Background/Aims: We examined the efficacy and safety of tegoprazan as a part of first-line triple therapy for Helicobacter pylori eradication. Methods: A randomized, double-blind, controlled, multicenter study was performed to evaluate whether tegoprazan (50 mg)-based triple therapy (TPZ) was noninferior to lansoprazole (30 mg)-based triple therapy (LPZ) (with amoxicillin 1 g and clarithromycin 500 mg; all administered twice daily for 7 days) for treating H. pylori. The primary endpoint was the H. pylori eradication rate. Subgroup analyses were performed according to the cytochrome P450 (CYP) 2C19 genotype, the minimum inhibitory concentration (MIC) of amoxicillin and clarithromycin, and underlying gastric diseases. Results: In total, 350 H. pylori-positive patients were randomly allocated to the TPZ or LPZ group. The H. pylori eradication rates in the TPZ and LPZ groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.009 and p=0.013), respectively. Subgroup analyses according to MICs or CYP2C19 did not show remarkable differences in eradication rate. Both first-line triple therapies were well-tolerated with no notable differences. Conclusions TPZ is as effective as proton pump inhibitor-based triple therapy and is as safe as first-line H. pylori eradication therapy but does not overcome the clarithromycin resistance of H. pylori in Korea

PURPOSE: Comparison between lung ultrasound (LUS) score and indices of respiratory severity in very preterm infants born at 28 to 31 weeks' gestation. METHODS: We retrospectively reviewed medical records of 32 very preterm infants born at 28 to 31 weeks' gestation at Keimyung University Dongsan Medical Center. Before surfactant administration, bedside LUS in the neonatal intensive care unit was recorded within the first hour of life. Partial pressure of capillary oxygen to fraction of inspired oxygen ratio (PcO2)/FiO2, alveolar-arterial gradient (A-aO2), modified oxygenation index (OI), and arterial to alveolar ratio were calculated. Correlation between LUS score and indices of respiratory severity were analyzed between the intubation and nasal continuous positive airway pressure (NCPAP) groups depending on the presence or absence of endotracheal intubation. RESULTS: Mean LUS scores, A-aO2, and modified OI in the intubation group were significantly higher than those in the NCPAP group. Conversely, PcO2/FiO2 and arterial to alveolar ratios in the intubation group were significantly lower than those in the NCPAP group. LUS score was found to be significantly correlated with A-aO2 (r=0.448, P>0.05) and modified OI (r=0.453, P>0.05), but not with PcO2/FiO2 ratio (r=−0.205, P<0.05) and arterial to alveolar ratio (r=−0.190, P>0.05). CONCLUSION: The LUS score is well correlated with indices of respiratory severity in very preterm infants born at 28 to 31 weeks' gestation. Further investigation is needed to use LUS as an alternative tool in infants with respiratory distress.
Capillaries ; Continuous Positive Airway Pressure ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Intubation ; Intubation, Intratracheal ; Lung ; Medical Records ; Oxygen ; Partial Pressure ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies ; Ultrasonography

PURPOSE: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. METHODS: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. RESULTS: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P < 0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4–1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3–1,628.7) and decreased activity (OR, 34; 95% CI, 1.8–633.4), were found to be associated with fatality. CONCLUSION: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.
Birth Weight ; Escherichia coli ; Gestational Age ; Gram-Negative Bacterial Infections ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal* ; Medical Records ; Mortality ; Neutropenia ; Prognosis ; Retrospective Studies ; Sepsis* ; Streptococcus

OBJECTIVES: The purpose of this study was to examine personality traits associated with suicidal symptoms (with history of suicide attempt or suicidal idea) in depressed patients. METHODS: A sample 186 patients diagnosed with major depressive disorder was divided into two groups : suicidal group (with history of suicide attempt or suicidal idea, n=70) and non-suicidal group (without history of suicide attempt or suicidal idea, n=116). NEO Personality Assessment System were used to evaluate personality trait. RESULTS: Neuroticism was high in suicidal group (p=0.041). In multivariate logistic regression, Neuroticism was also a significant influence on suicidal symptoms (Odds Ratio=1.04, 95% Confidence Interval 1.01–1.07, p=0.0145). CONCLUSIONS High Neuroticism is a useful information to identify individuals at high risk of suicide in depressive patients.

PURPOSE: We investigated fecal calprotectin (FC) levels in preterm infants with and without feeding intolerance (FI), and compared the FC levels according to the type of feeding. METHODS: The medical records of 67 premature infants were reviewed retrospectively. The fully enteral-fed infants were classified into two groups; the FI group (29 infants) and the control group (31 infants). Seven infants with necrotizing enterocolitis, sepsis, and perinatal asphyxia were excluded. If breast milk (BM) or preterm formula (PF) could not be tolerated by infants with FI, amino acid-based formula (AAF) was tried temporarily. Once FI improved, AAF was discontinued, and BM or PF was resumed. We investigated the FC levels according to the type of feeding. RESULTS: Significant differences were found in gestational age, birth weight, age when full enteral feeding was achieved, and hospital stay between the FI and control group (p < 0.05). The FC levels in the FI group were significantly higher than those in the control group (p < 0.05). The FC levels in the AAF-fed infants with FI were significantly lower than those in the BM- or PF-fed infants (p < 0.05). The growth velocities (g/d) and z scores were not significantly different between the FI and control group (p>0.05). CONCLUSION: The FC levels in AAF-fed infants with FI showed significantly lower than those in the BM- or PF-fed infants with FI. The mitigation of gut inflammation through the decrease of FC levels in AAF-fed infants with FI could be presumed.
Asphyxia ; Birth Weight ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Infant ; Infant Formula ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Length of Stay ; Leukocyte L1 Antigen Complex* ; Medical Records ; Milk, Human ; Retrospective Studies ; Sepsis

PURPOSE: Ultrasonography is non-ionizing, easy to operate, and performed at bedside in neonatal intensive care unit (NICU). We investigated the incidence of respiratory distress syndrome (RDS) with or without using lung ultrasound (LUS) in late preterm infants with postnatal respiratory difficulties. METHODS: We retrospectively reviewed medical records of 494 late preterm infants born at 34–36 weeks' gestation at Keimyung University Dongsan Medical Center. Fifty infants with postnatal respiratory difficulties were admitted to the NICU between May 2015 to October 2015 (period I), and forty-one were between November 2015 to February 2016 (period II). The diagnosis of RDS was based on chest radiography in period I. LUS was additionally performed at bedside in period II. All infants with RDS were received exogenous surfactant therapy. RESULTS: The overall incidence of RDS with surfactant replacement therapy was decreased in period II period II (9.4%, 20/212) compared to period I (14.5%, 41/282) (P=0.088). In terms of infants with postnatal respiratory difficulties, the incidence of RDS in period II (48.8%, 20/41) was significantly lower than that in period I (82.0%, 41/50) (P=0.001). There are no difference in the rate of reintubation, repeated doses of surfactant, oxygen demand at 48 hours after birth, air leak syndrome, pulmonary hemorrhage, persistent pulmonary hypertension of newborn, and mortality (P> 0.05). CONCLUSION: We could decrease the incidence of RDS with surfactant replacement therapy by using LUS in late preterm infants with postnatal respiratory difficulties. Further prospective studies are needed to apply LUS clinically to diagnose RDS.
Diagnosis* ; Female ; Hemorrhage ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Lung* ; Medical Records ; Mortality ; Oxygen ; Parturition ; Persistent Fetal Circulation Syndrome ; Pregnancy ; Prospective Studies ; Radiography ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies ; Thorax ; Ultrasonography*

BACKGROUND/AIMS: Post-operative ileus (POI) is a common complication of abdominal surgery. DA-9701, an extract of Pharbitis Semen and Corydalis Tuber, is a new prokinetic agent that also alleviates visceral pain. The aim of this study was to investigate whether DA-9701 can ameliorate POI in rats. METHODS: A total of 32 rats were divided into 4 groups: no surgery/no medication (NSNM), no surgery/medication (NSM), surgery/no medication (SNM), and surgery/medication (SM). Gastrointestinal transit (GIT), which is assessed by migration of charcoal, and cumulative stool weight were measured at 24 hours after surgery. RESULTS: GIT was significantly more delayed in the SNM group than in the other groups (SNM vs NSNM, P < 0.001; SNM vs NSM, P < 0.001; SNM vs SM, P = 0.005). Cumulative stool weight in that group was also lower than in the no surgery groups (SNM vs NSNM, P = 0.007; SNM vs NSM, P = 0.033), and there was no significant difference between the SM group and the no surgery groups (SM vs NSM, P = 0.703; SM vs NSNM, P = 0.347). CONCLUSION: DA-9701 can ameliorate POI by reducing delayed GIT and improving defecation in a rat model of POI.
Animals ; Charcoal ; Corydalis ; Defecation ; Gastrointestinal Transit ; Ghrelin ; Ileus* ; Models, Animal ; Rats* ; Semen ; Visceral Pain

PURPOSE: Hypoxic-ischemic encephalopathy is a significant cause of neonatal morbidity and mortality. Erythropoietin (EPO) is emerging as a therapeutic candidate for neuroprotection. Therefore, this study was designed to determine the neuroprotective role of recombinant human EPO (rHuEPO) and the possible mechanisms by which mitogen-activated protein kinase (MAPK) signaling pathway including extracellular signal-regulated kinase (ERK1/2), JNK, and p38 MAPK is modulated in cultured cortical neuronal cells and astrocytes. METHODS: Primary neuronal cells and astrocytes were prepared from cortices of ICR mouse embryos and divided into the normoxic, hypoxia (H), and hypoxia-pretreated with EPO (H+EPO) groups. The phosphorylation of MAPK pathway was quantified using western blot, and the apoptosis was assessed by caspase-3 measurement and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. RESULTS: All MAPK pathway signals were activated by hypoxia in the neuronal cells and astrocytes (P<0.05). In the neuronal cells, phosphorylation of ERK-1/-2 and apoptosis were significantly decreased in the H+EPO group at 15 hours after hypoxia (P<0.05). In the astrocytes, phosphorylation of ERK-1/-2, p38 MAPK, and apoptosis was reduced in the H+EPO group at 15 hours after hypoxia (P<0.05). CONCLUSION: Pretreatment with rHuEPO exerts neuroprotective effects against hypoxic injury reducing apoptosis by caspase-dependent mechanisms. Pathologic, persistent ERK activation after hypoxic injury may be attenuateed by pretreatment with EPO supporting that EPO may regulate apoptosis by affecting ERK pathways.
Animals ; Anoxia ; Apoptosis* ; Astrocytes ; Blotting, Western ; Caspase 3 ; DNA Nucleotidylexotransferase ; Embryonic Structures ; Erythropoietin* ; Humans ; Hypoxia-Ischemia, Brain ; MAP Kinase Signaling System ; Mice ; Mice, Inbred ICR ; Mitogen-Activated Protein Kinases ; Mortality ; Neurons ; Neuroprotection ; Neuroprotective Agents* ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; Phosphotransferases ; Protein Kinases*

BACKGROUND/AIMS: Gallstone pathogenesis is linked to mucin hypersecretion and bacterial infection. Several mucin genes have been identified in gallbladder epithelial cells (GBECs). We investigated MUC expression in cholesterol-associated gallbladder disease and evaluated the relationship between mucin and bacterial infection. METHODS: The present study involved 20 patients with cholesterol stones with cholecystitis, five with cholesterol stones with cholesterolosis, six with cholesterol polyps, two with gallbladder cancer, and six controls. Canine GBECs treated with lipopolysaccharide were also studied. MUC3, MUC5AC, MUC5B, and MUC6 antibodies were used for dot/slot immunoblotting and immunohistochemical studies of the gallbladder epithelial tissues, canine GBECs, and bile. Reverse-transcription polymerase chain reaction was performed to evaluate MUC3 and MUC5B expression. RESULTS: MUC3, MUC5AC, MUC5B, and MUC6 were expressed in the normal gallbladder epithelium, and of those, MUC3 and MUC5B exhibited the highest expression levels. Greatly increased levels of MUC3 and MUC5B expression were observed in the cholesterol stone group, and slightly increased levels were observed in the cholesterol polyp group; MUC3 and MUC5B mRNA was also upregulated in those groups. Canine GBECs treated with lipopolysaccharide also showed upregulation of MUC3 and MUC5B. CONCLUSIONS: The mucin genes with the highest expression levels in gallbladder tissue in cholesterol-associated diseases were MUC3 and MUC5B. Cholesterol stones and gallbladder infections were associated with increased MUC3 and MUC5B expression.
Antibodies ; Bacterial Infections ; Bile ; Cholecystitis ; Cholesterol ; Epithelial Cells ; Epithelium ; Gallbladder Diseases* ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Immunoblotting ; Mucins ; Polymerase Chain Reaction ; Polyps ; RNA, Messenger ; Up-Regulation

BACKGROUND/AIMS: We evaluated the characteristics of the National Cancer Screening Program (NCSP) and opinions regarding the National Endoscopy Quality Improvement Program (NEQIP). METHODS: We surveyed physicians performing esophagogastroduodenoscopy and/or colonoscopy screenings as part of the NCSP via e-mail between July and August in 2015. The 32-item survey instrument included endoscopic capacity, sedation, and reprocessing of endoscopes as well as opinions regarding the NEQIP. RESULTS: A total of 507 respondents were analyzed after the exclusion of 40 incomplete answers. Under the current capacity of the NCSP, the typical waiting time for screening endoscopy was less than 4 weeks in more than 90% of endoscopy units. Performance of endoscopy reprocessing was suboptimal, with 28% of respondents using unapproved disinfectants or not knowing the main ingredient of their disinfectants and 15% to 17% of respondents not following reprocessing protocols. Agreement with the NEQIP was optimal, because only 5.7% of respondents did not agree with NEQIP; however, familiarity with the NEQIP was suboptimal, because only 37.3% of respondents were familiar with the NEQIP criteria. CONCLUSIONS: The NEQ-IP remains suboptimal in Korea. Given the suboptimal performance of endoscopy reprocessing and low familiarity with the NEQIP, improved quality in endoscopy reprocessing and better understanding of the NEQIP should be emphasized in Korea.
Colonoscopy ; Colorectal Neoplasms ; Disinfectants ; Early Detection of Cancer ; Electronic Mail ; Endoscopes ; Endoscopy* ; Endoscopy, Digestive System ; Korea* ; Mass Screening ; Quality Improvement* ; Recognition (Psychology) ; Stomach Neoplasms ; Surveys and Questionnaires