• Title/Summary/Keyword: prospective

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Efficacy and Toxicity of Anti-VEGF Agents in Patients with Castration-Resistant Prostate Cancer: a Meta-analysis of Prospective Clinical Studies

  • Qi, Wei-Xiang;Fu, Shen;Zhang, Qing;Guo, Xiao-Mao
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.19
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    • pp.8177-8182
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    • 2014
  • Background: Blocking angiogenesis by targeting vascular endothelial growth factor (VEGF) signaling pathway to inhibit tumor growth has proven to be successful in treating a variety of different metastatic tumor types, including kidney, colon, ovarian, and lung cancers, but its role in castration-resistant prostate cancer (CRPC) is still unknown. We here aimed to determine the efficacy and toxicities of anti-VEGF agents in patients with CRPC. Materials and Methods: The databases of PubMed, Web of Science and abstracts presented at the American Society of Clinical Oncology up to March 31, 2014 were searched for relevant articles. Pooled estimates of the objective response rate (ORR) and prostate-specific antigen (PSA) response rate (decline ${\geq}50%$) were calculated using the Comprehensive Meta-Analysis (version 2.2.064) software. Median weighted progression-free survival (PFS) and overall survival (OS) time for anti-VEGF monotherapy and anti-VEGF-based doublets were compared by two-sided Student's t test. Results: A total of 3,841 patients from 19 prospective studies (4 randomized controlled trials and 15 prospective nonrandomized cohort studies) were included for analysis. The pooled ORR was 12.4% with a higher response rate of 26.4% (95%CI, 13.6-44.9%) for anti-VEGF-based combinations vs. 6.7% (95%CI, 3.5-12.7%) for anti-VEGF alone (p=0.004). Similarly, the pooled PSA response rate was 32.4% with a higher PSA response rate of 52.8% (95%CI: 40.2-65.1%) for anti-VEGF-based combinations vs. 7.3% (95%CI, 3.6-14.2%) for anti-VEGF alone (p<0.001). Median PFS and OS were 6.9 and 22.1 months with weighted median PFS of 5.6 vs. 6.9 months (p<0.001) and weighted median OS of 13.1 vs. 22.1 months (p<0.001) for anti-VEGF monotherapy vs. anti-VEGF-based doublets. Conclusions: With available evidence, this pooled analysis indicates that anti-VEGF monotherapy has a modest effect in patients with CRPC, and clinical benefits gained from anti-VEGF-based doublets appear greater than anti-VEGF monotherapy.

IORT in Gastric Cancer (위암의 수술중 방사선 치료)

  • Kim Myung Se;Kang Cheol Hoon;Kim Sung Kyu;Song Sun Kyo;Kwan Koing Bo;Kim Heung Dae
    • Radiation Oncology Journal
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    • v.9 no.1
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    • pp.87-91
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    • 1991
  • Total 28 patients with resectable, locally advanced gastric cancer were entered in our prospective randomized study from June 15, 1988 to Sep. 15, 1990 in Yeungnam University Hospital. This study consisted of curative resection, IORT, external irradiation and combination of chemotherapy. Twenty-four of 28 patients were treated with single dose of 1500 cGy with 9 MeV election intraoperatively. External irradiation of $4300\sim4500$ cGy with 180 cGy per fraction, 5 days per week was started within 4th weeks of postoperative days. Various chemotherapy with or without external irradiation were added for reducing hematogenous and/or peritoneal dissemination and determination of complication of each arm. Duration of follow up was $4\sim31$ months. No serious complication related with radiation were reported compare to resection and chemotherapy only group. Although our follow up period is too short to draw any conclusion, IORT appears to improve local control, hopely further survival. Continuous follow up should be needed for evaluation of real therapeutic gain such as complication vs. improved survival.

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Studies on the variations of hospital use and the changes in hospital revenues of 10 KDRGs under the PPS (일개 대학병원의 환자군별 진료서비스 변이와 포괄수가제 적용에 따른 진료수익 변화)

  • 전기홍;송미숙
    • Health Policy and Management
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    • v.7 no.1
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    • pp.100-124
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    • 1997
  • In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

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Assessment of Vibration Produced by the Grinder Used in the Shipbuilding Industry and Development of Prospective Prevalence Model of Hand-arm Vibration Syndrome (선박건조업에서 사용되는 그라인더의 진동평가와 수지진동증후군 예측 모델 개발)

  • Yim, Sanghyuk;Lee, Yunkeun;Park, Hee-Sok
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.16 no.4
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    • pp.398-412
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    • 2006
  • The purpose of this study is to investigate the relationship between the acceleration of vibration by the powered hand tools used in the shipbuilding industry, and to develop the prospective prevalence model for the hand-arm vibration syndrome among the shipbuilding workers.The acceleration levels and frequencies of six types of grinder were measured using the ISO5349 method along with the time of exposure to the vibration from the powered hand tools. Medical examination for 114 workers were performed using the cold provocation test. Comparisons were made between the estimated prevalence of hand-arm vibration syndrome from ISO5349 and the observed values from the medical examinations. By multiple regression, we developed the prospective prevalence model of hand-arm vibration syndrome produced by the hand tools used in the shipbuilding industry. 4 hour-energy-equivalent frequency-weighted accelerations were $6.23m/s^2$ in the grinding job done after welding, and $13.39m/s^2$ in the grinding job done before painting. The mean exposure time while holding powered hand tools was 4.64 hours. Prevalence rates of Raynaud's Phenomenon were 12.04% in the grinding after soldering, and 42.9% in the grinding before painting measured using the ISO5349 method. After exposure to vibration for 10.79 years, about a half of the workers in the grinding after welding could developed Raynaud's Phenomenon. For the workers in the grinding before painting, the latency was 5.02 years. The ISO equation for dose response relationship was not significantly correlated with observed recovery rates of finger skin temperatures, blood flows and amplitudes of nerve conduction velocities. A multiple regression model for dose-response relationship was proposed from the results. Recovery rate of the skin temperatures = -0.668+ 0.337 ${\times}$ 4 hour energy equivalent frequency-weighted accelerations + 0.767 ${\times}$ duration of vibration exposure(years) The validity was proved by multiple regression analysis after correlation transformation and regression results based on model-building data and validation data.

Meta-cognitive awareness and prospective memory retrieval process: The effect of voluntary attention allocation strategy (메타 인지적 인식과 미래계획기억 인출 과정: 자발적 주의 할당 전략의 효과)

  • Yoon, Yong-Sik;Sohn, Young-Woo
    • Korean Journal of Cognitive Science
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    • v.22 no.2
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    • pp.145-172
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    • 2011
  • Prospective memory (PM) is memory for activities to be performed in the future, such as remembering to purchase a piece of fruit on the way home or remembering to give someone a telephone message. Theoretically, PM retrieval can be accomplished either by controlled monitoring of intended action or by a more automatic process that spontaneously responds to the presence of intended event. The present study examined the effect of meta-cognitive awareness in PM retrieval process. In Experiment 1, we manipulated PM condition with a salient cue to stimulate participants' meta-cognitive awareness. Results showed the salient cue condition spontaneously triggered remembering to perform an intended action. In Experiment 2, we manipulated participants' meta-cognitive awareness about PM task difficulty and about the degree to which cognitive capacity is required to realize the PM task. Results showed that PM retrieval process varied with meta-cognitive awareness (i.e., more resources were allocated if the PM task was expected to be difficult). These results imply that participants' meta-cognitive awareness play an important role in PM retrieval process.

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Earth Science Prospective Teachers' Perceptions on the Relationship between Absolute Humidity and Dew Point Temperature (절대 습도와 이슬점 온도의 관계에 대한 지구과학 예비 교사들의 인식)

  • Kang, So Ra;Seo, Eun-Kyoung;Kim, Dong Young
    • Journal of the Korean earth science society
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    • v.40 no.6
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    • pp.624-638
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    • 2019
  • A questionnaire was administered, and all responses were analyzed to examine prospective teachers' conceptual understanding of the relationship between dew point temperature and absolute humidity in air parcels. The responses revealed that many prospective teachers have substantial misconceptions about the relationship. For example, some thought that the absolute humidity and the dew point temperature are proportional to each other, and that the dew point temperature is proportional to the water vapor mass in the parcel. The misconceptions seemingly stemmed from inadequate descriptions on the relationship in middle-school science textbooks of the 7th and 2007 revised curricula. The study notes that the first year students' textbook of the 2015 revised curriculum introduced the concepts of evaporation, condensation, and volume changes as a function of gaseous pressure and temperature, from a perspective of molecular motion. It is suggested that keeping this perspective in the middle school curriculum, while introducing water vapor pressure as the measure of water vapor amount and dew point temperature, should help prevent middle school teachers and students from having misconceptions. There should be a concerted effort to make the science curriculum more consistent and coherent across the grade levels.

A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study

  • Yeo, Yohwan;Ma, Seung Hyun;Park, Sue Kyung;Chang, Soung-Hoon;Shin, Hai-Rim;Kang, Daehee;Yoo, Keun-Young
    • Journal of Preventive Medicine and Public Health
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    • v.46 no.5
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    • pp.271-281
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    • 2013
  • Objectives: Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea. Methods: The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines. Results: The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ${\leq}5$ hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ${\geq}10$ hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ${\geq}60$ years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ${\leq}5$ hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (${\leq}5$ and ${\geq}10$ hours). Conclusions: Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

The Effect of Encoding strategy and Transfer Appropriate Processing on Prospective Memory Performance (부호화 전략 유형과 동시과제 처리 적절성이 미래계획기억 수행에 미치는 효과)

  • Park, Youngshin
    • Korean Journal of Cognitive Science
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    • v.27 no.1
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    • pp.101-127
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    • 2016
  • The present study was conducted to examine the effect of meta-cognitive strategy and transfer appropriate processing(TAP) on prospective memory performance. In two experiments, encoding strategy for PM target words was manipulated by instructions. Participants who were assigned to meta strategic condition were engaged to rate task difficulty(EOL) in addition to predict their own performance(JOL), while participants in cognitive strategy condition were to remember target words by pleasantness ratings and sentence generation. In experiment1 and experiment 2, all participants in both conditions performed not only TAP ongoing task but also TIP ongoing task. Results revealed the benefit of meta cognition and transfer appropriate processing on PM performance. Furthermore, the benefit of TAP was diminished in cognitive strategy condition. There were no-costs on judgement tasks across conditions. The findings suggest that meta-cognition allows to sustain PM targets and intention without regard to cognitive resource.

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Detection of Circulating Tumor Cells in Breast Cancer Patients: Prognostic Predictive Role

  • Turker, Ibrahim;Uyeturk, Ummugul;Sonmez, Ozlem Uysal;Oksuzoglu, Berna;Helvaci, Kaan;Arslan, Ulku Yalcintas;Budakoglu, Burcin;Alkis, Necati;Aksoy, Sercan;Zengin, Nurullah
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.3
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    • pp.1601-1607
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    • 2013
  • A determination of circulating tumor cell (CTC) effectiveness for prediction of progression-free survival (PFS) and overall survival (OS) was conducted as an adjunct to standard treatment of care in breast cancer management. Between November 2008 and March 2009, 22 metastatic and 12 early stage breast carcinoma patients, admitted to Ankara Oncology Training and Research Hospital, were included in this prospective trial. Patients' characteristics, treatment schedules and survival data were evaluated. CTC was detected twice by CellSearch method before and 9-12 weeks after the initiation of chemotherapy. A cut-off value equal or greater than 5 cells per 7.5 ml blood sample was considered positive. All patients were female. Median ages were 48.0 (range: 29-65) and 52.5 (range: 35-66) in early stage and metastatic subgroups, respectively. CTC was positive in 3 (13.6%) patients before chemotherapy and 6 (27.3%) patients during chemotherapy in the metastatic subgroup whereas positive in only one patient in the early stage subgroup before and during chemotherapy. The median follow-up was 22.0 (range: 21-23) and 19.0 (range: 5-23) months in the early stage and metastatic groups, respectively. In the metastatic group, both median PFS and OS were significantly shorter in any time CTC positive patients compared to CTC negative patients (PFS: 4.0 vs 14.0 months, Log-Rank p=0.013; and OS: 8.0 months vs. 20.5 months, Log-Rank p<0.001). OS was affected from multiple visceral metastatic sites (p=0.055) and higher grade (p=0.044) besides CTC positivity (log rank p<0.001). Radiological response of chemotherapy was also correlated with better survival (p<0.001). As a result, CTC positivity was confirmed as a prospective marker even in a small patient population, in this single center study. Measurement of CTC by CellSearch method in metastatic breast carcinoma cases may allow indications of early risk of relapse or death with even as few as two measurements during a chemotherapy program, but this finding should be confirmed with prospective trials in larger study populations.

Quality Assurance of Gastric Cancer Surgery (위암 수술의 질 관리)

  • Lee Hyuk-Joon;Yang Han-Kwang
    • Journal of Gastric Cancer
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    • v.5 no.2
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    • pp.79-88
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    • 2005
  • Quality assurance may be defined as the complete set of systemic actions that is required to achieve a better treatment result by standardizing treatment and by using various audit programs. In general, application of a quality assurance program in surgery is considered to be more difficult than it is in chemotherapy or radiotherapy. However, recently, the importance of quality assurance in the surgical field has been emphasized in clinical trials comparing different surgical procedures and evaluating the role of postoperative adjuvant therapy. In the case of gastric cancer surgery, excellent quality assurance programs have rarely been applied in most large prospective clinical trials. Although the quality assurance in Dutch trial was conducted very systemically and strictly, the situation is quite different from ours. On the other hand, several quality assurance programs in Japanese trials comparing D2 and D2 plus para-arotic lymph node dissection seem to be applicable to Korean clinical trials. Several factors, including selection of appropriate surgeons based on personal experience and annual number of operations, standardization of surgical procedures by education and consensus, development of a unified database program, application of standardized perioperative management, and standardization of pathologic examination, are required to guarantee a successful multi-institutional prospective clinical trial. In contrast, one needs to realize that protocols that are too strict and sophisticated can make the enrollment of patients and surgeons more difficult and can promote protocol violation during the clinical trials. (J Korean Gastric Cancer Assoc 2005;5:79-88)

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