Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

Brain SPECT 영상의 Attenuation Correction 방법들에 대한 비교

조진우,김창호,나수경,이귀원,Jo, Jin U,Kim, Chang Ho,Na, Soo Kyung,Lee, Gui Won 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.2

이 연구의 목적은 Brain SPECT (Single Photon Emission Computed Tomography)의 Non-attenuation correction (AC-non) 영상에 대한 attenuation correction(AC) 방법 중 Chang's method와 CT based attenuation correction(AC-CT) 사이의 count를 비교하기 위함이다. phantom study는 증류수로 채워진 hoffman 3D phantom에 $^{99m}Tc$ 37Mbq을 투여하였고, patient study는 normal volunteer에 $^{99m}Tc$-HMPAO 750Mbq를 정맥주입하고 Siemens사의 Symbia T6로 Brain SPECT 영상을 획득하였고 뇌 정량 분석을 하였다. 각각의 방법들을 적용한 transverse image는 같은 위치에서 재구성 되었으며 각각 10, 20, 30번째 slice에서 6개의 region of interest(ROI)를 그려 AC-non 과 AC-CT 그리고 Chang's method의 count를 비교하였다. phantom study에서 AC-non, AC-CT, Chang's method의 각각 평균 count는 $4606.8{\pm}511.3$, $16794.6{\pm}2429.4$, $8752.6{\pm}896.5$이었으며 patient study에서 $5460.8{\pm}519.6$, $15320{\pm}1171.6$, $12795{\pm}1422.1$이었다. phantom study에서 AC-CT와 AC-non 사이의 비는 3.70이고 Chang's method와 AC-non 사이의 비는 1.92였으며 patient study에서는 각각 2.85, 2.38이었다. 우리는 이 연구를 통하여 AC-CT가 Chang's method보다 더 높은 AC을 해준다는 걸 알 수 있었다. 그리고 Chang's method는 patient study에서의 AC 값이 phantom study에서의 AC값보다 더 높다는 것을 알 수 있었다. brain SPECT/CT를 시행하는 경우 scatter correction을 같이 시행하고 bone에 의한 감쇠 정보를 반영할 수 있는 AC-CT가 chang's method보다 정확하다 할 수 있겠다. Purpose : The purpose of this study was to compare count between Chang's method and CT-based attenuation correction (AC-CT) among the attenuation correction (AC) methods for non-attenuation correction (AC-non) images of Brain SPECT (Single Photon Emission Computed Tomography). Materials and Methods : We injected $^{99m}Tc$ 37Mbq in a Hoffman 3D phantom filled with distilled water in the phantom study, and injected intravenously $^{99m}Tc$-HMPAO 740Mbq in a normal volunteer in the patient study, and then obtained Brain SPECT images with Symbia T6 of Siemens and conducted quantitative brain analysis. Transverse images to which each method was applied were rebuilt at the same position, and 6 regions of interest (ROI) were drawn on each of Slice No. 10, 20 and 30 and then the counts of AC-non, AC-CT and Chang's method were compared. Results : The mean counts of AC-non, AC-CT and Chang's method were $4606.8{\pm}511.3$, $16794.6{\pm}2429.4$, and $8752.6{\pm}896.5$, respectively, in the phantom study and $5460.8{\pm}519.6$, $15320{\pm}1171.6$ and $12795{\pm}1422.1$, respectively, in the patient study. In the phantom study, the ratio of AC-CT to AC-non was 3.70 and the ratio of Chang's method to AC-non was 1.92, and in the patient study, they were 2.85 and 2.38, respectively. Conclusion : From this study, we found that AC-CT makes higher AC than Chang's method. In addition, when Chang's method was used, AC in the patient study was higher than that in the phantom study. These results need to be considered also in other examinations.

Fluoxetine과 Haloperidol의 병합투여시 정신병리 및 추체외로 증상의 변화

이민수,한창수,김제원,원경식,곽동일,Lee, Min-Soo,Han, Chang-Su,Kim, Jae-Won,Won, Kyung-Sik,Kwak, Dong-Il 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

본 연구는 정신분열증 환자 38명을 대상으로 하여 haloperidol과 fluoxetine을 8주간 병합투여 하였고, PANSS, CGI, Simpson-Angus 척도를 투여전과 투여후 2, 4, 6, 8주에 시행하여 임상증상 및 추체외로 부작용을 평가하였다. 결과는 다음과 같다. 1) 8주간의 연구기간동안 양성, 음성증상의 유의한 변화가 없었다. 2) 8주의 연구기간동안 추체외로 부작용의 증가가 나타나지 않았다. 이는 기존 연구에서 fluoxetine에 의해 haloperidol의 혈중농도가 증가하여 효과 및 부작용이 증가한다는 연구보고와는 다르며, 이 결과는 haloperidol과 fluoxetine의 병합사용을 안전하게 할 수 있다는 것을 의미한다고 하겠다. Objectives : The authors have intended to know the drug interaction of fluoxetine and haloperidol when coadministering two drugs to the chronic schizophrenics by assessing the changes of positive, negative symptoms and extrapyramidal symptoms. Method : We selected 38 patients, the chronic schizophrenics with no physical problems. they are randomly assigned to placebo group and drug group. And then, placebo or fluoxetine 20mg were administered to the subjects of each group during 8 week period. We have assessed their psychopatholgy and extrapyramidal symptoms using Positive and Negative Syndrome Scale(PANSS), Clinical Global Impression(CGI), Simpson-Angus Scale at 0, 2, 4, 6, 8 week during the period. Results : 38 patients have completed the study during 8 weeks. 1) PANSS, CGI : no significant difference between groups and no significant change according to the times. 2) Simpson-Angus Scale : no significant changes. Conclusion : When co-administering fluoxetine and haloperidol, there were no significant changes of psychopathology and extrapyramidal symptoms. These results suggest that it is safe to coadminister fluoxetine to schizophrenic patients with haloperidol treatmemt.

Ischemia-Related Changes in Galanin Expression in the Dentate Hilar Region after Transient Forebrain Ischemia in Gerbils

LEE, Hyeon Yong,HWANG, In Koo,KIM, Dae Ho,KIM, Jung Hwa,KIM, Chang Ho,LIM, Beong Ou,KANG, Tae-Cheon,BANG, Kyung Hwan,SEONG, Nak Sul,LEE, Hak Ju,KIM, Jong Dai,WON, Moo Ho Japanese Association for Laboratory Animal Science 2005 EXPERIMENTAL ANIMALS Vol.54 No.1

<P>Although galanin (GAL) protects hippocampal neurons from ischemic damage, no study has examined ischemia-related changes in endogenous GAL in the hippocampal dentate gyrus. We investigated the chronological changes of GAL, well-known as the potassium channel opener, expression in the dentate gyrus at various times after 5 min of transient forebrain ischemia in gerbils. A few GAL-immunoreactive (IR) neurons were found in the polymorphic layer of the sham-operated group. Three hours after ischemia-reperfusion, the pattern of GAL immunoreactivity was similar to that of the sham-operated group and the number of GAL-IR neurons and immunoreactivity were highest 12 h after ischemic insult. At this time, GAL-IR neurons in the polymorphic layer showed strong GAL immunoreactivity. Thereafter, GAL-IR neurons and immunoreactivity significantly decreased in the dentate hilar region. Four days after ischemic insult, GAL-IR neurons were not detectable. In addition, the results of a Western blot study showed a pattern of GAL expression similar to the immunohistochemical changes. GAL protein content also was highest 12 h after ischemia. In conclusion, the increased expression of endogenous GAL in the dentate gyrus after ischemia is related to response to the ischemic damage.</P>

한방 닭죽 개발 및 최적 배합비율 확립

김경연 ( Kyung Yeon Kim ),백무열 ( Moo Yeol Baik ),박천석 ( Cheon Seok Park ),최성원 ( Sung Won Choi ),김창남 ( Chang Nam Kim ),김병용 ( Byung Yong Kim ) 한국식품영양학회 2013 韓國食品營養學會誌 Vol.26 No.1

죽의 기능성 향상을 위하여 2:1:1:1의 배합으로 혼합한 한약재료(가시오가피, 숙지황, 산약, 백복령)와 닭가슴살 등의 재료를 사용해 한방 영양죽을 제조하였다. 한방 닭죽의 DPPH radical 소거능, SOD 유사활성, 맛의 선호도, cost는 수학적인 canonical model과 trace plot을 이용하여 분석한 결과, SOD 유사활성 이외에는 각 성분들이 독립적으로 작용하여 상호작용이 없는 선형 모델을 보여주었다. DPPH radical 소거능, SOD 유사활성, 맛의 선호도를 최대로, cost를 최소로 목적 범위를 설정하고, 각각의 canonical 계수를 이용하여 수적 최적화를 통하여 최적 배합비를 구한 결과, 한약 혼합물 101g, 닭가슴살 38.66g, 찹쌀 비율 41.34g의 최적 배합비를 구하였으며, 이 배합비에 따른 맛의 선호도는 6.39, DPPH radical 소거능은 17.25㎎VCE/ℓ, SOD 유사활성은 2.25%, cost는 1,382.39 won으로 나타났으며, 여러 결과들 사이에 최적화된 한 값에 수렴하는 desirability는 0.714로 나타났다. 이는 한약혼합물이 많을수록 기능성 면에서는 높게 나타나지만 맛의 선호도면에서는 낮게 나타냈고, 닭가슴살의 경우에도 그 함량이 많을수록 맛의 선호도는 올라갔지만 그에 반해 cost가 높게 올라간 것을 반영한 결과로 사료된다. The objectives of this study were to develop porridge with medicinal herbs and chicken breast meat and to find out the optimum mixing ratio. Several herb extracts such as Acanthopanacis senticosus, Rehmannia glutinosa, Disocorea japonica, and Poria cocos Wolf were used in the ratio of 2, 1, 1, and 1, respectively. The optimum processing condition for herbal chicken porridge was determined by a design expert program. Seventeen experimental points were selected, and herb extracts (82∼101g), chicken breast meat (30∼50g), and glutinous rice (40∼60g) were chosen as the independent variables. The measured responses were preference of taste, DPPH radical scavenging, SOD-like activity, and cost. The optimum formulation of herbal chicken porridge using the numerical analysis was set at herbal extracts (101g), chicken breast meat (38.66g), and glutinous rice (41.34g) with a 0.714 desirability value. DPPH radical scavenging effect, preference of taste and the cost showed a linear model, whereas SOD-like activity showed a quadratic model indicating a higher interaction among the mixture. As a result of proximate composition of optimized herbal chicken porridge, the contents of moisture, carbohydrate, crude protein, crude lipid, and ash contents were 76.4, 9.0, 1.4, 0.5, and 1.6%, the calories of the porridge was 46.1kcal/100g.

위용종의 내시경적 생검과 내시경적 절제술 후 병리학적 진단의 불일치

윤원재 ( Won Jae Yoon ),이동호 ( Dong Ho Lee ),이국래 ( Kook Lae Lee ),장동경 ( Dong Kyung Chang ),김병관 ( Byeong Gwan Kim ),김지원 ( Ji Won Kim ),정지봉 ( Ji Bong Jeong ),김나영 ( Na Young Kim ),김진욱 ( Jin Wook Kim ),황진혁 ( 대한내과학회 2005 대한내과학회지 Vol.69 No.5

목적 : 위용종이란 위의 내강으로 돌출한 종괴를 의미한다. 거의 90%에서 조직학적으로 과형성 용종이며 이러한 경우 암으로의 진행은 매우 적은 것으로 알려져 있다. 그러나 위선종은 일부에서 국소적으로 암성 병변을 동반하거나, 동반하고 있지 않더라도 시간이 지남에 따라 암으로 진행하는 것으로 알려져 있다. 그러나 내시경적 겸자 생검과 전체 병변의 절제 후 조직 소견에서는 차이가 있는 것으로 알려져 있다. 저자들은 내시경검사에서 위용종이 발견된 후 내시경적 절제술을 시행받은 74명의 환자, 85예의 위용종을 대상으로 임상적 및 병리학적 특성을 알아보고 겸자 생검과 내시경적 절제술 후 병리학적 진단의 불일치를 알아보고자 하였다. 방법 : 1996년 4월부터 2003년 2월까지 내시경검사에서 위용종이 발견된 후 내시경적 생검과 내시경적 절제술 후 조직학적 진단이 모두 이루어진 74명의 환자를 대상으로 내시경 사진, 의무 기록 및 병리 기록을 분석하였다. 결과 : 74명의 환자에서 총 85개의 용종을 관찰할 수 있었다. 위용종은 전정부에서 가장 호발하였으며(58.8%) 그 다음으로는 체하부(18.8%)에 호발하였다. 내시경적 겸자 생검에서 관상 선종은 48.2%, 과형성 용종은 30.6%, 염증성 용종은 15.3%, 위저선 용종은 2.4%, 이형성증은 2.4%, 관상융모 선종은 1.1%였다. 내시경적 절제술 후 조직학적 검사상 관상 선종은 45.9%, 과형성 용종은 31.8%, 염증성 용종은 9.4%, 과오종은 3.5%, 위저선 용종은 2.4%, 관상융모 선종은 2.4%, 선암은 2.4%, 이형성증은 1.1%, 점막 위지방종증은 1.1%였다. 내시경적 겸자 생검 결과와 내시경적 절제술 후 조직학적 진단의 불일치율은 27.1%였다. 용종의 크기에 따른 진단 일치율의 차이는 없었다(p>0.05). 결론 : 위용종의 겸자 생검과 내시경적 절제술 후 조직검사 소견은 차이가 있을 수 있다. 용종의 크기는 진단 일치율에 영향을 미치지 못했다. 따라서 특히 선종이 의심되는 경우에는 크기에 상관없이 내시경적 절제술을 통한 전체 병변의 조직검사가 필요할 것으로 생각된다. Background : Gastric polyp is a descriptive term referring to mucosal prominence that protrudes beyond the flat lining of the stomach. Almost 90% of gastric polyps are hyperplastic polyps. Adenomatous polyps may contain focal carcinomatous foci or undergo carcinomatous changes. It is known that there is some degree of discordance between the results of endoscopic forceps biopsy and pathology of resected specimens. The aim of this study was to investigate the discordance in pathologic findings between endoscopic forceps biopsy and endoscopic resection specimen of gastric polyps. Methods : We reviewed endoscopic photographs and medical records of the patients who underwent endoscopic resection from April, 1996 through February, 2003. Results : A total of 85 cases of gastric polyps from 74 patients were reviewed. Male-to-female ratio was 1:1.96. Mean age was 59.9±10.8 years. Multiple polyps were observed in 10.8%. Gastric polyps occurred in the antrum most frequently (58.8%). Pathology results on resected specimens were as follows: tubular adenoma 45.9%, hyperplastic polyp 31.8%, inflammatory polyp 9.4%, hamartoma 3.5%, fundic gland polyp 2.4%, tubulovillous adenoma 2.4%, adenocarcinoma 2.4%, dysplasia 1.1%, and mucosal pseudolipomatosis 1.1%. Discordance rate between endoscopic biopsy and pathology of resected specimens was 27.1%. There was no relationship between the size of the polyp and concordance rate. Conclusions : There was considerable discordance in pathologic findings between endoscopic forceps biopsy and resected specimens. Approaches to review the histology of an entire polyp should be performed, especially when an adenoma is suspected.(Korean J Med 69:481-486, 2005)

Increased Neutrophil Extracellular Trap Formation in Uremia Is Associated with Chronic Inflammation and Prevalent Coronary Artery Disease

Kim, Jwa-Kyung,Hong, Chang-won,Park, Mi Jin,Song, Young Rim,Kim, Hyung Jik,Kim, Sung Gyun Hindawi 2017 Journal of immunology research Vol.2017 No.-

<P><I>Background.</I> Neutrophils are involved in the pathogenesis of atherosclerosis by neutrophil extracellular trap (NET) formation. We hypothesized that the NET formation of neutrophils might be changed in end-stage renal disease (ESRD) patients, explaining their higher incidence of coronary artery diseases (CAD). <I>Method.</I> A cross-sectional study was performed in 60 maintenance hemodialysis (MHD) patients, 30 age- and sex-matched healthy individuals (HV, negative control), and 30 patients with acute infection (positive control). Neutrophil activation and function were measured with reactive oxygen species (ROS) activity, degranulation, NET formation, and phenotypical changes. <I>Result.</I> Compared with HV, neutrophils extracted from MHD patients displayed significantly increased levels of basal NET formation, ROS production, and degranulation, suggesting spontaneous activation in uremia. Also, an increase in citrullinated histone H3 was detected in this group compared to the HV. And neutrophils from HV were normal CD16<SUP>bright</SUP>/CD62L<SUP>bright</SUP> cells; however, neutrophils from MHD were CD16<SUP>bright</SUP>/CD62L<SUP>dim</SUP>, similar to those from patients with acute infections. Interestingly, multivariate analyses identified the prevalent CAD and neutrophil counts as independent determinants of baseline NET formation (<I>β</I> = 0.323, <I>p</I> = 0.016 and <I>β</I> = 0.369, <I>p</I> = 0.006, resp.). <I>Conclusions.</I> Uremia-associated-increased NET formation may be a sign of increased burden of atherosclerosis.</P>

고관절 전치환술에서 하지 길이의 변화(수술전 예상 측정치와 수술후 실제 측정치 사이의 차이에 대하여)

원중희 ( Choong Hee Won ),장관환 ( Kwan Whan Chang ),신건 ( Geon Shin ),전경철 ( Kyung Chul Jeon ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

We reviewed 40 cases of cementless primary total hip arthroplasty (THA) to see the leg length changes after THA and analysed the factors that could affect the discrepancies of preoperative estimation and postoperative measurement. The cases with severe preoperative leg length discrepancy such as untreated CDH were not included in our series. Inserted femoral components were CLS(Protek) or Omnifit(Osteonics) stems. All the acetabular cups were HG g (Zimmer) cups. Preoperatively the acetabular template was mounted on the film and the center of the acetabular cup was marked with pencil. Femoral template was also mounted on the femoral side and the center of the femoral head was marked. The distaoce between the two centers was a basis for preoperative estimation. Postoperatively the leg length change was measured by the change of the distance from interteardrop line to the greater trochanter tip. Leg length change estimated by preoperative templating was 5mm lengthening in average. Postoperative leg length change was 10mm lengthening in average. The discrepancies of pre and postoperative measurement were attributed to following factors. Standardization of taking the X-ray views was an important factor. Magnification, center of X-ray beam and the accurate position of the hip should be considered in taking preoperative X-rays. Templating technique was another factor. Postoperative acetabular center shifted frequently compared with preoperative estimation. Templating does not always tell accurate postoperative leg length change. To minimize the discrepancy of pre and postoperative measurement above factors should be considered in preoperative estimation.

Electro-hyperthermia up-regulates tumour suppressor Septin 4 to induce apoptotic cell death in hepatocellular carcinoma

Jeon, Tae-Won,Yang, Heebum,Lee, Chang Geol,Oh, Sang Taek,Seo, Daekwan,Baik, In Hye,Lee, Eun Hye,Yun, Ina,Park, Kyung Ran,Lee, Yun-Han Informa UK (TaylorFrancis) 2016 International journal of hyperthermia Vol.32 No.6

<P>Purpose: Modulated electro-hyperthermia (mEHT) has been shown to be effective against various types of human tumours, including hepatocellular carcinoma (HCC). Here we aimed to investigate the molecular mechanism underlying the cytotoxic effects of mEHT to HCC cells. Materials and methods: Human liver cancer cell lines, Huh7 and HepG2, were treated with mEHT (42 degrees C/60 min) three times at 2-day intervals. Growth inhibition and apoptotic induction were evaluated using MTS, microscopic analysis, a clonogenic assay, annexin V/PI staining and a ccK18 ELISA. Global changes in gene expression were examined using RNA sequencing to obtain insights into molecular changes in response to mEHT. For in vivo evaluation of mEHT we used HepG2 HCC xenografts grown in nude mice. Results: mEHT suppressed HCC cell proliferation and long-term colony formation through induction of apoptosis. The growth inhibitory effects are induced through a subset of molecular changes. Notably the expression level of septin 4 (SEPT4) (involved in pro-apoptotic activity and growth suppression) was up-regulated, whereas a key regulator of invasiveness G-Protein coupled receptor 64 (GPR64) was repressed. Subsequent Western blotting confirmed that the common increase in tumour suppressor SEPT4 in both Huh7 and HepG2 cells is accompanied by the restoration of cyclin-dependent kinase (CDK) inhibitor p21 and decrease in pro-caspase 7 and pro-caspase 3, thereby accelerating apoptotic signalling in HCC cells. Additionally, mEHT significantly inhibited the growth of human HCC xenografts in nude mice. Conclusions: These findings suggest that apoptotic cell death induced by mEHT is mediated by the up-regulation of tumour suppressor SEPT4 in human HCC cells.</P>