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Background and Objectives: Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy. Subjects and Methods: A total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC). Results: During follow-up (561.7±251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS). Conclusion: During the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.
Background: The purpose of this study was to evaluate the current status and trends in the coverage of molecular drug susceptibility testing (mDST), and the impact of mDST on the time to multidrug-resistant tuberculosis (MDR-TB) treatment initiation in Korea. Methods: We included confirmed rifampin-resistant (RR)/MDR-TB patients who submitted application forms for novel drug uses to the National TB Expert Review Committee from September 1, 2016 to November 30, 2019. We retrospectively reviewed their medical records. Results: Of the 621 MDR/RR-TB patients, mDST was performed in 442 (71.2%); Xpert MTB/ RIF (Xpert) alone in 109 (17.6%), MTBDRplus line probe assay (LPA) alone in 199 (32.0%), and both Xpert and LPA in 134 (21.6%) patients. The coverage rate of mDST has gradually increased to 70% in 2015, 50.7% in 2016, 67.9% in 2017, 75.2% in 2018, and 79.4% in 2019 (P for trend < 0.001). Median time to MDR-TB treatment initiation was 35 days (interquartile range25–75 0–72), which has gradually decreased during the study period (P < 0.001). Independent predictors of shorter time to MDR-TB treatment initiation were retreatment case (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.10–1.54), Xpert testing (aHR, 2.42; 95% CI, 2.03–2.88), and LPA testing (aHR, 1.83; 95% CI, 1.55–2.16). Transfer to another healthcare facility was inversely related to shorter time to treatment initiation (aHR, 0.74; 95% CI, 0.63–0.88). Conclusion: mDST coverage is gradually increasing and contributes to reducing the time to MDR-TB treatment initiation. Further efforts are needed to achieve universal access to mDST and to properly integrate mDST into routine clinical practice.
Background and Objectives:This study was designed to formulate a method for the qualitative and quantitative measurements of aortic valve sclerosis (AVS) and to assess the relationship between this method and the degree of the carotid intima-media thickness (IMT) in neurologically asymptomatic patients. Subjects and Methods:One hundred and seventeen patients (Male 43%, 57.9±13.1 years of age) were retrospectively studied. Only the right- and non-coronary cusps were analyzed. AVS (cusp thickness of ≥2.0 mm) severities were classified into two groups according to the thickness and presence of the restricted motion of the cusp:mild AVS:AVS of <3.0 mm in one cusp, without restricted motion;severe AVS:AVS (+) in both cusps, AVS (+) and restricted motion in the same cusp, or a thickness ≥3.0 mm. The far wall IMT was measured at its thickest part in the distal 10.0 mm section of the common carotid artery. A protruding lesion with a far wall IMT ≥1.2 mm in the carotid bulb was defined as a plaque. Results:According to the severity of AVS, there was a significant difference in the prevalence of an IMT ≥0.8 mm (38.7 vs. 50.0 vs. 75.8%, p<0.005 for trend) and ≥1.0 mm (14.5 vs. 13.6 vs. 42.4%, p<0.005 for trend), and a plaque (19.4 vs. 36.4 vs. 54.5%, p<0.0005 for trend). The severity of AVS was independently correlated with an IMT ≥0.8 mm and IMT ≥1.0 mm, and with the presence of a plaque from a multiple logistic regression model. Conclusion:There was a significant association between AVS and the carotid IMT/plaque in relation to both in the presence and severity. 배경 및 목적: 대동맥판막경화증은 죽상경화증의 위험인자를 흔히 동반하면서, 심혈관계 합병증의 발생도 높은 것으로 알려져 있으나 대동맥판막경화증의 정의는 연구자들마다 차이가 있다. 이 연구의 목적은 경흉부 초음파에서 대동맥판막경화증의 유무 및 정도를 평가하는 방법을 만들고 이 방법이 객관성이 있는지 알아보기 신경학적으로 증상이 없는 환자를 대상으로 목동맥의 내막-중막 두께 및 죽상 경화반의 유무와 비교하였다. 방 법: 경흉부 초음파와 목동맥 초음파를 동시에 검사 받은 117명(남자 43%, 평균 나이 57.9±13.1세)을 대상으로 하였다. 대상자는 대동맥판막의 연속파형 도플러심장초음파 검사에서 최고 속도가 1.8 m/sec 이하이고, 좌심실 박출계수가 55%이상이면서, 뇌중풍의 과거력이 없는 환자들이었다. 대동맥 첨판의 가장 두꺼운 부분이 2.0 mm 이상인 경우를 대동맥판막경화증으로 정의하였다. 경증 대동맥판막경화증은 첨판의 두께가 3.0 mm 미만이면서 운동의 제한이 없는 경우로 정의하였고, 중증 대동맥판막경화증은 두개의 첨판 모두에서 첨판의 두께가 2.0 mm 이상이거나, 한 첨판에서 3.0 mm 이상이거나, 3.0 mm 미만이더라도 그 첨판 운동이 제한되어 있는 경우로 정의하였다. 목동맥 초음파를 이용하여 총목동맥 원위부 10 mm에서 가장 두꺼운 내막-중막 두께를 측정하였고, 목동맥 팽대부에서 죽상 경화반의 유무를 알아보았는데, 죽상경화반의 정의는 내막-중막 두께가 1.2 mm이상이고 혈관의 일부분에서만 두꺼워져 있는 경우로 하였다. 결 과: 내막-중막 두께가0.8 mm 이상 되는 경우의 유병율(38.7% vs 50.0% vs 75.8%, p<0.005), 1.0 mm 이상 되는 경우의 유병율(14.5% vs 13.6% vs 42.4%, p<0.005), 평균 내막-중막 두께(0.68±0.22 mm vs 0.72±0.30 mm vs 0.84±0.17 mm, p<0.005) 및 죽상경화반의 유병율(19.4% vs 36.4% vs 54.5%, p<0.0005) 모두 대동맥판막경화증의 정도가 심해질수록 유의하게 증가하는 양상을 보였다. 죽상경화증 위험인자를 함께 고려한 다변량 로지스틱 회귀분석에서는 대동맥판막경화증 위중도는 내막-중막 두께가 0.8 mm이상(Odds Ratio(OR)=1.899, 95% confidence interval (CI)=1.153~3.127, p<0.05) 및 1.0 mm 이상(OR=1.863, 95% CI=1.026~3.383, p<0.05) 두꺼워지는 것 뿐만 아니라 죽상경화반(OR=2.819, 95% CI=1.552~5.119, p<0.005)의 존재와도 유의한 관계가 있었다. 결 론: 신경학적으로 증상이 없는 환자에서 경흉부 초음파상의 중증 대동맥판막경화증의 위중도는 목동맥의 내막-중막 두께의 증가 및 죽상경화반의 존재와 관계가 있었다.
This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The allcause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.
Primitive neuroectodermal tumor (PNET) arising primarily in the lung is an extremely rare and aggressive malignancy with poor chances of patient survival. We present a case of long-term survival by a 29-year-old woman with PNET diagnosed after a hertological and immunohertochemical examination of a biopsy specimen obtained by performing video-assisted thoracic surgery. The patient underwent a left lower lung lobe lobectomy and 6 cycles of adjuvant chemotherapy. The patient has been free of any symptoms of the recurrence of the disease for 6 years after treatment completion.