Impact of Sarcopenia on Early Postoperative Complications in Early-Stage Non–Small-Cell Lung Cancer

Background@#Risk assessment for pulmonary resection in patients with early-stage non– small-cell lung cancer (NSCLC) is important for minimizing postoperative morbidity. Depletion of skeletal muscle mass is closely associated with impaired nutritional status and limited physical ability. We evaluated the relationship between skeletal muscle depletion and early postoperative complications in patients with early-stage NSCLC. @*Methods@#Patients who underwent curative lung resection between 2016 and 2018 and who were diagnosed with pathological stage I/II NSCLC were included, and their records were retrospectively analyzed. The psoas volume index (PVI, cm3/m3) was calculated based on computed tomography images from routine preoperative positron emission tomography- computed tomography. Early postoperative complications, defined as those occurring within 90 days of surgery, were compared between the lowest sex-specific quartile for PVI and the remaining quartiles. @*Results@#A strong correlation was found between the volume and the cross-sectional area of the psoas muscle (R2=0.816). The overall rate of complications was 57.6% among patients with a low PVI and 32.8% among those with a normal-to-high PVI. The most common complication was prolonged air leak (low PVI, 16.9%; normal-to-high PVI, 9.6%), followed by pneumonia (low PVI, 13.6%; normal-to-high PVI, 7.9%) and recurrent pleural effusion (low PVI, 11.9%; normal-to-high PVI, 6.8%). The predictors of overall complications were low PVI (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.07–4.09; p=0.03), low hemoglobin level (OR, 0.686; 95% CI, 0.54–0.87; p=0.002), and smoking history (OR, 3.93; 95% CI, 2.03–7.58; p<0.001). @*Conclusion@#Low PVI was associated with a higher rate of early postoperative complications in patients with early-stage NSCLC.

Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer

Background@#Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). @*Methods@#A retrospective study was conducted in which 544 patients with stage I (T1abc–T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. @*Results@#In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12–2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04–1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89–8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. @*Conclusion@#Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.

The Influence of Grit on Turnover Intention of University Hospital Nurses: The Mediating Effect of Job Involvement / 간호학회지

PURPOSE: This study aimed to confirm the mediating effect of job involvement in the relationship between grit and turnover intention among nurses working at university hospitals. METHODS: Participants included 437 nurses from university hospitals located in C city, Gyeongnam. Data were collected from January 8 to 19, 2018, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffe's test, Pearson's correlation coefficient, and multiple regression, with the SPSS/22.0 program. A mediation analysis was performed according to the Baron and Kenny, and bootstrapping methods. RESULTS: There were significant relationships between grit and job involvement (r=.40, p<.001), grit and turnover intention (r=−.29, p<.001), and turnover intention and job involvement (r=−.52, p<.001). Job involvement showed partial mediating effects in the relationship between grit and turnover intention. CONCLUSION: Grit increased job involvement and lowered turnover intention. Therefore, to reduce nurses' turnover intention, it is necessary to develop a program and strategies to increase their grit.

The Influence of Grit on Turnover Intention of University Hospital Nurses: The Mediating Effect of Job Involvement

PURPOSE@#This study aimed to confirm the mediating effect of job involvement in the relationship between grit and turnover intention among nurses working at university hospitals.@*METHODS@#Participants included 437 nurses from university hospitals located in C city, Gyeongnam. Data were collected from January 8 to 19, 2018, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffe's test, Pearson's correlation coefficient, and multiple regression, with the SPSS/22.0 program. A mediation analysis was performed according to the Baron and Kenny, and bootstrapping methods.@*RESULTS@#There were significant relationships between grit and job involvement (r=.40, p<.001), grit and turnover intention (r=−.29, p<.001), and turnover intention and job involvement (r=−.52, p<.001). Job involvement showed partial mediating effects in the relationship between grit and turnover intention.@*CONCLUSION@#Grit increased job involvement and lowered turnover intention. Therefore, to reduce nurses' turnover intention, it is necessary to develop a program and strategies to increase their grit.

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy / 대한흉부외과학회지

BACKGROUND: Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. METHODS: The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. RESULTS: Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). CONCLUSION: Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

BACKGROUND@#Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center.@*METHODS@#The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed.@*RESULTS@#Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056).@*CONCLUSION@#Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

Thromboexclusion Treatment for Recurrent Aortic Aneurysm: Still an Option in Select Cases

Flow reversal and thromboexclusion constitute a valuable alternative for aortic surgeons to have within their technical armamentarium for the treatment of aortic aneurysmal disease. Although not usually a preferred treatment for general aortic pathologies, this technique can be considered as a treatment option in select situations, such as mycotic aneurysm, a hostile surgical field, and a poor condition of the patient. Here, we present a case of extra-anatomic bypass and thromboexclusion for recurrent aortic aneurysm after previous extra-anatomic bypass and thromboexclusion surgery.

Thromboexclusion Treatment for Recurrent Aortic Aneurysm: Still an Option in Select Cases / 대한흉부외과학회지

Flow reversal and thromboexclusion constitute a valuable alternative for aortic surgeons to have within their technical armamentarium for the treatment of aortic aneurysmal disease. Although not usually a preferred treatment for general aortic pathologies, this technique can be considered as a treatment option in select situations, such as mycotic aneurysm, a hostile surgical field, and a poor condition of the patient. Here, we present a case of extra-anatomic bypass and thromboexclusion for recurrent aortic aneurysm after previous extra-anatomic bypass and thromboexclusion surgery.

A Large Dentigerous Cyst Found in the Mandible

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are developmental epithelial-lined lesions which are formed from fluid accumulation in the space between the reduced enamel epithelium and the surface of crown. This may occure due to the obstructin of venous return caused by tooth impaction. The most prevalent location of dentigerous cysts are the third molar of mandible. While the single dentigerous cysts are the second most common odontogenic cysts following the radicular cysts of jaw, multiple cysts are observed in patients with some conditions such as mucopolysaccharidosis type IV, basal cell nevus syndrome, and cleidocranial dysplasia. They occur in young patients in the second or third decades of life, but it is a rare occurrence for children. A sixteen-year-old girl with painful swelling in the right mandible visited to our department. All routine laboratory test results were within normal limits. However, we were able to diagnose that she had facial asymmetry. Computed tomography showed a well-defined soft tissue mass obliterating right mandible ramus with an impacted tooth. We performed total enucleation of cyst and molar tooth. The pathology revealed a non-keratinized squamous epithelial lined cyst associated with an undamaged tooth.

Penetrating Neck Laceation with Epiglottis Amputation Which Was Successfully Repaired / 대한이비인후과학회지

Penetrating traumatic laryngeal injuries are relatively rare and traumatic injuries to the epiglottis are extremely rare. The present case is 58-year old man with suicidal history, chronic alcoholism, and schizophrenia who complained of neck laceration and unconsciousness after stab injury. Examination revealed a large transverse laceration of 7 cm in size, penetrating deep to the level of thyroid cartilage from the lateral border of the sternocleidomastoid muscle, exposing the thyroid cartilage. There was about a 3 cm-sized deep wound under the thyroid gland level but no major vessel injury. The stump of transected epiglottis accompanied by rupture of thyroid membrane was shown but the esophagus was intact. We sewed the amputated epiglottis with the rest of the epiglottis by using two Lambert sutures with vicryl 4-zero on each side under general anesthesia. There was no necrosis of the severed epiglottis, swallowing difficulty, and aspiration on eating food. We report here on the penetrating laceration with subtotal transection of epiglottis that was successfully repaired.

Blockade of vascular angiogenesis by Aspergillus usamii var. shirousamii-transformed Angelicae Gigantis Radix and Zizyphus jujuba

The matrix metalloproteinases (MMP) play an important role in tumor invasion, angiogenesis and inflammatory tissue destruction. Increased expression of MMP was observed in benign tissue hyperplasia and in atherosclerotic lesions. Invasive cancer cells utilize MMP to degrade the extracellular matrix and vascular basement membrane during metastasis, where MMP-2 has been implicated in the development and dissemination of malignancies. The present study attempted to examine the antiangiogenic activity of the medicinal herbs of Aspergillus usamii var. shirousamii-transformed Angelicae Gigantis Radix and Zizyphus jujube (tAgR and tZj) with respect to MMP-2 production and endothelial motility in phorbol 12-myristate 13-acetate (PMA)- or VEGF-exposed human umbilical vein endothelial cells (HUVEC). Nontoxic tAgR and tZj substantially suppressed PMA-induced MMP-2 secretion. In addition, 25 microg/mL tAgR and tZj prevented vascular endothelial growth factor-stimulated endothelial cell transmigration and tube formation. The results reveal that tAgR and tZj dampened endothelial MMP-2 production leading to endothelial transmigration and tube formation. tAgR and tZj-mediated inhibition of endothelial MMP may boost a therapeutic efficacy during vascular angiogenesis.

Protective actions of Rubus coreanus ethanol extract on collagenous extracellular matrix in ultraviolet-B irradiation-induced human dermal fibroblasts

Solar ultraviolet (UV) irradiation leads to distinct changes in the skin connective tissues by degradation of collagen, which is a major structural component in the extracellular matrix. UV irradiation induces the production of matrix metalloproteinases (MMP) capable of attacking native fibrillar collagen and responsible for inhibiting the construction of collagenous extracellular matrix. In this study, we attempted to investigate the protective actions of Rubus coreanus ethanol extract (RCE) on the MMP production and the consequent procollagen/collagen degradation in UV-B-irradiated human dermal fibroblasts. The analytical data showed that Rubus coreanus ethanol extract was mostly comprised of cyanidin 3-rutinoside. Pre-treatment of fibroblasts with this extract inhibited UV-B-induced production of MMP-1, MMP-8 and MMP-13 in dose-dependent manners. In addition, Western blot analysis and immunocytochemical staining assay revealed that RCE markedly augmented the cellular levels of procollagen/collagen declined in UV-B-exposed dermal fibroblasts. These results demonstrate that RCE blocks UV-B-induced increase of the collagen degradation by inhibiting MMP production. Thus, RCE may act as an agent inhibiting excessive dermal collagen degradation leading to the skin photoaging.

Resveratrol blunts tumor necrosis factor-alpha-induced monocyte adhesion and transmigration

The leukocyte recruitment and transmigration across the endothelial barrier into the vessel wall are crucial steps in atherosclerosis. Leukocyte trafficking on the endothelium is elicited by induction of endothelial adhesion molecules, and its transmigration is mediated by degradation of basement membrane proteins through enzymatic activity of matrix metalloproteinases (MMP). The current study investigated whether resveratrol, a polyphenol present in grapes and red wine, was capable of inhibiting leukocyte adhesion to tumor necrosis factor (TNF)-alpha-activated endothelium. It was found that resveratrol inhibited the TNF-alpha-activated endothelial expression of vascular cell adhesion molecule-1 in a dose-dependent manner. In addition, resveratrol hampered THP-1 monocyte adhesion to activated endothelial cells. This study further examined whether resveratrol interfered with transendothelial migration of leukocytes. The MMP-2 gelatinolytic activity of endothelial cells was enhanced by TNF-alpha, which was attenuated by an addition of > or =25 micrometer resveratrol. In addition, 25 micrometer resveratrol mitigated the MMP-9 activity of THP-1 cells, followed by a marked inhibition of transendothelial migration. These results demonstrated that resveratrol suppressed monocyte adhesion and migration induced by TNF-alpha through modulating expression of adhesion molecules and gelatinolytic activity of MMP. These findings suggest that dietary resveratrol may be therapeutic agent for inhibiting leukocyte recruitment into the subendothelium during inflammatory atherosclerosis.

Kimura's Disease as Unusual Cause of Head and Neck Masses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Kimura's disease is a rare, allergic, inflammatory disorder of unknown cause. Patients often present nontender subcutaneous swelling in the head and neck region. Lymphadenopathy, peripheral eosinophilia, and an elevated serum IgE are also present. Kimura's disease is easily mistaken for malignant tumor, and has been confused with angiolymphoid hyperplasia with eosinophilia (ALHE). The diagnosis is confirmed by a biopsy. Treatment options range from observation to surgical excision, steroid therapy, and radiotherapy. We summarize characteristics of clinical feature, laboratory results in six cases of Kimura's disease and report the results of treatment, including surgery and steroid therapy. SUBJECTS AND METHOD: Between May 1999 and August 2003, six cases were diagnosized as Kimura's disease at the Department of Otorhinolaryngology Head and Neck Surgery at the Inha University. Six cases included four males and two females, with the mean age of 47.3 years. Preoperative evaluation included CT or MRI, CBC, and urine analysis. The study was done retrospectively. RESULT: Primary sites were two parotid glands, one submandibular gland, two neck lymph nodes, one scalp and cheek. Complete excision with steroid therapy was done in all cases. Five cases had peripheral eosinophilia. All cases reveal renal involvement, postsurgical complication or recurrence. CONCLUSION: Steroid therapy following surgical excision is the treatment of choice for definitive diagnosis and initial management. Kimura's disease must be included in the differential diagnosis of unusual head and neck mass because Kimura's disease is an unusual condition and it imitates the neoplastic or imflammatory condition in the head and neck.

Antioxidative Effects of Water-Soluble Chitinous Compounds on Oxidation of Low Density Lipoprotein in Macrophages

It has been proposed that oxidative modification of LDL (oxLDL) plays a significant role in the pathogenicity of atherogenesis. We tested the hypothesis that chitin and chitosan may function as antioxidants with respect to 0.1 mg cholesterol/ml LDL incubated with 5 micrometer Cu2+ alone or in the P338Dl mouse macrophage system using L-ascorbic acid as a standard classical antioxidant. The degree of oxLDL formation was ascertained by the relative electrophoretic mobility (rEM) in the combination of thiobarbituric acid reactive substances (TBARS) levels, and the cytotoxicity of oxLDL was detected by macrophage viability. The oxLDL uptake and foam cell formation of macrophages were measured by Oil Red O staining. Incubation with Cu2+ and macrophages increased rEM of LDL and stimulated TBARS formation. Culture of macrophages with LDL in the presence 5 micrometer Cu2+ induced macrophage death. In cell-free system 200 microgram/ml water-soluble chitosan and chitosan-oligosaccharide blocked oxLDL formation. Water-soluble chitosan and chitosan-oligosaccharide blocked oxLDL formation near-completely relative to L-ascorbic acid, whereas water-soluble chitin and chitin-oligosaccharide had no measurable antioxidant effect. In macrophage system water-soluble chitosan and chitosan-oligosaccharide blocked oxidation of LDL with a significant increase in cell viability, and decreased TBARS in medium. As for the inhibitory effect on macrophage foam cell formation, chitosan and its oligosaccharide, but not watersoluble chitin, revealed the effectiveness. The endothelial expression of lectin-like oxLDL receptor-1 (LOX-1) was tested by Western blot analysis, and chitosan, chitosan-oligosaccharide and chitin-oligosaccharide blocked LOX-1 expression. These results indicate that water-soluble chitosan and its oligosaccharide showed the inhibitory effect on Cu2+-induced LDL oxidation of macrophages, and chitosan, chitosan-oligosaccharide and chitin-oligosaccharide had blocking effect on oxLDL receptor expression in the human umbilical vein endothelial system. Thus, water-soluble chitosan and its oligosaccharides possess anti-atherogenic potentials possibly through the inhibition of macrophage LDL oxidation or endothelial oxLDL receptor expression depending on chemical types.l types.

Significance of APACHE Score in Patients with a Gastrointestinal Perforation

BACKGROUND: The APACHE scoring system of the Health Care Financing Administration (HCFA) has been being used for serious patients. The scoring system is composed of acute physiologic variables and chronic disease. METHODS: Among patients who underwent emergency operations from 1992 to 1997 because of gastrointestinal perforation, we analyzed 110 cases with five kinds of diseases: duodenal ulcer perforation, small bowel perforation, perforated appendicitis, gastric ulcer perforation and colon perforation. RESULTS: The results were as follows: 1) The preoperative APACHE II scores ranged from 0 to 21. The scores of 64 cases (60.9%) were from 0 to 5. 2) There were no death in case for which pre-peration APACHE II score was from 0 to 10, 25% of the mortality occurred in cases with scores from 11 to 15, 50% in those with scores from 16 to 20, and 100% in those with scores above 21. 3) The APACHE II score decreased continuously from the 3rd to the 7th postoperative day. 4) The preoperative APACHE II scores in gastric ulcer perforation patients were significantly higher than those in duodenal ulcer perforation patients. In the cases of gastric and duodenal ulcer perforations, the APACHE II scores in patients who underwent primary closure were higher than the scores in those who underwent a more definitive operation. 5) In death cases, all of their APACHE II scores were higher at the 3rd postoperative than at the 7th postoperative day, but their APACHE III scores continuously increased postoperatively. CONCLUSIONS: It is thought that the APACHE scoring system is more reliable than clinical experience in the classification of patients by operative risk and in estinating the result and giving a prognosis. Thus, the principle of treatment should be established by estinating patient's score before the operation. Careful preoperative management is necessary for patients with scores more than 10. Because patientswith scores more than 21 have very a high mortality, operative time and method must be carefully decided. The APACHE III scoring system seems to be more sensitive than the APACHE II scoring system in predicting deaths and further investigations and clinical applications should be performed.