SCI 발표논문

전체 4,588편

17082015

제1저자 최병용 · 교신저자 송영욱

, , , ,
Characteristics of pleural effusions in systemic lupus erythematosus: differential diagnosis of lupus pleuritis.
Lupus. 2015;24(3):321-6.

Abstract
We investigated the clinical characteristics of pleural effusion in systemic lupus erythematosus (SLE). A prospective analysis of 17 SLE patients with pleural effusion (seven lupus pleuritis, eight transudative effusions and two parapneumonic effusions) was performed. Thirty non-SLE patients with pleural effusion were recruited as controls. A pleural fluid ANA titer ≥1:160 was found in 8/17 (47.1%) SLE patients and none of the 30 non-SLE patients (p = 0.0001). Pleural fluid to serum C3 ratios were significantly lower in SLE than in non-SLE (median (minimum-maximum) 0.29 (0.03-0.43) versus 0.52 (0.26-0.73), p = 0.0002). Among SLE patients, pleural fluid ANA titers ≥1:160 were more frequently found in patients with lupus pleuritis than in those with pleural effusion from causes other than lupus itself (85.7% versus 20.0%, p = 0.0152). Serum CRP levels were significantly increased in patients with lupus pleuritis compared with SLE patients with transudative pleural effusion (2.30 (0.30-5.66) versus 0.7 (0.12-1.47) mg/dl, p = 0.0062). In conclusion, pleural fluid ANA titer and serum CRP levels are significantly increased in lupus pleuritis.
PubMed IF 1.8 류마티스내과
17072015

제1저자 김학령 · 교신저자 조주희

, , , , ,
Association between invasively measured central aortic pressure and left ventricular diastolic function in patients undergoing coronary angiography.
Am J Hypertens. 2015;28(3):393-400.

Abstract
BACKGROUND Because of the invasive nature of catheterization, limited information is available on hemodynamic interaction between the left ventricle and aorta using invasive aortic pressure monitoring. Our aim was to investigate whether parameters of invasively measured central aortic pressure waveform were related with those of left ventricular (LV) diastolic function.
METHODS A total of 153 consecutive stable patients (mean age = 64±11 years; 62% men) undergoing invasive coronary angiography (ICA) and transthoracic echocardiography (TTE) were prospectively evaluated. Central aortic pressure waveform was obtained at the ascending aorta using a pigtail catheter before ICA. We calculated pulse pressure (PP), fractional PP (FPP; the ratio of PP to mean pressure), pulsatility index (PI; the ratio of PP to diastolic pressure), augmentation index, wave reflection time, and ejection duration and analyzed their associations with parameters of LV diastolic function in TTE.
RESULTS Most patients (n = 135/153; 88.2%) had significant stenosis (≥50%) of ≥1 epicardial coronary arteries. In multiple linear regression analyses, e' and E/e' were significantly correlated with PP, FPP, and PI even after adjustment for potential confounders. There were no significant correlations between other parameters of LV diastolic function, including E/A, deceleration time, and left atrial volume index and parameters of central aortic pressure wave.
CONCLUSIONS Invasively measured central aortic PP, FPP, and PI were independently associated with e' and E/e' in patients undergoing ICA. This result adds to the evidence of a close interaction between LV diastolic function and aortic stiffness in this population.
PubMed IF 2.9 순환기내과
17062015

제1저자 김재환, 이윤석 · 교신저자 황진혁

, , , , , , ,
Postoperative carcinoembryonic antigen as a complementary tumor marker of carbohydrate antigen 19-9 in pancreatic ductal adenocarcinoma.
J Korean Med Sci. 2015;30(3):259-63.

Abstract
The role of carcinoembryonic antigen (CEA) in pancreatic cancer remains poorly understood. Therefore, this study aimed to determine whether CEA is complementary to carbohydrate antigen 19-9 (CA19-9) in prognosis prediction after pancreatic cancer curative resection. We retrospectively reviewed records of 144 stage II curatively resected pancreatic cancer patients with preoperative and postoperative CEA and CA19-9 levels. Patients with normal preoperative CA19-9 were excluded. R0 resection margin, adjuvant treatment, and absence of angiolymphatic invasion were associated with better overall survival. There was no significant difference in median survival according to preoperative CEA levels. However, patients with normal postoperative CA19-9 (59.8 vs.16.2 months, P < 0.001) and CEA (29.4 vs. 9.3 months, P = 0.001) levels had longer overall survival than those with elevated levels. Among 76 patients with high postoperative CA19-9 levels, a better prognosis was observed in those with normal postoperative CEA levels than in those with elevated levels (19.1 vs. 9.3 months, P = 0.004). Postoperative CEA and CA19-9 levels are valuable prognostic markers in resected pancreatic cancer. Normal postoperative CEA levels indicate longer survival, even in patients with elevated postoperative CA19-9.
PubMed IF 3.2 소화기내과
17052015

제1저자 윤기철 · 교신저자 김나영

, , , , , , , , , , , ,
Ultimate eradication rate of Helicobacter pylori after first, second, or third-line therapy in Korea.
J Gastroenterol Hepatol. 2015;30(3):490-5.

Abstract
BACKGROUND AND AIMS Resistance rates of Helicobacter pylori to clarithromycin, metronidazole, and quinolone are over 30% in South Korea. The aim of this prospective study was to evaluate the ultimate eradication rate of H. pylori after first, second, or third-line therapy in Korea.
METHODS A cohort of 2202 patients with H. pylori was treated with proton pump inhibitor (PPI)-based triple therapy for seven days. In case of treatment failure or recurrence, moxifloxacin-based triple therapy (MA) or bismuth-based quadruple therapy (QUAD) was randomly given. When the second-line treatment failed or H. pylori recurred, the unused MA or QUAD was used as a third-line treatment.
RESULTS Eighty-six patients had recurrence at least once during consecutive lines of treatments. Among 2116 patients (intention-to-treat [ITT]) without recurrence, 1644 (77.7%, per-protocol [PP]) completely followed our treatment flow. The ITT and PP rates of first-line treatment were 69.8% and 89.3%. After second line, they reached 78.4% (ITT) and 98.4% (PP). The "final" eradication rate up to third line treatment were 80.0% (1692/2116) and 99.8% (1641/1644), respectively. Resistance to clarithromycin showed significantly lower eradication rate (OR 0.358, P < 0.001) than those with susceptible strains in multivariate analysis. However in PP analysis, there was no significant difference in ultimate success rate regarding resistance pattern.
CONCLUSION Final success rate of PP was high, 99.8% in Korea in spite of high antibiotic resistance rates. However, high rate of refusal of further treatment and follow-up loss made ITT eradication rate low. Proper strategy to improve the treatment adherence is needed.
PubMed IF 3.5 소화기내과
17042015

제1저자 고성준 · 교신저자 김주성

, , , , ,
Fexofenadine regulates nuclear factor-κB signaling and endoplasmic reticulum stress in intestinal epithelial cells and ameliorates acute and chronic colitis in mice.
J Pharmacol Exp Ther. 2015;352(3):455-61.

Abstract
The aim of this study was to evaluate the effect of fexofenadine on intestinal inflammation. HCT116 and COLO205 cells were pretreated with fexofenadine and then stimulated with tumor necrosis factor (TNF)-α. Interleukin (IL)-8 expression was determined by real-time reverse-transcription polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay. DNA-binding activity of nuclear factor-κB was assessed by electrophoretic mobility shift assay. The molecular markers of endoplasmic reticulum (ER) stress were evaluated by Western blot analysis and PCR. In the acute colitis model, mice were given 4% dextran sulfate sodium (DSS) for 5 days with or without fexofenadine. IL-10(-/-) mice were used to evaluate the effect of fexofenadine on chronic colitis. Fexofenadine significantly inhibited the upregulated expression of IL-8 in HCT116 and COLO205 cells stimulated with TNF-α. Fexofenadine suppressed nuclear factor-κB DNA-binding activity. C/EBP homologous protein mRNA expression was enhanced in the presence of TNF-α, and it was dampened by pretreatment of fexofenadine. In addition, the induction of ER stress markers caspase-12 and p-eukaryotic initiation factor 2 (eIF2)-α was significantly suppressed by the pretreatment of fexofenadine. Administration of fexofenadine significantly reduced the severity of DSS-induced murine colitis, as assessed by the disease activity index, colon length, and histology. In addition, the DSS-induced phospho-IκB kinase activation was significantly decreased in fexofenadine-pretreated mice. Finally, fexofenadine significantly reduced the severity of colitis and the immunoreactivity of caspase-12 and p-eIF2-α in IL-10(-/-) mice as compared with controls. These results suggest that fexofenadine is a potential therapeutic agent for the treatment of inflammatory bowel disease.
PubMed IF 4.3 소화기내과
17032015

제1저자 고수희 · 교신저자 박상원

, , ,
An outbreak of Burkholderia cepacia complex pseudobacteremia associated with intrinsically contaminated commercial 0.5% chlorhexidine solution.
Am J Infect Control. 2015;43(3):266-8.

Abstract
BACKGROUND Burkholderia cepacia complex (Bcc) is well-known for intrinsic resistance to certain antiseptics. We experienced a sudden rise in Bcc bloodstream infections in a 786-bed hospital. An investigation was conducted to identify the source and to intervene in the ongoing infections.
METHODS The cases were defined as patients with positive blood cultures for Bcc from October 10, 2013-December 16, 2013. We reviewed medical records, interviewed health care workers, and audited the clinical laboratory. A microbiologic culture for a suspected antiseptic was performed, and interventions were instituted.
RESULTS During the outbreak period, Bcc were isolated from 46 blood cultures from 40 patients. The temporal and spatial distributions did not reveal common factors. The clinical features of the case patients suggested pseudobacteremia. A 0.5% chlorhexidine solution product was found to be contaminated with Bcc and had been misused as a skin antiseptic during blood culture. After withdrawal of the product and staff education, the outbreak was terminated.
CONCLUSION The pseudobacteremia was caused by contaminated 0.5% chlorhexidine from a single company. This contamination was permitted by multiple breaches of infection control principles that could have caused significant outbreaks of true infections. Regulatory actions at the government level are needed to ensure the sterility of antiseptics.
PubMed IF 2.6 감염내과
17022015

제1저자 Delgado-Guay MO, 김유정 · 교신저자 Delgado-Guay MO

, , , , , ,
Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care.
J Pain Symptom Manage. 2015;49(3):497-504.

Abstract
CONTEXT Admissions to the emergency department (ED) can be distressing to patients with advanced cancer receiving palliative care. There is limited research about the clinical characteristics of these patients and whether these ED visits can be categorized as avoidable or unavoidable.
OBJECTIVES To determine the frequency of potentially avoidable ED visits (AvEDs) for patients with advanced cancer receiving outpatient palliative care in a large tertiary cancer center, identify the clinical characteristics of the patients receiving palliative care who visited the ED, and analyze the factors associated with AvEDs and unavoidable ED visits (UnAvEDs).
METHODS We randomly selected 200 advanced cancer patients receiving treatment in the outpatient palliative care clinic of a tertiary cancer center who visited the ED between January 2010 and December 2011. Visits were classified as AvED (if the problem could have been managed in the outpatient clinic or by telephone) or UnAvED.
RESULTS Forty-six (23%) of 200 ED visits were classified as AvED, and 154 (77%) of 200 ED visits were classified as UnAvED. Pain (71/200, 36%) was the most common chief complaint in both groups. Altered mental status, dyspnea, fever, and bleeding were present in the UnAvED group only. Infection, neurologic events, and cancer-related dyspnea were significantly more frequent in the UnAvED group, whereas constipation and running out of pain medications were significantly more frequent in the AvED group (P < 0.001). In a multivariate analysis, AvED was associated with nonwhite ethnicity (odds ratio [OR] 2.66; 95% CI 1.26, 5.59) and constipation (OR 17.08; 95% CI 3.76, 77.67), whereas UnAvED was associated with ED referral from the outpatient oncology or palliative care clinic (OR 0.24; 95% CI 0.06, 0.88) and the presence of baseline dyspnea (OR 0.46; 95% CI 0.21, 0.99).
CONCLUSION Nearly one-fourth of ED visits by patients with advanced cancer receiving palliative care were potentially avoidable. Proactive efforts to improve communication and support between scheduled appointments are needed.
PubMed IF 4 혈액종양내과
17012015

제1저자 박진주 · 교신저자 박현아

,
Prevalence of cigarette smoking among adult cancer survivors in Korea.
Yonsei Med J. 2015;56(2):556-62.

Abstract
PURPOSE Cigarette smoking is associated not only with increased risk of cancer incidence, but also influences prognosis, and the quality of life of the cancer survivors. Thus, smoking cessation after cancer diagnosis is necessary. However, smoking behavior among Korean cancer-survivors is yet unknown.
MATERIALS AND METHODS We investigated the smoking status of 23770 adults, aged 18 years or older, who participated in the Health Interview Survey of the Korea National Health and Nutrition Examination Survey from 2007 to 2010. Data on the cancer diagnosis and smoking history were obtained from an interview conducted by trained personals. "Cancer-survivor" was defined as anyone who has been diagnosed with cancer by a physician regardless of time duration since diagnosis. Smoking status was classified into "never-smoker", "former-smoker", and "current-smoker". Former-smoker was further divided into "cessation before diagnosis" and "cessation after diagnosis".
RESULTS Overall, 2.1% of Korean adults were cancer-survivors. The smoking rate of Korean cancer-survivors was lower than that of non-cancer controls (7.8±1.3% vs. 26.4±0.4%, p<0.001). However, 53.4% of the cancer-survivors continued to smoke after their cancer diagnosis. In multivariate analysis, male gender [odds ratio (OR), 6.34; 95% confidence interval (CI), 2.62-15.31], middle-aged group (OR, 2.74; 95% CI, 1.12-6.72), the lowest income (OR, 4.10; 95% CI, 1.19-14.15), living with smoking family member(s) (OR, 5.49; 95% CI, 2.42-12.48), and the poor self-perceived health status (OR, 2.78; 95% CI, 1.01-7.71) were independently associated with persistent smoking among Korean cancer-survivors.
CONCLUSION The smoking rate among Korean cancer survivors is low. However, the smoking cessation rate after the cancer diagnosis is also low. This mandates comprehensive and systematic intervention for smoking cessation among cancer-survivors.
PubMed IF 3.1 순환기내과
17002015

제1저자 김학령 · 교신저자 김명아

, , , , , ,
The effects of metabolic syndrome and its components on arterial stiffness in relation to gender.
J Cardiol. 2015;65(3):243-9.

Abstract
OBJECTIVES The influence of gender-dependent metabolic risk factors on arterial stiffness has not been fully determined. This study was performed to investigate the relationship between components of metabolic syndrome and brachial-ankle pulse wave velocity (baPWV) according to gender.
METHODS A total of 537 subjects (54.4±7.5 years and 70.6% men) who underwent baPWV measurement during routine check-ups were analyzed.
RESULTS BaPWV was 1363±229cm/s in men and 1387±269cm/s in women (p=0.313). The prevalence of metabolic syndrome was not different according to gender (23% in men versus 27% in women, p=0.335). In multiple linear regression analyses, after adjustment for age, baPWV was significantly associated with systolic and diastolic blood pressures, fasting glucose, and triglyceride in both genders. Waist circumference was associated with baPWV in women but not in men. High-density lipoprotein levels were not associated with baPWV in either gender. Subjects with metabolic syndrome had a higher baPWV than those without metabolic syndrome for women aged <55 years, but not for all men and women aged ≥55 years. As the number of the components of metabolic syndrome increased, baPWV increased proportionally in both genders. However, this correlation was more strong in women than that in men (β=0.408 versus β=0.146 after adjustment for age).
CONCLUSION In middle-aged Koreans, women showed stronger associations between each component of metabolic syndrome and baPWV than men. The association of each component of metabolic syndrome to arterial stiffness may differ between men and women.
PubMed IF 3.5 순환기내과
16992015

제1저자 심은진 · 교신저자 박흥우

, , , , , ,
Eosinophils Modulate CD4(+) T Cell Responses via High Mobility Group Box-1 in the Pathogenesis of Asthma.
Allergy Asthma Immunol Res. 2015;7(2):190-4.

Abstract
Eosinophils have been reported to modulate T cell responses. Previously, we reported that high-mobility group box 1 protein (HMGB1) played a key role in the pathogenesis of asthma. This study was conducted to test our hypothesis that eosinophils could modulate T cell responses via HMGB1 in the pathogenesis of asthma characterized by eosinophilic airway inflammation. We performed in vitro experiments using eosinophils, dendritic cells (DCs), and CD4(+) T cells obtained from a murine model of asthma. The supernatant of the eosinophil culture was found to significantly increase the levels of interleukin (IL)-4 and IL-5 in the supernatant of CD4(+) T cells co-cultured with DCs. HMGB1 levels increased in the supernatant of the eosinophil culture stimulated with IL-5. Anti-HMGB1 antibodies significantly attenuated increases of IL-4 and IL-5 levels in the supernatant of CD4(+) T cells co-cultured with DCs that were induced by the supernatant of the eosinophil culture. In addition, anti-HMGB1 antibodies significantly attenuated the expressions of activation markers (CD44 and CD69) on CD4(+) T cells. Our data suggest that eosinophils modulate CD4(+) T cell responses via HMGB1 in the pathogenesis of asthma.
PubMed IF 4.3 알레르기내과
16982015

제1저자 이주명 · 교신저자 김효수

, , , , , , , , , , , ,
Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis: a network meta-analysis of 11 randomized, controlled trials.
JACC Cardiovasc Interv. 2015;8(3):382-394.

Abstract
OBJECTIVES A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR).
BACKGROUND Optimal treatment options for ISR have not been well established.
METHODS Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure.
RESULTS This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI.
CONCLUSIONS Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.
PubMed IF 12.7 순환기내과
16972015

제1저자 서지연 · 교신저자 김주성

, , , , , , ,
Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma.
Gastrointest Endosc. 2015;81(3):655-64.

Abstract
BACKGROUND Advanced colorectal adenoma (ACA) refers to adenomas with the following predictive characteristics: ≥1 cm in diameter, and/or villous component, and/or high-grade dysplasia. ACA has high risk of transforming to colorectal cancer, and the recurrence rate is relatively high.
OBJECTIVE To assess the outcomes of patients with ACA undergoing endoscopic resection and to identify risk factors for local recurrence and development of metachronous advanced neoplasm.
DESIGN Retrospective cohort study.
SETTING Tertiary care medical center.
PATIENTS From 2005 to 2011, the records of 3625 patients who underwent colonoscopic polypectomy at Seoul National University Hospital were retrospectively reviewed. Patients with synchronous colorectal cancers, inflammatory bowel disease, previous colorectal resection, loss to follow-up, and incomplete resection were excluded.
INTERVENTION Endoscopic resection for ACA.
MAIN OUTCOME MEASUREMENTS Local recurrence and metachronous advanced neoplasm.
RESULTS The study included 917 patients with 1206 ACAs. The median duration of follow-up was 28.5 months (interquartile range, 12.8-51.7). Independent risk factors for local recurrence included ACA with 2 or more predictive characteristics (adjusted hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.11-5.48; P = .027) and piecemeal resection (adjusted HR, 6.96; 95% CI, 1.58-30.71; P = .010). Independent risk factors for metachronous advanced neoplasm were male gender (adjusted HR, 1.65; 95% CI, 1.02-2.65; P = .041), ≥3 adenomas (adjusted HR, 2.56; 95% CI, 1.72-3.82; P < .001), and ≥3 ACAs (adjusted HR, 1.44; 95% CI, 1.01-2.06; P = .045).
LIMITATIONS Retrospective design.
CONCLUSION ACAs with 2 or more predictive characteristics recurred locally at a higher rate than ACAs with 1 predictive characteristic. These results suggest that patients who are found to have ACAs with 2 or more predictive factors at index colonoscopy are at higher risk for local recurrence, and follow-up colonoscopy should be performed sooner.
PubMed IF 8 소화기내과
16962015

제1저자 정고은, 최수연 · 교신저자 김동희

, , , , , ,
Nonalcoholic fatty liver disease as a risk factor of arterial stiffness measured by the cardioankle vascular index.
Medicine (Baltimore). 2015;94(12):e654.

Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with risk factors for cardiovascular disease. The cardioankle vascular index (CAVI), a new measure of arterial stiffness, was recently developed and is independent of blood pressure. We investigated whether NAFLD is associated with arterial stiffness as measured using the CAVI in an apparently healthy population.A total of 2954 subjects without any known liver diseases were enrolled. NAFLD was diagnosed via typical ultrasonography. The clinical characteristics examined included age, sex, body mass index (BMI), waist circumference (WC), and the levels of aspartate aminotransferase, alanine aminotransferase, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol triglycerides, and glucose. Arterial stiffness was defined using an age- and sex-specific threshold of the upper quartile of the CAVI.NAFLD was found in 1249 (42.3%) of the analyzed subjects. Using an age-, sex-, and BMI-adjusted model, NAFLD was associated with a 42% increase in the risk for arterial stiffness (highest quartile of the CAVI). The risk for arterial stiffness increased according to the severity of NAFLD (adjusted odds ratio [95% confidence interval], 1.27 [1.02 - 1.57] vs 1.78 [1.37 - 2.31], mild vs moderate-to-severe, respectively). When adjusted for other risk factors, including BMI, WC, smoking status, diabetes, and hypertension, these relationships remained statistically significant.Patients with NAFLD are at a high risk for arterial stiffness regardless of classical risk factors. The presence of cardiometabolic risk factors may attenuate the prediction of arterial stiffness by means of NAFLD presence. Thus, physicians should carefully assess subjects with NAFLD for atherosclerosis and associated comorbidities.
PubMed IF 2 소화기내과
16952015

제1저자 김미소 · 교신저자 김태민

, , , , , , , , ,
Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus L-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL).
Ann Hematol. 2015;94(3):437-44.

Abstract
The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although L-asparaginase (L-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of L-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus L-asp (N = 22) or combination chemotherapy without L-asp (N = 48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. After a median follow-up period of 12.8 months (range, 1.1-186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus L-asp compared to those treated with chemotherapy without L-asp (overall response rate, 90.0 vs. 34.8 %, P < 0.001; complete remission rate, 65.0 vs. 21.7 %, P = 0.001). The OS and PFS were significantly higher for the IMEP plus L-asp group compared with the chemotherapy without L-asp group. In a multivariate analysis, the use of chemotherapy without L-asp was an independent predictor of reduced OS (hazards ratio (HR) = 2.18, 95 % confidence interval (CI) 1.08-4.40; P = 0.030) and PFS (HR = 2.29, 95 % CI 1.22-4.29; P = 0.010). IMEP plus L-asp is active against stage III/IV NTCL, and it is an independent predictor of improved survival.
PubMed IF 2.3 혈액종양내과
16942015

제1저자 정고은 · 교신저자 김동희

, , , , , ,
Visceral adipose tissue area as an independent risk factor for elevated liver enzyme in nonalcoholic fatty liver disease.
Medicine (Baltimore). 2015;94(9):e573.

Abstract
Chronic elevations in alanine aminotransferase (ALT) levels are associated with body composition. The aim of this study was to evaluate the relationship between elevated liver enzyme levels and the visceral tissue area in subjects with and without nonalcoholic fatty liver disease (NAFLD).An observational cohort study was conducted with subjects undergoing general health examinations. To evaluate the visceral and subcutaneous abdominal adipose tissue area, a computed tomography scan was performed. NAFLD was diagnosed if a person demonstrated fatty liver on ultrasonography without a history of significant alcohol consumption or chronic liver disease. Abnormal liver enzyme levels were based on ALT elevations according to the updated Asian definition.Of the 5100 subjects, 3712 (72.8%) met the inclusion criteria, and NAFLD was found in 1185 subjects. Elevated ALT values were positively correlated with body mass index, waist circumference, and subcutaneous and visceral adipose tissue area. These relationships were attenuated, although they remained significant in a dose-dependent manner, after adjusting for multiple liver injury risk factors. In addition, when body mass index and subcutaneous and visceral tissue areas were finally considered in combination, only visceral adipose tissue remained independently associated with elevated ALT levels in the ultrasonographically diagnosed NAFLD group (P for trend <0.001 for men and women).Elevated ALT levels were independently and dose-dependently associated with visceral fat accumulation in the healthy general population, especially in ultrasonographically diagnosed NAFLD patients. These results reemphasize the importance of visceral fat in the pathogenesis of NAFLD.
PubMed IF 2 소화기내과
16932015

제1저자 윤혁 · 교신저자 이동호

, , , , , , , , ,
Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding.
World J Gastroenterol. 2015;21(8):2497-503.

Abstract
AIM To evaluate when Helicobacter pylori (H. pylori) eradication therapy (ET) should be started in patients with peptic ulcer bleeding (PUB).
METHODS Clinical data concerning adults hospitalized with PUB were retrospectively collected and analyzed. Age, sex, type and stage of peptic ulcer, whether endoscopic therapy was performed or not, methods of H. pylori detection, duration of hospitalization, and specialty of the attending physician were investigated. Factors influencing the confirmation of H. pylori infection prior to discharge were determined using multiple logistic regression analysis. The H. pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.
RESULTS A total of 232 patients with PUB were evaluated for H. pylori infection by histology and/or rapid urease testing. Of these patients, 53.7% (127/232) had confirmed results of H. pylori infection prior to discharge. In multivariate analysis, duration of hospitalization and ulcer stage were factors independently influencing whether H. pylori infection was confirmed before or after discharge. Among the patients discharged before confirmation of H. pylori infection, 13.3% (14/105) were lost to follow-up. Among the patients found to be H. pylori-positive after discharge, 41.4% (12/29) did not receive ET. There was no significant difference in the H. pylori eradication rate between patients who received ET during hospitalization and those who commenced ET as outpatients [intention-to-treat: 68.8% (53/77) vs 60% (12/20), P=0.594; per-protocol: 82.8% (53/64) vs 80% (12/15), P=0.723].
CONCLUSION Because many patients with PUB who were discharged before H. pylori infection status was confirmed lost an opportunity to receive ET, we should confirm H. pylori infection and start ET prior to discharge.
PubMed IF 7.7 소화기내과
16922015

제1저자 이세원, 양지민 · 교신저자 김효수

, , , , , , ,
MicroRNA-26a induced by hypoxia targets HDAC6 in myogenic differentiation of embryonic stem cells.
Nucleic Acids Res. 2015;43(4):2057-73.

Abstract
The importance of epigenetic regulation for maintenance of embryonic stem cell (ESC) pluripotency or for initiation of differentiation is widely accepted. However, the molecular mechanisms are poorly understood. We recently reported that a hypoxic microenvironment induces ESC differentiation. In the present study, we found that hypoxia-responsive histone deacetylase 6 (HDAC6) performs an essential signaling function for myogenic differentiation of ESCs. HDAC6 was downregulated in hypoxic ESCs or during differentiation. A knock-down of HDAC6 in ESCs resulted in induction of myogenic markers, including Pax7. Suppression of HDAC6 increased acetylation of core histones H3 and H4, leading to enhanced binding of RNA polymerase II to the Pax7 promoter. Transplantation of HDAC6 knock-down cells facilitated muscle regeneration in vivo. Importantly, the downregulation of HDAC6 by hypoxia was not mediated by HIF1α or HIF2α, master transcription regulators under hypoxia, but by induction of microRNA-26a that directly targeted the 3'-untranslated region (3'-UTR) of HDAC6. A point mutation of the microRNA-26a-binding sequence in the HDAC6 3'-UTR diminished the luciferase reporter activity. Taken together, these results suggest that environmental cues of differentiation modulate the epigenetic machinery and guide stem cells to commit to a specific lineage.
PubMed IF 15 순환기내과
16912015

제1저자 박지인, 김명희 · 교신저자 이정표

, , , , , , , , , , , , ,
Not early referral but planned dialysis improves quality of life and depression in newly diagnosed end stage renal disease patients: a prospective cohort study in Korea.
PLoS One. 2015;10(2):e0117582.

Abstract
BACKGROUND Health-related quality of life (HRQOL) has recently become an important issue. It reportedly affects morbidity and mortality in patients with end-stage renal disease (ESRD). In this study, we investigated whether early referral and planned dialysis improve the HRQOL and depression of patients with ESRD.
METHODS We prospectively enrolled newly diagnosed patients with ESRD, from 31 hospitals in Korea, who completed questionnaires at 3 months after dialysis. We also got follow-up survey at 1 year after dialysis. To measure HRQOL and depression, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) and Beck's Depression Inventory (BDI) were utilized.
RESULTS A total of 643 patients were analyzed. Referral type did not affect either KDQOL-36 or BDI scores. However, the planned dialysis group showed significantly better scores in 4 of 5 KDQOL-36 domains than did the unplanned group at 3 months after dialysis and partly, the effect was sustained for 1 year after dialysis. The benefit of planned dialysis was significant after adjusting for age, sex, type of dialysis, marital status, educational attainment, occupation, modified Charlson comorbidity index, albumin, and hemoglobin levels. BDI scores were also lower which indicate less depressive mood in planned dialysis group than those in unplanned group both at 3 months and 1 year after dialysis.
CONCLUSIONS Not early referral but planned dialysis improved both the short- and long-term HRQOL and depression of patients with ESRD. Nephrologists should try to help patients to initiate dialysis in a planned manner.
PubMed IF 2.8 신장내과
16902015

제1저자 유정주, 이정훈 · 교신저자 윤정환

, , , , , , , , , ,
Hepatitis B virus-related glomerulonephritis: not a predominant cause of proteinuria in korean patients with chronic hepatitis B.
Gastroenterol Res Pract. 2015;2015:126532.

Abstract
Background/Aims. Hepatitis B virus (HBV) can form immune complexes which may result in various types of glomerulonephritis (GN). However, proteinuria can occur because of other kidney diseases besides HBV-related GN (HBV-GN). The aim of this study is to elucidate the causes of proteinuria and report on the clinical outcomes of HBV-GN. Methods. We reviewed the medical records of patients positive for serum hepatitis B surface antigen who underwent renal biopsies due to proteinuria at a tertiary medical center in Korea. Results. A total of 55 patients were included. HBV-GN was diagnosed in 20 (36.4%) of the patients by confirming the presence of immune complexes (12 of 13 membranoproliferative glomerulonephritis, 7 of 8 membranous glomerulonephritis, and 1 of 13 immunoglobulin A nephropathy). Twenty-one patients had other types of GN. A total of 13 (65%) HBV-GN patients were treated with antiviral agents for a median of 11 months. However, the degrees of proteinuria were not significantly reduced in the antiviral intervention group when compared to the control group. Conclusions. Proteinuria can be caused by various glomerular diseases and HBV-GN accounts for one-third of total GN cases. Well-designed prospective study is needed to assess whether antiviral therapy against HBV infection may improve the prognosis of HBV-GN.
PubMed IF 1.6 소화기내과
16892015

제1저자 김지원 · 교신저자 정지봉

, , , , , ,
Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction.
World J Gastroenterol. 2015;21(5):1580-7.

Abstract
AIM To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.
METHODS A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.
RESULTS The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).
CONCLUSION Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.
PubMed IF 7.7 소화기내과
16882015

제1저자 문준호, 구보경 · 교신저자 문민경

, ,
Optimal high-density lipoprotein cholesterol cutoff for predicting cardiovascular disease: Comparison of the Korean and US National Health and Nutrition Examination Surveys.
J Clin Lipidol. 2015;9(3):334-42.

Abstract
BACKGROUND Serum high-density lipoprotein cholesterol (HDL-C) has been reported to be lower in Asians than in Caucasians.
OBJECTIVE We compared HDL-C levels between the Korean and US populations using stratified analysis according to age and sex and estimated the optimal cutoff value for HDL-C that best predicts the risk of cerebrovascular accidents (CVAs) and ischemic heart disease (IHD) in Koreans.
METHODS The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012 and the National Health and Nutrition Examination Survey (NHANES) 2011-2012 were used for the Korean and US populations, respectively. HDL-C levels were compared using general linear models. To estimate the optimal HDL-C cutoff value that predicts CVAs and IHD, sensitivity and specificity of different HDL-C levels were calculated.
RESULTS The mean HDL-C level was significantly lower in KNHANES in both sexes (46.1 [standard error, 0.2] mg/dL in KNHANES and 47.7 [0.5] mg/dL in NHANES, P = .003 in men, and 51.2 [0.2] mg/dL in KNHANES and 58.3 [0.8] mg/dL in NHANES, P < .001 in women). The optimal HDL-C cutoff to predict CVA-IHD was 43 mg/dL and 48 mg/dL for Korean men and women, respectively, and 41 mg/dL and 56 mg/dL for US men and women, respectively.
CONCLUSION HDL-C levels are significantly lower in both sexes in the Korean population than the US population. The optimal cutoff HDL-C value to predict the risk of CVA-IHD was 43 mg/dL for men and 48 mg/dL for women in the Korean population.
PubMed IF 6.9 내분비대사내과
16872015

제1저자 김정희 · 교신저자 신찬수

, , , , , ,
Trabecular bone score as an indicator for skeletal deterioration in diabetes.
J Clin Endocrinol Metab. 2015;100(2):475-82.

Abstract
CONTEXT Trabecular bone score (TBS) is a novel texture index that evaluates the pixel gray-level variations in lumbar spine dual-energy X-ray absorptiometry images and is related to bone microarchitecture independent of bone mineral density (BMD).
OBJECTIVE We investigated lumbar spine TBS as an indicator for skeletal deterioration in diabetes.
DESIGN AND SETTING Cross-sectional data were collected from subjects participating in an ongoing prospective, community-based, cohort study from 2009 to 2010.
PARTICIPANTS We included 1229 men and 1529 postmenopausal women older than 50 years in the Ansung cohort.
OUTCOME MEASURES Biochemical parameters, lumbar spine TBS, and BMD from dual-energy X-ray absorptiometry images were measured.
RESULTS Lumbar spine TBS was lower in men with diabetes than in nondiabetic men (1.287 ± 0.005 vs 1.316 ± 0.003, P < .001), whereas lumbar spine BMD was higher in men with diabetes (1.135 ± 0.010 vs 1.088 ± 0.006 g/cm(2)). Lumbar spine TBS was lower in women with diabetes than in nondiabetic women only in an unadjusted model (1.333 ± 0.004 vs 1.353 ± 0.003). However, women younger than 65 years (n = 707) with diabetes had a lower TBS than those without diabetes, even after adjusted for covariates (P < .001). Diabetes was not associated with BMD at femur sites in both genders. TBS was negatively correlated with glycated hemoglobin, fasting plasma glucose, fasting insulin, and homeostasis model assessment for insulin resistance but not with homeostasis model assessment for β-cell function in both genders.
CONCLUSIONS The inverse association between lumbar spine TBS and insulin resistance may make it an indicator for determining skeletal deterioration in diabetic patients who have high BMD.
PubMed IF 5.4 내분비대사내과
16862015

제1저자 김은선 · 교신저자 이상민

, , , , , , , , ,
Validation of the GAP score in Korean patients with idiopathic pulmonary fibrosis.
Chest. 2015;147(2):430-437.

Abstract
BACKGROUND No study has determined whether the risk of mortality predicted by the GAP (gender, age, and physiologic variables) model matches the observed mortality from idiopathic pulmonary fibrosis (IPF) in non-Western populations. We evaluated the clinical course of IPF and validated the GAP model in Korean patients with IPF.
METHODS We included 268 patients who received a diagnosis of IPF at Seoul National University Hospital between 2005 and 2009. For each patient, demographics and clinical data, such as lung physiologic parameters at IPF diagnosis, were evaluated. We validated the GAP model using discrimination and calibration to predict the risk of death in Korean patients with IPF.
RESULTS The study population comprised 181 men and 87 women (mean age, 65.9 years). The mean baseline % predicted FVC was 77, and % predicted diffusing capacity of lung for carbon monoxide was 65.9. A total of 157 deaths (58.6%) occurred during follow-up, and the median time to death was 4.64 years. The observed cumulative mortality at 1, 2, and 3 years was 10.4%, 20.9%, and 31.0%, respectively. The GAP model produced estimates of 1-year mortality risk consistent with the observed data (C statistic: GAP calculator, 0.74; GAP index and staging system, 0.72; P < .29). However, calibration of the GAP model at 3 years was not satisfactory.
CONCLUSIONS The GAP model showed similar discrimination power compared with the original cohort but did not predict the 3-year risk of death accurately. Further multinational validation studies are needed.
PubMed IF 9.8 호흡기내과
16852015

제1저자 박가희, 김태혁 · 교신저자 박웅양

, , , , , , , , ,
Standard immunohistochemistry efficiently screens for anaplastic lymphoma kinase rearrangements in differentiated thyroid cancer.
Endocr Relat Cancer. 2015;22(1):55-63.

Abstract
The anaplastic lymphoma kinase (ALK) gene is frequently rearranged in various types of cancer and is highly responsive to targeted therapeutics. We developed a system to detect rearrangement of ALK in a large group of Korean thyroid cancer patients. We screened 474 malignant or benign thyroid tumor cases to identify ALK fusions. Expression and translocation of the ALK gene were analyzed by immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and digital multiplexed gene expression (DMGE) analysis in formalin-fixed paraffin-embedded tissues. Four cases of rearrangement of ALK were detected by IHC, and these cases were validated with FISH on 189 samples. On the other hand, DMGE analysis using Nanostring detected three out of four IHC-positive cases. Two rearrangements of ALK were striatin (STRN)-ALK fusions, which were identified by 5' RACE analysis. Rearrangements of ALK were found exclusively in v-raf murine sarcoma viral oncogene homolog B (BRAF) WT papillary carcinomas. Given the wide availability and accuracy of IHC for detecting ectopic expression of ALK in the thyroid, we suggest that IHC-based screening can be a practical method for identifying patients with ALK rearrangements in differentiated thyroid cancer.
PubMed IF 4.4 내분비대사내과
16842015

제1저자 원재경, 김범석 · 교신저자 전윤경, 정두현

, , , , , , , , ,
Concomitant ALK translocation and EGFR mutation in lung cancer: a comparison of direct sequencing and sensitive assays and the impact on responsiveness to tyrosine kinase inhibitor.
Ann Oncol. 2015;26(2):348-54.

Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation are considered mutually exclusive in nonsmall-cell lung cancer (NSCLC). However, sporadic cases having concomitant EGFR and ALK alterations have been reported. The present study aimed to assess the prevalence of NSCLCs with concomitant EGFR and ALK alterations using mutation detection methods with different sensitivity and to propose an effective diagnostic and therapeutic strategy.
PATIENTS AND METHODS A total of 1458 cases of lung cancer were screened for EGFR and ALK alterations by direct sequencing and flourescence in situ hybridization (FISH), respectively. For the 91 patients identified as having an ALK translocation, peptide nucleic acid (PNA)-clamping real-time PCR, targeted next-generation sequencing (NGS), and mutant-enriched NGS assays were carried out to detect EGFR mutation.
RESULTS EGFR mutations and ALK translocations were observed in 42.4% (612/1445) and 6.3% (91/1445) of NSCLCs by direct sequencing and FISH, respectively. Concomitant EGFR and ALK alterations were detected in four cases, which accounted for 4.4% (4/91) of ALK-translocated NSCLCs. Additional analyses for EGFR using PNA real-time PCR and ultra-deep sequencing by NGS, mutant-enriched NGS increased the detection rate of concomitant EGFR and ALK alterations to 8.8% (8/91), 12.1% (11/91), and 15.4% (14/91) of ALK-translocated NSCLCs, respectively. Of the 14 patients, 3 who were treated with gefitinib showed poor response to gefitinib with stable disease in one and progressive disease in two patients. However, eight patients who received ALK inhibitor (crizotinib or ceritinib) showed good response, with response rate of 87.5% (7/8 with partial response) and durable progression-free survival.
CONCLUSIONS A portion of NSCLC patients have concomitant EGFR and ALK alterations and the frequency of co-alteration detection increases when sensitive detection methods for EGFR mutation are applied. ALK inhibitors appear to be effective for patients with co-alterations.
PubMed IF 80.4 혈액종양내과
16832015

제1저자 이승표 · 교신저자 이활

, , , , , ,
Assessment of diffuse myocardial fibrosis by using MR imaging in asymptomatic patients with aortic stenosis.
Radiology. 2015;274(2):359-69.

Abstract
PURPOSE To assess whether native T1 mapping provides noninvasive estimation of diffuse myocardial fibrosis and whether it correlates with subclinical myocardial dysfunction in asymptomatic patients with aortic stenosis (AS).
MATERIALS AND METHODS The local institutional review board approved the study, and all patients gave informed consent. Eighty asymptomatic patients with moderate or severe AS and normal left ventricular (LV) ejection fraction (mean age, 67 years; range, 31-81 years) and 15 sex-matched control subjects (mean age, 33 years; range, 23-41 years) were prospectively enrolled. Patients underwent two-dimensional echocardiography, speckle tracking imaging, and cardiac 3.0-T magnetic resonance (MR) imaging, including mapping of T1 relaxation time by using the modified Look-Locker inversion-recovery sequence. Correlations between native T1 values and the degree of diffuse fibrosis in myocardial specimens obtained during aortic valve replacement surgery were analyzed in a subset of 20 patients. Correlations between parameters of myocardial function and structure and native T1 values were assessed with Pearson correlation coefficients.
RESULTS Native T1 values correlated well with the degree of diffuse myocardial fibrosis in intraoperative myocardial biopsy specimens (r = 0.777, P < .001) and differed significantly between patients with AS and control subjects (1208 msec ± 45 vs 1169 msec ± 21, P < .001). LV volumes and mass differed significantly according to AS groups, categorized by T1 tertiles (all P < .001), as well as degree of AS severity (0.55 cm(2)/m(2) ± 0.14 for lowest native T1 tertile, 0.46 cm(2)/m(2) ± 0.12 for middle native T1 tertile, and 0.45 cm(2)/m(2) ± 0.13 for highest native T1 tertile [P = .008] for indexed aortic valve area at echocardiography). Native T1 correlated significantly with global longitudinal strain measured with two-dimensional speckle tracking imaging (r = 0.598, P < .001), e' velocity (r = -0.437, P < .001), and indexed left atrial volume (r = 0.475, P < .001).
CONCLUSION Native T1 mapping provides a noninvasive estimation of diffuse myocardial fibrosis and correlates with subclinical myocardial dysfunction in asymptomatic patients with AS.
PubMed IF 17.6 순환기내과
16822015

제1저자 서경진 · 교신저자 김인호

, , , , , , ,
Total costs and clinical outcome of hematopoietic stem cell transplantation in adults with leukemia: comparison between reduced-intensity and myeloablative conditioning.
Clin Transplant. 2015;29(2):124-33.

Abstract
The total cost of hematopoietic stem cell transplantation (HSCT) as well as the financial impact of HSCT on the house holds of patients have been elusive. Between 2005 and 2012, we analyzed 191 HSCT in adult patients with leukemia with reduced-intensity conditioning (RIC) regimen (n = 79) and with myeloablative conditioning (MAC) regimen (n = 112). The direct medical costs were calculated from healthcare claims obtained from the Seoul National University Hospital, and the direct non-medical and the indirect costs were calculated from national statistics. The mean direct medical cost was $55,039, direct non-medical cost was $6394, and indirect cost was $7503 from transplantation to one yr after transplantation in the RIC group and $72,916, $6993, and $9057 in the MAC group, respectively, based on the exchange rate of Korean won 1060 = US$1. The total costs for one yr were $68,938 and $88,967, constituting for 273% and 357% of the per capita income, respectively. The total costs, direct medical costs, and indirect costs showed statistically significant differences (p = 0.006, p = 0.007, and p = 0.017). No significant differences were found for leukemia-free survival and overall survival. RIC-HSCT provides lower costs within the first year of transplantation with comparable long-term clinical outcomes.
PubMed IF 1.8 혈액종양내과
16812015

제1저자 정인아 · 교신저자 이재호

, , , , , ,
Drug-induced hepatotoxicity of anti-tuberculosis drugs and their serum levels.
J Korean Med Sci. 2015;30(2):167-72.

Abstract
The correlation between serum anti-tuberculosis (TB) drug levels and the drug-induced hepatotoxicity (DIH) remains unclear. The purpose of this study was to investigate whether anti-TB DIH is associated with basal serum drug levels. Serum peak levels of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB) were analyzed in blood samples 2 hr after the administration of anti-TB medication. Anti-TB DIH and mild liver function test abnormality were diagnosed on the basis of laboratory and clinical criteria. Serum anti-TB drug levels and other clinical factors were compared between the hepatotoxicity and non-hepatotoxicity groups. A total of 195 TB patients were included in the study, and the data were analyzed retrospectively. Seventeen (8.7%) of the 195 patients showed hepatotoxicity, and the mean aspartate aminotransferase/alanine aminotransferase levels in the hepatotoxicity group were 249/249 IU/L, respectively. Among the 17 patients with hepatotoxicity, 12 showed anti-TB DIH. Ten patients showed PZA-related hepatotoxicity and 2 showed INH- or RMP-related hepatotoxicity. However, intergroup differences in the serum levels of the 4 anti-TB drugs were not statistically significant. Basal serum drug concentration was not associated with the risk anti-TB DIH in patients being treated with the currently recommended doses of first-line anti-TB treatment drugs.
PubMed IF 3.2 호흡기내과
16802015

제1저자 김낙현, 구혜림 · 교신저자 김남중

, , , , , , , , , , , , , , ,
Inappropriate continued empirical vancomycin use in a hospital with a high prevalence of methicillin-resistant Staphylococcus aureus.
Antimicrob Agents Chemother. 2015;59(2):811-7.

Abstract
Vancomycin is frequently inappropriately prescribed, especially as empirical treatment. The aim of this study was to evaluate (i) the amount of inappropriate continued empirical vancomycin use as a proportion of total vancomycin use and (ii) the risk factors associated with inappropriate continued empirical vancomycin use. We reviewed the medical records of adult patients who had been prescribed at least one dose of parenterally administered vancomycin between January and June 2012, in a single tertiary care hospital. When empirically prescribed vancomycin treatment was continued after 96 h without documentation of beta-lactam-resistant Gram-positive microorganisms in clinical specimens with significance, the continuation was considered inappropriate, and the amount used thereafter was considered inappropriately used. We identified risk factors associated with inappropriate continued empirical vancomycin use by multiple logistic regression. During the study period, the amount of parenterally administered vancomycin prescribed was 34.2 defined daily doses (DDDs)/1,000 patient-days (1,084 prescriptions for 971 patients). The amount of inappropriate continued empirical vancomycin use was 8.5 DDDs/1,000 patient-days, which represented 24.9% of the total parenterally administered vancomycin used (8.5/34.2 DDDs/1,000 patient-days). By multivariate analyses, inappropriate continued empirical vancomycin use was independently associated with the absence of any documented etiological organism (adjusted odds ratio [aOR], 1.60 [95% confidence interval {CI}, 1.06 to 2.41]) and suspected central nervous system (CNS) infections (aHR, 2.33 [95% CI, 1.20 to 4.50]). Higher Charlson's comorbidity index scores were inversely associated with inappropriate continued empirical vancomycin use (aHR, 0.90 [95% CI, 0.85 to 0.97]). Inappropriate continued empirical vancomycin use represented 24.9% of the total amount of vancomycin prescribed, which indicates room for improvement.
PubMed IF 4.2 감염내과
16792015

제1저자 이윤빈,정은욱, 김보현 · 교신저자 이정훈

, , , , , , , , , , , , , , , , , , , , ,
Tenofovir monotherapy versus tenofovir plus lamivudine or telbivudine combination therapy in treatment of lamivudine-resistant chronic hepatitis B.
Antimicrob Agents Chemother. 2015;59(2):972-8.

Abstract
Tenofovir disoproxil fumarate (TDF) monotherapy is a therapeutic option for chronic hepatitis B (CHB) patients infected with hepatitis B virus (HBV) variants resistant to lamivudine (LAM). We evaluated the antiviral efficacy and safety of TDF alone compared to those of TDF plus LAM or telbivudine (LdT) combination in patients harboring HBV variants with genotypic resistance to LAM. This multicenter retrospective study included consecutive patients who had LAM-resistant HBV variants and were treated with TDF alone (monotherapy group) or TDF combined with LAM or LdT (combination therapy group) for at least 6 months. Inverse probability of treatment weighting (IPTW) for the entire cohort was applied to control for treatment selection bias. Overall, 153 patients (33 in the monotherapy group and 120 in the combination therapy group) were analyzed. The overall probability of achieving complete virologic suppression at month 12 was 91.6%: 88.6% in the monotherapy group and 92.6% in the combination therapy group. Combination therapy was not superior to monotherapy in viral suppression before and after IPTW (P=0.562 and P=0.194, respectively). Hepatitis B e antigen (HBeAg) loss, biochemical response, and virologic breakthrough did not differ between treatment groups. The probabilities of complete virologic suppression were comparable between treatment groups in the subsets according to HBeAg status and HBV DNA levels at baseline. No patient experienced any significant renal dysfunction during the treatment period. In conclusion, TDF monotherapy has antiviral efficacy comparable to that of TDF plus LAM or LdT combination therapy, with a favorable safety profile in CHB patients with LAM-resistant HBV variants.
PubMed IF 4.2 소화기내과

서울대학교병원 내과 교실이 발표한 SCI 논문입니다. 제목을 누르면 Abstract · 그림 등을, 저자 이름을 누르면 소속 · PubMed · ORCID 를 볼 수 있습니다. 굵은 이름은 동문과 연결된 저자입니다.