• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.4
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• pp.318-324
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• 2022

Backgrounds/Aims: Gallstone disease is a recognized complication of bariatric surgery. Subsequent management of choledocholithiasis may be challenging due to altered anatomy which may include Roux-en-Y gastric bypass (RYGB). We conducted a retrospective service evaluation study to assess the safety and efficacy of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in patients with RYGB anatomy. Methods: All the patients who underwent EDGE for endoscopic retrograde cholangiopancreatography after RYGB at two tertiary care centers in the United Kingdom between January 2020 and October 2021 were included in the study. Clinical and demographic details were recorded for all patients. The primary outcome measures were technical and clinical success. Adverse events were recorded. Hot Axios lumen apposing metal stents measuring 20 mm in diameter and 10 mm in length were used in all the patients for creation of a gastro-gastric or gastro-jejunal fistula. Results: A total of 14 patients underwent EDGE during the study period. The majority of the patients were female (85.7%) and the mean age of patients was 65.8 ± 9.8 years. Technical success was achieved in all but one patient at the first attempt (92.8%) and clinical success was achieved in 100% of the patients. Complications arose in 3 patients with 1 patient experiencing persistent fistula and weight gain. Conclusions: In patients with RYGB anatomy, EDGE facilitated biliary access has a high rate of clinical success with an acceptable safety profile. Adverse events are uncommon and can be managed endoscopically.

• Journal of radiological science and technology
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• v.37 no.4
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• pp.287-294
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• 2014

Gallstone is the most common disease of the biliary system. Korean has experienced an increase in the percentage of cholesterol gallstones. The major risk factors associated with cholesterol gallstones are age, gender as well as obesity. This study was designed to determine the prevalence of gallstones in the last three years and evaluate the associated risk factors in the population who underwent health screening. The study population consisted of 2,484 males and 2,212 females who visited the health promotion center in Dalseogu, Daegu in Korea from January 2011 to December 2013. Each participant in the study had their biliary system gallbladder examined using ultrasonography. Classified as underweight, normal weight or overweight using the population of obese according to the body mass index, and classified according to mood diagnosis of diabetes presented by the American Diabetes Association. Fasting blood glucose and number of liver function, the divided the control group by referring to the normal liver function values used herein. The geological map, I was classified as NCEP APT III. A showed of total 148 people were found to have gallstones. The prevalence of sex among 148 patients (3.15%) 84 men (1.79%) and 64 women 1.36%) which shows significantly there is little difference. 1.84% 40 years and below, 3.38% 40's showed age prevalence was 4.66% in 50's and above. In addition, Total-cholesterol was at the most in 52 people, LDL-cholesterol in 398 people, Triglyceride in 36 people, HDL-cholesterol in 19 people. The abnormal group, was created from the total-cholesterol categories from a physical examination of a subject that has been found to be gallstones in the gallbladder. A result of conducting the univariate analysis shows the prevalence of gallstones, a correlation that is meaningful. The logistic regression analysis of multiple ages was chosen to show risk factors age independent cholelithiasis. In spite of the conclusion, gallstones are not displayed in relation to the metabolic syndrome but in order to clarify this, not only the subject of a health examination is needed but, a further study of the general public when possible.

• The Journal of Korean Medical History
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• v.33 no.1
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• pp.31-41
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• 2020

Purpose : This study compares prescriptions in the 1901 edition of the Donguisusebowon (東醫壽世保元) and the 1901 edition of 24 Revised Tae-eum constitution prescriptions (新定太陰人病應用要藥二十四方) (1901PCDT) with medical herbs found in classical texts. This study also examines whether to include patterns which compose medical herbs for the person of Tae-eum constitution (太陰人). Method : The prescriptions for Tae-eum-in in the Shinchukbon and the ingredients of medical herbs of the prescriptions of the Complete Works of Zhang Jingyue (景岳全書), Secret Works of Universal Benefit (廣濟秘笈), Treasured Mirror of Eastern Medicine (東醫寶鑑), Comprised Edition for Formulas (方藥合編), Protecting Essence for Longevity (壽世保元), Introduction to Medicine (醫學入門), New Book for Saving People (濟衆新編 ENGLISH), and Compendium of Local Medicinals and Formulas (鄕藥集成方) were input into a database. The prescriptions were examined and combinations of medical herbs used to treat the person of Tae-eum constitution were noted. Result : Among the prescriptions for the person of Tae-eum constitution, similar examples of the 17 prescriptions of Kudzu Decoction to Relieve the Muscles (葛根解肌湯), Regulate the Stomach and Coordinate the Purity Decoction (調胃升淸湯), Clear the Heart and Lotus Pip Decoction (淸心蓮子湯), Decoction for Stabilizing Asthma with Ephedra (麻黃定喘湯), Profuse Heat and Sparse Cold Decoction (熱多寒少湯), Decoction for Coordinating Qi with Kudzu (葛根承氣湯), Major Decoction for Coordinating Qi with Kudzu (葛根大承氣湯), Minor Decoction for Coordinating Qi with Kudzu (葛根小承氣湯), Decoction for Dispersing the Exterior with Ephedra (麻黃發表湯), Boost the Lung Essence Decoction (補肺元湯), Major Supplementing Decoction with Deer Antler Velvet (鹿茸大補湯), Boosting Black Essence Pill (拱辰黑元丹), Honeylocust Fruit and Rhubarb Decoction (皂角大黃湯), Kudza and Duckweed Decoction (葛根浮萍湯), Sweet Flag and Polygala Powder (石菖蒲遠志散), Liriopis and Polygala Decoction Powder (麥門冬遠志散), and Cattle Gallstone Formula to Clear the Heart (牛黃淸心元) were found in important ancient literature and Dried Chestnut and Holotrichia Decoction (乾栗蠐螬湯) and Dried Chestnut and Tree of Heaven Root Bark Decoction (乾栗樗根皮湯) are the combination originally set by Lee Jema. Conclusion : Because 70.8% of the prescriptions in 1901PCDT could be found in literature which were pervasive in the period of the Joseon Dynasty (the period of Ming and Qing), it corresponds with Lee Jema's view that medical men in the Song, Yuan, and Ming Dynasties disclosed half of the prescriptions for Tae-eum person by studying these texts more.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5557-5563
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• 2015

Background: Cholelithiasis is associated in 54%-98% of patients with carcinoma of the gallbladder, and a high incidence among females suggests a role of female hormones in the etiology of the disease. Cytochrome $P450C17{\alpha}$ (CYP-17) is a key enzyme involved in estrogen metabolism and polymorphisms in CYP-17 are associated with altered serum levels of estrogens. Thus, we investigated whether the CYP-17 MspA1 gene polymorphism might impact on risk of gall bladder cancers or gallstones, as well as to determine if this gene polymorphism might be linked with estrogen serum levels and lipid profile among the North Indian gall bladder cancer or gallstone patients. Materials and Methods: CYP-17 gene polymorphisms (MspA1) were genotyped with PCR-RFLP in cancer patients (n=96), stone patients (n=102), cancer + stone patients (n=52) and age/sex matched control subjects (n= 256). Lipid profile was estimated using a commercial kit and serum estrogen was measured using ELISA. Results: The majority of the patients in all groups were females. The lipid profile and estrogen level were significantly higher among the study as compared to control groups. The frequency of mutant allele A2 of CYP17 MspA1 gene polymorphism was higher among cancer (OR=5.13, 95% CI+3.10-8.51, p=0.0001), stone (OR=5.69, 95%CI=3.46-9.37, p=0.0001) and cancer + stone (OR=3.54, 95%CI=1.90-6.60, p=0.0001) when compared with the control group. However there was no significant association between genotypes of CYP17 MspA1 gene polymorphism and circulating serum level of estrogen and lipid profile. Conclusions: A higher frequency of mutant genotype A1A2 as well as mutant allele A2 of CYP-17 gene polymorphism is significantly associated with risk of gallbladder cancer and stones. Elevated levels of estrogen and an altered lipid profile can be used as predictors ofgall bladder stones and cancer in post menopausal females in India.

• Journal of radiological science and technology
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• v.32 no.3
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• pp.293-298
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• 2009

Background/aim : Gallbladder stone is the most common disease of biliary tract. It is lead to acute abdominal pain. The cholecystitis which is caused by in gallbladder stone occurs frequently and the possibility of the gallbladder cancer comes to be high. Our study was designed to determine the prevalence and risk factors gallbladder stone in a population who community. Materials and Methods : We enrolled a total of 826 (male : 297, female : 529) persons who 60 or older in Jeju-do 10 places from 2008 July one months. The height, weight, liver function tests, lipid profile, fasting blood sugar, were all measurement. They had their gallbladder examined with using ultrasonography. Statistical significance was defined as a p-value less than 0.05. Results : Among 826 persons, gallbladder stone was found in 49 persons (5.9%). The male is 6.1% and the female is 5.8%, the male 1.03 times appeared more highly the female. The body mass index above of 23.0 kg/$m^2$ with the gallbladder stone was 69.3% (p<0.047). Conclusion : The gallbladder stone appeared highly according to age increases. The obesity is the risk factor of gallbladder stone. The weight management and diet control is a possibility of reducing a gallbladder stone creation.

• Proceedings of the Korean Society of Toxicology Conference
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• 2006.11a
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• pp.32-33
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• 2006

There is compelling evidence that chronic inflammation predisposes to biliary tract cancer. Previously we found that aspirin use and variants in the PTGS2 gene, both of which are closely linked to inflammation, were associated with biliary tract cancer risk in a population-based study in China. To test the inflammation hypothesis further, we examined the associations of variants in 20 genes involved in the inflammation pathway with risk of biliary tract cancer and stones in a large population-based case-control study in Shanghai, China. We genotyped 56 single nucleotide polymorphisms (SNPs)from 20 inflammation genes in 411 biliary tract cancer cases (237 gallbladder cancers, 127 extrahepatic bile duct cancers, and 47 ampullary cancers), 895 subjects with biliary stones, and 786 population controls. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (Cls) for the association of individual SNPs and haplotypes with biliary stones and biliary tract cancer risk. Of the 56 SNPs examined, 20 showed some associations with biliary cancer and stones. Specifically, variants of the IL8, IL8RB, RNASEL, TGF-beta, and TNF-alpha genes were associated with gallstone risk, while variants in the IL1A, IL10, VEGF, and RNASEL genes were associated with gallbladder cancer risk. Adjustment for multiple comparisons did not materially change these results. Of the 10 genes with multiple SNPs, we inferred halotypes; only one haplotype in the IL8RBgene was associated with gallstones. The haplotype frequency was significantly different between bile dict cancer cases and control (p=0.007). A haplotype comprising 3 SNPs in the IL8RB gene (rs2230054, rs1126579, rs1126580) was associated with a 54% increased risk of bile duct stones (95% CI 1.14-2.07, p=0.02), relative to the most frequent haplotype. In summary, common variants in immune-related genes influencing inflammatory responeses were associated with gallstones and biliary tract cancer, lending further support to the role of inflammation in the pathogenesis of biliary stones and biliary tract cancer. Future larger studies with more complete gene coverage are needed to confirm these results.

• The Korean Journal of Pharmacology
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• v.16 no.1 s.26
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• pp.41-50
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• 1980

Chenodeoxycholic acid(CDCA) has been used as a gallstone dissolving agent since 1972. Recently, ursodeoxycholic acid(UDCA) has been reported to be effective in dissolving gallstones. Both bile acids increased bile flow. The increase in bile flow associated with an increase in cholesterol level in bile after CDCA or UDCA infusion was reported. In this study, using the smooth muscle strips of guinea pig and fowl, responses of the cholates were observed. In addition, the influence of adrenergic blocking agents on the response of the strips to cholates was investigated. Also the effects of cholates on cardiac function were examined by using isolated atria of rabbit and heart of anesthetized frog. The results are as follows: 1) All cholates, such as UDCA, CDCA, and CA produced a marked inhibitory effect on the motility in isolated duodenal strip of guinea pig and fowl, however, only UDCA showed the contraction in the isolated esophagus of fowl. These effects of cholates were blocked by propranolol. 2) In isolated guinea pig stomach strip and gall bladder, cholates exhibited a marked inhibitory effect on the motility and the effects due to UDCA and CA were blocked by phenoxybenzamine while CDCA was not affected. 3) The spontaneous and ouabain induced arrhythmia was partially abolished by cholates. However, concomitant administration of cholates with ouabain or epinephrine caused a marked prolongation in occurrence of atrial arrhythmia in comparison with ouabain or epinephrine alone in isolated rabbit atria. 4) In the heart of anesthetized frog, the epinephrine-induced arrhythmia was partially abolished by cholates. The combined treatment with cholates and ouabain or epinephrine produced a marked prolongation in occurrence of the arrhythmia in comparison with, ouabain or epinephrine alone. From the above results, it can be suggested that the effects of cholates on the smooth muscle of duodenum and esophagus are produced in response to adrenergic ${\beta}$-receptor and the effect or gall bladder and stomach is more likely due to the direct effect on the muscle. In addition, cholates exhibit a slight antiarrhythmic effect on heart, therefore, cholates can be classified as a nonselective antiarrhythmic drug, such as propranolol.

• Journal of Korean Medicine Rehabilitation
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• v.25 no.1
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• pp.45-52
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• 2015

Objectives To check marker content for appropriate quality control of Woohwangchungsimwon sterilized to ensure microbiological safety and to observe antioxidant activity for any changes in efficacy. Methods To measure any effects of sterilization on the effective compounds, 8 ingredients of Woohwangchungsimwon were screened for any changes in marker content using HPLC-DAD. Using the colorimetric method on the microplate reader any changes in total phenolic compound and flavonoid levels were observed. Antioxidant activity was measured using the DPPH, ABTS, and FRAP. Results Of the ingredients of Woohwangchungsimwon, 8 were subject to quantitative analysis before and after sterilization. 21.6 mg and 1.93 mg of Glycyrrhizin was found in Glycyrrhiza uralensis Fischer pre and post sterilization, respectively. Decursin found in Angelica gigas Nakai increased from 0.16 mg to 0.29 mg after sterilization. Bilirubin found in Gallstone of Bostaurusvar. domesticus increased from 0.24 mg to 0.33 mg. Cinnamic acid found in Cinnamomum cassia Blume increased from 0.02 mg to 0.05 mg. Ginsenoside Rb1 found in Panax ginseng C. A. Meyer decreased from 0.02 mg to 0.14 mg. Paeoniflorin found in Paeonia lactiflora Pallas increased from 1.05 mg to 1.13 mg. Amygdalin found in Armeniacae Amarum Semen increased from 2.68 mg to 2.83 mg. L-muscone found in Musk increased from 0.63 mg to 0.76 mg. As for total phenolic compound and total flavonoid content, there was a 1.22 and 4.15-fold increase. DPPH and ABTS increased by 20.45% and 20.69%, respectively. FRAP activity was 2.78 times more active post stabilization. Conclusions This study confirmed that high temperature high pressure steam sterilization, a method used to ensure microbiological safety of Woohwangchungsimwon, does not affect marker content; in other words, does not affect quality of the Woohwangchungsimwon. It could also be seen that total phenolic compound and flavonoid content increased after sterilization. An antioxidant activity test showed that there was significantly increased activity of antioxidants.