Predictive factors of therapeutic intervention in on-call endoscopy for suspected gastrointestinal bleeding

BACKGROUND AND AIMS

Performing an endoscopy out of hours confer significant burdens on limited health-care resources. However, not all on-call endoscopies lead to therapeutic interventions. The purpose of the present study was to analyze predictive factors for performing therapeutic intervention in patients with suspected gastrointestinal bleeding.

METHODS

We reviewed and analyzed electronic medical records regarding on-call endoscopy that were prospectively collected for quality control. The subjects were patients with suspected gastrointestinal bleeding who underwent on-call endoscopies at night, on weekends and on holidays between April 2013 and January 2017 in Seoul National University Bundang Hospital. To determine predictive factors for performing therapeutic intervention, the following variables were analyzed: symptoms, patient status, coexisting disease, laboratory findings and medications. To clarify the association between the likelihood of therapeutic intervention in on-call endoscopy and AIMS65 score, the included variables were divided by cutoffs.

RESULTS

A total of 270 patients (male: 72.6%, mean age: 62.6 years) with suspected gastrointestinal bleeding had on-call endoscopies and 153 (56.7%) patients had therapeutic intervention. Gastroscopy, colonoscopy and both endoscopic techniques were performed in 215, 42 and 13 patients, respectively. In the multivariate analysis, hematemesis (p < .001, odds ratio [OR], 2.484) and prolonged prothrombin time-international normalized ratio (PT-INR) (p = .033; OR, 1.958) were correlated with performing therapeutic intervention in on-call endoscopy. AIMS65 score with a cutoff of 2 was associated with the likelihood of intervention (p = .043).

CONCLUSIONS

Hematemesis and prolonged PT-INR were predictive factors of therapeutic intervention when on-call endoscopy was performed in patients with suspected gastrointestinal bleeding.

Depigmentation efficacy of galacturonic acid through tyrosinase regulation in B16 murine melanoma cells and a three-dimensional human skin equivalent

Sugar is a well-known cosmetic ingredient for moisturizing skin with minimal side-effects. Several reports have demonstrated an antimelanogenic effect of sugar in melanocytes. We evaluated the whitening efficacy of galacturonic acid (GA), the main component of pectin, as an anti-melanogenic agent. GA significantly suppressed melanin synthesis and secretion in a concentration-dependent manner in α-melanocyte stimulating hormone-treated B16 melanoma cells, and inhibited tyrosinase activity and expression at a dose of 10 mmol/L. In a three-dimensional human skin equivalent (MelanoDerm), GA clearly brightened tissue colour. Haematoxylin and eosin and Fontana-Masson (F&M) staining of tissue sections revealed decreased melanin production without skin tissue collapse in the presence of GA. Interestingly, GA dramatically suppressed gene expression of the melanogenic proteins tyrosinase, tyrosinase-related protein (TYRP)-1 and microphthalmia-associated transcription factor, but not TYRP-2. The results support the utility of GA as an effective candidate antimelanogenic agent.

Effects of extrusion and microbial phytase on the apparent and standardized total tract digestibility of phosphorus in hemp hulls fed to growing pigs

An experiment was carried out to determine the apparent total tract digestibility (ATTD) and the standardized total tract digestibility (STTD) of P and the effects of extrusion and microbial phytase on ATTD and STTD of P in hemp hulls (HH). Thirty-six pigs (30.3 ± 2.7 kg) were randomly allotted to 1 of 6 experimental diets in a complete randomized design with 6 replicates per diet. A corn-soybean meal (SBM)-based basal diet was formulated. Two additional diets were formulated by replacing 40% of corn and SBM (on a 100% of total diet basis) with HH or extruded HH (EHH). The test ingredients, corn, and SBM were the only sources of P in the diets. Three additional diets were also prepared by supplementing 500 unit/kg of microbial phytase to the initial 3 diets (the corn-SBM basal diet and diets containing test ingredients). Pigs were fed experimental diets at 3 times the maintenance energy requirement (197 kcal ME/kg BW0.60). Results indicated that fecal P concentration and daily P output were reduced (P < 0.05) from pigs fed diets with dietary phytase compared with pigs fed diets without dietary phytase. The ATTD and STTD of P in experimental diets were not different. However, the ATTD and STTD of P in experimental diets supplemented with dietary phytase were increased (P < 0.05) compared with the diets without phytase. The ATTD and STTD of P in HH were 18.8% and 22.0%, respectively, whereas respective values for EHH were 22.5% and 26.3%. Extrusion had no effects on ATTD and STTD of P in HH. However, the ATTD and STTD of P in HH and EHH increased (P < 0.05) when dietary phytase was added to the diets. The concentration of Ca in feces and daily Ca output were reduced (P < 0.05) as a result of phytase supplementation. Addition of dietary phytase increased (P < 0.05) the ATTD of Ca in all experimental diets. In conclusion, the ATTD and STTD of P in HH fed to growing pigs were 18.8% and 22.0%, respectively. Respective values for EHH were 22.5% and 26.3%. Extrusion did not affect the ATTD and STTD of P in HH. However, the addition of microbial phytase to experimental diets increased the ATTD and STTD of P in diets and test ingredients and decreased fecal P output from pigs fed experimental diets. There was no interaction between extrusion and dietary phytase supplementation.

Harmonising clinical trials within the Gynecologic Cancer InterGroup: consensus and unmet needs from the Fifth Ovarian Cancer Consensus Conference

The Gynecologic Cancer InterGroup (GCIG) Fifth Ovarian Cancer Consensus Conference (OCCC) was held in Tokyo, Japan from 7 to 9 November 2015. It provided international consensus on 15 important questions in 4 topic areas, which were generated in accordance with the mission statement to establish 'International Consensus for Designing Better Clinical Trials'. The methodology for obtaining consensus was previously established and followed during the Fifth OCCC. All 29 clinical trial groups of GCIG participated in program development and deliberations. Draft consensus statements were discussed in topic groups as well as in a plenary forum. The final statements were then presented to all 29 member groups for voting and documentation of the level of consensus. Full consensus was obtained for 11 of the 15 statements with 28/29 groups agreeing to 3 statements, and 27/29 groups agreeing to 1 statement. The high acceptance rate of the statements among trial groups reflects the fact that we share common questions, and recognise important unmet needs that will guide future research in ovarian cancer.

Hepatic iron overload in the portal tract predicts poor survival in hepatocellular carcinoma after curative resection

BACKGROUND & AIMS

Hepatic iron overload is associated with liver injury and hepatocarcinogenesis; however, it has not been evaluated in patients with hepatocellular carcinoma (HCC) in Asia. The aim of this study was to clarify the degree and distribution of intrahepatic iron deposition, and their effects on the survival of HCC patients.

METHODS

Intrahepatic iron deposition was examined using non-tumorous liver tissues from 204 HCC patients after curative resection, and they were scored by 2 semi-quantitative methods: simplified Scheuer's and modified Deugnier's methods. For the Scheuer's method, iron deposition in hepatocytes and Kupffer cells was separately evaluated, while for the modified Deugnier's method, hepatocyte iron score (HIS), sinusoidal iron score (SIS) and portal iron score (PIS) were systematically evaluated, and the corrected total iron score (cTIS) was calculated by multiplying the sum (TIS) of the HIS, SIS, and PIS by the coefficient.

RESULTS

The overall prevalence of hepatic iron was 40.7% with the simplified Scheuer's method and 45.1% with the modified Deugnier's method with a mean cTIS score of 2.46. During a median follow-up of 67 months, the cTIS was not associated with overall survival. However, a positive PIS was significantly associated with a lower 5-year overall survival rate (50.0%) compared with a negative PIS (73.7%, P = .006). In the multivariate analysis, a positive PIS was an independent factor for overall mortality (hazard ratio, 2.310; 95% confidence interval, 1.181-4.517).

CONCLUSIONS

Intrahepatic iron deposition was common, and iron overload in the portal tract indicated poor survival in curatively resected HCC patients.

Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach

BACKGROUND

Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion.

HYPOTHESIS

Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan.

PATIENTS AND METHODS

Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7years (range, 27-84years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements.

RESULTS

The intra-operative estimation (mean, 21.5°±8.5°; range, 5.0°-39.0°) was greater than the CT measurement (mean, 19.5°±8.7°; range, 4.5°-38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion.

DISCUSSION

Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach.

LEVEL OF EVIDENCE

Level III, prospective case control study.

Net energy content of canola meal fed to growing pigs and effect of experimental methodology on energy values

An experiment was conducted to determine the digestible energy (DE), metabolizable energy (ME), and net energy (NE) contents of canola meal (CM) and to investigate the effects of basal diet [corn diet vs. corn-soybean meal (SBM) diet] and methodology (difference method vs. regression method) on energy values of CM. Thirty-six growing barrows (20.8 ± 1.0 kg initial body weight [BW]) were individually housed in metabolism crates and randomly allotted to one of six dietary treatments to give six replicates per treatment. The six experimental diets included a corn diet, a corn-SBM diet, a corn diet with 15 or 30% of CM, and a corn-SBM diet with 15 or 30% of CM. The DE, ME, and NE of CM were determined using the corn diet or the corn-SBM diet as a basal diet. In each basal diet, two additional diets containing 15 or 30% of CM were formulated to compare the determined energy values by the difference method and estimated energy values from the regression method. Feeding level was set at 550 kcal ME/kg BW0.6 per day. Pigs were fed experimental diets for 16 d including 10 d for adaptation and 6 d for total collection of feces and urine. Pigs were then moved into indirect calorimetry chambers to determine 24 h heat production (HP) and 12 h fasting HP. The DE, ME, and NE of CM determined by the difference method were within the 95% confidence intervals estimated for the DE, ME, and NE of CM by the regression method regardless of the basal diets used, which indicates that the difference and regression methods give equivalent DE, ME, and NE of CM. However, when the goodness of fit for the linear model was compared, the r2 of the regression analysis from the corn-SBM diet (0.78) was relatively greater than that from corn diet (0.40). The estimated NE of CM by the prediction equations generated by either the corn diet or corn-SBM diets were 2,096 kcal/kg and 1,960 kcal/kg (as-fed basis), respectively, whereas those values determined by the difference method were 2,233 kcal/kg and 2,106 kcal/kg (as-fed basis), respectively. In conclusion, the NE of CM determined in the current study was, on average, 2,099 kcal/kg (as-fed basis). The difference and regression methods do not give different NE value of CM fed to growing pigs. Although the NE values of CM determined using either the corn diet or the corn-SBM diet were not different, the greater r2 of the regression analysis from the corn-SBM diet than that from the corn diet suggests that the corn-SBM diet is a more appropriate basal diet for NE determination of ingredients.

Clinical outcomes of 23 patients who had repeat pelvic arterial embolisation for uncontrolled post-partum haemorrhage at a single centre

AIM

To evaluate the safety and efficacy of repeated pelvic arterial embolisation (PAE) for uncontrolled postpartum haemorrhage (PPH) after a single session of PAE and to compare angiographic findings between the two sessions of PAE.

MATERIALS AND METHODS

A total of 23 consecutive patients (age range, 23-44 years) who underwent repeated PAE for uncontrolled PPH between March 2001 and January 2016 in Severance Hospital were reviewed. The interval times between the two sessions of PAE, the angiographic findings, embolic materials, arteries embolised during PAE, and the clinical outcomes were reviewed retrospectively.

RESULTS

Overall clinical success was achieved after repeated PAE in 21 of 23 patients (91.3%). There were no procedure-related, major complications. On angiography, active bleeding from the uterine collateral arteries was more frequently observed in the second session of PAE (p>0.05), and embolisation of the anterior division of the internal iliac artery was significantly higher during the second session of PAE. Use of permanent embolic materials was significantly higher during the second session of PAE. Recanalisation of a previously embolised artery was identified in 14 patients (60.9%) during the second session.

CONCLUSION

Repeated PAE is safe and effective for managing recurrent bleeding after a single session of PAE. Repeated PAE is related to a higher chance of embolisation of the anterior division of the internal iliac artery, with the use of permanent embolic materials. Recanalisation of a previously embolised artery seems to be a principal source of rebleeding during a repeated session of PAE.

Double-blind Randomized Study to Evaluate the Safety and Efficacy of Over-the-counter Tooth-whitening Agents Containing 2.9% Hydrogen Peroxide

OBJECTIVES

In this double-blind randomized study, we evaluated the safety and efficacy of over-the-counter (OTC) bleaching products that included 2.9% hydrogen peroxide (H₂O₂) with two methods of application: strip and paint-on.

METHODS AND MATERIALS

A commonly used product was selected for each type (strip and paint-on) of OTC bleaching agent. In total, 75 volunteers were assigned randomly into five groups: two test groups (strip and paint-on), two negative control groups (products without H₂O₂), and one positive control group (dentist-supervised home bleaching). The tooth shade was evaluated with a spectrophotometer and Vita shade guide at baseline and 2 weeks and 4 weeks after use. To document any adverse reactions, such as hypersensitivity or tissue irritation, all patients were examined and the Gingival Index (GI), Plaque Index (PI), and a visual analog scale (VAS) measuring the cold response were obtained.

RESULTS

There were significant differences among the five groups ( p<0.001). The positive control showed the greatest color changes; then, in decreasing order, the strip-type test group, paint-on-type test group, and negative controls. The strip-type bleaching agent was significantly more effective than the paint-on-type agent and the negative control, while it was significantly less effective than the dentist-supervised home bleaching. Regardless of the treatment group, the canines showed greater color changes than did the central or lateral incisors. Some cases of gingival irritation and hypersensitivity were observed, but they were mild and reversible. GI, PI, and VAS scores were not significantly changed.

CONCLUSIONS

Within the limitations of this study, the results indicated that the strip-type and paint-on-type OTC bleaching agents were significantly less efficacious than was dentist-supervised home bleaching; however, they showed acceptable safety and efficacy. The strip-type was more effective than was the paint-on-type in this study.

Abstract P6-08-09: Incidence and risk factors for congestive heart failure in early breast cancer received anthracycline and/or trastuzumab; big-data analysis of Korean health insurance review and assessment service database

Background: Anthracycline (AC) and/or trastuzumab (T) are the most commonly used for neo-/adjuvant therapy for early breast cancer. However, use of those regimens are limited owing to congestive heart failure (CHF). Although reported incidence from pivotal trials is very low and acceptable, no big data-based population study has not been conducted in Koreans yet. The aim of this study was to analyze the incidence, time to occurrence, and risk factors for CHF in patients with early breast cancer, who were treated with AC and/or T therapy, in Korea.

Methods: We used the Health Insurance Review and Assessment Service database and included women with no prior history of CHF who were aged &gt;19 years and diagnosed as having early breast cancer between 2007 and 2016. Only patients who had received breast cancer surgery and AC and/or T therapy were included. Patients with metastatic cancer codes were excluded.

Result: In total, 86,086 patients were included for this analysis. The incidence and median time to occurrence of CHF according to chemotherapy type were, 3.27% and 683.5 days in the AC only group, 6.39% and 374 days in the AC followed by T group, and 4.43% and 286 days in the T with or without non-AC group, respectively.

The multivariate Cox regression analysis revealed that the adjusted hazard ratio (HR) for CHF was increased with older age; in those aged ≥65 years versus &lt;50 years (HR, 2.79; 95% confidence interval [CI], 2.50–3.12). The HR in the AC followed by T group was significantly higher than that in the AC only group (HR, 2.21; 95% CI, 2.05-2.37). The T with or without non-AC group also showed a significantly higher HR than the AC only group (HR, 1.67; 95% CI, 1.37-2.04). CCI scores of ≥2 were significant predictors of CHF; score 2 versus 0 (HR, 1.30; 95% CI, 1.18-1.45), and score ≥3 versus 0 (HR, 1.87; 95% CI, 1.69-2.06). In addition, preexisting medical conditions were significant predictors for CHF: hypertension (HR, 1.58; 95% CI, 1.45-1.72), diabetes (HR, 1.17; 95% CI, 1.07-1.28), and ischemic heart disease (HR, 1.60; 95% CI, 1.45-1.76).

Conclusion: This is the first big data-based population study in Korea on the development of CHF after treatment with AC and/or T. The overall incidence of CHF was 3% to 6%, with a median time to occurrence of 1 to 2 years. Adjusted HR increased with older age, AC followed by T therapy, CCI scores ≥2, and preexisting conditions.

Table 1. Incidence and median time to occurrence of congestive heart failure according to chemotherapy typeChemotherapy typeTotalCHF event (%)Median time to occurenceAC only66,6992,182 (3.27%)683.5AC followed by T17,0621,090 (6.39%)374T ± non-AC2,325103 (4.43%)286

Table 2. Cox proportional hazards model for congestive heart failure, adjusted for age, chemotherapy type, and Charlson comorbidity index scoreVariableP-valueHR95% CIAge (ref &lt;50 years)   50-64 years&lt;0.00011.541.43-1.66≥65 years&lt;0.00012.792.50-3.12Chemotherapy type (ref AC only)   AC folloewed by T&lt;0.00012.212.05-2.37T ± non-AC&lt;0.00011.671.37-2.04Charlson comorbidity index score (ref 0)   10.12061.080.98-1.192&lt;0.00011.301.18-1.45≥3&lt;0.00011.871.69-2.06

Citation Format: Choi JY, Cho EY, Lee JW, Kim JW, Choi YJ, You JY, Bae SY, Jung SP, Cho KR, Park KH. Incidence and risk factors for congestive heart failure in early breast cancer received anthracycline and/or trastuzumab; big-data analysis of Korean health insurance review and assessment service database [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-09.

3,3'-Diindolylmethane Suppressed Cyprodinil-Induced Epithelial-Mesenchymal Transition and Metastatic-Related Behaviors of Human Endometrial Ishikawa Cells via an Estrogen Receptor-Dependent Pathway

Cyprodinil (CYP) is a pyrimidine amine fungicide that has been extensively used in agricultural areas. 3,3′-Diindolylmethane (DIM) is a derivative of the dietary phytoestrogen, indole-3-carbinol (I3C), which is derived from cruciferous vegetables and considered to be a cancer-preventive phytonutrient agent. In this study, the effects of CYP and DIM were examined on the cell viability, invasion, and metastasis of human endometrial cancer cells, Ishikawa, via epithelial mesenchymal transition (EMT). CYP increased the level of cell viability of Ishikawa cells compared to DMSO as a control, as did E2. Ishikawa cells lost cell-to-cell contact and obtained a spindle-shaped or fibroblast-like morphology in response to the application of E2 or CYP by the cell morphology assay. In the cell migration and invasion assay, CYP enhanced the ability of migration and invasion of Ishikawa cells, as did E2. E2 and CYP increased the expressions of N-cadherin and Snail proteins, while decreasing the expression of E-cadherin protein as EMT-related markers. In addition, E2 and CYP increased the protein expressions of cathepsin D and MMP-9, metastasis-related markers. Conversely, CYP-induced EMT, cell migration, and invasion were reversed by fulvestrant (ICI 182,780) as an estrogen receptor (ER) antagonist, indicating that CYP exerts estrogenic activity by mediating these processes via an ER-dependent pathway. Similar to ICI 182,780, DIM significantly suppressed E2 and CYP-induced proliferation, EMT, migration, and invasion of Ishikawa cancer cells. Overall, the present study revealed that DIM has an antiestrogenic chemopreventive effect to withdraw the cancer-enhancing effect of E2 and CYP, while CYP has the capacity to enhance the metastatic potential of estrogen-responsive endometrial cancer.

Liver volume-based prediction model stratifies risks for hepatocellular carcinoma in chronic hepatitis B patients on surveillance

BACKGROUND AND AIM

The aim of this study was to determine whether dynamic computed tomography (CT)-measured liver volume predicts the risk of hepatocellular carcinoma (HCC) when the CT scans do not reveal evidence of HCC in chronic hepatitis B (CHB) patients on surveillance.

METHODS

This retrospective multicentre cohort study included 1,246 patients who received entecavir and regular HCC surveillance in three tertiary referral centres in South Korea. Liver volumes were measured on portal venous phase CT images. A nomogram was developed based on Cox independent predictors and externally validated. Time-dependent receiver operating characteristic (ROC) analysis was performed for comparison with previous prediction models.

RESULTS

Patients who received dynamic CT studies during surveillance had significantly higher risk for HCC compared to patients without CT studies (hazard ratio [HR] = 3.1; p < 0.001). Expected/measured liver volume ratio was an independent predictor of HCC (HR = 4.2; p = 0.002) in addition to age, sex and cirrhosis. The nomogram based on the four predictors discriminated risks for HCC (HR = 4.1 and 6.0 in derivation and validation cohort, respectively, for volume score > 150; p < 0.001). Time-dependent ROC analysis confirmed better performance of the volume score compared to HCC prediction models with conventional predictors (integrated area under curve = 0.758 vs. 0.661-0.712; p < 0.05).

CONCLUSIONS

CT-measured liver volume is an independent predictor of future HCC, and nomogram-based liver volume score may stratify the risks of HCC in CHB patients who showed negative CT findings for HCC during surveillance.

Orphan Spins in the S=5/2 Antiferromagnet CaFe_{2}O_{4}

CaFe_{2}O_{4} is an anisotropic S=5/2 antiferromagnet with two competing A (↑↑↓↓) and B (↑↓↑↓) magnetic order parameters separated by static antiphase boundaries at low temperatures. Neutron diffraction and bulk susceptibility measurements, show that the spins near these boundaries are weakly correlated and a carry an uncompensated ferromagnetic moment that can be tuned with a magnetic field. Spectroscopic measurements find these spins are bound with excitation energies less than the bulk magnetic spin waves and resemble the spectra from isolated spin clusters. Localized bound orphaned spins separate the two competing magnetic order parameters in CaFe_{2}O_{4}.

Nonocclusive Mesenteric Ischaemia Induced by Diltiazem Overdose: A Case Report

Acute mesenteric ischaemia is a rare complication of calcium channel blocker (CCB) overdose. A previous study reported a case of mesenteric ischaemia induced by poisoning with CCBs other than diltiazem. We present a case of nonocclusive mesenteric ischaemia (NOMI) induced by diltiazem poisoning. Through this case report, we wish to emphasize that the clinicians should keep the possibility of intestinal ischaemia in mind from the early phase of calcium channel blocker poisoning. In addition, close monitoring and intense abdominal examination including the abdominal computed tomography scan should be done if CCBs poisoning patients complained of an abdominal pain.

Effectiveness of 100 Beats per Minute Music on Cardiopulmonary Resuscitation Compression Rate Education: A Manikin Study

Introduction

Recent cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compression. The aim of this study is to determine the effect of education using music on the chest compression rate.

Methods

This randomised, open-labeled study enrolled 81 medical students. They were randomly divided into three groups. After they were educated in CPR according to the American Heart Association 2010 guidelines, they performed 100 chest compressions using a mannequin capable of collecting each compression depth and speed. After that, the control group received a verbal feedback about their own results. The metronome group was also notified of their own results, and listened to the metronome sound at 100 beats per minute (bpm). The music group listened to the music (about 100 bpm). Twenty-four hours after their CPR education, chest compressions were performed again with the method identical to the first evaluation. The results were compared using multivariate analysis of variances.

Result

Compression rate (bpm): There was a significant difference between the control (mean, 110.4; 95% CI: 104.4, 116.5) and metronome group (mean, 98.5; 95% CI: 91.6, 105.4) after education (p=0.01). There was a significant difference between control and music group (mean, 98.2; 95% CI: 94.6, 101.8) after education (p<0.001) There were no differences between the music and metronome group before or after education (p=0.50, p=0.94). However, the variance of music group was significantly less than the metronome group (p=0.01). Compression depth (inches): there was no difference between the groups according to the CPR education method. (Control: 1.8±0.3; Metronome group: 1.6±0.2; Music group: 1.7±0.3 p=0.09)

Conclusion

Both education method of using music and metronome are more effective than conventional method. However the effect of using music may be better than using metronome.

Specific mutations of penicillin-binding protein 1A in 77 clinically acquired amoxicillin-resistant Helicobacter pylori strains in comparison with 77 amoxicillin-susceptible strains

BACKGROUND

Amoxicillin (Amx) is one of the most important antibiotics for eradication of Helicobacter pylori (H. pylori). Main determinants of genetically stable Amx resistance are mutations in the C-terminus of penicillin-binding protein 1A (pbp1A). However, contribution of individual mutation remains unclear.

METHODS

77 Amx-resistant (Amx^R ) and 77 Amx-susceptible (Amx^S ) H. pylori strains were isolated from gastric tissues, and DNA sequencing was performed to compare C-terminus sequences of pbp1A gene between Amx^R and Amx^S strains. Natural transformation of these mutated genes into amoxicillin-susceptible strains was performed.

RESULTS

Among many mutations in pbp1A, D479E (OR: 37.4, 95% CI: 5.53-252.49, P < .001), and T593 mutation (OR: 32.0, 95% CI: 4.04-252.86, P < .001) independently contributed to Amx resistance in H. pylori strains. In the transformation experiment, T593 mutations were identified in their transformants showing Amx resistance. However, PCR product of D479E was not inserted into recipient (ATCC 43504) resulting in transformation failure.

CONCLUSION

Amx resistance is associated with various substitutions in pbp1A and T593 mutation contributes to Amx resistance of H. pylori.

The Clinicopathological and Prognostic Significance of the Gross Classification of Hepatocellular Carcinoma

Background

We aimed to determine the clinicopathological significance of the gross classification of hepatocellular carcinoma (HCC) according to the Korean Liver Cancer Association (KLCA) guidelines.

Methods

A retrospective analysis was performed on 242 cases of consecutively resected solitary primary HCC between 2003 and 2012 at Seoul National University Bundang Hospital. The gross classification (vaguely nodular [VN], expanding nodular [EN], multinodular confluent [MC], nodular with perinodular extension [NP], and infiltrative [INF]) was reviewed for all cases, and were correlated with various clinicopathological features and the expression status of “stemness”-related (cytokeratin 19 [CK19], epithelial cell adhesion molecule [EpCAM]), and epithelial-mesenchymal transition (EMT)–related (urokinase plasminogen activator receptor [uPAR] and Ezrin) markers.

Results

Significant differences were seen in overall survival (p=.015) and disease-free survival (p = .034) according to the gross classification; INF type showed the worst prognosis while VN and EN types were more favorable. When the gross types were simplified into two groups, type 2 HCCs (MC/NP/INF) were more frequently larger and poorly differentiated, and showed more frequent microvascular and portal venous invasion, intratumoral fibrous stroma and higher pT stages compared to type 1 HCCs (EN/VN) (p<.05, all). CK19, EpCAM, uPAR, and ezrin expression was more frequently seen in type 2 HCCs (p<.05, all). Gross classification was an independent predictor of both overall and disease-free survival by multivariate analysis (overall survival: p=.030; hazard ratio, 4.118; 95% confidence interval, 1.142 to 14.844; disease-free survival: p=.016; hazard ratio, 1.617; 95% confidence interval, 1.092 to 2.394).

Conclusions

The gross classification of HCC had significant prognostic value and type 2 HCCs were associated with clinicopathological features of aggressive behavior, increased expression of “stemness”- and EMT-related markers, and decreased survival.

Development of a nomogram for screening of hepatitis B virus-associated hepatocellular carcinoma

Current strategy of hepatocellular carcinoma (HCC) surveillance evaluates individual risks of HCC for defining candidates for surveillance, but estimated risks are not utilized for clinical decision-making during actual screening. We sought to determine whether consideration of individual risks improve the performance of ultrasound (US)-based HCC screening in a real-world chronic hepatitis B (CHB) cohort. This single center retrospective cohort study analyzed 27,722 screening US tests from 4,175 consecutive CHB patients. Logistic regression analysis was performed to identify independent parameters predicting presence of HCC. A nomogram was built based on the independent predictors of HCC and compared with US-only screening by receiver operating characteristics analysis. The cost-effectiveness of the nomogram was assessed by decision curve analysis. HCC developed in 222 patients with the incidence of 0.769 per 1000 person-year during the median follow-up of 63 months. Age, sex, presence of cirrhosis, serum alpha-fetoprotein (AFP) levels and positive US test results were independent predictors of HCC presence. A nomogram based on these predictors showed higher C-statistics compared to US-only screening (0.960 vs. 0.731 and 0.935 vs. 0.691 for derivation and validation cohort, respectively; p < 0.001). Decision curve analysis showed higher net benefit of the HCC nomogram-guided screening model compared to US-only screening in the risk threshold range between 0 and 0.3. A nomogram composed of age, sex, presence of cirrhosis, serum AFP levels and US findings better predicted the presence of HCC compared to US-only screening in CHB on surveillance.

Occupational blood exposures in health care workers: incidence, characteristics, and transmission of bloodborne pathogens in South Korea

BACKGROUND

Health care workers (HCWs) are at high risk for occupational blood exposures (OBEs) and transmission of bloodborne pathogens. This study elucidated the incidence rate and epidemiological characteristics of OBEs among HCWs and investigated the pathogen transmission rate for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

METHODS

Self-reported OBEs from January 1, 2011 to December 31, 2015 were obtained from the electronic recording system. OBE incidence densities per 100 person-years and per 100 bed-years were calculated with a 5-year trend analysis. OBE characteristics and pathogen transmission rates were evaluated.

RESULTS

Among 10,452 HCWs and 1072 average yearly beds, 1076 OBEs were reported. OBE incidence rate was 5.6 cases per 100 person (full-time equivalent)-years and 20.3 per 100 bed-years. Incidence rate decreased and was significantly associated with a decrease of beds served per HCW. Housekeeping showed the highest OBE rate (14.8%) followed by doctors (8.5%) and nurses (6.2%). OBEs occurred in wards, emergency rooms, and operating rooms (38.1%, 13.3% and 12.2%, respectively) via percutaneous (86.7%) and mucocutaneous exposures (13.2%). Of OBEs associated with HBV (n = 133), HCV (n = 126), and HIV (n = 25), only one led to an infection (HCV; transmission rate of 0.8%). Neither HBV nor HIV infection occurred.

CONCLUSIONS

OBE incidence rate in a Korean university hospital was 5.6 cases per 100 person-years and 20.3 per 100 bed-years and was related to HCW workload and work proficiency. Though the actual bloodborne pathogen transmission rate was low, efforts to prevent OBE should be made for hospital safety.

Incidence, prevalence, and mortality of Adamantiades-Behçet's disease in Korea: a nationwide, population-based study (2006-2015)

BACKGROUND

The epidemiology of Adamantiades-Behçet's disease varies among ethnic populations worldwide. Trends in the incidence of Adamantiades-Behçet's disease have not been investigated based on the Korean National Health Insurance database.

OBJECTIVES

This study investigated the incidence and mortality of Adamantiades-Behçet's disease by age using nationwide population data in Korea.

METHODS

A nationwide population-based cohort study was performed using the Korean National Health Insurance Claims Database from 2006 to 2015. The incidence of Adamantiades-Behçet's disease was calculated by age, sex, calendar year and habitat. And comorbid metabolic diseases were also analysed in patients with Adamantiades-Behçet's disease.

RESULTS

The annual incidence of Adamantiades-Behçet's disease per 100 000 person-years was 3.976 (2.587 for males and 5.373 for females) from 2006 to 2015. The incidence of Adamantiades-Behçet's disease peaked among people in their 40s (6.561 per 100 000 person-years). Incidence was significantly higher in subjects with comorbid metabolic conditions, such as diabetes mellitus, hypertension and dyslipidemia. The mortality rate per 1000 person-years increased with age in patients with Adamantiades-Behçet's disease.

CONCLUSIONS

This study showed the incidence, prevalence and mortality of Adamantiades-Behçet's disease. Metabolic conditions increased the risk of Adamantiades-Behçet's disease among Koreans.

Atypical subtrochanteric fractures in Korean hip fracture study

In Korean, atypical subtrochanteric fractures (ASF) were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF.

INTRODUCTION

Recently, ASF have been reported to increase among patients on bisphosphonate. However, the incidence of ASF and the association between ASF and bisphosphonate use have not been well defined in Asian population. Our purposes are (1) to estimate the proportion of ASF among Korean patients with proximal femur fracture and (2) to determine the associated risk factors of ASF in the Korean patients.

METHODS

We conducted a multicenter (16 academic hospitals), prospective Korean hip fracture study on hip fracture in a cohort of patients aged 50 years or older from South Korea between July 2014 and May 2016. As a part of Korean hip fracture study, primary analysis examined the proportion of ASF among proximal femur fracture. To identify ASF, according to the definition by ASBMR task force, all radiographs of subtrochanteric fracture were reviewed. Associated risk factors for occurrence of ASF were also evaluated by using multivariable logistic regression analysis.

RESULTS

Among 1361 patients with proximal femoral fractures due to low-energy trauma, 17 fractures (1.2%) were identified as ASF. Higher BMI and use of bisphosphonate before injury were independent risk factors of ASF.

CONCLUSION

In Korean, ASF were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF.

Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea

OBJECTIVES

To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection.

DESIGN

Retrospective case-control study.

SETTING

University-based tertiary care medical center.

PARTICIPANTS

Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study.

MAIN OUTCOME MEASURES

All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared.

RESULTS

Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients.

CONCLUSIONS

Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.

Effects of diet complexity and multicarbohydrase supplementation on growth performance, nutrient digestibility, blood profile, intestinal morphology, and fecal score in newly weaned pigs

To study the effects of diet complexity and multicarbohydrase (MC) supplementation, 144 piglets (6.70 ± 0.81 kg of BW) weaned at 21 ± 2 d of age (1:1 male to female ratio) were assigned to 1 of 6 dietary treatments in a 3 × 2 factorial arrangement based on diet complexity (complex1, complex2, and simple) and MC addition (0 vs. 0.1% of MC). Diets were provided in a 2-phase feeding program with phase I (d 1 to 14) and phase II diets (d 15 to 28). Complex1 was formulated to mimic a conventional weaner diet with blood plasma, fish meal, dried whey, and skim milk powder, whereas complex2 partially or totally replaced these ingredients with various plant-based ingredients. The simple diet primarily comprised corn, wheat, and soybean meal. No interactions were found between diet complexity and MC supplementation ( > 0.10), except for apparent total tract digestibility (ATTD) of ash and globulin concentration on d 28 ( < 0.05). Pigs fed the complex1 diet had greater ( < 0.01) ADG, ADFI, and G:F than those fed the other diets during the first week after weaning. However, no differences in ADG or ADFI were observed for pigs fed the complex1 and simple diets throughout the 28-d experimental period ( > 0.10), whereas the complex2 diet led to lower ADG and ADFI compared with the complex1 diet ( < 0.05). Overall, G:F was greater for pigs fed the simple diet compared with those fed the complex1 diet ( < 0.01). Pigs fed the simple diet showed ATTD of DM, OM, GE, and ash comparable to those fed the complex1 diet on d 14 ( > 0.10). In contrast, greater ATTD of DM, OM, NDF, GE, and ash was observed ( < 0.05) in pigs fed the complex1 diet than in those fed the complex2 diet or the simple diet on d 28. The simple diet increased the lymphocyte proportion in serum compared with the complex1 diet ( < 0.01) on d 14. Pigs fed the complex1 diet had a greater ( < 0.05) ratio of villus height (VH) to crypt depth (CD) in the ileum compared with the other diets. The complex2 diet decreased ( < 0.05) the fecal score during 3 wk of the postweaning period compared with the complex1 diet. Dietary MC supplementation increased ( < 0.05) G:F during the overall experimental period, VH in the ileum, VH:CD ratio in the duodenum, and ATTD of DM and GE but it reduced fecal score ( < 0.05). In conclusion, feeding a simple diet resulted in BW comparable to feeding the complex1 diet, but it led to inferior intestinal morphology and ATTD of nutrients on d 28. Also, MC supplementation could be beneficial regardless of diet complexity.

Overlap between irritable bowel syndrome and functional dyspepsia including subtype analyses

BACKGROUND AND AIM

Coexistent gastrointestinal symptom profiles and prevalence or associated factors for the overlap between each functional dyspepsia (FD) and irritable bowel syndrome (IBS) group remain unclear. Thus, the aim of the present study was to evaluate the clinicodemographic features of FD, IBS, and IBS-FD overlap and assess the risk factors thereof, including subtype and genetic polymorphisms for IBS-FD.

METHODS

Consecutive patients were enrolled from the outpatient Gastroenterology clinics of Bundang Seoul National University Hospitals in Korea. All gastrointestinal symptoms occurring at least once per week in the previous 3 months were recorded. Diagnostic criteria of functional gastrointestinal disorders were based on the Rome III criteria. Risk factors including genetic polymorphisms of 5-HTTLPR and ADRA2A 1291 G alleles and CCK-1R intron 779T>C were assessed using a multivariate logistic regression model.

RESULTS

A total of 632 subjects (278 control subjects, 308 FD, 156 IBS, and 110 who met the criteria for both FD and IBS) were included in this study. Patients with IBS-FD overlap had more severe symptoms (such as bloating, nausea, vomiting, hard or lumpy stools, defecation straining, and a feeling of incomplete bowel movement) and higher depression scores compared with non-overlap patients. Single/divorced or widowed marital status, nausea, bloating, and a feeling of incomplete emptying after bowel movements were independent risk factors for IBS-FD overlap among IBS patients. In contrast, young age, depression, bloating, and postprandial distress syndrome were positively associated with IBS-FD overlap among FD patients. 5-HTTLPR L/L was a risk factor for the co-occurrence of IBS-C among FD patients (OR: 12.47; 95% CI: 2.00-77.75; P = 0.007).

CONCLUSIONS

Bloating was a risk factor for IBS-FD overlap. Patients with postprandial distress syndrome have a higher risk of coexisting IBS, particularly constipation-dominant IBS.

Digestible, metabolizable, and net energy of camelina cake fed to growing pigs and additivity of energy in mixed diets

This experiment was conducted to determine the DE, ME, and NE contents of camelina cake (CC) and to test the hypothesis that dietary glucosinolates originating from CC will affect the additivity of energy in mixed diets containing different inclusion levels of corn, soybean meal (SBM), and CC. A total of 30 growing barrows ([Yorkshire × Landrace] × Duroc) with a mean BW of 16.8 kg (SD 1.4) were randomly allotted to 1 of 5 treatments with 6 replicates per treatment. Pigs were fed experimental diets for 16 d, including 10 d for adaptation and 6 d for total collection of feces and urine. The 5 experimental diets consisted of 3 corn-based diets to determine the DE, ME, and NE of the 3 ingredients (corn, SBM, and CC) and 2 mixed diets to test the additivity of DE, ME, and NE. The corn diet contained 97.52% corn; the SBM diet contained 67.52% corn and 30.0% SBM; the CC diet contained 67.52% corn and 30.0% CC; the Mixed diet 1 contained 67.52% corn, 20.0% SBM, and 10.0% CC; and the Mixed diet 2 contained 67.25% corn, 10.0% SBM, and 20.0% CC. Vitamins and minerals were included in the diets to meet or exceed the requirements for growing pigs (). Pigs were fed their assigned diets at 550 kcal ME/kg BW per day on the basis of BW on d 1, 5, and 10, which was close to ad libitum intake. Pigs had free access to water. Determined DE, ME, and NE contents of corn were 3,348, 3,254, and 2,579 kcal/kg, respectively; those of SBM were 3,626, 3,405, and 2,129 kcal/kg, respectively; and those of CC were 3,755, 3,465, and 2,383 kcal/kg, respectively. No differences between the predicted and determined DE, ME, and NE were observed in the 2 mixed diets. In conclusion, DE, ME, and calculated NE content of CC fed to growing pigs were 3,755, 3,465, and 2,383 kcal/kg (as-fed basis), respectively. In addition, additivity of DE, ME, and calculated NE was observed in the mixed diets containing corn, SBM, and CC, which indicates that dietary glucosinolates originating from up to 30% of CC inclusion do not affect DE, ME, and calculated NE of diets.

Management of Clevudine-Resistant Chronic Hepatitis B: A Multicenter Cohort Study

Background/Aims

Data are lacking regarding the management of chronic hepatitis B (CHB) with resistance to clevudine (CLV). This study evaluated the efficacy of different rescue therapies for CLV-resistant CHB.

Methods

Patients with CLV-resistant CHB were enrolled in the cohort, and all patients developed virologic breakthrough during CLV therapy and had confirmed-genotypic resistance to CLV (rtM204I mutation) before enrollment.

Results

Of the 107 patients, 12 received adefovir (ADV), 21 received a CLV plus ADV combination (CLV+ADV), 34 received a lamivudine plus ADV combination (LAM+ADV), and 40 received entecavir (ETV) therapy for 48 weeks. The CLV+ADV group had the lowest hepatitis B virus (HBV) DNA level (p<0.0001) and showed the greatest reduction of HBV DNA levels from baseline compared to all other groups (p=0.004) at week 48. HBV DNA was undetectable (<70 IU/mL) in 0%, 57.1%, 21.2%, and 27.5% (p=0.003) of the patients in each group, respectively, at week 48. At the end of the study, the mean alanine transaminase (ALT) level, rate of ALT normalization, and rate of hepatitis B envelope antigen loss or seroconversion did not differ between groups.

Conclusions

CLV+ADV combination therapy in patients with CLV-resistant CHB more effectively suppresses HBV replication than ETV, ADV, or LAM+ADV therapy.

Effects of N-acetylcysteine on First-Line Sequential Therapy for Helicobacter pylori Infection: A Randomized Controlled Pilot Trial

Background/Aims

To evaluate the adjuvant effects of N-acetylcysteine (NAC) on first-line sequential therapy (SQT) for Helicobacter pylori infection.

Methods

Patients with H. pylori infections were randomly assigned to receive sequential therapy with (SQT+NAC group, n=49) or without (SQT-only group, n=50) NAC. Sequential therapy consisted of rabeprazole 20 mg and amoxicillin 1 g for the first 5 days, followed by rabeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg for the remaining 5 days; all drugs were administered twice daily. For the SQT+NAC group, NAC 400 mg bid was added for the first 5 days of sequential therapy. H. pylori eradication was evaluated 4 weeks after the completion of therapy.

Results

The eradication rates by intention-to-treat analysis were 58.0% in the SQT-only group and 67.3% in the SQT+NAC group (p=0.336). The eradication rates by per-protocol analysis were 70.0% in the SQT-only group and 80.5% in the SQT+NAC group (p=0.274). Compliance was very good in both groups (SQT only/SQT+NAC groups: 95.2%/100%, p=0.494). There was no significant difference in the adverse event rates between groups (SQT-only/SQT+NAC groups: 26.2%/26.8%, p=0.947).

Conclusions

The H. pylori eradication rate was numerically higher in the SQT+NAC group than in the SQT-only group. As our data did not reach statistical significance, larger trials are warranted.

Living-donor liver transplantation for giant hepatic hemangioma with diffuse hemangiomatosis in an adult: a case report

Hepatic hemangioma represents the most common benign primary hepatic neoplasm. Although most such tumors are small and asymptomatic, giant hepatic hemangioma is frequently symptomatic, and requires intervention. Moreover, diffuse multiple hepatic hemangiomatosis occupying almost the entire liver is extremely rare in adults, and the optimal management for this condition is unclear. We report a case of a rapidly growing, symptomatic giant hepatic hemangioma with diffuse hepatic hemangiomatosis in a 50-year-old female patient who was treated by living-donor liver transplantation. This case shows malignant behavior of a benign hemangioma that required liver transplantation. Although this case could not meet the criteria for transplantation according to the MELD (model for end-stage liver disease) score system, it should be considered as an exceptional indication for deceased-donor liver allocation. Further studies of the mechanism underlying hemangioma growth are warranted.

Atopic dermatitis is inversely associated with hepatitis B antigen positivity: a population-based cohort study

BACKGROUND

No clear association between hepatitis B virus (HBV) infection and atopic dermatitis (AD) has been established. Some studies have reported that subjects with HBV had an increased risk of atopy; other studies reported an inverse association between HBV seropositivity and allergic diseases.

OBJECTIVE

We evaluated the association between AD and hepatitis B antigen (HBsAg) positivity using Korean National Health and Nutrition Examination Survey data.

METHODS

In total, 14 776 participants aged >19 years were included in the analysis. Multiple logistic regression analyses were used to evaluate the odds ratio of HBsAg positivity in association with AD and asthma.

RESULTS

The prevalence of HBsAg positivity was lower in individuals with AD than in those without AD (mean [SE], 0.7% [0.4] vs. 3.7% [0.2]; P < 0.001). However, HBsAg positivity was not significantly associated with asthma (3.7% [0.2] vs. 2.8% [0.8]; P < 0.001). HBsAg positivity decreased the risk of AD significantly (OR = 0.223; 95% CI = 0.069-0.72).

CONCLUSIONS

This study demonstrates an inverse association between AD and HBsAg positivity using a nationwide, population-based, cross-sectional health examination and survey.

Influence of a ring-shaped pump beam on temperature distribution and thermal lensing in end-pumped solid state lasers

A simple method for reducing thermal lensing in an end-pumped solid state laser using a ring-shaped pump beam is reported. Analytical expressions for the temperature distribution and the thermal lensing focal length in a laser medium end-pumped by a beam with a ring-shaped intensity profile are derived. The results indicate that thermal effects including thermal lensing can be significantly reduced due to a more uniform temperature distribution. This approach has been applied to a Nd:YVO₄ amplifier operating at 1064 nm confirming that the brightness of the output beam can be remarkably improved at high power levels due to the better beam quality for the ring-shaped pumping compared to the conventional quasi-top-hat pumping. The prospects for power scaling and further improvement in laser performance will be discussed.

Unified neural field theory of brain dynamics underlying oscillations in Parkinson's disease and generalized epilepsies

The mechanisms underlying pathologically synchronized neural oscillations in Parkinson's disease (PD) and generalized epilepsies are explored in parallel via a physiologically-based neural field model of the corticothalamic-basal ganglia (CTBG) system. The basal ganglia (BG) are approximated as a single effective population and their roles in the modulation of oscillatory dynamics of the corticothalamic (CT) system and vice versa are analyzed. In addition to normal EEG rhythms, enhanced activity around 4 Hz and 20 Hz exists in the model, consistent with the characteristic frequencies observed in PD. These rhythms result from resonances in loops formed between the BG and CT populations, analogous to those that underlie epileptic oscillations in a previous CT model, and which are still present in the combined CTBG system. Dopamine depletion is argued to weaken the dampening of these loop resonances in PD, and network connections then explain the significant coherence observed between BG, thalamic, and cortical population activity around 4-8 Hz and 20 Hz. Parallels between the afferent and efferent connection sites of the thalamic reticular nucleus (TRN) and BG predict low dopamine to correspond to a reduced likelihood of tonic-clonic (grand mal) seizures, which agrees with experimental findings. Furthermore, the model predicts an increased likelihood of absence (petit mal) seizure resulting from pathologically low dopamine levels in accordance with experimental observations. Suppression of absence seizure activity is demonstrated when afferent and efferent BG connections to the CT system are strengthened, which is consistent with other CTBG modeling studies. The BG are demonstrated to have a suppressive effect on activity of the CTBG system near tonic-clonic seizure states, which provides insight into the reported efficacy of current treatments in BG circuits. Sleep states of the TRN are also found to suppress pathological PD activity in accordance with observations. Overall, the findings demonstrate strong parallels between coherent oscillations in generalized epilepsies and PD, and provide insights into possible comorbidities.

Net energy of hemp hulls and processed hemp hull products fed to growing pigs and the comparison of net energy determined via indirect calorimetry and calculated from prediction equations

An experiment was conducted to determine the NE of hemp hulls (HH), extruded HH (EHH), and a blended product of HH with pea (HHP) fed to growing pigs using indirect calorimetry (IC) and to determine effects of dietary fiber on heat production (HP) and fasting HP (FHP). Twenty-four growing barrows with an average initial BW of 22.9 ± 1.75 kg were individually housed in adjustable metabolism crates. Pigs were randomly allotted to 1 of 4 dietary treatments with 6 replicates per treatment. A corn-soybean meal basal diet was prepared. Three additional diets were formulated to contain a constant ratio of corn and soybean meal and each of the test ingredients. Pigs were fed experimental diets for 16 d including 10 d for adaptation and 6 d for total collection of feces and urine to determine DE and ME of experimental diets. Pigs were then moved into IC chambers to determine HP and FHP. The apparent total tract digestibility (ATTD) of DM was greater ( < 0.01) in the HHP diet than in the HH and EHH diets but less ( < 0.01) than in the basal diet. Similarly, the ATTD of GE in the basal diet was greater ( < 0.01) compared with the HH, EHH, and HHP diets. The DE, ME, and NE of the basal diet were greater ( < 0.01) than those of the HH, EHH, and HHP diets. No significant differences were observed for the HP (on average, 1,904 kcal/kg DM) and FHP (on average, 1,320 kcal/kg DM) among treatments. However, the retained energy of pigs fed the basal diet (1,763 kcal/kg DM) was greater ( < 0.05) than for those fed the HH (1,501 kcal/kg DM) and HHP (1,482 kcal/kg DM) diets. The NE:ME ratio tended to be greater ( ≤ 0.10) for the basal diet (0.85) than for the HH (0.82), EHH (0.82), and HHP (0.83) diets. The NE of HH, EHH, and HHP determined by the IC method were 2,375, 2,320, and 2,399 kcal/kg DM, respectively, whereas values calculated using published prediction equations were 2,308, 2,161, and 2,278 kcal/kg DM, respectively. However there was no difference between determined and predicted values. In conclusion, the NE of HH, EHH, and HHP determined using the IC method were 2,375, 2,320, and 2,399 kcal/kg DM, respectively, and these values were 2.9, 7.1, and 5.2% greater, respectively, than the predicted values, although no difference was observed between determined and predicted values. However, the HP values observed for the basal diet and the diets containing high dietary fiber in the form of HH, EHH, or HHP were similar.

Acute endophthalmitis after cataract surgery: 164 consecutive cases treated at a referral center in South Korea

PurposeTo identify prognostic factors in patients referred with endophthalmitis after cataract surgery, and to evaluate the efficacy of primary vitrectomy as an initial management.MethodsOver an eight-year study period, we retrospectively reviewed the medical records of 164 patients who were referred with endophthalmitis following cataract surgery. Treatment generally conformed to standard guidelines, although primary vitrectomy was performed in several eyes with a visual acuity of hand motion or better, depending on the patient's status. Using multivariate analysis, we analyzed outcomes to determine the effect on final visual outcome.ResultsA final visual acuity of ≥20/40 was achieved in 92/164 (56.1%) cases after treatment. Bacterial cultures showed bacterial growth in 89/164 cases (54.3%). Among the various baseline characteristics, old age (P=0.028), poor visual acuity at presentation (P=0.004), gram-negative bacterial infection (P=0.030), and short time between cataract surgery and signs of endophthalmitis (P=0.021) were associated with poor visual outcome. The visual outcome showed no significant difference, in terms of initial treatment feature, between the primary vitrectomy with intraocular antibiotics injection (IOAI) and IOAI-only groups. However, reintervention was significantly less frequent in the primary vitrectomy group than in the IOAI group (12.5 and 32.7%, respectively; P=0.002).ConclusionOld age, poor visual acuity at presentation, type of cultured organism (gram-negative bacteria), and early onset of endophthalmitis after cataract surgery were significantly related to poor visual outcome after endophthalmitis treatment. Primary vitrectomy may decrease the need for reintervention to control infection, although the treatment showed no benefits with regard to visual outcome.

Three-dimensional imaging of dislocation dynamics during the hydriding phase transformation

Crystallographic imperfections significantly alter material properties and their response to external stimuli, including solute-induced phase transformations. Despite recent progress in imaging defects using electron and X-ray techniques, in situ three-dimensional imaging of defect dynamics remains challenging. Here, we use Bragg coherent diffractive imaging to image defects during the hydriding phase transformation of palladium nanocrystals. During constant-pressure experiments we observe that the phase transformation begins after dislocation nucleation close to the phase boundary in particles larger than 300 nm. The three-dimensional phase morphology suggests that the hydrogen-rich phase is more similar to a spherical cap on the hydrogen-poor phase than to the core-shell model commonly assumed. We substantiate this using three-dimensional phase field modelling, demonstrating how phase morphology affects the critical size for dislocation nucleation. Our results reveal how particle size and phase morphology affects transformations in the PdH system.

Standardized total tract digestibility of phosphorus in flaxseed meal fed to growing and finishing pigs without or with phytase supplementation

Two experiments were conducted to determine the apparent total tract digestibility (ATTD) and standardized total tract digestibility (STTD) of P in flaxseed meal (FM) and the effect of dietary microbial phytase on the digestibility of P in FM fed to growing and finishing pigs. In Exp. 1, eighteen growing barrows (26.6 ± 1.8 kg BW) were allotted to 1 of 3 experimental diets consisting of a diet containing 32% FM that was fed with or without phytase at 500 phytase units (FTU/kg and a P-free diet in a completely randomized design to give 6 replicates per diet. The experimental period lasted 12 d including first 7 d for adaptation and 5 d for total collection of feces. Pigs were fed their assigned diets at 4% of BW at the beginning of the experiment. The daily feed allowance was offered in 2 equal portions at 0800 and 1600 h. All experimental diets were provided in mash form. Results indicated that pigs fed the diets containing FM with dietary phytase had less ( < 0.05) fecal P concentration and daily P output than those fed the diets without phytase supplementation. Also, phytase supplementation increased ( < 0.05) the ATTD of P of the diets containing FM from 37.3% to 51.8% and STTD of P of the diets containing FM from 43.2% to 57.7%. The basal endogenous P losses (EPL) was calculated at 140 ± 11 mg/kg of DMI in growing pigs fed the P-free diet. In Exp. 2, eighteen finishing pigs (78.7 ± 2.4 kg BW) were randomly allotted to 1 of 3 dietary treatments. The experimental diets and procedures were similar to those described in Exp. 1. Similar to Exp. 1, pigs fed FM diets with phytase supplementation had less ( < 0.05) P concentration in feces than those fed diets without phytase supplementation. Also, daily P output was reduced ( = 0.08) when pigs were fed the FM diets with phytase compared to those fed the FM diets without phytase. The ATTD of P in FM diets was increased ( < 0.01) from 31.4% to 45.8%, whereas the STTD of P in FM diets was increased ( < 0.01) from 37.8% to 52.3% as a result of phytase supplementation. The basal EPL was calculated at 164 ± 19 mg/kg of DMI in finishing pigs fed the P-free diet. In conclusion, the ATTD and STTD of P in FM fed to growing pigs were 37.3% and 43.2%, respectively, whereas respective values for finishing pigs were 31.4%, and 37.8%, respectively. Also, dietary phytase supplementation improved both ATTD and STTD of P in FM for both stages of pigs by an average of 33%.

Differential MicroRNA Expression Between Gastric Cancer Tissue and Non-cancerous Gastric Mucosa According to Helicobacter pylori Status

Background

MicroRNAs (miRNAs) are key post-translational mechanisms which can regulate gene expression in gastric carcinogenesis. To identify miRNAs responsible for gastric carcinogenesis, we compared expression levels of miRNAs between gastric cancer tissue and non-cancerous gastric mucosa according to Helicobacter pylori status.

Methods

Total RNA was extracted from the cancerous regions of formalin-fixed, paraffin-embedded tissues of H. pylori-positive (n = 8) or H. pylori-negative (n = 8) patients with an intestinal type of gastric cancer. RNA expression was analyzed using a 3,523 miRNA profiling microarray based on the Sanger miRBase. Validation analysis was performed using TaqMan miRNA assays for biopsy samples from 107 patients consisted of control and gastric cancer with or without H. pylori. And then, expression levels of miRNAs were compared according to subgroups.

Results

A total of 156 miRNAs in the aberrant miRNA profiles across the miRNA microarray showed differential expression (at least a 2-fold change, P < 0.05) in cancer tissue, compared to noncancerous mucosa in both of H. pylori-negative and -positive samples. After 10 promising miRNAs were selected, validations by TaqMan miRNA assays confirmed that two miRNAs (hsa-miR-135b-5p and hsa-miR-196a-5p) were significantly increased and one miRNA (hsa-miR-145-5p) decreased in cancer tissue compared to non-cancerous gastric mucosa at H. pylori-negative group. For H. pylori-positive group, three miRNAs (hsa-miR-18a-5p, hsa-miR-135b-5p, and hsa-miR-196a-5p) were increased in cancer tissue. hsa-miR-135b-5p and hsa-miR-196a-5p were increased in gastric cancer in both of H. pylori-negative and -positive.

Conclusions

miRNA expression of the gastric cancer implies that different but partially common gastric cancer carcinogenic mechanisms might exist according to H. pylori status.

Preoperative clinical features of reactivated of Graves' orbitopathy after orbital decompression

PurposeTo investigate the incidence and preoperative clinical features of reactivated Graves' orbitopathy (GO) after orbital decompression.MethodsThis study included patients with GO who underwent orbital decompression for disfiguring proptosis and not compressive optic neuropathy and received postoperative follow-up care for more than 12 months. Patients who experienced active inflammatory signs within 6 months of decompression were excluded from analysis. The demographic characteristics, ophthalmic manifestations, and biochemical parameters of the patients were analyzed for association with reactivation of GO by logistic regression analysis.ResultsOut of the 92 patients included in this study, seven (7.6%) experienced reactivation of GO after orbital decompression. The mean time interval between surgery and reactivation of GO was 36.3±14.3 weeks. Univariate logistic regression analysis identified age, existing smoking habits, and modified NOSPECS and Gorman scores as significant factors for the reactivation of GO. The results of multivariate logistic regression analysis revealed that smoking and modified NOSPECS and Gorman scores were associated with the reactivation of GO.ConclusionsQuitting smoking is important for the prevention of reactivation of GO after orbital decompression. Patients with severe symptoms, especially those with restrictive myopathy, should be carefully monitored for reactivation of GO after orbital decompression.

Hypoallergenic and Physicochemical Properties of the A2 β-Casein Fractionof Goat Milk

Goat milk has a protein composition similar to that of breast milk and contains abundant nutrients, but its use in functional foods is rather limited in comparison to milk from other sources. The aim of this study was to prepare a goat A2 β-casein fraction with improved digestibility and hypoallergenic properties. We investigated the optimal conditions for the separation of A2 β-casein fraction from goat milk by pH adjustment to pH 4.4 and treating the casein suspension with calcium chloride (0.05 M for 1 h at 25°C). Selective reduction of β-lactoglobulin and α_s-casein was confirmed using sodium dodecyl sulphate-polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography. The hypoallergenic property of A2 β-casein fraction was examined by measuring the release of histamine and tumor necrosis factor alpha from HMC-1 human mast cells exposed to different proteins, including A2 β-casein fraction. There was no significant difference in levels of both indicators between A2 β-casein treatment and the control (no protein treatment). The A2 β-casein fraction is abundant in essential amino acids, especially, branched-chain amino acids (leucine, valine, and isoleucine). The physicochemical properties of A2 β-casein fraction, including protein solubility and viscosity, are similar to those of bovine whole casein which is widely used as a protein source in various foods. Therefore, the goat A2 β-casein fraction may be useful as a food material with good digestibility and hypoallergenic properties for infants, the elderly, and people with metabolic disorders.

Expression of Leucine-rich Repeat-containing G-protein Coupled Receptor 5 and CD44: Potential Implications for Gastric Cancer Stem Cell Marker

BACKGROUND

The human leucine-rich repeat-containing G-protein coupled receptor (LGR) 5 and CD44 are one of the candidates for the marker of gastric cancer stem cells. We compared the expressions of two genes among control, dysplasia and cancer groups.

METHODS

We compared the mRNA expression of LGR5, CD44 and CD44v8-10 and immunohistochemistry (IHC) of LGR5 and CD44 in gastric antral mucosa of 45 controls, 36 patients with gastric dysplasia, and 39 patients with early gastric cancer. Additionally, IHC of LGR5 in gastric body mucosa was analyzed. Normal mucosa adjacent to dysplastic or cancer lesions was used for the quantitative real-time-PCR and IHC.

RESULTS

Immunoreactivity of LGR5 in base of antral mucosa was higher in non-cancerous tissues of cancer than those of control (P = 0.006), whereas the expression of LGR5 mRNA was not different among the three groups. Immunostaining of LGR5 was much stronger in the antrum than in the body of stomach (P < 0.001). Although there was no difference in antral immunointensity of LGR5 according to the severity of intestinal metaplasia, stronger immunostaining was found in the body with an aggravation of intestinal metaplasia (P trend < 0.001). The expression of CD44v8-10 mRNA was higher in cancer patients than control subjects and patients with dysplasia (P = 0.018 and 0.009) while the expression of CD44 mRNA was higher in the control groups than the others.

CONCLUSIONS

IHC of LGR5 in crypt base and CD44 may be used for gastric CSC markers. LGR5 expression may be associated with the developing of corporal intestinal metaplasia. The expression of CD44v8-10 mRNA would be more suitable for gastric cancer stem cell marker than CD44 or LGR5 mRNA.

Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection

AIM

To clarify the prevalence of occult hepatitis B virus (HBV) infection (OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma (HCC), worsening of Child-Pugh class, or mortality in cases of chronic hepatitis C virus (HCV) infection.

METHODS

This prospective cohort study enrolled 174 patients with chronic HCV infection (chronic hepatitis, n = 83; cirrhosis, n = 47; HCC, n = 44), and evaluated disease progression during a mean follow-up of 38.7 mo. OBI was defined as HBV DNA positivity in 2 or more different viral genomic regions by nested polymerase chain reaction using 4 sets of primers in the S, C, P and X open reading frame of the HBV genome.

RESULTS

The overall OBI prevalence in chronic HCV patients at enrollment was 18.4%, with 16.9%, 25.5% and 13.6% in the chronic hepatitis C, liver cirrhosis and HCC groups, respectively (P = 0.845). During follow-up, 52 patients showed disease progression, which was independently associated with aspartate aminotransferase > 40 IU/L, Child-Pugh score and sustained virologic response (SVR), but not with OBI positivity. In 136 patients who were not in the SVR state during the study period, OBI positivity was associated with neither disease progression, nor HCC development.

CONCLUSION

The prevalence of OBI in chronic HCV patients was 18.4%, and OBI was not associated with disease progression in South Koreans.