Background: We developed a simplified variant of the ADV score, the AFP-PIVKAII (AP) score for post-transplant hepatocellular carcinoma (HCC) prognosis, which considers only AFP and PIVKA-II levels excluding morphometric tumor size information from the ADV score. This study investigated the prognostic performance of the AP score in predicting HCC recurrence and overall survival (OS) after living donor liver transplantation (LDLT). Methods: We analyzed 843 patients with HCC who underwent LDLT between 2006 and 2015, assessing HCC recurrence and OS in relation to AP score. Results: The median pretransplant AFP and PIVKA-II levels were 12.8 ng/mL and 27 mAU/mL, respectively. The median and mean AP scores were 2.6 log (range: 0.6–9.2 log) and 2.9±1.1 log, respectively. The 5-year time-dependent area under the receiver operating characteristic curve for the AP score in predicting post-transplant HCC recurrence was 0.672 (p<0.001). HCC recurrence and OS curves along AP score intervals of 1.0 log showed statistical differences in accordance with the AP scores (both p<0.001). Using a Youden index J-derived AP score cutoff of 4.0 log, two-tiered groups (ADV <4.0 log vs. ADV ≥4.0 log) showed statistically significant differences in HCC recurrence and OS (both p<0.001). Harrell’s c-indices for AP score with cutoff of 4.0 log and ADV scores with cutoff of 5.0 log regarding HCC recurrence and OS were similar. Conclusion The AP score functions as an integrated surrogate marker for predicting post-transplant outcomes in patients with HCC undergoing LDLT. It may serve as a simplified alternative to the ADV score, particularly in patients with small HCCs.

Purpose: To evaluate the safety, efficiency, and size-dependency of the ‘Inverted omega En-bloc (Ʊ)’ holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. Materials and Methods: A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014–2021. These patients were treated using the ‘Inverted omega En-bloc’ HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40–60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. Results: The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. Conclusions The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, ‘Inverted omega En-bloc’ HoLEP is a size-independent and effective method for all prostate sizes.

Background/Aims: High-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis. Methods: The study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared. Results: The positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis. Conclusions This study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

Background/Aims: High-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis. Methods: The study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared. Results: The positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis. Conclusions This study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

This study aimed to investigate walking ability and balance improvement of patients with ataxia caused by brain lesions after end-effector type robot (Morning Walk® )-assisted gait training. This study randomly assigned 19 patients to one of two groups: 30 minutes of Morning Walk® training with 1 hour of conventional physiotherapy (Morning Walk® group; n = 10) or 1.5 hours of conventional physiotherapy (Control group; n = 9). Five treatment sessions per week were given for 3 weeks. The primary outcomes were walking ability and balance, which were assessed by the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. The secondary outcomes included 10-meter Walk Test (10mWT), Rivermead Mobility Index (RMI), Motricity Index (MI), and Modified Barthel Index (MBI). At baseline, there was no statistically significant difference between the two groups except MBI. After the treatment, the Morning Walk® group showed significant improvement in the FAC, BBS, 10mWT, RMI and MBI. The control group showed significant improvement in the BBS, 10mWT, RMI and MBI. Inter-group comparison demonstrated that the ∆FAC, ∆10mWT and ∆RMI of the Morning Walk® group were significantly higher than those of the control group. Our results suggest that the patients with ataxia receiving Morning Walk® -assisted gait training might improve greater in walking ability and balance than those trained with conventional physiotherapy.

This study aimed to investigate walking ability and balance improvement of patients with ataxia caused by brain lesions after end-effector type robot (Morning Walk® )-assisted gait training. This study randomly assigned 19 patients to one of two groups: 30 minutes of Morning Walk® training with 1 hour of conventional physiotherapy (Morning Walk® group; n = 10) or 1.5 hours of conventional physiotherapy (Control group; n = 9). Five treatment sessions per week were given for 3 weeks. The primary outcomes were walking ability and balance, which were assessed by the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. The secondary outcomes included 10-meter Walk Test (10mWT), Rivermead Mobility Index (RMI), Motricity Index (MI), and Modified Barthel Index (MBI). At baseline, there was no statistically significant difference between the two groups except MBI. After the treatment, the Morning Walk® group showed significant improvement in the FAC, BBS, 10mWT, RMI and MBI. The control group showed significant improvement in the BBS, 10mWT, RMI and MBI. Inter-group comparison demonstrated that the ∆FAC, ∆10mWT and ∆RMI of the Morning Walk® group were significantly higher than those of the control group. Our results suggest that the patients with ataxia receiving Morning Walk® -assisted gait training might improve greater in walking ability and balance than those trained with conventional physiotherapy.

We investigated predictors of major adverse cardiac events (MACE) with two years after medical treatment for lesions with angiographically intermediate lesions with intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm² in non-proximal epicardial coronary artery. We retrospectively enrolled 104 patients (57 males, 62±10 years) with angiographically intermediate lesions (diameter stenosis 30–70%) with IVUS MLA <4 mm² in the non-proximal epicardial coronary artery with a reference lumen diameter between 2.25 and 3.0 mm. We evaluated the incidences of major adverse cardiovascular events (MACE including death, myocardial infarction, target lesion and target vessel revascularizations, and cerebrovascular accident) two years after medical therapy. During the two-year follow-up, 15 MACEs (14.4%) (including 1 death, 2 myocardial infarctions, 10 target vessel revascularizations, and 2 cerebrovascular accidents) occurred. Diabetes mellitus was more prevalent (46.7% vs. 18.0%, p=0.013) and statins were used less frequently in patients with MACE compared with those without MACE (40.0% vs. 71.9%, p=0.015). Independent predictors of MACEs with two years included diabetes mellitus (odds ratio [OR]=3.41; 95% CI=1.43–8.39, p=0.020) and non-statin therapy (OR=3.11; 95% CI=1.14–6.50, p=0.027). Long-term event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm² might be too large to be applied for defining significant stenosis. The predictors of long-term MACE were diabetes mellitus and statin therapy in patients with angiographically intermediate lesions in non-proximal epicardial coronary artery.
Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Male ; Myocardial Infarction ; Plaque, Atherosclerotic ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Interventional

Although coffee is known to have antioxidant, anti-inflammatory, and antitumor properties, there have been few reports about the effect and mechanism of coffee compounds in colorectal cancer. Heat shock proteins (HSPs) are molecular chaperones that prevent cell death. Their expression is significantly elevated in many tumors and is accompanied by increased cell proliferation, metastasis and poor response to chemotherapy. In this study, we investigated the cytotoxicity of four bioactive compounds in coffee, namely, caffeine, caffeic acid, chlorogenic acid, and kahweol, in HT-29 human colon adenocarcinoma cells. Only kahweol showed significant cytotoxicity. Specifically, kahweol increased the expression of caspase-3, a pro-apoptotic factor, and decreased the expression of anti-apoptotic factors, such as Bcl-2 and phosphorylated Akt. In addition, kahweol significantly attenuated the expression of HSP70. Inhibition of HSP70 activity with triptolide increased kahweol-induced cytotoxicity. In contrast, overexpression of HSP70 significantly reduced kahweol-induced cell death. Taken together, these results demonstrate that kahweol inhibits colorectal tumor cell growth by promoting apoptosis and suppressing HSP70 expression.
Adenocarcinoma ; Apoptosis* ; Caffeine ; Caspase 3 ; Cell Death ; Cell Proliferation ; Chlorogenic Acid ; Coffee ; Colon ; Colorectal Neoplasms* ; Drug Therapy ; Heat-Shock Proteins ; HSP70 Heat-Shock Proteins* ; Humans ; Molecular Chaperones ; Neoplasm Metastasis

PURPOSE: Recent data suggest that monotherapy with a broad-spectrum antibiotic may be as efficacious as, and potentially less costly than, standard multi-drug therapy. We compared mono-therapy with intravenous piperacillin-tazobactam (PT) with multi-drug therapy with cefotaxime and metronidazole (CM) in aspect of postoperative complications and hospital stay. METHODS: We reviewed the hospital records and medical costs of the pediatric patients who were managed for perforated appendicitis between April 2013 and May 2014 retrospectively. RESULTS: Forty-six patients with laparoscopic appendectomy for perforated appendicitis were included in our study. PT group was 20 and CM group was 26 patients. On admission, there were no significance in sex distribution, duration of symptoms, leukocyte count, and CRP levels. At postoperative third, fifth, and seventh day of each regimen, PT group have no statistical difference with CM group in leukocyte count, percentage of neutrophil, and CRP. There was no difference in abscess formation rate, wound infections, and hospital stay between two groups. There was only one patient who was readmitted with elevation of CRP and leukocyte count in CM group. CONCLUSION: Daily dosing with the mono-therapy of PT offers as efficient as multi-drug therapy of CM. To evaluate the efficacy of broad-spectrum antibiotics monotherapy in perforated appendicitis children, the cohort included more patients should be needed.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Case-Control Studies* ; Cefotaxime* ; Child* ; Cohort Studies ; Hospital Records ; Humans ; Length of Stay ; Leukocyte Count ; Metronidazole* ; Neutrophils ; Postoperative Complications ; Retrospective Studies ; Sex Distribution ; Wound Infection

PURPOSE: We applied a long Roux-en-Y (RY) gastrojejunostomy (bypassed jejunum over 100 cm) as a reconstruction method for diabetes control to gastric cancer patients with type 2 diabetes and body mass index (BMI) < 35 kg/m2. The effect of this procedure on diabetes control was assessed. METHODS: We prospectively performed modified RY gastrojejunostmy after curative radical distal gastrectomy. Thirty patients had completed a 1-year follow-up. Patients were followed concerning their diabetic status. The factors included in the investigation were length of bypassed jejunum, BMI and its reduction ratio, glycated hemoglobin (HbA1c), fasting blood glucose, and duration of diabetes. Diabetic status after surgery was assessed in three categories: remission, improvement, and stationary. In evaluation of surgical effects on diabetes control, remission and improvement groups were regarded as effective groups, while stationary was regarded as an ineffective group. RESULTS: At postoperative one year, statistical significance was observed in the mean BMI and HbA1c. Diabetes control was achieved in 50% of the patients (remission, 30%; improvement, 20%). BMI reduction ratio, preoperative HbA1c, and duration of diabetes were correlated to the status of type 2 diabetes mellitus. The preoperative HbA1c was the most influential predictor in diabetic control. CONCLUSION: The effect of long RY gastrojejunostomy after gastrectomy for diabetes control could be contentious but an applicable reconstruction method for diabetes control in gastric cancer patients with type 2 diabetes and BMI < 35 kg/m2. Diabetes remission is expected to be higher in patients with greater BMI reduction, short duration of diabetes, and lower preoperative HbA1c.
Anastomosis, Roux-en-Y ; Bariatric Surgery ; Blood Glucose ; Body Mass Index* ; Diabetes Mellitus, Type 2 ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass* ; Hemoglobin A, Glycosylated ; Humans ; Jejunum ; Prospective Studies ; Stomach Neoplasms*