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Biomedical subjects

D H Kang

Publications and source records attributed to D H Kang.

At least 73 records · Page 4Linked to original sources
PubMed2000

Metabolic acidosis and composite nutritional index (CNI) in CAPD patients.

BACKGROUND: Metabolic acidosis (MA) has been recognized as an important stimulus for net protein catabolism. Continuous ambulatory peritoneal dialysis (CAPD) is regarded to have advantage in normalizing the acid-base homeostasis over hemodialysis due to continuous supply of buffer. However, many CAPD patients still remain acidotic and the clinical impact of this MA is uncertain. Recent studies revealed no specific correlation between a certain degree of MA and protein nutritional status while others showed that mild alkalosis is nutritionally beneficial to CAPD patients. A cross-sectional study evaluating acid-base and nutritional status was performed to examine the relationship between acid-base status and overall nutritional status assessed by composite nutritional index (CNI) and to get a basic information about the optimal pH/HCO3 in CAPD patients. PATIENTS AND METHODS: Total 198 clinically stable patients maintained on CAPD more than 6 months were evaluated. Each of 10 nutritional parameters of CNI consisting of clinical (subjective global assessment), biochemical (total lymphocyte count, albumin, prealbumin, insulin-like growth factor-1, transferrin) and anthropometric parameters (body mass index, % lean body mass, triceps skinfold thickness, midarm muscle circumference) was graded from 0 to 3 point (0; normal, 1; mildly decreased, 2; moderately decreased, 3; severely decreased). RESULTS: Mean CNI score was 8.2 +/- 5.2 with a range of 0 to 25. CNI was positively correlated with age, duration of peritoneal dialysis, incidence of peritonitis, C-reactive protein (CRP), HCO3 and dialytic protein loss whereas it was inversely correlated with hemoglobin and nPNA. In patients with MA (n = 25, mean arterial HCO3 19.5 +/- 1.9 mM/l), CNI score was significantly lower (6.3 +/- 3.5) compared to patients with normal acid-base status (n = 63, 9.5 +/- 5.9, p < 0.01) or metabolic alkalosis (n = 47, 10.1 +/- 4.6, p < 0.001). Multiple regression analysis revealed that the incidence of peritonitis, duration of dialysis, CRP and dialytic protein loss were the independent predictors of CNI. CONCLUSIONS: CAPD patients with mild to moderate degree of MA appear to be associated with more favorable overall nutritional status expressed as CNI. Prospective studies evaluating changes in the nutritional parameters with the correction of acid-base abnormality are needed to understand the real impact of acid-base status on nutritional status and to know the optimal pH/HCO3 in CAPD patients.

Acidosis↗
PubMed1999

Heterozygous germ line hCHK2 mutations in Li-Fraumeni syndrome.

The hCHK2 gene encodes the human homolog of the yeast Cds1 and Rad53 G2 checkpoint kinases, whose activation in response to DNA damage prevents cellular entry into mitosis. Here, it is shown that heterozygous germ line mutations in hCHK2 occur in Li-Fraumeni syndrome, a highly penetrant familial cancer phenotype usually associated with inherited mutations in the TP53 gene. These observations suggest that hCHK2 is a tumor suppressor gene conferring predisposition to sarcoma, breast cancer, and brain tumors, and they also provide a link between the central role of p53 inactivation in human cancer and the well-defined G2 checkpoint in yeast.

Alleles↗
PubMed1999

Intravascular ultrasound comparison of chronic recoil among different stent designs.

Intravascular ultrasound studies were acquired in 70 native coronary artery lesions after implantation and at follow-up of Palmaz-Schatz, GFX, NIR, and CrossFlex stents. Chronic stent recoil was minimal in the Palmaz-Schatz, GFX, and NIR stents; however, there was small, but significant chronic recoil of the CrossFlex stent.

Coronary Disease↗
PubMed1999

Common nonsense mutations in RAD52.

RAD51, RAD52, and RAD54 encode proteins that are critical to the repair of double-strand DNA breaks by homologous recombination. The physical interactions among the products of RAD51, BRCA1, and BRCA2 have suggested that the BRCA1 and BRCA2 breast cancer susceptibility genes may function, at least in part, in this DNA damage repair pathway. Given the observation that different genes within a common functional pathway may be targeted by mutations in human cancers, we analyzed RAD51, RAD52, and RAD54 for the presence of germ-line mutations in 100 cases with early-onset breast cancer and for somatic mutations in 15 human breast cancer cell lines. Two premature stop codons, Ser346ter and Tyr415ter, were identified in germ-line RAD52 alleles from 5% of early-onset breast cancer cases. Together, these two heterozygous mutations were also found in 8% of a healthy control population, indicating that they do not confer an increased risk for breast cancer. A rare germ-line missense mutation was identified in RAD54, whereas no sequence variants were found in RAD51. None of the three RAD genes demonstrated somatic mutations in breast cancer cell lines. We conclude that, despite their potential functional association with the BRCA gene products, RAD51, RAD52, and RAD54 are not themselves targeted by mutations in human breast cancer. The presence of common nonsense mutations in RAD52 within the population may have significance for other conditions associated with potential alterations in DNA damage repair pathways.

Breast Neoplasms↗
PubMed1999

Different remodeling of descending thoracic aorta after acute event in aortic intramural hemorrhage versus aortic dissection.

The natural healing process of medically treated aortic dissection (AD) and aortic intramural hemorrhage (AIH) developed in the descending thoracic aorta was compared to test the hypothesis that absence of intimal tear and flow communication in AIH may have different impact on the remodeling of the affected aorta after the acute event. In 25 patients with AD and 20 with AIH involving distal descending thoracic aorta stabilized with medical treatment, follow-up (mean 9 months) transesophageal echocardiography was performed to measure the maximal dimensions of aorta, true lumen, false lumen in AD, and abnormal wall thickening in AIH. The sex ratio, prevalence of hypertension, baseline maximal dimension, and longitudinal extent of the affected aorta did not show any significant difference in both groups. Patients with AIH were older than those with AD (63 +/- 10 vs 50 +/- 9, p <0.01). Disappearance of abnormal wall thickening with complete restoration of the aorta occurred in 70% (14 of 20) patients with AIH, which was significantly more frequent than in AD (8%, p <0.01). In AD, progressive dilatation of the aorta with continuous flow communication in the false lumen resulted in larger dimension of the aorta than in AIH (44 +/- 13 vs 35 +/- 7 mm, p <0.01). Absence of persistent flow communication resulted in a favorable remodeling process in AIH affecting distal descending aorta. This finding, along with different mean age in AIH and AD, may suggest that AIH is not just a precursor of overt AD but a distinct disease entity with different pathophysiology.

Acute Disease↗
PubMed1999

Reproductive factors related to the risk of colorectal cancer by subsite: a case-control analysis.

The authors hypothesized that reproductive factors of colorectal cancer, which are probably mediated by endogenous hormones, would differ according to colonic subsite. Information on reproductive factors was obtained from 372 female colorectal cancer cases (113 proximal colon, 126 distal colon, 133 rectum) and 31,061 cancer-free controls at the Aichi Cancer Center Hospital, Japan, between 1988 and 1995. Multiple logistic analysis showed that late age at interview, family history of colorectal cancer among first-degree relatives, menstrual regularity, late age at menopause, late age at first pregnancy and late age at first full-term pregnancy were significantly associated with the risk of colorectal cancer. None of the risk factors were significantly dissociated between colon and rectal cancer. In polytomous logistic regression analysis, particularly noteworthy was the fact that the odds ratios for age at menarche (P-value for heterogeneity of odds ratios = 0.010), age at first pregnancy (P = 0.016) and age at first full-term pregnancy (P = 0.028) were significantly higher for distal than for proximal colon cancer. This study supports the hypotheses that there might be an association between reproductive factors and risk of colon cancer, and that the carcinogenesis of colon cancer, by subsite, might show aetiologic distinctions.

Case-Control Studies↗
PubMed1999

Development and evaluation of a 24 well microtitre plate method for isolation of Listeria spp. or Listeria monocytogenes from foods.

A rapid and simple method (24M) using 24 well microtitre plates was developed to determine the presence of Listeria monocytogenes or Listeria spp. in food samples. The 24M was composed of two 24 well microtitre plates connected with a yellow tip. The 24M was evaluated with pathogen cocktails and ground beef samples and compared with the conventional method for presumptive identification of Listeria spp. Only food-borne pathogen cocktails and ground beef samples containing L. monocytogenes or Listeria spp. showed a positive reaction in 24M after 24 h incubation at 35 degrees C. Test results were the same with the conventional method and the 24M method and showed high efficiency for recovery of Listeria spp. from foods. This new, convenient and economical method can isolate Listeria spp. simultaneously from 24 different food samples.

Animals↗
PubMed1999

Reduction of Escherichia coli O157:H7 by stimulated Pediococcus acidilactici.

This study was conducted to determine if stimulating the growth of meat starter culture (Pediococcus acidilactici) in a laboratory medium (Brain Heart Infusion broth +2.3% NaCl + 1.5% sucrose; LBHI) and during meat fermentation would control Escherichia coli O157:H7. In LBHI medium without P. acidilactici, the numbers of E. coli O157:H7 increased from 4.00 to 8.34 log10 cfu ml-1, whereas in the presence of P. acidilactici (approximately 6.0 log10 cfu ml-1) in LBHI, LBHIM (LBHI + 0.005% MnSO4), LBHIO (LBHI + 0.3 unit ml-1 Oxyrase), and LBHIMO (LBHI + M + O), the numbers of E. coli O157:H7 increased from 4.00 to 8.05, 7.50, 7.99, and 6.50 log10 cfu ml-1, respectively, after incubation at 40 degrees C for 15 h. During salami fermentation, the numbers of E. coli O157:H7 changed from 7.00 to 6.40 and 5.10 log10 cfu g-1 without and with P. acidilactici (approximately 7.0 log10 cfu g-1), respectively. Stimulated P. acidilactici by M, O, and MO further reduced the number of E. coli O157:H7 from 7.00 to 4.00, 4.80, and 3.65 log10 cfu g-1, respectively. The combination of MO was a better growth stimulator for P. acidilactici, which controlled E. coli O157:H7 in both systems (P < 0.05).

Animals↗
PubMed1999

Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients.

BACKGROUND: The study was carried out to evaluate the role of individual peritoneal membrane transport characteristics in the nutritional status expressed as the composite nutritional index (CNI) METHODS: Cross-sectional analyses of the overall nutritional status of 147 continuous ambulatory peritoneal dialysis (CAPD) patients were performed using the CNI. CNIs based on a scoring system of 10 nutritional indices including subjective global assessment, biochemical parameters and anthropometry were compared according to the results of a standard peritoneal equilibration test (PET) RESULTS: Patients were classified as low (n = 16, 10.9%), low average (n=59, 40.2%), high average (n=54, 36.7%) and high (n=18, 12.2%) transporters based on the D/P(Cr) after 4 h dwells. The mean 4 h D/P(Cr) was 0.65 +/- 0.12 (0.34-0.95), and there was no significant correlation between D/P(Cr) and other demographic parameters such as age, duration of peritoneal dialysis and body surface area. D/P(Cr) was correlated with dialytic albumin loss (r=0.47, P<0.001), serum albumin (r=-0.46, P<0.001), serum creatinine (r= -0.38, P<0.001), serum TGF-1 (r=-0.37, P<0.01) and LBM(Cr) (r= -0.26, P<0.05). In high transporters, the serum albumin was significantly lower while dialysate protein and albumin losses were significantly greater compared with low transporters. Serum creatinine and IGF-1 concentrations as well as LBM(Cr) were also decreased in higher transporters. The mean CNI score was 8.1 +/- 4.9, with a range of 0-24. CNI was positively correlated with age, duration of peritoneal dialysis, incidence of peritonitis, CRP and dialytic protein loss, whereas it was inversely correlated with ultrafiltration volume, haemoglobin and NPNA. The CNI score was significantly higher in high transporters compared with low transporters (11.7 +/- 4.3 vs. 5.9 +/- 1.6, P < 0.01). There was also a significant correlation between D/P(Cr) and CNI (r = 0.29, P < 0.05). Multiple regression analysis revealed that the incidence of peritonitis, duration of CAPD, CRP and D/P(Cr) were the independent factors affecting the CNI. CONCLUSION: Peritoneal membrane transport characteristics correlate with the overall nutritional status of peritoneal dialysis patients assessed by the scoring system of the CNI, although it is associated with a different impact on the individual nutritional indices. The results of this cross-sectional study also suggest that a high permeability state is a risk factor for malnutrition in CAPD patients. Prospective studies evaluating the changes in nutritional parameters among patients with different membrane transport rates are needed to understand better the relationship of peritoneal membrane characteristics to the nutritional status of CAPD patients.

Biological Transport↗
PubMed1999

Agar underlay method for recovery of sublethally heat-injured bacteria.

A method of recovering sublethally heat-injured bacteria was developed. The procedure (termed the agar underlay method) uses a nonselective agar underlaid with a selective medium. In a two-chambered petri dish, the Lutri plate (LP), a nonselective agar is inoculated with a population of sublethally heat-injured bacteria. After a 2-h repair incubation period, selective agar is added to the bottom chamber of the LP and incubated. By diffusing through the nonselective top agar, selective agents from the underlay medium impart selectivity to the system. By the agar underlay method, recovery rates of the heat-injured food-borne pathogens Escherichia coli O157:H7 and Salmonella typhimurium were not different (P > 0. 05) from recovery rates determined with nonselective media. Sublethally heat-injured cells (60 degrees C for 1.5 min in buffer or 80 degrees C for 30 s on meat surfaces) grew and produced a typical colony morphology and color reaction when the agar underlay procedure was used with the appropriate respective selective agars. Unlike agar overlay methods for injury repair, the agar underlay procedure allows the typical selective-medium colony morphology to develop and allows colonies to be more easily picked for further characterization. Higher recovery rates of heat-injured fecal enterococci from bovine fecal samples and total coliforms from animal waste lagoons were obtained by the agar underlay method with selective agars than by direct plating on the respective selective media.

Agar↗
PubMed1999

Left ventricular muscle mass regression after aortic valve replacement.

Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). There was no surgical mortality. The NYHA functional class improved from an average of 2.2+/-0.8 preoperatively to 1.3+/-0.5 post-operatively. Left ventricular muscle mass index (LVMI) regression failed to reach statistical significance in the 19 mm group, whereas in the other two groups a steady decrease in the LVMI occurred with follow up. ECG findings were less remarkable showing insignificant differences in voltage among the three groups (p=0.000). In conclusion, the current data suggest that the 19 mm SJM valve may not result in satisfactory left ventricular muscle mass regression despite adequate function, even in small patients. Therefore, additional procedures to accommodate a larger valve may be warranted in the aortic annulus smaller than 21 mm.

Adult↗
PubMed1999

Thin agar layer method for recovery of heat-injured Listeria monocytogenes.

A thin agar layer (TAL) method was developed to recover heat-injured Listeria monocytogenes. Modified Oxford medium (MOX), a selective plating medium, inhibits heat-injured L. monocytogenes from growing, whereas tryptic soy agar (TSA), a nonselective medium, does not. In order to facilitate recovery of heat-injured L. monocytogenes cells while providing selectivity of isolation of L. monocytogenes from other bacteria in the sample, a unique TAL procedure was developed by overlaying 5 ml of nonselective medium (TSA) onto prepoured and solidified MOX medium in an 8.5-cm-diameter petri dish. The injured L. monocytogenes repaired and started to grow in the TSA during the first few hours after incubation of the plate. During the resuscitation of injured cells, the selective agents from MOX diffused to the TSA top layer to inhibit other microorganisms. L. monocytogenes showed a typical reaction (black colonies) on TAL after 24 h of incubation at 37 degrees C. The recovery rate for heat-injured L. monocytogenes with the TAL method was compared with those rates associated with TSA, MOX, and the traditional overlay method (OV; pouring selective agar on top of resuscitated cells on TSA agar after 3 h incubation). Milk and 0.1% peptone water that were inoculated with L. monocytogenes (4 to 5 log CFU/ml) were heated for 15 min at 55 degrees C. L. monocytogenes was enumerated on TSA, MOX, OV, and TAL media and procedures. No significant difference occurred among TSA, OV, and TAL (P > 0.05) in terms of enumeration of heat-injured L. monocytogenes, but these media recovered significantly higher numbers than did MOX agar (P < 0.05)-in both samples. The TAL method involves only one step, whereas OV is a more cumbersome two-step procedure.

Agar↗
PubMed1999

Development of a medium for differentiation between Escherichia coli and Escherichia coli O157:H7.

A new medium (Escherichia coli O157:H7 medium: EOH) was developed for differentiation between E. coli and E. coli O157:H7. The EOH medium was compared with sorbitol MacConkey agar (SMAC), which is the most popular medium to enumerate E. coli O157:H7. Several combinations of 35 dyes were evaluated to develop the new medium. Indigo carmine (0.03) g/liter) and phenol red (0.036 g/liter) were found as the best combination for differentiation between E. coli O157:H7 and E. coli and added to the basal agar medium (SMAC medium excluding neutral red and crystal violet) for EOH medium. On the dark blue EOH medium, E. coli produced a yellow color with clear zone, whereas E. coli O157:H7 produced a red color without clear zone. For differentiation between E. coli and E. coli O157:H7, EOH has much better potential than SMAC. Furthermore. the red color produced by normal E. coli in SMAC may mask the light gray color produced by E. coli O157: H7, whereas the yellow color with clear zone did not mask the red color without clear zone in the EOH medium. The recovery numbers of E. coli O157:H7 from inoculated ground beef, pork, and turkey were not significantly different between SMAC and EOH media (P > 0.05). The recovery rates of heat- and cold-injured E. coli O157:H7 also were not significantly different (P > 0.05).

Animals↗
PubMed1999

Comparison of five anaerobic incubation methods for enumeration of Clostridium perfringens from foods.

This study compared the cost, speed, convenience, and sensitivity of five anaerobic systems. Fung's double-tube (FDT) method, the minitube method (MT), the sandwiched microtiter plate (SMP) method, and the Mitsubishi AnaeroPack System were compared with the Brewer anaerobic jar for total anaerobic bacterial counts in foods. Incubation was at 37 degrees C for 4, 8, 12, and 24 h. The results indicated that FDT, MT, SMP, and the Mitsubishi AnaeroPack System were as sensitive as the Brewer anaerobic jar for the detection and enumeration of Clostridium perfringens from food products. The FDT, MT, and SMP methods recovered higher numbers of C. perfringens compared to the Brewer anaerobic jar (P < 0.05) after 12 and 24 h incubation. The Brewer anaerobic jar was the most expensive method.

Anaerobiosis↗
PubMed1999

Effect of diacetyl on controlling Escherichia coli O157:H7 and Salmonella Typhimurium in the presence of starter culture in a laboratory medium and during meat fermentation.

Diacetyl is a flavor compound that possesses antimicrobial activity and is found in several dairy products. The effect of diacetyl on controlling the growth of two foodborne pathogens, Escherichia coli O157:H7 and Salmonella Typhimurium, when grown with Pediococcus acidilactici as a meat starter culture was evaluated in a laboratory medium and during salami fermentation. Diacetyl (50 ppm) added to each mixed culture system strongly inhibited the growth of E. coli O157:H7 and Salmonella Typhimurium in the laboratory medium (brain heart infusion, 2.3% of NaCl, 0.75% of dextrose) (P < 0.05). During meat fermentation, the growth of E. coli O157:H7 and Salmonella Typhimurium was inhibited significantly by addition of diacetyl (300 ppm) (P < 0.05) after 24 h fermentation. However, the acid production and growth of P. acidilactici were not affected by the addition of diacetyl (P > 0.05). After 24 h meat fermentation, about a 1.0-log CFU/g difference occurred in numbers of each foodborne pathogen mixed with P. acidilactici (P < 0.05) with and without 300 ppm diacetyl. Diacetyl and the acid produced by the meat starter culture reduced the growth of the two foodborne pathogens during salami fermentation. These results suggest that diacetyl can be used as a food ingredient during meat fermentation to control E. coli O157:H7 and Salmonella Typhimurium without harmful effects on the growth and acid production of P. acidilactici.

Animals↗
PubMed1999

Current status of peritoneal dialysis in Korea: efforts to achieve optimal outcome.

Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about US$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the "standard" prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/V urea > or = 2.0 and standardized creatinine clearance (SCCr) > or = 60 L/week/1.73 m2, were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.

Cause of Death↗
PubMed1998

Diagnosis of coronary vasospasm in patients with clinical presentation of unstable angina pectoris using ergonovine echocardiography.

Although coronary vasospasm can contribute to the development of unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting coronary vasospasm in patients with unstable angina. After control of chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography. Ergonovine echocardiography was performed in 52 patients with insignificant disease, and coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related arrhythmia or myocardial infarction occurred. Esophageal motility disorder and hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively. Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them chest pain redeveloped in 2 patients, and repeated ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of unstable angina, coronary vasospasm is the main cause of myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of coronary vasospasm in this setting.

Adult↗