Novel Genome-Wide Interactions Mediated via BOLL and EDNRA Polymorphisms in Intracranial Aneurysm

Objective@#: The association between boule (BOLL) and endothelin receptor type A (EDNRA) loci and intracranial aneurysm (IA) formation has been reported via genome-wide association studies. We sought to identify genome-wide interactions involving BOLL and EDNRA loci for IA in a Korean adult cohort. @*Methods@#: Genome-wide pairwise interaction analyses of BOLL and EDNRA involving 250 patients with IA and 296 controls were performed using the additive effect model after adjusting for confounding factors. @*Results@#: Among 512575 single-nucleotide polymorphisms (SNPs), 23 and 11 common SNPs suggested a genome-wide interaction threshold (p<1.25×10-8) involving rs700651 (BOLL) and rs6841581 (EDNRA). Rather than singe SNP effect of BOLL or EDNRA on IA development, they showed a synergistic effect on IA formation via multifactorial pair-wise interactions. The rs1105980 of PTCH1 gene showed the most significant interaction with rs700651 (natural log-transformed odds ratio [lnOR], 1.53; p=6.41×10-11). The rs74585958 of RYK gene interacted strongly with rs6841581 (lnOR, -19.91; p=1.64×10-9). Although, there was no direct interaction between BOLL and EDNRA variants, two EDNRA-interacting gene variants of TNIK (rs11925024 and rs1231) and FTO (rs9302654), and one BOLL-interacting METTL4 gene variant (rs549315) exhibited marginal interaction with BOLL gene. @*Conclusion@#: BOLL or EDNRA may have a synergistic effect on IA formation via multifactorial pair-wise interactions.

Identification of Differentially-Methylated Genes and Pathways in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

Objective@#: We reported the differentially methylated genes in patients with subarachnoid hemorrhage (SAH) using bioinformatics analyses to explore the biological characteristics of the development of delayed cerebral ischemia (DCI). @*Methods@#: DNA methylation profiles obtained from 40 SAH patients from an epigenome-wide association study were analyzed. Functional enrichment analysis, protein-protein interaction (PPI) network, and module analyses were carried out. @*Results@#: A total of 13 patients (32.5%) experienced DCI during the follow-up. In total, we categorized the genes into the two groups of hypermethylation (n=910) and hypomethylation (n=870). The hypermethylated genes referred to biological processes of organic cyclic compound biosynthesis, nucleobase-containing compound biosynthesis, heterocycle biosynthesis, aromatic compound biosynthesis and cellular nitrogen compound biosynthesis. The hypomethylated genes referred to biological processes of carbohydrate metabolism, the regulation of cell size, and the detection of a stimulus, and molecular functions of amylase activity, and hydrolase activity. Based on PPI network and module analysis, three hypermethylation modules were mainly associated with antigen-processing, Golgi-to-ER retrograde transport, and G alpha (i) signaling events, and two hypomethylation modules were associated with post-translational protein phosphorylation and the regulation of natural killer cell chemotaxis. VHL, KIF3A, KIFAP3, RACGAP1, and OPRM1 were identified as hub genes for hypermethylation, and ALB and IL5 as hub genes for hypomethylation. @*Conclusion@#: This study provided novel insights into DCI pathogenesis following SAH. Differently methylated hub genes can be useful biomarkers for the accurate DCI diagnosis.

Bioinformatics Analysis of Autophagy and Mitophagy Markers Associated with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage

Objective@#: To evaluate the interactions among differentially expressed autophagy and mitophagy markers in subarachnoid hemorrhage (SAH) patients with delayed cerebral ischemia (DCI). @*Methods@#: The expression data of autophagy and mitophagy-related makers in the cerebrospinal fluid (CSF) cells was analyzed by real-time reverse transcription-polymerase chain reaction and Western blotting. The markers included death-associated protein kinase (DAPK)-1, BCL2 interacting protein 3 like (BNIP3L), Bcl-1 antagonist X, phosphatase and tensin homolog-induced kinase (PINK), Unc-51 like autophagy activating kinase 1, nuclear dot protein 52, and p62. In silico functional analyses including gene ontology enrichment and the protein-protein interaction network were performed. @*Results@#: A total of 56 SAH patients were included and 22 (38.6%) of them experienced DCI. The DCI patients had significantly increased mRNA levels of DAPK1, BNIP3L, and PINK1, and increased expression of BECN1 compared to the non-DCI patients. The most enriched biological process was the positive regulation of autophagy, followed by the response to mitochondrial depolarization. The molecular functions ubiquitin-like protein ligase binding and ubiquitin-protein ligase binding were enriched. In the cluster of cellular components, Lewy bodies and the phagophore assembly site were enriched. BECN1 was the most connected gene among the differentially expressed markers related to autophagy and mitophagy in the development of DCI. @*Conclusion@#: Our study may provide novel insight into mitochondrial dysfunction in DCI pathogenesis.

Recent Stem Cell Research on Hemorrhagic Stroke : An Update

Although technological advances and clinical studies on stem cells have been increasingly reported in stroke, research targeting hemorrhagic stroke is still lacking compared to that targeting ischemic stroke. Studies on hemorrhagic stroke are also being conducted, mainly in the USA and China. However, little research has been conducted in Korea. In reality, stem cell research or treatment is unfamiliar to many domestic neurosurgeons. Nevertheless, given the increased interest in regenerative medicine and the increase of life expectancy, attention should be paid to this topic. In this paper, we summarized pre-clinical rodent studies and clinical trials using stem cells for hemorrhagic stroke. In addition, we discussed results of domestic investigations and future perspectives on stem cell research for a better understanding.

Profiling of T Cell Receptor β-Chain Complimentary Determining Regions 3 Repertoire in Subarachnoid Hemorrhage Patients Using High-Throughput Sequencing

Objective@#: The adaptive immune response following subarachnoid hemorrhage (SAH) is not well understood. We evaluated and compared the T cell receptor (TCR) immune repertoire of good-grade and poor-grade SAH patients to elucidate the T cell immunology after ictus. @*Methods@#: Peripheral blood from six SAH patients was collected at two different times, admission and at the 7-day follow-up. Composition and variation of the TCR β-chain (TCRB) complimentary determining regions (CDR) 3 repertoire was examined using high-throughput sequencing; the analysis was based on sampling time and disease severity (good vs. poor-grade SAH). @*Results@#: Clonality at admission and follow-up were 0.059 (0.037–0.038) and 0.027 (0.014–0.082) (median, 25th–75th percentile). Poor-grade SAH (0.025 [0.011–0.038]) was associated with significantly lower clonality than good-grade SAH (0.095 [0.079–0.101]). Poor-grade SAH patients had higher diversity scores than good-grade SAH patients. CDR length was shorter in good-grade SAH vs. poor-grade SAH. Differences in clonotype distribution were more prominent in TCRBV gene segments than TCRBJ segments. TCRBV19-01/TCRBJ02-04 and TCRBV28-01/TCRBJ02-04 were the most increased and the most decreased V-J pairs in the 7-day follow-up compared to admission in good-grade SAH. The most increased and decreased V-J pairs in poor-grade SAH patients were TCRBV28-01/TCRBJ02-06 and TCRBV30-01/TCRBJ02-04, respectively. @*Conclusion@#: The TCRB repertoire is dynamic in nature following SAH. TCRB repertoire may facilitate our understanding of adaptive immune response according to SAH severity.

Profiling of T Cell Receptor β-Chain Complimentary Determining Regions 3 Repertoire in Subarachnoid Hemorrhage Patients Using High-Throughput Sequencing

Objective@#: The adaptive immune response following subarachnoid hemorrhage (SAH) is not well understood. We evaluated and compared the T cell receptor (TCR) immune repertoire of good-grade and poor-grade SAH patients to elucidate the T cell immunology after ictus. @*Methods@#: Peripheral blood from six SAH patients was collected at two different times, admission and at the 7-day follow-up. Composition and variation of the TCR β-chain (TCRB) complimentary determining regions (CDR) 3 repertoire was examined using high-throughput sequencing; the analysis was based on sampling time and disease severity (good vs. poor-grade SAH). @*Results@#: Clonality at admission and follow-up were 0.059 (0.037–0.038) and 0.027 (0.014–0.082) (median, 25th–75th percentile). Poor-grade SAH (0.025 [0.011–0.038]) was associated with significantly lower clonality than good-grade SAH (0.095 [0.079–0.101]). Poor-grade SAH patients had higher diversity scores than good-grade SAH patients. CDR length was shorter in good-grade SAH vs. poor-grade SAH. Differences in clonotype distribution were more prominent in TCRBV gene segments than TCRBJ segments. TCRBV19-01/TCRBJ02-04 and TCRBV28-01/TCRBJ02-04 were the most increased and the most decreased V-J pairs in the 7-day follow-up compared to admission in good-grade SAH. The most increased and decreased V-J pairs in poor-grade SAH patients were TCRBV28-01/TCRBJ02-06 and TCRBV30-01/TCRBJ02-04, respectively. @*Conclusion@#: The TCRB repertoire is dynamic in nature following SAH. TCRB repertoire may facilitate our understanding of adaptive immune response according to SAH severity.

Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test / 고신대학교의과대학학술지

Objectives@#White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension.Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction.The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response. @*Methods@#We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data. @*Results@#There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group. @*Conclusions@#These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

A Preliminary Study of the Association between SOX17 Gene Variants and Intracranial Aneurysms Using Exome Sequencing

Objective@#Conflicting results regarding SOX17 genes and the risk of intracranial aneurysms (IA) exist in the Korean population, although significant positive correlations were noted in genome-wide association studies in European and Japanese populations. Therefore, we aimed to investigate an association between SOX17 gene variants and IA using exome sequencing data. @*Methods@#This study included 26 age-gender matched IA patients and 26 control subjects. The SOX17 gene variants identified from whole-exome sequencing data were examined. Genetic associations to estimate odds ratio (OR) and 95% confidence interval (CI) were performed using the software EPACTS. @*Results@#The mean age of the IA and control groups were 51.0±9.3 years and 49.4±14.3 years, respectively (p=0.623). Seven variants of SOX17, including six single nucleotide polymorphisms and one insertion and deletion, were observed. Among these variants, rs12544958 (A>G) showed the most association with IA, but the association was not statistically significant (OR, 1.97; 95% CI, 0.81-4.74; p=0.125). Minor allele frequencies of the IA patients and controls were 0.788 and 0.653, respectively. None of the remaining variants were significantly associated with IA formation. @*Conclusion@#No significant association between SOX17 gene variants and IA were noted in the Korean population. A large-scale exome sequencing study is necessary to investigate any Korean-specific genetic susceptibility to IA.

Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test / 고신대학교의과대학학술지

Objectives@#White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension.Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction.The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response. @*Methods@#We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data. @*Results@#There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group. @*Conclusions@#These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

Analysis of an Internet Community about Pneumothorax and the Importance of Accurate Information about the Disease

BACKGROUND: The huge improvements in the speed of data transmission and the increasing amount of data available as the Internet has expanded have made it easy to obtain information about any disease. Since pneumothorax frequently occurs in young adolescents, patients often search the Internet for information on pneumothorax. METHODS: This study analyzed an Internet community for exchanging information on pneumothorax, with an emphasis on the importance of accurate information and doctors’ role in providing such information. RESULTS: This study assessed 599,178 visitors to the Internet community from June 2008 to April 2017. There was an average of 190 visitors, 2.2 posts, and 4.5 replies per day. A total of 6,513 posts were made, and 63.3% of them included questions about the disease. The visitors mostly searched for terms such as ‘pneumothorax,’‘recurrent pneumothorax,’‘pneumothorax operation,’ and ‘obtaining a medical certification of having been diagnosed with pneumothorax.’ However, 22% of the pneumothorax-related posts by visitors contained inaccurate information. CONCLUSION: Internet communities can be an important source of information. However, incorrect information about a disease can be harmful for patients. We, as doctors, should try to provide more in-depth information about diseases to patients and to disseminate accurate information about diseases in Internet communities.

Comparison of Corneal Higher-order Aberration before and after Excision of Pterygium

PURPOSE: To investigate the types of corneal higher-order aberration (HOA) induced by pterygium, residual corneal HOA after pterygium surgery, and correlations between corneal HOA and the length of the pterygium. METHODS: Fifty-three patients who underwent pterygium excision with conjunctival autograft were enrolled. Corneal HOA was measured by Pentacam® (Oculus Inc., Wetzlar, Germany) preoperatively and 3 months postoperatively in the 6-mm optical zone. Preoperative and postoperative HOAs of eyes with pterygium were compared with HOAs of the fellow eye to evaluate HOAs induced by pterygium and residual HOAs after pterygium surgery. Partial correlation analysis was performed to investigate the relationship between HOAs and the length of pterygium. A postoperative HOA less than 0.35 µm in size was defined as a favorable surgical outcome and the surgical indications were estimated using receiver operator characteristic (ROC) curve. RESULTS: Horizontal coma, root mean square (RMS) of coma, oblique trefoil, horizontal trefoil, RMS of trefoil, and total HOA were significantly greater in the eye with preoperative pterygium. Three months after pterygium excision, only RMS of coma and total HOA remained significantly greater in eyes with pterygium. Vertical coma, horizontal coma, RMS of coma, and oblique tetrafoil were correlated with pterygium length. Pterygium excision when pterygium length was less than 1.6 mm led to favorable surgical outcomes. CONCLUSION: Pterygium induced greater than third-order corneal HOAs and these HOAs were corrected via pterygium surgery. Longer pterygium length was associated with larger RMS of coma and larger coma RMS persisted after pterygium surgery. A pterygium length of 1.6 mm should be considered the cutoff for pterygium excision for reducing postoperative corneal HOA.

Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision

PURPOSE: To compare preoperative and postoperative thickness and to investigate the difference in the thickness change of corneal epithelium and stroma after cataract surgery through scleral tunnel incision. METHODS: Forty eyes of forty patients who were 40 years old or older and underwent small-incision superior scleral tunnel cataract surgery with phacoemulsification were included. Using the RTVue instrument (Optovue Inc., Fremont, CA, USA), corneal epithelial (ET) and stromal thicknesses (ST) of all subjects were measured preoperatively and at 3 days, 1 week, and 1 month postoperatively. Thicknesses were classified into 3 zones according to the distance from the vertex: central zone (within 2 mm), paracentral zone (2-5 mm diameter) and midperipheral zone (5-6 mm diameter). RESULTS: Mean central ST was 486.68 ± 25.15 µm, 535.16 ± 48.13 µm, 515.98 ± 44.07 µm, and 502.28 ± 34.87 µm preoperatively, and at 3 days, 1 week, and 1 month postoperatively, respectively (p < 0.001 for all). ST showed significant thickening in all three zones from 3 days to 1 month postoperatively (p < 0.001 for all). Mean central, paracentral, and midperipheral ET was 52.13 ± 3.41 µm, 50.42 ± 2.97 µm, 49.12 ± 3.05 µm at preoperatively and 51.03 ± 3.63 µm, 48.96 ± 3.62 µm, 47.67 ± 3.81 µm at 1 month postoperatively, respectively (p = 0.061, 0.006, 0.001, respectively), while there were no signficant changes in all three zones at 3 and 7 days postoperatively. Changes in ET and ST were prominent at the superotemporal incision site. CONCLUSIONS: After scleral tunnel cataract surgery, corneal edema was observed in the stroma immediately after surgery. There was no significant change at early times after surgery in the epithelium, and there was a decrease in the peripheral cornea at 1 month postoperatively. The change in ET was considered a compensatory change due to stromal edema and appeared between 1 week to 1 month postoperatively.

Successful Management of Delayed Esophageal Rupture with T-Tube Drainage Using Video-Assisted Thoracoscopic Surgery

Spontaneous perforation of the esophagus after forceful vomiting is known as Boerhaave syndrome, a rare and life-threatening condition associated with a high rate of mortality. The management of Boerhaave syndrome is challenging, especially when diagnosed late. Herein, we report the successful management of late-diagnosed Boerhaave syndrome with T-tube drainage in a 55-year-old man. The patient was transferred to our institution 8 days after the onset of symptoms, successfully managed by placing a T-tube, and was discharged on postoperative day 46 without complications.

Cytomegalovirus Myocarditis Required Extracorporeal Membrane Oxygenation Support Followed by Ganciclovir Treatment in Infant

A 7-month-old girl with no medical history was treated with mechanical circulatory support due to myocarditis. Her cardiac contractility did not improve despite more than one week of extracorporeal membrane oxygenation treatment. Thus, we planned a heart transplant. However, a high level of cytomegalovirus was found in blood laboratory results by quantitative polymerase chain reaction. The patient's heart contractility recovered to normal range four days after ganciclovir treatment. She was discharged with slightly decreased cardiac contractility with a left ventricular ejection fraction of 45%.

Intracardiac Thrombosis Involving All Four Cardiac Chambers after Extracardiac Membranous Oxygenation Associated with MTHFR Mutations

A 4-month-old boy diagnosed with acute myocarditis was treated with extracorporeal membrane oxygenation (ECMO). Follow-up echocardiography eight hours after ECMO revealed intracardiac thrombosis involving all four heart chambers. Because of the high risk of systemic embolization due to a pedunculated thrombus of the aortic valve, we performed an emergency thrombectomy. After the operation, the patient had a minor neurologic sequela of left upper arm hypertonia, which had almost disappeared at the last outpatient clinic two months later. He was diagnosed with a major mutation in MTHFR (methylenetetrahydrofolate reductase), which is related to thrombosis.

A Successfully Treated Case of Gorham-Stout Syndrome with Sternal Involvement

Gorham-Stout Syndrome (GSS) is a rare disease characterized by localized bone resorption. Any part of the skeleton may be affected; therefore, symptoms can vary depending on the site involved. Pathological analysis reveals lymphovascular proliferation and osteolysis in the affected lesion, but the etiology of the disease is poorly understood. When GSS occurs in the chest, chylothorax or respiratory failure may occur. Thus far, a standard treatment for GSS has not been established, and the prognosis remains unknown. The following case report describes a successfully treated case of GSS in a 16-year-old boy with an affected sternum and ribs.

Clinical Significance of Klebsiella pneumoniae in Liver Abscess / 대한소화기학회지

BACKGROUND/AIMS: Klebsiella pneumoniae (K. pneumoniae) has been emerging as the leading cause of liver abscess although the most common pathogen was Escherichia coli in the past. Our study was to clarify the significance of K. pneumoniae as a pathogen of pyogenic liver abscess. METHODS: We reviewed 157 cases of pyogenic liver abscess treated at Yeungnam University Hospital from 1996 to 2001. They were classified into two groups: K. pneumoniae group and non-K. pneumoniae group. The clinical presentations, characteristics of liver abscess, laboratory findings and the results of bacteriological studies were compared. RESULTS: The K. pneumoniae group included 60 (60.6%) cases among 99 cases with positive culture. We found higher incidence of alcoholics (45.0%) or diabetes millitus (35.0%) in K. pnemoniae group. Cryptogenic cause (61.7%) was the most frequent portal entry in K. pneumoniae liver abscess. On the other hand, in non-K. pneumoniae group, the cause of portal entry was usually the secondary (23.1%) following biliary disease (61.5%). Statistically, there was no significant difference in age, sex, symptom, characteristics of abscess, laboratory findings except total bilirubin level between the two groups. CONCLUSIONS: Liver abscess caused by K. pneumoniae has emerged as an important infectious disease with new clinical significance. When clinicians see pyogenic liver abscess in patients with alcoholics or diabetes millitus, K. pneumoniae should be considered first as a cause of liver abscess.

Colonoscopic Polypectomy in Outpatients / 대한소화기내시경학회지

BACKGROUND/AIMS: The incidence of colon cancer has increased since 1990 in Korea. Though the cause of colon cancer is not clear, there are two theories of its development (adenoma-carcinoma sequence and de novo cancer). Recently, frequently performed colonoscopy and videoscopy make it possible to find colon polyps including tiny ones and do polypectomy. So, the authors studied safety of colonoscopic polypectomy on out-patient basis and its clinico-pathologic results. METHODS: From April 1999 to April 2000, the authors performed colonoscopy and polypectomy in patients for various gastrointestinal symptoms, follow-up after colon cancer operation, and colon cancer screening. We studied prospectively in out-patients basis after checking of bleeding tendency. If there was possibility of bleeding or perforation risk, we had done hemoclipping for prevention of complications. RESULTS: One thousand three hundred five colon polyps were found in 586 patients. 1,191 (91.3%) were smaller than 1 cm. Among the total 1,305 polyps, 10 revealed malignant transformation, in which 6 were smaller than 1 cm. Sigmoid colon and ascending colon are most common site of colon polyps, which could be removed with endoscopic mucosal resection snare. Only 1 case of postpolypectomy bleeding was noted after 9 days with mucosectomy without any other complications as perforation. CONCLUSIONS: The colon polyps are popular in the Korean and even the small polyps can be malignant. Any polyps could be removed in spite of small size and the polypectomy in out-patient basis is a safe procedure if postpolypectomy complications are fully comprehended and preventing endoscopic procedures are carried adequately.

Endoscopic resection in patients with early gastric cancer and follow-up / 대한내과학회지

BACKGROUND: As a result of endoscopic development and diagnostic technical improvements, the detection rate of early gastric cancer (EGC) has been increased and the prognosis of patients has been improved with surgical treatment. The most important factor for the prognosis of patients with EGC is the presence of regional lymph node metastasis, whose incidence is approximately 3% in patients with intramucosal EGC and 20% in patients with submucosal EGC. Recently, endoscopic resection has become the modality of treatment widely accepted in well selected cases of EGC. We have reviewed the results of endoscopic resection of EGC during 10 years and follow-up. METHODS: Over a ten year period from 1989 to 1999, 47 EGCs were resected endoscopically and the mean age of patients was 62.6 +/- 9.5 years. Thirty-six cases were treated by endoscopic mucosal resection and 11 cases were treated by snare polypectomy. RESULTS: Thirty-five cases were defined as complete resection by pathologic study and 33 cases were enrolled in follow-up study group. During follow-up period, there were 6 cases of death which was not related to the original disease. The mean follow-up duration of the survival group was 36.5 +/- 25.7 months. Local recurrence was detected in 1 case and a new lesion developed on the other site in 1 case. CONCLUSION: It appeared that endoscopic resection is an effective therapeutic procedure for some cases of EGC.

Impaired Osteophyte formation in Patients with Type II Diabetes Mellitus and Knee Osteoarthritis / 대한류마티스학회지

OBJECTIVE: Insulin has been known as a potent growth factor for connective tissues including cartilage and bone.The pathogenesis of type 2 diabetes mellitus is the insulin resistance due to insulin receptor or postreceptor abnormalities.In the present study,we investigate whether radiographic features of knee osteoarthritis in patients with type 2 DM differ from those in nondiabetogenic controls with knee osteoarthritis. METHODS: Radiographs (knee)from 59 female patients with diabetes and knee osteoarthritis were compared with those from 74 female controls who were similar with respect to age,weight,and duration of OA symptoms.Based on the Kellgren and Lawrence criteria,an overall OA severity grade for the index knee was assigned and was rated for the severity of subchondral sclerosis,osteophytes, geodes and joint space narrowing.Patients with inflammatory arthritis such as RA,severe peripheral neuropathy,or diabetic nephropathy were excluded. RESULTS: Although the 2 groups were similar with respect to the severity of joint space narrowing,geode formation,and subchondral sclerosis,osteophytes formation was less common in patients with type 2 diabetes (P=0.041)than controls.In the patients with symptomatic knee OA at least for 11 years,marked osteophyte formation was noted only in 7 of the 17 with DM (41%),but in 15 of the 27 controls (55%). CONCLUSION: Our results suggest that diminished availability of insulin at the cellular level or diabetic microvascular disease may attenuate the chondro- and osteogenesis required for osteophyte formation in the joint of patients with OA.The clinical significance of osteophyte and the pathologic mechanisms of diminished osteophyte formation in patients of knee osteoarthritis with type 2 diabetes is to be determined.