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First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

  • Jang-Hyun Baek;Byung Moon Kim;Sang Hyun Suh;Hong-Jun Jeon;Eun Hyun Ihm;Hyungjong Park;Chang-Hyun Kim;Sang-Hoon Cha;Chi-Hoon Choi;Kyung Sik Yi;Jun-Hwee Kim;Sangil Suh;Byungjun Kim;Yoonkyung Chang;So Yeon Kim;Jae Sang Oh;Ji Hoe Heo;Dong Joon Kim;Hyo Suk Nam;Young Dae Kim
    • Korean Journal of Radiology
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    • v.24 no.2
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    • pp.145-154
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    • 2023
  • Objective: We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. Materials and Methods: In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months. Results: Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004). Conclusion: Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.

Tokamak plasma disruption precursor onset time study based on semi-supervised anomaly detection

  • X.K. Ai;W. Zheng;M. Zhang;D.L. Chen;C.S. Shen;B.H. Guo;B.J. Xiao;Y. Zhong;N.C. Wang;Z.J. Yang;Z.P. Chen;Z.Y. Chen;Y.H. Ding;Y. Pan
    • Nuclear Engineering and Technology
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    • v.56 no.4
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    • pp.1501-1512
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    • 2024
  • Plasma disruption in tokamak experiments is a challenging issue that causes damage to the device. Reliable prediction methods are needed, but the lack of full understanding of plasma disruption limits the effectiveness of physics-driven methods. Data-driven methods based on supervised learning are commonly used, and they rely on labelled training data. However, manual labelling of disruption precursors is a time-consuming and challenging task, as some precursors are difficult to accurately identify. The mainstream labelling methods assume that the precursor onset occurs at a fixed time before disruption, which leads to mislabeled samples and suboptimal prediction performance. In this paper, we present disruption prediction methods based on anomaly detection to address these issues, demonstrating good prediction performance on J-TEXT and EAST. By evaluating precursor onset times using different anomaly detection algorithms, it is found that labelling methods can be improved since the onset times of different shots are not necessarily the same. The study optimizes precursor labelling using the onset times inferred by the anomaly detection predictor and test the optimized labels on supervised learning disruption predictors. The results on J-TEXT and EAST show that the models trained on the optimized labels outperform those trained on fixed onset time labels.

Effects of open-field summer warming and drought on the abnormal shoot growth of Pinus densiflora seedlings (실외 여름철 온난화 및 가뭄 처리가 소나무 묘목의 이상생장 반응에 미치는 영향)

  • Heejae Jo;Jieun Park;Jinseo Kim;Gwang-Jung Kim;Gaeun Kim;Hyung-Sub Kim;Yowhan Son
    • Korean Journal of Environmental Biology
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    • v.41 no.4
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    • pp.473-481
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    • 2023
  • Pinus densiflora is a fixed-growth coniferous species that elongates its shoot once a year and finishes growing in early summer. However, it may produce additional shoots in the same year in response to external stimuli, called abnormal shoot growth. This study investigated the effects of open-field summer warming and drought on the abnormal shoot growth of P. densiflora seedlings. In March 2022, two factorial combinations were constructed, including two temperature treatments (control and 4℃ increase) and two precipitation treatments (control and drought), with five replicates for each combination. The temperature treatment was performed for 87 days from May 14 to August 8, 2022, and the precipitation treatment was performed for 33 days from May 14 to June 15, blocking 100% of the ambient rainfall. The abnormal shoot occurrence rate and leaf unfolding stages were measured in November, and the shoot and root collar diameter growth rates were calculated by comparing the seedling height and root collar diameter measured in August(after the cessation of treatment) and October(after the end of growing period) with the initial values (i.e., May 2022). The abnormal shoot occurrence rate significantly increased under the warming treatment, showing a 410.6% increase in the warming plots (38.4%) compared to the control plots (7.5%). There was no significant difference in the shoot and root collar diameter growth rate regarding warming and drought treatments. Abnormal shoots may have been affected by high temperatures by inducing early transition to the next ontogenetic stage.

A Thermal Time-Driven Dormancy Index as a Complementary Criterion for Grape Vine Freeze Risk Evaluation (포도 동해위험 판정기준으로서 온도시간 기반의 휴면심도 이용)

  • Kwon, Eun-Young;Jung, Jea-Eun;Chung, U-Ran;Lee, Seung-Jong;Song, Gi-Cheol;Choi, Dong-Geun;Yun, Jin-I.
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.8 no.1
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    • pp.1-9
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    • 2006
  • Regardless of the recent observed warmer winters in Korea, more freeze injuries and associated economic losses are reported in fruit industry than ever before. Existing freeze-frost forecasting systems employ only daily minimum temperature for judging the potential damage on dormant flowering buds but cannot accommodate potential biological responses such as short-term acclimation of plants to severe weather episodes as well as annual variation in climate. We introduce 'dormancy depth', in addition to daily minimum temperature, as a complementary criterion for judging the potential damage of freezing temperatures on dormant flowering buds of grape vines. Dormancy depth can be estimated by a phonology model driven by daily maximum and minimum temperature and is expected to make a reasonable proxy for physiological tolerance of buds to low temperature. Dormancy depth at a selected site was estimated for a climatological normal year by this model, and we found a close similarity in time course change pattern between the estimated dormancy depth and the known cold tolerance of fruit trees. Inter-annual and spatial variation in dormancy depth were identified by this method, showing the feasibility of using dormancy depth as a proxy indicator for tolerance to low temperature during the winter season. The model was applied to 10 vineyards which were recently damaged by a cold spell, and a temperature-dormancy depth-freeze injury relationship was formulated into an exponential-saturation model which can be used for judging freeze risk under a given set of temperature and dormancy depth. Based on this model and the expected lowest temperature with a 10-year recurrence interval, a freeze risk probability map was produced for Hwaseong County, Korea. The results seemed to explain why the vineyards in the warmer part of Hwaseong County have been hit by more freeBe damage than those in the cooler part of the county. A dormancy depth-minimum temperature dual engine freeze warning system was designed for vineyards in major production counties in Korea by combining the site-specific dormancy depth and minimum temperature forecasts with the freeze risk model. In this system, daily accumulation of thermal time since last fall leads to the dormancy state (depth) for today. The regional minimum temperature forecast for tomorrow by the Korea Meteorological Administration is converted to the site specific forecast at a 30m resolution. These data are input to the freeze risk model and the percent damage probability is calculated for each grid cell and mapped for the entire county. Similar approaches may be used to develop freeze warning systems for other deciduous fruit trees.

Estimation of SCS Runoff Curve Number and Hydrograph by Using Highly Detailed Soil Map(1:5,000) in a Small Watershed, Sosu-myeon, Goesan-gun (SCS-CN 산정을 위한 수치세부정밀토양도 활용과 괴산군 소수면 소유역의 물 유출량 평가)

  • Hong, Suk-Young;Jung, Kang-Ho;Choi, Chol-Uong;Jang, Min-Won;Kim, Yi-Hyun;Sonn, Yeon-Kyu;Ha, Sang-Keun
    • Korean Journal of Soil Science and Fertilizer
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    • v.43 no.3
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    • pp.363-373
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    • 2010
  • "Curve number" (CN) indicates the runoff potential of an area. The US Soil Conservation Service (SCS)'s CN method is a simple, widely used, and efficient method for estimating the runoff from a rainfall event in a particular area, especially in ungauged basins. The use of soil maps requested from end-users was dominant up to about 80% of total use for estimating CN based rainfall-runoff. This study introduce the use of soil maps with respect to hydrologic and watershed management focused on hydrologic soil group and a case study resulted in assessing effective rainfall and runoff hydrograph based on SCS-CN method in a small watershed. The ratio of distribution areas for hydrologic soil group based on detailed soil map (1:25,000) of Korea were 42.2% (A), 29.4% (B), 18.5% (C), and 9.9% (D) for HSG 1995, and 35.1% (A), 15.7% (B), 5.5% (C), and 43.7% (D) for HSG 2006, respectively. The ratio of D group in HSG 2006 accounted for 43.7% of the total and 34.1% reclassified from A, B, and C groups of HSG 1995. Similarity between HSG 1995 and 2006 was about 55%. Our study area was located in Sosu-myeon, Goesan-gun including an approx. 44 $km^2$-catchment, Chungchungbuk-do. We used a digital elevation model (DEM) to delineate the catchments. The soils were classified into 4 hydrologic soil groups on the basis of measured infiltration rate and a model of the representative soils of the study area reported by Jung et al. 2006. Digital soil maps (1:5,000) were used for classifying hydrologic soil groups on the basis of soil series unit. Using high resolution satellite images, we delineated the boundary of each field or other parcel on computer screen, then surveyed the land use and cover in each. We calculated CN for each and used those data and a land use and cover map and a hydrologic soil map to estimate runoff. CN values, which are ranged from 0 (no runoff) to 100 (all precipitation runs off), of the catchment were 73 by HSG 1995 and 79 by HSG 2006, respectively. Each runoff response, peak runoff and time-to-peak, was examined using the SCS triangular synthetic unit hydrograph, and the results of HSG 2006 showed better agreement with the field observed data than those with use of HSG 1995.

Business Relationships and Structural Bonding: A Study of American Metal Industry (산업재 거래관계와 구조적 결합: 미국 금속산업의 분석 연구)

  • Han, Sang-Lin;Kim, Yun-Tae;Oh, Chang-Yeob;Chung, Jae-Moon
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.3
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    • pp.115-132
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    • 2008
  • Metal industry is one of the most representative heavy industries and the median sales volume of steel and nonferrous metal companies is over one billion dollars in the case America [Forbes 2006]. As seen in the recent business market situation, an increasing number of industrial manufacturers and suppliers are moving from adversarial to cooperative exchange attitudes that support the long-term relationships with their customers. This article presents the results of an empirical study of the antecedent factors of business relationships in metal industry of the United States. Commitment has been reviewed as a significant and critical variable in research on inter-organizational relationships (Hong et al. 2007, Kim et al. 2007). The future stability of any buyer-seller relationship depends upon the commitment made by the interactants to their relationship. Commitment, according to Dwyer et al. [1987], refers to "an implicit or explicit pledge of relational continuity between exchange partners" and they consider commitment to be the most advanced phase of buyer-seller exchange relationship. Bonds are made because the members need their partners in order to do something and this integration on a task basis can be either symbiotic or cooperative (Svensson 2008). To the extent that members seek the same or mutually supporting ends, there will be strong bonds among them. In other words, the principle that affects the strength of bonds is 'economy of decision making' [Turner 1970]. These bonds provide an important idea to study the causes of business long-term relationships in a sense that organizations can be mutually bonded by a common interest in the economic matters. Recently, the framework of structural bonding has been used to study the buyer-seller relationships in industrial marketing [Han and Sung 2008, Williams et al. 1998, Wilson 1995] in that this structural bonding is a crucial part of the theoretical justification for distinguishing discrete transactions from ongoing long-term relationships. The major antecedent factors of buyer commitment such as technology, CLalt, transaction-specific assets, and importance were identified and explored from the perspective of structural bonding. Research hypotheses were developed and tested by using survey data from the middle managers in the metal industry. H1: Level of technology of the relationship partner is positively related to the level of structural bonding between the buyer and the seller. H2: Comparison level of alternatives is negatively related to the level of structural bonding between the buyer and the seller. H3: Amount of the transaction-specific assets is positively related to the level of structural bonding between the buyer and the seller. H4: Importance of the relationship partner is positively related to the level of structural bonding between the buyer and the seller. H5: Level of structural bonding is positively related to the level of commitment to the relationship. To examine the major antecedent factors of industrial buyer's structural bonding and long-term relationship, questionnaire was prepared, mailed out to the sample of 400 purchasing managers of the US metal industry (SIC codes 33 and 34). After a follow-up request, 139 informants returnedthe questionnaires, resulting in a response rate of 35 percent. 134 responses were used in the final analysis after dropping 5 incomplete questionnaires. All measures were analyzed for reliability and validity following the guidelines offered by Churchill [1979] and Anderson and Gerbing [1988]., the results of fitting the model to the data indicated that the hypothesized model provides a good fit to the data. Goodness-of-fit index (GFI = 0.94) and other indices ( chi-square = 78.02 with p-value = 0.13, Adjusted GFI = 0.90, Normed Fit Index = 0.92) indicated that a major proportion of variances and covariances in the data was accounted for by the model as a whole, and all the parameter estimates showed statistical significance as evidenced by large t-values. All the factor loadings were significantly different from zero. On these grounds we judged the hypothesized model to be a reasonable representation of the data. The results from the present study suggest several implications for buyer-seller relationships. Theoretically, we attempted to conceptualize the antecedent factors of buyer-seller long-term relationships from the perspective of structural bondingin metal industry. The four underlying determinants (i.e. technology, CLalt, transaction-specific assets, and importance) of structural bonding are very critical variables of buyer-seller long-term business relationships. Our model of structural bonding makes an attempt to systematically examine the relationship between the antecedent factors of structural bonding and long-term commitment. Managerially, this research provides industrial purchasing managers with a good framework to assess the interaction processes with their partners and, ability to position their business relationships from the perspective of structural bonding. In other words, based on those underlying variables, industrial purchasing managers can determine the strength of the company's relationships with the key suppliers and its state of preparation to be a successful partner with those suppliers. Both the supplying and customer companies can also benefit by using the concept of 'structural bonding' and evaluating their relationships with key business partners from the structural point of view. In general, the results indicate that structural bonding gives a critical impact on the level of relationship commitment. Managerial implications and limitations of the study are also discussed.

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Oxidative Inactivation of Peroxiredoxin Isoforms by H2O2 in Pulmonary Epithelial, Macrophage, and other Cell Lines with their Subsequent Regeneration (폐포상피세포, 대식세포를 비롯한 각종 세포주에서 H2O2에 의한 Peroxiredoxin 동위효소들의 산화에 따른 불활성화와 재생)

  • Oh, Yoon Jung;Kim, Young Sun;Choi, Young In;Shin, Seung Soo;Park, Joo Hun;Choi, Young Hwa;Park, Kwang Joo;Park, Rae Woong;Hwang, Sung Chul
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.1
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    • pp.31-42
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    • 2005
  • Background : Peroxiredoxins (Prxs) are a relatively newly recognized, novel family of peroxidases that reduce $H_2O_2$ and alkylhydroperoxide into water and alcohol, respectively. There are 6 known isoforms of Prxs present in human cells. Normally, Prxs exist in a head-to-tail homodimeric state in a reduced form. However, in the presence of excess $H_2O_2$, it can be oxidized on its catalytically active cysteine site into inactive oxidized forms. This study surveyed the types of the Prx isoforms present in the pulmonary epithelial, macrophage, endothelial, and other cell lines and observed their response to oxidative stress. Methods : This study examined the effect of exogenous, excess $H_2O_2$ on the Prxs of established cell lines originating from the pulmonary epithelium, macrophages, and other cell lines, which are known to be exposed to high oxygen partial pressures or are believed to be subject to frequent oxidative stress, using non-reducing SDS polyacrylamide electrophoresis (PAGE) and 2 dimensional electrophoresis. Result : The addition of excess $H_2O_2$ to the culture media of the various cell-lines caused the immediate inactivation of Prxs, as evidenced by their inability to form dimers by a disulfide cross linkage. This was detected as a subsequent shift to its monomeric forms on the non-reducing SDS PAGE. These findings were further confirmed by 2 dimensional electrophoresis and immunoblot analysis by a shift toward a more acidic isoelectric point (pI). However, the subsequent reappearance of the dimeric Prxs with a comparable, corresponding decrease in the monomeric bands was noted on the non-reducing SDS PAGE as early as 30 minutes after the $H_2O_2$ treatment suggesting regeneration after oxidation. The regenerated dimers can again be converted to the inactivated form by a repeated $H_2O_2$ treatment, indicating that the protein is still catalytically active. The recovery of Prxs to the original dimeric state was not inhibited by a pre-treatment with cycloheximide, nor by a pretreatment with inhibitors of protein synthesis, which suggests that the reappearance of dimers occurs via a regeneration process rather than via the de novo synthesis of the active protein. Conclusion : The cells, in general, appeared to be equipped with an established system for regenerating inactivated Prxs, and this system may function as a molecular "on-off switch" in various oxidative signal transduction processes. The same mechanisms might applicable other proteins associated with signal transduction where the active catalytic site cysteines exist.

Measuring Consumer-Brand Relationship Quality (소비자-브랜드 관계 품질 측정에 관한 연구)

  • Kang, Myung-Soo;Kim, Byoung-Jai;Shin, Jong-Chil
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.2
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    • pp.111-131
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    • 2007
  • As a brand becomes a core asset in creating a corporation's value, brand marketing has become one of core strategies that corporations pursue. Recently, for customer relationship management, possession and consumption of goods were centered on brand for the management. Thus, management related to this matter was developed. The main reason of the increased interest on the relationship between the brand and the consumer is due to acquisition of individual consumers and development of relationship with those consumers. Along with the development of relationship, a corporation is able to establish long-term relationships. This has become a competitive advantage for the corporation. All of these processes became the strategic assets of corporations. The importance and the increase of interest of a brand have also become a big issue academically. Brand equity, brand extension, brand identity, brand relationship, and brand community are the results derived from the interest of a brand. More specifically, in marketing, the study of brands has been led to the study of factors related to building of powerful brands and the process of building the brand. Recently, studies concentrated primarily on the consumer-brand relationship. The reason is that brand loyalty can not explain the dynamic quality aspects of loyalty, the consumer-brand relationship building process, and especially interactions between the brands and the consumers. In the studies of consumer-brand relationship, a brand is not just limited to possession or consumption objectives, but rather conceptualized as partners. Most of the studies from the past concentrated on the results of qualitative analysis of consumer-brand relationship to show the depth and width of the performance of consumer-brand relationship. Studies in Korea have been the same. Recently, studies of consumer-brand relationship started to concentrate on quantitative analysis rather than qualitative analysis or even go further with quantitative analysis to show effecting factors of consumer-brand relationship. Studies of new quantitative approaches show the possibilities of using the results as a new concept of viewing consumer-brand relationship and possibilities of applying these new concepts on marketing. Studies of consumer-brand relationship with quantitative approach already exist, but none of them include sub-dimensions of consumer-brand relationship, which presents theoretical proofs for measurement. In other words, most studies add up or average out the sub-dimensions of consumer-brand relationship. However, to do these kind of studies, precondition of sub-dimensions being in identical constructs is necessary. Therefore, most of the studies from the past do not meet conditions of sub-dimensions being as one dimension construct. From this, we question the validity of past studies and their limits. The main purpose of this paper is to overcome the limits shown from the past studies by practical use of previous studies on sub-dimensions in a one-dimensional construct (Naver & Slater, 1990; Cronin & Taylor, 1992; Chang & Chen, 1998). In this study, two arbitrary groups were classified to evaluate reliability of the measurements and reliability analyses were pursued on each group. For convergent validity, correlations, Cronbach's, one-factor solution exploratory analysis were used. For discriminant validity correlation of consumer-brand relationship was compared with that of an involvement, which is a similar concept with consumer-based relationship. It also indicated dependent correlations by Cohen and Cohen (1975, p.35) and results showed that it was different constructs from 6 sub-dimensions of consumer-brand relationship. Through the results of studies mentioned above, we were able to finalize that sub-dimensions of consumer-brand relationship can viewed from one-dimensional constructs. This means that the one-dimensional construct of consumer-brand relationship can be viewed with reliability and validity. The result of this research is theoretically meaningful in that it assumes consumer-brand relationship in a one-dimensional construct and provides the basis of methodologies which are previously preformed. It is thought that this research also provides the possibility of new research on consumer-brand relationship in that it gives root to the fact that it is possible to manipulate one-dimensional constructs consisting of consumer-brand relationship. In the case of previous research on consumer-brand relationship, consumer-brand relationship is classified into several types on the basis of components consisting of consumer-brand relationship and a number of studies have been performed with priority given to the types. However, as we can possibly manipulate a one-dimensional construct through this research, it is expected that various studies which make the level or strength of consumer-brand relationship practical application of construct will be performed, and not research focused on separate types of consumer-brand relationship. Additionally, we have the theoretical basis of probability in which to manipulate the consumer-brand relationship with one-dimensional constructs. It is anticipated that studies using this construct, which is consumer-brand relationship, practical use of dependent variables, parameters, mediators, and so on, will be performed.

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Studies on the Amylase Production by Bacteria (세균(細菌)에 의(依)한 Amylase생산(生産)에 관한 연구(硏究))

  • Park, Yoon-Joong
    • Applied Biological Chemistry
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    • v.13 no.2
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    • pp.153-170
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    • 1970
  • 1. Isolation and identification of amylase-producing bacteria. The powerful strain A-12 and S-8 were respectively isolated from air and soil after screening a large number of amylase-producing bacteria. Their bacterial characteristics have been investigated and it has been found that all characteristics of strain A-12 and S-8 are similar to Bac. subtilis of Bergey's manual except for the acid formation from a few carbohydrates and the citrate utilization, i.e., the strain A-12 shows negative in the citrate utilization, and the acid formation from arabinose and xylose, S-8 shows negative in the acid formation from xylose. 2. Amylase production by Liquid cultures with solid materials. Several conditions for amylase production by strain A-12 in stationary cultures have been studied. The results obtained are as follows. (1) The optimum conditions are:temperature $35^{\circ}C$, initial pH 6.5 to 7.0 and incubation time 3 to 4 days. (2) The amylase production is not affected by the preservation period of the stock cultures. (3) Among the various solid material, the defatted soy bean is found to be the best for t1e amylase production. However, the alkali treatment of the defatted soy bean gives no effect contrary to the cage of defatted rape seed. The addition of soluble starch to the alkali extract of defatted soy bean shows the increased amylase production. (4) Up to 1% addition of ethanol to carbon dificient media gives the improved amylase production, whereas the above effect is not found in the case of carbon rich media. (5) The amylase production can be increased 2.5 times when 10% of defatted soy bean is admixed to cheaply available wheat bran. (6) The excellent effect is found for amylase production when 20% of wheat bran is admixed to defatted dry milk which is a poor medium. The activity is found to be $D^{40^{\circ}}_{30'}$ 7,000(L.S.V. 1,800) in 10% medium. (7) No significant effect is observed due to the addition of various inorganic salts. 3. Amylase production by solid cultures. Several conditions for amylase production by strain A-12 in wheat bran cultures have been studied and the results obtained are as follows. (1) The optimum conditions: are temperature $33^{\circ}C$, incubation lime 2 days, water content added 150 to 175% and the thickness of the medium 1.5cm, The activity is found to be $D^{40^{\circ}}_{30'}$ 36,000(L.S.V. 15,000) (2) No significant effect is found in the case of the additions of various organic and inorganic substances.

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Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer (침윤성 방광암 환자에서 방광 보존 치료)

  • Youn Seon Min;Yang Kwang Mo;Lee Hyung Sik;Hur Won Joo;Oh Sin Geun;Lee Jong Cheol;Yoon Jin Han;Kwon Heon Young;Jung Kyung Woo;Jung Se Il
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.237-244
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    • 2001
  • Purpose : To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. Method and Materials : From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by $39.6\~45\;Gy$ pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. Results : The Patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients $(81\%)$ successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients $(58\%)$ were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were $80\%\;and\;14\%$, respectively (u=0.001). Conclusion : In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

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