The Analysis of a Diet for the Human Being and the Companion Animal using Big Data in 2016

The purpose of this study was to investigate the diet tendencies of human and companion animals using big data analysis. The keyword data of human diet and companion animals' diet were collected from the portal site Naver from January 1, 2016 until December 31, 2016 and collected data were analyzed by simple frequency analysis, N-gram analysis, keyword network analysis and seasonality analysis. In terms of human, the word exercise had the highest frequency through simple frequency analysis, whereas diet menu most frequently appeared in the N-gram analysis. companion animals, the term dog had the highest frequency in simple frequency analysis, whereas diet method was most frequent through N-gram analysis. Keyword network analysis for human indicated 4 groups: diet group, exercise group, commercial diet food group, and commercial diet program group. However, the keyword network analysis for companion animals indicated 3 groups: diet group, exercise group, and professional medical help group. The analysis of seasonality showed that the interest in diet for both human and companion animals increased steadily since February of 2016 and reached its peak in July. In conclusion, diets of human and companion animals showed similar tendencies, particularly having higher preference for dietary control over other methods. The diets of companion animals are determined by the choice of their owners as effective diet method for owners are usually applied to the companion animals. Therefore, it is necessary to have empirical demonstration of whether correlation of obesity between human being and the companion animals exist.

Total laparoscopic hysterectomy via suture and ligation technique

OBJECTIVE: The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. METHODS: This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. RESULTS: Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. CONCLUSION: The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.

Effects of candesartan and propranolol combination therapy versus propranolol monotherapy in reducing portal hypertension

BACKGROUND/AIMS: Angiotensin receptor blockers (ARBs) inhibit activated hepatic stellate cell contraction and are thought to reduce the dynamic portion of intrahepatic resistance. This study compared the effects of combined treatment using the ARB candesartan and propranolol versus propranolol monotherapy on portal pressure in patients with cirrhosis in a prospective, randomized controlled trial. METHODS: Between January 2008 and July 2009, 53 cirrhotic patients with clinically significant portal hypertension were randomized to receive either candesartan and propranolol combination therapy (26 patients) or propranolol monotherapy (27 patients). Before and 3 months after the administration of the planned medication, the hepatic venous pressure gradient (HVPG) was assessed in both groups. The dose of propranolol was subsequently increased from 20 mg bid until the target heart rate was reached, and the candesartan dose was fixed at 8 mg qd. The primary endpoint was the HVPG response rate; patients with an HVPG reduction of >20% of the baseline value or to <12 mmHg were defined as responders. RESULTS: The mean portal pressure declined significantly in both groups, from 16 mmHg (range, 12-28 mmHg) to 13.5 mmHg (range, 6-20 mmHg) in the combination group (P<0.05), and from 17 mmHg (range, 12-27 mmHg) to 14 mmHg (range, 7-25 mmHg) in the propranolol monotherapy group (P<0.05). However, the medication-induced pressure reduction did not differ significantly between the two groups [3.5 mmHg (range, -3-11 mmHg) vs. 3 mmHg (range, -8-10 mmHg), P=0.674]. The response rate (55.6% vs. 61.5%, P=0.435) and the reductions in mean blood pressure or heart rate also did not differ significantly between the combination and monotherapy groups. CONCLUSIONS: The addition of candesartan (an ARB) to propranolol confers no benefit relative to classical propranolol monotherapy for the treatment of portal hypertension, and is thus not recommended.

Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis / 이화의대지

Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic Clostridium difficile colitis after repeated total hip replacement surgery. Infection control is the most important treatment of AA amyloidosis secondary to chronic infection. However, the patient's C. difficile colitis was not controlled well, eventually toxic megacolon with sepsis was developed. Consequently, he had to take total colectomy, but he expired with multi-organ failures. We suggested that early surgical procedure might be one option for intractable C. difficile colitis complicated with secondary amyloidosis.

A Case of Patient with Eisenmenger Syndrome Admitted to Intensive Care Unit Due to Septic Shock Complicated with Newlydiagnosed Down Syndrome and Moyamoya Disease / 대한구급학회지

Eisenmenger syndrome is a severe form of pulmonary arterial hypertension related to congenital cardiac defects. Many patients die at a young age from such complications. The treatment of primary pulmonary hypertension is being applied to Eisenmenger syndrome such as endothelin receptor antagonists, phosphodiesterase-5 blockers, and prostacyclin. We experienced a case of 29-year female with ventricular septal defect-related Eisenmenger syndrome complicated with Down syndrome and Moyamoya disease, who was admitted to intensive care unit due to enteritis-associated septic shock. After the combination treatment with iloprost and sildenafil within the intensive care unit, the patient was able to wean mechanical ventilation without further applications of invasive rescue therapy such as extracorporeal membrane oxygenator. She was later discharged with bosentan. She maintained bosentan therapy for 34 months continuously without aggravations of symptom but eventually died with intracranial hemorrhage, a complication of Moyamoya disease. To our knowledge, this is the first case report of Eisenmenger syndrome accompanied by mosaic Down syndrome and Moyamoya disease.

The Impact of Radiation Exposure on the Prevalence of Functional Dyspepsia and Irritable Bowel Syndrome in Hospital Radiation Workers

BACKGROUND/AIMS: Health care workers inevitably encounter many physical hazards including ionizing radiation, and have increased levels of psychological disturbance. This study was designed to investigate the prevalence of functional gastrointestinal disorders among hospital radiation workers and to determine significant factors associated with these results. METHODS: Whole body radiation doses of radiation workers were evaluated using the electronic dosimeter. The prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) were assessed by the bowel symptom questionnaire. The subjects were classified according to radiation dose, sleep quality, and psychological stress level, and the prevalence of FD and IBS was comparatively analyzed. RESULTS: A total of 70 subjects were recruited. The prevalence of FD and IBS was 31.4% and 22.9%, respectively. The average radiation dose per exposed worker for 1 year was 0.56+/-0.92 mSv. By multivariate logistic regression analysis, a significant factor associated with the prevalence of FD was their high level of stress (odds ratio, 6.37; 95% confidence interval, 1.38-29.53). Between radiation workers with IBS and those without IBS, there was no significant difference in radiation exposure level, sleep quality, and stress level. There was no difference in the prevalence of IBS (40.0% vs. 15.8%, P=0.09) and FD (30.0% vs. 31.6%, P=0.92) between the relatively high-dose (total dose accumulated during the 3 years > or =9.4 mSv) and low-dose exposed group (<9.4 mSv). CONCLUSIONS: Occupational exposure to low levels of radiation does not seem to be significantly related to IBS and FD, but high stress level seems to be related to FD.

The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data

BACKGROUND/AIMS: Liver stiffness measurement (LSM) has been proposed as a non-invasive method for estimating the severity of fibrosis and the complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence of portal hypertension, but its invasiveness limits its clinical application. In this study we evaluated the relationship between LSM and HVPG, and the predictive value of LSM for clinically significant portal hypertension (CSPH) and severe portal hypertension in cirrhosis. METHODS: LSM was performed with transient elastography in 59 consecutive cirrhotic patients who underwent hemodynamic HVPG investigations. CSPH and severe portal hypertension were defined as HVPG > or =10 and > or =12 mmHg, respectively. Linear regression analysis was performed to evaluate the relationship between LSM and HVPG. Diagnostic values were analyzed based on receiver operating characteristic (ROC) curves. RESULTS: A strong positive correlation between LSM and HVPG was observed in the overall population (r2=0.496, P or =10 mmHg) was 0.851, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for an LSM cutoff value of 21.95 kPa were 82.5%, 73.7%, 86.8%, and 66.7%, respectively. The AUROC at prediction of severe portal hypertension (HVPG > or =12 mmHg) was 0.877, and the sensitivity, specificity, PPV, and NPV at LSM cutoff value of 24.25 kPa were 82.9%, 70.8%, 80.6%, and 73.9%, respectively. CONCLUSIONS: LSM exhibited a significant correlation with HVPG in patients with cirrhosis. LSM could be a non-invasive method for predicting CSPH and severe portal hypertension in Korean patients with liver cirrhosis.

Prevalence and Predictive Factors of Fecal Incontinence

BACKGROUND/AIMS: Most previous epidemiologic studies about fecal incontinence were performed in specific populations in Korea. We aimed to estimate the prevalence and predictive factors of fecal incontinence in adult Korean population, both men and women aged 20 years and over. METHODS: Subjects who had undergone medical check-up for health screening were enrolled. They completed the structured questionnaires, including demographics, gastrointestinal symptoms, medical and social histories, and also about their bowel habits. Logistic regression models were constructed to identify the predictive factors for having fecal incontinence. RESULTS: Among the total of 1,149 subjects (mean age, 44.8 +/- 10.2 years; 648 males), the overall prevalence of fecal incontinence was 6.4%, while the older group (> 50 years old) showed the higher prevalence than the younger group (< or = 50 years old) (10.4% vs 4.9%, P = 0.001) without gender difference. Most patients had mild fecal incontinence in 78.4%. By multivariate analysis, old ages (Odd ratio [OR], 3.1; 95% confidence interval [CI], 1.9-5.2; P < 0.001), watery stool (OR, 2.8; 95% CI, 1.5-4.9; P = 0.001) and functional diarrhea (OR, 2.7; 95% CI, 1.4-5.4; P = 0.004) were found to be independent predictors for fecal incontinence. CONCLUSIONS: The prevalence of fecal incontinence in Korean adults was 6.4%, and it was significantly more prevalent in older people without any gender difference. Aging and diarrhea were independent predictive factors of fecal incontinence. Therefore, proper control of the bowel pattern would lead to the prevention of fecal incontinence.

A Case of Brunner's Gland Adenoma Presenting as Large Polyp with Stalk

Sporadic duodenal polyps are uncommon, being found at 5% of patient referred for upper endoscopy. They are often discovered incidentally and are usually asymptomatic. Endoscopic features and histologic results from endoscopically biopsied specimen cannot exclude malignancy. Recently, we experienced a Brunner's gland adenoma of duodenum mimicking malignant neoplasm. A 52-year-old female visited for evalution of a duodenal mass. A 3 cm sized polypoid mass located at the mesenteric border of 2nd portion of duodenum was found on endoscopic examination. Histologic results based on tissue taken from endoscopic biopsy showed gastric foveolar hyperplasia. Endoscopic polypectomy was performed to exclude malignancy and histological finding was consistent with Brunner's gland adenoma.

A Case of Primary Aortoenteric Fistula Mimicking Duodenal Subepithelial Tumor

Primary aortoenteric fistula is a fatal condition which poses a considerable diagnostic challenge because of its infrequency and nonspecific presentation. Here, the authors report the case of an 83-year-old man who presented with hematemesis and melena. During endoscopy, a 3 cm sized subepithelial mass with central ulceration was found in the second portion of the duodenum. At first, bleeding from a duodenal subepithelial tumor, such as, gastrointestinal stromal tumor was suspected. An endoscopic hemostasis trial failed and computed tomography (CT) scan was performed prior to possible angiographic embolization. The CT scan revealed the mass lesion observed by endoscopy as an aneurismal dilatation with fistula formation to the distal second portion of the duodenum. The patient succumbed to hypovolemic shock while preparations were being made for emergency surgery. This case provides an example of a primary aortoenteric fistula mimicking a duodenal subepithelial tumor during endoscopy.

A Case of Gastric Lipoma Removed Using a Detachable Snare

Gastrointestinal lipoma is a benign tumor of mature adipose tissue, surrounded by fibrous capsule. They can be located anywhere in the gastrointestinal tract, but rarely in the stomach, especially at the cardia. Gastric lipoma accounts for approximately 2~3% of all benign gastric tumors, and 5% of all gastrointestinal lipomas. Lipoma tends to have very low malignant potential, but if it induces symptoms like abdominal pain or hemorrhage, it needs to be removed. We report a case of gastric lipoma which was successfully removed by only using a detachable snare. A 72-years-old woman who had no specific symptom was found to have a submucosal tumor at cardia. During endoscopy, the fatty internal material accidently came out after tearing the mucosa with biopsy, and it was successfully removed using a detdachable snare.

Pathophysiology and Diagnosis of Irritable Bowel Syndrome / 대한내과학회지

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort with bowel habit changes. However, its pathogenesis and pathyphysiology have been poorly understood. There were many robust functional and anatomical evidences in Korea for visceral hypersensitivity, low-grade inflammation and immunologic alterations, brain-gut interaction and genetic factors in the development of IBS. The link between pathophysiologic changes and gastrointestinal symptoms would be the strong basis for the relevance of target therapy in this condition. The ROME III criteria represent the current gold standard for the identification of characteristic and supportive symptoms of IBS and for the categorization of IBS patients into symptom-based subgroups with exclusion of organic diseases. There were some limitations in use of Rome III criteria in the clinical practice and research fields. Test of Rome III are needed, especially in Korea.

Endoscopic Diagnosis of Gastric MALT Lymphoma

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 2~7% of gastric malignancy, and its occurrence has been increasing. The connection between Helicobacter pylori (H. pylori) and gastric MALT lymphoma has been well established. In low grade gastric MALT lymphoma, H. pylori eradication can induce complete remission, so early detection is very important. However, endoscopic findings of MALT lymphoma are nonspecific and diagnosis is difficult by the naked eye due to various endoscopic appearances such as erosion, erythema, ulceration, atrophy and submucosal mass. Repeated deep tissue biopsies of the suspicious lesions and confirmation of the typical lymphoepithelial lesions is essential for diagnosis. Endoscopic ultrasound (EUS) can aid in accurate diagnosis, staging, and prediction of prognosis in gastric MALT lymphoma.

A Case of Delayed Severe Hypersensitivity Reaction during Genexol-PM(R) Infusion / 결핵및호흡기질환

Although Taxol(R) is one of the most successful drugs in current cancer chemotherapy against solid tumors, a major problem is hypersensitivity reactions that arises as a consequence of activation of the complement (C) system, "C activation-related pseudo-allergy". Most severe hypersenstivity reactions occur within the first few minutes of Taxol(R) administration, usually after the first or second dose. Here we report a case of a severe hypersensitivity reaction in a 72-year-old man undergoing Genexol-PM(R) infusion. Hypotension and polymorphic pruritic skin rash appeared 2 hours after the start of Genexol-PM(R) infusion (with an appropriate premedication). Treating with methylprednisolone, epinephrine and inotropic agents, reduced the hypotension and the skin rash disappeared. We report this case with a review of the literature.

Inhibition of LPS-induced cyclooxygenase 2 and nitric oxide production by transduced PEP-1-PTEN fusion protein in Raw 264.7 macrophage cells

Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) is a tumor suppressor. Although it is well known to have various physiological roles in cancer, its inhibitory effect on inflammation remains poorly understood. In the present study, a human PTEN gene was fused with PEP-1 peptide in a bacterial expression vector to produce a genetic in-frame PEP-1-PTEN fusion protein. The expressed and purified PEP-1-PTEN fusion protein were transduced efficiently into macrophage Raw 264.7 cells in a time- and dose- dependent manner when added exogenously in culture media. Once inside the cells, the transduced PEP-1-PTEN protein was stable for 24 h. Transduced PEP-1-PTEN fusion protein inhibited the LPS-induced cyclooxygenase 2 (COX-2) and iNOS expression levels in a dose-dependent manner. Furthermore, transduced PEP-1-PTEN fusion protein inhibited the activation of NF-kappa B induced by LPS. These results suggest that the PEP-1-PTEN fusion protein can be used in protein therapy for inflammatory disorders.