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1.  OCT-1, ABCB1, and ABCG2 Expression in Imatinib-Resistant Chronic Myeloid Leukemia Treated with Dasatinib or Nilotinib 
Chonnam Medical Journal  2014;50(3):102-111.
This study explored drug transporter expression levels and their impact on clinical response to imatinib and second-generation tyrosine kinase inhibitors (TKIs) in imatinib- resistant chronic myeloid leukemia (CML). Imatinib-resistant chronic phase CML patients treated with dasatinib (n=10) and nilotinib (n=12) were enrolled. The mRNA expression of the OCT-1, ABCG2, and ABCB1 genes was quantified by using paired bone marrow samples obtained before administering imatinib and at the point of detecting imatinib resistance (just before starting second-generation TKIs). The expression levels of OCT-1 and ABCG2 were lower in follow-up than in imatinib-naïve samples. ABCB1 revealed highly variable expression levels before and after imatinib treatment. In addition, median ABCB1 expression in follow-up samples was lower in patients achieving complete cytogenetic response or major molecular response during imatinib treatment than in failed patients. Higher ABCG2 expression in imatinib-exposed samples showed a negative impact on optimal response to dasatinib. Patients with higher ABCG2 expression in imatinib-exposed samples also had shorter progression- free survival with dasatinib treatment. However, no significant correlation was found between these drug transporter expression levels in imatinib-naïve or imatinib- exposed samples and responses to nilotinib. In imatinib-resistant CML, OCT-1 and ABCG2 mRNA expression decreased after imatinib treatment. Patients with higher ABCG2 expression in imatinib-exposed samples showed poor treatment outcome with dasatinib. On the other hand, a higher expression level of ABCB1 in imatinib-exposed samples did not affect second-generation TKI responses but was correlated with poor imatinib responses.
doi:10.4068/cmj.2014.50.3.102
PMCID: PMC4276791  PMID: 25568846
ABCB1 protein; ABCG2 protein; Myeloid leukemia; Imatinib
2.  Thrombotic Occlusion during Intravascular Ultrasonography-Guided Percutaneous Coronary Intervention of Stumpless Chronic Total Occlusion 
Chonnam Medical Journal  2014;50(3):112-114.
Percutaneous coronary intervention (PCI) of stumpless chronic total occlusion (CTO) lesions with a side branch stemming from the occlusion have a significantly lower treatment success rate because physicians cannot identify an accurate entry point with only conventional angiographic images. An intravascular ultrasonography (IVUS)-guided wiring technique might be useful for the penetration of stumpless CTO. We recently experienced thrombotic occlusion during an IVUS-guided stumpless CTO procedure. The cause of the thrombosis is not completely understood; the thrombosis may have been associated with the long use of the IVUS catheter. Special precautions should be taken to prevent thrombus in such cases.
doi:10.4068/cmj.2014.50.3.112
PMCID: PMC4276792  PMID: 25568847
Thrombosis; Percutaneous coronary intervention; Ultrasonography, Interventional
3.  Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report 
Chonnam Medical Journal  2014;50(3):115-118.
The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization.
doi:10.4068/cmj.2014.50.3.115
PMCID: PMC4276793  PMID: 25568848
Lung diseases, interstitial; Pneumothorax; Arthritis, rheumatoid
4.  HDL-Associated Paraoxonase 1 as a Bridge between Postmenopausal Osteoporosis and Cardiovascular Disease 
Chonnam Medical Journal  2014;50(3):75-81.
The association of postmenopausal osteoporosis (PMOP) with both atherosclerosis and vascular/valvular calcification is well known. Recently, ample evidence has suggested a common etiologic factor, namely, reduced HDL-associated paraoxonase 1 (PON1) activity, as a causative factor in the development of PMOP and cardiovascular disease (CVD). This common etiologic factor not only contributes to atherosclerotic diseases but also to PMOP following an almost identical mechanism including dysfunctional HDL and lipid oxidation. According to recent studies, lipid oxidation might improve osteoblastic transformation of vascular cells and obstruct such transformation in bone cells. The primary objective of this current review was to summarize the evidence revealing the role of HDL-associated PON1 enzyme in PMOP. Additionally, the review aimed to address some of the subjects that need further investigation in order to define whether hyperhomocysteinemia and sensitivity to lipid oxidation may be risk factors for PMOP.
doi:10.4068/cmj.2014.50.3.75
PMCID: PMC4276794  PMID: 25568841
Osteoporosis; Menopause; Oxidative stress; Atherosclerosis; HDL
5.  Use of Umbilical Cord Serum in Ophthalmology 
Chonnam Medical Journal  2014;50(3):82-85.
Among blood preparations, serum has been topically used in the management of various ocular diseases in ophthalmology. Like peripheral blood serum, umbilical cord blood serum contains a high concentration of essential tear components, growth factors, neurotrophic factors, vitamin A, fibronectin, prealbumin, and oil. Umbilical cord serum can provide basic nutrients for epithelial renewal and can facilitate the proliferation, migration, and differentiation of the ocular surface epithelium. Eye drops made from umbilical cord serum have been applied to treat various ocular surface diseases, including severe dry eye with or without Sjögren's syndrome, ocular complications in graft-versus-host disease, persistent epithelial defects, neurotrophic keratopathy, recurrent corneal erosions, ocular chemical burn, and surface problems after corneal refractive surgery. Because mesenchymal stem cells from umbilical cord blood can be used to regenerate corneal tissue and retinal nerve cells, umbilical cord serum might be applied for tissue engineering and regenerative medicine in the future.
doi:10.4068/cmj.2014.50.3.82
PMCID: PMC4276795  PMID: 25568842
Ophthalmology; Umbilical cord; Serum; Dry eye
6.  Effect of Propofol on microRNA Expression Profile in Adipocyte-Derived Adult Stem Cells 
Chonnam Medical Journal  2014;50(3):86-90.
MicroRNA (miRNA) pathways have been implicated in stem cell regulation. This study investigated the molecular effects of propofol on adipocyte stem cells (ASCs) by analyzing RNA expression arrays. Human ASCs were isolated by use of a liposuction procedure. ASCs were treated with saline, 50 µM propofol, or 100 µM propofol in culture media for 3 hours. After the isolation of total RNA, the expression of 76 miRNAs was evaluated with peptide nucleic acid-miRNA array analysis through denaturation and hybridization processes. Treatment with 50 µM propofol resulted in significant down-regulation of expression of 18 miRNAs and upregulation of expression of 25 miRNAs; 100 µM propofol resulted in significant downregulation of expression of 14 miRNAs and upregulation of expression of 29 miRNAs. The lowest expression was seen for miR-204, which was 0.07-fold with 50 µM propofol and 0.18-fold with 100 µM propofol. The highest expression was seen for miR-208b, which was 11.23-fold with 50 µM propofol and 11.20-fold with 100 µM propofol. Expression patterns of miRNAs were not significantly different between 50 µM and 100 µM propofol treatment. The results of this study suggest that propofol is involved in altering the miRNA expression level in human ASCs. Additional research is necessary to establish the functional effect of miRNA alteration by propofol.
doi:10.4068/cmj.2014.50.3.86
PMCID: PMC4276796  PMID: 25568843
microRNA; Propofol; Stem cell
7.  Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure 
Chonnam Medical Journal  2014;50(3):91-95.
Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.
doi:10.4068/cmj.2014.50.3.91
PMCID: PMC4276797  PMID: 25568844
Mesh; Surgical tape; Urinary incontinence
8.  Risk Factors for Distant Metastasis as a Primary Site of Treatment Failure in Early-Stage Breast Cancer 
Chonnam Medical Journal  2014;50(3):96-101.
The aim of this study was to evaluate the risk factors for distant metastasis (DM) as a primary site of failure in early-stage breast cancer. Data from 294 patients diagnosed with pathologic stage I or II breast cancer between January 2000 and December 2005 were reviewed retrospectively. Median follow-up duration was 81.0 months (range, 18-135 months). The total number of patients with DM without evidence of locoregional recurrence was 20 and the median time between surgery and DM was 29 months (range, 9-79 months). Median survival time was 38 months (range, 22-77 months) after operation. HER-2 positivity (p=0.015), T stage of tumor (p=0.012), and number of involved lymph nodes (p=0.008) were significant predictors of DM in the univariable analysis. Number of involved lymph nodes [p=0.005, hazards ratio (HR): 1.741; 95% confidence interval (CI): 1.178-2.574] and HER-2 positivity (p=0.018, HR: 2.888; 95% CI: 1.201-6.941) had a statistically significant effect on DM-free survival in the multivariable analysis. A cautious evaluation may be helpful when patients with risk factors for DM have symptoms implying the possibility of DM. To reduce DM, applying intensive therapy is needed after curative surgery for patients with high risk for DM.
doi:10.4068/cmj.2014.50.3.96
PMCID: PMC4276798  PMID: 25568845
Breast neoplasm; Neoplasm metastasis; Risk factors
9.  Update on the Epidemiology, Treatment, and Outcomes of Carbapenem-resistant Acinetobacter infections 
Chonnam Medical Journal  2014;50(2):37-44.
Carbapenem-resistant Acinetobacter species are increasingly recognized as major nosocomial pathogens, especially in patients with critical illnesses or in intensive care. The ability of these organisms to accumulate diverse mechanisms of resistance limits the available therapeutic agents, makes the infection difficult to treat, and is associated with a greater risk of death. In this review, we provide an update on the epidemiology, resistance mechanisms, infection control measures, treatment, and outcomes of carbapenem-resistant Acinetobacter infections.
doi:10.4068/cmj.2014.50.2.37
PMCID: PMC4161759  PMID: 25229014
Acinetobacter baumannii; Colistin; Drug therapy
10.  Effects of Flavonoid Compounds on β-amyloid-peptide-induced Neuronal Death in Cultured Mouse Cortical Neurons 
Chonnam Medical Journal  2014;50(2):45-51.
Excessive accumulation of β-amyloid peptide (Aβ) is one of the major mechanisms responsible for neuronal death in Alzheimer's disease. Flavonoids, primarily antioxidants, are a group of polyphenolic compounds synthesized in plant cells. The present study aimed to identify flavonoid compounds that could inhibit Aβ-induced neuronal death by examining the effects of various flavonoids on the neurotoxicity of Aβ fragment 25-35 (Aβ25-35) in mouse cortical cultures. Aβ25-35 induced concentration- and exposure-time-dependent neuronal death. Neuronal death induced by 20 µM Aβ25-35 was significantly inhibited by treatment with either Trolox or ascorbic acid. Among 10 flavonoid compounds tested [apigenin, baicalein, catechin, epicatechin, epigallocatechin gallate (EGCG), kaempferol, luteolin, myricetin, quercetin, and rutin], all except apigenin showed strong 1,1-diphenyl-2-pycrylhydrazyl (DPPH) scavenging activity under cell-free conditions. The flavonoid compounds except apigenin at a concentration of 30 µM also significantly inhibited neuronal death induced by 20 µM Aβ25-35 at the end of 24 hours of exposure. Epicatechin, EGCG, luteolin, and myricetin showed more potent and persistent neuroprotective action than did the other compounds. These results demonstrated that oxidative stress was involved in Aβ-induced neuronal death, and antioxidative flavonoid compounds, especially epicatechin, EGCG, luteolin, and myricetin, could inhibit neuronal death. These findings suggest that these four compounds may be developed as neuroprotective agents against Alzheimer's disease.
doi:10.4068/cmj.2014.50.2.45
PMCID: PMC4161760  PMID: 25229015
β-Amyloid peptide; Alzheimer's disease; Flavonoids
11.  Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience 
Chonnam Medical Journal  2014;50(2):52-57.
We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48±5.69 cm2, the mean operative time was 78.93±38.72 minutes, and the mean hospital stay was 2.60±1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.
doi:10.4068/cmj.2014.50.2.52
PMCID: PMC4161761  PMID: 25229016
Kidney calculi; Supine position; Nephrostomy
12.  Levels of Salivary Antioxidant Vitamins and Lipid Peroxidation in Patients with Oral Lichen Planus and Healthy Individuals 
Chonnam Medical Journal  2014;50(2):58-62.
Oral lichen planus (OLP) is a chronic inflammatory mucosal disease of unknown etiology. Many studies have implicated the protective role of antioxidants in such diseases. The aim of this study was to compare salivary total antioxidant capacity (TAC and malondialdehyde (MDA) and antioxidant vitamin (vitamin s A, C and E) levels in patients with erosive OLP and healthy individuals. Thirty six patients with OLP (14 males, 22 females) and 36 control subjects (15 males, 21 females), matched for age and sex were enrolled in this case control study. The salivary levels of MDA, TAC, and antioxidant vitamin levels were measured in both case and control groups. The salivary level of MDA was significantly higher (p<0.001) in patients than in controls. In patients with OLP, the TAC of saliva was significantly lower than that in healthy subjects (p<0.001). Compared with controls, the levels of salivary antioxidant vitamins were significantly decreased in patients with OLP (p<0.001). In addition, a positive correlation was found between the decrease in the salivary amount of vitamin C and that in vitamin E in patients and controls. In addition to the lower salivary levels of antioxidant vitamins and the lower TAC, the higher level of MDA in patients with OLP suggests that free radicals and the resulting oxidative damage may be important in the pathogenesis of OLP lesions.
doi:10.4068/cmj.2014.50.2.58
PMCID: PMC4161762  PMID: 25229017
Oral Lichen Planus; Antioxidants; Oxidative Stress; Saliva
13.  Comparison of Growth Hormone Treatment in Patients with Idiopathic Short Stature and Idiopathic Growth Hormone Deficiency 
Chonnam Medical Journal  2014;50(2):63-66.
After recombinant human growth hormone (rhGH) was introduced in the treatment of patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS), many studies have addressed the effect of GH treatment and changes in the height standard deviation score (SDS) after GH treatment. However, few studies comparing the effect of GH in Korean patients with idiopathic GHD and ISS have been designed. Therefore, this study focused on the difference in effect of GH treatment between the two groups. We retrospectively reviewed the height SDS of 34 patients with idiopathic GHD and 12 patients with ISS. The mean ages of the patients with idiopathic GHD and ISS were 9.84±2.09 and 10.72±1.48 years, respectively. All patients were treated with GH for 1 year and body parameters were recorded before and after the GH treatment. Change in height SDS in patients with idiopathic GHD was significantly higher than that in patients with ISS (0.62±0.33 vs. 0.40±0.27, p=0.03). However, body mass index, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 were not significantly different between the two groups after GH treatment. These results suggest that GH treatment has a more powerful effect on increasing height SDS in patients with idiopathic GHD than in patients with ISS.
doi:10.4068/cmj.2014.50.2.63
PMCID: PMC4161763  PMID: 25229018
Growth hormone; Idiopathic short stature; Deficiency
14.  Polymicrobial Peritonitis with Lactococcus lactis in a Peritoneal Dialysis Patient 
Chonnam Medical Journal  2014;50(2):67-69.
Lactococcus lactis (L. lactis) is an important gram-positive bacterium in dairy products. It is a rare cause of opportunistic infections with only four cases of Lactococcus peritoneal dialysis (PD) peritonitis reported in the literature. In Korea, L. lactis infection was first reported in a liver abscess patient in 2010; however, PD peritonitis with Lactococcus has not been reported in Korea. Recently, we experienced a case of Lactococcus-associated polymicrobial PD peritonitis. The patient was initially managed with broad-coverage antibiotics; however, owing to a poor response, the PD catheter was removed and the patient was switched to hemodialysis. We discuss this case and review the literature.
doi:10.4068/cmj.2014.50.2.67
PMCID: PMC4161764  PMID: 25229019
Lactococcus lactis; Peritoneal Dialysis; Peritonitis
15.  Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent 
Chonnam Medical Journal  2014;50(2):70-73.
An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13×5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.
doi:10.4068/cmj.2014.50.2.70
PMCID: PMC4161765  PMID: 25229020
Aneurysm; Stents; Subclavian artery
16.  The Apical Junctional Complex in Respiratory Diseases 
Chonnam Medical Journal  2014;50(1):1-5.
The epithelium, including the respiratory system, acts as a selective gate between the outside environment and underlying tissue. Epithelial cells are polarized due to the formation of the apical junctional complex, which includes adherent junctions and tight junctions. Endothelial cells are one of the most important cellular constituents of blood vessels. Endothelial junctional proteins play important roles in tissue integrity as well as in vascular permeability, leukocyte extravasation, and angiogenesis. This review focuses on the apical junctional complex in respiratory diseases.
doi:10.4068/cmj.2014.50.1.1
PMCID: PMC4022791  PMID: 24855600
Epithelium; Permeability; Tight junctions
17.  Comparison of the Outcome in Bilateral Staged Total Hip Arthroplasty: Modified Two-Incision Minimally Invasive Technique versus the Conventional Posterolateral Approach 
Chonnam Medical Journal  2014;50(1):15-20.
This retrospective study was undertaken to compare the outcomes of staged bilateral total hip arthroplasty (THA) by the conventional approach with those of two-incision minimally invasive (MIS-2) THA in terms of clinical and radiological results, complications, and patient preferences. Twenty-two patients aged 30 to 80 years underwent staged bilateral THA. The conventional posterolateral approach was used on the first hips treated and a modified MIS-2 approach on the second hips. The mean time between the first and second procedures was 73.8 months, and the patients were followed up for at least 12 months after both procedures. At the last follow-up visits, THA via the MIS-2 approach was found to provide significantly earlier partial-weight-bearing ambulation, better postoperative Harris hip scores, and better ability to sit cross-legged and was found to be more preferred by patients than conventional THA. There were no significant differences in the complication rates for the two approaches. The present results show that MIS-2 THA is as safe as the conventional posterolateral approach in experienced hands and presents no additional complication risks.
doi:10.4068/cmj.2014.50.1.15
PMCID: PMC4022792  PMID: 24855602
Arthroplasty; Hip; Risk
18.  Medullary Sponge Kidney on Retrograde Pyelography 
Chonnam Medical Journal  2014;50(1):21-22.
A woman aged 31 had recurrent urinary tract infection with bloody urine. A series image of medullary sponge kidney presented by intravenous urography (IVU) was detected dynamically by retrograde pyelography (RP). Other than ultrasonography and IVU, RP is also a reliable method to detect medullary sponge kidney.
doi:10.4068/cmj.2014.50.1.21
PMCID: PMC4022793  PMID: 24855603
Medullary sponge kidney; Urography; Urinary tract infections
19.  Terrible Stent Thrombosis Induced by a Treadmill Test Performed Three Days after Percutaneous Coronary Intervention 
Chonnam Medical Journal  2014;50(1):23-26.
Generally, early exercise after coronary stenting is considered safe, but isolated cases of acute stent thrombosis have been associated with the performance of a treadmill exercise test after percutaneous coronary intervention (PCI). The treadmill exercise test is often used to noninvasively assess the functional result of PCI. In this report, we describe a case of terrible stent thrombosis related to an exercise test performed 3 days after stenting, and the patient died as the result of an intractable thrombus.
doi:10.4068/cmj.2014.50.1.23
PMCID: PMC4022794  PMID: 24855604
Exercise; Stents; Thrombosis; Percutaneous coronary intervention
20.  Diffuse Infiltrative Primary Cardiac Lymphoma with Delayed Extracardiac Involvement 
Chonnam Medical Journal  2014;50(1):27-30.
Primary cardiac lymphoma (PCL) is an extremely rare and fatal neoplasm of the heart. Traditionally, it is defined as lymphoma involving the heart or pericardium. PCL has a poor prognosis because of the diagnostic difficulty and its location. We present the case of a 48-year-old man who presented with pericardial effusion and diffuse cardiac wall thickening. We first suspected infiltrative heart disease. However, even after performing a biopsy, we could not establish an accurate diagnosis. After 20 months, primary cardiac diffuse large B cell lymphoma (DLBCL) was diagnosed by cervical lymph node biopsy. In this case, after chemotherapy, the DLBCL lesions, including cardiac wall thickening, improved. The treatment outcome suggests that the diagnosis was diffuse infiltrative PCL with delayed extracardiac involvement.
doi:10.4068/cmj.2014.50.1.27
PMCID: PMC4022795  PMID: 24855605
Heart; Lymphoma; Diagnosis
21.  Successful Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in a Patient with Severe Coronary Artery Disease Undergoing Off-Pump Coronary Artery Bypass Grafting 
Chonnam Medical Journal  2014;50(1):31-36.
It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.
doi:10.4068/cmj.2014.50.1.31
PMCID: PMC4022796  PMID: 24855606
Aortic aneurysm, Abdominal; Aneurysm; Coronary artery disease
22.  Gastroprotective Effects of Glutinous Rice Extract against Ethanol-, Indomethacin-, and Stress-induced Ulcers in Rats 
Chonnam Medical Journal  2014;50(1):6-14.
This study was designed to evaluate the efficacy of an orally administered aqueous extract of glutinous rice (GRE) to protect against acute gastric mucosal lesions induced by ethanol, indomethacin, and water immersion restraint stress in rats and to characterize the active substances responsible for the protection. GRE was shown to dose-dependently prevent the gastric lesions induced by the above ulcerogenic treatments at doses of 30 to 300 mg/kg. GRE treatment increased the gastric mucin content and partially blocked the ethanol-induced depletion of the gastric mucus layer. Also, it increased the nonprotein sulfhydryl concentration in the gastric mucosa. The gastroprotective action of GRE was markedly enhanced by co-treatment with 4-8 mg/kg tea extracts. The activity of GRE was completely lost by heat treatment at 80℃ for 3 min or treatment with 0.01% pepsin at 37℃ for 1 h. Protein extraction studies indicated that prolamins are involved in the gastroprotective activity of GRE. Our results suggest that glutinous rice proteins are useful for the prevention and treatment of gastritis and peptic ulcer.
doi:10.4068/cmj.2014.50.1.6
PMCID: PMC4022797  PMID: 24855601
Glutinous rice; Gastroprotection; Ulcer; Proteins; Prolamins
23.  Mitochondrial Dynamics in the Heart as a Novel Therapeutic Target for Cardioprotection 
Chonnam Medical Journal  2013;49(3):101-107.
Traditionally, mitochondria have been regarded solely as energy generators for cells; however, accumulating data have demonstrated that these complex organelles play a variety of roles within the cardiomyocyte that extend beyond this classic function. Mitochondrial dynamics involves mitochondrial movements and morphologic alterations by tethering, fusion, and fission, which depend on cellular energy requirements and metabolic status. Many studies have indicated that mitochondrial dynamics may be a fundamental component of the maintenance of normal cellular homeostasis and cardiac function. Mitochondrial dynamics is controlled by the protein machinery responsible for mitochondrial fusion and fission, but cardiomyocytes are densely packed as part of an intricate cytoarchitecture for efficient and imbalanced contraction; thus, mitochondrial dynamics in the adult heart are restricted and occur more slowly than in other organs. Cardiac mitochondrial dynamics is important for cardiac physiology in diseased conditions such as ischemia-reperfusion (IR) injury. Changes in mitochondrial morphology through modulation of the expression of proteins regulating mitochondrial dynamics demonstrates the beneficial effects on cardiac performance after IR injury. Thus, accurately defining the roles of mitochondrial dynamics in the adult heart can guide the identification and development of novel therapeutic targets for cardioprotection. Further studies should be performed to establish the exact mechanisms of mitochondrial dynamics.
doi:10.4068/cmj.2013.49.3.101
PMCID: PMC3881204  PMID: 24400211
Mitochondrial dynamics; Myocardial reperfusion injury; Myocytes, cardiac
24.  Increased Phosphorylation of PI3K/Akt/mTOR in the Obstructed Kidney of Rats with Unilateral Ureteral Obstruction 
Chonnam Medical Journal  2013;49(3):108-112.
The present study aimed to investigate changes in the mammalian target of rapamycin (mTOR) signaling pathway in the obstructed kidney of rats with unilateral ureteral obstruction (UUO). Male Sprague-Dawley rats were unilaterally obstructed by ligation of the left proximal ureter for 7 days. Control rats were treated in the same way except that no ligature was made. The expression levels of phosphorylated phosphatidylinositol 3-kinase (PI3K), Akt, and mTOR were determined in the kidney by semiquantitative immunoblotting. The protein expression levels of transforming growth factor (TGF)-β1, Bax, and Bcl-2 were also determined in the kidney. The phosphorylation of PI3K, Akt, and mTOR was increased in the kidney of ureteral obstruction rats compared with the control. In the obstructed kidney, the protein expression of TGF-β1 and Bax was also increased, whereas Bcl-2 expression was decreased. In conclusion, the phosphorylation of PI3K/Akt/mTOR was increased in the obstructed kidney of rats with UUO.
doi:10.4068/cmj.2013.49.3.108
PMCID: PMC3881205  PMID: 24400212
mTOR protein, rat; Ureteral Obstruction; Fibrosis; Apoptosis
25.  Factors Related to Catheter-Induced Hemorrhage after Brain Parenchymal Catheterization 
Chonnam Medical Journal  2013;49(3):113-117.
This article aimed to investigate the incidence rate and possible risk factors for catheter-induced hemorrhage (CIH) after brain parenchymal catheterization. Between January 2011 and March 2013, 381 patients (572 punctures) who underwent brain parenchymal catheterization were retrospectively evaluated. All patients were checked by computerized tomography scan for the detection of hemorrhage within 48 hours after catheter insertion. CIH was defined as any evidence of new hemorrhage on the post-procedural computerized tomography scan. The incidence rate and the possible risk factors were analyzed by surgeon (4 different surgeons performed the procedures), characteristics of the catheter device, and patient background. Of 381 patients, 572 punctures were performed and CIH developed in 122 puncture cases (122/572, 21.3%). The risk factors related to CIH were Glasgow Coma Scale (GCS) score ≤8 (p<0.01) and prothrombin time international normalized ratio (PT INR) ≥1.3 (p=0.038). The amount of hemorrhage was minimal without additional operations. A low GCS score and high PT INR are implicated as potential risk factors for CIH after brain parenchymal catheterization. Careful and delicate operative technique can help to reduce postoperative complications in these patients.
doi:10.4068/cmj.2013.49.3.113
PMCID: PMC3881206  PMID: 24400213
Drainage; Cerebral Hemorrhage; Brain; Catheterization

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