SCI 발표논문

2016년 247편

2172016

제1저자 조용숙 · 교신저자 김덕겸

, , , , ,
Discordance between MTB/RIF and Real-Time Tuberculosis-Specific Polymerase Chain Reaction Assay in Bronchial Washing Specimen and Its Clinical Implications.
PLoS One. 2016;11(10):e0164923.

Abstract
The prevalence and clinical implications of discordance between Xpert MTB/RIF assays and the AdvanSure TB/NTM real-time polymerase chain reaction (PCR) for bronchial washing specimens have not been studied in pulmonary TB (PTB) patients. The discordant proportion and its clinical impact were evaluated in 320 patients from the bronchoscopy registry whose bronchial washing specimens were tested simultaneously with Xpert MTB/RIF and the TB/NTM PCR assay for three years, and the accuracy of the assays, including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were studied. The clinical risk factors for discordance and false positivity of assays were also studied. Among 130 patients who were clinically diagnosed with PTB, 64 patients showed positive acid-fast bacilli culture results, 56 patients showed positive results in molecular methods and clinician diagnosed PTB without results of microbiology in 10 patients. The sensitivity, specificity, PPV, and NPV were 80.0%, 98.95%, 98.1%, and 87.9%, respectively, for Xpert MTB/RIF and 81.5%, 92.6%, 88.3%, and 88.0%, respectively, for TB/NTM PCR. The discordant proportion was 16.9% and was higher in culture-negative PTB compared to culture-confirmed PTB (24.3% vs. 9.4%, p = 0.024). However, there were no significant differences in the clinical characteristics, regardless of the discordance. The diagnostic yield increased with an additional assay (7.7% for Xpert MTB/RIF and 9.2% for TB/NTM PCR). False positivity was less common in patients tested with Xpert MTB/RIF (1.05% vs. 7.37%, p = 0.0035). No host-related risk factor for false positivity was identified. The Xpert MTB/RIF and TB/NTM PCR assay in bronchial washing specimens can improve the diagnostic yields for PTB, although there were considerable discordant results without any patient-related risk factors.
PubMed IF 2.8 호흡기내과
2162016

제1저자 이상훈 · 교신저자 박무석

, , , , , , , , , , , , , , , , , ,
Predicting survival of patients with idiopathic pulmonary fibrosis using GAP score: a nationwide cohort study.
Respir Res. 2016;17(1):131.

Abstract
BACKGROUND The clinical course of idiopathic pulmonary fibrosis (IPF) varies widely. Although the GAP model is useful for predicting mortality, survivals have not yet been validated for each GAP score. We aimed to elucidate how prognosis is related to GAP score and GAP stage in IPF patients.
METHODS The Korean Interstitial Lung Disease Study Group conducted a national survey to evaluate various characteristics in IPF patients from 2003 to 2007. Patients were diagnosed according to the 2002 criteria of the ATS/ERS. We enrolled 1,685 patients with IPF; 1,262 had undergone DL_CO measurement. Patients were stratified based on GAP score (0-7): GAP score Group 0 (n = 26), Group 1 (n = 150), Group 2 (n = 208), Group 3 (n = 376), Group 4 (n = 317), Group 5 (n = 138), Group 6 (n = 39), and Group 7 (n = 8).
RESULTS Higher GAP score and GAP stage were associated with a poorer prognosis (p < 0.001, respectively). Survival time in Group 3 was lower than those in Groups 1 and 2 (p = 0.043 and p = 0.039, respectively), and higher than those in groups 4, 5, and 6 (p = 0.043, p = 0.032, and p = 0.003, respectively). Gender, age, and DL_CO (%) differed significantly between Groups 2 and 3. All four variables in the GAP model differed significantly between Groups 3 and 4.
CONCLUSION The GAP system showed significant predictive ability for mortality in IPF patients. However, prognosis in IPF patients with a GAP score of 3 were significantly different from those in the other stage I groups and stage II groups of Asian patients.
PubMed IF 5.7 호흡기내과
2152016

제1저자 박준빈 · 교신저자 구본권

, , , , , , , , , , , , ,
Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics.
Heart. 2016;102(20):1655-61.

Abstract
OBJECTIVE To assess the distribution of pressure and shear-related forces acting on atherosclerotic plaques and their association with lesion characteristics using coronary CT angiography (cCTA)-based computational fluid dynamics (CFD) model of epicardial coronary arteries.
METHODS Patient-specific models of epicardial coronary arteries were reconstructed from cCTA in 80 patients (12 women, 63.8±9.0 years). The pressure and wall shear stress (WSS) in left anterior descending coronary arteries were assessed using CFD. High-risk plaques were defined as the presence of at least one of the following adverse plaque characteristics: low-density plaque, positive remodelling, napkin-ring sign and spotty calcification.
RESULTS At resting condition, 39.5% of stenotic segments (% diameter stenosis 52.3±14.4%) were exposed to high WSS (>40 dyne/cm(2)). When the stenotic lesion was subdivided into three segments, the distribution of WSS was different from that of pressure change and its magnitude was highest at minimal lumen area (p<0.001). High pressure gradient, proximal location, small lumen and short length were independent determinants of WSS (all p<0.05). The plaques exposed to the highest WSS tertile had a significantly greater proportion of high-risk plaques. The addition of WSS to % diameter stenosis significantly improved the measures of discrimination and reclassification of high-risk plaques (area under the curves from 0.540 to 0.718, p=0.031; net reclassification index 0.827, p<0.001).
CONCLUSIONS The cCTA-based CFD method can improve the identification of high-risk plaques and the risk stratification for coronary artery disease patients by providing non-invasive measurements of WSS affecting coronary plaques.
PubMed IF 4.4 순환기내과
2142016

제1저자 강시혁 · 교신저자 오세일

, , , , , , , , , , , , ,
Heat, heat waves, and out-of-hospital cardiac arrest.
Int J Cardiol. 2016;221:232-7.

Abstract
OBJECTIVE Cardiac arrest is one of the common presentations of cardiovascular disorders and a leading cause of death. There are limited data on the relationship between out-of-hospital cardiac arrest (OHCA) and ambient temperatures, specifically extreme heat. This study investigated how heat and heat waves affect the occurrence of OHCA.
METHODS Seven major cities in Korea with more than 1 million residents were included in this study. A heat wave was defined as a daily mean temperature above the 98th percentile of the yearly distribution for at least two consecutive days.
RESULTS A total of 50,318 OHCAs of presumed cardiac origin were identified from the nationwide emergency medical service database between 2006 and 2013. Ambient temperature and OHCA had a J-shaped relationship with a trough at 28°C. Heat waves were shown to be associated with a 14-% increase in the risk of OHCA. Adverse effects were apparent from the beginning of each heat wave period and slightly increased during its continuation. Excess OHCA events during heat waves occurred between 3PM and 5PM. Subgroup analysis showed that those 65years or older were significantly more susceptible to heat waves.
CONCLUSIONS Ambient temperature and OHCA had a J-shaped relationship. The risk of OHCA was significantly increased with heat waves. Excess OHCA events primarily occurred during the afternoon when the temperature was high. We found that the elderly were more susceptible to the deleterious effects of heat waves.
PubMed IF 3.3 순환기내과
2132016

제1저자 임문순, 김학령 · 교신저자 김상현

, , , , , , , , , , , , , , ,
Different prognostic factors according to left ventricular systolic function in patients with acute myocardial infarction.
Int J Cardiol. 2016;221:90-6.

Abstract
BACKGROUND Initial left ventricular (LV) systolic function is a main determinant of clinical outcomes in patients with acute myocardial infarction (AMI). This study was performed to investigate whether AMI patients have different prognostic factors according to their baseline LV systolic function.
METHODS A total of 12,988 patients with AMI from a nationwide database were analyzed. Major adverse cardiovascular events (MACEs) within 12months of AMI, including death, nonfatal myocardial infarction (MI), and revascularization, were assessed.
RESULTS Patients were stratified into two groups according to LV ejection fraction (LVEF): those with LVEF<40% and those with LVEF≥40%. Patients with LVEF<40% (n=1962, 15.1%) were older and had more unfavorable cardiovascular risk factors than those with LVEF≥40% (n=11,026, 84.9%). The rate of MACE was higher in patients with LVEF<40% than in those with LVEF≥40% (26.8% vs 11.4%, p<0.001). Independent predictors of 12-month MACEs in patients with LVEF≥40% were history of MI, high Killip stage, three-vessel disease, and lower renal function, which are already known as risk factors. However, diabetes mellitus (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.17-2.40; p=0.008), and the use of rennin-angiotensin system (RAS) blockers (HR, 0.63; 95% CI, 0.41-0.95; p=0.029) were independent factors for 12-month MACE in patients with LVEF <40%.
CONCLUSIONS Prognostic factors determining 12-month MACE after AMI are different according to LVEF. Management following AMI should be tailored according to their LV systolic function.
PubMed IF 3.3 순환기내과
2122016

제1저자 김충종 · 교신저자 김남중

, , , , , , , , , ,
Comparison of characteristics of culture-negative pyogenic spondylitis and tuberculous spondylitis: a retrospective study.
BMC Infect Dis. 2016;16(1):560.

Abstract
BACKGROUND Differences between the characteristics of culture positive pyogenic spondylitis (CPPS) and tuberculous spondylitis (TS) are well known. However, differences between the characteristics of culture negative pyogenic spondylitis (CNPS) and TS have not been reported; these would be more helpful in clinical practice especially when initial microbiologic examination of blood and/or biopsy tissue did not reveal the causative bacteria in patients with infectious spondylitis.
METHODS We performed a retrospective review of the medical records of patients with CNPS and TS. We compared the characteristics of 71 patients with CNPS with those of 94 patients with TS.
RESULTS Patients with TS had more previous histories of tuberculosis (9.9 vs 22.3 %, p = 0.034), simultaneous tuberculosis other than of the spine (0 vs 47.9 %, p < 0.001), and positive results in the interferon-gamma release assay (27.6 vs 79.2 %, p < 0.001). Fever (15.5 vs. 31.8 %, p = 0.018), psoas abscesses (15.5 vs 33.0 %, p = 0.011), and paravertebral abscesses (49.3 vs. 74.5 %, p = 0.011) were also more prevalent in TS than CNPS.
CONCLUSIONS Different from or contrary to the previous comparisons between CPPS and TS, fever, psoas abscesses, and paravertebral abscesses are more common in patients with TS than in those with CNPS.
PubMed IF 3.2 감염내과
2112016

제1저자 김상현 · 교신저자 오병희

, , , , , , , , , , , , , , , , , , , , ,
Blood Pressure and Cholesterol-lowering Efficacy of a Fixed-dose Combination With Irbesartan and Atorvastatin in Patients With Hypertension and Hypercholesterolemia: A Randomized, Double-blind, Factorial, Multicenter Phase III Study.
Clin Ther. 2016;38(10):2171-2184.

Abstract
PURPOSE A fixed-dose combination of a stain and an antihypertensive drug may be useful for the treatment of patients with hypertension and hyperlipidemia. It may also improve patient drug compliance to help control risk factors of cardiovascular disease. This study was designed to evaluate the blood pressure-lowering and cholesterol-lowering effect of a fixed-dose combination of irbesartan-atorvastatin compared with monotherapy by either agent over an 8-week treatment period.
METHODS Patients with comorbid hypertension and hypercholesterolemia were screened for this randomized, double-blind, Phase III study. Eligible study patients were randomly assigned to test groups receiving a combination of irbesartan 300 mg and atorvastatin 40 mg or 80 mg (IRB300 + ATO40 and IRB300 + ATO80). Comparator groups comprised monotherapy groups with irbesartan 300 mg (IRB300) or atorvastatin 40 mg (ATO40) or atorvastatin 80 mg (ATO80), or placebo. Patients who were eligible at screening were subjected to a 4- to 6-week washout period before commencing 8 weeks of therapy per their assigned group. The primary efficacy end points were percent change in LDL-C and sitting diastolic blood pressure (DBP) levels from baseline to end of therapy. Tolerability profiles of combination therapy were compared with other groups.
FINDINGS A total of 733 patients with comorbid hypertension and hypercholesterolemia were screened for this study; 230 eligible patients were randomized to treatment. The mean age of patients was 58.9 (8.5) years, and their mean body mass index was 25.8 (3.2) kg/m². More than two thirds (70.9%) of the study patients were male. Mean LDL-C and sitting DBP levels at baseline were 149.54 (29.19) mg/dL and 92.32 (6.03) mm Hg, respectively. Percent reductions in LDL-C after 8 weeks were 46.74% (2.06%) in the IRB300 + ATO40 group and 48.98% (2.12%) in the IRB300 + ATO80 group; these values were 47.13% (3.21%) and 48.30% (2.98%) in the ATO40 and ATO80 comparator groups. Similarly, a reduction in sitting DBP after 8 weeks was -8.50 (1.06) mm Hg in the IRB300 + ATO40 group and 10.66 (1.08) mm Hg in the IRB300 + ATO80 group compared with 8.40 (1.65) mm Hg in the IRB300 group. The incidence rate for treatment-emergent adverse events was 22.27% and was similar between the monotherapy and combination groups.
IMPLICATIONS A once-daily combination product of irbesartan and atorvastatin provided an effective, safe, and more compliable treatment for patients with coexisting hypertension and hyperlipidemia. ClinicalTrials.gov identifier: NCT01442987.
PubMed IF 3.7 순환기내과
2102016

제1저자 오도연 · 교신저자 방영주

, , , , , ,
Phase II trial of dacomitinib in patients with HER2-positive gastric cancer.
Gastric Cancer. 2016;19(4):1095-1103.

Abstract
BACKGROUND Dacomitinib, an irreversible panHER inhibitor, shows significant preclinical antitumor activity in human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC). The aim of this study was to evaluate the clinical activity of dacomitinib and discover potential biomarkers in HER2-positive GC patients.
METHODS We enrolled previously treated advanced HER2-positive GC [HER2 FISH (+) or HER2 IHC 3+] patients. The patients received dacomitinib 45 mg once daily.
RESULTS A total of 27 patients were enrolled. The number of prior chemotherapy regimens was 1 in 7 patients (26 %), 2 in 9 patients (33 %), and more than 2 in 11 patients (41 %). Seven patients had received prior anti-HER2 therapy. The 4-month progression-free survival (PFS) rate was 22.2 % and median PFS was 2.1 months (95 % CI, 2.3-3.4) There were 2 partial response (PRs) and 9 stable disease (SDs), resulting in 7.4 % (95 % CI, 0-17.5 %) of response rate (RR) and 40.7 % (95 % CI, 21.9-59.6 %) of disease control rate (DCR). Eleven patients (41 %) showed some degree of tumor shrinkage. Overall survival was 7.1 months (95 % CI, 4.4-9.8). The most common toxicities were skin rash, diarrhea, and fatigue, most of which were grade 1 or 2. The Ctrough of dacomitinib was lower in gastrectomy patients than nongastrectomy patients. Higher serum levels of HER2 extracellular domain (ECD) and lower levels of soluble E-cadherin (sECAD) correlated with higher dacomitinib activity.
CONCLUSIONS Dacomitinib functions as a single agent in HER2-positive GC patients with a tolerable safety profile. HER2 ECD and sECAD have the potential to be biomarkers for patient selection in a panHER inhibition strategy for HER2-positive GC. (ClinicalTrials.gov: NCT01152853).
PubMed IF 6.1 혈액종양내과
2092016

제1저자 조현진 · 교신저자 김나영

, , , , , , , , , , ,
Analysis of Gastric Microbiota by Pyrosequencing: Minor Role of Bacteria Other Than Helicobacter pylori in the Gastric Carcinogenesis.
Helicobacter. 2016;21(5):364-74.

Abstract
BACKGROUND Little is known about the role of gastric microbiota except for Helicobacter pylori (HP) in human health and disease. We compared the differences of human gastric microbiota according to gastric cancer or control and HP infection status and assessed the role of bacteria other than HP.
METHODS Gastric microbiota of 63 antral mucosal and 18 corpus mucosal samples were analyzed by bar-coded 454 pyrosequencing of the 16S rRNA gene. Antral samples were divided into four subgroups based on HP positivity in pyrosequencing and the presence of cancer. The analysis was focused on bacteria other than HP, especially nitrosating or nitrate-reducing bacteria (NB). The changes of NB in antral mucosa of 16 subjects were followed up.
RESULTS The number of NB other than HP (non-HP-NB) was two times higher in the cancer groups than in the control groups, but it did not reach statistical significance. The number of non-HP-NB tends to increase over time, but this phenomenon was prevented by HP eradication in the HP-positive control group, but not in the HP-positive cancer group.
CONCLUSION We could not find the significant role of bacteria other than HP in the gastric carcinogenesis.
PubMed IF 4.6 소화기내과
2082016

제1저자 최평균,박진용 · 교신저자 박완범

, , , , , , , , , , ,
Immune reconstitution inflammatory syndrome versus non-immune reconstitution inflammatory syndrome lymphoma in HIV patients on antiretroviral therapy.
Int J STD AIDS. 2016;27(11):1013-5.

Abstract
Little is known about differences between immune reconstitution inflammatory syndrome (IRIS) and non-IRIS lymphoma in HIV patients on antiretroviral therapy (ART). The aim of this study was to describe the characteristics of IRIS and non-IRIS lymphoma in Korean HIV-positive patients on ART compared with lymphoma in those off ART. Of 1490 patients, 41 (3%) had lymphoma. Of these, 27 cases (66%) were classified as lymphoma off ART, eight as IRIS lymphoma, and six as non-IRIS lymphoma on ART. Hodgkin lymphoma was significantly more common among patients with non-IRIS lymphoma on ART than among those with lymphoma off ART (P = 0.005), whereas there was no Hodgkin lymphoma among IRIS lymphoma. Stage IV lymphoma was significantly rarer in non-IRIS lymphoma on ART than in lymphoma off ART (P = 0.007). Non-IRIS lymphoma on ART tends to have a better survival rate than lymphoma off ART (Kaplan-Meier survival analysis, P = 0.167), while IRIS lymphoma exhibited a survival rate similar to lymphoma off ART (P = 0.618). In Korean HIV-positive patients, there were significantly more cases of Hodgkin lymphoma of a less advanced stage in non-IRIS lymphoma on ART than in lymphoma off ART, in contrast to IRIS lymphoma.
PubMed IF 1.6 감염내과
2072016

제1저자 서지연 · 교신저자 김주성

, , , , ,
Nimbolide Inhibits Nuclear Factor-КB Pathway in Intestinal Epithelial Cells and Macrophages and Alleviates Experimental Colitis in Mice.
Phytother Res. 2016;30(10):1605-1614.

Abstract
Nimbolide is a limonoid extracted from neem tree (Azadirachta indica) that has antiinflammatory properties. The effect of nimbolide on the nuclear factor-kappa B (NF-κB) pathway in intestinal epithelial cells (IECs), macrophages and in murine colitis models was investigated. The IEC COLO 205, the murine macrophage cell line RAW 264.7, and peritoneal macrophages from interleukin-10-deficient (IL-10^-/- ) mice were preconditioned with nimbolide and then stimulated with tumor necrosis factor-α (TNF-α) or lipopolysaccharide. Dextran sulfate sodium-induced acute colitis model and chronic colitis model in IL-10^-/- mice were used for in vivo experiments. Nimbolide significantly suppressed the expression of inflammatory cytokines (IL-6, IL-8, IL-12, and TNF-α) and inhibited the phosphorylation of IκBα and the DNA-binding affinity of NF-κB in IECs and macrophages. Nimbolide ameliorated weight loss, colon shortening, disease activity index score, and histologic scores in dextran sulfate sodium colitis. It also improved histopathologic scores in the chronic colitis of IL-10^-/- mice. Staining for phosphorylated IκBα was significantly decreased in the colon tissue after treatment with nimbolide in both models. Nimbolide inhibits NF-κB signaling in IECs and macrophages and ameliorates experimental colitis in mice. These results suggest nimbolide could be a potentially new treatment for inflammatory bowel disease. Copyright © 2016 John Wiley & Sons, Ltd.
PubMed IF 8.1 소화기내과
2062016

제1저자 김종민, 장은선 · 교신저자 정숙향

, , , , , , , ,
Association between hepatitis C virus infection and Parkinson's disease.
Mov Disord. 2016;31(10):1584-1585.

PubMed IF 7.7 소화기내과
2052016

제1저자 김경진, 김상현 · 교신저자 김효수, 채인호

, , , , , , , , , , , , , , , , , , ,
Effect of fixed-dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS-ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe).
Cardiovasc Ther. 2016;34(5):371-82.

Abstract
AIM We aimed to compare the effects of fixed-dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia, including a subgroup analysis of patients with diabetes mellitus (DM) or metabolic syndrome (MetS).
METHOD This multicenter eight-week randomized double-blind phase III study evaluated the safety and efficacy of fixed-dose combinations of ezetimibe 10 mg plus rosuvastatin, compared with rosuvastatin alone in patients with primary hypercholesterolemia. Four hundred and seven patients with primary hypercholesterolemia who required lipid-lowering treatment according to the ATP III guideline were randomized to one of the following six treatments for 8 weeks: fixed-dose combinations with ezetimibe 10 mg daily plus rosuvastatin (5, 10, or 20 mg daily) or rosuvastatin alone (5, 10, or 20 mg daily).
RESULTS Fixed-dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol, total cholesterol, and triglyceride levels compared with rosuvastatin alone. Depending on the rosuvastatin dose, these fixed-dose combinations of ezetimibe plus rosuvastatin provided LDL cholesterol, total cholesterol, and triglyceride reductions of 56%-63%, 37%-43%, and 19%-24%, respectively. Moreover, the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non-DM or non-MetS patients, respectively, whereas the effect of rosuvastatin alone did not differ between DM vs non-DM or MetS vs non-MetS patients.
CONCLUSION Fixed-dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy to rosuvastatin alone in lowering LDL cholesterol, total cholesterol, and triglyceride levels. Moreover, the reduction rate was greater in patients with DM or MetS.
PubMed IF 2.8 순환기내과
2042016

제1저자 조유리 · 교신저자 윤정환

, , , , , ,
Fucoidan-induced ID-1 suppression inhibits the in vitro and in vivo invasion of hepatocellular carcinoma cells.
Biomed Pharmacother. 2016;83:607-616.

Abstract
Hepatocellular carcinoma (HCC) is a fast growing tumor associated with a high tendency for vascular invasion and distant metastasis. Recently, we reported that fucoidan displays inhibitory effect on proliferation and invasion of HCC cells. In this study, we investigated the anti-metastatic effect of fucoidan on HCC cells and the key signal that modulates metastasis. The anti-metastatic effect of fucoidan was evaluated in vitro using an invasion assay with human HCC cells (Huh-7, SNU-761, and SNU-3085) under both normoxic (20% O₂ and 5% CO₂, at 37°C) and hypoxic (1% O_2, 5% CO₂, and 94% N_2, at 37°C) conditions. Complementary DNA (cDNA) microarray analysis was performed to find the molecule which is significantly suppressed by fucoidan. In vivo study using a distant metastasis model by injecting SNU-761 cells into spleen via portal vein was performed to confirm the inhibitory effect by small interfering RNA (siRNA) transfection. Immunoblot analyses were used to investigate the signaling pathway. Fucoidan significantly suppressed the invasion of human HCC cells (Huh-7, SNU-761, and SNU-3085). Using cDNA microarray analysis, we found the molecule, ID-1, which was significantly suppressed by fucoidan treatment. Downregulation of ID-1 by siRNA significantly decreased invasion of HCC cells, both in vitro and in vivo (both P<0.05) in a NDRG-1/CAP43-dependent manner. In immunoblot assay, downregulation of ID-1 by siRNA decreased the expressions of epithelial-mesenchymal transition markers including CK19, vimentin, MMP2, and fibronectin. Immunofluorescence study also revealed that actin rearrangement was inhibited when ID-1 was down-regulated in HCC cells. Interestingly, in SNU-761 cells, the ID-1 expressions under hypoxic conditions were lower as compared to those under normoxic conditions. Under hypoxic conditions, HIF-1α up-regulated NDRG-1/CAP43, while HIF-2α down-regulated ID-1, which might be a compensatory phenomenon against hypoxia-induced HCC invasion. In conclusion, NDRG-1/CAP43-dependent down-regulation of ID-1 suppressed HCC invasion both in vitro and in vivo, which was modulated by fucoidan treatment. Moreover, the compensatory down-regulation of ID-1 against hypoxia-induced HCC invasion was observed. ID-1 is a novel therapeutic target for the treatment of metastatic HCC.
PubMed IF 7.5 소화기내과
2032016

제1저자 박진주,윤창환 · 교신저자 채인호, 최동주

, , , , , ,
Reduction of Ischemic Time for Transferred STEMI Patients Using a Smartphone Social Network System.
J Am Coll Cardiol. 2016;68(13):1490-1492.

PubMed IF 22.3 순환기내과
2022016

제1저자 최윤정 · 교신저자 김나영

, , , , , , , , , , , , ,
PMK-S005 Alleviates Age-Related Gastric Acid Secretion, Inflammation, and Oxidative Status in the Rat Stomach.
Gut Liver. 2016;10(5):749-56.

Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the effect of the synthetic S-allyl-L-cysteine (SAC) PMK-S005 on gastric acid secretion, inflammation, and antioxidant enzymes in aging rats.
METHODS The rats were divided into four groups at 31 weeks of age and were continuously fed a diet containing a vehicle control, PMK-S005 (5 or 10 mg/kg), or lansoprazole (5 mg/kg). Gastric acid secretion and connective tissue thickness of the lamina propria were evaluated at 74 weeks and 2 years of age. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and COX-2 levels were measured by using enzyme-linked immunosorbent assays (ELISAs) or Western blot assays. Levels of antioxidant enzymes, including heme oxyganase 1 (HO-1) and
NAD(P)H quinone oxidoreductase 1 (NQO-1), were also measured.
RESULTS As the rats aged, gastric acid secretion significantly decreased, and the connective tissue of the lamina propria increased. However, 74-week-old rats in the PMK-S005 group exhibited greater levels of gastric acid secretion than those of the control and lansoprazole groups. The increase of TNF-α, IL-1β, and COX- 2 expression in 74-week and 2-year-old control rats were inhibited by PMK-S005. In addition, the decrease in HO-1 and NQO-1 protein expression that occurred with aging was inhibited by PMK-S005 in the 74-week-old rats.
CONCLUSIONS These results suggest that PMK-S005 has therapeutic potential as an antiaging agent to ameliorate age-related gastric acid secretion, inflammation, and oxidative stress in the stomach.
PubMed IF 4.1 소화기내과
2012016

제1저자 김재환 · 교신저자 류지곤

, , ,
MicroRNA 141 Expression Is a Potential Prognostic Marker of Biliary Tract Cancers.
Gut Liver. 2016;10(5):836-41.

Abstract
BACKGROUND/AIMS In recent years, a large number of microribonucleic acids (miRNAs) have been identified as putative prognostic biomarkers for solid cancers because of their role in controlling the expression of oncogenes and tumor suppressor genes. The aim of this study was to verify the utility of miRNA 141 as a prognostic biomarker of biliary tract cancers.
METHODS From June 2010 to June 2012, common bile duct cancer tissue samples and matched noncancerous tissues from the ampulla of Vater were obtained from patients with biliary tract cancer undergoing endoscopic retrograde cholangiopancreatography. Using quantitative real-time polymerase chain reaction assays, we measured the mean relative expression levels of miRNA 141 in both groups of tissues. Overexpression of miRNA 141 was defined as a greater than 2-fold increase in expression levels as determined by the 2(-ΔΔCt) method.
RESULTS In a cohort of 38 patients with biliary tract cancers (seven gallbladder, 13 hilar, and 18 distal bile duct cancers), 26 patients (68.4%) were male, and the median age was 69.5 (52 to 85) years. Nineteen patients (50%) had undergone R0 resection procedures, including three Whipple operations, seven pylorus-preserving pancreaticoduodenectomies, six bile duct resections, and three extended lobectomies. Among the patients who had undergone R0 resection, the overexpression of miRNA 141 was significantly associated with shorter disease-free survival and a greater risk of angiolymphatic invasion. Among the patients who did not undergo R0 resection, miRNA 141 overexpression was significantly associated with reduced overall survival.
CONCLUSIONS Overexpression of miRNA 141 is an indicator of a poor prognosis in patients with biliary tract cancer, suggesting that miRNA 141 may be a valuable prognostic biomarker of this disease.
PubMed IF 4.1 소화기내과
2002016

제1저자 서재빈 · 교신저자 김효수

, , , , , , , , , , , , , , ,
Predictors for Side Branch Failure During Provisional Strategy of Coronary Intervention for Bifurcation Lesions (from the Korean Bifurcation Registry).
Am J Cardiol. 2016;118(6):797-803.

Abstract
The most favored strategy for bifurcation lesion is stenting main vessel with provisional side branch (SB) stenting. This study was performed to elucidate predictors for SB failure during this provisional strategy. The study population was patients from 16 centers in Korea who underwent drug-eluting stent implantation for bifurcation lesions with provisional strategy (1,219 patients and 1,236 lesions). On multivariate analysis, the independent predictors for SB jailing after main vessel stenting were SB calcification, large SB reference diameter, severe stenosis of SB, and not taking clopidogrel. Regarding SB compromise, however, the independent predictors were true bifurcation lesion and small SB reference diameter, whereas possible predictors were parent vessel thrombus and parent vessel total occlusion. In addition, SB predilation helps us to get favorable SB outcome. The diameter of SB ostium after main vessel stenting became similar between severe SB lesions treated with predilation and mild SB lesions not treated with predilation. In conclusion, SB calcification, less clopidogrel use, large SB reference diameter, and high SB diameter stenosis are independent predictors for SB jailing, and true bifurcation and small SB reference diameter are independent predictors for SB compromise after main vessel stenting.
PubMed IF 2.5 순환기내과
1992016

제1저자 남아롱, 김지원 · 교신저자 오도연

, , , , , , , , , , , , ,
Therapeutic implication of HER2 in advanced biliary tract cancer.
Oncotarget. 2016;7(36):58007-58021.

Abstract
Currently, there is no validated therapeutic target for biliary tract cancer (BTC). This study aimed to investigate the pre-clinical and clinical implication of HER2 as a therapeutic target in BTC. We established two novel HER2-amplified BTC cell lines, SNU-2670 and SNU-2773, from gallbladder cancer patients. SNU-2670 and SNU-2773 cells were sensitive to trastuzumab, dacomitinib, and afatinib compared with nine HER2-negative BTC cell lines. Dacomitinib and afatinib led to G1 cell cycle arrest in SNU-2773 cells and apoptosis in SNU-2670 cells. Furthermore, dacomitinib, afatinib, and trastuzumab showed synergistic cytotoxicity when combined with some cytotoxic drugs including gemcitabine, cisplatin, paclitaxel, and 5-fluorouracil. In a SNU-2670 mouse xenograft model, trastuzumab demonstrated a good anti-tumor effect as a monotherapy and in combination with gemcitabine increasing apoptosis. In our clinical data, 13.0% of patients with advanced BTC were defined as HER2-positive. Of these, three patients completed HER2-targeted chemotherapy. Two of them demonstrated a partial response, and the other one showed stable disease for 18 weeks. In summary, these pre-clinical and clinical data suggest that HER2 could be a therapeutic target, and that a HER2-targeting strategy should be developed further in patients with HER2-positive advanced BTC.
PubMed IF 5.008 혈액종양내과
1982016

제1저자 임선영, 이정훈 · 교신저자 백승운

, , , , , , , , , , , , , , ,
Subclinical Ascites Does Not Affect the Long-term Prognosis in Hepatitis B Virus-related Cirrhosis Patients Receiving Antivirals.
J Clin Gastroenterol. 2016;50(8):676-85.

Abstract
BACKGROUND AND AIMS This study evaluated the clinical significance of subclinical ascites in patients with hepatitis B virus-related cirrhosis treated with lamivudine (LMV) or entecavir (ETV).
METHODS This multicenter retrospective study involved 8 hospitals. Patients were classified by degree of ascites: (1) no ascites (no ascites on imaging, no diuretics), (2) subclinical ascites (small amount of ascites on imaging, no diuretics), and (3) clinical ascites (moderate to severe ascites or diuretics).
RESULTS Out of 501 patients, 336 (68%), 51 (10%), and 114 (23%) patients were classified as no-ascites, subclinical ascites, and clinical ascites, respectively. In all, 100 (20%) and 401 (80%) were treated with LMV and ETV, respectively. Over 58±24 months of follow-up, 105 patients (21%) developed hepatocellular carcinoma. The cumulative incidence of hepatocellular carcinoma did not differ between LMV-treated and ETV-treated patients (P=0.61); it was higher in the clinical-ascites group than the no-ascites (P=0.054) and subclinical-ascites (P=0.03) groups, but it was comparable between the latter 2 (P=0.225). Forty-five patients (9%) died during follow-up. Survival was significantly shorter in the clinical-ascites group than the other 2 (both P<0.005), but it was comparable between no-ascites and subclinical-ascites groups (P=0.444). Multivariate analysis showed that mortality was significantly associated with prothrombin time [hazard ratio (HR)=2.42; 95% confidence interval (CI), 1.59-3.70], serum albumin (HR=0.54; 95% CI, 0.29-0.99), and presence of clinical ascites (HR=3.58; 95% CI, 1.54-8.30).
CONCLUSIONS Subclinical ascites did not affect prognosis in patients with hepatitis B virus-related cirrhosis receiving antiviral treatment.
PubMed IF 2.7 소화기내과
1972016

제1저자 김정현 · 교신저자 윤성수

, , , , , , ,
SLC29A1 (ENT1) polymorphisms and outcome of complete remission in acute myeloid leukemia.
Cancer Chemother Pharmacol. 2016;78(3):533-40.

Abstract
PURPOSE The solute carrier family 29 (equilibrative nucleoside transporter), member 1 (SLC29A1) is known to be involved in the transportation and resistance of the nucleoside analog cytosine arabinoside (AraC), one of the most effective drugs in the treatment of acute myeloid leukemia (AML).
METHODS In vitro functional analysis in AML cells and genetic association study were performed.
RESULTS Our functional analysis of SLC29A1 on anticancer effects of AraC showed that cytotoxic effects of AraC in AML cell lines were decreased by the reduction of SLC29A1 expression (P < 0.05). To investigate whether SLC29A1 polymorphisms could affect the achievement of complete remission (CR) in AML, we genotyped a total of six common single nucleotide polymorphisms on SLC29A1 in 103 AML patients, including 17 successes and 86 failures in CR. As a result, rs3734703 in 3'-untranslated region was significantly associated with CR even after correction for multiple testing (Fisher's exact test, P = 0.008; P corr = 0.04). A haplotype, ht3 (A-G-G-T-C-A; frequency = 0.294 in success group; frequency = 0.120 in failure group), also revealed a significant association with CR (P = 0.01; simulated P sim = 0.02).
CONCLUSIONS Although further replication in larger subjects and further functional evaluations are required, our results suggest the contribution of SLC29A1 to cytotoxic effects of AraC. In addition, genetic variations of SLC29A1 could be a potential marker for the achievement of CR of cancers of white blood cells including AML.
PubMed IF 2.5 혈액종양내과
1962016

제1저자 서원우 · 교신저자 김학령

, , , , , , , , ,
Incremental prognostic value of high-sensitive C-reactive protein in patients undergoing coronary computed tomography angiography.
J Cardiol. 2016;68(3):222-8.

Abstract
BACKGROUND This study was performed to investigate whether combined use of high-sensitivity C-reactive protein (hs-CRP) levels and coronary computed tomography angiography (CCTA) results have additional prognostic value for predicting cardiovascular events in patients with suspected coronary artery disease (CAD).
METHODS A total of 445 patients (61.6±9.3 years and 62.9% men) with suspected CAD who underwent both CCTA and hs-CRP measurement within one month were evaluated. Information on cardiovascular events, including cardiac death, non-fatal myocardial infarction, unstable angina and late (≥six months after CCTA) coronary revascularization was assessed.
RESULTS One hundred and eighty-five patients (41.6%) had obstructive CAD on CCTA (stenosis ≥50%). Both high hs-CRP (≥2.25mg/L) and obstructive CAD were the independent predictors of cardiovascular events. Kaplan-Meier analysis showed that event rates were significantly different according to the presence of obstructive CAD and hs-CRP levels. Addition of hs-CRP levels to combined information of clinical factors and CCTA results further increased the predictive power for cardiovascular events (global chi-square ratio, from 13.51 to 19.14, p=0.022). Event risks were approximately 21.0-fold higher in the highest-risk group with both obstructive CAD and high hs-CRP levels than in the lowest-risk group with both insignificant CAD and low hs-CRP levels (p=0.007).
CONCLUSIONS Combined use of hs-CRP levels and CCTA results provided a significant improvement in prognostic power for cardiovascular events in patients with suspected CAD. hs-CRP measurement may be a simple and useful method for determining risk stratification and treatment strategy in patients undergoing CCTA.
PubMed IF 3.5 순환기내과
1952016

제1저자 조재영 · 교신저자 이춘택

, , , , , , , ,
Long-Term Follow-up of Small Pulmonary Ground-Glass Nodules Stable for 3 Years: Implications of the Proper Follow-up Period and Risk Factors for Subsequent Growth.
J Thorac Oncol. 2016;11(9):1453-9.

Abstract
INTRODUCTION How long persistent and stable ground-glass nodules (GGNs) should be followed is uncertain, although a minimum of 3 years is suggested. Here, we evaluated a group of GGNs that had remained stable for an initial period of 3 years with the aim of determining the proportion of GGNs showing subsequent growth after the initial 3 years and identifying the clinical and radiologic factors associated with subsequent growth.
METHODS We retrospectively analyzed patients who underwent further computed tomography (CT) after the initial 3-year follow-up period showing a persistent and stable GGN (at least 5 years of follow-up from the initial CT).
RESULTS Between May 2003 and June 2015, 453 GGNs (438 pure GGNs and 15 part-solid GGNs) were found in 218 patients. Of the 218 patients, 14 had 15 GGNs showing subsequent growth after the initial 3 years during the median follow-up period of 6.4 years. For the person-based analysis, the frequency of subsequent growth of GGNs that had been stable during the initial 3 years was 6.7% (14 of 218). For the nodule-based analysis, the frequency was 3.3% (15 of 453). In a multivariate analysis, age 65 years or older (OR = 5.51, p = 0.012), history of lung cancer (OR = 6.44, p = 0.006), initial size 8 mm or larger (OR = 5.74, p = 0.008), presence of a solid component (OR = 16.58, p = 0.009), and air bronchogram (OR = 5.83, p = 0.015) were independent risk factors for subsequent GGN growth.
CONCLUSIONS For the individuals with GGNs having the aforementioned risk factors, the longer follow-up period is required to confirm subsequent GGN growth.
PubMed IF 23.3 호흡기내과
1942016

제1저자 정재우 · 교신저자 강혜련

, , , , ,
Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients.
Ann Allergy Asthma Immunol. 2016;117(3):304-309.e1.

Abstract
BACKGROUND Corticosteroid prophylaxis has been widely adopted for the prevention of acute allergic-like reactions to iodinated contrast media, but its use is still controversial because there is no strong evidence supporting its efficacy before administration of nonionic low osmolar contrast media (LOCM).
OBJECTIVE To assess the outcomes of premedication in patients with previous acute allergic-like reactions to LOCM in clinical practice.
METHODS A retrospective study was performed on 322 high-risk patients who were reexposed to LOCM after premedication composed of antihistamines and/or systemic corticosteroids because of a previous history of acute allergic-like reactions to LOCM.
RESULTS After premedication, 275 patients (85.4%) did not experience any reaction, but 47 patients (14.6%) still experienced a breakthrough reaction. The premedication rate and amount of corticosteroid administered were significantly higher in the nonrecurrence group than in the recurrence group (P = .04 and P = .04, respectively), and a linear trend was observed in the use of corticosteroid premedication and the efficacy of prevention (P for trend = .02). Multivariate binary logistic regression revealed that corticosteroid premedication was effective in preventing recurrence (odds ratio, 0.284; 95% confidence interval, 0.103-0.784). Nonetheless, despite corticosteroid premedication, 3.4% of high-risk patients still experienced moderate to severe reactions, and 14.3% of patients with a severe index reaction again had a severe reaction.
CONCLUSION Premedication with corticosteroids seems to be helpful in reducing the overall rate of recurrence of acute allergic-like reactions to LOCM in high-risk patients, but patients with severe index reactions are still at risk of developing severe reactions despite corticosteroid premedication.
PubMed IF 7.1 알레르기내과
1932016

제1저자 강지훈 · 교신저자 박경우

, , , , , ,
Usefulness of the Baseline Syntax Score to Predict 3-Year Outcome After Complete Revascularization by Percutaneous Coronary Intervention.
Am J Cardiol. 2016;118(5):641-6.

Abstract
Although we strive to achieve complete revascularization (CR) in those receiving percutaneous coronary intervention, it is uncertain which of these patients are at increased risk of clinical events. In this study, we aimed to investigate whether the baseline SYNTAX score (bSS) can predict adverse clinical events in patients receiving CR. From the Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting registry, the 3-year patient-oriented composite end point (POCE; all cause death, any myocardial infarction, and any revascularization) was compared according to bSS tertiles (1 ≤ low bSS < 6, 6 ≤ mid-bSS < 10, high bSS ≥ 10). Of the 5,088 patients, CR was achieved in 2,173 by percutaneous coronary intervention. The 3-year POCE increased significantly along with bSS tertile (7.3% vs 8.4% vs 14.8%, p <0.001). Multivariate analysis showed that, despite having the same residual SS of 0, the bSS was an independent predictor of 3-year POCE (hazard ratio 1.038, 95% confidence interval 1.018 to 1.058, p <0.001 per bSS point). In subgroup analysis, bSS was a predictor for 3-year POCE in multivessel diseases (hazard ratio 1.029, 95% confidence interval 1.004 to 1.054, p = 0.025 per bSS point), whereas in single-vessel diseases, the discriminative value of bSS was less significant. Also the clinical SYNTAX score, which added age, creatinine level, and ejection fraction to the bSS, was superior to the bSS in predicting 3-year POCE (area under the curve 0.595 vs 0.649, p = 0.008). In conclusion, the bSS was an independent predictor of long-term clinical outcomes in patients receiving CR, especially in those with multivessel coronary artery disease. Adding clinical factors to the bSS could increase the predictive power of clinical outcomes.
PubMed IF 2.5 순환기내과
1922016

제1저자 강지훈, 박종한 · 교신저자 박진주

, , , ,
The effects of erythropoiesis stimulating therapy for anemia in chronic heart failure: A meta-analysis of randomized clinical trials.
Int J Cardiol. 2016;218:12-22.

Abstract
BACKGROUND Although anemia is common in chronic heart failure (CHF), the use of erythropoiesis stimulating agents (ESAs) in CHF patients remains controversial. In this meta-analysis, we sought to clarify the efficacy and safety of ESAs in anemic patients with CHF.
METHODS We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, the U.S. National Institutes of Health registry of clinical trials. We included 13 randomized clinical trials (RCTs) in the meta-analysis. The co-primary outcome was all-cause mortality and rehospitalization. The safety analysis outcome was thromboembolic events.
RESULTS Preliminary analysis showed that ESA-treatment did not have any effect for all-cause mortality and rehospitalization. However, we revealed a significant small-study bias, and used the trim-and-fill method to reduce this bias. The summary effect of ESA-treatment was insignificant for all-cause mortality (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.59-1.42, p=0.69) and for rehospitalization (RR 0.91, 95% CI 0.67-1.23, p=0.53). Regarding symptoms, ESA-treatment improved dyspnea (NYHA grade improvement: 1.63, 95% CI 0.65-2.62, p<0.001) and quality-of-life measured by subjective questionnaires. However, in safety analysis, ESAs increased the over-all risk for thromboembolic events (RR 1.28, 95% CI 1.03-1.58, p=0.026), however, no specific increase was observed in severe thromboembolic events. Subgroup analysis showed no difference in ESA-treatment according to the type of ESAs (darbepoetin vs. erythropoietin) and between studies of different follow-up durations (<6months or ≥6months).
CONCLUSION Among CHF patients with anemia, ESA-treatment has a neutral effect on all-cause mortality and rehospitalization and improves symptoms, but has harmful effects on thromboembolic events.
PubMed IF 3.3 순환기내과
1912016

제1저자 이도영 · 교신저자 박영주, 하정훈

, , , , , , , ,
Recurrence and Survival After Gross Total Removal of Resectable Undifferentiated or Poorly Differentiated Thyroid Carcinoma.
Thyroid. 2016;26(9):1259-68.

Abstract
BACKGROUND This study aimed to evaluate the recurrence and survival after initial curative-intent surgery of resectable anaplastic thyroid cancer (ATC) and poorly differentiated thyroid cancer (PDTC).
METHODS A retrospective analysis was conducted on patients with ATC and PDTC who had been treated between 1985 and 2013. Among them, 119 patients who had undergone surgery with curative intent were included in this study. The outcome measures included the clinical response to treatment and the recurrence rates of three separate thyroid cancer groups: ATC, differentiated thyroid cancer (DTC) with anaplastic foci, and PDTC.
RESULTS Initial remission was achieved in 100 (84.0%) patients, with higher percentages in patients with DTC with anaplastic foci (97.8%) and PDTC (96.7%) compared with ATC (60.5%). The overall recurrence rate after initial remission was 30.8% in ATC, 25.9% in PDTC, and 6.7% in DTC with anaplastic foci. Pathologic diagnosis, preexisting goiter or tumors, along with tracheal and lymphatic/vascular invasion were correlated with recurrence (p < 0.001; p = 0.001, 0.006, 0.003, and 0.016, respectively). All patients without initial remission died due to local failure, and most patients with recurrence, apart from two PDTC patients, had distant metastasis. Overall mortality after initial curative-intent surgery was 58.1% in ATC, 8.7% in DTC with anaplastic foci, and 20% in PDTC.
CONCLUSIONS The initial remission of resectable tumors was higher and the recurrence rate was lower in DTC with anaplastic foci and PDTC compared with ATC. Careful monitoring of the development of distant metastasis is necessary, especially in patients with aggressive pathology with tracheal and lymphovascular invasion.
PubMed IF 6.6 내분비대사내과
1902016

제1저자 박준빈 · 교신저자 김형관

, , , , , , , , , , , , , ,
Prognostic Value of Cardiac MR Imaging for Preoperative Assessment of Patients with Severe Functional Tricuspid Regurgitation.
Radiology. 2016;280(3):723-34.

Abstract
Purpose To explore the prognostic value of cardiac magnetic resonance (MR) imaging in predicting postoperative cardiac death in patients with severe functional tricuspid regurgitation (TR). Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all patients. Prospectively collected data included cardiac MR images, New York Heart Association (NYHA) functional class, a comprehensive laboratory test, and clinical events over the follow-up period in 75 consecutive patients (61 women and 14 men; mean age ± standard deviation, 59 years ± 9) undergoing corrective surgery for severe functional TR. Cox proportional hazards models were used to assess the association between cardiac MR parameters and outcomes. Results During a median follow-up period of 57 months (range, 21-82 months), cardiac mortality and all-cause mortality were 17.3% and 26.7%, respectively, with a surgical mortality of 6.7%. Cardiac death risk was lower with a higher right ventricular (RV) ejection fraction (EF) on cardiac MR images (hazard ratio per 5% higher EF = 0.790, P = .048). By adjusting for confounding variables, RV EF remained a significant predictor for cardiac death (P < .05) and major postoperative cardiac events (P < .05). The area under the receiver operating characteristic curve (AUC) confirmed the incremental role of RV EF on cardiac MR images in the prediction of postoperative cardiac death (AUC, 0.681-0.771; P = .041) and major postoperative cardiac events (AUC, 0.660-0.745; P = .044) on top of NYHA class. RV end-systolic volume index was also independently associated with these outcomes but failed to increase the AUC significantly. Conclusion Preoperative assessment of cardiac MR imaging-based RV EF provides independent and incremental prognostic information in patients undergoing corrective surgery for severe functional TR. (©) RSNA, 2016 Online supplemental material is available for this article.
PubMed IF 17.6 순환기내과
1892016

제1저자 김정현 · 교신저자 이진우

, , , , , , , , ,
Factors influencing the initiation of intensive care in elderly patients and their families: A retrospective cohort study.
Palliat Med. 2016;30(8):789-99.

Abstract
BACKGROUND The number of elderly patients admitted to the intensive care unit is constantly growing. However, a decision regarding intensive care in these populations remains a challenge.
AIM To identify factors that influences the decision of elderly patients and their families about whether to initiate intensive care in case of an acute event.
DESIGN/PARTICIPANTS Medical records of patients (>80 years), who were admitted to general wards and referred for intensive care, were retrospectively reviewed. Patients who received intensive care were compared with those not agreeing to the initiation of intensive care.
RESULTS Among the 125 patients, 45 agreed to receiving intensive care. Baseline characteristics at the time of intensive care unit referral were similar between the intensive care and non-intensive care groups. Only one patient had advance directives before the intensive care unit referral. Lower economic status (odds ratio = 0.27, 95% confidence interval = 0.08-0.94) and cognitive impairment (odds ratio = 0.20, 95% confidence interval = 0.07-0.56) were found associated with a lower likelihood of agreeing to intensive care, while a large number of participants involved in the decision-making process were associated with a higher likelihood of intensive care unit use (odds ratio = 1.82, 95% confidence interval = 1.08-3.09). Mean duration of hospital stay was longer for the intensive care group as compared with the non-intensive care group (28.8 days and 19.8 days, respectively, p = 0.03). However, there was no significant difference in the survival rate.
CONCLUSION The initiation of intensive care in elderly patients was influenced not only by medical conditions but also by the patient's economic status and the number of family members involved in the decision-making process.
PubMed IF 6.4 호흡기내과
1882016

제1저자 최선미, 장안희 · 교신저자 김영환

, , , ,
Metformin Reduces Bleomycin-induced Pulmonary Fibrosis in Mice.
J Korean Med Sci. 2016;31(9):1419-25.

Abstract
Metformin has anti-inflammatory and anti-fibrotic effects. We investigated whether metformin has an inhibitory effect on bleomycin (BLM)-induced pulmonary fibrosis in a murine model. A total of 62 mice were divided into 5 groups: control, metformin (100 mg/kg), BLM, and BLM with metformin (50 mg/kg or 100 mg/kg). Metformin was administered to the mice orally once a day from day 1. We sacrificed half of the mice on day 10 and collected the bronchoalveolar lavage fluid (BALF) from their left lungs. The remaining mice were sacrificed and analyzed on day 21. The right lungs were harvested for histological analyses. The messenger RNA (mRNA) levels of epithelial-mesenchymal transition markers were determined via analysis of the harvested lungs on day 21. The mice treated with BLM and metformin (50 mg/kg or 100 mg/kg) showed significantly lower levels of inflammatory cells in the BALF compared with the BLM-only mice on days 10 and 21. The histological examination revealed that the metformin treatment led to a greater reduction in inflammation than the treatment with BLM alone. The mRNA levels of collagen, collagen-1, procollagen, fibronectin, and transforming growth factor-β in the metformin-treated mice were lower than those in the BLM-only mice on day 21, although statistical significance was observed only in the case of procollagen due to the small number of live mice in the BLM-only group. Additionally, treatment with metformin reduced fibrosis to a greater extent than treatment with BLM alone. Metformin suppresses the inflammatory and fibrotic processes of BLM-induced pulmonary fibrosis in a murine model.
PubMed IF 3.2 호흡기내과

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