Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments

Hee Kyong Na,Diogo Turiani Hourneaux De Moura,The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointe 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1

Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered themost effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric andmetabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or donot prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small boweltherapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possiblemechanisms of action, efficacy, and safety profile of these EMBTs.

Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial

( Hee Kyong Na ),( Hwoon-yong Jung ),( Dong Woo Seo ),( Hyun Lim ),( Ji Yong Ahn ),( Jeong Hoon Lee ),( Do Hoon Kim ),( Kee Don Choi ),( Ho June Song ),( Gin Hyug Lee ),( Jin-ho Kim ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.6

Background/Aims: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. Methods: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality. Results: A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported. Conclusions: Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.

Long-term Outcomes and Factors Affecting the Survival of Patients with Mucosal Esophageal Squamous Cell Carcinoma

( Ga Hee Kim ),( Hee Kyong Na ),( Ji Yong Ahn ),( Jeong Hoon Lee ),( Kee Wook Jung ),( Do Hoon Kim ),( Hyeong Ryul Kim ),( Kee Don Choi ),( Ho June Song ),( Yong-hee Kim ),( Gin Hyug Lee ),( Hwoon-yon 대한소화기학회 2021 Gut and Liver Vol.15 No.5

Background/Aims: Data regarding the prognosis of early esophageal cancer are lacking. This study investigated the long-term outcomes and factors affecting the survival of patients with mucosal esophageal squamous cell carcinoma (T1aESCC). Methods: We analyzed the clinical and tumor-specific parameters of 263 patients who received surgical resection (SR; n=63) or endoscopic resection (ER; n=200) for T1aESCC. Underlying comorbidities were scored using the Charlson comorbidity index (CCI). Overall survival (OS) was the primary outcome, and multivariate regression analysis was performed to predict factors for OS. Results: Of the study patients (age, 64.5±8.0 years), the CCI was 1.0±1.4 in the ER group and 0.6±0.9 in the SR group (p=0.107). The 5-year OS rate during follow-up (54.4±20.4 months) was 85.7% (ER group, 86.8%; SR group, 82.4%; p=0.631). The cumulative 5-year incidence of esophageal cancer recurrence was 10.5% in the ER group (vs 0% in the SR group). The overall mortality rate was 12.9% (ER group, 12.0%; SR group, 15.9%; p=0.399). The most common cause of mortality was second primary cancers in the ER group (75%) and organ dysfunction or postoperative complications in the SR group (70%). According to multivariate analysis, only CCI was significantly associated with OS (p< 0.001). The 5-year OS rate in patients with a CCI >2 and in those with a CCI ≤2 was 60.2% and 88.2%, respectively (p<0.001). The treatment method (ER vs SR) was not a significant affecting factor (p=0.238). Conclusions: The long-term prognosis of patients with T1aESCC was significantly associated with underlying comorbidities. (Gut Liver 2021;15:705-712)

와파린 및 새로운 경구용 항응고제를 복용하는 환자에서의 치료 내시경과 관련된 위장관 출혈 및 혈전색전증의 위험

나희경 ( Hee Kyong Na ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.5

내시경 시술 전 일시적으로 항응고제를 중단하는 것은 위장관 출혈의 위험과 혈전색전증의 위험 사이에 적절한 균형을 잡기 어렵기 때문에 논란의 여지가 많다.^1-3 와파린은 새로운 경구용 항응고제(direct oral anticoagulant agent, DOAC)보다 임상의에게 더 친숙하고, 효과를 쉽고 빠르게 전환시킬 수 있다는 장점이 있지만 복잡한 약역동학 특징과 좁은 치료적 범위 때문에 관리가 어렵다. 반면, DOAC는 약물의 모니터링 및 용량 조절 없이 정해진 용량으로 처방이 가능하며, 빠르게 작용하고, 반감기가 짧아 관리가 쉽지만 해독제가 없다는 단점이 있다. 이전 연구들에서 DOAC를 복용한 환자들은 와파린을 복용한 환자들보다 시술과 관련되지 않은 위장관 출혈의 위험이 높았다고 보고한 바 있다.^4,5 하지만 시술과 관련된 위장관 출혈 위험에 대하여는 알려진 바가 없는 실정이다. 미국이나 유럽 내시경 가이드라인들에서는 저위험 내시경 시술을 받는 환자들에서는 와파린과 DOAC를 유지하도록 권고하고 있으며, 고위험 시술의 경우에는 와파린를 사용하는 환자들에서 헤파린 교량 요법(heparin bridging)을 시행하도록 권고하고 있다.^1-3,6 임상적으로 DOAC를 사용하는 환자들 또한 혈전색전증을 예방하기 위하여 헤파린 교량 요법을 시행해볼 수 있는데,⁷ 와파린 및 DOAC의 헤파린 교량 요법과 관련된 출혈 및 혈전색전증 위험의 차이 또한 명확하지 않다. 따라서 저자들은 1) 와파린과 DOAC 치료를 받는 환자들에서의 출혈, 혈전색전증 및 사망의 위험을 비교하고자 하였으며, 2) 13종류의 고위험 내시경 시술 중에서 시술별 위험을 비교하고, 3) 헤파린 교량 요법이 합병증의 발생을 증가시키지 않는지 확인하고자 본 연구를 진행하였다. 일본 대규모 국가 입원 환자 데이터베이스를 이용하여 2014년 4월부터 2015년 5월까지 시술 전 와파린 또는 DOAC(rivaroxaban, apixaban, dabigatran, edoxaban)를 복용하고, 13종류의 고위험 내시경 시술을 시행받은 20세 이상의 성인 환자 총 16,977명을 확인하였다. 고위험 시술은 용종 절제술, 내시경 점막절제술, 내시경 점막하박리술, 협착 부위의 풍선확장술, 내시경 지혈술, 내시경 정맥결찰술, 내시경 주사경화요법, 내시경 괄약근절개술, 내시경 초음파 유도하 미세침흡인 검사, 경피적 위루술을 포함하였다. 일대일 성향 점수 매칭 분석(propensity score matching, 나이, 성별, 체질량 지수, 기저 질환, 병원의 규모, 시술의 종류, 약물의 종류를 매칭)을 시행하여 와파린군과 DOAC군에서 시술 위장관 출혈 및 혈전색전증, 사망의 발생을 비교하였다. 또한 경구항혈전제와 헤파린 교량 치료 시행 유무에 따라, DOAC 단독군, 와파린단독군, DOAC와 헤파린 교량 요법군, 와파린과 헤파린 교량요법군으로 나누어, 하위군(subgroup) 분석을 시행하였다. 5,046쌍이 성향 점수 매칭 분석에 포함되었으며, 와파린군에서 DOAC군보다 통계적으로 의미 있게 위장관 출혈의 비율이 높았다(12.0% vs. 9.9% p=0.02). 혈전색전증 발생률(5.4% vs. 4.7%)과 입원중 사망률(5.4% vs. 4.7%)은 양 군에서 의미 있는 차이는 없었다. DOAC 종류별로 나누어 하위군 분석을 시행하였을 때, 와파린군은 rivaroxaban군에 비하여 위장관 출혈의 비율이 높았으며, rivaroxaban군, dabigatran군에 비하여 혈전색전증의 비율이 높았고, 입원 중 사망률에서는 의미 있는 차이는 없었다. 내시경 시술의 종류로 보정하였을 때 위장관 출혈 및 혈전색전증, 사망률은 DOAC 단독으로 치료한 환자에서보다 와파린과 헤파린 교량 요법(bridging) 또는 DOAC과 헤파린 교량 요법을 시행한 환자에서 높았다. 시술 종류 중에서는 위루관 삽입술에 비하여 내시경 점막하박리술, 내시경 점막절제술 및 내시경 정맥류결찰술, 내시경 주사경화요법을 시행한 환자에서 위장관 출혈의 위험이 가장 높았으며, 하부 내시경 점막절제술, 하부 용종 절제술, 내시경적유두괄약근절제술 또는 내시경 초음파 유도하 미세침 흡인 검사는 중등도 위험을 보였다.

증례 : 감염 ; Campylobacter jejuni 감염으로 인한 패혈 유산 1예

나신 ( Shin Na ),나희경 ( Hee Kyong Na ),박현정 ( Hyun Jung Park ),박영훈 ( Young Hoon Park ),황금록 ( Keum Rock Whang ),박기호 ( Ki Ho Park ),우준희 ( Jun Hee Woo ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3

31세 초임부가 발열과 두통으로 내원하여 임신 중삼분기의 패혈 유산을 진단받았고 혈액배양 검사에서 C. jejuni가 동정되었다. 태반의 병리 소견에서 융모 사이 농양과 함께 급성 융모염이 관찰되었으며 태아 임신 중절과 항생제 사용으로 임상증상이 호전되었다. C. jejuni는 사람에서 발생하는 패혈 유산의 드문 원인균이고 아직까지 우리나라에서 보고 된 예가 없어 문헌고찰과 함께 보고하는 바이다. Campylobacter jejuni was isolated from the blood of a 31-year-old woman who suffered a mid-trimester septic abortion with fever and headache. Histologically, evidence of septic abortion was found, with an intervillous abscess and acute villitis. Complete clinical recovery followed termination of the pregnancy and the use of antibiotics. C. jejuni is an unusual cause of septic abortion in humans. To our knowledge, no case has been reported in Korea. (Korean J Med 2011;81:408-411)

Clinical Significance of Epstein-Barr Virus and Helicobacter pylori Infection in Gastric Carcinoma

Noh Jin Hee,Shin Jun Young,Lee Jeong Hoon,Park Young-Soo,Lee In-Seob,Kim Ga Hee,Na Hee Kyong,Ahn Ji Yong,Jung Kee Wook,Kim Do Hoon,Choi Kee Don,Song Ho June,Lee Gin Hyug,Jung Hwoon-Yong 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.1

Background/Aims: Epstein-Barr virus (EBV) and Helicobacter pylori (HP) coinfection may synergistically induce severe inflammatory responses in the stomach tissue, increasing the risk of developing gastric cancer. We aimed to analyze the effect of EBV and HP coinfection on the clinicopathologic features and prognosis of gastric cancer, as well as to evaluate the role of EBV infection in non-gastric carcinoma with lymphoid stroma (non-GCLS). Methods: Overall, 956 patients who underwent surgery for gastric cancer between September 2014 and August 2015 were eligible and divided into groups, according to GCLS morphology, EBV infection, and HP infection. Clinicopathologic characteristics and oncologic outcomes were analyzed retrospectively. Results: EBV and HP coinfection was significantly associated with male sex, proximal location, GCLS morphology, and equivocal p53 expression (p<0.001). Multivariate analysis revealed that EBV infection alone (hazard ratio [HR], 0.362; 95% CI, 0.131 to 0.996; p=0.049) and lower third location (HR, 0.624; 95% CI, 0.413 to 0.943; p=0.025) were inversely correlated with overall survival. During median follow-up period of 72 months, overall survival rate was not significantly different between the EBV and HP coinfection group and others (97.6% vs 86.8%, log-rank p=0.144). In non-GCLS patients (n=920), overall survival rate was not significantly different between the EBV infection group and others (96.9% vs 86.4%, log-rank p=0.126). Conclusions: EBV and HP coinfection is not an independent prognostic factor for gastric cancer. EBV infection status, regardless of HP infection, affects the clinicopathologic features of all types of gastric cancer. However, it does not lead to a significant difference in overall survival of non-GCLS patients.

A framework for nationwide COVID-19 vaccine safety research in the Republic of Korea: the COVID-19 Vaccine Safety Research Committee

Na-Young Jeong,Hyesook Park,Sanghoon Oh,Seung Eun Jung,Dong-Hyun Kim,Hyoung-Shik Shin,Hee Chul Han,Jong-Koo Lee,Jun Hee Woo,Byung-Joo Park,Nam-Kyong Choi 질병관리본부 2023 Osong Public Health and Research Persptectives Vol.14 No.1

With the introduction of coronavirus disease 2019 (COVID-19) vaccines, the Korea Disease Control and Prevention Agency (KDCA) commissioned the National Academy of Medicine of Korea to gather experts to independently assess post-vaccination adverse events. Accordingly, the COVID-19 Vaccine Safety Research Committee (CoVaSC) was launched in November 2021 to perform safety studies and establish evidence for policy guidance. The CoVaSC established 3 committees for epidemiology, clinical research, and communication. The CoVaSC mainly utilizes pseudonymized data linking KDCA’s COVID-19 vaccination data and the National Health Insurance Service’s claims data. The CoVaSC’s 5-step research process involves defining the target diseases and organizing ad-hoc committees, developing research protocols, performing analyses, assessing causal relationships, and announcing research findings and utilizing them to guide compensation policies. As of 2022, the CoVaSC completed this research process for 15 adverse events. The CoVaSC launched the COVID-19 Vaccine Safety Research Center in September 2022 and has been reorganized into 4 divisions to promote research including international collaborative studies, long-/short-term follow-up studies, and education programs. Through these enhancements, the CoVaSC will continue to swiftly provide scientific evidence for COVID-19 vaccine research and compensation and may serve as a model for preparing for future epidemics of new diseases.

Biomimetic fog harvesting surface by photo-induced micro-patterning of zinc-oxide silver hierarchical nanostructures

Kyong Kim, Na,Hee Kang, Dong,Eom, Hyeonjin,Wook Kang, Hyun Elsevier 2019 APPLIED SURFACE SCIENCE - Vol.470 No.-

<P><B>Abstract</B></P> <P>As water scarcity has become a major global problem, fog-harvesting technologies are considered an effective sustainable solution for water resources. Here, we report a novel approach to the fog-harvesting technology using zinc oxide-silver hierarchical nanostructures to mimic the <I>Stenocara</I> beetle’s back. Vertically aligned zinc oxide nanowires are first fabricated by a cost-effective and scalable hydrothermal method to produce a superhydrophilic surface. Silver nanoparticles are then selectively synthesized by an additional photo-induced synthetic process on the zinc oxide nanowire surfaces to form a hydrophobic surface using the hierarchical nanostructures. The fog-harvesting performance was investigated using an artificial fog flow and by measuring the amount of harvested water for efficient fog harvesting. On the superhydrophilic surface, although the water droplets immediately were captured, they formed a puddle at the bottom of the surface due to the high adhesion between water and the surface. In contrast, on the hydrophobic surface, the capturing rate was very low even though the water droplets easily rolled off the surface. Compared to the non-patterned surface, the captured water film on the patterned hydrophilic region grew rapidly into a spherical shape and separated from the surface due to the surrounding hydrophobic regions. As a result, the patterned surface with 0.5 mm pattern size afforded a higher fog collection rate of 1233 mg/h than those of the superhydrophilic and hydrophobic surfaces of 1105 mg/h and 879 mg/h respectively.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Facile, low-cost, and easy to operate method for the fabrication of mimetic <I>Stenocara</I> beetle’s back. </LI> <LI> Controlling a Surface wettability by the silver nanoparticles on the zinc oxide nanowires. </LI> <LI> Selectively synthesizing the silver nanoparticles and zinc oxide nanowires hierarchical nanostructure. </LI> <LI> Efficient water collection by hydrophobic surface with patterned hydrophilic regions. </LI> <LI> Application to multifunctional surface for water collection and desalination. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Poster Session : PS 0888 ; Lower GI Tract : Effect of Lactobacillus Gasseri BNR17 in Patients with IBS with Diarrhea on Improvement of Bowel Function

( Hee Man Kim ),( Hyun Soo Kim ),( Kyong Joo Lee ),( Hong Jun Park ),( Jae Woo Kim ),( Jae Hyun Kim ),( Hyun Sik Kim ),( Ji Hun Na ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The some complications of Crohn`s disease should be treated through surgical intervention. The risk factors of complications have been studied largely. However, there are few data about the trend of medicines against Crohn`s disease around surgeryin Koreans. Methods: This study was designed to investigate the association between medicines and surgery in patients with Crohn`s disease retrospectively. The CONNECT retrospective cohort was used in this study. Between 1982 and 2010, patients with confirmed Crohn`s disease were enrolled. The abdominal surgery (laparotomy) and perianal surgery were compared. The logistic regression analysis was performed. Results: A total of 1376 patients (M: 973, F: 403) were analyzed, and 622 patients received surgery. Of 1376 patients, 338 (24.6%) patients received laparotomy and 284 (20.6%). In multivariate analysis, laparotomy was significantly associated with azathioprine/ 6MP (odds ratio: 1.934, 95% CI: 1.168-3.210) and TNF-alpha antagonist (odds ratio: 2.232, 95%CI: 1.398-3.564). The perianal surgery was significantly associated with corticosteroid (odds ratio: 0.610, 95%CI: 0.399-0.932). As the perianal surgery was the reference, laparotomy significantly associated with TNF-alpha antagonist (odds ratio: 1.966, 95%CI: 1.123-3.442). Conclusions: Surgery is significantly associated with types of medications in patients with Crohn`s disease. It suggests that specific drug against Crohn`s disease would prevent surgery.

실내 미세먼지의 효율적 저감을 위한 인공신경망 기반 최적 환기 예측 기법

김나경(Na Kyong Kim),강동희(Dong Hee Kang),강현욱(Hyun Wook Kang) 대한기계학회 2020 대한기계학회 춘추학술대회 Vol.2020 No.12