Background/Aims: Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis. Methods: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included. Results: A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31–2.38 and RR, 3.05; 95% CI, 1.70–5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95–1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73–7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease. Conclusions Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.

Background/Aims: Some management strategies for acute colonic diverticulitis remain controversial in Korean real-world practice because their clinical features differ from those in the West. This study aimed to investigate the opinions of Korean physicians regarding the diagnosis and treatment of acute diverticulitis. Methods: A web-based survey was conducted among gastroenterologists specializing on treating lower gastrointestinal disorders. The questionnaires concerned overall management strategies for colonic diverticulitis, including diagnosis, treatment, and follow-up. Results: In total, 209 gastroenterologists responded to the survey. Less than one-fourth of the respondents (23.6%) answered that left-sided colonic diverticulitis is more likely to be complicated than right-sided colonic diverticulitis. Most respondents agreed that immunocompromised patients with diverticulitis have worse clinical outcomes than immunocompetent patients (71.3%). Computed tomography was the most preferred tool for diagnosing diverticulitis (93.9%). Approximately 89% of the respondents answered that they believed antibiotic treatment is necessary to treat acute uncomplicated diverticulitis. Most respondents (92.6%) agreed that emergency surgery is not required for diverticulitis with an abscess or microperforation without panperitonitis. Further, 94.7% of the respondents agreed that colon cancer screening is necessary in patients aged ≥ 50 years with diverticulitis after they have recovered from acute illness. Many respondents (71.4%) agreed that surgery for recurrent diverticulitis should be individualized. Conclusions Opinions regarding management strategies for colonic diverticulitis among Korean gastroenterologists were well agreed upon in some areas but did not agree well in other areas. Evidence-based guidelines that meet the practical needs of the Korean population should be developed.

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

PURPOSE: Although several studies have reported the morphological and electrical characteristics in patients with hypertrophic cardiomyopathy (HCM), comparison between asymmetric and apical HCM has not been investigated in a reasonably sized cohort. MATERIALS AND METHODS: Echocardiography and electrocardiography were quantitatively analyzed in patients with HCM in a Korean tertiary referral center. RESULTS: Of 864 patients (mean age 55.4+/-14.2 years, 68.9% men), 255 (29.5%) patients had apical HCM, 553 (64.0%) patients asymmetric HCM, and 56 (6.4%) patients mixed type HCM. In echocardiographic evaluations, about three quarters of patients (75.8%) had left atrial enlargement. Left ventricular (LV) dilatations and systolic dysfunction were observed in 6.1% and 2.4%, respectively. QRS widening, PR prolongation, and pathologic Q wave are frequent in patients with asymmetric HCM, while LV strain is frequent in patient with apical HCM. The prevalence of J-point elevations (9.4% in inferior, 2.2% in lateral leads) were substantially higher than that in general population. Giant negative T wave was observed in 15.0% of total patients (32.2% in apical, 6.2% in asymmetric, 25% in mixed type). There was no significant correlation between the thickness of the apical wall and the amplitude of T wave inversion (r=-0.005, p=0.71). CONCLUSION: In a large cohort of HCM including apical type, repolarization abnormalities, including early repolarization and QT prolongation as well as LV strain, were significantly observed. T wave inversion was not appropriate for screening of HCM and not correlated with apical wall thickness.
Adult ; Aged ; Cardiomyopathy, Hypertrophic/diagnosis ; Echocardiography/*methods ; Electrocardiography/*methods ; Female ; Heart Rate/*physiology ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology

In this study, we showed the direct interaction between Mycobacterium avium subsp. paratuberculosis fibronectin attachment protein (FAP) and toll-like receptor4 (TLR4) via co-localization and binding by using confocal microscopy and co-immunoprecipitation assays. FAP triggered the expression of pro- and anti-inflammatory cytokines in a TLR4-dependent manner. In addition, FAP-induced cytokine expression in bone marrow-derived dendritic cells (BMDCs) was modulated in part by glycogen synthase kinase-3 (GSK-3). FAP-induced expression of CD80, CD86, major histocompatibility complex (MHC) class I, and MHC class II in TLR4+/+ BMDCs was not observed in TLR4-/- BMDCs. Furthermore, FAP induced DC-mediated CD8+ T cell proliferation and cytotoxic T lymphocyte (CTL) activity, and suppressed tumor growth with DC-based tumor vaccination in EG7 thymoma murine model. Taken together, these results indicate that the TLR4 agonist, FAP, a potential immunoadjuvant for DC-based cancer vaccination, improves the DC-based immune response via the TLR4 signaling pathway.
*Adhesins, Bacterial/genetics/metabolism ; Animals ; CD8-Positive T-Lymphocytes/metabolism ; *Cancer Vaccines/therapeutic use ; Cell Proliferation ; Cytokines/metabolism ; Dendritic Cells/*cytology ; Disease Models, Animal ; Gene Expression Regulation ; Glycogen Synthase Kinase 3/metabolism ; Humans ; Mice ; Mice, Inbred C57BL ; Mycobacterium avium/genetics/metabolism ; Paratuberculosis/metabolism ; Protein Binding ; Signal Transduction ; T-Lymphocytes, Cytotoxic/metabolism ; *Thymoma/genetics/metabolism ; *Toll-Like Receptor 4/agonists/genetics/metabolism

OBJECTIVE: Current guidelines for initiating dialysis therapy are based on level of kidney function and clinical evidence of uremia. In several studies, early dialysis showed no benefit in mortality and complication rate. Thus we examined whether the timing of initiation of dialysis influenced mortality and complication rate with renal failure. METHODS: We retrospectively studied the clinical outcomes in 290 patients with renal failure who underwent dialysis therapy from 2001 to 2009. The early and late dialysis group defined as values more than and less than 10 mL/min/1.73 m2. The primary outcome was death from any cause and the secondary outcome was complication event. RESULTS: The survival rates and complication events were compared based on the estimated glomerular filtration rate, the survival rate in late dialysis group is better than in early dialysis group and the significant prognostic factors determined by multivariate analysis were age and residual renal function at time of initiation of dialysis. No difference in complication events were observed. Subgroup analysis in hemodialysis group shows no significant difference in survival rate. CONCLUSION: The survival rate in late dialysis group is better than in early dialysis group. And the complication rate were not different in two groups.
Dialysis ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Failure, Chronic ; Multivariate Analysis ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Survival Rate ; Uremia

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.
Anti-Bacterial Agents ; Cerebral Infarction ; Consensus ; Dialysis ; Endocarditis ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Renal Dialysis ; Transplantation, Homologous ; Transplants

OBJECTIVE: To investigate the safety of early symptom limited exercise stress test (GXT) performed within 10 days after coronary intervention in acute coronary syndrome patients. METHOD: Forty-six patients with acute coronary syndrome including unstable angina (UA) and acute myocardial infarction (AMI) were recruited. All of them performed GXT within 10 days after coronary intervention and received cardiac rehabilitation for 6 weeks. RESULTS: Mean age of the patients was 57.6+/-9.8 years (unstable angina 26 patients, acute myocardial infarction 23 patients). The number of the patients complained of cardiac events during GXT was 8 (16%); chest pain (3), ischemic changes on electrocardiogram (2) and hemodynamic instability (3). However, none of them showed any major adverse cardiac events such as acute myocardial infarction (AMI). Major cause of termination of GXT was patient's request such as dyspnea, fatigue, and musculoskeletal pain. After early GXT, there was no significant difference between two groups in all variables (p>0.05). CONCLUSION: Early GXT was safe in acute coronary syndrome patients and did not show any significant difference between UA patients and AMI patients.
Acute Coronary Syndrome ; Angina, Unstable ; Chest Pain ; Dyspnea ; Electrocardiography ; Exercise Test ; Fatigue ; Heart ; Hemodynamics ; Humans ; Musculoskeletal Pain ; Myocardial Infarction

The traditional treatment of piriformis syndrome includes heat modality, deep muscle massage, slow stretch exercise, injection of local anesthetics, and surgical division of piriformis muscles in some selected cases. More recently, the use of botulinum toxin (BTX) for the treatment of piriformis syndrome has been suggested. We experienced two cases of piriformis syndrome with distinctive clinical feature. The symptoms of these two cases were not controlled by conservative managements including physical therapy, direct injection of lidocaine or steroid, or caudal block. So we injected Type A BTX in the piriformis muscle with the guidance of CT scan. 8 weeks after the botulinum injection, symptoms had almost completely disappeared, and follow up CT scan showed sufficient atrophy of piriformis muscles. The CT guided BTX injection in the piriformis muscle might emerge as a feasible technique to obtain a good local therapeutic effect without risk of imprecise inoculation.
Anesthetics, Local ; Atrophy ; Botulinum Toxins ; Botulinum Toxins, Type A ; Follow-Up Studies ; Hot Temperature ; Lidocaine ; Massage ; Muscles ; Piriformis Muscle Syndrome

Unilateral renal agenesis associated with genito-urinary disease was found in 2 siblings of a single family. There are a few reports of familial unilateral renal agenesis. Bilateral renal agenesis is a fetal condition and unilateral renal agenesis or hypoplasia is usually asymptomatic, so investigations for renal anomalies have not been frequently undertaken in healthy members of families in which bilateral agenesis has occurred. The present report suggests that unilateral renal agenesis could occur as a manifestation of a genetic disorder.
Humans ; Kidney Diseases ; Siblings*