• Korean Journal of Clinical Laboratory Science
• /
• v.50 no.2
• /
• pp.126-135
• /
• 2018

This study examined whether the difference in the middle cerebral artery (MCA) velocities can predict the prognosis of stroke and whether the prognostic impact differs among stroke subtypes. Transient ischemic attack (TIA) or acute ischemic stroke patients, who underwent a routine evaluation and transcranial Doppler (TCD), were included in this study. The MCA asymmetry index was calculated using the relative percentage difference in the mean flow velocity (MFV) between the left and right MCA: (|RMCA MFV-LMCA MFV|/mean MCA MFV)${\times}100$. The stroke subtypes were determined using the TOAST classification. Poor functional outcomes were defined as a mRS score ${\geq}3$ at 3 months after the onset of stroke. A total of 988 patients were included, of whom 157 (15.9%) had a poor functional outcome. Multivariable analysis showed that only the MCA asymmetry index was independently associated with a poor functional outcome. ROC curve analysis showed that adding the MCA asymmetry index to the prediction model improved the discrimination of a poor functional outcome from acute ischemic stroke (from 88.6% [95% CI, 85.2~91.9] to 89.2% [95% CI, 85.9~92.5]). The MCA asymmetry index has an independent prognostic value for predicting a poor short-term functional outcome after an acute cerebral infarction. Therefore, TCD may be useful for predicting a poor functional outcome in patients with acute ischemic stroke.

• Journal of Yeungnam Medical Science
• /
• v.38 no.4
• /
• pp.337-343
• /
• 2021

Background: Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure. Methods: We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization. Results: In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors. Conclusion: The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.

• Genomics & Informatics
• /
• v.8 no.4
• /
• pp.212-218
• /
• 2010

An accurate system for predicting the survival of patients with oral squamous cell carcinoma (OSCC) will be useful for selecting appropriate therapies. A nomogram for predicting survival was constructed from 96 patients with primary OSCC who underwent surgical resection between January 1994 and June 2003 at the Yonsei Dental Hospital in Seoul, Korea. We performed univariate and multivariate Cox regression to identify survival prognostic factors. For the early stage patients group, the nomogram was able to predict the 5 and 10 year survival from OSCC with a concordance index of 0.72. The total point assigned by the nomogram was a significant factor for predicting survival. This nomogram was able to accurately predict the survival after treatment of an individual patient with OSCC and may have practical utility for deciding adjuvant treatment.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.2
• /
• pp.209-216
• /
• 2024

Objective : Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. Methods : This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. Results : A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. Conclusion : In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

• Journal of Chest Surgery
• /
• v.50 no.5
• /
• pp.329-338
• /
• 2017

Background: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. Methods: A retrospective review of 77 patients with E SCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. Results: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p=0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Conclusion: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.10
• /
• pp.4217-4224
• /
• 2014

Cholangiocarcinoma (CCA), a slow growing but highly metastatic tumor, is highly prevalent in Northeast Thailand. Specific tests that predict prognosis of CCA remain elusive. The present study was designed to investigate whether peripheral blood leukocyte (PBL) transcriptional profiles might be of use as a prognostic test in CCA patients. Gene expression profiles of PBLs from 9 CCA and 8 healthy subjects were conducted using the Affymetrix HG_U133 Plus 2.0 GeneChip. We indentified informative PBLs gene expression profiles that could reliably distinguish CCA patients from healthy subjects. Of these CCA specific genes, 117 genes were up regulated and 60 were down regulated. The molecular and cellular functions predicted for these CCA specific genes according to the Gene Ontology database indicated differential PBL expression of host immune response and tumor progression genes (EREG, TGF ${\beta}1$, CXCL2, CXCL3, IL-8, and VEGFA). The expression levels of 9 differentially expressed genes were verified in 36 CCA vs 20 healthy subjects. A set of three tumor invasion related genes (PLAU, CTSL and SERPINB2) computed as "prognostic index" was found to be an independent and statistically significant predictor for CCA patient survival. The present study shows that CCA PBLs may serve as disease predictive clinically accessible surrogates for indentifying expressed genes reflective of CCA disease severity.

• Journal of Acupuncture Research
• /
• v.31 no.1
• /
• pp.149-158
• /
• 2014

Objectives : The aim of this study is to investigate the influence of anxiety and depression on motor recovery of acute Bell's palsy to estimate how much psychological factors affect the clinical prognosis. Methods : A total of 20 inpatients with acute unilateral Bell's palsy within 1 week of onset participated in this study. The severity of participants' facial palsy was measured by Yanagihara(Y-system) score, FDI and House-Brackmann scale at the time of 1 week and 3 weeks from the onset. The motor recovery of acute Bell's palsy is defined as ${\Delta}Y$-system during 2 weeks. Beck anxiety scale(BAI) and the center for epidermiologic studies depression scale(CES-D) were adopted to assess anxiety and depression, respectively. Correlation analysis and linear regression analysis were conducted between ${\Delta}Y$-system and prognostic factors including anxiety and depression. Results : Significant associations were found between ${\Delta}Y$-system and depression(CES-D) but no significant associations were found between ${\Delta}Y$-system and other prognostic factors, hypertension, diabetes, postauricular pain, disgeusia, age, degree of initial palsy and anxiety(BAI). And a regression equation with 0.295 for coefficient of determination was obtained. Through this analysis, the ${\Delta}Y$-system can be predicted using regression equation which cover 29.5 % of depression index(CES-D). Conclusion : Depression is a significant clinical prognostic factor on motor recovery of acute Bell's palsy. So, Bell's palsy treatment should be combined with psychological care and support.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.12
• /
• pp.5273-5280
• /
• 2016

Objective: To evaluate stromal cells of the bone marrow microenvironment (BMM) in bone marrow trephine biopsy (BMTB) specimens, with a focus on fibronectin, tumor necrosis factor- alpha (TNF-${\alpha}$) and L-selectin in Non-Hodgkin's lymphoma (NHL) patients, before and after therapy. Materials and Methods: A total of 80 de novo NHL patients, 64 with B-cell lymphomas 80%, (follicular cell lymphoma (FCL) in 32, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in 12, and diffuse large cell lymphoma in 20) and 16 with T-cell lymphomas (20%) all diagnosed as T-Lymphoblastic lymphomas, were evaluated before and after therapy. For comparison, 25 age and sex matched BM donors, were included as a control group. BMTB material and BM aspirates were taken for morphological assessment of stromal cells, the plasma of these samples being examined for $TNF{\alpha}$ and L-selectin by ELISA, and fibronectin by radial immunodiffusion (RID). Results: BM stromal cells comprising reticular macrophages and fibroblasts were elevated in 53.3% of NHL cases at diagnosis, while BM fibronectin levels were decreased and BM $TNF{\alpha}$ and L-selectin were higher than in controls (p<0.05). In NHL cases, elevated values of BM $TNF{\alpha}$ and BM L-selectin were associated with signs of aggressive disease, including >1 extra nodal sites, detectable B symptoms, high grade, BM and CNS invasion, and a high International prognostic index (IPI) (p<0.05). Conclusion: BMM components, $TNF{\alpha}$, L-selectin and fibronectin, in NHL can be useful in evaluating disease activity, extent and response to treatment and as prognostic markers according to the IPI.

• Journal of Hospice and Palliative Care
• /
• v.24 no.4
• /
• pp.254-260
• /
• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Korean Foot and Ankle Society
• /
• v.16 no.4
• /
• pp.217-222
• /
• 2012

Purpose: The purpose of this study is to establish guidelines for ankle-brachial index (ABI), toe-brachial index (TBI) and toe pressure with regard to healing of diabetic foot amputation wound. Material and Methods: We designed a retrospective study that included patients with diabetic foot ulcer. From 2008 to 2011, 46 patients who had suffered from amputation of a foot due to diabetic foot ulcer were included in this study. We divided them into amputation-success group and amputation-revision group, and compared their ankle-brachial index (ABI), toe-brachial index (TBI) and toe pressure between two groups. Amputation-revision group is that first forefoot amputation is failed to heal successfully and need to have another proximal amputation. Results: Toe pressure was 78 mmHg (54~107) in the amputation success group, 0 mmHg (0~43) in the amputation revision group (p=0.000). Ankle-brachial index was 1.1650(1.0475~1.1975) in the amputation success group, 0.92(0.5275~1.0750) in the amputation revision group (p=0.05), and toe-brachial index was 0.6100(0.4050~0.7575) in the amputation success group, 0.00(0.00~0.4150) in the amputation revision group (p=0.04), respectively. Conclusion: ABI, TBI, toe pressure of amputation success group were significantly higher than those of amputation revision group.