Publications by authors named "Jae Seung Kang"

139 Publications

Outcomes of 5,000 pancreatectomies in Korean single referral center and literature reviews.

J Hepatobiliary Pancreat Sci 2021 Feb 26. Epub 2021 Feb 26.

Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Korea.

Background: Pancreatic resection has higher postoperative mortality and morbidity rates than other abdominal operations. Some centers have reported remarkable postoperative outcomes of minimally invasive surgery. This study investigated the chronological trends of pancreatectomies by analyzing a large-scale database.

Methods: The medical records of 5,175 patients who underwent pancreatic resection between 1961 and 2019 at a single institution were reviewed. To investigate the chronological change in survival outcomes of periampullary cancer, the survival data of 3,108 patients were analyzed.

Results: Patient age and the proportion with pancreatic cancer have increased over time. From 2015 to 2019, pancreatic cancer was the most common cause for resection (35.9%), followed by pancreatic cysts (24.8%) and common bile duct cancer (13.4%). The incidence of postoperative complications tended to decrease over time (26.0% from 2000 to 2004; 20.8% from 2015 to 2019). A comparison of survival outcomes of periampullary malignancies by period revealed that patients with pancreatic cancer significantly improved (5-year survival rate: 14.4% before 2000 vs. 15.2% from 2000 to 2009 vs. 29.0% after 2009, p<0.001).

Conclusions: Postoperative outcomes of pancreatic resection have improved over the past few decades. To improve outcomes in the future, an active multidisciplinary approach and postoperative management are required.
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http://dx.doi.org/10.1002/jhbp.933DOI Listing
February 2021

Suppressive effects of vitamin C-treated induced-regulatory T cells on heart allograft rejection under vitamin C-deficient or -sufficient conditions.

PLoS One 2021 12;16(2):e0246967. Epub 2021 Feb 12.

Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.

Foxp3 stability of vitamin C-treated induced-regulatory T cells (V-iTregs) is superior to that of conventional iTregs (C-iTregs). However, the role of V-iTregs in allograft rejection under vitamin C-deficient conditions, such as those seen in humans, remains unclear. We aimed to elucidate the role of vitamin C treatment on generation and maintenance of iTregs from gulo knockout (Gulo-KO) mice as well as wild type (WT) mice, and in vitro and in vivo suppressive effects of V-iTregs on heart allograft rejection in either Gulo-KO or WT recipient mice. Conversion efficiency of iTregs was similar between C- and V-iTregs in both WT and Gulo-KO mice. V-iTregs from WT or Gulo-KO mice showed better in vitro Foxp3 stability than C-iTregs, although there was no difference between WT V-iTregs and Gulo-KO V-iTregs. Furthermore, V-iTregs from WT or Gulo-KO mice suppressed in vitro T cell proliferation better than C-iTregs. Heterotrophic heart transplantation from BALB/c mice to WT or vitamin C-deficient Gulo-KO C57BL/6J mice was performed following adoptive transfer of C- or V-iTregs. V-iTregs as well as C-iTregs prolonged heart allograft survival in WT and Gulo-KO mice. However, there was no difference between the C- and V-iTreg groups. Supplementation of low- or high-dose vitamin C did not induce significant changes in heart allograft survival in Gulo-KO recipients that had received V-iTregs. In conclusion, V-iTregs do not exert better suppressive effects on heart allograft survival than C-iTregs in either WT or vitamin C-deficient recipients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246967PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880463PMC
February 2021

GV1001 interacts with androgen receptor to inhibit prostate cell proliferation in benign prostatic hyperplasia by regulating expression of molecules related to epithelial-mesenchymal transition.

Aging (Albany NY) 2021 Feb 4;13(3):3202-3217. Epub 2021 Feb 4.

Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea.

Prostate cell proliferation, driven by testosterone, is a major characteristic of benign prostatic hyperplasia (BPH). GV1001, a human telomerase reverse transcriptase catalytic subunit, is an injectable formulation used as a cancer vaccine. It functions as a cell penetrating peptide to regulate cell proliferation. Here, we found that GV1001 effectively suppressed proliferation of prostatic stromal myofibroblasts (WPMY-1) and prostatic epithelial cells (RWPE-1 and WPE-NA22) treated with dihydrotestosterone. Also, GV1001 bound to androgen receptors (ARs) in the cytosol of stromal and epithelial cells. In an experimental animal model implanted with an infusion pump for spontaneous and continuous release of testosterone, revealed that GV1001 reduced prostatic hypertrophy and inhibited the cell proliferation and the expression of Ki67, proliferating cell nuclear antigen, and prostate specific antigen. In addition, GV1001 prevented fibrosis of the prostate by downregulating expression of prostatic epithelial-mesenchymal transition (EMT)-related proteins such as transforming growth factor (TGF)-β, Snail, Slug, N-cadherin, and Vimentin, and by up-regulating E-cadherin. Taken together, these results suggest that GV1001, which suppresses TGF-β-mediated EMT by outcompeting testosterone for binding to AR, is a potential therapeutic drug for BPH accompanied by prostatic fibrosis.
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http://dx.doi.org/10.18632/aging.202242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906190PMC
February 2021

Hybrid Composite of Silver Nanoparticle-Porous Silicon Microparticles as an Image-Guided Localization Agent for Computed Tomography Scan of the Lungs.

ACS Biomater Sci Eng 2020 Aug 27;6(8):4390-4396. Epub 2020 Jun 27.

Department of Radiology, Chungbuk National University, Hospital, and Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea.

A hybrid composite of silver nanoparticles (AgNPs) and porous silicon microparticles (pSiMPs) was developed and applied for the computed tomography (CT) scanning of the lungs as an image-guided localization agent. We confirmed the grafting of AgNPs on oxidized pSiMPs template using various analytical equipment, including a scanning electron microscope (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and energy-dispersive X-ray spectroscopy (EDS). The hybrid composite showed a high CT contrast intensity (>1000 HU) that enabled us to produce and view images of the lungs. In addition, it showed the ability to maintain a strong CT signal at the injected area of the rabbit's lungs, up to an hour, without spreading. The lack of toxicity and immune response indicated that the composite could be fully utilized as a new image-guided localization agent of CT scans for lung cancer surgery.
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http://dx.doi.org/10.1021/acsbiomaterials.0c00611DOI Listing
August 2020

Natural history and optimal treatment strategy of intraductal papillary mucinous neoplasm of the pancreas: Analysis using a nomogram and Markov decision model.

J Hepatobiliary Pancreat Sci 2021 Feb 23;28(2):131-142. Epub 2020 Dec 23.

Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Background/purpose: With the increase in detection of intraductal papillary mucinous neoplasms (IPMN), a tailored approach is needed. This study was aimed at exploring the natural history of IPMN and suggest optimal treatment based on malignancy risk using a nomogram and Markov decision model.

Methods: Patients with IPMN who underwent surveillance or surgery were included. Changes in worrisome features/high-risk stigmata and malignancy conversion rate were assessed. Life expectancy and quality-adjusted life year (QALY) were compared using a nomogram predicting malignancy.

Results: Overall, 2006 patients with histologically confirmed or radiologically typical IPMN were enrolled. Of these, 1773 (88.4%), 81 (4.0%), and 152 (7.6%), respectively, had branch duct (BD)-, main duct-, and mixed-type IPMN at initial diagnosis. The cumulative risk of developing worrisome feature or high-risk stigmata was 19.0% and 35.0% at 5- and 10-year follow-up, respectively. The progression of malignancy rate at 10-year follow-up was 79.9% for main and mixed IPMNs and 5.9% for BD-IPMN. Nomogram-based malignancy risk prediction is well correlated with natural history based on pathologic biopsy and shows good stratification of survival. The decision model recommends surgery to maximize survival and QALY especially in those with >35% malignancy risk.

Conclusions: Compared with main duct- and mixed-type IPMN, which have a high risk of malignancy (79.9%), BD-IPMN is very indolent (5.9%). The nomogram-based decision model suggests surgery rather than surveillance for patients with a high malignancy risk. The optimal treatment strategy between surgery and surveillance should consider patients' health status, malignancy risk, and centers' experience.
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http://dx.doi.org/10.1002/jhbp.878DOI Listing
February 2021

Risk prediction for malignant intraductal papillary mucinous neoplasm of the pancreas: logistic regression versus machine learning.

Sci Rep 2020 11 18;10(1):20140. Epub 2020 Nov 18.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, South Korea.

Most models for predicting malignant pancreatic intraductal papillary mucinous neoplasms were developed based on logistic regression (LR) analysis. Our study aimed to develop risk prediction models using machine learning (ML) and LR techniques and compare their performances. This was a multinational, multi-institutional, retrospective study. Clinical variables including age, sex, main duct diameter, cyst size, mural nodule, and tumour location were factors considered for model development (MD). After the division into a MD set and a test set (2:1), the best ML and LR models were developed by training with the MD set using a tenfold cross validation. The test area under the receiver operating curves (AUCs) of the two models were calculated using an independent test set. A total of 3,708 patients were included. The stacked ensemble algorithm in the ML model and variable combinations containing all variables in the LR model were the most chosen during 200 repetitions. After 200 repetitions, the mean AUCs of the ML and LR models were comparable (0.725 vs. 0.725). The performances of the ML and LR models were comparable. The LR model was more practical than ML counterpart, because of its convenience in clinical use and simple interpretability.
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http://dx.doi.org/10.1038/s41598-020-76974-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676251PMC
November 2020

A comparison of outcomes in patients with intracholecystic papillary neoplasms or conventional adenocarcinomas of the gallbladder.

HPB (Oxford) 2020 Oct 19. Epub 2020 Oct 19.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Intracholecystic papillary neoplasm (ICPN) of the gallbladder (GB) is an exophytic intraepithelial neoplasm. This study aimed to investigate clinicopathologic findings, prognosis and recurrence patterns of patients with ICPN as compared to those patients with conventional adenocarcinoma of the gallbladder (GBC).

Methods: Patients who underwent surgical resection for suspected GB cancer between 2000 and 2018 were included. ICPN was defined as an exophytic papillary mass within the GB lumen with a size ≥1.0 cm.

Results: Of 607 patients, 241 patients (40%) were pathologically diagnosed with ICPN. Of the 241 patients with ICPNs, 110 (46%) were T1 or less. Following T stage-matched analysis, the rate of lymph node metastases were comparable (50 [52%] vs. 37 [49%], P = 0.581). The five-year survival rate was higher in ICPN, but after T stage-matching, they were comparable (69.1 vs. 63.2%, P = 0.171). Overall recurrence rates were also comparable, with the exception of lower peritoneal seeding in patients with ICPN.

Conclusion: Patients with ICPN who underwent resection were more likely to have an earlier T stage. There was no significant difference in prognosis and recurrence between ICPN and conventional GBC after stage matching. Therefore, the treatment strategy for ICPN should follow the same protocols used for conventional GBC.
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http://dx.doi.org/10.1016/j.hpb.2020.09.011DOI Listing
October 2020

Optimal stapler cartridge selection to reduce post-operative pancreatic fistula according to the pancreatic characteristics in stapler closure distal pancreatectomy.

HPB (Oxford) 2020 Oct 2. Epub 2020 Oct 2.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: Postoperative pancreatic fistula (POPF) is associated with potentially fatal complications, but there is lack of data on relationship between pancreas thickness, and stapler size and the POPF rate. This study aimed to suggest optimal stapler that reduces POPF rate according to the pancreas thickness.

Methods: This retrospective cohort study was conducted in two tertiary high-volume pancreas centers. 599 patients who underwent distal pancreatectomy were assessed for stump reinforcement methods, pathology findings, pancreas thickness, and cartridge used. The cartridges were grouped as I, II, III according to the closed height ≤1.5 mm, 1.8 mm, and ≥2.0 mm, respectively.

Results: The POPF rate increased according to the thickness. The stapler Groups I, II, and III had an overall POPF rate of 66.4% vs. 61.7% vs. 57.8%, but Group II stapler cartridge showed a significant reduction in the POPF rate than other cartridges in pancreas with thickness <13 mm (53.5% vs. 21.7% vs. 36.0%, p = 0.031). There was no significant difference between the POPF rate according to stapler groups when the pancreas was thicker than 13 mm.

Conclusion: Thickness is the strongest risk factor in predicting POPF. Use of Group II stapler cartridge for pancreas with a thickness of <13 mm can help reduce POPF.
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http://dx.doi.org/10.1016/j.hpb.2020.09.004DOI Listing
October 2020

Fate of Patients With Intraductal Papillary Mucinous Neoplasms of Pancreas After Resection According to the Pathology and Margin Status: Continuously Increasing Risk of Recurrence Even After Curative Resection Suggesting Necessity of Lifetime Surveillance.

Ann Surg 2020 Sep 15. Epub 2020 Sep 15.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.

Objective: This study evaluated the associated factors and prognosis according to pathology and margin after surgical resection of intraductal papillary mucinous neoplasms (IPMN).

Background: There is limited information on recurrence patterns according to pathology and margin in IPMN.

Methods: Total 577 patients who underwent operation for IPMN at a tertiary center were included. Factors associated with recurrence, survival and recurrence outcomes according to pathology and margin were analyzed.

Results: Among 548 patients analyzed, 353 had low-grade dysplasia (LGD); 78, high-grade dysplasia (HGD); and 117, invasive IPMN. Total 50 patients developed recurrences, with four resection margins, eight remnant pancreas, 11 locoregional, and 35 distant recurrences. Invasive IPMN showed worse 5-year cumulative recurrence risk (LGD vs HGD vs invasive: 0.7% vs 4.3% vs 37.6%, p < 0.001) and 5-year survival rate (89.0% vs 84.0% vs 48.4%, p < 0.001). Recurrence risk increased after 5 years, even in LGD and HGD. Malignant margin (HGD and invasive) had worse 5-year cumulative recurrence rate (R0 vs LGD vs malignant: 8.3% vs 5.9% vs 50.6%, p < 0.001) and 5-year survival rate (80.7% vs 83.0% vs 30.8%, p < 0.001). CA19-9 > 37 (p = 0.003), invasive IPMN (p < 0.001), and malignant margin (p = 0.036) were associated with recurrence.

Conclusions: Invasive IPMN developed more recurrences and had worse survival than LGD or HGD, indicating the need for more efficient postoperative treatment strategies. Patients with LGD and HGD also need regular follow-up for recurrence after 5 years. Malignant margins need additional resection to achieve negative or at least LGD margin.
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http://dx.doi.org/10.1097/SLA.0000000000004478DOI Listing
September 2020

Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis.

Cancers (Basel) 2020 Sep 14;12(9). Epub 2020 Sep 14.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.

The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01-1.79), size ≥ 3 cm (OR 1.90, CI 1.51-2.40), cystic wall thickening (OR 2.53, CI 1.50-4.27), mural nodule (OR 4.10, CI 3.38-4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11-4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49-22.06), lymphadenopathy (OR 8.55, CI 3.25-22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55-6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60-2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.
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http://dx.doi.org/10.3390/cancers12092618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563991PMC
September 2020

Penta-fluorophenol: a Smiles rearrangement-inspired cysteine-selective fluorescent probe for imaging of human glioblastoma.

Chem Sci 2020 Jun 11;11(22):5658-5668. Epub 2020 May 11.

Department of Biomedical Science , Graduate School , Kyung Hee University , Seoul 02447 , Korea . Email:

Two of the most critical factors for the survival of glioblastoma (GBM) patients are precision diagnosis and the tracking of treatment progress. At the moment, various sophisticated and specific diagnostic procedures are being used, but there are relatively few simple diagnosis methods. This work introduces a sensing probe based on a turn-on type fluorescence response that can measure the cysteine (Cys) level, which is recognized as a new biomarker of GBM, in human-derived cells and within on-site human clinical biopsy samples. The Cys-initiated chemical reactions of the probe cause a significant fluorescence response with high selectivity, high sensitivity, a fast response time, and a two-photon excitable excitation pathway, which allows the imaging of GBM in both mouse models and human tissue samples. The probe can distinguish the GBM cells and disease sites in clinical samples from individual patients. Besides, the probe has no short or long-term toxicity and immune response. The present findings hold promise for application of the probe to a relatively simple and straightforward following of GBM at clinical sites.
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http://dx.doi.org/10.1039/d0sc01085eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449700PMC
June 2020

Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX.

Gut Liver 2020 Aug 26. Epub 2020 Aug 26.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Background/aims: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of firstline chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC.

Methods: In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment.

Results: For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037).

Conclusions: FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient's general condition and clinical status.
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http://dx.doi.org/10.5009/gnl20070DOI Listing
August 2020

Visualizing mitochondria and mouse intestine with a fluorescent complex of a naphthalene-based dipolar dye and serum albumin.

J Mater Chem B 2020 09 29;8(34):7642-7651. Epub 2020 Jul 29.

Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea.

We have explored a new research field of fluorophores through the manipulation of fluorophore-binding proteins. The development of a new imaging agent for tracing a specific organelle or a particular site within a living organism has been of great interest in the field of basic science as well as translational medicine. In this work and for the first time, we will disclose a new naphthalene-based dipolar dye and its complex, with serum albumin (SA), and show their applicability for the selective imaging of mitochondria in cells and the intestine in a mouse. The SA-binding dipolar dye, IPNHC, was synthesized straightforwardly, and we identified its photophysical properties and binding mode with SA. IPNHC-SA complex showed a bright emission in the blue wavelength range with a high quantum yield and stability. In the fluorescence imaging study, bright fluorescence images of mouse intestines were observed under a UV light, as well as two-photon (TP) deep tissue imaging after intravenous injection of IPNHC and IPNHC-SA complex. The present findings hold great promise for the application of the fluorescent complex for use in the tracing and tracking of intestine-related diseases at clinical sites.
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http://dx.doi.org/10.1039/d0tb01314eDOI Listing
September 2020

The Role of Location of Tumor in the Prognosis of the Pancreatic Cancer.

Cancers (Basel) 2020 Jul 24;12(8). Epub 2020 Jul 24.

Department of surgery, Seoul National University Hospital, Seoul 03080, Korea.

Identification of prognostic factors is important to improve treatment outcomes in pancreatic cancer. This study aimed to investigate the effect of the location of pancreatic cancer on survival and to determine whether it was a significant prognostic factor. Altogether, 2483 patients diagnosed with pancreatic cancer were examined. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Cancers of the pancreatic head or the uncinate process were present in 49.5% of patients. The head/uncinate cancers had more clinical T1/T2 tumors (59.4% vs. 35.5%, < 0.001) and a significantly higher 5-year survival rate (8.9% vs. 7.3%, < 0.001) than the body/tail cancers. The 5-year survival rate in patients with head/uncinate cancers was significantly lower in the resectable ( = 0.014) and the locally advanced groups ( = 0.007). In patients who underwent resection with curative intent, the 5-year survival rate was lower in the head/uncinate group ( = 0.046). The overall outcome of the head/uncinate cancers was better than the body/tail cancers, due to the high proportion of resectable cases. In patients who underwent curative resection, the head/uncinate cancers had a higher number of T1/T2 tumors, but worse outcomes. In the multivariate analysis, tumor location was not an independent prognostic factor for pancreatic cancer.
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http://dx.doi.org/10.3390/cancers12082036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465041PMC
July 2020

Adverse oncologic effects of preoperative biliary drainage on early stage ampulla of Vater cancer.

HPB (Oxford) 2021 Feb 11;23(2):253-261. Epub 2020 Jul 11.

Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address:

Background: The preoperative biliary drainage (PBD) in ampulla of Vater (AoV) cancer is indiscriminately performed without logical backgrounds. This study was performed to evaluate the effect of PBD on short and long-term outcomes in AoV cancer.

Methods: 313 patients who underwent pancreaticoduodenectomy and were pathologically diagnosed as AoV cancer between January 2000 and December 2014 were reviewed.

Results: 167 patients (53.4%) underwent PBD: Endoscopic drainage was performed in 106 patients (33.9%) and percutaneous drainage in 61 (19.5%). The postoperative complication rate of PBD group was significantly higher than that of upfront surgery group (48.5% vs. 38.4%, p = 0.045). The 5-year disease-free survival rate (5Y-DFSR) was significantly lower in PBD group compared to upfront surgery group (53.8% vs. 74.3%, p < 0.001). Worse 5Y-DFSR of PBD group was more evident in T1/T2 stage (59.2% vs. 84.1%, p < 0.001). In multivariate analysis with T1/T2 staged patients, PBD was independently associated with worse outcome (hazard ratio 2.145 [95% confidence interval, 1.202-3.826], p = 0.010).

Conclusion: For T1/T2 AoV cancer, PBD adversely affected the short-term postoperative complication rate as well as the long-term oncologic outcomes. Therefore, especially in patients with T1/T2 AoV cancer, routine practice of PBD should be refrained and be reserved for selected cases such as cholangitis.
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http://dx.doi.org/10.1016/j.hpb.2020.06.005DOI Listing
February 2021

A brain tumor-homing tetra-peptide delivers a nano-therapeutic for more effective treatment of a mouse model of glioblastoma.

Nanoscale Horiz 2020 07;5(8):1213-1225

Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea.

Organ-specific cell-penetrating peptides (CPPs) are a class of molecules that can be highly effective at delivering therapeutic cargoes, and they are currently of great interest in cancer treatment strategies. Herein, we describe a new CPP (amino acid sequence serine-isoleucine-tyrosine-valine, or SIWV) that homes to glioblastoma multiforme (GBM) brain tumor tissues with remarkable specificity in vitro and in vivo. The SIWV sequence was identified from an isoform of annexin-A3 (AA3H), a membrane-interacting human protein. The mechanism of intracellular permeation is proposed to follow a caveolin-mediated endocytotic pathway, based on in vitro and in vivo receptor inhibition and genetic knockdown studies. Feasibility as a targeting agent for therapeutics is demonstrated in a GBM xenograft mouse model, where porous silicon nanoparticles (pSiNPs) containing the clinically relevant anticancer drug SN-38 are grafted with SIWV via a poly-(ethylene glycol) (PEG) linker. The formulation shows enhanced in vivo targeting ability relative to a formulation employing a scrambled control peptide, and significant (P < 0.05) therapeutic efficacy relative to free SN-38 in the GBM xenograft animal model.
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http://dx.doi.org/10.1039/d0nh00077aDOI Listing
July 2020

Erythematous Patch in Tsutsugamushi Disease - An Atypical Form of Eschar.

Infect Chemother 2020 Sep 13;52(3):403-406. Epub 2020 Jul 13.

Department of Microbiology, Inha University, Incheon, Korea.

Tsutsugamushi disease is caused by the bacterium, and transmitted by chigger mites. In addition to the typical dark eschar, various forms of the eschar, including papules and vesicles, develop at chigger bite sites. Macular lesions were reported only in a human inoculation study; the inoculation lesions relapsed as erythematous macules or erythema-based papules concomitant with fever relapse. Herein, we report an erythematous patch as an inoculation lesion in two patients with tsutsugamushi disease, which, additionally, displayed a central small circle of 1 mm in diameter, possibly a chigger bite site, and desquamation around the circle during doxycycline therapy.
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http://dx.doi.org/10.3947/ic.2020.52.3.403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533208PMC
September 2020

Regulatory T cells suppress skin inflammation in the imiquimod-induced psoriasis-like mouse model.

J Dermatol Sci 2020 Jun 28;98(3):199-202. Epub 2020 Apr 28.

Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jdermsci.2020.04.008DOI Listing
June 2020

Clinicoradiological features of resected serous cystic neoplasms according to morphological subtype and preoperative tentative diagnosis: can radiological characteristics distinguish serous cystic neoplasms from other lesions?

Ann Surg Treat Res 2020 May 28;98(5):247-253. Epub 2020 Apr 28.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Purpose: Serous cystic neoplasm (SCN) of the pancreas is considered benign in most cases. However, some SCN patients undergo surgical resection because lesions could not be differentiated preoperatively. This study evaluated causes of resection for SCN, investigated clinical and radiological features of surgically resected SCNs, and compared characteristics of SCNs diagnosed accurately and those misdiagnosed.

Methods: One hundred patients, who underwent surgery for pancreatic cystic tumors with pathological confirmation of SCN between 2000 and 2014 were retrospectively analyzed.

Results: The mean patient age was 52.9 years, 67 (67%) were female, and most lesions (72%) were located in the pancreatic body or tail. Fifty-one (51%) pathologically confirmed SCNs were preoperatively diagnosed as non-SCNs. Patients underwent surgery due to uncertain diagnosis (58%) or symptomatology (18%). According to radiological examination, most lesions were macrocystic (85%), exhibited septation (58%), or were enhancing lesions (48%). Compared with preoperatively diagnosed non-SCNs, accurately diagnosed SCNs exhibited septation (75.5% 41.2%, P = 0.001) and central scar (36.7% 11.8%, P = 0.003) more frequently in radiological examinations. In terms of macrocystic tumors (n = 85), most parameters did not differentiate preoperative diagnoses, although lesions accurately diagnosed as SCN exhibited septation more frequently than those preoperatively misdiagnosed as mucinous cystic neoplasm or intraductal papillary mucinous neoplasm (70.7% 38.9% 33.3%, respectively, P = 0.009).

Conclusion: It is difficult to accurately distinguish macrocystic SCNs from other cystic tumors using conventional radiological methods. For more accurate diagnosis, new biomarkers and/or other diagnostic modalities are needed and warrant further investigation.
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http://dx.doi.org/10.4174/astr.2020.98.5.247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200608PMC
May 2020

Robotic extended cholecystectomy in gallbladder cancer.

Surg Endosc 2020 Jul 18;34(7):3256-3261. Epub 2020 Apr 18.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Background: The application of minimally invasive surgery (MIS) in advanced gallbladder cancer (GBC) requiring extended cholecystectomy is challenging, in terms of achieving clinically safe and complete oncologic resection. Recently developed robotic systems, however, may provide advantages in overcoming difficulties faced by laparoscopic MIS. The purpose of this study is to investigate the feasibility and advantages of a robotic system to assist with extended cholecystectomy.

Methods: Patients diagnosed with clinically suspected stage T2 or above, GBC (as determined by preoperative computed tomography or ultrasonography) underwent robotic extended cholecystectomy (REC) from February 2018 to January 2020. The attached video shows the detailed procedure in the following order: the positioning of the patient and the trocars, Kocher maneuver, lymph node dissection (#8, 9, 12, 13), skeletonization of hepatoduodenal ligament, ligation of the cystic duct and liver resection.

Results: Of 16 patients who underwent REC, mean operation time was 198.3 min and the median estimated blood loss was 295 ml. 11 patients (68.8%) were pathologically diagnosed as stage T2 or above, and the metastatic lymph node was identified in 3 patients (18.8%). All cases had secured tumor-free resection margins, and 3 patients (18.8%) showed invasion to the hepatic parenchyma. The mean number of retrieved lymph nodes was 7.2. The median duration of hospital stay was 7 days. There were no mortality or recurrence within 90 days after the operation.

Conclusion: This study suggests that robotic systems can be safely utilized in advanced stage GBC, facilitating oncologically sufficient lymph node dissection and rapid recovery.
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http://dx.doi.org/10.1007/s00464-020-07554-zDOI Listing
July 2020

Perioperative and oncologic outcome of robot-assisted minimally invasive (hybrid laparoscopic and robotic) pancreatoduodenectomy: based on pancreatic fistula risk score and cancer/staging matched comparison with open pancreatoduodenectomy.

Surg Endosc 2020 Apr 10. Epub 2020 Apr 10.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.

Background: Robotic surgery is a novel approach that scores over conventional minimally invasive approaches, even in pancreatic surgery. We investigated clinical outcomes of robot-assisted minimally invasive (hybrid laparoscopic and robotic) pancreatoduodenectomy (RA-MIPD).

Methods: Total 150 patients who underwent RA-MIPD between 2015 and 2018 were compared with 710 patients who underwent open pancreatoduodenectomy (PD) during the same period. Demographics and surgical outcomes were analyzed, and propensity score-matched (PSM) analysis was performed to evaluate complications including clinically relevant postoperative pancreatic fistula (CR-POPF) and oncologic outcomes in patients with malignancy.

Results: PSM analysis was performed based on the pancreatic fistula risk. Patients undergoing RA-MIPD were younger (RA-MIPD vs. open PD: 61.2 vs. 65.5 years, P < 0.001); however, no significant intergroup difference was observed in sex (P = 0.091) and body mass index (P = 0.281). Operation time was longer in the RA-MIPD group (361.2 vs. 305.7 min, P < 0.001); however, estimated blood loss did not significantly differ (515.6 vs. 478.0 mL, P = 0.318). Overall complication (24.7% vs. 30.9%, P = 0.178) and CR-POPF rates (6.7% vs. 6.9%, P > 0.999) were similar. The RA-MIPD group showed lower pain scores and shorter length of postoperative hospitalization (11.5 vs. 17.2 days, P < 0.001). After PSM analysis for cancer and staging among patients with malignancies, no significant intergroup difference was observed in the R0 resection rate (96.7% vs. 93.3%, P = 0.527), tumor size (2.59 vs. 2.60 cm, P = 0.954), total number of retrieved lymph nodes (17.0 vs. 16.6, P = 0.793), and 2-year survival rates (84.4% vs. 77.8%, P = 0.898).

Conclusions: Compared with open PD, RA-MIPD is associated with better or at least similar early perioperative and equivalent midterm survival outcomes. RA-MIPD is safe and feasible and enables early postoperative recovery. RA-MIPD is expected to play a key role in near future.
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http://dx.doi.org/10.1007/s00464-020-07551-2DOI Listing
April 2020

Early outcomes of robotic extended cholecystectomy for the treatment of gallbladder cancer.

J Hepatobiliary Pancreat Sci 2020 Jun 15;27(6):324-330. Epub 2020 Feb 15.

Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea.

Background: Simple laparoscopic cholecystectomy is sufficient for patients with early gallbladder cancer (GBC). However, because advanced GBCs of T2 or more advanced stages require more complex procedures such as liver resection and lymph node dissection, minimally invasive surgery (MIS) has not been popularized. To evaluate the applicability of MIS for GBC, we report the early outcomes of robotic extended cholecystectomies (RECs).

Methods: Thirteen patients who radiologically suspected to have T2 or more advanced stages of GBC underwent REC from February 2018 to April 2019. Thirty-nine patients who underwent open extended cholecystectomy were selected by 1:3 propensity score matching, and the differences of clinicopathologic features according to surgical methods were analyzed.

Results: Compared with open method, operation time, estimated blood loss, postoperative complication rate, and number of retrieved lymph nodes were not significantly different. In REC group, duration of hospital stay was shorter (6.6 vs 8.3 days, P = .002) and postoperative pain was significantly lower in the REC group (P = .024).

Conclusion: The early outcomes of REC were favorable with regard to early recovery and less pain, with similar number of retrieved lymph nodes. REC is a promising option for treatment of GBC, but further long-term survival studies are needed.
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http://dx.doi.org/10.1002/jhbp.717DOI Listing
June 2020

Short- and long-term outcomes of pancreaticoduodenectomy in elderly patients with periampullary cancer.

Ann Surg Treat Res 2020 Jan 30;98(1):7-14. Epub 2019 Dec 30.

Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.

Purpose: Pancreaticoduodenectomy (PD) is recently performed in older cancer patients. The complication rate of PD is high. The present study was to compare the postoperative short- and long-term outcomes of PD in between older patients and younger patients.

Methods: Between 2000 and 2014, patients who underwent PD due to periampullary cancers were enrolled. Patients aged 75 years or over were included in the older group.

Results: Total 1,249 patients were enrolled in this study and 168 patients (13.5%) were included in the older group. Postoperative complication rates, duration of postoperative hospital stay, and 30-day mortality were comparable between the 2 groups, although the admission rate of intensive care unit postoperatively was higher in the older adult group (20.8% . 10.5%, P < 0.001). In terms of long-term outcomes, 5-year overall survival rate was lower in the older group (23.4% . 41.8%, P < 0.001), and 5-year cumulative recurrence rate was higher in the older group without statistical significance (63.9% . 57.9%, P = 0.095). However, there were no statistical differences of cumulative recurrence in pancreatic cancer patients (81.5% . 82.5%, P = 0.805).

Conclusion: PD for periampullary cancer is a safe and feasible treatment in the older patients. The treatment modality for obtaining better survival outcomes will be investigated.
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http://dx.doi.org/10.4174/astr.2020.98.1.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940429PMC
January 2020

The Eschar Size and Early Inoculation Lesion of Tsutsugamushi Disease on Jeju Island, Korea.

Infect Chemother 2019 Dec 26;51(4):345-354. Epub 2019 Nov 26.

Department of Microbiology, Inha University, Incheon, Korea.

Background: Tsutsugamushi disease, or scrub typhus, is an acute febrile illness caused by , which is followed by chronic latent infection. People who reside in areas endemic of tsutsugamushi disease may be frequently reinfected with this organism. Volunteers who are experimentally reinfected with manifest various systemic and local reactions, including the presence of small-sized eschar. The present study recorded the morphology and size of eschars in patients with tsutsugamushi disease on Jeju Island, Korea.

Materials And Methods: From March 2018 to February 2019, 23 patients manifesting clinical characteristics and epidemiologic features of tsutsugamushi disease on Jeju Island were investigated. For comparison of eschar sizes between the two regions, 12 patients with tsutsugamushi disease in Incheon were similarly examined.

Results: Three patients, two on the first day and one on the fourth day of fever, presented with papules of 2 - 5 mm in diameter. Another three patients, one on the second day and two on the fourth day, presented with ruptured vesicles of 5 - 8 mm in diameter. Thirteen patients presented with eschars covered with dark scabs, with a median diameter of 5 (95% confidence interval [CI], 5 - 7.5) × 4 (95% CI, 3 - 5) mm. The medians of the eschar sizes did not differ between the two cities ( = 0.46 by Mann-Whitney test), but eschars ≥10 mm in diameter were more frequent in Incheon than in Seogwipo-si (4 of 12 . 0 of 13 patients, = 0.04 by Fisher's exact test). One patient presented with multiple eschars, and no eschar was detected in the remaining three patients. Among 11 Jeju Island patients with positive IgG and IgM antibodies, seven patients revealed higher IgG than IgM antibody titers during the acute phase of the illness, , the IgG antibody response, two patients had equal IgG and IgM titers, and two patients presented the IgM antibody response. Life-threatening complications and death were not observed in this study.

Conclusion: The patients in Seogwipo-si had small-sized eschars and occasionally exhibited non-necrotic lesions. Many patients had serologically reinfected tsutsugamushi disease. Further studies are needed to investigate the association between these findings.
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http://dx.doi.org/10.3947/ic.2019.51.4.345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940375PMC
December 2019

Proposal of the minimal number of retrieved regional lymph nodes for accurate staging of distal bile duct cancer and clinical validation of the three-tier lymph node staging system (AJCC 8th edition).

J Hepatobiliary Pancreat Sci 2020 Feb 14;27(2):75-83. Epub 2019 Dec 14.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Background: The minimal required number of retrieved lymph nodes (MNRLNs) to enable accurate staging of distal bile duct (DBD) adenocarcinoma remains unclear. The three-tier 8th N staging system of the American Joint Committee on Cancer (AJCC) for DBD adenocarcinoma has been recently released. The present study is aimed at proposing the MNRLNs for accurate staging and validating the 8th N stage.

Methods: Between 1991 and 2015, patients with pathologically confirmed DBD adenocarcinoma who underwent pancreatoduodenectomy were enrolled. MNRLN was calculated via a log-rank test based on cut-off values. The concordance index (C-index) was utilized to compare the discrimination capability of the two- and three-tier N stages.

Results: A total of 780 patients were enrolled. Lymph node (LN) positivity and 5-year overall survival (5-YOS) rates stabilized and significant survival differences between node-negative and -positive patients were observed when ≥12 LNs were retrieved. 5-YOS rates between each 8th N stage significantly differ (N0 vs. N1, P = 0.037; N1 vs. N2, P = 0.003). The C-index of the 8th N stage was higher than that of the 7th (0.59 vs. 0.57).

Conclusions: For accurate staging, at least 12 LNs should be retrieved. The three-tier N staging system is valid for clinical practice and has a more accurate prognostic predictability than the two-tier system.
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http://dx.doi.org/10.1002/jhbp.690DOI Listing
February 2020

Hydrazine-Selective Fluorescent Turn-On Probe Based on Ortho-Methoxy-Methyl-Ether (-MOM) Assisted Retro-aza-Henry Type Reaction.

Sensors (Basel) 2019 Oct 17;19(20). Epub 2019 Oct 17.

Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Korea.

Hydrazine (NH) is one of the most widely used industrial chemicals that can be utilized as a precursor of pesticides, pharmaceutics, and rocket propellant. Due to its biological and environmental toxicity with potential health risks, various sensing tools have been developed. Among them, fluorescence-based molecular sensing systems have been highlighted due to its simple-operation, high selectivity and sensitivity, and biocompatibility. In our recent report, we disclosed a ratiometric type fluorescent probe, called , for the detection of hydrazine, which is based on -methoxy-methyl-ether (-MOM) moiety assisted hydrazone-formation of the donor (D)-acceptor (A) type naphthaldehyde backbone. As our follow-up research, we disclose a turn-on type fluorescent probe, named , as the next-generation hydrazine probe. The sensing rational of is based on the -MOM assisted retro-aza-Henry type reaction. The dicyanovinyl moiety, commonly known as a molecular rotor, causes significant emission quenching of a fluorescent platform in aqueous media, and its cleavage with hydrazone-formation, which induces a significant fluorescence enhancement. The high selectivity and sensitivity of shows practical explicabilities, including real-time paper strip assay, vapor test, soil analysis, and real water assay. We believe its successful demonstrations suggest further applications into a wide variety of fields.
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http://dx.doi.org/10.3390/s19204525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832147PMC
October 2019

Ultrasonographic and Three-Dimensional Analyses at the Glabella and Radix of the Nose for Botulinum Neurotoxin Injection Procedures into the Procerus Muscle.

Toxins (Basel) 2019 09 24;11(10). Epub 2019 Sep 24.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse lines or rhytids. Although there have been many cadaveric studies of the procerus, its depth and thickness have not been investigated thoroughly. The aim of this study was to measure the depth and thickness of the procerus and identify the location of the intercanthal vein using ultrasonographic (US) imaging and the three-dimensional scanning method, which is needed to know to avoid side effects during BoNT injections. The morphology of the procerus was classified into two types based on the US images obtained at the glabella. The procerus was located deeper below the skin surface at the glabella than the sellion (3.8 ± 0.7 mm versus 2.7 ± 0.6 mm). The width of the procerus in US images increased from the sellion (10.9 ± 0.2 mm) to the glabella (14.5 ± 4.6 mm), whereas its thickness decreased (from 1.6 ± 0.6 mm to 1.1 ± 0.5 mm). The intercanthal vein was located 5.1 ± 4.0 mm superior to the sellion and 3.0 ± 0.6 mm below the skin's surface. The present findings provide anatomical knowledge as well as the reference location information for use when injecting BoNT into the procerus.
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http://dx.doi.org/10.3390/toxins11100560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832436PMC
September 2019

Clinical validation of the 2017 international consensus guidelines on intraductal papillary mucinous neoplasm of the pancreas.

Ann Surg Treat Res 2019 Aug 29;97(2):58-64. Epub 2019 Jul 29.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Purpose: The 2017 international consensus guidelines (ICG) for intraductal papillary mucinous neoplasm (IPMN) of the pancreas were recently released. Important changes included the addition of worrisome features such as elevated serum CA 19-9 and rapid cyst growth (>5 mm over 2 years). We aimed to clinically validate the 2017 ICG and compare the diagnostic performance between the 2017 and 2012 ICG.

Methods: This was a retrospective cohort study. During January 2000-January 2017, patients who underwent complete surgical resection and had pathologic confirmation of branch-duct or mixed-type IPMN were included. To evaluate diagnostic performance, the areas under the receiver operating curves (AUCs) were evaluated.

Results: A total of 448 patients were included. The presence of mural nodule (hazard ratio [HR], 9.12; 95% confidence interval [CI], 4.60-18.09; P = 0.001), main pancreatic duct dilatation (>5 mm) (HR, 5.32; 95% CI, 2.67-10.60; P = 0.001), thickened cystic wall (HR, 3.40; 95% CI, 1.51-7.63; P = 0.003), and elevated CA 19-9 level (>37 unit/mL) (HR, 5.25; 95% CI, 2.05-13.42; P = 0.001) were significantly associated with malignant IPMN. Malignant lesions showed a cyst growth rate >5 mm over 2 years more frequently than benign lesions (60.9% vs. 29.7%, P = 0.012). The AUC was higher for the 2017 ICG than the 2012 ICG (0.784 vs. 0.746).

Conclusion: The new 2017 ICG for IPMN is clinically valid, with a superior diagnostic performance to the 2012 ICG. The inclusion of elevated serum CA 19-9 level and cyst growth rate to the 2017 ICG is appropriate.
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http://dx.doi.org/10.4174/astr.2019.97.2.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669133PMC
August 2019

History of Tsutsugamushi Disease in Korea.

Infect Chemother 2019 Jun;51(2):196-209

Department of Microbiology, Inha University School of Medicine, Incheon, Korea.

Tsutsugamushi disease or scrub typhus in Korea was first officially reported in foreign soldiers in 1951 and in indigenous persons in 1986. However, the history is further prolonged. The book , published in 1613, described "Soo Dok" (water poisoning), which is similar to tsutsugamushi disease. Further, the term was mentioned in the book , first published in 1232-1251. During the Japanese colonial rule (1910-1945), was identified in Suwon, Korea, in 1917. Although cases of tsutsugamushi disease in Korea with a murine typhus-like illness and OXK-positivity were reported in 1935, such atypical presentation was not recognized as tsutsugamushi disease. During the Korean War, in 1951, tsutsugamushi disease developed in two British soldiers stationed in the Imjin River, who presented typical features and positive OXK reactions. Indigenous cases have re-emerged since 1986. Thereafter, there were many studies on various aspects of tsutsugamushi disease: epidemiology, vector, small mammals, clinical features and complications, diagnosis, and treatment. Persistence of and its possible recrudescence with pneumonia were reported in 2012 and 2014, respectively.
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http://dx.doi.org/10.3947/ic.2019.51.2.196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609738PMC
June 2019

Clinical validation of scoring systems of postoperative pancreatic fistula after pancreatoduodenectomy: applicability to Eastern cohorts?

Hepatobiliary Surg Nutr 2019 Jun;8(3):211-218

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: Although several prediction models for the occurrence of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) exist, all were established using Western cohorts. Large-scale external validation studies in Eastern cohorts that consider demographic variables including lower body mass index (BMI) are scarce. The purpose of this study was to externally validate POPF prediction models using nationwide large-scale Korean cohorts.

Methods: Nine tertiary university hospitals in the Republic of Korea participated. Patients' preoperative characteristics, intraoperative factors, and pathologic findings were evaluated. POPF grades were determined according to the 2016 International Study Group on Pancreatic Surgery definition. Three POPF risk models (Callery, Roberts, and Mungroop) were selected for external validation.

Results: A total of 1,898 PD patients were enrolled. A non-pancreatic disease diagnosis [hazard ratio (HR), 1.856; 95% confidence interval (CI), 1.223-2.817; P=0.004), higher preoperative BMI (HR, 1.069; 95% CI, 1.019-1.121; P=0.006), and soft pancreatic texture (HR, 1.859; 95% CI, 1.264-2.735; P=0.002) were independent risk factors for clinically relevant POPF (CR-POPF). The area under the receiver operating characteristic curve (AUC) values were 0.61, 0.64, and 0.63 on the Callery, Roberts, and Mungroop models, respectively; all were lower than those published in each external validation study.

Conclusions: Western POPF prediction models performed less well when applied to Korean cohorts. Thus, a large-scale Eastern-specific and externally validated POPF prediction model is needed.
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http://dx.doi.org/10.21037/hbsn.2019.03.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561876PMC
June 2019