Real-World Long-Term Clinical Outcomes of Ultrathin Strut Biodegradable Polymer Drug-Eluting Stents in Korean ST-Segment-Elevation Myocardial Infarction (STEMI) Patients with or without Acute Heart Failure Undergoing Primary Percutaneous Coronary Intervention

Biodegradable polymers (BDPs) and ultrathin struts were recently introduced to drug-eluting stents (DES) to further improve outcomes. In this study, we analyzed and compared the effect of the ultrathin strut BDP-DES (UBDP-DES) with the conventional durable polymer-DES (DP-DES) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). A total of 356 STEMI patients (n = 160 in the UBDP-DES group and n = 196 in the DP-DES group) were enrolled. The primary endpoint was target lesion failure (TLF), including cardiac death, target vessel myocardial infarction, and ischemic-driven, target lesion revascularization (ID-TLR). The mean age was 60.3 ± 12.7 years (male 81.7%), and the median follow-up duration was 63.8 months. TLF was numerically more frequent in the UBDP-DES group (8.1% vs. 4.1%; HR 2.14; 95% CI 0.89-5.18; p = 0.091). Propensity score matching (PSM) was performed to balance discrepancies in the baseline characteristics due to patients in the UBDP-DES group initially having more unstable vital signs. However, after PSM (n = 116 in each group), there was no significant difference in TLF (5.3% vs. 5.3%; HR 1.04, 95% CI 0.34-3.22; p = 0.947) or other secondary endpoints including ID-TLR. In the subgroup analysis, subjects with initial acute heart failure (AHF), defined as Killip class ≥ 3, were associated with 13.6% chance of 30-day mortality (9-fold of those without AHF), although chances of repeat revascularization were low (3.0%). Among patients with AHF, the UBDP-DES group was associated with a numerically higher chance of TLF compared with the DP-DES group. There was no difference in TLF between groups in patients without AHF. This study showed that UBDP-DES has long-term clinical outcomes similar to those of conventional DP-DES in real-world Korean STEMI patients receiving PPCI, especially in those without initial AHF.ope

Microbial Modulation in Inflammatory Bowel Diseases

Gut dysbiosis is one of prominent features in inflammatory bowel diseases (IBDs) which are of an unknown etiology. Although the cause-and-effect relationship between IBD and gut dysbiosis remains to be elucidated, one area of research has focused on the management of IBD by modulating and correcting gut dysbiosis. The use of antibiotics, probiotics either with or without prebiotics, and fecal microbiota transplantation from healthy donors are representative methods for modulating the intestinal microbiota ecosystem. The gut microbiota is not a simple assembly of bacteria, fungi, and viruses, but a complex organ-like community system composed of numerous kinds of microorganisms. Thus, studies on specific changes in the gut microbiota depending on which treatment option is applied are very limited. Here, we review previous studies on microbial modulation as a therapeutic option for IBD and its significance in the pathogenesis of IBD.ope

Proteomic analysis-based discovery of a novel biomarker that differentiates intestinal Behçet's disease from Crohn's disease

Intestinal Behçet's disease (BD) and Crohn's disease (CD) present similar manifestations, but there are no specific diagnostic tests to differentiate them. We used a proteomic approach to discover novel diagnostic biomarkers specific to intestinal BD. Colon mucosa tissue samples were obtained from patients with intestinal BD or CD using colonoscopy-guided biopsy of the affected bowel. Peptides from seven intestinal BD and seven CD patients were extracted and labeled using tandem mass tag (TMT) reagents. The labeled peptides were identified and quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The proteins were further validated using immunohistochemical (IHC) analysis with tissue samples and an ELISA test with serum samples from 20 intestinal BD and 20 CD patients. Using TMT/LC-MS/MS-based proteomic quantification, we identified 39 proteins differentially expressed between intestinal BD and CD. Beta-2 glycoprotein 1 (APOH) and maltase-glucoamylase (MGAM) showed higher intensity in the IHC staining of intestinal BD tissues than in CD tissues. The serum MGAM level was higher in intestinal BD patients. Proteomic analysis revealed that some proteins were differentially expressed in patients with intestinal BD compared with those with CD. Differential MGAM expression in intestinal BD suggests its role as a potential novel diagnostic biomarker.ope

Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn's Disease Recurrence

Background/aims: Many patients with Crohn's disease (CD) undergo intestinal resection during the disease course. Despite surgery, postoperative recurrence (POR) commonly occurs. Although postoperative use of tumor necrosis factor α (TNF-α) inhibitors is known to be effective in preventing POR, few studies have evaluated the effectiveness of continuing the same TNF-α inhibitors postoperatively in patients who received TNF-ɑ inhibitors before surgery. Methods: This retrospective observational study was performed in a single tertiary medical center. We retrospectively reviewed patients who had undergone the first intestinal resection due to CD and divided them into two groups: TNF-α inhibitor users in both the preoperative and postoperative periods, and TNF-α inhibitor users in only the preoperative period. We compared the clinical outcomes between these two groups. Results: In total, 45 patients who used TNF-α inhibitors preoperatively were recruited. Among them, TNF-α inhibitors were used postoperatively in 20 patients (44.4%). The baseline characteristics except age at diagnosis were similar in both groups. The rates of surgical and endoscopic recurrence were not different between the two groups, but the cumulative clinical recurrence rate was significantly lower in the postoperative TNF-α inhibitors group (log-rank p=0.003). In multivariate Cox regression analysis, postoperative TNF-α inhibitors use was significantly associated with a decreased risk of clinical recurrence (adjusted hazard ratio, 0.204; 95% confidence interval, 0.060 to 0.691; p=0.011). Conclusions: Continuing TNF-α inhibitors postoperatively in patients who were receiving TNF-α inhibitors before surgery significantly reduced the rate of clinical recurrence. For patients with CD who received TNF-α inhibitors preoperatively, continuing their use after surgery could be recommended.ope

중합시간과 중합방법에 따른 자가중합형 상교 정용 레진의 중합률 비교에 관한 연구

학위논문(석사)--서울대학교 대학원 :치의학과 소아치과학 전공,1999.Maste

Bifidobacterium breve CBT BR3의 술잔 세포 증식 촉진을 통한 장 염증 개선효과

Probiotics are microorganisms that have beneficial properties for their hosts. Bifidobacterium is an anaerobic, gram-positive, catalase-negative, and rod-shaped bacterium. Bifidobacterium breve (B. breve) is the first isolated bacteria in the feces of healthy infants and is a dominant species in the guts of breast-fed infants. Some strains of B. breve are effective at relieving intestinal inflammation though pathogenesis is not elucidated in detail. In this study, I attempted to elucidate the pathogenesis of B. breve CBT BR3 isolated from South Korean infant feces using experimental animal models. B. breve CBT BR3 was orally administered to determine its effects as a probiotic on two kinds of murine colitis models. Colitis was induced with dextran sodium sulfate (DSS) and dinitrobenzene sulfonic acid (DNBS), respectively. The disease activity index (DAI) of the mice was recorded. After sacrifice, colon tissues were analyzed for periodic acid-Schiff staining and mRNA expression. B. breve CBT BR3 improved colitis symptoms as determined by the disease activity index. The DSS-induced colitis mice treated with B. breve CBT BR3 had a 62.5% survival rate while the DSS-vehicle group only had a 50% survival rate. Mice in both groups had similar body weights, colon lengths, and colon length-to-initial body weight ratios. B. breve CBT BR3 did not have a significant proliferative effect on goblet cells in normal mucosa but it did increase both goblet cell density and the number of goblet cells per crypt in both groups. In both the DSS- and DNBS-colitis groups, B. breve increased mRNA expression of Spdef and Klf4, genes associated with goblet cell differentiation, and Muc5, but not Muc2. The mRNA expression of Occludin, a membrane tight junction protein, and Foxo3, which is related to butyrate metabolism, are also increased. FACS analysis for Rag1 KO mice showed that B. breve may affect through innate lymphoid cells. This study showed that B. breve CBT BR3 is effective at relieving intestinal inflammation by augmenting goblet cell regeneration, possibly through innate lymphoid cells and cytokines such as IL-10. 유산균은 숙주에 이로운 효과를 주는 미생물로 이중 Bifidobacterium은 혐기성, 그램 양성, 카탈라제 음성인 간균이다. Bifidobacterium의 다양한 종 중에서 Bifidobacterium breve는 건강한 영아에서 잘 분리되는 박테리아로 모유수유를 한 영아에서 우세한 균주로 알려져 있다. Bifidobacterium breve의 일부 계통으로 시행된 동물 및 인간 연구에서 장 염증에 효과가 있었으나, 기전이 명확하지 않아, 이 연구에서는 실험 동물 모델을 통해 그 기전을 연구하고자 한다. Bifidobacterium breve CBT BR3가 두가지 동물 장 염증 모델, 즉 DSS 및 DNBS로 장 염증이 유도된 마우스 모델에 경구 투여되었고, 질병 활동성 지수(disease activity index)를 추적 관찰하였다. 또한 부검을 통해 장 조직을 채취 후 조직 병리, PAS 염색, goblet cell 밀도 및 mRNA 표현을 통해서 분석하였다. 그 결과 DSS 마우스 모델에서는 장 염증 증상 및 생존율이 개선되었고, 체중, 장 길이, 장 길이/초기 체중이 보존되었다. 또한 DSS, DNBS 모델 모두에서 현미경적, 조직학적으로 술잔 세포 숫자의 증가를 확인할 수 있었다. mRNA 분석 결과 DSS, DNBS 모델 모두에서 술잔 세포 분화와 연관된 Klf4, Spdef가 증가한 반면 mucin분비와 연관된 Muc5는 증가하였으나 반면 Muc2는 증가하지 않았다. 반면 DNBS 모델에서는 장내 미생물의 metabolite인 butyrate의 metabolism과 연관된 Foxo3 및 막 밀착 연접에 연관된 유전자인 Occludin의 발현이 모두 증가하였다. 또한 Rag1 KO 마우스에서 FACs 분석 결과, innate lymphoid cell이 B. breve 투여와 상관 관계가 있었다. 이상의 연구결과를 통해 Bifidobacterium breve CBT BR3가 butyrate metabolism 혹은 innate lymphoid cell과 연관된 경로를 통해 유전자 발현 촉진을 통해 술잔 세포 증식을 촉진하여 장 염증 개선 효과를 나타냄을 확인할 수 있었다.open박

중합시간과 중합방법에 따른 자가중합형 상교정용 레진의 중합률의 비교에 관한 연구

Autopolymerized resin facilitates a more rapid and easier means for the construction of removable orthodontic appliances than heat cured resin. But many reports reveal that more unreacted monomer is found in autopolymerized resin. It is very important to achieve maximum degree of polymerization because if polymerization is inadequate, high level of unreacted monomer has been shown to adversely affect mechanical and physical properties, and also the question of allergy or toxicity to methylmethacrylate must be considered. The purpose of this study was to compare the degree of polymerization according to curing method and curing time. Five groups were desinged ; Group 1 was polymerizied at room temperature() ; Group 2 in water ; Group 3 in water under 30psi pressure ; Group 4 in water ; Group 5 in water under 30psi pressure for 10 minutes, 1 hour 12 hours, 1 day and 3 days. The degree of polymerization was measured by means of Fourier Transform Infrared spectroscopy. The results were as follows: 1. The degree of polymerization increased constantly in accordance with curing time in all groups and after curing for 10 minutes, Group 1 showed significantly higher degree of polymerization after 12 hours and Group 2, Group 3, Group 4, Group 5 after 1 hour(p<0.05). 2. The degree of polymerization decreased in the order of Group 5, Group 4, Group 3, Group 2, Group 1 except when the curing time was 1 hour and 12 hours(p<0.05). 3. The degree of polymerization of Group 4, Group 5 cured at showed significantly higher degree of polymerization than Group 2, Group 3 at except when the curing time was 1 day(p<0.05). 4. Among Group 2, Group 3 and Group 4, Group 5, the pressure had no effect on polymerization except when the curing time was 12 hours(p<0.05). 5. Between Group 1 and Group 2, the method of storage had no effect on polymerization except when the curing time was 1 hour(p<0.05)

Prognostic Value of Terminal Ileal Inflammation in Patients with Ulcerative Colitis

Background/aims: Few studies have investigated terminal ileal lesions and their prognostic value in patients with ulcerative colitis (UC). We evaluated the clinical significance of these lesions as a prognostic factor in patients with UC who were in clinical remission. Methods: We retrospectively selected 567 of 4,066 colonoscopy reports that included positive findings from orificial observations of the terminal ileum (TI) and appendix in patients with UC. We finally recruited patients who were in clinical remission (n=204). We compared the clinical courses, including relapse and other prognostic parameters associated with UC, between the groups. Results: The baseline patient characteristics were not significantly different between patients with (n=69, TI+ group) and without TI lesions (n=135, TI- group), although there were more never-smokers in the TI+ group (n=57 [82.6%] in the TI+ group; n=86 [63.7%] in the TI- group; p=0.005). Of note, appendiceal orifice inflammation (AOI) was less frequently found in the TI+ group (14.5%) than in the TI- group (71.9%, p<0.001). The cumulative relapse rate was numerically higher in the TI- group, but it was not significantly different according to the Kaplan-Meier analysis (p=0.116). Multivariate Cox regression analysis also revealed advanced age at diagnosis as the most significant factor (adjusted hazard ratio, 0.964; 95% confidence interval, 0.932 to 0.998; p=0.037), but neither TI inflammation nor AOI were significantly associated with the cumulative relapse rate in patients with UC in clinical remission. Conclusions: For patients with UC in clinical remission, neither terminal ileal lesions nor AOI had significant clinical or predictive value for future relapse.ope