• Korean Journal of Radiology
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• v.25 no.9
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• pp.788-797
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• 2024

Objective: To investigate the potential association among preoperative breast MRI features, axillary nodal burden (ANB), and disease-free survival (DFS) in patients with early-stage breast cancer. Materials and Methods: We retrospectively reviewed 297 patients with early-stage breast cancer (cT1-2N0M0) who underwent preoperative MRI between December 2016 and December 2018. Based on the number of positive axillary lymph nodes (LNs) determined by postoperative pathology, the patients were divided into high nodal burden (HNB; ≥3 positive LNs) and non-HNB (<3 positive LNs) groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with ANB. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). Univariable and multivariable Cox proportional hazards regression analyses were performed to determine preoperative features associated with DFS. Results: We included 47 and 250 patients in the HNB and non-HNB groups, respectively. Multivariable logistic regression analysis revealed that multifocality/multicentricity (adjusted odds ratio [OR] = 3.905, 95% confidence interval [CI]: 1.685-9.051, P = 0.001) and peritumoral edema (adjusted OR = 3.734, 95% CI: 1.644-8.479, P = 0.002) were independent risk factors for HNB. Combined peritumoral edema and ultifocality/multicentricity achieved an AUC of 0.760 (95% CI: 0.707-0.807) for predicting HNB, with a sensitivity and specificity of 83.0% and 63.2%, respectively. During the median follow-up period of 45 months (range, 5-61 months), 26 cases (8.75%) of breast cancer recurrence were observed. Multivariable Cox proportional hazards regression analysis indicated that younger age (adjusted hazard ratio [HR] = 3.166, 95% CI: 1.200-8.352, P = 0.021), larger tumor size (adjusted HR = 4.370, 95% CI: 1.671-11.428, P = 0.002), and multifocality/multicentricity (adjusted HR = 5.059, 95% CI: 2.166-11.818, P < 0.001) were independently associated with DFS. Conclusion: Preoperative breast MRI features may be associated with ANB and DFS in patients with early-stage breast cancer.

• The Journal of Dong Guk Oriental Medicine
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• v.6 no.1
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• pp.1-34
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• 1997

The present writer studied the medical thought of 'You-Yi(尤怡)', the medical expert of the early 'Qing(淸)' Dynasty, which can be summarized as following. 1. 'You-Yi' writed many essays and treaties about 'Shang-Han-Lun(傷寒論)' and 'Jin-Gui-Yao-Lue(金?要略)', both of which are the writings of 'Zhang-Zhong-Jing(張仲景)', the medical saint of 'Han(漢)' Dynasty, and those writings include 'Shang-Han-Guan-Zhu-Ji(傷寒貫珠集)', 'Jin-Gui-Yao-Lue-Xin-Dian(金?要略心典)', 'Yi-Xue-Dou-Shu-Ji(醫學讀書記)', 'Jin-Gui-Yi(金?翼)', and 'Jing-Xiang-Lou-Yi-An(靜香樓醫案)'. 2. A theory of 'Tai-Yang(太陽)' syndrome, including 'San-Gang-Ding-Li(三綱鼎立)', was proposed by 'Fang-You-Zhi'(方有執)' and 'Yu-Chang(喩昌)' and it came to be one of the leading theory of the 'Shang-Han-Lun', 'You-Yi' rejected their opinions in which they insisted that the 'Feng(風)' hurts the 'Wei'(衛)' and the 'Han(寒)' hurts the 'Ying(營)', and he advocated his particular idea that the 'Xie-Qi'(邪氣)' can directly hit skin, flesh, 'Ying-Wei(營衛)', the Five Organs and the Six Viscera(五臟六腑), regardless of 'Zhong-Feng(中風)' or 'Shang-Han(傷寒)', and he insisted that there is need to be anxious about Whether the 'Ying-Wei' is strong or weak. 3. In 'Shang-Han-Guan-Zhu-Ji', 'You-Yi' invented the eight classifications in treating the 'Shang-Han' and he did not follow the old theories hitherto. He divided the book into six parts via the clinical experiences, and the Classification and Logics in Treatment(辨證論治), and he put several titles on 'Jin-Gui-Yao-Lue. And he newly edited the original text of 'Shang-Han-Lun' and arranged 'Zhong-Jing(仲景)'s Six Meridian(六經) categories. Each syndrome in 'Tai-Yang' 'Yang-Ming(陽明)', 'Shao-Yang(少陽)', 'Tai-Yin'(太陰)', 'Shao-Yin(少陰)' and 'Jue-Yin(厥陰)' has its own categories in treatment. 4. In explaining the Six Meridian(六經) and the Organs and Viscera(臟腑), 'You-Yi' legislated the syndrome in 'Three Yang(三陽)' into Meridian(經) and Viscera(腑) ; the syndrome in 'Three Yin(三陰)'into Meridian(經) and Organs(腑). He also concluded that 'Shang-Han-Lun' not only discussed 'Wai-Gan(外感)' but also included the Internal Hurt(內傷) and Miscellaneous Diseases(雜病). 5. In his academic research, 'You-Yi' followed 'Zhong-Jing' in classifications and prescriptions and succeeded the theory of 'Ma-Chu(마숙)' and 'Li-Zhong-Zi(李中梓)', but was not tied to any stereotyped former practices. He put emphasis on the Spleen(脾) and the Kidney(腎) as he harmonized the Middle Energizer(中焦焦) with the taste of 'Gan(甘)' and 'Wen(溫)' and enjoyed strengthening 'Yang' by benefitting the 'Qi(氣)'. 6. He discussed in detail the causes, mechanism and symptoms on 'Tan-Yin(痰飮)' and proposed the seven categorizes in treatment. 7. He sorted the causes of 'Zhong-Feng' into two kinds of the 'Feng' via 'Wai-Gan' and Internal Hurt, and recognized these two 'Feng's correlate as mutual sources of diseases. He insisted that the origin of the 'Feng' exists in the 'Liver(肝). He also established the eight categories in treating the 'Feng'. 8. 'You-Yi' belong to the classifications and Logical Treatment School. And he, considering he respected and followed 'Zhong-Jing' and 'Li-Zhong-Zi', belongs to the successor to the 'Wen-Bu(溫補)' School. 9. His writings, especially the 'Shang-Han-Guan-Zhu-Ji' and the 'Jin-Gui-Yao-Lue-Xin-Dian', are excellent commentary works on the originals, so they served as significant guide books for many junior scholars. For penetrating the 'Shang-Han-Lun' with his unique way of classification of treatment, he has been highly appreciated by later generations including scholars like 'Tang-Li-San(唐立三)' in the 'Qing' Dynasty, and so many more ones thenceforth. In conclusion, on the base of this study, it is hopefully proposed that the still more profound research on the medical thought of 'You-Yi', as one of the most distinguished scholars, an expert clinician and an earnest writer as well.

• 대한공업교육학회지
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• v.35 no.2
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• pp.70-81
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• 2010

The purpose of this study is to introduce formation 'International framework curriculum for a Master Degree for TVET teachers and lectures' to present implications about fostering Chinese vocational teachers and to analyze the contents related to it. In 2004, UNFSCO composed formation International framework curriculum for a Master Degree for TVET teachers and lectures ("framework curriculum") to improve the ability of professionals in the vocational education and training fields including teachers and training leaders as well as to promote international academic exchange. Universities which introduce the framework curriculum should form specialized committee and carry out education considering the specific situation including other universities' situation, students' ability, educational certification system, etc. The framework curriculum should include the latest trends of the development of international vocational education science and carry out united educational learning between several internal or external high schools. UNFSCO tries to promote the development of educational learning and study of basic departments of vocational education such as vocational educational learning theory, vocational science, etc through the framework curriculum and to improve knowledge of vocational educational teachers and realize specialization of them. The number of universities that established the master's degree of vocational education in China is approx. 20 and the number of students that they collect every year. As for the plans of the master's degree of vocational teachers in each university, the courses about the practical problems like educational courses and educational learning are insufficient. But the framework curriculum thinks that educational learning of application theory is more important and emphasizes practice about the specific area and educational learning much more. Utilization of preceding experiences of advanced countries has the important meaning in search of models that foster Chinese vocational teachers and departmental system. The framework curriculum implies several useful points in installment of majors and educational process of the process that fosters Chinese vocational teachers.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10407-10412
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• 2015

Background: ${\beta}$-elemene, extracted from herb medicine Curcuma wenyujin has potent anti-tumor effects in various cancer cell lines. However, the activity of ${\beta}$-elemene against glioma cells remains unclear. In the present study, we assessed effects of ${\beta}$-elemene on human glioma cells and explored the underlying mechanism. Materials and Methods: Human glioma U87 cells were used. Cell proliferation was determined with MTT assay and colony formation assay to detect the effect of ${\beta}$-elemene at different doses and times. Fluorescence microscopy was used to observe cell apoptosis with Hoechst 33258 staining and change of glioma apoptosis and cell cycling were analyzed by flow cytometry. Real-time quantitative PCR and Western-blotting assay were performed to investigated the influence of ${\beta}$-elemene on expression levels of Fas/FasL, caspase-3, Bcl-2 and Bax. The experiment was divided into two groups: the blank control group and ${\beta}$-elemne treatment group. Results: With increase in the concentration of ${\beta}$-elemene, cytotoxic effects were enhanced in the glioma cell line and the concentration of inhibited cell viability ($IC_{50}$) was $48.5{\mu}g/mL$ for 24h. ${\beta}$-elemene could induce cell cycle arrest in the G0/G1 phase. With Hoechst 33258 staining, apoptotic nuclear morphological changes were observed. Activation of caspase-3,-8 and -9 was increased and the pro-apoptotic factors Fas/FasL and Bax were upregulated, while the anti-apoptotic Bcl-2 was downregulated after treatment with ${\beta}$-elemene at both mRNA and protein levels. Furthermore, proliferation and colony formation by U87 cells were inhibited by ${\beta}$-elemene in a time and does-dependent manner. Conclusions: Our results indicate that ${\beta}$-elemene inhibits growth and induces apoptosis of human glioma cells in vitro. The induction of apoptosis appears to be related with the upregulation of Fas/FasL and Bax, activation of caspase-3,-8 and -9 and downregulation of Bcl-2, which then trigger major apoptotic cascades.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7459-7466
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• 2013

Background: Some 60 years after introduction of the Papanicolaou smear worldwide, cervical cancer remains a burden in developing countries where >85% of world new cases and deaths occur, suggesting a failure to establish comprehensive cervical-cancer control programs. Effective interventions are available to control cervical cancer but are not all affordable in low-income settings. Disease awareness saves lives by risk-reduction as witnessed in reducing mortality of HIV/AIDS and smoking-related cancers. Subjects and Methods: We initiated a community-based awareness program on cervical cancer in two low-income Muslim Uyghur townships in Kashi (Kashgar) Prefecture, Xinjiang, China in 2008. The education involved more than 5,000 women from two rural townships and awareness was then evaluated in 2010 and 2011, respectively, using a questionnaire with 10 basic knowledge questions on cervical cancer. Demographic information was also collected and included in an EpiData database. A 10-point scoring system was used to score the awareness. Results: The effectiveness and feasibility of the program were evaluated among 4,475 women aged 19-70 years, of whom >92% lived on/below US$1.00/day. Women without prior education showed a poor average awareness rate of 6.4% (164/2,559). A onetime education intervention, however, sharply raised the awareness rate by 4-fold to 25.5% (493/1,916). Importantly, low income and illiteracy were two reliable factors affecting awareness before or after education intervention. Conclusions: Education intervention can significantly raise the awareness of cervical cancer in low-income women. Economic development and compulsory education are two important solutions in raising general disease awareness. We propose that implementing community-based awareness programs against cervical cancer is realistic, locally affordable and sustainable in low-income countries, which may save many lives over time and, importantly, will facilitate the integration of comprehensive programs when feasible. In this context, adopting this strategy may provide one good example of how to achieve "good health at low cost".

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.11
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• pp.4603-4608
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• 2015

Background: To determine the potential value of serum tumor markers in predicting pCR (pathological complete response) during neoadjuvant chemotherapy. Materials and Methods: We retrospectively monitored the pro-, mid-, and post-neoadjuvant treatment serum tumor marker concentrations in patients with locally advanced breast cancer (stage II-III) who accepted pre-surgical chemotherapy or chemotherapy in combination with targeted therapy at Fudan University Shanghai Cancer Center between September 2011 and January 2014 and investigated the association of serum tumor marker levels with therapeutic effect. Core needle biopsy samples were assessed using immunohistochemistry (IHC) prior to neoadjuvant treatment to determine hormone receptor, human epidermal growth factor receptor 2(HER2), and proliferation index Ki67 values. In our study, therapeutic response was evaluated by pCR, defined as the disappearance of all invasive cancer cells from excised tissue (including primary lesion and axillary lymph nodes) after completion of chemotherapy. Analysis of variance of repeated measures and receiver operating characteristic (ROC) curves were employed for statistical analysis of the data. Results: A total of 348 patients were recruited in our study after excluding patients with incomplete clinical information. Of these, 106 patients were observed to have acquired pCR status after treatment completion, accounting for approximately 30.5% of study individuals. In addition, 147patients were determined to be Her-2 positive, among whom the pCR rate was 45.6% (69 patients). General linear model analysis (repeated measures analysis of variance) showed that the concentration of cancer antigen (CA) 15-3 increased after neoadjuvant chemotherapy in both pCR and non-pCR groups, and that there were significant differences between the two groups (P=0.008). The areas under the ROC curves (AUCs) of pre-, mid-, and post-treatment CA15-3 concentrations demonstrated low-level predictive value (AUC=0.594, 0.644, 0.621, respectively). No significant differences in carcinoembryonic antigen (CEA) or CA12-5 serum levels were observed between the pCR and non-pCR groups (P=0.196 and 0.693, respectively). No efficient AUC of CEA or CA12-5 concentrations were observed to predict patient response toward neoadjuvant treatment (both less than 0.7), nor were differences between the two groups observed at different time points. We then analyzed the Her-2 positive subset of our cohort. Significant differences in CEA concentrations were identified between the pCR and non-pCR groups (P=0.039), but not in CA15-3 or CA12-5 levels (p=0.092 and 0.89, respectively). None of the ROC curves showed underlying prognostic value, as the AUCs of these three markers were less than 0.7. The ROC-AUCs for the CA12-5 concentrations of inter-and post-neoadjuvant chemotherapy in the estrogen receptor negative HER2 positive subgroup were 0.735 and 0.767, respectively. However, the specificity and sensitivity values were at odds with each other which meant that improving either the sensitivity or specificity would impair the efficiency of the other. Conclusions: Serum tumor markers CA15-3, CA12-5, and CEA might have little clinical significance in predicting neoadjuvant treatment response in locally advanced breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.1
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• pp.217-223
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• 2013

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and the outcomes for patients are still poor. It is important to determine the original type of synchronous multinodular HCC for preoperative assessment and the choice of treatment therapy as well as for the prediction of prognosis after treatment. Aims: To analyze clinicopathologic characteristics and prognoses in patients with multicentric occurrence (MO) and intrahepatic metastasis (IM) of synchronous multinodular hepatocellular carcinoma (HCC). Methods: The study group comprised 42 multinodular HCC patients with a total of 112 nodules. The control group comprised 20 HCC patients with 16 single nodular HCC cases and 4 HCC cases with a portal vein tumor emboli. The mitochondrial DNA (mtDNA) D-loop region was sequenced, and the patients of the study group were categorized as MO or IM based on the sequence variations. Univariate and multivariate analyses were used to determine the important clinicopathologic characteristics in the two groups. Results: In the study group, 20 cases were categorized as MO, and 22 as IM, whereas all 20 cases in the control group were characterized as IM. Several factors significantly differed between the IM and MO patients, including hepatitis B e antigen (HBeAg), cumulative tumor size, tumor nodule location, cirrhosis, portal vein and/or microvascular tumor embolus and the histological grade of the primary nodule. Multivariate analysis further demonstrated that cirrhosis and portal vein and/or microvascular tumor thrombus were independent factors differentiating between IM and MO patients. The tumor-free survival time of the MO subjects was significantly longer than that of the IM subjects ($25.7{\pm}4.8$ months vs. $8.9{\pm}3.1$ months, p=0.017). Similarly, the overall survival time of the MO subjects was longer ($31.6{\pm}5.3$ months vs. $15.4{\pm}3.4$ months, p=0.024). The multivariate analysis further demonstrated that the original type (p=0.035) and Child-Pugh grade (p<0.001) were independent predictors of tumor-free survival time. Cirrhosis (p=0.011), original type (p=0.034) and Child-Pugh grade (p<0.001) were independent predictors of overall survival time. Conclusions: HBeAg, cumulative tumor size, tumor nodule location, cirrhosis, portal vein and/or microvascular tumor embolus and histological grade of the primary nodule are important factors for differentiating IM and MO. MO HCC patients might have a favorable outcome compared with IM patients.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.3773-3777
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• 2015

Background: This study aimed to establish a nomogram by combining clinicopathologic factors with overall survival of stage IA-IIB cervical cancer patients after complete resection with pelvic lymphadenectomy. Materials and Methods: This nomogram was based on a retrospective study on 1,563 stage IA-IIB cervical cancer patients who underwent complete resection and lymphadenectomy from 2002 to 2008. The nomogram was constructed based on multivariate analysis using Cox proportional hazard regression. The accuracy and discriminative ability of the nomogram were measured by concordance index (C-index) and calibration curve. Results: Multivariate analysis identified lymph node metastasis (LNM), lymph-vascular space invasion (LVSI), stromal invasion, parametrial invasion, tumor diameter and histology as independent prognostic factors associated with cervical cancer survival. These factors were selected for construction of the nomogram. The C-index of the nomogram was 0.71 (95% CI, 0.65 to 0.77), and calibration of the nomogram showed good agreement between the 5-year predicted survival and the actual observation. Conclusions: We developed a nomogram predicting 5-year overall survival of surgically treated stage IA-IIB cervical cancer patients. More comprehensive information that is provided by this nomogram could provide further insight into personalized therapy selection.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.18
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• pp.7849-7855
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• 2014

Purpose: To investigate the effect of deacetylase inhibitory trichostatin A (TSA) on anti HepG2 liver carcinoma cells and explore the underlying mechanisms. Materials and Methods: HepG2 cells exposed to different concentrations of TSA for 24, 48, or 72h were examined for cell growth inhibition using CCK8, changes in cell cycle distribution with flow cytometry, cell apoptosis with annexin V-FTIC/PI double staining, and cell morphology changes under an inverted microscope. Expression of ${\beta}$-catenin, HDAC1, HDAC3, H3K9, CyclinD1 and Bax proteins was tested by Western blotting. Gene expression for ${\beta}$-catenin, HDAC1and HDAC3 was tested by q-PCR. ${\beta}$-catenin and H3K9 proteins were also tested by immunofluorescence. Activity of Renilla luciferase (pTCF/LEF-luc) was assessed using the Luciferase Reporter Assay system reagent. The activity of total HDACs was detected with a HDACs colorimetric kit. Results: Exposure to TSA caused significant dose-and time-dependent inhibition of HepG2 cell proliferation (p<0.05) and resulted in increased cell percentages in G0/G1 and G2/M phases and decrease in the S phase. The apoptotic index in the control group was $6.22{\pm}0.25%$, which increased to $7.17{\pm}0.20%$ and $18.1{\pm}0.42%$ in the treatment group. Exposure to 250 and 500nmol/L TSA also caused cell morphology changes with numerous floating cells. Expression of ${\beta}$-catenin, H3K9and Bax proteins was significantly increased, expression levels of CyclinD1, HDAC1, HDAC3 were decreased. Expression of ${\beta}$-catenin at the genetic level was significantly increased, with no significant difference in HDAC1and HDAC3 genes. In the cytoplasm, expression of ${\beta}$-catenin fluorescence protein was not obvious changed and in the nucleus, small amounts of green fluorescence were observed. H3K9 fluorescence protein were increased. Expression levels of the transcription factor TCF werealso increased in HepG2 cells following induction by TSA, whikle the activity of total HDACs was decreased. Conclusions: TSA inhibits HDAC activity, promotes histone acetylation, and activates Wnt/${\beta}$-catenin signaling to inhibit proliferation of HepG2 cell, arrest cell cycling and induce apoptosis.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6047-6052
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• 2014

Background: Weight loss during chemotherapy has not been exclusively investigated. Macrophage inhibitory cytokine-1 (MIC-1) might play a role in its etiology. Here, we investigated the prognostic value of weight loss before chemotherapy and its relationship with MIC-1 concentration and its occurrence during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC). Materials and Methods: We analyzed 157 inoperable locally advanced or metastatic ESCC patients receiving first-line chemotherapy. Serum MIC-1 concentrations were assessed before chemotherapy. Patients were assigned into two groups according to their weight loss before or during chemotherapy:>5% weight loss group and ${\leq}5%$ weight loss group. Results: Patients with weight loss>5% before chemotherapy had shorter progression-free survival period (5.8 months vs. 8.7 months; p=0.027) and overall survival (10.8 months vs. 20.0 months; p=0.010). Patients with weight loss >5% during chemotherapy tended to have shorter progression-free survival (6.0 months vs. 8.1 months; p=0.062) and overall survival (8.6 months vs. 18.0 months; p=0.022), and if weight loss was reversed during chemotherapy, survival rates improved. Furthermore, serum MIC-1 concentration was closely related to weight loss before chemotherapy (p=0.001) Conclusions: Weight loss both before and during chemotherapy predicted poor outcome in advanced ESCC patients, and MIC-1 might be involved in the development of weight loss in such patients.