Quantitative Changes of Phenolic Compounds in Pine Twigs by Variety, Harvest Season, and Growing Region.

Three new phenolic compounds including pinosylvin 3-methoxy-5-O-ß-D-glucoside (PMG), taxiresinol 4'-O-α-L-rhamnoside (TRR), and lariciresinol 4'-O-α-L-rhamnoside (LRR) were first isolated and identified from red pine (Pinus densiflora Sieb. et Zucc.) twigs, together with four known compounds, such as (+)-catechin (CC), dihydromyricetin (DHM), dihydroquercetin 3-O-ß-D-glucoside (DHQG), and dihydroquercetin (DHQ). Additionally, the concentrations of seven phenolic compounds in pine twigs were measured by high-performance liquid chromatography based on cultivars, harvest seasons, and growing environments. Red and black pine twigs contain 379.33 and 308.83 mg/100 g of PMG as the predominant phenolics, respectively, and their contents were significantly higher in spring than in autumn. Red pine twigs contain higher amounts of three dihydroflavonols (DHM: 87.82, DHQG: 38.47, and DHQ: 68.07 mg/100 g) and two lignans (LRR: 15.63, TRR: 30.72 mg/100 g) than black pine twigs, except for higher (+)-CC level (21.88 mg/100 g) in black pine twigs. Two pine twigs had much higher flavonoid and lignan levels in the autumn than they had in the spring. Two pine twigs harvested in several different areas do not significantly differ in their phenolic compositions and contents. These results suggest that red pine twigs possessing phytochemical phenolics may be useful as potential sources for promoting human health.

Respiratory Safety Evaluation in Mice and Inhibition of Adenoviral Amplification in Human Bronchial Endothelial Cells Using a Novel Type of Chlorine Dioxide Gas Reactor.

Since the onset of the COVID-19 pandemic, there has been a growing demand for effective and safe disinfectants. A novel use of chlorine dioxide (ClO2) gas, which can satisfy such demand, has been reported. However, its efficacy and safety remain unclear. For the safe use of this gas, the stable release of specific concentrations is a must. A new type of ClO2 generator called Dr.CLOTM has recently been introduced. This study aimed to investigate: (1) the effects of Dr.CLOTM on inhibiting adenoviral amplification on human bronchial epithelial (HBE) cells; and (2) the acute inhalation safety of using Dr.CLOTM in animal models. After infecting HBE cells with a recombinant adenovirus, the inhibitory power of Dr.CLOTM on the virus was expressed as IFU/mL in comparison with the control group. The safety of ClO2 gas was indirectly predicted using mice by measuring single-dose inhalation toxicity in specially designed chambers. Dr.CLOTM was found to evaporate in a very constant concentration range at 0-0.011 ppm/m3 for 42 days. In addition, 36-100% of adenoviral amplification was suppressed by Dr.CLOTM, depending on the conditions. The LC50 of ClO2 gas to mice was approximately 68 ppm for males and 141 ppm for females. Histopathological evaluation showed that the lungs of female mice were more resistant to the toxicity from higher ClO2 gas concentrations than those of male mice. Taken together, these results indicate that Dr.CLOTM can be used to provide a safe indoor environment due to its technology that maintains the stable concentration and release of ClO2 gas, which could suppress viral amplification and may prevent viral infections.

Quantitative Changes of Flavonol Glycosides from Pine Needles by Cultivar, Harvest Season, and Thermal Process.

Five flavonol glycosides including quercetin 3-O-ß-D-glucoside (QG), kaempferol 3-O-ß-D-glucoside (KG), quercetin 3-O-(6″-O-acetyl)-ß-D-glucoside (QAG), kaempferol 3-O-(6″-O-acetyl)-ß-D-glucoside (KAG), and quercetin 3-O-(3″-O-p-coumaroyl)-ß-D-glucoside (QCG) were isolated and purified from red pine (Pinus densiflora Sieb. et Zucc.) nee-dles, and identified by nuclear magnetic resonance and mass spectrometer spectral analyses. In addition, the quantification of the five flavonol glycosides in pine needles was performed by high-performance liquid chromatography analysis according to cultivar, growing district, harvest season, and thermal processing. The red pine needles had higher amounts of the five flavonol glycosides than the black pine needles except for QCG. There were no large differences in flavonoid composition and content among pine needles grown in three different areas. Levels of the five flavonol glycosides in red pine needles harvested during Spring ranged from 6.13 to 27.03 mg/100 g dry weight. Levels of two flavonol glycosides, QG and KG, gradually decreased with increasing harvest time, whereas the acylated flavonol glycoside, QCG, a predominant flavo-noid in pine needles, increased gradually with increasing harvest time. Two acetyl flavonol glycosides, QAG and KAG, increased steadily through Spring to Autumn, and then decreased gradually by Winter. Meanwhile heat treatments, such as roasting and steaming, increased the five flavonol glycosides during heating for 3 min, but then slowly decreased these when heating for 10 min. Microwave processing increased to some extent the five flavonol glycosides when heating for 3 min, and remained unchanged during the 10 min heating. These results suggest that the pretreated red pine needles with enhanced flavonoid content may be useful as potential sources for nutraceuticals and cosmeceuticals.

Compliance with D2 lymph node dissection in reduced-port totally laparoscopic distal gastrectomy in patients with gastric cancer.

This phase II clinical trial was performed to determine whether reduced-port laparoscopic surgery with complete D2 lymph node (LN) dissection for gastric cancer is a safe and feasible surgical technique. The prospectively enrolled 65 gastric cancer patients underwent reduced-port surgery (i.e., triple-incision totally laparoscopic distal gastrectomy [Duet TLDG] with D2 lymphadenectomy). Compliance rate was the primary outcome, which was defined as cases in which there was no more than one missing LN station during D2 LN dissection. The secondary outcomes were the numbers of dissected and retrieved LNs in each station and other short-term surgical outcomes and postoperative course. The compliance rate was 58.5%. The total number of retrieved LNs was 41 (range: 14-83 LNs). The most common station missing from LN retrieval was station no. 5 (35/65; 53.8%), followed by station no. 1 (24/65; 36.9%). The overall postoperative complication rate was 20.0% (13/65). One patient underwent surgical treatment for postoperative complications. There was no instances of mortality. Duet TLDG is an oncologically and technically safe surgical method of gastrectomy and D2 lymphadenectomy.

Prognostic Impact of Increased Perioperative Platelet Count in Gastric Cancer Patients.

BACKGROUND: Solid tumors are a common cause of secondary (reactive) thrombocytosis, a paraneoplastic syndrome that is also a prognostic factor for various cancers. However, cutoff values for platelet count specific to gastric cancer and their prognostic roles are unknown. METHODS: We retrospectively analyzed records of 4643 patients with gastric cancer who underwent radical surgery from 2007 to 2010. The minimum P-value approach was used with the log-rank test to determine the optimal prognosis predicting threshold for preoperative platelet count. Change in perioperative platelet count over time was evaluated with a generalized estimating equation. Clinicopathologic features and prognostic significance were analyzed according to platelet count. RESULTS: Thrombocytosis prevalence (platelet count ≥40 × 104/µL) was 1.6% (75 of 4643 patients). The platelet count cutoff value with the lowest P-value was ≥25.5 × 104/µL, and patients with higher platelet count had more advanced disease. Multivariate analysis showed that cutoff value was an independent prognostic factor of overall survival (hazard ratio 1.19, 95% confidence interval 1.03-1.37, P = 0.017). Patients who underwent adjuvant chemotherapy (n = 1300) and had a greater than 10% increase in platelet count at postoperative 1 y compared to before surgery had significantly poorer overall survival (hazard ratio 1.65, 95% confidence interval 1.11-2.45, P = 0.013). CONCLUSIONS: Elevated preoperative platelet count (≥25.5 × 104/µL) and increased platelet count (≥10%) at postoperative 1 y in an adjuvant chemotherapy group were unfavorable prognostic factors. Platelet count could be a cost-effective biomarker for screening and monitoring patients with unfavorable survival outcomes.

Clinical and Laboratory Findings of Middle East Respiratory Syndrome Coronavirus Infection.

There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea. This hospital-based retrospective study compared MERS-CoV-positive and MERS-CoV-negative patients. A total of seven positive patients and 55 negative patients with a median age of 43 years (P = 0.845) were included. No statistical differences were observed with respect to their sex and the presence of comorbidities. At the time of admission, headache (28.6% vs. 3.6%; odds ratio [OR], 10.60; 95% confidence interval [CI], 1.22-92.27), myalgia (57.1% vs. 9.1%; OR, 13.33; 95% CI, 2.30-77.24), and diarrhea (57.1% vs. 14.5%; OR, 7.83; 95% CI, 1.47-41.79) were common among MERS-CoV-positive patients. MERS-CoV-positive patients were more likely to have a low platelet count (164 ± 76.57 vs. 240 ± 79.87) and eosinophil (0.27 ± 0.43 vs. 2.13 ± 2.01; P = 0.003). Chest radiography with diffuse bronchopneumonia was more frequent in MERS-CoV-positive patients than in negative patients (100% vs. 62.5%; P = 0.491). The symptoms of headache, myalgia, and diarrhea, as well as laboratory characteristics, including low platelet counts and eosinophil, and chest X-ray showing diffuse bronchopneumonia might enhance the ability to detect patients in South Korea infected with MERS-CoV.

The Association between Urinary Sodium Excretion and Metabolic Syndrome in Korean Adults from the 2010-2011 Korean National Health and Nutrition Examination Survey.

BACKGROUND: The sodium intake of Koreans was higher than that recommended by the World Health Organization. Urinary sodium, which is correlated with sodium intake, can be easily calculated by the Tanaka's equation. This study aimed to evaluate the association between urinary sodium and metabolic syndrome in Korean adults using the 2010-2011 Korean National Health and Nutrition Examination Survey (KNHANES). METHODS: A total of 5,870 participants from the 2010-2011 KNHANES were included in this study. Twenty-four hour urinary sodium was calculated by the Tanaka's equation using spot urine. Participants were divided into tertiles based on urinary sodium levels. The association between urinary sodium and metabolic syndrome was analyzed using multivariate logistic regression analysis. RESULTS: The odds ratios (ORs) and 95% confidence intervals (CIs) of metabolic syndrome for the 2nd and 3rd tertile of urinary sodium levels was 1.51 (1.16-1.97) and 1.56 (1.23-1.97) compared to the lowest tertile of urinary sodium in men. The ORs and 95% CIs of metabolic syndrome in women were 1.20 (0.95-1.51) for the 2nd tertile and 2.16 (1.68-2.78) for the 3rd tertile. These associations remained statistically significant, even after adjusting for multiple covariates such as age, education, regular exercise, smoking, and alcohol consumption. CONCLUSION: These findings indicate that urinary sodium is significantly associated with metabolic syndrome in Korean adults.

Estrogen receptor-related receptor γ regulates testicular steroidogenesis through direct and indirect regulation of steroidogenic gene expression.

Biosynthesis of testosterone, which mainly occurs in testicular Leydig cells, is controlled by steroidogenic proteins, such as StAR and P450c17. Although estrogen-related receptor gamma (ERRγ), an orphan nuclear receptor, is expressed in the testis, its role is not well understood. In this study, we investigated the expression of ERRγ in Leydig cells and its molecular action on testicular steroidogenesis. ERRγ is expressed in mouse Leydig cells from pre-pubertal stages. ERRγ overexpression in primary Leydig cells elevated the production of testosterone with a marked increase of P450c17 expression at both mRNA and protein levels, albeit decreased expression of StAR. Promoter-reporter analyses showed that ERRγ directly regulated the P450c17 promoter. Further deletion mutant analyses of the P450c17 promoter revealed that ERRγ activated expression of the P450c17 gene by binding to an ERRγ response element within the P450c17 promoter. Meanwhile, ERRγ suppressed cAMP-induced activation of the StAR promoter, which was likely due to ERRγ-mediated inhibition of the transcriptional activity of Nur77, which is induced by cAMP and regulates StAR gene expression in Leydig cells. Interestingly, ERRγ coexpression also decreased the protein level of Nur77, which occurred through proteasomal degradation, suggesting ERRγ-mediated regulation of steroidogenesis at another level. Taken together, these findings suggest that ERRγ regulates testicular steroidogenesis, both directly controlling and indirectly fine-tuning the expression of steroidogenic genes.

Does the interval of screening endoscopy affect survival in gastric cancer patients?: A cross-sectional study.

Gastric cancer remains the second most common cancer in Korea; however, its mortality has decreased due to earlier diagnosis. In Korea, screening endoscopy has been performed nationwide since 1999. The aim of this study was to elucidate the benefit of screening endoscopy on actual survival in gastric cancer patients and to determine the optimal interval of screening endoscopy.We analyzed 1651 patients diagnosed with gastric adenocarcinoma who underwent surgical treatment between June 2008 and December 2014. Patients were divided into 4 groups according to the interval of screening endoscopy prior to their gastric cancer diagnosis. (Group I = within 1 year, Group II = >1 but <2 years, Group III = more than 2 years, Group IV = no prior endoscopic examination). Patient demographics, clinicopathologic characteristics, and postoperative surgical outcomes including overall survival were compared.The 5-year gastric cancer-specific survival rates of groups I and II were significantly higher than groups III and IV (90.9% vs 85.4%, P = 0.002, respectively). Multivariate analysis showed that screening interval was an independent factor for the diagnosis of advanced gastric cancer. The risk of advanced gastric cancer decreased in group I (odds ratio: 0.515, 95% confidence interval [CI] 0.369-0.719; P < 0.001) and group II (odds ratio: 0.678, 95% CI 0.517-0.889, P = 0.005).Screening endoscopy was helpful in increasing the survival of gastric cancer patients. A 2-year endoscopic screening interval is suitable to detect early-stage gastric cancer.

Comparison of Reduced Port Totally Laparoscopic-assisted Total Gastrectomy (Duet TLTG) and Conventional Laparoscopic-assisted Total Gastrectomy.

BACKGROUND: The aim of this study was to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic-assisted total gastrectomy (duet TLTG) with those of patients undergoing conventional laparoscopic-assisted total gastrectomy (LATG). MATERIALS AND METHODS: Between January 2013 and 2015, 54 patients with gastric cancer underwent LATG at the Samsung Medical Center. Duet TLTG using 3 ports was performed in 30 patients, and conventional LATG using 5 ports was performed in 24 patients. Either extracorporeal or intracorporeal anastomosis was used for esophagojejunostomy. Surgical outcomes were compared between the operation methods. RESULTS: The operating time was similar for duet TLTG and conventional LATG [222 min (range, 163 to 287 min) vs. 233 min (range, 170 to 310 min), respectively; P=0.807]. Blood loss during surgery was also similar between duet TLTG and conventional LATG groups [100 mL (range, 50 to 400 mL) vs. 175 mL (range, 50 to 400 mL), respectively; P=0.249]. The median number of nodes dissected [duet TLTG vs. conventional LATG, 47 (20 to 67) vs. 41 (22 to 70), P=0.338] was not different between groups. Pain scores were 3.9, 3.3, and 2.9, and 3.9, 3.4, and 2.8, at postoperative days 1, 3, and 5, respectively, in the duet TLTG and the conventional LATG groups (P=0.857, 0.659, and 0.427, respectively). Overall complication rates in the duet TLTG and conventional LATG groups were not significantly different (36.7% vs. 16.7%, P=0.103). CONCLUSIONS: Duet TLTG is an acceptable procedure with quality of lymph node dissection, including the number of dissected lymph nodes and morbidity.

Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment?

PURPOSE: During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. MATERIALS AND METHODS: From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. RESULTS: Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. CONCLUSIONS: We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction.

Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report.

During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure.

Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer.

BACKGROUND: Laparoscopy-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single- or reduced-port LADG for these patients has been rarely reported. OBJECTIVE: To compare surgical outcomes of patients with gastric cancer undergoing single-port totally laparoscopic distal gastrectomy (TLDG) to those of patients undergoing reduced-port (three ports) TLDG. METHODS: This retrospective study included 94 patients with early gastric cancer who underwent single-port or reduced-port TLDG at Samsung Medical Center between May 2014 and December 2014. Surgical outcomes were compared between operation methods. RESULTS: There are more female patients (54.2 vs. 19.6 %, p = 0.001) and less obese patients (21.1 ± 2.1 vs. 24.6 ± 3.2 kg/m(2), p = 0.001) in the single-port TLDG group. There were no significant differences in blood loss during surgery, the number of dissected lymph nodes, and the pain score at postoperative first day between two groups. The variance in operation time for the reduced-port TLDG was significantly greater than that for single-port TLDG (p = 0.01). Complication rates in the single-port and reduced-TLDG groups were similar (20.8 vs. 21.7 %, p = 1.000). No postoperative deaths occurred in either group. CONCLUSIONS: Single-port TLDG might be considered as a treatment option for a limited subset, such as females or less obese patients with early gastric cancer.

Techniques of the Single-Port Totally Laparoscopic Distal Gastrectomy.

BACKGROUND: Single-port laparoscopic surgery for patients with early gastric cancer has been rarely reported. Our aim was to introduce techniques of the single-port totally laparoscopic distal gastrectomy (TLDG) in patients with early gastric cancer. METHODS: This procedure was performed using only one 3-3.5 cm skin incision on the umbilicus. One 12 mm and two 10 mm ports were used, and the flexible scope was used during the operation. Partial omentectomy with D1 + ß or more lymph node dissection was performed. Bowel continuity was restored by intracorporeal gastroduodenostomy using two linear staplers. RESULTS: A total of 30 patients underwent single-port TLDG from June to August 2014. Median age of patients was 55 years (range 33-77) and median body mass index of patients was 21.2 kg/m(2) (range 15.7-26.1). Sixteen of 30 patients (53.3 %) were female. Operating times were 122.6 min, and blood losses during operations were 103.2 ml on average. The median length of postoperative hospital stay was 7 days, and the median number of dissected lymph nodes was 40 (range 16-67). No patients had dissected lymph nodes <15. The rate of complications was 20 % (6/30 patients), and no patients had an incisional hernia. Two patients experienced ileus (6.7 %), another two patients experienced delayed gastric emptying (6.7 %), and one patient suffered from small bowel obstruction. There were no postoperative mortalities. CONCLUSIONS: The single-port TLDG for patients with early gastric cancer is feasible in very selected patients and in specialized gastric cancer centers with experience in multi-trocar laparoscopy and single-port laparoscopic surgery.

Gastric duplication cysts in adults: a report of three cases.

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal tract and is especially uncommon in adults. Most cases in adults are discovered incidentally on radiological examination or gastric endoscopy. Accurate diagnosis of these cysts before resection is difficult. Differential diagnoses are varied. Malignant transformation of a gastric duplication cyst is very rare. We present three cases of asymptomatic noncommunicating gastric duplication cysts in adults.

Comparison of Reduced Port Totally Laparoscopic Distal Gastrectomy (Duet TLDG) and Conventional Laparoscopic-Assisted Distal Gastrectomy.

BACKGROUND: Laparoscopic-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single or reduced port LADG has been rarely reported. This study aimed to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic distal gastrectomy (duet TLDG) to those of patients undergoing conventional LADG. METHODS: This retrospective study included 202 patients with early gastric cancer who underwent duet TLDG (102 patients) or conventional LADG (100 patients) at Samsung Medical Center between October 2013 and April 2014. RESULTS: Operating time was shorter for duet TLDG than for conventional LADG (mean ± SD 121.1 ± 19.3 min vs. 153.0 ± 38.1 min, P < 0.001). Blood loss during surgery was similar between duet TLDG and conventional LADG groups (91.4 ± 68.4 mL vs. 85.4 ± 59.8 mL, P = 0.506). Complication rates in the duet TLDG and conventional LADG groups were similar (15.7 % vs. 10.0 %, P = 0.294). The quality of lymph node dissection, including the median number of nodes dissected (median [range] duet TLDG vs. conventional LADG, 36 [17-76] vs. 34 [15-64], P = 0.570) and number of dissected nodes in each lymph node station, did not differ between groups. The median postoperative hospital stay was similar (7 [7-23] days vs. 7 [6-9], P = 0.423). Pain scores were 3.6, 3.2, and 2.8, and 3.7, 3.1, and 2.6, at postoperative days 1, 3, and 5, respectively, in the duet TLDG and conventional LADG groups (P = 0.408, 0.250, and 0.130). CONCLUSIONS: Reduced port duet TLDG for early gastric cancer is feasible in terms of patient safety and quality of lymph node dissection.

Techniques of reduced PRT laparoscopy-assisted distal gastrectomy (duet LADG).

BACKGROUND: Reduced-port laparoscopic surgery for patients with early gastric cancer has been rarely reported. The aim of this study was to introduce techniques of the reduced-port laparoscopy-assisted distal gastrectomy (duet LADG) in patients with early gastric cancer. METHODS: Duet LADG was performed by two persons, an operator and a scopist. Three 10 mm ports were used on the umbilicus and both sides of the lower abdomen. The same laparoscopic instruments were used for duet LADG as for conventional LADG. After the liver was retracted with a 1-0 nylon suture, partial omentectomy with D1 + ß or more lymph node dissection was made. After distal subtotal resection of the stomach, bowel continuity was restored by intracorporeal gastrojejunostomy using two linear staplers. A specimen was removed through the umbilical incision after the extension. RESULTS: A total of 30 consecutive patients underwent duet LADG from October to December 2013. The median age of the patients was 51 years (range 29-75 years), and their median body mass index was 23.2 kg/m(2) (range 18.5-29.6 kg/m(2)). Sixteen (53.3%) of 30 patients were female. Operating times for patients who received duet LADG were 121.2 ± 17.7 min. Blood loss during operations averaged 82 ml. The median number of dissected lymph nodes was 35 (range 24-66). There was no patient with fewer than 15 dissected lymph nodes. The rate of complications in patients who underwent duet LADG was 16.7% (5 of 30 patients). Two patients (6.7%) experienced ileus, and another 2 (6.7 %) patients experienced small bowel obstruction. One patient had pneumonia. There was no postoperative mortality. CONCLUSIONS: Duet LADG for patients with early gastric cancer is feasible without the need for additional ports, any special devices, or an assistant.

Concurrent robot-assisted distal gastrectomy and partial nephrectomy for synchronous early gastric cancer and renal cell carcinoma: an initial experience.

We report our experience of a concurrent robot assisted distal gastrectomy and partial nephrectomy for synchronous early gastric cancer and renal cell carcinoma. A 55-year-old female patient was diagnosed with early gastric cancer on screening endoscopy. Abdominal computed tomography showed an incidental right renal cell carcinoma. Robot assisted distal gastrectomy was performed, followed by partial nephrectomy. The final pathological examination showed signet ring cell carcinoma within the lamina propria and renal cell carcinoma with negative resection margins. The patient showed no evidence of recurrence at 6-months. A robot-assisted combined operation could be a treatment option for early stages of synchronous malignancies.

Treatment outcome and mortality among patients with multidrug-resistant tuberculosis in tuberculosis hospitals of the public sector.

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.