• Title/Summary/Keyword: Patterns of failure

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High Prevalence of Helicobacter pylori Resistance to Clarithromycin: a Hospital-Based Cross-Sectional Study in Nakhon Ratchasima Province, Northeast of Thailand

  • Tongtawee, Taweesak;Dechsukhum, Chavaboon;Matrakool, Likit;Panpimanmas, Sukij;Loyd, Ryan A;Kaewpitoon, Soraya J;Kaewpitoon, Natthawut
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.18
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    • pp.8281-8285
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    • 2016
  • Background: Helicobacter pylori is a cause of chronic gastritis, peptic ulcer disease, and gastric malignancy, infection being a serious health problem in Thailand. Recently, clarithromycin resistant H. pylori strains represent the main cause of treatment failure. Therefore this study aimed to determine the prevalence and pattern of H. pylori resistance to clarithromycin in Suranaree University of Technology Hospital, Suranree University of Technology, Nakhon Ratchasima, Northeastern Thailand, Nakhon Ratchasima province, northeast of Thailand. Materials and Methods: This hospital-based cross-sectional study was carried out between June 2014 and February 2015 with 300 infected patients interviewed and from whom gastric mucosa specimens were collected and proven positive by histology. The gastric mucosa specimens were tested for H. pylori and clarithromycin resistance by 23S ribosomal RNA point mutations analysis using real-time polymerase chain reactions. Correlation of eradication rates with patterns of mutation were analyzed by chi-square test. Results: Of 300 infected patients, the majority were aged between 47-61 years (31.6%), female (52.3%), with monthly income between 10,000-15,000 Baht (57%), and had a history of alcohol drinking (59.3%). Patient symptoms were abdominal pain (48.6%), followed by iron deficiency anemia (35.3%). Papaya salad consumption (40.3%) was a possible risk factor for H. pylori infection. The prevalence of H. pylori strains resistant to clarithromycin was 76.2%. Among clarithromycin-resistant strains tested, all were due to the A2144G point mutation in the 23S rRNA gene. Among mutations group, wild type genotype, mutant strain mixed wild type and mutant genotype were 23.8%, 35.7% and 40.5% respectively. With the clarithromycin-based triple therapy regimen, the efficacy decreased by 70% for H. pylori eradication (P<0.01). Conclusions: Recent results indicate a high rate of H. pylori resistance to clarithromycin. Mixed of wild type and mutant genotype is the most common mutant genotype in Nakhon Ratchasima province, therefore the use of clarithromycin-based triple therapy an not advisable as an empiric first-line regimen for H. pylori eradication in northeast region of Thailand.

The Overexpression of p53 in Head and Neck Squamous Cell Carcinoma as Prognostic Marker (두경부 편평 세포암에서 예후인자로서의 p53 발현)

  • Jeong Seung-Won;Lee Hyung-Seok;Park Chul-Won;Park Yong-Wook;Park Chan-Keum;Jang Se-Jin;Tae Kyung
    • Korean Journal of Head & Neck Oncology
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    • v.17 no.2
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    • pp.169-173
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    • 2001
  • Objectives: The p53 tumor suppressor gene encodes a nuclear transcription factor that is critical regulator of cell growth and proliferation through its action in cell-cycle checkpoint control. The wide variety of stressful stmuli which include DNA damage, hypoxia, heat shock, metabolic changes activate the p53 protein, which in turn drives a series of events that culminate either in cell cycle arrest or apoptosis. Mutations of the p53 gene is the most common genetic alteration in human cancer. This gene is altered in approximately 40-60% of head and neck cancers. Whereas the wild-type form of the p53 protein plays a central role in cell-cycle control in response to DNA damage, most of the mutant forms are unable to do so. The high levels of p53 protein expression in tissues are related to the increased cellular proliferative activity and may be associated with the poor clinical outcome. To determine whether the expression of the p53 protein has prognostic significance and is associated with patterns of treatment failure in head and neck squamous cell carcinoma (HNSCC), We analyzed p53 overexpression in 40 cases of HNSCC. Materials and Methods: Immunohistochemical analysis with a monoclonal antibody (DO7) specific for p53 protein was used to detect expression of the protein in formalin-fixed, paraffin-embedded tumor samples from 40 HNSCC. We evaluated p53 protein expression and analyzed the relationship between the p53 overexpression and age, sex, primary tumor site, stage, survival rate, recurrence. All reported P values resulted from two-sided statistical tests. Results: Overexpression of p53 was detected in 20 cases(50%) among 40 cases of HNSCC. The p53 overexpression was not associated with age, sex, primary tumor site, stage, recurrence and survival rate. Conclusions: In our results, p53 was not significant prognostic factor in HNSCC. Based on many previous studies, It is evident that p53 has a certain role in tumorigenesis of HNSCC. So, the further study is needed to evaluate the prognostic significance of p53 in HNSCC.

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Evaluation of Cardiac Function by Transthoracic Echocardiography in Patients with Myocardial Injury Secondary to Organophosphate Poisoning (유기인계 중독에 의한 심근손상 환자에서의 경흉부 심장 초음파검사를 사용한 심장기능평가)

  • Lee, Yoonsuk;Kim, Oh Hyun;Kim, Hyung Il;Cha, Kyoung Chul;Kim, Hyun;Lee, Kang Hyun;Hwang, Sung Oh;Cha, Yong Sung
    • Journal of The Korean Society of Clinical Toxicology
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    • v.13 no.2
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    • pp.62-70
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    • 2015
  • Purpose: Cardiac complications may occur in cases of organophosphate (OP) poisoning. However, a few studies regarding patterns of cardiac toxicity as determined by transthoracic echocardiography (TTE) after exposure to OP have been reported. In the current study, the authors examined cardiac functions using TTE in patients with myocardial injury caused by exposure to OP. Methods: A retrospective review was conducted on 16 consecutive cases of OP poisoning with myocardial injury (defined as elevated troponin I within 48 hours of arrival at the regional emergency center in South Korea and diagnosed and treated at the center from January 2012 to November 2014. Results: TTE was performed in 11 (69%) of the 16 patients with an elevated troponin I (TnI) level within 48 hours. Of these 11 patients, 5 patients (45.5%) exhibited reduced ejection fraction (EF), and 3 exhibited regional wall motion abnormality (RWMA). Two patients (18.2%) had both reduced systolic function and RWMA. Two of the 5 patients with reduced EF returned to normal systolic function, however two patients did not regain normal systolic function after admission. One patient expired due to multiple organ failure, and 4 patients were transferred with a moribund status. Twelve of 15 patients who survived to discharge (at 4 to 35 months) were followed. Five of these patients died during follow-up and 7 survived without further complications. Conclusion: OP can cause reversible cardiac dysfunction including reduced systolic function and RWMA. Serum TnI may be useful for initial assessment of cardiac function during the workup of patients suffering from OP poisoning. After the initial assessment of cardiac enzyme, further evaluation with TTE in patients with abnormal cardiac enzyme will be necessary to understand the cardiac toxicity.

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Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

  • Seo, Dong Kwang;Kim, Chung Hwan;Jung, Sang Ku;Kim, Moon Kyu;Choi, Soo Jung;Park, Jin Hoon
    • Journal of Korean Neurosurgical Society
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    • v.62 no.1
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    • pp.96-105
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    • 2019
  • Objective : The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery. Methods : This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes. Results : We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively). Conclusion : Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.

Investigation of the tensile behavior of joint filling under experimental test and numerical simulation

  • Fu, Jinwei;Haeri, Hadi;Sarfarazi, Vahab;Marji, Mohammad Fatehi;Guo, Mengdi
    • Structural Engineering and Mechanics
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    • v.81 no.2
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    • pp.243-258
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    • 2022
  • In this paper, tensile behavior of joint filling has been investigated under experimental test and numerical simulation (particle flow code). Two concrete slabs containing semi cylinder hole were prepared. These slabs were attached to each other by glue and one cubic specimen with dimension of 19 cm×15 cm×6 cm was prepared. This sample placed in the universal testing machine where the direct tensile stress can be applied to this specimen by implementing a special type of load transferring device which converts the applied compressive load to that of the tensile during the test. In the present work, two different joint filling thickness i.e., 3 mm and 6 mm were prepared and tested in the laboratory to measure their direct tensile strengths. Concurrent with experimental test, numerical simulation was performed to investigate the effect of hole diameter, length of edge notch, filling thickness and filling length on the tensile behavior of joint filling. Model dimension was 19 cm×15 cm. hole diameter was change in four different values of 2.5 cm, 5 cm, 7.5 cm and 10 cm. glue lengths were different based on the hole diameter, i.e., 12.5 cm for hole diameter of 2.5 cm, 10 cm for hole diameter of 5 cm, 7.5 cm for hole diameter of 7.5 cm and 5 cm for hole diameter of 10 cm. length of edge notch were changed in three different value i.e., 10%, 30% and 50% of glue length. Filling thickness were changed in three different value of 3 mm, 6 mm and 9 mm. Tensile strengths of glue and concrete were 2.37 MPa and 6.4 MPa, respectively. The load was applied at a constant rate of 1 kg/s. Results shows that hole diameter, length of edge notch, filling thickness and filling length have important effect on the tensile behavior of joint filling. In fixed glue thinks and fixed joint length, the tensile strength was decreased by increasing the hole diameter. Comparing the results showed that the strength, failure mechanism and fracture patterns obtained numerically and experimentally were similar for both cases.

Investigating the effects of non-persistent cracks' parameters on the rock fragmentation mechanism underneath the U shape cutters using experimental tests and numerical simulations with PFC2D

  • Fu, Jinwei;Haeri, Hadi;Sarfarazi, Vahab;Abad, Sh. Mohamadi Bolban;Marji, Mohammad Fatehi;Saeedi, Gholamreza;Yu, Yibing
    • Structural Engineering and Mechanics
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    • v.83 no.4
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    • pp.495-513
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    • 2022
  • This paper aims to study the fracture mechanism of rocks under the 'u'shape cutters considering the effects of crack (pre-existing crack) distances, crack spacing and crack inclination angles. The effects of loading rates on the rock fragmentation underneath these cutters have been also studied. For this purpose, nine experimental samples with dimensions of 5 cm×10 cm×10 cm consisting of the non-persistent cracks were prepared. The first three specimens' sets had one non-persistent crack (pre-existing crack) with a length of 2 cm and angularity of 0°, 45°, and 90°. The spacing between the crack and the "u" shape cutter was 2 cm. The second three specimens" set had one non-persistent crack with a length of 2 cm and angularity of 0°, 45°, and 90° but the spacing between pre-existing crack and the "u" shape cutter was 4 cm. The third three specimens'set has two non-persistent cracks with lengths of 2 cm and angularity of 0°, 45° and 90°. The spacing between the upper crack and the "u" shape cutter was 2 cm and the spacing between the lower crack and the upper crack was 2 cm. The samples were tested under a loading rate of 0.005 mm/s. concurrent with the experimental investigation. The numerical simulations were performed on the modeled samples with non-persistent cracks using PFC2D. These models were tested under three different loading rates of 0.005 mm/s, 0.01 mm/sec and 0.02 mm/sec. These results show that the crack number, crack spacing, crack angularity, and loading rate has important effects on the crack growth mechanism in the rocks underneath the "u" shape cutters. In addition, the failure modes and the fracture patterns in the experimental tests and numerical simulations are similar to one another showing the validity and accuracy of the current study.

LINE-1 and Alu Methylation Patterns in Lymph Node Metastases of Head and Neck Cancers

  • Kitkumthorn, Nakarin;Keelawat, Somboon;Rattanatanyong, Prakasit;Mutirangura, Apiwat
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.9
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    • pp.4469-4475
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    • 2012
  • Background: The potential use of hypomethylation of Long INterspersed Element 1 (LINE-1) and Alu elements (Alu) as a biomarker has been comprehensively assessed in several cancers, including head and neck squamous cell carcinoma (HNSCC). Failure to detect occult metastatic head and neck tumors on radical neck lymph node dissection can affect the therapeutic measures taken. Objective: The aim of this study was to investigate the LINE-1 and Alu methylation status and determine whether it can be applied for detection of occult metastatic tumors in HNSCC cases. Methods: We used the Combine Bisulfite Restriction Analysis (COBRA) technique to analyse LINE-1 and Alu methylation status. In addition to the methylation level, LINE-1 and Alu loci were classified based on the methylation statuses of two CpG dinucleotides in each allele as follows: hypermethylation ($^mC^mC$), hypomethylation ($^uC^uC$), and 2 forms of partial methylation ($^mC^uC$ and $^uC^mC$). Sixty-one lymph nodes were divided into 3 groups: 1) non-metastatic head and neck cancer (NM), 2) histologically negative for tumor cells of cases with metastatic head and neck cancer (LN), and 3) histologically positive for tumor cells (LP). Results: Alu methylation change was not significant. However, LINE-1 methylation of both LN and LP was altered, as demonstrated by the lower LINE-1 methylation levels (p<0.001), higher percentage of $^mC^uC$ (p<0.01), lower percentage of $^uC^mC$ (p<0.001) and higher percentage of $^uC^uC$ (p<0.001). Using receiver operating characteristic (ROC) curve analysis, $%^uC^mC$ and $%^mC^uC$ values revealed a high level of AUC at 0.806 and 0.716, respectively, in distinguishing LN from NM. Conclusion: The LINE-1 methylation changes in LN have the same pattern as that in LP. This epigenomic change may be due to the presence of occult metastatic tumor in LN cases.

Effect of early chemoradiotherapy in patients with limited stage small cell lung cancer

  • Ha, In-Bong;Jeong, Bae-Kwon;Jeong, Hojin;Choi, Hoon-Sik;Chai, Gyu-Young;Kang, Myoung-Hee;Kim, Hoon Gu;Lee, Gyeong-Won;Na, Jae-Beom;Kang, Ki-Mun
    • Radiation Oncology Journal
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    • v.31 no.4
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    • pp.185-190
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    • 2013
  • Purpose: We evaluated the effect of early chemoradiotherapy on the treatment of patients with limited stage small cell lung cancer (LS-SCLC). Materials and Methods: Between January 2006 and December 2011, thirty-one patients with histologically proven LS-SCLC who were treated with two cycles of chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy were retrospectively analyzed. The chemotherapy regimen was composed of etoposide and cisplatin. Thoracic radiotherapy consisted of 50 to 60 Gy (median, 54 Gy) given in 5 to 6.5 weeks. Results: The follow-up period ranged from 5 to 53 months (median, 22 months). After chemoradiotherapy, 35.5% of the patients (11 patients) showed complete response, 61.3% (19 patients) showed partial response, 3.2% (one patient) showed progressive disease, resulting in an overall response rate of 96.8% (30 patients). The 1-, 2-, and 3-year overall survival (OS) rates were 66.5%, 41.0%, and 28.1%, respectively, with a median OS of 21.3 months. The 1-, 2-, and 3-year progression free survival (PFS) rates were 49.8%, 22.8%, and 13.7%, respectively, with median PFS of 12 months. The patterns of failure were: locoregional recurrences in 29.0% (nine patients), distant metastasis in 9.7% (three patients), and both locoregional and distant metastasis in 9.7% (three patients). Grade 3 or 4 toxicities of leukopenia, anemia, and thrombocytopenia were observed in 32.2%, 29.0%, and 25.8%, respectively. Grade 3 radiation esophagitis and radiation pneumonitis were shown in 12.9% and 6.4%, respectively. Conclusion: We conclude that early chemoradiotherapy for LS-SCLC provides feasible and acceptable local control and safety.

The analysis of short term success rate and healing patterns of $Implantium^{(R)}$ Implant (($Implantium^{(R)}$) implant의 단기 생존율 및 치유 양상에 대한 연구)

  • Chae, Gyung-Joon;Chung, Sung-Min;Jung, Ui-Won;Cho, Kyoo-Sung;Chai, Jung-Kyu;Kim, Chong-Kwan;Choi, Seong-Ho;Kim, Chang-Sung
    • Journal of Periodontal and Implant Science
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    • v.36 no.3
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    • pp.683-691
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    • 2006
  • This study is an analysis of distribution of patients who installed Implantium implant in Yonsei University Dental Hospital and types of implant site for about 1 years recall check and success rate. 164 implants were installed to 52 patients in this study. It shows the conclusion below. 1. Patients at the age of 40s and 50s were 65% of all implant cases and average number of implant was 4 (man), and 2.7 (woman). 75 implants were operated on maxilla and 89 were mandible. 19 implants on anterior region and 145 implants on posterior region. 2. Most distribution of bone qaulity for implant site was type III(37.2%) and bone quantity was type C(61. 7%) 3. The majority of implants were those of 10, 12mm in length (85%) and regular diameter in width (48.8%). 4. 30 implants were installed with the advanced technique-GER, window opemng, osteotome technique. 5. Two implants were removed before prosthodontic treatment due to the osseointegraton failure. The success rate was 98.8% in 15.2 months follow up period and the marginal bone loss was 0.28mm. The results provided us with basic data on patient type, implant distribution, bone condition, and survival rate. Within the limit of present study, It was concluded that Implantium implant could be used satisfactorily in various clinical situations.

Clinical Features of Distal Tibial Fractures and Treatment Results of Minimally Invasive Plate Osteosynthesis (원위 경골 골절의 임상양상 및 최소 침습적 금속판 고정술의 결과)

  • Kim, Weon-Yoo;Ji, Jong-Hun;Kwon, Oh-Soo;Park, Sang-Eun;Kim, Young-Yul;Kil, Ho-Jin;Jeong, Jae-Jung
    • Journal of Korean Foot and Ankle Society
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    • v.16 no.2
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    • pp.94-100
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    • 2012
  • Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.