PURPOSE: The purpose of this study was to identify the clinical and pathological factors that differentiate pleomorphic invasive lobular carcinoma (PILC) from classic invasive lobular carcinoma (CILC). METHODS: We retrospectively reviewed the medical records of 65 patients (4.0% of all invasive breast cancer patients) who underwent surgical excision for invasive lobular carcinoma (ILC) between January 2000 and November 2013. All 65 patients were diagnosed with ILC with negative immunohistochemical staining for E-cadherin in the tumor cells. All hematoxylin and eosin slides of the previously diagnosed ILC were reviewed and confirmed by two expert pathologists and we compared the clinicopathologic features between CILC and PILC. RESULTS: CILC was found in 46 cases and PILC, in 19 cases. Of the mammographic findings, a mass or asymmetric density was the most common feature (42.3% of all ILC patients). The most common ultrasonographic feature was a mass (94.9% of all ILC patients). Tumor multiplicity was noted in 10 patients (15.4%) among all ILC patients; eight patients (17.4%) had CILC and two patients (10.5%) had PILC. PILC patients had more grade III tumors (66.7% vs. 8.7%, p=0.002) and a higher Ki-67 labeling index (55.6% vs. 18.6%, p=0.004) than those with CILC. There were no statistical differences in the type of combined in situ component, extensive intraductal component, tumor size, lymphovascular invasion, stage, hormone receptor status, human epidermal growth factor receptor 2 status, distribution of intrinsic subtype, or imaging findings. Moreover, there was no significant difference in survival between CILC and PILC. CONCLUSION: PILC showed more pathological aggressiveness than CILC in terms of tumor grade and Ki-67 index.
Breast ; Breast Neoplasms ; Cadherins ; Carcinoma, Lobular* ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Medical Records ; Receptor, Epidermal Growth Factor ; Retrospective Studies

PURPOSE: The objective of this study was to identify needs and barriers that cancer patients experience with returning to work (RTW) by analyzing posts of the patients on the Internet. METHODS: Posts of online communities of the cancer patients related to RTW were collected using key words from Jan. 2004 to Dec. 2017. PFNet and NodeXL were utilized to visualize intellectual interchanges of the keywords. Additional content analysis of the posts was then conducted to specify informational needs related to RTW. RESULTS: There were 996 posts and 6394 responses related to RTW. A total of 163 and 129 keywords were found for posts and responses respectively. Posts were categorized into four groups by network analysis: 1) cancer diagnosis and treatment; 2) changing working status after cancer diagnosis; 3) concerns about RTW during cancer treatment; 4) balance of work and life after cancer. Responses were grouped into similar themes but most of them were empathetic or encouraging messages. CONCLUSION: Cancer patients posted various concerns and needs in relation to RTW on the online communities. At the same time, they expressed difficulties to obtain information and resources about RTW both on and off line. Further studies would be necessary to develop appropriate intervention for helping cancer patients to return to work.
Diagnosis ; Humans ; Internet ; Return to Work ; Social Networking ; Survivors

PURPOSE: A growing number of residents bear children during residency training. This study was conducted to examine the pregnancy and maternity leave experiences of women who delivered infants during their residency training. METHODS: From March 2007 through June 2007, we surveyed 94 women who had given birth during their residency training during the past 5 years from the survey date. Participants were recruited using snowball sampling. RESULTS: Most of the respondents (70.2%) delivered in the 3rd and 4th year of residency. The average length of leave was 68.9 days, and more than half (54.3%) of the women expressed that a maternity leave policy was not formally established in the department. In general, participants believed that having a child during residency was difficult (mean=4.18 in 5-point Likert scale), and this perception was inversely related with systematic departmental support. CONCLUSION: Pregnancy is a special challenge for residents, with regard to not only physical overexertion but also psychosocial impacts on pregnant residents and their colleagues. However, most current residency programs do not have written policies on pregnancy. A formal policy and more flexible curriculum can help both the training program and the pregnant resident.
Child ; Curriculum ; Surveys and Questionnaires ; Female ; Humans ; Infant ; Internship and Residency ; Parental Leave ; Parturition ; Pregnancy ; Ursidae

BACKGROUND: To minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type. METHODS: The AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3x3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively. RESULTS: More rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group. CONCLUSIONS: These observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.
Amnion ; Biological Dressings ; Chondroitin Sulfates ; Collagen ; Dermis ; Fibroblasts ; Hyperplasia ; Skin ; Skin, Artificial ; Transplants ; Wound Healing

BACKGROUND: Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. METHODS: This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension (TcPO2) was evaluated using the Periflux System 5000 with TcPO2/CO2 unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. RESULTS: Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P < 0.01), day 14 (P < 0.001), and day 28 (P < 0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. CONCLUSIONS: In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.
Angiogenesis Modulating Agents ; Blood Gas Monitoring, Transcutaneous ; Debridement ; Diabetic Foot* ; Eosine Yellowish-(YS) ; Foot Ulcer ; Humans ; Inflammation ; Oxygen* ; Polydeoxyribonucleotides ; Prospective Studies ; Skin ; Transplants ; Ulcer* ; Wound Healing

BACKGROUND: Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. METHODS: This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension (TcPO2) was evaluated using the Periflux System 5000 with TcPO2/CO2 unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. RESULTS: Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P < 0.01), day 14 (P < 0.001), and day 28 (P < 0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. CONCLUSIONS: In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.
Angiogenesis Modulating Agents ; Blood Gas Monitoring, Transcutaneous ; Debridement ; Diabetic Foot* ; Eosine Yellowish-(YS) ; Foot Ulcer ; Humans ; Inflammation ; Oxygen* ; Polydeoxyribonucleotides ; Prospective Studies ; Skin ; Transplants ; Ulcer* ; Wound Healing

PURPOSE: The shape and location, the amount of the wound and the characteristics of the remaining tissues are known to influence wound contraction. The previous studies using small animals have not been an appropriate model because the wound healing mechanisms and skin structures are different from those of the human. The purpose of this study is to evaluate wound contraction according to the shape and location of the wound using a Micropig(R). METHODS: Four Micropigs(R)(Medikinetics, Pyeongtaek, Korea) that were 10 months of age weighed 25kg were used. Full thickness skin defects were made by clearing all the tissues above the fascial layer in the shape of square, a regular triangle and a circle of 9cm2 each on the back around the spine. Eight wounds were created on the back of each pig, 50mm apart from each other. The randomly chosen wound shapes included 11 squares, 11 regular triangles, and 10 circles. Wound dressing was done every other day with polyurethane foam. The wound size was measured using a Visitrak Digital(R)(Smith & Nephew, Hull, UK) on every other day after surgery from day 2 to day 28. A biopsy was performed on day 3, and 1, 2, 3 and 4 weeks to investigate the degree of acute and chronic inflammation, the number of microvesssel and myofibroblast density using H & E stain and immunohistochemistry. The wound contraction rate was calculated to figure out the differences among each of the shapes and the locations. RESULTS: The ultimate shape of the circle wound was oval, and that of the regular triangle and square were stellate. The maximum contraction rate was obtained on 8 to 10 days for all the shapes, which corresponds with the immunohistochemical finding that myofibroblast increases in the earlier 2 weeks whereas it decreases in the later 2 weeks. Epithelialization was seen in the wound margin on day 7 and afterwards. The final wound contraction rates were highest for the regular triangle shapes; however, there were no statistically significant differences. The wound contraction rates by locations showed statistically significant differences. The wound in the cephalic area presented more contractions than that of the wounds in the caudal area. CONCLUSION: The location of a wound is more important factor than the wound shape in wound contraction.
Animals ; Bandages ; Biopsy ; Contracts ; Humans ; Immunohistochemistry ; Inflammation ; Myofibroblasts ; Polyurethanes ; Skin ; Spine ; Wound Healing

Rheumatoid arthritis (RA) is an autoimmune disease that starts with decreased tolerance to modified self-antigens and eventually leads to synovitis and destruction of bone and cartilage. Age is a risk factor for developing RA. Major changes in the immune system come with age due to chronic oxidative stress on the deoxyribonucleic acid (DNA) damage pathway, somatic mutation, modifications of auto-antigens, T cell tolerance and activation of fibroblast-like synoviocytes (FLS). Reactive oxygen species (ROS) generated by nicotinamide adenine dinucleotide phosphate oxidase 2 (NADPH oxidase 2) suppress T cell receptor signaling. Sirtuin 1 (SIRT1) is a critical immune suppressor of T cell activation and a key regulator of oxidative stress. When oxidative stress reduces activity of SIRT1, the breakdown of tolerance to modified self-antigens is expected. Generation of ROS can be perpetuated by enhanced DNA damage and dysfunctional mitochondria in a feedback loop during the development of RA. Through major T cell loss and selective proliferation of peripheral T cells, pro-inflammatory T cell pools with abnormal features are established in the T cell compartment. Hypoxic and inflammatory condition in synovium perpetuates ROS generation, which leads to the activation of FLS. In both T cell and synovium compartment, oxidative stress reshapes the immune system into the development of pre-clinical RA.
Arthritis, Rheumatoid* ; Autoantigens ; Autoimmune Diseases ; Cartilage ; DNA ; DNA Damage ; Immune System ; Mitochondria ; NADP ; NADPH Oxidase ; Oxidative Stress ; Oxidoreductases ; Reactive Oxygen Species* ; Receptors, Antigen, T-Cell ; Risk Factors ; Sirtuin 1 ; Synovial Membrane ; Synovitis ; T-Lymphocytes

Herein, we report five cases of occult breast cancer treated with axillary node dissection only, without breast surgery or whole breast radio-therapy. The patients complained of a large, hard mass in the axillary area, although no breast masses were palpable. Biopsy of the axillary mass was performed in each case, and histological examination showed a metastatic carcinoma. No malignant findings were observed by mammography or ultrasonography. Magnetic resonance imaging and systemic examinations revealed no extramammary primary lesions. All patients underwent axillary lymph node dissection without breast surgery, and were administered adjuvant chemotherapy but not whole breast radiation therapy. The median follow-up period was 56 months (range, 15–241 months). The patients were all alive with no evidence of disease at the end of the follow-up period.
Axilla ; Biopsy ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Magnetic Resonance Imaging ; Mammography ; Neoplasms, Unknown Primary ; Ultrasonography

Meningothelial hamartoma is a benign tumor composed of ectopic meningothelial elements in the dermis and subcutaneous tissue. It mainly occurs in the scalp; however, the incidence is extremely low. The origin of meningothelial hamartoma has not been elucidated; nevertheless, it has been theorized that it derives from ectopic meningothelial rests displaced during embryologic development. It can be diagnosed histologically as proliferation of connective tissue elements and cells arranged in solid nests, resembling vascular tumors. On immunohistochemistry, it stains positively for epithelial membrane antigen and vimentin. At least 17 cases have been reported, verifying the rarity of the lesion. We present the case of a 16-year-old male patient with a soft scalp mass which was thought to be a lipoma, but turned out to be a meningothelial hamartoma on histology.