Purpose: Varlitinib is a pan-human epidermal growth factor receptor (HER) inhibitor targeting epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), and HER4. We present a phase Ib/II study of a combination of varlitinib and weekly paclitaxel as a second-line treatment for patients with EGFR/HER2 co-expressing advanced gastric cancer (AGC). Materials and Methods: Patients whose tumors with EGFR and HER2 overexpression by immunohistochemistry (≥ 1+) were enrolled. Varlitinib and paclitaxel were investigated every 4 weeks. After determining the recommended phase II dose (RP2D) in phase Ib, a phase II study was conducted to evaluate the antitumor activity. Results: RP2D was treated with a combination of varlitinib (300 mg twice daily) and paclitaxel. Among 27 patients treated with RP2D, the median progression-free survival and overall survival (OS) were 3.3 months (95% confidence interval [CI], 1.7 to 4.9) and 7.9 months (95% CI, 5.0 to 10.8), respectively, with a median follow-up of 15.7 months. Among 16 patients with measurable disease, the objective response rate (ORR) and disease control rate were 31% and 88%, respectively. Patients with strong HER2 expression (n=8) had a higher ORR and longer OS, whereas those with strong EGFR expression (n=3) had poorer outcomes. The most common adverse events (AEs) of any grade were neutropenia (52%), diarrhea (27%), aspartate aminotransferase/alanine transaminase elevation (22%), and nausea (19%). No treatment-related deaths or unexpected AEs resulting from treatment cessation were observed in patients with RP2D. Conclusion A combination of varlitinib and paclitaxel displayed manageable toxicity and modest antitumor activity in patients with EGFR/HER2 co-expressing AGC who progressed after first-line chemotherapy.

PURPOSE: The aim of this study was to compare the therapeutic effects of radiofrequency ablation (RFA) and hepatic resection (HR) with regards to procedural morbidity, mortality, overall survival (OS) and disease-free survival (DFS) rates in hepatocellular carcinoma (HCC) patients. METHODS: Retrospective studies were performed based on the medical records of 129 patients who underwent curative HR, and 57 who patients received RFA for HCC, between 2005 and 2009. The inclusion criteria of HCC were the presence of three or fewer nodules 3 cm or less in diameter or a single nodule of 5 cm or less. RESULTS: The 1-, 3- and 5-year OS rates in the HR group were 91.3%, 78.8%, and 64.9%, compared to 94.4%, 74.0%, and 74.0% in the RFA group, with no significant difference between the two groups (P = 0.725). The estimated 1- and 3-year DFS rates were 70.0% and 53.0% in the HR group and 65.2% and 24.7% in the RFA group, respectively. The DFS rates of HR group were significantly higher than RFA group (P = 0.015). Multivariate analysis identified that recurrence (P = 0.036) and portal hypertension (P = 0.036) were associated with OS and that portal hypertension (P = 0.048) and increased serum alpha-FP (P = 0.008) were the factors significantly associated with DFS. CONCLUSION: HCC within Milan criteria should consider hepatectomy as the primary treatment if the patient's liver function and general conditions are good enough to undergo surgical operation. But in that RFA revealed similar overall survival to HR, RFA can be an alternative therapy for patients who are eligible for surgical resection.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Disease-Free Survival ; Hepatectomy ; Humans ; Hypertension, Portal ; Liver ; Medical Records ; Mortality ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
Blood Transfusion ; Body Mass Index ; Chemotherapy, Adjuvant ; Cohort Studies ; Comorbidity ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Lymph Nodes ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

Peribiliary cysts, known as cystic dilatation, of the extramural peribiliary glands of the bile duct are rare, and are usually detectable under conditions of pre-existing hepatobiliary diseases such as liver cirrhosis. Preoperative diagnosis is often difficult, because they are usually asymptomatic. Distinction of peribiliary cysts from premalignant or malignant cystic lesions is mandatory. Herein, we report a case of peribiliary cyst, which was preoperatively assumed as unilobar Caroli's diseases in healthy young patients and briefly discuss the management of the condition.
Bile Ducts ; Caroli Disease ; Dilatation ; Humans ; Liver Cirrhosis ; Liver Neoplasms

Herein, we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma (collision tumor) in the ampulla of Vater, which has seldom been reported in the literature. A 51-year-old man presented with a month history of jaundice. MRCP disclosed about 1.9x1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, causing obstructions of distal common bile duct. He underwent pylorus-preserving pancreaticoduodenectomy under the diagnosis on ampulla of Vater cancer. Pathologically, sections on the ampulla of Vater showed conventional ductal adenocarcinoma extended and collided with poorly differentiated neuroendocrine carcinoma. In conclusion, we hereby presented a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma in the ampulla of Vater.
Adenocarcinoma* ; Ampulla of Vater* ; Carcinoma, Neuroendocrine* ; Common Bile Duct ; Diagnosis ; Humans ; Jaundice ; Middle Aged ; Pancreaticoduodenectomy

BACKGROUNDS/AIMS: The future liver remnant (FLR) is usually calculated as a ratio of the remnant liver volume (RLV) to the total functional liver volume (RLV/TFLV). In liver transplantation, it is generally accepted that the ratio of the graft volume to standard liver volume (SLV) needs to be at least 30% to 40% to fit the hepatic metabolic demands of the recipient. The aim of this study was to compare RLV/TFLV versus RLV/SLV as a predictor of postoperative liver function and liver failure. METHODS: CT volumetric measurements of RLV were obtained retrospectively in 74 patients who underwent right hemihepatectomy for a malignant tumor from January 2010 to May 2013. RLV and TFLV were obtained using CT volumetry, and SLV was calculated using Yu's formula: SLV (ml)=21.585 x body weight (kg)0.732 x height (cm)0.225. The RLV/SLV ratio was compared with the RLV/TFLV as a predictor of postoperative hepatic function. RESULTS: Postheptectomy liver failure (PHLF), morbidity, and serum total bilirubin level at postoperative day 5 (POD 5) were increased significantly in the group with the RLV/SLV < or =30% compared with the group with the RLV/SLV >30% (p=0.002, p=0.004, and p<0.001, respectively). But RLV/TFLV was not correlated with PHLF and morbidity (p=1.000 and 0.798, respectively). RLV/SLV showed a stronger correlation with serum total bilirubin level than RLV/TFLV (RLV/SLV vs. RLV/TFLV, R=0.706 vs. 0.499, R2=0.499 vs. 0.239). CONCLUSIONS: RLV/SLV was more specific than RLV/TFLV in predicting the postoperative course after right hemihepatectomy. To determine the safe limit of hepatic resection, a larger-scaled prospective study is needed.
Bilirubin ; Body Weight ; Humans ; Liver Failure ; Liver Transplantation ; Liver* ; Retrospective Studies ; Transplants

Anthracnose symptoms on young cabbages were found in cabbage nursery fields in Jangheung area of Korea in 1998. The symptoms developed on seedlings, leaves, and stems of young cabbages(Brassica oleracea var. capitata L.). The casual fungus was identified as Calletotrichum dernatium (Fr.) Grove based on morphological and cultural characteristics. Similar symptoms were observed on the cabbage when artificially inoculated on the plant leaves. The fungus was reisolated from the symptoms of the inoculated plant.
Brassica* ; Colletotrichum* ; Cultural Characteristics ; Fungi ; Korea ; Nurseries ; Plant Leaves ; Plants ; Seedlings

Plants have the ability to acquire an enhanced level of resistance to pathogen attack after being exposed to specific biotic stimuli. To obtain plant growth-promoting rhizobacteria inducing resistance against cucumber anthracnose by Colletotrichum orbiculare, more than 800 strains of rhizobacteria were screened in the greenhouse. Among these strains, Bacillus amyloliquefaciens solate EXTN-1 showed significant disease control efficacy on the plants. Induction of pathogenesis-related(PR-la) gene expression by EXTN-1 was assessed using tobacco plants transformed with PR-1a::beta-glucuronidase (GUS) construct. GUS activities of tobacco treated with EXTN-1 and salicylic acid-treated transgenic tobacco were significantly higher than those of tobacco plants with other treatments. Gene expression analyses indicated that EXTN-1 induces the accumulation of defense-related genes of tobacco. The results showed that some defense genes are expressed by the treatment with EXTN-1 suggesting the similar resistance mechanism by salicylic acid.
Bacillus* ; Colletotrichum ; Gene Expression ; Plants* ; Salicylic Acid ; Tobacco

Defense mechanisms against anthracnose disease caused by Colletotrichum orbiculare on the leaf surface of cucumber plants after pre-treatment with plant growth promoting rhizobacteria(PGPR), amino salicylic acid(ASA) or C. orbiculare were compared using a fluorescence microscope. Induced systemic resistance was mediated by the pre-inoculation in the root system with PGPR strain Bacillus amylolquefaciens EXTN-1 that showed direct antifungal activity to C. gloeosporioides and C. orbiculare. Also, systemic acquired resistance was triggered by the pre-treatments on the bottom leaves with amino salicylic acid or conidial suspension of C. orbiculare. The protection values on the leaves expressing SAR were higher compared to those expressing ISR. After pre-inoculation with PGPR strains no change of the plants was found in phenotype, while necrosis or hypersensitive reaction(HR) was observed on the leaves of plants pre-treated with ASA or the pathogen. After challenge inoculation, inhibition of fungal growth was observed on the leaves expressing both ISR and SAR. HR was frequently observed at the penetration sites of both resistance-expressing leaves. Appressorium formation was dramatically reduced on the leaves of plants pre-treated with ASA, whereas EXTN-1 did not suppress the appressorium formation. ASA also more strongly inhibited the conidial germination than EXTN-1. Conversely, EXTN-1 significantly increased the frequency of callose formation at the penetration sites, but ASA did not. The defense mechanisms induced by C. orbiculare were similar to those by ASA. Based on these results it is suggested that resistance mechanisms on the leaf surface was different between on the cucumber leaves expressing ISR and SAR, resulting in the different protection values.
Bacillus ; Colletotrichum* ; Defense Mechanisms ; Fluorescence ; Germination ; Necrosis ; Phenotype ; Plants ; Salicylic Acid

A clinical study was done on 16 cases of constrictive pericarditis admitted to National Medical Center, from january, 1970 to October, 1982, were reviewed, conclusion as follows: 1) The patients with constrictive pericarditis generally revealed clinical features of right heart failure but low incidence of its characteristic features. 2) Hemodynamic and echocardiographic examinations were much helpful in confirmation of clinical diagnosis. 3) pericardiectomy was highly succesful in achievement of clinical improvement.
Diagnosis ; Echocardiography ; Heart Failure ; Hemodynamics* ; Humans ; Incidence ; Pericardiectomy ; Pericarditis, Constrictive*