Expression and prognostic significance of microRNAs in Korean patients with myelodysplastic syndrome

BACKGROUND/AIMS@#Various alterations of microRNA (miRNA) expression have been reported in myelodysplastic syndrome (MDS). We aimed to investigate the unique patterns and prognostic significance of miRNA expression in Korean patients with MDS.@*METHODS@#Bone marrow mononuclear cells were collected from eight healthy controls and 26 patients with MDS, and miRNAs were isolated and assessed via quantitative real-time polymerase chain reaction for selected miRNAs, including miR-21, miR-124a, miR-126, miR-146b-5p, miR-155, miR-182, miR-200c, miR-342-5p, miR-708, and Let-7a.@*RESULTS@#MiR-124a, miR-155, miR-182, miR-200c, miR-342-5p, and Let-7a were significantly underexpressed in patients with MDS, compared to healthy controls. MiR-21, miR-126, 146b-5p, and miR-155 transcript levels were significantly lower in international prognostic scoring system lower (low and intermediate-1) risk MDS than in higher (intermediate-2 and high) risk MDS. Higher expression levels of miR-126 and miR-155 correlated with significantly shorter overall survival and leukemia-free survival. Higher miR-124a expression also tended to be related to shorter survivals.@*CONCLUSIONS@#Although our study was limited by the relatively small number of patients included, we identified several miRNAs associated with pathogenesis, leukemic transformation, and prognosis in MDS.

Multicenter Phase II Study of Oxaliplatin, Irinotecan, and S-1 as First-line Treatment for Patients with Recurrent or Metastatic Biliary Tract Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although gemcitabine plus cisplatin has been established as the standard first-line chemotherapy for patients with advanced biliary tract cancer (BTC), overall prognosis remains poor. We investigated the efficacy of a novel triplet combination of oxaliplatin, irinotecan, and S-1 (OIS) for advanced BTC. MATERIALS AND METHODS: Chemotherapy-naive patientswith histologically documented unresectable or metastatic BTC were eligible for this multicenter, single-arm phase II study. Patients received 65 mg/m2 oxaliplatin (day 1), 135 mg/m2 irinotecan (day 1), and 40 mg/m2 S-1 (twice a day, days 1-7) every 2 weeks. Primary endpoint was objective response rate. Targeted exome sequencing for biomarker analysis was performed using archival tissue. RESULTS: In total, 32 patients were enrolled between October 2015 and June 2016. Median age was 64 years (range, 40 to 76 years), with 24 (75%) male patients; 97% patients had metastatic or recurrent disease. Response rate was 50%, and median progression-free survival and overall survival (OS) were 6.8 months (95% confidence interval [CI], 4.8 to 8.8) and 12.5 months (95% CI, 7.0 to 18.0), respectively. The most common grade 3-4 adverse events were neutropenia (32%), diarrhea (6%), and peripheral neuropathy (6%). TP53 and KRAS mutations were the most frequent genomic alterations (42% and 32%, respectively), and KRAS mutations showed a marginal relationship with worse OS (p=0.07). CONCLUSION: OIS combination chemotherapy was feasible and associated with favorable efficacy outcomes as a first-line treatment in patients with advanced BTC. Randomized studies are needed to compare OIS with gemcitabine plus cisplatin.

Doctors' Ageism towards the Elderly Cancer Patients: Focusing on Disclosure of Cancer Diagnosis and Explanation on Treatment

BACKGROUND: This research is an exploratory study that is based on previous studies focusing on relationship between the doctors and the elderly cancer patients; moreover, the research focuses on the doctors' negative attitudes and discriminative behaviors towards the elderly cancer patients so that we may be able to suggest the ways to decrease the ageism. METHODS: Qualitative method and quantitative method were applied sequently. In this research, we practiced in-depth interviews with 8 doctors and then the surveys with 274 doctors. The in-depth interview questions were categorized depending on meaningful testimonies and the survey data were analyzed in the descriptive statistic analysis and paired t-test using PASW statistics 18. RESULTS: Through the in-depth interviews, the following is observed: the doctors rarely notify the elderly cancer patients directly; the family members of patients avoids the doctors to do so; and the doctors even show different attitudes or discriminatory actions to the elderly. Based on the in-depth interview results, the questions on notifying methods of the diagnosis and how to explain for treatment were developed and performed as a survey. Through the survey, only 8.4% of the doctors reported they directly notify the elderly cancer patient; moreover, they also reported they provide less information on treatment, side-effects, prognosis, and medical cost to the elderly than the middle-aged. CONCLUSIONS: This research not only discovered the presence of discrimination towards the elderly cancer patients but also suggested the causes of it. In order to resolve the phenomenon, doctors must consider individualized difference and variability of physiological function and should be aware of the psychological change after the cancer diagnosis to better communicate with them. Additionally, the social family culture which overprotects the elderly must be changed.

Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients

BACKGROUND: This study examined moderating effects of optimism and family support on the depression of family caregivers of cancer patients aged 55 and over by adopting stress process model. METHODS: 359 family caregivers who accompanied with cancer patients to out-patient clinics were recruited and completed questionnaire at three university hospitals located in Seoul and Gyeonggi province. Exploratory factor analysis was applied to test validity of the construction of the scale. Hierarchical multiple regression analysis was used to determine moderating effects of optimism and family support on depression after making mean centering of each variable. RESULTS: Results showed that spouse caregivers have more depression than do adult children as the nursing period gets longer. Education and income status were significant variables affecting depression of family caregivers. Optimism and family support for family caregivers have moderating effects on the association between stressors (emotional functioning of cancer patients and role overload of family caregivers) and depression of family caregivers. CONCLUSIONS: The findings suggest that more attentions are needed to the depression of spouse caregivers. Interventions are strongly recommended for health professionals to provide cancer patients and their family caregivers with "holding environments" caring for emotions and facilitating adjustment.

The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is a noninvasive imaging technique with the potential to detect bone marrow involvement by lymphoma. MATERIALS AND METHODS: We retrospectively reviewed medical records of lymphoma patients. All patients were examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up. RESULTS: The study population comprised 94 patients (median age, 60 years; 56 males) with Hodgkin's lymphoma (n=8) or non-Hodgkin's lymphoma (n=86). Maximum standardized uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were significantly higher than those of patients with intact bone marrow (2.2+/-1.2 g/mL vs. 1.3+/-0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin's lymphoma (NHL). CONCLUSION: FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients with increased FDG uptake on any iliac crest.

A Phase II Study to Evaluate the Efficacy of Ramosetron, Aprepitant, and Dexamethasone in Preventing Cisplatin-Induced Nausea and Vomiting in Chemotherapy-Naive Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Combination therapy with aprepitant, serotonin receptor antagonist, and steroids improves the complete response rate of both acute and delayed chemotherapy-induced nausea and vomiting (CINV). However, it is not known whether ramosetron is suitable for administration in combination with aprepitant. Therefore, we conducted a multicenter, open-label, prospective, phase II study in order to assess the efficacy and tolerability of combination therapy with ramosetron, aprepitant, and dexamethasone (RAD) for prevention of cisplatin-based CINV in chemotherapy-naive patients with solid cancers. MATERIALS AND METHODS: Forty-one patients with various solid cancers (31 male and 10 female; median age, 59 years) who received treatment with highly emetogenic chemotherapy (median cisplatin dose, 70 mg/m2; range 50 to 75 mg/m2) were enrolled in this study. Oral aprepitant (125 mg on day 1; 80 mg on days 2 and 3), intravenous ramosetron (0.6 mg on day 1), and oral dexamethasone (12 mg on day 1; 8 mg on days 2-4) were administered for prevention of CINV. RESULTS: The complete response (no emesisand retching and no rescue medication) rate was 94.9% in the acute period (24 hours post-chemotherapy), 92.3% in the delayed period (24-120 hours post-chemotherapy), and 92.3% in the overall period (0-120 hours). The absolute complete response (complete response plus no nausea) rate was 74.4% in the acute period, 51.3% in the delayed period, and 46.2% in the overall period. There were no grade 3 or 4 toxicities related to these antiemetic combinations. CONCLUSION: RAD regimen is a safe and effective antiemetic treatment for prevention of CINV in patients receiving highly emetogenic chemotherapy.

Long-term follow-up of alpha-interferon treatment in patients with HBeAg-positive chronic hepatitis B / 대한내과학회지

BACKGROUND: Data on the long-term effects of interferon alpha (IFN) treatment on disease progression and mortality in patients with chronic hepatitis B (CHB) are limited. To evaluate factors that influence clinical outcome and survival, we performed a follow-up study on hepatitis B e antigen (HBeAg) positive CHB patients treated with IFN. METHODS: A total of 98 patients with biopsy-proven HBeAg-positive CHB were treated with IFN- between 1988 and 2000 and followed. Data were collected by review of medical record, direct contact, or using database from Korea Central Cancer Registry. Sustained response (SR) to treatment was defined as HBeAg loss within 12 months after the end of IFN therapy and maintenance of HBeAg negativity for at least 3 years. We tried to find the factors associated with SR, hepatocellular carcinoma (HCC) incidence and survival. We also compared the cumulative rate of HCC and survival between SR group and non-sustained response (NSR)/nonresponder group. RESULTS: The mean IFN dose was 375+/-205 mega units. Mean follow-up was 92.0 months (SD 45 months). Twenty-six patients (27%) had sustained response to IFN treatment, although transient response was seen in 39% (38 out of 98 patients). Nine patients died of liver-related causes (hepatic failure, variceal bleeding) during follow-up. There were no significant differences of clinical outcomes such as survival and HCC incidence between responders and nonresponders (p=0.18, p=0.10, respectively). However, HCC developed in 6 patients, all of whom were nonresponders with an age older than 39 years. CONCLUSION: Age of 39 years and above at the time of IFN treatment might increase the risk of developing HCC. Therefore, interferon should be applied at the younger age to prevent HCC in patients with HBeAg-positive CHB.

A Case of Gastritis Cystica Profunda Associated with High Grade Tubular Adenoma / 대한소화기학회지

Gastritis cystica profunda is usually characterized by hyperplastic and cystic dilatation of pseudopyloric gland with submucosal invasion. These lesions possess malignant histologic features as metaplastic and even dysplastic alteration can be observed, however they usually exhibit benign behavior. Macroscopically, gastritis cystica profunda may present as a submucosal tumor or as a polyp. In rare case, however, it can be found as a giant mucosal fold. The proposed pathogenesis of lesion relates to ischemia, chronic inflammation, and the presence of foreign body. Herein, we report a case of gastritis cystica profunda associated with high grade tubular adenoma in a patient without antecedent surgery.

A case of bronchial asthma due to Tyrophagus putrescentiae in a non occupational setting / 천식및알레르기

Storage mites are believed one of the most important allergens in farmers and rural regions. Tyrophagus putrescentiae, belonging to storage mites, is found not only within storehouses but also in the house dust, and the third most common mites following Dermatophagoides farinae and Dermatophagoides pteronyssinus in house dust in Korea. The sensitization rate to Tyrophagus putrescentiae was reported as high as that of house dust mite in patients visiting the allergy clinic in large cities in Korea. We experienced a 69-year-old man who had suffered from dyspnea, wheezing, and coughing for 10 years. He retired from the teaching profession, and had lived in a large city, Deajeon. The skin prick test showed a positive reaction to Tyrophagus putrescentiae and negative reactions to house dust mites. The bronchial challenge test with Tyrophagus putrescentiae showed late asthmatic reaction. We confirmed a Tyrophagus putrescentiae-induced asthma in non occupational setting.