• Title/Summary/Keyword: treatment strategy

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Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome

  • Wang, Kai;Peng, Xiao-xin;Liu, Ao-fei;Zhang, Ying-ying;Lv, Jin;Xiang, Li;Liu, Yun-e;Jiang, Wei-jian
    • Journal of Korean Neurosurgical Society
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    • 제63권5호
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    • pp.590-597
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    • 2020
  • Objective : Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes. Methods : Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Long-term outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography. Results : Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months. Conclusion : Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

Hearing Outcome after Gamma Knife Stereotactic Radiosurgery in Vestibular Schwannoma Patients with Serviceable Hearing

  • Cho, Jae-Hoon;Paek, Sun-Ha;Chung, Hyun-Tai;Jeong, Sang-Soon;Jung, Hee-Won;Kim, Dong-Gyu
    • Journal of Korean Neurosurgical Society
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    • 제40권5호
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    • pp.336-341
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    • 2006
  • Objective : The authors conducted a retrospective study to evaluate the preservation rates of serviceable hearing and to determine its prognostic factors after gamma knife stereotactic radiosurgery[GK SRS] in the patient with vestibular schwannomas. Methods : Between December 1997 and March 2005, 54 patients with a sporadic vestibular schwannoma and serviceable hearing [Gardner Robertson grade I-II] were enrolled in this study. Electronic database of medical records and radiological examinations before and after GK SRS were investigated to the last follow up. The mean marginal dose was $12.3{\pm}0.7Gy$. The mean maximum dose delivered to the tumor center was 24.7Gy [$22{\sim}30Gy$]. The median tumor volume was 2cc [$0.1{\sim}9.1cc$]. The median follow-up period of magnetic resonance[MR] imaging was 31 months [$6{\sim}99\;months$], and the mean follow-up period of audiometry was 24 months [$4{\sim}70\;months$]. Results : The tumor control rate was 100% in the patients with the follow up period more than 2 years. The trigeminal and facial nerve preservation rates were 98% and 100%, respectively. Twenty-eight [52%] of the 54 patients preserved serviceable hearing and 16 [30%] patients retained their pre-GK G-R grade level after GK SRS. In the univariate and multivariate analysis, there was no significant prognostic factor in preservation of the serviceable hearing. Conclusion : The hearing preservation rate is still unsatisfactory compared with the results of other cranial nerve preservation and tumor control in the treatment of vestibular schwannoma by GK SRS. More sophisticated strategy during and after GK SRS is necessary to improve long-term hearing preservation.

고령군 뇌동맥류 환자의 치료 (Management of Elderly Patients with Intracranial Aneurysm)

  • 박현선;이재환;김진영;신용삼;주진양;허승곤;이규창
    • Journal of Korean Neurosurgical Society
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    • 제29권6호
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    • pp.786-793
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    • 2000
  • Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.

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Mutant p53-Notch1 Signaling Axis Is Involved in Curcumin-Induced Apoptosis of Breast Cancer Cells

  • Bae, Yun-Hee;Ryu, Jong Hyo;Park, Hyun-Joo;Kim, Kwang Rok;Wee, Hee-Jun;Lee, Ok-Hee;Jang, Hye-Ock;Bae, Moon-Kyoung;Kim, Kyu-Won;Bae, Soo-Kyung
    • The Korean Journal of Physiology and Pharmacology
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    • 제17권4호
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    • pp.291-297
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    • 2013
  • Notch1 has been reported to be highly expressed in triple-negative and other subtypes of breast cancer. Mutant p53 (R280K) is overexpressed in MDA-MB-231 triple-negative human breast cancer cells. The present study aimed to determine whether the mutant p53 can be a potent transcriptional activator of the Notch1 in MDA-MB-231 cells, and explore the role of this mutant p53-Notch1 axis in curcumin-induced apoptosis. We found that curcumin treatment resulted in an induction of apoptosis in MDA-MB-231 cells, together with downregulation of Notch1 and its downstream target, Hes1. This reduction in Notch1 expression was determined to be due to the decreased activity of endogenous mutant p53. We confirmed the suppressive effect of curcumin on Notch1 transcription by performing a Notch1 promoter-driven reporter assay and identified a putative p53-binding site in the Notch1 promoter by EMSA and chromatin immunoprecipitation analysis. Overexpression of mutant p53 increased Notch1 promoter activity, whereas knockdown of mutant p53 by small interfering RNA suppressed Notch1 expression, leading to the induction of cellular apoptosis. Moreover, curcumin-induced apoptosis was further enhanced by the knockdown of Notch1 or mutant p53, but it was decreased by the overexpression of active Notch1. Taken together, our results demonstrate, for the first time, that Notch1 is a transcriptional target of mutant p53 in breast cancer cells and suggest that the targeting of mutant p53 and/or Notch1 may be combined with a chemotherapeutic strategy to improve the response of breast cancer cells to curcumin.

Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma

  • Hong, Ji Hyun;Lee, Hyo Chun;Choi, Kyu Hye;Moon, Seok Whan;Kim, Kyung Soo;Hong, Suk Hee;Hong, Ju-Young;Kim, Yeon-Sil;Multidisciplinary Team of Lung Cancer in Seoul St. Mary's Hospital
    • Radiation Oncology Journal
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    • 제37권2호
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    • pp.101-109
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    • 2019
  • Purpose: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). Materials and Methods: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. Results: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). Conclusion: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.

CCR5 deficiency in aged mice causes a decrease in bone mass

  • Oh, Eun-Ji;Zang, Yaran;Kim, Jung-Woo;Lee, Mi Nam;Song, Ju Han;Oh, Sin-Hye;Kwon, Seung Hee;Yang, Jin-Woo;Koh, Jeong-Tae
    • International Journal of Oral Biology
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    • 제44권4호
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    • pp.173-181
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    • 2019
  • The CC chemokine receptor 5 (CCR5) is a G protein-coupled receptor that regulates chemotaxis and effector functions of immune cells. It also serves as the major co-receptor for the entry of human immunodeficiency virus (HIV). Recently, CCR5 inhibitors have been developed and used for the treatment or prevention of HIV infections. Additionally, it has been identified that CCR5 controls bone homeostasis by regulating osteoclastogenesis and the communication between osteoblasts and osteoclasts. However, the effects of CCR5 inhibition on bone tissue in elderly patients are unknown. This study aimed to examine the bone phenotype of aged CCR5 knockout (KO) mice. Femoral and tibial bones were isolated from 12-month and 18-month old wild-type (WT) and CCR5 KO mice, and microcomputed tomography and histology analyses were performed. Twelve-month-old CCR5 KO mice exhibited a decreased trabecular bone mass and cortical bone thickness in both femoral and tibial bones compared with age-matched WT mice. Eighteen-month-old mice also showed a decreased trabecular bone mass in femurs compared with control WT mice, but not in tibial bones. Unlike in 12-month-old mice, the cortical margin of femurs and tibias in 18-month-old mice were rough, likely because they were aggravated by the deficiency of CCR5. Overall, our data suggest that the deficiency of CCR5 with aging can cause severe bone loss. When CCR5 inhibitors or CCR5 inactivating technologies are used in elderly patients, a preventive strategy for bone loss should be considered.

Black Hispanic and Black Non-Hispanic Breast Cancer Survival Data Analysis with Half-normal Model Application

  • Khan, Hafiz Mohammad Rafiqullah;Saxena, Anshul;Vera, Veronica;Abdool-Ghany, Faheema;Gabbidon, Kemesha;Perea, Nancy;Stewart, Tiffanie Shauna-Jeanne;Ramamoorthy, Venkataraghavan
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권21호
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    • pp.9453-9458
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    • 2014
  • Background: Breast cancer is the second leading cause of cancer death for women in the United States. Differences in survival of breast cancer have been noted among racial and ethnic groups, but the reasons for these disparities remain unclear. This study presents the characteristics and the survival curve of two racial and ethnic groups and evaluates the effects of race on survival times by measuring the lifetime data-based half-normal model. Materials and Methods: The distributions among racial and ethnic groups are compared using female breast cancer patients from nine states in the country all taken from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry. The main end points observed are: age at diagnosis, survival time in months, and marital status. The right skewed half-normal statistical probability model is used to show the differences in the survival times between black Hispanic (BH) and black non-Hispanic (BNH) female breast cancer patients. The Kaplan-Meier and Cox proportional hazard ratio are used to estimate and compare the relative risk of death in two minority groups, BH and BNH. Results: A probability random sample method was used to select representative samples from BNH and BH female breast cancer patients, who were diagnosed during the years of 1973-2009 in the United States. The sample contained 1,000 BNH and 298 BH female breast cancer patients. The median age at diagnosis was 57.75 years among BNH and 54.11 years among BH. The results of the half-normal model showed that the survival times formed positive skewed models with higher variability in BNH compared with BH. The Kaplan-Meir estimate was used to plot the survival curves for cancer patients; this test was positively skewed. The Kaplan-Meier and Cox proportional hazard ratio for survival analysis showed that BNH had a significantly longer survival time as compared to BH which is consistent with the results of the half-normal model. Conclusions: The findings with the proposed model strategy will assist in the healthcare field to measure future outcomes for BH and BNH, given their past history and conditions. These findings may provide an enhanced and improved outlook for the diagnosis and treatment of breast cancer patients in the United States.

Significant Efficacy of Additional Concurrent Chemotherapy with Radiotherapy for Postoperative Cervical Cancer with Risk Factors: a Systematic Review and Meta-analysis

  • Qin, Ai-Qiu;Liang, Zhong-Guo;Ye, Jia-Xiang;Li, Jing;Wang, Jian-Li;Chen, Chang-Xian;Song, Hong-Lin
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권8호
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    • pp.3945-3951
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    • 2016
  • Background: Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial. Materials and Methods: A literature search strategy examined Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scientific meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non-randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3. Results: A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a benefit from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors significantly benefitted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no benefit from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No significant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88-10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Significant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26). Conclusions: In conclusion, concurrent chemoradiotherapy improves survival in postoperative cervical cancer with high risk factors but not in those with intermediate risk factors.

골프장에서 잔디의 예고와 통기작업이 곤충병원성선충의 굼벵이 방제효과에 미치는 영향 (Effect of Turfgrass Height and Aeration on Pathogenicity of Entomopathogenic Nematodes to White Grubs in Golf Courses)

  • 이동운;최우근;이상명;추호렬;권태웅
    • 한국응용곤충학회지
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    • 제45권1호
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    • pp.67-74
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    • 2006
  • 본 연구는 골프장 잔디 해충의 종합적 관리를 위하여 잔디의 관리 과정 중에 곤충병원성 선충을 투입함으로서 굼벵이 방제의 효율을 향상시키고, 작업 공정을 축소시킴으로서 노동력과 경비를 절감시키며, 환경친화적 방제를 통해 골프장 잔디의 관리자나 이용자들에게 쾌적한 환경을 제공하기 위한 목적으로 수행하였다. 잔디의 예고는 곤충병원성선충의 병원성에 영향을 미쳤는데 꿀벌부채 명나방 유충을 이용한 pot 실험과 등얼룩풍뎅이와 주황긴다리풍뎅이를 이용한 야외실험 모두에서 잔디의 예고가 짧을수록 선충의 방제 효과가 높았다. 통기작업은 곤충병원성 선충의 종에 따라 굼벵이에 대한 병원성에 차이를 보였다. 굼벵이에 대한 병원성이 낮은 곤충병원성 선충은 통기작업과 병행하여 처리하면 병원성이 높아졌으나 병원성이 높은 선충은 큰 차이를 보이지 않았다. 통기작업의 수행시기도 곤충병원성 선충의 병원성에 영향을 미쳤는데 곤충병원성 선충의 처리 전에 잔디에 대한 통기작업을 하는 것이 굼벵이의 방제효과를 높였다. Steinernema carpocapsae 포천 계통 처리 시 등얼룩풍뎅이 유충 밀도 감소율은 선충 처리 전 통기와 선충 처리 후 통기 처리에서 각각 80.4%와 66%를 보여 무통기 처리의 35.4%에 비하여 높았다.

Effects of $17{\beta}$-Estradiol and Estrogen Receptor Antagonists on the Proliferation of Gastric Cancer Cell Lines

  • Kim, Myung-Jin;Cho, Sung-Il;Lee, Kun-Ok;Han, Hyung-Joon;Song, Tae-Jin;Park, Seong-Heum
    • Journal of Gastric Cancer
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    • 제13권3호
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    • pp.172-178
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    • 2013
  • Purpose: The aims of this study were as follow: 1) to de scribe the expression status of estrogen receptor-${\alpha}$ and -${\beta}$ mRNAs in five gastric carcinoma cell lines; 2) to evaluate in vitro the effects of $17{\beta}$-estradiol and estrogen receptor antagonists on the proliferation of the cell lines. Materials and Methods: Detection of estrogen receptor-${\alpha}$ and estrogen receptor-${\beta}$ mRNA in five human gastric cancer cell lines (AGS, KATO III, MKN28, MKN45 and MKN74) was made by the reverse transcription-polymerase chain reaction system. To evaluate the effect of $17{\beta}$-estradiol and estrogen receptor antagonists on the proliferation of gastric cancer cell line, the cell lines which expressed both es trogen receptors were chosen and treated with $17{\beta}$-estradiol and estrogen receptor antagonists (methyl-piperidino-pyrazole and pyrazolo [1,5-a] pyrimidine). Cell proliferation was assessed with the methylthiazol tetrazolium test. Results: Estrogen receptor-${\alpha}$ and estrogen receptor-${\beta}$ mRNAs were expressed in three (KATO III, MKN28 and MKN45) and all of the five gastric cancer cell lines, respectively. At higher concentrations, $17{\beta}$-estradiol inhibited cell growth of MKN28, MKN45 and KATO III cell lines. Neither estrogen receptor-${\alpha}$ nor estrogen receptor-${\beta}$ antagonist blocked the anti-proliferative effect of $17{\beta}$-estradiol. Conclusions: Our results indicate that estrogen receptor-${\beta}$ mRNAs are preferentially expressed in gastric cancers and also imply that hormone therapy rather than estrogen receptor blockers may be a useful strategy for the treatment of estrogen receptor-${\beta}$ positive gastric cancer. Its therapeutic significance in gastric cancer are, however, limited until more evidence of the roles of estrogen receptors in the gastric cancer are accumulated.