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Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 619-625页

作者： Chan Sun Park Hee Seok Jeong Ki Bae Kim Joung-Ho Han Hee Bok Chae sei jin youn Seon Mee Park Department of Internal Medicine Chungbuk National University College of Medicine

BACKGROUND： Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. METHODS： We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Patients＇ demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospectively obtained from medical records. Clinical parameters and outcomes were compared between elderly （75-80 years, n= 156） and very elderly （≥81 years, n=175） patients. We analyzed the effects of methods [none, endoscopic retrograde cholangio- pancreatography （ERCP）, percutaneous transhepatic biliary drainage, or failure] and timing （urgent or early） of biliary drainage on mortality and hospital stay in these patients. RESULTS： Acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot＇s triad （4.2%） and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 （31.4%）, 175 （52.9%）, and 52 （15.7%）, respectively. Urgent bili-ary drainage （≤24 hours） was performed for 80.5% （247/307） of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of transient hiliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low （1.5%） and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis. CONCLUSIONS： The methods and timing used for biliary drainage and severity of cholangitis are the major determinants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for favorable prognosis in these patients.

关键词： acute cholangitis biliary drainage prognosis elderly very elderly

Corticotropin-releasing factor stimulates colonic motility via muscarinic receptors in the rat

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World Journal of Gastroenterology 2017年第21期23卷 3825-3831页

作者： Kyung-Jo Kim Ki Bae Kim Soon Man Yoon Joung-Ho Han Hee Bok Chae Seon Mee Park sei jin youn Department of Gastroenterology University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine Chungbuk National University College of Medicine

AIM To measure exogenous corticotropin-releasing factor(CRF)-induced motility of the isolated rat colon and to demonstrate the effect of pharmacologic inhibition on CRF-induced motility. METHODS The isolated vascularly-perfused rat colon was used. Luminal pressure was monitored via microtip catheter pressure transducers in the proximal and distal colon. At first, exogenous CRF was administered in a stepwise manner and the concentration of CRF yielding maximal colonic motility was selected. After recording basal colonic motility, hexamethonium, phentolamine, propranolol, atropine and tetrodotoxin were infused into the isolated colon. Initially, only the test drug was infused; then, CRF was added. The motility index was expressed as percentage change over basal level. RESULTS Administration of 1.4, 14.4, 144 and 288 pmol/L CRF progressively increased colonic motility in the proximal and distal colon. Infusion of atropine or tetrodotoxin reduced CRF-induced motility of both the proximal and distal colon, whereas hexamethonium, phentolamine and propranolol had no effect.CONCLUSION CRF-induced colonic motility appears to be mediated by local cholinergic signaling via muscarinic receptors. Muscarinic receptors are potential targets for counteracting CRF-induced colonic hypermotility.

关键词：胃肠的活动性老鼠应力冒号释放促肾皮素的因素

Dietary vitamin D intake and vitamin D related genetic polymorphisms are not associated with gastric cancer in a hospital-based case-control study in Korea

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The Journal of Biomedical Research 2018年第4期32卷 257-263页

作者： Sang-Yong Eom Dong-Hyuk Yim Dae-Hoon Kim Hyo-Yung Yun young-jin Song sei-jin youn Taisun Hyun Joo-Seung Park Byung Sik Kim Yong-Dae Kim Heon Kim Departments of Preventive Medicine and Medical Research Institute College of Medicine Departments of Preventive Medicine and Surgery College of Medicine Departments of Preventive Medicine and Internal Medicine College of Medicine Dartment of Food and Nutrition Chungbuk National UniversityCheongju 28644Korea Department of Surgery College of MedicineEulji UniversityDaejon 301746Korea Department of Surgery Asan Medical CenterCollege of MedicineUlsan UniversitySeoul 138736Korea

There have been few studies on the association between vitamin D levels and gastric cancer in Asian populations,but no studies have been performed on the interactions between vitamin D intake and polymorphisms in the vitamin D pathway.The effects of vitamin D intake,vitamin D related genetic polymorphisms,and their association with the incidence of gastric cancer were investigated in a hospital case-control study,including 715 pairs of newly diagnosed gastric cancer patients and controls matched for age and sex.Correlations between vitamin D intake and plasma vitamin D concentrations were also assessed in a subset of subjects.No statistically significant difference was observed in the dietary intake of vitamin D between the patients and controls,nor were there any evident associations between vitamin D intake and risk of gastric cancer in multivariate analyses.Vitamin D intake significantly correlated with the circulating 25-hydroxyvitamin D levels,but not with the active form of the vitamin,1,25-dihydroxyvitamin D.There were no statistically significant interactions between vitamin D intake,and VDR or TXNIP polymorphisms.This study suggests that dietary vitamin D intake is not associated with gastric cancer risk,and the genetic polymorphisms of vitamin D-related genes do not modulate the effect of vitamin D with respect to gastric carcinogenesis.

关键词： gastric cancer vitamin D vitamin D receptor gene-environment interaction

A case of idiopathic colonic varices: A rare cause of hematochezia misconceived as tumor

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World Journal of Gastroenterology 2006年第16期12卷 2629-2632页

作者： Joung-Ho Han Won-Joong Jeon Hee-Bok Chae Seon-Mee Park sei-jin youn Seok-Hyung Kim Il-Hun Bae Sang-Jeon Lee Department of Internal Medicine College of MedicineChungbuk National UniversityCheongjuRepublic of Korea Department of Pathology College of MedicineChungbuk National UniversityCheongjuRepublic of Korea Department of Radiology College of MedicineChungbuk National UniversityCheongjuRepublic of Korea Department of General Surgery College of MedicineChungbuk National UniversityCheongjuRepublic of Korea

结肠的静脉曲张是更低的胃肠的流血的一个很稀罕的原因。少数在英语文学比自发的结肠的静脉曲张(ICV ) 的结肠的静脉曲张，和 30 个案例的 100 个案例被报导了。在 ICV 的这 30 个案例之中， 19 个案例被血管造影术诊断，并且 7 个操作... 详细信息

结肠的静脉曲张是更低的胃肠的流血的一个很稀罕的原因。少数在英语文学比自发的结肠的静脉曲张(ICV ) 的结肠的静脉曲张，和 30 个案例的 100 个案例被报导了。在 ICV 的这 30 个案例之中， 19 个案例被血管造影术诊断，并且 7 个操作案例以后作为回盲肠静脉赤字被诊断，缝血管瘤，并且在 1 自发， 1， 5 个案例分别地。我们报导受不了在 11 年岁时改变学位的便血的多重事件的一个 24 岁的人的案例。他与 21 g/L 的血红素有严重贫血症。在结肠镜检查上，曲折地扩大了特别在书籍的右页 sigmoid 区域被黑暗坏死的纸巾盖住的粘膜下层静脉和脆的溃疡从直肠被看见直到远侧的下降结肠。它开始看起来是有静脉曲张的癌。肠系膜 angiographic 学习建议了一个结肠的缝血管瘤。低前面的切除术由于难处理的医学上和周期性的便血被做。另外的肠和 mes 伤寒脉管的结构显得正常。没有代表新容器生长，显微镜检查在整个粘膜下层和浆膜与扩大静脉揭示了正常结肠的粘膜。一起这些调查结果拿所有，病人作为 ICV 被诊断。他的手术后的功课是平静的。

关键词：结肠血管曲张便血肿瘤误诊

Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater

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World Journal of Gastroenterology 2013年第13期19卷 2037-2043页

作者： young Rak Choi Joung-Ho Han young Shim Cho Hye-Suk Han Hee Bok Chae Seon Mee Park sei jin youn Department of Internal Medicine College of MedicineChungbuk National University

AIM: To determine the efficacy of a cap-assisted endoscopy (CAE) to completely visualize the ampulla of Vater (AV) in patients failed by conventional endoscopy. METHODS: A prospective study was conducted on 120 patients > 20 years of ages who visited the Health Promotion Center of Chungbuk National University Hospital for conscious sedation esophagogastroduodenoscopy (EGD) as a screening test from July to October, 2011. First, forward-viewing endoscopy was performed with reasonable effort using a push and pull method. We considered complete visualization of the AV when we could observe the entire AV including the orifice clearly, and reported the observation as complete or incomplete (partial or not found at all). Second, in cases of complete failure of the observation, an additional AV examination was conducted by attaching a short cap (D-201-10704, Olympus Medical Systems, Tokyo, Japan) to the tip of a forward-viewing endoscope. Third, if the second method failed, we replaced the short cap with a long cap (MH-593, Olympus Medical Systems) and performed a re-examination of the AV. RESULTS: Conventional endoscopy achieved complete visualization of the AV in 97 of the 120 patients (80.8%) but was not achieved in 23 patients (19.2%). Age (mean ± SD) and gender [male (%)] were not significantly different between the complete observation and the incomplete observation groups. Additional short CAE was performed in patients in whom we could not completely visualize the AV. This group included 13 patients (10.9%) with partial observation of the AV and 10 (8.3%) in which the AV was not found. Short CAE permitted a complete observation of the AV in 21 of the 23 patients (91.3%). Patients in whom visualization of the AV failed with short CAE had satisfactory outcomes by replacing the short cap with a long cap. The additional time for CAE took an average of 141 ± 88 s. There were no complications and no significant mucosal trauma. CONCLUSION: CAE is safe to use as a salvage method to achieve complete visualization of the AV

关键词： Ampulla of Vater Conventional endoscopy Cap-assisted endoscopy Screening test Complete oservation

Preoperative CA 125 is significant indicator of curative resection in gastric cancer patients

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World Journal of Gastroenterology 2015年第4期21卷 1216-1221页

作者： Dae Hoon Kim Hyo Yung Yun Dong Hee Ryu Hye-Suk Han Joung-Ho Han Soon Man Yoon sei jin youn Department of Surgery Chungbuk National University College of MedicineCheongju 361-763South Korea Internal Medicine Chungbuk National University College of MedicineCheongju 361-763South Korea

AIM: To investigate the correlation among tumor markers, curative resection, and recurrence in gastric cancer.METHODS: The patients with preoperative tumormakers [Carcinoembryonic antigen, Carbohydrate antigen(CA) 19-9, and CA 125] and elective gastrectomy between January 2000 and December 2009 at Chungbuk National University Hospital were enrolled in this study. We analyzed the relationship among the tumor makers, curative resection and recurrence, retrospectively.RESULTS: Among the 679 patients with gastric cancer, curative resection was 93.6%(n = 636) and noncurative resection was 6.4%(n = 43). The independent risk factors for the non-curative resection were tumor location and the positivity of preoperative serum CA 19-9 and CA 125 levels. After curative resection, the independent prognostic risk factors for recurrence in curative resection were gender, stage, and preoperative increased serum CA 125 level(HR = 2.431, P =0.020), in a multivariate analysis. CONCLUSION: Preoperative CA 125 is a useful predictive biomarker for curative resection and prognostic biomarker for recurrence in gastric cancer patients.

关键词： Gastric Cancer Tumor Marker Carcinoembryonic antig

Evaluation of the relationship between dietary factors,CagA-positive Helicobacter pylori infection,and RUNX3 promoter hypermethylation in gastric cancer tissue

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World Journal of Gastroenterology 2013年第11期19卷 1778-1787页

作者： Yan-Wei Zhang Sang-Yong Eom Dong-Hyuk Yim young-jin Song Hyo-Yung Yun Joo-Seung Park sei-jin youn Byung-Sik Kim Yong-Dae Kim Heon Kim Department of Preventive Medicine and Medical Research Institute College of MedicineChungbuk National UniversityCheongju 361-763South Korea Department of Surgery College of MedicineChungbuk National UniversityCheongju 361-763South Korea Department of Surgery College of MedicineEulji UniversityDaejon 461-713South Korea Department of Internal Medicine College of MedicineChungbuk National UniversityCheongju 361-763South Korea Department of Surgery Asan Medical CenterCollege of MedicineUlsan UniversitySeoul 138-736South Korea

AIM:To evaluate the relationship among Helicobacter pylori(H.pylori) infection,CagA status,and dietary factors with RUNX3 promoter hypermethylation.METHODS:Gastric cancer tissue samples were collected from 184 South Korean patients.All patients were interviewed following a semi-quantitative food frequency questionnaire.The average frequencies of intake and portion sizes of 89 common food items were documented,and total intakes of calories,nutrients,vitamins,and minerals were calculated for each subject.DNA was extracted from gastric cancer tissue samples,and amplification of the HSP60 gene was performed to detect H.pylori infection.Nested polymerase chain reaction(PCR) was used to detect the presence of the CagA gene.RUNX3 gene expression was measured by reverse transcription-PCR,and RUNX3 methylation status was evaluated by methylation-specific PCR.The odds ratios(ORs) and 95%CI associated with RUNX3 promoter hypermethylation status were estimated for each of the food groups,lifestyle factors,and the interaction between dietary and lifestyle factors with CagA status of H.pylori infection.RESULTS:Overall,164 patients(89.1%) were positive for H.pylori DNA,with the CagA gene detected in 59(36%) of these H.pylori-positive samples.In all,106(57.6%) patients with gastric cancer demonstrated CpG island hypermethylation at the RUNX3 promoter.RUNX3 expression was undetectable in 52(43.7%) of the 119 gastric cancer tissues sampled.A high consumption of eggs may increase the risk of RUNX3 methylation in gastric cancer patients,having a mean OR of 2.15(range,1.14-4.08).A significantly increased OR of 4.28(range,1.19-15.49) was observed with a high consumption of nuts in patients with CagA-positive H.pylori infection.High intakes of carbohydrate,vitamin B1,and vitamin E may decrease the risk of RUNX3 methylation in gastric cancer tissue,particularly in CagA-or H.pylori-negative infection,with OR of 0.41(0.19-0.90),0.42(0.20-0.89),and 0.29(0.13-0.62),respectively.A high consumption of fruits may protect against RUNX3 methylat

关键词： Gastric cancer RUNX3 Helicobacter pylori CagA Dietary factors

Risk of gastric cancer is associated with PRKAA1 gene polymorphisms in Koreans

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World Journal of Gastroenterology 2014年第26期20卷 8592-8598页

作者： Yong-Dae Kim Dong-Hyuk Yim Sang-Yong Eom Sun In Moon Hyo-Yung Yun young-jin Song sei-jin youn Taisun Hyun Joo-Seung Park Byung Sik Kim Jong-young Lee Hee Kwan Won Heon Kim Department of Preventive Medicine College of MedicineChungbuk National University Department of Surgery College of MedicineChungbuk National University Department of Internal Medicine College of MedicineChungbuk National University Department of Food and Nutrition Chungbuk National University Department of Surgery College of MedicineEulji University Department of Surgery Asan Medical CenterCollege of MedicineUlsan University Center for Genome Science National Institute of Health Department of Internal Medicine Division of Endocrinology and MetabolismSchool of MedicineKonyang University

AIM:To evaluate the association between genetic polymorphisms of the gene encoding AMP-activated protein kinase(PRKAA1)and the risk of gastric cancer.METHODS:The study subjects consisted of 477 ageand sex-matched case-control pairs.Genotyping was performed for 5 tag single nucleotide polymorphisms(SNPs):rs13361707,rs154268,rs3805486,rs6882903,and rs10074991.Associations between gastric cancer and putative risk factors(including the SNPs)were analyzed with multivariate conditional logistic regression models,after adjusting for potential confounding factors.Multiple testing corrections were implemented following methodology for controlling the false discovery rate.Gene-based association tests were performed by using the versatile gene-based association study(VEGAS)method.RESULTS:In the dominant model,SNPs rs13361707[odds ratio(OR)=1.51,95%CI:1.07-2.11)],rs154268(OR=1.65,95%CI:1.22-2.22),rs6882903(OR=1.48,95%CI:1.09-2.00),and rs10074991(OR=1.53,95%CI:1.09-2.16)were significantly associated with an increased risk of gastric cancer.In the recessive model,SNPs rs154268(OR=1.66,95%CI:1.22-2.26),rs3805486(OR=0.63,95%CI:0.46-0.85),and rs10074991(OR=1.47,95%CI:1.15-1.88)were significant risk or protective factors for gastric cancer.In the codominant model,the ORs of each of the5 SNPs were statistically significant.All SNPs in the model showed a dose-response relationship between the minor allele frequency and the risk of gastric cancer.Most notably,subjects with a homozygous minor allele in SNP rs10074991 showed 2.15 times the risk of gastric cancer as subjects without a minor allele.The PRKAA1 gene showed a significant gene-based association with gastric cancer in the VEGAS test.CONCLUSION:All 5 tested tag SNPs of the PRKAA1gene(rs13361707,rs154268,rs3805486,rs6882903,and rs10074991)were significantly associated with gastric cancer.

关键词： AMP-activated protein kinase Gastric cancer PRKAA1

ITGA1 polymorphisms and haplotypes are associated with gastric cancer risk in a Korean population

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World Journal of Gastroenterology 2013年第35期19卷 5870-5876页

作者： Dong-Hyuk Yim Yan-Wei Zhang Sang-Yong Eom Sun In Moon Hyo-Yung Yun young-jin Song sei-jin youn Taisun Hyun Joo-Seung Park Byung Sik Kim Jong-young Lee Yong-Dae Kim Heon Kim Department of Preventive Medicine and Medical Research Institute College of Medicine Chungbuk National University Center for Disease Control and Prevention Department of Surgery College of Medicine Chungbuk National University Department of Internal Medicine College of MedicineChungbuk National University Department of Food and Nutrition Chungbuk National University Department of Surgery College of MedicineEulji University Department of Surgery Asan Medical Center College of Medicine Ulsan University Center for Genome Science National Institute of Health

AIM:To evaluate the association between the geneticpolymorphisms and haplotypes of the ITGA1 gene and the risk of gastric cancer.METHODS:The study subjects were 477 age-and sex-matched case-control pairs.Genotyping was performed for 15 single nucleotide polymorphisms(SNPs)in ITGA1.The associations between gastric cancer and these SNPs and haplotypes were analyzed with multivariate conditional logistic regression models.Multiple testing corrections were carried out following methodology for controlling the false discovery rate.Gene-based association tests were performed using the versatile gene-based association study(VEGAS)method.RESULTS:In the codominant model,the ORs for SNPs rs2432143(1.517;95%CI:1.144-2.011)and rs2447867(1.258;95%CI:1.051-1.505)were statistically significant.In the dominant model,polymorphisms of rs1862610 and rs2447867 were found to be significant risk factors,with ORs of 1.337(95%CI:1.029-1.737)and 1.412(95%CI:1.061-1.881),respectively.In the recessive model,only the rs2432143 polymorphism was significant(OR=1.559,95%CI:1.150-2.114).The C-C type of ITGA1 haplotype block 2 was a significant protective factor against gastric cancer in the both codominant model(OR=0.602,95%CI:0.212-0.709,P=0.021)and the dominant model(OR=0.653,95%CI:0.483-0.884).The ITGA1 gene showed a significant gene-based association with gastric cancer in the VEGAS test.In the dominant model,the A-T type of ITGA1 haplotype block 2 was a significant risk factor(OR=1.341,95%CI:1.034-1.741).SNP rs2447867 might be related to the severity of gastric epithelial injury due to inflammation and,thus,to the risk of developing gastric cancer.CONCLUSION:ITGA1 gene SNPs rs1862610,rs2432143,and rs2447867 and the ITGA1 haplotype block that includes SNPs rs1862610 and rs2432143 were significantly associated with gastric cancer.

关键词： Integrin ITGA1 Gastric cancer Polymorphism Haplotype