1.Endocrine Therapy for Breast Cancer.
The Ewha Medical Journal 2014;37(2):83-91
Breast cancer is the second most common cancer in Korean women and its mortality rate has increased steadily. Although breast cancer is heterogeneous tumor, hormone receptor-positive tumors comprise about 75 percent of all breast cancers. Therefore endocrine therapy that works by targeting estrogen receptor is a pivotal treatment for breast cancers. There are selective estrogen receptor modulators, such as tamoxifen and raloxifene, aromatase inhibitors, such as anastrozole, letrozole and exemestane, fulvestrant and luteinizing hormone-releasing hormone agonists used in endocrine therapy. Endocrine therapy is effective in treating early breast cancer as an adjuvant therapy and metastatic breast cancer as a palliative therapy. Also in women who are at high risk for breast cancer, tamoxifen or raloxifene can prevent breast cancer. Studies for neoadjuvant endocrine therapy are emerging. Considering side effects of each drug and overcoming drug resistance are needed to maximize effectiveness of treatment and advance endocrine therapy.
Antineoplastic Agents, Hormonal
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Aromatase Inhibitors
;
Breast
;
Breast Neoplasms*
;
Drug Resistance
;
Drug Therapy
;
Estrogens
;
Female
;
Gonadotropin-Releasing Hormone
;
Humans
;
Mortality
;
Palliative Care
;
Raloxifene Hydrochloride
;
Selective Estrogen Receptor Modulators
;
Tamoxifen
2.Anticancer Effect of Selenium.
The Ewha Medical Journal 2017;40(1):17-21
Selenium is an essential microelement in animals including human. Selenium plays an important role in cellular functions such as deoxygenation and detoxification. Also, it can be used in treatment of cardiac disease, hepatic disease, AIDS and various cancers. Recent meta-analysis showed that high selenium exposure was associated with decreased risk of several cancers. Selenium has an effect on anticarcinogesis through several mechanisms, which are regulation of cell cycles, apoptosis, DNA damage and repair, inhibition of cellular adhesion and migration, anti-angiogenesis and immune modulation. Even though many laboratory studies have provided convincing evidence of these mechanisms, results from epidemiologic and clinical studies of selenium does not coincide with each other. Well-designed trials considering dosage and chemical form of selenium supplement as well as confounding factors and long-term follow-up of them would be needed to use selenium in chemoprevention and therapy of cancers.
Animals
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Apoptosis
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Cell Cycle
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Chemoprevention
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DNA Damage
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Follow-Up Studies
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Heart Diseases
;
Humans
;
Selenium*
3.Chemotherapy Response Assay Test and Prognosis for Breast Cancer Patients Who Have Undergone Anthracycline- and Taxane-Based Chemotherapy.
Anbok LEE ; Woosung LIM ; Byung In MOON ; Nam Sun PAIK ; Suck Hwan KOH ; Jeong Yoon SONG
Journal of Breast Cancer 2011;14(4):283-288
PURPOSE: A chemotherapy response assay test is performed to evaluate the degree of tumor growth inhibition by a chemotherapeutic agent. Several studies have been done on its usefulness; however, to the best of our knowledge, only a few studies concerning the relationship between chemotherapy response assay test results and breast cancer patients' prognoses have been conducted. Thus, we performed this study to analyze this relationship. METHODS: Among breast cancer patients who underwent curative surgery and neoadjuvant or adjuvant chemotherapy between August 2004 and December 2009, 102 were enrolled in this study. Chemotherapeutic regimens for patients were doxorubicin plus taxane or doxorubicin plus cyclophosphamide followed by taxane. We divided these patients into two groups (sensitive group [n=19] and resistant group [n=83]) and analyzed the relationship between chemosensitivity results and patient prognosis. RESULTS: The sensitive group was associated with poor disease-free survival (DFS) (p=0.003) and overall survival (OS) (p<0.001). No significant differences were observed in tumor histology (p=0.548), tumor size (p=0.479), number of metastatic lymph nodes (p=0.326), histologic grade (p=0.077), or nuclear grade (p=0.216) between the two groups. However, in respect to molecular subtype, the HER2-positive type and triple negative breast cancer were more frequently observed in the sensitive group (p=0.001). In a univariate and multivariate analysis for DFS, doxorubicin sensitivity was significantly associated with a poor prognosis (p<0.05). CONCLUSION: Better chemosensitivity results are associated with a poor prognosis in breast cancer patients who have undergone anthracycline- and taxane-based chemotherapy, however, examination of additional cases and the use of a longer study period are needed.
Breast
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Breast Neoplasms
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Bridged Compounds
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Chemotherapy, Adjuvant
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Cyclophosphamide
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Disease-Free Survival
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Doxorubicin
;
Humans
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Lymph Nodes
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Multivariate Analysis
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Prognosis
;
Taxoids
4.Comparison of Endoscopic Thyroidectomy versus Conventional Thyroidectomy in Patient Satisfaction with Cosmetic Result.
Anbok LEE ; Jina JANG ; Woosung LIM ; Byung In MOON
Korean Journal of Endocrine Surgery 2010;10(3):170-175
PURPOSE: Endoscopic thyroidectomy has brought lots of advantages to the patients since its first introduction. The aim of this study is to evaluate the functional and cosmetic satisfaction of patients receiving endoscopic thyroidectomy with patients receiving conventional thyroidectomy. METHODS: From October 2009 to January 2010, 98 patients underwent with conventional (n=69) or endoscopic (n=22) thyroidectomy. Of these patients 91 who had responded to a questionnaire distributed during the visit outpatient clinic visit. The questionnaire responses were analyzed to compare the satisfaction and postoperative results of these patients. RESULTS: The patient mean age was 45.5±10.1 years and the male to female ratio was 1:8.1. Perceived cosmetic satisfaction was significantly greater in patients who received conventional thyroidectomy than in those who received endoscopic thyroidectomy (P=0.03). Otherwise, there were no significant differences concerning functional problems. The conventional surgery was significantly longer than the endoscopic surgery (P=0.001). However, there were no significant differences in estimated blood loss, postoperative hospital stayand complication rates (P>0.05). CONCLUSION: Endoscopic thyroidectomy might bring satisfactory cosmetic result compared to conventional thyroidectomy. However, further studies are necessary.
Ambulatory Care Facilities
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Female
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Humans
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Male
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Patient Satisfaction*
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Postoperative Hemorrhage
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Thyroidectomy*
5.Native low-density lipoprotein-induced superoxide anion contributes to proliferation of human aortic smooth muscle cells.
Hyun Kyo LIM ; Woosung SHIN ; Ji Yeon LEE ; Sungwoo RYOO
Korean Journal of Anesthesiology 2009;57(5):622-628
BACKGROUND: Native low-density lipoprotein (nLDL) was one of the modifiable risk factors contributed directly to cardiovascular diseases development. We investigated that nLDL stimulation induced NADPH oxidase activation and superoxide production that was an important factor on human aortic smooth muscle cells (hAoSMC) proliferation. METHODS: Superoxide generation was recorded with fluorescent-staining of dihydroethidine or by measuring lucigenin-induced chemiluminescence for 5 minutes. We examined cell proliferation with 4[-3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST-1) reagent and analyzed the change of gene expression by northern blot analysis. RESULTS: nLDL stimulation increased superoxide anion production in hAoSMC that confirmed through dihydroethidine staining and lucigenin-induced chemiluminescence methods. nLDL-induced proliferation abolished with preincubation of superoxide scavengers or NADPH oxidase inhibitor. NADPH as a substrate of NADPH oxidase increased superoxide generation in both nLDL-stimulated and unstimulated cell homogenate, which was completely blocked at the diphenylene iodinium (DPI)- or apocynin-pretreated hAoSMC homogenates. Furthermore, superoxide generation was only observed at the fraction of cellular precipitate, but not in soluble fraction. Expression of p22phox in mRNA level increased with nLDL treatment as early as 30 minutes and transfection of anti-sense oligonucleotide of p22phox completely abolished nLDL-induced proliferation of hAoSMC. CONCLUSIONS: The above results have shown that nLDL-induced proliferation in hAoSMC depends on superoxide production through NADPH oxidase activation.
Blotting, Northern
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Cardiovascular Diseases
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Cell Proliferation
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Dicarbethoxydihydrocollidine
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Gene Expression
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Humans
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Lipoproteins
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Luminescence
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Muscle, Smooth
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Myocytes, Smooth Muscle
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NADP
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NADPH Oxidase
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Risk Factors
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RNA, Messenger
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Superoxides
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Transfection
6.Correlation between the molecular subtype of breast cancer and the in vitro adenosine triphosphate-based chemosensitivity assay.
Jina CHANG ; Anbok LEE ; Jihyun LEE ; Woosung LIM ; Sun Hee SUNG ; Byung In MOON
Journal of the Korean Surgical Society 2013;84(6):313-320
PURPOSE: The empirical use of a chemotherapy regimen shows different results in individual breast cancer patient treatment. Recent studies showed the effectiveness of the adenosine triphosphate-based chemotherapy response assay (ATP-CRA). However, little is known about the correlation between chemosensitivity and breast cancer molecular subtypes. Therefore, we investigated whether the result of ATP-CRA is associated with a molecular subtype of breast cancer. METHODS: Two hundred eighty-seven patients diagnosed with breast cancer and receiving ATP-CRA at Mokdong Hospital, Ewha Womans University between September 2007 and December 2010 were enrolled in this study. Hormone receptor status, HER2/neu expression, and results of chemosensitivity tests of the patients was analyzed. RESULTS: In all of four subtypes, the combination of two agents showed significant higher mean cell death rate than a single agent. Within the breast cancer cell lines in this study, the range of chemosensitivity response was very wide and varied for each patient. For this reason, the molecular subtype of breast cancer is inconclusive in choosing an effective chemotherapeutic agent and in vitro chemosensitivity test, prior to therapy, could be a useful method for planning chemotherapy for each patient. CONCLUSION: Chemosensitivity response to anticancer agents was found to vary depending on the individual breast cancer patients. The molecular subtype of breast cancer is inconclusive to choose the effective chemotherapeutic agent and the in vitro chemosensitivity test, prior to therapy, could be more useful for planning chemotherapy for each patient.
Adenosine
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Adenosine Triphosphate
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Antineoplastic Agents
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Breast
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Breast Neoplasms
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Cell Death
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Cell Line
;
Chemotherapy, Adjuvant
;
Female
;
Humans
7.Arginase Inhibition by Ethylacetate Extract of Caesalpinia sappan Lignum Contributes to Activation of Endothelial Nitric Oxide Synthase.
Woosung SHIN ; To Dao CUONG ; Jeong Hyung LEE ; Byungsun MIN ; Byeong Hwa JEON ; Hyun Kyo LIM ; Sungwoo RYOO
The Korean Journal of Physiology and Pharmacology 2011;15(3):123-128
Caesalpinia sappan (C. sappan) is a medicinal plant used for promoting blood circulation and removing stasis. During a screening procedure on medicinal plants, the ethylacetate extract of the lignum of C. sappan (CLE) showed inhibitory activity on arginase which has recently been reported as a novel therapeutic target for the treatment of cardiovascular diseases such as atherosclerosis. CLE inhibited arginase II activity prepared from kidney lysate in a dose-dependent manner. In HUVECs, inhibition of arginase activity by CLE reciprocally increased NOx production through enhancement of eNOS dimer stability without any significant changes in the protein levels of eNOS and arginase II expression. Furthermore, CLE-dependent arginase inhibition resulted in increase of NO generation and decrease of superoxide production on endothelium of isolated mice aorta. These results indicate that CLE augments NO production on endothelium through inhibition of arginase activity, and may imply their usefulness for the treatment of cardiovascular diseases associated with endothelial dysfunction.
Animals
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Aorta
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Arginase
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Atherosclerosis
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Blood Circulation
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Caesalpinia
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Cardiovascular Diseases
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Endothelium
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Kidney
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Mass Screening
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Mice
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Nitric Oxide
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Nitric Oxide Synthase Type III
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Plants, Medicinal
;
Superoxides
8.Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial
Jun Woo LEE ; Jong Kyu KIM ; Hyungju KWON ; Woosung LIM ; Byung In MOON ; Nam Sun PAIK
Annals of Surgical Treatment and Research 2019;96(4):177-184
PURPOSE: Routine supplementation of high-dose calcium significantly decreased the risk of postoperative symptomatic hypocalcemia after thyroidectomy. However, there is an ongoing debate about whether the same results can be achieved with low-dose calcium supplementation. METHODS: Patients (n = 138) who underwent total thyroidectomy for thyroid cancer were 1:1 randomly assigned to receive oral supplements of 1,500 mg/day elemental calcium and 1,000 IU/day cholecalciferol for 2 weeks or no supplementation. Primary objective was to compare the incidence of symptomatic hypocalcemia for 3 days after total thyroidectomy. Secondary objective was to find the predictors for postoperative hypocalcemia in patients with thyroid cancer. RESULTS: Sixty-five patients in the calcium group and 69 patients in the control group were finally analyzed. The incidence of symptomatic hypocalcemia showed no difference between the calcium and control group (32.3% vs. 21.7%, P = 0.168). The total dosage of intravenous calcium (593.4 ± 267.1 mg vs. 731.6 ± 622.7 mg, P = 0.430) administered to patients with symptomatic hypocalcemia was also comparable between groups. In a multivariate analysis, parathyroid hormone level of 13 pg/mL at postoperative day 1 was only predictive for symptomatic hypocalcemia, and its incidence was 20.9 times (95% confidence interval, 6.8–64.5) higher in patients with parathyroid hormone <13 pg/mL. Other factors did not predict the development of hypocalcemia, including clinicopathological features and routine supplementation of low-dose calcium. CONCLUSION: Routine low-dose calcium supplementation did not reduce the risk of postoperative hypocalcemia. Patients who may benefit from calcium supplementation should be carefully selected.
Calcium
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Cholecalciferol
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Humans
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Hypocalcemia
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Hypoparathyroidism
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Incidence
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Multivariate Analysis
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Parathyroid Hormone
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Prospective Studies
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Thyroid Neoplasms
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Thyroidectomy
9.Efficacy of erector spinae plane block with opioid-sparing analgesic technique in breast-conserving surgery
Annals of Surgical Treatment and Research 2021;100(5):253-259
Purpose:
Breast-conserving surgery (BCS) is a surgical method designed to minimize intraoperative tissue injury. Although this technique is minimally invasive, it can cause significant postoperative pain and may be a risk factor for persistent pain.Erector spinae plane block (ESPB) is an easy interfascial plane block for analgesia in patients undergoing breast surgery. The primary outcome was the numeric rating scale scores measured separately on the breast and axilla. Secondary outcomes included correlation between pain score and skin sensitivity test.
Methods:
Forty patients were divided into 2 groups (ESPB group and control group). Patients in the ESPB group received an ESPB 30 minutes before the induction of general anesthesia, whereas patients in the control group did not receive any regional analgesia during the perioperative period.
Results:
Median pain scores of the breast were significantly lower in the ESPB group than that in the control group at 12, 24, and 48 hours after surgery. However, the median pain scores of the axilla were not significantly different between the groups, and the pain score was unrelated to skin sensitivity.
Conclusion
ESPB can effectively alleviate acute postoperative pain with an opioid-sparing analgesic technique in patients undergoing BCS, and a strong correlation is lacking between pain scores and skin sensitivity test.
10.Active Surveillance of Papillary Thyroid Cancer: Past, Present, and Future
Jong-Kyu KIM ; Hyungju KWON ; Woosung LIM ; Byung-In MOON ; Nam Sun PAIK
The Ewha Medical Journal 2021;44(2):37-40
Active surveillance (AS) of papillary thyroid microcarcinoma was first suggested by Dr. Akira Miyauchi at Kuma Hospital in 1993. Based on several subsequent evidences, AS was approved by the American Thyroid Association in 2015. AS is no longer an experimental treatment but has become an acceptable standard of care for patients with low-risk thyroid cancers. No molecular markers, such as BRAF mutations, have been identified to predict the prognosis of papillary thyroid cancer. However, future molecular studies may reveal the relationship between genetic mutations and thyroid cancer prognosis. AS involves closely monitoring thyroid cancer over time, instead of immediately treating it with surgery. Patients and medical doctors should consider these two options: observation or surgery.