MPI-GWAS: a supercomputing-aided permutation approach for genome-wide association studies

Permutation testing is a robust and popular approach for significance testing in genomic research that has the advantage of reducing inflated type 1 error rates; however, its compu-tational cost is notorious in genome-wide association studies (GWAS). Here, we developed a supercomputing-aided approach to accelerate the permutation testing for GWAS, based on the message-passing interface (MPI) on parallel computing architecture. Our application, called MPI-GWAS, conducts MPI-based permutation testing using a parallel computing approach with our supercomputing system, Nurion (8,305 compute nodes, and 563,740 central processing units [CPUs]). For 107 permutations of one locus in MPI-GWAS, it was calculated in 600 s using 2,720 CPU cores. For 107 permutations of ~30,000–50,000 loci in over 7,000 subjects, the total elapsed time was ~4 days in the Nurion supercomputer. Thus, MPI-GWAS enables us to feasibly compute the permutation-based GWAS within a reason-able time by harnessing the power of parallel computing resources.

Exome Chip Analysis of 14,026 Koreans Reveals Known and Newly Discovered Genetic Loci Associated with Type 2 Diabetes Mellitus

BackgroundMost loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.MethodsWe analyzed the association of exome array data from 14,026 Koreans to identify susceptible exonic loci for T2DM. We used genotype information of 50,543 variants using the Illumina exome array platform. ResultsIn total, 7 loci were significant with a Bonferroni adjusted P=1.03×10−6. rs2233580 in paired box gene 4 (PAX4) showed the highest odds ratio of 1.48 (P=1.60×10−10). rs11960799 in membrane associated ring-CH-type finger 3 (MARCH3) and rs75680863 in transcobalamin 2 (TCN2) were newly identified loci. When we built a model to predict the incidence of diabetes with the 7 loci and clinical variables, area under the curve (AUC) of the model improved significantly (AUC=0.72, PPP=8.00×10−5).ConclusionWe found exonic loci having a susceptibility for T2DM. We found that such genetic information is advantageous for predicting T2DM in a subgroup of obese individuals.

Exome Chip Analysis of 14,026 Koreans Reveals Known and Newly Discovered Genetic Loci Associated with Type 2 Diabetes Mellitus

BackgroundMost loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.MethodsWe analyzed the association of exome array data from 14,026 Koreans to identify susceptible exonic loci for T2DM. We used genotype information of 50,543 variants using the Illumina exome array platform. ResultsIn total, 7 loci were significant with a Bonferroni adjusted P=1.03×10−6. rs2233580 in paired box gene 4 (PAX4) showed the highest odds ratio of 1.48 (P=1.60×10−10). rs11960799 in membrane associated ring-CH-type finger 3 (MARCH3) and rs75680863 in transcobalamin 2 (TCN2) were newly identified loci. When we built a model to predict the incidence of diabetes with the 7 loci and clinical variables, area under the curve (AUC) of the model improved significantly (AUC=0.72, PPP=8.00×10−5).ConclusionWe found exonic loci having a susceptibility for T2DM. We found that such genetic information is advantageous for predicting T2DM in a subgroup of obese individuals.

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan

Purpose@#This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. @*Materials and Methods@#One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. @*Results@#PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0–F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. @*Conclusion@#PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

Exome Chip Analysis of 14,026 Koreans Reveals Known and Newly Discovered Genetic Loci Associated with Type 2 Diabetes Mellitus

Background@#Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation. @*Methods@#We analyzed the association of exome array data from 14,026 Koreans to identify susceptible exonic loci for T2DM. We used genotype information of 50,543 variants using the Illumina exome array platform. @*Results@#In total, 7 loci were significant with a Bonferroni adjusted P=1.03×10–6 . rs2233580 in paired box gene 4 (PAX4) showed the highest odds ratio of 1.48 (P=1.60×10−10 ). rs11960799 in membrane associated ring-CH-type fin­ger 3 (MARCH3) and rs75680863 in transcobalamin 2 (TCN2) were newly identified loci. When we built a model to predict the incidence of diabetes with the 7 loci and clinical variables, area under the curve (AUC) of the model improved significantly (AUC=0.72, P<0.05), but marginally in its magnitude, compared with the model using clinical variables (AUC=0.71, P<0.05). When we divided the entire population into three groups—normal body mass index (BMI; <25 kg/m2 ), overweight (25≤ BMI <30 kg/m2 ), and obese (BMI ≥30 kg/m2 ) individuals—the predictive performance of the 7 loci was greatest in the group of obese individuals, where the net reclassification improvement was highly significant (0.51; P=8.00×10–5 ). @*Conclusion@#We found exonic loci having a susceptibility for T2DM. We found that such genetic information is advantageous for predicting T2DM in a subgroup of obese individuals.

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan

Purpose@#This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. @*Materials and Methods@#One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. @*Results@#PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0–F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. @*Conclusion@#PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

COEX-Seq: Convert a Variety of Measurements of Gene Expression in RNA-Seq

Next generation sequencing (NGS), a high-throughput DNA sequencing technology, is widely used for molecular biological studies. In NGS, RNA-sequencing (RNA-Seq), which is a short-read massively parallel sequencing, is a major quantitative transcriptome tool for different transcriptome studies. To utilize the RNA-Seq data, various quantification and analysis methods have been developed to solve specific research goals, including identification of differentially expressed genes and detection of novel transcripts. Because of the accumulation of RNA-Seq data in the public databases, there is a demand for integrative analysis. However, the available RNA-Seq data are stored in different formats such as read count, transcripts per million, and fragments per kilobase million. This hinders the integrative analysis of the RNA-Seq data. To solve this problem, we have developed a web-based application using Shiny, COEX-seq (Convert a Variety of Measurements of Gene Expression in RNA-Seq) that easily converts data in a variety of measurement formats of gene expression used in most bioinformatic tools for RNA-Seq. It provides a workflow that includes loading data set, selecting measurement formats of gene expression, and identifying gene names. COEX-seq is freely available for academic purposes and can be run on Windows, Mac OS, and Linux operating systems. Source code, sample data sets, and supplementary documentation are available as well.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis

OBJECTIVE: Adenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women. METHODS: We used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method. RESULTS: A total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis. CONCLUSION: We must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

Genome-Wide Association Study of Metabolic Syndrome in Koreans

Metabolic syndrome (METS) is a disorder of energy utilization and storage and increases the risk of developing cardiovascular disease and diabetes. To identify the genetic risk factors of METS, we carried out a genome-wide association study (GWAS) for 2,657 cases and 5,917 controls in Korean populations. As a result, we could identify 2 single nucleotide polymorphisms (SNPs) with genome-wide significance level p-values (<5 x 10(-8)), 8 SNPs with genome-wide suggestive p-values (5 x 10(-8) < or = p < 1 x 10(-5)), and 2 SNPs of more functional variants with borderline p-values (5 x 10(-5) < or = p < 1 x 10(-4)). On the other hand, the multiple correction criteria of conventional GWASs exclude false-positive loci, but simultaneously, they discard many true-positive loci. To reconsider the discarded true-positive loci, we attempted to include the functional variants (nonsynonymous SNPs [nsSNPs] and expression quantitative trait loci [eQTL]) among the top 5,000 SNPs based on the proportion of phenotypic variance explained by genotypic variance. In total, 159 eQTLs and 18 nsSNPs were presented in the top 5,000 SNPs. Although they should be replicated in other independent populations, 6 eQTLs and 2 nsSNP loci were located in the molecular pathways of LPL, APOA5, and CHRM2, which were the significant or suggestive loci in the METS GWAS. Conclusively, our approach using the conventional GWAS, reconsidering functional variants and pathway-based interpretation, suggests a useful method to understand the GWAS results of complex traits and can be expanded in other genomewide association studies.

Replication of Interactions between Genome-Wide Genetic Variants and Body Mass Index in Fasting Glucose and Insulin Levels

The genetic regulation of glucose and insulin levels might be modified by adiposity. With regard to the genetic factors that are altered by adiposity, a large meta-analysis on the interactions between genetic variants and body mass index with regard to fasting glucose and insulin levels was reported by the Meta-Analyses of Glucose- and Insulin-related trait Consortium (MAGIC), based on European ancestry. Because no replication study has been performed in other ethnic groups, we first examined the link between reported single-nucleotide polymorphisms (SNPs) and fasting glucose and insulin levels in a large Korean cohort (Korean Genome and Epidemiology Study cohort [KoGES], n = 5,814). The MAGIC study reported 7 novel SNPs for fasting glucose levels and 6 novel SNPs for fasting insulin levels. In this study, we attempted to replicate the association of 5 SNPs with fasting glucose levels and 5 SNPs with fasting insulin levels. One SNP (rs2293941) in PDX1 was identified as a significant obesity-modifiable factor in Koreans. Our results indicate that the novel loci that were identified by MAGIC are poorly replicated in other ethnic groups, although we do not know why.

The Effect of Levonorgestrel-releasing Intrauterine System (Mirena(R)) on the Mammographic Density and Breast Ultrasonographic Findings in Korean Premenopausal Women / 대한폐경학회지

OBJECTIVES: The aim of the present study was to investigate the influence of levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena(R)) on the mammographic density, mammographic findings and breast ultrasonographic findings in Korean premenopausal women. METHODS: We reviewed medical records of 639 premenopausal women, who inserted LNG-IUS in our department from 2000-2011. Among these, 46 women, who underwent regular mammography (MMG) or breast ultrasonography (USG) examination in radiology department before and after insertion of the LNG-IUS after establishment of picture archiving and communication system (PACS) system in our hospital were finally included in this analysis. We compared the findings of MMG and breast USG between pre- and post-insertion of LNG-IUS. We also checked the pathologic results of any breast biopsy performed in these study participants. The Cochran-Armitage trend test was used to investigate the changes pre- and post-insertion of LNG-IUS. RESULTS: The mean age of participants was 42.3 +/- 4.9 years and the mean interval period for MMG and US follow-up (FU) was 25.5 +/- 10.8 months and 25.2 +/- 11.5 months, respectively. The density of MMG before insertion of LNG-IUS correlated well with the FU MMG density. The findings of MMG and US also correlated well before and after insertion of LNG-IUS. There was no case of breast cancer among women who were supposed to undergo breast biopsy because of abnormal findings in MMG and US. CONCLUSION: The use of LNG-IUS did not cause any changes in MMG density, findings of MMG, and findings of breast USG in healthy premenopausal Korean women.

Diagnosis of the Deep Vein Thrombosis with Multidetector-Row Computed Tomographic Venography after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Using the 64-channel multidetector-row computed tomographic venography (MDCT venography), we tried to know the incidence of the deep vein thrombosis (DVT) after total knee arthroplasty and the effectiveness of MDCT venography. MATERIALS AND METHODS: From April 2006 to December 2006, two groups of 280 consecutive patients, who underwent primary total knee arthroplasty, were enrolled in this study. We performed antithrombotic chemotherapy on the patients who were confirmed to have symptomatic DVT. RESULTS: For the first 140 consecutive cases, DVT was found in 48 (34%) patients and only 5 (3.6%) showed clinical symptoms of DVT. For the next 140 cases, 12 (8.6%) cases showed symptoms of DVT and in them 7 (5.0%) of these cases was diagnosed with symptomatic DVT. All the patients had recovered at the last follow-up and no other complications occurred in our series. CONCLUSION: Sixty four-channel MDCT venography is valuable as a diagnostic test for DVT after total knee arthroplasty in terms of efficacy and accuracy. Antithrombotic chemotherapy is recommended

Availability of D-dimer Test for the Diagnosis ofDeep Vein Thrombosis after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To investigate the prevalence of deep vein thrombosis (DVT) after Total knee arthroplasty (TKA) and evaluate the availability of D-dimer test for the diagnosis of DVT after TKA. MATERIALS AND METHODS: From April 2006 to July 2006, 140 consecutive patients, who had degenerative osteoarthritic knees and underwent primary total knee arthroplasty, were enrolled in this study. General and hematological risk factors were compared between DVT positive and negative patients. D-dimer level was checked preoperatively, and at 1, 7 and 14 days after surgery. A diagnosis of DVT was established by computed tomography venography. RESULTS: DVT was found in 48 (34%) patients and only 5 (10.4%) showed symptoms of DVT. Regarding the risk factors, only obesity was significantly associated with an increased incidence of DVT (p=0.049). Seven days after surgery, the average D-dimer level in the DVT positive and negative patients was 4.90 mg/L and 3.12 mg/L, respectively (p=0.000). CONCLUSION: In our study patients, the incidence of symptomatic DVT was lower than in the Western population. We recommend obesity, clinical symptoms and D-dimer value at 7 days after surgery as a valuable screening tests for detecting DVT.

Treatment of Bone Loss using Ilizarov Fixation after Resection ofBenign Tumor in the Long Bone / 대한정형외과학회잡지

PURPOSE: This study analyzed the results of treatment of bone loss using Ilizarov fixation after resection of benign tumor in the long bone radiologically and clinically. MATERIALS AND METHODS: Initial diagnoses were 5 osteofibrous dysplasia, 1 aneurysmal bone cyst and 1 giant cell tumor. Three indices were used to evaluate the results; percentage transport, healing index and percentage increase. The function of the affected limb was assessed according to Ennecking rating. And we assessed the radiological and functional results according to A.S.A.M.I.'s classification. RESULTS: Percentage transport averaged 75% (range: 29-144), healing index averaged 64.5 day/cm (range: 34.8-108.6) and the percentage increase averaged 13% (range: 11-20). In Enneking rating, there were 6 cases that were classified as being better than good. In A.S.A.M.I.'s classification, there were 6 good cases, and 1 fair case each in the bone result and functional result, respectively. CONCLUSION: Ilizarov technique is a reconstruction method using living bone. It is safe and effective for the treatment of bone loss after the resection of a benign tumor in the long bone.

Reverse Chevron Transmalleolar Osteotomy for Exposure of the Medial Talar Dome Lesions: Operative Technique / 대한족부족관절학회지

For the adequate intraarticular exposure in medial talar dome lesions, medial malleolar osteotomy is necessary in some cases. Many operative techniques including transverse, oblique, inverted V-shape, crescentic and step-cut osteotomies of the medial malleolus have been described previously. But their techniques have several problems such as nonunion, rotation and limited access to lesions. So we introduce the new reverse chevron medial malleolar osteotomy which provides excellent access to lesions, good stability and a broad cancellous surface for rapid healing.

Second-look Arthroscopy after Surgical Treatment for Osteochondral Lesion of Talus: Comparison of Mosaicplasty with Microfracture / 대한족부족관절학회지

PURPOSE: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy. MATERIALS AND METHODS: 7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was 15.0 x 7.7 mm in mosaicplasty and 7.1 x 6.6 mm in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy. RESULTS: By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures. CONCLUSION: Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.

Rotational Axes of the Femoral Componentin Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The degree of external rotation produced by the gap technique in total knee arthroplasties (TKA) was measured and compared with other methods. MATERIALS AND METHODS: Thirty-nine TKA patients (52 cases) were enrolled in this study. The transepicondylar axis (TEA) and the perpendicular line to the anteroposterior axis (APA) were drawn on the images of the computerized tomographs (CT). After resecting the posterior condyles using the gap technique, the maximal depths of the resected fragments were measured, and the resected lines (RL) were drawn on the same CT images. The differences in the angles between the RLs and the TEAs, the perpendicular lines to the APAs, and the lines that were externally rotated 3o from the posterior condylar axes, were evaluated. RESULTS: The posterior condylar axes formed 5.1+/-2.5 degrees angles with the RLs, 5.3+/-1.6 degrees angles with the TEAs, and 4.5+/-2.1 degrees angles with the lines that were perpendicular to the APAs. The RLs showed similar TEAs, and the APAs (0.2+/-2.6 degrees and 0.6+/-3.0 degrees, respectively). However, the lines of 3 degrees external rotation (2.1+/-2.5 degrees) were significantly different. CONCLUSION: A more ideal flexion gap could be obtained with the TEAs compared with other methods. However, resections of the posterior condyles using the gap technique might be more effective than with the TEAs due to the individual variations and errors in obtaining symmetric flexion gaps with this value.

Treatment in Distal Humerus Fracture with Anatomical Y Plate

PURPOSE: To evaluate the clinical results of this modified anatomical Y-plate in treatment of distal humerus fracture and factors that affect the results. MATERIALS AND METHODS: From April 1991 to January 2002, 40 cases (16 male, 24 female) of distal humeral fractures were treated using a modified anatomical Y plate. The patient's age, gender, pain, range of motion, instability, function, bone union, and complication were recorded. RESULTS: At the operation, the mean age of patients is 49.5 years (12~74 years) and mean follow up period is 18 months (13~82 months). In the range of motion, mean flexion is 122.1 degrees (75~140 degrees) and mean flexion contracture is 11.4 degrees (0~30 degrees). Results by Morrey's functional evaluation include 15 excellent, 23 good and 2 fair cases. There are 2 excellent and 5 good cases in patients of supracondylar fracture which didn't involve the articular surface (A2, A3 type of AO classification), and 13 excellent, 18 good and 2 fair cases in patients of intracondylar fracture which involve the articular surface (B2, C1, C2, C3 type). But there is no statistical significance in results between two groups. There are 3 excellent, 3 good cases in 6 open fracture and 2 excellent, 6 good and 1 fair case in 9 patients with multiple trauma. The patient's age, gender, open fracture, multiple trauma, and intraarticular fracture did not affect the results. CONCLUSION: Satisfactory results can be obtained if the modified anatomical Y-plate is used to treat a distal humerus fracture, regardless of many factors affecting the results.

Femoral Head Deformity in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To determine the developmental patterns of 4 major deformities of femoral head commonly observed in Legg-Calve-Perthes disease (LCPD): coxa plana, coxa magna, coxa vara, subluxation. MATERIALS AND METHODS: We reviewed the clinical records and radiographs of 85 unilateral LCPD children who were followed up from the early stage of disease to full skeletal maturity. Four major deformities were measured and observed during 3 periods: the active disease stages of avascular necrosis and fragmentation, the healing stage, and skeletal maturity. RESULTS: All four deformities were first observed at early stages of the disease, avascular or fragmentation stage. Appearance rates were 79% in coxa plana, 28% in coxa magna, 35% in coxa vara, and 27% in subluxation. The gradual progression of deformities with time which was demonstrated at the healing stage and at skeletal maturity were observed in all except subluxation. And this gradual increase was supposed to be dependent on the normal bony growth with aging. CONCLUSION: We determined the developmental pattern of major deformities of the femoral head. And this determination will help to understand the natural course of deformity which is clinically important in terms of late osteoarthritis.

Transcatheter arterial chemoembolization of hepatocellular carcinoma with portal vein invasion

Transcatheter arterial chemoembolization(TACE) is an imperative method for the managment of inoperable hepatocellular carcinoma(HCC). It is well known that primary HCC frequently invades the portal venous system and forms a tumor thrombus obstructing the portal blood flow which makes unfavorable prognosis of patiebt. We retrospetively reviewed 58 patients who reveived TACE(minimum 3 times) of HCC invading into portal venous system. Group 1(n=29) which showed peripheral portal vein invasion had better clinical and laboratory response. Group 2(n=17) which showed first order portal branch invasion had similar response to Group 3(n=12), which had main portal invasion. Group 1 showed no difference in survival time between TAC and TACE, but, in Group 2 and 3, emboliation with chemotherapy made longer survival than chemotherapy only. Clinical level of AFP was meaningful in Group 1 and 2 as decreasing value. Our results provides that careful selection of TACE and case by case Coil/Gelfoam embolization can improve the mean survival and clinical response when HCC evidently invades portal venous system.