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*

Tryptophan metabolites regulate a variety of physiological processes, and their downstream metabolites enter the kynurenine pathway. Age-related changes of metabolites and activities of associated enzymes in this pathway are suggestable and would be potential intervention targets. Blood levels of serum tryptophan metabolites in C57BL/6 mice of different ages, ranging from 6 weeks to 10 months, were assessed using high-performance liquid chromatography, and the enzyme activities for each metabolic step were estimated using the ratio of appropriate metabolite levels. Mice were subjected to voluntary chronic aerobic exercise or high-fat diet to assess their ability to rescue age-related alterations in the kynurenine pathway. The ratio of serum kynurenic acid (KYNA) to 3-hydroxylkynurenine (3-HK) decreased with advancing age. Voluntary chronic aerobic exercise and high-fat diet rescued the decreased KYNA/3-HK ratio in the 6-month-old and 8-month-old mice groups. Tryptophan metabolites and their associated enzyme activities were significantly altered during aging, and the KYNA/3-HK ratio was a meaningful indicator of aging. Exercise and high-fat diet could potentially recover the reduction of the KYNA/3-HK ratio in the elderly.
Aged ; Aging ; Animals ; Chromatography, Liquid ; Diet, High-Fat* ; Exercise* ; Humans ; Infant ; Kynurenic Acid ; Kynurenine* ; Mice ; Physiological Processes ; Tryptophan*

PURPOSE: This study was done to investigate the status of disinfection and sterilization in healthcare facilities. METHOD: A survey of 193 Korean healthcare facilities was conducted from February 8 to March 7, 2013. Data were analyzed using descriptive statistics, chi2 test, Fisher's exact test, one-way ANOVA, Scheffe with SPSS WIN 18.0. RESULTS: Of the healthcare facilities 93.2% had specific guidelines for disinfection/sterilization, but only 47.9% had a committee on disinfection/sterilization for decision-making, less than half (42.7%) conducted regular monitoring of actual practices, while 83.9% had established procedures for recovery in case of problems with the disinfection process and 89.0% kept records and archives of disinfection practices. Cleaning process, selection of chemical disinfectants and process of disinfection and sterilization were found to be inadequate in some healthcare facilities. Perception score for adequacy of medical instruments was 8.10, environmental disinfection was 7.20, and sterilizer management was 8.45 out of a possible 10. CONCLUSION: Compared to larger institutions, smaller healthcare facilities had less effective disinfection and sterilization management systems, while some facilities showed inadequate practices for medical equipment and general sterilization. Better academic and state-level support is recommended for smaller facilities in order to establish a better system-wide management system.
Delivery of Health Care* ; Disinfectants ; Disinfection* ; Sterilization*

PURPOSE: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center "1339" (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. METHODS: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency-related physicians at several hospitals on the level of emergency care in Busan. RESULTS: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). CONCLUSION: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.
Community Networks ; Emergencies ; Emergency Medical Services ; Hospital Information Systems ; Humans ; Information Centers ; Negotiating ; Surveys and Questionnaires

The aim of this study was to investigate the effects of Red L. platyphylla (RLP) on calcium and glucose levels during insulin secretion. To achieve this, alteration of insulin and calcium concentrations was measured in rat insulinoma-1 (INS-1) cells and animal models in response to RLP treatment. In INS-1 cells, maximum secretion of insulin was detected upon treatment with 200 microg/mL of RLP for 20 min. Nifedipine, an L-type calcium channel blocker, effectively inhibited insulin secretion from INS-1 cells. Regarding calcium levels, the maximum concentration of intracellular calcium in INS-1 cells was obtained by treatment with 100 microg/mL of RLP, whereas this level was reduced under conditions of 200 microg/mL of RLP. Further, RLP-treated INS-1 cells showed a higher level of intracellular calcium than that of L. platyphylla (LP), Korea White Ginseng (KWG), or Korea Red Ginseng (KRG)-treated cells. This RLP-induced increase in intracellular calcium was abrogated but not completely abolished upon treatment with 40 microM nifedipine in a dose-dependent manner. Furthermore, the insulin level was dramatically elevated upon co-treatment with high concentrations of glucose and RLP, whereas it was maintained at a low level in response to glucose and RLP co-treatment at low concentrations. In an animal experiment, the serum concentration of calcium increased or decreased upon RLP treatment according to glucose level compared to vehicle treatment. Therefore, these results suggest that insulin secretion induced by RLP treatment may be tightly correlated with calcium regulation, which suggests RLP is an excellent candidate for diabetes treatment.
Animal Experimentation ; Animals ; Calcium ; Calcium Channels, L-Type ; European Continental Ancestry Group ; Glucose ; Humans ; Insulin ; Insulinoma ; Korea ; Models, Animal ; Nifedipine ; Panax ; Rats

BACKGROUND/AIMS: Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. METHODS: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. RESULTS: The mean age of the patients was 65.8+/-12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. CONCLUSIONS: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis.
Abdominal Pain ; Arrhythmias, Cardiac ; Atrophy ; Biopsy ; Capillaries ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypertension ; Mucous Membrane ; Necrosis

PURPOSE: Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors. METHODS: A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109). RESULTS: An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects. CONCLUSION: This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.
Bile ; Biology ; Cholecystectomy, Laparoscopic ; Cohort Studies ; Drainage ; Early Diagnosis ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Laparoscopy ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Survival Rate

PURPOSE: Single port laparoscopic cholecystectomy (SPLC) is a new advanced technique in laparoscopic surgery. Many laparoscopic surgeons seek to gain skill in this new technique. However, little data has been accumulated and published formally yet. This article reports the achievement of 100 cases of SPLC with the hopes it will encourage laparoscopic surgery centers in the early adoption of SPLC. METHODS: A retrospective review of 100 prospectively selected cases of SPLC was carried out. All patients had received elective SPLC by a single surgeon in our center from May 2009 to December 2010. Our review suggests patients' character, perioperative data and postoperative outcomes. RESULTS: Forty-two men and 58 women with an average age of 45.8 years had received SPLC. Their mean body mass index (BMI) was 23.85 kg/m2. The mean operating time took 76.75 minutes. However, operating time was decreased according to the increase of experience of SPLC cases. Twenty-one cases were converted to multi-port surgery. BMI, age, previous low abdominal surgical history did not seem to affect conversion to multi-port surgery. No cases were converted to open surgery. Mean duration of hospital stay was 2.18 days. Six patients had experienced complications from which they had recovered after conservative treatment. CONCLUSION: SPLC is a safe and practicable technique. The operating time is moderate and can be reduced with the surgeon's experience. At first, strict criteria was indicated for SPLC, however, with surgical experience, the criteria and area of SPLC can be broadened. SPLC is occupying a greater domain of conventional laparoscopic cholecystectomy.
Achievement ; Adoption ; Body Mass Index ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Prospective Studies ; Retrospective Studies

BACKGROUND: Bile acids were important for the regulation of cholesterol homeostasis. Thyroid hormone increased the expression of CYP7A1 (cholesterol 7alpha-hydroxylase), catalyzing the first step in the biosynthesis of bile acids. However, the effect of thyroid hormone on bile acid export has not been previously assessed. The principal objective of this study is to evaluate the effects of thyroid hormone on the bile salt export pump (BSEP). METHODS: Thyroid hormone, T3 (1 mg/g) was administered to male mice via intraperitoneal injection. After 6 hours and 5 days of T3 treatment, we measured serum total and LDL cholesterol and hepatobiliary bile acid concentrations. We assessed the changes associated with bile acid synthesis and transport. In order to evaluate the direct effect of thyroid hormone, we assessed the changes in the levels of BSEP protein after T3 administration in human hepatoma cells. RESULTS: Serum total and LDL cholesterol were reduced and hepatobiliary bile acid concentrations were increased following T3 treatment. Expressions of Cyp7a1 and BSEP mRNA were increased following T3 treatment. The levels of the BSEP protein in the mouse liver as well as in the human hepatoma cells were increased after T3 treatment. CONCLUSION: Thyroid hormone can regulate LDL cholesterol metabolism. It increases bile acid synthesis and the excretion of bile acids via increased BSEP expression.
Animals ; Bile ; Bile Acids and Salts ; Carcinoma, Hepatocellular ; Cholesterol ; Cholesterol, LDL ; Homeostasis ; Humans ; Injections, Intraperitoneal ; Liver ; Male ; Mice ; Resin Cements ; RNA, Messenger ; Thyroid Gland ; Triiodothyronine

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases