Ameliorating effect of 2'-fucosyllactose and 6'-sialyllactose on lipopolysaccharide-induced intestinal inflammation.

Human milk oligosaccharides (HMO) affect gut microbiota during neonatal development, particularly with respect to the immune system. Bovine milk-based infant formulas have low oligosaccharide contents. Thus, efforts to fortify infant formulas with HMO are being undertaken. Two major HMO, 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL), exert anti-inflammatory effects; however, the associations between anti-inflammatory effects induced by 2'-FL and 6'-SL cotreatment and gut microbiota composition and metabolite modulation remain unclear. Therefore, in this study, we evaluated the effects of a mixture of these HMO. To determine the optimal HMO ratio for anti-inflammatory effects and elucidate its mode of action, LPS-induced inflammatory HT-29 epithelial cells and intestinal-inflamed suckling mice were treated with various mixtures of 2'-FL and 6'-SL. A 2'-FL:6'-SL ratio of 5:1 was identified as the most effective pretreatment HMO mixture in vitro; thus, this ratio was selected and used for low-, middle-, and high-dose treatments for subsequent in vivo studies. In vivo, high-dose HMO treatment restored LPS-induced inflammation symptoms, such as BW loss, colon length reduction, histological structural damage, and intestinal gene expression related to inflammatory responses. High-dose HMO was the only treatment that modulated the major phyla Bacteroidetes and Firmicutes and the genera Ihubacter, Mageeibacillus, and Saccharofermentans. These changes in microbial composition were correlated with intestinal inflammation-related gene expression and short-chain fatty acid production. To our knowledge, our study is the first to report the effects of Ihubacter, Mageeibacillus, and Saccharofermentans on short-chain fatty acid levels, which can subsequently affect inflammatory cytokine and tight junction protein levels. Conclusively, the HMO mixture exerted anti-inflammatory effects through changes in microbiota and metabolite production. These findings suggest that supplementation of infant formula with HMO may benefit formula-fed infants by forming unique microbiota contributing to neonatal development.

Socio-economic factors and medical conditions affecting regular stomach cancer screening in Korea: a retrospective longitudinal study using national public health data for 11 years.

OBJECTIVE: This study aimed to explore socio-economic factors and medical conditions that affect regular stomach cancer (SC) screening among Korean adults. STUDY DESIGN: This was a retrospective observational study. METHODS: Study subjects were 5545 adults aged ≥40 years who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey and were followed up to year 2017 based on data linking to the Korean National Health Insurance Service and Korean Health Insurance Review and Assessment. Socio-economic factors included sex, age, residential area, education, occupation, marital status, disability, public and private health insurance, service through local public health organizations, history of cancer except for SC, and family history of SC. Medical factors included six gastric lesions with the possibility of facilitating SC screening, including benign gastric neoplasm, chronic atrophic gastritis, gastric polyp, Helicobacter pylori infection, intestinal metaplasia, and peptic ulcers. The outcome was adherence to SC screening, which was divided into non-adherence, irregular adherence, and regular adherence. RESULTS: After adjusting for the effects of socio-economic factors, multivariate ordinal logistic regression revealed that participants with a history of four types of gastric lesions were more likely to regularly participate in SC screening: chronic atrophic gastritis (odds ratio [OR] 1.567; 95% confidence interval [CI] = 1.276-1.923), gastric polyps (OR 1.565; 95% CI = 1.223-2.003), H. pylori infection (OR 1.637; 95% CI = 1.338-2.003), and peptic ulcer (OR 2.226; 95% CI 1.750-2.831). CONCLUSIONS: To improve participation in SC screening, it is necessary to implement personalized strategies for individuals at risk for gastric cancer in addition to population-based strategies for vulnerable groups.

Lung function decline in non-tuberculous mycobacterial pulmonary disease according to disease severity.

BACKGROUND: The severity of non-tuberculous mycobacterial pulmonary disease (NTM-PD) can be classified based on an assessment of the patient´s body mass index, age, presence of cavity, erythrocyte sediment rate and sex (BACES). In this study, changes in lung function according to disease severity were analysed.METHODS: Patients with NTM-PD who underwent at least two lung function tests between 1 January 2011 and 31 December 2021, were classified according to their BACES score into mild (0-1), moderate (2-3) and severe (4-5) groups, and changes in lung function were assessed using BACES scores.RESULTS: A total of 354 patients were divided into three groups: mild (n = 108), moderate (n = 216) and severe (n = 30). As disease severity increased, the decrease in forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) was greater: respectively 26.4 mL/year, 31.3 mL/year and 35.7 mL/year in case of FEV1 (P for trend = 0.002); 18.9 mL/year, 25.5 mL/year and 48.9 mL/year in case of FVC (P for trend = 0.002); and 0.7%/year, 1.3%/year and 2.5%/year for DLCO (P for trend = 0.023) in the mild, moderate and severe groups.CONCLUSION: The decrease in lung function in NTM-PD was correlated with disease severity.

Differences in strategies for prevention of COVID-19 transmission in hospitals: nationwide survey results from the Republic of Korea.

BACKGROUND: Hospital infection control measures against coronavirus disease 2019 (COVID-19) are often based on expert discretion due to the lack of detailed guidelines. AIM: To survey the current strategies for preventing the transmission of COVID-19 in medical institutions. METHODS: Thirteen key issues related to the prevention of COVID-19 transmission within medical institutions were selected via discussion among infectious diseases specialists, and related critical questions were obtained following a review of national-level guidelines in government databases. Six hospitals had an open survey between 11th and 25th August 2020 to provide responses to these topics. An online questionnaire developed from these data was sent to infection control teams at 46 hospitals in South Korea between 31st January 2021 and 20th February 2021. FINDINGS: All 46 hospitals responded to the survey. All operated screening clinics, but 89.1% (41/46) allowed symptomatic patients without COVID-19-associated symptoms to visit general outpatient clinics. Most hospitals (87.2%, 34/39) conducted polymerase chain reaction (PCR) tests for all hospitalized patients. Of 35/46 (76.1%) hospitals with pre-emptive isolation policies for hospitalized patients, 31 (88.6%) released patients from isolation after a single negative PCR test, while most (76.9%, 20/26) allowed shared-room accommodation for patients meeting the national criteria for release from isolation despite positive PCR results with above cycle threshold values (34.6%, 9/26), or after a certain period that satisfied the national criteria (26.9%, 7/26). CONCLUSION: Individual hospitals in South Korea are currently relying on experience to frame relevant guidelines, and responded differently to some infection control issues on hospital settings during the COVID-19 pandemic.

Potential role of CMPK1, SLC29A1, and TLE4 polymorphisms in gemcitabine-based chemotherapy in HER2-negative metastatic breast cancer patients: pharmacogenetic study results from the prospective randomized phase II study of eribulin plus gemcitabine versus paclitaxel plus gemcitabine (KCSG-BR-13-11).

BACKGROUND: In this study, we evaluated the association between genetic polymorphisms of 23 genes associated with gemcitabine metabolism and the clinical efficacy of gemcitabine in breast cancer patients. PATIENTS AND METHODS: This prospective, pharmacogenetic study was conducted in cooperation with a phase II clinical trial. A total of 103 genetic polymorphisms of the 23 genes involved in gemcitabine transport and metabolism were selected for genotyping. The associations of genetic polymorphisms with overall survival, progression-free survival (PFS), and 6-month PFS were analyzed. RESULTS: A total of 91 breast cancer patients were enrolled in this study. In terms of 6-month PFS, rs1044457 in CMPK1 was the most significant genetic polymorphism [55.9% for CT and TT and 78.9% for CC, P < 0.001, hazard ratio (HR): 4.444, 95% confidence interval (CI): 1.905-10.363]. For the rs693955 in SLC29A1, the median duration of PFS was 5.4 months for AA and 10.5 months for CA and CC (P = 0.002, HR: 3.704, 95% CI: 1.615-8.497). For the rs2807312 in TLE4, the median duration of PFS was 5.7 months for TT and 10.4 months for CT and CC (P = 0.005, HR: 4.948, 95% CI: 1.612-15.190). In survival analysis with a multi-gene model, the TT genotype of rs2807312 had the worst PFS regardless of other genetic polymorphisms, whereas the CA genotype of rs693955 or the CT genotype of rs2807312 without the AA genotype of rs693955 had the best PFS compared with those of other genetic groups (P < 0.001). CONCLUSIONS: Genetic polymorphisms of rs1044457 in CMPK1, rs693955 in SLC29A1, and rs2807312 in TLE4 were significantly associated with the 6-month PFS rate and/or the duration of PFS. Further studies with a larger sample size and expression study would be helpful to validate the association of genetic polymorphisms and clinical efficacy of gemcitabine.

Visit-to-visit changes in fasting blood sugar and the risk for cardiovascular disease and mortality in the Korean population: a nationwide population-based cohort study.

OBJECTIVE: The importance of continuous monitoring of fasting blood sugar (FBS) levels of diabetic patients has been established. MATERIALS AND METHODS: An observational prospective study was conducted. Our analysis included 1,700,796 individuals from the nationwide South Korean National Health Insurance System cohort. FBS variability was measured by standard deviation (SD). RESULTS: Kaplan-Meier curves demonstrated elevated disease probability in the higher FBS fluctuation group compared with the lower FBS fluctuation group. After adjusting for confounding variables, Cox proportional hazards analysis showed that the hazard ratios of 411 individuals in the highest quartile of SD variation of FBS were 1.77 (95% confidence interval 1.37-2.28, p<0.001) compared with the lowest quartile of SD variation of FBS. The impact of FBS fluctuation on the risk of cardiovascular diseases (CVDs), cerebrovascular diseases, CVD mortality and all-cause mortality in the highest quartiles of diabetic and non-diabetic individuals was statistically significant. CONCLUSIONS: Visit-to-visit FBS variability has prognostic value for predicting micro- and macrovascular disease, cardiovascular mortality, and all-cause mortality.

Effect of alpine grazing on plasma and hair cortisol, serotonin, and DHEA in dairy cows and its welfare impact.

Through the analysis of blood and hair samples, this study evaluated the effects of grazing in alpine areas on welfare indices and indicators of stress in dairy cows. Twenty-one Holstein dairy cows (body weight: 637 ± 21.5 kg; days in milk: 133 ± 17.7, and second parity) were randomly assigned to 3 groups: control (nongrazing), 12 h of alpine grazing (12 hG), and 24 h of alpine grazing (24 hG). Blood samples for plasma collection were taken for 3 consecutive days at the end of the experiment. Hair samples were collected at the beginning and end of the experiment. Hormone measurements included cortisol, serotonin, and dehydroepiandrosterone (DHEA) in both plasma and hair samples. Plasma cortisol and DHEA levels did not differ among the 3 groups, whereas the plasma serotonin level was higher in the 24 hG group than that in the other groups. The plasma cortisol to DHEA ratio was lower in the 24 hG group than that in the control and 12 hG group. The hair samples taken at the end of the experiment showed that the cortisol level was significantly higher in the control group than that in both of the grazing groups and also higher in the 12 hG than that in the 24 hG group. Hair DHEA and serotonin levels were highest in the 24 hG group. The hair cortisol to DHEA ratio was significantly higher in the control group than that in the 12 hG and 24 hG groups and in the 12 hG group than that in the 24 hG group. Our study showed that grazing dairy cows in alpine areas for 24 h improved their welfare, as indicated by increased serotonin levels in hair and plasma, increased hair DHEA level, and decreased stress indicators, including the hair cortisol level and cortisol to DHEA ratio. Farm facilities should allocate optimal grazing time for optimal welfare of dairy cows.

Lactobacillus-fermented milk products attenuate bone loss in an experimental rat model of ovariectomy-induced post-menopausal primary osteoporosis.

AIM: In this study, we investigated the anti-osteoporotic effect of two fermented milk products (FMPs) fermented by Lactobacillus plantarum A41 and Lactobacillus fermentum SRK414 on a rat model of ovariectomy-induced post-menopausal primary osteoporosis. METHODS AND RESULTS: The two Lactobacillus FMPs increased the bone volume and bone mineral density (BMD) in ovariectomized (OVX) rats, and normalized the bone biomarkers in the serum. Additionally, they altered the gene expression levels of bone-metabolism-related markers. Furthermore, the two Lactobacillus FMPs downregulated bone-apoptosis-related genes stimulated by ovariectomy. Interestingly, the Lactobacillus FMPs decreased the levels of inflammation markers in the serum, bone, ileum and colon of the rats. Gut bacterial populations were also affected upon FMP treatment due to increase in the abundance of the genus Lactobacillus and Faecalibacterium prausnitzii. CONCLUSIONS: Milk products fermented by L. plantarum A41 and L. fermentum SRK414 can exhibit anti-osteoporotic effects on post-menopausal osteoporosis via regulating the expression of bone-metabolism-related markers. SIGNIFICANCE AND IMPACT OF THE STUDY: The two Lactobacillus FMPs used in the study can be an ideal method that has its potential of treating post-menopausal osteoporosis instead of drug treatments.

Device and method for nonlinear ultrasonic measurements on highly irradiated 304 stainless steel specimens in a hot cell environment.

This paper reports on the first successful nonlinear ultrasonic measurement on highly irradiated specimens in a hot cell environment. The specimens are ANSI 304 stainless steel specimens for which the microstructure characterization and ultrasonic velocity measurement have been previously conducted. The critical part of this research is the development of an automatic fixture device that can facilitate repeatable loading and unloading to place the contact ultrasonic transducers on and off of the specimen. The key step to achieve high measurement repeatability is a careful adjustment of the support-spring constants such that the contact force at the interface between the transducer face and specimen surface is as uniform and constant as possible. The longitudinal ultrasonic velocities, which are obtained as a by-product of the nonlinear ultrasonic measurements, show a level of random variation in terms of (max-min)/average (%) below 0.2%, and the velocity distributions and magnitudes are in good agreement with those from the previous work. The ultrasonic nonlinearity parameters show the level of random variation below 4.7%, which is extremely low, considering that the measurements are conducted in a hot cell environment. The nonlinearity parameters also show a strong dependence on the measurement location in a particular specimen with respect to the radiation source, demonstrating a possible inhomogeneous microstructure evolution in these 12.7 mm thick specimens. This research demonstrates the feasibility of making nonlinear ultrasonic measurement on highly radioactive materials and/or in a highly radioactive environment using the device and procedure developed.

Condylectomy as the treatment for active unilateral condylar hyperplasia of the mandible and severe facial asymmetry: retrospective review over 18 years.

Unilateral condylar hyperplasia (UCH) of the mandible is a disorder affecting the condyle size, resulting in facial asymmetry. This study was a retrospective review of 27 patients with UCH who underwent condylectomy between 2000 and 2017 at Yonsei University Dental Hospital. Patient demographic characteristics were summarized. UCH was divided into three subtypes: hemimandibular elongation (HE, n=15), hemimandibular hyperplasia (HH, n=4), and osteochondroma (OC, n=8). Of the 27 patients, only one with the HE type and five (18.5%) with the OC type complained of joint pain. Bone scans of all patients showed higher uptake on the UCH side. Lip and maxillary canting was prominent in the HH and HE types. Five patients (18.5%) underwent condylectomy alone, 13 (48.1%) underwent condylectomy with orthodontic treatment, and nine (33.3%) underwent adjunctive jaw surgery with orthodontic treatment. The treatment modalities varied according to the subtype. In all OC type patients, removal of the hyperplastic condyle treated the facial asymmetry. Additional post-surgical orthodontic treatment was necessary in only three cases (37.5%). All HH type patients required mandibuloplasty. All patients showed a stable occlusal outcome without relapse and an improvement in subjective symptoms, despite a decrease in mouth opening of 2.2mm. These findings might be useful in treatment planning for UCH patients.

Submandibular soft tissue changes after mandibular set-back surgery in skeletal Class III patients.

PURPOSE: To investigate the submandibular soft tissue changes related to the hard tissue changes after mandibular set-back surgery in skeletal Class III patients. METHODS: The subjects were adults with skeletal Class III malocclusion who underwent orthognathic surgery including mandibular set-back between June 2007 and January 2011 at Kyung Hee University Dental Hospital at Gandong. Standardized lateral cephalograms that were taken before and 6 to 12 months after surgery were collected. Sixty samples were selected. Each lateral cephalograms was traced and lines, angles and areas associated with submandibular soft tissues were measured and analyzed statistically. RESULTS: Anteroposterior submandibular soft tissue length was reduced with reduction of mandibular body length. FH to mandibular plane angle was decreased and FH to submandibular line angle was increased. A gender difference was found in soft tissue changes. Males showed altered vertical soft tissue thickness and submandibular tissue area reduction after surgery. Several hard tissue changes were correlated with soft tissue changes and through multiple regression models with stepwise selection method, several regression equation models to predict soft tissue changes related to hard tissue changes were made. CONCLUSION: After orthognathic surgery including mandibular set-back, the submandibular soft tissue profile changes. Equations to predict submandibular soft tissue changes after mandibular set-back surgery were developed.

Incidence and risk factors of immediate hypersensitivity reactions associated with low-osmolar iodinated contrast media: a longitudinal study based on a real-time monitoring system

OBJECTIVES: We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM. METHODS: This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS). RESULTS: The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not. CONCLUSION: The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM

OBJETIVOS: Estudio de la incidencia de reacciones de hipersensibilidad inmediata frente a diferentes medios de contraste de baja osmolaridad, así como la incidencia global de dichas reacciones con estos contrastes yodados. MÉTODOS: Estudio de cohortes en el que se incluyó de forma consecutiva a todos los pacientes a los que se realizó TAC con contraste yodados de baja osmolaridad durante los años 2012 a 2014. Se emplearon 5 contrastes yodados: iobitridol, iohexol, iomeprol, iopamidol, y iopromide. En todos los pacientes se valoró la presencia de efectos adversos. La aparición de cualquier síntoma fue registrada en el mismo momento de su aparición en el Contrast Safety Monitoring and Management System (CoSM2oS) en tiempo real. RESULTADOS: La incidencia global de reacciones de hipersensibilidad inmediata a medios de contraste yodados de baja osmolaridad fue de 0,97% (2.004 reacciones en 205.726 exploraciones con contraste). La incidencia fue significativamente mayor en los pacientes con historia previa de reacción adversa (16,99%) frente a tan solo 0,80% en los pacientes sin historia previa de reacción (p=.001). La incidencia de estas reacciones osciló desde el 0,72% con iohexol al 1,34% con iomeprol, sin alcanzar diferencias significativas entre los cinco contrastes. Un análisis longitudinal mostró que la incidencia de reacciones inmediatas de hipersensiblidad se incrementa de forma gradual en los pacientes con historia de reacciones previas con medios de contraste yodados (CR=2,006 (1.517-2.653), p<.001). este incremento solo se observaba en los pacientes con historia de reacciones previas, pero no en los sujetos sin historia previa de estas reacciones. CONCLUSIÓN: La incidencia de las reacciones de hipersensibilidad inmediata no fue significativamente diferente entre ninguno de los 5 contrastes utilizados en el estudio. Exposiciones repetidas a estos medios de contraste no aumentan el riesgo de este tipo de reacciones de hipersensibilidad inmediata en los pacientes que no habían presentado previamente este tipo de reacciones

Solvent-dependent self-assembly of two dimensional layered perovskite (C6H5CH2CH2NH3)2MCl4 (M = Cu, Mn) thin films in ambient humidity.

Two dimensional layered organic-inorganic halide perovskites offer a wide variety of novel functionality such as solar cell and optoelectronics and magnetism. Self-assembly of these materials using solution process (ex. spin coating) makes crystalline thin films synthesized at ambient environment. However, flexibility of organic layer also poses a structure stability issue in perovskite thin films against environment factors (ex. moisture). In this study, we investigate the effect of solvents and moisture on structure and property in the (C6H5(CH2)2NH3)2(Cu, Mn)Cl4 (Cu-PEA, Mn-PEA) perovskite thin films spin-coated on Si wafer using three solvents (H2O, MeOH, MeOH + H2O). A combination of x-ray diffraction (XRD) and x-ray absorption spectroscopy (XAS) show that relative humidity (RH) has a profound effect on perovskite thin films during sample synthesis and storage, depending on the kind of solvent used. The ones prepared using water (Cu-PEA:H2O, Mn-PEA:H2O) show quite different behavior from the other cases. According to time-dependent XRD, reversible crystalline-amorphous transition takes place depending on RH in the former cases, whereas the latter cases relatively remain stable. It also turns out from XAS that Mn-PEA thin films prepared with solvents such as MeOH and MeOH + H2O are disordered to the depth of about 4 nm from surface.

Identifying the mechanism of Escherichia coli O157:H7 survival by the addition of salt in the treatment with organic acids.

AIM: In this study, the effects of the addition of salt to treatment with acids (one of several organic acids and salt in various solutions including rich or minimal broth, buffer, or distilled water) on the reduction of Escherichia coli O157:H7 were investigated. The protein expression profiles corresponding to acid stress (acetic acid) with or without salt addition were studied using a comparative proteomic analysis of E. coli O157:H7. METHODS AND RESULTS: When acetic, lactic, or propionic acid was combined with 3% NaCl, mutually antagonistic effects of acid and salt on viability of E. coli O157:H7 were observed only in tryptone and yeast extract broth. After exposure to acetic acid alone or in combination with salt, approximately 851 and 916 protein spots were detected, respectively. Analysis of 10 statistically significant differentially expressed proteins revealed that these proteins are mainly related to energy metabolism. CONCLUSIONS: When we compared protein expression of E. coli O157:H7 treated with acetic acid and the combination of the acid and salt, the differentially expressed proteins were not related to acid stress- and salt stress-inducible proteins such as stress shock proteins. SIGNIFICANCE AND IMPACT OF THE STUDY: According to these results, the increased resistance of E. coli O157:H7 to acetic acid after the addition of salt may not be the result of synthesis of proteins related to these phenomena; therefore, further research needs to be conducted to identify the mechanism of the mutually antagonistic effect of some organic acids and salt.

Adenovirus-mediated Foxp3 expression in lung epithelial cells ameliorates acute radiation-induced pneumonitis in mice.

Forkhead transcription factor 3 (Foxp3) has a critical role in regulatory T cells (Treg). There are an increasing number of researches concerning the functions of Foxp3 in other cells, including lung epithelial cells besides Treg. However, the roles of Foxp3 in lung epithelial cells remain poorly understood. To examine the potential therapeutic benefits of Foxp3 for lung inflammation, this study investigates the effect of adenovirus-mediated Foxp3 overexpression in a radiation-induced lung damage model. Foxp3-EGFP expressing adenovirus was administered by intratracheal injection three times over 14 days after focal X-ray irradiation. To evaluate effects of Foxp3 overexpression in radiation-induced lung inflammation, immune cell profiles of bronchoalveolar lavage (BAL) fluid were analyzed. Foxp3 gene-delivered mice showed significant inhibition of immune cell infiltration, such as eosinophils, lymphocytes, macrophages and neutrophils in BAL fluid. Histopathological analysis also showed that Foxp3 overexpression inhibits inflammatory cell recruitment and collagen deposition in lung tissues. In addition, expression of inflammatory and fibrosis-related genes was decreased in the Foxp3 expression adenovirus-infected group. These results suggest that Foxp3 expression in lungs holds considerable therapeutic potential for attenuating inflammation and fibrosis in radiation-induced lung injury.

Impact of paraaortic lymphadenectomy for endometrial cancer with positive pelvic lymph nodes: A Korean Radiation Oncology Group study (KROG 13-17).

AIM: We investigated the role of paraaortic lymph node dissection (PALND) in patients with stage IIIC1 endometrial carcinoma after surgery followed by adjuvant radiotherapy (RT) alone or chemoradiotherapy (CTRT). METHODS: We performed a subgroup analysis in 151 patients treated with adjuvant pelvic RT. Paraaortic-recurrence free survival, disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS: In adjuvant RT alone, PALND was significantly related to reduced risk of paraaortic recurrence (0% vs. 17.1%) and distant metastasis (4.5% vs. 19.5%) compared with the no PALND group. PALND affected 5-year DFS (90.2% vs. 58.9%, p = 0.016) and OS (100% vs. 83.1%, p = 0.022). For the CTRT group, the paraaortic recurrence rate was 19.5% for the no PALND group and 12.8% for the PALND group (p = 0.682). Of patients who underwent PALND in the CTRT group, less extensive PALND was significantly related to increased paraaortic recurrence (≤10 vs. >10 dissected LNs, 17.1% vs. 0%). In the no PALND group (n = 82), 5-year paraaortic-recurrence free survival was 79.4% for the CTRT group and 76.2% for the RT alone group (p = 0.941). In multivariate analysis, PALND was significantly associated with reduced risk of disease-specific death (HR, 0.50; 95% CI, 0.26-0.96; p = 0.037). CONCLUSION: PALND provided excellent paraaortic control and improved outcome in stage IIIC1 endometrial cancer with favorable tumor features treated with adjuvant RT alone. Less extensive PALND was associated with significantly increased paraaortic recurrence in patients with advanced tumor features treated with adjuvant CTRT. Combined CTRT did not affect disease control in the paraaortic region compared with RT alone.

A surgical strategy for severe facial asymmetry due to unilateral condylar overgrowth.

Unilateral condylar overgrowth induces severe facial asymmetry. Therefore, treatment focuses on both elimination of the condyle lesion and correction of the facial asymmetry. The aim of this report is to present three patient cases, introducing a simpler surgical method, the indications for this surgical method, and a treatment planning flow that is consistently applicable regardless of the origin of the condylar lesion. Condylectomy was performed simultaneously with orthognathic surgery, with the vertical ramus osteotomy selected as the method of ramus surgery; ipsilateral ramus surgery was not performed on the condylectomy side. This method is applicable in cases in which facial asymmetry originates solely from unilateral condylar overgrowth, and the maxilla and mandible are presumed to have been in the normal class I anteroposterior position before the onset of condylar lesion growth. After surgery, temporomandibular joint pain and/or mouth limitations were resolved, the new condyle showed satisfactory bone remodelling, and favourable facial symmetry was attained. The postoperative results were maintained long-term and there was no recurrence on the condylectomy side. This simply modified surgical strategy for facial asymmetry due to unilateral condylar overgrowth may be used in selected patients, regardless of the origin of the condylar lesion.

Left ventricular end diastolic pressure for detection of intracoronary ergonovine-induced myocardial ischemia.

BACKGROUND: Recent consensus on variant angina defines significant spasm as total or subtotal occlusion of a coronary artery. However, the clinical significance of "less-than-subtotal" spasm needs to be reappraised, especially if the coronary spasm is combined with chest pain. Therefore, we evaluated the feasibility of left ventricular end diastolic pressure (LVEDP) as a tool to detect myocardial ischemia during ergonovine provocation testing. METHODS: After achieving two access sites, 29 patients underwent successful LVEDP monitoring using 5-Fr pigtail catheters during ergonovine provocation tests. Patients were divided into two groups based on the occurrence of anginal symptoms. RESULTS: Of the 29 patients, 16 (55 %) patients had anginal symptoms. LVEDP was significantly increased in the symptomatic group compared with the nonsymptomatic group (∆LVEDP 5.6 ± 4.2 vs. 1.2 ± 2.0 mmHg, p = 0.002). However, of the 16 patients with anginal symptoms, positive provocation test results were confirmed in only six patients (38 %) as per the traditional standard (> 90 % inducible spasm of the epicardial coronary artery). CONCLUSION: Compared with the traditional standard, LVEDP may have advantages in terms of elucidating anginal symptoms in patients suspected of having coronary vasospasm when performing ergonovine provocation tests.