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1.  The Relationship Between Physical Activity and Metabolic Syndrome in People With Chronic Obstructive Pulmonary Disease 
The prevalence of metabolic syndrome has been reported to be 20% to 50% in people with chronic obstructive pulmonary disease (COPD). Because such people are sedentary and physically inactive, they are at risk of metabolic syndrome. The extent of this problem, however, is not fully understood.
This study examined the relationship of sedentary time and physical activity to metabolic syndrome and the components of metabolic syndrome in a population-based sample of people with COPD.
This was a secondary analysis of existing cross-sectional data. Subjects with COPD (n = 223) were drawn from the National Health and Nutrition Examination Survey data set (2003–2006). Physical activity was measured by accelerometry. Waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, and fasting glucose level were used to describe metabolic syndrome. Descriptive and inferential statistics were used for analysis.
Fifty-five percent of the sample had metabolic syndrome. No significant differences in sedentary time and level of physical activity were found in people with COPD and metabolic syndrome and people with COPD only. However, those with a mean activity count of greater than 240 counts per minute had a lower prevalence of metabolic syndrome. Waist circumference and glucose level were significantly associated with the time spent in sedentary, light, and moderate to vigorous physical activity.
Metabolic syndrome is highly prevalent in people with COPD, and greater physical activity and less sedentary time are associated with lower rates of metabolic syndrome. This suggests that interventions to decrease the risk of metabolic syndrome in people with COPD should include both reducing sedentary time and increasing the time and intensity of physical activity.
PMCID: PMC4032377  PMID: 24165700
ActiGraph accelerometry; COPD; metabolic syndrome; physical activity; sedentary time
2.  Symptom cluster, healthcare use and mortality in patients with severe chronic obstructive pulmonary disease 
Journal of clinical nursing  2014;23(0):2658-2671.
Aims and objectives
To examine how subgroups of patients with chronic obstructive pulmonary disease, identified by ratings of symptoms (dyspnoea, anxiety, depression and fatigue), affect healthcare use and mortality.
People with chronic obstructive pulmonary disease often experience multiple symptoms. The importance of multiple symptoms and symptom clusters has received increased attention. However, little is known about symptom clusters and their effect on healthcare use and mortality in this population.
Descriptive cross-sectional study.
This secondary data analysis used data from the National Emphysema Treatment Trial. Participants (n = 597) had severe chronic obstructive pulmonary disease. Descriptive and inferential statistics were used to analyse the data that were drawn from structured interviews, questionnaires and clinical measures.
Three subgroup clusters emerged based on four symptom ratings. Mean age, proportion with higher education, proportion using oxygen, disease severity, exercise capacity and quality of life differed significantly between subgroups. Participants with high levels of symptoms used healthcare services more and were more likely to have died at the five-year follow-up than those with low levels of symptoms. Symptom cluster subgroups had more significant relationship with mortality than single symptoms.
Patients with high levels of symptoms require greater clinical attention.
Relevance to clinical practice
Understanding subgroups of patients, based on symptom ratings and their adverse effect on outcomes, may enable healthcare providers to assess multiple symptoms and identify subgroups of patients at risk of increased healthcare use and mortality. Targeting modifiable symptoms within the cluster may be more beneficial than focusing on a single symptom for certain health-related outcome.
PMCID: PMC4108559  PMID: 24460846
chronic obstructive pulmonary disease; healthcare use; mortality; National Emphysema Treatment Trial; symptoms
3.  Metabolic Syndrome and Associated Factors in People With Chronic Obstructive Pulmonary Disease 
The prevalence of metabolic syndrome (MetS) in people with chronic obstructive pulmonary disease (COPD) varies in European and Asian countries and does not always mirror the prevalence of the general population in a given country. We compared the prevalence of MetS in people with COPD with a comparison group in the United States. The National Health and Nutrition Evaluation Survey data set (2007–2010) was used to identify 94 people with COPD (mean age = 62). Data for demographic and clinical characteristics were obtained by interview and physical examination. Descriptive and inferential statistics were used to analyze the data. The prevalence of MetS was 57.5% in the COPD group and 53.6% in the comparison group. In people with COPD, the factors most significantly associated with MetS were age, income level, marital status, and respiratory symptoms. People with COPD should be screened for MetS.
PMCID: PMC4031648  PMID: 24292806
National Health and Nutrition Evaluation Survey; metabolic syndrome; chronic obstructive pulmonary disease
4.  Genetic polymorphism at codon 10 of the transforming growth factor-β1 gene in patients with alcoholic liver cirrhosis 
Transforming growth factor beta1 (TGF-β1) is a key cytokine in the production of extracellular matrix. A genetic polymorphism at codon 10 of the TGF-β1 gene is associated with liver fibrosis. We investigated the effect of genetic polymorphisms at codon 10 on the development of alcoholic liver cirrhosis (ALC).
In total, 119 controls and 182 patients with ALC, were enrolled in the study. Clinical and laboratory data including total lifetime alcohol intake were collected at enrollment. The genotype at codon 10 was determined for each patient by single-strand conformation polymorphism.
There were three types of genetic polymorphism at codon 10: homozygous proline (P/P), heterozygous proline/leucine (P/L), and homozygous leucine (L/L). Among the controls, the proportions of P/P, P/L, and L/L were 26.1%, 44.5%, and 29.4%, respectively in the ALC group, these proportions were 23.1%, 43.4%, and 33.5%, respectively. The genotype distribution did not differ between the controls and the ALC group. In the ALC group, age, total lifetime alcohol intake, and distribution of Child-Pugh class did not differ with the genotype. Of the male patients with ALC (n=164), the proportions of P/P, P/L, and L/L were 20.1%, 44.5%, and 35.4%, respectively the genotype distribution did not differ between the male controls and the male ALC patients.
The genotype at codon 10 in TGF-β1 does not appear to influence the development of ALC. Further study is needed to investigate other genetic factors that influence the development of ALC in patients with chronic alcohol intake.
PMCID: PMC3304620  PMID: 21494076
Transforming growth factor beta1; Alcoholic liver cirrhosis; Genetic polymorphism
5.  Atypical distribution of inflammation in newly diagnosed ulcerative colitis is not rare 
Ulcerative colitis (UC) is one of many conditions belonging to a broad group of inflammatory bowel diseases. Although UC has many characteristic, distinguishing features, previous reports have described a significant number of patients who show evidence of ‘skip lesions’, also referred to as appendiceal orifice inflammation. Increased awareness of these lesions and advances in endoscopic technology have led to more specificity in diagnosing subgroups of UC. However, because the natural course of UC in patients with skip lesions remains unclear, false diagnoses of other inflammatory bowel diseases occasionally occur. This study retrospectively reviewed colonoscopic findings of more than 200 patients with newly diagnosed, untreated UC in South Korea and found that atypical distributions of inflammatory lesions were not as rare as initially believed.
Appendiceal orifice inflammation (AOI) is a common ‘skip lesion’ in patients with ulcerative colitis (UC). However, other skip lesions are less well known.
To evaluate the atypical distribution of UC lesions, other than AOI, in terms of their frequency, pattern, risk factors and prognostic implications.
A retrospective analysis of colonoscopic findings and clinical course of 240 adult UC patients who were initially diagnosed at Asan Medical Center (Seoul, South Korea) was performed.
Of 240 patients, 46 (19.2%) showed an atypical distribution of lesions at initial colonoscopy: eight (3.3%) had rectal sparing (segmental-type UC); and 38 (15.8%) had patchy/segmental skip lesions other than AOI. Skip lesions were detected more frequently in proximal segments of the colon than in distal segments (P=0.001). An atypical distribution was more common in patients with AOI (31.3%) than in those without AOI (10.6%; P<0.001). The clinical course of patients with an atypical distribution was not different from that of patients with a typical distribution in terms of remission, relapse, disease extension, colectomy and mortality. In addition, of the 36 patients with an atypical distribution of lesions at diagnosis who underwent follow-up colonoscopy, 24 (66.7%) demonstrated a typical distribution of lesions.
Patchy/segmental skip lesions and rectal sparing occur not infrequently in adult patients with newly diagnosed, untreated UC. As such, these features alone should not be considered to be definitive evidence against a diagnosis of UC. There does not appear to be a prognostic implication of an atypical distribution of lesions.
PMCID: PMC4071881  PMID: 24619632
Colonoscopy; Diagnosis; Prognosis; Skip lesion; Ulcerative colitis
6.  Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003–2006) 
People with chronic obstructive pulmonary disease (COPD) are sedentary but the extent of the problem is not fully understood.
This study examines sedentary time and physical activity (PA) and the relative effects of demographic and clinical characteristics on sedentary time and PA in a population-based sample of people with COPD and a comparison group from the general population.
Subjects were drawn from the National Health and Nutrition Examination Survey dataset (2003–2006). Physical activity was measured by accelerometry.
People with COPD were sedentary and spent less time in most levels of PA. Age, gender, race, level of education, working status, shortness of breath, self-reported health, and body mass index were significantly associated with sedentary time or level of PA.
Findings emphasize the need to decrease sedentary time and increase PA in people with COPD.
PMCID: PMC4031646  PMID: 23726356
ActiGraph accelerometry; COPD; Physical activity; Sedentary time
7.  Subgroup analysis of symptoms and their effect on functioning, exercise capacity, and physical activity in patients with severe chronic obstructive pulmonary disease 
Little is known about symptom clusters and their effect on outcomes in people with chronic obstructive pulmonary disease (COPD).
To determine whether subgroups of patients with COPD could be identified by symptom ratings, whether they differed on selected demographic and clinical characteristics, and whether they differed on functioning, exercise capacity, and physical activity.
Subjects with severe COPD (n = 596) were drawn from the National Emphysema Treatment Trial dataset. Data were drawn from questionnaires and clinical measures.
Two subgroup clusters emerged from four symptoms. Mean age and the proportion of participants with higher education, higher income levels, and using oxygen at rest were significantly different between subgroups. Participants with high levels of symptoms had lower functioning and decreased exercise capacity. Symptom cluster subgroups were significantly associated with social functioning.
These findings suggest that screening for high levels of symptoms may be important in patients with severe COPD.
PMCID: PMC4031650  PMID: 24054947
Chronic obstructive pulmonary disease; Functioning; National Emphysema Treatment Trial; Symptoms; Symptom clusters
8.  Frailty in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003–2006) 
Little is known about frailty in people with chronic obstructive pulmonary disease (COPD). The purposes of this study were to describe frailty, to identify, which demographic and clinical characteristics contributed to frailty, and to examine the relationship between frailty and health-related outcomes in people with COPD.
This was a secondary cross-sectional study, using data from the National Health and Nutrition Evaluation Survey. The frailty index and outcome measures were derived primarily from survey responses.
The prevalence of frailty was 57.8%. Multivariate logistic regression showed that individuals with COPD who had self-reported shortness of breath and comorbid diabetes were more likely to be frail than those who did not. Frail people tended to have a greater number of disabilities.
The findings support the importance of frailty in the COPD population. Further study is needed to understand frailty in people with COPD, using objective measures for criteria of frailty.
PMCID: PMC4020241  PMID: 23535142
Accelerometer; Chronic obstructive pulmonary disease; Frailty; NHANES; Older people
9.  Extracellular Vesicles Derived from Gut Microbiota, Especially Akkermansia muciniphila, Protect the Progression of Dextran Sulfate Sodium-Induced Colitis 
PLoS ONE  2013;8(10):e76520.
Gut microbiota play an important part in the pathogenesis of mucosal inflammation, such as inflammatory bowel disease (IBD). However, owing to the complexity of the gut microbiota, our understanding of the roles of commensal and pathogenic bacteria in the maintenance of immune homeostasis in the gut is evolving only slowly. Here, we evaluated the role of gut microbiota and their secreting extracellular vesicles (EV) in the development of mucosal inflammation in the gut. Experimental IBD model was established by oral application of dextran sulfate sodium (DSS) to C57BL/6 mice. The composition of gut microbiota and bacteria-derived EV in stools was evaluated by metagenome sequencing using bacterial common primer of 16S rDNA. Metagenomics in the IBD mouse model showed that the change in stool EV composition was more drastic, compared to the change of bacterial composition. Oral DSS application decreased the composition of EV from Akkermansia muciniphila and Bacteroides acidifaciens in stools, whereas increased EV from TM7 phylum, especially from species DQ777900_s and AJ400239_s. In vitro pretreatment of A. muciniphila-derived EV ameliorated the production of a pro-inflammatory cytokine IL-6 from colon epithelial cells induced by Escherichia coli EV. Additionally, oral application of A. muciniphila EV also protected DSS-induced IBD phenotypes, such as body weight loss, colon length, and inflammatory cell infiltration of colon wall. Our data provides insight into the role of gut microbiota-derived EV in regulation of intestinal immunity and homeostasis, and A. muciniphila-derived EV have protective effects in the development of DSS-induced colitis.
PMCID: PMC3811976  PMID: 24204633
10.  Inhibition of 15-hydroxyprostaglandin dehydrogenase by Helicobacter pylori in Human Gastric Carcinogenesis 
Helicobacter pylori (H pylori) infection induces a chronic inflammatory response, which promotes gastric carcinogenesis. 15-hydroxyprostaglandin dehydrogenase (15–PGDH) plays a key role as a tumor suppressor in gastrointestinal cancers. The aim of this study was to elucidate the role of 15-PGDH in gastric carcinogenesis associated with H pylori. 15-PGDH expression in gastric biopsies from H pylori-infected (n=25) and non-infected (n=15) subjects was analyzed by quantitative real-time PCR, western blot analysis, and immunohistochemisty. 15-PGDH DNA methylation was evaluated by methylation specific PCR and pyrosequencing. The expression of 15-PGDH, Snail, ERK1/2, TLR4 and MyD88 in response to H pylori infection was assessed by immunoblot analysis. Compared to negative specimens, H pylori positive specimens had 2-fold lower 15-PGDH mRNA levels and significantly less 15-PGDH protein. In four H pylori infected subjects with longitudinal follow-up, the suppression of 15-PGDH expression was reversed by H pylori eradication therapy. In parallel with suppressing 15-PGDH expression, H pylori infection activated expression of TLR4 and MyD88 expression, increased levels of phospho-ERK1/2, and increased expression of epidermal growth factor receptor (EGFR)-Snail. Inhibition of Snail and MyD88 reversed suppression of 15-PGDH expression and small interfering Myd88 reduced phosphorylated ERK1/2. Similarly, treatment with an ERK1/2 and EGFR inhibitor also restored 15-PGDH expression. Heliocobacter pylori appeared to promote gastric carcinogenesis by suppressing15-PGDH. This process is mediated by the TLR4/MyD88 pathway via ERK1/2 or EGFR - Snail transcriptional regulation. 15-PGDH may be a useful marker and a potential therapeutic target in H pylori-induced gastric carcinogenesis.
PMCID: PMC3796116  PMID: 23430757
Gastric cancer; Helicobacter pylori; 15-prostaglandin dehydrogenase
11.  Electrical Stimulation Therapy in Chronic Functional Constipation: Five Years' Experience in Patients Refractory to Biofeedback Therapy and With Rectal Hyposensitivity 
Biofeedback therapy (BFT) can be unsuccessful in constipated patients, even those with pelvic floor dysfunction. Electrical stimulation therapy (EST) has been introduced as a novel therapeutic modality in patients with chronic constipation, especially those who have rectal hyposensitivity. We evaluated the efficacy of EST based on five years' clinical experience.
From January 2002 to February 2007, 159 patients underwent EST. After exclusion of 12 drop-outs, 147 (M:F = 61:86, 49 ± 17 years) finished all treatment sessions. Among them, 88 (M:F = 29:59, 49 ± 17 years) were refractory to BFT without rectal hyposensitivity (RH), and 59 (M:F = 32:27, 54 ± 17 years) were those with RH.
The overall response to EST was 59.2% (87/147) by per-protocol analysis. In the EST-responsive group, overall satisfaction improved significantly (from 7.3 ± 3.0 to 4.3 ± 2.5, P < 0.05). Subgroup analysis showed that the response rate was 64.8% (57/88) in patients refractory to BFT without RH, and 50.8% (30/59) in those with RH.
EST may have additional therapeutic efficacy in patients who are refractory to BFT. EST may also be effective in patients with RH, including restoration of rectal sensation. Therefore, EST could be considered as an alternative choice in patients refractory to BFT and with or without RH.
PMCID: PMC3714415  PMID: 23875104
Biofeedback; Constipation; Electric stimulation therapy
12.  Toxoplasma Encephalitis in an Allogeneic Hematopoietic Stem Cell Transplant Recipient in Korea 
PMCID: PMC3372812  PMID: 22707900
Toxoplasmosis; Cerebrum; Hematopoietic stem cell transplantation
13.  Regression of Advanced Gastric MALT Lymphoma after the Eradication of Helicobacter pylori 
Gut and Liver  2012;6(2):270-274.
A 66-year-old female presented with a 1-month history of dyspepsia. An initial upper gastrointestinal endoscopy with biopsy revealed a low-grade mucosa-associated lymphoid tissue (MALT) lymphoma. A rapid urease test was positive for Helicobacter pylori. Endoscopic ultrasound (EUS) and computed tomography (CT) revealed a 30×15-mm lymph node (LN) in the subcarinal area. Histopathologic and phenotypic analyses of the biopsy specimens obtained by EUS-guided fine-needle aspiration revealed a MALT lymphoma, and the patient was diagnosed with a stage 4E gastric MALT lymphoma. One year after H. pylori eradication, the lesion had disappeared, as demonstrated by endoscopy with biopsy, CT, fusion whole-body positron emission tomography, and EUS. Here, we describe a patient with gastric MALT lymphoma that metastasized to the mediastinal LN and regressed following H. pylori eradication.
PMCID: PMC3343168  PMID: 22570759
Marginal zone B-cell lymphoma; Stomach
14.  The effect of tracheal tube size on air leak around the cuffs 
This randomized single-blinded, cross-over study was done to evaluate the influence of the size of tracheal tubes on air leaks around the cuffs.
In a benchtop model, the number of longitudinal folds on the cuffs was evaluated for different sizes of tracheal tubes. In an anesthetized patient study, thirty patients scheduled for elective surgery under general anesthesia were included. After induction of anesthesia, the trachea was intubated with two sizes of tracheal tubes in a random sequence: in men, internal diameter of 7.5 mm and 8.0 mm; in women, internal diameter of 7.0 mm and 7.5 mm. After tracheal intubation with each tube, air leak pressures were evaluated at intracuff pressures of 20, 25 and 30 cmH2O by auscultation. To calculate the tracheal tube resistance (R), an inspiratory pause of 20% was applied and the resulting peak airway pressure (Ppeak), plateau pressure (Ppl) and mean expiratory tidal volume (Flow) were inserted in the formula R = (Ppeak - Ppl)/Flow.
More longitudinal folds of the tracheal tube cuffs occurred in larger sized tubes compared to the smaller ones in a benchtop model. Air leakage was significantly less for the smaller tracheal tubes than for the larger ones for each gender at intracuff pressures of 20, 25 and 30 cmH2O. Tracheal tube resistances were not significantly altered by the size of tracheal tube.
The use of a smaller tracheal tube within an acceptable size can reduce air leakage around the cuff without significantly changing the tracheal tube resistance.
PMCID: PMC3155132  PMID: 21860747
Anesthesia; Intratracheal; Intubation
15.  Additional Evidence for the Affective Dimension of Dyspnea in Patients with COPD 
Research in nursing & health  2010;33(1):4-19.
The primary purpose of this secondary analysis was to determine whether 103 participants with chronic obstructive pulmonary disease rated the affective dimension of dyspnea (dyspnea-related anxiety and dyspnea-related distress) separately from the sensory dimension (intensity) during baseline exercise testing conducted as part of a randomized clinical trial. A secondary purpose was to determine if dyspnea-related anxiety and distress were rated distinctly different from other measurements of anxiety. At the end of a 6-minute walk and an incremental treadmill test, participant ratings of the magnitude of dyspnea-related anxiety and distress on the Modified Borg Scale were significantly different from their ratings of the intensity of dyspnea. Dyspnea-related anxiety and distress also appeared to be concepts independent from measures of state anxiety, negative affect, and anxiety before a treadmill test.
PMCID: PMC3000805  PMID: 19937752
COPD; dyspnea; anxiety; affective dimension

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