Publications by authors named "Young-Bae Kim"

156 Publications

A Diagnostic Method for Gastric Cancer Using Two-Photon Microscopy With Enzyme-Selective Fluorescent Probes: A Pilot Study.

Front Oncol 2021 27;11:634219. Epub 2021 Aug 27.

Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.

Background: Endoscopy is the most important tool for gastric cancer diagnosis. However, it relies on naked-eye evaluation by endoscopists, and the histopathologic confirmation is time-consuming. We aimed to visualize and measure the activity of various enzymes through two-photon microscopy (TPM) using fluorescent probes and assess its diagnostic potential in gastric cancer.

Methods: β-Galactosidase (β-gal), carboxylesterase (CES), and human NAD(P)H: quinone oxidoreductase (hNQO1) enzyme activities in the normal mucosa, ulcer, adenoma, and gastric cancer biopsy samples were measured using two-photon enzyme probes. The fluorescence emission ratio at long and short wavelengths (Ch2/Ch1) for each probe was comparatively analyzed. Approximately 8,000 - 9,000 sectional images in each group were obtained by measuring the Ch2/Ch1 ratio according to the tissue depth. Each probe was cross-validated by measuring enzymatic activity from a solution containing lysed tissue.

Results: Total of 76 subjects were enrolled in this pilot study (normal 21, ulcer 18, adenoma 17, and cancer 20 patients, respectively). There were significant differences in the mean ratio values of β-gal (0.656 ± 0.142 . 1.127 ± 0.109, < 0.001) and CES (0.876 ± 0.049 . 0.579 ± 0.089, < 0.001) between the normal and cancer, respectively. The mean ratio value of cancer tissues was different compared to ulcer and adenoma ( < 0.001). The hNQO1 activity showed no significant difference between cancer and other conditions. Normal mucosa and cancer were visually and quantitatively distinguished through β-gal and CES analyses using TPM images, and enzymatic activity according to depth, was determined using sectional TPM ratiometric images. The results obtained from lysis buffer-treated tissue were consistent with TPM results.

Conclusions: TPM imaging using ratiometric fluorescent probes enabled the discrimination of gastric cancer from normal, ulcer, and adenoma. This novel method can help in a visual differentiation and provide quantitative depth profiling in gastric cancer diagnosis.
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http://dx.doi.org/10.3389/fonc.2021.634219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429903PMC
August 2021

Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy: Case report and review of literature.

Medicine (Baltimore) 2021 Aug;100(32):e26843

Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea.

Introduction: Secondary amyloidosis is a rare complication of rheumatoid arthritis (RA) that is histologically characterized by the deposition of amyloid fibrils in target organs, such as the kidneys and gastrointestinal tract. Controlling the inflammatory response is essential to prevent organ dysfunction in amyloid A (AA) amyloidosis secondary to RA, and no clear treatment strategy exists.

Patient Concerns And Diagnosis: A 66-year-old woman with RA, who had been treated with disease-modifying anti-rheumatic drugs for 1 year, presented with recurrent abdominal pain and prolonged diarrhea. Endoscopy showed chronic inflammation, and colon tissue histology confirmed AA amyloidosis.

Interventions And Outcomes: After tocilizumab therapy was begun, her diarrhea and abdominal pain subsided, and articular symptoms improved. Biologic drugs for RA have been used in patients with secondary AA amyloidosis, including tumor necrosis factor and Janus kinase inhibitors, interleukin 6 blockers, and a T cell modulator. Here, we systematically review existing case reports and compare the outcomes of RA-related AA amyloidosis after treatment with various drugs.

Conclusion: The data indicate that biologic drugs like tocilizumab might be treatments of choice for AA amyloidosis secondary to RA.
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http://dx.doi.org/10.1097/MD.0000000000026843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360491PMC
August 2021

Factors affecting the diagnostic yield of endoscopic transpapillary forceps biopsy in patients with malignant biliary strictures.

J Gastroenterol Hepatol 2021 Aug 8;36(8):2324-2328. Epub 2021 Apr 8.

Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.

Background And Aim: Transpapillary biliary forceps biopsy (TBFB) is a common method to obtain histological evidence for the differential diagnosis of biliary stricture. This study aimed to evaluate the factors associated with a positive cancer diagnosis from TBFB and the number of tissue samples required to increase the diagnostic yield in patients with malignant biliary strictures.

Methods: A total of 376 patients who underwent TBFB for investigation of biliary stricture were included. Factors affecting the diagnostic yield of TBFB were determined using univariate analysis and multivariate logistic regression analyses.

Results: Bile duct cancer (odds ratio [OR] = 3.50, P = 0.002), intraductal growing type (OR = 9.01, P = 0.001), and number of tissue samples (n < 5 vs 5 ≤ n < 10, OR = 4.13, P = 0.01; n < 5 vs n ≥ 10, OR = 12.25, P < 0.001; 5 ≤ n < 10 vs n ≥ 10, OR = 2.97, P = 0.046) were significant factors associated with positive results for malignancy. In patients with periductal infiltrating-type bile duct cancer, the number of tissue samples was a significant factor for diagnostic sensitivity (54.3% in the n < 5 group, 83.3% in the 5 ≤ n < 10 group and 98.2% in the n ≥ 10 group) (P < 0.001).

Conclusions: Bile duct cancer, intraductal growing type, and five or more tissue samples were significant predictors of positive TBFB results in patients with malignant biliary stricture. Increasing the number of tissue samples by five or more led to higher sensitivity in bile duct cancer patients with the periductal infiltrating type.
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http://dx.doi.org/10.1111/jgh.15497DOI Listing
August 2021

The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study.

Clin Shoulder Elb 2021 03 2;24(1):4-8. Epub 2021 Mar 2.

Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.

Background: As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs.

Methods: Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation.

Results: Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671).

Conclusions: Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.
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http://dx.doi.org/10.5397/cise.2021.00052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943380PMC
March 2021

Cytomegalovirus-Associated Hemophagocytic Syndrome Diagnosed by Liver Biopsy in a Kidney Transplant Recipient.

Yonsei Med J 2021 Mar;62(3):274-277

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Hemophagocytic syndrome (HPS) is a rare but potentially life-threatening disease in kidney transplant recipients, and is caused by systemic proliferation of macrophages actively phagocytizing other blood cells in the bone marrow, lymph nodes, and the spleen. Here, we report a 40-year-old male kidney transplant recipient who presented with fever, bicytopenia, and elevated liver enzymes 2 months after transplantation. Given that cytomegalovirus antigenemia and real-time polymerase chain reaction tests were positive, liver biopsy was performed under an assumption of cytomegalovirus-induced hepatitis. Hepatic histology revealed multifocal microabscess with cytomegalovirus inclusion bodies, marked Kupffer cell hyperplasia, and erythrophagocytosis by activated macrophages. As laboratory findings such as hyperferritinemia, elevated serum lactate dehydrogenase, low natural killer cell activity, and high soluble interleukin-2 receptor were also compatible with HPS, the recipient was diagnosed as having cytomegalovirus-induced hepatitis combined with reactive HPS. Following intravenous ganciclovir therapy with continuous administration of tacrolimus and corticosteroid, the symptoms resolved and laboratory findings were normalized. As far as we know, this is the first report of cytomegalovirus-induced hepatitis combined with reactive HPS in a kidney transplant recipient that is diagnosed by liver biopsy.
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http://dx.doi.org/10.3349/ymj.2021.62.3.274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934097PMC
March 2021

Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study.

Ann Rehabil Med 2021 Feb 9;45(1):24-32. Epub 2021 Feb 9.

Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea.

Objective: To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data.

Methods: This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted.

Results: No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003).

Conclusion: The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.
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http://dx.doi.org/10.5535/arm.20158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960949PMC
February 2021

Association Between Waiting Time from Diagnosis to Endoscopic Submucosal Dissection and Non-curative Resection in Gastric Neoplasm.

Anticancer Res 2021 Jan;41(1):459-466

Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea

Background/aim: Currently, there are no standard guidelines for the waiting time from the diagnosis of gastric neoplasms to endoscopic submucosal dissection (ESD).

Patients And Methods: A total of 1,605 patients who had undergone ESD for early gastric cancer (EGC) or high-grade dysplasia (HGD) were enrolled. Waiting time for ESD was defined as the time from the first diagnosis to ESD. Multivariable logistic regression analysis was conducted.

Results: The curative resection rate was 86.8% and the mean waiting time was 36.8 days. In the multivariable model, longer waiting time did not significantly affect non-curative resection, whereas age >70 years, submucosal fibrosis, and initial cancer diagnosis were significantly associated with non-curative resection. Waiting time was still not identified as a risk factor for non-curative resection in EGC and HGD groups.

Conclusion: A longer waiting time from diagnosis to ESD was not associated with non-curative resection.
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http://dx.doi.org/10.21873/anticanres.14796DOI Listing
January 2021

Potential Benefits of Allogeneic Haploidentical Adipose Tissue-Derived Stromal Vascular Fraction in a Hutchinson-Gilford Progeria Syndrome Patient.

Front Bioeng Biotechnol 2020 21;8:574010. Epub 2020 Oct 21.

National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, South Korea.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare, fatal, and genetic disorder in the gene encoding for prelamin A. Normally, prelamin A is processed to become lamin A protein. In HGPS patients, there is a heterozygous mutation in gene, in which there is a deletion of genetic codes responsible for 50 amino acids at the C-terminus of prelamin A. The processing of the abnormal prelamin A results in abnormal lamin A protein, called progerin, causing symptoms of accelerated early aging, probably due to the inflammaging process. It is well known that adipose tissue-derived mesenchymal stem cells (MSCs) have anti-inflammatory effects by modulating inflammatory cytokines and by extracellular vesicles. Here, we present a case of an HGPS patient who responded positively to injections of allogeneic haploidentical adipose tissue-derived stromal vascular fractions containing MSCs by showing rapid height and weight growth along with increased blood level of insulin-like growth factor 1.
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http://dx.doi.org/10.3389/fbioe.2020.574010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643450PMC
October 2020

Nitrogen-rich [email protected] as a metal-free electrocatalyst for oxygen reduction reaction.

Sci Rep 2020 Jul 24;10(1):12431. Epub 2020 Jul 24.

Department of Mechanical Engineering, Chonnam National University, Gwangju, Republic of Korea.

The metal-free nitrogen-doped [email protected] ([email protected]) is prepared from a composite of polyaniline and graphene by a facile polymerization following by pyrolysis for electrochemical oxygen reduction reaction (ORR). Pyrolysis creates a sponge-like with ant-cave-architecture in the polyaniline derived nitrogenous graphitic-carbon on graphene. The nitrogenous carbon is highly graphitized and most of the nitrogen atoms are in graphitic and pyridinic forms with less oxygenated is found when pyrolyzed at 800 °C. The electrocatalytic activity of [email protected] is even better than the benchmarked Pt/C catalyst resulting in the higher half-wave potential (8 mV) and limiting current density (0.74 mA cm) for ORR in alkaline medium. Higher catalytic performance is originated from the special porous structure at microscale level and the abundant graphitic- and pyridinic-N active sites at the nanoscale level on carbon-graphene matrix which are beneficial to the high O-mass transportation to those accessible sites. Also, it possesses a higher cycle stability resulting in the negligible potential shift and slight oxidation of pyridinic-N with better tolerance to the methanol.
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http://dx.doi.org/10.1038/s41598-020-68260-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381605PMC
July 2020

Controlled decompression of large ovarian cystic tumors via mini-laparotomy using Dermabond Advanced™.

Gynecol Oncol Rep 2020 May 17;32:100536. Epub 2020 Feb 17.

Department of Obstetrics & Gynecology, Tufts Medical Center, Boston, MA, United States.

Large cystic ovarian tumors usually require surgical removal because of symptoms and the possibility of malignancy. The ideal surgical approach would minimize the risk of spillage of tumor contents while minimizing surgical morbidity. The present study aims to demonstrate a novel technique to drain large cystic ovarian tumors without spillage. A mini-laparotomy is performed and the tumor surface is exposed. Dermabond Advanced™ (USA Medical and Surgical Supplies 2019a) is applied to the tumor and a surgical glove (USA Medical and Surgical Supplies 2019b) is applied to the glue area. A small incision is made in the center of the portion of the glove that is adherent to the tumor. The cyst fluid is allowed to drain into the glove where it is suctioned away, collapsing the tumor. Once the tumor is sufficiently decompressed, it is exteriorized and resected with the glove still attached. The technique was initially developed in a pig model and subsequently successfully performed by mini-laparotomy on two patients with >20 cm ovarian masses. This novel technique uses inexpensive and readily available materials for draining large cystic ovarian tumors without spillage so that they can be removed via mini-laparotomy.
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http://dx.doi.org/10.1016/j.gore.2020.100536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063233PMC
May 2020

Carbon nanotubes-based PdM bimetallic catalysts through N-system for efficient ethanol oxidation and hydrogen evolution reaction.

Sci Rep 2019 Jul 30;9(1):11051. Epub 2019 Jul 30.

Department of Mechanical Engineering, Chonnam National University, Gwangju, Republic of Korea.

Transitional metal-nitrogen-carbon system is a promising candidate to replace the Pt-based electrocatalyst due to its superior activity, durability and cost effectiveness. In this study, we have designed a simple strategy to fabricate carbon nanotubes-supported binary-nitrogen-carbon catalyst via wet-chemical method. Palladium and transitional metals (M, i.e. manganese cobalt and copper) nanoparticles are anchored through four-nitrogen system onto carbon nanotubes (denoted as PdM-N/CNTs). This material has been used as bifunctional electrocatalyst for electrochemical ethanol oxidation reaction and hydrogen evolution reaction for the first time. The N-linked nanoparticles onto carbon nanotubes plays a crucial role in intrinsic catalytic activity for both reactions in 1 M KOH electrolyte. Among three PdM-N/CNTs catalysts, the PdMn-N/CNTs catalyst exhibits higher catalytic activity in terms of current density, mass activity and stability compared to the benchmark Pt/C. The robust electrocatalysis are inherited from the better attachment of PdMn through N-system onto carbon nanotubes, comparatively smaller particles formation with better dispersion and higher electrical conductivity.
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http://dx.doi.org/10.1038/s41598-019-47575-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667450PMC
July 2019

Molecular classification of hepatocellular adenoma: A single-center experience.

Ann Hepatobiliary Pancreat Surg 2019 May 31;23(2):109-114. Epub 2019 May 31.

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Backgrounds/aims: Hepatocellular adenoma (HCA) is a rare benign tumor that has a risk of malignant transformation into hepatocellular carcinoma (HCC) and bleeding. The aim of this study was to analyze the characteristics of HCA by performing molecular classification.

Methods: We retrospectively collected data from nine patients who were diagnosed with HCA from 1995 to 2016. The patients underwent liver surgery due to the existence of clinical symptoms. Immunohistochemical (IHC) staining was performed to classify the subgroups of HCA.

Results: Four patients with both β-catenin and inflammation were classified as β-IHCA. Two patients were defined as β-HCA. Two patients were classified as HHCA. Only one patient was defined as IHCA. None of the patients had unclassified HCA. Seven of nine patients had a malignant transformation. By comparing the characteristics of HCA between two groups, we found the mean tumor size in the malignant transformation group was greater than the non-malignant transformation group.

Conclusions: Taken together, the mean tumor size and activation of catenin β1 mutation status might be the risk factors for the malignant transformation of HCA into HCC. Moreover, IHCA without the catenin β1 mutation could also have a possibility of malignant transformation into HCC.
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http://dx.doi.org/10.14701/ahbps.2019.23.2.109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558132PMC
May 2019

Differences in biological behaviors between young and elderly patients with colorectal cancer.

PLoS One 2019 18;14(6):e0218604. Epub 2019 Jun 18.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Background: We investigated the differences in biological behaviors of sporadic colorectal cancer (CRC) between young and elderly patients. CRC is a common cancer, with a mean age at onset of > 65 years. However, recent reports indicate increasing rates in younger populations. The biological behaviors of sporadic CRC in elderly patients could differ from those in young patients.

Methods: Between September 2007 and August 2012, we selected 723 CRC patients from our institution. The patients were divided into Group Y (n = 127, aged ≤50 years) and Group O (n = 596, aged >50 years). The clinicopathologic and oncologic outcomes in the two groups were compared.

Results: Group Y tumors were characterized by higher incidences of mucin production (13.4% vs. 6.7%; P = 0.017), high microsatellite instability (MSI-H) (19.8% vs. 5.2%; P < 0.001), and N2 stage (32.3% vs. 22.1%; P = 0.020) than those in Group O. The recurrence rates were similar in both groups (14.9% vs. 17.3%; P = 0.665). The 5-year overall survival and disease-free survival did not differ. Multivariate analysis indicated that cellular differentiation and pathologic stage were significant prognostic factors for 5-year overall survival.

Conclusion: Although age was not a prognostic factor for overall survival and young patients did not show a worse prognosis, there were differences in mucin production, MSI-H, and N2 stage between the two groups. Further studies are needed to clarify the clinical and biological characteristics of CRC, improve its treatment strategies, and promote better outcomes in young patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218604PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581287PMC
February 2020

Single-Arm Phases 1 and 2 Trial of Niraparib in Combination With Pembrolizumab in Patients With Recurrent Platinum-Resistant Ovarian Carcinoma.

JAMA Oncol 2019 Aug;5(8):1141-1149

Helen Diller Family Comprehensive Cancer Center, Department of Medicine, University of California, San Francisco, Medical Center at Mount Zion, San Francisco.

Importance: Patients with recurrent ovarian carcinoma frequently develop resistance to platinum-based chemotherapy, at which time treatment options become limited.

Objective: To evaluate the poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor niraparib combined with pembrolizumab in patients with recurrent ovarian carcinoma.

Design, Setting, And Participants: The TOPACIO/KEYNOTE-162 (Niraparib in Combination With Pembrolizumab in Patients With Triple-Negative Breast Cancer or Ovarian Cancer) trial, an open-label, single-arm phases 1 and 2 study enrolled women with advanced or metastatic triple-negative breast cancer (TNBC) or recurrent ovarian carcinoma, irrespective of BRCA mutation status. Median follow-up was 12.4 months (range, 1.2 to ≥23.0 months). Data were collected from April 15, 2016, through September 4, 2018, with September 4, 2018, as a data cutoff, and analyzed from September 4, 2018, through January 30, 2019.

Interventions: The recommended phase 2 dose (RP2D) was 200 mg of oral niraparib once daily and 200 mg of intravenous pembrolizumab on day 1 of each 21-day cycle.

Main Outcomes And Measures: The primary objectives of phase 1 were to evaluate dose-limiting toxic effects and establish the RP2D and dosing schedule. The primary objective of phase 2 was to assess objective response rate (ORR; complete plus partial responses). Results from the phase 1 ovarian carcinoma and TNBC cohorts and phase 2 ovarian carcinoma cohort are reported. Because of the similarity in the phase 1 and 2 ovarian carcinoma populations, the data were pooled to perform an integrated efficacy analysis.

Results: Fourteen patients (9 with ovarian carcinoma and 5 with TNBC) in phase 1 and 53 patients with ovarian carcinoma in phase 2 were enrolled, for a pooled ovarian carcinoma cohort of 62 patients (median age, 60 years [range, 46-83 years]). In the integrated efficacy phases 1 and 2 ovarian carcinoma population (60 of 62 evaluable patients), ORR was 18% (90% CI, 11%-29%), with a disease control rate of 65% (90% CI, 54%-75%), including 3 (5%) with confirmed complete responses, 8 (13%) with confirmed partial responses, 28 (47%) with stable disease, and 20 (33%) with progressive disease. The ORRs were consistent across subgroups based on platinum-based chemotherapy sensitivity, previous bevacizumab treatment, or tumor BRCA or homologous recombination deficiency (HRD) biomarker status. Median duration of response was not reached (range, 4.2 to ≥14.5 months). At data cutoff, 2 patients with a response and 1 patient with stable disease continued to receive treatment.

Conclusions And Relevance: Niraparib in combination with pembrolizumab is tolerable, with promising antitumor activity for patients with ovarian carcinoma who have limited treatment options regardless of platinum status, biomarker status, or prior treatment with bevacizumab. Responses in patients without tumor BRCA mutations or non-HRD cancers were higher than expected with either agent as monotherapy.

Trial Registration: ClinicalTrials.gov identifier: NCT02657889.
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http://dx.doi.org/10.1001/jamaoncol.2019.1048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567832PMC
August 2019

Functional loss of ARID1A is tightly associated with high PD-L1 expression in gastric cancer.

Int J Cancer 2019 08 8;145(4):916-926. Epub 2019 Feb 8.

Department of Pathology, Ajou University School of Medicine, Suwon, South Korea.

Notwithstanding remarkable treatment success with anti-PD-1 monoclonal antibody, oncogenic mechanism of PD-L1 regulation in gastric cancer (GC) remains poorly understood. We hypothesized that ARID1A might be related to tumor PD-L1 expression in GC. We found that tumor PD-L1 positivity was associated with loss of ARID1A and showed trend toward better survival of patients with various molecular subtypes of GC (experimental set, n = 273). Considering heterogeneous ARID1A expression, we validated this using whole tissue sections (n = 159) and found that loss of ARID1A was correlated with microsatellite instability-high (MSI-H), Epstein-Barr virus (EBV), and PD-L1 positivity. Furthermore, for patients with MSI-H tumors, the degree of PD-L1 expression was significantly higher in ARID1A-deficient tumors. After ARID1A knockdown in GC cell lines, total and membranous PD-L1 protein, and PD-L1 mRNA levels were increased based on Western blot, flow cytometry, and qRT-PCR, respectively. With IFN-γ treatment, PD-L1 expression was significantly increased both in ARID1A-deficient cancer cells and controls, but the increase was not more pronounced in the former. Loss of ARID1A increased PD-L1 via activating AKT signaling, while LY294002 (PI3K inhibitor) decreased PD-L1 levels. Furthermore, we found that 3 MSI-H tumors showing highest expression of PD-L1 had simultaneous KRAS mutation and loss of ARID1A, suggesting a possible synergistic role boosting PD-L1. Our results strongly indicate that loss of ARID1A is tightly associated with high PD-L1 expression in GC. These results would increase our understanding of the oncogenic mechanism of PD-L1 regulation in GC, and also help to find the optimal candidates for immunotherapy.
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http://dx.doi.org/10.1002/ijc.32140DOI Listing
August 2019

Stage IV Gestational Choriocarcinoma Diagnosed in the Third Trimester.

Obstet Gynecol 2019 01;133(1):163-166

Departments of Obstetrics and Gynecology and Pathology, Tufts Medical Center, Boston, Massachusetts.

Background: Gestational trophoblastic neoplasia rarely occurs in term pregnancies. Stage IV choriocarcinoma treated with conventional chemotherapy can result in death as a result of hemorrhagic sequelae at tumor sites.

Case: A 30-year-old woman at 34 weeks of gestation presented with a persistent cough, worsening dyspnea, and vaginal bleeding. Chest radiograph demonstrated innumerable lung nodules, and quantitative β-hcg concentration exceeded 1.3 million milli-international units/mL. Cesarean delivery was performed for presumed abruption. Placental pathology demonstrated choriocarcinoma, and imaging confirmed stage IV disease with a World Health Organization score of 14. Remission was achieved after two courses of low-dose induction chemotherapy followed by 10 cycles of combination chemotherapy.

Conclusion: Gestational trophoblastic neoplasia should be considered in a pregnant or postpartum woman presenting with atypical vaginal bleeding. Coexistent pulmonary or neurologic findings may suggest advanced disease.
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http://dx.doi.org/10.1097/AOG.0000000000003001DOI Listing
January 2019

Analysis of endoscopic features for histologic discrepancies between biopsy and endoscopic submucosal dissection in gastric neoplasms: 10-year results.

Dig Liver Dis 2019 01 3;51(1):79-85. Epub 2018 Sep 3.

Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea.

Background And Aim: The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD.

Methods: A total of 1427 patients, who were diagnosed with gastric adenoma by EFB, were enrolled. Cancer confirmed on EFB was excluded (n = 513). We retrospectively reviewed cases and compared histologic diagnoses in the biopsy sample with the final diagnosis in the endoscopically resected specimen.

Results: The diagnosis was upgraded (from low-grade dysplasia to high-grade dysplasia or adenocarcinoma, or from high-grade dysplasia to adenocarcinoma) in 328 cases (23.0%), concordant in 944 (66.1%), and downgraded (from high-grade dysplasia to low-grade dysplasia or non-neoplasia, or from low-grade dysplasia to non-neoplasia) in 155 (10.9%). Multivariate logistic regression analysis showed that surface ulceration and depressed lesions were associated with significant risk factors for upgrading. Age younger than 60 years and size <1 cm were associated with significant factors for downgrading.

Conclusions: Careful endoscopic observation should consider size, ulceration, and depression to ensure accurate diagnosis when a gastric neoplasm is suspected.
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http://dx.doi.org/10.1016/j.dld.2018.08.027DOI Listing
January 2019

EpCAM as a Predictive Marker of Tumor Recurrence and Survival in Patients Who Underwent Surgical Resection for Hepatocellular Carcinoma.

Anticancer Res 2018 Jul;38(7):4101-4109

Department of Gastroenterology, Institute of Medical Sciences, Ajou University School of Medicine, Suwon, Republic of Korea

Background/aim: Epithelial cell adhesion molecule (EpCAM) is expressed in hepatic progenitor cells and hepatocellular carcinoma (HCC), and is considered a marker of liver cancer stem cells.

Materials And Methods: A total of 262 patients were enrolled who had undergone surgical resection for HCC, with immunohistochemical staining results for EpCAM. The immunohistochemical expression of EpCAM and other stemness-related markers was evaluated as prognosticators of tumor recurrence and survival in patients who underwent surgical resection for HCC.

Results: A multivariate Cox regression analysis showed that tumor size [hazard ratio (HR)=2.26, p=0.005], intrahepatic metastasis (HR=2.31, p=0.011), and EpCAM positivity (HR=1.74, p=0.038) were associated with tumor recurrence. In a Kaplan-Meier survival analysis, patients with EpCAM-positive tumors had a significantly higher tumor recurrence rate and a reduced overall survival compared to those with EpCAM-negative tumors.

Conclusion: Immunohistochemical expression of EpCAM was identified as a poor prognosticator of recurrence and survival after surgical resection in patients with HCC.
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http://dx.doi.org/10.21873/anticanres.12700DOI Listing
July 2018

The capsule appearance of hepatocellular carcinoma in gadoxetic acid-enhanced MR imaging: Correlation with pathology and dynamic CT.

Medicine (Baltimore) 2018 Jun;97(25):e11142

Department of Radiology Department of Pathology, Ajou University School of Medicine, Suwon-si, Republic of Korea.

This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features.Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsule was compared with CT and GAeMR. Diagnostic performance of CT and GAeMR of each phase for histologic capsule was evaluated and compared by receiver operating characteristic curve. Interobserver agreement was assessed with kappa statistics.Histologically the capsule was complete in 12.7% (8/63) and incomplete in 60.3% (38/63). Four cases (6.3%) were pseudocapsule. Interobserver agreement for capsule appearance on GAeMR was good in Pre (κ = 0.684), moderate in PP (κ = 0.434), poor in TP (κ = 0.187), fair in HBP (κ = 0.395), and moderate on CT in PP (κ = 0.476) and DP (κ = 0.485). Diagnostic performance and sensitivity for the histologic capsule in DP on CT was highest among PP on CT and other phases on GAeMR. DP on CT images showed a higher Az value than PP on CT images with statistical significance (P < .001). PP on MR images revealed higher Az value than PP on CT images.The capsule appearance was most frequently observed in the DP on CT with highest diagnostic performance, and so DP images should be obtained on CT study for liver mass categorization. GAeMR yielded comparable capsule appearance to CT with moderate interobserver agreement. Considering hypointense rim on the HBP as fibrous capsule on pathology should be refrained, and so further study is warranted to correlate HBP hypointense rim with pathologic findings.
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http://dx.doi.org/10.1097/MD.0000000000011142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023655PMC
June 2018

Inhibition of Discoidin Domain Receptor 1 Prevents Stroma-Induced Peritoneal Metastasis in Gastric Carcinoma.

Mol Cancer Res 2018 10 4;16(10):1590-1600. Epub 2018 Jun 4.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Discoidin domain receptor 1 (DDR1) is activated by fibrillar (triple-helical) collagens and collagen IV, which are major components of tumor stroma; thus, DDR1 might be a critical mediator of communication between cancer cells and stroma. The aim of this study was to investigate the effect of DDR1 inhibition on stroma-induced peritoneal metastasis in gastric carcinoma. We analyzed by immunohistochemistry the correlation between DDR1 expression and the pattern of recurrence in gastric carcinoma tissues from a previously characterized and established gastric carcinoma patient cohort. We also cocultured human gastric carcinoma cell lines with gastric cancer-associated fibroblasts (CAF) and investigated DDR1 expression and activation. We evaluated CAF-induced tumorigenic properties of gastric carcinoma cell lines and the effect of a DDR1-specific inhibitor in organotypic cultures and in a peritoneal seeding xenograft animal model. The expression of DDR1 in gastric cancer tissues was positively associated with early recurrence ( = 0.043) and a high incidence of peritoneal recurrence ( = 0.036). We confirmed that coculturing with CAFs elevated DDR1 protein expression in gastric carcinoma cell lines and enhanced gastric carcinoma cell line spheroid formation in organotypic cultures in a tumor cell DDR1-dependent manner. Coimplantation of CAFs with gastric carcinoma cells enhanced peritoneal tumor formation , an effect that was sensitive to pharmacologic inhibition of DDR1. This study highlights that CAF-induced elevation of DDR1 expression in gastric carcinoma cells enhances peritoneal tumorigenesis, and that inhibition of DDR1 is an attractive strategy for the treatment of gastric carcinoma peritoneal metastasis. .
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http://dx.doi.org/10.1158/1541-7786.MCR-17-0710DOI Listing
October 2018

Trends in Place of Death Among Patients With Gynecologic Cancer in the United States.

Obstet Gynecol 2018 06;131(6):1111-1120

Department of Obstetrics & Gynecology, Tufts Medical Center, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts; and MD Anderson Cancer Center, Houston, Texas.

Objective: To describe the change over time in place of death (hospital, home, hospice) among all women in the United States who died of gynecologic malignancies and compare them with other leading causes of female cancer deaths.

Methods: This is a retrospective cross-sectional study using national death certificate data from the Mortality Multiple Cause-of-Death Public Use Record Data. All women who died from gynecologic, breast, lung, and colorectal cancers were identified according to International Classification of Diseases, 10 Revision, cause of death from 2003 to 2015. Regression analyses with ordinary least-squares linear probability modeling were used to test for differences in location of death over time, and differences in trends by cancer type, while controlling for age, race, ethnicity, marital status, and education status.

Results: From 2003 to 2015, 2,133,056 women died from gynecologic, lung, breast, and colorectal malignancies in the United States. A total of 359,340 died from gynecologic malignancies, including ovarian cancer (n=188,366 [52.4%]), uterine cancer (n=106,454 [29.6%]), cervical cancer (n=52,320 [14.6%]), and vulvar cancer (n=12,200 [3.4%]). Overall, 49.2% (n=176,657) of gynecologic cancer deaths occurred at home or in hospice. The relative increase from 2003 to 2015 in the rate of deaths at home or in hospice was 47.2% for gynecologic cancer deaths (40.5% in 2003 to 59.5% in 2015). In adjusted analyses, the trend in the percentage of deaths at home or in hospice increased at a rate of 1.6 percentage points per year for gynecologic cancer deaths (95% CI 1.5-1.6) vs 1.5 (95% CI 1.4-1.5, P<.001), 1.4 (95% CI 1.4-1.5, P<.001), and 1.5 (95% CI 1.4-1.5, P=.09) percentage points per year for lung, breast, and colorectal cancer deaths, respectively.

Conclusion: Between 2003 and 2015, there was a 47.2% increase (40.5-59.5%) in the rates of gynecologic cancer deaths occurring at home or in hospice. This trend may represent an increase in advance care planning and value-based treatment decisions.
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http://dx.doi.org/10.1097/AOG.0000000000002614DOI Listing
June 2018

Identification of genomic aberrations associated with lymph node metastasis in diffuse-type gastric cancer.

Exp Mol Med 2018 04 6;50(4):1-11. Epub 2018 Apr 6.

Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea.

Diffuse-type gastric cancer (DGC) is a GC subtype with heterogeneous clinical outcomes. Lymph node metastasis of DGC heralds a dismal progression, which hampers the curative treatment of patients. However, the genomic heterogeneity of DGC remains unknown. To identify genomic variations associated with lymph node metastasis in DGC, we performed whole exome sequencing on 23 cases of DGC and paired non-tumor tissues and compared the mutation profiles according to the presence (N3, n = 13) or absence (N0, n = 10) of regional lymph node metastasis. Overall, we identified 185 recurrently mutated genes in DGC, which included a significant novel mutation at CMTM2, as well as previously known mutations at CDH1, RHOA, and TP53. Noticeably, CMTM2 expression could predict the prognostic outcomes of DGC but not intestinal-type GC (IGC), indicating pivotal roles of CMTM2 in DGC progression. In addition, we identified a recurrent loss of heterozygosity (LOH) of DNA copy numbers at the 3p12-pcen locus in DGC. A comparison of N0 and N3 tumors showed that N3 tumors exhibited more frequent DNA copy number aberrations, including copy-neutral LOH and mutations of CpTpT trinucleotides, than N0 tumors (P = 0.2 × 10). In conclusion, DGCs have distinct profiles of somatic mutations and DNA copy numbers according to the status of lymph node metastasis, and this might be helpful in delineating the pathobiology of DGC.
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http://dx.doi.org/10.1038/s12276-017-0009-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938030PMC
April 2018

A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet.

Surg Endosc 2018 09 23;32(9):3777-3782. Epub 2018 Mar 23.

Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea.

Background: Endoscopic ultrasound (EUS)-guided tissue acquisition has become the most effective method of obtaining specimens from a solid lesion adjacent to the gastrointestinal tract. No data exist regarding the use of a stylet in the core biopsy needle during EUS-guided tissue acquisition. The aims of this study were to evaluate the feasibility, safety, and diagnostic yield of a 25-gauge core biopsy needle without (S-) a stylet and to compare its performance with that of a 25-gauge core biopsy needle with (S+) a stylet in patients with solid lesions adjacent to the gastrointestinal tract.

Methods: From November 2013 to January 2016, we performed 114 EUS-guided tissue acquisitions for the diagnosis of solid lesions adjacent to the gastrointestinal tract in a randomized controlled trial. Patients were randomly assigned to the S+ group (n = 57) or the S- group (n = 57). EUS-guided tissue acquisition was performed using a 25-gauge core biopsy needle without an on-site cytopathologist.

Results: There were no significant differences in technical success (100 vs. 100%, p = 1.000), the mean number of needle passes (7.0 ± 1.6 vs. 6.8 ± 1.5, p = 0.556), needle malfunction (0 vs. 1.8%, p = 1.000), or complications (1.8 vs. 0%, p = 1.000) between the S+ and S- groups. Both groups exhibited comparable outcomes with respect to cytological diagnostic accuracy (93.0 vs. 91.2%, p = 1.000) and histological diagnostic accuracy (86.0 vs. 87.7%, p = 1.000) for malignancy. The procedure time was significantly shorter in the S- group than in the S+ group (32.4 ± 11.7 vs. 39.7 ± 8.6 min, p < 0.001).

Conclusions: EUS-guided tissue acquisition using a 25-gauge core biopsy needle without a stylet did not decrease the diagnostic yield for malignancy and was associated with a shorter procedure time than that associated with a stylet.
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http://dx.doi.org/10.1007/s00464-018-6166-4DOI Listing
September 2018

Neural Invasion is a Significant Contributor to Peritoneal Recurrence in Signet Ring Cell Gastric Carcinoma.

Ann Surg Oncol 2018 May 15;25(5):1167-1175. Epub 2018 Feb 15.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Background: Gastric signet ring cell carcinoma (SRC) has shown a favorable outcome in early stages but has a worse prognosis than non-SRC in advanced stages. However, the cause for this stage-dependent prognostic impact has not been determined. This study aimed to compare clinicopathologic features and recurrence patterns between gastric SRC and non-SRC in a cohort of Eastern patients.

Methods: This study reviewed the prospectively collected data of 764 patients undergoing curative resection for gastric cancer from 2005 to 2008. The demographics, clinicopathologic characteristics, disease-specific survival (DSS) rate, and recurrence-free survival (RFS) rate of the patients were analyzed.

Results: The SRC patients (n = 176) had a worse prognosis than the non-SRC patients (n = 588), especially in stages T3 and T4. Peritoneal recurrence and the incidence of neural invasion (NI) were significantly increased in the SRC patients, albeit only in stages T3 and T4. In the T3 and T4 patients with NI, peritoneal recurrence occurred more frequently in SRC than in non-SRC (28.7% vs. 13.7%; p = 0.001), but not in the T3 and T4 patients without NI. Only in the patients with NI, SRC led to a significantly shorter DSS (67.6 vs. 90.7 months; p = 0.008) and RFS (67.1 vs. 80.3 months; p = 0.036) than non-SRC.

Conclusions: This report is the first to present the relationship between NI and peritoneal recurrence as the cause of stage-dependent prognoses for SRC. A better understanding of NI may lend insight into cancer spread and recurrence, especially in gastric SRC.
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http://dx.doi.org/10.1245/s10434-018-6371-3DOI Listing
May 2018

Development of Highly Active Bifunctional Electrocatalyst Using CoO on Carbon Nanotubes for Oxygen Reduction and Oxygen Evolution.

Sci Rep 2018 02 7;8(1):2543. Epub 2018 Feb 7.

Department of Mechanical Engineering, Chonnam National University, Gwangju, Republic of Korea.

Replacement of precious platinum catalyst with efficient and cheap bifunctional alternatives would be significantly beneficial for electrocatalytic oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) and the application of these catalysts in fuel cells is highly crucial. Despite numerous studies on electrocatalysts, the development of bifunctional electrocatalysts with comparatively better activity and low cost remains a big challenge. In this paper, we report a nanomaterial consisting of nanocactus-shaped CoO grown on carbon nanotubes (CoO/CNTs) and employed as a bifunctional electrocatalyst for the simultaneous catalysis on ORR, and OER. The CoO/CNTs exhibit superior catalytic activity toward ORR and OER with the smallest potential difference (0.72 V) between the [Formula: see text] (1.55 V) for OER and E (0.83 V) for ORR. Thus, CoO/CNTs are promising high-performance and cost-effective bifunctional catalysts for ORR and OER because of their overall superior catalytic activity and stability compared with 20 wt% Pt/C and RuO, respectively. The superior catalytic activity arises from the unique nanocactus-like structure of CoO and the synergetic effects of CoO and CNTs.
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http://dx.doi.org/10.1038/s41598-018-20974-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803219PMC
February 2018

Antimicrobial Resistance of Hypervirulent : Epidemiology, Hypervirulence-Associated Determinants, and Resistance Mechanisms.

Front Cell Infect Microbiol 2017 21;7:483. Epub 2017 Nov 21.

National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University, Yongin, South Korea.

is one of the most clinically relevant species in immunocompromised individuals responsible for community-acquired and nosocomial infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Since the mid-1980s, hypervirulent , generally associated with the hypermucoviscosity phenotype, has emerged as a clinically significant pathogen responsible for serious disseminated infections, such as pyogenic liver abscesses, osteomyelitis, and endophthalmitis, in a generally younger and healthier population. Hypervirulent infections were primarily found in East Asia and now are increasingly being reported worldwide. Although most hypervirulent isolates are antibiotic-susceptible, some isolates with combined virulence and resistance, such as the carbapenem-resistant hypervirulent isolates, are increasingly being detected. The combination of multidrug resistance and enhanced virulence has the potential to cause the next clinical crisis. To better understand the basic biology of hypervirulent , this review will provide a summarization and discussion focused on epidemiology, hypervirulence-associated factors, and antibiotic resistance mechanisms of such hypervirulent strains. Epidemiological analysis of recent clinical isolates in China warns the global dissemination of hypervirulent strains with extensive antibiotic resistance in the near future. Therefore, an immediate response to recognize the global dissemination of this hypervirulent strain with resistance determinants is an urgent priority.
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http://dx.doi.org/10.3389/fcimb.2017.00483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702448PMC
July 2018

Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center.

Ann Coloproctol 2017 Oct 31;33(5):192-196. Epub 2017 Oct 31.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Purpose: In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred.

Methods: Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging.

Results: The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively.

Conclusion: CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.
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http://dx.doi.org/10.3393/ac.2017.33.5.192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683970PMC
October 2017

A Novel Roux-en-Y Reconstruction Involving the Use of Two Circular Staplers after Distal Subtotal Gastrectomy for Gastric Cancer.

J Gastric Cancer 2017 Sep 26;17(3):255-266. Epub 2017 Sep 26.

Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Purpose: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction.

Materials And Methods: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery.

Results: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026).

Conclusions: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
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http://dx.doi.org/10.5230/jgc.2017.17.e32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620095PMC
September 2017

Prognostic Significance of Lymphocyte Counts in Colon Cancer Patients Treated with FOLFOX Chemotherapy.

World J Surg 2017 11;41(11):2898-2905

Department of Surgery, Ajou University School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Korea.

Purpose: There is increasing interest in immune function in combination with chemotherapy for cancer treatment. However, the effects of chemotherapy on the human immune system remain to be determined. The aim of this study was to investigate the prognostic impact of lymphocyte and neutrophil counts in colon cancer patients who were treated with curative surgery and adjuvant chemotherapy.

Methods: Two hundred thirty-one patients with colon cancers who underwent curative surgery and FOLFOX adjuvant chemotherapy between November 2005 and December 2011 were included. Oncologic outcomes were analyzed with neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR) before and after chemotherapy.

Results: The 5-year DFS rate was lower in colon cancer patients with low lymphocyte count during chemotherapy (61.9 vs. 76.7%, P = 0.026). Cox multivariate analysis demonstrated that low lymphocyte count during chemotherapy was independently associated with poor disease-free survival (HR 1.829; 95% CI 1.096-3.050; P = 0.021) in colon cancer patients who underwent FOLFOX adjuvant chemotherapy.

Conclusion: Lymphocyte count during chemotherapy is a strong predictor of worse disease-free survival in colon cancer patients who have undergone FOLFOX adjuvant chemotherapy.
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http://dx.doi.org/10.1007/s00268-017-4104-6DOI Listing
November 2017
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