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Purpose@#This multicenter retrospective study aimed to investigate clinical, radiologic, and treatment-related factors affecting survival in patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG) treated with radiotherapy. @*Materials and Methods@#Patients aged <30 years who underwent radiotherapy as an initial treatment for DIPG between 2000 and 2018 were included; patients who did not undergo magnetic resonance imaging at diagnosis and those with pathologically diagnosed grade I glioma were excluded. We examined medical records of 162 patients collected from 10 participating centers in Korea. The patients’ clinical, radiological, molecular, and histopathologic characteristics, and treatment responses were evaluated to identify the prognosticators for DIPG and estimate survival outcomes. @*Results@#The median follow-up period was 10.8 months (interquartile range, 7.5 to 18.1). The 1- and 2-year overall survival (OS) rates were 53.5% and 19.0%, respectively, with a median OS of 13.1 months. Long-term survival rate (≥ 2 years) was 16.7%, and median OS was 43.6 months. Age (< 10 years), poor performance status, treatment before 2010, and post-radiotherapy necrosis were independently associated with poor OS in multivariate analysis. In patients with increased post-radiotherapy necrosis, the median OS estimates were 13.3 months and 11.4 months with and without bevacizumab, respectively (p=0.138). @*Conclusion@#Therapeutic strategy for DIPG has remained unchanged over time, and the associated prognosis remains poor. Our findings suggest that appropriate efforts are needed to reduce the occurrence of post-radiotherapy necrosis. Further well-designed clinical trials are recommended to improve the poor prognosis observed in DIPG patients.
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Objectives@#. Particulate matter (PM) is a risk factor for various diseases. Recent studies have established an association between otitis media (OM) and PM exposure. To confirm this relationship, we developed a novel exposure model designed to control the concentration of PM, and we observed the effects of PM exposure on the Eustachian tube (ET) and middle ear mucosa of rats. @*Methods@#. Forty healthy, 10-week-old, male Sprague-Dawley rats were divided into 3-day, 7-day, 14-day exposure, and control groups (each, n=10). The rats were exposed to incense smoke as the PM source for 3 hours per day. After exposure, bilateral ETs and mastoid bullae were harvested, and histopathological findings were compared using microscopy and transmission electron microscopy (TEM). The expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor (VEGF) in the middle ear mucosa of each group were compared using real-time reverse transcription polymerase chain reaction (RT-PCR). @*Results@#. In the ET mucosa of the exposure group, the goblet cell count significantly increased after PM exposure (P=0.032). In the middle ear mucosa, subepithelial space thickening, increased angio-capillary tissue, and inflammatory cell infiltration were observed. Moreover, the thickness of the middle ear mucosa in the exposure groups increased compared to the control group (P<0.01). The TEM findings showed PM particles on the surface of the ET and middle ear mucosa, and RT-PCR revealed that messenger RNA (mRNA) expression of IL-1β significantly increased in the 3-day and 7-day exposure groups compared to the control group (P=0.035). VEGF expression significantly increased in the 7-day exposure group compared to the control and 3-day exposure groups (P<0.01). @*Conclusion@#. The ET and middle ear mucosa of rats showed histopathologic changes after acute exposure to PM that directly reached the ET and middle ear mucosa. Therefore, acute exposure to PM may play a role in the development of OM.
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Background@#Since the era of “thyroid cancer epidemic,” many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade. @*Methods@#This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson’s correlation analysis. @*Results@#The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09). @*Conclusion@#The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.
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Objective@#This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases. @*Methods@#Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes. @*Results@#The median follow-up duration was 22.2 months (range: 0.3–174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively). @*Conclusion@#A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.
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Methods@#We enrolled 40 patients who underwent either MISS (M group, 20 patients) or open posterior instrumentation surgery (O group, 20 patients) for the treatment of traumatic unstable burst fractures. Clinical outcomes were evaluated based on postoperative back pain, operation time, blood loss, hospital stay duration, and perioperative complications. For radiologic evaluation, preoperative magnetic resonance imaging and plain radiography were performed before and after the surgery to evaluate the changes in the kyphotic angle and fracture union. @*Results@#The change in the kyphotic angle was −8.2°±5.8° in the M group and −8.0°±7.8° in the O group. No significant difference was noted in terms of the change in the kyphotic angle (p=0.94, t-test) after 12 months of surgery. The Visual Analog Scale score was 1.5±0.7 points in the M group, while it was 5.2±1.4 points in the O group. In the M group, back pain has significantly decreased (p<0.01, t-test). The estimated blood loss was 195.5 mL in the M group and 1,077.5 mL in the O group; the operation time was significantly decreased in the O group from 290.7 to 120.7 minutes in the M group (p<0.05, t-test) (p=0.36, t-test). The average duration of hospital stay was 36.0 days in the M group and 41.9 days in the O group (p=0.36, t-test). @*Conclusions@#For the treatment of unstable burst fractures, MISS showed significant differences in terms of postoperative back pain, operation time, and blood loss as compared to open posterior instrumentation surgery.
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Purpose@#Atypical teratoid/rhabdoid tumor (ATRT) is a highly aggressive malignancy with peak incidence in children aged less than 3 years. Standard treatment for central nervous system ATRT in children under the age of 3 years have not been established yet. The objective of this study was to analyze characteristics and clinical outcomes of ATRT in children aged less than 3 years. @*Materials and Methods@#A search of medical records from seven centers was performed between January 2005 and December 2016. @*Results@#Forty-three patients were enrolled. With a median follow-up of 90 months, 27 patients (64.3%) showed at least one episode of disease progression (PD). The first date of PD was at 160 days after diagnosis. The 1- and 3-year progression-free survivals (PFS) were 51.2% and 28.5%, respectively. The 1- and 3-year overall survivals were 61.9% and 38.1%, respectively. The 3-year PFS was improved from 0% in pre-2011 to 47.4% in post-2011. Excluding one patient who did not receive any further therapy after surgery, 27 patients died due to PD (n=21), treatment-related toxicity (n=5), or unknown cause (n=1). In univariate analysis, factors associated with higher 3-year PFS were no metastases, diagnosis after 2011, early adjuvant radiotherapy, and high-dose chemotherapy (HDCT). In multivariate analysis, the use of HDCT and adjuvant radiotherapy remained significant prognostic factors for PFS (both p < 0.01). @*Conclusion@#Aggressive therapy including early adjuvant radiotherapy and HDCT could be considered to improve outcomes of ATRT in children under the age of 3 years.
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Purpose@#Atypical teratoid/rhabdoid tumor (ATRT) is a highly aggressive malignancy with peak incidence in children aged less than 3 years. Standard treatment for central nervous system ATRT in children under the age of 3 years have not been established yet. The objective of this study was to analyze characteristics and clinical outcomes of ATRT in children aged less than 3 years. @*Materials and Methods@#A search of medical records from seven centers was performed between January 2005 and December 2016. @*Results@#Forty-three patients were enrolled. With a median follow-up of 90 months, 27 patients (64.3%) showed at least one episode of disease progression (PD). The first date of PD was at 160 days after diagnosis. The 1- and 3-year progression-free survivals (PFS) were 51.2% and 28.5%, respectively. The 1- and 3-year overall survivals were 61.9% and 38.1%, respectively. The 3-year PFS was improved from 0% in pre-2011 to 47.4% in post-2011. Excluding one patient who did not receive any further therapy after surgery, 27 patients died due to PD (n=21), treatment-related toxicity (n=5), or unknown cause (n=1). In univariate analysis, factors associated with higher 3-year PFS were no metastases, diagnosis after 2011, early adjuvant radiotherapy, and high-dose chemotherapy (HDCT). In multivariate analysis, the use of HDCT and adjuvant radiotherapy remained significant prognostic factors for PFS (both p < 0.01). @*Conclusion@#Aggressive therapy including early adjuvant radiotherapy and HDCT could be considered to improve outcomes of ATRT in children under the age of 3 years.
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Background/Aims@#Inflammatory bowel disease (IBD) is an autoimmune disease characterized by chronic inflammation mainly in the large intestine. The interleukin-10 knockout (IL-10 KO) mouse is a well-known animal model of IBD that develops spontaneous intestinal inflammation resembling Crohn’s disease. Oxidative stress is considered to be the leading cause of cell and tissue damage. Reactive oxygen species (ROS) can cause direct cell injury and/or indirect cell injury by inducing the secretion of cytokines from damaged cells. This study evaluated the effects of mesenchymal stem cell (MSC) on the progression of IBD. @*Methods@#In this study, human bone marrow-derived MSCs were injected into IL-10 KO mice (MSC). Oxidative stress and inflammation levels were evaluated in the large intestine and compared with those in control IL-10 KO mice (CON) and normal wild-type control mice (Wild). @*Results@#The levels of ROS (superoxide and hydrogen peroxidase) and a secondary end-product of lipid peroxidation (malondialdehyde) were considerably higher in the CON, while superoxide dismutase and catalase levels were lower in the MSC. Inflammation-related marker (interferon-γ, tumor necrosis factor-α, IL-4, and CD8) expression and inflammatory histological changes were much less pronounced in MSC than in CON. @*Conclusions@#MSCs affect the redox balance, leading to the suppression of IBD.
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Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.
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Purpose@#High rate of false-positive tests is a major obstacle to use human papillomavirus (HPV) detectionas a diagnostic tool for high-grade squamous intraepithelial lesions or cervical cancer(HSIL+). We investigated whether type-specific viral load or physical state of HPV 16, 18,and 58 are useful biomarkers for HSIL+. @*Materials and Methods@#Type-specific viral loads of E6 and E2 genes in cervical cells from 240, 83, and 79 HPV 16–,18–, and 58–infected women, respectively, were determined using real-time polymerasechain reaction. Viral loads were normalized to cellular DNA (copy/cell). Total and integratedviral loads and physical state were compared between HSIL+ and controls, and diagnosticvalue was determined using receiver operating characteristic analysis. @*Results@#Viral loads of HPV 16, 18, and 58 were significantly different in lesions in the same pathologicgrade. High type-specific total viral loads were significantly associated with HSIL+ (oddsratio [OR], 14.065, 39.472, and 7.103 for HPV 16, 18, and 58, respectively). High integratedviral load was related to HSIL+ in women with HPV 16 (OR, 8.242), and integrated statewas associated with HSIL+ in women with HPV 18 (OR, 9.443). Type-specific total viral loadwas significantly associated with HSIL+ (area under curve, 0.914, 0.937, and 0.971 forHPV 16, 18, and 58, respectively), indicating an excellent performance in detecting HSIL+. @*Conclusion@#Type-specific total viral load may be a powerful diagnostic marker for HSIL+ in HPV 16–,18–, and 58–infected HSIL+ lesions. If demonstrated in all other high-risk HPV types, thismethod can lead to a paradigm shift in the strategy of equivocal cytologic abnormalities.
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A 49-year-old male was found unconscious at his accommodation and visited the emergency room. He was on antipsychotic and antidepressant drugs (vortioxetine hydrobromide, mirtazapine, sertraline hydrochloride, quetiapine, and alprazolam) for schizophrenia and major depression. At the time of discovery there were signs of overdose of the drugs around the patient. A physical examination revealed, pain, pallor, and edema in the left buttocks and lateral thigh. Active ankle movements below the left ankle were not possible and sensations in the tibia and peroneal nerves were lost. The pressure in the buttock compartment was measured at 42 mmHg. Magnetic resonance imaging revealed edema and high intensity signals in the left hip muscles and surrounding soft tissue. An emergency fasciotomy was performed and partial restoration of the lower extremity sensation and muscle strength were achieved after 24 hours.
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The medial and lateral plantar nerves are branched from the tibial nerve and move to the tip of the toes. A variation of medial plantar nerve was found on the left side of a 78-year-old Korean male cadaver. The tibial nerve was divided into the lateral and medial plantar nerves beneath the plantar flexor. The medial plantar nerve passed deep to plantar aponeurosis and superficial to the flexor digitorum brevis. It gave off a common plantar digital nerve and then divided into three proper plantar digital nerves near the metatarsal bases. In this article, we report a superficial course of the medial plantar nerve and describe its unique morphology and discuss the clinical significance of this variation.
Subject(s)
Aged , Humans , Male , Cadaver , Metatarsal Bones , Tibial Nerve , ToesABSTRACT
PURPOSE: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. METHODS: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. RESULTS: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. CONCLUSIONS: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.
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Animals , Humans , Aphakia , Astigmatism , Corneal Topography , Endothelial Cells , Hoof and Claw , Intraocular Pressure , Iris , Lenses, Intraocular , Refractometry , Retrospective Studies , Slit Lamp , Visual AcuityABSTRACT
Spinal epidural hematoma (SEH) can occur naturally or traumatically and is most common in patients with an underlying disease of the vascular structure or coagulation disorder. Most SEHs occur naturally for no apparent reason, and epidural hematoma caused by trauma is less common, comprising 1.0%–1.7% of total spinal injuries. Few reports of SEH induced cauda equine syndrome resulting from low-energy injury caused by osteoporotic vertebral compression fractures are available. The authors experienced a case of delayed SEH after hemorrhage due to a low-energy injury in an elderly patient. No cases in Korea have been reported; therefore, this case is reported with a review of the relevant literature.
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Aged , Humans , Allografts , Arthroplasty , Fractures, Compression , Hematoma , Hematoma, Epidural, Spinal , Hemorrhage , Humerus , Korea , Spinal InjuriesABSTRACT
PURPOSE: Noninvasive precursor lesions for pancreatic adenocarcinoma include pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm. PanIN is often found synchronously adjacent to resected pancreatic ductal adenocarcinoma (PDAC) tumors. However, its prognostic significance on outcome after PDAC resection is unknown. The purpose of the current study was to determine if the presence of PanIN has a prognostic or predictive effect on survival after resection for PDAC with curative intent. METHODS: We retrospectively reviewed the clinicopathologic data of patients who underwent pancreatectomy for PDAC from January 2002 to January 2013. Intraductal papillary mucinous lesions and mucinous cystic neoplasms were excluded. All available postoperative imaging and clinical follow-up data were reviewed. RESULTS: There were 95 patients who underwent pancreatectomy. Tumors were most commonly located in the pancreas head and as such pancreaticoduodenectomy was the most commonly performed operation. The median tumor size was 3.2 cm. An absence of PanIN lesions was identified in 39 patients (41%). Of the patients with PanIN lesions, high-grade PanIN (grade 3) was the most common type (64.3%) followed by grade 2 (28.6%). There was no significant difference in overall survival or disease-free survival between the non-PanIN and PanIN groups. CONCLUSION: The presence or absence of PanIN lesions did not affect survival in patients undergoing resection for pancreatic cancer. However, patients with high-grade PanINs tended to have better overall survival. Larger studies with longer follow up are needed to accurately determine its clinical significance.
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Humans , Adenocarcinoma , Carcinoma in Situ , Disease-Free Survival , Follow-Up Studies , Head , Mucins , Pancreas , Pancreatectomy , Pancreatic Ducts , Pancreatic Neoplasms , Pancreaticoduodenectomy , Retrospective StudiesABSTRACT
PURPOSE: This study retrospectively evaluated the clinical outcomes and complications of proton beam therapy (PBT) in a single institution in Korea and quantitatively analyzed the change in tumor volume after PBT using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twenty-four treatment-naïve patients who underwent PBT for choroidal melanoma between 2009 and 2015 were reviewed. Dose fractionation was 60-70 cobalt gray equivalents over 5 fractions. Orbital MRIs were taken at baseline and 3, 6, and 12 months after PBT and annually thereafter. The tumor volume was reconstructed and evaluated by stacking the tumor boundary in each thin-sliced axial T1-weighted image using MIM software. RESULTS: The median follow-up duration was 36.5 months (range, 9 to 82 months). One patient had suspicious local progression and two patients had distant metastasis. The 3-year local progression-free survival, distant metastasis-free survival, and overall survival rates were 95.8%, 95.8%, and 100%,respectively. Five Common Terminology Criteria for Adverse Event ver. 4.03 grade 3-4 toxicities were observed in four patients (16.7%), including one with neovascular glaucoma. The mean tumor volume at the baseline MRI was 0.565±0.084 mL (range, 0.074 to 1.610 mL), and the ratios of the mean volume at 3, 6, and 12 months to that at baseline were 81.8%, 67.3%, and 60.4%, respectively. CONCLUSION: The local controlrate and complication profile after PBT in patientswith choroidal melanoma in Korea were comparable with those reported in a previous PBT series. The change in tumor volume after PBT exhibited a gradual regression pattern on MRI.
Subject(s)
Humans , Choroid , Cobalt , Disease-Free Survival , Dose Fractionation, Radiation , Follow-Up Studies , Glaucoma, Neovascular , Korea , Magnetic Resonance Imaging , Melanoma , Neoplasm Metastasis , Orbit , Proton Therapy , Protons , Retrospective Studies , Survival Rate , Treatment Outcome , Tumor BurdenABSTRACT
PURPOSE: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. MATERIALS AND METHODS: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and diseasespecific survival (DSS) rates were calculated by the Kaplan–Meier method. RESULTS: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. CONCLUSION: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.
Subject(s)
Humans , Chordoma , Cobalt , Disease-Free Survival , Follow-Up Studies , Korea , Methods , Proton Therapy , Protons , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: Corticotropin-releasing hormone (CRH) is a crucial regulator of human pregnancy and parturition. Adenosine triphosphate (ATP)-sensitive potassium (KATP) channels are important for regulating myometrial quiescence during pregnancy. We investigated regulatory effects of different concentrations of CRH on KATP channel expression in human myometrial smooth muscle cells (HSMCs) in in vitro conditions. METHODS: After treating HSMCs with different concentrations of CRH (1, 10, 102, 103, 104 pmol/L), mRNA and protein expression of KATP channel subunits (Kir6.1 and SUR2B) was analyzed by reverse transcription-polymerase chain reaction and western blot. We investigated which CRH receptor was involved in the reaction and measured the effects of CRH on intracellular Ca2+ concentration when oxytocin was administered in HSMCs using Fluo-8 AM ester. RESULTS: When HSMCs were treated with low (1 pmol/L) and high (103, 104 pmol/L) CRH concentrations, KATP channel expression significantly increased and decreased, respectively. SUR2B mRNA expression at low and high CRH concentrations was significantly antagonized by antalarmin (CRH receptor-1 antagonist) and astressin 2b (CRH receptor-2 antagonist), respectively; however, Kir6.1 mRNA expression was not affected. After oxytocin treatment, the intracellular Ca2+ concentration in CRH-treated HSMCs was significantly lowered in low concentration of CRH (1 pmol/L), but not in high concentration of CRH (103 pmol/L), compared to control. CONCLUSION: Our data demonstrated the regulatory effect was different when HSMCs were treated with low (early pregnancy-like) and high (labor-like) CRH concentrations and the KATP channel expression showed significant increase and decrease. This could cause inhibition and activation, respectively, of uterine muscle contraction, demonstrating opposite dual actions of CRH.
Subject(s)
Animals , Female , Humans , Mice , Pregnancy , Adenosine Triphosphate , Adenosine , Blotting, Western , Corticotropin-Releasing Hormone , In Vitro Techniques , KATP Channels , Myocytes, Smooth Muscle , Myometrium , Oxytocin , Parturition , Potassium Channels , Potassium , Receptors, Corticotropin-Releasing Hormone , RNA, MessengerABSTRACT
Large cell neuroendocrine carcinoma (LCNEC) of the gallbladder is extremely rare and usually combined with other type of malignancy, mostly adenocarcinoma. We report an unusual case of combined adenosquamous carcinoma and LCNEC of the gallbladder in a 54-year-old woman. A radical cholecystectomy specimen revealed a 4.3×4.0 cm polypoid mass in the fundus with infiltration of adjacent liver parenchyma. Microscopically, the tumor consisted of two distinct components. Adenosquamous carcinoma was predominant and abrupt transition from adenocarcinoma to squamous cell carcinoma was observed. LCNEC showed round cells with large, vesicular nuclei, abundant mitotic figures, and occasional pseudorosette formation. The patient received adjuvant chemotherapy. However, multiple liver metastases were identified at 3-month follow-up. Metastatic nodules were composed of LCNEC and squamous cell carcinoma components. Detecting LCNEC component is important in gallbladder cancer, because the tumor may require a different chemotherapy regimen and show early metastasis and poor prognosis.