Poster Session : PS 0907 ; Lower GI Tract : Clinical Course of Patients with Crohn`s Disease Diagnosed by Bowel Resection in Korea: Results from the Connect Study

( Ji Min Lee ),( Kang Moon Lee ),( Yoon Yung Chung ),( Dae Bum Kim ),( Hyewon Lee ),( Hea Jung Sung ),( Yeon Ji Kim ),( Woo Chul Chung ),( Chang Nyol Paik ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Backgound: The previous European studies revealed that early surgery led to a more stable clinical course than surgery performed during the course of disease.The aim of this study was to compare the clinical course of CD following bowel resection performed at the time of diagnosis (early surgery) and during the course of the disease (late surgery). Methods: Total 1337 medical records were reviewed in the population-based cohort database which includes CD patients diagnosed before 2009 in Korea. We selected data of patients who underwent bowel resection. Age, sex, disease phenotype, time of surgery, medication history such as corticosteroid, immunomodulators, and biologics, admission history, and further operation history were assessed. The Statistical analysis: Logistic regression, Gehan`s wilcoxon method and Cox`s proportional hazards regression model. Results: 278 CD patients who had undergone bowel resection were involved. Among them, 109 patients underwent surgery at the time of diagnosis, while 169 underwent surgery 90.31 months (range 1-277) after diagnosis. The mean follow-up period after surgery was 97.7 months (range 1-323). Use of systemic steroids and biologics is signifi cantly higher in late surgery group than early surgery group (p = 0.004, and 0.013, respectively). Higher use of immunomodulators was shown in late surgery group than early surgery group with borderline signifi cance (p = 0.061). Early surgery was associated with lower clinical recurrence represented by use of biologics (Wilcoxon test p=0.015).Early surgery and less use of steroids were independent variables associated with less use of biologics by multivariate analysis. Conclusion: Early surgery is associated with less use of steroids and maintains longer clinical remission period compared to late surgery.

Poster Session : PS 0968 ; The Implications of a Positive Glucose Breath Test in Patients with Cholecystectomy

( Yeon Ji Kim ),( Hea Jung Sung ),( Hyewon Lee ),( Yeon Oh Jeong ),( Yoon Yung Chung ),( Dae Bum Kim ),( Ji Min Lee ),( Woo Chul Chung ),( Kang Moon Lee ),( Chang Nyol Paik ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Small intestinal bacterial overgrowth (SIBO) could be associated with postcholecystectomy patients. We aim to evaluate prevalence and characteristics of SIBO in patients with intestinal symptoms according to the history of cholecystectomy Methods: Sixty-two postcholecystectomy patients and 145 functional gastrointestinal disease (FGID) patients, and 30 healthy controls undergoing hydrogen (H2)-methane (CH4) glucose breath test (GBT) were reviewed. The GBT positivity (+) indicating the presence of SIBO, gas types and bowel symptoms were surveyed. Results: The GBT + were signifi cantly higher in postcholecystectomy patients (46.8%) than those in FGID patients (26.2%) (p < 0.01), or those in controls (13.3%) (p < 0.01), respectively. In the gas types, the GBT (H2) + in postcholecystectomy patients was signifi cantly higher than those in FGID patients (43.5% vs. 20%, p = 0.02). The positivity to fasting GBT (H2) among the GBT + patients with cholecystectomy was 76% (22 of 29), as diagnosed by elevated fasting H2 level. The GBT + group had higher symptom scores in abdominal discomfort, bloating, chest discomfort, early satiety, nausea and tenesmus, than those of the GBT - group Conclusions: The SIBO with high levels of baseline H2 might be the important etiologic factor of upper intestinal symptoms for postcholecystectomy patients

Clinical Significance of Various Pathogens in Acute Exacerbations of COPD: Multi-center Study in Korea

( Hyun Woo Ji ),( Ji Ye Jung ),( Soojoung Yu ),( Hyun Woo Lee ),( Yun Su Sim ),( Hyewon Seo ),( Jeong-Woong Park ),( Kyung Hoon Min ),( Jae Ha Lee ),( Byung-Keun Kim ),( Myung Goo Lee ),( Yeon Mok Oh 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0

Background One of the major causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is respiratory infection. In this study, we investigated types of bacteria and virus identified in AECOPD patients in Korea, and compared clinical difference according to different types of pathogen Methods We reviewed 1186 cases of AECOPD patients recruited at 28 hospitals in Korea from January 2015 to December 2019. Pathogen was identified by microbiological tests. We analyzed bacterial and viral identification rate, along with basic characteristics and clinical presentation of patients associated with the different types of pathogens, and risk factors for potentially drug-resistant (PDR) pathogen. Results The number of patients infected with bacteria, virus, and both bacteria and virus were 262 (22.1%), 265 (22.5%), and 129 (10.9%), respectively. The most common bacteria identified were Pseudomonas aeruginosa (9.8%), Mycoplasma pneumoniae (6.2%), and Streptococcus pneumoniae (5.0%). The most common virus identified Influenza A (10.4%), Rhinovirus (8.7%), and RSV (3.5%) Compared to patients without identified pathogens, patient with identified pathogens had a higher rate of systemic steroid use within six months (22.7% vs 16.9%; P=0.015), presented more cough and sputum (76.4% vs 68.9%; P=0.004, 78.9% vs 68.7%; P=0.015), and required longer period of systemic steroid during AECOPD (11.2days vs 4.4days; P=0.012). Past history of pulmonary tuberculosis (OR 1.66; P=0.046) and bronchiectasis (OR 1.99; P=0.032), and the history of triple inhaler use within six months (OR 2.04; P=0.005) have been confirmed as risk factors for the identification of PDR pathogen. In addition, hospital stay was longer (15.9days vs 12.4days; P=0.018) and ICU admission rate was high (15.9% vs 9.5%; P=0.030) when PDR pathogen was identified Conclusions The various types of pathogens caused AECOPD. In addition, risk factors for the identification of PDR pathogen were past history of pulmonary tuberculosis and bronchiectasis, and history of triple inhaler use.

Polymorphism in ASCL1 target gene DDC is associated with clinical outcomes of small cell lung cancer patients

( Sun Ha Choi ),( Ji Hyun Kim ),( Jin Eun Choi ),( Yun Yong Seon ),( Kwon Hee Won ),( Sun Ji Park ),( Ji Eun Park ),( Yong Hoon Lee ),( Hyewon Seo ),( Seung Soo Yoo ),( Jaehee Lee ),( Shin Yup Lee ),( 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Achaete-scute homolog 1 (ASCL1) is a basic helix- loop-helix transcription factor and is essential in the differentiation of neuroendocrine cells and neural tissues. ASCL1 is frequently overexpressed in small cell lung cancer (SCLC) and plays a crucial role in the pathogenesis of SCLC. This study was conducted to identify the association between single nucleotide polymorphisms (SNPs) in ASCL1 target genes and clinical outcomes of patients with SCLC after chemotherapy. The two-hundred sixty-one patients diagnosed as SCLC were enrolled in this study. The association between 103 SNPs in 58 ASCL1 target genes and the response to chemotherapy and survival of patients with SCLC were analyzed. Among the 103 SNPs, 10 SNPs were significantly associated with the response to chemotherapy, and 19 SNPs were associated with OS in multivariate analyses. Among these, Dopa Decarboxylase (DDC) rs12666409A>T was significantly associated with both worse response to chemotherapy and worse OS (adjusted odds ratio [aOR] = 0.40, 95% CI = 0.18-0.90, P = 0.03; adjusted hazard ratio [aHR] = 1.52, 95% CI = 1.10-2.10, P = 0.01, respectively, under a dominant model). In a stage-stratified analysis, the association was significant only in the extensive stage subgroup (aOR = 0.19, 95% CI = 0.06-0.60, P = 0.01; aHR = 1.73, 95% CI = 1.16-2.56, P = 0.01, respectively, under a dominant model), but not in the limited stage subgroup. These results suggest that DDC rs12666409A>T may be useful markers for predicting the clinical outcomes of patients with SCLC undergoing chemotherapy.

Role of Chest Computed Tomography in Patients Hospitalized with Community-acquired Complicated Parapneumonic Effusion or Empyema

( Ji-eun Park ),( Sunji Park ),( Sun Ha Choi ),( Hyewon Seo ),( Yong-hoon Lee ),( Seung-soo Yoo ),( Shin-yup Lee ),( Jaehee Lee ),( Chang-ho Kim ),( Jae-yong Park ),( Seung-ick Cha ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Background Data regarding predictors of the outcome for patients with community-acquired complicated parapneumonic effusion (CPPE) or empyema are insufficient. Method Patients with community-acquired pneumonia (CAP) were classified into CPPE or empyema and control groups based on pleural fluid analysis and microbiological data. The patients with CPPE or empyema were further divided into longer and shorter length of stay (LOS) groups, and clinical characteristics, pleural fluid data, and computed tomographic (CT) findings were compared between the two groups. Result Of outcome variables, LOS was significantly longer in CPPE or empyema group than in the control group (13 days [interquartile range, 10-17 days] versus 8 days [6-12 days], p < 0.001), whereas 30-day mortality and in-hospital mortality were not significantly different between the two groups. Patients with CPPE or empyema were divided into the shorter (≤ 13 days) and longer LOS (≥ 14 days) groups. Multivariate analysis demonstrated that pneumonia severity index (PSI) class IV-V (odds ratio [OR] 2.79, 95% CI 1.35-5.76, p=0.006), increased attenuation of extrapleural fat (OR 2.26, 95% CI 1.06-4.80, p=0.034), and air bubbles in pleural space (OR 3.93, 95% CI 1.03-14.98, p=0.045) were independent predictors of prolonged LOS in CAP patients with CPPE or empyema. Conclusion Increased attenuation of extrapleural fat and air bubbles in pleural space assessed with CT and PSI class IV-V independently predicted prolonged LOS in CAP patients with CPPE or empyema. These findings may be helpful to identify patients who need more intensive evaluation and intervention.

Clinical Characteristics and Neurologic Outcomes of X-Linked Myotubular Myopathy

Hyewon Woo,Seungbok Lee,Ji Yeon Han,Woo Joong Kim,Man Jin Kim,Moon-Woo Seong,Soo Yeon Kim,Anna Cho,Byung Chan Lim,Ki Joong Kim,Jong-Hee Chae 대한소아신경학회 2022 대한소아신경학회지 Vol.30 No.3

Purpose: X-linked myotubular myopathy (XLMTM) is a rare condition of centronuclear myopathy caused by myotubularin 1 (MTM1) mutations. Patients with XLMTM show different neurodevelopmental outcomes after the neonatal period depending on age and acquired hypoxic damage. We aim to evaluate the clinical characteristics and neurodevelopmental outcomes of patients with XLMTM who were followed up at a single center. It is essential to understand the volume and conditions to prepare for being a candidate for new therapeutic strategies. Methods: Patients diagnosed with centronuclear myopathy by muscle pathology and MTM1 mutation analysis were included. We retrospectively investigated motor milestones, communication skills, and bulbar and respiratory function in the patients. The patients were categorized into two groups: with and without hypoxic insults (HI). Results: All 13 patients were severely affected by neonatal hypotonia and required respiratory support and a feeding tube during the neonatal period. The follow-up duration was 4.4 years (range, 0.3 to 8.9). In the non-HI group, developmental milestones were delayed but were slowly achieved. Some patients underwent training in oral feeding with thickened foods and weaning from ventilation. Patients with HI showed poor motor function catch-up and communication skills. Three deaths were associated with acute respiratory failure. Conclusion: Patients with XLMTM without HI can survive long-term with the slow achievement of motor milestones and bulbar and respiratory function. However, hypoxic brain damage following acute respiratory failure negatively influences their developmental potential or even lead to death. Therefore, parental education for proper respiratory management is necessary, especially for young children.

Clinical Relevance of Emphysema in Patients Hospitalized with Community-acquired Pneumonia: Clinical Features and Prognosis

( Hyewon Seo ),( Seung-ick Cha ),( Ji-eun Park ),( Sunji Park ),( Sun Ha Choi ),( Yong-hoon Lee ),( Seung-soo Yoo ),( Shin-yup Lee ),( Jaehee Lee ),( Chang-ho Kim ),( Jae-yong Park ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Introduction Few studies have investigated the influence of emphysema on clinical features of patients presenting with community-acquired pneumonia (CAP). Objectives: The aim of this study was to examine the clinical and microbiological features of patients with both CAP and emphysema. Methods This retrospective study included patients with CAP who underwent computed tomography (CT) scan at the time of presentation. Patients were allocated into emphysema and control groups, and clinical variables were compared between the 2 groups. The emphysema group was further divided into 3 subgroups (mild, moderate, and severe) according to the extent of emphysema on CT scan. The clinical variables of each subgroup were compared with the control group. Results Of 1676 patients, 431 patients (25.7%) were classified into the emphysema group. CAP patients with emphysema were more likely to have a high CURB-65 score and pneumonia severity index and a lower incidence of complicated parapneumonic effusion or empyema. The emphysema group exhibited longer hospital stay. In addition, 30-day mortality in the severe emphysema group was significantly higher compared with the control group. As etiological agents, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterobacteriaceae, and multi-drug resistant pathogens were significantly more common in the emphysema group compared with the control group. Conclusion The presence of emphysema in CAP patients was associated with a more severe form of CAP, a longer hospital stay, and a lower incidence of complicated parapneumonic effusion or empyema. Moreover, CAP patients with severe emphysema exhibited higher 30-day mortality than those without emphysema.

Changes in Fundus Autofluorescence after Anti-vascular Endothelial Growth Factor According to the Type of Choroidal Neovascularization in Age-related Macular Degeneration

Ji Young Lee,Hyewon Chung,Hyung Chan Kim 대한안과학회 2016 Korean Journal of Ophthalmology Vol.30 No.1

Purpose: To describe the changes of fundus autofluorescence (FAF) in patients with age-related macular degeneration before and after intravitreal injection of anti-vascular endothelial growth factor according to the type of choroidal neovascularization (CNV) and to evaluate the correlation of FAF with spectral domain optical coherence tomography (SD-OCT) parameters and vision. Methods: This was a retrospective study. Twenty-one treatment-naïve patients with neovascular age-related macular degeneration were included. Study eyes were divided into two groups according to the type of CNV. Fourteen eyes were type 1 CNV and seven eyes were type 2 CNV. All eyes underwent a complete ophthalmologic examination, including an assessment of best-corrected visual acuity, SD-OCT, fluorescein angiography, and FAF imaging, before and 3 months after intravitreal anti-vascular endothelial growth factor injection. Gray scales of FAF image for CNV areas, delineated as in fluorescein angiography, were analyzed using the ImageJ program, which were adjusted by comparison with normal background areas. Correlation of changes in FAF with changes in SD-OCT parameters, including CNV thickness, photoreceptor inner and outer segment junction disruption length, external limiting membrane disruption length, central macular thickness, subretinal fluid, and intraretinal fluid were analyzed. Results: Eyes with both type 1 and type 2 CNV showed reduced FAF before treatment. The mean gray scales (%) of type 1 and type 2 CNV were 52.20% and 42.55%, respectively. The background values were 106.72 and 96.86. After treatment, the mean gray scales (%) of type 1 CNV and type 2 CNV were changed to 57.61% (p = 0.005) and 57.93% (p = 0.008), respectively. After treatment, CNV thickness, central macular thickness, and inner and outer segment junction disruption length were decreased while FAF increased. Conclusions: FAF was noted to be reduced in eyes with newly diagnosed wet age-related macular degeneration, but increased after anti-vascular endothelial growth factor therapy regardless of CNV lesion type.

Heterogeneous Clinical Characteristics of Allan-Herndon-Dudley Syndrome with SLC16A2 Mutations

Ji Yeon Han,Seungbok Lee,Hyewon Woo,Soo Yeon Kim,Hunmin Kim,Byung Chan Lim,Hee Hwang,Jieun Choi,Ki Joong Kim,Jong-Hee Chae 대한소아신경학회 2021 대한소아신경학회지 Vol.29 No.4

Purpose: The purpose of this study was to expand our understanding of phenotypic and genetic variation in Allan-Herndon-Dudley syndrome (AHDS), which is a rare X-linked mental retardation syndrome characterized by hypotonia, generalized spasticity, and moderate-to-severe psychomotor retardation. AHDS is caused by a mutation of solute carrier family 16 member 2 (SLC16A2), which encodes monocarboxylate transporter 8 (MCT8), a transporter of triiodothyronine (T3) into neurons. Methods: We enrolled nine patients with AHDS from unrelated families, except for two patients who were cousins, through a retrospective chart review. Clinical features, brain imaging, electroencephalograms, thyroid hormone profiles, and genetic data were reviewed retrospectively and compared with previously reported cases. Results: We found three novel and five previously reported pathogenic variants in nine patients from eight families. All patients presented with hypotonia, spasticity, severe developmental delay, and elevated serum T3 levels. Cataplexy, which is a previously unreported phenotype, was found in two patients with the same mutation. In our cohort, seizures were uncommon (n=1) but intractable. Conclusion: This study broadens the known phenotypic variations of AHDS, ranging from relatively mild global developmental delay to a severe form of encephalopathy with hypotonia, spasticity, and no acquisition of independent sitting. The syndromic classification or genetic etiology of global developmental delay is extremely heterogeneous; therefore, early clinical suspicion is challenging for clinicians. However, severe mental retardation with hypotonia, spasticity, and elevated serum T3 levels in boys is a highly suspicious clinical clue for the early diagnosis of AHDS.

Prognostic Factors in Patients Hospitalized with Community-acquired Aspiration Pneumonia

( Hyewon Seo ),( Seung-ick Cha ),( Ji-eun Park ),( Sun Ha Choi ),( Yong-hoon Lee ),( Seung-soo Yoo ),( Shin-yup Lee ),( Jaehee Lee ),( Chang-ho Kim ),( Jae-yong Park ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose Patients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of prognosis in patients with community-acquired AP are limited. The aim of this study was to determine the clinical factors that could predict short-term mortality in patients with AP. Methods Patients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups. Results Of 1,249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB- 65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality. Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, NT-proBNP and albumin, the c-statistics further increased to reach approximately 0.8. Conclusions CURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status, NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.