Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding.

BACKGROUND/AIMS: Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding. METHODS: The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients' medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment. RESULTS: A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p < 0.0001) and a hemoglobin level less than 8.6 g/dL (AOR, 1.768; 95% CI, 1.028 to 3.039; p = 0.039) were independent predictors for endoscopic hemostasis. Significant differences in the morbidity rates of endoscopic hemostasis were detected between the group with no predictive factors and the group with one or more predictive factors (OR, 2.677; 95% CI, 1.920 to 3.733; p < 0.0001). CONCLUSION: A bloody nasogastric lavage and hemoglobin < 8.6 g/dL were independent predictors of endoscopic hemostasis in patients with acute upper gastrointestinal bleeding.

Overexpression of peroxiredoxin-3 and -5 is a potential biomarker for prognosis in endometrial cancer.

Endometrial cancer is the sixth most common cancer in women worldwide. Peroxiredoxins (PRDXs) are antioxidant enzymes that serve important roles in cell differentiation, proliferation, and apoptosis. In the present study, the potential associations between PRDX expression and endometrial cancer were investigated. The expression levels of various PRDX mRNAs were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) in endometrial cancer tissues (n=26) and normal endometrial tissues (n=10). Additionally, the expression of PRDX isoforms was immunohistochemically examined in endometrial cancer tissues and adjacent normal endometrial tissues from 42 patients. Finally, the associations between high PRDX expression levels and clinicopathological features were examined in patients with endometrial cancer. Analysis of PRDX expression in endometrial cancer tissues and normal endometrial tissues by semi-quantitative RT-PCR showed that all PRDX isoforms had increased expression in the endometrial cancer tissues compared with that in the normal endometrium, and the differences in the expression levels of PRDX1 and PRDX3 between cancer and normal tissues were statistically significant (P=0.0015 and P=0.0134, respectively). Additionally, analysis of PRDX expression in endometrial cancer and paired normal endometrial tissues by immunohistochemistry showed strong cytoplasmic staining of PRDX3 and PRDX5 in cancer tissues, with high PRDX3 (25/42, 59.5%) and PRDX5 (32/42, 76.2%) appearing more frequently in endometrial cancer than in normal endometrial tissues (P=0.0001 and P=0.0023, respectively). Furthermore, high expression of PRDX5 was associated with advanced-stage endometrial cancer (P=0.0399). Although the 5-year survival rate was marginally higher in patients with low expression of PRDX3 and PRDX5, this result was not statistically significant. In summary, PRDX3 and PRDX5 are highly expressed in endometrial cancer and could be associated with advanced stage and poor prognosis. Therefore, these proteins may potentially be used as prognostic markers for endometrial cancer.

Clinical significance of elevated serum alpha-fetoprotein (AFP) level in acute viral hepatitis A (AHA).

BACKGROUND/AIMS: The clinical course of acute viral hepatitis A (AHA) is highly variable. Serum alphafetoprotein (AFP) level is often elevated in various types of acute liver injuries, indicating active liver regeneration. This study was aimed to investigate the clinical significance of serum AFP level in the aspect of the early recovery in AHA. METHODOLOGY: A total of 238 patients with AHA, confirmed by IgM anti-hepatitis A virus, were included. The patients were classified according to serum AFP level. Multivariate analysis by Cox proportional hazards model using dichotomized clinical variables was performed to identify the independent predictors for early recovery (ALT normalization within 2 weeks). RESULTS: The median age (range) was 30 (17-50) years and male dominant (62%, 147/238). Compared to low AFP group, high AFP group (>10 ng/mL) had significantly lower platelet counts (p <0.0001), lower albumin (p =0.003), lower AST (p <0.001), lower ALT (p = 0.001), higher total bilirubin level (p <0.0001) on univariate analysis. On Cox regression analysis, high AFP level (>10 ng/mL) was the only independent predictor for early recovery (Hazard ratio (HR); 2.392, 95% CI; 1.564-3.659, p = 0.0001). CONCLUSIONS: High serum AFP level (>10 ng/mL) may indicate the already-started recovery through active liver regeneration or the early recovery within 2 weeks in AHA.

[The Comparison between 6th and 7th International Union Against Cancer/American Joint Committee on Cancer Classification for Survival Prognosis of Gastric Cancer].

BACKGROUND/AIMS: The tumor-node-metastasis (TNM) staging is an useful system to assess the prognosis of any solid cancer. As new TNM staging classification of 7th stomach cancer was revised in 2009, we evaluated the prognostic predictability of the 7th International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) TNM classification compared to 6th UICC/AJCC TNM classification in gastric cancer. METHODS: From January 2000 to December 2009, 5-year survival rates of 266 patients with gastric cancer were calculated by the 6th and 7th UICC/AJCC TNM classification. RESULTS: Using the 7th UICC/AJCC TNM classification, there was no significant difference in the 5-year cumulative survival rates (5 YSR) between stage IIA and IIB, IIB and IIIA, and IIIA and IIIB (70% vs. 71%, p=0.530; 71% vs. 80%, p=0.703; 80% vs. 75%, p=0.576, respectively) though significant differences of the survival rates were observed among stages of 6th edition. Using T stage of 7th edition, 5 YSR was not different between T2 and T3 (86% vs. 82%, p=0.655). Using N stage of 7th edition, 5 YSR were not different between N1 and N2, N3a and N3b (79% vs. 81%, p=0.506; 41% vs. 17%, p=0.895, respectively). CONCLUSIONS: The 7th UICC/AJCC TNM classification had poor prognostic predictability in gastric cancer compared to the 6th edition.

The linear shrinkage and microhardness of packable composites polymerized by QTH or PAC unit.

This study evaluated the effectiveness of a plasma arc curing (PAC) unit for packable resin composite curing. The amount and speed of polymerization shrinkage and the microhardness of packable composites were evaluated in order to compare the PAC unit's effectiveness with a quartz tungsten halogen (QTH) unit. Sure Fil (Dentsply Caulk), Pyramid (BISCO Inc) and Synergy Compact (Colténe/Whaledent) were used as the packable composites. In the case of curing with the PAC unit, the composites were light cured with Apollo 95E (DMD System Inc) for 1 second (Group 1), 2 seconds (Group 2), 3 seconds (Group 3), 6 seconds (Group 4) and 12 seconds (Group 5). For light curing with the QTH unit, the composites were light cured for 60 seconds using XL3000 (Group 6). The linear polymerization shrinkage of each composite was measured using a custom made linometer, and the data was stored in a computer every 0.5 to 0.55 seconds for a total of 60 seconds. For each composite, the amount of polymerization was compared using one-way ANOVA with Tukey at the 95% confidence level. In order to compare the speed of polymerization, the peak time (PT), showing the highest speed of polymerization and maximum speed of polymerization (Smax), were determined from the data and compared using one-way ANOVA with Tukey at the 95% confidence level for each material. Based on the statistical analysis among the PAC-cure groups (Groups 1 through 5), the group that was not statistically different from the QTH-cure group (Group 6) in the amount of linear polymerization shrinkage was determined for each material, and the corresponding curing time of the group was defined as the tentative minimum PAC-curing time (TMPT). For microhardness measurements, the samples were placed in a 2-mm thick Teflon plate. Twenty specimens, randomly divided into the PAC-cure group (Group 1) or the QTH-cure group (Group 2), were prepared for each material. In Group 1, each composite was light cured for TMPT with the PAC unit. In Group 2, each composite was light cured for 60 seconds with the QTH unit. Microhardness was measured on the upper and lower surface. For each material, the microhardness of the upper and lower surface of Groups 1 and 2 was analyzed using two-way ANOVA with Tukey at the 95% confidence level. The amount of polymerization was Group 1

Comparison of linear polymerization shrinkage and microhardness between QTH-cured & LED-cured composites.

This study evaluated the effectiveness of second generation light emitting diode (2ndLED) units in composite curing. In order to compare their effectiveness with that of conventional quartz tungsten halogen light curing units (QTH) and first generation LEDs (1stLED), the amount of linear polymerization shrinkage, polymerization speed and microhardness were measured. Linear polymerization shrinkage was measured every 0.5-0.55 seconds for 60 seconds when composite specimens (Z250, 3M ESPE Dental Products, St Paul, MN, USA) were light cured with five different light sources: XL 3000 (QTH, 3M ESPE Dental Products), Elipar FreeLight 2 (2ndLED, 3M ESPE Dental Products), Ultra-Lume LED2 (2ndLED, Ultradent Products, South Jordan, UT, USA), Elipar FreeLight (1stLED, 3M ESPE Dental Products) and experimental product X (1stLED, Biomedisys, Seoul, Korea). The amount of linear polymerization shrinkage in 60 seconds and the speed of polymerization shrinkage in the first 15 seconds were measured for the different lighting units. The amount of polymerization was compared with one-way ANOVA using Tukey at the 95% confidence level. In order to compare the speed of polymerization, the peak time (PT) showing the highest speed of polymerization and maximum speed of polymerization (Smax) were determined from the data and compared using one-way ANOVA with Tukey at the 95% confidence level for each material. For microhardness measurements, the microhardness of 2-mm composites, Z250, which had been light cured by XL 3000 (G1), FreeLight 2 (G2), Ultra-Lume LED2 (G3), FreeLight (G4) or experimental product X (G5) were compared on the upper and lower surface. The microhardness of each surface was compared between groups using two-way ANOVA with Tukey test at 95% levels of confidence. The amount of polymerization shrinkage at 60 seconds was G1, G2, G3> G4, G5 (p<0.05). PT was G1, G3 G3 >G4, G5 (p<0.05). On the upper composite surface, there was no difference in microhardness between groups (p<0.05). On the lower surface, the microhardness was G1, G2> G3> G4, G5 (p<0.05). There was no difference in microhardness between the upper and lower surface in G1 and G2; whereas, microhardness of the lower surface was lower in G3, G4 and G5. It was concluded that 2ndLEDs and the conventional QTH unit cu red composites moreeffectively than 1stLEDs.

Curing units' ability to cure restorative composites and dual-cured composite cements under composite overlay.

This study compared the efficacy of using conventional low-power density QTH (LQTH) units, high-power density QTH (HQTH) units, argon (Ar) laser and Plasma arc curing (PAC) units for curing dual-cured resin cements and restorative resin composites under a pre-cured resin composite overlay. The microhardness of the two types of restorative resins (Z100 and Tetric Ceram) and a dual-cured resin cement (Variolink II) were measured after they were light cured for 60 seconds in a 2 mm Teflon mold. The recorded microhardness was determined to be the optimum microhard-ness (OM). Either one of the two types of restorative resins (Z100, Tetric Ceram) or the dual cured resin cement (Variolink II) were placed under a 1.5-mm thick and 8 mm diameter pre-cured Targis (Vivadent/Ivoclar AG, Schaan, Liechtenstein) overlay. The specimens that were prepared for each material were divided into four groups depending upon the curing units used (HQTH, PAC, Laser or LQTH) and were further subdi-vided into subgroups according to light curing time. The curing times used were 30, 60, 90 and 120 seconds for HQTH; 12, 24, 36 and 48 seconds for the PAC unit; 15, 30, 45 and 60 for the Laser and 60, 120 or 180 seconds for the LQTH unit. Fifteen specimens were assigned to each sub- group. The microhardness of the upper and and lower composite surfaces under the Targis overlay were measured using an Optidur Vickers hardness-measuring instrument (Göttfert Feinwerktechnik GmbH, Buchen, Germany). In each material, for each group, a three-way ANOVA with Tukey was used at the 0.05 level of significance to compare the microhardnesses of the upper and lower composite surfaces and the previously measured OM of the material. From the OM of each material, 80% OM was calculated and the time required for the microhardness of the upper and lower surface of the specimen to reach 100% and 80% of OM was determined. In Z100 and Tetric Ceram, when the composites were light cured for 120 seconds using the HQTH lamp, microhardnesses of the upper and lower surfaces reached OM. When they were cured with the PAC unit, only 48 seconds was needed for the upper and lower surfaces to reach OM. When they were cured using the laser, the lower surface did not reach OM in any of the groups. When the specimens were cured using the LQTH lamp, 180 seconds of curing was needed for Z100 to reach OM, whereas Tetric Ceram did not reach OM. In Z100, 60, 12, 30 and 60 seconds were needed in HQTH, PAC, Laser and LQTH, respectively, for the specimens to reach 80% OM. Tetric Ceram was needed 60,24,45 and 180 seconds to reach 80% OM. In the Variolink II specimen, microhardness of the upper and lower surfaces did not reach OM even though they were light cured with the HQTH lamp for 120 seconds. When they were cured with the PAC unit, 48 seconds was insufficient for them to reach OM. When they were cured with laser for 45 and 60 seconds, microhardness reached OM on the upper surface but not on the lower surface. However, when they were cured using the LQTH lamp, microhardness did not reach OM on the upper and lower surfaces even though the curing time was extended to three minutes. In Variolink II, 120, 36, 45 and >180 seconds were needed in HQTH, PAC, Laser and LQTH, respectively, for the specimens to reach 80% OM. In conclusion, the PAC system is the most effective curing system to cure the restorative composite and dual cured resin cement under the 1.5 mm Targis overlay, followed by the laser, HQTH and LQTH units. In addition, the restorative composites cured more efficiently than the dual-cured resin cements.