BACKGROUND: This study was conducted to investigate preoperative carcinoembryonic antigen (CEA) as a prognostic factor in colorectal cancer. METHODS: Between January 2000 and July 2011, 1298 patients with primary adenocarcinoma colorectal cancer without metastasis, who underwent curative resection were retrospectively identified. The patients were divided into two groups according to serum CEA level at primary diagnosis: a high CEA (HCEA) group (serum CEA ≥6 ng/mL) and a normal CEA (NCEA) group (serum CEA <6 ng/mL). A 1:1 propensity score matching analysis was applied to reduce bias. Finally, 364 patients were enrolled in this study. Matched variables were age, gender, preoperative chemoradiotherapy, tumor site, cell differentiation and pathologic stage. RESULTS: The clinicopathological characteristics of the two groups did not differ significantly difference. The systemic metastasis rate was 16.5% (30/182) and 25.3% (46/182) in the NCEA and HCEA groups, respectively (p=0.039). There were no significant differences in local recurrence or metastatic sites between groups. The 5-year disease-free survival (DFS) rate of the HCEA group was worse than that of the NCEA group; however, there was no significant difference in overall survival between the two groups. CONCLUSION: Elevated preoperative CEA was related to frequent systemic recurrence and low DFS. Therefore, elevated preoperative CEA could be considered a prognostic factor for worse clinical outcomes in patients with colorectal cancer.
Adenocarcinoma ; Bias (Epidemiology) ; Carcinoembryonic Antigen* ; Cell Differentiation ; Chemoradiotherapy ; Colorectal Neoplasms* ; Diagnosis ; Disease-Free Survival ; Humans ; Neoplasm Metastasis ; Prognosis ; Propensity Score* ; Recurrence ; Retrospective Studies

PURPOSE: We assessed the oncologic and anastomotic benefits of low ligation of the inferior mesenteric artery (IMA) with additional lymph node (LN) retrieval. METHODS: We performed a retrospective case-control study between January 2011 and July 2015. All patients underwent curative resection of a primary sigmoid or rectal tumor. We excluded patients with distant metastases at the time of diagnosis. The case group included patients who underwent high ligation of the IMA (high group, HG). The control group included patients who underwent low ligation of the IMA with low group with additional LN retrieval (LGAL). Controls were identified by matching patients based on age (±5 years), sex, tumor location, and final histopathological stage. Finally, each group included 97 patients. RESULTS: Clinical characteristics did not significantly differ between groups. The mean number of additional harvested LN was 2.19 (range, 0–11), and one patient in the LGAL had a metastatic LN among the additional harvested LN. The overall morbidity was 22.7% in the HG and 30% in the LGAL (P = 0.257). Anastomotic leakage occurred in 14 patients (14.4%) in the HG and 5 patients (5.2%) in the LGAL (P = 0.030). The mean disease-free survival time in the HG was longer than that in the LGAL (P = 0.008). The mean overall survival (OS) time was 70.4 ± 1.3 months. The mean OS was 63.7 ± 1.6 months in the HG and 69.1 ± 2.6 months in the LGAL (P = 0.386). CONCLUSION: Low ligation of the IMA with additional LN retrieval is technically safe. However, the oncologic effect was better after high ligation of IMA.
Anastomotic Leak ; Case-Control Studies ; Colon, Sigmoid ; Colorectal Neoplasms ; Diagnosis ; Disease-Free Survival ; Humans ; Ligation ; Lymph Nodes ; Mesenteric Artery, Inferior ; Neoplasm Metastasis ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND: This study was conducted to investigate preoperative carcinoembryonic antigen (CEA) as a prognostic factor in colorectal cancer.METHODS: Between January 2000 and July 2011, 1298 patients with primary adenocarcinoma colorectal cancer without metastasis, who underwent curative resection were retrospectively identified. The patients were divided into two groups according to serum CEA level at primary diagnosis: a high CEA (HCEA) group (serum CEA ≥6 ng/mL) and a normal CEA (NCEA) group (serum CEA <6 ng/mL). A 1:1 propensity score matching analysis was applied to reduce bias. Finally, 364 patients were enrolled in this study. Matched variables were age, gender, preoperative chemoradiotherapy, tumor site, cell differentiation and pathologic stage.RESULTS: The clinicopathological characteristics of the two groups did not differ significantly difference. The systemic metastasis rate was 16.5% (30/182) and 25.3% (46/182) in the NCEA and HCEA groups, respectively (p=0.039). There were no significant differences in local recurrence or metastatic sites between groups. The 5-year disease-free survival (DFS) rate of the HCEA group was worse than that of the NCEA group; however, there was no significant difference in overall survival between the two groups.CONCLUSION: Elevated preoperative CEA was related to frequent systemic recurrence and low DFS. Therefore, elevated preoperative CEA could be considered a prognostic factor for worse clinical outcomes in patients with colorectal cancer.
Adenocarcinoma ; Bias (Epidemiology) ; Carcinoembryonic Antigen ; Cell Differentiation ; Chemoradiotherapy ; Colorectal Neoplasms ; Diagnosis ; Disease-Free Survival ; Humans ; Neoplasm Metastasis ; Prognosis ; Propensity Score ; Recurrence ; Retrospective Studies

Purpose: Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. Methods: The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. Results: Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. Conclusion The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

Perianal Crohn's disease is a major problem that impair quality of life. This article reviews the current surgical treatment of Crohn's perianal fistula. Fistulotomy and loose seton are commonly used surgical methods for treatment of perianal Crohn's disease. Mucosal advancement flap and fibrin glue are used in this treatment, despite a lake of controlled trials. Fecal diversion is disturbingly high in complicated complex perianal fistula in Crohn's disease. Ligation of intersphincteric fistula and autologous or allogenic stem cells are new surgical procedures for treatment of Crohn's disease that need further studies. Treatment success might be improved by multimodal treatment and new surgical and medical treatment options.
Combined Modality Therapy ; Crohn Disease* ; Fibrin Tissue Adhesive ; Fistula* ; Lakes ; Ligation ; Quality of Life ; Stem Cells

PURPOSE: We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy. METHODS: This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy. RESULTS: There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract. CONCLUSION: Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.
Crohn Disease ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Infliximab ; Recurrence ; Retrospective Studies

PURPOSE: Coronary artery abnormalities (CAA) are the most important complications of Kawasaki disease (KD). Iron deficiency anemia (IDA) is a prevalent micronutrient deficiency and its association with KD remains unknown. We hypothesized that presence of IDA could be a predictor of CAA. METHODS: This retrospective study included 173 KD patients, divided into 2 groups according to absence (group 1) and presence (group 2) of CAA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a logistic regression model to estimate the association between CAA and other indicators. Due to collinearity between indicators of IDA, each indicator was paired with anemia in 3 models. RESULTS: Serum iron, iron saturation, and ferritin concentration, the 3 indicators of IDA, were significantly higher in group 1 than in group 2. Three sets of models including anemia with iron indicators produced the OR of CAA of 3.513, 3.171, and 2.256, respectively. The 3 indicators of IDA were negatively associated with CAA, by OR of 0.965, 0.914, and 0.944, respectively. The areas under the curve (AUCs) of ferritin concentration, iron saturation, serum iron, anemia, and Kobayashi score were 0.907 (95% CI, 0.851–0.963), 0.729 (95% CI, 0.648–0.810), 0.711 (95% CI, 0.629–0.793), 0.638 (95% CI, 0.545–0.731), and 0.563 (95% CI, 0.489–0.636), respectively. CONCLUSION: Indicators of IDA, especially ferritin, were highly associated with CAA; therefore, they were stronger predictors of CAA than Kobayashi scores. IDA indicators can be used to predict CAA development and to suggest requirements for early interventions.
Anemia ; Anemia, Iron-Deficiency ; Coronary Vessels ; Early Intervention (Education) ; Ferritins ; Humans ; Iron ; Logistic Models ; Micronutrients ; Mucocutaneous Lymph Node Syndrome ; Odds Ratio ; Retrospective Studies

Gross anatomy has traditionally been the foundation of medical education. Medical students have learned the structure of the human body through dissection, lecture, and textbooks. As tablets and three-dimensional (3D) applications are developed, 3D atlas applications are utilized in learning anatomy by medical students. The purpose of this research is to investigate the impacts of 3D atlas applications on students' understanding of gross anatomy. This research was targeted at medical students taking the Anatomy and Embryology class in 2017 and 2018, at Ewha Womans University. The correlation between use of 3D atlas and student's results on the Anatomy and Embryology test was analyzed. An open-book anatomy quiz was also carried out to analyze the correlation between the type of atlas each student refers to and the results of the quiz. Independent t test between groups did not show statistically significant difference in the results of the Anatomy and Embryology test. However, the group referring to 3D atlas showed significantly higher results on the simple questions of the open-book anatomy quiz (P<0.05). In conclusion, 3D atlas is not very helpful in acquiring deep anatomical knowledge or memorizing the location of anatomical structures, but it can simply aid in the rapid identification of anatomical structures. Additionally, the 3D atlas will show good synergy with the two-dimensional atlas if used properly in anatomy education, because most students think it is useful to use the 3D atlas.
Education ; Education, Medical ; Embryology ; Female ; Human Body ; Humans ; Learning ; Students, Medical ; Tablets

PURPOSE: Most patients with rectal cancer undergo a total mesorectal excision and a partial resection of the sigmoid colon to improve oncologic outcomes. The aim of this study was to assess the distribution of lymph nodes (LNs) in rectal cancer. METHODS: The records of 54 patients with mid and low rectal cancer between April 2015 and March 2017 were reviewed, and 49 patients were enrolled in this study. All harvested LNs were analyzed according to the harvested area: the mesorectum area (MA), the vascular pedicle area (VA), and the sigmoid area (SA). RESULTS: Finally, 865 LNs were harvested from all patients, and of these, 71 (8.2%) showed metastases. In stage III patients, 343 LNs were harvested, and of these, 52 (15.2%) showed metastases. Significant differences were found in the total numbers of harvested LNs by area (P < 0.001) and in the numbers of harvested positive LNs by area (P < 0.001). In stage III patients, LNs from the MA were more frequently to be positive than were those from the VA (P < 0.001) or the SA (P < 0.001). CONCLUSION: LN metastasis in the SA was rare. Therefore, resecting the mesorectum and the vascular pedicle may be more important than resecting the sigmoid mesentery due to concerns about LN metastases.
Colon, Sigmoid ; Humans ; Lymph Nodes ; Mesentery ; Neoplasm Metastasis ; Rectal Neoplasms

Purpose: The purpose of this study was to evaluate the validity and reliability of the Korean version of Person-Centered Practice Inventory– Staff (PCPI-S) for nurses. Methods: The English PCPI-S was translated into Korean with forward and backward translation. Data were collected from 338 nurses at one general hospital in Korea. Construct validity was evaluated with confirmatory factor analysis, convergent validity, and discriminant validity. Known-group validity was also evaluated. Cronbach’s α was used to assess the reliability. Results: The PCPI-S Korean version consisted of 51 items in three areas: prerequisites, the care environment, and person-centered process. The comparative fit index (CFI) and values of person-centered care process were improved after engagement and having sympathetic presence items were combined as one component. The construct validity of PCPI-S Korean version was verified using four-factor structures (.05 < RMSEA < .10, AGFI > .70, CFI > .70, and AIC). The convergent validity and discriminant validity of the entire PCPI-S question were verified using a two-factor structures (AVE > .50, construct reliability > .70). There was an acceptable known-group validity with a significant correlation between the PCPI-S level and the degree of person-centered care awareness and education. Internal consistency was reliable with Cronbach’s α .95. Conclusion The Korean version of PCPI-S is valid and reliable. It can be used as a standardized Korean version of person-centered care measurement tool. Abbreviation: RMSEA = root mean square error of approximation; AGFI = adjusted goodness of fit index; AIC = Akaike information criterion; AVE = average variance extracted.