Exposure to persistent organic pollutants(POPs)has been reported as a potential risk factor for diabetes in adults.However,effect modifications by sex and age,especially among Asian populations,have seldom been invest...Exposure to persistent organic pollutants(POPs)has been reported as a potential risk factor for diabetes in adults.However,effect modifications by sex and age,especially among Asian populations,have seldom been investigated.In the present study,we assessed associations of major POPs exposure including organochlorine pesticides(OCPs),polychlorinated biphenyls(PCBs),and polybrominated diphenyl ethers(PBDEs),with diabetes in Korean adults(n=1,295),a subset of the Korean National Environmental Health Survey(KoNEHS)Cycle 3(2015−2017).In the adult population,serum levels of dichlorodiphenyltrichloroethanes(DDTs)and PCB167 showed an increased odds ratio(OR)for diabetes.When stratified by gender,associations became stronger and more consistent in women:In women,serum levels of OCPs including p,p′-DDT,p,p′-dichlorodiphenyldichloroethylene(p,p′-DDE),andΣOCPs and mono-ortho PCBs,such as PCB118 and PCB157,were significantly associated with diabetes.In the male participants,however,no significant positive associations were detected.When stratified by a cutoff age of 50 years,most studied POPs except PBDEs,i.e.,p,p′-DDT,p,p′-DDE,PCB118,PCB157,PCB167,PCB138,and PCB153,showed significant associations with diabetes,in the older adults.In the younger group,however,no measured POPs showed a significant positive association.Effects of endogenous sex hormones or interaction of POPs on aryl hydrocarbon receptors may partly explain the observed differences by gender and age,although further experimental confirmations should follow.Our findings show that POPs exposure at the current levels is associated with diabetes among general Korean adults,and such associations could be modified by gender and age.展开更多
AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Se...AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.展开更多
To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedure...To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between a...BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.展开更多
AIM: To investigate the effect of Clostridium difficile (C. difficile) infection in an interleukin 10-deficient (IL-10<sup>-/-</sup>) mouse model of inflammatory bowel disease.
Introduction:Although an association between metabolic dysfunctionassociated fatty liver disease(MAFLD)and cardiovascular disease or overall mortality has been reported,it is unclearwhether there is an association bet...Introduction:Although an association between metabolic dysfunctionassociated fatty liver disease(MAFLD)and cardiovascular disease or overall mortality has been reported,it is unclearwhether there is an association between MAFLD and cancer incidence or mortality.We aimed to investigate the differential risk of all-and site-specific cancer incidence and mortality according to MAFLD subgroups categorized by additional etiologies of liver disease.Methods:Using the Korean National Health Insurance Service database,we stratified the participants into three groups:(1)single-etiology MAFLD(SMAFLD)or MAFLD of pure metabolic origin;(2)mixed-etiology MAFLD(M-MAFLD)or MAFLD with additional etiological factor(s)(i.e.,concomitant liver diseases and/or heavy alcohol consumption);and(3)non-MAFLD.Hepatic steatosis and fibrosiswere defined using the fatty liver index and the BARDscore,respectively.Cox proportional hazards regression was performed to estimate the risk of cancer events.Results:Among the 9,718,182 participants,the prevalence of S-MAFLD and M-MAFLD was 29.2%and 6.7%,respectively.During the median 8.3 years of follow-up,510,330(5.3%)individuals were newly diagnosed with cancer,and 122,774(1.3%)cancer-related deaths occurred among the entire cohort.Compared with the non-MAFLD group,the risk of all-cancer incidence and mortality was slightly higher among patients in the S-MAFLD group(incidence,adjusted hazard ratio[aHR]=1.03;95%confidence interval[CI]:1.02−1.04;mortality,aHR=1.06;95%CI:1.04−1.08)and highest among patients with M-MAFLD group(incidence,aHR=1.31;95%CI:1.29−1.32;mortality,aHR=1.45;95%CI:1.42−1.48,respectively).The M-MAFLD with fibrosis group(BARD score≥2)showed the highest relative risk of all-cancer incidence(aHR=1.38,95%CI=1.36–1.39),followed by the M-MAFLD without fibrosis group(aHR=1.09,95%CI=1.06–1.11).Similar trends were observed for cancer-related mortality.Conclusions:MAFLD classification,by applying additional etiologies other than pure metabolic origin,can be used to identify a subgroup of patients with poor cancer-related outcomes.展开更多
基金supported by grants from the National Institute of Environmental Research funded by the Ministry of Environment(MOE)of Korea(NIER-2019-01-02-082)National Research Foundation(NRF)of Korea(NRF-2020R1A2C3011269 and NRF-2022R1C1C2006982).
文摘Exposure to persistent organic pollutants(POPs)has been reported as a potential risk factor for diabetes in adults.However,effect modifications by sex and age,especially among Asian populations,have seldom been investigated.In the present study,we assessed associations of major POPs exposure including organochlorine pesticides(OCPs),polychlorinated biphenyls(PCBs),and polybrominated diphenyl ethers(PBDEs),with diabetes in Korean adults(n=1,295),a subset of the Korean National Environmental Health Survey(KoNEHS)Cycle 3(2015−2017).In the adult population,serum levels of dichlorodiphenyltrichloroethanes(DDTs)and PCB167 showed an increased odds ratio(OR)for diabetes.When stratified by gender,associations became stronger and more consistent in women:In women,serum levels of OCPs including p,p′-DDT,p,p′-dichlorodiphenyldichloroethylene(p,p′-DDE),andΣOCPs and mono-ortho PCBs,such as PCB118 and PCB157,were significantly associated with diabetes.In the male participants,however,no significant positive associations were detected.When stratified by a cutoff age of 50 years,most studied POPs except PBDEs,i.e.,p,p′-DDT,p,p′-DDE,PCB118,PCB157,PCB167,PCB138,and PCB153,showed significant associations with diabetes,in the older adults.In the younger group,however,no measured POPs showed a significant positive association.Effects of endogenous sex hormones or interaction of POPs on aryl hydrocarbon receptors may partly explain the observed differences by gender and age,although further experimental confirmations should follow.Our findings show that POPs exposure at the current levels is associated with diabetes among general Korean adults,and such associations could be modified by gender and age.
文摘AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.
文摘To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.
文摘AIM: To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.
文摘AIM: To investigate the effect of Clostridium difficile (C. difficile) infection in an interleukin 10-deficient (IL-10<sup>-/-</sup>) mouse model of inflammatory bowel disease.
基金Seoul National University Hospital,Grant/Award Numbers:04-2022-3140,30-2022-0340Liver Research Foundation of Korea。
文摘Introduction:Although an association between metabolic dysfunctionassociated fatty liver disease(MAFLD)and cardiovascular disease or overall mortality has been reported,it is unclearwhether there is an association between MAFLD and cancer incidence or mortality.We aimed to investigate the differential risk of all-and site-specific cancer incidence and mortality according to MAFLD subgroups categorized by additional etiologies of liver disease.Methods:Using the Korean National Health Insurance Service database,we stratified the participants into three groups:(1)single-etiology MAFLD(SMAFLD)or MAFLD of pure metabolic origin;(2)mixed-etiology MAFLD(M-MAFLD)or MAFLD with additional etiological factor(s)(i.e.,concomitant liver diseases and/or heavy alcohol consumption);and(3)non-MAFLD.Hepatic steatosis and fibrosiswere defined using the fatty liver index and the BARDscore,respectively.Cox proportional hazards regression was performed to estimate the risk of cancer events.Results:Among the 9,718,182 participants,the prevalence of S-MAFLD and M-MAFLD was 29.2%and 6.7%,respectively.During the median 8.3 years of follow-up,510,330(5.3%)individuals were newly diagnosed with cancer,and 122,774(1.3%)cancer-related deaths occurred among the entire cohort.Compared with the non-MAFLD group,the risk of all-cancer incidence and mortality was slightly higher among patients in the S-MAFLD group(incidence,adjusted hazard ratio[aHR]=1.03;95%confidence interval[CI]:1.02−1.04;mortality,aHR=1.06;95%CI:1.04−1.08)and highest among patients with M-MAFLD group(incidence,aHR=1.31;95%CI:1.29−1.32;mortality,aHR=1.45;95%CI:1.42−1.48,respectively).The M-MAFLD with fibrosis group(BARD score≥2)showed the highest relative risk of all-cancer incidence(aHR=1.38,95%CI=1.36–1.39),followed by the M-MAFLD without fibrosis group(aHR=1.09,95%CI=1.06–1.11).Similar trends were observed for cancer-related mortality.Conclusions:MAFLD classification,by applying additional etiologies other than pure metabolic origin,can be used to identify a subgroup of patients with poor cancer-related outcomes.
