Association Between Insulin Resistance and Bone Mass in Men

Context: The association between insulin resistance and bone mass is still not clear. Objective: The purpose of this study was to evaluate the association between insulin resistance and bone mass. Design and Setting: This was a cross-sectional survey of the nationally representative population. Participants: A total of 3113 men (aged >= 20 years) from the fourth Korean National Health and Nutrition Examination Survey of 2008-2009 were included. Main Outcome Measures: Bone mineral density (BMD) was measured using dual-energy x-ray absorptiometry. Osteopenia and osteoporosis were defined using the World Health Organization T score criteria. Fasting plasma insulin and glucose levels were measured, and insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. Results: Age-, height-, and weight-adjusted mean BMD values significantly decreased as quartiles of HOMA-IR and the fasting plasma insulin level increased (P for trends <.001). In multivariable logistic regression analyses, participants who had a higher HOMA-IR or fasting plasma insulin level had a higher odds ratio for osteoporosis/osteopenia. Interestingly, the association between fasting plasma insulin level and whole-body BMD differed by the degree of insulin resistance. In the lowest quartile of HOMA-IR, the fasting insulin level was positively associated with BMD. As insulin resistance increased, however, the fasting insulin level was inversely associated with BMD, and this relationship became more significant as the degree of insulin resistance increased. Conclusions: In a nationally representative sample of Korean men, insulin resistance and the fasting plasma insulin level were inversely associated with bone mass. Further studies are required to confirm this association and reveal the underlying mechanisms.OAIID:oai:osos.snu.ac.kr:snu2014-01/102/0000052039/4SEQ:4PERF_CD:SNU2014-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A079543DEPT_CD:806CITE_RATE:6.31FILENAME:association between insulin resistance and bone mass in men.pdfDEPT_NM:의과학과SCOPUS_YN:YCONFIRM:

Non-randomized comparison between revascularization and deferral for intermediate coronary stenosis with abnormal fractional flow reserve and preserved coronary flow reserve.

Limited data are available regarding comparative prognosis after percutaneous coronary intervention (PCI) versus deferral of revascularization in patients with intermediate stenosis with abnormal fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). From the International Collaboration of Comprehensive Physiologic Assessment Registry (NCT03690713), a total of 330 patients (338 vessels) who had coronary stenosis with FFR ≤ 0.80 but CFR > 2.0 were selected for the current analysis. Patient-level clinical outcome was assessed by major adverse cardiac events (MACE) at 5 years, a composite of all-cause death, target-vessel myocardial infarction (MI), or target-vessel revascularization. Among the study population, 231 patients (233 vessels) underwent PCI and 99 patients (105 vessels) were deferred. During 5 years of follow-up, cumulative incidence of MACE was 13.0% (31 patients) without significant difference between PCI and deferred groups (12.7% vs. 14.0%, adjusted HR 1.301, 95% CI 0.611-2.769, P = 0.495). Multiple sensitivity analyses by propensity score matching and inverse probability weighting also showed no significant difference in patient-level MACE and vessel-specific MI or revascularization. In this hypothesis-generating study, there was no significant difference in clinical outcomes between PCI and deferred groups among patients with intermediate stenosis with FFR ≤ 0.80 but CFR > 2.0. Further study is needed to confirm this finding.Clinical Trial Registration: International Collaboration of Comprehensive Physiologic Assessment Registry (NCT03690713; registration date: 10/01/2018).S

Delayed Development of Coronary Ostial Stenosis following Surgical Aortic Valve Replacement: A Case Report of Unusual Presentation

Coronary ostial stenosis is a rare but potentially life-threatening complication that occurs in 1%–5% of patients who undergo surgical aortic valve replacement (SAVR). Symptoms typically appear within the first 6 months and almost always within a year after SAVR. We report an unusually delayed presentation of non-ST segment elevation myocardial infarction due to coronary ostial stenosis 22 months after SAVR. A 71-year-old woman underwent uncomplicated SAVR with a bioprosthetic valve in August 2015 for severe aortic stenosis. A preoperative coronary angiogram demonstrated widely patent left and right coronary arteries. In June 2017, the patient presented to the hospital with chest pain. An electrocardiogram demonstrated 1 mm ST segment depression in the anterolateral leads, and serum troponin I level was elevated to 2.3 ng/ml. Diagnostic coronary angiography revealed severe ostial stenosis (99%) of the right coronary artery. A bare-metal stent was successfully placed with an excellent angiographic result, and the patient was asymptomatic at 4 months of follow-up after the procedure. As seen in our case, coronary ostial stenosis should be considered in the differential diagnosis of chest pain or arrhythmia in patients presenting with a history of SAVR, even if the procedure was performed more than 1 year prior to presentation

Delayed Development of Coronary Ostial Stenosis following Surgical Aortic Valve Replacement: A Case Report of Unusual Presentation

Coronary ostial stenosis is a rare but potentially life-threatening complication that occurs in 1%–5% of patients who undergo surgical aortic valve replacement (SAVR). Symptoms typically appear within the first 6 months and almost always within a year after SAVR. We report an unusually delayed presentation of non-ST segment elevation myocardial infarction due to coronary ostial stenosis 22 months after SAVR. A 71-year-old woman underwent uncomplicated SAVR with a bioprosthetic valve in August 2015 for severe aortic stenosis. A preoperative coronary angiogram demonstrated widely patent left and right coronary arteries. In June 2017, the patient presented to the hospital with chest pain. An electrocardiogram demonstrated 1 mm ST segment depression in the anterolateral leads, and serum troponin I level was elevated to 2.3 ng/ml. Diagnostic coronary angiography revealed severe ostial stenosis (99%) of the right coronary artery. A bare-metal stent was successfully placed with an excellent angiographic result, and the patient was asymptomatic at 4 months of follow-up after the procedure. As seen in our case, coronary ostial stenosis should be considered in the differential diagnosis of chest pain or arrhythmia in patients presenting with a history of SAVR, even if the procedure was performed more than 1 year prior to presentation

Delayed Development of Coronary Ostial Stenosis following Surgical Aortic Valve Replacement: A Case Report of Unusual Presentation

Coronary ostial stenosis is a rare but potentially life-threatening complication that occurs in 1%–5% of patients who undergo surgical aortic valve replacement (SAVR). Symptoms typically appear within the first 6 months and almost always within a year after SAVR. We report an unusually delayed presentation of non-ST segment elevation myocardial infarction due to coronary ostial stenosis 22 months after SAVR. A 71-year-old woman underwent uncomplicated SAVR with a bioprosthetic valve in August 2015 for severe aortic stenosis. A preoperative coronary angiogram demonstrated widely patent left and right coronary arteries. In June 2017, the patient presented to the hospital with chest pain. An electrocardiogram demonstrated 1 mm ST segment depression in the anterolateral leads, and serum troponin I level was elevated to 2.3 ng/ml. Diagnostic coronary angiography revealed severe ostial stenosis (99%) of the right coronary artery. A bare-metal stent was successfully placed with an excellent angiographic result, and the patient was asymptomatic at 4 months of follow-up after the procedure. As seen in our case, coronary ostial stenosis should be considered in the differential diagnosis of chest pain or arrhythmia in patients presenting with a history of SAVR, even if the procedure was performed more than 1 year prior to presentation

Use of selective serotonin reuptake inhibitors and risk of stroke: a systematic review and meta-analysis

Since several studies have inconsistently reported the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of stroke, we performed a meta-analysis on this issue. We identified studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to August, 2013. Pooled effect estimates were obtained by using random-effects meta-analysis. Thirteen relevant studies (three case-control, six nested case-control, and four cohort studies) were finally included in our study. In our meta-analyses, the use of SSRIs was associated with an increased risk of all types of stroke [adjusted odds ratio (aOR), 1.40; 95 % confidence interval (CI), 1.09-1.80], ischemic stroke (aOR 1.48; 95 % CI 1.08-2.02), and hemorrhagic stroke (aOR 1.32; 95 % CI 1.02-1.71). Between the two subtypes of hemorrhagic stroke, that is, intracerebral and subarachnoid, the increased risk of intracerebral hemorrhage was associated with the use of SSRIs (aOR 1.30; 95 % CI 1.02-1.67). When the analysis was restricted to the studies in which potential confounding by depression was considered, the risks were still higher in SSRI users than in non-users and the heterogeneities among studies were significantly decreased. Since there was heterogeneity among studies and a possible confounding effect from depression could not be fully excluded, further well-designed studies are needed to confirm this association.OAIID:oai:osos.snu.ac.kr:snu2014-01/102/0000052039/3SEQ:3PERF_CD:SNU2014-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A079543DEPT_CD:806CITE_RATE:3.841FILENAME:use of selective serotonin reuptake inhibitors and risk of stroke, a systematic review and meta-analysis..pdfDEPT_NM:의과학과SCOPUS_YN:YCONFIRM:

The Benefit of Bone Health by Drinking Coffee among Korean Postmenopausal Women: A Cross-Sectional Analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys

Purpose Although the concern about coffee-associated health problems is increasing, the effect of coffee on osteoporosis is still conflicting. This study aimed to determine the relationship between coffee consumption and bone health in Korean postmenopausal women. Methods: A population-based, cross-sectional study was performed using a nationally representative sample of the Korean general population. All 4,066 postmenopausal women (mean age 62.6 years) from the fourth and fifth Korean National Health and Nutrition Examination Survey (2008–2011), who completed the questionnaire about coffee consumption and had data of dual-energy X-ray absorptiometry (DXA) examination. Bone mineral density (BMD) was measured using DXA at the femoral neck and lumbar spine and osteoporosis was defined by World Health Organization T-score criteria in addition to self-report of current anti-osteoporotic medication use. Results: After adjusting for various demographic and lifestyle confounders (including hormonal factors), subjects in the highest quartile of coffee intake had 36% lower odds for osteoporosis compared to those in the lowest quartile (Adjusted odds ratio [aOR] = 0.64; 95% confidence interval [CI], 0.43–0.95; P for trend = 0.015). This trend was consistent in osteoporosis of lumbar spine and femoral neck (aOR = 0.65 and 0.55; P for trend = 0.026 and 0.003, respectively). In addition, age- and body mass index (BMI)-adjusted BMD of the femoral neck and lumbar spine increased with higher coffee intake (P for trend = 0.019 and 0.051, respectively). Conclusions: Coffee consumption may have protective benefits on bone health in Korean postmenopausal women in moderate amount. Further, prospective studies are required to confirm this association

Predictors of Recurrent Infective Endocarditis in Intravenous Drug Users

Background: Caring for hospitalized patients with infective endocarditis (IE) can be challenging due to the nature of the disease and its complications, underlying medical and psychiatric problems, socioeconomic status and environmental factors.Some of these patients develop recurrent IE after the first episode treated. On-going intravenous (IV) drug use after hospital discharge is the highest predictive factor for recurrent IE. Besides IV drug use, there are limited data of other contributing factors to recurrent IE. Those factors may be modifiable during the first hospitalization to reduce the incidence of recurrent IE. Methods: A retrospective cohort study was conducted at a large tertiary acute care medical center in Tampa, Florida. All consecutive patients with IE with history of IV drug use from January, 2011 to December, 2017 were included. Basic demographic information, co-morbidities (diabetes, hypertension, chronic lung and kidney diseases, HIV, Hepatitis B and C status, coronary artery diseases), valves involved, length of stay, complications at their first IE episode such as septic shock and stroke were included. Groups were identified based on the first episode, first recurrence and second or more recurrences of IE. Results: A total of 106 patients were identified based on the inclusion criteria. The association between the type of valve infection (right side and left side) and IE recurrence was found to be statistically significant. (P = 0.003). Right side valves are prone to have recurrent IE episodes. People with recurrent IE were more likely to have septic shock (P = 0.02) and requiring intensive care unit (ICU) admissions (P \u3c 0.001) during their first episode There was no statistically significant difference between other demographic information and recurrent endocarditis as well as other parameters such as organisms or type of substance used. (Table 1) Conclusion: Right-sided IE and presence of septic shock during their first episode of IE may be the predictors for recurrent IE. Interventions including closer follow-up, more aggressive septic shock recognition and management, socioeconomic assessment in addition to substance abuse treatments after discharge should be considered to prevent recurrent IE