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Background@#The prognostic consequences of transient hemodynamic deterioration due to cardiac displacement, which is most severe during left circumflex artery (LCX) grafting in off-pump coronary artery bypass surgery (OPCAB) are unknown. This study aimed to investigate the association between mixed venous oxygen saturation (SvO2) 24 h, cerebrovascular accident, and acute kidney injury. @*Results@#Among 1,071 patients, the composite of morbidity endpoints occurred in 303 (28%) patients. SvO2 < 60% during LCX grafting was significantly associated with the composite of morbidity (OR: 2.72, 95% CI [1.60, 4.61], P < 0.001) along with advanced age, chronic kidney disease, ratio of early mitral inflow velocity to mitral annular early diastolic velocity, and EuroSCORE II. Other major hemodynamic variables including the cardiac index were not associated with the outcome. Additional regression analysis revealed pre-operative anemia as a predictor of SvO2 < 60% during LCX grafting (OR: 2.09, 95% CI [1.33, 3.29], P = 0.001). @*Conclusions@#A decrease in SvO2 < 60%, albeit confined to the period of cardiac displacement, was associated with a 2.7-fold increased risk of detrimental outcomes after OPCAB, implying the prognostic importance of this transient deterioration in oxygen supply-demand balance.
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Background@#In patients with early-stage breast cancer, the treatment results of hypofractionated radiation therapy (RT) and conventional RT are evaluated in efficacy and cost. @*Methods@#We retrospectively evaluated 280 patients with early-stage (Tis-2N0M0) breast cancer (including 100 hypofractionated RT patients) with regards to treatment outcomes according to the RT schedule. The median whole-breast RT dose was 42.56 Gy/16 fractions for hypofractionated RT and 50.4 Gy/28 fractions for conventional RT. Most patients (n = 260, 92.9%) additionally received a tumor bed boost RT. We used propensity score matching (PSM) analysis to balance the baseline risk factors for recurrence. The co-primary endpoints of this study were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR).DFS or IBTR was analyzed using the Kaplan-Meier survival curve and log-rank test. @*Results@#Total 89 pairs of matched patients (1:1 matching, n = 178) were finally evaluated.The median follow-up was 23.6 months. After matching, the 3-year DFS was 100% in the hypofractionated RT group and 98.4% in the conventional RT group; there was no significant difference in DFS between the groups (P = 0.374). Furthermore, the IBTR did not differ between the hypofractionated RT and conventional RT groups (P = 0.374) after matching. The 3-year overall survival was not different between two groups (both 100%). Hypofractionated RT saved 26.6% of the total cost of RT compared to conventional RT. Additionally, the acute skin toxicity rate (≥ grade 2) was also not significantly different between the groups (hypofractionated RT: 10.1% vs. conventional RT: 2.2%). @*Conclusion@#Hypofractionated RT showed good IBTR and DFS, which were compatible to those in conventional RT in breast cancer. Hypofractionated RT is expected to be used more widely because of its low cost and convenience.
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no abstract available.
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While lymphangioma circumscriptum may present anywhere on the body, the vulva is a rare site. However, vulvar involvement can occur in some clinical settings, and Crohn’s disease is one of the underlying etiologies of acquired lymphangioma circumscriptum. A 31-year-old woman presented with an 8-year history of widespread verruciform plaques on her vulva. She complained of a mild itching sensation at the lesion site. She was diagnosed with Crohn’s disease 11 years prior but had not been treated. She had no history of trauma or surgery in the perineal area and no familial history of cancer or hereditary disorders. The histopathologic findings were consistent with lymphangioma. Based on the clinicopathologic findings, the patient was diagnosed with lymphangioma circumscriptum on the vulva. Herein, we report a rare case of acquired lymphangioma circumscriptum of the vulva mimicking condyloma acuminatum in a patient with Crohn’s disease.
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Since the first FDA approval of Lamivudine in 1998, many nucleo(t)side analogs such as Lamivudine, Adefovir, and Entecavir have been used. However, they only inhibit DNA synthesis, and if their administration is stopped a viral breakthrough can develop, making long-term administration necessary, ultimately followed by the development of resistance. Tenofovir has been developed and drug-resistant mutations have decreased significantly, but the problem of resistance due to long-term drug use still remains, along with the drug safety problem. In this review, we introduce the recent trend in the development of hepatitis B treatment agents and the Korea National Research Institute of Health (KNIH) research for the development of a novel treatment for hepatitis B (drug repositioning) without resistance and which targets the various life cycles of HBV.
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Hepatitis B virus (HBV) infection is a major public health problem, with some 250 million people currently at high risk of developing chronic liver diseases. The current antiviral treatment for chronic hepatitis B (CHB) is effective in controlling viral replication but fails to achieve a complete cure. Since the identification of sodium taurocholate cotransport polypeptide (NTCP) as an HBV receptor, anti-HBV drugs targeting viral entry, capsid assembly, cccDNA, transcription, and secretion have been developed. In this paper, the potential inhibitors in various steps of the HBV life cycle are summarized.
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While lymphangioma circumscriptum may present anywhere on the body, the vulva is a rare site. However, vulvar involvement can occur in some clinical settings, and Crohn’s disease is one of the underlying etiologies of acquired lymphangioma circumscriptum. A 31-year-old woman presented with an 8-year history of widespread verruciform plaques on her vulva. She complained of a mild itching sensation at the lesion site. She was diagnosed with Crohn’s disease 11 years prior but had not been treated. She had no history of trauma or surgery in the perineal area and no familial history of cancer or hereditary disorders. The histopathologic findings were consistent with lymphangioma. Based on the clinicopathologic findings, the patient was diagnosed with lymphangioma circumscriptum on the vulva. Herein, we report a rare case of acquired lymphangioma circumscriptum of the vulva mimicking condyloma acuminatum in a patient with Crohn’s disease.
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Since the first FDA approval of Lamivudine in 1998, many nucleo(t)side analogs such as Lamivudine, Adefovir, and Entecavir have been used. However, they only inhibit DNA synthesis, and if their administration is stopped a viral breakthrough can develop, making long-term administration necessary, ultimately followed by the development of resistance. Tenofovir has been developed and drug-resistant mutations have decreased significantly, but the problem of resistance due to long-term drug use still remains, along with the drug safety problem. In this review, we introduce the recent trend in the development of hepatitis B treatment agents and the Korea National Research Institute of Health (KNIH) research for the development of a novel treatment for hepatitis B (drug repositioning) without resistance and which targets the various life cycles of HBV.
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Hepatitis B virus (HBV) infection is a major public health problem, with some 250 million people currently at high risk of developing chronic liver diseases. The current antiviral treatment for chronic hepatitis B (CHB) is effective in controlling viral replication but fails to achieve a complete cure. Since the identification of sodium taurocholate cotransport polypeptide (NTCP) as an HBV receptor, anti-HBV drugs targeting viral entry, capsid assembly, cccDNA, transcription, and secretion have been developed. In this paper, the potential inhibitors in various steps of the HBV life cycle are summarized.
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Solitary fibrous tumors (SFT) are uncommon mesenchymal tumors. SFT have several synonyms including localized fibrous tumor, benign mesothelioma, localized fibrous mesothelioma, and submesothelial fibroma. SFT usually occur in the pleura or other serosal surfaces, but SFT can also develop in extrapleural areas including the nasal cavity, orbit, retroperitoneum, and pelvis. Cutaneous SFT is extremely rare, and more likely to occur in the head and neck region. Histologically, this tumor can mimic a variety of benign and malignant tumors such as dermatofibroma, dermatofibrosarcoma protuberans, spindle cell lipoma or other mesenchymal tumors. Most cases of SFT show non-aggressive clinical courses, with low recurrence rates. Herein, we describe a case of primary cutaneous SFT which presented with huge mass on the back.
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Dermatofibrossarcoma , Cabeça , Histiocitoma Fibroso Benigno , Lipoma , Mesotelioma , Cavidade Nasal , Pescoço , Órbita , Pelve , Pleura , Recidiva , Pele , Tumor Fibroso Solitário Pleural , Tumores Fibrosos SolitáriosRESUMO
Background@#Few studies have investigated the association between Behçet disease (BD) and cardiovascular disease (CVD). The aim of this study was to investigate the risk of various CVDs in patients with BD. @*Objective@#The aim of this study was to investigate the risk of various CVD in patients with BD. @*Methods@#Between 2003 and 2015, we performed a retrospective cohort study involving patients with BD selected from Korea’s National Health Insurance Service-National Sample Cohort database and age- and sex-matched controls. Age- and sex-matched controls were selected randomly from the NHIS-NSC database at a frequency of 1:5. @*Results@#Among the 998 patients with BD and the 4,990 controls studied, patients with BD showed significantly higher risk for angina pectoris (adjusted Hazard Ratio [HR] 1.522, 95% confidence interval [CI] 1.020∼2.273;p=0.04) and peripheral arterial disease (adjusted HR 2.939, 95% CI 1.296∼6.664; p=0.01) than the controls. The cumulative incidence rates of these diseases in patients with BD were also significantly higher than those in the controls. @*Conclusion@#Patients with BD showed independent risk for angina pectoris and peripheral arterial disease.
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PURPOSE: This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. RESULTS: The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progressionfree survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). CONCLUSION: SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.
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Humanos , Intervalo Livre de Doença , Elétrons , Seguimentos , Neoplasias Pulmonares , Pulmão , Neoplasia Residual , Tomografia por Emissão de Pósitrons , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Radiocirurgia , Recidiva , Estudos Retrospectivos , Curva ROCRESUMO
Background : Endoscopic vessel harvesting (EVH) is one of the less-invasive graft harvesting techniques for CABG. On the other hand, it needs certain amount of a learning curve to acquire sufficient technique. Inappropriate manipulation will cause damage of the vein, decrease the patency and affect the patient's long-term survival. Off-the-job training has the potential to shorten the length of the learning curve. In this study we evaluated the effectiveness of a newly developed saphenous vein harvesting model provided by EBM corporation. Purpose : To evaluate the effectiveness of concentrated training with the EVH simulator. Objective and Methods : One novice trainee doctor was recruited for this study. After 20 procedures using the simulator training clinical device, EVH was performed under supervision. This procedure was compared with the last case before the training in terms of setup for the EVH, visualization by endoscope, dissection, division of branches, duration of the procedure, and number required for repair. Results : The duration required to train with the simulator showed a stable average of 10 cases. All the elements in terms of EVH procedure were improved after the simulator training. Discussion : It is important to prepare an appropriate simulator, trainer, and clear purpose for effective training. It was beneficial to enhance the clinical level with the concentrated simulator training. Conclusions : The newly developed EVH model is an effective simulator before performing the initial clinical case.
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BACKGROUND/AIMS: Direct sequencing is the gold standard for the detection of drug-resistance mutations in hepatitis B virus (HBV); however, this procedure is time-consuming, labor-intensive, and difficult to adapt to high-throughput screening. In this study, we aimed to develop a dendron-modified DNA microarray for the detection of genotypic resistance mutations and evaluate its efficiency. METHODS: The specificity, sensitivity, and selectivity of dendron-modified slides for the detection of representative drug-resistance mutations were evaluated and compared to those of conventional slides. The diagnostic accuracy was validated using sera obtained from 13 patients who developed viral breakthrough during lamivudine, adefovir, or entecavir therapy and compared with the accuracy of restriction fragment mass polymorphism and direct sequencing data. RESULTS: The dendron-modified slides significantly outperformed the conventional microarray slides and were able to detect HBV DNA at a very low level (1 copy/μL). Notably, HBV mutants could be detected in the chronic hepatitis B patient sera without virus purification. The validation of our data revealed that this technique is fully compatible with sequencing data of drug-resistant HBV. CONCLUSIONS: We developed a novel diagnostic technique for the simultaneous detection of several drug-resistance mutations using a dendron-modified DNA microarray. This technique can be directly applied to sera from chronic hepatitis B patients who show resistance to several nucleos(t)ide analogues.
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Humanos , DNA , Resistência a Medicamentos , Vírus da Hepatite B , Hepatite B , Hepatite B Crônica , Hepatite , Lamivudina , Programas de Rastreamento , Análise de Sequência com Séries de Oligonucleotídeos , Sensibilidade e EspecificidadeRESUMO
The authors noticed that the original version of this paper contains typographical error in Fig. 2.
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Humanos , Peso Corporal , Radioterapia , Neoplasias do Colo do ÚteroRESUMO
PURPOSE: This study aimed to assess the effects of body mass index (BMI) on survival in cervical cancer patients who had undergone surgery and radiotherapy (RT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 70 cervical cancer patients who underwent surgery and RT from 2007 to 2012. Among them, 40 patients (57.1%) had pelvic lymph node metastases at the time of diagnosis. Sixty-seven patients (95.7%) had received chemotherapy. All patients had undergone surgery and postoperative RT. Median BMI of patients was 22.8 kg/m² (range, 17.7 to 35.9 kg/m²). RESULTS: The median duration of follow-up was 52.3 months (range, 16 to 107 months). Twenty-four patients (34.3%) showed recurrence. Local failure, regional lymph nodal failure, and distant failure occurred in 4 (5.7%), 6 (8.6%), and 17 (24.3%) patients, respectively. The 5-year actuarial pelvic control rate was 83.4%. The 5-year cancer-specific survival (CSS) and disease-free survival (DFS) rates were 85.1% and 65.0%, respectively. The presence of pelvic lymph node metastases (n = 30) and being overweight or obese (n = 34, BMI ≥ 23 kg/m²) were poor prognostic factors for CSS (p = 0.003 and p = 0.045, respectively). Of these, pelvic lymph node metastasis was an independent prognostic factor (p = 0.030) for CSS. CONCLUSION: Overweight or obese cervical cancer patients showed poorer survival outcomes than normal weight or underweight patients. Weight control seems to be important in cervical cancer patients to improve clinical outcomes.
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Humanos , Índice de Massa Corporal , Peso Corporal , Diagnóstico , Intervalo Livre de Doença , Tratamento Farmacológico , Seguimentos , Linfonodos , Prontuários Médicos , Metástase Neoplásica , Obesidade , Sobrepeso , Radioterapia , Recidiva , Estudos Retrospectivos , Magreza , Neoplasias do Colo do ÚteroRESUMO
PURPOSE: The association between metabolism and cancer has been recently emphasized. This study aimed to find the prognostic significance of obesity in advanced stage rectal cancer patients treated with surgery and radiotherapy (RT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 111 patients who were treated with combined surgery and RT for clinical stage 2-3 (T3 or N+) rectal cancer between 2008 and 2014. The prognostic significance of obesity (body mass index [BMI] ≥25 kg/m²) in local control was evaluated. RESULTS: The median follow-up was 31.2 months (range, 4.1 to 85.7 months). Twenty-five patients (22.5%) were classified as obese. Treatment failure occurred in 33 patients (29.7%), including local failures in 13 patients (11.7%), regional lymph node failures in 5, and distant metastases in 24. The 3-year local control, recurrence-free survival, and overall survival rates were 88.7%, 73.6%, and 87.7%, respectively. Obesity (n = 25) significantly reduced the local control rate (p = 0.045; 3-year local control, 76.2%), especially in women (n = 37, p = 0.021). Segregation of local control was best achieved by BMI of 25.6 kg/m² as a cutoff value. CONCLUSION: Obese rectal cancer patients showed poor local control after combined surgery and RT. More effective local treatment strategies for obese patients are warranted.