Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across d...Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across diverse patient populations and treatment settings.This study aimed to assess the outcomes of LDG vs.open distal gastrectomy(ODG)in patients with LAGC despite differences in clinical trial populations and treatment environments.Methods:The KLASS-02 and CLASS-01 trials are multicenter,non-inferiority,open-label,randomized controlled trials for patients with LAGC eligible for distal subtotal gastrectomy in Korea and China,respectively.Some 1,050 patients were enrolled in KLASS-02,and 1,056 patients were enrolled in CLASS-01.Individual patient data(IPD)from KLASS-02 and CLASS-01 were pooled and analyzed.Results:There were 900 patients in the LDG group and 920 in the ODG group.Baseline characteristics were well balanced between groups.The LDG group had better short-term and recovery outcomes than the ODG group,although anastomotic leakage was more frequent.For patients who underwent LDG vs.ODG,5-year overall survival(OS)was 82.7%[95%confidence interval(95%CI),80.2%-85.2%]vs.83.3%(95%CI,80.9%-85.8%)(P=0.706)and 5-year recurrence-free survival(RFS)was 76.9%(95%CI,74.1%-79.7%)vs.77.9%(95%CI,75.2%-80.6%)(P=0.666),respectively,with a median follow-up of 70 months.In the multivariable prognostic IPD meta-analysis,the operative approach was not independently associated with OS[hazard ratio(HR)=1.045,95%CI,0.833-1.311;P=0.706]or RFS(HR=1.044,95%CI,0.859-1.269;P=0.667)for LDG vs.ODG.In the subgroup analysis,LDG demonstrated a significant association with poorer RFS in the p T4 subgroup(HR=1.377,95%CI,1.022-1.760;P=0.034).Conclusions:Despite differences in patient populations,surgical practices,and postoperative treatments between trials,LDG is oncologically safe with the benefit of being minimally invasive for patients with LAGC,except for the p T4 patients.Therefore,LDG could be a good treatment alternative for patients with LAGC;however,caution should be warranted in its application for patients classified as T4.展开更多
The molecular targets of sunitinib are receptor tyrosine kinases (RTKs),and this drug has also been known to exert blocking effects on the activation of KIT,which is similar to the mechanism of action of imatinib. Mor...The molecular targets of sunitinib are receptor tyrosine kinases (RTKs),and this drug has also been known to exert blocking effects on the activation of KIT,which is similar to the mechanism of action of imatinib. Moreover,sunitinib has an additional anti-angiogenic effect through its inhibition of the vascular endothelial growth factor receptor activation. We report here a 70-year-old patient diagnosed with a recurrent gastrointestinal stromal tumor (GIST),which invaded the transverse colon and led to a perforation during sunitinib treatment. A computed tomography scan and 3-dimensional reconstruction showed necrosis of the recurrent hepatic mass and perforation of the invaded transverse colon. After percutaneous drainage of the intraperitoneal abscess,antibiotic treatment and restricted diet,the condition of the patient improved. The present case is the first to report that sunitinib,which is administered to treat GIST resistant to imatinib,can cause unexpected colon perforation and subsequent peritonitis.展开更多
Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here,we present a 77-year-old ...Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here,we present a 77-year-old female,diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The patient complained of left lower abdominal pain with a palpable mass. Abdominal CT showed an incarcerated small bowel hernia and the patient underwent segmental resection of the strangulated small bowel through a minimally extended port site incision.展开更多
An 85 year male patient complaining epigastric discomfort was admitted.From the esophagogastroduodenoscopy,three early gastric cancer(EGCa)lesions had been identified and these were diagnosed as adenocarcinoma with po...An 85 year male patient complaining epigastric discomfort was admitted.From the esophagogastroduodenoscopy,three early gastric cancer(EGCa)lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type.The patient underwent operation.From the post-operative mapping,however,additional 4 EGCa lesions were found,and the patient was diagnosed with 7 synchronous EGCa.Out of the 7 EGCa lesions,6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3layer of submucosa.In spite of such superficial invasions,28 of 48 lymph nodes had been identified as metastases.The multiple lesions of EGCa do not increase the risk of lymph node metastasis,but if their differentiations are poor or if they have lympho-vascular invasion,multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.展开更多
To the Editor:Variations in cystic duct anatomy are quite common,but double cystic ducts arising from one gallbladder is extremely rare,which have only been reported in less than 20 cases in literature[1–4].It is dif...To the Editor:Variations in cystic duct anatomy are quite common,but double cystic ducts arising from one gallbladder is extremely rare,which have only been reported in less than 20 cases in literature[1–4].It is difficult to diagnose the anatomic anomaly preoperatively,and the rate of open conversion and post-operation complications were high due to ductal injury during surgery[2].展开更多
Objective:The laparoscopic approach for locally advanced gastric cancer has recently been adopted based on the results of several randomized controlled trials(RCTs).However,findings from RCTs have not been examined at...Objective:The laparoscopic approach for locally advanced gastric cancer has recently been adopted based on the results of several randomized controlled trials(RCTs).However,findings from RCTs have not been examined at the national level.This study aimed to investigate the external validity of the Korean Laparoscopic Gastrointestinal Surgery Study-02(KLASS-02)trial involving 13 tertiary hospitals,using data from the Korean Gastric Cancer Association(KGCA)-led nationwide survey involving 68 tertiary or general hospitals.Methods:Data on patients who underwent laparoscopic or open distal gastrectomy for pathological stageⅠB-ⅢC gastric cancer under the same conditions were collected from the KLASS-02 trial and the KGCA nationwide survey datasets.Surgical outcomes were assessed for each dataset and multivariable analyses were performed to examine the effect of the laparoscopic approach on surgical outcomes.Results:The laparoscopic group had a lower overall complication rate than the open group in both KLASS-02and KGCA datasets(16.1%vs.23.5%for the KLASS-02 and 12.6%vs.19.6%for the KGCA).Moreover,the laparoscopic group had fewer wound problems,and fewer gradeⅡ,Ⅲa,andⅣcomplications than the open group in the KGCA data(0.8%vs.3.4%,5.8%vs.10.4%,2.3%vs.3.7%,and 0.5%vs.1.4%,respectively),which were not observed in the KLASS-02 data.Multivariable analyses revealed that the laparoscopic approach was not associated with overall complications,but reduced wound problems and more harvested lymph nodes in the KGCA survey data(adjusted odds ratios,0.19 for wound problems,adjustedβcoefficient 4.39 for number of harvested lymph nodes),which were not shown in the KLASS-02 data.Conclusions:The safety and feasibility of the laparoscopic approach for locally advanced gastric cancer were validated at a national level.The laparoscopic approach for locally advanced gastric cancer can be implemented in the Republic of Korea.展开更多
Recognizing the variation of genetic resources is the first step in selection.One of the most important variations in grain crops is the uniformity of seed grain weight,which can be converted into seed size.However,it...Recognizing the variation of genetic resources is the first step in selection.One of the most important variations in grain crops is the uniformity of seed grain weight,which can be converted into seed size.However,it has been challenging since it needs high labor costs and time to measure it on a large scale.The current study used an image analysis technique to measure the grain seed area of about 100 seeds per accession with 64 germplasm of Tartary buckwheat(Fagopyrum tataricum)to study variation among and within them.To understand the nature of variation,skewness and kurtosis analysis of probability density function curve for seed area were used.As a result,a large variation among and within accessions was found.This means that the seed sizes within an accession are not uniform in this given cleistogamous species due to its non-uniform flowering time.This implies that the seed size should be considered an important factor for the germplasm enhancement program.展开更多
Objective： In recent years, oxidative stress has been implicated in a variety of degenerative process and diseases, including acute and chronic inflammatory conditions such as wound healing. Green tea polyphenols hav...Objective： In recent years, oxidative stress has been implicated in a variety of degenerative process and diseases, including acute and chronic inflammatory conditions such as wound healing. Green tea polyphenols have shown anti-oxidant property. The present study discussed the application of chitosan green tea polyphenol complex on the wound healing. Methods： The wound healing effect ofchitosan green tea polyphenol complex was studied in tenweek-old healthy male Sherman rats weighing 150-180 g by two wound models. The rats were randomly chosen and divided into four groups （n=5）, administered with distilled water in Group A as control group, epigallocatechin-3-gallate （EGCG） in Group B, chitosan-EGCG complex in Group C and chitosan-green tea polyphenols complex in Group D, respectively. In rats＇incision wound model, two straight paravertebral incisions were made and skin tensile strength was measured using continuous water flow technology on the 10th day. In rats＇excision wound model, wound contraction and period of epithelization were measured. The polyphenols release from the complex was continuously monitored by an elution technique in aqueous solution at different pH values （pH=4, 5, 6, 7）. Results： The treatment groups showed significantly enhanced the breaking strength in incision wound （328±14.5） g and 021±18.5） g compared with control （264±16.7） g. In the excision wound model, the wound contraction percentage in treatment groups was relatively increased during the recovery period. Respectively, the percentage of wound contraction ranged from 47.60%±2.15% on day 4 to 107.98% ± 1.26% on day 16 compared with control group （8.46%±5.42% to 59.80%±4.47%）. The complex demonstrated a gradual increase in the release rate from the initial stage and slow increase at different pH values. The release rate approximated 0.6-0.7 in the complex and remained stable 6 hours after injury, which may be the end of the release process. Conclusions： In our study, chitosan polyphenol complex has enhanced the healing of incision wounds by increasing the breaking strength of the wounds. In excision wound model, the complex hastens the period of epithelialization. The study on the optimal release of complex among various pH values could be applied in the wound test, which can lead to a gradually active substance （polyphenols） release and efficient coverage of epithelial layers found in the healing of incision and excision wound.展开更多
Dysfunction of pancreaticβcells caused by zinc deficiency is related to the pathogenesis of diabetes.1 Impaired zinc homeostasis in diabetes is associated with reduced zinc transporters.2 Down-regulation of HuD,an es...Dysfunction of pancreaticβcells caused by zinc deficiency is related to the pathogenesis of diabetes.1 Impaired zinc homeostasis in diabetes is associated with reduced zinc transporters.2 Down-regulation of HuD,an essential factor for normalβcell function,has been shown in diabetes.展开更多
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the 2024 intramural research fund of Ajou University Medical Center(No.M-2024-C0460-00083)+3 种基金an Investigator-Initiated Study granted from Ethicon,Inc-Johnson and Johnson Med Tech(No.ENG-2021-04)the Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer(No.2020B121201004)Guangdong Provincial Major Talents Project(No.2019JC05Y361)Major Clinical Technology Project in Guangzhou(No.2023P-ZD01)。
文摘Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across diverse patient populations and treatment settings.This study aimed to assess the outcomes of LDG vs.open distal gastrectomy(ODG)in patients with LAGC despite differences in clinical trial populations and treatment environments.Methods:The KLASS-02 and CLASS-01 trials are multicenter,non-inferiority,open-label,randomized controlled trials for patients with LAGC eligible for distal subtotal gastrectomy in Korea and China,respectively.Some 1,050 patients were enrolled in KLASS-02,and 1,056 patients were enrolled in CLASS-01.Individual patient data(IPD)from KLASS-02 and CLASS-01 were pooled and analyzed.Results:There were 900 patients in the LDG group and 920 in the ODG group.Baseline characteristics were well balanced between groups.The LDG group had better short-term and recovery outcomes than the ODG group,although anastomotic leakage was more frequent.For patients who underwent LDG vs.ODG,5-year overall survival(OS)was 82.7%[95%confidence interval(95%CI),80.2%-85.2%]vs.83.3%(95%CI,80.9%-85.8%)(P=0.706)and 5-year recurrence-free survival(RFS)was 76.9%(95%CI,74.1%-79.7%)vs.77.9%(95%CI,75.2%-80.6%)(P=0.666),respectively,with a median follow-up of 70 months.In the multivariable prognostic IPD meta-analysis,the operative approach was not independently associated with OS[hazard ratio(HR)=1.045,95%CI,0.833-1.311;P=0.706]or RFS(HR=1.044,95%CI,0.859-1.269;P=0.667)for LDG vs.ODG.In the subgroup analysis,LDG demonstrated a significant association with poorer RFS in the p T4 subgroup(HR=1.377,95%CI,1.022-1.760;P=0.034).Conclusions:Despite differences in patient populations,surgical practices,and postoperative treatments between trials,LDG is oncologically safe with the benefit of being minimally invasive for patients with LAGC,except for the p T4 patients.Therefore,LDG could be a good treatment alternative for patients with LAGC;however,caution should be warranted in its application for patients classified as T4.
文摘The molecular targets of sunitinib are receptor tyrosine kinases (RTKs),and this drug has also been known to exert blocking effects on the activation of KIT,which is similar to the mechanism of action of imatinib. Moreover,sunitinib has an additional anti-angiogenic effect through its inhibition of the vascular endothelial growth factor receptor activation. We report here a 70-year-old patient diagnosed with a recurrent gastrointestinal stromal tumor (GIST),which invaded the transverse colon and led to a perforation during sunitinib treatment. A computed tomography scan and 3-dimensional reconstruction showed necrosis of the recurrent hepatic mass and perforation of the invaded transverse colon. After percutaneous drainage of the intraperitoneal abscess,antibiotic treatment and restricted diet,the condition of the patient improved. The present case is the first to report that sunitinib,which is administered to treat GIST resistant to imatinib,can cause unexpected colon perforation and subsequent peritonitis.
文摘Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here,we present a 77-year-old female,diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The patient complained of left lower abdominal pain with a palpable mass. Abdominal CT showed an incarcerated small bowel hernia and the patient underwent segmental resection of the strangulated small bowel through a minimally extended port site incision.
文摘An 85 year male patient complaining epigastric discomfort was admitted.From the esophagogastroduodenoscopy,three early gastric cancer(EGCa)lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type.The patient underwent operation.From the post-operative mapping,however,additional 4 EGCa lesions were found,and the patient was diagnosed with 7 synchronous EGCa.Out of the 7 EGCa lesions,6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3layer of submucosa.In spite of such superficial invasions,28 of 48 lymph nodes had been identified as metastases.The multiple lesions of EGCa do not increase the risk of lymph node metastasis,but if their differentiations are poor or if they have lympho-vascular invasion,multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.
文摘To the Editor:Variations in cystic duct anatomy are quite common,but double cystic ducts arising from one gallbladder is extremely rare,which have only been reported in less than 20 cases in literature[1–4].It is difficult to diagnose the anatomic anomaly preoperatively,and the rate of open conversion and post-operation complications were high due to ductal injury during surgery[2].
基金supported by a grant from the Patient-Centered Clinical Research Coordinating Center(PACEN)funded by the Ministry of Health&Welfare,Republic of Korea(No.RS-2020-KH095827)。
文摘Objective:The laparoscopic approach for locally advanced gastric cancer has recently been adopted based on the results of several randomized controlled trials(RCTs).However,findings from RCTs have not been examined at the national level.This study aimed to investigate the external validity of the Korean Laparoscopic Gastrointestinal Surgery Study-02(KLASS-02)trial involving 13 tertiary hospitals,using data from the Korean Gastric Cancer Association(KGCA)-led nationwide survey involving 68 tertiary or general hospitals.Methods:Data on patients who underwent laparoscopic or open distal gastrectomy for pathological stageⅠB-ⅢC gastric cancer under the same conditions were collected from the KLASS-02 trial and the KGCA nationwide survey datasets.Surgical outcomes were assessed for each dataset and multivariable analyses were performed to examine the effect of the laparoscopic approach on surgical outcomes.Results:The laparoscopic group had a lower overall complication rate than the open group in both KLASS-02and KGCA datasets(16.1%vs.23.5%for the KLASS-02 and 12.6%vs.19.6%for the KGCA).Moreover,the laparoscopic group had fewer wound problems,and fewer gradeⅡ,Ⅲa,andⅣcomplications than the open group in the KGCA data(0.8%vs.3.4%,5.8%vs.10.4%,2.3%vs.3.7%,and 0.5%vs.1.4%,respectively),which were not observed in the KLASS-02 data.Multivariable analyses revealed that the laparoscopic approach was not associated with overall complications,but reduced wound problems and more harvested lymph nodes in the KGCA survey data(adjusted odds ratios,0.19 for wound problems,adjustedβcoefficient 4.39 for number of harvested lymph nodes),which were not shown in the KLASS-02 data.Conclusions:The safety and feasibility of the laparoscopic approach for locally advanced gastric cancer were validated at a national level.The laparoscopic approach for locally advanced gastric cancer can be implemented in the Republic of Korea.
基金supported by a grant from the Standardization and Integration of Resources Information for Seed-Cluster in Hub-Spoke Material Bank Program(Project No.PJ01587004),Rural Development Administration,Republic of Korea.
文摘Recognizing the variation of genetic resources is the first step in selection.One of the most important variations in grain crops is the uniformity of seed grain weight,which can be converted into seed size.However,it has been challenging since it needs high labor costs and time to measure it on a large scale.The current study used an image analysis technique to measure the grain seed area of about 100 seeds per accession with 64 germplasm of Tartary buckwheat(Fagopyrum tataricum)to study variation among and within them.To understand the nature of variation,skewness and kurtosis analysis of probability density function curve for seed area were used.As a result,a large variation among and within accessions was found.This means that the seed sizes within an accession are not uniform in this given cleistogamous species due to its non-uniform flowering time.This implies that the seed size should be considered an important factor for the germplasm enhancement program.
文摘Objective： In recent years, oxidative stress has been implicated in a variety of degenerative process and diseases, including acute and chronic inflammatory conditions such as wound healing. Green tea polyphenols have shown anti-oxidant property. The present study discussed the application of chitosan green tea polyphenol complex on the wound healing. Methods： The wound healing effect ofchitosan green tea polyphenol complex was studied in tenweek-old healthy male Sherman rats weighing 150-180 g by two wound models. The rats were randomly chosen and divided into four groups （n=5）, administered with distilled water in Group A as control group, epigallocatechin-3-gallate （EGCG） in Group B, chitosan-EGCG complex in Group C and chitosan-green tea polyphenols complex in Group D, respectively. In rats＇incision wound model, two straight paravertebral incisions were made and skin tensile strength was measured using continuous water flow technology on the 10th day. In rats＇excision wound model, wound contraction and period of epithelization were measured. The polyphenols release from the complex was continuously monitored by an elution technique in aqueous solution at different pH values （pH=4, 5, 6, 7）. Results： The treatment groups showed significantly enhanced the breaking strength in incision wound （328±14.5） g and 021±18.5） g compared with control （264±16.7） g. In the excision wound model, the wound contraction percentage in treatment groups was relatively increased during the recovery period. Respectively, the percentage of wound contraction ranged from 47.60%±2.15% on day 4 to 107.98% ± 1.26% on day 16 compared with control group （8.46%±5.42% to 59.80%±4.47%）. The complex demonstrated a gradual increase in the release rate from the initial stage and slow increase at different pH values. The release rate approximated 0.6-0.7 in the complex and remained stable 6 hours after injury, which may be the end of the release process. Conclusions： In our study, chitosan polyphenol complex has enhanced the healing of incision wounds by increasing the breaking strength of the wounds. In excision wound model, the complex hastens the period of epithelialization. The study on the optimal release of complex among various pH values could be applied in the wound test, which can lead to a gradually active substance （polyphenols） release and efficient coverage of epithelial layers found in the healing of incision and excision wound.
基金supported by the Basic Science Research Programs through the National Research Foundation of Korea(NRF)grant funded by the Korean government(MSIT)(No.2021R1A2C1004128).
文摘Dysfunction of pancreaticβcells caused by zinc deficiency is related to the pathogenesis of diabetes.1 Impaired zinc homeostasis in diabetes is associated with reduced zinc transporters.2 Down-regulation of HuD,an essential factor for normalβcell function,has been shown in diabetes.
