Computed Tomography Features of Appendiceal Metastasis in Patients With Underlying Malignancy: Comparison With Pathological Findings.

OBJECTIVE: To evaluate the computed tomography (CT) findings compared with pathologic features and to determine whether CT findings are useful for diagnosis of appendiceal metastasis in patients with underlying malignancy. MATERIALS AND METHODS: Preoperative CT examinations of 59 patients who had underlying malignancy and underwent appendectomy were evaluated. Appendiceal metastasis (n = 21) and nonmetastasis (n = 38) were pathologically confirmed. Computed tomography features (appendiceal morphology and diameter, presence of ascites, rectal shelf, omental cake, lymphadenopathy or organ metastasis) were retrospectively reviewed, and compared with histopathological findings. Fisher exact test and Wilcoxon rank sum test were performed for statistical analysis. RESULTS: Mean diameter of appendiceal metastasis was significantly larger (9.1 mm) than that of nonmetastasis (5.2 mm), (P < 0.0001). The CT morphology of appendiceal metastasis showed broad spectrum, and 3 cases of nodular thickening was only detected in appendiceal metastasis. There was a significant difference between groups (P = 0.0102). Appendiceal metastasis was more frequently associated with peritoneal seeding (ascitis, rectal shelf, omental cake) than nonmetastasis (P < 0.0001). Histopathological invasion of appendiceal metastasis was more frequently seen in serosa-mesoappendix (n = 20, 100%) or muscularis propria (n = 17, 85%), than in submucosa (n = 10, 50%) or mucosa layer (n = 7, 35%). Acute appendicitis was more commonly detected in metastasis (n = 4) than in nonmetastasis (n = 1) (P = 0.0495). CONCLUSIONS: Evaluation of CT features of appendix and peritoneum may be useful for prediction of appendiceal metastasis in patients with underlying malignancy.

Prevalence and Relationships of Iron Deficiency Anemia with Blood Cadmium and Vitamin D Levels in Korean Women.

Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) are common disorders. This study was undertaken to determine the prevalence of anemia, ID, and IDA in Korean females. We examined the associations between IDA, heavy metals in blood, vitamin D level and nutritional intakes. The study was performed using on data collected from 10,169 women (aged ≥ 10 yr), including 1,232 with anemia, 2,030 with ID, and 690 with IDA during the fifth Korea National Health and Nutrition Examination Survey (KNHANES V; 2010-2012). Prevalence and 95% confidence intervals were calculated, and path analysis was performed to identify a multivariate regression model incorporating IDA, heavy metals in blood, vitamin D level, and nutritional intakes. The overall prevalence of anemia, ID and IDA was 12.4%, 23.11%, and 7.7%, respectively. ID and IDA were more prevalent among adolescents (aged 15-18 yr; 36.5% for ID; 10.7% for IDA) and women aged 19-49 yr (32.7% for ID; 11.3% for IDA). The proposed path model showed that IDA was associated with an elevated cadmium level after adjusting for age and body mass index (ß=0.46, P<0.001). Vitamin D levels were found to affect IDA negatively (ß=-0.002, P<0.001). This study shows that the prevalence of anemia, ID, and IDA are relatively high in late adolescents and women of reproductive age. Path analysis showed that depressed vitamin D levels increase the risk of IDA, and that IDA increases cadmium concentrations in blood. Our findings indicate that systematic health surveillance systems including educational campaigns and well-balanced nutrition are needed to control anemia, ID, and IDA.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes.

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (ß = 0.001, P < 0.001), serum triglyceride (ß = 0.001, P < 0.001), CCr (ß = -0.003, P = 0.001), hsCRP (ß = 0.157, P = 0.001), fibrinogen (ß = 0.001, P < 0.001) and BMI (ß = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Kinematic change of the meniscus and the tibiofemoral joint space in asymptomatic volunteers using a wide bore 3T closed MRI system.

OBJECTIVES: To evaluate kinematic changes in menisci and tibiofemoral joint spaces in extension and flexion using asymptomatic volunteers using a wide-bore 3-T closed MRI system. METHODS: Twenty-two knees from asymptomatic volunteers were examined in knee extension and flexion using a 3-T MRI (sagittal 2D FSE T2-weighted sequence and sagittal 3D isotropic FSE proton density-weighted cube sequence). The meniscal positions, meniscal floating and flounce were evaluated. The widths of the medial and lateral tibiofemoral joint spaces and coronal tibiofemoral angles were measured. RESULTS: In the anteroposterior direction, meniscal extrusion was most frequently seen in the anterior horn of the medial menisci (100%) in extensions (maximum 6.04 mm). Most of the menisci moved significantly to the posterior side from extension to flexion. The anteroposterior meniscal movement was the greatest for the anterior horn of the medial meniscus and least for the posterior horn of the medial meniscus. In the mediolateral direction, meniscal extrusion was seen in 52% of the medial menisci in extensions (maximum 1.91 mm) and 29% of lateral menisci in flexions (maximum 2.36 mm). From the extension to flexion, all medial and lateral menisci moved significantly to the lateral side. Meniscal floating was frequently observed in the posterior horn of medial menisci in extension. Meniscal flounce was frequently seen in lateral menisci in flexion with a widened lateral tibiofemoral joint space gap. The coronal tibiofemoral angle showed medial wedging in flexion, but not in extension. CONCLUSIONS: Wide-bore 3-T closed MRI revealed significant kinematic changes in the menisci and tibiofemoral joint spaces in asymptomatic volunteers.

Effect of lifestyle modification on serum chemerin concentration and its association with insulin sensitivity in overweight and obese adults with type 2 diabetes.

OBJECTIVE: Chemerin, a recently identified adipokine, has been linked to adiposity, insulin resistance, metabolic syndrome risk factors and inflammation. Here, we evaluated whether a 12-week lifestyle intervention in overweight and obese adults with type 2 diabetes could significantly affect the average blood glucose and serum chemerin levels over time. DESIGN: Thirty-five overweight or obese subjects with type 2 diabetes were randomized to receive intensive lifestyle modification including supervised exercise sessions or usual care for 12 weeks. Anthropometric and clinical data were collected before the intervention and after 12 weeks. RESULTS: Lifestyle intervention induced a significant decrease in HbA1c (-1·0 ± 0·5 vs 0·1 ± 0·6%, P < 0·001), BMI, total body fat content, serum lipocalin-2 and chemerin levels (-8·1 ± 21·6 vs + 8·2 ± 15·9 ng/ml, P = 0·021) and a significant increase in VO2 max after 12 weeks compared to the usual care group. Baseline chemerin levels were positively correlated with the homoeostasis model of assessment of insulin resistance (HOMA-IR), fasting insulin and the high-sensitivity C-reactive protein (hsCRP) and negatively correlated with insulin sensitivity index (ISI). Changes in the chemerin concentration during 12 weeks were independently negatively correlated with changes in ISI and positively correlated with changes in fasting plasma glucose, total cholesterol and lipocalin-2 levels. CONCLUSIONS: A 12-week intensive lifestyle intervention significantly decreased serum chemerin level compared to usual care. Decrease in serum chemerin level was associated with improved insulin sensitivity, and this may be involved in the beneficial effects of lifestyle intervention in overweight and obese type 2 diabetic patients.

Biological advantages of porous hydroxyapatite scaffold made by solid freeform fabrication for bone tissue regeneration.

Presently, commercially available porous bone substitutes are manufactured by the sacrificial template method, direct foaming method, and polymer replication method (PRM). However, current manufacturing methods provide only the simplest form of the bone scaffold and cannot easily control pore size. Recent developments in medical imaging technology, computer-aided design, and solid freeform fabrication (SFF), have made it possible to accurately produce porous synthetic bone scaffolds to fit the defected bone shape. Porous scaffolds were fabricated by SFF and PRM for a comparison of physical and mechanical properties of scaffold. The suggested three-dimensional model has interconnected cubic pores of 500 µm and its calculated porosity is 25%. Whereas hydroxyapatite scaffolds fabricated by SFF had connective macropores, those by PRM formed a closed pore external surface with internally interconnected pores. SFF was supposed to be a proper method for fabricating an interconnected macroporous network. Biocompatibility was confirmed by testing the cytotoxicity, hemolysis, irritation, sensitization, and implantation. In summary, the aim was to verify the safety and efficacy of the scaffolds by biomechanical and biological tests with the hope that this research could promote the feasibility of using the scaffolds as a bone substitute.

Primary diffuse large B-cell lymphoma of the vulva: a case report.

Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin lymphoma (NHL) and is estimated to account for approximately 30% of all NHL cases. NHL can also occur in the female genital tract and accounts for approximately 1.5% of all NHL cases. Many doctors have difficulty diagnosing or treating vulvar DLBCL because of its very low prevalence. A 55-year-old woman presented with a solid mass on the right side of the vulva. No significantly enlarged lymph nodes were observed in the inguinal region. She underwent excisional biopsy at our institution. DLBCL was diagnosed based on histological examination. According to the Hans algorithm, the lesion was diagnosed as a non-germinal center B-cell-like subtype. The patient was referred to a hematologic oncologist. The disease stage was classified as IE according to the Ann Arbor staging classification. The patient received four cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and localized radiation therapy with 36 Gy in 20 fractions. She showed complete remission and maintained this status on the latest computed tomography scan. Gynecologists should rule out lymphoma in patients presenting with a vulvar mass.

Nanocomposite Engineering of a High-Capacity Partially Ordered Cathode for Li-Ion Batteries.

Understanding the local cation order in the crystal structure and its correlation with electrochemical performances has advanced the development of high-energy Mn-rich cathode materials for Li-ion batteries, notably Li- and Mn-rich layered cathodes (LMR, e.g., Li1.2 Ni0.13 Mn0.54 Co0.13 O2 ) that are considered as nanocomposite layered materials with C2/m Li2 MnO3 -type medium-range order (MRO). Moreover, the Li-transport rate in high-capacity Mn-based disordered rock-salt (DRX) cathodes (e.g., Li1.2 Mn0.4 Ti0.4 O2 ) is found to be influenced by the short-range order of cations, underlining the importance of engineering the local cation order in designing high-energy materials. Herein, the nanocomposite is revealed, with a heterogeneous nature (like MRO found in LMR) of ultrahigh-capacity partially ordered cathodes (e.g., Li1.68 Mn1.6 O3.7 F0.3 ) made of distinct domains of spinel-, DRX- and layered-like phases, contrary to conventional single-phase DRX cathodes. This multi-scale understanding of ordering informs engineering the nanocomposite material via Ti doping, altering the intra-particle characteristics to increase the content of the rock-salt phase and heterogeneity within a particle. This strategy markedly improves the reversibility of both Mn- and O-redox processes to enhance the cycling stability of the partially ordered DRX cathodes (nearly ≈30% improvement of capacity retention). This work sheds light on the importance of nanocomposite engineering to develop ultrahigh-performance, low-cost Li-ion cathode materials.

Antenatal differential diagnosis of congenital chloride diarrhea: a case report.

Congenital chloride diarrhea (CCD) is a rare disease characterized by profound, watery diarrhea. It is inherited as an autosomal recessive trait and is caused by a dysfunction of electrolyte transport in the brush border of the ileum. CCD is a medically treatable condition but is frequently misdiagnosed as a surgically treatable condition, such as bowel obstruction, because of similar antenatal ultrasonographic findings. Therefore, a correct diagnosis is of upmost importance before treatment initiation. Although some methods for antenatal differential diagnosis were reported, antenatal diagnosis of CCD remains difficult. Here, we report the case of a patient with CCD, which was presumed antenatally and confirmed postnatally. We also discuss the results of antenatal ultrasonography and amniocentesis and provide some tips regarding ultrasonographic findings for the antenatal differential diagnosis of CCD. Further, we present a brief literature review.

Laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy in patients with FIGO stage IB1-II B cervical carcinoma.

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the safety, feasibility, and clinical outcomes of laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy in patients with FIGO stage IB1-IIB cervical carcinoma. METHODS: Between August 1999 and April 2009, we performed 59 laparoscopic transperitoneal lymphadenectomies; specifically, 12 procedures were performed up to the level of the left renal vessels, and 47 procedures were performed up to the level of the inferior mesenteric artery. We retrospectively analyzed the pathology reports and clinical data and compared the 2 groups. The data were analyzed with a nonparametric Mann-Whitney test, Kaplan-Meier log-rank test, and Pearson's correlation analysis. RESULTS: The 2 groups did not significantly differ with respect to histologic type (P = .093), clinical stage (P = .053), tumor size (P = .383), time interval to start adjuvant therapy postoperatively (P = .064), and type of adjuvant therapy (P = .407). The blood loss (P = .131), operative time (P = .200), mean hospital stay (P = .417), and postoperative self-voiding (P = .306) did not significantly differ between the groups, with the exception of the number of harvested lymph nodes (P = .001). The disease-free survival was better in the group that underwent infrarenal para-aortic lymphadenectomy than the group that did not (P = .017); however, the 2 groups did not differ with respect to overall survival (P = .115). CONCLUSION: We suggest that laparoscopic transperitoneal infrarenal lymphadenectomy for cervical cancer is feasible and safe. The rate of positive lymph nodes in infrarenal lymphadenectomy is very rare in patients with locally advanced cervical carcinoma. Infrarenal lymphadenectomy in patients with cervical cancer did not provide additional survival benefits in this study.

Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group.

Background: Electronic medical records (EMRs) have the highest value among real-world data (RWD). The aim of the present study was to propose a data collection framework of EMR-based RWD to evaluate the effectiveness and safety of cancer drugs by conducting a nationwide real-world study based on the Korean Cancer Study Group. Methods: We considered all patients who received ramucirumab plus paclitaxel (RAM/PTX) for gastric cancer and trastuzumab emtansine (T-DM1) for breast cancer at relevant institutions in South Korea. Standard operating procedures for systematic data collection were prospectively developed. Investigator reliability was evaluated using the concordance rate between the recommended input value for representative fictional cases and the input value of each investigator. Reliability of collected data was evaluated twice during the study period at three institutions randomly selected using the concordance rate between the previously collected data and data collected by an independent investigator. The reliability results of the investigators and collected data were used for revision of the electronic data capture system and site training. Results: Between the starting date of medical insurance coverage and December 2018, a total of 1063 patients at 56 institutions in the RAM/PTX cohort and 824 patients at 60 institutions in the T-DM1 cohort were included. Mean investigator reliability in the RAM/PTX and T-DM1 cohorts was 73.5% and 71.9%, respectively. Mean reliability of collected data in the RAM/PTX and T-DM1 cohort was 90.0% for both cohorts in the first analysis and 89.0% and 84.0% in the second analysis, respectively. Mean missing values of the RAM/PTX and T-DM1 cohorts at the time of simulation of fictional cases and final data analysis decreased from 20.7% to 0.46% and from 18.5% to 0.76%, respectively. Conclusion: This real-world study provides a framework that ensures relevance and reliability of EMR-based RWD for evaluating the effectiveness and safety of cancer drugs.

Classification of endometriosis.

Endometriosis is a chronic disease associated with pelvic pain and infertility. Several classification systems for the severity of endometriosis have been proposed. Of these, the revised American Society for Reproductive Medicine classification is the most well-known. The ENZIAN classification was developed to classify deep infiltrating endometriosis and focused on the retroperitoneal structures. The endometriosis fertility index was developed to predict the fertility outcomes in patients who underwent surgery for endometriosis. Finally, the American Association of Gynecological Laparoscopists classification is currently being developed, for which 30 endometriosis experts are analyzing and researching data by assigning scores to categories considered important; however, it has not yet been fully validated and published. Currently, none of the classification systems are considered the gold standard. In this article, we review the classification systems, identify their pros and cons, and discuss what improvements need to be made to each system in the future.

Abnormally High-Lithium Storage in Pure Crystalline C60 Nanoparticles.

Li+ intercalates into a pure face-centered-cubic (fcc) C60 structure instead of being adsorbed on a single C60 molecule. This hinders the excess storage of Li ions in Li-ion batteries, thereby limiting their applications. However, the associated electrochemical processes and mechanisms have not been investigated owing to the low electrochemical reactivity and poor crystallinity of the C60 powder. Herein, a facile method for synthesizing pure fcc C60 nanoparticles with uniform morphology and superior electrochemical performance in both half- and full-cells is demonstrated using a 1 m LiPF6 solution in ethylene carbonate/diethyl carbonate (1:1 vol%) with 10% fluoroethylene carbonate. The specific capacity of the C60 nanoparticles during the second discharge reaches ≈750 mAh g-1 at 0.1 A g-1 , approximately twice that of graphite. Moreover, by applying in situ X-ray diffraction, high-resolution transmission electron microscopy, and first-principles calculations, an abnormally high Li storage in a crystalline C60 structure is proposed based on the vacant sites among the C60 molecules, Li clusters at different sites, and structural changes during the discharge/charge process. The fcc of C60 transforms tetragonal via orthorhombic Lix C60 and back to the cubic phase during discharge. The presented results will facilitate the development of novel fullerene-based anode materials for Li-ion batteries.

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years' experience in a single institute.

BACKGROUND: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital. METHODS: We retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients' demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. RESULTS: A total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%-38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). CONCLUSION: Minimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Undifferentiated carcinoma arising in ovarian mature cystic teratoma: a case report and literature review.

Malignant transformation is a rare complication of the mature cystic teratoma of the ovary. Most of these histologic types are squamous cell carcinoma, and other types are exceptionally rare. Here, we present an extremely rare histology of malignant transformation, an undifferentiated carcinoma, arising in mature cystic teratoma of the ovary. A 48-year-old woman was referred due to abdominal distension and palpable pelvic mass. Computed tomography showed 16- and 12-cm-diameter mixed solid and cystic tumors in bilateral ovaries. Surgical exploration revealed bilateral ovarian tumors with multiple nodules on the whole peritoneum, liver capsule, and diaphragm. Cytoreductive surgery was performed, leaving <1 cm tumors. On pathologic review, the tumor was confirmed as undifferentiated with an adenosquamous carcinoma component arising in mature cystic teratoma. The patient died 7 days postoperatively due to uncontrolled malignant ascites and pleural effusion. We report a case of undifferentiated carcinoma arising from mature cystic teratoma, and we review the clinicopathologic features of this rare case.

Clinical and histopathologic analysis of gynecological cancer: a single institute experience over 7 years.

BACKGROUND: Approximately 100,000 women are diagnosed with cancer each year in Korea. According to a survey by the Korean central cancer registry in 2016, uterine cervical cancer, uterine corpus cancer, and ovarian cancer were the 5th, 7th, and 8th most prevalent cancers respectively among Korean women. The present study aims to review the clinico-pathologic characteristics of patients who were treated for major gynecological malignancies at Yeungnam University Medical Center. METHODS: Patients with invasive gynecological cancers from January 2012 to February 2019 were retrospectively identified. We analyzed the clinical features, demographic profiles, pathologic data, treatment modality used, adjuvant treatment used, complications, recurrence, and survival outcomes. RESULTS: A total of 287 patients (cervical cancer 115; corporal cancer 86; and ovarian, tubal, or primary peritoneal cancer 90) were included. Most cervical (82.7%) and corporal cancers (89.5%) were diagnosed in the early stages (stage I or II), while more than half (58.9%) the cases of ovarian, tubal or peritoneal cancers were diagnosed in the advanced stages (stage III or IV). Surgical complications were observed in 12.2% of cervical cancers, 16.3% of uterine corpus cancers, and 11.1% of ovarian, tubal, and peritoneal cancers, respectively. The 5-year overall survival rate was 94.1%, 91.0%, and 77.1% for cervical, corporal, and ovarian, tubal, or peritoneal cancers, respectively. CONCLUSION: Surgical treatment was satisfactory in terms of the incidence of complications, and survival outcomes were generally good. Clinicians should be aware of the clinical and histopathological characteristics of patients with gynecological cancers to be able to provide optimal strategies and counseling.

Prognosis-Predicting Model Based on [18F]fluorodeoxyglucose PET Metabolic Parameters in Locally Advanced Cervical Cancer Patients Treated with Concurrent Chemoradiotherapy: Multi-Center Retrospective Study.

This study aimed to develop a prognosis-predicting model based on [18F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and clinicopathologic factors in locally advanced cervical cancer patients treated with concurrent chemoradiotherapy (CCRT). The medical records of 270 locally advanced cervical cancer patients who were treated with CCRT were collected from three institutions and reviewed retrospectively. A nomogram was used for predicting 2-year disease-free survival (DFS) and 5-year overall survival (OS) based on Cox proportional hazards regression. Predictor variables included nodal maximum standardized uptake value (SUVmax), primary tumor SUVmax, age, tumor size, stage, serum squamous cell carcinoma antigen level, and human papillomavirus status. Internal nomogram validation was performed. A nomogram for predicting the 2-year DFS and 5-year OS was constructed using six and seven parameters, respectively. With a focus on 2-year DFS, our model found nodal SUVmax to be the highest weighted negative prognostic factor. With a focus on 5-year OS, young age was the highest weighted negative prognostic factor. The concordance index was 0.75 and 0.78 for the 2-year DFS and 5-year OS, respectively. This nomogram is a predictive tool that can be used to counsel patients for predicting survival outcomes. Moreover, our prognosis-predicting model may make it possible to personalize treatment.