1
|
Real-world eligibility and cost-effectiveness analysis for empagliflozin in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Empagliflozin was approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) for reducing cardiovascular mortality and heart failure (HF) hospitalization in both patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Purpose
Limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and cost-effectiveness based on a nationwide prospective HF registry.
Methods
For the study, 3108 HFrEF and 2070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analysed. Eligibility was estimated by FDA and EMA label criteria and by inclusion and exclusion criteria of EMPEROR-Reduced and EMPEROR-Preserved trials. The cost-effectiveness analysis was performed using the decision tree model, where effectiveness was the avoidance of the first hospitalization.
Results
Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The main factor for exclusion in the clinical trial-based empagliflozin eligibility was low systolic blood pressure, including 18.7% of HFrEF and 11.0% of HFpEF patients. Other factors were acute (<4 weeks) myocardial infarction and impaired renal function (eGFR <20 mL/min/1.73 m2 or requiring dialysis). The overall expected hospitalization rate and cost reduction were 3.6 and US$ 14,885 per 100 eligible HF patients per year. In HFrEF patients, hospitalization rate and cost reduction were 4.8 and US$ 28,442. However, in HFpEF, the cost was increased by US$ 7,576, while hospitalization reduction was 1.7.
Conclusion(s)
There is a large discrepancy of real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. The cost-effectiveness benefit was more evident in patients with HFrEF than HFpEF. The efficacy and safety of empagliflozin in real-world patients should be further investigated for a broader range of clinical applications.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Minister of Science and Information and Communication Technologies (NRF-2021R1F1A1063430), by the Catholic Medical Center Research Foundation (2022), and by the Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E6300300, 2014-E63003-01, 2015-E63003-02, 2016-ER6303-00, and 2017-ER6303-01).
Collapse
|
2
|
Characterization of myocardial proteomics in biopsy proven cardiomyopathies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Difference in proteomic expression according to the etiology of cardiomyopathies is not well known.
Purpose
We aimed to identify proteome based pathogenesis in patients with biopsy proven cardiomyopathies.
Methods
Comparative proteomic analysis of biopsy specimens were performed from 9 patients with cardiomyopathy (3 dilated cardiomyopathy (DCM), 2 hypertrophic cardiomyopathy (HCM) and 4 myocarditis) as well as 5 controls (normal endomyocardial biopsy specimen from one-year surveillance of heart transplant recipients) by tandem mass tag combined with liquid chromatography-mass spectrometry. Differential expression protein analysis, gene ontology analysis and Ingenuity pathway analysis were done to discover molecular mechanism for the differentially expressed proteins in each cardiomyopathy compared to the control.
Results
Differential expression protein analysis showed higher proportion of significantly increased proteins (Log2 fold change ≥1) in HCM and myocarditis, whereas higher proportion of significantly decreased proteins (Log2 fold change ≤−1) in DCM compared to controls (Figure). According to the gene ontology analysis, upregulation of neutrophil degranulation, and down-regulation of mitochondrial translation protein was noted in patients with DCM. In patients with HCM, platelet degranulation protein was increased, and mitochondrial ATP synthesis coupled electron transport, was decreased. In patients with myocarditis, neutrophil related proteins and calcium ion binding protein was increased, but muscle cell development, protein was decreased. Ingenuity pathway analysis revealed downregulation of oxidative phosphorylation and upregulation of sirtuin signalling pathway both in DCM and HCM. In myocarditis, various pathways related to inflammation were upregulated with only RHO GDP dissociation inhibitors downregulated.
Conclusions
This study showed that each cardiomyopathy exhibited different proteomic expression compared to normal heart. Further large detailed study is needed to understand the association between proteomic expression and disease pathophysiology.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
3
|
The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019. J Korean Med Sci 2020; 35:e349. [PMID: 33045772 PMCID: PMC7550234 DOI: 10.3346/jkms.2020.35.e349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUNDS The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. METHODS This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. RESULTS A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). CONCLUSION The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.
Collapse
|
4
|
Cardiovascular Complications of Novel Anti-Cancer Immunotherapy: Old Problems from New Agents? Korean Circ J 2020; 50:743-753. [PMID: 32725983 PMCID: PMC7440999 DOI: 10.4070/kcj.2020.0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
Many novel anti-cancer therapies have dramatically improved outcomes of various cancer patients. However, it also poses a risk for cardiovascular complications as well. For the novel anti-cancer agent with which physicians does not have enough clinical experiences to determine the characteristics of cardiovascular complications, it is important to assess risk factors for cardiotoxicity before starting anti-cancer therapy. High-risk patient should be consulted to cardiologist before initiating anti-cancer therapy and pre-emptive cardiac function monitoring plan might be prepared in advance. The biomarkers, electrocardiography and echocardiography are useful tools for the detection of subclinical cardiotoxicity during anti-cancer therapy. This review article tried to suggest the cardiac function monitoring strategies for newly encountered potential cardiotoxic anti-cancer agents and to summarize the cardiovascular complications of novel anti-cancer immunotherapies including immune checkpoint inhibitor (ICI) and chimeric antigen receptor (CAR) T-cell therapy. ICIs can cause fatal myocarditis, which usually occurs early after initiation, and prompt treatment with high-dose corticosteroid is necessary. CAR T-cell therapy can cause cytokine release syndrome, which may result in circulatory collapse. Supportive treatment as well as tocilizumab, an anti-interleukin-6 receptor antibody are cornerstones of treatment.
Collapse
|
5
|
Increased Risk with Older Donor Age and More Frequent Pre-transplant ECMO: the Second Official KOTRY Report. Korean Circ J 2019; 49:738-741. [PMID: 31165597 PMCID: PMC6675697 DOI: 10.4070/kcj.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/11/2022] Open
|
6
|
KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure. Korean Circ J 2019; 49:22-45. [PMID: 30637994 PMCID: PMC6331324 DOI: 10.4070/kcj.2018.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/14/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
Collapse
|
7
|
The Past, Present and Future of Cardiac Resynchronization Therapy. Korean Circ J 2019; 49:384-399. [PMID: 31074211 PMCID: PMC6511527 DOI: 10.4070/kcj.2019.0114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 01/28/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has revolutionized the care of the patients with heart failure with reduced ejection fraction and electrical dyssynchrony. The current guidelines for patient selection include measurement of left ventricular systolic function, QRS duration and morphology, and functional classification. Despite consistent and increasing evidence supporting CRT use in appropriate patients, CRT has been underutilized. Notwithstanding the heterogeneous definitions of non-response, more than one-third of patients demonstrate a lack of echocardiographic reverse remodeling or poor clinical outcome following CRT. Since the causes of this non-response are multifactorial, it will require multidisciplinary efforts to overcome including optimal patient selection, procedural strategies, as well as optimizing post-implant care in patients undergoing CRT. The innovations of novel pacing approaches combined with advanced imaging technologies may eventually offer a personalized CRT system uniquely tailored to each patient's dyssynchrony signature.
Collapse
|
8
|
A New Era of Targeting Pathogenic Immune Mechanisms in Cardiovascular Disease. Korean Circ J 2018; 48:944-946. [PMID: 30238712 PMCID: PMC6158452 DOI: 10.4070/kcj.2018.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/04/2018] [Indexed: 01/08/2023] Open
|
9
|
The Past, Present and Future of Heart Transplantation. Korean Circ J 2018; 48:565-590. [PMID: 29968430 PMCID: PMC6031715 DOI: 10.4070/kcj.2018.0189] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 01/04/2023] Open
Abstract
Heart transplantation (HTx) has become standard treatment for selected patients with end-stage heart failure. Improvements in immunosuppressant, donor procurement, surgical techniques, and post-HTx care have resulted in a substantial decrease in acute allograft rejection, which had previously significantly limited survival of HTx recipients. However, limitations to long-term allograft survival exist, including rejection, infection, coronary allograft vasculopathy, and malignancy. Careful balance of immunosuppressive therapy and vigilant surveillance for complications can further improve long-term outcomes of HTx recipients.
Collapse
|
10
|
Understanding the Current Status of Korean Heart Transplantation Based on Initial KOTRY Report. Korean Circ J 2017; 47:858-860. [PMID: 29192425 PMCID: PMC5711676 DOI: 10.4070/kcj.2017.0330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023] Open
|
11
|
Prognostic Value of Body Fat Mass in Acutely Decompensated Heart Failure. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Comparison of association of glomerular filtration rate with metabolic syndrome in a community-based population using the CKD-EPI and MDRD study equations. Clin Chim Acta 2014; 429:157-62. [DOI: 10.1016/j.cca.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/07/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
|
13
|
Prognostic Value of New-Onset Anemia in Patients With Acute Decompensated Heart Failure and Severe Renal Dysfunction. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
14
|
Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: Data from the Korean Heart Failure (KorHF) Registry. Int J Cardiol 2012; 157:416-8. [DOI: 10.1016/j.ijcard.2012.03.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/17/2012] [Indexed: 11/28/2022]
|
15
|
Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta 2012; 413:992-7. [PMID: 22406179 DOI: 10.1016/j.cca.2012.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/02/2012] [Accepted: 02/21/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED). METHODS We retrospectively analyzed 907 patients with acute dyspnea who visited the ED from January 2009 to May 2009. Primary outcome was 30-day mortality. RESULTS Acute decompensated heart failure (29.9%) was the most common adjudicated discharge diagnosis followed by cancer (14.8%) and pneumonia (12.5%). There was a stepwise increase of 30-day mortality risk from lowest (RDW<12.9%) to highest (RDW>14.3%) RDW tertiles (1.4% vs. 8.3% vs. 18.3%; log-rank P<0.001). In multivariate Cox hazard analysis, RDW was an independent predictor of 30-day mortality after adjusting for other risk factors (HR 1.23; 95% CI 1.11-1.36; P<0.001). Adding RDW to conventional clinical predictors significantly improved prediction for 30-day mortality as measured by the area under the ROC curve (AUC, from 0.873 to 0.885; P=0.023) and the net reclassification improvement (NRI=14.1%; P<0.001)/integrated discrimination improvement (IDI=0.038; P=0.006). CONCLUSIONS Our findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea.
Collapse
|
16
|
The Severe Cognitive Impairment Rating Scale--an instrument for the assessment of cognition in moderate to severe dementia patients. Dement Geriatr Cogn Disord 2008; 25:321-8. [PMID: 18319591 DOI: 10.1159/000119124] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to develop a brief, reliable and valid test for cognitive function of severely demented patients. METHODS We constructed the Severe Cognitive Impairment Rating Scale, which consisted of 11 items covering memory, language, visuospatial function, frontal function and orientation, and investigated its reliability and validity on 267 subjects [normal: 65, very mild Alzheimer's disease (AD): 42, mild AD: 58, moderate AD: 36, severe AD: 44, profound AD: 22]. RESULTS The internal consistency obtained by Cronbach's coefficient alpha was 0.93. The interrater reliability and test-retest reliability in the moderately to severely impaired subjects with an MMSE score of <or=14 was 0.99 (p < 0.001) and 0.90 (p < 0.001), respectively. It showed significant correlation with Severe MMSE (r = 0.96, p < 0.01), MMSE (r = 0.86, p < 0.01) and Clinical Dementia Rating (r = -0.83, p < 0.01). It was robust to both the floor effect in the severe/profound stage of AD and the ceiling effect in the mild/moderate stage of AD. Exploratory factor analysis yielded 2 factors (automatic informational processing and controlled informational processing) accounting for 73.5% of the total variance. CONCLUSIONS The Severe Cognitive Impairment Rating Scale is a valid and reliable test for evaluating the cognitive function of advanced AD patients.
Collapse
|
17
|
Association of serum RANTES concentrations with established cardiovascular risk markers in middle-aged subjects. Int J Cardiol 2008; 132:102-8. [PMID: 18190991 DOI: 10.1016/j.ijcard.2007.10.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 10/06/2007] [Accepted: 10/27/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND RANTES (regulated upon activation, normal T cells expressed and secreted) is known to be related to an inflammatory part of the atherosclerotic process. We investigated the association of serum concentrations of RANTES with the risk of coronary artery disease (CAD) in a case-control study. METHODS One hundred fifty one CAD male patients aged 40 to 65 years and 151 age-matched healthy male controls were included and the main outcome measure was the odds ratio (OR) for CAD associated with increased levels of RANTES. RESULTS Serum levels of RANTES were higher in CAD patients when compared with controls (47.1+/-1.57 ng/mL vs 37.3+/-1.48; P<0.001). In addition, values in the second and top tertile of RANTES were associated with an increased OR for CAD when compared with values in the bottom tertile; OR for RANTES top tertile was 2.86 (95% CI, 1.53 to 5.34) in the age- and WHR-adjusted model and 3.23 (95% CI, 1.02 to 10.3) after the fully adjustment. Furthermore, there was a positive correlation of serum RANTES with acute phase proteins such as hs-CRP (r=0.310, P<0.001) and fibrinogen (r=0.333, P<0.001). RANTES concentrations also displayed a moderate correlation of WHR, triglyceride, HDL-cholesterol, interleukin-1 beta, interleukin-6, adiponectin, platelet and white blood cell counts. CONCLUSION In the present study, RANTES is associated with CAD risk in middle-aged subjects.
Collapse
|
18
|
Ectopic Cushing's syndrome due to concurrent corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) secreted by malignant gastrinoma. Exp Clin Endocrinol Diabetes 2007; 115:13-6. [PMID: 17286228 DOI: 10.1055/s-2007-948212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ectopic Cushing's syndrome due to various malignancies is not uncommon. However, a few cases of ectopic Cushing's syndrome caused by corticotropin-releasing hormone (CRH), or CRH with adrenocorticotropic hormone (ACTH) have been reported. A 28-year-old woman presented with acute upper gastrointestinal bleeding caused by an active ulcer, located atypically in the 2nd portion of duodenum. Further work-up revealed high gastrin levels and abdominal computed tomography (CT) scans showed a large pancreatic head mass with multiple liver metastases. The serum cortisol and ACTH levels were checked due to hypokalemia with metabolic alkalosis and recent amenorrhea. Cortisol and ACTH were both highly elevated with pituitary hyperplasia and elevated CRH. The existence of ectopic ACTH and CRH in the liver biopsy was also demonstrated immunohistochemically. Since an operation was not feasible, chemotherapy was conducted using paclitaxel and etoposide. These two drugs were chosen according to the IN VITRO chemotherapy response assay to maximize the treatment. This report demonstrates concurrent ACTH- and CRH-related ectopic Cushing's syndrome caused by malignant gastrinoma with multiple liver metastases that was treated with marginal success using a multidisciplinary medical approach.
Collapse
|
19
|
Depression in vascular dementia is quantitatively and qualitatively different from depression in Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 23:67-73. [PMID: 17114882 DOI: 10.1159/000097039] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To compare the prevalence and characteristics of depression in vascular dementia (VaD) and Alzheimer's disease (AD) after adjusting for dementia severity and gender. METHODS One hundred and eight pairs of VaD and AD patients matched for dementia severity and gender were assessed. RESULTS Major depressive disorder (MDD) was more prevalent in the VaD group than in the AD group (20.4% in VaD, 10.2% in AD, p = 0.04, Cochran-Mantel-Haenszel, CMH, test) regardless of the dementia severity and gender. The odds ratio for developing MDD in the VaD group versus the AD group was estimated to be 2.20 (95% confidence interval = 1.02-4.74). Neurovegetative symptoms such as 'felt tired and weak all the time' (30.6% in VaD, 13.9% in AD, p = 0.003, CMH test) and 'changed weight without trying' (16.7% in VaD, 6.5% in AD, p = 0.02, CMH test) were more prevalent in the VaD group than in the AD group. CONCLUSION Depression in VaD was quantitatively and qualitatively different from that in AD regardless of the severity of dementia and gender; depression was more prevalent, severer and more retarded and vegetative in VaD than in AD.
Collapse
|
20
|
Factors affecting long-term clinical outcomes of endoscopic mucosal resection of early gastric cancer. HEPATO-GASTROENTEROLOGY 2006; 53:643-7. [PMID: 16995480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND/AIMS Endoscopic mucosal resection (EMR) has been widely accepted as a treatment option for early gastric cancer (EGC) in selected cases. The purposes of this study were to evaluate the long-term outcomes and the factors affecting the clinical outcomes, of EMR performed in EGC. METHODOLOGY Between April 1996 and March 2005, 147 patients have undergone EMR to treat EGC at Yonsei University Medical Center, Seoul, Korea. We assessed the clinical outcomes of the EMR for EGC in a long-term follow-up period. We also reviewed the medical records of the patients including demographic data, endoscopic characteristics of the lesion and histopathologic findings. RESULTS The histopathologic evaluations after the EMR treatment showed that overall complete resection rate was 84.6% (126/149) while complete resec tion rate of 93.5% was achieved in mucosal cancers (115/123). The success of complete resection was significantly affected by endoscopic gross type (depressed lesion), the degree of differentiation, and the depth of invasion, independently. There were only 5 cases of local recurrence during the follow-up periods, and the recurred or incompletely resected lesions were successfully treated by salvage operation or endoscopic retreatment. There was no disease-related or treatment-related mortality during the follow-up period. CONCLUSIONS EMR is a good and safe curative treatment option with feasible clinical outcomes in patients with EGC. It must be emphasized that a proper selection of candidates is mandatory to improve the clinical outcome of EMR in EGC.
Collapse
|
21
|
Severe hypothyroidism induced by thyroid metastasis of colon adenocarcinoma: a case report and review of the literature. Endocr J 2006; 53:339-43. [PMID: 16714841 DOI: 10.1507/endocrj.k05-115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An 85-year-old man who had undergone a right hemicolectomy for colon cancer presented with severe hypothyroidism and hoarseness 21 months after the operation. The serum thyrotropin (TSH) was markedly elevated to 118.14 microIU/mL and serum free thyroxine (fT4) level was markedly suppressed to 0.34 ng/dL. Symptoms of hoarseness and neck swelling were already evident 4 months prior at which time tests for normal thyroid function were performed. The patient was referred due to aggravated pain on his diffusely enlarged hard goiter. An enlarged thyroid with some calcification was noticed in the neck ultrasonography with multiple cervical lymphadenopathies. Core biopsy of the thyroid gland showed invasion of poorly differentiated adenocarcinoma cells. Immunohistochemical studies showed positive staining only for carcinoembryonic antigen (CEA). There were multiple lung parenchymal nodules and adrenal masses at the time of evaluation. The patient was started on palliative chemotherapy with thyroid hormone replacement and gradually became euthyroid. From these findings and the clinical observations, thyroid metastasis with hypothyroidism developing acutely from metastatic colon adenocarcinoma was diagnosed.
Collapse
|
22
|
Diagnostic accuracy of mini-mental status examination and revised hasegawa dementia scale for Alzheimer's disease. Dement Geriatr Cogn Disord 2005; 19:324-30. [PMID: 15785033 DOI: 10.1159/000084558] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2004] [Indexed: 12/26/2022] Open
Abstract
To compare the diagnostic accuracies of the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental Status Examination (MMSE) for Alzheimer's diseases (AD), we administered them simultaneously to 82 AD patients and 82 age- and sex-matched nondemented control subjects. The area under the receiver operator curve (AUC) for AD of the HDS-R (AUC(HDS-R)) and MMSE (AUC(MMSE)) were bigger than 0.90 indicating that both tests are useful for detecting AD. However, AUC(HDS-R) (0.952) was significantly larger than that of the AUC(MMSE )(0.902) regardless of the educational level of the subjects, indicating that the HDS-R is more accurate than MMSE in diagnosing AD. Moreover, the superiority of the HDS-R (AUC(HDS-R) = 0.894) to the MMSE (AUC(MMSE) = 0.704) remained significant in mild AD patients alone, who are the focus of screening. In conclusion, the HDS-R is better than the MMSE as a screening instrument for AD.
Collapse
|
23
|
Abstract
OBJECTIVE The purpose of this study was the development of the Korean Version of Alzheimer's Disease Assessment Scale (ADAS-K). METHOD ADAS-K was administrated to 84 AD patients as well as 105 non-demented control subjects. Three aspects of reliability were tested. To evaluate the validity of ADAS-K, discriminant validity and concurrent validity were tested. To evaluate the sensitivity of ADAS-K to disease severity, all subjects, AD patients and control subjects, were grouped by CDR scale and their mean scores on ADAS-K were compared. RESULT ADAS-K demonstrated high levels of reliability. Mean ADAS-K scores for AD patients were significantly different from the control group (p < 0.01). Furthermore, ADAS-K exhibited significant correlations with other tests and scales (range 0.45-0.85, p < 0.01). In ROC curve analysis, ADAS-K displayed high diagnostic efficacy and the optimal cut-off point was selected between 18/19. ADAS-K was able to discriminate the degree of AD severity according to CDR classification. Our results suggested that ADAS-K-cog was sensitive to very mild AD. CONCLUSION We demonstrated that ADAS-K is a reliable and valid instrument not only for AD diagnosis but also for evaluation of its severity.
Collapse
|
24
|
Apolipoprotein E epsilon 4 allele is not associated with the cognitive impairment in community-dwelling normal elderly individuals. Int J Geriatr Psychiatry 2002; 17:635-40. [PMID: 12112161 DOI: 10.1002/gps.664] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to examine whether the APOE epsilon 4 allele also confers a risk for the cognitive impairment in normal aging. METHODS We administered all the eight neuropsychological tests from the CERAD neuropsychological battery to the CVD-free, community-dwelling normal elderly individuals, and compared their performance by the occurrence of the APOE epsilon 4 allele. RESULTS Either the impact of APOE epsilon 4 allele itself or its interaction terms with age and gender of the subjects did not influence the performance of the eight neuropsychological tests (epsilon p > 0.1 by ANCOVA). CONCLUSIONS The APOE epsilon 4 allele is not a risk factor for the cognitive decline in normal elderly individuals regardless of age and gender.
Collapse
|
25
|
The domain-specific, stage-limited impact of the apolipoprotein E epsilon-4 allele on cognitive functions in Alzheimer's disease. Dement Geriatr Cogn Disord 2002; 13:125-9. [PMID: 11893834 DOI: 10.1159/000048644] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To examine the impact of the APOE epsilon4 allele on the cognitive functions of Alzheimer's disease (AD) patients, we administered the eight neuropsychological tests from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery to 118 Korean AD patients. The impact of the APOE epsilon4 allele was significant in the Word List Recall Test (WLRT) and the Word List Recognition Test (WLRcT) only, and its impact was confined to the very mild AD (VMAD) patients (F = 7.65, d.f. = 2, p < 0.01 for WLRT; F = 3.27, d.f. = 2, p = 0.04 for WLRcT). In the VMAD group, the performance on the two tests of the APOE-epsilon4-positive patients was poorer than that of the APOE-epsilon4-negative patients. Our findings suggest that the impact of the APOE epsilon4 allele on cognitive functions in AD may be domain specific and confined to the early stage of AD.
Collapse
|
26
|
Neither the butyrylcholinesterase K variant nor transferrin C2 variant confers a risk for Alzheimer's disease in Koreans. J Neural Transm (Vienna) 2002; 108:1159-66. [PMID: 11725818 DOI: 10.1007/s007020170005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To investigate the possible involvement of the butyrylcholinesterase (BCHE) K variant and transferrin (TF) C2 variant in the manifestation of Alzheimer's disease (AD), we analyzed the BCHE, TF and apolipoprotein E (APOE) genotypes of 164 sporadic AD patients and 239 normal elderly controls. The frequencies of the BCHE K and TF C2 did not differ between the AD patients and controls (P > 0.1). The occurrence of the APOE epsilon4 did not influence the distribution of the BCHE K and TF C2 variants (P > 0.1). No linkage disequilibrium between the BCHE K and TF C2 was observed either in both the AD patients and controls (P > 0.1). In conclusion, neither the BCHE K nor the TF C2 confers a risk for AD.
Collapse
|
27
|
Association of alpha-2-macroglobulin deletion polymorphism with sporadic Alzheimer's disease in Koreans. J Neurol Sci 2001; 184:21-5. [PMID: 11231028 DOI: 10.1016/s0022-510x(00)00494-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alpha-2-macroglobulin (A2M) deletion polymorphism was recently reported to be associated with Alzheimer's disease (AD) in a way comparable to apolipoprotein E (APOE) polymorphism in a family-based study. However, the association of A2M deletion polymorphism with AD has not been consistently replicated in successive case-controlled studies. In order to evaluate whether this A2M polymorphism is associated with AD in Koreans, we examined the frequencies of the A2M deletion (D) allele and D-bearing genotypes in a group of Koreans composed of 100 sporadic AD patients and 203 control subjects. The frequency of the deletion (D) allele (P=0.046) was significantly different between the total group of AD patients and the controls, although the frequency of the D-bearing genotypes did not attain significance (P=0.078). When the subjects were stratified according to age at onset, there was significant difference in the frequencies of the D allele (P=0.044) and D-bearing genotypes (P=0.041) between late-onset AD patients (> or =65 years) and the controls. However, no significant difference was observed between early-onset AD patients (<65 years) and the control group. Additionally, when we divided the late-onset AD and control subjects by APOE epsilon4 status, the difference of the A2M D allelic frequency was significant only in the APOE epsilon4 negative subjects (P=0.015). In conclusion, our data suggests that the A2M D allele is a modest risk factor for late-onset sporadic AD in Koreans, and the AD risk conferred by the A2M D allele increases in APOE epsilon4 negative subjects.
Collapse
|