Purpose: Immune checkpoint inhibitors (ICIs) have been shown significant oncological improvements in several cancers.However, ICIs are still in their infancy in hepatocellular carcinoma (HCC). Programmed cell death-ligand 1 (PD-L1), tumorinfiltrating lymphocytes (TILs), and epithelial-mesenchymal transition (EMT) have been known as prognostic factors in HCC. Therefore, we have focused on identifying the molecular mechanisms between each marker to evaluate a predictive role. Methods: Formalin-fixed paraffin-embedded samples were obtained from 166 patients with HCC who underwent surgery. The expression of PD-L1 and TILs and EMT marker were evaluated by immunohistochemical analysis. Results: The multivariate analysis showed that TIL expression (hazard ratio [HR], 0.483; 95% confidence interval [CI], 0.269–0.866; P = 0.015) were independent prognostic factors for overall survival. The prognostic factors for disease-free survival were EMT marker expression (HR, 1.565; 95% CI, 1.019–2.403; P = 0.005). Patients with high expression of TILs had significantly better survival compared to patients with low expression (P = 0.023). Patients who were TIL+/EMT– showed a significantly better prognosis than those who were TIL–/EMT+ (P = 0.049). Conclusion This study demonstrates that PD-L1 expression of TILs is closely associated with EMT marker expression in HCC. Clinical investigations using anti–PD-1/PD-L1 inhibitors in patients with EMT-associated PD-L1 upregulation are warranted.

BACKGROUND/OBJECTIVES: Oxidative stress is caused by reactive oxygen species and free radicals that accelerate inflammatory responses and exacerbate fatigue. Tormentic acid (TA) has antioxidant and anti-inflammatory properties. Thus, the aim of present study is to determine the fatigue-regulatory effects of TA in H2O2 -stimulated myoblast cell line, C2C12 cells and treadmill stress test (TST) and forced swimming test (FST) animal models.MATERIALS/METHODS: In the in vitro study, C2C12 cells were pretreated with TA before stimulation with H2O2 . Then, malondialdehyde (MDA), lactate dehydrogenase (LDH), creatine kinase (CK) activity, tumor necrosis factor (TNF)-α, interleukin (IL)-6, superoxide dismutase (SOD), catalase (CAT), glycogen, and cell viability were analyzed. In the in vivo study, the ICR male mice were administered TA or distilled water orally daily for 28 days. FST and TST were then performed on the last day. In addition, biochemical analysis of the serum, muscle, and liver was performed. RESULTS: TA dose-dependently alleviated the levels of MDA, LDH, CK activity, TNF-α, and IL-6 in H2O2 -stimulated C2C12 cells without affecting the cytotoxicity. TA increased the SOD and CAT activities and the glycogen levels in H2O2 -stimulated C2C12 cells. In TST and FST animal models, TA decreased the FST immobility time significantly while increasing the TST exhaustion time without weight fluctuations. The in vivo studies showed that the levels of SOD, CAT, citrate synthase, glycogen, and free fatty acid were increased by TA administration, whereas TA significantly reduced the levels of glucose, MDA, LDH, lactate, CK, inflammatory cytokines, alanine transaminase, aspartate transaminase, blood urea nitrogen, and cortisol compared to the control group. CONCLUSIONS TA improves fatigue by modulating oxidative stress and energy metabolism in C2C12 cells and animal models. Therefore, we suggest that TA can be a powerful substance in healthy functional foods and therapeutics to improve fatigue.

Background: The objective of this study was to determine whether manually performed calibration and quality control (QC) processes could be replaced with an automated laboratory system when installed analyzers fail to provide automated calibration and QC functions. Methods: Alanine aminotransferase (ALT), total cholesterol (TC), creatinine (Cr), direct bilirubin (DB), and lipase (Lip) items were used as analytes. We prepared pooled serum samples at 10 levels for each test item and divided them into two groups; five for the analytical measurement range (AMR) group and five for the medical decision point (MDP) group. Calibration and QC processes were performed for five consecutive days, and ALT, TC, Cr, DB, and Lip levels were measured in the two groups using automated and manual methods. Precision and the mean difference between the calibration and QC methods were evaluated using the reported values of the test items in each group. Results: Repeatability and within-laboratory coefficients of variation (CVs) between the automated system and the conventional manual system in the AMR group were similar. However, the mean reported values for test items were significantly different between the two systems. In the MDP group, repeatability and within-laboratory CVs were better with the automation system. All calibration and QC processes were successfully implemented with the Aptio total laboratory automation system. Conclusion The Aptio total laboratory automation system could be applied to routine practice to improve precision and efficiency.

Background: We sought to compare the performance of three commercially available automated urine sediment analyzers that represent the current urine sediment analysis technology. Methods: A total of 232 patient samples were analyzed using manual microscopy and three automated analyzers: IRIS Iq200 (Beckman Coulter, USA), UF-1000i (Sysmex, Japan), and Cobas u701 (Roche, Switzerland). We analyzed precision, linearity, carry-over, concordance rate, and agreement between the three analyzers and manual microscopy. Results: The repeatability and within-laboratory precision showed results similar to those of previous studies. All analyzers showed excellent linearity. The carry-over rates were within 1%. The correlation coefficient (r) between the three analyzers and manual microscopy was good. Regarding red blood cell (RBC), the UF-1000i showed a better concordance rate (90.52%) with manual microscopy than the other two analyzers and the agreement was substantial for UF-1000i (κ=0.63) and IRIS Iq200 (κ=0.61). Regarding white blood cell (WBC), Cobas u701 showed the best concordance rate (96.55%) and the agreement was moderate for IRIS Iq200 (κ=0.57) and Cobas u701 (κ=0.56), and fair for UF-1000i (κ=0.47). Regarding epithelial cell (EPI), IRIS Iq200 showed the highest concordance rate (99.2%) and the agreement was moderate for IRIS Iq200 (κ=0.59) and Cobas u701 (κ=0.54), and fair for UF-1000i (κ=0.40). Conclusions IRIS Iq200 offered the best agreement with manual microscopy for WBC and EPI count, while UF-1000i showed a better agreement for RBC count. The agreement is insufficient for fully replacing the manual microscopy.

Background: We sought to compare the performance of three commercially available automated urine sediment analyzers that represent the current urine sediment analysis technology. Methods: A total of 232 patient samples were analyzed using manual microscopy and three automated analyzers: IRIS Iq200 (Beckman Coulter, USA), UF-1000i (Sysmex, Japan), and Cobas u701 (Roche, Switzerland). We analyzed precision, linearity, carry-over, concordance rate, and agreement between the three analyzers and manual microscopy. Results: The repeatability and within-laboratory precision showed results similar to those of previous studies. All analyzers showed excellent linearity. The carry-over rates were within 1%. The correlation coefficient (r) between the three analyzers and manual microscopy was good. Regarding red blood cell (RBC), the UF-1000i showed a better concordance rate (90.52%) with manual microscopy than the other two analyzers and the agreement was substantial for UF-1000i (κ=0.63) and IRIS Iq200 (κ=0.61). Regarding white blood cell (WBC), Cobas u701 showed the best concordance rate (96.55%) and the agreement was moderate for IRIS Iq200 (κ=0.57) and Cobas u701 (κ=0.56), and fair for UF-1000i (κ=0.47). Regarding epithelial cell (EPI), IRIS Iq200 showed the highest concordance rate (99.2%) and the agreement was moderate for IRIS Iq200 (κ=0.59) and Cobas u701 (κ=0.54), and fair for UF-1000i (κ=0.40). Conclusions IRIS Iq200 offered the best agreement with manual microscopy for WBC and EPI count, while UF-1000i showed a better agreement for RBC count. The agreement is insufficient for fully replacing the manual microscopy.

Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward.

BACKGROUND AND OBJECTIVES: To prevent noise induced hearing losses caused by listening to music with personal listening devices for young adults, this study was aimed to measure output levels of an MP3 and to identify preferred listening levels (PLLs) depending on earphone types, music genres, and listening durations. SUBJECTS AND METHODS: Twenty-two normal hearing young adults (mean=18.82, standard deviation=0.57) participated. Each participant was asked to select his or her most PLLs when listened to Korean ballade or dance music with an earbud or an over-the-ear earphone for 30 or 60 minutes. One side of earphone was connected to the participant’s better ear and the other side was connected to a sound level meter via a 2 or 6 cc-couplers. Depending on earphone types, music genres, and listening durations, loudness A-weighted equivalent (LAeq) and loudness maximum time-weighted with A-frequency sound levels in dBA were measured. RESULTS: Neither main nor interaction effects of the PLLs among the three factors were significant. Overall output levels of earbuds were about 10-12 dBA greater than those of over-the-ear earphones. The PLLs were 1.73 dBA greater for earbuds than over-the-ear earphones. The average PLL for ballad was higher than for dance music. The PLLs at LAeq for both music genres were the greatest at 0.5 kHz followed by 1, 0.25, 2, 4, 0.125, 8 kHz in the order. CONCLUSIONS: The PLLs were not different significantly when listening to Korean ballad or dance music as functions of earphone types, music genres, and listening durations. However, over-the-ear earphones seemed to be more suitable to prevent noise induce hearing loss when listening to music, showing lower PLLs, possibly due to isolation from the background noise by covering ears.
Dancing ; Ear ; Hearing ; Hearing Loss ; Humans ; MP3-Player ; Music ; Noise ; Young Adult

OBJECTIVES: The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. METHODS: We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. RESULTS: The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P= 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P= 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. CONCLUSIONS: Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.
Acute Kidney Injury ; Blood Urea Nitrogen ; Creatinine ; Early Diagnosis* ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Lipocalins* ; Nephrectomy* ; Neutrophils* ; Oxidative Stress ; Prospective Studies ; Renal Insufficiency, Chronic ; ROC Curve