Surgical treatment of nasolabial cysts in a single institute

OBJECTIVES

To analyse the results of treatment for nasolabial cysts according to whether an intraoral sublabial or endoscopic transnasal approach was used, and to determine the recent surgical trend in our hospital.

METHODS

Twenty-four patients with a histopathologically and radiologically confirmed nasolabial cyst between January 2010 and December 2017 were enrolled in this study.

RESULTS

Nasolabial cysts were predominant in females (91.7 per cent) and on the left side (54.2 per cent). Treatment involved an intraoral sublabial approach in 12 cases (48.0 per cent) and a transnasal endoscopic approach in 13 cases (52.0 per cent). In 13 cases (52.0 per cent) surgery was performed under local anaesthesia, while in 12 cases (48.0 per cent) it was conducted under general anaesthesia. The most common post-operative complications were numbness of the upper lip or teeth (n = 9, 36.0 per cent). Only one patient (4.0 per cent), who underwent a transnasal endoscopic approach, experienced a reoccurrence.

CONCLUSION

Surgical resection through an intraoral sublabial or transnasal endoscopic approach is the best treatment for a nasolabial cyst, showing very good results and a low recurrence rate. The recent surgical trend in our hospital is to treat nasolabial cysts using a transnasal endoscopic approach under local anaesthesia.

Unobtrusive monitoring of behavior and movement patterns to detect clinical depression severity level via smartphone

The number of individuals with mental disorders is increasing and they are commonly found among individuals who avoid social interaction and like to live alone. Amongst such mental health disorders is depression which is both common and serious. The present paper introduces a method to assess the depression level of an individual using a smartphone by monitoring their daily activities. The time domain characteristics from a smartphone acceleration sensor were used alongside a vector machine algorithm to classify physical activities. Additionally, the geographical location information was clustered using a smartphone GPS sensor to simplify movement patterns. A total of 12 features were extracted from individuals' physical activity and movement patterns and were analyzed alongside their weekly depression scores using the nine-item Patient Health Questionnaire. Using a wrapper feature selection method, a subset of features was selected and applied to a linear regression model to estimate the depression score. The support vector machine algorithm was then used to classify the depression severity level among individuals (absence, moderate, severe) and had an accuracy of 87.2% in severe depression cases which outperformed other classification models including the k-nearest neighbor and artificial neural network. This method of identifying depression is a cost-effective solution for long-term use and can monitor individuals for depression without invading their personal space or creating other day-to-day disturbances.

Outcomes of treatment of mammary analogue secretory carcinoma of the parotid gland

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a newly-described, rare, malignant tumour. Few patients present with MASC of the parotid gland, so the exact characteristics, outcomes of treatment, and prognosis are unknown. The aim of this study was to analyse the clinical features and outcomes of treatment of MASC of the parotid gland in patients being treated at a single hospital. Five patients with histopathologically-confirmed MASC of the parotid gland between January 2015 and August 2018 were retrospectively enrolled. In all cases preoperative fine-needle aspiration cytology had failed to provide an accurate diagnosis. All patients underwent a macroscopically complete oncological resection. Two patients had postoperative radiotherapy (RT). On immunohistochemical examination all tumours stained for S-100 and mammaglobin but not for DOG1. There were no regional recurrences or distant metastases in any of the patients at their last follow-up. We obtained good results for patients with MASC of the parotid gland with surgical treatment and postoperative RT.

Dental implant and fungus ball in the ethmoid sinus

Dental migration into the ethmoid sinus is extremely rare. Furthermore, it is very unusual that a displaced dental implant is associated with a concomitant fungus ball in the ethmoid sinus. Herein, we report an unusual case of the coexistence of a dental implant and fungus ball in the ethmoid sinus. It appears that this condition has not been reported previously.

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

BACKGROUND AND PURPOSE

Classic findings of intracranial hypotension on MR imaging, such as brain stem slumping, can be variably present and, at times, subjective, potentially making the diagnosis difficult. We hypothesize that the angle between the cerebral peduncles correlates with the volume of interpeduncular cistern fluid and is decreased in cases of intracranial hypotension. We aimed to investigate its use as an objective assessment for intracranial hypotension.

MATERIALS AND METHODS

Brain MRIs of 30 patients with intracranial hypotension and 30 age-matched controls were evaluated by 2 fellowship-trained neuroradiologists for classic findings of intracranial hypotension and the interpeduncular angle. Group analysis was performed with a Student t test, and receiver operating characteristic analysis was used to identify an ideal angle threshold to maximize sensitivity and specificity. Interobserver reliability was assessed for classic findings of intracranial hypotension using the Cohen κ value, and the interpeduncular angle, using the intraclass correlation.

RESULTS

The interpeduncular angle had excellent interobserver reliability (intraclass correlation coefficient value = 0.833) and was significantly lower in the intracranial hypotension group compared with the control group (25.3° versus 56.3°; P < .001). There was significant correlation between the interpeduncular angle and the presence of brain stem slumping (P < .001) and in cases with ≥3 classic features of intracranial hypotension (P = .01). With a threshold of 40.5°, sensitivity and specificity were 80% and 96.7%, respectively.

CONCLUSIONS

The interpeduncular angle is a sensitive and specific measure of intracranial hypotension and is a reliably reproducible parameter on routine clinical MR imaging.

Fuel-Composition Dependent Reactor Antineutrino Yield at RENO

We report a fuel-dependent reactor electron antineutrino (ν[over ¯]_{e}) yield using six 2.8 GW_{th} reactors in the Hanbit nuclear power plant complex, Yonggwang, Korea. The analysis uses 850 666 ν[over ¯]_{e} candidate events with a background fraction of 2.0% acquired through inverse beta decay (IBD) interactions in the near detector for 1807.9 live days from August 2011 to February 2018. Based on multiple fuel cycles, we observe a fuel ^{235}U dependent variation of measured IBD yields with a slope of (1.51±0.23)×10^{-43}  cm^{2}/fission and measure a total average IBD yield of (5.84±0.13)×10^{-43}  cm^{2}/fission. The hypothesis of no fuel-dependent IBD yield is ruled out at 6.6σ. The observed IBD yield variation over ^{235}U isotope fraction does not show significant deviation from the Huber-Mueller (HM) prediction at 1.3 σ. The measured fuel-dependent variation determines IBD yields of (6.15±0.19)×10^{-43} and (4.18±0.26)×10^{-43}  cm^{2}/fission for two dominant fuel isotopes ^{235}U and ^{239}Pu, respectively. The measured IBD yield per ^{235}U fission shows the largest deficit relative to the HM prediction. Reevaluation of the ^{235}U IBD yield per fission may mostly solve the reactor antineutrino anomaly (RAA) while ^{239}Pu is not completely ruled out as a possible contributor to the anomaly. We also report a 2.9 σ correlation between the fractional change of the 5 MeV excess and the reactor fuel isotope fraction of ^{235}U.

Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials

BACKGROUND

Previous meta-analyses of randomized controlled trials (RCTs) of vitamin D supplementation and total cancer incidence and mortality found inconsistent results, and most included trials administered generally low doses of vitamin D (≤1100 IU/day). We updated the meta-analysis by incorporating recent RCTs that have tested higher doses of vitamin D supplements.

MATERIALS AND METHODS

PubMed and Embase were searched from the inception to November 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a random-effects model.

RESULTS

For total cancer incidence, 10 trials were included [6537 cases; 3-10 years of follow-up; 54-135 nmol/l of attained levels of circulating 25(OH) vitamin D [25(OH)D] in the intervention group]. The summary RR was 0.98 (95% CI, 0.93-1.03; P = 0.42; I2 = 0%). The results remained null across subgroups tested, including even when attained 25(OH)D levels exceeded 100 nmol/l (RR, 0.95; 95% CI, 0.83-1.09; P = 0.48; I2 = 26%). For total cancer mortality, five trials were included [1591 deaths; 3-10 years of follow-up; 54-135 nmol/l of attained levels of circulating 25(OH)D in the intervention group]. The summary RR was 0.87 (95% CI, 0.79-0.96; P = 0.005; I2 = 0%), which was largely attributable to interventions with daily dosing (as opposed to infrequent bolus dosing). No statistically significant heterogeneity was observed by attained levels of circulating 25(OH)D (Pheterogeneity = 0.83), with RR being 0.88 (95% CI, 0.78-0.98; P = 0.02; I2 = 0%) for ≤100 nmol/l and 0.85 (95% CI, 0.70-1.03; P = 0.11; I2 = 0%) for >100 nmol/l.

CONCLUSIONS

In an updated meta-analysis of RCTs, vitamin D supplementation significantly reduced total cancer mortality but did not reduce total cancer incidence.

Measurement of Reactor Antineutrino Oscillation Amplitude and Frequency at RENO

The RENO experiment reports more precisely measured values of θ_{13} and |Δm_{ee}^{2}| using ∼2200 live days of data. The amplitude and frequency of reactor electron antineutrino (ν[over ¯]_{e}) oscillation are measured by comparing the prompt signal spectra obtained from two identical near and far detectors. In the period between August 2011 and February 2018, the far (near) detector observed 103 212 (850 666) ν[over ¯]_{e} candidate events with a background fraction of 4.8% (2.0%). A clear energy and baseline dependent disappearance of reactor ν[over ¯]_{e} is observed in the deficit of the measured number of ν[over ¯]_{e}. Based on the measured far-to-near ratio of prompt spectra, we obtain sin^{2}2θ_{13}=0.0896±0.0048(stat)±0.0047(syst) and |Δm_{ee}^{2}|=[2.68±0.12(stat)±0.07(syst)]×10^{-3}  eV^{2}.

Cannulation of Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: Usefulness of a Frontier-Wire Probing Technique

BACKGROUND AND PURPOSE

Pursuing an alternative access route for transvenous embolization of cavernous sinus dural arteriovenous fistulas can be challenging in patients with an occluded inferior petrosal sinus. We found that cannulation of even a completely occluded inferior petrosal sinus is feasible, especially when using a standard hydrophilic-polymer-jacketed 0.035-inch guidewire as a frontier-wire for probing.

MATERIALS AND METHODS

From 2002 to 2017, the frontier-wire technique was tried in 52 patients with occluded inferior petrosal sinuses for transvenous embolization of cavernous sinus dural arteriovenous fistulas at our center. Technical success was defined as access into the affected cavernous sinus compartment with a microcatheter through the occluded inferior petrosal sinus and deployment of at least 1 coil. The complications and treatment outcomes were analyzed.

RESULTS

The frontier-wire technique was applied in 52 patients with 57 occluded inferior petrosal sinuses (52 ipsilateral and 5 contralateral inferior petrosal sinuses). Technical success rates were 80.8% (42/52) of patients and 73.7% (42/57) of inferior petrosal sinuses. Alternative transvenous routes were used in 3 patients, and transarterial access was used in 7 patients. Complete embolization of fistulas was achieved in 82.2% (37/45) of patients in the transvenous embolization group and in 14.3% (1/7) of patients in the transarterial group. No procedure-related morbidity or mortality was observed.

CONCLUSIONS

Transvenous embolization of cavernous sinus dural arteriovenous fistulas, even through a completely occluded inferior petrosal sinus, is feasible. The difficulty of passing the microcatheter can be minimized by prior probing of the occluded inferior petrosal sinus using a standard 0.035-inch guidewire; the trace of the guidewire on the roadmap image serves as a guide for microcatheter navigation through the inferior petrosal sinus on fluoroscopy.

Comparison of overall survival between antiviral-induced viral suppression and inactive phase chronic hepatitis B patients

Nucleot(s)ide analogues (NAs) reduce the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. However, the risk of HCC is reportedly higher for NA-treated patients than for patients in the inactive CHB phase. This study aimed to compare the long-term outcomes of CHB patients with NA-induced viral suppression and those of patients with inactive CHB. This retrospective study involved 1118 consecutive CHB patients whose HBV DNA level was continuously <2000 IU/mL during follow-up with/without antiviral agents. The patients were classified into inactive CHB (n = 373) or NA groups (n = 745). The primary endpoint was overall survival. Secondary endpoints included development of HCC and other liver-related events. The median duration of follow-up was 41.0 (interquartile range = 26.5-55.0) months. The difference in overall survival between the NA group vs. the inactive CHB group was not significant (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.33-1.85; P = .57). The NA group showed a significantly higher risk of HCC (HR = 3.44; 95% CI = 1.82-6.52; P < .01), but comparable risk for non-HCC liver-related events (HR = 1.02; 95% CI = 0.66-1.59; P = .93), compared with the inactive CHB group. Among patients with cirrhosis, the NA group showed a significantly lower risk of death (HR = 0.31; 95% CI = 0.097-0.998; P = .05) and non-HCC liver-related events (HR = 0.51; 95% CI = 0.31-0.83; P < .01), but a slightly higher risk of HCC (HR = 2.39; 95% CI = 0.85-6.75; P = .09), compared to the inactive CHB group. The overall survival of untreated patients with inactive CHB and of CHB patients achieving viral suppression with NA was comparable. However, NA treatment of cirrhotic patients was significantly associated with longer overall survival and lower risk of liver-related events.

Identification of transfusion-transmitted hepatitis A through postdonation information in Korea: results of an HAV lookback (2007-2012)

BACKGROUND AND OBJECTIVES

Despite safety measures to minimize the risk of transfusion-transmitted infections, a residual risk remains. To trace and review some such cases, we ask donors to notify the blood centre if they are diagnosed with an infection after they donate blood.

MATERIALS AND METHODS

We analysed all data on postdonation cases of hepatitis A reported between 2007 and 2012. Archived specimens from these donors were tested for hepatitis A virus (HAV) using anti-HAV IgM/IgG and HAV-PCR as markers. If any of the test results were positive, we reviewed the medical records of the recipients and, if necessary, tested them for hepatitis A.

RESULTS

Fifteen blood donors notified the blood centres of having been diagnosed with hepatitis A after donation. All archived samples except for one were HAV-PCR-positive and anti-HAV IgM/IgG-negative. Of the donated components, four RBCs and 14 FFPs had not been transfused to patients and were recalled. Among 26 recipients of the implicated components, fourteen were still alive when they were notified. Two patients showed clinical symptoms of hepatitis A and had positive results with anti-HAV IgM.

CONCLUSION

Transfusion-transmitted hepatitis A is rare but exists. To reduce the risk, donors should be told to notify the blood centre if they are diagnosed with blood-borne diseases after they donate blood. Physicians should consider the possibility of transfusion-transmitted hepatitis A if a transfused patient has hepatitis A but no history of travel or route of faecal-oral infection.

Entecavir and tenofovir reduce hepatitis B virus-related hepatocellular carcinoma recurrence more effectively than other antivirals

Nucleos(t)ide analogues (NAs) have been shown to decrease the risk of hepatocellular carcinoma (HCC) recurrence. This study evaluated whether high-potency NAs (entecavir and tenofovir disoproxil fumarate [TDF]) reduce the risk of tumour recurrence more potently than low-potency NAs after curative treatment of hepatitis B virus (HBV)-related HCC. This study included 607 consecutive HBV-related HCC patients treated with surgical resection or radiofrequency ablation. The patients were categorized into three groups according to antiviral treatment: group A (no antiviral; n = 261), group B (low-potency NA; n = 90) and group C (high-potency NA; n = 256). The primary end-point was recurrence-free survival (RFS). During the duration of follow-up, the median RFS was 29.4, 25.1, and 88.2 months in groups A, B and C, respectively (P < .001, log-rank test). The multivariate Cox analysis indicated that group C had a significantly longer RFS than both group A (adjusted hazard ratio [HR] = 0.39, P < .001) and group B (adjusted HR = 0.47, P < .001). When baseline characteristics were balanced using inverse probability weighting, group C still had a significantly longer RFS than group A (adjusted HR = 0.46, P < .001) and group B (adjusted HR = 0.59, P = .007). Group C had significantly lower risk of viral breakthrough than group B (HR = 0.19, P < .001). Viral breakthrough was an independent risk factor for shorter RFS among groups B and C (adjusted HR = 2.03, P = .007, time-dependent Cox analysis). Antiviral agents with high genetic barrier to resistance (entecavir and TDF) reduced the risk of HCC recurrence compared with other antivirals and no antiviral treatment, especially in patients with high baseline viral load.

Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B-endemic area

BACKGROUND

Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC).

AIM

To investigate the effectiveness of HCC surveillance in a hepatitis B-endemic population.

METHODS

This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead-time and length-time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed.

RESULTS

The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57-0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69-1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead-time. When the subjects were restricted to cirrhotic patients or Child-Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups.

CONCLUSIONS

HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance.

Localized Marked Elongation of the Distal Internal Carotid Artery with or without PHACE Syndrome: Segmental Dolichoectasia of the Distal Internal Carotid Artery

BACKGROUND AND PURPOSE

Segmental intracranial dolichoectasia of the distal ICA is a feature of PHACE syndrome or a sporadic phenomenon. We evaluated the relationship between intracranial dolichoectasia of the distal ICA and PHACE syndrome and illustrated the characteristic radiologic findings of the lesions.

MATERIALS AND METHODS

Intracranial dolichoectasia of the distal ICA was identified in 20 patients at our institution from 2005 to 2016 through a review of diagnostic cerebral angiography results. All radiologic images were reviewed to determine the vascular morphologic dispositions around the distal ICA, including dysplasia, mural calcification, vessel wall enhancement, lumen narrowing, and aneurysm formation. Medical records were reviewed to determine the symptoms of PHACE syndrome. Subsequently, the correlation between radiologic findings and PHACE syndrome was assessed.

RESULTS

In this cohort, which had a strong female predominance (male/female ratio= 2:18), intracranial dolichoectasia had a more ipsilateral vascular morphologic disposition. Mural calcification was detected more frequently in elderly patients, whereas vessel wall enhancement was detected more frequently in younger patients. Follow-up images showed a slow progression of the lesions. However, no significant differences in the vascular morphologic disposition and brain structural changes were observed between patients with (n = 11) and without (n = 9) PHACE syndrome.

CONCLUSIONS

The striking elongation and tortuosity of the distal ICA generally appeared to be a type of congenital lesion occurring early in embryogenesis as either a sporadic phenomenon or an arterial change associated with PHACE syndrome. Imaging findings revealed various mural abnormalities with a benign clinical course.

Can persistent organic pollutants distinguish between two opposite metabolic phenotypes in lean Koreans?

AIMS

This study investigated the association of persistent organic pollutants (POPs), an emerging new risk factor for type 2 diabetes and the metabolic syndrome, with the presence of opposite phenotypes of glucose and lipid metabolism among normal-weight Koreans of similar body composition.

METHODS

Fifty subjects, randomly selected from an ongoing community-based cohort study, from two opposite phenotype groups - metabolically unhealthy normal weight (MUHNW) and metabolically healthy normal weight (MHNW) - were matched for waist circumference, visceral fat mass and demographic variables, then compared for serum concentrations of POPs.

RESULTS

Most POPs (10 out of 13 compounds) were present in higher serum concentrations in the MUHNW than in the MHNW. In particular, serum concentrations of all compounds of the organochlorine pesticide class were 2.2 to 4.7 times higher in cases than in controls. Compared with the lowest tertile of summary measures of POPs, Odds ratios (95% confidence interval) for the second and third tertiles were 7.4 (1.9-29.4) and 10.4 (2.6-41.2), respectively. Adjusting for possible confounders did not change the results.

CONCLUSION

Taken altogether, these findings from the present and previous studies suggest that increased serum POP concentrations may play an important role in the development of unhealthy metabolic phenotypes in lean people.

Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years

BACKGROUND

Atrophic gastritis and intestinal metaplasia are premalignant conditions for gastric cancer. Their reversibility by Helicobacter pylori eradication remains controversial.

AIM

To evaluate the reversibility of atrophic gastritis and intestinal metaplasia by H. pylori eradication with long-term follow-up.

METHODS

598 subjects were prospectively enrolled and followed for up to 10 years. They were categorised as H. pylori-negative (n = 65), H. pylori non-eradicated (n = 91), and H. pylori-eradicated (n = 442). Histological assessment was performed for antrum and corpus by Sydney classification.

RESULTS

Histological follow-up was performed regularly at 1, 2, 3-4 and ≥5 years, with mean follow-up of 1.07 ± 0.21, 2.29 ± 0.83, 3.93 ± 1.02, and 6.45 ± 1.28 years, respectively. Atrophic gastritis in antrum and corpus gradually and significantly (both P < .05 for all timepoints) improved only in the H. pylori-eradicated group compared to that at baseline. Significant difference in atrophic gastritis between H. pylori-eradicated and H. pylori-negative groups disappeared from 1-year follow-up. Similarly, intestinal metaplasia in antrum and corpus improved significantly (both P < .05 for all timepoints) only in the H. pylori-eradicated group in comparison with that at baseline. Significant difference in intestinal metaplasia between H. pylori-eradicated and H. pylori-negative groups disappeared from ≥5 years of follow-up in the antrum and from 3 years of follow-up in the corpus.

CONCLUSION

H. pylori eradication may be a preventative strategy for intestinal-type gastric cancer by regression of atrophic gastritis and intestinal metaplasia.

Genetic parameters of carcass and meat quality traits in different muscles (longissimus dorsi and semimembranosus) of Hanwoo (Korean cattle)

We estimated heritability () and genetic and phenotypic correlations for carcass and meat quality traits of longissimus dorsi (LD) and semimembranosus (SM) muscles in 30-mo-old Hanwoo steers. Variance and covariance components were estimated using REML procedures under univariate and bivariate models. The mean carcass weight (CWT), eye muscle area (EMA), back fat thickness (BFT), and marbling score (MS) were 428.20 ± 46.30 kg, 87.38 ± 8.54 cm2, 13.00 ± 5.14 mm, and 5.21 ± 1.56, respectively. The mean CIE reflectance of meat lightness (L*), redness (a*), and yellowness (b*) were 40.01 ± 2.73, 22.37 ± 2.18, and 10.35 ± 1.46, respectively, in LD muscles and 36.33 ± 2.44, 22.91 ± 2.43, and 10.25 ± 1.65, respectively, in SM muscles. The mean Warner-Bratzler shear force (WBSF), intramuscular fat content (IMF), water-holding capacity (WHC), and protein and ash content in LD and SM muscles were 3.84 ± 0.96 and 6.52 ± 1.21 kg, 15.91 ± 4.39 and 5.10 ± 1.94%, 62.07 ± 3.38 and 71.61 ± 2.06%, 20.01 ± 1.39 and 21.34 ± 0.89%, and 0.80 ± 0.10 and 0.93 ± 0.07, respectively. The estimates of CWT, EMA, BFT, and MS were 0.51 ± 0.13, 0.45 ± 0.13, 0.29 ± 0.09, and 0.22 ± 0.08, respectively. The estimates were moderate for meat quality traits and were 0.37 ± 0.12, 0.40 ± 0.12, 0.33 ± 0.10, 0.33 ± 0.10, 0.30 ± 0.11, and 0.24 ± 0.09 for L*, WBSF, IMF, WHC, and protein and ash content, respectively, in LD muscle; estimates from SM muscle were comparatively low (0.08 ± 0.06 to 0.25 ± 0.09). Estimates of for a* and b* were also low (0.08 ± 0.06 to 0.13 ± 0.07). Carcass weight had a moderate, positive genetic correlation with EMA (0.60 ± 0.13) and a weak correlation with MS and BFT. The genetic correlations among the 3 colorimeter variants were strong and positive within and between muscles. Intramuscular fat content had moderate to strong and negative genetic correlations with WBSF (-0.49 ± 0.18), WHC (-0.99 ± 0.01), and protein (-0.93 ± 0.04) and ash content (-0.98 ± 0.06) in LD muscle, whereas the associations were less pronounced in SM muscle. In general, CWT and EMA had low genetic and phenotypic correlations with meat quality traits, which suggests that the traits are independent and have distinct genetic contributions in each muscle. Conversely, with few exceptions, meat quality traits had genetic and phenotypic correlations with MS and BFT. In conclusion, the estimated genetic parameters for carcass and meat quality traits could be used for genetic evaluation and breeding programs in Korean Hanwoo cattle populations.

Adipochemokines induced by ultraviolet irradiation contribute to impaired fat metabolism in subcutaneous fat cells

BACKGROUND

Adipose tissue is now appreciated as the pivotal regulator of metabolic and endocrine functions. Subcutaneous (SC) fat, in contrast to visceral fat, may protect against metabolic syndrome and systemic inflammation. We demonstrated that chronic as well as acute ultraviolet (UV) irradiation to the skin induces loss of underlying SC fat. UV-irradiated SC fat may produce chemokines or cytokines that modulate lipid homeostasis and secretion of adipokines.

OBJECTIVES

To elucidate UV-induced specific adipochemokines implicated in UV-induced modulation of SC fat.

METHODS

Primary cultured adipocytes were treated with conditioned medium from UV- or sham-irradiated skin cells. Young and older healthy participants provided SC fat from sun-exposed and sun-protected skin. Sun-protected skin from other participants was irradiated with UV. Differentially expressed adipochemokines were screened by cytokine array, and confirmed in vitro and in vivo. The functions of select adipochemokines involved in lipid metabolism were examined via short interfering RNA-mediated knockdown of cognate receptors.

RESULTS

Specific adipochemokines, including C-X-C motif chemokine (CXCL) family members such as CXCL5/ENA-78, and C-C motif chemokine (CCL) family members such as CCL20/MIP-3α and CCL5/RANTES, were greatly induced in SC fat by UV exposure. They could impair triglyceride synthesis via downregulation of lipogenic enzymes and sterol regulatory element-binding protein-1 through their respective cognate receptors, CXC chemokine receptor type (CXC-R)2, C-C chemokine receptor type (CCR)-6, and CCR-5. In addition, UV irradiation induced infiltration of adipose tissue macrophages responsible for the secretion of several chemokines into SC fat.

CONCLUSIONS

These UV-induced adipochemokines may be implicated in the reduction of lipogenesis in SC fat, leading to impairment of fat homeostasis and associated comorbidities such as obesity.

Afatinib versus gefitinib in patients with EGFR mutation-positive advanced non-small-cell lung cancer: overall survival data from the phase IIb LUX-Lung 7 trial

Background

In LUX-Lung 7, the irreversible ErbB family blocker, afatinib, significantly improved progression-free survival (PFS), time-to-treatment failure (TTF) and objective response rate (ORR) versus gefitinib in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). Here, we present primary analysis of mature overall survival (OS) data.

Patients and methods

LUX-Lung 7 assessed afatinib 40 mg/day versus gefitinib 250 mg/day in treatment-naïve patients with stage IIIb/IV NSCLC and a common EGFR mutation (exon 19 deletion/L858R). Primary OS analysis was planned after ∼213 OS events and ≥32-month follow-up. OS was analysed by a Cox proportional hazards model, stratified by EGFR mutation type and baseline brain metastases.

Results

Two-hundred and twenty-six OS events had occurred at the data cut-off (8 April 2016). After a median follow-up of 42.6 months, median OS (afatinib versus gefitinib) was 27.9 versus 24.5 months [hazard ratio (HR) = 0.86, 95% confidence interval (CI) 0.66‒1.12, P = 0.2580]. Prespecified subgroup analyses showed similar OS trends (afatinib versus gefitinib) in patients with exon 19 deletion (30.7 versus 26.4 months; HR, 0.83, 95% CI 0.58‒1.17, P = 0.2841) and L858R (25.0 versus 21.2 months; HR 0.91, 95% CI 0.62‒1.36, P = 0.6585) mutations. Most patients (afatinib, 72.6%; gefitinib, 76.8%) had at least one subsequent systemic anti-cancer treatment following discontinuation of afatinib/gefitinib; 20 (13.7%) and 23 (15.2%) patients received a third-generation EGFR tyrosine kinase inhibitor. Updated PFS (independent review), TTF and ORR data were significantly improved with afatinib.

Conclusion

In LUX-Lung 7, there was no significant difference in OS with afatinib versus gefitinib. Updated PFS (independent review), TTF and ORR data were significantly improved with afatinib.

Clinicaltrials.gov identifier

NCT01466660.

Effect of the Factor V Leiden Mutation on the Clinical Expression of Severe Hemophilia A

To determine whether the factor V Leiden mutation is associated with decreased bleeding in individuals with severe hemophilia A, factor concentrate utilization, maximum annual number of bleeding episodes, and the prevalence of hemophilic arthropathy between carriers and non-carriers of the factor V Leiden mutation were compared. Heterozygosity for the factor V Leiden mutation was found in 6 of 137 subjects (4.4%). Carriers of the factor V Leiden mutation utilized less factor concentrate (geometric mean: 310 vs. 1185 units/kg/year) and had fewer bleeding episodes than non-carriers (proportion with 10 or fewer bleeding episodes in their worst year: 50 vs. 11%). However, the factor V Leiden mutation was not associated with the absence of arthropathy. The intron 22 inversion mutation of the factor VIII gene was tested for in a subgroup of 80 subjects, but it was not found to be a significant variable for any of the bleeding endpoints. The results of this small study are consistent with the hypothesis that the factor V Leiden mutation imparts a protective effect; however, a larger confirmatory study in which the factor VIII molecular defects can be controlled for is needed. Furthermore, most severe hemophiliacs who used fewer than 200 units/kg/year of factor concentrate or who had experienced 10 or fewer bleeding episodes per year did not carry the factor V Leiden mutation, suggesting that the proportion of severe hemophiliacs whose mild clinical course can be attributed to the factor V Leiden mutation is small.

The Effect of Animation-Assisted Informed Consent Using Tablet Personal Computer for Contrast-Enhanced Computed-Tomography in Emergency Department

Introduction

Informed consent is essential patient's right even in overcrowded emergency department (ED). We compared the effect of animation-assisted informed consent using tablet PC with the standard informed consent for contrast-enhanced computed-tomography (CT) in ED.

Methods

We included 150 patients scheduled to undergo contrast-enhanced CT in ED from November 2010 through January 2011. Participants were randomised to either animation-assisted information (AAI) (n=75) or standard verbal information (SVI) group (n=75). AAI was provided by tablet personal computer (PC); and SVI by clinicians. All participants completed 10-point scale questionnaires after the CT scan. The questionnaires included two main categories – understanding and satisfaction of informed consent.

Results

Participants in the AAI group had a better understanding of purpose (8.95±1.48 vs. 8.32±1.88, p=0.026) and methods (8.93±1.43 vs. 8.37±1.83, p=0.048) of CT scans compared to participants in the SVI group. Every score in satisfaction categories was significantly higher in the AAI group. In the SVI group, relatively low-educated participants had a lower score in understanding when compared with university-educated participants (7.53±2.28 vs. 8.52±1.40, p=0.029). Regardless of education level, understanding score was high in the AAI group (8.73±1.27 vs. 8.57±1.50, p=0.71).

Conclusions

Participants receiving animation assisted informed consent with tablet PC shows a higher degree of understanding and satisfaction compared with patients receiving standard verbal informed consent. Particularly in patients with lower education, animation-assisted informed consent may be better for understanding of contrast-enhanced CT.

Preparedness of Young Male Physicians for Biological Terrorism and Warfare in South Korea

Introduction

The events of 11th September 2001, and the subsequent anthrax attacks in the United States brought the threat of bioterrorism to the forefront of concern for public health departments. Moreover, the rising confrontation between North and South Korea emphasizes the possibility of aggression with biological weapons and our vulnerability to bioterrorism. While the importance of physicians' interests and management ability is becoming more critical, no studies have yet been undertaken in Korea to assess whether primary care physicians are well informed and capable of managing bioterrorism. This study evaluates the awareness and response of young male physicians to potential bioterrorism in South Korea.

Method

A total of 692 young male physicians completed the knowledge and awareness survey during the education period of military service on 9th April 2005.

Results

Forty-five percent of the participants responded that the possibility of biological warfare in Korea was high. The level of bioterrorism knowledge, however, was low. Eighty-seven percent acknowledged the necessity of education and training for bioterrorism, and 69.9% were willing to accept education and training in bioterrorism preparedness.

Conclusion

These findings suggest that young physicians should receive continuous education and training to improve preparedness for biological terrorism and warfare in South Korea.

Severe Glyphosate-Surfactant Intoxication: Successful Treatment with Continuous Renal Replacement Therapy

Glyphosate-surfactant is one of the most commonly used herbicides in the world. Its key component, glyphosate, is a competitive inhibitor of the shikimate pathway, a metabolic pathway found only in plants. However, severe intoxication, including lethal cases by ingestion of, glyphosate-surfactant has been reported. We describe the full recovery of two patients from glyphosate-polyoxyethyleneamine surfactant intoxication and multi-organ system failure following continuous renal replacement therapy. Both patients developed persistent shock, acute kidney injury, lactic acidosis, hyperkalaemia and multi-organ failure despite of resuscitation. We believe that continuous renal replacement therapy should be initiated immediately for removal of glyphosate-polyoxyethyleneamine surfactant in patients with signs of cardiopulmonary compromise, lactic acidosis, and renal failure. We propose the addition of glyphosate-polyoxyethyleneamine surfactant to the list of toxins for which early haemodialysis should be indicated.

Serial Serum Cholinesterase Activities as a Prognostic Factor in Organophosphate Poisoned Patients

Objective

Organophosphate poisoning is a serious clinical entity and of considerable morbidity and mortality. Several factors have been identified to predict outcomes of organophosphate poisoning. This investigation aims to identify the relationship between the dynamics of serum cholinesterase (SChE) activity and mortality.

Methods

In this retrospective study, medical records of all patients with acute organophosphate poisoning were reviewed from January 2001 to December 2009. Clinical features, SChE activity, Glasgow Coma Scale, laboratory findings, electrocardiogram finding, management and their outcomes were examined.

Results

A total of 169 patients were included in this study. A total of 55 patients were enrolled. Deceased patients were 8 in number. Absence of an increase in SChE activity was related with mortality in organophosphate poisoned patients (p value=0.036; odds ratio, 5.445; 95% confidence interval, 1.121-26.551).

Conclusions

The absence of an increase in SChE activity is associated with higher mortality in organophosphate poisoning. The SChE dynamic activity can provide a guide to physicians in the evaluation and management of organophosphate poisoned patients.

A Case of Electrocardiographic Change Caused by Subarachnoid Haemorrhage Mimicking Acute Myocardial Infarction

A 60-year-old woman was admitted to the emergency department due to syncope. The electrocardiogram (ECG) revealed normal sinus rhythm with ST segment elevation in leads I, II, and aVL. There was no stenosis or vasospasm in the coronary arteries. Transient electrocardiographic ST segment elevation which is indistinguishable from that associated with acute myocardial infarction has been reported in patients with subarachnoid hemorrhage (SAH). Until now no case was ever reported with the ECG finding with pattern of posterolateral myocardial infarction in SAH patients. So we describe a patient with SAH mimicking acute myocardial infarction.

An Analysis of Escalator-Related Injuries in an Emergency Department

Background

Escalator-related injuries have been considered uncommon and most likely to occur in children. In this study, we described the epidemiology of these injuries with focus on the aged population in order to determine whether escalators are safe for the aged, and to obtain information to help in preventing escalator-related injuries.

Methods

A prospective survey was taken to identify the number and nature of these injuries from May 2004 to December 2008. We enrolled patients who had sustained escalator-related injuries. A standard list of questions and answers were recorded by the emergency physician. A total of 104 questionnaires were completed during the study period.

Results

The average patient age was 59.2±24.0 years (range 1-94). There were 64 (61.5%) females. Only 11 (10.6%) were younger than 15 years old, and 59 (56.7%) were aged 65 or above; 35 (59.3%) of the aged people were injured while standing on the escalator. However, out of the 45 patients younger than age 65, 22 (48.9%) were injured from walking on a moving escalator. Head injury was the commonest site of injury overall and all were due to fall or slipping down.

Conclusions

Escalator-related injuries are not as rare as previously believed and the aged population 65 years old or above is the highest risk group. In particular, walking on a moving escalator was the main cause of injury in people under age 65. Therefore, primary prevention strategies are needed to prevent users from walking on escalators, especially young people, and educate aged people the safe utilization of escalators to prevent slip and fall injuries.

Haemopericardium and Liver Laceration Associated with Airbag Deployment

Airbags and seat belts are safety devices in automobiles. First invented in the 1950s, they are now commonplace in most automobiles. However, a seat occupant may sustain unexpected injuries even if the airbag deploys in a car collision. We describe a patient who was suspected of simultaneously sustaining haemopericardium and liver laceration during the “punch out” and “membrane force” phases of airbag deployment. The patient's vital signs stabilised after an emergency pericardiocentesis was performed. In a car accident when high-energy injury is suspected despite airbag deployment, computed tomography of the chest and abdomen or echocardiography should be considered because of the possibility of abdominal solid organ and chest injury.