Purpose: We investigated the feasibility of using an anatomically localized, target-enriched liquid biopsy (TLB) in mouse models of lung cancer. Materials and Methods: After irradiating xenograft mouse with human lung cancer cell lines, H1299 (NRAS proto-oncogene, GTPase [NRAS] Q61K) and HCC827 (epidermal growth factor receptor [EGFR] E746-750del), circulating (cell-free) tumor DNA (ctDNA) levels were monitored with quantitative polymerase chain reaction on human long interspersed nuclear element-1 and cell line-specific mutations. We checked dose-dependency at 6, 12, or 18 Gy to each tumor-bearing mouse leg using 6-MV photon beams. We also analyzed ctDNA of lung cancer patients by LiquidSCAN, a targeted deep sequencing to validated the clinical performances of TLB method. Results: Irradiation could enhance the detection sensitivity of NRAS Q61K in the plasma sample of H1299-xenograft mouse to 4.5- fold. While cell-free DNA (cfDNA) level was not changed at 6 Gy, ctDNA level was increased upon irradiation. Using double-xenograft mouse with H1299 and HCC827, ctDNA polymerase chain reaction analysis with local irradiation in each region could specify mutation type matched to transplanted cell types, proposing an anatomically localized, TLB. Furthermore, when we performed targeted deep sequencing of cfDNA to monitor ctDNA level in 11 patients with lung cancer who underwent radiotherapy, the average ctDNA level was increased within a week after the start of radiotherapy. Conclusion TLB using irradiation could temporarily amplify ctDNA release in xenograft mouse and lung cancer patients, which enables us to develop theragnostic method for cancer patients with accurate ctDNA detection.

Objective: This study examined the characteristics of the patients taking poison intentionally at the pre-hospital stage to prevent it at the community level. Methods: We retrospectively reviewed the data that had been reported to fire stations from January 2017 to December 2018. This data included sex, age, occupation, the season of the year, time, place, methods, alcohol ingestion, transferred to the hospital or not, and we examined how taking poison had an effect on the suicide success rate. Results: The subjects were a total of 1,356 patients who had been reported to fire stations due to intentionally taking poison. Forty-five point five percent of them were male, and 54.5% were female. The most common method of intentional taking poison was sedatives (58.3%), followed by pesticides (24.6%), antidepressants (19.0%), and other methods (12.6%). The home place was preferred more than any other places. The suicide success rate was 2.1% in males and 1.4% in females. For the age groups, those patients 40-64 years old tried taking poison much more than the other age groups. In the aspect of the season of the year, summer was the highest season for taking poison, at 30.3%. The daytime was more preferred than the night time. Conclusion In this study, we analyzed the characteristics of the pre-hospital intentional poisoning cases according to gender, age, occupation, season of the year, time, and between the transferred and the untransferred groups. Efforts should be made in cooperation with the community to prevent suicide attempts by intentionally taking poison.

PURPOSE: We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). MATERIALS AND METHODS: A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed. RESULTS: After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). CONCLUSION: This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.
Arm ; Chemoradiotherapy ; Compliance ; Disease-Free Survival ; Drug Therapy* ; Humans ; Induction Chemotherapy ; Methods ; Nasopharyngeal Neoplasms ; Propensity Score* ; Radiotherapy ; Recurrence ; Republic of Korea ; Retrospective Studies* ; Standard of Care ; Treatment Outcome

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
Adult ; Cerebral Infarction ; Female ; Humans ; International Classification of Functioning, Disability and Health ; Lupus Erythematosus, Systemic ; Lupus Vasculitis, Central Nervous System* ; Peripheral Nervous System ; Polyneuropathies ; Posterior Leukoencephalopathy Syndrome ; Quality of Life ; Rehabilitation*

BACKGROUND/AIMS: Interferon beta (IFN-beta) has been shown to have antiviral activity, and thus could be useful in treating viral infections. Therefore, we compared the efficacy and safety of recombinant IFN-beta(IFN-beta-1a) plus oral ribavirin versus interferon alpha (IFN-alpha) plus ribavirin therapy for the treatment of chronic hepatitis C (HCV). METHODS: Twenty treatment-naive patients were randomized into two equal-sized treatment groups. Both IFN-beta-1a (44microgram) and IFN-alpha (3 MIU) were given subcutaneously three times a week, while ribavirin was given orally at 1,000-1,200 mg/day. Patients were treated for 24 weeks and followed for an additional 24 weeks. RESULTS: After 24 weeks of treatment, six (60%) and four patients (40%) in the IFN-beta-1a group and IFN-alpha groups, respectively, achieved viral clearance. The sustained virological response (SVR) at the end of the observation period was similar in both groups (40%). However, the baseline viral load was significantly higher (p=0.034) in the IFN-beta-1a group than in the IFN-alpha group, and there were more HCV genotype 1 patients in the IFN-beta-1a group (eight versus seven). The IFN-beta-1a group was associated with similar adverse events in terms of frequency and severity. CONCLUSIONS: The SVR rate and safety profile were similar for the combination of IFN-beta-1a and ribavirin and that of IFN-alpha and ribavirin.
Genotype ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Interferon-alpha ; Interferon-beta ; Interferons ; Pilot Projects ; Prospective Studies ; Ribavirin ; Treatment Outcome ; Viral Load

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus. METHODS: Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated 'control group' (n=17) and 'treated group' (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed. RESULTS: The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out. CONCLUSIONS: Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate.
Adolescent ; Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*pathology/*therapy ; Combined Modality Therapy ; Female ; *Heart Atria/pathology ; Heart Diseases/*etiology ; Humans ; Liver Neoplasms/mortality/*pathology/*therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Thrombosis/*etiology ; Treatment Outcome ; *Vena Cava, Inferior/pathology

BACKGROUND/AIMS: The long-term virologic and biochemical changes in patients with HBeAg negative HBV infection, especially in Asia, remain unclear. To address this issue, we conducted a 3 year- retrospective, cohort study. METHODS: A total of 157 patients with HBeAg negative HBV infection who were monitored without treatment were reviewed between January 1999 and March 2004. Those patients were followed up every 3 months with liver function tests and serologic tests. All patients were stratified into 3 groups; inactive carrier (IC), viremic carrier (VC) and chronic hepatitis (CH). Serum HBV DNA was measured by a hybridization assay (sensitivity: 1.4 x 10(5) genomes/mL, Digene Diagnostics, Silver Spring, USA). RESULTS: The median age of enrolled patients was 42.7 years (M:F=2.3:1). By single time-point observations, the 3 year-cohort prevalence of HBeAg negative CH varied from 12.7 to 35.8% (median 20.7%) HBeAg negative CH was accumulated over time (P=0.002) and transition rates among three groups after 3 years of follow-up are as follows: IC to CH, 6.0%; IC to VC, 4.1%; VC to CH, 23.2%. VC seems to be a disease state in the middle of transition from IC to CH. CONCLUSIONS: We demonstrated the dynamic changing patterns of HBeAg negative CH with time, of which the change from IC or VC to CH was dominant.
Middle Aged ; Male ; Humans ; Hepatitis B, Chronic/*immunology/virology ; Hepatitis B e Antigens/*blood ; Female ; Carrier State/immunology ; Adult

BACKGROUND/AIM: We identified risk factors for hepatocellular carcinoma (HCC) through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver diseases. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. METHODS: We studied a total of 994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. RESULTS: 90 (9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into three groups by their risk index and probability of HCC development. These patients were classified into a low risk group (less than 5% probability), an intermediate risk group (5% to 10% probability), and a high risk group (more than 10% probability). According to this classification, 1 of 191 patients in the low risk group (0.523%), 5 of 176 patients in the intermediate risk group (2.84%), and 21 of 113 patients in the high risk group (18.6%) were diagnosed with HCC. CONCLUSION: We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Humans ; Korea* ; Liver Diseases ; Logistic Models ; Mass Screening ; Risk Factors*

BACKGROUNDS/AIMS: The relationship between HBV infection and nephropathy has been reported with some differences according to the investigators and regions studied. Liver biopsies were not performed in most of the reports. In this study both liver and kidney biopsies were performed. The histologic correlation was analyzed between chronic B viral hepatitis and nephropathy. METHODS: From January 1985 to June 2000, both liver and kidney biopsies were performed on 26 patients who had chronic hepatitis B, proteinuria, and hematuria. Also, a new histopathologic classification of chronic hepatitis was applied in the assessment of liver disease. RESULT: Light microscopy of kidneys showed IgA nephropathy in 7 cases (27%); minimal change nephrotic syndrome (MCNS) in 1 case (3.8%); and membranous glomerulonephritis (MGN) in 9 cases (34.6%), membranoproliferative glomerulonephritis (MPGN) in 9 cases (34.6%). Among the cases with a higher hepatitis activity index and fibrosis score, the frequency of MGN and MPGN was higher. The hepatitis activity index of cases with MGN was significantly higher than IgA nephropathy and MPGN (p=0.011, p=0.039). The fibrosis score of cases with MGN and MPGN was significantly higher than IgA nephropathy (p=0.011, p=0.003). The positivity of HBeAg was highest in cases with MGN. Serum C3 level was low in all cases but the serum C4 level was within normal range. Immunofluorescence studies showed granular deposition of IgG and C3 in the capillary loops in MGN. CONCLUSION: The frequency of MGN and MPGN was higher when the liver disease was more severe. It was suggested that HBeAg, IgG and C3 might contribute to the pathogenesis of MGN in HBsAg positve patients.
Biopsy ; Capillaries ; Classification ; Fibrosis ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunoglobulin G ; Kidney ; Liver ; Liver Diseases ; Microscopy ; Nephrosis, Lipoid ; Proteinuria ; Reference Values ; Research Personnel

Barraquer-Simmons syndrome, also known as cephalothoracic lipodystrophy, is an uncommon disorder of unknown origin. Patients with this syndrome lose their subcutaneous fat of face and it progresses to the thoracic region. Simultaneously, the accumulation of subcutaneous fatty tissue in lower extremity occurs. The onset of this syndrome is known to be in their teens and patients are mainly female. The progression of this condition stops spontaneously in their early twenties. Twenty percents of patients show nephropathy with complement disorder which aggravates the prognosis. We present a 34-year-old female with typical features of this syndrome. This patients was treated with autologous free fat graft harvested from the gluteal area. The donor and recipient site healed uneventfully and the result was comparatively satisfactory. Autologous fat graft method is easy to perform, allows fast recovery with minimal donor site morbidity and is a useful method for the patients with Barraquer-Simmons syndrome.
Adipose Tissue ; Adolescent ; Adult ; Complement System Proteins ; Female ; Humans ; Lipomatosis, Multiple Symmetrical ; Lower Extremity ; Prognosis ; Subcutaneous Fat ; Tissue Donors ; Transplants*