Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer

Purpose@#Cancer patients receiving various anti-cancer treatments commonly experience malnutrition, and many studies have reported that nutritional status is associated with survival and prognosis. Although standard neoadjuvant chemoradiotherapy (CRT) is commonly used in patients with locally advanced rectal cancer owing to its tumor-downsizing and downstaging effects, there is a lack of research on the impact of patients’ nutritional status on the efficacy of neoadjuvant CRT. @*Methods@#We investigated the immunonutritional markers before and after long-course neoadjuvant CRT in 131 patients diagnosed with locally advanced rectal cancer from March 2013 to March 2022. @*Results@#We divided the patients into two groups: a low prognostic nutritional index (PNI) with a cutoff value of 50.92, and a high PNI. In both groups, significant decreases in lymphocyte count and PNI and an increase in neutrophil-to-lymphocyte ratio (NLR) were observed before and after CRT (P<0.001). Furthermore, a higher proportion of patients experienced adverse effects in the low PNI group than in the high PNI group (76.6% in low PNI vs. 54.8% in high PNI, P=0.013). The most commonly reported CRT-induced adverse effect was lower gastrointestinal tract toxicity. @*Conclusion@#By measuring the PNI and NLR without additional tests prior to starting neoadjuvant CRT in patients with locally advanced rectal cancer, it is possible to predict the risk of acute adverse effects caused by CRT. Additionally, providing external nutritional support to reduce the immunonutritional changes that occur during CRT can decrease side effects and potentially increase treatment compliance.

Clinical relevance and prognostic role of preoperative cell-free single-stranded DNA concentrations in colorectal cancer patients

Purpose@#Circulating cell-free single-stranded DNA (ccf-ssDNA) is extracellular DNA and it is a useful biomarker for the diagnosis of tumors and predicting the prognosis of tumors. However, the clinical usefulness of ccf-ssDNA in colorectal cancer (CRC) is not well known. Thus, the purpose of this study was to investigate the clinical usefulness of ccf-ssDNA in CRC. @*Methods@#The study was conducted on 44 patients who had undergone surgery for CRC, and ccf-ssDNA level was measured before surgery and statistical analysis was performed on clinical factors. @*Results@#The association between ccf-ssDNA level and clinicopathological factors was analyzed and compared, and these factors included age, sex, body mass index, diabetes mellitus, hypertension, tumor markers (carcinoembryonic antigen and carbohydrate antigen 19-9), tumor location, size, stage (TNM), recurrence, and death. The group with a ccf-ssDNA level of ≥ 7.5 ng/μL had a lower age (P = 0.010), and was associated with diabetes mellitus (P = 0.037) and lymph node metastasis (P = 0.049). Multivariate analysis of disease-free survival showed that lymph node metastasis and ccf-ssDNA level (hazard ratio, 10.011; 95% confidence interval, 2.269–44.175; P = 0.002) were independent prognostic factors for recurrence. In terms of overall survival, there were no statistically significant results except for vascular invasion. @*Conclusion@#This study showed that ccf-ssDNA level in plasma in CRC patients was an independent prognostic factor that could predict recurrence non-invasively. In this regard, further evaluation with a prospective, large sample size study will be needed to obtain additional results.

Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer

PURPOSE: To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.METHODS: This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.RESULTS: The mean age was 21.3 years (8–44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.CONCLUSIONS: Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.

Serial Culture of Eyedrops: Room Temperature vs. under Refrigeration

Purpose@#We investigated the serial culture of multiuse eye drops applied by medical personnel by intentionally touching the tip of the bottle. @*Methods@#Ten different unpreserved and preserved eye drops including eye drops for allergies, artificial tears, antibiotics, and corticosteroids were included. One bottle was stored at room temperature and the other bottle stored under refrigeration. The experimenter intentionally touched the tip of the bottle with a finger twice daily. The first culture test was performed 2 weeks after contamination and the culture were performed six times; 2 weeks apart. @*Results@#Contamination was noted in three types of eye drops (artificial tears without preservatives, corticosteroids, and anti-allergic eye drops) under refrigerated conditions and four types of eye drops (artificial tears without preservatives, artificial tears with preservatives, corticosteroids, and anti-allergic eye drops) under room temperature conditions. The contamination in 13 eye drops was attributable to five microbial species: Staphylococcus epidermidis (m/c), Staphylococcus hominis, Rhodotorula sp., Corynebacterium sp., and Bacillus sp. Under refrigerated conditions, three eyedrop bottles were contaminated, with five positive cultures in 12 weeks. However, at room temperature, four eye drop bottles were contaminated with eight positive cultures. The culture results changed according to culture time. In some cases, the same result was obtained 2 weeks after the first positive culture but in other cases the result was negative or one of two strains disappeared. @*Conclusions@#Eye drops can be contaminated under both room temperature and refrigerated conditions. We should consider serial culture for eye drops because the culture results could be variable according to time.

The Clinical Characteristics of Spontaneous Separated Idiopathic Epiretinal Membrane

PURPOSE@#To investigate the clinical characteristics of spontaneous separation of idiopathic epiretinal membrane (ERM) patients without any surgical treatment.@*METHODS@#Retrospective medical records analysis was performed for patients with spontaneous separation of the idiopathic ERM without treatment. The patients' age, average time until ERM separation, best-corrected visual acuity (BCVA), refractive error, intraocular pressure (IOP), optical coherence tomography (OCT) data, central macular thickness (CMT), and the presence of posterior vitreous detachment (PVD) were evaluated and recorded.@*RESULTS@#Twenty-two eyes of 22 patients were included in the study. The mean age of patients was 52.0 ± 8.6 years, and the average time until ERM separation was 14.1 ± 16.2 months. The average BCVA (logMAR) was 0.12 ± 0.12 before separation and improved (p = 0.032) to 0.07 ± 0.08 after separation. The average CMT before separation was 386.1 ± 63.2 µm, after separation, the average CMT decreased (p < 0.001) to 299.1 ± 46.7 µm. The differences in IOP and refractive error before and after ERM separation were not statistically significant. Not all patients experienced PVD before ERM separation, however, they all showed PVD after the separation.@*CONCLUSIONS@#ERM patients of a relatively young age and without PVD showed spontaneous separation of the ERM and improved visual acuity with PVD, which suggests that ERM could be improved through conservative observation without surgery.

The Clinical Course of Superior Oblique Tuck Surgery in Patients with Unilateral Superior Oblique Palsy

PURPOSE: To evaluate the effects of surgery depending on the follow-up duration after superior oblique tuck was performed as the first surgery in unilateral superior oblique palsy patients. METHODS: Sixteen patients who were followed-up for a minimum of 3 months were retrospectively evaluated. The vertical deviation, abnormal head posture, superior oblique underaction, and inferior oblique overaction were evaluated before and at 3, 6, and 12 months after the surgery and at the last follow-up. The angle between the center of the optic disc and fovea (disc-fovea angle) was measured using fundus photography to investigate changes in ocular torsion. RESULTS: The mean follow-up period was 24.9 ± 21.9 months and the mean tuck was 11.4 ± 4.0 mm. Vertical deviation <7 prism diopters in the primary position was observed in 53.9% of patients at 3 months postoperatively, 50.0% at 6 months, 83.3% at 12 months, and 62.5% at the last follow-up (p = 0.55). Head posture was improved in 66.7% of patients at 3 months, 71.4% at 6 months, 50% at 12 months, and 80% at the last follow-up after surgery (p = 0.73). Ocular torsion was decreased in 37.5% of patients at 3 months postoperatively, 66.7% at 6 months, 75% at 12 months, and 80.0% at the last follow-up (p = 0.11). Superior oblique underaction was improved in 100%, 77.8%, 60%, and 75% of the patients and inferior oblique overaction was improved in 100%, 88.9%, 85.7%, and 81.3% of the patients at postoperative month 3, 6, and 12, and at the last follow-up, respectively. CONCLUSIONS: Superior oblique tuck resulted in the maintenance of an improved condition of patients at 3, 6, and 12 months postoperatively, and there was no significant difference in motor measurements between the follow-up periods.

Clinical relevance of Lgr5 expression in colorectal cancer patients

PURPOSE: Lgr5 is a well-known stem cell marker in colorectal cancer (CRC). This retrospective study evaluated the expressions of Lgr5 in CRC specimens, and examined whether these expressions were associated with survival outcomes.METHODS: We used immunohistochemistry to retrospectively examine expressions of Lgr5 in paraffin-embedded specimens from 337 patients with CRC between January 2009 and December 2013. All clinicopathologic data were collected by retrospective review based on medical records. The correlation between its expression and clinicopathological data as well as clinical outcomes of patients was analyzed.RESULTS: Low expression and high expression of Lgr5 in 337 patients were 175 (51.9%) and 162 (48.1%), respectively. There was no statistically significant difference in the association of Lgr5 expression with clinicopathologic factors (age, tumor location, lymphatic invasion, vascular invasion, perineural invasion, TNM stage, and differentiation). In the survival analysis, the high expression group of Lgr5 showed a better prognosis than the low expression group in disease-free survival (P=0.044). However, overall survival was not significantly different between the two groups (P=0.087). In multivariate analysis, we found that high expression of Lgr5 was independent prognostic factor for tumor relapse (hazard ratio, 0.601; 95% confidence interval, 0.388–0.929; P=0.022).CONCLUSION: In present study, high expression of Lgr5 is an independent predictor of favorable prognosis in patients with CRC. So, further well designed, prospective, large scale studies are needed to examine the value of Lgr5 as a prognostic biomarker for CRC.

Association Between c-Met and Lymphangiogenic Factors in Patients With Colorectal Cancer

PURPOSE: Animal models show a strong relationship between lymphangiogenesis and lymph node metastasis. However, the clinical significance of lymphangiogenesis in patients with colorectal cancer (CRC) remains uncertain. This study aimed to evaluate the association between c-Met and lymphangiogenic factors and to elucidate the prognostic significance of c-Met in patients with CRC. METHODS: A total of 379 tissue samples were obtained from surgically resected specimens from patients with CRC at Soonchunhyang University Cheonan Hospital between January 2002 and December 2010. The expressions of c-Met, vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGF receptor (VEGFR)-3, and podoplanin were examined using immunohistochemistry. The expression of c-Met and clinical factors were analyzed. RESULTS: Of the 379 tissues, 301 (79.4%) had c-Met expression. High expression of c-Met in tumor cells was significantly associated with high expression of VEGF-C (P < 0.001) and VEGFR-3 (P = 0.001). However, no statistically significant association with podoplanin (P = 0.587) or VEGF-D (P = 0.096) was found. Of the 103 evaluable patients, expression of c-Met in tumor cells was significantly associated with advanced clinical stage (P = 0.020), positive lymph node status (P = 0.038), and high expression of VEGF-C (P = 0.020). However, no statistically significant association with podoplanin (P = 0.518), VEGFR-3 (P = 0.085), VEGF-D (P = 0.203), or overall survival (P = 0.360) was found. CONCLUSION: Our results provide indirect evidence for an association and possible regulatory link of c-Met with the lymphangiogenic markers, but c-Met expression in patients with CRC is not a prognostic indicator for overall survival.

Programmed death-1 (PD-1) ligand 1 and PD-1 ligand 2 expressions and their clinical relevance in colorectal cancer

PURPOSE: Programmed death-1 and its ligands (PD-L1 and PD-L2) can induce T-cell apoptosis in many solid tumors, although there is limited information regarding their roles in colorectal cancer.METHODS: We used immunohistochemistry to retrospectively examine expressions of PD-L1 and PD-L2 in paraffin-embedded specimens from 104 patients with colorectal cancer.RESULTS: Among the 104 included patients, 31 patients (29.8%) had positive PD-L1 expression and 73 patients (70.2%) had negative PD-L1 expression. Positive PD-L2 expression was observed in 83 patients (79.8%) and negative PD-L2 expression was observed in 21 patients (20.2%). Positive PD-L1 expression group showed higher overall survival rate (OS) and disease-free survival (DFS) than negative PD-L1 expression group. However, the overall survival and DFS were not significantly different between positive and negative PD-L2 expressions group. The multivariate analyses revealed that short OS was independently associated with positive PD-L1 expression (hazard ratio [HR], 2.781; 95% confidence interval [CI], 1.284–6.026; P=0.01), regional lymph node status (HR, 2.611; 95% CI, 1.258–5.418; P=0.01), and distant metastasis (HR, 4.279; 95% CI, 1.449–12.638; P=0.009). In addition, short DFS was independently associated with positive PD-L1 expression (HR, 2.846; 95% CI, 1.393–5.815; P=0.004) and regional lymph node status (HR, 2.310; 95% CI, 1.122–4.758; P=0.023).CONCLUSION: Although prospective multi-center studies are needed to validate our findings, we found that PD-L1 expression predicted OS and DFS among patients with colorectal cancer.

Anti-Proliferative Effects of Rutin on OLETF Rat Vascular Smooth Muscle Cells Stimulated by Glucose Variability

PURPOSE: Proliferation of vascular smooth muscle cells (VSMCs) plays a crucial role in atherosclerosis. Rutin is a major representative of the flavonol subclass of flavonoids and has various pharmacological activities. Currently, data are lacking regarding its effects on VSMC proliferation induced by intermittent hyperglycemia. Here, we demonstrate the effects of rutin on VSMC proliferation and migration according to fluctuating glucose levels. MATERIALS AND METHODS: Primary cultures of male Otsuka Long-Evans Tokushima Fatty (OLETF) rat VSMCs were obtained from enzymatically dissociated rat thoracic aortas. VSMCs were incubated for 72 h with alternating normal (5.5 mmol/L) and high (25.0 mmol/L) glucose media every 12 h. Proliferation and migration of VSMCs, the proliferative molecular pathway [including p44/42 mitogen-activated protein kinases (MAPK), mitogen-activated protein kinase kinase 1/2 (MEK1/2), p38 MAPK, phosphoinositide 3-kinase (PI3K), c-Jun N-terminal protein kinase (JNK), nuclear factor kappa B (NF-kappaB), and Akt], the migratory pathway (big MAPK 1, BMK1), reactive oxygen species (ROS), and apoptotic pathway were analyzed. RESULTS: We found enhanced proliferation and migration of VSMCs when cells were incubated in intermittent high glucose conditions, compared to normal glucose. These effects were lowered upon rutin treatment. Intermittent treatment with high glucose for 72 h increased the expression of phospho-p44/42 MAPK (extracellular signal regulated kinase 1/2, ERK1/2), phospho-MEK1/2, phospho-PI3K, phospho-NF-kappaB, phospho-BMK1, and ROS, compared to treatment with normal glucose. These effects were suppressed by rutin. Phospho-p38 MAPK, phospho-Akt, JNK, and apoptotic pathways [B-cell lymphoma (Bcl)-xL, Bcl-2, phospho-Bad, and caspase-3] were not affected by fluctuations in glucose levels. CONCLUSION: Fluctuating glucose levels increased proliferation and migration of OLETF rat VSMCs via MAPK (ERK1/2), BMK1, PI3K, and NF-kappaB pathways. These effects were inhibited by the antioxidant rutin.

Surgical Timing of Treating Adult Trauma: Emergency/Urgency

No abstract available.

Clinicopathologic Analysis of Papillary Thyroid Cancer with or without Hashimoto's Thyroiditis / 대한내분비외과학회지

PURPOSE: The causal association between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) remains controversial. This research attempted to analyze clinicopathological relationships between HT and PTC, and to determine what influence the former has on the latter. METHODS: We retrospectively reviewed 773 patients who underwent thyroid surgery with PTC. These patients were divided into two groups, coexistent HT group and PTC alone group, and the clinicopathologic data were analyzed. RESULTS: Out of 773 patients, the coexistent HT group included 269/773 (34.8%) patients and the control group included 504/773 (65.2%) patients. In comparison of these two groups, there were no significant differences in age, extent of surgery, serum T3, Free T4, number of tumors, multifocality, tumor size, extrathyroidal extension, and lymph node metastasis. In sex, women were at the higher rate in coexistent HT group than in the control group (P=0.008). Serum TSH level was higher in the coexistent HT group (P<0.001). In addition, using the AMES scoring system, the coexistent HT group showed a significantly higher rate of low risk than the control group (P=0.048). Multivariate analysis showed no significant association between HT and lymph node metastasis (P=0.081, odds ratio=1.335; 95% CI, 0.965~1.847). CONCLUSION: The rate of women and serum TSH level were higher in the coexistent HT group. In addition, the low-risk group showed the higher rate in the case of accompanying HT, and though the HT does not affect the lymph node metastasis but much more researches would be needed on that.

Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients: Minimum 2-Years Follow-up Results

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.

Comparison of Conventional and Digital Templating Technique in Total Hip Arthroplasty

PURPOSE: To examine the effectiveness of digital templating in patients who underwent primary total hip arthroplasty by comparing and analyzing the accuracy of acetate and digital templating. MATERIALS AND METHODS: One hundred and nine patients who underwent primary total hip arthroplasty between November 2002 and May 2006 were assigned to the acetate templating group (group I), and 113 patients between June 2006 and April 2009 were assigned to the digital templating group (group II). The sizes of the acetebular cup and femoral stem were examined to determine the accuracy of each method. RESULTS: In group I, acetabular cup accuracy was found in 46.8% of cases, and 94.5% showed a mismatch less than +/- 1 sizes. In the case of the femoral stem, accuracy was found in 53.2% and 92.7% showed a mismatch. In group II, acetebular cup accuracy was observed in 43.4% of cases, and 92.9% showed a mismatch below +/- 1 size. In femoral stem cases, 46.9% were accurate and 93.8% showed a mismatch. CONCLUSION: The accuracy of the digital templating method is equivalent to that of acetate templating, and should replace acetate templating before the operation.

Clinical and Radiologic Results of Transtibial Single Bundle Reconstruction and Double Bundle Reconstruction of the Posterior Cruciate Ligament Using the Allo-achilles Tendon / 대한정형외과학회잡지

PURPOSE: We performed transtibial single and double bundle reconstruction of the posterior cruciate ligament using the allo-achilles tendon and compared the results of single bundle reconstruction and double bundle reconstruction both clinically and radiologically. MATERIALS AND METHODS: This study included 41 cases of posterior cruciate ligament reconstruction between February 2000 and June 2007 that had data available for at least 2 years of follow-up. Twenty-two cases (53.7%) underwent single bundle reconstruction and 19 cases (46.3%) underwent double bundle reconstruction. Clinical results were analyzed by Lysholm score and IKDC standards scale, and the radiologic results were analyzed by the Telos(R) posterior translation test. RESULTS: The average Lysholm score at last follow-up was 85.4+/-4.7 in the single bundle group and 87.5+/-5.1 in the double bundle group. IKDC scores were grade A in 4 (18.2%), grade B in 14 (63.6%) and grade C in 4 (18.2%) in the single bundle group; they were 1 (15.3%), 15 (78.9%) and 3 (15.8%) in the double bundle group. Telos(R) posterior translation test scores were 5.06 mm (3.04-7.43 mm) in the single bundle group, and 4.04 mm (2.18-7.20 mm) in the double bundle group. There was significant improvement in clinical and radiological scores in both groups (p0.05). CONCLUSION: Further study with longer term follow-up is needed.

Efficiency of Anterior Interbody Fusion using Cage Packed with DBM in the Distractive Flexion Injury of Cervical Spine: Demineralized Bone Matrix vs Autoiliac Cancellous Bone

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine. SUMMARY OF LITERATURE REVIEW: AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment. MATERIALS AND METHODS: We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II). RESULTS: All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups. CONCLUSIONS: AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.