Publications by authors named "Dong Hee Ryu"

37 Publications

Spontaneous heterotopic mesenteric ossification around the pancreas causing duodenal stenosis: A case report with literature review.

Int J Surg Case Rep 2021 Apr 6;81:105702. Epub 2021 Mar 6.

Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea. Electronic address:

Introduction And Importance: Heterotopic mesenteric ossification (HMO) is a rare condition that can be hereditary or nonhereditary. It can lead to small bowel obstruction, which may require corrective surgery. Most affected patients have a history of abdominal surgery or trauma. Spontaneously occurring HMO is even rarer, with only 7 cases reported till date. There has been no previous report of spontaneous peripancreatic HMO.

Case Presentation: A 60-year-old man presented with complaints of recurrent nausea and vomiting for 2 months. Esophagogastroduodenoscopy revealed luminal stenosis and edematous changes involving the second and third parts of the duodenum but not its complete obstruction. Abdominopelvic computed tomography showed faintly enhanced thickening of the involved duodenal walls along with mild dilatation of the common bile duct. Considering the possibility of periampullary cancer, we performed a pylorus-preserving pancreaticoduodenectomy. Histopathological examination confirmed the diagnosis of HMO with extensive fibrosis involving the peripancreatic soft tissue.

Clinical Discussion: The peripancreatic HMO with severe fibrosis can occur duodenal stenosis, and it is mimicking periampullary cancer. However, the preoperative diagnosis of spontaneous HMO is difficult, and a diagnosis confirmed after surgery.

Conclusion: Herein, we described our experience of managing a rare case of duodenal stenosis due to spontaneous HMO involving peripancreatic tissue.
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http://dx.doi.org/10.1016/j.ijscr.2021.105702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073193PMC
April 2021

Influence of School-Based Smoking Prevention Education on Reducing Gap in Exposure to Anti-Tobacco Media Message among Korean Adolescents.

Int J Environ Res Public Health 2020 11 25;17(23). Epub 2020 Nov 25.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea.

Korean adolescents at high risk for smoking are less exposed to anti-tobacco media messages. This study examines whether school-based smoking prevention education is related to media exposure and whether it can contribute to reducing the gap in exposure to anti-tobacco media messages between smoking vulnerable and non-vulnerable groups. A nationally representative dataset, the 2018 Korea youth risk behavior web-based survey, comprising 59,410 students from grades 7-12, was analyzed. Logistic regression models were designed to evaluate the association between school-based smoking prevention education and media messages exposure. Within-group differences in exposure levels based on sociodemographic characteristics were compared depending on participation or nonparticipation in school-based smoking prevention education. Experience of smoking prevention education within a year was significantly associated with exposure to anti-tobacco media messages. Among Korean adolescents who participated in smoking prevention education compared to those who did not, the media messages exposure rate was more than 20% higher, and the exposure gap within the subgroups by sociodemographic characteristics was narrower. Participation in school-based smoking prevention education was significantly related to media messages exposure. This relationship can be used to improve the overall media messages exposure rate and to reduce the differences in exposure rate based on sociodemographic traits.
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http://dx.doi.org/10.3390/ijerph17238742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727860PMC
November 2020

Association between Intention to Quit Cigarette Smoking and Use of Heated Tobacco Products: Application of Smoking Intensity Perspective on Heated Tobacco Product Users.

Int J Environ Res Public Health 2020 11 16;17(22). Epub 2020 Nov 16.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea.

Tobacco companies have designed sophisticated marketing strategies for heated tobacco products (HTPs), and many smokers are exposed to advertisements purporting that HTPs can replace combustible cigarettes. The present study evaluates the relationship between poly-use of tobacco products and intention to quit cigarette smoking in association with smoking intensity, a meaningful indication of one's interest in quitting cigarette smoking. A total of 36,397 current cigarette smokers who participated in the 2019 Korea Community Health Survey were evaluated. A multivariable logistic regression model was designed. Additionally, smoking-intensity-stratified analyses were conducted. A total of 4.7% of the participants reported planning to quit cigarette smoking within one month. Current dual users of combustible cigarettes and HTPs presented no significantly increased likelihood of intention to quit cigarette smoking regardless of cigarette-smoking intensity. By contrast, light and heavy daily smokers who accompanied e-cigarette use presented significant adjusted odds ratios (aORs) of 1.81 (95% confidence interval (CI): 1.04-3.14) and 1.97 (95% CI: 1.14-3.42), respectively. Occasional and daily smokers who reported using both HTPs and e-cigarettes presented no significance. The results of the present study suggested that a complete replacement of combustible cigarettes with HTPs was unlikely.
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http://dx.doi.org/10.3390/ijerph17228471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696897PMC
November 2020

Fall characteristics among elderly populations in urban and rural areas in Korea.

Medicine (Baltimore) 2020 Nov;99(46):e23106

Department of Rehabilitation Medicine, Hanyang University, College of Medicine.

Falling is one of the leading causes of injury among elderly populations. As the population over 65 years old increases, medical costs due to falling will also increase. Urban and rural areas have different fall characteristics, and research into these differences is lacking.A survey was conducted on 2012 people over 60 years old between September 1, 2015, to October 12, 2015. Guro-gu (Seoul), Yeongdeungpo-gu (Seoul), and Jung-gu (Daegu) were classified as urban areas and included 1205 of the study participants. Dalseong-gun (Daegu) and Yangpyeong-gun (Gyeonggi-do) were categorized as rural areas and included 807 participants. The survey included questions about fall history, cause, season and time of recent falls, and external conditions associated with recent falls, like floor or ground materials and shoe types.Rural respondents were older than urban respondents (P < .001) but did not differ significantly in gender proportion (P = .082). Fall history over the past year was not different between the 2 regions (P = .693), but lifetime fall history was greater among rural respondents (P < .001). Only 5.1% of all respondents had undergone fall-prevention education. A slippery floor was the most common cause of falls in both regions, but there was a significant difference in pattern of fall causes (P < .001). Falls were more frequent in the summer, spring, and the afternoon in urban areas, and in the summer, autumn, and the morning in rural areas. Cement and asphalt were the most common ground materials at the time of falls in both regions, but rural respondents had higher fall rates when walking on soil and when wearing slippers.A fall-prevention program that reflects the characteristics and differences of falls in urban and rural areas should be developed and used to effectively prevent falling among elderly people.
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http://dx.doi.org/10.1097/MD.0000000000023106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668504PMC
November 2020

Examining Liver Cancer Patients and a High-Risk Group in a Vulnerable Area: An Experience from the Ulleung Liver Cancer Prevention and Management Project.

Int J Environ Res Public Health 2020 10 23;17(21). Epub 2020 Oct 23.

Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.

Ulleung county is a small island on the eastern side of the Korean peninsula. The Ulleung Liver Cancer Prevention and Management Project was launched in order to minimize newly developing liver cancer within this region. Population-based regional cancer registry data were analyzed to investigate the status and characteristics of registered liver cancer patients. The Interagency Workgroup of the project provided a special screening program from 1 November to 3 November 2018, and from 23 April to 25 April 2019, undertaking liver cancer screening and health behavior surveys. Logistic regression analysis was used to determine factors associated with recent liver cancer screening. In Ulleung county, hepatocellular carcinoma was identified as the main type of liver cancer, accompanied by a high incidence of hepatitis B. Approximately 25.0% of the participants were not aware of their liver condition. People who were aware of their liver condition and those who reported a general understanding of hepatitis B were more likely to have undergone recent liver cancer screening. To prevent the development and spread of the disease in the community, adequate infrastructure for cancer screening and an enhanced monitoring system are required, along with measures to create awareness to periodically determine liver condition in high-risk groups.
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http://dx.doi.org/10.3390/ijerph17217757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660348PMC
October 2020

Cigarette or E-Cigarette Use as Strong Risk Factors for Heated Tobacco Product Use among Korean Adolescents.

Int J Environ Res Public Health 2020 09 24;17(19). Epub 2020 Sep 24.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea.

Heated tobacco products (HTPs) were first introduced in Korea in June 2017. This study examined the prevalence of current HTP use among Korean adolescents and its association with conventional cigarette (CC) or electronic cigarette (EC) use. The study analyzed nationally representative data (the 2019 Korea Youth Risk Behavior Web-based Survey) from a sample of 57,303 Korean students from grades 7-12. Multinomial logistic regression models were designed to evaluate the association between EC or CC use and HTP use. A total of 2.6% of respondents were current HTP users and 95.9% of them were dual or triple users of CC or EC. The likelihood of HTP use was higher among current CC or EC users and highest among dual users. When the association between each tobacco product and current HTP use was analyzed, the dual use tendency of HTPs and other products steadily increased with the increase of CC or EC smoking frequency. Adolescents who use ECs and/or CCs are likely to use HTPs. Thus, HTPs could be a new public health concern for adolescents in terms of dual or triple use patterns of CC or EC.
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http://dx.doi.org/10.3390/ijerph17197005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579640PMC
September 2020

Corrigendum to "Heated tobacco products: Cigarette complements, not substitutes" [Drug and Alcohol Depend. 204 (2019) 107576].

Drug Alcohol Depend 2020 Mar 23;208:107872. Epub 2020 Jan 23.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea. Electronic address:

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http://dx.doi.org/10.1016/j.drugalcdep.2020.107872DOI Listing
March 2020

Laparoscopic management for stump appendicitis: A case series with literature review.

Medicine (Baltimore) 2019 Nov;98(47):e18072

Department of Surgery, Chungbuk National University Hospital.

Introduction: Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of the remnant part of the appendix. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis of stump appendicitis is often delayed.

Methods: Between January 2008 and December 2017, 6 patients were diagnosed with stump appendicitis with or without perforation at a single institution. They had undergone operative management with laparoscopic approach. The clinical data of these patients were retrospectively analyzed by reviewing the medical records and pathologic reports.

Results: Five patients were male, with a mean age of 42.4 years (range 11-77 years). The time interval after initial appendectomy ranged from 2 weeks to 30 years. Three patients underwent laparoscopic completion appendectomy, and the others underwent laparoscopic ileocecectomy. The mean hospital stay was 9 days (range 5-13 days). There were no cases of open conversion.

Conclusions: Stump appendicitis is a rare complication after appendectomy. A laparoscopic procedure can be performed for management of stump appendicitis with or without perforation.
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http://dx.doi.org/10.1097/MD.0000000000018072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882645PMC
November 2019

Heated tobacco products: Cigarette complements, not substitutes.

Drug Alcohol Depend 2019 11 21;204:107576. Epub 2019 Sep 21.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea. Electronic address:

Background: In Korea, the sale of the first heated tobacco product (HTP), IQOS®, commenced in June 2017. This study evaluates the rates of HTP use and examines HTP users' smoking patterns of various tobacco products.

Methods: The study analyzed the 2018 Korea Community Health Survey data of a Korean provincial division, which includes 11 cities and 14 counties. Of 21,100 participants, the proportion of current HTP users was calculated and their smoking patterns, in regard to cigarette use, were examined. A multinomial logistic regression model was used to evaluate the related factors of HTP use.

Results: The proportion of current HTP users (HTP use within the past 30 days) was 2.13% of the study population. Of these current HTP users, 96.25% were dual users of cigarettes. The adjusted odds ratio (AOR) for current HTP use increased proportionately with frequency and amount of cigarette consumption with statistical significance. The AOR values showed a quadratic curve, descending after the peak value for moderate daily smokers (10-19 cigarettes/day) (P<0.001, P<0.001). Current cigarette smokers who also used HTPs were not associated with an intention to quit cigarette smoking within a month.

Conclusions: Given the smoking pattern of HTP users in terms of mutual use with cigarettes, HTPs might not be an alternative to cigarettes as tobacco companies claim.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107576DOI Listing
November 2019

Urinary Cell-Free DNA IQGAP3/BMP4 Ratio as a Prognostic Marker for Non-Muscle-Invasive Bladder Cancer.

Clin Genitourin Cancer 2019 06 9;17(3):e704-e711. Epub 2019 Apr 9.

Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea. Electronic address:

Background: Disease monitoring in non-muscle-invasive bladder cancer (NMIBC) patients is crucial for early identification of disease recurrence and progression. High IQGAP3/BMP4 and IQGAP3/FAM107A ratios in urinary cell-free DNA (ucfDNA) are a diagnostic biomarker for bladder cancer. We aimed to investigate whether the levels of these biomarkers in ucfDNA can be used to monitor disease recurrence or progression in patients with NMIBC.

Patients And Methods: A total of 103 patients with NMIBC (pTa-pT1) were enrolled. The IQGAP3/BMP4 and IQGAP3/FAM107A ratios in ucfDNA were measured by real-time PCR, and the results were compared with clinical outcome by Kaplan-Meier curves and Cox regression analyses.

Results: Overall, 55 patients (53.4%) experienced recurrence and 29 (28.2%) experienced disease progression during a median follow-up of 42.7 months (range, 6.1-172.2 months). Kaplan-Meier analysis revealed that NMIBC patients with a high IQGAP3/BMP4 ratio had worse recurrence-free survival and progression-free survival (PFS) (P = .001 and < .001, respectively), and those with a high IQGAP3/FAM107A ratio had worse PFS (P = .006). Multivariate Cox regression analysis revealed that the IQGAP3/BMP4 ratio was independently associated with recurrence-free survival (hazard ratio, 2.462; P = .003) and PFS (hazard ratio = 3.871; P = .004), whereas the IQGAP3/FAM107A ratio was not an independent factor for PFS (P = .079).

Conclusion: The IQGAP3/BMP4 ratio in ucfDNA might be a valuable novel biomarker for predicting disease recurrence and progression in patients with NMIBC.
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http://dx.doi.org/10.1016/j.clgc.2019.04.001DOI Listing
June 2019

Is Chronic Exposure to Low-Dose Organochlorine Pesticides a New Risk Factor of T-cell Immunosenescence?

Cancer Epidemiol Biomarkers Prev 2018 10 10;27(10):1159-1167. Epub 2018 Jul 10.

Department of Preventive Medicine, School of Medicine, Kyungpook National University, Jung-gu, Daegu, Republic of Korea.

T-cell immunosenescence, a hallmark of an aging immune system, is potentially linked to the risk of developing cancer and other aging-related diseases. Chronic infection by cytomegalovirus (CMV) has been widely studied as a risk factor for T-cell immunosenescence, but the role of persistent chemicals has never been examined. As a typical example of persistent chemicals, we evaluated whether organochlorine pesticides (OCPs) are related to T-cell immunosenescence in the general population. Serum concentrations of β-hexachlorocyclohexane, '-DDT, '-DDE, and trans-nonachlor were measured in 95 Korean adults ages 30 to 64 years. T-cell immunosenescence was assessed by the frequencies of CD8CD57, CD8CD28, CD4CD57, and CD4CD28 T lymphocytes in 20 mL of fresh peripheral blood. The senescence of CD8 T lymphocytes was the most consistently associated with OCPs. For quartiles of measurements of OCPs, adjusted mean percentages of CD8CD57 and CD8CD28 T lymphocytes in the CD8 T lymphocyte population were 23.9, 27.6, 31.0, and 38.7 ( < 0.01) and 25.6, 27.3, 28.0, and 35.5 ( = 0.02), respectively. When we compared the strength of the associations among OCPs, CMV IgG titer, and age, OCPs showed the strongest association with markers of immunosenescence. Importantly, the association between OCPs and immunosenescence markers was more prominent among participants without known risk factors, such as a young age or low CMV immunoglobulin G titer. Chronic exposure to low-dose OCPs may be a new risk factor for T-cell immunosenescence. T-cell immunosenescence may be one possible mechanism linking low-dose OCPs and many chronic diseases. .
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http://dx.doi.org/10.1158/1055-9965.EPI-17-0799DOI Listing
October 2018

Complications and Socioeconomic Costs Associated With Falls in the Elderly Population.

Ann Rehabil Med 2018 Feb 28;42(1):120-129. Epub 2018 Feb 28.

Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea.

Objective: To explore the incidence, characteristics, complications and socioeconomic impacts associated with falls in community-dwelling elderly.

Methods: From September 1, 2015 to October 12, 2015, a questionnaire-based survey was conducted involving a total of 2,012 elderly who lived in Guro-gu (Seoul), Yeongdeungpo-gu (Seoul), Yangpyeong-gu (Gyeonggi-do), Dalseong-gu (Daegu), and Jung-gu (Daegu). The subjects were interviewed using a structured questionnaire to obtain demographic characteristics and comprehensive falling histories. The socioeconomic cost related to falls was estimated using the statistical data provided by the Health Insurance Review and Assessment Service.

Results: Falls were recorded in 666 out of the 2,012 subjects (33.1%) during the past year. Frequent falls occurred during December, in the afternoons, when the floor was slippery. The most common injuries included the low back and the most common injury type was sprain. The total direct costs related to falls involving the 2,012 subjects were 303,061,019 KRW (Korean won). The average medical cost related to falls in the 2,012 subjects was 150,627 KRW and the average medical cost of 666 subjects who experienced falls was 455,047 KRW. Estimates of the total population over the age of 60 years showed that the annual direct costs associated with falls in Korea over the age of 60 years were about 1.378 trillion KRW.

Conclusion: This study was conducted to explore the incidence, characteristics, complications, and socioeconomic impacts of falls in community-dwelling elderly. This study is expected to be used as a source of basic data for the establishment of medical policy for the elderly and the development of a fall prevention program for the elderly in Korea.
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http://dx.doi.org/10.5535/arm.2018.42.1.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852215PMC
February 2018

Clinical features of gastric emptying after distal gastrectomy.

Ann Surg Treat Res 2017 Dec 1;93(6):310-315. Epub 2017 Dec 1.

Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Purpose: Gastric emptying may influence the quality of life of patients who undergo distal gastrectomy. Little is known, however, about gastric emptying after distal gastrectomy. The aim of our study was to investigate gastric emptying patterns after distal gastrectomy.

Methods: This gastric-emptying study investigated patients who underwent distal gastrectomy in the 6 months or more before May 2008 to July 2013 at Chungbuk National University Hospital with a study sample of 205 patients. We analyzed patterns of gastric emptying.

Results: Delayed gastric emptying was found in 109 of the 205 patients (53.2%). Food stasis was more frequent in a group with delayed gastric emptying. In multivariate analysis, risk factors for gastroparesis were laparoscopic operation (hazard ratio [HR], 2.731; P = 0.008) and duration of less than 24 months after distal gastrectomy (HR, 2.795; P = 0.001). Delayed gastric emptying tended to decrease with duration of the postoperative period.

Conclusion: Delayed gastric emptying is common in distal gastrectomy, and is related to laparoscopic operation and duration of the postoperative period. Food stasis was more frequent in a group with delayed gastric emptying.
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http://dx.doi.org/10.4174/astr.2017.93.6.310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729125PMC
December 2017

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City.

J Prev Med Public Health 2017 Sep;50(5):283-293

Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Objectives: The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries.

Methods: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves.

Results: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services.

Conclusions: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.
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http://dx.doi.org/10.3961/jpmph.17.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637057PMC
September 2017

Exploring Nursing Intention, Stress, and Professionalism in Response to Infectious Disease Emergencies: The Experience of Local Public Hospital Nurses During the 2015 MERS Outbreak in South Korea.

Asian Nurs Res (Korean Soc Nurs Sci) 2017 Sep 21;11(3):230-236. Epub 2017 Aug 21.

Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.

Purpose: This study aimed to examine levels of stress and professionalism of nurses who provided nursing care during the 2015 Middle East respiratory syndrome outbreak based on their experience, to investigate the nurses' intention to respond to possible future outbreaks in relation to their experience during the outbreak, and to determine the relationship between the outbreak experience and nursing intention considering stress and professionalism.

Methods: A self-administered questionnaire was designed based on modifications of related questionnaires, and used to assess levels of stress, professionalism, and nursing intention according to participants' experiences during the outbreak. Multiple regression analysis was used to examine the relationship between the outbreak nursing experience and nursing intention considering stress and nursing professionalism.

Results: The overall stress, professionalism, and nursing intention scores for the firsthand experience group were 33.72, 103.00, and 16.92, respectively, whereas those of the secondhand experience group were 32.25, 98.99, and 15.60, respectively. There were significant differences in professionalism and nursing intention scores between the groups (p = .001 and p < .001, respectively). The regression analysis revealed that the regression estimate between stress and nursing intention was B(SE) = -0.08(0.02), beta = -0.21, p < .001 and the regression estimate between professionalism in nursing and nursing intention was B(SE) = 0.05(0.01), beta = 0.23, p < .001.

Conclusion: Prior outbreak nursing experience was importantly associated with intention to provide care for patients with a newly emerging infectious disease in the future considering stress and professionalism. Gathering information about nurses' experience of epidemics and regular assessment of job stress and professionalism are required.
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http://dx.doi.org/10.1016/j.anr.2017.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104949PMC
September 2017

Expression levels of as a prognostic marker for the progression of primary pT1 bladder cancer and its association with mutation status.

Oncol Lett 2017 Sep 20;14(3):3817-3824. Epub 2017 Jul 20.

Department of Urology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Chungcheongbuk-do 28644, Republic of Korea.

The present study examined the utility of fibroblast growth factor receptor 3 () mutation status and gene expression as a prognostic marker in primary pT1 bladder cancer (BC). A total of 120 patients with primary pT1 BC were enrolled. mutation status was determined by direct sequencing and mRNA expression level was determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. The results were compared with the clinicopathological parameters, and the prognostic value of was evaluated by Kaplan-Meier analysis and a multivariate Cox regression test. mutations were identified in 48/120 (40.0%) patients with pT1 BC. mRNA expression level was significantly higher in those with BC harboring mutations (P<0.001). Low expression level was associated with high-grade tumors and cancer progression (P=0.006 and P=0.001), whereas mutation status was not associated with cancer progression. Kaplan-Meier analysis revealed a similar result (log-rank, P<0.001). Multivariate analysis identified low expression level (odds ratio, 3.300; 95% confidence interval, 1.310-8.313; P=0.011) as an independent predictor of cancer progression. Stratification by exon site of mutations yielded significant differences in mRNA expression level. None of the patients with BC harboring mutations in exon 9 demonstrated disease progression. The mRNA expression level of the gene may be used to precisely identify subsets of patients with pT1 BC that have a relatively better prognosis. The prognostic influences of mutations may be modulated by the exon site of mutations.
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http://dx.doi.org/10.3892/ol.2017.6621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587943PMC
September 2017

Primary hepatic peripheral T-cell lymphoma mimicking hepatocellular carcinoma: a case report.

Ann Surg Treat Res 2017 Aug 28;93(2):110-114. Epub 2017 Jul 28.

Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.

Peripheral T-cell lymphomas (PTCLs) are aggressive neoplasms which may involve the liver. The imaging manifestations of hepatic lymphoma are highly variable and show overlapping appearances of numerous other hepatic diseases. As the management and prognosis of lymphoma differ markedly from those of other malignant diseases, prompt diagnosis and early effective treatment are very important. Here, we report an atypical case of primary PTCL not otherwise specified involving the liver that exhibited a solitary hepatic mass mimicking hepatocellular carcinoma (HCC) on CT. Liver biopsy is not commonly recommended in highly suspicious cases of HCC. However, in a patient without risk factors for HCC, consideration of other diagnostic possibilities is required and needle biopsy may be a more rational choice. An imaging approach, based on a careful review of clinical and laboratory findings is essential to prevent false-positive diagnosis of HCC and subsequent invasive treatment.
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http://dx.doi.org/10.4174/astr.2017.93.2.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566745PMC
August 2017

Increased Expression of Herpes Virus-Encoded hsv1-miR-H18 and hsv2-miR-H9-5p in Cancer-Containing Prostate Tissue Compared to That in Benign Prostate Hyperplasia Tissue.

Int Neurourol J 2016 Jun 24;20(2):122-30. Epub 2016 Jun 24.

Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.

Purpose: Previously, we reported the presence of virus-encoded microRNAs (miRNAs) in the urine of prostate cancer (CaP) patients. In this study, we investigated the expression of two herpes virus-encoded miRNAs in prostate tissue.

Methods: A total of 175 tissue samples from noncancerous benign prostatic hyperplasia (BPH), 248 tissue samples from patients with CaP and BPH, and 50 samples from noncancerous surrounding tissues from these same patients were analyzed for the expression of two herpes virus-encoded miRNAs by real-time polymerase chain reaction (PCR) and immunocytochemistry using nanoparticles as molecular beacons.

Results: Real-time reverse transcription-PCR results revealed significantly higher expression of hsv1-miR-H18 and hsv2-miRH9- 5p in surrounding noncancerous and CaP tissues than that in BPH tissue (each comparison, P<0.001). Of note, these miRNA were expressed equivalently in the CaP tissues and surrounding noncancerous tissues. Moreover, immunocytochemistry clearly demonstrated a significant enrichment of both hsv1-miR-H18 and hsv2-miR-H9 beacon-labeled cells in CaP and surrounding noncancerous tissue compared to that in BPH tissue (each comparison, P<0.05 for hsv1-miR-H18 and hsv2- miR-H9).

Conclusions: These results suggest that increased expression of hsv1-miR-H18 and hsv2-miR-H95p might be associated with tumorigenesis in the prostate. Further studies will be required to elucidate the role of these miRNAs with respect to CaP and herpes viral infections.
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http://dx.doi.org/10.5213/inj.1632552.276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932644PMC
June 2016

Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys.

J Prev Med Public Health 2016 Mar 24;49(2):118-28. Epub 2016 Mar 24.

Department of Physical Therapy, Kwangju Wom-en's University, Gwangju, Korea.

Objectives: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services.

Methods: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012.

Results: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively).

Conclusions: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.
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http://dx.doi.org/10.3961/jpmph.16.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829372PMC
March 2016

Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections.

Surg Endosc 2016 08 5;30(8):3611-7. Epub 2015 Nov 5.

Department of Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Cheong-ju, Republic of Korea.

Background: The liver hanging maneuver is a novel technique that is widely used in open liver resection. The hanging technique has been rarely applied during laparoscopic liver resection because a blind dissection between the anterior surface of the inferior vena cava and the liver is required. Dissection between the right and middle hepatic vein is necessary in right hepatectomy, as is dissection between the middle and left hepatic vein in left hepatectomy. The aim of this study was to introduce the lateral approach liver hanging maneuver in laparoscopic anatomical liver resections.

Method: For this technique, the upper end of the hanging tape was placed on the lateral side of the right or left hepatic vein and the lower end of the hanging tape between three Glisson's pedicles. The pathway of the tape was situated along the lateral side of the inferior vena cava in right-sided hepatectomy or the ligamentum venosum in left-sided hepatectomy.

Results: From February 2013 to October 2014, this technique was performed in 35 patients. Of these patients, ten patients underwent a right hepatectomy, 5 patients underwent a right posterior sectionectomy, 12 patients underwent a left hepatectomy, and 8 patients underwent a left lateral sectionectomy. The median operative time was 240 min (range 90-390 min), and median blood loss was 350 ml (range 60-700 ml). Blood transfusion was required in six patients (17.1 %). In two patients (5.7 %), postoperative complications were observed due to intra-abdominal fluid collection and pneumonia, respectively. No postoperative mortality was encountered.

Conclusion: The lateral approach liver hanging maneuver is a simple, safe, and reproducible approach as dissection of the anterior surface of the inferior vena cava and between the three major hepatic veins is not required. This technique may be useful in laparoscopic anatomical liver resections.
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http://dx.doi.org/10.1007/s00464-015-4663-2DOI Listing
August 2016

Lymphoepithelial cyst of the pancreas mimicking malignant cystic tumor: report of a case.

Korean J Hepatobiliary Pancreat Surg 2015 Aug 28;19(3):129-32. Epub 2015 Aug 28.

Department of Surgery, Chungbuk National University, College of Medicine and Medical Research Institute, Cheongju, Korea.

Lymphoepithelial cysts of the pancreas are a type of true cyst that can mimic pseudocysts and cystic neoplasms. They are very rare, non-malignant lesions that are unilocular or multilocular cystic lesions lined predominantly by mature squamous epithelium and surrounded by non-neoplastic lymphoid elements. We, herein, present a patient with a cystic pancreas tumor mimicking a malignant cystic neoplasm. The patient was admitted with upper abdominal discomfort. Computed tomography showed a 64×39 mm cystic mass in the pancreas tail. She underwent distal pancreatectomy and splenectomy. In the fluid analysis of the pancreas cystic mass, the CEA and CA19-9 were 618 ng/ml and 3.9 U/ml, respectively. The resected pancreas specimen showed a 6.5 cm-sized cyst the pancreas tail. The cyst was well circumscribed and multilocular. The final pathology report of the resected pancreas specimen noted that the cyst was multilocular, and the cyst lining was showing stratified squamous epithelium covering the lymphoid tissue (containing lymphoid follicles), which was consistent with a lymphoepithelial cyst. The patient recovered uneventfully from surgery and has been doing well for the past 3 months. A differential diagnosis of cystic pancreatic lesions is important. We suggest that lymphoepithelial cysts, although very rare, may be included in the differential diagnosis of cystic pancreatic tumors.
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http://dx.doi.org/10.14701/kjhbps.2015.19.3.129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568600PMC
August 2015

Interaction Effect between Weight Perception and Comorbidities on Weight Control Behavior in Overweight and Obese Adults: Is There a Sex Difference?

J Korean Med Sci 2015 Aug 15;30(8):1017-24. Epub 2015 Jul 15.

Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

We investigated the interaction effect between body weight perception and chronic disease comorbidities on body weight control behavior in overweight/obese Korean adults. We analyzed data from 9,138 overweight/obese adults ≥20 yr of age from a nationally representative cross-sectional survey. Multiple logistic regression using an interaction model was performed to estimate the effect of chronic disease comorbidities on weight control behavior regarding weight perception. Adjusted odds ratios for weight control behavior tended to increase significantly with an increasing number of comorbidities in men regardless of weight perception (P<0.05 for trend), suggesting no interaction. Unlike women who perceived their weight accurately, women who under-perceived their weight did not show significant improvements in weight control behavior even with an increasing number of comorbidities. Thus, a significant interaction between weight perception and comorbidities was found only in women (P=0.031 for interaction). The effect of the relationship between accurate weight perception and chronic disease comorbidities on weight control behavior varied by sex. Improving awareness of body image is particularly necessary for overweight and obese women to prevent complications.
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http://dx.doi.org/10.3346/jkms.2015.30.8.1017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520930PMC
August 2015

Clinical Implications and Prognostic Values of Prostate Cancer Susceptibility Candidate Methylation in Primary Nonmuscle Invasive Bladder Cancer.

Dis Markers 2015 13;2015:402963. Epub 2015 May 13.

Department of Urology, College of Medicine, Chungbuk National University, Cheongju 362-763, Republic of Korea.

DNA methylation is the most common and well-characterized epigenetic change in human cancer. Recently, an association between prostate cancer susceptibility candidate (PRAC) methylation and genitourinary cancer was proposed. The aim of the present study was to evaluate the association between PRAC methylation status and clinicopathological parameters and prognosis in long-term follow-up primary nonmuscle invasive bladder cancer (NMIBC). The clinical relevance of PRAC methylation was determined in 136 human bladder specimens (eight normal controls [NCs] and 128 primary NMIBCs) using quantitative pyrosequencing analysis. PRAC methylation was significantly higher in NMIBC patients than in NCs and was significantly associated with higher grade and more advanced stage of cancer. Kaplan-Meier estimates revealed significant difference in tumor recurrence and progression according to PRAC methylation status (both p < 0.05). Multivariate Cox regression analysis revealed that the PRAC methylation status was a strong predictor of recurrence (hazard ratio [HR], 2.652; p = 0.012) and progression (HR, 9.531; p = 0.035) of NMIBC. Enhanced methylation status of PRAC was positively associated with a high rate of recurrence and progression in NMIBC patients, suggesting that PRAC methylation may be a promising prognostic marker of NMIBC.
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http://dx.doi.org/10.1155/2015/402963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444592PMC
February 2016

Preoperative CA 125 is significant indicator of curative resection in gastric cancer patients.

World J Gastroenterol 2015 Jan;21(4):1216-21

Dae Hoon Kim, Hyo Yung Yun, Dong Hee Ryu, Department of Surgery, Chungbuk National University College of Medicine, Cheongju 361-763, South Korea.

Aim: To investigate the correlation among tumor markers, curative resection, and recurrence in gastric cancer.

Methods: The patients with preoperative tumor makers [Carcinoembryonic antigen, Carbohydrate antigen (CA) 19-9, and CA 125] and elective gastrectomy between January 2000 and December 2009 at Chungbuk National University Hospital were enrolled in this study. We analyzed the relationship among the tumor makers, curative resection and recurrence, retrospectively.

Results: Among the 679 patients with gastric cancer, curative resection was 93.6% (n=636) and non-curative resection was 6.4% (n=43). The independent risk factors for the non-curative resection were tumor location and the positivity of preoperative serum CA 19-9 and CA 125 levels. After curative resection, the independent prognostic risk factors for recurrence in curative resection were gender, stage, and preoperative increased serum CA 125 level (HR=2.431, P=0.020), in a multivariate analysis.

Conclusion: Preoperative CA 125 is a useful predictive biomarker for curative resection and prognostic biomarker for recurrence in gastric cancer patients.
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http://dx.doi.org/10.3748/wjg.v21.i4.1216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306166PMC
January 2015

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct.

Ann Surg Treat Res 2014 Nov 24;87(5):273-5. Epub 2014 Oct 24.

Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.
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http://dx.doi.org/10.4174/astr.2014.87.5.273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217254PMC
November 2014

Practical guidelines for the surgical treatment of gallbladder cancer.

J Korean Med Sci 2014 Oct 8;29(10):1333-40. Epub 2014 Oct 8.

Department of Surgery, Sungkyunkwan University College of Medicine, Seoul, Korea.

At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
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http://dx.doi.org/10.3346/jkms.2014.29.10.1333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214932PMC
October 2014

The experience of transumbilical endoscopic appendectomies.

Ann Surg Treat Res 2014 May 24;86(5):278-82. Epub 2014 Apr 24.

Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 ± 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 ± 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
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http://dx.doi.org/10.4174/astr.2014.86.5.278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024928PMC
May 2014

Suppressive effects of an ethanol extract of Gleditsia sinensis thorns on human SNU-5 gastric cancer cells.

Oncol Rep 2013 Apr 4;29(4):1609-16. Epub 2013 Feb 4.

Department of Biotechnology, Chungju National University, Chungju, Chungbuk 380-702, Republic of Korea.

The thorns of Gleditsia sinensis are a traditional Oriental medicine used for the treatment of swelling, suppuration, carbuncle and skin diseases. In the present study, we identified a novel molecular mechanism by which an ethanol extract of Gleditsia sinensis thorns (EEGS) inhibits the growth of the SNU-5 human gastric cancer cell line. EEGS treatment inhibited cell growth and was associated with G1 phase cell cycle arrest at a concentration of 400 µg/ml (IC50) in SNU-5 cells. Treatment with EEGS also stimulated p21WAF1 expression, which significantly decreased the expression of cyclins and cyclin-dependent kinases (CDKs). Further study suggested that p38 MAP kinase pathways may be involved in the inhibition of cell proliferation through p21WAF1‑dependent G1 phase cell cycle arrest in EEGS-treated cells. In addition, NF-κB and AP-1 transcription factor binding sites were identified as the cis-elements for tumor necrosis factor-α (TNF-α)-induced matrix metalloproteinase-9 (MMP-9) expression in SNU-5 cells, as determined by gel-shift assay. Treatment of cells with EEGS suppressed MMP-9 expression induced by TNF-α via a decrease in the binding activity of both NF-κB and AP-1 motifs. These data demonstrate that EEGS-mediated inhibition of cell growth appears to involve the activation of p38 MAP kinase, subsequently leading to the induction of p21WAF1 and the downregulation of cyclin D1/CDK4 and cyclin E/CDK2 complexes. Moreover, EEGS strongly inhibited TNF-α-induced MMP-9 expression by impeding the DNA binding activity of NF-κB and AP-1. Overall, these results provide a potential mechanism for EEGS in the treatment of gastric cancer.
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http://dx.doi.org/10.3892/or.2013.2271DOI Listing
April 2013

Gallbladder Metastasis of Non-small Cell Lung Cancer Presenting as Acute Cholecystitis.

Chin J Cancer Res 2012 Sep;24(3):249-52

Department of Internal Medicine.

Although non-small cell lung cancer (NSCLC) can metastasize to almost any organ, metastasis to the gallbladder with significant clinical manifestation is relatively rare. Here, we report a case of gallbladder metastasis of NSCLC presenting as acute cholecystitis. A 79-year-old man presented with pain in the right upper quadrant and fever. A computed tomography (CT) scan of the chest and abdomen showed a cavitary mass in the right lower lobe of the lung and irregular wall thickening of the gallbladder. Open cholecystectomy and needle biopsy of the lung mass were performed. Histological examination of the gallbladder revealed a moderately-differentiated squamous cell carcinoma displaying the same morphology as the lung mass assessed by needle biopsy. Subsequent immunohistochemical examination of the gallbladder and lung tissue showed that the tumor cells were positive for P63 but negative for cytokeratin 7, cytokeratin 20 and thyroid transcription factor-1. A second primary tumor of the gallbladder was excluded by immunohistochemical methods, and the final pathological diagnosis was gallbladder metastasis of NSCLC. Although the incidence is extremely rare, acute cholecystitis can occur in association with lung cancer metastasis to the gallbladder.
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http://dx.doi.org/10.1007/s11670-012-0249-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555279PMC
September 2012
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