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Background/Aims@#Several prediction models for evaluating the prognosis of nonmetastatic resected pancreatic ductal adenocarcinoma (PDAC) have been developed, and their performances were reported to be superior to that of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. We developed a prediction model to evaluate the prognosis of resected PDAC and externally validated it with data from a nationwide Korean database. @*Methods@#Data from the Surveillance, Epidemiology and End Results (SEER) database were utilized for model development, and data from the Korea Tumor Registry System-Biliary Pancreas (KOTUS-BP) database were used for external validation. Potential candidate variables for model development were age, sex, histologic differentiation, tumor location, adjuvant chemotherapy, and the AJCC 8th staging system T and N stages. For external validation, the concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC) were evaluated. @*Results@#Between 2004 and 2016, data from 9,624 patients were utilized for model development, and data from 3,282 patients were used for external validation. In the multivariate Cox proportional hazard model, age, sex, tumor location, T and N stages, histologic differentiation, and adjuvant chemotherapy were independent prognostic factors for resected PDAC. After an exhaustive search and 10-fold cross validation, the best model was finally developed, which included all prognostic variables. The C-index, 1-year, 2-year, 3-year, and 5-year time-dependent AUCs were 0.628, 0.650, 0.665, 0.675, and 0.686, respectively. @*Conclusions@#The survival prediction model for resected PDAC could provide quantitative survival probabilities with reliable performance. External validation studies with other nationwide databases are needed to evaluate the performance of this model.
ABSTRACT
BACKGROUNDS/AIMS: Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. METHODS: Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). RESULTS: The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). CONCLUSIONS: Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.
Subject(s)
Female , Humans , Male , Acetic Acid , Acute Kidney Injury , Bile , Dyspepsia , Ethanol , Hematoma , Hemorrhage , LiverABSTRACT
PURPOSE: To compare autonomic dysfunction in patients with urge urinary incontinence(UUI), patients with stress urinary incontinence(SUI) and normal group, we measured and analyzed heart rate variability to compare among the three groups. MATERIALS AND METHODS: We studied heart rate variability(HRV) in 30 patients with UUI(mean age, 47.7+/-10.0 years old), 40 patients with SUI(mean age, 47.6+/-8.7 years old), 120 healthy controls(mean age 45.2+/-6.9 years old). The parameters of HRV of the three groups were compared. RESULTS: There was no difference in uroflowmetry and heart rate among the three groups. In time domain, square root of the mean squared difference of successive N-N interval(RMSSD) in UUI was higher than that of the others, and standard deviation of N-N interval(SDNN) showed no difference. In frequency domain, low frequency(LF) in UUI, an indicator of cardiac sympathetic tone, was higher than thar of the others. Very low frequency(VLF), LF, low-frequency/high-frequency ratio(LF/HF ratio) didn't show difference. CONCLUSION: All parameters of HRV analysis in UUI were not same as those of SUI and controls. The increase in RMSSD and HF means that there could be imbalance in autonomic nervous system and it could be the cause of detrusor overactivity in UUI.
