Background/Aims: A comprehensive analysis of trends in the incidence of hepatocellular carcinoma (HCC) is important for planning public health initiatives. We aimed to analyze the trends in HCC incidence in South Korea over 10 years and to predict the incidence for the year 2028. Methods: Data from patients with newly diagnosed HCC between 2008 and 2018 were obtained from Korean National Health Insurance Service database. Age-standardized incidence rates (ASRs) were calculated to compare HCC incidence. A poisson regression model was used to predict the future incidence of HCC. Results: The average crude incidence rate (CR) was 22.4 per 100,000 person-years, and the average ASR was 17.6 per 100,000 person-years between 2008 and 2018. The CR (from 23.9 to 21.2 per 100,000 person-years) and ASR (from 21.9 to 14.3 per 100,000 person-years) of HCC incidence decreased during the past ten years in all age groups, except in the elderly. The ASR of patients aged ≥80 years increased significantly (from 70.0 to 160.2/100,000 person-years; average annual percent change, +9.00%; P<0.001). The estimated CR (17.9 per 100,000 person-years) and ASR (9.7 per 100,000 person-years) of HCC incidence in 2028 was declined, but the number of HCC patients aged ≥80 years in 2028 will be quadruple greater than the number of HCC patients in 2008 (from 521 to 2,055), comprising 21.3% of all HCC patients in 2028. Conclusions The ASRs of HCC in Korea have gradually declined over the past 10 years, but the number, CR, and ASR are increasing in patients aged ≥80 years.

Background/Aims: We aimed to assess the role of vitamin D supplementation in the response to pegylated interferon-α (PEG-IFN-α) plus ribavirin (RBV) treatment in patients with chronic hepatitis C (CHC). Methods: Our study was a multi-center, randomized controlled trial in 11 hospitals. CHC patients were randomly assigned (1:1) to two groups namely, PEGIFN-α plus RBV (control group) or PEG-IFN-α plus RBV + vitamin D (800 IU daily) (vitamin D group). The primary end-point was the rate of sustained virologic response (SVR). Results: One hundred forty eight CHC patients were randomly assigned to two groups. Seventy-one patients received the PEG-IFN-α plus RBV and 77 patients received the PEG-IFN-α plus RBV + vitamin D. A total of 105 patients completed the study (control group, 47 vs. vitamin D group, 58). Baseline characteristics were mostly similar in both the groups. There was a modest but non-significant increase in SVR in the vitamin D group compared to the control group with the intention to treat analysis (64.0% vs. 49.3 %, p = 0.071) as well as in the per protocol analysis (control group vs. vitamin D group: 74.5% vs. 84.5%, p = 0.202). Fifty-two patients (73.2%) in the control group and 63 patients (81.8%) in the vitamin D group experienced at least one adverse event. The drop-out rate due to adverseeffects was not different between both groups (control group vs. vitamin D group: 19.7% vs. 10.4%, p = 0.111). Conclusions Vitamin D supplement did not increase SVR in treatment naïve patients with CHC irrespective of genotype.

BACKGROUND/AIMS: Deficiencies of 25-hydroxyvitamin D (25(OH)D) are prevalent in patients with chronic liver disease (CLD). Liver fibrosis is the main determinant of CLD prognosis. The present study was performed to evaluate the correlation between 25(OH)D levels and liver fibrosis as assessed by transient elastography (TE) in patients with compensated CLD. METHODS: Serum 25(OH)D levels and liver stiffness were determined in a total of 207 patients who were subjected to the following exclusion criteria: patients with decompensated CLD; patients who had malignancies; patients who were taking medications; and patients who were pregnant. RESULTS: The most common etiology was chronic hepatitis B (53.1%). Advanced liver fibrosis (defined by TE [≥9.5 kPa]) was present in 75 patients (36.2%). There was a significant correlation between 25(OH)D deficiency and liver stiffness. Based on the multivariate analysis, the following factors were independently associated with advanced liver fibrosis: 25(OH)D deficiency (odds ratio [OR], 3.46; p=0.004), diabetes mellitus (OR, 3.04; p=0.041), and fibrosis-4 index (OR, 2.01; p<0.001). CONCLUSIONS: Patients with compensated CLD exhibit a close correlation between vitamin D level and liver stiffness as assessed by TE. Vitamin D deficiency was independently associated with advanced liver fibrosis.
Diabetes Mellitus ; Elasticity Imaging Techniques* ; Hepatitis B, Chronic ; Humans ; Liver Cirrhosis* ; Liver Diseases* ; Liver* ; Multivariate Analysis ; Prognosis ; Vitamin D ; Vitamin D Deficiency

OBJECTIVE: We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. MATERIALS AND METHODS: Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. RESULTS: Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. CONCLUSION: A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.
Adult ; Aged ; Autopsy/*methods ; Cadaver ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prospective Studies ; Tomography, X-Ray Computed/*methods ; *Whole Body Imaging

Mesenchymal stem cells (MSCs) are capable of self-renewal and differentiation into lineages of mesenchymal tissues that are currently under investigation for a variety of therapeutic applications. The purpose of this study was to compare cytokine gene expression in MSCs from human placenta, cord blood (CB) and bone marrow (BM). The cytokine expression profiles of MSCs from BM, CB and placenta (amnion, decidua) were compared by proteome profiler array analysis. The cytokines that were expressed differently, in each type of MSC, were analyzed by real-time PCR. We evaluated 36 cytokines. Most types of MSCs had a common expression pattern including MIF (GIF, DER6), IL-8 (CXCL8), Serpin E1 (PAI-1), GROalpha(CXCL1), and IL-6. MCP-1, however, was expressed in both the MSCs from the BM and the amnion. sICAM-1 was expressed in both the amnion and decidua MSCs. SDF-1 was expressed only in the BM MSCs. Real-time PCR demonstrated the expression of the cytokines in each of the MSCs. The MSCs from bone marrow, placenta (amnion and decidua) and cord blood expressed the cytokines differently. These results suggest that cytokine induction and signal transduction are different in MSCs from different tissues.
Bone Marrow Cells/*cytology ; Cytokines/genetics/*metabolism ; Female ; Fetal Blood/*cytology ; Gene Expression Profiling ; Humans ; Mesenchymal Stem Cells/cytology/*metabolism ; Placenta/*cytology ; Pregnancy ; Protein Array Analysis

OBJECTIVE: In order to elucidate the retrogressive degeneration of orofacial cleft, the fissured tissues of prenatal and postnatal cleft lip and palate were examined by histological and immunohistochemical methods. DESIGN: Totally 42 cases of prenatal (n=17) and postnatal (n=25) cleft lip and/or palate were examined in comparison with 10 cases of normal lip and oral mucosa using immunohistochemical stainings of MMP-3, MMP-9, MMP-10, cathepsin G, PCNA, E-cadherin, TGase 2, HSP-70, vWF, and VEGF. MAIN OUTCOME MEASURES: In the fissured tissue the sebaceous glands were strongly positive for PCNA and grew into the underlying fibromuscular tissue (24/42). Some hyperplastic sebaceous glands of prenatal cleft lip produced infundibular follicular cyst (9/17). The skin and mucosal epithelia from the postnatal cleft lip and palate (10/25) showed severe basal hyperplasia (11/25) and melanocyte infiltration (7/25). RESULTS: The immunostaining of MMP-3 and HSP-70 were strongly positive in the hyperplastic sebaceous glands and nearby atrophying muscle bundles of the fissured tissue, while MMP-9, MMP-10, and cathepsin G were almost negative. The immunoreactions of the other antibodies used in this study were similar between in the fissured tissues and in the normal controls. CONCLUSIONS: These data suggest that the over-expression of MMP-3 is closely related to the sebaceous gland hyperplasia, epithelial dysplasia, and the muscle degeneration, and that the over-expression of MMP-3 in the fissured tissue may continuously aggravate the cleft condition in the later life.
Adult ; Antibodies ; Cadherins ; Cathepsin G ; Cleft Lip* ; Follicular Cyst ; Humans ; Hyperplasia ; Lip ; Melanocytes ; Mouth Mucosa ; Outcome Assessment (Health Care) ; Palate* ; Proliferating Cell Nuclear Antigen ; Sebaceous Glands ; Skin ; Vascular Endothelial Growth Factor A

We describe the case of a 61-year-old woman who manifested with paroxysmal supraventricular tachycardia (PSVT). She was scheduled with gastrectomy and partial hepatectomy because of stomach cancer metastasis. EKG findings were normal in the preoperative period but she had symptoms of palpitation, restlessness, and a high systolic blood pressure (180 mmHg) in the operating room before anesthesia induction. On her EKGs, we recognized a PSVT characterized by a high pulse rate of 180 beats per minute, a narrow QRS complex of 40 msec, and no P wave. These findings were not terminated by carotid massage or antiarrhythmics (verapamil and lidocaine), but were completely treated by the beta-blocker, esmolol. We consider that esmolol is a good choice for the treatment of PSVT with a narrow QRS complex combined with a high blood pressure in case with known hypertension or that have experienced preoperative anxiety or stress.
Anesthesia* ; Anxiety ; Blood Pressure ; Electrocardiography ; Female ; Gastrectomy ; Heart Rate ; Hepatectomy ; Humans ; Hypertension ; Massage ; Middle Aged ; Neoplasm Metastasis ; Operating Rooms ; Preoperative Period ; Psychomotor Agitation ; Stomach Neoplasms ; Tachycardia, Supraventricular*

BACKGROUND: Generally, 0.6-0.7 MAC of anesthetics are used to minimize the effect of anesthetics on the fetus during cesarean section. Therefore the possibility of awareness is a considerable problem in cesarean section. This study was designed to compare enflurane with sevoflurane in terms of intraoperative bispectral index (BIS) and posoperative recall during a cesarean section. METHODS: Eighty patients of ASA physical status 1 who underwent an elective cesarean section under general anesthesia were investigated in this study. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then maintained with O2 (2 L), N2O (2 L) and enflurane 1.0 vol% (n = 40) or sevoflurane 1.2 vol% (n = 40). We monitored BIS throughout the operation and recorded recall by asking the patients 1 day after the operation. RESULTS: BIS values of the sevoflurane group were significantly lower than those of the enflurane group after delivery (P < 0.05). However, no patient could recall intraoperative events postoperatively. CONCLUSIONS: Even though no patient could recall intraoperative events, high BIS values, which can produce awareness, were detected by 17.5% of patients after delivery in enflurane group. Therefore, sevoflurane is probably a better choice than enflurane in terms of preventing postoperative recall during cesarean section under general anesthesia.
Anesthesia ; Anesthesia, General ; Anesthetics ; Cesarean Section* ; Enflurane* ; Female ; Fetus ; Humans ; Pregnancy ; Succinylcholine ; Thiopental

BACKGROUND: It is well known that body core temperature reduces during general anesthesia. Midazolam premedication for relieving anxiety might also reduce body core temperature by inhibiting tonic thermoregulatory vasoconstriction in elderly patients. Therefore, an effort to maintain temperature must be started before anesthesia. This study was designed to evaluate the effect on body core temperature of midazolam, atropine and glycopyrrolate, which are commonly used for premedication. METHODS: Six hundred and eleven patients of ASA physical status 1 or 2, aged 18 to 65, were involved in this study. They were randomly assigned to premedication with: 1) saline control (n = 92); 2) midazolam 0.04 mg/kg (n = 96); 3) midazolam 0.04 mg/kg with glycopyrrolate 0.004 mg/kg (n = 117); 4) midazolam 0.04 mg/kg with atropine 0.01 mg/kg (n = 93); 5) glycopyrrolate 0.004 mg/kg (n = 116); and 6) atropine 0.01 mg/kg (n = 97). All premedication was given intramuscularly about 30 min before operation. Temperatures were measured at the tympanic membrane at the time of premedication and 30 min after premedication. RESULTS: Temperatures increased slightly after injection in the control (0.14 +/- 0.36oC; mean +/- SD) and this increase was less in the midazolam group (0.07 +/- 0.39oC). The changes of temperature in the midazolam with glycopyrrolate (0.16 +/- 0.39oC), midazolam with atropine (0.19 +/- 0.40oC), and in the glycopyrrolate group were no different from that of the control group. However, there was a statistically significant increase in temperature after injection in the atropine group (0.26 +/- 0.42oC) versus the control group. Compared with the midazolam group, a statistically significant increase in temperature was observed in the midazolam with atropine, the glycopyrrolate, and in the atropine group. CONCLUSIONS: From these results, low dose midazolam (0.04 mg/kg), midazolam with glycopyrrolate, and midazolam with atropine for premedication have little affect on temperature. Midazolam with glycopyrrolate premedication is recommended for preserving body core temperature.
Aged ; Anesthesia ; Anesthesia, General ; Anxiety ; Atropine ; Glycopyrrolate ; Humans ; Midazolam ; Premedication* ; Tympanic Membrane ; Vasoconstriction

OBJECTIVES: Because shipyard workers are involved with various manufacturing process, they are exposed to many kinds of hazardous materials. Welders especially, are exposed to bisphenol-A (BPA) during the welding and flame cutting of coated steel. This study was conducted to assess the exposure status of the endocrine disruptor based on the job-exposure matrix. The effects of the genetic polymorphism of xenobiotic enzyme metabolisms involved in the metabolism of BPA on the levels of urinary metabolite were investigated. METHODS: The study population was recruited from a shipyard company in the K province. A total of 84 shipbuilding workers 47 and 37 in the exposed and control groups, respectively, were recruited for this study. The questionnaire variables included, age, sex, use of personal protective equipment, smoking, drinking and work duration. The urinary metabolite was collected in the afternoon and correction made for the urinary creatinine concentration. The of the CYP1A1, CYP2E1 and UGT1A6 genotypes were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods with the DNA extracted from venous blood. RESULTS: The urinary BPA level in the welders group was significantly higher than in the control group (p< 0.05). The urinary BPA concentration with the wild type UGT1A6 was higher than the other UGT1A6 genotypes, but with no statistical significant. From themultiple regression analysis of the urinary BPA, the regression coefficient for job grade was statistically significant (p< 0.05). CONCLUSIONS: The grade of exposure to BPA affected the urinary BPA concentration was statistically significant. However, the genetic polymorphisms of xenobiotics enzyme metabolism were not statistically significant. Further investigation of the genetic polymorphisms with a larger sample size is needed.
Biomarkers* ; Creatinine ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 CYP2E1 ; DNA ; Drinking ; Genotype ; Hazardous Substances ; Metabolism ; Personal Protective Equipment ; Polymorphism, Genetic ; Sample Size ; Smoke ; Smoking ; Steel ; Welding ; Xenobiotics