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Purpose: To investigate a new image acquisition method [four dimensional T1-weighted high resolution imaging with volume excitation (4D THRIVE)] which enables an accurate hepatic arterial phase definition. The feasibility and its potential for detection and characterizing focal liver lesions (FLLs) are being evaluated. Materials and Methods: 115 FLLs underwent liver MRI that included the 4D THRIVE-contrast enhanced timing robust acquisition order (CENTRA)-keyhole sequence. Triple arterial phase was obtained during a single breath-hold. Images were reviewed for image quality, lesion conspicuity, and lesion detection. Two radiologists independently assessed images from phase I, II, III and through the triple arterial phase, which were all reviewed separately and in random order. The image quality was scored by using the five-point scale, and then, one phase for lesion with greatest conspicuity was selected. The enhancement pattern for FLLs was analyzed. Results: The detection rate was the highest on phase III. The image quality was greater than grade 3 with fair inter-observer agreements. The phase III showed greater conspicuity than phase I and II. Hepatocellular carcinomas (n = 38) showed variable enhancement pattern. Metastasis (n = 14) showed rim enhancement (n = 6), homogenous [n = 3) and no enhancement (n = 5). Most hemangiomas demonstrated homogenous enhancement (6/9, 67%). Conclusion: Triple arterial MRI using the 4D THRIVE-CENTRA-keyhole technique is feasible in despite of the relatively low detection rate, and is thus, helpful for the characterization of focal liver lesions. [ABSTRACT FROM AUTHOR]

Intrahepatic cholangiocarcinoma (ICC) is a rare malignancy and many cases of ICCs are diagnosed in an unresectable state. Until now there has been no effective palliative treatment for these cases. Recently yttrium-90 (90Y) radioembolization has been highlighted as a new palliative treatment for these cases. In Korea, there has been no reported case of unresectable ICC which was treated by 90Y radioembolization up until now. We treated two cases of unresectable ICCs with 90Y radioembolization and the ICCs were necrotized effectively without significant toxicity. [ABSTRACT FROM AUTHOR]

Purpose: To describe the characteristics of residual contrast enhancement (CE) in cryoablated renal cell carcinoma (RCC) with regard to eventual resolution and the presence of residual tumor on follow-up CT and MRI. Materials and Methods: 22 patients with 24 RCCs underwent laparoscopic renal cryoablation and follow-up CT (n = 19) and MRI (n = 3) for a mean of 28 months. Two radiologists retrospectively assessed the CT and MRI images for the tumor size and characteristics of residual CE in the cryolesions: peripheral rim (< 100/a of the maximum cryolesion diameter), focal eccentric (10-25%), and thick internal enhancement (> 25%). Results: Residual CE was seen in 13 cryolesions (54%) at 3-month follow-up. Peripheral rim and focal eccentric enhancement was seen in six (25%) and four (16.7%) cryolesions, persisted for a mean follow-up of 4.5 and 6 months, and disappeared completely at a mean follow-up of 10.5 and 12 months, respectively. Three (12.5%) cryolesions showed persistent thick internal enhancement at 6-month follow-up, and were treated with radiofrequency ablation or chemotherapy. The cryolesions had decreased in size by an average of 20.2% and 39.7% at 6 and 12 months after cryoablation, respectively. Conclusion: Follow-up for ⩾ 12 months is needed to assess treatment outcomes in patients with peripheral rim or focal eccentric enhancement of cryoablated RCCs, which may persist until 12 months postoperatively without remnant viable tumor. [ABSTRACT FROM AUTHOR]

Purpose: To assess gallbladder (GB) wall thickening and periportal tracking on CT in patients with acute pyelonephritis (APN) by each kidney involvement. Materials and Methods: A total of 117 patients diagnosed with APN by clinical examination and CT were included in this retrospective study. The patients were divided into three groups based on kidney involvement seen on CT: right APN, left APN, and bilateral APN. Two radiologists reviewed CT images in consensus for the presence of diffuse GB wall thickening and periportal tracking. The prevalence of these two manifestations was compared among the three groups. Results: The prevalence of GB wall thickening in patients with right APNJ (26.4%) and bilateral APN (19%) was significantly higher than in patients with left APN (0%) (p < 0.016). The prevalence of periportal tracking in patients with right APN (15.1%) and bilateral APN (26%) was higher than in patients with left APN (3%), with a significant difference between patients with bilateral ARN and left APN (p <0.016). Conclusion: GB wall thickening and periportal tracking are predominantly encountered on CT in patients with APN involving the right kidney (right and bilateral APN), and should be considered in differential diagnosis of diseases associated with GB wall thickening and periportal tracking. [ABSTRACT FROM AUTHOR]

Background/Aims: Epigallocatechin-3-gallate (EGCG), the primary catechin in green tea, has anti-inflammatory and anti-oxidative properties. The aim of the current study was to characterize the impact of EGCG on lipopolysaccharide (LPS)-induced innate signaling in bone marrow-derived macrophages (BMMs) isolated from ICR mice. Methods: The effect of EGCG on LPS-induced pro-inflammatory gene expression and nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK) signaling was examined using reverse transcription-polymerase chain reaction, Western blotting, immunofluorescence, and the electrophoretic mobility shift assay. Results: EGCG inhibited accumulation of LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA in BMMs. EGCG blocked LPS-induced IκBα degradation and RelA nuclear translocation. EGCG blocked the DNA-binding activity of NF-κB. LPS-induced phosphorylation of ERK1/2, JNK, and p38 was inhibited by EGCG. U0126 (an inhibitor of MEK- 1/2) suppressed the LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA accumulation in BMMs. Conclusions: These results indicate that EGCG may prevent LPSinduced pro-inflammatory gene expression through blocking NF-κB and MAPK signaling pathways in BMMs. [ABSTRACT FROM AUTHOR]

Background/Aims: Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic cough. The aims of this study were to evaluate the diagnostic usefulness of multichannel intraluminal impedance combined with pH monitoring (MII/pH monitoring) in patients with suspected symptoms of gastroesophageal reflux disease (GERD) and to assess the correlation between GER symptoms and reflux nature. Methods: Seventy patients with suspected symptoms of GERD (such as heartburn, acid regurgitation, noncardiac chest pain, globus and chronic cough) were enrolled. All patients were asked to discontinue medications that would influence esophageal motor function and gastric acid secretion at least one week ago. All subjects underwent MII/pH monitoring. Results: Forty-five patients (64.3%) were diagnosed with GERD. Among these patients, eleven patients (15.7%) had pathologic acid reflux by pH data and thirty-four patients (48.6%) had pathologic bolus exposure by impedance. Subjects with chronic cough had a higher De- Meester score (p=0.009), percentage of acid exposure time (p=0.007), acid bolus exposure % time (p=0.027), distal acid reflux episodes (p=0.015) and proximal acid reflux episodes (p=0.030) than subjects without chronic cough. Conclusions: The results of this study showed that the impedance monitoring enhanced diagnostic sensitivity than pH-monitoring alone by 48.6%. In addition, reflux episodes at the distal and proximal esophagus were noted to be important factors associated with chronic cough. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the impact of the black tea polyphenol, theaflavin, on the expression of adhesion molecules and activation of lipopolysaccharide (LPS)-induced innate signaling in rat intestinal epithelial (RIE) cells. Methods: The effect of theaflavin on neutrophil adhesion, expression of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1, LPS-induced nuclear factor-kappa B (NF-κB), and mitogen-activated protein kinase (MAPK) signaling was examined by neutrophil adhesion assay, RT-PCR, Western blotting, immunofluorescence, and electrophoretic mobility shift assay (EMSA). Results: Theaflavin suppressed adhesion of neutrophils to LPS-stimulated RIE cells. LPS-induced ICAM-1 and VCAM-1 expressions were inhibited by theaflavin. LPS-induced IκBα phosphorylation/degradation and nuclear translocation of NF-κB/p65 were blocked by theaflavin. Also, theaflavin blocked NF-κB DNA-binding activity in EMSA. LPS-induced phosphorylation of JNK was inhibited by theaflavin. Bay11-7082 (a NF-κB inhibitor) and SP600125 (a JNK inhibitor) suppressed the LPS-induced ICAM-1 and VCAM-1 mRNA accumulations. Conclusions: These results indicate that black tea polyphenol theaflavin suppresses LPS-induced ICAM-1 and VCAM-1 expressions through blockage of NF-κB and JNK activation in intestinal epithelial cells. [ABSTRACT FROM AUTHOR]

Background: Duodenal Dieulafoy's lesions are rare and only several cases were reported so far. Their characteristic appearance and location make it difficult to be diagnosed in the clinical practice. Massive bleeding often results from these lesions and can impede the accurate early treatment. Case presentation: 67 years old male patient suffered a fatal bleeding from Dieulafoy-like lesion located at the mouth of the periampullary diverticulum. Inintial endoscopic therapy and radiologic embolization failed to stop the bleeding, while direct observation and hemoclipping by the side viewing endoscopy successfully established correct diagnosis and permanent cure of the lesion. Conclusion: Aggressive endoscopic examinations combined with the accurate endoscopic threatment should be adopted when Dieulafoy-like lesion is suspected as a possible cause of the proximal small bowel hemorrahge. Verification of the diagnosis and definitive treatment often needed repeated examination by side-viewing endoscope as well as stabilization of the patient. [ABSTRACT FROM AUTHOR]

Caspase 8 and survivin are known as key molecules of apoptosis in hepatocellular carcinoma (HCC). The purpose of the present study was to investigate the relationship between promoter methylation and expression and apoptotic function of caspase 8 and survivin in HCC. Promoter methylation of the caspase 8 and survivin gene was analyzed in 73 primary HCC using methylation-specific polymerase chain reaction. The relationship between immunohistochemical expression of gene products and proliferative/apoptotic indices, and clinicopathological parameters was also investigated. Twenty-five (34%) and 24 (33%) patients had promoter methylation of caspase 8 and survivin gene. Immunohistochemical staining of caspase 8 and survivin was observed in 35 (48%) and 32 (44%). The methylation of caspase 8 and survivin demonstrated a negative correlation with immunohistochemical expression of gene products ( P= 0.049 and P= 0.001). Methylation of caspase 8 and positive expression of its gene product was significantly correlated with high apoptotic indices ( P= 0.032 and P= 0.026). Nuclear survivin expression was significantly correlated with high proliferative index ( P= 0.001). On survival analysis, positive nuclear survivin expression was associated with a poor prognosis in HCC ( P= 0.043). In conclusion, epigenetic alteration by promoter methylation of caspase 8 and survivin may constitute an important regulatory mechanism for expression of those genes in HCC. [ABSTRACT FROM AUTHOR]

Motivation: The small number of samples in many microarray experiments is a challenge for the correct identification of differentially expressed gens (DEGs) by conventional statistical means. Information from public microarray databases can help more efficient identification of DEGs. To model various experimental conditions of a public microarray database, we applied Gaussian mixture model and extracted bi- or tri-modal distributions of gene expression. Prior variance of Baldi's Bayesian framework was estimate for the analysis of the small sample-sized datasets. [ABSTRACT FROM PUBLISHER]

Background: Duodenal Dieulafoy's lesions are rare and only several cases were reported so far. Their characteristic appearance and location make it difficult to be diagnosed in the clinical practice. Massive bleeding often results from these lesions and can impede the accurate early treatment. Case presentation: 67 years old male patient suffered a fatal bleeding from Dieulafoy-like lesion located at the mouth of the periampullary diverticulum. Inintial endoscopic therapy and radiologic embolization failed to stop the bleeding, while direct observation and hemoclipping by the side viewing endoscopy successfully established correct diagnosis and permanent cure of the lesion. Conclusion: Aggressive endoscopic examinations combined with the accurate endoscopic threatment should be adopted when Dieulafoy-like lesion is suspected as a possible cause of the proximal small bowel hemorrahge. Verification of the diagnosis and definitive treatment often needed repeated examination by side-viewing endoscope as well as stabilization of the patient. [ABSTRACT FROM AUTHOR]

Background: Previous differential coexpression analyses focused on identification of differentially coexpressed gene pairs, revealing many insightful biological hypotheses. However, this method could not detect coexpression relationships between pairs of gene sets. Considering the success of many set-wise analysis methods for microarray data, a coexpression analysis based on gene sets may elucidate underlying biological processes provoked by the conditional changes. Here, we propose a differentially coexpressed gene sets (dCoxS) algorithm that identifies the differentially coexpressed gene set pairs between conditions. Results: dCoxS is a two-step analysis method. In each condition, dCoxS measures the interaction score (IS), which represents the expression similarity between two gene sets using Renyi relative entropy. When estimating the relative entropy, multivariate kernel density estimation was used to model gene-gene correlation structure. Statistical tests for the conditional difference between the ISs determined the significance of differential coexpression of the gene set pair. Simulation studies supported that the IS is a representative measure of similarity between gene expression matrices. Single gene coexpression analysis of two publicly available microarray datasets detected no significant results. However, the dCoxS analysis of the datasets revealed differentially coexpressed gene set pairs related to the biological conditions of the datasets. Conclusion: dCoxS identified differentially coexpressed gene set pairs not found by single gene analysis. The results indicate that set-wise differential coexpression analysis is useful for understanding biological processes induced by conditional changes. [ABSTRACT FROM AUTHOR]

This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram. [ABSTRACT FROM AUTHOR]

This study was designed to compare the detectability of high-resolution ultrasound (HRUS) and bedside chest radiography (CR) for a pneumothorax. During the last 14 months, 97 consecutive patients who were admitted to our institute to undergo a transthoracic needle aspiration and biopsy (TNAB) of the lung were included. Both HRUS and CR were performed immediately after the TNAB procedure. The HRUS images were saved in sequence using the cine-review mode and displayed as an animation on a workstation. Four radiologists independently analyzed both HRUS images and a soft copy of the CR on a diagnostic monitor and identified the pneumothorax. With CT as the reference standard, statistical parameters were calculated. From 97 patients, 35 pneumothorax cases were found on CT after the TNAB. The sensitivities in detecting the pneumothorax were 80 and 47% in HRUS and CR, respectively. The specificities were 94 and 94%. The diagnostic accuracies were 89 and 77%. The inter-observer agreement was excellent (?=0.85) in the HRUS images and moderate (?=0.49) in the CR. The results of this study suggest that HRUS is a more sensitive and confident method for diagnosing a pneumothorax when compared to bedside chest radiography. [ABSTRACT FROM AUTHOR]

Objective. We describe the imaging findings of malignant mixed müllerian tumor (MMMT) of the ovary, which have not previously been reported. Materials and methods. We experienced 13 cases of ovarian MMMT in eight patients. All patients underwent surgical resection and the MMMTs were confirmed pathologically. US (n=8), CT (n=8), and MRI (n=1) examinations were performed before operation. Imaging features were analyzed retrospectively for bilaterality, tumor solidity (cystic or solid), size, and contrast enhancement of the tumor on CT and MRI. Presence of ascites and other evidence of peritoneal seeding, adjacent organ invasion, distant metastasis, and surgical staging were also evaluated. Results. There were bilateral ovarian MMMTs in five patients and unilateral MMMTs in three patients. Two of the MMMTs were multiseptated cystic, and 11 were mixed (solid and cystic). The diameter of the largest dimension was less than 5 cm in one case, 5–10 cm in two cases, and larger than 10 cm in 10 cases. Dense homogeneous contrast enhancement of the solid component was seen in 11 mixed masses. Ascites were found in all patients. Other evidence of peritoneal seeding and direct invasion into adjacent organ such as the uterus or sigmoid colon was seen in five patients each. Pleural metastasis was present in one patient. Surgical stages were FIGO classification IIIb and IV in one patient each, and IIIc in six patients. Conclusion. Ovarian MMMTs usually present as aggressive, bilateral, large, solid and cystic tumors, combined with ascites, frequent peritoneal seeding, and adjacent organ invasion. [ABSTRACT FROM AUTHOR]

Background/Aims Characteristics of extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) are not fully understood and guidelines for adequate surveillance for detection of EHM is still lacking. Therefore, we aimed to elucidate the characteristics of EHM of HCC and the need for follow up surveillance of EHM following RFA. Methods We enrolled 661 patients who underwent RFA as a first-line treatment for HCC between January 2008 and December 2017. Results EHM was diagnosed in 44 patients (6.7%) during median follow-up period of 1,204 days. Extra-hepatic recurrence at initial recurrence was only 1.2%. Median time to diagnosis of EHM was 2.68 years and 68.2% of patients developed EHM within 2 years at first recurrence, irrelevant to recurrence free survival duration. The locations of EHM were as follows; intra-abdominal lymph nodes (36.3%), bone (25.0%), lung (29.5%) and peritoneum (27.3%). Abdomen computed tomography (CT)/magnetic resonance imaging (MRI) was used for diagnosis of EHM for 33 patients (75.0%) and chest CT was only used for three patients (6.8%). Thirty patients (30/38, 78.9%) had increment of tumor marker at the time diagnosis of EHM. At multivariate analysis, recurrence free survival less than 2 years, ratio of ablation zone by RFA and tumor size less than 2 and AFP >400 IU/mL at 1st recurrence were associated with high risk of EHM. Conclusions Only 1.2% was diagnosed with EHM at first recurrence and it was possible to detect most of EHM with abdomen CT and chest X-ray combined with tumor marker, and the role of chest computed tomography for EHM after RFA was limited. [ABSTRACT FROM AUTHOR]

Background/Aims With the development of treatment for colorectal cancer, stenting is used with increasing as a treatment for malignant colorectal obstruction. Compared with surgery, colorectal stent insertion shows similar result and less complications, successful colorectal stent insertion will improve quality of life in curative and palliative treatment patients. The aim of this study is to predict factors related to technical/clinical success in colorectal stent insertion for improvement of the success rate. Methods From January 2013 to December 2019, we retrospectively identified 479 patients with malignant colorectal obstruction who underwent placement of colorectal self-expandable metal stent (SEMS) at Chonnam National University Hwasun Hospital, Korea. Main outcome measures included technical success, clinical success, complications, and predictors of outcome. Results The incidence Technical success was achieved in 86.4% (414/479) and clinical success in 74.3% (356/479) of the cases. Pain and tenderness were present in 75.8% (363/479) and 44.1% (211/379), there were statistically related factor to technical failure of SEMS insertion (odds ratio [OR], 3.041; p=0.029 and OR, 2.358; p=0.012). Also, metastasis and microperforation were present in 306 of 479 (63.9%), 17 of 479 (3.6%) and it was a statistically significant factor associated with technical failure (OR, 7.128; p=0.04 and OR, 4.413; p=0.008). But there were no statistically factor associated with clinical failure in multivariate analysis. Conclusions Pain, tenderness, microperforation, and metastasis were a predict factor of technical failure of colorectal SEMS insertion in malignant colorectal obstruction. [ABSTRACT FROM AUTHOR]

Abstract Background/Aims We retrospectively compared the effect of endoscopic variceal obturation (EVO) and retrograde transvenous obliteration (RTO) in acute cardiofundal variceal bleeding. Methods Patients with acute cardiofundal variceal bleeding treated with EVO or RTO at two hospitals were included. Results Ninety patients treated with EVO and 86 treated with RTO were analyzed. The mean model for end-stage liver disease score was significantly higher in EVO group than in RTO group (13.5 vs. 11.7, P = 0.016). The bleeding control rates were high (97.8% vs. 96.5%), and the treatment-related complication rates were low in both EVO and RTO groups (2.2% vs. 3.5%). During the median follow-up of 18.0 months, gastric variceal (GV) and esophageal variceal rebleeding occurred in 34 (19.3%) and 7 (4.0%) patients, respectively. The all-variceal rebleeding rates were comparable between EVO and RTO groups (32.4% vs. 20.8% at 2-year, P = 0.150), while the GV rebleeding rate was significantly higher in EVO group than in RTO group (32.4% vs. 12.8% at 2-year, P = 0.003). On propensity score-matched analysis (71 patients in EVO vs. 71 patients in RTO group), both all-variceal and GV rebleeding rates were significantly higher in EVO group than in RTO group (all P

Abstract Background For patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of therapeutic strategies. DJ stents should be replaced at least once every 6 months to avoid infection or obstruction. Although DJ stents are generally replaced under cystoscopy, successful fluoroscopy-guided retrograde replacement of DJ stents in the interventional suite has been described in the literature. Methods Between April 2004 and May 2020, we exchanged 143 DJ stents in 19 male and 22 female patients under fluoroscopic guidance using Nelaton catheters, snare catheters, and 8F DJ stents. All procedures were performed with patients under sedation and local anesthesia. There were 39 patients with malignant ureteral obstruction and two patients with benign ureteral strictures. This study was approved by the Institutional Review Board. Technical success, clinical success, complications, procedure time, and mean interval between two procedures were retrospectively reviewed, and the factors affecting the success rate of the procedure were analyzed. Results Obstruction was detected at the abdominal ureter in 4 patients, pelvic ureter in 29 patients, and intravesical ureter in 8 patients. Twenty-six patients underwent two or more sessions of the procedures, whereas 15 patients underwent single-session procedures. Total 34 outpatient-based procedures and 109 inpatient-based procedures were performed. Technical success and clinical success were achieved in 94.4% (135/143) and 93.3% (126/135) procedures, respectively. Mean procedure time was 21.5 min (range 9–192 min). Mean procedure interval was 101.8 days (range 5–306 days). Technical success was negatively affected by male sex and obstruction at the pelvic ureter and was positively affected by previous successful exchange. Left-sided ureteral stent placement and old age negatively influenced clinical success. Septic shock occurred in one patient and was treated with antibiotics. Conclusion Fluoroscopy-guided trans-urethral exchange of DJ stents is an effective and less painful procedure.

Abstract Extrahepatic recurrence (EHR) after curative hepatectomy for hepatocellular carcinoma (HCC) is associated with a poor prognosis. We investigated the features of EHR and identified its predictive factors. This retrospective study included 398 treatment-naive patients who underwent curative hepatectomy for HCC at two tertiary hospitals. Multivariate Cox-regression analysis was performed to identify the variables associated with EHR. EHR was diagnosed in 94 patients (23.6%) over a median follow-up period of 5.92 years, most commonly in the lungs (42.6%). The 5-/10-year cumulative rates of HCC recurrence and EHR were 63.0%/75.6% and 18.1%/35.0%, respectively. The median time to EHR was 2.06 years. Intrahepatic HCC recurrence was not observed in 38.3% of patients on EHR diagnosis. On multivariate analysis, pathologic modified Union for International Cancer Control stage (III, IVa), surgical margin involvement, tumor necrosis, sum of tumor size > 7 cm, and macrovascular invasion were predictive factors of EHR. Four risk levels and their respective EHR rates were defined as follows: very low risk, 1-/5-year, 3.1%/11.6%; low risk, 1-/5-year, 12.0%/27.7%; intermediate risk, 1-/5-year, 36.3%/60.9%; and high risk, 1-year, 100.0%. Our predictive model clarifies the clinical course of EHR and could improve the follow-up strategy to improve outcomes.

BackgroundTo explore the feasibility and safety of natural killer (NK) cell therapy in HCC, we performed a prospective, open-label, phase I trial to evaluate the synergistic effect of locoregional high-dose autologous NK cell therapy in combination with hepatic arterial infusion chemotherapy (HAIC).MethodsPatients with locally advanced HCC who were refractory to the standard treatment were eligible for this study. Patients received expanded and activated NK cells for 5 consecutive days in a dose-escalating manner (dose 2.5×108, 5×108, 10×108 NK cells/injection) through hepatic arterial infusion following 4 cycles of HAIC with 5-fluorouracil (750 mg/m2) and cisplatin (25 mg/m2). The primary endpoint was the safety of NK cell-based immunotherapy, and the secondary endpoints were objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and immunologic responses.ResultsOf the 11 patients enrolled, the confirmed ORR was 63.6% (complete response [CR]: 36.4%, confirmed partial response [PR]: 27.3%). Stable disease (SD) and progressive disease (PD) were observed in two patients (18.2%) each, resulting in a disease control rate (DCR) of 81.8%. The median PFS and OS were 10.3 and 41.6 months, respectively. There were no incidences of decompensation or severe adverse events during HAIC, and no adverse events related to NK cell infusion were noted.ConclusionThe combination of HAIC and locoregional high-dose NK cell therapy is a safe and effective treatment for locally advanced HCC patients who were refractory to the standard treatment. This result warrants further development of this novel treatment to establish its efficacy in HCC. Clinical Trial Registrationcris.nih.go.kr, identifier KCT0003973.

Purpose: This study aimed to determine the correlation between protein induced by vitamin K absence or antagonist-II (PIVKA-II) and stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and Methods: Sixty-one patients received SBRT between 2015 and 2020 with a median dose of 48 Gy (range, 39 to 60 Gy) with a median of 4 fractions. Changes in tumor markers before and after SBRT were analyzed. Results: The median follow-up period was 31 months (range, 12 to 64 months). The estimated 2-year in-field failure-free survival, progression-free survival (PFS), and overall survival rates were 82.0%, 39.3%, and 96.7%, respectively. Patients with decreased PIVKA-II levels through SBRT had significantly few in-field failures (p = 0.005). Patients with PIVKA-II levels of ≤25 mAU/mL after SBRT had significantly long PFS (p = 0.004). Conclusion: PIVKA-II could be a useful surrogate marker for response or survival outcomes in patients with localized HCC receiving SBRT. [ABSTRACT FROM AUTHOR]

ObjectivesAmiodarone is widely used to treat arrhythmia. However, amiodarone is known for its severe toxicity to the liver, lungs, and thyroid. Amiodarone causes liver damage ranging from asymptomatic serum aminotransferase elevation to hepatic failure requiring liver transplantation. Although amiodarone toxicity has been reported, its simultaneous multi-organ toxicity is not well-known. Here, we introduce a novel case of multi-systemic amiodarone toxicity involving the liver, lungs, thyroid, and eyes.Case PresentationA 61-year-old woman visited the emergency room due to general weakness, nausea, visual disturbance, heat intolerance, and a non-productive cough. The patient had been using clopidogrel and amiodarone due to underlying atrial fibrillation. The total level of bilirubin was 0.71 mg/dL, aspartate aminotransferase was 358 U/L, alanine aminotransferase was 177 U/L, and prothrombin time was 27.1 s. Computed tomography showed diffuse increased liver intensity and scattered hyperattenuated nodular consolidations in both lungs. Transthoracic needle lung biopsy revealed fibrinoid interstitial inflammation with atypical change of type II pneumocytes and intra-alveolar foamy macrophages. In addition, the thyroid-stimulating hormone level was

OBJECTIVES Injection drug use is a major risk factor for hepatitis C virus (HCV) infection; however, limited data on this topic are available in Korea. Thus, this study aimed to investigate the epidemiological and clinical characteristics, treatment uptake, and outcomes of HCV infection among people who inject drugs (PWID). METHODS We used the data from the Korea HCV cohort, which prospectively enrolled patients with HCV infection between 2007 and 2019. Clinical data and results of a questionnaire survey on lifetime risk factors for HCV infection were analyzed according to a self-reported history of injection drug use (PWID vs. non-PWID group). RESULTS Among the 2,468 patients, 166 (6.7%) were in the PWID group, which contained younger patients (50.6±8.2 vs. 58.2±13.1 years) and a higher proportion of male (81.9 vs. 48.8%) than the non-PWID group. The distribution of PWID showed significant regional variations. Exposure to other risk factors for HCV infection was different between the groups. The proportion of patients with genotype non-2 infection was higher in the PWID group. Treatment uptake was higher in the PWID group in the interferon era; however, it was comparable between the groups in the direct-acting antiviral era. The rate of sustained virological response did not significantly differ between the groups. CONCLUSIONS As of 2019, PWID constituted a minority of HCV-infected people in Korea. The epidemiological characteristics, but not treatment uptake and outcomes, were different between the PWID and non-PWID groups. Therefore, active HCV screening and treatment should be offered to PWID in Korea.

Background/Aims: The success rate of endoscopic variceal ligation (EVL) is about 85-94%. There is only a few studies attempting to determine the cause of EVL failure, and to date, on-site rescue treatments remains unestablished. This study aimed to elucidate the risk factors for EVL failure and the effectiveness of on-site rescue treatment. Methods : Data of 454 patients who underwent emergency EVL at Chonnam National University Hospital were retrospectively analyzed. Enrolled patients were divided into two groups: the EVL success and EVL failure groups. EVL failures were defined as inability to ligate the varices due to poor endoscopic visual field, or failure of hemostasis after band ligation for the culprit lesion. Results : Forty-seven patients experienced EVL failure. In the multivariate analysis, male patients, initial hypovolemic shock, active bleeding on endoscopy, and history of previous EVL were independent risk factors for EVL failure. During endoscopic procedure, we came across the common causes of EVL failure, including unsuctioned varix due to previous EVL-induced scars followed by insufficient ligation of the stigmata and inability to ligate the varix due to poor endoscopic visual field. Endoscopic variceal obturation using N-butyl-2-cyanoacrylate (48.9%) was the most commonly used on-site rescue treatment method, followed by insertion of Sangstaken Blakemore tube (14.9%), and EVL retrial (12.8%). The rescue treatments successfully achieved hemostasis in 91.7% of those in the EVL failure group. Conclusions: The risk factors of EVL failure should be considered before performing EVL, and in case of such scenario, on-site rescue treatment is needed.

Aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015. Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection. Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group. Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination. [ABSTRACT FROM AUTHOR]

Backgrounds/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions: Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding. [ABSTRACT FROM AUTHOR]

Background/Aims: Patients with Hansen's disease are the most vulnerable to hepatitis C. However, no data on the treatment efficacy of direct-acting antiviral agents (DAAs) are available in this group. Therefore, we elucidated the prevalence and clinical outcomes of hepatitis C in persons affected by leprosy in Sorokdo, Jeollanam-do, Korea. Methods: We retrospectively included 50 leprosy patients with positive hepatitis C virus (HCV) RNA test results (group A) hospitalized at the Sorokdo National Hospital from May 2016 to March 2018 and 73 patients with chronic hepatitis C who were treated with DAAs at the Chonnam National University Hospital (group B) from May 2016 to December 2017. Results: Overall, at the Sorokdo National Hospital, positive HCV antibody and HCV RNA rates were 18.4% and 11.0%, respectively. The mean participant age was 76.5±7 years, and 58% of participants were men. The genotypes were type 1b in 44% (22 out of 50) and type 2 in 56% (28 out of 50). Sustained virologic response was achieved at a rate of 95.5% (21/22) in genotype 1b and 92.9% (26/28) in genotype 2 patients. Ribavirin-induced hemolytic anemia occurred in 57.1% (16/28) of patients with genotype 2. Among these, 28.5% (8/28) received blood transfusions. Conclusions: Treatment efficacy was not different between the leprosy-affected population and the general population. However, severe ribavirin-induced hemolytic anemia requiring transfusion was present in 28.5% of genotype 2 patients. Therefore, we suggest ribavirin-free DAAs for the treatment of genotype 2 hepatitis C in leprosy-affected persons in the future. [ABSTRACT FROM AUTHOR]

Chylothorax is a rare postoperative complication of a thoracic surgical procedure. Here, we report a case of chylothorax after thoracic endovascular aortic repair with debranching for the distal arch aneurysm of the aorta. First, the patient was treated by a medical method (nil per os, fat-free diet, and octreotide), but this method failed. The patient strongly refused surgical treatment. Therefore, we tried to occlude the thoracic duct by lymphangiography Lipiodol, and this line of treatment was successful.

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS. [ABSTRACT FROM AUTHOR]

The article discusses the study which aims to evaluate the correlation between the computed tomography urography (CTU) findings and histological grade of ureteral urothelial carcinoma (UUC) and to identify predictors of high-grade UUC. It states that Grade 3 or higher hydronephrosis on CTU may be predictive of high-grade UUC and that radical surgery should be considered.

Aim: To investigate the risk factors and characteristics of hepatocellular carcinoma (HCC) in the patients with drug-resistant chronic hepatitis B (CHB)., Methods: A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004 to December 2012. The patients were divided into two groups: the HCC group (n = 57) and the non-HCC group (n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC. Secondarily, patient and tumor characteristics of HCC patients with naïve CHB (N group, n = 117) were compared to the HCC group (R group, n = 57) to identify any difference in HCC characteristics between them., Results: A significant difference was found for age, platelet count, alpha-fetoprotein (AFP), positivity of HBeAg, seroconversion rate of HBeAg, virologic response, the Child-Pugh score, presence of rtM204I, and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis, age (> 50 years), HBeAg (+), virologic non-responder status, and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein (CRP) and AFP levels, earlier stage tumors, and a shorter mean tumor surveillance period than the N group. However, the total follow-up duration was not significantly different between the two groups., Conclusion: 13.2% of patients with drug-resistant CHB developed HCC. Age, cirrhosis, YIDD status, HBeAg status, and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.

Variceal bleeding is the most serious complication of portal hypertension, and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients. Currently, endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding. Endoscopic treatments include band ligation and injection sclerotherapy. Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding. Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding, injection of N-butyl-2-cyanoacrylate is associated with a variety of complications, including systemic embolization. Herein, we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.