Dae Ryong Kang

Ajou University Medical Center, 수원시, Gyeonggi-do, South Korea

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Publications (69)173.59 Total impact

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    ABSTRACT: We aimed to examine differential effects of WMH on progression of depressive symptoms according to APOE ε4 status in the elderly. We obtained data from elderly Korean subjects (n=707) aged 60 years or older at baseline from the CREDOS study from November 2005 to July 2014. A linear mixed model stratified according to APOE genotype (APOE ε4 carrier vs. non-carrier) was constructed using GDS score as a primary outcome and degree of overall, deep, periventricular WMH evaluated by a visual rating scale as a risk factor of interest. We also tested interaction between APOE ε4, WMH and time as predictors of clinical progression on GDS scores to examine the moderating effect of APOE ε4 allele on the relationship between degree of WMH and progression of geriatric depressive symptoms. The mean (SD) follow-up duration of the participants was 2.0 (0.8) years. Among APOE ε4 carriers, a severe degree of overall and deep WMH, but not periventricular WMH, predicted progression of geriatric depressive symptoms (overall WMH: coefficient=0.96, p=0.010; deep WMH: 0.87, p=0.016). There were significant interaction between APOE ε4, degree of WMH and time in predicting GDS increase (5df, F=2.28, p=0.046). Only subjects seeking medical attention and with follow-up measurements were enrolled in this study. Specific location of WMH and use of antidepressant were uncontrolled. Considering biological markers such as degree of WMH and APOE ε4 status may be clinically relevant to predicting progression of geriatric depressive symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 09/2015; 188:28-34. DOI:10.1016/j.jad.2015.08.032 · 3.38 Impact Factor
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    ABSTRACT: Aromatase inhibitors (AIs), the standard therapy for estrogen receptor- or progesterone receptor-positive breast cancer in postmenopausal women, lead to increased hip fractures in breast cancer patients. To investigate the mechanism of increased incidence of hip fractures in breast cancer patients treated with AIs, we evaluated bone mineral density (BMD) in the cortical and trabecular compartments and assessed femoral geometry using quantitative computed tomography (QCT) in breast cancer patients. In total, 249 early breast cancer patients who underwent QCT in their fifties (mean age 54.3 years) were retrospectively analyzed. Proximal femoral BMD and geometrical parameters were compared. In all regions of the proximal femur, cortical areal BMDs were lower in the AI group than in the non-AI group (p < 0.05). Cortical thickness of the femoral neck, trochanter, and total hip was significantly lower in the AI group compared with the non-AI group (p < 0.05). Analysis of the narrowest section of the femoral neck showed significantly thinner cortical bone and smaller cortical area in the AI group than in the non-AI group (p < 0.05), especially in the superoposterior quadrant. Bone strength parameters in the femoral neck, such as the section modulus and cross-sectional moment of inertia, were significantly lower in the AI group than in the non-AI group (p < 0.05). In conclusion, AI treatment in breast cancer patients is associated with deterioration of femoral cortical BMD and geometry, which could contribute in site-specific weakened bone strength and increased incidence of hip fractures.
    Calcified Tissue International 08/2015; DOI:10.1007/s00223-015-0046-x · 3.27 Impact Factor
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    ABSTRACT: Although inconsistent, reports have shown fibrinogen levels to be associated with atherosclerosis. Accordingly, since cigarette smoking is associated with increased levels of fibrinogen and atherosclerosis, it may also affect the association between fibrinogen and atherosclerosis. We investigated the associations between fibrinogen and carotid intima-media thickness (IMT) according to smoking status in a Korean male population. Plasma fibrinogen levels were measured in 277 men aged 40-87 years without a history of myocardial infarction or stroke. High-resolution B-mode ultrasonography was used to examine the common carotid arteries. IMT level was analyzed both as a continuous (IMT-max, maximum value; IMT-tpm, 3-point mean value) and categorical variable (higher IMT; presence of plaque). Serial linear and logistic regression models were employed to examine the association between fibrinogen and IMT according to smoking status. Fibrinogen levels were positively associated with IMT-max (standardized β=0.25, p=0.021) and IMT-tpm (standardized β=0.21, p=0.038), even after adjusting for age, body mass index, systolic blood pressure, fasting glucose, and total cholesterol to high-density lipoprotein cholesterol ratio in current smokers (n=75). No significant association between fibrinogen and IMT, however, was noted in former smokers (n=80) or nonsmokers (n=122). Adjusted odds ratios (95% confidence interval) for having plaque per one standard deviation higher fibrinogen level were 2.06 (1.09-3.89) for current smokers, 0.68 (0.43-1.10) for former smokers, and 1.06 (0.60-1.87) for nonsmokers. Our findings suggest that cigarette smoking may modify the association between fibrinogen and carotid atherosclerosis. Further studies are required to confirm this finding in different populations.
    Yonsei medical journal 07/2015; 56(4):921-927. DOI:10.3349/ymj.2015.56.4.921 · 1.29 Impact Factor
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    ABSTRACT: Objectives: Eisenmenger syndrome (ES) is commonly associated with depressive symptoms and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). We investigated the predictive value of depressive symptoms and NTproBNP levels for long-term outcomes in patients with ES. Methods: Blood was drawn to measure NT-proBNP, and depressive symptoms were measured using the Korean version of the Beck Depression Inventory (BDI) in an outpatient clinic sample of 64 patients with ES (67% female; median age = 41.5 years [range, 21.0-74.8 years]). Cardiac events (hospitalization, emergency department visits, and cardiac death) were monitored during 3 years of follow-up. Results: During the follow-up period, 15 (23.4%) patients experienced a cardiac event. The combination of depressive symptoms and NT-proBNP levels better predicted future cardiac events than either variable alone. Patients with NT-proBNP > 510 pg/ml and a total BDI score > 10 had a 9.6 times higher risk for cardiac events than did patients with NT-proBNP ≤ 510 pg/ml or total BDI score ≤ 10 (p < .001). Conclusions: Depressive symptoms and NT-proBNP levels are both associated with adverse clinical outcomes in ES.
    Psychosomatic Medicine 06/2015; 77(7):1. DOI:10.1097/PSY.0000000000000201 · 3.47 Impact Factor
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    ABSTRACT: To prospectively evaluate the neuropsychological effect of levetiracetam (LVT) in comparison with carbamazepine (CBZ) and its efficacy and tolerability as a monotherapy in children with focal epilepsy. A total of 121 out of 135 screened children (4-16 years) were randomly assigned to LVT or CBZ groups in a multicenter, parallel-group, open-label trial. The study's primary endpoints were defined as the end of 52 weeks of treatment, followed by analysis of changes observed in a series of follow-up neurocognitive, behavioral, and emotional function tests performed during treatment in the per protocol population. Drug efficacy and tolerability were also analyzed among the intention-to-treat (ITT) population (ClinicalTrials.gov, number NCT02208492). Eighty-one patients (41 LVT, 40 CBZ) from the randomly assigned ITT population of 121 children (57 LVT, 64 CBZ) were followed up to their last visit. No significant worsening or differences were noted between groups in neuropsychological tests, except for the Children's Depression Inventory (LVT -1.97 vs CBZ +1.43, p = 0.027, [+] improvement of function). LVT-treated patients showed an improvement (p = 0.004) in internalizing behavioral problems on the Korean Child Behavior Checklist. Seizure-free outcomes were not different between the 2 groups (CBZ 57.8% vs LVT 66.7%, p = 0.317). Neither LVT nor CBZ adversely affected neuropsychological function in pediatric patients. Both medications were considered equally safe and effective as monotherapy in children with focal epilepsy. This study provides Class II evidence that in patients with pediatric focal epilepsy, LVT and CBZ exhibit equivalent effects on neuropsychological function. © 2015 American Academy of Neurology.
    Neurology 05/2015; 84(23). DOI:10.1212/WNL.0000000000001661 · 8.29 Impact Factor
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    ABSTRACT: To investigate the trends of admission through emergency department and admission undertaking invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea. The National Health Insurance (NHI) claim database between 2007 and 2011 was used. We included all claims for AMI admissions according to the International Classification of Diseases-10th revision codes I21.X as primary or secondary diagnoses. We merged multiple claims into admission episodes using the dates of admission and discharge from every successive hospitalizations. We calculated the proportion of admission through emergency department and admission undertaking invasive or surgical procedures during hospitalization. Invasive or surgical procedures include coronary angiography, coronary angioplasty, and coronary artery bypass surgery. We identified 295,001 discrete AMI admission episodes. The number of claimed AMI admission had been gradually decreased from 66,883 in 2007 to 47,656 in 2011. During the same period, the number and proportion of admission through emergency department had also been decreased from 38,118 (57.0%) to 24,001 (50.4%). However, admission undertaking invasive or surgical procedures had been increased from 15,342 (22.9%) to 17,505 (36.7%). Recently, claims for AMI admission and admission through emergency department has been decreased in the NHI system, but admission undertaking invasive or surgical procedures has been increased. However, using only the insurance claim data might bias the incidence of AMI.
    05/2015; 37. DOI:10.4178/epih/e2015022
  • International Journal of Pediatric Endocrinology 04/2015; 2015(Suppl 1):O27. DOI:10.1186/1687-9856-2015-S1-O27
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    ABSTRACT: Many studies have investigated the association between Guillain-Barré syndrome (GBS) and vaccinations during the influenza A H1N1 pandemic of 2009 (pH1N1). Based on a nationally representative sample, we estimated the incidence of GBS during the pandemic period in Korea. All medical records of GBS cases were reviewed in 28 randomly selected hospitals during 2008-2010, and the number of GBS cases at the national level was extrapolated using emergency care utilization data. The GBS rate per 100,000 person-years was estimated in the reference and pandemic periods. The incidence of GBS was 0.63 (95% CI: 0.37-0.89) per 100,000 person-years in the reference period and 0.87 (0.49-1.26) in the pandemic period. During the vaccination season, the pandemic period GBS incidence rate was not significantly higher than the reference period incidence rate (Rate ratio: 1.52; 0.99-2.32), but difference was observed among persons aged 20-34 years. Rate of GBS increased after pH1N1 vaccination compared to the reference period (1.46, 1.26-1.68). The incidence of GBS increased slightly but not significantly during the pandemic period, although pH1N1 vaccination increased the GBS rate. Therefore, mass influenza vaccination programs should not be precluded on the basis of GBS. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 02/2015; 33(15). DOI:10.1016/j.vaccine.2015.02.035 · 3.62 Impact Factor
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    ABSTRACT: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95 % confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95 % confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.
    Gastric Cancer 02/2015; DOI:10.1007/s10120-015-0472-5 · 3.72 Impact Factor
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    ABSTRACT: Dose-limiting toxicities of docetaxel are widely considered to be neutropenia, anemia, skin toxicity, and nausea. One of the factors that limit the use of docetaxel is its unpredictability of inter-individual variation in toxicity. In order to identify the genetic factors that affect the risk of docetaxel-induced toxicities, we recruited patients who received docetaxel chemotherapy. We genotyped 92 patients with single-nucleotide polymorphisms (SNPs) in 5 genes: CYP3A4 (CYP3A4*1B, CYP3A4*18, and CYP3A4*3), CYP3A5 (CYP3A5*2 and CYP3A5*3), ABCB1 (C1236T, G2677G/T, and C3435T), SLCO1B3 (rs11045585), and ABCC2 (rs12762549). Out of 92 patients, 70 had grade 3 or 4 neutropenia; 4 had grade 1 or 2; and 18 had no toxicity (76.1%, 4.3%, and 19.6%, respectively). The findings of the SNP analysis showed that patients with TT genotype of ABCB1 3435C>T polymorphism showed significantly higher risk of neutropenia and anemia (p=0.029 and p=0.044, respectively). There were significant associations between docetaxel-induced leucopenia and 2677G/T of ABCB1 and rs12762549 of ABCC2 (p=0.025 and p=0.028, respectively). In a multivariate analysis, we observed that patients carrying 2677G>T in ABCB1might be associated with higher risk of chemo-resistance when treated with docetaxel (odds ratio [OR], 6.48; confidence interval, 1.92 to 21.94; p=0.003). In a subgroup analysis of non-small cell lung cancer patients, a significant association of tumor response with G2677T/A (OR, 4.54) in ABCB1 and SLCO1B3 (OR, 9.44) was observed. Our data suggest that ABCB1 (2677G/T) and SLCO1B3 (rs11055585) might be major genetic predictors of docetaxel-related toxicities in patients receiving docetaxel chemotherapy.
    Cancer Research and Treatment 12/2014; 47(3). DOI:10.4143/crt.2014.012 · 3.32 Impact Factor
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    ABSTRACT: Endoscopic resection (ER) and gastrectomy are widely used for early gastric cancer (EGC). However, unexpected cases, which show no cancer after treatment, have occurred. The present study was designed to characterize cancer negative cases after ER and gastrectomy, and determine their long term prognosis. Patients with EGC who underwent ER from January 2004 to October 2012 and gastrectomy from January 2000 to December 2007 were analyzed. There were 13 CFG from 1508 EGC cases after ER (0.9%) and 13 CFG from 4,101 gastrectomy (0.3%), respectively. The tumor size of the CFG group after ER was smaller than the control group (median value of tumor area of CFG vs. control groups, 48.0 mm2 vs. 146.0 mm2, respectively, P = 0.008). However, the CFG group, after gastrectomy, showed marginal differences in size and biopsy number when compared with the control group. There was no mortality in the all CFG. The small diameter and area of EGC are factors which determine if the lesion can be completely removed by forcep biopsy. A final pathology report of “No cancer was detected” after ER and surgery of EGC is not detrimental to the patient.
    Hepato-gastroenterology 10/2014; 61(135):2133-40. DOI:10.5754/hge13479 · 0.93 Impact Factor
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    ABSTRACT: Background: Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD). Methods: We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years). Results: As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD. Conclusion: Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
    International Psychogeriatrics 09/2014; 27(01):1-10. DOI:10.1017/S1041610214001483 · 1.93 Impact Factor
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    ABSTRACT: Purpose Post-polypectomy bleeding is the most common colonoscopic polypectomy complication. However, the risk of post-polypectomy bleeding in liver cirrhosis is unknown. We aimed to evaluate the risk of post-polypectomy bleeding in patients with liver cirrhosis. Materials and Methods We included 89 patients with liver cirrhosis who received colonoscopic polypectomy between January 2006 and October 2012. Three hundred forty-eight subjects without liver disease who underwent colonoscopic polypectomy comprised the control group. Risks of post-polypectomy bleeding were analyzed according to patient- and polyp-related factors. Results Among 89 patients, 75 (84.3%) were Child-Pugh class A, 10 (11.2%) were class B, and 4 (4.5%) were class C. Incidence of immediate post-polypectomy bleeding was significantly increased in cirrhosis with Child-Pugh class B or C compared to liver cirrhosis with Child-Pugh class A or control group [hazard ratio (HR) 3.5; p<0.001]. Polyp size (HR 3.6; p=0.032) and pedunculated polyps (HR 2.4; p=0.022) were also significant risk factors for immediate post-polypectomy bleeding in multivariate analysis. Conclusion Cirrhotic patients with Child-Pugh class B or C have a high risk of immediate post-polypectomy bleeding. Thus, endoscopists should be cautious about performing colonoscopic polypectomy in patients with Child-Pugh class B or C.
    Yonsei Medical Journal 09/2014; 55(5):1281-8. DOI:10.3349/ymj.2014.55.5.1281 · 1.29 Impact Factor
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    ABSTRACT: Context: Although mild to moderate chronic kidney disease (CKD) and vitamin D deficiency are prevalent in the elderly population worldwide and are associated with sarcopenia, their influence on bone mineral density (BMD) has not been determined. Objective: The objective of the study was to determine the combined effects of vitamin D deficiency and CKD on BMD in the elderly population and their relationships with sarcopenia and PTH levels. Design, Setting, and Subjects: This was a cross-sectional study with nationally representative samples of 6949 subjects aged 55 years or older from the Korea National Health and Nutrition Examination Surveys conducted between 2008 and 2011. Main Outcome Measures: The study population was divided into four groups according to vitamin D and CKD status. The combined association of CKD and vitamin D deficiency (<20 ng/mL) with osteopenia or osteoporosis was assessed, and the status of PTH and the sarcopenic index (appendicular skeletal muscle mass as a percentage of body weight or appendicular skeletal muscle mass per weight) as a measure of sarcopenia were evaluated. Results: BMD in the total hip and femoral neck as well as femoral bone geometry was markedly deteriorated in stage 3 and 4 CKD subjects with vitamin D deficiency compared with other groups. Regardless of gender, these subjects also had higher levels of PTH and increased prevalence of sarcopenia. Multivariable logistic regression analyses demonstrated that CKD subjects with vitamin D deficiency showed a significantly increased risk of osteoporosis or osteopenia [odds ratios 1.49 and 2.06 (1.81 and 2.65) at the femur neck and total hip, respectively, in women (men)], which was mainly associated with elevated levels of PTH and sarcopenia in these groups. Conclusions: The combination of mild to moderate CKD and vitamin D deficiency was significantly associated with low BMD in a geriatric population, linked with hyperparathyroidism and sarcopenia.
    Journal of Clinical Endocrinology &amp Metabolism 05/2014; 99(10):jc20133764. DOI:10.1210/jc.2013-3764 · 6.21 Impact Factor
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    ABSTRACT: New-onset postoperative atrial fibrillation (POAF) is associated with poor short- and long-term outcomes after isolated coronary artery bypass graft (CABG). This study evaluated whether new-onset POAF is independently associated with long-term (>1 year) atrial fibrillation (AF) and mortality. Among 1,171 consecutive patients who had undergone CABG, AF and mortality were compared between patients with POAF (POAF group, n = 244) and those without POAF (no-POAF group, n = 927) after propensity score matching. During the follow-up period of 41 ± 23 months (range 0-87 months), the POAF group had a higher incidence of total (20/927 [2.2%] vs 46/244 [18.9%], P < .001) and long-term AF recurrence (13/927 [1.4%] vs 25/244 [10.2%], P < .001). Even after propensity score matching, the POAF group still showed a higher incidence of total (7/244 [2.9%] vs 46/224 [18.9%], P < .001) and long-term AF recurrence (4/244 [1.6%] vs 25/224 [10.2%], P < .001). In addition, the POAF group had a lower cumulative survival free of long-term AF than the no-POAF group (P < .001). In competing risk regression, POAF was an independent predictor of long-term newly developed AF (hazard ratio 4.99, 95% CI 1.68-14.84, P = .004). Cumulative survival free of death was worse in patients with POAF (P = .01). New-onset POAF was shown to be a predictor of long-term newly developed AF in CABG patients. The results of this study suggest that patients who develop POAF should undergo strict surveillance and routine screening for AF during follow-up after surgery.
    American heart journal 04/2014; 167(4):593-600.e1. DOI:10.1016/j.ahj.2013.12.010 · 4.46 Impact Factor
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    ABSTRACT: The clinical significance of spontaneous hepatocellular carcinoma (HCC) rupture association with recurrence pattern and long-term surgical outcomes remains under debate. We investigated the impact of spontaneous HCC rupture on recurrence pattern and long-term surgical outcomes after partial hepatectomy. From 2000 to 2012, 119 patients with diagnosed ruptured HCC were reviewed. To compare outcomes between staged hepatectomy in spontaneously ruptured HCC and hepatectomy in non-ruptured HCC, we performed propensity score-matching to adjust for significant differences in patient characteristics. Overall survival, disease-free survival, and recurrence pattern were compared between the matched groups. Forty-four patients with newly diagnosed ruptured HCC and Child A class were initially treated with transcatheter arterial embolization for hemostasis. Three patients underwent emergency laparotomy, 18 underwent staged hepatectomy, and 23 received transarterial chemoembolization (TACE) alone after transcatheter arterial embolization. Among the 23 patients treated with TACE alone, 10 had resectable tumors. The staged hepatectomy group shows significantly higher overall survival with TACE alone than the resectable tumor group (P < 0.001). After propensity score-matching, overall survival, disease-free survival, and recurrence pattern were not significantly different between the ruptured HCC with staged hepatectomy group and the non-ruptured HCC with hepatectomy group. Peritoneal recurrence rates were similar at 14.3 % versus 10.0 %, respectively (P = 0.632). Patients with spontaneously ruptured HCC with staged hepatectomy show comparable long-term survival and recurrence pattern as patients with non-ruptured HCC having similar tumor characteristics and liver functional status. Thus, spontaneous HCC rupture may not increase peritoneal recurrence and decrease long-term survival after partial hepatectomy.
    World Journal of Surgery 03/2014; 38(8). DOI:10.1007/s00268-014-2502-6 · 2.64 Impact Factor
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    ABSTRACT: Purpose A number of longitudinal studies have tracked blood pressure over time in children and adults. Although there are a few blood pressure tracking studies for Asian populations, they are all relatively short-term studies with around only 10 years of follow-up. Accordingly, we assessed the stability of blood pressure tracking from childhood to adulthood over a 24-year follow-up period among participants in the Kangwha Study. Materials and Methods The Kangwha Study was a community-based prospective cohort study that started in 1986 in Kangwha County, South Korea. The study dataset included 14 blood pressure measurements over a 24-year period from 266 (123 male and 143 female) participants who completed the 2010 examination. All participants were 7 years old when the study began and were followed for the next 24 years. Results The tracking coefficient (95% confidence interval) for systolic blood pressure was 0.81 (0.52-1.11) in men and 0.72 (0.51-0.92) in women; diastolic blood pressure was 0.53 (0.26-0.80) in men and 0.33 (0.15-0.52) in women. After adjusting for body mass index, the tracking coefficient for systolic blood pressure was 0.68 (0.39-0.97) in men and 0.67 (0.44-0.89) in women; diastolic blood pressure was 0.51 (0.24-0.78) in men and 0.33 (0.15-0.51) in women. All tracking coefficients were statistically significant (p<0.001). Conclusion In this 24-year longitudinal study, we confirmed the stability of blood pressure tracking from childhood to adulthood for participants in the Kangwha Study.
    Yonsei medical journal 03/2014; 55(2):360-6. DOI:10.3349/ymj.2014.55.2.360 · 1.29 Impact Factor
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    ABSTRACT: Previous preclinical studies have suggested a close relationship between cerebrovascular disease (CVD) and Alzheimer's disease. However, a direct correlation between CVD and amyloid burden has not yet been shown in humans. If there is a relationship between CVD and amyloid burden, it is possible that the apolipoprotein E4 (APOE4) genotype may have an effect on this relationship because APOE4 is a risk factor for the development of AD. We therefore evaluated the effects of APOE4 on the relationship between white matter hyperintensities (WMH), a marker of CVD, and amyloid burden, measured by 11C-Pittsburgh compound B (PiB) PET. We recruited 53 patients with subcortical vascular cognitive impairments, who had both WMH on MRI and amyloid deposition assessed by PiB PET. Twenty-two of these patients were APOE4 carriers (41.5%). In the APOE4 non-carriers, a significant positive correlation was shown between the volume of WMH and PiB retention (β = 7.0 × 10-3, p = 0.034) while no significant correlation was found in APOE4 carriers (β = -9.0 × 10-3, p = 0.085). Statistical parametric mapping analyses in APOE4 non-carriers showed that WMH were associated with PiB retention in the bilateral medial occipitotemporal gyrus, cuneus, and superior cerebellum. Our results suggested that WMH are correlated with amyloid burden especially in the posterior brain regions in APOE4 non-carriers. However, this correlation was not observed in APOE4 carriers, perhaps because in these subjects the influence of APOE4 overrides the effect of CVD.
    Journal of Alzheimer's disease: JAD 02/2014; 40(4). DOI:10.3233/JAD-130461 · 4.15 Impact Factor
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    ABSTRACT: Accurate tumor size measurement is critical for selecting proper candidates for endoscopic resection (ER) of early gastric cancer (EGC). However, size discrepancy between endoscopic size and pathologic size often occurs during ER for EGC. The purposes of this study were to investigate the clinicopathological characteristics related to size discrepancy and the clinical implications of size discrepancies in terms of therapeutic outcomes. Between April 2006 and June 2013, a total of 820 patients with 826 EGCs underwent ER. Enrolled lesions were categorized into the following three groups based on size discrepancy between endoscopic size and pathologic size: well-estimated (N = 308), underestimated (N = 215), or overestimated (N = 303) lesions. The well-estimated group was defined as lesions with a ratio of endoscopic size to pathologic size from 0.7 to 1.3. The overall median size discrepancy was 5.0 mm (interquartile range 2.0-9.0). Size, location, macroscopic type, primary tumor stage, and histology differed significantly between the three groups. Larger size [odds ratio (OR) 5.07, 95 % confidence interval (CI) 3.38-7.59, p < 0.001], flat/depressed type (OR 1.71, 95 % CI 1.15-2.55, p = 0.008), and undifferentiated histology (OR 2.24, 95 % CI 1.31-3.83, p = 0.003) were independent risk factors for endoscopic size underestimation in multivariate analysis. Smaller size (OR 10.95, 95 % CI 4.64-25.87, p < 0.001) was the only independent predictor for endoscopic overestimation of size. Significantly lower complete resection and curative resection rates were detected in the underestimated group compared with the well-estimated group, while the complete resection rate in the overestimated group tended to be higher than in the well-estimated group. There was no significant difference of curative resection rate between the overestimated and the well-estimated groups. Larger size, flat/depressed type, and undifferentiated histology of EGC carry a significant risk for endoscopic underestimation of lesion size, which results in the lower rates of complete and curative resections for EGC. Further studies to reduce size discrepancy are warranted.
    Surgical Endoscopy 02/2014; 28(7). DOI:10.1007/s00464-014-3453-6 · 3.26 Impact Factor
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    ABSTRACT: Purpose To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer. Materials and Methods A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included. Results The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression. Conclusion If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.
    Yonsei medical journal 01/2014; 55(1):61-9. DOI:10.3349/ymj.2014.55.1.61 · 1.29 Impact Factor

Publication Stats

495 Citations
173.59 Total Impact Points


  • 2015
    • Ajou University Medical Center
      수원시, Gyeonggi-do, South Korea
    • Ajou University
      Sŏul, Seoul, South Korea
  • 2014
    • Wonju Severance Christian Hospital
      Genshū, Gangwon, South Korea
  • 2006–2014
    • Yonsei University Hospital
      • • Surgery
      • • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2003–2014
    • Yonsei University
      • • College of Medicine
      • • Graduate School of Public Health
      Sŏul, Seoul, South Korea
  • 2010
    • Ewha Womans University
      • Department of Preventive Medicine
      Sŏul, Seoul, South Korea
  • 2004
    • University of Suwon
      Suigen, Gyeonggi Province, South Korea