In the title compound,[Zn(C(20)H(14)NO)(2)]·2CH(3)OH, the Zn(II) atom lies on a crystallographic twofold rotation axis and is coordinated by two O atoms and two N atoms from two bidentate 2-{[(9H-fluoren-2-yl)methyl-idene]amino}-phenolate ligands within a distorted tetra-hedral geometry. The dihedral angle between the two chelate rings is 82.92 (5)°. In the coordinated ligand, the phenol ring is twisted at 30.22 (9)° from the mean plane of the fluorene ring. In the crystal, O-H⋯O hydrogen bonds link the complex mol-ecules to the methanol solvent mol-ecules.

OBJECTIVES: The accuracies of biomarkers checked in the hepatic vein (HV) and peripheral vein (PV) were compared in the prediction of advanced fibrosis (AF) of liver. METHODS: Patients with chronic viral hepatitis (n=101) who underwent hepatic venous pressure gradient, liver biopsy, and paired HV-PV samples (6 biomarkers: hyaluronic acid [HA], haptoglobin, matrix metalloproteinase-2 [MMP2], tissue inhibitor of metalloproteinases-1 [TIMP1], procollagen III N-terminal peptide [PIIINP], and apolipoprotein-A1 [Apo-A1]) were enrolled. RESULTS: Differences were displayed between the HV and PV in the predictive logit-models for predicting AF (-3.13+0.017×MMP2-0.019×haptoglobin and -0.270+0.007×HA-0.018×haptoglobin, respectively). In the area under the receiver operating characteristic curves, PIIINP (0.74/0.68, p=0.03), MMP2 (0.72/0.63, p=0.04), HA (0.79/0.76, p=0.94), Apo-A1 (0.56/0.48, p=0.73), and predictive logit-model (0.81/0.78, p=0.68) showed higher diagnostic value in the HV sample. CONCLUSIONS: While most biomarkers were correlated better with hepatic fibrosis in HV than in PV, individually and in predictive logit-models, they were inadequate to determine the degree of advanced fibrosis.

OBJECTIVE The study of synchronous multiple gastric carcinoma is of the utmost importance in the management of carcinoma of the gastric remnant and in the epidemiology and histogenesis of gastric carcinoma. We compared the clinicopathologic features and outcome of patients with synchronous multiple gastric carcinoma (SMGC) to those of patients with single gastric carcinoma. METHODS Of the 3,320 patients diagnosed with gastric carcinoma who underwent surgery in our hospital, 188 patients (5.7%) were diagnosed with SMGCs. RESULTS Early carcinomas were more frequently observed in patients with SMGCs than in patients with single gastric carcinoma (p < 0.001). In addition, lymph node metastasis was less common in patients with SMGCs than in patients with single gastric carcinomas (p < 0.05). Regarding the operative procedures, total gastrectomy was more frequently performed in patients with SMGC (32.5 vs. 20.2%; p < 0.001). The 5-year survival rate of patients with SMGCs was higher than that of patients with single gastric carcinoma (69.3% vs. 54.1%, p < 0.001). Multivariate analysis showed that lymph node metastasis, serosal invasion, and curative resection were significant prognostic factors for the survival of patients with SMGCs. CONCLUSION More recently, endoscopic or laparoscopic resection for early gastric carcinoma has frequently been performed. Careful preoperative and intraoperative evaluation and postoperative follow-ups are essential to detect any missed lesions in the remnant stomach, particularly in elderly patients with early gastric carcinoma.

BACKGROUND: We conducted a population-based retrospective cohort study to investigate the influence of hospital volume, delay of surgery, and both together on the long-term survival of postoperative cancer patients. METHODS: Using information from the Korea Central Cancer Registry from 2001 through 2005 and the National Health Insurance claim database, we determined survival for 147 682 patients who underwent definitive surgery for any of six cancers. RESULTS: Regardless of cancer site, surgical patients in low- to medium-volume hospitals showed significantly worse survival [adjusted hazard ratio (aHR)= 1·36-1·86] than those in high-volume hospitals in multivariable analyses. Among the latter, treatment delays >1 month were not associated with worse survival for stomach, colon, pancreatic, or lung cancer but were for rectal [aHR = 1·28; 95% confidence interval (CI), 1·17-1·40] and breast (aHR = 1·59; 95% CI, 1·37-1·84) cancer. For patients in low- to medium-volume hospitals, treatment delay was associated with worse survival for all types of cancer (aHR = 1·78-3·81). CONCLUSION: Our findings suggest that the effect of hospital volume and surgical treatment delay on overall survival of cancer patients should be considered in formulating or revising national health policy.

BACKGROUND: Routine antenatal ultrasound scans increased the detection of the neuroblastoma (NB) in neonates. We reviewed the treatment outcome and clinical presentation of neonatal NB. METHODS: We included patients who had pathologically confirmed NB presented within 28 days after birth from January 1999 to December 2010. RESULTS: There were 17 patients (8 females and 9 males), which consist of 16 % of total NB cases of children in our institution. Nine were followed from prenatal period as an abdominal mass and eight were presented postnatally (5 abdominal distensions, 2 tachypnea, and 1 persistent jaundice). The primary lesion was located in adrenal gland in ten patients, retroperitoneum in four, and posterior mediastinum in three. The tumor size was median 4.1 cm (range, 3-7). The stage of the patients were as follows: stage 1 in six, stage 2 in one, stage 3 in three, stage 4S in five, and stage 4 in two. Six patients were in the low-risk group, seven were intermediate-risk group, and four were high-risk group. Thirteen showed favorable histology among 15 specimens. Five patients (29.4 %) showed MYCN amplification. The median follow-up period was 78.4 months (range, 17.4-138.6). Fifteen of 17 (88.2 %) are alive without evidence of recurrences and two patients of stage 4S with MYCN amplification in high-risk group died. CONCLUSIONS: The overall survival of neonatal NB is 88.2 %, but we observed a high ratio of stage 4 and stage 4S tumors and MYCN amplification. We suggested that early treatment might be better for neonatal NB more than 3 cm in size. Aggressive treatment for neonatal NB could bring more favorable outcome.

INTRODUCTION The main methods of treatment of endometrial carcinoma are hysterectomy and bilateral oophorectomy with lymphadenectomy. However, another option for hormonal treatment of endometrial carcinoma, the use of progesterone in young patients to preserve childbearing capacity, has been reported, and a high remission rate has been described in well-selected stage I, grade 1 endometrial cancer. Although it is intriguing that hormonal therapy alone can treat endometrial carcinoma without surgery or cytotoxic chemotherapy, the molecular basis for the effects of progesterone on endometrial carcinoma is not clearly known. MicroRNAs (miRNAs) are a class of naturally occurring small, noncoding RNA molecules that control cellular function and are known to function as both tumor suppressors and oncogenes. Thus, in the present study, changes in the miRNA profile of endometrial carcinoma cells on progesterone treatment were studied. METHOD To elucidate the mechanism of hormonal treatment in endometrial carcinoma cells, we studied the changes in miRNA expression in endometrial carcinoma cells on treatment with progesterone using the Hec1A endometrial carcinoma cell line as a model system. Hec1A cells were treated with medroxyprogesterone acetate, and total RNA was extracted. The changes in the miRNA profile after progesterone treatment were determined using a microarray containing 868 miRNAs. RESULTS Of 868 miRNAs, the expression levels of miR-625*,-21,-142-5p, and 146b-5p were increased by more than 400%, whereas the expression levels of miR-633,-29c,-29*, and -193b were decreased by 50%. To validate the array results, quantitative real-time polymerase chain reactions were performed. CONCLUSIONS MiRNA expression was modulated by progesterone treatment in endometrial carcinoma cells, implying a possible critical role of miRNAs in regulating posttranscriptional gene expression on progesterone treatment. Further studies are required to clarify the mechanism involved in the hormonal treatment of endometrial carcinoma.

PURPOSE: To perform a prospective phase II study to investigate the efficacy and safety of preoperative pelvic radiation therapy and concomitant small-field boost irradiation with 5-fluorouracil and leucovorin for 5 weeks in locally advanced rectal cancer patients. METHODS AND MATERIALS: Sixty-nine patients with locally advanced, nonmetastatic, mid-to-lower rectal cancer were prospectively enrolled. They had received preoperative chemoradiation therapy and total mesorectal excision. Pelvic radiation therapy of 43.2 Gy in 24 fractions plus concomitant boost radiation therapy of 7.2 Gy in 12 fractions was delivered to the pelvis and tumor bed for 5 weeks. Two cycles of 5-fluorouracil and leucovorin were administered for 3 days in the first and fifth week of radiation therapy. The pathologic response, survival outcome, and treatment toxicity were evaluated for the study endpoints. RESULTS: Of 69 patients, 8 (11.6%) had a pathologically complete response. Downstaging rates were 40.5% for T classification and 68.1% for N classification. At the median follow-up of 69 months, 36 patients have been followed up for more than 5 years. The 5-year disease-free survival (DFS) and overall survival rates were 66.0% and 75.3%, respectively. Higher pathologic T (P =.045) and N (P =.032) classification were significant adverse prognostic factors for DFS, and high-grade histology was an adverse prognostic factor for both DFS (P =.025) and overall survival (P =.031) on the multivariate analysis. Fifteen patients (21.7%) experienced grade 3 or 4 acute toxicity, and 7 patients (10.1%) had long-term toxicity. CONCLUSION: Preoperative pelvic radiation therapy with concomitant boost irradiation with 5-fluorouracil and leucovorin for 5 weeks showed acceptable acute and long-term toxicities. However, the benefit of concomitant small-field boost irradiation for 5 weeks in rectal cancer patients was not demonstrated beyond conventional irradiation for 6 weeks in terms of tumor response and survival.

Recently, a less toxic regimen comprising reduced cyclophosphamide (Cy), fludarabine, and anti-thymocyte globulin (ATG)(Cy-Flu-ATG) was used to condition high-risk patients scheduled for allogeneic hematopoietic cell transplantation (alloHSCT) instead of standard Cy-ATG in patients with severe aplastic anemia (AA). We performed a randomized phase III study to compare the regimen-related toxicities (RRTs) of two different conditioning regimens: Cy-ATG vs. Cy-Flu-ATG. Patients in the Cy-ATG arm received Cy at 200 mg/kg. Those in the Cy-Flu-ATG arm received fludarabine (Flu) at 150 mg/m(2) and Cy at 100 mg/kg. A total of 83 patients (40 in the Cy-ATG and 43 in the Cy-Flu-ATG) were enrolled. Seventy-nine patients had AA and four had MDS. All predefined RRTs were significantly lower in patients of the Cy-Flu-ATG arm (23.3 vs. 55.0 %; p = 0.003). Infection with identified causative organism and sinusoidal obstruction syndrome, hematuria, febrile episodes, and death from any cause tended to be more frequent in Cy-ATG arm but did not differ significantly between arms. There was no difference in neutrophil engraftment failure (2.5 vs. 2.33 %; p = 0.959), acute graft-versus-host disease (GvHD)(15.0 vs. 23.3 %; p = 0.388), and chronic GvHD (16.7 vs. 16.2 %; p = 0.961) between Cy-ATG and Cy-Flu-ATG arms. The 4-year survival rate did not differ between the Cy-ATG and Cy-Flu-ATG arms. Preconditioning with Cy-Flu-ATG was superior to that afforded by Cy-ATG in terms of reducing RRT levels without increasing engraftment failure.(ClinicalTrials.gov number: NCT01145976).

OBJECTIVE: To investigate the clinical outcomes of nonoperative management of emphysematous urinary tract infections (EUTIs). METHODS: We retrospectively reviewed 28 consecutive cases of EUTI over a 5-year period, all of which were treated with urinary drainage and medical management without surgical intervention. EUTIs were classified as either emphysematous pyelonephritis (EP) or emphysematous cystitis (EC). Clinical, diagnostic, and therapeutic data were analyzed. RESULTS: Of the 28 patients evaluated, 13 had EP and 15 had EC, all of which were diagnosed by computed tomography. Of EP patients, the mean age was 54 years with a median serum creatinine (sCr) of 1.8 mg/dL (estimated glomerular filtration rate [eGFR] 38 mL/min/1.73 m(2)). Obstructive uropathy was present in 69%, and 100% received antibiotics and percutaneous drainage without mortality. Median follow-up was 10 months without any subsequent nephrectomy and median sCr decreased to 1.1 mg/dL (P =.04) and eGFR increased to 63.5 mL/min/1.73 m(2)(P =.06). Of EC patients, the mean age was 60 years with a median sCr of 1.3 mg/dL (eGFR 55 mL/min/1.73 m(2)). All were managed with antibiotics and catheter drainage with a single mortality (7%). Median follow-up was 2 months and median sCr decreased to 1.2 mg/dL (P =.83) and eGFR increased to 46 mL/min/1.73 m(2)(P =.68). The most common causative pathogen was Escherichia coli for both EP (54%) and EC (53%). CONCLUSION: Early detection, medical management, and urinary drainage of EUTI can result in a favorable prognosis. This strategy results in low levels of mortality without the need for surgical intervention and can preserve renal function.

Factor X (FX) deficiency is a rare, autosomal-recessive coagulation disorder. Diagnosis can be confirmed by a factor X assay. Although fresh frozen plasma and prothrombin complex concentrates have been used as a temporary treatment of bleeding symptoms and preparation for surgery, frequent transfusion has its risk and prothrombin complex is not available in Korea. We report the first pediatric case of successful liver transplantation for the correction of a severe congenital FX deficiency in a child with recurrent life-threatening hemorrhagic episodes.