Blunt Trauma in Children: Efficacy and Safety of Transarterial Embolization, 10-Year Experiences in a Single Trauma Center.

BACKGROUND: Transcatheter arterial embolization (TAE) is an established approach for controlling hemorrhage in adults with acute abdominal and pelvic trauma. However, its application in pediatric trauma is not well established. This study aimed to evaluate the safety and effectiveness of TAE in a population of pediatric patients with blunt trauma. METHODS: This retrospective study was conducted in pediatric patients (<18 years) who underwent TAE for blunt trauma between February 2014 and July 2022. The patients were categorized into subgroups based on age and body weight. Patient demographics, injury severity, transfusion requirements, and clinical outcomes were analyzed. RESULTS: Exactly 73 patients underwent TAE. Technical success was achieved in all patients (100%), and clinical success was achieved in 83.6%. The mortality and complication rates were 4.1% and 1.4%, respectively. The mean duration of hospitalization was 19.3 days. Subgroup analysis showed that age, body weight, and sex did not significantly affect clinical success. The injury severity score and transfusion requirement were predictors of clinical success, with lower values associated with better outcomes. CONCLUSIONS: TAE is effective and safe for managing blunt pediatric trauma in younger and lighter patients. Injury severity and transfusion requirement are predictors of clinical success.

Clinical outcomes of splenic arterial embolization for blunt splenic injury in pediatric and adolescent patients.

BACKGROUND: Splenic arterial embolization (SAE) is an effective intervention for the management of arterial hemorrhage asso-ciated with blunt splenic injury. However, its role and clinical outcomes in pediatric and adolescent patients are unclear. The aim of this study is to assess the role and the clinical outcomes of SAE for blunt splenic injuries in pediatric and adolescent trauma patients. METHODS: A retrospective cohort study was performed in patients aged ≤17 years with blunt splenic injury transferred to a re-gional trauma center in a tertiary referral hospital between November 01, 2015, and September 30, 2020. The final study population consisted of 40 pediatric and adolescent patients with blunt splenic injuries. The patient demographics, mechanisms of injury, details of injuries, angiographic findings, embolization techniques, and technical and clinical outcomes, including spleen salvage rates and pro-cedure-related complications, were examined. RESULTS: Of the 40 pediatric and adolescent patients with blunt splenic injury, 17 underwent SAE (42.53%). The clinical success rate was 88.2% (15/17). No cases of embolization-related complications or clinical failure were observed. Spleen salvage after SAE was achieved in all patients. In addition, no statistically significant differences were observed in clinical outcomes (clinical success and spleen salvage rates) between low-grade (World Society of Emergency Surgery [WSES] spleen trauma classification I or II) and high-grade (WSES classification III or IV) splenic injury groups. CONCLUSION: SAE is a safe and feasible procedure, and is effective for successful spleen salvage of blunt splenic injuries in pediatric and adolescent patients.

Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma.

BACKGROUND: In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE). METHODS: We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs. RESULTS: The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage. CONCLUSIONS: In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective.

Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture.

BACKGROUND: While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture. METHODS: Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients' outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes. RESULTS: The median DTE time was 150 min (interquartile range, 121-184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20-3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04-1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28. CONCLUSION: Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

Morphological and Chemical Evaluations of Leaf Surface on Particulate Matter2.5 (PM2.5) Removal in a Botanical Plant-Based Biofilter System.

Particulate matter has been increasing worldwide causing air pollution and serious health hazards. Owing to increased time spent indoors and lifestyle changes, assessing indoor air quality has become crucial. This study investigated the effect of watering and drought and illumination conditions (constant light, light/dark cycle, and constant dark) on particulate matter2.5 (PM2.5) removal and surface characterization of leaf in a botanical plant-based biofilter system. Using Ardisia japonica and Hedera helix as experimental plants in the plant-based biofilter system, PM2.5, volatile organic carbon, and CO2, as the evaluators of indoor air quality, were estimated using a sensor. Morphological and chemical changes of the leaf surface (i.e., roughness and wax) associated with PM2.5 removal were characterized via scanning electron microscopy, Fourier transform infrared spectroscopy, and atomic force microscopy. The highest PM2.5 removal efficiency, stomata closure, high leaf roughness, and wax layer were observed under drought with constant light condition. Consequently, PM2.5 removal was attributed to the combined effect of leaf roughness and wax by adsorption rather than stomatal uptake. These results suggest that operating conditions of indoor plant-based biofilter system such as watering (or drought) and illumination may be applied as a potential strategy for enhancing PM2.5 removal.

Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization.

Purpose: We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods: Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results: Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion: TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Transarterial embolisation is associated with improved survival in patients with pelvic fracture: propensity score matching analyses.

INTRODUCTION: Transarterial embolisation (TAE) is an effective intervention for management of arterial haemorrhage associated with pelvic fracture. However, its effects on survival and clinical outcomes are unclear. METHODS: Trauma patients with survival data between November 2015 and December 2019 were identified using a trauma database. Patients were divided between TAE and non-TAE groups, and a propensity score was developed using multivariate logistic regression. Survival at 28 days was compared between the groups after propensity score matching. RESULTS: Among 881 patients included in this study, 308 (35.0%) were treated with TAE. After propensity score matching, 130 pairs were selected. Survival at 28 days was significantly higher among patients treated with TAE than among those treated without TAE [122 (93.9%) vs. 112 (86.2%); odds ratio = 2.45; 95% CI 1.02-5.86; p = 0.039]. CONCLUSIONS: TAE use was associated with improved survival at 28 days in patients with pelvic fracture and should therefore be considered in the management of severely injured patients with pelvic fracture.

Complete Posterior Urethral Disruption Accompanied by Complex Pelvic Fractures: Clinical Outcomes of Fluoroscopic Primary Posterior Urethral Realignment.

PURPOSE: To evaluate the clinical outcomes of fluoroscopic primary posterior urethral realignment (PPUR) for complete posterior urethral disruption (PUD) accompanied by complex pelvic fractures. MATERIALS AND METHODS: Data from 15 male patients (median age, 58 years; range, 32-76 years) with traumatic PUD treated with fluoroscopic PPUR between 2016 and 2019 at a regional trauma center were retrospectively analyzed. The technical success (continuity of the ruptured urethra in PUD by Foley catheter placement) rate of fluoroscopic PPUR, trauma mechanism, concurrent embolization for pelvic arterial hemorrhage, time from the hospital visit to the start of the procedure, procedure time, Foley catheterization duration, and delayed complications were investigated. RESULTS: Fluoroscopic PPUR was technically successful for 13 of 15 (87%) patients. Concurrent embolization for pelvic arterial hemorrhage was performed in 11 of 15 (73%) patients. The mean time between the hospital visit and procedure initiation was 181.6 minutes ± 83.2. The mean procedure time was 66.3 minutes ± 26.6. The mean Foley catheterization duration for 13 patients (technical success group) was 52.3 days ± 39.8 (median, 40 days; range, 21-177 days). Symptomatic urethral stricture developed in 9 of 13 (69.2%) patients after the procedure; 7 underwent visual internal urethrotomy, 4 required regular urethral dilatation, and 2 needed urethral stent insertion. Three of 13 (23%) patients did not have delayed complications during the 1-year follow-up. CONCLUSIONS: PPUR with fluoroscopic guidance appears safe and effective for achieving the continuity of the ruptured urethra in PUD. It enables PPUR without general anesthesia and the lithotomy position in patients with complex pelvic fractures.

Characteristics of exposure and health risk air pollutants in public buses in Korea.

The objective of this study was to estimate the concentrations of indoor air pollutants in unregulated public transport means in Korea and to determine the factors affecting the air quality as well as to assess the harmful effects of indoor air pollutants on the health of passengers. The correlation between particulate matter (PM10) and number of passengers on intra-city buses, express buses, town shuttle buses, or rural buses was insignificant whether it was during rush hours or non-rush hours. In regard to PM10 on express buses, there was no case where the standard limit was exceeded during the winter and summer seasons. In winter, however, the average concentration of PM10 increased by the travel distance. In regard to CO2, there was a statistically significant correlation (p < 0.05) between CO2 concentrations and the number of passengers, owing to human respiration. Unlike the case of PM10, there was a difference between rush hours and non-rush hours. Regarding volatile organic compounds (VOCs) and aldehydes, the values were high among recently manufactured vehicles regardless of bus types. The standard limit was exceeded during the summer season, which seemed to be related to the temperature and humidity in both indoor and outdoor. The results of this study indicate that the excess mortality resulting from PM10 was as high as the safety margin during both non-rush hours and rush hours among all unregulated public transportation means. The excess cancer risk and non-cancer risk of VOCs and aldehydes were as high as the safety margin during both non-rush hours and rush hours.

Clinical Results of Distal Embolization in Grade V Splenic Injury: Four-Year Experience from a Single Regional Trauma Center.

PURPOSE: To evaluate the benefits and risks of splenic artery embolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) grade V blunt spleen injury (BSI) MATERIALS AND METHODS: Medical records of 88 patients treated with SAE between April 2013 and May 2017 at a regional trauma care center were reviewed retrospectively. The BSI grade according to the AAST spleen injury scale (revised version 2018) was determined by using computed tomography (CT) images. A total of 42 patients (46.6%) had AAST grade V injury and were included in the analysis. Patient demographics, angiographic findings, embolization techniques, and technical and clinical outcomes, including splenic salvage rate and procedure-related complications, were examined. RESULTS: SAE was performed within 2 hours after admission for 78.5% of the patients. All patients underwent selective distal embolization (n = 42). Primary clinical success rate was 80.9% (n = 34), and secondary clinical success rate was 88.1% (n = 37). The clinical failure group consisted of 5 patients. Four patients underwent splenectomy, and 1 patient died due to acute respiratory distress syndrome after embolization. The splenic salvage rate was 85.7% (n = 36). No patient had sepsis at follow-up (median, 247.0 days; interquartile range, 92.0-688.0). Clinical success rates (P = .356) and spleen salvage rates (P = .197) of patients who were hemodynamically stable (n = 19) showed no significant differences from those who were unstable (n = 23). CONCLUSIONS: Distal embolization of grade V BSI is a safe and feasible procedure which is effective for successful spleen salvage.

Evaluation of IAQ Management Using an IoT-Based Indoor Garden.

This study was designed to verify the effectiveness of smart gardens by improving indoor air quality (IAQ) through the installation of an indoor garden with sensor-based Internet-of-Things (IoT) technology that identifies pollutants such as particulate matter. In addition, the study aims to introduce indoor gardens for customized indoor air cleaning using the data and IoT technology. New apartments completed in 2016 were selected and divided into four households with indoor gardens installed and four households without indoor gardens. Real-time data and data on PM2.5, CO2, temperature, and humidity were collected through an IoT-based IAQ monitoring system. In addition, in order to examine the effects on the health of occupants, the results were analyzed based on epidemiological data, prevalence data, current maintenance, and recommendation criteria, and were presented and evaluated as indices. The indices were classified into a comfort index, which reflects the temperature and humidity, an IAQ index, which reflects PM2.5 and CO2, and an IAQ composite index. The IAQ index was divided into five grades from "good" to "hazardous". Using a scale of 1 to 100 points, it was determined as follows: "good (0-20)", "moderate (21-40)", "unhealthy for sensitive group (41-60)", "bad (61-80)", "hazardous (81-100)". It showed an increase in the "good" section after installing the indoor garden, and the "bad" section decreased. Additionally, the comfort index was classified into five grades from "very comfortable" to "very uncomfortable". In the comfort index, the "uncomfortable" section decreased, and the "comfortable" section increased after the indoor garden was installed.

Development of p-Coumaric Acid Analysis in Human Plasma and Its Clinical Application to PK/PD Study.

It has been recognized that p-Coumaric acid (p-CA) has protective effects as an antioxidant, anti-inflammatory agent. A sensitive and efficient Liquid Chromatography-Mass Spectrometry (LC-MS) method for maximum determination of p-CA in human plasma has been established using Ultra-performance liquid Chromatography-tandem mass Spectrometry (UPLC-MS/MS). This study provides the developed analysis of p-CA extracted from Bambusae Caulis in Taeniam (BC) to examine the improvement of the treatment p-CA, IGF-1 and Osteocalcin level in human children which are important factors on the growth of children's height through Pharmacokinetics/Pharmacodynamics (PK/PD) model. p-CA and internal standard in a plasma sample were detected by the Multiple Reaction Monitoring (MRM) scan mode with positive ion detection. The sample participating in the study was made of 34 subjects (placebo = 18, treatment = 16). The subjects were enrolled to be randomized to the control group and BC group. Randomized subjects took tested treatment twice a day, three capsules with oral administration (258 mg/capsule) each time after a meal. Standard calibration curves (reproducibility) were constructed and the lower limit of quantitation (LLOQ) for p-CA was found to be 0.2 ng/mL on injection of the sample into the UPLC-MS/MS system. Accuracy and precision were evaluated and the intra-accuracy was 99.2-103.8% with precision of 1.0-5.6% and inter-accuracy was 99.6-108.4% and precision of 1.3-6.4% for p-CA. The method has been successfully applied to PK/PD studies of p-CA in human plasma. The p-CA, BC in Taeniam extract increased the level of IGF-1 and Osteocalcin, and changed the height from baseline, which suggested that the p-CA could play an important role in longitudinal bone growth. Therefore, the p-CA extracted from BC in Taeniam might be a good alternative medicine to growth hormone (GH) therapy.

Concentrations of particulate matter, carbon dioxide, VOCs and risk assessment inside Korean taxis and ships.

The objective of this study was to investigate the concentration distribution of indoor air pollutants in taxis and ships (passengers) which are frequently used for public transportation and recreational activities in South Korea. In addition, it aimed to assess air quality factors to establish and evaluate the health risks of exposure to polluted indoor air. Particulate matter (PM10) concentrations were not affected by the number of passengers, time of day, and driving characteristics because there were only a few passengers (2 to 4 people) and the space was confined. In the ships, indoor air pollutants responded more sensitively to the operation characteristics depending on the time of sailing (i.e., anchoring and departure, movement of vehicles on the ship, movement of passengers, combustion in the shop, and ventilation) than to the number of people boarding and alighting. The carbon dioxide concentrations in different ship rooms did not vary according to season and degree of congestion; however, there were differences between different ships. These differences may result from the size, type, and operating characteristics of the ships. Volatile organic compounds (VOCs) and aldehydes in new taxis exceeded the standard levels during summer. VOC concentrations in ships were particularly high during summer when the outdoor temperature was high. Similar observations were made for other means of transportation. The risk assessment depended on the means of transportation and demonstrated that mortality risks due to PM10 and excess carcinogenic and non-carcinogenic risks from VOCs and aldehydes were within safety levels.

Indoor contamination from pesticides used for outdoor insect control.

The present study assessed the indoor level of pesticide residue contamination at a total of 45 dwelling facilities in 5 cities of South Korea from June to November 2014. Pesticide residue contamination was assessed by measuring the frequency and concentration of chlorpyrifos, dichlorvos, and cypermethrin residues in airborne particles, indoor dust, and surface wipes. A preparatory test showed a decreasing tendency in the concentrations of pesticide residues in indoor air over time: from 0.458 to 0.073mg/m3 in dichlorvos for 4weeks and from below 0.050mg/m3 to non-detection in the other substances for 2weeks. Then, pesticide residues were detected indoors 4weeks after outdoor chemical control, implying the infiltration of pesticide particles from outdoors. Airborne particles of dichlorvos were found at a higher level (74.4% of samples at a concentration of 0.053mg/m3), whereas those of the other substances were detected at lower levels (6.1% at 0.002mg/m3 in chlorpyrifos and 9.4% at 0.022mg/m3 in cypermethrin). There was no consistent tendency in the indoor levels of pesticide residue contamination according to dwelling types or indoor height. The indoor levels of dichlorvos residue contamination were lower in industrial districts than in urban or rural districts: 63.9% and 0.013mg/m3 for airborne particles, 13.3% and 0.002µg/g for indoor dust, and 6.7% and 0.001mg/cm2 for surface wipes, respectively. There were no significant differences in the indoor levels of pesticide residue contamination between urban and rural districts. The current study found that most dwelling facilities managed their indoor levels of pesticide residue contamination below permissible exposure limit (PEL, 1.0mg/m3) or threshold limit value (TVL, 0.1mg/m3), whereas some facilities did not. So, we suggest that certain guidelines should be drawn up regarding the indoor environment management.

Pharmacokinetic interactions between glimepiride and rosuvastatin in healthy Korean subjects: does the SLCO1B1 or CYP2C9 genetic polymorphism affect these drug interactions?

To improve cardiovascular outcomes, dyslipidemia in patients with diabetes needs to be treated. Thus, these patients are likely to take glimepiride and rosuvastatin concomitantly. Therefore, this study aimed to evaluate the pharmacokinetic (PK) interactions between these two drugs in healthy males and to explore the effect of SLCO1B1 and CYP2C9 polymorphisms on their interactions in two randomized, open-label crossover studies. Glimepiride was studied in part 1 and rosuvastatin in part 2. Twenty-four participants were randomly assigned to each part. All subjects (n=24) completed part 1, and 22 subjects completed part 2. A total of 38 subjects among the participants of the PK interaction studies were enrolled in the genotype study to analyze their SLCO1B1 and CYP2C9 polymorphisms retrospectively (n=22 in part 1, n=16 in part 2). Comparison of the PK and safety of each drug alone with those of the drugs in combination showed that both glimepiride and rosuvastatin did not interact with each other and had tolerable safety profiles in all subjects. However, with regard to glimepiride PK, the SLCO1B1 521TC group had a significantly higher maximum plasma concentration (Cmax,ss) and area under the plasma concentration-time curve during the dose interval at steady state (AUCτ,ss) for glimepiride in combination with rosuvastatin than those for glimepiride alone. However, other significant effects of the SLCO1B1 or CYP2C9 polymorphism on the interaction between the two drugs were not observed. In conclusion, there were no significant PK interactions between the two drugs; however, the exposure to glimepiride could be affected by rosuvastatin in the presence of the SLCO1B1 polymorphism.

Effects of Aqueous Extract of Phyllostachyos Caulis in Taeniam on Longitudinal Bone Growth in Adolescent Rats.

This study examined whether treatment with Phyllostachyos Caulis in Taeniam aqueous extract improves longitudinal bone growth in adolescent male rats. Three-week-old male Sprague-Dawley rats were divided into three groups: a control group, a Phyllostachyos Caulis in Taeniam group (200 mg/kg, p.o.), and a recombinant human growth hormone group (20 µg/kg, s.c.). The total tibial length and the height of each growth plate zone were evaluated by radiography and histomorphometry. The total number of proliferative cells and 5-bromo-2'-deoxyuridine-positive cells were counted after 5-bromo-2'-deoxyuridine staining. Serum total osteocalcin levels were assayed using an enzyme-linked immunosorbent assay. The average total tibial length of the Phyllostachyos Caulis in Taeniam group was significantly longer than that of the control group. The heights of the proliferative and hypertrophic zones in the Phyllostachyos Caulis in Taeniam group were increased, and the ratio of 5-bromo-2'-deoxyuridine-positive to total cells in the proliferative zone was also increased. The serum osteocalcin, growth hormone, and insulin-like growth factor-1 levels were significantly increased in the Phyllostachyos Caulis in Taeniam group compared to the control group. Insulin-like growth factor-1 and insulin-like growth factor-1 receptor were highly expressed in the proliferative and hypertrophic zones in the Phyllostachyos Caulis in Taeniam group. The Phyllostachyos Caulis in Taeniam extract increased bone length, promoted cell proliferation, and activated the growth plate zones, which suggested that the extract could play an important role in longitudinal bone growth. Therefore, the Phyllostachyos Caulis in Taeniam extract might be a good alternative medicine to growth hormone therapy.

Ki-67 and p53 expression as a predictive marker for early postoperative recurrence in pancreatic head cancer.

PURPOSE: This study aimed to evaluate the clinical significance of Ki-67 and p53 expressions in patients with pancreatic head cancer. METHODS: Between May 2008 and April 2013, immunohistochemical staining for Ki-67 and p53 was performed in 34 patients with pancreatic head cancer (ductal adenocarcinoma). All 34 patients underwent pancreaticoduodenectomy at Chonnam National University Hwasun Hospital, Hwasun, Korea. Clinical and histopathological characteristics were analyzed, relative to p53 expression. RESULTS: Thirty (88.2%) and twenty-one (61.7%) of the 34 pancreatic head cancers exhibited positive expression of Ki-67 and p53, respectively. Patients expressing Ki-67 and p53 experienced more frequent tumor recurrences within 1 year after surgical resection (P = 0.003 and P = 0.030, respectively). However, no correlation was detected between Ki-67 and p53 expression. Ki-67 expression was correlated with pathological grade, lymph node metasatsis, and clinical stage (P < 0.05). Importantly, Ki-67 was the independent predictive factor for postoperative recurrence within 1 year in both univariable and multivariable analyses (odds ratio, 27.219; 95% confidence interval, 1.403-528.135; P = 0.029). CONCLUSION: The expression of Ki-67 and p53 are significantly related to early postoperative recurrence within 1 year after surgical resection in pancreatic head cancer. Especially, Ki-67 was the independent predictive factor for postoperative recurrence within 1 year. Therefore, immunohistochemical staining for Ki-67 and p53 may be applied as a predictive marker for early postoperative recurrence in pancreatic head cancer.

A selective involvement of putamen functional connectivity in youth with internet gaming disorder.

Brain cortico-striatal circuits have consistently been implicated in the pathology of addiction related disorders. We applied a reliable seed-based analysis of the resting-state brain activity to comprehensively delineate the subdivisions of striatal functional connectivity implicated in internet gaming disorder. Among twelve right-handed male adolescents with internet gaming disorder and 11 right-handed and gender-matched healthy controls, we examined group differences in the functional connectivity of dorsal and ventral subdivisions of the caudate nucleus and putamen, as well as the association of these connectivity indices with behavioral measures of internet use. Adolescents with internet gaming disorder showed significantly reduced dorsal putamen functional connectivity with the posterior insula-parietal operculum. More time spent playing online games predicted significantly greater functional connectivity between the dorsal putamen and bilateral primary somatosensory cortices in adolescents with internet gaming disorder, and significantly lower functional connectivity between the dorsal putamen and bilateral sensorimotor cortices in healthy controls. The dorsal putamen functional connectivity was significantly and specifically different in adolescents with internet gaming disorder. The findings suggest a possible biomarker of internet gaming disorder.