Obesity Is Associated With Increasing Esophageal Acid Exposure in Korean Patients With Gastroesophageal Reflux Disease Symptoms

BACKGROUND/AIMS: Obesity is regarded as an important contributor to the increasing occurrence of gastroesophageal reflux disease. The aims of this study were to determine whether obesity is associated with gastroesophageal reflux in patients with gastroesophageal reflux disease and to identify the factors affecting increased acid exposure in obese patients. METHODS: We retrospectively analyzed the data of patients who underwent ambulatory 24-hour pH monitoring and esophageal manometry at Seoul St. Mary's Hospital. Obesity was classified according to the Asia-Pacific criteria. RESULTS: A total of 366 patients were analyzed; 18 were underweight, 152 normal weight, 104 overweight, and 92 obese. Obesity was more frequent in men and younger patients. The percentage time of pH < 4 in the total, upright, and postprandial periods was significantly higher in obese patients than in normal or underweight patients. The DeMeester score was also higher in obese patients. Body mass index correlated positively with reflux parameters. Multivariate analysis showed that being male and obesity were significantly associated with abnormal acid exposure (P < 0.005). The total lower esophageal sphincter length shortened as body mass index increased (P < 0.005). The gastroesophageal pressure gradient increased as body mass index increased (P < 0.05). CONCLUSIONS: Obesity is associated with increasing esophageal acid exposure. The mechanism responsible for the relationship between gastroesophageal reflux disease and obesity may be associated with shortening of the lower esophageal sphincter length and increasing the gastroesophageal pressure gradient.

Usefulness of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Evaluation of Gastric Cancer Stage / 대한소화기학회지

BACKGROUND/AIMS: The usefulness of 18F-fluoro-2-deoxyglucose (FDG)-PET in detecting primary cancer, lymph node metastasis, and distant metastasis were studied in the gastric cancer patients. METHODS: The subjects were 392 gastric cancer patients who received FDG-PET and an abdominal CT test prior to surgery. The results of FDG-PET and CT were compared with the surgical and pathologic results. RESULTS: The primary site detection rate of FDG-PET was 74.4%, 50.3% in early gastric cancer and 92.0% in advanced gastric cancer. Detection rate was higher when tumors were larger than 3.5 cm, had deeper depth of invasion, and at a later stage (p or =T2), and lymph node metastasis were statistically significant factors in primary site detection rate. The sensitivity, specificity, and positive predictive value of FDG-PET to lymph node metastasis were 59.6%, 88.8%, and 81.1% respectively, sensitivity being lower compared to CT while specificity and positive predictive value were higher. Sensitivity, specificity, and positive predictive value to distant metastasis were, respectively, 66.7%, 99.2%, and 88.0%, similar to CT. In 21 of the 392 patients (5.4%), synchronous double primary cancers were detected. CONCLUSIONS: In gastric cancer, usefullness of FDG-PET is limited to the advanced stage. Diagnostic value of this test was not superior to CT. However, FDG-PET may be useful in detecting synchronous double primary cancers.

Optimization of Muffins Containing Dried Leek Powder Using Response Surface Methodology

The purpose of this study was to develop a muffin containing dried leek powder. The complete analysis was conducted using the Design Expert 7 program (Stat - Easy Co., Minneapolis, MN, USA). The leek muffins were produced with varying amounts of leek powder (A), sugar (B), and butter (C). According to response surface methodology (RSM), there were 16 experimental points, including two replicates. The leek muffin formulation was optimized using rheology and sensory analyses. For the results, a quadratic model was applied in determining lightness, volume, hardness, and sensory characteristics, including flavor, texture, and overall quality; redness and height were represented by a linear model. Lightness decreased and redness increased with increasing amounts of leek powder (p<0.001). In addition, hardness displayed significant differences (p<0.001) with increasing amounts of leek powder. The sensory evaluation results showed significant differences for color, flavor, texture, and overall quality (p<0.05). Based on the numerical and graphical methods, the optimal formulation was determined as 8.30 g of leek power, 88.37 g of sugar, and 81.70 g of butter.

Clinical courses and risk factors for renal graft survival in renal retransplantation patients / 대한내과학회지

BACKGROUND: It has been reported that the results of second renal transplantation are inferior to that of first transplantation and affected by several factors. The purpose of this study is to suggest guidelines for successful retransplantion by evaluating the factors which might affect the clinical courses and graft survival rates in the second renal transplantation. METHODS: Between March 1969 and February 2005, 1476 kidneys were transplanted in Kangnam St Mary's hospital. Among these, 77 cases were retransplantation (72 cases were second transplantation, 5 cases were third transplantation). Especially for the second transplantation, we retrospectively analysed the clinical courses of grafted kidneys and sought the factors which might be related to the long term graft survival. RESULTS: Among second transplant patients, male were 52 cases, female were 20 cases. The mean age at retransplantation was 38.4+/-11 years. Living donor were 62 cases and cadaver donor were 10 cases. The mean duration between primary graft failure and second transplantation was 20.1+/-36 months. The 1 yr, 3 yr, 5 yr survival rates of the second grafts were 86.4%, 78%, 71% respectively, and it is not significantly inferior to that of total primary transplantation at our center. Multivariate analysis showed that the duration of the first graft survival and the postoperative recovery pattern significantly predicted graft survival in the second renal transplantation. CONCLUSIONS: This study suggests retransplantation can be considered for patients who lost primary graft function. And the longer the duration of the first graft survival and the earlier the postoperative graft function recovery, the prognosis of retransplanted graft would be better.

The Effect of Withdrawal of Angiotensin II Blockers on Serum Creatinine and Potassium in Patients with Chronic Kidney Diseases / 대한신장학회잡지

BACKGROUND: Renin-ngiotensin system (RAS) blockers have been used to delay the progression of various renal diseases, but these medications cause hyperkalemia and the elevation of serum creatinine which impede the continuation of the medications. So far, there have been no data on the changes of serum creatinine or serum potassium after withdrawal of the RAS blockers. METHODS: We reviewed medical records of 60 patients who stopped the RAS blockers due to the elevation of serum creatinine or hyperkalemia between March 1995 and May 2005. They were assigned to either the elevated creatinine group or the hyperkalemia group according to the cause of the withdrawal. RESULTS: In the elevated creatinine group (n=37), the serum creatinine and GFR values at the point of withdrawal were 4.0+/-1.8 mg/dL and 18.2+/-10.4 mL/min/1.73m2, respectively. After discontinuation of the medications, a decrease in serum creatinine and an increase in GFR were noted at one month. After one month, however, serum creatinine increased continuously up to 6 months. Serum potassium levels decreased significantly after the drug withdrawal until the end of the study period. In the hyperkalemia group (n=23), the serum creatinine and serum potassium values at the point of withdrawal were 3.0+/-1.0 mg/dL and 6.4+/-0.4 mEq/L, respectively. A significant decrease in serum potassium was also noted after the withdrawal and this decrease lasted up to 6 months. But the transient decrease of serum creatinine, observed in the creatinine group, was not seen in this group. CONCLUSION: It was found that there was a beneficial effect on serum creatinine and GFR immediately after the withdrawal of RAS blockers only when they were stopped due to elevation of the serum creatinine concentration. The serum potassium levels were consistently decreased after the withdrawal of RAS blockers in both elevated creatinine and hyperkalemia groups.

Clinical Significance of C4d-Positivity in Renal Transplant Recipients with Acute Rejection / 대한이식학회지

PURPOSE: C4d detection in peritubular capillaries in acute allograft rejection has been regarded as a poor prognostic factor for graft kidney survival. We investigated the clinical importance of C4d positivity in renal transplant recipients with acute rejection. METHODS: Forty eight renal allograft biopsies were selected, which were available for immunofluorescence study. The samples were divided into two groups, one which was diagnosed as acute rejection clinically (n=30), the other which underwent protocol biopsy 2 weeks after transplantation (n=18). Among the acute rejection group, C4d staining was positive in 50% of acute rejection cases (C4d (+), n=15) and negative in the others. (C4d (-), n=15). We compared the C4d (+) group and the C4d (-) group in terms of clinical parameters and graft survival duration. RESULTS: Renal function was reduced in the C4d (+) group compared to the C4d (-) group. In the C4d (+) group, 8 of 15 cases resulted in graft loss, but only one graft loss developed in the C4d (-) group. Graft survival duration after kidney biopsy was reduced in the C4d (+) group compared to the C4d (-) group. CONCLUSION: Renal transplant recipient with C4d-positive acute rejection shows inferior graft survival duration. So tight management in addition to steroid pulse therapy should be considered for these patients.

Clinical Significance of Cystoscopy in the Evaluation of Isolated Asymptomatic Microscopic Hematuria / 대한신장학회잡지

BACKGROUND: As health screening examinations are becoming more popular, increasing number of patients are found to have hematuria. In case of isolated microscopic hematuria, when to refer these patients to urologists for cystoscopy to find bladder cancer has been a matter of debate. METHODS: From January 1998 to May 2004, 287 patients older than 50 years of age visited our clinic for the evaluation of hematuria. Of these patients, 50 isolated asymptomatic microscopic patients underwent cystoscopy for the evaluation of bladder cancer. Additionally, 275 patients were retrospectively analyzed who had been found to have urologic malignancy during the same period. RESULTS: There were 50 patients (9 men, 41 women) with asymptomatic isolated microscopic hematuria who agreed to undergo cystoscopy examinations. Cystoscopic findings included normal in 41 patients, benign prostatic hyperplasia in 2 patients, cystitis in 2 patients, ureterocele in 1 patient, bladder neck contracture in 1 patient, urethral stricture in 1 patient, bladder diverticulum in 1 patient and ureter stone in 1 patient, but no bladder cancer was detected. In retrospective analysis, among 22 patients with bladder cancer and initial asymptomatic microscopic hematuria, one patient was found to have bladder cancer by cystoscopy after negative findings on radiologic examinations and urine cytology. CONCLUSION: Cystoscopy in patients with asymptomatic isolated microscopic hematuria to diagnose bladder cancer seems to be limited in the cost and efficacy aspect in the current study. A prospective multicenter study is needed establish the criteria for cystoscopy in these patients.

Quantitative Viral Load Monitoring and Cidofovir Therapy in BK Virus Nephropathy / 대한신장학회잡지

BACKGROUND: BK virus nephropathy (BKVN) has been increasingly recognized as an important cause of renal transplant dysfunction, but no specific antiviral therapy is currently available. Furthermore, a method evaluating the degree of viral infection has not been developed yet. Recently, there have been several case reports in which BKVN was successfully treated with cidofovir injection. In the current study, we report a case with BKVN successfully treated with cidofovir injection. In addition, we assessed the usefulness of quantitative viral load monitoring using a competitive polymerase chain reaction (PCR) in the treatment of BKVN. METHODS: A renal allograft recipient with BKVN was injected with cidofovir. To monitor BK viral load in urine and plasma, we developed a competitive PCR assay and followed the patient prospectively. RESULTS: A 49 year old renal transplant recipient developed a progressive rise in serum creatinine reaching 1.9 mg/dL at 15 months post-transplantation. Subsequently, the patient was diagnosed as BKVAN by allograft biopsy. At this time, BKV DNA was detected in plasma and urine. Despite a reduction of the dose of mycophenolate mofetil, serum creatinine continued to rise, which prompted the initiation of cidofovir trial. The patient was given intravenous cidofovir. After cidofovir treatment, BK virus associated findings disappeared on repeat biopsy, and BK virus in plasma was decreased to the undetectable level. For 7 months after cidofovir treatment, her renal function remained stable. CONCLUSION: Cidofovir therapy may be effective in the treatment for BKVN. Viral load in plasma reflected well the clinical and pathological course of the BK virus infection.

Development of a Rapid Molecular Detection Marker for Colletotrichum species with AFLP

Sweet persimmons have been increasingly cultivated in the southern part of Korea. However, anthracnose disease caused by Colletotrichum species is one of the major hindrances in cultivation and productions. In this study, we used polymerase chain reaction(PCR) to detect Colletotrichum species with the AFLP(amplified fragment length polymorphism) method. In AFLP, we used E3(5'-GACTGCGTACCAATTCTA-3') and M1(5'-GATGAGTCCTGAGTAACAG-3') primer combination and, as a result, 262 bp segment was observed in Colletotrichum species only. Specific PCR primers were designed from the sequence data and used to detect the presence of the fungus in genomic DNA isolated from symptomless sweet persimmon plants. Based on sequence data for specific segments, Co.B1(5'-GAGAGAGTAGAATTGCGCTG-3') and Co.B2(5'-CTACCATTCTTCTA GGTGGG-3') were designed to detect Colletotrichum species. The 220 bp segment was observed in Colletotrichum species only, but not in other fungal and bacterial isolates.

Identification of DNA Markers Linked to Metalaxyl Insensitivity Loci in Phytophthora infestans

A total of 24 isolates of Phytophthora infestans were tested and analyzed for their resistance to metalaxyl fungicides. Sensitivity to metalaxyl was determined by growing isolates on 20% V8 medium amended with 0, 5, and 100 microg/ml metalaxyl. Four isolates among the 24 tested were resistant to metalaxyl. Eleven isolates were intermediate and nine isolates were sensitive. Amplified fragment length polymorphism (AFLP) assay was used to identify the amplification products of resistant isolates. As a result, selected fragments were cloned, sequences and primer pairs were developed which linked to metalaxyl insensitivity in P. infestans using competitive PCR.

Relationship of the Changes in Biogenic Amines to Nitric Oxide and Oxygen Free Radicals During Cerebral Ischemia/Reperfusion

Recently oxygen free radicals and nitric oxide (NO) are known to play an important role in neuronal reperfusion injury. This study was aimed to investigate the role of oxygen f ree radicals and NO during cerebral ischemia/reperfusion, using dimethylthiourea (DMTU) and NG-monomethyl-L-arginine (NMMA), an oxygen f ree radical scavenger and a competitive NOS inhibitor respectively. In the in vivo experiment, the ischemia/reperfusion-induced changes of cerebral biogenic amines were examined in Mongolian gerbil (Meriones unguiculatus) pre-treated with NMMA and/or DMTU. To induce cerebral ischemia/reperfusion, bilateral common carotid arteries were clamped for 10 minutes and then released for 15 minutes. The biogenic amines were measured by using HPLC-ECD(High Performance Liquid Chromatography-Electrochemical detection). To confirm the results from the in vivo experiments, the effect of NMMA and/or DMTU on [3H]dopamine release from striatal slices exposed to hypoxia was investigated. The results are as follows; 1) Ischemia/reperfusion increased the ratio of DOPAC/dopamine and HVA/dopamine as well as the concentrations of DOPAC and HVA, which were evident only in corpus striatum. 2) NMMA attenuated the ischemia/reperfusion-induced increase in the ratio of DOPAC/dopamine in corpus striatum. However, the change of DOPAC or HVA was minimal. 3) DMTU attenuated the ischemia/reperfusion-induced increase of DOPAC and HVA, and the ratio ofDOPAC / dopa- mine and HVA/dopamine in corpus striatum. 4) Simultaneous pre-treatment with NMMA and DMTU attenuated the ischemia/reperfusion-induced increase of DOPAC and HVA, and the ratio Of DOPAC/dopamine and HVA/dopamine in corpus striatum. The extent of attenuation was greater than the single treatment group with NMMA or DMTU. 5) Exposure to hypoxia markedly increased the release of [3H]dopamine in the striatal slices. 6) The administration of either NMMA or DMTU attenuated the increase of [3H]dopamine release induced by hypoxia in the striatal slices. 7) The administration of both NMMA or DMTU markedly attenuated the increase of [3H]dopamine release induced by hypoxia to the extent of the control in the striatal slices. These results suggest that oxygen free radicals play an important role in cerebral ischemia/reperfusion injury, for which NO seems to be responsible.