SCI 발표논문
전체 4,588편
- 11082012
제1저자 박종선 · 교신저자 임재준
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Monthly follow-ups of interferon-γ release assays among health-care workers in contact with patients with TB.Chest. 2012;142(6):1461-1468.
PubMed IF 9.8 호흡기내과Abstract
BACKGROUND Interferon-γ (IFN-γ) release assays (IGRAs), which can overcome several limitations of the tuberculin skin test in detecting latent TB infection, were introduced recently in routine clinical practice. However, IGRAs are highly dynamic tests, and the T-cell responses tend to fluctuate over time. We wanted to evaluate the conversion and reversion rates of monthly IGRAs over 1 year among health-care workers (HCWs) in contact with patients with TB in South Korea, a country with an intermediate TB burden.
METHODS Forty-nine HCWs in contact with patients with active pulmonary TB were prospectively enrolled. Interviews on exposure to patients with active TB, a physical examination, and a QuantiFERON TB Gold In-Tube assay (QFT-GIT) were carried out monthly for 1 year.
RESULTS Among 48 participants, 25 (52%) showed inconsistent results in serial testing. When an increase from< 0.35 IU/mL to ≥ 0.70 IU/mL was applied as the definition of a conversion, inconsistent IGRA results were identified in 13 participants (27.0%). Consistency in QFT-GIT results was associated with age, length of service, and baseline IFN-γ levels, but not with the profession of the participant, degree of TB exposure, or wearing of an N95 mask. In five participants, fluctuations in IFN-γ levels showed levels > 0.70 IU/mL two or more times.
CONCLUSIONS Fluctuation in IGRA findings was common when HCWs in contact with patients with TB were tested monthly. This could be a result of poor reproducibility of the assay, repeated infection and true reversion, or periodic secretion of antigens from Mycobacterium tuberculosis.
TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01121068; URL: www.clinicaltrials.gov
- 11072012
제1저자 강현재, 김민경 · 교신저자 김효수
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Five-year results of intracoronary infusion of the mobilized peripheral blood stem cells by granulocyte colony-stimulating factor in patients with myocardial infarction.Eur Heart J. 2012;33(24):3062-9.
PubMed IF 45.3 순환기내과Abstract
AIM To evaluate the long-term effects of peripheral blood stem cell therapy in myocardial infarction (MI) patients.
METHODS AND RESULTS A total of 163 patients with MI who were successfully revascularized with drug-eluting stents were enrolled and randomly assigned to four groups: acute MI (AMI) cell infusion, AMI control, old MI (OMI) cell infusion, and OMI control. We compared 5 years' clinical outcomes between the cell infusion group (57 and 22 patients with AMI and OMI, respectively) and the control (60 and 24 patients with AMI and OMI, respectively). In the time-sequence comparison from baseline to 6 and 24 months follow-up after AMI, left ventricular ejection fraction (LVEF) by cardiac magnetic resonance imaging was significantly improved in the cell infusion group (n = 57), but not in the control group (n = 60). In the between-group comparison, the difference in improvement of LVEF for 2 years after AMI did not reach statistical significance between cell infusion and control groups. Intriguingly, the major adverse cardiac events for 5 years were significantly reduced in the cell infusion group (n = 79) compared with the control (n = 84; composite of cardiac death, non-fatal MI, hospitalization for heart failure and angina, and target vessel revascularization; 22.8 vs. 39.3%, P = 0.015).
CONCLUSIONS Peripheral blood stem cell therapy has potential to improve long-term cardiovascular outcomes in MI patients.
- 11062012
제1저자 이주명 · 교신저자 김효수
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Comparison of endothelialization and neointimal formation with stents coated with antibodies against CD34 and vascular endothelial-cadherin.Biomaterials. 2012;33(35):8917-27.
PubMed IF 13.6 순환기내과Abstract
Vascular endothelial-cadherin (VE-cadherin) is exclusively expressed on the late endothelial progenitor cells (EPC). Therefore, VE-cadherin could be an ideal target surface molecule to capture circulating late EPC. In the present study, we evaluated whether anti-VE-cadherin antibody-coated stents (VE-cad stents) might accelerate endothelial recovery and reduce neointimal formation more than anti-CD34 antibody-coated stents (CD34 stents) through the superior ability to capture the late EPC. The stainless steel stents were coated with anti-human VE-cadherin antibodies or anti-human CD34 antibodies under the same condition. In vitro, VE-cad stents showed higher number of adhering EPC (823.6 ± 182.2 versus 379.2 ± 137.2 cells per HPF, p < 0.001). VE-cad stents also demonstrated better specific capturing of cells with endothelial lineage markers than CD34 stents did in flow cytometric analysis. VE-cad stents showed more effective re-endothelialization after 1 h, 24 h, and 3 days in vivo. At 42 days, VE-cad stents demonstrated significantly smaller neointima area (0.92 ± 0.38 versus 1.24 ± 0.41 mm(2), p = 0.002) and significantly lower PCNA positive cells in neointima (1684.8 ± 658.8/mm(2) versus 2681.7 ± 375.1/mm(2), p = 0.008), compared with CD34 stents. In conclusion, VE-cad stents captured EPC and endothelial cells more selectively in vitro, accelerated re-endothelialization over stents, and reduced neointimal formation in vivo, compared with CD34 stents.
- 11052012
제1저자 박효은 · 교신저자 김효수
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Diagnostic value of myocardial SPECT to detect in-stent restenosis after drug-eluting stent implantation.Int J Cardiovasc Imaging. 2012;28(8):2125-34.
PubMed IF 1.5 순환기내과Abstract
Different angiographic patterns and restenosis rate may affect diagnostic value of single-photon emission computed tomography (SPECT) in the era of drug-eluting stents (DES). We aimed to determine the ability of myocardial SPECT to detect in-stent restenosis (ISR) in patients treated with DES compared to that of patients treated with bare metal stent (BMS). We evaluated 228 consecutive patients who underwent 6 months follow-up SPECT and coronary angiography (CAG) after stent implantation. In 228 patients, 354 vessels were treated with stent implantation (BMS, n = 105; DES, n = 249) and 65 (18.4%) vessels showed ISR (angiographic % diameter stenosis ≥ 50%) at the 6-month follow-up CAG. In patients with BMS-ISR (n = 37), restenosis was primarily diffuse (70.3%), whereas patients with DES-ISR (n = 28) exhibited more focal restenosis (53.6%, p = 0.028). The sensitivity and specificity of myocardial SPECT did not differ significantly between patients with BMS and those with DES (BMS vs. DES: sensitivity 56.8 vs. 39.3%, p = 0.163; specificity 72.1 vs. 76.5%, p = 0.460). Evaluation of 71 false positive and 33 false negative lesions showed that the most common cause of false-positive results in SPECT was the perfusion decrease which improved but not disappeared compared with the baseline (46 among 71 vascular territories). Despite different patterns of restenosis and ISR rates, the diagnostic value of SPECT did not differ between BMS and DES. Further study looking at ISR in larger number of patients and using other protocol such as Fleming-Harrington Redistribution Wash-in Washout may give additional information.
- 11042012
제1저자 이세원 · 교신저자 이춘택
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The association of down-regulated toll-like receptor 4 expression with airflow limitation and emphysema in smokers.Respir Res. 2012;13(1):106.
PubMed IF 5.7 호흡기내과Abstract
BACKGROUND An association between innate immunity including Toll-like receptors (TLRs) and COPD is reported recently; TLR4 deficiency in lung can cause emphysema in animals, which is not evident in humans. We analyzed the association of TLR4 expression, airflow limitation and emphysema in smokers.
METHODS We enrolled patients of ≥40years old with smoking histories of ≥10 pack-years and who had undergone lung resection. We measured TLR4 expression in lung lysates. The severity of emphysema was evaluated on computed tomography. TLR4 expression was also evaluated immunohistochemically.
RESULTS In total, 53 patients were enrolled. Forced expiratory volume in one second per forced vital capacity (FEV1/FVC) increased (P=0.03) and emphysema score decreased (P=0.01) as TLR4 expression increased. These were still significant, in multiple regression analysis including sex, age, tuberculosis history, smoking history and inhaled corticosteroid (ICS) usage. We also classified patients as high, intermediate, and low expressers according to TLR4 expression. Although no differences in age, gender, tuberculosis, or smoking history were observed among the groups, emphysema severity increased significantly (P = 0.02) and FEV1/FVC decreased significantly (P = 0.006) in TLR4 low expresser. The difference in TLR4 expression based on immunohistochemistry was most prominent in bronchial and alveolar epithelial cells.
CONCLUSION Down-regulated TLR4 expression in lung was associated with emphysema and airflow limitation in smokers.
- 11032012
제1저자 정수진 · 교신저자 박민정
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Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea.Int J Cancer. 2012;131(10):2376-84.
PubMed IF 4.9 소화기내과Abstract
We investigated risk factors for gastric cancer (GC) and effect of annual endoscopic screening on detection and treatment modality of GC. Asymptomatic adults who underwent upper endoscopy during health checkups at Seoul National University Hospital Healthcare System Gangnam Center were enrolled. We compared clinicopathologic characteristics of GC according to screening interval (repeated vs. infrequent, annual vs. biennial). After age- and sex-matching, relative risk was computed by hazard ratio (HR) using Cox proportional regression with multivariate adjustment. Of the 58,849 subjects who received screening endoscopy, 277 (0.47%) were found to have GC. Intestinal type comprised 55.4% (102/184) followed by diffuse type (n = 65, 35.3%). Age ≥ 50 years, family history and smoking independently increased the risk of GC for both types, whereas male gender [HR = 4.81, 95% confidence interval (CI): 2.72-8.03] and intestinal metaplasia (IM) (HR = 10.87, 95% CI: 3.36-22.30) were significant predictors for intestinal type only. Proportion of early gastric cancer (EGC) was 98.6% (71/72) in annual screening group and 80.7% (46/57) in biennial screening group (p < 0.01). In the former, tumor size was smaller (1.7 ± 1.3 vs. 2.3 ± 1.8 cm; p < 0.01] and proportion of intramucosal cancer was larger (75.0 vs. 56.1%; p = 0.04). Endoscopic resection was performed more frequently in annual screening group (56.9 vs. 33.3%; p = 0.02). IM along with male gender and older age was a strong risk factor for intestinal type GC. Annual screening group improved detection of early-stage and endoscopically treatable GC suggesting that intensive screening and surveillance may be useful for high-risk subpopulations with epidemiologic risk factors or premalignant lesions such as IM.
- 11022012
제1저자 안정명 · 교신저자 나기영
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Hypoxia-inducible factor activation protects the kidney from gentamicin-induced acute injury.PLoS One. 2012;7(11):e48952.
PubMed IF 2.8 신장내과Abstract
Gentamicin nephrotoxicity is one of the most common causes of acute kidney injury (AKI). Hypoxia-inducible factor (HIF) is effective in protecting the kidney from ischemic and toxic injury. Increased expression of HIF-1α mRNA has been reported in rats with gentamicin-induced renal injury. We hypothesizd that we could study the role of HIF in gentamicin-induced AKI by modulating HIF activity. In this study, we investigated whether HIF activation had protective effects on gentamicin-induced renal tubule cell injury. Gentamicin-induced AKI was established in male Sprague-Dawley rats. Cobalt was continuously infused into the rats to activate HIF. HK-2 cells were pre-treated with cobalt or dimethyloxalylglycine (DMOG) to activate HIF and were then exposed to gentamicin. Cobalt or DMOG significantly increased HIF-1α expression in rat kidneys and HK-2 cells. In HK-2 cells, HIF inhibited gentamicin-induced reactive oxygen species (ROS) formation. HIF also protected these cells from apoptosis by reducing caspase-3 activity and the amount of cleaved caspase-3, and -9 proteins. Increased expression of HIF-1α reduced the number of gentamicin-induced apoptotic cells in rat kidneys and HK-2 cells. HIF activation improved the creatinine clearance and proteinuria in gentamicin-induced AKI. HIF activation also ameliorated the extent of histologic injury and reduced macrophage infiltration into the tubulointerstitium. In gentamicin-induced AKI, the activation of HIF by cobalt or DMOG attenuated renal dysfunction, proteinuria, and structural damage through a reduction of oxidative stress, inflammation, and apoptosis in renal tubular epithelial cells.
- 11012012
제1저자 김선문 · 교신저자 임춘수
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The association between albumin to creatinine ratio and total protein to creatinine ratio in patients with chronic kidney disease.Clin Nephrol. 2012;78(5):346-52.
PubMed IF 0.8 신장내과Abstract
AIMS Although albumin to creatinine ratio (ACR) and total protein to creatinine ratio (PCR) in random urine have been supposed as alternatives to 24-h urine measurements, there are few studies comparing these tests in CKD patients. Therefore, we investigated the relations between ACR and PCR in CKD patients and the factors that affect the relationship.
METHODS We enrolled 808 patients with CKD prospectively and compared ACR, PCR and urine dipstick test in random urine.
RESULTS Albuminuria was well correlated with proteinuria (β = 1.114, p < 0.001). The association between albuminuria and proteinuria was greater in patients with following characteristics: dipstick protein positive compared with negative (p < 0.001 for interaction), urine creatinine level ≥ 60 mg/dl compared with < 60 mg/dl (p = 0.024 for interaction) and estimated glomerular filtration rate < 60 ml/min/1.73 m2 compared with ≥ 60 ml/min/1.73 m2 (p = 0.040 for interaction). However, the association between albuminuria and proteinuria was not affected by sex, the presence of diabetes, or old age (≥ 60 years).
CONCLUSIONS Both ACR and PCR in random urine are correlated well and can be used for monitoring of protein excretion in CKD patients, alternatively. However, the correlation is not strong in patients with low amount of protein excretion or with low urinary creatinine concentration.
- 11002012
제1저자 김재환 · 교신저자 이상협
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Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography.Surg Endosc. 2012;26(11):3293-300.
PubMed IF 3.3 소화기내과Abstract
BACKGROUND Perforation after endoscopic retrograde cholangiopancreatography (ERCP) is a rare but severe complication. The purpose of this study was to assess the clinical outcomes with perforations after ERCP from a large number of cases.
METHODS Among 11,048 patients who underwent ERCP during 10 years, medical records from 68 patients (0.62 %) who experienced post-ERCP perforation with radiologic, endoscopic, or surgical evidence were retrospectively reviewed. We assessed the clinical outcomes of patients and analyzed the factors associated with poor outcomes, which were defined as mortality, prolonged hospital stay due to complications, or loss of chance of cure in the case of cancer.
RESULTS Twenty-nine patients were male, and the median age was 65.0 years. Therapeutic ERCP was performed in 52 cases (77 %). Common mechanisms of perforation were endoscopic sphincterotomy (37 %), catheter or guidewire (34 %), and endoscope (19 %). In contrast to 9 patients who underwent emergent operation, 59 patients (87 %) were conservatively treated. In 44 patients, perforation was detected during the procedure; however, detection after 24 h or permitted oral intake before detection occurred in 18 cases (27 %). Although 58 patients recovered without poor outcomes, 10 patients (15 %) experienced poor outcomes, which consisted of mortality (n = 4), loss of chance of cure (n = 2), and prolonged hospital stay without surgery more than 1 month due to complications (n = 4). By multiple logistic regression analysis, perforation by endoscope and rebound tenderness was statistically associated with poor outcomes (odds ratio: 13.7 and 7.3, respectively).
CONCLUSIONS Most patients fully recovered from perforation; however, some patients experienced grave outcomes, including mortality. Perforation by endoscope and rebound tenderness was significantly associated with poor outcomes.
- 10992012
제1저자 김종엽 · 교신저자 정숙향
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Behavioral and healthcare-associated risk factors for chronic hepatitis C virus infection in Korea.J Korean Med Sci. 2012;27(11):1371-7.
PubMed IF 3.2 소화기내과Abstract
The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (≥ 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, ≥ 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.
- 10982012
제1저자 서명기 · 교신저자 김형관
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Electrocardiographic QRS duration reflects right ventricular remodeling in patients undergoing corrective surgery for isolated tricuspid regurgitation: a comparative study with cardiac magnetic resonance imaging.Clin Cardiol. 2012;35(11):692-9.
PubMed IF 2.8 순환기내과Abstract
BACKGROUND The role of electrocardiogram (ECG) is unclear for the longitudinal follow-up of patients who undergo corrective surgery for isolated severe tricuspid regurgitation (TR).
HYPOTHESIS This study sought to investigate the usefulness of changes in QRS duration of ECG after TR surgery in predicting right ventricular (RV) reverse remodeling as determined by cardiac magnetic resonance imaging (CMR).
METHODS We enrolled 30 consecutive TR patients (27 women, aged 57.8 ± 9.6 years) who had undergone prior left-sided valve surgery. A computer-assisted analysis was performed for objective calculation of QRS duration before and after surgery.
RESULTS At a median CMR follow-up of 27.5 months postsurgery, QRS duration was cut by 14.6%, from 110.4 ± 14.6 msec to 96.9 ± 11.9 msec (P < 0.001), while CMR showed a decrease in RV end-diastolic volume index (RV-EDVI) from 179.5 ± 59.7 to 119.1 ± 30.4 mL/m(2) (P < 0.001). QRS duration correlated significantly with RV-EDVI and RV end-systolic volume index (r = 0.65, P < 0.001 and r = 0.53, P < 0.001, respectively), and a percent change in QRS duration was significantly correlated with a percent change in RV-EDVI (r = 0.40, P = 0.03). When significant RV reverse remodeling was defined as a reduction in RV-EDVI ≥20% following TR surgery, the sensitivity and specificity for significant RV reverse remodeling were 75% and 78%, respectively, with a 9% reduction in QRS duration (P = 0.01, area underneath the receiver operator curve [AUC] = 0.81).
CONCLUSIONS The extent of changes in postoperative QRS duration can be used as a useful, inexpensive, and simple index reflecting the occurrence of significant RV reverse remodeling in patients undergoing corrective TR surgery.
- 10972012
제1저자 이진우 · 교신저자 이상민
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Outcome of patients with connective tissue disease requiring intensive care for respiratory failure.Rheumatol Int. 2012;32(11):3353-8.
PubMed IF 3.5 호흡기내과Abstract
Occasionally acute respiratory failure (ARF) develops in patients with connective tissue disease (CTD), but the etiologies of ARF in these patients are not fully elucidated. The objective of this study is to find out the causes of ARF leading to intensive care unit (ICU) admission in these patients and to assess their clinical outcome. The medical records of 1,870 consecutive patients admitted to the ICU in Seoul National University Hospital since January 2005-September 2008 were reviewed. A total of 66 patients with CTD were analyzed. The median age was 58 years, and 45 patients were women. The median length of ICU stay was 16 days with a median duration of mechanical ventilation support of 15 days. The distribution of underlying CTD was 17 patients with systemic lupus erythematosus; 15 with rheumatoid arthritis; 14 with systemic vasculitis; and nine with polymyositis-dermatomyositis. Pneumonia was the leading cause of ARF in 24 patients (36%). We could not identify the cause of ARF in 14. Other causes of ARF were acute pulmonary edema for nine patients, diffuse alveolar hemorrhage for eight and Pneumocystis pneumonia for four. Forty-one patients (62%) died during admission, and the mortality rate was the lowest in those with acute pulmonary edema. Use of norepinephrine was statistically higher in nonsurvivors. We could identify the cause of ARF leading to ICU admission in at least 80% of patients with CTD. However, these patients still showed a high mortality rate regardless of etiology. Their survival might be influenced by hemodynamic status.
- 10962012
제1저자 송경호 · 교신저자 김홍빈, 최희정
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Differences in the risk factors for surgical site infection between total hip arthroplasty and total knee arthroplasty in the Korean Nosocomial Infections Surveillance System (KONIS).Infect Control Hosp Epidemiol. 2012;33(11):1086-93.
PubMed IF 2.6 감염내과Abstract
OBJECTIVE To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.
DESIGN Retrospective cohort study.
SETTING Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).
PATIENTS From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.
RESULTS SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were "severe" SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.
CONCLUSIONS Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.
- 10952012
제1저자 고영일 · 교신저자 임석아
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The lack of CD34 expression in gastrointestinal stromal tumors is related to cystic degeneration following imatinib use.Jpn J Clin Oncol. 2012;42(11):1020-7.
PubMed IF 2.5 혈액종양내과Abstract
OBJECTIVE We evaluated the characteristics of the gastrointestinal stromal tumors that showed discrepancies between their assessment using the Response Evaluation Criteria in Solid Tumor (RECIST) and Choi's criteria. We also investigated the clinical applicability of Choi's criteria to Korean gastrointestinal stromal tumor patients undergoing imatinib therapy.
METHODS Patients with advanced gastrointestinal stromal tumors treated with frontline imatinib were analyzed. Computed tomography images of these patients were reviewed and genotyping for the KIT and PDGFRA genes was performed. Immunohistochemical staining of c-KIT, CD34, platelet derived growth factor receptor-alpha, platelet derived growth factor receptor-beta, AKT, P-ERK and vascular endothelial growth factor was followed.
RESULTS Ninety-five patients were enrolled. When using Choi's criteria to evaluate the 61 patients who achieved at least partial response by Choi's criteria, 27 patients showed discrepancies in their response to treatment between these two sets of criteria. A lack of CD34 expression in tumors was found to be related to cystic degeneration after imatinib treatment (P=0.001). Patients who showed partial response by Choi's criteria but stable disease by RECIST criteria had a similar progression-free survival to cases who showed a partial response under both systems (P=0.951).
CONCLUSIONS Gastrointestinal stromal tumors showing cystic degeneration after imatinib treatment lack CD34 expression. Choi's criteria have a clinical value in terms of the progression-free survival in Korean patients treated with imatinib.
- 10942012
제1저자 구본권 · 교신저자 김효수
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Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions.JACC Cardiovasc Interv. 2012;5(11):1126-32.
PubMed IF 12.7 순환기내과Abstract
OBJECTIVES This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions.
BACKGROUND Discrepancy exists between stenosis severity and clinical outcomes in bifurcation lesions. However, its mechanism has not been fully evaluated yet.
METHODS Sixty-five patients with left anterior descending coronary artery (LAD) bifurcation lesions were prospectively enrolled. Chest pain and 12-lead electrocardiogram were assessed after 1-min occlusion of coronary flow and coronary wedge pressure (Pw) was measured using a pressure wire.
RESULTS ST-segment elevation was more frequent during LAD occlusion (92%) than during diagonal branch occlusion (37%) (p < 0.001). Pain score was also higher with the occlusion of LAD than with the diagonal branch (p < 0.001). However, both Pw and Pw/aortic pressure (Pa) were lower in the LAD than in diagonal branches (Pw: 21.0 ± 6.5 vs. 26.7 ± 9.4, p < 0.0001; Pw/Pa: 0.22 ± 0.07 vs. 0.27 ± 0.08, p = 0.001). The corrected QT interval was prolonged with LAD occlusion (435.0 ± 39.6 ms to 454.0 ± 45.4 ms, p < 0.0001) but not with diagonal branch occlusion. There was no difference in vessel size between the diagonal branches with and without ST-segment elevation during occlusion. Positive and negative predictive values of vessel size (≥2.5 mm) to determine the presence of ST-segment elevation were 48% and 72%, respectively.
CONCLUSIONS Diagonal branch occlusion caused fewer anginas, less electrocardiogram change, less arrhythmogenic potential, and higher Pw than did a LAD occlusion. These differences seem to be the main mechanism explaining why aggressive treatment for side branches has not translated into clinical benefit in coronary bifurcation lesions. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409).
- 10932012
제1저자 윤연이 · 교신저자 구본권
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Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve.JACC Cardiovasc Imaging. 2012;5(11):1088-96.
PubMed IF 19 순환기내과Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of coronary computed tomography angiography (CCTA)-derived computed fractional flow reserve (FFR(CT)) and transluminal attenuation gradient (TAG) for the diagnosis of lesion-specific ischemia.
BACKGROUND Although CCTA is commonly used to detect coronary artery disease (CAD), it cannot reliably assess the functional significance of CAD. Novel technologies based on CCTA were developed to integrate anatomical and functional assessment of CAD; however, the diagnostic performance of these methods has never been compared.
METHODS Fifty-three consecutive patients who underwent CCTA and coronary angiography with FFR measurement were included. Independent core laboratories determined CAD severity by CCTA, TAG, and FFR(CT). The TAG was defined as the linear regression coefficient between intraluminal radiological attenuation and length from the ostium; FFR(CT) was computed from CCTA data using computational fluid dynamics technology.
RESULTS Among 82 vessels, 32 lesions (39%) had ischemia by invasive FFR (FFR ≤0.80). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratio of TAG (≤ -0.654 HU/mm) for detection of ischemia were 38%, 88%, 67%, 69%, 3.13, and 0.71, respectively; and those of FFR(CT) were 81%, 94%, 90%, 89%, 13.54, and 0.20, respectively. Receiver-operating characteristic curve analysis showed a significantly larger area under the curve (AUC) for FFR(CT) (0.94) compared to that for TAG (0.63, p < 0.001) and CCTA stenosis (0.73, p < 0.001). In vessels with noncalcified plaque or partially calcified plaque, FFR(CT) showed a larger AUC (0.94) compared to that of TAG (0.63, p < 0.001) or CCTA stenosis (0.70, p < 0.001). In vessels with calcified plaque, AUC of FFR(CT) (0.92) was not statistically larger than that of TAG (0.75, p = 0.168) or CCTA stenosis (0.80, p = 0.195).
CONCLUSIONS Noninvasive FFR computed from CCTA provides better diagnostic performance for the diagnosis of lesion-specific ischemia compared to CCTA stenosis and TAG.
- 10922012
제1저자 김인경, 김병관 · 교신저자 김원
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Clinical prediction of failure of Lamivudine prophylaxis for hepatitis B virus-infected patients undergoing cytotoxic chemotherapy for malignancy.Antimicrob Agents Chemother. 2012;56(11):5511-9.
PubMed IF 4.2 소화기내과Abstract
Although lamivudine (LAM) prophylaxis is recommended for patients infected with hepatitis B virus (HBV) undergoing chemotherapy for malignant disease, HBV reactivation sometimes occurs during or after LAM administration. The aim of this study was to determine predictors of LAM prophylactic failure in patients with malignancies. Patients with malignancies were routinely screened for serum hepatitis B surface antigen (HBsAg) from June 2002 to August 2008. All consecutive, HBsAg-positive patients received LAM prophylaxis during and after completion of chemotherapy. We assessed risk factors for virologic breakthrough and withdrawal hepatitis. Death without HBV reactivation was regarded as a competing risk event, which was adjusted by Fine and Gray's model. A total of 110 patients were included in this study. They received LAM prophylaxis for a median of 9.2 months. Virologic breakthrough occurred in 15 patients at a median of 10.9 months from the initiation of LAM prophylaxis. Withdrawal hepatitis occurred in 15 patients at a median of 2.4 months after cessation of LAM prophylaxis. Multivariable analysis showed that high baseline HBV DNA titer (≥2,000 IU/ml) (hazard ratio [HR], 9.94; P = 0.0063) and the use of rituximab (HR, 3.19; P = 0.027) were significant predictors of virologic breakthrough and that high baseline HBV DNA titer (HR, 5.90; P = 0.007), liver cirrhosis (HR, 10.4; P = 0.002), and distant metastasis (HR, 5.14; P = 0.008) were independent risk factors for withdrawal hepatitis. Patients with high viremia, liver cirrhosis, rituximab treatment, and distant metastasis are at high risk of prophylactic failure and need antiviral agents with a greater barrier to resistance.
- 10912012
제1저자 박효은 · 교신저자 최수연
, , ,
Cardio-ankle vascular index reflects coronary atherosclerosis in patients with abnormal glucose metabolism: assessment with 256 slice multi-detector computed tomography.J Cardiol. 2012;60(5):372-6.
PubMed IF 3.5 순환기내과Abstract
OBJECTIVE The association between arterial stiffness, as measured by the cardio-ankle vascular index (CAVI), and coronary atherosclerosis, using coronary artery computed tomography (CT), was investigated in the asymptomatic general population, with special interest in subjects with abnormal glucose metabolism.
PATIENTS AND METHODS A total of 158 normoglycemic subjects and 373 subjects with abnormal glucose metabolism were evaluated. CAVI was assessed in relation with coronary artery calcium score (CACS) and degree of stenosis detected by CT.
RESULTS The association of CAVI with other clinical parameters was evaluated in patients with abnormal glucose metabolism. CAVI was higher, and CACS and the degree of coronary artery stenosis were both greater compared to the normal group. CAVI showed a significant correlation with CACS and the degree of stenosis (r=0.167, p=0.001; r=0.182, p<0.001, respectively). The cut-off level of CAVI from receiver operating characteristic (ROC) curve was ≥ 8.0 for predicting ≥ 50% coronary artery stenosis (area under the curve 0.713, sensitivity 69%, and specificity 61%). CAVI ≥ 8.0 was independently associated with significant coronary artery stenosis, even after adjusting for age, sex, and presence of hypertension and hypercholesterolemia (odds ratio 3.143, 95% confidence interval 1.004-9.842, p=0.049).
CONCLUSION CAVI is an independent parameter which reflects coronary atherosclerosis in patients with abnormal glucose metabolism. CAVI can be a useful tool not only to assess arterial stiffness, but also to evaluate the risk for subclinical coronary atherosclerosis in asymptomatic patients.
- 10902012
제1저자 강현재 · 교신저자 김효수
, , , , , , , , , , , , , , , , ,
Effects of celecoxib on restenosis after coronary intervention and evolution of atherosclerosis (Mini-COREA) trial: celecoxib, a double-edged sword for patients with angina.Eur Heart J. 2012;33(21):2653-61.
PubMed IF 45.3 순환기내과Abstract
AIMS In the previous COREA-TAXUS trial, a 6-month adjunctive use of celecoxib reduced target-lesion revascularization (TLR) without increased thrombotic risk. We aimed to confirm the effects of 3-month celecoxib in patients receiving drug-eluting stent (DES) implantation in the larger prospective, randomized trial.
METHODS AND RESULTS Patients (n = 909) treated for native coronary lesions were randomized into four groups: the control or the celecoxib group with stratification by stents: paclitaxel-eluting stent (PES) or zotarolimus-eluting stent (ZES). In the celecoxib group, 200 mg of celecoxib was given twice daily for 3 months after the procedure. The primary endpoint was in-stent late loss (LL) at 6 months. In-stent LL was significantly lower in the celecoxib group than the control group (0.64 ± 0.54 vs. 0.55 ± 0.47 mm, P = 0.02). The trend of LL reduction in the celecoxib group was maintained in the ZES and PES subgroups, although it did not reach statistical significance. There was a trend towards the reduced clinically driven TLR in the celecoxib group (5.7 vs. 3.2%, log-rank P = 0.09), but adverse cardiac events rate did not differ between the two groups (composite of cardiac death, non-fatal myocardial infarction, and TLR; 8.6 vs. 7.7%, log-rank P = 0.84). Non-fatal myocardial infarction and cardiac death occurred in 1.6% of the patients in the celecoxib group when compared with 0.2% in the control group (log-rank P = 0.03).
CONCLUSION Three-month adjunctive celecoxib would be useful to reduce LL of DES. However, this study may raise the concern about increased thrombotic risk with celecoxib even in patients receiving dual anti-platelet therapy.
- 10892012
제1저자 장은선 · 교신저자 정숙향
, , , , , , , , , , ,
Effects of coffee, smoking, and alcohol on liver function tests: a comprehensive cross-sectional study.BMC Gastroenterol. 2012;12:145.
PubMed IF 3.2 소화기내과Abstract
BACKGROUND Liver function tests (LFTs) can be affected by many factors and the proposed effects of coffee on LFT require a comprehensive evaluation. The aim of this study was to elucidate whether drinking coffee, smoking, or drinking alcohol have independent effects on LFTs in Korean health-check examinees.
METHODS We used the responses of 500 health-check examinees, who had participated in a self-administered questionnaire survey about coffee, alcohol drinking, and smoking habits.
RESULTS Coffee consumption was closely related to male gender, high body mass index (BMI), alcohol drinking, and smoking. On univariable and multivariable analyses, drinking coffee lowered serum levels of total protein, albumin, and aspartate aminotransferases (AST). On multivariable analyses, smoking raised serum γ-glutamyl transferase (GGT) level and decreased serum protein and albumin levels, while alcohol drinking raised GGT level after adjustment for age, gender, regular medication, BMI, coffee and alcohol drinking amounts, and smoking.
CONCLUSIONS Coffee consumption, smoking, and alcohol drinking affect the individual components of LFT in different ways, and the above 3 habits each have an impact on LFTs. Therefore, their effects on LFTs should be carefully interpreted, and further study on the mechanism of the effects is warranted.
- 10882012
제1저자 이반석/황진혁 · 교신저자 이상협
, , , , , , , , ,
Older adults with biliary tract cancer: treatment and prognosis.J Am Geriatr Soc. 2012;60(10):1862-71.
PubMed IF 4.6 소화기내과Abstract
OBJECTIVES To compare survival in older (≥65) and younger (<65) individuals with biliary tract cancer (BTC) and to determine whether treatment efficacy varies according to age.
DESIGN Retrospective cohort study and nested case-control study.
SETTING Tertiary referral center in Korea.
PARTICIPANTS Five hundred thirty-one individuals diagnosed with BTC from 2003 to 2011.
MEASUREMENTS Demographic and clinical characteristics of 326 older (≥65) and 205 younger (<65) individuals with BTC were compared. Differences in survival were also assessed after matching according to propensity score.
RESULTS There were no significant differences in sex, symptoms and signs, tumor histology, stage, or surgery between the two groups, but older participants had more comorbidities and poorer performance status and underwent less chemotherapy and radiotherapy (P < .05). Survival of the two groups was compared. After adjustment for baseline characteristics using the propensity score method, survival was still comparable (P = .72). When survival of older participants in the treatment group (TG, those who underwent surgery, chemotherapy, or radiotherapy) was compared with that of those in the supportive care group (SCG, those who received only supportive care), those in the TG had a longer survival time than those in the SCG (P < .001). This result was confirmed in the propensity analysis (including individuals undergoing surgery, P < .001; excluding individuals undergoing surgery, P < .001). In the multivariable Cox analysis, surgical resection and chemotherapy were significantly associated with longer survival, and advanced tumor stage, lower baseline serum albumin level, and greater comorbidity were found to significantly predict poor survival. Age was not associated with survival in individuals with BTC (P = .33).
CONCLUSION Older age was not associated with poor survival in BTC, and treated individuals had longer survival in the older BTC population. Therefore, treatment should not be restricted on the basis of age.
- 10872012
제1저자 정영희 · 교신저자 송경호
, , , , , , , , , , , , , , ,
Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea.BMC Infect Dis. 2012;12:239.
PubMed IF 3.2 감염내과Abstract
BACKGROUND Healthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI).
METHODS We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset KpBSI.
RESULTS Of 553 patients with community-onset KpBSI, 313 (57%) were classified as HCA- KpBSI and 240 (43%) as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006). Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001). In multivariate analysis, high Charlson's weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality.
CONCLUSIONS HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.
- 10862012
제1저자 강해연 · 교신저자 김상균
, , , , ,
Effect of Helicobacter pylori eradication according to the IL-8-251 polymorphism in Koreans.J Korean Med Sci. 2012;27(10):1202-7.
PubMed IF 3.2 소화기내과Abstract
Previous studies suggested that polymorphisms of proinflammatory cytokine genes are important host genetic factors in Helicobacter pylori infection. The present study evaluated whether IL-8-251 polymorphism affected H. pylori eradication rate and to investigate the effect of H. pylori eradication on angiogenesis and the inflammatory process according to the IL-8-251 polymorphism. A total of 250 H. pylori-positive patients treated by endoscopic resection of the gastric neoplasm were classified into 3 groups (134 H. pylori-eradicated group, 19 H. pylori-eradication failure group, and 97 H. pylori-infected group). H. pylori status, histology, and angiogenic factor levels were evaluated at baseline, 6 months, and 18 months. H. pylori eradication rate was 92.9% in AA genotype, 85.7% in AT genotype and 88.4% in TT genotype (P value = 0.731). Elevated IL-8 and matrix metalloproteinase-9 concentrations in H. pylori-infected gastric mucosa were reversible by successful eradication of H. pylori, independent of the IL-8-251 polymorphism. It is suggested that elevated IL-8 and MMP-9 concentrations in H. pylori-infected gastric mucosa are altered significantly after successful eradication and these conditions continue for 18 months. However, IL-8-251 polymorphism does not affect H. pylori eradication rate and the sequential changes of related angiogenic factors after H. pylori eradication in Koreans.
- 10852012
제1저자 장제현 · 교신저자 김세중
, , , , , , , ,
Early start of dialysis has no survival benefit in end-stage renal disease patients.J Korean Med Sci. 2012;27(10):1177-81.
PubMed IF 3.2 신장내과Abstract
The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m(2) in the early-start group compared with 6.1 mL/min/1.73 m(2) in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged ≥ 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels ≥ 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.
- 10842012
제1저자 김상완 · 교신저자 Henry M Kronenberg
, , , , , , , ,
Intermittent parathyroid hormone administration converts quiescent lining cells to active osteoblasts.J Bone Miner Res. 2012;27(10):2075-84.
PubMed IF 6.5 내분비대사내과Abstract
Intermittent administration of parathyroid hormone (PTH) increases bone mass, at least in part, by increasing the number of osteoblasts. One possible source of osteoblasts might be conversion of inactive lining cells to osteoblasts, and indirect evidence is consistent with this hypothesis. To better understand the possible effect of PTH on lining cell activation, a lineage tracing study was conducted using an inducible gene system. Dmp1-CreERt2 mice were crossed with ROSA26R reporter mice to render targeted mature osteoblasts and their descendents, lining cells and osteocytes, detectable by 5-bromo-4-chloro-3-indolyl-β-d-galactopyranoside (X-gal) staining. Dmp1-CreERt2(+):ROSA26R mice were injected with 0.25 mg 4-OH-tamoxifen (4-OHTam) on postnatal days 3, 5, 7, 14, and 21. The animals were euthanized on postnatal day 23, 33, or 43 (2, 12, or 22 days after the last 4-OHTam injection). On day 43, mice were challenged with a subcutaneous injection of human PTH (1-34, 80 µg/kg) or vehicle once daily for 3 days. By 22 days after the last 4-OHTam injection, most X-gal (+) cells on the periosteal surfaces of the calvaria and the tibia were flat. Moreover, bone formation rate and collagen I(α1) mRNA expression were decreased at day 43 compared to day 23. After 3 days of PTH injections, the thickness of X-gal (+) cells increased, as did their expression of osteocalcin and collagen I(α1) mRNA. Electron microscopy revealed X-gal-associated chromogen particles in thin cells prior to PTH administration and in cuboidal cells following PTH administration. These data support the hypothesis that intermittent PTH treatment can increase osteoblast number by converting lining cells to mature osteoblasts in vivo.
- 10832012
제1저자 송우정 · 교신저자 장윤석
, , , , , , , , , , ,
Association between obesity and asthma in the elderly population: potential roles of abdominal subcutaneous adiposity and sarcopenia.Ann Allergy Asthma Immunol. 2012;109(4):243-8.
PubMed IF 7.1 알레르기내과Abstract
BACKGROUND Obesity is a significant risk factor for asthma; however, the association of asthma with obesity has rarely been studied in the elderly population. The role of central obesity has been suggested as a link between the 2 entities but has not been comprehensively studied in elderly populations.
OBJECTIVE To investigate the mechanisms of association between obesity and asthma in the elderly population.
METHODS This cross-sectional analysis included 994 participants (aged ≥65 years) in the Korean Longitudinal Study on Health and Aging. Asthma was defined by using questionnaires. Spirometry and chest radiography were performed to exclude asthma-mimicking conditions. Measurements of abdominal subcutaneous and visceral fat were calculated by computed tomography of the abdomen, and regional body compositions were measured by dual energy X-ray absorptiometry. Biochemical parameters were also measured.
RESULTS The prevalence of asthma was 5.4%. The study population had a mean body mass index (BMI) of 24.0. Multivariate logistic regression tests revealed that the risk of asthma increased in proportion to an increase in BMI or abdominal subcutaneous adiposity. However, no association was found with visceral adiposity, serum adiponectin levels, or serum vitamin D levels. The dual energy X-ray absorptiometry-measured appendicular fat-free mass index was inversely related to asthma among patients with a BMI of 25.0 or greater.
CONCLUSION Our findings suggest that the relationships between obesity and asthma in the elderly population may be mediated by factors such as abdominal subcutaneous adiposity and sarcopenia. These associations warrant further investigations to identify their potential roles.
- 10822012
제1저자 정우영, 강지훈 · 교신저자 조영석
, , , , , , , , , , , , ,
A randomized, prospective, two-center comparison of sirolimus-eluting stent and zotarolimus-eluting stent in acute ST-elevation myocardial infarction: the SEZE trial.Chin Med J (Engl). 2012;125(19):3373-81.
PubMed IF 9.1 순환기내과Abstract
BACKGROUND The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies. However, this has not been thoroughly evaluated in ST elevation myocardial infarction.
METHODS This was a prospective, randomized, controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction, treated with zotarolimus-eluting stents or sirolimus-eluting stents. From March 2007 to February 2009, 122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion. The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography, and secondary endpoints were percent diameter stenosis, binary restenosis rate, major adverse cardiac events (a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization), and late-acquired incomplete stent apposition.
RESULTS Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49 ± 0.65) mm vs. (0.10 ± 0.46) mm, P = 0.001). Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0 ± 17.9)% vs. (17.6 ± 14.0)%, P < 0.001). In-segment analysis showed similar findings. There were no significant differences in binary restenosis rate, major adverse cardiac events, and late-acquired incomplete stent apposition.
CONCLUSIONS Compared to sirolimus-eluting stents, the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction. Although there was no significant difference in 1-year clinical outcomes, the clinical implication of increased late lumen loss should be further studied.
- 10812012
제1저자 이은주 · 교신저자 김효수
, , , , , , , ,
Regeneration of peripheral nerves by transplanted sphere of human mesenchymal stem cells derived from embryonic stem cells.Biomaterials. 2012;33(29):7039-46.
PubMed IF 13.6 순환기내과Abstract
In cell therapy, the most important factor for therapeutic efficacy is the stable supply of cells with best engraftment efficiency. To meet this requirement, we have developed a culture strategy such as three-dimensional sphere of human embryonic stem cell-derived mesenchymal stem cells (hESC-MSCs) in serum-free medium. To investigate the in vivo therapeutic efficacy of hESC-MSC spheres in nerve injury model, we transected the sciatic nerve in athymic nude mice and created a 2-mm gap. Transplantation of hESC-MSC as sphere repaired the injured nerve significantly better than transplantation of hESC-MSC as suspended single cells in regard to 1) nerve conduction (sphere; 28.81 ± 3.55 vs. single cells; 18.04 ± 2.10, p < 0.05) and 2) susceptibility of nerve stimulation at low voltage (sphere; 0.38 ± 0.08 vs. single cells; 0.66 ± 0.11, p < 0.05) at 8 weeks. Recovery after sphere transplantation was near-complete when compared with the data of normal control (sphere 28.81 ± 3.55 vs normal 32.62 ± 2.85 in nerve conduction : sphere 0.38 ± 0.08 vs normal 0.36 ± 0.67 in susceptibility of nerve stimulation, no significant difference, respectively). Recovery in function of the injured nerve was well corroborated by the histologic evidence of regenerated nerve. In the mechanistic analysis, the supernatant of sphere-forming hESC-MSC contains hepatocyte growth factor and insulin-like growth factor-binding protein-1 significantly more than the supernatant of the single cells of hESC-MSC has, which might be the key factors for the improved engraftment efficiency and greater regeneration of injured peripheral nerve.
- 10802012
제1저자 방영주 · 교신저자 방영주
Treatment of ALK-positive non-small cell lung cancer.Arch Pathol Lab Med. 2012;136(10):1201-4.
PubMed IF 3.3 혈액종양내과Abstract
Crizotinib (Xalkori), the first inhibitor of both anaplastic lymphoma kinase (ALK) and c-Met receptor kinases, has been approved in the United States, Korea, and other countries for the treatment of ALK-positive non-small cell lung cancer (NSCLC). This approval came within just 4 years of the discovery of rearrangements in the ALK gene in a subset of patients with NSCLC. Oral crizotinib 250 mg twice daily showed excellent efficacy in patients with advanced ALK-positive NSCLC, with objective response rates of 61% and 51% in ongoing phase I and II studies, respectively. Objective response rates of current standard, single-agent, second-line therapies are less than 10%. Median progression-free survival was 10 months (95% confidence interval, 8.2-14.7) in the phase I study expanded cohort and has yet to be reached in the phase II study; progression-free survival with current therapies is less than 3 months. Crizotinib was well tolerated; grade 1/2 gastrointestinal toxicity and visual disturbances were the most common adverse events. Patients in the phase II study reported improvements in fatigue, dyspnea, and cough, based on quality of life assessments. Phase III studies investigating crizotinib for the first- and second-line treatment of advanced ALK-positive NSCLC, versus current standards of care, are ongoing. Crizotinib represents a new standard of care for patients with ALK-positive NSCLC and highlights the importance of the role of the pathologist, as molecular profiling becomes a part of initial workups for newly diagnosed patients with NSCLC. This approach will ensure effective individualized treatment for patients with NSCLC.
- 10792012
제1저자 윤호일 · 교신저자 Don D. Sin
, , , , , , , , ,
The complex relationship of serum adiponectin to COPD outcomes COPD and adiponectin.Chest. 2012;142(4):893-899.
PubMed IF 9.8 호흡기내과Abstract
BACKGROUND COPD is a chronic inflammatory disorder with high risk of cardiovascular morbidity and mortality. Adiponectin is a hormone that has anti inflammatory, antidiabetic, and anti atherogenic activities. We investigated the relationship of serum adiponectin to health outcomes in COPD.
METHODS We measured adiponectin levels in serum samples from participants of the Lung Health Study, who were smokers with mild to moderate airflow limitation. We determined the relationship of serum adiponectin to hospitalization and mortality using a Cox proportional hazards model and to baseline lung function measurements and bronchial reactivity using multiple regression methods.
RESULTS Serum adiponectin concentrations were inversely related to hospitalizations and mortality from coronary heart disease (hazard ratio [HR], 0.73; 95% CI, 0.62-0.86) and to cardiovascular disease (HR, 0.83; 95% CI, 0.73-0.94) and positively related to deaths from respiratory causes (HR, 2.09; 95% CI, 1.41-3.11). However, serum adiponectin concentrations were not significantly related to total mortality (HR, 1.10; 95% CI, 0.93-1.29) or cancer-related mortality(HR, 1.11; 95% CI, 0.92-1.34). Serum adiponectin concentrations were significantly related to increased bronchial reactivity and an accelerated decline in lung function (both P , .0001). Smoking status had no material influence on serum adiponectin concentrations.
CONCLUSIONS Adiponectin is a complex serum biomarker in COPD that is associated with decreased risk of cardiovascular events but increased risk of respiratory mortality. Because serum adiponectin is not significantly influenced by smoking status, it is a very promising biomarker of cardiovascular outcomes in COPD.
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