Objective: Regional control is occasionally unsatisfactory in cervical cancer, with the optimal radiation dose for nodal metastases in definitive radiotherapy (RT) with concurrent chemotherapy (CRT) remaining controversial. We investigated dose-response relationship for nodal local control in cervical cancer. Methods: We identified 115 patients with 417 metastatic nodes who received definitive CRT for cervical cancer with nodal metastases. External beam radiation therapy and brachytherapy plans were summated to determine total dose received by each node. Prognostic factors of nodal control and dose-response relationship were investigated using Cox-regression and restricted cubic spline function. Results: The 2-year progression-free survival rate was 69.4%. Among 43 patients with failures, 17 patients (37.5%) had regional failure included in first failure sites of which all except one were in-field only regional failures. Total 30 nodes showed recurrence at initial metastatic site after treatment. Neutrophil-to-lymphocyte ratio (NLR) ≥3.1, total radiation dose (minimum dose received by 98% of the target volume in equivalent dose in 2 Gy per fractions), and initial nodal volume ≥5.29 mL were poor prognostic factors (all p<0.050) of nodal local control. Restricted cubic spline functions revealed strongest dose-response relationship in high NLR (NLR ≥3.1) and initial nodal volume ≥5.29 mL subgroup. Conclusion Initial nodal volume, radiation dose, and NLR were significant factors of nodal local control in cervical cancer; a stronger dose-response relationship was seen in bulky nodes with high NLR. Clinicians may consider these factors when determining the RT dose and the need for boost to nodal metastases in cervical cancer.

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

Purpose: The Rubus coreanus fruit (RF) is an important traditional medicinal herb having antioxidant, anti-inflammatory, and immunoregulatory properties. These activities are known to change dramatically, depending on maturity of the RF. It is presumed that change of functional components, such as flavonoids, tannins, phenolic acids, triterpenoids and organic acids in RF, affect the various bioactivities. This study aimed to confirm changes in the anti-melanogenic effects of RF based on maturity, and to identify the bioactive compounds responsible. Methods: The cell viability of mature RF (MRF) and immature RF (IRF) extracts was investigated using B16F10 cells. To compare the anti-melanogenic effect of MRF and IRF extracts, we first assessed the melanin content. High-performance liquid chromatography analysis was performed to evaluate changes in the level of ellagic acid according to maturity of the RF. In addition, tyrosinase inhibitory activity of both extracts was examined. Results: MRF and IRF extracts (50–200 μg/mL) do not affect the cell viability of B16F10 melanoma cells. IRF extract more effectively inhibited melanin synthesis than MRF extract. The content of ellagic acid in IRF extract was higher than that obtained in MRF extract. Furthermore, greater inhibition of tyrosinase activity was observed after exposure to IRF extract than MRF extract. A positive correlation was determined between ellagic acid content and tyrosinase inhibitory activity, and a negative correlation was obtained between ellagic acid content and melanin content. Taken together, our results indicate that ellagic acid is one of the major bioactive compounds of RF that imparts a whitening effect. Conclusion Our results indicate that ellagic acid in MRF and IRF extracts affect the anti-melanogenesis effect through inhibition of tyrosinase activity. Therefore, the ellagic acid rich IRF has greater potential for application as a natural and functional cosmetic material.

PURPOSE: Astragalus membranaceus (AM) is an important traditional medicinal herb. Pharmacological research has indicated that AM has various physiological activities such as antioxidant, anti-inflammatory, immunoregulatory, anticancer, hypolipidemic, antihyperglycemic, and hepatoprotective activities. The bioactive substances responsible for the physiological activities in AM, including many antioxidant substances, change during the roasting process. This study investigated and compared the changes in the antioxidant constituents of AM caused by roasting. METHODS: DPPH (1,1-diphenyl-2-picryl hydrazyl) and ABTS⁺ (2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt) radical scavenging activities and their total phenolic content (TPC) were measured. High-performance liquid chromatography (HPLC) analysis was performed to confirm any changes in the isoflavonoids of roasted AM (R-AM),. The cell viability of UVB-induced HDF (Human dermal fibroblast) cells treated with AM and R-AM extracts was investigated. The comet assay was used to examine the inhibitory effects of R-AM extracts on DNA damage caused by oxidative stress. RESULTS: The DPPH and ABTS⁺ radical scavenging activities were 564.6±20.9 and 108.2±3.1 (IC₅₀ value) respectively, from the 2R-AM. The total phenol content was 47.80±1.40 mg GAE/g from the 1R-AM. The values of calycosin and formononetin, which are the known isoflavonoid constituents of AM, were 778.58±2.72 and 726.80±3.45 µg/g respectively, from the 2R-AM. Treatment of the HDF cells with R-AM (50 ~ 200 µg/mL) did not affect the cell viability. Furthermore, the R-AM extracts effectively protected against UVB-induced DNA damage. CONCLUSION: The findings of this study indicate that R-AM increases its isoflavonoid constituents and protects against UVB-induced DNA damage in HDF cells.
Astragalus membranaceus ; Cell Survival ; Chromatography, Liquid ; Comet Assay ; DNA Damage ; Oxidative Stress ; Phenol ; Plants, Medicinal

OBJECTIVE: We aimed to assess the efficacy of neoadjuvant chemotherapy followed by surgery (NACT+S), and compared the clinical outcome with that of concurrent chemoradiotherapy (CCRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) IB-IIB cervical cancer. METHODS: We reviewed 85 patients with FIGO IB-IIB cervical cancer who received NACT+S between 1989 and 2012, and compared them to 358 control patients who received CCRT. The clinical application of NACT was classified based on the following possible therapeutic benefits: increasing resectability after NACT by reducing tumor size or negative conversion of node metastasis; downstaging adenocarcinoma regarded as relatively radioresistant; and preservation of fertility through limited surgery after NACT. RESULTS: Of 85 patients in the NACT+S group, the pathologic downstaging and complete response rates were 68.2% and 22.6%, respectively. Only two young patients underwent limited surgery for preservation of fertility. Patients of the NACT+S group were younger, less likely to have node metastasis, and demonstrated a higher proportion of FIGO IB cases than those of the CCRT group (p≤0.001). The 5-year locoregional control, progression-free survival, and overall survival rates in the NACT+S group were 89.7%, 75.6%, and 92.1%, respectively, which were not significantly different from the rates of 92.5%, 74%, and 84.9% observed in the CCRT group, respectively (p>0.05). CONCLUSION: NACT+S has no therapeutic advantages over CCRT, the standard treatment. Therefore, NACT+S should be considered only in selected patients through multidisciplinary discussion or clinical trial setting.
Adult ; Aged ; Aged, 80 and over ; *Chemoradiotherapy ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm Staging ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnosis/mortality/pathology/*therapy

PURPOSE: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. RESULTS: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. CONCLUSION: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
Brachytherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Electrons ; Follow-Up Studies ; Glycolysis ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; ROC Curve ; Uterine Cervical Neoplasms*

PURPOSE: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. RESULTS: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. CONCLUSION: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
Brachytherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Electrons ; Follow-Up Studies ; Glycolysis ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; ROC Curve ; Uterine Cervical Neoplasms*

Canine atopic dermatitis (CAD) is an allergic skin disease with characteristic clinical features associated with immunoglobulin E (IgE) antibodies. Identification of the causative allergens is the diagnostic goal, which is essential to treat and manage CAD patients. CAD is commonly associated with environmental allergens surrounding the patients. For this reason, it is important for diagnostic tests to select allergens that are related to the environment of each country and each province. There are two main allergen-specific tests, serological IgE test (SAT) and intradermal skin test (IDT). SAT did not show direct cutaneous reaction but did show serological reaction against allergens. However, SAT is simpler and more convenient than IDT in small animal practice. In this study, we selected domestically prevalent allergens for SAT, including 60 food allergens and 60 inhalant allergens, and tested eight dogs tentatively diagnosed with CAD based on Favrot's criteria. Furthermore, IDT was performed on four dogs from the SAT group for comparison of SAT and IDT, and the results were very similar. In SAT, four types of mites (Bloomia tropicalis, Glycophagus domesticus, Euroglyphus maynei, and mite mixture 1 Korea; house dust mites), four types of molds (Botrytis cinerea, Alternaria alternata, mold fungi mixture 11, mold fungi mixture), and one type of pollen (tree pollen mix 3 Korea) induced a reaction in more than half of dogs tested. In IDT, all four dogs reacted positively to Dermatophagoides farinae, and three reacted positively to Dermatophagoides pteronyssinus and house dust. The mean agreement rate between SAT and IDT in this study was 76.3%. This is the first trial to apply local allergens for SAT in Korean veterinary medicine, and it might play an important role for diagnoses and management of animal allergic diseases.
Allergens ; Alternaria ; Animals ; Antibodies ; Dermatitis, Atopic* ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Diagnosis ; Diagnostic Tests, Routine ; Dogs ; Dust ; Fungi ; Humans ; Immunoglobulin E* ; Immunoglobulins* ; Korea ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Serologic Tests ; Skin Diseases ; Skin Tests ; Veterinary Medicine

OBJECTIVE: To analyze patterns of abdominopelvic failures and to define subgroups for the use of adjuvant radiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer (EOC). METHODS: We reviewed 149 patients treated with debulking surgery followed by intravenous taxane and platinum chemotherapy between 1999 and 2008. Patient characteristics, patterns of failure, abdominopelvic failure APF-free survival (APFFS) and overall survival (OS) were analyzed. RESULTS: The median age of the patients was 51 years. Thirty-two patients (21.5%) were found to have residuum >2 cm after surgery. The median pretreatment CA-125 was 604 and 54.4% of patients had a decline in CA-125 > or =90% between pretreatment and at postoperative 1 month. With a median follow-up of 50 months, 79 patients (53.0%) experienced abdominopelvic failure (APF). The 5-year APF-free survival rate was 41.1%. Lymph node metastasis, size of residual disease, and decline in CA-125 were found to be significant prognostic factors for APF upon multivariate analysis. The group of patients in whom abdominopelvic irradiation was indicated as definitive postoperative treatment comprised 55% of the overall patient population and their 5-year survival rate was 68%. CONCLUSION: The stratification was suggested to predict APF based on lymph node metastasis, size of residual tumor, and decline in CA-125. Adjuvant radiotherapy covering the whole abdominopelvis using the intensity modulation technique may be considered to reduce APF in FIGO stage III EOC patients with intermediate risk.
Bridged Compounds ; Follow-Up Studies ; Gynecology ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Ovarian Neoplasms ; Platinum ; Radiotherapy, Adjuvant ; Survival Rate ; Taxoids

Thus far, the role of adjuvant radiotherapy (RT) after radical cystectomy (RC) in urinary bladder cancer patients has yet to be defined. The purpose of this study is to analyze patterns of failure, and suggest the rationale for RT. Between 1986 and 2005, a total of 259 patients treated with RC and pelvic lymph node dissection was enrolled. The age range was 27-82 yr (median, 62 yr). Node positivity increased according to tumor staging. Patients were divided into the following two groups based on pathologic analysis: organ-confined disease group (n=135) and extravesical/lymph node-positive disease group (n=80). Pelvic failures (PF) were observed in 8 (4.9%) in organ-confined disease group, and 21 (21.7%) in extravesical/lymph node-positive disease group. Five-year PF-free survival rates were 91.2% in organ-confined disease group and 68.0% in extravesical/lymph node-positive disease group. Five-year cancer-specific survival rates were 86.2% in organ-confined disease group and 53.9% in extravesical/lymph node-positive disease group. In conclusion, a relatively high PF rate was observed in extravesical lymph node-negative and lymph node-positive disease patients in this study. Adjuvant pelvic RT may be considered to reduce pelvic failures in extravesical lymph node-positive bladder cancer. Future prospective trials are required to test the clinical benefit of adjuvant RT.