The Relationship Between Retinal and Choroidal Thickness and Adiponectin Concentrations in Patients With Type 2 Diabetes Mellitus.

Purpose: To evaluate the association between retinal and choroidal thickness and serum and aqueous humor (AH) adiponectin concentrations in patients with diabetic retinopathy (DR). Methods: This prospective study enrolled diabetic patients without DR (group 1, n = 46) and with DR (n = 130). Central foveal thickness (CFT), subfoveal choroidal thickness (SCT), and adiponectin in serum and AH concentrations were compared. For subgroup analysis, the DR group was divided into four subgroups: mild (group 2), moderate (group 3), severe nonproliferative DR (group 4), and panretinal photocoagulation (group 5). Results: The log-transformed serum and AH adiponectin concentrations in patients with DR (groups 2-5) were higher than in patients without DR (all Ps < 0.001). In addition, serum and AH adiponectin concentrations showed a positive linear correlation with DR severity (P < 0.001 and P = 0.001, respectively). In univariate analysis between serum or AH adiponectin concentrations and CFT or SCT, AH adiponectin significantly correlated with CFT and SCT (all Ps < 0.001). However, serum adiponectin concentration significantly correlated with SCT (P = 0.041) but not with CFT (P = 0.337). In multivariate analysis, AH adiponectin concentration significantly correlated with CFT, but serum adiponectin concentration did not (P = 0.002 and 0.309, respectively). In contrast, serum and AH adiponectin concentrations significantly correlated with SCT (P = 0.048 and 0.041, respectively). Conclusions: Serum and AH adiponectin concentrations are positively associated with DR development and progression. Additionally, SCT looks related to the serum and AH adiponectin concentrations, whereas CFT looks related to AH adiponectin concentrations.

Serum and aqueous humor adiponectin levels correlate with diabetic retinopathy development and progression.

PURPOSE: To compare adiponectin (APN) levels in the serum and aqueous humor (AH) and evaluate their association with the development/progression of diabetic retinopathy (DR). METHODS: Diabetic patients with (group 3; n = 59) and without (group 2; n = 39) DR and age- and sex-matched normal subjects (group 1; n = 35) were compared. Duration of diabetes, body mass index, serum HbA1c, vascular endothelial growth factor (VEGF), APN, pentraxin 3 (PTX3), platelet derived growth factor (PDGF), intercellular adhesion molecule-1 (ICAM-1), and APN were measured and analyzed. RESULTS: One hundred and thirty-three participants were included. Compared to patients without diabetes, diabetic patients with DR had significantly elevated average serum APN levels (5.99±3.89 µg/ml versus 3.51±1.44 µg/ml, P = 0.002) and average AH APN levels (10.94±11.74 ng/ml versus 3.65±3.33 ng/ml, P<0.001). Serum APN was significantly correlated with AH APN (R = 0.512, P<0.001) and AH VEGF (R = 0.202, P = 0.020). The log serum APN was significantly correlated with intraocular cytokines, including log APN, log VEGF, log ICAM, log leptin, log PTX3, log PDGF, angiopoietin, C-reactive protein, and interleukins (IL)-5 and IL-10 (P<0.001, P = 0.020, P<0.001, P<0.001, P = 0.001, P<0.001, P = 0.008, P = 0.009, P<0.001, and P = 0.046, respectively). Log serum VEGF showed a significant correlation only with log AH VEGF (P = 0.001). Multivariate logistic analysis was performed to evaluate the association of DR progression and cytokine concentrations; log Serum APN and log AH APN showed good correlation with the DR progression in each model. CONCLUSIONS: AH APN levels correlated well with DR development and progression. Serum APN could be a better marker for estimating intraocular cytokines, including both intraocular APN and VEGF concentrations in clinical field, than serum VEGF in DR patients.

Quantitative evaluation of choriocapillaris using optical coherence tomography and optical coherence tomography angiography in patients with central serous chorioretinopathy after half-dose photodynamic therapy.

PURPOSE: To quantify the structural and perfusion changes in choriocapillaris in chronic central serous chorioretinopathy after half-dose photodynamic therapy by using spectral-domain optical coherence tomography and optical coherence tomography angiography. METHODS: This retrospective interventional case series examined the eyes of patients with central serous chorioretinopathy. Patients underwent full ophthalmic examinations, including spectral-domain optical coherence tomography and angiography, prior to and 1, 3, and 6 months after the treatment. Clinical and tomographic features of the choriocapillaris and choroidal thickness and vascular changes were evaluated by assessing flow signal voids. RESULTS: All 56 eyes of 56 patients showed complete resolution of subretinal fluid at 3 months after photodynamic therapy. The best-corrected visual acuity significantly improved at 6 months (p<0.001). The central subfield thickness, subfoveal choroidal thickness, subfoveal choroidal large vessel layer thickness, and mean total area of flow signal voids decreased significantly at 6 months (all p values < 0.001), but the subfoveal choriocapillaris layer thickness did not change significantly at 6 months (p≥0.16). Multivariate analysis revealed positive linear correlations of the central subfield thickness and subfoveal choroidal large vessel layer thickness with the mean total area of flow signal voids at 6 months (p<0.001). There was a negative linear correlation between the subfoveal choriocapillaris layer and the mean total area of flow signal voids at 6 months (p = 0.013). CONCLUSION: Half-dose photodynamic therapy improved the anatomic and functional outcomes of central serous chorioretinopathy, induced subfoveal choroidal thickness thinning, and increased choriocapillaris perfusion. In addition, the recovery of the subfoveal choriocapillaris layer thickness and improved choriocapillaris perfusion were closely associated.

Intraocular Pressure (IOP) Change and Frequency of IOP Spike After Cataract Surgery in Normal-tension Glaucoma: A Case-Control Study.

PURPOSE: To evaluate the early-postoperative intraocular pressure (IOP) changes and frequency of IOP spike after cataract surgery in normal-tension glaucoma (NTG) eyes and to compare them with those of nonglaucomatous eyes. MATERIALS AND METHODS: This was a case-control study. We reviewed the medical records of patients who had undergone cataract surgery. One-to-one (1:1) case matching was performed, each matched set consisting of 1 NTG and 1 nonglaucomatous eye as the control eye. Comparisons between those 2 groups were performed. Specifically, IOP was measured preoperatively and 1 day, 1, 2, and 4 weeks postoperatively. The incidence of IOP spike was evaluated according to the criteria of IOP higher than 21, 25, 30 mm Hg, higher than 5, 10 mm Hg over baseline IOP, and 50% above preoperative IOP. RESULTS: A total of 298 eyes (149 NTG eyes and 149 control eyes) were enrolled. Preoperative IOP did not show any significant difference between the 2 groups (P=0.687). IOP significantly decreased in both the NTG and control groups [P<0.001, repeated-measures analysis of variance (ANOVA)]. No significant differences in this regard were detected between the 2 groups (P=0.618, repeated-measures ANOVA). When IOP spike was evaluated according to the 6 criteria, the frequencies were <3% at any timepoint. There was no significant difference between the 2 groups. CONCLUSIONS: In both the NTG and control groups, IOP gradually decreased in the early-postoperative period after cataract surgery, and there was no significant difference between the 2 groups. The frequency of IOP spike was <5% in both the NTG group and the control group.

Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation.

BACKGROUND: Laparoscopic primary repair is one of the main procedures used for perforated gastric ulcers, and this technique requires reproducible and secure suturing. The aim of this study was to investigate the safety and efficacy of a novel continuous suture method with barbed sutures during laparoscopic repair for perforated peptic ulcers. PATIENTS AND METHODS: Clinical data from 116 consecutive patients undergoing laparoscopic repair for perforated peptic ulcers were collected between November 2009 and October 2015. Continuous suturing with 15-cm-long unidirectional absorbable barbed sutures was used for laparoscopic repair in the study group, termed group V (n = 51). Patients who underwent laparoscopic repair with conventional interrupted sutures were defined as group C (n = 65). The complication and operative data were compared between groups. RESULTS: Although there was no difference between group V and group C in the overall complication rate (15.7% vs. 24.6%; p = 0.259), the complication rate related to suturing was lower (3.9% vs. 15.4%; p = 0.04) in group V. Group V showed rates of 0% for leakage, 2% for intra-abdominal fluid collection, and 2% for stricture; the corresponding rates in group C were 3.1, 7.7, and 4.6%, respectively. Regarding operative data, the total operation time (V vs. C, 87.7 min vs. 131.2 min), total suture time (7.1 min vs. 25.3 min), and suture time per stitch (1.2 min vs. 6.2 min) were significantly shorter in group V than in group C (p < 0.001). CONCLUSION: The use of a continuous suture technique with unidirectional barbed sutures is as safe as the conventional suture technique and allows easier and faster suturing in the repair of perforated peptic ulcers.

Overexpression of Neuron-Specific Enolase as a Prognostic Factor in Patients with Gastric Cancer.

PURPOSE: Enolase is a cytoplasmic enzyme that catalyzes the conversion of 2-phosphoglycerate to phosphoenolpyruvate in the glycolytic pathway. The aim of this study was to investigate whether the overexpression of neuron-specific enolase (NSE) can serve as a prognostic factor in patients with gastric cancer (GC). MATERIALS AND METHODS: To assess its prognostic value in GC, NSE expression was measured by immunohistochemistry in a clinically annotated tissue microarray comprising of 327 human GC specimens. Cytoplasmic NSE expression was scored from 0 to 4, reflecting the percentage of NSE-positive cells. RESULTS: In terms of histology as per the World Health Organization criteria (P=0.340), there were no differences between the NSE overexpression (NSE-OE) and NSE underexpression (NSE-UE) groups. The NSE-OE group showed a significantly lower rate of advanced GC (P<0.010), lymph node metastasis (P=0.010), advanced stage group (P<0.010), cancer-related death (P<0.010), and cancer recurrence (P<0.010). Additionally, a Kaplan-Meier survival analysis revealed that the NSE-OE group had longer cumulative survival times than the NSE-UE group (log-rank test, P<0.010). However, there were no significant differences in the serum levels of NSE expression in patients with GC and healthy volunteers (P=0.280). CONCLUSIONS: Patients with NSE overexpressing GC tissues showed better prognostic results, implying that NSE could be a candidate biomarker of GC.

Experimental Demonstration of Four-Dimensional Photonic Spatial Entanglement between Multi-core Optical Fibres.

Fibre transport of multi-dimensional photonic quantum states promises high information capacity per photon without space restriction. This work experimentally demonstrates transmission of spatial ququarts through multi-core optical fibres and measurement of the entanglement between two fibres with quantum state analyzers, each composed of a spatial light modulator and a single-mode fibre. Quantum state tomography reconstructs the four-dimension entangled state that verifies the nonlocality through concurrences in two-dimensional subspaces, a lower bound of four-dimensional concurrence and a Bell-type CGLMP inequality.

In vivo intraocular pressure monitoring during microincision vitrectomy with and without active control of infusion pressure.

PURPOSE: To evaluate intraocular pressure (IOP) fluctuation during vitrectomy, we directly monitored IOP in vivo using 2 vitrectomy machines with or without constant infusion pressure monitoring and control. METHODS: Among 61 eyes of 61 consecutive patients, 32 were assigned to the Accurus system (group 1) and 29 were assigned to the Constellation system (group 2) in this prospective case series. The IOP fluctuations were evaluated during routine vitrectomy procedures. RESULTS: The initial IOP before vitrectomy was 20.3 ± 2.4 mm Hg in group 1 using a conventional vented gas forced infusion system and 20.0 ± 0.0 mm Hg in group 2 using active IOP control at 20 mm Hg (p = 0.532). However, the average IOP change during core vitrectomy was -8.6 ± 4.3 mm Hg in group 1 and -0.8 ± 1.1 in group 2 (p<00.001). Maximum IOP was significantly decreased in group 1 (-17.0 ± 2.6 mm Hg) compared with that in group 2 (-4.1 ± 2.2 mm Hg) (p<00.001). Partial ocular collapse was observed during vitrectomy only in group 1 (78.1%). Peak IOP significantly increased during scleral compression and gas and fluid injection but was not significantly different between the groups (all p≥0.147). The IOP fluctuation range was 50-70 mm Hg in both groups. CONCLUSIONS: The IOP fluctuated significantly during routine vitrectomy using both systems. Hypotony and partial ocular collapse were more frequently observed during vitrectomy with the Accurus system than with the Constellation system. Both systems were vulnerable to IOP surge during indentation and intravitreal injection.

A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis from Co-Occurring Prostate Cancer.

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.

Cooccurrence of Metastatic Papillary Thyroid Carcinoma and Salmonella Induced Neck Abscess in a Cervical Lymph Node.

Cervical lymph node metastasis is common in patients with papillary thyroid carcinoma (PTC). Salmonella species are rarely reported as causative agents in focal infections of the head and neck. The cooccurrence of lymph node metastasis from PTC and a bacterial infection is rare. This report describes a 76-year-old woman with a cervical lymph node metastasis from PTC and Salmonella infection of the same lymph node. The patient presented with painful swelling in her left lateral neck region for 15 days, and neck ultrasonography and computed tomography showed a cystic mass along left levels II-IV. The cystic mass was suspected of being a metastatic lymph node; modified radical neck dissection was performed. Histopathological examination confirmed the presence of PTC in the resected node and laboratory examination of the combined abscess cavity confirmed the presence of Salmonella Typhi. Following antibiotic sensitivity testing of the cultured Salmonella Typhi, she was treated with proper antibiotics. Cystic lesions in lymph nodes with metastatic cancer may indicate the presence of cooccurring bacterial infection. Thus, culturing of specimen can be option to make accurate diagnosis and to provide proper postoperative management.

Relationship between low body mass index and morbidity after gastrectomy for gastric cancer.

PURPOSE: This study aimed to evaluate the association between low body mass index (BMI) and morbidity after gastric cancer surgery. METHODS: A total of 1,805 patients were included in the study. These subjects had undergone gastric cancer surgery at a single institution between January 1997 and December 2013. Clinicopathologic and morbidity data were analyzed by dividing the patients into 2 groups: underweight patients (BMI < 18.5 kg/m(2)) and nonunderweight patients (BMI ≥ 18.5 kg/m(2)). RESULTS: The overall complication rate as determined by our study was 24.4%. Pulmonary complications occurred more frequently in the underweight group (UWG) than in the non-UWG (10.5% vs. 3.8%, respectively; P = 0.012). Multivariate analysis revealed two independent factors responsible for postoperative pulmonary complications-weight of the patients (UWG vs. non-UWG, 10.8% vs. 3.8%; P < 0.007) and stage of gastric cancer (early stage vs. advanced stage, 3.1% vs. 6.8%; P < 0.023). Multivariate analysis revealed that underweight (UWG vs. non-UWG, 10.8% vs. 3.8%, respectively, P < 0.007) and advanced cancer stage (early stage vs. advanced stage, 3.1% vs. 6.8%, respectively, P = 0.023) were significant risk factors for postoperative pulmonary complications. CONCLUSION: We concluded that underweight patients had a higher pulmonary complication rate. Additionally, underweight and advanced cancer stage were determined to be independent risk factors for the development of postoperative pulmonary complications.

Comparison of Learning Curves for Major and Minor Laparoscopic Liver Resection.

BACKGROUND: Because laparoscopic liver resection (LLR) has a steep learning curve, analyzing experience is important for trainees. Several authors have described the learning curve of LLR, without comparing the learning curves between major and minor LLR. METHODS: Perioperative data were retrieved from the medical records of 170 consecutive patients who underwent LLR by a single surgeon at a tertiary hospital. Learning curves were generated and compared between major and minor LLR using cumulative sum control charts and the moving average. RESULTS: Major and minor LLR was performed in 96 and 74 patients, respectively. The learning curves showed a steady state after case 50 for major LLR. Because of discordant results in minor LLR, subgroup analyses were performed, showing competency in LLR after cases 25 and 35 for left lateral sectionectomy and tumorectomy, respectively. Transfused red blood cell volume (0.6 versus 2.2 packs, P < .001) decreased after achievement of competence in major LLR. Blood loss exceeding 500 mL (odds ratio 2.395, 95% confidence interval 1.096-5.233, P = .028) was independently associated with LLR failure. CONCLUSIONS: The number of cases required to accomplish LLR differed according to the extent of resection. Extensive blood loss was independently associated with LLR failure.

Comparison of perioperative and oncologic outcomes between open and laparoscopic liver resection for intrahepatic cholangiocarcinoma.

BACKGROUND: Laparoscopic liver resection (LLR) has become an essential method for treating malignant liver tumors. Although the perioperative and oncologic outcomes of LLR in patients with hepatocellular carcinoma have been reported, there are few reports of LLR for intrahepatic cholangiocarcinoma (IHCC). METHODS: Patients who underwent liver resection for T1 or T2 IHCC between March 2010 and March 2015 in Gyeongsang National University Hospital were enrolled. They were divided into open (n = 23) and laparoscopic (n = 14) approaches, and the perioperative and oncologic outcomes were compared. RESULTS: The Pringle maneuver was less frequently used (p = 0.015) and estimated blood loss was lesser (p = 0.006) in the laparoscopic group. There were no significant differences in complication rate (p = 1.000), hospital stay (p = 0.371), tumor size (p = 0.159), lymph node metastasis (p = 0.127), and the number of retrieved lymph nodes (p = 0.553). The patients were followed up for a median of 21 months. The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 74.7 and 55.2 %, respectively. No differences were observed in the 3-year OS (75.7 vs 84.6 %, p = 0.672) and RFS (56.7 vs 76.9 %, p = 0.456) rates between the open and laparoscopic groups, even after the groups were divided into patients that received liver resection with or without lymph node dissection. CONCLUSION: LLR for IHCC is a treatment modality that should be considered as an option alongside open liver resection in selected patients.

A Comparative Study of Topical Mitomycin C, Cyclosporine, and Bevacizumab after Primary Pterygium Surgery.

PURPOSE: To compare the recurrence rates and complications associated with instillation of topical mitomycin C, cyclosporine, and bevacizumab after primary pterygium surgery. METHODS: Between July 2013 and June 2014, we performed surgery using the bare sclera method on 132 eyes (132 patients) with primary pterygium. We randomly selected 33 eyes (33 patients) and treated them with artificial tears four times a day for three months, 29 eyes (29 patients) were treated with topical 0.02% mitomycin C four times a day for five days, 34 eyes (34 patients) were treated with topical 0.05% cyclosporine four times a day for three months, and 36 eyes (36 patients) were treated with topical 2.5% bevacizumab four times a day for three months after surgery. We prospectively determined the recurrence rates of pterygium and complications at the six-month follow-up examination. RESULTS: At six months after surgery, the recurrence rates in each group were as follows: 45.5% (15 eyes) in the control group, 10.3% (three eyes) in the mitomycin C group, 20.6% (seven eyes) in the cyclosporine group, and 41.7% (15 eyes) in the bevacizumab group (p = 0.004). No serious complications, except subconjunctival hemorrhages, were observed in any group. CONCLUSIONS: Groups receiving topical 0.02% mitomycin C and 0.05% cyclosporine after surgery showed lower recurrence rates than the control group; however, no difference in recurrence rate was observed between the control group and the group receiving topical 2.5% bevacizumab after surgery.

A case of gallbladder cancer combined with ectopic individual opening of pancreatic and bile ducts to the duodenal bulb.

Ectopic opening of the pancreatic and bile ducts (EOPBD) into the duodenal bulb is an extremely rare congenital anomaly with unknown clinical implications. We presented a case of gallbladder cancer with EOPBD into the duodenal bulb. A 57-year-old male was referred to our hospital with intermittent right upper abdominal pain. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed individual EOPBD into the duodenal bulb with no papillary structure, and a focal nodular lesion in the gallbladder. A follow-up abdominal computed tomography scan 9 months later revealed a slight increase in the size of the fundal nodule, which was suspected as gallbladder cancer. An intraoperative frozen biopsy identified the nodular lesion as adenocarcinoma involving the cystic duct, and the patient underwent radical cholecystectomy including bile duct resection with hepaticojejunostomy. EOPBD is an extremely rare condition that can be associated with gallbladder malignancy as well as benign disease. Clinicians should follow up carefully and consider surgical treatment for suspected malignant lesions.

Multi-core fiber interferometer using spatial light modulators for measurement of the inter-core group index differences.

We demonstrate an experimental technique to generate and measure arbitrary superpositions of core modes in a multi-core fiber. Two spatial light modulators couple the fundamental mode of a single-mode fiber with multiple-core modes of the MCF to constitute a Mach-Zehnder-type multi-path interferometer. The phase tunability of each path is verified by comparing two-, three-, and four-path interference patterns with the theory. Interference fringes in the wavelength domain estimates the inter-core group index differences with a resolution of 10(-5) using a fiber length of 1 m.

Impact of tumor size on subclinical central lymph node metastasis in papillary thyroid microcarcinoma depends on age.

BACKGROUND: The aim of this study is to evaluate whether the associations between clinicopathologic factors of papillary thyroid microcarcinoma (PTMC), especially tumor size, and subclinical central lymph node metastasis (LNM) are dependent on patient age. METHODS: The medical records of 428 patients who underwent thyroid surgery for PTC measuring ≤1 cm were reviewed. All patients were clinically lymph node negative and underwent thyroidectomy with unilateral or bilateral central lymph node dissection. Univariate and multivariate analyses were performed to identify clinicopathologic factors associated with central LNM. RESULTS: Central LNM was identified in 96 of 428 (22.4%) patients. Mean tumor size was significantly greater in patients with than without central LNM (0.74 ± 0.22 cm vs. 0.64 ± 0.23 cm, P = 0.001). Tumor size > 0.5 cm was significantly predictive of central LNM. Subgroup analysis according to age groups showed that tumor size was an independent predictor of subclinical central LNM only in patients aged ≥45 years. CONCLUSIONS: Factors predictive of central LNM in patients with PTMC differed by age. PTMC size was an independent predictor of subclinical central LNM only in patients aged ≥45 years.

Risk factors for fluoroquinolone resistance in ocular cultures.

PURPOSE: To identify the risk factors associated with fluoroquinolone resistance in patients undergoing cataract surgery. METHODS: A total of 1,125 patients (1,125 eyes) who underwent cataract surgery at Veterans Health Service Medical Center from May 2011 to July 2012 were enrolled in this study. Conjunctival cultures were obtained from the patients on the day of surgery before instillation of any ophthalmic solutions. The medical records of patients with positive coagulase negative staphylococcus (CNS) and Staphylococcus aureus (S. aureus) cultures were reviewed to determine factors associated with fluoroquinolone resistance. RESULTS: Of 734 CNS and S. aureus cultures, 175 (23.8%) were resistant to ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin. Use of fluoroquinolone within 3 months and within 1 year before surgery, topical antibiotic use other than fluoroquinolone, systemic antibiotic use, recent hospitalization, ocular surgery, intravitreal injection and use of eyedrops containing benzalkonium chloride were significantly more frequent in resistant isolates than in susceptible isolates. In multivariable logistic regression analysis, ocular surgery (odds ratio [OR], 8.457), recent hospitalization (OR, 6.646) and use of fluoroquinolone within 3 months before surgery (OR, 4.918) were significant predictors of fluoroquinolone resistance, along with intravitreal injection (OR, 2.976), systemic antibiotic use (OR, 2.665), use of eyedrops containing benzalkonium chloride (OR, 2.323), use of fluoroquinolone within 1 year before surgery (OR, 1.943) and topical antibiotic use other than fluoroquinolone (OR, 1.673). CONCLUSIONS: Recent topical fluoroquinolone use, hospitalization and ocular surgery were significantly associated with fluoroquinolone resistance in CNS and S. aureus isolates from ocular culture.

Prognostic importance of ultrasound BI-RADS classification in breast cancer patients.

OBJECTIVE: We investigated the prognostic importance of pre-operative Breast Imaging Reporting and Data System classification in ultrasound imaging. METHODS: Histopathological differences and disease-free survival were analyzed in Breast Imaging Reporting and Data System classification subgroups. Univariate and multivariate analyses were used to identify the prognostic factors. RESULTS: We identified 531 invasive breast cancer patients eligible for this study. Most patients classified as Breast Imaging Reporting and Data System 5 had large tumors and a higher rate of lymph node metastasis. However, hormonal receptor or HER-2 status did not differ according to Breast Imaging Reporting and Data System classification. During a median post-operative follow-up of 42.0 months, 43 patients were diagnosed with a disease-specific event. Disease-free survival was significantly lower in patients with Breast Imaging Reporting and Data System 5 than in patients with Breast Imaging Reporting and Data System 3-4. Subgroup analysis of patients with invasive breast cancer of Stage I showed that Breast Imaging Reporting and Data System 5 was an independent negative prognostic indicator of disease-free survival (hazard ratio 9.195; 95% confidence interval, 1.175-71.955; P = 0.035). CONCLUSIONS: Breast Imaging Reporting and Data System classification might be considered as prognostic factors especially in Stage I breast cancer. Further confirmatory studies are needed.

A noble method for intraoperative fine localization during laparoscopic gastric local resection: endoscopic submucosal cutting and light transmission.

BACKGROUND: The main requirements when performing laparoscopic local resection for early mucosal tumors of the stomach are a clearly defined cancer-free margin and precise tumor localization. In this study, a novel method for precise intraoperative tumor localization and appropriate resection in a porcine model is introduced: endoscopic submucosal cutting and light transmission (ESCLT). METHODS: A total of 15 cases of laparoscopic local resection were performed in 6 pigs. The size of the target lesions was approximately 20 mm. The imaginary lesions were located in the high body anterior wall, posterior wall, lower body posterior wall, angle, and antrum anterior wall of the stomach. Mucosal marking around the lesions, mucosal precutting surrounding the marking, and submucosal cutting along the precutting line using white light endoscopy were sequentially performed. Next, an endoscopic light source was placed directly in front of the lesion. Exact oval-shaped submucosal cutting margins were identified via laparoscopy. Laparoscopic local resection was performed after the minimal distance from the stapler line to the submucosal cutting line was confirmed. The sizes of the mucosal marking, submucosal cutting line, and the entire resected mucosa and serosa were measured. RESULTS: The procedure was completed successfully in all pigs. Local resection was completed on all of the lesions. The mean endoscopic and laparoscopic procedure times were 26.1 and 12.7 min, respectively. The mean size of the resected specimens was: (i) marking lesion, 22 × 19.5 mm; (ii) submucosal cutting line, 26.7 × 23.2 mm; (iii) entire resected mucosa, 37 × 31 mm; and (iv) entire resected serosa, 41.7 × 33.1 mm. There was no intraoperative morbidity. CONCLUSION: ESCLT provides a precise and useful method of intraoperative tumor localization during laparoscopic local resection of the stomach in terms of minimizing the resection of normal stomach tissue and guaranteeing adequate mucosal safety margins.