Byung-Keuk Kim

DIFFERENTIAL DIAGNOSIS OF INTESTINAL BEHCET'S DISEASE and CROHN'S DISEASE BY COLONOSCOPIC FINDINGS

BACKGROUND AND STUDY AIMS Intestinal Behçets disease and Crohns disease are chronic inflammatory bowel diseases that are difficult to distinguish from each other. We investigated their colonoscopic features and identified simple and valuable strategies for differential diagnosis. PATIENTS AND METHODS Between 1995 and 2006, 250 consecutive patients with ulcers on colonoscopy (115 Behçets, 135 Crohns cases) were reviewed. All patients with Behçets fulfilled the criteria of the International Study Group for Behçets Disease or of the Behçets Disease Research Committee of Japan, while Crohns disease was confirmed by clinicopathological data. Patients were randomly allocated to a training set (70 %) or a validation set (30 %). Ulcer shapes, distributions, numbers, margins, and border contours, and the presence of aphthous, cobblestone, perianal, and strictured lesions were compared, in the training set. Univariate and multivariate analysis were performed, using the X2-test and logistic regression. In addition, a classification and regression tree (CART) was then used to generate simplified algorithms for differential diagnosis. RESULTS Round shape, five or fewer in number, focal distributions, and absence of aphthous and cobblestone lesions were significantly dominant features in Behçets disease, according to multivariate analysis of the training set. The CART-generated algorithms proposed sequential use of shape (round, irregular/geographic, or longitudinal) and distribution (focal single/focal multiple, or segmental/diffuse). Diagnosis of Behçets disease in the validation set produced sensitivity, specificity, and negative and positive predictive values of 94.3 %, 90.0 %, 94.7 %, and 89.2 %, respectively. Using the CART model, we made the correct diagnosis of intestinal Behçets disease or Crohns disease in 69 of 75 patients (92 %). CONCLUSION It was determined that round and longitudinal ulcers are suggestive of Behçets disease and Crohns disease, respectively. Irregular/geographic-shaped ulcers and focal distributions are suggestive of Behçets disease, while segmental/diffuse lesions suggest Crohns.

Interleukin‐6 (IL‐6) –572C→G promoter polymorphism is associated with type 2 diabetes risk in Koreans

Objective  Increased levels of inflammatory markers, such as interleukin‐6 (IL‐6), are associated with type 2 diabetes (T2DM). We investigated the association of IL‐6 gene polymorphisms with T2DM and circulating levels of IL‐6 in Koreans.

Relation of Homocysteinemia to Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Hyperhomocysteinemia induces oxidative stress and endothelial dysfunction, which share the proposed pathophysiologic mechanisms of contrast-induced nephropathy (CIN). However, no study has investigated the relation between hyperhomocysteinemia and CIN. The aim of the present study was to evaluate the effects of hyperhomocysteinemia on CIN in patients undergoing percutaneous coronary intervention. This was an observational cohort study that included 572 patients who underwent percutaneous coronary intervention. CIN was defined as an absolute ≥0.5 mg/dl or a relative ≥25% increase in the serum creatinine level at 48 hours after the procedure. The incidence of CIN was significantly greater in patients in the third homocysteine tertile (from lowest to highest, 4.7%, 7.3%, and 24.2%, p <0.001). Furthermore, the homocysteine levels were significantly greater in patients with CIN than in those without CIN (16.9 ± 4.9 vs 13.5 ± 4.2 μmol/L, p <0.001). In multiple logistic regression models, hyperhomocysteinemia was an independent risk factor for CIN (per the SD change in the plasma homocysteine level [4.44 μmol/L], odds ratio 1.70, 95% confidence interval 1.07 to 2.71, p = 0.025) after adjusting for major risk factors such as age, diabetes, and baseline cardiac and renal function. In subgroup analyses according to diabetes, acute coronary syndrome, or baseline estimated glomerular filtration rate, significant, graded associations were found between the homocysteine level and the incidence of CIN. In conclusion, hyperhomocysteinemia is independently associated with a greater risk of CIN in patients undergoing percutaneous coronary intervention.

Renal denervation for treatment of uncontrolled hypertension in an Asian population: results from the Global SYMPLICITY Registry in South Korea (GSR Korea)

Reports detailing the response of hypertensive patients to renal denervation (RDN) in Asian patients are limited. We evaluated 6- and 12-month outcomes after RDN in an Asian population and compared outcomes to a primarily Caucasian population. The Global SYMPLICITY Registry (GSR) is a prospective, all-comer, worldwide registry that evaluates the safety and effectiveness of RDN and includes the Korean registry substudy (GSR Korea) and a Caucasian subset (GSR Caucasian). Given differences in baseline characteristics among GSR Korea (n=93) as compared with GSR Caucasian (n=169) patients, including lower baseline office systolic blood pressure (SBP), lower body mass index and differences in medications, propensity score adjustment was performed when comparing the change in SBP between subsets. The 6- and 12-month change in SBP in GSR Korea was −19.4±17.2 and −27.2±18.1 mm Hg, respectively (P<0.001 for both vs baseline). GSR Caucasian had a SBP change similar to GSR Korea at 6 months (−20.9±21.4 mm Hg, unadjusted P=0.547, adjusted P=0.998), whereas at 12 months the change was significantly less pronounced (−20.1±23.9 mm Hg, unadjusted P=0.004, adjusted P=0.002). There were no protocol-defined procedure-related adverse events and no chronic adverse events associated with the device in an Asian population. RDN provided a significant reduction in 6- and 12-month office SBP among Asian patients, with a favorable safety profile. The 12-month SBP reduction was larger than that observed in Caucasian patients.

Effects of Combination Therapy with Celecoxib and Doxycycline on Neointimal Hyperplasia and Inflammatory Biomarkers in Coronary Artery Disease Patients Treated with Bare Metal Stents

Purpose Cyclooxygenase (COX)-2 and matrix metalloproteinase (MMP)-9 play a key role in the pathogenesis of in-stent restenosis. We investigated the effect of a short-term therapy of celecoxib, a COX-2 inhibitor, with or without doxycycline, an MMP inhibitor, after coronary stenting on inflammatory biomarkers and neointimal hyperplasia. Materials and Methods A total of 75 patients (86 lesions) treated with bare metal stents were randomized into three groups: 1) combination therapy (200 mg celecoxib and 20 mg doxycycline, both twice daily), 2) celecoxib (200 mg twice daily) only, and 3) non-therapy control. Celecoxib and doxycycline were administered for 3 weeks after coronary stenting. The primary endpoint was neointimal volume obstruction by intravascular ultrasound (IVUS) at 6 months. The secondary endpoints included clinical outcomes, angiographic data, and changes in blood levels of inflammatory biomarkers. Results Follow-up IVUS revealed no significant difference in the neointimal volume obstruction among the three treatment groups. There was no difference in cardiac deaths, myocardial infarctions, target lesion revascularization or stent thrombosis among the groups. Blood levels of high-sensitivity C-reactive protein, soluble CD40 ligand, and MMP-9 varied widely 48 hours and 3 weeks after coronary stenting, however, they did not show any significant difference among the groups. Conclusion Our study failed to demonstrate any beneficial effects of the short-term therapy with celecoxib and doxycycline or with celecoxib alone in the suppression of inflammatory biomarkers or in the inhibition of neointimal hyperplasia. Large scale randomized trials are necessary to define the role of anti-inflammatory therapy in the inhibition of neointimal hyperplasia.

PCR-reverse blot hybridization assay for fast and accurate identification of causative species in superficial fungal infections.

Superficial fungal infections are a very common problem in dermatological clinics. The diagnostic method of fungal culture is time‐consuming and has inconsistent sensitivity. Therefore, a practical method for rapid and accurate identification of the species causing superficial fungal infections is needed.