A 75 kDa glycoprotein isolated from Cudrania tricuspidata Bureau induces colonic epithelial proliferation and ameliorates mouse colitis induced by dextran sulfate sodium / 中国天然药物

Cudrania tricuspidata Bureau (CTB), a species of the Moraceae plant, has been used as a bruise recovery treatment. This study aimed to determine whether the 75 kDa phytoglycoprotein extracted from CTB has a regulatory effect on the proliferation of human colon epithelial cells and the pathological process of inflammatory bowel disease (IBD). We found that CTB glycoprotein significantly induces the proliferation of human colon epithelial HT-29 cells by activating protein kinase C. CTB glycoprotein stimulated the phosphorylation of c-Jun N-terminal kinase and transcription factor nuclear factor-κB, which are responsible for the expression of cell-cycle-related proteins (CDK2, CDK4, cyclin D1 and cyclin E) during its promotion of cell proliferation. Experimental colitis was induced in mice by adding dextran sulfate sodium to their drinking water at a concentration of 4% (W/V) for seven days. We found that CTB glycoprotein ameliorates the pathological process of IBD and lowers the disease activity index score, which was composed of body weight change, diarrhea, and hematochezia in ICR mice treated with dextran sulfate sodium. Hence, we suggest that CTB glycoprotein has the ability to prevent IBD by promoting cell proliferation signaling events via the activation of PKC, JNK and NF-κB in colon epithelial cells.

Harmonization of laboratory results by data adjustment in multicenter clinical trials

BACKGROUND/AIMS: In multicenter clinical trials, laboratory tests are performed in the laboratory of each center, mostly using different measuring methodologies. The purpose of this study was to evaluate coefficients of variation (CVs) of laboratory results produced by various measuring methods and to determine whether mathematical data adjustment could achieve harmonization between the methods. METHODS: We chose 10 clinical laboratories, including Green Cross Laboratories (GC Labs), the central laboratory, for the measurement of total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum triglycerides, creatinine, and glucose. The serum panels made with patient samples referred to GC Labs were sent to the other laboratories. Twenty serum samples for each analyte were prepared, sent frozen, and analyzed by each participating laboratory. RESULTS: All methods used by participating laboratories for the six analytes had traceability by reference materials and methods. When the results from the nine laboratories were compared with those from GC Labs, the mean CVs for total cholesterol, HDL-C, LDL-C, and glucose analyzed using the same method were 1.7%, 3.7%, 4.3%, and 1.7%, respectively; and those for triglycerides and creatinine analyzed using two different methods were 4.5% and 4.48%, respectively. After adjusting data using Deming regression, the mean CV were 0.7%, 1.4%, 1.8%, 1.4%, 1.6%, and 0.8% for total cholesterol, HDL-C, LDL-C, triglyceride, creatinine, and glucose, respectively. CONCLUSIONS: We found that more comparable results can be produced by laboratory data harmonization using commutable samples. Therefore, harmonization efforts should be undertaken in multicenter trials for accurate data analysis (CRIS number; KCT0001235).

Association of Public CPR Education with Willingness to Perform Bystander CPR: A Metropolitan City Wide Survey

PURPOSE: Bystander cardiopulmonary resuscitation (CPR) is an important factor in improving the survival rate and neurologic prognosis for out-of-hospital cardiac arrest patients. Here, we aimed to establish factors related to CPR education, such as timing of education, interval from the most recent education session, and contents, that may influence CPR willingness. METHODS: In February 2012, an interview survey of 1,000 Daegu citizens was conducted via organized questionnaire, administered by trained interviewers. Subjects were aged 19 years or older and selected by a quota sampling technique. Social and population characteristics, factors related to CPR, and factors related to CPR education, were investigated. The chi-square test and multivariate logistic regression analysis were used to evaluate education-related factors that may affect the willingness to perform CPR. RESULTS: The adjusted odds ratio (OR) for CPR willingness was 3.38 (95% confidence interval [CI], 2.3–5.0) among the respondents in the didactic plus practice group. The adjusted OR for CPR willingness was 7.68 (95% CI, 3.21–18.35) among the respondents receiving over 4 CPR education sessions. The adjusted OR for CPR willingness, in accordance with the time interval from the last CPR education session, was 4.47 (95% CI, 1.29–15.52) for intervals under 6 months and 3.80 (95% CI, 1.91–7.56) for intervals between 6 months and 1 year. If automated external defibrillator (AED) training was included in CPR education, the adjusted OR for CPR willingness was 5.98 (95% CI, 2.30–15.53). CONCLUSION: Including practice sessions and AED training in public CPR education, more frequent CPR revision and short time intervals in between CPR education sessions are associated with greater willingness to perform CPR.

Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey

OBJECTIVE: Bystander cardiopulmonary resuscitation (CPR) is an important factor associated with improved survival rates and neurologic prognoses in cases of out-of-hospital cardiac arrest. We assessed how factors related to CPR education including timing of education, period from the most recent education session, and content, affected CPR willingness. METHODS: In February 2012, trained interviewers conducted an interview survey of 1,000 Daegu citizens through an organized questionnaire. The subjects were aged ≥19 years and were selected by quota sampling. Their social and demographic characteristics, as well as CPR and factors related to CPR education, were investigated. Chi-square tests and multivariate logistic regression analyses were used to evaluate how education-related factors affected the willingness to perform CPR. RESULTS: Of total 1,000 cases, 48.0% were male. The multivariate analyses revealed several factors significantly associated with CPR willingness: didactic plus practice group (adjusted odds ratio [AOR], 3.38; 95% confidence interval [CI], 2.3 to 5.0), group with more than four CPR education session (AOR, 7.68; 95% CI, 3.21 to 18.35), interval of less than 6 months from the last CPR education (AOR, 4.47; 95% CI 1.29 to 15.52), and education with automated external defibrillator (AOR, 5.98; 95% CI 2.30 to 15.53). CONCLUSION: The following were associated with increased willingness to perform CPR: practice sessions and automated electrical defibrillator training in public CPR education, more frequent CPR training, and shorter time period from the most recent CPR education sessions.

Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study / 대한소화기학회지

BACKGROUND/AIMS: There are no studies that looked into the bubble eliminating efficacy of polyethylene glycol with ascorbic acid (PEGA), which has been one of the shortcomings of polyethylene glycol (PEG). In this study, we compared newly introduced PEGA regimen by adding either simethicone or 1 L of water. METHODS: A prospective randomized controlled study was carried out at Dongguk Universtiy Gyeongju Hospital from July 2014 to September 2014. A total of 90 patients were randomly assigned to 3 groups; PEGA group (n=30) which served as control, simethicone addition group (n=30) to which simethicone 400 mg was additionally prescribed, and water addition group (n=30) to whom additional 1 L of water was given. Cleansing effectiveness, gas elimination efficacy, side effects, and patient satisfaction were compared between the groups. RESULTS: PEGA group demonstrated the highest cleansing effectiveness, but there was no statistically significant difference among the groups. Simethicone addition group showed significantly lesser amount of bubbles than the other groups (2.57±2.05 vs. 1.10±1.83 vs. 2.60±2.84, p=0.017). The rates of side effects in each group were 20.00% vs. 16.77% vs. 53.33%. Water addition group had significantly more side effects than the PEGA group and the simethicone addition group (p=0.003). The patient satisfaction score of each group was 3.37±0.85 vs. 3.73±0.74 vs. 3.20±0.66 with simethicone addition group showing significantly higher satisfaction than water addition group (p=0.020). CONCLUSIONS: PEGA bowel preparation agent showed satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone resulted in better bubble elimination.

Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study / 대한소화기학회지

BACKGROUND/AIMS: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. METHODS: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. RESULTS: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). CONCLUSIONS: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.

Clinical Outcomes of the Endoscopic Submucosal Dissection of Early Gastric Cancer Are Comparable between Absolute and New Expanded Criteria

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.

Clinical Outcomes of the Endoscopic Submucosal Dissection of Early Gastric Cancer Are Comparable between Absolute and New Expanded Criteria

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.

Survey of Endoscope Reprocessing in Korea

BACKGROUND/AIMS: There is a growing emphasis on quality management in endoscope reprocessing. Previous surveys conducted in 2002 and 2004 were not practitioner-oriented. Therefore, this survey is significant for being the first to target actual participants in endoscope reprocessing in Korea. METHODS: This survey comprised 33 self-filled questions, and was personally delivered to nurses and nursing auxiliaries in the endoscopy departments of eight hospitals belonging to the society. The anonymous responses were collected after 1 week either by post or in person by committee members. RESULTS: The survey included 100 participants. In the questionnaire addressing compliance rates with the reprocessing guideline, the majority (98.9%) had a high compliance rate compared to 27% of respondents in 2002 and 50% in 2004. The lowest rate of compliance with a reprocessing procedure was reported for transporting the contaminated endoscope in a sealed container. Automated endoscope reprocessors were available in all hospitals. Regarding reprocessing time, more than half of the subjects replied that reprocessing took more than 15 minutes (63.2%). CONCLUSIONS: The quality management of endoscope reprocessing has improved as since the previous survey. A national survey expanded to include primary clinics is required to determine the true current status of endoscope reprocessing.

Antihypertensive drug combinations

Hypertension has a diverse pathophysiology. Theoretically, one drug is not sufficient to control high blood pressure (BP) in most hypertension. Therefore, the combination of two or more drugs with different mechanisms is needed to meet the target BP. In setting the target BP, a low-dose combination of two drugs with different mechanisms has greater efficacy and safety than a higher dose of one drug. Recent clinical trials and hypertension guidelines from different parts of the world report that the combination of renin-angiotensin system inhibitors with calcium channel antagonists or diuretics is generally recommended but combinations including beta-blockers, rarely so. However, if even a combination of three drugs all with different mechanisms, each at full dose does not control the BP, then a beta-blocker and/or other antihypertensive drug should be considered. Rarely, an interventional procedure such as renal sympathetic denervation has been applied, but evidence supporting such therapies remains limited.

Antihypertensive drug therapy: a review based on recent guidelines

In 2013 and 2014, many guidelines regarding the management of hypertension were released from various worldwide professional bodies. These guidelines are similar in their recommendations, but some differences are evident due to different choices and interpretations of evidence from clinical trials used in setting the guidelines. A noticeable change that is common to all the guidelines is an increase in the target blood pressure for the treatment of hypertension to 140/90 mmHg. The guidelines also introduce invasive approaches, such as renal sympathetic denervation, as additional measures to better manage resistant hypertension. This review gives a summary of recent guidelines from North America, Europe, and Asia for the management of hypertension, with a focus on pharmacological treatment, and compares these guidelines with the Korean guidelines.

Pregnancy-associated pulmonary embolism during the peripartum period: An 8-year experience at a single center

OBJECTIVE: The purpose of this study was to estimate the incidence, timing of onset, risk factors, and mortality rate of pregnancy-associated pulmonary embolism (PAPE). METHODS: We analyzed PAPE cases that occurred between January 2005 and December 2012 at Cheil General Hospital & Women's Healthcare Center. Those cases that were not confirmed by computed tomography scan or were confirmed as amniotic fuid embolisms were excluded. We analyzed various risk factors such as previous surgery, mode of delivery, maternal age, and obesity in PAPE. RESULTS: There were 57,092 deliveries over 8 years. Of them, 13 cases (0.023%) were diagnosed with PAPE. All cases occurred in the postpartum period after cesarean delivery. There were no cases of PAPE after vaginal deliveries. Of the total cases, 10 cases (76.9%) were diagnosed in the early postpartum period within 48 hours. Eight cases (61.5%) had a history of previous surgery. There were 3 cases (23.1%) of multiple pregnancy and 3 cases (23.1%) of preterm delivery. No cases had a history of venous thromboembolism. Among 13 cases, 10 cases improved with only anticoagulation, 2 cases received surgical thrombectomy, and one case was maternal death. CONCLUSION: Our results indicated that the incidence of PAPE was very low (0.023%) and occurred mainly in the postpartum period after cesarean section. However, its maternal mortality rate was significantly high (7.7%). Therefore, we suggest that immediate diagnosis and prompt treatment should be prioritized for improvement of PAPE patients' survival rate.

The Evolution of Bowel Preparation and New Developments / 대한소화기학회지

Bowel preparation is essential for successful colonoscopy examination, and the most important factor is the bowel preparation agent used. However, selection of a bowel preparation agent invariably involves compromise. Originally, bowel preparation was performed for radiologic and surgical purposes, when the process involved dietary limitations, cathartics, and enemas, which had many side effects. Development of polyethylene glycol (PEG) solution led to substantive advancement of bowel preparation; however, despite its effectiveness and safety, the large volume involved, and its salty taste and unpleasant odor reduce compliance. Accordingly, modified PEG solutions requiring consumption of lower volumes and sulfate-free solutions were developed. Aqueous sodium phosphate is more effective and better tolerated than PEG solutions; however, fatal complications have occurred due to water and electrolyte shifts. Therefore, aqueous sodium phosphate was withdrawn by the US Food and Drug Administration, and currently, only sodium phosphate tablets remain available. In addition, oral sulfate solution and sodium picosulfate/magnesium citrate are also available, and various studies have reported on adjunctive preparations, such as hyperosmolar or stimulant laxatives, antiemetics, and prokinetics, which are now in various stages of development.

A Review of Current Disinfectants for Gastrointestinal Endoscopic Reprocessing

Gastrointestinal endoscopy is gaining popularity for diagnostic and therapeutic purposes. However, concerns over endoscope-related nosocomial infections are increasing, together with interest by the general public in safe and efficient endoscopy. For this reason, reprocessing the gastrointestinal endoscope is an important step for effective performance of endoscopy. Disinfectants are essential to the endoscope reprocessing procedure. Before selecting an appropriate disinfectant, their characteristics, limitations and means of use must be fully understood. Herein, we review the characteristics of several currently available disinfectants, including their uses, potency, advantages, and disadvantages. Most disinfectants can be used to reprocess gastrointestinal endoscopes if the manufacturer's guidelines are followed. The selection and use of a suitable disinfectant depends on the individual circumstances of each endoscopy suite.

Steps of Reprocessing and Equipments

With the increasing interest in endoscopy and the rising number of endoscopic examinations in hospitals, the importance of endoscopic reprocessing is also increasing. Cure facilities that are understaffed and ill-equipped are trying to cope with the problems of insufficient cleaning and high infection risks. To prevent endoscopy-associated infection, the endoscope cleaning, and disinfection guidelines prepared by the Korean Society of Gastrointestinal Endoscopy must be followed. In this review, the steps of endoscopic reprocessing and the equipments required in each step are discussed.

The Expression of CD10 and CD15 Is Progressively Increased during Colorectal Cancer Development

BACKGROUND: The aim of this study was to examine the expression of CD10 and CD15 in tumor cells, stromal cells and infiltrating inflammatory cells during colorectal carcinoma (CRC) development and to investigate their expression levels between the tumor center and invasive front and compare them to clinicopathological parameters in invasive CRC. METHODS: We performed immunohistochemical staining for CD10, CD15, and E-cadherin in 42 cases of CRC, 49 of tubular adenoma, 15 of hyperplastic polyp, and 17 of non-neoplastic colon. RESULTS: CD10 was expressed in tumor cells (tCD10), stromal cells (sCD10) and infiltrating inflammatory cells (iCD10), and CD15 was expressed in tumor cells (tCD15) and infiltrating inflammatory cells (iCD15). Their expressions were progressively increased during CRC development and the iCD10 expression level was significantly correlated with the iCD15 expression level in invasive CRC. Invasive front revealed a higher expression level of iCD10 and iCD15 than the tumor center. Moreover, the iCD15 expression level of invasive front was significantly correlated with the degree of tumor budding and tCD15 in whole tissue sections was closely associated with tumor depth. CONCLUSIONS: The present study suggests that the expression of CD10 and CD15 is associated with the development and progression of CRC.

Arterial Function Test / 대한내과학회지

No abstract available.

The Current Status of Cardiopulmonary Resuscitation Training for School

PURPOSE: Cardiopulmonary resuscitation (CPR) education for school is extremely important in the community. In Korea, the curriculum for health care training including CPR has been established by law since 2009. The aim of this survey was to investigate the current status of CPR training in school from the viewpoint of program administration and their aids. METHODS: In January 2012, we conducted an interview survey with 243 health teachers regarding their educational status and confidence, current education condition for school, teaching materials, and opinion on governmental health policy. The characteristics of survey respondents were compared according to elementary, middle, and high school. According to their place of work, we focused on teaching methods and programs for implementation of adequate CPR practices. RESULTS: Half of the participants worked in elementary schools, 29% in middle schools, and 20% in high schools. Ninety-four percent of elementary respondents reported having ever run a CPR curriculum, and 51% of middle school respondents and 41% of high school respondents administered CPR education in 2011. The median time for CPR lessons was two class hours [interquartile range (IQR): 1~2]. The median number of students per lesson was 30 (IQR: 26~71). Among those who had been trained, 84% of the elementary school, 56% of middle school, and 55% of the high school had performed manikin practice. Healthcare textbooks (58%), group-used manikins (31%), visual aids (24%), and only 6% of individual practice manikins were secured for use as CPR teaching aids. CONCLUSION: Wide variations in CPR curriculums and educational materials were observed among different school levels, and the standard program administrations and equipment were insufficient. Therefore, strategies and guidelines for program administration should be established as soon as possible.

Multicenter Survey of Intoxication Cases in Korean Emergency Departments: 2nd Annual Report, 2009

PURPOSE: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. METHODS: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, management of the patients in the emergency departments, and the clinical outcome. RESULTS: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. CONCLUSION: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.

Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy

BACKGROUND AND OBJECTIVES: The aim of this study was to identify the association of pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) with the development of venous thromboembolism (VTE). SUBJECTS AND METHODS: This was a retrospective study of 57,009 pregnancies during 2002-2008 at Cheil General Hospital, Kwandong University. The diagnosis of VTE {deep vein thrombosis or pulmonary embolism (PE)} was based on clot visualization via ultrasound or computed tomography. RESULTS: In total, 27 cases (PE, 20 cases) were detected. The incidence of VTE was 0.47 per 1,000 pregnancies. To determine risk factors associated with pregnancy-induced VTE, univariate analysis using a chi-square test was performed. Cesarean (C)-section, multiple pregnancy, PIH, placenta previa, and assisted reproduction technique (ART) were statistically significant compared to the controls (all, p=0.000). However, age, premature rupture of membrane, and GDM were not statistically related to VTE. Logistic regression analysis was used to calculate the odds ratios for the risk factors. Placenta previa showed a 12.6-fold higher risk, while PIH had a 9.8-fold higher risk for the occurrence of VTE. C-section and ART procedures increased the risk of VTE by 4.2 times compared to that of the controls. CONCLUSION: Placenta previa and PIH were significant risk factors for VTE, whereas the known traditional risk factors of increased age and GDM were not found to be associated with VTE.