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This study investigated the antidiabetic outcomes after gastrectomy with long-limb RY reconstruction (LRYR) and the prognostic factors for remission after 1 year in patients with type 2 diabetes (T2DM) and gastric cancer. In 25 Koreans with T2DM and gastric cancer, plasma glucose and insulin levels were measured during a 75 g oral glucose tolerance test, before and 1 week after gastrectomy with LRYR. Patients were examined after 1 year and we defined glycemic control as "remission" when the HbA1c level after 1 year was6.0% without medication. One year after surgery, 12 patients achieved HbA1c6.0% without medication. Among the preoperative indices, the duration of diabetes was shorter in the remission group than that in the non-remission group (median 2.0 [0-6.5] years vs 7.0 [4.5-10.0] years, P = .023). At 1 week after surgery, significant improvements in fasting, 30 minutes, 60 minutes, 90 minutes stimulated glucose levels and insulin resistance (HOMA-IR and Matsuda index) were found only in the remission group. The multivariable logistic regression analysis results showed that higher 30 minutes stimulated glucose level and HOMA-IR index at 1 week after surgery were independent factors for lower odds of 1-year diabetes remission. Shorter duration of diabetes and early postoperative improvements in 30 minutes stimulated glucose level and HOMA-IR were important determinants of long-term antidiabetic outcomes after gastrectomy with LRYR in patients with T2DM and gastric cancer.

Background: Amino acid metabolites (AAMs) have been linked to glucose homeostasis and type 2 diabetes (T2D). We investigated whether (1) baseline AAMs predict T2D remission 12 months after bariatric surgery and (2) whether AAMs are superior for predicting T2D remission postoperatively compared with existing prediction models. Methods: Among 24 participants undergoing bariatric surgery, 16 diabetes-related AAMs were quantified at baseline and postoperative 3 and 12 months. Existing prediction models included the ABCD, DiaRem, and IMS models. Results: Baseline L-dihydroxyphenylalanine (L-DOPA) (areas under receiver operating characteristic curves (AUROC), 0.92, 95% confidence interval (CI), 0.75 to 1.00) and 3-hydroxyanthranilic acid (3-HAA) (AUROC, 0.85, 95% CI, 0.67 to 1.00) better predicted T2D remission 12 months postoperatively than the ABCD model (AUROC, 0.81, 95% CI, 0.54 to 1.00), which presented the highest AUROC value among the three models. The superior prognostic performance of L-DOPA (AUROC at 3 months, 0.97, 95% CI, 0.91 to 1.00) and 3-HAA (AUROC at 3 months, 0.86, 95% CI, 0.63 to 1.00) continued until 3 months postoperatively. Conclusions: The AAM profile predicts T2D remission after bariatric surgery more effectively than the existing prediction models.

The Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) held its congress in Tokyo at the end of March, 2018, and representatives from Asia-Pacific countries presented the current status of bariatric/metabolic surgery in the “National Reports” session. The data are summarized here to show the current status and problems in the Asia-Pacific region in 2017. A questionnaire including data of 2016 and 2017 and consisting of eight general questions was prepared and sent to representatives in 18 Asia-Pacific countries by e-mail before the congress. After the congress, the data were analyzed and summarized. Seventeen of 18 countries responded to the survey. The frequency of obesity (BMI ≥ 30) in the 4 Gulf countries was > 30%, much higher than that in the other countries. In total, 1640 surgeons and 869 institutions were engaging in bariatric/metabolic surgery. In many East and Southeast Asian countries, the indication for bariatric surgery was BMI ≥ 35 or ≥ 37, whereas in many Gulf countries and Australia, it was BMI ≥ 40 or ≥ 35 with obesity-related disease. Ten of the 17 countries (58.8%) but only one of the 5 Southeast Asian countries (20.0%) had public health insurance coverage for bariatric surgery. In 2017, 95,125 patients underwent bariatric/metabolic surgery, with sleeve gastrectomy accounting for 68.0%, bypass surgery for 19.5%, and others for 12.5%. Current problems included public insurance coverage, training system, national registry, and lack of awareness and comprehension. This summary showed that bariatric/metabolic surgery is rapidly developing along with various problems in Asia-Pacific countries.

Summary: Background/Objective: The number of gastric cancer and type II diabetes mellitus is increasing in Korea. Metabolic surgery could be extended to gastric cancer patients with type II diabetes, especially those who are expected to achieve long-term survival. This study aimed to investigate change of diabetic status in patients undergoing long-limb Roux-en-Y bypass reconstruction compared with conventional Billroth II after curative gastrectomy. In total, 130 patients from five university hospital centers underwent long-limb Roux-en Y reconstruction after radical distal gastrectomy. Methods: In the long-limb group, the length of biliopancreatic limbs was more than 80 cm, and the length of the Roux limb was more than 80 cm. The control group comprised 96 patients who underwent conventional Billroth II reconstruction after distal gastrectomy. Follow-up data at three, six, nine, and 12 months were compared between the two groups. Results: Fasting blood sugar (FBS) and hemoglobin (Hb) A1c levels decreased more significantly in the long-limb Roux-en-Y group (FBS: 28.8 mg/dL; HbA1c: 0.72%). However, decreases in body mass index, albumin, and hemoglobin did not differ significantly between the two groups. Diabetes control significantly improved in the long-limb group. In multivariate analysis, long-limb bypass reconstruction was the significant factor for glycemic outcomes. Conclusion: Roux-en-Y bypass with increased length of limbs after gastrectomy shows a favorable glycemic control for gastric cancer patients with type II diabetes without nutritional deficit and anemia. To obtain future perspectives, large-scale prospective studies with long-term outcomes are needed. Keywords: Type II DM, Gastric cancer, Long limb Roux-en Y

Inorganic pyrophosphatase (PPase) catalyzes the hydrolysis of pyrophosphate to form orthophosphate. Pyrophosphate can substitute for ATP under certain circumstances. We previously conducted a proteomic analysis to investigate tumor-specific protein expression in gastric cancer, and PPase was identified as a potential gastric tumor-specific marker; it was therefore selected for further study. Clinicopathological analysis, using proteomic analysis and immunohistochemistry, was used to validate PPase as a prognostic marker in gastric cancers. Proteomic analysis showed that PPase was overexpressed in patients with lymph node (LN) metastases and high tumor node metastasis (TNM) stages (p < 0.05). Based on immunohistochemistry, patients whose tumors overexpressed PPase had higher T stages, LN metastasis, a higher TNM stage, a higher cancer recurrence rate, and shorter survival times than patients whose tumors exhibited PPase underexpression (p < 0.05). Gain-of-function and loss-of-function approaches were employed to examine the malignant phenotypes of PPase-overexpressing or PPase-depleted cells. A decrease in PPase expression caused a significant decrease in gastric cancer cell migration and invasion in vitro, whereas forced overexpression of PPase enhanced migration but not invasion. Our findings indicate that PPase is involved in gastric tumor progression and that PPase may be a useful marker for poor prognosis of human gastric cancers.

Purpose The impressive effect of LRYGBP on mildly obese patients (30 kg/m2 < BMI < 35 kg/m2) with T2DM raises the argument for lowering the threshold for surgical intervention to non-obesity (BMI < 30 kg/m2). The goal of this study was to evaluate the effect of gastrectomy on non-obese patients with T2DM and what preoperative clinical factors are associated with postoperative long term improvement. Methods In this retrospective review, we analyzed the change in diabetic status in 75 patients with gastric cancer undergoing three different gastrectomies in a single institution from June 1996 to September 2009. Pre- and postoperative fasting blood glucose, serum hemoglobin A1c and diabetic medication requirements were compared. The demographic data and other biochemical markers were also collected. Results At an average follow-up of 35.0 ± 25.9 months, we collected the data of 75 patients and evaluated the change of diabetes status. There was no resolution of diabetes in Billroth-I (B-I) group, and 45.2% of patients improved whereas the resolution rate of Billroth-II (B-II) and RY group was 22.2% and 23.5% and 85.2% and 88.2%, respectively. The improvement rate of diabetes mellitus (DM) status was 7.46 times higher in B-II than in B-I patients. The method of reconstruction is the most powerful factor and severity and duration of diabetes showed significant clinical factors for the improvement of the disease after surgery. Conclusion According to these results, foregut-bypass procedure may improve the type 2 DM better than can be explained by the effect of weight loss only. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years.

Purpose: In Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans. Methods: In this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery. Results: Body mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean ± standard deviation, 39.0 ± 6.2 vs. 34.3 ± 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%). Conclusion: Bariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

Backgrounds/Aims: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. Methods: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. Results: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p＜0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren"t any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p＜0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p＜0.001). Conclusions: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery. (Korean J Hepatobiliary Pancreat Surg 2011;15:225-230)

The design of micro speaker has been studied to improve to apply SMT to the connection of voice coil and micro speaker. Speaker is populated in PCB by SMT, and then connected to frame as one module. This makes it possible of precise population. sound pressure level(SPL) is same as previous, this improvement was confirmed SPL between 200Hz ~ 1KHz to use dual diaphragm composed of a polyether ether ketone, and the aluminum laminated film, and "Deep" phenomenon is remove in 8KHz bandwidth though smaller rectangular magnet is applied than previous circular magnet. The total harmonic distortion(THD) between 300Hz and 800Hz is improved within 10%, and also in low sound quality.

Purpose: Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 ㎏/㎡ in early postoperative period. Methods: Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 ㎎/㎗ of 75 g OGTT at 120 min or below 200 ㎎/㎗ at every other time in spite of over 200 ㎎/㎗ at 120 min. Results: A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 ㎏/㎡ and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 ㎎/㎗ to 125, 170, 200, 225 and 241 ㎎/㎗, respectively (P＜0.001). Only patients’ age was an independent factor resolution of T2DM based on this study. Conclusion: Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.

Purpose: Endoleak is a common complication following endovascular aortic aneurysm repairs (EVAR). The aim of this study was to discover the frequency and characteristics after EVAR with on-label use. Methods: A retrospective review was performed on 25 patients who underwent EVAR in Inha University Hospital between December 2005 and February 2009. The data included in this study accounted for patient characteristics, anatomic features, operative technical details, and types of devices used. The results of EVAR were analyzed for clinical success, technical success and endoleak. Results: Endoleaks were observed during 11 (47.8%) procedures. Type Ⅰ endoleaks were observed in 2 (18.2%) cases. A total of 6 type Ⅱ intraoperative endoleaks (54.5%) were observed. 3 type Ⅲ endoleaks (27.3%) occurred. But all endoleaks were resolved without additional intervention CT scan after 6 months. Conclusion: Although the endovascular management of AAAs is less invasive than open surgery, many complications including endoleak were still the most common adverse event during the first postoperative month. However, observation may be a good treatment for minor endoleak after EVAR.