SCI 발표논문

2010년 155편

1252010

제1저자 이지영 · 교신저자 오도연

, , , , ,
Clinicopathologic features and clinical outcomes of gastric cancer that initially presents with disseminated intravascular coagulation: a retrospective study.
J Gastroenterol Hepatol. 2010;25(9):1537-42.

Abstract
BACKGROUND AND AIM Few systematic studies have been published on prognosis and clinical outcome of gastric cancer patients with disseminated intravascular coagulation (DIC) as the first presentation of malignancy. We evaluated the clinicopathologic features and clinical outcomes of this population.
METHODS We reviewed the medical records of patients with metastatic or recurred gastric cancer that initially presented with DIC.
RESULTS Twenty-one patients were included. Median age was 47 years (range, 24-72 years). Eighteen patients (85.7%) had bone metastasis, and nine patients (42.9%) had hemorrhagic complication of DIC. Fourteen patients received palliative chemotherapy, and seven patients received best supportive care (BSC). The most common factor influencing the decision to abandon the palliative chemotherapy was uncontrolled bleeding (57.1%). The median overall survival (OS) of all patients was 58 days (range, 2-342 days). The OS was significantly shorter in BSC than in the chemotherapy group (median, 16 vs 99 days, P < 0.001). In multivariate analysis, chemotherapy was independently associated with longer OS. In the chemotherapy group, the response to treatment was evaluable in 11 patients: two (18.2%) had a partial response, five (45.5%) had stable disease and four (36.4%) had progressive disease. The OS of patients with progressive disease was significantly longer in the chemotherapy group than in the BSC group (median, 92 vs 16 days, P = 0.009).
CONCLUSIONS The prognosis is poor with gastric cancer that initially presents with DIC but palliative chemotherapy, compared with BSC, prolongs OS. Therefore, early and intensive management for correctable DIC followed by chemotherapy should be considered in this population.
PubMed IF 3.5 소화기내과
1242010

제1저자 윤정민 · 교신저자 김영환

, , , , , , , , ,
The immune modulation of Clara cell-10 in human peripheral monocytes and dendritic cells.
Int J Mol Med. 2010;26(3):415-23.

Abstract
Although Clara cell secretory protein (CC-10, CC-16 or uteroglobin, secretoglobin 1A1) has been ascribed anti-inflammatory, immunomodulatory and anti-cancer activity roles in lung diseases including lung cancer, its precise function remains unclear. The objective of the present study was to evaluate the role of CC-10 in the immunomodulation of human monocytes and dendritic cells (DCs). The human lung adenocarcinoma cell line A549, was used to examine PGE2 production after cyclooxygenase (COX) inhibition and adenovirus encoding human CC-10 cDNA (Ad-CC-10) transfection. Type I and II cytokines were measured from peripheral blood mononuclear cells (PBMCs) and DCs which were cultured with tumor supernatant (TSN) or Ad-CC-10 transfected TSN. When PBMCs were cultured with supernatant A549 (tumor supernatant, TSN), the levels of T-cell helper type 1 (Th1) and 2 (Th2) cytokines increased. However, CC-10 inhibited the induction of Th2 cytokines of PBMCs stimulated with TSN. In DCs, TSN inhibited Th1 type cytokines but induced Th2 type. In contrast, TSN treated with either CC-10 or NS398 (COX-2 inhibitor) stimulated Th1 type and inhibited Th2 type without any phenotypic changes. The supernatants generated in the presence of NS-398 or CC-10 prevented tumor-induced inhibition of allogeneic T-cell stimulation. While the level of interleukin (IL)-10 secretion from DC-Ad-CC-10 was decreased, the level of IL-12 secretion was increased by CC-10. Collectively our data suggest that a supernatant of NSCLC causes an imbalance in the immune response of PBMCs and DCs, which is reversed by CC-10. This suggests that CC-10 is a candidate for the development of a new immunotherapy for lung cancer.
PubMed IF 8.5 호흡기내과
1232010

제1저자 최인실 · 교신저자 이근욱

, , , , ,
Three-weekly S-1 plus cisplatin chemotherapy as first-line treatment for advanced gastric cancer.
Med Oncol. 2010;27(3):992-7.

Abstract
Combination chemotherapy of S-1 and cisplatin has shown promising activity against advanced gastric cancer, but the schedules and dose intensities of S-1 and cisplatin have not been consistent in several clinical trials. We investigated the efficacy and toxicity of 3-weekly S-1/cisplatin chemotherapy as first-line treatment in metastatic or relapsed gastric cancer (MRGC). Forty-six patients with MRGC were prospectively enrolled. S-1 (80 mg/m(2)/day; days 1-14) and cisplatin (60 mg/m(2); day 1) were administrated every 3 weeks. Among 46 patients who received chemotherapy, one achieved a complete response and 21 achieved a partial response, resulting in an overall response rate (RR) of 48%. Thirteen patients (28%) had stable disease and eight patients (17%) had progressive disease. After a median follow-up duration of 48.3 weeks, the median progression-free survival (PFS) and overall survival (OS) were 21.1 weeks and 68.3 weeks, respectively. Patients with good Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-1 had prolonged PFS and OS compared with patients with ECOG PS of 2. Common hematologic toxicities were anemia (93%), leucopenia (61%), and neutropenia (61%). However, grade 3/4 anemia, leucopenia, and neutropenia developed in only 11, 9, and 24% of patients, respectively. Grade 3/4 non-hematologic toxicities included anorexia (22%), fatigue (13%), nausea (7%), and diarrhea (7%). No treatment-related mortality occurred. Three-weekly S-1/cisplatin chemotherapy was active and well-tolerated in MRGC patients.
PubMed IF 4.7 혈액종양내과
1222010

제1저자 최정민 · 교신저자 김상균

, , , , ,
Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer.
Endoscopy. 2010;42(9):705-13.

Abstract
BACKGROUND AND STUDY AIMS This study aimed to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with that of conventional endoscopy for staging depth of invasion (T staging) in early gastric cancer.
PATIENTS AND METHODS A total of 955 patients with suspected early gastric cancer were prospectively registered. EUS staging was carried out prospectively by a single endoscopist using either miniprobe or radial EUS depending on the endoscopic appearance of the tumor. Conventional endoscopy staging was performed retrospectively by consensus between two endoscopists who were blinded to the EUS staging. Conventional endoscopy staging was conducted on the basis of endoscopic features such as surface nodularity and fold convergence. Patients underwent either surgical (n = 586) or endoscopic resection (n = 369) with curative intent. The staging accuracy of each test was compared with the pathological staging of the resected specimen.
RESULTS The presence of a T1m tumor was histologically confirmed in 644 cases (67.4 %) and that of a T1sm tumor in 311 cases (32.6 %). The overall accuracy of EUS staging was 67.4 % (644 / 955) and that of conventional endoscopy staging was 73.7 % (704 / 955) ( P < 0.001). The accuracy of miniprobe EUS was significantly higher than that of radial EUS (79.5 % vs. 59.6 %, P < 0.001), but did not differ significantly from that of conventional endoscopy (79.0 %).
CONCLUSIONS EUS does not substantially impact on pretreatment T staging of patients with early gastric cancer compared with conventional endoscopy. Therefore, EUS may not be necessary routinely, and conventional endoscopy may be sufficient for determining the optimal therapeutic strategy, especially in relation to endoscopic resection for early gastric cancer.
PubMed IF 11.8 소화기내과
1212010

제1저자 황태준 · 교신저자 김나영

, , , , , , , , , ,
Change in antibiotic resistance of Helicobacter pylori strains and the effect of A2143G point mutation of 23S rRNA on the eradication of H. pylori in a single center of Korea.
J Clin Gastroenterol. 2010;44(8):536-43.

Abstract
BACKGROUND The current prevalence of primary antibiotic resistance of H. pylori is not known in Korea. This study was done to evaluate the prevalence of primary antibiotic resistance of H. pylori, and to evaluate the effect of point mutations of 23S rRNA on the rate of eradication of H. pylori.
METHODS H. pylori were isolated from gastric mucosal biopsy specimens obtained from 222 Koreans. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, and levofloxacin were examined using the agar dilution method. DNA sequencing was carried out to detect H. pylori 23S rRNA mutations.
RESULTS The resistance to clarithromycin, tetracycline, ciprofloxacin, and levofloxacin increased during the period of 2007 to 2009 compared with 2003 to 2005 (P<0.05). However, amoxicillin and metronidazole resistance slightly decreased. The rates of eradication were 95.5% for the clarithromycin-sensitive strains, which was higher than the 67.9% for the clarithromycin-resistant strains (P=0.001). By contrast, the eradication rate was 100% in patients with amoxicillin-resistant H. pylori. Among 26 clarithromyin-resistant strains, 6 (23%) had A2143G mutations, and all of the cases in which these mutations were present were not eradicated by proton pump inhibitor-based triple therapy (P=0.0004). By contrast, none of the 26 clarithromyin-sensitive strains had A2143G mutations. The T2183C and A2223G mutations were frequently found in the sensitive strains and in the resistant strains.
CONCLUSIONS Clarithromycin resistance of H. pylori, which determined the efficacy of H. pylori eradication of proton pump inhibitor triple regimen, was found to be increased in a single center study. A2143G was an important 23S rRNA mutation associated with clarithromycin resistance and affected the H. pylori eradication efficacy.
PubMed IF 2.7 소화기내과
1202010

제1저자 이신원 · 교신저자 박완범

, , , , , , ,
Discrepancy between histology and culture in filamentous fungal infections.
Med Mycol. 2010;48(6):886-8.

Abstract
Although the incidence of non-Aspergillus filamentous fungal infections has increased, there is little data regarding the correlation between the results of histologic analysis and those of microbiologic culture in clinical practice. We investigated the results of fungal cultures inoculated with tissue specimens that had been found to have fungal hyphae on histologic examination at a university-affiliated tertiary care hospital. Culture studies were requested for microbiologic diagnosis for 122 (31%) of 393 patients with histologic evidence of the presence of filamentous fungal infections. In 53 (43.4%) out of the 122 specimen, fungi were recovered and identified. In 9 (17%) out of the 53 cases, the histology and culture results were discordant. These data serve to remind physicians of the need for obtaining fungus cultures in these types of cases.
PubMed IF 3.5 감염내과
1192010

제1저자 방영주 · 교신저자 방영주

, , , , , , , , , , , , , , , ,
Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial.
Lancet. 2010;376(9742):687-97.

Abstract
BACKGROUND Trastuzumab, a monoclonal antibody against human epidermal growth factor receptor 2 (HER2; also known as ERBB2), was investigated in combination with chemotherapy for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer.
METHODS ToGA (Trastuzumab for Gastric Cancer) was an open-label, international, phase 3, randomised controlled trial undertaken in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry or gene amplification by fluorescence in-situ hybridisation. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus cisplatin or fluorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab. Allocation was by block randomisation stratified by Eastern Cooperative Oncology Group performance status, chemotherapy regimen, extent of disease, primary cancer site, and measurability of disease, implemented with a central interactive voice recognition system. The primary endpoint was overall survival in all randomised patients who received study medication at least once. This trial is registered with ClinicalTrials.gov, number NCT01041404.
FINDINGS 594 patients were randomly assigned to study treatment (trastuzumab plus chemotherapy, n=298; chemotherapy alone, n=296), of whom 584 were included in the primary analysis (n=294; n=290). Median follow-up was 18.6 months (IQR 11-25) in the trastuzumab plus chemotherapy group and 17.1 months (9-25) in the chemotherapy alone group. Median overall survival was 13.8 months (95% CI 12-16) in those assigned to trastuzumab plus chemotherapy compared with 11.1 months (10-13) in those assigned to chemotherapy alone (hazard ratio 0.74; 95% CI 0.60-0.91; p=0.0046). The most common adverse events in both groups were nausea (trastuzumab plus chemotherapy, 197 [67%] vs chemotherapy alone, 184 [63%]), vomiting (147 [50%] vs 134 [46%]), and neutropenia (157 [53%] vs 165 [57%]). Rates of overall grade 3 or 4 adverse events (201 [68%] vs 198 [68%]) and cardiac adverse events (17 [6%] vs 18 [6%]) did not differ between groups.
INTERPRETATION Trastuzumab in combination with chemotherapy can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer.
FUNDING F Hoffmann-La Roche.
PubMed IF 109 혈액종양내과
1182010

제1저자 서정원, 이승표 · 교신저자 김효수

, , , , , , , , , , , , , ,
Study design and rationale of 'Influence of Cilostazol-based triple anti-platelet therapy on ischemic complication after drug-eluting stent implantation (CILON-T)' study: A multicenter randomized trial evaluating the efficacy of Cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease.
Trials. 2010;11:87.

Abstract
BACKGROUND Current guidelines recommend dual anti-platelet therapy, aspirin and clopidogrel, for patients treated with drug-eluting stent for coronary heart disease. In a few small trials, addition of cilostazol on dual anti-platelet therapy (triple anti-platelet therapy) showed better late luminal loss. In the real-world unselected patients with coronary heart disease, however, the effect of cilostazol on platelet reactivity and ischemic vascular events after drug-eluting stent implantation has not been tested. It is also controversial whether there is a significant interaction between lipophilic statin and clopidogrel.
METHODS/DESIGN CILON-T trial was a prospective, randomized, open-label, multi-center, near-all-comer trial to demonstrate the superiority of triple anti-platelet therapy to dual anti-platelet therapy in reducing 6 months' major adverse cardiovascular/cerebrovascular events, composite of cardiac death, nonfatal myocardial infarction, target lesion revascularization and ischemic stroke. It also tested whether triple anti-platelet therapy is superior to dual anti-platelet therapy in inhibiting platelet reactivity in patients receiving percutaneous coronary intervention with drug-eluting stent. Total 960 patients were randomized to receive either dual anti-platelet therapy or triple anti-platelet therapy for 6 months and also, randomly stratified to either lipophilic statin (atorvastatin) or non-lipophilic statin (rosuvastatin) indefinitely. Secondary endpoints included all components of major adverse cardiovascular/cerebrovascular events, platelet reactivity as assessed by VerifyNow P2Y12 assay, effect of statin on major adverse cardiovascular/cerebrovascular events, bleeding complications, and albumin-to-creatinine ratio to test the nephroprotective effect of cilostazol. Major adverse cardiovascular/cerebrovascular events will also be checked at 1, 2, and 3 years to test the 'legacy' effect of triple anti-platelet therapy that was prescribed for only 6 months after percutaneous coronary intervention.
DISCUSSION CILON-T trial will give powerful insight into whether triple anti-platelet therapy is superior to dual anti-platelet therapy in reducing ischemic events and platelet reactivity in the real-world unselected patients treated with drug-eluting stent for coronary heart disease. Also, it will verify the laboratory and clinical significance of drug interaction between lipophilic statin and clopidogrel.
TRIAL REGISTRATION National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00776828).
PubMed IF 2.1 순환기내과
1172010

제1저자 김수정 · 교신저자 오도연

, , , , , , , , ,
Biological characteristics and treatment outcomes of metastatic or recurrent neuroendocrine tumors: tumor grade and metastatic site are important for treatment strategy.
BMC Cancer. 2010;10:448.

Abstract
BACKGROUND Studies about the biology, treatment pattern, and treatment outcome of metastatic/recurrent neuroendocrine tumor (NET) have been few.
METHODS We enrolled patients with metastatic/recurrent NET diagnosed between January 1996 and July 2007 and retrospectively analyzed.
RESULTS A total of 103 patients were evaluated. Twenty-six patients (25.2%) had pancreatic NET, 27 (26.2%) had gastrointestinal NET, 2 (1.9%) had lung NET, 28 (27.2%) had NET from other sites, and 20 (19.4%) had NET from unknown origin. The liver was the most common metastatic site (68.9%). Thirty-four patients had grade 1 disease, 1 (1.0%) had grade 2 disease, 15 (14.6%) had grade 3 disease, 9 (8.7%) had large cell disease, and 7 (6.8%) had small cell disease.Sixty-six patients received systemic treatment (interferon, somatostatin analogues or chemotherapy), 64 patients received local treatment (TACE, radiofrequency ablation, metastasectomy, etc.). Thirty-six patients received both systemic and local treatments.Median overall survival (OS) was 29.0 months (95% confidence interval, 25.0-33.0) in the 103 patients. OS was significantly influenced by grade (p = .001). OS was 43.0, 23.0, and 29.0 months in patients who received local treatment only, systemic treatment only, and both treatments, respectively (p = .245). The median time-to-progression (TTP) was 6.0 months. Overall response rate was 34.0% and disease-control rate was 64.2%. TTP was influenced by the presence of liver metastasis (p = .011).
CONCLUSIONS OS of metastatic/recurrent NET was different according to tumor grade. TTP was different according to metastasis site. Therefore, development of optimal treatment strategy based on the characteristics of NET is warranted.
PubMed IF 4.1 혈액종양내과
1162010

제1저자 장희창 · 교신저자 오명돈

, , , , , , , , , , , ,
A randomized, double-blind, controlled clinical trial to evaluate the efficacy and safety of CJ-50300, a newly developed cell culture-derived smallpox vaccine, in healthy volunteers.
Vaccine. 2010;28(36):5845-9.

Abstract
A randomized, double-blind, controlled clinical trial was conducted to evaluate the efficacy and safety of CJ-50300, a newly developed cell culture-derived smallpox vaccine, and to determine its minimum effective dose. The overall rates of cutaneous "take" reaction and humoral and cellular immunogenicity in CJ-50300 vaccinees were 100% (123/123), 99.2% (122/123), and 90.8% (109/120), respectively, and these rates did not differ significantly between the conventional-dose and the low-dose CJ-50300 (1.0x10(8) and 1.0x10(7) plaque-forming units/mL, respectively) (P>0.05 for each). No serious adverse reaction was observed. However, one case of possible generalized vaccinia occurred in the conventionally dosed group [ClinicalTrials.gov Identifier: NCT00607243].
PubMed IF 3.4 감염내과
1152010

제1저자 William AR, 구본권 · 교신저자 LaDisa JF

, , , ,
Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation.
J Appl Physiol (1985). 2010;109(2):532-40.

Abstract
Abnormal blood flow patterns promoting inflammation, cellular proliferation, and thrombosis may be established by local changes in vessel geometry after stent implantation in bifurcation lesions. Our objective was to quantify altered hemodynamics due to main vessel (MV) stenting and subsequent virtual side branch (SB) angioplasty in a coronary bifurcation by using computational fluid dynamics (CFD) analysis. CFD models were generated from representative vascular dimensions and intravascular ultrasound images. Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and fractional flow reserve (FFR) were quantified. None of the luminal surface was exposed to low TAWSS (<4 dyn/cm(2)) in the nondiseased bifurcation model. MV stenting introduced eccentric areas of low TAWSS along the lateral wall of the MV. Virtual SB angioplasty resulted in a more concentric region of low TAWSS in the MV distal to the carina and along the lateral wall of the SB. The luminal surface exposed to low TAWSS was similar before and after virtual SB angioplasty (rest: 43% vs. 41%; hyperemia: 18% vs. 21%) and primarily due to stent-induced flow alterations. Sites of elevated OSI (>0.1) were minimal but more impacted by general vessel geometry established after MV stenting. FFR measured at a jailed SB was within the normal range despite angiographic stenosis of 54%. These findings indicate that the most commonly used percutaneous interventional strategy for a bifurcation lesion causes abnormal local hemodynamic conditions. These results may partially explain the high clinical event rates in bifurcation lesions.
PubMed IF 3.7 순환기내과
1142010

제1저자 박영식 · 교신저자 임재준

, , , , , , , ,
Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea.
Int J Tuberc Lung Dis. 2010;14(8):1069-71.

Abstract
The incidence of non-tuberculous mycobacteria (NTM) disease is thought to correlate negatively with the tuberculosis (TB) burden. To determine the recent trend in the number of patients with NTM lung disease at a tertiary referral hospital in South Korea, where the incidence of TB has been stationary, a retrospective analysis was performed. From 2002 to 2008, the number of patients with NTM lung diseases increased from 82 to 133, while the number of TB patients decreased from 436 to 276. NTM lung diseases might be increasing in South Korea despite the stationary incidence of TB.
PubMed IF 3.6 호흡기내과
1132010

제1저자 서정균 · 교신저자 이상협

, , , , , , , , , , , , , ,
Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts.
Eur J Gastroenterol Hepatol. 2010;22(8):989-96.

Abstract
BACKGROUND Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases.
AIMS The aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC.
METHODS We retrospectively reviewed preoperative diagnoses, overall characteristics and postoperative outcome of 20 BCTs and 19 cystadenoma-mimicking simple cysts that were pathologically confirmed.
RESULTS Comparing with atypical simple cysts, symptoms, left-lobe cyst, thick wall, septation, mural nodule, bile duct dilatation and an increase of serum alkaline phosphatase were associated with BCTs. However, on multivariate analysis, mural nodule, left-lobe cyst, and an increase of serum alkaline phosphatase were significantly frequent in BCTs with odds ratios of 75.5, 13.8, and 33.0, respectively. Among the 20 BCTs, seven BCACs were diagnosed. The characteristics of BCACs were mural nodule (P<0.01), intrahepatic cyst debris (P<0.01), and bile duct dilation (P=0.04). Cystic fluid analysis provided no significant differences between BCT and simple cyst. After fine needle aspiration cytology of BCTs, all except one BCAC with atypical cell showed nonspecific findings. After complete surgical excision (97.4% of patients), only one patient with BCAC had recurrence during 29 months of follow-up period.
CONCLUSION In hepatic cysts with mural nodule, left-lobe cyst or increment of serum alkaline phosphatase seem to be indicative of BCTs in the diagnosis of suspicious hepatic cyst. Intracystic debris, bile duct dilation, and mural nodule may be suggestive clinical features of malignancy in BCTs.
PubMed IF 2.1 소화기내과
1122010

제1저자 유광하 · 교신저자 조상헌

, , , , , , ,
Customized Asthma Control Test with reflection on sociocultural differences.
J Korean Med Sci. 2010;25(8):1134-9.

Abstract
We evaluated the utility and feasibility of customizing Asthma Control Test (ACT) items to generate a Korean Asthma Control Test (KACT) specific for Korean patients. We surveyed 392 asthma patients with 19 items, selected to reflect the Korean sociocultural context. Guideline ratings were integrated with the evaluations of specialists (i.e., using both guide base rating together with specialist's rating), and items with the greatest discriminating validity were identified. Stepwise regression methods were used to select items. KACT scale scores showed significant differences between the asthma control ratings generated by integrating ratings (r=0.77, P<0.001), by specialist's evaluations (r=0.54, P<0.001), or by FEV(1) percent predicted (r=0.39, P<0.001). Specialist's and guideline ratings detected 56% and 48.6% of patients with well-controlled asthma, respectively. However, the integrated ratings indicated that only 34.3% of the patients in the test sample were well controlled. The overall agreement between KACT and the integrated rating ranged from 45% to 78%, depending on the cut-off points used. It is possible to formulate a valid, useful country-specific diagnostic tool for the assessment of asthma patients based on the original ACT that reflect differences in sociocultural context.
PubMed IF 3.2 알레르기내과
1112010

제1저자 이승아 · 교신저자 박주헌

, , , , , , , , , ,
Emphysema as a risk factor for the outcome of surgical resection of lung cancer.
J Korean Med Sci. 2010;25(8):1146-51.

Abstract
It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV(1)/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.
PubMed IF 3.2 혈액종양내과
1102010

제1저자 문민경 · 교신저자 박영주

, , , , , , , , , , ,
Subclinical hypothyroidism has little influences on muscle mass or strength in elderly people.
J Korean Med Sci. 2010;25(8):1176-81.

Abstract
Sarcopenia, the age-related decline in muscle mass, affects the muscle strength and muscle quality, and these changes decrease functional capacity. The prevalence of thyroid dysfunction increases with age, and changes in thyroid hormone level lead to neuromuscular deficits. We investigated the effects of subclinical hypothyroidism on the muscle mass, strength or quality in elderly people. One thousand one hundred eighteen subjects aged > or = 65 yr were randomly selected from a local population and classified into a euthyroid (280 men and 358 women), subclinically hypothyroid (61 men and 75 women), or overtly hypothyroid (7 men and 16 women) group. Although women with subclinical hypothyroidism had a higher prevalence of sarcopenia, defined according to the ratio of appendicular skeletal muscle mass to the square of height, muscle mass, strength or quality did not differ in relation to thyroid status in men or in women. Multivariate analysis including age, diabetes, hypertension, acute coronary event, alcohol, smoking, presence of pain, physical activity score, and lipid profile, showed that thyroid-stimulating hormone level was not associated with muscle mass, strength or quality. In conclusion, subclinical hypothyroidism has little influences on muscle mass, strength or quality, and may not be associated with sarcopenia.
PubMed IF 3.2 내분비대사내과
1092010

제1저자 김지혜 · 교신저자 이재호

, , , , ,
Relation of ghrelin, leptin and inflammatory markers to nutritional status in active pulmonary tuberculosis.
Clin Nutr. 2010;29(4):512-8.

Abstract
BACKGROUNDS & AIMS Malnutrition is a prominent feature of tuberculosis. Little is known about the role of the appetite-related hormones, ghrelin and leptin, in malnutrition in tuberculosis. This study was undertaken to determine whether ghrelin and leptin contribute to malnutrition in active pulmonary tuberculosis.
METHODS Nutritional parameters and plasma levels of ghrelin, leptin, and inflammatory cytokines were measured before treatment and after clinical improvement following anti-tuberculosis chemotherapy in 23 tuberculosis subjects and 23 healthy controls prospectively. Patients were divided into well-nourished (n=15) and malnourished (n=8) groups.
RESULTS Ghrelin but not leptin levels were significantly lower in the malnourished tuberculosis group than in the well-nourished tuberculosis group [44.0 (43.0-54.0) vs. 122 (108-158)pg/mL; p<0.05]. Malnutrition score was negatively correlated to ghrelin (rho=-0.76, p<0.01) but not to leptin levels. TNF-alpha and IL-6 levels were significantly higher in the malnourished tuberculosis group than in the well-nourished tuberculosis group and controls. Plasma levels of ghrelin tended to decrease as inflammatory cytokines increased before treatment.
CONCLUSIONS Decreased plasma ghrelin levels, in addition to increased plasma inflammatory cytokine levels, may be associated with malnutrition in active pulmonary tuberculosis.
PubMed IF 7.9 호흡기내과
1082010

제1저자 이주희 · 교신저자 김태유

, , , , , , , ,
Inhibition of histone deacetylase 10 induces thioredoxin-interacting protein and causes accumulation of reactive oxygen species in SNU-620 human gastric cancer cells.
Mol Cells. 2010;30(2):107-12.

Abstract
Histone deacetylase (HDAC)10, a novel class IIb histone deacetylase, is the most similar to HDAC6, since both contain a unique second catalytic domain. Unlike HDAC6, which is located in the cytoplasm, HDAC10 resides in both the nucleus and cytoplasm. The transcriptional targets of HDAC10 that are associated with HDAC10 gene regulation have not been identified. In the present study, we found that knockdown of HDAC10 significantly increased the mRNA expression levels of thioredoxin-interacting protein (TXNIP) in SNU-620 human gastric cancer cells; whereas inhibition of HDAC1, HDAC2, and HDAC6 did not affect TXNIP expression. TXNIP is the endogenous inhibitor of thioredoxin (TRX), which acts as a cellular antioxidant. Real-time PCR and immunoblot analysis confirmed that inhibition of HDAC10 induced TXNIP expression. Compared to class I only HDAC inhibitors, inhibitors targeting both class I and II upregulated TXNIP, indicating that TXNIP is regulated by class II HDACs such as HDAC10. We further verified that inhibition of HDAC10 induced release of cytochrome c and activated apoptotic signaling molecules through accumulation of reactive oxygen species (ROS). Taken together, our results demonstrate that HDAC10 is involved in transcriptional downregulation of TXNIP, leading to altered ROS signaling in human gastric cancer cells. How TXNIP is preferentially regulated by HDAC10 needs further investigation.
PubMed IF 8.2 혈액종양내과
1072010

제1저자 정인아 · 교신저자 박상원

, , , ,
Mild form of 2009 H1N1 influenza infection detected by active surveillance: implications for infection control.
Am J Infect Control. 2010;38(6):482-5.

Abstract
BACKGROUND Screening patients with suspected influenza is a key step for infection control within communities and institutions. By analyzing the clinical characteristics of mild 2009 H1N1 influenza cases detected by active surveillance, we assessed the utility of the commonly used influenza case definition.
METHODS We retrospectively reviewed medical records of 44 patients who were hospitalized and quarantined and who tested positive for the 2009 H1N1 virus using real-time reverse-transcriptase polymerase chain reaction between May 29 and July 28, 2009.
RESULTS Patient median age was 17 years (range, 8-79 years), and 37 patients were male (84%). Common symptoms included cough (34/44; 77.3%), subjective fever (23/44; 52.3%), rhinorrhea or nasal congestion (22/44; 50%), sore throat (19/44; 43.2%), and diarrhea (7/44; 15.9%). All patients were treated with oseltamivir after the onset of initial symptoms (mean, 2.6 days). Common laboratory test results included leucopenia (23/44; 52.3%) and mildly elevated C-reactive protein (26/44; 59.1%).
CONCLUSION There were many mild afebrile cases of the 2009 pandemic H1N1 influenza. Cough, mild leukopenia, and mildly elevated C-reactive protein were relatively common clinical manifestations. Thus, case-based surveillance for the index cluster of 2009 pandemic influenza is not an effective method for infection control in communities or hospital settings.
PubMed IF 2.6 감염내과
1062010

제1저자 이상협 · 교신저자 정숙향

, , , , , , , , , , ,
An epidemiologic study on the incidence and significance of HFE mutations in a Korean cohort with nonalcoholic fatty liver disease.
J Clin Gastroenterol. 2010;44(7):e154-61.

Abstract
BACKGROUND/AIM The incidence and significance of HFE mutations (C282Y, H63D, and S65C) in nonalcoholic fatty liver disease (NAFLD) has not been investigated in Korea.
METHODS Mutation analysis of HFE gene and measurement of blood iron indices were carried out in 125 NAFLD patients and 221 controls.
RESULTS Neither C282Y nor S65C gene mutations were detected. The prevalence of the H63D mutation was higher in the NAFLD group (14.4%) than in the controls (7.2%) (P=0.032). The estimated odds ratio (OR) of NAFLD for H63D mutations was 3.09 (P=0.008) by multivariate analysis, and age, gender, obesity, diabetes mellitus, and hypercholesterolemia were independent variables associated with NAFLD. However, in the multivariate analysis containing interaction of the types of HFE mutations and gender, the prevalence of the H63D mutation was significantly higher in the male NAFLD group than in the male control group (OR=5.51, P=0.007); the difference of the prevalence between the NAFLD and the control group in females was not significant. The NAFLD patients with H63D mutations had higher levels of TS than those with the wild type (OR=3.14, P=0.048) by the multivariate analysis. A higher TS was significantly associated with the lower body mass index only in the male NAFLD group by multivariate analysis (OR=0.67, P=0.002).
CONCLUSIONS The presence of H63D mutations was an independent factor associated with NAFLD and elevated TS. Therefore, the H63D mutation may increase susceptibility to NAFLD probably associated with peripheral iron overload, especially in males.
PubMed IF 2.7 소화기내과
1052010

제1저자 조상헌 · 교신저자 최병휘

, , , , , , ,
Effectiveness of a computer-assisted asthma management program on physician adherence to guidelines.
J Asthma. 2010;47(6):680-6.

Abstract
BACKGROUND AND OBJECTIVE Asthma is an example of a chronic disease for which there are evidence-based guidelines for primary care. The authors undertook this study to demonstrate that physicians' use and adherence to asthma management guidelines are improved when the guidelines are furnished in a computer-based format.
METHODS Based on established guidelines, the authors devised a practical and simple computer-assisted program focused on asthma treatment and monitoring. They then undertook a preliminary investigation, "Easy Asthma Management (EAM)" study, using this program. Finally, the authors evaluated the program's effectiveness by measuring clinical outcomes and changes in prescription patterns before and after the study.
RESULTS A total of 4682 asthma patients followed by 377 physicians were recruited, and 2187 completed the study (46.7%). The means of diurnal and nocturnal symptom scores were significantly reduced after a 3-month enrollment in the EAM study. Interestingly, the fraction of prescriptions for oral beta(2)-agonists, oral methylxanthines, and systemic steroids (oral or injection) significantly decreased after the EAM study (p = .02, p <.001, p <.001, respectively), whereas the fraction of prescriptions for inhaled forms of steroids combined with beta(2)-agonists increased significantly (p <.001).
CONCLUSIONS These findings suggest that a computer-assisted asthma management program can be used to improve the clinical outcomes of patients with asthma, and increase physician adherence to established guidelines.
PubMed IF 1.6 알레르기내과
1042010

제1저자 송지현 · 교신저자 김상균

, , , , ,
The interleukin-8-251 AA genotype is associated with angiogenesis in gastric carcinogenesis in Helicobacter pylori-infected Koreans.
Cytokine. 2010;51(2):158-65.

Abstract
Helicobacter pylori (H. pylori) is an important risk factor of gastric adenocarcinoma. Interleukin (IL)-8 is a potent angiogenic factor and plays an important role in inflammation of gastric mucosa by H. pylori. Host susceptibility may help to predict H. pylori-infected individuals with a higher risk of gastric adenocarcinoma. The aim of this study was to clarify the effect of IL-8 polymorphism on angiogenesis in the process of gastric carcinogenesis in H. pylori-infected Koreans. The IL-8-251A/T polymorphism was genotyped by PCR-RFLP from a total of 395 subjects; 92 normal controls, 87 H. pylori-infected controls, 108 chronic atrophic gastritis and/or intestinal metaplasia and 108 adenocarcinoma. The gastric mucosal concentrations of IL-8, membrane metalloproteinase (MMP)-9, angiopoietin (Ang)-1, and vascular endothelial growth factor (VEGF) were measured by ELISA. MMP-9 concentrations were increased with disease progression. There was significant correlation between MMP-9 and disease progression in AA (r=0.42, p<0.01) and AT genotype (r=0.43, p<0.01). Ang-1 concentrations were increased in AA genotype (r=0.40, p=0.01). However, there was no significant correlation between VEGF and disease progression in AA genotype. In conclusion, IL-8-251 AA genotype may be associated with angiogenesis in gastric carcinogenesis in H. pylori-infected Koreans.
PubMed IF 3.6 소화기내과
1032010

제1저자 곽민선 · 교신저자 김나영

, , , , ,
Predictive power of serum pepsinogen tests for the development of gastric cancer in comparison to the histologic risk index.
Dig Dis Sci. 2010;55(8):2275-82.

Abstract
BACKGROUND AND AIM The selection of a high-risk group of gastric cancer is important. This study was performed to compare the efficacy of non-invasive gastric cancer screening through the measurement of pepsinogen (PG) I/II ratio and endoscopic screening using histologic criteria (Meining's risk index for gastric cancer) in Korean patients.
METHODS Included in the study were 460 gastric cancer patients and 460 control cases who underwent upper endoscopy between June 2003 and July 2008 at Seoul National University Bundang Hospital. Serum PG I/II ratio and histologic characteristics were evaluated for each participant. Multivariate logistic regression was performed to compare the predictive power for gastric cancer of both the PG II/I ratio (the inverse form of PG I/II ratio) and the histologic gastric cancer risk index.
RESULTS A higher PG II/I ratio was significantly associated with a higher risk for gastric cancer (odds ratio of highest quartile for cancer vs. lowest quartile, 3.51; 95% confidence interval, 2.29-5.36) in the multivariate logistic model. The validity (in terms of calibration and discrimination) of the PG-including multivariate logistic model was comparable to the histologic gastric cancer risk index model. The results were similar regardless of the staging of the cancer, Lauren's histologic classification, and the location of the cancer.
CONCLUSIONS These results suggest that non-invasive measurement of serum PG I/II ratio is as effective as Meining's histologic gastric cancer risk index in predicting gastric cancer occurrence.
PubMed IF 2.8 소화기내과
1022010

제1저자 조남한 · 교신저자 조보연

, , , , , , , , , ,
Interaction between cigarette smoking and iodine intake and their impact on thyroid function.
Clin Endocrinol (Oxf). 2010;73(2):264-70.

Abstract
OBJECTIVE Several population-based studies in iodine-deficient areas have shown an association between smoking and thyroid function. There are no population-based studies about the effects of smoking in iodine-sufficient areas. We examined the effect of smoking on thyroid function and the association with iodine intake in Korea, an area with sufficient iodine intake, much more than recommended by the World Health Organization (WHO).
DESIGN Of 5018 subjects in a population-based cohort, we included 3399 who had no history of thyroid disease were not taking thyroid medication and whose blood samples were available for measurement of thyroid function.
MEASUREMENTS Thyroid function test, questionnaire about smoking status and dietary intake.
RESULTS Of 3399 subjects, 397(11.7%) had subclinical hypothyroidism (SCH). Female sex was an independent risk factor for SCH. Multivariate analysis in female subjects showed the following were independent risk factors for SCH: older age, positive antithyroid peroxidase (anti-TPO) antibody status and iodine intake, whereas current smoking was inversely related with SCH. However, in male subjects, only age showed a weak association with SCH. When the interaction between smoking and other risk factors was analysed, smoking showed no association with anti-TPO antibody status, whereas it showed a significant negative interaction with iodine intake (odds ratio, 0.930; 95% CI, 0.869-0.996; P = 0.037). Furthermore, the risk for SCH was observed only in the never-smoker group; however, it was abolished in current- and ex-smoker groups.
CONCLUSION Cigarette smoking was associated with a lower prevalence of SCH in a negative interaction with iodine intake.
PubMed IF 2.8 내분비대사내과
1012010

제1저자 정숙향 · 교신저자 정숙향

, , , , , , , , , , , , ,
Atypical manifestations of hepatitis A infection: a prospective, multicenter study in Korea.
J Med Virol. 2010;82(8):1318-26.

Abstract
The clinical outcome of symptomatic hepatitis A and the incidence and clinical characteristics of atypical presentation of hepatitis A were studied using prospective, multicenter design. The atypical presentation included delayed anti-hepatitis A virus (HAV) immunoglobulin M (IgM) seroconversion defined as positive anti-HAV IgM on the repeated test within 7 days of hospital admission after the initially negative result, prolonged cholestasis, and acute kidney injury (AKI). A total of 595 patients with symptomatic hepatitis A requiring hospital admission were enrolled prospectively from September 2006 to August 2008 in four major hospitals in a Korean city with a population of approximately 1 million. Clinical outcomes of symptomatic hepatitis A showed a case fatality rate of 0.2%, and fulminant hepatitis in 0.5%. Delayed anti-HAV IgM seroconversion was found in 6.4%, and was significantly associated with shorter intervals from symptom onset to hospital admission, higher body mass index, and lower alanine aminotransferase (ALT) level at admission. Prolonged cholestasis was found in 4.7% of patients, and could be predicted by preexisting chronic hepatitis B viral infection, prolonged prothrombin time, and higher total bilirubin level. AKI was complicated in 1.5%, which could be predicted by lower albumin level, higher ALT level, and higher white blood cell (WBC) count. More than half of the patients required hemodialysis. Substantial occurrence of delayed anti-HAV IgM seroconversion, prolonged cholestasis, and AKI was confirmed with various predictable factors, which could be helpful for accurate diagnosis and management of hepatitis A patients.
PubMed IF 3.7 소화기내과
1002010

제1저자 조현재 · 교신저자 김효수/박영배

, , , , , , , , , , , , ,
Induction of pluripotent stem cells from adult somatic cells by protein-based reprogramming without genetic manipulation.
Blood. 2010;116(3):386-95.

Abstract
The concept of reprogramming of somatic cells has opened a new era in regenerative medicine. Transduction of defined factors has successfully achieved pluripotency. However, during the generation process of induced pluripotent stem (iPS) cells, genetic manipulation of certain factors may cause tumorigenicity, which limits further application. We report that that a single transfer of embryonic stem (ES) cell-derived proteins into primarily cultured adult mouse fibroblasts, rather than repeated transfer or prolonged exposure to materials, can achieve full reprogramming up to the pluripotent state without the forced expression of ectopic transgenes. During the process, gene expression and epigenetic status were converted from somatic to ES-equivalent status. We verified that protein-based reprogramming was neither by the contamination of protein donor ES cell nor by DNA/RNA from donor ES cell. Protein-iPS cells were biologically and functionally very similar to ES cells and differentiated into 3 germ layers in vitro. Furthermore, protein-iPS cells possessed in vivo differentiation (well-differentiated teratoma formation) and development (chimeric mice generation and a tetraploid blastocyst complementation) potentials. Our results provide an alternative and safe strategy for the reprogramming of somatic cells that can be used to facilitate pluripotent stem cell-based cell therapy.
PubMed IF 23.9 순환기내과
992010

제1저자 이연이 · 교신저자 박경수

, , , , , ,
Tauroursodeoxycholate (TUDCA), chemical chaperone, enhances function of islets by reducing ER stress.
Biochem Biophys Res Commun. 2010;397(4):735-9.

Abstract
The exposure to acute or chronic endoplasmic reticulum (ER) stress has been known to induce dysfunction of islets, leading to apoptosis. The reduction of ER stress in islet isolation for transplantation is critical for islet protection. In this study, we investigated whether tauroursodeoxycholate (TUDCA) could inhibit ER stress induced by thapsigargin, and restore the decreased glucose stimulation index of islets. In pig islets, thapsigargin decreased the insulin secretion by high glucose stimulation in a time-dependent manner (1h, 1.35+/-0.16; 2h, 1.21+/-0.13; 4h, 1.17+/-0.16 vs. 0h, 1.81+/-0.15, n=4, p<0.05, respectively). However, the treatment of TUDCA restored the decreased insulin secretion index induced by thapsigargin (thapsigargin, 1.25+/-0.12 vs. thapsigargin+TUDCA, 2.13+/-0.19, n=5, p<0.05). Furthermore, the culture of isolated islets for 24h with TUDCA significantly reduced the rate of islet regression (37.4+/-5.8% vs. 14.5+/-6.4%, n=12, p<0.05). The treatment of TUDCA enhanced ATP contents in islets (27.2+/-3.2pmol/20IEQs vs. 21.7+/-2.8pmol/20IEQs, n=9, p<0.05). The insulin secretion index by high glucose stimulation is also increased by treatment of TUDCA (2.42+/-0.15 vs. 1.92+/-0.12, n=12, p<0.05). Taken together, we suggest that TUDCA could be a useful agent for islet protection in islet isolation for transplantation.
PubMed IF 2.5 내분비대사내과
982010

제1저자 천재영 · 교신저자 김원

, , , , , , , , ,
High viremia, prolonged Lamivudine therapy and recurrent hepatocellular carcinoma predict posttransplant hepatitis B recurrence.
Am J Transplant. 2010;10(7):1649-59.

Abstract
Hepatitis B virus (HBV) recurrence following orthotopic liver transplantation (OLT) is generally preventable by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM). However, HBV recurrence sometimes develops despite prophylaxis. This study assessed posttransplant outcomes and identified predictors of HBV recurrence. We analyzed the outcomes of 209 consecutive patients positive for hepatitis B surface antigen who underwent OLT, who received either combination prophylaxis with HBIG and LAM (89.0%) or HBIG monoprophylaxis (11.0%). The median follow-up was 36.8 months (range, 1.0-84.4). Posttransplant HBV recurrence occurred in 22 patients (10.5%), including 13 patients with drug-resistant mutations. HBV recurrence was observed in six patients after hepatocellular carcinoma (HCC) recurrence. Independent predictors of HBV recurrence were recurrent HCC (p < 0.001), LAM therapy >1.5 years (p = 0.001) and high HBV DNA titers (> or =10(5) copies/mL) at OLT (p = 0.036). In conclusion, high viremia at OLT and prolonged exposure to LAM should be further stressed as main predictors of HBV recurrence.
PubMed IF 8.1 소화기내과
972010

제1저자 정혜승 · 교신저자 이명식

,
Role of autophagy in diabetes and mitochondria.
Ann N Y Acad Sci. 2010;1201:79-83.

Abstract
Type 2 diabetes mellitus is characterized by insulin resistance and failure of pancreatic beta-cells producing insulin. Mitochondrial dysfunction may play a role in both processes of diabetes. Autophagy maintains cellular homeostasis through degradation and recycling of organelles such as mitochondria. As dysfunctional mitochondria are the main organelles removed by autophagy, we studied the role of autophagy in diabetes using mice with beta-cell-specific deletion of the Atg7 gene. Atg7-mutant mice showed reduction in beta-cell mass and pancreatic insulin content. Electron microscopy showed swollen mitochondria and other ultrastructural changes in autophagy-deficient beta-cells. Insulin secretory function ex vivo was also impaired. As a result, Atg7-mutant mice showed hypoinsulinemia and hyperglycemia. These results suggest that autophagy is necessary to maintain structure, mass, and function of beta-cells. Besides its effect on beta-cells, autophagy may affect insulin sensitivity because mitochondrial dysfunction has been implicated in insulin resistance and autophagy is involved in the maintenance of the organelles. Furthermore, since aging is associated with impaired glucose tolerance, decline of autophagic activity may be involved in age-associated reduction of glucose tolerance.
PubMed IF 4.5 내분비대사내과
962010

제1저자 민주원 · 교신저자 이재호

, , , , ,
Real-time polymerase chain reaction in bronchial aspirate for rapid detection of sputum smear-negative tuberculosis.
Int J Tuberc Lung Dis. 2010;14(7):852-8.

Abstract
SETTING The real-time polymerase chain reaction (RT-PCR) has increasingly been used for the detection of various micro-organisms, including mycobacteria.
OBJECTIVE To determine the role of RT-PCR in confirming the diagnosis of tuberculosis (TB) when acid-fast bacilli (AFB) smear results in sputum samples were not available (i.e., no sputum or negative smear results).
DESIGN We analysed the data of consecutive patients whose bronchial aspirate (BA) was tested for RT-PCR for the diagnosis of TB from January 2006 to April 2008. Computed tomography (CT), bronchoscopy and tissue biopsies were performed in all patients for confirmatory diagnosis, and BA was collected for microbiological analyses and RT-PCR. Final diagnoses were based on microbiological or clinicopathological criteria.
RESULTS Final diagnoses were made in 136 patients, and TB was confirmed in 77 (including 65 culture-positive patients). RT-PCR was positive in 51.9% (40/77) of the confirmed TB patients. More TB patients (20.8%) were detected using RT-PCR than using BA-AFB stain (40 vs. 20, P < 0.001). Of the 77 TB patients, 44 (57.1%) were detected within a few days using a combination of BA-AFB and RT-PCR.
CONCLUSION Real-time RT-PCR of bronchial aspirate seems to be useful for the rapid diagnosis of TB in suspects with smear-negative TB sputum or no sputum.
PubMed IF 3.6 호흡기내과

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