Background/Aims: A previous history of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a risk factor for PEP, suggesting that there may be a genetic predisposition to PEP. However, nothing is known about this yet. The aim of this study was to identify genetic variations associated with PEP. Methods: A cohort of high-risk PEP patients was queried from December 2016 to January 2019. For each PEP case, two propensity score-matched controls were selected. Whole exome sequencing was performed using blood samples. Genetic variants reported to be related to pancreatitis were identified. To discover genetic variants that predispose to PEP, a logistic regression analysis with clinical adjustment was performed. Gene-wise analyses were also conducted. Results: Totals of 25 PEP patients and 50 matched controls were enrolled. Among the genetic variants reported to be associated with pancreatitis, only CASR rs1042636 was identified, and it showed no significant difference between the case and control groups. A total of 54,269 non-synonymous variants from 14,313 genes was identified. Logistic regression analysis of these variants showed that the IRF2BP1 rs60158447 GC genotype was significantly associated with the occurrence of PEP (odds ratio 2.248, FDR q value = 0.005). Gene-wise analyses did not show any significant results. Conclusions This study found that the IRF2BP1 gene variant was significantly associated with PEP. This genetic variant is a highly targeted PEP risk factor candidate and can be used for screening high-risk PEP groups before ERCP through future validation. (ClinicalTrials.gov no. NCT02928718)

BACKGROUND/AIMS: To investigate the efficacy and safety of tocilizumab (TCZ) humanized anti-interleukin-6 receptor monoclonal antibody, in Korean patients with active rheumatoid arthritis (RA) refractory to conventional disease modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX) METHODS: The main study was a 24-week, randomized, double-blind, controlled trial that was followed by a 48-week, open-labeled, extension phase. TCZ (8 mg/kg) or placebo was intravenously administered every 4 weeks. RESULTS: Those treated with TCZ showed more favorable outcomes in terms of 20% according to the American College of Rheumatology response criteria (ACR20) and ACR50 responses, individual parameters of ACR core set, disease activity score in 28 joints (DAS28) remission, and European League Against Rheumatism (EULAR) response at week 24. These improvements were maintained or increased during the extension period. DAS28 remission at week 72 was associated with EULAR good response at week 12. The patients who experienced any adverse event (AE) were more frequent in the TCZ group compared to the placebo group. Most AEs were mild or moderate in intensity, although TCZ therapy had possible AEs including serious infection, abnormal liver function, and atherogenic lipid profile. CONCLUSIONS TCZ infusion add-on is highly efficacious and well-tolerated in Korean patients with active RA refractory to conventional DMARDs including MTX. EULAR good response at week 12 could predict DAS28 remission at week 72.

OBJECTIVE: Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. MATERIALS AND METHODS: Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. RESULTS: Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. CONCLUSION: Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.
Aneurysm, Dissecting* ; Angiography, Digital Subtraction ; Diagnosis ; Endovascular Procedures ; Humans ; Prognosis ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery*

PURPOSE: With extended life expectancy, the mean age of patients at the time of diagnosis of colorectal cancer and its treatment, including radical resection, is increasing gradually. We aimed to evaluate the impact of age on postoperative clinical outcomes after a laparoscopic resection of colorectal cancers. METHODS: This is a retrospective review of prospectively collected data. Patients with primary colorectal malignancies or premalignant lesions who underwent laparoscopic colectomies between January 2009 and April 2013 were identified. Patients were divided into 6 groups by age using 70, 75, and 80 years as cutoffs: younger than 70, 70 or older, younger than 75, 75 or older, younger than 80, and 80 or older. Demographics, pathological parameters, and postoperative clinical outcomes, including postoperative morbidity, were compared between the younger and the older age groups. RESULTS: All 578 patients underwent a laparoscopic colorectal resection. The overall postoperative complication rate was 21.1% (n = 122). There were 4 cases of operative mortality (0.7%). Postoperative complication rates were consistently higher in the older groups at all three cutoffs; however, only the comparison with a cutoff at 80 years showed a statistically significant difference between the younger and the older groups. CONCLUSION: Age over 80 is a possible risk factor for postoperative morbidity after a laparoscopic resection of colorectal cancer.
Colectomy ; Colonic Neoplasms ; Colorectal Neoplasms* ; Demography ; Diagnosis ; Humans ; Laparoscopy ; Life Expectancy ; Mortality ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Risk Factors*

A 21-year-old woman with a history of systemic lupus erythematosus (SLE) was admitted with dyspnea on exertion for a year. A transesophageal echocardiogram showed dilated aortic root with intimal thickening. A positron emission tomography/computed tomography demonstrated increase in glucose hypermetabolic along the walls of the aortic valve, ascending aorta, aortic arch, and aorta, vasculitis was observed. She underwent the Bentall operation due to inflammation at sinus of right coronary cusp. She started high dose glucocorticoid after the operation. Currently she is able to sustain with low dose steroid after gradually tapered. Her symptoms were disappeared, and inflammatory markers decreased to within the normal range. Aortitis and aortic aneurysms are an uncommon manifestation of SLE. Furthermore, almost of lupus patients with medium and large vessel vasculitis are not biopsied or studied histologically. We present first case in Korea that was a 21-year-old woman who diagnosed with lupus aortitis by pathology after aortic valve replacement operation.
Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Valve ; Aortitis* ; Dyspnea ; Electrons ; Female ; Glucose ; Humans ; Inflammation ; Korea ; Lupus Erythematosus, Systemic* ; Pathology ; Reference Values ; Vasculitis ; Young Adult

Sarcoidosis is a systemic inflammatory granulomatous disease affecting multiple organs, including liver, spleen, heart, eyes, and skin. Liver involvement is reported in 11.5% of cases and many studies have reported on the association between hepatitis C virus infection and sarcoidosis. However, the role of hepatitis B virus (HBV) infection as a trigger for sarcoidosis has never been reported. We describe a case of hepatic sarcoidosis in a patient with chronic hepatitis B infection, with a possible link between the two. It is the first case report of a patient with interferon-alpha-naive chronic HBV infection presenting with hepatic sarcoidosis accompanied by portal hypertension and liver cirrhosis.
Heart ; Hepacivirus ; Hepatitis B virus ; Hepatitis B, Chronic* ; Humans ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Sarcoidosis* ; Skin ; Spleen

PURPOSE: To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a community-based, prospective longitudinal cohort study. METHODS: In a suburban area in Korea, 1,514 subjects aged > or =45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of > or =8 points during the 3-year follow-up period. RESULTS: LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of > or =50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration. CONCLUSIONS: The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration.
Aged ; Cohort Studies* ; Diet ; Dietary Proteins ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Korea ; Lower Urinary Tract Symptoms* ; Male ; Motor Activity* ; Prevalence ; Prospective Studies* ; Prostate ; Risk Factors ; Smoke* ; Smoking* ; Ultrasonography

PURPOSE: This study was conducted to establish the production conditions through optimization of the production process of beverages using Aspergillus oryzae CF1001, and to analyze volatile compounds and antidiabetic activity. METHODS: The optimum condition was selected using the response surface methodology (RSM), through a regression analysis with the following independent variables gelatinization temperature (GT, X1), saccharogenic time (ST, X2), and dependent variable; DeltaE value (y). The condition with the lowest DeltaE value occurred with combined 45 min ST and 50degrees C GT. The volatile compounds were analyzed quantitatively by GC-MS. RESULTS: Assessment of antidiabetic activity of saccharogenic mixed grain beverage (SMGB) was determined by measurement of alpha-glucosidase inhibition activity, and glucose uptake activity and glucose metabolic protein expression by reverse transcriptase polymerase chain reaction (RT-PCR) and western blot analysis. Results of volatile compounds analysis, 62 kinds of volatile compounds were detected in SMGB. Palmitic acid (9.534% ratio), benzaldehyde (8.948% ratio), benzyl ethyl ether (8.792% ratio), ethyl alcohol (8.35% ratio), and 2-amyl furan (4.826% ratio) were abundant in SMGB. We confirmed that alpha-glucosidase inhibition activity, glucose uptake activity, and glucose-metabolic proteins were upregulated by SMGB treatment with concentration dependent manner. CONCLUSION: Saccharogenic mixed grain beverage (SMGB) showed potential antidiabetic activity. Further studies will be needed in order to improve the taste and functionality of SMGB.
alpha-Glucosidases ; Aspergillus oryzae ; Beverages* ; Blotting, Western ; Edible Grain* ; Ethanol ; Ether ; Gelatin ; Glucose ; Palmitic Acid ; Reverse Transcriptase Polymerase Chain Reaction

PURPOSE: Conventional laparoscopic appendectomy is performed using three ports, and single-port appendectomy is an attractive alternative in order to improve cosmesis. The aim of this study was to compare pain after transumbilical single-port laparoscopic appendectomy (SA) with pain after conventional three-port laparoscopic appendectomy (TA). METHODS: From April to September 2011, 50 consecutive patients underwent laparoscopic appendectomy for simple appendicitis without gangrene or perforation. Patients who had undergone appendectomy with a drainage procedure were excluded. The type of surgery was chosen based on patient preference after written informed consent was obtained. The primary endpoint was postoperative pain evaluated by the visual analogue scale score and postoperative analgesic use. Operative time, recovery of bowel function, and length of hospital stay were secondary outcome measures. RESULTS: SA using a SILS port (Covidien) was performed in 17 patients. The other 33 patients underwent TA. Pain scores in the 24 hours after surgery were higher in patients who underwent SA (P = 0.009). The change in postoperative pain score over time was significantly different between the two groups (P = 0.021). SA patients received more total doses of analgesics (nonsteroidal anti-inflammatory drugs) in the 24 hours following surgery, but the difference was not statistically significant. The median operative time was longer for SA (P < 0.001). CONCLUSION: Laparoscopic surgeons should be concerned about longer operation times and higher immediate postoperative pain scores in patients who undergo SA.
Analgesics ; Appendectomy ; Appendicitis ; Drainage ; Gangrene ; Humans ; Informed Consent ; Laparoscopy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Patient Preference

BACKGROUND/AIMS: Radiofrequency ablation (RFA) has been mostly used as a therapeutic alternative to hepatic resection for treating liver metastasis of colorectal cancer. The purpose of the present study was to determine whether there were differences in outcome between RFA and surgical resection in the treatment of colorectal cancer with liver metastases. METHODS: We performed a retrospective analysis of 53 patients who underwent only hepatic resection or only RFA for colorectal liver metastases. Twenty-five patients who underwent hepatic resection were compared with 28 patients who underwent RFA for synchronous or metachronous liver metastases. RESULTS: The median CEA level at the time of diagnosis of liver metastases was significantly higher in the resection group (14.2 ng/mL vs. 2.8 ng/mL, p=0.002). The median size of main liver metastases was significantly larger in the resection group (4.0 cm vs. 2.05 cm, p=0.002). There was no difference in the percentage of patients experiencing major complication (one patient in each group). The marginal recurrence rate was significantly higher in the RFA group (p=0.004). Disease-free and overall survival were longer in the resection group (p=0.008 and 0.017, respectively). In multivariate analysis, only the type of treatment was a factor associated with disease-free and overall survival (p=0.004 and 0.007, respectively). CONCLUSIONS: Because of the high marginal recurrence rate, RFA shows an inferior outcome in comparison with surgical resection. Therefore, RFA should be considered for only selected patients with unresectable (by any means) disease or with high operative risk.
Adult ; Aged ; Aged, 80 and over ; *Catheter Ablation ; Colorectal Neoplasms/*pathology ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/mortality/secondary/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Retrospective Studies ; Survival Analysis ; Tomography, X-Ray Computed