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Background/aims: Intraductal papillary mucinous neoplasms (IPMN) are precursor lesions of fatal pancreatic cancer. Physiological function of microRNA is to regulate the stability and translation of mRNA. The aberrant microRNA expression is commonly observed in many cancers. The aim of this study was to analyze the expression pattern of microRNA in IPMN and evaluate the role of the microRNA., Methods: Using two paraffin-embedded IPMN tissues, microRNA expression of normal tissue, IPMN adenoma and carcinoma were compared by cDNA-mediated annealing, selection, extension and ligation microarray assay. Using real time PCR, expression levels of aberrantly up-regulated microRNAs were assessed in another 20 IPMNs, four pancreatic cancer cell lines (Panc1, MiaPaCa-2, XPA-3, BxPC-3) and immortalized pancreatic ductal cell line (HPNE). Effect of suppressing highly over-expressed two microRNAs in pancreatic cancer cell lines with anti-microRNA inhibitors were evaluated using CCK-8 assay., Results: Among aberrantly expressed 122 microRNAs in IPMN, miR-552, miR-25*, miR-183, miR-1300, miR-196a, miR-182*, and miR-30c-1* were consistently increased more than 3-fold. On average, miR-196a and miR-183 increased 10,824 folds and 26,519 folds in four pancreatic cancer cell lines compared with HPNE. These two microRNAs were also over-expressed in 20 IPMNs compared with HPNE. After applying anti-miRNA inhibitors, cell survival of four pancreatic cancer cell lines decreased by 24.5% with anti-miR-196a and by 14.2% with anti-miR-183 on average., Conclusions: Aberrant expression of 122 microRNAs was observed in IPMN. Two microRNAs, miR-196a and miR-183-increased in IPMN and pancreatic cancer cell lines compared with immortalized dancreatic ductal cell line. The inhibitions of these microRNAs repressed cell proliferation of pancreatic cancer cell lines. (Korean J Gastroenterol 2011;58:190-200).

Purpose: The purpose of this study was to develop and implement the Hospice Smart Patient Program and to evaluate its effectiveness., Methods: It was quasi-experimental non-equivalent pre-post study. Breast cancer patients who underwent surgery, chemotherapy or radiotherapy, or who needed palliative care, participated in the study. Participants were divided into two groups, experimental and control groups based on their preferences. The program was developed after literature review and discussion among experts on hospice and palliative care. Participants who were in the experimental group received either face-to-face or phone "Hospice Smart Patient" Service at least once a week for 5 months., Results: There was a significant difference in quality of life and communication skill between the two groups after the service was provided. In addition, participants in experimental group showed improved decision making skills, mastery sense, and understanding of hospice and palliative care, which would be beneficial in improving their quality of life., Conclusion: We have concluded that the "Hospice Smart Patient" Program is useful for cancer patients in decision making, improving self-control and choosing hospice care to improve their quality of life.

Purpose: This study was conducted to assess optimal needle length for gluteal intramuscular injections (IM) via simple skinfold thickness (SFT)., Methods: For this study, 190 healthy adults were recruited and grouped into eight groups according to gender and body mass index (BMI) (kg/m²). The Korean Society for the Study of Obesity criteria defines a BMI under 20 as underweight, 20.1-22.9 as normal, 23-24.9 as overweight and over 25 as obese. For each participant, the SFT of dorsoguteal (DG) and ventrogluteal (VG) sites were measured using a caliper. Subcutaneous tissue thickness was acquired through ultrasonic images., Results: For men in the overweight and obese groups at the DG site, for the obese group at the VG site, and for women in the normal weight, overweight and obese groups at both sites, the mean subcutaneous tissue thickness exceeded 1.84 cm, the minimal length for a 1 inch needle used for IM. At the DG site, optimal intramuscular needle length (OINL) was 1.4 times in women and 1.0 times in men compared to SFT. At the VG site, OINL was 1.3 times in women and 0.9 times in men compared to SFT., Conclusion: The results of this study suggest that SFT is a reliable index to determine optimal needle length with minimal effort prior to IM.

Purpose: This study was done to develop and examine the effects of a self-management program (SMP) on physical, psychological functions, and symptoms in patients with Parkinson's disease(PD)., Methods: In a two-group pre-and post-test design, a total of 40 patients were assigned to the experimental group(21) or the control group (19). The experimental group received eight weekly 2-hour sessions for 10-15 literate adults of all ages, while the control group did not receive any intervention., Results: The experimental group showed significant improvements in muscle strength, balance, self-efficacy, depression, quality of life(QL), quality of sleep, and discomfort of constipation. It also reduced the number of participants using assistive walking devices. There were no significant changes in fear of falling and duration of sleep., Conclusion: The eight week SMP in patients with PD was found to be significantly effective in enhancing muscle strength, balance, self-efficacy, QL, and quality of sleep. It also decreased depression, discomfort of constipation, and assistive walking devices. These results suggest that a SMP can have effects on physical, psychological functions and symptoms in patients with PD. Further research with a larger sample and for a longer follow up period is needed to expand our understanding of the effects of a SMP for patients with PD.

There has been an increase in the number of patients treated with pegylated interferon (PEG-IFN) and ribavirin due to the better antiviral efficacy. The main serious adverse events of PEG-IFN plus ribavirin combination therapy are bone marrow suppression and hemolytic anemia. However, there are few reports of vasculitis occurring during PEG-IFN therapy. We describe a patient who developed vasculitis during the treatment of chronic hepatitis C with PEG-IFN and ribavirin.

Background/aims: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis., Methods: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes., Results: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case., Conclusions: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.

Background/aims: Although diagnosis and surgical treatment for distal common bile duct cancer have enormously advanced, survival is not satisfactory and its prognostic factors are still being debated. Thus, we evaluated the outcomes and prognostic factors after major resection for distal extrahepatic cholangiocarcinoma (dCC)., Methods: One hundred and fifty-four patients who underwent major resection such as pancreatic oduodenectomy for dCC were retrospectively analyzed. We investigated clinical features, postoperative complications, survival, and prognostic factors of dCC., Results: One hundred and three (66.9%) male and 51 (33.1%) female patients were enrolled and their mean age was 59.6 (31-78) years. Among them, 97 patients (63.0%) underwent Whipple's procedure, 45(29.2%) pylorus-preserving pancreatic oduodenectomy, 7 (4.5%) total pancreatectomy, and 5 (3.3%) hepatopancreaticoduodenectomy, respectively. Mean follow-up duration was 26.6 (0.4-108.5) months. The postoperative morbidity and mortality were 42.2% and 1.3%, respectively. Five-year survival rate was 32.8% and mean survival duration was 47.2 (39.1-55.3) months. Type of biliary drainage (percutaneous transhepatic biliary drainage), lymph node status (positive), and cellular differentiation (moderate or poor) were significant indicators for death in multivariate analysis of resectable dCC., Conclusions: Moderate or poor cellular differentiation and lymph node metastasis maybe independent poor prognostic factors for resectable dCC.

Background/aims: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy., Methods: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months., Results: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable., Conclusions: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

Background/aims: Long-term efficacy and the rate of viral breakthrough in patients with HBeAg- negative chronic hepatitis B receiving lamivudine therapy is uncertain. This study was conducted to determine the rate of viral breakthrough according to the HBeAg status and the relation of viral breakthrough with YMDD mutants., Methods: Two hundred and five patients with HBeAg-positive and 49 patients with HBeAg-negative chronic hepatitis B, who had received lamivudine for at least 9 months, were included. The mean durations of the lamivudine treatment were 176 months and 155 months in HBeAg-positive and negative patients, respectively. Analysis of HBV genome for YMDD mutations was performed by restriction-fragment-length polymorphism assay and direct sequencing., Results: While the cumulative rates of viral breakthrough at 12th and 24th months of the lamivudine therapy were 0% and 7% in the HBeAg-negative group, they were 12% and 39% in the HBeAg-positive group. The cumulative rate of viral breakthrough in the HBeAg-negative group was significantly lower than in the HBeAg-positive group (p<0.01). In multivariate analysis, the only significant factor related to viral breakthrough was the HBeAg status (p<0.05). The YMDD mutants were detected in all patients with viral breakthrough irrespective of HBeAg status. However, in patients without viral breakthrough, the rate of YMDD mutants was significantly higher in the HBeAg-negative group than in the HBeAg-positive group (13.3% vs 5.1%; p<0.01)., Conclusions: Lamivudine is expected to be more persistently effective in HBeAg-negative chronic hepatitis B because of a lower viral breakthrough rate than in HBeAg-positive chronic hepatitis B in spite of the emergence of YMDD mutants.

This study was undertaken to evaluate the role of peritoneal exudate cells in the transfer of immunity against the liver fluke, Clonorchis sinensis in the inbred BALB/c mice. Ten donor mice were divided into 2 groups. One group consisted of 5 mice was infected orally with 20 metacercariae of C. sinensis, and the other group was injected intraperitoneally with 20 excysted larvae. Thirty days after immunization, the peritoneal exudate cells were obtained from the donor mice. Twenty recipient mice were divided into 4 equal groups for the purpose of primary immunization. The mice of Group I were injected intraperitoneally with 2 x 10(6) peritoneal exudate cells of the donor mice infected orally, those of Group III were injected intraperitoneally with 2 x 10(6) peritoneal exudate cells of the donor mice injected intraperitoneally. Those of Group II were injected orally with 20 metacercariae of C. sinensis. The group IV mice served as controls. Four days after the primary immunization all recipient mice were challenged orally with 20 metacercariae of C. sinensis, and then killed 30 days after the challenging infection. When the peritoneal exudate cells were injected into the recipient mice, pronounced reduction in eggs per gram of the feces was found in the mice of Group I and Group II, but no reduction in those of Group III. In the worm burdens of C. sinensis, the number of flukes found in the mice of Group II was only significantly less than those in the control group(IV). In addition the number of plaque forming cells per spleen in the mice of Group II was found larger than those in Group I. It is likely that donor peritoneal exudate cells transferred to the recipients might result in the production of relative immunity.

A study of infestation patterns for larval trematodes from fresh-water fish and brackish-water fish was carried out during the period from June to October in 1982. They were collected by netting, fishing with rod and line, and using the bait of crushed oil cake in a transparent plastic bowls at the three localities, Daebon-dong, Kugil-dong, and Hoam-dong in the river Taechong, Kyungpook Province, Korea. Five species of fresh-water fish, the crussian carp, Carassius carassius Linnaeus, the bullhead, Coreobagrus brevicorpus Mori, the fat minnow, Moroco oxycephalus (Bleeker), the flat bitterling, Paracheilognathus rhombea(Temminck et Schlegel), and the catfish, Parasilurus asotus (Linnaeus), and two kinds of brackish-water fish, the grey mullet, Mugil cephalus (Linnaeus) and the sweetfish, Plecoglossus altivelis (Temminck et Schlegel) were examined. Four species of the metacercariae, Exorchis oviformis, Metacercari hasegawai, Metorchis orientalis and undetermined larvae were found. Of these, the encysted larvae of the human intestinal fluke, Metagonimus yokogawai, were found from three kinds of fresh-water fish, the crussian carp, the bullhead and the fat minnow and one species of brackish-water fish, the sweetfish and the infestation rates for the larvae varied appreciably from fish to fish. The intensity of infestation with the Metagonimus larvae in the three species of fresh-water fish as low, and the average number of the larvae per gram of flesh varied from 0.5 to 0.2. By comparison, the brackish-water fish was more heavily infested and the mean number of cysts per gram of flesh in Plecoglossus altivelis was 109.2. It was found that infection with Metagonimus yokogawai is caused by consuming raw fresh-water fish and brackish-water fish caught in the river Taechong, Kyungpook Province, Korea.

Polypeptide antigen as isolated from adult worms of Clonorchis sinensis by means of diluted HCl-extraction method. Preliminary intradermal examination with those polypeptide antigen(CPT) were performed on patients of clonorchiasis, paragonimiasis and metagonimiasis and the result of the intradermal test with CPT antigen were compared with those of Clonorchis protein fraction(CPF) and Veronal buffer saline extraction (VBS) antigen. The result of the examination were summerized as follows: 1. When 0.05 ml (1 microgram) of CPT was injected intradermally, the positive intradermal reaction appeared in 42.7 per cent (37 of 82) on the patients of clonorchiasis. 2. The sizes of the wheal and erythema with CPT antigen was smaller than that of CPF and VBS antigen. 3. Intradermal reaction with CPT antigen was carried out for other parasitic diseases, such as paragonimiasis and metagonimiasis. The result indicated that CPT antigen may be showed no cross reactions. 4. Clonorchiasis pateints who with negative reaction to CPT antigen, reacted negatively to CPF and VBS antigens.

1. Metacercariae of a kind of Levinseniella species were found from a brackish water crabs, Macrophthalmus japonicus de Haan, in the brackish area of Hyungsan river of Kyungpook province. 2. Habitats were the epigastric and progastric regions of Macrophthalmus japonicus. 3. One hundred and seventy five crabs out of 178 examined (98.3 per cent) were infested with metacercariae of Levinseniella species. The infested number of metacercariae in each crabs was average 100 ea. 4. The excystation of metacercaria has not developed in vitro (both saline and tyrode's solution). 5. Many eggs were observed in the metacercariae maintained for 24 or 48 hours in the water-bath. 6. No differences were observed between semi-adult fluke from rat host and those maintained for 24 or 48 hours in vitro.

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii, in the downstream of Hyungsan river which is located in Kyungpook Province of Korea, were carried out serially and the following results were obtained. 1)Metacercariae of Pseudexorchis major were found in six fishes(15.8 %) out of 38 examined. 2)Parasitic frequencies of the encysted metacercaria of Psedexorchis major in Tribolodon taczanowskii were 15.8 %(6 out of 38) in the scale, 10.5 %(4 out of 38) in the fin, 13.2 %(5 out of 38) in the gill, 10.5 %(4 out of 38) in the oral cavity and 7.9 %(3 out of 38) in the flesh. 3)The worms were identified as Pseudexorchis major (Hasegawa, 1935) Yamaguti, 1938 by morphological studies on the metacercariae, excysted metacercariae, adults and eggs, and compared with prereported Pseudexorchis species.

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii Steindachner, in the downstream of Hyungsan river which is located in Kyungpook province of Korea, were carried out, and the following results were obtained. 1)Metacercariae of Metagonimus species were found in seventy five fishes (40.5 percent) out of 185 examined. 2)Parasitic frequencies of the encysted matacercaria of Metagonimus species in Tribolodon taczanowskii were 23.2 percent (43 out of 185) in the scale, 7.0 percent (13 out of 185) in the gill, and 10.3 percent (19 out of 185) in the flesh. 3)The number of the metacercaria in the scale, gill and flesh were fewer than that of the others. 4)The worms were identified as Metagonimus yokogawai Katsurada, 1912 by morphological studies on the adults and eggs, and compared with prereported Metagonimus species.

1. Metacercariae of Centrocestus species were found from a brackish water fish, Tribolodon taczanowskii Steindachner in the downstream of Hyungsan river. 2. Thirty one fishes out of 154 examined (31.8 per cent) were infected with the metacercariae of Centrocestus. sp. 3. Metacercariae were fed to the mouse experimentally and adult worms were recovered from the intestinal mucosa. And they were identified C. asadai Mishima and compared with the prereported Centrocestus sp.