Nonsurgical endoscopic or percutaneous dilatation and insertion of an endoprosthesis is the treatment of choice in the majority of patiens with incurabie malignant biliary obsturction. But these palliative treatment of extrahepatic cholestasis with an endoscopic or percutaneous biliary endoprosthesis is limited by clogging. One of the factors thought to be of importance is the diameter of the stent. So in order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. Wallstent is braided in the form of a tubular mesh from surgical grade stainless alloy. This prosthesis is geometrically stable, pliable and self expanding. Its elastic properties are such that its diameter can be substantially reduced by moderate elongation. The stent is constrainded on a small diameter delivery catheter(total outside diameter: 9 French). During the implantation procedure the final position of the partially released endoprosthesis can be adjusted by gradual removal of the delivery catheter. If full expansion to 30 French occurs, the stent will be shortened by approximately 30% to their normal length range between 34-102mm. Now in this article we report a new method for endoscopic retrograde placement of biliary Wallstent in a patient with obsturctive jaundice due to periampullary choangiocacrcinoma.
Alloys ; Catheters ; Cholestasis, Extrahepatic ; Dilatation ; Endoscopes ; Humans ; Jaundice ; Palliative Care ; Prostheses and Implants ; Stents

Background: Nivolumab and pembrolizumab are antagonists of the programmed death-ligand 1 (PD-L1) receptor that function as immuno-oncological agents. This study aimed to evaluate the safety and efficacy of nivolumab and pembrolizumab in elderly patients in outpatient settings. Methods: The safety and efficacy of nivolumab and pembrolizumab were compared retrospectively among patients at the Veterans Health Service (VHS) Medical Center in Seoul, South Korea, from September 1, 2017 to August 25, 2018. Results: Eighty-seven patients were selected for the study. The median progression-free survival was 63 days for nivolumab (95% confidence interval (CI), [14 to 282]) vs. 243 days for pembrolizumab (95% CI, [22 to 348]) (p =0.04). The objective response rate (ORR) was 0% in the nivolumab group vs 5.6% in the pembrolizumab group (p =0.310). All the patients exhibited treatmentrelated adverse effects. More than 89% of the patients exhibited diseases of the gastrointestinal (GI) tract. Pneumonia, of grades three or higher, was the most common adverse effect, followed by weakness and anorexia. Conclusions There was no statistically significant difference between the nivolumab group and the pembrolizumab group with respect to the ORR. The incidence and severity of the adverse effects in this study were higher than those of previous studies; however, these adverse effects are generally manageable in a real-world clinical setting. Further randomized controlled studies will be necessary to confirm these results in elderly patients.

Background: Nivolumab and pembrolizumab are antagonists of the programmed death-ligand 1 (PD-L1) receptor that function as immuno-oncological agents. This study aimed to evaluate the safety and efficacy of nivolumab and pembrolizumab in elderly patients in outpatient settings. Methods: The safety and efficacy of nivolumab and pembrolizumab were compared retrospectively among patients at the Veterans Health Service (VHS) Medical Center in Seoul, South Korea, from September 1, 2017 to August 25, 2018. Results: Eighty-seven patients were selected for the study. The median progression-free survival was 63 days for nivolumab (95% confidence interval (CI), [14 to 282]) vs. 243 days for pembrolizumab (95% CI, [22 to 348]) (p =0.04). The objective response rate (ORR) was 0% in the nivolumab group vs 5.6% in the pembrolizumab group (p =0.310). All the patients exhibited treatmentrelated adverse effects. More than 89% of the patients exhibited diseases of the gastrointestinal (GI) tract. Pneumonia, of grades three or higher, was the most common adverse effect, followed by weakness and anorexia. Conclusions There was no statistically significant difference between the nivolumab group and the pembrolizumab group with respect to the ORR. The incidence and severity of the adverse effects in this study were higher than those of previous studies; however, these adverse effects are generally manageable in a real-world clinical setting. Further randomized controlled studies will be necessary to confirm these results in elderly patients.

The present study was conducted to provide the basis for improvement of clinical nutrition services through development of job standards of clinical dietitian for the clinical nutrition therapy to cancer patients in hospitals. Developing A Curriculum (DACUM) method was used for job analysis and development of job standards for clinical dietitians for cancer care. Based on DACUM analysis, information about duties, tasks, and task elements of clinical dietitians for cancer care was collected. Developed job standards were applied to clinical nutrition care for cancer patients in hospitals for evaluation. Based on DACUM analysis, consultations from professionals, and field application tests, the final job standards were composed of four duties, 18 tasks, and 56 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring.evaluation. For cancer nutrition care, 109 work activities were developed. They were composed of 75 basic and 34 recommended work activities. The application of developed job standards for clinical dietitians for cancer care at 10 hospitals showed a performance rate of 72.3%. In conclusion, job standards for clinical dietitians for cancer care developed in this study might be effectively used as guidelines for providing clinical nutrition services for cancer patients in hospitals.
Curriculum ; Diagnosis ; Humans ; Nutrition Assessment ; Nutrition Therapy* ; Nutritionists* ; Referral and Consultation

High-mobility group box 1 (HMGB1) protein has been demonstrated to play an important role in chronic inflammatory diseases including rheumatoid arthritis, and systemic lupus erythematosus. This study investigated the association between extracellular HMGB1 expression and disease activity, and clinical features of Behcet's disease (BD). Extracellular HMGB1 expression in the sera of 42 BD patients was measured and was compared to that of 22 age- and sex-matched healthy controls. HMGB1 expression was significantly increased in BD patients compared to healthy controls (78.70 +/- 20.22 vs 10.79 +/- 1.90 ng/mL, P = 0.002). In addition, HMGB1 expression was significantly elevated in BD patients with intestinal involvement compared to those without (179.61 +/- 67.95 vs 61.89 +/- 19.81 ng/mL, P = 0.04). No significant association was observed between HMGB1 concentration and other clinical manifestations, or disease activity. It is suggested that extracellular HMGB1 may play an important role in the pathogenesis of BD.
Adult ; Aged ; Behcet Syndrome/genetics/*metabolism/pathology ; Extracellular Space/metabolism ; Female ; HMGB1 Protein/genetics/*metabolism ; Humans ; Inflammation ; Intestinal Diseases/blood/genetics ; Male ; Middle Aged ; Young Adult

No abstract available.
Aminophylline* ; Humans* ; Neutrophils* ; Pneumonia* ; Sepsis* ; Superoxides*

Copy number variation has been associated with various autoimmune diseases. We investigated the copy number (CN) of the DEFA1 gene encoding alpha-defensin-1 in samples from Korean individuals with Behcet's disease (BD) compared to healthy controls (HC). We recruited 55 BD patients and 35 HC. A duplex Taqman(R) real-time PCR assay was used to assess CN. Most samples (31.1%) had a CN of 5 with a mean CN of 5.4 +/- 0.2. There was no significant difference in the CN of the DEFA1 gene between BD patients and HC. A high DEFA1 gene CN was significantly associated with intestinal involvement in BD patients. Variable DEFA1 gene CNs were observed in both BD patients and HC and a high DEFA1 gene CN may be associated with susceptibility to intestinal involvement in BD.
Adult ; Behcet Syndrome/*complications/*genetics ; Female ; Gene Dosage ; Genetic Predisposition to Disease ; Genotype ; Humans ; Intestinal Diseases/*etiology/*genetics ; Male ; Middle Aged ; Real-Time Polymerase Chain Reaction ; alpha-Defensins/*genetics

The possible association of colorectal adenomatous polyps, a precursor lesion for colorectal cancer, with risk factors including cigarette smoking, alcohol consumption, coffee consumption, family history and dietary factors was investigated in a case-control study. Between January 1993 and March 1995, 143 cases of patients with pathologically confirmed incident colorectal adenomatous polyps and 301 control subjects were collected from Our Lady of Mercy Hospital. Information on exposure was obtained by structured interviews. After adjustment for age and sex, statistically significant odds ratio (highest-lowest tercile) were found for cigarette smoking(5.53; 95% confidence interval CI, 3.26 9.38), coffee consumption (2.01 ; 95% CI 1. 15-3.53). For dietary factors, significant odds ratio were found for yogurt consumption (0.35 ; 95% CI 0.14-0.85) and milk consumption (0.34; 95% CI 0.17-0.70). No significant associations were observed for total fat intake and total fiber intake after adjustment for age, sex and total calorie. Odds ratio of family history of colorectal cancer and/or polyp was 3.05(95% CI 0.84-11.05). Cigarette smoking, coffee consumption, appears to be a significant risk factor, and milk consumption, yogurt consumption appears to be a significant protective factor for colorectal adenomatous polyps.
Adenomatous Polyps* ; Alcohol Drinking ; Case-Control Studies* ; Coffee ; Colorectal Neoplasms ; Humans ; Milk ; Odds Ratio ; Polyps ; Risk Factors* ; Smoking ; Tobacco Products ; Yogurt

OBJECTIVE: This cross-sectional study aimed to investigate the association between rheumatoid factor (RF) positivity and bone mineral density (BMD) in male Korean subjects without any history of joint disease. METHODS: Of 84,344 males who had undergone a comprehensive health checkup program in 2012, 1,390 male health examinees were recruited, whose BMD and RF results were available. A RF titer ≥20 IU/mL was considered positive. BMD was measured at lumbar spine (L1~L4) or hip (femoral neck and total hip) by dual-energy X-ray absorptiometry. RESULTS: The association between RF positivity and BMD was assessed by multiple linear regression analysis. The mean age was 52.7±10.9 years (range 19~88 years), and RF was detected in 64 subjects (4.6%). Demographics and laboratory data were not different between RF-positive and -negative subjects except hepatitis B surface antigen (HBsAg), which was more frequently seen in RF-positive subjects (15.6% vs. 4.3%, p=0.001). RF-positive subjects had significantly lower BMD compared to RF-negative subjects in lumbar spine but not in total hip regardless of the existence of HBsAg (1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.002 in total subjects; 1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.004 in HBsAg-negative subjects). After adjusting for multiple confounders, RF positivity was negatively associated with lumbar spine BMD (B=−0.088 and standard error=0.035, p=0.011). CONCLUSION: Our results show that the presence of RF could have an unfavorable impact on bone density in apparently normal males. Additional studies to elucidate the osteoimmunological mechanism of rheumatoid factor are warranted.
Absorptiometry, Photon ; Arthritis* ; Bone Density ; Cross-Sectional Studies ; Demography ; Hepatitis B Surface Antigens ; Hip ; Humans ; Joint Diseases ; Linear Models ; Male* ; Men's Health ; Neck ; Rheumatoid Factor* ; Spine

Background: Interprofessional education (IPE) is important for collaboration between professionals in the team-based practices of the healthcare field. Objectives: This study aimed to examine pharmacy students across in Korea on the experience of IPE and the perceptions of the importance of interprofessional collaboration (IPC) and the need of IPE. Methods: A cross-sectional survey using a 20 questionnaire to pharmacy students nationwide was conducted from March to May 2019. Results: A total of 555 students from 32 pharmacy schools participated. They recognized that the importance of close pharmacist-medical doctor collaboration was an average of 5.38 points (out of 6 points), but the current level of pharmacist-to-medical doctor collaboration was an average of 2.51 points (out of 6 points), and the reasons for the insufficient IPC were the lack of an environment encouraging mutual cooperation (79.5%) and the psychological distance to the other professional (35.3%). They perceived the necessity of IPE between pharmacistmedical doctor was 4.95 points (out of 6 points), with the curriculum including how to cooperate with medical doctors (78.2%), communication skills (51.0%), and understanding of medical doctors’ functions (44.5%), etc. Only 52 respondents (9.4%) had experience in IPE. Respondents who recognized the importance of IPC (≥5 points) showed 4.44-fold higher agreement on the need for IPE than those who did not (≤4 points) (OR 4.44, 95% CI 2.56, 7.68). Conclusions Further attention and discussion to add IPE program in the pharmacy school curriculum is necessary in order to cultivate pharmacists with sufficient professional collaboration capabilities.