Predictive factors for risk of hepatocellular carcinoma in immune inactive chronic hepatitis B.

BACKGROUND AND AIMS: The risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) have not been clarified. The aim of this study was to investigate the predictive factors for HCC inimmune inactive CHB. METHODS: A total of 337 patients in immune inactive CHB were consecutively enrolled in Kangdong Sacred Heart Hospital from 1995 to 2017. Univariate and multivariate analyses were performed to identify the independent risk factors for HCC development. RESULTS: During the mean 63 months of follow-up, the incidence of HCC of study population was 4.5% (15/337). Patients who developed HCC were older, had more cirrhosis at baseline, and were more likely to experience ALT elevation>2 X upper limit of normal (ULN) during follow-up than those without HCC. In Cox regression analysis, increased ALT levels>2 X ULN during follow-up (hazard ratio [HR], 3.774; 95% confidence interval [CI], 1.145-12.443; P=0.029] and presence of cirrhosis (HR, 11.768; 95% CI, 3.350-41.336; P<0.001) were identified as the independent factors for HCC in immune inactive CHB. With increasing number of risk factors, the respective cumulative incidence of HCC at 10 years was 6.3%, 8.8%, and 63.5%. CONCLUSIONS: Underlying cirrhosis and hepatic inflammation reflected by increased ALT levels>2 X ULN were significant predictors for HCC in immune inactive CHB. ALT elevation showed a synergistic effect in HCC development combined with cirrhosis. It suggests that patients with high serum ALT levels, especially those with cirrhosis, are required closer surveillance for HCC even in immune inactive CHB.

Study Design, Rationale and Procedures for Human Biomonitoring of Hazardous Chemicals from Foods and Cooking in Korea.

Objectives: A nationwide biomonitoring program identified the long-term trends of environmental exposures to hazardous chemicals in the general population and found geographical locations where body burdens of an exposed group significantly differed from those of the general population. The purpose of this study is to analyze the hazardous compounds associated with foods and cooking in the nationwide general population for evaluation of the environmental exposures and health risk factors and for the establishment of the reference levels at the national level. Methods: During 2009-2010, the National Institute of Food and Drug Safety Evaluation (NIFDS) conducted a nationwide human biomonitoring study, including a questionnaire survey and environmental exposure assessments for specific hazardous compounds from foods and cooking among the general population in South Korea. Results: A total of 2139 individuals voluntarily participated in 98 survey units in South Korea, including 889 (41.6%) men and 1250 women (58.4%). Bio-specimens (serum and urine) and questionnaires were collected from the study population. Acrylamides, heterocyclic amines (HCAs), phenols, and phthalates were analyzed from urine, and perfluorinated compounds (PFCs) and organic chloride pesticides (OCPs) were analyzed from serum samples. The information on exposure pathway and geographical locations for all participants was collected by questionnaire interviews, which included demographic characteristics, socioeconomic status, history of family diseases, conditions of the indoor and outdoor environment, lifestyles, occupational history, and food and dietary information. Conclusion: We describe the design of the study and sampling of human biospecimen procedures including bio-sample repository systems. The resources produced from this nationwide human biomonitoring study and survey will be valuable for use in future biomarkers studies and for the assessment of exposure to hazardous compounds associated with foods and cooking.

Serum concentrations of per- and poly-fluoroalkyl substances and factors associated with exposure in the general adult population in South Korea.

Per- and polyfluoroalkyl substances (PFASs) are ubiquitous contaminants found worldwide, including in South Korea. As a result, they are frequently detected in Koreans. However, there is limited representative data and information on potential sources in Korea. Therefore, we measured the serum concentrations of ten PFASs in nationally representative samples of the Korean population (n=1874, 18-69 years) and evaluated the factors associated with their exposure. Serum PFOS, PFDA, PFOA, and PFNA were detected in nearly all participants (83.1-99.9%). However, serum PFPA, PFHxA, and PFHpA were almost undetected (<0.5% of participants). PFOS had the highest population-weighted geometric mean of 10.23ng/mL (95% CI: 9.99-10.47), which was followed by PFOA with 2.85ng/mL (95% CI: 2.73-2.97) and PFDA with 2.17ng/mL (95% CI: 2.12-2.23). PFNA, PFDA, PFHxS, PFOA, and PFOS concentrations were higher in males (p<0.001) and older adults (p<0.001). PFNA was higher in those who used wax, polish, and water-resistant materials (adjusted proportional change=1.14; 95% CI: 1.08-1.22), and those who ate cooked fish (1.16; 95% CI: 1.03-1.31) compared to those who ate nearly no fish. PFDA was higher in those who used herbicides and pesticides (1.05; 95% CI: 1.02-1.09), those who drank beverages in a plastic bag on a daily basis (1.10; 95% CI: 1.03-1.19), and those who ate raw fish (1.15; 95% CI: 1.03-1.29) or cooked fish (1.13; 95% CI: 1.05-1.23) compared to those who ate nearly no fish. PFHxS was higher in those who used traditional Korean health supplement foods (1.08; 95% CI: 1.01-1.15). PFOA was higher in those who used plastic wrap in a microwave daily or weekly (1.08; 95% CI: 1.00-1.16), and those who used disposable paper cups (1.07; 95% CI: 1.01-1.13). PFOS was lower in underweight participants (0.84; 95%CI: 0.75-0.93) compared to those who were obese, and higher in those who exercised regularly (1.08; 95% CI: 1.03-1.14) or irregularly (1.06, 95% CI: 1.01-1.12) compared to those who did not exercise. Subjects who used severely damaged Teflon appliances had lower concentrations of PFOA (0.78, 95% CI: 0.65-0.95), while regular use of Gore-Tex goods was related to higher PFNA (1.15, 95% CI: 1.03-1.28) and PFDA (1.11; 95% CI: 1.02-1.20) levels. These findings suggest that most Koreans are frequently exposed to PFASs, and that serum concentrations of PFASs vary with age, sex, and exposure factors.

Urinary levels of phthalate metabolites and associations with demographic characteristics in Korean adults.

The objective of this study is to assess human exposure to phthalates and its associations with demographic characteristics of the subjects in the Korean National Human Biomonitoring Survey. The subjects aged between 18 and 69 were selected through nationwide stratified sampling. A total of 1874 urine samples were collected and stored at -20 °C until measurement for ten selected metabolites of phthalates (MnBP, MiBP, MBzP, MCHP, MnOP, MEHP, MEOHP, MEHHP, MiNP, and MiDP) using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). The difference in the level of urinary phthalate metabolites by the characteristics of the subjects was tested for statistical significance using SAS Surveyreg procedure. The coefficients and standard errors from multiple linear regressions were exponentiated to estimate the adjusted proportional change (APC) and 95% CIs compared with a referent level. The proportion of data above LOQ was less than 20% for MCHP, MnOP, MiNP, and MiDP. Geometric means of creatinine-adjusted concentrations (unit: µg/g creatinine) of six other phthalate metabolites among Korean adults were 41.7 (95% CI 39.6-43.9) for MnBP, 17.1 (95% CI 16.1-18.1) for MiBP, 15.7 (95% CI 14.4-17.1) for MBzP, 8.65 (95% CI 8.10-9.22) for MEHP, 17.5 (95% CI 16.8-18.3) for MEOHP, and 38.1 (95% CI 36.2-40.2) for MEHHP. Urinary level of phthalates tended to be higher among subjects with older age, females, and those with vigorous daily physical activity and tended to be lower among drinkers and those with higher income. Our results suggest that the level of phthalate exposure is significant among Korean adults and thus warrants further studies to identify major source and route of exposure to phthalates.

Diagnostic value of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma.

AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) in chronic hepatitis B (CHB). METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma (HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP and their combination were calculated and compared. RESULTS: The optimal cutoff values for PIVKA-II and AFP were 40 mAU/mL and 10 ng/mL, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-II and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-II and AFP were not significantly different (0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-II was significantly better than that of AFP in patients with cirrhosis (0.870 vs 0.812, P = 0.042). When PIVKA-II and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-II alone for the differentiation of HCC from nonmalignant CHB (P < 0.05), especially when cirrhosis was present (P < 0.05). CONCLUSION: Serum PIVKA-II might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.

Is There Any Difference in the Eradication Rate of Helicobacter pylori Infection According to the Endoscopic Stage of Peptic Ulcer Disease?

BACKGROUND: The eradication rate of Helicobacter pylori (H. pylori) infection might be affected by the degree of inflammation of gastric mucosa represented by the endoscopic stage of peptic ulcer disease (PUD). The aims of this study were to evaluate the eradication rates of H. pylori infection according to the endoscopic stage of PUD and to document whether early eradication in the active stage could yield a higher eradication rate in patients with peptic ulcer bleeding (PUB). MATERIALS AND METHODS: A total of 1,177 patients with PUD (380 gastric ulcer, 710 duodenal ulcer, and 87 combined ulcer) who received proton-pump inhibitor (PPI)-based triple therapy were included, and the eradication rates were compared by ulcer stage. Univariate and multivariate analyses were conducted to identify factors influencing eradication rate. In PUB, the eradication rates between the early eradication group (≤7 days) and the late eradication group (>7 days) were compared. RESULTS: The eradication rates according to endoscopic stage were significantly different in gastric ulcer (active vs healing vs scarring; 84.8% vs 82.7% vs 70.6%, p = .014, respectively), but there were no significant differences in duodenal ulcer (active vs healing vs scarring; 87.6% vs 80.9%% vs 80.9% p = .169, respectively). In multivariate analyses, active ulcer as well as age younger than 50 was a significantly independent predictor of successful eradication (Odds ratio; 2.799, 95% CI; 1.659-4.723, p = .0001). The eradication rate of the early eradication group was significantly higher than the late eradication group in PUB (89.2% vs 71.9%, 95% CI; 1.265-8.269, p = .011). CONCLUSIONS: There was a significant difference in the eradication rate according to the endoscopic stage of gastric ulcer. Active ulcer was an independent predictor of successful eradication. Furthermore, early H. pylori eradication should be considered in patients with PUB to yield a higher eradication rate.

Phylogenetic analyses of HBV pre-s/s genes in mother-child pairs with long-term infection by presumed vertical transmission.

Vertical transmission from mother to child, the main route of chronic hepatitis B virus (HBV) infection in the East Asia, is considered one of the most important predictors for the response to antiviral therapies as well as its complications such as cirrhosis and hepatocellular carcinoma. Therefore, it is critical in both etiologic and prognostic aspects to confirm whether or not chronic HBV infection is acquired vertically. This study investigated whether mother-to-child infection could be proved by the phylogenetic analyses of HBV pre-S/S genes ever since several decades have elapsed in mother-child pairs with presumed vertical transmission. The pre-S and S regions of HBVs were compared and analyzed phylogenetically in a total of 36 adults (18 mother-child pairs) with chronic HBV infection. All of the isolates of HBV were genotype C and serotype adr. The divergence between mothers and offsprings was 0 to 1.5%. Phylogenetic trees revealed that 17 of 18 pairs (94%) with presumed vertical transmission were grouped into the same cluster. Vertical transmission from mother to child could be strongly suggested even in adults with a history of several decades of HBV infection using the phylogenetic analyses of pre-S and S genes.

Urinary concentrations of acrylamide (AA) and N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) and associations with demographic factors in the South Korean population.

Acrylamide (AA) and N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) are important urinary biomarkers of acrylamide exposure in human biomonitoring, because AA is classified as a probable carcinogen in humans. In this study, urinary AA and AAMA were assessed in the South Korean adult population aged 18-69, based on the Korean National Human Biomonitoring Survey conducted in 2009. Urinary metabolites in samples were analyzed with LC-MS/MS system. Relying on data from 1873 representative South Korean adults, the population-weighted geometric means of urinary AA and AAMA concentrations were 6.8 ng/ml (95% CI: 6.4-7.3), and 30.0 ng/ml (95% confidence interval (CI): 28.2-31.8), respectively. The creatinine-adjusted geometric means of AA and AAMA were 6.2 µg/g creatinine (95% CI: 5.8-6.7) and 26.4µg/g creatinine (95% CI: 24.9-28.0), respectively. When covariates for predictors of urinary metabolites were adjusted simultaneously in a log-linear multiple regressions, the strongest predictors of urinary AA were education (OR=1.08-1.28; 95% CI: 1.11-1.48; p=0.0024) and age (OR=0.66-0.84; 95% CI: 0.54-0.97; p=0.0003), and those of urinary AAMA were smoking status (OR=1.16-2.63; 95% CI: 0.98-3.08; p=0.001) and education (OR=1.12-1.19; 95% CI: 1.02-1.38; p=0.0425). The ratio of current/never smokers for urinary AA was 1.3, whereas the same ratio for urinary AAMA was 3.0. These findings suggested that most South Koreans had detectable levels of AA and AAMA (98.7% and 99.4%, respectively) in their urine and that the body burden of AA and AAMA varied according to demographic, geographic, and lifestyle (smoking) factors.

The simple predictors of pseudomembranous colitis in patients with hospital-acquired diarrhea: a prospective observational study.

BACKGROUND/AIMS: As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC. METHODS: The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital. RESULTS: Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors. CONCLUSIONS: The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC.

Urinary concentrations of trichlorophenols in the Korean adult population: results of the National Human Biomonitoring Survey 2009.

Trichlorophenols such as 2,4,5-trichlorophenol (2, 4,5-TCP) and 2,4,6-trichlorophenol (2,4,6-TCP) are organochlorine compounds to which the general public can be exposed via contaminated food, water, and air. This study assessed exposure to 2,4,5-TCP and 2,4,6-TCP in Koreans age 18-69 years based on the Korean National Human Biomonitoring Survey conducted in 2009. Using data from 1,865 representative Koreans, we found that the geometric mean urinary concentrations of 2,4,5-TCP and 2,4,6-TCP were 83.4 pg/mL [95 % confidence interval (CI)=78.6-88.6] and 0.39 ng/mL (95 % CI=0.35-0.42), respectively. The creatinine-adjusted geometric mean 2,4,5-TCP and 2,4, 6-TCP levels were 78.8 ng/g creatinine (95 % CI=73.8-84.1) and 0.36 µg/g creatinine (95 % CI=0.33-0.40), respectively. Of the Korean adult population, about 67.5 and 87.5 % had respective urine 2,4,5-TCP and 2,4,6-TCP concentrations >0.05 ng/mL (the limit of detection, LOD). Urine 2,4,5-TCP concentrations were significantly associated with age and place of residence, whereas urine 2,4,6-TCP concentrations were higher in rural residents. These findings suggest that most Koreans had detectable levels of 2,4,5-TCP and 2,4,6-TCP in their urine and that the body burden of 2,4,5-TCP and 2,4,6-TCP varied according to demographic and geographic factors.

Secondhand smoke exposure and urine cotinine concentrations by occupation among Korean workers: results from the 2008 Korea National Survey for Environmental Pollutants in the Human Body.

This study aimed to estimate the status of secondhand smoke (SHS) exposure through urine cotinine analysis among nonsmoking workers in Korea and to analyze factors affecting urine cotinine concentrations. Data were based on "The 2008 Korea National Survey for Environmental Pollutants in the Human Body," a cross-sectional study of the National Institute of Environmental Research of Korea. We selected 1448 nonsmoking adult workers from 200 localities to participate in this survey. Urine cotinine concentrations were analyzed using a gas chromatograph-mass selective detector. We calculated separate covariate-adjusted geometric means for socio-demographic variables for males, females, and total subjects by analysis of covariance (ANCOVA). Statistical analyses were performed using SPSS version 18.0 (SPSS Inc., Chicago, Ill.). The prevalence of self-reported exposure to SHS was 36.9%. The geometric mean (95% confidence interval) of urine cotinine concentrations among all participants was 16.50 (14.48-18.80) µg/L. Gender, living area, education, and SHS exposure showed significant differences in urine cotinine concentrations. The urine cotinine concentrations of farmworkers and blue-collar workers such as skilled agricultural, forestry, and fishery workers, and elementary occupations were higher than those of white-collar workers such as clerical support workers, technicians, and associate professionals. Such a high proportion of the population having high urine cotinine levels indicates widespread exposure to SHS among nonsmoking workers in Korea. Furthermore, the urine cotinine levels among nonsmoking workers exposed to SHS varied by occupation. The measured urine cotinine concentration is suggested to be a valuable indication of SHS exposure in Korea.

[A case of Clostridium liver abscess with sepsis].

Clostridial septicemia usually occurrs in patients with immunocompromised diseases such as diabetes and malignancy. Clostridial liver abscess is very rare but highly fatal. We experienced a case of Clostridial septicemia due to liver abscess in a 73-year-old man. He was presented with fever and chills. On admission, abdominal CT scan showed about 35 mm sized hypoattenuated lesion with multiple central air-bubbles. After the diagnosis of liver abscess, the patient underwent prompt empirical antimicrobial therapy and percutaneous drainage. In spite of early therapy, the patient had gone into shock and death.

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.

Korea National Survey for Environmental Pollutants in the human body 2008: 1-hydroxypyrene, 2-naphthol, and cotinine in urine of the Korean population.

The Korea National Survey for Environmental Pollutants in the human body conducts representative Korean population studies, which were first initiated in 2005 in Korea. This study was conducted from 2008 to 2009 to determine the exposure levels of polycyclic aromatic hydrocarbons and nicotine in the Korean general population. The study population consisted of 4702 adult subjects from 196 sampling locations including coastal, rural, and urban areas. The urinary levels of 1-hydroxypyrene, 2-naphthol, and cotinine were measured for exposure of polycyclic aromatic hydrocarbons and nicotine. The geometric means of the urinary 1-hydroxypyrene, 2-naphthol and cotinine concentrations in the Korean general population were 0.15 µg/L (95% confidence interval (CI): 0.13-0.17), 3.84 µg/L (95% CI: 3.57-4.11) and 47.42 µg/L (95% CI: 40.52-54.32) respectively. When these values were compared with reference ranges for the United States and Germany, the levels of 1-hydroxypyrene, 2-naphthol, and cotinine were very similar for Korea and Germany, however, these levels were slightly lower in the United States. This study is the first nationwide survey of exposure to polycyclic aromatic hydrocarbons and nicotine in Korea and provides a background reference range for exposure to polycyclic aromatic hydrocarbons and nicotine in the Korean general population.

The COX-2-1195AA Genotype Is Associated with Diffuse-Type Gastric Cancer in Korea.

BACKGROUND/AIMS: The potential role of the cyclooxygenase (COX)-2 polymorphism has been reported in relation to the risk of gastrointestinal tract malignancies. Therefore, we investigated whether COX-2 polymorphisms are associated with the risk of gastric cancer (GC) in Korea, one of the areas with a high prevalence of this condition. METHODS: We evaluated the genotypic frequencies of COX-2-765 and -1195 in 100 peptic ulcer patients, 100 GC patients, and 100 healthy controls. The polymorphisms of the COX-2-765 and -1195 genes were analyzed by polymerase chain reaction and restriction fragment length polymorphisms. RESULTS: The frequencies of the COX-2-1195 GG, GA, and AA genotype were 20%, 60%, and 20% in intestinal-type GC and 8%, 48%, and 44% in diffuse-type GC, respectively (p=0.021). There were no significant differences in the frequency of COX-2-765 genotypes between intestinal-type GC and diffuse-type GC (p=0.603). Age- and sex-adjusted logistic regression analysis showed that the COX-2-1195 AA genotype was the independent risk factor of diffuse-type GC compared with the COX-2-1195 GG genotype (p=0.041; odds ratio, 6.22; 95% confidence interval, 1.077 to 35.870). CONCLUSIONS: The COX-2-1195 AA genotype may render subjects more susceptible to diffuse-type GC.

Korea National Survey for Environmental Pollutants in the Human Body 2008: heavy metals in the blood or urine of the Korean population.

BACKGROUND: Recently, there have been several nationwide episodes involving imported toys contaminated with toxic metals and environmental hormones. In addition, cadmium intoxication has occurred due to soil contamination with cadmium from abandoned metal mines. OBJECTIVES: To investigate the distribution, extent and factors influencing the levels of toxic metals in the blood or urine of the Korean general population over twenty years of age, we studied the blood or urine concentrations of heavy metals in a representative sample of 5087 Koreans in 2008. METHODS: Multiple biological substrates were collected from each participant to determine the most suitable samples for an environmental health survey system. Information regarding exposure conditions of all subjects was collected by questionnaire-based interviews. RESULTS: The geometric means of the blood lead, mercury and manganese levels were 19.1, 3.23 and 10.8 µg/L, respectively. The geometric means of urinary arsenic and cadmium concentrations were 43.5 and 0.65 µg/L, respectively. Blood mercury and urinary arsenic levels in the Korean general population were significantly higher than in European and American populations. CONCLUSIONS: The higher levels of blood mercury and urinary arsenic could be explained by the greater seafood consumption among the Korean population. This biomonitoring study of blood or urine heavy metals in the Korean general population provides important reference data stratified by demographic and lifestyle factors that will be useful for the ongoing surveillance of environmental exposure of Koreans to toxic metals.

[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.

Urinary concentrations of bisphenol A and triclosan and associations with demographic factors in the Korean population.

Bisphenol A (BPA) and triclosan are synthetic phenolic compounds to which the general public can be extensively exposed via consumer products and environmental contamination. In this study, we assessed exposure to BPA and triclosan in the Korean adult population aged 18-69 based on the Korean National Human Biomonitoring Survey conducted in 2009. Relying on data from 1870 representative Koreans, we found that the geometric mean urinary concentrations of BPA and triclosan were 1.90 ng/ml [95% confidence interval (CI): 1.81-1.99] and 1.68 ng/ml (95% CI: 1.48-1.90), respectively. The creatinine-adjusted geometric means of BPA and triclosan were 1.79 µg/g creatinine (95% CI: 1.70-1.90) and 1.58 µg/g creatinine (95% CI: 1.39-1.81), respectively. About 99.8% of the Korean adult population had urinary concentrations of BPA and about 92.6% of the Korean adult population had urinary concentrations of triclosan above the level of 0.05 ng/ml (limit of detection, LOD). Urinary BPA concentrations were higher in residents of rural areas, whereas urinary triclosan concentrations were significantly associated with cigarette smoking. These findings suggested that most Koreans had detectable levels of BPA and triclosan in their urine and that the body burden of BPA and triclosan varied according to demographic and geographic factors.