Kyungpook National University Hospital Research Articles

The effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes.

PURPOSETo evaluate the effect of periodontal and prosthodontic therapy on glycated hemoglobin A(HbA1c) level in patients with diabetes.MATERIALS AND METHODSThis is a retrospective study of 70 patients suffering from diabetes who visited the Kyungpook National University Hospital between January 2016 and May 2018. Patients underwent medical evaluation for their routine check-up, which includes laboratory test for HbA1c levels. Among the 70 patients, 35 patients also visited Kyungpook National University Dental Hospital during the same period to receive periodontal and prosthodontic therapy, while the other 35 patients did not receive such therapy. The HbA1c levels were compared before and after periodontal and prosthodontic therapy. Comparisons between groups and within groups were performed using independent t-test.RESULTSThe HbA1c levels in the group who have received periodontal and prosthodontic therapy decreased from 7.2 to 6.7 (P=.001). The HbA1c levels in the control group decreased from 7.2 to 7.1 (P=.580). The difference in changes between the two patient groups was statistically significant (P=.011).CONCLUSIONPeriodontal and prosthodontic therapy can be effective on glycemic control in patients with diabetes.

Efficacy and tolerability of adjunctive perampanel treatment in children under 12 years of age with refractory epilepsy.

PurposeThere is limited data on the use of perampanel in children under 12 years of age. We evaluated the efficacy and tolerability of adjunctive perampanel treatment in children under 12 years of age with refractory epilepsy.MethodsThis retrospective observational study was performed in Kyungpook National University Hospital from July 2016 to March 2018. A responder was defined as a patient with ≥50% reduction in monthly seizure frequency compared with the baseline. Adverse events and discontinuation data were obtained to evaluate tolerability.ResultsTwenty-two patients (8 males, 14 females) aged 3.1–11.4 years (mean, 8.0±2.5 years) were included in this study. After an average of 9.2 months (range, 0.5–19 months) of follow-up, 15 patients (68%) showed a reduction in seizure frequency, including 5 patients (23%) with seizure freedom. The age at epilepsy onset was significantly lower (P=0.048), and the duration of epilepsy was significantly longer (P=0.019) in responders than in nonresponders. Nine patients (41%) experienced adverse events, including somnolence (23%), respiratory depression (9%), violence (4.5%), and seizure aggravation (4.5%). The most serious adverse event was respiratory depression, which required mechanical ventilation in 2 patients (9%). Eight patients (36%) discontinued perampanel due to lack of efficacy or adverse events. Three out of 4 patients (75%) who discontinued perampanel due to adverse events had an underlying medical condition.ConclusionPerampanel offers a treatment option for refractory epilepsy in children. Adjunctive treatment with perampanel requires special consideration in those with underlying medical conditions to prevent serious adverse events.

Risk Factors Associated With Reintervention After Thoracic Endovascular Aortic Repair for Descending Aortic Pathologies.

Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection. Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months. The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively). Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.

Comparison of exogenous and endogenous lipoid pneumonia: the relevance to bronchial anthracofibrosis.

Lipoid pneumonia, caused by the accumulation of lipids in the alveoli, is classified into two forms (exogenous vs. endogenous) according to the source of the lipid exposure. There are no data directly comparing patients with exogenous and endogenous lipoid pneumonia. All patients who were diagnosed with lipoid pneumonia between January 2008 and December 2016 at Kyungpook National University Hospital, a tertiary referral hospital in South Korea, were retrospectively reviewed. The clinical, radiologic, and bronchoscopic findings for the two forms of lipoid pneumonia were compared. A total of 13 patients who met the criteria for a confirmed diagnosis of lipoid pneumonia were included. Dyspnea at presentation, predominant lower lobes involvement, bronchial anthracofibrosis (BAF), and recurrent episodes were more frequent in patients with the endogenous form than in those with the exogenous form. Of them, a notable finding was that BAF was identified in all five patients with the endogenous form, whereas BAF was observed in only one of the eight patients with the exogenous form (P=0.005). This finding suggests that BAF may be associated with endogenous form. Awareness of this association between endogenous lipoid pneumonia and BAF may help clinicians avoid delaying diagnoses.

Relationships between vitamin D and paraspinal muscle: human data and experimental rat model analysis

Background ContextVitamin D deficiency (VDD) has been closely linked with skeletal muscle atrophy in many studies, but to date no study has focused on the paraspinal muscle. PurposeTo verify paraspinal muscle changes according to serum vitamin D level. Study DesignA cross-sectional study of patients who visited our hospital and an in vivo animal study. MethodsWe measured serum vitamin D concentration in 91 elderly women and stratified them according to their vitamin D status in three groups, control, vitamin D insufficiency, and VDD, and obtained magnetic resonance imaging data of the lumbar spine and evaluated the quality and quantity of the paraspinal muscles. Additionally, we designed experimental rat models for VDD and VDD replacement. Then, we analyzed the microcomputed tomography data and histologic data of paraspinal muscles, and the histologic data and reverse transcription-quantitative polymerase chain reaction data of intramyonuclear vitamin D receptor (VDR) in paraspinal muscle through comparison with control rats (n=25, each group). This work was supported by a Biomedical Research Institute grant ($40,000), Kyungpook National University Hospital (2014). ResultsIn the human studies, a significant decrease was noted in the overall paraspinal muscularity (p<.05) and increase in fatty infiltration in the VDD group as compared with the other groups (p<.05). In the rat experiment, a decrease was noted in paraspinal muscle fiber size and VDR concentration and VDR gene expression level, and total muscle volume of the VDD rats as compared with the control rats (p<.05). Vitamin D replacement after VDD could partially restore the muscle volume, muscle fiber size, and intramyonuclear VDR concentration levels (p<.05) of the paraspinal muscles. ConclusionsVDD induces paraspinal muscle atrophy and decreases the intramyonuclear VDR concentration and VDR gene expression level in these muscles. Vitamin D replacement contributes to the recovery from atrophy and restoration of intramyonuclear VDR concentration in VDD status.

Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury.

ObjectiveTo investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI).MethodsA retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group.ResultsOf the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors.ConclusionCompared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.

EP25.05: Sonographic markers in treatment of hemoperitoneum caused by corpus luteal cyst rupture

To know considerable factors to make decisions such as surgical intervention or conservative treatment in patients of hemoperitoneum, corpus luteal cyst rupture. We conducted a retrospective review of the patients diagnosed hemoperitoneum with ruptured corpus luteal cyst in Kyungpook National University Hospital in Daegu, South Korea between January 2010 and March 2015. We divided into two groups, surgical intervention or conservative treatment, compare with clinical characteristics, vital signs, laboratory tests and sonographic findings at initial visit in both groups. A total of 99 women were enrolled in our study. 78(78.8%) women were treated conservatively and 21(21.2%) women were needed surgical interventions. In two groups, there are statistically differences in initial pulse rate (p=0.027), hemoglobin (p=0.026), the amount of posterior cul-de-sac fluid (p=0.001), total cul-de-sac fluid (p=0.001), liver dome fluid (p=0.006), estimated fluid amount (p=0.001) at sonographically. In multiple logistic regression analysis, the most important risk factor to make surgical treatment is liver dome fluid collection(OR 1.2 with 95% CI, 1.111-1.202) Sonographic finding such as subhepatic fluid collection is helpful in making decision of treatment in corpus luteal cyst rupture. EP25.05: Table 1. Characteristics and sonographic findings

Traumatic Brain Injury in Children under Age 24 Months: Analysis of Demographic Data, Risk Factors, and Outcomes of Post-traumatic Seizure.

ObjectiveTraumatic brain injury (TBI) in children under age 24 months has characteristic features because the brain at this age is rapidly growing and sutures are opened. Moreover, children this age are completely dependent on their parents. We analyzed the demographic data and risk factors for outcomes in TBI patients in this age group to elucidate their clinical characteristics.MethodsWe retrospectively reviewed the medical records and radiological films of children under 24 months who were admitted to Kyungpook National University Hospital from January 2004 to December 2013 for TBI. Specifically, we analyzed age, cause of injury, initial Glasgow coma scale (GCS) score, radiological diagnosis, seizure, hydrocephalus, subdural hygroma, and Glasgow outcome scale (GOS) score, and we divided outcomes into good (GOS 4–5) or poor (GOS 1–3). We identified the risk factors for post-traumatic seizure (PTS) and outcomes using univariate and multivariate analyses.ResultsThe total number of patients was 60, 39 males and 21 females. Most common age group was between 0 to 5 months, and the median age was 6 months. Falls were the most common cause of injury (n=29, 48.3%); among them, 15 were falls from household furniture such as beds and chairs. Ten patients (16.7%) developed PTS, nine in one week; thirty-seven patients (61.7%) had skull fractures. Forty-eight patients had initial GCS scores of 13–15, 8 had scores of 12–8, and 4 had scored 3–7. The diagnoses were as follows: 26 acute subdural hematomas, 8 acute epidural hematomas, 7 focal contusional hemorrhages, 13 subdural hygromas, and 4 traumatic intracerebral hematomas larger than 2 cm in diameter. Among them, two patients underwent craniotomy for hematoma removal. Four patients were victims of child abuse, and all of them had PTS. Fifty-five patients improved to good-to-moderate disability. Child abuse, acute subdural hematoma, and subdural hygroma were risk factors for PTS in univariate analyses. Multivariate analysis found that the salient risk factor for a poor outcome was initial GCS on admission.ConclusionThe most common cause of traumatic head injury in individuals aged less than 24 months was falls, especially from household furniture. Child abuse, moderate to severe TBI, acute subdural hematoma, and subdural hygroma were risk factors for PTS. Most of the patients recovered with good outcomes, and the risk factor for a poor outcome was initial mental status.

Mid-Term Outcomes of Single-Port versus Conventional Three-Port Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax.

BackgroundThe benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS.MethodsBetween March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients.ResultsThe mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups.ConclusionNo significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.

Obesity Markers as Predictors for Colorectal Neoplasia.

BackgroundThe goal of this study was to determine the relations between the risk of colorectal neoplasia and obesity markers: body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR).MethodsThe subjects who underwent screening colonoscopies at a Kyungpook National University Hospital in Daegu from July to December 2010 were enrolled. We defined colorectal neoplasia as tubular adenoma, advanced adenoma, or cancer. We performed a logistic regression analysis to investigate the correlations between obesity and colorectal neoplasia and a receiver operating characteristic (ROC) curve analysis to determine the cut-off obesity marker values for detecting colorectal neoplasia.ResultsAmong the total of 268 subjects, 83 (31.0%) subjects had colorectal neoplasia. Subjects with neoplasia had higher BMI, WC, and WHtR than the subjects without any neoplasia. The adjusted odds ratio (aOR) of WHtR ≥0.5 with the association of neoplasia was 1.927 (95% confidence interval [CI], 1.041–3.569) in the total subjects. In women, the obesity markers of WC ≥85 cm (aOR 4.611; 95% CI, 10.166–18.240) and WHtR ≥0.5 (aOR 1.747; 95% CI, 1.149–19.617) were significantly related to neoplasia; however, there was no significant result in men. The ROC analysis showed the optimal cut-off values of BMI as >23.14 kg/m2 (P=0.002), WHtR as >0.50 (P<0.001), and WC as>82.5 cm (P=0.650) in men and >77 cm in women (P<0.001).ConclusionObesity is significantly associated with the increased risk of colorectal neoplasia. WC and WHtR have more significant correlations with neoplasia; thus, obese people should undergo regular colonoscopy screenings to detect colorectal neoplasia.

Video‐Assisted Thoracoscopic Left Cardiac Sympathetic Denervation in Patients with Hereditary Ventricular Arrhythmias

Left cardiac sympathetic denervation (LCSD) has been underutilized in patients with hereditary ventricular arrhythmia syndromes such as congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The purpose of this study was to investigate the safety and efficacy of video-assisted thoracoscopic (VATS) LCSD in such patients. Fifteen patients (four men, 24.6 ± 10.5 years old) who underwent VATS-LCSD between November 2010 and January 2015 for hereditary ventricular arrhythmia syndromes at Kyungpook National University Hospital were enrolled in this study. The safety and efficacy of VATS-LCSD were evaluated by periprocedural epinephrine tests and assessing the development of complications and cardiac events during follow-up. Fourteen patients with LQTS and one patient with CPVT underwent VATS-LCSD. Six and one patients developed ventricular tachyarrhythmia during preprocedural and postprocedural epinephrine test, respectively (P = 0.063). No serious complications such as Horner syndrome, pneumothorax, or bleeding developed after LCSD. Mean hospital stay after VATS-LCSD was 3.7 ± 1.5 days. During a mean follow-up of 927 ± 350 days, one LQTS patient and one CPVT patient, neither of whom manifested tachyarrhythmia during post-LCSD epinephrine test, developed torsades de pointes and syncope, respectively. The annual event rates of six patients who were symptomatic during the period preceding LCSD decreased from 0.97 to 0.19 events/year (P = 0.045). VATS-LCSD was a safe, and effective procedure for patients with hereditary ventricular tachycardia syndrome, with no serious adverse events and with short hospital stay.

Efficacy of G-CSF Primed DLI Using Cells Reserved at the Time of Harvest in Patients with Hematologic Malignancies Who Lately Relapsed after Allogeneic PBSCT

IntroductionThere is no standard therapeutic approach for the relapse after allogeneic hematopoietic cell transplantation (allo-HCT). The aim of this paper is to confirm the role of granulocyte colony-stimulating factor (G-CSF) primed donor lymphocyte infusion (DLI) according to the timing of relapse after allo-HCT with limited CD34+ cell dose (<6x106/kg)MethodsOne hundred ten patients who had relapsed after allo-HCT at Kyungpook National University Hospital from November 2001 to December 2014, including 40 patients who received DLI from cryopreserved cells derived from the original G-CSF primed graft, were retrospectively reviewed. The patients were classified into early relapse or late relapse group by the median time of relapse after transplant.ResultsThe median age at transplant was 38.5 years (range, 17-67 years) and male was 69 patients (62.2%). Primary diseases for allo-HCT included AML/MDS (n=63, 57.3%), ALL (n=32, 29.1%), CML (n=8, 7.3%), and NHL (n=7, 6.4%). Fifty four patients (49.1%) were in CR1 (complete remission), 16 (14.5%) in CR2, and 40 (36.4%) in relapsed and refractory status at the time of HCT. Sixty nine patients (62.2%) received myeloablative conditioning regimen. The median dose of CD34+ cells was 5.06x106/kg (range, 1~20.6x106/kg). Ninety nine percent of patients achieved the neutrophil recovery (> 500x103/mm3 for 3 days) at a median time of 13 days (range 9-24 days). The median time from HCT to relapse was 139 days (range, 21~1801 days). The median relapse free survival (RFS) since HCT was not significantly different according to the dose of CD34+ cells: median 147 days (range, 122-171) and 157 days (range, 87-227) in CD34+ < 6x106/kg and > 6x106/kg, respectively (p=0.249). The median overall survival (OS) since HCT was not significantly different according to the dose of CD34+ cells: median 324 days (range, 272-375) and 262 days (range, 235-288) in CD34+ < 5.06x106/kg and > 5.06x106/kg, respectively (p=0.554).The incidence of chronic GVHD was more frequent in higher CD34+ group (32.9% vs. 48.2%, P=0.042). After relapse, 57 patients (51.8%) were treated with salvage chemotherapy, 13 patients (11.8%) with second allo-HCT, and 40 patients (36.4%) with G-CSF primed DLI. The median number of CD3+T cell was 2.95x107/kg (range, 0.1~5.43x107/kg). Fourteen patients (23.6%) achieved DLI-induced CR, 20 patients progressed, and 6 patients were not evaluable for response. DLI-induced acute GVHD was observed in 25 patients (62.5%) and chronic GVHD developed in 4 patients (10%). The 1-year overall survival (OS) since relapse was not significantly different according to the use of DLI in early relapse group (11.7 +/- 5.3% and 10.0 +/- 6.7%, p=0.663), but in late relapse group, significantly higher in DLI than non-DLI (43.3 +/- 11.3% and 17.1 +/- 6.9%, p=0.021). The patients treated with DLI showed significantly higher RFS in late relapse group (286 days vs. 165 days, p=0.004). The incidence of DLI-induced GVHD did not differ between two groups.ConclusionsG-CSF primed DLI after allo-HCT with limited CD34+ cell dose can be feasible and effective option in terms of response, donor convenience and its cost. In the late relapse group, it may replace the second transplantation for the patients with hematologic malignancies lately relapsed after first allo-HCT. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Overexpression of Aquaporin-1 is a Prognostic Factor for Biochemical Recurrence in Prostate Adenocarcinoma.

Aquaporins (AQP) are transmembrane proteins that provide channels for water and solutes, and some are involved in tumor progression and invasion. We evaluated the expression of AQP-1, AQP-3, and AQP-5 and their clinicopathological significance in prostate adenocarcinomas (PCA). Prostatectomy specimens (n = 99) were retrieved from the surgical pathology archives and clinicopathological data were obtained from the medical database at Kyungpook National University Hospital. Immunohistochemical staining for AQP-1, AQP-3, and AQP-5 was performed on tissue microarrays comprising paired malignant and benign prostatic tissues. Seventeen PCA cases (17.2%) showed AQP-1 overexpression, specifically 7 tumors (9.7%) with lower Gleason scores (GS) and 10 tumors (37.0%) with higher GS, with statistical significance (P = 0.001). AQP-1 overexpression was significantly associated with higher GS (P = 0.001), higher pathologic T (pT) stages (P = 0.024), and biochemical recurrence (BR) (P = 0.002). The difference in AQP-3 and AQP-5 expression between neoplastic and non-neoplastic tissues was not established and there were no correlations with clinicopathological parameters. AQP-1 overexpression was evident in tumors with higher GS, it was less evident in tumors with lower GS, and it was associated with BR and a higher pT stage. AQP-1 overexpression is associated with prostate cancer progression.

Outcomes of standard and tailored anti-tuberculosis regimens in patients with tuberculous pleural effusion.

In an era of increasing concerns about drug resistance, there are limited data on treatment outcomes and recurrence rates after standard short-course anti-tuberculosis treatment in patients with culture-negative tuberculous pleural effusion (TPE). To compare treatment outcomes and recurrence rates between a standard anti-tuberculosis regimen with negative culture and unavailable drug susceptibility testing (DST) data, and a tailored anti-tuberculosis regimen based on individual DST data. We analysed the data of all patients with TPE from the TB registry database at Kyungpook National University Hospital, South Korea, during 2008-2012. The study population was divided into two groups according to regimen. Standard and tailored anti-tuberculosis regimens were administered to respectively 124 and 146 patients with TPE. Drug resistance was detected in 10% of patients with TPE, about a quarter of whom were multidrug-resistant. The treatment completion rate was not significantly different between the two groups (91% vs. 93%). During a median 20-month follow-up, the recurrence rate was also similar in both groups (1% vs.1%). Despite limited statistical power, these preliminary results support the hypothesis that immunocompetent patients with culture-negative TPE can be appropriately managed with a standard short-course anti-tuberculosis regimen, even in this era of increasing concerns about drug resistance.

Clinical analysis of the factors contributing to pupillary optic capture after transscleral fixation of posterior chamber intraocular lens for dislocated intraocular lens

To study the incidence of and risk factors for pupillary capture after transscleral fixation of a posterior chamber intraocular lens (PC IOL) for dislocated IOLs. Department of Ophthalmology, Kyungpook National University Hospital, Daegu, South Korea. Retrospective case series. Charts of patients who had PC IOL transscleral fixation for the treatment of dislocated IOLs between January 2010 and August 2015 were reviewed. Demographic data, anterior chamber depth (ACD), axial length (AL), anterior chamber volume (ACV), and anterior chamber angle (ACA) were recorded. The cases of postoperative pupillary capture were collected and the characteristic clinical findings evaluated. Charts of 63 eyes of 63 patients were reviewed. The mean age was 63years±11 (SD). The mean follow-up after transscleral fixation was 47.8±25.3months. There were 5 cases of postoperative pupillary capture (incidence 7.8%). A deeper anterior chamber was statistically correlated with an increased incidence of pupillary capture (β coefficient: 0.423; 95% confidence interval, 0.043-0.379; P<.015). There were no significant differences in the incidence of postoperative pupillary capture and age, sex, intraocular pressure, corrected visual acuity, astigmatism, AL, ACV, ACA, trauma history, associated ocular morbidity, or general comorbidity. To reduce the incidence of pupillary capture when ACD values are large, the scleral penetrating point should be adjusted from the corneal limbus. Neither author has a financial or proprietary interest in any material or method mentioned.

Evaluation of therapeutic mammoplasty techniques in the surgical management of female patients with idiopathic granulomatous mastitis with mild to moderate inflammatory symptoms in terms of recurrence and patients' satisfaction.

Although idiopathic granulomatous mastitis (IGM) affects young females, its surgical management usually leads to disfigurement of the breasts. To assess the use of therapeutic mammoplasty techniques for management of IGM in terms of recurrence and postoperative patients' satisfaction. This prospective clinical study included thirteen patients who were diagnosed histologically as IGM. Patients with moderate to large breasts, who had a breast mass between 20-50% of the breast size with failed medical treatment or intolerability to steroids were subjected to therapeutic mammoplasty techniques. Only patients with large breasts were offered contra-lateral reduction mammoplasty to resume symmetry and achieve better aesthetic results. Early postoperative bleeding that was encountered in one patient (7.7%) was the only serious postoperative complication. Patient was re-operated and the bleeder was secured. Recurrence occurred in 2 patients (15.4%) at 16 and 24 months after the operation. Kyungpook National University Hospital (KNUH) breast reconstruction satisfaction questionnaire used to assess patients' satisfaction 6 months after the operation and revealed that 10 patients (76.9%) were satisfied after the operation. Using therapeutic mammoplasty techniques in surgical management of IGM in moderate to large breasts seems justifiable with good results regarding recurrence and postoperative patients' satisfaction.

3:54 PMAbstract No. 65 - Evaluation of hepatocellular carcinoma after treatment with microwave ablation plus transarterial embolization versus radiofrequency ablation plus transarterial embolization: a single center experience

Do geometric features of hepatocellular carcinomas correlate with survival following radiofrequency ablation (RFA) with and without lyso-thermosensitive liposomal doxorubicin (LTLD/Thermodox)? M. Castro, S. Leonard, H. Celik, P. Wakim, J. Karanian, W. Pritchard, N. Borys, R. Lencioni, M. O’Neal, W. Tak, B. Wood; NIH, Bethesda, MD; FDA/CDRH Laboratory of Cardiovascular and Interventional Therapeutics, Laurel, MD; Food and Drug Administration, Rockville, MD; Celsion Corporation, Princeton, NJ; University of Miami Miller School of Medicine, Miami, FL; BioClinica,Inc., Princeton, NJ; Kyungpook National University Hospital, Jung-gu, Daegu.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms.

BackgroundPersistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to reveal the effects of POPs on the endocrine and nervous system and on cancer, few studies focus on the relationship between low-dose POPs and public health. We attempted to find a relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation.MethodsWe recruited 121 subjects who visited Kyungpook National University Hospital for a health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls and 23 types of organochlorine pesticides. Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms.ResultsOur results showed that abdominal discomfort had an inverse relationship with several polychlorinated biphenyls. Moreover, an inverted U-shaped relationship was observed between abdominal discomfort and several other organochlorine pesticides including p,p'-dichlorodiphenyldichloroethane and p,p'-dichlorodiphenyltrichloroethane, and the effects of these pesticides on abdominal discomfort were similar to that of organochlorine pesticides on obesity and metabolic syndrome.ConclusionOur results suggest that mild and unspecified gastrointestinal symptoms with no clear cause could be related to POPs levels.

Plasma neutrophil gelatinase-associated lipocalin as a predictive biomarker for the detection of acute kidney injury in adult poisoning

Context: Acute kidney injury (AKI) is a serious complication in intoxicated patients. Recently, a new biomarker - neutrophil gelatinase-associated lipocalin (NGAL) - was used to predict AKI in patients who were critically ill or had sepsis. Objective: To evaluate the utility of plasma NGAL as an early predictor of AKI in adults with acute poisoning. Materials and methods: This retrospective, observational, cohort study was conducted between December 2013 and November 2014. A total of 157 consecutive adult patients who presented to the emergency department (Level 1 regional center) of Kyungpook National University Hospital, a tertiary teaching hospital in Daegu, Korea, within 24 h of poisoning were included. Initial plasma NGAL levels and laboratory parameters were concurrently measured upon hospital arrival. AKI was defined according to Acute Kidney Injury Network criteria. Development of AKI was predicted using plasma NGAL levels and by analyzing the area under the receiver operating characteristic curve (AUC). Results: The overall rate of AKI was 14.6% (n = 23). Plasma NGAL levels in the AKI group were higher than those in the non-AKI group (median, 310 vs. 86 ng/mL; p <0.001). Additionally, baseline NGAL levels allowed for better prediction of AKI than initial creatinine levels. The AUC of plasma NGAL was 0.895 (95% confidence interval [CI]: 0.832–0.941), with a cut-off value of 227 ng/mL (sensitivity, 76.2%; specificity, 95.8%). Plasma NGAL had a higher predictive capacity for AKI than serum creatinine (AUC 0.741, 95% CI: 0.662–0.810), base deficit (AUC 0.795, 95% CI: 0.701–0.870), lactate (AUC 0.781, 95% CI: 0.690–0.856), and anion gap (AUC 0.636, 95% CI: 0.535–0.730). Conclusion: Plasma NGAL may serve as a good predictor of AKI in cases of adult poisoning.

Clinical Implication of Serine Metabolism-Associated Enzymes in Colon Cancer

Purpose: Recently, enzymes of the serine synthetic pathway (SSP) have been suggested as key player in the metabolic adaptation of oncogenesis. We assessed the expression of enzymes of the SSP in colonic tumor tissue (TT) and paired normal tissue (pNT) and the prognostic implications. Methods: From 2006 to 2010, we included 486 patients with colon cancer who underwent curative surgery at Kyungpook National University Hospital. Phosphoglycerate dehydrogenase (PHGDH), pyruvate dehydrogenase kinase (PDK) 1, PDK2, pyruvate kinase M2 (PKM2), and phosphoserine aminotransferase (PSAT) expression were investigated by immunohistochemical staining (IHC) in TT and pNT. The IHC values were calculated by multiplying intensity by proportion. The final score was classified as follows: 0-2 as negative and 3-12 as positive. Results: During the median follow-up duration of 55.5 months (37.4-90.6), 78 patients experienced recurrence. The expression of PHGDH, PDK1, and PSAT was significantly higher in TT than pNT (p < 0.001 for each). The univariate analysis for relapse-free survival revealed that TT PDK2 positivity was the only positive prognostic factor (p = 0.023). However, the expression of TT PDK2 did not represent a prognostic value in multivariate analysis. Conclusions: In conclusion, PHGDH, PDK1, and PSAT were significantly increased in colonic TT compared with pNT. The prognostic implication of these enzymes needs to be further investigated.