Search

Background: In previous studies, increasing body mass index (BMI, kg/m2) was related to chronic gastrointestinal symptoms, such as frequent vomiting, upper abdominal pain, bloating and diarrhea. However, there have been no reports about the relationship between increasing BMI and abnormal upper endoscopic findings such as gastritis or ulcer. Methods: The study group consisted of 27 319 individuals who underwent medical checkup at a healthcare center from 1 January to 31 December 2003. The following classification of BMI was applied. (i) underweight; BMI < 18.5; (ii) normal weight; 18.5 ≤ BMI < 25.0; (iii) overweight; 25.0 ≤ BMI < 30.0; and (iv) obese; BMI ≥ 30.0. The subjects were grouped according to the findings of upper endoscopy as follows: group 1, those with erosive gastritis, gastric ulcers (benign and malignant) and duodenal ulcers; group 2, those with reflux esophagitis; and group 3, those with findings of upper endoscopy other than group 1 and group 2. Results: The prevalence of obesity and overweight was 2.2% and 30.5%, respectively. By multivariate analyses, overweight (OR 1.31, 95% CI; 1.22–1.40, P = 0.000) and obesity (OR 1.40, 95% CI; 1.14–1.72, P = 0.001) were significant contributors of group 1. Overweight (OR 1.61, 95% CI; 1.42–1.83, P = 0.000) and obesity (OR 2.23, 95% CI; 1.59–3.11, P = 0.000) were also significant contributors of group 2. Conclusions: In the general population, increasing BMI was associated with abnormal upper endoscopic findings, such as erosive gastritis, gastric ulcer, duodenal ulcer and reflux esophagitis. Clarification of the cause-and-effect relationships and the mechanisms of these associations require further investigation. [ABSTRACT FROM AUTHOR]

Background: We sought to evaluate the diagnostic use of multidetector computed tomography (MDCT) cholangiography with multiplanar reformation (MPR) for the assessment of patients with biliary obstruction. Methods: MDCT cholangiography with the MPR technique was performed in 58 patients who were thought to have biliary obstruction. No cholangiographic contrast agent was administered. MRCP in 24 patients, Endoscopic retrograde cholangiopancreatography (ERCP) in 46 patients and percutaneous transhepatic cholangiography (PTC) in 24 patients were performed. Eighteen patients underwent biopsy or surgery. The findings on MDCT cholangiography were compared with those of MRCP, ERCP, PTC, biopsy or surgery. Results: The findings of MDCT cholangiography were as follows: choledocholithiasis ( n = 34, 56.7%), malignant stricture ( n = 14, 23.3%), benign stricture ( n = 1, 1.7%), and cholelithiasis ( n = 11, 18.3%). A small common bile duct (CBD) stone in one patient could not be detected on MDCT cholangiography. One patient with a small stone in distal CBD detected on MDCT cholangiography had no stone on ERCP. Two patients with initial diagnoses of CBD stones by MDCT cholangiography were disclosed to have malignant bile duct stricture by reference examination. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stones were 96.9% and 96.2%, respectively. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stricture were 85.7% and 100%, respectively. The overall accuracy of MDCT cholangiography for the diagnoses of the causes of biliary obstruction was 89.8%. Conclusion: MDCT cholangiography with the MPR technique is a fast and non-invasive technique with relatively high sensitivity and specificity for the diagnoses of the causes of biliary obstruction. [ABSTRACT FROM AUTHOR]

Lemierre's syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. The authors present the case of a 52-year-old woman with literature review. She developed flu-like symptoms and fever, and then painful swelling of the left side of her neck and left arm. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein, subclavian vein, and brachiocephalic vein and diffuse soft tissue inflammation around the veins, No microorganism was identified in the blood and venous thrombus, which was obtained by percutaneous aspiration thrombectomy. Systemic antibiotics and anticoagulation therapy achieved complete resolution of the symptoms. Recanalization of the thrombosed veins with no residual thrombi was observed on duplex scanning after 3 months. No pulmonary embolism or other metastatic infection was observed. Clinical suspicion seems to be essential to make an accurate diagnosis during the early stage of the disease, which is critical to obtain a successful outcome for Lemierre's syndrome. [ABSTRACT FROM AUTHOR]

Helicobacer pyloriinfection is a major gastric cancer risk factor. Deficient DNA mismatch repair (MMR) caused byH. pylorimay underlie microsatellite instability (MSI) in the gastric epithelium and may represent a major mechanism of mutation accumulation in the gastric mucosa during the early stages ofH. pylori-associated gastric carcinogenesis. In this study, we examined the expression of DNA MMR protein (hMLH1 and hMSH2) in patients with chronicH. pyloriinfection before and after eradication of the infection.Gastric tissue samples were collected from 60 patients withH. pylorigastritis and peptic ulcer disease before and after eradication of the infection. The DNA MMR protein expression (hMLH1 and hMSH2) was determined by immunohistochemical staining in 60 patients before and afterH. pylorieradication. The percentage of epithelial cell nuclei and intensity of staining were then compared in gastric biopsies before and after eradication.The percentage of hMLH1 (76.60 ± 20.27, 84.82 ± 12.73,p = .01) and hMSH2 (82.36 ± 12.86, 88.11 ± 9.27,p < .05) positive epithelial cells significantly increased in 53 patients who becameH. pylori-negative after eradication therapy. However, the intensity of hMLH1 and hMSH2 staining was not significantly different. In those 7 patients, who did not respond to the eradication therapy and were stillH. pylori-positive, the percent positivity and intensity of hMLH1 and hMSH2 staining did not change.The expression of DNA MMR proteins increased in the gastric mucosa afterH. pylorieradication, indicating thatH. pylorigastritis may be associated with a reduced DNA MMR system during infection. The effect ofH. pyloriinfection on MMR protein expression appears to be at least partially reversible afterH. pylorieradication. These data suggest thatH. pylorigastritis might lead to a deficiency of DNA MMR in gastric epithelium that may increase the risk of mutation accumulation in the gastric mucosa cells during chronicH. pyloriinfection. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Whether isolated hepatitis B core antibody (anti-HBc) positivity is a risk factor for long-term liver-related outcomes in hepatitis B virus (HBV)-endemic areas remains unclear. We aimed to investigate liver related and liver cancer mortality of isolated anti-HBc positivity in Korean adults. METHODS: A cohort study comprised 609,299 Korean adults who underwent hepatitis B serologic markers, as a part of health examination. Liver-related and liver cancer mortality were determined using the National Death Records. RESULTS: During a median follow-up of 9.0 years (interquartile range, 5.5–13.7 years), 554 liver-related deaths were identified (liver-related mortality, 9.6 cases per 105 person-years). The prevalence of isolated anti- HBc positivity was 3.8% (n= 23,399) and was age-dependent. After adjustment for age, sex, and other confounders, hazard ratios (95% confidence interval) for liver-related mortality in isolated anti-HBc-positive and hepatitis B surface antigen–positive subjects compared with HBV-unexposed subjects were 1.69 (1.22–2.33) and 27.02 (21.45–34.04), respectively. These associations were pronounced in the analyses using liver cancer mortality as an outcome. Among isolated anti-HBc-positive patients, the risks of liver-related and liver cancer mortality were significantly higher in those with high fibrosis-4 scores compared with patients unexposed to HBV with the multivariable-adjusted hazard ratios (95% confidence interval) of 15.59 (9.21–26.37) and 72.66 (36.96–142.86), respectively. DISCUSSION: In this cohort of Korean adults, isolated anti-HBc positivity was associated with an increased risk of liver-related and liver cancer mortality, especially when accompanied by a high fibrosis score. Isolated anti-HBc positivity may be an independent risk factor for liver-related outcomes, especially in high-endemic areas. [ABSTRACT FROM AUTHOR]

Background/Aims We aimed to validate the updated version of Korean stroop test for MHE screening. Methods Liver cirrhosis (LC) patients without history of overt HE were recruited prospectively from 13 centers. All participants completed Korean paper-pencil test (KPPT) and the Korean stroop test. Korean stroop test consisted of two stroop-off states (color and word) and two stroop-on states (inhibition and switching). Four types of "on time+off time"s were analyzed (color-plus-inhibition, color-plus-switching, word-plus-inhibition, and word-plus-switching). MHE was diagnosed when KPPT scores ≥2. Results A total of 119 LC patients and 792 healthy controls were enrolled. The most common etiology of LC was alcohol (62.8%). Mean Model for End Stage Liver Disease (MELD) score of LC patients was 11. Prevalence of MHE was 39.5% by KPPT. Four types of "on time+off time" significantly differed among healthy controls, cirrhosis patients without MHE, and cirrhosis patients with MHE. All types of "on time+off time" showed positive correlation with PHES scores (all p<0.01). The highest area under the curve (AUC) among "on time+off time"s, was for word-plus-inhibition (AUC, 0.699; 95% confidence interval, 0.603 to 0.795; p<0.001) in discrimination of MHE. Ln prothrombin time (international normalized ratio; odds ratio [OR), 197.33; p=0.008) and word-plus-inhibition (OR, 1.012; p=0.011) were significant in multivariate analysis for MHE diagnosis. The cutoff point for the highest Youden's index value was 155 seconds for word-plus-inhibition time with 78.8% of sensitivity and 60.6% of specificity. In the subgroup of patients with MELD score less than 11, on time+off time for word-plus-inhibition was the only prognostic factor in the diagnosis of MHE (OR, 1.008; p=0.037). Conclusions The Korean Stroop Test is simple and valid for screening of MHE. [ABSTRACT FROM AUTHOR]

Background/Aims This study aimed to investigate the relationship between serum zinc level and liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods A cross-sectional study was conducted using nationally representative samples from the Korean National Health and Nutrition Examination Survey 2010. A total of 1,366 adults were enrolled in the study. NAFLD was defined as NAFLD liver fat score -0.640. Liver fibrosis was assessed using fibrosis-4 (FIB-4) index. Zinc was measured using inductively coupled plasma mass spectrometry using PerKinElmer ICP-MS. The change of FIB-4 index according to increases of serum zinc level were analyzed. All analyses were done based on gender. Results Of 1,366 adults, a total of 300 patients with NAFLD (197 males and 103 females) were finally analyzed. The mean levels of serum zinc level increases in male and female were 144.3±30.3 and 131.3±27.2 ug/dL, respectively. FIB-4 index was significantly decreased as serum zinc level increases in male patients with NAFLD (FIB-4: 1.21±0.90, 1.06±0.64, and 0.84±0.45 in serum zinc level <120, 120-160, and ≥160 ug/dL, respectively; p=0.007). On the other hand, there is no significant difference in FIB-4 index in female patients with NAFLD according to serum zinc level (FIB-4: 0.89±0.47, 0.96±0.48, and 0.81±0.38 in serum zinc level <120, 120-160, and ≥160 ug/dL, respectively; p=0.521). Conclusions The relationship between serum zinc level and liver fibrosis in NAFLD is different according to gender. Liver fibrosis in NAFLD is decreased as serum zinc level increases in male patients but not female patients. Further studies are needed clarity the effect of zinc on liver fibrosis in NAFLD. [ABSTRACT FROM AUTHOR]

Background/Aims Besifovir dipivoxil maleate (BSV) is an acyclic nucleotide phosphonate with a potent antiviral activity against hepatitis B virus (HBV). An antiviral efficacy of BSV for 48 weeks was shown to be comparable to tenofovir disoproxil fumarate (TDF) with improved renal and bone safety. We evaluated the efficacy and safety of BSV in treatment- naïve chronic hepatitis B patients in 192 weeks follow-up study. Methods After 48 weeks of double-blind comparison of BSV to TDF, patients continued to participate in the open-label BSV study. We evaluated antiviral efficacy and drug safety up to 192 weeks for both BSV continuing group (BSV-BSV) and the group switched from TDF to BSV after 48 weeks (TDF-BSV). The primary endpoint was virological response (HBV DNA <69 IU/mL). Results Among 197 patients who received randomized treatments, 170 for 2nd year, 157 for 3rd year and 152 for 4th entered the open-label phase extensional study. Finally, 150 patients completed 192 weeks of follow-up. The virological response rate over 192 weeks was 92.5% in BSV-BSV while 93.1% in TDF-BSV patients (p=0.90). HBeAg seroconversion and alanine aminotransferase normalization rates were similar between the groups. There were no drug resistant mutations to BSV. Bone mineral density and renal function were well preserved in BSV-BSV while those were once worsened and then recovered after switching therapy in TDF-BSV patients. Conclusions BSV maintained antiviral efficacy over 192 weeks without any resistance. BSV was also effective for those who have switched from TDF to BSV. BSV was safe and well tolerated. [ABSTRACT FROM AUTHOR]

A correction to the article "Nocardia Brain Abscess in an Immunocompetent Patient" is presented.

A correction to the article "A Case of Acute Pyogenic Sacroiliitis and Bacteremia Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus" is presented.

A correction to the article "A Case of Acute Pyogenic Sacroiliitis and Bacteremia Caused by Community-Acquired Methicillin-Resistant Staphylococcus areus," which appeared in the previous issue is presented.

INTRODUCTION: Dietary carbohydrate restriction or ketogenic diets are known to be beneficial in preventing liver fat accumulation. However, the effect of ketonemia on the risk of nonalcoholic fatty liver disease (NAFLD) in nondiabetic population is largely unknown. We investigated the association between fasting ketonuria and the risk of incident NAFLD in healthy adults. METHODS: A cohort of 153,076 nondiabetic Koreans with no hepatic steatosis and low probability of fibrosis at baseline was followed for a median of 4.1 years. The outcome was incident hepatic steatosis with or without liver fibrosis, and it was assessed by liver ultrasound and noninvasive fibrosis indices, including fibrosis-4 and the NAFLD fibrosis score (NFS). Parametric proportional hazard models were used to estimate hazard ratios (HRs) for outcome according to ketonuria status. RESULTS: Within 677,702.1 person-years of follow-up, 31,079 subjects developed hepatic steatosis. Compared with no ketonuria (reference), fasting ketonuria was significantly associated with a decreased risk of incident hepatic steatosis, with multivariable-adjusted HRs (95% confidence interval) of 0.81 (0.78-0.84). The corresponding HRs for incident hepatic steatosis with intermediate-to-high NFS were 0.79 (0.69-0.90). Similar associations were observed replacing NFS with fibrosis-4. In addition, the presence of persistent ketonuria at both baseline and subsequent visit was associated with the greatest decrease in the adjusted HR for incident NAFLD. DISCUSSION: Ketonuria was associated with a reduced risk of developing incident hepatic steatosis with and without intermediate-to-high probability of advanced fibrosis in a large cohort of nondiabetic healthy individuals. The role of hyperketonemia in the prevention of NAFLD requires further exploration. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Chronic hepatitisB(CHB) remains a major worldwide public health concern. Besifovir dipivoxil maleate (BSV) is a new promising treatment for CHB. However, long-term efficacy and safety have not yet been evaluated. Therefore, the goal of the study is to determine the antiviral efficacy and safety of BSV treatment over a 144-week duration (BSV-BSV) in comparison with those of a sequential treatment with tenofovir disoproxil fumarate (TDF) followed by a 96-week duration BSV administration (TDF-BSV). METHODS: After 48 weeks of a double-blind comparison between BSV and TDF treatments, patients continued the open-label BSV study. Weevaluated antiviral efficacy and drug safety up to 144 weeks for BSV-BSV and TDF-BSV groups. The primary endpoint was a virological response (hepatitis B virus DNA < 69 IU/mL). RESULTS: Among the 197 patients enrolled, 170 and 158 patients entered the second-year and third-year openlabel phase extensional study, respectively, whereas 153 patients completed the 144-week follow-up. The virological response rate over the 144-week period was 87.7% and 92.1% in BSV-BSV and TDFBSV groups, respectively (P 5 0.36). The rates of ALT normalization and HBeAg seroconversion were similar between the groups. No drug-resistant mutations to BSV were noted. Bone mineral density and renal function were well preserved in the BSV-BSV group and were significantly improved after switching therapy in TDF-BSV patients. DISCUSSION: This extensional study of a phase 3 trial (NCT01937806) suggests that BSV treatment is efficacious and safe for long-term use in treatment-naıve and TDF-experienced patients with CHB. [ABSTRACT FROM AUTHOR]

Background: Escherichia coli is the predominant causative pathogen for community-acquired urinary tract infections (UTIs), and the increase in fluoroquinolone-resistant E. coli is of great concern in Korea. The objectives of this study were to investigate the genotypic characteristics and molecular epidemiology of ciprofloxacin-resistant (CIP-R) E. coli isolated from community-acquired UTIs in Korea. Materials and Methods: E. coli samples isolated from the blood or urine were collected from patients with community-acquired acute pyelonephritis aged 15 years and more who were admitted to 12 Korean hospitals from 1st April 2010 to 29th February 2012. Phylogenetic typing, multilocus sequence typing, and molecular characterization of β-lactamase and plasmid mediated quinolone resistance determinants were performed for CIP-R E. coli isolates. Results: A total of 569 E. coli isolates were collected, and 122 (21.4%) isolates were CIP-R isolates. The most prevalent sequence type (ST) was ST131 (28.7%, 35/122), followed by ST393 (14.7%, 18/122), ST1193 (13.1%, 16/122), ST38 (9.0%, 11/122), and ST405 (8.2%, 10/122). The antimicrobial resistance rates of ST131 to cefepime (22.9%, 8/35), ST38 to gentamicin (100%, 11/11), and ST405 to cefotaxime (66.7%, 6/9) were significantly higher than the resistance rates of all other STs combined. Notably, 40% (4/10) of ST405 clones produced extended spectrum β-lactamases and were co-resistant to trimethoprim/sulfamethoxazole. aac(6)-1b-cr (20%, 7/35) and CTX-M-14 (40%, 4/10) were more frequently observed in ST131 and ST405 compared with other clones, respectively. Conclusions: Among the CIP-R uropathogenic E. coli isolates in this study, ST131, ST38, and ST405 were specifically associated with antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background/Aims: Colorectal cancer incidence among patients aged ≤50 years is increasing. This study aimed to develop and validate an advanced colorectal neoplasm (ACRN) screening model for young adults aged <50 years in Korea. Methods: This retrospective cross-sectional study included 59,575 consecutive asymptomatic Koreans who underwent screening colonoscopy between 2003 and 2012 at a single comprehensive health care center. Young Adult Colorectal Screening (YCS) score was developed as an optimized risk stratification model for ACRN using multivariate analysis and was internally validated. The predictive power and diagnostic performance of YCS score was compared with those of Asia-Pacific Colorectal Screening (APCS) and Korean Colorectal Screening (KCS) scores. Results: 41,702 and 17,873 subjects were randomly allocated into the derivation and validation cohorts, respectively, by examination year. ACRN prevalence was 0.9% in both cohorts. YCS score comprised sex, age, alcohol, smoking, obesity, glucose metabolism abnormality, and family history of CRC, with score ranges of 0 to 10. In the validation cohort, ACRN prevalence was 0.6% in the low-risk tier (score, 0-4), 1.5% in the moderate-risk tier (score, 5-7), and 3.4% in the high-risk tier (score, 8-10). ACRN risk increased 2.5-fold (95% confidence interval [CI], 1.8-3.4) in the moderaterisk tier and 5.8-fold (95% CI, 3.4-9.8) in the high-risk tier compared with the low-risk tier. YCS score identified better balanced accuracy (53.9%) than APCS (51.5%) and KCS (50.7%) scores and had relatively good discriminative power (area under the curve = 0.660). Conclusions: YCS score based on clinical and laboratory risk factors was clinically effective and beneficial for predicting ACRN risk and targeting screening colonoscopy in adults aged <50 years. [ABSTRACT FROM AUTHOR]