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Recurrence after Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma: A Meta-analysis

  • Ye, J.Z.;Miao, Z.G.;Wu, F.X.;Zhao, Y.N.;Ye, H.H.;Li, L.Q.
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.1771-1777
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    • 2012
  • The impact of anatomic resection (AR) as compared to non-anatomic resection (NAR) for hepatocellular carcinoma (HCC) as a factor for preventing intra-hepatic and local recurrence after the initial surgical procedure remains controversial. A systematic review and meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990 to 2010 in PubMed and Medline, Cochrane Library, Embase, and Science Citation Index were therefore performed. Intra-hepatic recurrence, including early and late, and local recurrence were considered as primary outcomes. As secondary outcomes, 5 year survival and 5 year disease-free survival were considered. Pooled effects were calculated utilizing either fixed effects or random effects models. Eleven non-randomized studies including 1,576 patients were identified and analyzed, with 810 patients in the AR group and 766 in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis, more favorable hepatic function, and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group. Anatomic resection significantly reduced the risks of local recurrence and achieved a better 5 years disease-free survival. Also, anatomic resection was marginally effective for decreasing the early intra-hepatic recurrence. However, it was not advantageous in preventing late intra-hepatic recurrence compared with non-anatomic resection. No differences were found between AR and NAR with respect to postoperative morbidity, mortality, and hospitalization. Anatomic resection can be recommended as superior to non-anatomic resection in terms of reducing the risks of local recurrence, early intra-hepatic recurrence and achieving a better 5 year disease-free survival in HCC patients.

Diversity of Bacillus thuringiensis Strains Isolated from Citrus Orchards in Spain and Evaluation of Their Insecticidal Activity Against Ceratitis capitata

  • J.C., Vidal-Quist;Castanera, P.;Gonzalez-Cabrera, J.
    • Journal of Microbiology and Biotechnology
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    • v.19 no.8
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    • pp.749-759
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    • 2009
  • A survey of Bacillus thuringiensis (Berliner) strains isolated from Spanish citrus orchards has been performed, and the strains were tested for insecticidal activity against the Mediterranean fruit fly Ceratitis capitata (Wiedemann), a key citrus pest in Spain. From a total of 150 environmental samples, 376 isolates were selected, recording a total B. thuringiensis index of 0.52. The collection was characterized by means of phase-contrast microscopy, SDS-PAGE, and PCR analysis with primer pairs detecting toxin genes cry1, cry2, cry3, cry4, cry5, cry7, cry8, cry9, cry10, cry11, cry12, cry14, cry17, cry19, cry21, cry27, cry39, cry44, cyt1, and cyt2. Diverse crystal inclusion morphologies were identified: bipyramidal (45%), round (40%), adhered to the spore (7%), small (5%), and irregular (3%). SDS-PAGE of spore-crystal preparations revealed 39 different electrophoresis patterns. All primer pairs used in PCR tests gave positive amplifications in strains of our collection, except for primers for detection of cry3, cry19, cry39, or cry44 genes. Strains containing cry1, cry2, cry4, and cry27 genes were the most abundant (48.7%, 46%, 11.2%, and 8.2% of the strains, respectively). Ten different genetic profiles were found, although a total of 109 strains did not amplify with the set of primers used. Screening for toxicity against C. capitata adults was performed using both spore-crystal and soluble fractions. Mortality levels were less than 30%. We have developed a large and diverse B. thuringiensis strain collection with huge potential to control several agricultural pests; however, further research is needed to find out Bt strains active against C. capitata.

Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach

  • You, Yung Hun;Kim, Yoo Min;Ahn, Dae Ho
    • Journal of Gastric Cancer
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    • v.15 no.4
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    • pp.270-277
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    • 2015
  • Purpose: Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon. Materials and Methods: Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups. Results: MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity. Conclusions: This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon.

Effect of Body Mass Index on Global DNA Methylation in Healthy Korean Women

  • Na, Yeon Kyung;Hong, Hae Sook;Lee, Duk Hee;Lee, Won Kee;Kim, Dong Sun
    • Molecules and Cells
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    • v.37 no.6
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    • pp.467-472
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    • 2014
  • Obesity is known to be strongly associated with cardiovascular disease and cancer, the leading causes of mortality worldwide, and develops owing to interactions between genes and the environment. DNA methylation can act as a downstream effector of environmental signals, and analysis of this process therefore holds substantial promise for identifying mechanisms through which genetic and environmental factors jointly contribute to disease risk. Global DNA methylation of peripheral blood cells has recently been proposed as a potential biomarker for disease risk. Repetitive element DNA methylation has been shown to be associated with prominent obesity-related chronic diseases, but little is known about its relationship with weight status. In this study, we quantified the methylation of Alu elements in the peripheral blood DNA of 244 healthy women with a range of body mass indexes (BMIs) using pyrosequencing technology. Among the study participants, certain clinical laboratory parameters, including hemoglobin, serum glutamic oxaloacetic transaminase, serum glutamic- pyruvic transaminase, total cholesterol, and triglyceride levels were found to be strongly associated with BMI. Moreover, a U-shaped association between BMI and Alu methylation was observed, with the lowest methylation levels occurring at BMIs of between 23 and $30kg/m^2$. However, there was no significant association between Alu methylation and age, smoking status, or alcohol consumption. Overall, we identified a differential influence of BMI on global DNA methylation in healthy Korean women, indicating that BMI-related changes in Alu methylation might play a complex role in the etiology and pathogenesis of obesity. Further studies are required to elucidate the mechanisms underlying this relationship.

Gender Differences in Hypertension Control Among Older Korean Adults: Korean Social Life, Health, and Aging Project

  • Chu, Sang Hui;Baek, Ji Won;Kim, Eun Sook;Stefani, Katherine M.;Lee, Won Joon;Park, Yeong-Ran;Youm, Yoosik;Kim, Hyeon Chang
    • Journal of Preventive Medicine and Public Health
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    • v.48 no.1
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    • pp.38-47
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    • 2015
  • Objectives: Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients' attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. Methods: This cross-sectional study analyzed data from 653 Koreans aged ${\geq}60years$ who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. Results: Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one's blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). Conclusions: This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.

The Effects of Lead(II) Nitrate on the Embryo Development in Native Amphibians (질산납이 한국산 무미양서류의 배아발달에 미치는 영향)

  • Lee, Hae-Bum;Ko, Sun-Kun
    • Korean Journal of Environmental Biology
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    • v.35 no.4
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    • pp.706-714
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    • 2017
  • An investigation of the effects of Pb for domestic anuran embryos were evaluated with the Frog Embryo Teratogenesis Assay; Xenopus (FETAX). Depending on the species, the difference between the embryo size and the embryonic development time was determined. As a result, mortality and malformation rates were increased, malformation patterns were changed and larval body length were decreased in a dose dependent manner of the Pb. The half maximal lethal concentration ($LC_{50}$) of the Bufo gargarizans, Hyla japonica, Rana nigromaculata and Bombina orientalis were 0.58, 0.49, 0.52, $0.54mg\;L^{-1}$, respectively. The half maximal effective concentration ($EC_{50}$) of the Bufo gargarizans, Hyla japonica, Rana nigromaculata and Bombina orientalis were 0.35, 0.74, 0.30, $0.29mg\;L^{-1}$, respectively. The teratogenic index (TI) were 1.66 in the Bufo gargarizans, 1.81 in the Hyla japonica, 1.73 in the Rana nigromaculata and 1.86 in the Bombina orientalis, respectively. Therefore, the Pb seems likely to have a teratogenic effect in all four species' embryonic development. The Bombina orientalis was the most sensitive to the Pb. This means that the difference between the different species, even if they have all been exposed to the same concentration of pollutants depending on the species. The result above show that the Pb acts as a teratogenic agent in the development of the four domestic frog species.

Experiences of thoracic esophagectomy with laparoscopic gastric pull up in thoracic esophageal cancer patient in single center

  • Jun, Jin-Woo;Kim, Wooshik;Park, Jong-Min
    • Korean Journal of Clinical Oncology
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    • v.14 no.2
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    • pp.95-101
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    • 2018
  • Purpose: The standard treatment of esophageal cancer is the Ivor-Lewis operation, which consists of an abdominal phase involving gastric tube formation, and a chest phase involving esophagectomy and anastomosis. We aimed to report our experience of performing thoracic esophagectomy with the laparoscopic gastric pull up (LGPU) technique and its surgical outcomes. Methods: Clinicopathologic data and short-term surgical outcomes of 14 patients who underwent LGPU for thoracic esophageal cancer from August 2008 to May 2016 were retrospectively reviewed. Results: Mean age of the patients was 62.3 years and mean body mass index was $21.7kg/m^2$. Eleven patients had medical comorbidities. Patients' mean American Society of Anesthesiologists score was 2. Mean operation time was 428.5 minutes, with the mean abdominal operation time being 138.9 minutes. There was no open conversion case. Three patients had pneumonia, three patients had surgical site infection, and one patient had subcutaneous emphysema within 30 days after surgery. One patient had minor anastomosis site leakage. There was one 30-day mortality case. One patient with postoperative aspiration pneumonia developed acute respiratory distress disease, and died due to sepsis. Mean postoperative intensive care unit stay was 3.5 days, and mean postoperative hospital stay was 20.6 days. Nasogastric tubes were removed on average at 3.4 days, and mean oral intake time was 3.4 days. Conclusion: If the gastrointestinal surgeon has extensive experience in laparoscopic procedures, LGPU will be a safe and feasible technique for thoracic esophagectomy in patients with intrathoracic esophageal cancer.

Endovascular Treatment for Arterioureteral Fistula of the Abdominal Aorta: A Case Report and Literature Review (복부 대동맥에 발생한 동맥-요관 누공의 혈관 내 치료: 증례 보고와 문헌고찰)

  • Hyoung Nam Lee;Woong Hee Lee
    • Journal of the Korean Society of Radiology
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    • v.81 no.4
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    • pp.953-957
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    • 2020
  • We present a rare case demonstrating successful endovascular management of an arterioureteral fistula involving the abdominal aorta. Arterioureteral fistulas are rare but life-threatening, with mortality rates ranging from 7% to 23%. Early recognition and prompt management are essential for preventing catastrophic consequences, including hypovolemic shock. However, recognition of an arterioureteral fistula requires a high index of clinical suspicion due to its rarity and the lack of a sensitive diagnostic method. Arterioureteral fistulas could be induced by traumatic events in patients who have a history of pelvic surgery, radiation, and prolonged placement of a ureteral stent. Endovascular stent graft placement could be a valid treatment option for arterioureteral fistulas involving the abdominal aorta.

The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients (외상환자의 전산화 단층촬영소견에서 나타난 달무리 소견의 임상적 유용성)

  • Lee, Seung Yong;Sohn, You Dong;Ahn, Hee Cheol;Kang, Gu Hyun;Choi, Jung Tae;Ahn, Moo Eob;Seo, Jeong Youl
    • Journal of Trauma and Injury
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    • v.20 no.2
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    • pp.144-148
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    • 2007
  • Purpose: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. Methods: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS ${\geq}$ 5. Results: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. Conclusion: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.

A Study on Relationship to Risk Factors according to Menopausal Status in Breast Cancer (유방암 환자에 있어서 폐경상태에 따른 위험인자의 상관성 연구)

  • Yoon, Han-Sik
    • Journal of radiological science and technology
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    • v.23 no.1
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    • pp.49-54
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    • 2000
  • It is important to identify modifiable risk factors for breast cancer, because the breast cancer is one of the major causs of mortality among women. Some reported that obesity is a risk factor for breast cancer, but the results are not constant. Many risk factors are related to the duration of estrogenic stimulation of the breast. In general, early menarche and late menopause are positive risk factors. Human breast cancer has different characteristics according to the status of menopause(premenopause and postmenopause). In premenopausal women, about 60% of circulating estrogen is from the ovaries in the form of estradiol, and the remaining 40% is estrogen formed primarily in the adipose(fat) tissue via aromatization of androstenedion from the adrenal glands. After menopause this adipose cell production of estrone is the main source of estrogens and the level of estrone is maintained approximately at premenopausal levels. This study was undertaken to determine the role of body size and body mass index by status of menopause in development of breast cancer using retrospective case/control study. From March 1991 to February 1997 at the Wonkwang University Hospital, the breast cancer cases(n=72) and controls(n=86) were selected. By statistical analysis method, regression analysis, paired T-test and multiple logistic regression were done to estimate the influenced factors same as height, weight, BMI, age at menarche and age at menopause. The following results were obtained : 1. In premenopausal women, age at menarche was showed comparatively high correlation coefficients and BMI was described prominently highly in postmenopause. 2. At the results of multiple regression analysis, age at monarch, BMI and weight were showed as significant variables. In this method, critical factor ($R^2$) was 0.054. 3. Paired samples T-test was undertaken to test mean difference between two groups of cases and controls. The result of test performance showed a significant difference. 4. In comparison with women whose weight less than 50 kg, the ORs for the upper 5th group was 1.82(95% confidence interval). The heaviest women had a higher risk(OR=1.14, 95% confidence interval $1.12{\sim}1.31$, p=0.005). Higher body mass index was significantly associated with increased risk of premenopausal breast cancer (OR=1.01, 95% confidence interval $1.08{\sim}l.18$, p=0.05).

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