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Estimated Risk of Radiation Induced Contra Lateral Breast Cancer Following Chest Wall Irradiation by Conformal Wedge Field and Forward Intensity Modulated Radiotherapy Technique for Post-Mastectomy Breast Cancer Patients

  • Athiyaman, Hemalatha;M, Athiyaman;Chougule, Arun;Kumar, HS
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.12
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    • pp.5107-5111
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    • 2016
  • Background: Epidemiological studies have indicated an increasing incidence of radiation induced secondary cancer (SC) in breast cancer patients after radiotherapy (RT), most commonly in the contra-lateral breast (CLB). The present study was conducted to estimate the SC risk in the CLB following 3D conformal radiotherapy techniques (3DCRT) including wedge field and forward intensity modulated radiotherapy (fIMRT) based on the organ equivalent dose (OED). Material and Methods: RT plans treating the chest wall with conformal wedge field and fIMRT plans were created for 30 breast cancer patients. The risks of radiation induced cancer were estimated for the CLB using dose-response models: a linear model, a linear-plateau model and a bell-shaped model with full dose response accounting for fractionated RT on the basis of OED. Results: The plans were found to be ranked quite differently according to the choice of model; calculations based on a linear dose response model fIMRT predict statistically significant lower risk compared to the enhanced dynamic wedge (EDW) technique (p-0.0089) and a non-significant difference between fIMRT and physical wedge (PW) techniques (p-0.054). The widely used plateau dose response model based estimation showed significantly lower SC risk associated with fIMRT technique compared to both wedge field techniques (fIMRT vs EDW p-0.013, fIMRT vs PW p-0.04). The full dose response model showed a non-significant difference between all three techniques in the view of second CLB cancer. Finally the bell shaped model predicted interestingly that PW is associated with significantly higher risk compared to both fIMRT and EDW techniques (fIMRT vs PW p-0.0003, EDW vs PW p-0.0032). Conclusion: In conclusion, the SC risk estimations of the CLB revealed that there is a clear relation between risk associated with wedge field and fIMRT technique depending on the choice of model selected for risk comparison.

MTHFR Polymorphisms and Pancreatic Cancer Risk:Lack of Evidence from a Meta-analysis

  • Li, Lei;Wu, Sheng-Di;Wang, Ji-Yao;Shen, Xi-Zhong;Jiang, Wei
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.2249-2252
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    • 2012
  • Objective: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be associated with pancreatic cancer, but the published studies had yielded inconsistent results.We therefore performed the present meta-analysis. Methods: A search of Google scholar, PubMed, Cochrane Library and CNKI databases before April 2012 was conducted to summarize associations of MTHFR polymorphisms with pancreatic cancer risk. Assessment was with odds ratios (ORs) and 95% confidence intervals (CIs). Publication bias were also calculated. Results: Four relative studies on MTHFR gene polymorphisms (C667T and A1298C) were involved in this meta-analysis. Overall, C667T(TT vs. CC : OR = 1.61, 95%CI = 0.78 - 3.34; TT vs. CT : OR = 1.41, 95%CI = 0.88-2.25; dominant model: OR = 0.68, 95%CI = 0.40-1.17; recessive model: OR = 0.82, 95%CI = 0.52-1.30) and A1298C(CC vs. AA:OR=1.01, 95%CI=0.47-2.17; CC vs. AC: OR=0.99,95%CI=0.46-2.14; dominant model: OR=1.01, 95%CI = 0.47-2.20; recessive model: OR = 1.01, 95%CI = 0.80-1.26) did not increase pancreatic cancer risk. Conclusion: This meta-analysis indicated that MTHFR polymorphisms (C667T and A1298C) were not associated with pancreatic cancer risk.

Comparison of the second and third intercostal spaces regarding the use of internal mammary vessels as recipient vessels in DIEP flap breast reconstruction: An anatomical and clinical study

  • Seong, Ik Hyun;Woo, Kyong-Je
    • Archives of Plastic Surgery
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    • v.47 no.4
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    • pp.333-339
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    • 2020
  • Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images. Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS. Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

A Study on Knowledge and Control Beliefs Regarding Breastfeeding of University Students by Their General Characteristics and Experienced Education in Breastfeeding (대학생의 일반적 특성 및 모유수유교육경험에 따른 모유수유 지식 및 통제신념에 관한 연구)

  • Lee, Jo Yoon;Lee, Kang Wook;Hyun, Wha Jin
    • Korean Journal of Community Nutrition
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    • v.18 no.5
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    • pp.457-466
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    • 2013
  • This study was conducted to investigate the effect of breastfeeding education experience on knowledge, control beliefs, and future intention toward breastfeeding to consider the needs of breastfeeding education program of university students. The breastfeeding knowledge, control beliefs and related habits of 445 male and female college students were evaluated between September 1, 2011 to April 30, 2012. Data were collected from self-administered questionnaires and analyzed using SPSS for Window V.17.0. ${\chi}^2$-test, t-test and ANOVA were used for the calculation of differences between groups. The percentage of students who intended to breastfeed their baby was 80.7% (male: 73.6%, female: 84.2%). Only 21.6% of students experienced breastfeeding education. Students planned to get information related to breastfeeding from their mothers (32.4%), breastfeeding experts (23.8%) and Medical doctors & nurses (10.6%). breastfeeding education group showed higher knowledge level (14.46 vs 10.56) and control beliefs (3.48 vs 3.16) to breastfeeding than non-education group (p < 0.001). General attitude toward breastfeeding was similar between groups; the specific intention to breastfeed for 6 months was higher in the education group (83.3% vs 58.2%) (p < 0.01). Percentage of students who gave correct answers to knowledge questions related to breastfeeding was also higher in the breastfeeding education group than non-education group (72.3% vs 52.8%). Among 20 questions, only 2 questions showed no significant differences between the groups. These findings suggested that breastfeeding education was effective in encouraging or improving breastfeeding practices.

Performance of Hanwoo calves fed a commercial colostrum replacer versus natural bovine colostrum

  • Ahmadi, Farhad;Kim, Seongjin;Hwangbo, Deok;Oh, Yongik;Yu, Jisu;Bae, Jisun;Kim, Na Yeon
    • Journal of Animal Science and Technology
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    • v.63 no.5
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    • pp.1114-1125
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    • 2021
  • Supplying a sufficient amount of high-quality colostrum is a prevailing challenge in Hanwoo calf production systems. This study aimed to describe the efficiency of a lacteal-derived colostrum replacer versus natural bovine colostrum (from Holstein) fed to Hanwoo calves. Forty newborn Hanwoo calves (25 males and 15 females; 30.7 ± 3.15 kg body weight [mean ± standard deviation]) were blocked by sex and birth weight and fed either natural colostrum or a commercial colostrum replacer. Calves displayed a narrow difference in the evolution of body weight and structural body dimensions when they received a commercial versus natural colostrum. Minor differences existed in the starter and total dry matter consumption between calves fed natural or commercial colostrum. Although the colostrum source had no significant effects on days to first diarrhea (average of 7.6 days; p = 0.17), the duration of diarrhea was longer in natural colostrum-fed calves (3.2 vs. 4.5 days; p = 0.04). Consumption of natural colostrum resulted in greater mean serum immunoglobulin G (IgG) on day 2 (14.7 vs. 10.8 ± 0.92 mg/mL) and day 7 (8.21 vs. 5.12 ± 0.82 mg/mL) of calf life, resulting in a greater proportion of commercial colostrum-fed calves (50% vs. 15%; day 2) to experience failure of passive transfer of immunity (serum IgG < cutoff point of 10 mg/mL). Overall, growth rate, body frame development, and incidence of diarrheal disease were not different in both groups. These results suggested that the colostrum replacer product tested in this study could be an alternative to natural colostrum derived from Holstein cow in securing calf growth and health in Hanwoo calf-rearing operations.

Sensory Quality and Histochemical Characteristics of Longissimus Thoracis Muscles between Hanwoo and Holstein Steers from Different Quality Grades

  • Kim, Jae Yeong;Lee, Boin;Kim, Dong Hwan;Lee, Kichoon;Kim, Eun Joong;Choi, Young Min
    • Food Science of Animal Resources
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    • v.41 no.5
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    • pp.779-787
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    • 2021
  • This study compared the meat quality characteristics, palatability, and histochemical characteristics of low-marbled Hanwoo and Holstein steers of different beef quality grades (1, 2, and 3). No differences were observed in muscle pH24 h and cooking loss between the groups (p>0.05); however, quality grade 1 of Hanwoo steers (HA1) showed a darker muscle surface compared to grade 1 of Holstein steers (HO1) (30.9 vs. 33.9, p<0.05). The HA2 group exhibited a lower value of Warner-Bratzler shear force compared to the HO1 and HO3 groups (60.8 vs. 69.2 and 87.8 N, p<0.001). For sensory quality attributes, steaks from the HA1 group showed higher scores of softness, initial tenderness, and amount of perceptible residue than steaks from the HO1 group (p<0.001). Within the quality grade 2, Hanwoo steers had a higher score of softness compared to Holstein steers (p<0.001). There were no differences in juiciness and flavor intensity between Hanwoo and Holstein steers at the same quality grade (p>0.05). This difference in tenderness attributes between the breeds within the quality grade was associated with morphological traits of muscle bundle, and Hanwoo steers had smaller bundle area (0.37 vs. 0.50 mm2, p<0.05) and higher fiber number per bundle (88.2 vs. 121, p<0.05) compared to Holstein steers. Therefore, bundle characteristics of longissimus thoracis muscle can be crucial for explaining factor for the explanation of tenderness variations between different breeds at the same beef quality grade or marbling.

Comparing Pre- and Post-Operative Findings in Patients Who Underwent Laparoscopic Proximal Gastrectomy With a Double-Flap Technique: A Study on High-Resolution Manometry, Impedance pH Monitoring, and Esophagogastroduodenoscopy Findings

  • Hyun Joo Yoo;Jin-Jo Kim
    • Journal of Gastric Cancer
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    • v.24 no.2
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    • pp.137-144
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    • 2024
  • Purpose: Laparoscopic proximal gastrectomy (LPG) is a viable choice for treating proximal gastric lesions. However, the occurrence of severe reflux has limited its widespread adoption. To address this issue, the double flap technique (DFT), which incorporates artificial lower esophageal sphincteroplasty, has been developed to prevent reflux problems after proximal gastrectomy. In this study, we aimed to investigate the usefulness of this technique using high-resolution manometry (HRM), impedance pH monitoring, and esophagogastroduodenoscopy (EGD). Materials and Methods: The findings of pre- and postoperative 6-month HRM, pH monitoring, and EGD were compared for 9 patients who underwent LPG with DFT for various proximal gastric lesions at Incheon St. Mary's Hospital from January 2021 to December. Results: A total of 9 patients underwent proximal gastrectomy. Approximately half of the patients had Hill's grade under II preoperatively, whereas all patients had Hill's grades I and II in EGD findings. In the HRM test, there was no significant difference between distal contractile integral (1,412.46±1,168.51 vs. 852.66±495.62 mmHg·cm·s, P=0.087) and integrated relaxation pressure (12.54±8.97 vs. 8.33±11.30 mmHg, P=0.27). The average lower esophageal sphincter (LES) pressure was 29.19±14.51 mmHg preoperatively, which did not differ from 19.97±18.03 mmHg after the surgery (P=0.17). DeMeester score (7.02±6.36 vs. 21.92±36.17, P=0.21) and total acid exposure time (1.49±1.48 vs. 5.61±10.17, P=0.24) were slightly higher, but the differences were not statistically significant. Conclusions: There is no significant functional difference in HRM and impedance pH monitoring tests after DFT. DFT appears to be useful in preserving LES function following proximal gastrectomy.

Automated Segmentation of Left Ventricular Myocardium on Cardiac Computed Tomography Using Deep Learning

  • Hyun Jung Koo;June-Goo Lee;Ji Yeon Ko;Gaeun Lee;Joon-Won Kang;Young-Hak Kim;Dong Hyun Yang
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.660-669
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    • 2020
  • Objective: To evaluate the accuracy of a deep learning-based automated segmentation of the left ventricle (LV) myocardium using cardiac CT. Materials and Methods: To develop a fully automated algorithm, 100 subjects with coronary artery disease were randomly selected as a development set (50 training / 20 validation / 30 internal test). An experienced cardiac radiologist generated the manual segmentation of the development set. The trained model was evaluated using 1000 validation set generated by an experienced technician. Visual assessment was performed to compare the manual and automatic segmentations. In a quantitative analysis, sensitivity and specificity were calculated according to the number of pixels where two three-dimensional masks of the manual and deep learning segmentations overlapped. Similarity indices, such as the Dice similarity coefficient (DSC), were used to evaluate the margin of each segmented masks. Results: The sensitivity and specificity of automated segmentation for each segment (1-16 segments) were high (85.5-100.0%). The DSC was 88.3 ± 6.2%. Among randomly selected 100 cases, all manual segmentation and deep learning masks for visual analysis were classified as very accurate to mostly accurate and there were no inaccurate cases (manual vs. deep learning: very accurate, 31 vs. 53; accurate, 64 vs. 39; mostly accurate, 15 vs. 8). The number of very accurate cases for deep learning masks was greater than that for manually segmented masks. Conclusion: We present deep learning-based automatic segmentation of the LV myocardium and the results are comparable to manual segmentation data with high sensitivity, specificity, and high similarity scores.

Prevalence of posttraumatic stress disorder in orthopedic trauma patients and a call to implement the Injured Trauma Survivor Screen as a prospective screening protocol in the United States

  • Victoria J. Nedder;Mary A. Breslin;Vanessa P. Ho;Heather A. Vallier
    • Journal of Trauma and Injury
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    • v.37 no.1
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    • pp.67-73
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    • 2024
  • Purpose: Posttraumatic stress disorder (PTSD) is prevalent and is associated with protracted recovery and worse outcomes after injury. This study compared PTSD prevalence using the PTSD Checklist for DSM-5 (PCL-5) with the prevalence of PTSD risk using the Injured Trauma Survivor Screen (ITSS). Methods: Adult trauma patients at a level I trauma center were screened with the PCL-5 (sample 1) at follow-up visits or using the ITSS as inpatients (sample 2). Results: Sample 1 (n=285) had significantly fewer patients with gunshot wounds than sample 2 (n=45) (8.1% vs. 22.2%, P=0.003), nonsignificantly fewer patients with a fall from a height (17.2% vs. 28.9%, P=0.06), and similar numbers of patients with motor vehicle collision (40.7% vs. 37.8%, P=0.07). Screening was performed at a mean of 154 days following injury for sample 1 versus 7.1 days in sample 2. The mean age of the patients in sample 1 was 45.4 years, and the mean age of those in sample 2 was 46.1 years. The two samples had similar proportions of female patients (38.2% vs. 40.0%, P=0.80). The positive screening rate was 18.9% in sample 1 and 40.0% in sample 2 (P=0.001). For specific mechanisms, the positive rates were as follows: motor vehicle collisions, 17.2% in sample 1 and 17.6% in sample 2 (P>0.999); fall from height, 12.2% in sample 1 and 30.8% in sample 2 (P=0.20); and gunshot wounds, 39.1% in sample 1 and 80.0% in sample 2 (P=0.06). Conclusions: The ITSS was obtained earlier than PCL-5 and may identify PTSD in more orthopedic trauma patients. Differences in the frequency of PTSD may also be related to the screening tool itself, or underlying patient risk factors, such as mechanism of injury, or mental or social health.

Efficacy and safety of denosumab treatment for Korean patients with Stage 3b-4 chronic kidney disease and osteoporosis

  • Jin Taek Kim;You Mi Kim;Kyong Yeun Jung;Hoonsung Choi;So Young Lee;Hyo-Jeong Kim
    • The Korean journal of internal medicine
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    • v.39 no.1
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    • pp.148-159
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    • 2024
  • Background/Aims: We evaluated the efficacy and safety of denosumab treatment in severe chronic kidney disease (CKD) patients with osteoporosis. We also investigated whether the treatment affects the coronary artery calcifications. Methods: Twenty-seven postmenopausal women with Stage 3b-4 CKD and osteoporosis were enrolled. Twenty patients received denosumab plus calcium carbonate and vitamin D, and seven controls received calcium carbonate and vitamin D for 1 year. Dual-energy X-ray absorptiometry and coronary artery calcium (CAC) scoring computed tomography were performed before and after treatment. Hypocalcemic symptoms and serum calcium levels were evaluated. Results: After 1 year of treatment, the percent changes of femur neck (3.6 ± 3.2% vs. -0.7 ± 4.4%, p = 0.033) and total hip (3.4 ± 3.8% vs. -1.9 ± 2.1%, p = 0.001) bone mineral density (BMD) were significantly increased in the denosumab treated group compared to the control group. However, the percent change of lumbar spine BMD did not differ between two groups (5.6 ± 5.9% vs. 2.7 ± 3.9%, p = 0.273). The percent change of bone alkaline phosphatase was significantly different in the denosumab-treated group and control group (-31.1 ± 30.0% vs. 0.5 ± 32.0%, p = 0.027). CAC scores did not differ between groups. No hypocalcemic events occurred in both groups. Conclusions: If carefully monitored and supplemented with calcium and vitamin D, denosumab treatment for 1 year provides significant benefits in patients with Stage 3b-4 CKD and osteoporosis. However, denosumab treatment did not affect coronary artery calcifications in these patients.