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Purpose@#Immune checkpoint inhibitors (ICIs) have been shown significant oncological improvements in several cancers.However, ICIs are still in their infancy in hepatocellular carcinoma (HCC). Programmed cell death-ligand 1 (PD-L1), tumorinfiltrating lymphocytes (TILs), and epithelial-mesenchymal transition (EMT) have been known as prognostic factors in HCC. Therefore, we have focused on identifying the molecular mechanisms between each marker to evaluate a predictive role. @*Methods@#Formalin-fixed paraffin-embedded samples were obtained from 166 patients with HCC who underwent surgery. The expression of PD-L1 and TILs and EMT marker were evaluated by immunohistochemical analysis. @*Results@#The multivariate analysis showed that TIL expression (hazard ratio [HR], 0.483; 95% confidence interval [CI], 0.269–0.866; P = 0.015) were independent prognostic factors for overall survival. The prognostic factors for disease-free survival were EMT marker expression (HR, 1.565; 95% CI, 1.019–2.403; P = 0.005). Patients with high expression of TILs had significantly better survival compared to patients with low expression (P = 0.023). Patients who were TIL+/EMT– showed a significantly better prognosis than those who were TIL–/EMT+ (P = 0.049). @*Conclusion@#This study demonstrates that PD-L1 expression of TILs is closely associated with EMT marker expression in HCC. Clinical investigations using anti–PD-1/PD-L1 inhibitors in patients with EMT-associated PD-L1 upregulation are warranted.
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Background@#Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward. @*Methods@#This retrospective study included patients who were admitted between 2009 and 2018. Patients were provided regular meals at fixed times according to ideal body weights during hospitalization. We categorized the patients into two groups: those with and those without hypoglycemia during hospitalization. @*Results@#Of the 3,031 patients, 379 experienced at least one episode of hypoglycemia during hospitalization (HYPO group). Hypoglycemia occurred more frequently particularly in cases of premixed insulin therapy. Compared with the control group, the HYPO group was older (61.0±16.8 years vs. 59.1±16.5 years, p=0.035), with more females (60.4% vs. 49.6%, p<0.001), lower body mass index (BMI) (23.5±4.2 kg/m 2 vs. 25.1±4.4 kg/m 2 , p<0.001), and higher prevalence of type 1 diabetes mellitus (6.1% vs. 2.6%, P< 0.001), They had longer hospital stay (11.1±13.5 days vs. 7.6±4.6 days, p<0.001). After discharge the HYPO group had lower glycosylated hemoglobin reduction rate (−2.0%±0.2% vs. −2.5%±0.1%, p=0.003) and tended to have more frequent cases of cardiovascular disease. @*Conclusion@#Hypoglycemia occurred more frequently in older female patients with lower BMI and was associated with longer hospital stay and poorer glycemic control after discharge. Therefore, clinicians must carefully ensure that patients do not experience hypoglycemia during hospitalization.
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BACKGROUND/AIMS@#The purpose of the study is to investigate the associations between sarcopenia and health-related quality of life in elderly men and women in Korea.@*METHODS@#In a cross-sectional study using data from 2008 to 2011 Korean National Health and Nutrition Examination Survey, 4,937 adults aged 60 years and older who underwent a dual-energy X-ray absorptiometry scan were included in the study. Sarcopenia is defined as an appendicular skeletal muscle index of two standard deviations or more below the mean for young, healthy reference populations. The health-related quality of life was measured using the EuroQol-5 dimension questionnaire.@*RESULTS@#The overall prevalence of sarcopenia was 6.6% in these Korean people over the age of 60 years: 11.1% for men and 3.2% for women. Sarcopenic men tended to have lower income, lower physical activity, lower body mass index, and smaller waist circumference compared with nonsarcopenic men. Sarcopenic women tended to have higher body mass index and larger waist circumference compared with nonsarcopenic women. Sarcopenic men showed higher impairments in mobility, self-care, usual activities, and pain/discomfort compared with nonsarcopenic men. Women with sarcopenia also showed higher impairments in mobility, self-care, usual activities, and anxiety/depression compared with nonsarcopenic women. Sarcopenia showed an association with impairments in selfcare for men, and with impairments in self-care, usual activities, and anxiety/depression for women, after adjusting for other confounding factors.@*CONCLUSIONS@#There is a significant association between sarcopenia and impaired health-related quality of life in this elderly Korean population, and these results differ between men and women.
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BACKGROUND AND OBJECTIVES: To determine appropriate counseling time for the first hearing aids user, we measured the effectiveness of first counseling time limit of 20 minutes for those who need hearing aids and collected predictive parameters during history taking. SUBJECTS AND METHOD: We reviewed the medical records of 956 patients (age 66.5±12.1) with hearing impairment who needed hearing aids. We divided patients into two groups, those who had counseling time limited to 20 minutes and others who had no time limitation. Job status, working condition of noise status, social activity and audiological variables were analyzed as probable predicting factors influencing the purchasing of the hearing aid (penetration rate). RESULTS: Of the total 956 patients, 48.64% of subjects decided to purchase hearing aids at first counseling. The two groups showed no significant difference (p=0.396): 49.81% of the group without time limitation purchased the hearing aid and 47.04% of those with time limitation purchased the aid. The social status, right side pure tone threshold and right side tinnitus were significant for calculating the explanation power (64.15%) in the hearing aid uptake probability equation. CONCLUSION: The level of social activity, hearing threshold and tinnitus were predictive variables obtained during the counseling. The time limitation of 20 minutes did not affect the rate of decision to purchase hearing aids. These results might help hearing clinics improve efficient time management at hearing aid clinics.
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PURPOSE: Defensin alpha 6 (DEFA6) is cationic short peptide with known functional activities in innate antimicrobial immunity. DEFA6 is also highly expressed in colorectal cancer tissue. The mechanism and function of DEFA6 have not been reported how to play a significant role in carcinogenesis and cancer progression. The aim of this study was to evaluate the protumorigenic functions of DEFA6 in the colorectal cancer cell line and the clinical significance of DEFA6 expression in colorectal cancer patients.METHODS: DEFA6 expression was investigated by immunohistochemistry in 151 cases of colorectal cancer tissue and the association of DEFA6 expression was correlated with patient's cancer charecteristics.RESULTS: Immunohistochemistry analysis showed that the DEFA6 protein was expressed higher in advanced cancer group (high T stage, patients with lymph node metastasis, patients with vascular invasion) than early cancer group (low T stage, patients without lymph node metastasis, patients without vascular invasion) (P=0.007/0.032/0.047).CONCLUSION: As patient's survival usually depends on migration and invasion of the cancer cell, the high expression of DEFA6 in colorectal cancer cell is associated with patient's cancer charecteristics and could be a biomarker for colorectal cancer. The future study about characterization of DEFA6 will clarify its specific role in oncogenesis and its therapeutic potential.