Mucinous adenocarcinoma arising from a chronic anorectal fistula is a rare condition. It is often confused with a hemorrhoid or perineal abscess, which consequently delays accurate diagnosis. Here, we report the case of a 58-year-old man with blood-tinged stool who reported a rectal mass, which was diagnosed as mucinous adenocarcinoma arising from an anal fistula. After initial computed tomography-guided needle aspiration biopsy had failed to provide an accurate diagnosis, transrectal punch biopsy was performed to obtained adequate tissue sample for confirmative histological diagnosis. The patient was successfully treated with neoadjuvant concurrent chemoradiotherapy followed by surgical intervention.
Abscess ; Adenocarcinoma, Mucinous* ; Biopsy* ; Biopsy, Needle ; Chemoradiotherapy* ; Fistula* ; Hemorrhoids ; Humans ; Middle Aged ; Mucins* ; Needles ; Neoadjuvant Therapy ; Rectal Fistula

PURPOSE: We investigated the value of an interferon-gamma release assay (IGRA) for the diagnosis of active pulmonary tuberculosis (PTB) among sputum smear negative PTB suspects in an environment with intermediate burden of PTB and high Bacillus Calmette-Guerin (BCG) vaccination rate. MATERIALS AND METHODS: We retrospectively reviewed IGRA, medical records, chest PA and CT scan of PTB suspects seen at Gangnam Severance Hospital, Seoul, Korea from Oct. 2007 to Apr. 2013. "Active PTB" was diagnosed when 1) M. tuberculosis culture positive, 2) confirmation by pathologic examination; or 3) clinical findings compatible with TB. RESULTS: Of 224 sputum smear negative PTB suspects, 94 were confirmed as having active PTB. There were no statistically significant differences in the diagnostic yield of IGRA between immunocompromised and immunocompetent sputum smear negative PTB suspects. IGRA did show superior sensitivity [81.9%, 95% confidence interval (CI); 74.13-89.70%] in the diagnosis of sputum smear negative PTB when compared with chest high-resolution computed tomography (HRCT), tuberculin skin test (TST), and chest X-ray (p<0.001). Also, IGRA showed highest negative predictive value (82.7%, 95% CI; 75.16-90.15%) when compared with HRCT, TST and chest X-ray (p=0.023). However, combining the results of IGRA with those of HRCT, TST, or both did not increase any diagnostic parameters. CONCLUSION: Failure to increase diagnostic yields by combination with other diagnostic modalities suggests that additional enforcement with IGRA may be insufficient to exclude other diagnoses in sputum smear negative PTB suspects and to screen active PTB in an environment with intermediate TB prevalence and a high BCG vaccination rate.
Adult ; Aged ; Female ; Humans ; Interferon-gamma Release Tests/*methods ; Male ; Middle Aged ; Retrospective Studies ; Sputum/*microbiology ; Tuberculosis, Pulmonary/blood/*diagnosis/metabolism

Extramammary Paget’s Disease (EMPD) is a rare intraepithelial malignancy of apocrine bearing glands, which occur usually in the perianal region, vulva, scrotum, penis and ax-illa. Most of the disease are treated by surgical resection and the prognosis is generally good. Even though recurrent disease, it is usually slowly progressed with good prognosis. Here we describe the case of a 70-year-old male who has presented with initially just as an EMPD component of squamous cell carcinoma in inguinal skin, but he showed recur-rence of EMPD. The disease has progressed rapidly, finally he died of that EMPD in 2 months of recurrence. The purpose of this study is to report the rare case of fulminant disease course of EMPD after recurrence.

Background: Genome-wide association studies (GWAS) on type 2 diabetes mellitus (T2DM) have identified more than 400 distinct genetic loci associated with diabetes and nearly 120 loci for fasting plasma glucose (FPG) and fasting insulin level to date. However, genetic risk factors for the longitudinal deterioration of FPG have not been thoroughly evaluated. We aimed to identify genetic variants associated with longitudinal change of FPG over time. Methods: We used two prospective cohorts in Korean population, which included a total of 10,528 individuals without T2DM. GWAS of repeated measure of FPG using linear mixed model was performed to investigate the interaction of genetic variants and time, and meta-analysis was conducted. Genome-wide complex trait analysis was used for heritability calculation. In addition, expression quantitative trait loci (eQTL) analysis was performed using the Genotype-Tissue Expression project. Results: A small portion (4%) of the genome-wide single nucleotide polymorphism (SNP) interaction with time explained the total phenotypic variance of longitudinal change in FPG. A total of four known genetic variants of FPG were associated with repeated measure of FPG levels. One SNP (rs11187850) showed a genome-wide significant association for genetic interaction with time. The variant is an eQTL for NOC3 like DNA replication regulator (NOC3L) gene in pancreas and adipose tissue. Furthermore, NOC3L is also differentially expressed in pancreatic β-cells between subjects with or without T2DM. However, this variant was not associated with increased risk of T2DM nor elevated FPG level. Conclusion We identified rs11187850, which is an eQTL of NOC3L, to be associated with longitudinal change of FPG in Korean population.

Purpose: This study investigated the effects of healthy lifestyle interventions (HLSIs) on health-related quality of life (HR-QoL) in childhood and adolescent cancer survivors (CACS). Methods: Major databases were searched for English-language original articles published between January 1, 2000 and May 2, 2021. Randomized controlled trials (RCTs) and non-RCTs were included. Quality was assessed using the revised Cochrane risk-of-bias tool, and a meta-analysis was conducted using RevMan 5.3 software. Results: Nineteen studies were included. Significant effects on HR-QoL were found for interventions using a multi-modal approach (exercise and education) (d=-0.46; 95% confidence interval [CI]=-0.84 to -0.07, p=.02), lasting not less than 6 months (d=-0.72; 95% CI=-1.15 to -0.29, p=.0010), and using a group approach (d=-0.46; 95% CI=-0.85 to -0.06, p=.02). Self-efficacy showed significant effects when HLSIs provided health education only (d=-0.55; 95% CI=-0.92 to -0.18; p=.003), lasted for less than 6 months (d=-0.40; 95% CI=-0.69 to -0.11, p=.006), and were conducted individually (d=-0.55; 95% CI=-0.92 to -0.18, p=.003). The physical outcomes (physical activity, fatigue, exercise capacity-VO2, exercise capacity-upper body, body mass index) revealed no statistical significance. Conclusion Areas of HLSIs for CACS requiring further study were identified, and needs and directions of research for holistic health management were suggested.

Purpose: This study aimed to evaluate the feasibility of measuring liver fat using the volumetric measurement method (Fatvol) by comparing it with the conventional 27-regions of interest drawing method (Fatroi). Materials and Methods: This retrospective study included 67 patients who underwent liver magnetic resonance imaging with fat quantification in August or September 2020.Two experienced abdominal radiologists measured the proton density fat fraction (PDFF) of the liver using the mDIXON-Quant sequence for each of two methods. The PDFF was measured twice with each method at intervals of at least 4 weeks to avoid recall bias. Measurement times were recorded. The intra-class correlation coefficient (ICC) was calculated for intra-exam repeatability, inter-reviewer reproducibility, and inter-exam agreement. Results: Measurement times for Fatvol were significantly shorter than for Fatroi. Measurement times for Fatroi and Fatvol, respectively, for reviewer A were 209.4 ± 55.1 s and 137.2 ± 51.5 s in session 1, and 180.9 ± 37.3 s and 127.0 ± 46.1 s in session 2. For reviewer B, the times were 190.7 ± 30.1 s and 74.8 ± 27.4 s in session 1, and 174.6 ± 21.8 s and 64.1 ± 17.5 s in session 2. In all cases, p < 0.001. The mean PDFF values were 7.2% ± 6.4% and 7.2% ± 6.5% (sessions 1 and 2, respectively) for Fatroi and 7.4% ± 6.0% and 7.3% ± 6.1% for Fatvol for reviewer A. For reviewer B, they were 7.1% ± 6.6% and 7.1% ± 6.6% for Fatroi and 7.4% ± 5.8% and 7.4% ± 5.8% for Fatvol. The ICCs between measurement methods (0.998 and 0.995 for reviewers A and B, respectively), for Fatvol within each reviewer (0.999 and 1.000 in sessions 1 and 2, respectively), and between reviewers (0.999) were excellent. Conclusion The measurement time could be significantly reduced using Fatvol compared to Fatroi while maintaining the consistency of the liver fat measurement values.

Anthocyanins are water soluble plant pigments which are responsible for the blue, red, pink, violet colors in several plant organs such as flowers, fruits, leaves and roots. In recent years, anthocyanin-rich foods have been favored as dietary supplements and health care products due to diverse biological activities of anthocyanins including antioxidant, anti-allergic, anti-diabetic, anti-microbial, anti-cancer and preventing cardiovascular disease. High-performance countercurrent chromatography (HPCCC) coupled with reversed-phase medium pressure liquid chromatography (RP MPLC) method was applied for the rapid and efficient isolation of cyanidin 3-glucoside (C3G) and peonidin 3-glucoside (P3G) from black rice (Oryza sativa L., Poaceae). The crude black rice extract (500 mg) was subjected to HPCCC using two-phase solvent system composed of tert-butyl methyl ether/n-butanol/acetonitrile/0.01% trifluoroacetic acid (TBME/B/A/0.01% TFA, 1 : 3 : 1 : 5, v/v, flow rate - 4.5 mL/min, reversed phase mode) to give enriched anthocyanin extract (37.4 mg), and enriched anthocyanin extract was sequentially chromatographed on RP-MPLC to yield C3G (16.5 mg) and P3G (8.7 mg). The recovery rate and purity of isolated C3G were 76.0% and 98.2%, respectively, and those of P3G were 58.3% and 96.3%, respectively. The present study indicates that HPCCC coupled with RP-MPLC method is more rapid and efficient than multi-step conventional column chromatography for the separation of anthocyanins.
Anthocyanins ; Cardiovascular Diseases ; Chromatography* ; Chromatography, Liquid ; Countercurrent Distribution* ; Delivery of Health Care ; Dietary Supplements ; Flowers ; Fruit ; Plants ; Trifluoroacetic Acid ; Viola

Cyanidin-3-glucoside (C3G) and cyanidin-3-rutinoside (C3R) were isolated by high-performance countercurrent chromatography (HPCCC) using a two-phase solvent system composed of tert-butyl methyl ether/n-butanol/acetonitrile/water/trifluoroacetic acid (1 : 3 : 1 : 5 : 0.01, v/v) to give pure C3G (34.1 mg) and C3R (14.3 mg) from 1.5 g crude mulberry fruit extract. Using the pure C3G and C3R, a reliable high-performance liquid chromatography (HPLC) method was developed and validated to determine the C3G and C3R contents in mulberry fruit. C3G and C3R were separated simultaneously using an Eclipse XDB-C18 column (4.6 x 250 mm I.D., 5 microm) coupled with a photodiode array detector (PDA). The gradient elution of the mobile phase consisting of acetonitrile (0.5% formic acid) and water (0.5% formic acid) was applied (1.0 mL/min), and the detection wavelength was 520 nm. The calibration curves of C3G and C3R showed good linearity (both with r2 = 0.9996) in the concentration range 15.625 - 500 microg/mL, and the relative standard deviations (RSD%) of intra- and interday variability were in the ranges 2.1 - 8.2% and 4.1 - 17.1%, respectively. The accuracies were ranged 96.5 - 102.6% for C3G and C3R, respectively. The developed HPLC method was used to determine the contents of C3G and C3R in newly harvested mulberry from eight different provinces of Korea.
Calibration ; Chromatography, High Pressure Liquid ; Chromatography, Liquid* ; Countercurrent Distribution* ; Fruit* ; Korea ; Morus* ; Water

Supernumerary ectopic limb(s) (SEL) is a congenital anomaly defined as the presence of accessory limb(s) attached to various body regions. This paper describes a case of SEL with ectopic lung and ectopia cordis in a newborn calf, based on macroscopic, microscopic and radiographic findings. External features of multiple congenital anomalies included an ectopic lung growing over the middle of the backbone and covered with normal haired skin. Ectopia cordis was found in the abdominal cavity and attached to the liver. Two extra abnormal limbs originated separately from within the ectopic lung. Most of the abdominal organs were exposed to the outside through the opened abdominal cavity. Microscopically the ectopic lung tissue had edema in the connective tissue around the bronchus and artery. Changes in other organs included congestion of the renal medulla, infiltration of inflammatory cells (lymphocytes and eosinophils) around the hepatic portal tract, and edema surrounding blood vessels and neurons in the brain. The rudimentary humerus of the forelimb was attached to the thoracic spine, as viewed radiographically. The hindlimb was consisted of an irregularly shaped femur, short tibia and fibula, two tarsal bones, one metatarsal bone, and three phalanges. This is the first description of congenital anomalies involving the SEL, ectopic lung and ectopia cordis in a calf.
Abdominal Cavity ; Animals ; Arteries ; Blood Vessels ; Body Regions ; Brain ; Bronchi ; Connective Tissue ; Ectopia Cordis ; Edema ; Estrogens, Conjugated (USP) ; Extremities ; Femur ; Fibula ; Forelimb ; Hair ; Hindlimb ; Humans ; Humerus ; Infant, Newborn ; Liver ; Lung ; Metatarsal Bones ; Neurons ; Skin ; Spine ; Tarsal Bones ; Tibia

Fetal adenocarcinoma is a rare adenocarcinoma subtype of pulmonary blastoma. A 48-year-old male patient is being referred to our hospital due to progressive dyspnea. A chest X-ray showed a lung mass of unknown origin that was obstructing the right main bronchus. After relieving the airway obstruction with stent insertion via bronchoscopy, a diagnosis of fetal adenocarcinoma is being confirmed through thoracoscopic biopsy. Due to the locally advanced state of the lung cancer, it seemed to be inoperable, and concurrent chemo-radiation therapy was being administered with docetaxel. The stent was removed after improvements in the airway obstruction followed by a lung mass shrinkage. Comparing to other contexts which describe fetal adenocarcinoma as lower grade malignancy with low-associated mortality, herein, we describe a case of locally-advanced fetal adenocarcinoma (T4N3M0). This is the first documented case being treated with concurrent chemoradiation therapy. The followed-up image studies represent a partial response and the patient is currently under further observations.
Adenocarcinoma ; Airway Obstruction ; Biopsy ; Bronchi ; Bronchoscopy ; Dyspnea ; Humans ; Lung ; Lung Neoplasms ; Male ; Pulmonary Blastoma ; Stents ; Taxoids ; Thorax