SCI 발표논문

2012년 229편

1392012

제1저자 배재현 · 교신저자 김상완

, , , , , , , , ,
Preoperative predictive factors for parathyroid carcinoma in patients with primary hyperparathyroidism.
J Korean Med Sci. 2012;27(8):890-5.

Abstract
This study was conducted to review the clinical characteristics of parathyroid carcinoma (PC) and to evaluate potential preoperative predictive factors for PC in patients with primary hyperparathyroidism (PHPT). We performed a retrospective review of electronic medical records of 194 patients with pathologically confirmed PHPT in affiliated teaching hospitals of Seoul National University from January 2000 to March 2011. Adenoma was diagnosed in 171 patients, hyperplasia in 12, and carcinoma in 11. Several biochemical measurements were higher in patients with PC than in patients with benign disease, including serum total calcium (P < 0.001), intact parathyroid hormone (P = 0.003), and alkaline phosphatase (ALP) (P < 0.001). Tumors were larger in PC than in benign disease (P < 0.001). Multivariate analysis revealed that serum ALP level (P < 0.001) and tumor size were associated with PC (P = 0.03). Tumor size and serum ALP level were evaluated as preoperative predictive factors for PC using ROC analyses: a tumor size of 3.0 cm (sensitivity 90.9%, specificity 92.1%) and serum ALP level of 285 IU/L (83.3%, 97.0%) had predictive value for the diagnosis of PC in patients with PHPT. In conclusion, elevated serum ALP and a large parathyroid mass at the time of diagnosis can be helpful to predict PC in patients with PHPT.
PubMed IF 3.2 내분비대사내과
1382012

제1저자 박종선 · 교신저자 윤호일, 이춘택

, , , , ,
Udenafil improves exercise capacity in patients with chronic obstructive pulmonary disease: a prospective study.
COPD. 2012;9(5):499-504.

Abstract
Pulmonary hypertension (PH) is a serious complication of chronic obstructive pulmonary disease (COPD), and there is no effective pharmacological treatment for COPD-associated PH. We evaluated the effect of udenafil, a phosphodiesterase-5 (PDE-5) inhibitor, on the exercise capacity of patients with severe COPD. Patients with severe and very severe COPD (forced expiratory volume in one second (FEV(1)) <50% of predicted) received udenafil (50 mg daily) for 8 weeks. A 6-min walk test (6MWT), lung function test, Doppler echocardiography, and Saint George's Respiratory Questionnaire (SGRQ) were completed before and after therapy. The primary outcome was a change in the 6-min walk distance (6MWD). Thirty-eight patients were screened for eligibility, and 23 completed the study. After 8 weeks of udenafil treatment, the mean 6MWD increased from 315 to 348 m (p = 0.02), and median PASP decreased from 36 to 30 mmHg (p = 0.02). There were no changes in the SGRQ score, Borg dyspnea score, or pulmonary function parameters. The PDE-5 inhibitor udenafil improved exercise capacity and decreased pulmonary artery pressure in patients with severe COPD. However, due to the small sample size, uncontrolled design and high dropout rate, the efficacy of udenafil in severe COPD needs to be confirmed in a large-scale randomized controlled study. This study was registered at ClinicalTrials.gov (number: NCT01364181).
PubMed IF 2.8 호흡기내과
1372012

제1저자 김경희 · 교신저자 김형관

, , , , , , , ,
Myocardial scarring on cardiovascular magnetic resonance in asymptomatic or minimally symptomatic patients with "pure" apical hypertrophic cardiomyopathy.
J Cardiovasc Magn Reson. 2012;14(1):52.

Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) enables state-of-the-art in vivo evaluations of myocardial fibrosis. Although LGE patterns have been well described in asymmetrical septal hypertrophy, conflicting results have been reported regarding the characteristics of LGE in apical hypertrophic cardiomyopathy (ApHCM). This study was undertaken to determine 1) the frequency and distribution of LGE and 2) its prognostic implication in ApHCM.
METHODS Forty patients with asymptomatic or minimally symptomatic pure ApHCM (age, 60.2 ± 10.4 years, 31 men) were prospectively enrolled. LGE images were acquired using the inversion recovery segmented spoiled-gradient echo and phase-sensitive inversion recovery sequence, and analyzed using a 17-segment model. Summing the planimetered LGE areas in all short axis slices yielded the total volume of late enhancement, which was subsequently presented as a proportion of total LV myocardium (% LGE).
RESULTS Mean maximal apical wall thickness was 17.9±2.3 mm, and mean left ventricular (LV) ejection fraction was 67.7 ± 8.0%. All but one patient presented with electrocardiographic negative T wave inversion in anterolateral leads, with a mean maximum negative T wave of 7.2 ± 4.7 mm. Nine patients (22.5%) had giant negative T waves, defined as the amplitude of ≥ 10 mm, in electrocardiogram. LGE was detected in 130 segments of 30 patients (75.0%), occupying 4.9 ± 5.5% of LV myocardium. LGE was mainly detected at the junction between left and right ventricles in 12 (30%) and at the apex in 28 (70%), although LGE-positive areas were widely distributed, and not limited to the apex. Focal LGE at the non-hypertrophic LV segments was found in some ApHCM patients, even without LGE of hypertrophied apical segments. Over the 2-year follow-up, there was no one achieving the study end-point, defined as all-cause death, sudden cardiac death and hospitalization for heart failure.
CONCLUSIONS LGE was frequently observed not only in the thickened apex of the heart but also in other LV segments, irrespective of the presence or absence of hypertrophy. The simple presence of LGE on CMR was not representative of adverse prognosis in this population.
PubMed IF 5 순환기내과
1362012

제1저자 한세원 · 교신저자 김태유

, , , , , , , , , , , , , , ,
Correlation of HER2, p95HER2 and HER3 expression and treatment outcome of lapatinib plus capecitabine in her2-positive metastatic breast cancer.
PLoS One. 2012;7(7):e39943.

Abstract
BACKGROUND Lapatinib plus capecitabine is an effective treatment option for trastuzumab-refractory HER2-positive metastatic breast cancer. We have investigated the correlation between quantitative measures of HER2, p95HER2, and HER3 and treatment outcomes using lapatinib and capecitabine.
METHODS Total HER2 (H2T), p95HER2 (p95), and total HER3 (H3T) expression were quantified in formalin-fixed paraffin-embedded samples using the VeraTag assays. Patients received lapatinib and capecitabine treatment following trastuzumab failure according to the Lapatinib Expanded Access Program. The association between the protein expression levels and clinical outcomes was analyzed.
RESULTS A total of 52 patients were evaluable. H2T level was significantly higher in responders (median 93.49 in partial response, 47.66 in stable disease, and 17.27 in progressive disease; p = 0.020). Longer time-to-progression (TTP) was observed in patients with high H2T [p = 0.018, median 5.2 months in high (>14.95) vs. 1.8 in low (<14.95)] and high H3T [p = 0.017, median 5.0 months in high (>0.605) vs. 2.2 in low (<0.605)]. Patients having both high H2T and high H3T had significantly longer TTP [adjusted hazard ratio (HR) 0.38 (95% CI 0.20-0.73), p = 0.004] and overall survival [adjusted HR 0.46 (95% CI 0.24-0.89), p = 0.020]. No significant association between p95 and response or survival was observed.
CONCLUSIONS These data suggest a correlation between high HER2 and high HER3 expression and treatment outcome, while no significant difference was observed between clinical outcome and p95 expression level in this cohort of HER2-positive, trastuzumab-refractory metastatic breast cancer patients treated with lapatinib and capecitabine.
PubMed IF 2.8 혈액종양내과
1352012

제1저자 곽민선 · 교신저자 김윤준

, , , , , , , , , , , ,
Association of polymorphism in pri-microRNAs-371-372-373 with the occurrence of hepatocellular carcinoma in hepatitis B virus infected patients.
PLoS One. 2012;7(7):e41983.

Abstract
BACKGROUND Micro RNAs-371-372-373 (miRNAs-371-373), originating from the same pri-miRNA transcript, are reported to be upregulated in hepatocellular carcinoma (HCC) and to be related to the regulation of hepatitis B virus (HBV) infection. Our study investigated whether pri-miRNAs-371-373 polymorphisms are associated with the risk of HCC occurrence and HBV clearance.
METHODS Genetic variations were identified through direct DNA sequencing using TaqMan assay. Three sequence variants of pri-miRNAs-371-373 were identified. Genetic associations of those with HCC occurrence and HBV clearance among patients with HBV infection were analyzed using logistic regression analyses with adjustment for age and gender (n = 1439).
RESULTS For the occurrence of HCC, polymorphism rs3859501C>A acted as a protective factor both in chronic carriers (OR = 0.75, P = 0.005 in a codominant model; OR = 0.71, P = 0.02 in a dominant model; OR = 0.66, P = 0.03 in recessive model) and liver cirrhosis patients (OR = 0.69, P = 0.001 in a codominant model; OR = 0.60, P = 0.003 in a dominant model; OR = 0.63, P = 0.03 in a recessive model). The pri-miRNAs-371-373_ht2 [C-A-C] also showed a protective effect on HCC occurrence both in the chronic carrier and liver cirrhosis groups (P<0.05 in both). However, there was no significant association between pri-miRNAs-371-373 polymorphisms and HBV clearance.
CONCLUSIONS In conclusion, among chronic carriers and liver cirrhosis patients, the A allele of rs3859501 and the haplotype pri-miRNAs-371-373_ht2 were more protective to HCC than other genotypes and haplotypes. Further studies into the roles of rs3859501 and pri-miRNAs-371-373_ht2 haplotype in hepatocarcinogenesis are needed.
PubMed IF 2.8 소화기내과
1342012

제1저자 이준구, 박혜성 · 교신저자 김동완

, , , , , , , , , ,
Comparative analyses of overall survival in patients with anaplastic lymphoma kinase-positive and matched wild-type advanced nonsmall cell lung cancer.
Cancer. 2012;118(14):3579-86.

Abstract
BACKGROUND The purpose of this study was to investigate the overall survival (OS) of patients with advanced ALK-positive nonsmall cell lung cancer (NSCLC) who were managed in the pre-ALK inhibitor era and to compare their survival with that of a matched case cohort of ALK wild-type (WT) patients.
METHODS Data from 1166 patients who had stage IIIB/IV NSCLC with nonsquamous histology were collected from the NSCLC database of Seoul National University Hospital between 2003 and 2009. ALK fluorescence in situ hybridization (FISH) was used to analyze 262 patients who either had the WT epidermal growth factor receptor (EGFR) or were nonresponders to previous EGFR tyrosine kinase inhibitor (TKI) therapy. Overall survival (OS) was compared between 3 groups: 1) ALK-positive patients, 2) EGFR mutation-positive patients, and 3) ALK-WT/EGFR-WT patients. Progression-free survival (PFS) after first-line chemotherapy and EGFR TKIs also was analyzed.
RESULTS Twenty-three patients were ALK-positive according to FISH analysis and did not receive ALK inhibitors during follow-up. The median OS for ALK-positive patients, EGFR mutation-positive patients, and WT/WT patients was 12.2 months, 29.6 months, and 19.3 months, respectively (vs EGFR mutation-positive patients, P = .001; vs WT/WT, P = .127). The PFS after first-line chemotherapy for the 3 groups was not different. However, the PFS for patients who received EGFR TKIs was shorter in ALK-positive patients compared with the other 2 groups (vs EGFR mutation-positive patients, P < .001; vs WT/WT, P < .021).
CONCLUSIONS In the pre-ALK inhibitor era, ALK-positive patients experienced the shortest survival, although it did not differ statistically from that of WT/WT patients. Although their responses to platinum-based chemotherapy were not different from comparator groups, ALK-positive patients were even more resistant to EGFR TKI treatment than WT/WT patients.
PubMed IF 5.6 혈액종양내과
1332012

제1저자 윤지연 · 교신저자 김태유

, , , , , , , , , ,
Gene silencing of EREG mediated by DNA methylation and histone modification in human gastric cancers.
Lab Invest. 2012;92(7):1033-44.

Abstract
Epiregulin (EREG) induces cell growth by binding to the epidermal growth factor receptor (EGFR). Expression of EREG affects sensitivity to cetuximab a chimeric monoclonal antibody that inhibits the EGFR signaling pathway. The mechanism through which EREG is regulated is largely unknown, but a methyl-array study previously performed by our group revealed that EREG is methylated in gastric cancer cells. In this study, we found that EREG gene expression was low in 7 out of 11 gastric cancer cells and this downregulation was mediated by aberrant CpG methylation of the EREG promoter. Treatment with 5-aza-CdR restored EREG expression and demethylated CpG sites in the EREG promoter. Compared with DNA methyltransferase 1 (DNMT1), knock-down of DNA methyltransferase 3b (DNMT3b) significantly increased the expression of EREG and led to the demethylation of specific CpG sites in the EREG promoter, suggesting that DNMT3b primarily regulates CpG methylation and silencing of the EREG gene. EREG methylation was observed in 30% (4/13) of human primary gastric tumor tissues we evaluated. In addition to DNA methylation, results from a chromatin immunoprecipitation assay demonstrated that transcriptional levels of EREG were associated with the enrichment of active histone marks (H3K4me3 and AcH3) and of a repressive mark (H3K27me2). Treatment with 5-aza-CdR dynamically increased the low occupancy of H3K4me3 and AcH3, while decreasing the high enrichment of H3K27me2, indicating that dynamic histone modifications contribute to EREG regulation in addition to DNA methylation. Finally, the combination of 5-aza-CdR and cetuximab exerted a synergistic anti-proliferative effect on gastric cancer cells. Taken together, the results of our study showed for the first time that EREG is epigenetically silenced in gastric cancer cells by aberrant DNA methylation and histone modification.
PubMed IF 4.1 혈액종양내과
1322012

제1저자 송진수 · 교신저자 김남중

, , , , , , , ,
Risk factors for 30-day mortality in adult patients with pneumococcal bacteraemia, and the impact of antimicrobial resistance on clinical outcomes.
Epidemiol Infect. 2012;140(7):1267-76.

Abstract
The clinical impact of antimicrobial resistance on the outcome of pneumococcal bacteraemia has remained unclear. This study aimed to evaluate risk factors for mortality and determine the impact of antimicrobial resistance on clinical outcomes. A total of 150 adult patients with pneumococcal bacteraemia were identified over a period of 11 years at Seoul National University Hospital. Of the 150 patients, 122 (81.3%) had penicillin-susceptible (Pen-S) strains and 28 (18.7%) penicillin-non-susceptible (Pen-NS) strains; 43 (28.7%) had erythromycin-susceptible (EM-S) strains and 107 (71.3%) erythromycin-non-susceptible (EM-NS) strains. On multivariate analysis, elevated APACHE II score [odds ratio (OR) 1.24, 95% confidence interval (CI) 1.14-1.34, P<0.001) and presence of solid organ tumour (OR 2.99, 95% CI 1.15-7.80, P=0.025) were independent risk factors for mortality. Neither erythromycin resistance nor penicillin resistance had a significant effect on clinical outcomes. However, for the 76 patients with pneumococcal pneumonia, the time required for defervescence was significantly longer in the EM-NS group than in the EM-S group (5.45 ± 4.39 vs. 2.93 ± 2.56, P=0.03 by log rank test). In conclusion, antimicrobial resistance does not have an effect on mortality in adult patients with pneumococcal bacteraemia.
PubMed IF 2.5 감염내과
1312012

제1저자 구현경 · 교신저자 임재준

, , , , , , , , , , , , ,
Vitamin D deficiency and changes in serum vitamin D levels with treatment among tuberculosis patients in South Korea.
Respirology. 2012;17(5):808-13.

Abstract
BACKGROUND AND OBJECTIVE Vitamin D deficiency has been reported to be associated with the development of active tuberculosis (TB), but many discrepancies exist among studies. The aims of this study were to compare the frequency of vitamin D deficiency in a Korean population of TB patients and control subjects, and to monitor the changes in vitamin D levels during TB treatment.
METHODS Patients with newly diagnosed TB were prospectively enrolled. In addition, healthy volunteers or patients with diseases other than TB were enrolled as controls. Baseline serum 25-hydroxyvitamin D (25-OHD) levels were measured in both groups and compared. In the TB patients, measurements of serum 25-OHD were repeated 1 month after the initiation of treatment and again after completion of treatment.
RESULTS In total, 116 patients with TB and 86 control subjects were recruited. The median 25-OHD concentration was not different in TB patients at diagnosis (13.9 ng/mL; interquartile range (IQR) 8.80-21.8) compared with control subjects (13.2 ng/mL; IQR 9.6-19.3) (P = 0.97). The frequency of vitamin D deficiency (≤ 10 ng/mL) was also not different in TB patients (36.2%) compared with controls (27.3%) (P = 0.21). In TB patients, the median 25-OHD concentration decreased significantly during treatment, to 12.5 ng/mL at 1 month and 11.0 ng/mL on completion of treatment (P = 0.01).
CONCLUSIONS Vitamin D levels do not appear to be associated with the development of TB in the Korean population. The median 25-OHD concentration decreased after treatment for TB.
PubMed IF 7.2 호흡기내과
1302012

제1저자 배세연 · 교신저자 송영욱, 강재승

, , , , , , , ,
α-Enolase expressed on the surfaces of monocytes and macrophages induces robust synovial inflammation in rheumatoid arthritis.
J Immunol. 2012;189(1):365-72.

Abstract
α-Enolase (ENO1) is a multifunctional glycolytic enzyme expressed abundantly in the cytosol. It has been implicated in autoimmune and inflammatory diseases. Serum Abs against ENO1 were reported in rheumatoid arthritis (RA). Cell-surface expression of ENO1 has been found to be increased rapidly in response to inflammatory stimuli, but its expression and function has not been reported in RA. In this study, we show that cell-surface expression of ENO1 is increased on monocytes and macrophages isolated from RA patients but not on those from osteoarthritis patients, and Ab against ENO1 can stimulate these cells to produce higher amounts of proinflammatory mediators, such as TNF-α, IL-1 α/β, IFN-γ, and PGE(2) via p38 MAPK and NF-κB pathway. The frequency of ENO1-positive cells in synovial fluid mononuclear cells was higher than PBMCs. ENO1-positive cells were also found in the inflamed synovium from RA patients and arthritic ankle tissues of mice with collagen-induced arthritis. Taken together, these findings suggest that Abs against ENO1 present in RA sera may stimulate monocytes and macrophages expressing cell-surface ENO1 and contribute to production of proinflammatory mediators during the effector phase of synovial inflammation.
PubMed IF 4 류마티스내과
1292012

제1저자 박경우 · 교신저자 김효수

, , , , , , , , , , , , , ,
Multicenter international registry of unprotected left main coronary artery percutaneous coronary intervention with everolimus-eluting stents.
J Invasive Cardiol. 2012;24(7):316-9.

Abstract
OBJECTIVE The aim of this study was to assess the clinical outcomes of percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES) for the treatment of unprotected left main coronary artery (ULMCA) disease.
BACKGROUND The standard of care for the treatment of ULMCA disease is coronary artery bypass grafting (CABG). Data suggest that PCI with drug-eluting stents is a viable alternative to CABG for the treatment of ULMCA disease. Randomized trials demonstrated superior event-free survival with EES compared with paclitaxel-eluting stents in non-ULMCA lesions. However, data with ULMCA PCI with EES are limited.
METHODS This multicenter international registry included 178 patients from the United States, South Korea, and Italy who underwent ULMCA PCI with EES from 2008 to 2010. The primary endpoint was freedom from target lesion failure (TLF), defined as cardiac death, myocardial infarction (MI), and ischemia-driven target lesion revascularization (TLR) at 1 year.
RESULTS At 30 days, 4 patients (2.2%) died from cardiac causes, and no patient experienced MI or TLR. One-year freedom from TLF was 94.4%. One-year freedom from cardiac death, MI, and ischemia-driven TLR was 96.6%, 98.9%, and 98.3%, respectively. Two patients (1.1%) had definite or probable stent thrombosis.
CONCLUSION PCI with EES is safe and effective and may be a viable option for the treatment of ULMCA disease.
PubMed IF 1.6 순환기내과
1282012

제1저자 정윤정 · 교신저자 임재준

, , , , , , , , , ,
Positive tuberculin skin test or interferon-gamma release assay in patients with radiographic lesion suggesting old healed tuberculosis.
J Korean Med Sci. 2012;27(7):761-6.

Abstract
Radiographic lesions suggesting old healed tuberculosis (TB) is considered a risk factor for the subsequent development of active TB. The aim of this study was to estimate the positive rates of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in persons with old healed TB. Participants with lesions suggesting old healed TB on chest images and controls without such lesions were prospectively enrolled between January 1, 2010, and January 31, 2011. TST and the QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. In total, 193 participants with old healed TB and 126 controls were recruited. The rates of positive TST and QFT-GIT among patients with old healed TB were 54.6% and 77.7%, respectively. The rates of positive TST and QFT-GIT among patients without old healed TB were 38.9% and 61.9%. Sixteen percent of participants with old healed TB showed negative results by both TST and QFT-GIT. The positive rate of TST waned among participants with old healed TB who were older than 60 yr, whereas QFT-GIT positivity was unaffected by age. The positive rates of TST and IGRA among participants with radiographic lesions suggesting old healed TB was higher than without those lesions. In addition, IGRA may be more accurate than TST for the detection of latent TB infection, especially in populations of individuals older than 60 yr.
PubMed IF 3.2 호흡기내과
1272012

제1저자 이하정 · 교신저자 채동완

, , , , , ,
Serum phosphorus as a predictor of low-grade albuminuria in a general population without evidence of chronic kidney disease.
Nephrol Dial Transplant. 2012;27(7):2799-806.

Abstract
BACKGROUND High levels of serum phosphorus, even within the normal range, have been associated with cardiovascular (CV) morbidity. Low-grade albuminuria (LGA) was demonstrated to be related to increased CV events in various study populations. The present study aimed to investigate the association between serum phosphorus levels and LGA in the general population.
METHODS We examined the individuals who had undergone health inspections. We evaluated the correlation between serum phosphorus and LGA in 8953 participants (mean age, 47.4 years) with estimated glomerular filtration rates (eGFRs)≥60 mL/min/1.73 m2 and urinary albumin-to-creatinine ratios (UACRs)<30 mg/g. Participants who underwent a colonoscopy were excluded.
RESULTS The mean UACR was significantly higher in the uppermost quartile group of serum phosphorus concentrations than in other quartile groups. In the multivariate regression analysis, serum phosphorus remained an independent predictor of increased UACR (B=0.610, P<0.001). Subgroup analyses showed that this association was maintained irrespective of age, gender, presence of hypertension or diabetes, body mass index and eGFR.
CONCLUSIONS In our population-based study, higher serum phosphorus was independently related to LGA in individuals without evidence of renal dysfunction. Further investigations are warranted to clarify the precise mechanism of the association between serum phosphorus and LGA.
PubMed IF 8.3 신장내과
1262012

제1저자 김광일 · 교신저자 김철호

,
Treating hypertension to reduce cardiovascular risk: a Korean perspective.
Clin Ther. 2012;34(7):1559-68.

Abstract
BACKGROUND Hypertension usually clusters with other cardiovascular risk factors; however, it has not been reported whether hypertension treatment has an impact on the awareness and treatment of other cardiovascular risk factors such as diabetes mellitus and hypercholesterolemia.
OBJECTIVE To analyze the effect of hypertension treatment on the management of other risk factors in a Korean population.
METHODS The Korean National Health and Nutrition Examination Survey (KNHANES) was a cross-sectional, nationally representative survey in which a stratified multistage sampling design was used. The most recent KNHANES survey, conducted in 2008, was analyzed.
RESULTS A total of 6547 adults (aged ≥20 years) were included in the analysis. Mean (SD) age was 49.1 (16.3) years, and 42.0% of the participants were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity was 26.9%, 10.5%, 9.5%, and 31.2%, respectively. The prevalence of diabetes mellitus, hypercholesterolemia, and obesity was significantly higher in the hypertensive group compared with normotensive participants (P < 0.001). Furthermore, clustering of cardiovascular risk factors was observed in the patients with hypertension. Treatment of hypertension was significantly associated with a higher awareness and treatment of diabetes mellitus and hypercholesterolemia, especially in moderate- to high-risk patients. Moreover, the total cholesterol concentration and glycosylated hemoglobin levels were significantly lower in the treated hypertensive patients (P < 0.001 for total cholesterol and P = 0.003 for glycosylated hemoglobin).
CONCLUSIONS Hypertension is a prevalent risk factor and is commonly associated with other cardiovascular risk factors. In the Korean population, treatment of hypertension can reduce global risk not only by lowering blood pressure but also by improving the control of other risk factors, such as diabetes mellitus and hypercholesterolemia.
PubMed IF 3.7 순환기내과
1252012

제1저자 장재현 · 교신저자 김세중

, , , , , ,
The relationship between coronary artery calcification and renal function in nondialyzed patients.
Yonsei Med J. 2012;53(4):685-90.

Abstract
PURPOSE Coronary artery calcification (CAC) has been described in individuals with chronic kidney disease (CKD), and its presence is associated with an increased risk of cardiovascular death. However, it is unclear whether there is an independent relationship between renal function and CAC. Therefore, we evaluated the association between renal function and CAC.
MATERIALS AND METHODS We retrospectively reviewed 870 Korean patients who had undergone computed tomographic coronary angiography. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study formula with an ethnic factor for the Korean population. The CKD stages were classified using estimated GFR (eGFR) and proteinuria.
RESULTS The mean age of the participants was 56.8±11.8 years, and the mean eGFR was 89.4±16.5 mL/min/1.73 m². Hypertension and diabetes were noted in 41.5 and 17.0% of patients, respectively. There were 584 and 286 patients with no CAC and with CAC, respectively. After adjusting for confounding variables, late stage CKD was associated with CAC [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.05-7.46]. However, early stage CKD was not associated with CAC (OR 1.61, 95% CI 0.92-2.82). Diabetes was an independent risk factor of CAC (OR 2.06, 95% CI 1.36-3.13). There was no significant association between proteinuria and CAC (OR 1.65, 95% CI 0.96-2.85).
CONCLUSION CAC is related to late stage CKD in nondialyzed patients. These findings emphasize that individuals with CAC should be considered a high-risk population for decreased renal function.
PubMed IF 3.1 신장내과
1242012

제1저자 정고은 · 교신저자 김동희

, , , , , , ,
Non-alcoholic fatty liver disease across the spectrum of hypothyroidism.
J Hepatol. 2012;57(1):150-6.

Abstract
BACKGROUND & AIMS The aim of this study was to characterize the relationship between the broad spectrum of hypothyroidism and NAFLD.
METHODS A cross-sectional study with 4648 health check-up subjects (2324 cases with hypothyroidism vs. age- and sex-matched controls) was conducted. The subjects were categorized as having either subclinical [thyroid-stimulating hormone (TSH) ≥4.1 mIU/L and normal free thyroixine (T(4)) level (0.7-1.8 ng/dl)] or overt hypothyroidism [free T(4)<0.7 ng/dl]. NAFLD was diagnosed on the basis of typical ultrasonographic findings, and alcohol consumption of less than 20 g/day in the absence of other causes of liver disease.
RESULTS The mean age of the subjects was 48.6±11.8 years and 62.4% were female. NAFLD was significantly associated with hypothyroidism (30.2% patients vs. 19.5% control, p<0.001). The prevalence of NAFLD and abnormal liver enzyme levels (ALT>33/25 IU/L) increased steadily with increasing grades of hypothyroidism (for NAFLD, subclinical: 29.9% and overt: 36.3%; for abnormal ALT, 20.1% and 25.9%, p<0.001, respectively). Multivariate regression analysis showed that NAFLD was statistically significantly associated with hypothyroidism (odds ratio (OR) 1.38, 95% confidence interval (CI), 1.17-1.62) and the grade of hypothyroidism in a dose-dependent manner (OR 1.36, 95% CI, 1.16-1.61 in subclinical hypothyroidism and OR 1.71, 95% CI, 1.10-2.66 in overt hypothyroidism).
CONCLUSIONS Subclinical hypothyroidism, even in the range of upper normal TSH levels, was found to be related to NAFLD in a dose-dependent manner. Hypothyroidism is closely associated with NAFLD independently of known metabolic risk factors, confirming a relevant clinical relationship between these two diseases.
PubMed IF 40.1 소화기내과
1232012

제1저자 박경우 · 교신저자 김효수

, , , , , , , , , , , , , ,
Enhanced clopidogrel response in smokers is reversed after discontinuation as assessed by VerifyNow assay: additional evidence for the concept of 'smokers' paradox'.
Heart. 2012;98(13):1000-6.

Abstract
BACKGROUND Previous reports on smokers' paradox to clopidogrel have only been able to show an association between cigarette smoking and enhanced response to clopidogrel therapy. No study has shown reversal of enhanced clopidogrel response after smoking cessation.
OBJECTIVE To conduct a prospective observational longitudinal study in order to measure the impact of cigarette smoking on on-clopidogrel platelet reactivity (OPR).
DESIGN From the prospective CROSS-VERIFY cohort, 810 subjects with repeated measurement of OPR at least 1 month apart were analysed. With smoking status ascertained at two time points, baseline and follow-up, study subjects were categorised into never smokers (n=628), smoking quitters (n=77) and persistent smokers (n=105). Dependent variables included OPR measured by the VerifyNow assay and the percentage of subjects with high OPR (HOPR).
RESULTS At baseline, current smokers showed significantly lower OPR compared with never smokers, with no significant differences in OPR between future quitters and future persistent smokers within current smokers. While the OPR of never smokers and persistent smokers did not change significantly during the follow-up, the mean OPR of quitters increased significantly by 19 P2Y12 reaction units (p=0.013). The frequency of HOPR showed similar results, with an 8-10% increase in smoking quitters in contrast to no significant changes in never and persistent smokers. Both mean OPR and the frequency of HOPR showed a linear inverse relationship with the amount of smoking.
CONCLUSIONS Enhanced clopidogrel response in smokers is reversed after smoking discontinuation, suggesting a causal relationship in addition to the previously reported association between smoking and enhanced clopidogrel response.
PubMed IF 4.4 순환기내과
1222012

제1저자 이현정 · 교신저자 김태민

, , , , , , ,
A case of erdheim-chester disease with asymptomatic renal involvement.
Cancer Res Treat. 2012;44(2):146-50.

Abstract
Erdheim-Chester disease is a rare non-Langerhans-cell histiocytosis involving bones and multiple organs. Its clinical course can vary, from an asymptomatic state to a fatal disease, with renal involvement being a common cause of death. A 41-year-old man presented with a 10-month history of bilateral lower limb pain. Left perirenal soft-tissue infiltration had been found incidentally two years earlier. No progression of the lesion or deterioration of renal function was observed for a period of two years. At admission, plain radiography and magnetic resonance imaging of the patient's lower limbs showed patchy osteosclerosis. Biopsy of the tibia revealed histiocytic infiltration, which was found to be positive for CD68 and negative for CD1a. This report describes an unusual case of Erdheim-Chester disease involving a stationary course of disease with no specific treatment for a long period of time.
PubMed IF 4.2 혈액종양내과
1212012

제1저자 임규형 · 교신저자 오도연

, , , , ,
Outcome of infusional 5-fluorouracil, doxorubicin, and mitomycin-C (iFAM) chemotherapy and analysis of prognostic factors in patients with refractory advanced biliary tract cancer.
Oncology. 2012;83(2):57-66.

Abstract
OBJECTIVE The purpose of this study was to determine the efficacy and safety of infusional 5-fluorouracil (5-FU), doxorubicin, and mitomycin-C (iFAM) as salvage chemotherapy in biliary tract cancer (BTC) and to identify prognostic factors.
METHODS Fifty patients received 5-FU 800 mg/m(2) over 10 h on days 1-5, doxorubicin 30 mg/m(2) on day 1 and mitomycin-C 8 mg/m(2) on day 1, every 4 weeks. The primary endpoint was the overall survival (OS) rate at 6 months.
RESULTS The responses to iFAM were as follows: partial response in 2 patients (4.2%) and stable disease in 9 patients (18.7%). The median progression-free survival and OS were 2.2 months and 5.6 months, respectively. The 6-month OS rate was 48%. Grade 3/4 adverse events included neutropenia (10%), thrombocytopenia (8%), and anemia (2%). Based on multivariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status, serum albumin, and response to previous chemotherapy were significantly associated with OS. Three risk groups based on the number of 3 poor prognostic factors (0 vs. 1 vs. 2-3) were well correlated to OS (8.7 vs. 5.5 vs. 2.4 months, respectively; p = 0.0002).
CONCLUSIONS iFAM as salvage regimen has modest effect and tolerable toxicity in advanced BTC. The described risk group classification may help guide treatment plans.
PubMed IF 1.9 혈액종양내과
1202012

제1저자 김정희 · 교신저자 김성연, 김상완

, , , , ,
Recurrence of Cushing's disease after primary transsphenoidal surgery in a university hospital in Korea.
Endocr J. 2012;59(10):881-8.

Abstract
Successful long-term management of patients with Cushing's disease (CD) remains a challenge. To date, studies on the long-term outcome of patients with CD have been conducted mainly in Caucasians. Our objective was to assess the recurrence rate in patients who underwent transsphenoidal surgery (TSS) in the management of CD and to identify predictive markers for the long-term outcomes of CD in Korea. The long-term outcome in 54 patients who underwent TSS for the treatment of CD from 1984 to 2010 was retrospectively reviewed. Recurrence was defined as an elevated serum cortisol or an elevated 24 hour urine free cortisol or a suppressed serum cortisol by dexamethasone higher than 138 nmol/L. Mean age at diagnosis was 35.8 ± 12.8 years and median follow-up duration was 50.7 months. Initial successful TSS was obtained in 38 patients (70.4%). Among these 38 patients, 18 (47.4%) patients had a recurrence of CD. Preoperative serum cortisol level was significantly associated with recurrence. Pathologic confirmation of an adenoma was marginally associated with lower risk of recurrence. Positive results of imaging study and presence of microadenoma were not associated with risk of recurrence. Recurrence rate of CD after initial successful TSS was 32.4% at 5 years and 54.6% at 10 years, respectively. Following initial successful TSS, close long-term endocrine surveillance is mandatory as the recurrence rate increases with time. Preoperative serum cortisol level and pathologic confirmation of an adenoma may have a predictive value for recurrence of CD after TSS.
PubMed IF 2.5 내분비대사내과
1192012

제1저자 박현경 · 교신저자 정숙향

, , , , , ,
Seroprevalence of anti-hepatitis E virus (HEV) in a Korean population: comparison of two commercial anti-HEV assays.
BMC Infect Dis. 2012;12:142.

Abstract
BACKGROUND Hepatitis E virus (HEV) has emerged as an important cause of epidemic and sporadic acute viral hepatitis worldwide. This study investigated the seroprevalence of anti-HEV in a Korean population and compared the performance of two commercially available anti-HEV assays.
METHODS A total 147 health-check examinees were randomly sampled as matched to the age- and sex- adjusted standard population based on the Korean National Census of 2007. Serum immunoglobulin G anti-HEV was determined by using the Genelabs assay (Genelabs, Singapore) and the Wantai assay (Wantai, Beijing, China).
RESULTS The overall anti-HEV seroprevalence was 23.1% (95% CI, 16.1-30.1%) using the Wantai assay and 14.3% (95% CI, 8.3-20.3%) using the Genelabs assay. Only 12 samples (8.1%) were positive for anti-HEV as measured by both assays; agreement between the two assays was poor (kappa value of 0.315). The anti-HEV seroprevalence increased with age from 2% and 3% in the people younger than 20-years-of-age to 34.6% and 42.3% in those over 59-years-of-age by the Genelabs and Wantai assay, respectively.
CONCLUSIONS The HEV seroprevalence in Korean population is about 20% overall, with seroprevalence increasing in this population with increasing age. There was poor concordance in the results of the Genelabs and Wantai assays, which warrants further study concerning a reliable diagnostic test for the diagnosis of hepatitis E.
PubMed IF 3.2 소화기내과
1182012

제1저자 강승주 · 교신저자 김지원

, , , , , , , , , ,
Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis.
World J Gastroenterol. 2012;18(22):2837-43.

Abstract
AIM To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC).
METHODS A retrospective analysis of data was performed on consecutive patients who underwent peritoneoscopic and abdominal computed tomography (CT) evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients (36.0%) and 25 patients (33.3%) were diagnosed with TBP and PC, respectively. Diagnosis was confirmed by peritoneoscopic biopsy.
RESULTS Serum c-reactive protein (7.88 ± 6.62 mg/dL vs 3.12 ± 2.69 mg/dL, P = 0.01), ascites adenosine deaminase (66.76 ± 32.09 IU/L vs 13.89 ± 8.95 IU/L, P < 0.01), ascites lymphocyte proportion (67.77 ± 23.41% vs 48.36 ± 18.78%, P < 0.01), and serum-ascites albumin gradient (0.72 ± 0.49 g/dL vs 1.05 ± 0.50 g/dL, P = 0.03) were significantly different between the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohydrate antigen 19-9 showed significant difference between two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group (77.8% vs 40.7%) whereas nodular involvement was more common in the PC group (14.8% vs 40.7%, P = 0.04). From receiver operating characteristic (ROC) curves ascites adenosines deaminase (ADA) showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively.
CONCLUSION Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differential diagnosis of TBP and PC.
PubMed IF 7.7 소화기내과
1172012

제1저자 권재우 · 교신저자 조상헌

, , , , , , , , , , , , , ,
Airway hyperresponsiveness is negatively associated with obesity or overweight status in patients with asthma.
Int Arch Allergy Immunol. 2012;159(2):187-93.

Abstract
BACKGROUND Obesity is a risk factor for asthma in the general population, but the effect of obesity on airway hyperresponsiveness (AFHR) or airway inflammation in asthma is not clear. This study evaluated the relationship between obesity and asthma, assessing aspects of symptoms, AHR, and severity.
METHODS In total, 852 patients with asthma diagnosed by asthma specialists based on AHR as confirmed by a methacholine bronchial provocation test, were enrolled from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) adult asthma cohort. The intensity of AHR was assessed by the concentration of methacholine needed to cause a 20% decrease in FEV(1) (PC(20)). Patients were classified into four categories based on body mass index (BMI): underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30).
RESULTS BMI was negatively correlated with FEV(1) (l), FVC (l), and FEV(1)/FVC (%) in lung function tests. The prevalence of wheezing increased with higher BMI after adjustment for age, sex, smoking, medication history, and PC(20) (p < 0.0001). logPC(20) was lower in the normal weight group compared with the overweight group (p = 0.003). The risk of moderate or severe AHR (PC(20) ≤ 4 mg/ml) decreased with increased BMI after adjustment for age, sex, smoking, and medication history (p = 0.035).
CONCLUSIONS Obesity is a risk factor for asthma in the general population, but obesity in asthmatic patients is negatively correlated with the intensity of AHR and is not related to asthma severity. Obesity is positively related with the prevalence of wheezing but negatively related to AHR in asthmatic patients.
PubMed IF 2.3 알레르기내과
1162012

제1저자 임상엽, 박현웅 · 교신저자 연태진

, , , , , , ,
The efficacy and safety of PRO-kinetic metal alloy stent in hospitalized patients with acute ST-elevation myocardial infarction (The PROMETHEUS Study).
J Invasive Cardiol. 2012;24(6):270-3.

Abstract
BACKGROUND We evaluated the clinical and angiographic outcomes of silicon carbide-coated cobalt chromium PROKinetic bare-metal stent in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).
METHODS Patients with acute STEMI (2.75-5.00 mm vessels; lesion length ≤30 mm by visual estimation) were treated with PRO-Kinetic stents at 5 centers in Korea. The primary endpoint was the rate of major adverse cardiac events (MACE), defined as all-cause death, new myocardial infarction, and target lesion revascularization (TLR) at 6-month follow-up. Follow-up angiography was recommended after the completion of the 6-month clinical followup.
RESULTS A total of 64 patients (56.6 ± 12.9 years old, 56 male) were enrolled in the study. Procedural success was achieved in 100% of the lesions. The mean stent size was 3.51 ± 0.67 mm and the mean stent length was 20.3 ± 4.4 mm. There was 1 case of in-hospital death due to cardiac tamponade. During the 6-month clinical follow-up, 4 patients (6.3%) received TLR. Therefore, the total rate of MACE was 7.8%. Angiographic follow-up data were available for 42 patients (65.6%) and the in-stent late lumen loss was 1.02 ± 0.62 mm and in-segment late lumen loss was 0.99 ± 0.64 mm. Binary restenosis occurred in 53% of reference vessel diameters (RVDs) ≤3.0 mm, 25% of RVDs between 3.0 and 3.5 mm, and 0% of RVDs >3.5 mm (P=.006).
CONCLUSIONS The use of the PRO-Kinetic stent seems to be safe and feasible in primary PCI for acute STEMI, and shows favorable clinical and angiographic outcomes in large (>3.0 mm) coronary arteries, but not in small arteries.
PubMed IF 1.6 순환기내과
1152012

제1저자 배승진 · 교신저자 김나영

, , , , , , , ,
Incidence and 30-day mortality of peptic ulcer bleeding in Korea.
Eur J Gastroenterol Hepatol. 2012;24(6):675-82.

Abstract
OBJECTIVES To estimate the rates of peptic ulcer bleeding (PUB) incidence and the association of demographic factors with 30-day mortality after PUB.
METHODS Diagnostic algorithms for PUB were derived and validated on the basis of 115 true PUB patients at one tertiary hospital in 2005, followed by estimation of age-specific PUB incidence and 30-day mortality rates, using the Korean National Health Insurance claim database. A Cox proportional hazard model was used to determine the impact of demographic factors on the 30-day mortality rate ratio (MRR) after PUB.
RESULTS The diagnostic algorithm showed 89 and 88% positive predictive value and sensitivity, respectively. On the basis of this algorithm, the rate of PUB incidence was 22.1 per 100 000 during 2006-2007 and the age-specific incidence rate increased with advanced age. This incidence rate was more than three times higher among men than women. Among 21 107 PUB patients, the overall 30-day mortality rate was 2.15%, but it ranged from 0.83% for patients younger than 60 years to 7.65% for patients older than 80 years. The adjusted 30-day mortality rate ratio for patients older than 80 was 8.13 (95% confidence interval 6.10-10.8) compared with those younger than 60 and 7.09 (95% confidence interval 2.78-4.51) for patients with a high level of comorbidity compared with a low level of comorbidity.
CONCLUSION PUB incidence was higher among men and increased with advanced age. Increased 30-day mortality was observed in association with increasing age, after adjusting for comorbidity.
PubMed IF 2.1 소화기내과
1142012

제1저자 김형관 · 교신저자 김형관

, , , , , , , , , ,
Load independence of two-dimensional speckle-tracking-derived left ventricular twist and apex-to-base rotation delay in nonischemic dilated cardiomyopathy: implications for left ventricular dyssynchrony assessment.
J Am Soc Echocardiogr. 2012;25(6):652-60.

Abstract
BACKGROUND Left ventricular (LV) twist mechanics are a promising, sensitive tool for assessing pathophysiologic changes in patients with systolic heart failure. Although LV twist is known to be load dependent in healthy volunteers, this has not been examined in patients with "long-standing" dilated cardiomyopathy (DCM). The aim of this study was to determine whether LV twist remains load dependent in the setting of long-standing, nonischemic DCM.
METHODS Thirty-four patients with DCM with baseline LV ejection fractions (LVEFs) < 40% and 13 subjects with preserved LVEFs (≥50%) were enrolled. After baseline measurements, pneumatic compression of the lower extremities (Pcom) was used to increase LV afterload. Subsequently, sublingual nitroglycerin (SL-NG) was administered to modify preload. Conventional echocardiographic parameters, LV end-systolic wall stress, net LV twist angle, and apex-to-base-rotation delay (ABRD) were assessed under each condition.
RESULTS In patients with DCM, although LV end-systolic wall stress significantly increased under Pcom (196.9 ± 64.9 g/m(2) at baseline vs 231.8 ± 78.9 g/m(2) under Pcom, P < .017) and decreased after SL-NG application (231.8 ± 78.9 g/m(2) under Pcom vs 197.4 ± 67.4 g/m(2) after SL-NG, P < .017), net LV twist angle and ABRD showed no significant changes depending on LV loading condition (for LV twist, 7.63 ± 4.47° at baseline vs 7.03 ± 4.13° under Pcom vs 7.35 ± 4.36° after SL-NG, P = 0.65; for ABRD, 16.56 ± 13.81% at baseline vs 17.19 ± 14.81% under Pcom vs 15.95 ± 13.27% after SL-NG, P = .53). Careful examination of individual patient data revealed that LV twist was load independent when patients had LV twist < 12°. ABRD was also found to be load independent, but only in patients with LVEFs < 34%. In contrast, LV twist and ABRD were load dependent in patients with preserved LVEFs.
CONCLUSIONS LV twist and its component, ABRD, had relatively load insensitive properties in patients with long-standing DCM and can be used in future clinical trials as load-independent indexes of LV dyssynchrony.
PubMed IF 8.3 순환기내과
1132012

제1저자 이지연 · 교신저자 김영환

, , , , , , , , , , , ,
Treatment response and long term follow-up results of nonspecific interstitial pneumonia.
J Korean Med Sci. 2012;27(6):661-7.

Abstract
The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.
PubMed IF 3.2 호흡기내과
1122012

제1저자 오세원 · 교신저자 진호준

, , , , , , , ,
Mild decrease in estimated glomerular filtration rate and proteinuria are associated with all-cause and cardiovascular mortality in the general population.
Nephrol Dial Transplant. 2012;27(6):2284-90.

Abstract
BACKGROUND A recent collaborative meta-analysis by Kidney Disease: Improving Global Outcomes reported that an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) and an albumin-to-creatinine ratio of ≥ 10 mg/g were independent predictors for mortality in the general population. However, selection bias, heterogeneity of the cohorts and measurement issues could be limitations.
METHODS We analyzed the relationship of eGFR and proteinuria with mortality in the Korean general population, represented by 112,115 participants, aged ≥ 20 years, who had a voluntary health check-up with homogenous calibration of creatinine measurement from 2003 to 2009. Proteinuria (trace or more) was determined by urine dipstick.
RESULTS eGFR and proteinuria were independently associated with all-cause mortality (ACM) and cardiovascular mortality (CVM), and progressive increases in risks for mortality were noted according to eGFR level and the presence of proteinuria. Compared with eGFR 90-105 mL/min/1.73 m(2), hazard ratio (HRs) for ACM were 1.60 [95% confidence interval (CI) 1.12-2.30] for eGFR 60-74 mL/min/1.73 m(2) and 3.54 (2.20-5.68) for eGFR <60 mL/min/1.73 m(2) in participants with no proteinuria. In participants with proteinuria, HRs for ACM were 2.10 (1.41-3.12) for eGFR 75-89 mL/min/1.73 m(2), 2.30 (1.50-3.53) for eGFR 60-74 mL/min/1.73 m(2) and 3.77 (2.15-6.38) for eGFR <60 mL/min/1.73 m(2). Similar findings were observed for CVM.
CONCLUSIONS eGFR <75 mL/min/1.73 m(2) and urine dipstick trace or more were independent risk factors of ACM and CVM. The risks of adverse outcomes are greater in the general population with mild renal impairment or mild proteinuria.
PubMed IF 8.3 신장내과
1112012

제1저자 문민경, 김민주 · 교신저자 박영주

, , , , , , , , , , ,
Bisphenol A impairs mitochondrial function in the liver at doses below the no observed adverse effect level.
J Korean Med Sci. 2012;27(6):644-52.

Abstract
Bisphenol A (BPA) has been reported to possess hepatic toxicity. We investigated the hypothesis that BPA, below the no observed adverse effect level (NOAEL), can induce hepatic damage and mitochondrial dysfunction by increasing oxidative stress in the liver. Two doses of BPA, 0.05 and 1.2 mg/kg body weight/day, were administered intraperitoneally for 5 days to mice. Both treatments impaired the structure of the hepatic mitochondria, although oxygen consumption rate and expression of the respiratory complex decreased only at the higher dose. The hepatic levels of malondialdehyde (MDA), a naturally occurring product of lipid peroxidation, increased, while the expression of glutathione peroxidase 3 (GPx3) decreased, after BPA treatment. The expression levels of proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) also increased. In HepG2 cells, 10 or 100 nM of BPA also decreased the oxygen consumption rate, ATP production, and the mitochondrial membrane potential. In conclusion, doses of BPA below the NOAEL induce mitochondrial dysfunction in the liver, and this is associated with an increase in oxidative stress and inflammation.
PubMed IF 3.2 내분비대사내과
1102012

제1저자 오윤정 · 교신저자 김동기

, , , , , , , , , , ,
A threshold value of estimated glomerular filtration rate that predicts changes in serum 25-hydroxyvitamin D levels: 4th Korean National Health and Nutritional Examination Survey 2008.
Nephrol Dial Transplant. 2012;27(6):2396-403.

Abstract
BACKGROUND Vitamin D deficiency is known as an important risk factor for mortality in patients with chronic kidney disease (CKD). Nevertheless, the association of renal function itself with vitamin D status or serum 25-hydroxyvitamin D (25OHD) level has not been investigated thoroughly.
METHODS We examined the association between the estimated glomerular filtration rate (eGFR) and serum 25OHD levels using data from the 4th Korean National Health and Nutritional Examination Survey 2008. Generalized additive models (GAMs) were used to examine the relationship between eGFR and serum 25OHD levels and to estimate a threshold value of eGFR that predicts changes in serum 25OHD levels.
RESULTS The mean serum 25OHD level was 20.4 ± 9.1 ng/mL, and the overall prevalence of vitamin D deficiency was 29.9% in this population. The prevalence of vitamin D deficiency began to increase at eGFR levels <45 mL/min/1.73 m(2). After adjustment, the logistic regression of dichotomized eGFR levels with a cut-point of 45 mL/min/1.73 m(2) yielded an increased odds ratio for vitamin D deficiency. Additionally, the continuous relationship between eGFR and 25OHD levels was explored using GAMs adjusted for various confounding factors. In this analysis, the difference from the mean serum 25OHD started to increase below an eGFR threshold of 55.4 mL/min/1.73 m(2), which suggests that renal function is directly related to the serum 25OHD levels in patients with CKD Stages 3-5.
CONCLUSION Although moderate renal dysfunction (eGFR < 45 mL/min/1.73 m(2)) is an important predictor of vitamin D deficiency, serum 25OHD levels start to decrease below an eGFR level of ~60 mL/min/1.73 m(2) independent of other risk factors. These results suggest that more careful attention to 25OHD levels may be needed when patients reach Stage 3 CKD.
PubMed IF 8.3 신장내과

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