Analysis of Plasma Circulating Tumor DNA in Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Modified FOLFIRINOX: Clinical Relevance of DNA Damage Repair Gene Alteration Detection / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#There are no reliable biomarkers to guide treatment for patients with borderline resectable pancreatic cancer (BRPC) in the neoadjuvant setting. We used plasma circulating tumor DNA (ctDNA) sequencing to search biomarkers for patients with BRPC receiving neoadjuvant mFOLFIRINOX in our phase 2 clinical trial (NCT02749136). @*Materials and Methods@#Among the 44 patients enrolled in the trial, patients with plasma ctDNA sequencing at baseline or post-operation were included in this analysis. Plasma cell-free DNA isolation and sequencing were performed using the Guardant 360 assay. Detection of genomic alterations, including DNA damage repair (DDR) genes, were examined for correlations with survival. @*Results@#Among the 44 patients, 28 patients had ctDNA sequencing data qualified for the analysis and were included in this study. Among the 25 patients with baseline plasma ctDNA data, 10 patients (40%) had alterations of DDR genes detected at baseline, inclu-ding ATM, BRCA1, BRCA2 and MLH1, and showed significantly better progression-free survival than those without such DDR gene alterations detected (median, 26.6 vs. 13.5 months; log-rank p=0.004). Patients with somatic KRAS mutations detected at baseline (n=6) had significantly worse overall survival (median, 8.5 months vs. not applicable; log-rank p=0.003) than those without. Among 13 patients with post-operative plasma ctDNA data, eight patients (61.5%) had detectable somatic alterations. @*Conclusion@#Detection of DDR gene mutations from plasma ctDNA at baseline was associated with better survival outcomes of pati-ents with borderline resectable pancreatic ductal adenocarcinoma treated with neoadjuvant mFOLFIRINOX and may be a prognostic biomarker.

Evaluation of Synergistic Effect of Combined Treatment with Linalool and Colistin on Multidrug-Resistant Acinetobacter baumannii to Expand Candidate for Therapeutic Option / 대한임상미생물학회지

BACKGROUND: Acinetobacter baumannii infection is a significant health problem worldwide due to increased drug resistance. The limited antimicrobial alternatives for the treatment of severe infections by multidrug-resistant A. baumannii (MDRAB) make the search for other therapeutic options more urgent. Linalool, the major oil compound in Coriandrum sativum, was recently found to have high antibacterial activity against A. baumannii. The purpose of this study was to investigate the synergistic effect of linalool and colistin combinations against MDRAB and extensively drug-resistant A. baumannii (XDRAB).METHODS: A total of 51 strains of A. baumannii clinical isolates, consisting of 10 MDRAB and 41 XDRAB were tested. We determined the minimum inhibitory concentration (MIC) of linalool for the test strains using the broth microdilution method and searched for interactions using the time-kill assay.RESULTS: The time-kill assay showed that the linalool and colistin combination displayed a high rate of synergy (92.1%) (by synergy criteria 2), low rate of indifference (7.8%), and a high rate of bactericidal activity (74.5%) in the 51 clinical isolates of A. baumannii. The synergy rates for the linalool and colistin combination against MDRAB and XDRAB were 96% and 92.1%, respectively. No antagonism was observed for the linalool and colistin combination.CONCLUSION: The combination of linalool and colistin showed a high synergy rate, which may be beneficial for controlling MDRAB infections. Therefore, this combination is a good candidate for in vivo studies to assess its efficacy in the treatment of MDRAB infections.

Comparison of the Utility of dnaJ and 16S rDNA Sequences for Identification of Clinical Isolates of Vibrio Species

BACKGROUND: Among the many Vibrio species that can cause infections in humans, several species can cause a fatal outcome. Therefore, accurate identification of Vibrio species is very important. Since some species show atypical phenotypic features, selecting an appropriate molecular method is necessary to avoid misdiagnosis. METHODS: Vibrio clinical isolates (N=53) and reference strains (N=8) were used in this study. We analyzed the following sequences for identification: dnaJ gene, 16S rDNA, gyrase B (gyrB) V. vulnificus-specific sequence, gyrB V. navarrensis-specific sequence, and V. vulnificus hemolysin gene PCR (Vvh PCR). We performed phylogenetic analysis of the 16S rDNA, dnaJ, and gyrB sequences. Final identification was based on the combined results of all tests described above. Concordance of the 16S rDNA and dnaJ sequence analysis was measured using the Chi-square test. RESULTS: The 61 Vibrio strains were identified as follows, in descending order: V. vulnificus (78.69%), V. parahaemolyticus (6.56%), V. navarrensis (4.92%), V. mimicus (1.64%), V. cholera (1.64%), V. furnissii (1.64%), V. alginolyticus (1.64%), and Grimontia hollisae (1.64%). The accuracy rates of the dnaJ gene and 16S rDNA sequence for identification were 91.80% and 86.89%, respectively. The 16S rDNA and dnaJ sequences showed a concordance rate of 0.45, which indicates moderate agreement. CONCLUSIONS: Our results suggest that analysis of the dnaJ sequence may be a useful method for the identification of clinical isolates of Vibrio species, especially for distinguishing between closely related Vibrio species.

Mediation analysis of dietary habits, nutrient intakes, daily life in the relationship between working hours of Korean shift workers and metabolic syndrome : the sixth (2013 ~ 2015) Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: This study examined the mediation effects of dietary habits, nutrient intake, daily life in the relationship between the working hours of Korean shift workers and metabolic syndrome. METHODS: Data were collected from the sixth (2013–2015) Korea National Health and Nutrition Examination Survey (KNHANES). The stochastic regression imputation was used to fill missing data. Statistical analysis was performed in Korean shift workers with metabolic syndrome using the SPSS 24 program for Windows and a structural equation model (SEM) using an analysis of moment structure (AMOS) 21.0 package. RESULTS: The model fitted the data well in terms of the goodness of fit index (GFI) = 0.939, root mean square error of approximation (RMSEA) = 0.025, normed fit index (NFI) = 0.917, Tucker-Lewis index (TLI) = 0.984, comparative fit index (CFI) = 0.987, and adjusted goodness of fit index (AGFI) = 0.915. Specific mediation effect of dietary habits (p = 0.023) was statistically significant in the impact of the working hours of shift workers on nutrient intake, and specific mediation effect of daily life (p = 0.019) was statistically significant in the impact of the working hours of shift workers on metabolic syndrome. On the other hand, the dietary habits, nutrient intake and daily life had no significant multiple mediator effects on the working hours of shift workers with metabolic syndrome. CONCLUSION: The appropriate model suggests that working hours have direct effect on the daily life, which has the mediation effect on the risk of metabolic syndrome in shift workers.

Pelvic Bone Fracture with Bladder Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. MATERIALS AND METHODS: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. RESULTS: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. CONCLUSION: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Balloon-Occluded Percutaneous Transhepatic Obliteration of Isolated Vesical Varices Causing Gross Hematuria

Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.

A survey on the clinical practice and the guidelines for sexually transmitted infections in Korea

Every year 150 million new cases of sexually transmitted infection are expected to occur around the world with high occurrence and morbidity rates in both males and females. To respond to dramatically changing social and cultural environments, clinical treatment guidelines for diagnosis, treatment, and prevention of sexually transmitted infections have been developed in many countries, and South Korea has also prepared treatment guidelines which can be used in medical institutions treating primarily these diseases. Against this background, this study conducted a 31-item questionnaire survey by mail and e-mail to investigate the actual clinical practices of physicians treating sexually transmitted infections. In total, 250 and 1,068 questionnaires were distributed through mail and e-mail, respectively, and 274 of them were completed and returned for a response rate of 20.8%. According to the results, physicians' actual clinical practices were found to be different from textbook guidelines to some degree. Therefore, treatment guidelines that take into account the current situation for sexually transmitted infections should be developed in Korea, and a foundation for national management of the diseases should be established through active advertisements.

The Ciprofloxacin Resistance Pattern of Escherichia coli Isolated from Female Patients with Community- acquired Urinary Tract Infection in the Jeonnam and Gwangju Region for the Recent 2-years / 대한비뇨기과학회지

PURPOSE: The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli(E. coli). We studied the prevalence od the ciprofloxacin-resistant(CR) E. coli that were isolated from female patients with community-acquired urinary tract infection(CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI. MATERIALS AND METHODS: From January 2006 to December 2007, we retrospectively analyzed 910 female patients with CAUTI. Among them, we chose 387 patients infected by E. coli and we evaluated the resistance rate to ciprofloxacin and its relationship with age, the disease causing the UTI and the previous antibiotics. We also compared the resistance to ciprofloxacin with that of other antibiotics, including cephalosporin and the other antibiotics recommended by the guidelines of the Infectious Diseases Society of America(IDSA). RESULTS: The incidence of UTI by E. coli increased with age(p<0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age(p=0.034), complicated UTI(p=0.04) and a previous history of antibiotic use(p=0.023). Trimethoprim/sulfamethoxazole(TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime(5.9%). CONCLUSIONS: Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI.

Bladder Hemangioma as a Cause of Massive Hematuria: Treatment with Selective Arterial Embolization / 대한비뇨기과학회지

Hemangioma of the urinary bladder is a benign, congenital tumor that accounts for 0.6% of all primary bladder neoplasms. The most common symptom is gross hematuria. However, bladder hemangioma as a cause of massive hematuria is rare. The management of patients with hemangioma is controversial and numerous therapeutic approaches are available. Herein, we describe the use of selective arterial embolization to terminate an episode of massive hematuria in an 87-year-old woman with bladder hemangioma.

A Comparative Study of the Tension-free Vaginal Tape and Transobturator Vaginal Tape Inside-out for the Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: We compared the preoperative with the postoperative outcomes between tension-free vaginal tape (TVT) and transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence MATERIALS AND METHODS: From January 2003 to December 2005, 72 women, one is TVT group(n=52) and the other is TVT-O group(n=20), after operation following were assigned. The preoperative and postoperative evaluations analysis and urodynamic study and Korean version of I-QoL, surgical outcomes, complications and uroflowmetry were analysed. RESULTS: All outcomes included the patients`states, incontinence quality of life(I-QoL)(p=0.013), the success rate of the cure(p=0.003) and the rate of the patient satisfaction(p=0.001) were not comparable statistically between two groups and there are no differences and no long-term complications such as bladder perforation or prolonged voiding difficulty. Preoperative and postoperative uroflowmetry was similar between the two groups. Mean operation time(TVT: 15.6 min, TVT-O: 13.2 min) was significantly shorter in TVT-O than in TVT. CONCLUSION: The observation of 1-year following-up shows the equally effectiveness between two groups(TVT and TVT-O) as the surgical treatment of stress urinary incontinence.

Penile Necrosis by Longtime Installation of a Constriction Ring in a Patient using a Vacuum Constriction Device / 대한비뇨기과학회지

A vacuum constriction device has been described as a safe and satisfactory treatment for erectile dysfunction. The main complications of the device are mostly minor symptoms and serious side effects are rarely reported. We report here on a case of wide ischemic necrosis of the penis including the skin, subcutaneous tissue, tunica albuginea and corpus cavernosum by a constriction ring that had been installed for 72 hours in a 61 year old patient.

Complications of Retroperitoneal Laparoscopic Surgery / 대한비뇨기과학회지

PURPOSE: Laparoscopic surgery is known to be safe and have low morbidity. Herein, all the complications of retroperitoneal laparoscopic procedures were evaluated. MATERIALS AND METHODS: A total of 120 retroperitoneal laparoscopic surgeries were performed between January 2002 and December 2005. Every abnormal event was investigated retrospectively, and classified in detail according to the surgical steps and severity. RESULTS: The complication ratio (total complications/total surgeries) was 0.38 (46/120). Open conversion was performed in 5 (4.2%). A transfusion was performed in 8 (6.7%) patients. 5 patients (4.2%) had neuromuscular problem related to position and 9 (7.5%) had access and insufflation related complications, including subcutaneous emphysema, abdominal wall hemorrhage, pneumothorax and pneumomediastinum. The intraoperative complications (5.8%) included peritoneal tearing, vascular injury and diaphragmatic injury. Postoperative complications occurred in 25 patients (20.8%), including pleural effusion, atelectasis/pulmonary infiltrate, wound dehiscence, paralytic ileus, retroperitoneal hematoma and urine leakage. 5 complications (4.2%) were classified as being major; main vascular injury (1.7%), urine leakage (1.7%) and diaphragmatic injury (0.8%). No serious complications, such as death, bowel injury, deep vein thrombosis, with pulmonary embolism, or gas embolism occurred. Other complications (41/46) were minor and managed conservatively, without any problem. CONCLUSIONS: The most common complications of retroperitoneal laparoscopic surgery seem to occur during the postoperative period, and are nonspecific to retroperitoneoscopy. Most complications are subclinical problems, which can be managed by conservative treatment. Retroperitoneal laparoscopic surgery is a safe procedure, with a low potential for complications.

Non-surgical Treatment of Voiding Dysfunction Following Tension-Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

The tension-free vaginal tape procedure(TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation.

Primary Small Cell Carcinoma of the Kidney / 대한비뇨기과학회지

Small cell carcinoma is a malignant neoplasm, which has neuroendocrine and epithelial features immunohistochemically and ultrastructurally. Primary small cell carcinoma originating from the kidneys is extremely rare, aggressive and lethal. Approximately half the reported cases show combined features of transitional cell carcinoma. A case of primary renal small cell carcinoma without features of transitional cell carcinoma is reported, which was studied under light microscopy and by immunohistochemistry and treated by retroperitoneal laparoscopic radical nephrectomy and chemotherapy.

Design and Clinical Application of Safe Air-Pressure Reduction System for Intussusception

PURPOSE: This study was performed to design a safe air-pressure reduction system which can absorb rapidlyrising intraluminal pressure during intussusception, and comparison with other reduction systems to test itsclinical availability. MATERIALS AND METHODS: The air-pressure reduction system consisted of a pressure gauge,air insufflators, a pressure controller, buffers, and rapid exhaustion devices, and to determine itsabsorbability, it was connected with a bowel model. By using it in 20 infants with intussusception, we comparedthe absorbability of our air-pressure reduction system with preexisting systems. RESULTS: While extraluminalpressure was applied to the bowel model in which baseline intraluminal pressure was set to 120mmHg, this rose to176mmHg (56mmHg high to standard, 100%) in the direct infusion system, but to only 130 mmHg (10mmHg high tostandard, 17.9%) in a system connected to a large buffer of 10,500 mL capacity. Immediately after the applicationof extraluminal pressure for less than 1 sec, this air-pressure reduction system showed better absorbability thanthe hydrostatic reduction system. Applying this system to 20 infants with intussusception, this was successfullyreduced in 19 cases(95%), without complications. CONCLUSION: In this experiment, it was proved that the systemabsorbed rapid intraluminal pressure elevation. Its use would help prevent bowel perforation during air reductionoccurring during intussusception.

The Normal Width of the Anterior Commissure of the True Vocal Cord in Korean Adults Measured by Helical CT

PURPOSE: To evaluate the mean width of anterior commissure of true vocal cord in Korean adults by measuringits dimension on spiral CT scans. MATERIALS AND METHODS: We reviewed the CT scans of 53 Korean adults(age range,23-73years; mean age 39.2years; M:F=41:12) without laryngeal disorders. Spiral CT scanning was performed aroundthe anterior commissure with 1mm slice thickness and table incrementation for 15 seconds. The anteroposteriorwidth of the anterior commissure was measured on CT scan where the true vocal cord and arytenoid, cricoid andthyroid cartilages were all present. We determined the mean width of the anterior commissure and whether there wasa relationship between age and the width of the anterior commissure. RESULTS: The width of the anteriorcommissure was between 0.9mm and 2.3mm ; mean width was 1.60+/-0.38mm(mean+/-SD). Using two SDs above the mean wouldhave defined 2.36mm as the upper limit of normal width. Statistically, no significant correlation existed betweenthe age and the width of the anterior commissure(p>0.05). CONCLUSION: An awareuess of the normal width range ofthe anterior commissure in Korean adults evaluated by spiral CT enhances the possibility of early detection ofinvasion of the anterior commissure by glottic cancer.