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Eight Year Survival Analysis of Patients with Triple Negative Breast Cancer in India

  • Doval, Dinesh Chandra;Suresh, P;Sinha, Rupal;Azam, Saud;Batra, Ullas;Talwar, Vineet;Kumar, Kapil;Mehta, Anurag
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.6
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    • pp.2995-2999
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    • 2016
  • Background: Triple-negative breast cancer (TNBC) often presents as an interval cancer with short survival upon metastasis and thus represents an important clinical challenge. The present study investigated the clinicopathologic characteristics and long term survival outcome of early and locally advanced TNBC. Materials and Methods: Medical records were reviewed retrospectively for 148 consecutive confirmed cases of TNBC treated in a single unit at our centre. Demographic profile, tumor type, histopathology details, treatment and follow-up information was recorded and immunohistochemistry was performed. Results: Age group >50 years was associated with tumors of clinical stage 3 (53.8%), pathological stage 3 (46.2%), pathological grade 3 (45.7%), presence of extracapsular extension (ECE, 48.5%) and lymphovascular invasion (LVI, 64.9%). Locally advanced breast cancers (LABCs) were characterized by pathological stage 3 (96.2%), presence of ECE (100%) and absence of LVI (46.7%) as compared to early breast cancers (EBCs) which had higher incidence of lower stage tumors (100%), absence of ECE (82%) and presence of LVI (91.9%; p-value <0.001. Better relapse free survival was observed in patients with no axillary involvement (69%; p-value <0.001) and absence of ECE (64%; p-value <0.001). Improved overall survival was seen in patients with EBC (90%; p-value 0.008), clear axilla (86%; p-value <0.001), absence of ECE (87%; p-value <0.001) and negative lymph nodes (90%; p-value 0.006). Conclusions: TNBCs are aggressive tumors which show poor long term survival. Patients with TNBC benefit from chemotherapy, thus better and less toxic treatment options are needed. Identification of newer targets and development of targeted therapies are the need of the hour.

A Study on the Problems and Improvements of the Management System for Foreign Seafarers Boarding Korean Ocean-Going Vessels (우리나라 외항상선에 승선하는 외국인 선원 관리제도의 문제점 및 개선방안에 관한 연구)

  • Kim, Kun-Jin;Shin, Sang-hoon;Shin, Yong-John
    • Journal of Navigation and Port Research
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    • v.43 no.6
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    • pp.384-394
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    • 2019
  • This study investigated the current status of the management system for foreign seafarers boarding Korean ocean-going vessels and analyzed the problems and suggested measures for improvement through the survey of shipping companies, ship management companies, crew manning companies and related associations. The conclusion is summarized as follow. First, it is necessary to reorganize and apply the collective agreements or the laws applicable to the foreign seafarer separately in regard to the foreign seafarer related laws and collective agreements applied in the same way as the Korean seafarer. Second, it is necessary to change the decision-making to shipowner in deciding on the number of foreign seafarers employed by the Korean ocean-going vessels or if the decision-maker remains the same, the relevant laws must be clearly defined pertinent to the decision-maker. Additionally, the number of foreign seafarers should be applied for each position and ship's type. The third is to expand the recognition arrangement for certificate of ships' officers to Eastern Europe and Asian countries to expand the range of options for hiring foreign seafarers. The fourth is to prevent the waste of administrative manpower by simplifying complicated and unnecessary administrative procedures from hiring and boarding of foreign seafarers. The fifth is to establish a systematic training and education system for foreign seafarers in cooperation with related shipping companies and government authorities, associations and so on. This study will contribute to providing a more efficient and systematic management of foreign seafarers boarding Korean ocean-going vessels.

The nature of UN support of the Korea War (유엔의 6.25전쟁 지원과 성격 -신정공세 전후 유엔의 휴전교섭 노력을 중심으로-)

  • Yang, Yong-Jo
    • Journal of National Security and Military Science
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    • s.8
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    • pp.1-48
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    • 2010
  • The purpose of this study is to examine and analyze the Untied Nations' efforts for peace on Korean peninsular after CCF's participation in Korean War. The Untied Nation tried to negotiate th peace plan between two sides from the end of 1950. Once the CCF's entry into the war had been confirmed, the war situation moved to a new phase, and the UN forces, which had guided the war in an effort to destroy the NKP A forces, and to punish North Korea, had to set up new guidelines to cope with the new situation. Accordingly, in late November, 1950, the UN forces camp, mainly the US Joint Chiefs of Staff and the United Nations Command, discussed various options, such as an expansion of the war up to the Chinese territory, a cease fire along the 38th Parallel, or a forced and inevitable evacuation. The Korean delegation to the UN insisted that "the unification of Korea should be achieved only by victory in the war. The Chinese intervention in the war is a Challenge to the UN in the same way as the North Korean invasion. The UN participation in the war was to repulse the invasion. With the same spirit we should drive back the Chinese Communists." The Korean delegation also emphasized to the friendly nations the political objective and will of unification, and that a cease fire at a threshold of unification might return us to the status quo ante bellum, and would be contrary to the Korean nation's desire. At that time, particularly, the US strongly considered the employment of nuclear weapons as one of the new strategies to cope with the Chinese invasion. The international effects of these casual remarks were realized almost at once. The British Prime Minister who had not wanted the expansion of war in the Far East, especially from the view point of the interest of NATO's security, visited Washington. so the conference had a very important meaning for the UN forces' new strategy. On the other hand, at the UN, on the 5th of December, the very day Truman and Attlee agreed to seek a cease-fire under UN auspices, a group of thirteen Asian and Arab states proposed to ask China and North Korea not to cross the 38th Parallel, and sounded out both sides about a cease fire along the 38th Parallel. The United States and the United Kingdom gave their assent, but China and North Korea gave no direct response. The CCF, who were securing the initiative of operation, were not agreeable with the proposal of the UN forces. The Untied Nation has tried to negotiate th peace plan between two sides from the December of 1950 and January of 1951. The Untied Nations' has achieved great results to negotiate for the peace plan on Korean peninsular after CCF's participation in Korean War. It's the results considering both the operation situation and political opinions.

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Transareolar-Perinipple Dual Pockets Breast Augmentation (횡유륜 유두주위절개를 통한 이중포켓 유방확대술)

  • Lee, Paik Kwon;Kim, Jee Hoon;Seo, Byung Chul;Oh, Deuk Young;Rhie, Jong Won;Ahn, Snag Tae
    • Archives of Plastic Surgery
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    • v.34 no.1
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    • pp.93-98
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    • 2007
  • Purpose: Many options are available for the incision and pocket selection in breast augmentation. Each method has its advantages and disadvantages. To leave an invisible operation scar and to achieve easier pocket dissection by the central location of the incision on the breast, we made a transareolar-perinipple incision. To overcome the disadvantages of the transareolar incision, originally advocated by Pitanguy in 1973, we modified the direction of incision line and dissection plane. Methods: To avoid the injury of 4th intercostal nerve responsible for nipple sensation, we made perinipple incision on the medial side of the nipple instead of trans-nipple incision and made the transareolar incision as 11-5 o'clock on the left side and 1-7 o'clock on the right side instead of 3-9 o'clock on both sides. To avoid the possible infection and breast feeding problem caused by the injury to the lactiferous duct, and the possible implant hernia caused by the incisions lying on a same plane of pocket dissection, we made a subcutaneous dissection just above the breast tissue medially down to the bottom of breast tissue and made a subglandular or subfascial pocket, which may avoid the injury of lactiferous duct and create different planes for skin incision and pocket dissection. Other advantages of the transareolar-perinipple incision include easier pocket dissection, less chance of hematoma, and as a result less postoperative pain because of the central location of the approach which allow finger dissection and meticulous bleeding control with direct vision, without any specialized instrument such as an endoscope or long mammary dissectors. As for pocket selection, we made dual pockets. We prefer subglandular or subfascial pocket. Also, we made a subpectoral pocket in the upper 1/4 of the pocket to add more volume on the upper part of the augmented breast, which can make aesthetically more desirable breasts in thin Asian women with small breasts. Possible disadvantages of our method are subclinical infection and scar widening, which could be overcome by meticulous operation techniques, antibiotic therapy, and intradermal tattooing. Results: From September, 2003 to August, 2005, 12 patients underwent breast augmentation using round smooth surface saline implants by our method. During the mean follow-up period of 13 months, there were no complications such as infection, hematoma, capsular contracture, and sensory change of nipple, and results were satisfactory. Conclusion: We suggest breast augmentation via transareolar-perinipple incision and dual pockets(subpectoral-subglandular or subfascial) as a valuable method in thin oriental women with small breasts.

Trends and Costs of External Electrical Bone Stimulators and Grafting Materials in Anterior Lumbar Interbody Fusion

  • D'Oro, Anthony;Buser, Zorica;Brodke, Darrel Scott;Park, Jong-Beom;Yoon, Sangwook Tim;Youssef, Jim Aimen;Meisel, Hans-Joerg;Radcliff, Kristen Emmanuel;Hsieh, Patrick;Wang, Jeffrey Chun
    • Asian Spine Journal
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    • v.12 no.6
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    • pp.973-980
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    • 2018
  • Study Design: Retrospective review. Purpose: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery. Overview of Literature: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion. Methods: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were performed using logistic regression analysis, chi-square test, and odds ratio (OR) analysis. Results: Approximately 19% of the patients (495/2,613) received external stimulators following ALIF surgery. There was a slight increase in stimulator use from 2008 to 2014 (multi-level $R^2=0.08$, single-level $R^2=0.05$). Patients who underwent multi-level procedures were more likely to receive stimulators than patients who underwent single-level procedures (p<0.05; OR, 3.72; 95% confidence interval, 3.02-4.57). Grafting options associated with most frequent stimulator use were bone marrow aspirates (BMA) plus autograft or allograft for single-level and allograft alone for multi-level procedures. In both cohorts, patients treated with bone morphogenetic proteins were least likely to receive electrical stimulators (p<0.05). Patients who received stimulation generally had higher reimbursements. Concurrent posterior lumbar fusion (PLF) (ALIF+PLF) increased the likelihood of receiving stimulators (p<0.05). Patients who received electrical stimulators had similar revision rates as those who did not receive stimulation (p>0.05), except those in the multilevel ALIF+PLF cohort, wherein the patients who underwent stimulation had higher rates of revision surgery. Conclusions: Concurrent PLF or multi-level procedures increased patients' likelihood of receiving stimulators, however, the presence of comorbidities did not. Patients who received BMA plus autograft or allograft were more likely to receive stimulation. Patients with and without bone stimulators had similar rates of revision surgery.

Acanthamoeba in Southeast Asia - Overview and Challenges

  • Bunsuwansakul, Chooseel;Mahboob, Tooba;Hounkong, Kruawan;Laohaprapanon, Sawanya;Chitapornpan, Sukhuma;Jawjit, Siriuma;Yasiri, Atipat;Barusrux, Sahapat;Bunluepuech, Kingkan;Sawangjaroen, Nongyao;Salibay, Cristina C.;Kaewjai, Chalermpon;Pereira, Maria de Lourdes;Nissapatorn, Veeranoot
    • Parasites, Hosts and Diseases
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    • v.57 no.4
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    • pp.341-357
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    • 2019
  • Acanthamoeba, one of free-living amoebae (FLA), remains a high risk of direct contact with this protozoan parasite which is ubiquitous in nature and man-made environment. This pathogenic FLA can cause sight-threatening amoebic keratitis (AK) and fatal granulomatous amoebic encephalitis (GAE) though these cases may not commonly be reported in our clinical settings. Acanthamoeba has been detected from different environmental sources namely; soil, water, hotspring, swimming pool, air-conditioner, or contact lens storage cases. The identification of Acanthamoeba is based on morphological appearance and molecular techniques using PCR and DNA sequencing for clinico-epidemiological purposes. Recent treatments have long been ineffective against Acanthamoeba cyst, novel anti-Acanthamoeba agents have therefore been extensively investigated. There are efforts to utilize synthetic chemicals, lead compounds from medicinal plant extracts, and animal products to combat Acanthamoeba infection. Applied nanotechnology, an advanced technology, has shown to enhance the anti-Acanthamoeba activity in the encapsulated nanoparticles leading to new therapeutic options. This review attempts to provide an overview of the available data and studies on the occurrence of pathogenic Acanthamoeba among the Association of Southeast Asian Nations (ASEAN) members with the aim of identifying some potential contributing factors such as distribution, demographic profile of the patients, possible source of the parasite, mode of transmission and treatment. Further, this review attempts to provide future direction for prevention and control of the Acanthamoeba infection.

Efficiency and Side Effects of Sorafenib Therapy for Advanced Hepatocellular Carcinoma: A Retrospective Study by the Anatolian Society of Medical Oncology

  • Berk, Veli;Kaplan, Mehmet Ali;Tonyali, Onder;Buyukberber, Suleyman;Balakan, Ozan;Ozkan, Metin;Demirci, Umut;Ozturk, Turkan;Bilici, Ahmet;Tastekin, Didem;Ozdemir, Nuriye;Unal, Olcun Umit;Oflazoglu, Utku;Turkmen, Esma;Erdogan, Bulent;Uyeturk, Ummugul;Oksuzoglu, Berna;Cinkir, Havva Yesil;Yasar, Nurgul;Gumus, Mahmut
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7367-7369
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    • 2013
  • Background: Inoperable and metastatic hepatocellular carcinoma (HCC) is associated with a poor prognosis and low chemotherapeutic efficiency. Sorafenib is an oral multi-kinase inhibitor exerting its effects via the RAF/MEK/ERK pathway, vascular endothelial growth factor receptor (VEGFR) and platelet derived growth factor receptor beta (PDGFR-${\beta}$) tyrosine kinases. Randomized studies have shown a significant contribution of sorafenib to life expectancy and quality of life of cancer patients. The aim of the present study is to evaluate the efficacy and side effects of sorafenib therapy in Turkey. Materials and Methods: Data for 103 patients (82 males, 21 females) receiving sorafenib therapy in 13 centers from February 2008 to December 2012 were evaluated. Median age was 61 years and median ECOG performance status was 1 (range: 0-2). 60 patients (58%) had hepatitis B, 15 patients (15%) had hepatitis C infection and 12 patients (12%) had a history of alcohol consumption. All of the patients had Child scores meeting the utilization permit of the drug in our country (Child A). Results: A total of 571 cycles of sorafenib therapy were administered with a median of four per patient. Among the evaluable cases, there was partial response in 15 (15%), stable disease in 52 (50%), and progressive disease in 36 (35%). Median progression-free survival was 18 weeks and median overall survival was 48 weeks. The dose was reduced only in 6 patients and discontinued in 2 patients due to grade 3-4 toxicity, 18 patients (17%) suffering hand-foot syndrome, 7 (7%) diarrhea, and 2 (2%) vomiting. Conclusions: This retrospective study demonstrated better efficacy of sorafenib therapy in patients with advanced HCC compared to the literature while progression-free survival and overall survival findings were comparable. The side effect rates indicate that the drug was tolerated well. In conclusion, among the available treatment options, sorafenib is an efficient and tolerable agent in patients with inoperable or metastatic HCC.