SCI 발표논문

전체 4,588편

13482013

제1저자 구보경 · 교신저자 문민경

, , ,
Asymptomatic subjects with diabetes have a comparable risk of coronary artery disease to non-diabetic subjects presenting chest pain: a 4-year community-based prospective study.
BMC Cardiovasc Disord. 2013;13:87.

Abstract
BACKGROUND Although diabetes mellitus is an important risk factor of coronary artery disease (CAD), routine screening for CAD is not recommended for asymptomatic diabetic patients. We assessed the impact of chest pain on CAD risk according to the presence or absence of diabetes mellitus.
METHODS We investigated the future CAD event rate in subjects with and without chest pain according to the presence or absence of diabetes in a prospective large-scale community-based study in Korea.
RESULTS Among 8,574 subjects (4,032 men and 4,542 women) without a history of CAD, 0.8% and 2.2% of non-diabetic and diabetic subjects, respectively, reported newly developed CAD events during 4 years of follow-up. Although the presence of chest pain at baseline was also significantly associated with an increased risk of CAD of more than 2-fold in both non-diabetic and diabetic subjects (P < 0.01), the risk of future CVD event in asymptomatic diabetic patients was not significantly different from that in non-diabetic subjects with chest pain (hazard ratio, 0.907; 95% confidence interval, 0.412 - 1.998).
CONCLUSIONS The CAD event rate of asymptomatic subjects with diabetes was comparable to that of non-diabetic subjects reporting chest pain. Considering the high risk of CAD in asymptomatic diabetic patients, more clinical trials aimed at formulating strategies to screen asymptomatic diabetic subjects should be carried out.
PubMed IF 3.1 내분비대사내과
13472014

제1저자 서정원 · 교신저자 김효수

, , , , , , , , ,
Relationship between statin type and responsiveness to clopidogrel in patients treated with percutaneous coronary intervention: a subgroup analysis of the CILON-T trial.
J Atheroscler Thromb. 2014;21(2):140-50.

Abstract
AIM To compare the responsiveness to clopidogrel in patients who were prescribed two different types of statins, atorvastatin vs. rosuvastatin, following percutaneous coronary intervention.
METHODS A total of 915 patients were randomized according to the antiplatelet therapy strategy in the CILON-T trial. In this subgroup analysis, we included patients who took atorvastatin(20 mg/day, n=295) or rosuvastatin(10 mg/day, n=261) during the entire study period and underwent measurement of the P2Y12 reaction unit(PRU) values at both discharge and six months. We compared the P2Y12 reaction unit(PRU) values at six months and investigated the relationship between the genotypes of cytochrome P450(CYP) 3A4, 3A5 and 2C19 with the PRU values at six months in both groups.
RESULTS The baseline characteristics did not differ between the groups. There were no significant differences in the PRU values at discharge(atorvastatin 221.0±87.3 vs. rosuvastatin 217.1±84.7, p=0.59). However, the rosuvastatin group had higher PRU values than the atorvastatin group at six months(atorvastatin 226.4±79.3 vs. rosuvastatin 241.5±88.2, p=0.033). In the genotype analysis, the number of CYP2C19 loss-of-function (LOF) alleles((＊)2 or (＊)3) was positively associated with a higher PRU value in both statin groups, and there were no significant interactions regarding the PRU values between the number of CYP 2C19 LOF alleles and the type of statin(p for interaction=0.56). In the multivariate analysis, the use of rosuvastatin was a significant predictor of a PRU value of ＞273(the highest tertile)(OR 1.67, 95% confidence interval 1.05-2.65, p=0.031).
CONCLUSIONS Rosuvastatin is associated with high on-treatment platelet reactivity compared with atorvastatin following the coadministration of clopidogrel for six months. Further studies are therefore warranted to clarify the mechanism underlying this relationship.
PubMed IF 3.4 순환기내과
13462013

제1저자 김덕겸, Donavan T. Cheng · 교신저자 Ruth J. Mayer11y, Sreekumar G. Pillai

, , , , , , , , , , , , , , , , , , , , , , , , ,
Systemic soluble receptor for advanced glycation endproducts is a biomarker of emphysema and associated with AGER genetic variants in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med. 2013;188(8):948-57.

Abstract
RATIONALE Emphysema in chronic obstructive pulmonary disease (COPD) can be characterized by high-resolution chest computed tomography (HRCT); however, the repeated use of HRCT is limited because of concerns regarding radiation exposure and cost.
OBJECTIVES To evaluate biomarkers associated with emphysema and COPD-related clinical characteristics, and to assess the relationships of soluble receptor for advanced glycation endproducts (sRAGE), a candidate systemic biomarker identified in this study, with single-nucleotide polymorphisms (SNPs) in the gene coding for RAGE (AGER locus) and with clinical characteristics.
METHODS Circulating levels of 111 biomarkers were analyzed for association with clinical characteristics in 410 patients with COPD enrolled in the TESRA study. sRAGE was also measured in the ECLIPSE cohort in 1,847 patients with COPD, 298 smokers and 204 nonsmokers. The association between 21 SNPs in the AGER locus with sRAGE levels and clinical characteristics was also investigated.
MEASUREMENTS AND MAIN RESULTS sRAGE was identified as a biomarker of diffusing capacity of carbon monoxide and lung density in the TESRA cohort. In the ECLIPSE cohort, lower sRAGE levels were associated with increased emphysema, increased Global Initiative for Chronic Obstructive Lung Disease stage, and COPD disease status. The associations with emphysema in both cohorts remained significant after covariate adjustment (P < 0.0001). One SNP in the AGER locus, rs2070600, was associated with circulating sRAGE levels both in TESRA (P = 0.0014) and ECLIPSE (7.07 × 10(-16)), which exceeded genome-wide significance threshold. Another SNP (rs2071288) was also associated with sRAGE levels (P = 0.01) and diffusing capacity of carbon monoxide (P = 0.01) in the TESRA study.
CONCLUSIONS Lower circulating sRAGE levels are associated with emphysema severity and genetic polymorphisms in the AGER locus are associated with systemic sRAGE levels. Clinical trial registered with www.clinicaltrials.gov (NCT 00413205 and NCT 00292552).
PubMed IF 21.7 호흡기내과
13452013

제1저자 박진주 · 교신저자 구본권

, , , , , ,
Clinical validation of the resting pressure parameters in the assessment of functionally significant coronary stenosis; results of an independent, blinded comparison with fractional flow reserve.
Int J Cardiol. 2013;168(4):4070-5.

Abstract
BACKGROUND The role of resting pressure parameters, i.e. instantaneous wave-free ratio (iFR), and resting distal coronary pressure/aortic pressure (Pd/Pa) in assessing functionally significant stenosis remains controversial. We sought to assess the diagnostic performance of iFR and resting whole-cycle Pd/Pa in Asian patients.
METHODS In this study, 238 consecutive lesions (no total occlusions) in which fractional flow reserve (FFR) was measured with both intravenous and intracoronary adenosine administration were included. Coded resting pressure data were sent to the core laboratory in which iFR was calculated in a blinded fashion.
RESULTS FFR and iFR had unimodal distributions and the correlation was r = 0.77 (95% confidence interval, 0.71 to 0.82). In a receiver-operating-characteristic curve analysis, iFR had an area under the curve (AUC) of 0.9 at FFR ≤ 0.80. The best cut-off value for iFR was 0.90 with a sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of 76%, 86%, 82% and 80%, and 82%, respectively. The resting whole-cycle Pd/Pa cut-off of 0.91 demonstrated a diagnostic accuracy of 82% (AUC 0.9). However, iFR had higher discriminatory power than the resting whole-cycle Pd/Pa.
CONCLUSION Both iFR and resting whole-cycle Pd/Pa showed good diagnostic performance to define the functionally significant stenosis in an independent Asian cohort distributed unimodally and without total occlusions. However, further validation is needed to explore the areas of disagreement between different physiologic parameters prior to adoption of resting pressure parameters into routine clinical practice.
PubMed IF 3.3 순환기내과
13442013

제1저자 서아영 · 교신저자 김나영

, ,
Abdominal bloating: pathophysiology and treatment.
J Neurogastroenterol Motil. 2013;19(4):433-53.

Abstract
Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating.
PubMed IF 3.7 소화기내과
13432013

제1저자 이주엽 · 교신저자 김나영

, , , , , , , , , , , , , , ,
Clinical characteristics and treatment outcomes of 3 subtypes of achalasia according to the chicago classification in a tertiary institute in Korea.
J Neurogastroenterol Motil. 2013;19(4):485-94.

Abstract
BACKGROUND/AIMS Achalasia is classified into 3 types according to the Chicago classification. The aim of this study was to investigate characteristics and treatment outcomes of 3 achalasia subtypes in Korean patients.
METHODS Fifty-five patients diagnosed with achalasia based on conventional or high-resolution esophageal manometry were consecutively enrolled. Their clinical characteristics, manometric, endoscopic and esophagographic findings and treatment responses were analyzed among the 3 subtypes of achalasia.
RESULTS Of 55 patients, 21 (38.2%) patients had type I, 28 (50.9%) patients had type II and 6 (10.9%) patients had type III. The median follow-up period was 22.4 (interquartile range, 3.6-67.4) months. Type III patients were older than type I and II patients (70.0 vs. 46.2 and 47.6 years, P = 0.023). The width of the esophagus in type I patients was wider with more frequent bird's beak appearance on esophagogram than the other 2 types (P = 0.010 and 0.006, respectively). Of the 50 patients who received the evaluation for treatment response at 3 months, 7 patients (36.8% vs. 26.9%) were treated with pneumatic dilatation and 4 patients (21.1% vs. 15.4%) with laparoscopic Heller's myotomy in type I and II groups, respectively. The treatment responses of pneumatic dilatation and Heller's myotomy in type I group were 71.4 and 50.0% and in type II were 85.7 and 75.0%, respectively, and all 5 patients in type III group showed good response to medical therapy.
CONCLUSIONS Clinical characteristics of 3 achalasia subtypes in Korean patients are consistent with other studies. Treatment outcomes are variable among 3 subtypes.
PubMed IF 3.7 소화기내과
13422013

제1저자 박경우 · 교신저자 김효수

, , , , , , , , , , , ,
Everolimus- versus sirolimus-eluting stents for the treatment of unprotected left main coronary artery stenosis (results from the EXCELLENT registry).
Int J Cardiol. 2013;168(3):2738-44.

Abstract
BACKGROUND Data concerning the results of 2nd generation DES in the treatment of unprotected left main coronary artery (ULMCA) stenosis are limited. The aim of this study was to evaluate the efficacy and safety of stenting with everolimus- (EES) with sirolimus-eluting stent (SES) for the treatment of ULMCA stenosis in the "real world" setting.
METHODS In this multi-center all-comer registry, a total of 275 patients with ULMCA stenosis were analyzed; 160 receiving EES and 115 receiving SES. The primary endpoint was major adverse cardiac events (MACE), defined as death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year.
RESULTS Baseline characteristics were similar between the two stent groups. At 1 year, the rate of MACE was comparable between the two groups (7.5% for EES vs. 13.9% for SES, HR: 0.55 [0.26-1.17], p = 0.117). However, after multivariable or propensity score adjustment, the risk of MACE was significantly lower for EES compared with that for SES (multivariable adjusted HR: 0.42 [0.19-0.92], p = 0.030; propensity score-adjusted HR: 0.43 [0.20-0.95], p = 0.037). These results were mainly driven from the numerically lower rate of repeat revascularization in the EES group (2.5% for EES vs. 7.0% for SES, p = 0.096). As for hard endpoint (death or myocardial infarction) and stent thrombosis, no differences were found between the 2 groups.
CONCLUSIONS In a large cohort of patients receiving ULMCA stenting, the MACE rate was numerically lower in the EES compared with that in the SES (statistically significant only after adjustment), which was mainly driven by significantly lower rates of repeat revascularization.
PubMed IF 3.3 순환기내과
13412013

제1저자 박흥우 · 교신저자 조상헌

, , , , , , , , , , , , , ,
Differences between asthma in young and elderly: results from the COREA study.
Respir Med. 2013;107(10):1509-14.

Abstract
BACKGROUND There has been no large-scale and comprehensive study of the differences between asthma in elderly asthmatics (EA) and non-elderly (i.e. young) asthmatics (NEA).
METHODS We performed principal component analysis (PCA) using 2067 asthmatics (434 EA and 1633 NEA) from the Korean Cohort for Reality and Evolution of adult Asthma (COREA). EA was defined as asthmatics with the chronological age of 65 or more and eleven clinical variables measured at enrollment were used for PCA; symptom score, symptom duration, number of exacerbation during previous one year, smoking pack year, number of controller medications, body mass index, predicted % of FEV1, predicted % FVC, post-bronchodilator FEV1/FVC ratio, atopy index and number of eosinophils in peripheral blood.
RESULTS PCA of all asthmatics showed that EA and NEA were distinctly separated by the first and second principal component on the plot of individual asthmatics according to their scores. For further analysis, we divided all asthmatics into the EA and the NEA group and performed PCA again in each group. The first four principal components with eigenvalues ≥ 1.0 were identified in both groups and they explained 55.5% of the variance in the EA group and 52.4% in the NEA group respectively. Clinical variables showed distinctly different patterns of loading on the first four principal components between the EA and the NEA group.
CONCLUSION EA and NEA have different compositional patterns underlying their clinical variables. These observations helped in understanding the differences between EA and NEA from the integrated view covering various clinical aspects.
PubMed IF 3.3 알레르기내과
13402013

제1저자 김혜원 · 교신저자 송영욱

,
ANCA-associated vasculitis: report from Korea.
Clin Exp Nephrol. 2013;17(5):708-711.

Abstract
We investigated the clinical features of Korean patients with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) by reviewing the literature. The characteristics of AAV in Korean patients were as follows: (1) granulomatous and limited disease is prevalent in granulomatosis with polyangiitis (Wegener's) (GPA), (2) ANCA positivity is lower in GPA (56.6-68.9%) and eosinophilic granulomatosis with polyangiitis (EGPA) (5.9-8.3%), whereas it is higher in microscopic polyangiitis (MPA) (69-94%), (3) C-ANCA/proteinase 3 (PR3)-ANCA positivity is 71.5-100% in GPA and P-ANCA/myeloperoxidase (MPO)-ANCA positivity reached 94-100% in patients with MPA, (4) renal involvement or progression to end-stage renal disease was lower in Korean patients with GPA and EGPA than in Caucasians with GPA and EGPA (according to data provided in reports). The data provided here may need to be confirmed in large-scale studies.
PubMed IF 2.4 류마티스내과
13392013

제1저자 고원중, 이승헌 · 교신저자 임재준

, , , , , , , , , , , , , , , , , , , , , , , , ,
Comparison of levofloxacin versus moxifloxacin for multidrug-resistant tuberculosis.
Am J Respir Crit Care Med. 2013;188(7):858-64.

Abstract
RATIONALE Levofloxacin (LFX) and moxifloxacin (MXF) are the two most frequently recommended fluoroquinolones for treatment of patients with multidrug-resistant tuberculosis (MDR-TB). However, studies comparing the effectiveness of LFX and MXF among patients with MDR-TB are lacking.
OBJECTIVES To compare the effectiveness of LFX and MXF in terms of culture conversion after 3 months of treatment for MDR-TB.
METHODS In this prospective multicenter randomized open label trial, we randomly assigned 182 patients with MDR-TB (sensitive to LFX and MXF) to receive either LFX (750 mg/day; 90 patients) or MXF (400 mg/day; 92 patients) with a background drug regimen. The primary outcome was the proportion of patients who achieved sputum culture conversion at 3 months of treatment. Secondary outcomes were time to culture conversion and time to smear conversion, with data censored at 3 months, and the proportions of adverse drug reactions.
MEASUREMENTS AND MAIN RESULTS At 3 months of treatment, 68 (88.3%) of the 77 patients in the LFX group and 67 (90.5%) of the 74 in the MXF group showed conversion to negative sputum cultures (odds ratio for LFX compared with MXF, 0.78; 95% confidence interval, 0.27-2.20). Adverse drug reactions were reported in six patients (7.7%) in the LFX group and four (5.2%) in the MXF group (P = 0.75).
CONCLUSIONS The choice of LFX or MXF for treatment of patients with MDR-TB may not affect sputum culture conversion at 3 months of treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 01055145).
PubMed IF 21.7 호흡기내과
13382013

제1저자 이해영 · 교신저자 이해영

, ,
Perivascular adipose tissue in the pathogenesis of cardiovascular disease.
Atherosclerosis. 2013;230(2):177-84.

Abstract
Adipose tissue, which has been considered mainly as a site of energy storage and mobilization, is found in many depots throughout the body. Adipose depots may have structural properties such as, for instance, the fat pads located in the hands and feet and the periorbital fat supporting the eyes. Adipose tissue also shows remarkable regional heterogeneity. For instance, substantial differences have been reported in the metabolic properties of visceral (intra-abdominal) vs. subcutaneous adipose depots. Visceral adipose tissue (VAT) has active endocrine and paracrine functions with the secretion of various pro-inflammatory chemokines potentially contributing to the progression of atherosclerosis related with obesity. In addition, adipose depots surrounding the heart, such as epicardial (EAT) and perivascular adipose tissues (PAT) may also exert important roles in the pathogenesis of cardiovascular disease beyond the contribution of VAT due to their close anatomic relationships with vascular structures and myocardium. The purpose of the present review is to outline the current understanding of the pathophysiological links between EAT, PAT and atherosclerotic cardiovascular disease. Also, we discuss the current investigative methods for PAT quantification and discuss the potential impact of PAT on cardiovascular risk prediction. Finally, potential clinical implications of these notions are discussed.
PubMed IF 7.1 순환기내과
13372013

제1저자 김예안, 최형진 · 교신저자 신찬수, 조남한

, , , , ,
Replication of Caucasian loci associated with bone mineral density in Koreans.
Osteoporos Int. 2013;24(10):2603-10.

Abstract
SUMMARY Most bone mineral density (BMD) loci were reported in Caucasian genome-wide association studies (GWAS). This study investigated the association between 59 known BMD loci (+200 suggestive SNPs) and DXA-derived BMD in East Asian population with respect to sex and site specificity. We also identified four novel BMD candidate loci from the suggestive SNPs.
INTRODUCTION Most GWAS have reported BMD-related variations in Caucasian populations. This study investigates whether the BMD loci discovered in Caucasian GWAS are also associated with BMD in East Asian ethnic samples.
METHODS A total of 2,729 unrelated Korean individuals from a population-based cohort were analyzed. We selected 747 single-nucleotide polymorphisms (SNPs). These markers included 547 SNPs from 59 loci with genome-wide significance (GWS, p value less than 5 × 10(-8)) levels and 200 suggestive SNPs that showed weaker BMD association with p value less than 5 × 10(-5). After quality control, 535 GWS SNPs and 182 suggestive SNPs were included in the replication analysis.
RESULTS Of the 535 GWS SNPs, 276 from 25 loci were replicated (p < 0.05) in the Korean population with 51.6 % replication rate. Of the 182 suggestive variants, 16 were replicated (p < 0.05, 8.8 % of replication rate), and five reached a significant combined p value (less than 7.0 × 10(-5), 0.05/717 SNPs, corrected for multiple testing). Two markers (rs11711157, rs3732477) are for the same signal near the gene CPN2 (carboxypeptidase N, polypeptide 2). The other variants, rs6436440 and rs2291296, were located in the genes AP1S3 (adaptor-related protein complex 1, sigma 3 subunit) and RARB (retinoic acid receptor, beta).
CONCLUSION Our results illustrate ethnic differences in BMD susceptibility genes and underscore the need for further genetic studies in each ethnic group. We were also able to replicate some SNPs with suggestive associations. These SNPs may be BMD-related genetic markers and should be further investigated.
PubMed IF 5.4 내분비대사내과
13362013

제1저자 이창현, 임종필 · 교신저자 장동경

, , , , , , , , ,
Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study.
Surg Endosc. 2013;27(10):3806-15.

Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is performed to provide nutrition to patients with swallowing difficulties. A multicenter study was conducted to evaluate the predictors of complications and mortality after PEG placement.
METHODS This study retrospectively analyzed patients who underwent initial PEG placement between January 2004 and December 2011 at seven tertiary hospitals in the Republic of Korea.
RESULTS All 1,625 patients underwent PEG placement by the pull-string method. The median age of the patients was 66 years, and 1,108 of the patients were men. The median follow-up period was 254 days. The common indications were stroke (31.6%) and malignancy (18.9%). The complication rate was 13.2%. The prophylactic use of antibiotics (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.38-0.88; p = 0.010) reduced the PEG-related infection rate, but the actual usage rate was 81.1%. The use of anticoagulants (OR, 7.26; 95% CI, 2.23-23.68; p = 0.001) and the presence of diabetes mellitus (OR, 4.02; 95% CI, 1.49-10.87; p = 0.006) increased the risk of bleeding, but antiplatelet therapy did not. The procedural, 30-day, and overall mortality rates were 0.2, 2.4 and 14.0%, respectively. Serum albumin levels lower than 31.5 g/L (OR, 8.55; 95% CI, 3.11-23.45; p < 0.001) and C-reactive protein levels higher than 21.5 mg/L (OR, 3.01; 95% CI, 1.27-7.16; p = 0.012) increased the risk of 30-day mortality, and the patients who had both risk factors had a significantly shorter median survival time than those who did not (1,740 vs 3,181 days) (p < 0.001, log-rank).
CONCLUSIONS The findings showed PEG to be a safe and feasible procedure, but the patient's nutritional and inflammatory status should be considered in predicting the outcomes of PEG placement.
PubMed IF 3.3 소화기내과
13352013

제1저자 조선욱 · 교신저자 신찬수

, , , , , , , , , , ,
Positive regulation of osteogenesis by bile acid through FXR.
J Bone Miner Res. 2013;28(10):2109-21.

Abstract
Farnesoid X receptor (FXR) is a nuclear receptor that functions as a bile acid sensor controlling bile acid homeostasis. We investigated the role of FXR in regulating bone metabolism. We identified the expression of FXR in calvaria and bone marrow cells, which gradually increased during osteoblastic differentiation in vitro. In male mice, deletion of FXR (FXR(-/-) ) in vivo resulted in a significant reduction in bone mineral density by 4.3% to 6.6% in mice 8 to 20 weeks of age compared with FXR(+/+) mice. Histological analysis of the lumbar spine showed that FXR deficiency reduced the bone formation rate as well as the trabecular bone volume and thickness. Moreover, tartrate-resistant acid phosphatase (TRACP) staining of the femurs revealed that both the osteoclast number and osteoclast surface were significantly increased in FXR(-/-) mice compared with FXR(+/+) mice. At the cellular level, induction of alkaline phosphatase (ALP) activities was blunted in primary calvarial cells in FXR(-/-) mice compared with FXR(+/+) mice in concert with a significant reduction in type I collagen a1(Col1a1), ALP, and runt-related transcription factor 2 (Runx2) gene expressions. Cultures of bone marrow-derived macrophages from FXR(-/-) mice exhibited an increased number of osteoclast formations and protein expression of nuclear factor of activated T cells, cytoplasmic 1 (NFATc1). In female FXR(-/-) mice, although bone mineral density (BMD) was not significantly different from that in FXR(+/+) mice, bone loss was accelerated after an ovariectomy compared with FXR(+/+) mice. In vitro, activation of FXR by bile acids (chenodeoxycholic acid [CDCA] or 6-ECDCA) or FXR agonists (GW4064 or Fexaramine) significantly enhanced osteoblastic differentiation through the upregulation of Runx2 and enhanced extracellular signal-regulated kinase (ERK) and β-catenin signaling. FXR agonists also suppressed osteoclast differentiation from bone marrow macrophages. Finally, administration of a farnesol (FOH 1%) diet marginally prevented ovariectomy (OVX)-induced bone loss and enhanced bone mass gain in growing C57BL/6J mice. Taken together, these results suggest that FXR positively regulates bone metabolism through both arms of the bone remodeling pathways; ie, bone formation and resorption.
PubMed IF 6.5 내분비대사내과
13342013

제1저자 이창현 · 교신저자 양종인

, , , , ,
Status of primary liver cancer found through routine health check-up.
J Korean Med Sci. 2013;28(10):1449-53.

Abstract
This study aimed to investigate the status of primary liver cancers found through a routine health check-up. The data of subjects who were diagnosed with primary liver cancer for the first time through a routine health check-up during a period of 8-yr were analyzed. Primary liver cancers were detected for the first time in 34 subjects among 91,219 routine health check-up subjects. Only 11.8% of primary liver cancer subjects had been under previous surveillance. Of them, 55.8% were positive for HBsAg, 17.7% were positive for anti-HCV, and 8.8% were heavy alcohol comsumers. However, 17.7% of the subjects were neither heavy alcohol consumers nor positive for both HBsAg and anti-HCV. Of the subjects, 50.0% had a single nodular tumor, 23.5% had multi-nodular tumors, and 26.5% had an infiltrative tumor. A routine health check-up may provide beneficial opportunities to detect a liver cancer in a very early stage. It is beneficial to start surveillance in high-risk subjects for liver cancer or to detect any liver cancer in subjects without risk factors of chronic viral hepatitis or heavy alcohol consumption.
PubMed IF 3.2 소화기내과
13332013

교신저자 윤성수

, , , , , , , , , , , , , , , ,
Hepatic sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation in adult patients with idiopathic aplastic anemia.
Leuk Res. 2013;37(10):1241-7.

Abstract
We retrospectively investigated the incidence, risk factors, and outcomes of SOS (sinusoidal obstruction syndrome; previously veno-occlusive disease [VOD]) after allogeneic hematopoietic stem cell transplantation (alloHSCT) in aplastic anemia. Two hundred and sixty patients were included in the analysis. SOS developed in 7.3% (n=19/260) of patients. Classical Cy (200 mg/m(2))-ATG was the most common conditioning regimen (84.2%) in the SOS group. The SOS mortality rate was 4/19 (21.1%). Univariate analyses revealed that Cy 200 mg/m(2) conditioning (p=0.035), classical Cy-ATG conditioning (p=0.007), and horse ATG conditioning (p<0.001) were significant risk factors for developing SOS. Multivariate analysis revealed that only horse ATG conditioning was a poor prognostic factor (HR=3.484; 95% CI 1.226-9.904; p=0.002). Rabbit ATG (HR 12.719; 95% CI 2.332-69.373; p=0.003) and weight gain>10% (HR 35.655; 95% CI 2.208-575.805; p=0.012) were risk factors in the overall SOS group. Both rabbit ATG conditioning and weight gain of more than 10% were associated with poor overall survival with a median of 1.2 months (5Y survival rate, any risk factor vs. none: 74.6% vs. 0.0%; p<0.001; Fig. 2) in the SOS group. In conclusion, SOS is a relatively rare (7.3%) but highly fatal (21.1%) acute complication of alloHSCT in AA, and the horse ATG conditioning regimen was a significant risk factor for developing SOS.
PubMed IF 2.4 혈액종양내과
13322013

제1저자 이창훈 · 교신저자 임재준

, , , , ,
Risk of hospital admission or emergency room visit for pneumonia in patients using respiratory inhalers: a case-crossover study.
Respirology. 2013;18(7):1116-27.

Abstract
BACKGROUND AND OBJECTIVE The impact of inhaled corticosteroid (ICS) use on the development of pneumonia has been heavily debated. The aim of this study was to elucidate the association between the use of inhalers, including ICS, and a hospital admission or an emergency room (ER) visit for pneumonia.
METHODS A case-crossover study was conducted based on the Korean national claims database. We identified users of respiratory inhalers admitted to the hospital or having visited the ER for pneumonia between 1 January 2008 and 31 December 2010. The case period was defined as 0-30 days before the event. Control periods of 30-60, 90-120, 180-210 and 360-390 days before the event were used.
RESULTS A total of 186 018 inhaler users were admitted to the hospital or visited the ER for pneumonia during the study period. With the period 30-60 days before the event as a control, the use of an ICS without a long-acting β2 agonist (LABA) was associated with an increased risk of hospital admission or ER visit for pneumonia (adjusted odds ratio (aOR), 1.73; 95% confidence interval (CI): 1.64-1.83). In contrast, the use of an ICS and a LABA was associated with a decreased risk for pneumonia-related hospital admission or ER visit (aOR, 0.63; 95% CI: 0.61-0.66).
CONCLUSIONS We suggest that the use of ICS with LABA decreases the risk of hospital admission or ER visit for pneumonia, whereas the use of ICS alone may increase that risk.
PubMed IF 7.2 호흡기내과
13312013

제1저자 강은하 · 교신저자 송영욱

, , , , , ,
Genetic and non-genetic factors affecting the visual outcome of ocular Behcet's disease.
Hum Immunol. 2013;74(10):1363-7.

Abstract
OBJECTIVE To examine the prognostic factors for visual outcome in Korean BD patients with uveitis.
METHODS Seventy-seven Korean BD patients with uveitis were enrolled. HLA-B and HLA-A genotypes were determined by PCR-based method. Visual acuity was measured by Snellen chart. Vision loss was graded into visual impairment (VI) defined as VA<20/40 for more than 6 months, loss of useful vision (LUV) as VA < 20/200, and near total blindness (NTB) as VA of light perception or worse.
RESULTS VI was associated with a longer duration of uveitis, posterior uveitis, and cataract, LUV with male gender, a longer duration of uveitis, posterior uveitis, and cataract, and NTB with a longer duration of uveitis, cataract, and glaucoma. HLA-B*51 and HLA-A*26:01 did not show any association with VI, LUV, or NTB. However, HLA-B*51 carriers had earlier onset of uveitis and HLA-A*26:01 was strongly associated with posterior uveitis. In patients with posterior uveitis, VI was associated with a longer duration of uveitis and cataract, LUV with a longer duration, and NTB with HLA-B*51.
CONCLUSION Longer duration of uveitis, posterior uveitis, male gender, cataract, and glaucoma were found to be associated with poor visual outcome in BD-related uveitis. HLA-B*51 was associated with NTB in patients with posterior uveitis. HLA-A*26:01 showed no association with VI, LUV, or NTB, however, was strongly associated with posterior uveitis.
PubMed IF 2.1 류마티스내과
13302013

제1저자 성문혁 · 교신저자 정숙향

, , , , , , ,
Clinical and epidemiological features of hepatitis C virus infection in South Korea: a prospective, multicenter cohort study.
J Med Virol. 2013;85(10):1724-33.

Abstract
The epidemiological and clinical features of hepatitis C virus (HCV) infection in South Korea were examined in a prospective, multicenter cohort study that included 1,173 adult patients with positive results for anti-HCV antibody who completed a questionnaire survey on the risk factors for HCV infection from January 2007 to December 2011 at five university hospitals. The HCV cohort had a mean age of 55.4 years with 48.3% men, and diagnostic categories of acute hepatitis (n = 63, 5.3%), past infection (n = 37, 3.2%), chronic hepatitis (n = 777, 66.2%), cirrhosis of the liver (n = 179, 15.3%), and hepatocellular carcinoma (n = 117, 10.0%). The major HCV genotypes were genotype 1 (52.7%) and genotype 2 (45.3%). Liver biopsy was performed in 301 patients (25.7%), and 42.8% of the subjects received antiviral therapy against HCV. The behavioral risk factors possibly related to HCV infection were intravenous drug use (5%), needle stick injury (7%), blood transfusion before 1995 (19%), sexual relationship with more than three partners (28%), piercings (35%), tattoos (36%), surgery (43%), acupuncture (83%), diagnostic endoscopy (85%), and dental procedures (93%). Age, intravenous drug use, needle stick injury, transfusion before 1995, and tattoos were the independent risk factors of HCV infection.
PubMed IF 3.7 소화기내과
13292013

제1저자 김범석 · 교신저자 김동완

, , , , , , ,
How Molecular Understanding Affects to Prescribing Patterns and Clinical Outcome of Gefitinib in Non-small Cell Lung Cancer? 10 Year Experience of Single Institution.
Cancer Res Treat. 2013;45(3):178-85.

Abstract
PURPOSE Gefitinib was introduced in 2002 for treatment of non-small cell lung cancer (NSCLC); however, it is not clear whether its use in daily practice has changed the outcome of patients. The purpose of this study is to evaluate the question of how molecular understanding regarding gefitinib and epidermal growth factor receptor (EGFR) mutation affect the prescribing patterns and clinical outcomes of treatment with gefitinib in NSCLC, in a real practical field.
MATERIALS AND METHODS We conducted a retrospective analysis of the consecutive database of NSCLC patients who were treated with gefitinib at Seoul National University Hospital between January 2002 and December 2011. Prescribing patterns and clinical outcomes were analyzed by year.
RESULTS A total of 1,115 NSCLC patients, who received gefitinib at recurred or metastatic setting, were included in this study. Proportion of patients receiving gefitinib, for the first line, showed a gradual increase, from 5.2% in 2002-2003 to 30.6% in 2010-2011. Proportion of patients who underwent EGFR mutation testing showed a rapid increase, from 0.6% in 2004-2005 to 73.5% in 2010-2011. The response rate also showed a gradual increase, from 17.2% in 2002-2003 to 57.1% in 2010-2011 (p<0.001). The median progression-free survival of gefitinib was increased with statistical significance from 2.8 months in 2002-2003 to 9.1 months in 2010-2011 (p<0.001).
CONCLUSION We demonstrated that molecular understanding and practical use of EGFR mutation testing have resulted in a change in the prescription patterns of gefitinib. Use of an enrichment strategy can lead to improvement in the efficacy of gefitinib in real practice.
PubMed IF 4.2 혈액종양내과
13282013

제1저자 김효진 · 교신저자 이정표

, , , , , , , , , , ,
Outcomes of kidney allograft in recipients with kidney disease of unknown etiology.
Clin Transplant. 2013;27(6):866-74.

Abstract
The etiology of renal disease is important because the primary renal pathology may affect the outcomes of kidney allograft with respect to recurrence, rejection, and survival. However, for a significant number of patients who undergo kidney transplantation, the disease etiology is unknown. Here, allograft outcomes for patients with kidney disease of unknown etiology (UEK) at three affiliated Korean hospitals were identified. The incidence of biopsy-proven acute rejection (BPAR) for UEK was 22.9%, which was similar to the rates for diabetic nephropathy (DN, 24.4%) and IgA nephropathy (IgAN, 20.0%; p = 0.345). The cumulative incidence of post-transplant glomerulonephritis (PTGN) among patients with UEK was significantly lower than that among patients with IgAN (p < 0.001). Overall graft survival of the UEK group was superior to that of the DN group (hazards ratio 0.39, 95% confidence interval 0.17-0.92, p = 0.030). Preemptive transplantation for UEK significantly reduced the incidence of BPAR (preemptive vs. non-preemptive 9.6% vs. 30.3%, p = 0.001), but graft survival and recurrence were not affected by preemptive transplantation. The outcomes of kidney transplantation for patients with UEK were not inferior to those for patients with IgAN or DN. Preemptive kidney transplantation may be encouraged for UEK patients.
PubMed IF 1.8 신장내과
13272013

제1저자 박경우 · 교신저자 김효수

, , , , , , , , , ,
Thiazolidinedione usage is associated with decreased response to clopidogrel in DM patients.
Int J Cardiol. 2013;168(1):608-10.

PubMed IF 3.3 순환기내과
13262013

제1저자 김민수 · 교신저자 김나영

, , , , , ,
Long-term follow up Helicobacter Pylori reinfection rate after second-line treatment: bismuth-containing quadruple therapy versus moxifloxacin-based triple therapy.
BMC Gastroenterol. 2013;13:138.

Abstract
BACKGROUND The increasing trend of antibiotic resistance requires effective second-line Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori after second-line treatment that would determine the long-term follow up effect of the rescue therapy.
METHODS A total of 648 patients who had failed previous H. pylori eradication on standard triple therapy were randomized into two regimens: 1, esomeprazole (20 mg b.i.d), tripotassium dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (20 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, H. pylori tests were performed with 13C urea breath test or invasive tests. In patients who maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. For the evaluation of risk factors of reinfection, gender, age, clinical diagnosis, histological atrophic gastritis or intestinal metaplasia were analyzed.
RESULTS The recrudescence rate of the EBMT was 1.7% and of the MEA group 3.3% (p = 0.67). The annual reinfection rate of H. pylori of EBMT was found to be 4.45% and the MEA group 6.46%. Univariate analysis (Log-rank test) showed no association with any clinical risk factor for reinfection.
CONCLUSIONS The long-term reinfection rate of H. pylori stayed low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy; thus reinfection cannot affect the choice of second-line treatment.
TRIAL REGISTRATION Clinical Trial Registration Number NCT01792700.
PubMed IF 3.2 소화기내과
13252013

제1저자 박경우 · 교신저자 김효수

, , , , , , , , , , , ,
Usefulness of the SYNTAX and clinical SYNTAX scores in predicting clinical outcome after unrestricted use of sirolimus- and everolimus-eluting Stents.
Circ J. 2013;77(12):2912-21.

Abstract
BACKGROUND The SYNTAX score (SS) and clinical SS (cSS) can assess coronary lesion complexity and are useful indices in predicting outcomes after percutaneous coronary intervention. However, their validity has not been fully investigated in daily practice where "limus"-eluting stents are used.
METHODS AND RESULTS The SS and cSS were independently assessed from the Efficacy of Xience/Promus vs. Cypher in rEducing Late Loss after stENTing (EXCELLENT) registry, together with the 1-year patient-oriented composite endpoint (POCE; all-cause death, any myocardial infarction (MI), and any revascularization) and target-lesion failure (TLF; cardiac death, target-vessel MI, and target-lesion revascularization). Among 5,102 patients, tertiles for SS were defined as low-SS <8, 8≤mid-SS≤16, high-SS >16. Both POCE (4.2% vs. 7.7% vs. 12.2%, P<0.001) and TLF (1.6% vs. 2.4% vs. 4.5%, P<0.001) increased significantly with increasing SS tertile, and SS was an independent predictor of POCE (P<0.001 for trend) and TLF (P=0.023 for trend) in multivariate analysis. The predictability of SS and cSS was similar for POCE (area under the curve (AUC): 0.635 vs. 0.629, P=0.599), whereas SS was superior in predicting restenosis-related outcomes such as revascularization (AUC: 0.624 vs. 0.577, P<0.001) and cSS was superior in other components such as death (AUC: 0.654 vs. 0.795, P<0.001).
CONCLUSIONS Both SS and cSS were applicable to unrestricted use of "limus"-eluting stents in predicting the risk of 1-year clinical outcomes.
PubMed IF 5.8 순환기내과
13242013

제1저자 조현진 · 교신저자 김나영

, , , , , , , ,
The Effect of Cochinchina momordica Seed Extract on Gastric Acid Secretion and Morphologic Change in Aged Rat Stomach.
Gut Liver. 2013;7(5):560-8.

Abstract
BACKGROUND/AIMS Cochinchina momordica seed extract (SK-MS10) has a gastric protective effect. We aimed to assess the effect of SK-MS10 on gastric acid secretion with morphologic changes in the aged rat.
METHODS Acid secretions were evaluated in the male F344 rats of four different ages (6-, 31-, 74-week, and 2-year). The 31-week-old rats were divided to three groups and continuously administered chow containing vehicle, SK-MS10 and lansoprazole, respectively. At the age of 74 weeks and 2 years, basal and stimulated acid was measured and the expression of mRNA and protein of H(+)-K(+)-ATPase were determined. The area of connective tissue of lamina propria was measured.
RESULTS Basal and stimulated gastric acid significantly decreased and connective tissue of lamina propria increased with age. The expression of mRNA and protein of H(+)-K(+)-ATPase significantly decreased with age. However, 74-week-old rats in the SK-MS10 group had higher stimulated gastric acid secretion than those in the vehicle and lansoprazole groups. In 2-year-old rats of SK-MS10 group, there was no increase of connective tissue.
CONCLUSIONS As SK-MS10 kept the capacity of acid secretion as well as connective tissue area to comparable to young rats, it might valuable to perform further research regarding mechanism of SK-MS10 as an antiaging agent in the stomach.
PubMed IF 4.1 소화기내과
13232013

제1저자 이윤석 · 교신저자 이상협

, , , , , ,
Immunoglobulin g4-related disease mimicking unresectable gallbladder cancer.
Gut Liver. 2013;7(5):616-20.

Abstract
Immunoglobulin G4 (IgG4)-related disease is a novel disease entity that can involve diverse organs, causing specific diseases, including autoimmune pancreatitis, sclerosing cholangitis, cholecystitis, inflammatory aortic aneurysm, and inflammatory pseudotumor. IgG4-related disease is characterized by elevated serum IgG4 concentrations, abundant IgG4 lymphoplasmacytic infiltration, and dramatic steroid responses. It is clinically important to differentiate this rare disease from primary sclerosing cholangitis and cholangiocarcinoma, because the treatment and prognosis of these two diseases are completely different. However, the preoperative diagnosis is challenging, and the disease is frequently misdiagnosed. If the serum level of IgG4 is within the normal range, the diagnosis of IgG4-related disease is more difficult. This article reports on a 59-year-old man with IgG4-related disease mimicking unresectable gallbladder cancer with normal serum IgG4 concentrations.
PubMed IF 4.1 소화기내과
13222013

제1저자 이주명 · 교신저자 연태진

, , , , , , , , ,
Comparison of 9-month angiographic outcomes of Resolute zotarolimus-eluting and everolimus-eluting stents in a real world setting of coronary intervention in Korea.
BMC Cardiovasc Disord. 2013;13:65.

Abstract
BACKGROUND Clinical outcomes of new-generation drug-eluting stents (DES), Everolimus-eluting stent (EES) or Resolute zotarolimus-eluting stent (R-ZES), have been reported. However, angiographic follow-up data of new-generation DES are limited, especially in Asians. We investigated the angiographic and clinical outcomes of EES and R-ZES in a real-world setting of Korean patients.
METHODS Angiographic and clinical outcomes of 679 patients (866 lesions) who had been treated with EES or R-ZES from Jun 2008 to May 2010 were evaluated. The primary analysis was to compare in-segment late loss at 9 months and the secondary analyses were to compare the clinical outcomes.
RESULTS In-segment late loss at 9-month follow-up angiography was 0.23 ± 0.52 mm for EES and 0.29 ± 0.64 mm for R-ZES (p = 0.248). In addition, the rate of binary restenosis did not show between-group differences (5.8% vs. 6.8% for EES and R-ZES, respectively, p = 0.716). During a median follow-up of 33 months, there were no significant differences in Kaplan-Meier estimates of target lesion failure (TLF) (7.5% vs. 7.9% for EES and R-ZES, respectively, p = 0.578) and patient-oriented composite outcomes (POCO including all-cause death, any myocardial infarction, and any revascularization, 22.8% vs. 20.1%, p = 0.888). The adjusted hazard ratios for TLF and POCO were 0.875 (95% CI 0.427 - 1.793; p = 0.715) and 1.029 (95% CI 0.642 - 1.650; p = 0.904), respectively, for EES over R-ZES in the propensity score matched group analysis.
CONCLUSIONS In Korean patients undergoing new-generation DES implantation for coronary artery disease, EES and R-ZES showed similar angiographic outcomes at 9 months and comparable clinical outcomes during 2.8 years of median follow-up.
PubMed IF 3.1 순환기내과
13212013

제1저자 나기영 · 교신저자 임춘수

, , , ,
Effect of beraprost sodium on arterial stiffness in patients with type 2 diabetic nephropathy.
Trials. 2013;14:275.

Abstract
BACKGROUND Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). Cardiovascular (CV) complications are the most common cause of death among ESRD patients. Beraprost sodium (BPS) is a prostacyclin analog with vasodilatory and antiplatelet effects.
METHODS This is a multicenter prospective, randomized, double-blind, placebo-controlled trial to determine whether treatment with BPS improves arterial stiffness in patients with type 2 diabetic nephropathy. A total of 102 participants with type 2 diabetic nephropathy will be screened, enrolled, and randomly assigned to receive either 80 μg BPS or placebo daily for 12 weeks. The primary outcome is the change in brachial-ankle pulse wave velocity between baseline and after 12 weeks of medication use. The secondary outcomes will include changes in the ankle-brachial index, the urine albumin to creatinine ratio, the estimated glomerular filtration rate, lipid profiles, and blood pressure from baseline to after treatment.
DISCUSSION This clinical trial is the first to investigate the effects of BPS on changes in CV biomarkers, albuminuria, renal function, and lipid profiles in patients with diabetic nephropathy.
TRIAL REGISTRATION ClinicalTrials.gov number NCT01796418.
PubMed IF 2.1 신장내과
13202013

제1저자 Huang D, 김동완 · 교신저자 Park K, Mao M

, , , , , , , , , , , , , , ,
Multiplexed deep sequencing analysis of ALK kinase domain identifies resistance mutations in relapsed patients following crizotinib treatment.
Genomics. 2013;102(3):157-62.

Abstract
The recently approved ALK kinase inhibitor crizotinib has demonstrated successful treatment of metastatic and late stage ALK fusion positive non-small cell lung cancer (NSCLC). However, the median duration of clinical benefit is ~10-11months due to the emergence of multiple and simultaneous resistance mechanisms in these tumors. Mutations in the ALK kinase domain confer resistance to crizotinib in about one-third of these patients. We developed a multiplex deep sequencing method using semiconductor sequencing technology to quickly detect resistance mutations within the ALK kinase domain from tumor biopsies. By applying a base-pair specific error-weighted mutation calling algorithm (BASCA) that we developed for this assay, genomic DNA analysis from thirteen relapsed patients revealed three known crizotinib resistance mutations, C1156Y, L1196M and G1269A. Our assay demonstrates robust and sensitive detection of ALK kinase mutations in NSCLC tumor samples and aids in the elucidation of resistance mechanisms pertinent to the clinical setting.
PubMed IF 3.6 혈액종양내과
13192013

제1저자 최종경/류지곤 · 교신저자 이상협

, , , , , , , , ,
Palliative treatment of unresectable hepatocellular carcinoma with obstructive jaundice using biliary drainage with subsequent transarterial chemoembolization.
J Palliat Med. 2013;16(9):1026-33.

Abstract
BACKGROUND Nonsurgical biliary drainage is considered as a priority for obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC). Successful drainage allows the patient to receive antitumor therapy, such as transarterial chemoembolization (TACE). However, only limited data are available on clinical outcomes in patients who treated biliary drainage with subsequent TACE.
OBJECTIVE This study evaluated the clinical outcome of biliary drainage with subsequent TACE in unresectable HCC patients with obstructive jaundice.
DESIGN This was a retrospective study.
SETTING/SUBJECTS A total of 60 patients received endoscopic biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD) in two tertiary care referral centers.
MEASUREMENTS Successful drainage and survival were measured.
RESULTS Successful drainage was achieved in 39 (65%) patients. The median survival of 39 patients in whom successful drainage was achieved, regardless of which procedure was performed, was much longer than that of 21 patients without successful drainage (147 days versus 38 days, respectively, P<.001). In particular, the median survival was longer in 17 patients who underwent TACE after achieving successful drainage than in 22 patients who were treated conservatively after achieving successful drainage (410 days versus 77 days, respectively, P<.001). Multivariable analysis in 39 patients in the successful drainage group showed that TACE (hazard ratio 0.15; 95% confidence interval 0.05-0.45, P=.001) was an independent predictive factor of a favorable outcome.
CONCLUSIONS Effective palliation by successful biliary drainage with subsequent TACE might prolong the survival in patients with obstructive jaundice caused by unresectable HCC.
PubMed IF 1.8 소화기내과

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