Purpose: Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS. Methods: RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases. Results: Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < –1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC − 1.35, p < 0.001, and HDAC1: log 2-FC − 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24–20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04–9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC. Conclusion Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.

The aim of this study was to identify the risk factors for presence and severity of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in Korean children and adolescents. A retrospective chart review of children and adolescents newly diagnosed with T1DM was conducted in seven secondary and tertiary centers in Korea. Eligible subjects were < 20 years of age and had records on the presence or absence of DKA at the time of T1DM diagnosis. DKA severity was categorized as mild, moderate, or severe. Data were collected on age, height, body weight, pubertal status, family history of diabetes, delayed diagnosis, preceding infections, health insurance status, and parental education level. A total of 361 patients (male 46.3%) with T1DM were included. Overall, 177 (49.0%) patients presented with DKA at T1DM diagnosis. Risk factors predicting DKA at T1DM diagnosis were age ≥ 12 years, lower serum C-peptide levels, presence of a preceding infection, and delayed diagnosis. Low parental education level and preceding infection increased the severity of DKA. These results suggest that alertness of the physician and public awareness of diabetes symptoms are needed to decrease the incidence and severity of DKA at T1DM diagnosis.
Adolescent* ; Body Height ; C-Peptide ; Child* ; Delayed Diagnosis ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis* ; Diagnosis* ; Education ; Humans ; Incidence ; Insurance, Health ; Korea ; Parents ; Retrospective Studies ; Risk Factors

Postoperative fluid collection is a major complication after pancreaticoduodenectomy and can lead to increased mortality and hospital length of stay. External drainage has widely been used for postoperative fluid collections. Recently, EUS-guided drainage has also been used successfully in treating postoperative fluid collections. A 60-year-old woman was admitted due to weight loss and jaundice. She underwent pancreaticoduodenectomy for cholangiocarcinoma of the common bile duct. After 2 weeks, she had fever with abdominal pain and leukocytosis. CT showed a increased fluid collection in superior recess of lesser sac and EUS-guided drainage was performed. The symptoms resolved without any complication after drainage. This is the first case report of EUS-guided drainage for lesser sac in Korea.
Abdominal Pain ; Cholangiocarcinoma ; Common Bile Duct ; Drainage* ; Endosonography ; Female ; Fever ; Humans ; Jaundice ; Korea ; Length of Stay ; Leukocytosis ; Middle Aged ; Mortality ; Pancreaticoduodenectomy* ; Peritoneal Cavity* ; Postoperative Complications ; Weight Loss

The reactivation of hepatitis B virus (HBV) is well known complication among lymphoma patient related with chemotherapy. Rituximab is monoclonal antibody that targets B-lymphocytes for treatment of lymphoma and it increases reactivation of HBV. Although most of reactivation occurs in HBV carrier, it can also rarely occur when hepatitis B surface antigen (HBsAg) is negative. Furthermore it is less frequently reported in lymphoma patient when HBV serology shows HBsAg is negative and anti-HBs is positive. We report a case of HBV reactivation following 6 cycle of rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy for diffuse large B-cell lymphoma in HBsAg negative/anti-HBs positive 58-year-old male, with a review of the literature.
B-Lymphocytes ; Doxorubicin ; Drug Therapy* ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Male ; Middle Aged ; Vincristine ; Rituximab

Codonopsis lanceolata has been used as an herbal medicine for several lung infl ammatory diseases, such as asthma, tonsillitis, and pharyngitis. Previously, we showed the neuroprotective effect of steamed and fermented C. lanceolata (SFC) in vitro and in vivo. In the current study, the treatment of HT22 cells with SFC decreased glutamate-induced cell death, suggesting that SFC protected HT22 cells from glutamate-induced cytotoxicity. Based on these, we sought to elucidate the mechanisms of the neuroprotective effect of SFC by measuring the oxidative stress parameters and the expression of Bax and caspase-3 in HT22 cells. SFC reduced contents of ROS, Ca2+ and NO. Moreover, SFC restored contents of glutathione and glutathione reductase as well as inhibited Bax and caspase-3 activity in HT22 cells. These results indicate that steamed and fermented C. lanceolata (SFC) extract protected HT22 cells by anti-oxidative effect and inhibition of the expression of Bax and caspase-3.
Asthma ; Caspase 3 ; Cell Death ; Codonopsis* ; Glutathione ; Glutathione Reductase ; Herbal Medicine ; Lung ; Neuroprotective Agents* ; Oxidative Stress ; Palatine Tonsil ; Pharyngitis ; Steam* ; Tonsillitis

Codonopsis lanceolata (Campanulaceae) traditionally have been used as a tonic and to treat patients with lung abscesses. Recently, it was proposed that the extract and some compounds isolated from C. lanceolata reversed scopolamine-induced memory and learning deficits. The purpose of this study was to evaluate the improvement of cognitive enhancing effect of C. lanceolata by steam and fermentation process in scopolamine-induced memory impairment mice models by passive avoidance test and Morris water maze test. The extract of C. lanceolata or the extract of steamed and fermented C. lanceolata (SFCE) was orally administered to male mice at the doses of 100 and 300 mg/kg body weight. As a result, mice treated with steamed and fermented C. lanceolata extract (SFCE) (300 mg/kg body weight, p.o.) showed shorter escape latencies than those with C. lanceolata extract or the scopolamine-administered group in Morris water maze test. Also, it exerted longer step-through latency time than scopolamine treated group in passive avoidance test. Furthermore, neuroprotective effect of SFCE on glutamate-induced cytotoxicity was assessed in HT22 cells. Only SFCE-treated cells showed significant protection at 500 microg/ml. Interestingly, steamed C. lanceolata with fermentation contained more phenolic acid including gallic acid and vanillic acid than original C. lanceolata. Collectively, these results suggest that steam and fermentation process of C. lanceolata increased cognitive enhancing activity related to the memory processes and neuroprotective effect than original C. lanceolata.
Animals ; Body Weight ; Codonopsis* ; Fermentation ; Gallic Acid ; Humans ; Learning ; Lung Abscess ; Male ; Maze Learning ; Memory* ; Mice* ; Neuroprotective Agents ; Phenol ; Scopolamine Hydrobromide ; Steam* ; United Nations ; Vanillic Acid

Previous studies have shown that hematopoietic stem cell transplantation (HSCT) may result in growth impairment. The purpose of this study was to evaluate the growth during 5 yr after HSCT and to determine factors that influence final adult height (FAH). We retrospectively reviewed the medical records of acute myeloid leukemia (AML) patients who received HSCT. Among a total of 37 eligible patients, we selected 24 patients who began puberty at 5 yr after HSCT (Group 1) and 19 patients who reached FAH without relapse (Group 2). In Group 1, with younger age at HSCT, sex, steroid treatment, hypogonadism and hypothyroidism were not significantly associated with growth impairment 5 yr after HSCT. History of radiotherapy (RT) significantly impaired the 5 yr growth after HSCT. Chronic graft-versus-host disease (cGVHD) only temporarily impaired growth after HSCT. In Group 2, with younger age at HSCT, steroid treatment and hypogonadism did not significantly reduce FAH. History of RT significantly reduced FAH. Growth impairment after HSCT may occur in AML patients, but in patients without a history of RT, growth impairment seemed to be temporary and was mitigated by catch-up growth.
Adolescent ; Body Height/*radiation effects ; Child ; Child, Preschool ; Female ; Graft vs Host Disease/pathology/prevention & control ; *Hematopoietic Stem Cell Transplantation ; Humans ; Hypogonadism/drug therapy/pathology ; Infant ; Leukemia, Myeloid, Acute/radiotherapy/*therapy ; Male ; Recurrence ; Retrospective Studies ; Risk Factors ; Steroids/therapeutic use

PURPOSE: To compare surgical outcomes and complications after percutaneous nephrolithotomy (PCNL) under regional or general anesthesia. MATERIALS AND METHODS: One hundred and one patients who underwent PCNL as a first-line treatment for kidney calculi between June 2004 and June 2013 were enrolled in this retrospective study. Patients were classified into two groups by anesthetic method: 77 were allocated to the regional anesthesia group and 24 to the general anesthesia group. Patient general characteristics, stone features, surgical outcomes, and complications were compared between the two groups. RESULTS: The two groups were similar in terms of mean age and stone size, number, and type. Furthermore, they did not differ significantly in terms of general characteristics, treatment outcomes, or complications excluding postoperative fever. However, mean hospital stay was significantly shorter in the regional anesthesia group than in the general anesthesia group (8.9+/-3.2 days vs. 11.5+/-6.9 days, respectively, p=0.025). Also, the postoperative fever rate was significantly higher in the general anesthesia group (53.2% vs. 83.3%, respectively, p=0.007). CONCLUSIONS: Regional anesthesia is as effective as general anesthesia during percutaneous nephrolithotomy and is associated with shorter hospital stays and lower rates of postoperative fever.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General* ; Fever ; Humans ; Kidney Calculi ; Length of Stay ; Methods ; Nephrostomy, Percutaneous* ; Retrospective Studies

PURPOSE: To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. MATERIALS AND METHODS: We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher's exact tests were used to analyze qualitative data. RESULTS: Mean stone sizes in groups A and B were 2.41+/-1.62 mm and 4.11+/-2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. CONCLUSIONS: Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.
Colic ; Emergencies ; Humans ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Ureteroscopy

We report here on a case of a neurogenic tumor of the neck with an uncertain origin on the preoperative evaluation. A 67-year-old woman with a palpable mass in the left side of the neck was referred to our hospital. The mass had slowly grown over 7 years and her dyspnea had gradually become more severe over the recent 6 months. Computerized tomography and magnetic resonance imaging showed an 8 cm sized solid mass that abutted the trachea and the esophagus without invasion, but the origin of the mass was not clearly identified. During surgical exploration, we identified that the tumor was located in the esophageal muscle layer. Immunohistochemical staining revealed that the tumor cells were positive for S-100 protein, which confirmed a diagnosis of schwannoma.
Aged ; Diagnosis ; Diagnosis, Differential* ; Dyspnea ; Esophagus ; Female ; Humans ; Magnetic Resonance Imaging ; Neck ; Neurilemmoma ; S100 Proteins ; Thyroid Gland ; Trachea