Hepatocellular carcinoma (HCC) is one of the major cancers with a high incidence and mortality in Korea. A Korean multidisciplinary collaborative committee consisting of hepatologists, radiologists, epidemiologists and family medicine doctors systematically reviewed clinical practice guidelines in the world and literatures. The level of evidence for each recommendation was assessed and discussed to reach a consensus. Meta-analysis was also conducted to evaluate the grade of recommendation for the five key questions. Several randomized controlled studies and cohort studies showed a survival gain associated with surveillance for those at risk of developing HCC. The target populations for HCC surveillance were identified as hepatitis B virus or hepatitis C virus carriers and cirrhotic patients, since numerous studies revealed that these patients have significantly higher risk of HCC compared with non-infected or non-cirrhotic controls. Individual surveillance strategy according to treatment history or degree of fibrosis in patients with viral hepatitis remains to be settled. Based on several cohort and randomized studies, a surveillance interval of six months was recommend. The starting age of surveillance was determined as 40 years from the epidemiologic data. Although ultrasonography (US) is the mainstay for detection of HCC, its sensitivity is not fully accepted. Measurement of serum alpha-fetoprotein can complement US examination, increasing the sensitivity of HCC detection. The recommendation for HCC surveillance is that those with hepatitis B virus (or hepatitis C virus) infection or cirrhosis should have liver US and serum alpha-fetoprotein measurement every six months from 40 years of age or at the time of diagnosis of cirrhosis.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cohort Studies ; Complement System Proteins ; Consensus ; Diagnosis ; Fibrosis ; Health Services Needs and Demand ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Hepatitis C ; Humans ; Incidence ; Korea ; Liver ; Mortality ; Ultrasonography

Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.
Adult ; Aged ; *Bone Density ; Creatinine/blood ; Female ; Femur/physiopathology ; Femur Neck/physiopathology ; Glomerular Filtration Rate ; Humans ; Lumbar Vertebrae/physiopathology ; Male ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Osteoporosis/etiology ; Regression Analysis ; Renal Insufficiency, Chronic/complications/*physiopathology ; Republic of Korea ; Severity of Illness Index

BACKGROUND: Regulatory T cells (Tregs) are known to be key regulators of immune responses in patients with autoimmune disease and infection and also for attenuating antitumor immunity by the host. It has been reported that high numbers of tumor-infiltrating Tregs might be associated with poor clinical outcomes for several malignant tumors. Therefore, this study aimed to examine the impact of tumor-infiltrating Tregs on the prognosis of gastric carcinoma patients. METHODS: The immunohistochemical staining for anti-fork head Box P3 (FoxP3) antibody was performed by using a 3 mm core from the tumor specimens of each of the 173 gastric cancer patients for constructing a tissue microarray. FoxP3-positive Tregs were quantified by calculating the numbers of positive cells per 5 high-power fields on light microscopy. Thereafter, the 173 patients were subdivided into the low Tregs group (< or = 3/5 high power fields [HPF], n = 41) and the high Tregs group (> 3/5 HPF, n = 132). RESULTS: The high Tregs group was significantly associated with a higher stage, more invasion depth and lymph node metastasis (p = 0.009, p = 0.036, p = 0.006, respectively). The high Tregs group showed significantly poorer overall survival and event-free survival (p = 0.004, p = 0.017, respectively) on the univariate analysis. The Tregs group and the tumor, node and metastasis stage were also independent prognostic factors that were significantly associated with overall survival (p = 0.025, p < 0.001, respectively) by multivariate analysis. CONCLUSIONS: Our results indicated that a high number of tumor-infiltrating FoxP3-positive Tregs could be an indicator of poor long term survival for gastric carcinoma patients.
Autoimmune Diseases ; Disease-Free Survival ; Forkhead Transcription Factors ; Head ; Humans ; Light ; Lymph Nodes ; Microscopy ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; T-Lymphocytes, Regulatory

BACKGROUND: An unhealthy lifestyle is the most important cause of lifestyle-induced illness (diabetes, hypertension, liver enzyme abnormality, dyslipidemia etc.). This study was carried out to evaluate that relation between employees' lifestyle and their health status in a Korean electronic research and development company. METHODS: We conducted a descriptive cross-sectional survey. 3,041 consecutive workers in a Korean R&D company were enrolled in this study. A checkup list for the health examination (from the National Health Insurance Coperation), which contained the information on the lifestyle, and the results of the health examination, which contained information on the body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP), and liver function tests (LFT, AST, ALT, gamma-GTP) and cholesterol profiles (total cholesterol, TG, HDL, LDL) were done for all the subjects. We evaluated the health profile as normal or abnormal. Statistical analysis of the health profiles and the lifestyle of the employees' was performing by using multiple logistic regression analysis. RESULTS: The prevalence of 'excessive alcohol drinking' was 52.9% (n=1,610), that for 'lack of exercise' was 86.2% (n=2,662), that for 'meat eating' 12.2% (n=370) and that for 'current smoker' was 31.3% (n=952). According to results of health examination, the prevalence of obesity was 27.1% (n=824), hypertension was 7.1% (n=215), diabetes was 1.0% (n=30), abnormal LFT was 15.4% (n=469) and dyslipidemia was 18.7% (n=569). On multiple logistic regression analysis of the health profile and lifestyle, 'meat eating' was related to obesity, hypertension, abnormal LFT (ALT, gamma-GTP), dyslipidemia (LDL). 'Excessive alcohol drinking' was related to obesity, hypertension, abnormal LFT (gamma-GTP). 'Lack of exercise' was related to dyslipidemia (HDL). 'Current smoker' was related to obesity, diabetes, abnormal LFT (ALT, gamma-GTP), and dyslipidemia (TG, HDL) with statistically significance. CONCLUSIONS: For workers in the R&D company, an unhealthy lifestyle (such as diet, alcohol drinking, lack of exercise and smoking) were related to obesity, hypertension, diabetes, abnormal LFT and dyslipidemia. Therefore health promotion is necessary for the young employees of an Korean R&D company.
Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cross-Sectional Studies ; Diet ; Dyslipidemias ; Electronics ; Electrons ; Health Promotion ; Hypertension ; Life Style ; Liver ; Liver Function Tests ; Logistic Models ; National Health Programs ; Obesity ; Prevalence

OBJECTIVES: The objectives of this study were to determine the relationship between lifestyle-implementation and metabolic syndrome in an electronics research and development company, and to provide a foundation for health providers of health management programs for setting priorities. METHODS: From July 1 to July 16, 2008 we carried out a descriptive cross-sectional survey. Consecutive workers of one R & D company in Seoul, Korea (N=2,079) were enrolled in study. A checklist for lifestyle (from the National Health Insurance Corporation) consisted of questions regarding diet, drinking, smoking and exercise. After the survey, researchers obtained data from health profiles for metabolic syndrome(waist-circumference, triglycerides, HDL cholesterol, blood pressure and fasting blood sugar level). Lifestyle was recorded as good or not good. Statistical analysis of metabolic syndrome and the lifestyle of subjects was done using multiple logistic regression analysis. RESULTS: The prevalence of metabolic syndrome in our study gropu was 13.3% (N=277). After adjustment for age, the adjusted odds ratios (odds ratio, 95% confidence intervals) for metabolic syndrome increased in proportion to the number of bad habits: two (1.72, 1.23-2.44), three (2.47, 1.73-3.56), and four (3.63, 2.03-6.34). Relative to subjects eating both vegetables and meat', the OR for 'meat' eaters was 1.66 (1.18-2.31). Compared with 'non-smokers and ever-smoker', the OR for 'current-smoker' was 1.62 (1.25-2.10). Compared with 'Healthy drinker', the OR for 'unhealthy drinker' was 1.38 (1.05-1.83). CONCLUSIONS: Poor lifestyle was associated with an increased likelihood of metabolic syndrome. These findings suggest that lifestyle-based occupational health interventions for young employees should include a specific diet, smoking cessation, and healthy-drinking programs.
Adult ; Blood Glucose/analysis ; Blood Pressure ; Body Weights and Measures ; Cross-Sectional Studies ; *Electronics ; *Health Behavior ; Humans ; Korea ; *Life Style ; Lipids/blood ; Male ; Men's Health ; Metabolic Syndrome X/*epidemiology ; Prevalence ; *Research

OBJECTIVES: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. METHODS: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. RESULTS: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. CONCLUSIONS: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.
Alcohol Drinking ; Body Mass Index ; Confounding Factors (Epidemiology) ; Electronics ; Electrons ; Humans ; Liver ; Liver Diseases ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Questionnaires

OBJECTIVES: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. METHODS: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. RESULTS: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. CONCLUSIONS: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.
Alcohol Drinking ; Body Mass Index ; Confounding Factors (Epidemiology) ; Electronics ; Electrons ; Humans ; Liver ; Liver Diseases ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Questionnaires

OBJECTIVES: This study estimated the relationship between job stress and unemployment through a 2-year follow-up study in the KOSS cohort. METHODS: We established the KOSS cohort in 2004. Among this cohort, we selected 5680 persons with complete KOSS scores and resident registration numbers. We investigated the state of unemployment using unemployment insurance data from Jan. 2005 to Oct. 2006. Multiple logistic regression analysis was performed to evaluate the relationship between job stress and unemployment. We also adjusted for age, education, marital status, experience of medical visiting, and size of enterprise. RESULTS: Insufficient job control, interpersonal conflict, job insecurity, occupational system, and lack of reward were related to unemployment for men, while only lack of reward was an unemployment risk factor for women. CONCLUSIONS: Insufficient job control, interpersonal conflict, job insecurity, occupational system, and lack of reward were found to be risk factors for male unemployment. Efforts should be made to reduce these job stressors as risk factors.
Cohort Studies ; Education ; Female ; Follow-Up Studies ; Humans ; Insurance ; Logistic Models ; Male ; Marital Status ; Reward ; Risk Factors ; Unemployment

This study was to evaluate the expression of vascular endothelial growth factor receptors (VEGFRs) in tumor and stromal cells of tougue squamous cell carcinoma (SCC). We also wanted to characterize the differences, from the angiogenic aspect, between cancer-associated stromal cells and non-malignant stromal cells. Paraffin-embedded tumor specimens from eleven patients with tongue SCCs were studied. Immunohistochemical staining for VEGFR-1,-2, and -3 was performed on the tumor cells, stromal fibroblasts and tumor-associated macrophages of the specimens. The expression of all 3 receptors was detected in the tumor cells themselves of the biopsy specimens. All 3 receptors were also expressed on stromal cells, except that VEGFR-2 was not expressed in stromal fibroblasts. In radical excision specimens, the staining intensity for VEGFR-1, -2 in the tumor cells and VEGFR-1,-3 in the tumor-associated macrophages was significantly lower than that in the biopsy specimens (P < 0.05). By using the general marker of fibroblast and macrophage, 5B5 and CD68, respectively, we performed double immunofluorescence staining for 5B5 and each VEGFR in the stromal fibroblasts and for CD68 and each VEGFR in the tumor-associated macrophages of the radical excision specimens. We used 4 cases of fibroma and 4 cases of chronic inflammation tissue as the controls. It was found that only each marker was expressed in the control group, however, 5B5/VEGFR-1 and 5B5/VEGFR-3 in the stromal fibroblasts, and CD68/VEGFR-1 and CD68/VEGFR-3 in the tumor-associated macrophages were double stained in the radical excision specimens. Although our study used small number of specimens, the results of our study showed that in tongue SCC, in association with the angiogenesis, the stromal cells showed the activated phenotype and this was different from the nonmalignant stromal cells.
Biopsy ; Carcinoma, Squamous Cell* ; Fibroblasts ; Fibroma ; Fluorescent Antibody Technique ; Humans ; Inflammation ; Macrophages ; Phenotype ; Receptors, Vascular Endothelial Growth Factor* ; Stromal Cells* ; Tongue* ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factor Receptor-1 ; Vascular Endothelial Growth Factor Receptor-2

r cells, and the efficacy of drug delivery can be high in richly vascularized tumors. So, this study was conducted to evaluate the effect of neoadjuvant chemotherapy on microvessel density from 11 patients with tongue cancers. Our results showed that neoadjuvant chemotherapy was seemed to decrease VEGF expression in tumor cells, however, it did not significantly alter VEGF expression in tumor-associated macrophages. Also, Neoadjuvant chemotherapy had little effect on the microvessel density using CD34, and tumor-associated macrophage level using CD68. Thus, tumorassociated macrophages seem to be the key factor associated with the maintenance of microvessel density after neoadjuvant chemotherapy in tongue cancer.
Drug Therapy* ; Humans ; Macrophages* ; Microvessels* ; Tongue Neoplasms* ; Tongue* ; Vascular Endothelial Growth Factor A