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BACKGROUND: Cadmium is a nephrotoxicant at high exposure levels. Few studies have evaluated the role of cadmium in kidney function at low-exposure levels. OBJECTIVE: We evaluated the association of blood cadmium with estimated glomerular filtration rate (eGFR) in the Korean adult population. METHODS: We evaluated 1,909 adults ≥20 years of age who participated in the 2005 Korean National Health and Nutrition Examination Survey and had blood cadmium determinations. eGFR was calculated using the Modification of Diet in Renal Disease equation. RESULTS: Blood cadmium geometric means were 1.57 μg/L for men and 1.49 μg/L for women. The difference in eGFR levels that compared participants in the highest versus lowest cadmium tertiles, after multivariable adjustment, was .1.85 [95% confidence interval (CI): .3.55, .0.16] mL/min per 1.73 m2 in women and 0.67 (.1.16, 2.50) mL/min per 1.73 m2 in men. Among men, the association between blood cadmium and eGFR was modified by blood lead levels (p-value for interaction = 0.048). The fully adjusted differences in eGFR levels for a 2-fold increase in blood cadmium levels were .1.14 (.3.35, 1.07) and 1.84 (0.54, 3.14) mL/min per 1.73 m2 in men with blood lead levels below and above the median (2.75 μg/dL), respectively. CONCLUSION: Elevated blood cadmium levels were associated with lower eGFR in women, which supports the role of cadmium as a risk factor for chronic kidney disease. In men, there was no overall association, although elevated blood cadmium levels were associated with higher eGFR levels in men with high blood lead levels and nonstatistically associated with lower eGFR levels in men with low blood lead levels. [ABSTRACT FROM AUTHOR]

Background: The technique of endoscopic submucosal dissection (ESD) was introduced to be able to obtain en bloc specimens of large early GI neoplasms. The drawback of ESD is its technical difficulty, which, consequently, is associated with a higher rate of complication and which requires advanced endoscopic techniques and a long procedure time., Objective: To assess the therapeutic outcome of ESD by expert endoscopists who have at least 3 years' experience of EMR in Korea., Design: A retrospective, multicenter study., Patients: From January 2006 to June 2007, 1000 early gastric cancers in 952 patients (502 men, 450 women; mean age 62.1 years, range 43-90 years) were treated by using ESD at 6 Korean ESD study group (KESG)-related university hospitals in Korea., Intervention: We performed ESD procedures with typical sequences (marking, incision, and submucosal dissection)., Main Outcome Measurements: The rate of en bloc resection, incidence of complication, and length of procedure. Predetermined factors (various endoscopic and final pathologic features) for these outcomes., Results: The rates of en bloc resection, complete en bloc resection, vertical incomplete resection, and piecemeal resection were 95.3%, 87.7%, 1.8%, and 4.1%, respectively. The rates of delayed bleeding, significant bleeding, perforation, and surgery related to complication were 15.6%, 0.6%, 1.2%, and 0.2%, respectively. The mean procedure time was 47.8 +/- 38.3 minutes. The rates of en bloc resection differed significantly in relation to the location of the lesions (upper portion vs middle portion vs lower portion of the stomach, 88.6% vs 95.2% vs 96.0%, respectively; P = .02), presence of a scar (no vs yes, 96.0% vs 89.5%, respectively; P = .002), and histologic type (low-grade adenoma vs high-grade adenoma vs differentiated early gastric cancer vs undifferentiated early gastric cancer, 95.8% vs 94.6% vs 96.2% vs 83.8%, respectively; P = .007). The rates of delayed bleeding differed significantly in relation to location (upper portion vs lower portion of the stomach, 28.6% vs 13.8%, respectively; P = .003), the size of the tumor (>40 mm vs <20 mm, 28.6% vs 13.7%, respectively; P = .009), recurrent lesion (29.4% vs 15.1%, respectively; P = .024), and macroscopic type (flat vs elevated, 18.8% vs 12.4%, respectively; P = .047). Factors related to the longer procedure time were location (upper portion vs lower portion of the stomach, 64.8 vs 44.1 minutes, respectively; P < .001), the size of the tumor (>40 mm vs < 20 mm, 67.1 vs 42.0 minutes, respectively; P < .001), the presence of ulcer (54.6 vs 46.8 minutes; P < .045), and the presence of a scar (69.2 vs 45.0 minutes; P < .001)., Conclusions: ESD is an effective and safe therapy in the management of early gastric neoplasms. Endoscopists have to accept the need for advanced endoscopic techniques for performing ESD in the case of large lesions, scar lesions, undifferentiated cancers, or for the lesions in the upper portion of the stomach. Endoscopists require more experience to decrease complications in patients who have a large or recurrent lesion in the upper portion of the stomach; these lesions also take more time to complete the ESD procedure.

Objective: Relations between host genetic factors and clinical outcomes of Helicobacter pylori infection are variable among ethnicities. The aim of this study was to examine gastric mucosal cytokines, matrix metalloproteinase 3 (MMP-3), and serum pepsinogen levels before and after eradication of H. pylori according to IL-1B genotypes and benign gastroduodenal phenotypes in a Korean population., Material and Methods: A total of 349 Koreans including H. pylori-infected subjects (n=230) and H. pylori-negative controls (n=119) were enrolled. The former subjects were classified into groups according to the presence of non-atrophic gastritis (n=74), atrophic gastritis (n=56), gastric ulcer (n=37), and duodenal ulcer (n=63). IL-1B polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Gastric mucosal IL-1beta, IL-8, and MMP-3, and serum pepsinogen I and II levels were measured by ELISA and radioimmunoassay, respectively., Results: There were no significant differences between the IL-1B-31/-511 haplotype (TT/CC, CT/CT, and CC/TT) frequencies among the H. pylori-positive and -negative groups. The genotypes of IL-1B-31/-511 polymorphisms did not affect clinical phenotypes, inflammatory cytokines, MMP-3, and pepsinogen secretion. Subjects with H. pylori-infected atrophic gastritis exhibited significantly higher basal levels of cytokines and a lower pepsinogen I/II ratio than those of other groups. Following H. pylori eradication, inflammatory cytokines significantly decreased and the pepsinogen I/II ratio increased in all groups., Conclusions: Mucosal inflammatory cytokines, MMP-3, and pepsinogen secretion are related to gastroduodenal phenotypes but not to IL-1B genotypes. Eradication of H. pylori can reduce mucosal inflammation and restore pepsinogen secretion.

Objective: This study assessed the iron status of Korean male lead workers by measuring the dietary iron intake and biochemical indices, and tested the hypothesis that a high blood lead level is associated with impaired iron function, which results in higher prevalence of iron deficiency when the route of exposure is not the gastrointestinal tract., Methods: One hundred eighteen lead workers and 42 non-lead workers were recruited from mandatory annual health surveillance sites for industrial workers. Blood lead, hemoglobin, and hematocrit levels were evaluated as hematologic parameters, and serum iron concentrations, total iron-binding capacity, and percentage of transferrin saturation were evaluated as iron-status parameters. Dietary iron intake was assessed by a 24-h recall method., Results: Lead workers had significantly lower hemoglobin, hematocrit, serum iron levels, percentage of transferrin saturation, and dietary iron intake than did non-lead workers, and they had significantly higher (P < 0.01) total iron-binding capacity. The occurrence of iron-deficiency cases, as assessed by hematocrit values, was significantly higher (P < 0.001) in lead workers than in non-lead workers, and the prevalence of iron deficiency was associated with high blood lead levels (P = 0.033). The dietary iron intake was inversely associated with zinc protoporphyrin (P = 0.032)., Conclusions: This study confirmed the adverse effects of high blood lead levels on hematologic pathways and the effectiveness of dietary iron intake as a secondary preventive intervention against lead toxicity. To promote health and to prevent toxic effects of lead exposure in Korean lead workers, an adequate intake of dietary iron is strongly recommended.