Purpose : To evaluate our clinical experience with the combination of teletherapy and intraluminal brachytherapy in patients with unresectable or inoperable esophageal cancers. Materials and Methods : From Nov 1989 to Mar 1993, twenty patients with esophageal cancer were treated with radical radiotherapy and intraluminal brachytherapy at Yonsei Cancer Center. All patients had squamous histolgy and stage distribution was as follows: stage II, 4($20{\%}$)patients; III, 15 ($75{\%}$)patients; IV, 1($5{\%}$)patients. A dose of S-12Gy/1-3weeks with intraluminal brachytherapy (3-5Gy/fraction) to 5mm from the outside of the esophageal tube using high dose rate Iridium-192 remotely afterloading brachytherapy machine was given 2 weeks after a total dose of 59-64Gy with external radiotherapy. Induction chemotherapy using cisplatin and 5-FU was performed in 13 patients with median 3 cycles(1-6 cycles), Response rate, local control rate, survival and complications were analysed retrospectively. Results : Two-year overall survival rate and median survival were $15.8{\%}$ and 13.5 months. Response rates were as follows complete remission(CR) 5($25{\%}$): partial remission a(PRa) 7($35{\%}$): partial remission b(PRb) 7($35{\%}$), no response(NR) 1($5{\%}$). Patterns of failure were as follows; local failure 13($65{\%}$), local and distant failure 3($15{\%}$), distant failure 0($0{\%}$). Ultimate local control rate was $20{\%}$. Treatment related complications included esophageal ulcer in two patients and esophageal stricture in one. Conclusion : Though poor local conrol rate, median survival was improved as compared with previous results of radiation therapy alone(8months) and chemoradiation combined treatment(11 months) in Yonsei Cancer Center High-dose-rate intraluminal brachytherapy following external irradiation is an effective treatment modality with acceptable toxicity in esophageal cancer.
Lee, Kum Joo;Yun, Soo Young;Lee, Ran;Hean, Jae Ho;Jung, Ghee Young;Park, Jin Hee;Park, Young Sun
Clinical and Experimental Pediatrics
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v.45
no.5
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pp.596-602
/
2002
Purpose : The purpose of this study was to analyze the association of peripheral neutrophil count with the development of respiratory failure in preterm infants. Methods : A retrospective study was conducted from January 1993 to December 1999 on 44 preterm infants, who were admitted to the neonatal intensive care unit of St. Francisco hospital. Preterm infants(birth weight 500 to 1,350 gm) who had a complete blood count obtained within 2 hours after delivery. Patients in the lowest of neutrophil count(early neutropenia, < $1.0{\times}10^9/L$) were compared with patients in the remaining group. Results : Low neutrophil count were transient in early neutropenia group. The concentration the circulating neutrophil count rose from $0.85{\pm}0.11{\times}10^9/L$ at average of 2 hours after delivery to $5.3{\pm}2.7{\times}10^9/L$ at 24 hours after delivery in the early neutropenia group and from $3.6{\pm}1.6{\times}10^9/L$ to $5.8{\pm}3.2{\times}10^9/L$ in the non-neutropenia group during the same time period. Compare to the non-neutropenia group, the neutropenia group had a lower birth weight($1,046.50{\pm}180.76gm$ Vs $1,156.70{\pm}124.99gm$), a lower Apgar score(1 min : $3.41{\pm}1.18$ Vs $4.30{\pm}1.46$, 5 min : $5.41{\pm}0.87$ Vs $6.15{\pm}0.95$), and a higher incidence of bronchopulmonary dysplasia(27.27% Vs 7.0%). Patients who had early neutropenia were more likely to require mechanical ventilation, supplemental oxygen and hospital stay. Also, main effect factors for the two groups were birth weight(Odds ratio=5.457, 95% CI=1.551-27.525), initial peripheral blood white cells(odds ratio=8.308, 95% CI=2.054-52.699), and bronchopulmonary dysplasia(odds ratio=0.099, 95% CI=0.017-0.397). Conclusion : A low count of neutrophil in the systemic circulation of premature infants within 2 hours of birth is associated with more severe respiratory distress.
This study was conducted on the biological control effects of the natural enemy, Amblyseius cucumeris, against Polyphagotarsonemus latus. The broad mite moved to a new habitat after the carrying capacity of the preferred habitat on the upper leaf has been reached. Population dynamics between predator, Amblyseius cucumeris, and prey, P. latus, were quite well synchronized since the predator followed the movement of the prey. In predation test by Amblyseius cucumeris on P. latus, A. cucumeris fed on 8.8, 15.2, 27.0 and 30.3 individuals/day under the temperatures of 15, 20, 25, and $30^{\circ}C$, respectively. The A. cucumeris larva, protonymph, deutonymph, adult male, and adult female fed on 0.5, 1.6, 5.2, 3.8, and 27 individuals of adult P. latus per day, respectively, under $25^{\circ}C$ condition. The functional response curve of adult P. latus to the densities of A. cucumeris showed Holling's Type II curve. The consumption of prey by A. cucumeris increased with the prey density increase, but the consumption rate decreased. The critical ratio of predator vs. prey effectively to suppress (98% over) the population of P. latus by releasing A. cucumeris was 1:40 on red pepper.
Objective: This study was performed to investigate the influences of extraction and nonextraction treatment on smile esthetics by measuring dental arch width changes. Methods: Pretreatment and posttreatment study models of 30 first premolar extraction cases and 30 nonextraction cases were randomly selected to determine whether extraction treatment results in narrow dental arches, and a consequent unaesthetic smile. Arch widths were measured from the cusp tips of the canines and the first molars. Posterior arch widths were also measured at a constant arch depth derived by averaging randomly chosen nonextraction models. Results: The intercanine widths increased significantly in the extraction sample, whereas the intermolar widths decreased significantly. The arch width at a standardized arch depth was significantly wider in the extraction subjects. Conclusion: These results elucidate that constriction in arch width is not a materialized consequence of extraction treatment. It leads to postulate that an esthetically compromising effect from narrow dental arches on smile is hardly anticipated with extraction treatment.
Journal of the Korea Organic Resources Recycling Association
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v.28
no.1
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pp.15-25
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2020
Biogas production potential was experimentally estimated for mono- and co-digestion of cow manure and waste grass. The two organic wastes were mixed at five different ratios (100:0, 75:25, 50:50, 25:75, 0:100) on the volatile solids basis, and were assessed using biochemical methane potential (BMP) test. Thee reaction temperatures, 25℃, 30℃ and 35℃, were applied as well, resulting in 15 different combinations for the test. The results showed that both higher temperature and waste grass mixing ratio resulted in higher methane yield and maximum methane production rate. Based on the experimental results, a theoretical farm- or community-scale (240 or 2400 ㎥) anaerobic digester was designed to evaluate the energy balance associated with mono- and co-digestion of the wastes at different temperatures. Although the energy production increased as the temperature and the waste grass mixing ratio increased, the net energy gain, energy production subtracted by energy consumption for heating and maintenance, was estimated to be the highest at 30℃, followed by at 35℃ and 25℃. Therefore, it is advised that both the experimental methane production and the detailed design parameters must be considered for the optimization of the net energy gain from these wastes.
Recently developed TRAP assay(Total Radical-trapping Antioxidant Potential) is a new technique which enable effectively the measurement of total antioxidant status in the plasma. Researches using TRAP method have rarely been reported in Korea. Therefore, we investigated effects of various life-style and dietary factors on plasma TRAP level in Korean adult population. The subjects consisted of 161 health adult male(n=105) and female (n=56) aged 19-57. A self-administered questionnaire ascertained life-style factors including smoking habits, alcohol use, physical activity. Dietary factors were analyzed by 24 hour recall method. TRAP was determined spectrophotometrically in plasma at 734nm. Mean plasma TRAP concentrations were slightly higher in males (1.35$\pm$0.02mM) and females(1.30$\pm$0.02mM) without significance. There were significant correlations between plasma TRAP levels and life-style factors including exercise and smoking Plasma TRAP levels were affected more by exercise than by smoking. Moderate amount exerciser(exercise time $\geq$30min/day) had significantly higher level of plasma TRAP levels in male smokers(1.33$\pm$0.03mM) were significantly lower than those in male nonsmokers(1.39$\pm$0.01mM, p<0.05), but the difference was not seen in female subjects. Intakes of vitamin C(r=0.288, p=0.007) or folate (r=0.258, p=0.016) were positively correlated with plasma TRAP levels in nonsmokers, but those relations were not seen in smokers. Dietary factors such as vegetables (r=0.288, p=0.007)or folate (r=0.258, p=0.016) were positively correlated with plasma TRAP levels in nonsmokers, but those relations were not seen in smokers. Dietary factors such as vegetables (r=0.277, p=0.009) and legumes(r=0.263, p=0.013) consumption were positively related to plasma TRAP concentrations also in nonsmokers only. Regular green tea drinkers showed significantly greater level of plasma TRAP than the non green tea drinkers(1.36$\pm$0.01mM vs 1.30$\pm$0.03mM, p<0.05). These results suggest that the regular exercise($\geq$30min daily), nonsmoking, and consumption of vegetables, legumes and green tea would contribute to improving plasma TRAP levels in Korean adults.
Human noroviruses (HuNoVs) are a leading cause of gastroenteritis outbreaks worldwide. However, the paucity of appropriate cell culture models for HuNoV replication has prevented developing effective anti-HuNoV therapies. In this study, first, the replication of the virus at various temperatures in different cells was compared, which showed that lowering the culture temperature from 37℃ significantly increased virus replication in Madin-Darby canine kidney (MDCK) cells. Second, the expression levels of autophagy-, immune-, and apoptosis-related genes at 30℃ and 37℃ were compared to explore factors affecting HuNoV replication. HuNoV cultured at 37℃ showed significantly increased autophagy-related genes (ATG5 and ATG7) and immune-related genes (IFNA, IFNB, ISG15, and NFKB) compared to mock. However, the virus cultured at 30℃ showed significantly decreased expression of autophagy-related genes (ATG5 and ATG7), but not significantly different major immune-related genes (IFNA, ISG15, and NFKB) compared to mock. Importantly, expression of the transcription factor FOXO1, which controls autophagy- and immune-related gene expression, was significantly lower at 30℃. Moreover, FOXO1 inhibition in temperature-optimized MDCK cells enhanced HuNoV replication, highlighting FOXO1 inhibition as an approach for successful virus replication. In the temperature-optimized cells, various HuNoV genotypes were successfully replicated, with GI.8 showing the highest replication levels followed by GII.1, GII.3, and GII.4. Furthermore, ultrastructural analysis of the infected cells revealed functional HuNoV replication at low temperature, with increased cellular apoptosis and decreased autophagic vacuoles. In conclusion, temperature-optimized MDCK cells can be used as a convenient culture model for HuNoV replication by inhibiting FOXO1 and providing adaptability to different genotypes.
Jae Beom Jeon;Cho Hee Lee;Yongwhan Lim;Min-Chul Kim;Hwa Jin Cho;Do Wan Kim;Kyo Seon Lee;In Seok Jeong
Journal of Chest Surgery
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v.56
no.4
/
pp.244-251
/
2023
Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients' mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11-0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63-0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.
Jeong Hyun Park;Danbee Kang;Seok Jin Nam;Jeong Eon Lee;Seok Won Kim;Jonghan Yu;Byung Joo Chae;Se Kyung Lee;Jai Min Ryu;Yeon Hee Park;Mangyeong Lee;Juhee Cho
Quality Improvement in Health Care
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v.30
no.1
/
pp.120-131
/
2024
Purpose: This study aimed to evaluate the impact of implementing a clinical pathways (CPs) on the clinical outcomes and costs of patients undergoing breast cancer surgery. Methods: This retrospective cohort study included patients who were newly diagnosed with primary breast cancer at the Samsung Medical Center between 2014 and 2019 (N=8482; 2931 patients in the pre-path and 5551 patients in the post-path). Clinical outcomes included reoperation during hospitalization, readmission, and emergency room visits within 30 days of discharge. The cost data for each unit were obtained from an activity-based management accounting system. We performed an interrupted time series analysis. Results: The post-path period showed a significantly shorter hospital length of stay (LOS) than the pre-path period (6.3 days in pre-path vs. 5.0 days in post-path; -1.3 days' difference; p=.001), and fewer reoperations during hospitalization and within 30 days after discharge than the pre-path period. After adjusting for inflation rates and relative value scores, the model demonstrated savings of $146 per patient in the post-path for total costs, and $537 per patient for patient out-of-pocket costs (p=.001). Conclusion: CPs can help reduce costs without compromising the quality of care by reducing the number of reoperations, readmissions, and complications.
Purpose : IgA nephropathy(IgAN) and thin glomerular basement membrane disease(TGBMD) are common glomerular diseases that cause hematuria in childhood. IgAN has characteristics of IgA deposit as the sole or predominantly localized to the mesangium Recently, it has been reported that thinning of glomerular basement membrane(GBM) is commonly accompanied with precipitation of electron dense deposits in IgAN. We performed this study to examine the frequency of thinning of GBM among children with IgAN and to analysis tile correlation between urinary abnormalities and GBM thickness and furthermore to conduct comparative analysis of the clinical and pathological features of IgAN and TGBMD. Methods : This study summarizes data collected from Department of Pediatrics, Busan Paik Hospital, Inje Medical College. Data include 51 cases who were diagnosed as IgAN from 1995 to 2000, and 26 cases who were diagnosed as TGBMD from 1990 to 2000 by percutaneous renal biopsy. Results : Males accounted for 29/51($56.9\%$) patients with IgAN and 8/26($30.8\%$) of those with TGBMD. The clinical and laboratory features between IgAN and TGBMD were significantly different regarding the incidence of proteinuria(IgAN vs TGBMD: $43.1\%\;vs\;3.8\%$, p=0.001), the incidence of co-appearance of proteinuria with hematuria ($41.2\%\;vs\;3.8\%$, p=0.001), total amount of protein in 24 hours collected urine ($808{\pm}\;mg\;vs\;251{\pm}200.7\;mg$, p=0.001) and the incidence of proteinuria more than 1 gm in 24 hours collected urine ($23.5\%\;vs\;3.8\%$, p=0.01). On the contrary, there were no significant differences in the levels of serum albumin, creatinine, BUN, and Ccr between two groups. The mean thickness of GBM in patients with IgAN was $293.0{\pm}79.2\;nm$(139.7-461.9 nm) and $180.9{\pm}35.8\;nm$(110.5-229.5 nm) in patients with TGBMD. The mean GBM thickness revealed significantly thinner in TGBMD compared than those with IgAN (P=0.0001). The frequency of thickness being less than 250 nm was $37.4{\pm}34.4\%$ in IgAN and $93.0{\pm}7.0\%$ in TGBMD (P=0.0001). But there were no correlations between urinary abnormalities and GBM thickness in patients with IgAN. Conclusion : The thinning of GBM would be one of the common pathological findings in IgAN Moreover, there is no significant correlations between urinary abnormalities and GBM thickness in patients with IgAN, However, patients with IgAN tend to have significantly higher possibilities of proteinuria, co-appearance of proteinuria with hematuria and higher total amount of protein in 24 hours collected urine compared those with TGBMD. These differences might be play all important role as progressive prognostic indicators in patients with IgAN. (J Korean Soc Pediatr Nephrol 2001;5 : 136-46)
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