Highly prevalent BRAF V600E and low-frequency TERT promoter mutations underlie papillary thyroid carcinoma in Koreans

Background@#The presence of telomerase reverse transcriptase (TERT) promoter mutations have been associated with a poor prognosis in patients with papillary thyroid carcinomas (PTC). The frequency of TERT promoter mutations varies widely depending on the population and the nature of the study. @*Methods@#Data were prospectively collected in 724 consecutive patients who underwent thyroidectomy for PTC from 2018 to 2019. Molecular testing for BRAF V600E and TERT promoter mutations was performed in all cases. @*Results@#TERT promoter alterations in two hotspots (C228T and C250T) and C216T were found in 16 (2.2%) and 4 (0.6%) of all PTCs, respectively. The hotspot mutations were significantly associated with older age at diagnosis, larger tumor size, extrathyroidal extension, higher pathologic T category, lateral lymph node metastasis, and higher American Thyroid Association recurrence risk. The patients with C216T variant were younger and had a lower American Thyroid Association recurrence risk than those with hotspot mutations. Concurrent BRAF V600E was found in 19 of 20 cases with TERT promoter mutations. Of 518 microcarcinomas measuring ≤1.0 cm in size, hotspot mutations and C216T variants were detected in five (1.0%) and three (0.6%) cases, respectively. @*Conclusions@#Our study indicates a low frequency of TERT promoter mutations in Korean patients with PTC and supports previous findings that TERT promoter mutations are more common in older patients with unfavorable clinicopathologic features and BRAF V600E. TERT promoter mutations in patients with microcarcinoma are uncommon and may have a limited role in risk stratification. The C216T variant seems to have no clinicopathologic effect on PTC.

Effect of a combination of 2% lidocaine jelly and thermally softened endotracheal tube on postoperative sore throat

BACKGROUND: Postoperative sore throat (POST) is a common adverse event after general anesthesia. The aim of this study was to evaluate the effectiveness of 2% lidocaine jelly applied on the single-lumen endotracheal tube (ETT) and thermal softening of the ETT, and a combination of both interventions on the development of POST. METHODS: Patients (n = 144) undergoing general anesthesia were randomly assigned to one of four groups: Control group (un-softened ETT lubricated with saline); Lidocaine group (un-softened ETT lubricated with 2% lidocaine jelly); Softened group (thermally softened ETT lubricated with saline); and Combined group (thermally softened ETT lubricated with 2% lidocaine jelly). Sore throat was evaluated at 0, 1, 6, 24, and 48 h after extubation. The occurrence of any postoperative complication was also assessed including hoarseness and coughing. RESULTS: No significant difference was observed in the severity of POST at all time points. However, the incidences of POST for overall (0–48 h) and the immediately following period (0 h) were significantly lower in the Combined group (52.9% and 47.1%) than in the Control group (79.4% and 76.5%), Lidocaine group (81.8% and 78.8%), and Softened group (82.9% and 74.3%). The overall incidence of hoarseness did not differ among the groups. No other postoperative complication was observed in any of the patients. CONCLUSIONS: No differences were observed in the severity of POST. However, 2% lidocaine jelly applied on thermally softened ETT reduced the overall incidence of POST. Therefore, this combined intervention could be considered as an alleviating strategy for POST.

Cytotoxic activity and subset populations of peripheral blood natural killer cells in patients with chronic pain

BACKGROUND: Chronic pain reportedly exerts complex effects on immune function. Natural killer (NK) cells are lymphocytes that play a critical role in cellular and innate immunity. This study examined changes in the subset populations and cytotoxic activity of peripheral blood NK cells in patients with chronic pain. METHODS: Thirty patients with chronic moderate-to-severe pain (group P) and age-matched pain-free subjects (group NoP) were enrolled. Peripheral whole blood was analyzed for the percentage and expression of NK cell surface markers (CD56 and CD16) by flow cytometry. Cytotoxic activity was assayed by evaluating CD69 expression on CD3−/CD56+NK cells. RESULTS: The percentage of NK cells among total lymphocytes was not significantly different between groups P and NoP (16.3 ± 9.3 vs. 20.2 ± 10.5%). Likewise, the percentages of two major NK cell subsets, CD56bright and CD56dim, were also not significantly different between the two groups. However, the percentage of CD56bright/CD16+ subset, was slightly but significantly increased in group P (1.0 ± 0.9%; P < 0.01) compared with group NoP (0.5 ± 0.6%). The cytotoxicity of NK cells was not different between the two groups, showing similar CD69 expression (P vs. NoP = 29.2 ± 15.2 vs. 32.0 ± 15.0%). These findings were not influenced by pain intensity, opioid use, or disease causing pain in group P. CONCLUSIONS: NK cell cytotoxic activity and major subset populations, with the exception of an increased percentage of the CD56bright/CD16+ subset, are not significantly altered in patients with chronic severe pain.

Forkhead Transcription Factor FOXO1 Inhibits Angiogenesis in Gastric Cancer in Relation to SIRT1 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We previously reported that forkhead transcription factors of the O class 1 (FOXO1) expression in gastric cancer (GC) was associated with angiogenesis-related molecules. However, there is little experimental evidence for the direct role of FOXO1 in GC. In the present study, we investigated the effect of FOXO1 on the tumorigenesis and angiogenesis in GC and its relationship with SIRT1. MATERIALS AND METHODS: Stable GC cell lines (SNU-638 and SNU-601) infected with a lentivirus containing FOXO1 shRNA were established for animal studies as well as cell culture experiments. We used xenograft tumors in nude mice to evaluate the effect of FOXO1 silencing on tumor growth and angiogenesis. In addition, we examined the association between FOXO1 and SIRT1 by immunohistochemical tissue array analysis of 471 human GC specimens and Western blot analysis of xenografted tumor tissues. RESULTS: In cell culture, FOXO1 silencing enhanced hypoxia inducible factor-1alpha (HIF-1alpha) expression and GC cell growth under hypoxic conditions, but not under normoxic conditions. The xenograft study showed that FOXO1 downregulation enhanced tumor growth, microvessel areas, HIF-1alpha activation and vascular endothelial growth factor (VEGF) expression. In addition, inactivated FOXO1 expression was associated with SIRT1 expression in human GC tissues and xenograft tumor tissues. CONCLUSION: Our results indicate that FOXO1 inhibits GC growth and angiogenesis under hypoxic conditions via inactivation of the HIF-1alpha-VEGF pathway, possibly in association with SIRT1. Thus, development of treatment modalities aiming at this pathway might be useful for treating GC.

Cytotoxicity of newly developed pozzolan cement and other root-end filling materials on human periodontal ligament cell

OBJECTIVES: The purpose of this study was to evaluate in vitro cytotoxicity of the pozzolan cement and other root-end filling materials using human periodontal ligament cell. MATERIALS AND METHODS: Endocem (Maruchi), white ProRoot MTA (Dentsply), white Angelus MTA (Angelus), and Super EBA (Bosworth Co.) were tested after set completely in an incubator at 37degrees C for 7 days, Endocem was tested in two ways: 1) immediately after mixing (fresh specimens) and 2) after setting completely like other experimental materials. The methods for assessment included light microscopic examination, cell counting and WST-1 assay on human periodontal ligament cell. RESULTS: In the results of microscopic examination and cell counting, Super EBA showed significantly lower viable cell than any other groups (p < 0.05). As the results of WST-1 assay, compared with untreated control group, there was no significant cell viability of the Endocem group. However, the fresh mixed Endocem group had significantly less cell viability. The cells exposed to ProRoot MTA and Angelus MTA showed the highest viability, whereas the cells exposed to Super EBA displayed the lowest viability (p < 0.05). CONCLUSIONS: The cytotoxicity of the pozzolan cement (Endocem) was comparable with ProRoot MTA and Angelus MTA. Considering the difficult manipulation and long setting time of ProRoot MTA and Angelus MTA, Endocem can be used as the alternative of retrofilling material.

Correlation of transvaginal radiofrequency myolysis and estrogen, progesteron receptor in uterine myoma / 대한산부인과학회지

OBJECTIVE: The aim of this study was to investigate the changes in hormone receptors of myoma cells and volume decrement of myoma after radiofrequency myolysis. METHODS: From 2005 January to 2006 January, thirty patients who have had high-frequency myolysis were included in this study. Needle aspiration biopsy was done at the central portion of myoma pre- and 6 months post-operation. Radiofrequency myolysis were done for 20 minutes until discoloration of myoma was accomplished to 80%. The stain intensity of estrogen receptor (ER) and progesterone receptor (PR) was classified into "negative", "trace", "weak", "moderate" and "strong". RESULTS: The volume decrement was 96.4% in the group that showed trace to week stain intensity (under 50% stain intensity), but it decreased to 66.6% in the group that showed strong stain intensity (over 50%, moderate to strong)(P<0.05). ER showed moderate to strong positive response in 79% of patients before operation, but it showed negative to week response in 83% of patients after the operation. Also, PR showed moderate to strong positive response in 80% of patients before operation, but it showed negative to week response in 86% of patients after the operation. CONCLUSIONS: To coagulate entire myoma, we suggested that controlling the intensity of operation by lengthening the time or expanding the extent of operation was more effective in treatment, because the volume decrement of myoma was larger in case that ER and PR was under 50% before the operation.

The Outcome of Pregnancy Combined with Idiopathic Thrombocytopenia Purpura and the Effect of Pregnancy on the Severity of This Disease / 대한주산의학회잡지

OBJECTIVE: The incidence of idiopathic thrombocytopenic purpura (ITP) is greatest in female during their childbearing years, so the concurrence of pregnancy and ITP is not unusual. Numerous studies have examined the outcomes of newborns, whereas fewer studies have been conducted with regard to the morbidity of obstetric patients with ITP. This study was aimed to find the outcome of pregnancy combined with ITP and the influence of the pregnancy on the severity of this disease. METHODS: From January 1996 to December 2005, a total of 62 pregnant women with ITP and their 73 deliveries were recruited for the study. Among them, 38 were diagnosed with ITP during pregnancy and the other 24 had pre-existing ITP before pregnancy. RESULTS: The severity of thrombocytopenia was exacerbated during pregnancy, but recovered to a level of non-pregnant period after delivery in most cases. The outcome of pregnancy of all the patients was uneventful except each one case of fetal demise at 35 gestational weeks and preterm delivery at 30 gestational weeks. One patient suffered from multiple subdural hemorrhage during pregnancy, which was spontaneouly recovered. Twenty newborns (27.8%) had transient congenital thrombocytopenia and 18 of them required treatment for hemostatic impairment. CONCLUSION: For women with ITP, Pregnancy can affect the severity of ITP, but life-threatening complication was almost lacking. Although, in not a few cases, there may need to treat both mothers and infants to raise their platelet counts, most mothers with ITP can proceed with their pregnancies and delivery healthy infant without complication.

The Incidence and Risk Factors of Posttraumatic Seizure in Children / 소아과

PURPOSE: The goal of our study was to identify the incidence and clinical, neurophysiological and neuroradiological variables with predictive value for posttraumatic seizure(PTS). METHODS: The medical records of 625 children with head traumas under 15-year-old who were admitted to the Wonju Christian Hospital, from January, 1993 to January, 2002 were retrospectively reviewed. Among them, 472 patients were included in this study. The PTS patients were divided into early PTS, in whom seizure occurred within one week after head trauma and late PTS, in whom seizure occurred beyond the first week after head trauma. The injuries were classified into mild(Glasgow Coma Scale, GCS 13 to 15 or no brain CT abnormality and a brief hospital stay), moderate(GCS, 9 to 12, or a GCS above 12 and longer than 48-hour hospital stay, or brain CT abnormalites) and severe(GCS, below 9). The variables such as age, sex, duration of unconsciousness, GCS, brain CT scan finding, initial neurologic finding and anticonvulsant therapy were analyzed for risk factors of PTS. RESULTS: Early PTS was developed in 41(8.7%) patients, 35(77.8%) patients among them had a seizure within 24 hours after head trauma. Late PTS was developed in 17(3.6%) patients. The frequency and duration of PTS were not correlated with the latency of PTS. And there was correlation between the frequency and duration of PTS. The 82.9% of early PTS and the 76.5% of late PTS were generalized tonic-clonic seizure. There was a significant difference in the incidence of PTS by severity of head trauma. The incidence of PTS after mild head trauma(5.8%) was lower than after severe head trauma(29.9%). The risk factors of early PTS were unilateral hemorrhage, neurologic finding(hemiparesis and coma), GCS(under 12 score), and diffuse contusion. And the late PTS were the same as early PTS, except for diffuse contusion, and age factor(under 2 years was also significant). CONCLUSION: The incidence and risk factors of PTS were correlated with severity of head trauma.

Acute appendicitis in pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical course and pregnancy outcome, according to perforation or no perforation of appendix, in the patients who went through the appendectomy for acute appendicitis during pregnancy. METHODS: We reviewed the chart of paients who went through the appendectomy for acute appendicitis during pregnancy in department of general surgery of the Catholic University of Korea Holy Family Hospital and St. mary's Hospital from January 1994 to May 2004. RESULTS: The incidence rate of acute appendicitis during pregnancy (56.1%) was highest at the 2nd trimester of pregnancy. There was not significant difference in clinical course, subjective symptoms, physical examination results, and the incidence rate of leukocytosis between non-perforated appendicitis (NPAPP) group and perforated appendicits (PAPP) group. The incidence rate of pregnancy loss that was spontaneous abortion and intrauterine fetal death, was 2.9% in NPAPP group and 7.7% in PAPP group, but, there was not significant differnence between two groups. There was not also significant difference in the incidence rate of low birth weight for gestational age. We could find nothing for fetal anomaly. Finally, the term delivery rate was 92.8% and 92.3% in each of the two groups, and patients had no obstetrical and surgical complications. CONCLUSION: In this study, we could find that perforation or no perforation of appendix wieghed with the clinical course, objective symptoms, examination results, and pregnancy outcome of patients. But, we thought that the larger population of perforation group would be needed for more accurate results.

Effect of Delayed Intensification on Survival of Childhood Acute Lymphoblastic Leukemia

PURPOSE: In 1970, the Berlin-Frankfurt-Munster(BFM) group introduced an intensification therapy after remission induction to reduce relapse of acute lymphoblastic leukemia(ALL) in childhood. Delayed intensification(DI) phase has been included for treatment of ALL in our hospital since the mid-1990s. The purpose of this study is to evaluate the outcome with vs. without DI phase and the outcome with two vs. one DI phase for intermediate risk patients. METHODS: One hundred and thirty nine children with ALL who were treated at the Department of Pediatrics of Wonju Christian Hospital and Yonsei University Medical Center between March, 1990 and July, 2002 were analysed retrospectively. RESULTS: Thirty-eight patients were treated with a DI phase, and 101 patients were treated without a DI phase. Among the DI patients, seven patients were treated with a double DI phase. Five-year overall survival(OS) in the low, intermediate, and high risk groups were 68%, 66% and 58%, respectively. 5-year OS in DDI, DI, and control were 95%, 86% and 40%, espectively. In the low risk group, 5-year event free survival(EFS) in DI, and control were 94% and 58%, respectively. CONCLUSIONS: Delayed intensification improved EFS on childhood ALL in all risk groups.

A Case of Distal 10q Partial Trisomy Syndrome

Since Yunis and Sanchez described in 1974, distal 10q partial trisomy has been recognised as a chromosomal anomaly, which has typical features, psychomotor delays, distinctive dysmorphic appearance and growth retardation. Also, it is associated with cardiac, renal and ocular anomalies. Most of them result from an unbalanced tanslocation or a deletion but, pure duplications are very rare. We report a 19-month-old boy with typical clinical features of distal 10q partial trisomy with a pure duplicatin of 10q.

Differences in tumor markers and rheumatoid factors between elderly and young adults

BACKGROUND: The elderly is known to have many different clinical laboratory data compared with the young adults. There have been rare studies comparing tumor markers and rheumatoid factors between young adults and the elderly in Korea. This study was conducted to evaluate the differences in tumor markers and rheumatoid factor between elderly and young adults. METHODS: We gathered 94 healthy elderly cases and 91 healthy young adults who have taken periodic health examination from November 1996 to February 1997 at one hospital. We compared the mean of rheumatoid factor and tumor markers between two groups and took multiple regression analysis. RESULTS: In the elderly, the mean of CEA and AFP are significantly higher than young adults. The number of abnormally elevated rheumatoid factor is significantly higher in elderly group, but in case of CEA the number of abnormal data is not significantly different. The CEA level is significantly high in smoker group than non smoker group. The factors that increase the CEA level are old age, smoking amount, albumin level. The factors that increase the AFP level are old age, hemoglobin level. The factor that increase the rheumatoid factor is old age only. CONCLUSION: When we interpretate the level of tumor markers and rheumatoid factor, we must consider the patient's age. Aging is a factor that is associated with CEA, AFP, rheumatoid factor.