SCI 발표논문
2010년 155편
- 352010
제1저자 김진현 · 교신저자 이은봉
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The prognostic factors of systemic sclerosis for survival among Koreans.Clin Rheumatol. 2010;29(3):297-302.
PubMed IF 2.7 류마티스내과Abstract
Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis of the skin and internal organs, which can cause significant morbidity and mortality. The prognostic factors for survival were not fully evaluated in Asian population. We investigated the prognostic factors for survival of SSc among Korean patients. A total of 243 SSc patients were enrolled from Seoul National University Hospital between 1972 and 2007. Age at onset, gender, cutaneous subset, autoantibody status, major organ involvement, and occurrence of malignancy were evaluated with all-cause mortality as the end point. A multivariate Cox proportional hazard model was used to retrieve the prognostic factors for survival. During the follow-up of 1,967 person-years, 33 patients died. Old age at onset (hazard ratio [HR] 7.4, 95% confidence interval [95% CI] 1.9-28.1), diffuse cutaneous subset (HR 2.5, 95% CI 1.1-5.9), presence of anti-Scl-70 antibody (HR 3.0, 95% CI 1.2-7.1), forced vital capacity less than 70% (HR 2.8, 95% CI 1.3-6.2), and heart involvement (HR 4.2, 95% CI 1.7-10.2) were found to be significant risk factors for mortality in multivariate analysis. In Korean SSc patients, old age, diffuse cutaneous involvement, anti-Scl-70 antibody, and internal organ involvement are risk factors for mortality.
- 342010
제1저자 고영일 · 교신저자 김동완
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Expression of class III beta-tubulin correlates with unfavorable survival outcome in patients with resected non-small cell lung cancer.J Thorac Oncol. 2010;5(3):320-5.
PubMed IF 23.3 혈액종양내과Abstract
BACKGROUND We analyzed the significance of class III beta-tubulin (TUBB3) expression in curatively resected non-small cell lung cancer as a prognostic marker along with previously reported excision repair cross complementation group 1 (ERCC1).
METHODS One hundred and thirty-six consecutive patients were included in this retrospective study. Patients who received adjuvant chemotherapy were excluded. We used immunohistochemistry to evaluate TUBB3 and ERCC1 expression on tissue microarray in duplicate. Semiquantitative H score was used for the scoring of tumor staining.
RESULTS Sixty percent of patients had stage I disease, 17% stage II, 18% stage IIIA, and 5% stage IIIB. TUBB3 H score showed bimodal distribution with the minimum at the value of 4, which was used as a cutoff value for determination of TUBB3 positivity. TUBB3 was expressed in 60 patients (44%). Patients with a positive TUBB3 expression survived shorter than did the patients with a negative expression (5-year overall survival [OS] rate was 40% versus 61%; p = 0.005/5-year disease-free survival rate was 34% versus 55%; p = 0.024). ERCC1 expression showed tendency for prolonged OS without reaching statistical significance. A multivariate analysis that incorporated covariates including TUBB3 expression, age, stage, EGFR mutation status, histology, and ERCC1 expression showed that TUBB3 was an independent unfavorable prognostic factor for OS (hazard ratio 2.083; p = 0.008) and relapse free survival (hazard ratio 1.978; p = 0.020).
CONCLUSIONS TUBB3 expression is an independent unfavorable prognostic marker in patients with curatively resected non-small cell lung cancer who did not receive adjuvant chemotherapy.
- 332010
제1저자 이근욱 · 교신저자 방수미
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The incidence, risk factors and prognostic implications of venous thromboembolism in patients with gastric cancer.J Thromb Haemost. 2010;8(3):540-7.
PubMed IF 5.2 혈액종양내과Abstract
BACKGROUND Data on venous thromboembolism (VTE) in gastric cancer (GC) are very scarce.
OBJECTIVE To investigate the incidence, risk factors and prognostic implications of VTE in Asian GC patients.
METHODS Prospective databases containing clinical information on GC patients (n = 2,085) were used.
RESULTS The 2-year cumulative incidences of all VTE events were 0.5%, 3.5% and 24.4% in stages I, II-IV(M0) and IV(M1), respectively. Advanced stage, older age and no major surgery were independent risk factors for developing VTE. When the VTE cases were classified into extremity venous thrombosis (EVT), pulmonary thromboembolism (PTE) or intra-abdominal venous thrombosis (IVT), IVTs (62%) were more common than EVTs (21%) or PTEs (17%). Although peri-operative pharmacologic thromboprophylaxis was not routinely administered, the VTE incidence after major surgery was only 0.2%. During chemotherapy, EVT/PTE developed more frequently than IVT (54% vs. 19%); however, during untreated or treatment-refractory periods, IVT developed more frequently than EVT/PTE (69% vs. 36%). In multivariate models, the development of EVT/PTE was a significant predictor of early death when compared with no occurrence of VTE (P < 0.05). However, IVT did not affect survival.
CONCLUSION This is the largest study that specially focused on VTE in GC and the VTE incidence in Asian GC patients was first demonstrated. Considering the low incidence of post-operative VTE development, the necessity of peri-operative pharmacologic thromboprophylaxis should be evaluated separately in Asian patients. The clinical situation of the development of EVT/PTE and IVT differed. Only EVT/PTE had an adverse effect on survival and IVT had no prognostic significance.
- 322010
제1저자 한승석 · 교신저자 나기영
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Impact of C-reactive protein and pulse pressure evaluated at the start of peritoneal dialysis on cardiovascular events in the course of treatment with peritoneal dialysis.Perit Dial Int. 2010;30(3):300-10.
PubMed IF 1.8 신장내과Abstract
BACKGROUND Despite a reduced number of infectious complications, cardiovascular (CV) mortality remains unchanged in peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effects of high-sensitivity C-reactive protein (hs-CRP) and pulse pressure (PP) at the start of PD on the development of CV events (CVEs) in these patients.
METHODS The study population was comprised of 291 patients that started PD between January 2003 and June 2008 and were treated for more than 6 months. Baseline clinical, biochemical, and echocardiographic data, indices of dialysis adequacy, and peritoneal transport rate were reviewed retrospectively. The clinical outcome was the occurrence of a CVE.
RESULTS Mean duration of follow-up was 28 (range 6 - 70) months. A CVE was observed in 33 patients (11.3%). The 1-, 3-, and 5-year cumulative incidences of CVEs were 4.0%, 13.7%, and 27.5%, respectively. Although multiple variables were correlated with the prevalence of a CVE in the univariate analysis, hs-CRP, PP, and comorbidity remained significant after adjustment: hs-CRP: odds ratio (OR) 4.09 (1.53 - 10.95), p = 0.005; PP: OR 2.79 (1.26 - 6.17), p = 0.012. PP and hs-CRP, which were not intercorrelated in our data, combined adversely to increase the incidence of CVEs. The incidence of CVEs increased with the number of risk factors, which included high hs-CRP, high PP, and the presence of comorbidity (no risk factor, 0%; 1 risk factor, 1.5%; 2 risk factors, 30.8%; 3 risk factors, 53.9%).
CONCLUSIONS Our study suggests that measurements of hs-CRP and PP at the start of PD may be helpful in predicting the development of CVEs in the course of treatment with PD.
- 312010
제1저자 김세훈 · 교신저자 조유숙
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The tyrosine phosphatase, SHP-1, is involved in bronchial mucin production during oxidative stress.Biochem Biophys Res Commun. 2010;393(1):137-43.
PubMed IF 2.5 알레르기내과Abstract
Mucus hypersecretion is a clinically important manifestation of chronic inflammatory airway diseases, such as asthma and Chronic obstructive pulmonary disease (COPD). Mucin production in airway epithelia is increased under conditions of oxidative stress. Src homology 2 domain-containing protein tyrosine phosphatase (SHP)-1 suppression is related to the development of airway inflammation and increased ROS levels. In this study, we investigated the role of SHP-1 in mucin secretion triggered by oxidative stress. Human lung mucoepidermoid H292 carcinoma cells were transfected with specific siRNA to eliminate SHP-1 gene expression. Cultured cells were treated with hydrogen peroxide (H(2)O(2)), and Mucin 5AC(MUC5AC) gene expression and mucin production were determined. Activation of p38 mitogen activated protein kinase (MAPK) in association with MUC5AC production was evaluated. N-acetylcysteine (NAC) was employed to determine whether antioxidants could block MUC5AC production. To establish the precise role of p38, mucin expression was observed after pre-treatment of SHP-1-depleted H292 cells with the p38 chemical blocker. We investigated the in vivo effects of oxidative stress on airway mucus production in SHP-1-deficient heterozygous (mev/+) mice. MUC5AC expression was enhanced in SHP-1 knockdown H292 cells exposed to H(2)O(2), compared to that in control cells. The ratio between phosphorylated and total p38 was significantly increased in SHP-1-deficient cells under oxidative stress. Pre-treatment with NAC suppressed both MUC5AC production and p38 activation. Blockage of p38 MAPK led to suppression of MUC5AC mRNA expression. Notably, mucin production was enhanced in the airway epithelia of mev/+ mice exposed to oxidative stress. Our results clearly indicate that SHP-1 plays an important role in airway mucin production through regulating oxidative stress.
- 302010
제1저자 오도연 · 교신저자 김열홍
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A multicenter phase II study of gemcitabine and S-1 combination chemotherapy in patients with unresectable pancreatic cancer.Cancer Chemother Pharmacol. 2010;65(3):527-36.
PubMed IF 2.5 혈액종양내과Abstract
PURPOSE To confirm the efficacy and toxicity of gemcitabine and S-1 combination chemotherapy when used as a first-line therapy in patients with unresectable pancreatic cancer.
METHODS Patients with locally advanced or metastatic or recurrent pancreatic adenocarcinoma, which was histologically or cytologically proven, with at least one measurable lesion were eligible for the study. Gemcitabine at a dose of 1,000 mg/m2 was intravenously given over 30 min on days 1 and 8, while S-1 at a dose of 40 mg/m2 was orally given twice daily from day 1 to 14, and the cycle was repeated every 3 weeks. The objective response rate, which was assessed according to RECIST criteria, was the primary end point.
RESULTS A total of 38 patients were enrolled between June 2006 and June 2007. The median number of treatment courses was 5.5 (range 1-22). Thirty-four patients were evaluable for response. Although no complete response was seen, partial responses were achieved in 11 patients, resulting in an overall response rate of 32% [95% confidence interval (CI) 17-48%]. The median response duration was 6.0 months (95% CI 4.6-8.3 months), the median time-to-progression was 5.4 months (95% CI 2.9-8.0 months), and the median overall survival was 8.4 months (95% CI 5.7-11.1 months). The major grade 3/4 hematologic toxicities were neutropenia (39.5%), leukopenia (15.8%), thrombocytopenia (2.6%), and anemia (7.9%). The major grade 3/4 non-hematologic toxicities included anorexia (10.5%), stomatitis (2.6%), rash (7.9%), fatigue (7.9%) and hyperbilirubinemia (5.3%).
CONCLUSIONS Gemcitabine and S-1 combination chemotherapy was effective and tolerable in patients with unresectable pancreatic cancer.
- 292010
제1저자 "강시혁, 박계현" · 교신저자 최동주
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Coronary artery bypass grafting versus drug-eluting stent implantation for left main coronary artery disease (from a two-center registry).Am J Cardiol. 2010;105(3):343-51.
PubMed IF 2.5 순환기내과Abstract
Recent studies have suggested that percutaneous coronary intervention (PCI) in patients with unprotected left main coronary artery (LMCA) disease renders outcomes comparable to those from coronary artery bypass grafting (CABG). It is necessary to stratify individual patient risk and select the optimal revascularization strategy. We compared the clinical outcomes of patients with unprotected LMCA disease who had undergone PCI with drug-eluting stents or CABG. We identified 462 patients who were treated from January 2003 to December 2006 for unprotected LMCA or LMCA-equivalent disease: 257 had undergone CABG and 205 had undergone PCI with drug-eluting stents. Analyses using propensity scores were performed to minimize the selection bias in the present observational study. After a median follow-up of 33.5 months, no significant difference was found between the CABG and PCI groups in the risk of death (12.1% vs 14.1%, respectively; p = 0.428) or the risk of a composite of death, myocardial infarction, or cerebrovascular accident (17.5% vs 20.0%, respectively; p = 0.434). The rate of major adverse cardiac and cerebrovascular events was significantly lower in the CABG group than in the PCI group (21.8% vs 35.1%, respectively; p = 0.001); the difference was mainly driven by a decrease in the rate of repeat revascularizations (5.1% vs 22.4%; p <0.001). The analyses after propensity score adjustment and matching corroborated the crude group results. In conclusion, PCI with drug-eluting stents showed a safety profile comparable to that of CABG in patients with unprotected LMCA disease. However, the risk of repeat revascularization was significantly greater in the PCI group.
- 282010
제1저자 임재준 · 교신저자 Selvaraj P
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Genetic susceptibility in tuberculosis.Respirology. 2010;15(2):241-56.
PubMed IF 7.2 호흡기내과Abstract
The importance of host genetic factors in determining susceptibility to tuberculosis (TB) has been studied extensively using various methods, such as case-control, candidate gene and genome-wide linkage studies. Several important candidate genes like human leucocyte antigen/alleles and non-human leucocyte antigen genes, such as cytokines and their receptors, chemokines and their receptors, pattern recognition receptors (including toll-like receptors, mannose binding lectin and the dendritic cell-specific intercellular adhesion molecule-3 grabbing nonintegrin), solute carrier family 11A member 1 (formerly known as natural resistance-associated macrophage protein 1) and purinergic P2X7 receptor gene polymorphisms, have been associated with differential susceptibility to TB in various ethnic populations. This heterogeneity has been explained by host-pathogen and gene-environment interactions and evolutionary selection pressures. Although the achievements of genetics studies might not yet have advanced the prevention and treatment of TB, researchers have begun to widen their scope of investigation to encompass these practical considerations.
- 272010
제1저자 이병환 · 교신저자 김나영
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Bismuth-containing quadruple therapy as second-line treatment for Helicobacter pylori infection: effect of treatment duration and antibiotic resistance on the eradication rate in Korea.Helicobacter. 2010;15(1):38-45.
PubMed IF 4.6 소화기내과Abstract
BACKGROUND The eradication rate of first-line Helicobacter pylori treatment is only 70-85% and has been decreasing due to the increase in antibiotic resistance. The aim of this study was to evaluate the efficacy of bismuth-containing quadruple therapy as second-line treatment for H. pylori infection based on treatment duration.
METHODS We prospectively enrolled 227 patients that were found to have persistent H. pylori infection after first-line proton-pump inhibitor-clarithromycin-amoxicillin triple therapy. Patients were randomized to 1-week (112 patients) and 2-week (115 patients) quadruple therapy with tripotassium dicitrate bismuthate 300 mg q.i.d., metronidazole 500 mg t.i.d., and tetracycline 500 mg q.i.d. and esomeprazole 20 mg b.i.d. The eradication rate, drug compliance, and adverse events were compared based on treatment duration.
RESULTS The eradication rates were 72/112 (64.3%, 95% CI: 0.504-0.830) and 71/92 (77.2%, 0.440-0.749) with 1-week group, and 95/115 (82.6%, 1.165-2.449) an 88/94 (93.6%, 1.213-5.113) with 2-week group by intention-to-treat therapy (p = .002) and per-protocol analysis (p = .001), respectively. The adverse events increased as the treatment durations increased from 7 to 14 days (20.0 and 42.5%, respectively, p < .001). However, there was no significant difference in the patient compliance or the rate of major adverse events between the 1- and 2-week groups (6.3 and 12.5%, respectively, p = .133).
CONCLUSION Two-week bismuth-containing quadruple therapy was more effective than the 1-week treatment, and should be considered for second-line treatment in Korea.
- 262010
제1저자 이은주 · 교신저자 김효수
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Novel embryoid body-based method to derive mesenchymal stem cells from human embryonic stem cells.Tissue Eng Part A. 2010;16(2):705-15.
PubMed IF 2.8 순환기내과Abstract
Application of human embryonic stem cells (hESCs) to stem-cell therapy is not feasible because of the risk of tumorigenicity and rejection. In contrast, human mesenchymal stem cells (hMSCs) are free from the risk of tumorigenicity and also have immune privilege. However, hMSCs obtained from adults have infinite variety in terms of the biological characteristics and functionality. We report here a new derivation method of hMSCs from hESCs. The derivation of hMSCs from three different hESC lines (SNUhES3, CHA3-hESC, and H9) was performed by embryoid bodies formation and subsequent culture with stage-different media without using inductive xenogenic feeder and mechanical selection procedure. The derived cells were morphologically similar to the unique fingerprint-like pattern of hMSCs and grew stably for at least 35 passages in vitro. These cells had hMSCs-like immunophenotypes: negative for CD34 and CD45; positive for CD29, CD44, CD73, CD90, and CD105. They could be differentiated into multiple lineages including osteocytes, chondrocytes, adipocytes, and myocytes. They maintained normal karyotype during the long-term cultivation and did not show tumorigenicity when transplanted into the immunodeficient mice. In conclusion, the new embryoid body-based derivation method of hMSCs from hESCs is simple, safe, and reproducible in three different hESC lines. We expect that this method will provide a more effective and powerful tool to derive hMSCs from various hESC lines.
- 252010
제1저자 "조익성, 민희석" · 교신저자 장혁재
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Coronary atherosclerosis detected by coronary CT angiography in asymptomatic subjects with early chronic kidney disease.Atherosclerosis. 2010;208(2):406-11.
PubMed IF 7.1 순환기내과Abstract
OBJECTIVES The purpose of this study is to assess the independent association between early CKD (stages 1-3a) with coronary atherosclerosis and the feasibility of risk stratification of coronary atherosclerosis according to The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines using non-invasive coronary angiography.
METHODS We consecutively enrolled 4297 asymptomatic subjects who underwent coronary CT angiography as part of a general health evaluation and had estimated glomerular filtration rates (eGFR) over 45 ml/min/1.73 m(2). Subjects were categorized from no CKD to stage 3a CKD, and multiple regression analyses for coronary atherosclerosis were performed.
RESULTS Early CKD was an independent risk factor for coronary artery disease (CAD) and obstructive CAD. However, neither the risk of CAD nor CACS >100 increased as stage of CKD advanced. The reason for unsuccessful stratification of coronary atherosclerosis risk was that the presence of proteinuria, which was used to define stages 1 and 2 CKD, was an independent risk factor for coronary atherosclerosis, but eGFR of 45-89 ml/min/1.73 m(2) was not associated with coronary atherosclerosis.
CONCLUSIONS Early CKD was an independent risk factor for coronary atherosclerosis, and the risk stratification for coronary atherosclerosis should be based on the presence of proteinuria rather than decreased eGFR within early CKD.
- 242010
제1저자 한승석 · 교신저자 김연수
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Impact of recurrent disease and chronic allograft nephropathy on the long-term allograft outcome in patients with IgA nephropathy.Transpl Int. 2010;23(2):169-75.
PubMed IF 3.6 신장내과Abstract
Although recurrent IgA nephropathy (IgAN) may lead to graft dysfunction after transplantation, donation from living related donor (LRD), with whom the risk of recurrence may be higher, is not a contraindication. Herein, we evaluated the natural history of allograft in recipients with IgAN and the risk factors influencing long-term allograft outcome. Recurrence rate and graft survival were assessed retrospectively in 221 IgAN patients, including transplants from 139 LRDs (62.9%). Ten-year cumulative rate for recurrent IgAN was 30.8%. The operation at younger age and donation from LRD were significant for the recurrence by multivariate analysis. Ten-year graft survival was affected by recurrent IgAN (61.0% in recurrent IgAN group vs. 85.1% in nonrecurrent, P < 0.01). However, transplants from LRDs did not show poor graft survival when compared with those from other types of donors. In transplants from LRDs, the incidence of chronic allograft nephropathy (CAN) was lower than those in grafts from deceased donors (10.8% vs. 19.5%, P < 0.05). When CAN was considered in addition to recurrence, the variance of graft survival was affected significantly by the development of CAN than by the recurrence. These results suggest that the detection and adequate management of CAN could improve graft outcome in transplant recipients with IgAN.
- 232010
제1저자 진호준 · 교신저자 김성권
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The effect of the World Kidney Day campaign on the awareness of chronic kidney disease and the status of risk factors for cardiovascular disease and renal progression.Nephrol Dial Transplant. 2010;25(2):413-9.
PubMed IF 8.3 신장내과Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide problem. We describe the trends in CKD awareness before and after the World Kidney Day (WKD) campaign and the impact of the WKD campaign in increasing awareness and appropriate management of the risk factors for cardiovascular disease and renal progression.
METHODS We selected 57 718 people who had undergone a routine health check-up.
RESULTS The average CKD awareness was 3.1% (95% CI: 2.6-3.7%) and was increased with progressing CKD stage. The awareness was increased from 1.1% before the WKD campaign to 5.8% after the campaign (P < 0.001). CKD awareness in the post-WKD period was increased in CKD stages 2 (OR 4.535: 95% CI: 2.044-10.062) and 3 (OR 6.614: 95% CI: 4.282-10.217) and profoundly increased in stage 4 (OR 13.800: 95% CI: 2.127-89.524), compared to the pre-WKD period. In the CKD-aware group compared to the CKD-unaware group, the awareness of diabetes mellitus (90.0% versus 54.2%, P < 0.001) and hypertension (87.2% versus 64.7%, P < 0.001) was higher and the levels of systolic blood pressure (116.9 +/- 1.0 versus 120.1 +/- 0.2, P < 0.01) and serum cholesterol (198.3 +/- 2.7 versus 205.0 +/- 0.5, P < 0.05) were lower by covariance analysis.
CONCLUSIONS The WKD campaign had a positive impact on the awareness and control of risk factors in CKD subjects but the absolute frequency of CKD awareness still remains undesirable in Korea. We need new campaign strategies to publicize the importance of early diagnosis and appropriate management of CKD.
- 222010
제1저자 임규형 · 교신저자 오도연
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Metaplastic breast carcinoma: clinicopathologic features and prognostic value of triple negativity.Jpn J Clin Oncol. 2010;40(2):112-8.
PubMed IF 2.5 혈액종양내과Abstract
OBJECTIVE Metaplastic breast carcinomas (MBC) are a rare type of breast cancer and are generally characterized by hormone receptor and human epidermal growth factor receptor 2 (HER2) negativity. There is a paucity of information on prognosis according to hormone receptor and HER2 expression for these rare tumors. The aim of this study was to compare the clinical features and prognosis between triple-negative metaplastic carcinoma (TNMC) and non-triple-negative metaplastic carcinoma (NTNMC).
METHODS We retrospectively analyzed MBC patients treated at Seoul National University Hospital between 1996 and 2006. The medical records were reviewed.
RESULTS Fifty-one patients were identified. At a median follow-up of 40.8 months, the 3-year disease-free survival (DFS) and overall survival (OS) rates were 75.5% and 86.3%, respectively. Non-triple negativity (P = 0.012) correlated significantly with OS in multivariate analysis. Of the 51 patients, 41 (80.4%) had TNMC and 10 (19.6%) had NTNMC. The two groups did not differ significantly by age, tumor size or nodal status. In patients with NTNMC, the positivity rates for estrogen receptor, progesterone receptor and HER2 were 20.0%, 30.0% and 80.0% in NTNMC. The 3-year OS rates in patients with TNMC and NTNMC were 93.4% and 58.2%, respectively (P = 0.007). With respect to DFS, there was no statistically significant difference between patients with TNMC and those with NTNMC (P = 0.149).
CONCLUSIONS In MBC, the non-triple-negative group had a poor prognosis compared with the triple-negative group, which is contrary to what has been reported in patients with invasive ductal carcinoma of breast. Further research exploring the mechanism underlying this result is needed.
- 212010
제1저자 신철민 · 교신저자 김나영
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Stomach cancer risk in gastric cancer relatives: interaction between Helicobacter pylori infection and family history of gastric cancer for the risk of stomach cancer.J Clin Gastroenterol. 2010;44(2):e34-9.
PubMed IF 2.7 소화기내과Abstract
GOALS To identify the risk of gastric cancer in first-degree relatives of gastric cancer patients, and to determine if there is an interaction between Helicobacter pylori (H. pylori) infection and family history of gastric cancer in gastric carcinogenesis.
BACKGROUND It is unclear to what degree a family history of gastric cancer is associated with stomach cancer risk in Korea.
STUDY From May 2003 to July 2008, 428 gastric cancer patients and 368 controls were included in the analyses. Logistic regression models including age, sex, family history of gastric cancer, residency during childhood, smoking, monthly income, spicy food diet and H. pylori status were evaluated to estimate the odds ratios (ORs) of developing gastric cancer.
RESULTS Adjusted OR for gastric cancer increased 3-fold for subjects reporting first-degree relatives with gastric cancer [OR 2.85, 95% confidence interval (CI): 1.83-4.46]. The association was strong in the 40 to 59 years age group (OR 4.00, 95% CI: 2.06-7.76), and became weaker in subjects older than 60 years of age (OR 1.81, 95% CI: 0.95-3.46). Compared with the uninfected subjects without a family history, subjects with both a family history and H. pylori infection had a 5-fold increased risk (OR 5.32, 95% CI: 2.76-10.25).
CONCLUSIONS After adjusting for environmental factors and H. pylori infection, a family history of gastric cancer remained independently associated with gastric cancer. The interaction between H. pylori infection and family history of gastric cancer might be a rationale for H. pylori eradication in the gastric cancer relatives as a strategy to prevent gastric cancer.
- 202010
제1저자 김홍빈 · 교신저자 David Hooper
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Transferable quinolone resistance in Vibrio cholerae.Antimicrob Agents Chemother. 2010;54(2):799-803.
PubMed IF 4.2 감염내과Abstract
Ciprofloxacin was introduced for treatment of patients with cholera in Bangladesh because of resistance to other agents, but its utility has been compromised by the decreasing ciprofloxacin susceptibility of Vibrio cholerae over time. We correlated levels of susceptibility and temporal patterns with the occurrence of mutation in gyrA, which encodes a subunit of DNA gyrase, followed by mutation in parC, which encodes a subunit of DNA topoisomerase IV. We found that ciprofloxacin activity was more recently further compromised in strains containing qnrVC3, which encodes a pentapeptide repeat protein of the Qnr subfamily, members of which protect topoisomerases from quinolone action. We show that qnrVC3 confers transferable low-level quinolone resistance and is present within a member of the SXT integrating conjugative element family found commonly on the chromosomes of multidrug-resistant strains of V. cholerae and on the chromosomes of Escherichia coli transconjugants constructed in the laboratory. Thus, progressive increases in quinolone resistance in V. cholerae are linked to cumulative mutations in quinolone targets and most recently to a qnr gene on a mobile multidrug resistance element, resulting in further challenges for the antimicrobial therapy of cholera.
- 192010
제1저자 한승석 · 교신저자 진호준
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Lean mass index: a better predictor of mortality than body mass index in elderly Asians.J Am Geriatr Soc. 2010;58(2):312-7.
PubMed IF 4.6 신장내과Abstract
OBJECTIVES To evaluate the correlation between body mass index (BMI), body composition, and all-cause mortality in an elderly Asian population.
DESIGN A prospective observational cohort study with 3.5-year follow-up.
SETTING The Korean Longitudinal Study on Health and Aging Project for elderly residents in Seongnam City, Korea.
PARTICIPANTS Eight hundred seventy-seven subjects aged 65 and older for whom baseline body composition data was available.
MEASUREMENTS BMI, waist circumference, and body composition of each subject was evaluated. Body composition was examined using bioelectrical impedance analyses of measures, including lean mass (kg), fat mass (kg), and fat proportion (%). In addition, lean mass index (LMI, kg/m(2)) was calculated by dividing lean mass by the square of height. Participants were divided into three groups: Group 1 (<25th percentile), Group 2 (25-75th percentiles), and Group 3 (> or =75th percentile) for BMI, waist circumference, body composition, and LMI.
RESULTS In the fully adjusted Cox proportional hazard model, BMI, waist circumference, and fat composition were not correlated with mortality, but higher lean mass and LMI were considered predictors of lower mortality when comparing Group 3 and Group 1 (in lean mass, relative risk reduction of 84%, 95% confidence interval (CI)=45-96%, P=.004; in LMI, relative risk reduction of 69%, 95% CI=12-89%, P=.03).
CONCLUSION The present study indicates that the recommendation of low BMI as a means of obtaining a survival advantage in the elderly is not supported. Instead, higher lean mass and higher LMI are associated with better survival in the elderly Asian population.
- 182010
제1저자 최평균 · 교신저자 김홍빈
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Usefulness of routine lumbar puncture in non-HIV patients with latent syphilis of unknown duration.Sex Transm Infect. 2010;86(1):39-40.
PubMed IF 3 감염내과Abstract
OBJECTIVES To evaluate the usefulness of routine lumbar puncture in non-HIV patients with untreated latent syphilis.
METHODS We conducted a prospective study in Seoul National University Bundang Hospital from May 2003 to December 2005. Participants in routine health check-ups of the healthcare system were screened for serological evidence of syphilis by the Treponema pallidum particle agglutination (TPPA) test. Lumbar puncture was performed, with consent, on untreated latent syphilitic patients. Neurosyphilis was defined as positivity for cerebrospinal fluid Venereal Disease Research Laboratory (CSF VDRL) or pleocytosis with positivity for CSF TPPA or elevation of CSF protein with IgG index exceeding 0.85.
RESULTS Of 21 507 participants, 282 (1.4%) had serological evidence of syphilis. 117 (41%) of these had a history of syphilis treatment and 2 were seropositive for HIV. Among the 163 non-HIV patients with untreated latent syphilis, 70 (43%) underwent lumbar puncture. All the patients had VDRL titres less than 1:16. Abnormal neurological signs or symptoms were present in eight (11%) patients. CSF abnormalities were seen in 57 (81%), but no patient (0%, 95% CI 0 to 6.2) was diagnosed with neurosyphilis.
CONCLUSIONS The estimated prevalence of neurosyphilis among non-HIV patients with untreated latent syphilis and serum VDRL <1:16, was below 6.2%.
- 172010
제1저자 고영일 · 교신저자 방수미
, , , , , , , , , , , , , , , , , ,
Low incidence of clinically apparent thromboembolism in Korean patients with multiple myeloma treated with thalidomide.Ann Hematol. 2010;89(2):201-6.
PubMed IF 2.3 혈액종양내과Abstract
The frequency of thromboembolic events (TE) in Caucasian patients with multiple myeloma (MM) receiving thalidomide as the initial treatment has been reported to be 10~58% without prophylactic anticoagulation. Korean MM patients treated with thalidomide were studied to determine the frequency of TE and associated risk factors. A retrospective medical record review of the Korean MM registry from 25 centers in Korea between 2003 and 2007 was performed. We assessed the incidence of arterial and venous TE and the associated clinical parameters. Three hundred and sixty MM patients (median age 61 years, range 32-88 years) received thalidomide treatment. Fourteen patients (3.9%) developed TE: 12 had venous and two had arterial locations. The sites for the venous TE included lungs (seven), lower extremities (four), upper extremities (one), and neck (one). Arterial TE developed in cerebral and peripheral arteries each. No single clinical parameter such as prerequisite for the metabolic syndrome, disease status, and treatment regimen were predictive for the development of TE. The frequency of TE in patients who received thalidomide as initial therapy (7/155) was not different from those who received thalidomide for progressive or relapsed disease (7/205, p = 0.592). The frequency of TE during thalidomide treatment in Korean patients with MM was low. No significant clinical factor was found to be a risk factor. The subgroup requiring thromboprophylaxis among the Korean patients with MM, receiving thalidomide, needs to be clarified.
- 162010
제1저자 정숙향 · 교신저자 이효석
,
Hepatitis A: clinical manifestations and management.Intervirology. 2010;53(1):15-9.
PubMed IF 1.8 소화기내과Abstract
Due to improved living conditions and subsequent changes in hepatitis A epidemiology, the disease burden of hepatitis A is increasing in many regions. Recently, Korea has faced a large, community-wide outbreak of hepatitis A, which has prompted a vaccination program. The clinical spectrum of hepatitis A virus infection ranges from asymptomatic infection to fulminant hepatitis. Clinical manifestations depend on the age of the host: less than 30% of infected young children are symptomatic, while about 80% of infected adults manifest severe hepatitis with remarkably elevated serum aminotransferases. Fulminant hepatitis is rare, with a reported incidence from 0.015 to 0.5%. Atypical manifestations include relapsing hepatitis and prolonged cholestasis, and complicated cases with acute kidney injury have been reported. Extrahepatic manifestations, such as autoimmune hemolytic anemia, aplastic anemia, pure red cell aplasia, pleural or pericardial effusion, acute reactive arthritis, acute pancreatitis, acalculous cholecystitis, mononeuritis, and Guillain-Barré syndrome, have been rarely reported. Management of hepatitis A includes general supportive care, and critical decisions regarding liver transplantation await further studies on prognostic predictors. Fundamental management of hepatitis A is active vaccination. However, a vaccination program should be adapted to the regional situation, according to differing epidemiology and disease burden.
- 152010
제1저자 김윤준 · 교신저자 이효석
,
Increasing incidence of hepatitis A in Korean adults.Intervirology. 2010;53(1):10-4.
PubMed IF 1.8 소화기내과Abstract
Hepatitis A infection is caused by the hepatitis A virus (HAV), which is transmitted through the fecal-oral route. Lifelong protective antibodies are present after infection. The number of cases of adult hepatitis A has progressively been increasing during the last several decades in Korea. In addition, the pattern of age-specific seroprevalence of anti-HAV has changed with economic growth. The prevalence of anti-HAV in the 10-50-year age range has declined rapidly during the last 3 decades. As a result, this age group has a high risk for HAV infection and clinically overt hepatitis A is increasing in adolescents and adults. It is well established that the severity of the disease is related to the age of the patients. The development of more cases of adult hepatitis A with severe presentation is expected in the near future. The clinical features and the epidemiological shift of HAV underscore the importance in Korea, as well as in other countries with similar issues, of childhood vaccination and consideration of catch-up vaccination for adolescents and adults as well as of targeted vaccination for individuals at increased risk for infection or its complications. There is a need to extensively evaluate the nationwide epidemiology of HAV infection, make cost-benefit analyses of HAV vaccination, and establish guidelines for HAV vaccination.
- 142010
제1저자 박영주 · 교신저자 박도준
, , , , , , , , , ,
Papillary microcarcinoma in comparison with larger papillary thyroid carcinoma in BRAF(V600E) mutation, clinicopathological features, and immunohistochemical findings.Head Neck. 2010;32(1):38-45.
PubMed IF 2.2 내분비대사내과Abstract
BACKGROUND Papillary thyroid microcarcinoma (PMC; <or=1 cm) is thought to take a benign course during the lifetime. However, recent studies showed high recurrence rates for PMC.
METHODS We analyzed the clinicopathological features, long-term prognosis, and some molecular characteristics including BRAF(V600E) mutation by retrospectively reviewing the records of 1150 patients with papillary thyroid carcinoma (PTC), 278 with PMC, and 868 with PTC >1 cm.
RESULTS The prevalence of extrathyroidal invasion (52.2%) and initial nodal metastasis (34.9%) in patients with PMC was surprisingly high and almost as high as that for patients with PTC (72.4% and 51.8%, respectively). The rate of recurrent or persistent disease did not differ between patients with PMC and PTC (recurrent or persistent disease, 6.1% vs 14.1%; 53.4- vs 84.2-month follow-up; n = 98 vs 647; corrected p = .112). The frequency of BRAF(V600E) mutation was similar in patients with PMC and PTC (65.6% vs 67.2%). Immunohistochemical staining showed no different expression pattern according to the tumor size.
CONCLUSION These results suggest that PMC is not an occult cancer and it can act like larger PTC. Therefore, PMC should not be underestimated in practice.
- 132010
제1저자 강현우 · 교신저자 김동희
, , , , , , , , , , ,
Visceral obesity and insulin resistance as risk factors for colorectal adenoma: a cross-sectional, case-control study.Am J Gastroenterol. 2010;105(1):178-87.
PubMed IF 7.6 소화기내과Abstract
OBJECTIVES Colorectal adenoma is known to be associated with obesity, but the association between colorectal adenoma and visceral adipose tissue (VAT) area measured by abdominal computed tomography (CT) has not been documented clearly. In addition, the relationship between insulin resistance and colorectal adenomas, which underlies the mechanism that links obesity and colorectal adenoma, has not been studied extensively. The aim of this study was to examine VAT area and insulin resistance as risk factors of colorectal adenoma.
METHODS A cross-sectional, case-control study was conducted in Koreans that presented for health check-ups. Subjects underwent various laboratory tests, abdominal CT, and colonoscopy. VAT, subcutaneous adipose tissue (SAT), and homeostatic metabolic assessment (HOMA) index were evaluated as potential risk factors of colorectal adenoma in 2,244 age- and sex-matched subjects.
RESULTS According to univariate analysis, the prevalences of smoking, hypertension, metabolic syndrome, and family history of colorectal cancer were higher in the adenoma group than in the normal control group. In addition, body mass index, waist circumference, triglyceride, high-density lipoprotein cholesterol, and VAT and SAT areas were significantly different in the two groups. According to the multivariate analysis adjusted for multiple confounders, VAT area was independently associated with the risk of colorectal adenoma (odds ratio (OR)=3.09, 95% confidence interval (CI): 2.19-4.36, highest quintile vs. lowest quintile). Mean HOMA index was higher in the adenoma group than in the control group (OR=1.99, 95% CI: 1.35-2.92, highest vs. lowest quintile).
CONCLUSIONS Visceral obesity was found to be an independent risk factor of colorectal adenoma, and insulin resistance was associated with the presence of colorectal adenoma.
- 122010
제1저자 김혜정 · 교신저자 김덕겸
, , , , , , , ,
The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis.Int J Tuberc Lung Dis. 2010;14(1):79-85.
PubMed IF 3.6 호흡기내과Abstract
SETTING A metropolitan governmental medical centre, Seoul, Republic of Korea.
OBJECTIVE To elucidate the impact of the nutritional deficit assessed by the Nutritional Risk Score (NRS) on the outcomes of in-patients with pulmonary tuberculosis (PTB).
DESIGN All hospitalised patients with microbiologically confirmed PTB were enrolled. A four-point NRS included low body mass index (<18.5 kg/m(2)), hypoalbuminaemia (<30.0 g/l), hypocholesterolaemia (<2.33 mmol/l) and severe lymphocytopaenia (<7 x 10(5) cells/l). The primary outcome was overall in-hospital mortality. The degree of radiographical resolution after anti-tuberculosis treatment was also evaluated.
RESULTS In a total of 156 patients, the male to female ratio was 1.6:1. The overall mortality was 13.5% and tuberculosis-specific fatality was 3.9%. Predisposing factors and high NRS (> or = 3 points) were independent risk factors for in-hospital death after adjusting for the severity of PTB. High NRS (OR = 16.8, P < 0.001) and predisposing factors (OR = 5.4, P = 0.032) were independent risk factors for 30-day survival. The NRS was not associated with radiographic improvement.
CONCLUSION Regardless of disease severity, the high NRS was a significant negative predictor among in-patients with PTB; this finding should therefore be considered in the management of PTB despite the current era of effective anti-tuberculosis chemotherapy.
- 112010
제1저자 정고은 · 교신저자 윤정환
, , , , , , , , ,
High expression of microRNA-15b predicts a low risk of tumor recurrence following curative resection of hepatocellular carcinoma.Oncol Rep. 2010;23(1):113-9.
PubMed IF 4.7 소화기내과Abstract
MicroRNAs (miRNA) have recently been implicated in carcinogenesis and tumor progression. Hepatocellular carcinoma (HCC) is well known for frequent relapses following curative resection. We attempted to identify the miRNAs associated with HCC recurrence. We analyzed miRNA expression profiles in 25 pairs of HCC and adjacent non-tumor liver tissues from HCC patients using miRNA microarray. Out of 449 miRNAs assayed, we identified seven miRNAs associated with HCC recurrence. In particular, the highest ranked miR-15b was negatively correlated with recurrence. MiR-15b inhibitor transfection increased HCC cell proliferation and inhibited TRAIL-induced apoptosis, while miR-15b precursor transfection decreased proliferation and enhanced apoptosis. Bcl-w was identified as a target molecule regulated by miR-15b. These results indicate that miR-15b expression in HCC tissues may predict a low risk of HCC recurrence. In addition, the modulation of miR-15b expression may be useful as an apoptosis-sensitizing strategy for HCC treatment.
- 102010
제1저자 서정원 · 교신저자 최동주
, , , , , , , , , ,
HMG-CoA reductase inhibitor improves endothelial dysfunction in spontaneous hypertensive rats via down-regulation of caveolin-1 and activation of endothelial nitric oxide synthase.J Korean Med Sci. 2010;25(1):16-23.
PubMed IF 3.2 순환기내과Abstract
Hypertension is associated with endothelial dysfunction and increased cardiovascular risk. Caveolin-1 regulates nitric oxide (NO) signaling by modulating endothelial nitric oxide synthase (eNOS). The purpose of this study was to examine whether HMG-CoA reductase inhibitor improves impaired endothelial function of the aorta in spontaneous hypertensive rat (SHR) and to determine the underlying mechanisms involved. Eight-week-old male SHR were assigned to either a control group (CON, n=11) or a rosuvastatin group (ROS, n=12), rosuvastatin (10 mg/kg/day) administered for eight weeks. Abdominal aortic rings were prepared and responses to acetylcholine (10(-9)-10(-4) M) were determined in vitro. To evaluate the potential role of NO and caveolin-1, we examined the plasma activity of NOx, eNOS, phosphorylated-eNOS and expression of caveolin-1. The relaxation in response to acetylcholine was significantly enhanced in ROS compared to CON. Expression of eNOS RNA was unchanged, whereas NOx level and phosphorylated-eNOS at serine-1177 was increased accompanied with depressed level of caveolin-1 in ROS. We conclude that 3-Hydroxy-3-methylglutaryl Coenzyme-A (HMG-CoA) reductase inhibitor can improve impaired endothelial dysfunction in SHR, and its underlying mechanisms are associated with increased NO production. Furthermore, HMG-CoA reductase inhibitor can activate the eNOS by phosphorylation related to decreased caveolin-1 abundance. These results imply the therapeutic strategies for the high blood pressure-associated endothelial dysfunction through modifying caveolin status.
- 92010
제1저자 송영림 · 교신저자 나기영
, , , , , , , ,
Activation of hypoxia-inducible factor attenuates renal injury in rat remnant kidney.Nephrol Dial Transplant. 2010;25(1):77-85.
PubMed IF 8.3 신장내과Abstract
BACKGROUND Chronic hypoxia in the kidney has been suggested as a final common pathway to end-stage renal disease. Hypoxia-inducible factor (HIF) is a transcription factor that regulates cellular hypoxic responses, and it is a promising target with therapeutic potential in various kidney disease models. In this study, we investigated whether HIF activation could attenuate renal injury in the rat remnant kidney model.
METHODS Two weeks after a subtotal nephrectomy, rats received a continuous infusion of dimethyloxalylglycine (DMOG) for 4 weeks to activate HIF.
RESULTS The DMOG infusion halted the progression of proteinuria. A histological evaluation revealed that the glomerulosclerosis and tubulointerstitial injury were significantly decreased by DMOG treatment. DMOG increased renal HIF-1alpha protein. The expression of glucose transporter-1 (GLUT-1) and prolyl hydroxylase 3 (PHD3) and the immunostaining of vascular endothelial growth factor (VEGF) were increased by DMOG. DMOG-treated rats showed less podocyte injury manifested by decreased immunostaining of desmin and the restoration of podoplanin staining. Furthermore, plasma malondialdehyde (MDA), a marker of oxidative stress, showed a tendency to decrease, and the renal expression of catalase, an antioxidant, was significantly increased by DMOG. The DMOG treatment decreased macrophage infiltration and reduced fibrosis, as manifested by decreased type IV collagen and osteopontin expression.
CONCLUSIONS Activation of HIF by DMOG halted the progression of proteinuria and attenuated structural damage by preventing podocyte injury in the remnant kidney model. This renoprotection was accompanied by a reduction of oxidative stress, inflammation and fibrosis.
- 82010
제1저자 명선정 · 교신저자 박완범
, , , , , ,
The use of standardized patients to teach medical students clinical skills in ambulatory care settings.Med Teach. 2010;32(11):e467-70.
PubMed IF 4 감염내과Abstract
BACKGROUND Ambulatory medicine is being increasingly emphasized in undergraduate medical education. Because of the limited availability of real patients, we introduced a standardized patient (SP) encounter program in an ambulatory care setting.
AIMS This study was undertaken to assess the usefulness of SPs for teaching undergraduate students clinical skills in ambulatory settings.
METHOD Third-year medical students met two different SPs, who presented common authentic problems, during internal medicine clerkship. Each SP encounter of 30 min was followed by SP and a tutor's feedback, using a video recording of the SP encounter. We surveyed students for program evaluation purposes at the end of their three-year internal medicine clerkships (from 2006 to 2008).
RESULTS Most students found that the consecutive SP sessions were instructive and helpful. Video recordings of clinical encounters allowed students to reflect on their behavior and receive feedback from tutors. However, students identified several weaknesses of these SP encounters. For example, pre-exposure to the SP scenario reduced tension of the experience and inconsistent feedback from tutors caused confusion.
CONCLUSIONS SP encounters in an ambulatory care setting, followed by tutor's feedback based on a video recording, can be used for teaching basic clinical ambulatory care skills.
- 72010
제1저자 임재준 · 교신저자 Selvaraj P
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Sequential bilateral lung resection in a patient with Mycobacterium abscessus lung disease refractory to medical treatment.Yonsei Med J. 2010;51(1):141-4.
PubMed IF 3.1 호흡기내과Abstract
Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.
- 62010
제1저자 김나영 · 교신저자 김나영
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The discrepancy between genetic polymorphism of p53 codon 72 and the expression of p53 protein in Helicobacter pylori-associated gastric cancer in Korea.Dig Dis Sci. 2010;55(1):101-10.
PubMed IF 2.8 소화기내과Abstract
The p53 gene has been referred to as 'the guardian of the genome' because it controls apoptosis and cell cycle arrest. The purpose of this study was to evaluate the association of p53 codon 72 genetic polymorphism and the p53 immunohistochemistry with Helicobacter pylori-associated gastroduodenal diseases, including gastric cancer. This study included 1,852 subjects: controls and patients with gastric cancer, dysplasia, benign gastric ulcers, and duodenal ulcers (DU). Biallelic polymorphism was genotyped by restriction fragment length polymorphism. Immunohistochemical analysis for the detection of mutant type p53 expression was performed. The frequency of the Pro/Pro allele of the p53 codon 72 was higher in the patients with H. pylori-positive dysplasia than in controls (OR: 2.3, 95% CI: 1.3-4.3), but it was less frequent among patients with a H. pylori-positive DU (OR: 0.5, 95% CI: 0.3-0.8). However, there was no significant association with gastric cancer, including the location, stage, or histological type of gastric cancer. Expression of a mutant type of p53 protein was detected in 6.3% of dysplastic tissues and 26.5% of cancerous tissues compared 0% in the controls. Positive expression was higher in the intestinal type of cancer (34.9%) than in the diffuse type (15.0%; P = 0.001). These results suggest that genetic polymorphism of p53 codon 72 played a role in the determination of H. pylori-associated gastroduodenal diseases, but p53 immunostaining did not correlate with those of the p53 genetic polymorphism analysis.
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