Sex Differences in Gut Microbiota

Factors Influencing the Diagnostic Accuracy of Acoustic Radiation Force Impulse Elastography in Patients with Chronic Hepatitis B

BACKGROUND/AIMS: To determine factors predictive of discordance in staging liver fibrosis using liver biopsy (LB) and acoustic radiation force impulse (ARFI) elastography in patients with chronic hepatitis B (CHB). METHODS: Consecutive patients with CHB who underwent LB and ARFI elastography on the same day from November 2010 to March 2013 were prospectively recruited from three tertiary hospitals. RESULTS: We analyzed 105 patients (median age of 47 years). The F0-1, F2, F3, and F4 fibrosis stages were identified in 27 (25.7%), 27 (25.7%), 21 (20.0%), and 30 (28.6%) patients, respectively. The areas under the receiver operating characteristics curves for ARFI elastography in assessing ≥F2, ≥F3, and F4 was 0.814, 0.848, and 0.752, respectively. The discordance of at least one stage between LB and ARFI was observed in 68 patients (64.8%) and of at least two stages in 16 patients (15.2%). In a multivariate analysis, advanced fibrosis stage (F3-4) was the only factor that was negatively correlated with one-stage discordance (p=0.042). Moreover, advanced fibrosis stage was negatively (p=0.016) correlated and body mass index (BMI) was positively (p=0.006) correlated with two-stage discordance. CONCLUSIONS: Advanced fibrosis stage (F3-4) was a predictor of nondiscordance between LB and ARFI elastography; BMI also influenced the accuracy of ARFI elastography.

Clinicopathologic Characteristics of Interval Gastric Cancer in Korea

BACKGROUND/AIMS: Interval gastric cancer (IGC) is defined as cancer that is diagnosed between the time of screening and postscreening esophagogastroduodenoscopy (EGD). Unfortunately, little is known about the characteristics of IGC in Korea, a country with a high incidence of gastric cancer. The aim of this study was to evaluate the clinicopathologic characteristics of IGCs in Korea. METHODS: From January 2006 to July 2011, a total of 81,762 subjects underwent screening EGD at Yonsei University Health Promotion Center, Seoul, Korea. We defined missed cancer as cancer diagnosed within 1 year of screening EGD and latent cancer as cancer diagnosed more than 1 year after EGD. RESULTS: A total of 16 IGC patients (17 lesions; three missed cancers and 14 latent cancers) were identified, with a mean age of 60.68 years and a mean interval time of 19.64 months. IGCs tended to be undifferentiated (12/17, 70.6%), located in the lower body of the stomach (12/17, 70.6%) and exhibited flat/depressed endoscopic morphology (11/17, 64.7%). The patients with missed cancer were generally younger than the patients with latent cancer (51.3 years vs 62.8 years, p=0.037), and the patients with undifferentiated cancer were significantly younger than those with differentiated cancer (57.0 years vs 68.8 years, p=0.008). CONCLUSIONS: IGCs tended to be undifferentiated, located in the lower body of the stomach, and exhibited flat/depressed endoscopic morphology.

Clinicopathologic Characteristics of Interval Gastric Cancer in Korea

BACKGROUND/AIMS: Interval gastric cancer (IGC) is defined as cancer that is diagnosed between the time of screening and postscreening esophagogastroduodenoscopy (EGD). Unfortunately, little is known about the characteristics of IGC in Korea, a country with a high incidence of gastric cancer. The aim of this study was to evaluate the clinicopathologic characteristics of IGCs in Korea. METHODS: From January 2006 to July 2011, a total of 81,762 subjects underwent screening EGD at Yonsei University Health Promotion Center, Seoul, Korea. We defined missed cancer as cancer diagnosed within 1 year of screening EGD and latent cancer as cancer diagnosed more than 1 year after EGD. RESULTS: A total of 16 IGC patients (17 lesions; three missed cancers and 14 latent cancers) were identified, with a mean age of 60.68 years and a mean interval time of 19.64 months. IGCs tended to be undifferentiated (12/17, 70.6%), located in the lower body of the stomach (12/17, 70.6%) and exhibited flat/depressed endoscopic morphology (11/17, 64.7%). The patients with missed cancer were generally younger than the patients with latent cancer (51.3 years vs 62.8 years, p=0.037), and the patients with undifferentiated cancer were significantly younger than those with differentiated cancer (57.0 years vs 68.8 years, p=0.008). CONCLUSIONS: IGCs tended to be undifferentiated, located in the lower body of the stomach, and exhibited flat/depressed endoscopic morphology.

Antiviral efficacies of currently available rescue therapies for multidrug-resistant chronic hepatitis B

BACKGROUND/AIMS: The incidence of multidrug-resistant (MDR) chronic hepatitis B (CHB) during sequential lamivudine (LAM) and adefovir dipivoxil (ADV) treatment is increasing. We investigated the antiviral efficacies of various rescue regimens in patients who failed sequential LAM-ADV treatment. METHODS: Forty-eight patients (83.3% of whom were HBeAg-positive) who failed sequential LAM-ADV treatment were treated with one of the following regimens: entecavir (ETV) (1 mg) monotherapy (n=16), LAM+ADV combination therapy (n=20), or ETV (1 mg)+ADV combination therapy (n=12). All patients had confirmed genotypic resistance to both LAM and ADV and were evaluated every 12 weeks. RESULTS: The baseline characteristics and treatment duration did not differ significantly among the study groups. During the treatment period (median duration: 100 weeks), the decline of serum HBV DNA from baseline tended to be greatest in the ETV+ADV group at all-time points (week 48: -2.55 log10 IU/mL, week 96: -4.27 log10 IU/mL), but the difference was not statistically significant. The ETV+ADV group also tended to have higher virologic response rates at 96 weeks compared to the ETV monotherapy or LAM+ADV groups (40.0% vs. 20.0% or 20.0%, P=0.656), and less virologic breakthrough was observed compared to the ETV monotherapy or LAM+ADV groups (8.3% vs. 37.5% or 30.0%; P=0.219), but again, the differences were not statistically significant. HBeAg loss occurred in one patient in the ETV+ADV group, in two in the ETV monotherapy group, and in none of the LAM+ADV group. The safety profiles were similar in each arm. CONCLUSIONS: There was a nonsignificant tendency toward better antiviral efficacy with ETV+ADV combination therapy compared to LAM+ADV combination therapy and ETV monotherapy for MDR CHB in Korea, where tenofovir is not yet available.

Crohn's Duodeno-colonic Fistula Preoperatively Closed Using a Detachable Endoloop and Hemoclips: A Case Report / 대한소화기학회지

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.

Factors Predictive of High-Risk Adenomas at the Third Colonoscopy after Initial Adenoma Removal

Evaluating predictive factors for high-risk adenomas at the third colonoscopy based on two prior colonoscopies may help evaluate high-risk adenoma at the third colonoscopy. We analyzed clinical data of 131 patients at Severance Hospital from January 1997 to January 2011. All of them underwent two subsequent colonoscopies after removal of adenomas during an initial colonoscopy. Among 20 patients with high-risk adenoma at the first and second colonoscopies, 10 (50%) patients had high-risk adenoma at the third colonoscopy. Among the 67 patients who had high-risk adenoma only once at the first or second colonoscopy, 15 (22.4%) patients had high-risk adenoma at the third colonoscopy but among the 44 patients without high-risk adenoma at the first and second colonoscopies, only 1 (2.3%) patient had high-risk adenoma at the third colonoscopy (P < 0.001). A multivariate time dependent covariate Cox regression analysis confirmed that high-risk adenoma at the first and/or second colonoscopy (HR, 9.56; 95% CI, 2.37-38.54; P = 0.002) was independent predictor of high-risk adenoma at the third colonoscopy. Given these findings, data from two prior colonoscopies, not one prior examination, may help identify high-risk populations at the third colonoscopy who require careful colonoscopic surveillance.

A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.

The Relationship between Sense of Humor, Coping with Humor, Perceived Stress and Self-esteem in the Middle-aged Women / 성인간호학회지

PURPOSE: This study was performed to identify the relationship between Sense of Humor, Coping Humor, Perceived stress and self-esteem in the middle-aged women. METHODS: Data were collected from the 20th of June to the 30th of August in 2009 from 145 middle-aged women living in Seoul. Data analysis was done with SPSS/WIN 12.0 program for descriptive statistics and Pearson correlation. RESULTS: The mean score of the humor sense was 55.94+/-6.52, coping humor was 21.11+/-3.82, perceived stress was 22.21+/-3.03 and self-esteem was 27.50+/-2.88. Subcategories of sense of humor were that emotional expressiveness was average 20.75+/-2.70, meta-message sensitivity was average 20.12+/-2.74 and liking of humor was average 15.13+/-3.44. Sense of humor was difference according to the economic status(t=2.000, p=.047), coping humor was difference according to the on medication use(t=2.227, p=.027). There was a significant correlation between the coping humor, perceived stress and the self-esteem. When the coping humor was higher, perceived stress was lower and the self-esteem was higher. CONCLUSION: This study showed that medication and economic status influences the humor scores and the sense of humor and coping humor were related to perceived stress and self-esteem in middle-aged women Therefore, these findings can provide the basis for the development of nursing intervention to increase the ability to coping with stress.

Cancer Survivors' Life Experience / 종양간호학회지

PURPOSE: The purpose of this study was to describe and understand the meaning of cancer survivors' life experience after being discharged from the primary cancer treatment. METHODS: Data were collected through a tape-recorded in-depth interview from six participants living in Gyeonggi province from September 2007 to January 2008. The analysis of the data was made through the phenomenological analytic method suggested by Colaizzi. RESULTS: Thirteen themes regarding the survivors' life experience were found. From these thirteen themes, six major theme were emerged. The six major theme included 'keeping his/her mind comfortable', 'going ahead with new hope', 'accepting for his/her existing burden', 'maintaining a good health for a new life', 'improving the strength and relationship among the family member', and 'being faithful to his/her religion'. CONCLUSIONS: The results of this study would help oncology nurses to understand the cancer survivors' life and to develop a quality of life improvement program for physical, psychosocial, and spiritual aspects of nursing.

Prolonged Horner's Syndrome Following Interscalene Brachial Plexus Block: A case report / 대한마취과학회지

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as high epidural block, total spinal anesthesia, permanent neurologic damage, phrenic nerve block, cardiac arrest, pneumothorax and Horner's syndrome etc. were reported. Ipsilateral Horner' syndrome can be used for confirmation of the accompanying sympathetic block. We experienced a case of 35-year old male patient who developed ipsilateral Horner's syndrome following the injection of 40ml of 1% lidocaine with 1 : 200,000 epinephrine to brachial plexus by interscalene approach. This compication lasted for 10days after interscalene brachial plexus block.

Effects of Balloon Dilation Technique on Incidence of Epistaxis and Ease of Tube Advancement in the Nasal Cavity / 대한마취과학회지

BACKGROUND: When the insertion of endotracheal tubes(ETTs) through the nostril, The tubemay be encountered some resistance. Forcing ETT into the nasal cavity develop mucosal and soft tissue injuries and subsequent epistaxis during passage of the tube even when vasoconstrictors and/or a lubricated tube are employed. Therefore, We determined whether balloon dilation technique(BDT) reduces the incidence of epistaxis and increases the ease of the tube advancement in the nasal cavity during nasotracheal intubation. METHODS: Sixty adult patients who scheduled for maxillofacial surgery were divided into two groups, BDT(n=30) and non BDT(n=30). The BDT group received an armored tube, which a 14 Fr-all-silicone Foley catheter insert through the tube, while non BDT group received a plain armored tube. All patients in both groups was inserted ETTs by conventional nasotracheal insertion techniques. RESULTS: The BDT group had a signifieantly lower incidence of epistaxis(0/30 vs 8/30 : p<0.05) and provided a significantly easier passage in the nasal cavity than non BDT group (difficult tube advancement in the nasal cavity, 3/30 vs 17/30 : p<0.05). CONCLUSIONS: The BDT helps to make an easy and smooth passage of the tube and to prevent epistaxis during nasotracheal tube insertion. This study indicates that nasotracheal intubation using BDT is an easily learned, safe, effective and atraumatic method.

Clinical Applications of the Balloon Dilation Technique during the Insertion of the Nasotracheal Tube / 대한마취과학회지

Nasotracheal intubation is often the method of choice in oral or maxillofacial operations. During the insertion of endotracheal tube (ETT) through nostril, a considerable damage can be inflicted on the nasal mucosa by forcing ETT into the nasal cavity, and epistaxis may occur as a result of mucosal damage even when vasoconstrictors, a lubricated tube, and careful manipulation are employed. This study was conducted to observe whether balloon dilation technique(BDT) can help to minimize the expected problems during nasotracheal tube insertion and was to tried to get a data for further studies. In 30 patients in whom the nasotracheal tube was placed, smooth passage into the nasal cavity without using BDT occurred in 9 patients(30.0%). Of 21 patients(70.0%) who were come into the use of BDT when resistance to tube insertion due to anatomical structures of the nasal cavity was encountered, epistaxis was not developed. By the above results, The BDT appers to prevent epistaxis during nasotracheal tube insertion and to make an easy and smooth passage of the tube and then it suggest that the BDT should provide a basic data and an alternative to conventional techniques for a safe and atraumatic nasotracheal intubation.

A Clinical Survey on Anesthetic Management in Patients with Maxillo - Facial Trauma / 대한마취과학회지

A clinical analysis of 249 patients with maxillo-facial trauma, who underwent general anes- thesia from January 1992 to December 1993 at Lee-Rha General Hospital, were made in order to investigate various case characteristics such as sex ratio, age distribution, types of trauma, fracture sites, associated injuries, underlying medical problems, abnormal laboratory findings, intubation, and preoperative physical condition. It was found that males outnumbered females showing the peak age incidence in 20's and 30's. The high velocity motor vehicle accidents was the most common cause of trauma and the mandible was the most frequent fracture sites. Among 96 associated injury cases, 63 cases were neumsurgical problems. Underlying medical problems or abnormal laboratory findings were present in 28.9% of the patients studied and preoperative physical status 1 or 1E (ASA classification) was most common accounting for 54.8% of the patients studied. Of the patients who received endotracheal intubation, 73.5% were done via a nasotracheal route.