• Title/Summary/Keyword: Prognosis

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[Republished study] Assessing Nutritional Status in Outpatients after Gastric Cancer Surgery: A Comparative Study of Five Nutritional Screening Tools ([재출판] 위암 수술 후 외래환자의 영양상태 평가: 5가지 영양검색도구의 비교연구)

  • Cho, Jae Won;Youn, Jiyoung;Choi, Min-Gew;Rha, Mi Young;Lee, Jung Eun
    • Korean Journal of Community Nutrition
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    • v.27 no.3
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    • pp.205-222
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    • 2022
  • Objectives: This study examined the characteristics of patients according to nutritional status assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results: Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions: NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

Comparative Review of the Correlation Between Electroneurography, Electromyography, Hematology Tests, or the Heart Rate Variability Test, with an Improvement in the Severity of Bell's Palsy Symptoms

  • Hwang, Ji-Min;Kim, Jun-Yeon;Kim, Ha-Na;Park, Kyeong-Ju;Jo, Min-Gi;Jang, Jun-Yeong;Nam, Sang-Soo;Goo, Bon Hyuk;Kim, Jung-Hyun;Ko, Min Jung;Chae, Sang Yeup;Park, Young Jae
    • Journal of Acupuncture Research
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    • v.38 no.3
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    • pp.192-199
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    • 2021
  • Background: In this retrospective study, we aimed to determine which diagnostic tests were associated with an improvement in Bell's palsy symptoms. Methods: There were 30 patients who visited Kyung Hee University Korean Medicine Hospital from April 1, 2017 to February 29, 2020, and who received East-West collaboration treatment for Bell's palsy. The tests included electroneurography (ENoG), electromyography (EMG), hematology, and heart rate variability (HRV) results which were used to determine if any test correlated with improvement of Bell's palsy symptoms. Results: The initial severity of symptoms did not correlate with the tests performed, with the exception of mean corpuscular hemoglobin concentration (p = 0.013). For both ENoG for oculi degeneration and mean EMG tests, the rate of nerve degeneration showed a significant negative correlation with the improvement of Bell's palsy symptoms. Amongst the HRV test indicators, the square root of the mean of the sum of the squares of differences between the adjacent normal R-R wave interval, the standard deviation of intervals, total power, very low frequency, and high frequency of the wave was negatively correlated with improvement of Bell's palsy symptoms. Similarly, glycosylated hemoglobin Type A1c (HbA1c) and erythrocyte sedimentation rate (ESR) showed a negative correlation with improvement of symptoms of Bell's palsy. With the exception of HbA1c and ESR, the remaining hematology test results showed no significant difference when comparing before and after treatment. Conclusion: ENoG, EMG, HRV test, HbA1c, and ESR negatively correlated with improvements in Bell's palsy symptoms and may determine the prognosis of Bell's palsy.

A Case of Pleural Effusion in a Patient with Heart Failure with Preserved Ejection Fraction Improved by A Combined Korean-Western Medicine Approach (좌심실 수축 기능 보전 심부전증으로 인한 흉수에 대한 한양방 복합치료 치험 1례)

  • Ha, Won Jung;Seo, Yuna;Lee, Young seon;Cho, Ki-Ho;Mun, Sang-Kwan;Jung, Woo-Sang;Kwon, Seungwon
    • The Journal of the Society of Stroke on Korean Medicine
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    • v.22 no.1
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    • pp.45-56
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    • 2021
  • ■ Background Heart Failure with Preserved Ejection Fraction(HFpEF) is a heart failure that appears to have normal contraction function. In the case of HFpEF, no pharmacological therapy has been found to improve clinical prognosis, so it should be approached as an symptomatic treatment, therefore alternatives are needed due to concerns over adverse effects such as electrolyte imbalance caused by medication. ■ Case report A 81 year old female patient with Heart Failure with Preserved Ejection Fraction(HFpEF) patient complained dyspnea. Herbal prescription Mokbanggi-tang and Oryeongsan was administered on 6th day and 8th day respectively since the symptoms started. The NYHA Classification and Chest X-ray had been evaluated during the treatment period. Until the 7th day, the patient was classified as Class II, and when discharged from the hospital on the 28th day, it gradually improved and was classified as Class II. Chest X-Ray took on 2nd day showed pleural effusion and it was aggravated until 13th day. Follow up Chest X-Ray showed improving state of pleural effusion from 20th day and gradually got better. Mokbanggi-tang treatment continued for 52 days and stopped on 58th day. After Mokbanggi-tang treatment ended, only Oryeongsan treatment was maintained. ■ Conclusion The present case report suggests that Korean-Western medicine approach with Mokbangki-tang and Oryeongsan might be effective to pleural effusion and heart failure symptoms such as poor physical activity shown in a NYHA Classification. This shows that Mokbanggi-tang and Oryeongsan can be a therapeutic option as a treatment for patient with Heart Failure with Preserved Ejection Fraction(HFpEF).

Quantitative Comparison of Motion Artifacts in PET Images using Data-Based Gating (데이터 기반 게이팅을 이용한 PET 영상의 움직임 인공물의 정량적 비교)

  • Jin Young, Kim;Gye Hwan, Jin
    • Journal of the Korean Society of Radiology
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    • v.17 no.1
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    • pp.91-98
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    • 2023
  • PET is used effectively for biochemical or pathological phenomena, disease diagnosis, prognosis determination after treatment, and treatment planning because it can quantify physiological indicators in the human body by imaging the distribution of various biochemical substances. However, since respiratory motion artifacts may occur due to the movement of the diaphragm due to breathing, we would like to evaluate the practical effect by using the a device-less data-driven gated (DDG) technique called MotionFree with the phase-based gating correction method called Q.static scan mode. In this study, images of changes in moving distance (0 cm, 1 cm, 2 cm, 3 cm) are acquired using a breathing-simulated moving phantom. The diameters of the six spheres in the phantom are 10 mm, 13 mm, 17 mm, 22 mm, 28 mm, and 37 mm, respectively. According to maximum standardized uptake value (SUVmax) measurements, when DDG was applied based on the moving distance, the average SUVmax of the correction effect by the moving distance was improved by 1.92, 2.48, 3.23 and 3.00, respectively. When DDG was applied based on the diameter of the phantom spheres, the average SUVmax of the correction effect by the moving distance was improved by 2.37, 2.02, 1.44, 1.20, 0.42 and 0.52 respectively.

The Prognosis of Glyphosate herbicide intoxicated patients according to their salt types (글라이포세이트 중독 환자에서 포함된 염의 종류에 따른 예후의 차이)

  • Jeong, Min Gyu;Keum, Kyoung Tak;Ahn, Seongjun;Kim, Yong Hwan;Lee, Jun Ho;Cho, Kwang Won;Hwang, Seong Youn;Lee, Dong Woo
    • Journal of The Korean Society of Clinical Toxicology
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    • v.19 no.2
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    • pp.83-92
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    • 2021
  • Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group. As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion: There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

Determination of Survival of Gastric Cancer Patients With Distant Lymph Node Metastasis Using Prealbumin Level and Prothrombin Time: Contour Plots Based on Random Survival Forest Algorithm on High-Dimensionality Clinical and Laboratory Datasets

  • Zhang, Cheng;Xie, Minmin;Zhang, Yi;Zhang, Xiaopeng;Feng, Chong;Wu, Zhijun;Feng, Ying;Yang, Yahui;Xu, Hui;Ma, Tai
    • Journal of Gastric Cancer
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    • v.22 no.2
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    • pp.120-134
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    • 2022
  • Purpose: This study aimed to identify prognostic factors for patients with distant lymph node-involved gastric cancer (GC) using a machine learning algorithm, a method that offers considerable advantages and new prospects for high-dimensional biomedical data exploration. Materials and Methods: This study employed 79 features of clinical pathology, laboratory tests, and therapeutic details from 289 GC patients whose distant lymphadenopathy was presented as the first episode of recurrence or metastasis. Outcomes were measured as any-cause death events and survival months after distant lymph node metastasis. A prediction model was built based on possible outcome predictors using a random survival forest algorithm and confirmed by 5×5 nested cross-validation. The effects of single variables were interpreted using partial dependence plots. A contour plot was used to visually represent survival prediction based on 2 predictive features. Results: The median survival time of patients with GC with distant nodal metastasis was 9.2 months. The optimal model incorporated the prealbumin level and the prothrombin time (PT), and yielded a prediction error of 0.353. The inclusion of other variables resulted in poorer model performance. Patients with higher serum prealbumin levels or shorter PTs had a significantly better prognosis. The predicted one-year survival rate was stratified and illustrated as a contour plot based on the combined effect the prealbumin level and the PT. Conclusions: Machine learning is useful for identifying the important determinants of cancer survival using high-dimensional datasets. The prealbumin level and the PT on distant lymph node metastasis are the 2 most crucial factors in predicting the subsequent survival time of advanced GC.

P3H4 promotes renal cell carcinoma progression and suppresses antitumor immunity via regulating GDF15-MMP9-PD-L1 axis

  • Tian, Shuo;Huang, Yan;Lai, Dong;Wang, Hanfeng;Du, Songliang;Shen, Donglai;Chen, Weihao;Xuan, Yundong;Lu, Yongliang;Feng, Huayi;Zhang, Xiangyi;Zhao, Wenlei;Wang, Chenfeng;Wang, Tao;Wu, Shengpan;Huang, Qingbo;Niu, Shaoxi;Wang, Baojun;Ma, Xin;Zhang, Xu
    • Advances in nano research
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    • v.12 no.6
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    • pp.639-652
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    • 2022
  • The prolyl 3-hydroxylase family member 4 (P3H4), is associated with post-translational modification of fibrillar collagens and aberrantly activated in cancer leading to tumor progression. However, its role in clear cell renal cell carcinoma (ccRCC) is still unknown. Here we reported that P3H4 was highly expressed in renal cancer tissues and significantly positive correlated with poor prognosis. Knockdown of P3H4 inhibited the proliferation, migration and metastasis of renal cancer cells in vitro and in vivo, and also, overexpression of it enhanced the oncogenic process. Mechanistically, P3H4 depletion decreased the levels of GDF15-MMP9 axis and repressed its downstream signaling. Further functional studies revealed that inhibition of GDF15 suppressed renal cancer cell growth and GDF15 recombinant human protein (rhGDF15) supplementation effectively rescued the inhibitory effect induced by P3H4 knockdown. Moreover, decreased levels of MMP9 caused by inhibition of P3H4-GDF15 signaling constrained the expression of PD-L1 and suppression of P3H4 accordingly promoted anti-tumor immunity via stimulating the infiltration of CD4+ and CD8+ T cells in syngeneic mice model. Taken together, our findings firstly demonstrated that P3H4 promotes ccRCC progression by activating GDF15-MMP9-PD-L1 axis and targeting P3H4-GDF15-MMP9 signaling pathway can be a novel strategy of controlling ccRCC malignancy.

Leiomyosarcoma of the Somatic Soft Tissue: Clinical Manifestation and Treatment Results (연부조직에 발생한 평활 근육종의 임상양상 및 치료 결과)

  • Kim, Yong Sung;Kong, Chang-Bae;Cho, Wan-Hyeong;Jeon, Dae-Geun;Kim, Kyung Hoon;Song, Won Seok
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.5
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    • pp.397-404
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    • 2020
  • Purpose: The purpose of this study was to evaluate the treatment outcome of leiomyosarcoma (LMS) of the somatic soft tissue and investigate the prognostic factors. Materials and Methods: Seventy-two patients with soft tissue LMS (extremities and trunk) between 2001 and 2017 were reviewed retrospectively. The local recurrence and metastasis after treatment were examined. The survival rates and prognostic factors affecting survival were investigated. Only patients followed-up more than one year were included. The mean follow-up time was 41 months (range, 7-163 months). Results: The overall survival rates at five-year and 10-year were 73.6% and 66.2%, respectively. The tumor size (p=0.018), grade (p=0.017), and local recurrence (p=0.04) affected survival. Metastases developed in 31.9% (23/72) and the median post metastasis survival was 15.6 months (range, 3-78 months). Conclusion: LMS of the soft tissue developed mainly at the lower extremity. The tumor size, grade, and local recurrence were associated with survival. Post metastatic survival was generally poor despite treatment.

Prognostic Indicators of Extremity Liposarcoma (사지에 발생하는 지방육종의 예후 인자에 대한 분석)

  • Park, Kee Young;Kim, Jeung Il;Lee, In Sook;Song, You Seon;Choi, Kyung Un
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.4
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    • pp.331-337
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    • 2020
  • Purpose: The aim of this retrospective study was to define the prognostic factors for liposarcoma to aid in the selection of effective treatments. Materials and Methods: This study analyzed 41 cases out of 45 cases diagnosed with and treated for liposarcoma 2002 to 2015; 4 cases of well-differentiated liposarcoma were excluded. The effects of sex, age, site, stage, and histological classification on survival were analyzed retrospectively. For 28 cases diagnosed with myxoid liposarcoma, additional analysis was performed after the inclusion of round cell components. Results: The mean age at diagnosis was 52.05 years (range 25-82 years) and the average follow-up period was 63.7 months. The disease-free survival rate was 43.2%. Most factors, including sex and age, were not significantly associated with the survival rate. On the other hand, the stage (Musculoskeletal Tumor Society stage) was significantly associated with the survival rate. The survival rate of patients with myxoid liposarcoma was 69% and the local recurrence and metastasis results varied according to the presence of round cells. Conclusion: The stage of liposarcoma and the sex of the patient were found to be effective factors for prognosis. When planning the treatment for liposarcoma, the treatment outcome for liposarcoma differs according to several prognostic factors.

Clinical Factors Affecting the Results of Regenerative Endodontic Procedure (재생근관치료 결과에 영향을 미치는 인자의 분석)

  • Kim, In-Ki;Kim, Hyuntae;Song, Ji-Soo;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.4
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    • pp.449-459
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    • 2021
  • This study retrospectively analyzed the effect of clinical factors on the outcomes of REP(regenerative endodontic procedure). Patients who received the REP using triple antibiotic paste due to trauma or fracture of dens evaginatus from February, 2011 to January, 2020 were included in the study. Finally, 57 teeth in 54 patients were selected. Investigated clinical factors were as follows: intentional bleeding, etiology, and root development stage. Treatment outcomes evaluated were as follows: improvement of subjective symptoms, changes in the periapical lesion, and the amounts of root development after REP. To compensate for differences in angulation and position between repeated radiographic examinations, images were aligned by Turboreg plugin. To evaluate the amounts of root development, apical diameter, root area, and root length were measured by ImageJ software. Among the aforementioned factors, intentional bleeding had no significant effect on treatment results. Regarding the etiology, the increase in the root area and the root length was significantly less in trauma cases than in dens evaginatus fracture cases. Considering root development stage, more immature teeth presented more increase in the root area.