1H NMR Serum Metabolomic Change of Trimethylamine N-oxide (TMAO) Is Associated with Alcoholic Liver Disease Progression

Without early detection and treatment, chronic and excessive alcohol consumption can lead to the development of alcoholic liver disease (ALD). With this in mind, we exploit the recent concept of the liver-gut axis and analyze the serum profile of ALD patients for identification of microbiome-derived metabolites that can be used as diagnostic biomarkers for onset of ALD. 1H-NMR was used to analyze serum metabolites of 38 ALD patients that were grouped according to their Child-Turcotte-Pugh scores (CTP): class A (CTP-A; 19), class B(CTP-B; 10), and class C (CTP-C; 9). A partial least squares-discriminant analysis (PLS-DA) and a variable importance of projection (VIP) score were used to identify significant metabolites. A receiver operating characteristic (ROC) curve and correlation heatmap were used to evaluate the predictability of identified metabolites as ALD biomarkers. Among 42 identified metabolites, 6 were significantly correlated to exacerbation of ALD. As ALD progressed in CTP-C, the levels of trimethylamine N-oxide (TMAO), malate, tyrosine, and 2-hydroxyisovalerate increased, while isobutyrate and isocitrate decreased. Out of six metabolites, elevated levels of TMAO and its precursors (carnitine, betaine, choline) were associated with severity of ALD. This indicates that TMAO can be used as an effective biomarker for the diagnosis of ALD progression.

Serum cadmium is associated with hepatic steatosis and fibrosis: Korean national health and nutrition examination survey data IV-VII

Although cadmium (Cd) is correlated with elevated levels of hepatic amino transferases, its influence on the degree of liver steatosis and fibrosis are unknown yet. We aimed to investigate the associations between the serum level of Cd and degree of liver steatosis/fibrosis.Clinical data were obtained from Korean National Health and Nutrition Examination Surveys IV-VII. Alanine aminotransferase (ALT) elevation was defined as ≥ 33 IU/L for men and ≥ 25 IU/L for women. Significant steatosis was defined as a hepatic steatosis index ≥ 36, while significant fibrosis was defined as a fibrosis index (FIB-4) ≥ 2.67 and as an aspartate aminotransferase and platelet ratio index ≥ 0.7. Adjusted odds ratios and 95% confidence intervals were calculated after adjustment.The levels of serum Cd were assessable in 15,783 subjects. The serum cadmium concentrations were significantly associated with ALT elevation, significant liver steatosis and fibrosis. Multivariate logistic regression analysis demonstrated serum Cd level in the forth quartile had a positive correlation with ALT elevation, hepatic steatosis index ≥ 36, FIB-4 ≥ 2.67 and aspartate aminotransferase-to-platelet ratio ≥ 0.7 using the first quartile of serum Cd level as the reference, (adjusted odds ratios 1.90, 1.26, 1.73, and 2.53, respectively; P values <.001).The serum level of Cd was associated with liver steatosis and fibrosis. The evaluation of serum Cd may help for assessing an unexplained liver steatosis and fibrosis, and further prospective studies are needed to confirm our findings.

Durability of Sustained Virologic Response and Improvement of Fibrosis Markers after Daclatasvir and Asunaprevir Treatment in Genotype 1b Hepatitis C Virus-Infected Patients: a Real Life and Multicenter Study

BACKGROUND

The long-term data with direct acting antiviral agents were rare. This study investigated the durability of a sustained virologic response (SVR) and the improvement of fibrosis after daclatasvir and asunaprevir (DCV/ASV) treatment in genotype 1b (GT1b) hepatitis C virus (HCV)-infected patients.

METHODS

A total of 288 HCV GT1b patients without baseline non-structural 5A (NS5A) resistance-associated substitution (RAS) treated with DCV/ASV were enrolled. Virologic response was measured at 12 weeks and 1 year after treatment completion. In cirrhotic patients, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) at baseline and 1 year after treatment completion were evaluated.

RESULTS

SVR12 was obtained in 278 patients (96.5%). Six patients who checked NS5A RAS after treatment failure were RAS positive. Only one patient showed no durability of SVR. In cirrhotic patients who achieved SVR12 (n = 59), the changes of albumin (3.8 [2.2-4.7] to 4.3 [2.4-4.9] g/dL; P < 0.001), platelet count (99 [40-329] to 118 [40-399] × 10³/mm³; P < 0.001), APRI (1.8 [0.1-14.8] to 0.6 [0.1-4.8]; P < 0.001), FIB-4 index (5.45 [0.6-32.8] to 3.3 [0.4-12.2]; P < 0.001), FI (5.5 [0.6-32.8] to 3.3 [0.4-12.2]; P < 0.001), and LSM (17.2 [5.3-48.0] to 11.2 [3.7-28.1] kPa; P = 0.001) between baseline and 1 year after treatment completion were observed.

CONCLUSION

DCV/ASV treatment for HCV GT1b infected patients without RAS achieved high SVR rates and showed durable SVR. Cirrhotic patients who achieved SVR12 showed the improvement of liver function and fibrosis markers.

Body mass index and the risk of acute pancreatitis by etiology: A prospective analysis of Korean National Screening Cohort

BACKGROUND

It is unclear whether obesity increases the incidence of acute pancreatitis (AP) in the general population. Further, no study has prospectively examined the associations of the risk of AP by etiology with measured body mass index (BMI) values.

METHODS

A total of 512 928 Korean participants in routine health examinations during 2002-2003 were followed up until 2013 via linkage to national hospital discharge records to assess AP incidence. Multivariable-adjusted hazard ratios were calculated using BMI measurements.

RESULTS

During 10.5 mean years of follow-up, 1656 persons developed AP (337 gallstone related and 1319 non-gallstone related). Nonlinear associations were found: U-curves for total and non-gallstone-related AP and a reverse L-curve for gallstone-related AP. Each 5 kg/m² increment in BMI increased gallstone-related AP by 123% (95% confidence interval = 48-234%) and non-gallstone-related AP by 42% (9-84%) in the range ≥ 25 kg/m² (P_{heterogeneity}  = 0.068). Obese persons had a doubled risk of gallstone-related AP compared with normal-weight persons. In the range < 25 kg/m² , BMI had inverse association with non-gallstone-related AP but no association with gallstone-related AP (P_{heterogeneity}  < 0.001). In subgroup analyses, for non-gallstone-related AP, hazard ratios per each 5 kg/m² BMI increment were 0.50 (men), 0.73 (women), 0.46 (alcohol drinkers), 0.69 (alcohol non-drinkers), 0.43 (ever smokers), and 0.73 (never smokers).

CONCLUSIONS

Gallstone-related AP and non-gallstone-related AP have different nonlinear associations with BMI. Higher BMI increases the risk of both gallstone-related AP and non-gallstone-related AP but more strongly for gallstone-related AP. For non-gallstone-related AP, in the range < 25 kg/m² , BMI has inverse associations that were stronger in men, current alcohol drinkers, and ever smokers than in their counterparts.

Fatty liver disease and the risk of erosive oesophagitis in the Korean population: a cross-sectional study

OBJECTIVES

To investigate an association between fatty liver disease (FLD) and erosive oesophagitis.

DESIGN AND SETTING

This was a cross-sectional study of subjects selected from examinees who underwent health check-up, including oesophagogastroduodenoscopy in one hospital between 2004 and 2011. Erosive oesophagitis was classified according to the Los Angeles classification and FLD was diagnosed with ultrasonography. The anthropometric and laboratory data of the subjects were analysed using χ² test and multivariate logistic regression. Additionally, we have analysed our data with two-stage least square estimation using the Baltagi-Chang one-way model to clarify unobserved confounding variable.

PRIMARY OUTCOME MEASURE

The effect of FLD on erosive oesophagitis.

RESULTS

Among the 14 723 eligible subjects, 4232 (28.7%) subjects diagnosed with FLD were classified into the fatty liver group and 10 491 (71.3%) subjects without FLD were classified into the non-fatty liver group. The incidence rate of erosive oesophagitis was significantly higher in the fatty liver group than in the non-fatty liver group (10.4%vs6.1%, p<0.0001). The multivariate analysis revealed that the fatty liver group was significantly associated with erosive oesophagitis (OR 1.19, 95% CI 1.03 to 1.37, p=0.016).

CONCLUSION

FLD diagnosed by ultrasonography is an independent risk factor of erosive oesophagitis. It suggests that FLD-related metabolic abnormality may be associated with erosive oesophagitis.

Risk factors for hepatocellular carcinoma by age, sex, and liver disorder status: A prospective cohort study in Korea

BACKGROUND

To the authors' knowledge, relatively little is known regarding the interaction of risk factors for hepatocellular carcinoma (HCC) with age, sex, and liver disorder status.

METHODS

The authors followed 504,646 Korean patients aged 40 to 80 years who underwent routine health checkups between 2002 and 2003 until 2013 via linkage to national hospital discharge records.

RESULTS

HCC occurred in 2744 individuals. In the sex-adjusted and age-adjusted analysis, cirrhosis increased the incidence of HCC by 42-fold, followed by hepatitis B virus (21-fold), hepatitis C virus (HCV; 19-fold), male sex (4.3-fold), and each 5-year age increment (1.24-fold). In the multivariable adjusted analysis, diabetes increased the risk of HCC by 80%, alcohol consumption ≥80 g/day increased the risk by 75%, alcohol consumption of 40 to 79 g/day increased the risk by 37%, and being a current smoker increased the risk by 25%. The multivariable adjusted hazard ratios of male sex and HCV were 6.27 and 5.72, respectively, at age <50 years, but were 2.09 and 22.51, respectively, at age ≥70 years. Each 20 g/day of alcohol consumption increased the risk of HCC by 6% (P = .11), 8% (P = .02), 16% (P<.001), and 30% (P<.001), respectively, in individuals aged <50 years, 50 to 59 years, 60 to 69 years, and 70 to 80 years. In individuals without a liver disorder, body mass index was found to be positively associated with HCC, whereas patients with a liver disorder demonstrated an inverse association. Women had higher adjusted hazard ratios associated with age and cirrhosis compared with men.

CONCLUSIONS

With advancing age, the effects of alcohol use and HCV on the development of HCC become stronger, whereas the effect of male sex weakens. Lifetime moderate alcohol consumption may cause HCC in the elderly. Smoking increases the risk of HCC irrespective of viral hepatitis, and diabetes increases the risk of HCC independent of cirrhosis. Cancer 2018;124:2748-2757. © 2018 American Cancer Society.

The IL-1B Genetic Polymorphism Is Associated with Aspirin-Induced PepticUlcers in a Korean Ethnic Group

Background/Aims

Single nucleotide polymorphisms (SNPs) are associated with aspirin-induced peptic ulcers. However, SNPs of specific genes vary among races, and data regarding SNPs in the Korean population are scarce. In this study, we aimed to investigate the relationships between SNPs of the COX-1, IL-1β, IL-1RN, and TNF genes and aspirin-induced peptic ulcers, as pilot research in a Korean population.

Methods

Patients who had been taking low-dose aspirin (100 mg) for at least 4 weeks were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed.

Results

A total of 48 patients were enrolled (23 peptic ulcer patients vs 25 nonulcer controls). Three exon SNPs (IL-1β -581C/T [rs1143627], IL-1β -1061C/T [rs16944], and IL-1RN -1129 [rs4251961]) and one intron SNP (IL-1β IVS2+242C/T) were significantly different between the two groups. On the multivariate analysis after adjustments for age and sex, the CC/CT genotypes of IL-1β -581C/T, and the CT/TT genotypes of IL-1β -1061C/T were positively associated with aspirin-induced peptic ulcers (odds ratio [OR], 4.6, 95% confidence interval [CI], 1.054 to 20.303, p=0.04; OR, 4.6, 95% CI, 1.054 to 20.303, p=0.04).

Conclusions

The IL-1β -581C/T and IL-1β -1061C/T genotypes may be associated with low-dose aspirin-induced peptic ulcers in a Korean ethnic group.

Effect of condensed corn distillers solubles concentration on lactation performance of Holstein cows

Forty-eight Holstein cows (32 multiparous and 16 primiparous) in mid to late lactation averaging 219±71 days in milk and 30.5±6.6 kg/d of 3.5% fat-corrected milk were used in a 56-d completely randomized design experiment to evaluate condensed corn distillers solubles (CCDS) inclusion in high-fiber total mixed rations (TMR). Inclusion rates evaluated were 0, 6.6, 13.2, and 19.8% CCDS as a percentage of dry matter (DM). Distiller solubles substituted for soybean meal, corn grain, and whole cottonseed such that diets were similar in protein (16.6%) and fat (4.50%). Water was added to 0, 6.6, and 13.2% CCDS treatments so that final TMR DM concentrations (47.8%) were similar across diets. The forage portion of the diet was kept constant at 19.6% annual ryegrass hay and 26.0% sorghum baleage. Diet in vitro true digestibility tended to increase as CCDS addition increased, but neutral detergent fiber digestibility trended lower in CCDS diets. Percent P (0.39, 0.55, 0.69, and 0.73%) and S (0.32, 0.35, 0.39, and 0.42%) in TMR increased as CCDS concentration increased. Milk yield (23.5, 24.7, 25.5, and 24.8 kg/d of 3.5% fat-corrected milk) was similar for control and CCDS diets. Milk fat (3.88, 3.73, 3.78, and 3.68%), protein (3.28, 3.27, 3.31, and 3.31%), and lactose (4.61, 4.66, 4.69, and 4.77) percentages were similar across diets. Milk urea nitrogen (16.60, 15.58, 15.43, and 14.75 mg/dL) declined with increasing CCDS addition. Animal activity, body weight, body condition scores, and locomotion scores were not influenced by CCDS. Day 28 poststudy locomotion scores were similar across diets. Ruminal acetate concentrations did not differ among diets, but propionate and butyrate concentrations were elevated in rumen fluid of cows receiving 19.6% CCDS. Although rumen fluid pH values were similar (6.5, 6.4, 6.3, and 6.2), the two highest CCDS diets exhibited depressed acetate:propionate ratios relative to controls. The results from this study indicate that CCDS may be included in high-fiber TMR for lactating dairy cows at up to nearly 20% of diet DM; however, caution is recommended because high CCDS P concentrations may create Ca:P imbalances and excess P may be introduced into the environment.

Serum HBV surface antigen positivity is associated with low prevalence of metabolic syndrome in Korean adult men

Background

Metabolic syndrome has clinical implications for chronic liver disease, but the relationship between chronic hepatitis B and metabolic syndrome remains unclear. The aim of this study was to determine whether hepatitis B surface antigen (HBsAg) positivity is associated with metabolic syndrome.

Methods

Data were obtained from the Third Korean National Health and Nutrition Examination Survey (KNHANES). Participant sera were tested for HBsAg. Metabolic syndrome was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III guidelines for Koreans.

Results

Of the 5108 participants, 209 (4.1%) tested positive for HBsAg, and 1364 (26.7%) were diagnosed with metabolic syndrome. The prevalence of metabolic syndrome was 23.4% in HBsAg-positive men, 31.5% in HBsAg-negative men, 18.6% in HBsAg-positive women, and 23.7% in HBsAg-negative women. After adjusting for multiple factors, male participants who tested positive for serum HBsAg had an odds ratio of 0.612 (95% confidence interval [CI] 0.375–0.998) for metabolic syndrome and an odds ratio of 0.631 (95% CI 0.404–0.986) for elevated triglycerides. Women who tested positive for serum HBsAg had an odds ratio of 0.343 (95% CI 0.170–0.693) for elevated triglycerides.

Conclusions

Positive results for serum HBsAg are inversely associated with metabolic syndrome in men and with elevated triglycerides in men and women. This suggests that elevated triglycerides may contribute to the inverse association between HBsAg and metabolic syndrome.

Bale Location Effects on Nutritive Value and Fermentation Characteristics of Annual Ryegrass Bale Stored in In-line Wrapping Silage

In southeastern regions of the US, herbage systems are primarily based on grazing or hay feeding with low nutritive value warm-season perennial grasses. Nutritious herbage such as annual ryegrass (Lolium multiflorum Lam.) may be more suitable for preserving as baleage for winter feeding even with more intensive production inputs. Emerging in-line wrapped baleage storage systems featuring rapid wrapping and low polyethylene film requirements need to be tested for consistency of storing nutritive value of a range of annual ryegrass herbage. A ryegrass storage trial was conducted with 24-h wilted ‘Marshall’ annual ryegrass harvested at booting, heading and anthesis stages using three replicated in-line wrapped tubes containing ten round bales per tube. After a six-month storage period, nutritive value changes and fermentation end products differed significantly by harvest stage but not by bale location. Although wilted annual ryegrass exhibited a restricted fermentation across harvest stages characterized by high pH and low fermentation end product concentrations, butyric acid concentrations were less than 1 g/kg dry matter, and lactic acid was the major organic acid in the bales. Mold coverage and bale aroma did not differ substantially with harvest stage or bale location. Booting and heading stage-harvested ryegrass baleage were superior in nutritive value to anthesis stage-harvested herbage. Based on the investigated nutritive value and fermentation characteristics, individual bale location within in-line tubes did not significantly affect preservation quality of ryegrass round bale silages.

Moisture concentration variation of silages produced on commercial farms in the South-central USA

Preservation of forage crops as silage offers opportunity to avoid the high risk of rain-damaged hay in the humid south-central USA. Recent developments with baled silage or baleage make silage a less expensive option than typical chopped silage. Silage has been important in the region primarily for dairy production, but baleage has become an option for the more extensive beef cattle industry in the region. Silage samples submitted to the Louisiana State University Agricultural Center Forage Quality Lab from 2006 through 2013 were assessed for dry matter (DM) and forage nutritive characteristics of chopped silage and baleage of the different forage types from commercial farms primarily in Louisiana and Mississippi. Of the 1,308 silage samples submitted, 1,065 were annual ryegrass (AR) with small grains (SG), the warm-season annual (WA) grasses, sorghums and pearl millet, and the warm-season perennial (WP) grasses, bermudagrass and bahiagrass, providing the remaining samples. Concentration of DM was used to indicate an effective ensiling opportunity, and AR silage was more frequently within the target DM range than was the WA forage group. The AR samples also indicated a high-quality forage with average crude protein (CP) of 130 g/kg and total digestible nutrient (TDN) near 600 g/kg. The cooler winter weather at harvest apparently complicated harvest of SG silage with chopped SG silage lower in both CP and TDN (104 and 553 g/kg, respectively) than either AR silage or baleage of SG (137 and 624 g/kg for CP and TDN, respectively). The hot, humid summer weather along with large stems and large forage quantities of the WA grasses and the inherently higher fiber concentration of WP grasses at harvest stage indicate that preservation of these forage types as silage will be challenging, although successful commercial silage samples of each forage type and preservation approach were included among samples of silages produced in the region.

Effect of liver dysfunction on circulating sclerostin

Sclerostin is a Wnt inhibitor produced specifically by osteocytes. It decreases bone formation by repressing osteoblast differentiation and proliferation. Whether circulating sclerostin level is affected by liver function is not currently clear. The aim of the study was to evaluate this relationship. Our cross-sectional study included 47 patients with liver cirrhosis and 50 healthy controls. Serum sclerostin level was analyzed by ELISA. Serum sclerostin levels were significantly higher in patients with cirrhosis than in controls (50.8 ± 38.2 vs. 35.1 ± 8.8 pmol/L, p = 0.008). After further adjustment for age, sex, body mass index, serum creatinine, and presence of diabetes, cirrhosis patients had higher sclerostin than controls. Subgroup analysis found that patients with Child-Pugh class B or C had higher sclerostin levels than patients with class A or controls after adjusting for multiple confounding factors. Multiple regression analysis showed that gender (p = 0.022), presence of diabetes (p < 0.001), albumin (p = 0.010), and serum creatinine (p = 0.037) were independent factors for circulating sclerostin level. Circulating sclerostin was higher in patients with advanced liver cirrhosis than in healthy controls or patients with early liver cirrhosis. The elevated sclerostin levels clearly correlated with markers of liver dysfunction such as albumin. The relationship between circulating sclerostin and liver function indicates a possible role of the liver in sclerostin metabolism.

Individual prediction model for lamivudine treatment response in hepatitis B virus e antigen-positive chronic hepatitis B patients

BACKGROUND AND AIMS

Although prolonged lamivudine (LAM) therapy is associated with the emergence of LAM-resistant mutations, it is still a commonly used therapy in many Asian countries because of its established long-term safety and low cost. The aim of our study was to assess the predictors of long-term LAM treatment response and to establish an individual prediction model (IPM) for hepatitis B virus e antigen (HBeAg) seroconversion in HBeAg-positive chronic hepatitis B (CHB) patients.

METHODS

This was a multicenter analysis of 838 patients treated with LAM between January 1999 and August 2004. Of these, 748 patients were followed up for at least 24 months.

RESULTS

The median age was 43.0 years (range, 19-79 years) and the mean duration of LAM monotherapy was 34.2 ± 0.7 months. In the multivariate analysis, age (odds ratio [OR] = 0.974, P < 0.001), baseline alanine aminotransferase level (OR = 1.001, P = 0.014), and baseline hepatitis B virus DNA level (OR = 0.749, P < 0.001) were independent factors for HBeAg seroconversion. Based on the predictors, an IPM was established. Patients were classified into high (> 50%), intermediate (30-50%), or low (≤ 30%) response groups based on their probability of HBeAg seroconversion according to the IPM. The cumulative HBeAg seroconversion rate at 6 years for the high, intermediate, and low response groups was 66.0%, 48.5%, and 21.8%, respectively (P < 0.001).

CONCLUSIONS

An IPM was developed based on predictors of HBeAg seroconversion in HBeAg-positive CHB patients on LAM monotherapy. This model will allow screening of LAM responders prior to the commencement of antiviral treatment.

NSAID is inversely associated with asymptomatic gastric ulcer: local health examination data from the Korean National Health Insurance Corporation

BACKGROUND. Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. AIM. We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. METHODS. The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. RESULTS. From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, p = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. CONCLUSION. NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.

[A case of IgG4 associated sclerosing cholangitis without clinical manifestations of autoimmune pancreatitis]

IgG4-related systemic diseases are characterized by a diffuse or mass forming inflammatory reaction rich in lymphocytes and IgG4-positive plasma cells (lymphoplasmacytic infiltration), fibrosclerosis of variable organs and obliterative phlebitis. They usually involve various organs including the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate. However, most of them are accompanied by autoimmune pancreatitis, and good response to steroid treatment is one of the hallmarks of this disease. We report a case of an 67-year-old man with IgG4 associated sclerosing cholangitis, who was diagnosed by endoscopic retrograde cholangiopancreatography and successfully treated with steroid therapy.

Is esophagogastroduodenoscopy necessary in patients with positive fecal occult blood tests and negative colonoscopy?

BACKGROUND

False positives of fecal occult blood tests (FOBT) regarding colorectal cancer detection are common. The aim was to investigate the upper gastrointestinal (GI) condition confirmed by endoscopy in positive FOBT patients without advanced colorectal neoplasia, hemorrhoid, or colitis.

METHODS

The authors reviewed the collective data of 340 positive FOBT patients who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy from January 2005 to October 2011. Demographic data, effects of medications, including antiplatelet agents, nonsteroidal anti-inflammatory drugs, or warfarin on the results of FOBT, presence or absence of GI mucosal lesions confirmed by EGD and colonoscopy, and FOBT titer in 552 positive FOBT patients were analyzed.

RESULTS

On colonoscopy, colorectal cancer was detected in 35 patients (10.3%), advanced adenoma in 22 patients (6.4%). "Negative colonoscopy" included no significant lesions and non-advanced adenomas. In 243 patients with "negative colonoscopy", EGD findings included 3 (1.2%) gastric cancers and 39 (16%) peptic ulcer diseases. Gastric cancers were all found in patients who had no experience of EGD within 2 years; however, the incidence of peptic ulcer disease was not different in patients with or without previous EGD within 2 years. Two or more antiplatelet agents increased false positive rates of FOBT.

CONCLUSIONS

Upper GI evaluation is mandatory in patients with positive FOBTs and negative colonoscopy especially in patients without experience of EGD within 2 years.

A pilot study of single-use endoscopy in screening acute gastrointestinal bleeding

AIM: To investigate the feasibility of a single-use endoscopy as an alternative procedure to nasogastric lavage in patients with acute gastrointestinal (GI) bleeding.

METHODS: Patients who presented with hematemesis, melena or hematochezia were enrolled in this study. EG scan™ and conventional esophagogastroduodenoscopy (EGD) were subsequently performed. Active bleeding was defined as blood in the stomach, and inactive bleeding was defined as coffee ground clots and clear fluid in the stomach. The findings were recorded and compared.

RESULTS: Between January and March, 2011, 13 patients that presented with hematemesis (n = 4), melena (n = 6), or bleeding from a previous nasogastric feeding tube (n = 3), were enrolled in this study. In 12 patients with upper GI bleeding, the EG scan device revealed that 7 patients had active bleeding and 5 patients had inactive bleeding, whereas conventional EGD revealed that 8 patients had active bleeding and 4 patients had inactive bleeding. The sensitivity and specificity of the EG scan device was 87.5% and 100% for active bleeding, with conventional EGD serving as a reference. No complication were reported during the EG scan procedures.

CONCLUSION: The EG scan is a feasible device for screening acute upper GI bleeding. It may replace nasogastric lavage for the evaluation of acute upper GI bleeding.

[A case of emphysematous gastritis in a patient with end-stage renal disease]

Emphysematous gastritis is a rare infection of the stomach wall with high mortality rate. It is caused by gas forming organisms and may arise by local spread through the mucosa or hematogenous dissemination from distant focus. Clinical manifestation includes acute abdomen with systemic toxicity, and diagnosis is based on radiologic demonstration of gas within the gastric wall. Treatment should be aimed to cover gram-negative organisms and anaerobes using wide-spectrum intravenous antibiotics, and sometimes surgical management may be needed in order to enhance survival. Herein, we report a case of emphysematous gastritis in a patient with end stage renal disease on hemodialysis.

Forage conservation efficiency and lactation response to bahiagrass conserved as barn-stored hay, outdoor-stored hay, or baleage

A study was conducted to determine the effect of conserving bahiagrass as outdoor-stored hay (OSH), barn-stored hay (BSH), or baleage (BAL) on storage losses and lactation performance by Holstein cows. For baleage production, bahiagrass forage was cut and allowed to dry for 20 h in windrows, baled (1.2 × 1.4 m), and individually wrapped with white stretch film. Forage cut on the same day was dried to hay stage, baled (1.2 × 1.6 m round bales), and stored either outdoors (OSH) or in an enclosed hay barn (BSH). Bales were core sampled and weighed at harvest and again following a 6-mo storage period. At the end of the storage period, 30 multiparous mid-lactation Holstein cows [39.2 ± 5.6 kg of 3.5% fat-corrected milk and 142 ± 27 d in milk (DIM)] were stratified according to milk yield and DIM and randomly assigned to 1 of the 3 forage conservation treatments. Cows were trained to Calan feeding gates and were offered a common partial mixed ration in a 10-d covariate period followed by a 42-d treatment feeding period. Forage dry matter losses were highest for OSH, but were similar between BSH and baleage. Conservation method had little effect on poststorage crude protein levels, but acid detergent fiber and neutral detergent fiber concentrations were higher in OSH than in either BSH or BAL, which resulted in a 12.8% depression in net energy for OSH compared with the other treatments. Dry matter intake (20.5 vs. 22.1 kg/d) and milk yield (28.2 vs. 30.2 kg/d) tended to be lower for OSH than for BSH. Lactation performance was similar between BSH and BAL: 29.6 versus 28.7 kg/d of fat-corrected milk, respectively. No differences in milk composition, feed efficiency, body weight, or body condition score change related to conservation system were observed. In this study, dry matter losses and lactation performance from bahiagrass conserved as baleage were similar to that of similar forage stored indoors as hay, whereas hay stored outside resulted in less satisfactory forage quality.

Old age and male sex are associated with increased risk of asymptomatic erosive esophagitis: analysis of data from local health examinations by the Korean National Health Insurance Corporation

BACKGROUND AND AIMS

Silent gastroesophageal reflux disease (GERD) is often detected during routine screening esophagogastroduodenoscopy (EGD). However, the risk factors and clinical implications of silent GERD remain unclear. In the present study, we investigated the risk factors for asymptomatic erosive esophagitis by analyzing the local area health examination data.

METHODS

The Korean National Health Insurance Corporation provides a bi-annual health examination performed by qualified local hospitals for the early detection of cancer in medical insurance holders over 40 years of age. Participants who completed self-reported questionnaires on health, followed by EGD at the Myongji Hospital (Goyang, Korea), were enrolled in this study.

RESULTS

The data of a total of 5301 participants who underwent EGD between January 2005 and December 2008 were analyzed. The prevalence of erosive esophagitis was 6%. In the multivariate analysis, erosive esophagitis was strongly associated with an age greater than 60 years (odds ratio [OR]: 0.7, 95% confidence interval [CI]: 0.6-1.0), male sex (OR: 2.3, 95% CI: 1.7-3.0), hiatus hernia (OR: 2.9, 95% CI: 2.1-4.0), duodenal ulcer (OR: 1.6, 95% CI: 1.1-2.5), hypertension (OR: 1.5, 95% CI: 1.2-2.0), and smoking (OR: 1.4, 95% CI: 1.0-1.8). Of the 320 participants with erosive esophagitis, 145 (45.3%) were asymptomatic participants, and those who were more frequently greater than 60 years (OR: 1.8, 95% CI: 1.1-3.1) and male (OR: 1.8, 95% CI: 1.1-3.2).

CONCLUSIONS

Asymptomatic erosive esophagitis in adults older than 40 years is strongly associated with old age (≥ 60 years) and male sex compared with symptomatic erosive esophagitis.

Role of the coinhibitory receptor cytotoxic T lymphocyte antigen-4 on apoptosis-Prone CD8 T cells in persistent hepatitis B virus infection

An excess of coinhibitory signals has been proposed to drive the T-cell exhaustion characteristic of persistent viral infections. In this study we examined the contribution of the coinhibitory receptor cytotoxic T lymphocyte antigen-4 (CTLA-4) to CD8 T cell tolerance in chronic hepatitis B virus (HBV) infection (CHB). CD8 T cells in patients with CHB have an increased propensity to express the coinhibitory receptor CTLA-4 and this correlates with viral load. CTLA-4 is up-regulated on those HBV-specific CD8 T cells with the highest levels of the proapoptotic protein Bim, which we have previously shown mediates their premature attrition; abrogation of CTLA-4-mediated coinhibition can reduce Bim expression. Longitudinal study of CHB patients beginning antiviral therapy reveals that HBV DNA suppression induces transient reconstitution of HBV-specific CD8 T cells but does not reprogram their CTLA-4(hi) Bim(hi) tolerogenic phenotype. Blocking CTLA-4 is able to increase the expansion of interferon gamma (IFN-γ)-producing HBV-specific CD8 T cells in both the peripheral and intrahepatic compartments. The rescue of anti-HBV responses by either CTLA-4 or PD-L1 blockade is nonredundant.

CONCLUSION

CTLA-4 is expressed by HBV-specific CD8 T cells with high levels of Bim and helps to drive this proapoptotic phenotype. CTLA-4 blockade could form one arm of a therapeutic approach to modulate the diverse patterns of coregulation of T-cell exhaustion in this heterogeneous disease.

Lamivudine maintenance beyond one year after HBeAg seroconversion is a major factor for sustained virologic response in HBeAg-positive chronic hepatitis B

The reported durability of virologic response after successful lamivudine monotherapy is variable, and the question remains as to whether virologic responses can be maintained over an extended follow-up period. The aim of this study was to investigate posttreatment durability, the optimal duration of additional treatment after HBeAg clearance or seroconversion, and determinants for sustained virologic response (SVR) following lamivudine monotherapy in patients with HBeAg-positive chronic hepatitis B (CHB). From January 1999 to August 2004, 178 Korean patients with HBeAg-positive CHB were treated with lamivudine and achieved complete responses, defined as a loss of serum HBeAg and hepatitis B virus DNA, and alanine aminotransferase normalization. The mean duration of lamivudine monotherapy was 26 months (range, 12-77). SVR was maintained in 138 patients (77.5%). Host and viral factors were compared between 138 patients with SVR and 40 patients whose response was not sustained. The cumulative relapse rates increased from 15.9% at 1 year to 30.2% at 5 years, with a mean time to relapse after cessation of lamivudine of 12 months (range, 7-42). Most relapses occurred within 2 years after discontinuation of lamivudine (33/40, 82.5%). On multivariate analysis, age <or=40 years and additional treatment for more than 12 months after HBeAg clearance or seroconversion were independent factors for SVR.

CONCLUSION

The lamivudine-induced virologic response was durable in patients under 40 years old and those receiving lamivudine for more than 12 months after HBeAg clearance or seroconversion. Age and additional treatment were major predictive factors for SVR.

The TiO(2) nanoparticle effect on the performance of a conducting polymer Schottky diode

Among the conjugate polymers, poly(3,4-ethylenedioxythiophene):poly (styrenesulfonate) (PEDOT:PSS) has been paid a great deal of attention for various application fields. The absorption intensity of the whole UV-visible range increases linearly, as the concentration of PEDOT:PSS increases. When a small amount of TiO(2) nanoparticles are dispersed in the PEDOT:PSS solution, the absorption in the visible range normally increases, but the UV range absorption (TiO(2) absorption area) is greatly depressed as the concentration of PEDOT:PSS increases. Various weight ratios of TiO(2) nanoparticles in PEDOT:PSS were prepared. The TiO(2)/PEDOT:PSS solution was spin-coated onto the Al electrode and thermally treated to remove water molecules and densify the film. These thermal processes generated nanocracks and nanoholes on the surface of the TiO(2)/PEDOT:PSS film. As the heating temperature increased, wider and longer nanocracks were generated. These nanocracks and nanoholes can be removed by subsequent coating and heating processes. Schottky diodes were fabricated using four different concentrations of TiO(2)-PEDOT:PSS solution. The forward current increased nearly two orders of magnitude by doping approximately 1% of TiO(2) nanoparticles in PEDOT:PSS. Increasing the TiO(2) nanoparticles in the PEDOT:PSS matrix, the forward current was continuously enhanced. The enhancement of forward current is nearly four orders of magnitude with respect to the pristine PEDOT:PSS Schottky diode. The possible conduction mechanisms were examined by using various plotting and curve-fitting methods including a space-charge-limited conduction mechanism [Ln(J) versus Ln(V)], Schottky emission mechanism [Ln(J) versus E(1/2)], and Poole-Frenkel emission mechanism [Ln(J/V) versus E(1/2)]. The plot of Ln(J) versus Ln(V) shows a linear relationship, implying that the major conduction mechanism is SCLC. As the concentration of TiO(2) increased, the conduction mechanism slightly detracted from the ideal SCLC mechanism.

A case of successful treatment of stomal variceal bleeding with transjugular intrahepatic portosystemic shunt and coil embolization

Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.

The JAK2 V617F mutation in de novo acute myelogenous leukemias

A missense somatic mutation in JAK2 gene (JAK2 V617F) has recently been reported in chronic myeloproliferative disorders, including polycythemia vera, essential thrombocythemia and myelofibrosis with myeloid metaplasia, strongly suggesting its role in the pathogenesis of myeloid disorders. As activation of JAK2 signaling is occurred in other malignancies as well, we have analysed 558 tissues from common human cancers, including colon, breast and lung carcinomas, and 143 acute adulthood leukemias by polymerase chain reaction -- single strand conformation polymorphism analysis. We found three JAK2 mutations in the 113 acute myelogenous leukemias (AMLs) (2.7%), but none in other cancers. The mutations consisted of two V617F mutations and one K607N mutation. None of the AML patients with the JAK2 V617F mutation had a history of previous hematologic disorders. This is the first report on the JAK2 gene mutation in AML, and the data indicated that the JAK2 gene mutation may not only contribute to the development of chronic myeloid disorders, but also to some AMLs.

[A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement]

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.

A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

A new member of alpha 1-adrenoceptor-coupled G alpha h (transglutaminase II) family in pig heart: purification and characterization

We previously reported an identification of a 77-kDa GTP-binding protein that co-purified with the alpha 1-adrenoceptor following ternary complex formation. In the present paper, we report on the purification and characterization of this GTP-binding protein (termed G alpha h5) isolated from pig heart membranes. After solubilization of pig heart membranes with NaCl, G alpha h5 was purified by sequential chromatographies using DEAE-Cellulose, Q-Sepharose, and GTP-agarose columns. The protein displayed high-affinity GTP gamma S binding which is Mg(2+)-dependent and saturable. The relative order of affinity of nucleotide binding by G alpha h5 was GTP > GDP > ITP >> ATP > or = adenyl-5'-yl imidodiphosphate, which was similar to that observed for other heterotrimeric G-proteins involved in receptor signaling. Moreover, the G alpha h5 demonstrated transglutaminase (TGase) activity that was blocked either by EGTA or GTP gamma S. In support of these observations, the G alpha h5 was recognized by a specific antibody to G alpha h7 or TGase II, indicating a homology with G alpha h (TGase II) family. These results demonstrate that 77-kDa G alpha h5 from pig heart is an alpha 1-adrenoceptor-coupled G alpha h (TGase II) family which has species-specificity in molecular mass.

Identification of a distinct molecular mass G alpha(h) (transglutaminase II) coupled to alpha1-adrenoceptor in mouse heart

Our previous studies on alpha1-adrenoceptor signaling suggested that G alpha(h) family is a signal mediator in different species. To elucidate the species-specificity of G alpha(h) family in molecular mass, we used the solubilized membranes from mouse heart and the ternary complex preparations containing alpha1-agonist/receptor/G-protein. Binding of [35S]GTPgammaS and the intensity of the [alpha-32P]GTP photoaffinity labeled protein resulting from activation of the alpha1-adrenoceptor were significantly attenuated by the antagonist, phentolamine. The molecular mass of the specific GTP-binding protein was approximately 72-kDa; homologous with G alpha(h) (transglutaminase II) family. Furthermore, immunological cross-reactivity of ternary complex from mouse heart and purified G alpha(h) from rat, guinea pig, and bovine using anti-G alpha(h7) antibody showed that their molecular masses were distinctly different and approximately 72-kDa G alpha(h) from mouse heart was the lowest molecular mass. Consistent with these observations, in co-immunoprecipitation and co-immunoadsorption of the alpha1-adrenoceptor in the ternary complex preparation by anti-G alpha(h7) antibody, the G alpha(h) family protein tightly coupled to alpha1-adrenoceptor. These results demonstrate the species-specificity of G alpha(h) family in molecular mass, especially the lowest molecular mass in mouse.

Phospholipase C-delta1 and oxytocin receptor signalling: evidence of its role as an effector

Although the oxytocin receptor modulates intracellular Ca2+ ion levels in myometrium, the identities of signal molecules have not been clearly clarified. Our previous studies on oxytocin receptor signalling demonstrated that 80 kDa Ghalpha is a signal mediator [Baek, Kwon, Lee, Kim, Muralidhar and Im (1996) Biochem. J. 315, 739-744]. To elucidate the effector in the oxytocin receptor signalling pathway, we evaluated the oxytocin-mediated activation of phospholipase C (PLC) by using solubilized membranes from human myometrium and a three-component preparation containing the oxytocin receptor-Ghalpha-PLC-delta1 complex. PLC-delta1 activity in the three-component preparation, as well as PLC activity in solubilized membranes, was increased by oxytocin in the presence of Ca2+ and activated Ghalpha (GTP-bound Ghalpha). Furthermore the stimulated PLC-delta1 activity resulting from activation of Ghalpha via the oxytocin receptor was significantly attenuated by the selective oxytocin antagonist desGly-NH2d(CH2)5[Tyr(Me)2,Thr4]ornithine vasotocin or GDP. Consistent with these observations, co-immunoprecipitation and co-immunoadsorption of PLC-delta1 in the three-component preparation by anti-Gh7alpha antibody resulted in the PLC-delta1 being tightly coupled to activated Ghalpha on stimulation of the oxytocin receptor. These results indicate that PLC-delta1 is the effector for Ghalpha-mediated oxytocin receptor signalling.

Graft-versus-host disease--clinical and pathological analysis of 11 biopsy proven cases

Graft-versus-host disease (GVHD) is a life threatening complication that may occur following allogenic bone marrow transplantation (BMT) in the patients with aplastic anemia, leukemia or genetic immunodeficiency. It has been known that GVHD occurs approximately 70% of recipients of BMT in western countries but no definite incidence has been reported in Korea. In our St. Mary's Hospital, GVHD occurs in about 30% of BMT recipients. Histopathologically the acute phase skin shows diffuse lymphocytic infiltrates in the upper dermis with extensive exocytosis. Scattered throughout the epidermis are many degenerated keratinocytes, which are often associated with one or more satellite lymphocytes (satellite cell necrosis). In the chronic phase, acanthosis, eosinophilic keratinocytes resembling colloid bodies and mononuclear cell infiltrates in the upper dermis are noted. We reviewed 5 cases of acute GVHD and 6 cases of chronic GVHD. All patients received allogenic BMT from Jan. 1, 1992 to July 1, 1993. Ten patients were male and one was female. The mean age was 34 (20-70). The pathologic diagnosis was 3 cases of CML, 2 of ALL, 2 of AML (FAB M2), 2 of aplastic anemia, 1 of CLL and 1 of AML (FAB M5). The interval from BMT to GVHD varied from 14 days to 4 years (median 220 days). The skin and GI tract were involved in all eleven cases. Ten cases were histologically proven by skin biopsies, and two cases by salivary gland and colonic biopsies, respectively. The histological findings of the skin, salivary gland and colonic biopsieds were described. Immunohistochemical stain of the skin was done using CD4, CD8, HLA DR and Leu 7 antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Allogeneic bone marrow transplantation for the patients with hemopoietic stem cell disorders: CUMC experience

Bone marrow transplantation from an HLA-identical sibling is increasingly used as a curative therapy for patients with hemopoietic stem cell disorders including acute leukemia, chronic myelogenous leukemia and severe aplastic anemia. Between March 1983 and March 1991, we performed 86 cases of allogeneic bone marrow transplantation (BMT) for the patients with hemopoietic stem cell disorders: 25 acute myelogenous leukemia (AML); 15 acute lymphoblastic leukemia (ALL); 20 chronic myelogenous leukemia (CML); and 26 severe aplastic anemia (SAA). Ten out of 25 AML are in disease free survival (DFS). The causes of death were recurrence of leukemia (12), acute GVHD (3), sepsis (1) and veno-occlusive disease (1). Nine of 15 ALL are in unmaintained remission. Thirteen out of 20 CML are in DFS. Among 26 SAA, 21 are enjoying DFS, but 1 died of engraftment failure, 3 of graft rejection followed by cytomegalovirus (1) and aspergillus pneumonia (1). Comparing the survival between standard [less than or equal to CR1: 9/14 (64%)] and high risk [greater than or equal to CR1: 1/11 (9%)] AML, our data suggest that preparative regimen for high risk AML was not potent enough to eradicate the minimal residual disease in advanced AML. Although our cases are limited and the follow-up period is short, our result of ALL [overall: CCR (60%), standard risk (adult less than or equal to CR1, children less than or equal to CR2; 8/11 (73%) and high risk; 1/4 (25%)] and CML [overall: 65%, CP; 9/10 (90%), AP; 4/6 (67%), BP; 0/4 (0%)] are optimistic. It is of our interest that the incidence of death related with IP (1/33: 3%) and with AGVHD 94/33: 12%) were much less than that of other's observation but the explanation for this still remains to be clear.

[A study on the change of the primipara mother-infant interaction by infant's age in months]

The intent of this longitudinal descriptive correlational study is to investigate the change of the mother-infant interactions over the periods of one month, three months and six months of the infant's age. This study is also intended to explore the interrelationships among three major factors--the perception of pregnancy, the mother-infant interaction and the maternal attitude. The samples participated are 36 pairs of mother and infant from two university hospitals in Seoul. A data collection was made, from October in 1988 to September in 1989, for each subject at five periods of time; prenatal period (after 36 weeks in pregnancy), postpartum two or three days, one month, three months and six months of infant's age. The research tools used in this investigation are Mother-Infant Play Interaction Scale (MIPIS), Prenatal Self-Evaluation Questionnaire and Cohler's Maternal Attitude Scale. Some of the findings are as follows; 1. There is a significant increase in the mother-infant interaction from one month to three months and six months of infant's age. The highest score of the mother-infant interaction during three periods is at the time of three months. 2. The primipara's mother-infant interaction is not affected by the demographic characteristics, such as age, education and vocation of mother, types of delivery, or sex of infant. 3. Among seven categories of the perception of pregnancy, the most positively perceived categories by primiparas are acceptance of pregnancy and identification of a motherhood role; whereas the negative ones are preparation for labor, concern for well-being of self and baby, and fear of pain, helplessness and loss of control in order of negativity. 4. There is no significant relationship between the perception of pregnancy and the mother-infant interactions. 5. There is no significant change in the maternal attitude over the period of one month, three months, and six months of infant's age. 6. There is no significant relationship between the maternal attitude and the mother-infant interactions. 7. The significant relationships are found between the perception of pregnancy and maternal attitude, especially in the categories of concern for well-being of self and baby, acceptance of pregnancy, identification of a motherhood role, fear of pain, helplessness and loss of control, and relationship with husband. In conclusion, it is confirmed that primipara's mother-infant interactions change over time period, and that perception of pregnancy and the maternal attitude do not affect the mother-infant interactions despite a significant relationship between those two variables.(ABSTRACT TRUNCATED AT 400 WORDS)

[A phenomenological study on mother-infant interacting behavior patterns relating to newborn infant feeding in Korea]

The purpose of this study was to describe mother-infant interacting behavior patterns related to newborn infant feeding and to explore the mother's cultural belief about their infant. The data collection was conducted by observation and interview. Twenty-five mothers and their newborn infants who were normally delivered and were also planned to breastfeed were comprised as the subjects of this study. All subjects were interviewed and observed individually at 1 to 5 days after the delivery at the hospital, mid-wife's clinic, Maternal Child Health Center and their home throughout the country from remote area to big city. The observation data were recorded with symbolic letter on a recording sheet newly developed as a result of preliminary study. The interview data were tape recorded and then recorded in narrative form. Mother-infant interaction behaviors in early-feeding period were analyzed based on 19 analytic sub-categories and their composing elements. Unit of analysis were mother, infant and mother-infant dyad. 8 analytic categories draw from the data. Each were preparation, instrument, interaction inducing, evaluation referred to mother's behavior, preparation, instrument, interaction inducing referred to infant's behavior and synchronic behaviors referred to mother-infant dyad. Frequencies of behavior items based on the categories were converted to percent. The result showed that in mother's preparation behavior, the breast condition of Korean mother can be an affecting factor for mother-infant interaction during feeding, and vocalization behavior was observed most frequently in interaction inducing behavior while the least frequent behavior observed was contacting. Subcultural characteristics of mother-infant interaction behaviors were analyzed for their relationships between groups of mothers who have lived in remote area vs urban area, and who were multipara vs primipara. Using a chi-square test, there were statistically significant relationships in the activity of psychological readiness in preparation behavior and the movement of extremities for the position of instrumental behavior in both groups. However, interaction inducing behaviors were not related with statistical significance in any set of groups. Accomplishment of marriage, bonding and emotional mediation of family members were the categories related to mother's cultural belief about the infant in aspect of functional values. Infant at birth is considered little more than a biological organism without social capabilities. Although the newborn infant is still be attached to his mother, he makes his mother extend her territoriality. The mother's interacting behavior toward her infant based on those beliefs appeared task oriented, separative behavioral series.(ABSTRACT TRUNCATED AT 400 WORDS)

[A study mother-infant interaction and maternal identity in mother-infant dyads of premature and full-term infants]

The study was conducted to examine Mother-Infant interaction and Maternal identity in two groups, that is, premature infant and its mother and full-term infant and its mother. For this purpose, the data were collected from 24 sample groups (12 for premature dyads and the remaining 12 for full-term dyads) by using observation method and questionnaires during July 20 through September 30, 1987. The results are summarized as follows: 1. In terms of Mother-Infant Interaction, full-term dyads considerably stood out compared to that of premature dyads (u = 21, p less than 0.01). 2. In terms of Maternal Identity, though full-term dyads showed somewhat high results, there was not a significant difference between two groups. 3. There was not a significant correlation between Mother-Infant Interaction and Maternal Identity.