• Korean Journal of Radiology
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• v.24 no.1
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• pp.39-50
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• 2023

Objective: To assess the contrast-enhanced CT and ultrasonography (US) findings of intracholecystic papillary neoplasm (ICPN) and determine the imaging features predicting ICPN associated with invasive carcinoma (ICPN-IC). Materials and Methods: In this retrospective study, we enrolled 119 consecutive patients, including 60 male and 59 female, with a mean age ± standard deviation of 63.3 ± 12.1 years, who had pathologically confirmed ICPN (low-grade dysplasia [DP] = 34, high-grade DP = 35, IC = 50) and underwent preoperative CT or US. Two radiologists independently assessed the CT and US findings, focusing on wall and polypoid lesion characteristics. The likelihood of ICPN-IC was graded on a 5-point scale. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of ICPN-IC separately for wall and polypoid lesion findings. The performances of CT and US in distinguishing ICPN-IC from ICPN with DP (ICPN-DP) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: For wall characteristics, the maximum wall thickness (adjusted odds ratio [aOR] = 1.4; 95% confidence interval [CI]: 1.1-1.9) and mucosal discontinuity (aOR = 5.6; 95% CI: 1.3-23.4) on CT were independently associated with ICPN-IC. Among 119 ICPNs, 110 (92.4%) showed polypoid lesions. Regarding polypoid lesion findings, multiplicity (aOR = 4.0; 95% CI: 1.6-10.4), lesion base wall thickening (aOR = 6.0; 95% CI: 2.3-15.8) on CT, and polyp size (aOR = 1.1; 95% CI: 1.0-1.2) on US were independently associated with ICPN-IC. CT showed a higher diagnostic performance than US in predicting ICPN-IC (AUC = 0.793 vs. 0.676; p = 0.002). Conclusion: ICPN showed polypoid lesions and/or wall thickening on CT or US. A thick wall, multiplicity, presence of wall thickening in the polypoid lesion base, and large polyp size are imaging findings independently associated with invasive cancer and may be useful for differentiating ICPN-IC from ICPN-DP.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.998-1008
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• 2022

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion: Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

• Clinical Nutrition Research
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• v.12 no.1
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• pp.29-39
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• 2023

Previous studies have frequently reviewed how different macronutrients affect liver health. Still, no study centered around protein intake and the non-alcoholic fatty liver disease (NAFLD) risk relationship. This study aimed to examine the association between the consumption of total and different sources of protein and NAFLD risk. We allocated 243 eligible subjects to the case and control groups, including 121 incidence cases of NAFLD, and 122 healthy controls. Two groups were matched in age, body mass index, and sex. We evaluated the usual food intake of participants using FFQ. Binary logistic regression was conducted to estimate the risk of NAFLD in relation to different sources of protein intake. The age of participants was 42.7 years on average, and 53.1% were male. We found Higher intake of protein in total (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11-0.52) was significantly associated with a lower risk of NAFLD, despite adjusting for multiple confounders. in detail, higher tendency to the vegetables (OR, 0.28; 95% CI, 0.13-0.59), grains (OR, 0.24; 95% CI, 0.11-0.52), and nuts (OR, 0.25; 95% CI, 0.12-0.52) as the main sources of protein, were remarkably correlated with lower NAFLD risk. In contrary, increased intake of meat protein (OR, 3.15; 95% CI, 1.46-6.81) was positively associated with a higher risk. Totally, more calorie intake from proteins was inversely associated with lower NAFLD risk. This was more likely when the protein sources were selected less from meats and more from plants. Accordingly, increasing the consumption of proteins, particularly from plants, may be a good recommendation to manage and prevent NAFLD.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.40-48
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• 2023

Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.

• Clinical Endoscopy
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• v.57 no.1
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• pp.36-47
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• 2024

Background/Aims: Scissor-type endoscopic submucosal dissection (ST-ESD) knives can reduce the adverse events associated with ESDs. This study aimed to compare ST-ESD and non-scissor-type (NST)-ESD knives. Methods: We identified ten studies that compared the performance characteristics and safety profiles of ST-ESD and NST-ESD knives. Fixed- and random-effects models were used to calculate the pooled proportions. Heterogeneity was assessed using the I² test. Results: On comparing ST-ESD knives to NST-ESD knives, the weighted odds of en bloc resection was 1.61 (95% confidence interval [CI], 0.90-2.90; p=0.14), R0 resection was 1.10 (95% CI, 0.71-1.71; p=0.73), delayed bleeding was 0.40 (95% CI, 0.17-0.90; p=0.03), perforation was 0.35 (95% CI, 0.18-0.70; p<0.01) and ESD self-completion by non-experts was 1.89 (95% CI, 1.20-2.95; p<0.01). There was no heterogeneity, with an I² score of 0% (95% CI, 0%-54.40%). Conclusions: The findings of reduced odds of perforation, a trend toward reduced delayed bleeding, and an improvement in the rates of en bloc and R0 resection with ST-ESD knives compared to NST-ESD knives support the use of ST-ESD knives when non-experts perform ESDs or as an adjunct tool for challenging ESD procedures.

• Clinical Endoscopy
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• v.55 no.3
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• pp.355-364
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• 2022

Background/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions. Methods: A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling. Results: Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09-0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02-0.07). Conclusions: CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

• Korean Journal of Agricultural Science
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• v.51 no.2
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• pp.205-216
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• 2024

Although Aster yomena has recently attracted attention for its potential anti-cancer, antimicrobial, and immune-boosting effects, there are concerns about residual pesticides because they are consumed in salad-like forms. This study investigated residual characteristics and human dietary risks of the imidazole fungicide prochloraz applied to the herbal medicine Aster yomena with different spray frequency and timing. Residual analysis of prochloraz and its three main metabolites (BTS44595, BTS44596, and 2,4,6-trichlorophenol) in Aster yomena samples was performed using the QuEChERS method and LC-MS/MS. Mean recovery rates of the fungicide and its metabolites were satisfactory in the range of 80.1 ± 1.2% to 108.2 ± 3.8%. The residual concentration of the fungicide calculated as the sum of prochloraz and its metabolites was the highest (4.14 mg·kg^-1) in the Aster yomena sample applied three times at weekly intervals with the fungicide until immediately before harvest. The fungicide residue concentration in the Aster yomena was below the method-limit of quantification (MLOQ) when it was applied twice at the interval of 9 day until 21 days before harvest. The theoretical maximum daily intake of prochloraz, calculated based on the daily intake of Aster yomena, mean adult body weight, and the highest residue level analyzed in the this study, was safe at < 80% of the acceptable daily intake of the fungicide (0.01 mg^-1·kg·bw^-1·day). In conclusion, the triple application method with prochloraz at weekly intervals until the harvest day is recommended to produce safe Aster yomena from the fungicide residues and risks to humans.

• Journal of Veterinary Clinics
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• v.41 no.4
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• pp.207-214
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• 2024

An adult castrated male dog was presented with persistent hematochezia. Digital rectal examination and endoscopy found multiple colorectal masses. Complete blood count and serum biochemical results were within the reference interval. Fine needle aspirate of the masses indicated a diagnosis of inflamed polyps with a primary differential of malignancy. Histopathologic examination using endoscopy-guided incisional biopsy of the masses revealed an inflamed neoplasm with ossification. A colectomy was performed to remove the tumor. Subsequent histopathologic examination of the surgically resected masses resulted in a diagnosis of colorectal carcinoma in situ (CiS) with immune infiltrates, which were subject to immunohistochemical and flow cytometric immunophenotyping. The immunohistochemistry confirmed intraepithelial CD3⁺ T cells within CiS. The flow cytometric analysis indicated tumor-infiltrating CD4⁺ T, CD8⁺ T, and CD11b⁺ myeloid subsets. The flow cytometric analysis of circulating and tumor-infiltrating leukocytes demonstrated a preferential expansion of CD25⁺FOXP3⁺ regulatory T cells within CiS. To the author's knowledge, this is the first report to show clinical evidence emphasizing the immunogenicity and immune-suppressive environment of canine colorectal CiS. Our case will be valuable in providing a rationale for basic research that dissects the immune environment for canine colorectal cancers for the future development of cancer immunotherapy.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.2
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• pp.123-129
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• 2015

Purpose : The goal of this study was to verify and analyze the source position according to the curvature of the universal applicator and 4 different angle applicators when using RALS(Remote After Loading System). Materials and Methods : An interval of 1 cm and 15 second dwell times in each source position were applied for plan. To verify the accuracy of source position, we narrowed the distance between MultiSource container and GAFCHROMIC$^{(R)}$ EBT3 film by 5 cm, 10 cm, 20 cm so that the universal applicator transfer tube had some curvature. Also 4 applicators(Intrauterine tube: $0^{\circ}$, $15^{\circ}$, $30^{\circ}$, Ovoid tube: $65^{\circ}$) were used in the same condition. The differences between desired and actual source position were measured by using Image J. Results : In case of using 4 different angles of applicator with the straight universal applicator transfer tube, the average error was the lowest for $0^{\circ}$ applicator, greatest for $65^{\circ}$ applicator. However, All average errors were within ${\pm}2mm$ recommended in TG-56. When MultiSource container was moved 5 cm, 10 cm, 20 cm towards the EBT3 film, the average errors were beyond ${\pm}2mm$. The first dwell position was relatively located in accuracy, while the second and third dwells were displaced by an increasing magnitude with increasing curvature of the transfer tube. Furthermore, with increasing the angle of applicators, the error of all other dwell positioning was increased. Conclusion : The results of this study showed that both the curvature of universal applicator transfer tube and the angle of applicators affect the source dwell position. It is recommended that using straight universal applicator transfer tubes is followed in all cases, in order to avoid deviations in the delivered source dwell position. Also, It is advisable to verify the actual dwell position, using video camera quality control tool prior to all treatments.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.136-140
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• 1999

Purpose : Prostate specific antigen (PSA) is a useful tumor marker, which is widely used as a diagnostic index and predictor of both treatment and follow-up result in prostate cancer. A prospective analysis was carried out to obtain the period of PSA normalization and the half life of PSA and to analyze the factors influencing the period of PSA normalization. The PSA level was checked before and serially after radical radiotherapy. Materials and Method : Twen쇼 patients with clinically localized prostate cancer who underwent radical external beam radiotherapy were enrolled in this study. Accrual period was from April 1993 to May 1998. Median follow-up period was 20 months. Radiotherapy was given to whole pelvis followed by a boost to prostate. Dose range for the whole pelvis was from 45 Gy to 50 Gy and boost dose to prostate, from 14 Gy to 20 Gy. The post-irradiation PSA normal value was under 3.0 ng/ml. The physical examination and serum PSA level evaluation were performed at 3 month interval in the first one year, and then at every 4 to 6 months. Results : PSA value was normalized in nineteen patients (95%) within 12 months. The mean period of PSA normalization was 5.3 (${\pm}$2.7) months. The half life of PSA Of the nonfailing patients was 2.1 (${\pm}$0.9) month. The nadir PSA level Of the nonfailing Patients waS 0.8 (${\pm}$0.5) ng/ml. The period of PSA normalization had the positive correlation with pretreatment PSA level (R$^{2}$=0.468). The nadir PSA level had no definite positive correlation with the pretreatment PSA level (R$^{2}$=0.075). The half life of serum PSA level also had no definite correlation with pretreatment PSA level (R$^{2}$=0.029). Conclusion :The PSA level was mostly normalized within 8 months (85%). If it has not normalized within 12 months, we should consider the residual disease in prostate or distant metastasis. In 2 patients, the PSA level increased 6 months or 20 months before clinical disease was detected. So the serum PSA level can be used as early diagnostic indicator of treatment failure.