Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.

Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.

Objective: This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. Methods: Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. Results: Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. Conclusion The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.

Objective: This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. Methods: Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. Results: Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. Conclusion The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.

PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. MATERIALS AND METHODS: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy₁₀ (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy₁₀ (median, 56.0 Gy₁₀). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.
Carcinoma, Hepatocellular ; Classification ; Disease-Free Survival ; Humans ; Korea ; Liver ; Liver Diseases ; Multivariate Analysis ; Portal Vein ; Radiotherapy ; Radiotherapy, Conformal ; Retrospective Studies ; Thrombosis ; Treatment Outcome

PURPOSE: Cell-free DNA (cfDNA) is gaining attention as a novel biomarker for oncologic outcomes. We investigated the clinical significance of cfDNA in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT). MATERIALS AND METHODS: Fifty-five patients with HCC who received RT were recruited from two prospective study cohorts: one cohort of 34 patients who underwent conventionally fractionated RT and a second of 21 patients treated with stereotactic body radiation therapy. cfDNA was extracted and quantified. RESULTS: In total, 30% of the patients had multiple tumors, 77% had tumors >2 cm, and 32% had portal vein tumor thrombus. Optimal cut-off values for cfDNA levels (33.65 ng/mL and 37.25 ng/mL, before and after RT) were used to divide patients into low-DNA (LDNA) and high-DNA (HDNA) groups. The pre-RT HDNA group tended to have more advanced disease and larger tumors (p=0.049 and p=0.017, respectively). Tumor response, intrahepatic failure-free rates, and local control (LC) rates were significantly better in the post-RT LDNA group (p=0.017, p=0.035, and p=0.006, respectively). CONCLUSION: Quantitative analysis of cfDNA was feasible in our cohorts. Post-RT cfDNA levels were negatively correlated with treatment outcomes, indicating the potential for the use of post-RT cfDNA levels as an early predictor of treatment responses and LC after RT for HCC patients.
Biomarkers ; Carcinoma, Hepatocellular* ; Cohort Studies ; DNA* ; Humans ; Plasma* ; Portal Vein ; Prospective Studies ; Radiotherapy* ; Thrombosis

OBJECTIVES: The purpose of this study was to examine oral health literacy in a sample of Korean of 5th and 6th grade elementary school children. METHODS: Data were obtained from a convenience sample of 274 5(th) and 6(th) grade children from two elementary schools located in Seoul and Uijeongbu. The oral health literacy assessment tool for children of Korea (OHLC-K) takes approximately 11 minutes to complete, and consists of 20 self-report questions with a score range of 0 to 20. Item analysis, descriptive statistics, correlation and multiple linear regression were performed using SPSS 23.0 and testAn 1.0. RESULTS: The lowest and highest percentage of correct answers were found in “Definition of periodontal disease (19.3%)” and “Definition of halitosis (92.7%),” respectively. The mean score for oral health literacy was found to be 14.95 ± 2.83, corresponding to a score of approximately 75% correct answers. The correlation coefficient for Korean and OHLC-K scores was high (r=.73, P < .01). In the multiple linear regression, oral health literacy was associated with grade and gender. CONCLUSION: The present findings revealed that a quarter of the subjects were likely to misunderstand oral health information. Oral health education is indispensable to all children and, therefore, it is necessary to pay greater attention to children who exhibit poor oral health literacy.
Child ; Education ; Halitosis ; Humans ; Korea ; Linear Models ; Literacy ; Oral Health ; Periodontal Diseases ; Seoul

OBJECTIVES: This study aimed to determine the oral health behaviors and the relationships between social support, self-esteem, and oral health behaviors. METHODS: The institutions were selected based on the “2016 Elderly Welfare Facilities Status.” A total of 195 people participated in interviews conducted using a 39-item questionnaire. It included information on the following topics: a) sociodemographic and health-related characteristics (11 items), b) oral health behaviors (6), c) social support (12), and d) self-esteem (10). Statistical analyses included descriptive statistics, a reliability test, a t-test, an ANOVA, a Pearson's correlation test, and a stepwise multiple regression, conducted using the SPSS 23.0 program. RESULTS: Of the 195 participants, 165 (84.6%) brushed their teeth twice a day; however only 74 (38.0%) participants used oral care products. Although many (64.6%) elderly people visited a dentist at least once a year, only a few (24.6%) visited the dentist for preventive purposes. Oral health behaviors had a positive correlation with self-esteem, significant others' support, and friends'support (.337, .270, and .254, respectively; P<.01). According to the multiple regression analysis, self-esteem, significant others' support, perceived health status, number of existing permanent teeth, friends' support, degree of exercise, gender, and average monthly expenditure had a significant effect on the participants' oral health behaviors. CONCLUSIONS: We demonstrated that social support and self-esteem might be major predictors of oral health behaviors. These results suggest that psychosocial factors need to be taken into account in the oral health education provided for elderly people.
Aged* ; Dentists ; Education ; Health Expenditures ; Humans ; Oral Health* ; Psychology ; Tooth

PURPOSE: The aim of this study was to examine patterns of radiotherapy (RT) in Korean patients with hepatocellular carcinoma (HCC) according to the evolving guideline for HCC established by the Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC). MATERIALS AND METHODS: We reviewed 765 patients with HCC who were treated with RT between January 2011 and December 2012 in 12 institutions. RESULTS: The median follow-up period was 13.3 months (range, 0.2 to 51.7 months). Compared with previous data between 2004 and 2005, the use of RT as a first treatment has increased (9.0% vs. 40.8%). Increased application of intensity-modulated RT resulted in an increase in radiation dose (fractional dose, 1.8 Gy vs. 2.5 Gy; biologically effective dose, 53.1 Gy10 vs. 56.3 Gy10). Median overall survival was 16.2 months, which is longer than that reported in previous data (12 months). In subgroup analysis, treatments were significantly different according to stage (p < 0.001). Stereotactic body RT was used in patients with early HCC, and most patients with advanced stage were treated with three-dimensional conformal RT. CONCLUSION: Based on the evolving KLCSG-NCC practice guideline for HCC, clinical practice patterns of RT have changed. Although RT is still used mainly in advanced HCC, the number of patients with good performance status who were treated with RT as a first treatment has increased. This change in practice patterns could result in improvement in overall survival.
Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Liver Neoplasms ; Practice Patterns, Physicians'* ; Radiation Oncology* ; Radiotherapy*

OBJECTIVES: The purpose of this study was to develop and appraise an oral health literacy assessment tool for upper elementary school students. METHODS: Twenty-eight preliminary assessment items were developed on the basis of various types of oral health education literature for children. They contained verbal and functional sections and they were classified into 2 cognitive processes (literal and inferential). The questionnaires were analyzed using the testAn v.1.0 program for identified Cronbach's α, item discrimination, and difficulty through classical test theory. A final evaluation tool was developed and selected by conducting three surveys and 20 items. RESULTS: The final survey was completed by 132 fifth and sixth grade elementary school students in Seoul. The Cronbach's α value, item discrimination, and difficulty were .71, .38, and .75, respectively. The mean score for oral health literacy of children was 14.9 (±3.2, theoretical range: 0-20, 75% correct answers). CONCLUSIONS: These results suggest that this tool could be relied on to help determine the level of oral health literacy in children and in preparing appropriate oral health education programs for children.
Child ; Discrimination (Psychology) ; Education ; Humans ; Literacy* ; Oral Health* ; Seoul