토끼 장골동맥의 과확장 손상시 고콜레스테롤 혈증이 비만세포의 침윤 및 p53 발현에 미치는 영향에 대한 연구

Thesis (doctoral)--서울대학교 대학원 :의학과 내과학전공,2000.Docto

Effect of Neprilysin Inhibition for Ischemic Mitral Regurgitation after Myocardial Injury

Angiotensin receptor neprilysin inhibitor (ARNI) treatment reduces functional mitral regurgitation (MR) to a greater extent than angiotensin receptor blocker (ARB) treatment alone, but the mechanism is unclear. We evaluated the mechanisms of how ARNI has an effect on functional MR. After inducing functional MR by left circumflex coronary artery occlusion, male Sprague Dawley rats (n = 31) were randomly assigned to receive the ARNI LCZ696, the ARB valsartan, or corn oil only (MR control). Excised mitral leaflets and left ventricle (LV) were analyzed, and valvular endothelial cells were evaluated focusing on molecular changes. LCZ696 significantly attenuated LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume, 461.3 +/- 13.8 mu L versus 525.1 +/- 23.6 mu L; p < 0.05), while valsartan did not (471.2 +/- 8.9 mu L; p > 0.05 to control). Histopathological analysis of mitral leaflets showed that LCZ696 strongly reduced fibrotic thickness compared to the control group (28.2 +/- 2.7 mu m vs. 48.8 +/- 7.5 mu m; p < 0.05). Transforming growth factor-beta and downstream phosphorylated extracellular-signal regulated kinase were also significantly lower in the LCZ696 group. Consequently, excessive endothelial-to-mesenchymal transition (EndoMT) was mitigated in the LCZ696 group compared to the control group and leaflet area was higher (11%) in the LCZ696 group than in the valsartan group. Finally, the MR extent was significantly lower in the LCZ696 group and functional improvement was observed. In conclusion, neprilysin inhibitor has positive effects on LV reverse remodeling and also attenuates fibrosis in MV leaflets and restores adaptive growth by directly modulating EndoMT

Impact of Early Surgery and Staging Classification on Survival in Asymptomatic Very Severe Aortic Stenosis

No abstract availabl

Heart. 2021 Dec;107(24):1980-1986.

Abstract Objective: The decision to perform percutaneous mitral commissurotomy (PMC) on asymptomatic patients requires careful weighing of the potential benefits against the risks of PMC, and we conducted a multicentre, randomised trial to compare long-term outcomes of early PMC and conventional treatment in asymptomatic, severe mitral stenosis (MS). Methods: We randomly assigned asymptomatic patients with severe MS (defined as mitral valve area between 1.0 and 1.5 cm2) to early PMC (84 patients) or to conventional treatment (83 patients). The primary endpoint was a composite of major cardiovascular events, including PMC-related complications, cardiovascular mortality, cerebral infarction and systemic thromboembolic events. The secondary endpoints were death from any cause and mitral valve (MV) replacement during follow-up. Results: In the early PMC group, there were no PMC-related complications. During the median follow-up of 6.4 years, the composite primary endpoint occurred in seven patients in the early PMC group (8.3%) and in nine patients in the conventional treatment group (10.8%) (HR 0.77; 95% CI 0.29 to 2.07; p=0.61). Death from any cause occurred in four patients in the early PMC group (4.8%) and three patients in the conventional treatment group (3.6%) (HR 1.30; 95% CI 0.29 to 5.77). Ten patients (11.9%) in the early PMC group and 17 patients (20.5%) in the conventional treatment group underwent MV replacement (HR 0.59; 95% CI 0.27 to 1.29). Conclusions: Compared with conventional treatment, early PMC did not significantly reduce the incidence of cardiovascular events among asymptomatic patients with severe MS during the median follow-up of 6 years

Successful Lobar Lung Transplant From a Marginal Deceased Donor With a History of Treated Pulmonary Tuberculosis: A Case Report

The shortage of available donor lungs is a continuing clinical problem. Lobar lung transplant and the extension of donor lung criteria may expand the pool of donor lungs. We here report a case of lobar lung transplant from a marginal deceased donor with bronchiectasis and fibrosis at the left upper lobe and a history of treated pulmonary tuberculosis. Our experience with this case suggests that a lobar lung transplant can be considered not only for size mismatches but also for use of locally damaged lungs. In addition, lungs from a donor who received treatment for pulmonary tuberculosis may be feasible for transplant with chemoprophylaxis for latent tuberculosis infection. Our current case indicates one possible option to overcome the persistent shortage of available donor lungs