Loss of Human Leukocyte Antigen Class I Expression Is Associated with Poor Prognosis in Patients with Advanced Breast Cancer

BACKGROUND: Human leukocyte antigen class I (HLA-I) molecules play important roles in regulating immune responses. Loss or reduction of HLA-I expression has been shown to be associated with prognosis in several cancers. Regulatory T-cells (Tregs) also play critical functions in immune response regulation. Evaluation of HLA-I expression status by the EMR8-5 antibody and its clinical impact in breast cancer have not been well studied, and its relationship with Tregs remains unclear. METHODS: We evaluated HLA-I expression and Treg infiltration by immunohistochemistry in 465 surgically resected breast cancer samples. We examined the correlation between HLA-I expression and Treg infiltration and clinicopathologic characteristics and survival analyses were performed. RESULTS: Total loss of HLA-I expression was found in 84 breast cancer samples (18.1%). Univariate survival analysis revealed that loss of HLA-I expression was significantly associated with worse disease-specific survival (DSS) (p = .029). HLA-I was not an independent prognostic factor in the entire patient group, but it was an adverse independent prognostic factor for DSS in patients with advanced disease (stage II–IV) (p = .031). Treg numbers were significantly higher in the intratumoral stroma of HLA-I–positive tumors than in HLA-I–negative tumors (median 6.3 cells/high power field vs 2.1 cells/high power field, p < .001). However, Tregs were not an independent prognostic factor in our cohort. CONCLUSIONS: Our findings suggest that the loss of HLA-I expression is associated with poor prognosis in breast cancer patients, highlighting the role of HLA-I alterations in immune evasion mechanisms of breast cancer. HLA-I could be a promising marker that enables the application of more effective and precise immunotherapies for patients with advanced breast cancer.

Effects of Total Quality Management Performance on Dietitians' Job Satisfaction and Organizational Commitment in Business and Industry Foodservice Operations

The purpose of the study was to identify the relationships Total Quality Management (TQM) performance, job satisfaction, and organizational commitment among dietitians in business and industry foodservice. A total of 300 dietitians working in business and industry foodservices in Seoul and Gyeonggi province were surveyed using a self-administrated questionnaire and 203 responses were obtained. The data were analyzed using SPSS Windows (Ver. 12.0) for descriptive analysis and reliability analysis, and AMOS (Ver. 5.0) for structural equation modeling. The respondents were all female, 56.7% single, and 71.4% under regular employment. By foodservice management type, 52.7% of the foodservice operations were self-operated. The majority of the operations provided meals more than twice a day (73.9%), and 70.4% offered a non-selective menu. The dietitians of the contracted foodservices tended to have higher TQM performance scores than those of the self-operated foodservices (P<0.01). There were no significant differences in job satisfaction and organizational commitment scores by the type of the foodservice management. TQM performance was found to have a positive effect on job satisfaction, and job satisfaction affected organizational commitment for both the self-operated and contracted foodservices. A relationship between TQM performance level and organizational commitment of self-operated foodservices was not found. On the other hand, TQM performance level was the principal significant factor for increasing the organizational commitment of contracted foodservices. This research suggests that business and industry foodservices need to improve TQM performance to enhance job satisfaction and organizational commitment of foodservice dietitians and to develop specified TQM strategies that can be applied to each type of foodservice management.

Trend of Socioeconomic Inequality in Participation in Cervical Cancer Screening among Korean Women / 예방의학회지

OBJECTIVES: While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. METHODS: Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. RESULTS: Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. CONCLUSIONS: Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

Breast Reconstruction with the Extended Latissimus Dorsi Musculocutancous Flap

Breast cancer patients who underwent mastectomy often experience stress, depression from body changes and loss of femininity. Choice of surgical method is important, because Korean women tend to be sensitive to the shape of the reconstructed breast, donor site scars and the changes in body contour. The latissimus dorsi musculocutaneous flap was one of the first methods of breast reconstruction. However, due to lack of volume, the latissimus dorsi flap has become a secondary choice for breast reconstruction. The authors evaluated the clinical cases who underwent breast reconstruction with the extended latissimus dorsi flaps at the authors' institution from March 2002 to February 2005. During the period, 87 cases of breast reconstruction with the extended latissimus dorsi flap were performed in 86 patients. All flaps survived completely. There occurred no partial necrosis and fat necrosis. The extended latissimus dorsi flap alone without implant could provide good to excellent autologous breast reconstruction for small to moderate sized breasts. Free TRAM flap is currently considered the "Gold standard" in autogenous breast reconstruction. But, the extended latissimus dorsi flap without implant could provide sufficient volume for breast reconstruction in selected cases and it is a reliable method for autologous breast reconstruction.

Volume and Weight Changes of Autologous Costal Cartilage Grafts with and without Perichondrium in Human

Autologous cartilage grafts have become an integral part of aesthetic and reconstructive plastic surgery. However, little objective information is available about the actual quantitative resorption of cartilage in human. This study sought to objectively quantify and compare the resorption of costal cartilage in human. To compare the resorption characteristics of rib cartilage autografts, we harvested rib cartilage grafts from 37 microtia patients. All autografts were implanted subcutaneously on chest and then removed after 6 to 17 months. Graft mass and volume were compared before and after implantion. Rib cartilage grafts with perichondrium averaged 10.8+/-7.4% resorption by volume, On the other hand rib cartilage grafts without perichondrium 25.5+/-6.8%. There was no evidence of necrosis or inflammatory changes. The rib cartilage is the preferred source of autogenous cartilage for auricular reconstruction. Short-term resorption of rib cartilage without perichondrium appears to be higher than with perichondrium. The low resorption of cartilage with perichondrium may be due to in part to cartilage forming capacity of the perichondrium. It remains to be seen whether these differences in resorption persist in the long term.