SCI 발표논문

1. 922013

   제1저자 김성은 · 교신저자 김나영

   Kim SE, Park YS, Kim N, Kim MS, Jo HJ, Shin CM, Lee SH, Hwang JH, Kim JW, Jeong SH, Lee DH, Jung HC

   Effect of Helicobacter pylori Eradication on Functional Dyspepsia.

   J Neurogastroenterol Motil. 2013;19(2):233-43.

   Abstract

   BACKGROUND/AIMS This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses.

   METHODS A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated.

   RESULTS Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (≥ 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year.

   CONCLUSIONS H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.

   PubMed IF 3.7 소화기내과
2. 912013

   제1저자 조현주, 조현재 · 교신저자 김효수

   Cho HJ, Cho HJ, Lee HJ, Song MK, Seo JY, Bae YH, Kim JY, Lee HY, Lee W, Koo BK, Oh BH, Park YB, Kim HS

   Vascular calcifying progenitor cells possess bidirectional differentiation potentials.

   PLoS Biol. 2013;11(4):e1001534.

   Abstract

   Vascular calcification is an advanced feature of atherosclerosis for which no effective therapy is available. To investigate the modulation or reversal of calcification, we identified calcifying progenitor cells and investigated their calcifying/decalcifying potentials. Cells from the aortas of mice were sorted into four groups using Sca-1 and PDGFRα markers. Sca-1(+) (Sca-1(+)/PDGFRα(+) and Sca-1(+)/PDGFRα(-)) progenitor cells exhibited greater osteoblastic differentiation potentials than Sca-1(-) (Sca-1(-)/PDGFRα(+) and Sca-1(-)/PDGFRα(-)) progenitor cells. Among Sca-1(+) progenitor populations, Sca-1(+)/PDGFRα(-) cells possessed bidirectional differentiation potentials towards both osteoblastic and osteoclastic lineages, whereas Sca-1(+)/PDGFRα(+) cells differentiated into an osteoblastic lineage unidirectionally. When treated with a peroxisome proliferator activated receptor γ (PPARγ) agonist, Sca-1(+)/PDGFRα(-) cells preferentially differentiated into osteoclast-like cells. Sca-1(+) progenitor cells in the artery originated from the bone marrow (BM) and could be clonally expanded. Vessel-resident BM-derived Sca-1(+) calcifying progenitor cells displayed nonhematopoietic, mesenchymal characteristics. To evaluate the modulation of in vivo calcification, we established models of ectopic and atherosclerotic calcification. Computed tomography indicated that Sca-1(+) progenitor cells increased the volume and calcium scores of ectopic calcification. However, Sca-1(+)/PDGFRα(-) cells treated with a PPARγ agonist decreased bone formation 2-fold compared with untreated cells. Systemic infusion of Sca-1(+)/PDGFRα(-) cells into Apoe(-/-) mice increased the severity of calcified atherosclerotic plaques. However, Sca-1(+)/PDGFRα(-) cells in which PPARγ was activated displayed markedly decreased plaque severity. Immunofluorescent staining indicated that Sca-1(+)/PDGFRα(-) cells mainly expressed osteocalcin; however, activation of PPARγ triggered receptor activator for nuclear factor-κB (RANK) expression, indicating their bidirectional fate in vivo. These findings suggest that a subtype of BM-derived and vessel-resident progenitor cells offer a therapeutic target for the prevention of vascular calcification and that PPARγ activation may be an option to reverse calcification.

   PubMed IF 6.9 순환기내과
3. 902013

   제1저자 김미영 · 교신저자 김세훈

   Kim MY, Jo EJ, Kang SY, Chang YS, Yoon IY, Cho SH, Min KU, Kim SH

   Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma.

   Ann Allergy Asthma Immunol. 2013;110(4):253-7, 257.e1.

   Abstract

   BACKGROUND Recent data suggest that obstructive sleep apnea (OSA) is an important contributor to severe uncontrolled asthma.

   OBJECTIVE To investigate the clinical characteristics, asthma control, and asthma-related quality of life in adult patients with asthma at a high risk for OSA.

   METHODS A total of 217 patients with asthma who visited our tertiary-care clinic were randomly recruited. They completed the Berlin questionnaire, which screens for OSA risk, a quality-of-life questionnaire for adult Korean patients with asthma (QLQAKA), and underwent an asthma control test (ACT). Fraction of exhaled nitric oxide (FeNO), lung function, blood lipid profiles, and body composition were evaluated.

   RESULTS The mean age was 58.4 ± 15.4, and 91 (41.9%) were male. Eighty-nine subjects (41.0%) were classified as high risk for OSA from the Berlin questionnaire. Patients with a high OSA risk were significantly older, had a higher prevalence of hypertension, higher BMI, non-atopic predisposition, and longer asthma treatment duration in the baseline clinical characteristics. The high OSA risk group had a lower ACT score than the low OSA risk group, but it was not statistically significant (20.9 ± 3.6 vs 21.5 ± 3.3, P = .091). The QLQAKA score was significantly lower in the high OSA risk group compared with the low OSA risk group (64.4 ± 10.9 vs 68.1 ± 11.1, P = .026), especially in the activity-domain (P = .005). The FeNO was not significantly different between the 2 groups.

   CONCLUSION Quality of life is significantly decreased in adult patients with asthma with a high risk of OSA. Special consideration is needed for the care and treatment of patients with asthma who have a high risk of OSA.

   PubMed IF 7.1 알레르기내과
4. 892013

   제1저자 김세훈 · 교신저자 장윤석

   Kim SH, Jo EJ, Kim MY, Lee SE, Kim MH, Yang MS, Song WJ, Choi SI, Kim JH, Chang YS

   Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions.

   Ann Allergy Asthma Immunol. 2013;110(4):258-62.

   Abstract

   BACKGROUND Some radiocontrast media (RCM) hypersensitivity reactions may have underlying IgE- or T-cell-mediated mechanisms. RCM skin testing may be useful for predicting future reactions.

   OBJECTIVE To investigate the clinical value of RCM skin testing before computed tomography and after RCM hypersensitivity reactions.

   METHODS Patients who underwent RCM skin testing were a prospective sample of convenience at a single medical center and were tested just before their pending nonionic RCM-enhanced computed tomogram. In addition, skin test data of patients who were referred to the allergy clinic because of their previous RCM hypersensitivity reactions were reviewed retrospectively.

   RESULTS A total of 1048 patients enrolled in the study prospectively. Of these, 672 (64.1%) had never been exposed to RCM. Of the 376 previously exposed to RCM, 61 (16.2%) had a history of at least one mild RCM-associated reaction, 56 (91.8%) had immediate reactions, and 5 had no-immediate reactions. There was only 1 positive immediate hypersensitivity RCM skin test result (0.09%). There were 51 mild immediate reactions (4.9%), 1 moderate immediate reaction (0.09%), 8 mild nonimmediate reactions (0.76%), and 1 moderate nonimmediate reaction (0.09%). There was only 1 positive delayed hypersensitivity skin test result (0.09%), retrospectively determined, in 1 (11.1%) of the nonimmediate RCM-associated reactions. Sensitivity of RCM skin testing was significantly higher with severe immediate reactions (57.1%) than mild reactions (12.9%) and moderate reactions (25.0%) in the retrospective review of diagnostic skin test data (P = .03).

   CONCLUSION RCM skin testing for screening is of no clinical utility in predicting hypersensitivity reactions. RCM skin testing may have modest utility in retrospectively evaluating severe adverse reactions.

   PubMed IF 7.1 알레르기내과
5. 882013

   제1저자 박철기 · 교신저자 이세훈

   Park CK, Lee SH, Kim TM, Choi SH, Park SH, Heo DS, Kim IH, Jung HW

   The value of temozolomide in combination with radiotherapy during standard treatment for newly diagnosed glioblastoma.

   J Neurooncol. 2013;112(2):277-83.

   Abstract

   The current best standard care for glioblastoma still has limitations and unsatisfactory outcomes in patients with an unmethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter. Whether the effects of temozolomide are primarily due to its concomitant use with radiotherapy or are also mediated by their independent use in the adjuvant phase remain unclear. To validate the concomitant use of temozolomide in the standard protocol, we compared the overall survival of two prospective patient groups: one treated with radiotherapy alone followed by adjuvant temozolomide (RT → TMZ group) and the other treated with concomitant radiotherapy and temozolomide followed by adjuvant temozolomide (CCRT-TMZ group). Each patient in the RT → TMZ group (n = 25) was matched with two patients in the CCRT-TMZ group (n = 50) with respect to age, extent of resection, MGMT promoter methylation status, and postsurgical performance status to minimize the influence of confounding factors. In patients with MGMT promoter methylation, the CCRT-TMZ group showed superior overall survival (OS; median, 41.0 months) and progression-free survival (PFS; median, 24.0 months) compared with the RT → TMZ group. However, the OS and PFS did not differ between the CCRT-TMZ and the RT → TMZ groups in the patients without MGMT promoter methylation. Although this data is from a retrospective analysis using small number of patients, the study might indicate that concomitant use of temozolomide with radiotherapy is a crucial step in the standard treatment for glioblastoma patients with MGMT promoter methylation. And the use of temozolomide, either concurrently or by adjuvant after radiotherapy, remains a questionable value for those with an unmethylated MGMT promoter.

   PubMed IF 3.4 혈액종양내과
6. 872013

   제1저자 장은선 · 교신저자 윤정환

   Jang ES, Yoon JH, Chung JW, Cho EJ, Yu SJ, Lee JH, Kim YJ, Lee HS, Kim CY

   Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization.

   J Cancer Res Clin Oncol. 2013;139(4):635-43.

   Abstract

   PURPOSE Transarterial chemoembolization (TACE) is highly effective and safe therapeutic modality for unresectable hepatocellular carcinoma (HCC). However, the role of TACE for infiltrative HCC has never been elucidated owing to the concern about hepatic failure and subsequent mortality after the procedure. In this study, we aimed to document whether patients with infiltrative HCC would benefit from TACE.

   METHODS Child-Pugh class A/B patients who were newly diagnosed as infiltrative HCC and treated with curative-intent TACE were enrolled. All radiological images were reviewed by a radiologist with more than 20 years of experience in TACE.

   RESULTS Among 1,184 patients newly diagnosed as HCC, 233 (19.7 %) had infiltrative-type tumors and 128 (54.9 %) underwent curative-intent TACE. Although the median overall survival was 5.4 months (IQR 3.1-13.9 months) and 16 (12.5 %) patients had experienced significant complications, 19 (15.9 %) patients survived more than 2 years after the first diagnosis. In multivariable analysis, age >60 years old (HR 0.54, 95 % CI 0.31-0.92), Child-Pugh class A (HR 0.48, 95 % CI 0.30-0.76), and a major PVT without parasitic supply (HR 0.66, 95 % CI 0.44-0.99) were independent favorable prognostic factors. Development of significant complication after TACE was a significant hazard factor of survival (HR 1.99, 95 % CI 1.09-3.62).

   CONCLUSIONS In carefully selected patients with preserved hepatic function and good performance, TACE may achieve long-term survival of infiltrative HCC patients with major PVT without parasitic supply. However, the risk of morbidity and immediate mortality after TACE should be considered to select subjects for the procedure.

   PubMed IF 3.3 소화기내과
7. 862013

   제1저자 김민수 · 교신저자 김나영

   Kim MS, Kim N, Kim SE, Jo HJ, Shin CM, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Lee DH, Kim JM, Jung HC

   Long-term follow-up Helicobacter pylori reinfection rate and its associated factors in Korea.

   Helicobacter. 2013;18(2):135-42.

   Abstract

   BACKGROUND The reinfection rate of Helicobacter pylori has been reported to be low in developed countries but high in developing countries. The aim of this study is to evaluate the long-term reinfection rate of H. pylori and to investigate its associated risk factors in South Korea.

   METHODS During 2003-2010, H. pylori-positive 970 patients received standard proton pump inhibitor (PPI)-based triple eradication therapy, and follow-up H. pylori tests were performed with (13) C urea breath test or invasive tests (Giemsa histology, CLO test, and culture) 4 weeks after completion of treatment. A total of 331 patients who were maintained an H. pylori-eradicated state at 1 year after eradication were divided into two groups according to reinfection. For the evaluation of risk factors of reinfection, gender, age, smoking, alcohol, income, education, gastrointestinal symptoms, clinical diagnosis, histologic atrophic gastritis or intestinal metaplasia, and clarithromycin resistance were analyzed.

   RESULTS The follow-up period was 18-95 months (mean: 37.1 months), and H. pylori reappeared in 36 of 331 patients (10.9%), resulting in the annual reinfection rate of 3.51% per year. Multivariate analysis showed that male gender (HR 2.28; 95% CI, 1.05-5.00, p = .037) and low monthly family income (≤5000$ vs >5000$) (HR 3.54; 95% CI, 1.08-11.67, p = .038) were associated with H. pylori reinfection.

   CONCLUSION This long-term reinfection rate of H. pylori stayed rather low (3.51% per year), and male and low income determined the reinfection, factors already known to be important for H. pylori infection.

   PubMed IF 4.6 소화기내과
8. 852013

   제1저자 고영일 · 교신저자 이세훈

   Koh Y, Lim HY, Ahn JH, Lee JL, Rha SY, Kim YJ, Kim TM, Lee SH

   Phase II trial of everolimus for the treatment of nonclear-cell renal cell carcinoma.

   Ann Oncol. 2013;24(4):1026-31.

   Abstract

   BACKGROUND We investigated the efficacy of everolimus against nonclear-cell renal cell carcinoma (nccRCC). Patients and methods Patients with nccRCC received 10-mg everolimus once daily until disease progression or unacceptable toxicity.

   PATIENTS who had received a VEGF- tyrosine kinase inhibitor (TKI) previously were included.

   RESULTS A total of 49 patients were enrolled. Twenty-three patients (46.9%) received prior anti-VEGF agents. A partial response was observed in five patients (10.2%) and stable disease in 25 patients (51.0%). The disease progressed in 16 patients (32.7%) despite the administration of everolimus. Two of the five patients who showed an objective response to everolimus had chromophobe carcinoma, whereas two had papillary carcinoma and one had unclassifiable carcinoma. Thirty-six patients experienced disease progression during follow-up, and the median progression-free survival (PFS) was 5.2 months. Chromophobe RCC patients seemed to have longer PFS than nccRCC patients with the other histological subtypes (P = 0.084). Previous VEGF-TKI treatment did not influence the efficacy of everolimus, and the toxicity profiles were in line with previous reports.

   CONCLUSION Everolimus shows certain efficacy against nccRCC, particularly in patients with chromophobe RCC, and prior treatment with a VEGF-TKI appears not influencing the outcome of everolimus therapy in nccRCC patients. ClinicalTrials.gov number NCT00830895.

   PubMed IF 80.4 혈액종양내과
9. 842013

   제1저자 장성아 · 교신저자 김형관

   Chang SA, Kim HK, Lee SC, Kim EY, Hahm SH, Kwon OM, Park SW, Choe YH, Oh JK

   Assessment of left ventricular mass in hypertrophic cardiomyopathy by real-time three-dimensional echocardiography using single-beat capture image.

   J Am Soc Echocardiogr. 2013;26(4):436-42.

   Abstract

   BACKGROUND Left ventricular (LV) mass is an important prognostic indicator in hypertrophic cardiomyopathy. Although LV mass can be easily calculated using conventional echocardiography, it is based on geometric assumptions and has inherent limitations in asymmetric left ventricles. Real-time three-dimensional echocardiographic (RT3DE) imaging with single-beat capture provides an opportunity for the accurate estimation of LV mass. The aim of this study was to validate this new technique for LV mass measurement in patients with hypertrophic cardiomyopathy.

   METHODS Sixty-nine patients with adequate two-dimensional (2D) and three-dimensional echocardiographic image quality underwent cardiac magnetic resonance (CMR) imaging and echocardiography on the same day. Real-time three-dimensional echocardiographic images were acquired using an Acuson SC2000 system, and CMR-determined LV mass was considered the reference standard. Left ventricular mass was derived using the formula of the American Society of Echocardiography (M-mode mass), the 2D-based truncated ellipsoid method (2D mass), and the RT3DE technique (RT3DE mass).

   RESULTS The mean time for RT3DE analysis was 5.85 ± 1.81 min. Intraclass correlation analysis showed a close relationship between RT3DE and CMR LV mass (r = 0.86, P < .0001). However, LV mass by the M-mode or 2D technique showed a smaller intraclass correlation coefficient compared with CMR-determined mass (r = 0.48, P = .01, and r = 0.71, P < .001, respectively). Bland-Altman analysis showed reasonable limits of agreement between LV mass by RT3DE imaging and by CMR, with a smaller positive bias (19.5 g [9.1%]) compared with that by the M-mode and 2D methods (-35.1 g [-20.2%] and 30.6 g [17.6%], respectively).

   CONCLUSIONS RT3DE measurement of LV mass using the single-beat capture technique is practical and more accurate than 2D or M-mode LV mass in patients with hypertrophic cardiomyopathy.

   PubMed IF 8.3 순환기내과
10. 832013

    제1저자 박영식 · 교신저자 박영식

    Park YS, Lee J, Pang JC, Chung DH, Lee SM, Yim JJ, Yang SC, Yoo CG, Kim YW, Han SK

    Clinical implication of microscopic anthracotic pigment in mediastinal staging of non-small cell lung cancer by endobronchial ultrasound-guided transbronchial needle aspiration.

    J Korean Med Sci. 2013;28(4):550-4.

    Abstract

    Microscopic anthracotic pigment (MAP) is frequently observed in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen in non-small cell lung cancer, but its clinical interpretation is not well-known. The aim of this study was to evaluate the clinical implication of MAP in mediastinal staging of non-small cell lung cancer. From May 2010 to July 2011, consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited. Of the total 133 patients, 102 (76.7%) were male patients. Median age was 68 yr. Total 279 mediastinal lymph nodes were sampled by EBUS-TBNA; station 4R (100, 35.8%) and station 7 (86, 30.8%) were the most common sites. Malignant lymph nodes were 100 (35.8%). MAP was observed in 61 (21.7%) lymph nodes, and among them only 3 were malignant lymph nodes (P < 0.001). The lymph nodes with MAP were smaller (9.0 vs 10.8 mm, P = 0.001) and showed low standard uptake values on FDG-PET (4.4 vs 4.7, P = 0.256). In multivariate analysis, MAP was negatively associated with malignant lymph node (adjusted OR, 0.12; 95% CI, 0.03-0.42; P < 0.001). In potentially operable non-small cell lung cancer patients, MAP in endobronchial ultrasound-guided transbronchial needle aspiration specimens is strongly associated with benign mediastinal and hilar lymph nodes.

    PubMed IF 3.2 호흡기내과
11. 822013

    제1저자 백우현 · 교신저자 황진혁

    Paik WH, Kim HR, Park JK, Song BJ, Lee SH, Hwang JH

    Chemosensitivity induced by down-regulation of microRNA-21 in gemcitabine-resistant pancreatic cancer cells by indole-3-carbinol.

    Anticancer Res. 2013;33(4):1473-81.

    Abstract

    BACKGROUND/AIM Overexpression of microRNA-21 (miR-21) indicates chemoresistance in pancreatic cancer. We evaluated the change of chemosensitivity to gemcitabine through the down-regulation of miR-21 in human pancreatic cancer cells (Panc-1).

    MATERIALS AND METHODS The efficacy of indole-3-carbinol (I3C) in suppressing miR-21 expression and its anticancer effect in combination with gemcitabine were investigated.

    RESULTS Down-regulation of miR-21 by I3C was positively-correlated in a time- and dose-dependent manner. I3C and gemcitabine combination therapy increased cytotoxicity in Panc-1 cells. Transfection of miR-21 mimic abrogated I3C-induced sensitivity to gemcitabine. DNA fragmentation and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assays showed that pre-treatment with I3C enhanced apoptosis and this effect was attenuated by miR-21 transfection. The expression of programmed cell death-4 (PDCD4) was increased by I3C and reduced by miR-21 transfection.

    CONCLUSION I3C would be effective for enhancing sensitivity of pancreatic cancer cells to gemcitabine via down-regulation of miR-21. Such enhanced chemosensitivity might be explained by the increased expression of PDCD4, which is a downstream target which miR-21 negatively regulates.

    PubMed IF 1.8 소화기내과
12. 812013

    제1저자 김도영 · 교신저자 정숙향

    Kim DY, Kim IH, Jeong SH, Cho YK, Lee JH, Jin YJ, Lee D, Suh DJ, Han KH, Park NH, Kang HY, Jung YK, Kim YS, Kim KA, Lee YJ, Lee BS, Yim HJ, Lee HJ, Baik SK, Tak WY, Lee SJ, Chung WJ, Choi SK, Cho EY, Heo J, Kim DJ, Song BC, Kim MW, Lee J, Chae HB, Choi DH, Choi HY, Ki M

    A nationwide seroepidemiology of hepatitis C virus infection in South Korea.

    Liver Int. 2013;33(4):586-94.

    Abstract

    BACKGROUND & AIMS The aim of this study was to reveal nationwide seroprevalence of HCV infection in South Korea by a large-scale survey.

    METHODS From January to December 2009, a total of 291 314 adults underwent health check-up in 29 centres nationwide. The data concerning anti-HCV antibody and biochemical tests were obtained from all participants. Among subjects with positive anti-HCV, such data as HCV RNA, genotypes and treatment detail were additionally analysed.

    RESULTS Using an estimated 2009 population of Korea, the age, sex and area-adjusted anti-HCV positive rate was 0.78%. Anti-HCV prevalence in female patients (0.83%) was higher than that in male patients (0.75%). Gradual increase in anti-HCV positivity was observed, from 0.34% in those aged 20-29 years to 2.31% in those >70 years. The age- and sex-adjusted anti-HCV prevalence varied in different areas, being higher in Busan and Jeonnam (1.53-2.07%), mid-level in Seoul and surrounding districts (0.50-0.61%) and lower in Jeju (0.23%). The comparative analysis of laboratory variables between anti-HCV (+) and anti-HCV (-) group revealed significantly higher levels of alanine aminotransferase and lower levels of serum lipids in anti-HCV (+) group. Among 1 718 anti-HCV positive subjects, serum HCV RNA was measured only in 478 people, of whom 268 (56.1%) patients had detectable HCV RNA in serum. Among 50 patients for whom assessment of response to antiviral therapy was feasible, overall sustained virological response was achieved in 84% of patients.

    CONCLUSION The prevalence of HCV infection is low in South Korea. Studies to analyse risk factors are warranted to reduce HCV infection.

    PubMed IF 6.2 소화기내과
13. 802013

    제1저자 신기철 · 교신저자 이은봉

    Shin K, Kim JW, Moon KW, Yang JA, Lee EY, Song YW, Lee EB

    The efficacy of diacerein in hand osteoarthritis: a double-blind, randomized, placebo-controlled study.

    Clin Ther. 2013;35(4):431-9.

    Abstract

    BACKGROUND Diacerein is a drug used in osteoarthritis (OA) that elicits an inhibitory effect on interleukin-1 and metalloproteases. Although diacerein has shown modest efficacy and safety in the treatment of knee and hip OA, there have been no placebo-controlled clinical trials for hand OA.

    OBJECTIVE The aim of the current study was to investigate the efficacy and tolerability of diacerein in patients with hand OA.

    METHODS Patients fulfilling the American College of Rheumatology criteria for hand OA participated in this randomized, double-blind, placebo-controlled study. Eligible patients were >40 years of age, had at least 1 tender joint, and had a joint pain visual analog scale of >30 mm. Patients received diacerein (50 mg) or placebo BID for 12 weeks. The primary end point was the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain score at 4 weeks. Secondary end points were AUSCAN pain score at 12 weeks and AUSCAN physical function and stiffness score, patient and physician global assessment, functional index of hand OA scores, and multidimensional health assessment questionnaire results at 4 weeks and 12 weeks.

    RESULTS Eighty-six Korean patients were enrolled (42 diacerein, 44 placebo). The intention-to-treat and per-protocol analyses revealed no significant differences between the 2 groups in terms of change in AUSCAN pain score at 4 weeks, except for improvement in physician global assessment at 4 weeks (per-protocol analysis, P = 0.004). The safety profile of diacerein was comparable to placebo, except for frequent discoloration of the urine (88% vs 20%).

    CONCLUSION These results suggest that diacerein 50 mg BID may be ineffective in controlling the symptoms of hand OA. ClinicalTrials.gov identifier: NCT00685542.

    PubMed IF 3.7 류마티스내과
14. 792013

    제1저자 안효석 · 교신저자 김형관

    Ahn HS, Kim HK, Park EA, Lee W, Kim YJ, Cho GY, Park JH, Sohn DW

    Coronary flow reserve impairment in apical vs asymmetrical septal hypertrophic cardiomyopathy.

    Clin Cardiol. 2013;36(4):207-16.

    Abstract

    BACKGROUND Mechanisms underlying a reduction in coronary flow reserve (CFR) in hypertrophic cardiomyopathy (HCM), especially apical HCM (ApHCM), are elusive. This study set out to evaluate mechanisms underlying a reduction in CFR in 2 HCM subtypes.

    HYPOTHESIS Mechanisms for CFR reduction in HCM are different between the 2 subtypes of HCM.

    METHODS Thirty-one patients with asymmetrical septal hypertrophy (ASH), 43 with ApHCM, and 27 healthy volunteers were recruited. Mean diastolic coronary flow velocity (CFmv) was monitored before and after adenosine infusion by transthoracic echocardiography in the mid-to-distal left anterior descending coronary artery. Coronary flow reserve was defined as the ratio between CFmv before and after adenosine infusion. Left ventricular mass index and stress myocardial perfusion were assessed by cardiac magnetic resonance imaging.

    RESULTS Although basal CFmv was higher in ASH patients than in healthy controls (P<0.05), it was similar in ApHCM patients and controls (P=0.85). Poststress CFmv was significantly lower in both HCM subtypes than in controls (P<0.05). Consequently, CFR was higher in controls than in ASH or ApHCM patients (P<0.05). When HCM patients were stratified into 2 groups based on the presence of CFR impairment, no difference was observed between these 2 groups in terms of left ventricular mass index by cardiac magnetic resonance imaging. Multivariate logistic regression analysis identified basal CFmv as the only independent variable associated with CFR reduction in HCM (r2=0.49, P<0.001).

    CONCLUSIONS Whereas the inability to augment coronary flow to its maximal level during stress was found to underlie CFR impairment in both HCM subtypes, the recruitment of vasodilatory capacity at baseline was more prominent in ASH than in ApHCM patients.

    PubMed IF 2.8 순환기내과
15. 782013

    제1저자 김낙현 · 교신저자 박완범

    Kim NH, Hwang JH, Song KH, Choe PG, Kim ES, Park SW, Kim HB, Kim NJ, Park WB, Oh MD

    Tigecycline in carbapenem-resistant Acinetobacter baumannii bacteraemia: susceptibility and clinical outcome.

    Scand J Infect Dis. 2013;45(4):315-9.

    Abstract

    Although tigecycline is considered one of the few therapeutic options for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteraemia, its role in the treatment of CRAB bacteraemia remains unclear. We describe the clinical outcomes of 9 patients who received tigecycline for CRAB bacteraemia. Although all CRAB blood isolates were susceptible to tigecycline, 5 (56%) deaths were related to CRAB bacteraemia and 1 case of breakthrough CRAB bacteraemia was observed during tigecycline therapy. Clinical outcomes of tigecycline therapy may be poor in patients with tigecycline-susceptible CRAB bacteraemia, although multiple factors including delayed treatment could contribute to the poor outcomes.

    PubMed IF 1.722 감염내과
16. 772013

    제1저자 김동희 · 교신저자 김웅

    Kim D, Kim WR, Kim HJ, Therneau TM

    Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.

    Hepatology. 2013;57(4):1357-65.

    Abstract

    UNLABELLED The clinical and public health significance of nonalcoholic fatty liver disease (NAFLD) is not well established. We investigated the long-term effect of NAFLD on mortality. This analysis utilized the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 score. Of 11,154 participants, 34.0% had NAFLD--the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS <-1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS >0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (for NFS: HR, 1.69, 95% CI: 1.09-2.63; for APRI: HR, 1.85, 95% CI: 1.02-3.37; for FIB-4: HR, 1.66, 95% CI: 0.98-2.82) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (for NFS: HR, 3.46, 95% CI: 1.91-6.25; for APRI: HR, 2.53, 95% CI: 1.33-4.83; for FIB-4: HR, 2.68, 95% CI: 1.44-4.99).

    CONCLUSIONS Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.

    PubMed IF 18 소화기내과
17. 762013

    제1저자 이반석/황진혁 · 교신저자 이상협

    Lee BS, Hwang JH, Lee SH, Jang SE, Jang ES, Jo HJ, Shin CM, Park YS, Kim JW, Jung SH, Kim N, Lee DH, Lee JK, Ahn S

    Risk factors of organ failure in patients with bacteremic cholangitis.

    Dig Dis Sci. 2013;58(4):1091-9.

    Abstract

    BACKGROUND Bacteremic cholangitis carries a high mortality rate of up to 10 % in relation to organ failure (OF), including septic shock.

    AIM The purpose of this study was to elucidate predictive factors for OF in bacteremic cholangitis.

    METHODS A retrospective review of all patients diagnosed with acute cholangitis and proven bacteremia from 2003 to 2011 was performed. Comprehensive clinical and laboratory data of 211 patients were analyzed.

    RESULTS There were 42 cases (19.9 %) of OF and 5 deaths (2.4 %). In the multivariate logistic regression analysis, significant predictive factors for OF were successful biliary decompression, presence of extended-spectrum beta-lactamase organism (ESBL), higher total bilirubin, and higher blood urea nitrogen (BUN) level at admission with odds ratios (ORs) of 0.129, 6.793, 1.148, and 1.089, respectively. Subgroup analysis of 165 patients who underwent biliary decompression before an event (with OF: 20, without OF: 145) was performed to elucidate the risk factors for organ failure even after successful biliary drainage. Variables significantly associated with OF included ESBL and BUN (OR = 4.123 and 1.177, respectively). We developed a scoring system with regression coefficient of each significant variable. The organ failure score was calculated using the following equation: (1.4 × ESBL) + (0.2 × BUN). This scoring system for predicting OF was highly sensitive (85.0 %) and specific (83.4 %).

    CONCLUSIONS Biliary decompression, ESBL, total bilirubin, and BUN are prognostic determinants in patients with bacteremic cholangitis. An organ failure scoring system may allow clinicians to identify groups with poor prognosis even after successful biliary decompression.

    PubMed IF 2.8 소화기내과
18. 752013

    제1저자 이경훈 · 교신저자 김태유

    Lee KH, Chang HJ, Han SW, Oh DY, Im SA, Bang YJ, Kim SY, Lee KW, Kim JH, Hong YS, Kim TW, Park YS, Kang WK, Shin SJ, Ahn JB, Kang GH, Jeong SY, Park KJ, Park JG, Kim TY

    Pharmacogenetic analysis of adjuvant FOLFOX for Korean patients with colon cancer.

    Cancer Chemother Pharmacol. 2013;71(4):843-51.

    Abstract

    PURPOSE Ethnic diversity of genetic polymorphism can result in individual differences in the efficacy and toxicity of cancer chemotherapy.

    METHODS We analyzed 20 germline polymorphisms in 10 genes (TS, MTHFR, ERCC1, XPD, XRCC1, ABCC2, AGXT, GSTP1, GSTT1 and GSTM1) from prospectively enrolled 292 Korean patients treated with adjuvant oxaliplatin plus leucovorin plus 5-fluorouracil (FOLFOX) for colon cancer.

    RESULTS In contrast to previous studies in Caucasians, neutropenia (grade 3-4, 60.5 %) was frequently observed, whereas only 16.4 % experienced grade 2 or more sensory neuropathy. Neutropenia was more frequent in MTHFR 677TT [adjusted odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.19-4.55] and ERCC1 19007TT (adjusted OR 4.58, 95 % CI 1.20-17.40) genotypes. Patients harboring XRCC1 23885GG experienced less grade 2-4 neuropathy [adjusted OR 0.52, 95 % CI 0.27-0.99]. MTHFR 677TT (p = 0.002) and XRCC1 23885GG (p = 0.146) genotypes were also more prevalent in Koreans compared to Caucasians. TS 'low' genotype (adjusted HR 1.83, 95 % CI 1.003-3.34) was significantly related to shorter disease-free survival. Overall survival was not significantly different according to the polymorphisms.

    CONCLUSIONS Polymorphisms in MTHFR, XRCC1 and TS are related to toxicities and disease-free survival in patients with colon cancer. The ethnic differences in frequencies of genotypes may explain the ethnic difference in toxicity profile following adjuvant FOLFOX chemotherapy.

    PubMed IF 2.5 혈액종양내과
19. 742013

    제1저자 김정희 · 교신저자 신찬수

    Kim JH, Choi SH, Lim S, Lim JY, Kim KW, Park KS, Shin CS, Jang HC

    Thigh muscle attenuation measured by computed tomography was associated with the risk of low bone density in community-dwelling elderly population.

    Clin Endocrinol (Oxf). 2013;78(4):512-7.

    Abstract

    OBJECTIVES Although muscle mass has been shown to be positively related with bone mineral density (BMD), there are only a few studies that investigated the association between muscle strength or muscle quality and BMD. We investigated the effects of muscle strength and muscle fat infiltration, as a measure of muscle quality, adjusted for muscle mass on femoral neck BMD in Korean elderly cohort.

    METHODS We recruited 242 men and 231 women aged over 65 years who participated in the Korean Longitudinal Study on Health and Ageing. Leg muscle mass and femoral neck BMD were measured by dual-energy X-ray absorptiometry. Isokinetic strength of knee extensors was measured as a peak torque value by an isokinetic device. Computed tomography scan of the mid-thigh measured the mean Hounsfield unit (HU) of the lean tissue. Low bone density was defined as femoral neck T-score ≤-2·0.

    RESULTS Leg muscle mass, knee extensor strength and thigh muscle HU values were significantly positively correlated with femoral neck BMD in both men and women. However, muscle strength was not a significant determinant for the presence of low bone mass after adjusting for muscle mass in multiple logistic regression analyses. Notably, thigh muscle HU values were strong and independent determinant for the risk of low bone density.

    CONCLUSION Decreased thigh muscle HU values, a measure of fatty infiltration of muscle, were independently associated with increased risk of low bone density in the elderly population.

    PubMed IF 2.8 내분비대사내과
20. 732013

    제1저자 김소연/김태민 · 교신저자 김동완

    Kim S, Kim TM, Kim DW, Go H, Keam B, Lee SH, Ku JL, Chung DH, Heo DS

    Heterogeneity of genetic changes associated with acquired crizotinib resistance in ALK-rearranged lung cancer.

    J Thorac Oncol. 2013;8(4):415-22.

    Abstract

    BACKGROUND Anaplastic lymphoma kinase (ALK)-rearranged non-small-cell lung cancer (NSCLC) is markedly sensitive to the ALK inhibitor crizotinib. However, acquired resistance to crizotinib is inevitable through several mechanisms. Therefore, this study was conducted to identify genetic alterations associated with crizotinib resistance.

    METHODS Tumor samples were derived from seven ALK-positive NSCLC patients who showed acquired resistance to crizotinib, and these patients were analyzed for ALK, EGFR, and KRAS mutations and ALK and EGFR gene amplifications. In vitro cytotoxicity of crizotinib and ALK downstream signals were compared between crizotinib-naive and -resistant NSCLC cells.

    RESULTS After a median duration of 6 months (range, 4-12 months), seven ALK-positive NSCLC patients developed acquired resistance to crizotinib. Three patients harbored secondary ALK mutations, including one patient with both mutations: L1196M (n = 2) and G1269A (n = 2). Of note, one patient displayed ALK gene copy number gain (4.1-fold increase compared with the pre-crizotinib specimen) and EGFR L858R mutation with high polysomy. The amphiregulin concentration was high in the supernatant fluid from five patients with malignant pleural effusion (116.4-18934.0 pg/ml). SNU-2535 cells derived from a patient who harbored the G1269 mutation were resistant to crizotinib treatment similar to H3122 CR1 cells. L1196M and G1269A mutant clones were less sensitive to crizotinib and ALK downstream signals were ineffectively suppressed in these clones.

    CONCLUSIONS Genetic changes associated with crizotinib resistance are heterogeneous in ALK-rearranged NSCLC patients who respond to crizotinib and subsequently develop resistance.

    PubMed IF 23.3 혈액종양내과
21. 722013

    제1저자 이준구 · 교신저자 임석아

    Lee JK, Im SA, Lee D, Kim JY, Lim Y, Lee E, Moon HG, Kim TY, Han SW, Oh DY, Lee SH, Han W, Kim DW, Kim TY, Noh DY

    Efficacy of exemestane in korean patients with metastatic breast cancer after failure of nonsteroidal aromatase inhibitors.

    J Breast Cancer. 2013;16(1):66-71.

    Abstract

    PURPOSE Exemestane has shown good efficacy and tolerability in postmenopausal women with hormone receptor-positive metastatic breast cancer. However, clinical outcomes in Korean patients have not yet been reported.

    METHODS Data on 112 postmenopausal women with metastatic breast cancer were obtained retrospectively. Clinicopathological characteristics and treatment history were extracted from medical records. All patients received 25 mg exemestane daily until objective disease progression. Progression-free survival (PFS) was the primary endpoint, and secondary endpoints were overall survival (OS), objective response rate (ORR), and clinical benefit rate (CBR=complete response+partial response+stable disease for 6 months).

    RESULTS The median age of the subjects was 55 years (range, 28-76 years). Exemestane treatment resulted in a median PFS of 5.7 months (95% confidence interval [CI], 4.4-7.0 months) and median OS of 21.9 months (95% CI, 13.6-30.3 months). ORR was 6.4% and CBR was 46.4% for the 110 patients with evaluable lesions. Symptomatic visceral disease was independently associated with shorter PFS (hazard ratio, 3.611; 95% CI, 1.904-6.848; p<0.001), compared with bone-dominant disease in a multivariate analysis of PFS after adjusting for age, hormone receptor, human epidermal growth factor receptor 2, Ki-67 status, dominant metastasis site, and sensitivity to nonsteroidal aromatase inhibitor (AI) treatment. Sensitivity to previous nonsteroidal AI treatment was not associated with PFS, suggesting no cross-resistance between exemestane and nonsteroidal AIs.

    CONCLUSION Exemestane was effective in postmenopausal Korean women with hormone receptor-positive metastatic breast cancer who failed previous nonsteroidal AI treatment.

    PubMed IF 3.6 혈액종양내과
22. 712013

    제1저자 박준빈 · 교신저자 최수연

    Park JB, Park HE, Choi SY, Kim MK, Oh BH

    Relation between cardio-ankle vascular index and coronary artery calcification or stenosis in asymptomatic subjects.

    J Atheroscler Thromb. 2013;20(6):557-67.

    Abstract

    AIM The cardio-ankle vascular index (CAVI) is an index of arterial stiffness. We investigated the association of CAVI with the severity of coronary artery calcification (CAC) and coronary stenosis by coronary computed tomography angiography (CTA) in an asymptomatic population.

    METHODS A total of 549 asymptomatic Korean individuals who underwent CAVI and CTA were analyzed retrospectively. CAC and coronary stenosis were measured by CTA and assessed for the correlation with CAVI.

    RESULTS The degree of CAC and coronary stenosis demonstrated a significant correlation with CAVI (r= 0.187, p<0.001 and r= 0.212, p<0.001 for the CAC score and stenosis, respectively). After adjustment for potential confounders, including age, gender, hypertension, diabetes mellitus, and dyslipidemia, a predefined cutoff value of CAVI ≥8 was associated with advanced CAC (CAC ≥300) and significant coronary stenosis (stenosis ≥50%). Specifically, the adjusted odds ratio (95% confidence interval) of CAC ≥300 and coronary stenosis ≥50% was 3.57 (1.92-6.66) and 2.81 (1.13-7.00), respectively. Additional inclusion of CAVI improved the predictive power of the receiver operating characteristic curves for predicting coronary atherosclerosis based on traditional risk factors; the area under the curve for predicting CAC ≥300 and coronary stenosis ≥50% increased from 0.739 to 0.791 (p for difference= 0.023), and from 0.761 to 0.842 (p= 0.032), respectively.

    CONCLUSIONS CAVI reflects coronary atherosclerosis and may be used as a screening tool for assessing subclinical atherosclerotic burden in an asymptomatic population.

    PubMed IF 3.4 순환기내과
23. 702013

    제1저자 김민혜 · 교신저자 강혜련

    Kim MH, Jung JW, Kang HR

    The usefulness of job relocation and serum eosinophil cationic protein in baker's asthma.

    Int Arch Allergy Immunol. 2013;161(3):252-7.

    Abstract

    BACKGROUND Although the most widely recommended treatment for occupational asthma is to completely avoid the causative agents, job relocation within the same company is often substituted for a complete career change. However, there is not much data on the efficacy of job relocation within the workplace and appropriate follow-up parameters. We investigated baker's asthma patients to validate the efficacy of job relocation and follow-up markers.

    METHODS Twelve bakery plant workers diagnosed with baker's asthma were enrolled in the study. Asthma-related symptoms and methacholine provocation test were followed up 6 months after a job relocation. Skin prick test and ELISA to detect wheat flour-specific IgE and eosinophil cationic protein (ECP) in sputum and serum were also followed up to evaluate the status of allergic inflammation.

    RESULTS After a 6-month job relocation, all 12 workers showed an improvement in symptoms, and airway hyperresponsiveness to methacholine was negatively converted in 9 of them. There were no significant differences in skin reactivity and serum flour-specific IgE levels before and after the relocation. While sputum ECP levels did not show a significant difference (338.3 ± 93.0 μg/l vs. 175.0 ± 78.9 μg/l, p = 0.118), there was a remarkable difference in serum ECP levels before and after the relocation (12.2 ± 3.0 μg/l vs. 2.8 ± 3.1 μg/l, p = 0.004).

    CONCLUSIONS Job relocation was effective in managing baker's asthma. Serum ECP level was a useful follow-up marker of baker's asthma.

    PubMed IF 2.3 알레르기내과
24. 692013

    제1저자 김태민/팽진철 · 교신저자 허대석

    Kim TM, Paeng JC, Chun IK, Keam B, Jeon YK, Lee SH, Kim DW, Lee DS, Kim CW, Chung JK, Kim IH, Heo DS

    Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma.

    Cancer. 2013;119(6):1195-202.

    Abstract

    BACKGROUND This study was undertaken to evaluate the prognostic value of quantitative metabolic parameters in [(18) F]2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) for diffuse large B cell lymphoma (DLBCL).

    METHODS A total of 140 DLBCL patients underwent FDG-PET scans before rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy. The maximal standardized uptake value (SUVmax ) and total lesion glycolysis (TLG) were calculated, with the margin thresholds as 25%, 50%, and 75% of SUVmax of all lesions. Treatment outcomes were compared between groups according to metabolic parameters and the International Prognostic Index (IPI).

    RESULTS After a median follow-up of 28.5 months (range, 5-81 months), the 2-year progression-free survival (PFS) and overall survival (OS) were 83% and 87%, respectively. Among metabolic parameters, TLG at the threshold of 50% (TLG50 ) was significantly associated with treatment outcomes. High TLG50 values (>415.5) were associated with reduced survivals compared with low TLG50 values (≤415.5) (2-year PFS of 73% versus 92%, P = .007; and 2-year OS of 81% versus 93%, P = .031). High IPI score (≥3) significantly reduced OS (2-year OS of 79% versus 90%, P = .049). Ann Arbor stage III/IV adversely affected PFS (P = .013). However, high IPI score and Ann Arbor stage of III/V did not significantly shorten PFS (P = .200) and OS (P = .921), respectively. High TLG50 values independently predicted survivals by multivariate analysis (hazard ratio = 4.4; 95% confidence interval = 1.5-13.1; P = .008 for PFS and hazard ratio = 3.1; 95% confidence interval = 1.0-9.6; P = .049 for OS).

    CONCLUSIONS Combined assessment of volume and metabolism (ie, TLG) is predictive of survivals in DLBCL patients who are treated with R-CHOP. Cancer 2013. © 2012 American Cancer Society.

    PubMed IF 5.6 혈액종양내과
25. 682013

    제1저자 고성준 · 교신저자 임종필

    Koh SJ, Im JP, Kim JW, Kim BG, Lee KL, Kim SG, Kim JS, Jung HC

    Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy.

    World J Gastroenterol. 2013;19(10):1632-8.

    Abstract

    AIM To investigate long-term outcome in obscure gastrointestinal bleeding (OGIB) after negative capsule endoscopy (CE) and identify risk factors for rebleeding.

    METHODS A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital. Ninety-five patients (84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study. Follow-up data were obtained from the patients' medical records. The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases. The primary outcome measure was the detection of rebleeding after CE, and factors associated with rebleeding were evaluated using multivariate analysis.

    RESULTS Of the 95 enrolled patients (median age 61 years, range 17-85 years), 62 patients (65.3%) were male. The median duration of follow-up was 23.7 mo (range 6.0-89.4 mo). Seventy-three patients (76.8%) underwent CE for obscure-overt bleeding. Complete examination of the small bowel was achieved in 77 cases (81.1%). Significant lesions were found in 38 patients (40.0%). The overall rebleeding rate was 28.4%. The rebleeding rate was higher in patients with positive CE (36.8%) than in those with negative CE (22.8%). However, there was no significant difference in cumulative rebleeding rates between the two groups (log rank test; P = 0.205). Anticoagulation after CE examination was an independent risk factor for rebleeding (hazard ratio, 5.019; 95%CI, 1.560-16.145; P = 0.007), regardless of CE results.

    CONCLUSION Patients with OGIB and negative CE have a potential risk of rebleeding. Therefore, close observation is required and alternative modalities should be considered in suspicious cases.

    PubMed IF 7.7 소화기내과
26. 672013

    제1저자 안동원 · 교신저자 류지곤

    Ahn DW, Ryu JK, Kim J, Yoon WJ, Lee SH, Kim YT, Yoon YB

    Endoscopic papillectomy for benign ampullary neoplasms: how can treatment outcome be predicted?

    Gut Liver. 2013;7(2):239-45.

    Abstract

    BACKGROUND/AIMS Endoscopic papillectomy is increasingly performed with curative intent for benign papillary tumors. This study was performed to identify factors that predict the presence of malignancy and affect endoscopic success.

    METHODS We retrospectively analyzed the medical records of patients who received an endoscopic papillectomy for papillary adenoma from 2006 to 2009.

    RESULTS A total of 43 patients received endoscopic papillectomy. The pathologic results after papillectomy revealed adenocarcinoma in five patients (12%), and the risk of malignancy was high in cases of large lesions, preprocedural pathology of high-grade dysplasia or high serum alkaline phosphatase. Endoscopic success was observed in 37 patients (86%) at the end of follow-up (mean duration, 10.4±9.6 months). The factor significantly affecting success was a complete resection at the initial papillectomy (p=0.007). Two patients experienced recurrence 10 and 32 months after the complete resection, but both achieved endoscopic success with repeated endoscopic treatment. Six patients with endoscopic failure received surgical resection.

    CONCLUSIONS Endoscopic papillectomy is a safe and effective method for the curative resection of benign papillary tumors, especially when complete resection is achieved at the initial papillectomy. Follow-up with surveillance should be performed for at least 3 years because of the possible recurrence of tumors during these periods.

    PubMed IF 4.1 소화기내과
27. 662013

    제1저자 윤혁 · 교신저자 김상균

    Yoon H, Kim SG, Jung HC, Song IS

    High Recurrence Rate of Idiopathic Peptic Ulcers in Long-Term Follow-up.

    Gut Liver. 2013;7(2):175-81.

    Abstract

    BACKGROUND/AIMS Our aim was to compare the long-term clinical outcomes of idiopathic peptic ulcer disease (IPUD) with those of Helicobacter pylori-positive and nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcer disease (PUD).

    METHODS Patients with endoscopically diagnosed PUD were retrospectively reviewed. According to their H. pylori-infection status and history of NSAIDs use, patients were categorized into three groups: H. pylori-positive PUD, NSAID-induced PUD, and IPUD. Clinical outcomes were analyzed, and the recurrence rate of PUD was compared among the three groups.

    RESULTS A total of 238 patients were enrolled. Those with IPUD, NSAID-induced PUD, and H. pylori-positive PUD comprised of 56, 60, and 122 patients, respectively. The 5-year cumulative incidences of recurrent ulcers were 24.3% (95% confidence interval [CI], 11.6% to 37.0%) in IPUD, 10.9% (95% CI, 2.6% to 19.2%) in NSAID-induced PUD, and 3.8% (95% CI, 0.1% to 7.5%) in H. pylori-positive PUD (IPUD vs NSAID-induced PUD/H. pylori-positive PUD, p=0.43/p<0.001 by log-rank test). In the Cox-proportional hazards model, only IPUD remained as an independent risk factor associated with recurrent ulcers (hazard ratio, 5.97; 95% CI, 1.94 to 18.34; p=0.002).

    CONCLUSIONS IPUD exhibited a higher recurrence rate than H. pylori-positive and NSAID-induced PUD in long-term follow-up and was an independent risk factor for ulcer recurrence.

    PubMed IF 4.1 소화기내과
28. 652013

    제1저자 김서윤 · 교신저자 김덕겸

    Kim SY, Yim JJ, Park JS, Park SS, Heo EY, Lee CH, Chung HS, Kim DK

    Clinical effects of gemifloxacin on the delay of tuberculosis treatment.

    J Korean Med Sci. 2013;28(3):378-82.

    Abstract

    Although gemifloxacin has low in vitro activity against Mycobacterium tuberculosis, the effect of gemifloxacin on the delay of tuberculosis (TB) treatment has not been validated in a clinical setting. The study group included patients with culture-confirmed pulmonary TB who initially received gemifloxacin for suspected community-acquired pneumonia (CAP). Two control groups contained patients treated with other fluoroquinolones or nonfluoroquinolone antibiotics. Sixteen cases were treated with gemifloxacin for suspected CAP before TB diagnosis. Sixteen and 32 patients were treated with other fluoroquinolones and nonfluoroquinolones, respectively. The median period from the initiation of antibiotics to the administration of anti-TB medication was nine days in the gemifloxacin group, which was significantly different from the other fluoroquinolones group (35 days). The median times for the nonfluoroquinolone group and the gemifloxacin group were not significantly different. There were no significant differences between the gemifloxacin and other fluoroquinolone group in terms of symptomatic and radiographic improvements. However, the frequency of radiographic improvement in the other fluoroquinolones group tended to be higher than in the gemifloxacin group. Gemifloxacin might be the preferred fluoroquinolone for treating CAP, to alleviate any concerns about delaying TB treatment.

    PubMed IF 3.2 호흡기내과
29. 642013

    제1저자 황정환 · 교신저자 김남중

    Hwang JH, Choe PG, Kim NH, Bang JH, Song KH, Park WB, Kim ES, Park SW, Kim HB, Kim NJ, Oh MD, Choe KW

    Incidence and risk factors of tuberculosis in patients with human immunodeficiency virus infection.

    J Korean Med Sci. 2013;28(3):374-7.

    Abstract

    Korea is a low prevalence country for human immunodeficiency virus (HIV) infection and has an intermediate tuberculosis (TB) burden. We previously reported that the incidence of TB in HIV-infected patients was 9.6 cases per 100 person-years (P-Y) between 1988 and 1997. The aims of the present study were to measure any change in incidence from the previous study, and to identify risk factors for TB in HIV-infected patients. We reviewed all medical records of HIV-infected patients who were followed-up in one tertiary hospital between 1998 and 2010. Over the total observation period of 5858.33 P-Y, TB developed in 70 patients (1.19 cases per 100 P-Y; 95% confidence interval [CI], 0.91-1.47 cases per 100 P-Y). Based on Poisson regression, one risk factor associated with TB was an initial CD4+ cell count below 200 cells/µL (relative risk, 2.34; 95% CI, 1.47-3.73). Mean CD4+ cell counts of pulmonary, extrapulmonary, and both pulmonary and extrapulmonary TB were 179.8 cells/µL, 138.3 cells/µL, and 114.2 cells/µL, respectively (P = 0.55). In conclusion, the incidence of TB in HIV-infected patients has decreased since the previous study. An initial CD4+ cell count below 200 cells/µL is an independent risk factor for development of TB in HIV-infected patients.

    PubMed IF 3.2 감염내과
30. 632013

    제1저자 박준빈 · 교신저자 김효수

    Park JB, Kang DY, Yang HM, Cho HJ, Park KW, Lee HY, Kang HJ, Koo BK, Kim HS

    Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug-eluting stent.

    Eur Heart J. 2013;34(12):920-31.

    Abstract

    AIMS The association between alkaline phosphatase (ALP) and mortality was reported in several subgroups of patients. But, the role of ALP in overall coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to examine the prognostic value of the ALP level in patients with CAD who underwent PCI with drug-eluting stent (DES).

    METHODS AND RESULTS We prospectively included CAD patients who underwent PCI with DES. After exclusion of patients with liver disease and cancer, 1636 patients were selected for the analysis of clinical outcomes (median duration of follow-up; 762 days, inter-quartile range; 494-1068 days), and were classified into tertiles by baseline measurements of ALP (<63, 63-78, and >78 IU/L). After adjustment of potential confounders including angiographic data, the independent and dose-dependent association was observed between tertile of ALP and the adjusted hazard ratio (HR) of all-cause mortality (P for trend < 0.0001). Specifically, compared with the lowest ALP tertile, the adjusted HR of all-cause mortality in the highest tertile was 4.21 (95% confidence interval 2.03-8.71). In subgroup of patients with stable or unstable angina, a similar association was noted (P for trend < 0.0001). In terms of cardiovascular mortality, myocardial infarction, and stent thrombosis, the adjusted HRs in the highest ALP tertile were 3.92 (1.37-11.20), 1.98 (0.91-4.29), and 2.73 (1.33-5.61), respectively, compared with the lowest tertile. Furthermore, evaluation of both ALP and C-reactive protein provided better predictive value than either alone. Interesting result suggesting the mechanism was that ALP was significantly associated with the presence of angiographic coronary calcification (P for trend = 0.046).

    CONCLUSION Our study demonstrated that the higher serum ALP level is an independent predictor of mortality, myocardial infarction, and stent thrombosis in CAD patients after PCI with DES.

    PubMed IF 45.3 순환기내과

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