BACKGROUND/AIMS: This study was conducted to clarify the sustained virological response (SVR) prediction ability of baseline and treatment-related factors in patients with chronic hepatitis C virus (HCV) infection. METHODS: This retrospective study collected data at four tertiary referral hospitals between June 2004 and July 2012. Out of 476 patients, 330 treatment-naïve patients with chronic HCV infection were recruited. Pegylated interferon α-2a/-2b plus ribavirin was administered for either 24 or 48 weeks depending on the HCV genotype. The baseline and treatment-related predictive factors of SVR were evaluated by analyzing data measured before treatment (i.e., baseline) and during treatment. RESULTS: SVR rates for genotypes 1 and 2 were 63% (97/154) and 79.5% (140/176), respectively (p = 0.001). Multivariate analysis for baseline factors revealed that young age (p = 0.009), genotype 2 (p = 0.001), HCV RNA level of < 800,000 IU/mL (p < 0.001), and a baseline platelet count of > 150 × 10³/µL (p < 0.001) were significant SVR predictors, regardless of the genotype. In particular, predictive accuracy for achievement of SVR was 87.3% for a baseline platelet count of > 150 × 10³/µL. In multivariate analysis for treatment-related factors, SVR was associated with achievement of a rapid virological response (RVR; p < 0.001), treatment adherence of ≥ 80/80/80 (p < 0.001). CONCLUSIONS Young age, genotype 2, low HCV RNA level, RVR, and treatment adherence were significantly associated with SVR. In addition, platelet count was an independent predictive factor for SVR. Therefore, platelet count could be used to develop individualized treatment regimens and to optimize treatment outcomes in patients with chronic HCV infection.

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.
Anti-Inflammatory Agents ; Blotting, Western ; Cell Line ; Critical Illness ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunosuppression ; Inflammation ; Lipopolysaccharides ; Macrophage Migration-Inhibitory Factors ; Macrophages ; Monocytes ; Saline Solution, Hypertonic ; T-Lymphocytes

PURPOSE: Trauma-induced suppression of cellular immune function likely contributes to sepsis, multiple organ dysfunction syndrome and death. T cell proliferation decreases after traumatic stress. The addition of prostaglandin E2 (PGE2), which depresses immune function after hemorrhage and trauma, to T-cells decreases T-cell proliferation; and hypertonic saline restores PGE2-induced T-cell suppression. Recently, it has become apparent that macrophage migration inhibitory factor (MIF) plays a central role in several immune responses, including T-cell proliferation. However, the role of MIF in mediating hypertonic saline (HTS) restoration of T cell dysfunction is unknown. Therefore, we hypothesize that T cell immune restoration by HTS occurs, at least in part, by a MIF-mediated mechanism. METHODS: Jurkat cells were cultured in Roswell Park Memorial Institute media, at a final concentration of 2.5 x 106 cell/mL. The effects of HTS on T-cell proliferation following PGE2-induced suppression were evaluated in Jurkat cells: HTS at 20 or 40 mmol/L above isotonicity was added. MIF levels were determined by enzyme-linked immunosorbent assay and western blot analysis. RESULTS: PGE2 caused a 15.0% inhibition of Jurkat cell proliferation, as compared to the control. MIF levels decreased in PGE2-suppressed cells, as compared to the control. MIF levels were higher in cells treated with HTS than PGE2-stimulated cells. CONCLUSION: The role of HTS in restoring Jurkat cells proliferation suppressed by PGE2, at least in part, should be mediated through a MIF pathway.
Blotting, Western ; Cell Proliferation ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hypertonic Solutions ; Jurkat Cells ; Macrophage Migration-Inhibitory Factors ; Macrophages ; Multiple Organ Failure ; Negotiating ; Prostaglandins E ; Sepsis ; T-Lymphocytes

PURPOSE: A medical disaster assistance team from our hospital was sent to the Haiti earthquake for 7 days of medical support. METHODS: We analyzed the characteristics of patients who visited our field clinic at the scene during the subacute period after the disaster. RESULTS: We treated 120 patients over 4 days, including two patients during the preparatory period. Most patients had visited a clinic in the second half of the period. Internal medicine and pediatrics were associated with the chief complaints of most patients. Acute tonsillitis had the largest number of patients(24.6%), followed by skin infections (9.2%), contusions and sprains(8.4%), and gastric ulcers (8.4%). Most of the medications were for conservative management(68.3%). CONCLUSION: During the subacute period after the earthquake, most patients had secondary injuries, such as wound complications and complications from air and water pollution, rather than direct injuries from the earthquake. We recommend that more medical preparation than surgical preparation is required during subacute periods after an earthquake.
Contusions ; Disasters ; Earthquakes ; Haiti ; Humans ; Internal Medicine ; Medical Assistance ; Palatine Tonsil ; Pediatrics ; Skin ; Stomach Ulcer ; Tonsillitis ; Water Pollution

Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.
Acute Coronary Syndrome ; Cardiomyopathies ; Hemodynamics ; Hospital Mortality ; Influenza, Human ; Pandemics ; Pneumonia, Viral ; Public Health ; Swine

PURPOSE: The rate of second primary lung cancer development for patients with head and neck cancer (HNC) has been noted. The aim of our study was to evaluate the incidence and clinical features of suspected second primary lung cancer that developed in patients with primary HNC. MATERIALS AND METHODS: We conducted a retrospective study of 469 patients who were newly diagnosed with HNC at the Korea University Medical Center between January 2000 and December 2006. RESULTS: A total of 469 patients were included (389 men and 80 women). Eighteen patients (3.8%) had suspected second primary lung cancers. Statistically significant clinical variables for lung cancer development included the origin site for the primary HNC (oro-hypopharynx and larynx) (p=0.048), abnormal chest x-ray findings (p=0.027) and the histological HNC type (squamous cell carcinoma) (p=0.032). When the second primary lung cancers were combined with HNCs, the adjusted overall survival of patients with a second primary lung cancer was 16 months (p<0.001). CONCLUSIONS: Considering the relative risk factors for a second primary lung cancer developing in patients with HNC, advanced diagnostic tools, such as chest CT or PET CT scan, should be applied for the early detection of a second primary lung cancer.
Academic Medical Centers ; Head ; Head and Neck Neoplasms ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Male ; Neoplasms, Second Primary ; Retrospective Studies ; Risk Factors ; Thorax

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that lipoprotein (a) [Lp(a)] plays an important role in atherothrombogenesis and to be associated with an increased risk for cardiovascular disease. SUBJECTS AND METHODS: We evaluated the distribution of Lp (a) and its association with cardiovascular risk factors, by conducting a cross sectional survey of 14,516 apparently healthy Koreans. The study group consisted of 8,007 men and 6,509 women, aged 20 years and over. RESULTS: The mean, medium and 75th percentile Lp (a) levels were 20.1, 13.2 and 23.8 mg/dL, respectively. The distribution of Lp (a) was highly skewed toward a lower level. The Lp (a) level was positively associated with age (p<0.001) and low density lipoprotein (LDL)(p<0.001). The body mass index (BMI)(p=0.006), log (triglyceride)(p<0.001) and alcohol consumption more than 3 times per week (p<0.047) were inversely related to the Lp (a) level. However, no relationship was seen with smoking, gender, exercise, homeostatic model assessment-insulin resistance (HOMA-IR) and high sensitivity C reactive protein (hsCRP). CONCLUSION: The Lp (a) level was positively associated with age and low density lipoprotein (LDL). The body mass index (BMI) and log (triglyceride) were inversely related to the Lp (a) level. However, the association between Lp (a) and cardiovascular disease in the general Korean population should be confirmed via large scale prospective cohort studies.
Alcohol Drinking ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Lipoprotein(a)* ; Lipoproteins ; Male ; Risk Factors* ; Smoke ; Smoking

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.
Adenosine Diphosphate Ribose ; Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Humans ; Ovarian Neoplasms* ; Paclitaxel ; Celecoxib

A premenarcheal 10-year-old girl visited our clinic due to a rapidly growing and painless mass of the right breast of three months duration. The breast mass was removed using a wide local excision. The pathological findings revealed the tumor was made up of a phyllodes tumor. A phyllodes tumor, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor of the breast, which accounts for 0.3 to 1.0 % of all breast neoplasms. They have a greater degree of stromal cellularity than fibroadenomas, with a characteristic leaf-like projection. These tumors can occur between the ages of 9 to 88 years, but are most common in the third and fourth decades of life; therefore, are uncommon in children. A phyllodes tumor in an adolescent patient was first studied by Amerson, in 1970, at which time he reviewed 355 cases from the American literature, and found a five percent incidence in subjects below 20 years old. Because only a few cases have been reported in the literature; here we report a case of a phyllodes tumor in a 10-year-old girl.
Adolescent ; Breast ; Breast Neoplasms ; Child* ; Female* ; Fibroadenoma ; Humans ; Incidence ; Phyllodes Tumor* ; Young Adult

BACKGROUND: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. METHODS: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandelsigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. RESULTS: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; falls in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. CONCLUSION: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-making in head-injuried patients.
Alcohol Drinking ; Automobiles ; Coma ; Craniocerebral Trauma* ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Head* ; Humans ; Korea ; Medical Records ; Physical Examination ; Pupil ; Retrospective Studies ; Schools, Medical ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting