• 한국간담췌외과학회지
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• 제26권1호
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• pp.58-68
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• 2022

Backgrounds/Aims: Mechanisms for the development of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-infected patients remain unclear. The aim of the present study was to identify genes and pathways involved in the development of HBV-associated HCC. Methods: The GSE121248 gene dataset, which included 70 HCCs and 37 adjacent liver tissues, was downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) in HCCs and adjacent liver tissues were identified. Gene ontology and Kyoto Encyclopedia of Genes and Genome pathway enrichment analyses were then performed. Results: Of 134 DEGs identified, 34 were up-regulated and 100 were down-regulated in HCCs. The 34 up-regulated DEGs were mainly involved in nuclear division, organelle fission, spindle and midbody formation, histone kinase activity, and p53 signaling pathway, whereas the 100 down-regulated DEGs were involved in steroid and hormone metabolism, collagen-coated extracellular matrix, oxidoreductase activity, and activity on paired donors, including incorporation or reduction of molecular oxygen, monooxygenase activity, and retinol metabolism. Analyses of protein-protein interaction networks with a high degree of connectivity identified significant modules containing 14 hub genes, including ANLN, ASPM, BUB1B, CCNB1, CDK1, CDKN3, ECT2, HMMR, NEK2, PBK, PRC1, RACGAP1, RRM2, and TOP2A, which were mainly associated with nuclear division, organelle fission, spindle formation, protein serine/threonine kinase activity, p53 signaling pathway, and cell cycle. Conclusions: This study identified key genes and carcinogenic pathways that play essential roles in the development of HBV-associated HCC. This may provide important information for the development of diagnostic and therapeutic targets for HCC.

• Korean Circulation Journal
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• 제52권7호
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• pp.513-526
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• 2022

Background and Objectives: Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. Methods: Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). Results: Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. Conclusions: Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

• Korean Circulation Journal
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• 제52권2호
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• pp.123-133
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• 2022

Background and Objectives: Atherectomy as a pretreatment has the potential to improve the outcomes of drug-coated balloon (DCB) treatment by reducing and modifying atherosclerotic plaques. The present study investigated the outcomes of atherectomy plus DCB (A+DCB) compared with DCB alone for the treatment of femoropopliteal artery disease. Methods: A total of 311 patients (348 limbs) underwent endovascular therapy using DCB for native femoropopliteal artery lesions at two endovascular centers. Of these, 82 limbs were treated with A+DCB and 266 limbs with DCB alone. After propensity score matching based on clinical and lesion characteristics, a total of 82 pairs was compared for immediate and mid-term outcomes. Results: For the matched study groups, the lesion length was 172.7±111.2 mm, and severe calcification was observed in 43.3%. The technical success rate was higher in the A+DCB group than in the DCB group (80.5% vs. 62.2%, p=0.015). However, the A+DCB group showed more procedure-related minor complications (37.0% vs. 13.4%, p=0.047). At 2-year follow-up, primary clinical patency (73.8% vs. 82.6%, p=0.158) and the target lesion revascularization (TLR)-free survival (84.3% vs. 88.2%, p=0.261) did not differ between the two groups. In Cox proportional hazard analysis, atherectomy showed no significant impact on the outcome of DCB treatments. Conclusions: The pretreatment with atherectomy improved technical success of DCB treatment; however, it was associated with increased minor complications. In this study, A+DCB showed no clinical benefit in terms of TLR-free survival or clinical patency compared with DCB treatment alone.

• The Korean journal of internal medicine
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• 제39권3호
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• pp.439-447
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• 2024

Background: Helicobacter pylori infection, prevalent in more than half of the global population, is associated with various gastrointestinal diseases, including peptic ulcers and gastric cancer. The effectiveness of early diagnosis and treatment in preventing gastric cancer highlights the need for improved diagnostic methods. This study aimed to develop a simple scoring system based on endoscopic findings to predict H. pylori infection. Methods: A retrospective analysis was conducted on 1,007 patients who underwent upper gastrointestinal endoscopy at Asan Medical Center from January 2019 to December 2021. Exclusion criteria included prior H. pylori treatment, gastric surgery, or gastric malignancies. Diagnostic techniques included rapid urease and ¹³C-urea breath tests, H. pylori culture, and assessment of endoscopic features following the Kyoto gastritis classification. A new scoring system based on endoscopic findings including regular arrangement of collecting venules (RAC), nodularity, and diffuse or spotty redness was developed for predicting H. pylori infection, utilizing logistic regression analysis in the development set. Results: The scoring system demonstrated high predictive accuracy for H. pylori infection in the validation set. Scores of 2 and 3 were associated with 96% and 99% infection risk, respectively. Additionally, there was a higher prevalence of diffuse redness and sticky mucus in cases where the initial H. pylori eradication treatment failed. Conclusions: Our scoring system showed potential for improving diagnostic accuracy in H. pylori infection. H. pylori testing should be considered upon spotty redness, diffuse redness, nodularity, and RAC absence on endoscopic findings as determined by the predictive scoring system.

• 대한영상의학회지
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• 제85권4호
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• pp.746-753
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• 2024

목적 본 연구는 기능 부전의 동정맥루에 대한 경피적 혈관성형술 후 발생한 정맥 파열의 유병률 및 관리에 대하여 다루고자 하였다. 대상과 방법 1998년 1월부터 2015년 12월까지, 6732명의 환자(여성 3685명, 남성 3047명, 평균 나이 58.60 ± 12.84세; 평균 혈액투석 접근 시기: 34.32 ± 39.35개월)에 대하여 시행된 13506건의 경피적 혈관성형술, 기계적 혈전제거술, 그리고 혈전용해술이 검토되었다. 경피적 혈관성형술 후 정맥 혈관이 파열된 비율을 확인하였고 일차 개통은 시술 후 정맥 혈관의 파열된 상태, 혈전의 존재 유무, 치료 방법에 따라 결정되었다. 결과 정맥 파열은 13506건의 시술 중 604건에서 발생했다. 정맥 혈관 파열은 여성, 동정맥 이식, 그리고 혈전이 동반되었을 경우 호발하였다. 풍선 탐포네이드는 604건의 파열 사례에서 시행되었고 스텐트 시술은 조영제 유출과 혈류 정체가 지속되었을 때, 119건에서 시행되었다. 일차 개통은 파열군보다 비파열군에서 더 우수하게 나타났다. 그러나, 접근 유형과 혈전의 존재 유무는 개통 측면에서 유의한 차이가 없었다. 파열 환자의 일차 개통 시간은 지속적인 풍선 탐포네이드 후 8.4개월 이였고 스텐트 시술 후 11.2개월이었다. 결론 풍선 탐포네이드와 비피막형 스텐트 설치는 경피적 혈관성형술 관련 정맥 파열에서 적용될 수 있는 치료 방법이다. 특히, 스텐트 설치는 비파열군과 유사한 개통 시간을 보여주었다.

• 대한한방부인과학회지
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• 제37권3호
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• pp.1-19
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• 2024

Objectives: The purpose of this study is to analysis the clinical study trends on Korean Medicine treatment for Bell's palsy during pregnancy. Methods: Key words such as 'facial palsy', 'Bell's palsy, 'Korean medicine', 'herbal medicine', 'acupuncture', 'pregnancy' were searched through the 'RISS', 'OASIS', 'KISS', 'PubMed' and 'CNKI' databases. Results: Ten clinical studies with 107 patients were selected, and 1 randomized controlled trial and 9 case reports were included as the target studies. In the 9 case reports, the gestational age at the onset of facial palsy was most common in the third trimester (29-42 weeks) in 38 cases (56.7%). The most commonly used Korean medicine interventions were acupuncture, with the most frequently used acupoints being ST4, ST2, ST6, BL2, TE23, LI20, GB1, GB14, SI18, and CV24. The herbal medicine treatment most commonly utilized was Geumgwedanggwi-san (金匱當歸散), which is related to the principles of clearing heat, nourishing blood, and stabilizing the fetus (淸熱養血安胎). Among the 65 participants evaluated using the House-Brackmann facial nerve grading system, 81.5% showed complete recovery to grade 1, while 6% remained at grade 4 with no effect, indicating the efficacy of Korean medicine treatment for facial palsy during pregnancy. All the selected studies reported no abnormalities in the mothers or fetal growth, and all participants who had the reported delivery had full-term childbirth. Conclusions: The effect on Korean Medicine treatment for Bell's palsy during pregnancy had mostly positive results. However, further large, well-designed clinical trials are needed to establish the foundation of Korean Medicine treatment for Bell's palsy during pregnancy.

• Annals of Occupational and Environmental Medicine
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• 제34권
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• pp.4.1-4.11
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• 2022

Background: Long working hours are known to account for approximately one-third of the total expected work-related diseases, and much interest and research on long working hours have recently been conducted. Additionally, as the prevalence of prediabetes and the high-risk group for diabetes are increasing worldwide, interest in prediabetes is also rising. However, few studies have addressed the development of type 2 diabetes and long working hours in prediabetes. Therefore, the aim of this longitudinal study was to evaluate the relationship between long working hours and the development of diabetes in prediabetes. Methods: We included 14,258 prediabetes participants with hemoglobinA1c (HbA1c) level of 5.7 to 6.4 in the Kangbuk Samsung Cohort Study. According to a self-reported questionnaire, we evaluated weekly working hours, which were categorized into 35-40, 41-52, and > 52 hours. Development of diabetes was defined as an HbA1c level ≥ 6.5%. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of diabetes were estimated using Cox proportional hazards analyses with weekly working 35-40 hours as the reference. Results: During a median follow-up of 3.0 years, 776 participants developed diabetes (incidence density, 1.66 per 100 person-years). Multivariable-adjusted HRs of development of diabetes for weekly working > 52 hours compared with working 35-40 hours were 2.00 (95% CI: 1.50-2.67). In subgroup analyses by age (< 40 years old, ≥ 40 years old), sex (men, women), and household income (< 6 million KRW, ≥ 6 million KRW), consistent and significant positive associations were observed in all groups. Conclusions: In our large-scale longitudinal study, long working hours increases the risk of developing diabetes in prediabetes patients.

• Korean Circulation Journal
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• 제52권7호
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• pp.529-540
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• 2022

Background and Objectives: Limited data are available regarding long-term clinical outcomes of iliac artery endovascular therapy (EVT) in real-world practice. This study investigated long-term outcomes according to Trans-Atlantic Inter-Society Consensus (TASC) classifications. Methods: We analyzed data from 1,705 limbs of 1,364 patients from the retrospective cohort of the multicenter Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease registry. The primary endpoint was target lesion revascularization (TLR)-free survival. Results: TASC A, B, C, and D lesions were present in 19.4%, 26.2%, 28.7%, and 25.7% of the treated limbs, respectively. The technical success rate was 96.2% and did not differ between TASC lesion types. Complications occurred in 6.8% of cases and more occurred in TASC D (11.8%). Iliac artery EVT showed a 5-year TLR-free survival of 89.2%. The TASC D group had the lowest TLR-free rate of 79.3%. TASC D (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.12-2.73; p=0.014), plain old balloon angioplasty (HR, 4.25; 95% CI, 2.03-8.88; p<0.001), current smoker (HR, 1.89; 95% CI, 1.26-2.83; p=0.002), previous bypass surgery (HR, 3.04; 95% CI, 1.28-7.19; p=0.011), combined femoropopliteal treatment (HR, 4.89; 95% CI, 3.19-7.50; p<0.001), combined below the knee treatment (HR, 2.20; 95% CI, 1.25-3.89; p=0.007), and complications (HR, 1.86; 95% CI, 1.07-3.24; p=0.028) were predictors for TLR. Conclusions: Iliac artery EVT achieved excellent technical success and 5-year TLR-free survival. TASC D showed a favorable but lower 5-year TLR-free survival rate and higher complication rate compared with other TASC groups.

• 재활치료과학
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• 제13권3호
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• pp.37-50
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• 2024

우리나라 자살률은 Organization for Economic Cooperation and Development 국가 중 압도적 1위이며, 특히 아동·청소년들은 삶의 만족도가 낮고, 자살률 또한 매년 증가하고 있다. 아동·청소년 시기는 어느 발달단계보다 격동적이고 충동적인 시기로 자살 그 자체가 치명적이고, 전염성이 높다. 또한 의미 있는 작업을 잃어버렸을 경우에도 자살률이 높은데, 이는 자살고위험군 아동·청소년도 마찬가지이다. 정신건강복지법이 개정되고, 정신건강전문요원에 작업치료사가 포함되기 시작하면서 정신건강서비스에 있어 작업치료를 포함한 다학제적 접근이 강조되고 있다. 아동·청소년 자살을 막기 위한 선별도구로 자살사고척도(Suicidal Ideation Questionnaire), Beck의 자살사고척도(Beck Scale for Suicide Ideation), 콜롬비아 대학 자살 심각성 평가 척도(Columbia-Suicide Severity Rating Scale), 청소년용 삶의 이유척도(The Reasons for Living Inventory for Adolescents), 학생 정서·행동 특성검사(Student Emotional and Behavioral Screening Test)가 사용되었고, 작업치료평가도구인 Canadian Occupational Performance Measure도 사용되었다. 또한 다양한 학문과 기관에서 다양한 자살예방프로그램이 제시되고 있다. 하지만 자살고위험군 현실적 특성상 신속하고 적기에 서비스를 제공해야 하기 때문에 다른 자살예방프로그램보다 상대적으로 그 수가 적으며 이 또한 대부분 인지행동적 측면에 초점이 맞춰져 있다. 따라서 본 연구는 아동·청소년 자살고위험군을 대상으로 정신건강서비스를 제공하는 전문가들에게 다양한 자살예방프로그램을 소개하고, 각기 처해 있는 실정에 맞게 현장에서 활용할 수 있도록 하는 데 목적이 있다.

• 재활치료과학
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• 제13권3호
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• pp.85-100
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• 2024

목적 : 사례연구를 통해 심장이식 수술 후 연하장애가 발생한 환자의 증상을 알아보고 작업치료실에서 적용한 연하장애 재활치료의 효과에 대해 알아보고자 하였다. 연구방법 : 심장 이식 수술 후 연하장애가 발생한 환자 1명을 대상으로 비디오 투시 연하검사를 통해 기능적 연하장애 척도와 침습-흡인 척도, 삼킴 곤란 결과 및 증증도 척도를 2주 간격으로 총 3회 실시하였다. 치료 기간은 2023년 7월 19일부터 8월 21일까지 회기당 30분씩 총 8회 실시하였다. 후두 상승과 상부식도조임근의 충분한 열림 및 잔여물의 감소를 위한 교정적 치료(혀-유지 기법, 저항성 턱 당기기 운동, 멘델슨 기법, 노력 삼킴, 호흠근육 운동)와 기도보호를 위한 보상적 치료(턱 당기기 자세, 여러 번 삼키기, 음식 양과 점도 변경) 및 보호자 교육을 실시하였다. 결과 : 기능적 연하장애 척도 검사의 점수가 50점에서 30점으로 감소하였으며, 침습-흡인 척도의 단계는 5단계에서 3단계로 향상되었다. 삼킴 곤란 결과 및 중증도 척도에서는 2단계에서 4단계로 향상되었다. 결론 : 심장 이식 수술 후 연하장애를 보이는 경우 연하재활치료가 환자의 삼킴 기능 향상에 도움을 주는 것을 확인하였다. 향후 심장 이식 수술 환자의 연하장애 재활치료의 효과에 대한 보완 연구가 필요할 것이다.