No absract available.
Follow-Up Studies* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.
Carcinoma, Hepatocellular* ; Liver ; Liver Neoplasms ; Radiotherapy*

OBJECTIVES: The purpose of this study was to develop and appraise an oral health literacy assessment tool for upper elementary school students. METHODS: Twenty-eight preliminary assessment items were developed on the basis of various types of oral health education literature for children. They contained verbal and functional sections and they were classified into 2 cognitive processes (literal and inferential). The questionnaires were analyzed using the testAn v.1.0 program for identified Cronbach's α, item discrimination, and difficulty through classical test theory. A final evaluation tool was developed and selected by conducting three surveys and 20 items. RESULTS: The final survey was completed by 132 fifth and sixth grade elementary school students in Seoul. The Cronbach's α value, item discrimination, and difficulty were .71, .38, and .75, respectively. The mean score for oral health literacy of children was 14.9 (±3.2, theoretical range: 0-20, 75% correct answers). CONCLUSIONS: These results suggest that this tool could be relied on to help determine the level of oral health literacy in children and in preparing appropriate oral health education programs for children.
Child ; Discrimination (Psychology) ; Education ; Humans ; Literacy* ; Oral Health* ; Seoul

OBJECTIVES: This study aimed to determine the oral health behaviors and the relationships between social support, self-esteem, and oral health behaviors. METHODS: The institutions were selected based on the “2016 Elderly Welfare Facilities Status.” A total of 195 people participated in interviews conducted using a 39-item questionnaire. It included information on the following topics: a) sociodemographic and health-related characteristics (11 items), b) oral health behaviors (6), c) social support (12), and d) self-esteem (10). Statistical analyses included descriptive statistics, a reliability test, a t-test, an ANOVA, a Pearson's correlation test, and a stepwise multiple regression, conducted using the SPSS 23.0 program. RESULTS: Of the 195 participants, 165 (84.6%) brushed their teeth twice a day; however only 74 (38.0%) participants used oral care products. Although many (64.6%) elderly people visited a dentist at least once a year, only a few (24.6%) visited the dentist for preventive purposes. Oral health behaviors had a positive correlation with self-esteem, significant others' support, and friends'support (.337, .270, and .254, respectively; P<.01). According to the multiple regression analysis, self-esteem, significant others' support, perceived health status, number of existing permanent teeth, friends' support, degree of exercise, gender, and average monthly expenditure had a significant effect on the participants' oral health behaviors. CONCLUSIONS: We demonstrated that social support and self-esteem might be major predictors of oral health behaviors. These results suggest that psychosocial factors need to be taken into account in the oral health education provided for elderly people.
Aged* ; Dentists ; Education ; Health Expenditures ; Humans ; Oral Health* ; Psychology ; Tooth

PURPOSE: To investigate the presence of adaptive response by low dose radiation in murine tumors in relation to radiation induced apoptosis as well as related mechanism. MATERIALS AND METHODS: Syngeneic murine tumors, OCa-I and HCa-I, were given 0.05 Gy pretreatment followed by therapeutic dose of 25 Gy radiation. Induction of apoptosis was analyzed for each treatment group. Regulating molecules of apoptosis, p53, Bcl-2, Bax, Bcl-X, were also analyzed by Western blotting. RESULTS: In 0.05 Gy pretreatment group of OCa-I, 25 Gy-induced apoptosis per 1000 cells was 229, which was estimated at 30% lower level than the expected (p<0.05). In contrast, this reduction in radiation induced apoptosis was not seen in HCa-I. In the expression of apoptosis regulating molecules, p53 increased in both tumors in response to radiation. Bcl-2 and Bax did not show significant change in both tumors however, the expression of Bcl-2 surpassed that of Bax in 0.05 Gy pretreatment group of OCa-I. Bcl-X was not expressed in OCa-I. In HCa-I, Bcl-X showed increased expression even with 0.05 Gy. CONCLUSION: Adaptive response by low dose radiation is shown in one murine tumor, OCa-I, in relation to radiation induced apoptosis. Apoptosis regulating molecules including Bcl-2/Bax and Bcl-X, appear to related. This study shows an evidence that adaptive response is present, but not a generalized phenomenon in vivo.
Apoptosis* ; Blotting, Western ; Radiation Dosage

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) patients with spinal metastasis (SM) show heterogeneous lengths of survival. In this study, we develop and propose a graded prognostic assessment for HCC patients with SM (HCC-SM GPA). METHODS: We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors that significantly affected survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016. RESULTS: We developed the HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status (0–2, 0 point; 3–4, 1 point), controlled primary HCC (yes, 0 point; no, 2 points), and extrahepatic metastases other than bone (no, 0 point; yes, 1 point). Patients were stratified into low (GPA=0), intermediate (GPA=1 to 2), and high risk (GPA=3 to 4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 17.8%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p<0.001). CONCLUSIONS: Our newly proposed HCC-SM GPA successfully predicted survival outcomes.
Carcinoma, Hepatocellular* ; Cohort Studies ; Humans ; Neoplasm Metastasis* ; Radiotherapy ; Survival Rate

PURPOSE: Cell-free DNA (cfDNA) is gaining attention as a novel biomarker for oncologic outcomes. We investigated the clinical significance of cfDNA in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT). MATERIALS AND METHODS: Fifty-five patients with HCC who received RT were recruited from two prospective study cohorts: one cohort of 34 patients who underwent conventionally fractionated RT and a second of 21 patients treated with stereotactic body radiation therapy. cfDNA was extracted and quantified. RESULTS: In total, 30% of the patients had multiple tumors, 77% had tumors >2 cm, and 32% had portal vein tumor thrombus. Optimal cut-off values for cfDNA levels (33.65 ng/mL and 37.25 ng/mL, before and after RT) were used to divide patients into low-DNA (LDNA) and high-DNA (HDNA) groups. The pre-RT HDNA group tended to have more advanced disease and larger tumors (p=0.049 and p=0.017, respectively). Tumor response, intrahepatic failure-free rates, and local control (LC) rates were significantly better in the post-RT LDNA group (p=0.017, p=0.035, and p=0.006, respectively). CONCLUSION: Quantitative analysis of cfDNA was feasible in our cohorts. Post-RT cfDNA levels were negatively correlated with treatment outcomes, indicating the potential for the use of post-RT cfDNA levels as an early predictor of treatment responses and LC after RT for HCC patients.
Biomarkers ; Carcinoma, Hepatocellular* ; Cohort Studies ; DNA* ; Humans ; Plasma* ; Portal Vein ; Prospective Studies ; Radiotherapy* ; Thrombosis

OBJECTIVES: The purpose of this study was to examine oral health literacy in a sample of Korean of 5th and 6th grade elementary school children. METHODS: Data were obtained from a convenience sample of 274 5(th) and 6(th) grade children from two elementary schools located in Seoul and Uijeongbu. The oral health literacy assessment tool for children of Korea (OHLC-K) takes approximately 11 minutes to complete, and consists of 20 self-report questions with a score range of 0 to 20. Item analysis, descriptive statistics, correlation and multiple linear regression were performed using SPSS 23.0 and testAn 1.0. RESULTS: The lowest and highest percentage of correct answers were found in “Definition of periodontal disease (19.3%)” and “Definition of halitosis (92.7%),” respectively. The mean score for oral health literacy was found to be 14.95 ± 2.83, corresponding to a score of approximately 75% correct answers. The correlation coefficient for Korean and OHLC-K scores was high (r=.73, P < .01). In the multiple linear regression, oral health literacy was associated with grade and gender. CONCLUSION: The present findings revealed that a quarter of the subjects were likely to misunderstand oral health information. Oral health education is indispensable to all children and, therefore, it is necessary to pay greater attention to children who exhibit poor oral health literacy.
Child ; Education ; Halitosis ; Humans ; Korea ; Linear Models ; Literacy ; Oral Health ; Periodontal Diseases ; Seoul

PURPOSE: To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study. MATERIALS AND METHODS: A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. RESULTS: The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 2~3 cm distal to the anastomosis in patient whose sphincter was saved, and 2~3 cm distal to the perineal scar in patients whose anal sphincter was sacrificed; anterior margin at the posterior tip of the symphysis pubis or 2~3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.5~2 cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). CONCLUSION: These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved by following the Korean Patterns of Care Study.
Anal Canal ; Cicatrix ; Consensus ; Humans ; Lymph Nodes ; Radiotherapy ; Rectal Neoplasms* ; Sacroiliac Joint ; Sacrum ; Seoul

Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
Adult ; Carcinoma, Hepatocellular/complications/drug therapy/surgery/*therapy ; *Chemoradiotherapy ; Cisplatin/therapeutic use ; Disease-Free Survival ; Female ; Fluorouracil/therapeutic use ; Humans ; Liver Neoplasms/complications/drug therapy/surgery/*therapy ; *Liver Transplantation ; *Living Donors ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Portal Vein ; Venous Thrombosis/*complications