Association between D-Dimer Levels and the Prognosis of Terminal Cancer Patients in the Last Hours of Life.

Purpose: D-dimer levels are known to be associated with poor outcomes in patients with various cancers, but their significance at the end of life remains unclear. This study investigated D-dimer levels as a prognostic indicator for terminal cancer patients in the last hours of life. Methods: The retrospective study was conducted at a palliative care unit of a tertiary cancer center, using a database to analyze the records of patients treated from January 1, 2010 to December 31, 2018. In total, 67 terminal cancer patients with available data on D-dimer levels were included. Patients' demographic data, clinical information, and laboratory values, including D-dimer levels, were collected. Survival was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional-hazards model was used to identify prognostic factors of poor survival. Results: The most common site of cancer was the lung (32.8%) and the median survival time was 5 days. Most laboratory results, particularly D-dimer levels, deviated from the normal range. Patients with high D-dimer levels had a significantly shorter survival time than those with low D-dimer levels (4 days vs. 7 days; P=0.012). In the Cox regression analysis, only a high D-dimer level was identified as a predictor of a poor prognosis (hazard ratio, 1.83; 95% confidence interval, 1.09~3.07). Conclusion: Our results suggest that at the very end of life, D-dimer levels may serve as a prognostic factor for survival in cancer patients.

Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy.

OBJECTIVES: The purpose of this prospective observational study is to evaluate the relation of the comprehensive geriatric assessment (CGA) to tolerability and survival of multi-agent chemotherapy for curative intent in elderly patients with aggressive non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS: Patients who were 1) age ≥65 years, 2) newly diagnosed aggressive NHL, and 3) treated with multi-agent chemotherapy within 2 weeks from the time of diagnosis were enrolled from January 2011 to June 2014. Baseline clinical, laboratory, and CGA data being composed of Mini Nutritional Assessment-Short Form (MNA-SF), Korean version of Mini Mental Status Exam, Korean-Geriatric Depression Scale, and Groningen Frailty Index (GFI), were collected and analyzed for the relation to the outcome factors. RESULTS: Seventy patients were included; the median age was 73.5 years, 27 (38.6%) patients were Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 or more, and half of the patients were high or high-intermediate risk by age-adjusted international prognostic index (aaIPI). Most patients received CHOP or CHOP-like chemotherapy. Factors affecting discontinuation of chemotherapy within 12 weeks were poor MNA-SF, poor GFI, poor PS, and presence of B symptom. Among those, poor MNA-SF was independent of other variables in multivariate analysis. Poor MNA-SF, bone marrow involvement, and baseline anemia of hemoglobin<10g /dL were found to be independent factors associated with inferior overall survival whereas aaIPI factors were not. CONCLUSION: MNA-SF predicted tolerability to multi-agents chemotherapy and overall survival in elderly patients with aggressive NHL who were treated with multi-agent chemotherapy.

Relationships between serum osteocalcin, leptin and the effect of weight loss by pharmacological treatment in healthy, nonsmoking Korean obese adults.

BACKGROUND: Recent studies have reported a relationship between osteocalcin (OC) levels and factors associated with energy metabolism and insulin resistance. As any detailed understanding of OC mechanisms still remains elusive, this study aimed at revealing a correlation between serum OC levels and obesity in healthy, nonsmoking, Korean obese adults who had undergone weight loss through pharmacological treatment. METHODS: 119 healthy, nonsmoking, Korean obese adults were investigated at 3 months following weight loss through pharmacological treatment. Serum OC, leptin, HOMA score, ghrelin, visceral fat mass, total body fat, and BMI were measured. RESULTS: Increase in serum OC was significantly associated with decreases in: BMI (and weight change %) (r=-0.209, p=0.023), visceral fat mass (r=-0.189, p=0.049), HOMA (r=-0.203 p=0.027), and leptin (r=-0.253 p=0.006), but not with changes in adiponectin (r=+0.029, p=NS), and Ghrelin (r=+0.019, p=NS). Decrease in leptin (ß=-0.280, p=0.002) was significantly associated with an increase in serum OC, after pharmacological weight loss treatment was adjusted for age, sex, drug type, and BMI (or visceral fat mass). CONCLUSIONS: Serum OC was significantly increased at 3 months after pharmacological weight loss. We further found that leptin levels were associated with changes in serum OC. These findings suggest a relationship between bone and adipose tissue.

Trans-placental transfer of thirteen perfluorinated compounds and relations with fetal thyroid hormones.

While the results of animal studies have shown that perfluorinated compounds (PFCs) can modulate concentrations of thyroid hormones in blood, limited information is available on relationships between concentrations of PFCs in human blood serum and fetal thyroid hormones. The relationship between concentrations of PFCs in blood and fetal thyroid hormone concentrations or birth weight, and ratios of major PFCs between maternal and fetal serum were determined. Concentrations of PFCs were measured in blood serum of pregnant women (n = 44), fetal cord blood serum (n = 43) and breast milk (n = 35). Total concentrations of thyroxin (T4), triiodothyronin (T3) and thyroid stimulating hormone (TSH) in blood serum were also quantified. The ratios of major PFCs in maternal versus fetal serum were 1:1.93, 1.02, 0.72, and 0.48 for perfluorotridecanoic acid (PFTrDA), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorooctane sulfonate (PFOS), respectively. Fetal PFOS, PFOA, PFTrDA and maternal PFTrDA were correlated with fetal total T4 concentrations, but after adjusting for major covariates, most of the relationships were no longer statistically significant. However, the significant negative correlations between maternal PFOS and fetal T3, and maternal PFTrDA and fetal T4 and T3 remained. Since thyroid hormones are crucial in the early development of the fetus, its clinical implication should be evaluated. Given the observed trans-placental transfer of PFCs, efforts should be also made to elucidate the exposure sources among pregnant women.

The relationship between normal serum uric acid and nonalcoholic fatty liver disease.

The objective of the present study was to determine the relationship between serum uric acid (SUA) level and the presence of nonalcoholic fatty liver disease (NAFLD). We analyzed data of 9,019 Koreans who visited a health check up center. The SUA levels of all of these subjects were within the normal range. The participants were divided into 4 groups according to the quartiles of the SUA levels for both sexes. Hepatic steatosis was diagnosed on the basis of ultrasonographic findings. Multivariate logistic regression modeling was performed across the SUA quartiles. The presence of NAFLD and metabolic abnormalities were found significantly in subjects with high-normal SUA levels. After adjustment for age, metabolic components, and the liver-function test, the adjusted odds ratio (OR, 95% CIs) for the presence of NAFLD in the subjects with the highest SUA level was 1.46 (1.17-1.82) for men and 2.13 (1.42-3.18) for women, as compared to the subjects with the lowest SUA level. Our results suggest that increased SUA concentrations, even within the normal range, are independently associated with the presence of NAFLD.

A comparison of predictability of cardiovascular events between each metabolic component in patients with metabolic syndrome based on the revised National Cholesterol Education Program criteria.

PURPOSE: The prevalence of metabolic syndrome (MetS) generally varies depending on its diagnostic definition, and many different definitions inevitably lead to substantial confusion and lack of comparability between studies. Despite extensive research, there is still no gold standard for the definition of MetS, which continues to be a matter of debate. In this study, we investigate whether and to what extent its individual components are related to the risk of cardiovascular disease (CVD) in Korean population. MATERIALS AND METHODS: We used data from the 2005 Korea National Health and Nutrition Examination Survey, which is a nationally representative survey of the noninstitutionalized civilian population. The study sample consisted of 1,406 Korean adults (587 men, 819 women) who were diagnosed with MetS based on the revised National Cholesterol Education Program (NCEP) criteria. Central obesity is defined as a waist circumference cutoff point reported in Asia-Pacific criteria for obesity based on waist circumference by the World Health Organization. CVD was defined as presence of stroke, myocardial infarction, or angina pectoris on a medical history questionnaire. RESULTS: The CVD prevalence among the subjects was 6.8% for men and 8.6% for women. Besides age, the components of MetS showing a significant difference in the number of CVD events were high fasting glucose (FG) in men and high blood pressure (BP) and high FG in women. After adjusting for gender and age, high FG was shown to yield a significant difference (odds ratio: unadjusted 2.08, adjusted 1.81), alone among all MetS components. However, after adjusting for only age, no significant difference was found. CONCLUSION: Fasting glucose level is the highest predicting factor for CVD in Korean patients with MetS based on the revised NECP definition.

Infravesical obstruction due to benign intraurethral prostatic cyst.

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.