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Background Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. Methods In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. Results The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P < 0.05). Postoperative cardiovascular complications were related to frequent intraoperative hypotension (P

Acute appendicitis is the most common cause of acute abdomen and on rare occasions can present atypically with a retroperitoneal abscess. In this report, we present a rare case of acute appendicitis combined with iliopsoas muscle abscess. A laparoscopic appendectomy and iliopsoas abscess drainage were performed by a one-step laparoscopic procedure that did not incur any intraoperative or postoperative complications. The results of this case demonstrate that the laparoscopic approach is feasible and effective for the treatment of appendicitis complicated by retroperitoneal abscess. J Curr Surg. 2017;7(1-2):23-25 doi: https://doi.org/10.14740/jcs313w

Vulvar pain is a common complaint in women during reproductive and post-reproductive years. A 70-year-old woman experienced severe intractable vulvar pain after bladder cancer surgery and adjuvant radiation therapy. We performed five fluoroscopy-guided pudendal nerve blocks. Her numeric rating scale decreased from 10 to 3, and after 5 months, her pain was controlled only with oral medication. Pudendal nerve block might stop ongoing sensitization which lead acute nociceptive vulvar pain into chronic neuropathic vulvodynia by attenuating nociceptive stimulation and inflammation.

Despite rapid advancements in laparoscopic surgical devices and techniques, pain remains a significant issue. We examined the efficacy of preemptive transversus abdominis plane (TAP) block for acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed 153 patients who underwent laparoscopic colorectal cancer surgery with or without TAP block, among them, 142 were allocated to the TAP or non-TAP group. We performed between-group comparisons of demographic, clinical, and anesthetic data and pain scores at a postoperative anesthesia care unit (PACU) and at postoperative days 1, 3, and 5. There were no significant between-group differences in demographic and clinical characteristics. The mean arterial pressure, heart rate, and minimum alveolar concentration (MAC) were significantly lower in the TAP group at the start and end of surgery. The post-extubation bispectral index was significantly higher in the TAP group. There were no significant between-group differences in the pain scores and opioid consumption at the PACU or at postoperative days 1, 3, and 5, or in the time to pass flatus, the hospital stay length, and postoperative complications. Preemptive TAP block showed an intraoperative, but not postoperative, analgesic effect, characterized by a low mean arterial pressure, heart rate, and MAC.

The name of the author of the original published version of this article was presented incorrectly. The author name "JungWook Huh" should have been presented as "Jung Wook Huh".

Several studies have shown that brain and muscle aryl hydrocarbon receptor nuclear translocator-like 1 (BMAL1), an important molecule for maintaining circadian rhythms, inhibits the growth and metastasis of tumor cells in several types of cancer, including lung, colon, and breast cancer. However, its role in glioblastoma has not yet been established. Here, we addressed the function of BMAL1 in U87MG glioblastoma cells with two approaches&mdash, loss and gain of function. In the loss of function experiments, cell proliferation in U87MG cells transfected with small interfering RNA (siRNA) targeting BMAL1 was increased by approximately 24% (small interfering (si)-NC 0.91 &plusmn, 0.00 vs. si-BMAL1 1.129 &plusmn, 0.08) via upregulation of cyclin B1. In addition, cell migration and invasion of BMAL1 siRNA-treated glioblastoma cells were elevated by approximately 20% (si-NC 51.00 &plusmn, 1.53 vs. si-BMAL161.33 &plusmn, 0.88) and 209% (si-NC 21.28 &plusmn, 1.37 vs. si-BMAL1 44.47 &plusmn, 3.48), respectively, through the accumulation of phosphorylated-AKT (p-AKT) and matrix metalloproteinase (MMP)-9. Gain of function experiments revealed that adenovirus-mediated ectopic expression of BMAL1 in U87MG cells resulted in a 19% (Adenovirus (Ad)-vector 0.94&plusmn, 0.03 vs. Ad-BMAL1 0.76 &plusmn, 0.03) decrease in cell proliferation compared with the control via downregulation of cyclin B1 and increased early and late apoptosis due to changes in the levels of BCL2-associated X protein (BAX), B-cell lymphoma 2 (BCL-2), and cleaved caspase-3. Likewise, cell migration and invasion were attenuated by approximately 24% (Ad-vector 55.00 &plusmn, 0.00 vs. Ad-BMAL1 41.83 &plusmn, 2.90) and 49% (Ad-vector 70.01 &plusmn, 1.24 vs. Ad-BMAL1 35.55 &plusmn, 1.78), respectively, in BMAL1-overexpressing U87MG cells following downregulation of p-AKT and MMP-9. Taken together, our results suggest that BMAL1 acts as an anti-cancer gene by altering the proliferation, migration, and invasion of glioblastoma cells. Therefore, the BMAL1 gene could be a potential therapeutic target in the treatment of glioblastoma.

Background There have been few studies comparing clinical and radiological outcomes between the conventional and knotless suture-bridge techniques. The purpose of this study was to evaluate and compare the functional outcomes and repair integrity of arthroscopic conventional and knotless suture-bridge technique for full-thickness rotator cuff tears. Methods We prospectively followed 100 consecutive patients (100 shoulders) with full-thickness rotator cuff tears treated with the arthroscopic conventional or knotless suture-bridge technique from October 2012 to July 2014. Enrolled patients returned for follow-up functional evaluations at 1 and 2 years after the operation. There were four outcome measures in this study: American Shoulder and Elbow Surgeons (ASES) scores, Shoulder Rating Scale of the University of California at Los Angeles (UCLA) scores, Constant scores, and visual analog scale (VAS) pain scores. Enrolled patients returned for follow-up magnetic resonance imaging or ultrasonography evaluation to confirm the integrity of the repaired cuff at 6 months post-operation (97% follow-up rate). Also, we investigated the preoperative cuff retraction of enrolled patients using preoperative MRI to find out correlation between the stage of cuff retraction and re-tear rate. Results At final follow-up, the average UCLA, ASES, Constant, and VAS scores had improved significantly to 32.5, 88.0, 80.4, and 1.3, respectively, in the conventional suture-bridge technique group and to 33.0, 89.7, 81.2, and 1.2, respectively, in the knotless suture-bridge technique group. The UCLA, ASES, Constant, and VAS scores improved in both groups after surgery (all p

Macrophages play an important role in structural cardiac remodeling and the transition to heart failure following myocardial infarction (MI). Previous research has focused on the impact of blood-derived monocytes on cardiac repair. Here we examined the contribution of resident cavity macrophages located in the pericardial space adjacent to the site of injury. We found that disruption of the pericardial cavity accelerated maladaptive post-MI cardiac remodeling. Gata6

The prognostic role of tumor regression grade is not clear. This study evaluated the prognostic significance of tumor regression grade in patients with rectal cancer after preoperative chemoradiotherapy.A total of 639 patients with confirmed rectal cancer who had undergone preoperative chemoradiotherapy and radical resection during the period October 2002 through December 2011 were included in this study. The tumor regression grade was graded: TRG0 (complete response), TRG1 (moderate), TRG2 (minimal), and TRG3 (poor). The prognostic significance of tumor regression grade was evaluated.With a median follow-up of 56.7 months, the rates of 5-year overall survival, disease-free survival, and local recurrence-free survival among the TRG groups differed significantly (all P.001). For patients with TRG0, TRG1, and TRG2-3, disease-free survivals were different between the ypStage (P.001, P.001, and P = .043). Multivariate analysis revealed findings to substantiate that the tumor regression grade represents a valuable and independent prognostic factor for long-term, disease-free survival (P = .041). Independent predictors of TRG2-3 consisted of lymphovascular invasion, tumor budding, and the pretreatment serum level of carcinoembryonic antigen in multivariate regression analysis. Clinical risk grouping, using 3 predictors for TRG2-3 was different (P.001).The tumor regression grade may represent a useful prognostic variable to better individualize the prognosis and potentially further therapy for each rectal cancer patient who underwent chemoradiotherapy.

Purpose: This study compared the functional outcome and repair integrity of arthroscopic rotator cuff repair according to articular-side repair state in full-thickness tears. Methods: We prospectively enrolled 80 consecutive patients with full-thickness rotator cuff tears of 1.5–3.5 cm at the anterior to posterior dimension. These patients were divided into two groups according to intraoperative articular-side repair state during operation: complete and incomplete repair groups. Repair integrity was evaluated at 6 months after the operation by magnetic resonance image or ultrasonography. Clinical outcomes were evaluated at 1 year and 2 years postoperatively. Four outcome measures were used in this study: visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score, and range of motion. Results: At 2-year follow-up, the average UCLA, ASES, and constant score improved significantly to 32.46, 87.94, and 79.69, respectively, in the complete group and to 32.50, 87.65, and 78.92, respectively, in the incomplete group. The UCLA, ASES, and constant score improved in both groups postoperatively (all p s < 0.000); however, there was no significant difference between the two groups ( p = 0.960, 0.921, and 0.796, respectively). The re-tear rate was 13.7% in the shoulders that underwent complete repair and 33.3% in the shoulders that underwent incomplete repair; this difference was statistically significant ( p = 0.041). Conclusion: Regardless of the repair state of articular-side rotator cuff, the arthroscopic rotator cuff repair resulted in comparable functional outcomes between two groups at short-term follow-up. However, patients who repaired articular-side rotator cuff incompletely revealed higher re-tear rate after operation than those who repaired completely.

Ultra-wideband mobile communication systems that support hundreds of Gbps data rates require the use of very large bandwidths. To implement such an ultra-wideband communication system, a high-speed ADC is essential. Ultra-wideband (UWB) ADCs have been studied for many years to use very low resolution ADCs to reduce circuit complexity and power consumption. From the viewpoint of encoding theory, we try to solve the problem of low resolution ADC use. The compute-and-forward framework, which has been studied in the field of network information theory recently, uses a technique that allows the receiver to decode a linear combination of transmission messages. In this paper, we analyze the achievable channel capacity of a MIMO system that achieves diversity and multiplexing gain in a low resolution ADC environment using this structured code theory. In particular, the relationship between this achievable channel capacity and the quantization level q. The results of this paper are expected to be used as a theoretical basis for the development of UWB communication systems for high- capacity transmission system applications.

Sequencing of the mutant allele fraction of circulating cell-free DNA (cfDNA) derived from tumors is increasingly utilized to detect actionable genomic alterations in cancer. We conducted a prospective blinded study of a comprehensive cfDNA sequencing panel with 54 cancer genes. To evaluate the concordance between cfDNA and tumor DNA (tDNA), sequencing results were compared between cfDNA from plasma and genomic tumor DNA (tDNA). Utilizing next generation digital sequencing technology (DST), we profiled approximately 78,000 bases encoding 512 complete exons in the targeted genes in cfDNA from plasma. Seventy-five patients were prospectively enrolled between February 2013 and March 2014, including 61 metastatic cancer patients and 14 clinical stage II CRC patients with matched plasma and tissue samples. Using the 54-gene panel, we detected at least one somatic mutation in 44 of 61 tDNA (72.1%) and 29 of 44 (65.9%) cfDNA. The overall concordance rate of cfDNA to tDNA was 85.9%, when all detected mutations were considered. We collected serial cfDNAs during cetuximab-based treatment in 2 metastatic KRAS wild-type CRC patients, one with acquired resistance and one with primary resistance. We demonstrate newly emerged KRAS mutation in cfDNA 1.5 months before radiologic progression. Another patient had a newly emerged PIK3CA H1047R mutation on cfDNA analysis at progression during cetuximab/irinotecan chemotherapy with gradual increase in allele frequency from 0.8 to 2.1%. This blinded, prospective study of a cfDNA sequencing showed high concordance to tDNA suggesting that the DST approach may be used as a non-invasive biopsy-free alternative to conventional sequencing using tumor biopsy.

// Jeeyun Lee 1, * , Hee Cheol Kim 2, * , Jung Yong Hong 3, * , Kai Wang 4 , Sun Young Kim 1 , Jiryeon Jang 1 , Seung Tae Kim 1 , Joon Oh Park 1 , Ho Yeong Lim 1 , Won Ki Kang 1 , Young Suk Park 1 , Jiyun Lee 1 , Woo Yong Lee 2 , Yoon Ah Park 2 , Jung Wook Huh 2 , Seong Hyeon Yun 2 , In-Gu Do 5 , Seok Hyung Kim 5 , Sohail Balasubramanian 4 , Philip J. Stephens 4 , Jeffrey S. Ross 4, 6 , Gang Gary Li 7 , Zachary Hornby 7 , Siraj M. Ali 4 , Vincent A. Miller 4 , Kyoung-Mee Kim 5, 8 , Sai-Hong Ignatius Ou 9 1 Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 3 Department of Internal Medicine, Chung-Ang University College of Medicine, Dongjak-Gu, Seoul, Republic of Korea 4 Foundation Medicine Inc, Cambridge, Massachusetts, USA 5 Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 6 Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA 7 Ignyta Inc, San Diego, California, USA 8 Innovative Cancer Medicine Institute, Samsung Medical Center, Seoul, Korea 9 Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, California, USA * These authors have contributed equally to this work Correspondence to: Sai-Hong Ignatius Ou, e-mail: Ignatius.ou@uci.edu Kyoung-Mee Kim, e-mail: kkmkys@skku.edu Keywords: colorectal carcinoma, anaplastic lymphoma kinase (ALK) rearrangement, immunohistochemistry, next generation sequencing Received: April 02, 2015 Accepted: June 19, 2015 Published: July 01, 2015 ABSTRACT Purpose: Anaplastic lymphoma kinase (ALK) rearrangement has been detected in colorectal carcinoma (CRC) using advanced molecular diagnostics tests including exon scanning, fluorescence in situ hybridization (FISH), and next generation sequencing (NGS). We investigated if immunohistochemistry (IHC) can be used to detect ALK rearrangement in gastrointestinal malignancies. Experimental designs: Tissue microarrays (TMAs) from consecutive gastric carcinoma (GC) and CRC patients who underwent surgical resection at Samsung Medical Center, Seoul, Korea were screened by IHC using ALK monoclonal antibody 5A4. IHC positive cases were confirmed by FISH, nCounter assays, and NGS-based comprehensive genomic profiling (CGP). ALK IHC was further applied to CRC patients enrolled in a pathway-directed therapeutic trial. Results: Four hundred thirty-two GC and 172 CRC cases were screened by IHC. No GC sample was ALK IHC positive. One CRC (0.6%) was ALK IHC positive (3+) that was confirmed by ALK FISH and a novel CAD-ALK (C35; A20) fusion variant that resulted from a paracentric inversion event inv(2)(p22–21p23) was identified by CGP. One out of 50 CRC patients enrolled in a pathway-directed therapeutic trial was ALK IHC positive (3+) confirmed by ALK FISH and found to harbor the EML4-ALK (E21, A20) fusion variant by CGP. Growth of a tumor cell line derived from this EML4-ALK CRC patient was inhibited by ALK inhibitors crizotinib and entrectinib. Conclusions: ALK IHC is a viable screening strategy for identifying ALK rearrangement in CRC. ALK rearrangement is a potential actionable driver mutation in CRC based on survival inhibition of patient tumor-derived cell line by potent ALK inhibitors.

Objective To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. Patients and Methods A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (−). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. Results A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (−), P =.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P =.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P =.58). Conclusions Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.

In this study, a thin hybrid circuit-analog (CA) microwave absorbing double slab composite structure is presented. Unlike conventional CA absorbers, the composite spacer in the proposed structure is made up of a glass/epoxy and high permittivity layer of glass/epoxy-MWCNT composite, which contributes to the stable absorption performance in the curved surface while maintaining the thin thickness of the composite spacer. To design the microwave absorber, the genetic algorithm which is the most used evolutionary algorithm technique in this field was used. The total thickness of the designed double slab CA absorber was very thin thickness of 2.37 mm. Although the designed absorber has very thin thickness, it could satisfy the −10 dB absorption in whole X-band (8.2–12.4 GHz). The absorbing performance of the designed absorber was compared with other types of absorber. Also, to check the absorbing performance of the proposed structure in the curved surface, the echo radar cross section (RCS) was simulated in the X-band with other types of absorber. The simulated results proved an excellent performance of a proposed novel double slab CA absorber.

Background Anastomotic leakage is a common complication that can be associated with catastrophic consequences. However, the risk factors and incidence of anastomotic leakage vary considerably among clinical studies because of the lack of a standardized definition, clinical course and appropriate treatment options. The aim of this study was to identify and classify the clinical manifestations and treatment of anastomotic leakage and analyse the possible risk factors after low anterior resection. Methods From January 2009 to June 2010, 632 patients underwent low anterior resection for primary colorectal cancer at Samsung Medical Center. Patients with only one colorectal anastomosis were included from this prospectively collected medical database. Results The overall leakage rate was 6.0% (n = 38). In cases of generalized leakage, the patients that selected surgical management, regardless of having protective enterostomy and time of occurrence, had better outcomes. Protective enterostomy did not have a preventive effect and was not associated with a lower rate of anastomotic leakage. However, protective enterostomy confined the inflammation to only the pelvic cavity (P = 0.045) and no surgical intervention was initially needed. Male gender (P = 0.021, relative risk (RR) = 2.680, 95% confidence interval (CI) = 1.164–6.171) and side-to-end/J pouch-to-end anastomosis (P = 0.012, RR = 2.696, 95% CI = 1.249–5.818) were significant risk factors that affected anastomotic leakage. Conclusion Surgical management is the best choice for generalized leakage. A protective enterostomy diminished the occurrence of generalized leakage and consequent surgical management; therefore, fragile patients at high risk for anastomotic leakage are recommended to undergo protective enterostomy.

To compare outcomes from radiofrequency ablation (RFA) and hepatectomy for treatment of colorectal liver metastasis (CRLM).From January 2000 to December 2009, 408 patients underwent curative intent treatment for CRLM. We excluded patients using the criteria: size of CRLM3 cm, number of CRLM ≥ 5, percutaneous RFA, follow-up period12 mo, double primary cancer, or treatment with both RFA and hepatectomy. We matched 51 patients who underwent RFA with 102 patients who underwent hepatectomy by propensity scores.The median follow-up period was 45 mo (range, 12 mo to 158 mo). Hepatic recurrence was more frequent in the RFA than the hepatectomy group (P = 0.021) although extrahepatic recurrence curves were similar (P = 0.716). Survival curves of hepatectomy group were better than that of RFA for multiple, large (2 cm) CRLM (P = 0.034). However, survival curves were similar for single or small (≤ 2 cm) CRLM (P = 0.714, P = 0.740).Hepatectomy is better than RFA for the treatment of CRLM. However, RFA might be suitable for selected patients with single, small (≤ 2 cm) CRLM.

The risk factors for acquiring an infection with multidrug-resistant (MDR) bacteria in patients with anastomotic leakage after colorectal cancer surgery are poorly understood. We evaluated the risk factors associated with the initial acquisition of MDR pathogens in patients with anastomotic leakage after colorectal cancer surgery. This study was a retrospective review of prospectively collected data at a university affiliated-tertiary referral hospital in South Korea. From January 2009 to April 2013, a total of 6767 consecutive patients with colorectal cancer who underwent surgery were registered. Of these patients, 190 (2.8 %) were diagnosed with anastomotic leakage. Finally, 143 (2.1 %) patients with culture test results were included in this study. Of the 143 enrolled patients, 46 (32.2 %) were classified in the MDR group. The use of antibiotics for more than 5 days before diagnosis of anastomosis site leakage (p = 0.016) and diabetes mellitus (p = 0.028) was identified as independent risk factors for MDR acquisition by multivariate analysis. The rate of adequate initial empirical antibiotic therapy in the MDR group was lower than in the non-MDR group (35 vs. 75 %, p

Background The benefit of adjuvant chemotherapy for patients with locally advanced rectal cancer who have received neoadjuvant concurrent chemoradiation therapy (CCRT) and undergone curative resection remains unclear. Methods This study was a retrospective review of prospectively collected data. Patients with locally advanced rectal cancer who underwent curative surgery after neoadjuvant CCRT between January 2006 and March 2011 were identified. Four hundred forty-one patients who completed adjuvant chemotherapy (chemo group) were compared with 35 patients who did not receive any adjuvant treatment (nonchemo group). Results The 5-year disease-free survival (DFS) was significantly higher in the chemo group (78.5% vs. 63.1%, P = 0.016). After stratification of the patients according to nodal status, these differences were no longer significant, but there were trends toward inferior DFS in the nonchemo group in all survival curves. In multivariate Cox regression analysis, no adjuvant chemotherapy (HR, 2.306; 95% CI, 1.101–4.829; P = 0.027) emerged as an independent prognostic factor associated with decreased DFS. Conclusions Adjuvant chemotherapy was significantly associated with increased DFS among patients who had undergone neoadjuvant CCRT and radical resection for locally advanced rectal cancer. Adjuvant chemotherapy should be considered in every patient after neoadjuvant CCRT irrespective of the final pathology stage. J. Surg. Oncol. 2015 111:439–444. © 2014 Wiley Periodicals, Inc.

The prevailing view is that therapeutic antibodies deplete cells through opsonization and subsequent phagocytosis, complement-dependent lysis or antibody-dependent cellular-cytotoxicity. We used high resolution in vivo imaging to identify a new antibody-dependent cell death pathway where Kupffer cells ripped large fragments off crawling antibody-coated iNKT cells. This antibody-dependent fragmentation process resulted in lethality and depletion of crawling iNKT cells in the liver sinusoids and lung capillaries. iNKT cell depletion was Fcy-receptor dependent and required iNKT cell crawling. Blood, spleen or joint iNKT cells that did not crawl were not depleted. The antibody required high glycosylation for sufficiently strong binding of the iNKT cells to the Fc Receptors on Kupffer cells. Using an acetaminophen overdose model, this approach functionally depleted hepatic iNKT cells and affected the severity of liver injury. This study reveals a new mechanism of antibody-dependent killing in vivo and raises implications for the design of new antibodies for cancer and auto-reactive immune cells.

Background The introduction of complete mesocolic excision (CME) with central vessel ligation (CVL) for right-sided colon cancer has improved oncologic outcomes. However, there is controversy over the oncologic safety of laparoscopic CME with CVL. This study compared short-term and long-term oncologic outcomes between laparoscopic and open modified CME (mCME) with CVL in patients with right-sided colon cancer. Methods We enrolled 1239 patients who underwent open mCME with CVL and 1010 patients treated by a laparoscopic approach for right-side colon cancer between 2000 and 2013 and used 1:1 propensity score matching to adjust for potential baseline confounders between two groups. Results After propensity score matching, 683 patients who underwent open mCME with CVL were compared with 683 patients treated with a laparoscopic approach. There were no significant differences between these groups in age, sex, ASA score, TNM stage, tumor size, lymphovascular invasion, and perineural invasion. Comparison of open and laparoscopic mCME groups showed no significant difference in postoperative morbidity (21.4 vs. 18.3%, p = 0.175) and mortality (0.1 vs. 0%, p = 1.000). The laparoscopic mCME group showed shorter length of hospital stay. The 5-year overall survival rate was 83.7% in the open group and 94.7% in the laparoscopic group (p

This study investigated the prognostic impact of serum carcinoembryonic antigen (CEA) level in recurrent rectal cancer. We reviewed 745 patients who developed recurrence after curative treatment for rectal cancer between January 2000 and December 2012. Multivariate analyses for survival revealed that age > 60 years (p = 0.005), r-CEA ≥ 5 ng/ml (p < 0.001), disease free interval (DFI) < 12 months (p < 0.001), and palliative or conservative treatment (p < 0.001) were unfavorable factors.

Purpose There are patients who do not undergo surgery, regardless of tumor response for neoadjuvant chemoradiotherapy (nCRT) in rectal cancer. However, there have been few reports focused on how oncologic outcomes are worse in these patients. We sought to investigate oncologic outcomes for these non-operated patients with rectal cancer after nCRT. Materials and Methods A total of 1,063 records of patients with rectal cancer who were treated with nCRT from January 2002 to December 2013 were retrospectively reviewed. We categorized patients into the non-operated group (n=77), transanal local excision (TLE) group (n=54), ortotal mesorectal excision (TME) group (n=932) and compared each group using propensity score matching. Results In the non-operated group, the most common reason for no surgery was patient refusal (n=64). Eleven patients were considered to have achieve clinical complete response (cCR), which was an independent prognostic factor of progression-free survival (p=0.045). In patients with disease progression in the non-operated group, the overall survival did not improved according to salvage treatments (p=0.451). The non-operated group showed worse survivals compared to the TLE or TME group before and after matching (p < 0.001). This finding was also noted in the analysis of survival only in patients with cCR. Conclusion In this study, non-operated patients did not secure oncologic safety regardless of cCR after nCRT. Our results suggest that a non-operative management must be carefully considered even if cCR is achieved.

Purpose: Tumors continuously evolve to maintain growth; secondary mutations facilitate this process, resulting in high tumor heterogeneity. In this study, we compared mutations in paired primary and metastatic colorectal cancer tumor samples to determine whether tumor heterogeneity can predict tumor metastasis. Experimental Design: Somatic variations in 46 pairs of matched primary-liver metastatic tumors and 42 primary tumors without metastasis were analyzed by whole-exome sequencing. Tumor clonality was estimated from single-nucleotide and copy-number variations. The correlation between clinical parameters of patients and clonal heterogeneity in liver metastasis was evaluated. Results: Tumor heterogeneity across colorectal cancer samples was highly variable; however, a high degree of tumor heterogeneity was associated with a worse disease-free survival. Highly heterogeneous primary colorectal cancer was correlated with a higher rate of liver metastasis. Recurrent somatic mutations in APC, TP53, and KRAS were frequently detected in highly heterogeneous colorectal cancer. The variant allele frequency of these mutations was high, while somatic mutations in other genes such as PIK3CA and NOTCH1 were low. The number and distribution of primary colorectal cancer subclones were preserved in metastatic tumors. Conclusions: Heterogeneity of primary colorectal cancer tumors can predict the potential for liver metastasis and thus, clinical outcome of patients. Clin Cancer Res; 23(23); 7209–16. ©2017 AACR.

This paper predicts the complex permittivity of MWNT added epoxy depending on agglomeration bynumerical analysis. 1wt% MWNT added epoxy specimen is prepared using 3-roll-mill method and its complexpermittivity is measured in X-band (8.2~12.4 GHz) using freespace measurement system. The analytic model iscomprised of cube epoxy and perfect sphere agglomeration. The complex permittivity of the agglomeration model ispredicted by complex permittivity mixing rule using the measured complex permittivity of epoxy and 1 wt% MWNTadded epoxy. Commercial electromagnetic analysis software, CST, is used to obtain S-parameter of the analytic modeland MATLAB code is used to calculate complex permittivity from the S-parameter. It is confirmed that the complexpermittivity increases when the agglomeration size decreases.초록 : 본 연구에서는 MWNT(Multi-walled carbon nanotube)의 응집크기와 복소유전율의 관계를 수치해석적인 방법을 통하여 접근하였다. 이를 위하여 3-roll-mill 장비를 사용하여 1wt% MWNT가 첨가된 에폭시 시편을 제작하였다. 제작된 시편은 X-band(8.2~12.4 GHz)에서 네트워크 분석기와 자유공간 측정 장비를 이용하여 복소유전율을측정하였다. 측정된 복소유전율과 복소유전율 혼합 모델을 이용하여 에폭시와 MWNT 응집으로 이루어진 해석모델의 유전율을 결정하였다. 해석 모델은 앞서 말한 것과 같이 에폭시와 MWNT의 응집으로 이루어져 있으며,정육면체 에폭시 내에 구 형태의 MWNT 응집을 가정하였다. 이에 따라 에폭시와 MWNT의 부피비율은 고정되며, 변수는 응집의 크기로 한정하였다. 수치해석은 상용 전자기 해석프로그램인 CST를 사용하였다. CST로부터 모델의 S-parameter를 얻었고, 복소유전율은 Nicolson 방법을 사용하여 얻었다. MATLAB으로 코드를 만들어 S-parameter로부터 복소유전율을 얻었다. 수치해석 결과 응집의 크기가 작아질수록 복소유전율 값이 높아지는 모습을 살펴볼수 있었으며, 이는 나노 입자의 이용에 있어서 분산도는 기계적인 특성뿐 아니라 전자기적 특성인 복소유전율에도 영향을 미친다고 볼 수 있으며, 같은 나노 입자 함량에서 분산도가 좋을수록 높은 복소유전율을 기대할 수 있다.

Background Perineural invasion (PNI) may influence the prognosis of colon cancer, but little is known about its predictive value. The aim of this study was to reveal the role of PNI in predicting prognosis after curative resection of colon cancer, especially T3N0. Methods Two hundred and fifty-five patients who underwent curative resection for colon cancer at Samsung Medical Center and were later diagnosed with stage T3N0 by a pathological report between November 2004 and December 2007 were retrospectively recruited into the study. Results Among the 255 patients, 156 were male and 99 were female. The mean age was 61 years (range, 25 to 88 years). The most common tumour location was the sigmoid colon (93 patients, 36.5%). The median follow-up period was 61 months (range, 1 to 98 months). PNI was detected in 18 patients (7.1%). Adjuvant chemotherapy was performed in 205 patients (80.4%). The 5-year disease-free survival rate was greater for patients with PNI negative tumours compared with those with PNI positive tumours (92.0% versus 76.0%, P = 0.025). Adjuvant chemotherapy was not associated with significant differences in survival rate (94.8% versus 96.9%, P = 0.625). On multivariate analysis, PNI was an independent prognostic factor for disease-free and overall survival (P = 0.046, hazard ratio (HR) = 3.113, 95% confidence interval (CI) = 1.020–9.505 and P = 0.019, HR = 9.395, 95% CI = 1.453–60.755 respectively). Conclusions PNI is the only significant prognostic factor affecting disease-free and overall survival in patients with T3N0 colon cancer.

Background There is ongoing debate about the appropriate criterion for defining a positive circumferential resection margin after radical surgery for rectal cancer. Objective The purpose of this work was to determine the importance of the extent of the circumferential resection margin with regard to outcomes in patients with rectal cancer who underwent total mesorectal excision with and without neoadjuvant chemoradiotherapy. Design This was a retrospective review of prospectively collected data. Settings The study was conducted in a tertiary care hospital. Patients We reviewed the medical charts of 780 patients with rectal cancer who underwent radical surgery from 2004 to 2009. There were 599 patients (76.8%) who did not receive neoadjuvant chemoradiotherapy and 181 patients (23.2%) who did. Main outcome measures The relationship between the extent of the circumferential resection margin (0.5, 1.0, 2.0, and 3.0 mm) and recurrence and survival was assessed. Results Among circumferential resection margins ≤0.5, ≤1.0, ≤2.0, and ≤3.0 mm, the HR was highest and disease-free survival was longest for a circumferential resection margin ≤1 mm in both the chemoradiotherapy and nonchemoradiotherapy groups. A circumferential resection margin ≤1 mm, lymphatic invasion, histology, pathologic T category, pathologic N category, preoperative CEA, and adjuvant chemotherapy were independent predictors of disease-free survival in the nonchemoradiotherapy group. In the chemoradiotherapy group, a circumferential resection margin ≤1 mm and histology were independent predictors of disease-free survival. Multivariate analysis revealed that a circumferential resection margin ≤1 mm was an independent prognostic factor for overall survival in both of the 2 groups. Limitations This was a single-institution, retrospective study. Conclusions A circumferential resection margin of ≤1 mm had a strong association with disease-free survival compared with circumferential resection margins ≤0.5, ≤2.0, and ≤3 mm. A circumferential resection margin ≤1 mm was an independent predictor of a poor outcome in both the nonchemoradiotherapy and chemoradiotherapy groups.

The aim of this study is to evaluate the safety and feasibility of laparoscopic reintervention compared with open surgery in patients with anastomotic leakage after minimally invasive colorectal surgery.Between January 2008 and December 2012, 77 patients who required surgical reintervention for anastomotic leakage following minimally invasive colorectal surgery were included in this study. Data on the patients' demographics, operative management, morbidity, hospital stay, and mortality were analyzed for differences based on whether they received laparoscopic or open surgery.Sixteen patients underwent open surgery following laparoscopy, and 61 patients received laparoscopic reintervention following laparoscopy. The conversion rate was 8.2 % (5/61). The median total hospital stay following reintervention was significantly shorter for laparoscopic surgery (16.0 days, range 9-117 days) than for open surgery (35.5 days, range 10-135 days, p 0.001). The postoperative 30-day morbidity rate, including wound dehiscence (25.0 vs 3.3 %, p = 0.015) and intra-abdominal infection (31.3 vs 6.6 %, p = 0.016), was lower in the laparoscopic surgery group than in the open surgery group. The rate of stoma closure was lower in the open surgery group than in the laparoscopic surgery group (43.8 vs 80.5 %, p 0.001). There was one in-hospital mortality in the open surgery group.Laparoscopic reintervention for anastomotic leakage following minimally invasive colorectal surgery is associated with a shorter hospital stay, fewer postoperative complications, and a higher stoma closure rate than open surgery. Laparoscopic reintervention for anastomotic leakage is feasible and safe.

Background and Objectives The purpose of this study was to determine the risk factors for requirement of surgical or endoscopic interventions for complications caused by the primary tumor during chemotherapy in patients with unresectable metastatic colorectal cancer. Methods A total of 259 patients were diagnosed with uncomplicated colorectal cancer with unresectable metastatic disease and underwent chemotherapy as an initial treatment. Among them, 57 (22.0%) patients underwent palliative interventions because of complications caused by the primary tumor during chemotherapy, including bypass surgery or diverting enterostomy for 22 patients, insertion of colonic stent for 22, and resection of primary tumor for 13. Results Multivariate analysis revealed that rectal lesion (RR, 2.132; 95% CI, 1.080–4.210; P = 0.029) and tumor size larger than 5 cm (RR = 3.644, 95% CI = 1.923–6.902; P

Background Although a single incision laparoscopic (SIL) technique has been used increasingly in colorectal surgery, there are only a few reports on the clinical availability of this approach coupled with low anterior resection (SIL–LAR) for colorectal cancers. We report here 96 consecutive cases of SIL–LAR and reduced port LAR cases, of which the initial approach was SIL. Methods This is a retrospective review of prospectively collected data of SIL–LAR cases performed by a single surgeon in Samsung Medical Center between June 2011 and June 2012. Results Out of 96 cases, 28 were finished as ‘pure’ SIL–LAR. Sixty-four cases were performed with one additional port, and four needed two more ports. There was no open conversion. The median duration of operation was 165 min. Proximal and distal resection margins were negative in all cases. Circumferential resection margins were positive in four cases. The median duration of postoperative stay was 7 days and the complication rate was 20%. There were six cases of anastomosis leakage (6%). Conclusion The SIL–LAR technique can be applied safely with the optional use of an additional port. One additional port in the right suprapubic area is useful for obtaining a secure distal division and a safe total mesorectal excision, especially in patients with lower lesions or history of neoadjuvant chemoradiation.

Purpose: Anastomotic leakage (AL) is a major complication occurring after low anterior resection (LAR). Several methods for anastomotic protection have been tried. However, the effectiveness of these methods at preventing AL is questioned. The present study examined whether direct application of fibrin glue to an anastomotic site could be an effective method for reducing aspects of AL, such as leakage rate. Methods: This study targeted patients who had undergone LAR between March and September 2012 for primary rectal cancer or rectosigmoid cancer which curative resection was possible. Anastomosis was performed with end to end anastomosis in all patients. Fibrin glue was used in 99 patients and conventional methods in the controls (130 patients). The research was conducted as a prospective non-randomized study. Results: AL occurred in seven cases (7.1%) in the fibrin glue group and seven cases (5.4%) in the control group; this difference wasn’t statistically significant. No significant differences were found between the two groups in terms of clinical stage of primary cancer, operation time, and length of hospital stay after surgery or in the severity of leakage or the treatment policy decisions for patients with AL. An analysis of risk factors showed that the occurrence of AL was significantly higher in male patients. Conclusion: Fibrin glue applied to an anastomotic site to prevent AL during LAR did not reduce the rate of AL. No differences were noted in other aspects of AL that would favor the use of fibrin glue over conventional methods.

In this paper, we consider a resource allocation scheme for millimeter-wave-based wireless personal area networks (WPANs) using directional antennas. This scheme involves scheduling the reservation period of medium access control (MAC) for IEEE 802.15.3c, one of the standards for millimeter-wave-based WPANs adopting directional antennas. Objective functions are considered to minimize the average delay and maximize throughput, and two scheduling algorithms, namely, MInMax concurrent transmission and MAxMin concurrent transmission, are proposed to provide a suboptimal solution to each objective function. These are based on an exclusive region and two decision rules that determine the length of reservation times and transmission order of groups. Each group consists of flows that are concurrently transmittable via spatial reuse. The algorithms appropriately apply two decision rules according to their objectives. A real video trace is used for the numerical results, which show that the proposed algorithms satisfy their objectives. They outperform other schemes on a range of measures, showing the effect of using a directional antenna. The proposed scheme efficiently supports variable bit rate traffic during the reservation period, reducing resource waste.

Purpose: This study was conducted to evaluate the systemic inflammatory response in colorectal cancer patients, and to estimate the usefulness of the Glasgow prognostic score (GPS) as a prognostic factor. Methods: Patients with biopsy-proven colorectal adenocarcinoma who were operated between April 2005 and December 2008 were enrolled in this study. The GPS was estimated based on the measurement of CRP and serum albumin level. The GPS was compared with other clinicopathological factors. Univariate and multivariate analyses were performed to evaluate the factors affecting cancer-specific survival. Results: GPS was significantly higher in patients with anemia, thrombocytosis, a high neutrophil to lymphocyte ratio, tumor of the colon, and large tumor. Patient age, gender, serum CEA level, tumor gross appearance, TNM stage, and tumor differentiation were not related with the GPS. In univariate analysis, hemoglobin, CEA, gross appearance of tumor, TNM stage, tumor differentiation, and GPS were associated with cancer-specific survival. In multivariate analysis, TNM stage (III or IV : I or II; hazard ratio [HR], 12.322; P = 0.015), tumor differentiation (poorly differentiated : well or moderately differentiated; HR, 3.112; P = 0.021), and GPS (GPS 2 : GPS 0 or 1; HR, 5.168; P = 0.003) were identified as independent prognostic factors in colorectal cancer. Conclusion: Our study showed that the GPS was an independent variable from tumor stage and a good and convenient prognostic factor in colorectal cancer patients.

Prognostic significance of intraoperative staging by surgeons and its possible complementary role with the pathological stage for evaluating the prognosis of rectal cancer after preoperative chemoradiation (CRT) is unknown. The goal of this study is to evaluate the diagnostic accuracy and prognostic role of intraoperative surgical staging by surgeons in patients with rectal cancer after preoperative CRT. A total of 267 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from December 2007 to March 2010 were retrospectively reviewed. Surgical staging was evaluated by determining its diagnostic accuracy and analyzing its prognostic significance. Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative diagnosis of good responders (ypT0-2) were 78, 67, 53, and 86 %, respectively. The overall accuracy of good responders by surgeons was 71 %. A multivariate analysis revealed that pretreatment N stage and maximal tumor diameter were independent predictors for accordance of surgical and pathological diagnoses in T staging. The 3-year disease-free survival rates of the patients with surgical T0, T1, T2, T3, and T4 were 100, 94, 85, 84, and 58 %, respectively, and 86, 81, and 67 % for patients with surgical N0, N1, and N2 disease, respectively (P

Background Despite significant improvements in colon cancer outcomes over the past few decades, preclinical development of more effective therapeutic strategies is still limited by the availability of clinically relevant animal models. To meet those clinical unmet needs, we generated a well-characterized in vivo preclinical platform for colorectal cancer using fresh surgical samples. Methods Primary and metastatic colorectal tumor tissues (1–2 mm 3 ) that originate from surgery were implanted into the subcutaneous space of nude mice and serially passaged in vivo . Mutation status, hematoxylin and eosin staining, short tandem repeat profiling, and array comparative genomic hybridization were used to validate the similarity of molecular characteristics between the patient tumors and tumors obtained from xenografts. Results From surgical specimens of 143 patients, 97 xenograft models were obtained in immunodeficient mice (establish rate = 67%). Thirty-nine xenograft models were serially expanded further in mice with a mean time to reach a size of 1000–1500 mm 3 of 90 ± 20 d. Histologic and immunohistochemical analyses revealed a high degree of pathologic similarity including histologic architecture and expression of CEA, CK7, and CD20 between the patient and xenograft tumors. Molecular analysis showed that genetic mutations, genomic alterations, and gene expression patterns of each patient tumor were also well conserved in the corresponding xenograft tumor. Conclusions Xenograft animal models derived from fresh surgical sample maintained the key characteristic features of the original tumors, suggesting that this in vivo platform can be useful for preclinical development of novel therapeutic approaches to colorectal cancers.

Although laparoscopic colorectal resection and laparoscopic liver resection have been accepted as effective alternatives to conventional open procedures, there are only a few reports on the clinical availability of simultaneous performance of these two procedures. We report our collective experience of patients with colorectal cancers treated with totally laparoscopic colorectal and liver resection, in comparison with those treated with an open approach.This study is a retrospective, case-match review of prospectively collected data. Between May 2008 and December 2012, 24 patients with primary colorectal cancer and associated hepatic lesions underwent simultaneous laparoscopic colorectal and liver resection (laparoscopic group). They were matched with patients who underwent an open procedure (open group; n=24 out of 232) based on the types of surgery. Patient demographics, operative details, tumor-related parameters, and postoperative outcomes were analyzed.Demographic features and pathologic outcomes were similar in both groups. The median duration of operation was significantly longer in the laparoscopic group than in the open group (290 versus 244 minutes; P=.008), and the median estimated blood loss was larger (325 versus 250 mL; difference not significant, P=.35). However, the time to starting a soft blended diet (3.0 versus 4.5 days; P.001) and postoperative stay (8.0 versus 10.5 days; P=.001) in the laparoscopic group were both significantly shorter than in the open group. The postoperative complication rate was lower in the laparoscopic group (17% versus 42%; difference not significant, P=.06). The minor complication rate was significantly lower in the laparoscopic group (4% versus 33%; P=.02).A totally laparoscopic approach might provide short-term benefits associated with enhanced postoperative recovery despite a longer procedure time and larger blood loss. It can be a reasonable option for simultaneous colorectal and hepatic resection.

Background The aim of this study was to evaluate the predictive role of the mismatch repair (MMR) system and p53 expression for lymph node metastasis and long-term survival in patients with T1 and T2 colorectal cancer. Methods A total of 543 patients with T1 or T2 colorectal cancers who underwent radical surgery with regional lymphadenectomy from December 2007 to December 2009 were analyzed. Predictive factors for lymph node metastasis and prognostic factors were analyzed. Results During the median follow-up period of 4 years, the 5-year disease-free survival rate for patients without lymph node metastasis was 94.8%, which was significantly higher than that for those with lymph node metastases (85.2%; P

The aim of this study is to evaluate the prognostic factors associated with primary cancer in patients with curatively resected stage IV colorectal cancer, based on lymph node status.A total of 468 consecutive patients with curatively resected stage IV colorectal cancer from October 1994 to December 2010 were prospectively enrolled. Survival curves were constructed using the Kaplan-Meier method, and multivariate analysis assessed independent prognostic factors.During the median follow-up period of this study, which was 37 months (range 1-177), the 3- and 5-year overall survival rates were 66.5 and 52.1%, respectively, and the 3- and 5-year disease-free survival rates were 43.0 and 38.2%, respectively. According to multivariate analysis, adjuvant chemotherapy and the preoperative serum carcinoembryonic antigen (CEA) level were independent prognostic factors for overall survival, and primary tumor location and preoperative serum CEA level were independent variables for disease-free survival. For the patients with N0 and N1 tumors, the overall survival curves in the preoperative CEA groups differed significantly (P = 0.046 and P0.013, respectively). However, for patients with pN2 tumors, the overall survival did not differ significantly according to the preoperative CEA (P = 0.948).The preoperative serum CEA level is a reliable predictor of recurrence and survival after curative surgery in patients with metastatic colorectal cancer. A multidisciplinary approach that combines both complete resection and adjuvant chemotherapy may achieve improved overall survival in these patients.

Purpose: The epithelial-mesenchymal transition (EMT) is known to be associated with tumor progression, invasion and metastasis in colorectal cancer (CRC). Materials and Methods: Tissue samples obtained from 409 patients with stage III CRC treated from 2006 to 2007 were examined by immunohistochemistry to reveal the expression levels of E-cadherin, fibronectin, vimentin and α-smooth muscle actin (SMA). Results: Among the 409 patients, 402 cases (98.3%) showed positive E-cadherin expression. Positive E-cadherin expression was associated with well or moderately differentiated cell types and a stable microsatellite status. In multivariate analysis, a preoperative carcinoembryonic antigen level >5 ng/ml (p = 0.021), advanced N stage (p = 0.017), positive vascular invasion (p = 0.048), positive perineural invasion (p = 0.002) and negative E-cadherin expression (p = 0.002, relative risk = 5.098, 95% CI = 1.801-14.430) were poor prognostic factors affecting disease-free survival. The declining E-cadherin expression was associated with a poor outcome in terms of overall survival in univariate (p = 0.016) but not in multivariate analyses (p = 0.303, relative risk = 1.984, 95% CI = 0.539-7.296). Fibronectin, vimentin and α-SMA were of no prognostic value in this study. Conclusion: The expression pattern of EMT markers in stage III CRC suggests that declining E-cadherin expression is a possible immunohistochemical predictor of patient prognosis.

Summary Macrophages play an important role in structural cardiac remodeling and the transition to heart failure following myocardial infarction (MI). Previous research has focused on the impact of blood-derived monocytes on cardiac repair. Here we examined the contribution of resident cavity macrophages located in the pericardial space adjacent to the site of injury. We found that disruption of the pericardial cavity accelerated maladaptive post-MI cardiac remodeling. Gata6+ macrophages in mouse pericardial fluid contributed to the reparative immune response. Following experimental MI, these macrophages invaded the epicardium and lost Gata6 expression but continued to perform anti-fibrotic functions. Loss of this specialized macrophage population enhanced interstitial fibrosis after ischemic injury. Gata6+ macrophages were present in human pericardial fluid, supporting the notion that this reparative function is relevant in human disease. Our findings uncover an immune cardioprotective role for the pericardial tissue compartment and argue for the reevaluation of surgical procedures that remove the pericardium.

Intra-articular hyaluronic acid (HA) is widely used to treat symptomatic osteoarthritis (OA) in the carpometacarpal joint (CMCJ) of the thumb. However, although apparently effective and relatively safe, intra-articular HA injections act relatively slowly. Therefore, a nonsteroidal anti-inflammatory drug could be added for more prompt pain relief. The aim of this study was to compare the efficacy and safety of ultrasound (US)-guided intra-articular injection of HA and ketorolac with that of HA alone in patients with OA of the CMCJ of the thumb. Seventy-four patients identified by chart review to have a diagnosis of OA of the CMCJ of the thumb received either a US-guided intra-articular injection of 0.5 mL of sodium hyaluronate and 0.5 mL of ketorolac (n = 38) or 0.5 mL of sodium hyaluronate and 0.5 mL of saline (n = 36). Disabilities of the arm, shoulder, and hand (DASH) and verbal numeric scale (VNS) pain scores were recorded before and 1, 3, and 6 months after injection. Univariable analyses (using the chi-squared test) and multiple logistic regression analysis were performed to evaluate the relationship between potential predictors of the outcome (treatment allocation, patient age and sex, duration of pain, and Eaton–Littler classification) and therapeutic effects. The DASH and VNS scores were improved at 1, 3, and 6 months postinjection in both groups. The onset of pain relief was significantly more rapid (at 1 month) after the injection containing HA and ketorolac than after the injection containing HA alone. In 55.3% of cases, pain and function were improved postinjection compared with baseline and remained so for up to 6 months. The success rate was not significantly different between the assessments at 1, 3, and 6 months, and the univariable analyses did not identify any statistically significant potential predictors of the outcome. Multiple logistic regression analysis did not identify any independent predictors of a successful outcome at midterm follow-up. The onset of analgesic action was more rapid after an injection containing HA and ketorolac than after 1 containing HA alone in patients with OA of the CMCJ of the thumb. There were no serious complications.

Purpose The purpose of this study is to evaluate the prognostic value of preoperative serum CA 19-9 levels in colorectal cancer patients. Methods Between 2008 and 2011, 4,794 consecutive patients who underwent curative resection for colorectal cancer were analyzed. These patients were classified into 2 groups according to preoperative CA 19-9 (high CA 19-9: ≥37 ng/mL, n = 440; normal CA 19-9

Fistula is a representative devastating complication in Crohn's patients due to refractory to conventional therapy and high recurrence. In our phase I clinical trial, adipose tissue-derived stem cells (ASCs) demonstrated their safety and therapeutic potential for healing fistulae associated with Crohn's disease. This study was carried out to evaluate the efficacy and safety of ASCs in patients with Crohn's fistulae. In this phase II study, forty-three patients were treated with ASCs. The amount of ASCs was proportioned to fistula size and fistula tract was filled with ASCs in combination with fibrin glue after intralesional injection of ASCs. Patients without complete closure of fistula at 8 weeks received a second injection of ASCs containing 1.5 times more cells than the first injection. Fistula healing at week 8 after final dose injection and its sustainability for 1-year were evaluated. Healing was defined as a complete closure of external opening without any sign of drainage and inflammation. A modified per-protocol analysis showed that complete fistula healing was observed in 27/33 patients (82%) by 8 weeks after ASC injection. Of 27 patients with fistula healing, 26 patients completed additional observation study for 1-year and 23 patients (88%) sustained complete closure. There were no adverse events related to ASC administration. ASC treatment for patients with Crohn's fistulae was well tolerated, with a favorable therapeutic outcome. Furthermore, complete closure was well sustained. These results strongly suggest that autologous ASC could be a novel treatment option for the Crohn's fistula with high-risk of recurrence.

Background The aim of the current study was to evaluate the clinical availability of local excision (LE) for advanced rectal cancer without lymph node metastasis after neoadjuvant chemoradiation therapy (nCRT) in Korea. Methods From June 2000 to October 2009, 40 patients with cT2-3N0M0 rectal cancer underwent nCRT followed by LE according to a retrospective multicenter analysis. Results Of the 40 patients, 22 were men and 18 were women. Eighteen patients were cT2, and 22 patients were cT3. The median follow-up duration was 38 months. Three patients (7.5%) had morbidity after LE. Four patients (10%) had recurrence (local recurrence [1 patient] and systemic metastasis [3 patients]). The 3-year disease-free survival rate was 85.9%. Only pCR was a recurrence-related prognostic factor ( P = .040). Conclusions Although the current study was not a randomized controlled study, LE after nCRT in T2-3N0 rectal cancer patients appears to be a safe and effective treatment, especially in pCR patients.