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Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7th Edition Staging System

  • Arslan, Deniz;Bozcuk, Hakan;Gunduz, Seyda;Tural, Deniz;Tattli, Ali Murat;Uysal, Mukremin;Goksu, Sema Sezgin;Bassorgun, Cumhur Ibrahim;Koral, Lokman;Coskun, Hasan Senol;Ozdogan, Mustafa;Savas, Burhan
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.6
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    • pp.2465-2472
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    • 2014
  • Background: The American Joint Committee on Cancer (AJCC) published a new staging system ($7^{th}$ edition) in 2009. In our study, we evaluated the survival results and prognostic factors among T4 local advanced non-small cell lung cancer (LA-NSCLC) patients in a large heterogeneous group, in accordance with this new system. Materials and Methods: We retrospectively evaluated the files of 122 T4 N0-3 M0 LA-NSCLC patients, identified according to the new staging system, treated at two centers between November 2003 and June 2012. Variables correlating with univariate survival at p<0.20 were later included in multivariate Cox regression analysis. Here, selection of relevant predictors of survival was carried out in accordance with the likelihood ratio formula with p<0.05 regarded as significant. Results: The median age was 60 and the median follow-up period was 17.4 months. Median overall survival (OS) was 18.3 months, the 1 year overall survival (OS) rate was 72%, and the 5 year OS rate was 28%. Statistically significant predictors of survival were (p<0.20) ECOG-PS (Eastern Cooperative Oncology Group Performance Status), age, T4 factor subgroup, stage and primary treatment in OS univariate analysis. On multivariate analysis for OS ECOG-PS (p=0.001), diagnostic stage (p=0.021), and primary treatment (p=0.004) were significant. In the group receiving non-curative treatment, the median OS was 11.0 months, while it was 19.0 months in the definitive RT group and 26.6 months in the curative treatment group. There was a significant difference between the non-curative group and the groups which had definitive RT and curative operations (respectively p<0.001 and p=0.001) in terms of OS, but not between the groups which had definitive RT and curative operations. The median event free survival (EFS) rate was 9.9 months, with rates of 46% and 19% at 3 and 5 years, respectively. On univariate analysis of EFS rate with ECOG-PS, weight loss and staging, statistical significance was found only for thorax computerized tomography (CT)+18F-fluorodeoxy-glucose positron emission tomography-CT (PET-CT) use, stage and primary treatment (p<0.20). In multivariate analysis with EFS, only the primary treatment was statistically significant (p=0.001). In the group receiving non-curative treatment, the median EFS was 10.5 months while in the curative operation group it was 14.7 months. When all the primary treatment groups were taken into consideration, grade III/IV side effect swas observed in 57 patients (46.6%). Esophagitis was most prominent among those that received definitive radiotherapy. Conclusions: Independent prognostic factors among these 122 heterogeneous LA-NSCLC T4 N0-3 M0 patients were age at diagnosis, ECOG-PS, stage and primary treatment, the last also being a significant prognostic indicator of EFS. Our findings point to the importance of appropriate staging and a multidisciplinary approach with modern imaging methods in this patient group. In those with T4 lesions, treatment selection and the effective use of curative potential should be the most important goal of clinical care.

Effect of Epidural Analgesia on the Post-thoracotomy Patient (경막외 진통법이 개흉술후 환자에게 미치는 영향)

  • Lee, Yong-Jai;Shin, Hwa-Kyun;Kim, Sun-Han;Kwon, Oh-Chun;Nam, Chung-Hee;Rho, Jung-Kee;Lee, Kihl-Rho;Kim, Young-Ah;Lee, Jang-Won;Shin, Hyung-Chul;Kim, Il-Ho;Kim, Soon-Im;Kim, Sun-Chong;Park, Wook
    • The Korean Journal of Pain
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    • v.5 no.1
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    • pp.37-43
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    • 1992
  • Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxemia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine for control of postoperative pain was reported by Behar and associates. This study was carried out for twenty patients who received posterolateral thoracostomy with bleb resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes under general endotracheal anesthesia. For the relief of post-thoracotomy pain following of the general anesthesia, we selected ten patients as control group which were treated intermittently IM with injection of pethidine(50 mg) according to the conventional method and another ten patients as study group which were managed with thoracic epidural analgesia. The tip of the catheter was inserted to T4-5 epidural space through T12-L1 or L1-2 interspinous region before the induction of the general anesthesia and then the epidural analgesics(0.25% bupivacaine 15 ml+morphine 3 mg) was injected once a day via the catheter until 4 th POD in the study group. The epidural catheters were removed at postoperative 4 th day in study group. Clinical observations were done about vital signs, ABG, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; (1) The values of $V_T$ and FVC were significantly improved in study group(85% and 66%) as compared with control group(76% and 61%) during the postoperative 4 day of the epidural analgesia. (2) After the end of the epidural analgesia(7th POD), the values of FVC were improved invertly rather in control group(98%) than study group(84%). It suggested that the reduction of FVC in study group were caused by the raised pain sensitivity following the end of epidural analgesia. (3) The side effects of epidural analgesia such as transient urinary retention(2 cases), itching sensation(1) and headache(1) were noted.

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Change of Residual Deltamethrin Sprayed in the Stream Water according to Wind Speed and Diffusion (풍속 및 수중확산에 따른 방역용 Deltamethrin의 수중 잔류변화)

  • Cho, Kyung-Won;Pak, Jae-Hun;Lim, Jong-Sung;Yoon, Ji-Yeong;Moon, Hye-Ree;Lee, Yong-Ju;Lee, Sung-Kyu;Lee, Kyu-Seung
    • The Korean Journal of Pesticide Science
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    • v.17 no.2
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    • pp.126-132
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    • 2013
  • The objectives of this study were to provide the basic data of the residue of deltamethrin in the stream water. Deltamethrin was treated on side of Ban-Suk stream and Juk-Dong ditch for hygienic purpose by air spray. The drift concentration of deltamethrin was investigated with different wind speed condition on Ban-Suk stream (A), and the change of residue with time course on Juck-dong ford (B). Also we found the residual change of deltamethrin until 48 hour in Yu-Seong stream confluence (C) where two streams join. Maximum residues of A were $0.17{\mu}g/L$ (5 min, 200 m) at strong wind speed and $4.42{\mu}g/L$ (0 min, 25 m) at moderate wind speed according to different wind velocity. Residues of B were $0.15{\sim}0.26{\mu}g/L$ (0~480 min) after spraying, and decreased to a non-detected level after 720 min. Residues of C were $0.15{\mu}g/L$ (0 min), $0.11{\mu}g/L$ (1 min) and $0.10{\mu}g/L$ (12 hr) after spraying, and no residues were detected in any other samples. From these results, it is concluded that deltamethrin residues in water should be rapidly diluted into stream water and affected negligible toxic effect to stream ecosystem.

Effects of the Mixture of Vitamin C, Vitamin E, Pycnogenol and Evening Primrose Oil on the UV-Induced Pigmentation and Wrinkle Reductions in Human Skin (비타민과 불포화지방산, 그리고 피크노제놀을 함유한 복합제제의 주름 완화 및 자외선에 의한 색소침착 개선 효과)

  • Chang, Min-Youl;Park, Sang-Ki;Kwak, Taek-Jong;Park, Hyoung-Kook;Lee, Cheon-Koo;Lee, Heon-Sik;Ly, Sun-Yung;Kim, Seong-Jin
    • Journal of Nutrition and Health
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    • v.42 no.6
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    • pp.516-522
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    • 2009
  • In this study, the effects of a mixture consisting of vitamin E, vitamin C, pycnogenol and evening primrose oil (mixture LGNC-5) on ultraviolet light (UV) induced pigmentation and wrinkle reductions of normal healthy volunteers were studied. In a double-blind placebo-controlled study, each of 54 subjects took daily either 4 capsules of the mixture LGNC-5 (Group ABC; 282.5 mg/capsule) or placebo (Group Ganada). We irradiated 2.5 MED UV on the upper arms and measured the whitening effect by colorimeter-based L value. The level of wrinkle reduction was determined by image analysis using skin replica around the crow' feet, and the level of serum vitamin E was determined at baseline and 12 weeks. After 12-week oral administration, the treated group showed a significant reduction in skin pigmentation and wrinkles compared with the placebo group (p = 0.011 and p = 0.000005, respectively). Also, the level of serum vitamin E was significantly increased in the treated group after 12-week oral adminstration of the mixture compared with that in the placebo group (p = 0.0001). In conclusion, 12-week oral administration of LGNC-5 as a dietary supplement could be effective to reduce both UV induced pigmentation and skin wrinkle without side effects.

The Effect of Bee Venom Therapy on Skin Aging (봉독이 피부 노화에 미치는 영향)

  • Kim, Jin-Myoung;Kim, Yoon-Bum
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.23 no.2
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    • pp.27-40
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    • 2010
  • Background and Objective : Increasing interest in anti-aging and anti-wrinkling agents for the skin has triggered the recent outflow of researches and studies in this field. This study was designed to investigate the effects of bee venom on skin wrinkling and skin aging by testing the skin wrinkling, skin elasticity, trans-epidermal water loss (TEWL), free radical level, anti-oxidative agent level, and skin tissue after infusion of bee venom on hairless mouse. Materials and Methods : Fifteen hairless mice aged between 36~40 weeks were divided randomly into 3 Group; the Bee Venom Syringe Group, the Bee Venom Needle Group, and the control group. The Bee Venom Syringe Group were injected subcutaneously with bee venom (0.1cc in total) using an insulin syringe on three spots in the lumbar spine (one spot on the center and two spots 1~2cm to the side bilaterally). The Bee Venom Needle Group were pricked with bee venom-smeared acupuncture needles on three longitudinal spots in the lumbar spine each 1cm apart, after which the needles were removed 10 minutes later. The Control Group did not receive any form of intervention. All procedures took place thrice a week for four weeks, during which the mice were allowed free access to water and fodder. The mice were measured and compared in the weight, skin wrinkling scale, skin elasticity, and TEWL before and after the experiment. After the experiment, blood samples were taken to measure the free radical and anti-oxidative agent level, and the skin tissue was sliced for examination. Data was analyzed using the SPSS program (ver 12.0). The ANOVA analysis was used to compare and contrast the three groups, and t-test for paired samples was used to evaluate skin-wrinkling before and after experiment. The cut-off p-value of significance was set at p<0.05. Results : 1. Administration of bee venom did not cause serious weight loss or gain. 2. Compared to the control group, the Bee Venom Syringe Group and the Bee Venom Needle Group both showed a decrease in skin wrinkling scale after intervention. Especially, the Bee Venom Syringe Group showed a significant decrease (p<0.05). 3. Compared to the control group, the Bee Venom Syringe Group and the Bee Venom Needle Group both showed an increase in skin elasticity. Especially, the Bee Venom Syringe Group showed a significant increase (p<0.05). 4. No significant change in TEWL was found in the mice in all the three groups before and after experiment. 5. Free radical level was normal in all 15 mice in all the three groups, and anti-oxidative agent was not significantly different across the three groups. 6. The Bee Venom Syringe Group, the Bee Venom Needle Group, and the control group did not show any significant difference in the thickness of epidermis and dermis, infiltration of inflammatory cells, and skin wrinkling. The epidermis layer was relatively better preserved in the Bee Venom Syringe Group as compared to the Bee Venom Needle Group and the control group. Conclusion : Direct injection of bee venom on the hairless mouse using a syringe was found to improve wrinkling of the skin and increase skin elasticity but did not show effectiveness on skin dryness due to water loss. The bee venom appears to have suppressive effects on skin wrinkling, one of the symptoms of skin aging, through a process independent of suppression of free radicals or increase of anti-oxidative agent.

The vertical location of the center of resistance for maxillary six anterior teeth during retraction using three dimensional finite element analysis (상악 6전치부의 후방견인시 저항중심의 수직적 위치에 관한 3차원 유한요소법적 연구)

  • Lee, Hye-Kyoung;Chung, Kyu-Rhim
    • The korean journal of orthodontics
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    • v.31 no.4 s.87
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    • pp.425-438
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    • 2001
  • The delivery of optimal orthodontic treatment is greatly influenced by clinician's ability to predict and control tooth movement by applying well-known force system to dentition. It is very important to determine the location of the centers of resistance of a tooth or teeth in order to have better understanding the nature of displacement characteristics under various force levels. In this study, three dimensional finite element analysis was used to measure the initial displacement of the consolidated teeth under loading. The purpose of this study was to define the location of the centers of resistance at the upper six anterior segment. To observe the changes of six anterior segment, 200gm, 250gm, 300gm, and 350gm forces at right and left hand side each were imposed toward lingual direction. For this study, two cases, six anterior teeth and six anterior teeth after corticotomy, were reviewed. In addition, it was reviewed the effects of changes on the location of the center of resistance in both cases based on different degree of forces aforementioned. The results were that : 1. The instantaneous center of resistance for the six anterior teeth was vertically located between level 4 and level 5, which is, at 6.76mm, $44.32\%$ apical to the cementoenamel junction level. 2. The instantaneous center of resistance for the six anterior teeth after corticotomy was located vertically between level 4 and level 5, that is, at 7.09mm $46.38\%$ apical to the cementoenamel junction level. 3. Changes of force showed little effect on the location of the center of resistance in each case. 4. It was observed that the location of the instantaneous center of resistance for the six anterior teeth after corticotomy was changed more than the six anterior teeth without corticotomy to the apical part, and the displacement of the consolidated anterior teeth moved further in case of the consolidated teeth after corticotomy.

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Analysis of Communication of Dental Hygienist in Oral Hygiene Instruction during Scaling (치과위생사의 스케일링시 구강보건교육의 의사소통분석)

  • Kang, Su-Kyung;Bae, Hyun-Sook;Lim, Soon-Ryun
    • Journal of dental hygiene science
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    • v.14 no.4
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    • pp.546-553
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    • 2014
  • The purpose of this study was to investigate the actual condition of communication of dental hygienist in oral hygiene instruction during scaling. The research was intended for 67 dental hygienists who worked dental hospitals and clinics. Oral hygiene instruction during scaling was audiotaped. Pearson correlation analysis, t-test, one-way ANOVA, and chi-squared test were conducted. The results gained by the research were as follows. An analysis of 67 dental hygienists has found that 63 dental hygienists (94%) educated the patients with dentiform and 65 of them (97%) did rolling method. Thirty-three of them (49.3%) recommended oral care products to the patients. Only 14 of all educators (21%) said simple greetings and educated importance of care of subjects' teeth, side effect of scaling, when they finished all the scaling stage. The average time of oral hygiene education was 161.3 seconds. In detail, the dental hygienists told 155.0 seconds, the patients did 6.3 seconds on average. The percentage of education time without patients' comments and dialogue each other were 35.8% and 37.3% respectively. The conversation frequency according to the education level of dental hygienist showed significant difference (p<0.05). There was a negative correlation between total education time and patients coming for scaling per day and there was a positive correlation between total number of questions and patient talking time. The result of chi-squared test showed that there was significant difference on asking regards depending on setting a limitation of scaling time (p<0.05). The research showed that the dental hygienists seem to educate the patients mechanically, uniformly rather than educate them according to their oral hygiene condition.

Cerebral Activity by Motor Task in Welders Exposed to Manganese through fMRI (fMRI를 이용한 망간 노출 용접공의 운동수행에 따른 뇌 활성도 평가)

  • Choi, Jae-Ho;Jang, Bong-Ki;Lee, Jong-Wha;Hong, Eun-Ju;Lee, Myeong-Ju;Ji, Dong-Ha
    • Journal of Environmental Health Sciences
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    • v.37 no.2
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    • pp.102-112
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    • 2011
  • Objectives: The purpose of this study is to analyze the effects of chronic exposure by welders to manganese (Mn) through an analysis of the degree of brain activity in different activities such as cognition and motor activities using the neuroimaging technique of functional magnetic resonance imaging (fMRI). The neurotoxic effect that Mn has on the brain was examined as well as changes in the neuro-network in motor areas, and the usefulness of fMRI was evaluated as a tool to determine changes in brain function from occupational exposure to Mn. Methods: A survey was carried out from July 2010 to October 2010 targeting by means of a questionnaire 160 workers from the shipbuilding and other manufacturing industries. Among them, 14 welders with more than ten years of job-related exposure to Mn were recruited on a voluntary basis as an exposure group, and 13 workers from other manufacturing industries with corresponding gender and age were recruited as a control group. A questionnaire survey, a blood test, and an fMRI test were carried out with the study group as target. Results: Of 27 fMRI targets, blood Mn concentration of the exposure group was significantly higher than that of the control group (p<0.001), and Pallidal Index (PI) of the welder group was also significantly higher than that of the control group (p<0.001). As a result of the survey, the score of the exposure group in self-awareness of abnormal nerve symptoms and abnormal musculoskeletal symptoms was higher than those of the control group, and there was a significant difference between the two groups (p<0.05, respectively). In the correlation between PI and the results of blood tests, the correlation coefficient with blood Mn concentration was 0.893, revealing a significant amount of correlation (p<0.001). As for brain activity area within the control group, the right and the left areas of the superior frontal cortex showed significant activity, and the right area of superior parietal cortex, the left area of occipital cortex and cerebellum showed significant activity. Unlike the control group, the exposure group showed significant activity selectively on the right area of premotor cortex, at the center of supplementary motor area, and on the left side of superior temporal cortex. In the comparison of brain activity areas between the two groups, the exposure group showed a significantly higher activation state than did the control group in such areas as the right and the left superior parietal cortex, superior temporal cortex, and cerebellum including superior frontal cortex and the right area of premotor cortex. However, in nowhere did the control group show a more activated area than did the exposure group. Conclusions: Chronic exposure to Mn increased brain activity during implementation of hand motor tasks. In an identical task, activation increased in the premotor cortex, superior temporal cortex, and supplementary motor area. It was also discovered that brain activity increase in the frontal area and occipital area was more pronounced in the exposure group than in the control group. This result suggests that chronic exposure to Mn in the work environment affects brain activation neuro-networks.

Effects of Sourdough on the Quality Characteristics of Rye-Wheat Mixed Bread (Sourdough 대체가 호밀-밀 혼합빵의 품질 특성에 미치는 영향)

  • Kim, Mun-Yong;Chun, Soon-Sil
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.37 no.5
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    • pp.625-632
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    • 2008
  • Rye-wheat mixed bread samples made with substitutions of 20, 40, 60 and 80% sourdough, and control made with the addition of naturally fermented raisin extract, were examined for quality characteristics such as pH, total titratable acidity, fermentation power of dough expansion, specific volume, baking loss, water activity, color, texture, external and internal surface appearance, and sensory qualities, in order to determine the optimal ratio of sourdough in the formulation. As the incubation time of sourdough increased, pH decreased, while total titratable acidity increased. The pH of rye-wheat mixed doughs decreased with increasing sourdough content, but total titratable acidity increased. The rye-wheat mixed breads prepared with substitutions of sourdough had higher pH and lower total titratable acidity than the control group. Fermentation power of dough expansion of rye-wheat mixed doughs increased with increasing incubation time. Specific volume was maximum on the 20% substitution sourdough. Baking loss was inferior with the 80% substitution sourdough. Water activity and lightness was minimum on the control group. The higher amounts of sourdough showed the higher tendency of lightness, redness and yellowness. In the texture characteristics, hardness, gumminess, and chewiness was minimum on the control group and tended to increase with higher substitution of sourdough. Substitution of sourdough showed decrease adhesiveness. Fracturability, cohesiveness, and resilience of all rye-wheat mixed breads were not significantly different. Springiness was maximum on the 20% substitution sourdough and minimum on the 40%. A side of loaf of rye-wheat mixed breads, except for 20%, had a poor break and shred. In sensory evaluation, as substitution amount of sourdough increased, the scores of color and consistency of crumb, uniformity of crumb pore, gumminess, and overall acceptability decreased; while the density of crumb pore, springiness of crumb, aroma of rye flour, sourness, and bitterness showed the reverse effect; the 20, 40, and 60% sourdough samples obtained fairly good scores. In conclusion, these results indicated that $20{\sim}60%$ of sourdough could be very useful as a substitute for baker's yeast in developing rye-wheat mixed bread.

Reduction Effect of Aromatherapy on Stress and Insomnia (아로마요법의 스트레스 및 수면장애 감소효과)

  • Park, Sang-Ock;Kim, Seok-Beom;Lee, Kyeong-Soo;Kang, Pock-Soo
    • Journal of agricultural medicine and community health
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    • v.27 no.2
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    • pp.17-26
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    • 2002
  • Reducing the level of stress and insomnia by aromatherapy is proposed as a method of self-care and health promotion in the future. Of the people who received aromatherapy from July, 1999 to February, 2000 at the Complementary and Alternative Medicine Center at the Gyeongu City Health Center, 48 people agreed to participate in a questionnaire survey, presented before and after their aromatherapy, and the data were analyzed. When the people received aromatherapy at the Complementary and Alternative Medicine Center, they inhaled the aroma from a vaporizer and when at home, they inhaled from a tissue, gauze or washbowl. Two sessions per week (2 hrs./session) were provided at the Center in the total 1-month duration of the therapy. The oil made from a blend of clarysage, geranium, rose at a ratio of 3:2:1 was used for relieving stress, and the oil made from a blend of clarysage, lavender, and lemon at 2:2:1 ratio was used for relieving insomnia. The scores of stress of 92.5 17.5 points before aromatherapy significantly reduced to $87.4{\pm}4.2$ points after therapy(p<0.01), and the scores of insomnia of $2.5{\pm}1.2$ points before aromatherapy significantly reduced to $1.0{\pm}1.1$ points after therapy(p<0.01). The reduction in stress and insomnia from aromatherapy was more significant in those who were experiencing high levels of stress and insomnia. Therefore, stress and its related insomnia can be effectively relieved with proper application of aromatherapy. With benefits such as little side-effects, convenient and simple education, low cost, and the do-it-yourself feature. aromatherapy can be expanded into a self-management program for promoting health of the community people.

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