Accurate measurements of liver stiffness using shear wave elastography in children and young adults and the role of the stability index

PURPOSE: The purpose of this study was to evaluate the usefulness of the stability index (SI) in liver stiffness measurements using shear wave elastography (SWE) in children. METHODS: A total of 29 children and young adults (mean age, 16.1 years; range, 8 to 28 years; 11 boys and 18 girls) who underwent liver stiffness measurements using SWE under free-breathing and breath-holding conditions were included in our study. Ten SWE measurements were acquired in each of four groups: free-breathing and breath-holding, and with and without using the SI. The failure rate of acquisition of SI values over 90% was calculated in each group. To evaluate variability in the SWE measurements, the standard deviation, coefficient of variation, and percentage of unreliable measurements were compared. Intraobserver agreement and the optimal minimal number of measurements were calculated using intraclass correlation coefficients. RESULTS: A failure to acquire SI values over 90% was observed in 17% of the scans in the free-breathing group and in 7% of the scans in the breath-holding group. In both groups, utilizing the SI led to a significantly lower standard deviation and coefficient of variation. When using the SI, the percentage of unreliable measurements decreased from 16.7% to 8.3% in the free-breathing group and 14.8% to 0% in the breath-holding group. With the use of the SI, intraobserver agreement increased and the optimal minimal number of repeated measurements decreased in both the free-breathing and breath-holding groups. CONCLUSION: Utilization of the SI in the measurement of liver SWE in children reduced measurement variability and increased reliability in both free-breathing and breath-holding conditions.

Association between Sarcopenic Obesity and Metabolic Syndrome in Postmenopausal Women: A Cross-sectional Study Based on the Korean National Health and Nutritional Examination Surveys from 2008 to 2011

BACKGROUND: Menopause contributes to an increase in visceral fat mass and a decrease in muscle protein synthesis. Therefore, we performed this study to examine their relationship how effect the changes of body composition as obesity and sarcopenia on metabolic syndrome (MS) as a predictor of cardiovascular disease in postmenopausal women. METHODS: Using data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we estimated that 4,183 postmenopausal women underwent dual energy X-ray absorptiometry scans. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 1 standard deviation below the sex specific mean for the young reference group. After classification into four groups, the results were adjusted with menopausal age and hormonal treatment. The relationship between sarcopenic obesity (SO) and MS in postmenopausal women was analyzed by logistic regression analysis in a complex sampling. RESULTS: In an unadjusted model, the odds ratio (OR) of MS for sarcopenia was 1.94 (95% confidence interval [CI], 1.52-2.49); the obesity group had an OR of 4.55 (95% CI, 3.63-5.71); and distinctly, the SO group had an OR of 6.26 (95% CI, 5.10-7.70). Even though there was controlling for variable adjustment, no definite difference was seen in the results. CONCLUSIONS: Sarcopenia and obesity were associated with MS independent of other metabolic impairment risk factors in both early menopausal and postmenopausal women. The results showed that, in particular, the prevalence of MS has increased more in postmenopausal women compared with previous research.

Secular Trends for Body-shape Perception, Weight-loss Efforts, and Weight-loss Behaviors in Korean Adults Using the Korea National Health and Nutrition Examination Survey from 2001 to 2014

BACKGROUND: The objective of study was to investigate secular trends for body-shape perception, weight-loss efforts, and weight-loss behaviors from 2001 to 2014 in Korean adults and factors related to those weight-related attitude. METHODS: Self-reported body-shape perception, weight-loss efforts, and weight-loss behaviors were used in 26,480 men and 35,051 women aged 19 or older using the Korean National Health and Nutrition Survey from 2001 to 2014 (from 2005 to 2014 for weight-loss behaviors). Multivariable logistic regression analysis was conducted using complex sampling design in each sex. RESULTS: Body-shape misperception tended to decrease from 2001 to 2014 and weight-loss efforts tended to increase over the period in all subjects, whereas unhealthy weight-loss behaviors tended to increase over the period in women. In multivariable logistic regression model, body-shape misperception in men was inversely associated with survey year, while positively associated with age and weight status. In women, body-shape misperception was inversely associated with survey year, education, and income, while positively associated with age and weight status. Weight-loss efforts in both sexes were inversely associated with age, while positively associated with survey year, education, income, and weight status. Healthy weight-loss behaviors were positively associated with education but inversely associated with age in men. In women, those behaviors were positively associated with education and weight status, while inversely associated with survey year. CONCLUSIONS: We found decreased body-shape misperception and increased weight-loss efforts in Korean men and women from 2001 to 2014, and decreased healthy weight-loss behaviors in women from 2005 to 2014.

Immunologic properties of differentiated and undifferentiated mesenchymal stem cells derived from umbilical cord blood

The expression of immunogenic markers after differentiation of umbilical cord blood (UCB)-derived mesenchymal stem cells (MSC) has been poorly investigated and requires extensive in vitro and in vivo testing for clinical application. The expression of human leukocyte antigen (HLA) classes on UCB-derived MSC was tested by Fluorescence-activated cell sorting analysis and immunocytochemical staining. The undifferentiated MSC were moderately positive for HLA-ABC, but almost completely negative for HLA-DR. The MSC differentiated to chondrocytes expressed neither HLA-ABC nor HLA-DR. The proliferation of MSC was not significantly affected by the allogeneic lymphocytes stimulated with concanavalin A. The responder lymphocytes showed no significant decrease in proliferation in the presence of the MSC, but the apoptosis rate of the lymphocytes was increased in the presence of MSC. Taken together, these findings indicate that UCB-derived MSC differentiated to chondrocytes expressed less HLA class I and no class II antigens. The MSC showed an immunomodulatory effect on the proliferation and apoptosis of allogeneic lymphocytes. These data suggest that the differentiated and undifferentiated allogeneic MSC derived from umbilical cord blood can be a useful candidate for allogeneic cell therapy and transplantation without a major risk of rejection.

S100 expression in dendritic cells is inversely correlated with tumor grade in endometrial carcinoma

OBJECTIVE: The aim of this study was to determine the expression of S100 positive dendritic cells (DCs) and the relationship with clinicopathologic factors in endometrial carcinoma. METHODS: Samples were collected from 89 patients with endometrial endometrioid adenocarcinoma treated in Pusan National University Hospital from 2004 to 2011. Normal endometrial tissues were obtained from 30 hysterectomized women with benign adnexal masses and served as controls. Paraffin-embedded sections were immunohistochemically stained for S100 was performed, and the number of positive DCs was counted. The relationship of these cells to the stage, histological grade, myometrial invasion, and lymph node metastasis was analyzed. RESULTS: The proportion of S100-positive DCs in the endometrial endometrioid adenocarcinoma was 31.5% (28/89), which was significantly higher (P<0.05) than in the control group. The proportion of S100-positive DC expression was negatively correlated with the histologic grade, but was not associated with the stage, myometrial invasion, or lymph node metastasis. CONCLUSION: High DC density was inversely correlated with histologic grade in endometrial carcinoma. Tumor-infiltrating S100+ DCs may be used as pathologic marker in endometrial carcinoma.

Congenital leukemia of fetus with acquired AML1 gene duplication

Congenital leukemia is very rare, and its prevalence according to recently published papers is from 1 to 5 per million live births. This can be often diagnosed in postpartum throughout bone marrow biopsy, showing abnormal proliferation of immature blasts and granulocytic precursors. Hepatosplenomegaly is the most common feature which is found during perinatal examinations, that diagnosing is difficult during perinatal period. Hepatosplenomegaly can occur not only in congenital leukemia but in many other cases such as infection which is the most common cause. In other words, congenital leukemia is the one of the rare causes of hepatosplenomegaly. However, this case shows the fetus with the features of hepatosplenomegaly during perinatal period and being diagnosed as congenital leukemia associated with acquired AML1 gene duplication in postpartum through bone marrow biopsy. Due to its rare instance, we are to describe the case with a review of literatures.

A Case of Intra- and Extra-Mural Hematomas During Recanalization for Chronic Total Occlusion

An intramural hematoma is an accumulation of blood between the internal and external elastic membranes within the medial space, whereas an extramural hematoma is a dilution and/or dissemination of blood throughout the adventitia. Intra- and extra-hematomas are observed by intravascular ultrasound during percutaneous coronary intervention (PCI). The patient described herein presented with angina pectoris. Her coronary angiogram showed diffuse narrowing of the mid-left anterior descending artery and total occlusion of the distal right coronary artery (RCA). Intra- and extra-mural hematomas developed during PCI of the RCA; however, the lesions were covered successfully using long drug-eluting stents.

A case of cholestatic hepatitis by Epstein-Barr virus infection / 대한내과학회지

Epstein-Barr virus (EBV) is a rare causative agent of acute hepatitis during the course of infectious mononucleosis. EBV-associated hepatitis is usually mild and it resolves without serious complications. Clinically long-standing jaundice with a high bilirubin level (greater than 6.0 mg/dL and longer than 6 weeks) is extremely rare. We recently experienced a-16-yr-old man with long-standing severe jaundice (peak: 21 mg/dL, duration: 16weeks) that was caused by EBV in the absence of any other common features of infectious mononucleosis. EBV infection was demonstrated by serologic testing that showed positive IgM anti-EBV VCA (viral capsid antigen). We also confirmed that the liver was the primary site of EBV infection by in situ hybridization, which was performed on the liver tissues. The patient recovered completely without complications after 16 weeks with only supportive care. We report here on this case along with a literature review. EBV-associated hepatitis can occur with severe long-standing hyperbilirubinemia as an unusual manifestation.

Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus / 대한산부인과학회지

OBJECTIVE: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. METHODS: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. RESULTS: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. CONCLUSION: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.

YS 49, a Synthetic Isoquinoline Alkaloid, Protects Sheep Pulmonary Artery Endothelial Cells from tert-butylhydroperoxide-mediated Cytotoxicity

Endothelium, particularly pulmonary endothelium, is predisposed to injury by reactive oxygen species (ROS) and their derivatives. Heme oxygenase (HO) has been demonstrated to provide cytoprotective effects in models of oxidant-induced cellular and tissue injuries. In the present study, we investigated the effects of YS 49 against oxidant [tert-butylhydroperoxide (TBH) ]-induced injury using cultured sheep pulmonary artery endothelial cells (SPAECs). The viability of SPAECs was determined by quantifying reduction of a fluorogenic indicator Alamar blue. We found that TBH decreased cell viability in a time- and concentration-dependent manner. YS 49 concentration- and time-dependently increased HO-1 induction on SPAECs. As expected, YS 49 significantly decreased the TBH-induced cellular injury. In the presence of zinc protophorphyrin, HO-1 inhibitor, effect of YS 49 was significantly inhibited, indicating that HO-1 plays a protective role for YS 49. Furthermore, YS 49 showed free radical scavenging activity as evidenced by 1, 1-diphenyl-2-picrylhydrazyl (DPPH) and inhibition of lipid peroxidation. However, YS 49 did not inhibit apoptosis induced by lipopolysaccharide (LPS) in SPAECs. Taken together, HO-1 induction along with strong antioxidant action of YS 49 may be responsible for inhibition of TBH-induced injury in SPAECs.

Mucinous Borderline tumor associated with Mature Cystic Teratoma of Ovary / 부인종양

OBJECTIVE: To evaluate the clinicopathological characteristics of mucinous borderline tumor associated with mature cystic teratoma and the origin of its cell type. METHODS: Five patients who were diagnosed as mucinous borderline tumor associated with mature cystic teratoma and treated in Samsung Cheil Hospital from January 1996 to September 2004 were analyzed. In addition MEDLINE, other data bases in English as well as in Korean revealed two more cases. We analyzed the result with patient's characteristics, preoperative symptoms, mass sizes, serum CA-125, operative procedure, stages, recurrence and survival period. Histological slides of the specimens were analysed for expression of cytokeratin (CK)-7 and cytokeratin (CK)-20 by immunohistochemical staining to know the origin of the cell. RESULTS: The mean age was 45 years (25-61 years). Preoperative symptoms were palpable abdominal mass, abdominal pain and urinary frequency. The mean level of CA-125 was 46.05 U/mL and the mean tumor size was 16.75 cm (8.8-22.0 cm). Post surgical FIGO staging was; stage Ia in 6 cases, stage Ic in 1 case. Four cases were CK7(-)/CK20(+), reflecting gastrointestinal origin, and also showed pattern of pseudomyxoma peritoneii. Mean survival period was 32.7 months (6-67 months) without evidence of recurrence, except one case. CONCLUSION: Our findings suggest that mucinous borderline tumor associated with mature cystic teratoma, is diagnosed at relatively young age and early stage, associated with good prognosis.

Inhibition of Inducible Nitric Oxide Synthase Expression by YS 49, a Synthetic Isoquinoline Alkaloid, in ROS 17/2.8 Cells Activated with TNF-alpha, IFN-gamma and LPS

Nitric oxide (NO) has been suggested to act as a mediator of cytokine-induced effects of turn over of bone. Activation of the inducible nitric oxide synthase (iNOS) by inflammation has been related with apoptotic cell death in osteoblast. YS 49, a synthetic isoquinoline alkaloid, inhibits NO production in macrophages activated with cytokines. In the present study, we investigated the molecular mechanism of YS 49 to inhibit iNOS expression in ROS 17/2.8 cells, which were activated with combined treatment of inflammatory cytokines (TNF-alpha, IFN-gamma) and lipopolysaccharide (LPS). Results indicated that YS 49 concentration-dependently reduced iNOS mRNA and protein expression, as evidenced by Northern and Western blot analysis, respectively. The underlying mechanism by which YS 49 suppressed iNOS expression was not to affect iNOS mRNA stability but to inhibit activation and translocation of NF-kappaB by preventing the degradation of its inhibitory protein IkappaBalpha. As expected, YS 49 prevented NO-induced apoptotic cell death by sodium nitroprusside. Taken together, it is concluded that YS 49 inhibits iNOS expression by interfering with degradation of phosphorylated inhibitory kappaBalpha (p-IkappaBalpha). These actions may be beneficial for the treatment of inflammation of the joint, such as rheumatoid arthritis.

Role of Nitric Oxide in the Relaxation of Rabbit Vaginal Smooth Muscle / 대한비뇨기과학회지

PURPOSE: Vaginal engorgement depends, in part, on the relaxation of vaginal smooth muscle. The aim of this study was to evaluate the role of nitric oxide(NO) in the relaxation of the vaginal smooth muscle. MATERIALS AND METHODS: New Zealand White female rabbits(n=8) were sacrificed and distal 1/3 of the vagina was dissected. Strips of vaginal tissues were immediately processed for isometric tension measurement in the organ bath. The vaginal strips were precontracted with phenylephrine and the responses to electrical field stimulation(EFS) or sodium nitroprusside were examined. Each preparations was also processed immunohistochemically to determine the presence of neuronal NO synthase(n-NOS) in the tissue. RESULTS: EFS caused a frequency-dependent relaxation, which was significantly inhibited in the presence of Nw-nitro-L-arginine methyl ester(L-NAME), a competitive inhibitor of NOS. Sodium nitroprusside, a NO donor, caused concentration-dependent relaxations in the vaginal tissue and the relaxation was not affected by L-NAME(10-4M). n-NOS immunoreactivity was detected in perivascular space and vicinity of vaginal smooth muscle. CONCLUSIONS: These results suggest that the relaxation of the rabbit vaginal smooth muscle is partly mediated by the NO pathway.

Flow Cytometric Analysis of DNA patterns in Carcinoma of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Flow cytometric deoxyribonucleic acid (DNA) content analysis has been shown to be of prognostic importance in some cancers. In this study, DNA patterns obtained by flow cytometry in patients with cervical cancer have been shown to be related to a prognostic importance in cervical carcinoma. METHODS AND MATERIALS: We retrospectively reviewed 59 cervical cancer patients who admitted to the department of obstetrics and gynecology, Samsung Medical Center firom January 1995 to May 1997. RESULTS: A total of 59 archival paraffin-embedded blocks were proc 42.4 percent were found to be DNA content aneuploid (DNA-A) and 57.6 percent DNA content diploid (DNA-D). The S-phase fraction was significantly increased with stage. The incidences of aneuploid and relative DNA index were not significantly increased with the stage(P=0.280) and age of patients(P=0.088). The results had no significant differences between the squamous cell carcinoma and adenocarcinoma, and no relationship between the groups with keratinizing cell type and nonkeratinizing type(P=0.409). The DNA ploidy patterns were not significantly correlated with metastasis to lymph node(P=0.179), tumor size(P=0.109), invasion depth(P=0.361) and recurrent group(P=0.285). High S-phase fraction had a tendency to correlate with the invasion depth(P=0,011), size(P=0.027), lymph node metastasis(P=0.039) and recurence(P=0.099) of cervical cancer. CONCLUSION: Flow cytometric DNA content analysis is being used more frequently in the management of different malignant tumors. Our study shows that DNA content analysis may not serve as an important biological indicator in determining the prognosis in cervical carcinoma, but High S-phase fraction has been connected with more aggressive tumors.