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Past research indicates that an individual’s affective reactivity to daily stressors is associated with elevated levels of inflammatory biomarkers such as interleukin-6 and C-reactive protein. Here, we assessed individuals’ positive and negative affective reactivity to daily stressors, and their association with expression levels of genes in the conserved transcriptional response to adversity (CTRA; proinflammatory and type-1 interferon antiviral genes). We hypothesize that gene expression levels of CTRA genes are a possible explanatory mechanistic link between higher levels of affective reactivity and inflammatory markers. Our study included 199 individuals from the Midlife in the United States Refresher study (ages 26-71, 52.8% female, and 17.9% non-white) who participated in the Gene Expression and Daily Diary Projects. Individuals provided whole blood for gene expression analysis and completed an 8-day telephone interview to assess daily experiences. Positive and negative affective reactivity scores were used to indicate magnitude of an individual’s changes in daily affect on stressor-days versus non-stressor-days, and were computed using multilevel modeling. Three CTRA gene expression scores were created for each individual, representing the average expression of proinflammatory, type-1 interferon, and a combination of both. Preliminary findings suggest a negative association between the CTRA composite score and negative affective reactivity to daily stressors (β = -0.963, p = 0.034), controlling for covariates. Further analyses will use affective reactivity to predict individual CTRA genes, correcting for multiple testing. This study will be the first to examine the relationship between daily assessments of emotions and gene expression levels in a representative U.S. cohort.

Background/Aims: For metastatic renal cell carcinoma (RCC), various prognostic scoring systems have been developed. However, owing to the low prevalence of non-clear cell RCC, the three most commonly used tools were mainly developed based on patients with clear cell histology. Accordingly, this study applied three prognostic models to Korean non-clear cell RCC patients treated with first-line temsirolimus. Methods: This study analyzed data for 74 patients with non-clear cell RCC who were treated with temsirolimus as the first-line therapy at eight medical centers between 2011 and 2016. The receiver-operating characteristic (ROC) curves for the different prognostic models were analyzed. Results: Twenty-seven (36.5%), 24 (32.4%), and 44 patients (59.5%) were assigned to the poor prognosis groups of the Memorial Sloan-Kettering Cancer Center (MSKCC), International Metastatic RCC Database Consortium (IMDC), and Advanced Renal Cell Carcinoma (ARCC) risk stratification models, respectively. All three prognostic models reliably discriminated the risk groups to predict progression-free survival and overall survival (p < 0.001). The area under the ROC curve (AUC) for progression and survival was highest for the ARCC model (0.777; 0.734), followed by the IMDC (0.756; 0.724) and the MSKCC (0.742; 0.712) models. Furthermore, the sensitivity and specificity for predicting progression were highest with the ARCC model (sensitivity 63.6%, specificity 85.7%), followed by the MSKCC (sensitivity 58.2%, specificity 86.5%) and the IMDC models (sensitivity 56.4%, specificity 85.7%). Conclusions: All three prognostic models accurately predicted the survival of the non-clear cell RCC patients treated with temsirolimus as the first-line therapy. Furthermore, the ARCC risk model performed better than the other risk models in predicting survival.

Background: Active surveillance is recommended as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC), and determining meaningful changes in diameter and volume...

Objective This study aims to identify distinct patterns of 10-year multimorbidity trajectory among Korean older adults and examine factors associated with the patterns. Methods Data were drawn from the six waves of the Korean Longitudinal Study of Ageing (KLoSA, 2006–2016). We examined trajectories of multimorbidity of 1,705 older adults aged 65 and older using Growth Mixture Modeling. Then, the identified patterns were used as dependent variables to examine the correlates of multimorbidity trajectories. Explanatory variables considered were sociodemographic, psychological, health behavioural and interpersonal factors at baseline. Results Four distinct patterns of multimorbidity trajectories were identified: ‘maintaining-low’ (59.4%), ‘chronically-high’ (7.5%), ‘moderately-increasing’ (26.0%) and ‘rapidly- increasing’ (7.1%). Gender, depressive symptoms, life satisfaction and frequency of contacts with others were associated with trajectory membership. Specifically, women were more likely to be in the ‘chronically-high’ group than any other groups. Compared to the ‘maintaining-low’ group, those with higher levels of depressive symptoms and lower levels of life satisfaction were more likely to belong to the ‘chronically-high’ group and ‘moderately-increasing’ group, respectively. Respondents who had less frequent meetings with others in close relationships were more likely to be in the ‘rapidly-increasing’ group than the ‘maintaining-low’ group. Discussion These findings are suggestive of distinct trajectories of multimorbidity across older adulthood, indicating that multimorbidity experiences might differ among older adults. Moreover, results suggest that there may be gender inequalities in multimorbidity trajectories, and that levels of psychological well-being and social engagement could be useful in identifying older adults who are at higher risk of worsening multimorbidity.

Purpose Genexol-PM is a Cremophor EL–free formulation of low-molecular-weight, non-toxic, and biodegradable polymeric micelle-bound paclitaxel. We conducted a phase III study comparing the clinical efficacy and toxicity of Genexol-PM with conventional paclitaxel (Genexol). Materials and Methods Patients were randomly assigned (1:1) to receive Genexol-PM 260 mg/m2 or Genexol 175 mg/m2 intravenously every 3 weeks. The primary outcome was the objective response rate (ORR). Results The study enrolled 212 patients, of whom 105 were allocated to receive Genexol-PM. The mean received dose intensity of Genexol-PM was 246.8±21.3 mg/m2 (95.0%), and that of Genexol was 168.3±10.6 mg/m2 (96.2%). After a median follow-up of 24.5 months (range, 0.0 to 48.7 months), the ORR of Genexol-PM was 39.1% (95% confidence interval [CI], 31.2 to 46.9) and the ORR of Genexol was 24.3% (95% CI, 17.5 to 31.1) (pnon-inferiority=0.021, psuperiority=0.016). The two groups did not differ significantly in overall survival (28.8 months for Genexol-PM vs. 23.8 months for Genexol; p=0.52) or progression-free survival (8.0 months for Genexol-PM vs. 6.7 months for Genexol; p=0.26). In both groups, the most common toxicities were neutropenia, with 68.6% occurrence in the Genexol-PM group versus 40.2% in the Genexol group (p < 0.01). The incidences of peripheral neuropathy of greater than grade 2 did not differ significantly between study treatments. Conclusion Compared with standard paclitaxel, Genexol-PM demonstrated non-inferior and even superior clinical efficacy with a manageable safety profile in patients with metastatic breast cancer.

Nanostructured lipid carriers (NLCs) and chitosan-coated NLCs (CH-NLCs) were prepared by a combined double emulsion and melt dispersion method. The physicochemical properties of them were investigated to determine the optimum conditions. At 3% emulsifier concentration, the NLCs showed about 191.0 ± 4.1 nm mean particle size and low polydispersity index value compared to those observed under other conditions. The encapsulation efficiency of CH-NLCs was 83.9% which was about 10% higher than that of NLCs. In vitro release test showed that low release amount of iron from the NLCs (11%) and CH-NLCs (5%) in simulated gastric condition within 3 h, whereas the iron release amounts of the NLCs and CH-NLCs were high (over 77%) in simulated intestinal condition because both NLCs and CH-NLCs were totally destructed in the intestinal condition after 3 h. In the thiobarbituric acid test, the absorbance of milk-fortified NLC and CH-NLCs was lower than that of original milk. Based on these results, CH-NLCs showed great potential for iron fortification in milk.

Being an “aged” society, only recently in Korea have there been growing interests in well-dying and end-of-life planning. Therefore, the purpose of this study was to investigate the factors associated with the level of end-of-life planning among Korean older adults. For the analyses, 2017 National Survey of Older Koreans was utilized and the sample was 10,073 older adults aged 65 and above. The independent variables were age, gender, employment, education level, marital status, household income, religion, number of children, and life satisfaction. The dependent variable, the level of end-of-life planning, was measured as the sum of five items of the question asking whether they have prepared the following items in preparation for end-of-life: shroud (8.3% prepared), cemetery/charnel house (25.1% prepared), mutual aid society (13.7% subscribed), will (0.5% prepared), lectures in preparation for end-of-life (0.4% participated). The results from multiple regressions using STATA 15.0 indicated that the level of end-of-life planning was significantly associated with age (b=.02, p

The years around menopause are the time that associates not only with hormonal changes but with psychological and social transitions, and previous studies have consistently revealed the relationship between menopause and depression. The present study examined the moderating effect of perceived partner responsiveness (PPR) on the association between menopausal symptoms (MS) and depressed affect (DA). The sample was middle-aged climacteric women (N = 754, Age=49-60) from the second wave of Midlife in the United States (MIDUSⅡ). Measurement for MS consisted of the frequency of five symptoms in the past 30 days (insomnia, heavy sweating, painful intercourse, hot flashes, and irritability). PPR was assessed using three items matched the core components of responsiveness (understanding, validating, and caring). Results revealed that there were significant interactions between menopausal symptoms and PPR (b = 0.05, p < 0.039). Specifically, the level of elevation of DA in response to MS was smaller in women with higher levels of PPR (b = 2.93, p < 0.001) than in those with lower levels of PPR (b =3.05, p < 0.001). According to the region of significance analysis, the coefficients of MS on DA were significant within the -2SD to +2SD range of PPR, but it decreased as the PPR increased. Findings suggest that partners’ careful responsiveness may mitigate the detrimental effects of MS on DA among climacteric women.

The aim of this study was to identify distinct patterns of cognitive function trajectory among Korean older women in single households and to investigate their associated factors. We used data from the five waves of the Korean Longitudinal Study of Ageing (KLoSA), a nationally representative longitudinal survey collected biennially from 2006 to 2014. The sample was 244 women aged 65 or above who had maintained the single household status for the five waves. Using Growth Mixture Modeling, distinct patterns of cognitive function trajectory were identified. Then, multinomial regression analysis was employed to examine the associations between identified trajectories and various factors (socio-demographic, health-related, psychological, and interpersonal factors at wave 1). Results showed that there were three distinct patterns of cognitive function trajectory: ‘maintaining-low’ (20.9%), ‘moderate-decreasing’ (33.6%), and ‘maintaining-high’ (45.5%). Specifically, compared to the ‘maintaining-low’ group, younger women were more likely to belong to the ‘moderate-decreasing’ group and the ‘maintaining-high’ group. Furthermore, those with higher household income, and who participated in more various types of social activities (e.g., participation in leisure/culture/sports clubs, volunteering work) were more likely to belong to the ‘maintaining-high’ group. Compared to the ‘moderate-decreasing’ group, those who were younger and participated in more various types of social activities were more likely to belong to the ‘maintaining-high’ group. Findings suggest that socioeconomic status and social engagements may be critical for cognitive function among older women in single households, and encouraging them to remain socially active may help prevent poorer cognitive outcomes.

The aim of this study is to explore the relationship between social exclusion and suicidal ideation among bereaved older people living alone. When people with a significant loss in the familial relationship are exposed to social exclusion, they likely experience poor mental health and suicidal ideation. Using the Korean Community Health Survey 2017, logistic regression model was applied to the bereaved older people living alone, 65 to 110 of age (N=14,659). Social exclusion was comprised of three network-based components: exclusion from relationships, social participation, and community. Relationship exclusion means the lack of contact with family, friends, and neighbors, respectively, at least once a week. Social participation exclusion refers to the lack of participation in a religious, socializing, and leisure activity, respectively, at least once a month. Community exclusion covers two indicators of trust in neighbors and perception of neighborhood reciprocity. Results showed that indicators of relationship, social participation, and community exclusion were associated with suicidal ideation. Bereaved, living-alone older people were likely to have suicidal ideation when they lack contact with neighbors (OR=1.13, p

Previous studies note daily emotional well-being and sleep duration as significant correlates of cardiovascular health including cardiometabolic syndrome. However, not much is known about the interactive effects of emotional well-being and sleep. Expanding upon current research, this study examined whether sleep deficiency, defined as having on average

This study aimed to examine how stressors and positive events are related to sleep duration in daily life and whether these associations differed by age. The second wave of National Study of Daily Experiences of Midlife in the United States study was used (N=1,851). Reports of daily events was coded as two categorical variables indicating experiences of concurrent and previous-day daily events: experiencing both stressors and positive events, only stressors, only positive events, and neither (reference). Results from multilevel analysis showed that experiencing an event, either a stressor or a positive event, was associated with shorter amount of sleep the same day compared to a non-event day. In particular, sleep duration was shorter when individuals experienced stressors compared to when they only reported positive events the same day. There were no age differences in these associations. Findings suggest that stressors exert a stronger influence on daily sleep than positive events.

The purpose of this study is to explore the effect of employment on depression and life satisfaction among old-aged. Using 12th (2017) wave and 13th (2018) wave of Korean Welfare Panel Study (KoWePS), three stages of analyses were conducted. First, through propensity score matching (PSM) method, sample with similar propensity scores was matched between the group that did not work in 12th wave but worked in 13th wave (experimental group, N=180), and the group that did not work in 12th and 13th wave (comparative group, N=180). Second, the matched sample was used to conduct multiple regression analysis with the group dummy variable (experimental group, comparative group) as an independent variable, and depression and life satisfaction as the dependent variables. Third, combined model of propensity score matching (PSM) and double difference (DD) method was conducted to more appropriately derive the net effect of employment. The results of multiple regression after propensity matching showed that employment had a positive effect on reducing depression (B= -1.70, p< .01) and increasing life satisfaction (B= .12, p< .01) in old-aged. Furthermore, in combined model of PSM and DD, life satisfaction was improved when employed compared to non-employed (B= .15, p< .05). The results of this study are meaningful in that the meaning of employment in old-aged is more clearly derived by solving selection bias and endogenous problems. Also, this study may provide reference for establishing welfare policies related to employment among old-aged.

Previous studies show that physical activity is beneficial for emotional well-being. This study extends prior research by examining whether engagement in physical activity moderates the association between daily stressor severity and daily emotional well-being. We used data from the second wave of the National Study of Daily Experiences, a sub-project of the Midlife in the United States (MIDUS) study. Respondents (N = 1,851; ages 33 to84) reported their daily experiences across eight consecutive days. Multilevel models explored concurrent and lagged interaction effects between daily stressor severity and physical activity on negative and positive affect and whether these associations differed by age. Physical activity was measured by engagement in vigorous physical activity for at least 30 minutes. Results showed significant interactions between stressor severity and physical activity on same-day negative and positive affect. Specifically, stressor severity was associated with smaller elevation in daily negative affect on physically active days (b = 0.08, p < 0.001) compared to non-active days (b = 0.11, p < 0.001). Reductions in daily positive affect were greater on physically inactive days (b = -0.11, p < 0.001) compared to active days (b = -0.08, p < 0.001). These associations did not differ by age, but additional findings revealed that stressor severity was associated with greater elevation in negative affect among younger respondents (b = 0.12, p < 0.001) than older adults (b = 0.10, p < 0.001). These results highlight the importance of engagement in physical activity for emotional well-being under stressful situations in daily context.

The present study aims to examine whether duration of sleep moderates the relationship between daily stressor severity and headache severity and test age differences in these associations. We used the second wave of the Midlife in the United States (MIDUS) study and its subproject, the National Study of Daily Experiences (N=1,590). Stress severity was measured based on the respondents’ perception of reported stressors, and headache severity was indicative of subjective rating of the symptom. Multilevel analysis results showed significant interaction effects between concurrent-day stressor severity and duration of sleep. Specifically, stressor severity was associated with more severe headache when people slept for shorter amount of time the same day. There were no differences by age in these associations. These results suggest that shorter-than-usual sleep may aggravate the intensity of headache on stressful days in daily life.

Glomerulonephritis associated with malignancy is deemed to be paraneoplastic glomerulonephritis. Myelodysplastic syndrome (MDS) is a group of heterogeneous clonal hematopoietic stem cell disorders characterized by impaired hematopoietic cell differentiation and cytopenia. The pathophysiology of MDS ...

BACKGROUND In vitro generation of red blood cells (RBCs) from hematopoietic stem cells (HSCs) has been reported, but the collection of 1 × 105 to 1 × 106 CD34+ cells present in cord and peripheral blood is too small for expansion to 1 × 1012 cells in 1 unit of RBCs. We transduced JAK2V617F gene, the most common mutation with polycythemia vera (PV), into cord blood–derived CD34+ cells. This PV model was expected to increase cell proliferation without the addition of erythropoietin (EPO) in early phase of differentiation. STUDY DESIGN AND METHODS Empty vector (control), wild-type JAK2 (wJAK2), and mutant JAK2V617F (mJAK2) were transduced into CD34+ cells using a lentivirus system. The CD34+ cells were then differentiated to the RBCs in a culture system. The cells were analyzed for cell number, differential count, and morphologic changes. Cultured RBCs were tested for oxygen equilibrium. RESULTS wJAK2- and mJAK2-transduced cells showed higher proliferation capacity until Day 21 than control cells; interestingly, only mJAK2-transduced cells were highly increased on Day 7 during EPO-free culture. However, both wJAK2- and mJAK2-tranduced cells had more delayed differentiation than control, but they had a higher portion of completely matured RBCs and orthochromatic erythroblasts. Furthermore, mJAK2-tranduced cells showed more differentiation into RBCs than wJAK2-transduced cells and they had a normal hemoglobin dissociation curve. CONCLUSION This is the first trial to use a PV erythropoiesis model for RBC differentiation from stem cells. The transduction of HSCs with mJAK2 increased their proliferation capacity in EPO-free culture conditions. This model may also be useful for investigating the pathogenesis of PV.

Background: The rationale for developing an alternative paclitaxel formulation concerns Cremophor EL-related side effects, and a novel paclitaxel delivery system might augment its therapeutic efficacy. Genexol-PM is a novel polymeric micelle formulated paclitaxel free of Cremophor. The polymeric micelle formulation is composed of hundreds of low molecular weight, non-toxic, and biodegradable amphiphilic diblock copolymers which include monomethoxy poly (ethylene glycol)-block-poly (D,L-lactide). This multicenter phase III study was designed to evaluate the non-inferiority of efficacy of Genexol-PM compared to conventional CrEL-based paclitaxel. Methods: In this phase III study, 213 patients were enrolled onto the study and randomly assigned (1:1) to treatment group according to prior recurrent or metastatic breast cancer chemotherapy. The study evaluated the objective response rate for the primary objective, and others including overall survival (OS), progression free survival (PFS), time to tumor progression (TTP), duration of overall response and adverse events. Eligible patients were randomly assigned to receive either Genexol-PM or standard paclitaxel. Genexol-PM or standard paclitaxel was administered on the first day of every 3 weeks. Measurable disease was assessed by imaging using the RECIST 1.0 criteria. Results: The objective response rate (ORR) was higher by the administration of the study drug (39.05% v 24.30% in ITT, 56.92% v 39.29% in PP). One-sided 95% upper confidence limit was -4.36%, which is lower than the non-inferiority threshold (7%), indicating that the study group is not inferior to the control group. OS, PFS, TTP and duration of overall response were analyzed in the ITT population. The analysis of OS showed no significant difference (p=0.5878) (859 days, 95% CI : 732.00∼1,025.00 v 726 days, 95% CI : 553.00∼ -). Median PFS periods were 232 days (95% CI: 164.00∼274.00) vs. 191 days (95% CI: 159.00∼237.00). Median TTPs were 233 days (95% CI: 165.00∼286.00) vs. 191 days (95% CI: 159.00∼241.00) between the groups. Difference in PFSs and TTPs between the groups were not statistically significant. (p=0.2407, 0.2076, respectively) Genexol-PM was not significantly different from the comparator in terms of safety. Conclusion: Genexol-PM demonstrated non-inferior efficacy and comparable safety profile compared with standard paclitaxel in this patient population. Of note, Genexol-PM permits the delivery of a higher paclitaxel dose without additional toxicity achieved with CrEL-based formulation. In the absence of CrEL, no filter or special tubing is required that conventional PVC infusion sets can be used. Citation Format: Jung Sil Ro, Joo Hyuk Sohn, Sung Bae Kim, Keun Seok Lee, Joo Seop Chung, Jae Hoo Park, Soo Hyeon Lee, Tae You Kim, Kyung Hae Jung, Eun Kyung Cho, Yang Soo Kim, Hong Suk Song, Jae Hong Seo, Hun Mo Ryoo, Sun Ah Lee, So Young Yoon, Chul Soo Kim, Yong Tai Kim, Hwa Jung Sung, Si Young Kim, Yong Jin Lee. A open-label, randomized, parallel, phase III trial to evaluate the efficacy and safety of Genexol®-PM compared to Genexol®(conventional paclitaxel with cremorphor EL) in recurrent or metastatic breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-10-04.

An alternative path for the preparation of triacetylcellulose (TAC) from unrefined biomass Palm Empty Fruit Bunch (EFB) has been found with environmental benefits. The method comprises separation and regeneration of cellulose from lignocellulosic biomass dissolved in ionic liquid BMIMCl, and also modification of cellulose to TAC. The triacetylcellulose with a degree of substitution of 2.93 was obtained by the reaction of acetic anhydride at 55。C with drastically reducing number of steps currently required to produce this derivative from raw materials itself. TAC was characterized using NMR analysis. The triacetate cellulose is typically used for the creation of fibers and film base.

The importance of oxazolidinone functional group has been well documented in synthetic and medicinal chemistry. In the latter area, recent interests are focused on N-arylsubstituted oxazolidin-2-one structures, as exemplified by linezolid and eperezolid, which represent a new class of antibacterials with activity against drug-resistant Grampositive pathogens, including MRSA. Biologically active enantiomers of the oxazolidinone antibacterials are those with the (S)-configuration. Synthesis of the (S)-enantiomers have been achieved in enantiopure form starting from various glycidol derivatives such as (R)-glycidyl butyrate, (S)and (R)-epichlorohydrin, N-Boc-glycidylamine, and more recently, (R)-glycidyl tosylate. Other enantiopure starting materials include 3-chloro-1,2-propanediol, mannitol, protected glyceraldehyde, and aziridine-2carboxamide. Several routes employing asymmetric reactions have also been reported. Of those enantiopure starting materials, epichlorohydrin and glycidyl tosylate are particularly useful as they are doubly activated (at both C-1 and C-3) toward nucleophilic substitutions. The tandem, three-step sequence of the epoxide ring-opening, carbamate formation and oxazolidin-2one ring-closure (sometimes referred to as “1,3-cycloaddition”) represents an atom-economic key step in the synthesis of oxazolidinone antibacterials (Scheme 1). Yu et al. first employed this process with epichlorohydrin as the starting material; we then followed it up with glycidyl tosylate, and showed that this crystalline and storage-stable compound was a viable starting material for oxazolidinone antibacterials. Our work with glycidyl tosylate reminded us how the issues of regioand stereochemistry were entwined together for the doubly activated glycidol derivatives. It also prompted us to wonder how these issues had played out in Yu’s work with epichlorohydrin. As the details were not discussed in their original communication, we decided to reexamine the tandem, three-step sequence with epichlorohydrin as the starting material. The 1,3-cycloaddition reaction of (R)-epichlorohydrin and phenyl isocyanate was performed with a catalytic amount of LiBr. In the absence of detailed experimental procedure in the original work, also to make a meaningful comparison with our findings with glycidyl tosylate, we maintained the reaction conditions as close as possible to the ones employed in the glycidyl tosylate process [in THF (0.067 M) at reflux with phenyl isocyanate (3 eq) and LiBr (0.1 eq)]. Epichlorohydrin underwent the tandem, three-step sequence more slowly with LiBr than glycidyl tosylate did with LiI. The reaction took 8 h to complete (vs ~30 min for glycidyl tosylate/LiI). The desired chloro oxazolidinone product was isolated in 93% yield, seemingly validating the results in the original report. A careful examination, however, revealed the presence of a by-product, suggesting concurrent sidereaction pathway(s) and potential complications in the process. In order to gain a fuller picture of the process, we postulated possible reaction pathways for the 1,3-cycloaddition reaction of epichlorohydrin/PhNCO/LiBr and set out to assess the significance of each pathway quantitatively (Scheme 2). Model reactions revealed that the products could undergo secondary displacements, not one-way, but in both ways, hence Paths IV and V in addition to Path III. This raised an extra issue for the epichlorohydrin process. In the glycidyl tosylate process, a single reaction pathway was responsible for the formation of the desired product, whose stereochemical integrity was therefore maintained through the entire course of the reaction. In the epichlorohydrin process, on the other hand, we now needed to consider multiple pathways for the formations of the desired as well as undesired products (Paths I, IV and V for 2; Paths II and III for 3), each resulting in a distinct stereochemical outcome. Significance of these pathways may be assessed in a time study in which the enantiomeric purities as well as the chemical yields of both products would be determined at various reaction times.

The use of systemic chemotherapy after resection remains controversial in patients with resectable metachronous pulmonary metastases from colorectal cancer (CRC). This retrospective study compared systemic chemotherapy with observation alone after resection of pulmonary metastases from CRC.Between 2001 and 2015, 91 patients with metachronous pulmonary metastases underwent curative surgical resection at five centers. Patients with stage IV at diagnosis were excluded. Overall survival (OS) was defined as the time from pulmonary resection until death. The disease-free interval (DFI) was defined as the time from pulmonary resection until recurrence or death.Among the 91 patients, 63 were in the chemotherapy group, while 28 were in the observation alone group. The characteristics were similar between the two groups, except for the carcinoembryonic antigen level after pulmonary metastases and the use of adjuvant treatment after resection of the primary tumor. With a median follow-up duration of 46 months (11-126), the estimated 5-year DFI and OS rates were 32.8 and 61.4%, respectively. The chemotherapy following pulmonary resection was not significantly associated with the DFI (p = 0.416) and OS (p = 0.119).Systemic chemotherapy after pulmonary resection was not found to have a significant effect on survival.

Nanostructured lipid carriers (NLCs) and chitosan-coated NLCs (CH-NLCs) were prepared by a combined double emulsion and melt dispersion method. The physicochemical properties of them were investigated to determine the optimum conditions. At 3% emulsifier concentration, the NLCs showed about 191.0 ± 4.1 nm mean particle size and low polydispersity index value compared to those observed under other conditions. The encapsulation efficiency of CH-NLCs was 83.9% which was about 10% higher than that of NLCs. In vitro release test showed that low release amount of iron from the NLCs (11%) and CH-NLCs (5%) in simulated gastric condition within 3 h, whereas the iron release amounts of the NLCs and CH-NLCs were high (over 77%) in simulated intestinal condition because both NLCs and CH-NLCs were totally destructed in the intestinal condition after 3 h. In the thiobarbituric acid test, the absorbance of milk-fortified NLC and CH-NLCs was lower than that of original milk. Based on these results, CH-NLCs showed great potential for iron fortification in milk.

137Cs was measured in soil samples collected in Korea from 2006 to 2008 using a low-level background gamma-ray spectrometer that was designed and developed by KRISS (Korea Research Institute of Standards and Science). The objectives of this study are to evaluate the newly developed low-level background gamma-ray spectrometer and, consequently, to provide information on the horizontal and vertical distribution of 137Cs in Korean soil. 137Cs concentrations in surface soil varied from 12.8 ± 0.9 to 108 ± 4 Bq kg−1, and the vertical profiles of 137Cs from the Nari basin in Ulleung Island in the East Sea/Sea of Japan and Seongsan Ilchulbong Peak, Jeju Island, showed a higher concentration in the surface layer that gradually decreased with depth. On the other hand, the 137Cs concentration in soil samples collected from Bukhan Mountain National Park in Seoul showed a subsurface maximum and decreased with depth. The 137Cs inventories in the soil column were calculated to be 1,830–4,360 Bq m−2 with a mean of 2,770 Bq m−2, which was the same order of magnitude as the global fallout inventories in the mid-latitude region of the Northern Hemisphere.

Based on the currently proposed algorithms, antibodies specificities (sp-ANAs) are identified mainly in samples positive for fluorescent antinuclear antibodies (FANA) screening tests. The purpose of the present study was to compare diagnostic performances of FANA and line immune assay (LIA) detecting 15 sp-ANAs in patients with systemic rheumatic diseases (SRD). In 948 sera from the patients with SRD (n = 590) and non-SRD (n = 358), we evaluated the fluorescent patterns and intensities in the FANA test, and compared the FANA results with sp-ANAs against nRNP, Sm, SS-A, Ro52, SS-B, Scl-70, PM/Scl, Jo-1, CENP B, PCNA, dsDNA, nucleosome, histone, ribosomal-P, and M2. The sensitivity and specificity was 75.9% and 52.5% of FANA test and 62.0% and 84.4% of sp-ANAs test for SRD detection. The overall agreement between FANA and sp-ANAs results was 69.2% (Kappa coefficient; 0.404). According to the clinical diagnosis, the levels of agreement varied from 33.3% to 83.1%. The positive predictive values of each FANA pattern for the detection of sp-ANAs were less than 50% except for the discrete speckled pattern (91.7%). The 1:100 intensity of FANA as well as the monoreactivity of LIA, anti-SSA(−)/anti-Ro52(+), or FANA(−)/sp-ANAs(+) was associated with non-SRD. Antibodies against ribosomal-P or PCNA were specific for systemic lupus eryhthematosus. This study highlights the need for careful interpretation of FANA test results to assess sp-ANAs and the application of sp-ANAs tests including less-common autoantibodies. In patients with clinical suspicion of SRD, screening with both FANA and sp-ANAs tests could improve diagnostic efficiency. J. Clin. Lab. Anal. 26:307-314, 2012. © 2012 Wiley Periodicals, Inc.

Objective: To evaluate the effectiveness of OROS® hydromorphone in reducing breakthrough pain (BTP) medication frequency in Korean patients with chronic cancer pain. Settings and Design: Multicenter, prospective, open-label, phase IV study. Participants: Patients with chronic malignant pain using immediate-release oxycodone more than two times per day for BTP. Interventions: Patients were stabilized on their ongoing drug for 3 days immediately before baseline measurements (day 0). Medication was changed to OROS® hydromorphone at a dose equianalgesic to oxycodone using a 2.5:1 controlledrelease oxycodone to hydromorphone hydrochloride conversion ratio; the patients were observed for 7 days. Dose was titrated, if required, and the patients were observed for another 7 days. Effectiveness and safety parameters were measured at baseline, day 7, and day 14. Main Outcomes: BTP medication frequency on days 7 and 14, compared to baseline. Results: Of the 141 patients screened, 114 received study drug and 98 completed the study. Compared to day 0, daily BTP medication frequency on day 14 decreased from 2.93 to 2.00 (p < 0.0001), daily BTP frequency decreased from 3.67 to 2.44 (p < 0.0001), and end-of-dose pain frequency decreased by 44 percent. Pain was controlled adequately during daytime and night-time. Pain intensity decreased by 11 percent as assessed using the Korean Brief Pain Inventory and by 17 percent as assessed using the numerical rating scale. About 61.2 percent patients and 60.2 percent physicians were satisfied with the treatment. Common adverse events, which occurred in 91.2 percent patients, were constipation, somnolence, and dizziness. Conclusion: Once-daily OROS® hydromorphone is efficient in the reduction of cancer pain-related BTP episodes, including end-of-dose pain.

Although 89% of older Korean adults have at least one chronic disease, most self-management interventions are clinic-based, delivered through face-to-face education, and highly focused on disease information. This pilot study developed and tested a mHealth protocol to empower older adults to manage their chronic diseases at home.

Since the discovery of the fact that compounds bearing a vinylic fluoride moiety often exhibit remarkable biological activities such as enzyme inhibitors, many synthetic methods for fluorine-substituted vinylic compounds have been developed. The synthesis of selectively fluorinated building blocks, such as arylsubstituted fluoro-alkenes, also has become an area of interest in recent years. Herein we describe a novel and practical method for the synthesis of 1,1-difluoro- and 1-fluoroalkenes starting from easily accessible trifluoroacetophenone derivatives. Various 1,1-difluoro- and 1-fluoroalkenes were prepared by the reaction of the corresponding tosyl hydrazones that were derived from trifluoroacetophenone derivatives by treating with alkyl or aryllithium reagents via addition-elimination and single electron transfer (SET) mechanism.

An efficient synthesis of 4-arylcoumarins has been accomplished via Kostanecki reactions of 2-hydroxybenzophenones with acetic anhydride employing DBU at ambient temperature. Using the same strategy, several 2-acyloxybenzophenone derivatives were readily converted to 3,4-difunctionalized coumarins. This protocol offers a notable improvement in reaction conditions for coumarin synthesis and takes advantage of its synthetic capability, especially for highly functionalized 4-arylcoumarins with structural diversity.

E-mail: kilee@krict.re.krReceived January 24, 2014, Accepted February 25, 2014Key Words : Asymmetric reduction, β-Chloro ketone, Borane, Spiroborate ester, DuloxetineSerotonin and norepinephrine neurotransmitters are intimatelyinvolved in a number of neurochemical and physiologicalprocesses, such as depression and pain disorders. Selectiveserotonin or norepinephrine reuptake inhibitors are theimportant class of antidepressants, such as fluoxetine, niso-xetine, tomoxetine, and duloxetine featuring the structuralsimilarity of 1-ary-3-aminopropanol.

In examining the dynamics between positive and negative experiences on health, previous studies suggest two possible pathways – the buffering hypothesis and blunting hypothesis. Buffering hypothesis suggests that positive experiences offset the harmful effects of negative experiences, while blunting hypothesis predicts that negative experiences will nullify the benefits of positive experiences. To test these hypotheses, this study examined interactions between daily positive events and daily stress severity on inflammation and whether the associations differ by age. Sample used were adults aged 34 to 82 (N = 597) from the Midlife in the United States Study Wave 2. Reports of respondents’ daily experiences of positive events and stress severity were used as predictors, and log-transformed interleukin-6 (IL-6) and C-reactive protein (CRP) were used as outcome variables. Results showed significant interaction between daily stress severity and daily positive events, with evidence supporting the blunting hypothesis. Specifically, daily positive events were associated with lower levels of IL-6 (b = -0.16, p < .01) and CRP (b = -0.27, p < .01) among adults with lower levels of stress severity, but not for those with high stress severity. Buffering hypothesis was not supported; that is, daily positive events did not attenuate the associations between daily stress severity and IL-6 or CRP. Age did not moderate the interaction between daily positive events and stress severity on inflammation. Findings suggest that with severely stressful experiences, the benefits of positive events on inflammation diminishes significantly among midlife and older adults.

Several imine species comprising N-sulfinyl and N-sulfonyl ketimine, oxime, and enamine derivatives were subjected to asymmetric transfer hydrogenation in an azeotropic mixture of formic acid/triethylamine. Among them, the Rh-catalyzed transfer hydrogenation of N-sulfonyl ketimine afforded the corresponding 1-arylalkylamines in excellent yield and with high enantioselectivity.

Background: Patient flow in a trauma center can be improved by multidisciplinary discharge rounds (MDR), but the content and logistics of MDR discussions have not been well quantified for purposes of improvement and adoption. We characterized the discussion content and time spent during MDRs and measured success rates in implementing communicated plans. Methods: Bedside MDRs in seven patient care units were observed during consecutive working days in a major academic trauma center. Patient: Discussions were timed and their content coded. Coding reliability was assessed with kappa statistics. Implementations of communicated plans were assessed during sequential working days. Results: MDRs over 23 days comprising 1,769 patient-discussions were observed. MDRs lasted a median of 34 minutes for a median of 78 patients. Kappa statistics for the discussions were 0.63 to 0.96. Each patient-discussion lasted a median of 13 seconds (range, 2 seconds-233 seconds), and 96% lasted less than a minute. Clinical topics were presented in 71.5%, new complications in 12%, discharge plans in 67%, surgical plans in 19%, and care advancement in 8% of them. Discussions >30 seconds duration were likely to contain exploration of care advancement, systems related, and clinical topics (p < 0.05). Advancement of care exploration correlated moderately with census of the trauma center (r = 0.53, p = 0.01). Ninety-four percent of the communicated plans were implemented with most delays caused by systems factors (82%). Conclusions: The short duration and goal-focused communication may have made MDRs sustainable. Given the benefits of successful implementation of communicated plans and previously demonstrated improved patient outcomes, time for MDRs is well spent.

This research aims at determining psychological elements that influence team coordination between a captain and a first officer in a commercial airline cockpit. It also examines how these elements interact between one another in different cultural settings. We propose that mutual inclusiveness of differential status enhances psychological safety and engagement in safety improvement efforts. Survey results based on 254 airline pilots suggest that status (captain, first officer) and mutual inclusiveness (openness between team members) influence psychological safety and mutual inclusiveness moderates the relationship between status and psychological safety. The results also suggest that psychological safety is positively associated with engagement in safety improvement efforts and also mediates the relationship between mutual inclusiveness and improvement efforts. This research provides insights into antecedents of fostering safety improvement efforts in airline crew teams in which cultural differences and professional hierarchy exist.

Primary retroperitoneal mucinous cystadenocarcinoma is a rare tumor. Only about 30 such cases have been reported in the worldwide literature, and a few Korean cases have been reported. The pathogenesis is not clear, and coelomic metaplasia of the retroperitoneal mesothelium has gained wide support. There is no consensus on the appropriate treatment, but surgical exploration is needed for the diagnosis and treatment, and adjuvant chemotherapy may be recommended following complete surgical excision. The long-term prognosis has not been established. We report here on a 32-year-old woman who was diagnosed as having a retroperitoneal mucinous cystadenocarcinoma with mural nodules of sarcomatoid change. Tumor excision and adjuvant chemotherapy were done and the patient is doing well without any evidence of recurrence at 42 months postoperatively.