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Purpose: The luminal subtype of breast cancer has heterogeneous biological characteristics with respect to the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), and Ki-67. We analyzed luminal B breast cancer subcategorized by PR expression and identified clinically relevant prognostic factors.Methods: We collected the clinical and pathologic data of 247 breast cancer patients (stage 1-4) who were diagnosed with luminal B subtype, defined as ER- and/or PR-positive and/or HER2-positive and with a high Ki-67 proliferation index (>14%). We classified them into PR intact and PR low groups according to PR expression pattern. We also analyzed the clinical and pathological data of each group, including age at diagnosis, tumor size, node metastasis, breast and axillary operative method, margin involvement, tumor-node-metastasis (TNM) stage, histological grade, nuclear grade, number of tumors, and expression of ER, PR, Ki-67, and Bcl-2; evaluated recurrence or metastatic characteristics; and analyzed disease-free survival (DFS) and overall survival (OS) in both groups.Results: Among the 247 luminal B breast cancer patients (stage 1-4), 141 were classified into the PR intact group (57.1%) and 106 into the PR low group (42.9%). The PR low group was associated with age >50 years (p=0.001), low Bcl-2 expression (p

Purpose: The biggest concern related to ductal carcinoma in situ (DCIS) is local recurrence and recurrence patterns. The purpose of this study was to investigate the relationship between clinicopathological factors and relapse in patients treated with DCIS.Methods: We reviewed medical records of 104 patients who were diagnosed as DCIS between January 1999 and December 2015 at a single institute. We compared and analyzed clinicopathological factors such as age at diagnosis, preoperative lesions on ultrasonography, preoperative tumor markers, operation methods in the breast, histological grade, nuclear grade, resection margin, comedonecrosis, estrogen receptor/ progesterone receptor expression, human epidermal factor receptor 2/neu expression, Ki-67, postoperative implementation of adjuvant hormonal therapy, and radiotherapy by dividing them into recurrent and non-recurrent groups.Results: Seventeen patients (16.3%) of 104 patients relapsed in the ipsilateral or contralateral breast. The median follow-up period of non-relapsed group was 4.9 years (range, 0.5–19.15) and the median follow-up period of relapsed group was 3.5 years (range, 1.4–14.13). Clinicopathological factors that were significantly related to relapse were nuclear grade (p=0.022) and Ki-67 (p=0.025) based on the results of chi-square or Fisher’s exact analysis. In multivariate analysis using logistic regression, Ki-67 (p=0.021) was significantly associated with DCIS relapse.Conclusion: This study suggested that the higher Ki-67 over 14% was strongly associated with DCIS relapse.

Background Thisretrospective cohort study analyzed the risk of gastrointestinal (GI) cancer in patients who underwent hysterectomy due to a benign gynecologic disease in comparison with the no hysterectomy group using Korean health insurance data. Methods This population-based retrospective cohort study was conducted using insurance data provided by the Health Insurance Review and Assessment Service (HIRA) from January 1, 2007, to December 31, 2020. The hysterectomy group included 40- to 59-year-old women who underwent hysterectomy with uterine leiomyoma or uterine endometriosis from January 1, 2011, to December 31, 2014. The control group included women aged 40 to 59 years who visited medical institutions for medical examination from January 1, 2011 to December 31, 2014. Results The hysterectomy and no hysterectomy groups comprised 66,204 and 89,768 subjects, respectively. The median ages in the no hysterectomy group and hysterectomy group were 48 (range: 43–53) and 46 (range: 44–49) years, respectively. In the unadjusted results of the analysis, all colorectal cancer (CRC) increased in the hysterectomy alone group (HR 1.222, 95% confidence interval (CI) 1.016-1.47, p = 0.033), sigmoid colon cancer increased in the hysterectomy alone group (HR 1.71, 95% CI 1.073-2.724, p = 0.024), and rectal cancer increased in the hysterectomy with adnexal surgery group (HR 1.924, 95% CI 1.073-2.724, p = 0.002). The adjusted results showed that all CRC increased in the hysterectomy alone group (HR 1.406, 95% CI 1.057-1.871, p = 0.019), colon cancer increased in the hysterectomy alone group (HR 1.523, 95% CI 1.068-2.17, p = 0.02), and rectal cancer increased in the hysterectomy with adnexal surgery group (HR 1.933, 95% CI 1.131-3.302, p = 0.016). The all-cause mortality of GI cancer increased in the hysterectomy alone group (HR 3.495, 95% CI 1.347-9.07, p = 0.001). Conclusions This study showed that the risk of all CRC increased in women who underwent hysterectomy compared with women who did not. In particular, the risk of rectal cancer was significantly higher in the women who underwent hysterectomy with adnexal surgery than in the controls.

Purpose: It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer.Methods: Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS.Results: Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS.Conclusion: Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.

Purpose: To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.Methods: This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.Results: Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.Conclusion: Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Objective The aim of this study was to identify predictive factors for pathologic central lymph node metastasis (CLNM) in patients with clinically negative CLNM (cN0) papillary thyroid microcarcinoma (PTMC) to suggest a specific group of cN0 PTMC patients who benefit from prophylactic central lymph node dissection (CLND). Background PTMC have excellent prognosis, however, 8% have recurrent disease. Recurrence is associated with regional lymph node metastasis. It has been reported that pathologic CLNM is found in 30 to 65% of cN0 PTMC patients. However, prophylactic CLND for cN0 PTMC remains controversial. Methods We reviewed the records of papillary thyroid carcinoma patients with a tumor size on preoperative ultrasonography (US) of ≤10 mm and negative CLNM on preoperative physical examination, US, and positron emission tomography/computed tomography (PET/CT), who underwent total thyroidectomy or thyroid lobectomy with prophylactic CLND between April 2010 and February 2013. In total, 163 patients were included. We evaluated the relationship between preoperatively assessable factors including age, gender, body mass index, preoperative metformin use, primary tumor size through preoperative US, the maximum standardized uptake value (SUVmax) of the primary tumor through preoperative PET/CT, and the bilaterality of the primary tumor and pathologic CLNM. Results A SUVmax of the primary tumor of >3 was an independent preoperatively assessable factor predictive of pathologic CLNM in cN0 PTMC patients. Conclusions Prophylactic CLND might be considered in cN0 PTMC patients with a SUVmax of the primary tumor of > 3 to reduce the risks of residual CLNM and recurrence.

Summary: Background/Objective: Axillary lymph node staging (ALNS) is an important step in the treatment of breast cancer and sentinel lymph node biopsy (SLNB) is a standard procedure for ALNS. Recently, the use of positron emission tomography/computed tomography (PET/CT) for whole body staging in patients with breast cancer has been increasing. The negative predictive value (NPV) of the specific diagnostic modality is the crucial value for excluding axillary lymph node metastasis (ALNM) and guiding the decision not to proceed with axillary lymph node dissection. The aim of this study was to identify patient groups in which PET/CT yields a high NPV for ALNS. Methods: We reviewed data from the records of 262 patients with breast cancer who underwent PET/CT before surgery between February 2009 and March 2018. We searched for factors associated with pathological axillary lymph node metastasis in patients with negative ALNM on PET/CT. Then, we calculated the NPV of PET/CT for ALNS in the patient group without the identified factors and in all patients. Results: Age ≥75 years and tumor size on ultrasonography (US) ≥ 15 mm were the associated factors; the NPV of PET/CT in patients without these factors compared to all patients was 97.2% versus 88.7%. Conclusion: The NPV of PET/CT for ALNS in patients younger than 75 years and with tumor size on US

Purpose: Adjuvant chemotherapy (AC) is recommended for patients with stage II colorectal cancer with adverse features. However, the effect of adjuvant treatment in elderly patients with high-risk stage II colorectal cancer remains controversial. This study aimed to investigate the oncologic outcomes in elderly high-risk stage II colorectal cancer patients who underwent curative resection with or without AC.Methods: Patients aged over 70 years having stage II colorectal adenocarcinoma with at least 1 adverse feature who underwent radical surgery between 2008 and 2017 at a single center were included. We compared recurrence-free survival (RFS) and overall survival (OS) between patients who received more than 80% of the planned AC cycle (the AC+ group) and those who did not receive it (the AC− group).Results: The AC+ and AC– group contained 46 patients and 50 patients, respectively. The log-rank test revealed no significant intergroup differences in RFS (P = 0.083) and OS (P = 0.122). In the subgroup of 27 patients with more than 2 adverse features, the AC+ group (n = 16) showed better RFS (P = 0.006) and OS (P = 0.025) than the AC− group. In this subgroup, AC was the only significant factor affecting RFS in the multivariate analysis (P = 0.023). AC was significantly associated with OS (P = 0.033) in the univariate analysis, but not in the multivariate analysis (P = 0.332).Conclusion: Among elderly patients with stage II high-risk colorectal cancer, the AC+ group did not show better RFS or OS than the AC− group. However, selected patients with more than 2 adverse features might benefit from AC.

Purposes To identify factors significantly associated with mortality of patients with left colonic perforation, and to compare the outcome of the Hartmann procedure (HP) and primary repair (PR) or primary anastomosis (PA) in left colonic perforation patients without factors associated with mortality. Methods This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U tests were used to analyze the data. Results Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Risk factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute renal failure, hemodynamic instability, and existence of generalized peritonitis and feculent ascites. Advanced age, leukopenia, and acute renal failure were independent risk factors for mortality. Seventy-nine patients did not have leukopenia, and among them, 30 patients who underwent PR without diversion were excluded from the sub-analysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no benefit for reducing overall mortality (p=0.458) and morbidity. Conclusions Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve overall mortality of the patients without leukopenia. For such patients, PR or PA could be a good option for left colonic perforation.

Purpose: Weight change during chemotherapy is reported to be associated with a worse prognosis in breast cancer. Our study was aimed to evaluate the relation of weight change during AC (anthracycline+cyclophosphamide) +taxanes chemotherapy and recurrence. Methods: Patients included 89 women diagnosed with breast cancer who have been treated by AC+taxenes chemotherapy regimen. The weight variation between prechemotherapy and postchemotherapy was calculated ([weight at postchemotherapy-weight at prechemotherapy]/weight at prechemotherapy×100) and categorized into either weight change (≥5%) or stable ( Results: During chemotherapy, 37of total 89 patients (41.6%) presented notable weight change and 52 patients (58.4%) were not weight change. Median follow-up period was 45.1 months, 17 of total 89 patients (19.1%) presented recurrence on the radiologic image tests. Eight of 17 recurrence patients were presented notable weight change, 9 patients were not weight change. In univariate analyses, weight change was not associated with recurrence. Conclusion: In our study, weight change during AC+taxanes chemotherapy in breast cancer was not associated with recurrence. Many studies that relation of weight change and recurrence were presented various result. So, we need more clinical studies many patients included and well designed.

Background The luminal subtype of breast cancer is sensitive to anti-estrogen therapy and shows a better prognosis than that of human epidermal growth factor receptor2 (HER2)-enriched or triple-negative breast cancer. However, the luminal type of breast cancer is heterogeneous and can have aggressive clinical features. We investigated the clinical implications of single hormone receptor negativity in a luminal B HER2-negative group. Methods We collected luminal B HER2-negative breast cancer data that were estrogen receptor (ER) and/or progesterone receptor (PR) positive, Ki 67 high (>14 %), and HER2 negative and divided them into the ER- and PR-positive group and the ER- or PR-negative group. We analyzed the clinical and pathological data and survival according to ER or PR loss. Results There were no statistical differences in TNM stage, breast and axillary operative methods, or number of tumors between the ER- and PR-positive group and ER- or PR-negative group. However, the ER- or PR-negative group was associated with older age (≥45 years), higher histological grade, lower Bcl-2 expression, and far higher Ki 67 (>50 %). Disease-free survival (DFS) and overall survival (OS) were shorter in the ER- or PR-negative group than that in the ER- and PR-positive group (p = 0.0038, p = 0.0071). Conclusions ER- or PR-negative subgroup showed worse prognosis than ER- and PR-positive subgroup in the luminal B HER2-negative group. We could consider the negativity of ER or PR as prognostic marker in luminal B HER2-negative subtype of breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0999-x) contains supplementary material, which is available to authorized users.

Backgrounds/Aims: We investigated patients’ clinical and radiological data to determine preoperative factors that predict cholesterol gallbladder (GB) polyps of large size, which can be helpful for decision on further diagnostic tools. Methods: In this study, we retrospectively analyzed 126 patients who underwent laparoscopic cholecystectomy for GB polyps ＞10 mm diagnosed preoperatively by abdominal ultrasonography between February 2002 and February 2016 in Department of Surgery, Sanggye Paik Hospital. Patients were divided into non-cholesterol polyps group and cholesterol polyps group, based on the postoperative pathologic diagnosis. Clinical and radiological data, such as gender, age, body weight, height, body mass index (BMI), laboratory findings, size, number and shape of the polypoid lesions, and presence of the concurrent GB stone were compared between the two groups. Results: Of the 126 cases, 73 had cholesterol polyps (57.9%) and 53 cases were non-cholesterol polyps (42.1%). The younger age (＜48.5 years), size of polyp ＜13.25 mm and multiple polyps were independent predictive variables for cholesterol polyps, with odd ratios(OR) of 2.352 (p=0.045), 5.429 (p＜0.001) and 0.472 (p＜0.001), respectively. Conclusions: Age, size and polyp number were used to predict cholesterol GB polyp among polypoid lesions of the gallbladder ＞10 mm. For cases in which these factors are not applicable, it is strongly recommended to evaluate further diagnostic tools, such as computed tomography, endoscopic ultrasonography and tumor markers.

Introduction The office-based endovascular facility has increased in number recently due in part to expedient patient experience. This study analyzed treatment outcomes of procedures performed in our office-based endovascular suite. Methods Treatment outcomes of 5134 consecutive procedures performed in our office-based endovascular suites from 2006 to 2013 were analyzed. Five sequential groups (group I–V) of 1000 consecutive interventions were compared with regard to technical success and treatment outcomes. Results Our patients included 2856 (56%) females and 2267 (44%) males. Procedures performed included diagnostic arteriogram, arterial interventions, venous interventions, dialysis access interventions, and venous catheter management, which were 1024 (19.9%), 1568 (30.6%), and 3073 (60.0%), 621(12.1%), and 354 (6.9%), respectively. The complication rates for group I, II, III, IV, and V were 3%, 1.5%, 1%, 1.1%, and 0.7%, respectively. The complication rate was higher in group I when compared to each of the remaining four groups ( p Conclusions Endovascular procedure can be performed safely in an office-based facility with excellent outcomes. Lessons learned in establishing office-based endovascular suites with efforts to reduce procedural complications and optimize quality patient care are discussed.

Result of statistic analysis. (DOCX 389 kb)

This paper suggests the design and analysis of the fuzzy sliding mode control for a nonlinear system using Takagi-Sugeno(T-S) fuzzy model. In this control scheme, identifying procedure that the input gain matrices in a T-S fuzzy model are manipulated into the same one is needed. The input disturbances generated in the identifying procedure are resolved by incorporating the disturbance treatment method of the conventional sliding mode control. The proposed control strategy can also treat the input disturbances that can not be linearized in the linearization procedure of T-S fuzzy modeling. Design example for the nonlinear system, an inverted pendulum on a cart, demonstrates the utility and validity of the proposed control scheme.

Purpose For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. Methods We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications. Results The patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 ± 22.74 minutes whereas that in the LA group was 61.70 ± 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. Conclusion Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.

Major advancements in T-RAM cell manufacturability are reported. A fully planar implementation of a T-RAM cell is presented, which is easily integrated into a baseline 130nm SOI CMOS logic technology by adding photo-mask and ion-implantation steps. The cell area of 0.562/spl mu/m/sup 2/ (33F/sup 2/) is four times smaller than conventional 6T-SRAM. A new scheme, called Restore, significantly improves control of the cell standby current. Excellent T-RAM cell temperature stability is demonstrated between 0/spl deg/C and 125/spl deg/C. Measurement results from a 9Mb T-RAM test chip with full SRAM functionality show good bit yield, 2ns cell write speed, 1.7ns cell read speed, and a cell standby current of /spl sim/1nA/cell.

A capacitor-less DRAM cell using a thin capacitively-coupled thyristor (TCCT DRAM) is introduced. Experimental results from unit memory cell fabricated in a 130nm SOI logic technology demonstrate Ion/Ioff ratio of 107, non-destructive read; write speed less than 2ns at 125C, and solid retention characteristics. These cell characteristics combined with a small cell area (as low as 9F2) and simple process integration make TCCT DRAM a suitable candidate for high-performance high-density embedded or standalone memory applications

Purpose Luminal-type breast cancer has a good prognosis compared to other types, such as human epidermal growth factor receptor 2 and triple negative types. Luminal-type breast cancer is classified into luminal A and B, according to the proliferation index. We investigated the clinicopathological factors that affect the prognosis of the luminal-type subgroups. Methods We reviewed the medical records and the pathologic reports of 159 luminal-type breast cancer patients who were treated between February 2005 and November 2007. We divided luminal-type breast cancer into luminal A and B, according to Ki-67 (cutoff value, 14%) and analyzed the clinicopathologic factors, such as age at diagnosis, intensity score of estrogen receptor and progesterone receptor, histologic grade, and Bcl-2. Moreover, we compared the disease-free survival (DFS) of each group. Results In the univariate analysis, age (p=0.004), tumor size (p=0.010), lymph node metastasis (p=0.001), and Bcl-2 (p=0.002) were statistically significant factors in luminal-type breast cancer. In the multivariate analysis, lymph node (p=0.049) and Bcl-2 (p=0.034) were significant relevant factors in luminal-type breast cancer. In the subgroup analysis, the increased Bcl-2 (cutoff value, 33%) was related with a longer DFS in the luminal B group (p=0.004). Conclusion In our study, luminal A breast cancer showed a longer DFS than luminal B breast cancer, further, Bcl-2 may be a potent prognostic factor in luminal-type breast cancer.

17세 여자가 골반염증성질환으로 입원하여 항생제 치료를 시작하였다. 증상 호전 중 입원 5일째 갑자기 오심과 구토 증상이 시작되었다. 보존적 처치에도 불구하고 증상이 심해져 7일째 시행한 단순복부촬영과 복부골반 전산화단층촬영에서 허혈성 소장폐쇄 소견이 보였다. 응급개복술을 시행하였고 소장 장간막 부위에 그물막이 붙어 유착띠가 형성되어 있었고 20 cm 정도의 소장이 끼어 있었다. 부분 그물막절제술, 유착띠박리술, 부수적으로 충수돌기절제술을 시행하였다. 수술 후 증상은 완전히 소실되었으며 11개월간 외래 추적 관찰에서도 특이사항은 없었다. 이 증례는 골반염과 동반된 오심 구토 증상이 지속될 경우 골반염증질환의 드문 합병증인 장폐쇄를 의심하여야 하겠고, 정확한 진단과 의사결정을 위해 단순복부촬영뿐만 아니라 복부골반 전산화단층촬영의 유용성을 보여준다. 저자들은 Chlamydia trachomatis 감염에 의한 골반염성 질환 환자에서 발생한 유착성 소장폐쇄 1예를 경험하였기에 이에 간단한 문헌 고찰을 함께 보고하는 바이다.