PURPOSE: To evaluate the patterns of tumor shape and to compare tumor volume derived from simple diameter-based ellipsoid measurement with that derived from tracing the entire tumor contour using region of interest (ROI)-based 3D volumetry with respect to the prediction outcome in cervical cancer patients treated with concurrent chemotherapy and radiotherapy. MATERIALS AND METHODS: Magnetic resonance imaging was performed in 98 patients with cervical cancer (stage IB-IIIB). The tumor shape was classified into two categories: ellipsoid and non-ellipsoid shape. ROI-based volumetry was derived from each magnetic resonance slice on the work station. For the diameter-based surrogate "ellipsoid volume," the three orthogonal diameters were measured to calculate volume as an ellipsoid. RESULTS: The more than half of tumor (55.1%) had a non-ellipsoid configuration. The predictions for outcome were consistent between two volume groups, with overall survival of 93.6% and 87.7% for small tumor (<20 mL), 62.9% and 69.1% for intermediate-size tumor (20-39 mL), and 14.5% and 16.7% for large tumors (> or =40 mL) using ROI and diameter based measurement, respectively. Disease-free survival was 93.8% and 90.6% for small tumor, 54.3% and 62.7% for intermediate-size tumor, and 13.7% and 10.3% for large tumor using ROI and diameter based method, respectively. Differences in outcome between size groups were statistically significant, and the differences in outcome predicted by the tumor volume by two different methods. CONCLUSION: Our data suggested that large numbers of cervical cancers are not ellipsoid. However, simple diameter-based tumor volume measurement appears to be useful in comparison with ROI-based volumetry for predicting outcome in cervical cancer patients.
Disease-Free Survival ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Tumor Burden ; Uterine Cervical Neoplasms

No abstract available.
Animals ; Rats*

Regular exercise and a certain level of physical activity reduce the mortality rate in the elderly. The purpose of this study was to investigate the effect of physical activity on the prevention of fracture in the middle aged or older in Korea. The basic data are based on the Ansan and Ansung community cohort studies of the Korean Genome and Epidemiology Study conducted by the Korea Centers for Disease Control and Prevention in 2001, and the fracture data from the third survey in 2005 to the sixth survey in 2011. The physical activity of the aged in the 40s was mostly distributed in the World Health Organization (WHO) recommended range of 7.5 to 30.0 metabolic equivalent·hr/wk, and the activity was gradually divided into the low and high groups in the 50s and 60s. In the 60s, the risk of fracture was reduced to 0.63 times compared to that of the 50s when physical activity was the recommended level (odds ratio, 0.63; p<0.001). For Korean adults, there was no significant difference in fracture incidence according to the amount of physical activity in the middle-aged people. However, for the elderly aged 60 and over, the risk of fracture decreased when the WHO recommended level of activity was performed, and the risk increased when less or more activities were performed.
Adult* ; Aged ; Centers for Disease Control and Prevention (U.S.) ; Cohort Studies* ; Epidemiology ; Fractures, Bone ; Genome ; Gyeonggi-do ; Humans ; Incidence ; Korea ; Middle Aged ; Mortality ; Motor Activity* ; World Health Organization

PURPOSE: The objective of our study was to evaluate the immunohistochemical expression of p53 and bax proteins as prognostic markers in FIGO stage IIb invasive squamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: Sixty-five cases of squamous cell carcinoma of the cervix (stage IIb) that were diagnosed from October 1996 to December 2003 were analyzed retrospectively for the bax and p53 expression. These expressions were determined immunohistochemically and they were correlated to the patients' overall survival and disease-free survival. RESULTS: The overall 5-year survival (OS) rate and the disease-free survival (DFS) rate were 65.1% and 62.9%, respectively. p53 and bax immunoreactivity was seen in 26.2% and 52.3% of cases, respectively, with variable levels of expression. On the univariate analysis, only p53 positivity correlated with poor survival in DFS (log-rank test p=0.027), but this significance was not maintained on multivariated analysis by Cox's regression. The nine cases with the immunophenotype p53+/bax- had the poorest survival. CONCLUSION: Neither p53 nor bax expression are independent predictors of the prognosis for stage IIb cervical squamous cancers. Evaluation of p53 and bax co-expression may affect the clinical outcome and further investigation is needed.
bcl-2-Associated X Protein ; Carcinoma, Squamous Cell ; Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Prognosis ; Retrospective Studies

PURPOSE: Recently, the use of radiosurgery as a local therapy in patients with early stage non-small cell lung cancer has become favored over surgical resection. To evaluate the efficacy of radiosurgery, we analyzed the results of stereotactic body radiosurgery in patients with primary or recurrent non-small cell lung cancer. MATERIALS AND METHODS: We reviewed medical records retrospectively of total 24 patients (28 lesions) with non-small cell lung cancer (NSCLC) who received stereotactic body radiosurgery (SBRT) at Inha University Hospital. Among the 24 patients, 19 had primary NSCLC and five exhibited recurrent disease, with three at previously treated areas. Four patients with primary NSCLC received SBRT after conventional radiation therapy as a boost treatment. The initial stages were IA in 7, IB in 3, IIA in 2, IIB in 2, IIIA in 3, IIIB in 1, and IV in 6. The T stages at SBRT were T1 lesion in 13, T2 lesion in 12, and T3 lesion in 3. 6MV X-ray treatment was used for SBRT, and the prescribed dose was 15~60 Gy (median: 50 Gy) for PTV1 in 3~5 fractions. Median follow up time was 469 days. RESULTS: The median GTV was 22.9 mL (range, 0.7 to 108.7 mL) and median PTV1 was 65.4 mL (range, 5.3 to 184.8 mL). The response rate at 3 months was complete response (CR) in 14 lesions, partial response (PR) in 11 lesions, and stable disease (SD) in 3 lesions, whereas the response rate at the time of the last follow up was CR in 13 lesions, PR in 9 lesions, SD in 2 lesions, and progressive disease (PD) in 4 lesions. Of the 10 patients in stage I, one patient died due to pneumonia, and local failure was identified in one patient. Of the 10 patients in stages III-IV, three patients died, local and loco-regional failure was identified in one patient, and regional failure in 2 patients. Total local control rate was 85.8% (4/28). Local recurrence was recorded in three out of the eight lesions that received below biologically equivalent dose 100 Gy10. Among 20 lesions that received above 100 Gy10, only one lesion failed locally. There was a higher recurrence rate in patients with centrally located tumors and T2 or above staged tumors. CONCLUSION: SBRT using a CyberKnife was proven to be an effective treatment modality for early stage patients with NSCLC based on high local control rate without severe complications. SBRT above total 100 Gy10 for peripheral T1 stage patients with NSCLC is recommended.
Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Lung ; Medical Records ; Pneumonia ; Radiosurgery ; Recurrence ; Retrospective Studies

Purpose: As thyroid cancer patients are experiencing longer disease-free survival periods, evaluating their quality of life after surgery has become crucial. However, studies on this topic have primarily focused on Western populations, leaving a gap in understanding the Korean patient population’s experiences and needs. This study aims to address this gap and provide insights into the quality of life of thyroid cancer patients in Korea. Methods: This cross-sectional study evaluated the quality of life of Korean thyroid cancer patients who underwent thyroid lobectomy or total thyroidectomy. Patients were surveyed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30, ver. 3.0) during outpatient clinic visits from January to September 2015. The results were analyzed by comparing them to scores of the general population and based on the time elapsed since surgery. This approach allowed for a comprehensive evaluation of the quality-of-life outcomes in this patient population. Results: The study found that thyroidectomy had a notable impact on patients’ role and cognitive functions. Patients also experienced worsened symptoms such as fatigue, dyspnea, and constipation, which improved over time and returned to normal levels. However, there were no significant changes in other functions and symptoms after surgery. Conclusion The study’s findings showed that thyroidectomy had a relatively minor impact on the functional and symptomatic well-being of patients. Therefore, the results suggest that thyroid surgery may be a safe and effective treatment option for thyroid cancer patients seeking to maintain a good quality of life.

Lateral neck lymph node dissection (LND) along with total thyroidectomy is the standard treatment for thyroid cancer patients with metastases to the lateral neck lymph nodes. In general, lateral neck LND removes lymph nodes located at levels II to V ipsilateral to the thyroid cancer and preserves the spinal accessory nerve, internal jugular vein, and sternomastoid muscle during surgery. This video article was written to introduce the robotic bilateral axillo-breast approach for lateral neck LND and to describe the surgical method

Lithium is the drug of choice for treating bipolar affective disorders. However, it has a narrow therapeutic index and acute and chronic toxicity can occur in patients with chronic ingestion. Chronic toxicity commonly presents as nephrogenic diabetes insipidus or thyroid dysfunction. Neurologic symptoms such as apathy, hyperreflexia, or clonus can also occur in acute toxicity. However, it rarely causes peripheral neuropathy. We experienced a case of lithium-induced peripheral polyneuropathy who had already nephrogenic diabetes insipidus and chronic kidney disease during 25 years of lithium ingestion due to bipolar disorder.
Apathy ; Bipolar Disorder ; Diabetes Insipidus ; Diabetes Insipidus, Nephrogenic* ; Eating ; Humans ; Lithium ; Mood Disorders ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Polyneuropathies* ; Reflex, Abnormal ; Renal Insufficiency, Chronic ; Thyroid Gland ; Upper Extremity*

Pulmonary arterial hypertension (PAH) is a rare but progressive and currently incurable disease, which is characterized by vascular remodeling in association with muscularization of the arterioles, medial thickening and plexiform lesion formation. Despite our advanced understanding of the pathogenesis of PAH and the recent therapeutic advances, PAH still remains a fatal disease. In addition, the susceptibility to PAH has not yet been adequately explained. Much evidence points to the involvement of epigenetic changes in the pathogenesis of a number of human diseases including cancer, peripheral hypertension and asthma. The knowledge gained from the epigenetic study of various human diseases can also be applied to PAH. Thus, the pursuit of novel therapeutic targets via understanding the epigenetic alterations involved in the pathogenesis of PAH, such as DNA methylation, histone modification and microRNA, might be an attractive therapeutic avenue for the development of a novel and more effective treatment. This review provides a general overview of the current advances in epigenetics associated with PAH, and discusses the potential for improved treatment through understanding the role of epigenetics in the development of PAH.
Animals ; DNA Methylation/drug effects ; Drug Discovery/methods ; *Epigenesis, Genetic/drug effects ; Genetic Therapy/methods ; Humans ; Hypertension, Pulmonary/*genetics/therapy ; MicroRNAs/*genetics

PURPOSE: This study investigated the role of the education level (EL) as a prognostic factor for breast cancer and analyzed the relationship between the EL and various confounding factors. MATERIALS AND METHODS: The data for 64,129 primary breast cancer patients from the Korean Breast Cancer Registry were analyzed. The EL was classified into two groups according to the education period; the high EL group (≥ 12 years) and low EL group (< 12 years). Survival analyses were performed with respect to the overall survival between the two groups. RESULTS: A high EL conferred a superior prognosis compared to a low EL in the subgroup aged > 50 years (hazard ratio, 0.626; 95% confidence interval [CI], 0.577 to 0.678) but not in the subgroup aged ≤ 50 years (hazard ratio, 0.941; 95% CI, 0.865 to 1.024). The EL was a significant independent factor in the subgroup aged > 50 years according to multivariate analyses. The high EL group showed more favorable clinicopathologic features and a higher proportion of patients in this group received lumpectomy, radiation therapy, and endocrine therapy. In the high EL group, a higher proportion of patients received chemotherapy in the subgroups with unfavorable clinicopathologic features. The EL was a significant prognosticator across all molecular subtypes of breast cancer. CONCLUSION: The EL is a strong independent prognostic factor for breast cancer in the subgroup aged > 50 years regardless of the molecular subtype, but not in the subgroup aged ≤ 50 years. Favorable clinicopathologic features and active treatments can explain the main causality of the superior prognosis in the high EL group.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Education* ; Educational Status ; Humans ; Mastectomy, Segmental ; Multivariate Analysis ; Prognosis ; Survival Analysis