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The risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) have not been clarified. The aim of this study was to investigate the predictive factors for HCC inimmune inactive CHB.A total of 337 patients in immune inactive CHB were consecutively enrolled in Kangdong Sacred Heart Hospital from 1995 to 2017. Univariate and multivariate analyses were performed to identify the independent risk factors for HCC development.During the mean 63 months of follow-up, the incidence of HCC of study population was 4.5% (15/337). Patients who developed HCC were older, had more cirrhosis at baseline, and were more likely to experience ALT elevation2 X upper limit of normal (ULN) during follow-up than those without HCC. In Cox regression analysis, increased ALT levels2 X ULN during follow-up (hazard ratio [HR], 3.774; 95% confidence interval [CI], 1.145-12.443; P=0.029] and presence of cirrhosis (HR, 11.768; 95% CI, 3.350-41.336; P0.001) were identified as the independent factors for HCC in immune inactive CHB. With increasing number of risk factors, the respective cumulative incidence of HCC at 10 years was 6.3%, 8.8%, and 63.5%.Underlying cirrhosis and hepatic inflammation reflected by increased ALT levels2 X ULN were significant predictors for HCC in immune inactive CHB. ALT elevation showed a synergistic effect in HCC development combined with cirrhosis. It suggests that patients with high serum ALT levels, especially those with cirrhosis, are required closer surveillance for HCC even in immune inactive CHB.

The objective of this study is to assess human exposure to phthalates and its associations with demographic characteristics of the subjects in the Korean National Human Biomonitoring Survey. The subjects aged between 18 and 69 were selected through nationwide stratified sampling. A total of 1874 urine samples were collected and stored at -20 °C until measurement for ten selected metabolites of phthalates (MnBP, MiBP, MBzP, MCHP, MnOP, MEHP, MEOHP, MEHHP, MiNP, and MiDP) using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). The difference in the level of urinary phthalate metabolites by the characteristics of the subjects was tested for statistical significance using SAS Surveyreg procedure. The coefficients and standard errors from multiple linear regressions were exponentiated to estimate the adjusted proportional change (APC) and 95% CIs compared with a referent level. The proportion of data above LOQ was less than 20% for MCHP, MnOP, MiNP, and MiDP. Geometric means of creatinine-adjusted concentrations (unit: μg/g creatinine) of six other phthalate metabolites among Korean adults were 41.7 (95% CI 39.6-43.9) for MnBP, 17.1 (95% CI 16.1-18.1) for MiBP, 15.7 (95% CI 14.4-17.1) for MBzP, 8.65 (95% CI 8.10-9.22) for MEHP, 17.5 (95% CI 16.8-18.3) for MEOHP, and 38.1 (95% CI 36.2-40.2) for MEHHP. Urinary level of phthalates tended to be higher among subjects with older age, females, and those with vigorous daily physical activity and tended to be lower among drinkers and those with higher income. Our results suggest that the level of phthalate exposure is significant among Korean adults and thus warrants further studies to identify major source and route of exposure to phthalates.

Objectives: A nationwide biomonitoring program identified the long-term trends of environmental exposures to hazardous chemicals in the general population and found geographical locations where body burdens of an exposed group significantly differed from those of the general population. The purpose of this study is to analyze the hazardous compounds associated with foods and cooking in the nationwide general population for evaluation of the environmental exposures and health risk factors and for the establishment of the reference levels at the national level. Methods: During 2009&ndash, 2010, the National Institute of Food and Drug Safety Evaluation (NIFDS) conducted a nationwide human biomonitoring study, including a questionnaire survey and environmental exposure assessments for specific hazardous compounds from foods and cooking among the general population in South Korea. Results: A total of 2139 individuals voluntarily participated in 98 survey units in South Korea, including 889 (41.6%) men and 1250 women (58.4%). Bio-specimens (serum and urine) and questionnaires were collected from the study population. Acrylamides, heterocyclic amines (HCAs), phenols, and phthalates were analyzed from urine, and perfluorinated compounds (PFCs) and organic chloride pesticides (OCPs) were analyzed from serum samples. The information on exposure pathway and geographical locations for all participants was collected by questionnaire interviews, which included demographic characteristics, socioeconomic status, history of family diseases, conditions of the indoor and outdoor environment, lifestyles, occupational history, and food and dietary information. Conclusion: We describe the design of the study and sampling of human biospecimen procedures including bio-sample repository systems. The resources produced from this nationwide human biomonitoring study and survey will be valuable for use in future biomarkers studies and for the assessment of exposure to hazardous compounds associated with foods and cooking.

Objectives: This study estimated the adult Korean daily intake of acrylamide (AA) and investigated its relationship with demographic, lifestyle and dietary habits by using urinary concentrations of N-acetyl-S-(2- carbamoylethyl)-cysteine (AAMA). Methods: Human data (n=1870) was collected in a nationwide cross-sectional biomonitoring program representing the population (18–69 years) residing in South Korea. Urinary AAMA was analyzed with a LCMS/MS system. Daily intakes of AA were estimated using mass daily AAMA, which was calculated through urinary AAMA concentration and daily creatinine excretion. Statistical analysis was performed with SAS procedures for calculating geometric means, confidence intervals and the exponentiated beta coefficient of multiple linear regressions. Results: Daily intake of AA was estimated at 0.475 μg/kg body weight (BW) per day (95% confidence interval (CI): 0.447-0.503). In the case of current smokers, AA intake was 0.957 μg/kg BW per day (95% CI: 0.847-1.067), which was significantly higher than that of former smokers and never smoked (p Conclusion: The Korean daily intake of AA in adults was estimated to be similar with those found in developed countries. The factors increasing daily AA intake were coffee, cup noodles and canned foods, and decreasing factors were fresh fruit, cooked beef and cooked pork.

Objectives: In Korea, the system of management of medical waste largely relies on the incineration method. Our study aimed to identify any regional imbalances between the generation and treatment of medical waste, and provide reference data for future policy in Korea. Methods: We analyzed data on the amount of medical waste from 2,000 hospitals in 2012, 2013, and 2014 obtained from the Korea Environment Corporation. In the Arc GIS program (version 10.2.3), the addresses of hospitals and incinerators were transformed into map coordinates. The amount of waste generated by each hospital and the amount incinerated were represented by density and size of a triangle symbol, respectively. Results: As of 2014, the total amount of medical waste from the top 2,000 hospitals was 136,073 tons, out of which about half (49%) was generated in the capital area. Eleven incineration companies (three in the capital area, two in the Chungcheong Provinces area, one in the Jeolla Provinces area, and five in the Gyeongsang Provinces area) treated this waste. For the years 2012, 2013, and 2014, about 60% of the medical waste generated from the hospitals in the capital area was treated within the capital area and about 40% was transported to other areas, especially the Gyeongsang Provinces area, for treatment. On the other hand, about 90% of the medical waste incinerated in the capital area originated from the capital area. Conclusion: Our results suggest a spatial imbalance between the generation and treatment of medical waste in Korea and warrants multilateral policies, including the expansion of on-site treatment, strengthening regulation of the containment of medical wastes, promoting reductions in medical waste and more.

Background The eradication rate of Helicobacter pylori (H. pylori) infection might be affected by the degree of inflammation of gastric mucosa represented by the endoscopic stage of peptic ulcer disease (PUD). The aims of this study were to evaluate the eradication rates of H. pylori infection according to the endoscopic stage of PUD and to document whether early eradication in the active stage could yield a higher eradication rate in patients with peptic ulcer bleeding (PUB). Materials and Methods A total of 1,177 patients with PUD (380 gastric ulcer, 710 duodenal ulcer, and 87 combined ulcer) who received proton-pump inhibitor (PPI)-based triple therapy were included, and the eradication rates were compared by ulcer stage. Univariate and multivariate analyses were conducted to identify factors influencing eradication rate. In PUB, the eradication rates between the early eradication group (≤7 days) and the late eradication group (>7 days) were compared. Results The eradication rates according to endoscopic stage were significantly different in gastric ulcer (active vs healing vs scarring; 84.8% vs 82.7% vs 70.6%, p = .014, respectively), but there were no significant differences in duodenal ulcer (active vs healing vs scarring; 87.6% vs 80.9%% vs 80.9% p = .169, respectively). In multivariate analyses, active ulcer as well as age younger than 50 was a significantly independent predictor of successful eradication (Odds ratio; 2.799, 95% CI; 1.659–4.723, p = .0001). The eradication rate of the early eradication group was significantly higher than the late eradication group in PUB (89.2% vs 71.9%, 95% CI; 1.265–8.269, p = .011). Conclusions There was a significant difference in the eradication rate according to the endoscopic stage of gastric ulcer. Active ulcer was an independent predictor of successful eradication. Furthermore, early H. pylori eradication should be considered in patients with PUB to yield a higher eradication rate.

Acrylamide (AA) and N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) are important urinary biomarkers of acrylamide exposure in human biomonitoring, because AA is classified as a probable carcinogen in humans. In this study, urinary AA and AAMA were assessed in the South Korean adult population aged 18-69, based on the Korean National Human Biomonitoring Survey conducted in 2009. Urinary metabolites in samples were analyzed with LC-MS/MS system. Relying on data from 1873 representative South Korean adults, the population-weighted geometric means of urinary AA and AAMA concentrations were 6.8 ng/ml (95% CI: 6.4-7.3), and 30.0 ng/ml (95% confidence interval (CI): 28.2-31.8), respectively. The creatinine-adjusted geometric means of AA and AAMA were 6.2 μg/g creatinine (95% CI: 5.8-6.7) and 26.4μg/g creatinine (95% CI: 24.9-28.0), respectively. When covariates for predictors of urinary metabolites were adjusted simultaneously in a log-linear multiple regressions, the strongest predictors of urinary AA were education (OR=1.08-1.28; 95% CI: 1.11-1.48; p=0.0024) and age (OR=0.66-0.84; 95% CI: 0.54-0.97; p=0.0003), and those of urinary AAMA were smoking status (OR=1.16-2.63; 95% CI: 0.98-3.08; p=0.001) and education (OR=1.12-1.19; 95% CI: 1.02-1.38; p=0.0425). The ratio of current/never smokers for urinary AA was 1.3, whereas the same ratio for urinary AAMA was 3.0. These findings suggested that most South Koreans had detectable levels of AA and AAMA (98.7% and 99.4%, respectively) in their urine and that the body burden of AA and AAMA varied according to demographic, geographic, and lifestyle (smoking) factors.

Vertical transmission from mother to child, the main route of chronic hepatitis B virus (HBV) infection in the East Asia, is considered one of the most important predictors for the response to antiviral therapies as well as its complications such as cirrhosis and hepatocellular carcinoma. Therefore, it is critical in both etiologic and prognostic aspects to confirm whether or not chronic HBV infection is acquired vertically. This study investigated whether mother-to-child infection could be proved by the phylogenetic analyses of HBV pre-S/S genes ever since several decades have elapsed in mother-child pairs with presumed vertical transmission. The pre-S and S regions of HBVs were compared and analyzed phylogenetically in a total of 36 adults (18 mother-child pairs) with chronic HBV infection. All of the isolates of HBV were genotype C and serotype adr. The divergence between mothers and offsprings was 0 to 1.5%. Phylogenetic trees revealed that 17 of 18 pairs (94%) with presumed vertical transmission were grouped into the same cluster. Vertical transmission from mother to child could be strongly suggested even in adults with a history of several decades of HBV infection using the phylogenetic analyses of pre-S and S genes. Graphical Abstract Keywords: Hepatitis B Virus, Multilocus Sequence Typing, Mutation, Infectious Disease Transmission, Vertical INTRODUCTION Chronic hepatitis B virus (HBV) infection is considered as a major risk factor of chronic liver diseases including cirrhosis and hepatocellular carcinoma (HCC). Parenteral infection during the adulthood is a main route of chronic HBV infection in western countries, whereas vertical (or perinatal) transmission from mother to child is thought of a critical one in the East Asia (1, 2). Of importance, the modes of infection, together with other factors such as viral titer, genotype, genetic mutations of HBV, age and gender of the host may determine the long-term clinical course of chronic HBV infection. The mode of vertical transmission, in particular, is one of the most important determinants for the therapeutic responsiveness to antiviral therapies, or the natural course in terms of hepatitis e antigen seroconversion and even the development of complications (3, 4, 5). Previous studies using a comparison of HBV DNA sequences and phylogenetic analyses have shown that HBV of chronically infected children originates mainly from their respective mothers or fathers (6, 7, 8). Although there has been hitherto a molecular evidence of vertical transmission of HBV in the pairs of mother-young child, it is improbable to identify exactly the mode of infection (especially vertical vs non-vertical) in real clinical settings because medical information from the adults for the source of HBV, relying on history taking alone, is highly obscure and there could be recall bias. There have been, so far, no reports about whether it was possible to demonstrate the molecular evidence of vertical transmission of HBV even after several decades of infection. Taken together, 'Vertical or non-vertical transmission' is so crucially informative that it enables clinicians to manage effectively the patients with chronic HBV infection and also foresee the prognosis or therapeutic responses. Therefore, this study was conducted to prove the vertical transmission by showing the molecular closeness of HBVs between adult patients with clinically presumed vertical transmission and their respective mothers with the phylogenetic analyses of pre-S/S genes of HBV. It must provide valuable information to design a further strategy of management if the mode of HBV infection can be disclosed even after long-term period of infection.

Background/Aims As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC. Methods The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital. Results Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors. Conclusions The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC.

Trichlorophenols such as 2,4,5-trichlorophenol (2,4,5-TCP) and 2,4,6-trichlorophenol (2,4,6-TCP) are organochlorine compounds to which the general public can be exposed via contaminated food, water, and air. This study assessed exposure to 2,4,5-TCP and 2,4,6-TCP in Koreans age 18–69 years based on the Korean National Human Biomonitoring Survey conducted in 2009. Using data from 1,865 representative Koreans, we found that the geometric mean urinary concentrations of 2,4,5-TCP and 2,4,6-TCP were 83.4 pg/mL [95 % confidence interval (CI) = 78.6–88.6] and 0.39 ng/mL (95 % CI = 0.35–0.42), respectively. The creatinine-adjusted geometric mean 2,4,5-TCP and 2,4,6-TCP levels were 78.8 ng/g creatinine (95 % CI = 73.8–84.1) and 0.36 μg/g creatinine (95 % CI = 0.33–0.40), respectively. Of the Korean adult population, about 67.5 and 87.5 % had respective urine 2,4,5-TCP and 2,4,6-TCP concentrations >0.05 ng/mL (the limit of detection, LOD). Urine 2,4,5-TCP concentrations were significantly associated with age and place of residence, whereas urine 2,4,6-TCP concentrations were higher in rural residents. These findings suggest that most Koreans had detectable levels of 2,4,5-TCP and 2,4,6-TCP in their urine and that the body burden of 2,4,5-TCP and 2,4,6-TCP varied according to demographic and geographic factors.

Creatinine-adjustment is an important process in the urinary monitoring of the environmental exposure of children and adolescents. The purpose of this study was to investigate the concentrations of urinary creatinine and factors associated with them among Korean children and adolescents. We recruited 1,025 persons from 128 extracted schools. They were from three to 18 years old and supplied urine samples for measuring creatinine. The concentrations of urinary creatinine were 98.18 mg/dl (SD, 67.67) in arithmetic mean and 72.05 mg/dl (GSD 2.49) in geometric mean, were significantly higher among male children/adolescents than females in all age groups, and higher values appeared following increasing ages, heights and BMIs. The rates of the number who were below the lowest limit recommended by WHO (300 mg/dl) were 0.0% among three to twelve year olds. The coefficient of determination R-square of the fitted regression model for urinary creatinine was 27.4% with general characteristic variables of sex, age, BMI and height. The significant variables among these were height (standardized beta

Background Recently, there have been several nationwide episodes involving imported toys contaminated with toxic metals and environmental hormones. In addition, cadmium intoxication has occurred due to soil contamination with cadmium from abandoned metal mines. Objectives To investigate the distribution, extent and factors influencing the levels of toxic metals in the blood or urine of the Korean general population over twenty years of age, we studied the blood or urine concentrations of heavy metals in a representative sample of 5087 Koreans in 2008. Methods Multiple biological substrates were collected from each participant to determine the most suitable samples for an environmental health survey system. Information regarding exposure conditions of all subjects was collected by questionnaire-based interviews. Results The geometric means of the blood lead, mercury and manganese levels were 19.1, 3.23 and 10.8 μg/L, respectively. The geometric means of urinary arsenic and cadmium concentrations were 43.5 and 0.65 μg/L, respectively. Blood mercury and urinary arsenic levels in the Korean general population were significantly higher than in European and American populations. Conclusions The higher levels of blood mercury and urinary arsenic could be explained by the greater seafood consumption among the Korean population. This biomonitoring study of blood or urine heavy metals in the Korean general population provides important reference data stratified by demographic and lifestyle factors that will be useful for the ongoing surveillance of environmental exposure of Koreans to toxic metals.

Background/Aims: The potential role of the cyclooxygenase (COX)-2 polymorphism has been reported in relation to the risk of gastrointestinal tract malignancies. Therefore, we investigated whether COX-2 polymorphisms are associated with the risk of gastric cancer (GC) in Korea, one of the areas with a high prevalence of this condition. Methods: We evaluated the genotypic frequencies of COX-2-765 and -1195 in 100 peptic ulcer patients, 100 GC patients, and 100 healthy controls. The polymorphisms of the COX-2-765 and -1195 genes were analyzed by polymerase chain reaction and restriction fragment length polymorphisms. Results: The frequencies of the COX-2-1195 GG, GA, and AA genotype were 20%, 60%, and 20% in intestinal-type GC and 8%, 48%, and 44% in diffuse-type GC, respectively (p=0.021). There were no significant differences in the frequency of COX-2-765 genotypes between intestinal-type GC and diffuse-type GC (p=0.603). Age- and sex-adjusted logistic regression analysis showed that the COX-2-1195 AA genotype was the independent risk factor of diffuse-type GC compared with the COX- 2-1195 GG genotype (p=0.041; odds ratio, 6.22; 95% con- fi dence interval, 1.077 to 35.870). Conclusions: The COX-2- 1195 AA genotype may render subjects more susceptible to diffuse-type GC. (Gut Liver 2012;6:321-327)

Bisphenol A (BPA) and triclosan are synthetic phenolic compounds to which the general public can be extensively exposed via consumer products and environmental contamination. In this study, we assessed exposure to BPA and triclosan in the Korean adult population aged 18–69 based on the Korean National Human Biomonitoring Survey conducted in 2009. Relying on data from 1870 representative Koreans, we found that the geometric mean urinary concentrations of BPA and triclosan were 1.90 ng/ml [95% confidence interval ( CI ): 1.81–1.99] and 1.68 ng/ml (95% CI : 1.48–1.90), respectively. The creatinine-adjusted geometric means of BPA and triclosan were 1.79 μg/g creatinine (95% CI : 1.70–1.90) and 1.58 μg/g creatinine (95% CI : 1.39–1.81), respectively. About 99.8% of the Korean adult population had urinary concentrations of BPA and about 92.6% of the Korean adult population had urinary concentrations of triclosan above the level of 0.05 ng/ml (limit of detection, LOD). Urinary BPA concentrations were higher in residents of rural areas, whereas urinary triclosan concentrations were significantly associated with cigarette smoking. These findings suggested that most Koreans had detectable levels of BPA and triclosan in their urine and that the body burden of BPA and triclosan varied according to demographic and geographic factors.

Summary. This study aimed to evaluate the long-term efficacy of entecavir (ETV) in adefovir (ADV)-refractory chronic hepatitis B (CHB) patients with prior lamivudine (LMV) resistance. A total of 55 ADV-refractory CHB patients with prior LMV resistance, who received rescue therapy with ETV 1 mg daily for at least 12 months, were consecutively enrolled and analysed. Forty-four patients were men, and their median age was 47 (25–69). Ten patients had liver cirrhosis and 46 patients were positive for hepatitis B e antigen (HBeAg). Median hepatitis B virus DNA levels were 6.6 (4.3–8.0) log10 copies/mL, and the median duration of ETV therapy was 24 (12–47) months. Cumulative virologic response rates at 6, 12, 24 and 36 months were 18%, 29%, 58% and 75%, respectively. HBeAg loss occurred in 10 (21.7%) of 46 HBeAg-positive patients. In multivariate analysis, only initial virologic response at 3 months remained as an independent predictor for virologic response (RR 3.143; 95% CI 1.387–7.120; P = 0.006). The patients with a virological response at 3 months had not only a significantly higher probability of achieving a virologic response (P

Hepatitis D virus (HDV) infection can cause severe acute and chronic liver disease in patients infected with hepatitis B virus (HBV). Despite the significant decline in the global HDV infection, it remains a major health concern in some countries. This study aimed to investigate the prevalence and clinical features of HDV co-infection in patients with chronic HBV infection in Korea, where HBV infection is endemic. Nine hundred forty patients [median age, 48 (18-94) years; men, 64.5%] infected chronically with HBV were enrolled consecutively. All patients who were positive for hepatitis B surface antigen (HBsAg) for at least 6 months and were tested for anti-HDV. A portion of the HDV delta antigen was amplified, sequenced, and subjected to molecular and phylogenetic analysis using sera from the patients who were anti-HDV positive. Clinical features and virologic markers were evaluated. Inactive HBsAg carriers, chronic hepatitis B, cirrhosis and hepatocellular carcinoma accounted for 29.5%, 44.7%, 17.9%, and 8.0%, respectively. Only three patients were positive for anti-HDV, corresponding to a 0.32% positive rate. All patients who were positive for anti-HDV were inactive HBsAg carriers. HDV RNA could be amplified by PCR from the sera of two patients. Phylogenetic analysis showed that both carried HDV genotype 1. In conclusion, the prevalence of HDV infection is very low (0.32%) in Korea. All HDVs were genotype 1 and detected in inactive HBsAg carriers. Therefore, HDV co-infection may not have a significant clinical impact in Korean patients with chronic HBV infection.

Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.

Bulk amorphous composite with three amorphous phases was fabricated by consolidation of milled amorphous composite powders. The amorphous composite powder was synthesized by a controlled milling process using the Cu-based amorphous powder blended with 30 vol% Zr-based amorphous powders. The milled composite powders show a layered structure with three amorphous phases, which is formed as a result of mechanical mixing by milling. By spark plasma sintering of milled amorphous powders in the supercooled liquid region, a fully dense bulk amorphous composite was successfully synthesized.

The modified simultaneous differential staining technique, which enables double staining of cartilage and bones, needs to be improved to prevent soft tissues from being damaged during the staining process. Key factors influencing the extent to which soft tissues are damaged include the fixative used, macerating time, potassium hydroxide concentration, incubation temperature and the removal of skin from specimens. Here we describe a protocol that enables the hardening of tissues during bleaching and maceration. We also describe a method for objectively measuring rates of cartilage and bone growth. The use of formalin as a fixative rendered soft tissues more rigid due to the resulting chemical bonds formed between proteins. Blotted specimens were immersed in 1% potassium hydroxide (KOH) and incubated at 37℃ for 1 day (smaller specimens) or 2-3 days (larger specimens). The 1% KOH solution was also used as the diluent solution for the subsequent immersion in a graded series of 30%, 50%, 70%, 90%, 100% glycerol solutions, a procedure that made soft tissues even more transparent and hardened. It was not necessary to remove the skin of specimens shorter than 2 ㎝, since the macerating solution could easily penetrate their thin skin layer and continuously remove those pigments hindering visibility. Since excessive osmosis is another factor that can damage soft tissues in the macerating process by causing the rupture of those cells not able to withstand the osmotic pressure, here it was minimized by balancing the salt concentration between the interior and exterior of cells with the addition of 0.9% sodium chloride (NaCl) in the macerating solution. Finally, to determine the proportions of cartilage and bone growth, photographs of the stained specimens were taken with a dissecting microscope and sections corresponding to the cartilage and bones were cut out from the printed pictures and weighed. Our results show that this method is suitable for the objective evaluation of bone and cartilage growth.

Dept. of Environmental Education, Kongju National University*Dept. of Health Science, Dongduk Women's University(Received March 28, 2010/Revised April 30, 2010/Accepted June 10, 2010)ABSTRACTThe purpose of this study was to investigate the relevance of gender, age, and BMI (Body Mass Index) to changesin the urinary creatinine concentration in Korean adults. We recruited and surveyed 2,156 persons ≥20 years of age from98 districts across the country, and collected urine samples for analyzing the creatinine concentration. Participants were41.6% men and 58.4% women. In terms of age, the percentage of the population in their 20’s and ≥60 years of agewas relatively similar, with 13.6% and 17.8%, respectively, while the percentages in their 30’s, 40’s and 50’s were alsorelatively similar, with 22.0%, 24.0%, and 22.6%, respectively. The proportion of participants in their 20’s and 30’s whowere underweight (according to the BMI) was 25% and 19.2%, respectively, but only 6.2~6.4% of those ≥40 years ofage were underweight. This showed that the underweight proportion in elder generations was less than that in youngergenerations. Meanwhile, the proportion who were overweight was 13.7%, 18.8%, 28.6%, 27.9%, 32.0% when theparticipants were in their 20’s, 30’s, 40’s, 50’s and ≥60 years of age, respectively (p

Antibody to hepatitis B surface antigen (HBsAg) (anti-HBs) can exist in patients with chronic hepatitis B virus (HBV) infection. To date, little is known about the association of concurrent HBsAg and anti-HBs (concurrent HBsAg/ anti-HBs) with hepatocellular carcinoma (HCC). The aim of this study was to investigate the clinical relevance of concurrent HBsAg/anti-HBs with preS deletion mutations and HCC in chronic HBV infection. A total of 755 patients with chronic HBV infection were included consecutively at a tertiary center. Logistic regression analysis was used to identify risk factors for HCC, and serum HBV DNA was amplified, followed by direct sequencing to detect preS deletions. The prevalence of concurrent HBsAg/anti-HBs was 6.4% (48/755) and all HBVs tested were genotype C. HCC occurred more frequently in the concurrent HBsAg/anti-HBs group than in the HBsAg only group [22.9% (11/48) vs. 7.9% (56/707), P = 0.002]. In multivariate analyses, age >40 years [odds ratio (OR), 14.712; 95% confidence interval (CI), 4.365-49.579; P < 0.001], male gender (OR 2.431; 95% CI, 1.226-4.820; P = 0.011), decompensated cirrhosis (OR, 3.642; 95% CI, 1.788-7.421; P < 0.001) and concurrent HBsAg/anti-HBs (OR, 4.336; 95% CI, 1.956-9.613; P < 0.001) were associated independently with HCC. In molecular analysis, preS deletion mutations were more frequent in the concurrent HBsAg/anti-HBs and HCC groups than in the HBsAg without HCC group (42.3% and 32.5% vs. 11.3%; P = 0.002 and 0.012, respectively). In conclusion, concurrent HBsAg/anti-HBs is associated with preS deletion mutations and may be one of the risk factors for HCC in chronic HBV infection with genotype C.

In Korea, there have been a number of efforts to measure levels of exposure to environmental pollutants among the population. This paper focuses on investigating the distribution of, extent of, and factors influencing the blood levels of lead, cadmium, and mercury in the Korean population, working from data obtained from the Second Korean National Human Exposure and Bio-monitoring Examination. To that end, blood metal concentrations were analyzed from a total of 2369 participants who were 18 years of age and older. The geometric mean concentrations and their 95% confidence intervals of metals in blood were found to be lead, 1.72 microg/dL (95% CI, 1.68-1.76); cadmium, 1.02 microg/L (95% CI, 1.00-1.05); and mercury, 3.80 microg/L (95% CI, 3.66-3.93). Regression analyses indicate that the levels of metals in the blood are mainly influenced by gender, age, and the education levels of the participants. Current smoking status is also found to be a significant factor for increasing both lead and cadmium levels. Although our study, as the first nationwide survey of exposure to environmental pollutants in Korea, has value on its own, it should be expanded and extended in order to provide information on environmental exposure pathways and to watch for changes in the level of exposure to environmental pollutants among the population.

Background & Aims This study aimed to identify the predictors for early hepatitis B e antigen (HBeAg) seroconversion following acute exacerbation (AE) in patients with HBeAg-positive chronic hepatitis B (CHB). Methods A total of 151 patients with HBeAg-positive CHB and AE were consecutively enrolled. AE was defined as an elevation of alanine aminotransferase level to more than 5 times the upper limit of normal and more than twice the patients' baseline value. Early HBeAg seroconversion was defined as HBeAg loss and the appearance of hepatitis B e antibody within 6 months of AE. Clinical and laboratory data were compared between an early HBeAg seroconversion group and a nonearly HBeAg seroconversion group. Results All patients had genotype C hepatitis B virus (HBV). Early HBeAg seroconversion occurred in 35.5% (39/110). Under univariate analysis, age, transmission mode, disease status, and serum HBV DNA level were associated with early HBeAg seroconversion. Multivariate analysis showed that nonvertical transmission mode (RR, 3.681; 95% CI, 1.279–10.592; P = .016) and low serum HBV DNA levels (≤ log [copies/mL]; RR, 6.891; 95% CI, 2.165–21.935; P = .001) were independent predictors. Conclusions Patients with CHB with genotype C may have a higher chance of early HBeAg seroconversion after AE in the context of nonvertical transmission and/or had low serum HBV DNA levels (≤7 log [copies/mL]) at AE. Therefore, we should take into account transmission modes and serum HBV DNA levels when choosing appropriate management strategies for patients who exhibit AE of HBeAg-positive CHB with genotype C.

Background and Aim: Interleukin (IL)-1 gene polymorphism has been reported to be associated with the increment of gastric cancer (GC) and the decrement of duodenal ulcers (DU). In addition, IL-2 is known to induce Helicobacter pylori (H. pylori)-associated gastric atrophy, but it is not known whether IL-2 gene polymorphism increases the risk of GC (GC) or peptic ulcer diseases. Therefore, we compared the genotypes of IL-1B, IL-1RN, and IL-2 gene polymorphisms with risk of gastric ulcers (GU), GC, and DU in Korean patients. Methods: In total, 116 GU, 122 GC, and 104 DU patients were included consecutively and compared with 100 healthy controls. Polymorphisms of the IL-1B-511/-31 gene, the penta-allelic variable number of tandem repeats of the IL-1RN gene, and the IL-2-330 gene were analyzed by polymerase chain reaction with restriction fragment length polymorphism or confronting two-pair primers methods. Results: The age–sex-adjusted odds ratios (OR) for the IL-1B-511 T genotype relative to the C/C genotype (OR = 0.82, 95% confidence interval [CI] 0.41–1.65), IL-1RN*2 genotype relative to the L/L genotype (OR = 0.85, 95% CI 0.41–1.78), and IL-2-330 T genotype relative to the G/G genotype (OR = 1.94, 95% CI 0.76–4.96) were not increased in GC. There was also no significant difference in the genotypes of these cytokine polymorphisms between the study group (GU or DU) and control group. In addition, genotypic frequency was not associated with H. pylori positivity and histological type of GC. Conclusion: IL-1B-511, IL-1RN, and IL-2 genetic polymorphisms were not important contributors to the pathogenesis of GU, GC, and DU in Korean patients.

The purpose of this study was to investigate the teratological effects of enrofloxacin, a veterinary antibiotic, on the embryos and fetus of hatching chicken eggs. A control group and four experimental fertilized egg groups were set up. The four experimental groups were injected with 0.05 ml, 0.1 ml, 0.2 ml, and 0.3 ml enrofloxacin () respectively. During the hatching period, the weights of total eggs, inside material(yolk and white) and embryos or fetuses, embryo growth, and teratological effects were investigated. In the experimental groups (fertilized eggs injected with 0.05 ml, 0.1 ml, 0.2 ml and 0.3 ml enrofloxacin), the weights of total eggs were decreased, but the yolk and white weights were increased by the higher amount of antibiotics. The weights of embryos (fetuses) in experimental groups were 86.1%, 78.6%, 65.6% and 61.4% of the control, respectively. Retarded growth, deformity and embryo loss were observed in experimental groups. Teratological effects such as undeveloped eyes, wings and legs, and deformed head and bill were also detected. In conclusion, we found that veterinary antibiotics, enrofloxacin have made teratological effects on the embryos and fetus of hatching eggs.

This study evaluates the protective effects of Korean garlic juice against the toxicity of methyl mercuric chloride (MMC) in relation to fetal ossification in pregnant Fischer 344 rats. This study has as its basis, both theory and data that neutral amino acids in garlic juice have protective effects against mercury poisoning. Pregnant rats were dosed in various combination with 20 mg MMC/kg body wt. and 0.5 or 1.0 garlic juice/kg body wt. on the 7th day of gestation. Fetuses were extracted from the dams on 20th day of gestation, and the fetal bones were stained and measured. The results obtained are as follows: 1. Fetal body weights, body lengths, and head length were significantly decreased by as much as 23.5%, 21.3%, 15.5% respectively in 20 mg/wt kg methyl mercuric chloride groups (p and of controls. 3. The ossified pectoral girdles were significantly decreased by as much as 66.6% in clavicle, and in other areas in the 20 mg/wt kg methyl mercuric chloride groups (p and of the controls. 4. The ossified pelvic girdles were significantly decreased by as much as 57.1% and 56.1% in two ischium, in metacarpals in the 20 mg/wt kg methyl mercuric chloride groups (p and of the controls. 5. The ossified terenebrae were unchanged or significantly decreased; 0.0% in 5th, 54.1% in 1st, 83.9% in 2nd, 75.0% in 3rd, 72.7% in 4th, 79.8% in 6th of 20 mg/wt kg methyl mercuric chloride groups (p and of the controls. 6. The ossified ribs were significantly decreased by as much as in 20 mg/wt kg methyl mercuric chloride groups (p and of the controls. In conclusion, Korean garlic juice significantly protected against the toxicity of MMC in relation to the fetal ossification in pregnant rats.

Although acute hepatitis A (AH-A) is usually self-limited, the clinical manifestations can vary from mild to severe liver dysfunction. However, little is known about the simple, valuable predictors for clinical manifestation in AH-A. The objective of this study was to identify the simple clinical predictors for severe liver dysfunction and its clinical course.A total of 162 IgM anti-hepatitis A virus (HAV) positive patients were enrolled in the study. Severe AH-A was defined as a prothrombin time40% of control activity. Various liver-unrelated and liver-related parameters at presentation were compared separately between the severe AH-A group and the non-severe group.Mean age (+/-SD) was 27.5 (+/-7.1) years and the proportion of males was 54% (88/162). Fourteen patients (8.7%) experienced severe AH-A. Of the liver-unrelated parameters, leukopenia (4000/microl), thrombocytopenia (150,000/microl), and high serum C-reactive protein levels (8 mg/l) at presentation were significant predictors for severe AH-A in a univariate analysis (p0.05). On multivariate analysis, only thrombocytopenia was an independent predictor for severe AH-A (odds ratio (OR) 5.562, 95% confidence interval (CI) 1.153-26.834, p=0.033). Of the liver-related parameters, there were no independent predictors, as shown by multivariate analysis. The thrombocytopenia group (33%, 54/162) not only had a longer recovery time (28 days (range, 14-140) versus 37 days (20-128), p0.001), but also more frequent complications (OR 4.632, 95% CI 1.886-11.372, p=0.001) than the non-thrombocytopenia group.Initial thrombocytopenia may be a simple, valuable predictor for severity and clinical course in AH-A.

This study was performed to find clinical risk factors for developing ischemic colitis in patients experiencing lower abdominal discomfort with or without bloody diarrhea. A total of 467 patients who underwent sigmoidoscopy or colonoscopy because of lower abdominal discomforts with or without blood in stool were consecutively enrolled; 147 patients were diagnosed endoscopically and histologically as having ischemic colitis. The control group was composed of the remaining 320 patients with nonspecific endoscopic/histologic findings. Clinical variables were compared between the ischemic colitis group and the control group. After excluding 67 patients in the ischemic colitis group, we compared the remaining 80 patients to the control group, using various clinical parameters. According to the logistic regression analysis, six factors were significantly related to ischemic colitis: older than aged 60 years (adjusted odds ratio, 5.7; 95 percent confidence interval: 2.6–11.7), hemodialysis (5; 1.2–21.6), hypertension (4.9; 2.3–10.5), hypoalbuminemia (3.5; 1.8–6.7), diabetes mellitus (3.4; 1.3–8.8), and constipation-inducing medications (2.8; 1.1–7.1). Through our analysis, we were able to predict the development of ischemic colitis for the patients with 0, 1, 2, 3, or 4+ risk factors: 8, 21, 55, 79, and 100 percent, respectively. Old age, hemodialysis, hypertension, diabetes mellitus, hypoalbuminemia, and constipation-inducing medications are clinically important risk factors for ischemic colitis in patients experiencing lower abdominal discomfort with or without bloody stool. By considering these factors, we were able to predict with high accuracy the development of ischemic colitis.

To investigate the prevalence of occult HBV infection among subjects with normal serum ALT levels in South Korea.A total of 195 serum samples were collected from subjects without a past history of alcohol abuse and with normal serum ALT levels. They were negative for HBsAg, anti-HCV, and anti-HIV. HBV-DNA was detected from sera by nested polymerase chain reaction (PCR) using specific primers of the surface antigen region of the HBV genome. We performed a quantitation assay using hybrid capture II test to determine the levels of serum HBV-DNA.HBV-DNA was detected in 31 of 195 subjects (16%). Prevalence of occult hepatitis B was significantly higher in the male subjects (23%) than in the female (8%), (P0.05). We were able to detect HBV-DNA in 15% (7/47) even in which sera were all negative for anti-HBs and IgG anti-HBc. Serum HBV-DNA levels were as high as 10(5) copies/mL in 18 of 31 subjects (58%) with occult HBV infection.The prevalence of occult HBV infection and their HBV-DNA levels were significantly high among subjects with normal serum ALT levels in South Korea. Thus, more meticulous attention should be given to prevent HBV transmission by blood transfusion or organ transplantation in endemic areas, and further studies on clinical implication and mechanism of occult HBV infection are required.

Pseudomembranous colitis is a severe form of antibiotic-associated diarrhea. However, there have been no reports about the factors that make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. This study was designed to determine the clinical risk factors for pseudomembranous colitis among the patients with presumed antibiotic-associated diarrhea. This was a retrospective study of 150 consecutive patients admitted to our institution between January 2000 and December 2004 with a diagnosis of presumed antibiotic-associated diarrhea. All patients underwent sigmoidoscopy or colonoscopy because of diarrhea after administration of antibiotics. Pseudomembranous colitis was confirmed both endoscopically and histologically. Various clinical parameters were compared between the pseudomembranous colitis group and non-pseudomembranous colitis group. The mean age of patients was 61 years, and 60 percent (90/150) was female. Pseudomembranous colitis was diagnosed in 53 percent (80/150). On univariate analysis, older than aged 70 years (P = 0.014), antibiotic therapy for more than 15 days (P < 0.0001), hospital stay for more than 20 days (P < 0.0001), number of antibiotics used more than one (P = 0.01), and surgical procedures (P = 0.029) were significant parameters for pseudomembranous colitis. On multivariate analysis, the important clinical risk factors were advanced age (older than aged 70 years; adjusted odds ratio, 2.7; 95 percent confidence interval, 1.208–6.131; P < 0.016) and long hospital stay (more than 20 days; adjusted odds ratio, 5.1; 95 percent confidence interval, 2.1–12.259; P < 0.0001). When both risk factors were present, the positive predictive value of pseudomembranous colitis was 0.86. Advanced age and long hospital stay may make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. Therefore, pseudomembranous colitis should be first suspected in cases with presumed antibiotic-associated diarrhea having such risk factors.

Background and Aims: This study was aimed to find clinical predictors for developing delirium tremens (DT) in alcohol dependence. Methods: This cohort study was retrospectively carried out among patients who were diagnosed as having alcohol dependence between January 2001 and July 2004. Fifteen parameters were compared between patients who developed DT and ones who did not. We identified clinical predictors for DT by using multivariate analysis. Results: A total of one hundred and seventy-eight consecutive admission cases from 147 patients were analyzed. The mean age was 47.8 years, and 95.5% were male. Delirium tremens developed in 59 cases (33%) during hospitalization. On multiple logistic regression analysis, a previous history of DT (odds ratio (OR) 3.990; 95% CI 1.631, 9.759) and high pulse rate above 100 b.p.m. (OR 4.158; 95% CI 2.032, 8.511) were significant predictors for developing DT. When combined, DT developed in just 20.4% of cases without any predictors; however, if one predictor was present, DT developed in 45.6%, and if two predictors were present, DT developed in all cases (100%). Conclusions: A simple assessment using the past history of DT and the pulse rate, which may be easily evaluated in clinical settings, can allow physicians to readily identify the patients who are at a high risk of developing DT during an alcohol dependence period and reserve more intensive therapies for the selected cases. © 2005 Blackwell Publishing Asia Pty Ltd

3,3?-dichlorobenzidine (DCB) can be metabolically N-acetylated and/or N-oxidized, and can form hemoglobin adducts. Gas chromatography/mass spectrometry-selected ion monitoring detection mode (GC/MS-SIM) could be a good analytical method to detect them. 4-Aminobiphenyl and phenanthrene-d10 were used as internal standards, and standard metabolites of DCB were synthesized from DCB. Pyridine is a promoter and acetic acid is a controller in the acetylation of DCB during titrating with acetyl chloride. After washing with acetone, the purity of N-acetyl DCB and N, N?-diacetyl DCB were 98.72% and 98.82%, respectively. The maximum detection limits (MDLs) by GC/MS-SIM were 0.5 mg/L in DNA adduct and 1.0 ng/g in hemoglobin for DCB and N-acetyl DCB. The base peaks of their fragmentation pattern were 252 m/z at the peak of DCB, 252 m/z and 294 m/z at the peak of N-acetyl DCB, and 252 m/z, 294 m/z, and 336 m/z at the peak of N, N?-diacetyl DCB. This analytical method was applied to determine hemoglobin adducts formed in young female Sprague -Dawley rats orally exposed with 20, 30, and 40 mg DCB/kg/day for three weeks. Two adducts were detectable by GC/MS-SIM after alkaline hydrolysis of hemoglobin samples and extraction. The structure of these adducts could be assigned to DCB and N-acetyl DCB by co-chromatography with the synthetic standards. After the first week of treatment, the total amount of hemoglobin adducts determined was 837.5∼2501 ng/g hemoglobin. The adduct levels were increased up to 1203.3∼2605.4 ng/g after the second week, and slightly decreased after the third week. The ratio of DCB and N-acetyl DCB was nearly similar in all treatment groups at the third week, such as 4.28∼4.78. Three different treatments (20, 30, and 40 mg DCB/kg) of rats resulted in dose-proportional increases in the total and DCB amount of hemoglobin adducted formed for three weeks. The relative contribution of DCB and N-acetyl DCB to the total hemoglobin adduct level was strongly dose dependent. The results show that GC/MS-SIM is suitable for the biological monitoring of humans exposed to DCB or DCB-containing products

glands may contribute to the pathogenesis of EIPD. In the normal esophagus, secretory products of the submucosal glands are continuously excreted on the mucosal surface by an active contractile movement of myoepithelial cells. In EIPD, this excretory mechanism is disturbed by some underlying cause, which most likely includes congenital abnormality, motor dysfunction of the esophageal wall, GERD, and infection. As a consequence, the ductal portion of the glands is considered to become dilated, forming pseudodiverticular pouches. The present observations, however, suggested that even in the dilated ducts in EIPD, continuous excretory movement is still preserved to some degree. This is probably one of the reasons many patients with EIPD remain asymptomatic for a long time. In conclusion, although EIPD has been considered a static condition similar to diverticulosis, seen, for example, in the large intestine, our observations suggest that EIPD is not a static pathological condition but rather an active, continuously mobile process by which mucinous material within the submucosal pouches is repeatedly discharged onto the mucosal surface.

AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) in chronic hepatitis B (CHB). METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma (HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP and their combination were calculated and compared. RESULTS: The optimal cutoff values for PIVKA-II and AFP were 40 mAU/mL and 10 ng/mL, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-II and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-II and AFP were not significantly different (0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-II was significantly better than that of AFP in patients with cirrhosis (0.870 vs 0.812, P = 0.042). When PIVKA-II and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-II alone for the differentiation of HCC from nonmalignant CHB (P < 0.05), especially when cirrhosis was present (P < 0.05). CONCLUSION: Serum PIVKA-II might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.

The clinical course of acute viral hepatitis A (AHA) is highly variable. Serum alphafetoprotein (AFP) level is often elevated in various types of acute liver injuries, indicating active liver regeneration. This study was aimed to investigate the clinical significance of serum AFP level in the aspect of the early recovery in AHA.A total of 238 patients with AHA, confirmed by IgM anti-hepatitis A virus, were included. The patients were classified according to serum AFP level. Multivariate analysis by Cox proportional hazards model using dichotomized clinical variables was performed to identify the independent predictors for early recovery (ALT normalization within 2 weeks).The median age (range) was 30 (17-50) years and male dominant (62%, 147/238). Compared to low AFP group, high AFP group (10 ng/mL) had significantly lower platelet counts (p0.0001), lower albumin (p =0.003), lower AST (p0.001), lower ALT (p = 0.001), higher total bilirubin level (p0.0001) on univariate analysis. On Cox regression analysis, high AFP level (10 ng/mL) was the only independent predictor for early recovery (Hazard ratio (HR); 2.392, 95% CI; 1.564-3.659, p = 0.0001).High serum AFP level (10 ng/mL) may indicate the already-started recovery through active liver regeneration or the early recovery within 2 weeks in AHA.

This study aimed to estimate the status of secondhand smoke (SHS) exposure through urine cotinine analysis among nonsmoking workers in Korea and to analyze factors affecting urine cotinine concentrations. Data were based on "The 2008 Korea National Survey for Environmental Pollutants in the Human Body," a cross-sectional study of the National Institute of Environmental Research of Korea. We selected 1448 nonsmoking adult workers from 200 localities to participate in this survey. Urine cotinine concentrations were analyzed using a gas chromatograph-mass selective detector. We calculated separate covariate-adjusted geometric means for socio-demographic variables for males, females, and total subjects by analysis of covariance (ANCOVA). Statistical analyses were performed using SPSS version 18.0 (SPSS Inc., Chicago, Ill.). The prevalence of self-reported exposure to SHS was 36.9%. The geometric mean (95% confidence interval) of urine cotinine concentrations among all participants was 16.50 (14.48-18.80) μg/L. Gender, living area, education, and SHS exposure showed significant differences in urine cotinine concentrations. The urine cotinine concentrations of farmworkers and blue-collar workers such as skilled agricultural, forestry, and fishery workers, and elementary occupations were higher than those of white-collar workers such as clerical support workers, technicians, and associate professionals. Such a high proportion of the population having high urine cotinine levels indicates widespread exposure to SHS among nonsmoking workers in Korea. Furthermore, the urine cotinine levels among nonsmoking workers exposed to SHS varied by occupation. The measured urine cotinine concentration is suggested to be a valuable indication of SHS exposure in Korea.

Clostridial septicemia usually occurrs in patients with immunocompromised diseases such as diabetes and malignancy. Clostridial liver abscess is very rare but highly fatal. We experienced a case of Clostridial septicemia due to liver abscess in a 73-year-old man. He was presented with fever and chills. On admission, abdominal CT scan showed about 35 mm sized hypoattenuated lesion with multiple central air-bubbles. After the diagnosis of liver abscess, the patient underwent prompt empirical antimicrobial therapy and percutaneous drainage. In spite of early therapy, the patient had gone into shock and death.

Background/aims The tumor-node-metastasis (TNM) staging is an useful system to assess the prognosis of any solid cancer. As new TNM staging classification of 7th stomach cancer was revised in 2009, we evaluated the prognostic predictability of the 7th International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) TNM classification compared to 6th UICC/AJCC TNM classification in gastric cancer. Methods From January 2000 to December 2009, 5-year survival rates of 266 patients with gastric cancer were calculated by the 6th and 7th UICC/AJCC TNM classification. Results Using the 7th UICC/AJCC TNM classification, there was no significant difference in the 5-year cumulative survival rates (5 YSR) between stage IIA and IIB, IIB and IIIA, and IIIA and IIIB (70% vs. 71%, p=0.530; 71% vs. 80%, p=0.703; 80% vs. 75%, p=0.576, respectively) though significant differences of the survival rates were observed among stages of 6th edition. Using T stage of 7th edition, 5 YSR was not different between T2 and T3 (86% vs. 82%, p=0.655). Using N stage of 7th edition, 5 YSR were not different between N1 and N2, N3a and N3b (79% vs. 81%, p=0.506; 41% vs. 17%, p=0.895, respectively). Conclusions The 7th UICC/AJCC TNM classification had poor prognostic predictability in gastric cancer compared to the 6th edition.