SCI 발표논문
전체 4,588편
- 12282013
제1저자 강민정 · 교신저자 김태유
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Proteomic analysis reveals that CD147/EMMPRIN confers chemoresistance in cancer stem cell-like cells.Proteomics. 2013;13(10-11):1714-25.
PubMed IF 4.1 혈액종양내과Abstract
Cancer stem cells (CSCs) are a subpopulation of tumor cells that can self-renew, metastasize, and promote cancer recurrence. A comprehensive characterization of the CSC proteome has been hampered due to their scarcity and rapid differentiation. Here, we present a systematic analysis of the cell-surface proteome using a CSC-like cell line derived from MDA-MB453 breast cancer cells, which exhibited a CD44(+) /CD24(-) (where CD is cluster of differentiation) phenotype and chemoresistance. We identified differentially expressed proteins in CSC-like cells, including upregulated plasma membrane proteins such as CD44, CD133, epidermal growth factor receptor (EGFR), CD147, cadherin 1, integrins, and catenin (cadherin-associated protein), beta 1 (CTNNB1), using an in-situ biotinylation approach followed by MS analysis. We examined the role of CD147 in the promotion of CSC growth and survival, and demonstrated that inhibition of CD147 with a monoclonal antibody induced significant inhibition of cell growth. siRNA-mediated silencing of CD147 gene expression restored the sensitivity of CSC-like cells to 5-fluorouracil (5-FU), along with decreasing the expression of thymidylate synthase, p-AKT, and β-catenin, while increasing the expression of p-glycogen synthase kinase (GSK)3β. Increased CD147 expression in the CSC-like cells, as seen by proteomic analysis, and the functional consequences of CD147 overexpression in CSC-like cells suggest that CD147 may be one of the critical cell-surface proteins involved in promoting chemoresistance and survival in CSCs.
- 12272013
제1저자 한세원 · 교신저자 김태유
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Methylation and microsatellite status and recurrence following adjuvant FOLFOX in colorectal cancer.Int J Cancer. 2013;132(9):2209-16.
PubMed IF 4.9 혈액종양내과Abstract
The prognostic impact of CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) on the treatment outcome of colon cancer patients receiving adjuvant 5-fluorouracil/leucovorin/oxaliplatin (FOLFOX) is unclear. We investigated CIMP and MSI status in colorectal cancer patients treated with adjuvant FOLFOX. Stages II and III sporadic colorectal cancer patients who underwent curative resection followed by adjuvant FOLFOX were included. Eight CpG island loci (CACNA1G, CRABP1, IGF2, MLH1, NEUROG1, CDKN2A (p16), RUNX3 and SOCS1) and five microsatellite markers were examined. Disease-free survival (DFS) was analyzed according to CIMP and MSI status. A total of 322 patients were included: male/female 192/130, median age 61 years (range 30-78), proximal/distal location 118/204 and Stages II/III 43/279. CIMP status was high in 25 patients (7.8%) and 21 patients (6.5%) had MSI-high tumor. CIMP/MSI status was not significantly associated with DFS: 3-year DFS 100% in CIMP(-)/MSI(+), 84% in CIMP(-)/MSI(-), 82% in CIMP(+)/MSI(-) and 75% in CIMP(+)/MSI(+) (p = 0.33). Results of exploratory analysis showed that concurrent methylation at NEUROG1 and CDKN2A (p16) was associated with shorter DFS: 3-year DFS 69% in NEUROG1(+)/CDKN2A (p16)(+) versus 87% in NEUROG1(-)/CDKN2A (p16)(-) (p = 0.006). In conclusion, concurrent methylation of NEUROG1 and CDKN2A (p16) is associated with recurrence following adjuvant FOLFOX in Stages II/III colorectal cancer.
- 12262013
제1저자 이윤규 · 교신저자 김인호
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Comparative analysis between azacitidine and decitabine for the treatment of myelodysplastic syndromes.Br J Haematol. 2013;161(3):339-47.
PubMed IF 3.6 혈액종양내과Abstract
The present study aimed to directly compare the efficacy and safety of azacitidine and decitabine in patients with myelodysplastic syndromes (MDS). We compared the overall response rate (ORR) (complete responses, partial responses, marrow complete responses, and haematological improvements), overall survival (OS), event-free survival (EFS), time to leukaemic transformation, and adverse outcomes between azacitidine and decitabine. To minimize the effects of treatment selection bias in this observational study, adjustments were made using the propensity-score matching method. Among 300 patients, 203 were treated with azacitidine and 97 with decitabine. Propensity-score matching yielded 97 patient pairs. In the propensity-matched cohort, there were no significant differences between the azacitidine and decitabine groups regarding ORR (44% vs. 52%), OS (26 vs. 22.9 months), EFS (7.7 vs. 7.0 months), and rate of leukaemic transformation (16% vs. 22% at 1 year). In patients ≥ 65 years of age, survival was significantly better in the azacitidine group (P = 0.017). Patients who received decitabine experienced more frequent episodes of grade 3 or 4 cytopenia and infectious episodes. We found that azacitidine and decitabine showed comparable efficacy. Among patients ≥ 65 years of age, survival was significantly better in the azacitidine group (ClinicalTrials.gov Identifier: NCT01409070).
- 12252013
제1저자 진광남 · 교신저자 이창훈
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Bubble-like air opacities in the mediastinum.Am J Respir Crit Care Med. 2013;187(9):e16-7.
- 12242013
제1저자 유수종 · 교신저자 김윤준
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Hepatocellular carcinoma: high hepatitis B viral load and mortality in patients treated with transarterial chemoembolization.Radiology. 2013;267(2):638-47.
PubMed IF 17.6 소화기내과Abstract
PURPOSE To determine the relationship between hepatitis B virus (HBV) DNA level and the survival of patients with hepatocellular carcinoma treated by means of transarterial chemoembolization (TACE).
MATERIALS AND METHODS This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. From January 2005 to March 2007, 183 patients with HBV-related hepatocellular carcinoma who underwent TACE but never received antiviral therapy were consecutively enrolled in our cohort. All patients were tested for pre-TACE serum level of HBV DNA, and overall survival was measured from date of enrollment until death from any cause. Radiologic progression was evaluated by using the modified response evaluation criteria in solid tumors by means of independent radiologic assessment.
RESULTS The median overall survival was 19 months (95% confidence interval: 13.7, 24.3) and median time to progression was 4 months (95% confidence interval: 3.03, 4.97). Multivariate analysis revealed that a high pre-TACE serum level of HBV DNA (> 2000 IU/L) was an independent risk factor for reduced overall survival (P = .021; hazard ratio [HR], 1.725), high cancer progression-related mortality (P = .014; HR, 1.936), and hepatic failure-related mortality associated with cancer progression (P = .005, HR, 3.908). Pre-TACE level of HBV DNA did not significantly affect hepatic failure-related mortality that was not caused by cancer progression.
CONCLUSION A high pre-TACE serum level of HBV DNA was associated with poor overall survival and rapid progression of hepatocellular carcinoma after TACE, and the cause of mortality was not hepatitis exacerbation but cancer progression.
- 12232013
제1저자 윤혁 · 교신저자 김상균
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Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer.Surg Endosc. 2013;27(5):1561-8.
PubMed IF 3.3 소화기내과Abstract
BACKGROUND In cases with a tumor-positive resection margin after endoscopic resection of early gastric cancer (EGC), not all patients are found to have residual or recurrent tumor. The aim of this study was to identify risk factors associated with residual/recurrent tumor in patients with incomplete endoscopic resection of EGC.
METHODS A retrospective analysis was performed on consecutive patients who underwent endoscopic resection of EGC at a single institution in South Korea. Patients with a tumor-positive resection margin in the specimen were divided into two groups, with and without residual/recurrent tumor, and the clinicopathologic characteristics were compared.
RESULTS A total of 102 patients with a tumor-positive lateral or vertical resection margin after endoscopic mucosal resection (n = 10) or submucosal dissection (n = 92) were enrolled. Overall, the rate of residual/recurrent tumor was 33.3 % (34/102): 17 residual tumors in 46 patients who immediately underwent additional endoscopic or surgical resection, and 17 recurrent tumors in 56 patients who were initially followed up with regular endoscopy during a median period of 17 (range = 2-70) months. Univariate analysis showed that the presence of ulcer, the direction of the tumor-positive resection margin, and length of lateral resection margin involvement by the tumor were associated with the incidence of residual/recurrent tumor. In multivariate analysis, total length (cm) of lateral resection margin involvement was the only independent risk factor for residual/recurrent tumor (OR 2.05; 95 % CI 1.22-3.44, p = 0.006).
CONCLUSIONS Patients with extensive tumor involvement of a lateral resection margin after endoscopic resection of EGC should consider additional endoscopic or surgical resection due to a high risk of residual/recurrent tumor.
- 12222013
제1저자 서정원 · 교신저자 최동주
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A single-center prospective randomized controlled trial evaluating the safety and efficacy of IntraCoronary Erythropoietin delivery BEfore Reperfusion: gauging infarct size in patients with acute ST-segment elevation myocardial infarction. Study design and rationale of the 'ICEBERG Trial'.Contemp Clin Trials. 2013;35(1):145-50.
PubMed IF 1.9 순환기내과Abstract
BACKGROUND Erythropoietin (EPO) protected the myocardium from ischemia and reperfusion injury in preclinical studies. However, whether EPO can reduce myocardial injury in patients with acute myocardial infarction (MI) is controversial. The inconsistent results of previous studies have been attributed to differences in the doses, timing, and routes of administration of EPO. In this study, we will evaluate intracoronary treatment with a long-acting EPO analog, darbepoetin-α, administered immediately before reperfusion in patients with acute anterior ST-segment elevation MI.
METHODS This trial will be a single-center, prospective, randomized, two-arm, controlled trial with blind evaluation of the endpoints. At the time of the primary percutaneous coronary intervention, 80 patients will randomly receive one of the following treatments immediately before the first ballooning: intracoronary darbepoetin-α (ARANESP®; Jeil-Kirin Pharm., Korea) 300μg (n=40) or saline (n=40), administered via the over-the-wire balloon system. The objectives of this study are to evaluate the safety and efficacy of intracoronary darbepoetin-α therapy.
DISCUSSION This is the first study to evaluate the safety and efficacy of intracoronary darbepoetin-α treatment in patients with acute MI.
- 12212013
제1저자 김상균, 송호준 · 교신저자 정현채
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Helicobacter pylori eradication on iatrogenic ulcer by endoscopic resection of gastric tumour: a prospective, randomized, placebo-controlled multi-centre trial.Dig Liver Dis. 2013;45(5):385-9.
PubMed IF 4.9 소화기내과Abstract
INTRODUCTION The role of Helicobacter pylori (H. pylori) eradication has not been clarified in the healing of iatrogenic ulcer after endoscopic resection of gastric neoplasm. The aim of this study was to evaluate whether H. pylori eradication could facilitate the healing of iatrogenic ulcer after endoscopic resection of gastric neoplasm.
METHODS A total of 232 patients with H. pylori-positive early gastric cancer or gastric adenoma underwent endoscopic resection and were randomly allocated to eradication or placebo group in a prospective, double-blinded, and placebo-controlled manner. The primary outcome was measured by healing rate of ulcer, and the secondary outcomes by reduction rate of ulcer size, relief rate from ulcer-related symptoms, and adverse event rates.
RESULTS The healing rate of ulcer was 53% in eradication group and 51.6% in placebo group, respectively (p value=0.95). The reduction rate of ulcer size, relief rate from ulcer-related symptoms and adverse event rates were also not different between two groups. In multivariate analysis, initial ulcer size more than 3 cm and histology of cancer were significant factors affecting iatrogenic ulcer healing.
CONCLUSIONS H. pylori eradication did not facilitate iatrogenic ulcer healing at early and late phase after endoscopic resection of gastric neoplasm.
- 12202013
제1저자 조유리 · 교신저자 김윤준
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The efficacy of adefovir plus entecavir combination therapy in patients with chronic hepatitis B refractory to both lamivudine and adefovir.Dig Dis Sci. 2013;58(5):1363-70.
PubMed IF 2.8 소화기내과Abstract
BACKGROUND The efficacy of adefovir (ADV) plus entecavir (ETV) combination in patients with chronic hepatitis B (CHB) who developed multidrug refractoriness had not been fully evaluated. We aimed to evaluate the efficacy of ADV plus ETV as compared to that of lamivudine (LAM) plus ADV in the patients with antiviral refractoriness to sequential LAM monotherapy and then ADV monotherapy.
METHODS Twenty-seven patients were treated with a combination of ADV plus ETV and 63 patients were treated with a combination of LAM plus ADV. The virological and biochemical parameters were compared between the two groups, retrospectively.
RESULTS Treatment with a combination of ADV plus ETV produced significantly superior virological response than that of a combination of LAM plus ADV. At 12 months, the HBV DNA declined more in the ADV plus ETV group than in the LAM plus ADV (-4.52 ± 1.956 vs. -2.65 ± 1.723 log 10 IU/mL; p = 0.001). The rate of a complete response at 12 months was greater in the ADV plus ETV group than that in the LAM plus ADV group (63.16 vs. 14.81 %, p < 0.001).
CONCLUSION In the patients with CHB refractory to both LAM and ADV, the response to ADV plus ETV was significantly superior compared to that of the LAM plus ADV in suppressing HBV DNA. The result indicates that ADV plus ETV can be used as a bridging therapy in the patients with refractoriness to both LAM and ADV, especially in the areas where tenofovir is not yet available.
- 12192013
제1저자 주권욱, 김세중 · 교신저자 나기영
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Dipeptidyl peptidase IV inhibitor attenuates kidney injury in rat remnant kidney.BMC Nephrol. 2013;14:98.
PubMed IF 2.9 신장내과Abstract
BACKGROUND The inhibition of dipeptidyl peptidase (DPP) IV shows protective effects on tissue injury of the heart, lung, and kidney. Forkhead box O (FoxO) transcriptional factors regulate cellular differentiation, growth, survival, the cell cycle, metabolism, and oxidative stress. The aims of this study were to investigate whether the DPP IV inhibitor sitagliptin could attenuate kidney injury and to evaluate the status of FoxO3a signaling in the rat remnant kidney model.
METHODS Rats were received two-step surgery of 5/6 renal mass reduction and fed on an oral dose of 200 mg/kg/day sitagliptin for 8 weeks. Before and after the administration of sitagliptin, physiologic parameters were measured. After 8 weeks of treatment, the kidneys were harvested.
RESULTS The sitagliptin treatment attenuated renal dysfunction. A histological evaluation revealed that glomerulosclerosis and tubulointerstitial injury were significantly decreased by sitagliptin. Sitagliptin decreased DPP IV activity and increased the renal expression of glucagon-like peptide-1 receptor (GLP-1R). The subtotal nephrectomy led to the activation of phosphatidylinositol 3-kinase (PI3K)-Akt and FoxO3a phosphorylation, whereas sitagliptin treatment reversed these changes, resulting in PI3K-Akt pathway inactivation and FoxO3a dephosphorylation. The renal expression of catalase was increased and the phosphorylation of c-Jun N-terminal kinase (JNK) was decreased by sitagliptin. Sitagliptin treatment reduced apoptosis by decreasing cleaved caspase-3 and -9 and Bax levels and decreased macrophage infiltration.
CONCLUSIONS In rat remnant kidneys, DPP IV inhibitor attenuated renal dysfunction and structural damage. A reduction of apoptosis, inflammation and an increase of antioxidant could be suggested as a renoprotective mechanism together with the activation of FoxO3a signaling. Therefore, DPP IV inhibitors might provide a promising approach for treating CKD, but their application in clinical practice remains to be investigated.
- 12182013
제1저자 김진원, 전은주 · 교신저자 이근욱
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A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: an inquiry into the application of Western guidelines to Asian cancer patients.PLoS One. 2013;8(4):e61968.
PubMed IF 2.8 혈액종양내과Abstract
Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents underwent routine duplex Doppler ultrasonography (DUS) on days 5-12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9-3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54-43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. In conclusion, the incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.
- 12172013
제1저자 박진현 · 교신저자 김태유
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The beneficial effect of palliative resection in metastatic colorectal cancer.Br J Cancer. 2013;108(7):1425-31.
PubMed IF 7.8 혈액종양내과Abstract
BACKGROUND We aimed to determine the role of palliative resection in metastatic colorectal cancer (mCRC) and ascertain which patient populations would benefit most from this treatment.
METHODS A total of 1015 patients diagnosed with mCRC at Seoul National University Hospital between 2000 and 2009 were retrospectively studied.
RESULTS Of the 1015 patients, 168 patients with only liver and/or lung metastasis received curative resection. The remaining 847 patients were treated with palliative chemotherapy and/or palliative resection combined with best supportive care. Palliative resection was performed in 527 (62.2%) cases (complete resection with negative margin (R0) in 93, R1/2 in 434). Resected patients had a more prolonged median overall survival (OS) than unresected patients (21.3 vs 14.1 months; P<0.001). In multivariate analysis, R0 resection was found to be associated with a superior OS compared with R1/2 resection (51.3 vs 19.1 months; P<0.001) and no resection (51.3 vs 14.1 months; P<0.001). When we performed propensity score matching, palliative resection was found to be related to prolonged OS (hazard ratio=0.72, 95% confidence interval=0.59-0.89; P=0.003).
CONCLUSION Palliative resection without residual disease and chemotherapy confers a longer-term survival outcome than palliative chemotherapy alone in mCRC patient subset.
- 12162013
제1저자 조현진 · 교신저자 김나영
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Predictable Marker for Regression of Barrett's Esophagus by Proton Pump Inhibitor Treatment in Korea.J Neurogastroenterol Motil. 2013;19(2):210-8.
PubMed IF 3.7 소화기내과Abstract
BACKGROUND/AIMS There has been no report regarding the regression of Barrett's esophagus (BE) by continuous treatment of proton pump inhibitor (PPI). The aim of this study was to determine the regression rate of BE by PPI and predictable markers related to regression.
METHODS Thirty-five patients diagnosed as BE were consecutively enrolled and most of them took continuous PPI. The 25 patients underwent endoscopic surveillance and received biopsy. If the specialized intestinal metaplasia (SIM) was lost at any point of surveillance and did not recur, the case was regarded as the regression group. The proportion of SIM was graded and the mucin phenotype was decided using immunohistochemistry for MUC2, MUC5AC and MUC6. To assess the cell proliferation indexes and the degree of intestinal maturation, immunohistochemistry for Ki67 and CDX2 were performed.
RESULTS The regression of BE occurred in the 11 (44%) patients. The clinical and demographic factors showed no difference between the regression (n = 11) and persistence group (n = 14). The lower grade of SIM (P < 0.001) and gastric predominant mucin phenotype (P = 0.018) were more frequent, and the number of Ki67 positive cell per gland (P = 0.008) and the mean extent of CDX2 (P = 0.022) were lower in the regression group than in the persistence group.
CONCLUSIONS The regression of BE by PPI treatment was frequent in Korea. The immunohistochemical detection of mucin phenotype, grade of SIM, Ki67 and CDX2 expression in Barrett's mucosa could be useful as a predictable marker for regression of SIM in BE.
- 12152013
제1저자 김성은 · 교신저자 김나영
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Effect of Helicobacter pylori Eradication on Functional Dyspepsia.J Neurogastroenterol Motil. 2013;19(2):233-43.
PubMed IF 3.7 소화기내과Abstract
BACKGROUND/AIMS This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses.
METHODS A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated.
RESULTS Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (≥ 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year.
CONCLUSIONS H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.
- 12142013
제1저자 조현주, 조현재 · 교신저자 김효수
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Vascular calcifying progenitor cells possess bidirectional differentiation potentials.PLoS Biol. 2013;11(4):e1001534.
PubMed IF 6.9 순환기내과Abstract
Vascular calcification is an advanced feature of atherosclerosis for which no effective therapy is available. To investigate the modulation or reversal of calcification, we identified calcifying progenitor cells and investigated their calcifying/decalcifying potentials. Cells from the aortas of mice were sorted into four groups using Sca-1 and PDGFRα markers. Sca-1(+) (Sca-1(+)/PDGFRα(+) and Sca-1(+)/PDGFRα(-)) progenitor cells exhibited greater osteoblastic differentiation potentials than Sca-1(-) (Sca-1(-)/PDGFRα(+) and Sca-1(-)/PDGFRα(-)) progenitor cells. Among Sca-1(+) progenitor populations, Sca-1(+)/PDGFRα(-) cells possessed bidirectional differentiation potentials towards both osteoblastic and osteoclastic lineages, whereas Sca-1(+)/PDGFRα(+) cells differentiated into an osteoblastic lineage unidirectionally. When treated with a peroxisome proliferator activated receptor γ (PPARγ) agonist, Sca-1(+)/PDGFRα(-) cells preferentially differentiated into osteoclast-like cells. Sca-1(+) progenitor cells in the artery originated from the bone marrow (BM) and could be clonally expanded. Vessel-resident BM-derived Sca-1(+) calcifying progenitor cells displayed nonhematopoietic, mesenchymal characteristics. To evaluate the modulation of in vivo calcification, we established models of ectopic and atherosclerotic calcification. Computed tomography indicated that Sca-1(+) progenitor cells increased the volume and calcium scores of ectopic calcification. However, Sca-1(+)/PDGFRα(-) cells treated with a PPARγ agonist decreased bone formation 2-fold compared with untreated cells. Systemic infusion of Sca-1(+)/PDGFRα(-) cells into Apoe(-/-) mice increased the severity of calcified atherosclerotic plaques. However, Sca-1(+)/PDGFRα(-) cells in which PPARγ was activated displayed markedly decreased plaque severity. Immunofluorescent staining indicated that Sca-1(+)/PDGFRα(-) cells mainly expressed osteocalcin; however, activation of PPARγ triggered receptor activator for nuclear factor-κB (RANK) expression, indicating their bidirectional fate in vivo. These findings suggest that a subtype of BM-derived and vessel-resident progenitor cells offer a therapeutic target for the prevention of vascular calcification and that PPARγ activation may be an option to reverse calcification.
- 12132013
제1저자 김미영 · 교신저자 김세훈
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Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma.Ann Allergy Asthma Immunol. 2013;110(4):253-7, 257.e1.
PubMed IF 7.1 알레르기내과Abstract
BACKGROUND Recent data suggest that obstructive sleep apnea (OSA) is an important contributor to severe uncontrolled asthma.
OBJECTIVE To investigate the clinical characteristics, asthma control, and asthma-related quality of life in adult patients with asthma at a high risk for OSA.
METHODS A total of 217 patients with asthma who visited our tertiary-care clinic were randomly recruited. They completed the Berlin questionnaire, which screens for OSA risk, a quality-of-life questionnaire for adult Korean patients with asthma (QLQAKA), and underwent an asthma control test (ACT). Fraction of exhaled nitric oxide (FeNO), lung function, blood lipid profiles, and body composition were evaluated.
RESULTS The mean age was 58.4 ± 15.4, and 91 (41.9%) were male. Eighty-nine subjects (41.0%) were classified as high risk for OSA from the Berlin questionnaire. Patients with a high OSA risk were significantly older, had a higher prevalence of hypertension, higher BMI, non-atopic predisposition, and longer asthma treatment duration in the baseline clinical characteristics. The high OSA risk group had a lower ACT score than the low OSA risk group, but it was not statistically significant (20.9 ± 3.6 vs 21.5 ± 3.3, P = .091). The QLQAKA score was significantly lower in the high OSA risk group compared with the low OSA risk group (64.4 ± 10.9 vs 68.1 ± 11.1, P = .026), especially in the activity-domain (P = .005). The FeNO was not significantly different between the 2 groups.
CONCLUSION Quality of life is significantly decreased in adult patients with asthma with a high risk of OSA. Special consideration is needed for the care and treatment of patients with asthma who have a high risk of OSA.
- 12122013
제1저자 김세훈 · 교신저자 장윤석
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Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions.Ann Allergy Asthma Immunol. 2013;110(4):258-62.
PubMed IF 7.1 알레르기내과Abstract
BACKGROUND Some radiocontrast media (RCM) hypersensitivity reactions may have underlying IgE- or T-cell-mediated mechanisms. RCM skin testing may be useful for predicting future reactions.
OBJECTIVE To investigate the clinical value of RCM skin testing before computed tomography and after RCM hypersensitivity reactions.
METHODS Patients who underwent RCM skin testing were a prospective sample of convenience at a single medical center and were tested just before their pending nonionic RCM-enhanced computed tomogram. In addition, skin test data of patients who were referred to the allergy clinic because of their previous RCM hypersensitivity reactions were reviewed retrospectively.
RESULTS A total of 1048 patients enrolled in the study prospectively. Of these, 672 (64.1%) had never been exposed to RCM. Of the 376 previously exposed to RCM, 61 (16.2%) had a history of at least one mild RCM-associated reaction, 56 (91.8%) had immediate reactions, and 5 had no-immediate reactions. There was only 1 positive immediate hypersensitivity RCM skin test result (0.09%). There were 51 mild immediate reactions (4.9%), 1 moderate immediate reaction (0.09%), 8 mild nonimmediate reactions (0.76%), and 1 moderate nonimmediate reaction (0.09%). There was only 1 positive delayed hypersensitivity skin test result (0.09%), retrospectively determined, in 1 (11.1%) of the nonimmediate RCM-associated reactions. Sensitivity of RCM skin testing was significantly higher with severe immediate reactions (57.1%) than mild reactions (12.9%) and moderate reactions (25.0%) in the retrospective review of diagnostic skin test data (P = .03).
CONCLUSION RCM skin testing for screening is of no clinical utility in predicting hypersensitivity reactions. RCM skin testing may have modest utility in retrospectively evaluating severe adverse reactions.
- 12112013
제1저자 박철기 · 교신저자 이세훈
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The value of temozolomide in combination with radiotherapy during standard treatment for newly diagnosed glioblastoma.J Neurooncol. 2013;112(2):277-83.
PubMed IF 3.4 혈액종양내과Abstract
The current best standard care for glioblastoma still has limitations and unsatisfactory outcomes in patients with an unmethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter. Whether the effects of temozolomide are primarily due to its concomitant use with radiotherapy or are also mediated by their independent use in the adjuvant phase remain unclear. To validate the concomitant use of temozolomide in the standard protocol, we compared the overall survival of two prospective patient groups: one treated with radiotherapy alone followed by adjuvant temozolomide (RT → TMZ group) and the other treated with concomitant radiotherapy and temozolomide followed by adjuvant temozolomide (CCRT-TMZ group). Each patient in the RT → TMZ group (n = 25) was matched with two patients in the CCRT-TMZ group (n = 50) with respect to age, extent of resection, MGMT promoter methylation status, and postsurgical performance status to minimize the influence of confounding factors. In patients with MGMT promoter methylation, the CCRT-TMZ group showed superior overall survival (OS; median, 41.0 months) and progression-free survival (PFS; median, 24.0 months) compared with the RT → TMZ group. However, the OS and PFS did not differ between the CCRT-TMZ and the RT → TMZ groups in the patients without MGMT promoter methylation. Although this data is from a retrospective analysis using small number of patients, the study might indicate that concomitant use of temozolomide with radiotherapy is a crucial step in the standard treatment for glioblastoma patients with MGMT promoter methylation. And the use of temozolomide, either concurrently or by adjuvant after radiotherapy, remains a questionable value for those with an unmethylated MGMT promoter.
- 12102013
제1저자 장은선 · 교신저자 윤정환
, , , , , , , ,
Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization.J Cancer Res Clin Oncol. 2013;139(4):635-43.
PubMed IF 3.3 소화기내과Abstract
PURPOSE Transarterial chemoembolization (TACE) is highly effective and safe therapeutic modality for unresectable hepatocellular carcinoma (HCC). However, the role of TACE for infiltrative HCC has never been elucidated owing to the concern about hepatic failure and subsequent mortality after the procedure. In this study, we aimed to document whether patients with infiltrative HCC would benefit from TACE.
METHODS Child-Pugh class A/B patients who were newly diagnosed as infiltrative HCC and treated with curative-intent TACE were enrolled. All radiological images were reviewed by a radiologist with more than 20 years of experience in TACE.
RESULTS Among 1,184 patients newly diagnosed as HCC, 233 (19.7 %) had infiltrative-type tumors and 128 (54.9 %) underwent curative-intent TACE. Although the median overall survival was 5.4 months (IQR 3.1-13.9 months) and 16 (12.5 %) patients had experienced significant complications, 19 (15.9 %) patients survived more than 2 years after the first diagnosis. In multivariable analysis, age >60 years old (HR 0.54, 95 % CI 0.31-0.92), Child-Pugh class A (HR 0.48, 95 % CI 0.30-0.76), and a major PVT without parasitic supply (HR 0.66, 95 % CI 0.44-0.99) were independent favorable prognostic factors. Development of significant complication after TACE was a significant hazard factor of survival (HR 1.99, 95 % CI 1.09-3.62).
CONCLUSIONS In carefully selected patients with preserved hepatic function and good performance, TACE may achieve long-term survival of infiltrative HCC patients with major PVT without parasitic supply. However, the risk of morbidity and immediate mortality after TACE should be considered to select subjects for the procedure.
- 12092013
제1저자 김민수 · 교신저자 김나영
, , , , , , , , , , , ,
Long-term follow-up Helicobacter pylori reinfection rate and its associated factors in Korea.Helicobacter. 2013;18(2):135-42.
PubMed IF 4.6 소화기내과Abstract
BACKGROUND The reinfection rate of Helicobacter pylori has been reported to be low in developed countries but high in developing countries. The aim of this study is to evaluate the long-term reinfection rate of H. pylori and to investigate its associated risk factors in South Korea.
METHODS During 2003-2010, H. pylori-positive 970 patients received standard proton pump inhibitor (PPI)-based triple eradication therapy, and follow-up H. pylori tests were performed with (13) C urea breath test or invasive tests (Giemsa histology, CLO test, and culture) 4 weeks after completion of treatment. A total of 331 patients who were maintained an H. pylori-eradicated state at 1 year after eradication were divided into two groups according to reinfection. For the evaluation of risk factors of reinfection, gender, age, smoking, alcohol, income, education, gastrointestinal symptoms, clinical diagnosis, histologic atrophic gastritis or intestinal metaplasia, and clarithromycin resistance were analyzed.
RESULTS The follow-up period was 18-95 months (mean: 37.1 months), and H. pylori reappeared in 36 of 331 patients (10.9%), resulting in the annual reinfection rate of 3.51% per year. Multivariate analysis showed that male gender (HR 2.28; 95% CI, 1.05-5.00, p = .037) and low monthly family income (≤5000$ vs >5000$) (HR 3.54; 95% CI, 1.08-11.67, p = .038) were associated with H. pylori reinfection.
CONCLUSION This long-term reinfection rate of H. pylori stayed rather low (3.51% per year), and male and low income determined the reinfection, factors already known to be important for H. pylori infection.
- 12082013
제1저자 고영일 · 교신저자 이세훈
, , , , , , ,
Phase II trial of everolimus for the treatment of nonclear-cell renal cell carcinoma.Ann Oncol. 2013;24(4):1026-31.
PubMed IF 80.4 혈액종양내과Abstract
BACKGROUND We investigated the efficacy of everolimus against nonclear-cell renal cell carcinoma (nccRCC). Patients and methods Patients with nccRCC received 10-mg everolimus once daily until disease progression or unacceptable toxicity.
PATIENTS who had received a VEGF- tyrosine kinase inhibitor (TKI) previously were included.
RESULTS A total of 49 patients were enrolled. Twenty-three patients (46.9%) received prior anti-VEGF agents. A partial response was observed in five patients (10.2%) and stable disease in 25 patients (51.0%). The disease progressed in 16 patients (32.7%) despite the administration of everolimus. Two of the five patients who showed an objective response to everolimus had chromophobe carcinoma, whereas two had papillary carcinoma and one had unclassifiable carcinoma. Thirty-six patients experienced disease progression during follow-up, and the median progression-free survival (PFS) was 5.2 months. Chromophobe RCC patients seemed to have longer PFS than nccRCC patients with the other histological subtypes (P = 0.084). Previous VEGF-TKI treatment did not influence the efficacy of everolimus, and the toxicity profiles were in line with previous reports.
CONCLUSION Everolimus shows certain efficacy against nccRCC, particularly in patients with chromophobe RCC, and prior treatment with a VEGF-TKI appears not influencing the outcome of everolimus therapy in nccRCC patients. ClinicalTrials.gov number NCT00830895.
- 12072013
제1저자 장성아 · 교신저자 김형관
, , , , , , , ,
Assessment of left ventricular mass in hypertrophic cardiomyopathy by real-time three-dimensional echocardiography using single-beat capture image.J Am Soc Echocardiogr. 2013;26(4):436-42.
PubMed IF 8.3 순환기내과Abstract
BACKGROUND Left ventricular (LV) mass is an important prognostic indicator in hypertrophic cardiomyopathy. Although LV mass can be easily calculated using conventional echocardiography, it is based on geometric assumptions and has inherent limitations in asymmetric left ventricles. Real-time three-dimensional echocardiographic (RT3DE) imaging with single-beat capture provides an opportunity for the accurate estimation of LV mass. The aim of this study was to validate this new technique for LV mass measurement in patients with hypertrophic cardiomyopathy.
METHODS Sixty-nine patients with adequate two-dimensional (2D) and three-dimensional echocardiographic image quality underwent cardiac magnetic resonance (CMR) imaging and echocardiography on the same day. Real-time three-dimensional echocardiographic images were acquired using an Acuson SC2000 system, and CMR-determined LV mass was considered the reference standard. Left ventricular mass was derived using the formula of the American Society of Echocardiography (M-mode mass), the 2D-based truncated ellipsoid method (2D mass), and the RT3DE technique (RT3DE mass).
RESULTS The mean time for RT3DE analysis was 5.85 ± 1.81 min. Intraclass correlation analysis showed a close relationship between RT3DE and CMR LV mass (r = 0.86, P < .0001). However, LV mass by the M-mode or 2D technique showed a smaller intraclass correlation coefficient compared with CMR-determined mass (r = 0.48, P = .01, and r = 0.71, P < .001, respectively). Bland-Altman analysis showed reasonable limits of agreement between LV mass by RT3DE imaging and by CMR, with a smaller positive bias (19.5 g [9.1%]) compared with that by the M-mode and 2D methods (-35.1 g [-20.2%] and 30.6 g [17.6%], respectively).
CONCLUSIONS RT3DE measurement of LV mass using the single-beat capture technique is practical and more accurate than 2D or M-mode LV mass in patients with hypertrophic cardiomyopathy.
- 12062013
제1저자 박영식 · 교신저자 박영식
, , , , , , , , ,
Clinical implication of microscopic anthracotic pigment in mediastinal staging of non-small cell lung cancer by endobronchial ultrasound-guided transbronchial needle aspiration.J Korean Med Sci. 2013;28(4):550-4.
PubMed IF 3.2 호흡기내과Abstract
Microscopic anthracotic pigment (MAP) is frequently observed in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen in non-small cell lung cancer, but its clinical interpretation is not well-known. The aim of this study was to evaluate the clinical implication of MAP in mediastinal staging of non-small cell lung cancer. From May 2010 to July 2011, consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited. Of the total 133 patients, 102 (76.7%) were male patients. Median age was 68 yr. Total 279 mediastinal lymph nodes were sampled by EBUS-TBNA; station 4R (100, 35.8%) and station 7 (86, 30.8%) were the most common sites. Malignant lymph nodes were 100 (35.8%). MAP was observed in 61 (21.7%) lymph nodes, and among them only 3 were malignant lymph nodes (P < 0.001). The lymph nodes with MAP were smaller (9.0 vs 10.8 mm, P = 0.001) and showed low standard uptake values on FDG-PET (4.4 vs 4.7, P = 0.256). In multivariate analysis, MAP was negatively associated with malignant lymph node (adjusted OR, 0.12; 95% CI, 0.03-0.42; P < 0.001). In potentially operable non-small cell lung cancer patients, MAP in endobronchial ultrasound-guided transbronchial needle aspiration specimens is strongly associated with benign mediastinal and hilar lymph nodes.
- 12052013
제1저자 백우현 · 교신저자 황진혁
, , , , ,
Chemosensitivity induced by down-regulation of microRNA-21 in gemcitabine-resistant pancreatic cancer cells by indole-3-carbinol.Anticancer Res. 2013;33(4):1473-81.
PubMed IF 1.8 소화기내과Abstract
BACKGROUND/AIM Overexpression of microRNA-21 (miR-21) indicates chemoresistance in pancreatic cancer. We evaluated the change of chemosensitivity to gemcitabine through the down-regulation of miR-21 in human pancreatic cancer cells (Panc-1).
MATERIALS AND METHODS The efficacy of indole-3-carbinol (I3C) in suppressing miR-21 expression and its anticancer effect in combination with gemcitabine were investigated.
RESULTS Down-regulation of miR-21 by I3C was positively-correlated in a time- and dose-dependent manner. I3C and gemcitabine combination therapy increased cytotoxicity in Panc-1 cells. Transfection of miR-21 mimic abrogated I3C-induced sensitivity to gemcitabine. DNA fragmentation and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assays showed that pre-treatment with I3C enhanced apoptosis and this effect was attenuated by miR-21 transfection. The expression of programmed cell death-4 (PDCD4) was increased by I3C and reduced by miR-21 transfection.
CONCLUSION I3C would be effective for enhancing sensitivity of pancreatic cancer cells to gemcitabine via down-regulation of miR-21. Such enhanced chemosensitivity might be explained by the increased expression of PDCD4, which is a downstream target which miR-21 negatively regulates.
- 12042013
제1저자 김도영 · 교신저자 정숙향
, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
A nationwide seroepidemiology of hepatitis C virus infection in South Korea.Liver Int. 2013;33(4):586-94.
PubMed IF 6.2 소화기내과Abstract
BACKGROUND & AIMS The aim of this study was to reveal nationwide seroprevalence of HCV infection in South Korea by a large-scale survey.
METHODS From January to December 2009, a total of 291 314 adults underwent health check-up in 29 centres nationwide. The data concerning anti-HCV antibody and biochemical tests were obtained from all participants. Among subjects with positive anti-HCV, such data as HCV RNA, genotypes and treatment detail were additionally analysed.
RESULTS Using an estimated 2009 population of Korea, the age, sex and area-adjusted anti-HCV positive rate was 0.78%. Anti-HCV prevalence in female patients (0.83%) was higher than that in male patients (0.75%). Gradual increase in anti-HCV positivity was observed, from 0.34% in those aged 20-29 years to 2.31% in those >70 years. The age- and sex-adjusted anti-HCV prevalence varied in different areas, being higher in Busan and Jeonnam (1.53-2.07%), mid-level in Seoul and surrounding districts (0.50-0.61%) and lower in Jeju (0.23%). The comparative analysis of laboratory variables between anti-HCV (+) and anti-HCV (-) group revealed significantly higher levels of alanine aminotransferase and lower levels of serum lipids in anti-HCV (+) group. Among 1 718 anti-HCV positive subjects, serum HCV RNA was measured only in 478 people, of whom 268 (56.1%) patients had detectable HCV RNA in serum. Among 50 patients for whom assessment of response to antiviral therapy was feasible, overall sustained virological response was achieved in 84% of patients.
CONCLUSION The prevalence of HCV infection is low in South Korea. Studies to analyse risk factors are warranted to reduce HCV infection.
- 12032013
제1저자 신기철 · 교신저자 이은봉
, , , , , ,
The efficacy of diacerein in hand osteoarthritis: a double-blind, randomized, placebo-controlled study.Clin Ther. 2013;35(4):431-9.
PubMed IF 3.7 류마티스내과Abstract
BACKGROUND Diacerein is a drug used in osteoarthritis (OA) that elicits an inhibitory effect on interleukin-1 and metalloproteases. Although diacerein has shown modest efficacy and safety in the treatment of knee and hip OA, there have been no placebo-controlled clinical trials for hand OA.
OBJECTIVE The aim of the current study was to investigate the efficacy and tolerability of diacerein in patients with hand OA.
METHODS Patients fulfilling the American College of Rheumatology criteria for hand OA participated in this randomized, double-blind, placebo-controlled study. Eligible patients were >40 years of age, had at least 1 tender joint, and had a joint pain visual analog scale of >30 mm. Patients received diacerein (50 mg) or placebo BID for 12 weeks. The primary end point was the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain score at 4 weeks. Secondary end points were AUSCAN pain score at 12 weeks and AUSCAN physical function and stiffness score, patient and physician global assessment, functional index of hand OA scores, and multidimensional health assessment questionnaire results at 4 weeks and 12 weeks.
RESULTS Eighty-six Korean patients were enrolled (42 diacerein, 44 placebo). The intention-to-treat and per-protocol analyses revealed no significant differences between the 2 groups in terms of change in AUSCAN pain score at 4 weeks, except for improvement in physician global assessment at 4 weeks (per-protocol analysis, P = 0.004). The safety profile of diacerein was comparable to placebo, except for frequent discoloration of the urine (88% vs 20%).
CONCLUSION These results suggest that diacerein 50 mg BID may be ineffective in controlling the symptoms of hand OA. ClinicalTrials.gov identifier: NCT00685542.
- 12022013
제1저자 안효석 · 교신저자 김형관
, , , , , , ,
Coronary flow reserve impairment in apical vs asymmetrical septal hypertrophic cardiomyopathy.Clin Cardiol. 2013;36(4):207-16.
PubMed IF 2.8 순환기내과Abstract
BACKGROUND Mechanisms underlying a reduction in coronary flow reserve (CFR) in hypertrophic cardiomyopathy (HCM), especially apical HCM (ApHCM), are elusive. This study set out to evaluate mechanisms underlying a reduction in CFR in 2 HCM subtypes.
HYPOTHESIS Mechanisms for CFR reduction in HCM are different between the 2 subtypes of HCM.
METHODS Thirty-one patients with asymmetrical septal hypertrophy (ASH), 43 with ApHCM, and 27 healthy volunteers were recruited. Mean diastolic coronary flow velocity (CFmv) was monitored before and after adenosine infusion by transthoracic echocardiography in the mid-to-distal left anterior descending coronary artery. Coronary flow reserve was defined as the ratio between CFmv before and after adenosine infusion. Left ventricular mass index and stress myocardial perfusion were assessed by cardiac magnetic resonance imaging.
RESULTS Although basal CFmv was higher in ASH patients than in healthy controls (P<0.05), it was similar in ApHCM patients and controls (P=0.85). Poststress CFmv was significantly lower in both HCM subtypes than in controls (P<0.05). Consequently, CFR was higher in controls than in ASH or ApHCM patients (P<0.05). When HCM patients were stratified into 2 groups based on the presence of CFR impairment, no difference was observed between these 2 groups in terms of left ventricular mass index by cardiac magnetic resonance imaging. Multivariate logistic regression analysis identified basal CFmv as the only independent variable associated with CFR reduction in HCM (r2=0.49, P<0.001).
CONCLUSIONS Whereas the inability to augment coronary flow to its maximal level during stress was found to underlie CFR impairment in both HCM subtypes, the recruitment of vasodilatory capacity at baseline was more prominent in ASH than in ApHCM patients.
- 12012013
제1저자 김낙현 · 교신저자 박완범
, , , , , , , , ,
Tigecycline in carbapenem-resistant Acinetobacter baumannii bacteraemia: susceptibility and clinical outcome.Scand J Infect Dis. 2013;45(4):315-9.
PubMed IF 1.722 감염내과Abstract
Although tigecycline is considered one of the few therapeutic options for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteraemia, its role in the treatment of CRAB bacteraemia remains unclear. We describe the clinical outcomes of 9 patients who received tigecycline for CRAB bacteraemia. Although all CRAB blood isolates were susceptible to tigecycline, 5 (56%) deaths were related to CRAB bacteraemia and 1 case of breakthrough CRAB bacteraemia was observed during tigecycline therapy. Clinical outcomes of tigecycline therapy may be poor in patients with tigecycline-susceptible CRAB bacteraemia, although multiple factors including delayed treatment could contribute to the poor outcomes.
- 12002013
제1저자 김동희 · 교신저자 김웅
, , ,
Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.Hepatology. 2013;57(4):1357-65.
PubMed IF 18 소화기내과Abstract
UNLABELLED The clinical and public health significance of nonalcoholic fatty liver disease (NAFLD) is not well established. We investigated the long-term effect of NAFLD on mortality. This analysis utilized the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 score. Of 11,154 participants, 34.0% had NAFLD--the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS <-1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS >0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (for NFS: HR, 1.69, 95% CI: 1.09-2.63; for APRI: HR, 1.85, 95% CI: 1.02-3.37; for FIB-4: HR, 1.66, 95% CI: 0.98-2.82) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (for NFS: HR, 3.46, 95% CI: 1.91-6.25; for APRI: HR, 2.53, 95% CI: 1.33-4.83; for FIB-4: HR, 2.68, 95% CI: 1.44-4.99).
CONCLUSIONS Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.
- 11992013
제1저자 이반석/황진혁 · 교신저자 이상협
, , , , , , , , , , , , ,
Risk factors of organ failure in patients with bacteremic cholangitis.Dig Dis Sci. 2013;58(4):1091-9.
PubMed IF 2.8 소화기내과Abstract
BACKGROUND Bacteremic cholangitis carries a high mortality rate of up to 10 % in relation to organ failure (OF), including septic shock.
AIM The purpose of this study was to elucidate predictive factors for OF in bacteremic cholangitis.
METHODS A retrospective review of all patients diagnosed with acute cholangitis and proven bacteremia from 2003 to 2011 was performed. Comprehensive clinical and laboratory data of 211 patients were analyzed.
RESULTS There were 42 cases (19.9 %) of OF and 5 deaths (2.4 %). In the multivariate logistic regression analysis, significant predictive factors for OF were successful biliary decompression, presence of extended-spectrum beta-lactamase organism (ESBL), higher total bilirubin, and higher blood urea nitrogen (BUN) level at admission with odds ratios (ORs) of 0.129, 6.793, 1.148, and 1.089, respectively. Subgroup analysis of 165 patients who underwent biliary decompression before an event (with OF: 20, without OF: 145) was performed to elucidate the risk factors for organ failure even after successful biliary drainage. Variables significantly associated with OF included ESBL and BUN (OR = 4.123 and 1.177, respectively). We developed a scoring system with regression coefficient of each significant variable. The organ failure score was calculated using the following equation: (1.4 × ESBL) + (0.2 × BUN). This scoring system for predicting OF was highly sensitive (85.0 %) and specific (83.4 %).
CONCLUSIONS Biliary decompression, ESBL, total bilirubin, and BUN are prognostic determinants in patients with bacteremic cholangitis. An organ failure scoring system may allow clinicians to identify groups with poor prognosis even after successful biliary decompression.
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