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PDF - 73K, Supplementary Table S1. Effects of Various NSAIDs on Urinary 11-α-hydroxy-9, 15-dioxo-2, 3, 4, 5-tetranor-prostane-1, 20-dioic acid (PGE-M) levels.

Naproxen [(S)-6-methoxy-α-methyl-2-naphthaleneacetic acid] is a potent nonsteroidal anti-inflammatory drug that inhibits both COX-1 and COX-2 and is widely used as an over-the-counter medication. Naproxen exhibits analgesic, antipyretic, and anti-inflammatory activities. Naproxen, as well as other nonsteroidal anti-inflammatory drug, has been reported to be effective in the prevention of urinary bladder cancer in rodents. However, potential targets other than the COX isozymes have not been reported. We examined potential additional targets in urinary bladder cancer cells and in rat bladder cancers. Computer kinase profiling results suggested that phosphoinositide 3-kinase (PI3K) is a potential target for naproxen. In vitro kinase assay data revealed that naproxen interacts with PI3K and inhibits its kinase activity. Pull-down binding assay data confirmed that PI3K directly binds with naproxen in vitro and ex vivo. Western blot data showed that naproxen decreased phosphorylation of Akt, and subsequently decreased Akt signaling in UM-UC-5 and UM-UC-14 urinary bladder cancer cells. Furthermore, naproxen suppressed anchorage-independent cell growth and decreased cell viability by targeting PI3K in both cell lines. Naproxen caused an accumulation of cells at the G1 phase mediated through cyclin-dependent kinase 4, cyclin D1, and p21. Moreover, naproxen induced significant apoptosis, accompanied with increased levels of cleaved caspase-3, caspase-7, and PARP in both cell types. Naproxen-induced cell death was mainly because of apoptosis in which a prominent downregulation of Bcl-2 and upregulation of Bax were involved. Naproxen also caused apoptosis and inhibited Akt phosphorylation in rat urinary bladder cancers induced by N-butyl-N-(4-hydroxybutyl)-nitrosamine. Cancer Prev Res; 7(2); 236–45. ©2013 AACR.

PDF - 982K, Supplementary figure 2. Common gene network for NO-naproxen and naproxen treated rat liver.

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Urinary bladder cancer prevention studies were performed with the nonsteroidal anti-inflammatory drugs (NSAID) naproxen (a standard NSAID with a good cardiovascular profile), sulindac, and their nitric oxide (NO) derivatives. In addition, the effects of the ornithine decarboxylase inhibitor, difluoromethylornithine (DFMO), alone or combined with a suboptimal dose of naproxen or sulindac was examined. Agents were evaluated at their human equivalent doses (HED), as well as at lower doses. In the hydroxybutyl(butyl)nitrosamine (OH-BBN) model of urinary bladder cancer, naproxen (400 or 75 ppm) and sulindac (400 ppm) reduced the incidence of large bladder cancers by 82%, 68%, and 44%, respectively, when the agents were initially given 3 months after the final dose of the carcinogen; microscopic cancers already existed. NO-naproxen was highly effective, whereas NO-sulindac was inactive. To further compare naproxen and NO-naproxen, we examined their effects on gene expression in rat livers following a 7-day exposure. Limited, but similar, gene expression changes in the liver were induced by both agents, implying that the primary effects of both are mediated by the parent NSAID. When agents were initiated 2 weeks after the last administration of OH-BBN, DFMO at 1,000 ppm had limited activity, a low dose of naproxen (75 ppm) and sulindac (150 ppm) were highly and marginally effective. Combining DFMO with suboptimal doses of naproxen had minimal effects, whereas the combination of DMFO and sulindac was more active than either agent alone. Thus, naproxen and NO-naproxen were highly effective, whereas sulindac was moderately effective in the OH-BBN model at their HEDs. Cancer Prev Res; 7(2); 246–54. ©2013 AACR.

PDF file - 85K, The effect of naproxen on JNK1 (A), Akt1 (B), Akt2 (C) and Src (D) kinase activities. Active JNK1 (20 ng), Akt1 (50 ng), Akt2 (50 ng) or Src (400 ng) was mixed with naproxen (0, 0.5, 1 or 2 mM) and then incubated with gamma-32P ATP. The radioactive incorporation was determined using a scintillation counter.

Aims: To investigate the diagnostic performance of ultrasound-guided attenuation parameter (UGAP) for the detection of hepatic steatosis in nonalcoholic fatty liver disease (NAFLD) cohorts using histopathology as the reference standard andcomparing it with that of various imaging modalities.Materials and methods: A total of 87 subjects who underwent UGAP, controlled attenuation parameter (CAP), and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) between December, 2020 and January, 2022 were enrolled. Of these patients, 38 patients had NAFLD. The association between UGAP and clinical and imaging parameters was assessed using Pearson’s or Spearman’s correlations. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance.Results: The UGAP and MRI-logPDFF demonstrated strong positive correlations (correlation coefficient= 0.704, P

Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg1.5 mL/kg, and Perlas grade.CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871).Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.

The purpose of our study was to validate the oral effervescent agent improving magnetic resonance cholangiopancreatography (MRCP) in patients with suspicious pancreatobiliary disease.One hundred and eleven consecutive patients with alleged or suspected pancreatobiliary tree problems who had undergone two-dimensional (2D) MRCP imaging both before and after oral effervescent enhancement (conventional-MRCP and enhanced-MRCP) were included. Two radiologists independently scored overall image quality, visualization of ten ductal segments, and gastroduodenal fluid signal intensity score. In consensus, they assessed the presence of gastroduodenal fluids and pancreatobiliary tree overlapping. The data were analyzed using Wilcoxon's signed-rank test, McNemar test, and pairedThe grades of overall image quality and individual biliary duct visualization for ten targeted ductal segments, and gastroduodenal fluid signal intensity scores increased significantly on enhanced-MRCP by both readers (P≤0.02), but there was no significant increase for pancreatic duct (PD) at head and tail. On enhanced-MRCP, gastroduodenal fluids except for gastric fundus were less detected rather than those on conventional-MRCP. Anatomic structures of gastroduodenal fluids overlapping extrahepatic bile duct were mainly gastric antrum, duodenal bulb, and 2nd portion on conventional-MRCP. However, these fluids were less overlapped on enhanced-MRCP (P0.001). Gastric body and antrum were main anatomic structures of gastroduodenal fluids overlapping PD on conventional-MRCP, and fluid in these locations significantly less overlapped PD on enhanced-MRCP (P≤0.02).Oral administration of effervescent agent provided effective elimination of gastroduodenal fluid overlapping pancreatobiliary ductal system at MRCP and can improve the quality of the examination in the patients with known or suspected pancreatobiliary disease.

Background Significant hepatic fibrosis is associated with higher mortality. However, data on the estimated prevalence of liver fibrosis in the general population are scarce. Aim To use magnetic resonance elastography (MRE) to investigate the prevalence of hepatic fibrosis in a Korean health check-up clinic cohort. Methods We enrolled 2170 participants at our health check-up clinic between January 2015 and May 2018, all of whom had MR with chemical shift technique and MRE. The primary objective was to estimate the prevalence of liver fibrosis. For generalisation, sex- and age-standardised prevalence was calculated based on the Korean Statistical Information Service (KOSIS) during the period 2015-2018. Results The prevalence of F2 (≥3.0 kPa) and F3 (≥3.6 kPa) in the overall cohort was 5.1% and 1.3% respectively (sex- and age-adjusted prevalence of 3.8% and 1.3%). Non-alcoholic fatty liver disease (NAFLD) prevalence (>5% fat fraction) was 27.7% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 8.0% and 1.5% respectively. In participants with diabetes, 12.5% had ≥F2 and 4.3% ≥F3. In participants with NAFLD plus diabetes, 24.1% had ≥F2 and 6.0% ≥F3. On multivariate analysis, only age, insulin, diabetes and fatty liver on MR were independently associated with significant fibrosis. Conclusions In a Korean health check-up clinic setting, the prevalence of significant and advanced liver fibrosis was 5.1% and 1.3% (sex- and age-adjusted prevalence of 3.8% and 1.3%). The prevalence of advanced liver fibrosis was five times higher for diabetic participants with NAFLD.

Due to COVID-19, high-intensity nonpharmaceutical interventions (NPIs) are implemented and these regulations may trigger changes in the incidence of other infectious diseases. The goal is to determine the impact of NPIs on other infectious diseases and mental illnesses in South Korea. Data were collected from an open-source dataset concerning NPIs covering the period of January 2018 to July 2020. The data comprised average daily mask production volume and number of companies newly authorized to offer disinfection and sterilization services, and numbers of patients with sentinel surveillance infectious disease and mental illness. This study compared changes in NPIs and incidence of infectious diseases and mental illnesses before and after the COVID-19 outbreak in South Korea. In 2020, the average daily mask production volume and the number of companies newly authorized to offer disinfection and sterilization services markedly increased following the virus outbreak (380% and > 94.8–99.5%, respectively). Meanwhile, the incidence of respiratory and intestinal infectious diseases declined, including those of influenza (49–55%), acute respiratory infection (78–79%), hand-foot-and-mouth disease (84–94%), enterovirus (94–97%), and intestinal infectious disease (36–40%). The weekly incidence of sexually transmitted diseases in 2020 remained constant regardless of the COVID-19 outbreak. Meanwhile, the number of outpatients increased by 7–16% for depressive episodes, 5–12% for other anxiety disorders, and 10–28% for sleep disorders. NPIs significantly reduced the incidence of respiratory and intestinal infectious diseases and negatively affected mental health. Therefore, while NPIs should be continued to prevent the spread of infections, systematic policies must be enacted to support mental health.

The aim of this prospective study was to evaluate the gastric emptying time of a rice-based meal by serial ultrasonography of the stomach. After baseline ultrasonographic assessment of ten fasted healthy volunteers, volunteers ingested standardized 420 g, 536 kcal rice-based meal (bibimbap), and serial evaluations were performed every hour until the stomach became empty. At baseline, all the participants had an empty stomach. The average time of complete gastric emptying of the rice-based meal was 5.8 ± 0.8 h (95% confidence interval (CI), 5.0 h to 6.5 h). Since the first postintake cross-sectional area (CSA) measurement, a decrease was observed, and CSA was maintained until postprandial 3–4 h (P>0.05). It declined rapidly 4 h after meal intake (P=0.031), reaching the nadir at approximately 6 h after meal intake. The gastric CSA and hunger score showed a positive correlation (correlation r = 0.616, P<0). The rice-based meal is emptied after 5.8 ± 0.8 h on average in healthy volunteers. Based on our results, 6.5 h (upper limit of CI) of fasting after the ingestion of a rice-based meal would be a safe preoperative fasting time, and this is in accordance with the current guidelines for preoperative fasting.

It is unknown whether a selective-bundle tear of the anterior cruciate ligament (ACL) shows a different prevalence of posterolateral corner (PLC) injury than a both-bundle tear.The prevalence of injury of PLC stabilizer in relation to the type of combined ACL tear (both-bundle and selective-bundle tears) has been investigated.This retrospective study included 94 patients who were diagnosed with an ACL tear after knee joint magnetic resonance imaging and underwent arthroscopic surgery. We compared the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. We used Fischer exact tests to compare the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear.Both-bundle tears occurred in 55 cases (56%) and selective-bundle tears in 39 cases (44%). The most common PLC injury with an ACL tear was inferior popliteomeniscal fascicle (PMF) injury, followed by superior PMF injury. The prevalence of each PLC injury was higher for both-bundle tears than selective-bundle tears, with the exception of popliteus tendon injury diagnosed by reader 1 (P.H.J). However, these differences were statistically significant for superior PMF injury only ( p 0.05). The prevalence of PLC injury was unrelated to the type of selective-bundle tear (anteromedial vs posterolateral).Superior PMF injury is more common in both-bundle tears than selective-bundle tears. There is no statistically significant difference in the prevalence of PLC injury between both-bundle tears and selective-bundle tears.

Purpose We compared two imaging techniques to assess whether 3D VISTA imaging could replace 2D FSE in diagnosing PCL reconstruction complications. Materials and methods This retrospective study included 40 patients who underwent surgery of PCL reconstruction and follow-up knee MRI (3D VISTA and 2D FSE) for evaluation of PCL graft integrity. Each image was interpreted independently by two radiologists without knowledge of radiologic reports or clinical history. The diagnostic performance of the 2D FSE PCL view, 3D VISTA PCL view, orthogonal 2D FSE image, and combined sequences were evaluated in terms of sensitivity, specificity, and accuracy for diagnosing complications of PCL graft. The reference diagnoses were made arthroscopically or clinically. Results The sensitivities of the 3D VISTA PCL view were similar to those of the 2D PCL view. The sensitivities of the combination of the orthogonal view and the 3D VISTA PCL view were also similar to those of the combination of the orthogonal view and the 2D PCL view. The specificities and accuracies of each image exhibited similar results. There was no statistically significant difference in diagnostic performance between the 3D VISTA PCL view and the 2D PCL view (solitary or combined with the orthogonal view). Conclusions The diagnostic performance of the PCL views on 3D VISTA images is comparable to that of 2D FSE images in the diagnosis of PCL graft complications.

Taeniasis is a cosmopolitan helminthic disease caused by Taenia species, which included Taenia solium, Taenia saginata, and Taenia asiatica. These parasites typically infect the small intestine, but cases of aberrant migration have been reported. We treated a 70-year-old man who presented with vomiting and colicky abdominal pain. On physical examination, Murphy’s sign was positive, and laboratory findings indicated severe inflammation. Computed tomography and magnetic resonance cholangiopancreatography revealed typical features of cholecystitis. An 82-cm-long, slender and degenerated, parasite-like organism was aspirated through a percutaneous transhepatic gallbladder drainage tube. After extensive washing of the organism, we detected yellowish-brown colored, spherical 37.9 × 33.8-µm-sized taenid eggs with thick transverse striations. Hematoxylin–eosin-stained worm sections also contained Taeniidae eggs. Polymerase chain reaction amplification of DNA extracted from the worm with species-specific cytochrome c1 (cox1) primer sets detected a T. solium–specific fragment. Because of sustained high fever combined with inflammatory signs, the patient underwent laparoscopic cholecystectomy and inflamed gallbladder removal. A histopathologic specimen demonstrated chronic reactive cholecystitis. The patient’s fever and leukocytosis rapidly resolved after surgery. We experienced an uncommon case of biliary taeniasis representing cholecystitis caused by adult worm of T. solium.

Autophagy and cellular senescence are two potent tumor suppressive mechanisms activated by various cellular stresses, including the expression of activated oncogenes. However, emerging evidence has also indicated their pro-tumorigenic activities, strengthening the case for the complexity of tumorigenesis. More specifically, tumorigenesis is a systemic process emanating from the combined accumulation of changes in the tumor support pathways, many of which cannot cause cancer on their own but might still provide excellent therapeutic targets for cancer treatment. In this review, we discuss the dual roles of autophagy and senescence during tumorigenesis, with a specific focus on the stress support networks in cancer cells modulated by these processes. A deeper understanding of such context-dependent roles may help to enhance the effectiveness of cancer therapies targeting autophagy and senescence, while limiting their potential side effects. This will steer and accelerate the pace of research and drug development for cancer treatment.

IntroductionMegaShield®is a newly developed temperature-sensitive anti-adhesive containing micronized acellular dermal matrix. The aim of this study was to investigate the efficacy and safety of MegaShield®compared with Guardix-SG®in the prevention of adhesions in patients undergoing bilateral total thyroidectomy.MethodWe conducted a multicenter trial between October 2018 and March 2020 in patients undergoing total thyroidectomy. The patients were randomly assigned to either the MegaShield®group or the Guardix-SG®group. The primary outcome was the esophageal movement using marshmallow six weeks after the surgery and the secondary outcome was the assessed adhesion score. The safety assessment was also evaluated.ResultsThe study included 70 patients each in the MegaShield®and control (Guardix-SG®) groups. Baseline clinical characteristics, the mean score of marshmallow esophagography, and the sum of adhesion scores were not statistically different between the two groups. Inferiority test demonstrated that the efficacy of MegaShield®is not inferior to that of Guardix-SG®. There were no device-related complications in both groups.ConclusionThe efficacy and safety of MegaShield®were not inferior than those of Guardix-SG®. MegaShield®demonstrated the potential of ADM as a potential future anti-adhesive agent.Trial registrationThe name of trial registry CRIS (Clinical Research Information Service)https://cris.nih.go.kr/cris/index.jsp. (The full trial protocol can be accessed) Registration number:KCT0003204.

Autophagy and cellular senescence are two potent tumor suppressive mechanisms activated by various cellular stresses, including the expression of activated oncogenes. However, emerging evidence has also indicated their pro-tumorigenic activities, strengthening the case for the complexity of tumorigenesis. More specifically, tumorigenesis is a systemic process emanating from the combined accumulation of changes in the tumor support pathways, many of which cannot cause cancer on their own but might still provide excellent therapeutic targets for cancer treatment. In this review, we discuss the dual roles of autophagy and senescence during tumorigenesis, with a specific focus on the stress support networks in cancer cells modulated by these processes. A deeper understanding of such context-dependent roles may help to enhance the effectiveness of cancer therapies targeting autophagy and senescence, while limiting their potential side effects. This will steer and accelerate the pace of research and drug development for cancer treatment.

Macroautophagy/autophagy is a sophisticated quality control program that limits cellular damage and maintains homeostasis, being an essential part of several lifespan-promoting interventions. However, autophagy is also necessary for full establishment of cellular senescence, a causal factor for many age-related diseases and aging. What lies ahead of us to unravel such a paradoxical role of autophagy in senescence is to identify specific targets degraded by autophagy during senescence and determine their importance in the senescence regulatory network. Recently, we developed the “Selective autophagy substrates Identification Platform (SIP)” to advance these goals, providing a rich set of autophagy substrate proteins involved in senescence. Our study demonstrated that selective autophagy coordinates the stress support networks in senescent cells by degrading multiple regulatory components, echoing its homeostatic roles in normal cells. Targeting this type of selective autophagy might provide a unique opportunity to develop non-senescence addiction-based therapeutic strategies for senotherapy by disturbing the homeostatic state of senescent cells.

Summary Cellular senescence is a complex stress response implicated in aging. Autophagy can suppress senescence but is counterintuitively necessary for full senescence. Although its anti-senescence role is well described, to what extent autophagy contributes to senescence establishment and the underlying mechanisms is poorly understood. Here, we show that selective autophagy of multiple regulatory components coordinates the homeostatic state of senescence. We combined a proteomic analysis of autophagy components with protein stability profiling, identifying autophagy substrate proteins involved in several senescence-related processes. Selective autophagy of KEAP1 promoted redox homeostasis during senescence. Furthermore, selective autophagy limited translational machinery components to ameliorate senescence-associated proteotoxic stress. Lastly, selective autophagy of TNIP1 enhanced senescence-associated inflammation. These selective autophagy networks appear to operate in vivo senescence during human osteoarthritis. Our data highlight a caretaker role of autophagy in the stress support network of senescence through regulated protein stability and unravel the intertwined relationship between two important age-related processes.

Background The relationship between the imaging parameters on postoperative ultrasound (US) other than repaired tendon integrity with clinical outcome such as postoperative residual pain has not been well defined. Purpose To investigate whether the repaired tendon thickness and subdeltoid fluid collection after rotator cuff repair are correlated with early postoperative clinical outcome. Material and Methods This retrospective study included 54 patients who underwent repair of the arthroscopic rotator cuff either by suture-bridge or single-row technique and postoperative US. We assessed the relationship between the sonographic parameters, including repaired supraspinatus tendon thickness and subdeltoid fluid collection, with the clinical outcome represented by the Korean Shoulder Scoring system (KSS) score using correlation coefficients (R). Also, the subgroup analysis was done to assess the differences by surgical technique and patients’ age. Results There was a significant inverse relationship between the amount of subdeltoid fluid collection and degree of self-assessed pain improvement of the patients ( P 60 years, a statistically significant inverse relationship between thickness of subdeltoid fluid collection and difference value of the KSS scores in category of function was observed with both interpreters ( P = 0.015 and P = 0.04, respectively). Conclusion Subdeltoid fluid collection measured on US after repair of the arthroscopic rotator cuff in the early postoperative period has significant association with the patients’ subjective clinical outcome.

Summary Senescent cells constantly experience stressful conditions and restrain their protein translation to cope with it. Here, we present a detailed protocol to measure the rate of global protein synthesis using L-azidohomoalanine (L-AHA)-based click chemistry in human senescent fibroblasts. We optimized several aspects of the procedure, including senescence induction, a flow cytometry analysis of senescent cells, and the duration of L-AHA incorporation. This protocol uses senescent human fibroblasts but can be applied to other types of cells or circumstances. For complete details on the use and execution of this protocol, please refer to Lee et al. (2021)., Graphical abstract, Highlights • An optimized protocol to measure the global translation rate in senescent cells • Use of L-AHA-based click chemistry enables a sensitive measurement of protein translation • Flow cytometry allows quantitative analysis of the global translation rate, Senescent cells constantly experience stressful conditions and restrain their protein translation to cope with it. Here, we present a detailed protocol to measure the rate of global protein synthesis using L-azidohomoalanine (L-AHA)-based click chemistry in human senescent fibroblasts. We optimized several aspects of the procedure, including senescence induction, a flow cytometry analysis of senescent cells, and the duration of L-AHA incorporation. This protocol uses senescent human fibroblasts but can be applied to other types of cells or circumstances.

Summary Background CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults. Methods We did this pragmatic, multicentre, randomi s ed controlled non-inferiority trial at 20 South Korean teaching hospitals with little experience with low-dose CT. Patients aged 15–44 years with suspected appendicitis were randomly assigned (1:1), via computer-generated random assignments (permuted block sizes of two, four, six, and eight) concealed in sequentially numbered envelopes, to receive low-dose CT (2 mSv) or standard-dose CT (≤8 mSv). Randomisation was stratified by site. Group allocation was concealed from patients, outcome assessors, and adverse event adjudicators; care providers, site pathologists, and data collectors were aware of allocation. The primary endpoint was the negative (unnecessary) appendectomy rate among all appendectomies, with a non-interiority margin of 4·5% for low-dose versus standard-dose CT. Primary analy s is was by modified intention to treat, which included all patients who received an appendectomy in the group to which they were assigned. This trial is registered with ClinicalTrials.gov, number NCT01925014. Findings Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group. Interpretation Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future. Funding Korea Health Industry Development Institute, Seoul National University Bundang Hospital, Dasol Life Science, and Bracco Imaging Korea.

This study was intended to develop a Korean-dietary inflammatory index (K-DII) for metabolic disease patients, by using health examinee cohort data. It was also intended to evaluate the validity of K-DII. Based on 18 food groups in the Korean Genome and Epidemiology Study (KoGES), food groups were reclassified into 51 groups. Food groups showing significance correlation with hs-CRP by binomial logistic regression analysis were selected. In order to evaluate the validity of the developed K-DII, the researchers analyzed the correlation with health indicators and the relationship between the odd ratio of metabolic syndrome and K-DII. ANOVA and logistic regression analysis were carried out, according to tertile of K-DII, by using SPSS 23 version. Final 17 food groups were selected as factors utilized for the formula to calculate the K-DII assessment tool. The formula was the sum of product of intakes and beta values in each food group. A significant difference was shown in age, body mass index, waist measurement, diastolic blood pressure, triglyceride and hs-CRP, according to tertile of K-DII. In the results of analyzing metabolic syndrome risk according to K-DII, it was shown that metabolic syndrome risk in the group having the highest K-DII was 1.204 times higher than the lowest K-DII group (95% Cl; 1.123-1.290)(p=0.002, p for trend=0.000). The K-DII was composed of food groups that represented the inflammatory potential in Korean diet. Its strong relationship with metabolic syndrome showed a usefulness in assessing the inflammatory status of total diets. It is hoped that the K-DII can be utilized in actual clinical settings as a nutritional assessment tool, after validation in different metabolic disease patients.

AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODS Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.

High-resolution rectal MRI plays a crucial role in evaluating rectal cancer by providing multiple prognostic findings and imaging features that guide proper patient management. Quality reporting is critical for accurate effective communication of the information among multiple disciplines, for which a systematic structured approach is beneficial. Existing guides on reporting of rectal MRI are divergent on some issues, largely reflecting the differences in overall management of rectal cancer patients between the United States and Europe. The Korean Society of Abdominal Radiology (KSAR) study group for rectal cancer has developed an expert consensus recommendation regarding essential items for structured reporting of rectal cancer MRI using a modified Delphi method. This recommendation aims at presenting an up-to-date, evidence-based, practical, structured reporting template that can be readily adopted in daily clinical practice. In addition, a thorough explanation of the clinical and scientific rationale underlying the reporting items and their formats is provided. This KSAR recommendation may serve as a useful tool to help achieve more standardized optimal care for rectal cancer patients using rectal MRI.

Background: The prevalence of significant and advanced liver fibrosis in the general population has not been well characterized. Using magnetic resonance elastography (MRE), we investigated the prevalence of significant fibrosis in a general community-based cohort. Methods: The study analyzed 2,170 participants who underwent the MR chemical shift technique and MRE. We also conducted subgroup analyses for participants with non-alcoholic fatty liver disease (NAFLD), metabolic syndrome, and diabetes mellitus (DM). Findings: The prevalence of F2 (≥3.0 kPa) and F3 fibrosis (≥3.6 kPa) in the general population was 5.1% and 1.3%, respectively. The prevalence of NAFLD (>5% hepatic fat fraction) was 20.8% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 7.5% and 1.1%, respectively. The prevalence of DM was 7.7% in the general population, with significant fibrosis in 13.7% and advanced fibrosis in 4.8%. In participants with fatty liver (of any etiology) plus diabetes, 27.5% had ≥F2 and 7.2% ≥F3. Multivariate analyses indicated that older age, lower platelet count, higher AST/ALT ratio, diabetes, and fatty liver were independently associated with significant fibrosis. Interpretation: In the general population, the prevalence of significant and advanced fibrosis was 5.1% and 1.3%, respectively, and increased three- to four-fold in diabetes. Funding: None. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Institutional Review Board of Kangbuk Samsung Hospital (IRB No. KBSMC 2018-06-008-001), and the protocol was registered at the Clinical Research Information Service (http://cris.nih.go.kr/) with registration number KCT0003782.

Poster: "ECR 2015 / C-0731 / The usefulness of the quantitative evaluation of diffusion-weighted MRI in the diagnosis of anterior cruciate ligament tear" by: "H. J. Park, C. Han; Seoul/KR"

Recent research has advanced exploration of developmental stage and age-related distinctions in understanding the perpetration of child maltreatment. Using longitudinal data from the National Survey of Child and Adolescent Well-being I (NSCAW-I), this exploratory study investigated heterogeneity in caregiver risks in cases of both neglect and emotional abuse of adolescents (N = 511). Using MPlus software, a person-centered data analytic strategy–latent class analysis was performed to identify distinct classes of caregiver risk factors that were associated with the reports of maltreatment among adolescents. Subsequently exploring the distinct characteristics of the classes, we examined the related demographic characteristics, child welfare system variables (e.g., type of placement status; change in placement type between waves), and youth factors such as the presence of clinical range problem behaviors (Child Behavior Checklist). Results demonstrate four distinct classes of caregiver risk factors, with a nearly even split between those who have an absence of risk factors and those who have a whole host of risk determinants. Differences between the classes regarding the duration of time in out-of-home placements between Wave 1 and Wave 3 also emerged significant.

Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this study explores the characteristics of child welfare involvement for children (N = 639; aged 3–17.5 years) with at least one developmental disability. In addition, a central focus of this exploration was to examine respective differences in how caregivers and caseworkers initiated referrals for services for children with disabilities. The sample was divided into three exclusive groups based on type of developmental disability: learning disability (weighted percentage 70.3%); Mental Retardation (now referred to as Intellectual Disability), Downs Syndrome, or; developmental delay (weighted percentage 1.8%); and presence of multiple types of disabilities, including autism (weighted percentage 27.9%). Results from the logistic regression analyses indicate children in this population who are placed in out-of-home care receive more referrals than those residing in-home with biological caregivers; older children and children with...

본 연구에서는 녹차, 삼백초, 귀룽나무 등을 포함한 식물성 추출물의 샴푸로서의 특성에 대해 연구하였다. 녹차와 삼백초의 잎은 열수추출 후 동결건조하여 유효성분을 획득하였으며, 귀룽나무 줄기는 숙성과정을 거쳐 열수 추출 후 역삼투 및 초음파 추출로 유효성분을 획득하였다. 식물성 추출물을 함유한 샴푸, 계면활성제(Sodium dodecylsulfate,Quillaja Bark Saponin)와 피마자유 간의 계면장력을 측정한 결과, 샴푸의 계면장력은 저농도에서는 SDS와 QBS보다 낮았으나, 100% 원액에서는 대조군과 유사한 계면장력을 나타내었다. 식물성 추출물을 함유한 샴푸는 황색포도상구균과 칸디다균에 대해서는 약간의 항균력을 보였다. 식물성 추출물의 세포독성시험(MTT assay) 결과, 100~350 μg/ml 범위의 농도에서는 80% 이상의 세포생존율을 보였으나 그 이상의 농도에서는 세포독성을 나타내었다. 식물성 추출물을 함유한 샴푸의 시간변화에 따른 장기 안정성 시험결과, 제조 후 초기 3개월은 pH, 점도, 외관의 변화가 안정적이었으나 그 이후 상온이 높아짐에 따라 pH와 점도의 변화가 심하여 제형의 보완이 필요한 것으로 나타났다. 따라서 샴푸의 제형을 다소 개선한다면 녹차, 삼백초, 귀룽나무 등을 함유한 식물성 추출물은 샴푸로의 사용 시 높은 가능성을 보였다.

141 Background: Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases from several types of malignancies. Methods: A retrospective analysis was performed for the safety and efficacy of percutaneous RFA in patients with metastatic colorectal cancer between October 2016 and June 2019 as well as assessing prognostic factors of local tumor control. Results: RFA was carried out for 48 lung metastases in 31 consecutive colorectal cancer patients. Male was 17 patients (55%), and the median age at RFA was 61 years (range, 42-81). The mean diameter of metastases targeted for RFA was 12 mm (range, 4-32), and 17 tumors (35%) were located in a sub-pleural or deep position. Although five cases (10%) were failed due to immediate complications, there was no procedure-related death. In terms of immediate complication, a total of 12 cases (25%) had events including nine pneumothorax (percutaneous drain in four), one pleural effusion, and two hemoptysis (ICU care in one). Delayed complications were lung abscess and diaphragm injury in each one patient, respectively. At the time of analysis, the median follow-up duration from RFA was 12.0 months (interquartile range, 6.5-23.1). Only two patients (6%) died of disease progression, and 3-year overall survival rate was 85.5% (95% CI, 75.5-95.5). RFA site progression was observed in 11 patients (23%), and 1-year and 2-year progression-free survival rates were 71.5% (95% CI, 58.7-84.3) and 56.6% (95% CI, 42.6-70.6), respectively. Multivariate analysis showed that extra-pulmonary progression (hazard ratio 17.49; p = 0.023) was only one independent prognostic factor associated with RFA site progression after adjusting for confounding factors including sex, age, performance, tumor size, location, contact with the vessel, last chemotherapy response, and duration. Conclusions: RFA is a comparatively safe and effective option for the treatment of small-sized lung metastases; however, the control of extra-pulmonary metastases should be accompanied for effective local control.