• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권2호
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• pp.121-131
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• 2020

Purpose: To determine the long-term efficacy of the anti-tumor necrosis factor (TNF) agents, infliximab (IFX) and adalimumab (ADA), in pediatric luminal Crohn's disease (CD) by performing a systematic literature review. Methods: An electronic search was performed in Medline, Embase, and the Cochrane Library from inception to September 26, 2019. Eligible studies were cohort studies with observation periods that exceeded 1 year. Studies that reported time-to-event analyses were included. Events were defined as discontinuation of anti-TNF therapy for secondary loss of response. We extracted the probabilities of continuing anti-TNF therapy 1, 2, and 3 years after initiation. Results: In total, 2,464 papers were screened, 94 were selected for full text review, and 13 studies (11 on IFX, 2 on ADA) met our eligibility criteria for inclusion. After 1 year, 83-97% of patients were still receiving IFX therapy. After 2 and 3 years the probability of continuing IFX therapy decreased to 67-91% and 61-85%, respectively. In total, 5 of the 11 studies subgrouped by concomitant medication consistently showed that the probabilities of continuing IFX therapy in patients with prolonged immunomodulator use were higher than those in patients on IFX monotherapy. Conclusion: This review of real-world evidence studies confirms the long-term therapeutic benefit of IFX therapy in diverse cohorts of children with luminal CD. Moreover, it supports the view that combination therapy with an immunomodulator prolongs the durability of IFX therapy in patients who previously failed to recover following first-line therapy. The limited number of time-to-event studies in patients on ADA prevented us from drawing definite conclusions about its long-term efficacy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.439-446
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• 2020

Purpose: The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. Methods: Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. Results: We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). Conclusion: Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.

• Journal of Preventive Medicine and Public Health
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• 제28권2호
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• pp.386-397
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• 1995

A cross sectional study was performed to evaluate the neurobehavioral effects of chronic exposure of complex organic solvents, using NCTB(Neurobehavioral Core Test Battery) recommended by WHO(World Health Organization). Forty female shoe factory workers and twenty-two controls matched with age were participated. The tests were performed in the morning before start of work, to exclude the effects of acute exposure. Workers were exposed mainly to toluene, methyl ethyl ketone, n-hexane, cyclo-hexane, dichloroethylene, trichloroethylene, benzene, xylenes etc. The ranges of present solvent exposure of hygienic effect were $0.46\sim0.71$ in the process using adhesives indirectly, and $1.83\sim2.39$ in the process using it directly. We reclassified the subjects, according to cumulative exposure. It showed significantly poorer performances in high exposed group on Santa Ana Dexterity and Benton Visual Retention, compared with control group. After controlling confounder, the significances were still remained. But, further cohort studies, having the information of personal exposure dose from entering a factory, are required to clarify the effects of chronic exposure of complex organic solvents in relation to dose and duration of exposure.

• 동의신경정신과학회지
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• 제22권2호
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• pp.27-37
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• 2011

Objectives : The purpose of this research is to investigate the corelationship between Hwa-Byung and type A behavior pattern (TABP), cardiovascular disease. Methods : 637 people participated in the community based cohort study in Wonju City of South Korea from July 2nd to August 30th in 2006. Educated investigators checked up EKG and surveyed Hwa-Byung Diagnostic Interview Schedule(HBDIS), Framingham Type A Pattern Score(FTA score). Collected data were analyzed by the chi-square test & t-test. Results : 1. TABP, Hwa-Byung group was 24(70.6%), non Hwa-Byung group was 288(27.8%) p-value was 0.016. Difference of the two group was valid. 2. FTA score, Hwa-Byung group was $5.77{\pm}2.25$, non Hwa-Byung group was $4.41{\pm}2.30$, p-value was 0.002. Difference of the two group was valid. Conclusions : TABP ratio, FTA score was high in Hwa-Byung group compared with non Hwa-Byung group.

• Journal of Chest Surgery
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• 제46권1호
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• pp.22-26
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• 2013

Background: Constrictive pericarditis after coronary artery bypass surgery has been known to affect cardiac output by limiting diastolic ventricular filling. We aimed to assess the influence of postoperative constrictive physiology on the early outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: Between January 2008 and July 2011, 903 patients underwent an isolated OPCAB and postoperative transthoracic-echocardiography. The patient cohort was classified into two groups: group A, constrictive physiology and group B, control group without constrictive physiology. Early outcomes were analyzed between the two groups. Results: Of the total 903 patients, group A consisted of 153 patients (16.9%). The amount of blood loss in group A during the postoperative 24 hours was greater than that of group B, but this was not statistically significant (p=0.20). No significant differences were found in the mortality rates (group A, 0.6%; group B, 1.4%; p=0.40) and 30-day major adverse cardiac and cerebrovascular events (MACCEs; group A, 3.3%; group B, 6.1%; p=0.42). Conclusion: Postoperative constrictive physiology does not affect 30-day MACCEs or other major complications after OPCAB. The results of this study suggest that patients with early postoperative constrictive physiology do not need medical or surgical treatment, and that conservative care is sufficient.

• Clinical and Experimental Pediatrics
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• 제56권3호
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• pp.130-134
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• 2013

Purpose: Anthracyclines have been utilized in the treatment of children with acute lymphoblastic leukemia (ALL). Recent studies have shown that anthracyclines may induce toxicity in the vascular endothelium. This study was performed using brachial artery reactivity (BAR) to evaluate vascular endothelial function in ALL patients who were treated with anthracycline chemotherapy. Methods: We included 21 children with ALL who received anthracycline chemotherapy and 20 healthy children. The cumulative dose of anthracyclines in the ALL patients was $142.5{\pm}18.2/m^2$. The last anthracycline dose was administered to the patients 2 to 85 months prior to their examination using BAR. The diameter of the brachial artery was measured in both groups using echocardiography, and BAR was calculated as the percentage change in the arterial diameter after release of the cuff relative to the baseline vessel diameter. Results: In the anthracycline-treated group, BAR was observed to be $3.4%{\pm}3.9%$, which was significantly lower than that observed in the control group ($12.1%{\pm}8.0%$, P<0.05). The time elapsed after the last anthracycline treatment and the age at the time of treatment did not affect the change in BAR (P =0.06 and P =0.13, respectively). Conclusion: These results provided evidence that treatment of ALL patients with anthracycline results in endothelial dysfunction. A larger cohort study and a longer follow-up period will be required to clarify the relationship between endothelial dysfunction resulting from anthracycline treatment for childhood ALL and occurrence of cardiovascular diseases later in life.

• Journal of Microbiology and Biotechnology
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• 제28권2호
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• pp.338-346
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• 2018

Two molecular epidemiologic methods, IS6110 restriction fragment length polymorphism (IS6110-RFLP) and 24-locus mycobacterial interspersed repetitive unit-variable-number tandem repeat (MIRU-VNTR), are used worldwide in studies of Mycobacterium tuberculosis (MTB). Conversely, because of its poor resolution, pulsed-field gel electrophoresis (PFGE) is not widely used for MTB. In this study, we improved the 24-locus MIRU-VNTR and PFGE protocols and compared the effectiveness of these approaches for the molecular typing of MTB using 75 clinical isolates obtained from a cohort investigation of high-risk populations infected with MTB. The 24-locus MIRU-VNTR method demonstrated superior discriminatory ability, followed by PFGE and IS6110-RFLP. Next, we analyzed six isolates with clear epidemiologic connections; that is, isolates from patients who attended the same school. IS6110-RFLP and PFGE identified these samples as the same type. By contrast, according to MIRU-VNTR, two isolates differed from four other isolates at one locus each; one isolate was identified as Mtub29 and the other as QUB-26. In summary, the 24-locus MIRU-VNTR assay was the most useful molecular typing method among the three methods investigated due to its discriminatory power, short time required, and availability as an epidemiologic investigation tool. PFGE was the second-best method. Compared with the other loci assessed in the 24-locus MIRU-VNTR assay, the Mtub29 and QUB-26 loci appeared to exhibit greater variability during transmission.

• 한국정보과학회논문지:컴퓨팅의 실제 및 레터
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• 제15권12호
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• pp.928-932
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• 2009

생체 내에서 질병 발생은 다양한 요인들의 복합적인 작용에 의해 발생한다. 하지만, 대부분의 질병 관련 원인을 발견하고자하는 연구들에서는 여러 요인들의 다양한 조합들을 복합적으로 고려하여 분석하기에는 한계가 있는 경우가 많다. 단 하나의 질병 관련 요인들을 찾는 것데 그치고 있다. 본 연구에서는 유전체 정보과 임상 정보를 이용하여 질병 분류 모델 기반 인자 조합들의 진화적 학습 방법을 제안한다. 이 방법을 이용하여 본 연구에서는 질병 관련 주요 인자를 찾고, 이를 시각화할 수 있는 시스템을 만드는 것을 목적으로 한다. 본 연구를 통해 정확도 높은 당뇨병 환자군 분류 모델을 만들고, 당뇨병 발생에 중요한 영향을 미치는 인자들의 조합을 찾을 수 있었다. 또한 생뭍학적인 분석을 통해 본 연구에서 찾은 인자들의 조합이 실제로도 당뇨병 발생에 영향을 미치는 인자가 될 수 있음을 확인하고, 특히 각 인자들이 하나씩 존재할 때보다. 조합으로 존재할 경우 당뇨병 발생 가능성이 높아질 수 있음을 확인할 수 있었다.

• Clinical and Experimental Pediatrics
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• 제60권5호
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• pp.145-150
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• 2017

Purpose: The gut microbiota can influence several diseases through immune modulation; however, the exact role of microbes such as Clostridium difficile and the relationship between microbiota colonization and allergic diseases are not well known. This study aimed to determine the relationship between C. difficile colonization and/or infection (CDCI) during infancy and allergic diseases during early childhood. Methods: Infants 1-12 months of age presenting changes in bowel habits for more than 2 weeks were enrolled in this study. After dividing them into 2 groups according to the presence and absence of C. difficile, the risk of allergic disease development during childhood was identified and compared. Results: Sixty-five patients were included in this study; 22 (33.8%) were diagnosed with CDCI. No significant differences were observed in baseline characteristics between the C. difficile-positive and-negative groups except for antibiotic exposure (22.7% vs. 60.5%, P=0.004). Compared to the C. difficile-negative group, the risk of developing at least one allergic disease was higher in the C. difficile-positive group after adjusting other variables (adjusted odds ratios, 5.61; 95% confidence interval, 1.52-20.74; P=0.007). Furthermore, food allergies were more prevalent in the C. difficile-positive group (P=0.03). Conclusion: CDCI during infancy were associated with a higher risk of developing allergic diseases during early childhood. These results suggest that CDCI during infancy might reflect the reduced diversity of the intestinal microbiota, which is associated with an increased risk of allergic sensitization. To identify the underlying mechanism, further investigation and a larger cohort study will be needed.

• Nutrition Research and Practice
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• 제6권1호
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• pp.78-85
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• 2012

Whether the $FTO$ polymorphisms interact with environmental factors has not yet been evaluated in associations with metabolic syndrome (MS) risk. The present study investigated the association of the $FTO$ rs9939609 genotypes, body mass index (BMI), and lifestyle-related factors including smoking, alcohol drinking, physical activity, and diet with MS incidence. A population-based prospective cohort study comprised 3,504 male and female Koreans aged 40 to 69 years. At the beginning of the study, all individuals were free of MS and known cardiovascular disease. Incident cases of MS were identified by biennial health examinations during a follow-up period from April 17, 2003 to April 15, 2009. Pooled logistic regression analysis was applied to obtain relative odds (RO) of MS with its 95% confidence interval (CI). After controlling for potential MS risk factors, we observed no association between the rs9939609 genotypes and MS incidence. In analysis stratified by BMI, however, carriers with the $FTO$ risk allele whose BMI is $29kg/m^2$ or greater showed an approximately 6-fold higher RO (95% CI: 3.82 to 9.30) compared with non-carriers with BMI less than $25kg/m^2$. In particular, the association between the rs9939609 variants and MS risk was significantly modified by high BMI (P-value for interaction < 0.05). Such significant interaction appeared in associations with central obesity and high blood pressure among the MS components. Because carriers of the $FTO$ risk alleles who had BMI of $29kg/m^2$ or greater are considered a high risk population, we suggest that they may need intensive weight loss regimens to prevent MS development.