[Influencing Factors on Lactulose Breath Test Results].

Background/Aims: This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS). Methods: The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed. Results: Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0-80.0 years) and 22.5 kg/m2 (range, 14.4-34.3 kg/m2), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001). Conclusions: Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.

A Review of Hepatocellular Carcinoma in Elderly Patients Focused on Management and Outcomes.

Recent studies report a significant age-specific increase in hepatocellular carcinoma (HCC) development among persons over 75 years old. Therefore, there is an urgent need to determine the optimal treatment strategy in elderly patients with HCC. This systemic review examines the clinical characteristics, efficacy, and safety of first-line treatment modalities. The literature was searched regarding epidemiology and clinical outcomes in elderly patients (age ≥75 years) undergoing first-line treatment for HCC. Causative or comorbid conditions of HCC in elderly patients differed from those in younger patients. Radiofrequency ablation may be effective and safe in early stages. Surgical resection may also be feasible in the early stages for selected patients. Transarterial chemoembolization may be safe and effective for intermediate HCC, and sorafenib may be feasible in elderly patients with advanced HCC. Prospective randomized trials are needed to establish the treatment strategy for elderly patients with HCC.

Sofosbuvir plus ribavirin for the treatment of hepatitis C virus genotype 2 in Korea: What's the optimal dosage of ribavirin in real-world setting?

OBJECTIVE: This study aimed to investigate the efficacy and safety of sofosbuvir plus ribavirin for the treatment of hepatitis C virus (HCV) genotype 2 infection and to determine the optimal ribavirin dosage. METHODS: From May 2016 to March 2017, 199 patients received sofosbuvir plus ribavirin treatment for HCV genotype 2 infection at four centers in Jeollanam-do Province, Korea. After excluding patients lost to follow-up and those with insufficient data, we retrospectively assessed the data for 194 patients. The treatment efficacy and safety of sofosbuvir plus ribavirin were evaluated. RESULTS: A sustained virological response was achieved in 189 patients (intention-to-treat [ITT] 97.4%; per protocol [PP]: 99.5%, both at 12 and 24 weeks) whose average ribavirin dosage was 937.1 mg/day. The most frequent adverse event was anemia (17.5%), and its incidence significantly increased (P < 0.001) with a higher ribavirin dosage per body weight. Discontinuation of ribavirin or dosage reduction occurred in 27 (14.2%). The ribavirin dosage reduction rate increased at a dosage of >15 mg/kg (area under the receiver operating characteristic curve 0.652, 95% confidence interval [CI] 0.54-0.76, P = 0.01). Multivariate analysis showed that age ≥70 years, with liver cirrhosis, and female gender were associated with ribavirin dosage reduction. CONCLUSIONS: Remarkable outcomes were attained in patients with HCV genotype 2 infection treated with sofosbuvir plus ribavirin. Age ≥70 years, with liver cirrhosis, and female gender were associated with ribavirin dosage reduction. Thus, sustained virological response can be achieved with <1000 mg of ribavirin, with an optimal dosage of 15 mg/kg.

Manipulation of p-/n-Type Thermoelectric Thin Films through a Layer-by-Layer Assembled Carbonaceous Multilayer Structure.

Recently, with the miniaturization of electronic devices, problems with regard to the size and capacity of batteries have arisen. Energy harvesting is receiving significant attention to solve these problems. In particular, the thermoelectric generator (TEG) is being studied for its ability to harvest waste heat energy. However, studies on organic TEGs conducted thus far have mostly used conductive polymers, making the application range of TEGs relatively narrow. In this study, we fabricated organic TEGs using carbonaceous nanomaterials (i.e., graphene nanoplatelet (GNP) and single-walled carbon nanotube (SWNT)) with polyelectrolytes (i.e., poly(vinyl alcohol) (PVA) and poly (diallyldimethyl ammonium chloride) (PDDA)) via layer-by-layer (LbL) coating on polymeric substrates. The thermoelectric performance of the carbonaceous multilayer structure was measured, and it was confirmed that the thermoelectric performance of the TEG in this study was not significantly different from that of the existing organic TEG fabricated using the conductive polymers. The 10 bilayer SWNT thin films with polyelectrolyte exhibited a thermopower of -14 µV·K-1 and a power factor of 25 µW·m-1K-2. Moreover, by simply changing the electrolyte, p- or n-type TEGs could be easily fabricated with carbonaceous nanomaterials via the LbL process. Also, by just changing the electrolyte, p- or n-type of TEGs could be easily fabricated with carbonaceous nanomaterials with a layer-by-layer process.

The prevalence of abnormal vaginal flora and predictive factors for intrauterine infection in pregnant Korean women with preterm labor.

OBJECTIVE: To investigate the prevalence of abnormal vaginal flora (AVF) and predictive factors for intrauterine infection in pregnant Korean women with preterm labor. MATERIALS AND METHODS: The authors reviewed the medical records of 106 pregnant Korean women with preterm labor admitted to Eulji Medical Center between January 2006 and August 2011. The results of vaginal discharge tests and maternal serum C-reactive protein (CRP) level at admission, placental biopsy, and perinatal outcomes were searched. The prevalence of abnormal vaginal flora was calculated. The perinatal outcomes and predictive factors for intrauterine infections were analyzed based on placental pathology and early-onset neonatal sepsis. RESULTS: The prevalence of abnormal vaginal flora was 75.4%. Ureaplasma urealyticunz (UU), intermediate flora, Candidiasis, bacterial vaginosis, and aerobic bacterial colonization were detected in 40.6%, 38.7%, 17%, 14.2%, and 11.3% of the women, respectively. The frequency of early-onset neonatal sepsis was significantly different between women with aerobic bacterial colonization and those with normal flora (p = 0.008). An elevated maternal serum CRP level was an independent intrauterine infection predictor (odds ratio, 1.918; 95% confidence interval, 1.102-3.338; p = 0.048). CONCLUSION: Aerobic bacterial colonization may predict early-onset neonatal sepsis. An elevated maternal serum CRP level was an independent intrauterine infection predictor based on placental infections and early-onset neonatal sepsis.

Efficacy of Body Weight Reduction on the SGLT2 Inhibitor in People with Type 2 Diabetes Mellitus.

BACKGROUND: Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces hyperglycemia and body weight by inhibiting renal glucose reabsorption. However, only a few studies have demonstrated efficacy of dapagliflozin for type 2 diabetic patients in Korea. We evaluated the efficacy and safety of dapagliflozin for Korean type 2 diabetes patients. METHODS: This is a retrospective study that included data from 61 patients who received 12 months of dapagliflozin therapy and who visited a single medical center between January 2015 and July 2016. Patients were separated into three groups: dual combination of dapagliflozin and metformin, triple combination of dapagliflozin and metformin with sulfonylurea, or dipeptidyl peptidase IV inhibitors, and quadriple combination of dapagliflozin, metformin, and sulfonylurea with dipeptidyl peptidase IV inhibitors. Patients who achieved ≥5% body weight reduction were classified as responders, and those who achieved <5% body weight reduction were classified as non-responders. RESULTS: After 12 months, the mean change from baseline body weight was -3.4±2.6 kg (P<0.001) for all patients, -3.4±3.1 kg (P<0.001) for group 1, -2.7±2.0 kg (P=0.008) for group 2, and -4.0±2.3 kg (P<0.001) for group 3. Fasting C-peptide level was higher in the responder group than in the non-responder group (3.25±1.07 ng/mL vs. 2.62±1.02 ng/mL, P=0.023). In total, reductions in HbA1c, PP2, and FPG levels were -0.61±0.82% (P=0.000), -35.4±62 mg/dL (P=0.000), and -21.3±56.2 mg/dL (P=0.012), respectively. They had mild adverse events included orthostatic dizziness and urinary tract infection. CONCLUSION: SGLT2 inhibitor improved glycemic control and reduced body weight in a safe manner for patients with type 2 diabetes mellitus.

Acute ST Elevated Myocardial Injury due to Coronary Thrombosis during Thoracic Endovascular Aortic Repair in Patient with Protein S Deficiency.

A 71-year-old woman who had suffered from pulmonary thromboembolism with deep vein thrombosis for 12 years presented the hospital with a huge thoracic aortic aneurysm. During thoracic endovascular therapy, she had a sudden coronary artery occlusion without having organized stenosis or plaque rupture even under the dual antiplatelet treatment and heparinization. She turned out to be having a protein S deficiency. A procedure related thrombotic adverse event in patient with protein S deficiency is very rare, so we report a case with literature review.

Prevalence of dry eye syndrome after a three-year exposure to a clean room.

OBJECTIVE: To measure the prevalence of dry eye syndrome (DES) among clean room (relative humidity ≤1%) workers from 2011 to 2013. METHODS: Three annual DES examinations were performed completely in 352 clean room workers aged 20-40 years who were working at a secondary battery factory. Each examination comprised the tear-film break-up test (TFBUT), Schirmer's test I, slit-lamp microscopic examination, and McMonnies questionnaire. DES grades were measured using the Delphi approach. The annual examination results were analyzed using a general linear model and post-hoc analysis with repeated-ANOVA (Tukey). Multiple logistic regression was performed using the examination results from 2013 (dependent variable) to analyze the effect of years spent working in the clean room (independent variable). RESULTS: The prevalence of DES among these workers was 14.8% in 2011, 27.1% in 2012, and 32.8% in 2013. The TFBUT and McMonnies questionnaire showed that DES grades worsened over time. Multiple logistic regression analysis indicated that the odds ratio for having dry eyes was 1.130 (95% CI 1.012-1.262) according to the findings of the McMonnies questionnaire. CONCLUSIONS: This 3-year trend suggests that the increased prevalence of DES was associated with longer working hours. To decrease the prevalence of DES, employees should be assigned reasonable working hours with shift assignments that include appropriate break times. Workers should also wear protective eyewear, subdivide their working process to minimize exposure, and utilize preservative-free eye drops.

Arrays of silicon micro/nanostructures formed in suspended configurations for deterministic assembly using flat and roller-type stamps.

The ability to create and manipulate large arrays of inorganic semiconductor micro/nanostructures for integration on unconventional substrates provides new possibilities in device engineering. Here, simple methods are described for the preparation of structures of single crystalline silicon in suspended and tethered configurations that facilitate their deterministic assembly using transfer-printing techniques. Diverse shapes (e.g., straight or curved edges), thicknesses (between 55 nm and 3 µm), and sizes (areas of 4000 µm(2) to 117 mm(2) ) of structures in varied layouts (regular or irregular arrays, with dense or sparse coverages) can be achieved, using either flat or cylindrical roller-type stamps. To demonstrate the technique, printing with 100% yield onto curved, rigid supports of glass and ceramics and onto thin sheets of plastic is shown. The fabrication of a printed array of silicon p(+) -i-n(+) junction photodiodes on plastic is representative of device-printing capabilities.

9-cis retinoic acid induces insulin-like growth factor binding protein-3 through DR-8 retinoic acid responsive elements.

Retinoic acids, which have shown potential chemopreventive and therapeutic activities for several neoplastic diseases in vitro, modulate the growth-promoting and anti-apoptotic activities of insulin-like growth factors (IGFs), in part by influencing the expression of insulin-like growth factor binding protein-3 (IGFBP-3). This study sought to investigate the effect of 9-cis retinoic acid (9cRA) on the expression of IGFBP-3 and the underlying mechanisms involving retinoic acid receptor-beta (RAR-beta). The pharmacologic activity of 9cRA was characterized by monitoring target modulation as well as by evaluating the underlying mechanisms in NSCLC cells. Treatment of 9cRA inhibited proliferation of a part of NSCLC cell lines including H460 cells in clinically-achievable concentrations and induced IGFBP-3 expression in dose- and time-dependent manners. Transient transfection with a reporter constructs driven by the human IGFBP-3 gene promoter indicated that 9cRA induces gene expression via the -534 to -445 region (relative to translation start site) of the IGFBP-3 promoter. Unilateral deletion and site-directed mutagenesis identified a retinoic acid responsive element (RARE), a direct repeat of two GGGTCA-related hexanucleotides separated by just 8 bp (DR-8-type response element). A cotransfection assay with a RAR-beta expression vector potentiated (and with siRNA for RAR-beta, diminished) the effect of 9cRA on IGFBP-3 expression. IGFBP-3 gene expression by 9cRA is mediated by a distinct DR-8 RARE located in the proximal region of the IGFBP promoter and involves the RAR-beta, a putative tumor suppressor in NSCLC.

Extensive and divergent chromosomal losses in squamous and spindle-cell components of esophageal sarcomatoid carcinoma.

Sarcomatoid carcinoma of the esophagus is an unusual type of squamous cell carcinoma (SCC) with a variable component of sarcomatoid spindle cells (SA). The loss of heterozygosity (LOH) involving multiple cancer-associated chromosomal arms has been reported to have a concerted, rather than an individual, effect on tumor progression. In order to delineate the role of LOH in the evolution of a biphasic tumor, the carcinoma in situ (CIS), invasive squamous cell carcinoma (ISCC), and SA components from a sarcomatoid carcinoma of the esophagus were compared for their clonality and extent of LOH. Forty microsatellite markers on the cancer-associated chromosomes, 3p, 4p, 5q, 8p, 9p, 13q, 17p, and 18q, were used for the polymerase chain reaction-based LOH analysis. All eight sarcomatoid carcinomas tested revealed extensive LOHs, involving an average of seven chromosomal arms. All CIS, ISCC, and SA components carried not only a high-level primary LOH (mean chromosomal involvement, 5.3) in common but also a low-level secondary LOH (mean chromosomal involvement, 1.8) in disparity. Interestingly, more secondary LOHs were always burdened in the CIS (four cases) rather than the matched ISCC. SA had a greater (four cases), equal (one case), or fewer (one case) number of secondary LOHs than ISCC. Given that excessive chromosomal losses may confer a disadvantage for tumor growth or a benefit for a metaplastic transformation, these results suggest that the multidirectional differentiation of a SCC precursor is stimulated by extensive and divergent LOHs acquired at the initial or early stages, and a precursor burdened with excessive LOH either remains in CIS or expands as a SA component.