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Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations. We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index. Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1–2, ≥ 3); PLN 4 (PLN = 0, 1–3, ≥ 4); LNR (LNR = 0, 0–0.269, ≥ 0.27); and LODDS (LODDS

Aims and background The relationship between cancer and metabolism has recently been receiving attention. We investigated the prognostic influence of type 2 diabetes mellitus in patients with hepatocellular carcinoma (HCC) treated with curative resection. Methods and Study Design The records of 58 patients who underwent curative resection for HCC pT1-2N0M0 between 2010 and 2014 were reviewed retrospectively. Fourteen patients (24.1%) had diabetes mellitus at diagnosis. Local control (LC) was defined as time to recurrence in the liver. Results The median follow-up was 23.3 months. Relapses occurred in 20 patients (34.5%) during the follow-up period; 17 of them developed intrahepatic recurrence, which was associated with diabetes mellitus (p = 0.013) and alpha fetoprotein (AFP) levels >500 ng/mL (p = 0.019). Overall relapses (n = 20) were related to T stage (p = 0.044), AFP level (p = 0.005), and diabetes (p = 0.044). The 3-year local control (intrahepatic control), disease-free survival, and overall survival rates were 56.7%, 50.5%, and 84.3%, respectively. LC was affected by diabetes mellitus (p = 0.046), Barcelona Clinic Liver Cancer staging (pConclusions Diabetes mellitus is correlated with intrahepatic HCC recurrence after surgery. Greater attention should be paid to managing patients with HCC and diabetes mellitus.

Snail, a zinc-finger transcriptional repressor of E-cadherin expression, is one of the key inducers of epithelial-mesenchymal transition (EMT) in epithelial cancer. In breast cancer, EMT has been associated with malignancies, including metastasis, cancer stem-like properties, and resistance to chemotherapy and radiotherapy. In this study, we analysed the role of Snail in the highly metastatic mesenchymal TUBO‑P2J mouse breast cancer cells, by loss of function using short hairpin RNA. Though silencing Snail did not restore the E-cadherin expression or induce morphological changes, Snail silencing significantly ablated in vitro and in vivo metastatic potentials. In addition, Snail silencing also reduced resistance to chemotherapy drugs and cancer stem-like properties, such as CD44 expression, aldehyde dehydrogenase (ALDH) activity, colony formation, and in vivo tumour formation and growth. However, radioresistance was not decreased by silencing Snail. Collectively, this study suggested that Snail is a main regulator of the maintenance of malignancy potentials and is a good target to prevent cancer metastasis and to increase chemotherapy susceptibility.

Background The purpose of this study was to investigate the correlation between human epidermal growth factor receptor 2 (HER2) overexpression and clinicopathologic factors and overall survival rate in patients who underwent curative gastrectomy for gastric adenocarcinoma. Methods Among patients who underwent curative gastrectomy for gastric adenocarcinoma at Inje University Paik Hospital from January 2012 to December 2015, 782 patients underwent an immunohistochemical analysis to evaluate HER2 expression levels. Clinicopathologic records that were collected from a gastric cancer database were retrospectively reviewed to identify clinicopathologic factors and survival rates of the patients. Results HER2 overexpression was detected in 166 patients (21.2%). There was a statistically significant correlation between HER2 expression level and sex (p = 0.013), histologic differentiation (p

Background The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet. Methods Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared. Results Of 179 patients, 121 patients with LND were divided into the NC (n = 89) and PP groups (n = 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p = 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234–15.453, p = 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p = 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p = 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p = 0.004) and RFS (8.8% vs 28.6%, p = 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p = 0.462) and RFS (41.3% vs. 0%, p = 0.056) were found between the N0 and N1 patients. Conclusion The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.

Purpose This study examined the safety and facilitative aspects of laparoscopic gastrectomy, with respect to clinicopathologic factors and complications in patients with gastric cancer, in comparison with open gastrectomy. The study also compared the safety of laparoscopic gastrectomy, with respect to the 5-year survival rate and recurrence in terms of the oncologic results, with that of open gastrectomy. Methods This retrospective study included 424 patients with gastric cancer who had undergone gastrectomy at Busan Paik Hospital, Inje University, over a 5-year period from January 2010 to December 2014. The gastric cancer database, comprising data collected from the patients' medical records, was examined for the analysis of clinicopathologic factors, complications, survival rates, and recurrence. Results Of the 424 patients, 146 underwent laparoscopic gastrectomy and 278 underwent open gastrectomy. Differences were observed between laparoscopic and open gastrectomy with respect to clinicopathologic features such as tumor size, number of harvested lymph nodes, differentiation, T stage, N stage, TNM stage, lymphatic invasion, vascular invasion, and perineural invasion. The complication rates of laparoscopic and open gastrectomy were 4.8% and 4.3%, respectively, and the recurrence rates were 3.4% and 11.5%, respectively. The 5-year overall survival rates (OSRs) of laparoscopic and open gastrectomy were 90.5% and 85.9%, respectively, and the 5-year disease-free survival rates (DFSRs) were 90.2% and 75.6%, respectively, with significant differences. The 5-year OSRs of laparoscopic and open gastrectomy for stage I disease were 96.6% and 96.9%, respectively, those for stage II disease were 44.4% and 97.7%, respectively, and those for stage III disease were 75.0% and 61.7%, respectively. The 5-year DFSRs of laparoscopic and open gastrectomy for stage I disease were 95.4% and 96.9%, respectively, those for stage II disease were 60.6% and 84.9%, respectively, and those for stage III disease were 64.3% and 40.1%, respectively, with no significant difference. Conclusion This study showed that laparoscopic gastrectomy is a safe and beneficial modality compared with open gastrectomy in patients with gastric cancer. In terms of the oncologic results, laparoscopic gastrectomy is also considered safe and provides the same results as open gastrectomy.

UDP-glucuronosyltransferase (UGT)-mediated drug-drug interactions are commonly evaluated during drug development. We present a validated method for the simultaneous evaluation of drug-mediated inhibition of six major UGT isoforms, developed in human liver microsomes through the use of pooled specific UGT probe substrates (cocktail assay) and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The six probe substrates used in this assay were estradiol (UGT1A1), chenodeoxycholic acid (UGT1A3), trifluoperazine (UGT1A4), 4-hydroxyindole (UGT1A6), propofol (UGT1A9), and naloxone (UGT2B7). In a cocktail incubation, UGT1A1, UGT1A9, and UGT2B7 activities were substantially inhibited by other substrates. This interference could be eliminated by dividing substrates into two incubations: one containing estradiol, trifluoperazine, and 4-hydroxyindole, and the other containing chenodeoxycholic acid, propofol, and naloxone. Incubation mixtures were pooled for the simultaneous analysis of glucuronyl conjugates in a single LC-MS/MS run. The optimized cocktail method was further validated against single-probe substrate assays using compounds known to inhibit UGTs. The degree of inhibition of UGT isoform activities by such known inhibitors in this cocktail assay was not substantially different from that in single-probe assays. This six-isoform cocktail assay may be very useful in assessing the UGT-based drug-interaction potential of candidates in a drug-discovery setting.

Purpose: Prostaglandin E2 (PGE2) is a contributory carcinogen in gastric adenocarcinoma. 15-Hydroxyprostaglandin dehydrogenase (15-PGDH) catabolizes PGE2 by oxidizing its 15(s)-hydroxy group. The aim of this study was to investigate the expression of 15-PGDH in gastric adenocarcinoma tissue and the relationship between 15-PGDH expression and clinicopathologic features of gastric adenocarcinoma. Methods: Ninety-nine patients who underwent surgical resection for gastric adenocarcinoma between January 2007 and December 2007 were enrolled and evaluated retrospectively. Results: In 62 patients (62.6%), 15-PGDH expression was lower in gastric adenocarcinoma tissue than in nonneoplastic tissue. Regarding the relationship between 15-PGDH expression and clinicopathological features, 15-PGDH expression was significantly lower in tissues with poor differentiation (P = 0.002), advanced T stage (P = 0.0319), a higher number of lymph node metastases (P = 0.045), lymphatic invasion (P = 0.031), and vascular invasion (P = 0.036). Conclusion: 15-PGDH expression was associated with a subset of clinicopathologic features such as differentiation grade, T stage, lymphatic invasion, and vascular invasion.

Background Carcinoma-associated fibroblasts (CAFs) contribute to carcinogenesis and cancer progression, although their origin and role remain unclear. We recently identified and investigated the in situ identity and implications of gastric submucosa-resident mesenchymal stem cells (GS-MSCs) in the progression of gastric carcinogenesis. Methods We isolated GS-MSCs from gastric submucosa using hydrogel-supported organ culture and defined their identity. Isolated cells were assessed in vitro by immunophenotype and mesengenic multipotency. Reciprocal interactions between GS-MSCs and gastric cancer cells were evaluated. To determine the role of GS-MSCs, xenografts were constructed of gastric cancer cells admixed with or without GS-MSCs. Results Isolated cells fulfilled MSCs requirements in regard to plastic adherence, stromal cell immunophenotype, and multipotency. We demonstrated a paracrine loop that gastric cancer cells enhanced the migration, proliferation, and differentiation of GS-MSCs; additionally, GS-MSCs promoted the proliferation of gastric cancer cell in vitro. Xenograft experiments showed that GS-MSCs significantly promoted cancer growth and angiogenesis. GS-MSCs that integrated into gastric cancer became not only CAFs but also rarely endothelial cells which contributed to the formation of cellular and vascular cancer stroma. Conclusions Endogenous GS-MSCs play an important role in gastric cancer progression.

Iris recognition is a biometric technology which can identify a person using the iris pattern. It is important for the iris recognition system to extract the feature which is invariant to changes in iris patterns. Those changes can be occurred by the influence of lights, changes in the size of the pupil, and head tilting. In this paper, we propose a novel method based on Zernike Moment which is robust to rotations of iris patterns. we utilized a selection of Zernike moments for the fast and effective recognition by selecting global optimum moments and local optimum moments for optimal matching of each iris class. The proposed method enables high-speed feature extraction and feature comparison because it requires no additional processing to obtain the rotation invariance, and shows comparable performance to the well-known previous methods.

Few reports have described the association between mutations in the entire X gene of the hepatitis B virus (HBV) and the clinical status of HBV-infected patients. We studied the association between HBV X gene mutations and the disease status of patients infected with HBV genotype C.Mutations in the HBV X genes of 194 patients were determined by direct sequencing. The subject population consisted of patients with chronic hepatitis (n=60), liver cirrhosis (n=65), and hepatocellular carcinoma (HCC) (n=69). The sequencing results of these 3 groups were compared.Each of the mutations G1386M, C1485T, C1653T, T1753V, A1762T, and G1764A was significantly associated with the patient's clinical status. The T1753V (p0.001) and A1762T/G1764A (p0.001) mutations were found more frequently in Hepatitis B e antigen (HBeAg)-negative than in HBeAg-positive patients. Specific X gene mutations (G1386M, C1653T, and A1762T/G1764A) were more prevalent in patients with liver cirrhosis and HCC than in chronic hepatitis patients (p0.005 for all). In addition, the T1753V (p0.001) and C1485T (p0.001) mutations were significantly more prevalent in HCC patients than in chronic hepatitis patients. Only the prevalence of the T1753V mutation increased as the HBV infection progressed from liver cirrhosis to HCC (p=0.023).Our findings show a difference in the pattern of X gene mutations that were associated with the clinical status of patients with chronic HBV infection.

Iris recognition is a biometric technology that uses iris pattern information, which has features of stability, security etc. Because of this reason, it is especially appropriate under certain circumstances of requiring a high security. Recently, using the iris information has a variety uses in the fields of access control and information security. In extracting the iris feature, it is desirable to extract the feature which is invariant to size, lights, rotation. We have easy solutions to the problem of iris size and lights by previous processing but there is still problem of iris feature extract invariant to rotation. In this paper, To improve an awareness ratio and decline in speed for a revision of rotation, it is proposed that the iris recognition method using Zernike Moment and Daubechies Wavelet. At first step, the proposed method groups rotated iris into similar things by statistical feature of Zernike Moment invariant to a rotation, which shortens processing time of iris recognition and looks equal to an established method in the performance of recognition too. therefore, proposed method could confirm the possibility of effective application for large scale iris recognition system.

Solitary necrotic nodules of the liver occur rarely. Although these nodules are usually benign, they are surgically removed in most cases because they cannot be differentiated from malignant lesions. To date, the natural history of solitary fibrous nodules remains unclear. We present the case of an incidentally detected hepatic mass (diameter 2 cm) in a 35-year-old man. The hepatic mass was diagnosed as a solitary necrotic nodule by liver biopsy. Follow-up radiologic examination revealed that the solitary necrotic nodule had spontaneously regressed. This is the first report on the natural course history of a solitary necrotic nodule.

Hepatocellular carcinoma (HCC) is widely known to develop more frequently in cirrhotic patients with a high expression of Hepatitis B virus X protein (HBx), which is controlled by the enhancer 1 (Enh1)/X-promoter. To examine the effect of the mutations in the Enh1/X-promoter region in hepatitis B virus (HBV) genomes on the development of HCC, we investigated the differences in HBV isolated from cirrhotic patients with or without HCC along with the promoter activities of certain specific mutations within the Enh1/X-promoter. We examined 160 hepatitis B surface antigen (HBsAg)-positive cirrhotic patients (80 HCC patients, 80 non-HCC patients) by evaluating the biochemical, virological, and molecular characteristics. We evaluated the functional differences in certain specific mutations within the Enh1/X-promoter. The isolated sequences included all of the subgenotypes C2. The sites that showed higher mutation rates in the HCC group were G1053A and G1229A, which were found to be independent risk factors through multiple logistic analysis (P < 0.05). Their promoter activities were elevated 2.38- and 4.68-fold, respectively, over that of the wild type in the HepG2 cells. Similarly, both the mRNA and protein levels of HBx in these two mutants were much higher than that in wild type-transfected HepG2 cells. Mutated nucleotides of the Enh1/X-promoter, especially G1053A and G1229A mutations in the HBV subgenotype C2 of patients with cirrhosis, can be risk factors for hepatocarcinogenesis, and this might be due to an increase in the HBx levels through the transactivation of the Enh1/X-promoter.

Gastropleural fistula is a rare complication of prior lung surgery, gastric ulcer, trauma and malignancy. A 62 year old female patient who had received surgical repair of a perforated gastric wall 10 years prior, underwent open pleural decortication. At 4 days after surgery, food residuums were noticed at the chest bottles. Hence, an emergency esophagogram was done. The esophagogram revealed a gastropleural fistula. The patient received a total gastrectomy, intra-abdominal diaphragmatic repair and massive thoracic saline irrigation through a previous thoracic wound. The patient was discharged 11 days after surgery without other morbidity.

The authors assessed the efficacy and antiviral resistance of 48-week clevudine therapy versus lamivudine in treatment of naive patients with HBeAg positive chronic hepatitis B. In this retrospective study, a total of 116 HBeAg positive patients, who received 30 mg of clevudine once daily (n=53) or 100 mg of lamivudine once daily (n=63) for 48 weeks, were included. At week 48, clevudine therapy produced a significantly greater mean reductions in serum HBV DNA levels from baseline than lamivudine therapy (-5.2 vs. -4.2 log(10)IU/mL; P=0.005). Furthermore, a significantly higher proportion of patients on clevudine achieved negative serum HBV DNA by PCR (

Objectives: The authors compared the efficacies and tolerabilities of pegylated interferon-α2a (PEG-IFN-α2a) + ribavirin and pegylated interferon-α2b (PEG-IFN-α2b) + ribavirin for the initial treatment of chronic hepatitis C. Methods: A total of 126 treatment-naive patients (29.4% genotype 1, 70.6% genotype non-1) were treated with PEG-IFN-α2a 180 µg/week (group A, n = 79) or PEG-IFN-α2b 1.5 µg/kg/week (group B, n = 47) with ribavirin (800 mg/day for genotype non-1 or 1,000–1,200 mg/day for genotype 1) for 24 (genotype non-1) or 48 weeks (genotype 1). Results: End-of-treatment virologic response, sustained virologic response, and biochemical response were not significantly different in groups A and B (84.8 vs. 89.4%, 70.9 vs. 72.3%, and 70.9 vs. 74.5%, respectively; p > 0.05). In patients with the HCV genotype 1 or non-1, treatment responses were not significantly different. Multivariate analysis showed that HCV genotype only was an independent factor that affected sustained virologic response (p = 0.048). The proportions of treatment discontinuations in groups A and B were similar (10.1 vs. 10.6%; p = 1.000). Conclusions: PEG-IFN-α2a or PEG-IFN-α2b + ribavirin combination therapies showed similar efficacies and tolerabilities as initial treatments for chronic hepatitis C.

Specific mutations in the hepatitis B virus (HBV) genome have been reported to be associated with the development of hepatocellular carcinoma (HCC). The goal of this study was to determine whether mutations in the HBV X gene are associated with the development of HCC in hepatitis B patients with cirrhosis. Forty-two patients infected with HBV genotype C2 with cirrhosis and HCC were compared with 46 patients with cirrhosis but without HCC. X gene mutations were determined by direct sequencing in all patients. The HCC and non-HCC groups were similar with respect to clinical characteristics, and the presence of T1762/A1764, T1653, and V1753 mutations was not significantly different between the two groups (P = 0.068, P = 0.097, P = 0.442, respectively). Only the B1499 mutation was associated significantly with HCC (P = 0.015) (odds ratio: 3.42, 95% CI: 1.24–9.48). In hepatitis Be antigen (HBeAg)-positive patients, advanced age was associated significantly with HCC (P = 0.038), whereas in HBeAg-negative patients, the B1499 mutation was associated more significantly with HCC (P = 0.01). Patients in the B1499 mutation group exhibited significantly higher AST and ALT levels compared with patients infected the wild-type virus. In conclusion, B1499 is a novel mutation associated with HCC in Korean patients with cirrhosis infected with HBV genotype C2. J. Med. Virol. 81:1721–1725, 2009. © 2009 Wiley-Liss, Inc.

Iris recognition is a biometric technology which can identify a person using the iris pattern. Recently, iris information is used in many fields such as access control and information security. It is important for the iris recognition system to extract the feature which is invariant to changes in iris patterns. Those changes can be occurred by the influence of lights, changes in the size of the pupil. In this paper, we propose a novel method based on vector summation of gradient orientation vectors. Experimental results show that the proposed method reduces processing time with simple vector calculation, requires small feature space and has comparable performance to the well-known previous methods.

In many cases, the process of cancer cell differentiation is associated with the programmed cell death. In the present study, interestingly, we found that eupatilin, one of the pharmacologically active ingredients of Artemisia asiatica that has been reported to induce apoptosis in human gastric cancer AGS cells, also triggers differentiation of these cells. Treatment of AGS cells with eupatilin induced cell cycle arrest at the G(1) phase with the concomitant induction of p21(cip1), a cell cycle inhibitor. This led us to test whether eupatilin may trigger AGS cells to differentiate into the matured phenotypes of epithelial cells and this phenomenon may be coupled to the apoptosis. Eupatilin induced changes of AGS cells to a more flattened morphology with increased cell size, granularity, and mitochondrial mass. It also markedly induced trefoil factor 1 (TFF1), a gene responsible for the gastrointestinal cell differentiation. Eupatilin dramatically induced redistribution of tight junction proteins such as occludin and ZO-1, and F-actin at the junctional region between cells. It also induced phosphorylation of extracellular signal-regulated kinase 2 and p38 kinase. Blockade of ERK signaling by PD098059 or the dominant-negative ERK2 significantly reduced eupatilin-induced TFF1 and p21 expression as well as ZO-1 redistribution, indicating that ERK cascades may mediate eupatilin-induced AGS cell differentiation. Collectively, our results suggest that eupatilin acts as a novel anti-tumor agent by inducing differentiation of gastrointestinal cancer cells rather than its direct role in inducing apoptotic cell death.

Iris recognition is a biometric technology which can identify a person using the iris pattern. Recently, using iris information is used in many fields such as access control and information security. But Perform complex operations to extract features of the iris. because High-end hardware for real-time iris recognition is required. This paper is appropriate for the embedded environment using local gradient histogram embedded system using iris feature extraction methods have implement. Experimental results show that the performance of proposed method is comparable to existing methods using Gabor transform noticeably improves recognition performance and it is noted that the processing time of the local gradient histogram transform is much faster than that of the existing method and rotation was also a strong attribute.

Background Esophageal metastasis of hepatocellular carcinoma (HCC) is extremely rare; it was not serially followed-up by endoscopy. Objective Our purpose was to report the endoscopic findings according to the progression of esophageal metastatic HCC. Design Case report. Results In the review of the cases, submucosal tumor or polypoid mass were the most common endoscopic findings, and the locations of esophageal metastatic tumors are variable. The tumors had progressed from a submucosal mass to a polypoid mass in the current case. Limitation Small number of cases. Conclusions The endoscopic findings of esophageal metastasis of HCC may be changed from submucosal mass to polypoid mass.

Background FOLFOX-based adjuvant chemotherapy is a benefit for high-risk stage II and stage III colon cancer after curative resection. But, the prognostic factor or predictive marker for the efficacy of FOLFOX remains unclear. This study was aimed to identify the prognostic value and cumulative impact of adjuvant FOLFOX on the stage II and III colon cancer patients. Methods A total of 196 stage II and III colon cancer patients were retrospectively enrolled in prospectively collected data. They underwent curative resection followed by FOLFOX4 adjuvant chemotherapy. The oncological outcomes included the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate. Cox-regression analysis was performed to identify the prognostic value, and its cumulative impact was analyzed. Results The 5-year DFS rate of the patients was 71.94% and the 5-year OS rate was 81.5%. The prognostic values for the 5-year DFS rate and 5-year OS rate were T4 stage and preoperative anemia in a multivariate analysis. Each patient group who had no prognostic value, single, or both factors revealed 95.35%, 69.06%, and 28.57% in the 5-year DFS rate, respectively (p

The vibrational system of this study is consisted of a rotating cantilever pipe conveying fluid and the tip mass. The equation of motion is derived by using the Lagrange equation. The influences of the rotating angular velocity and the velocity of fluid flow in a cantilever pipe have been studied on the dynamic characteristics of a rotating cantilever pipe by the numerical method. The effects of a tip mass on the dynamic response of a cantilever pipe are also studied. The tip-amplitude and maximum tip-deflection of each direction are directly proportional to the tip mass of the cantilever pipe in steady state. It identifies that the influence of the fluid velocity and the rotating angular velocity of the cantilever pipe give much variation the bending tip-displacement of steady state and the bending tip-displacement of non-steady state, respectively. The influence of the rotating angular velocity gives much the deflection of axial direction.

The present study was initiated to examine the dietary intake, blood level and urinary concentration of lead (Pb) and cadmium (Cd) among children in Korea, in comparison with the findings in their mothers.Peripheral blood, spot urine and 24-h food duplicate samples were collected in Busan, Korea, from 38 pairs of children (4-10 years of age) and their mothers (28-46 years, non-smoking, mostly housewives), who provided informed consent. Samples were wet-ashed by being heated in the presence of mineral acids, and Pb and Cd in the wet-ashed samples were analyzed by graphite furnace atomic absorption spectrometry. Pb and Cd in food (Pb-F, Cd-F), blood (Pb-B, Cd-B) and urine [observed value (Pb-Uob, Cd-Uob), and values corrected for creatinine (Pb-Ucr, Cd-Ucr) or a specific gravity (1.016; Pb-Usg, Cd-Usg)] were presented in terms of geometric mean (GM) and geometric standard deviation (GSD).Pb-F and Cd-F in the children were 0.337 microg Pb and 0.457 microg Cd/kg body weight per day as GM, respectively. Pb-B and Cd-B were 38.0 microg Pb and 1.51 microg Cd/l, and Pb-U and Cd-Uob were 5.44 microg Pb/l and 1.33 microg Cd/l, respectively. Pb-F and Pb-B for children were not significantly different from the values for their mothers. In contrast, Cd-F and Cd-B were significantly different between children and their mothers. Cd-F for children correlated with Cd-F for mothers, but no significant correlation was observed in Cd-B, Cd-U, Pb-F, Pb-B or Pb-U between children and their mothers. The dietary intake of Pb in total Pb intake (i.e., respiratory and dietary intake) accounted for 51.7 and 64.8% in children and their mothers, respectively, whereas the corresponding proportions were 97.8 and 98.2%, respectively, for Cd.Cd intake was exclusively from food, both in children and mothers. Dietary Cd intake of children significantly correlated with that of their mothers. Dietary Pb intake in children, however, did not correlate with that of their mothers. Pb uptake from ambient air tended to be higher in children than in their mothers.

Adjuvant chemotherapy is benefit for high-risk stage II and stage III colon cancer after curative resection. But, the optimal time between surgical and initiation of adjuvant chemotherapy remains unclear. Moreover, no study of efficacy with different lengths of adjuvant chemotherapy has appeared. This study was aimed to identify association between time (initiation and length) and oncological outcomes of adjuvant chemotherapy on the stages II and III colon cancer patients. A total of 406 high-risk stages II and III colon cancer patients were retrospectively enrolled in prospectively collected data. They were categorized into three groups representing chemotherapy initiation time: less than 4 weeks (group 1), 4 to 6 weeks (group 2), and more than 6 weeks (group 3). They were categorized into two groups representing chemotherapy length time : less than 200 days (group 1a) and more than 200 days (group 2a). The 5-year disease-free survival (DFS) rates were 74.97 % in group 1, 76.94 % in group 2, and 63.97 % in group 3 (p > 0.05). The 5-year DFS rates were 75.49 % in the group that received adjuvant chemotherapy within 6 weeks and 63.97 % in the group that received adjuvant chemotherapy >6 weeks (p = 0.0539). The 5-year DFS rates were 77.21 % in group 1a and 81.82 % in group 2a (p > 0.05). Adjuvant chemotherapy should be safely offered within 6 weeks after surgical excision in patients with colon cancer after considering the patient’s general physical condition and hematological factors, even if the chemotherapy length is prolonged.

Introduction : The prostaglandin (PG) E2 level, which is associated with oncogenesis, progression and metastasis in various types of cancer, is determined by reciprocal regulation of 15-prostaglandin dehydrogenase (15-PGDH) and cyclooxygenase-2. This study investigated 15-PGDH expression in gastric adenocarcinoma, the associations between 15-PGDH expression and clinicopathological factors, and the correlation between 15-PGDH expression and the 5-year gastric-cancer-specific survival rate (5-year GCSS). Methods : From 175 patients who underwent gastrectomy, we obtained biopsies of gastric adenocarcinoma tissues and adjacent normal tissues for preparation as formalin-fixed, paraffin-embedded specimens and conducted an immunohistochemical analysis. Results : 15-PGDH expression was low in 65.1% of cases. 15-PGDH expression showed no relationship with age or gender, but was significantly correlated with the pathologic type, T stage, N stage, TNM stage, positive lymph node metastasis, metastasis to a larger quantity of lymph nodes, positive lymphatic invasion, positive vascular invasion, positive perineural invasion, and palliative gastrectomy. The 5-year GCSS of the low-expression group was 77.19% and a lower level of 15-PGDH expression correlated to a lower 5-year GCSS. 15-PGDH expression significantly influenced the 5-year GCSS on univariate but not multivariate analysis. Conclusion : Our findings indicate that 15-PGDH expression was low in gastric adenocarcinoma and was correlated with the clinicopathological factors associated with prognosis and a more advanced stage of gastric adenocarcinoma. Also, 15-PGDH expression was significantly associated with the 5-year GCSS, but was not an independent prognostic factor thereof.

Ansa-zirconocene diamide complex rac-(EBI)Zr(NMe2)2 [rac-1, EBI = ethylene-1,2-bis(1-indenyl)] reacted with AlR3 (R = Me, Et, iBu) or Al(iBu2)H and then with [CPh3][B(C6F5)4] (2) in toluene in order to perform propylene polymerization by cationic alkylzirconium species, which are in situ generated during polymerization. Through the sequential NMR-scale reactions of rac-1 with AlR3 or Al(iBu2)H and then with 2, rac-1 was demonstrated to be transformed to the active alkyzirconium cations via alkylated intermediates of rac-1. The cationic species generated by using AlMe3, AlEt3, and Al(iBu2)H as alkylating reagents tend to become heterodinuclear complex; however, those by using bulky Al(iBu)3 become base-free [rac-(EBI)Zr(iBu)]+ cations. The activity of propylene polymerization by rac-1/AlR3/2 catalyst was deeply influenced by various parameters such as the amount and the type of AlR3, metallocene concentration, [Al]/[2] ratio, and polymerization temperature. Generally the catalytic systems using bulky alkylaluminum like Al(iBu)3 and Al(iBu)2H show higher activity but lower stereoregularity than those using less bulky AlMe3 and AlEt3. The alkylating reagent Al(iBu)3 is not a transfer agent as good as AlMe3 or AlEt3. The polymerization activities show maximum around [Al]/[2] ratio of 1.0 and increase monotonously with polymerization temperature. The overall activation energy of both rac-1/Al(iBu)3/2 and rac-1/Al(iBu)2H catalysts is 6.0 kcal/mol. As the polymerization temperature increases, the stereoregularity of the resulting polymer decreases markedly, which is demonstrated by the decrease of [mmmm] pentad value and by the increase of the amount of polymer soluble in low boiling solvent. The physical properties of polymers produced in this study were investigated by using 13C-NMR, differential scanning calorimetry (DSC), viscometry, and gel permeation chromatography (GPC). © 1999 John Wiley & Sons, Inc. J Polym Sci A: Polym Chem 37: 1523–1539, 1999

Ticlopidine is a first-generation thienopyridine antiplatelet drug that prevents adenosine 5'-diphosphate (ADP)-induced platelet aggregation. We identified the enzymes responsible for the two-step metabolic bioactivation of ticlopidine in human liver microsomes and plasma. Formation of 2-oxo-ticlopidine, an intermediate metabolite, was NADPH dependent and cytochrome P450 (CYP) 1A2, 2B6, 2C19, and 2D6 were involved in this reaction. Conversion of 2-oxo-ticlopidine to thiol metabolites was observed in both microsomes (M1 and M2) and plasma (M1). These two metabolites were considered as isomers, and mass spectral analysis suggested that M2 was a thiol metabolite bearing an exocyclic double bond, whereas M1 was an isomer in which the double bond was migrated to an endocyclic position in the piperidine ring. The conversion of 2-oxo-ticlopidine to M1 in plasma was significantly increased by the addition of 1 mM CaCl2. In contrast, the activity in microsomes was not changed in the presence of CaCl2. M1 formation in plasma was inhibited by EDTA but not by other esterase inhibitors, whereas this activity in microsomes was substantially inhibited by carboxylesterase (CES) inhibitors such as bis-(p-nitrophenyl)phosphate (BNPP), diisopropylphosphorofluoride (DFP), and clopidogrel. The conversion of 2-oxo-ticlopidine to M1 was further confirmed with recombinant paraoxonase 1 (PON1) and CES1. However, M2 was detected only in NADPH-dependent microsomal incubation, and multiple CYP isoforms were involved in M2 formation with highest contribution of CYP2B6. In vitro platelet aggregation assay demonstrated that M2 was pharmacologically active. These results collectively indicated that the formation of M2 was mediated by CYP isoforms whereas M1, an isomer of M2, was generated either by human PON1 in plasma or by CES1 in the human liver.

Purpose To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) 1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively. Conclusion This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed.

PURPOSE The serum level of carcinoembryonic antigen (CEA) is a clinical prognostic factor in the follow-up evaluation of patients with colon cancer. We aimed to evaluate the prognostic significance of the rate of decrease of the perioperative serum CEA level in patients with colon cancer after a curative resection. METHODS A total of 605 patients who underwent a curative resection for colon cancer between January 2000 and December 2007 were enrolled retrospectively. The rate of decrease was calculated using the following equation: ([preoperative CEA - postoperative CEA]/[preoperative CEA] ×100). RESULTS In the group with a preoperative serum CEA level of >5 ng/mL, the normalized group with a postoperative serum CEA level of ≤5 ng/mL showed a better overall survival (OS) rate and disease-free survival (DFS) rate than those of the non-normalized group (P ≤ 0.0001). The "cutoff values" of the rate of decrease in the perioperative serum CEA that determined the OS and the DFS were 48.9% and 50.8%, respectively. In the multivariate analysis of preoperative serum CEA levels >5 ng/mL, the prognostic factors for the OS and the DFS were the cutoff value (P < 0.0001) and the pN stage (P < 0.0001). CONCLUSION A rate of decrease of more than 50% in the perioperative serum CEA level, as well as the normalization of the postoperative serum CEA level, may be useful factors for determining a prognosis for colon cancer patients with high preoperative CEA levels.

Various types of adhesion barriers are widely used to prevent intra-abdominal adhesion. However, few studies have compared the efficacy of adhesion barriers using the same animal model. The aim of this study was to compare the anti-adhesive effects of various barrier agents using a newly developed, severe adhesion model. A severe adhesion model was established by excision of a 1-cm2 intra-abdominal wall and application of cyanoacrylate in rat. Eighty male Sprague–Dawley rats (10 weeks old; 370 ± 50 g) were divided randomly into four groups (n = 20 each): the untreated control group, G-group using a hyaluronic acid and sodium carboxymethyl cellulose gel (Guardix-sol®), A-group using 4 % icodextrin (Adept®), and S-group using a hyaluronate–carboxymethyl cellulose membrane (Seprafilm®). The effect of each adhesion barrier was evaluated by means of the extent and severity of adhesion, difficulty of adhesiolysis scoring systems, and microscopic grade of fibrosis. The G-group showed no difference in adhesion score and fibrosis, the A-group demonstrated only a significantly lower fibrosis, and the S-group exhibited a significantly lower adhesion score and lower fibrosis compared with the control group. The S-group had a significantly lower adhesion score and reduced fibrosis compared with the G-group; however, no significant difference in adhesion score and fibrosis was noted with the A-group. The membranous barrier Seprafilm® may be effective in the prevention of adhesion in the condition of peritoneal injury combined with foreign material. Adept® showed a tendency of decreasing the severity of adhesion and was effective in the prevention of fibrosis.

Purpose Extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC) is a risk factor for tumor recurrence. By TNM Classification (7th edition), differentiated thyroid carcinoma with ETE is designated T3 (minimal invasion), T4a (extended invasion), or T4b (more extensive unresectable invasion), according to the degree of tumor involvement. We subsequently focused our investigation on minimal ETE (MEE), analyzing the clinicopathologic characteristics, recurrence rate, and recurrence-free survival (RFS) in this setting. Methods A retrospective study was conducted, based on 332 patients undergoing thyroidectomy for PTC between January 2005 and December 2006. Results The study population was stratified into two groups: PTC with MEE (103/332; 31.0%) and PTC without MEE (229/332; 69.0%). In patients with PTC, MEE correlated with gender, tumor size, multifocality, lymph node (LN) metastasis, underlying Hashimoto's thyroiditis, and the nature of the surgery. However, no significant intergroup differences were evident with respect to age, recurrence rate, and LN metastasis. In multivariate analysis, LN metastasis (odds ratio = 2.273; 95% confidence interval, 1.280–4.037) was recognized as an independent correlate of mETE ( p = 0.005). However, recurrence-free survival did not differ significantly between the groups ( p = 0.153), even when further stratified by the presence or absence of LN metastasis. Conclusion In patients with PTC, MEE does not impact RFS. Thus, appropriate surgical intervention and postoperative follow up are mandatory in PTC, regardless of its extent.

Background/Aims While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. Methods The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. Results The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P

Mesenchymal stem cells (MSCs) have been discovered in a multitude of organs, but their distribution and identity are still uncertain. Furthermore, loose connective tissue (LCT) is dispersed throughout virtually all organs, but its biological role in tissue homeostasis is unclear. Here, we describe a unique organ culture system to explore the omnipresence and in situ identity of MSCs among the LCTs. This culture system included the use of the fibrin hydrogel coupled with dynamic culture conditions, using native LCTs obtained from various organs as starting materials. This culture allowed MSC outgrowth into the hydrogel to be robustly supported, while maintaining the structural integrity of LCTs during in vitro culture. Subcultured outgrown cells fulfilled the minimal requirements for defining MSCs on the basis of clonogenicity, multipotency, and immunophenotypic characteristics. In vitro label-retaining assay demonstrated that the numbers of mobilized and proliferated cells in situ increased in the pericapillary region and expressed both MSCs and pericytes markers, indicating that the in situ identity of MSCs represents a certain population of pericapillary pericytes. Our results indicate that this culture system affords a unique strategy for both isolating MSCs and recapitulating their niche in LCTs.

Purpose The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution. Methods A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence. Results The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 ± 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016). Conclusion The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up.

Conventional systems for isolating adipose-derived stem cells (ASC) require enzymatic digestion of adipose tissue (AT), followed by monolayer culture to the enrich the stem cell population. However, these systems are hindered by low cell yields and a lack of reproducibility. The present study was aimed at developing a unique strategy for isolating ASC based on fibrin matrix-supported three-dimensional (3-D) organ culture of native AT. Furthermore, we tried to optimize the fibrin composition by adjusting the fibrinogen and thrombin concentrations to allow rapid outgrowth and proliferation of ASC in the 3-D fibrin matrix. Human cutaneous AT fragments were encapsulated within the fibrin matrix to construct a 3-D environment and cultured under dynamic conditions. During in vitro culture the fibrin matrix provided physical support for the AT and also allowed selective outgrowth of ASC from embedded AT fragments. In situ expanded outgrown cells were recovered from the fibrin matrix by selective fibrinolysis and propagated under monolayer culture conditions. The cultured cells fulfilled the following criteria for ASC: adhesion to culture plastic, multipotent differentiation, correct immunophenotypic profile. Fibrin matrix-supported 3-D organ culture produced ASC that with high competency in terms of growth and differentiation capabilities, and resulted in a larger and more consistent cell yield than obtained with conventional culture systems. The fibrinogen and thrombin concentrations inversely affected spreading, migration, and ASC outgrowth from native AT. Our results indicate that this 3-D organ culture system for AT can be used as an efficient and reproducible method for ASC isolation.

The authors compared the efficacies and tolerabilities of pegylated interferon-alpha2a (PEG-IFN-alpha2a) + ribavirin and pegylated interferon-alpha2b (PEG-IFN-alpha2b) + ribavirin for the initial treatment of chronic hepatitis C.A total of 126 treatment-naive patients (29.4% genotype 1, 70.6% genotype non-1) were treated with PEG-IFN-alpha2a 180 microg/week (group A, n = 79) or PEG-IFN-alpha2b 1.5 microg/kg/week (group B, n = 47) with ribavirin (800 mg/day for genotype non-1 or 1,000-1,200 mg/day for genotype 1) for 24 (genotype non-1) or 48 weeks (genotype 1).End-of-treatment virologic response, sustained virologic response, and biochemical response were not significantly different in groups A and B (84.8 vs. 89.4%, 70.9 vs. 72.3%, and 70.9 vs. 74.5%, respectively; p0.05). In patients with the HCV genotype 1 or non-1, treatment responses were not significantly different. Multivariate analysis showed that HCV genotype only was an independent factor that affected sustained virologic response (p = 0.048). The proportions of treatment discontinuations in groups A and B were similar (10.1 vs. 10.6%; p = 1.000).PEG-IFN-alpha2a or PEG-IFN-alpha2b + ribavirin combination therapies showed similar efficacies and tolerabilities as initial treatments for chronic hepatitis C.

Backgrounds/Aims: Considering the incidence of prevailing hepatitis B virus (HBV) genotypes in neighboring nations, the predominance of genotype C in Korea is exceptional and needs to be confirmed by nationwide investigation. Methods: A total of 510 HBsAg (+) or HBeAg (+) serum samples was collected from subjects in several cities and harbors throughout the Korean peninsula for genotype (A-G)-specific multiplex PCR analysis. Another 40 serum samples from chronic HBV carriers from Iksan city were selected for sequencing of the entire HBV genome. Phylogenetic analysis was performed with 22 whole genomic sequences of Korean HBV strains enrolled in GenBank. Results: An amplicon was found in 377 specimens and genotype C occupied 98.1% (370 cases); none of the other genotypes were found. A mixed pattern of genotypes B and C was seen in seven specimens (1.9%), of which five were tested using PCR targeting the X fragment; no genotype B bands were found. With the exception of 1 case, which was subgenotype A2, whole sequences of Korean HBV strains (n=62) belonged to subgenotype C2. Conclusions: The prevailing HBV genotype in Korea is C2; the other genotypes occur only rarely. Future studies should include confirmation of the detection of genotypes other than C. (Korean J Hepatol 2009;15:140-147)

Esophageal bezoars are rare, but are recognized as a distinct clinical entity. They are known to occur in patients with esophageal structural and functional abnormalities, but only a few cases of the development of esophageal bezoars in patients with esophageal motility disorders have only been described. We report a rare case of an esophageal bezoar that developed in a patient with achalasia, and review the literature concerning esophageal bezoars associated with esophageal motility disorders.

TNFRSF17 is preferentially expressed in mature B lymphocytes, and may be important for the development of B cells. TNFRSF17 is selected as a candidate susceptibility gene to IBD pathogenesis by our cDNA microarray analysis, and we showed the specific expression of TNFRSF17 in resting and activated CD19+ cells obtained from human blood. We identified four SNPs (g-1729G>A, g.2295T>C, g.2445G>A and g.2493G>A) and one variation site (g.894delT) in the TNFRSF17 gene using direct sequencing analysis. In addition, the association of the genotype and allelic frequencies of these SNPs was studied in healthy controls and in patients with ulcerative colitis (UC) or irritable bowel syndrome (IBS). Although, the genotype and allelic frequencies of these SNPs, in the UC and IBS patients, were not significantly different from those in the healthy controls, the distribution of the AAG, GGA, AGG and AAA haplotypes, of the SNPs (g.-1729G>A, g.2445G> A and g.2493G>A) associated with the TNFRSF17 gene, in the UC patients, were notably different from those of the healthy controls (P = 0.002, 0.002, 4.7E-4 and 3.3E-6, respectively). Moreover, the frequencies of the AAG, AGG, GAG and GAA haplotypes were significantly different in the IBS patients compared to the healthy controls (P = 4.2E-5, 4.4E-17, 1.8E-22 and 1.6E-10, respectively). These results suggest that the haplotypes of the TNFRSF17 polymorphisms might be associated with UC and IBS susceptibility.

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by the formation of abscess, draining sinuses, abundant granulation, and dense fibrous tissue. Actinomycosis of the gallbladder is extremely rare. We report a case of an 56-years old man who abruptly presented with right upper quadrant abdominal pain. Abdominal CT showed that the gallbladder had 2 cm sized stone and an edematous thick wall. Our preoperative diagnosis was acute calculous cholecystitis. After the management of acute cholecystitis, laparoscopic cholecystectomy was performed but converted to open surgery due to severe adhesion to liver and greater omentum. Partial cholecystectomy was performed. Histologic section of the gallbladder showed sulfur granule with gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous penicillin G for 2 weeks, followed by oral penicillin for 3 months.

Malignant fibrous histiocytoma (MFH) is an uncommon soft-tissue sarcoma that occurs primarily in the extremities and rarely involves the retroperitoneum and abdomen. A 63-year-old man was admitted to the emergency room because of epigastric pain. Computed tomography revealed a large heterogeneous enhanced mass originating from the omentum with hemoperitoneum. The patient underwent laparoscopic omental mass excision and hematoma evacuation. Histological examination of the resected tumor revealed MFH. This case was therefore omental MFH presenting with hemoperitoneum.