Chronic kidney disease is a significant health burden worldwide, with increasing incidence. Although several genome- wide association studies (GWAS) have investigated single nucleotide polymorphisms (SNP) associated with kidney trait, most studies were focused on European ancestry. Methods: We utilized clinical and genetic information collected from the Korean Genome and Epidemiology Study (KoGES). Results: More than five million SNPs from 58,406 participants were analyzed. After meta-GWAS, 1,360 loci associated with estimated glomerular filtration rate (eGFR) at a genome-wide significant level (p = 5 × 10–8) were identified. Among them, 399 loci were validated with at least one other biomarker (blood urea nitrogen [BUN] or eGFRcysC) and 149 loci were validated using both markers. Among them, 18 SNPs (nine known ones and nine novel ones) with 20 putative genes were found. The aggregated effect of genes estimated by MAGMA gene analysis showed that these significant genes were enriched in kidney-associated pathways, with the kidney and liver being the most enriched tissues. Conclusion: In this study, we conducted GWAS for more than 50,000 Korean individuals and identified several variants associated with kidney traits, including eGFR, BUN, and eGFRcysC. We also investigated functions of relevant genes using computational methods to define putative causal variants.

PURPOSE: Preoperative chemoradiation therapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer, 15%–30% of patients still progress while being treated with CRT. The aim of this study was to identify as important biomarker of poor response and evaluate the mechanism associated with CRT resistance. METHODS: This study included 60 human colon tumour pre-irradiation specimens. Expressions of epidermal growth factor receptor (EGFR), p53, Krüppel-like factor 5 (KLF5), C-ern, Ki67 were assessed and correlated with tumor regression grades and complete remission. We added in vitro study with biomarker which has been identified as important biomarker of poor response to evaluate the mechanism associated with CRT resistance. RESULTS: Pathologic complete remission (pCR) was achieved by 9 patients (18%). EGFR and KLF5 were significantly associated with pCR (P = 0.048, P = 0.023, respectfully). And multivariate analysis showed high KLF5 intensity was worse factor for pCR (P = 0.012). In vitro study, radiation or chemotherapy therapy stabilized KLF5 protein levels in a time- and dose-depended manner in HCT116 and Caco-2 cells. KLF5 overexpression in HCT116 stable cell line showed significantly better cell viability by increasing cyclinD1 and b-catenin compared to control cells in MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, suggesting that KLF5 mediates cell survival. CONCLUSION: KLF5 was significantly associated with the presence of KRAS mutations, and KLF5 was an independent poor response predictor of CRT in rectal cancer. Our study is pilot study and more research will be needed in the future.
Caco-2 Cells ; Cell Line ; Cell Survival ; Chemoradiotherapy ; Colon ; Drug Therapy ; Humans ; In Vitro Techniques ; Multivariate Analysis ; Pilot Projects ; Polymerase Chain Reaction ; Prognosis ; Receptor, Epidermal Growth Factor ; Rectal Neoplasms

In the original publication, the authors found a mistake in 4th author's name. The 4th author's name Younghee Choi is the correct spell rather than Yong Hee Choi.

BACKGROUND: Suicide is one of the ten largest causes of death in the world. The rate of suicide is recently significantly increasing in Korea and the rate is relatively high, particularly in adolescence. The purpose of this study was to support the establishment of appropriate measures for prevention of suicide through a better recognition of suicide and to investigate the factors that lead to suicide in adolescence with high school students who have large risk factors of suicide due to entrance examination, future courses, etc. METHODS: A questionnaire regarding the factors influencing the impulse of suicide was conducted to 770 high school students in eight high schools in Seoul and local areas between June 1 and July 31, 2005. Suicidal impulses was checked by SSI (scale for suicidal ideation). Depressive mood and internet addiction degrees was evaluated by BDI (Beck's depression inventory) and IAS (internet addiction scale), respectively. RESULTS: The final subjects of the study were 719 (93.3%) high school students among 770 students in eight high schools in Seoul and local areas, excluding 51 (6.6%) students with insufficient response. There were, 362 (50.3%) male students and 357 (49.7%) female students. Among the total 443 (61.6%) of the subjects had a high risk of suicide. The risk was high in subjects whose parents were divorced, who solved their difficulties by themselves, either expressed suicidal ideation to friends or not expressed suicidal ideation, knew an suicidal internet site and had freguent visits to the internet site. And alcohol experience, drug abuse, BDI and IAS were also connected with a high risk of suicide (P<0.05). Marital status of parents, resolution of problems, expression of suicidal ideation, BDI and IAS were independent factors affecting SSI (OR= 3.7, 0.7, 0.8, 2.4, and 1.6, P<0.05) in logistic regression analysis. CONCLUSION: High suicidal risk is associated with complex factors. We have discovered several causes which augment the impulse of suicide in adolescence. They are parent's divorce or separation, an expression of suicidal ideation, depressive mood, and the extent of internet addiction, etc. Therefore in order, to prevent adolescent suicide, a unified personal, family, and social efforts are required.
Adolescent* ; Cause of Death ; Depression ; Divorce ; Female ; Friends ; Humans ; Internet ; Korea ; Logistic Models ; Male ; Marital Status ; Parents ; Risk Factors ; Seoul ; Substance-Related Disorders ; Suicidal Ideation ; Suicide* ; Surveys and Questionnaires

The prognosis of primary hepatocellular carcinoma is very poor, and a curative resection is capable only in few selected patients. Most patients die from tumor recurrence. The rate of intrahepatic recurrence of hepatocellular carcinoma is much higher than extrahepatic recurrence or metastasis. The most common site of extrahepatic metastasis is lung, and followed by lymph nodes, bone and adrenal gland. Common sites of node metastasis are celiac lymph nodes and hepatoduodenal lymph nodes, however paraaortic lymph node metastasis is very rare. Here, we report an experience of solitary paraaortic lymph node metastasis from hepatocellular carcinoma which was misdiagnosed as primary retroperitoneal tumor by preoperative imaging studies.
Adrenal Glands ; Carcinoma, Hepatocellular* ; Humans ; Lung ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Retroperitoneal Neoplasms

Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.
Middle Aged ; Male ; Magnetic Resonance Imaging ; Liver Diseases/*diagnosis/pathology/*surgery ; Liver/pathology/surgery ; Humans ; *Hepatectomy ; Granuloma, Plasma Cell/*diagnosis/pathology/*surgery ; Diagnosis, Differential

BACKGROUND: This study aimed at finding out how much the rate of the JNC-7 guideline was carried out, and assessed the degree of evidence based clinical practice patterns and the validity of the new guideline by comparatively analyzing primary care practice patterns in hypertensive patients. METHODS: A questionnaire regarding the management of hypertension was conducted by mail between May 15 and July 15, 2005, to 1,008 of the Korean Association of Family Medicine listed in the address book. There were 195 respondents with a response rate of 19.4%. RESULTS: Among the total respondents, 91.1% were aware of the new guideline and had received information mainly through training lectures and seminars. They said that the biggest difference between the new guideline from the previous one was the inclusion of prehypertension (62.3%), and 61.1% were using the new term prehypertension in their practice. The most frequency advice given to patients related to lifestyle modification were in the order of smoking cessation (44.8%), exercise (41.7%) and weight reduction (38.0%). Calcium channel blocker was the most commonly used (60.9%) as the first-line agent. When physicians failed to control blood pressure with the first medication in cases of stage 1 hypertension, 67.7% added other agents. In treating stage 2 hypertension, 59.9% started with a single agent and gradually added other agents. CONCLUSIONS: Family physicians in primary care clinics had a good understanding of the JNC-7 guideline. However, the rate at which they applied it in treatment was low. To effectively apply the guideline in actual treatments, aggressive education of practitioners and improvement on medical system and treatment guidelines are needed.
Blood Pressure ; Calcium Channels ; Surveys and Questionnaires ; Education ; Humans ; Hypertension ; Lectures ; Life Style ; Physician's Practice Patterns ; Physicians, Family ; Postal Service ; Prehypertension ; Primary Health Care* ; Smoking Cessation ; Weight Loss

The five-year survival rate of patients after curative resection of hepatocellular carcinoma (HCC) has been reported to be 30 to 50 %, however the actual survival rate may be different. We analyzed the actual 5-year survival rate and prognostic factors after curative resection of HCC. Retrospective analysis was performed on 63 HCC patients who underwent curative resection from 1998 to 1999. A total of 63 cases were reviewed, consisting of 53 men and 10 women, with a median age of 49 years. These cases included all four pathologic T stages (pT stage) and had the following representation: stage 1 (1 case), stage 2 (17 cases), stage 3 (38 cases), and stage 4 (7 cases). In our study, the actual 5-year survival rate was 57.0% and the median survival time was 60 months. In addition, the patients in our study had an actual 5-year disease-free survival rate of 50.2% and a median disease-free survival time of 46 months. Thirty-one patients had recurrences, with a majority occurring within one year (65%). These patients with early recurrences had a poor actual 5-year survival rate of 5%. A univariate analysis showed that the prognostic factors influencing survival rate were the presence of satellite nodules, increased pT stage, HCC recurrence, and the time to recurrence (within one year). Interestingly, microvascular invasion made a difference in survival rate but was not statistically significant (p = 0.08). Furthermore, factors influencing the disease free survival rate include the presence of satellite nodules, microvascular invasion, and pT stage. Multivariate analysis identified pT stage as the only statistically related factor in determining the disease-free survival rate. The most important prognostic factor of HCC is recurrence. Moreover, the major risk factor for recurrence is an advanced pT stage. Therefore, performing prospective studies of postoperative adjuvant therapy is necessary to prevent recurrences after hepatic resection. Furthermore, active preventative treatment and early diagnosis of recurrences should be of the highest priority in the care of high-risk patient groups that have an advanced pT stage.
Survival Rate ; Retrospective Studies ; Middle Aged ; Male ; Liver Neoplasms/*mortality/pathology/*surgery ; Liver/pathology/surgery ; Humans ; *Hepatectomy ; Female ; Carcinoma, Hepatocellular/*mortality/pathology/*surgery ; Aged ; Adult

PURPOSE: The aim of this study was to assess the regeneration rate and functional recovery of the liver due to the stage of parenchymal fibrosis following a hepatectomy. METHODS: We reviewed 41 patients that had undergone a hepatectomy for living liver donation and 35 for an HCC. The HCC patients were classified into three groups according to their histopathological status. The liver volume was serially estimated using CT scans before the operation, and on postoperative days (POD) 7 and 30. The liver function tests for AST, ALT and bilirubin were serially checked before the operation, immediately postoperative, and on POD 1, 3, 5, 7 and 30. RESULTS: There were 61 and 15 males and females, respectively, with a mean age of 40 years. Patients were divided into four subgroups: parenchymal fibrosis, none (normal), periportal, septal and cirrhotic fibrosis. Within all the patients 55, 13 and 8 right lobectomy (RL), left lobectomy (LL) and left lateral segmentectomy (LLS), respectively, were performed. In the RL cases, the regeneration rate (RR) was significantly higher than those in the cases of LL and LLS. The RR of the fibrotic livers was significantly lower than that of normal livers, and became lower as the degree fibrosis increased. The RR at POD #7 was lowest in cirrhotic livers. The levels of Serum AST and ALT rapidly increased on the immediate postoperative day, and increased maximally on POD #1, but thereafter decreased gradually, and recovered to normal on POD #30. The serum bilirubin level reached a maximal value on POD #2, and returned to normal on POD #7. CONCLUSION: The regenerative activity in chronic hepatitis patients is poor, especially in cases of severe fibrosis - cirrhosis. Therefore, in cases of major resection in HCC patients with chronic hepatitis, it is advisable to decide the extent of resection after confirmation of the stage of fibrosis.
Bilirubin ; Female ; Fibrosis* ; Hepatectomy ; Hepatitis, Chronic ; Humans ; Liver Function Tests ; Liver Regeneration ; Liver* ; Male ; Mastectomy, Segmental ; Regeneration ; Tomography, X-Ray Computed

An inflammatory pseudotumor of the liver is a rare benign tumor, which is frequently misdiagnosed as malignant. A 63 year-old man presented with a 4-month history of weight loss and a 2-month history of intermittent fever and chills. A computed tomographic (CT) scan and magnetic resonance imaging of the abdomen demonstrated a large tumor in segment 8 of the liver. An ultrasound-guided core biopsy confirmed an inflammatory pseudotumor of the liver. His fever persisted for 3 months, despite the administration of Naproxen and antibiotics. A right trisegmentectomy was carried out, after which the fever subsided. The patient has remaineds well for the last 7 months.
Abdomen ; Anti-Bacterial Agents ; Biopsy ; Chills ; Fever ; Granuloma, Plasma Cell* ; Humans ; Liver* ; Magnetic Resonance Imaging ; Middle Aged ; Naproxen ; Weight Loss