To evaluate the influence of overcome semen viscosity (SV) on clinical outcomes according to two types of insemination method (i.e., conventional in vitro fertilization or intracytoplasmic sperm injection) in fresh embryo transfer cycles. Retrospective cohort study of 681 IVF/ICSI cycles from January 2013 to October 2017. Cycles were divided into 4 groups according to the presence of SV and the types of insemination method (IVF: SV, n = 51 vs. no SV, n = 77 and ICSI: SV, n = 255 vs. no SV, n = 298). Cycles with poor responder, advanced maternal age (≥38 years), frozen sperm, and surgically retrieved sperm were excluded. Semen parameters were evaluated according to the WHO 2010. SV (length of ≥2 cm) was checked by gentle aspiration of liquefied semen into a 5-mL serological pipette and then allowing the semen to drop by gravity and observing the length of any thread. To overcome semen viscosity, a sterile 5-mL syringe fitted with a sterile 18G needle was used. The semen was gently drawn into the syringe and expelled slowly back into the tube and repeated. Semen was treated by swim-up method. Patients' characteristics between SV and no SV in the IVF or the ICSI group were not statistically significant difference (p > 0.05). We observed similar rates of fertilization and good-quality embryos on day 3 between SV and no SV in IVF or the ICSI group, respectively. Moreover, the rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, and implantation per cycle also did not significantly differ between SV and no SV in the IVF or the ICSI group (p > 0.05).Tabled 1Table 1. Clinical outcomes in SV versus no SV according to insemination methodIVF-SVIVF-no SVp-valueICSI-SVICSI-no SVp-valueCycles (n)5177255298Oocytes fertilized rate (%)84.7 (533/629)83.1 (726/874)0.38673.7 (2238/3037)73.6 (2503/3401)0.931Good quality embryos rate (%)18.6 (99/533)21.8 (158/726)0.16514.3 (319/2238)15.8 (396/2503)0.132Biochemical pregnancy rate (%)60.8 (31/51)50.6 (39/77)0.25949.8 (127/255)48.3 (144/298)0.728Clinical pregnancy (%)51.0 (26/51)36.4 (28/77)0.10139.6 (101/255)37.2 (111/298)0.569Ongoing pregnancy (%)41.2 (21/51)33.8 (26/77)0.39532.9 (84/255)34.2 (102/298)0.749Abortion (%)19.2 (5/26)7.1 (2/28)0.24316.8 (17/101)8.1 (9/102)0.053Implantation (%)36.2 (38/105)25.5 (41/161)0.06123.7 (129/544)21.3 (132/621)0.316 Open table in a new tab When SV was overcome, it did not affect the clinical outcomes of fresh embryo transfer cycles regardless of insemination methods.

To identify the most viable embryo is the main goal for embryo selection. However, it still remains a challenge despite the numerous scoring methods currently in use. This study was performed to determine whether the sequential embryo assessment on day 2 and day 3 could be a simple and non-invasive method for embryo selection. A retrospective cohort study was conducted between June 2012 and May 2015. A total of 416 cycles (younger than 36 years) which underwent GnRH agonist or antagonist protocol with fresh embryo transfer were analyzed. Cycles with oocyte/sperm donation, surrogacy, preimplantation genetic screening, severe male factor, surgically retrieved sperm, or frozen sperm were excluded. The sequential embryo assessment (SEA, n=202) was performed on day 2 and day 3, four-cell stage embryos were selected and cultured separately from non-4-cell stage at 40-42 hours after insemination and then 8-cell stage embryos with good morphology derived from pre-selected 4-cell stage were sequentially selected at 64-66 hours after insemination. The morphological assessment only (MAO, n=214) was performed on day 3, eight-cell stage embryos with good morphology were selected at 64-66 hours after insemination without pre-selection. There were no differences between SEA and MAO regarding female age (32.7 ± 2.3 vs. 32.4 ± 2.3, p=0.128), number of previous IVF failure (0.5 ± 0.8 vs. 0.6 ± 1.0, p=0.060), number of retrieved oocytes (13.1 ± 5.8 vs. 12.4 ± 6.1, p=0.259), maturation rate (93.2% vs. 93.6%, p=0.332), fertilization rate (76.8% vs. 80.1%, p=0.952), 4-cell stage embryo formation rate (42.2% vs. 40.9%, p=0.559), and number of transferred embryos (2.0 ± 0.2 vs. 1.9 ± 0.2, p=0.765). However, SEA achieved significantly higher rates of biochemical pregnancy (71.3% vs. 55.1%, p=0.001), clinical pregnancy (60.9% vs. 46.3%, p=0.003), ongoing pregnancy (54.5% vs. 41.6%, p=0.009), and implantation (43.4% vs. 32.0%, p=0.001) than those of MAO. Although the rate of 4-cell stage embryo formation was similar in the two groups, transfer of sequentially assessed embryos results in significantly higher rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and implantation. Therefore the sequential embryo assessment on day 2 and day 3 could be a simple and non-invasive method for embryo selection in human IVF.

Congenital anomalies of the coronary artery are associated with various symptoms including syncope, myocardial ischemia, and sudden cardiac death. The abnormality depends on the adjacent structure and pathway of the coronary artery. Most patients with an anomalous left coronary artery that arises from a right coronary sinus of the valsalva have no symptoms and are usually diagnosed at autopsy. Therefore, their first symptom might present as sudden death, particularly when the left coronary arterial course is between the aorta and the pulmonary trunk. Symptomatic patients could be diagnosed early with an anomalous coronary artery, and the risk of fatal events could be decreased by surgical correction. Here, we report the case of 62-year-old male who experienced a first episode of syncope with an anomalous left coronary artery arising from the right sinus of the valsalva with a separate orifice from the right coronary artery. He is alive and in good health receiving medical treatment, and has had no medical events for over 2 years. (Korean J Med 2014;87:722-727)

Amiodarone is an antiarrhythmic drug known to have adverse effects on multiple organs. Most studies have reported the side effects of the drug, which may result from rapid administrations or from long-term, high dosage administrations. However, toxicity issues have also been reported from patients administered with low doses of the drug for a long period of time. Here we report a case of an 82-year-old female who had shown symptoms and signs of pulmonary, hepatic, and neurotoxicity after taking amiodarone for 14 months in order to treat her atrial fibrillation without regular outpatient follow-up. We highlight the importance of the recommended evaluations, including lung, liver, and thyroid functions, as well as the neurological examinations in patients treated with amiodarone for a long period of time during regular follow-up.

Because the mechanisms of the biological effects of statin and angiotensin converting enzyme inhibitor therapies differ, we studied the vascular responses to these therapies in hypercholesterolemic patients with coronary artery disease. We administered simvastatin 20mg and placebo or ramipril 10mg daily during 2 months with washout 2 months to 32 hypercholesterolemic patients with coronary artery disease. This study was randomized, double-blind, placebo-controlled, crossover in design. Simvastatin alone or combined with ramipril significantly changed lipoproteins, and improved the percent flow-mediated dilator response to hyperemia relative to baseline measurements by 33 ± 6% and by 50 ± 14%, respectively (both P < 0.001) and reduced plasma levels of nitrate relative to baseline measurements (P = 0.413 and 0.037, respectively), the plasma MDA levels relative to baseline measurements by 8 ± 8% and by 18 ± 9% (P = 0.039 and P < 0.001, respectively) and MCP-1 relative to baseline measurements by 7 ± 4% and by 13 ± 3%, respectively (P = 0.019 and P < 0.001, respectively), and CRP from 0.22 to 0.14mg/dl and from 0.22 to 0.15mg/dl, respectively (P = 0.124 and 0.002, respectively), and PAI-1 antigen relative to baseline measurements (P = 0.690 and 0.018, respectively). However, simvastatin combined with ramipril changed to greater but statistically insignificant extent the percent flow-mediated dilator response to hyperemia and plasma levels of nitrate, MDA, MCP-1, and PAI-1 antigen than simvastatin alone. Simvastatin alone or combined with ramipril showed significant beneficial effects on endothelial function in hypercholesterolemic patients with coronary artery disease. However, simvastatin combined with ramipril did not significantly change, compared with simvastatin alone.

We administered placebo, losartan 100 mg/day, irbesartan 300 mg/day, and candesartan 16 mg/day during 2 months to 122 patients with mild to moderate hypertension. Compared with placebo, angiotensin II type-1 receptor blockers significantly improved the percent flow-mediated dilator response to hyperemia (p = 0.019 by analysis of variance [ANOVA]) and reduced plasma levels of malondialdehyde (p = 0.005 by ANOVA). However, only irbesartan and candesartan therapies significantly lowered plasma levels of plasminogen activator inhibitor type-1 antigen (p <0.001 by ANOVA) with no differences between the 2, and only candesartan therapy significantly lowered plasma levels of monocyte chemoattractant protein-1 (p = 0.004 by ANOVA).

We investigated the effects of statin on lipoproteins, vasomotor function, serologic markers of infl ammation, plaque stability, thrombogenicity, and the mechanism of regulation compared with the Step I Diet.  Sixty-three patients with angiographically documented coronary artery disease were enrolled in this study. All patients were in Canadian Cardiovascular Society class I or II. All patients were taught and placed on the American Heart Association Step I Diet throughout the study period. Data on baseline characteristics of study participants and brachial artery endothelium-dependent reactivity, as well as lipoprotein levels, markers of infl ammation, and plaque stability in blood have been reported previously and are listed in Tables 1 and 2. 1 The 2 groups were age- and gender-matched. Mean age of patients was 62 years, and 13 of 32 patients were men. The risk factors were hypertension (68% vs 72%; diet and placebo group vs diet and simvastatin group, respectively), diabetes (23% vs 25%), and current smoking (35% vs 31%). The proportion of medications were -adrenergic blockers (81% vs 81%), calcium channel blockers (48% vs 47%), angiotensin-converting enzyme inhibitors (23% vs 28%), long-acting nitrates (81% vs 84%), and aspirin (84% vs 88%). We administered diet placebo (n 31) and diet simvastatin 20 mg/day (n 32) in a randomized order for 14 weeks in patients with coronary artery disease using a singleblind prospective randomized design. The study was approved by the Gil Hospital Institutional Review Board, and all participants gave written informed consent. Blood samples for laboratory assays were obtained at approximately 8:00 A.M. following an overnight fast after pretreatment and simvastatin for 14 weeks. The samples were immediately coded so that investigators performing laboratory assays were blinded to subject identity or study sequence. Assays for lipoproteins and plasminogen activator inhibitor type-1 (PAI-1) antigens were performed as previously described. 2 Tumor necrosis factor (TNF)-, matrix metalloproteinase (MMP)-9, tissue inhibitor of matrix metalloproteinase (TIMP)-1, C-reactive protein (CRP), fi brinogen, and antithrombin III were measured in duplicates by an enzyme-linked immunosorbent assay (R & D Systems, Minneapolis, Minnesota) and rate nephelometry (IMMAGE; Beckman Coulter, Brea, California) as previously described. 3–5 Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) activity were measured in duplicate by actichrome assays (American Diagnostica, Greenwich, Connecticut) as previously described.5,6 All samples from the same patient (batch samples) were measured in blinded pairs on the same enzyme-linked immunosorbent assay kit to minimize run-to-run variability. The interassay and intraassay coeffi cients of variation were 6%. Data are expressed as mean SD or median (range 25% to 75%). After testing data for normality, we used Student’s paired t or Wilcoxon’s signed rank test to compare values between baseline and treatment

Objective: Plaque stability and thrombogenicity contribute to development and clinical expression of atherosclerosis. Experimental studies have shown that lipoproteins or mevalonate regulate matrix metalloproteinase (MMP)-9, tissue factor (TF), plasminogen activator inhibitor-1 (PAI-1) expression, providing nonlipid mechanism. Methods: We administered simvastatin 20 mg daily during 14 weeks to 32 hypercholesterolemic patients with coronary artery disease. Results: Compared with pretreatment values, simvastatin significantly lowered lipoprotein levels (all P<0.01). Compared with pretreatment values, simvastatin significantly lowered plasma levels of MMP-9, TF, and PAI-1 (P=0.009, P=0.032, and P=0.007, respectively). There were significant inverse correlations between pretreatment MMP-9, TF activity or PAI-1 antigen and the degree of change in those levels after simvastatin (r=−0.793, P<0.001; r=−0.482, P=0.005 and r=−0.590, P<0.001, respectively). Of interest, there were significant correlation between pretreatment or percent changes in MMP-9 levels and pretreatment or percent changes in PAI-1 antigen (r=0.293, P=0.019 and r=0.375, P=0.034, respectively). However, no significant correlations between lipoprotein levels and levels of plaque stability or thrombogenicity markers were determined. Conclusions: Reduction of plaque stability and thrombogenicity markers with statin may contribute to the cardiovascular event reduction and explain the early clinical benefit in clinical trials, independent of lipoprotein changes.

W e have previously observed that hormone replacement therapy (HRT) significantly increased tissue factor (TF) activity in healthy women(1) and tended to increase prothrombin fragment 1+2 levels in 20 hypertensive and/or overweight postmenopausal women.(2) However, we did not measure other indexes of coagulation activation or inhibition, nor did we measure C-reactive protein (CRP), which in experimental preparations stimulates the synthesis and release of the coagulation activator TF.(3) TF pathway inhibitor (TFPI) may interact with TF to maintain homeostasis.(4,5) Thus, this study examines (1) whether HRT increases TF activity, which may facilitate thrombin formation in hypertensive and/or overweight postmenopausal women, and (2) whether HRT-induced TF activity is associated with changes in CRP or TFPI that might provide mechanistic insight.

Background and Objectives:Platelet-derived growth factor (PDGF) seems to be one of the most powerful factors associated with the proliferative process that occurs after percutaneous transluminal coronary angioplasty (PTCA), and leads to restenosis. Trapidil (Triazolopyrimidine), a potent inhibitor of PDGF, was shown to decrease restenosis after experimental balloon angioplasty. The aim of this study was to assess the effects of trapidil, on intimal hyperplasia, following coronary artery stenting, using volumetric intravascular ultrasound (IVUS) analysis. Subjects and Methods:The patients were divided in 2 groups;Group I (n=14, age=53±8, male=11) received trapidil (600 mg) for 6 months, aspirin (200 mg) indefinitely and ticlopidine (250 mg) for 4 weeks, Group 2 (n=15, age=55±2, male=9) received aspirin (200mg) indefinitely and ticlopidine (500 mg) for 4 weeks, starting at least 3 days before the angioplasty. A serial IVUS study was performed post-stenting, with a 6 month follow up period. Both the stent (SA) and lumen areas (LA) were measured, and the stent (SV), lumen (LV) and intimal hyperplasia volumes (IHV) were calculated using Simpson’s rule. Results:The reference (RD), pre minimal luminal (MLD) and post minimal luminal diameters, as measured by quantitative coronary angiographic analysis (QCA), were not different between the two groups. Using serial IVUS measurements, SV and LV were not different between the two groups. Also, the IHV was not different between the two groups (51.9 ±26.1 and 61.3±25.3 mm, respectively, p=NS). Conclusion:Trapidil failed to reduce intimal hyperplasia following coronary stenting compared with the controls. (Korean Circulation J 2003;33 (8):680-686)

Background and Objectives:A cutting balloon (CB) is a balloon catheter with 3 or 4 metal blades on its surface used for making controlled endovascular surgical incisions and promising minimal intimal injury. Some reports suggest advantages of the use of CB in the treatment of in-stent restenosis (ISR). The purpose of this study was to report the clinical experience of the use of CB for ISR. Subjects and Methods:28 patients were enrolled in this study. Angiographic success (defined by 40% residual stenosis), in-hospital, 30 days and 6 months clinical outcomes were evaluated. Results:Angiographic success was 92.9% (26/28). The number of inflations and maximal inflation pressure were 2.8±0.9 and 10.1±1.3 ATM, respectively. The balloon/ artery (B/A) ratio was 1.1±0.2. There was a case of stent insertion for treating type D dissection and a case of rotational atherectomy for suboptimal result after CB angioplasty. 25 cases underwent analysis through 6 months of clinical follow-up. During the 6-month clinical follow-up, 4 cases of re-PTCA were documented, while MACE during in-hospital time and the subsequent 30 days was 0%. Conclusion:Our experience demonstrated that CB can be performed safely and effectively in coronary ISR. Further clinical and angiographic effectiveness are warranted in a large-scale clinical trial. (Korean Circulation J 2002;32(4):317-321)

Background:Elevation in plasma homocysteine has been widely studied as an independent risk factor for atherosclerosis. Additionally, epidemiologic studies have demonstrated that persons who take the folate and vitamin B6 have a lower incidence of atherosclerotic vascular disease and lower plasma homocysteine llevels. However, the effects of vitamin B6 and folate on the level of plasma homocysteine and brachial artery dilation on healthy subjects have not yet been evaluated. Methods:We evaluated the effects of 50 mg of vitamin B6 and 1 mg of folate on endothelial, function and plasma homocysteine levels in two healthy postmenoausal women and twenty-one men enrolled in a randomized, double-blind, placebo-controlled, crossover design study. Results:Despite a significant lowering of plasma homocysteine level (placebo:folate=6.56±1.55 mol/L vs. 5.37±1.04 mol/L, p=0.001), the supplement of vitamin B6 and folate had no statistically significant incremental effect on flow-mediated dilation (FMD) of healthy subjects as compared to the placebo (placebo: folate=5.12±3.26% vs. 6.69±2.60%, p=0.070). Conclusion:Despite the lowering of the plasma homocysteine level, vitamin B6 and folate had no significant effect in regards to improving the flow-mediated (eg, nitric oxide dependent) vasodilation of healthy persons. (Korean Circulation J 2001;31(3):305-310)

Observational studies of the long-term effects of hormone replacement therapy (HRT) have generally demonstrated favorable cardiovascular effects.(1) The beneficial effects of HRT may involve nonlipid mechanisms that affect endothelial function: Plaque stability, inflammatory responses, and fibrinolysis. Hypertension and obesity are associated with "insulin resistance syndrome" and a prothrombic state.(2,3) Accordingly, HRT may not have comparable benefit in hypertensive or overweight postmenopausal women.

BACKGROUND:Results of clinical trials of statin therapy demonstrate that an improvement in incidence of cardiovascular end points and coronary stenosis can be achieved. The beneficial effects of statins on clinical events may involve nonlipid mechanisms that affect endothelial function, such as inflammatory responses, formation of thrombi, and stabilization of plaque. OBJECTIVE:To investigate levels of serologic markers, which may be useful surrogates for activity of vascular disease after administration of statin. METHODS:We administered 20-40 mg simvastatin daily for 14 weeks to 13 patients established to have coronary artery disease who remained hypercholesterolemic during step-II diet therapy. RESULTS:Administration of simvastatin significantly lowered lipoprotein levels and the low: high-density lipoprotein cholesterol level ratio and apolipoprotein B:A-I level ratio compared with pretreatment values (P < 0.01). Administration of simvastatin significantly lowered plasma levels of matrix metalloproteinase-9 (MMP-9) and monocyte chemoattractant protein-I [33+/-46 and 13+/-19%, respectively (P = 0.027 and 0.020, respectively)]. Furthermore, administration of simvastatin tended to lower plasma levels of plasminogen activator inhibitor type-1 and tumor necrosis factor-alpha [by 20+/-44 and 13+/-29%, respectively (P= 0.066 and 0.110, respectively)]. There were significant inverse correlations between pretreatment levels of MMP-9 and the degree of change in those levels after administration of simvastatin (r = -0.714, P= 0.005). However, there was no significant correlation between levels of lipoprotein and levels of MMP-9, monocyte chemoattractant protein-I, and plasminogen activator inhibitor type-1 during administration of simvastatin. CONCLUSIONS:Our current data support the hypothesis that nonlipid mechanisms elicited by administration of simvastatin contribute to the decrease in incidence of cardiovascular events and explain the early clinical benefit observed in clinical trials, independent of changes in levels of lipoprotein.

Background and Objectives:Primary coronary stenting has been shown to be an effective reperfusion therapy for acute myocardial infarction (AMI). However, few data exist regarding long-term follow-up. We examine the long-term clinical and angiographic outcomes associated with primary coronary stenting performed after early AMI diagnosis. Methods:Between September 1995 and October 1999, coronary stenting was attempted in 181 consecutive patients who had been admitted and diagnosed with AMI within 6 hours from of the onset of chest pain. The incidence of all post-stenting clinical events, including death, MI, coronary bypass surgery and repeat angioplasty, was recorded for 1 year. Angiograms were obtained at baseline, after stenting, at 2 weeks and 6 months. Results:Of the initial group, 168 patients (92.8%) completed 1 year of clinical follow-up. Inhospital deaths occurred in 5 patients (3%). Follow-up angiography was performed at 6.4±2.1 months after stent implantation in 105 (62.5%) patients and restenosis occurred in 21.9%. Clinical events occurring within 1 year included death (6.5%), myocardial infarction (1.2%), bypass surgery (1.8%) and repeat angioplasty (7.7%). The remaining 82.2% of patients had experienced no adverse cardiac events at 1 year. Conclusion: Primary stenting is safe and feasible in AMI patients, even in large thrombus containing lesions, and it is associated with in excellent long-term outcomes.(Korean Circulation J 2001;31(8):742-748)