PURPOSE: Human papilloma viruses (HPVs) play a central role in the pathogenesis of neoplastic lesions of the uterine cervix. The viral oncoprotein HPV E6 degrades the p53 protein, and the HPV E7 protein inactivates pRB and increases the expression of the CDK inhibitor, p16(INK4A). We investigated the usefulness of p16(INK4A) as a biologic marker for the cervical dysplastic and neoplastic cells. MATERIALS AND METHODS: We examined the expression of p16(INK4A) and cytokeratin in a mixed population of normal peripheral blood mononuclear cells (PBMC) and the cervical cancer cell lines (HeLa, SiHa, and CasKi) using flow cytometry. RESULTS: The DNA indices of the HeLa, SiHa and CasKi cell lines were 1.89, 1.53 and 1.75, respectively, indicating that these cells are aneuploid cells. Furthermore, the positive rate of p16(INK4A) expression was 86.7% for the HeLa mixed population, 85.6% for the SiHa mixed population, and 92.2% for the CasKi mixed population. According to the FL3A vs FL3W histogram, electrical gating of the HeLa, SiHa and CasKi mixed populations showed the expression levels of both cytokeratin and p16(INK4A) to be identical, at 86.6%, 84.8% and 85.0%, respectively. These findings revealed that almost all cells selected through electrical gating were cervical cancer cells originating from the epithelium and which expressed cytokeratin and p16(INK4A). On the other hand, when each mixed population was electrically gated for normal PBMC, we found that the PBMCs expressed neither cytokeratin nor p16(INK4A). CONCLUSION: Using flow cytometry, we observed the enhanced expression of p16(INK4A) in cervical cancer cell lines. These RESULTS suggest the usefulness of p16(INK4A) for the selective detection of cervical dysplastic and cancer cells in the liquid-based samples, which are taken from the cervices and contaminated with blood and stromal cells.
Aneuploidy ; Biological Markers ; Cell Line* ; Cervix Uteri ; Cyclin-Dependent Kinase Inhibitor p16* ; DNA ; Epithelium ; Female ; Flow Cytometry ; Hand ; Humans ; Keratins ; Papilloma ; Stromal Cells ; Uterine Cervical Neoplasms*

BACKGROUND: Impairment in activities of daily living (ADL) is a major problem in Alzheimer's disease (AD), and is related to increased caregiver burden.The present study evaluated whether there are any components of initial dementia evaluation that could predict ADL decline in years follow-up. METHODS: The 32 subjects underwent more than two consecutive neuropsychological evaluation and maintained anti-dementia medication from the Ewha Dementia Cohort. The first clinical, neuropsychological test results, medial temporal atrophy rating and white matter ratings were correlated with the final ADL scores. The subjects were further divided into ADL-preserved and declined groups for the comparison depending on final ADL scores. RESULTS: The annual decline of the Korean Mini-mental status examination (K-MMSE) score was 1.5+/-1.2 and of the Seoul-instrumental ADL score was 6.1+/-4.6. The Factors correlated with the ADL at baseline were the clinical dementia rating, K-MMSE, memory function score and the total neuropsychological test score, left medial temporal lobe atrophy rating, and the neuropsychiatric total score. Only the neuropsychological component including total test, frontal and visuospatial function scores were statistically different between the two groups in the baseline evaluation. CONCLUSIONS: The result of our preliminary study emphasize the other study results that the initial cognitive and dementia status are the strong predictive factors not only for the initial ADL dysfunction but also for the ADL decline in years followed-up dementia cohort.
Activities of Daily Living* ; Alzheimer Disease* ; Atrophy ; Caregivers ; Cohort Studies ; Dementia* ; Follow-Up Studies* ; Humans ; Memory ; Methods ; Neuropsychological Tests ; Temporal Lobe

SAPHO syndrome, which has different skin changes and osteoarticular inflammation, is an acronym that stands for synovitis, acne, pustulosis, hyperostosis, and osteitis. Treatment of SAPHO syndrome includes non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs, such as colchicines, corticosteroids and bisphosphonates, and disease-modifying agents. However, the treatment of SAPHO syndrome is controversial because it is a new clinical entity with unclear etiopathogenesis and inadequate clinical studies. We report a case with refractory SAPHO syndrome, which was successfully treated with a tumor necrosis factor (TNF)-alpha blocker.
Acne Vulgaris ; Acquired Hyperostosis Syndrome ; Adrenal Cortex Hormones ; Antirheumatic Agents ; Diphosphonates ; Hyperostosis ; Immunoglobulin G ; Inflammation ; Osteitis ; Receptors, Tumor Necrosis Factor ; Skin ; Synovitis ; Tumor Necrosis Factor-alpha ; Etanercept

Biliary cystadenomas are benign but potentially malignant cystic neoplasm. The preferred treatment is radical resection because it is difficult to differentiate a benign from a malignant biliary cystadenoma. A 40 year-old woman presented with moderate abdominal discomfort. Esophageal varix was found up to mid-esophagus on endoscopy. She has no prior history of liver disease or chronic alcohol ingestion. About 15cm sized biliary cystadenoma was diagnosed by ultrasonography, computed tomography and magnetic resonance imaging. Serum level of bilirubin, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase and tumor marker were elevated. The patient underwent US-guided aspiration. Tumor markers from the aspirated fluid are increased. Left hepatectomy was performed to completely remove the cyst. Histology of the resected specimen confirmed a biliary cystadenoma of the liver with ovary-like stroma. Without prior history of liver disease or chronic alcoholic ingestion, incidental finding of esophageal varix could show an important clue for diagnosis of biliary cystadenoma.
Alanine Transaminase ; Alcoholics ; Alkaline Phosphatase ; Bilirubin ; Biomarkers, Tumor ; Cystadenoma* ; Diagnosis ; Eating ; Endoscopy ; Esophageal and Gastric Varices* ; Female ; gamma-Glutamyltransferase ; Hepatectomy ; Humans ; Incidental Findings ; Liver ; Liver Diseases ; Magnetic Resonance Imaging ; Ultrasonography

BACKGROUND/AIMS: Treatment using multiple daily insulin (MDI) should give diabetic patients many benefits. Nevertheless, few studies have examined the impact of an increased frequency of daily insulin injection on quality of life, anxiety levels, and depression in diabetic patients, and individual's continued compliance with MDI is unclear. This study examined these issues using standardized questionnaires. METHODS: This was a cross-sectional, randomized study. Ninety-nine insulin-treated type 2 diabetic patients (mean age 53.1+/-12 years, mean duration of diabetes 10.3+/-6.5 years) were divided a group (n=50) who injected insulin four times daily (mean age 49.6+/-12.3 years, mean duration of diabetes 6.5+/-6.4 years) and a group (n=49) who injected insulin once or twice daily (mean age 56.4+/-11.6 years, mean duration of diabetes 11.5+/-5.8 years). All patients independently completed the Korean Version of the World Health Organization Quality of Life Scale Abbreviated Version and standardized Hospital Anxiety and Depression Scale for Koreans. RESULTS: No significant differences were evident with respect to age, gender, and duration of diabetes between the two groups (p<0.05). No significant differences were evident in the results of the questionnaires between the two groups, except for the physical health domain (p<0.05). CONCLUSIONS:Multiple daily insulin injections had nearly no influence on quality of life, anxiety levels, or depression in type 2 diabetic patients. Therefore, treatment with MDI should be considered for patients who would benefit from this.
Anxiety ; Compliance ; Depression ; Diabetes Mellitus ; Humans ; Insulin ; Quality of Life ; World Health Organization ; Surveys and Questionnaires

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.
Bronchiectasis ; Japan ; Korea ; Lung ; Lung Diseases ; Mycobacterium avium ; Mycobacterium avium Complex* ; Mycobacterium* ; Needles ; Nontuberculous Mycobacteria ; Solitary Pulmonary Nodule ; United States

BACKGROUNDS/AIMS: Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation. METHODS: After analyzing the institutional profiles of 500 GBC patients who have undergone surgical resection, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gallbladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively. RESULTS: In the LC only group (n=30), mean age of the 16 pT1 patients was 65.7+/-12.5 years and mean age of the 14 pT2 patients was 66.7+/-10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6+/-9.9 years and in 26 pT2 patients, mean age was 59.2+/-7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reoperation were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hepatectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45). CONCLUSIONS: The survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reoperation for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.
Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Gallbladder ; Gallbladder Diseases ; Gallbladder Neoplasms ; Hepatectomy ; Humans ; Liver ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Reoperation ; Survival Rate

BACKGROUND/AIMS: Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. Although CE does not require the skill of endoscope insertion, the images should be interpreted by a person with experience in assessing images of the gastrointestinal mucosa. This investigation aimed to document the number of cases needed by trainees to gain the necessary experience for CE competency. METHODS: Fifteen cases were distributed to 12 trainees with no previous experience of CE during their gastroenterology training as clinical fellows. Twelve trainees and an expert were asked to read CE images from one patient each week for 15 weeks. The diagnosis was reported using five categories (no abnormalities detected, small bowel erosion or ulcer, small bowel tumor, Crohn disease, and active small bowel bleeding with no identifiable source). We then examined, using the kappa coefficient, how the degree of mean agreements between the trainees and the expert changed as the training progressed each week. RESULTS: The agreement rate of CE diagnosis increased as the frequencies of interpretation increased. Most of the mean kappa coefficients were >0.60 and >0.80 after week 9 and 11, respectively. CONCLUSIONS: Experience with approximately 10 cases of CE is appropriate for trainees to attain CE competency.
Capsule Endoscopy* ; Crohn Disease ; Diagnosis ; Endoscopes ; Gastroenterology ; Hemorrhage ; Humans ; Learning Curve* ; Learning* ; Mucous Membrane ; Ulcer

BACKGROUND: For phosphate control, patient education is essential due to the limited clearance of phosphate by dialysis. However, well-designed randomized controlled trials about dietary and phosphate binder education have been scarce. METHODS: We enrolled maintenance hemodialysis patients and randomized them into an education group (n = 48) or a control group (n = 22). We assessed the patients’ drug compliance and their knowledge about the phosphate binder using a questionnaire. RESULTS: The primary goal was to increase the number of patients who reached a calcium-phosphorus product of lower than 55. In the education group, 36 (75.0%) patients achieved the primary goal, as compared with 16 (72.7%) in the control group (P = 0.430). The education increased the proportion of patients who properly took the phosphate binder (22.9% vs. 3.5%, P = 0.087), but not to statistical significance. Education did not affect the amount of dietary phosphate intake per body weight (education vs. control: −1.18 ± 3.54 vs. −0.88 ± 2.04 mg/kg, P = 0.851). However, the dietary phosphate-to-protein ratio tended to be lower in the education group (−0.64 ± 2.04 vs. 0.65 ± 3.55, P = 0.193). The education on phosphate restriction affected neither the Patient-Generated Subjective Global Assessment score (0.17 ± 4.58 vs. −0.86 ± 3.86, P = 0.363) nor the level of dietary protein intake (−0.03 ± 0.33 vs. −0.09 ± 0.18, P = 0.569). CONCLUSION: Education did not affect the calcium-phosphate product. Education on the proper timing of phosphate binder intake and the dietary phosphate-to-protein ratio showed marginal efficacy.
Body Weight ; Compliance ; Dialysis ; Diet* ; Dietary Proteins ; Education* ; Humans ; Hyperphosphatemia ; Patient Education as Topic ; Phosphates ; Renal Dialysis*

Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.