The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer

PURPOSE: Preoperative chemoradiation therapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer, 15%–30% of patients still progress while being treated with CRT. The aim of this study was to identify as important biomarker of poor response and evaluate the mechanism associated with CRT resistance. METHODS: This study included 60 human colon tumour pre-irradiation specimens. Expressions of epidermal growth factor receptor (EGFR), p53, Krüppel-like factor 5 (KLF5), C-ern, Ki67 were assessed and correlated with tumor regression grades and complete remission. We added in vitro study with biomarker which has been identified as important biomarker of poor response to evaluate the mechanism associated with CRT resistance. RESULTS: Pathologic complete remission (pCR) was achieved by 9 patients (18%). EGFR and KLF5 were significantly associated with pCR (P = 0.048, P = 0.023, respectfully). And multivariate analysis showed high KLF5 intensity was worse factor for pCR (P = 0.012). In vitro study, radiation or chemotherapy therapy stabilized KLF5 protein levels in a time- and dose-depended manner in HCT116 and Caco-2 cells. KLF5 overexpression in HCT116 stable cell line showed significantly better cell viability by increasing cyclinD1 and b-catenin compared to control cells in MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, suggesting that KLF5 mediates cell survival. CONCLUSION: KLF5 was significantly associated with the presence of KRAS mutations, and KLF5 was an independent poor response predictor of CRT in rectal cancer. Our study is pilot study and more research will be needed in the future.

Benign multicystic peritoneal mesothelioma treated with laparoendoscopic single site surgery: a case report and review of the literature

Benign multicystic peritoneal mesothelioma (BMPM) is rare and difficult to diagnose before surgery. We report a case of BMPM incidentally discovered during laparoendoscopic single site surgery (LESS) for treatment of a pelvic mass. A 47-year-old Korean menopaused woman presented to our outpatient clinic with a pelvic mass. She had a history of right ovary cystectomy with adhesiolysis at a local hospital in 2010. Imaging study of the pelvis revealed a multilocular cystic mass. LESS was performed and multiple grapelike clusters of cysts were seen in the uterus, cul-de-sac, both adnexa, pelvic wall, and omentum. The appendix was grossly free. Frozen biopsy confirmed BMPM. Excision of multiple cyst clusters of cysts, resection of the uterus with both adnexa, appendectomy, omentectomy, and adhesiolysis were performed with LESS. She is well for 2 years with no recurrence. BMPM should be included in the differential diagnosis when small multichamber cystic mass is found on ultrasonography.

Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term

OBJECTIVE: To evaluate the significance of fetal Doppler parameters in predicting adverse neonatal outcomes and the risk of cesarean delivery due to non-reassuring fetal status, in severe small for gestational age (SGA) fetuses of late preterm and term gestation. METHODS: Fetal brain and umbilical artery (UmA) Doppler parameters of cerebroplacental ratio (CPR) and UmA pulsatility index (PI) were evaluated in a cohort of 184 SGA fetuses between 34 and 41 weeks gestational age, who were less than the 5th percentile. The risks of neonatal morbidities and cesarean delivery due to non-reassuring fetal status were analyzed. RESULTS: Univariate analysis revealed that abnormal CPR was significantly associated with cesarean delivery due to non-reassuring fetal status (P=0.018), but not with neonatal morbidities. However, abnormal CPR did not increase the risk of cesarean delivery due to non-reassuring fetal status in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA was associated with low Apgar score at 1 minute (P=0.048), mechanical ventilation (P=0.013) and cesarean delivery due to non-reassuring fetal status (P < 0.001), in univariate analysis. It increased risk of cesarean delivery for non-reassuring fetal status (adjusted odds ratio, 7.0; 95% confidence interval, 1.2–41.3; P=0.033), but did not increase risk of low Apgar score or mechanical ventilation in multivariate logistic regression analysis. CONCLUSION: Abnormal CPR with abnormal PI of UmA increases the risk of cesarean delivery for non-reassuring fetal status, in severe SGA fetuses of late preterm and term. Monitoring of CPR and PI of UmA can help guide management including maternal hospitalization and fetal monitoring.

Uterine Torsion in Third Trimester Pregnancy / 대한주산의학회잡지

The preoperative diagnosis of uterine torsion is very difficult due to the rarity of this disorder and its nonspecific clinical course. A primigravida woman visited our hospital with severe abdominal pain at 34 weeks of gestation. Emergency cesarean section was carried out due to development of fetal distress and severe abdominal pain. During the cesarean section, we noticed the uterus was rotated 180 degrees and the torsion was corrected after the delivery by making a vertical incision at the posterior uterine wall. High degree of suspicion and prompt management are important factors contributing to good prognosis of uterine torsion.

Uterine Torsion in Third Trimester Pregnancy / 대한주산의학회잡지

The preoperative diagnosis of uterine torsion is very difficult due to the rarity of this disorder and its nonspecific clinical course. A primigravida woman visited our hospital with severe abdominal pain at 34 weeks of gestation. Emergency cesarean section was carried out due to development of fetal distress and severe abdominal pain. During the cesarean section, we noticed the uterus was rotated 180 degrees and the torsion was corrected after the delivery by making a vertical incision at the posterior uterine wall. High degree of suspicion and prompt management are important factors contributing to good prognosis of uterine torsion.

Cystic Dysplasia of the Testis Associated with Ipsilateral Hypoplastic Type of Renal Dysplasia and Ureterovesical Junction Obstruction / 대한비뇨기과학회지

Cystic dysplasia of the testis is a rare benign congenital lesion of the rete testis that is often associated with renal and ureteral abnormalities. Herein, a case of cystic dysplasia of the testis, associated with an ipsilateral hypoplastic type of renal dysplasia and an ureterovesical junction obstruction, is reported in a 7-year-old boy.

Locus of Control and Eating behavior of Obese Middle School Girls / 아동간호학회지

PURPOSE: The purpose of this study was to investigate the relationship between health locus of control(HLOC) and eating behavior in obese middle school girls. METHOD: The sample consisted of 170 obese middle school girls in Seoul. RESULT: 1. The average scores of HLOC were HLOC-Internal ; 4.11, HLOC-External ; 2.45, HLOC-Chance ; 2.09. 2. The average scores of eating behavior factors were Disinhibition ; 2.69, Dietary Restraint ; 2.67, Hunger ; 2.55. 3.The HLOC-Internal and eating behavior(dietary restraint and hunger) were correlated positively. The HLOC-Chance and disinhibition was correlated positively. But HLOC-Chance and dietary restraint was correlated negatively. The HLOC-External and eating behavior(dietary restraint, disinhibition and hunger) were correlated positively. 4. There was not a significant difference in HLOC depending on the demographic characteristics(grade, degree of obesity, father & mother's body shape, existence of obese sibling). There were significant differences in HLOC-Internal and HLOC-External according to thinking about oneself who is obese or not. 5. There was not a significant difference in eating behavior depending on the demographic characteristics(grade, degree of obesity, father & mother's body shape, existence of obese sibling, perception of oneself as a obese). CONCLUSION: This study has shown a correlation between HLOC and eating behavior. As a result of these findings, clinical and school nurses should be involved in management and counselling of obese girls concerning individual health locus of control and eating behavior.

The Correlation between HRCT Emphysema Score and Exercise Pulmonary Testing Parameters / 결핵

BACKGROUND: The correlation between the high resolution computed tomography(HRCT) emphysema score and the physiologic parameters including resting and exercise pulmonary function test was investingated in 14 patients(60.6±10.3 years) with pulmonary emphysema. METHODS: The patients underwent a HRCT, a resting pulmonary function test, and incremental exercise testing(cycle ergometer, 10 W/min). Computed tomography scans were obtained on a GE highlight at 10 mm intervals using 10 mm collimation, from the apex to the base after a full inspiration. The emphysema scores wer determined by a CT program 'Density mask' outlining the areas with attenuation values less than -900 HU, indicating the emphysema areas, and providing an overall percentage of lung involvement by emphysema. RESULTS: Among the resing PFT parameters, only the diffusing capacity(r=-0.75) and PaO2 (r=-0.66) correlated with the emphysema score(p<0.05). Among the exercise test parameers, the emphysema score correlated significantly with the maximum power(r=-0.74), maximum oxygen consumption(r=-0.68), anaerobic threshold(V-slope method : r=-0.69), maximal O2-pulse(r=-0.73), and the physiologic dead space ratio at the maximum workload(r=-0.80)(p<0.01). CONCLUSION: We could find that exercise testing parameters showed a much better correlation with the HRCT emphysema score, which is known to have a good correlation with the pathologic severity than the resting PFT parameters. Therefore it is suggested that exercise testing is superior to resting PFT for estimating in the estimation of the physiologic disturbance in emphysema patients.