• Title/Summary/Keyword: Early Tertiary

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Roles of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in the Early Diagnosis of Malignant Ovarian Masses

  • Yildirim, Mem Arjen;Seckin, Kerem Doga;Togrul, Cihan;Baser, Eralp;Karsli, Mehmet Fatih;Gungor, Tayfun;Gulerman, Hacer Cavidan
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.16
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    • pp.6881-6885
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    • 2014
  • Background: The present study aimed to investigate the utility and importance of the various parameters of complete blood count panel for benign-malignant differentiation of adnexal masses. Materials and Methods: This retrospective study involved 316 patients with documented benign and 253 patients with malignant adnexal masses who underwent primary surgical treatment at a tertiary referral center. Prior to the study, all benign and malignant cases were compared within their own groups and then the benign and malignant cases were compared to each other. For all cases, cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), neutrophil, lymphocyte, platelet and CA-125 parameters, and the results were compared in regards to the groups. Results: NLR, PLR, neutrophil, CA-125, and platelet values were higher in the malignant compared to the benign cases (p<0.01). The lymphocyte value was lower in the malignant cases (p<0.01). No significant differences were found for basophils and eosinophils (p > 0.05). For CA-125, the sensitivity, specificity, PPV and NPV for all cases were 78%, 62%, 62% and 78%, respectively. For NLR, they were 65.6%, 72.1%, 65.3%, and 72.3%, and for PLR, 48%, 81%, 67%, and 66%. Additionally, the sensitivity and specificity were 55% and 77% for CA-125, 66% and 58% for NLR, and 61% and 58% for PLR in early malignant cases. Conclusions: NLR and PLR appear to be useful methods that can be applied together with CA-125 due to the relatively high sensitivity values for the malign-benign differentiation of ovarian masses. Although the specificity of these parameters is lower than CA-125, especially in cases with early malignant ovarian pathology, their sensitivity being higher is promising for the early diagnosis of ovarian cancer. It can be used to detect ovarian malignancies in the early stages, and it will increase the treatment options and improve survival rates.

Sperm-Associated Antigen 9 is a Promising marker for Early Diagnosis of Endometrial Cancer

  • Baser, Eralp;Togrul, Cihan;Ozgu, Emre;Ayhan, Sevgi;Caglar, Mete;Erkaya, Salim;Gungor, Tayfun
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7635-7638
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    • 2013
  • Background: Sperm-associated antigen 9 (SPAG9) has been recently proposed as a novel biomarker for early diagnosis of several human tumors, including ovarian, cervical and breast cancers. Its clinical value remains to be clarified for endometrial cancer (EC). In this study, we investigated the utility of serum SPAG9 levels in diagnosis of EC and its association with important clinicopathological parameters. Materials and Methods: This cross-sectional study was performed at a tertiary women's referral center in Ankara, Turkey. Preoperative serum samples were collected from patients surgically treated for endometrial cancer between June 2012-April 2013. Similar aged women with a biopsy proven benign endometrium were used as controls. Serum SPAG9 levels were measured with an enzyme-linked immunosorbent assay (ELISA) method and assessed for links with clinicopathological factors. Receiver operating characteristic (ROC) curve analysis was performed to assess power of SPAG9 levels for EC prediction. P values less than 0.05 were considered statistically significant. Results: A total of 63 women with EC and 27 with benign endometrium were included in the study. Mean age in the EC group was $58.7{\pm}1.1$. Median SPAG9 levels in the EC and control groups were 18.3 (range, 12.7-53.8) and 14.1 (range, 4.3-65.3), respectively (p<0.001). A cut-off value of 17 ng/ml for SPAG9 predicted presence of malignant endometrium with 74% sensitivity and 83% specificity [Area under curve (AUC)=0.82, p<0.001]. SPAG9 levels did not demonstrate any significant association with histological type, FIGO stage, tumor grade, size, myometrial invasion, lymphovascular space invasion, cervical involvement, adnexal involvement, peritoneal cytology or lymph node status (all p>0.05). Conclusions: Testing for SPAG9 may be useful for early detection of EC in asymptomatic high-risk women. Its role in post-treatment follow-up and early detection of recurrence should be assessed in future trials.

Effect of Comprehensive Breast Care on Breast Cancer Outcomes: A Community Hospital Based Study from Mumbai, India

  • Gadgil, Anita;Roy, Nobhojit;Sankaranarayanan, Rengaswamy;Muwonge, Richard;Sauvaget, Catherine
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.4
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    • pp.1105-1109
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    • 2012
  • Breast cancer is the second most common cancer in women in India and the disease burden is increasing annually. The lack of awareness initiatives, structured screening, and affordable treatment facilities continue to result in poor survival. We present a breast cancer survival scenario, in urban population in India, where standardised care is distributed equitably and free of charge through an employees' healthcare scheme. We studied 99 patients who were treated at our hospital during the period 2005 to 2010 and our follow-up rates were 95.95%. Patients received evidence-based standardised care in line with the tertiary cancer centre in Mumbai. One-, three- and five-year survival rates were calculated using Kaplan-Meier method. Socio-demographic, reproductive and tumor factors, relevant to survival, were analysed. Mortality hazard ratios (HR) were calculated using Cox proportional hazard method. Survival in this series was compared to that in registries across India and discrepancies were discussed. Patients mean age was 56 years, mean tumor size was 3.2 cms, 85% of the tumors belonged to T1 and T2 stages, and 45% of the patients belonged to the composite stages I and IIA. Overall 5-year survival was 74.9%. Patients who presented with large-sized tumors (HR 3.06; 95% CI 0.4-9.0), higher composite stage (HR 1.91; 0.55-6.58) and undergone mastectomy (HR 2.94; 0.63-13.62) had a higher risk of mortality than women who had higher levels of education (HR 0.25; 0.05-1.16), although none of these results reached the significant statistical level. We observed 25% better survival compared to other Indian populations. Our results are comparable to those from the European Union and North America, owing to early presentation, equitable access to standardised free healthcare and complete follow-up ensured under the scheme. This emphasises that equitable and affordable delivery of standardised healthcare can translate into early presentation and better survival in India.

The Mineralogical and Geochemical Study on Korean Scheelites and its Application to the Ore Prospecting (한국산 灰重石鑛의 광물학적, 지화학적 연구 및 그의 探査에의 이용)

  • So, Chil-Sup;Park, Maeng-Eon
    • Economic and Environmental Geology
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    • v.12 no.2
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    • pp.79-93
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    • 1979
  • Twenty five samples of the scheelite-powellite series from twelve Korean tungsten deposits of various geologic settings were studied mineralogically and geochemically. Variations in the trace-element contents of the scheelite minerals are considered in relation to geologic settings and mineralogic properties. Scheelites from ore deposits developed in similar geologic settings and under similar physicochemical conditions are characterized by specific combinations of trace elements.

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Ultrastructural Studies on Oocyte Development and Vitellogenesis in Oocytes During Oogenesis in Female Pampus echinogaster in western Korea (한국 서해산 암컷 덕대 Pampus echinogaster (Basilewsky)의 난형성과정 중 난모세포 발달과 난모세포 내에서의 난황형성과정에 관한 미세구조적 연구)

  • KIM, Sung-Han
    • Journal of Fisheries and Marine Sciences Education
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    • v.28 no.5
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    • pp.1231-1243
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    • 2016
  • The ultrastructural study on oocyt development and the process of vitellogensis in the oocytes during oogenesis in female Pampus echinogaster were investigated by electron microscope observations. In the previtellogenic phase, in particular, several intermitochondrial cements appear in the cytoplasms of the chromatin nucleleolus oocyte and perinuclear oocyte. The number of intermitochondrial cements are associated with the multiplication of the number of mitochondria in the early developmental stage. In the early vitellogenic phase, the Golgi complex in the cytoplasm of the yolk vesicle oocyte is involved in the formation of yolk vesicles containing carbohydrate yolks. At this time, many pinocytotic vesicles containing yolk precursors (exogenous substances) by pinocytosis are observed in the cytoplasm near the region of initial formation of the zona pellucida. In the late vitellogenic phase, two morphological different bodies, which formed by the modified mitochondria, appeared remarkably in the yolked oocytes. The one is the multivesicular bodies and another is yolk precursors. The multivesicular bodies were transformed into the primary yolk globules, while yolk precursors were connected with exogeneous pinocytotic vesicles near the zona pellucida. After the pinocytotic vesicles were taken into yolk precursors, the yolk precursors were transformed into the primary yolk globules. Thereafter, primary yolk globules mixed with each other, eventually, they developed into secondary and tertiary yolk globules. In this study, vitellogenesis of this species occurred by way of endogenous autosynthesis and exogenous heteogenesis. Vitellogenesis occurred through the processes of endogeneous autosynthesis, involving the combined activity of the Golgi complex, mitochondria and multivesicular bodies formed by modified mitochondria. However, the process of heterosynthesis involved pinocytotic incorporation of extraovarian precursors (such as vitellogenin in the liver) into the zona pellucida (by way of granulosa cells and thecal cells) of vitellogenic oocytes.

Assessment of early nutritional state in critical patients with intoxication and the effect of nutritional status on prognosis (중독 중환자에서의 초기 영양상태평가와 예후와의 관계)

  • Ko, Dong-wan;Choi, Sangcheon;Min, Young-gi;Lee, Hyuk jin;Park, Eun Jung
    • Journal of The Korean Society of Clinical Toxicology
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    • v.19 no.2
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    • pp.93-99
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    • 2021
  • Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis. Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled. Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge. Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.

Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma

  • Park, Jung Yun;Kim, Myoung Jun;Lee, Jae Gil
    • Journal of Trauma and Injury
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    • v.32 no.1
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    • pp.26-31
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    • 2019
  • Purpose: Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ${\geq}5,000$) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1-3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods: We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ${\geq}1,000U/L$ and ${\geq}5,000U/L$, respectively. The diagnosis of AKI was based on RIFLE criteria. Results: The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions: Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.

Early initiation of breastfeeding and factors associated with its delay among mothers at discharge from a single hospital

  • Mary, J. Jenifer Florence;Sindhuri, R.;Kumaran, A. Arul;Dongre, Amol R.
    • Clinical and Experimental Pediatrics
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    • v.65 no.4
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    • pp.201-208
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    • 2022
  • Background: According to the National Family Health Survey-4, in India, 78.9% of deliveries occur in institutions, although only 42.6% of new mothers initiate breastfeeding within 1 hour of delivery. Purpose: To estimate the proportion of early initiation of breastfeeding (EIBF) among new mothers at discharge from a tertiary care hospital and identify the determinants of delayed initiation of breastfeeding among them. Methods: This was a hospital-based analytical cross-sectional study of 108 new mothers. After obtaining Institutional Review Board approval and informed consent, we interviewed the new mothers on the day of discharge. Multivariate logistic regression was performed using IBM SPSS Statistics ver. 24. Results: The median breastfeeding initiation time was 90 minutes (interquartile range, 30-180 minutes). Overall, 43.5% of the mothers practiced EIBF, 77.4% practiced exclusive breastfeeding, and 43.5% were rooming in at discharge. Reasons for breastfeeding delays included extended recovery time from spinal anesthesia, maternal lassitude, and uncomfortable breastfeeding position due to post-cesarean pain. In the multivariate analysis, a birth weight less than 2,500 g (adjusted odds ratio [aOR], 4.33; 95% confidence interval [CI], 1.12-16.82; P=0.03), cesarean section delivery (aOR, 4.68; 95% CI, 1.57-13.92; P=0.005), and mother's poor knowledge of breastfeeding (aOR, 4.61; 95% CI, 1.44-14.72; P=0.010) were more likely to delay the initiation of breastfeeding. Conclusion: EIBF was practiced by less than half of the new mothers as determined by the cesarean section, baby's birth weight, and mothers' awareness of breastfeeding. Thus, it is vital to improve breastfeeding and nutritional counseling among mothers during the antenatal period and improve healthcare professionals' training to facilitate EIBF, even in circumstances such as cesarean section.

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

  • Bin Chet Toh;Jingli Chong;Baldwin PM Yeung;Chin Hong Lim;Eugene KW Lim;Weng Hoong Chan;Jeremy TH Tan
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.401-407
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    • 2022
  • Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Ultrastructural Studies on Oocyte Development and Vitellogenesis During Oogenesis in Female Boleophthalmus pectinirostris

  • Chung, Ee-Yung;Choi, Ki-Ho;Jun, Je-Cheon;Choi, Moon-Sul;Lee, Ki-Young
    • Animal cells and systems
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    • v.13 no.1
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    • pp.49-57
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    • 2009
  • For the study of the reproductive mechanism associated with the process of vitellogenesis, oocyte development and vitellogenesis during oogenesis in female Boleophthalmus pectinirostris were investigated by electron microscopic observations. The ovary consists of a pair of saccular structures with many ovarian lobules. In the early vitellogenic oocyte, the Golgi complex plays an important role leading to the formation of yolk vesicles containing carbohydrate yolks. At this time many pinocytotic vesicles containing yolk precursors are observed in the cytoplasm near the region of initial formation of the zona radiata. In the late vitellogenic oocytes, the multivesicular bodies, which are formed by modified mitochondria, are involved in the formation of the primary yolk granules. Precursors of yolk granules and multivesicular bodies develop to primary yolk globules with participation of pinocytotic vesicles. After primary yolk globules mix with each other, they develop into secondary and tertiary yolk globules. Based on these findings, vitellogenesis of B. pectinirostris occurs by way of the processes of endogenous autosynthesis and exogenous heterosynthesis. The process of autosynthesis involves the combined activity of the Golgi complex, mitochondria, and multivesicular bodies. However, the process of heterosynthesis involves pinocytotic incorporation of extraovarian precursors into the zona radiata of vitellogenic oocytes by way of the thecal cell layers and granulosa cells.