An FP-CIT PET Comparison of the Differences in Dopaminergic Neuronal Loss Between Idiopathic Parkinson Disease With Dementia and Without Dementia

Song, In-Uk,Kim, Young-Do,Cho, Hyun-Ji,Chung, Sung-Woo,Chung, Yong-An Lippincott WilliamsWilkins, Inc. 2013 Alzheimer disease and associated disorders Vol.27 No.1

Previous studies have demonstrated a decreased density of dopamine transporters (DAT) in basal ganglia in patients with idiopathic Parkinson disease (IPD) using I-n-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane (FP-CIT), and the reductions in striatal DAT levels were inversely correlated with the severity of motor dysfunction in IPD. However, there has been no study on the correlation of DAT levels between IPD patients with and without cognitive dysfunction. Thus, we evaluated the differences in regional DAT density in the brain of patients with IPD without dementia and those with dementia using FP-CIT positron emission tomography. We recruited 24 consecutive patients with IPD, including 7 with IPD without dementia and 17 with IPD with dementia, and 18 healthy controls. FP-CIT positron emission tomography scans were acquired 90 and 210 minutes after the FP-CIT injection. The DAT density did not differ in the caudate nucleus or the putamen between patients with IPD without dementia and those with dementia. However, the DAT density between the 2 groups with IPD demonstrated a significantly decreased density compared with that of healthy controls in the putamen. We cautiously suggest that there is no relationship between DAT density and cognitive severity because there were no significant differences in the DAT density between IPD with dementia and those without dementia.

Long-term Clinical Outcome of Helicobacter pylori-negative Gastric Mucosa-associated Lymphoid Tissue Lymphoma is Comparable to That of H. pylori-positive Lymphoma

Chung, Su Jin,Kim, Joo Sung,Kim, Hansoo,Kim, Sang Gyun,Kim, Chul Woo,Jung, Hyun Chae,Song, In Sung Lippincott WilliamsWilkins, Inc. 2009 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.43 No.4

GOALS AND BACKGROUND: Little is still known regarding the clinical features and prognosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma without Helicobacter pylori (H. pylori) infection. STUDY: From January 1996 to April 2006, a total of 185 patients with gastric MALT lymphoma were enrolled at Seoul National University Hospital. To assess the differences in clinical characteristics and long-term outcomes between H. pylori-negative (n=29, 15.7%) and H. pylori-positive (n=156, 84.3%) cases, we compared these 2 types of lymphoma. RESULTS: The overall median follow-up period was 39 months. There were no significant differences between the 2 groups in terms of age, macroscopic phenotype, or histologic grade. H. pylori-negative group showed male predominancy (72.4%) and higher percentage of proximal stomach location (62.1%). Although H. pylori-negative lymphomas were more frequently presented as advanced disease (stage IIE or IV, 37.9%), no significant differences in both the overall complete response and overall survival rates were observed between the 2 groups. CONCLUSIONS: Our results suggest that H. pylori-negative gastric MALT lymphoma shows a favorable long-term outcome, which is comparable to that of H. pylori-positive lymphoma.

Effects of Helicobacter pylori Infection on Gastric Mucin Expression

Kang, Hyung Min,Kim, Nayoung,Park, Young Soo,Hwang, Jin-Hyeok,Kim, Jin-Wook,Jeong, Sook-Hyang,Lee, Dong Ho,Lee, Hye Seung,Jung, Hyun Chae,Song, In Sung Lippincott WilliamsWilkins, Inc. 2008 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.42 No.1

AIMS: This study was performed to determine the gastric distributions of MUC5AC and MUC6 depending on Helicobacter pylori (H. pylori) infection, and to evaluate whether the expressions of MUC5 and MUC6 change in H. pylori-associated gastroduodenal diseases. In addition, MUC5AC and MUC6 expressional changes were investigated before and after H. pylori eradication. METHODS: In the 224 individuals (136 H. pylori-positive and 88 H. pylori-negative) who came from control (N=48), duodenal ulcer (N=35), benign gastric ulcer (N=61), dysplasia plus stomach cancer (N=80) groups, MUC5AC and MUC6 expressions were determined by immunohistochemical staining in the antrum and body, respectively. This staining for MUC5AC and MUC6 were reperformed in 113 of the 136 H. pylori-positive patients after successful H. pylori eradication by proton pump inhibitor-based triple therapy. RESULTS: (1) No difference was found between the H. pylori-positive and negative groups in terms of MUC5AC expression. In contrast, MUC6 expression was significantly lower in the H. pylori-positive group than in the H. pylori-negative group in the gastric body. Moreover, reduced MUC6 expression increased to the H. pylori-negative level after eradication. (2) Expressions of MUC5AC and MUC6 were significantly lower in the dysplasia plus cancer group than those of control in case of H. pylori positive. Similarly, MUC5AC and MUC6 expressions were significantly lower in the presence of atrophic gastritis with intestinal metaplasia in case of H. pylori positive. (3) Aberrant expressions of MUC6 in foveolar cells were observed in both antrum (11.3%) and body (5.3%) only in the H. pylori-positive group, but this reverted to normal after H. pylori eradication. CONCLUSION: These results suggest that H. pylori infection causes alterations of mucin expression, closely related with the development of gastric atrophy with intestinal metaplasia, probably contributing to carcinogenesis.

Clinical Spectrum of Reflux Esophagitis Among 25,536 Koreans Who Underwent a Health Check-up: A Nationwide Multicenter Prospective, Endoscopy-based Study

Shim, Ki-Nam,Hong, Su Jin,Sung, Jae Kyu,Park, Kyung Sik,Kim, Seong-Eun,Park, Hyun-Shin,Kim, Young Sun,Lim, Seon Hee,Kim, Chung Hyeon,Park, Min Jung,Yim, Jeong Yoon,Cho, Kyung Ran,Kim, Donghee,Park, Se Lippincott WilliamsWilkins, Inc. 2009 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.43 No.7

BACKGROUND: Gastroesophageal reflux is a commonly encountered condition, but detailed data on reflux symptoms in Asian countries are lacking. GOALS: To evaluate the prevalence and to document the clinical spectrum of endoscopic reflux esophagitis (RE). STUDY: A total 25,536 subjects underwent an upper gastrointestinal endoscopic examination as part of a health check, and completed a gastroesophageal reflux questionnaire. Endoscopic findings classified according to the Los Angeles (LA) classification and the data from gastroesophageal reflux questionnaire were analyzed. RESULTS: On the basis of endoscopic findings, 2019 subjects (7.91%) were found to have RE: 5.87% in LA-A; 1.84% in LA-B; 0.18% in LA-C; and 0.02% in LA-D. Heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough, and epigastric soreness were found to be associated with RE (P<0.05). Heartburn, acid regurgitation, and epigastric soreness were more frequent in LA-B than in LA-A (P<0.05). Epigastric soreness was most bothersome in LA-A and LA-B, and acid regurgitation was most bothersome in LA-C and LA-D (P<0.01). Heartburn, hoarseness, and globus sensation were more frequent in men with RE, and acid regurgitation was most common in women. CONCLUSIONS: The prevalence of RE was found to be 7.91% in Korea, and the profiles of reflux symptoms were found to depend on grade of RE and sex.

Comparison of the Validity of Three Biomarkers for Gastric Cancer Screening: Carcinoembryonic Antigen, Pepsinogens, and High Sensitive C-reactive Protein

Chung, Hye Won,Kim, Ju Won,Lee, Jong-han,Song, Si Young,Chung, Jae Bock,Kwon, Oh Hun,Lim, Jong-Baeck Lippincott WilliamsWilkins, Inc. 2009 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.43 No.1

PURPOSE: To identify a desirable serum marker for screening tools for gastric cancer, we evaluated the validity of 3 biomarkers, namely, carcinoembryonic antigen (CEA), pepsinogens (PGs), and high sensitive C-reactive protein (hsCRP). METHODS: We estimated the mean serum levels of CEA, PGs, and hsCRP and compared the sensitivity and specificity of these 3 biomarkers in 378 subjects who were classified into 7 groups: normal, chronic atrophic gastritis, intestinal metaplasia, adenoma, early gastric cancer (EGC), advanced gastric cancer (AGC) without metastasis, and AGC with metastasis (M1). RESULTS: There were no significant differences among the normal, high-risk (chronic atrophic gastritis, intestinal metaplasia, and adenoma), and EGC groups for CEA and hsCRP. However, the levels of CEA were relatively higher in the AGC group with intestinal-type cancer (P<0.01). Likewise, hsCRP was relatively higher in the AGC group with diffuse-type cancer (P<0.01). For the PG I/II ratio, there was no significant difference among the normal, high-risk, and cancer groups, including EGC (P<0.01). In addition, there was a negative correlation with grades (&ggr;s=−0.480, P<0.01). However, the PG I/II ratio was relatively less effective in diffuse-type cancer compared with intestinal-type cancer. The combination of serum hsCRP and the PG I/II ratio had a higher sensitivity (77%) than did the PG I/II ratio alone (61%) in diffuse-type cancers. CONCLUSIONS: The combination of serum hsCRP and PG I/II ratio would be helpful as a screening tool for gastric cancer in high incidence populations and may help to select high-risk subjects in need of further specific invasive screening tools such as endoscopy.

The Clinical Course of Postinfectious Irritable Bowel Syndrome: A Five-year Follow-up Study

Jung, In Su,Kim, Hee Sun,Park, Hyojin,Lee, Sang In Lippincott WilliamsWilkins, Inc. 2009 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.43 No.6

OBJECTIVES: Irritable bowel syndrome (IBS) is a common disorder seen in general practice. Bacterial gastroenteritis has been known to be a risk factor for IBS. We investigated the clinical course, risk factors, and prognosis of postinfectious IBS (PI-IBS) 5 years after Shigella infection. METHODS: We recruited 153 individuals and used a questionnaire to investigate their current bowel habits. We also looked for the presence of other functional bowel disorders (FBDs). The Shigella-exposed group consisted of hospital employees and medical students who experienced abdominal pain, diarrhea, or fever during the shigellosis outbreak and whose stool culture revealed Shigella sonnei. The control group consisted of age-matched and sex-matched subjects who corresponded fairly well with patients, considering that they were enrolled from the same hospital and were not infected. RESULTS: Complete data were obtained from 119 individuals who were divided into the Shigella-exposed group (59) and the control group (60). In the Shigella-exposed group, 3 patients had IBS before infection (previous IBS) and 6 out of 13 cases of PI-IBS after 3 years showed persistent IBS after 5 years. Five out of 11 PI-IBS patients (45.5%, 2 excluded), 3 out of 6 previous IBS patients (50%) in the Shigella-exposed group, and 7 out of 11 previous IBS patients (63.6%) in the control group recovered after 5 years (P>0.05). Five cases in the Shigella-exposed group and 3 in the control group developed new cases of IBS after 5 years. The prevalence of PI-IBS after 5 years in the previous FBD groups was 63.6%, whereas the prevalence of PI-IBS without a history of FBDs was 36.4% (P<0.05). There were no significant differences among the other risk factors in each group. CONCLUSIONS: About half of PI-IBS and previous IBS patients with or without infection recover over 5 years. Previous IBS and FBDs are risk factors of PI-IBS after 5 years. We suggest that our results support the understanding of the clinical course and prognosis of PI-IBS.

Effect of Sirolimus on Calcineurin Inhibitor-Induced Nephrotoxicity Using Renal Expression of KLOTHO, an Antiaging Gene

Han, Dong He,Piao, Shang Guo,Song, Ji-Hyun,Ghee, Jung Yeon,Hwang, Hyeon Seok,Choi, Bum Soon,Kim, Jin,Yang, Chul Woo Lippincott WilliamsWilkins, Inc. 2010 Transplantation Vol.90 No.2

BACKGROUND.: The aim of this study was to observe the effect of sirolimus (SRL) on calcineurin inhibitor (CNI)-induced nephrotoxicity in the aging process by using renal expression of KLOTHO, an antiaging gene. METHODS.: Mice were treated with vehicle (VH; 1 mL/kg/day of olive oil), cyclosporine A (CsA; 30 mg/kg/day), or tacrolimus (FK; 1 mg/kg/day) with or without SRL (0.3 mg/kg/day) for 2 weeks. KLOTHO expression was evaluated by using reverse-transcriptase polymerase chain reaction, immunoblotting, and immunohistochemistry. Oxidative stress was evaluated by using immunohistochemistry and urinary excretion of 8-hydroxy-2&vprime;-deoxyguanosine (8-OHdG). The calcium metabolism was evaluated by using renal ectopic calcification, serum intact parathyroid hormone level, and renal fibroblast factor 23 (FGF23) expression. RESULTS.: Treatment with CsA or FK alone significantly decreased KLOTHO expression and increased urinary 8-OHdG excretion compared with VH treatment but SRL treatment did not. Treatment SRL+CsA or SRL+FK further decreased KLOTHO expression and increased urinary 8-OHdG excretion compared with treatment of CsA or FK alone. There was a strong correlation between KLOTHO expression and urinary 8-OHdG excretion (r=−0.893; P<0.001). Treatment of CsA or FK alone increased renal ectopic calcification and serum intact parathyroid hormone level and decreased renal FGF23 expression compared with VH treatment (P<0.05) but SRL treatment did not. Treatment with SRL+CNI aggravated these parameters compared with CNI alone. CONCLUSIONS.: SRL accelerates the CNI-induced oxidative process by down-regulating the renal antioxidant KLOTHO expression in the kidney.

How Can We Enhance the Performance of Liver Stiffness Measurement Using FibroScan in Diagnosing Liver Cirrhosis in Patients With Chronic Hepatitis B?

Kim, Seung Up,Kim, Do Young,Park, Jun Yong,Lee, Jin Ha,Ahn, Sang Hoon,Kim, Ja Kyung,Paik, Yong Han,Lee, Kwan Sik,Chon, Chae Yoon,Choi, Eun Hee,Song, Ki Jun,Park, Young Nyun,Han, Kwang-Hyub Lippincott WilliamsWilkins, Inc. 2010 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.44 No.1

GOAL: This study aimed to enhance the diagnostic accuracy by defining different cutoff liver stiffness measurement (LSM) values according to alanine aminotransferase (ALT) level and combining LSM with noninvasive models in patients with chronic hepatitis B (CHB). BACKGROUND: Several studies have indicated that ALT influences LSM using FibroScan. STUDY: The study prospectively enrolled 200 patients (143 men, mean age 45.4 y) between June 2007 and November 2008 who had been diagnosed with CHB and underwent both liver biopsy and LSM on the same day. RESULTS: The area under the receiver operating characteristic curves (AUROC) of LSM for predicting cirrhosis in patients with ALT ≤upper limit of normal (ULN) was higher than that of all patients or those with ALT >ULN and ≤2× ULN (AUROC=0.884 vs. 0.849 and 0.867). The cutoff LSM values for ≥F2, ≥F3, and F4 were 6.0, 7.5, and 10.1 kPa, respectively, in patients with ALT ≤ULN, whereas they were 8.9, 11.0, and 15.5 kPa, respectively, in those with ALT >ULN and ≤2× ULN. The combination of LSM and the age-spleen-platelet ratio index performed the best at predicting cirrhosis, regardless of ALT level (AUROC=0.917 in patients with ALT ≤ULN, 0.909 in those with ALT ≤2× ULN, and 0.894 in all patients). CONCLUSIONS: Different cutoff LSM values according to ALT level and combination with age-spleen-platelet ratio index can enhance the performance of LSM in CHB, regardless of ALT level.

Response Rates to Medical Treatments and Long-term Clinical Outcomes of Nonsurgical Patients With Intestinal Behçet Disease

Chung, Moon Jae,Cheon, Jae Hee,Kim, Seung Up,Park, Jae Jun,Kim, Tae Il,Kim, Nam Kyu,Kim, Won Ho Lippincott WilliamsWilkins, Inc. 2010 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.44 No.6

BACKGROUND: The aims of this study were to evaluate the efficacy of medical treatments and to identify factors to predict clinical outcome of intestinal Behçet disease (BD) during medical treatment. METHODS: We performed a retrospective review of the medical records of 93 patients who were diagnosed and medically treated with intestinal BD at Severance Hospital, Seoul, Korea from 1992 to 2007. A therapeutic response was evaluated 8 weeks after the initiation of medical treatment, and cumulative recurrence and surgery rates were also assessed during long-term follow-up. RESULTS: The initial remission rate at 8 weeks after treatment was 66.7%. During the follow-up period, cumulative recurrence rates for intestinal BD were 24.9% at 2 years and 43.0% at 5 years. The recurrence rate was significantly higher in patients with apparent gastrointestinal symptoms at their initial presentation, volcano-type and deep intestinal ulcers, and those who failed to achieve complete remission during the initial treatment. Cumulative rates for surgery were 6.7% at 2 years and 15.1% at 5 years. The typical type of ulcers was the only predictive factor for the likelihood of surgery. CONCLUSIONS: Our study demonstrates that a considerable number of patients experience disease relapse during follow-up despite a high-remission rate after medical treatment for intestinal BD. Careful observation and intensive treatment should be carried out, especially in patients without complete remission after initial treatment, with deep and volcano-shaped ulcers, or with apparent gastrointestinal symptoms at the time of diagnosis.

Prognostic significance of lymphovascular invasion in sporadic colorectal cancer.

Lim, Seok-Byung,Yu, Chang Sik,Jang, Se Jin,Kim, Tae Won,Kim, Jong Hoon,Kim, Jin Cheon Lippincott [etc.] ; Lippincott WilliamsWilkins 2010 Diseases of the colon and rectum Vol.53 No.4

<P>PURPOSE: It remains unclear whether lymphovascular invasion marks a poor prognosis for patients with sporadic colorectal cancers. Here, we analyzed the association between lymphovascular invasion and the clinicopathological features and prognosis of sporadic colorectal cancer patients. METHODS: The clinicopathological features and prognosis of 2417 patients with sporadic primary colorectal cancer who underwent an operation at the Asan Medical Center between January 1998 and December 2002 were examined. The patients' clinicopathological parameters and follow-up and survival data were obtained from a prospectively collected database. RESULTS: Of the 2417 patients, a lymphovascular invasion-positive tumor was detected in 610 (25.2%). Compared with patients with lymphovascular invasion-negative tumors those with lymphovascular invasion-positive tumors were older (P < .001) and had higher preoperative serum carcinoembryonic antigen levels (P = .011). Their tumors were also more likely to be poorly differentiated (P < .001) and more advanced in terms of T and N categories (P < .001 and P < .001, respectively). The lymphovascular invasion-positive tumors were also more likely to have metastasized systemically (P < .001). Although lymphovascular invasion-positive and lymphovascular invasion-negative tumors metastasized equally frequently to the liver, lung, peritoneum, and bone, lymphovascular invasion-positive tumors metastasized to systemic lymph nodes more often (P < .001). These tumors also recurred at systemic lymph nodes after curative intent surgery more often (P = .007). Lymphovascular invasion-positive status was an independent unfavorable prognostic factor for the 5-year overall and 5-year disease-free survival of patients with sporadic colorectal cancer (P < .001 and P < .001, respectively). CONCLUSION: Lymphovascular invasion-positive status could be used to identify patients with sporadic primary colorectal cancer with aggressive tumors and as a factor that independently indicates an unfavorable prognosis.</P>