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Clinicopathological Characteristics of Triple Negative Breast Cancer at a Tertiary Care Hospital in India

  • Dogra, Atika;Doval, Dinesh Chandra;Sardana, Manjula;Chedi, Subhash Kumar;Mehta, Anurag
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10577-10583
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    • 2015
  • Background: Triple-negative breast cancer (TNBC), characterized by the lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2, is typically associated with a poor prognosis. The majority of TNBCs show the expression of basal markers on gene expression profiling and most authors accept TNBC as basal-like (BL) breast cancer. However, a smaller fraction lacks a BL phenotype despite being TNBC. The literature is silent on non-basal-like (NBL) type of TNBC. The present study was aimed at defining behavioral differences between BL and NBL phenotypes. Objectives: i) Identify the TNBCs and categorize them into BL and NBL breast cancer. ii) Examine the behavioral differences between two subtypes. iii) Observe the pattern of treatment failure among TNBCs. Materials and Methods: All TNBC cases during January 2009-December 2010 were retrieved. The subjects fitting the inclusion criteria of study were differentiated into BL and NBL phenotypes using surrogate immunohistochemistry with three basal markers $34{\beta}E12$, c-Kit and EGFR as per the algorithm defined by Nielsen et al. The detailed data of subjects were collated from clinical records. The comparison of clinicopathological features between two subgroups was done using statistical analyses. The pattern of treatment failure along with its association with prognostic factors was assessed. Results: TNBC constituted 18% of breast cancer cases considered in the study. The BL and NBL subtypes accounted for 81% and 19% respectively of the TNBC group. No statistically significant association was seen between prognostic parameters and two phenotypes. Among patients with treatment failure, 19% were with BL and 15% were with NBL phenotype. The mean disease free survival (DFS) in groups BL and NBL was 30.0 and 37.9 months respectively, while mean overall survival (OS) was 31.93 and 38.5 months respectively. Treatment failure was significantly associated with stage (p=.023) among prognostic factors. Conclusions: Disease stage at presentation is an important prognostic factor influencing the treatment failure and survival among TNBCs. Increasing tumor size is related to lymph node positivity. BL tumors have a more aggressive clinical course than that of NBL as shown by shorter DFS and OS, despite having no statistically significant difference between prognostic parameters. New therapeutic alternatives should be explored for patients with this subtype of breast cancer.

A Study on Characteristics of Jinsatak(陳士鐸)'s Clinic Theory (진사탁(陳士鐸) 임상 이론의 특징에 관한 연구)

  • Jeong, Kyung-Ho;Kim, Ki-Wook;Park, Hyun-Guk
    • Journal of Korean Medical classics
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    • v.22 no.3
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    • pp.31-51
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    • 2009
  • The characteristics of Jin's ideas on clinic theory can be arranged as follows. 1. Jin emphasized warming and tonifying[溫補] in treatment and the part that shows this the best is the taking care of[調理] the Vital gate[命門], kidney, liver, and spleen. His ideas were based on his understanding of a human life's origin, and was influenced by Seolgi(薛己), Joheon-ga(趙獻可) and Janggaebin(張介賓)'s Vital gate and source Gi theory(元氣說) so scholastically, he has that in common with them but was later criticized by later doctors such as Oksamjon(玉三尊) as an 'literary doctor(文字醫)' who followed the ideas of "Uigwan(醫貫)". 2. The warming and tonifying school[溫補學派], who were influenced by Taoism, said in their theory of disease outbreak[發病學說] that since one must not hurt one's Yin essence and Yang fire [陰精陽火] there is more deficiency than excess, so that was why they used tonifying methods. Jin was also like them and this point of view is universal in internal medicine, gynecology, pediatric medicine and surgery and so on. 3. Jin, who saw the negative form of pulse diagnosis[診脈] emphasized following symptoms over pulse diagnosis using the spirit of ‘finding truth based on truth[實事求是]' in "Maekgyeolcheonmi(脈訣闡微)", but emphasized 'the combination of pulse and symptoms[脈證合參]'. He understood pulse diagnosis as a defining tool for symptoms, and in "Seoksilbirok(石室秘錄)" simplified pulse diagnosis into 10 methods : floating/sunken(浮沉), slow/fast(遲數), large/fine(大小), vacuous/replete(虛實) and slippery/rough(滑澀). 4. Jin used 'large formulas(大方)' a lot that usually featured a large dose, and in " Bonchosinpyeon(本草新編)" he thought of the seven formulas(七方) and ten preparations(十劑) as the standard when using medicine. He did away with old customs and presented a 'new(新)' and 'extra(奇)' point of view. He especially used a lot of Insam(人蔘) when tonifying Gi and Geumeunhwa(金銀花) when treating sores and ulcers. 5. In the area of surgery Jin gave priority to the early finding and treatment of disease with internal treatment[內治] and was against the overuse of acupuncture. However records of surgical measures in a special situation like lung abscesses(肺癰) and liver abscesses(肝癰), and anesthetic measures using 'Manghyeongju(忘形酒)' and 'Singoiyak(神膏異藥)' and opening the abdomen or skull, and organ transplants using a dog's tongue are important data. 6. Jin stated the diseases of Gi and blood broadly. Especially in the principles of treating blood, blood diseases had to be forwarded[順] and Gi regulation[理氣] was the number one priority and stated the following two treatments. First, in "Jeonggiinhyeolpyeon(精氣引血篇)" of volume 6 of "Oegyeongmieon(外經微言)", for the rules for treating blood he stated the pattern identification of finding Gi in blood and blood in Gi. Second, he emphasized Gi regulation(理氣) in blood diseases and stated that the Gi must be tonifyed after finding the source of the loss of blood.

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Shoes from Pinet to the Present

  • June, Swann
    • Proceedings of the Korea Society of Costume Conference
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    • 2001.08a
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    • pp.11-13
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    • 2001
  • For those unfamiliar with the shoe world, Pinet (1817-1897) was a contemporary of Worth, the great Parisian couturier. So I look at the glamour shoes and the world of haute couture, and indeed the development of the named designer. That is a concept we are all familiar with now. So it is not easy to comprehend the lack of names for the exquisite work before 1850. Straightway I have to say that the number of noted shoe designers is far fewer than famous dress designers, but I will introduce you to some of them, against the background of contemporary shoe fashions. Franc;ois Pinet was born in the provinces (probably Touraine) in 1817, two years after the end of the Napoleonic Wars. His father, an ex-soldier, settled to shoemaking, a comparatively clean and quiet trade. It had a tradition of literacy, interest in politics, and was known as the gentle craft, which attracted intelligent people. We should presume father would be helped by the family. It was usual for a child to begin by the age of 5-6, tying knots, sweeping up, running errands and gradually learning the job. His mother died 1827, and father 1830 when he was 13, and at the time when exports of French shoes were flooding world markets. He went to live with a master shoemaker, was not well treated, and three years later set out on the tour-de- France. He worked with masters in Tours and Nantes, where he was received as Compagnon Cordonnier Bottier du Devoir as Tourangeau-Ia rose dAmour (a name to prove most appropriate). He went on to Bordeaux, where at 19 he became president of the local branch. In 1841 he went to Paris, and in 1848, revolution year, as delegate for his corporation, he managed to persuade them not to go on strike. By now the shoemakers either ran or worked for huge warehouses, and boots had replaced shoes as the main fashion. In 1855 Pinet at the age of 38 set up his own factory, as the first machines (for sewing just the uppers) were appearing. In 1863 he moved to new ateliers and shop at Rue ParadisPoissoniere 44, employing 120 people on the premises and 700 outworkers. The English Womans Domestic Magazine in 1867 records changes in the boots: the soles are now wider, so that it is no longer necessary to walk on the uppers. There is interest in eastern Europe, the Polonaise boots with rosette of cord and tassels and Bottines Hongroises withtwo rows of buttons, much ornamented. It comments on short dresses, and recommends that the chaussure should correspond to the rest of the toilet. This could already be seen in Pinets boots: tassels and superb flower embroidery on the higher bootleg, which he showed in the Paris Exposition that year. I think his more slender and elegant Pinet heel was also patented then or 1868. I found little evidence for colour-matching: an English fashion plate of 1860 shows emerald green boots with a violetcoloured dress.

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The Nutrient Intakes and their Relationships with the Use of Diuretics, Symptom Severity and Physical Functioning in Heart Failure Patients (심부전 환자의 이뇨제 사용, 증상의 중증도 및 신체활동능력과 영양소 섭취 상태와의 관련성)

  • Jang, Jun Hee;Lee, Haejung;Park, Youngjoo;Chun, Kook Jin;Kim, Jong Hyun
    • Korean Journal of Community Nutrition
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    • v.21 no.2
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    • pp.190-199
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    • 2016
  • Objectives: The purpose of this study was to identify the differences in nutrient intake according to using diuretics, symptom severity and degree of physical functioning in heart failure patients. Methods: A secondary data analysis was conducted by using baseline data of an intervention study for heart failure patients. In this study, 131 heart failure patients were included. Data were collected using medical records, NYHA (New York Heart Association functional classification) class, and 6-minute-walking test and 24-hour diet recall. Data were analyzed using descriptive statistics and Chi-square test by SPSS 21.0. Nutrient intake was assessed using CAN-pro 2.0. Results: Majority of the participants consumed total calorie less than Estimated Energy Requirement (EER) and consumed carbohydrates more than 65% of their total calorie intakes. 24.4% of the participants consumed fat more than 30% of their total calorie intakes and 23.7% consumed saturated fat more than 7% of their total calorie intakes. 100.0% of the participants consumed protein less than 7% of their total calorie intakes and 73.3% of the participants consumed more than recommended intakes of sodium. More than 90.0% of the participants consumed less than adequate intakes of potassium (90.1%) and Vitamin D (91.6%), respectively. 100% and 62.6% of the participants consumed less than Estimated Average Requirement (EAR) of magnesium and Vitamin $B_1$, respectively. Nutrient intakes in heart failure patients were different for potassium intake according to the usage of diuretics. The participants with symptom severity tended to intake protein less properly and the participants walking more than 300.0 m tended to intake sodium improperly high. Conclusions: The findings of this study indicated the need for screening nutrient intakes of heart failure patients. It is necessary to increase the intake of total calories and most nutrients and to restrict sodium intakes among heart failure patients.

Regional Estimation of Site-specific Seismic Responses at Gyeongju by Building GIS-based Geotechnical Information System (GIS 기반의 지반 정보 시스템 구축을 통한 경주 지역 부지고유 지진 응답의 지역적 평가)

  • Sun, Chang-Guk;Chung, Choon-Ki
    • Journal of the Korean Association of Geographic Information Studies
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    • v.11 no.2
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    • pp.38-50
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    • 2008
  • The site-specific seismic responses and corresponding seismic hazards are influenced mainly by the subsurface geologic and geotechnical dynamic characteristics. To estimate reliably the seismic responses in this study, a geotechnical information system (GTIS) within GIS framework was developed by introducing new concepts, which consist of the extended area containing the study area and the additional site visit for acquiring surface geo-knowledge data. The GIS-based GTIS was built for Gyeongju area, which has records of abundant historical seismic hazards reflecting the high potential of future earthquakes. At the study area, Gyeongju, intensive site investigations and pre-existing geotechnical data collections were performed and the site visits were additionally carried out for assessing geotechnical characteristics and shear wave velocity ($V_S$) representing dynamic property. Within the GTIS for Gyeongju area, the spatially distributed geotechnical layers and $V_S$ in the entire study area were reliably predicted from the site investigation data using the geostatistical kriging method. Based on the spatial geotechnical layers and $V_S$ predicted within the GTIS, a seismic zoning map on site period ($T_G$) from which the site-specific seismic responses according to the site effects can be estimated was created across the study area of Gyeongju. The spatial $T_G$ map at Gyeongju indicated seismic vulnerability of two- to five-storied buildings. In this study, the seismic zonation based on $T_G$ within the GIS-based GTIS was presented as regional efficient strategy for seismic hazard prediction and mitigation.

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Unplanned Readmission to Intensive Care Unit during the same Hospitalization at a Teaching Hospital (계획에 없던 중환자실 재입실 실태 및 원인)

  • Song, Dong-Hyun;Lee, Sun-Gyo;Kim, Chui-Gyu;Choi, Dong-Ju;Lee, Sang-Il;Park, Su-Kil
    • Quality Improvement in Health Care
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    • v.10 no.1
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    • pp.28-41
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    • 2003
  • Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

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New Prognostic Significance of Malignant Pleural Effusion In Patients with Non-Small Cell Lung Cancer (비소세포폐암의 예후 결정에 있어 악성 흉수의 새로운 의의)

  • Kim, So-Young;Park, Seong-Hoon;Shin, Jeong-Hyun;Shin, Seong-Nam;Kim, Dong;Lee, Mi-Kung;Lee, Sam-Youn;Choi, Soon-Ho;Kim, Hak-Ryul;Jeong, Eun-Taik;Moon, Sun-Rock;Lee, Kang-Kyu;Yang, Sei-Hoon
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.23 no.3
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    • pp.710-714
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    • 2009
  • Several studies showed that the survival rate of stage IIIB disease with malignant pleural effusion is worse than stage IIIB disease without malignant effusion. But, malignant pleural effusion was considered T4. To analyze changes the survival time for malignant pleural effusion, in the seventh revision of TNM classification for lung cancer. The records of all patients had to have either a histological or cytological diagnosis of non-small cell lung cancer (NSCLC), who were admitted to Wonkwang university hospital between January 2004 and December 2006 were reviewed retrospectively. We evaluated the survival time of 187 patients with advanced lung cancer with and without malignant pleural effusion. This included the pleural effusion or nodule M1 a (pleural dissemination, currently classified as T4), nodule(s) in the other lung M1 a (contralateral lung nodule, currently classified as M1), nodule(s) with the same lobe as the primary tumor T3 (currently classified as T4), other T4 factors T4 (T4 MO anyN), and extrathoracic sites of disease M1b (distant metastasis, currently classified M1). Among the 187 patients, T4anyNMO was 57 patients in the current TNM classification. In the next edition of the TNM classification, T4MOanyN-T4 (excluding same lobe nodules) was 12 patients, pleural dissemiantion-M1a was 45 patients, contralateral lung nodule(s)-M1a was 7 patients, and metastatic disease-M1b was 55 patients. We compared the survival time for these groups. Survival time was 11 months, 8 months, 11 months, and 4 months. The survival time of malignant pleural effusion was shorter than other T4 factors without pleural effusion. But, there was no remarkable difference in statistics due to small cases (p=0.23). We strongly suggest that malignant pleural effusion in advanced NSCLC will be categorized with metastatic disease.

View of Nature and Science in Perception of Dreams in the Chosun Dynasty (조선시대(朝鮮時代) 꿈(몽(夢)) 인식에서 나타난 자연관(自然觀)과 과학성(科學性)의 성격)

  • Kim, Seong soo
    • The Journal of Korean Medical History
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    • v.19 no.2
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    • pp.101-118
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    • 2006
  • Phenomena experienced by all individuals and cultural interpretation of such phenomena seem to be irrelevant to the change of time. The subject dream to be discussed in this study is one of them. Nevertheless, people's attitude of understanding dreams in the past is obviously different from the contemporary one, and the interpretation of dreams reveals the science of the corresponding age. Bishop Daveluy, a missionary to Chosun in the mid 19th century, observed Korean people's hardly understandable response to dreams. According to his explanation, Chosun people regarded what they saw in a dream as a fact. It might have been quite long that a dream is regarded as a sign of the future. However, how a dream can be a sign of the future is explained different according to the science of the corresponding age. Many records on dreams since the late Koryo Dynasty and the early Chosun Dynasty did not give satisfactory answers to this question. However, new interpretations of dreams were attempted occasionally in the process that the Sung Confucian view of nature in the Chosun Dynasty was being matured. One of such interpretations is that a dream is obviously a phenomenon of human cognition and there is a rule behind dreams. I t was believed that the rule is a flow of energy defined by reason penetrating through the past, the present and the future and, as a consequence, dreams are future oriented. The view that a dream is a phenomenon with a causal relation is observed more specifically in medicine. I t was understood basically as a pathological phenomenon but, at the same time, a substance in an organic relation with the human body. In addition, it was understood as the results of facts (physiological and pathological processes) experienced by the body in the past and the sign of diseases in the future. However, from the viewpoint of contemporary science based on empirical rationalism, such foreseeability is fundamentally unacceptable. In contemporary science, in which scientific analysis of phenomena has to be of the past tense, dreams exist as the representations of the past. What Bishop Daveluy saw in Korean people was a phenomenon observed when the pre modern met the modern as pre modern people's life and idea were viewed from a modern people's eye.

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Problems and Improvement Measures for the transformation of World Geodetic System (지적공부의 세계측지계 변환에 따른 문제점 및 개선방안)

  • Kim, Geun-Bae;Jeong, Gu-Ha;Jeon, Jeong-Bae
    • Journal of Cadastre & Land InformatiX
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    • v.49 no.2
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    • pp.123-134
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    • 2019
  • The introduction of the world geodetic reference system in cadastral sector can apply the international standardization of cadastral survey and can be the basis for the creation of new industries by merging with other industries based on spatial information. With the introduction of the world geodetic reference system, non-coincidence land may cause problems which are whether the cadastral record and the real estate register are not consistent, etc. This problem infringes on the protection of ownership of citizens suggested in the main purpose of 「Act On The Establishment, Management, Etc. Of Spatial Data」. We have analyzed at overlapping cases between private land and overlapping cases between national and public land and suggested institutional improvement measures to solve problems arising on the site. As a result, it will be necessary to introduce a transformation verification measure by the world geodetic reference system in order to assign a function as a cadastral records to mapping converted to the world geodetic reference system. It is also expected that the legal and institutional basis should be established for alert adjustment and positioning through verification measures. Finally, it is difficult to determine the transformation factor as the co-ordinates of common points also differ because survey results vary by work area. Therefore, it is deemed necessary to consider the requirement to use the cadastral measurement basis by the world geodetic reference system in 2021.

A Development of Remote Bird Observation System Using FMCW RADAR (FMCW 레이더를 이용한 원격 조류(鳥類) 관측 시스템 개발)

  • Lee, Hee-Yong;Hwang, Hun-Gyu;Choi, Myung-Gil
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.17 no.3
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    • pp.247-256
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    • 2014
  • Recently, camera and RADAR are used for more effective and accurate observation of the bird migration. In recent years, many researches on the bird migration using RADAR are undertaking and in active, thus causes the advent of "RADAR ornithology" as a new academic field. Due to the lack of accessibility, economic feasibility and mobility of weather RADAR, airport searching RADAR and tracking RADAR, Nowadays, a marine RADAR is widely used for a bird observation. In this paper, we deals with a study on development of a remote bird observation system using marine FMCW RADAR, which monitors, records and analyzes bird movement by RADAR image processing and target recognition technology. Also, we conduct first test and second test for availability of the developed system, and verify the system to apply in bird observation domain. Consequently, we figured problems out, and correct the problems to improve the system. The developed system can apply in other domains such as environment evaluation. In the future, the system needs to improve accuracy of statistics and to track migration route of bird.