Liquid biopsy, the analysis of circulating biomarkers from peripheral blood, such as circulating tumor cells (CTCs) and circulating tumor DNA, and exosomes, offers a less invasive, new source of cancer-derived materials that may reflect the status of the disease better and thereby contribute to personalized treatment. Recent advances in microfluidics and molecular analysis technologies have resulted in greatly improved CTC enumeration and detection. In this article, we review commercially available technologies used to isolate CTCs from peripheral blood, including immunoaffinity and label-free, physical property-based isolation methods. Although enormous technological progress has been made, especially within the last decade, only a few CTC detection methods have been approved for routine clinical use. Here, we provide an overview of the current CTC isolation methods and examples of their potential application for early diagnosis, prognosis, treatment monitoring, and prediction of resistance to cancer therapy. Furthermore, the challenges that remain to be addressed before such tools are implemented for routine use in clinical settings are discussed.
Biomarkers ; Biopsy ; DNA ; Early Diagnosis ; Exosomes ; Humans ; Methods* ; Microfluidics ; Neoplastic Cells, Circulating* ; Prognosis ; Stomach Neoplasms

Koreans have undergone many changes in dietary patterns with economic growth. The purpose of this research was to examine changes in dietary patterns using data from the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. The study included 21,525 subjects (8,295 from 1998, 6,880 from 2001, and 6,350 from 2005) who were 20 years or older and who participated in a 24-h diet recall. The percentage energy intake from 22 food groups was calculated, and a cluster analysis was applied to identify dietary patterns. Two dietary patterns emerged; the first pattern was characterized by high intake of white rice, legumes, vegetables, kimchi, and seaweeds, the so-called "traditional" pattern (53%), whereas the other pattern was characterized by high intake of other grains, noodle dumplings, floured bread, pizza, hamburgers, cereals and snacks, potatoes, sugared sweets, nuts, fruits, meat.its products, eggs, fish, milk and dairy products, oils, beverages and seasoning, or the so-called "modified" pattern. The modified pattern comprised a higher proportion of younger aged, metropolitan residents with more education and higher incomes. However, the gender distribution was not significantly different. The modified pattern had a significantly higher intake of all nutrients except carbohydrates and had a higher proportion of energy from fat and protein. No association with a risk for metabolic syndrome was found for either dietary pattern. After age was standardized, the traditional pattern included 52% of the respondents in 1998, 54% in 2001, and 50% in 2005. However, the modified pattern was significantly more prevalent in the younger age group (20-29 yr), whereas the traditional pattern increased significantly in the older age group (> or = 65 yr). In conclusion, a secular trend was found for dietary pattern by age group, suggesting that it is necessary to monitor the changes in dietary pattern by age group and to develop appropriate dietary education and guidelines.
Adult ; Aged ; Beverages ; Bread ; Carbohydrates ; Cluster Analysis ; Dairy Products ; Diet ; Economic Development ; Edible Grain ; Eggs ; Energy Intake ; Fabaceae ; Flour ; Fruit ; Humans ; Milk ; Nutrition Surveys ; Nuts ; Oils ; Organothiophosphorus Compounds ; Ovum ; Seasons ; Snacks ; Solanum tuberosum ; Surveys and Questionnaires ; Vegetables

Background: We investigated whether Lactobacillus plantarum strain LMT1-48, isolated from Korean fermented foods and newborn feces, is a suitable probiotic supplement to treat overweight subjects. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 100 volunteers with a body mass index of 25 to 30 kg/m2 were assigned randomly (1:1) to receive 2×1010 colony forming units of LMT1-48 or to a placebo treatment group. Body composition was measured by dual-energy X-ray absorptiometry, and abdominal visceral fat area (VFA) and subcutaneous fat area were measured by computed tomography scanning. Changes in body fat, VFA, anthropometric parameters, and biomarkers were compared between the two treatment groups (ClinicalTrials.gov number: NCT03759743). Results: After 12 weeks of treatment, the body weight decreased significantly from 76.6±9.4 to 75.7±9.2 kg in the LMT1-48 group but did not change in the placebo group (P=0.022 between groups). A similar pattern was found in abdominal VFA between the two groups (P=0.041). Serum insulin levels, the corresponding homeostasis model assessment of insulin resistance, and leptin levels decreased in the LMT1-48 group but increased in the placebo group (all P<0.05). Decrease in body weight and body mass index by treatment with LMT1-48 was correlated with increase in Lactobacillus levels significantly. LMT1-48 also increased Oscillibacter levels significantly, which were negatively correlated with triglyceride and alanine transaminase levels. Conclusion Administration of LMT1-48 decreased body weight, abdominal VFA, insulin resistance, and leptin levels in these subjects with overweight, suggesting its anti-obesogenic therapeutic potential.

Background: Long term quality of life is becoming increasingly crucial as survival following partial pancreatectomy rises. The purpose of this study was to investigate the difference in glucose dysregulation after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). Methods: In this prospective observational study from 2015 to 2018, 224 patients who underwent partial pancreatectomy were selected: 152 (67.9%) received PD and 72 (32.1%) received DP. Comprehensive assessment for glucose regulation, including a 75 g oral glucose tolerance test was conducted preoperatively, and 1, 12, and 52 weeks after surgery. Patients were further monitored up to 3 years to investigate development of new-onset diabetes mellitus (NODM) in patients without diabetes mellitus (DM) at baseline or worsening of glucose regulation (≥1% increase in glycosylated hemoglobin [HbA1c]) in those with preexisting DM. Results: The disposition index, an integrated measure of β-cell function, decreased 1 week after surgery in both groups, but it increased more than baseline level in the PD group while its decreased level was maintained in the DP group, resulting in a between-group difference at the 1-year examination (P<0.001). During follow-up, the DP group showed higher incidence of NODM and worsening of glucose regulation than the PD group with hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.49 to 12.3) and HR 2.15 (95% CI, 1.09 to 4.24), respectively, in the multivariate analysis including dynamic glycemic excursion profile. In the DP procedure, distal DP and spleen preservation were associated with better glucose regulation. DP had a stronger association with glucose dysregulation than PD. Conclusion Proactive surveillance of glucose dysregulation is advised, particularly for patients who receive DP.

The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and beta-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including beta-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.
Adrenal Cortex Hormones ; Adult ; Antithyroid Agents ; Cholestyramine Resin* ; Drug Resistance ; Female ; Glycogen Storage Disease Type VI ; Graves Disease* ; Humans ; Hypersensitivity ; Iodine ; Thyroid Function Tests ; Thyroid Gland ; Thyroidectomy* ; Thyrotoxicosis

RESULTS: RBS supplementation improved serum triglyceride and free fatty acid levels in OVX rats. Histological analysis showed that RBS significantly attenuated hepatic fat accumulation and decreased hepatic lipid, total cholesterol, and triglyceride levels. Additionally, RBS suppressed the estrogen deficiency-induced upregulation of lipogenic genes, such as sterol regulatory element-binding protein 1 (SREBP1), acetyl-CoA carboxylase 1, fatty acid synthase, glycerol-3-phosphate acyltransferase, and stearoyl-CoA desaturase 1. CONCLUSIONS RBS and γ-oryzanol effectively reduced lipid accumulation in a HepG2 cell hepatic steatosis model. RBS improves OVX-induced hepatic steatosis by regulating the SREBP1-mediated activation of lipogenic genes, suggesting the benefits of RBS in preventing fatty liver in postmenopausal women.

Lymphomatoid granulomatosis (LYG) is an Epstein-Barr virus (EBV)-associated lymphoproliferative disease. It is considered a rare entity in pediatric patients. An adolescent male with lobar consolidation suspected of having pneumonia was resistant to antibiotics and had persistently abnormal radiographs with chest pain. The patient was diagnosed with pulmonary LYG through video-assisted thoracoscopic surgery (VATS) lung biopsy. He received eight cycles of rituximab, vincristine, cyclophosphamide, and prednisolone (R-CVP) but had progressive disease. As the patient developed hypogammaglobulinemia after eight courses of rituximab, he received intravenous gamma globulin (IVIG) at regular interval. With immune augmentation effect of IVIG and immune modulation treatment with prednisolone, the patient has shown no aggravation of the lung lesions. Considering its rarity, high mortality, and frequent relapses, diagnostic methods investigating the radiologic abnormalities can help in early treatment initiation.

Objective: To investigate demographic and skeletodental characteristics of one-jaw (1J-OGS) and two-jaw orthognathic surgery (2J-OGS) in patients with skeletal Class III malocclusion. Methods: 750 skeletal Class III patients who underwent OGS at 10 university hospitals in Korea between 2015 and 2019 were investigated; after dividing them into the 1J-OGS (n = 186) and 2J-OGS groups (n = 564), demographic and skeletodental characteristics were statistically analyzed. Results: 2J-OGS was more frequently performed than 1J-OGS (75.2 vs. 24.8%), despite regional differences (capital area vs. provinces, 86.6 vs. 30.7%, p < 0.001). Males outnumbered females, and their mean operation age was older in both groups. Regarding dental patterns, the most frequent maxillary arch length discrepancy (ALD) was crowding in the 1J-OGS group (52.7%, p < 0.001) and spacing in the 2J-OGS group (40.4%, p < 0.001). However, the distribution of skeletal pattern was not significantly different between the two groups (all p > 0.05). The most prevalent skeletal patterns in both groups were hyper-divergent pattern (50.0 and 54.4%, respectively) and left-side chin point deviation (both 49.5%).Maxillary spacing (odds ratio [OR], 3.645; p < 0.001) increased the probability of 2J-OGS, while maxillary crowding (OR, 0.672; p < 0.05) and normo-divergent pattern (OR, 0.615; p < 0.05) decreased the probability of 2J-OGS. Conclusions In both groups, males outnumbered females, and their mean operation age was older. The most frequent ALD was crowding in the 1J-OGS group, and spacing in the 2J-OGS group, while skeletal characteristics were not significantly different between the two groups.

Purpose: This study aimed to investigate the incidence and risk factors for secondary malignant neoplasms (SMN) in pediatric solid tumors, focusing on the effects of tandem high-dose chemotherapy (HDCT). Materials and Methods: Patients (aged < 19 years) diagnosed with or treated for pediatric solid tumors between 1994 and 2014 were retrospectively analyzed. The cumulative incidence of SMN was estimated using competing risk methods by considering death as a competing risk. Results: A total of 1,435 patients (413 with brain tumors and 1,022 with extracranial solid tumors) were enrolled. Seventy-one patients developed 74 SMNs, with a 10-year and 20-year cumulative incidence of 2.680±0.002% and 10.193±0.024%, respectively. The types of SMN included carcinoma in 28 (37.8%), sarcoma in 24 (32.4%), and hematologic malignancy in 15 (20.3%) cases. Osteosarcoma and thyroid carcinoma were the most frequently diagnosed tumors. Multivariate analysis showed that radiotherapy (RT) > 2, 340 cGy, and tandem HDCT were significant risk factors for SMN development. The SMN types varied according to the primary tumor type; carcinoma was the most frequent SMN in brain tumors and neuroblastoma, whereas hematologic malignancy and sarcomas developed more frequently in patients with sarcoma and retinoblastoma, respectively. Conclusion The cumulative incidence of SMN in pediatric patients with solid tumors was considerably high, especially in patients who underwent tandem HDCT or in those who received RT > 2,340 cGy. Therefore, the treatment intensity should be optimized based on individual risk assessment and the long-term follow-up of pediatric cancer survivors.

Objective: To investigate the pattern of accuracy change in artificial intelligence-assisted landmark identification (LI) using a convolutional neural network (CNN) algorithm in serial lateral cephalograms (Lat-cephs) of Class III (C-III) patients who underwent twojaw orthognathic surgery. Methods: A total of 3,188 Lat-cephs of C-III patients were allocated into the training and validation sets (3,004 Lat-cephs of 751 patients) and test set (184 Lat-cephs of 46 patients; subdivided into the genioplasty and non-genioplasty groups, n = 23 per group) for LI. Each C-III patient in the test set had four Lat-cephs: initial (T0), pre-surgery (T1, presence of orthodontic brackets [OBs]), post-surgery (T2, presence of OBs and surgical plates and screws [S-PS]), and debonding (T3, presence of S-PS and fixed retainers [FR]). After mean errors of 20 landmarks between human gold standard and the CNN model were calculated, statistical analysis was performed. Results: The total mean error was 1.17 mm without significant difference among the four timepoints (T0, 1.20 mm; T1, 1.14 mm; T2, 1.18 mm; T3, 1.15 mm). In comparison of two time-points ([T0, T1] vs. [T2, T3]), ANS, A point, and B point showed an increase in error (p < 0.01, 0.05, 0.01, respectively), while Mx6D and Md6D showeda decrease in error (all p < 0.01). No difference in errors existed at B point, Pogonion, Menton, Md1C, and Md1R between the genioplasty and non-genioplasty groups. Conclusions The CNN model can be used for LI in serial Lat-cephs despite the presence of OB, S-PS, FR, genioplasty, and bone remodeling.