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Survival benefit of neoadjuvant FOLFIRINOX for patients with borderline resectable pancreatic cancer

  • Evelyn Waugh;Juan Glinka;Daniel Breadner;Rachel Liu;Ephraim Tang;Laura Allen;Stephen Welch;Ken Leslie;Anton Skaro
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.2
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    • pp.229-237
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    • 2024
  • Backgrounds/Aims: While patients with borderline resectable pancreatic cancer (BRPC) are a target population for neoadjuvant chemotherapy (NAC), formal guidelines for neoadjuvant therapy are lacking. We assessed the perioperative and oncological outcomes in patients with BRPC undergoing NAC with FOLFIRINOX for patients undergoing upfront surgery (US). Methods: The AHPBA criteria for borderline resectability and/or a CA19-9 level > 100 µ/mL defined borderline resectable tumors retrieved from a prospectively populated institutional registry from 2007 to 2020. The primary outcome was overall survival (OS) at 1 and 3 years. A Cox Proportional Hazard model based on intention to treat was used. A receiver-operator characteristics (ROC) curve was constructed to assess the discriminatory capability of the use of CA19-9 > 100 µ/mL to predict resectability and mortality. Results: Forty BRPC patients underwent NAC, while 46 underwent US. The median OS with NAC was 19.8 months (interquartile range [IQR], 10.3-44.24) vs. 10.6 months (IQR, 6.37-17.6) with US. At 1 year, 70% of the NAC group and 41.3% of the US group survived (p = 0.008). At 3 years, 42.5 % of the NAC group and 10.9% of the US group survived (p = 0.001). NAC significantly reduced the hazard of death (adjusted hazard ratio, 0.20; 95% confidence interval, 0.07-0.54; p = 0.001). CA19-9 > 100 µ/mL showed poor discrimination in predicting mortality, but was a moderate predictor of resectability. Conclusions: We found a survival benefit of NAC with FOLFIRINOX for BRPC. Greater pre-treatment of CA19-9 and multivessel involvement on initial imaging were associated with progression of the disease following NAC.

Prognostic Value of an Immune Long Non-Coding RNA Signature in Liver Hepatocellular Carcinoma

  • Rui Kong;Nan Wang;Chun li Zhou;Jie Lu
    • Journal of Microbiology and Biotechnology
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    • v.34 no.4
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    • pp.958-968
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    • 2024
  • In recent years, there has been a growing recognition of the important role that long non-coding RNAs (lncRNAs) play in the immunological process of hepatocellular carcinoma (LIHC). An increasing number of studies have shown that certain lncRNAs hold great potential as viable options for diagnosis and treatment in clinical practice. The primary objective of our investigation was to devise an immune lncRNA profile to explore the significance of immune-associated lncRNAs in the accurate diagnosis and prognosis of LIHC. Gene expression profiles of LIHC samples obtained from TCGA database were screened for immune-related genes. The optimal immune-related lncRNA signature was built via correlational analysis, univariate and multivariate Cox analysis. Then, the Kaplan-Meier plot, ROC curve, clinical analysis, gene set enrichment analysis, and principal component analysis were performed to evaluate the capability of the immune lncRNA signature as a prognostic indicator. Six long non-coding RNAs were identified via correlation analysis and Cox regression analysis considering their interactions with immune genes. Subsequently, tumor samples were categorized into two distinct risk groups based on different clinical outcomes. Stratification analysis indicated that the prognostic ability of this signature acted as an independent factor. The Kaplan-Meier method was employed to conduct survival analysis, results showed a significant difference between the two risk groups. The predictive performance of this signature was validated by principal component analysis (PCA). Additionally, data obtained from gene set enrichment analysis (GSEA) revealed several potential biological processes in which these biomarkers may be involved. To summarize, this study demonstrated that this six-lncRNA signature could be identified as a potential factor that can independently predict the prognosis of LIHC patients.

The Differentiation of Malignant and Benign Musculoskeletal Tumors by F-18 FDG PET/CT Studies - Determination of maxSUV by Analysis of ROC Curve (F-18 FDG PET/CT에서 양성과 악성 근골격 종양의 감별진단 - 수신자 판단특성곡선을 이용한 maxSUV의 절단값 결정)

  • Kong, Eun-Jung;Cho, Ihn-Ho;Chun, Kyung-Ah;Won, Kyu-Chang;Lee, Hyung-Woo;Choi, Jun-Heok;Shin, Duk-Seop
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.6
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    • pp.553-560
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    • 2007
  • Purpose: We evaluated the standard uptake value (SUV) of F-18 FDG at PET/CT for differentiation of benign from malignant tumor in primary musculoskeletal tumors. Materials and Methods: Forty-six tumors (11 benign and 12 malignant soft tissue tumors, 9 benign and 14 malignant bone tumors) were examined with F-18 FDG PET/CT (Discovery ST, GE) prior to tissue diagnosis. The maxSUV(maximum value of SUV) were calculated and compared between benign and malignant lesions. The lesion analysis was based on the transverse whole body image. The maxSUV with cutoff of 4.1 was used in distinguishing benign from malignant soft tissue tumor and 3.05 was used in bone tumor by ROC curve. Results: There was a statistically significant difference in maxSUV between benign (n=11; maxSUV $3.4{\pm}3.2$) and malignant (n=12; maxSUV $14.8{\pm}12.2$) lesions in soft tissue tumor (p=0.001). Between benign bone tumor (n=9; maxSUV $5.4{\pm}4.0$) and malignant bone tumor (n=14; maxSUV $7.3{\pm}3.2$), there was not a significant difference in maxSUV. The sensitivity and specificity for differentiating malignant from benign soft tissue tumor was 83% and 91%, respectively. There were four false positive malignant bone tumor cases to include fibrous dysplasia, Langerhans-cell histiocytosis (n=2) and osteoid osteoma. Also, one false positive case of malignant soft tissue tumor was nodular fasciitis. Conclusion: The maxSUV was useful for differentiation of benign from malignant lesion in primary soft tissue tumors. In bone tumor, the low maxSUV correlated well with benign lesions but high maxSUV did not always mean malignancy.

Comparative Quantitative Study of Surfactant Protein C mRNA by Filter Hybridization and Solution Hybridization in Rats (Filter Hybridization과 Solution Hybridization 방법에 의한 백서 Surfactant Protein C mRNA 정량측정의 비교)

  • Kim, Jin-Ho;Sohn, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.6
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    • pp.517-529
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    • 2001
  • Background : Surfactant protein C(SP-C) is a hydrophobic 5,000 dalton molecule. SP-C has the primary roles in accelerating surface spreading of a surfactant phospholipid. The filter hybridization and solution hybridization assays are both rapid and sensitive and can be used to measure the RNAs complementary to any cloned DNA sequence. Methods : The authors measured the SP-C mRNA levels quantitatively using solution hybridization and filter hybridization assays to obtain a standard curve equation to quantify the mRNA of unknown samples comparatively. Results : 1. The minimum level of the specimens by solution hybridization was 3 pg for SP-C mRNA. 2. The standard curve equation of the solution hybridization assay between the counts per minute(Y) and the SP-C mRNA transcript input(X) was Y=6.46 X+244. The correlation coefficient was 0.99. 3. The minimum detection level of specimens by filter hybridization was 0.1 ng for SP-C mRNA. 4. The standard curve equation of the filter hybridization assay between the counts per minute(Y) and SP-C mRNA transcript input(X) is Y=2541.6 X+252.7. The correlation coefficient was 0.99. Conclusions : A comparison of CPM/filter in the linear range allowed an accurate and reproducible estimation of the SP-C mRNA copy number. Filter hybridization and solution hybridization assays are both rapid and sensitive and can be used to measure the RNAs complementary to any cloned DNA sequence. It is ideally suited to situations where accurate quantitation of multiple samples is required.

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Differentiation of True Recurrence from Delayed Radiation Therapy-related Changes in Primary Brain Tumors Using Diffusion-weighted Imaging, Dynamic Susceptibility Contrast Perfusion Imaging, and Susceptibility-weighted Imaging (확산강조영상, 역동적조영관류영상, 자화율강조영상을 이용한 원발성 뇌종양환자에서의 종양재발과 지연성 방사선치료연관변화의 감별)

  • Kim, Dong Hyeon;Choi, Seung Hong;Ryoo, Inseon;Yoon, Tae Jin;Kim, Tae Min;Lee, Se-Hoon;Park, Chul-Kee;Kim, Ji-Hoon;Sohn, Chul-Ho;Park, Sung-Hye;Kim, Il Han
    • Investigative Magnetic Resonance Imaging
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    • v.18 no.2
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    • pp.120-132
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    • 2014
  • Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weighted imaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patients treated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newly appearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions were confirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume (nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for the enhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regression model was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtained from receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy for the diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004), and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference was observed in the mean ADC values between the two groups. A multivariable logistic regression analysis showed that proSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11 of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesions more than one year after RT completion in brain tumor patients.

Prognostic Value of Preoperative Positron Emission Tomography-Computed Tomography in Surgically Resected Stage I and II Non-Small Cell Lung Cancer (I, II병기 비소세포폐암의 예후에 대한 수술 전 양전자방출 컴퓨터 단층촬영기의 임상적 의의)

  • Song, Sung-Heon;Sohn, Jang-Won;Kwak, Hyun-Jung;Kim, Sa-Il;Kim, Sang-Heon;Kim, Tae-Hyung;Yoon, Ho-Joo;Shin, Dong-Ho;Choi, Yoon-Young;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.71 no.6
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    • pp.425-430
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    • 2011
  • Background: High 2-[$^{18}F$] fluoro-2-deoxy-D-glucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT) is a prognostic factor for poor survival in non-small cell lung cancer (NSCLC), especially in Stage I. We determined whether the high FDG uptake value of a primary tumor was associated with recurrence and death in patients with resected Stage I and Stage II NSCLC. Methods: We identified consecutive patients who underwent complete surgical resection for Stage I and II NSCLC between 2006 and 2009, who had preoperative PET-CT, and reviewed clinical records retrospectively. FDG uptake was measured as the maximal standardized uptake value (SUVmax) for body weight. Patients were divided into two groups based on SUVmax: (i) above or (ii) below the cut-off value (SUVmax=5.9) determined by a receiver operating characteristic (ROC) curve. Results: Of 57 patients who were enrolled consecutively, 32 (56%) had Stage I NSCLC and 25 (44%) had Stage II. The 5-year recurrence-free survival (RFS) for patients with high (${\geq}5.9$) and low (<5.9) SUVmax were 31% and 57%, respectively (p=0.014). The 5-year overall survival (OS) rates were 39% and 60%, respectively (p=0.029). In univariate analyses, SUVmax (p=0.014), T staging (p=0.025), and differentiation of tumor tissue (p=0.034) were significantly associated with RFS. But, multivariate analyses did not show that SUVmax was an independently significant factor for RFS (p=0.180). Conclusion: High FDG uptake on PET-CT is not an independent prognostic factor for poor outcomes (disease recurrence in patients with resected Stage I and II NSCLC).

Forecasting of Car Distribution Considering the Population Aging (인구 고령화를 고려한 승용차 보급예측 연구)

  • Kim, Hyunwoo;Lee, Du-Heon;Yang, Junseok
    • Korean Journal of Construction Engineering and Management
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    • v.15 no.5
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    • pp.31-39
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    • 2014
  • It has been a long time since cars had become important means of transportation in human life. Since 1970s, cars have been increasing steadily because of rising individual income and changing lifestyle toward leisure and convenience. The number of cars is just 1.8 per thousand populations in 1970s, however, in 2012, it has increased to 291.15. Forecasting the demand for cars would be useful to plan, construction or management in the field of motor industry, road building and establishing facilities. Our study predicts the demand of cars through estimating the growth curve model. Especially, we include ageing variables to forecasting identifying the effect of ageing on the demand of cars. The main findings are as follows. In 2045, the number of cars is expected to reach 486.8 per thousand populations with passing a primary saturation point at early 2020s. Also, due to effect of ageing, the predicted demand of cars is about 10% lower than in case of which if ageing effect not exist.

Treatment Adherence of Osmotic-Controlled Release Oral Delivery System Methylphenidate in Korean Children and Adolescents with Attention-Deficit Hyperactivity Disorder (주의력결핍 과잉행동장애 아동에서 Osmotic-Controlled Release Oral Delivery System Methylphenidate의 치료순응도)

  • Kim, Bongseog;Lee, Jeong-Seop;Kim, Eui-Jung;Sung, Hyung-Mo;Shin, Yun Mi;Hwang, Seong-Hye;Yoo, Hanik K.
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.25 no.2
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    • pp.65-72
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    • 2014
  • Objectives : The objective of this study was to evaluate the treatment duration and adherence of osmotic-controlled release oral delivery system (OROS) methylphenidate for treatment of attention-deficit hyperactivity disorder (ADHD). Methods : A total of 843 children with ADHD were recruited : 213 children (25.3%) who had previously taken medications for ADHD and 630 drug-na$\ddot{i}$ve children (74.7%) were recruited. The dosage was adjusted according to the clinician's judgment. The primary efficacy endpoint of this study was treatment retention rate, which was estimated at Week 12 and Week 20 using the Kaplan-Meier curve. The Swanson, Nolan and Pelham-IV (SNAP-IV), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement, and the side effect rating scale were measured at every visit. Remission rates were presented based on SNAP-IV and CGI-S, respectively. Results : The treatment retention rate at 12 weeks and at 20 weeks was 76.2% and 66.8%, respectively. Divided according to 6-8, 9-11, 12-14 and 15-18 years of age, younger children tended to show a statistically higher treatment retention rate (p=.02). Based on SNAP-IV and CGI scores, children with better response to medication showed tendencies of statistically higher treatment retention rate. The most common adverse events included loss of appetite (7.1%) and insomnia (3.3%). There was no serious adverse event related to the treatment, such as death. Conclusion : The use of OROS methylphenidate for treatment of ADHD was safe and tolerable for children. In this study, lower age and better treatment response showed a statistically significant relationship with higher treatment adherence. Boys showed a trend of high treatment adherence. The treatment adherence at 20 weeks was satisfactory, however, the treatment adherence after 20 weeks showed a sharp decrease. Therefore, treatment persistence for six months after the beginning of ADHD treatment is important. In addition, the positive role of psycho-education for children and parents is necessary for increasing treatment adherence.

Narrative Strategies for Learning Enhanced Interface Design "Symbol Mall"

  • Uttaranakorn, Jirayu;McGregor, Donna-Lynne;Petty, Sheila
    • Proceedings of the IEEK Conference
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    • 2002.07a
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    • pp.417-420
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    • 2002
  • Recent works in the area of multimedia studies focus on a wide range of issues from the impact of multimedia on culture to its impact on economics and anything in between. The interconnectedness of the issues raised by this new practice is complicated by the fact that media are rapidly converging: in a very real way, multimedia is becoming a media prism that reflects the way in which media continually influence each other across disciplines and cultural borders. Thus, the impact of multimedia reflects a complicated crossroads where media, human experience, culture and technology converge. An effective design is generally based on shaping aesthetics for function and utility, with an emphasis on ease of use. However, in designing for cyberspace, it is possible to create narratives that challenge the interactor by encoding in the design an instructional aspect that teaches new approaches and forms. Such a design offers an equally aesthetic experience for the interactor as they explore the meaning of the work. This design approach has been used constructively in many applications. The crucial concern is to determine how little or how much information must be presented for the interactor to achieve a suitable level of cognition. This is always a balancing act: too much difficulty will result in interactor frustration and the abandonment of the activity and too little will result in boredom leading to the same negative result In addition, it can be anticipated that the interactor will bring her or his own level of experiential cognition and/or accretion, to the experience providing reflective cognition and/or restructure the learning curve. If the design of the application is outside their present experience, interactors will begin with established knowledge in order to explore the new work. Thus, it may be argued that the interactor explores, learns and cognates simultaneously based on primary experiential cognition. Learning is one of the most important keys to establishing a comfort level in a new media work. Once interactors have learned a new convention, they apply this cognitive knowledge to other new media experiences they may have. Pierre Levy would describe this process as a "new nomadism" that creates "an invisible space of understanding, knowledge, and intellectual power, within which new qualities of being and new ways of fashioning a society will flourish and mutate" (Levy xxv 1997). Thus, navigation itself of offers the interactors the opportunity to both apply and loam new cognitive skills. This suggests that new media narrative strategies are still in the process of developing unique conventions and, as a result, have not reached a level of coherent grammar. This paper intends to explore the cognitive aspects of new media design and in particular, will explore issues related to the design of new media interfaces. The paper will focus on the creation of narrative strategies that engage interactors through loaming curves thus enhancing interactivity.vity.

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Strength and Lateral Torsional Behavior of Horizontally Curved Steel I-Girders Subjected to Equal End Moments (양단 균일 모멘트를 받는 수평곡선 I형 강재 거더의 횡-비틀림 거동 및 강도 산정 방안)

  • Lee, Keesei;Lee, Manseop;Choi, Junho;Kang, Youngjong
    • Journal of Korean Society of Steel Construction
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    • v.30 no.1
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    • pp.1-12
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    • 2018
  • A curved member should resist bending and torsional moments simultaneously even though the primary load is usually supposed to be gravitational load. The torsional moment causes complicate stress state and also can result in early yielding of material to reduce member strength. According to analysis results, the strength of a curved member that has 45 degrees of subtended angle could decrease more than 50% compare to straight girder. Nevertheless, there have been very few of researches related with ultimate strength of curved girders. In this study, various kinds of stiffness about bending, pure torsion and warping were considered with a number of models in order to verify the main factor that affects ultimate behavior of curved girder. Lateral and rotational displacement of curved member were introduced as lateral-torsional-vertical behavior and bending-torsional moment interaction curve was derived. Finally, a strength equation for ultimate moment of horizontally curved steel I-girders subjected to equal end moments based on the interaction curves. The equation could take account of the effect of curvature, unbraced length and sectional properties.