Purpose: Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC. Materials and Methods: We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group. Results: Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma in situ, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model. Conclusions The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.

No abstract available.
Korea ; Prekallikrein

Human toxocariasis is a common helminthozoonosis due to the infestation of toxocara canis or toxocara cati larvae, and is a common cause of blood eosinophilia in Korea. Toxocariasis has various clinical manifestations depending on the involved organ, and cardiac involvement can range from asymptomatic to fulminant myocarditis with cardiogenic shock. Treatment of toxocariasis is based on corticosteroid and anthelmintic therapies. Here, we report a case of a 57-year-old male with eosinophilic myocarditis caused by toxocariasis as diagnosed via serial echocardiography follow up.
Echocardiography ; Eosinophilia ; Eosinophils* ; Follow-Up Studies ; Humans ; Korea ; Larva ; Larva Migrans, Visceral ; Male ; Middle Aged ; Myocarditis ; Shock, Cardiogenic ; Toxocara ; Toxocara canis ; Toxocariasis*

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.
Acute Kidney Injury ; Adenoma ; Aged, 80 and over ; Creatinine ; Dialysis ; Dyspnea ; Female ; Hemorrhage* ; Humans ; Kidney Cortex Necrosis* ; Oliguria ; Pregnancy ; Pulmonary Edema ; Renal Dialysis ; Tranexamic Acid

Nodular type malignant melanoma is uncommon in fingers. In previous publications, treatment, diagnosis and case reports of subungal melanoma is often, however fingertip lesion was not focused. A 64-year-old woman who had a non-healing red and dark colored nodular mass with ulceration over the finger tip in the right thumb visited our clinics. Biopsy results was malignant melanoma then we performed amputation surgery of distal phalanx. Lymph node biopsy and resection margin was negative for melanoma. Chemotherapy was administered immediately. After 5 months, pulmonary nodular lesion was found and diagnosed as metastatic malignant melanoma by the wedge resection surgery. The patient is treated for additional chemotherapy consistently and disease free for 2 years. Nodular type melanoma of the finger is uncommon and it could be presented as ulceration and amelanotic nodular mass. Therefore we recommend biopsy to diagnose correctly if there are chronic non healing lesions on the fingers.
Amputation ; Biopsy ; Diagnosis ; Drug Therapy ; Female ; Fingers ; Humans ; Lymph Nodes ; Melanoma* ; Middle Aged ; Thumb* ; Ulcer

BACKGROUND: Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws. METHODS: A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla. RESULTS: Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction. CONCLUSIONS: Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.
Absorbable Implants ; Follow-Up Studies ; Foreign Bodies* ; Foreign-Body Reaction* ; Humans ; Maxilla ; Maxillofacial Injuries ; Sutures

The apoptotic effect of bacteria-derived beta-glucan was investigated in human colon cancer cells SNU-C4 using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay, reverse transcription-polymerase chain reaction (RT-PCR) expressions of Bcl-2, Bax, and Caspase-3 genes, and assay of caspase-3 enzyme activity. beta-Glucan of 10, 50, and 100 microg/mL decreased cell viability in a dose-dependent manner with typical apoptotic characteristics, such as morphological changes of chromatin condensation and apoptotic body formation from TUNEL assay. In addition, beta-glucan (100 microgram/mL) decreased the expression of Bcl-2 by 0.6 times, whereas the expression of Bax and Caspase-3 were increased by 3.1 and 2.3 times, respectively, compared to untreated control group. Furthermore, the caspase-3 activity in the beta-glucan-treated group was significantly increased compared to those in control group (P < 0.05). Bacterial derived beta-glucan could be used as an effective compound inducing apoptosis in human colon cancer.
Apoptosis ; Caspase 3 ; Cell Survival ; Chromatin ; Colon ; Colonic Neoplasms ; DNA Nucleotidylexotransferase ; Humans ; In Situ Nick-End Labeling

PURPOSE: The purpose of this study was to identify the effects of a multi agent obesity control program in obese school children. This program was composed of strategies to modify diet and exercise habits and to change cognitive behavior variables(stress, coping, and self-efficacy). METHOD: The subjects were 40 obese school children who participated in our project voluntarily via homepage, TV, newspaper, public paper and school official documents. The program was implemented daily for 4 sessions per day for ten days from August 16 to 26, 2004. The daily program consisted of exercise therapy, dance therapy, cognitive behavior therapy and aroma therapy. The data was analyzed by paired t-test using the SPSSWIN program. RESULT: There was a significant decrease in children's waist-hip ratio (p=.04) and in children's stress (p=.00) after the program. There was a significant increase in children's self-confidence after the program(p=.02) and a significant decrease in children's diet habit after the program(p=.02). CONCLUSION: This study provides evidence that a multiagent obese control program is effective in changing waist-hip ratio, stress, self-confidence, and diet habits in obese school children.
Child ; Child Behavior ; Diet, Reducing ; Female ; Food Habits ; Humans ; Male ; Multivariate Analysis ; Obesity/psychology/*therapy ; *Program Evaluation ; Schools ; Self Efficacy ; Waist-Hip Ratio ; Weight Loss

Natural infections with influenza A viruses have been reported in a variety of animal species including humans, pigs, horses, sea mammals, and birds. Although viruses of relatively few haemagglutinin(HA) and neuraminidase(NA) subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. During the past few years, several subtypes of avian influenza A have been shown to cross the species barrier and infect humans. During an outbreak of a highly pathogenic influenza A(H5N1) virus among poultry in Hong Kong in 1997, 6 of 18 people with confirmed infection died. And a total of 89 human infections with influenza A(H7N7), including 1 resulting in the death of a Dutch veterinarian, occurred during the extensive outbreak in 2003. During late 2003 and early 2004, there were reports of large outbreaks of H5N1 among poultry throughout Asia (including Korea, Japan, Indonesia, Vietnam, Thailand, Laos, Cambodia, and China). In Korea, we had also highly pathogenic avian influenza(HPAI) outbreak in 2003~2004 with a first suspected case reported on 10 December 2003. The case was reported at a parent stock farm for broilers, which was located in Chungbuk province, and the farm was immediately placed under movement restrictions. Laboratory tests confirmed the outbreak of HPAI on 12 December 2003. Up to 20 March 2004, a total of 19 farms were confirmed as having been infected with HPAI virus. No further outbreaks occurred after that date. Fortunately there were no human cases founded in this epidemic in Korea. In January 2004, there was confirmation that influenza A(H5N1) virus had been isolated from patients who had died of a respiratory illness in Vietnam. Total 107 human confirmed cases were reported until June 2005 to WHO, threatening new pandemic outbreak. We reviewed our prevention and control strategies of avian influenza and preparedness to the pandemic outbreak.
Animals ; Asia ; Birds ; Cambodia ; Chungcheongbuk-do ; Communicable Diseases, Emerging ; Disease Outbreaks ; Epidemiology* ; Hong Kong ; Horses ; Humans ; Indonesia ; Influenza A virus ; Influenza in Birds* ; Influenza, Human ; Japan ; Korea ; Laos ; Mammals ; Pandemics ; Parents ; Poultry ; Swine ; Thailand ; Veterinarians ; Vietnam

Thrombospondin-1 (TSP-1) level is tightly regulated at the transcriptional level. To determine the detailed molecular mechanisms of TSP-1 expression, nine serial 5'-deletion constructs of the human genomic tsp-1 promoter (nucleotides -2,220 to +756) were prepared, inserted into luciferase reporter plasmids, and transiently transfected into the Hep3B human hepatocarcinoma cell. Among the nine 5'-deletion constructs, pTSP-Luc-4 (-767~+756) had consistently decreased luciferase activity with or without PMA stimulation, whereas a further truncated construct [pTSP-Luc-4' (-407~+756)] had increased levels of expression. By searching the nucleotides from -767 to -407, a consensus binding sequence (5'-CCATTTT-3') for the repressor Yin Yang-1 (YY-1) at nucleotide -440 was identified. The suppression induced by this site was weakened in the presence of the region upstream of nucleotide -767 (pTSP-Luc-1 and -2). Nuclear protein directly bound to an oligonucleotide containing the repressive YY-1 sequence but the binding capacity of the sequence was decreased by the increased c-Jun levels. Moreover, proteins immunoprecipitated with anti-YY-1 revealed an interaction between c-Jun and YY-1 factor. These data suggest that the repressive YY-1 site of the tsp-1 promoter could not be functional via activating positive cis-elements on the upstream from this site and weakened via c-Jun/YY-1 interactions.
Binding Sites/genetics ; Cell Line, Tumor ; DNA-Binding Proteins/*metabolism ; Down-Regulation/genetics ; Electrophoretic Mobility Shift Assay ; Genes, Reporter/genetics ; Humans ; Luciferases/analysis/genetics ; Promoter Regions (Genetics)/*genetics ; Proto-Oncogene Proteins c-jun/genetics/*metabolism ; Repressor Proteins/*metabolism ; Research Support, Non-U.S. Gov't ; Sequence Deletion/genetics ; Thrombospondin 1/*genetics/metabolism ; Transcription Factor AP-1/metabolism ; Transcription Factors/*metabolism