• Title/Summary/Keyword: Clinical progression

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The Use of MR Perfusion Imaging in the Evaluation of Tumor Progression in Gliomas

  • Snelling, Brian;Shah, Ashish H.;Buttrick, Simon;Benveniste, Ronald
    • Journal of Korean Neurosurgical Society
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    • v.60 no.1
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    • pp.15-20
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    • 2017
  • Objective : Diagnosing tumor progression and pseudoprogression remains challenging for many clinicians. Accurate recognition of these findings remains paramount given necessity of prompt treatment. However, no consensus has been reached on the optimal technique to discriminate tumor progression. We sought to investigate the role of magnetic resonance perfusion (MRP) to evaluate tumor progression in glioma patients. Methods : An institutional retrospective review of glioma patients undergoing MRP with concurrent clinical follow up visit was performed. MRP was evaluated in its ability to predict tumor progression, defined clinically or radiographically, at concurrent clinical visit and at follow up visit. The data was then analyzed based on glioma grade and subtype. Resusts : A total of 337 scans and associated clinical visits were reviewed from 64 patients. Sensitivity, specificity, positive and negative predictive value were reported for each tumor subtype and grade. The sensitivity and specificity for high-grade glioma were 60.8% and 87.8% respectively, compared to low-grade glioma which were 85.7% and 89.0% respectively. The value of MRP to assess future tumor progression within 90 days was 46.9% (sensitivity) and 85.0% (specificity). Conclusion : Based on our retrospective review, we concluded that adjunct imaging modalities such as MRP are necessary to help diagnose clinical disease progression. However, there is no clear role for stand-alone surveillance MRP imaging in glioma patients especially to predict future tumor progression. It is best used as an adjunctive measure in patients in whom progression is suspected either clinically or radiographically.

Dose Intensity of Oxaliplatin in 5-Fluorouracil and Leucovorin Regimens in Pretreated Metastatic Colorectal Cancer (5-Fluorouracil, Leucovorin과 병용 투여된 Oxaliplatin의 Dose Intensity가 재발된 전이성 대장암 치료에 미치는 영향)

  • Jeong, Kyong-Ju;Choi, Seung-Ki;Oh, Jung-Mi
    • Korean Journal of Clinical Pharmacy
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    • v.14 no.1
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    • pp.1-10
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    • 2004
  • Studies of oxaliplatin, 5-fluorouracil and leucovorin in pretreated metastatic colorectal cancer showed that oxaliplatin dose intensity is important prognostic factor for objective response rates and progression-free-survival (PFS). To evaluate response rates, PFS and toxicity according to oxaliplatin dose intensity, we retrospectively analyzed data from patients with metastatic colorectal cancer received oxaliplatin,5-fluorouracil, leucovorin regimens. Sixty-three patients were reviewed in this study, 42 patients received low dose intensity oxaliplatin (LDI: $\leq85\;mg/m^2/2wks$) and 21 patients high dose intensity oxaliplatin (HDI: $>85\;mg/m^2/2wks$). Objective responses occurred in 10 $(47.7\%)$ HDI patients and 9 $(21.4\%)$ LDI patients (p = 0.014). Median PFS was 24.7 weeks in HDI group, with $45.1\%$ of HDI patients progression free at 6 months, and 20.5 weeks in LDI group, with $33.5\%$ of LDI patients progression free at 6 months (p = 0.344). Increased oxaliplatin dose intensity was not associated with neutropenia, thrombocytopenia, neuropathy, nausea and vomiting. This study showed that oxaliplatin dose intensification significantly improves objective response rate in pretreated metastatic colorectal cancer without increasing severe toxicity.

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Effect of oral antioxidants on the progression of canine senile cataracts: a retrospective study

  • Park, Sanghyun;Kang, Seonmi;Yoo, Sukjong;Park, Youngwoo;Seo, Kangmoon
    • Journal of Veterinary Science
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    • v.23 no.3
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    • pp.43.1-43.14
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    • 2022
  • Background: Cataracts are the leading cause of impaired vision or blindness in dogs. There are many antioxidants that can prevent cataract progression, but whether they are clinically effective in dogs has not been established. Objectives: To analyze the delaying or preventing effect of oral antioxidants on canine senile cataracts through retrospective analysis. Methods: Medical records of dogs from January 1, 2015 to July 10, 2020 were reviewed. Dogs that were 8 yr of age or older with senile cataracts were included in this study. The dogs were divided into two treatment groups (dogs administered with Ocu-GLO supplement and dogs administered with Meni-One Eye R/C supplement) and a control group (dogs that were not administered any supplement). Dogs with incipient and immature cataracts were included in this study. Altogether, 112 dogs (156 eyes) with incipient cataracts and 60 dogs (77 eyes) with immature cataracts were included. The period of time that cataracts progressed from incipient to immature, and from immature to mature was recorded for each dog. Results: There was no significant delaying effect on the progression of incipient cataracts. However, both Ocu-GLO (hazard ratio = 0.265, p = 0.026) and Meni-One (hazard ratio = 0.246, p = 0.005) significantly delayed the progression of immature cataracts compared to the control group. Conclusions: Although there was no significant delaying effect of oral antioxidants on incipient cataract progression, antioxidants could be used to delay the progression of senile immature cataract.

Role of Cerebrospinal Fluid Biomarkers in Clinical Trials for Alzheimer's Disease Modifying Therapies

  • Kang, Ju-Hee;Ryoo, Na-Young;Shin, Dong Wun;Trojanowski, John Q.;Shaw, Leslie M.
    • The Korean Journal of Physiology and Pharmacology
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    • v.18 no.6
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    • pp.447-456
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    • 2014
  • Until now, a disease-modifying therapy (DMT) that has an ability to slow or arrest Alzheimer's disease (AD) progression has not been developed, and all clinical trials involving AD patients enrolled by clinical assessment alone also have not been successful. Given the growing consensus that the DMT is likely to require treatment initiation well before full-blown dementia emerges, the early detection of AD will provide opportunities to successfully identify new drugs that slow the course of AD pathology. Recent advances in early detection of AD and prediction of progression of the disease using various biomarkers, including cerebrospinal fluid (CSF) $A{\beta}_{1-42}$, total tau and p-tau181 levels, and imagining biomarkers, are now being actively integrated into the designs of AD clinical trials. In terms of therapeutic mechanisms, monitoring these markers may be helpful for go/no-go decision making as well as surrogate markers for disease severity or progression. Furthermore, CSF biomarkers can be used as a tool to enrich patients for clinical trials with prospect of increasing statistical power and reducing costs in drug development. However, the standardization of technical aspects of analysis of these biomarkers is an essential prerequisite to the clinical uses. To accomplish this, global efforts are underway to standardize CSF biomarker measurements and a quality control program supported by the Alzheimer's Association. The current review summarizes therapeutic targets of developing drugs in AD pathophysiology, and provides the most recent advances in the clinical utility of CSF biomarkers and the integration of CSF biomarkers in current clinical trials.

Impact of tumour associated macrophages in pancreatic cancer

  • Mielgo, Ainhoa;Schmid, Michael C.
    • BMB Reports
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    • v.46 no.3
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    • pp.131-138
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    • 2013
  • During cancer progression, bone marrow derived myeloid cells, including immature myeloid cells and macrophages, progressively accumulate at the primary tumour site where they contribute to the establishment of a tumour promoting microenvironment. A marked infiltration of macrophages into the stromal compartment and the generation of a desmoplastic stromal reaction is a particular characteristic of pancreatic ductal adenocarcinoma (PDA) and is thought to play a key role in disease progression and its response to therapy. Tumour associated macrophages (TAMs) foster PDA tumour progression by promoting angiogenesis, metastasis, and by suppressing an anti-tumourigenic immune response. Recent work also suggests that TAMs contribute to resistance to chemotherapy and to the emergence of cancer stem-like cells. Here we will review the current understanding of the biology and the pro-tumourigenic functions of TAMs in cancer and specifically in PDA, and highlight potential therapeutic strategies to target TAMs and to improve current therapies for pancreatic cancer.

Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study

  • Kim, Myoung Jun;Park, Jung Yun;Kim, Mi Kyoung;Lee, Jae Gil
    • Journal of Trauma and Injury
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    • v.32 no.1
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    • pp.17-25
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    • 2019
  • Purpose: We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma. Methods: We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers. Results: Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals "age" (p<0.001; OR, 1.068), "pre-hospital SI >0.9" (p<0.001; OR, 11.629), and "delta SI ${\geq}0.3$" (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression. Conclusions: SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Definitive Concurrent Chemoradiotherapy in Cervical Cancer - a University of Malaya Medical Centre Experience

  • Zamaniah, W.I. Wan;Mastura, M.Y.;Phua, C.E.;Adlinda, A.;Marniza, S.;Rozita, A.M.
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.20
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    • pp.8987-8992
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    • 2014
  • Background: The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre. Materials and Methods: A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin ($40mg/m^2$) concurrent with daily EBRT to pelvis of 45-50Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated. Results: The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients. Conclusions: The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.

Association of serum carotenoid, retinol, and tocopherol concentrations with the progression of Parkinson's Disease

  • Kim, Ji Hyun;Hwang, Jinah;Shim, Eugene;Chung, Eun-Jung;Jang, Sung Hee;Koh, Seong-Beom
    • Nutrition Research and Practice
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    • v.11 no.2
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    • pp.114-120
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    • 2017
  • BACKGROUND/OBJECTIVES: A pivotal role of oxidative stress has been emphasized in the pathogenesis as well as in the disease progression of Parkinson's disease (PD). We aimed at investigating serum levels of antioxidant vitamins and elucidating whether they could be associated with the pathogenesis and progression of PD. MATERIALS/METHODS: Serum levels of retinol, ${\alpha}$- and ${\gamma}$-tocopherols, ${\alpha}$- and ${\beta}$-carotenes, lutein, lycopene, zeaxanthin and ${\beta}$-cryptoxanthin were measured and compared between 104 patients with idiopathic PD and 52 healthy controls matched for age and gender. In order to examine the relationship between antioxidant vitamins and the disease progression, multiple group comparisons were performed among the early PD (Hoehn and Yahr stage I and II, N = 47), advanced PD (stage III and IV, N = 57) and control groups. Separate correlation analyses were performed between the measured antioxidant vitamins and clinical variables, such as Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale (UPDRS) motor score. RESULTS: Compared to controls, PD patients had lower levels of ${\alpha}$- and ${\beta}$-carotenes and lycopene. ${\alpha}$-carotene, ${\beta}$-carotene and lycopene levels were significantly reduced in advanced PD patients relative to early PD patients and were negatively correlated with Hoehn and Yahr stage and UPDRS motor score in PD patients. No significant differences were found in serum levels of retinol, ${\alpha}$- and ${\gamma}$-tocopherols, and other carotenoids between PD patients and controls. No significant correlations were found between these vitamin levels and clinical variables in PD patients. CONCLUSTIONS: We found that serum levels of some carotenoids, ${\alpha}$-carotene, ${\beta}$-carotene and lycopene, were lower in PD patients, and that these carotenoids inversely correlated with clinical variables representing disease progression. Our findings suggest that decreases in serum ${\alpha}$-carotene, ${\beta}$-carotene and lycopene may be associated with the pathogenesis as well as progression of PD.

C-Reactive Protein a Promising Biomarker of COVID-19 Severity

  • Fazal, Muntaha
    • Korean Journal of Clinical Laboratory Science
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    • v.53 no.3
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    • pp.201-207
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    • 2021
  • The 2019 coronavirus outbreak poses a threat to scientific, societal, financial, and health resources. The complex pathogenesis of severe acute respiratory syndrome coronavirus centers on the unpredictable clinical progression of the disease, which may evolve abruptly and result in critical and life-threatening clinical complications. Effective clinical laboratory biomarkers that can classify patients according to risk are essential for ensuring timely treatment, and an analysis of recently published studies found cytokine storm and coagulation disorders were leading factors of severe COVID-19 complications. The following inflammatory, biochemical, and hematology biomarkers markers have been identified in COVID-19 patients; neutrophil to lymphocyte ratio, c-reactive protein, procalcitonin, urea, liver enzymes, lactate dehydrogenase, serum amyloid A, cytokines, d-dimer, fibrinogen, ferritin, troponin, creatinine kinase, and lymphocyte, leukocyte, and platelet counts. These factors are predictors of disease severity and some are involved in the pathogenesis of COVID-19. CRP is an acute-phase, non-specific serological biomarker of inflammation and infection and is related to disease severities and outcomes. In the present study, CRP levels were found to rise dramatically among COVID-19 patients, and our findings suggest CRP could be utilized clinically to predict COVID-19 prognosis and severity even before disease progression and the manifestation of clinical symptoms.

A study of clinical meaning and characteristic of Eight extra meridians(奇經八脈) (기경팔맥(奇經八脈)의 특징과 임상적 의의 연구)

  • Sohn, In-Chul
    • Korean Journal of Acupuncture
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    • v.25 no.1
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    • pp.39-50
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    • 2008
  • Objectives : The purpose of this study was to inquire clinical meaning and characteristic of Eight extra meridians(奇經八脈) by researching building and progression of Eight extra meridians theory. Results : As a result of research of building and progression of Eight extra meridians(奇經八脈) theory, we can regard that the origin of Eight extra meridians was based on lower Danjeon(丹田) which was the root of Primordial energy and the origin of the Twelve meridians and collaterals(十二經脈) was based on Middle energizer which was the root of Acquired energy. On this, we could know that Eight extra meridians and the Twelve meridians and collaterals are based on Primordial energy and Acquired energy and function of Eight extra meridians and the Twelve meridians and collaterals are complement each other. So, we can say that considering the Twelve meridians and collaterals means that is valued on Acquired energy clinically, and considering Eight extra meridians means that is valued on Primordial energy in health preserving method (養生).

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