BACKGROUND: Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS: A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m² or proteinuria as at least grade 2+ of urine protein. RESULTS: HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m² (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m² along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m². CONCLUSION: Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m² and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
Anemia ; Antigens, Surface ; Bilirubin ; Case-Control Studies* ; Female ; Glomerular Filtration Rate ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Male ; Multivariate Analysis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic*

The aim of this study was to develop guidelines for the prevention and management of particulate matter (PM)/Asian dust particle (ADP)-induced adverse effects in patients with pulmonary diseases. The guideline development committee reviewed the literature on particulate matter, ADP, and pulmonary diseases. In adults, exposure to particulate matter with a diameter of 10 microm or less (PM10) induces a decline in lung function. PM exposure confers an increased risk of lung cancer, and PM10 is associated with increased hospital admission and mortality due to chronic obstructive pulmonary disease. ADP exposure is associated with increased hospital admission and emergency room visits due to chronic obstractive pulmonary disease exacerbation. Idiopathic pulmonary fibrosis exacerbation may also be induced by pollution, although the evidence for this is very weak. There is no published study on the proper prevention or management of the exacerbation of pulmonary diseases due to PM or ADP exposure. The preventive use of a facial mask with a filter in patients with pulmonary disease should be considered carefully because there have been no clinical study of the efficacy and adverse effects of masks in pulmonary diseases. The committee created guidelines based on a discussion of the peer-reviewed literature. The proper management of PM- and ADP-induced exacerbation of pulmonary disease and the efficacy of facial mask use should be evaluated in future studies.
Adenosine Diphosphate ; Adult ; Air Pollution ; Dust* ; Emergency Service, Hospital ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases* ; Lung Neoplasms ; Masks ; Mortality ; Particulate Matter ; Pulmonary Disease, Chronic Obstructive

In this study, we investigated the effect of methanolic extract isolated from the root of Lycoris aurea (LA) on the growth of cancer cells and the tube formation activity of endothelial cells. Various cancer cells were treated with LA at doses of 0.3, 1, 3, 10 or 30 microg/ml and LA significantly suppressed the growth of several cancer cell lines, including ACHN, HCT-15, K-562, MCF-7, PC-3 and SK-OV-3, in a dose-dependent manner. We also found that LA induced cell cycle arrest at G2/M phase in ACHN renal cell adenocarcinoma cells. Further study demonstrated that LA concentration-dependently inhibited the tube formation, which is a widely used in vitro model of reorganization stage of angiogenesis, in human umbilical vein endothelial cells. Collectively, these results show that LA inhibits the growth of cancer cells and tube formation of endothelial cells and the growth-inhibitory effect of LA might be mediated, at least in part, by blocking cell cycle progression.
Carcinoma, Renal Cell ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line ; Endothelial Cells ; Human Umbilical Vein Endothelial Cells ; Lycoris ; Methanol

BACKGROUND: The release of interferon-gamma (IFN-gamma) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-gamma release assays from pleural fluid for the diagnosis in tuberculous pleurisy. METHODS: We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden. RESULTS: Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-gamma secreting T cells and the concentration of IFN-gamma were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-gamma producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood. CONCLUSION: These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-gamma release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.
Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Mycobacterium tuberculosis ; Pleural Effusion ; Prevalence ; Prospective Studies ; Republic of Korea ; ROC Curve ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pleural

PURPOSE: To identify the clinical features and outcomes of endogenous endophthalmitis in Korea. MATERIALS AND METHODS: We reviewed 18 patients with endogenous endophthalmitis at 2 Korean hospitals, treated over a 14 year period between January 1993 and December 2006. RESULTS: The comorbidities observed in these cases were diabetes mellitus and liver cirrhosis. The most common pathogens, which were found in 7 patients each (38.9%), were Klebsiella pneumonia and Pseudomonas aeruginosa. All patients were treated with systemic antibiotics and fortified topical antibiotics. A surgical approach including vitrectomy was performed in 9 cases (50.0%). The prognosis was generally poor, and visual acuity improved slightly in 6 patients (33.3%). CONCLUSION: In this study, diabetes mellitus and Klebsiella pneumonia showed a close relationship with endogenous endophthalmitis, respectively. Endogenous endophthalmitis is a serious risk to sight and careful attention to establishing the diagnosis and management may decrease the ocular morbidity.
Aged ; Diabetes Complications/*epidemiology/microbiology ; Endophthalmitis/complications/*epidemiology/microbiology ; Female ; Humans ; Incidence ; Klebsiella pneumoniae/isolation & purification ; Liver Cirrhosis/*complications/epidemiology/microbiology ; Male ; Middle Aged ; Pseudomonas aeruginosa/isolation & purification ; Republic of Korea/epidemiology ; Retrospective Studies

Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.
Adult ; Bilirubin/*blood ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/*blood/complications ; Humans ; Hypertension/complications ; Incidence ; Kidney Failure, Chronic/*blood/complications ; Male ; Middle Aged ; Risk ; Risk Factors ; Treatment Outcome

PURPOSE: Hypertension (HT) has been known to play an important role in progression of chronic kidney disease (CKD). However, limited data are available in Korean HT patients. We evaluated the prevalence of CKD and the predictors of decrease in kidney function (DKF) in HT patients. METHODS: We retrospectively analyzed the medical records of outpatients with HT in Bundang Seoul National University hospital. DKF was defined as annual loss of estimated glomerular filtration rate (eGFR) more than 7% of baseline eGFR. RESULTS: The prevalence of CKD was 51% in 981 total participants. In HT patients without CKD (NCKD-HT), the incidence of DKF was 46.2%. The incidence of DKF in HT patients with CKD (CKD- HT) was 40.8%. Age was only baseline risk factor of DKF in NCKD-HT group. In multifactorial analysis, history of diabetes mellitus (odds ratio [OR], 2.99; 95% Confidence Interval [CI], 1.88+/-4.78), hemoglobin levels (OR, 0.86; 95% CI, 0.76+/-0.98), proteinuria (OR, 1.86; 95% CI, 1.16+/-2.98), and hematuria (OR, 1.62; 95% CI, 1.02+/-2.58) were related to DKF in CKD-HT group. CONCLUSION: We suggest that the prevalence of CKD in HT patients is high and DKF is frequent in both NCKD-HT and CKD-HT groups. The pattern of the predictors of DKF shows the difference between the two groups. Especially diabetes, abnormal urinalysis, and anemia are strongly associated with DKF in CKD-HT group.
Anemia ; Diabetes Mellitus ; Glomerular Filtration Rate ; Hematuria ; Hemoglobins ; Humans ; Hypertension ; Incidence ; Kidney ; Medical Records ; Outpatients ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Urinalysis

Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan's cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD.
Biopsy ; Cyclophosphamide ; Erdheim-Chester Disease ; Femur ; Hip ; Histiocytes ; Histiocytosis ; Humans ; Humerus ; Inflammation ; Magnetic Resonance Spectroscopy ; Middle Aged ; Osteolysis ; Polycythemia Vera ; Prognosis ; Rare Diseases ; Sclerosis ; Shoulder ; Thorax

PURPOSE: To compare prospectively and randomly tension-free vaginal tape(TVT) with transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: One hundred twenty women with SUI were alternately assigned to either the TVT group(n=60) or TVT-O group(n=60). The preoperative evaluation included urodynamic study and a Korean version of the incontinence quality of life questionnaire(I-QoL). At 1-year after operation, surgical outcome, patient I-QoL parameters, long-term complications and uroflowmetry were evaluated in 2 groups. RESULTS: Preoperative patient characteristics including I-QoL and urodynamic study were comparable in the two groups. The rates of cure(86.8% for TVT vs. 86.8% for TVT-O), improvement(6.6% for TVT vs. 8.2% for TVT-O), and failure (6.6% for TVT vs. 5.0% for TVT-O) were similar for the two groups. The I-QoL parameters one year after surgery were improved significantly in both groups(p<0.001) and there was no difference between the two groups(p>0.05). The rates of the patient satisfaction with the procedure were 93.4% in the TVT group versus 95.0% in the TVT-O group(p>0.05). Mean operation time(11.5+/-1.4 min versus 15.2+/-1.8 min, p<0.05) was significantly shorter in the TVT-O than TVT. There were no long-term complications, such as vaginal erosion and prolonged voiding difficulty, in either group. CONCLUSION: TVT-O appears to be equally effective as TVT for the surgical treatment of stress urinary incontinence in women at a 1-year follow-up.
Female* ; Follow-Up Studies* ; Humans ; Patient Satisfaction ; Prospective Studies* ; Quality of Life ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: To prospectively investigated the symptom changes in women with an overactive bladder (OAB) after discontinuation of 3 months of successful treatment with antimuscarinics and the pre-treatment factors that contributed to retreatment. MATERIALS AND METHODS: Sixty-eight women (mean age 51.4 years) with improvement in the symptoms of OAB after 4 weeks of treatment with propiverine hydrochloride (20mg/day) were prospectively enrolled in a protocol consisting of 8 further weeks of medication and a 4-week period of discontinuation. The frequency-volume charts were assessed before treatment, after the 12 weeks of therapy, and 4 weeks the end of the therapy. Changes in the frequencies, nocturia, urgency scores and urge incontinence at 12 and 16 weeks were evaluated. RESULTS: All of the OAB symptoms 4 weeks after discontinuation of medication remained improved compared to those initially recorded, but then deteriorated during further medication. At the baseline, and 12 and 16 weeks, the mean frequencies, nocturia and urgency scores per day were 11.2, 7.3 and 8.3, 1.6, 0.4 and 0.8, and 1.7, 0.6 and 1.2, respectively. The retreatment rate was 35.3%. Patients in the retreatment group were older (58.8 vs. 47.3 years, p<0.001) and had higher initial urgency scores (1.9 vs. 1.6, p=0.034). In an urodynamic study of 23 patients, those without detrusor overactivity (DO) maintained a significantly improved frequency after cessation of mediation, whereas those with DO (60.9%) did not. The retreatment rate was higher in patients with DO, but the difference was not significant. CONCLUSIONS: Three months of antimuscarinic therapy for OAB may not be sufficient. Older patients, or those with severe urgency, may be more likely to return to treatment.
Female ; Humans ; Muscarinic Antagonists ; Negotiating ; Nocturia ; Prospective Studies* ; Retreatment ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics