BACKGROUND/AIMS: Because there is a lack of effective biomarkers, we aimed to discover proteomic candidate markers for hepatocellular carcinoma (HCC) in cirrhotic patients at the highest-risk of HCC, and to validate the markers. METHODS: We collected tumor tissue from 5 cirrhotics with HCC, and from 5 cirrhotics without HCC, who underwent liver resection or transplantation. These tissue samples were analyzed by 2-dimensional difference gel electrophoresis coupled with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and potential markers were validated at the transcriptional and translational levels. We also performed western blot assays using other blood samples from 10 cirrhotics with HCC and 10 without HCC. RESULTS: Among the 66 distinguishable spots on 2-D gel images, we identified 15 proteins overexpressed more than 1.5 fold in terms of volume ratio in the tumors. Ten of the over-expressed proteins were identified by MALDI-TOF MS; of those, only methionine adenosyltransferase 1 (MAT1), a protein specific for liver, and acyl-CoA dehydrogenase were significantly up-regulated in tumors in further immunoblotting analyses (Ps<0.05). There was no between-pair difference in MAT1 mRNA measured by real-time polymerase chain reaction (P=0.96). However, in western blots of serum samples, distinct MAT1 bands were observed in all 10 HCC patients, but in only 2 of the non-HCC patients. CONCLUSIONS: MAT1 is a potential marker for surveillance in cirrhotic patients with and without prior HCC.
Acyl-CoA Dehydrogenase ; Biomarkers ; Blotting, Western ; Carcinoma, Hepatocellular ; Humans ; Immunoblotting ; Liver ; Liver Cirrhosis ; Mass Spectrometry ; Methionine Adenosyltransferase ; Methionine ; Proteomics ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Two-Dimensional Difference Gel Electrophoresis

PURPOSE: Gastric emptying may influence the quality of life of patients who undergo distal gastrectomy. Little is known, however, about gastric emptying after distal gastrectomy. The aim of our study was to investigate gastric emptying patterns after distal gastrectomy. METHODS: This gastric-emptying study investigated patients who underwent distal gastrectomy in the 6 months or more before May 2008 to July 2013 at Chungbuk National University Hospital with a study sample of 205 patients. We analyzed patterns of gastric emptying. RESULTS: Delayed gastric emptying was found in 109 of the 205 patients (53.2%). Food stasis was more frequent in a group with delayed gastric emptying. In multivariate analysis, risk factors for gastroparesis were laparoscopic operation (hazard ratio [HR], 2.731; P = 0.008) and duration of less than 24 months after distal gastrectomy (HR, 2.795; P = 0.001). Delayed gastric emptying tended to decrease with duration of the postoperative period. CONCLUSION: Delayed gastric emptying is common in distal gastrectomy, and is related to laparoscopic operation and duration of the postoperative period. Food stasis was more frequent in a group with delayed gastric emptying.
Chungcheongbuk-do ; Gastrectomy* ; Gastric Emptying* ; Gastroparesis ; Humans ; Multivariate Analysis ; Postoperative Period ; Quality of Life ; Risk Factors ; Stomach Neoplasms

PURPOSE: Gastric emptying may influence the quality of life of patients who undergo distal gastrectomy. Little is known, however, about gastric emptying after distal gastrectomy. The aim of our study was to investigate gastric emptying patterns after distal gastrectomy. METHODS: This gastric-emptying study investigated patients who underwent distal gastrectomy in the 6 months or more before May 2008 to July 2013 at Chungbuk National University Hospital with a study sample of 205 patients. We analyzed patterns of gastric emptying. RESULTS: Delayed gastric emptying was found in 109 of the 205 patients (53.2%). Food stasis was more frequent in a group with delayed gastric emptying. In multivariate analysis, risk factors for gastroparesis were laparoscopic operation (hazard ratio [HR], 2.731; P = 0.008) and duration of less than 24 months after distal gastrectomy (HR, 2.795; P = 0.001). Delayed gastric emptying tended to decrease with duration of the postoperative period. CONCLUSION: Delayed gastric emptying is common in distal gastrectomy, and is related to laparoscopic operation and duration of the postoperative period. Food stasis was more frequent in a group with delayed gastric emptying.
Chungcheongbuk-do ; Gastrectomy* ; Gastric Emptying* ; Gastroparesis ; Humans ; Multivariate Analysis ; Postoperative Period ; Quality of Life ; Risk Factors ; Stomach Neoplasms

BACKGROUND: Arterial hypertension is one of the major factors for progression to end stage renal disease (ESRD) in chronic kidney disease (CKD). Pulse pressure, which stands for arterial stiffness, is a well known risk factor for cardiovascular disease, especially in old patients. A few reports showed that increased arterial stiffness is associated with decreased glomerular filtration rate (GFR). The aim of this study is to investigate the effects of pulse pressure on renal outcome in CKD patients. METHODS: Total 153 patients were included who visited our institution for the first time between January 2000 and December 2000. Patients' medical records were reviewed retrospectively. CKD was defined as GFR by MDRD equation less than 60 mL/ min/1.73 m2. Patients with CKD 5 were excluded. The primary end point of this study for progression of renal disease was doubling serum creatinine. RESULTS: On multivariate analysis based on baseline clinical and laboratory data, pulse pressure was an independent risk factor for progression of CKD. Antihypertensive treatment for 1 year (since the first visit) decreased both systolic and diastolic blood pressure (BP) significantly, and pulse pressure as well. At the end of follow up of 3.7 years (mean), while systolic BP tended to increase slightly, diastolic BP was persistently decreased. Consequently, pulse pressure was further widened compared to that of 1 year. Pulse pressure was positively correlated with age, fasting glucose, and calcium phosphorus product (CPP) whereas it was negatively correlated with hemoglobin and GFR. CONCLUSION: This study shows that pulse pressure is a good predictor for renal outcome in CKD. Besides age and hypertension, anemia, fasting glucose, CPP and uremia can adversely affect pulse pressure in CKD. Therefore, BP control and correction of those factors are recommended to attenuate the progression of CKD.
Anemia ; Blood Pressure* ; Calcium ; Cardiovascular Diseases ; Creatinine ; Fasting ; Follow-Up Studies ; Glomerular Filtration Rate ; Glucose ; Humans ; Hypertension ; Kidney Failure, Chronic ; Medical Records ; Multivariate Analysis ; Phosphorus ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Risk Factors ; Uremia ; Vascular Stiffness

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

BACKGROUND: Primary focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome in adult. Although primary FSGS has been known to be refractory to treatment, recent studies reveal higher remission rate and better prognosis. And it has been reported that some clinical and histopathologic parameters are significant to prognosis. But, confirmative prognostic indices remain to be defined. In order to further clarify the prognostic factors for therapeutic response and risk factors for progression to chronic renal failure (CRF), we reviewed the medical records of primary adult FSGS patients. METHODS: Forty-adult patients diagnosed as primary FSGS between 1991 to 2002 were enrolled. We retrospectively analyzed the clinical and histopathological parameters of all patinents at the time of renal biopsy. In addition, the therapeutic responses to immunosuppressants and the renal survival were analyzed. RESULTS: At the time of renal biopsy, 26 patients (65%) had proteinuria of the nephrotic range and 14 patients (35%) had proteinuria of the non-nephrotic range. The serum creatinine level was higher in nephrotic-ranged patients than that in non nephrotic-ranged patients (p<0.05). The other parameters were not significantly different between two groups. Twenty-seven patients were treated with immunosuppressants and 15 patients (55.6%) responded to the treatment. There was no significant difference in clinical or histopathological variables between the responders and the non-responders. High serum creatinine level at diagnosis and responsiveness to treatment appeared to be significant as risk factors for progression to CRF (p<0.05). The patients treated with immunosuppressants had longer survival period, compared with those without treatment. And the responders had significantly longer survival period compared with the non-responders (p<0.05). CONCLUSION: The patients with initial impairment of renal function or poor response to therapy may have worse prognosis, and the intense treatment with regular follow-up of renal function should be recommended for these patients.
Adult* ; Biopsy ; Creatinine ; Diagnosis ; Follow-Up Studies ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Medical Records ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Retrospective Studies ; Risk Factors

Cornified envelope is highly insoluble structure formed beneath the plasma membrane during terminal differentiation of keratinocytes and is stabilized by cross linking of various proteins, including involucrin, loricrin, and cornifin. Psoriasis is a chronic skin disease characterizing inflammatory reaction and hyperproliferation of keratinocyte. There are some differences in involucrin immunolabelling in stratum corneum between normal and psoriasis epidermis. Labelling was convergent to cornified envelope in psoriasis skin but throughout cytoplasm in normal skin. To compare terminal differentiation patterns of normal and psoriasis keratinocytes, we reconstructed normal and psoriatic artificial skin by using primary cultured keratinocytes from normal and psoriasis skin and then performed immunogold labelling for involucrin in stratum corneum. Psoriatic artificial skin had thin and poorly organized corneal layer. Immunogold labelling for involucrin revealed same pattern of that in vivo by showing throughout cytoplasm in lower layer but convergent cornified envelope in upper layer. Compared with psoriatic artificial skin, normal artificial skin had well organized and thick stratum corneum. Involucrin labelling was throughout cytoplasm in most of corneal layer but convergent to cornified envelope in some uppermost cells. Even though some cells show convergent pattern in normal artificial skin, absolute number of this pattern was no lesser than in artificial psoriatic skin because of normal artificial skin had thick stratum corneum. This result showed there was no difference in involucrin distribution in terminal differentiation of normal and psoriasis keratinocytes in organotypic culture model. It is concluded that although well organized multiple corneal layers are formed in normal artificial skin, they can not reach to full maturation of cornified envelope, and difference of involucrin localization in cornified envelope of psoriasis epidermis is related with not peculiarities of the cells but rapid growing in vivo.
Cell Membrane ; Cytoplasm ; Epidermis ; Keratinocytes ; Psoriasis ; Skin ; Skin Diseases ; Skin, Artificial*

PURPOSE: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer. MATERIALS AND METHODS: From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery received preoperative CRCT. Thirty-seven patients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4~6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients. RESULTS: The compliance to the current preoperative CRCT protocol was excellent, where 92.5% (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9%), while resection was abandoned during laparotomy in two patients (5.7%). Gross complete resection was performed in 30 patients, gross incomplete resection was performed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5% (15/33), and the complete resection rate with the negative resection margin 78.8% (26/33). During the CRCT course, grade 3~4 neutropenia developed in four patients (10.8%). Local recurrence after surgical resection developed in 12.1% (4/33), and distant metastases after the preoperative CRCT start developed in 21.6% (8/37). The overall 3-years survival rate was 87%. CONCLUSION: Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.
Compliance ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Laparotomy ; Leucovorin ; Liver ; Lung ; Neoplasm Metastasis ; Neutropenia ; Pelvis ; Prone Position ; Rectal Neoplasms* ; Recurrence ; Survival Rate

BACKGROUND: Continuous ambulatory peritoneal dialysis(CAPD) patients with low albumin(LA) and signs of inflammation reflected by increased C-reactive protein(CRP) level have an increased mortality, but the mechanism of this phenomenon is not clear yet. METHODS: To answer whether LA and inflammation also enhance cardiovascular risk in CAPD patients, we performed cross sectional study measuring carotid artery intima-media thickness(IMT), calculated intima-media area(cIM area) and the presence of plaque by high-resolution B-mode ultrasonography in 93 non-diabetic CAPD patients. RESULTS: Patients with coronary artery disease (CAD, n=8) had significantly increased IMT(0.79+/-0.21 mm vs. 0.60+/-0.11 mm, p < 0.05) and higher prevalence of carotid plaques(75.0% vs. 63.5%) compared to the non-CAD patients. Significant inverse correlation was observed between serum albumin (SA) level and cIM area(r=-0.27, p < 0.05). Those patients with LA(SA <3.5 g/dL) had significantly increased IMT compared to non-LA patients(0.67+/-0.15 mm vs 0.61+/-0.12 mm, p < 0.05). Prevalence of carotid plaques was also significantly higher in LA patients (68.0% vs. 55.8%, p < 0.05). CRP level revealed a significant positive correlation with cIM area(r=0.21, p < 0.05). Patients with high CRP(>or=0.8 mg/dL, n=18) had higher prevalence of carotid plaques (65.8% vs. 50.0%, p < 0.05) compared to those patients with CRP <0.8 mg/dL, but IMT and cIMT area were not different. By multivariate logistic regression analysis, old age, high CRP, history of CAD and low SA were the independent risk factors affecting IMT. CONCLUSION: Our study strongly suggests that low albumin and chronic inflammatory state of CAPD patients could be associated with increasing atherosclerotic cardiovascular disease.
Atherosclerosis ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Arteries* ; Coronary Artery Disease ; Humans ; Inflammation ; Logistic Models ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence ; Risk Factors ; Serum Albumin ; Ultrasonography*

BACKGROUND: We evaluated the clinical efficacy and safety of recombinant human erythropoietin(Epokine(R)). METHODS: A comparative prospective study of intravenously and subcutaneously administrated Epokine(R) conducted 13 patients performing hemodialysis and 28 patients performing continuous ambulatory peritoneal dialysis with end-stage renal disease. Epokine(R) was given initially at a dosage of 100 unit/kg, subcutaneously, two times a week. The patients had achieved stable or more than 10 g/dL of hemoglobin level for 12 weeks and then we randomized switching intravenously or subcutaneously administrated Epokine(R) for another 12 weeks. RESULTS: Hemoglobin(g/dL) and hematocrit(%) increased significantly from baseline levels beginning from 2 weeks after Epokine(R) administration. In HD patients, hemoglobin increased significantly from 7.3 to 9.5 after 12 weeks and to 10.6 after 24 weeks. In CAPD patients, hemoglobin increased significantly from 6.8 to 10.2 after 12 weeks and then 10.8 after 24 weeks(p < 0.05). Corrected reticulocyte count(%) was significantly increased from baseline levels beginning from 1 week after Epokine(R) administration and continuously increased during study period in both group. Serum ferritin and serum iron decreased significantly and total iron binding capacity increased significantly after 2 weeks. At 12 weeks, HD patients were significantly needed more dosage of Epokine(R) than CAPD patients(142.2+/-20.5 vs 117.3+/-33.6 U/kg/wk, p < 0.001), but at 24 weeks, the dosage was not different(123.6+/-41.5 vs 99.2+/-49.3 U/kg/wk, p > 0.05). In HD patients, intravenously administrated Epokine(R) group was more dosage than subcutaneously group(97.4+/-15.4 vs 145.4+/-2.9 U/kg/wk, p < 0.002), but CAPD patients were not different by administration method(93.0+/-60.2 vs 105.4+/-9.7 U/kg/ wk, p > 0.05). The 9 cases(18.8%) were suffered from headache and flu-like syndrome, but these side effects were not severe and disappeared from conventional therapy. CONCLUSION: Epokine(R) administration is safe and effective in treating anemia of ESRD patients and subcutaneously administration is significantly more effective than intravenously.
Anemia ; Ferritins ; Headache ; Humans* ; Injections, Intravenous ; Injections, Subcutaneous ; Iron ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory ; Prospective Studies* ; Renal Dialysis ; Reticulocytes