There have been some controversies on prognostic significance of lymph node (LN) micrometastasis (MM) in advanced gastric carcinomas (AGCs). The present study aimed at 1) determination of prognostic significance of MM, 2) evaluation of the relationship between MM and clinicopathological parameters, and 3) determination of LN group where MMs were frequently found. We studied 70 cases of AGC without LN metastasis on initial examination. The tumors were examined for location, size, depth of invasion, differentiation, histologic type, lymphatic invasion, and c-erbB-2 expression. To evaluate MM, pancytokeratin immunohistochemistry was performed in all LNs from 70 cases of AGCs. Among 2,203 dissected LNs from 70 patients, 37 (1.6%) LNs from 19 (27.1%) patients revealed MM. Micrometastases were seen in only group 1 and 2 LNs: none had group 3 and 4 LN involvement. The gender, age, tumor size, location of tumor, histologic type, differentiation, depth of invasion, lymphatic invasion, and c-erbB-2 expression were not significantly associated with MM status. The survival time of the MM-positive group (mean: 62 months) was significantly shorter than that of the MM-negative group (mean: 72 months) (p=0.046). The findings of this study indicate that the presence of MM in LNs is an important prognostic factor in AGC patients.
Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis*

BACKGROUND: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. METHODS: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. RESULTS: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. CONCLUSION: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
Antirheumatic Agents* ; Arthritis, Rheumatoid* ; Delivery of Health Care ; Health Care Costs ; Humans ; Injections, Subcutaneous* ; Outpatients ; Palliative Care ; Rheumatology ; Abatacept ; Adalimumab ; Etanercept

BACKGROUND: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. METHODS: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. RESULTS: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. CONCLUSIONS: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.
Diskectomy ; Diskectomy, Percutaneous ; Equipment Design ; Fluoroscopy ; Humans ; Magnetic Resonance Imaging ; Needles ; Skin ; Spine ; Stereotaxic Techniques

Cleft lip and palate are common defects in congenital deformity. Nose deformity is most common among various facial deformities at the center of face. So we must operate to correct the deformity at the earliest stage to give the patients and parents mental relief from anxiety. It is also necessary to establish the facial anthropometry in newborns, because of the current trend of early intervention, such as fetal surgery, lip adhesion, and use of nasoalveolar molding devices. But there is a lack of literature and research on newborns. So we carried out this research to form base data for operations. The nose of 90 newborns in Gwangju-Jeonnam area were analyzed quantitatively, based on 13 facial measuring points and 18 anthropometric values taken directly from the face of newborns. The relationship between the nasal measurements were studied in 11 proportion indices. Followings are our results for newborns. Width of the nasal root was 13.9mm. Width of the nose was 22.1mm. Width of the columella was 4.5mm. Height of the nose was 22.6 mm. Length of the nasal bridge was 20.1mm. Nasal tip protrusion was 8.9 mm. Width of the nostril floor was 6.4mm. Thickness of the nasal ala and length of the nasal ala were 4.0mm, 15.4mm. Length of the columella was 3.9mm. The most common nostril shape was Type II(0-45 degrees in inclination of the nostril axis from the horizontal). Nasal index was 97.8. Columella-nasal tip protrusion length index was 43.9. The development of the columella was relatively incomplete in the case of newborns. The normal indices could be used clinically in identifying it's normality as well as morphologic characteristics of the craniofacial structures. They also could be used in different diagnosis between the morphologically similar congenital craniofacial anomalies, in preoperative design, and assessing the effect of the operation.
Anthropometry* ; Anxiety ; Axis, Cervical Vertebra ; Cleft Lip ; Congenital Abnormalities ; Diagnosis ; Early Intervention (Education) ; Fungi ; Humans ; Infant, Newborn* ; Lip* ; Nose* ; Palate ; Parents

Recent evidence shows that transcriptional silencing as a consequence of hypermethylation of CpG islands is an important mechanism in the inactivation of p16INK4 tumor suppressor gene. This study is designed to clarify the significance of p16INK4 hypermethylation in 23 cases of glioblastomas (GBMs) by methylation-specific polymerase chain reaction (PCR) and p16 immunostaining. Fourteen cases (60.9%) out of 23 GBMs revealed hypermethylation on p16. p16 immunostaining revealed that 13 (93%) of these 14 hypermethylation cases showed complete loss of immunoreactivity and only one (7%) case retained immunoreactivity. Among 9 methylation-negative cases, 4 were immunonegative, which might be related to mutations or deletions other than hypermethylation. The most significant finding was that of 17 cases with immunonegativity, 13 cases (76.5%) showed hypermethylation. We reconfirmed that p16 hypermethylation may be one of the major mechanisms of tumorigenesis of GBMs and the results between the methylation specific-PCR study and p16 immunostaining had a good correlation.
5' Untranslated Regions/metabolism* ; 5' Untranslated Regions/genetics ; Adult ; Antisense Elements (Genetics) ; Brain Neoplasms/pathology ; Brain Neoplasms/genetics* ; Brain Neoplasms/chemistry ; CpG Islands/physiology* ; DNA Methylation* ; Female ; Gene Silencing/physiology ; Glioblastoma/pathology ; Glioblastoma/genetics* ; Glioblastoma/chemistry ; Human ; Male ; Middle Age ; Polymerase Chain Reaction ; Protein p16/genetics* ; Protein p16/analysis

The morphologic change of the mouse brain after exposure to magnetic field is studied. Our magnetic field model was a pulsed unipolar magnetic field with the flux density of 0.2 - 0.3 tesla and the frequency of 60 hertz. Twelve adult male mice were exposed to the magnetic field for 2, 4, 8, 12, 18 and 24 hours. After the exposure to the magnetic field mice were anesthetized with chloral hydrate, and paraformaldehyde was infused through the left ventricle for fixation. During exposure to the magnetic field, behavioral and weight changes of mice were observed. Mice became irritable and restless, especially during first 2 hours of the exposure. Microscopic and ultrastructural examination on the brain revealed nuclear chromatin clumping of the neuron in mice exposed to the magnetic field for more than four hours. The change was proportional to the exposed time and more prominent in the cerebral cortex. An immunohistochemical study for amyloid precursor protein (APP) was also performed. There was an increased expression of APP in the neuronal cytoplasm of the mouse brain exposed to the magnetic field for 4 hours or more. But the reaction was not proportional to the exposure time and reactive neuron was diffusely distributed through the whole brain. Anti-APP antibody reactivity was not correlated with the chromatin clumping. The mechanism of APP induction was postulated as stress-induced APP-gene induction, and the role of APP was presumed to protect the neuron against hazardous environment.
Adult ; Male ; Female ; Humans ; Mice ; Animals

BACKGROUND/OBJECTIVES: Sageretia thea is traditionally used as a medicinal herb to treat various diseases, including skin disorders, in China and Korea. This study evaluated the inhibitory effect of Sageretia thea fruit on melanogenesis and its underlying mechanisms in B16F10 mouse melanoma cells. The active chemical compounds in anti-melanogenesis were determined in Sageretia thea. MATERIALS/METHODS: Solvent fractions from the crude extract were investigated for anti-melanogenic activities. These activities and the mechanism of anti-melanogenesis in B16F10 cells were examined by determining melanin content and tyrosinase activity, and by performing western blotting. RESULTS: The n-hexane fraction of Sageretia thea fruit (HFSF) exhibited significant anti-melanogenic activity among the various solvent fractions without reducing viability of B16F10 cells. The HFSF suppressed the expression of tyrosinase and tyrosinase-related protein 1 (TRP1). The reduction of microphthalmia-associated transcription factor (MITF) expression by the HFSF was mediated by the Akt/glycogen synthase kinase 3 beta (GSK3β) signaling pathway, which promotes the reduction of β-catenin. Treatment with the GSK3β inhibitor 6-bromoindirubin-3'-oxime (BIO) restored HFSF-induced inhibition of MITF expression. The HFSF bioactive constituents responsible for anti-melanogenic activity were identified by bioassay-guided fractionation and gas chromatography-mass spectrometry analysis as methyl linoleate and methyl linolenate. CONCLUSIONS: These results indicate that HFSF and its constituents, methyl linoleate and methyl linolenate, could be used as whitening agents in cosmetics and have potential for treating hyperpigmentation disorders in the clinic.
alpha-Linolenic Acid ; Animals ; Bleaching Agents ; Blotting, Western ; Camellia ; China ; Fruit ; Gas Chromatography-Mass Spectrometry ; Hyperpigmentation ; Korea ; Linoleic Acid ; Melanins ; Melanoma ; Mice ; Microphthalmia-Associated Transcription Factor ; Monophenol Monooxygenase ; Phosphotransferases ; Plants, Medicinal ; Skin

Cryptotia is a relatively common congenital anomaly in orientals. It is charaterized by obliteration of auriculocephalic sulcus and buried ear cartilage of upper pole beneath the scalp skin. In addition, there is often a posterior displacement of the superior crus of antihelix. The goals of surgical correction are the coverage of skin deficit, deepening of the auriculocephalic sulcus and the correction of deformed cartilage. Some authors stressed a tendency for the superior portion of the auricle to spring back to the original portion after surgery. We have devised a surgical method to prevent recurrence of the cartilagenous deformity using combined method of Fukuda and Onizuka. From March in 2001 to Jan, 2004, We have repaired 6 cryptotic deformities in 5 patients including one bilateral cryptotia. Between them We used combined method of Fukuda and Onizuka in 4 severely deformed cryptotic superior ear cartilage correction with satisfactory results. Single Fukuda's method was used in 2 mildly deformed cryptotias. The combined method composed of Z-plasty incision for skin releasing, and incision along the crus and then flattened the crus by mattress suture, multiple incisions in the back of the superior crus and then grafting the piece of conchal cartilage producing a splinting to hold the crus out in a smooth, curved configuration for the correction of the superior portion of the deformed ear. The results were remarkable improvement of profile in severely deformed cryptotia. And so this combined method is useful method for the correction of severely deformed cartilage in cryptotia.
Cartilage ; Congenital Abnormalities ; Ear ; Ear Cartilage ; Humans ; Nose ; Recurrence ; Scalp ; Skin ; Splints ; Sutures ; Transplants

Background: Gastrointestinal microbiota, which comprises hundreds of different types of microbes, biologically plays crucial roles in the host’s health. Probiotics (PRO) did not always have a positive benefit on the host, depending on strains of microbes and the physiochemical properties of prebiotics (PRE), indicating that the properties of PRE in combination with PRO might have different effects on the gut ecology. The aim of this study was to assess the effects of insoluble or soluble PRE with PRO on intestinal digestive hydrolase, the fecal microbes, and immunological biomarkers in SD rats fed an AIN-93G diet. Results: Forty, 8-week-old SD rats were randomly assigned to 4 groups with 10 replicates in each; cellulose (CELL), cellulose + probiotics (CELPRO), oatmeal (OATS), and oatmeal + probiotics (OATPRO) groups. After 4-week feeding trial, rats were treated with saline or lipopolysaccharide (LPS, 1 mg/kg) to examine the alleviating effects of PRO and PRE on immunological responses. There was a significant (p < 0.05) decrease in feed intake of rats fed the oatmeal supplemented diet without affecting growth performance. Blood triglyceride was significantly (p < 0.05) decreased in rats fed the oatmeal diet, and aspartate aminotransferase (AST) was significantly (p < 0.05) decreased in rats fed the PRO supplemented diet. Intestinal maltase, sucrose, and lactase activities were significantly (p < 0.05) higher in rats fed PRO compared with rats not fed PRO. Rats fed the oatmeal showed a significant (p < 0.01) increase in the fecal colony forming units (CFU) of Lactobacillus plantarum, Bacillus subtilis, and Saccharomyces cerevisiae compared with those fed cellulose. LPS-treated rats fed PRO showed a significant (p < 0.05) increase in blood secretory immunoglobulin A (sIgA) compared with those not fed PRO. The LPS-treated rats fed PRO resulted in decreased (p < 0.05) blood IL-6 compared with those not fed PRO, indicating that a dietary PRO alleviated inflammatory response in LPS-treated rats. Conclusions Dietary oatmeal increased fecal microbes, and PRO supplement resulted in increased intestinal hydrolase and immune functions of the host, demonstrating that soluble PRE with supplemented with PRO could be a more bioactive combination of synbiotics in SD rats.

Preclinical ischemic stroke studies extensively utilize the intraluminal suture method of middle cerebral artery occlusion (MCAo). General anesthesia administration is an essential step for MCAo, but anesthetic agents can lead to adverse effects causing death and making a considerable impact on inducing cerebral ischemia. The purpose of this study was to comparatively assess the effect of isoflurane and xylazine on transient cerebral ischemia in a mouse model of MCAo. Twenty animals were randomly divided into four groups: sham group (no MCAo), control group (MCAo under isoflurane, no agent till reperfusion), isoflurane group (MCAo under isoflurane continued till reperfusion), xylazine group (MCAo under isoflurane, and administration of xylazine till reperfusion). The survival rate, brain infarct volume, and neurologic deficits were studied to assess the effect of isoflurane and xylazine on the stroke model. Our results showed that the body weight showed statistically significant change before and 24 h after surgery in the control and Isoflurane groups, but no difference in the Xylazine group. Also, the survival rate, brain infarct volume, and neurologic deficits were slightly reduced in the isoflurane group at 24 h after reperfusion injury. However, the xylazine and control groups showed similar BIV and neurologic deficits. Interestingly, a high survival rate was observed in the xylazine group. Our results indicate that the modified method of inhalation anesthetics com‑ bined with xylazine can reduce the risk of mortality and develop a reproducible MCAo model with predictable brain ischemia. In addition, extended isoflurane anesthesia after MCAo is associated with the risk of mortality.