Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.
Biomarkers ; Hemodynamics* ; Hydrodynamics ; Magnetic Resonance Imaging*

PURPOSE: Combined hepatocellular cholangiocarcinoma (ChC) is a rare type of primary liver cancer, which is thought to have a poorer prognosis than hepatocellular carcinoma (HCC). Cancer stem cells are associated with tumorigenesis, tumor progression, recurrence, metastasis, and poor prognosis in several malignancies including HCC. The aim of this study was to investigate the expression pattern of cancer stem cell markers in ChC and HCC, and to evaluate whether this pattern correlated to patient prognosis. METHODS: Thirteen patients who underwent curative hepatic resection for ChC and 13 patients who underwent curative hepatic resection for HCC (matched control cases) were included. Immunohistochemical staining for cancer stem cell markers (cytokeratin [CK]7, CK19, C-kit, cluster of differentiation [CD] 44, CD133, and epithelial cell adhesion molecule) was performed and clinical outcomes were analyzed retrospectively. RESULTS: There was no significant difference in cancer stem cell marker expression between ChC and HCC. In ChC, the group that expressed CD44 showed earlier recurrence than the group that did not express CD44 (P = 0.040). CONCLUSION: The expression of cancer stem cell markers in ChC did not show a different pattern compared to that found in HCC. The expression of cancer stem cell marker CD44 was associated with poor prognosis in patients with ChC.
Carcinogenesis ; Carcinoma, Hepatocellular ; Cholangiocarcinoma* ; Epithelial Cells ; Humans ; Liver Neoplasms ; Neoplasm Metastasis ; Neoplastic Stem Cells ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: This study was conducted in order to investigate the nutrient and food intake status, and dietary quality in Korean adults according to abdominal obesity based on waist circumference. METHODS: We analyzed data from the combined 2010~2012 KNHANES (Korean National Health and Nutrition Examination Survey). The analysis included 6,974 adults aged 40 to 64 years. In this study, according to abdominal obesity based on waist circumference (male > or = 90 cm, female > or = 85 cm), we classified the subjects into the obesity group (male, n = 775, female, n = 1,113) and control group (male, n = 2,038, female, n = 3,048). The nutrient and food group intake, ND (nutrient density), NAR (nutrient adequacy ratio), MAR (mean adequacy ratio), INQ (index of nutritional quality), DDS (dietary diversity score), and DVS (dietary variety score) were analyzed using data from the 24-recall method. RESULTS: For male, no significant difference in quality index of the diet was observed between the obesity group and the normal group. In female, in diet quality (ND, NAR, and INQ), vitamin B2 (ND, NAR, and INQ) calcium (NAR), phosphorous (ND, INQ) and potassium (ND) of the obesity group was significantly lower than those of the control group. DDS and DVS in the obesity group (3.57, 30.95) were significantly lower than those of the control group (3.68, 32.84) (p = 0.0043, 0.0002). DVS (DVS > or = 39.9) showed association with lower risk of waist obesity in a logistic regression model after adjustments for multiple confounding factors including age, education, income, alcohol intake frequency, smoking, physical activity, energy intake, and body mass index (OR: 0.616, 95% CI: 0.420-0.903). CONCLUSION: In conclusion, females with abdominal obesity had lower micronutrient intake quality, DVS than those of the control group. In Korean females, food intake variety can adversely affect waist circumference.
Adult* ; Body Mass Index ; Calcium ; Diet ; Eating* ; Education ; Energy Intake ; Female ; Humans ; Logistic Models ; Male ; Micronutrients ; Motor Activity ; Nutrition Surveys* ; Obesity ; Obesity, Abdominal* ; Potassium ; Riboflavin ; Smoke ; Smoking ; Waist Circumference*

BACKGROUND AND OBJECTIVES: The purposes of this study are 1) to investigate the relationship between resting baseline Pd/Pa, determined by the ratio of the pressures proximal (Pa) and distal (Pd) to the target lesion before, inducing hyperemia and fractional flow reserve (FFR) and 2) to identify a resting baseline Pd/Pa range that might reliably preclude the need for hyperemic induction. SUBJECTS AND METHODS: A total of 622 pressure wire data sets obtained from intermediate stenotic lesions were analyzed. RESULTS: There was a good linear relationship between resting baseline Pd/Pa and FFR (r=0.746, p<0.001). Receiver-operating characteristic curves of the resting baseline Pd/Pa with FFR < or =0.80 as the reference variable showed an area under the curve of 0.89 (95% confidence intervals 0.863-0.914, p<0.001) with a diagnostic accuracy of 82.3% when the resting baseline Pd/Pa was < or =0.92. These results showed that certain cutoff values can reliably predict FFR, whether positive or negative. The resting baseline Pd/Pa >0.95 (n=257, 41.3%) had a negative predictive value (NPV) of 98.1% and a sensitivity of 97.3%. the resting baseline Pd/Pa < or =0.88 (n=65, 10.5%) had a positive predictive value (PPV) of 96.2% and a specificity of 99.8%. These were consistent regardless of coronary vessel, lesion location, lesion length, or degree of stenosis. CONCLUSION: In intermediate lesions, the resting baseline Pd/Pa was linearly related to FFR. A certain range of the resting baseline Pd/Pa values had an excellent NPV with high sensitivity or excellent PPV with high specificity for determining the lesion significance.
Coronary Vessels ; Fractional Flow Reserve, Myocardial ; Glycosaminoglycans ; Hyperemia ; Sensitivity and Specificity

PURPOSE: We investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths. MATERIALS AND METHODS: We retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage < or =3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced-stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m2). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death. RESULTS: The number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality. CONCLUSION: Proteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.
Aged ; Colorectal Neoplasms/complications/*mortality/pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prevalence ; Proteinuria/*complications/epidemiology ; Renal Insufficiency/complications ; Retrospective Studies ; Risk Factors

The National Evidence-based Collaborating Agency (NECA) holds the NECA Round-table Conference that not only disseminates objective and systematic information on topics of social concern in public health care but also organizes discussions on core issues under dispute in the literature through panels composed of multidisciplinary experts. Accordingly, the Round-table Conference was composed of multidisciplinary experts including medical specialists in the areas of psychiatry and preventive medicine, psychiatric and mental health nursing, psychologists, social welfare experts, consultation experts, religious leaders, and government officials from the Ministry of Education, Science and Technology, and Ministry of Health and Welfare. The Round-table Conference, tasked with analysis of the actual status and causes of, and search for solutions for suicide in adolescents, has reached consensus on the current status, trend, risk factors and prevention factors, problems and issues in prevention and coping strategies, effective prevention and coping strategies and areas of research needed for the future. The Round-table Conference commented on the actual status and gravity of suicides in adolescents, and came to the agreement that mental health issues including stress from interpersonal relationships and depression are the key risk factors of suicide. It was further agreed that problems in the measures being implemented for each of the areas include lack of manpower and funding, and inadequate organic association and cooperation among relevant institutions. They also agreed that development of a government-initiated suicide prevention program for adolescents, association among relevant experts, and development, and management of practical guidelines that are of broad and practical use are important. Furthermore, the panels were in agreement that the mass media must comply with the recommended level of coverage in reporting of suicide as adolescents are greatly influenced by provocative mass media reports due to their strong impulsive dispositions.
Adenosine-5'-(N-ethylcarboxamide) ; Adolescent ; Cause of Death ; Consensus ; Depression ; Dissent and Disputes ; Financial Management ; Gravitation ; Humans ; Mass Media ; Mental Health ; Occupational Groups ; Porphyrins ; Preventive Medicine ; Public Health ; Risk Factors ; Social Welfare ; Specialization ; Suicide

Carcinosarcoma of gallbladder (CSGB) is a rare malignancy characterized by malignant epithelial and mesenchymal components. Its pathogenesis is unknown and most CSGBs are associated with poor survival because the disease normally presents at an advanced stage, and as a result, curative resection is uncommon. This report describes a case that underwent curative resection. A 77-year-old woman presented with right upper quadrant pain. The preoperative diagnosis was gallbladder (GB) cancer, and thus, curative radical cholecystectomy was performed. However, pathologic examination of the surgical specimen revealed that the tumor was composed of two histologic components of squamous cell carcinoma and spindle cell sarcoma, which was consistent with a diagnosis of carcinosarcoma. The tumor was found to extend to the perimuscular connective tissue and to have metastasized to one lymph node (LN). The prognosis of CSGB remains poor despite curative resection, and thus, the authors recommend that effort be made to improve surgical outcomes.
Aged ; Carcinoma, Squamous Cell ; Carcinosarcoma ; Cholecystectomy ; Connective Tissue ; Female ; Gallbladder ; Humans ; Lymph Nodes ; Prognosis ; Sarcoma

BACKGROUND AND OBJECTIVES: Vasospastic angina (VA) is a specific type of coronary artery disease and develops as a result of coronary artery spasm. Recently, a few studies have revealed that VA caused by coronary artery spasm is related to genetic traits. The objective of this study was to use the recently developed technique of array comparative genomic hybridization (CGH) to screen the genetic aberrations of VA. SUBJECTS AND METHODS: To identify candidate genes that might be causally involved in the pathogenesis of VA, genomic deoxyribonucleic acids were extracted from whole blood of 28 patients with VA who presented at Department of Cardiology at Seoul St. Mary's Hospital, Seoul, Korea. The copy number profiles of these patients was then analyzed using array CGH and reverse transcriptase (RT) quantitative polymerase chain reaction (PCR). RESULTS: Array CGH revealed gains in 31 different regions, with losses in the 4q35.2, 7q22.1, 10q26.3, 15q11.2, 16p13.11, 17p11.2 and 19q13.3 regions (more than 32% aberration in these regions). Several loci were found to be frequently including gains of 5p and 11q (50% of samples). The most common losses were found in 7q (54% of samples). Copy number aberrations in chromosomal regions were detected and corresponding genes were confirmed by RT quantitative PCR. The fold change levels were highest in the CTDP1 (18q23), HDAC10 (22q13.33), KCNQ1 (11p15.5-p15.4), NINJ2 (12p13.33), NOTCH2 (1p12-p11.2), PCSK6 (15q26.3), SDHA (5p15.33), and MUC17 (7q22.1) genes. CONCLUSION: Many candidate chromosomal regions that might be related to the pathogenesis of VA were detected by array CGH and should be systematically investigated to establish the causative and specific genes for VA.
Cardiology ; Coat Protein Complex I ; Comparative Genomic Hybridization ; Coronary Artery Disease ; Coronary Vessels ; DNA ; Humans ; Korea ; Polymerase Chain Reaction ; RNA-Directed DNA Polymerase ; Spasm

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Fasting ; Gallbladder ; Humans ; Length of Stay ; Retrospective Studies

Duodenal duplication cysts are rare congenital malformations. Most symptomatic cases are diagnosed in children and usually present with obstructive findings or bleeding symptoms. Treatment traditionally involves surgical resection, which can be often difficult because of the close proximity of the cysts to the papilla and bilopancreatic confluence. Endoscopic therapy has been used as an alternative to open surgery in a few selected cases. We report a case with a duodenal duplication cyst containing a brown pigmented stone within the cystic lumen. He was visited because of sudden right upper quadrant abdominal pain. An abdominal computed tomography revealed the presence of a cyst with a stone, which was finally removed by endoscopic resection.
Abdominal Pain ; Ampulla of Vater ; Child ; Hemorrhage ; Humans