Search

목적: 만성 B형 간염은 우리나라에서 2011년 3.0%의 유병률을 보이고 있고, 간경변이나 간세포암 등의 합병증을 유발하는 원인이 된다. 최근에 임상에 적용된 테노포비어 디소프록실 푸마레이트(TDF)는 아데노신 5`-모노포스페이트의 유사체로 비교적 안전하고 내성이 거의 없으면서 만성 B형 간염 치료에 효과가 있는 것으로 보고되었다. 테노포비어를 단독으로 사용한 경우 1년 후의 결과는 보고된 바 있지만, 2년후 연구 결과는 부족한 실정이다. 본 연구는 만성 B형 간염에서 테노포비어를 초치료로 사용한 경우에서 치료 48주, 96주후의 항바이러스 효과를 알아보기 위해 진행하였다. 대상 및 방법: 본 연구는 2012년 11월부터 2016년 1월까지 건양대학교병원에서 만성 B형 간염의 초치료로 테노포비어300 mg/day로 단독치료를 받은 환자를 대상으로 후향적으로 시행하였다. 이 연구에 포함된 환자는 179명이었고, 연구에 포함된 환자들의 이전 항바이러스 치료제의 기왕력 및 내성여부를 확인하였으며, 치료 시작 시점의 HBV DNA 역가, HBe 항원, 항체의 유무, 혈청 아미노전이효소, 간경변, 간암유무를 조사하였다. 테노포비어 치료를 시작하고 48주, 96주에 HBV DNA 역가, 바이러스 반응, 알라닌 아미노전달효소, HBeAg 양성 유무, 초음파나 컴퓨터단층촬영으로 추적 관찰을 하였다. 결과: 테노포비어 단독치료는 HBV DNA 역가 감소에 효과가 있으며, 치료 2년 후 완전 바이러스 반응은 83.2%였다. 또한 치료 2년 후 완전 바이러스 반응을 예측할 수 있는 인자는 기저 HBV DNA 역가 및 남성이었다. 그리고 모든 관련인자를 보정하였을 때 기저 HBV DNA 역가가 치료 1년 후의 테노포비어의 완전 바이러스 반응에 영향을 미치는 인자였으며, 치료 2년 후의 완전 바이러스 반응에 영향을 미치는 인자는 남성이었다. 결론: 테노포비어는 만성 B형 간염 치료를 함에 있어 초치료로 시행하는데 효과가 있으며, 완전 바이러스 반응을 얻는데 기여를 할 것으로 생각된다. 하지만 우리나라에서 테노포비어가 만성 B형 간염 치료에 사용하게 된 지는 3년 정도밖에 되지 않아, 많은 수의 환자를 대상으로 한 연구는 부족한 실정이다. 따라서 보다 정확한 테노포비어의 바이러스 반응 및 효과에 대한 연구가 지속적으로 필요하다고 생각된다.

The diagnosis of gastric intestinal metaplasia (IM) is currently performed by histologic assessment of multiple endoscopic biopsies, methylene blue chromoendoscopy, or narrow-band imaging with magnification. However, practical and readily available methods are lacking. We assessed the diagnostic accuracy and reproducibility of acetic acid chromoendoscopy (AAC) for determining the extent of gastric IM.One hundred twenty-six participants were enrolled. The participants underwent screening EGD with 1.5% acetic acid instillation for the detection of acetowhite reaction. Subsequently, targeted biopsies were performed at the 5 standard intra-gastric locations of the updated Sydney system. The accuracy of AAC was calculated using the histology results as a reference. Two endoscopists, each of whom was blinded to the other's result, determined the presence or absence of acetowhite reaction.The overall diagnostic accuracy of AAC was 89.0%, and the sensitivity and specificity were 77.6% and 94.4%, respectively. The specificity for the gastric body was94%. The proportion of extensive IM, a strong risk factor for gastric cancer, increased from 0.9% to 18.1% when AAC was used instead of conventional EGD alone (P .001). Endoscopically determined atrophy had a negative effect on the diagnosis of AAC (odds ratio, 3.012; 95% confidence interval, 1.625-5.583). There was substantial inter- and intra-observer agreement.AAC is a valid and reproducible tool for determining the extent of gastric IM and may serve as a practical method of identifying populations at high risk of gastric cancer. (Clinical trial registration number: NCT01499576.).

4020 Background: In the TeloVac study, GV1001 with Gemcitabine/capecitabine (G/C) did not show increased overall survival (OS) than G/C in patients (pts) with advanced pancreatic ductal adenocarcinoma (PDA). But cytokine examination suggested high serum eotaxin level may predict improved survivals in pts received GV1001 with G/C. This phase III trial was designed to assess the efficacy of GV1001 with G/C for previous untreated eotaxin-high Korean pts with advanced PDA. Methods: Eligible pts with histologically proven locally advanced and metastatic PDA (except peritoneal carcinomatosis), age > 18 years, and ECOG PS 0–2 were recruited. Pts were randomly assigned (1:1) to receive either G/C or G/C with GV1001 (G/C/GV). All pts receiving G/C/GV were with high serum eotaxin level (≥81.02 ng/mL), and the pts receiving G/C were randomly assigned again (1:1) to eotaxin-high and eotaxin-low pts. Study was designed according to Korean MFDS guidance for approval of clinical trial. G/C treatment included G (1000 mg/m2, 30 min IVF, D 1, 8, & 15) and C (830 mg/m2 BID for 21 days per month (m). G/C/GV treatment included an intradermal injection of GM-CSF (75 μg) and GV1001 (0.56 mg; D 1, 3, & 5, once on week 2–4, & 6, then monthly thereafter) from the start of G/C. The primary endpoint was OS. The secondary endpoints included time to progression (TTP), objective response rate, and safety. Survival data was analyzed using the copula graphic estimate method under dependent censoring. The response was independently assessed per RECIST v1.1. Under the one-sided significance level of 2.5% and to achieve the power of 80% of the statistical significance with the median OS difference from 7.9 to 14.9 m (HR = 0.53), 85 events and 118 registrations needed. Considering 20% drop-outs, 148 registrations were required. Results: Between Nov 2015 and Apr 2020, of 511 pts screened in 16 centers, eotaxin-high pts were identified as 34.7% (174 / 502 pts). 148 pts randomly assigned to G/C/GV (n = 75; all eotaxine-high) and G/C (n = 73; 37 eotaxine-high, 36 eotaxine-low). Median OS was significantly improved in the G/C/GV group with 11.3m [95% CI 8.6-14.0] than G/C group with 7.5 m [95% CI 5.1-10.0] (p = 0.021). Also, median TTP was significantly improved in the G/C/GV group (7.3 m [95% CI 5.0-9.7]) than in the G/C group (4.5 m [95% CI 3.2-5.8], p = 0.021). In other secondary endpoints, no statistical significance was confirmed between the two groups. Grade 3-4 treatment-emergent adverse events were reported in 49 pts (73.13%) vs. 58 pts (77.33%) in the G/C and G/C/GV group, without significant differences (p = 0.562). Conclusions: G/C/GV treatments significantly extend OS and TTP in advanced PDA than G/C, and specific safety-related issues had not been found. GV1001 should be considered as one of the options in PDA pts with high serum eotaxin levels. Clinical trial information: NCT02854072.

Purpose: The induction of tissue-localized virus-specific CD8 T-cell response is essential for the development of an effective therapeutic vaccine against genital diseases, such as cervical cancer and genital herpes. Here, we aimed to elucidate the immunologic role of IL7 in the induction of mucosal cellular immunity. Experimental Design: IL7 was engineered through Fc fusion to enhance mucosal delivery across the genital epithelial barrier. The immunomodulatory role of IL7 was evaluated by monitoring the kinetics of various immune cells and measuring the expression of chemokines and cytokines after intravaginal administration of Fc-fused IL7 (IL7-Fc). The antitumor effects of intramuscular human papillomavirus (HPV) DNA vaccine or topical IL7-Fc alone or in a combinational regimen on mice survival were compared using a orthotopic cervical cancer model. Results: Intravaginal treatment of IL7-Fc, but not native IL7, induces upregulation of chemokines (CXCL10, CCL3, CCL4, and CCL5), cytokines (IFNγ, TNFα, IL6, and IL1β), and an adhesion molecule (VCAM-1) in the genital tract, leading to the recruitment of several leukocytes, including CD4, CD8, γδ T cells, and dendritic cells. Importantly, in this murine cervical cancer model, topical administration of IL7-Fc after intramuscular HPV DNA vaccination increases the number of HPV-specific CD8 T cells in the genital mucosa, but not in the spleen, leading to stronger antitumor activity than the HPV DNA vaccine alone. Conclusions: Our findings provide an important insight into the immunomodulatory role of IL7-Fc via topical application and the design of therapeutic vaccine regimen that induces effective genital–mucosal CD8 T-cell responses. Clin Cancer Res; 22(23); 5898–908. ©2016 AACR.

Remanufacturing of disposable parts has the advantage in cost and environment aspects. Remanufacturing technology requires the three technologies of part cleansing technology, disassembly technology, and part restoration technology. Also, recycling and disposal must be determined through failure mode analysis. In this paper, the failure causes of magnet valve and spill valve of injector were analyzed, and the proper restoration method on main causes were researched. As a result, magnet valve was appropriate through polishing, tap manufacturing and DLC coating of spill valve was evaluated to be most appropriate.

Purpose Recently, there has been a rise in the interest to understand the composition of indoor dust due to its association with lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. Furthermore, it has been found that bacterial extracellular vesicles (EVs) within indoor dust particles can induce pulmonary inflammation, suggesting that these might play a role in lung disease. Methods We performed microbiome analysis of indoor dust EVs isolated from mattresses in apartments and hospitals. We developed diagnostic models based on the bacterial EVs antibodies detected in serum samples via enzyme-linked immunosorbent assay (ELISA) in this analysis. Results Proteobacteria was the most abundant bacterial EV taxa observed at the phylum level while Pseudomonas, Enterobacteriaceae (f) and Acinetobacter were the most prominent organisms at the genus level, followed by Staphylococcus. Based on the microbiome analysis, serum anti-bacterial EV immunoglobulin G (IgG), IgG1 and IgG4 were analyzed using ELISA with EV antibodies that targeted Staphylococcus aureus, Acinetobacter baumannii, Enterobacter cloacae and Pseudomonas aeruginosa. The levels of anti-bacterial EV antibodies were found to be significantly higher in patients with asthma, COPD and lung cancer compared to the healthy control group. We then developed a diagnostic model through logistic regression of antibodies that showed significant differences between groups with smoking history as a covariate. Four different variable selection methods were compared to construct an optimal diagnostic model with area under the curves ranging from 0.72 to 0.81. Conclusions The results of this study suggest that ELISA-based analysis of anti-bacterial EV antibodies titers can be used as a diagnostic tool for lung disease. The present findings provide insights into the pathogenesis of lung disease as well as a foundation for developing a novel diagnostic methodology that synergizes microbial EV metagenomics and immune assays.

Background : /Aims: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. Methods : : Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. Results : : The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size ＞6 cm, the presence of gas-forming abscess, APACHE II score ≥20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-forming abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. Conclusion : s: The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA. (Korean J Gastroenterol 2016;67:245-252)

There is general consensus that water instillation helps insert a colonoscope. However, the most effective method for water instillation has not yet been established, especially for endoscopists-in-training. The aim of this study was to determine volume and temperature for effective water instillation colonoscopy. This is a prospective, randomized, controlled trial that was carried out at a single center, and a total of 207 consecutive subjects who underwent colonoscopic examination for health checkup were included in the study. Water instillation of supplied water was conducted under four different conditions: 100 and 300 ml at room temperature, 300 ml at 30°C and no use of water instillation. The following parameters were recorded and analyzed: intubation success rate, independent predictors of successful intubation and intubation time to reach the cecum. The intubation success rate was not significantly different between individual groups. Independent predictors of successful intubation were younger age (P = 0.004) and later examined subjects (P = 0.016). The 300-ml warm water instillation during colonoscopy significantly reduced intubation time over the conventional method without water instillation (P = 0.034). Instillation of 300-ml warm (30°C) water during colonoscopy can reduce cecal intubation time for in-training endoscopists without improving the intubation success rate.

In this letter, we consider the uplink packet scheduling for non-real-time data users in a DS-CDMA system. As an effort to jointly optimize throughput and fairness, we formulate a time-span minimization problem incorporating the time-multiplexing of different simultaneous transmission schemes. Based on simple rules, we propose efficient scheduling algorithms and compare them with the optimal solution obtained by linear programming.

Wiper blade is one of inexpensive automotive components, but the component is very important part considering car safety for securing automotive visual field. Therefore study for securing longer endurance of wiper blade was proceeding, that is about variables effecting on endurance. In this paper, it was proved that the effect to extend endurance could be acquired by securing proper friction coefficient. Be compared endurance in Weibull distribution that is reliability technique and seized effect about blade pressure distribution, contact pressure, blade rubber surface treatment etc. for securing proper friction coefficient. Relation between these variables was cleared through test. Also, designed and proposed tester for measuring friction coefficient of wiper blade.

The effect of axial loading resulting from torque on the fatigue life of bolts has been investigated. It was found that the fatigue limit of bolts increased by an amount proportional to the increase in torque. There was a linear relationship between torque and fatigue limit. Using the Shigley method, the prediction of fatigue limit from calculated stress concentration factors was also examined. A good correlation was found between the experimental and predicted fatigue limit. The Shigley method was appropriate for the prediction of fatigue life of bolts.

Time Interleaved A/D Converter (TI-ADC) is a parallel combination of multiple ADCs having low sampling rates and it is capable of high-speed sampling in real time. The performance of the digital system to receive the analog signal depends on the performance of the ADC. However it has the disadvantage of increasing the cost using high-speed sampling ADC. To solve this problem, high-speed sampling ADC is implemented using time interleaving by a combination of a low cost, low-speed ADC and can be used for a system demanding high-speed real time sampling technology.

Automobile pedal which is loaded by driver’s input is transmitting load to throttle cable, braking device and clutch device and controlling automobile. Measuring working condition and applying equivalent damage are needed for reliability of developing pedal. The measuring working condition is requiring more investigation with various respects because of widely ranged drivers, road condition and environmental condition. Additionally, when equivalent damage is applied, there are not suitable for test condition if equivalent damage is too high level to apply or unused region. In this study, load history is measured with 95percentile customer. Measured load history is converted to stress history about critical area of pedal by FEM. There are drawn up histogram of pedal cycles and load from stress history with rain flow cycle counting method, calculated relative damage of extended stress history with Palmgren-Miner rule. From the results, calculated total relative damage is applied to calculation method of test time and load. Calculation method for test condition is carried out with three methods which are enforcing with total stress by rain flow cycle counting, representative load and blocked load. Accelerated durability test condition of pedal using with relative damage and acceleration factors are proposed.

The fatigue life of hexagon head and socket head bolts, attached to vehicle a wheel, is assessed and the estimation of the residual life of existing bolts in vehicle wheel is investigated. Fieldmeasured load histories were applied in this test. Tensile tests and fatigue tests were performed to evaluate the effect of tightening torque and to obtain the basic experimental data. Miner’s rule was used to predict the fatigue life of bolts. The results indicate the prediction of fatigue life of the bolts was in good agreement with the real life of vehicle wheel bolts in this test.

In this study, the fatigue life evaluation of automatic transfer devices under stress concentrations due to the notch effect is performed. To investigate residual life of a notched component, load histories were obtained through strain measurement. A fatigue test was performed on a specimen imitating a real component and results were compared with each notch root radius of the concentration area. Three-dimensional finite element analysis was also performed to evaluate the local stress fields. Miner’s rule was used to predict the fatigue life calculation. As a result, the predicted life of a notched component was in good agreement with a real component and introduced a special method for measuring load using real machine components.

This letter discusses how to enhance the capacity of uplink DS-CDMA networks that support multihop transmission. For this purpose, we derived simple theoretic conditions by which one can choose between singlehop- and multihop transmission. Numerical results show that we can significantly increase the radio network capacity by adopting only a few number of multihop transmissions.

Impact behaviors of Aluminum Honeycombs Sandwich Panel (AHSP) by drop weight test were investigated in this study. Two types of specimens with l/2" and l/4" cell size were tested by two impactors with the weight of 5.25kgf and 11.9kgf respectively. Transient, contact and elastic-plastic analyses were performed by finite element method. Impact behavior of AHSP about impact sites appeared nearly the same in low impact energy, but it was different in high impact energy. Face was the strongest about impact and short-edge was the weakest. The damaged area of AHSP was enlarged with the increase of impactor weight that is corresponding to impact energy. After 3-point bending test, fracture modes of AHSP were analyzed with AE counts, lower face sheet was fractured in the long-edge direction first, and then separation between face sheet and core happened. In the short-edge direction after core wrinkled, lower face sheet was torn, impact behavior by FE analysis were increased localized damage in high velocity because the faster velocity of the impact was, the smaller the stress of core was. Consequently, impactor weight had an effect on widely damaged area, while the impact velocity gave rise to localized damaged area.

The Combine is necessary equipment in the agricultural industry. The components of the Combine are worked for a long time under inferior environmental condition. Especially reaping knife is worked in high frequency domain, and submit fatigue load while use. So, fatigue test was performed to obtain the S-N curve of real component, and load history is measured through field test. The local stresses due to these loads have been calculated by FEM. These results have been used as the input values for the multi-axial fatigue analysis of real components. For the assessment of multi-axial fatigue damage, the critical plane methods have been employed. The used parameters of critical plane methods are Morrow’s, Smith-Waston-Topper’s, and Brown-Miller’s, those were modified for the high cycle fatigue region within elastic behavior. In addition, design improvement is performed about shape of reaping knife to increase the endurance limit, and durability test for improved knife is performed. It is found that the fatigue life of improved reaping knife is increased, and durability test result show that life of reaping knife is increased enough.

The fatigue life of hexagon head and socket head bolts, attached to vehicle a wheel, is assessed and the estimation of the residual life of existing bolts in vehicle wheel is investigated. Field- measured load histories were applied in this test. Tensile tests and fatigue tests were performed to evaluate the effect of tightening torque and to obtain the basic experimental data. A three-dimensional finite element analysis was also performed to evaluate the local stress fields. Miner’s rule was used to predict the fatigue life of bolts. The results indicate the prediction of fatigue life of the bolts was in good agreement with the real life of vehicle wheel bolts in this test.

When tracking a human face in the moving pictures with complex background under irregular lighting conditions, the detected face can be larger including background or smaller including only a part of the face. Even background can be detected as a face area. To solve these problems, this paper proposes a new face tracking method using a block difference image and a Kalman estimator. The block difference image allows us to detect even a small motion of a human and the face area is selected using the skin color inside the detected motion area. If the pixels with skin color inside the detected motion area, the boundary of the area is represented by a code sequence using the 8-neighbor window and the head area is detected analysing this code. The pixels in the head area is segmented by colors and the region most similar with the skin color is considered as a face area. The detected face area is represented by a rectangle including the area and its four vertices are used as the states of the Kalman estimator to trace the motion of the face area. It is proved by the experiments that the proposed method increases the accuracy of face detection and reduces the fare detection time significantly.

Background/aims Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder in patients with chronic kidney disease (CKD). However, little is known about the prevalence of GERD in dialysis patients. The aim of the present study was to investigate the difference in the prevalence of GERD in peritoneal dialysis and hemodialysis patients. Methods From July 2010 to August 2011, peritoneal dialysis patients (n=30) and hemodialysis patients (n=38) were enrolled. The prevalences of GERD were assessed at a single center with endoscopic findings and interviews using a questionnaire. Also, risk factors of GERD were evaluated. Results The prevalences of GERD in peritoneal dialysis and hemodialysis patients were 33.3% and 39.5% (p=0.748), respectively. The prevalences of erosive reflux esophagitis (ERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 23.7% (p=0.477), respectively. The prevalences of nonerosive reflux disease (NERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 13.2% (p=0.685), respectively. The prevalences of GERD, ERD and NERD were higher than those of the general population. The risk factor for GERD was age in hemodialysis patients. Conclusions The prevalence of GERD in dialysis patients was higher than that in the general population. However, there was no significant difference between peritoneal dialysis and hemodialysis patients.

Non-destructive road scanning is one of hot research issues for the paved road testing technology. We introduce a high-speed and high-accuracy road scanning algorithm by using the orthogonal frequency division modulation (OFDM) technique. We provide simulation and experimental results for the suggested algorithm.

To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis.We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominal pain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD.Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006).If patients have left-sided localized abdominal pain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.

Purpose: Durable complete remission of metastatic renal cell carcinoma (RCC) has rarely been achieved with current treatment modalities. To solve this problem, alternative therapeutic options with high efficacy and minimal side effects are strongly needed. Experimental Design: Mesenchymal stem cells (MSC) were engineered to coexpress dodecameric TRAIL and herpes simplex virus thymidine kinase (MSC/dTRAIL-TK). The antitumor effects of MSCs expressing dTRAIL (MSC/dTRAIL) or HSV-TK alone (MSC/TK) and MSC/dTRAIL-TK were compared with murine RCC cells using in vitro coculture system and in vivo experimental lung metastasis model. The effects of different doses and schedules of engineered MSCs on mice survival were also evaluated. Results: MSC/dTRAIL-TK exerted stronger apoptotic response in Renca cells than did MSC/TK or MSC/dTRAIL after ganciclovir (GCV) treatment. In vivo imaging results suggest that MSCs reside longer in the lungs of metastatic tumor-bearing mice, compared with that of control mice, regardless of genetic engineering. In addition, MSC/dTRAIL-TK treatment followed by ganciclovir administrations significantly decreased the number of tumor nodules in the lung, to a greater degree than MSC/dTRAIL or MSC/TK, and led to a prolonged survival. More importantly, the antimetastatic effect of MSC/dTRAIL-TK was markedly enhanced by repeated injections but not by increased dose, and resulted in 100% survival of tumor-bearing mice after three injections. Conclusion: Sequential combination gene therapy using MSC/dTRAIL-TK achieved long-term remission of metastatic RCC without noticeable toxicity. Our findings provide an innovative therapeutic approach to completely eradicate metastatic tumors by simple, repeated administrations of MSC/dTRAIL-TK. Clin Cancer Res; 19(2); 415–27. ©2012 AACR.

Background/Aims: The endoscopic findings and clinical relevance of portal hypertensive colopathy are not well described in Korea. We aimed to do a retrospective study of mucosal changes in the colon of patients with liver cirrhosis and to find their association with clinical characteristics. Methods: We reviewed the clinical data and endoscopic findings of 48 patients with liver cirrhosis and 48 patients, matched for age and sex, with irritable bowel disease (IBS) who underwent colonoscopy over a 5 year span. Results: Patients with liver cirrhosis were more likely to have colitis-like lesions and vascular abnormalities than IBS patients. Low platelet count (p=0.005) and severe esophageal varices (p=0.011) were associated with portal hypertensive colopathy, whereas the etiologies and severity of cirrhosis were not associated with these findings. Conclusions: Portal hypertensive colopathy can be defined with colitis-like lesions or vascular lesions. These lesions are more frequently present in patients with more severe esophageal varices and thrombocytopenia. (Korean J Gastroenterol 2011;58:332-337)

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

Background/Aims: Pyogenic liver abscess remains a major diagnostic and therapeutic challenge, despite advances in diagnostic technology and new strategies for treatment. This study was conducted to compare the differences in clinical features and outcomes of pyogenic liver abscess according to age. Methods: In total, 166 patients were enrolled and included 63 (＜65 years old, group I), 62 (65-74 years old, group II), 41 (＞75 years old, group III) patients in each group. We reviewed the medical records retrospectively including etiology, underlying diseases, characteristics of the liver abscess, laboratory and microbiologic findings, treatment, and outcome of the patients. Results: Group I had higher prevalence rates of male patients and chronic alcoholics, but lower prevalence rates of biliary disease, hypertension, and malignancy. In laboratory findings, group II had higher incidence of thrombocytopenia, elevated blood urea nitrogen and creatinine. There were no differences in symptoms and microbiologic findings in blood and pus among the three groups. Liver abscesses were more common in right liver in Group I. The lengths of stay and the treatment modalities were similar in three groups. Conclusions: Although there were differences in sex ratio, etiology, underlying disease among the different age groups, they did not cause difference in treatment and clinical outcome of pyogenic liver abscess. Thus, we recommend active treatments in patients of all age. (Korean J Gastroenterol 2010;56:90-96)

BACKGROUND: Foreign objects in the gastrointestinal tract are usually the result of accidental swallowing. Yet foreign object ingestion is often seen in prisoners who mainly desire to leave prison. We report here on a series of 33 Korean prisoners with foreign object ingestion and they were treated endoscopically or surgically. METHODS: We reviewed the medical records of 33 Korean prisoners (52 episodes) who were admitted due to ingestion of foreign objects between January 1998 and June 2004 to Konyang University Hospital and Gyeongsang National University Hospital. RESULTS: All the patients were male with a mean age of 35 years. The most common duration from ingestion to the visit to the ER was within 24 hours (25/52 episodes). Most of the foreign objects were located in the esophagus (42.3%) and stomach (42.3%). The number of foreign objects was one in 28 episodes, two in 12 episodes and three or more in twelve episodes. The most common foreign objects were metal wires (26/52 episodes). The mean size of the foreign objects was 11.9 centimeters long. Successful endoscopic treatment was performed in most patients (46/52 episodes, 88.5%). The remaining six cases were treated surgically. CONCLUSIONS: The foreign objects in prisoners were a variety of unusual things because of the prison environment, and endoscopy is a mainstay of treatment for foreign object removal in Korean prisoners. Language: en

Objective: To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Materials and Methods: Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Results: Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Conclusion: Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5 x 1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.

Percutaneous vertebroplasty (PVP) is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures (OVCFs). However, some patient populations experience recurrent vertebral fracture after initial successful procedure. There are a lot of literatures about the effectiveness of this procedure but few concerning the development of recurrent, new compression fracture. This is a retrospective review of all PVPs performed in author’s institution from September 1999 to December 2001 to investigate the factors related to the development of new symptomatic OVCFs after PVPs. A retrospective review of 244 cases of PVP for symptomatic OVCFs at 382 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed and compared between the two patient groups (control group : no further symptomatic OVCFs after the initial PVP, “new symptomatic fracture” group: with newly developed symptomatic OVCF). Statistical analysis was performed between the variables of the two groups. Survival analysis was performed using the Kaplan–Meier method. Over all, 38 among 244 treated patients (15.6%) had experienced newly developed symptomatic OVCF(s) during the follow up period (mean 52.5 months). Old age and the presence of multiple treated vertebrae at the initial PVP were assessed as a strong parameter for predicting new symptomatic OVCF. With increasing preoperative wedging deformity the risk of developing new symptomatic OVCF decreased. The Kaplan-Meier estimate of the 1 year fracture-free rate was 92.2%. The Kaplan–Meier curve showed that 7.8% of the patients would experience new symptomatic OVCF within 1 year after initial PVP. A preoperative only mild wedge deformity of the fractured vertebra(e) could indicate the increased risk of developing new symptomatic OVCF after vertebroplasty.

A retrospective review was conducted to determine the availability of anterior lumbar interbody fusion (ALIF) in selected patients who presented with recurrent lumbar disc herniation.A total of 22 patients who underwent ALIF were studied clinically and radiographically. The patients were 11 men and 11 women, with a mean age of 46 years (range 23-60 years) at the time of ALIF. The mean follow-up duration was 35 months (range 30-42 months). The fused level at which the ALIF was performed was as follows: L3-L4 (1 patient), L4-L5 (14 patients), and L5-S1 (7 patients). Back pain, leg pain, and functional outcomes were measured both before surgery and at the last follow-up visit. Patient satisfaction index was also assessed.Leg pain, back pain, and functional status all demonstrated statistically significant improvements between preoperative and postoperative scores by 86%, 77%, and 82%, respectively (P0.001). Nineteen of 22 patients (86.3%) were satisfied with their clinical results. Solid fusion was found in all patients.The authors found ALIF to be an effective procedure with satisfactory clinical results in selected patients with a recurrent disc herniation in the lumbar spine.

Recently, there has been strong interest in distributed schemes for intrusion detection in order to defend against distributed attacks such as DDoS attacks. In this paper, we focus on a placement problem of a detection system across large-scale networks for distributed intrusion detection approaches. We formulate the placement problem as a set packing problem that is NP-hard. We then present an efficient algorithm for minimizing the number of detection systems and finding the optimal placement while limiting the impact of distributed attacks.

Purpose Although previous studies have focused on risk factors for osteoarthritis, there is some debate on this issue. Furthermore, associated factors with arthritic symptom (arthralgia) have not been sufficiently investigated, despite its clinical importance in the management of osteoarthritis. This study was performed to examine the risk factors for osteoarthritis and the contributing factors to current arthritic pain in older adults. Materials and Methods The Fourth Korean National Health and Nutrition Examination Surveys was conducted in 2009. Therein, 720 males and 1008 females aged 65 years and older were included. Comprehensive data on habitual, socioeconomic, medical, nutritional, and psychological factors were collected along with the presence of osteoarthritis and arthritic pain. After univariate analysis, binary logistic regression analysis was performed to identify risk factors for osteoarthritis and contributing factors to current arthritic pain. Results Age (p=0.005), female gender (p

교신저자: 김용석, 302-718, 대전시 서구 관저동로 158, 건양대학교 의과대학 소화기내과학교실 Correspondence to: Yong Seok Kim, Department of Internal Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-718, Korea. Tel: +8242-600-9370, Fax: +82-42-600-9090, E-mail: stonedrag@hanmail.net Financial support: None. Conflict of interest: None. 요약: 세계적으로 췌장암은 발생률 10위권 내의 악성종양 으로, 암 사망률은 3위를 차지하고 있다. 따라서 췌장암의 발 생률을 낮추기 위한 약물요법을 찾기 위해 많은 역학 조사 및 무작위 대조군 연구가 진행되었다. 본 연구는 현재까지 발 표된 아스피린의 췌장암 예방효과에 대한 역학 조사들을 분석 하여 췌장암에 대한 아스피린의 예방효과에 대해 알아보고자 하였다. 2002년부터 2011년까지 발표된 10개의 연구를 메타 분석하였으며, 7,252명의 췌장암 환자와 120,000명 이상의 건강대조군을 대상으로 하였다. 10개의 연구 중 환자군-대조 군 연구가 4개, 전향적 코호트 연구가 5개, 무작위 대조군 연 구가 1개였다. 7개 연구는 미국에서 시행되었고, 3개의 연구 는 덴마크, 영국, 이탈리아에서 시행되었다. 췌장암 예방에 대한 고용량 아스피린의 효과를 알아보기 위한 연구는 8개 연구가 등록되었으며, 고용량의 아스피린을 투여한 군에서는 그렇지 않은 군에 대해 위험률(OR)이 0.88 로 근소한(marginal) 예방 효과가 있는 것으로 분석되었다 (OR 0.88, 95% CI 0.76-1.01, p=0.069). 특히 다른 연구에 영향을 많이 주는 일부 연구를 제외할 경우 위험률이 0.78로 췌장암 예방에 통계적으로 의미 있는 효과가 있는 것으로 분 석되었다(OR 0.78, 95% CI 0.64-0.95, p=0.014). 미국인을 대상으로 한 그룹 분석에서도 근소한 효과를 보여주었다(OR 0.82, 95% CI 0.65-1.02, p=0.078). 하지만 남녀 간의 통계적 차이는 보이지 않았다. 저용량 아스피린 복용의 췌장암 예방효과에 관한 연구는 8개 연구가 등록되었으며, 저용량의 아스피린을 사용할 경우 위험률은 0.99로 췌장암 발생률에 영향을 미치지 못하는 것으 로 나타났다(OR 0.99, 95% CI 0.91-1.07, p=0.732). 이는 환 자군-대조군 연구와 전향적 코호트 연구를 나누어 분석하여 도 비슷한 결과를 보였다. 미국인을 대상으로 한 분석에서도 통계적인 차이는 없었으며(OR 1.00, 95% CI 0.87-1.14, p=0.959), 성별에 따른 차이도 없었다(for the men: OR 1.00, 95% CI 0.91-1.09, p=0.946; for the women: OR 1.06, 95% CI 0.91-1.23, p=0.488). 결론으로 아스피린을 꾸준히 복용할 경우 저용량에서 췌장 암 발생에 미치는 예방효과는 없으며 고용량에서는 췌장암 발 병을 근소하게나마 예방할 수 있을 것으로 보고하였다.

Background/Aims: It is well-known that patients with chronic liver disease commonly have nutritional deficiency. In the present study, we investigated the differences in malnutrition risk between patients with liver cirrhosis and viral hepatitis carrier. Methods: Patients with chronic liver disease who have been hospitalized at Konyang University Hospital from May 2012 to April 2013 were analyzed retrospectively. The malnutrition risk was divided into three categories (low, intermediate, and high) according to Konyang University Hospital Malnutrition Screening, which include BMI, serum albumin, total lymphocyte count (TLC), hemoglobin, weight change, appetite, and dysphagia, within 24 hours of hospitalization. Results: Among a total of 460 patients, 313 had liver cirrhosis (LC), and 147 were viral hepatitis carriers. Age (p＜0.001), serum albumin level (p＜0.001), TLC (p=0.011), hemoglobin (p＜0.001) and serum cholesterol level (p=0.005) were significant different between the two groups. However, there were no difference in height, weight, and BMI. The malnutrition risk of the patients with viral hepatitis carrier was significantly lower than that of the patients with LC (p＜0.001). In addition, among 313 patients with LC, malnutrition risk of the patients with Child-Pugh class A (n=150) was significantly lower than that of the patients with class B (n=90) or C (n=73) (p＜0.001). Conclusions: Viral hepatitis carrier group had significantly lower malnutrition risk than LC group. The risk of malnutrition in Child-Pugh class A group was significantly lower than that in class B or C group. (Korean J Gastroenterol 2014;64:284-289)

Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-α and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis C virus (HCV) infection. She had been treated for 7 months. Her headaches were refractory to analgesics, and she developed subtle nuchal rigidity. The cerebral spinal fluid (CSF) revealed a white blood cell count of 205/mm(3), 51 mg/dL protein, 35 mg/dL glucose, and negative Cryptococcus antigen. The CSF culture resulted in no growth. Five days later, the CSF was positive for Cryptococcus antigen. We administered amphotericin B and flucytosine, followed by fluconazole. Approximately 2 months later, she was discharged. For the first time, we report a case of cryptococcal meningitis during the treatment of chronic HCV with PEG-interferon-α and ribavirin.

Splenic pseudocyst is a rare disease associated with chronic and acute pancreatitis splenic pseudocyst is treated by distal pancreatectomy and splenectomy. A 47-year old woman with a 10-year history of alcohol abuse presented with epigastric and left upper quadrant pain of 3 days duration. Abdominal CT showed a 4.0×4.5 cm sized cystic lesion in the tail of the pancreas. Analgesics was administrated for the relief of abdominal pain. On the 4th hospital day, the patient complained more of left upper quadrant pain, so we took follow up CT scans. On follow up CT, one large splenic pseudocyst with size of 9.5×4.5×10.0 cm was noted. The patient was treated conservatively by percutaneous catheter drainage and discharged on the 13th hospital day. This case is the first case report of splenic pseudocyst treated conservatively, not by surgery in Korea.

Background/Aims: Cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea. Methods: Age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, com- plications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangio- ma and 18 cases of literature consideration reported in Korea. Results: Intraabdominal cystic lymphangioma com- monly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All pa- tients were discharged without any complications, and no recurrence was reported. Conclusions: Preoperative di- agnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intraabdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intra- abdominal mass and active diagnostic evaluation is mandatory. (Korean J Gastroenterol 2010;56:353-358)