Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

40 years or new hires with less than 1 year of service.

Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval

Purpose@#The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5–7 mm) than those for endoscopically resected specimens (2–3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD). @*Materials and Methods@#This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI. @*Results@#Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7–80.3% (P<0.001 for all three sets) and 55.3–63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4–10 (2.7%–6.7%) at 4-mm intervals, and 10–17 (6.7%–11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI. @*Conclusions@#After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up.

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors / 대한내과학회지

The incidence of rectal neuroendocrine tumors (NETs) has increased worldwide, including in Korea. Rectal NETs are usually single lesions, but synchronous multiple lesions are reported in 2–4.5% of patients. Small rectal NETs (≤ 10 mm) are usually confined to the submucosal layer and rarely give rise to lymph node or distant metastases. Here we describe the case of a 54-year-old woman referred to National Cancer Center for the management of two rectal subepithelial tumors. Because computed tomography revealed a small hepatic nodule suggesting atypical hemangioma rather than metastasis, endoscopic submucosal dissection was performed. However, the size of the nodules increased during follow-up. The pathologic results of a liver biopsy confirmed metastatic NET. This case was unusual in that synchronous small rectal NETs and distant liver metastasis occurred in the absence of any risk factors for metastasis. Thus, patients with rectal NETs should be carefully evaluated, especially for the possibility of metastasis.

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors / 대한내과학회지

The incidence of rectal neuroendocrine tumors (NETs) has increased worldwide, including in Korea. Rectal NETs are usually single lesions, but synchronous multiple lesions are reported in 2–4.5% of patients. Small rectal NETs (≤ 10 mm) are usually confined to the submucosal layer and rarely give rise to lymph node or distant metastases. Here we describe the case of a 54-year-old woman referred to National Cancer Center for the management of two rectal subepithelial tumors. Because computed tomography revealed a small hepatic nodule suggesting atypical hemangioma rather than metastasis, endoscopic submucosal dissection was performed. However, the size of the nodules increased during follow-up. The pathologic results of a liver biopsy confirmed metastatic NET. This case was unusual in that synchronous small rectal NETs and distant liver metastasis occurred in the absence of any risk factors for metastasis. Thus, patients with rectal NETs should be carefully evaluated, especially for the possibility of metastasis.

Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea / 예방의학회지

OBJECTIVES: A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009. METHODS: The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants. RESULTS: Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291). CONCLUSIONS: The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.

Human CD36 overexpression in renal tubules accelerates the progression of renal diseases in a mouse model of folic acid-induced acute kidney injury

BACKGROUND: Acute kidney injury (AKI) is a risk factor for progression to chronic kidney disease, with even subclinical AKI episodes progressing to chronic kidney disease. Several risk factors such as preexisting kidney disease, hyperglycemia, and hypertension may aggravate renal disease after AKI. However, mechanisms underlying the progression of AKI are still unclear. This study identified the effect of human cluster of differentiation 36 (CD36) overexpression on the progression of folic acid-induced AKI. METHODS: Pax8–rtTA/tetracycline response element–human CD36 transgenic mice were used to elucidate the effect of human CD36 overexpression in the proximal tubules on folic acid-induced AKI. RESULTS: Results of histological analysis showed severely dilated tubules with casts and albuminuria in folic acid-treated transgenic mice overexpressing human CD36 compared with folic acid-treated wild-type mice. In addition, analysis of mRNA expression showed a significant increase in the collagen 3a1 gene in folic acid-treated transgenic mice overexpressing human CD 36 compared with folic acid-treated wild type mice. CONCLUSION: Human CD36-overexpressing transgenic mice showed severe pathological changes and albuminuria compared with wild-type mice. Moreover, mRNA expression of the collagen 3a1 gene increased in folic acid-treated transgenic mice. These results suggest that human CD36 overexpression is a risk factor of AKI and its progression to chronic kidney disease.

Phlegmonous Gastritis with Early Gastric Cancer

Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the stomach wall, with a high mortality rate. Antibiotics with or without surgical treatment are required for treatment. We present a case in which phlegmonous gastritis occurred during the diagnostic evaluation of early gastric cancer. The patient showed improvement after antibiotic treatment, but attempted endoscopic submucosal dissection failed because of submucosal pus. We immediately applied argon plasma coagulation since surgical resection was also considered a high-risk procedure because of the submucosal pus and multiple comorbidities. However, there was local recurrence two years later, and the patient underwent subtotal gastrectomy with lymph node dissection. Considering the risk of incomplete treatment immediately after recovery from phlegmonous gastritis and that recurrent disease can be more difficult to manage, delaying treatment and evaluation until after complete recovery of PG might be a better option in this particular clinical situation.

A Case of Curative Resection of Advanced Combined Hepatocellular-cholangiocarcinoma after Neoadjuvant Chemotherapy / 대한췌담도학회지

Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a primary liver cancer with histopathologic features of both hepatocelluar carcinoma and cholangiocarcinoma. As combined HCC-CC has been associated with poor outcomes, accurate diagnosis and proper treatment planning for patients are considered to be important for improving survival. Currently, surgery is known as the only treatment modality offering potential cure for localized disease. However, there are little published treatment options for advanced or recurrent disease. Furthermore, no published reports exist in respect to the applying successful curative resection after neoadjuvant therapy for advanced combined HCC-CC. Here, we report a case of combined HCC-CC subtype with stem cell feature, intermediate type who underwent curative surgical resection after neoadjuvant chemotherapy consisting of cisplatin and gemcitabine. Pathologic report revealed negative resection margin and follow-up imaging study shows no evidence of tumor recurrence.

A Case of Newly Detected Ectopic Mediastinal Parathyroid Gland in Chronic Renal Failure Patient after Parathyroidectomy / 대한신장학회지

Hyperparathyroidism is one of the most serious complications for hemodialysis patients. Parathyroidectomy is indicated in patients with severe hyperparathyroidsm refractory to medical treatment. An 39- year-old man who were maintained by hemodialysis underwent parathyroidectomy due to tertiary hyperparathyroidism. The level of intact PTH fell after parathyroidectomy but subsequently rose. We checked up the parathyroid gland by MIBI scan and CT. As a result, a mass was found in the anterior mediastinum. So it is important to suspect the ectopic parathyroid gland when the PTH level elevation is persistent after parathyroidectomy in chronic renal failure patient.

Zinc deficiency decreased cell viability both in endothelial EA.hy926 cells and mouse aortic culture ex vivo and its implication for anti-atherosclerosis

Zinc plays a protective role in anti-atherosclerosis but the clear mechanism has not been proposed yet. In the present study, we evaluated whether zinc modulates atherosclerotic markers, VACM-1 and ICAM-1 and cell viability both in endothelial cells in vitro and mouse aortic cell viability ex vivo. In study 1, as in vitro model, endothelial EA.hy926 cells were treated with TNFalpha for 5 hours for inducing oxidative stress, and then treated with Zn-adequacy (15 micrometer Zn) or Zn-deficiency (0 micrometer Zn) for 6 hours. Pro-atherosclerosis factors, VCAM-1 and ICAM-1 mRNA expression and cell viability was measured. In study 2, as ex vivo model, mouse aorta ring was used. Mourse aorta was removed and cut in ring then, cultured in a 96-well plate. Aortic ring was treated with various TNFalpha (0-30 mg/ml) and intracellular zinc chelator, N, N, N', N', -tetrakis (2-pyridylmethyl) ethylenediamine (TPEN, 0-30 microM) for cellular zinc depletion for 2 days and then cell viability was measured. The results showed that in in vitro study, Zn-adequate group induced more VCAM-1 & ICAM-1 mRNA expression than Zn-deficient group during 6-hour zinc treatment post-5 hour TNF-alpha treatment, unexpectedly. These results might be cautiously interpreted that zinc would biologically induce the early expression of anti-oxidative stress through the increased adhesion molecule expression for reducing atherosclerotic action, particularly under the present 6-hour zinc treatment. In ex vivo, mouse aortic ring cell viability was decreased as TNF-alpha and TPEN levels increased, which suggests that mouse aortic blood vessel cell viability was decreased, when oxidative stress increases and cellular zinc level decreases. Taken together, it can be suggested that zinc may have a protective role in anti-atherosclerosis by cell viability in endothelial cells and aorta tissue. Further study is needed to clarify how pro-atherosclerosis molecule expression is modulated by zinc.

A Study on the Subjectivity of Change of Life in Middle Aged Men / 성인간호학회지

PURPOSE: The purpose of the study was to investigate change of life in middle-aged men. METHOD: The research method employed Q-methodology. twenty-five participants rated 39 selected Q-statements on a scale of 1~9. The collected data were analyzed using pc- QUNAL software. RESULT: Principal component analysis identified 3 types of change of life in middle-aged men. The categories were labeled 'Mature-oriented', 'Effeminate-oriented', 'Juvenescence-oriented'. CONCLUSION: We have found change of life in middle-aged men through this research. To setup and apply differences based on this result is needed.

A Study on the Subjectivity of Change of Life in Middle Aged Men / 성인간호학회지

PURPOSE: The purpose of the study was to investigate change of life in middle-aged men. METHOD: The research method employed Q-methodology. twenty-five participants rated 39 selected Q-statements on a scale of 1~9. The collected data were analyzed using pc- QUNAL software. RESULT: Principal component analysis identified 3 types of change of life in middle-aged men. The categories were labeled 'Mature-oriented', 'Effeminate-oriented', 'Juvenescence-oriented'. CONCLUSION: We have found change of life in middle-aged men through this research. To setup and apply differences based on this result is needed.

A Study on the Subjectivity of the Meaning of Life for Middle-Aged Women / 성인간호학회지

PURPOSE: The purpose of the study was to investigate the meaning of the life of middle-aged women. METHOD: The research method employed Q-methodology. Thirty-one participants rated 30 selected Q-statements on a scale of 1~7. The collected data were analyzed using PC-QUNAL software. RESULT: Principal component analysis identified 4 types of the meaning of the life of middle-aged women. The categories were labeled 'May I help you?', 'Alone', 'Who am I ?', 'No regret'. CONCLUSION: We have found meaning of life of middle-aged women through this research. The study result could be data to perform effective nursing intervention for positive life of middle-aged women.