Hyperprogressive disease (HPD) is a distinct pattern of progression characterized by acceleration of tumor growth after treatment with anti-PD-1/PD-L1 Abs. However, the immunological characteristics have not been fully elucidated in patients with HPD. We prospectively recruited patients with metastatic non-small cell lung cancer treated with anti-PD-1/PD-L1 Abs between April 2015 and April 2018, and collected peripheral blood before treatment and 7-days post-treatment. HPD was defined as ≥2-fold increase in both tumor growth kinetics and tumor growth rate between pre-treatment and post-treatment.Peripheral blood mononuclear cells were analyzed by multi-color flow cytometry to phenotype the immune cells. Of 115 patients, 19 (16.5%) developed HPD, 52 experienced durable clinical benefit (DCB; partial response or stable disease ≥6 months), and 44 experienced non-hyperprogressive progression (NHPD). Patients with HPD had significantly lower progression-free survival (p<0.001) and overall survival (p<0.001). When peripheral blood immune cells were examined, the pre-treatment frequency of CD39+ cells among CD8+T cells was significantly higher in patients with HPD compared to those with NHPD, although it showed borderline significance to predict HPD. Other parameters regarding regulatory T cells or myeloid derived suppressor cells did not significantly differ among patient groups. Our findings suggest high pre-treatment frequency of CD39+ CD8+ T cells might be a characteristic of HPD. Further investigations in a larger cohort are needed to confirm our results and better delineate the immune landscape of HPD.

PURPOSE: To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS: Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS: In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION: Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.
Abdomen ; Classification ; Extremities ; Head ; Humans ; Medical Records ; Neck ; Neurologic Manifestations ; Pelvis ; Retrospective Studies ; Spine ; Thorax ; Upper Extremity

PURPOSE: We report upon a web-based system for Patterns of Care Study (PCS) devised for Korean radiation oncology. This PCS was designed to establish standard tools for clinical quality assurance, to determine basic parameters for radiation oncology processes, to offer a solid system for cooperative clinical studies and a useful standard database for comparisons with other national databases. MATERIALS AND METHODS: The system consisted of a main server with two back-ups in other locations. The program uses a Linux operating system and a MySQL database. Cancers with high frequencies in radiotherapy departments in Korea from 1998 to 1999 were chosen to have a developmental priority. RESULTS: The web-based clinical PCS system for radiotherapy in www.pcs.re.kr was developed in early 2003 for cancers of the breast, rectum, esophagus, larynx and lung, and for brain metastasis. The total number of PCS study items exceeded one thousand. Our PCS system features user-friendliness, double entry checking, data security, encryption, hard disc mirroring, double back-up, and statistical analysis. Alphanumeric data can be input as well as image data. In addition, programs were constructed for IRB submission, random sampling of data, and departmental structure. CONCLUSION: For the first time in the field of PCS, we have developed a web-based system and associated working programs. With this system, we can gather sample data in a short period and thus save, cost, effort and time. Data audits should be performed to validate input data. We propose that this system should be considered as a standard method for PCS or similar types of data collection systems.
Brain ; Breast ; Computer Security ; Data Collection ; Esophagus ; Ethics Committees, Research ; Korea* ; Larynx ; Lung ; Neoplasm Metastasis ; Radiation Oncology* ; Radiotherapy ; Rectum

OBJECTIVE: This study was performed to evaluate the efficacy of treating of unruptured ectopic pregnancy by systemic and transvaginal local administration of methotrexate. METHODS: We reviewed the medical records of 32 patients who were treated with methotrexate from June 1995 to October 1999. Among the patients, 14 were treated by ultrasound-guided transvaginal local injection and 18 were treated by systemic intramuscular administration. Success rate of the treatment was examined for each group, and the cases of methotrexate failure were characterized and compared with the success group. RESULTS: The success rate was similar between the transvaginal (85.7%) and the systemic (77.8%) groups. There were no differences in initial serum hCG levels, size of gestational sac, fetal cardiac activity between the success group and failure group. CONCLUSION: The results of this study suggest that there is no difference in efficacy between systemic and transvaginal local methotrexate administration, and there are no useful parameters in identifying the risk for the failure of methotrexate treatment.
Female ; Gestational Sac ; Humans ; Medical Records ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic*

OBJECTIVE: The aim of the study is to assess the effects of treatment with an extract from Cimicifuga racemosa for 1 year in postmenopausal women with symptoms. METHODS: In a randomised, open-label, group-comparative study, the change on the Kupperman menopausal index, serum FSH and E2 level, bone densitometry (BMD), and mammographic density by an extract from Cimicifuga racemosa (GYNO-Qx ) (N=40) were compared with an conjugated equine estrogen combined with medroxyprogesterone acetate (CEE/MPA) (N=36) during 12 months in menopausal women. RESULTS: There were no statistical differences in the change of Kupperman index, serum FSH and E2 level, and mammographic density between two groups after 12 months, except the effect of BMD that the CEE/MPA group (+6.6%) was significantly increased as compared to the extract from Cimicifuga racemosa (+1.1%) baseline. CONCLUSION: This study suggests that an extract of Cimicifuga racemosa is a safe, effective alternative to estrogen replacement therapy for patients in whom hormone replacement therapy is either refused or contraindicated.
Cimicifuga* ; Densitometry ; Estrogen Replacement Therapy ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Medroxyprogesterone Acetate ; Menopause

Beckwith-Wiedemann syndrome(BWS) is a group of disorders having in common coexistence of a macrosomia, macroglossia, abdominal wall defects, visceromegaly, hypoglycemia in the neonatal period and embryonal cancers of infancy and early childhood. Beckwith-Wiedemann first reported this distinct clinical entity, and about 200cases have subsequently been reported. Etiology is usually sporadic. BWS is a multigenic disorder with dysregulation of the expression of imprinted genes involved in growth and cell cycle control in the 11p15.5 chromosomal region. Placental endocrine dysfunction leading to increased levels of growth hormone and insulin-like growth factors would causes the visceromegaly. Early visceromegaly may pedispose to omphalocele, malrotation anomalies, and diaphragmatic herniation. Detection and treatment of hypoglycemia in any neonate with features of this syndrome are critical. The frequency of hypoglycemia in this population is between 30 and 50%. The majority of infants with hypoglycemia will be asymptomatic and have resolution of the hypoglycemia within the first 3 days of life. Less than 5% of infoots will have hypoglycemia beyound neonatal period one requive either continous feeding or a partial pancreatectomy. We have experienced and case of Beckwith-Wiedemann syndrome so that we report with brief review of the concerned literature.
Abdominal Wall ; Beckwith-Wiedemann Syndrome* ; Cell Cycle Checkpoints ; Growth Hormone ; Hernia, Umbilical ; Humans ; Hypoglycemia ; Infant ; Infant, Newborn ; Macroglossia ; Neoplasms, Germ Cell and Embryonal ; Pancreatectomy ; Somatomedins

OBJECTIVE: The purpose of the study was to determine the effects of co-culture with oviductal epithelial cells and Vero cells on mouse embryo. METHOD: For the control group, mouse embryos were cultured alone in Ham's F-10 with 10% FBS. Subcultured oviductal epithelial cell and Vero cell were cocultured in Ham's F-10 with 10% FBS with the mouse embryo and used as the treatment group. Development of mouse embryos were observed. Result: The development rate and hatching rate of embryos that cocultured with oviductal epithelial cell and Vero cell was significantly higher (p<0.05) than control group. When subcultured oviductal epithelial cells were co-cultured with mouse embryo, there was no significant difference in development rate and hatching rate among subculture step. When oviductal epithelial cells that have been frozen-thawed were co-cultured with mouse embryo, there was no significant difference in development rate and hatching rate among subculture step. No statistical significance was seen in the development rate and hatching rate between subcultured oviductal epithelial cells and frozen-thawed oviductal epithelial cells when cocultured with mouse embryo, Vero cells and frozen-thawed when cocultured with mouse embryo, and Vero cells and oviductal epithelial cells when cocultured with mouse embryo. CONCLUSION: Oviductal epithelial cells and Vero cell may have a stimulatory role in early mouse embryonal development compared to control in vitro. As well, there is no significant difference in development rate and hatching rate among subculture step, when early mouse embryo was cocultured with cells that subcultured and frozen-thawed.
Animals ; Coculture Techniques ; Embryonic Structures ; Epithelial Cells* ; Humans* ; Mice* ; Oviducts* ; Vero Cells*

A rare but typical case of trisomy 9 shows the characteristic phenotype of this syndrome: microcephaly, low-set malformed ears, micrognathia, broad nose with bulbous tip, small and up-slanting palpebral fissures, deep-set eyes, congenital heart diseases, dislocation of joints, abnormal hands and feet, cryptorchidism, micropenis, mental retardation, and growth failure. In addition to karyotyping results, ultrasound findings are important in achieving diagnosis. We experienced a case of trisomy 9 mosaicism (47,XX,+9/46,XX) and so present it with a brief review of literature.
Cryptorchidism ; Diagnosis ; Dislocations ; Ear ; Foot ; Hand ; Heart Diseases ; Intellectual Disability ; Joints ; Karyotyping ; Male ; Microcephaly ; Mosaicism* ; Nose ; Phenotype ; Trisomy* ; Ultrasonography

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol(PGE1) versus dinoprostone(PGE2) for labor induction in a prospective controlled trial. METHOD: One hundred eleven patients for labor induction (including preterm rupture of membranes) were randomly assigned to receive either misoprostol 50microgram or dinoprostone 3mg intravaginally. The interval of doses was 8 hours after first dose, with a potential maximum of six dose until active labor pain was achieved. RESULTS: Among 111 patients enrolled, 55 were randomized to receive misoprostol 50microgram and 56 to receive dinoprostone 3mg with every 8 hours interval intravaginally. There were no significant differences in demographic characteristics except in Bishop score(3.81+/-1.52 vs 4.38+/-1.29, P<0.05). There were no significant differences in indications for labor induction. The interval of induction to delivery was shorter in the misoprostol group(750.8+/-518.8min) than in the dinoprostone group(1264.1+/-730.7min). Delivery within 24 hours after administration occurred more often in the misoprostol group than in the dinoprostone group (86.3% vs 65.2%, P<0.05). More than two doses for completion of delivery were frequent in dinoprostone group(36.96% vs 9.8% in misoprostol group, P<0.05). Additional Oxytocin augmentation was needed more commonly in the misoprostol group(3.64%) than in the dinoprostone group(14.29%)(P<0.05), but no significant differences were noted between two groups in total oxytocin doses and indications. Tachysystole occurred more often in the misoprostol group (12.73% vs 1.79% in the dinoprostone, P<0.05) Precipitating delivery occurred more commonly in the misoprostol group(21.82% vs 7.14% in the dinoprostone group, P<0.05). No differences in the cesarean section rate, fetal heart rate abnormalities, hyperstimulation syndrome, meconium staining, fetal outcome (Apgar score at 1 and 5 minutes, birth weight), and marternal outcome (nausea and vomitting, postpartum bleeding) were noted. The cost of misoprosl is one hundredth cheaper than dinoprostone. There was no significant differences in the fetal outcome and maternal outcome. CONCLUSION: These results suggest that intravaginal misoprostol(PGE1) is a safe drug for labor induction which is more effective and cheaper compare to intravaginal dinoprostone(PGE2).
Alprostadil* ; Cesarean Section ; Dinoprostone* ; Female ; Heart Rate, Fetal ; Humans ; Labor Pain ; Meconium ; Misoprostol* ; Oxytocin ; Parturition ; Postpartum Period ; Pregnancy ; Prospective Studies ; Rupture

OBJECTIVE: To analyze the relationship between the degree of expression of E-cadherin and presence of high risk prognostic factors (lymph node metastasis or parametrium involvement), clinical stages and pathologic types in invasive cervical cancer. METHODS: An immunohistochemical technique has been applied to formalin-fixed, paraffin- embedded samples from 20 radical hysterectomy without risk factors and 16 radical hysterectomy with risk factors. The degree of expressions of E-cadherin immunostaining was compared with the International Federation of Gynecology and Obstetrics (FIGO) stage, presence of high risk prognostic factors, and pathologic types. RESULTS: The difference of the degree of expression of E-cadherin was not statistically significant between high-risk group (lymph node metastasis or parametrium invasion) and non-risk group. The difference of the degree of expression of E-cadherin was not statistically significant according to clinical stages and variable pathologic types either. CONCLUSIONS: These results suggest that the degree of the expression of E-cadherin has no relationship with known high risk prognostic factors, clinical stages and pathologic types in invasive cervical cancer.
Cadherins* ; Gynecology ; Humans ; Hysterectomy* ; Neoplasm Metastasis ; Obstetrics ; Risk Factors ; Uterine Cervical Neoplasms*