[Prognostic value of skeletal muscle measured by CT at the T4 level in advanced EGFR-positive non-small cell lung cancer patients treated with ecotinib].

Objective: To investigate the prognostic value of skeletal muscle measured by CT at the level of the fourth thoracic vertebra (T4) in advanced epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC) patients treated with ecotinib. Methods: The study retrospectively reviewed clinical and pathological characteristics of 176 patients with advanced EGFR-positive NSCLC who received ecotinib and underwent chest CT scans at Wuhan Union Hospital between January 2017 and October 2020. Among them, 70 were male and 106 were female, with ages ranging from 27 to 80 (58.6±10.6) years. As of August 21, 2021, the median follow-up duration was 19.2 months (95%CI: 15.3 to 23.7 months). The optimal cut-off value of skeletal muscle density (T4-SMD) on CT images at the T4 level were determined using X-tile software. Kaplan-Meier analysis and log-rank test were used to plot progression-free survival curves. Cox proportional hazards regression models were employed to analyze factors influencing 1-year progression-free survival (PFS), and a nomogram prognostic model was constructed accordingly. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were utilized to evaluate the predictive value of the nomogram. Results: The T4-SMD [M (Q1,Q3)] of 176 patients was 42.56 (37.05, 45.93) HU. Patients were divided into low T4-SMD group (n=122) and high T4-SMD group (n=54) based on the cut-off value (The values for males and females were 49.44 and 41.41 HU, respectively) of T4-SMD. The median PFS time and 1-year PFS rate in the low T4-SMD group were significantly lower than those in the high T4-SMD group [10.4 (95%CI: 9.3-11.8) vs 13.7 (95%CI: 11.1-18.5) months, 36.1% vs 59.3%, respectively, P=0.034]. Eastern Cooperative Oncology Group performance status (HR=3.308, 95%CI: 1.183-9.247, P=0.023), lactate dehydrogenase level (HR=1.852, 95%CI: 1.037-3.307, P=0.037), systemic immune-inflammation index (HR=1.772, 95%CI: 1.019-3.080, P=0.043), and T4-SMD (HR=0.563, 95%CI: 0.325-0.974, P=0.040) were prognostic factors for 1-year PFS in advanced EGFR-positive NSCLC patients treated with ecotinib. A nomogram for predicting 1-year PFS of advanced EGFR-positive NSCLC patients treated with ecotinib was constructed based on the four indicators selected by multivariate Cox regression analysis. The area under the ROC curve of the nomogram was 0.775 (95%CI: 0.676-0.874). The calibration curve showed good consistency between the predicted and actual 1-year PFS. DCA demonstrated good clinical prediction effectiveness of the nomogram. Conclusion: Low T4-SMD is a prognostic risk factor for patients with advanced EGFR-positive NSCLC receiving icotinib therapy.

Associations between osteoporosis and coronary artery disease in postmenopausal women.

OBJECTIVE: Coronary artery disease (CAD) and osteoporosis are major causes of mortality and morbidity in postmenopausal women. We aimed to investigate the association between osteoporosis and CAD in asymptomatic postmenopausal women at a single center. METHODS: This study included 863 postmenopausal women without histories of cardiovascular diseases who visited the Health Promotion Center from June 1, 2004 to May 31, 2015. All subjects were screened for bone mineral density (BMD) by dual-energy X-ray absorptiometry and for the degree of CAD by multidetector computed tomography. RESULTS: Low BMD including osteopenia and osteoporosis was found to be significantly associated with old age, low body mass index, and a higher prevalence of diabetes mellitus. The incidences of CAD including a high coronary artery calcium score (≥100), obstructive coronary artery disease, and multivessel disease were significantly higher in subjects with low BMD. After adjusting for age and cardiovascular risk factors, osteoporosis was associated with a high coronary artery calcium score (p = 0.015) and with obstructive coronary artery disease (p = 0.002). There was a trend toward significance with multivessel disease (p = 0.052). CONCLUSIONS: High coronary artery calcium score and obstructive coronary artery disease, as revealed by multidetector computed tomography, were associated with osteoporosis in asymptomatic postmenopausal women, independent of cardiovascular risk factors and age.

Elevated serum antibodies against insulin-like growth factor-binding protein-2 allow detecting early-stage cancers: evidences from glioma and colorectal carcinoma studies.

BACKGROUND: Tumor-specific immunity of insulin-like growth factor-binding protein-2 (IGFBP-2) has been reported in several cancers. We aimed to assess the role of serum IGFBP-2 antibodies (IGFBP-2 Abs) in early cancer detection. PATIENTS AND METHODS: Glioma and colorectal carcinoma (CRC) were used as models. Serum IGFBP-2 and IGFBP-2 Abs were measured in 260 tumor patients (145 gliomas, 45 colorectal polyps, and 70 CRCs) and 141 controls. Receiver operating characteristic curves were applied. RESULTS: Serum IGFBP-2 Ab levels were significantly elevated in tumors (mean: 82 ng/ml, median: 17 ng/ml, range: 0-1387 ng/ml) compared with controls (11, 0, 0-212 ng/ml) (P < 0.0001) and higher in early than advanced cancers opposite of serum IGFBP-2 levels. IGFBP-2 Abs effectively discriminated between controls and grade II and III gliomas [area under the curve (AUC): 0.821-0.864; 95% confidence interval (CI) = 0.762-0.936; P < 0.0001], and CRC I-II (AUC: 0.668; 95% CI = 0.566-0.770; P = 0.002) as well as indicative of advanced polyps at high risk of CRC (AUC: 0.72; 95% CI = 0.630-0.811; P < 0.0001). The sensitivity and specificity for diagnosing grade II-III gliomas reached 66%-84% and 81%. Combined serum IGFBP-2 and IGFBP-2 Abs augmented the discriminative power of all stage tumors (AUC: 0.823), gliomas (AUC: 0.800), and CRCs (AUC = 0.917). CONCLUSION: Our results first demonstrate IGFBP-2 Abs for early cancer detection and in combination of serum IGFBP-2 for improved cancer diagnosis.

Associations between Hair Mineral Concentrations and Skeletal Muscle Mass in Korean Adults.

OBJECTIVES: Muscle health plays an important role in maintaining function and independence in the elderly, and some nutrients provide protection against the age-related decline of muscle strength and function. Minerals are important nutrients that may contribute to the prevention and treatment of sarcopenia, but they have not been well-studied. This study investigated whether hair mineral concentrations differ between subjects with low muscle mass (LMM) and subjects with normal muscle mass. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 232 adults ≥ 20 years of age who visited the Health Promotion Center of the University Hospital in Gyeonggi-do, Republic of Korea. MEASUREMENTS: The data from 232 subjects were analyzed and divided into LMM and normal groups based on the appendicular skeletal muscle mass index (ASMI) (LMM was defined as ASMI < 7.0 kg/m2 in men and < 5.7 kg/m2 in women). Skeletal muscle mass was estimated using a multi-frequency bioelectrical impedance analysis (BIA) device with a body composition analyzer. RESULTS: Overall mean age of participants was 50.4±11.6 years (29.7% women). Subjects with LMM showed significantly lower triglyceride levels, greater high-density lipoprotein cholesterol levels, and lower body mass index (BMI), compared with subjects who had normal muscle mass. No significant differences in hair mineral concentrations were observed between subjects with LMM and subjects with normal muscle mass, with the exception of copper. Hair copper concentrations were significantly greater in subjects with LMM than in subjects with normal muscle mass after adjustment for covariates and factors (65.7±14.2 vs 33.1±4.3 µg/g, P = 0.035). CONCLUSION: These results suggest that hair mineral status may play a role in the development of LMM. Therefore, further studies with larger numbers of subjects are required to identify the effects of mineral imbalances, their relationships with sarcopenia, and the differences between subjects with LMM and subjects with normal muscle mass.

Radiological evaluation of temporal bone surgical landmarks for a transcanal transpromontorial approach to the internal auditory canal using three-dimensional computed tomography.

OBJECTIVE: This study aimed to analyse a three-dimensional transcanal transpromontorial approach to the internal auditory canal using three-dimensional computed tomography. METHOD: This study was a retrospective investigation of 48 ears of 24 patients using three-dimensional reconstruction data from normal temporal bone computed tomography. The inner structures of the temporal bone were three-dimensionally reconstructed. Eight points were marked in the three-dimensional object with reference to the axial, coronal and sagittal plane images of the computed tomography scans. Distances and angles to each point were measured from the oval and round windows. RESULTS: The point of the facial nerve from the internal auditory canal to the labyrinthine segment could be traced between the cochlear apex and the geniculate ganglion based on the oval window. CONCLUSION: This technique helps with identifying the locations of important surgical landmarks using three-dimensional reconstructions of pre-operative computed tomography scans and to identify the facial nerve from the internal auditory canal during surgery.

Fish oil supplementation improves large arterial elasticity in overweight hypertensive patients.

OBJECTIVES: To observe the effect of fish oil supplementation on arterial elasticity and blood pressure (BP) in overweight hypertensive patients. SUBJECTS AND METHODS: This was a double-blind, randomized and placebo-controlled clinical study, in which 52 overweight hypertensive patients from a community were selected and randomly allocated to two groups (26 in the fish oil group (3 g day(-1), fish oil capsules) and 26 in the placebo group (only capsules). All the subjects were follow-up for 8 weeks. The arterial elasticity was determined by CVProfilor DO-2020 and expressed as elasticity indexes (C(1)-large artery and C(2)-small artery). During the follow-up, totally nine cases were dropped out (three cases from the fish oil group and six cases from the placebo group). RESULTS: After 8 weeks follow-up, the large artery elasticity in the fish oil group, compared with its baseline, was significantly improved (C(1): 15.5+/-1.5 vs 12.8+/-3.7 ml mm Hg(-1) x 10), whereas no effects were found in the placebo group (C(1): 13.0+/-3.4 vs 13.4+/-3.8 ml mm Hg(-1) x 10), P=0.027, RM-ANOVA across the two groups. The small artery elasticity (C(2)), BP and pulse pressure were not found any changes, either in the fish oil group or in the placebo group. At same time, the serum soluble vascular cell adhesion molecule-1(sVCAM-1) and leptin levels, the lipid profile and insulin sensitivity index (ISI) as well, did not show significant differences between two groups. CONCLUSIONS: Fish oil supplementation certainly would improve large arterial elasticity but no effect on BP in overweight hypertensive patients. Further study is needed to confirm the benefits of fish oil supplementation on age-related increases in arterial stiffness.

Exogenous superoxide dismutase prevents peroxynitrite-induced apoptosis in non-heart-beating donor livers.

OBJECTIVE: To investigate the role of oxygen free radicals in the induction of apoptosis in non-heart-beating donor (NHBD) livers, and if superoxide dismutase (SOD) ameliorates these alterations. METHODS: Rat livers were perfused via the portal vein with histidine/tryptophan/alpha-ketoglutarate solution from heart-beating donors (HBD) or 60-min warm ischemia from NHBD, with or without the addition of SOD. After 24 h, cold storage livers were evaluated by isolated reperfusion. RESULTS: NHBD showed significantly higher enzyme leakage and elevated portal venous pressure (PVP) versus HBD. Bile and total adenine nucleotides (TAN) were significantly decreased. Apoptosis was prominent in sinusoidal lining cells, coupled with strong nitrotyrosine staining (NTR). The concentrations of nitric oxide and lipoperoxides were largely increased. SOD medication reduced hepatic enzyme release by 30% and lipoperoxides by nearly 50%. Apoptosis and NTR were significantly decreased, and PVP was strikingly reduced to normal values. A 3-fold enhancement in bile production and 1.5-fold increase in TAN of the liver tissue were also observed. CONCLUSION: NHBD livers are prone to severe reoxygenation injury promoted by oxygen free radicals, massive nitrite oxide production and peroxynitrite-induced apoptosis within the sinusoids. Antioxidant medication with SOD should be considered as a useful means of preserving NHBD livers.

pH-Controllable drug release using hydrogel encapsulated mesoporous silica.

Amine-functionalized mesoporous SBA-15 silica loaded with bovine serum albumin (BSA) has been successfully encapsulated with a thin layer coating of poly(acrylic acid) PAA, with the entrapped BSA being released from the PAA-encapsulated SBA-15 at the higher pH value of 7.4 rather than at the lower pH value of 1.2. This novel drug delivery system has a potential application in the release of protein drug to the site of higher pH value, such as small intestine or colon.

Clinical features and radiological evaluation of otic capsule sparing temporal bone fractures.

OBJECTIVE: To evaluate the clinical and radiological aspects of otic capsule sparing temporal bone fractures. METHODS: Using medical records, 188 temporal bones of 173 patients with otic capsule sparing temporal bone fractures were evaluated. Otoscopic findings and symptoms, facial paralysis, and hearing loss were assessed. RESULTS: Using regional analysis, 7 fractures were classified as type I, 85 as type II, 169 as type III and 114 as type IV. Fourteen of the 17 facial paralysis cases improved to House-Brackmann grade II or lower at an average of 57.6 days after the initial evaluation. Thirty-one patients underwent initial and follow-up pure tone audiometry examinations. The air-bone gap closed significantly from 27.2 dB at an average of 21.8 days post-trauma to 19.6 dB at an average of 79.9 days post-trauma, without the need for surgical intervention. CONCLUSION: Initial conservative treatment for facial paralysis or conductive hearing loss is possible in otic capsule sparing fracture cases after careful evaluation of the patient.

Prevalence of Intracranial Aneurysms in Patients with Aortic Dissection.

BACKGROUND AND PURPOSE: There is an uncertainty about the association between intracranial aneurysms and aortic dissection. We aimed to determine the prevalence of intracranial aneurysms in patients with aortic dissection and evaluate the independent risk factors for the presence of intracranial aneurysms in these patients. MATERIALS AND METHODS: Seventy-one patients with a confirmed aortic dissection who underwent additional brain imaging were enrolled as the aortic dissection group, and 2118 healthy individuals with brain imaging, as controls. Demographic data were obtained from their medical records, including age, sex, comorbidities, and arch vessel involvement of aortic dissection. Two readers reviewed all brain images independently regarding the presence, morphology, size, and location of intracranial aneurysms. Baseline characteristics were compared between the aortic dissection group and controls by propensity score matching, and logistic regression analysis was performed for independent risk factors for the presence of intracranial aneurysms. RESULTS: The prevalence of intracranial aneurysms was 12.96% in the aortic dissection group and 1.85% in controls (P = .022). The mean diameter of intracranial aneurysms was significantly larger in the aortic dissection group (5.79 ± 3.26 mm in aortic dissection versus 3.04 ± 1.57 mm in controls; P = .008), and intracranial aneurysms of >7 mm were also more common in the aortic dissection group (28.6% in aortic dissection versus 5.3% in controls, P = .003). On multivariate analysis, arch vessel involvement of aortic dissection was an independent risk factor for the presence of intracranial aneurysms (odds ratio, 6.246; 95% confidence interval, 1.472-26.50; P = .013). CONCLUSIONS: Patients with aortic dissection have a high prevalence of intracranial aneurysms, and selective screening for brain vessels could be considered in these patients with arch vessel involvement. A further prospective study is needed to demonstrate a substantial prevalence of intracranial aneurysms.

A thermally induced alteration in lysosome membranes: salt permeability at 0 and 37 degrees C.

Preparations of radioactive lysosomes were obtained from mouse kidney after injection of radioactive iodine-labeled bovine ribonuclease. Stability of these lysosomes in various media was estimated from measurements of proteolytic activity towards the ribonuclease, and of ribonuclease retention in particles. The lysosomes were stable at 37 degrees C in isotonic, sucrose-free solutions of KCl, NaCl, and potassium acetate, and in mixtures of these with MgCl2, showing that these salts are relatively impermeant through the lysosomal membranes. The membranes were less permeable to Na+ than to K+. Both KCl and NaCl exerted their optimal protective effects over a broad concentration range above 0.125 M in 0.025 M acetate buffer. Mg2+ enhanced the protective effect of both K4 and Na+; the osmotic effect of 0.075 M NaC1-0.05 M MgCl2 was indistinguishable during the entire course of ribonuclease digestion from that of isotonic sucrose. Osmotic protection by KC1-MgC12 was demonstrated over the H range5.5-7.0. A marked alteration in membrane properties occurs at lower temperatures in 0.11 M KC1-0.01 M MgCl2 such that, at 0 degrees C, K+ permeability is much higher than at 37 degrees C, as shown by a several-fold decrease in stability at the lower temperature.

Enhancing effects of captafol on the development of GST-P-positive liver cell foci in a medium-term bioassay, and protection by L-cysteine of the enhancement in rats.

The modifying effects of captafol and protective effects of L-cysteine on the development of glutathione S-transferase placental form-positive (GST-P +) foci of the liver and expression of proliferating cell nuclear antigen (PCNA) in the kidney were investigated in a medium-term bioassay using D-galactosamine (DGA) in rats. Male 6-week-old F344 rats were initially given a single i.p. injection (200 mg/kg) of diethylnitrosamine (DEN) and after 2 weeks on basal diet, received two i.p. injections of DGA (300 mg/kg) at the ends of weeks 2 and 5, and were fed a diet supplemented with test chemicals for weeks 3-8. Animals in group 1 were given 1500 ppm captafol in the diet, while group 2 received 1500 ppm captafol in diet as well as 1500 ppm L-cysteine in drinking water, animals in control group being given basal diet alone. Positive results regarding increased numbers and areas of GST-P + liver cell foci were obtained in rats treated with captafol alone. On the other hand, significant reduction by L-cysteine in the areas of GST-P + liver cell foci initiated by DEN and promoted by captafol was observed. In addition, the PCNA-labelling indices of renal tubule cells were elevated in rats treated with captafol alone and significantly reduced in rats treated simultaneously with L-cysteine. The protocol used in the present study therefore allowed the in vivo determination of promoting effects of captafol and inhibitory influence of L-cysteine by analyzing GST-P + foci in the livers as marker lesions, within a relatively short period of 8 weeks. Thus, this bioassay protocol could have applicability as a new in vivo assay system for the screening of hepatic carcinogenic or anti-carcinogenic agents.

Multifocal phototherapeutic keratectomy for the treatment of persistent epithelial defect.

PURPOSE: To evaluate the use of multifocal phototherapeutic keratectomy (PTK) for the treatment of indolent and persistent epithelial defect (PED). SETTING: Department of Ophthalmology, Kangnam St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea. METHODS: Fifteen eyes diagnosed with PED were treated with Summit excimer laser PTK. In all patients (N = 15), the epithelium had previously failed to cover with at least 1 method of medical or surgical treatment. Multifocal ablations were delivered to the elevated margin surrounding the epithelial defect area using PTK with a diameter of 1.0 mm and depth of 150 to 200 pulse ablations. The mean follow-up was 17.7 months (range 9 to 37 months). RESULTS: Complete reepithelialization occurred within 7 days in 13 eyes and within 11 days and 12 days in 1 eye each. All corneas except 1 remained healed for at least 9 months of follow-up. One eye had a recurrence 3 months after PTK and was retreated. Postoperative visual acuity improved in 8 eyes and was unaltered in 7. CONCLUSION: Multifocal PTK with the 193 nm excimer laser is a safe, effective treatment for PED that is unresponsive to conventional therapy.

26-Week repeated oral dose toxicity study of the new quinolone antibacterial DW-116 in Sprague-Dawley rats.

The purpose of this study is to investigate the potential subchronic toxicity of DW-116 by a 26-week repeated oral dose in Sprague-Dawley rats. The test article, DW-116, was administered daily by gavage to male and female rats at dose levels of 0, 5, 25 and 125 mg/kg/day. At the end of the treatment period, 12 rats/sex/group were sacrificed, while six extra rats/sex in the vehicle control and highest dose groups were sacrificed after a 4-week recovery. During the test period, clinical signs, mortality, body weights, food and water consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, gross findings, organ weights and histopathology were examined. There was no treatment-related mortality. An increase in the incidence of post-dosing salivation was observed in both sexes of the highest dose group. At the scheduled autopsy, an increase in the liver weight was observed in males of the highest dose group in a dose-dependent manner. Hematological investigations revealed a dose-dependent increase in the total white blood cell (WBC) and lymphocyte counts in males treated with the 125 mg/kg dose. Total bilirubin and alanine aminotransferase (ALT) values were also increased in males at the same dose. These effects were completely reversible during the recovery period. There were no adverse effects on body weight, food and water consumption, ophthalmoscopy, urinalysis, necropsy findings and histopathology in any treatment group. Based on these results, it was concluded that the 26-week repeated oral dose of DW-116 caused increases in the liver weight, WBC counts, total bilirubin and ALT values in males at a dose level of 125 mg/kg/day. The target organ was determined to be the liver and WBC in males, but not in females. The no-observed-adverse-effect level (NOAEL) was considered to be 25 mg/kg/day for males and 125 mg/kg/day for females.

Field study of an oral contraceptive among IUD drop-outs in rural Korea.

PIP: From November 1966 to December 1967, 911 IUD dropouts in Koyang County, Korea, were interviewed in a study by the Yonsei University College of Medicine on the acceptability and use-effectiveness of an oral contraceptive (Ovulen). Another purpose of the study was to gain experience that might be a useful reference in setting up the technical and administrative policies for adding the pill service to the national program. Results showed that 1) 61.4% of the subjects wanted to use the pill after terminating IUD use; 2) women over 30 years with 4 or more children and/or with a higher educational level were the best prospects for recruitment; 3) more than 60% of the users felt well and sometimes lost their preacceptance symptoms, although 27.4% had side effects (nausea, breast tenerness, bleeding); 4) by the end of the study, 49.2% had discontinued the pill for medical and nonmedical (difficulty in obtaining pills, separation from husband) reasons; and 5) the cumulative continuation rate was 41.0% at the end of 1 year. It was recommended that pills be made more readily available to rural Koreans to reduce the cost of obtaining them.^ieng

Immunohistochemical detection of galectin-3 in canine gastric carcinomas.

Galectin-3 was detected immunohistochemically in nine canine gastric carcinomas. In normal gastric tissue adjacent to the neoplasms, the gastric epithelial cells showed faint immunolabelling for galectin-3, but in all the tumours the neoplastic cells showed moderate to strong immunolabelling. Galectin-3 was localized in the cytoplasm of the normal mucosal cells, whereas it was found in both the cytoplasm and the nucleus of the neoplastic cells. Positive cells typically exhibited dark brown coloration of the nucleus or cytoplasm, without background labelling. The results suggest that galactin-3 has a pathophysiological role in canine gastric carcinoma.

Comparison between of the attenuated BR-Oka and the wild type strain of Varicella Zoster Virus (VZV) on the DNA level.

Oka strain VR-795 (Varicella Zoster Virus, VZV) of American Type Culture Collection (ATCC) has been used for chickenpox vaccine production. In order to use this strain for vaccine production, the strain must be identified and its stability must be confirmed. The identification of the Oka strain has been confirmed using Restriction Fragment Length Polymorphism (RFLP) and DNA sequence analysis of glycoprotein-II (gp-II). The amino acid sequences of Oka deduced from the DNA sequence of gp-II have changed at three amino acids against Ellen and at one amino acid against Webster. To prove the stability of the Oka strain during the passage, RFLP and DNA sequence analyses were also used with 11, 15 and 23 times of virus passage. We found that the Oka strain was stable at passages of up to 23 times, based on the RFLP and DNA sequence analyses. The confirmed Oka strain was renamed as BR-Oka for the purposes of chickenpox vaccine production.

Clinical Feasibility of Multiplanar Reconstruction Images of Temporal Bone CT in the Diagnosis of Temporal Bone Fracture with Otic-Capsule-Sparing Facial Nerve Paralysis.

The aim of this study is to evaluate the feasibility of multiplanar reconstructive (MPR) imaging of temporal bone CT in the diagnosis of temporal bone fracture with oticcapsule-sparing facial nerve paralysis. Twelve patients with traumatic facial nerve paralysis with otic-capsule sparing and temporal bone fractures were selected. Multiplanar reconstruction images were obtained with the V-works 4.0 software program (Cybermed, Seoul, Korea) using axial scanning of high-resolution temporal bone CT of the fracture line. The clinical profiles of the patients displaying temporal bone fractures were examined in relation to the findings. Multiplanar images of the fracture line provided information regarding the direction of the external force that fractured the temporal bone. The fracture line was more continuous in the MPR images than in the axial view. All patients showed an imaginary extended fracture line directed toward the otic capsule. The direction of the fracture line toward the middle ear cavity is important, as it may suggest insult to the otic capsule. The MPR image parallel to the fracture line of the temporal bone provides a guideline for the vector of the force that induced the fracture. Thorough investigation of the critical organs during surgical exploration is recommended if the direction of the fracture in the MPR image points toward the otic capsule in the middle ear even if the fracture line relative to the otic capsule is not well defined in the axial or CT view.

The fate of patients on the waiting list for lung transplantation in Korea.

Lung transplantation for end-stage lung disease results in prolonged actuarial survival and improved pulmonary function. However, the shortage of donor lungs has been a major limiting factor in transplantation. The purpose of this study was to analyze the waiting time and mortality rate for each disease entity. The medical records of all patients listed in The Korean Network for Organ Sharing (KONOS) from May 1996 to May 2011 were analyzed to identify waiting times and causes of death. During the study period, 146 patients (86 males and 60 females) of mean age of 46.6 years (range; 5 to 73 years) showed idiopathic pulmonary fibrosis (IPF; n = 61), chronic obstructive pulmonary disease (COPD; n = 19) or bronchiectasis (n = 15). Sixty-five patients (44.5%) underwent lung or heart-lung transplantation. Sixty-two patients (42.5%) expired during the waiting period, and 19 patients are still on the waiting list. The mortality rate while waiting was highest among patients with primary pulmonary hypertension (62.5%) followed by IPF (57.4%), and acute respiratory distress syndrome (ARDS) (55.6%). The mean time from diagnosis to registration in KONOS was 15.5 months among the expired and 13.2 months in the transplanted group (P = .455). The mean time on waiting list was 8.2 months in the expired group and 3.7 months in the transplanted group (P = .012). In the expired group, the mean survival time was significantly shorter among patients with ARDS (2.2 months, P = .004) compared to IPF (7.9 months), COPD (10.7 months), and primary pulmonary hypertension (PPH) (30.0 months). The high mortality rate (42.5%) during the waiting period in Korea may result from the lack of donors and the delay in registration.