Introduction: Although bleomycin/etoposide/cisplatinum (BEP) chemotherapy is established as the standard treatment for germ cell tumours, it requires significant experience in administration and toxicity management to maintain optimal dose intensity. A retrospective review of 30 patients was conducted at UKMMC to study treatment outcomes. Methods & Materials: Patients with GCTs and treated with at least two cycles of BEP chemotherapy between January 2003 and Oct 2009 were eligible for this study. Patients received 4-6 cycles of bleomycin 30,000IU IV D1, D8 & D15 and either etoposide $100mg/m^2$ IV D1-D5 and cisplatin $20mg/m^2$ IV D1-D5 (5 day BEP regimen) or etoposide $165mg/m^2$ D1-D3 and cisplatin $50mg/m^2$ D1-3 (3 day BEP regimen) every three weeks per cycle. All patients received prophylactic granulocyte colony-stimulating factor (GCSF) from days 6 to 10 of each cycle. The overall response rates, 2 year progression-free survival and overall survival of the whole cohort were assessed. Results: Thirty patients fulfilled the inclusion criteria. Non-seminomatous GCTs comprised 93.3% of cases and gonadal and mediastinal primary sites were the most common. Sixty percent were classified as IGCCCG poor risk disease. Median follow-up was 26.6 months. The overall response rate (CR+PR) was 70%. The two year PFS and OS were 70% and 66%. There was a significant difference in terms of the overall response rate (85% vs 40%, p = 0.03) and in PFS (94.7% vs 50%, p = 0.003) between gonadal and extragonadal primary sites. Conclusion: It is possible to achieve outcomes similar to those in international clinical trials with close monitoring and good supportive care of patients undergoing BEP chemotherapy. There is a strong argument for patients with IGCCCG poor prognosis disease to be treated in specialist tertiary centres to optimize treatment outcomes.
The Journal of the Convergence on Culture Technology
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v.8
no.1
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pp.1-8
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2022
This study examined whether the integrated education social studies textbooks developed for students with disabilities were properly implemented in terms of universal design for learning. For analysis, "Teaching and learning materials for inclusive education of students with disabilities: grade 3~6 social studies textbooks", which were instructional adaptation, were selected for students with disabilities who are unable to learn the contents of general textbooks for the 3rd to 6th grade of the elementary school social course in the 2015 revised curriculum. The social curriculum grades are composed of 20 units, including general public, geography and history. The content analysis standard was based on detailed items of 9 definitions according to the 3 principles of UDL presented in CAST (2018). Overall, the aspect of providing multiple means of action and expression was the most frequently observed, followed by providing multiple means of representation and providing multiple means of engagement. Special education teachers and textbook developers can use these results as a resource for designing curricula and lessons for students with disabilities in the inclusive classroom.
Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.
International Journal of Computer Science & Network Security
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v.22
no.8
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pp.15-24
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2022
The article clarifies the conditions for information, digital and educational accessibility for higher education seekers with disabilities in terms of distance learning caused by quarantine restrictions. It is established that such conditions are regulated by international and Ukrainian legal documents (The Standard Rules on the Equalization of Opportunities for Persons with Disabilities, Convention on the Rights of Persons with Disabilities, Sustainable Development Goals, Law of Ukraine "On Education", Law of Ukraine "On Higher Education", Strategy for the Development of Higher Education in Ukraine 2021-2031, Development Strategy areas of innovation for the period up to 2030, Development strategy of the sphere of innovation activity for the period up to 2030). As a part of information barrierlessness, Higher Education Institutions (HEI) should provide access to information in various formats and using technologies, in particular Braille script, large-type printing, audio description (audio descriptive commenting), sign language interpretation, subtitling, a format suitable for reading by screen access programs, formats of simple speech, easy-to-read formats, means of alternative communication. The experience of Pavlo Tychyna Uman State Pedagogical University is described. In particular, special attention is paid to the study of sign language: in view of this, the initiative group implemented the project "Learning to hear and overcome social isolation together" with the financial support of the British Council in Ukraine. Within the framework of digital accessibility, the official website of the Faculty of Social and Psychological Education has been adapted for the visually impaired in accordance with WCAG 2.0 World Standards. In 2021, Pavlo Tychyna Uman State Pedagogical University implemented the project "Cultural, Recreational and Tourist Cherkasy Region: Inclusive Social 3D Map" funded by the Ukrainian Cultural Foundation; a site with available content for online travel in the region to provide barrier-free access to the historical and cultural heritage of Cherkasy region was created. Educational accessibility is achieved by increasing the number of people with special educational needs, receiving education in inclusive groups; activities of the Center for Social and Educational Integration and Inclusive Rehabilitation Social Tourism "Bez barieriv" ("Without barriers"); implementation of a research topic for financing the Ministry of Education and Science of Ukraine: "Social and psychological rehabilitation of children and youth with special educational needs by means of inclusive tourism"; implementation of the project "Social inclusion of distance educational process"; development of information campaigns to popularize the ideas of accessibility, the need for its implementation, ongoing training programs and competitions, etc.
Background: As a common and essential contrast medium at present, gadobenate dimeglumine has shown better performance than some other agents when applied to Breast Magnetic Resonance Imaging Screening (Breast MRI Screening). Nevertheless, reports on the diagnostic performance of these two mediums (gadobenate dimeglumine and gadopentetate dimeglumine) are not completely consistent. Objective: To assess the diagnostic value of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening in patients suffering from breast cancer and to provide more convinced evidence to guide clinical practice in terms of appropriate contrast agents. Data Sources and Review Methods: Original articles in English and Chinese published before January 2013 were selected from available databases (The Cochrane Library, PUBMED, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Journal Full-text). The criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis. Then, the area under curve (AUC) of SROC and the spearman rank correlation of sensitivity against (1-specificity) were calculated. Results: Total of 17 researches involving 1934 patients were included. The pooled sensitivity of gadobenate dimeglumine and gadopentetate dimeglumine were 0.99 (0.97, 1.00) and 0.93 (0.88, 1.00) respectively. The pooled specificity for these two contrast agents were 0.924 (0.902, 0.943) and 0.838 (0.817, 0.858) respectively, and the AUC of SROC curve were 0.9781 and 0.9215 respectively. Conclusions: Gadobenate dimeglumine can be regarded as a more effective and feasible contrast medium for Breast MRI Screening. At least 5% differences in diagnostic performance are usually considered as clinically relevant.
Journal of The Korean Society of Integrative Medicine
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v.9
no.3
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pp.87-97
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2021
Purpose : The purpose of this meta-analysis was to evaluate the effects of transcranial direct current stimulation on the lower extremity function of stroke patients. Methods : Domestic data were gathered from studies that conducted clinical trials associated with transcranial direct current stimulation and its impact on lower extremity function of stroke patients. A total of 592 studies published between 2012 and 2020 were identified, with 7 studies satisfying the inclusion data. The studies consisted of patient, intervention, comparison, and outcome (PICO) data. The search outcomes were items associated with muscle activity, balance, muscle strength and walking ability. Cochrane risk of bias (ROB) was used to evaluate the quality of 3 randomized control trials. The quality of 4 non-randomized control trials was evaluated using risk of bias assessment tool for non-randomized studies (RoBANS). Effect sizes in this study were computed as the corrected standard mean difference (SMD). A random-effect model was used to analyze the effect size because of the high heterogeneity among the studies. Egger's regression and 'trim-and-fill' tests were carried out to analyze the publishing bias. Results : The following factors had a large total effect size (Hedges's g=2.10, 95 %CI=1.54~2.66) involving transcranial direct current stimulation on stroke patients: muscle activity (Hedges's g=2.38, 95 %CI=1.08~3.68), balance (Hedges's g4=2.41, 95 %CI=1.33~3.60), walking ability (Hedges's g=1.54, 95 %CI=0.49~2.59), and muscle strength (Hedges's g=2.45, 95 % CI: 0.85~4.05). Egger's regression test showed that the publishing bias had statistically significant differences but 'trim-and-fill' test showed that there was still statistical difference. Conclusion : This study provides evidence for the effectiveness of transcranial direct current stimulation on the lower extremity in terms of muscle activity, balance, walking ability, and muscle strength in stroke patients. However, due to the low quality of studies and high heterogeneity factors, the results of our study should be interpreted cautiously.
Objectives This study investigated the trends in domestic and international clinical research in craniosacral therapy, classified as a type of Chuna manual therapy, and suggested further directions in Korean medicine. Methods This scoping review was performed using the Arksey and O'Malley methodological framework and preferred reporting items as per the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist. Eight electronic databases (PubMed, EMBASE, Cochrane Library, Koreanstudies Information Service System [KISS], KMBASE, Oriental Medicine Advanced Searching Integrated System [OASIS], Research Information Sharing Service [RISS], ScienceON) were searched to identify articles with the search terms "craniosacral therapy" and "cranial osteopathy" until December 2021. Results Forty-five studies were eligible as per our inclusion criteria. Most research studies (n=44) were conducted in the field of medicine and pharmacy, especially in rehabilitation medicine (n=16). As a result of the study design, randomized controlled trials (n=20) were the most common, and chronic pain (n=9) was the most frequently targeted disease, followed by headache (n=7). Thirty-two studies suggested interventions and 20 studies used Upledger's 10-step protocol. The average duration of craniosacral therapy was 41 min per session, administered 1.4 times per week. Outcome measurements were analyzed and categorized with the examination procedure for the patient. Conclusions This is the first scoping review of craniosacral therapy in Korea, and we believe that our findings could support its utility as Chuna. In the future, more studies should be conducted to establish the evidence of clinical efficacy of craniosacral therapy and develop standard techniques in Korean medicine.
Music was made popular through the modern mass media. Nonetheless, if a period of high standard performances and appreciation by a minority of culture connoisseurs can be qualified with the expression "gentrification of culture", then a period when anyone can access culture through the mass media can be qualified with the terms "popularization of culture" and in this period the reorganization of performance culture can only be driven by the public. In fact, the Jabga, which is a type of traditional song that received strong public adhesion by means of phonograph records and radio broadcasts at the time, stands as a typical example to it. Gagok and Sijo up until the 1920s and even the 1930s are believed to engage actively in the changing media environment and the new modes of music enjoyment and transmission. The Album recording of faster rhythm music and the inclusion of the Sijo, Jabga, and folk songs in one broadcast programme can be seen as reflecting such an effort. However, it can only be hard for the Sijo and Gagok to challenge the predominance of the Jabga which made its lyrics more popular and the new songs written in accordance with the new media environment. Until the 1930s in this changing environment of music enjoyment, Gagok and Sijo performers rather sought to distinguish themselves from the existing popular song style by reproducing traditional forms. The album recording and broadcasting of Lee Wangjik Aakbu, the beginnings of local singers, the participation of male performers not only contributed to the diversification the enjoyment culture of songs and sijo, but also made the 'difference in standard' with the popular songs even more salient.
Inclusion body hepatitis-hydropericardium syndrome (IBH-HPS) is an acute viral disease usually found in broilers aged from 3 to 5 weeks and causes up to 75% mortality. Among the 12 serotypes of fowl adenovirus group 1, serotype-4 (FAdV-4) was identified as a primary agent of IBH-HPS and was usually isolated in IBH-HPS cases in Korea since 2007. To prevent these IBH-HPS outbreaks in Korea, we developed the FAdV-4 inactivated vaccine using Korean isolate (ADL070244) and evaluated the efficacy of this vaccine. For the efficacy test, 2-week-old specific-pathogen-free (SPF) chickens intramuscularly inoculated with 1 or 2 dose of inactivated vaccine were used and challenged with FAdV-4 through either intramuscular or oral route at 2 weeks after vaccination. The vaccine induced good seroconversion which was confirmed by agar gel precipitation (AGP) test. In addition, the vaccine could decrease the FAdV-4 detection rate and histological lesion severity such as lymphocyte infiltration and necrosis in the liver comparing with those of non-vaccination group. Based on the current results, the developed FAdV-4 inactivated vaccine in this study was effective in the terms of reduction of virus detection rate and histological lesions severity. However, it was difficult to confirm the efficacy of the vaccine clearly because of no mortality and clinical signs in the non-vaccinated group after challenge. Therefore, we need further study to develop a standard challenged model system which could clearly evaluate the efficacy of the vaccines for FAdV-4.
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