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1.  Long-Term Clinical Outcomes of Korean Patient With Crohn's Disease Following Early Use of Infliximab 
Intestinal Research  2014;12(4):281-286.
Several recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.
Patients with a diagnosis of CD established between July 1987 and January 2012 were investigated in 12 university hospitals in Korea. Because insurance coverage for IFX treatment began in August 2005, patients were assigned to either of 2 groups based on diagnosis date. The first group included patients diagnosed from July 1987 to December 2005, and the second from January 2006 to January 2012. We compared the cumulative probabilities of operation and reoperation between the two groups using the Kaplan-Meier method and a log-rank test.
Of the 721 patients investigated, 443 (61.4%) comprized the second group. Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.
The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD. These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.
PMCID: PMC4214954  PMID: 25374493
Crohn disease; Infliximab; Prognosis
2.  Superior Mesenteric Vein Thrombosis as an Early Presentation of Myelodysplastic Syndrome: A Case Report 
Intestinal Research  2014;12(2):157-161.
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
PMCID: PMC4204708  PMID: 25349584
Mesenteric vein; Thrombosis; Myelodysplastic syndrome
3.  Comparison of the Clinical Characteristics of Patients with Small Bowel and Gastric Anisakiasis in Jeju Island 
Gut and Liver  2012;7(1):23-29.
Anisakiasis is frequent in Jeju Island because of the people's habit of ingesting raw fish. This study evaluated the clinical characteristics of patients with small bowel anisakiasis and compared them with those of patients with gastric anisakiasis.
We retrospectively reviewed the medical records of 109 patients diagnosed with anisakiasis between May 2003 and November 2011.
Of the 109 patients diagnosed with anisakiasis, those with suspicious anisakiasis (n=38) or possible anisakiasis (n=12) were excluded. The age and gender distributions did not differ between patients with small bowel anisakiasis (n=30; age, 45±13 years) and those with gastric anisakiasis (n=29; age, 46±10 years). The mean duration of hospitalization was 5.4±4.3 days for patients with small bowel anisakiasis and 0.5±1.7 days for patients with gastric anisakiasis. Small bowel anisakiasis was accompanied by leukocytosis (76.7% vs 25.5%, p=0.003) and elevated C-reactive protein levels (3.4±3.2 mg/dL vs 0.5±0.3 mg/dL, p=0.009). Contrast-enhanced abdominopelvic computed tomography showed small bowel wall thickening with dilatation in 93.3% (28/30) of patients and a small amount of ascites in 80.0% (24/30) of patients with small bowel anisakiasis.
Compared with gastric anisakiasis patients, small bowel anisakiasis patients had a longer hospitalization time, higher inflammatory marker levels, and small bowel wall thickening with ascites.
PMCID: PMC3572316  PMID: 23423474
Anisakiasis; Small intestine; Stomach; Characteristics
4.  Infants’ Reasoning About Others’ False Perceptions 
Developmental Psychology  2008;44(6):1789-1795.
Prior research suggests that children younger than age 3 or 4 do not understand that an agent may be deceived by an object’s misleading appearance. The authors asked whether 14.5-month-olds would give evidence in a violation-of-expectation task that they understand that agents may form false perceptions. Infants first watched events in which an agent faced a stuffed skunk and a doll with blue pigtails; the agent consistently reached for the doll, suggesting that she preferred it over the skunk. Next, while the agent was absent, the doll was hidden in a plain box, and the skunk was hidden in a box with a tuft of blue hair protruding from under its lid. Infants expected the agent to be misled by the tuft’s resemblance to the doll’s hair and to falsely perceive it as belonging to the doll. These and other results indicate that 14.5-month-old infants can already reason about agents’ false perceptions.
PMCID: PMC3372913  PMID: 18999340
infant cognition; action comprehension; psychological reasoning; theory of mind; false perception
5.  Effect of Probiotic Lactobacillus (Lacidofil® Cap) for the Prevention of Antibiotic-associated Diarrhea: A Prospective, Randomized, Double-blind, Multicenter Study 
Journal of Korean Medical Science  2010;25(12):1784-1791.
Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic use. There is growing interest in probiotics for the treatment of AAD and Clostridium difficile infection because of the wide availability of probiotics. The aim of this multicenter, randomized, placebo-controlled, double-blind trial was to assess the efficacy of probiotic Lactobacillus (Lacidofil® cap) for the prevention of AAD in adults. From September 2008 to November 2009, a total of 214 patients with respiratory tract infection who had begun receiving antibiotics were randomized to receive Lactobacillus (Lacidofil® cap) or placebo for 14 days. Patients recorded bowel frequency and stool consistency daily for 14 days. The primary outcome was the proportion of patients who developed AAD within 14 days of enrollment. AAD developed in 4 (3.9%) of 103 patients in the Lactobacillus group and in 8 (7.2%) of 111 patients in the placebo group (P=0.44). However, the Lactobacillus group showed lower change in bowel frequency and consistency (50/103, 48.5%) than the placebo group (35/111, 31.5%) (P=0.01). Although the Lacidofil® cap does not reduce the rate of occurrence of AAD in adult patients with respiratory tract infection who have taken antibiotics, the Lactobacillus group maintains their bowel habits to a greater extent than the placebo group.
PMCID: PMC2995234  PMID: 21165295
Probiotics; Lactobacillus; Antibiotic-associated Diarrhea
6.  Can an agent’s false belief be corrected by an appropriate communication? Psychological reasoning in 18-month-old infants 
Cognition  2008;109(3):295-315.
Do 18-month-olds understand that an agent’s false belief can be corrected by an appropriate, though not an inappropriate, communication? In Experiment 1, infants watched a series of events involving two agents, a ball, and two containers: a box and a cup. To start, agent1 played with the ball and then hid it in the box, while agent2 looked on. Next, in agent1’s absence, agent2 moved the ball from the box to the cup. When agent1 returned, agent2 told her “The ball is in the cup!” (informative-intervention condition) or “I like the cup!” (uninformative-intervention condition). During test, agent1 reached for either the box (box event) or the cup (cup event). In the informative-intervention condition, infants who saw the box event looked reliably longer than those who saw the cup event; in the uninformative-intervention condition, the reverse pattern was found. These results suggest that infants expected agent1’s false belief about the ball’s location to be corrected when she was told “The ball is in the cup!”, but not “I like the cup!”. In Experiment 2, agent2 simply pointed to the ball’s new location, and infants again expected agent1’s false belief to be corrected. These and control results provide additional evidence that infants in the second year of life can attribute false beliefs to agents. In addition, the results suggest that by 18 months of age infants expect agents’ false beliefs to be corrected by relevant communications involving words or gestures.
PMCID: PMC2808001  PMID: 18976745
7.  Reinfection rate and endoscopic changes after successful eradication of Helicobacter pylori 
AIM: To determine the long-term outcomes regarding reinfection with Helicobacter pylori (H. pylori) and endoscopic changes after successful H. pylori eradication.
METHODS: From June 1994 to January 2007, 186 patients (M:F = 98:88; mean age 50.0 ± 11.4 years), in whom H. pylori had been successfully eradicated, were enrolled. The mean duration of follow up was 41.2 ± 24.0 mo.
RESULTS: H. pylori reinfection occurred in 58 patients (31.2%). The average annual reinfection rate was 9.1% per patient year. No recurrence of peptic ulcer was detected at the follow up endoscopy. There were no significant differences between the H. pylori eradication regimens for the reinfection rate and no significant differences in endoscopic findings between the H. pylori-recurred group and the H. pylori-cured group.
CONCLUSION: The reinfection rate in Korea is 9.1% which represents a decreasing trend. There was no relationship between H. pylori infection status and changes in endoscopic findings. There was also no recurrence or aggravation of ulcers.
PMCID: PMC2806565  PMID: 20066746
Helicobacter pylori; Eradication; Reinfection; Endoscopy
8.  Discourse prominence effects on 2.5-year-old children’s interpretation of pronouns 
Three experiments examined 2.5-year-olds’ sensitivity to discourse structure in pronoun interpretation. Children heard simple two-character stories illustrated by pictures on two video screens. In Experiments 1 and 2, one character in each story was established as more prominent than the other in several context sentences because it was mentioned first, appeared in subject position, was mentioned more often, and was pronominalized once. In Experiment 3, one character was singled out as more prominent only by being mentioned first and placed in subject position. In all three experiments, after hearing a pronoun subject in the final (test) sentence of each story, children looked longer at the character established as more prominent in the preceding sentences. These experiments show that 2.5-year-olds, like older children and adults, interpret pronouns relative to a discourse representation in which referents are ranked in prominence, and that the prominence of discourse referents is influenced by some of the same factors that guide pronoun interpretation in adulthood.
PMCID: PMC2151753  PMID: 18978930
language acquisition; pronouns; discourse processing; discourse prominence; incremental processing
9.  Is it necessary to delay antiviral therapy for 3-6 months to anticipate HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B in endemic areas of HBV genotype C? 
Clinical and Molecular Hepatology  2014;20(4):355-360.
Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection.
Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels.
Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA ≥5.1×107 IU/mL and ALT ≥5×ULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure.
Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
PMCID: PMC4278066  PMID: 25548741
Hepatitis B virus, chronic hepatitis B; acute exacerbation of hepatitis B, HBV genotype
10.  Doing More with Less: Verb Learning in Korean-Acquiring 24-Month-Olds 
Language acquisition  2013;20(4):292-304.
Research on early word learning reveals that verbs present a unique challenge. While English-acquiring 24-month-olds can learn novel verbs and extend them to new scenes, they perform better in rich linguistic contexts (when novel verbs appear with fully lexicalized noun phrases naming the event participants) than in sparser linguistic contexts (Arunachalam & Waxman, 2011; Waxman et al., 2009). However, in languages like Korean, where noun phrases are often omitted when their referents are highly accessible, rich linguistic contexts are less frequent. The current study investigates the influence of rich and sparse linguistic contexts in verb learning in Korean-acquiring 24-month-olds. In contrast to their English-acquiring counterparts, 24-month-olds acquiring Korean perform better when novel verbs appear in sparse linguistic contexts. These results, which provide the first experimental evidence on early verb learning in Korean, indicate that the optimal context for verb learning depends on many factors, including how event participants are typically referred to in the language being acquired.
PMCID: PMC4195537  PMID: 25320551
11.  Are Nouns Learned Before Verbs? Infants Provide Insight into a Longstanding Debate 
Child development perspectives  2013;7(3):10.1111/cdep.12032.
For decades, a spirited debate has existed over whether infants’ remarkable capacity to learn words is shaped primarily by universal features of human language or by specific featuers of the particulare native language they are acquiring. A strong focus for this debate has been a well-documented difference in early word learning: Infants’ success in learning verbs lags behind their success in learning nouns.. In this review, we articulate both sides of the debate and summarize new cross-linguistic evidence from infants that underscores the role of universal features and begins to clarify the impact of distinctly different languages on early language and conceptual development.
PMCID: PMC3821773  PMID: 24223064
12.  The Development of Infants’ Use of Novel Verbal Information when Reasoning about Others' Actions 
PLoS ONE  2014;9(3):e92387.
How sophisticated are infants at using novel verbal information when reasoning about which of two objects an agent is likely to select? The present research examined the development of infants’ ability to interpret a change from one novel word to another as signaling a possible change in which object the agent would choose next. In three experiments, 7- and 12-month-olds were familiarized to an event in which they heard a novel word ("A dax!") and then saw an agent reach for one of two distinct objects. During test, the infants heard a different novel word ("A pilk!") and then saw the agent grasp the same object or the other object. At 7 months, infants ignored the change in word and expected the agent to continue reaching for the same object. At 12 months, however, infants attended to the change in word: They realized that it signaled a possible change in the agent’s upcoming actions, though they were unable to form a specific expectation about what these new actions might be, most likely due to their limited mutual-exclusivity assumption. Control conditions supported these interpretations. Together, these results suggest that by 12 months of age, infants understand not only that words are selected for communicative purposes, but also that a change from one novel word to another may signal a change in an agent’s upcoming actions.
PMCID: PMC3963909  PMID: 24664282
13.  Guidelines for Bowel Preparation before Video Capsule Endoscopy 
Clinical Endoscopy  2013;46(2):147-154.
The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.
PMCID: PMC3630308  PMID: 23614124
Capsule endoscopy; Bowel preparation; Guideline
14.  Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute 
Journal of Gastric Cancer  2012;12(4):223-231.
Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute.
Materials and Methods
We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging.
The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm.
Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.
PMCID: PMC3543972  PMID: 23346494
Stomach neoplasms; Neoplasm staging; Gastroscopy; Technology, radiologic
15.  Clinical Characteristics of an Esophageal Fish Bone Foreign Body from Chromis notata 
Journal of Korean Medical Science  2012;27(10):1208-1214.
Damselfish Chromis notata is a small fish less than 15 cm long and it is widespread in the Indo-Pacific Ocean. Of all the cases of fish bone foreign body (FBFB) disease at our hospital, a damselfish FBFB was very common, and a specific part of the bone complex was involved in the majority of cases. This study was performed to evaluate the clinical characteristics of damselfish FBFB in Jeju Island. We retrospectively reviewed the medical records from March 2004 to March 2011 for foreign body diseases. Among 126 cases of foreign body diseases, there were 77 (61.1%) cases of FBFB. The mean age ± standard deviation was 57.8 ± 12.7 yr, and this was higher in females 60.9 ± 14.6 yr vs 54.1 ± 8.7 yr. Damselfish was the most common origin of a FBFB 36 out of total 77 cases. The anal fin spine-pterygiophore complex of damselfish was most commonly involved and cause more severe clinical features than other fish bone foreign bodies; deep 2.7 ± 0.8 cm vs 2.3 ± 0.8 cm; P < 0.01, more common mural penetration 23/36 vs 10/41; P < 0.01, and longer hospital stay 12.6 ± 20.0 days 4.7 ± 4.8 days; P = 0.02. We recommend removing the anal fin spine-pterygiophore complex during cleaning the damselfish before cooking.
PMCID: PMC3468758  PMID: 23091319
Foreign Body; Fish Bone; Pterygiophore; Damselfish; Chromis notata
16.  Can infants attribute to an agent a disposition to perform a particular action? 
Cognition  2005;98(2):B45-B55.
The present research investigated whether 13.5-month-old infants would attribute to an actor a disposition to perform a recurring action, and would then use this information to predict which of two new objects—one that could be used to perform the action and one that could not—the actor would grasp next. During familiarization, the infants watched an actor slide various objects forward and backward on an apparatus floor. During test, the infants saw two new identical objects placed side by side: one stood inside a short frame that left little room for sliding; the other stood inside a longer frame that left ample room for sliding. The infants who saw the actor grasp the object inside the short frame looked reliably longer than those who saw the actor grasp the object inside the long frame. This and control results from a lifting condition provide evidence that by 13.5 months, infants can attribute to an actor a disposition to perform a particular action.
PMCID: PMC3357324  PMID: 15993398
17.  Can 9.5-month-old infants attribute to an agent a disposition to perform a particular action on objects? 
Acta Psychologica  2006;124(1):79-105.
The present research examined whether 9.5-month-old infants can attribute to an agent a disposition to perform a particular action on objects, and can then use this disposition to predict which of two new objects—one that can be used to perform the action and one that cannot—the agent is likely to reach for next. The infants first received familiarization trials in which they watched an agent slide either three (Experiments 1 and 3) or six (Experiment 2) different objects forward and backward on an apparatus floor. During test, the infants saw two new identical objects placed side by side: one stood inside a short frame that left little room for sliding, and the other stood inside a longer frame that left ample room for sliding. The infants who saw the agent slide six different objects attributed to her a disposition to slide objects: they expected her to select the “slidable” as opposed to the “unslidable” test object, and they looked reliably longer when she did not. In contrast, the infants who saw the agent slide only three different objects looked about equally when she selected either test object. These results add to recent evidence that infants in the first year of life can attribute dispositions to agents, and can use these dispositions to help predict agents’ actions in new contexts.
PMCID: PMC3357326  PMID: 17092476
Infant cognition; Disposition; Action comprehension; Psychological reasoning
18.  Attributing false beliefs about non-obvious properties at 18 months 
Cognitive psychology  2010;61(4):366-395.
Reports that infants in the second year of life can attribute false beliefs to others have all used a search paradigm in which an agent with a false belief about an object’s location searches for the object. The present research asked whether 18-month-olds would still demonstrate false-belief understanding when tested with a novel non-search paradigm. An experimenter shook an object, demonstrating that it rattled, and then asked an agent, “Can you do it?” In response to this prompt, the agent selected one of two test objects. Infants realized that the agent could be led through inference (Experiment 1) or memory (Experiment 2) to hold a false belief about which of the two test objects rattled. These results suggest that 18-month-olds can attribute false beliefs about non-obvious properties to others, and can do so in a non-search paradigm. These and additional results (Experiment 3) help address several alternative interpretations of false-belief findings with infants.
PMCID: PMC2990968  PMID: 21047625
19.  Tight and loose are not created equal: An asymmetry underlying the representation of fit in English and Korean speakers 
Cognition  2008;109(3):316-325.
Research concerning the spatial dimension fit (tight versus loose) has been based on a tacit but untested assumption that the dimension fit is symmetrical, with tight- and loose-fitting relations highlighting the dimension fit with equal force. We propose a reformulation, documenting that adult speakers of English (Experiment 1) and Korean (Experiment 2) are sensitive to the dimension fit, but that their representation is asymmetric, with tight-fitting events highlighting fit with greater force than loose-fitting events. We propose that sensitivity to the dimension fit is more resilient than has previously been suggested, and that the asymmetry documented here provides a foundation upon which to pursue nuanced questions about the relationship between language and our underlying representations of space.
PMCID: PMC2617708  PMID: 19010464
20.  The First Case of Antibiotic-associated Colitis by Clostridium difficile PCR Ribotype 027 in Korea 
Journal of Korean Medical Science  2009;24(3):520-524.
Clostridium difficile (C. difficile) is a common causative agent of pseudomembranous colitis (PMC). C. difficile-associated diarrhea (CDAD) ranges from mild diarrhea to life threatening PMC. Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan. A 52-yr-old woman with anti-tuberculosis medication and neurogenic bladder due to traffic accident experienced five episodes of C. difficile PMC after taking antibiotics for pneumonia along with septic shock and acute renal failure. She was readmitted to the intensive care unit and treated with oral vancomycin with refractory of oral metronidazole, inotropics and probiotics for over 60 days. C. difficile isolated both at the first and the last admission was identified as C. difficile ribotype 027 by ribotyping, toxinotyping, and tcdC gene sequencing, which turned out the same pathogen as the epidemic hypervirulent B1/NAP1 strain. This is the first case of C. difficile PCR ribotype 027 in Korea. After discharge, she was maintained on probiotics and rifaximin for 3 weeks. She had no relapse for 6 months.
PMCID: PMC2698204  PMID: 19543521
Enterocolitis, Pseudomembranous; Clostridium difficile; Ribotype 027
21.  The Prevalence and Clinical Characteristics of Reflux Esophagitis in Koreans and Its Possible Relation to Metabolic Syndrome 
Journal of Korean Medical Science  2009;24(2):197-202.
The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44±10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m2 (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol ≥160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride ≥150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose ≥110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusiosn, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.
PMCID: PMC2672116  PMID: 19399258
Esophagitis, Peptic; Endoscopy; Metabolic Syndrome
22.  Methylation of the Tumor Suppressor Gene RUNX3 in Human Gastric Carcinoma 
Gut and Liver  2008;2(2):119-125.
RUNX3 (PEBP2αC/CBFA3/AML2) is a novel tumor suppressor gene in the human gastric carcinoma. The aims of this study were to determine the methylation of RUNX3 promoter and the association between RUNX3 methylation and the clinicopathological characteristics of patients with gastric carcinoma.
Seventy-nine patients with gastric carcinoma were studied prospectively from April 2005 to May 2007. The methylations of RUNX3 promoter on the gastric carcinoma specimens and the corresponding nonneoplastic mucosa were evaluated by methylation-specific polymerase chain reaction.
Comparison of the results with the clinicopathological characteristics identified RUNX3 monoallelic methylation in 32.9% (26/79) of the gastric carcinoma patients and in 11.4% (9/79) of those with nonneoplastic mucosa (p=0.053). The monoallelic methylated gastric carcinoma specimens predominantly consisted of well- and moderately differentiated carcinomas (44.7%), with the unmethylated group constituting 22.0% of them (p=0.031). Among the 48 patients (60.8%) who underwent gastrectomy, there was no correlation between the two groups with regard to Lauren's classification (p=0.235), depth of invasion (p=0.990), nodal status (p=0.601), stage (p=0.900), lymphatic invasion (p=0.537), and vascular invasion (p=0.815).
Methylation of the tumor suppressor gene RUNX3 might be one of the mechanisms involved in the pathogenesis of gastric carcinoma.
PMCID: PMC2871588  PMID: 20485621
Runx3 protein; Gastric cancers; Methylation
23.  A Case of Ischemic Colitis Associated with the Herbal Food Supplement Ma Huang 
Yonsei Medical Journal  2008;49(3):496-499.
Ischemic colitis is a condition that usually occurs in the elderly, as a form of vascular disease. However, ischemic colitis also occurs, though rarely, in healthy young adults. Moreover, food supplements containing Ephedra sinica or ma huang have been linked to adverse central nervous and cardiovascular events. A 40-year-old man was admitted to our emergency department after 2 episodes of abdominal pain and bloody diarrhea that lasted 24 hours. His medical history was unremarkable for risk factors of bowel ischemia, except for well-controlled hypertension. However, a weight-loss supplement, Ephedra sinica, had been prescribed for daily use during the previous month. Both abdominal/pelvic computed tomography and colonoscopy revealed findings compatible with ischemic colitis. His conditions spontaneously improved without any serious complications, and he was advised to discontinue the use of herbal medications containing ephedrine. In this paper, we describe a case of ischemic colitis that was potentially linked to the use of ma huang with a review of the relevant literature.
PMCID: PMC2615353  PMID: 18581601
Ischemic colitis; ephedra sinica; ma huang
24.  Antibiotic-Associated Diarrhea: Candidate Organisms other than Clostridium Difficile 
The direct toxic effects of antibiotics on the intestine can alter digestive functions and cause pathogenic bacterial overgrowth leading to antibiotic-associated diarrhea (AAD). Clostridium Difficile (C. Difficile) is widely known to be responsible for 10~20% of AAD cases. However, Klebsiella oxytoca, Clostridium perfringens, Staphylococcus aureus, and Candida species might also contribute to AAD.
We prospectively analyzed the organisms in stool and colon tissue cultures with a C. Difficile toxin A assay in patients with AAD between May and December 2005. In addition, we performed the C. Difficile toxin A assays using an enzyme-linked fluorescent assay technique. Patients were enrolled who had diarrhea with more than three stools per day for at least 2 days after the initiation of antibiotic treatment for up to 6~8 weeks after antibiotic discontinuation.
Among 38 patients (mean age 59±18 years, M:F=18:20), the organism isolation rates were 28.9% (11/38) for stool culture, 18.4% (7/38) for colon tissue cultures and 13.2% (5/38) for the C. Difficile toxin A assay. The overall rate of identification of organisms was 50.0% (19/38). Of the five patients that had a positive result by the C. Difficile toxin A assay, two had no organism isolated by the stool or colon tissue culture. The organisms isolated from the stool cultures were C. Difficile (4), Klebsiella pneumoniae (K. pneumoniae) (3), Candida species (3), and Staphylococcus aureus (1). C. Difficile (4) and K. pneumoniae (3) were isolated from the colon tissue culture.
For C. Difficile negative AAD patients, K. pneumoniae, Candida species, and Staphylococcus aureus were found to be potential causative organisms.
PMCID: PMC2686956  PMID: 18363274
Antibiotic-associated; Diarrhea; Organism
25.  Decreased Hepatic Nerve Fiber Innervation in Patients with Liver Cirrhosis 
Gut and Liver  2007;1(2):165-170.
Hepatic nerve innervation plays important roles in hepatic metabolism and hemodynamic mechanisms. We compared the distribution patterns of hepatic nerves between normal livers and two liver diseases to elucidate the effects of liver disease on the distribution of hepatic nerves.
Tissue specimens were obtained by ultrasonography-guided needle biopsies from 10 normal controls, 74 patients with chronic hepatitis (CH), and 35 patients with liver cirrhosis (LC). The obtained specimens were immunohistochemically stained using antibodies for S-100 protein and α-smooth-muscle actin (α-SMA). The degree of the expression in liver tissues was quantified by manual counting of positively stained nerve fibers under light microscopy. The serum hyaluronic acid level was assayed in all subjects to evaluate hepatic fibrosis. Electron microscopy examinations were also performed.
The hepatic nerve innervation was significantly lower in LC than in normal controls, as indicated by S-100 protein staining. α-SMA and hyaluronic acid levels were higher in LC and CH than in normal controls. Electron microscopy revealed that unmyelinated nerve fiber bundles in the intralobar connective tissue coursed in the vicinity of hepatic triads.
These results suggest that hepatic nerve innervation can be decreased by hepatic inflammatory responses and/or fibrotic changes in LC patients. Further study is needed to clarify this observation.
PMCID: PMC2871629  PMID: 20485634
α-SMA; Electron microscopy; Hepatic nerve innervation; Hyaluronic acid; S-100

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