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BACKGROUND: Whether obesity and being overweight, defined by body mass index (BMI), increase hepatocellular carcinoma (HCC) has been less apparent in Asian populations. METHODS: Overall, 14,265,822 Korean adults who underwent routine health examinations during 2003–2006 were followed up for HCC. Multivariable-adjusted hazard ratios (HRs) associated with BMI were calculated. RESULTS: During 13.7 years (mean) of follow-up, 47,308 individuals developed HCC. HRs of HCC associated with BMIs of 25.0–26.4, 26.5–27.9, 28.0–29.4, 29.5–30.9 and ≥31 kg/m² compared to those for 23.5–24.9 kg/m² were 1.05, 1.20, 1.39, 1.59 and 2.13, respectively. For BMI

Indoleamine 2, 3-dioxygenase 1 (IDO1) is an immunomodulatory enzyme that catalyzes the degradation of tryptophan to kynurenine and induces immune tolerance in tumor cells. The effects of IDO1 on extrahepatic bile duct carcinoma (EHBDC) are poorly understood. Therefore, the present study aimed to investigate the expression and prognostic significance of IDO1 in EHBDC. An immunohistochemical microarray analysis of IDO1 expression was performed for 76 surgically resected cases of EHBDC. CD8

Background/aim Oxaliplatin-based chemotherapy is associated with hepatic sinusoidal obstruction syndrome (SOS). Patients and methods We analyzed patients from two prospective trials, in which capecitabine/oxaliplatin (XELOX, 8 cycles; n=51) and S-1/oxaliplatin [SOX, continuous (SOX-C, n=50), or intermittent (discontinuation after cycle 6 and restart on progression, SOX-I, n=50)] were administered. We compared severity (splenomegaly, thrombocytopenia, liver enzyme levels, and hepatic parenchymal heterogeneity), clinical significance (delay or dose-reduction of chemotherapy), and reversibility of SOS (splenomegaly and thrombocytopenia after stopping chemotherapy) between SOX and XELOX in gastric cancer patients. Results SOX was more likely to be associated with splenomegaly, thrombocytopenia, hyperbilirubinemia, and hepatic parenchymal heterogeneity than XELOX. Splenomegaly was partially reversible after stopping chemotherapy in both regimens, but recovery rate was lower in SOX. Proportion of delayed or dose-reduced chemotherapy cycles due to thrombocytopenia was significantly higher in SOX-C than in XELOX. Conclusion S-1 combination is more likely to worsen oxaliplatin-induced hepatic sinusoidal injuries than capecitabine in gastric cancer patients.

Pancreatic ductal adenocarcinoma (PDAC) and extrahepatic bile duct carcinoma (EBDC) are distinct entities with different clinicopathological implications. Therefore, research to differentiate between the two diseases is compulsory. In this study, four biomarkers were selected (Hippocalcin-like 1 (HPCAL1); annexin A10 (ANXA10); MUC5AC; sodium/potassium-transporting ATPase subunit beta-1 (ATP1B1)) and focus was placed on clarifying the diagnostic performance of each biomarker and pioneering novel-combined biomarker panels to discriminate between PDAC and EBDC.An immunohistochemical microarray analysis of HPCAL1, ANXA10, MUC5AC, and ATP1B1 was conducted for surgically resected 55 PDACs and 77 EBDCs. The diagnostic performance discriminating between PDAC and EBDC was evaluated using four biomarkers and the combined biomarker panels.PDACs exhibited more positive expressions for HPCAL1, ANXA10, and MUC5AC, whereas EBDCs exhibited more ATP1B1-positive expressions. The PDAC panel with the best diagnostic performance was the profile of (+ in ≥ 2 among HPCAL1, ANXA10, MUC5AC)/ATP1B1-. The immunophenotype pattern of (- in ≥ 1 among HPCAL1, ANXA10, MUC5AC)/ATP1B1+ is the EBDC panel with the most excellent discriminating power.The suggested combined biomarker panels demonstrate the distinguishing diagnostic ability between PDAC and EBDC is better than previous studies. Therefore, for differentiation between PDAC and EBDC, these panels are expected to help unravel the clinicopathological enigma as promising biomarker panels in the future.

Background: Indoleamine 2, 3-dioxygenase 1 (IDO1) is an immunomodulatory enzyme that catalyzes the degradation of tryptophan to kynurenine (Kyn) and induces immune tolerance in tumour cells. The effects of IDO1 on extrahepatic bile duct carcinoma (EHBDC) are poorly understood. This study aimed to investigate the expression and prognostic significance of IDO1 in EHBDC. Methods: An immunohistochemical microarray analysis of IDO1 expression was performed for 77 surgically resected cases of EHBDC, and the results were compared with various clinicopathologic variables including survival data. CD8+ tumour infiltrating lymphocytes (TILs) were also investigated to elucidate their relationship with IDO1 expression and prognosis through a combination analysis with IDO1 expression. Results: IDO1 was highly expressed in 25 of 76 (32.9%) cases. High expression of IDO1 was associated with decreased numbers of CD8+ TILs (P=0.008), a higher pN category (P=0.007), an advanced overall stage (P=0.001), and frequent recurrence (P=0.018). When IDO1 expression was further stratified with CD8+ TIL state, the IDO1high /CD8low subgroup showed the worst prognosis in terms of overall survival (P = 0.025, Cox risk ratio = 2.168) and disease-free survival (P = 0.015, Cox risk ratio = 2.460) in a multivariate analysis. Conclusions: Our study confirmed that high IDO1 expression was correlated with a decreased number of CD8+ TILs and associated with a poor prognosis. As IDO1 may be a new target of immunotherapy applications, IDO1/CD8+ TIL subgrouping can be a useful prognostic prediction tool in the patients with EHBDC.

Oxaliplatin-based chemotherapy is associated with hepatic sinusoidal obstruction syndrome (SOS).We analyzed patients from two prospective trials, in which capecitabine/oxaliplatin (XELOX, 8 cycles; n=51) and S-1/oxaliplatin [SOX, continuous (SOX-C, n=50), or intermittent (discontinuation after cycle 6 and restart on progression, SOX-I, n=50)] were administered. We compared severity (splenomegaly, thrombocytopenia, liver enzyme levels, and hepatic parenchymal heterogeneity), clinical significance (delay or dose-reduction of chemotherapy), and reversibility of SOS (splenomegaly and thrombocytopenia after stopping chemotherapy) between SOX and XELOX in gastric cancer patients.SOX was more likely to be associated with splenomegaly, thrombocytopenia, hyperbilirubinemia, and hepatic parenchymal heterogeneity than XELOX. Splenomegaly was partially reversible after stopping chemotherapy in both regimens, but recovery rate was lower in SOX. Proportion of delayed or dose-reduced chemotherapy cycles due to thrombocytopenia was significantly higher in SOX-C than in XELOX.S-1 combination is more likely to worsen oxaliplatin-induced hepatic sinusoidal injuries than capecitabine in gastric cancer patients.

Background: Previous studies have proposed various physical tests for screening fall risk in older adults. However, older adults may have physical or cognitive impairments that make testing difficult. This study describes the differences in individual, physical, and psychological factors between adults in good and poor self-rated health statuses. Further, we identified the physical or psychological factors associated with self-rated health by controlling for individual variables. Methods: Data from a total of 1577 adults aged 65 years or over with a history of falls were analyzed, using the 2017 National Survey of Older Persons in South Korea. Self-reported health status was dichotomized as good versus poor using the 5-point Likert question: &ldquo, poor&rdquo, (very poor and poor) and &ldquo, good&rdquo, (fair, good, and very good). Results: Visual/hearing impairments, ADL/IADL restriction, poor nutrition, and depression were more frequently observed in the group with poor self-rated health. Multivariable logistic regression revealed that poor self-reported health was significantly associated with hearing impairments (OR: 1.51, 95% CI 1.12&ndash, 2.03), ADL limitation (OR: 1.77, 95% CI 1.11&ndash, 2.81), IADL limitation (OR: 2.27, 95% CI 1.68&ndash, 3.06), poor nutrition (OR: 1.36, 95% CI 1.05&ndash, 1.77), and depression (OR 3.77, 95% CI 2.81&ndash, 5.06). Conclusions: Auditory impairment, ADL/IADL limitations, poor nutrition, and depression were significantly associated with poor self-reported health. A self-rated health assessment could be an alternative tool for older adults who are not able to perform physical tests.

As the population ages, falls are becoming one of the leading causes of morbidity and mortality. Joint disease (either osteoarthritis or rheumatoid arthritis) is a well-known predictor of falls, and these medical conditions increase in accordance with the aging population. This study aimed to describe individual, physical, and psychological characteristics between older adults with and without a fall history. Further, we aimed to identify statistically significant physical or psychological factors associated with falls by controlling individual variables. We analyzed data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults. Adults aged 65 years or over with doctor-diagnosed joint disease were eligible. A total of 2707 women and 784 men (n = 3491) were enrolled. Of these, 1174 patients suffered a fall within a year (average number of falls = 2.4). We adopted individual variable-adjusted models and found that limited activities of daily living (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.04&ndash, 1.87), fear of falling (OR 7.18, 95% CI 4.26&ndash, 12.09), and depression (OR 1.28, 95% CI 1.09&ndash, 1.50) significantly increased fall risks on logistic regression analysis. Our findings suggest that physical and psychological factors, especially the fear of falling, need to be addressed to prevent falls in elderly patients with arthritis.

Background Korean comprehensive nursing-caregiving service, which is covered by national insurance, has been officially initiated in 2016. Following interim analysis presented at JSMO 2018, we report our 1-year experience of cancer-oriented comprehensive nursing-caregiving unit´s outcomes and issues. Methods and Results Our institution is a general hospital (827 beds) with 246 doctors and 703 RNs. We are running cancer-oriented comprehensive nursing-caregiving service (46 beds with 25 RNs and 12 nurses aides) since December 2017. This special ward is caring only medical oncology patients. For 12 months, 11,946 inpatients (average 32.4 patients/day, bed turnover rate 85.7%) and 5,682 patients received chemotherapy in our unit. We evaluated our Results in three categories: structure, process, and outcome. First, structural (environmental) improvements were found in more interval between beds (1.5m), fully automatic beds with fall prevention sensors, comfortable patient lounge. Second, process improvements such as nursing time, quality of oncologic nursing is improved. For example, missed nursing care has been improved (nursing caregiving ward vs. general ward: 0.1 vs. 1.3 events/month). Finally, patient and nurse outcome are much improved when compared with general wards. Patient satisfaction (will to revisit: 91.7% vs. 78.4%, will to recommend to others: 95.0% vs. 76.8%) have been increased. Safety indicators such as pressure ulcer (0.3 vs. 0.8 events/month), falls (1.6 vs. 1.5 events/month) have dropped. Nurse outcomes such as resignation rate have been stabilized (resignation rate: 0 vs. 14.9%). Issues during unit operation were found in still heavy workloads for nursing staff and low compensation by the government compared with other countries. Conclusion Comprehensive nursing-caregiving service for medical oncology patients is a key to success in both improved quality of cancer care and nursing staff´s job satisfaction.

Background Since the introduction of nab-paclitaxel plus gemcitabine (nab-P + GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P + GEM. Methods Among the 203 patients previously treated with 1L nab-P + GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P + GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors. Results Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in 2 (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 month from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 vs 3.81 months, P = 0.40) or OS (7.04 vs 7.43 months, P = 0.86). A high neutrophil-lymphocyte ratio (>2.2) and a short time to progression with 1L nab-P + GEM ( Conclusions 2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P + GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

e22195Background: Oxaliplatin (OX)-based chemotherapy is known to cause hepatic sinusoidal injury, resulting portal hypertension with splenomegaly (SM). We compared this OX-induced hepatopathy, SM,...

As product life cycle becomes shortened, high product quality becomes necessary for survival, markets become highly diversified and global, and continuous and unexpected change becomes the key factor for success. The need for a method of rapidly and cost-effectively developing products, production facilities and supporting software including design, process planning, shop floor control systems is becoming urgent. The essence of this concept of manufacturing would be characterized by introducing a new term agility or rapidity. When compared with computer integrated manufacturing, agile manufacturing can be defined as the capability of surviving and prospering in a competitive environment of continuous and unpredictable change by reacting quickly and effectively to changing markets, driven by customer-designed products and services. Critical to successfully accomplishing agile manufacturing are a few enabling technologies such as the standard for the exchange of products (STEP), concurrent engineering, virtual manufacturing, component-based heterarchical shop floor control system information and communication infrastructure, etc. This article details key concepts of those enabling technologies and presents various activities related to agile manufacturing under development in Korea, especially an agile manufacturing test-bed at Pohang University of Science and Technology and a prototype of the life cycle engineering study of a product model made in a consumer electronic industry.

In this paper, a novel parameter extraction algorithm based on modified simulated diffusion (SD) is presented. The utility of this program is demonstrated by applying it to the parameter extraction of a 40 V bipolar transistor and a 2 /spl mu/m polysilicon emitter bipolar transistor. It is the first time that DC and AC bipolar model parameters have been extracted simultaneously via the global optimization methodology using SD. Indeed this tool, supported by an excellent agreement between the measured and simulated data, is a powerful means for the modeling of any devices. >

The conventional optimization technique such as the gradient-based Levenberg-Marquardt (L-M) method, which has been typically used in the commercially available parameter extraction tools, can easily be trapped in the local minima of the objective function, On the contrary, a method called simulated diffusion (SD), inspired by the simulated annealing, is known to be the most effective way to find the global minimum. In this paper, the parameter extraction algorithm based on the SD, which we have modified slightly to improve the efficiency, is presented. This is the first time that "both" dc and ac model parameters of a bipolar transistor or dc model parameters of NMOS transistors in different geometry have been extracted simultaneously via the global optimization methodology using the SD. >