Evaluation of the Public Health Emergency Response to the COVID-19 Pandemic in Daegu, Korea During the First Half of 2020.

OBJECTIVES: This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. METHODS: After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu's responses were organized into 4 phases and evaluated by applying the response model. RESULTS: In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation-based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. CONCLUSIONS: This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

Clinical impact of medication adherence on 10-year cardio-cerebrovascular mortality in newly diagnosed hypertensive patients.

The purpose of this study is to evaluate the impact of medication adherence on cardio-cerebrovascular (CCV) mortality in newly diagnosed hypertensive patients. The authors retrospectively reviewed data from 20,836 patients who newly diagnosed hypertension from January 1, 2003 to December 31, 2005. Medication adherence was calculated from the compliance ratio (CR) during the first year after the diagnosis of hypertension. CCV mortality for 10 years was assessed according to the presence or absence of complications of hypertension. The risk of CCV death was significantly reduced in the CR ≥ 70% group than in the CR < 70% group (hazard ratio, 0.70; p = .004) for 10 years. In the patients without complications, the risk of CCV death was significantly lower in the CR ≥ 70% group than in the CR < 70% group (hazard ratio, 0.56; p = .014). However, in patients with complications, there was no significant difference in risk of CCV death between the CR ≥ 70% group and the CR < 70% group (hazard ratio, 0.79; p = .100). Only the CR ≥ 90% group had a significantly lower risk of CCV death (hazard ratio, 0.56; p < .001) for those with complications. Medication adherence is significantly associated with CCV mortality during 10 years in newly diagnosed hypertensives patients. Patients with complications of hypertension have to continue a high adherence rate (CR ≥ 90) for better long-term clinical outcomes.

Improvement of testosterone deficiency by fermented Momordica charantia extracts in aging male rats.

This study evaluated the efficacy of Momordica charantia (MC; bitter melon) extracts against andropause symptoms. We fermented MC with Lactobacillus plantarum and verified the ability of the fermented MC extracts (FMEs) to control testosterone deficiency by using aging male rats as an animal model of andropause. FME administration considerably increased total and free testosterone levels, muscle mass, forced swimming time, and total and motile sperm counts in aging male rats. In contrast, sex hormone-binding globulin, retroperitoneal fat, serum cholesterol, and triglyceride levels were significantly reduced in the treated groups compared to the non-treated control aging male rats. Furthermore, we observed that FME enhanced the expression of testosterone biosynthesis-related genes but reduced the expression of testosterone degradation-related genes in a mouse Leydig cell line. These results suggest that FME has effective pharmacological activities that increase and restore free testosterone levels and that FME may be employed as a promising natural product for alleviating testosterone deficiency syndrome. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10068-020-00872-x.

A study on evaluator factors affecting physician-patient interaction scores in clinical performance examinations: a single medical school experience.

BACKGRUOUND: This study is an analysis of evaluator factors affecting physician-patient interaction (PPI) scores in clinical performance examination (CPX). The purpose of this study was to investigate possible ways to increase the reliability of the CPX evaluation. METHODS: The six-item Yeungnam University Scale (YUS), four-item analytic global rating scale (AGRS), and one-item holistic rating scale (HRS) were used to evaluate student performance in PPI. A total of 72 fourth-year students from Yeungnam University College of Medicine in Korea participated in the evaluation with 32 faculty and 16 standardized patient (SP) raters. The study then examined the differences in scores between types of scale, raters (SP vs. faculty), faculty specialty, evaluation experience, and level of fatigue as time passes. RESULTS: There were significant differences between faculty and SP scores in all three scales and a significant correlation among raters' scores. Scores given by raters on items related to their specialty were lower than those given by raters on items out of their specialty. On the YUS and AGRS, there were significant differences based on the faculty's evaluation experience; scores by raters who had three to ten previous evaluation experiences were lower than others' scores. There were also significant differences among SP raters on all scales. The correlation between the YUS and AGRS/HRS declined significantly according to the length of evaluation time. CONCLUSION: In CPX, PPI score reliability was found to be significantly affected by the evaluator factors as well as the type of scale.

A Brief Telephone Severity Scoring System and Therapeutic Living Centers Solved Acute Hospital-Bed Shortage during the COVID-19 Outbreak in Daegu, Korea.

With the epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, the number of infected patients was rapidly increasing in Daegu, Korea. With a maximum of 741 new patients per day in the city as of February 29, 2020, hospital-bed shortage was a great challenge to the local healthcare system. We developed and applied a remote brief severity scoring system, administered by telephone for assigning priority for hospitalization and arranging for facility isolation ("therapeutic living centers") for the patients starting on February 29, 2020. Fifteen centers were operated for the 3,033 admissions to the COVID-19 therapeutic living centers. Only 81 cases (2.67%) were transferred to hospitals after facility isolation. We think that this brief severity scoring system for COVID-19 worked safely to solve the hospital-bed shortage. Telephone scoring of the severity of disease and therapeutic living centers could be very useful in overcoming the shortage of hospital-beds that occurs during outbreaks of infectious diseases.

Association Between Atrial Fibrillation and the Risk of Dementia in the Korean Elderly: A 10-Year Nationwide Cohort Study.

OBJECTIVES: The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. METHODS: A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. RESULTS: In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. CONCLUSIONS: Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.

Venous Thromboembolism in Children and Young Adults in Korea: Analysis of the Korean Health Insurance Review and Assessment Service Database.

BACKGROUND: Venous thromboembolism (VTE) is very rare in childhood. Nevertheless, its incidence has increased recently. This study aimed to identify risk factors for developing thrombosis in childhood cancers and other childhood diseases through the Korean Health Insurance Review and Assessment Service database. METHODS: Data were extracted from the Korean Health Insurance Review and Assessment Service database. Children and young adults from 1 month to 29 years of age were eligible, and 21,747 cases of VTE between January 2008 and December 2016 were identified. RESULTS: The VTE incidence was high in children younger than 1 year of age. After 1 year of age, its incidence decreased rapidly and gradually increased. The VTE incidence for children between 0 and 1 year of age was 10.23-fold higher than that for those between 1 and 5 years of age. Annual VTE incidence increased by year. The age-standardized annual incidence rates were 9.98 per 100,000 population in 2008 and 22.53 per 100,000 population in 2016. The age-standardized annual incidence rate increased 2.25-fold during the 8 years. The lower extremity was the most common site of venous thrombosis. CONCLUSION: The incidence of VTE in a population younger than 30 years was 13.11 per 100,000 persons in Korea. We found a bimodal age distribution of the VTE incidence with peaks at infancy and again after 16 years. The incidence of portal vein thrombosis was high in infants, and infection and malignancy were the most common comorbidities in patients with VTE.

Association of physical and psychological health status between chronic obstructive pulmonary disease patients and their family caregivers.

We performed this cross-sectional study with 72 chronic obstructive pulmonary disease (COPD) patients and their family caregivers to analyze relationship of physical and psychological health status between COPD patients and caregivers. Most caregivers were female (100%). Caregiver depression and burden were significantly associated with caregiving hours. In path analysis, the higher the patient's social support, the higher the patient's self-efficacy. The higher the patient's self-efficacy, the lower the care burden of the caregiver. Based on our results, there was a significant correlation of physical and psychological factors between patients and family caregivers.

Efficacy and Safety of a Mixed Extract of Trigonella foenum-graecum Seed and Lespedeza cuneata in the Treatment of Testosterone Deficiency Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

PURPOSE: The aim of this study was to investigate the efficacy and safety of a mixed extract of Trigonella foenum-graecum seed and Lespedeza cuneata (TFGL) for the treatment of testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: Patients were instructed to take a placebo or 200 mg TFGL capsule twice per day for 8 weeks. The primary efficacy variable was the change from baseline in the Aging Males' Symptoms scale (AMS), as well as levels of serum total and free testosterone. Secondary efficacy measurements included changes from baseline in the number of 'yes' answers on the Androgen Deficiency in the Aging Male (ADAM) questionnaire, levels of serum total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride, all domain scores of the International Index of Erectile Function (IIEF), perceived stress scale-10 (PSS-10), as well as changes in body composition. RESULTS: The TFGL group exhibited a significant improvement in the AMS scores at 8 weeks, total testosterone at 8 weeks, and free testosterone at 4 and 8 weeks. At 4 weeks, 25% of the TFGL group changed to negative in terms of ADAM scores and 34.1% of the TFGL group had negative scores at the end of the study. The TFGL group exhibited a significant improvement in total cholesterol, HDL-C, LDL-C, triglyceride, IIEF scores, and PSS-10 scores at 8 weeks. CONCLUSIONS: The mixed extract of TFGL resulted in significant improvements in symptoms of TDS, as measured by the AMS, ADAM, PSS-10 and testosterone levels.

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City.

OBJECTIVES: The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. METHODS: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. RESULTS: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. CONCLUSIONS: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013.

BACKGROUND: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. METHODS: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. RESULTS: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. CONCLUSION: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Oral health related quality of life and it's related factors of stroke patients at home in Korea.

OBJECTIVE: Due to physical impairments of stroke patients oral health tends to deteriorate, which may have an impact on the oral health-related quality of life (OHRQoL). Therefore, the aim of this study was to evaluate the OHRQoL and analyze its related factors among stroke patients cared for at home in Korea. METHODS: OHRQoL of 549 stroke patients aged over 50 who received care at home was assessed by Oral Health Impact Profile-14 (OHIP-14) in a City, Korea, from May to June 2009. Trained researchers and five nurses conducted interviews with patients or caregivers in their homes using structured questionnaires. Demographic, general health, stroke, and oral health related variables were surveyed. Statistically, t-test, an analysis of variance (ANOVA), and multiple regression analyses were used to evaluate the relationship between OHRQoL and various covariates. RESULTS: Mean of total OHIP-14 score was 35.7 ± 10.0. Age, activity of daily living (ADL) (p<0.001), subjective general and oral health status (p<0.001), degree of disability (p<0.001), frequency of tooth brushing (p<0.001), use of dental floss (p<0.01), missing teeth, and use of denture (p<0.001) showed significant association with the OHIP-14 scores. In multiple regression analyses, ADL, frequency of tooth brushing per day, subjective general status, and oral health status were identified as significant factors with the OHIP-14 scores in stroke patients who received care at home. CONCLUSION: Among strong patients who received care at home, participants who had more severe physical disability, poorer oral hygiene and more missing teeth showed poorer OHRQoL.

Relationship between bone mineral density, its associated physiological factors, and tooth loss in postmenopausal Korean women.

BACKGROUND: Previous studies have proposed a relationship between bone mineral density (BMD) and oral health. However, the relationship between BMD and tooth loss in female individuals is not yet well understood. Therefore, the aim of this study was to assess the association between BMD, including its related physiological factors, and tooth loss among postmenopausal women in Korea. METHODS: A total of 3,992 postmenopausal women aged 50 years or above were selected from the Fourth and Fifth Korea National Health and Nutrition Examination Surveys, which were cross-sectional in design and conducted from 2008 to 2011. The participants' BMD and number of teeth were assessed by radiologists and dentists. Socioeconomic characteristics and female-related physiological factors, including menarche age, duration of menopause, number of pregnancies, age at first child's birth, and duration of oral contraceptive or female hormone use, were surveyed. RESULTS: Participants who had lower BMD had significantly fewer teeth (p < 0.001). Female-related physiological factors, including the duration of menopause, number of pregnancies, age at first child's birth, duration of oral contraceptive or female hormone use, and calcium intake level, showed a significant relationship with the number of teeth. Using multiple regression analysis, BMD, duration of menopause, age at first child's birth, and duration of female hormone use significantly influenced the number of teeth. CONCLUSIONS: BMD and its related physiological factors in female individuals showed a significant relationship with the number of teeth in postmenopausal Korean women, implicating osteoporosis as a risk factor for tooth loss in postmenopausal women.

Metabolic syndrome parameters in adolescents may be determinants for the future periodontal diseases.

AIM: The prevalence of metabolic syndrome (MetS) increases even in adolescents. The evidence that MetS is associated with the periodontal diseases in adolescents has been understudied. Therefore, our aim was to assess the association between MetS parameters and gingivitis in adolescents. MATERIAL AND METHODS: A total of 941 participants (590 boys, 351 girls), aged 12-18 years was selected from the Fourth Korea National Health and Nutrition Examination Survey, a cross-sectional and nationally representative survey, which had had information on waist circumference, blood pressure, serum triglyceride, high-density lipoprotein (HDL) cholesterol, and the fasting blood sugar and community periodontal Index (CPI). RESULTS: The number of positive parameters of MetS showed significant positive correlation with gingivitis; adjusted and crude ORs with one positive parameters of MetS were 1.92 (95% CI: 1.21-3.04) and 1.88(95% CI: 1.28-2.76), respectively. And adjusted OR with three or more positive parameters of MetS was 3.29 (95% CI: 1.24-8.71). Among five parameters of MetS, Low HDL-cholesterol showed significant association with gingivitis (crude OR 2.12, 95% CI 1.20-3.73; adjusted OR 1.96, 95% CI 1.24-3.12). CONCLUSIONS: Having more positive parameters of MetS and low HDL-cholesterol parameter had an independent relationship with the prevalence of gingivitis, which may be determinants for the future periodontal diseases even in adolescents.

Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis.

[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words "muscle hypertonia OR spasticity" were used for spasticity, and the key words "shock wave OR ESWT" were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], -0.792; 95% confidence interval [CI], -1.001 to -0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, -0.735; 95% CI, -0.951 to -0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.

Effect of an oral hygienic care program for stroke patients in the intensive care unit.

PURPOSE: The effects of an oral hygienic care program (OHCP) have been reported in several diseases. However, no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit (ICU) has been reported, thus we sought to investigate the potential effect of an OHCP. MATERIALS AND METHODS: Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups: the intervention (29 patients) and control groups (27 patients). The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU (mean, 2.2 weeks). The plague index, gingival index, clinical attachment loss, and colonization degree of candida albicans were assessed. RESULTS: After OHCP, the plaque index, gingival index, and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group (p<0.05). However, no significant difference was observed in clinical attachment loss and the colonization degree of candida albicans on the tongue (p>0.05). CONCLUSION: Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU. Therefore, we recommend administration of the OHCP for stroke patients during their stay in the ICU.

The relationship between metabolic conditions and prevalence of periodontal disease in rural Korean elderly.

The aim of this study was to investigate the relationship between the duration and number of components of metabolic syndrome and periodontal disease among rural elderly in Korea over 60 years old. This longitudinal study consisted of 399 participants who underwent regular health examinations at Seongju-gun Public Health Center from 2000 to 2007. The components of metabolic syndrome (diabetes mellitus, hypertension, obesity, and hypercholesterolemia) were evaluated from clinical records of Seongju-gun Public Health Center, which were recorded from 2000 to 2007, and periodontal examination by Community Periodontal Index, recorded from 2006 to 2007. Participants suffering from longer durations of diabetes mellitus, hypertension, and obesity were more likely to have periodontal disease. Individuals with a greater number of metabolic syndrome components were more likely to have periodontal disease. Older rural Koreans with components of metabolic syndrome have unmet periodontal treatment needs. Medical and dental professionals need to coordinated systemic and oral care for these people.

Multiple cancers in a patient with systemic sclerosis and aggravated interstitial lung disease by chemotherapy.

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

Evaluation of reliability of computerized neurobehavioral tests in Korean children.

Neurobehavioral tests are among the most efficient methods of identifying the adverse health effects of neurotoxicants. The reliability of neurobehavioral tests may be affected by racial or cultural backgrounds, but the widely used computerized neurobehavioral tests have been developed and standardized for Western children. It is thus necessary to assess the reliability of the existing computerized neurobehavioral tests for Korean children. For this reason, 254 healthy 7- to 8-year-old Korean children completed a neurobehavioral test-retest, with the test and retest held two months apart. Six neurobehavioral test items adapted from Korean Computerized Neurobehavioral Tests (KCNT) and modified to match the children's ability levels: Simple Reaction Time, Choice Reaction Time, Color Word Vigilance, Addition, Symbol Digit, and Finger Tapping Speed. The test reliability was assessed using the Pearson product-moment correlation coefficient (r) and the intraclass correlation coefficient (ICC). The ICCs ranged from 0.46 to 0.84 and were very similar to the Pearson coefficients. High reliability was detected in Symbol Digit (r=0.84, ICC=0.83), followed by the Finger Tapping Speed of the dominant hand (r=0.67, ICC=0.67) and of the non-dominant hand (r=0.65, ICC=0.65). The study findings suggest that the reliability of most computerized neurobehavioral tests is appropriate for epidemiological researches on Korean children, and that Symbol Digit and Finger Tapping Speed are more satisfactory bases for the periodic examination of neurobehavioral performance. These findings can also be useful in the future assembly of a neurobehavioral test battery, by providing more stable neurobehavioral test items for Korean children.

Association between Genetic Instability and Helicobacter pylori Infection in Gastric Epithelial Dysplasia.

Background. In gastric carcinogenesis, changes of DNA methylation appear to be an early molecular event, and the genome-wide methylation state is closely correlated with the level of long interspersed nucleotide element-1 (LINE-1) methylation. In this study, we measured LINE-1 methylation level according to genetic instability and evaluated the effect of Helicobacter pylori infection on genetic instability in gastric epithelial dysplasia. Methods. Total 100 tissue samples of gastric epithelial dysplasia were analyzed. Seven loci that linked to tumor suppressor genes were used to identify significant structural chromosomal aberrations. Microsatellite status was investigated for two different microsatellite marker loci (BAT25 and BAT26). Also, we measured LINE-1 methylation level by combined bisulfite restriction analysis (COBRA-LINE-1) method. Results. There were no significant differences of LINE-1 methylation level according to chromosomal/microsatellite instability and H. pylori state. In the dysplastic lesions with H. pylori infection, LINE-1 methylation level of MSI lesion was significantly lower than that of microsatellite stable (MSS) lesion (40.23 ± 4.47 versus 43.90 ± 4.81%, P < 0.01). Conclusions. In gastric epithelial dysplasia with H. pylori infection, MSI is correlated with reduced LINE-1 methylation level. Coexistence of H. pylori infection and MSI might be a driving force of gastric carcinogenesis.