BACKGROUND/AIMS: Transarterial chemoembolization (TACE) is performed for single hepatocellular carcinoma (HCC) that are not eligible for surgery or ablation therapy. We investigated the clinical outcomes of patients with a single HCC ≤ 5 cm treated with TACE. METHODS: This study analyzed 175 consecutive patients who underwent TACE as an initial treatment for single HCC ≤ 5 cm. Predictive factors for complete response (CR), recurrence after CR, and overall survival (OS) were evaluated. RESULTS: Total 119 patients (68%) achieved CR after TACE. Tumor size < 3 cm and hepatitis B virus infection were significant predictors of CR (p < 0.05). Recurrent HCC was detected in 73 patients (61.3%) after CR. Age > 65 years and absence of liver cirrhosis were predictive factors for non-recurrence after CR (p < 0.05). The OS for all patients was 80.7 ± 5.6 months, and the 1-, 3-, and 5-year OS rates were 88.1%, 64.8%, and 49.9%, respectively. In multivariate analysis for OS, CR (hazard ratio [HR], 0.467; 95% confidence interval [CI], 0.292 to 0.747) and Child class A (HR, 0.390; 95% CI, 0.243 to 0.626) were significant factors. The OS for the CR and Child class A group were 92 and 93.6 months, respectively, and that of the non-CR and Child B, C group were 53.3 and 50.7 months, respectively (p < 0.001). CONCLUSIONS TACE can be a valid treatment in patients with a single HCC ≤ 5 cm not suitable for curative treatment, especially in patients with Child class A and CR after TACE.

No abstract available.
Humans ; Male ; Sjogren-Larsson Syndrome

BACKGROUND/AIMS: To investigate the predictive factors for complete response (CR) and recurrence after CR in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). METHODS: Among 691 newly diagnosed HCC patients, 287 were treated with TACE as a first therapy. We analyzed the predictive factors for CR, recurrence after CR, and overall survival (OS). RESULTS: Eighty-one patients (28.2%) achieved CR after TACE, and recurrence after CR was detected in 35 patients (43.2%). In multivariate analyses, tumor size (≤5 cm) and single nodularity were predictive factors for CR, with hazard ratios (HRs) of 0.35 (p=0.002) and 0.41 (p<0.001), respectively. Elevated serum α-fetoprotein (AFP) (>20 ng/mL) level and multinodularity exhibited significant relationships with recurrence after CR, with HRs of 2.220 (p=0.026) and 3.887 (p<0.001), respectively. Tumor size (>5 cm), multinodularity, elevated serum AFP (>20 ng/mL) level, Child-Turcotte-Pugh score (B and C), and portal vein thrombosis were significant factors for OS. CONCLUSIONS: In patients treated with TACE as a first therapy, tumor size (≤5 cm) and single nodularity were predictive factors for CR, and multinodularity and elevated serum AFP (>20 ng/mL) levels were predictive factors for recurrence after CR. These factors were also significant for OS.
Carcinoma, Hepatocellular* ; Chemoembolization, Therapeutic ; Humans ; Multivariate Analysis ; Recurrence* ; Venous Thrombosis

PURPOSE: Although violence occurs frequently in Korean television dramas, its description or definition is unusual. Many studies have shown that TV dramas have a powerful effect on society and the violence shown in medical dramas helps in comprehension of hospital violence occurring in real life. Therefore, this study will cover the types and levels of violence. METHODS: We selected five recent Korean medical dramas. These five dramas, which consisted of 94 episodes and were broadcast from 2007 to 2011, are analyzed. Violence is limited to the occurrence inside the hospital; violence that occurs outside of the hospital is excluded. Media violence is analyzed within PAT (perpetrator-action-target). In addition, the violence levels and violence relationships are analyzed. RESULTS: Among the types of violence, 88.5% is verbal abuse, 3.5% is physical threat, and 8.0% is physical violence. In comparison of the violence relationship, violence between a doctor and a doctor forms the highest rate of 72.6%. In the level of violence, 0 level of violence caused by verbal abuse is the highest (88.5%); however, 5 level of violence level, which is death, is not observed. There are 1475 minutes of violence scenes from 6243 minutes, which is 23.6% of total time. CONCLUSION: Frequency of violence in Korean medical dramas is higher than that of normal dramas. Considering the powerful influence of the mass media, the violence of medical dramas should be controlled. To resolve the problem, the role of advisory doctors seems important.
Comprehension ; Drama ; Korea ; Mass Media ; Television ; Violence

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.
Catheterization ; Emergencies ; Humans ; Pain Management ; Prospective Studies ; Sex Distribution ; Sports

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.
Catheterization ; Emergencies ; Humans ; Pain Management ; Prospective Studies ; Sex Distribution ; Sports

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-gamma has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-gamma were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Ralpha1/alpha2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-gamma levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Ralpha1, rather than IL-13Ralpha2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.
Adult ; Female ; Humans ; Idiopathic Interstitial Pneumonias/diagnosis/*metabolism ; Idiopathic Pulmonary Fibrosis/diagnosis/*metabolism ; Interferon-gamma/analysis ; Interleukin-13/*analysis ; Interleukin-13 Receptor alpha1 Subunit/*metabolism ; Interleukin-13 Receptor alpha2 Subunit/*metabolism ; Interleukin-4/analysis ; Lung/physiopathology ; Male ; Middle Aged

Mesenchymal stem cells (MSCs) are capable of self-renewal and differentiation into lineages of mesenchymal tissues that are currently under investigation for a variety of therapeutic applications. The purpose of this study was to compare cytokine gene expression in MSCs from human placenta, cord blood (CB) and bone marrow (BM). The cytokine expression profiles of MSCs from BM, CB and placenta (amnion, decidua) were compared by proteome profiler array analysis. The cytokines that were expressed differently, in each type of MSC, were analyzed by real-time PCR. We evaluated 36 cytokines. Most types of MSCs had a common expression pattern including MIF (GIF, DER6), IL-8 (CXCL8), Serpin E1 (PAI-1), GROalpha(CXCL1), and IL-6. MCP-1, however, was expressed in both the MSCs from the BM and the amnion. sICAM-1 was expressed in both the amnion and decidua MSCs. SDF-1 was expressed only in the BM MSCs. Real-time PCR demonstrated the expression of the cytokines in each of the MSCs. The MSCs from bone marrow, placenta (amnion and decidua) and cord blood expressed the cytokines differently. These results suggest that cytokine induction and signal transduction are different in MSCs from different tissues.
Bone Marrow Cells/*cytology ; Cytokines/genetics/*metabolism ; Female ; Fetal Blood/*cytology ; Gene Expression Profiling ; Humans ; Mesenchymal Stem Cells/cytology/*metabolism ; Placenta/*cytology ; Pregnancy ; Protein Array Analysis

BACKGROUND AND OBJECTIVES: The state of the coronary microcirculation is an important determinant of the myocardial viability and clinical outcomes for patients suffering with acute myocardial infarction (AMI). However, there are scant comparative studies on the most reliable invasive, on-site measurement for assessing the microvascular integrity and myocardial viability in AMI patients. The aim of this study is to evaluate the usefulness of a novel index of microcirculatory resistance (IMR) and the coronary physiologic parameters for predicting the myocardial viability after primary percutaneous coronary intervention (PCI) in AMI patients. SUBJECTS AND METHODS: Twenty-four patients (21 males, mean age: 55+/-11 years) underwent primary PCI for AMI (LAD: 17, RCA: 6, LCX: 1) were enrolled. After successful PCI, using a pressure-temperature sensor-tipped coronary wire, the thermodilution-derived CFR (CFRthermo) and coronary wedge pressure (Pcw) were measured and the ratio of the Pcw and the mean aortic pressure (Pcw/Pa) was calculated, along with the IMR, which was defined as the distal coronary pressure divided by the inverse of the hyperemic mean transit time. 18F-fluorodeoxyglucose (FDG) PET was performed after primary PCI at 7 days post-AMI to evaluate the myocardial viability by the regional percentage of FDG uptake in the infarct-related segments. RESULTS: There were good correlations between all the coronary pressure measurements and the regional FDG uptake (CFRthermo, r=0.454, p=0.026; Pcw, r=-0.407, p=0.048; Pcw/Pa, r=-0.480, p=0.018; IMR, r=-0.696, p<0.001, respectively). Multiple logistic regression analysis demonstrated that the IMR was an adjusted predictor for myocardial viability as defined by the 50% FDG-PET threshold value among all the coronary pressure measurements (OR=0.884, p=0.021). The cut-off value of IMR for predicting myocardial viability was 22 U (a sensitivity of 82%, a specificity of 85% and an accuracy of 85%). CONCLUSIONS: Intracoronary pressure wire-based indexes are useful for on-site assessment of myocardial viability after primary PCI. IMR is a novel index that represents the microvascular integrity, and it is a better predictor of myocardial damage than the current techniques for evaluating the microvasculature after primary PCI.
Angioplasty* ; Arterial Pressure ; Humans ; Logistic Models ; Male ; Microcirculation ; Microvessels ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Pulmonary Wedge Pressure ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES : Microvascular integrity has been associated with the clinical outcomes in acute myocardial infarction (AMI). The present study was conducted to determine the value of many microvascular indexes assessed by an intracoronary (IC) pressure/Doppler wire in AMI following primary PCI for detecting viable myocardium by comparing with the 18F-fluorodeoxyglucose uptake rate (%FDG uptake) on positron-emission tomography (PET). SUBJECTS AND METHODS : We studied 35 patients who had their first AMI (age: 56+/-12, male: 30). After primary PCI, the TMPG (TIMI myocardial perfusion grade) was assessed. We measured the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw), the Pcw/ Pa (mean aortic pressure) and the hyperemic microvascular resistance index (hMVRI) by an IC Doppler/ pressure wire. 18FDG PET scan was obtained at 7 days after the primary PCI; viable myocardium was defined that the %FDG uptake was more than 50% in infarct-related myocardium. RESULTS : There were significant correlations between TMPG, CFR, Pcw, Pcw/Pa, DDT, hMVRI and %FDG uptake (r=0.651, p<0.001; r=0.386, p=0.020; r=-0.388, p=0.021; r=-0.473, p=0.004; r=0.589, p<0.001; r=-0.442, p=0.008, respectively). The best cutoff values and area under curves (AUC) of the CFR, Pcw, Pcw/Pa, DDT and hMVRI for 50% FDG uptake were 1.8 (0.737), 27 mmHg (0.600), 0.33 (0.660), 600 msec (0.802) and 2.55 mmHg.cm-1.sec (0.768), respectively. The DDT had a significantly higher AUC than that of Pcw (p=0.029) and it was an independent index to predict the myocardial viability (p=0.011). CONCLUSION : DDT was the most reliable hemodynamic microvascular index that was assessed within 24 hours following primary PCI for predicting the viable myocardium in AMI patients.
Area Under Curve ; DDT ; Deceleration ; Fluorodeoxyglucose F18 ; Hemodynamics ; Humans ; Male ; Myocardial Infarction ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Pulmonary Wedge Pressure