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Lee KH, Heo ST, Jeong SU, Kim MY, Jeong WS, Hyun CL, Kim YK, Yoo JR. Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi. Infect Chemother 2020; 52:621-625. [PMID: 32869554 PMCID: PMC7779989 DOI: 10.3947/ic.2020.52.4.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
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Affiliation(s)
- Keun Hwa Lee
- Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Mi Yeon Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Seong Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Kyu Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
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Yao CW, Kang KA, Piao MJ, Ryu YS, Fernando PMDJ, Oh MC, Park JE, Shilnikova K, Na SY, Jeong SU, Boo SJ, Hyun JW. Reduced Autophagy in 5-Fluorouracil Resistant Colon Cancer Cells. Biomol Ther (Seoul) 2017; 25:315-320. [PMID: 27737524 PMCID: PMC5424642 DOI: 10.4062/biomolther.2016.069] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/23/2022] Open
Abstract
We investigated the role of autophagy in SNUC5/5-FUR, 5-fluorouracil (5-FU) resistant SNUC5 colon cancer cells. SNUC5/5-FUR cells exhibited low level of autophagy, as determined by light microscopy, confocal microscopy, and flow cytometry following acridine orange staining, and the decreased level of GFP-LC3 puncta. In addition, expression of critical autophagic proteins such as Atg5, Beclin-1 and LC3-II and autophagic flux was diminished in SNUC5/5-FUR cells. Whereas production of reactive oxygen species (ROS) was significantly elevated in SNUC5/5-FUR cells, treatment with the ROS inhibitor N-acetyl cysteine further reduced the level of autophagy. Taken together, these results indicate that decreased autophagy is linked to 5-FU resistance in SNUC5 colon cancer cells.
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Affiliation(s)
- Cheng Wen Yao
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Kyoung Ah Kang
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Mei Jing Piao
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Yea Seong Ryu
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | | | - Min Chang Oh
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Jeong Eon Park
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Kristina Shilnikova
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Soo-Young Na
- School of Medicine No.2, Jeju National University, Jeju 63241, Republic of Korea
| | - Seung Uk Jeong
- School of Medicine No.2, Jeju National University, Jeju 63241, Republic of Korea
| | - Sun-Jin Boo
- School of Medicine No.2, Jeju National University, Jeju 63241, Republic of Korea
| | - Jin Won Hyun
- School of Medicine No.1 and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
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Choi EK, Kim JH, Jeong SU, Na SY, Boo SJ, Kim HU, Song BC. Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series. Clin Endosc 2017; 50:297-300. [PMID: 28395397 PMCID: PMC5475510 DOI: 10.5946/ce.2016.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/30/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.
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Affiliation(s)
- Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Choi YM, Jeong SU, Jwa HY, Choi EK, Kim MJ. [Hemoperitoneum from Spontaneous Rupture of a Metastatic Abdominal Lymph Node in Gallbladder Cancer: A Case Report]. Korean J Gastroenterol 2017; 69:79-82. [PMID: 28135796 DOI: 10.4166/kjg.2017.69.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.
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Affiliation(s)
- Young Min Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Young Jwa
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
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Lee SJ, Cho YK, Na SY, Choi EK, Boo SJ, Jeong SU, Song HJ, Kim HU, Kim BS, Song BC. Regression of esophageal varices and splenomegaly in two patients with hepatitis-C-related liver cirrhosis after interferon and ribavirin combination therapy. Clin Mol Hepatol 2016; 22:390-395. [PMID: 27572075 PMCID: PMC5066381 DOI: 10.3350/cmh.2015.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/13/2015] [Accepted: 11/06/2015] [Indexed: 01/31/2023] Open
Abstract
Some recent studies have found regression of liver cirrhosis after antiviral therapy in patients with hepatitis C virus (HCV)-related liver cirrhosis, but there have been no reports of complete regression of esophageal varices after interferon/peg-interferon and ribavirin combination therapy. We describe two cases of complete regression of esophageal varices and splenomegaly after interferon-alpha and ribavirin combination therapy in patients with HCV-related liver cirrhosis. Esophageal varices and splenomegaly regressed after 3 and 8 years of sustained virologic responses in cases 1 and 2, respectively. To our knowledge, this is the first study demonstrating that complications of liver cirrhosis, such as esophageal varices and splenomegaly, can regress after antiviral therapy in patients with HCV-related liver cirrhosis.
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Affiliation(s)
- Soon Jae Lee
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yoo-Kyung Cho
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyung Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Bong Soo Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Kim JK, Kang KA, Piao MJ, Ryu YS, Han X, Fernando PMDJ, Oh MC, Park JE, Shilnikova K, Boo SJ, Na SY, Jeong YJ, Jeong SU, Hyun JW. Endoplasmic reticulum stress induces 5-fluorouracil resistance in human colon cancer cells. Environ Toxicol Pharmacol 2016; 44:128-133. [PMID: 27163731 DOI: 10.1016/j.etap.2016.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/27/2016] [Accepted: 05/01/2016] [Indexed: 06/05/2023]
Abstract
Colon cancer can be treated with 5-fluorouracil (5-FU), but 5-FU resistance frequently occurs. We determined whether 5-FU resistance arises as a result of endoplasmic reticulum (ER) stress. 5-FU-resistant SNUC5 colon cancer cells (SNUC5/FUR cells) expressed higher levels of ER stress-related proteins than drug-sensitive SNUC5 cells. SNUC5/FUR cells also exhibited more intense ER staining and higher level of mitochondrial Ca(2+) overload. SNUC5/FUR cells transfected with siRNA against GRP78, ATF6, ERK, or AKT were more sensitive to 5-FU than siControl RNA-transfected cells. These results suggested that 5-FU resistance was associated with ER stress in colon cancer.
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Affiliation(s)
- Joon Ki Kim
- Department of Bio and Nanochemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Kyoung Ah Kang
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Mei Jing Piao
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Yea Seong Ryu
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Xia Han
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | | | - Min Chang Oh
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Jeong Eon Park
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Kristina Shilnikova
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea
| | - Sun Jin Boo
- School of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Soo-Young Na
- School of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Yong Joo Jeong
- Department of Bio and Nanochemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Seung Uk Jeong
- School of Medicine, Jeju National University, Jeju 63241, Republic of Korea.
| | - Jin Won Hyun
- School of Medicine and Institute for Nuclear Science and Technology, Jeju National University, Jeju 63243, Republic of Korea.
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Kim JK, Kang KA, Ryu YS, Piao MJ, Han X, Oh MC, Boo SJ, Jeong SU, Jeong YJ, Chae S, Na SY, Hyun JW. Induction of Endoplasmic Reticulum Stress via Reactive Oxygen Species Mediated by Luteolin in Melanoma Cells. Anticancer Res 2016; 36:2281-2289. [PMID: 27127134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study aimed to investigate whether luteolin, a flavonoid, induces apoptosis in human melanoma cells via endoplasmic reticulum (ER) stress. MATERIALS AND METHODS To investigate the effects of luteolin in human melanoma cells, the anti-proliferation, apoptosis, ER stress induction and reactive oxygen species (ROS) generation were evaluated using MTT, Hoechst 33342, ER-tracker Blue White DPX and DCF-DA staining assays, respectively. RESULTS Luteolin inhibited cell proliferation and increased apoptotic body formation. Luteolin induced ER stress, as shown by ER staining and mitochondrial Ca(2+) overloading. Luteolin increased expression of the ER stress-related proteins; protein kinase RNA-like ER kinase, phospho eukaryotic translation initiation factor 2α, activating transcription factor (ATF) 6, CCAAT/enhancer-binding protein-homologous protein (CHOP), and cleaved caspase 12. Furthermore, luteolin increased the level of intracellular ROS, leading to ROS-mediated apoptosis and ER stress. However, N-acetyl cysteine, a ROS scavenger, decreased ROS levels, apoptosis, and ER stress induced by luteolin treatment. In addition, knockdown of CHOP and ATF6 by small-interfering RNA inhibited luteolin-induced cell death. CONCLUSION Luteolin induces apoptosis by ER stress via increasing ROS levels.
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Affiliation(s)
- Joon Ki Kim
- Department of Bio and Nanochemistry, Kookmin University, Seoul, Republic of Korea
| | - Kyoung Ah Kang
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Yea Seong Ryu
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Mei Jing Piao
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Xia Han
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Min Chang Oh
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Sun Jin Boo
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Seung Uk Jeong
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Yong Joo Jeong
- Department of Bio and Nanochemistry, Kookmin University, Seoul, Republic of Korea
| | - Sungwook Chae
- KM Based Herbal Drug Development Group, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Soo-Young Na
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jin Won Hyun
- School of Medicine, Jeju National University, Jeju, Republic of Korea
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Jwa HY, Cho YK, Choi EK, Kim HU, Song HJ, Na SY, Boo SJ, Jeong SU, Kim BS, Lee BW, Song BC. Regression of esophageal varices during entecavir treatment in patients with hepatitis-B-virus-related liver cirrhosis. Clin Mol Hepatol 2016; 22:183-7. [PMID: 27044771 PMCID: PMC4825159 DOI: 10.3350/cmh.2016.22.1.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 12/19/2022] Open
Abstract
Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.
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Affiliation(s)
- Hye Young Jwa
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yoo-Kyung Cho
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Bong Soo Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju, Korea
| | - Byoung-Wook Lee
- Department of Internal Medicine, Yeollin Hospital, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Song BC, Cho YK, Jwa H, Choi EK, Kim HU, Song HJ, Na SY, Boo SJ, Jeong SU. Erratum. Clin Mol Hepatol 2015; 21:104. [PMID: 25834809 PMCID: PMC4379191 DOI: 10.3350/cmh.2015.21.1.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
[This corrects the article on p. 355 in vol. 20, PMID: 25548741.][This corrects the article on p. 368 in vol. 20, PMID: 25548743.].
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Song BC, Cho YK, Jwa H, Choi EK, Kim HU, Song HJ, Na SY, Boo SJ, Jeong SU. Is it necessary to delay antiviral therapy for 3-6 months to anticipate HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B in endemic areas of HBV genotype C? Clin Mol Hepatol 2014; 20:355-60. [PMID: 25548741 PMCID: PMC4278066 DOI: 10.3350/cmh.2014.20.4.355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 11/27/2014] [Accepted: 11/28/2014] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection. Methods Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels. Results Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA ≥5.1×107 IU/mL and ALT ≥5×ULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure. Conclusions Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
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Affiliation(s)
- Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yoo-Kyung Cho
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyeyoung Jwa
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Cho YK, Cui XJ, Jeong SU, Song BC. Different mechanism of selection of adefovir-resistant mutant viruses during adefovir monotherapy in patients with lamivudine-resistant chronic hepatitis B. Antiviral Res 2014; 112:8-17. [PMID: 25303802 DOI: 10.1016/j.antiviral.2014.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/29/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adefovir (ADV) resistance is more frequent in lamivudine (LMV)-resistant chronic hepatitis B (CHB) patients than in nucleos(t)ide analogue-naïve patients. The majority of LMV-resistant mutants harbor the rtM204V/I mutation, while a minor fraction harbor the rtA181V/T mutation. We aimed to elucidate the mechanism of the high rate of ADV resistance in LMV-resistant patients during ADV therapy. METHODS We performed a clonal analysis of HBV reverse transcriptase in treatment-naïve (n = 3) and LMV-resistant patients before ADV therapy (n = 14). Dynamic changes in the viral population (n = 9) during ADV therapy were also analyzed. RESULTS Before ADV therapy, rtA181V/T was observed in 30 of 680 clones (4.4%) from 7 patients with LMV resistance under dominant rt204V/I mutation and in one of 150 clones in treatment-naïve patients. The rtA181V/T mutation was more frequently found in clones from LMV-resistant patients than in treatment-naïve patients (p = 0.029). The rtN236T mutation was not observed in any clone. During ADV therapy, most rtM204V/I mutants were replaced by wild type in all 3 patients without the rtA181V/T mutation and in one patient with the rtA181V/T mutation. Subsequently, wild type was replaced by the rtN236T and/or rtA181V/T mutant. In patients with the rtA181V/T mutation (n = 6), the rtA181V/T mutant overtook the rtM204V/I mutant in 3 of 4 patients with ADV resistance. In 2 patients without ADV resistance, most of the viral population was replaced by wild type by the last follow-up. CONCLUSION The high rate of ADV resistance in patients with LMV-resistance might be attributable to preexisting rtA181V/T mutant virus.
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Affiliation(s)
- Yoo-Kyung Cho
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Xiu-Ji Cui
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea.
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Kim JB, Lee SS, Kim SH, Byun JH, Park DH, Lee TY, Lee BU, Jeong SU, Seo DW, Lee SK, Kim MH. Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single-center experience. J Gastroenterol Hepatol 2014; 29:409-16. [PMID: 24303923 DOI: 10.1111/jgh.12410] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM Peripancreatic tuberculous lymphadenopathy is very rare and can be misdiagnosed with pancreatic or peripancreatic malignancies. The clinical characteristics and treatment outcome have not been well known. Herein, we investigated the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), clinical features, and treatment outcomes. METHODS We retrospectively analyzed 42 patients diagnosed with peripancreatic tuberculosis between December 2004 and January 2011 at the tertiary care hospital in Korea. RESULTS Median age was 36 years (interquartile range, 30-55), and female was 66.7% (28/42). Nineteen patients (45.2%) had no symptoms, while the others had non-specific various symptoms. Thirteen (31.0%) had a previous history of tuberculosis. Initial impressions of the mass were pancreatic cancer in 14 (33.3%) and tuberculous lymphadenopathy in 13 patients (31.0%). EUS-FNA was performed in all 42 patients, with a diagnostic yield of pathologic examinations in 80.5%, polymerase chain reaction for tuberculosis in 42.9%, culture in 47.4%, and acid-fast bacilli staining in 10.0%. Tuberculosis is confirmed in 28 (66.7%), and probable tuberculosis in 14 (33.3%). All patients received anti-tuberculosis treatment, a 6-months regimen in 12 (28.6%) and a 9-months regimen in 28 (66.7%). Treatment response evaluated in 35 patients (83.3%) by computed tomography criteria showed complete response in 10 patients (28.6%), partial response in 23 (65.7%), stable disease in 1 (2.9%), and progressive disease in 1 (2.9%). CONCLUSIONS Peripancreatic tuberculous lymphadenopathy is frequently mistaken for pancreatic malignancy. EUS-FNA can be helpful for an accurate diagnosis. Complete resolution of the lesion, however, was not common on following imaging study after treatment.
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Affiliation(s)
- Ji-Beom Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kim YS, Kim MH, Jeong SU, Lee BU, Lee SS, Park DH, Seo DW, Lee SK. Comparison between Midazolam Used Alone and in Combination with Propofol for Sedation during Endoscopic Retrograde Cholangiopancreatography. Clin Endosc 2014; 47:94-100. [PMID: 24570889 PMCID: PMC3928499 DOI: 10.5946/ce.2014.47.1.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 12/28/2022] Open
Abstract
Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation for its successful conduction. We investigated the efficacy and safety of the combined use of intravenous midazolam and propofol for sedation during ERCP. Methods A retrospective review of patient records from a single tertiary care hospital was performed. Ninety-four patients undergoing ERCP received one of the two medication regimens, which was administered by a nurse under the supervision of a gastroenterologist. Patients in the midazolam (M) group (n=44) received only intravenous midazolam, which was titrated to achieve deep sedation. Patients in the midazolam pulse propofol (MP) group (n=50) initially received an intravenous combination of midazolam and propofol, and then propofol was titrated to achieve deep sedation. Results The time to the initial sedation was shorter in the MP group than in the M group (1.13 minutes vs. 1.84 minutes, respectively; p<0.001). The recovery time was faster in the MP group than in the M group (p=0.031). There were no significant differences between the two groups with respect to frequency of adverse events, pain experienced by the patient, patient discomfort, degree of amnesia, and gag reflex. Patient cooperation, rated by the endoscopist as excellent, was greater in the MP group than in the M group (p=0.046). Conclusions The combined use of intravenous midazolam and propofol for sedation during ERCP is more effective than midazolam alone. There is no difference in the safety of the procedure.
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Affiliation(s)
- Yu Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Uk Jeong
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Uk Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Soo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Wan Seo
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Koo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jeong SU, Moon SH, Kim MH. Endoscopic papillary balloon dilation: Revival of the old technique. World J Gastroenterol 2013; 19:8258-8268. [PMID: 24363517 PMCID: PMC3857449 DOI: 10.3748/wjg.v19.i45.8258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/18/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD.
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Jeong SU, Aizan H, Song TJ, Seo DW, Kim SH, Park DH, Lee SS, Lee SK, Kim MH. Forward-viewing endoscopic ultrasound-guided NOTES interventions: A study on peritoneoscopic potential. World J Gastroenterol 2013; 19:7160-7167. [PMID: 24222961 PMCID: PMC3819553 DOI: 10.3748/wjg.v19.i41.7160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/09/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS).
METHODS: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications.
RESULTS: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study.
CONCLUSION: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES.
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Jang JW, Kim MH, Jeong SU, Kim J, Park DH, Lee SS, Seo DW, Lee SK, Kim JH. Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis. J Gastroenterol Hepatol 2013; 28:731-8. [PMID: 23301513 DOI: 10.1111/jgh.12121] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Comparatively little is known about acute pancreatitis or acute recurrent pancreatitis (AP/ARP) with intraductal papillary mucinous neoplasm of the pancreas (IPMN) as the causative lesion although there have been many reports about the malignant potential of IPMN as a premalignant lesion. METHODS From 2000 to 2008, in a single tertiary referral center, out of 784 patients coded by the International Classification of Disease-10 with IPMN, 489 patients fulfilled our diagnostic criteria of IPMN. After careful exclusion of all known causes of AP/ARP, 34 patients with IPMN as the cause of AP/ARP were enrolled. RESULTS AP/ARP caused by IPMN occurred in 34 (7%) out of 488 patients with IPMN, and the prevalence rate of AP/ARP was higher in the main-duct/combined type than in the branch-duct type (14% [16/111] vs 5% [18/378], respectively, P = 0.002). The severity of pancreatitis was mild, based on the computed tomography severity index score (median 2, range 0-4). Histologic review of 24 patients with surgical resection revealed four adenomas (17%), 17 borderline malignancies (71%), two carcinomas in situ (8%), and one invasive carcinoma (4%). AP/ARP did not recur in any of the 24 surgically resected patients during the follow-up period (median 52 months, range 38-115 months). CONCLUSIONS AP/ARP caused by IPMN was of infrequent occurrence. AP/ARP caused by IPMN occurred more frequently in the main-duct/combined type than in the branch-duct type. Most cases were mild in severity and benign in histopathology. AP/ARP can be an initial manifestation of IPMN, though uncommon, which leads to diagnosis.
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Affiliation(s)
- Ji Woong Jang
- Department of Gastroenterology, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
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Kim T, Song HJ, Jeong SU, Choi EK, Cho YK, Kim HU, Song BC, Kim KS, Kim BS, Kim YR. Comparison of the clinical characteristics of patients with small bowel and gastric anisakiasis in jeju island. Gut Liver 2012; 7:23-9. [PMID: 23423474 PMCID: PMC3572316 DOI: 10.5009/gnl.2013.7.1.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/28/2012] [Accepted: 04/07/2012] [Indexed: 11/30/2022] Open
Abstract
Background/Aims Anisakiasis is frequent in Jeju Island because of the people's habit of ingesting raw fish. This study evaluated the clinical characteristics of patients with small bowel anisakiasis and compared them with those of patients with gastric anisakiasis. Methods We retrospectively reviewed the medical records of 109 patients diagnosed with anisakiasis between May 2003 and November 2011. Results Of the 109 patients diagnosed with anisakiasis, those with suspicious anisakiasis (n=38) or possible anisakiasis (n=12) were excluded. The age and gender distributions did not differ between patients with small bowel anisakiasis (n=30; age, 45±13 years) and those with gastric anisakiasis (n=29; age, 46±10 years). The mean duration of hospitalization was 5.4±4.3 days for patients with small bowel anisakiasis and 0.5±1.7 days for patients with gastric anisakiasis. Small bowel anisakiasis was accompanied by leukocytosis (76.7% vs 25.5%, p=0.003) and elevated C-reactive protein levels (3.4±3.2 mg/dL vs 0.5±0.3 mg/dL, p=0.009). Contrast-enhanced abdominopelvic computed tomography showed small bowel wall thickening with dilatation in 93.3% (28/30) of patients and a small amount of ascites in 80.0% (24/30) of patients with small bowel anisakiasis. Conclusions Compared with gastric anisakiasis patients, small bowel anisakiasis patients had a longer hospitalization time, higher inflammatory marker levels, and small bowel wall thickening with ascites.
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Affiliation(s)
- Taeyun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Abstract
Obesity is an important health problem in the world and related to many critical diseases, such as diabetes, cardiovascular disease, and metabolic syndrome. Obesity leads to fat infiltration of multiple organs and infiltrated adipose tissue produces many cytokines resulting in the dysfunction of organs such as the gallbladder. In the biliary diseases, obesity and overweight have been known as a major risk factor for gallstones. According to current studies, obesity, insulin resistance, hyperinsulinemia, and metabolic syndrome are related to various gallbladder diseases including gallbladder stones, cholecystitis, gallbladder polyps, and gallbladder cancers. We reviewed further literature on the obesity and gallbladder diseases, in aspects of epidemiology, mechanism, pathology and prevention.
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Affiliation(s)
- Seung Uk Jeong
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Jeong SU, Kang DG, Lee DH, Lee KW, Lim DM, Kim BJ, Park KY, Chin HJ, Koh G. Clinical Characteristics of Type 2 Diabetes Patients according to Family History of Diabetes. Korean Diabetes J 2010; 34:222-8. [PMID: 20835339 PMCID: PMC2932891 DOI: 10.4093/kdj.2010.34.4.222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 06/08/2010] [Indexed: 12/18/2022]
Abstract
Background Type 2 diabetes mellitus (T2DM) has a strong genetic component, and its prevalence is notably increased in the family members of T2DM patients. However, there are few studies about the family history of T2DM. We carried out this study to assess the influences of family history on clinical characteristics in T2DM patients. Methods This is a cross-sectional study involving 651 T2DM patients. Patient history and physical examination were performed and fasting blood was taken. If any first degree relative was diabetic, a family history of diabetes was considered to exist. Results Among the total 621 patients, 38.4% had a family history of diabetes. Patients with a family history had a younger age, higher weight, younger age at diagnosis and higher triglyceride level than did those without a family history. Dyslipidemia medication and metabolic syndrome were more prevalent in familial diabetes. Sex, blood pressure, previous treatment for diabetes, HbA1c, C-peptide, total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were not different between familial and non-familial diabetes. Upon multiple linear regression analysis, the family history of diabetes remained significantly associated with serum triglyceride level. Conclusion In T2DM patients with a family history of diabetes, the disease tended to develop earlier. Metabolic syndrome and cardiovascular risk factors are more prevalent in familial T2DM than they were in non-familial T2DM. These results support the necessity of earlier screening for diabetes in family members of T2DM patients and more active prevention against cardiovascular disease in T2DM patients with a family history.
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Affiliation(s)
- Seung Uk Jeong
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
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Song BC, Cui XJ, Shin JW, Park NH, Cho YK, Song HJ, Hyun S, Jeong SU, Choi EK, Kim HU. Response to Adefovir Depends on Mutation Patterns in Precore Region, Basal Core Promoter and Reverse Transcriptase, and On-Treatment Responses in Lamivudine-Resistant Chronic Hepatitis B Patients. Intervirology 2010; 53:203-10. [DOI: 10.1159/000299062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 12/22/2009] [Indexed: 11/19/2022] Open
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Lee H, Cho YK, Kim HU, Choi EK, Hyun S, Kang D, Jeong SU, Kim HJ, Kim KS, Song BC. Distribution of hepatitis C virus genotypes in Jeju Island. Korean J Hepatol 2008; 14:28-35. [DOI: 10.3350/kjhep.2008.14.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Hojun Lee
- Department of Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Yoo-Kyung Cho
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Soyoung Hyun
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Donggu Kang
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Hyun Ju Kim
- Department of Family Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Kwang Sik Kim
- Department of General Surgery, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Cheju National University College of Medicine Cheju National University Hospital, Jeju, Korea
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