[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to investigate the association between clinical variables and sudden unexpected death in epilepsy (SUDEP) and identify risk factors for SUDEP. SUDEP is one of the most frequent causes of death in patients with epilepsy. Previous studies have reported possible risk factors associated with SUDEP, but there need to be elucidated yet. The cases were 26 patients with SUDEP and three control patients were included for each case, matched for age, sex, and date of initial clinical visit. All demographic and clinical characteristics, including age, sex, disease duration, classification of epilepsy, age at seizure onset, kind and number of antiepileptic drugs, were compared between cases and controls. Seizure frequency was higher in SUDEP cases than in controls (P=0.035). Univariate analysis using conditional logistic regression showed that higher seizure frequency (odds ratio [OR]=3.1, P=0.021) and the number of antiepileptic drugs (AEDs) (OR=2.0, P=0.009) were significantly associated with SUDEP. Only the number of AEDs remained significant in multivariate analysis (OR=1.8, P=0.026). Frequent seizures and multi-drug therapy were associated with SUDEP. This may suggest that the severity of epilepsy is associated with SUDEP, regardless of the type of AED used.
Journal of Korean medical science 06/2015; 30(6):788-92. DOI:10.3346/jkms.2015.30.6.788 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are limited data on the performance of narrow band imaging (NBI) and Fujinon intelligent color enhancement (FICE) for differentiating polyp histologies.
The aim of this study was to compare the diagnostic performances of NBI and FICE in differentiating neoplastic from non-neoplastic colorectal polyps <10 mm during screening colonoscopy.
A total of 955 average-risk adults undergoing screening colonoscopies were randomly allocated to NBI or FICE groups. Four board-certified staff endoscopists without prior experience using NBI or FICE participated. The main outcomes of this study were overall accuracy, sensitivity, and specificity of FICE and NBI in identifying neoplastic polyps.
There was no significant difference in the number of subjects with adenoma between the NBI (143/475, 30.1 %) and FICE groups (139/480, 29.0 %) (after excluding adenoma ≥1 cm) (P > 0.05). The overall accuracy of NBI was 81.0 %, compared with 81.4 % for FICE (P = 0.867). The overall sensitivity and specificity of NBI and FICE were 84.6 and 78.0 % (P = 0.054); 75.1 and 86.5 % (P = 0.009), respectively. For polyps measuring ≤5 mm, the accuracy was 79.4 % for NBI and 80.1 % for FICE (P = 0.835; sensitivity 81.9 vs. 74.5 %, P = 0.064; specificity 75.7 vs. 88.4 %, P = 0.006).
The overall accuracy of NBI and FICE was similar for differentiating small polyp histologies during screening colonoscopy. However, better results should be achieved before using NBI or FICE as real-time optical biopsy of colorectal polyps in screening colonoscopy.
[Show abstract][Hide abstract] ABSTRACT: Background and AimGallbladder polyps (GBPs) appear to be strongly associated with obesity and metabolic disease. To date, the relationship between GBPs and fatty liver has not been adequately evaluated. The aim of the present study was to investigate whether GBPs are associated with fatty liver, which is an ectopic regional fat deposit, independent of visceral adipose tissue (VAT).MethodsA cross-sectional study using 2,643 health check-up subjects (961 patients with GBP and 1,682 age- and sex-matched healthy controls) was conducted. The subjects underwent various laboratory tests, abdominal fat computed tomography (CT), and hepatic ultrasonography.ResultsThe mean age of the subjects was 51.4 ± 8.3 years, and 74.1% were male. GBPs were significantly associated with fatty liver. Multivariate regression analysis revealed that GBPs were significantly associated with the presence of fatty liver (OR 1.23, 95% CI 1.02-1.48), and adjusting for the HOMA index had little effect on this association (OR 1.23, 95% CI 1.02-1.48). Additionally, GBPs remained significantly associated with the presence of fatty liver after adjustments for CT-measured VAT and SAT (OR 1.24, 95% CI 1.03-1.50). The degree of fatty liver showed an independent (OR 1.37 95% CI 1.03-1.80) and dose-dependent relationship (moderate-severe fatty liver: OR 1.55 95% CI 1.07-2.23, P for trend = 0.014) with large GBPs (≥5mm).Conclusions
Fatty liver, an ectopic regional fat deposit, was found to be closely associated with GBPs independent of known metabolic risk factors, insulin resistance, and CT-measured VAT, confirming a relevant clinical relationship between the two diseases.
Journal of Gastroenterology and Hepatology 11/2014; 30(4). DOI:10.1111/jgh.12841 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Goals: The aim of this study was to prospectively assess the effects of the order of colonoscopic procedures and other possible factors on the adenoma detection rate (ADR). Background: There have been conflicting studies regarding the timing or order of a colonoscopy and its ability to detect adenomas. Study: Between March 2011 and July 2011, consecutive colonoscopies were prospectively performed by 7 board-certified staff endoscopists at the Seoul National University Hospital Healthcare System Gangnam Center. The primary outcome was the overall ADR according to the procedure order of the colonoscopies, and the secondary outcome was the identification of other possible factors influencing the ADR. Results: A total of 1908 colonoscopies were analyzed. The detection rate was 56.5% for all polyps and 37.3% for adenomas. The ADR increased as the performance order of the colonoscopy increased and was highest for the third procedure (43.4%). However, the ADR of the remaining procedures, including later procedures, was similar throughout the workday. In the multivariable analysis, the ADR was significantly associated with older age, male sex, high body mass index, personal history of colorectal polyps, long withdrawal time, and an experienced endoscopist. However, the colonoscopy procedure order was not significantly associated with the ADR. Conclusions: The ADR was stable according to the procedure order for the later procedures of the workday in a setting of moderate daily procedure volumes. The withdrawal time and experience level of the endoscopist were more important than the procedure order in detecting adenomas by colonoscopy. Copyright
Journal of Clinical Gastroenterology 10/2014; Publish Ahead of Print(8). DOI:10.1097/MCG.0000000000000258 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Various factors including age, sex, body mass index (BMI) and history of operation have been linked to the colonoscopic intubation time. The aims of this study were to identify the factors predicting cecal intubation time (CIT) and to evaluate the effect of the visceral adipose tissue (VAT) area on CIT.
Material and methods:
A total of 1386 consecutive subjects who underwent colonoscopy and abdominal CT on the same day for a health checkup at a single health care center in Korea from August to December 2011 were studied prospectively. Age, sex, BMI, height, waist circumference, history of operation, symptoms of irritable bowel syndrome, bowel preparation status, experience of colonoscopists, VAT amount on abdominal CT and time required to reach the cecum were analyzed.
The mean age of the subjects was 53.0 ± 9.6 years, and 63.5% were male. The median CIT was 271 s. Univariate analyses showed that female gender, old age, shorter height, lower BMI, prior history of surgery and lower VAT were associated with longer CIT. To adjust for confounding effects of the gender, we investigated the genders separately in multivariate analysis. Older age and lower VAT were associated with prolonged CIT. However, the significance of association of VAT on prolonged CIT disappeared in women.
This study demonstrates that CIT is prolonged by lower VAT area in men. This is the first study to demonstrate a direct association between VAT area and CIT.
[Show abstract][Hide abstract] ABSTRACT: Abstract High mobility group box 1 (HMGB1) is not only a non-histone nuclear protein but also a pro-inflammatory cytokine. Previously, it has been shown that HMGB1 box A domain (HMGB1A) is an antagonist of HMGB1. HMGB1A can deliver plasmid DNA (pDNA) into cells due to its positive charge and ability to form complexes with pDNA. In this study, TAT-linked HMGB1A (TAT-HMGB1A) was produced using recombinant DNA technology. The pDNA/TAT-HMGB1A/R3V6 ternary complex was then prepared for efficient delivery of pDNA by coating the pDNA/HMGB1A complex with the R3V6 amphiphilic peptide. The particle size of the pDNA/TAT-HMGB1A/R3V6 complex was approximately 120 nm and had the highest delivery efficiency at a 1:5:15 weight ratio. The pDNA/TAT-HMGB1A/R3V6 complex had a higher transfection efficiency than the pDNA/poly-l-lysine (PLL), pDNA/R3V6, and pDNA/TAT-HMGB1A complexes. In the RAW 264.7 cells activated by lipopolysaccharides, the TNF-α and IL-6 levels were decreased by the addition of the pDNA/TAT-HMGB1A/R3V6 complex, suggesting that TAT-HMGB1A maintained the anti-inflammatory effect of HMGB1A. Delivery of the heme oxygenease-1 (HO-1) gene using TAT-HMGB1A/R3V6 further decreased the pro-inflammatory cytokines, due to the anti-inflammatory effect of HO-1. The results suggest that the pDNA/TAT-HMGB1A/R3V6 complex may be a useful gene carrier for gene therapy of inflammatory diseases.
Journal of Drug Targeting 05/2014; 22(8):1-9. DOI:10.3109/1061186X.2014.916711 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Catamenial hemoptysis is a rare condition, characterized by recurrent hemoptysis associated with the presence of intrapulmonary or endobronchial endometrial tissue. Therapeutic strategies proposed for intrapulmonary endometriosis with catamenial hemoptysis consist of medical treatments and surgery. Bronchial artery embolization is a well-established modality in the management of massive or recurrent hemoptysis, but has seldom been used for the treatment of catamenial hemoptysis. We report a case of catamenial hemoptysis associated with pulmonary parenchymal endometriosis, which was successfully treated by a bronchial artery embolization.
Tuberculosis and Respiratory Diseases 05/2014; 76(5):233-6. DOI:10.4046/trd.2014.76.5.233
[Show abstract][Hide abstract] ABSTRACT: Methanotrophic denitrification under a non-aerated condition (without external supply of oxygen or air) was investigated in a bioreactor coupled with a membrane diffuser. Batch experiment demonstrated that both methane consumption and nitrogen production rates were not high in the absence of oxygen, but most of the nitrate was reduced into with 88% recovery efficiency. The methane utilized for nitrate reduction was determined at 1.63 mmol /mmol -N, which was 2.6 times higher than the theoretical value. In spite of no oxygen supply, methanotrophic denitrification was well performed in the bioreactor, due to enhanced mass transfer of the methane by the membrane diffuser and utilization of oxygen remaining in the influent. The denitrification efficiency and specific denitrification rate were 47% and 1.69 mg , respectively, which were slightly lower than for methanotrophic denitrification under an aerobic condition. The average concentration of total organic carbon in the effluent was as low as 2.45 mg/L, which indicates that it can be applicable as a post-denitrification method for the reclamation of secondary wastewater effluent. The dominant fatty acid methyl ester of mixed culture in the bioreactor was and , which was predominantly found in type I and II methanotrophs, respectively. This study presents the potential of methanotrophic denitrification without externally excess oxygen supply as a post-denitrification option for various water treatment or reclamation.
Environmental Engineering Research 03/2014; 19(1). DOI:10.4491/eer.2014.19.1.075
[Show abstract][Hide abstract] ABSTRACT: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In patients with SLE, the prevalence of antiphospholipid antibodies is considerably higher, and is largely responsible for thrombosis. Splenic infarction is a rare complication of arterial thrombosis in patients with SLE. It is important to consider splenic infarction in a patient with SLE complaining of left upper quadrant (LUQ) pain because of the possibility of severe infarction-related complications, such as subcapsular hemorrhage and splenic rupture. We report a case of solitary splenic infarction in a patient with SLE. The only symptom was LUQ pain of 3-day duration. Lupus anticoagulant activity was positive and abdominal-pelvic computed tomography (CT) was consistent with splenic infarction. She did not show any other evidence of thrombotic events. The patient was diagnosed with antiphospholipid syndrome that presented as a splenic infarction in a SLE patient.
[Show abstract][Hide abstract] ABSTRACT: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology and is characterized by presence of variable pathogenic auto-antibodies and multiple organ involvement. Serositis is common in SLE, but peritoneal involvement is relatively rare. This is a case report of 28-year-old female who initially presented with abdominal pain and ascites. After ruling out many other possibilities such as liver cirrhosis, neoplasm, and infectious etiologies, we confirmed SLE with clinical features, serologic tests and radiological findings. To conclude, her abdominal pain and ascites were caused by lupus peritonitis. After administration of corticosteroid therapy, her symptoms fairly improved.
[Show abstract][Hide abstract] ABSTRACT: Virtual chromoendoscopy (CE) is expected to enhance adenoma yield and reduce variation in performance between colonoscopists. This study aimed to compare the efficacy of narrow band imaging (NBI), flexible spectral imaging CE (FICE) and white light (WL) colonoscopy and their impact for less experienced endoscopists.
We performed a randomised tandem colonoscopy trial controlling for withdrawal time and bowel preparation. Average-risk adults undergoing screening colonoscopy were enrolled and randomly assigned to first withdrawal with one of the three imaging modalities (NBI (NBI-WL group), FICE (FICE-WL group) and WL (WL-WL group)). Eight colonoscopists were categorised into expert and non-expert subgroups.
1650 subjects (mean age 51.4 years, 63.9% men) were included (550 in each group). Compared with WL, neither NBI nor FICE increased the mean number of adenomas detected per patient (0.37 vs 0.35 and 0.36; p=0.591) or the percentage of patients with adenoma (25.3% vs 24.5% and 23.6%; p=0.753). For all three modalities, expert subgroups had higher yields of adenomas than non-expert subgroups. Learning curves were observed only for non-expert subgroups with all three modalities. The percentage of missed adenomas did not differ between the three groups (20.8% by WL vs 22.9% by NBI and 26.0% by FICE, p=0.300) and was not affected by endoscopists' expertise.
Neither NBI nor FICE improved adenoma detection or miss rates, with no difference in diagnostic efficacy between the two systems. Virtual CE had no additional benefits over WL for non-experts.
Gut 07/2013; 63(5). DOI:10.1136/gutjnl-2013-304578 · 14.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To evaluate physical activity and other lifestyle risk factors in relation to the prevalence of colorectal adenomas in asymptomatic Koreans.
A total of 1,526 asymptomatic subjects who underwent a colonoscopy were enrolled. Lifestyle factors such as physical activity and smoking data were obtained using a questionnaire. The subjects were grouped into three exposure levels by tertiles of metabolic equivalent hours per week. We evaluated the risk factors in subjects with adenomas by risk stratification (low-risk adenoma group vs. high-risk adenoma group) and by anatomic location (proximal colon, distal colon, rectum, and multiple locations). The high-risk adenoma group was defined as subjects with advanced adenomas or multiple (≥ 3) adenomas.
A total of 456 participants had colorectal adenomas, and 861 had no polyps. In multivariate analyses, higher levels of physical activity were associated with a significantly decreased risk of colorectal adenomas (OR = 0.56, 95% CI 0.40-0.79). This inverse association was stronger for the risk of high-risk adenomas (OR = 0.39, 95% CI 0.21-0.73) than for low-risk adenomas (OR = 0.62, 95% CI 0.43-0.89). The negative relation of physical activity was significant for distal colon adenomas (OR = 0.54, 95% CI 0.30-0.95) and the adenomas with multiple locations (OR = 0.39, 95% CI 0.21-0.72).
Increased physical activity is associated with a reduced prevalence of colorectal adenomas. The inverse association between physical activity and adenoma was stronger for the risk of advanced or multiple adenomas.
Cancer Causes and Control 06/2013; 24(9). DOI:10.1007/s10552-013-0247-4 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of dietary risk factors in colorectal carcinogenesis remains unclear. We investigated the association between dietary intakes and colorectal adenomas who visited a health promotion center for a routine health check-up colonoscopy.
We conducted a retrospective case-control study using data from individuals who had colonoscopy at Seoul National University Hospital Healthcare System Gangnam Center from October 2003 to December 2007. The subjects were 242 patients (162 males and 80 females) with histopathologically confirmed colorectal adenoma, and 464 (272 males and 192 females) controls. Dietary data were obtained via 24 hour dietary recall, assisted by a registered dietitian. The student's t-test and the chi-square test were performed for the statistical comparison of means and proportions among groups. Multivariate analyses using logistic regression were performed to assess the relation between dietary intake and colorectal adenoma.
The total average energy intake of the patients (male: 2,407.5±429.2 kcal, female: 1,901.3±316.9 kcal) was higher than the controls (male: 2,249.6±430.4 kcal, female: 1,752.4±275.0 kcal; p=0.001). High energy intake (male: OR=4.13, 95% CI=1.70-10.05, p=0.002; female: OR=4.00, 95% CI=1.51-10.61, p=0.005) and animal protein intake (male: OR=3.97, 95% CI=1.66-9.49, p=0.002; female: OR=5.76, 95% CI=1.99-16.169, p=0.001) were found to be associated with the risk of colorectal adenoma after adjusting for confounders such as age, BMI, waist circumference, metabolic syndrome and smoking.
In summary, high energy intake and animal protein were associated with colorectal adenoma.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 08/2012; 60(2):102-8. DOI:10.4166/kjg.2012.60.2.102
[Show abstract][Hide abstract] ABSTRACT: Tacrobell(®) (TB) is a generic tacrolimus which showed the comparable efficacy to original product, Prograf(®) (PG) in renal transplantation, but toxicity between two drugs is unclear. The aim of this study was to compare the toxicity between these two formulations. TB and PG (0.5, 1 and 2 mg/kg/day) was administered to rats for 4 weeks. The rat survival rate, kidney, liver and pancreas injury was investigated. The survival rate was similar between TB- and PG-treated rats. TB and PG induced renal dysfunction in a dose-dependent manner. Compared to PG treatment in equal dose, TB treatment reduced urinary creatinine clearance in a less degree and renal interstitial fibrosis was comparable between two regimens. The r-glutamyl transpeptidase was aggravated by tacrolimus treatment, and this was not different between TB and PG treatment. In the intraperitoneal glucose tolerance test, a significant diabetogenic effect was observed in all tacrolimus treated-rats. The glucose tolerance of TB-treated rats was similar to those of PG-treated rats in each dose. The decrement in pancreatic β-cell mass by tacrolimus showed the dose-dependent response and it was comparable between TB and PG treatment. In conclusion, TB is similar to PG in terms of nephrotoxicity, hepatoxicity and diabetogenic effect.
Immunopharmacology and Immunotoxicology 10/2011; 34(3):434-42. DOI:10.3109/08923973.2011.618135 · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postpolypectomy surveillance guidelines for colorectal cancer introduced the concept of 'risk stratification'; however, few studies have been conducted for validation of its usefulness. The aim of this study was to assess the 5-year incidence of advanced neoplasia recurrence based on the risk stratification scheme of the guidelines and to identify its risk factors.
A prospective study of surveillance colonoscopy after screening colonoscopy was carried out at the Seoul National University Hospital Healthcare System Gangnam Center. 3803 asymptomatic Koreans aged 50-69 were enrolled prospectively and 5-year cumulative adenoma rates were analysed according to three risk groups: normal (no baseline adenoma), low-risk (1-2 adenomas <10 mm) and high-risk (an advanced adenoma or ≥ 3 adenomas) groups. The RR was computed by HR using Cox proportional regression after multivariate adjustments. The primary outcome was the 5-year cumulative rate of recurrent advanced adenoma in each risk category and the secondary outcome was its predictive factors.
Among 3803 subjects enrolled between 2003 and 2005, 2452 were followed-up within 5 years: 1242, 671 and 539 in the normal, low-risk and high-risk groups, respectively. Compared with the normal group, the low-risk group had a sufficiently low 5-year incidence and did not show an increased risk for subsequent advanced adenoma (2.4% vs 2.0%, HR=1.14, 95% CI 0.61 to 2.17). Conversely, a significantly higher 5-year rate (12.2%) and early recurrence (4.6, 7.4 and 9.6% at 1, 2 and 3 years) of advanced adenoma were revealed in the high-risk group. Among various patients and adenoma characteristics, only high-risk adenoma (HR=5.95, 95% CI 3.66 to 9.68) along with a number of ≥ 3 (HR=3.06, 95% CI 1.51 to 6.57) and size ≥ 10 mm (HR=3.02, 95% CI 1.80 to 5.06) were independent predictors.
The surveillance interval for low-risk patients could be extended beyond 5 years. Colonoscopic surveillance should be targeted to high-risk patients, and 3-year follow-up after initial polypectomy may be appropriate.
Gut 03/2011; 60(11):1537-43. DOI:10.1136/gut.2010.232876 · 14.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the efficacy of a new polyclonal enzyme immunoassay for the detection of Helicobacter pylori (H. pylori) antigen in stool by determination of the optimal cut-off value in the screening population.
A consecutive 515 patients undergoing a routine health check-up were prospectively enrolled. H. pylori infection was defined if at least two of four tests (histology, rapid urease test, (13)C-urea breath test, and serology) were positive. A stool antigen test (EZ-STEP H. pylori) was performed for the detection of H. pylori. The optimal cut-off value was determined by the receiver-operator characteristic curve. The diagnostic performance of each test was evaluated with regard to the histological diagnosis of atrophic gastritis (AG)/intestinal metaplasia (IM), degree of AG/IM, and old age.
Sensitivity, specificity, positive and negative predictive values, and accuracy of the stool antigen test were 93.1%, 94.6%, 95.1%, 92.3%, and 93.8%, respectively. The sensitivity of histology, rapid urease test, and the (13)C-urea breath test ranged from 89.1% to 97.6%, and their specificity was > 98%, while serology had high sensitivity, but low specificity. The accuracy of the stool antigen test was comparable to that of other methods (93.6-95.9%), whereas it was higher than that of serology. The stool antigen test still showed good diagnostic performance in the setting of progression of AG/IM and in patients over 40 years.
The performance of a new stool antigen test was comparable to that of other methods in the diagnosis of H. pylori infection for the screening population, even with the presence of AG/IM.
Journal of Gastroenterology and Hepatology 03/2011; 26(6):1053-9. DOI:10.1111/j.1440-1746.2011.06705.x · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea.
From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale.
Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%).
We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.
Journal of neurogastroenterology and motility 01/2011; 17(1):54-60. DOI:10.5056/jnm.2011.17.1.54 · 2.30 Impact Factor