, blood pressure, fasting blood glucose, hemoglobin A1c and triglyceride levels were decreased, while the high-density lipoprotein cholesterol level was increased.

CONCLUSION

Our study evaluated the overall health status using grip strength in postmenopausal women. The grip strength adjusted by body size was suitable in evaluating the overall health status, including inflammatory and metabolic indices. Additionally, increased grip strength was associated with a better health status in postmenopausal women.

Accuracy of implantable loop recorders for detecting atrial tachyarrhythmias after atrial fibrillation catheter ablation

Background

Implantable loop recorders (ILRs) can provide an enhanced possibility to detect atrial fibrillation (AF), but the accuracy, especially the positive predictive value (PPV), is controversial. This study aimed to evaluate the accuracy of ILRs for detecting AF through a comparison with Holter.

Method and results

Thirteen patients who underwent AF ablation were enrolled. ILRs were implanted in all patients, who were scheduled to have Holter monitorings after the procedure. The incidence of AF was compared between the two modalities and analyzed for any correlations. A total of 51 Holters (67,985.5 min) and concomitant ILRs were available for the comparison. The judgment of the presence of AF did not perfectly correlate between the ILR and Holter (Kappa = 0.866, P < 0.001). In the ILR data, the sensitivity of detecting AF on the Holter was 81.6% (95% confidence interval [CI] 0.812–0.820; P < 0.001). The specificity was 99.9% (95% CI 0.998–0.999; P < 0.001). When the ILR detected AF, the PPV was 99.5% (95% CI 0.994–0.995), but the ILR did not detect AF, and the negative predictive value was 94.2% (95% CI 0.941–0.944). A separate analysis of AF/atrial tachycardia (AT) showed that the AT detection rate of the ILR was 2.3%.

Conclusion

The ILR had a low false positive value and high PPV for AF events. However, it was limited in identifying AT.

Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis

Background

Surgery is the most important treatment modality for papillary thyroid cancer (PTC). However, the relationship between surgeon volume and long-term oncological outcomes has not been explored.

Methods

Patients diagnosed with N1b PTC after initial thyroid surgery between 1 July 1994 and 31 December 2011 were eligible for inclusion in the study. Surgeons were categorized into high (at least 100 operations per year) and low (fewer than 100 operations per year) volume groups. Kaplan–Meier survival analysis according to surgeon volume was performed, and Cox proportional hazard modelling was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals according to patient, tumour and surgeon factors.

Results

A total of 1103 patients with a median follow-up of 81 (i.q.r. 62–108) months were included in the study. During follow-up, 200 patients (18·1 per cent) developed structural recurrence. A high surgeon volume was associated with low structural recurrence (P = 0·006). After adjustment for age, sex and conventional risk factors for recurrence (histology, tumour size, gross extrathyroidal extension, margin status, more than 5 positive lymph nodes, radioactive iodine therapy), the adjusted HR for structural recurrence for low-volume surgeons was 1·46 (95 per cent c.i. 1·08 to 1·96), compared with high-volume surgeons. Distant metastasis (P = 0·242) and disease-specific mortality (P = 0·288) were not affected by surgeon volume.

Conclusion

Surgeon volume is associated with structural recurrence, but not distant metastasis or cancer-specific death in patients with N1b PTC. Surgeon volume is important in initial surgery for advanced PTC with extensive nodal metastasis in order to ensure curative outcome and reduce treatment-related morbidity.

Clinical Outcomes in Patients with Deferred Coronary Lesions according to Disease Severity Assessed by Fractional Flow Reserve

Data on the clinical outcomes in deferred coronary lesions according to functional severity have been limited. This study evaluated the clinical outcomes of deferred lesions according to fractional flow reserve (FFR) grade using Korean FFR registry data. Among 1,294 patients and 1,628 lesions in Korean FFR registry, 665 patients with 781 deferred lesions were included in this study. All participants were consecutively categorized into 4 groups according to FFR; group 1: ≥ 0.96 (n = 56), group 2: 0.86-0.95 (n = 330), group 3: 0.81-0.85 (n = 170), and group 4: ≤ 0.80 (n = 99). Primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, and target vessel revascularization. The median follow-up period was 2.1 years. During follow-up, the incidence of MACE in groups 1-4 was 1.8%, 7.6%, 8.8%, and 13.1%, respectively. Compared to group 1, the cumulative rate by Kaplan-Meier analysis of MACE was not different for groups 2 and 3. However, group 4 had higher cumulative rate of MACE compared to group 1 (log-rank P = 0.013). In the multivariate Cox hazard models, only FFR (hazard ratio [HR], 0.95; P = 0.005) was independently associated with MACE among all participants. In contrast, previous history of percutaneous coronary intervention (HR, 2.37; P = 0.023) and diagnosis of acute coronary syndrome (ACS) (HR, 2.35; P = 0.015), but not FFR, were independent predictors for MACE in subjects with non-ischemic (FFR ≥ 0.81) deferred coronary lesions. Compared to subjects with ischemic deferred lesions, clinical outcomes in subjects with non-ischemic deferred lesions according to functional severity are favorable. However, longer-term follow-up may be necessary.

Stimulating TRPV1 externalization and synthesis in dorsal root ganglion neurons contributes to PGE2 potentiation of TRPV1 activity and nociceptor sensitization

BACKGROUND

Persistent peripheral sensitization contributes to chronic pain. Plasticity of nociceptive dorsal root ganglion (DRG) neurons (nociceptors) induced by pro-inflammatory mediators contributes to sensitization. Prostaglandin E2 (PGE2) enriched in injured tissues is known not only directly to sensitize DRG neurons, but also to potentiate sensitizing effects of other pain mediators such as capsaicin and its receptor transient receptor potential vanilloid-1 (TRPV1). It remains unknown whether PGE2 potentiates TRPV1 activity by stimulating its synthesis, cell surface and axonal trafficking in DRG neurons.

METHODS

Combined biochemical, morphological, pharmacological and behavioral approaches have been used to address this issue in both in vitro and in vivo models.

RESULTS

PGE2 increased TRPV1 externalization in cultured rat DRG neurons in a time- and concentration-dependent manner, an event blocked by an inhibitor of protein synthesis or anterograde export. EP1 and EP4, but not EP2 and EP3, mediated this event. EP1 agonist-induced TRPV1 externalization was suppressed by inhibitors of CaMKII, PLC, PKC and PKCε, while EP4 agonist-induced TRPV1 externalization by inhibitors of cAMP/PKA and ERK/MAPK. Pre-exposure to PGE2 potentiated release of calcitonin gene-related peptide from cultured DRG neurons evoked by subsequent capsaicin stimulation. This event was blocked by an inhibitor of protein synthesis or export, suggesting that PGE2-induced TRPV1 synthesis and externalization is coupled to enhanced TRPV1 activity. Pre-exposure to PGE2 not only prolonged tactile allodynia evoked by subsequent capsaicin challenge, but also increased TRPV1 levels in L4-6 DRG, sciatic nerves and plantar skin.

CONCLUSIONS

Our data indicate that facilitating TRPV1 synthesis, cell surface and axonal trafficking is a novel mechanism underlying PGE2 potentiation of TRPV1 activity.

Genetic Variation of SCN5A in Korean Patients with Sick Sinus Syndrome

Background and Objectives

Due to recent studies that have shown an association between the genetic variation of SCN5A and sick sinus syndrome (SSS), we sought to determine if a similar correlation existed in Korean patients with SSS.

Subjects and Methods

We enrolled 30 patients with SSS who showed a sinus pause (longer than 3.0 s) in Holter monitoring, in addition to 80 controls. All exons including the putative splicing sites of the SCN5A gene were amplified by polymerase chain reaction and sequenced either directly or following subcloning. Wild-type and single nucleotide polymorphisms were expressed in human embryonic kidney cells, and the peak sodium current (I_Na) was analyzed using the whole-cell patch-clamp technique.

Results

A total of 9 genetic variations were identified: 7 variations (G87A-A29A, IVS9-3C>A, A1673G-H558R, G3823A-D1275N, T5457C-D1819D, T5963G-L1988R, and C5129T-S1710L) had been previously reported, and 2 variants (A3075T-E1025D and T4847A-F1616Y) were novel; the potential structural effects of F1616Y were analyzed in a three-dimensional model of the SCN5A domain. Patch-clamp studies at room temperature demonstrated that the peak I_Na was significantly increased by 140% in HEK cells transfected with F1616Y compared with wild-type (-335.13 pA/pF±24.04, n=8 vs. -139.95 pA/pF±23.76, n=7, respectively). Furthermore, the voltage dependency of the activation and steady-state inactivation of F1616Y were leftward-shifted compared with wild-type (V_h activation=-55.36 mv±0.22, n=8 vs. V_h activation=-44.21 mV±0.17, n=7; respectively; V_h inactivation=-104.47 mV±0.21, n=7 vs. V_h inactivation=-84.89 mV±0.09, n=12, respectively).

Conclusion

F1616Y may be associated with SSS.

Bio-optics based sensation imaging for breast tumor detection using tissue characterization

The tissue inclusion parameter estimation method is proposed to measure the stiffness as well as geometric parameters. The estimation is performed based on the tactile data obtained at the surface of the tissue using an optical tactile sensation imaging system (TSIS). A forward algorithm is designed to comprehensively predict the tactile data based on the mechanical properties of tissue inclusion using finite element modeling (FEM). This forward information is used to develop an inversion algorithm that will be used to extract the size, depth, and Young's modulus of a tissue inclusion from the tactile data. We utilize the artificial neural network (ANN) for the inversion algorithm. The proposed estimation method was validated by a realistic tissue phantom with stiff inclusions. The experimental results showed that the proposed estimation method can measure the size, depth, and Young's modulus of a tissue inclusion with 0.58%, 3.82%, and 2.51% relative errors, respectively. The obtained results prove that the proposed method has potential to become a useful screening and diagnostic method for breast cancer.

Optical-based artificial palpation sensors for lesion characterization

Palpation techniques are widely used in medical procedures to detect the presence of lumps or tumors in the soft breast tissues. Since these procedures are very subjective and depend on the skills of the physician, it is imperative to perform detailed a scientific study in order to develop more efficient medical sensors to measure and generate palpation parameters. In this research, we propose an optical-based, artificial palpation sensor for lesion characterization. This has been developed using a multilayer polydimethylsiloxane optical waveguide. Light was generated at the critical angle to reflect totally within the flexible and transparent waveguide. When a waveguide was compressed by an external force, its contact area would deform and cause the light to scatter. The scattered light was captured by a high-resolution camera and saved as an image format. To test the performance of the proposed system, we used a realistic tissue phantom with embedded hard inclusions. The experimental results show that the proposed sensor can detect inclusions and provide the relative value of size, depth, and Young's modulus of an inclusion.

Metachronous double primary cancer after diagnosis of gastric cancer

Purpose

The pattern of double primary cancers after treatment for gastric cancer is important for a patient's survival.

Materials and Methods

We analyzed the clinicopathologic data of 214 gastric cancer patients from October 1996 to November 2007 with regard to metachronous second primary cancers.

Results

Out of 5,778 patients with gastric cancer, metachronous second primary cancers occurred in 214 patients. The median age was 61.8 years, the number of male and female patients was 140 (65.4%), 74 (34.6%), respectively. The median time to the occurrence of second cancers after diagnosis of the first was 39.2 months (standard deviation, 31.2 months). The most common cancer was colorectal cancer, which occurred in 44 patients (20.6%), and lung cancer in 33 patients (15.4%), hepatocellular carcinoma in 26 patients (12.1%), ovarian cancer in 15 patients (7.0%), cervical cancer in 12 patients (7.0%), breast cancer in 11 patients (5.1%), and esophageal cancer in 11 patients (5.1%). The observed/expected (O/E) ratio showed a significant increase in colorectal (1.25), male biliary (1.60), ovarian (8.72), and cervical cancer (3.33) with primary gastric cancer. After five years from diagnosis of gastric cancer, secondary cancer occurred in 50 patients (23.4%), and breast cancer, prostate cancer, laryngeal cancer, lung cancer, and hepatocellular carcinoma were the most frequent.

Conclusion

The O/E ratio showed a significant increase in colorectal, male biliary, ovarian, and cervical cancer with primary gastric cancer, and second primary cancer as the main cause of death for these patients. A follow-up examination for metachronous double primary cancer is needed in order to improve the survival time in patients with gastric cancer.

Acute Stent Thrombosis and Heparin Induced Thrombocytopenia in a Patient With ST-Segment Elevation Myocardial Infarction

Heparin is an essential drug in the treatment of acute coronary syndrome and it is used during percutaneous coronary intervention (PCI). Heparin-induced thrombocytopenia (HIT), albeit a serious complication of heparin therapy characterized by thrombocytopenia and high risk for venous and arterial thrombosis, has rarely been previously reported during PCI. We report a case of an acute stent thrombosis due to an unusual cause, HIT during primary PCI, in a patient with acute myocardial infarction.

Genetic Analysis of SCN5A in Korean Patients Associated with Atrioventricular Conduction Block

Recent several studies have shown that the genetic variation of SCN5A is related with atrioventricular conduction block (AVB); no study has yet been published in Koreans. Therefore, to determine the AVB-associated genetic variation in Korean patients, we investigated the genetic variation of SCN5A in Korean patients with AVB and compared with normal control subjects. We enrolled 113 patients with AVB and 80 normal controls with no cardiac symptoms. DNA was isolated from the peripheral blood, and all exons (exon 2-exon 28) except the untranslated region and exon-intron boundaries of the SCN5A gene were amplified by multiplex PCR and directly sequenced using an ABI PRISM 3100 Genetic Analyzer. When a variation was discovered in genomic DNA from AVB patients, we confirmed whether the same variation existed in the control genomic DNA. In the present study, a total of 7 genetic variations were detected in 113 AVB patients. Of the 7 variations, 5 (G87A-A29A, intervening sequence 9-3C>A, A1673G-H558R, G3578A-R1193Q, and T5457C-D1819D) have been reported in previous studies, and 2 (C48G-F16L and G3048A-T1016T) were novel variations that have not been reported. The 2 newly discovered variations were not found in the 80 normal controls. In addition, G298S, G514C, P1008S, G1406R, and D1595N, identified in other ethnic populations, were not detected in this study. We found 2 novel genetic variations in the SCN5A gene in Korean patients with AVB. However, further functional study might be needed.

Comorbidity study on type 2 diabetes mellitus using data mining

BACKGROUND/AIMS

The aim of this study was to analyze comorbidity in patients with type 2 diabetes mellitus (T2DM) by using association rule mining (ARM).

METHODS

We used data from patients who visited Keimyung University Dongsan Medical Center from 1996 to 2007. Of 411,414 total patients, T2DM was present in 20,314. The Dx Analyze Tool was developed for data cleansing and data mart construction, and to reveal associations of comorbidity.

RESULTS

Eighteen associations reached threshold (support, ≥ 3%; confidence, ≥ 5%). The highest association was found between T2DM and essential hypertension (support, 17.43%; confidence, 34.86%). Six association rules were found among three comorbid diseases. Among them, essential hypertension was an important node between T2DM and stroke (support, 4.06%; confidence, 8.12%) as well as between T2DM and dyslipidemia (support, 3.44%; confidence, 6.88%).

CONCLUSIONS

Essential hypertension plays an important role in the association between T2DM and its comorbid diseases. The Dx Analyze Tool is practical for comorbidity studies that have an enormous clinical database.

A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

Background

The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules.

Methods

We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the design of decision support models, including the Chi-square test, Fisher's exact test, the Mann-Whitney U-test (p < 0.01), and Wald forward logistic regression (entry and removal criteria of 0.01 and 0.05, or 0.05 and 0.10, respectively). The final decision support models were constructed using the C5.0 decision tree algorithm of Clementine 12.0 after pre-processing.

Results

Of 55 variables, two subsets were found to be indispensable for early diagnostic knowledge discovery in acute appendicitis. The two subsets were as follows: (1) lymphocytes, urine glucose, total bilirubin, total amylase, chloride, red blood cell, neutrophils, eosinophils, white blood cell, complaints, basophils, glucose, monocytes, activated partial thromboplastin time, urine ketone, and direct bilirubin in the univariate analysis-based model; and (2) neutrophils, complaints, total bilirubin, urine glucose, and lipase in the multivariate analysis-based model. The experimental results showed that the model with univariate analysis (80.2%, 82.4%, 78.3%, 76.8%, 83.5%, and 80.3%) outperformed models using multivariate analysis (71.6%, 69.3%, 73.7%, 69.7%, 73.3%, and 71.5% with entry and removal criteria of 0.01 and 0.05; 73.5%, 66.0%, 80.0%, 74.3%, 72.9%, and 73.0% with entry and removal criteria of 0.05 and 0.10) in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under ROC curve, during a 10-fold cross validation. A statistically significant difference was detected in the pairwise comparison of ROC curves (p < 0.01, 95% CI, 3.13-14.5; p < 0.05, 95% CI, 1.54-13.1). The larger induced decision model was more effective for identifying acute appendicitis in patients with acute abdominal pain, whereas the smaller induced decision tree was less accurate with the test data.

Conclusions

The decision model developed in this study can be applied as an aid in the initial decision making of clinicians to increase vigilance in cases of suspected acute appendicitis.

P4-11-20: Observational Study of Body Weight Changes and Metabolic Syndrome in Breast Cancer Patients Receiving Adjuvant Therapy: Characteristics of Dietary Pattern in Korean Breast Cancer Patients

Backgroud: Obesity, postdiagnosis weight gain, and presence of metabolic syndrome in breast cancer are reported to adversely affect survival among breast cancer survivors. Most of the studies on weight gain and metabolic syndrome in breast cancer are from Western countries and few information is available on Asian population. We designed this prospective observational study to characterize weight and metabolic changes during adjuvant treatment in women with early breast cancer and to identify factors associated with occurrence of metabolic syndrome, focusing on dietary pattern.

Methods: Patients aged 18–75 who underwent curative surgery with stage I-III invasive breast cancer were enrolled from 2008 to 2010. We measured glucose (FBS), hemoglobin A1c (HbA1c), total cholesterol (TC), HDL cholesterol, and triglyceride (TG) level in fasting serum samples before starting adjuvant therapy, at 6 months and 12 months after enrollment. Body weight, body mass index (BMI), body fat mass, and percent body fat at baseline, 6 months, and 12 months were also measured. Dietary intake was assessed using valid semi-quantitative Food frequency questionnaire (FFQ).

Results: Total of 63 patients were enrolled. Median age of the enrolled patients were 48 (range, 25–68), with premenopausal/postmenopausal 40 (63.5%)/ 23 (36.5%). Fifty (82.0%) and 10 (16.4%) received adjuvant chemotherapy followed by hormone therapy and hormone therapy alone. Hormone receptor positive (ER+/PR+) and HER2 positive cancer accounted for 52 (83.9%) and 7 (12.1%). Mean FBS, HbA1c, TC, HDL, and TG level was 99.9 mg/dL (range, 83–159), 5.59 mg/dL (range, 4.8−7.5), 197.4 mg/dL (125-298), 51.9 mg/dL (range, 30–90), and 119.7 mg/dL (42-371). Mean height, weight, and BMI was 158 cm (range, 149–169), 61.7kg (range, 46.2−96.0), and 24.7 kg/m2 (range, 18.7−35.7), respectively. According to the WHO and NTH guidelines for Asian, normal (BMI 18.5−22.9), overweight (BMI 23–24.9), and obesity (BMI≥25) was 18 (28.6%), 13 (20.6%), and 32 (50.8%), respectively. Number of patients with metabolic syndrome was 18 (34%). Mean BMI (26.1 vs 24.0, p=0.021) and TG (180.6 vs 92.0, p&lt;0.001) was higher, HDL cholesterol was lower (42.2 vs 57.3, p&lt;0.001) in patients with metabolic syndrome. Composition of daily calorie intake consisted of 13.5% (range 10.7−21.8) of protein, 6.7% (range, 3.3−22.1) of fat, and 70.1% (range, 28.1−79.5) of carbohydrate. The presence of metabolic syndrome was associated with a higher carbohydrate intake (carbohydrate intake per ideal body weight&gt;6.0) (p=0.071). The TG level of patients who indigested high carbohydrate was significantly higher (143.8 vs 102.9, p=0.023). The HDL level of patients who took high fat diet (&gt;20% of total calorie) was lower (45.3 vs 53.5, p=0.045).

Conclusion: In our cohort of Korean breast cancer patients, 34% had metabolic syndrome at baseline. Those patients with metabolic syndrome consumed higher proportion of carbohydrate, which resulted in significantly higher level of TG. Our data suggest that composition of calorie intake is different in Asian population compared to Western countries, warranting for reappraisal on the recommendation on life style modification and diet.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-20.

Diagnostic analysis of patients with essential hypertension using association rule mining

Objectives

The purpose of this study was to analyze the records of patients diagnosed with essential hypertension using association rule mining (ARM).

Methods

Patients with essential hypertension (ICD code, I10) were extracted from a hospital's data warehouse and a data mart constructed for analysis. Apriori modeling of the ARM method and web node in the Clementine 12.0 program were used to analyze patient data.

Results

Patients diagnosed with essential hypertension totaled 5,022 and the diagnostic data extracted from those patients numbered 53,994. As a result of the web node, essential hypertension, non-insulin dependent diabetes mellitus (NIDDM), and cerebral infarction were shown to be associated. Based on the results of ARM, NIDDM (support, 35.15%; confidence, 100%) and cerebral infarction (support, 21.21%; confidence, 100%) were determined to be important diseases associated with essential hypertension.

Conclusions

Essential hypertension was strongly associated with NIDDM and cerebral infarction. This study demonstrated the practicality of ARM in co-morbidity studies using a large clinic database.

Intra-His bundle block in second-degree Mobitz I atrioventricular block with right bundle branch block

Because second-degree Mobitz I atrioventricular (AV) block is usually associated with a disturbance at the AV nodal level, and rarely at the infra- or intra-His bundle level, it has been considered as mostly benign in character. We report on a patient with intra-His bundle block in second-degree Mobitz I AV block with right bundle branch block.

Which oblique plane is more helpful in diagnosing an anterior cruciate ligament tear?

AIM

To evaluate the diagnostic role of additional oblique coronal and oblique sagittal magnetic resonance imaging (MRI) for an anterior cruciate ligament (ACL) tear.

MATERIALS AND METHODS

A total of 101 patients who had undergone preoperative knee MRI examinations with orthogonal and two sets of oblique images were enrolled in the study. Two radiologists evaluated the MRI images by the use of four methods: orthogonal images only (method A); orthogonal and additional oblique coronal images (method B); orthogonal and oblique sagittal images (method C); and orthogonal images with oblique coronal and sagittal images (method D). The status of the ACL (normal or tear) was determined by consensus. The sensitivity, specificity, and accuracy for an ACL tear with the use of each method were calculated in comparison with arthroscopy as the reference standard, and values were statistically analysed using the McNemar test. The diagnostic accuracies were compared using receiver operating characteristic (ROC) analysis.

RESULTS

Arthroscopy identified 10 partial ACL tears and 30 complete ACL tears. The specificities and accuracies for methods B, C, and D were significantly higher than the specificities and accuracies for method A (p<0.05). There was no significant difference in the sensitivity, specificity, and accuracy for methods B, C, and D. Diagnostic ability was not significantly different for each method, as determined by ROC analysis (p>0.05).

CONCLUSIONS

Additional oblique imaging for an ACL tear improved the specificity. Either of the oblique imaging methods is sufficient, and no further improvement in the diagnostic efficacy was achieved by simultaneous use.

Incessant monomorphic ventricular tachycardia associated with pneumococcal meningitis: a case report

A 22-year-old man with incessant ventricular tachycardia (VT) associated with pneumococcal meningitis without obvious heart disease manifesting as febrile sensation and severe headache visited our emergency department. Initial electrocardiography showed ventricular premature couplets, but the rhythm grew more serious and developed into incessant monomorphic VT resulting in an electrical storm. After examining the cerebrospinal fluid, bacterial meningitis was suspected. The electrical storm ended 21 hr after he had received conservative treatment for meningitis. Streptococcus pneumonia was cultured from the cerebrospinal fluid. No VT was observed during the remainder of the hospital stay and could not be induced in the electrophysiological study.

Promoter methylation of p16, DAPK, CDH1, and TIMP-3 genes in cervical cancer: correlation with clinicopathologic characteristics

This study was conducted to investigate the promoter methylation status of the p16, DAPK, CDH1, and TIMP-3 genes in primary cervical cancer and its correlation with clinicopathologic characteristics. Promoter methylation was evaluated using a methylation-specific polymerase chain reaction in 78 cervical cancer tissue specimens and 24 control, normal cervical tissue specimens. Clinicopathologic parameters were obtained from medical records, and the relationship between the discrete variables and the methylation status was evaluated. The frequencies of promoter methylation of p16, DAPK, CDH1, and TIMP-3 in cervical cancer were 57%, 44.9%, 52.6%, and 9%, respectively. Primary cervical cancer had significantly higher methylation frequencies for the p16 and DAPK promoters than did the control, normal cervix (P < 0.0001). The promoter methylation of TIMP-3 was significantly higher in adenocarcinoma than in squamous cell carcinoma (41.7% vs 3%, respectively, P= 0.0175). High-stage cancers exhibited an increased promoter methylation frequency for p16 (P= 0.0061). The promoter methylation of the p16 gene is a frequent event in cervical carcinogenesis and may have potential clinical application as a marker for the progression and prognosis of cancer.

A two-year longitudinal study of dental caries in permanent first molars of Korean elementary schoolchildren

OBJECTIVE

This longitudinal study investigated dental caries increment in permanent first molars of Korean elementary schoolchildren.

METHODS

A convenience sample of 722 children aged 7-9 years attending one urban elementary school was examined at baseline, with follow-up examinations at one and two years. Coronal surfaces of permanent first molars were scored with regard to caries experience and sealant status.

RESULTS

Among sound occlusal surfaces at baseline, 21 percent of upper and 25 percent of lower surfaces developed caries during the two-year interval. In teeth that erupted between baseline and the first follow-up exam, over 10 percent of occlusal surfaces developed caries. Pit and fissure caries accounted for 93 percent of all new carious surfaces, while sealants had been placed on 16 percent of occlusal surfaces during the study.

CONCLUSIONS

Recognizing the limitations of this convenience sample, dental sealants should be used more widely in this Korean population, and should be applied soon after tooth eruption.

Postprandial hypertriglyceridemia impairs endothelial function by enhanced oxidant stress

AIMS

it appears that hypertriglyceridemia (HTG) is a risk factor of atherosclerosis as demonstrated by recent studies. In this study, we analyzed the effects of acute HTG on endothelial function and oxidative stress, which are important mechanisms in the pathogenesis of atherosclerosis.

METHODS AND RESULTS

in a high fat meal group (n = 11), serum triglycerides and PMA-activated leukocyte O(2)(-)* production were significantly (P < 0.005) increased from 146 +/- 69 mg/dl and 4.09 +/- 0.93 nmol/10(6) cells/min preprandially to 198 +/- 88 mg/dl and 5.49 +/- 1.19 nmol/10(6) cells/min, respectively, 2 h after eating a high-fat meal. The flow-mediated endothelium-dependent brachial artery dilation (FMD; high-resolution ultrasound) was decreased from 13.7 +/- 3.3% preprandially to 8.2 +/- 3.7%, 2 h after eating a high-fat meal (P < 0.005). However, following a low-fat meal (n = 9), there were no significant changes in triglycerides, leukocyte O(2)(-)* production and FMD. Changes of serum triglycerides were correlated negatively (r = -0.650, P < 0.005) with changes of FMD, but were correlated positively (r = 0.798, P < 0.001) with changes of leukocyte O(2)(-)* production, which - in turn - were correlated negatively (r = -0.784, P < 0.001) with changes of FMD in all study subjects (mean age: 56 years, n = 20).

CONCLUSIONS

this study suggests that acute HTG causes endothelial dysfunction via enhanced oxidant stress and this may pave the way for the development of atherosclerosis under chronic conditions.

Estrogen modulation of prolactin gene expression requires an intact mitogen-activated protein kinase signal transduction pathway in cultured rat pituitary cells

Expression of the PRL gene is regulated by many factors, including cAMP, estradiol (E2), phorbol esters, epidermal growth factor (EGF), and TRH. The promoter region of the rat PRL gene has been shown to contain DNA sequences that are thought to support the direct interaction of estrogen receptors (ERs) with DNA. It is by this direct ER/DNA interaction that estrogen is thought to modulate expression of PRL. We report here that estrogeninduced PRL expression requires an intact mitogen-activated protein kinase (MAPK) signal transduction pathway in cultured rat pituitary cells (PR1 lactotroph and GH3 somatolactotroph cell lines). Interfering with the MAPK signaling cascade by inhibiting the activity of MAPK kinase (MEK) ablates the ability of estrogen to induce PRL mRNA and protein. In these cell lines, estrogen activates extracellular regulated protein kinases ERK-1 and ERK-2 enzyme activities maximally within 10 min of 1 nM E2 treatment. This activity is blocked by pretreatment of the cells with the MEK inhibitors PD98059 and UO126. The mechanism by which ERKs-1 and -2 are activated by estrogen appears to be independent of c-Src since the effects of estrogen on PRL gene expression are not affected by herbimycin A or PP1 administration. c-Raf-1 may be involved in the effects of E2 because estrogen causes the rapid and transient tyrosine phosphorylation of c-Raf-1. The ER antagonist ICI 182,780 blocks both ERK-1 and ERK-2 activation in addition to PRL protein and mRNA, implying a central role for the classical ER in the activation of the MAPK pathway resulting in PRL gene expression.

Pituitary apoplexy in a patient with acute myeloid leukemia and thrombocytopenia

We describe a 72-year-old woman with a history of acute myeloid leukemia who developed pituitary apoplexy associated with thrombocytopenia secondary to chemotherapy. She presented with new onset severe headache, nausea, vomiting and blurred vision. Initial physical examination was unremarkable. CT scan of the head was initially negative. Upon admission for further work up, She developed a high-grade fever, hypotension and obtundation. Subsequent physical examination revealed bitemporal visual fields defects and decreased visual acuity. Repeat imaging of head revealed a hemorrhagic pituitary mass compressing the optic chiasm. Laboratory results were compatible with the diagnosis of pan-hypopituitary syndrome. She received high dose steroids and was transferred for transnasal sphenoidotomy decompression surgery. The visual defects improved postoperatively. A literature review of Pituitary apoplexy is presented. Pituitary apoplexy secondary to thrombocytopenia has never been reported.

Epidermal growth factor-stimulated tyrosine phosphorylation of caveolin-1. Enhanced caveolin-1 tyrosine phosphorylation following aberrant epidermal growth factor receptor status

Caveolin-1 is the major coat protein of caveolae and has been reported to interact with various intracellular signaling molecules including the epidermal growth factor (EGF) receptor. To investigate the involvement of caveolin-1 in EGF receptor action, we used mouse B82L fibroblasts transfected with (a) wild type EGF receptor, (b) a C-terminally truncated EGF receptor at residue 1022, (c) a C-terminally truncated EGF receptor at residue 973, or (d) a kinase-inactive EGF receptor (K721M). Following EGF treatment, there was a distinct electrophoretic mobility shift of the caveolin-1 present in cells expressing the truncated forms of the EGF receptor, but this shift was not detectable in cells bearing either normal levels of the wild type EGF receptor or a kinase-inactive receptor. This mobility shift was also not observed following the addition of other cell stimuli, such as platelet-derived growth factor, insulin, basic fibroblast growth factor, or phorbol 12-myristate 13-acetate. Analysis of caveolin-1 immunoprecipitates from EGF-stimulated or nonstimulated cells demonstrated that the EGF-induced mobility shift of caveolin-1 was associated with its tyrosine phosphorylation in cells expressing truncated EGF receptors. Maximal caveolin-1 phosphorylation was achieved within 5 min after exposure to 10 nM EGF and remained elevated for at least 2 h. Additionally, several distinct phosphotyrosine-containing proteins (60, 45, 29, 24, and 20 kDa) were co-immunoprecipitated with caveolin-1 in an EGF-dependent manner. Furthermore, the Src family kinase inhibitor, PP1, does not affect autophosphorylation of the receptor, but it does inhibit the EGF-induced mobility shift and phosphorylation of caveolin-1. Conversely, the MEK inhibitors PD98059 and UO126 could attenuate EGF-induced mitogen-activated protein kinase activation, they do not affect the EGF-induced mobility shift of caveolin-1. Because truncation and overexpression of the EGF receptor have been linked to cell transformation, these results provide the first evidence that the tyrosine phosphorylation of caveolin-1 occurs via an EGF-sensitive signaling pathway that can be potentiated by an aberrant activity or expression of various forms of the EGF receptor.