Protective Effect of Proton Pump Inhibitor for Survival in Patients with Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis

BACKGROUND/AIMS

The prevalence of gastroesophageal reflux disease (GERD) is high in patients with idiopathic pulmonary fibrosis (IPF). GERD may cause chronic microaspiration that leads to repeated subclinical lung injury, which leads to pulmonary fibrosis. Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear.

METHODS

We retrospectively reviewed 786 consecutive adult patients with IPF at Seoul National University Bundang Hospital between April 2003 and March 2015.

RESULTS

Mean duration of follow-up was 2.6 ± 2.8 years. Of the 786 patients with IPF, 107 (13.6%) were given diagnoses of GERD, and 103 (13.1%) died due to IPF-related pneumonia or respiratory failure. The prevalence of GERD and the cumulative incidence of de novo GERD increased depending on the period of follow-up in patients with IPF. Patients administered PPI for more than four months had a lower IPF-related mortality rate than patients on PPI less than 4 months (Log-rank P -value = 0.024 in Kaplan-Meier curve). In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality.

CONCLUSIONS

In Korean patients with IPF, the prevalence of GERD was lower than in other countries. PPI use for at least 4 months may have a protective effect against IPF-related mortality.

Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

Background/Aims

In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings.

Methods

In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR.

Results

The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings.

Conclusions

In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types.

Clinical Features and Outcomes of Patients With Genotype 3 Hepatitis C Virus Infection in Korea: A Retrospective Observational Study

Hepatitis C virus (HCV) genotype 3 infection is very rare in high-income Asia Pacific. The aim of our retrospective observational study was to evaluate the incidence, clinical features, and treatment outcomes of patients with a genotype 3 HCV infection in the Gyeongnam Province of Korea. Ninety-eight consecutive patients diagnosed with a genotype 3 HCV infection at Gyeongsang National University Hospital, between January 2005 and December 2014, were enrolled into the study. Relevant characteristics of the study group included: 80.6% men, mean age of 41.8 years, and including 69 patients with chronic hepatitis, 25 with liver cirrhosis, and 4 with hepatocellular carcinoma (HCC). Risk factors for HCV infection, sustained virologic response rate, development of HCC, and mortality in patients with genotype 3 were retrospectively analyzed.Among all patients diagnosed with a HCV infection during the study period, the prevalence of genotype 3 was 7.3%. The incidence of genotype 3 was higher in young patients with a risk factor of IVDU (54.0%) and tattooing (62.3%). Among 45 treatment-naive genotype 3 patients, sustained virologic response was achieved with a combination of pegylated-interferon alpha and ribavirin in 75.6%. The cumulative 5-year incidence of HCC was 13.6%, and 8.9% for overall mortality. Liver cirrhosis at enrollment was an independent risk factor for HCC development.This is the first study to elucidate the clinical features and outcomes among the patients with HCV genotype 3 infection in Korea. Further prospective studies are needed to investigate transmission routes and outcomes for HCV genotype 3 infections.

Hepatitis C and not Hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury

BACKGROUND

The risk of anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic viral hepatitis (CVH) is not clear. The aim of this study was to investigate incidence and risk factors associated with TB DILI in CVH and non-CVH patients.

METHODS

Retrospectively, a total of 128 CVH patients who received anti-TB medication from January 2005 to February 2014 were reviewed. Among these, 83 patients had hepatitis B virus (HBV), 41 patients had hepatitis C virus (HCV) and 4 patients were dual hepatitis B and hepatitis C virus co-infected (HBV + HCV) with 251 non-CVH patients who received anti-TB medication selected as the controls. There were no human immunodeficiency virus co-infected patients. Risk factors for DILI were analyzed using cox regression analysis.

RESULTS

The incidence of DILI was significantly higher in the HCV group (13/41 [31.7%], p < 0.001) and HBV + HCV groups (3/4 [75.0%], p = 0.002) compared to the control group (25/251 [10.0%]). The incidence of transient liver function impairment in the hepatitis B virus group was higher than in the control group (18/83 [21.7%] vs. 27/251 [10.8%] p = 0.010), but not in DILI (11/83 [13.3%] vs. 25/251 [10.0%], p = 0.400). In total patients, HCV, HBV + HCV co-infection, older age, and baseline liver function abnormality were independent factors of DILI.

CONCLUSIONS

It is recommended to carefully monitor for DILI in patients with HCV or HBV/HCV co-infection, older age, and baseline liver function abnormality.

Early monitoring for detection of antituberculous drug-induced hepatotoxicity

BACKGROUND/AIMS

We investigated the time of onset of antituberculous drug-induced hepatotoxicity (ADIH) and related characteristics.

METHODS

Adult patients (n = 1,031) treated with first-line antituberculous drugs between February 2009 and January 2013 were enrolled.

RESULTS

Of the 1,031 patients, 108 patients (10.5%) developed ADIH a mean of 39.6 ± 43.7 days after treatment initiation. Twenty-eight patients (25.9%) developed ADIH within 7 days, 73 (67.6%) within 30 days, and the rest after 30 days. The ≤ 30-day group was characterized by higher peak alanine aminotransferase (ALT) level and a high proportion of patients with maintenance of first-line antituberculous drugs compared to the > 30-day group. In subgroup analysis, the ≤ 7-day group was characterized by higher baseline aspartate aminotransferase and ALT, high proportion of patients with maintenance of first-line antituberculous drugs, and high proportion of patients with extrapulmonary tuberculosis compared to patients with ADIH that developed beyond 7 days. In multivariate analysis, serum ALT > 40 IU/L (odds ratio [OR], 2.995; 95% confidence interval [CI], 1.580 to 5.680; p = 0.001) and presence of anti-hepatitis C virus (OR, 4.204; 95% CI, 1.822 to 9.700, p = 0.001) were independent risk factors for development of ADIH.

CONCLUSIONS

Approximately 70% of the cases of ADIH occurred in the first month of antituberculous treatment, and were associated with continuation of the first-line drug regimen.

Adequate Dextran Sodium Sulfate-induced Colitis Model in Mice and Effective Outcome Measurement Method

Background:

Dextran sodium sulfate (DSS)-induced colitis mouse model is used for research of inflammatory bowel disease. The aim of this study was to establish the adequate conditions for DSS mice model, and to find useful tool to measure inflammation.

Methods:

The 2.5% DSS was administered to six male C57BL/6 mice and 4% DSS to eight mice at 5 or 9 weeks of age. Each group was consisted of 6 mice with control group in which vehicle was administered instead of DSS. The mice were sacrificed on the 7th day after DSS or vehicle administration. Body weight, diarrhea, and hematochezia were recorded daily. Disease activity index (DAI) score which was composed of body weight change, diarrhea, and hematochezia was measured every day. Colon length was measured after sacrifice and colon mucosal level of interleukin 1 beta (IL-1β) was measured by ELISA assay. Histological score was compared between ascending and descending colon in the DSS group.

Results:

Colon length of five- and nine-week DSS group was significantly shorter than each control group but there was no statistical significance depending on DSS concentration or age. DAI score of 4% DSS group in nine-week was significantly higher than that five-week (P = 0.012) but there was no difference between 2.5% and 4% DSS group. The level of IL-1β in DSS mice was much higher than control group (P < 0.01), but there was no difference among several DSS groups. The histological score was higher in the descending colon than in the ascending colon but there was no statistical difference between each pair of DSS groups.

Conclusions:

The 4% DSS mice in nine-week was adequate for DSS-induced colitis model. DAI score was useful tool and descending colon was more appropriate site for histological evaluation of colitis than ascending colon.

The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE

It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism.

MATERIALS AND METHODS

Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertal patients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score.

RESULTS

Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5.

CONCLUSIONS

Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

The uncovering of ESE-1 in human neutrophils: implication of its role in neutrophil function and survival

Epithelium-specific Ets transcription factor 1 (ESE-1) is a member of the E26 transformation-specific family of transcription factors that has an epithelial-restricted constitutive expression but is induced by inflammatory stimuli in non-epithelial cells. Here we report that ESE-1 is constitutively expressed in human, but not in murine, neutrophils and that ESE-1 is modestly upregulated in septic patient neutrophils. In normal human neutrophils, ESE-1 was detected at both RNA and protein levels but was found to be an unstable nuclear protein ex vivo. ESE-1 transcription was also induced during all-trans retinoic acid-mediated HL-60 differentiation, a human promyelocytic cell line often used as an in vitro model of human neutrophils. Elf3-/- mice had normal neutrophils but a reduced number of circulating B-lymphocytes. These findings indicate a potential role of ESE-1 in regulating human neutrophil differentiation and function, and that it has different roles in the immune system of different species.

Current status and scope of lymph node micrometastasis in gastric cancer

Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node micrometastasis remains debatable, its clinical impact is apparently remarkable in both early and advanced gastric cancer. At present, studies on the prognostic value of lymph node micrometastasis are evolving to overcome its current limitations and extend the scope of its application.

The prognostic factors and the cause of death in patients with advanced or recurrent gastric cancer

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Background: The purpose of this study is to evaluate significant prognostic factor and compare the cause of death in patients with advanced or recurrent gastric cancer. Methods: We reviewed the medical records of 170 patients who had been diagnosed as advanced or recurrent gastric cancer between January 2006 and September 2013. The patients were divided into two groups. One group (advanced gastric cancer: AC) included 104 patients had undergone chemotherapy for advanced gastric cancer, and the other group (recurrent gastric cancer: RC) 66 for recurrence after surgical treatment. The causes of death and overall survival were compared between two groups, and the significant prognostic factors were investigated by multivariate analysis. Also, subgroup analysis was performed for 18 patients with gastrectomy for curative intent, and they were proved to have unresectable gastric cancer after surgery (non-palliative surgery for advanced gastric cancer: NS). Results: In the comparison for the causes of death, two groups showed no statistical difference, but AC group had more tendency to die because of bleeding ( p = 0.054) and infection ( p = 0.075). Overall survival of AC group did not differ from that of RC ( p = 0.901). In multivariate analysis, bone metastasis ( p = 0.013, HR = 1.923), peritoneal seeding ( p = 0.001, HR = 2.182) and the frequency of chemotherapy ( p < 0.001, HR = 0.887) were significantly associated with the overall survival. In a subgroup analysis, the overall survival of NS was significantly higher than AC ( p = 0.032). Conclusions: In the patients with advanced or recurrent gastric cancer, AC might have more possibility to die because of bleeding and infection than RC. Additionally, the prognosis of patients with advanced or recurrent gastric cancer was affected by the presence of bone metastasis, peritoneal seeding and frequency of chemotherapy. Non-palliative surgery for gastric cancer might show the better prognosis than AC in the specific conditions.

Primary gastric malignant melanoma mimicking adenocarcinoma

We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.

Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience

BACKGROUND

The aim of the present study was to evaluate the feasibility of laparoscopic completion total gastrectomy (LCTG) in patients with remnant gastric cancer.

METHODS

Patients who underwent completion total gastrectomy for remnant gastric cancer between May 2003 and December 2012 were divided into two groups: an open completion total gastrectomy (OCTG) group and an LCTG group. Clinicopathological data, operative data, and patient survival rates were analyzed.

RESULTS

Thirty-four remnant gastrectomies (17 OCTG and 17 LCTG) were performed. The mean time interval between the prior gastrectomy and the remnant gastrectomy was 17.2 years, and benign disease showed a longer time interval than malignancy (30.9 vs. 8.1 years; p < 0.0001). LCTG required a longer operation time than OCTG (234.4 vs. 170.0 min; p = 0.002); however, there were no significant differences in the estimated blood loss, the number of retrieved lymph nodes, the time to first flatus passage, the length of hospital stay, complication rates, and postoperative analgesia between the two groups. Eight patients (47.1%) required conversion to open surgery during LCTG. The median overall survival was 69.1 months. There was no difference in 5-year survival between the two groups (p = 0.085).

CONCLUSION

LCTG was technically feasible; however, it showed no definitive clinical advantage over OCTG.

Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach

Minimally invasive surgery has become common in the surgical resection of gastrointestinal submucosal tumors (SMTs). The purpose of this article is to review recent trends in minimally invasive surgery for gastric SMTs. Although laparoscopic resection has been main stream of minimally invasive surgery for gastrointestinal SMTs, recent advances in endoscopic procedures now provide various treatment modalities for gastric SMTs. Moreover, investigators have developed several hybrid techniques that include the advantages of both laparoscopic and endoscopic procedure. In addition, several types of reduced port surgeries, modification of conventional laparoscopic procedures, have been recently applied to the surgical resection of SMTs. Meanwhile, robotic surgery for SMTs requires further evidence and improvement.

Should lymph node micrometastasis be considered in node staging for gastric cancer?: the significance of lymph node micrometastasis in gastric cancer

BACKGROUND

In TNM staging system, lymph node staging is based on the number of metastatic lymph nodes in gastric cancer and micrometastasis is not considered. Several reports proposed the importance of lymph node micrometastasis as the causative factor for recurrence and poor survival, but it remains controversial among researchers.

METHODS

A total of 482 gastric cancer patients who underwent curative resection from 2004 to 2010 at Korea University Medical Center Ansan Hospital, South Korea were prospectively enrolled. For detecting lymph node micrometastasis, immunohistochemical staining with anti-cytokeratin antibody (CAM 5.2) was performed on negative lymph nodes by hematoxylin-eosin (H-E) staining. Survival differences were compared between conventional node staging and new node staging that took micrometastasis into consideration. Also, the prognostic value of lymph node micrometastasis was investigated in multivariate analysis.

RESULTS

A total of 156 patients (32.4%) showed lymph node micrometastasis. Overall, the micrometastatic group had more advanced tumor and lymph node stage, lymphovascular cancer cell invasion, a higher rate of recurrence, and poor survival. Furthermore, when the cumulative numbers of macro- and micrometastatic lymph nodes were calculated together, the discriminative power of survival difference between each node stage became more stratified. Also, multivariate analysis using Cox's proportional hazards model demonstrated perineural invasion, pathologic T stage, dissected lymph nodes, macro- and micrometastatic lymph nodes are independent prognostic factors.

CONCLUSIONS

Lymph node micrometastasis was clinically significant as a risk factor for recurrent gastric cancer. Lymph node micrometastasis should be considered when estimating TNM stage for determining prognosis and the best treatment strategy.

Length of negative resection margin does not affect local recurrence and survival in the patients with gastric cancer

AIM: To investigate the influence of the resection margin on local recurrence and survival in gastric cancer patients.

METHODS: We reviewed the medical records of 1788 patients who had undergone gastrectomy for gastric cancer at the Seoul National University Bundang Hospital, South Korea, between May 2003 and July 2009. The patients were divided into early and advanced gastric cancer groups. In each group, we analyzed the relationship between clinicopathologic factors and survival outcomes, and compared the hazard rates of event occurrence between patients with resection margins above and below the cut-off value, using a Cox proportional hazard model.

RESULTS: The early and advanced gastric cancer groups included 1001 and 787 patients, respectively. The hazard rates of event occurrence did not significantly differ between the patients with resection margins above the cut-off value and those with resection margins below the cut-off value (P > 0.05, in all comparisons). Based on the multivariable analyses, the proximal and distal resection margins were not significantly associated with survival outcomes and local recurrence (P > 0.05, in all analyses).

CONCLUSION: The proximal or distal resection margins did not affect the prognosis of patients with gastric cancer if the margins were pathologically negative.

Monotherapy with tacrolimus for heart and liver transplant: a case report

BACKGROUND

Multiple-organ transplantation cases are rare, partly due to the shortage of donor organs. However, recent reports of outcomes of multiple-organ transplantations show encouraging survival rates for recipients as compared to single-organ transplant recipients.

CASE REPORT

A 33-year-old female who was a known hepatitis B carrier and who had been diagnosed with peripartum dilated cardiomyopathy was experiencing end-stage heart failure. The patient received orthotopic heart transplantation. After heart transplantation, the recipient received prednisolone, cyclosporine, and mycophenolate mofetil for immunosuppressive therapy. Seventy-one days later, the recipient began to develop progressive jaundice, ascites, and hepatoencephalopathy and was re-admitted to the hospital. Fulminant hepatitis was diagnosed. She was referred for emergency cadaveric liver transplantation 110 days after the heart transplantation because of her critical condition. After transplantation, she was improved and her condition maintained by a single immunosuppressive therapy, tacrolimus, with mean dose of 0.06 mg/kg/d.

CONCLUSION

We presented a case that was complicated by fulminant hepatitis after heart transplantation and successfully rescued by liver transplantation.

Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog

A seven-month-old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors' knowledge, this case represents the first report of such a pulmonary anomaly in a dog.

Effects of White Radish (Raphanus sativus) Enzyme Extract on Hepatotoxicity

Raphanus sativus (Cruciferaceae), commonly known as radish is widely available throughout the world. From antiquity it has been used in folk medicine as a natural drug against many toxicants. The present study was designed to evaluate the hepatoprotective activity of radish (Raphanus sativus) enzyme extract (REE) in vitro and in vivo test. The IC50 values of REE in human liver derived HepG2 cells was over 5,000 μg/ml in tested maximum concentration. The effect of REE to protect tacrine-induced cytotoxicity in HepG2 cells was evaluated by MTT assay. REE showed their hepatoprotective activities on tacrineinduced cytotoxicity and the EC50 value was 1,250 μg/ml. Silymarin, an antihepatotoxic agent used as a positive control exhibited 59.7% hepatoprotective activitiy at 100 μg/ml. Moreover, we tested the effect of REE on carbon tetrachloride (CCl4)-induced liver toxicity in rats. REE at dose of 50 and 100 mg/kg and silymarin at dose of 50 mg/kg were orally administered to CCl4-treated rats. The results showed that REE and silymarin significantly reduced the elevated levels of serum enzyme markers induced by CCl4. The biochemical data were supported by evaluation with liver histopathology. These findings suggest that REE, can significantly diminish hepatic damage by toxic agent such as tacrine or CCl4.

Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

PURPOSE

Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer.

MATERIALS AND METHODS

A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated.

RESULTS

Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula.

CONCLUSIONS

Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.

Coupling of air/metal and substrate/metal surface plasmon polaritons in Au slit arrays fabricated on quartz substrate

We report on the coupling of the air/metal mode and the substrate/metal mode surface plasmon polaritons in one-dimensional metallic slit arrays fabricated on a dielectric substrate. Anti-crossing is exhibited at an incident angle where the two independent modes can be resonantly excited at a specific wavelength. The size of the anti-crossing gap was measured while changing the metal thickness.

Laparoscopic gastrectomy for gastric cancer with simultaneous organ resection

OBJECTIVES

Simultaneous organ resection is performed in 10% of laparoscopic gastrectomies for gastric cancer. The purpose of this study is to investigate the feasibility and safety of simultaneous organ resection with laparoscopic gastrectomy for gastric cancer.

SUBJECTS AND METHODS

We retrospectively reviewed the medical records from a prospectively collected database of patients who underwent laparoscopic gastrectomy from May 2003 to April 2012 in a single center. The patients were classified into three groups: a gastrectomy-only (no simultaneous resection [NS]) group as a control, a combined resection (CB) group characterized by additional resection due to tumor invasion and extensive lymphadenectomy, and a concomitant resection (CC) group, including patients with other pathologic conditions. The clinical outcomes, in particular morbidity and mortality, were compared among the three groups.

RESULTS

The NS, CB, and CC groups included 1883 (90.1%), 66 (3.2%), and 140 (6.7%) patients, respectively. Mean operation time was longer in CB and CC patients than in NS patients (233.0 ± 59.3, 227.4 ± 100.9, and 180.1 ± 54.0 minutes, respectively; P<.001), and mean hospital stay was longer in the CB and CC groups than in the NS group (9.6 ± 5.2, 8.3 ± 4.7, and 6.9 ± 4.4 days, respectively; P<.001). However, there were no statistically significant differences among the groups in the incidence of complications (P=.185), complications more severe than grade II (P=.077), and mortality (P=1.000).

CONCLUSIONS

Laparoscopic simultaneous organ resection during laparoscopic gastrectomy for gastric cancer prolonged the operation time and hospital stay but did not increase morbidity and mortality.

Laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for advanced gastric cancer with isolated para-aortic lymph node metastasis

Prophylactic para-aortic lymphadenectomy is not recommended in curable advanced gastric cancer. However, there are few reports on therapeutic para-aortic lymphadenectomy after palliative chemotherapy in far advanced gastric cancer. We report three cases of laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for the first time in Korea. Three gastric cancer patients with isolated para-aortic lymph node (PAN) metastasis showed partial response to capecitabine-based chemotherapy, and laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy was performed with curative intent. The mean total operation time was 365 minutes (range, 310 to 415 minutes), and the mean estimated blood loss was 158 mL (range, 125 to 200 mL). The mean number of retrieved PAN was 9 (range, 8 to 11), and all pathologic results showed no metastasis of para-aortic region. All patients recovered and were discharged without any significant complications.

Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey

SUMMARY

The association between secondhand smoke (SHS) exposure and lumbar and femoral neck osteoporosis was assessed in postmenopausal never-smoking Korean women. The presence of family members who actively smoked was associated with femoral neck osteoporosis. The number of cigarettes consumed by cohabitant smokers was positively associated with lumbar and femoral neck osteoporosis.

INTRODUCTION

This study aimed to assess the association between SHS and postmenopausal osteoporosis.

METHODS

Of 2,067 postmenopausal women (age, ≥55 years) participating in the Fourth Korea National Health and Nutrition Examination Survey, 925 never-smokers identified through interviews and urinary cotinine level verification were enrolled. Cross-sectional relationships between self-reported SHS exposure and osteoporosis of the lumbar vertebrae and femoral neck (defined using the World Health Organization T-score criteria) were investigated by bone densitometry.

RESULTS

Participants having actively smoking family members showed increased adjusted odds ratio (aOR) for femoral neck osteoporosis compared with participants not exposed to SHS (aOR, 3.68; 95 % confidence interval [CI], 1.23-10.92). Participants whose cohabitant smokers consumed any number of cigarettes per day showed increased occurrences for lumbar and femoral neck osteoporosis compared with the nonexposed group. Participants whose cohabitant smokers consumed ≥20 cigarettes/day showed increased aORs for lumbar (aOR, 5.40; 95 % CI, 1.04-28.04) and femoral neck (aOR, 4.35; 95 % CI, 1.07-17.68) osteoporosis compared with participants not exposed to SHS.

CONCLUSIONS

In postmenopausal never-smoking Korean women, exposure to SHS was positively associated with osteoporosis. This finding further emphasizes a need to identify vulnerable groups exposed to SHS to increase bone health.

Induction of ER Stress-Mediated Apoptosis by α-Lipoic Acid in A549 Cell Lines

Background

α-Lipoic acid (α-LA) has been studied as an anticancer agent as well as a therapeutic agent for diabetes and obesity. We performed this study to evaluate the anticancer effects and mechanisms of α-LA in a lung cancer cell line, A549.

Materials and Methods

α-LA-induced apoptosis of A549 cells was detected by fluorescence-activated cell sorting analysis and a DNA fragmentation assay. Expression of apoptosis-related genes was analyzed by western blot and reverse transcription-polymerase chain reaction analyses.

Results

α-LA induced apoptosis and DNA fragmentation in A549 cells in a dose- and time-dependent manner. α-LA increased caspase activity and the degradation of poly (ADP-ribose) polymerase. It induced expression of endoplasmic reticulum (ER) stress-related genes, such as glucose-regulated protein 78, C/EBP-homologous protein, and the short form of X-box binding protein-1, and decreased expression of the anti-apoptotic protein, X-linked inhibitor of apoptosis protein. Reactive oxygen species (ROS) production was induced by α-LA, and the antioxidant N-acetyl-L-cysteine decreased the α-LA-induced increase in expression of apoptosis and ER stress-related proteins.

Conclusion

α-LA induced ER stress-mediated apoptosis in A549 cells via ROS. α-LA may therefore be clinically useful for treating lung cancer.

Enhancement in the critical current density of C-doped MgB2 wire using a polyacrylic acid dopant

C-doped MgB2 wires were fabricated from a polyacrylic acid (PAA) using a conventional in-situ PIT technique. The effects of the PAA content on the lattice parameter, microstructure, critical temperature (Tc) and critical current density (Jc) were examined. With increasing PAA content, the amount of MgO in the sample increased but the crystallinity, a-axis lattice parameter, and Tc of MgB2 wires decreased, indicating that the C that decomposed from PAA during heat treatment had substituted for B. All doped samples exhibited a higher Jc than the undoped sample at high magnetic field, and the Jc(B) property improved with increasing PAA content: for the 7 wt% doped sample, the Jc was approximately 3-times higher than that of the pristine sample (1.28 kA/cm2 vs. 3.43 kA/cm2) at 5 K and 6.6 T. The improved Jc(B) of the doped sample was attributed to the decreased grain size, enlarged lattice distortion and increased C doping level.

Magnetic resonance venography evaluating veins flow for legs by application of long stretch elastic bandage

AIM

Varicose veins are a common feature of chronic venous disease that causes pain and swelling of legs. Long stretch elastic bandages are one of the methods used to prevent and treat venous disease, but diagnostic benefit by magnetic resonance imaging (MRI) is not widely promoted. This study aims to evaluate the effects of long stretch elastic bandages using a non-contrast magnetic resonance venographic (MRV) technique by detecting influence on circumferences and flow velocities of varicose and deep veins, before and immediately after application of long stretch elastic bandages.

METHODS

Twelve patients presenting with visible varicose veins underwent MRV. The level of the superficial varicose and deep veins before and after wearing long stretch elastic bandages was recorded.

RESULTS

By comparing before and after long stretch elastic bandages, all 12 cases showed statistical significant decrease of the superficial venous flow areas; 9 out of 12 cases showed statistical significant change of the superficial (decreased) and deep (increased) venous flow rates. However, due to technical limitation, over half of the cases could not record the change of the deep venous flow areas.

CONCLUSION

The non-contrast MRV technique with Cine phase contrast, is capable to detect the short term beneficial effects of long stretch elastic bandages by measuring change of the superficial venous flow areas and superficial and deep venous flow rates.

Aspirin use and risk for lung cancer: a meta-analysis

BACKGROUND

Aspirin has received increasing attention owing to its potential as a chemopreventive agent against lung cancer. Previous observational studies have reported inconsistent findings on this issue. We investigated the association between aspirin use and risk for lung cancer by conducting a meta-analysis.

PATIENTS AND METHODS

Relevant studies were identified by searching Medline, EMBASE, and Cochrane Library to December 2009. We also reviewed relevant bibliographies from the retrieved articles. Two authors independently extracted data and assessed study quality. Disagreements were resolved by consensus.

RESULTS

Fifteen studies (six case-control studies and nine prospective cohort studies) were included in the final meta-analysis. When all studies were pooled, the odds ratio (OR) of aspirin use for lung cancer risk was 0.86 [95% confidence interval (CI) 0.76-0.98]. In subgroup meta-analyses, there was no association between aspirin use and lung cancer risk among cohort studies (relative risk, 0.97; 95% CI 0.87-1.08), while there was a significant association among case-control studies (OR, 0.74; 95% CI 0.57-0.99). In a subgroup meta-analysis by quality of study methodology, a significant protective effect of aspirin use on lung cancer was observed only among eight low-quality studies (OR, 0.82; 95% CI 0.68-0.99), but not among seven high-quality studies (OR, 0.90; 95% CI 0.76-1.07).

CONCLUSIONS

Overall, the findings of this meta-analysis support that there was no association between aspirin use and lung cancer risk. Our findings should be confirmed in future prospective cohort studies or randomized, controlled trials.

Activation of AMP-activated protein kinase on human gastric cancer cells by apoptosis induced by corosolic acid isolated from Weigela subsessilis

Corosolic acid is one of the triterpenoids present in the leaves of Weigela subsessilis. The antidiabetic activity of corosolic acid has been reported previously, but to date, the anticancer effects on gastric cancer have been poorly studied. In this study, corosolic acid showed growth inhibition on SNU-601 human gastric cancer cells, with an IC₅₀ value of 16.9 ± 2.9 μM. Corosolic acid also triggered the activation of caspase-3 and poly (ADP-ribose) polymerase, while it was recovered by Z-VAD-FMK. Moreover, the cell growth/apoptosis activities of corosolic acid were regulated by the AMP-activated protein kinase-mammalian target of rapamycin (AMPK-mTOR) signals. These results showed that corosolic acid-mediated AMPK activation leads to inhibition of mTOR, thus providing a possible mechanism of action of corosolic acid in the inhibition of cancer cell growth and the induction of apoptosis.

Modified FOLFOX-4 as first-line and salvage treatment in advanced gastric cancer

BACKGROUND/AIMS

Oxaliplatin, leucovorin and fluorouracil combination therapy (FOLFOX) was effective and safe treatment in AGC. The aim of this study was to evaluate the efficacy and safety of the modified FOLFOX-4 using low dose leucovorin for patients with advanced gastric cancer and analyze the efficacy of this regimen as first-line and salvage treatment.

METHODOLOGY

Forty-two patients with recurrent or metastatic gastric cancer received oxaliplatin 85 mg/m2 and leucovorin 20 mg/m2 followed by 5-FU bolus 400 mg/m2 and then 5-FU 600 mg/m2 every 2 weeks.

RESULTS

1 (2.4%) complete response and 10 (23.8%) partial responses were observed. Stable disease and progressive disease were observed in 18 (42.9%) and 13 (30.9%). Median overall survival and progression free survival were 9.3 and 4.9 months. Among them, 26 (61.9%) and 16 (38.1%) of patients were treated as first-line and salvage treatment. Median overall survivals in the first-line and salvage treatment were 11.1 and 8.2 months respectively. And progression free survivals in first-line and salvage treatment were 6.0 and 4.7 month. Performance status was the only independent prognostic factor in overall survival in advanced gastric cancer.

CONCLUSIONS

Our study showed modified FOLFOX-4 regimen had significant effects and favorable toxicities as first-line and salvage treatment for patients with advanced gastric cancer.

Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels

OBJECTIVES

The aim of this study was to evaluate the relationships between the severity of appendicitis as depicted on CT and blood inflammatory markers of serum white blood cell (WBC) count and C-reactive protein (CRP).

METHODS

CT images in 128 patients (109 surgically proven and 19 with clinically excluded appendicitis) were retrospectively reviewed. Two radiologists by consensus evaluated and scored (using a 0, 1 or 2 point scale) severities based on CT-determined appendiceal diameters, appendiceal wall changes, caecal changes, periappendiceal inflammatory stranding and phlegmon or abscess formation. We investigated whether CT findings were significantly related to elevated WBC counts or CRP levels and performed the correlations of WBC counts and CRP levels with CT severity scores. Patients were also subjectively classified using four grades from normal (Grade I) to perforated appendicitis (Grade IV) on the basis of CT findings to evaluate differences in WBC counts and CRP levels between grades.

RESULTS

Only appendiceal wall changes and the phlegmon or abscess formation were related to elevated WBC counts and CRP levels, respectively (p<0.05). CT severity scores were found to be more strongly correlated with CRP levels (r = 0.669) than with WBC counts (r = 0.222). On the basis of CT grades, the WBC counts in Grade I were significantly lower than in other grades (p<0.001), whereas CRP levels in Grade IV were significantly higher than in other grades (p<0.001).

CONCLUSION

CRP levels were found to correlate with CT-determined acute appendicitis severity and could be a useful predictor for perforated appendicitis, whereas WBC counts might be useful to detect early acute appendicitis.

Energy spectra of a single-electron magnetic dot using the massless Dirac-Weyl equation

In this paper, we study the low-lying energy spectra of a two-dimensional (2D) graphene-based magnetic dot in a perpendicular and radially inhomogeneous magnetic field with the use of the massless Dirac-Weyl equation. Numerical calculations are performed using 2D harmonic basis states for direct diagonalization. Effects of both the dot size and the magnetic field on the low-lying energy spectra are discussed.

[A case of limited Wegener's granulomatosis with gastroenteritis and mesenteric lymphadenopathy]

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.

Aggregation in insect communities colonizing cattle-dung

Ruminant dung is a highly ephemeral, patchily distributed resource, which is used by a diverse community of invertebrate species. In such environments, high levels of insect aggregation may be important in facilitating stability and coexistence across patchily distributed populations. The aim of the present work was to quantify the aggregation of the insects colonising cow-dung in cattle pasture in southwest England and to test the hypothesis that the dung-pat community assemblage observed was the result of stochastic colonization. This was examined using batches of ten standardised, 1.5 kg, artificial cow pats placed out in cattle pastures in each of 24 weeks between May and October in 2001. Pats were left exposed in the field for seven days before being brought back to the laboratory, where any insect colonizers were collected and identified. Individual pats contained, on average, only half the number of insect taxa present in an entire batch put out at any one time. All larval coleopteran taxa, 20 of the 22 adult coleopteran taxa and 22 of the 23 dipteran taxa, showed significant aggregation, with the abundance of most taxa within pats approximating a negative binomial distribution. A simulation analysis was used to show that the observed relative frequency of taxa within pats did not differ from that expected by chance if colonisation is a random binomial event in which each species colonises a pat independently of all other species. Aggregated populations, of even highly abundant insects, may be more susceptible to the deleterious effects of insecticidal contaminants in dung than if they were evenly distributed, if by chance they colonize a pat containing insecticidal residues from a recently treated animal.

In vitro potential of Ascophyllum nodosum phenolic antioxidant-mediated alpha-glucosidase and alpha-amylase inhibition

Ascophyllum nodosum is a brown seaweed that grows abundantly in the Northeast coastal region. In this study, the potential of A. nodosum for type 2 diabetes management through antioxidant-mediated alpha-glucosidase and alpha-amylase inhibition was investigated. After the initial screening of 4 locally harvested seaweeds, A. nodosum was chosen for its highest phenolic content and was subjected to water extraction. Among extraction ratios of 50 g to 100 to 1000 mL at room temperature, 50 g/400 mL yielded the highest phenolic content of 4.5 mg/g wet weight. For evaluation of extraction temperature ranging from 20 to 80 degrees C, 50 g/400 mL was chosen as a minimum amount of extractant. Among temperatures studied, extraction at 80 degrees C resulted in the highest total phenolic contents (4.2 mg/g wet weight). All extracts had similar levels of antioxidant activity in the range of 60% to 70% in terms of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity. The 80 degrees C extract had the highest alpha-glucosidase and alpha-amylase inhibitory activity with IC(50) of 0.24 and 1.34 microg phenolics, respectively, compared to the IC(50) of acarbose, reference inhibitor, being 0.37 and 0.68 microg. The results show that fresh A. nodosum has strong alpha-glucosidase and mild alpha-amylase inhibitory activities that correlated with phenolic contents. This study suggests a nutraceutical potential of A. nodosum based on phytochemical antioxidant and antihyperglycemia activities.

Covalently linked immunomagnetic separation/adenosine triphosphate technique (Cov-IMS/ATP) enables rapid, in-field detection and quantification of Escherichia coli and Enterococcus spp. in freshwater and marine environments

AIMS

Developing a rapid method for detection of faecal pollution is among the critical goals set forth by the Environmental Protection Agency in its revision of water quality criteria. The purpose of this study is to devise and test covalently linked antibody-bead complexes for faecal indicator bacteria (FIB), specifically Escherichia coli or Enterococcus spp., in measuring water quality in freshwater and marine systems.

METHODS AND RESULTS

Covalently linked complexes were 58-89% more robust than antibody-bead complexes used in previous studies. Freshwater and marine water samples analysed using covalently linked immunomagnetic separation/adenosine triphosphate quantification technique (Cov-IMS/ATP) and culture-based methods yielded good correlations for E. coli (R = 0·87) and Enterococcus spp. (R = 0·94), with method detection limits below EPA recreational water quality health standards for single standard exceedances (E. coli- 38 cells per 100 ml; Enterococcus spp. - 25 cells per 100 ml). Cov-IMS/ATP correctly classified 87% of E. coli and 94% of Enterococcus spp. samples based on these water quality standards. Cov-IMS/ATP was also used as a field method to rapidly distinguish differential loading of E. coli between two stream channels to their confluence.

CONCLUSIONS

Cov-IMS/ATP is a robust, in-field detection method for determining water quality of both fresh and marine water systems as well as differential loading of FIB from two converging channels.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first work to present a viable rapid, in-field assay for measuring FIB concentrations in marine water environments. Cov-IMS/ATP is a potential alternative detection method, particularly in areas with limited laboratory support and resources, because of its increased economy and portability.