Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

BACKGROUND: We investigated an association between the levels of plasma microRNA (miRNA)-21,
Carcinoma, Hepatocellular ; Chemoembolization, Therapeutic ; Follow-Up Studies ; Hepatitis B, Chronic ; Humans ; Liver Transplantation ; MicroRNAs ; Multivariate Analysis ; Plasma ; Real-Time Polymerase Chain Reaction

PURPOSE: The prognostic significance of tumor-infiltrating lymphocytes (TILs) has been determined in breast cancers. Interferons can affect T-cell activity through direct and indirect mechanisms. Myxovirus resistance A (MxA) is an excellent marker of interferon activity. Here,we evaluated TILs and MxA expression in human epidermal growth factor receptor 2 (HER2)–positive breast cancers. MATERIALS AND METHODS: Ninety cases of hormone receptor (HR)+/HER2+ tumors and 78 cases of HR–/HER2+ tumors were included. The TILs level was assessed using hematoxylin and eosin–stained full face sections, and MxA expressionwas evaluated by immunohistochemistrywith a tissue microarray. RESULTS: MxA protein expression was significantly higher in tumors with high histologic grade (p=0.023) and high levels of TILs (p=0.002). High levels of TILs were correlated with high histological grade (p=0.001), negative lymphovascular invasion (p=0.007), negative lymph node metastasis (p=0.007), absence of HR expression (p < 0.001), abundant tertiary lymphoid structures (TLSs) around ductal carcinoma in situ (p=0.018), and abundant TLSs around the invasive component (p < 0.001). High levels of TILs were also associated with improved disease-free survival, particularly in HR–/HER2+ breast cancers. However, MxA was not a prognostic factor. CONCLUSION: High expression of MxA in tumor cells was associated with high levels of TILs in HER2-positive breast cancers. Additionally, a high level of TILs was a prognostic factor for breast cancer, whereas the level of MxA expression had no prognostic value.
Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Disease-Free Survival ; Epidermal Growth Factor* ; Hematoxylin ; Humans* ; Interferons ; Lymph Nodes ; Lymphocytes, Tumor-Infiltrating* ; Myxovirus Resistance Proteins ; Neoplasm Metastasis ; Orthomyxoviridae* ; Receptor, Epidermal Growth Factor* ; T-Lymphocytes

PURPOSE: The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea. MATERIALS AND METHODS: The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated. RESULTS: This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups. CONCLUSION: A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy.
Ablation Techniques ; Adult ; Carcinoma/metabolism/*radiotherapy/surgery ; *Diet ; Female ; Humans ; Iodides/urine ; Iodine/administration & dosage/urine ; Iodine Radioisotopes/metabolism/*therapeutic use ; Male ; Middle Aged ; Republic of Korea ; Thyroid Neoplasms/metabolism/*radiotherapy/surgery ; Thyroidectomy ; Treatment Outcome

PURPOSE: The purpose of this study is to investigate the perinatal risk factors for severity of intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWIs) and to study the following neurodevelopmental outcomes depending on the degree of IVH severity. METHODS: The retrospective study included 145 VLBWIs who were admitted at Seoul St. Mary's Hospital between May of 2009 and April of 2013. Prenatal, obstetric and postnatal risk factors for IVH were investigated. VLBWIs were divided into the group of IVH grade 1-2 and IVH grade 3-4. During this study period, 26 VLBWIs were died and 11 VLBWIs were lost to followed up, thereby 108 infants were included in the final analysis. They were regularly followed up and assessed for presence of major neurodevelopmental impairments including cognitive impairment, cerebral palsy, visual deficit, hearing deficit, and epilepsy. Among 108 infants, 23 (21.3%) patients had neurodevelopmental impairments. RESULTS: The lower gestational age and birth weight were significant prenatal risk factors for severe IVH. Lower Apgar score at 1 and 5 min, hypotension/shock, higher levels of partial pressure of carbon dioxide, presence of patent ductus arteriosus, pneumothorax, thrombocytopenia, necrotizing enterocolitis, and bronchopulmonary dysplasia were significant postnatal risk factors for severe IVH. After multiple logistic regression analysis, gestational age, birth weight, and hypotension/shock were independent risk factors for severe IVH. The incidence of major neurodevelopmental impairments were also significantly higher in VLBWIs who survived after severe IVH. CONCLUSION: In addition to preterm birth, minimizing hypotension/shock, the risk factor of severe IVH, is important to prevent major neurodevelopmental impairments in VLBWIs.
Apgar Score ; Birth Weight ; Bronchopulmonary Dysplasia ; Carbon Dioxide ; Cerebral Palsy ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Epilepsy ; Gestational Age ; Hearing ; Hemorrhage* ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Logistic Models ; Partial Pressure ; Pneumothorax ; Premature Birth ; Retrospective Studies ; Risk Factors* ; Seoul ; Thrombocytopenia

Knowledge of the prevalence of human Toxoplasma gondii infection is required in the Republic of Korea. In this study, we surveyed the seroprevalence of T. gondii infection and analyzed the risk factors associated with seropositivity among residents in 2 administrative districts; Seoul and the island of Jeju-do, which have contrasting epidemiologic characteristics. Sera and blood collected from 2,150 residents (1,114 in Seoul and 1,036 in Jeju-do) were checked for IgG antibody titers using ELISA and for the T. gondii B1 gene using PCR. In addition, participants completed a questionnaire that solicited information on gender, age, occupation, eating habits, history of contact with animals, and travel abroad. The T. gondii B1 gene was not detected in all residents examined. However, ELISA showed 8.0% (89 of 1,114 sera) positive for IgG antibodies against T. gondii in Seoul and 11.3% (117 of 1,036 sera) in Jeju-do. In both districts, the positive rates were higher in males than in females, and those 40-79 years of age showed higher rates than other ages. In Seoul, residents older than 70 years of age showed the highest positive rate, 14.9%, whereas in Jeju-do the highest prevalence, 15.6%, was in those in their sixties. The higher seropositive rate in Jeju-do than in Seoul may be related to eating habits and occupations. The present results and a review of related literature are indicative of an increased seroprevalence of T. gondii in Korea in recent years.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Animals ; Antibodies, Protozoan/*blood ; Child ; DNA, Protozoan/blood ; Female ; Humans ; Immunoglobulin G/*blood ; Male ; Mice ; Mice, Inbred BALB C ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Seroepidemiologic Studies ; Sex Factors ; Toxoplasma/genetics/*immunology ; Toxoplasmosis/*epidemiology/parasitology ; Young Adult

BACKGROUND/AIMS: Apolipoprotein E (ApoE) plays an important role in regulating lipid and lipoprotein metabolism, and ApoE genotypes are known to affect plasma lipoprotein concentrations. We investigated whether ApoE genotype determines the disease outcome in hepatitis B virus (HBV)-infected individuals, and verified the association between ApoE genotype and the occurrence of hepatocellular carcinoma (HCC) in patients with chronic liver diseases of various etiologies. METHODS: This hospital-based, case-controlled study enrolled 156 subjects (47 healthy controls, 50 HBV-related liver cirrhosis patients, and 59 HCC patients). ApoE genotypes were determined using PCR-based ApoE genotyping kits. The biological significance of ApoE genotype was verified by measuring serum ApoE levels using an ELISA kits. RESULTS: The epsilon3 allele was the most common allele, with allele frequencies among the entire cohort of 5.8%, 84.3%, and 9.9% for the epsilon2, epsilon3, and epsilon4 alleles, respectively. Significantly more of those patients carrying the epsilon3/3 genotype had developed liver cirrhosis compared to the control subjects. Being an ApoE4 carrier was associated with a lower probability of developing liver cirrhosis. The allele frequencies and genotype distribution of ApoE did not differ significantly between the liver cirrhosis and HCC patients. The serum level of ApoE was significantly higher in patients with liver cirrhosis than in the healthy controls, but did not differ significantly with the ApoE genotype. CONCLUSIONS: The ApoE epsilon3/3 genotype frequency was higher in patients with HBV-associated liver cirrhosis than in the controls.
Adult ; Aged ; Aged, 80 and over ; Alleles ; Apolipoproteins E/*genetics/metabolism ; Carcinoma, Hepatocellular/*metabolism/pathology ; Case-Control Studies ; Child ; Chronic Disease ; Cohort Studies ; Female ; Gene Frequency ; Genotype ; Hepatitis B/complications/metabolism/virology ; Hepatitis B virus/*physiology ; Humans ; Liver Cirrhosis/etiology/*metabolism ; Liver Neoplasms/*metabolism/pathology ; Male ; Middle Aged ; Young Adult

Pleurotus nebrodensis is an edible and commercially available mushroom in Korea. This study was conducted in order to evaluate the anticancer and immunopotentiating activities of crude polysaccharides, extracted in methanol, neutral saline, and hot water (hereafter referred to as Fr. MeOH, Fr. NaCl, and Fr. HW, respectively) from the fruiting bodies of P. nebrodensis. beta-Glucan and protein contents in Fr. MeOH, Fr. NaCl, and Fr. HW extracts of P. nebrodensis ranged from 23.79~36.63 g/100 g and 4.45~6.12 g/100 g, respectively. Crude polysaccharides were not cytotoxic against sarcoma 180, HT-29, NIH3T3, and RAW 264.7 cell lines at a range of 10~2,000 microg/mL. Intraperitoneal injection with crude polysaccharides resulted in a life prolongation effect of 11.76~27.06% in mice previously inoculated with sarcoma 180. Treatment with Fr. NaCl resulted in an increase in the numbers of spleen cells by 1.49 fold at the concentration of 50 microg/mL, compared with control. Fr. HW improved the immuno-potentiating activity of B lymphocytes through an increase in alkaline phosphatase activity by 1.65 fold, compared with control at 200 microg/mL. Maximum production of nitric oxide (14.3 microM) was recorded in the Fr. NaCl fraction at 200 microg/mL. Production of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) was significantly higher, compared to control, and IL-6 production was highest, in contrast to TNF-alpha, IL-1beta, and positive control, concanavalin at the tested concentration of the various fractions. Results of the current study suggest that polysaccharides extracted from P. nebrodensis have a strong anticancer effect and may be useful as an ingredient of biopharmaceutical products for treatment of cancer.
Agaricales ; Alkaline Phosphatase ; Animals ; B-Lymphocytes ; Cell Line ; Fruit ; Immunomodulation ; Injections, Intraperitoneal ; Interleukin-1beta ; Interleukin-6 ; Korea ; Life Support Care ; Methanol ; Mice ; Nitric Oxide ; Pleurotus ; Polysaccharides ; Sarcoma ; Sarcoma 180 ; Spleen ; Tumor Necrosis Factor-alpha ; Water

We report a case of fulminant hepatic failure related to ingesting Dictamnus dasycarpus. The patient had taken D. dasycarpus for 8 weeks after boiling down the root of D. dasycarpus in water, to promote health. The main symptoms and signs were general weakness and jaundice. Serology found no evidence of hepatitis A, B, or C infections. Imaging studies, including abdominal ultrasonography and abdominal computed tomography, did not reveal any bile duct structural abnormalities. Based on the RUCAM score (8 points), D. dasycarpus was the probable cause for the drug-induced liver injury. Despite meticulous monitoring and supportive care, the patient died by a progression to fulminant hepatic failure. This case indicates that D. dasycarpus can cause lethal outcomes by fulminant hepatic failure.
Bile Ducts ; Dictamnus ; Drug-Induced Liver Injury ; Hepatitis A ; Humans ; Jaundice ; Liver Failure, Acute ; Water

Clopidogrel, a thienopyridine derivative, is an anti-platelet agent that acts as an antagonist of the platelet adenosine diphosphate receptor and considered for essential prophylaxis for intracoronary stent thrombosis in the treatment of ischemic heart disease. Clopidogrel is considered as safe as aspirin but a few cases of severe hematologic adverse reactions associated with clopidogrel had been reported such as neutropenia, aplastic anemia, thrombocytopenic purpura, and thrombocytopenia. We report a rare case of neutropenia induced by clopidogrel in chronic renal failure in a patient who underwent percutaneous coronary intervention.
Adenosine Diphosphate ; Anemia, Aplastic ; Aspirin ; Blood Platelets ; Humans ; Kidney Failure, Chronic ; Myocardial Ischemia ; Neutropenia ; Purpura, Thrombocytopenic ; Pyridines ; Stents ; Thrombocytopenia ; Thrombosis ; Ticlopidine