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Background: Recently, the outcomes of surgical treatment for advanced hepatocellular carcinoma (HCC) have improved. However, despite the technical advancements in laparoscopic liver resection (LLR), it is still not recommended as the standard treatment for HCC with portal vein tumor thrombosis (PVTT) because of the poor oncological outcomes. This study aims to compare the clinical outcomes of open liver resection (OLR) and LLR in patients with HCC with PVTT. Methods: A total of 86 patients with PVTT confirmed in the pathological report between January 2014 and December 2018, were enrolled. Short-term, postoperative, and long-term outcomes, including recurrence-free survival and overall survival rates, were evaluated. Results: No difference between the two groups, except for age, was detected. The median age in the laparoscopic group was significantly higher than that in the open group. Regarding the pathological features, the maximal tumor size was significantly larger in the OLR; other pathological factors did not differ. There was no significant difference between overall survival (OS) and recurrence-free survival (RFS). Vp3 PVTT (hazards ratio [HR] 6.1, 95% confidence interval [CI] 1.9–18.5), Edmondson grade IV (HR 4.7, 95% CI 1.7–12.9, p = 0.003), and intrahepatic metastasis (HR 3.9, 95% CI 2.1–7.2, p < 0.001) remained the unique independent predictors of recurrence-free survival according to a multivariate Cox proportional hazard regression analysis. Conclusions: Laparoscopic liver resection for the management of HCC with PVTT provides the same short- and long-term results as those of the open approach. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P =.03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review and meta-analysis. Objective: Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. Methods: Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P <.05). Results: Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P =.006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P =.04)]. Conclusion: Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques. [ABSTRACT FROM AUTHOR]

Patients with cartilage invasion in hypopharyngeal squamous cell carcinoma (HPSCC) would benefit from partial laryngopharyngectomy (PLP). The purpose of this study was to examine the treatment outcomes of PLP for HPSCC with cartilage invasion, with a focus on the oncological safety and the function preservation. We performed a retrospective review of 28 patients with HPSCC with thyroid or cricoid cartilage invasion who had undergone upfront surgery and were followed for more than one year between 1993 and 2019. Twelve patients treated with PLP (42.9%) and 16 patients treated with total laryngopharyngectomy (TLP) for cartilage invasion in HPSCC were identified. There was no significant difference in recurrence between the PLP group (7/12, 58.3%) and the TLP group (8/16, 50.0%) (p =.718). PLP was not associated with decreased five-year disease free survival (p =.662) or disease specific survival (p =.883) rates compared to TLP. Nine patients receiving PLP could be decannulated and retained intelligible speech (9/12, 75%). Gastrostomy tubes were placed in the PLP group (5/12, 42.9%) and TLP group (1/16, 6.2%) (p =.057). PLP appears to be a feasible option for the treatment of thyroid or cricoid cartilage invasion in HPSCC. [ABSTRACT FROM AUTHOR]

While sevoflurane and desflurane have been regarded as inhalation agents providing rapid induction and emergence, previous studies demonstrated the superiority of desflurane-anesthesia compared to sevoflurane-anesthesia in the postoperative recovery in obese and geriatric patients. We investigated whether a short-term switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia enhances patient postoperative recovery profile in non-obese patients. We randomly divide patients undergoing elective surgery (n = 60) into two groups: sevoflurane-anesthesia group (Group-S, n = 30) and sevoflurane-desflurane group (Group-SD, n = 30). In Group-S, patients received only sevoflurane-anesthesia until the end of surgery (for >2 hours). In Group-SD, sevoflurane was stopped and switched to desflurane-anesthesia before the completion of sevoflurane-anesthesia (for approximately 30 minutes). We assessed the intergroup differences in the times to get eye-opening, extubation, and a bispectral index of 80 (BIS-80). Group-SD showed significantly shorter times to get eye-opening (438 ± 101 vs. 295 ± 45 s; mean difference, 143 s; 95% confidence interval [CI], 101–183; p < 0.001), extubation (476 ± 108 vs. 312 ± 42 s; mean difference, 164 s; 95% CI, 116–220; p < 0.001), and BIS-80 (378 ± 124 vs. 265 ± 49 minutes; mean difference, 113 s; 95% CI, 58–168 p < 0.001) compared to Group-S. There was no between-group difference in postoperative nausea, vomiting, and hypoxia incidences. Our results suggested that the short-term (approximately 30 minutes) switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia can facilitate the speed of postoperative patient recovery. [ABSTRACT FROM AUTHOR]

Background. Herbal medicine is widely recommended to treat viral infectious diseases. Over 123,000,000 individuals have been infected with the coronavirus since a worldwide pandemic was declared in March 2020. We conducted this research to confirm the potential of herbal medicine as a treatment for coronavirus. Methods. We infected the A549 cell line with betacoronavirus OC43 and then treated it with 100 μg/mL Hyunggaeyungyo-tang (HGYGT) or distilled water with a control of HGYGT. We measured the mRNA expression levels of proinflammatory cytokines and interferon stimulated genes (ISGs) to confirm the effectiveness of HGYGT upon coronavirus infection. Results. We found that the effects of HYGYT decrease the expression level of pPKR, peIF2α, IFI6, IFI44, IFI44L, IFI27, IRF7, OASL, and ISG15 when administered to cells with coronavirus infection. The expressions of IL-1, TNF-α, COX-2, NF-κB, iNOS, and IKK mRNA were also significantly decreased in the HGYGT group than in the control group. Conclusion. Through the reduction of the amount of coronavirus RNA, our research indicates that HGYGT has antiviral effects. The reduction of IKK and iNOS mRNA levels indicate that HGYGT reduces coronavirus RNA expression and may inhibit the replication of coronavirus by acting on NF-kB/Rel pathways to protect oxidative injury. In addition, decreases in mRNA expression levels of proinflammatory cytokines indicate that the HGYGT may relieve the symptoms of coronavirus infections. [ABSTRACT FROM AUTHOR]

Background: Radical resection is the only curative treatment for patients with hilar cholangiocarcinoma. While left-side hepatectomy (LH) may have an oncological disadvantage over right-side hepatectomy (RH) owing to the contiguous anatomical relationship between right hepatic inflow and biliary confluence, a small future liver remnant after RH could cause worse surgical morbidity and mortality. We retrospectively compared surgical morbidity and long-term outcome between RH and LH to determine the optimal surgical strategy for the treatment of hilar cholangiocarcinoma. Methods: This study considered 83 patients who underwent surgical resection for hilar cholangiocarcinoma between 2010 and 2017. Among them, 57 patients undergoing curative-intent surgery including liver resection were enrolled for analysis—33 in the RH group and 27 in the LH group. Prospectively collected clinicopathologic characteristics, perioperative outcomes, and long-term survival were evaluated. Results: Portal vein embolization was more frequently performed in the RH group than in the LH group (18.2% vs. 0%, P = 0.034). The proportion of R0 resection was comparable in both groups (75.8% vs. 75.0%, P = 0.948). The 5-year overall and recurrence-free survival rates did not differ between the groups (37.7% vs. 41.9%, P = 0.500, and 26.3% vs. 33.9%, P = 0.580, respectively). The side of liver resection did not affect long-term survival. In multivariate analysis, transfusion (odds ratio, 3.12 [1.42–6.87], P = 0.005) and post-hepatectomy liver failure (≥ grade B, 4.62 [1.86–11.49], P = 0.001) were independent risk factors for overall survival. Conclusions: We recommend deciding the side of liver resection according to the possibility of achieving radical resection considering the anatomical differences between RH and LH. [ABSTRACT FROM AUTHOR]

Blinatumomab, a bispecific T cell-engaging antibody, has demonstrated efficacy for relapsed or refractory acute lymphoblastic leukemia (ALL). In this study, we evaluated the efficacy and toxicity of blinatumomab in adult Korean patients with relapsed or refractory Philadelphia-negative B cell precursor ALL. A total of 50 patients received blinatumomab treatment between June 2016 and August 2017 in Korea. The median number of prior therapy was one (range, 1-4). Among the 49 evaluable patients, 22 (44.9%) achieved complete response (CR) or CR with incomplete blood count recovery, and 16 of whom subsequently underwent allogenic stem cell transplantation. Although no statistically significant differences were observed, patients with extramedullary disease and poor performance status had lower responses to blinatumomab treatment. In addition, the use of high-dose dexamethasone prior to blinatumomab treatment did not affect the response to blinatumomab. The median event-free survival and overall survival of the responders were 7.5 and 8.1 months, respectively. For non-hematologic toxicities, the most common toxicity was infection. The incidences of severe cytokine release syndrome and neurologic toxicity each was 4%. In conclusion, blinatumomab was an effective and tolerable therapy in adult Korean patients with relapsed or refractory Philadelphia-negative B cell precursor ALL. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.Methods: The present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy.Results: Five-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS.Conclusion: Margin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery. [ABSTRACT FROM AUTHOR]

Purpose: AGM-130 is a cyclin-dependent kinase inhibitor that exhibits dose-dependent efficacy in xenograft mouse models. During preclinical pharmacokinetic (PK) studies, mice and rats showed comparable PK parameters while dogs showed unusually high clearance (CL), which has made human PK prediction challenging. To address this discrepancy, we performed a human microdosing PK and developed a mouse PK/PD model in order to guide the first-in-human studies.Methods: A microdose of AGM-130 was given via intravenous injection to healthy subjects. Efficacy data obtained using MCF-7 breast cancer cells implanted in mice was analyzed using pre-existing tumor growth inhibition models. We simulated a human PK/PD profile with the PK parameters obtained from the microdose study and the PD parameters estimated from the xenograft PK/PD model.Results: The human CL of AGM-130 was 3.08 L/h/kg, which was comparable to CL in mice and rats. The time-courses of tumor growth in xenograft model was well described by a preexisting model. Our simulation indicated that the human doses needed for 50 and 90% inhibition of tumor growth were about 100 and 400 mg, respectively.Conclusions: This is the first report of using microdose PK and xenograft PK/PD model to predict efficacious doses before the first-in-human trial in cancer patients. In addition, this work highlights the importance of integration of all of information in PK/PD analysis and illustrates how modeling and simulation can be used to add value in the early stages of drug development. [ABSTRACT FROM AUTHOR]

Objective: (18F-fluoropentyl)triphenylphosphonium salt (18F-FPTP) is a new promising myocardial PET imaging tracer. It shows high accumulation in cardiomyocytes and rapid clearance from liver. We performed compartmental analysis of 18F-FPTP PET images in rat and evaluated two linear analyses: linear least-squares (LLS) and a basis function method (BFM) for generating parametric images. The minimum dynamic scan duration for kinetic analysis was also investigated and computer simulation undertaken.Methods: 18F-FPTP dynamic PET (18 min) and CT images were acquired from rats with myocardial infarction (MI) (n = 12). Regions of interest (ROIs) were on the left ventricle, normal myocardium, and MI region. Two-compartment (K 1 and k 2; 2C2P) and three-compartment (K 1-k 3; 3C3P) models with irreversible uptake were compared for goodness-of-fit. Partial volume and spillover correction terms (V a and α = 1 - V a ) were also incorporated. LLS and BFM were applied to ROI- and voxel-based kinetic parameter estimations. Results were compared with the standard ROI-based nonlinear least-squares (NLS) results of the corresponding compartment model. A simulation explored statistical properties of the estimation methods.Results: The 2C2P model was most suitable for describing 18F-FPTP kinetics. Average K 1, k 2, and V a values were, respectively, 6.8 (ml/min/g), 1.1 (min-1), and 0.44 in normal myocardium and 1.4 (ml/min/g), 1.1 (min-1), and 0.32, in MI tissue. Ten minutes of data was sufficient for the estimation. LLS and BFM estimations correlated well with NLS values for the ROI level (K 1: y = 1.06x + 0.13, r 2  = 0.96 and y = 1.13x + 0.08, r 2  = 0.97) and voxel level (K 1: y = 1.22x - 0.30, r 2  = 0.90 and y = 1.26x + 0.00, r 2  = 0.92). Regional distribution of kinetic parametric images (αK 1, K 1, k 2, V a) was physiologically relevant. LLS and BFM showed more robust characteristics than NLS in the simulation.Conclusions: Fast kinetics and highly specific uptake of 18F-FPTP by myocardium enabled quantitative analysis with the 2C2P model using only the initial 10 min of data. LLS and BFM were feasible for estimating voxel-wise parameters. These two methods will be useful for quantitative evaluation of 18F-FPTP distribution in myocardium and in further studies with different conditions, disease models, and species. [ABSTRACT FROM AUTHOR]

Background: The optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months.Methods: A total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group.Results: The mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery.Conclusions: We suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome. [ABSTRACT FROM AUTHOR]

Background: A few studies have reported only short-term outcomes of various robotic and laparoscopic liver resection types; however, published data in left lateral sectionectomy (LLS) have been limited. The aim of this study was to compare the long- and short-term outcomes of robotic and laparoscopic LLS.Methods: We retrospectively compared demographic and perioperative data as well as postoperative outcomes of robotic (n = 12) and laparoscopic (n = 31) LLS performed between May 2007 and July 2013. Resection indications included malignant tumors (n = 31) and benign lesions (n = 12) including intrahepatic duct (IHD) stones (n = 9).Results: There were no significant differences in perioperative outcomes of estimated blood loss, major complications, or lengths of stay, but operating time was longer in robotic than in laparoscopic LLS (391 vs. 196 min, respectively) and the operation time for IHD stones did not differ between groups (435 vs. 405 min, respectively; p = 0.190). Disease-free (p = 0.463) and overall (p = 0.484) survival of patients with malignancy did not differ between groups. The 2- and 5-year disease-free survival rates were 63.2 and 36.5 %, respectively. However, robotic LLS costs were significantly higher than laparoscopic LLS costs ($8183 vs. $5190, respectively; p = 0.009).Conclusions: Robotic LLS was comparable to laparoscopic LLS in surgical outcomes and oncologic integrity during the learning curve. Although robotic LLS was more expensive and time intensive, it might be a good option for difficult indications such as IHD stones. [ABSTRACT FROM AUTHOR]

Background: No novel chemotherapeutic combinations have demonstrated superior efficacy to etoposide/cisplatin (EP), a standard treatment regimen for extensive-stage small cell lung carcinoma (ES-SCLC) over the past decade. We aimed to compare the efficacy and safety of belotecan/cisplatin (BP) and EP regimens in chemotherapy- and radiotherapy-naïve patients with previously untreated ES-SCLC.Methods: We conducted a multi-center, randomized, open-label, parallel-group, phase III clinical study. A total of 157 patients were recruited at 14 centers with 147 patients meeting the inclusion/exclusion criteria and randomized to either BP (n = 71) or EP (n = 76) treatment arms. A non-inferior response rate (RR) in the BP arm, analyzed by intent-to-treat analysis according to Response Evaluation Criteria in Solid Tumors version 1.0 criteria, was used as the primary endpoint. The secondary endpoints were progression-free survival (PFS) and overall survival (OS).Results: In the BP arm, one patient had a complete response, 41 had a partial response (PR), and 17 had stable disease (SD). In the EP arm, 35 patients had PR and 28 had SD. The RR in the BP arm was non-inferior to the EP regimen in patients with ES-SCLC (BP: 59.2 %, EP: 46.1 %, difference: 13.1 %, 90 % two-sided confidence interval: -0.3-26.5, meeting the predefined non-inferiority criterion of -15.0 %). No significant differences in OS or PFS were observed between the treatment arms. Hematologic toxicities, including grade 3/4 anemia and thrombocytopenia, were significantly more prevalent in the BP arm than the EP arm.Conclusions: The RR to the BP regimen was non-inferior to the EP regimen in chemotherapy- and radiotherapy-naïve patients with previously untreated ES-SCLC. Hematologic toxicities were significantly more prevalent in the BP group, indicating that BP should be used with care, particularly in patients with a poor performance status. Further studies assessing PFS and OS are required to validate the superiority of the BP regimen.Trial Registration: ClinicalTrials.gov identifier NCT00826644 . Date of Registration: January 21, 2009. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Effect of Cilostazol in Acute Lacunar Infarction Based on Pulsatility Index of Transcranial Doppler (ECLIPse) study showed a significant decrease in transcranial Doppler pulsatility index (PI) with cilostazol treatment after 90 days of acute lacunar infarction. The aim of this analysis was to perform a subgroup analysis of the ECLIPse study to explore the relationship between serum uric acid (UA) and the volume of white matter hyperintensities (WMH) in patients with acute lacunar infarction.Methods: The ECLIPse was a multicenter, randomized, double-blind, placebo-controlled study conducted in Korea. For this subgroup analysis, WMH volume was measured for those subjects for whom FLAIR or T2-weighted images were available using semiautomated computerized software.Results: Of the 203 patients in 8 hospitals in the ECLIPse study, 130 in 6 hospitals were entered for this subgroup analysis. The mean age was 64.7 ± 9.95 years, and 20.8% were women. The mean WMH volume was 11.57 cm(3) (.13 to 68.45, median 4.86) and mean serum UA was 5.2 mg/dL (1.5 to 8.9). Multiple linear regression analysis revealed that age (P < .001) and serum UA (P = .013) were significantly associated with WMH volume. Age-adjusted scatterplots showed that serum UA level was positively related to WMH volume in patients with acute lacunar infarction (r = 0.275, P = .003).Conclusions: This study showed that serum UA was associated with cerebral WMH in patients with acute lacunar infarction. [ABSTRACT FROM AUTHOR]

A comparison of critical flow models between the Trapp–Ransom and Henry–Fauske models for all SBLOCA (small break loss of coolant accident) scenarios of the ATLAS (advanced thermal–hydraulic test loop for accident simulation) facility was performed using the MARS-KS code. For the comparison of the two critical models, the accumulated break mass was selected as the main parameter for the comparison between the calculations and tests. Four cases showed the same respective discharge coefficients between the two critical models, e.g., 6″ CL (cold leg) break and 25%, 50%, and 100% DVI (direct vessel injection) breaks. In the case of the 4″ CL break, no reasonable results were obtained with any possible Cd values. In addition, typical system behaviors, e.g., PZR (pressurizer) pressure and collapsed core water level, were also compared between the two critical models. From the comparison between the two critical models for CL breaks, the Trapp–Ransom model predicted quite well with respect to the other model for the smallest and larger breaks, e.g., 2″, 6″, and 8.5″ CL breaks. In addition, from the comparison between the two critical models for DVI breaks, the Trapp–Ransom model predicted quite well with respect to the other model for the smallest and larger breaks, e.g., 5%, 50%, and 100% DVI breaks. In the case of 50% and 100% breaks, the two critical models predicted the test data quite well. [ABSTRACT FROM AUTHOR]

The purpose of this study is to provide information for the protection of Korean homecare patients with senile dementia by investigating accident cases using a survey. With the survey of accident cases, the caregivers of 55 Korean homecare patients with senile dementia (75.9 ± 7.0 years) were administered the short form of the Samsung Dementia Questionnaire (S-SDQ) and an activities of daily living (ADL) test. Twelve risk elements were extracted. The order of frequency of occurrence from highest to lowest was "egress," "fall," "violence," "collision," "gas accident," "slip," "faucet misuse," "overeating," "drop," "discharge," "weird eating," and "self-injury." The percentage of risk elements resulting in physical harm was 40.1% across all risk elements. The risk elements resulting in the most physical harm were "fall," "collision," "slip," and "drop," respectively. Regarding the location of occurrence of risk elements, risk elements resulting in physical harm showed no significant differences between indoors and outdoors. Some risk elements, such as "egress," "fall," and "gas accident" happened concurrently with more than four other elements, while "collision," "drop," and "violence" happened together with more than two other elements. "Slip" happened significantly more often in the low ADL score group, while "gas accident" happened significantly more often in the high ADL score group. This study provides basic information about monitoring factors to protect senior homecare patients with senile dementia. [ABSTRACT FROM AUTHOR]

Background: Single-agent chemotherapy is considered a good and safe treatment option for elderly patients with advanced gastric cancer (AGC). We investigated the efficacy and safety of trastuzumab plus low-dose capecitabine in elderly patients with previously untreated human epidermal growth factor receptor 2 (HER2)-positive AGC.Methods: Patients aged 75 years or older with tumors having HER2 overexpression defined as either immunohistochemistry (IHC) 3+ or IHC 2+ and in situ hybridization-positive were eligible for inclusion. Patients received capecitabine (1000 mg/m(2)) orally twice daily on days 1-14 and trastuzumab (8 mg/kg for cycle 1, followed by 6 mg/kg) intravenously on day 1 of a 21-day cycle. The primary endpoint was progression-free survival (PFS).Results: Twenty patients were enrolled. The median age was 79 years (range 75-91). Nine patients (45 %) had ECOG performance status 2. Median PFS was 5.2 months (95 % CI 1.9-8.4 months), and median overall survival was 9.3 months (95 % CI 4.0-14.6 months). The confirmed response rate was 40 % (95 % CI 19-64 %) with disease control rate of 80 %. Grade 3-4 toxicities were anorexia (10 %), fatigue (5 %), stomatitis (5 %), and anemia (5 %). No treatment-related deaths or symptomatic congestive heart failure were observed.Conclusions: Low-dose capecitabine plus trastuzumab is effective and well tolerated in elderly patients with HER2-positive AGC. [ABSTRACT FROM AUTHOR]

Background: Previous studies have indicated that the model for end-stage liver disease (MELD) score may fail to predict post-transplantation patient survival. Similarly, other scores (donor MELD score, balance of risk score) that have been developed to predict transplant outcomes have not gained widespread use. These scores are typically derived using linear statistical models. This study aimed to compare the performance of traditional statistical models with machine learning approaches for predicting survival following liver transplantation.Materials and Methods: Data were obtained from 785 deceased donor liver transplant recipients enrolled in the Korean Organ Transplant Registry (2014-2019). Five machine learning methods (random forest, artificial neural networks, decision tree, naïve Bayes, and support vector machine) and four traditional statistical models (Cox regression, MELD score, donor MELD score and balance of risk score) were compared to predict survival.Results: Among the machine learning methods, the random forest yielded the highest area under the receiver operating characteristic curve (AUC-ROC) values (1-month = 0.80; 3-month = 0.85; and 12-month = 0.81) for predicting survival. The AUC-ROC values of the Cox regression analysis were 0.75, 0.86, and 0.77 for 1-month, 3-month, and 12-month post-transplant survival, respectively. However, the AUC-ROC values of the MELD, donor MELD, and balance of risk scores were all below 0.70. Based on the variable importance of the random forest analysis in this study, the major predictors associated with survival were cold ischemia time, donor ICU stay, recipient weight, recipient BMI, recipient age, recipient INR, and recipient albumin level. As with the Cox regression analysis, donor ICU stay, donor bilirubin level, BAR score, and recipient albumin levels were also important factors associated with post-transplant survival in the RF model. The coefficients of these variables were also statistically significant in the Cox model (p < 0.05). The SHAP ranges for selected predictors for the 12-month survival were (-0.02,0.10) for recipient albumin, (-0.05,0.07) for donor bilirubin and (-0.02,0.25) for recipient height. Surprisingly, although not statistically significant in the Cox model, recipient weight, recipient BMI, recipient age, or recipient INR were important factors in our random forest model for predicting post-transplantation survival.Conclusion: Machine learning algorithms such as the random forest were superior to conventional Cox regression and previously reported survival scores for predicting 1-month, 3-month, and 12-month survival following liver transplantation. Therefore, artificial intelligence may have significant potential in aiding clinical decision-making during liver transplantation, including matching donors and recipients. [ABSTRACT FROM AUTHOR]

For parametric evaluations of direct vessel injection (DVI) line break scenarios, the pressurizer (PZR) pressure, core collapsed water level, and peak cladding temperature were investigated between analyses and tests. The PZR pressure was mainly dependent upon the break flow model, e.g., discharge coefficient of the Henry-Fauske critical model. The core collapsed water level and peak cladding temperature were mainly dependent upon the counter-current flow limit (CCFL) option of the fuel alignment plate (FAP). The CCFL option of the cross-over leg (COL) affected the PZR pressure due to loop seal clearings, and seemed to have little effect on the core collapsed water level. Proper C d values and applicable CCFL options were summarized. C d values seemed to be dependent upon the sizes of the DVI line break. Although there is little difference for the CCFL options of the COL, the Ku-option was a preference for COLs’ CCFL option. The CCFL options of the FAP appeared to be sensitive to the core collapsed water level and peak cladding temperature. The Ku-option of the FAP tended to negatively exaggerate the core behavior and showed excessively conservative results, especially on the peak cladding temperature. For smaller breaks, e.g., ⩽25%, NA- and Wa-options will be applicable for the FAP. However, for larger breaks, e.g., ⩾50%, the Wa-option of the FAP was the preferred option. From comparisons between tests and analyses for four different DVI line break scenarios with respect to the PZR pressure, the downcomer water level, core water level, and clad temperature, selected C d , and CCFL options showed conservatively good results. [ABSTRACT FROM AUTHOR]

Because of the characteristics of cable-supported bridges, the cable tensile force is considered a critical item in their maintenance. In particular, because the evaluation of the cable tensile force in a cable-stayed bridge is essential for understanding the general status of the structural system, identifying the initial values of this force in the construction of a bridge and then accurately predicting and comparing its estimated values during traffic use are very important tasks for the maintenance of a cable-stayed bridge. Therefore, in this study, a vision-based monitoring system that utilizes an image processing technique was developed to estimate the tensile force of stay cables during traffic use. A remotely controllable pan-tilt drive was installed in the developed vision-based monitoring system to estimate the forces on multiple cables using a single system. The use of a 20× electric zoom lens made it possible to achieve sufficient resolution to remotely derive the dynamic characteristics of the stay cables. [ABSTRACT FROM PUBLISHER]

To effectively evaluate and analyze R&D performance, it is necessary to measure the relative importance of performance analysis factors and quantitative analysis methods that consider the objectivity and relevance of detail factors that constitute performance evaluation. This study suggests a framework for R&D performance evaluations by computing weights through an AHP (Analytical Hierarchy Process) expert survey and by applying a Bayesian Network approach whereby, through which, giving objectivity and allowing inference analyses. This framework can be used as a performance analysis indicator, which uses input and output performance factors in order to perform quantitative analysis for projects. We can quantitatively define the satisfactory level of each project and each performance analysis factor by assigning probability values. It is possible to analyze the relationship between project evaluation results (qualitative evaluation) and performance analysis indicator (quantitative performance). This performance analysis framework can infer posteriori probability using the prior probability and the likelihood function of each performance factor. In addition, by inferring the relationships among performance factors, it allows performing probability analyses on the successful and unsuccessful factors, which can provide further feedback. In conclusion, the framework would improve the national R&D program in terms of financial investment efficiency by aligning budget allocation and performance evaluation. [ABSTRACT FROM AUTHOR]

Genomic analyses have revealed the enormous heterogeneity in essentially all cancer types. However, the identification of precise subtypes, which are biologically informative and clinically useful, remains a challenge. The application of integrative analysis of multilayered genomic profiles to define the chromosomal regions of genomic copy number alterations with concomitant transcriptional deregulation is posited to provide a promising strategy to identify driver targets. In this study, we performed an integrative analysis of the DNA copy numbers and gene expression profiles of hepatocellular carcinoma (HCC). By comparing DNA copy numbers between HCC subtypes based on gene expression pattern, we revealed the DNA copy number alteration with concordant gene expression changes at 6p21–p24 particularly in the HCC subtype of aggressive phenotype without expressing stemness genes. Among the genes at 6p21–p24, we identified IER3 as a potential driver. The clinical utility of IER3 copy numbers was demonstrated by validating its clinical correlation with independent cohorts. In addition, short hairpin RNA–mediated knock-down experiment revealed the functional relevance of IER3 in liver cancer progression. In conclusion, our results suggest that genomic copy number alterations with transcriptional deregulation at 6p21–p24 identify an aggressive HCC phenotype and a novel functional biomarker. [ABSTRACT FROM AUTHOR]

Rod-shapedordered mesoporous carbons (OMCs) with different lengths,prepared by replication method using the corresponding size-tunableSBA-15 silicas with the same rodlike morphology as templates, areexplored as anode material for Li-ion battery. All of the as-synthesizedOMCs exhibit much higher Li storage capacity and better cyclabilityalong with comparable rate capability as compared with commercialgraphite. Particularly, the OMC-3 with the shortest length demonstratesthe highest reversible discharge capacity of 1012 mAh g–1at 100 mA g–1and better cyclability with 86.6%retention of initial capacity after 100 cycles. Although the Coulombicefficiencies of all the OMCs are relatively low at the beginning,they improve promptly and after 10 cycles reach the level comparableto commercial graphite. Based on their specific capacity, cycle efficiency,and rate capability, the OMC-3 outperforms considerably its carbonpeers, OMC-1 and OMC-2 with longer length. This behavior is mainlyattributed to higher specific surface area, which provides more activesites for Li adsorption and storage along with the larger mesoporevolume and shorter mesopore channels, which facilitate fast Li iondiffusion and electrolyte transport. The enhancement in reversibleLi storage performance with decrease in the channel length is alsosupported by low solid electrolyte interphase resistance, contactresistance, and Warburg impedance in electrochemical impedance spectroscopy. [ABSTRACT FROM AUTHOR]

Background: The technique of totally laparoscopic total gastrectomy (TLTG) has been developed for gastric cancer, but its feasibility and surgical outcomes remain unclear. This is the first study comparing the early surgical outcomes of TLTG with those of conventional open total gastrectomy (OTG) for gastric cancer. Patients and Methods: Between January 2011 and December 2011, 139 patients underwent TLTG, and 207 patients underwent OTG for gastric cancer; surgical procedures were selected by means of preoperative diagnostic tests under T3N2M0. Clinicopathologic characteristics and early surgical outcomes in the two groups were compared retrospectively. Results: There were no significant difference in preoperative characteristics between the two groups, and the durations of surgery were not significantly different. However, TLTG was superior to OTG in terms of time to first flatus, time to commencement of soft diet, pain score (visual analog scale), need for analgesics, length of hospital stay, and overall postoperative complications (each P<.05). The median number of lymph nodes harvested was significantly higher in the TLTG group (37 versus 34; P=.039). Resection margins were negative in all patients. Conclusions: TLTG should be considered as a safe and practicable alternative to OTG for the treatment of gastric cancer. Moreover, it is less invasive and results in faster recovery than OTG. [ABSTRACT FROM AUTHOR]

Background: To investigate the extent and pattern of fibrovascular ingrowth of porous silicone sphere implants compared to porous polyethylene implants. Methods: Experimental porous silicone sphere implants and porous polyethylene implants were implanted in the left socket of 20 New Zealand white rabbits after enucleation. Fibrovascular ingrowth and maturation was evaluated at 4 weeks and 8 weeks after implantation by histopathologic examination and scanning electron microscope. Results: At 4 weeks after surgery, porous polyethylene implants showed deeper fibrovascular ingrowth than porous silicone sphere implants; 42.4% versus 34.2% of radius of the implants respectively ( p = 0.047). However there was no significant difference in the depth of fibrovascular ingrowth between the two groups at 8 weeks after implantation, although porous polyethylene implants showed deeper fibrovascular ingrowth than porous silicone sphere implants; 71.6% versus 63.6% ( p = 0.102). Conclusions: Porous silicone orbital implants demonstrated a comparable extent of fibrovascular ingrowth to that for porous polyethylene implants. Therefore, this new porous silicone sphere implant may be a good candidate to substitute for current porous implants at a lower cost. [ABSTRACT FROM AUTHOR]

We compared the bone regeneration potentials of autologous cultured osteoblasts and of bone-marrow-derived autologous MSCs in combination with allogeneic cancellous bone granules in a rabbit radial defect model. Radial shaft defects over 15 mm were made in 26 New Zealand white rabbits. The animals underwent insertion of allogeneic cancellous bone granules containing autologous osteoblasts into right-side defects (the experimental group) and of allogeneic cancellous bone granules with autologous MSCs into left-side defects (the control group). To quantitatively assess bone regeneration, radiographic evaluations as well as BMD and BMC measurements were performed 3, 6, 9 and 12 weeks post-implantation and histology as well as micro-CT image analysis were performed at 6 and 12 weeks. Radiographic evaluations 3 weeks post-implantation showed that the experimental group had a higher mean bone quantity index ( p < 0.05) and micro-CT image analysis showed that experimental sides had a greater mean total regenerated bone volume and surface area than the control sides ( p < 0.05). Histologic evaluations obtained at 6 and 12 weeks revealed distinctly greater granule resorption and new bone formation in the experimental group. This in vivo study demonstrates that a combination of autologous osteoblasts and small-sized, allogeneic cancellous bone granules leads to more rapid bone regeneration than autologous MSCs and small-sized, allogeneic cancellous bone granules. [ABSTRACT FROM AUTHOR]

Background/introduction: Dilatation of intercellular space (IS) of esophageal epithelial cells is described as a sensitive early marker for epithelial damage by refluxate. Esophageal epithelia are morphologically subdivided into three layers according to the shape of the cells and nuclei. Meanwhile, ten transmission electron microscopy (TEM) photographs and ten randomly selected measurements per photo from gastroesophageal reflux disease (GERD) patients have been widely accepted without any theoretical criticism. We assumed that the IS differs among each layer and thus studied IS according to subdivided layers of normal esophageal epithelium. We also evaluated an optimal number of IS measurements per photograph.Materials and Methods: Esophagogastroduodenoscopy was performed in 15 healthy adults without any symptom of GERD, taking biopsies from mucosa above 5 cm from the squamo-columnar junction. Tissues were handled and prepared for TEM, verifying three layers of esophageal mucosa, i.e., squamous cell layer, prickle cell layer, and basal layer. Ten digital photomicrographs were taken from each three layers by TEM, and ISs were measured with a computerized image analysis program. For the method of measuring IS, 5, 10, 20, 30, and 40 measurements per photomicrograph were respectively performed by four different examiners. Mean value and intraclass correlation coefficient (ICC) was also yielded.Results: Mean IS of lower esophagus irrelevant to three epithelial layers were 0.39 ± 0.30 μm. When subdivided into three layers, however, mean IS of squamous cell layer was 0.62 ± 0.23 μm, prickle cell layer 0.23 ± 0.19 μm, and basal layer 0.55 ± 0.36 μm, with their difference statistically significant (p < 0.05). On the other hand, ICC of 5, 10, 20, 30, and 40 measurements were 0.688, 0.917, 0.837, 0.790, and 0.765, respectively.Conclusions: Mean IS values of each three layers of esophageal epithelium in normal subjects were significantly different, and reconsideration of the standard measurement method is needed. Ten measurements per photo had an adequate inter-observer agreement. [ABSTRACT FROM AUTHOR]

Purpose: (18)F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan reflects tumor differentiation and predicts clinical outcome in patients with hepatocellular carcinoma (HCC). We investigated the correlation of PET scans with tumor differentiation and early tumor recurrence (time-to-recurrence <1 year).Methods: We reviewed the medical records of 93 patients with HCC who underwent curative resection at our hospital from August 2004 through December 2008. PET scans were performed preoperatively, and the maximum standardized uptake value of the tumor (SUV(tumor)) and the tumor-to-non-tumor SUV ratio (TNR) were calculated from FDG uptake.Results: Twenty-six (27.9%) had recurrences and 12 of them (46.2%) had early recurrences. SUV(tumor) and TNR correlated strongly with tumor differentiation (p < 0.001). Early recurrence-free and the overall survival rates in the low TNR group (TNR <2.0) were higher than in the high TNR group (TNR ≥2.0) (p = 0.015, p = 0.013). According to univariate analysis, predictors of early tumor recurrence were large tumor size (≥5 cm), high TNR (≥2), high SUV(tumor) (≥4), and high Edmoson-Steiner grade. However, on multivariate analysis, none of the examined factors were statistically significant independent predictor.Conclusion: PET scans reflect tumor differentiation in HCCs. Because high TNR (TNR ≥2) and SUV(tumor) (SUV ≥4) were these cutoff point significant predictors in univariate analysis, future studies with more statistical power are needed to assess the significance. [ABSTRACT FROM AUTHOR]

Background and Aims: Capsule endoscopy (CE) has the problem that lumen visualization is impaired by bubbles, bile, and debris. The benefits of bowel preparation are still controversial and the best method remains to be determined. The objective of this study was to evaluate the effect of the method of bowel preparation on the quality of visualization and on transit time.Methods: The study sample consisted of 68 patients for CE. Patients were randomly allocated to three groups. In group A (n = 23), patients fasted for 12 h before CE. In groups B (n = 20) and C (n = 25), patients received 2 and 4 l of polyethylene glycol (PEG), respectively. Small bowel images were evaluated by use of a cleansing score system. Representative frames were serially selected at 5-min intervals and scored by assessment of two properties (proportion of luminal visibility and extent of obscuration).Results: The median scores of image quality in groups A, B, and C were 2.26, 2.43, and 2.55 respectively, (P = 0.034). Cecal completion rates, gastric transit time, and small bowel transit time were no different among the three groups. Detection of lesions in groups A, B, and C was 56.5, 65.0, and 68.0%, respectively.Conclusions: Bowel preparation with PEG resulted in better image quality than fasting alone. No significant difference was observed between 2 and 4 l. PEG 2 l rather than 4 l may be a useful method of preparation for CE. [ABSTRACT FROM AUTHOR]

Background and Purpose: Salinomycin (Sal) has recently been shown to inhibit various cancer stem cells. Here, we investigated whether Sal could sensitize cancer cells to the effects of doxorubicin (DOX) or etoposide (ETO).Experimental Approach: Using the Comet assay, immunocytochemistry and Western blot analysis, we assessed the ability of Sal to increase DNA breakage. We performed a cell proliferation assay to determine cell viability, cellular detachment, increased pre-G1 region, Annexin V staining and TUNEL assay to measure the ability of Sal to increase apoptosis.Key Results: Sal increased DNA breakage and phosphorylated levels of p53 and H2AX. Sal also induced the formation of DNA foci with pH2AX and 53BP1. Furthermore, Sal increased the sensitivity of cancer cells to the apoptotic effects of DOX or ETO. We found that pH2AX, pBRCA1, p53BP1 and pChk1 levels were greatly increased after co-treatment of Sal with DOX or ETO. The level of anti-apoptotic p21 protein was increased by DOX or ETO but decreased by Sal, which increased proteasome activity.Conclusions and Implications: This is the first study to report that Sal increases DNA damage, and this effect plays an important role in the increased apoptosis caused by Sal. Overall, we demonstrated that the ability of Sal to sensitize cancer cells to the effects of DOX or ETO is associated with an increase in DNA damage and a decrease in anti-apoptotic protein p21 levels. These results may contribute to the development of Sal-based chemotherapy for cancer patients receiving DOX or ETO treatment. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Success rate of cecal intubation, endoscopist's difficulty, and procedure-related patient pain are still problems for beginners performing colonoscopy. New methods to aid colonoscopic insertion such as warm water instillation and oil lubrication have been proposed. The aim of this study is to evaluate the feasibility of using warm water or oil in colonoscopy.Methods: Colonoscopy was performed in 117 unsedated patients by three endoscopists-in-training. Patients were randomly allocated to three groups, using a conventional method with administration of antispasmodics, warm water instillation, and oil lubrication, respectively. Success rate of total intubation within time limit (15 min), cecal intubation time, degree of endoscopist's difficulty, and level of patient discomfort were compared among the three groups.Results: Cecal intubation time was shorter in the warm water group than in the conventional and oil groups. Degree of procedural difficulty was lower in the warm water group, and patient pain score was higher in the oil lubrication group, compared with the other groups. However, there was no significant difference in success rate of intubation within time limit among the three groups.Conclusions: The warm water method is a simple, safe, and feasible method for beginners. Oil lubrication may not be a useful method compared with conventional and warm water method. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that insulin sensitivity is relatively better preserved in arm muscle than in leg muscle in both healthy controls and type 2 DM, based on measurements of basal and insulin-mediated glucose clearance performed simultaneously in the two sets of muscles. It has also been reported that glucose uptake rates are higher in arm compared to leg muscles in the fasted state during normo-insulinaemia. However, the mechanism(s) for this are unknown. Currently, no information is available on the content of glucose transport proteins between arm and leg muscles. Therefore, we compared four proteins, Caveolin-1 (Cav-1), Caveolin-3 (Cav-3), GLUT4, and IR-beta, each of which plays an important role in regulating glucose transport between arm and leg muscles using muscle samples that were obtained from the deltoid (DEL) and vastus lateralis (VAS) of 14 male college pentathlon athletes before and after two swimming trials performed over 100 and 1,500 m. In the present study, we have shown the levels of Cav-1, -3, GLUT4, and IR-beta measured together for the first time in human arm and leg muscles. There was no difference in the levels of these proteins between arm and leg muscles. Cav-3, GLUT4, and IR-beta were unchanged from the resting levels after both exercise trials in DEL, while Cav-1 was increased (17%) at the end of the longer swim trial. In contrast, all measurements of Cav-1, -3, GLUT4, and IR-beta after the 1,500 m swim trial in VAS were increased, by 120, 46, 123, and 60%, respectively. These data imply that there was no functional difference in glucose transport capacity between arm and leg muscles in highly trained pentathlon athletes in the resting state. Although Cav-3, GLUT4, and IR-beta were unchanged from the resting levels at the end of both exercise trials in DEL, all measures, including Cav-1, increased after the 1,500 m swim trial in VAS. [ABSTRACT FROM AUTHOR]

Background: Peritoneal fibrosis is a serious complication in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, but the underlying mechanism is not well understood. Since high glucose activates the p38 mitogen-activated protein kinase (MAPK) pathway in various kinds of cells, and because mesothelial cells are always exposed to high glucose dialysate, we examined the activity and expression of p38 MAPK members in cultured human peritoneal mesothelial cells (HPMCs) under high glucose conditions.Methods: HPMCs were isolated from omentum and subcultured. After serum restriction, HPMCs were exposed to 5.6 mmol/L glucose (low glucose), 5.6 mmol/L glucose + 34.5 mmol/L mannitol (low glucose + mannitol), or 40 mmol/L glucose (high glucose) for 3 minutes to 48 hours with or without SB203580. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were performed to determine mRNA and protein expression, respectively.Results: p38 MAPK and cyclic adenosine monophosphate (cAMP)-responsive element binding protein (CREB) activities and mRNA expressions were significantly increased in HPMCs exposed to high glucose compared to low glucose or low glucose + mannitol after 10 minutes and remain at higher levels to 48 hours (P < 0.05), but total p38 MAPK and CREB protein expressions did not differ. MAPK kinase 3/6 (MKK3/6) activity and mRNA expression were also higher in high glucose cells after 3 minutes (P < 0.05), and fibronectin mRNA expression was significantly increased in HPMCs exposed to high glucose after 2 hours (P < 0.05). In contrast, high glucose significantly inhibited MAPK phosphatase-1 (MKP-1) protein and mRNA expression after 10 minutes (P < 0.05). SB203580 (1 micromol/L) pretreatment for 1 hour significantly reduced high glucose-induced CREB activity and fibronectin mRNA expression by 89% and 75%, respectively (P < 0.05).Conclusion: p38 MAPK activity was increased in HPMCs exposed to high glucose, in parallel with increased MKK3/6 activity and decreased MKP-1 expression, resulting in CREB activation. This activated p38 MAPK pathway may play a role in the pathogenesis of peritoneal fibrosis. [ABSTRACT FROM AUTHOR]

1. The effects of acharan sulphate, a glycosaminoglycan isolated from the giant African snail Achatina fulica, on angiogenesis in the granulation tissue were analysed using an air pouch-type carrageenin-induced inflammation model in rats and a cotton thread-induced inflammation model in mice. 2. In the carrageenin-induced inflammation model in rats, intra-pouch injections of acharan sulphate (5 and 50 micro g) inhibited the pouch fluid accumulation and the granulation tissue formation as well as the angiogenesis in the granulation tissue at day 6 in a dose-dependent manner. 3. The inhibitory effects of acharan sulphate at 50 micro g on the pouch fluid accumulation and the leucocyte infiltration into the pouch fluid was not so effective as that of the cyclo-oxygenase inhibitor indomethacin at 100 micro g, but the inhibitory effects of acharan sulphate at 50 micro g on the granulation tissue formation and angiogenesis in the granulation tissue were almost the same as those of indomethacin at 100 micro g. 4. Acharan sulphate did not affect levels of vascular endothelial growth factor (VEGF) in the granulation tissue and in the pouch fluid at day 6, but indomethacin significantly lowered them. 5. In the cotton thread-induced inflammation model in mice, injections of acharan sulphate (10 micro g) at the site of the cotton thread implantation inhibited the granulation tissue formation and angiogenesis as indomethacin (20 micro g) did. Acharan sulphate (10 micro g) did not affect levels of VEGF in the cotton thread-induced granulation tissue at day 5, but indomethacin (20 micro g) significantly lowered them. 6. In culture of human vascular endothelial cells, acharan sulphate at 10 and 100 micro g ml(-1) inhibited VEGF-induced capillary tube formation. 7. These findings suggest that the inhibitory effect of acharan sulphate on angiogenesis in carrageenin- and cotton thread-induced granulation tissues is not due to the inhibition of VEGF protein induction, but is due to the inhibition of VEGF-induced vascular tube formation. [ABSTRACT FROM AUTHOR]

Although penicillin tolerance has been increasingly recognized among clinical isolates of many Gram-positive organisms, the significance of this phenomenon in vivo is not clear. The present study was performed to characterize penicillin-tolerant enterococci by several in-vitro parameters and to examine the significance in vivo in a rabbit model of infective endocarditis. Tolerant enterococci exhibited several characteristics which distinguished them from non-tolerant bacteria: significantly greater ratios of MIC to MBC of penicillin, resistance to penicillin-induced lysis and killing, and growth in areas of superinhibitory concentrations of penicillin upon transfer from penicillin gradient to penicillin-free plates. In-vivo studies of aortic valve endocarditis in rabbits treated with procaine penicillin G (300 mg/kg/day) revealed strikingly different responses between infections due to one tolerant and one non-tolerant strain. Animals infected with a tolerant enterococcus showed consistently greater bacterial counts in vegetations during ten days of therapy and significantly lower rates of vegetation sterilization. Serum penicillin levels were not significantly different between the two groups, but serum bactericidal titres were significantly lower for the tolerant than for the non-tolerant strains. These findings indicate that penicillin tolerance identified by several in-vitro criteria is a significant determinant of the in-vivo response of enterococci to penicillin therapy. [ABSTRACT FROM AUTHOR]

Intravenous immunoglobulins are stable monomeric pooled human IgG preparations for therapeutic use. Three intravenous immunoglobulins licensed in the United States are generally therapeutically equivalent. Intravenous immunoglobulin is the preferred agent for replacement therapy for most patients with primary or secondary antibody immunodeficiency because of the rapidity and ease of giving large quantities of IgG, even by self-administration. Disadvantages of intravenous immunoglobulins include frequent (approximately 10%) but usually not serious side effects, the need for venous access (often difficult in infants and young children), and high cost. Intravenous immunoglobulins are also beneficial in the prevention of certain viral infections, such as cytomegalovirus pneumonia and varicella; they may also have a synergistic effect with antibiotics in certain bacterial diseases. Intravenous immunoglobulin has also been used successfully in the management of idiopathic thrombocytopenia purpura, Kawasaki disease, and certain autoimmune diseases. Intravenous immunoglobulin may also be of use in certain high-risk and premature newborns. [ABSTRACT FROM AUTHOR]

Tolerogenic dendritic cells (tolDCs) can induce the differentiation of immunosuppressive regulatory T cells and are therefore candidates for the prevention or treatment of various inflammatory diseases. Galangin, a major component of propolis and Alpinia officinarum, has well-established anti-inflammatory effects, but its ability to induce a tolerogenic state in DCs has not been demonstrated. In this study, we investigated the effects of galangin on DC differentiation and immune responses. In particular, we compared phenotypic and functional differences between DCs (Gal-DCs) generated by galangin treatment during DC differentiation and bone marrow-derived DCs. Gal-DCs were generated by adding culture medium containing various doses of galangin (1.8-18.5 µM) on 3 and 6 day. Upon lipopolysaccharide (100 ng/mL) stimulation for 24 h, Gal-DCs generated with 7.4 µM galangin treatment showed lower levels of CD86 and lower major histocompatibility complex class II antigen-presentation than those of bone marrow-derived DCs. Furthermore, Gal-DCs showed markedly increased programmed death ligand 1 expression and IL-10 production via the activation of mitogen-activated protein kinases. Interestingly, Gal-DCs co-cultured with allogeneic CD4 T cells exhibited the reduced cell proliferation and differentiation into Th1-, Th2-, and Th17-type cell; instead, Gal-DCs contributed to the induction of CD4+CD25+Foxp3+ Tregs. Taken together, our data suggest that exposure to galangin during DC differentiation confers tolerogenic properties, efficiently inducing Th cell differentiation to immunosuppressive Tregs. These findings provide new insights into the molecular mechanism underlying the anti-inflammatory effects of galangin on DCs. [ABSTRACT FROM AUTHOR]

Background: Titanium surface coating on cobalt-chromium (CoCr) alloy has characteristics desirable for an orthopedic implant as follows: strength, osteointegrative capability, and biocompatibility. Creating such a coated surface takes a challenging process and two dissimilar metals are not easily welded. In our study, we utilized additive manufacturing with a 3D printing called direct metal fabrication (DMF) and compared it to the plasma spraying method (TPS), to coat titanium onto CoCr alloy. We hypothesized that this would yield a coated surface quality as acceptable or better than the already established method of plasma spraying. For this, we compared characteristics of titanium-coated surfaces created by direct metal fabrication method (DMF) and titanium plasma spraying (TPS), both in vitro and in vivo, for (1) cell morphology, (2) confocal microscopy images of immunofluorescent assay of RUNX2 and fibronectin, (3) quantification of cell proliferation rate, (4) push-out biomechanical test, and (5) bone histomorphometry. Method: For in vitro study, human osteoblast cells were seeded onto the coated surfaces. Cellular morphology was observed with a scanning electron microscope. Cellular proliferation was validated with ELISA, immunofluorescent assay. For in vivo study, coated rods were inserted into the distal femur of the rabbit and then harvested. The rods were biomechanically tested with a push-out test and observed for histomorphometry to evaluate the microscopic bone to implant ratio. Result: For cell morphology observation, lamellipodia and filopodia, a cytoplasmic projection extending into porous structure, formed on both surfaces created by DMF and TPS. The proliferation of the osteoblasts, the DMF group showed a better result at different optic density levels (p = 0.035, 0.005, 0.001). Expression and distribution of fibronectin and Runx-2 genes showed similar degrees of expressions. The biomechanical push-out test yielded a similar result (p = 0.714). Histomorphometry analysis also showed a similar result (p = 0.657). Conclusion: In conclusion, DMF is a method which can reliably create a proper titanium surface on CoCr alloy. The resulting product of the surface shows a similar quality to that of the plasma spraying method, both in vivo and in vitro, in terms of biological and mechanical property. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of progressive axial myopia associated with traumatic glaucoma in a juvenile patient with no systemic disease.Design: Interventional case report.Methods: In a 15-year-old male, serial ocular examinations, including manifest refraction, tonometry, and axial eye length measurement, were performed over a 6-year period, beginning with blunt trauma, right eye, followed by a series of surgical procedures for traumatic cataract and glaucoma.Results: A 4-diopter myopic shift (from -1.25 to -5.25) with a 1.5 mm increase in the axial eye length occurred, whereas the intraocular pressure increased from 21 to 46 mm Hg, during a 2-year period. The refraction, axial eye length, and intraocular pressure remained stable during the same period in the fellow, normal eye.Conclusion: Progressive axial myopia associated with traumatic glaucoma is possible in a juvenile patient in his late teens. [ABSTRACT FROM AUTHOR]

Pinus densiflora (Korean red pine) is widely distributed in East Asia and considered one of the most important species in Korea. In this study, the complete chloroplast genome of P. densiflora was sequenced by combining the advantages of Oxford Nanopore MinION and Illumina MiSeq. The sequenced genome was then compared with that of a previously published conifer plastome. The chloroplast genome was found to be circular and comprised of a quadripartite structure, including 113 genes encoding 73 proteins, 36 tRNAs and 4 rRNAs. It had short inverted repeat regions and lacked ndh gene family genes, which is consistent with other Pinaceae species. The gene content of P. densiflora was found to be most similar to that of P. sylvestris. The newly attempted sequencing method could be considered an alternative method for obtaining accurate genetic information, and the chloroplast genome sequence of P. densiflora revealed in this study can be used in the phylogenetic analysis of Pinus species. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to measure the effect of different drilling depths on compression forces generated by two commonly used headless compression screws using the two different types of drill bit, the Acutrak® mini (conical type drill bit) and the Synthes 3.0 HCS® (cylindrical type drill bit). Methods: A load cell was placed between two Sawbone blocks, which were 12 mm and 40 mm in thickness, respectively. After placing the guide pin into the center of the block, the drilling depth of the Acutrak® mini and Synthes HCS® screws ranged from 16 to 28 mm and 22 to 28 mm, respectively. The 24-mm screws were inserted and the compression force was measured immediately and at 30 min post-insertion. Results: The Acutrak® mini generated greater compression force compared to the Synthes 3.0 HCS® when drilled to a depth of less than 24 mm. The compression force of the Acutrak® mini showed a strong inverse correlation with the drilling depth. There was no significant inverse correlation observed between the compression force of the Synthes HCS® and the drilling depth. Conclusions: If the screw length and the drill depth are the same, the Synthes 3.0 HCS® (cylindrical type drill bit) is safer and easier to use as it has no change in the compression force even when over-drilling because the compression force of the two screws is similar. As for the Acutrak® mini (conical type drill bit), while it is technically demanding due to varying compression force according to the drill depth, it can be used in certain cases because it can give stronger compression force through under-drilling. [ABSTRACT FROM AUTHOR]

For the low-cost hardware-based intrusion detection systems, this paper proposes a memory-efficient parallel string matching scheme. In order to reduce the number of state transitions, the finite state machine tiles in a string matcher adopt bit-level input symbols. Long target patterns are divided into subpatterns with a fixed length; deterministic finite automata are built with the subpatterns. Using the pattern dividing, the variety of target pattern lengths can be mitigated, so that memory usage in homogeneous string matchers can be efficient. In order to identify each original long pattern being divided, a two-stage sequential matching scheme is proposed for the successive matches with subpatterns. Experimental results show that total memory requirements decrease on average by 47.8 percent and 62.8 percent for Snort and ClamAV rule sets, in comparison with several existing bit-split string matching methods. [ABSTRACT FROM AUTHOR]

Abstract: Gasification experiments with railroad wood ties treated with creosote were conducted in a two-stage gasifier to produce a high caloric producer gas with low tar content. In the experiments, sand and dolomite as the bed material were compared, and the effects of temperature in a range from 666 to 818°C and equivalence ratio from 0.19 to 0.52 were also investigated. Additionally, the effectiveness of additives (biomass-based activated carbon, coal-based activated carbon and dolomite) and their combination on the removal of tar were examined. As a result, the combination of dolomite as the bed material and coal-based activated carbon in the tar cracking zone gave the best performance with respect to tar removal. With this combination, the total amount of tar was reduced by 91.9%, compared to that obtained by using only sand as the bed material in the gasifier. Furthermore, the tar content in the producer gas was below 0.1g/Nm3. Coal-based activated carbon also improved the production of hydrogen up to about 29vol.%. The LHVs of most producer gases in these experiments were above 7MJ/Nm3. [Copyright &y& Elsevier]

Background: Gastric neuroendocrine carcinomas (NECs), consisting of both large- and small-cell NECs, and mixed adenoneuroendocrine carcinomas (MANECs), including mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs), are a group of high-grade malignancies. Few studies to date have reported clinical outcomes, including prognosis, in patients with these tumors. This study therefore evaluated the clinicopathologic outcomes and prognosis in patients with NECs and MANECs.Methods: This study included 36 patients diagnosed with gastric NECs, including 23 with large-cell and 13 with small-cell NECs, and 85 with MiNENs, including 70 with high-grade and 15 with intermediate-grade MiNENs. Clinical outcomes, including overall survival (OS) and disease-free survival (DFS), were assessed.Results: DFS was significantly poorer in patients with NEC than in patients with intermediate-grade MiNEN (P < .05), whereas both OS and DFS were similar in patients with NEC and high-grade MiNEN (P > .05). Patients with large-cell NEC were more likely to undergo aggressive surgery than patients with high-grade MiNEN (P < .05). Lymphovascular invasion was more frequent and DFS poorer in patients with large-cell than small-cell NECs (P < .05 each).Conclusion: DFS is significantly poorer in patients with NEC than in patients with intermediate-grade MiNEN and significantly lower in patients with large-cell than small-cell NECs. [ABSTRACT FROM AUTHOR]

Purpose: We investigated treatment satisfaction with flexible-dose fesoterodine in patients with overactive bladder (OAB) who were dissatisfied with previous anticholinergic therapy.Materials and Methods: The subjects were prescribed fesoterodine 4 mg for 4 weeks and fesoterodine 4 mg or 8 mg for another 8 weeks. The primary end point of this study was patients' satisfaction after 12 weeks of fesoterodine treatment on a five-point Likert scale. Secondary end points included a change in the number of daytime micturition, urgency incontinence episodes, urgency episodes, and nocturnal micturition in a 24-hour period from baseline to final assessment.Results: Overall, 84 patients were assigned to the treatment group in this study and 63 patients completed the 12-week treatment course. A final fesoterodine dose of 4 mg and 8 mg was used by 45 (71.4%) and 18 (28.6%) patients, respectively. The satisfaction and dissatisfaction rates at 12 weeks were 69.9% and 14.2%, respectively. Mean changes in the daytime micturitions (9.73 ± 4.72 vs. 7.76 ± 2.86), urgency episodes (7.73 ± 5.68 vs. 3.71 ± 4.09), and nocturnal micturitions (2.13 ± 1.36 vs. 1.68 ± 1.12) in 24 hours improved significantly with flexible-dose fesoterodine treatment (P < .05). Most adverse events were mild and none were severe.Conclusion: The flexible dose fesoterodine represents an alternative treatment modality in patients with OAB who are dissatisfied with previous anticholinergic therapy in Korea. [ABSTRACT FROM AUTHOR]

Highlights: [•] Effects of break location between the cold leg and the DVI nozzle were investigated. [•] The DVI line break case was found to be more limiting than the cold leg break. [•] The cold leg break case resulted in more complex behavior than the DVI line break. [•] The system code predictions for the water levels were not so satisfactory. [Copyright &y& Elsevier]

Abstract: Flocculation is most preferred method for harvesting microalgae, however, the role of bacteria in microalgal flocculation process is still unknown. This study proves that bacteria play a profound role in flocculating by increasing the floc size resulting in sedimentation of microalgae. A flocculating activity of 94% was achieved with xenic Chlorella vulgaris culture as compared to 2% achieved with axenic culture. Denaturing gradient gel electrophoresis (DGGE) analysis of 16S rRNA gene of xenic C. vulgaris culture revealed the presence of Flavobacterium sp., Terrimonas sp., Sphingobacterium sp., Rhizobium sp. and Hyphomonas sp. as microalgae-associated bacteria. However when Flavobacterium, Terrimonas, Sphingobacterium were eliminated by fluorescence activated cell sorter (FACS), flocculating activity reduced to 3%. Further studies with cell free extracts also suggest that bacterial extracellular substances might also have a role in enhancing flocculation. We conclude that the collective presence of certain bacteria is the determining factor in flocculation of C. vulgaris. [Copyright &y& Elsevier]

Abstract: Polybrominated diphenyl ethers (PBDEs), commonly used flame retardants, have been reported as potential endocrine disruptor and neurodevelopmental toxicants, thus giving rise to the public health concern. The goal of this study was to investigate the relationship between umbilical cord blood, maternal blood, and breast milk concentrations of PBDEs in South Korean. We assessed PBDE levels in paired samples of umbilical cord blood, maternal blood, and breast milk. The levels of seven PBDE congeners were measured in 21 paired samples collected from the Cheil Woman’s Hospital (Seoul, Korea) in 2008. We also measured thyroid hormones levels in maternal and cord blood to assess the association between PBDEs exposure and thyroid hormone levels. However, there was no correlation between serum thyroxin (T4) and total PBDEs concentrations. The total PBDEs concentrations in the umbilical cord blood, maternal blood, and breast milk were 10.7±5.1ngg−1 lipid, 7.7±4.2ngg−1 lipid, and 3.0±1.8ngg−1 lipid, respectively. The ranges of total PBDE concentrations observed were 2.28–30.94ngg−1 lipid in umbilical cord blood, 1.8–17.66ngg−1 lipid in maternal blood, and 1.08–8.66ngg−1 lipid in breast milk. BDE-47 (45–73% of total PBDEs) was observed to be present dominantly in all samples, followed by BDE-153. A strong correlation was found for major BDE-congeners between breast milk and cord blood or maternal blood and cord blood samples. The measurement of PBDEs concentrations in maternal blood or breast milk may help to determine the concentration of PBDEs in infant. [Copyright &y& Elsevier]

Abstract: Aim: To date, no data are available on the use of PET/CT for preoperative staging of gastric cancer. We attempted to evaluate the value of PET/CT for preoperative staging of advanced gastric cancer, and to compare the use of PET/CT with contrast-enhanced CT (CECT). Materials and methods: We analyzed PET/CT of 78 patients with surgically proven advanced gastric cancer who had undergone preoperative CECT. Qualitative analysis was conducted by assessing the presence of primary tumors and metastases with PET/CT and CECT. Results: Among 71 patients who underwent a gastrectomy, 69 primary tumors (93%) were diagnosed by PET/CT, while 64 primary tumors (90%) were detected by CECT (p =0.55). For regional lymph node metastasis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT vs. CECT were 41% vs. 25% (p =0.00019), 100% vs. 92% (p =0.31), 100% vs. 98% (p =0.46), 26% vs. 42% (p =0.14), and 51% vs. 72% (p =0.00089), respectively. Conclusion: Overall, PET/CT showed comparable diagnostic performance to CECT in diagnosing primary tumors and regional lymph node metastases, though PET/CT was inferior to CECT for the sensitivity and accuracy in diagnosing regional lymph node metastases. Nevertheless, PET/CT would be useful when CECT findings were equivocal due to its high positive predictability. [Copyright &y& Elsevier]