Protective effects of a polymethoxy flavonoids-rich Citrus aurantium peel extract on liver fibrosis induced by bile duct ligation in mice

OBJECTIVE@#To evaluate the possible protective effect of Citrus aurantium peel extract (CAE) against apoptosis in cholestatic liver fibrosis induced by bile duct ligation in mice.@*METHODS@#Male ICR mice were divided to 5 groups: 1) Control group (Sham-operated mice), 2) Cholestatic liver injury group induced by bile duct ligation (BDL), 3) BDL mice treated with silymarin (200 mg/kg) for 4 weeks, 4) BDL mice treated with 50 mg/kg CAE for 4 weeks, 5) BDL mice treated with 200 mg/kg CAE for 4 weeks. Mice were sacrificed and liver fibrosis was evaluated by serum and hepatic tissue biochemistry tests and liver histopathological examination. Effects of CAE on inflammation and apoptosis gene regulation were investigated through real-time PCR. CAE effect on lipid metabolism related signaling was determined by western blot analysis.@*RESULTS@#In BDL mice, administration of CAE for 4 weeks markedly attenuated liver fibrosis based on histopathological alteration. Serum and hepatic tissue biochemistry results revealed that CAE (50 and 200 mg/kg) decreased the levels of alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, total bilirubin, nitric oxide, and thiobarbituric acid reactive substances. Real-time PCR and western blot analysis showed that CAE regulated inflammation, apoptosis, and lipid metabolism factors increased by BDL. Interleukin family, tumor necrosis factor α, and related apoptosis factors mRNA levels were increased by BDL treatment. However, these increases were suppressed by CAE administration. In addition, CAE effectively increased phosphorylation of AMP-activated protein kinase, nuclear factor E2-related factor 2, and related cytoprotective proteins.@*CONCLUSIONS@#CAE can efficiently regulate BDL-induced liver injury with antioxidant, anti-inflammatory, and anti-apoptotic activities.

Green coffee bean extract improves obesity by decreasing body fat in high-fat diet-induced obese mice

OBJECTIVES@#To evaluate possible lipid catabolism and body fat regulation effects of 3-caffeoylquinic acid in Green coffee bean extract (GCBE) in high-fat diet (HFD)-induced obese mice.@*METHODS@#Obesity was induced in mice using a HFD for four weeks. Then, mice were fed only HFD or HFD with GCBE at 50, 100, and 200 mg/kg. Fatty acid synthesis mechanism regulation of body fat was investigated through real-time PCR and Western blot assay. Body fat reduction was measured through dual-energy X-ray absorptiometry.@*RESULTS@#In HFD-induced obese mice, GCBE treatment significantly decreased body weight gain, liver weight and white adipose tissue weights with regulation of adipose tissue lipolysis hormones, like adiponectin and leptin. GCBE treatment decreased mRNA expression levels of adipogenesis and adipocyte metabolism related genes in adipose tissues and the liver, and decreased the corresponding protein expression. Dual energy X-ray absorptiometry measurements were used to compare body fat between mice on high-fat and those treated with GCBE. GCBE treated mice had a lower fat mass compared to HFD alone fed mice and relative body weight and fat mass were markedly decreased.@*CONCLUSIONS@#GCBE has a potential anti-obesity effect with lowering body fat accumulation by regulating adipogenesis and lipid metabolism-related genes and proteins in WAT and liver.

Green coffee bean extract improves obesity by decreasing body fat in high-fat diet-induced obese mice

Objectives To evaluate possible lipid catabolism and body fat regulation effects of 3-caffeoylquinic acid in Green coffee bean extract (GCBE) in high-fat diet (HFD)-induced obese mice. Methods Obesity was induced in mice using a HFD for four weeks. Then, mice were fed only HFD or HFD with GCBE at 50, 100, and 200 mg/kg. Fatty acid synthesis mechanism regulation of body fat was investigated through real-time PCR and Western blot assay. Body fat reduction was measured through dual-energy X-ray absorptiometry. Results In HFD-induced obese mice, GCBE treatment significantly decreased body weight gain, liver weight and white adipose tissue weights with regulation of adipose tissue lipolysis hormones, like adiponectin and leptin. GCBE treatment decreased mRNA expression levels of adipogenesis and adipocyte metabolism related genes in adipose tissues and the liver, and decreased the corresponding protein expression. Dual energy X-ray absorptiometry measurements were used to compare body fat between mice on high-fat and those treated with GCBE. GCBE treated mice had a lower fat mass compared to HFD alone fed mice and relative body weight and fat mass were markedly decreased. Conclusions GCBE has a potential anti-obesity effect with lowering body fat accumulation by regulating adipogenesis and lipid metabolism-related genes and proteins in WAT and liver.

Protective effects of a polymethoxy flavonoids-rich Citrus aurantium peel extract on liver fibrosis induced by bile duct ligation in mice

Objective To evaluate the possible protective effect of Citrus aurantium peel extract (CAE) against apoptosis in cholestatic liver fibrosis induced by bile duct ligation in mice. Methods Male ICR mice were divided to 5 groups: 1) Control group (Sham-operated mice), 2) Cholestatic liver injury group induced by bile duct ligation (BDL), 3) BDL mice treated with silymarin (200 mg/kg) for 4 weeks, 4) BDL mice treated with 50 mg/kg CAE for 4 weeks, 5) BDL mice treated with 200 mg/kg CAE for 4 weeks. Mice were sacrificed and liver fibrosis was evaluated by serum and hepatic tissue biochemistry tests and liver histopathological examination. Effects of CAE on inflammation and apoptosis gene regulation were investigated through real-time PCR. CAE effect on lipid metabolism related signaling was determined by western blot analysis. Results In BDL mice, administration of CAE for 4 weeks markedly attenuated liver fibrosis based on histopathological alteration. Serum and hepatic tissue biochemistry results revealed that CAE (50 and 200 mg/kg) decreased the levels of alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, total bilirubin, nitric oxide, and thiobarbituric acid reactive substances. Real-time PCR and western blot analysis showed that CAE regulated inflammation, apoptosis, and lipid metabolism factors increased by BDL. Interleukin family, tumor necrosis factor α, and related apoptosis factors mRNA levels were increased by BDL treatment. However, these increases were suppressed by CAE administration. In addition, CAE effectively increased phosphorylation of AMP-activated protein kinase, nuclear factor E2-related factor 2, and related cytoprotective proteins. Conclusions CAE can efficiently regulate BDL-induced liver injury with antioxidant, anti-inflammatory, and anti-apoptotic activities.

Roots extracts of Adenophora triphylla var. japonica improve obesity in 3T3-L1 adipocytes and high-fat diet-induced obese mice

OBJECTIVE@#To investigate the anti-obesity activity and the action mechanism of the roots of Adenophora triphylla var. japonica extract (ATE) in high-fat diet (HFD)-induced obese mice and 3T3-L1 adipocytes.@*METHODS@#The roots of Adenophora triphylla were extracted with 70% ethanol. To demonstrate the compounds, linoleic acid was analyzed by using gas chromatography; and the anti-obesity effects and possible mechanisms of ATE were examined in 3T3-L1 adipocytes and HFD-induced obese mice.@*RESULTS@#Treatment with ATE inhibited the lipid accumulation without cytotoxicity in 3T3-L1 adipocytes. Furthermore, 200 and 400 mg/kg ATE treatment significantly decreased the body weight gain, white adipose tissues (WATs) weight and plasma triglyceride level, while 100 and 200 mg/kg ATE treatment increased the plasma high-density lipoprotein cholesterol level in the HFD-induced obese mice, as compared with the HFD group. Treatment with 200 and 400 mg/kg ATE also lowered the size of adipocytes in adipose tissue and reduced the lipid accumulation in liver. ATE treatment showed significantly lower expression level of adipogenesis-related proteins, such as peroxisome proliferator-activated receptor γ, fatty acid binding protein (aP2), fatty acid synthase in 3T3-L1 adipocytes; and furthermore, decreased peroxisome proliferator-activated receptor γ, aP2, fatty acid synthase, sterol regulatory element binding protein-1c, and lipoprotein lipase mRNA expression levels in WAT of the HFD-induced obese mice.@*CONCLUSIONS@#These results suggested that the ATE has an anti-obesity effect, which may be elicited by regulating the expression of adipogenesis and lipogenesis-related genes and proteins in adipocytes and WAT of the HFD-induced obese mice.

Monascus pilosus-fermented black soybean inhibits lipid accumulation in adipocytes and in high-fat diet-induced obese mice

OBJECTIVE@#To explore the anti-obesity effects and the mechanism of action of Monascus pilosus(M. pilosus)-fermented black soybean (MFBS) extracts (MFBSE) and MFBS powders (MFBSP) in adipocytes and high-fat diet (HFD)-induced obese mice, respectively.@*METHODS@#Black soybean was fermented with M. pilosus, and the main constituents in MFBS were analyzed by HPLC analysis. In vitro, MFBSE were examined for anti-adipogenic effects using Oil-Red O staining. In vivo, mice were fed a normal-fat diet (NFD) control, HFD control or HFD containing 1 g/kg MFBSP for 12 weeks, and then body weight gain and tissues weight measured. Real-time PCR and western blot assay were used to determine the mechanism of anti-adipogenic effects.@*RESULTS@#MFBSE inhibited lipid accumulation in 3T3-L1 adipocytes without exerting cell cytotoxicity. MFBSP treatment in HFD-fed mice significantly decreased the body weight gain compared with the HFD control mice. MFBSE and MFBSP treatment resulted in significantly lower mRNA levels of adipogenesis-related genes, such as peroxisome proliferator-activated receptor γ(PPAR γ), fatty acid-binding protein 4 (FABP4), and fatty acid synthase (FAS), in adipocytes and in white adipose tissue (WAT) of HFD-induced obese mice.@*CONCLUSIONS@#These results suggest that the anti-obesity effects of MFBS are elicited by regulating the expression of adipogenesis-related genes in adipocytes and WAT of HFD-induced obese mice.

Roots extracts of Adenophora triphylla var. japonica improve obesity in 3T3-L1 adipocytes and high-fat diet-induced obese mice

Objective: To investigate the anti-obesity activity and the action mechanism of the roots of Adenophora triphylla var. japonica extract (ATE) in high-fat diet (HFD)-induced obese mice and 3T3-L1 adipocytes. Methods: The roots of Adenophora triphylla were extracted with 70% ethanol. To demonstrate the compounds, linoleic acid was analyzed by using gas chromatography; and the anti-obesity effects and possible mechanisms of ATE were examined in 3T3-L1 adipocytes and HFD-induced obese mice. Results: Treatment with ATE inhibited the lipid accumulation without cytotoxicity in 3T3-L1 adipocytes. Furthermore, 200 and 400 mg/kg ATE treatment significantly decreased the body weight gain, white adipose tissues (WATs) weight and plasma triglyceride level, while 100 and 200 mg/kg ATE treatment increased the plasma high-density lipoprotein cholesterol level in the HFD-induced obese mice, as compared with the HFD group. Treatment with 200 and 400 mg/kg ATE also lowered the size of adipocytes in adipose tissue and reduced the lipid accumulation in liver. ATE treatment showed significantly lower expression level of adipogenesis-related proteins, such as peroxisome proliferator-activated receptor γ, fatty acid binding protein (aP2), fatty acid synthase in 3T3-L1 adipocytes; and furthermore, decreased peroxisome proliferator-activated receptor γ, aP2, fatty acid synthase, sterol regulatory element binding protein-1c, and lipoprotein lipase mRNA expression levels in WAT of the HFD-induced obese mice. Conclusions: These results suggested that the ATE has an anti-obesity effect, which may be elicited by regulating the expression of adipogenesis and lipogenesis-related genes and proteins in adipocytes and WAT of the HFD-induced obese mice.

Monascus pilosus-fermented black soybean inhibits lipid accumulation in adipocytes and in high-fat diet-induced obese mice

Objective: To explore the anti-obesity effects and the mechanism of action of Monascus pilosus(M. pilosus)-fermented black soybean (MFBS) extracts (MFBSE) and MFBS powders (MFBSP) in adipocytes and high-fat diet (HFD)-induced obese mice, respectively. Methods: Black soybean was fermented with M. pilosus, and the main constituents in MFBS were analyzed by HPLC analysis. In vitro, MFBSE were examined for anti-adipogenic effects using Oil-Red O staining. In vivo, mice were fed a normal-fat diet (NFD) control, HFD control or HFD containing 1 g/kg MFBSP for 12 weeks, and then body weight gain and tissues weight measured. Real-time PCR and western blot assay were used to determine the mechanism of anti-adipogenic effects. Results: MFBSE inhibited lipid accumulation in 3T3-L1 adipocytes without exerting cell cytotoxicity. MFBSP treatment in HFD-fed mice significantly decreased the body weight gain compared with the HFD control mice. MFBSE and MFBSP treatment resulted in significantly lower mRNA levels of adipogenesis-related genes, such as peroxisome proliferator-activated receptor γ(PPAR γ), fatty acid-binding protein 4 (FABP4), and fatty acid synthase (FAS), in adipocytes and in white adipose tissue (WAT) of HFD-induced obese mice. Conclusions: These results suggest that the anti-obesity effects of MFBS are elicited by regulating the expression of adipogenesis-related genes in adipocytes and WAT of HFD-induced obese mice.

Antioxidant activity and free radical scavenging activities of Streptomyces sp. strain MJM 10778

OBJECTIVE@#To investigate the antioxidant activity of soil-borne actinobacteria.@*METHODS@#The total phenolic contents, the level of antioxidant potential by DPPH radical scavenging activity, NO scavenging activity, and ABTS radical scavenging activity in ethyl acetate extract were determined.@*RESULTS@#The 16S rDNA sequencing analysis revealed that Streptomyces sp. strain MJM 10778, which was isolated from Hambak Mountain, Korea, has 99.9% similarity to Streptomyces misionensis (S. misionensis) NBRC 13063. The physiological and the morphological test revealed that the strain MJM 10778 has different characteristics from the strain NBRC 13063. The entire antioxidant assay with the ethyl acetate extract displayed good radical scavenging activity. The IC50 values of the strain MJM 10778 extract on DPPH, NO, and ABTS radicals were identified to be 92.8 μg/mL, 0.02 μg/mL, and 134.9 μg/mL, respectively. The ethyl acetate extract of the strain MJM 10778 showed an 81.50% of cell viability at 100 μg/mL in Raw264.7 cell viability assay.@*CONCLUSIONS@#The results obtained suggest that the ethyl acetate extract of Streptomyces sp. strain MJM 10778 could be considered as a potential source of drug for the diseases that is caused by free radicals with its anti-oxidant activities and low cytotoxicity.

Antioxidant activity and free radical scavenging activities of Streptomyces sp. strain MJM 10778

Objective: To investigate the antioxidant activity of soil-borne actinobacteria. Methods: The total phenolic contents, the level of antioxidant potential by DPPH radical scavenging activity, NO scavenging activity, and ABTS radical scavenging activity in ethyl acetate extract were determined. Results: The 16S rDNA sequencing analysis revealed that Streptomyces sp. strain MJM 10778, which was isolated from Hambak Mountain, Korea, has 99.9% similarity to Streptomyces misionensis (S. misionensis) NBRC 13063. The physiological and the morphological test revealed that the strain MJM 10778 has different characteristics from the strain NBRC 13063. The entire antioxidant assay with the ethyl acetate extract displayed good radical scavenging activity. The IC

Ultrasonographic Findings of the Gallbladder in Patients with Acute Hepatitis A: Do They Have Clinical Relevance?

PURPOSE: To determine the association of gallbladder (GB) abnormalities on ultrasonography (US) of patients with acute hepatitis A with demographic, clinical, and biochemical factors, and with other US findings. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. We retrospectively evaluated 152 consecutive patients with acute hepatitis A who underwent US. The diagnosis of acute hepatitis A was made during acute illness by demonstrating anti-HAV of the IgM class. US images were reviewed simultaneously by two abdominal radiologists and a consensus was reached for GB wall thickening, GB collapse, lymphadenopathy, and hepatic echogenicity. The associations between demographic, clinical, biochemical, and US findings and GB wall thickening or collapse were then assessed. RESULTS: GB wall thickening was present in 123 (81%) and GB collapse in 96 (63%) of the 152 patients. Total bilirubin level and GB collapse differed significantly (p < 0.05) between patients with and without GB wall thickening. Gender ratio, total and peak total bilirubin level, and GB wall thickness differed significantly (p < 0.05) between patients with and without GB collapse. Multivariate analysis showed that GB wall thickening was associated with GB collapse and vice versa. CONCLUSION: GB wall thickening and GB collapse are common US abnormalities associated with each other in patients with acute hepatitis A. However, GB wall thickening or collapse is not associated with any demographic, clinical, or biochemical factors, or with other US findings, in patients with acute hepatitis A.

Treatment of Skin Laxity and Facial Wrinkles with Combinationof Radiofrequency and Infrared Light / 대한피부과학회지

BACKGROUND: A device using radiofrequency and infrared has been used as a nonablative method for producing noninvasive skin tightening. However, the method combining radiofrequency and infrared light has not been used widely for treating both skin wrinkling and tightening. OBJECTIVE: To investigate the efficacy of a new nonablative Korean medical device, AntiLax(TM) (Jeisys Medical, Seoul, Korea), which uses both radiofrequency and infrared light, on facial wrinkling and laxity. METHODS: Thirty-three patients with facial laxity and wrinkles were enrolled in this study. Three patients failed to complete the three treatment sessions spaced 4 weeks apart so, ultimately, 30 patients completed the scheduled procedure. Serial photographs of the patients were obtained during the study period. A final clinical assessment was made 3 months after the last treatment. Punch biopsies of the treatment areas were obtained 1 week before treatment and 1 month after the last treatment in five patients who agreed to undergo skin biopsies. RESULTS: Doctors' assessments of the photographs taken before and 3 months after the treatment observed marked differences in the effect of treatment on skin laxity, according to location, but no differences in the effect of treatment on skin wrinkling, according to location. The efficacy of treatment of both skin laxity and wrinkling increased with the number of treatments. Patient satisfaction scores paralleled the clinical improvements observed. Secondary benefits reported by patients 3 months after treatment included decreased pore size, reduced sebum secretion, and improved skin texture. The side effects were mild and limited to transient erythema, edema, and rare vesicle formation. Histopathologically, there were increased, thickened collagen fibers 1 month after the last treatment, as compared to pretreatment. However, quantitative morphometric methods are needed to evaluate the histological changes objectively. CONCLUSION: Noninvasive radiofrequency combined with infrared light appears to be a safe, effective method for treating skin laxity and facial wrinkles.

Radiofrequency Ablation with Epinephrine Injection: In Vivo Study in Normal Pig Livers

PURPOSE: We wanted to evaluate whether epinephrine injection prior to radiofrequency (RF) ablation can increase the extent of thermally mediated coagulation in vivo normal pig liver tissue. MATERIALS AND METHODS: Eighteen RF ablation zones were created in six pigs using a 17-gauge internally cooled electrode under ultrasound guidance. Three RF ablation zones were created in each pig under three conditions: RF ablation alone, RF ablation after the injection of 3 mL of normal saline, and RF ablation after the injection of 3 mL of epinephrine (1:10,000 solution). After the RF ablation, we measured the short and long diameters of the white zones in the gross specimens. RESULTS: Three of the RF ablations were technically unsuccessful; therefore, measurement of white zone was finally done in 15 RF ablation zones. The mean short and long diameters of the white zone of the RF ablation after epinephrine injection (17.2 mm +/- 1.8 and 20.8 mm +/- 3.7, respectively) were larger than those of RF ablation only (10 mm +/- 1.2 and 12.2 mm +/- 1.1, respectively) and RF ablation after normal saline injection (12.8 mm +/- 1.5 and 15.6 mm +/- 2.5, respectively) (p < .05). CONCLUSION: RF ablation with epinephrine injection can increase the diameter of the RF ablation zone in normal pig liver tissue.

The Effect of Piezoelectric Shock Wave Lithotripsy (EDAP LT02) for Pediatric Urolithiasis / 대한비뇨기과학회지

PURPOSE: The efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of pediatric urolithiasis was evaluated, and a retrospective analysis of the feasibility of various methods of pain control for ESWL performed according to the age of the patients. MATERIALS AND METHODS: Between 1987 and 2004, 30 boys and 32 girls diagnosed with urolithiasis were treated. Their records were reviewed and analyzed for metabolic and anatomical anomalies, the size and location of the stones and for the treatment outcomes and complications. RESULTS: The success rates were 27.4, 61.3 and 80.6% after one, two and three sessions of ESWL, respectively, with an overall success rate of 93.5%. The locations of the stone were the upper calyx, the mid calyx, the lower calyx, the upper ureter, the mid ureter and the lower ureter in 6, 4, 7, 15, 4 and 25 cases, respectively. All patients underwent ESWL with a piezoelectric lithotriptor (EDAP LT02). There was only one patient who required general anesthesia. Most of the patients younger than 6 years underwent the ESWL with IM or IV sedation only. Generally, the patients older than 6 years old required no sedation. Pyelonephritis occurred in one patient (1.6%). CONCLUSIONS: ESWL is an efficient and safe treatment modality for pediatric urolithiasis. Patients older than 6 years can undergo ESWL with analgesics or oral sedation only.

Febrile Seizure-induced Neuroexcitability in Immature Rat Hipocampus / 소아과

PURPOSE: To determine whether febrile seizure enhances neuroexcitability by altering synaptic transmission and whether febrile seizure-induced hyperexcitability leads to long-lasting neuronal death. METHODS: We investigated the expression of synaptic and postsynaptic proteins and the apoptosis of neuronal cells in rat pup hippocampus after hyperthermic seizure using immunoblotting and confocal microscopy. RESULTS: Hyperthermic seizure enhanced the long-term expressions of presynaptic proteins such as syntaxin, VAMP, SNAP-25 and nSec1, whereas that of NSF was decreased. The expressions of postsynaptic NMDA receptors 1, 2a and 2b were up-regulated. The expression of postsynaptic AMPA glutamate receptors 1 month after hyperthermic seizures altered by way of increasing the ratio of GluR1 to GluR2 and decreasing NSF-GluR2 interaction, which leads to the formation of Ca2+permeable AMPA receptors and enhanced toxicity. However, in spite of enhanced neuroexcitability, there was a transient increase of neuronal death in hipocampus one week after hyperthermic seizure, but returned to baseline one month later. CONCLUSION: These results demonstrate both presynaptic and postsynaptic forms of long-term enhancement of glutamate synaptic transmission after hyperthermic seizure and support the idea that early-life febrile seizure might have persistent effects on neuronal excitability in the hippocampus.

A Case of Myotubular Myopathy

The term myotubular myopathy (MTM) implies a maturational arrest of fetal muscle during the myotubular stage of development at 8-15 weeks of gestation. Characteristic muscle histopathology consists of small hypotrophic muscle fibers with centrally placed nuclei and a surrounding clear area devoid of myofibrils. X-linked recessive inheritance is the most common trait. Autosomal recessive and autosomal dominant forms are less frequently reported. The clinical diagnostic criterion for X-linked MTM has relied on a positive family history and the demonstration of the presence of characteristic biopsy findings from affected male subjects. Additional features may include perinatal onset, severe hypotonia, respiratory failure, dysphagia, thin ribs, contractures of the hips or knees, puffy eyelids and ophthalmoplegia. The prognosis is often fatal, and most patients die within the first year of life from respiratory failure. The authors report a case of presumed X-linked MTM with severe hypotonia, muscle weakness and respiratory failure at birth.

Multivariate Analysis of Prognostic Factors in Gastric Cancer

BACKGROUND: Worldwide stomach cancer death rates have been steadily declining in most countries since World War II, but in Korea the incidence of stomach cancer is still high and is a major concern for public health. Surgical resection is the best method of treatment and offers a chance for cure, but the overall results of surgical treatment have been dismal. METHODS: The authors performed a retrospective study of 958 patients treated for adenocarcinomas of the stomach with curative intent over the period from March 1986 through December 1994 at Kyung Hee University Hospital. The study examined the prognostic influence of 2 host factors (age and sex of the patients), 7 tumor factors (location of tumor, number of lesions, size of tumor, depth of invasion, extent of lymph-node involvement, number of metastatic lymph nodes, and TNM stage), and 4 treatment factors (type of gastrectomy, combined resection, extent of lymph-node dissection, and adjuvant chemotherapy) by univariate and multivariate analysis. RESULTS: In univariate analysis, 9 prognostic factors - the age of the patients, the size of lesions, the depth of invasion, the extent of lymph-node involvement, the number of metastatic lymph nodes, the TNM stage, the type of gastrectomy, the extent of lymph-node dissection, and combined resection - were significantly correlated with survival. In multivariate analysis using the Cox proportional hazard model, 5 independent prognostic factors significantly correlated with survival: the age of the patients (RR = 1.480), the depth of invasion (RR = 1.287), the number of metastatic lymph nodes (RR = 2.700), the TNM stage (RR = 1.592), and the extent of lymph-node dissection (RR = 1.390). CONCLUSIONS: The authors can make a prognosis for stomach cancer more precisely on the basis of these independent prognostic factors, and an extended D2 operation (D2 alpha operation) may be a valuable means to treat gastric cancer.

Spiral CT for the Measurement of Hepatic Metastatic Mass from Gastrointestinal Malignant Tumor: Relative Value of Arterial, Portal and Delayed Phase Scanning

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.

Prophylactic Treatment of Anemia of Prematurity with Recombinant Human Erythropoietin and High Doses of Iron

PURPOSE: We conducted randomized study to determine whether high doses (6mg/kg/ day) of iron would exert a more supplemental effect than low doses (3mg/kg/day), and which regimen of recombinant human erythropoietin (rHuEPO) and iron would be more beneficial in the prophylactic treatment of anemia of prematurity. METHODS: We randomly assigned 38 sick premature infants who were more likely than symptom-free premature infants requiring erythrocyte transfusions for infants with anemia of prematurity to receive rHuEPO, 100unit/kg, tiw, subcutaneously, plus iron, 3mg/kg/day, po, daily from the second day of life (group 1), 100unit/kg and 6mg/kg/ day (group 2), 200unit/kg and 3mg/kg/day (group 3), and 200unit/kg and 6mg/kg/day (group 4), respectively. RESULTS: There were no significant differences of hemoglobin levels and iron balances during treatment among all 4 groups. The rates of increase in reticulocyte counts were greater in group 4 and group 2 compared with group 3 and group 1, respectively, though these rates were statistically not significant. The blood volume differences (volume of phlebotomies-volume of transfusions) during treatment were higher in group 4 compared with group 1 (p<0.05). CONCLUSIONS: High doses of iron may be more effective in rapidly increasing reticulocyte counts, and 200unit/kg, tiw of rHuEPO plus 6mg/kg/day of iron is more beneficial in reducing the need for blood transfusions than any other regimen. Therefore the prophylactic treatment of anemia of prematurity and acute blood loss from frequent blood sampling in risky premature infants with rHuEPO, 200unit/kg, tiw, subcutaneously, plus iron 6mg/kg/day, po, daily from the second day of life is effective in reducing the number of blood transfusions. Additional controlled trials utilizing high doses of iron with rHuEPO and larger numbers of patients are justified.

A Study on Blood Lead Levels in Pediatric Inpatients

Lead is one of the most widespread environmental toxins and its poisoning in children was considered a rarity, usually resulting from unique circumstances such as inappropriate use of leadbased body cosmetics or direct administration of lead-containing folk medicines. The increasing concern about children with lower levels of lead exposure has developed, but there are no data regarding the mean blood lead levels and the incidence of symptomatic or asymptomatic lead poisoning in Korean children. We analyzed the zinc protoporphyrine (ZPP) values and blood lead concentrations in 163 pediatric inpatients for a prospective study of lead exposure. The blood lead concentrations in all 163 children were 15~54 g/dl, of whom 111 children (68.1%) were 25~54 g/dl which needs decision to chelate based on the EDTA provocation test. Among 111 children whose blood lead concentrations are 25~54 g/dl, 59 children(53.2%) were between 7 months and 3 years of age, which revealed no significant higher incidence of lead exposure than any other age group. The ZPP values in 126 children (77.3%) were above 35 g/dl. The mean blood lead concentration and ZPP values are 27.8 g/dl and 48.8 g/dl, respectively. We conclude that there are many asymptomatic children with increased absorption of lead in the urban area of Korea, and we need further studies regarding lead poisoning. It is important that there must be a national counterplan and that pediatricians continue to pay attention to lead posioning in children.