• 제목/요약/키워드: A protocol for follow-up

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Neuroblastoma in Iran: An Experience of 32 Years at a Referral Childrens Hospital

  • Mehdiabadi, Gholamreza Bahoush;Arab, Elaheh;Rafsanjani, Khadijeh Arjmandi;Ansari, Shahla;Moinzadeh, Amir Majid
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.2739-2742
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    • 2013
  • Background: This survey aim was to evaluate the epidemiology and outcomes of neuroblastoma patients in one the most important children referral hospitals in Iran as a model from developing countries. Materials and Methods: This retrospective, non-randomized analytic study was conducted on 219 newly diagnosed neuroblastoma cases. Results: The age of patients ranged from 1-156 months with the average of $40.5{\pm}2.44$, with a male/female ratio of 1.9/1. Of the total, 172 (78.5%) were children and 47 (21.5%) were infants The adrenals were the most common primary site (60%). Stage 4 at diagnosis accounted for about 54% of all enrolled patients. Infants had significantly better cumulative survival ($85{\pm}8%$) than children ($33{\pm}7%$) during the follow up period and the survival rate improved from $33{\pm}7%$ in 1974-1994 to $58{\pm}9%$ in 1995-2005. Conclusions: This study indicates that our patient population with neuroblastomas tends to have more advanced disease, perhaps with poor biologic markers, but our analysis shows that the outcomes have improved over 32 years although the overall survival of Iranian neuroblastoma patients is still lower than developed countries. Late diagnosis, inability to determine risk group during the years of study and using single protocol for all enrolled patients can be the reasons of lower survival rate.

Traumatic degloving injuries: a prospective study to assess injury patterns, management, and outcomes at a single center in northern India

  • Divij Jayant;Atul Parashar;Ramesh Sharma
    • Journal of Trauma and Injury
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    • v.36 no.4
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    • pp.385-392
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    • 2023
  • Purpose: This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. Methods: A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Results: Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. Conclusions: DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

Preliminary Results of Concurrent Radiation Therapy and Chemotherapy in Locally Advanced Cervical Carcinoma (국소적으로 진행된 자궁 경부암에서 방사선과 항암화학요법 병행치료의 예비적 결과)

  • Yang KM;Ahn SD;Choi EK;Chang HS;Kim YT;Nam JH;Mok JE
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.355-361
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    • 1993
  • Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIIB. 5-FU (1000 $mg/m^2/24hr$ for 96 hour iv infusion) and Cis-platinum (20 $mg/m^2/day$ IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HDR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB,4 stage IIIB,2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than $10\%$ of initial weight. One patient developed grade 3 leukopenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in $62\%(8/13)$ and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

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Role of HER2 in Brain Metastasis of Breast Cancer: a Systematic Review and Meta-Analysis

  • Hedayatizadeh-Omran, Akbar;Rafiei, Alireza;Alizadeh-Navaei, Reza;Tehrani, Mohsen;Valadan, Reza;Moradzadeh, Kambiz;Panbechi, Mohammad;Taghavi, Seyed Mehdi
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.4
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    • pp.1431-1434
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    • 2015
  • Background: Breast cancer is one of the most common cancers among women worldwide and the HER2 receptor plays an important role in its development and progression. This systematic review aimed to summarize the role of HER2 in brain metastasis in patients with breast cancer. Materials and Methods: We conducted a literature search by advanced search in title field using the Scopus, Pubmed, and Google scholar databases until the end of June 2014. With metastasis, metastatic, HER2, brain, and breast cancer, as terms of search we selected 31 articles, which were reviewed by two independent and blinded expert reviewers. The studies were first selected according to their titles and abstracts. Quality of the studies were then assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) protocol for observational studies and CONSORT(Consolidation of Standards for Reporting Trials) protocol for clinical trials. For statistical analyses, we used STATA, version 11.0 software. Forest and funnel diagrams were drawn and for heterogeneity, index was also considered. Also we used meta regression analysis. Results: Finally, we reviewed 10 studies. The prevalence of brain metastasis in HER2-positive breast cancer patients was 24.9%. There was publication bias in the reviewed studies. Meta regression analysis showed that follow up time had no significant effect (p=0.396) on the prevalence of brain metastasis. Conclusions: The results showed a high prevalence of brain metastasis in HER2 positive breast cancer patients.

Cancer Patients' Needs When Chemotherapy Ends (항암화학요법 종료 시기 암환자의 요구)

  • Han, Kyung-Ja;Lee, Eun-Ok;Kim, Mae-Ja;Park, Young-Sook;Hah, Yang-Sook;Song, Mi-Soon;Chung, Chae-Weon;Park, Sung-Hee;Kim, Bo-Yul
    • Asian Oncology Nursing
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    • v.5 no.2
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    • pp.107-115
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    • 2005
  • Purpose: The present study was designed to identify cancer patients' needs when chemotherapy ends. Method: In-depth interview with focus questions was applied for the study. The participants were recruited from the patients receiving cancer chemotherapy in a university hospital. They were seven cancer patients with stomach cancer and two with liver cancer at the ending period of their chemotherapy protocol. Participants were interviewed on discharge date of last treatment and when they returned for the first outpatient follow-up. The focus question was 'what are your needs at this point?' The interviews were audio-taped and transcribed before analysis. The data were analyzed for common categories, special analytic categories, and conceptual categories. Results: Thirty two common categories, ten special analytic categories, and six conceptual categories were identified as patient's needs. The six conceptual categories were comfort needs, social needs, information needs, humanism needs, environmental needs, and self-efficacy needs. Conclusion: There were characteristic specific patients' needs when chemotherapy ends. There are needs to develop and to apply nursing intervention for cancer patients.

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Protocol of a Nationwide Observational Study among Patients with Nontuberculous Mycobacterium Pulmonary Disease in South Korea (NTM-KOREA)

  • Kwak, Nakwon;Choi, Hongjo;Jeon, Doosoo;Jhun, Byung Woo;Jo, Kyung-Wook;Kang, Young Ae;Kwon, Yong-Soo;Lee, Myungsun;Mok, Jeongha;Shim, Tae-Sun;Shin, Hong-Joon;Whang, Jake;Yim, Jae-Joon
    • Tuberculosis and Respiratory Diseases
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    • v.83 no.2
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    • pp.141-146
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    • 2020
  • Background: The burden of nontuberculous mycobacterial (NTM) pulmonary disease (PD) is increasing globally. To understand the treatment outcomes and prognosis of NTM-PD, a unified registry is needed. In this project, we aim to construct a multicenter prospective observational cohort with NTM-PD in South Korea (NTM-KOREA). Methods: The primary objective of this study is to analyze treatment outcomes according to the species. In addition, recurrence rate, adverse events, the impact of each drug on treatment outcomes as well as the impact of characteristics of mycobacteriology will be analyzed. The inclusion criteria for the study are as follows: fulfilling the criteria for NTM-PD having one of the following etiologic organisms: Mycobacterium avium complex, M. abscessus subspecies abscessus, M. abscessus subspecies massiliense, or M. kansasii; receiving the first treatment for NTM-PD after enrollment; age >20 years; and consenting to participate in the study. Seven institutions will participate in patient enrollment and about 500 patients are expected to be enrolled. Participants will be recruited from 1 March 2020 until 19 March 2024 and will be observed through 19 March 2029. During the follow-up period, participants' clinical course will be tracked and their clinical data as well as NTM isolates will be collected. Conclusion: NTM-KOREA will be the first nationwide observational cohort for NTM-PD in South Korea. It will provide the information to optimize treatment modalities and will contribute to deeper understanding of the treatment outcomes and long-term prognosis of patients with NTM-PD in South Korea.

MALIGNANT FIBROUS HISTIOCYTOMA OF THE MAXILLA ; REPORT OF A CASE (상악골에 발생한 악성섬유성조직구종)

  • Ryu, Sun-Youl;Park, Suk-In;Lee, Jin-Hwan;Chung, Mu-Gang;Chung, Jong-Chull;Choi, Hong-Ran
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.14 no.1_2
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    • pp.117-123
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    • 1992
  • Malignant fibrous histiocytoma rarely occurs in the jaws. A case of malignant fibrous histiocytoma originated from the maxillary sinus is reported with review of literature. A 59-year-old woman visited the Chonnam University Hospital in March, 1990, with chief complaint of swelling and tenderness in the right cheek. Radiographic findings revealed wide destruction of the maxilla. The biopsy taken from the maxilla showed histopatholgic findings of malignant fibrous histiocytoma. Accordingly the patient received preoperative and postoperative anticancer chemotherapy by the modified CY-VA-DIC protocol of the Southwest Oncology Group (SWOG). Preoperative and postoperative radiotherapy were also given to her in total 40Gy of $^{60}Co$ And she underwent radical resection of the maxilla. No evidence of recurrence or metastasis was shown for 2-year period of postoperative follow up.

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Controlled active exercise after open reduction and internal fixation of hand fractures

  • Jun, Dongkeun;Bae, Jaehyun;Shin, Donghyeok;Choi, Hyungon;Kim, Jeenam;Lee, Myungchul
    • Archives of Plastic Surgery
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    • v.48 no.1
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    • pp.98-106
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    • 2021
  • Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes. Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed. Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up. Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

Correlation Analysis on the Duration and CO2 Emission Following the Earth-work Equipment Combination (토공장비조합에 따른 공사기간 및 이산화탄소 배출량의 상관성 분석)

  • Kim, Byungsoo
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.31 no.4D
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    • pp.603-611
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    • 2011
  • After Kyoto Protocol was adopted for green gas reduction, each nations are stepping up efforts to reduce $CO_2$ of a typical green gas. Construction industry also is trying $CO_2$ reduction with the techniques of two types which are software and hardware techniques. The software technique are Passive Design considered green gas emission and the environment impact assessment by LCA. The hardware techniques are adjustment of equipment system and development of eco- friendly material. But, it is nonexistent that a study related to $CO_2$ emission considered detail process in construction industry. This study analyzed the correlation of equipment combination, $CO_2$ emission and duration by calculate $CO_2$ emission follow to equipment combination on earth-work which is the process emitted most $CO_2$ among railway bedding construction.

Impact of Transcranial Direct Current Stimulation Combined With Constraint-Induced Movement Therapy on Upper Limb Function in Chronic Stroke: A Systematic Review (뇌졸중 환자의 상지기능 향상을 위한 경두개 직류 자극과 강제 유도 운동 치료의 결합 중재 효과에 대한 체계적 고찰)

  • Kim, Sun-Ho
    • Therapeutic Science for Rehabilitation
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    • v.8 no.4
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    • pp.7-18
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    • 2019
  • Objective : This systematic review aimed to investigate the impact of transcranial direct current stimulation combined with constraint-induced movement therapy (CIMT) in patients with stroke Methods : PubMed and NDSL databases were employed to review literature published between January 2009 and December 2018. The main search terms were "Transcranial direct current stimulation" or "tDCS," "Constraint-induced movement therapy" or "CIMT," "Upper extremity function," "Upper limb," and "Stroke." Based on the inclusion and exclusion criteria, 6 articles were selected. Furthermore, intervention effects on upper extremity function, activities of daily living, and cortical activity were assessed. Results : The current intensity, application time, and protocol of the CIMT varied the between studies. However, the intervention procedures to perform CIMT immediately after transcranial direct current stimulation was the same. Transcranial direct current stimulation combined with CIMT was effective in improving upper limb function and activities of daily living in patients with stoke and had a significant effect on cerebral cortex activation. Conclusions : This study provides information on transcranial direct current stimulation combined with CIMT for use by clinical therapists. Further studies are needed to standardize the stimulation time, current intensity, and electrode attachment position. Furthermore, randomized controlled trials, including long-term follow up, are needed for larger populations using the most appropriate CIMT protocol.