Pulmonary pleomorphic carcinoma presenting as undifferentiated non-small cell carcinoma with giant cells: A case report and review of literature.

Pulmonary pleomorphic carcinoma (PPC) is a poorly differentiated non-small cell lung carcinoma, including squamous cell carcinoma, adenocarcinoma, or undifferentiated non-small cell lung carcinoma with at least 10% spindle and/or giant cells. Here, we report a case of PPC showing undifferentiated non-small cell lung carcinoma with giant cells. A 71-year-old man with dyspnea underwent right lobectomy because of a mass in the right upper lobe of the lung. A 5.0 × 3.0 × 1.5 cm-sized tumor was identified; microscopically, the tumor composed of undifferentiated large sized tumor cells admixed with syncytial tumor giant cells and emperipoletic giant cells. Immunohistochemically, the tumor cells were reactive for pan-cytokeratin, but negative for P40, thyroid transcription factor 1 (TTF-1), and vimentin. The tumor cells were also positive for 3 clones of programmed death-ligand 1 (PD-L1). The clinical and histologic findings supported the diagnosis of an undifferentiated non-small cell lung carcinoma with giant cells, which is a subtype of pulmonary pleomorphic carcinoma. Unfortunately, after surgery, multifocal lymph node metastasis was identified in radiologic examination. Only palliative chemotherapy was administered to the patient, although he was indicated for immunochemotherapy. Pulmonary pleomorphic carcinoma is known to have a poor prognosis, even in early stages of the disease, therefore, we should be careful in the diagnosis to ensure optimal treatment.

Nodular Fasciitis of the Chest in a Young Woman.

Nodular fasciitis is a benign reactive proliferation that usually involves the deep fascia. Although it is relatively common in the adult population, it is often misdiagnosed as sarcoma due to its rapid growth and pathological features. It rarely presents as a chest wall tumor in young patients. Here, we report a case of nodular fasciitis involving the chest wall of an 18-year-old woman and its surgical management. This case underscores the need to consider nodular fasciitis in the differential diagnosis of chest wall tumors in young patients.

High-sensitivity C-reactive protein and mean platelet volume as predictive values after percutaneous coronary intervention for long-term clinical outcomes: a comparable and additive study.

This study was designed to establish the relationship of high-sensitivity C-reactive protein (hsCRP) and mean platelet volume (MPV) with the development of adverse outcomes after percutaneous coronary intervention (PCI). hsCRP levels and MPV were analysed in 372 patients who underwent PCI, with the primary endpoint as major adverse cardiac and cerebrovascular events (MACCE): a composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), ischemic stroke and stent thrombosis. During the follow-up period (mean, 25.8 months), there were 21 cardiac deaths, 10 MIs including four stent thrombosis events, seven ischemic strokes and 29 TVRs. The hsCRP cut-off level was set at 0.31 mg/dl using the receiver operating characteristic curve to differentiate between the groups with and without MACCE. The MPV cut-off level was set at 8.00 fl by the receiver operating characteristic curve to differentiate between the groups with and without MACCE. A Kaplan-Meier analysis revealed that the high hsCRP group (≥0.31 mg/dl) had a significantly higher cardiac death and MACCE rate than the low hsCRP group (<0.31 mg/dl), and the high MPV group (>8.00 fl) had a significantly higher cardiac death and MACCE rate than the low MPV group (≤8.00 fl). Furthermore, the high hsCRP and MPV groups were significantly associated with an increased risk of MACCE. These results show that hsCRP and MPV are predictive markers after PCI for MACCE; they are also additively associated with a higher risk of MACCE.

Brachial-ankle pulse wave velocity and mean platelet volume as predictive values after percutaneous coronary intervention for long-term clinical outcomes in Korea: A comparable and additive study.

This study aimed to determine the association of the brachial-ankle pulse wave velocity (baPWV) and mean platelet volume (MPV) with the development of adverse outcomes after percutaneous coronary intervention (PCI). The baPWV and MPV were analyzed in 372 patients who underwent PCI, with the primary endpoint as cardiac death. The secondary endpoint was cardiovascular events (CVE): a composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), ischemic stroke, and stent thrombosis (ST). During the follow-up period (mean, 25.8 months), there were 21 cardiac deaths, 10 MIs including four events of ST, seven ischemic strokes, and 29 TVRs. The baPWV cut-off level was set at 1672 cm/s using the receiver operating characteristic curve; the sensitivity and specificity was 85.7 and 60.1%, respectively, to differentiate between the groups with and without cardiac death. The MPV cut-off level was set at 8.20 fL using the receiver operating characteristic curve; the sensitivity and specificity were 81 and 53.3%, respectively, to differentiate between the groups with and without cardiac death. Kaplan-Meier analysis revealed that the higher baPWV group (≥ 1672 cm/s) had a significantly higher cardiac death and CVE rate than the lower baPWV group (<1672 cm/s) (11.4 vs. 1.4%, log-rank: p < 0.0001; 25.3 vs. 7.5%, log-rank: p < 0.0001; respectively), and the higher MPV group (median, >8.20 fL,) had a significantly higher cardiac death and CVE rate than the lower MPV group (≤ 8.20 fL) (9.4 vs. 2.1%, log-rank: p = 0.0026; 23.8 vs. 6.8%, log-rank: p < 0.0001; respectively). Furthermore, the high baPWV and MPV groups were significantly associated with an increased risk of cardiac death. These results show that baPWV and MPV are predictive markers after PCI for cardiac death; they are also additively associated with a higher risk of cardiac death.

Paraquat Induces Apoptosis through Cytochrome C Release and ERK Activation.

Paraquat has been suggested to induce apoptosis by generation of reactive oxygen species (ROS). However, little is known about the mechanism of paraquat-induced apoptosis. Here, we demonstrate that extracellular signal-regulated protein kinase (ERK) is required for paraquat-induced apoptosis in NIH3T3 cells. Paraquat treatment resulted in activation of ERK, and U0126, inhibitors of the MEK/ERK signaling pathway, prevented apoptosis. Moreover, paraquat-induced apoptosis was associated with cytochrome C release, which could be prevented by treatment with the MEK inhibitors. Taken together, our findings suggest that ERK activation plays an active role in mediating paraquat-induced apoptosis of NIH3T3 cells.

Analysis of Intermediate Term Results of Short Vein Bypass Graft in the Patient with Critical Limb Ischemia.

PURPOSE: Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB. MATERIALS AND METHODS: From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type. RESULTS: There were 11 males and 16 females and the mean age was 66.6±12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00). CONCLUSION: The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.

Changes in background and characteristics in freshmen in one graduate medical school from 2009 to 2011.

PURPOSE: We examined the changes in background and characteristics in freshmen in graduate medical school from 2009 to 2011. METHODS: We analyzed the responses to a self-questionnaire which were about sex, age, graduation, major, religion and etc. The data were analyzed by t-test, chi-square test. RESULTS: The freshman population in 2009 and 2011 year was 44% and 58.4% male, and 56% and 41.6% female; had a mean age of 27.3 and 27.4; 41.6% and 32.0% Christian, 33.6% and 47.2% atheist, 76.0% and 68.8% graduates; and 48.0% and 50.4% in the capital region, respectively. With regard to future career, 43.2% and 43.2% of freshmen responded clinical professor, 29.6% and 27.2% private clinics, 8.0% and 13.6% medical researcher, 8.8% and 6.4% public officer, 6.4% and 3.2% basic science faculty, and 4.0% and 6.4% others. With regard to future majors, 20.0% and 20.0% answered internal medicine, 11.2% and 8.0% psychiatrics, 8.8% and 8.8% general surgery, 8.0% and 8.8% pediatrics, 4.8% and 4.8% chest surgery, 33.6% and 36.0% others, and 13.6% and 13.6% undecided, respectively. CONCLUSION: The populations of males, atheists, graduation candidate, and medical researchers increased, those of females, Christian, and those born in Gwangju and Jeonnam decreased, and those of mean age, future careers and majors, birth place in the capital region were unchanged.

Oncogenic Ras-mediated downregulation of Clast1/LR8 is involved in Ras-mediated neoplastic transformation and tumorigenesis in NIH3T3 cells.

Oncogenic Ras proteins transform cells by way of multiple downstream signaling pathways that promote the genesis of human cancers. However, the exact cellular mechanisms by which downstream targets are regulated are not fully understood. Here, we show that oncogenic Ras reduced Clast1/LR8 transcript levels in mouse NIH3T3 fibroblasts and human WI38 fibroblasts. Clast1/LR8 transcript was undetectable in H460, A549, and H1299 cells showing high Ras activity, but was relatively abundant in DMS53 cells displaying low Ras activity. We also showed that K-Ras siRNA restored Clast1/LR8 expression in H460 and A549 cells, and that inhibitors of DNA methylation and histone deacetylation reversed oncogenic H-Ras-mediated suppression of Clast1/LR8 transcription. Additionally, ectopic expression of Clast1/LR8 inhibited serum-stimulated phosphorylation of ERK1/2 and Akt in H-RasV12-transformed NIH3T3 cells. We further showed that the expression of Clast1/LR8 interfered with oncogenic Ras-induced NIH3T3 cell transformation and invasion. Finally, our results showed that Clast1/LR8 inhibited Ras-induced proliferation of, and tumor formation by, oncogenic H-RasV12-transformed NIH3T3 cells in vivo. This study identifies the downregulation of Clast1/LR8 as a potentially important mechanism by which oncogenic Ras-mediated neoplastic transformation occurs.

Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect.

We examined the usefulness of the modified single-patch technique for the surgical management of complete atrioventricular septal defect (AVSD). Sixty-one patients undergoing total correction for complete AVSD from January 1997 to December 2006 were classified to the modified single-patch technique group (18 patients) and the classical one-/two-patch technique group (43 patients). The surgical outcomes of the modified single-patch technique were compared with those of the classical-patch technique. Aortic cross-clamp time was shorter in the modified single-patch technique group (110.8+/-27.5 min vs. 134.4+/-42.5 min, P=0.03). During the follow-up period, two patients required reoperation for atrioventricular valve dysfunction in the modified single-patch technique group vs. three patients in the classical-patch technique group (P=0.63). One late death occurred in the modified single-patch technique and two late deaths in the classical-patch technique group (P=0.90). There was no significant difference in surgical outcomes between the two groups. And the modified single-patch technique has the advantage of relative simplicity and shorter ischemic time, and thus it is thought to be a feasible surgical option for the repair of complete AVSD.

Angiographic results of the radial artery graft patency according to the degree of native coronary stenosis.

OBJECTIVE: Radial arteries are gaining widespread acceptance as complementary arterial conduits for surgical myocardial revascularization, but there are limited reports about its angiographic patency compared with that of the internal thoracic artery or saphenous vein according to the degree of native coronary stenosis. Therefore, we tried to evaluate the mid-term angiographic results of the radial artery graft patency focusing on the native coronary stenotic status in a prospective manner. METHODS: From March 2000 to September 2006, a total of 488 patients underwent coronary artery bypass grafting using radial artery graft at our institution. From this group, 123 patients (mean age of 59.02+/-8.9 years (range 34-73 years)) were enrolled in the present study, and underwent a postoperative angiography after surgery (mean 32 months). The angiograms were assessed visually and quantitatively. RESULTS: A total of 382 distal anastomoses were performed and 352 anastomosis remained patent (92.1%). Left internal thoracic artery showed the most excellent patency in all of the conduits (128/129, 99.2%). Overall the radial artery graft patency was 92% (160/174). In the univariate analysis, patency was significantly worse for targets of the right coronary system (left coronary system 129/135, 94.4% vs right coronary system 31/39, 79.4%. p<0.05) and the radial artery graft showed a higher patency rate in the case of a severe stenotic lesion that preoperatively revealed more than 90% stenosis (defined as critical stenotic lesion) than in the case of a less severe lesion (50%

Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease: Effects of the cryo-maze procedure and predictors for late recurrence.

OBJECTIVE: The aim of this study was to evaluate the effects of the modified maze procedure using cryoablation for treating chronic atrial fibrillation (AF) associated with rheumatic mitral valve disease and to assess the risk factors for late failure of sinus rhythm restoration. METHODS: Between March 2000 and June 2004, 170 consecutive patients, who underwent the modified maze procedure using cryoablation concomitant with mitral valve surgery for atrial fibrillation associated with rheumatic mitral valve disease, were divided into two groups based on the type of right-sided maze: the modified Cox-maze III (CM group, n=93) and modified Kosakai-maze (KM group, n = 77) procedures. The postoperative and mid-term follow-up results were analyzed and compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of atrial fibrillation. RESULTS: There were three in-hospital deaths, including two in the CM group (2.2%) and one in the KM group (1.3%), and there were no significant differences in the incidence of postoperative complications between the two groups. The cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the KM group than the CM group. At discharge, the sinus rhythm rate was 70% in the CM group and 74% in the KM group (p = 0.55). Follow-up was completed in 97% of the patients, with a mean time of 26.6+/-15.2 months. At the latest follow-up, one death occurred in the CM group (0.6%). Sinus rhythm was documented in 141 (84%) out of all the patients, including 76 (84%) in the CM group and 65 (86%) in the KM group (p=0.72). The 4-year actuarial survival free from stroke was 90.3+/-5.9% for the CM group and 96.4+/-3.5% for the KM group (p = 0.68), and 4-year event-free survival was 81.2+/-7.4% for the CM group and 96.4+/-3.5% for the KM group (p = 0.078). Using a multivariate analysis, a left atrial dimension >65 mm (p = 0.011) and repair for rheumatic mitral valve disease (p = 0.038) were independent risk factors for a late recurrence of AF. CONCLUSIONS: The modified maze procedures using cryoablation are safe and effective in treating chronic atrial fibrillation associated with rheumatic mitral valve disease.