• Title/Summary/Keyword: clinical grading

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Clinicopathological Features and Prognosis of Gastroenteropancreatic Neuroendocrine Tumors: Analysis from a Single-institution

  • Zeng, Yu-Jie;Liu, Lu;Wu, Heng;Lai, Wei;Cao, Jie-Zhi;Xu, He-Yang;Wang, Jie;Chu, Zhong-Hua
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.10
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    • pp.5775-5781
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    • 2013
  • Background: The gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) is the most common type of neuroendocrine neoplasm. We summarized data in our centre to investigate the clinicopathological features, diagnostic methods, therapeutic approaches and prognosis for this neoplasm to increase knowledge of this disease in Asian populations. Method: A total of 122 patients treated at Sun Yet-san Memorial Hospital of Sun Yat-sen University between January 2000 and December 2011 were analyzed retrospectively. Results: Pancreas was the most common site of involvement (65/122, 53.3%); this disease has no special symptoms; positive rates of chromogranin A (CgA) and synaptophysin (Syn) were 81.1% and 87.7%, respectively. The positive rate of Syn had statistical difference among the three grades, but not CgA. Some 68 patients had G1 tumors, 32 G2 tumors and 22 G3 tumors, and Chi-square test showed that higher grading was correlated with worse prognosis (${\chi}^2=32.825$, P=0.0001). A total of 32 patients presented with distant metastasis, and 8 cases emerged during following up. Cox proportional hazards regression modeling showed that the tumor grade (P=0.01), lymphatic metastasis (P=0.025) and distant metastasis (P=0.031) were predictors of unfavorable prognosis. The overall 5-year survival rate was 39.6%, the 5-year survival rate of G1 was 55.7%, and the G2 and G3 were 34.2% and 0%, respectively. Conclusions: The incidence of gastroenteropancreatic neuroendocrine tumors has risen over the last 12 years. All grades of these diseases metastasize readily, and further research regarding the treatment of patients after radical surgery is needed to prolong disease-free survival.

Predictive Efficacy of Radioisotope Voiding Cystography for Renal Outcome (방사성동위원소 배뇨방광촬영술의 신장예후 예측성능)

  • Kim, Seok-Ki;Lee, Dong-Soo;Kim, Kwang-Myeung;Choi, Whang;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.2
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    • pp.135-143
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    • 2000
  • Purpose: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. Materials and Methods: In 35 children (18 males, 17 females), radiologic voiding cystoure-thrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. Results: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. Conclusion: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.

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Effects of Medium on Blastocyst Formation, Cell Number and Percentage of ICM in Mice (마우스에서 배반포 형성, 세포 수 및 ICM의 비율에 미치는 배양액의 효과)

  • Park, Kee-Sang;Lee, Taek-Hoo;Chun, Sang-Sik;Song, Hai-Bum
    • Clinical and Experimental Reproductive Medicine
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    • v.29 no.4
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    • pp.237-243
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    • 2002
  • Objective : The aim of this study was to evaluate the influence of different media on blastulation, mean cell number, percentage of inner cell mass (ICM) of total cells and ICM : trophectoderm (TE) ratio in mice. Materials and methods: A total 552 two cell embryos were retrieved from ICR female mice (4 weeks old) at 48 hr after hCG injection (mated just after hCG injection) and cultured in MEM (n=276) or TCM (n=276) supplemented with 20% hFF. The grading of blastocysts from zona-intact (ZiB) to -escape (hatching and hatched, ZeB) was performed at 72 hours after culture. Total, TE and ICM cell numbers were analyzed by differential staining of blastocyst. Statistical analysis was performed using t-test with SigmaPlot-2001. P-values < 0.05 were accepted as statistically significant. Results: The blastulation rate in MEM ($64.9{\pm}4.95%$) was significantly higher (p=0.0031) than that in TCM ($57.2{\pm}5.22%$). No differences were found in the number of ZiB and ZeB between MEM ($31.9{\pm}2.62$, $33.0{\pm}4.58%$), and TCM ($27.2{\pm}4.28$, $30.1{\pm}4.58%$). A total 314 blastocysts (MEM=166; TCM=148) were stained differentially. Mean cell number of blastocysts was significantly higher (p=0.0002) in TCM ($73.1{\pm}3.3$) than in MEM ($61.7{\pm}2.5$). Differential staining was successfully performed in 155 blastocysts (MEM=77; TCM=78). The percentage of ICM was significantly higher in MEM than in TCM ($20.9{\pm}1.3$ vs. $17.1{\pm}1.2%$, p=0.0281). The ICM : TE ratio was higher in TCM than in MEM (1 : $4.85{\pm}0.68$ vs. 1 : $3.78{\pm}0.78$, NS). Conclusion: These results show that MEM increase the blastocyst formation and percentage of ICM of total cells comparing with TCM in mice.

A Review of Assessment Tools in Traditional Medicine on the High Frequent Skin Diseases (다빈도 피부질환에 대한 국내외 한의학 논문에서 평가도구 사용현황에 대한 고찰)

  • Park, So-Young;Kang, Min-Seo;Kim, Min-Hee;Kwak, Jae-Young;Choi, In-Hwa
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.31 no.4
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    • pp.31-41
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    • 2018
  • Objectives : The purpose of this study is to establish the basis of the assessment tools that can be used for the diagnosis and assessment of skin diseases by reviewing the present status of the assessment tools used in domestic and overseas traditional medicine papers for the past five years. Methods : This study is based on analysis of papers on clinical trials about atopic dermatitis, psoriasis, acne, urticaria published from 1st July 2013 to 30th June 2018. The papers were searched from Oriental Medicine Advanced Searching Integrated System(OASIS), Korean Traditional Knowledge Portal(KTKP), Pubmed, MEDLINE. Results : 40 articles on atopic dermatitis, 34 articles on psoriasis, 26 articles on acne and 10 articles on urticaria were selected. Among them, 38 articles(90%), 20 articles(85%), 22 articles(85%) and 5 articles(50%) used assessment tools in order. Conclusions : SCoring Atopic Dermatitis(SCORAD), objective SCORing of Atopic Dermatitis index(OSI), Eczema Area and Severity Index(EASI) were used in studies on atopic dermatitis. In the case of psoriasis, The Psoriasis Area and Severity Index(PASI) was used in most papers. In the study on acne, most of Korean papers used Korean Acne Grading System(KAGS), but in the overseas papers, various assessment tools were used. In the case of urticaria, the rate of use of the assessment tool was the lowest, but the assessment tool used was unified by Urticaria Activity Score(UAS). Since skin diseases can cause stress and a decrease in quality of life, the quality of life should be taken into account when evaluating treatment effects.

Paraspinal Muscle Sparing versus Percutaneous Screw Fixation: A Prospective and Comparative Study for the Treatment of L5-S1 Spondylolisthesis

  • Jang, Kun-Soo;Kim, Heyun-Sung;Ju, Chang-Il;Kim, Seok-Won;Lee, Sung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.49 no.3
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    • pp.163-166
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    • 2011
  • Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

The Clinical Research of Cervical Chuna Treatment's Effects on Bell's Palsy (벨마비에 미치는 경추 추나요법의 영향에 대한 임상적 고찰)

  • Jeong, Jae Yoeb;Lee, Eun Sol;Seo, Dong Goon;Shin, So Yeon;Kim, Shin Young;Kwon, Hyung Keun;Kim, Cheol Hong;Jang, Kyung Jeon;Yoon, Hyun Min
    • Journal of Acupuncture Research
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    • v.31 no.3
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    • pp.45-55
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    • 2014
  • Objectives : The purpose of this study is to investigate the effect of cervical Chuna treatment for Bell's palsy. Methods : We investigated 30 patients with Bell's palsy who had visited at Department of Acupuncture & Moxibustion, of Korean Medicine Hospital Dong-Eui University from June $1_{st}$, 2013 to April $15_{th}$, 2014. Subjects were randomly divided into two groups. Group A(experimental group) was treated by Korean-Western combination treatment with Cervical Chuna treatment and group B(control group) was treated by Korean-Western combination treatment without it. The cervical Chuna treatment was done twice a week, for a total of 8 times. We evaluated the change of each group by using Yanagihara's unweighed grading system. Results : Yanagihara's score in group A was significantly improved during each period from the first visit to four weeks later. However, Yanagihara's score in group B was significantly improved except during first week. The improvement of Yanagihara's score in group A is higher than group B during every period. And significant differences were shown after two weeks from the first visit between the two groups. Conclusions : These results suggest that cervical Chuna treatment may be effective for Bell's palsy.

The Protective Effect of Green Tea Extract on Alpha-amanitin Induced Hepatotoxicity (알파 아마니틴에 의한 간독성에 대한 녹차 추출물의 보호 효과)

  • An, Su Hwan;Sun, Kyung Hoon;Hong, Ran;Lee, Byoung Rai;Park, Yongjin
    • Journal of The Korean Society of Clinical Toxicology
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    • v.17 no.2
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    • pp.58-65
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    • 2019
  • Purpose: Alpha-amanitin induces potent oxidative stress and apoptosis, and may play a significant role in the pathogenesis of hepatotoxicity. This study examined the mechanisms of α-amanitin-induced apoptosis in vitro, and whether green tea extract (GTE) offers protection against hepatic damage caused by α-amanitin (AMA) induced apoptosis in vivo. Methods: The effects of GTE and SIL on the cell viability of cultured murine hepatocytes induced by AMA were evaluated using an MTT assay. Apoptosis was assessed by an analysis of DNA fragmentation and caspase-3. In the in vivo protocol, mice were divided into the following four groups: control group (0.9% saline injection), AMA group (α-amanitin 0.6 mg/kg), AMA+SIL group (α-amanitin and silibinin 50 mg/kg), and AMA+GTE group (α-amanitin and green tea extract 25 mg/kg). After 48 hours of treatment, the hepatic aminotransferase and the extent of hepatonecrosis of each subject was evaluated. Results: In the hepatocytes exposed to AMA and the tested antidotes, the cell viability was significantly lower than the AMA only group. An analysis of DNA fragmentation showed distinctive cleavage of hepatocyte nuclear DNA in the cells exposed to AMA. In addition, the AMA and GTE or SIL groups showed more relief of the cleavage of the nuclear DNA ladder. Similarly, values of caspase-3 in the AMA+GTE and AMA+SIL groups were significantly lower than in the AMA group. The serum AST and ALT levels were significantly higher in the AMA group than in the control and significantly lower in the AMA+GTE group. In addition, AMA+GTE induced a significant decrease in hepatonecrosis compared to the controls when a histologic grading scale was used. Conclusion: GTE is effective against AMA-induced hepatotoxicity with its apoptosis regulatory properties under in vitro and in vivo conditions.

Development and Validation of Figure-Copy Test for Dementia Screening (치매 선별을 위한 도형모사검사 개발 및 타당화)

  • Kim, Chobok;Heo, Juyeon;Hong, Jiyun;Yi, Kyongmyon;Park, Jungkyu;Shin, Changhwan
    • 한국노년학
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    • v.40 no.2
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    • pp.325-340
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    • 2020
  • Early diagnosis and intervention of dementia is critical to minimize future risk and cost for patients and their families. The purpose of this study was to develop and validate Figure-Copy Test(FCT), as a new dementia screening test, that can measure neurological damage and cognitive impairment, and then to examine whether the grading precesses for screening can be automated through machine learning procedure by using FCT imag es. For this end, FCT, Korean version of MMSE for Dementia Screening (MMSE-DS) and Clock Drawing Test were administrated to a total of 270 participants from normal and damaged elderly groups. Results demonstrated that FCT scores showed high internal constancy and significant correlation coefficients with the other two test scores. Discriminant analyses showed that the accuracy of classification for the normal and damag ed g roups using FCT were 90.8% and 77.1%, respectively, and these were relatively higher than the other two tests. Importantly, we identified that the participants whose MMSE-DS scores were higher than the cutoff but showed lower scores in FCT were successfully screened out through clinical diagnosis. Finally, machine learning using the FCT image data showed an accuracy of 73.70%. In conclusion, our results suggest that FCT, a newly developed drawing test, can be easily implemented for efficient dementia screening.

Interpretation of Complete Tumor Response on MRI Following Chemoradiotherapy of Rectal Cancer: Inter-Reader Agreement and Associated Factors in Multi-Center Clinical Practice

  • Hae Young Kim;Seung Hyun Cho;Jong Keon Jang;Bohyun Kim;Chul-min Lee;Joon Seok Lim;Sung Kyoung Moon;Soon Nam Oh;Nieun Seo;Seong Ho Park
    • Korean Journal of Radiology
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    • v.25 no.4
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    • pp.351-362
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    • 2024
  • Objective: To measure inter-reader agreement and identify associated factors in interpreting complete response (CR) on magnetic resonance imaging (MRI) following chemoradiotherapy (CRT) for rectal cancer. Materials and Methods: This retrospective study involved 10 readers from seven hospitals with experience of 80-10210 cases, and 149 patients who underwent surgery after CRT for rectal cancer. Using MRI-based tumor regression grading (mrTRG) and methods employed in daily practice, the readers independently assessed mrTRG, CR on T2-weighted images (T2WI) denoted as mrCRT2W, and CR on all images including diffusion-weighted images (DWI) denoted as mrCRoverall. The readers described their interpretation patterns and how they utilized DWI. Inter-reader agreement was measured using multi-rater kappa, and associated factors were analyzed using multivariable regression. Correlation between sensitivity and specificity of each reader was analyzed using Spearman coefficient. Results: The mrCRT2W and mrCRoverall rates varied widely among the readers, ranging 18.8%-40.3% and 18.1%-34.9%, respectively. Nine readers used DWI as a supplement sequence, which modified interpretations on T2WI in 2.7% of cases (36/1341 [149 patients × 9 readers]) and mostly (33/36) changed mrCRT2W to non-mrCRoverall. The kappa values for mrTRG, mrCRT2W, and mrCRoverall were 0.56 (95% confidence interval: 0.49, 0.62), 0.55 (0.52, 0.57), and 0.54 (0.51, 0.57), respectively. No use of rectal gel, larger initial tumor size, and higher initial cT stage exhibited significant association with a higher interreader agreement for assessing mrCRoverall (P ≤ 0.042). Strong negative correlations were observed between the sensitivity and specificity of individual readers (coefficient, -0.718 to -0.963; P ≤ 0.019). Conclusion: Inter-reader agreement was moderate for assessing CR on post-CRT MRI. Readers' varying standards on MRI interpretation (i.e., threshold effect), along with the use of rectal gel, initial tumor size, and initial cT stage, were significant factors associated with inter-reader agreement.

Clinical Experience with 3.0 T MR for Cardiac Imaging in Patients: Comparison to 1.5 T using Individually Optimized Imaging Protocols (장비 별 최적화된 영상 프로토콜을 이용한 환자에서의 3.0T 심장 자기공명영상의 임상경험: 1.5 T 자기공명영상과의 비교)

  • Ko, Jeong Min;Jung, Jung Im;Lee, Bae Young
    • Investigative Magnetic Resonance Imaging
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    • v.17 no.2
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    • pp.83-90
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    • 2013
  • Purpose : To report our clinical experience with cardiac 3.0 T MRI in patients compared with 1.5 T using individually optimized imaging protocols. Materials and Methods: We retrospectively reviewed 30 consecutive patients and 20 consecutive patients who underwent 1.5 T and 3 T cardiac MRI within 10 months. A comparison study was performed by measuring the signal-to-noise ratio (SNR), the contrast-to-noise ratio (CNR) and the image quality (by grading each sequence on a 5-point scale, regarding the presence of artifacts). Results: In morphologic and viability studies, the use of 3.0 T provided increase of the baseline SNRs and CNRs, respectively (T1: SNR 29%, p < 0.001, CNR 37%, p < 0.001; T2-SPAIR: SNR 13%, p = 0.068, CNR 18%, p = 0.059; viability imaging: SNR 45%, p = 0.017, CNR 37%, p = 0.135) without significant impairment of the image quality (T1: $3.8{\pm}0.9$ vs. $3.9{\pm}0.7$, p = 0.438; T2-SPAIR: $3.8{\pm}0.9$ vs. $3.9{\pm}0.5$, p = 0.744; viability imaging: $4.5{\pm}0.8$ vs. $4.7{\pm}0.6$, p = 0.254). Although the image qualities of 3.0 T functional cine images were slightly lower than those of 1.5 T images ($3.6{\pm}0.7$ vs. $4.2{\pm}0.6$, p < 0.001), the mean SNR and CNR at 3.0 T were significantly improved (SNR 143% increase, CNR 108% increase, p < 0.001). With our imaging protocol for 3.0 T perfusion imaging, there was an insignificant decrease in the SNR (11% decrease, p = 0.172) and CNR (7% decrease, p = 0.638). However, the overall image quality was significantly improved ($4.6{\pm}0.5$ vs. $4.0{\pm}0.8$, p = 0.006). Conclusion: With our experience, 3.0 T MRI was shown to be feasible for the routine assessment of cardiac imaging.