PURPOSE: The purpose of this study was to demonstrate the prognostic significance of changes in body composition in patients with newly diagnosed hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Patients (n=178) newly diagnosed with HCC participated in the study between 2007 and 2012. Areas of skeletal muscle and abdominal fat were directly measured using a three-dimensional workstation. Cox proportional-hazards modes were used to estimate the effect of baseline variables on overall survival. The inverse probability of treatmentweighting (IPTW) method was used to minimize confounding bias. RESULTS: Cutoff values for sarcopenia, obtained from receiver-operating characteristic curves, were defined as skeletal muscle index at the third lumbar vertebra of ≤ 45.8 cm/m2 for males and ≤ 43.0 cm/m2 for females. Sarcopenia patients were older, more likely to be female, and had lower body mass index. Univariable analysis showed that the presence of sarcopenia and visceral to subcutaneous fat area ratio (VSR) were significantly associatedwith prognosis. The multivariable analyses revealed that VSR was predictive of overall survival. However, in the multivariable Cox model adjusted by IPTW, sarcopenia, not VSR, were associated with overall survival. CONCLUSION: The presence of sarcopenia at HCC diagnosis is independently associated with survival.
Abdominal Fat ; Bias (Epidemiology) ; Body Composition ; Body Mass Index ; Carcinoma, Hepatocellular* ; Diagnosis ; Female ; Humans ; Intra-Abdominal Fat ; Liver* ; Male ; Methods ; Muscle, Skeletal ; Prognosis* ; Sarcopenia* ; Spine ; Subcutaneous Fat

PURPOSE: The success of cardiopulmonary resuscitation (CPR) depends on how soon after a heart attack the intervention is done and on how the quality of the CPR is. Although in Korea there are several CPR education courses, CPR done by bystanders to an attack remains very low. This might be related to different causes such as the complexity of the CPR sequence and the difficulty of learning CPR, specifically ventilation maneuvers. The American Heart Association (AHA) has recently recommended 'Hands Only(TM) CPR', without ventilation, for bystander rescuers. In the present study, we investigated the educational effects of 'Hands Only(TM) CPR' in elementary school students. We further analyzed the effects of this variable on CPR skill learning and retention for a 3 months period. METHODS: We selected two groups of 5th grade elementary school students to perform this study. One group received CPR education with ventilation (CPR with ventilation group); the other received 'Hands Only(TM) CPR' education ('Hands Only(TM) CPR' group). The Laerdal PC Skill Reporting system was used for both education sessions and for evaluation immediately after the sessions. Skill performance data, together with ventilation data and compression data were recorded for further comparisons. RESULTS: There were no differences between the two groups regarding chest compression (average rate, average duty cycle, registered with no error, average depth, etc.). The average chest compression count per minute was 118+/-12/min in the 'Hands Only(TM) CPR' group and 85+/-13/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 23+/-29% in the 'Hands Only(TM) CPR' group and 23+/-31% in the CPR with ventilation group (p=0.962). The total hands off time was 18+/-7 seconds in the 'Hands Only(TM) CPR' group and 40+/-11 seconds in the CPR with ventilation group. After 3 months there were still no differences in chest compression between the two groups. The average count per minute at 3 months was 109+/-15/min in the 'Hands Only(TM) CPR' group and 83+/-17/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 26+/-31% in the 'Hands Only(TM) CPR' group and 31+/-35% in the CPR with ventilation group (p=0.334). The total hands off time was 12+/-5 seconds in the 'Hands Only(TM) CPR' group and 31+/-12 seconds in the CPR with ventilation group (p=0.001). CONCLUSION: The 'Hands Only(TM) CPR' program in elementary school children increased the chest compression rate. However, there was no between groups difference in adequate compression depth. We were unable to demonstrate that the 'Hands Only(TM) CPR' education program in elementary school children led to a better effect.
American Heart Association ; Cardiopulmonary Resuscitation ; Child ; Hand ; Heart ; Humans ; Korea ; Learning ; Retention (Psychology) ; School Health Services ; Thorax ; Ventilation

The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (Ptrend = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (Ptrend = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (Ptrend < 0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).
Asian Continental Ancestry Group ; Cohort Studies ; Cross-Sectional Studies ; Demography ; Diabetes Mellitus, Type 2/*complications/diagnosis ; Dietary Fiber ; *Energy Intake ; Female ; Humans ; Male ; Middle Aged ; Obesity/*etiology ; Odds Ratio ; Republic of Korea ; Risk Factors

Hepatocellular carcinoma (HCC) has extremely poor prognosis. Immunotherapy has emerged as a new treatment for a number of cancers. Adoptive immunotherapy is one of the important cancer immunotherapy, which relies on the various lymphocytes including cytotoxic T lymphocytes, natural killer (NK) and cytokine induced killer cells. Also, there has been advance in techniques of NK cell activation to more effectively kill the cancer cells. Of note, recently the blocking antibodies targeting programmed cell death protein 1 (PD-1) have shown promising results in diverse cancers including HCC. We report our recent experience of a patient accompanying advanced HCC with extrahepatic metastases. Disease progression had occurred after sorafenib administration, while the patient showed local tumor control and tumor marker decrease by NK cell immunotherapy combined with PD-1 inhibitor therapy. Though, there was no definite survival advantage due to impaired liver function, which might be caused by treatment related toxicities as well as cancer progression.
Antibodies, Blocking ; Carcinoma, Hepatocellular ; Cell Death ; Cytokine-Induced Killer Cells ; Disease Progression ; Humans ; Immunotherapy ; Immunotherapy, Adoptive ; Killer Cells, Natural ; Liver ; Lymphocytes ; Neoplasm Metastasis ; Prognosis ; Programmed Cell Death 1 Receptor ; T-Lymphocytes, Cytotoxic

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake. METHODS: Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors. RESULTS: Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9–8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122–8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404–7.228; P=0.47). CONCLUSIONS: Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.
Biopsy ; Carcinoma, Hepatocellular ; Fatty Liver ; Follow-Up Studies ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Incidence ; Liver ; Liver Neoplasms ; Non-alcoholic Fatty Liver Disease ; Propensity Score