SCI 발표논문

전체 4,588편

14082014

제1저자 한재준 · 교신저자 김유정

, , , , , , , , , , , ,
Salvage treatment with low-dose weekly paclitaxel in elderly or poor performance status patients with metastatic urothelial carcinoma.
Tumori. 2014;100(4):439-45.

Abstract
AIMS AND BACKGROUND To evaluate the efficacy of weekly, low-dose paclitaxel chemotherapy after the failure of platinum-based combination chemotherapy in elderly or poor performance status patients with metastatic urothelial carcinoma.
METHODS We retrospectively reviewed the medical records of 25 patients. The regimen consisted of paclitaxel, 60 mg/m2 on days 1, 8 and 15, with or without carboplatin (AUC 2). Treatment was repeated every 4 weeks until disease progression.
RESULTS Of 25 patients, the median age was 68 years (range, 47-82), 4 (16%) were female, and 15 (60%) had an ECOG performance status of 2. All patients were ≥65 years or had a performance status of 2 in the cases aged <65 years. Six patients received paclitaxel in combination with carboplatin. The overall response rate was 24% (95% CI, 7.3-40.7) with 6 partial responses. Eight patients (32%) achieved stable disease and 5 (20%) had progressive disease. The median time to progression was 4.0 months (95% CI, 2.9-5.1), and median overall survival was 5.5 months (95% CI, 3.7-7.3). Grade 3-4 toxicities were as follows: neutropenia in 9 patients (36%), anemia in 11 (44%), thrombocytopenia in 2 (8%), neutropenic fever in 2 (8%), asthenia in 4 (16%), anorexia in 2 (8%), nausea in 2 (8%), and peripheral neuropathy in 1 (4%). ECOG performance status (0-1 vs 2) was a significant prognostic factor in multivariate analysis.
CONCLUSIONS Low-dose weekly paclitaxel seems to be a meaningful salvage treatment with moderate activity and acceptable toxicity in elderly or poor performance status patients with metastatic urothelial carcinoma. Oncologists should carefully consider the opportunity of chemotherapy versus best supportive care in these patients.
PubMed IF 2 혈액종양내과
14072014

제1저자 김진원 · 교신저자 임석아

, , , , , , , , , , , , ,
Ataxia-telangiectasia-mutated protein expression with microsatellite instability in gastric cancer as prognostic marker.
Int J Cancer. 2014;134(1):72-80.

Abstract
The prognostic significance of ataxia-telangiectasia-mutated (ATM) expression in gastric cancer remains unclear. The functional loss of ATM gene exhibits a biologic correlation with microsatellite instability (MSI). In this study, we investigated the significance of ATM expression with MSI by evaluating gastric cancer patients who had underwent curative resection. ATM expression was classified into low ATM expression (-, ±, +) and high ATM expression (++, +++) using immunohistochemistry analysis. MSI status was classified as MSI-negative (MSS, MSI-low) and MSI-positive (MSI-high). Of 321 patients, 205 (63.9%) exhibited low ATM expression and 116 (36.1%) exhibited high ATM expression. Low ATM expression was more frequently identified in patients of older age, more advanced stage and with MSI-positive tumor (p = 0.025, p = 0.001 and p = 0.014, respectively). The probability of 5-year disease-free survival (DFS) and overall survival (OS) was lower in low ATM expression group compared with the high ATM expression group (DFS: 62.5%, 76.4%, p = 0.017, OS: 65.9%, 78.5%, p = 0.027, respectively). According to MSI status, a subgroup of MSI-negative and low ATM expression cases exhibited the worst prognosis for DFS and OS; this subgroup also exhibited poorer DFS according to multivariable analysis (hazard radio = 1.8, 95% confidence interval, 1.2-2.8, p = 0.010), although prognostic value of ATM expression alone did not remain in the multivariable analysis. Taken together, these findings indicate that ATM expression with MSI status is an independent factor for gastric cancer prognosis in gastric cancer patients who received curative surgery.
PubMed IF 4.9 혈액종양내과
14062014

제1저자 김상균/정혜경 · 교신저자 이용찬

, , , , , , , , ,
Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition.
J Gastroenterol Hepatol. 2014;29(7):1371-86.

Abstract
The Korean College of Helicobacter and Upper Gastrointestinal Research first developed guidelines for the diagnosis and treatment of Helicobacter pylori (H. pylori) infection in 1998, and revised guidelines were proposed in 2009 by the same group. Although the revised guidelines were based on a comprehensive review of published articles and the consensus of expert opinions, the revised guidelines were not developed using an evidence-based process. The new guidelines presented in this study include specific changes regarding indication and treatment of H. pylori infection in Korea, and were developed through the adaptation process using an evidence-based approach. After systematic review of the literature, six guidelines were selected using the Appraisal of Guidelines for Research and Evaluation (AGREE) II process. A total of 21 statements were proposed with the grading system and revised using the modified Delphi method. After the guideline revisions, 11 statements about indication of test and treatment, four statements about diagnosis, and four statements about treatment of H. pylori infection were developed. The revised guidelines were reviewed by external experts before receiving official endorsement from the Korean College of Helicobacter and Upper Gastrointestinal Research, and disseminated to physicians and other medical professionals for use in clinical practice in Korea. The guidelines will continue to be updated and revised periodically.
PubMed IF 3.5 소화기내과
14052014

제1저자 홍은실 · 교신저자 임수

, , , , , , ,
Effect of carnitine-orotate complex on glucose metabolism and fatty liver: a double-blind, placebo-controlled study.
J Gastroenterol Hepatol. 2014;29(7):1449-57.

Abstract
BACKGROUND AND AIM Effective medicines have not been introduced for insulin resistance-related fatty liver. The efficacy and safety of treatment between a combination of metformin and carnitine-orotate complex and metformin alone in a 12-week, double-blind, randomized, placebo-controlled study on drug-naïve patients with impaired glucose metabolism and fatty liver were compared.
METHODS Fifty-two patients with fasting glucose 100-240 mg/dL or glycosylated hemoglobin (HbA1c) ≥ 6.0% and alanine aminotransferase (ALT) 40-250 IU/L were randomized to receive metformin (250 mg t.i.d.), or metformin (250 mg t.i.d.) and carnitine-orotate complex (300 mg t.i.d.) for 12 weeks (n = 26 per group). The primary end-point was a change from baseline ALT level. Secondary end-points were changes in fasting glucose, HbA1c, aspartate aminotransferase levels, mitochondrial DNA (mtDNA) copy number in the peripheral blood, and urinary output of 8-hydroxy-2'-deoxyguanosine, a marker of oxidative stress.
RESULTS The combined treatment reduced ALT level significantly more than metformin alone (-51.5 ± 33.2 IU/L vs -16.7 ± 31.3 IU/L, P = 0.001). The HbA1c levels also decreased significantly in both groups but there was no significant difference between them (-0.9% ± 1.0% vs -0.7% ± 0.9%). Treatment with the complex decreased the urinary 8-hydroxy-2'-deoxyguanosine level and increased mtDNA copy number significantly compared with metformin alone (both P < 0.05). No severe adverse events were observed.
CONCLUSION A 12-week treatment with metformin and carnitine-orotate complex significantly improved liver function enzyme levels. This was associated with changes in oxidative stress and mtDNA copy number compared with metformin alone in patients with impaired glucose metabolism and fatty liver (clinical trial number: KCT0000193).
PubMed IF 3.5 내분비대사내과
14042014

제1저자 이예나 · 교신저자 최성희

, , , , , , , , , , ,
Serum FGF21 concentration is associated with hypertriglyceridaemia, hyperinsulinaemia and pericardial fat accumulation, independently of obesity, but not with current coronary artery status.
Clin Endocrinol (Oxf). 2014;80(1):57-64.

Abstract
OBJECTIVE Fibroblast growth factor 21 (FGF21) is an emerging metabolic regulator associated with glucose and lipid metabolism. However, previous studies of FGF21 have been largely confounded by obesity, and data are limited for advanced outcomes such as coronary artery disease (CAD) and ectopic fat accumulation. We investigated the associations between serum FGF21 concentrations and glucose/lipid metabolism, CAD, and pericardial fat deposition in subjects strictly matched for obesity parameters.
DESIGN, PATIENTS AND MEASUREMENTS We enrolled 189 patients who had undergone cardiac multidetector coronary computed tomography. We measured cardiometabolic parameters and serum FGF21 levels within body mass index (BMI)-matched groups. Correlations and linear regressions were analysed among serum FGF21 levels, pericardial fat volumes and cardiometabolic parameters. Serum FGF21 concentrations were compared in patients with and without diabetes, metabolic syndrome (MS) or CAD.
RESULTS Serum FGF21 concentrations were significantly higher in BMI-matched patients with MS (107·2 ± 83·6 vs 82·1 ± 67·4 ng/l without MS, P < 0·05), but not among those with diabetes (84·3 ± 56·4 vs 96·3 ± 98·9 ng/l without diabetes, P = 0·300) or CAD (89·6 ± 65·8 vs 84·2 ± 83·1 ng/l without CAD, P = 0·633). Serum FGF21 concentrations correlated positively with triglycerides, low-density lipoprotein-cholesterol, insulin, HOMA-IR and pericardial fat volume. They showed an independent association with pericardial fat volume (β = 0·111 ± 0·053, P < 0·05).
CONCLUSIONS Serum FGF21 concentrations were significantly associated with lipid profiles, insulin resistance, pericardial fat volume and MS, independently of obesity, but not with overt CAD or diabetes.
PubMed IF 2.8 내분비대사내과
14032014

제1저자 이무용/조비룡 · 교신저자 김광일

, , , , , , ,
Blood pressure lowering effect of Korea ginseng derived ginseol K-g1.
Am J Chin Med. 2014;42(3):605-18.

Abstract
We investigated the effect of Panax ginseng extract, which is rich in the ginsenoside protopanaxatriol (Ginseol K-g1), on blood pressure (BP). Adults over 20 years old with a systolic BP (SBP) between 120 and 159 mm Hg or a diastolic BP (DBP) between 80 and 99 mm Hg were included. At the end of an initial 2-week washout period, the patients were divided into three groups: the control group (placebo), the low-dose Ginseol K-g1 group (100 mg), and the high-dose Ginseol K-g1 (300 mg) group. The primary end point was the difference in seated SBP (seSBP) and seated DBP (seDBP) changes between the placebo and Ginseol K-g1 groups after 8 weeks of treatment. A total of 90 subjects participated in the study (mean age; 55.2 ± 11.8 years, 43 males). At week 8, levels of seSBP and seDBP were significantly decreased from baseline in the high-dose Ginseol K-g1 group (-3.1 mm Hg and -2.3 mm Hg, respectively, p < 0.05). In contrast, there was no significant decrease in seSBP or seDBP in the control or low-dose Ginseol K-g1 groups. No significant difference of seSBP and seDBP was identified among the three treatment groups at week 8. In patients who had a seSBP ≥ 130 mm Hg or an seDBP ≥ 85 mm Hg, the high dose of Ginseol K-g1 decreased the BP compared with the control group at week 4; however, there was no significant difference at week 8. The proportions of patients who experienced adverse events were comparable among the treatment groups. In conclusion, Ginseol K-g1 has a favorable effect on BP after 4 weeks of treatment, especially at a high dose. However, the effect is not maintained over 8 weeks. (Clinical trial registration information is available at http://www.clinicaltrials.gov , identifier: NCT01483430.).
PubMed IF 7.8 순환기내과
14022014

제1저자 조유리 · 교신저자 이정훈

, , , , , , , , , , , , , , , ,
High-sensitivity C-reactive protein level is an independent predictor of poor prognosis in cirrhotic patients with spontaneous bacterial peritonitis.
J Clin Gastroenterol. 2014;48(5):444-9.

Abstract
BACKGROUND/AIMS The production of high-sensitivity C-reactive protein (hs-CRP) may be affected by hepatic function, and the clinical importance of hs-CRP in patients with liver cirrhosis is still not clear. The aim of this study was to evaluate the clinical implications of hs-CRP in cirrhotic patients with spontaneous bacterial peritonitis (SBP).
METHODS We retrospectively investigated 336 consecutive patients treated for SBP from 2007 to 2012. The relationship between serum hs-CRP and the result of the treatment was assessed.
RESULTS A response to antibiotics was observed in 182 patients (54.2%), and 126 patients (37.5%) died of SBP. The initial hs-CRP (odds ratio=1.061, P=0.016), coexistent hepatocellular carcinoma, and Child-Pugh (CP) score were independent prognostic factors for high in-hospital mortality. Serum hs-CRP level was also an independent predictor of lower antibiotic response rate (odds ratio=0.916, P<0.001). However, hs-CRP was negatively correlated with the CP score (r=-0.199, P<0.001) and Model for End-Stage Liver Disease score (r=-0.182, P=0.001).
CONCLUSIONS This study found that serum hs-CRP level is related to a lower response rate to antibiotics, a higher mortality rate in patients with SBP. The hs-CRP level was negatively correlated with the CP and Model for End-Stage Liver Disease scores, which suggests that the prognostic function of hs-CRP was not a surrogate for hepatic dysfunction.
PubMed IF 2.7 소화기내과
14012014

제1저자 조은정 · 교신저자 김세훈

, , , , , , , , , ,
Eosinophilic airway inflammation and airway hyperresponsiveness according to aeroallergen sensitization pattern in patients with lower airway symptoms.
Allergy Asthma Immunol Res. 2014;6(1):39-46.

Abstract
PURPOSE Sensitization to specific allergens may be important in the development of allergic airway inflammation and airway hyperresponsiveness (AHR). We evaluated the effect of specific aeroallergen sensitization on eosinophilic airway inflammation and AHR.
METHODS We reviewed retrospectively the clinical data of subjects who underwent skin prick tests to aeroallergens, induced sputum analysis, and methacholine bronchial provocation tests to evaluate lower airway symptoms as well as analyzed the associations between the pattern of aeroallergen sensitization and sputum eosinophilia or AHR.
RESULTS Of the 1,202 subjects be enrolled, 534 (44.4%) were sensitized to at least one aeroallergen in skin tests. AHR was demonstrated in 23.5% and sputum eosinophilia in 38.8%. Sputum eosinophilia was significantly associated with sensitization to perennial allergens (OR, 1.9; 95% CI, 1.4-2.5), house dust mite (OR, 1.7; 95% CI, 1.3-2.3), dog (OR, 1.9; 95% CI, 1.1-3.3), and cat (OR, 2.1; 95% CI, 1.4-3.4). AHR was associated with sensitization to perennial allergens (OR, 2.7; 95% CI, 2.0-3.7), house dust mite (OR, 2.2; 95% CI, 1.6 3.2), Alternaria (OR, 2.3; 95% CI, 1.2-4.7), and cat (OR, 2.7; 95% CI, 1.7-4.3). Sensitization to more perennial allergens increased the risk for sputum eosinophilia and AHR. There was no relationship with individual seasonal allergens.
CONCLUSION The development of airway eosinophilic inflammation and AHR in an adult Korean population was associated with sensitization to perennial allergens rather than seasonal allergens.
PubMed IF 4.3 알레르기내과
14002014

제1저자 임지완 · 교신저자 김나영

, , , , , , , , , , ,
Gastroprotective effect of Cochinchina momordica seed extract in nonsteroidal anti-inflammatory drug-induced acute gastric damage in a rat model.
Gut Liver. 2014;8(1):49-57.

Abstract
BACKGROUND/AIMS The major compounds of Cochinchina momordica seed extract (SK-MS10) include momordica saponins. We report that the gastroprotective effect of SK-MS10 in an ethanol-induced gastric damage rat model is mediated by suppressing proinflammatory cytokines and downregulating cytosolic phospholipase A2 (cPLA2), 5-lipoxygenase (5-LOX), and the activation of calcitonin gene-related peptide. In this study, we evaluated the gastroprotective effects of SK-MS10 in the nonsteroidal anti-inflammatory drug (NSAID)-induced gastric damage rat model.
METHODS The pretreatment effect of SK-MS10 was evaluated in the NSAID-induced gastric damage rat model using aspirin, indomethacin, and diclofenac in 7-week-old rats. Gastric damage was evaluated based on the gross ulcer index by gastroenterologists, and the damage area (%) was measured using the MetaMorph 7.0 video image analysis system. Myeloperoxidase (MPO) was measured by enzyme-linked immunosorbent assay, and Western blotting was used to analyze the levels of cyclooxygenase (COX)-1, COX-2, cPLA2, and 5-LOX.
RESULTS All NSAIDs induced gastric damage based on the gross ulcer index and damage area (p<0.05). Gastric damage was significantly attenuated by SK-MS10 pretreatment compared with NSAID treatment alone (p<0.05). The SK-MS10 pretreatment group exhibited lower MPO levels than the diclofenac group. The expression of cPLA2 and 5-LOX was decreased by SK-MS10 pretreatment in each of the three NSAID treatment groups.
CONCLUSIONS SK-MS10 exhibited a gastroprotective effect against NSAID-induced acute gastric damage in rats. However, its protective mechanism may be different across the three types of NSAID-induced gastric damage models in rats.
PubMed IF 4.1 소화기내과
13992014

제1저자 김선문 · 교신저자 임춘수

, , , , , ,
Prevalence of vitamin D deficiency and effects of supplementation with cholecalciferol in patients with chronic kidney disease.
J Ren Nutr. 2014;24(1):20-5.

Abstract
OBJECTIVE We aimed to evaluate the vitamin D status, the effect of cholecalciferol supplementation, and the factors associated with vitamin D restoration in nondialytic patients with chronic kidney disease (CKD).
DESIGN The present study was a prospective open-label trial.
SETTING This study took place at the Seoul National University Boramae Medical Center.
SUBJECTS Patients with nondialytic CKD (estimated glomerular filtration rate [eGFR] 10-59 mL/min per 1.73 m(2)) participated in this study.
INTERVENTION Vitamin D status in 210 CKD patients was assessed and the patients with vitamin D deficiency (<30 ng/mL) were administered cholecalciferol (1,000 IU/day) for 6 months.
MAIN OUTCOME MEASURE The restoration rate of vitamin D deficiency at 3 and 6 months and the response-related factors were analyzed.
RESULTS The prevalence of vitamin D deficiency was 40.7% in CKD Stage 3, 61.5% in Stage 4, and 85.7% in Stage 5. The subgroup with vitamin D deficiency had a greater proportion of patients with diabetes, lower eGFR, and higher proteinuria. With the supplementation, 52 patients (76.5%) reached levels of 25-hydroxy vitamin D (25(OH)D) of 30 ng/mL or greater at 3 months, and the restoration of vitamin D was observed in 61 patients (89.7%) at 6 months. Lower levels of 25(OH)D and a higher amount of proteinuria at baseline were the factors associated with lower response to vitamin D supplementation.
CONCLUSION Vitamin D deficiency rate was high in nondialytic CKD patients, and the proportion increased as renal function decreased. A higher amount of proteinuria was the independent risk factor of nonresponse with supplementation. Vitamin D was replenished in most patients with cholecalciferol supplementation without any significant adverse effects.
PubMed IF 4 신장내과
13982014

제1저자 길호 · 교신저자 정숙향

, , , , , , ,
Role of interleukin-28B genetic polymorphisms in Korean patients with hepatitis C virus infection.
Gut Liver. 2014;8(1):70-8.

Abstract
BACKGROUND/AIMS This study investigated the role of single nucleotide polymorphisms (SNPs) near the interleukin-28B (IL28B) gene with respect to clinical outcomes and the antiviral response in hepatitis C virus (HCV) infection to suggest the practical utility of IL28B genotyping in Korea.
METHODS Two SNPs near IL28B, rs12979860 and rs8099917, were analyzed using an allelic discrimination assay in a total of 454 individuals, including 147 health-check examinees and 307 patients with HCV infection.
RESULTS The CC genotype frequency was significantly higher in the spontaneous recovery group than in the chronic infection group and was higher in the chronic hepatitis group than in the liver cirrhosis or hepatocellular carcinoma group, suggesting its favorable role in the clinical outcome. Multivariate analysis revealed that the rs12979860 CC genotype was an independent predictor of sustained virologic response (SVR) in genotype 1 HCV infection. During the currently used response-guided therapy, IL28B genotyping was most helpful for the patients who exhibit early virologic responses without rapid virologic responses, as those patients exhibiting the non-CC type did not achieve SVR, although they represented approximately one-third of the total patients.
CONCLUSIONS The IL28B SNP is an independent predictor of SVR. Our results may be helpful if the findings are carefully applied to select patients in Korea.
PubMed IF 4.1 소화기내과
13972013

제1저자 황의진 · 교신저자 이세훈, 최승홍

Hwang EJ, Cha Y, Lee AL, Yun TJ, Kim Tm, Park CK, Kim JH,Sohn CH, Park SH, Kim IH, Hwo DS, Choi SH
Early response evaluative for recurrent hign grade gliomas treed wiith bevcacizumab: a volumetric anaysis using giffusion-weightd
J Neurooncol. 2013.

IF 3.214 혈액종양내과
13962013

제1저자 J.Lee · 교신저자 임재준

J.Lee, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Han SK, Yim JJ
Antiplatelet or anticogulant therapy might not increase the risk of haemoptysis in patients with bronchiectasis
Int J Tuberc Lung Dis. 2013;17(7):989-991.

IF 2.61 호흡기내과
13952013

제1저자 김계형 · 교신저자 오명돈

Kim K-H, Yi J, Kim G, Choi SJ, Jun KI, Kim NK, Choe PG, Kim NJ, Lee JK, Oh MD
Severe fever with thrombocytopenia syndrome
Emerg Infect Dis. 2013;19(11).

IF 5.993 감염내과
13942013

제1저자 강승주 · 교신저자 김동희

Kang SJ, Kim D, Park HE, Chung GE, Choi SH, Choi SY, Lee W, Kim JS, Cho SH
Elevated serum bilirubin levels are inversely asociated with coronary artery atherosclerosis
Atherosclerosis. 2013;230:242-248.

IF 3.706 소화기내과
13932013

제1저자 이은영, Kyung-Hyun Park-min · 교신저자 Lionel B Ivashkiv

K-H Park-m, Lee EY, Neal K Moskowittz, Elisha Lim, Lee SK, Joseph A Lorenzo, Chuanxin Huang, Ari M Melnick, P Edward Purdue, Steven R Goldring, and Lionel B Ivashkiv
Negative regulation of OC precursor diff by CD11b and B2 integrin-BCL6 signaling
JBMR. 2013;28(1):135-149.

IF 6.373 류마티스내과
13922013

제1저자 김미나 · 교신저자 김상균

Kim MN, Kang SJ, Kim SG, Im JP, Kim JS, Jung HC, Song IS
Prediction of risk of malignancy of gastriintestinal stromal tumors by endoscopic ultrasonography
Gut Liver. 2013;7:642-647.

IF 1.314 소화기내과
13912013

제1저자 송현진 · 교신저자 김나영, 박영수

Song HJ, Kwon JW, Kim N, Park YS
Cost Effectiveness Associated with Helicobacter pylori Screening and Eradication in Patients Taking Nonsteroidal Anti-Inflammatory Drugs and/or Aspirin
Gut and Liver. 2013;7:182-189.

IF 0.829 소화기내과
13902013

제1저자 임지환 · 교신저자 김나영

Lim JH, Kim N, Lee HS, Choe G, Jo SY, Chon I, Choi C, Yoon H, Shin CM, Park YS, Lee DH, Jung HC
Correlation of endoscopic and histoloical diagnoses of gastric intestinal metaplasia
Gut Liver. 2013;7(1):41-50.

IF 0.829 소화기내과
13892013

제1저자 김지원, 고영일 · 교신저자 김동완

, , , , , , , , , , ,
Clinical Implications of VEGF, TGF-β1, and IL-1β in Patients with Advanced Non-small Cell Lung Cancer.
Cancer Res Treat. 2013;45(4):325-33.

Abstract
PURPOSE Vascular endothelial growth factor (VEGF)-A, VEGF165b, interleukin (IL)-1β, and transforming growth factor (TGF)-β1 are known to influence tumor angiogenesis. Clinical implications of these cytokines need to be elucidated.
MATERIALS AND METHODS Using clinical data and baseline serum samples of 140 consecutive patients with advanced non-small cell lung cancer who received platinum-based combination chemotherapy, we investigated the association among serum cytokine levels, treatment outcomes, as well as leukocyte and platelet counts.
RESULTS The median age of patients was 64 years (range, 26 to 86 years). The male to female ratio was 104:36. High TGF-β1 and IL-1β levels were associated with shorter progression-free survival, and high VEGF-A and IL-1β levels were associated with shorter overall survival in the univariate analysis. VEGF165b was not related to the treatment outcomes. Leukocytosis and thrombocytosis were associated with shorter overall survival. The multivariate analysis demonstrated that VEGF-A, IL-1β, and leukocytosis were significant prognostic factors (p=0.0497, p=0.047, and p<0.001, respectively). Leukocytosis was not associated with recent pneumonia (p=0.937) and correlated with VEGF-A (p<0.001) and TGF-β1 (p=0.020) levels.
CONCLUSION Serum VEGF-A, TGF-1β, and IL-1β levels, in addition to leukocyte and platelet counts, are shown to be associated with clinical outcomes. Leukocyte and platelet counts are correlated with serum VEGF-A and TGF-β1 levels.
PubMed IF 4.2 혈액종양내과
13882013

제1저자 안신영 · 교신저자 진호준

, , , , , , ,
Incident chronic kidney disease and newly developed complications related to renal dysfunction in an elderly population during 5 years: a community-based elderly population cohort study.
PLoS One. 2013;8(12):e84467.

Abstract
BACKGROUND Few studies have evaluated the association between incident chronic kidney disease (CKD) and related complications, especially in elderly population. We attempted to verify the association between GFR and concurrent CKD complications and elucidate the temporal relationship between incident CKD and new CKD complications in a community-based prospective elderly cohort.
METHOD We analyzed the available data from 984 participants in the Korean Longitudinal Study on Health and Aging. Participants were categorized into 6 groups according to eGFR at baseline examination (≥90, 75-89, 60-74, 45-59, 30-44, and <30 ml/min/1.73 m(2)).
RESULT The mean age of study population was 76 ± 9.1 years and mean eGFR was 72.3 ± 17.0 ml/min/1.73 m(2). Compared to eGFR group 1, the odds ratio (OR) for hypertension was 2.363 (95% CI, 1.299-4.298) in group 4, 5.191 (2.074-12.995) in group 5, and 13.675 (1.611-115.806) in group 6; for anemia, 7.842 (2.265-27.153) in group 5 and 13.019 (2.920-58.047) in group 6; for acidosis, 69.580 (6.770-715.147) in group 6; and for hyperkalemia, 19.177 (1.798-204.474) in group 6. Over a 5-year observational period, CKD developed in 34 (9.6%) among 354 participants with GFR ≥ 60 ml/min/1.73 m(2) at basal examination. The estimated mean number of new complications according to analysis of co-variance was 0.52 (95% CI, 0.35-0.68) in subjects with incident CKD and 0.24 (0.19-0.29) in subjects without CKD (p = 0.002). Subjects with incident CKD had a 2.792-fold higher risk of developing new CKD complications. A GFR level of 52.4 ml/min/1.73 m(2) (p = 0.032) predicted the development of a new CKD complication with a 90% sensitivity.
CONCLUSION In an elderly prospective cohort, CKD diagnosed by current criteria is related to an increase in the number of concurrent CKD complications and the development of new CKD complications.
PubMed IF 2.8 신장내과
13872013

제1저자 송경호 · 교신저자 김홍빈

, , , , , , , , , , , , , , , , , ,
Characteristics of invasive Staphylococcus aureus infections in three regions of Korea, 2009-2011: a multi-center cohort study.
BMC Infect Dis. 2013;13:581.

Abstract
BACKGROUND Despite the importance of invasive Staphylococcus aureus (ISA) infection, its overall burden in non-selected populations has only been defined in a small number of studies in Europe and North America. To define the characteristics of ISA infections in Korea, we conducted a multi-center cohort study to estimate population-based incidence rates.
METHODS We conducted a multicenter prospective cohort study at nine university-affiliated active-surveillance core centers (ASCs) in three regions of Korea. To cover all available clinical microbiologic laboratories, we classified the laboratories in these regions into three groups according to their clinical environment as: 1) Nine ASCs, 2) Five major commercial laboratories and 3) Forty-four acute-care hospital-affiliated microbiology laboratories. We requested all the laboratories to report prospectively their numbers of cases of S. aureus isolated from normally sterile sites. Detailed clinical information was collected about the cases in the nine ASCs.
RESULTS From 1 July 2009 to 30 June 2011, a total of 1,198 cases of ISA infection were identified at the nine ASCs, including 748 (62%) methicillin-resistant S. aureus (MRSA) infections. Most (81%) ISA infections were healthcare-associated (HCA): 653 (55%) hospital-onset and 322 (27%) community-onset. 223 (19%) were community-associated infections. The most common primary diagnosis was catheter-associated infection (225 cases, 19%). Respiratory tract infection (160, 13%), skin & soft tissue (152, 13%) and bone & joint infections (120, 10%) were also common. 30-day and 12-week mortality rates were 25.6% (262/1,024) and 36.5% (314/860), respectively. Complications, including metastatic infection within 12 weeks, occurred in 17.8% of ISA infections. The most common site of metastatic infection was the lung (9.8%, 84/860). Based on the total of 2,806 observed cases of ISA infection, estimated annual rates of ISA and invasive MRSA infections were 43.3 and 27.7 per 100,000 populations, respectively.
CONCLUSIONS Our data provide important information about the clinical characteristics of ISA infections. We estimate that over 21,000 ISA infections and 13,000 invasive MRSA infections occurred in Korea in 2010.
PubMed IF 3.2 감염내과
13862013

제1저자 최은경 · 교신저자 김동희

, , ,
Association of visceral obesity and early colorectal neoplasia.
World J Gastroenterol. 2013;19(45):8349-56.

Abstract
AIM To examine whether visceral adipose tissue (VAT) serves as a risk factor for colorectal adenoma-early colorectal cancer (CRC) sequence.
METHODS A retrospective case-control study was conducted with 153 patients with stage I CRC, age/sex-matched 554 patients with colorectal adenoma and 557 normal controls. All subjects underwent various laboratory tests, abdominal fat computed tomography (CT), and colonoscopy. VAT was defined as an intra-abdominal adipose tissue area measured by CT scan. Adipose tissue area was measured at the level of the umbilicus from CT scan. We used the lowest quartile of VAT and subcutaneous adipose tissue area as a reference group.
RESULTS The body mass index (BMI), total cholesterol, fasting glucose and VAT areas were significantly different among normal, adenoma and CRC groups. The VAT area was 120.6 ± 49.0 cm(2) in normal controls, 130.6 ± 58.4 cm(2) in adenoma group and 117.6 ± 51.6 cm(2) in CRC group (P = 0.002). In univariate analysis, increased BMI was a risk factor for CRC compared to control (P = 0.025). However, VAT area was not a risk factor for CRC compared to control. In multivariate analysis that adjusted for smoking, alcohol consumption and subcutaneous adipose tissue area, VAT area was inversely related to CRC, compared to the adenoma (OR = 0.53, 95%CI: 0.31-0.92, highest quartile vs lowest quartile).
CONCLUSION Our study shows that visceral obesity is not a risk factor for early CRC. Visceral obesity might influence the normal-adenoma sequence but not the adenoma-early carcinoma sequence.
PubMed IF 7.7 소화기내과
13852013

제1저자 임수 · 교신저자 장학철

, , , , , , , ,
The association of maximum body weight on the development of type 2 diabetes and microvascular complications: MAXWEL study.
PLoS One. 2013;8(12):e80525.

Abstract
BACKGROUND Obesity precedes the development of type 2 diabetes (T2D). However, the relationship between the magnitude and rate of weight gain to T2D development and complications, especially in non-White populations, has received less attention.
METHODS AND FINDINGS We determined the association of rate and magnitude of weight gain to age at T2D diagnosis (Age(T2D)), HbA1c at T2D diagnosis (HbA1c(T2D)), microalbuminuria, and diabetic retinopathy after adjusting for sex, BMI at age 20 years, lifestyles, family history of T2D and/or blood pressure and lipids in 2164 Korean subjects aged ≥30 years and newly diagnosed with diabetes. Body weight at age 20 years (Wt(20y)) was obtained by recall or from participants' medical, school, or military records. Participants recalled their maximum weight (Wt(max)) prior to T2D diagnosis and age at maximum weight (Age(max_wt)). The rate of weight gain (Rate(max_wt)) was calculated from magnitude of weight gain (ΔWt = Wt(max)-Wt(20y)) divided by ΔTime (Age(max_wt) -20 years). The mean Age(max_wt) and Age(T2D) were 41.5±10.9 years and 50.1±10.5 years, respectively. The Wt(20y) and Wt(max) were 59.9±10.5 kg and 72.9±11.4 kg, respectively. The Rate(max_wt) was 0.56±0.50 kg/year. After adjusting for risk factors, greater ΔWt and higher Rate(max_wt) were significantly associated with earlier Age(T2D), higher HbA1c(T2D) after additional adjusting for Age(T2D), and microalbuminuria after further adjusting for HbA1c(T2D) and lipid profiles. Greater ΔWt and higher Rate(max_wt) were also significantly associated with diabetic retinopathy.
CONCLUSIONS This finding supports public health recommendations to reduce the risk of T2D and its complications by preventing weight gain from early adulthood.
PubMed IF 2.8 내분비대사내과
13842013

제1저자 이창훈 · 교신저자 임재준

, , , , ,
Use of inhaled corticosteroids and the risk of tuberculosis.
Thorax. 2013;68(12):1105-13.

Abstract
BACKGROUND Inhaled corticosteroid (ICS) use could decrease local immunity of the lung. Concerns have been raised regarding the risk of tuberculosis (TB) development among ICS users. The aim of this study was to elucidate the association between ICS use and development of TB among patients with various respiratory diseases in South Korea, an intermediate-TB-burden country.
METHODS A nested case-control study based on the Korean national claims database was performed. The eligible cohort consisted of 853 439 new adult users of inhaled respiratory medications between 1 January 2007 and 31 December 2010. Patients diagnosed as having TB after initiation of inhaled medication were included as cases. For each case individual, up to five control individuals matched for age, sex, diagnosis of asthma or chronic obstructive pulmonary disease (COPD) and initiation date of inhaler use were selected.
RESULTS From the cohort population, we matched 4139 individuals diagnosed as having TB with 20 583 controls. ICS use was associated with increased rate of TB diagnosis (adjusted OR (aOR), 1.20; 95% CI 1.08 to 1.34). The association was dose dependent (p for trend <0.001). A subgroup analysis revealed that ICS use increased the risk of TB development among non-users of oral corticosteroid (OCS) but not among OCS users.
CONCLUSIONS ICS use increases the risk of TB in an intermediate-TB-burden country. Clinicians should be aware of the possibility of TB development among patients who are long-term high-dose ICS users.
PubMed IF 9.1 호흡기내과
13832013

제1저자 이사민 · 교신저자 오병희

, , , , , , , ,
Comparison of antiplatelet effect and safety of clopidogrel napadisilate with clopidogrel bisulfate in coronary artery disease patients: multi-center, randomized, double-blind, phase IV, non-inferiority clinical trial.
Am J Cardiovasc Drugs. 2013;13(6):413-24.

Abstract
BACKGROUND Clopidogrel napadisilate has better clopidogrel stability than clopidogrel bisulfate. There are no data, however, on the antiplatelet efficacy and tolerability of clopidogrel napadisilate in coronary artery disease (CAD) patients.
OBJECTIVE The aim of this study is to demonstrate that the combination therapy of aspirin and clopidogrel napadisilate is not inferior to that of aspirin and clopidogrel bisulfate with respect to its effectiveness in inhibiting platelet aggregation, if it is given for 4 weeks to CAD patients who had been treated with a drug-eluting stent more than 12 months prior and had remained in a stable condition with a single antiplatelet agent, aspirin.
METHODS This study was a prospective, randomized, double-blind, double-dummy, parallel-group, phase IV clinical trial. A total of 162 patients were prospectively recruited from three centers. The subjects were randomized to either the test group that was treated with 75 mg of clopidogrel napadisilate once daily or to the control group that was treated with 75 mg of clopidogrel bisulfate once daily. The primary outcome was the percent inhibition of the platelet aggregation change after the medication, as assessed by a VerifyNow™ P2Y12 assay. The secondary outcome was the change in P2Y12 reaction units (PRUs) from the baseline to the end of 4 weeks of treatment. The prevalence of adverse events was assessed at each visit through a direct interview.
RESULTS The mean increase in the percent inhibition after 4 weeks of treatment was 19.4 % in the clopidogrel napadisilate group and 19.5 % in the clopidogrel bisulfate group. The lower bound of the 95 % two-sided confidence interval for the difference in the change between the two groups (-5.46) was greater than the pre-defined non-inferiority margin of (-10.5). Therefore, clopidogrel napadisilate was deemed non-inferior to clopidogrel bisulfate with respect to its effectiveness in inhibiting platelet aggregation. The PRU decreased by 73.1 ± 30.7 in the clopidogrel napadisilate group, which decreased by -7.8 more than in the clopidogrel bisulfate group (65.3 ± 62.1); but the difference between the two groups was statistically insignificant (p = 0.435). There was no significant difference in the drug-related adverse events between the two groups (12.3 vs. 10.1 %; p = 0.804).
CONCLUSION The platelet inhibitory efficacy of clopidogrel napadisilate is not inferior to that of clopidogrel bisulfate. There were also no statistically significant differences between the two treatment groups in the safety analyses. Therefore, clopidogrel napadisilate can be a suitable alternative to clopidogrel bisulfate in stable CAD patients who have undergone a drug-eluting stent placement.
CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov as NCT01830491.
PubMed IF 3.2 순환기내과
13822013

제1저자 김동희 · 교신저자 김웅

,
An ALTer ego of serum ALT: is it more than a marker of liver inflammation?
Gastroenterology. 2013;145(6):1191-3.

PubMed IF 29.7 소화기내과
13812013

제1저자 이연주 · 교신저자 이창훈

, , , , , ,
The effectiveness of a brochure describing an acceptable method of sputum collection for tuberculosis testing.
Int J Tuberc Lung Dis. 2013;17(12):1587-9.

Abstract
We evaluated the effectiveness of an educational brochure explaining proper sputum collection techniques for tuberculosis (TB) diagnosis. Patients with suspected pulmonary TB (PTB) were randomly assigned to either the brochure-using group or the non-using group. No significant difference in positive TB culture rates was observed between the brochure-using and non-using groups (33.1% vs. 35.6%, P = 0.690). The proportions of acceptable specimen samples for bacterial pneumonia were also similar between the two groups (37.1% vs. 35.6%). An educational brochure provided by the attending physician explaining an acceptable specimen collection method for TB testing did not result in a higher detection rate of PTB.
PubMed IF 3.6 호흡기내과
13802013

제1저자 이준규/박창욱 · 교신저자 이상협/강현우

, , , , , , , , ,
Updates in bacteriological epidemiology of community-acquired severe acute cholangitis and the effectiveness of metronidazole added routinely to the first-line antimicrobial regimen.
J Infect Chemother. 2013;19(6):1029-34.

Abstract
Prompt antimicrobial therapy, together with subsequent biliary drainage, is crucial to prevent the rapidly deteriorating course of severe acute cholangitis. Therefore, updates in bacteriological epidemiology and resistance profile are important for management of this critical disease. Also, because the routine addition of metronidazole to the first-line regimen is controversial, we intended this prospective study with historical controls. Patients with severe acute cholangitis who fulfilled the definition of severity by the Tokyo Guidelines and underwent biliary drainage within 24 h from presentation were enrolled prospectively from January 2010 to December 2011. During that period, metronidazole was not added to third-generation cephalosporins, which were used as the initial antimicrobials except for patients who were allergic to penicillin and received ciprofloxacin instead (no metronidazole group). Outcomes were compared with a historical cohort from March 2007 to December 2009 when metronidazole was added routinely (metronidazole group). A unified strategy was maintained throughout the whole period excepting the use of metronidazole. Outcomes between the metronidazole group (n = 338) and the no metronidazole group (n = 338) did not differ in terms of the rate of successful biliary drainage by interventional procedures (93.2% vs. 94.7%, p = 0.88), time elapsed for cholangitis to be controlled (10.4 ± 0.6 vs. 8.9 ± 1.2 days, p = 0.38), and mortality (1.2% vs. 0.6% with p = 0.34 for all causes and 0.9% vs. 0% with p = 0.15 for cholangitis-related, respectively). As the routine addition of metronidazole did not improve outcomes, it can be excluded from the first-line regimen if emergent biliary drainage can be performed efficiently.
PubMed IF 1.7 소화기내과
13792013

제1저자 김효진 · 교신저자 진호준

, , , , , , , , ,
Association of insulin resistance with lower glomerular filtration rate and all-cause mortality in the Korean elderly population: a community-based prospective cohort study.
Tohoku J Exp Med. 2013;231(4):271-9.

Abstract
Insulin resistance (IR) is a common metabolic disorder in chronic kidney disease patients. In the elderly population, it is not clear whether IR is associated with lower glomerular filtration rate (GFR) and mortality. Here, we analyzed the association between IR and GFR, all-cause mortality (ACM), or cardiovascular mortality (CVM) in the elderly population. This was a community-based prospective study. Participants were selected by random sampling from those aged ≥ 65 years in Seongnam, a satellite city of Seoul, Korea. A total of 743 participants were analyzed. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The mean age was 76.4 ± 9.3 years. After multivariate analysis, HOMA-IR was negatively associated with GFR as a continuous variable (per 10 mL/min/1.73 m(2) increase, β = -0.10, P = 0.004). Analyzing GFR as a categorical variable, HOMA-IR was still higher those with GFR < 60 mL/min/1.73 m(2) (GFR < 60 vs. 60-89 and ≥ 90 mL/min/1.73 m(2): 1.3 vs. 1.2 and 1.1, respectively; P = 0.025 and 0.019) by covariance analysis. During the follow-up period of 62.9 ± 16.9 months, there were 168 (22.6%) cases of ACM and 47 (6.3%) cases of CVM. Those in the third quintile HOMA-IR group showed the lowest ACM rate, compared with the other quintiles (P < 0.001). CVM was not significantly associated with HOMA-IR. In conclusion, a lower GFR is associated with higher IR in the elderly population. Moreover, the lowest or the highest levels of HOMA-IR are associated with higher mortality rates.
PubMed IF 1.5 신장내과

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