Subcellular expression pattern and clinical significance of CBX2 and CBX7 in breast cancer subtypes.

Chromobox (CBX)2 and CBX7, members of CBX family protein, show diverse expression patterns and contrasting roles in certain cancers. We aimed to investigate the subcellular expression patterns and clinical significances of CBXs in breast cancer (BC) subtypes, which have heterogeneous clinical course and therapeutic responses. Among the subtypes, the triple-negative BC (TNBC) is a heterogeneous group that lacks specific markers. We categorized TNBC into quadruple-negative BC (QNBC) and TNBC, based on androgen receptor (AR) status, to make the groups more homogeneous. Immunohistochemistry for CBX proteins was performed on 323 primary invasive BC tissues and their clinical significances were analyzed. Cytoplasmic CBX2 (CBX2-c) was linked to adverse clinicopathological factors and TNBC and QNBC subtypes. In contrast, nuclear CBX7 (CBX7-n) was associated with favorable parameters and luminal A subtype. CBX2-c expression increased progressively from that in benign lesions to that in in situ carcinomas and invasive cancers, whereas CBX7-n and AR expressions showed sequential downregulation. AR was lower in metastatic tissues compared to matched primary cancer tissues. We speculate that the upregulation of CBX2-c and downregulation of CBX7-n could play a role in breast oncogenesis and an adverse clinical course, suggesting them as potential prognostic markers and therapeutic targets in invasive BCs.

Parent and child characteristics associated with treatment non-response to a short- versus long-term lifestyle intervention in pediatric obesity.

BACKGROUND/OBJECTIVES: This study aimed to identify the factors associated with short- or long-term non-response to an obesity intervention in children and adolescents. SUBJECTS/METHODS: In this observational study, a total of 242 children and adolescents (sex- and age-specific body mass index (BMI) ≥ 85th percentile) were divided into three groups according to the BMI z-score change after 6 (n = 163) and 24 months (n = 110) of participating in an obesity intervention: responders, low responders, and non-responders if the BMI z-score decrease was ≥0.25, 0 to 0.25, and if it increased, respectively. RESULTS: Short-term non-response was associated with higher maternal psychosocial stress (OR = 2.34, 95% CI [1.07-5.11]) and adolescence (>11 years; OR = 2.40, 95% CI [1.10-5.22]). The odds of long-term non-response were reduced by an increased vegetable consumption of more than five dishes per week (OR = 0.21, 95% CI [0.07-0.69]) and an hour of increased sleep duration during weekends (OR = 0.14, 95% CI [0.04-0.53]). CONCLUSIONS: Short-term non-response was associated with child and maternal characteristics, whereas long-term non-response was associated with actual lifestyle changes such as sleep duration and vegetable consumption. Children with obesity may benefit from an hour of weekend catch-up sleep in lowering the risk of long-term treatment non-response. An individualized approach should be considered for children of older age and mothers with a higher level of stress, as they may not benefit from a conventional short-term lifestyle intervention.

Health-related quality of life using WHODAS 2.0 and associated factors 1 year after stroke in Korea: a multi-centre and cross-sectional study.

BACKGROUND: Little is known about the self-perceived level of disability of stroke survivors in the community. We aimed to characterise Health-related quality of life (HRQoL) 1 year after stroke and investigate how sociodemographic and stroke-related factors and medical adherence explain the self-perceived level of disability in a Korean stroke population. METHODS: This was a multicentre cross-sectional study. A total of 382 ischaemic stroke survivors at 1 year after onset from 11 university hospitals underwent a one-session assessment, including socioeconomic variables, the modified Rankin Scale (mRS), various neurological sequelae, the Morisky, Green and Levin-Medication Adherence Questionnaire (MGL), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-items. The relationship between disability and different variables was analysed using ordinal logistic regression. RESULTS: The prevalence of disability based on global WHODAS 2.0 was 62.6% (mild, 41.6%; moderate, 16.0%; severe, 5.0%). The prevalence of severe disability was higher in participation in society (16.8%) and getting around (11.8%) than in other domains. Low MGL- motivation was the only factor determining a significant association between all six domains of disability after adjustment. Different predictors for specific domains were age, mRS, dysarthria, trouble seeing, cognition problems, and MGL-motivation for understanding and communicating; age, recurrent stroke, mRS, hemiplegia, facial palsy, general weakness, and MGL-motivation for getting around; age, education, mRS, hemiplegia, and MGL-motivation for self-care; education, recurrent stroke, hemiplegia, dysarthria, and MGL-motivation for getting along with people; age, education, income, mRS, hemiplegia, dysarthria, MGL-knowledge, and MGL-motivation for life activities; living without a spouse, mRS, hemiplegia, dysarthria, trouble seeing, cognition problems, general weakness, and MGL-motivation for participation in society. CONCLUSIONS: Self-perceived disability according to the WHODAS 2.0 at 1 year after stroke was highly prevalent. Each disability domain showed a different prevalence and associated factors. Interventions promoting medical adherence to motivation seemed to help achieve high HRQoL in all domains.

The intergenerational transmission of maternal adverse childhood experiences on offspring's psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study.

Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring's psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6-18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring's psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring's psychiatric disorders (p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring's psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring's psychiatric disorders, the partial mediation model through maternal depression was significant. The mother's experience of household dysfunction before the age of 18 has a significant impact on her offspring's psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring's psychopathology.

Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty.

INTRODUCTION: Adequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP). MATERIALS AND METHODS: Between January 2010 and July 2019, 18 patients [mean age, 74.8 (68-89) years; average follow-up period, 14.8 (12-43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening. RESULTS: The average time to union was 18.4 weeks (range, 10-51 weeks) and to callus formation was 7.8 weeks (range, 2-14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24-53), average knee ROM was 110.3° (range, 80-135°), and average varus-valgus angles of the distal femur were 3.2° (range, -2.9-10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients. CONCLUSION: MIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures.

INTRODUCTION: Intramedullary nailing (IMN) is currently considered the gold standard in the surgical treatment of tibial shaft fractures in adult patients. In this case-control comparative study, we aimed to compare the efficacy of minimally invasive plate osteosynthesis (MIPO) and IMN in treating tibial shaft fractures. MATERIALS AND METHODS: The clinical and radiological outcomes, such as a modified trauma scale, operation time, fracture healing, rate of re-operation, and complications such as malunion, nonunion, shortening, and infection were assessed between IMN and MIPO for the treatment of tibial shaft fractures. RESULTS: Seventy-three skeletally mature patients who underwent IMN (group I) or MIPO (group M) for a closed extra-articular tibial shaft fracture (AO/OTA type 42) from June 2010 to May 2016 were retrospectively reviewed. The mean age was 51.16 (18~79) years, and the mean follow-up period was 22 (12~50) months. Bony union was achieved in all cases but one for each group - group I (35 cases) and group M (36 cases) (p > 0.05). Mean callus formation was observed in 12 (8 - 16) weeks in both groups (p > 0.05). There was no significant difference in operative time, hospital stay, bone healing, and the rate of complications among the two groups (p > 0.05). There was also no postoperative difference in functional evaluation between the two methods (p > 0.05). CONCLUSIONS: No discrepancy was found in radiological and clinical outcomes between IMN and MIPO for tibial shaft fractures. It can be concluded that both IMN and MIPO are equally effective treatment modalities for tibial shaft fractures.

Minimally invasive plate osteosynthesis (MIPO) for mid-shaft fracture of the tibia (AO/OTA classification 42): A retrospective study.

BACKGROUND: There is abundance of literature regarding the treatment of tibial mid-shaft fracture, and intramedullary nailing (IMN) is described as the treatment of choice. However, problems such as malunion and knee pain are known disadvantages of this approach. Minimally invasive plate osteosynthesis (MIPO) technique is another treatment option for tibial mid-shaft fracture.The purpose of this study is to evaluate the clinical, radiological results, and complication rates of tibial mid-shaft fractures treated with MIPO technique. MATERIALS AND METHOD: Thirty-seven skeletally mature patients who underwent MIPO for a mid-shaft fracture of tibia (AO/OTA classification 42) from June 2016 to May 2018 were retrospectively reviewed. A total of 37 patients (12 females, 25 males) with a mean age of 52.7 years (range 28-78 years) were included. The clinical and radiological outcomes, such as the Jeju Lower Extremity Trauma Scale (JLETS), time to callus formation, time to bony union, and complications such as delayed union, malunion, nonunion, and infection were assessed. RESULTS: Bony union was achieved in all cases but one (36 cases). Average callus formation was observed in 10.7 (6.5-14.5) weeks. The average time to union was 19.8 (11.5-26.5) weeks. The average JLETS score was 46.9 (40-53) point. Malunion deformities were observed in 3 cases (8.1%). Two superficial infection cases all resolved spontaneously. There was no statistically significant difference in clinical and radiographic outcomes by different AO/OTA fracture types. CONCLUSION: The MIPO technique with locking compression plate provides stable fixation and satisfactory clinical and radiological results for mid-shaft fractures of tibia irrespective of the fracture type. Future study should aim to compare MIPO and IMN cases directly to clarify the differences and similarities between the two treatment modalities.

Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis.

BACKGROUND: The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis. METHODS: We retrospectively reviewed the medical records of 41 patients who underwent surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography. RESULTS: The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to maintain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (subjects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were additionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional brachiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007). CONCLUSION: Transit-time flow, as measured with intraoperative transit-time ultrasonography, was associated with patency without the need for intervention at 1 year after initiation of hemodialysis.

Non-Melanocytic Skin Cancers of the Head and Neck: A Clinical Study in Jeju Province.

BACKGROUND: Jeju Island is geographically and socioeconomically distinct from the mainland of South Korea. Thus, the presentation and management of non-melanocytic skin cancers (NMSC) of the head and neck may differ from those in other regions of the country. We compared the clinical characteristics and treatment modalities of NMSC on Jeju Island with the findings of similar regional studies. METHODS: Patient data, including age, sex, diagnosis, tumor site, treatment, and recurrence, were obtained from the medical and pathology records of patients diagnosed with NMSC between January 2010 and June 2015. RESULTS: In total, 190 patients (57 men) with a mean age of 75 years (range, 42-97) were assessed. Overall, 203 NMSCs were diagnosed, including 123 basal cell carcinomas and 80 squamous cell carcinomas. The tumor sites included the nose, cheeks, periorbital area, and lips (n=55, 54, 25, and 20, respectively). We identified 92 T1-stage and 60 T2-stage tumors, and 120 cases were treated with wide surgical resection and 17 cases were treated with radiation therapy at the medical center. Of the 120 cases treated surgically, 69 required reconstructive surgery using a local skin flap, 22 required full-thickness skin grafting, and 12 underwent primary closure. Basal and squamous cell carcinomas recurred in 2 and 1 cases, respectively. CONCLUSIONS: Compared to the reports from other regions, the average patient age was 10 years higher, with a marked female preponderance. While the proportion of squamous cell carcinoma was higher than in other regions, the tumor distribution and surgical management profiles were similar.

The association between wind-related variables and stroke symptom onset: A case-crossover study on Jeju Island.

BACKGROUND: Although several studies have investigated the effects of ambient temperature on the risk of stroke, few studies have examined the relationship between other meteorological conditions and stroke. Therefore, the aim of this study was to analyze the association between wind-related variables and stroke symptoms onset. METHODS: Data regarding the onset of stroke symptoms occurring between January 1, 2006, and December 31, 2007 on Jeju Island were collected from the Jeju National University Hospital stroke registry. A fixed-strata case-crossover analysis based on time of onset and adjusted for ambient temperature, relative humidity, air pressure, and pollutants was used to analyze the effects of wind speed, the daily wind speed range (DWR), and the wind chill index on stroke symptom onset using varied lag terms. Models examining the modification effects by age, sex, smoking status, season, and type of stroke were also analyzed. RESULTS: A total of 409 stroke events (381 ischemic and 28 hemorrhagic) were registered between 2006 and 2007. The odds ratios (ORs) for wind speed, DWR, and wind chill among the total sample at lag 0-8 were 1.18 (95% confidence interval (CI): 1.06-1.31), 1.08 (95% CI: 1.02-1.14), and 1.22 (95% CI: 1.07-1.39) respectively. The ORs for wind speed, DWR, and wind chill for ischemic stroke patients were slightly greater than for patients in the total sample (OR=1.20, 95% CI: 1.08-1.34; OR=1.09, 95% CI: 1.03-1.15; and OR=1.22, 95% CI: 1.07-1.39, respectively). Statistically significant season-specific effects were found for spring and winter, and various delayed effects were observed. In addition, age, sex, and smoking status modified the effect size of wind speed, DWR, and wind chill. CONCLUSIONS: Our analyses showed that the risk of stroke symptoms onset was associated with wind speed, DWR, and wind chill on Jeju Island.

Exploratory investigation of genetic associations with basal cell carcinoma risk: genome-wide association study in Jeju Island, Korea.

AIM: Little is known about the genetic associations with Basal cell carcinoma (BCC) risk in non-Caucasian populations, in which BCC is rare, as in Korea. We here conducted a pilot genome-wide association study (GWAS) in 12 patients and 48 standard controls. METHOD: A total of 263,511 SNPs were analyzed with the Illumina HumanOmni1 Quad v1.0 DNA Analysis BeadChip for cases and Korean HapMap 570K for controls. RESULTS: SNP-based analyses, based on the allele genetic model with adjustment for sex and age showed suggestive associations with BCC risk for 6 SNPs with a P-value (P < 0.0005). However, these associations were not statistically significant after Bonferroni correction: rs1040503, rs2216491, rs13407683, rs4751072, rs9891263, and rs1368474. In addition, results from gene-based analyses showed suggestive associations with BCC risk for 33 candidate genes with a P-value (P <0.0005). Consistent with previous GWAS and replication studies in Caucasian populations, PADI6, RHOU and SLC45A2 were identified as having null associations with BCC (P > 0.05), likely due to the smaller sample size. CONCLUSIONS: Although this was a small-scale negative study, to our knowledge, we have conducted the first GWAS for BCC risk in an Asian population. Further large studies in non-Caucasian populations are required to achieve statistical significance and confirm these findings.

Cognitive profile of CADASIL patients with R544C Notch3 mutation.

BACKGROUND: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by mutations in the Notch3 gene. In the present study, we aimed to analyze cognitive and neuroimaging profiles of CADASIL patients with R544C mutation. METHODS: Fifty-eight consecutive patients with R544C mutation and 26 normal controls were investigated. The patients were divided into two groups depending on the presence (CADASIL with dementia: CADASIL-D) or absence of dementia (CADASIL no dementia: CADASIL-ND). We applied the same neuropsychological test to the three groups. Brain magnetic resonance images were obtained from 58 patients with R544C mutation. Linear regression models were used to assess the impact of lacunes and white matter hyperintensities on cognitive function in the CADASIL-ND group. RESULTS: Compared to controls, the CADASIL-ND group demonstrated significant difficulties concerning measures of attention, executive function, and motor control. The CADASIL-D group was impaired in all cognitive domains that were assessed, except the language domain. After correction for age and educational level, the number of lacunes was associated with lower scores in the Alzheimer's Disease Assessment Scale cognitive subtest and Stroop color test in the CADASIL-ND group. CONCLUSIONS: Non-Caucasian CADASIL patients with R544C mutation and Caucasian CADASIL patients show similar patterns of cognitive impairment.

Citrus fruit intake and breast cancer risk: a quantitative systematic review.

PURPOSE: We investigated the association between dietary intake of citrus fruits and breast cancer risk. METHODS: The PubMed and EMBASE were searched for relevant articles on diet and breast cancer up to January 2012. All of the epidemiological studies that assessed dietary intake of citrus fruits and presented risk estimates of the association between citrus fruits intake and risk of breast cancer were reviewed. Multivariable-adjusted odds ratios (OR) and associated 95% confidence intervals (CI) for highest versus lowest intake of dietary citrus fruits level were extracted. Overall summary OR was calculated by using a fixed-effect meta-analysis. RESULTS: Six case-control studies out of five articles were eligible. Overall summary OR showed a 10% reduction in risk of breast cancer associated with high intake of citrus fruits (summary OR, 0.90; 95% CI, 0.85-0.96; p<0.001); results were consistent across the studies (I (2)=0). Visual inspection of the results did not suggest a publication bias. CONCLUSION: Pooled results from observational studies showed an inverse association between citrus fruits intake and the risk of breast cancer.

Trends in the incidence of hospitalized acute myocardial infarction and stroke in Korea, 2006-2010.

This study attempted to calculate and investigate the incidence of hospitalized acute myocardial infarction (AMI) and stroke in Korea. Using the National Health Insurance claim data, we investigated patients whose main diagnostic codes included AMI or stroke during 2006 to 2010. As a result, we found out that the number of AMI hospitalized patients had decreased since 2006 and amounted to 15,893 in 2010; and that the number of those with stroke had decreased since 2006 and amounted to 73,501 in 2010. The age-standardized incidence rate of hospitalized AMI, after adjustment for readmission, was 41.6 cases per 100,000-population in 2006, and had decreased to 29.4 cases in 2010 (for trend P < 0.001). In the case of stroke was estimated at 172.8 cases per 100,000-population in 2006, and had decreased to 135.1 cases in 2010 (for trend P < 0.001). In conclusion, the age-standardized incidence rates of both hospitalized AMI and stroke in Korea had decreased continuously during 2006 to 2010. We consider this decreasing trend due to the active use of pharmaceuticals, early vascular intervention, and the national cardio-cerebrovascular disease care project as the primary and secondary prevention efforts.

V-Y advancement flaps for scalp closure after acute cranial volume expansion.

Sometimes the surgeon who contemplates a coronal incision for craniofacial surgery, such as fronto-orbital advancement, faces a situation in which closure by primary suture becomes impossible because of acute cranial volume expansion. To avoid such a situation, the authors invented V-Y advancement flap method. This flap was found to be highly effective in 6 craniofacial patients who were treated between March 2007 and March 2008. The method consists of an incision line that starts from the highest spot on the ear and proceeds in the direction of the hairline at 45 degrees, and then runs up to the vertex in a sawtooth manner. This line is used when acute cranial volume expansion is expected after surgery. Another incision line is symmetrically drawn on the opposite side of the head. These 2 lines are conjoined at the vertex. The lengths of the 2 sides of a single sawtooth are both about 2 to 3 cm. When the scalp of an expanded cranium is closed, some V-shaped scalp margins under normal tension can simply be sutured using a traditional V-V advancement flap. However, the others under increased tension need to be in a Y-shaped pattern. During the follow-up period (6 months on average), application of this V-Y advancement flap method led to good functional and aesthetic outcomes in all 6 cases. The authors attribute these results to scalp closure using a mixture of V-V and V-Y flaps.

Participation determinants in the DRG payment system of obstetrics and gynecology clinics in South Korea.

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Determinants of public satisfaction with the National Health Insurance in South Korea.

To explore the determinants of public satisfaction with the National Health Insurance, this study re-analyzed the 2004 public satisfaction survey with the Korean National Health Insurance (KNHI) conducted by Korean National Health Insurance Corporation (KNHIC). One thousand samples were selected with probability proportional to population size (by region/sex/age). The data collected by home-visit interview were transformed into the final data set by matching them to the insured's benefit database and the qualification database. The results showed that metropolitan residence, insured type, relationship between respondent and householder, subjective health status, benefit-cost ratio, and attitudes toward KNHI were direct determinants of satisfaction with KNHI. In addition, various demographic and socioeconomic variables and the health status of the respondent's family indirectly influenced satisfaction with KNHI. Among these variables, the attitude toward KNHI was the most vital factor to determine public satisfaction. The study results show that equity in monthly contributions and an enhanced quantity and quality of medical services are required to improve public satisfaction with KNHI. Furthermore, it is important to improve the public perception of social values and solidarity for increased public satisfaction with KNHI.