PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

PURPOSE: Although home renovation exposure during childhood has been identified as a risk factor for the development of allergy, there is limited information on the association between prenatal exposure to home renovation and cord blood (CB) IgE response. The aims of this study were to identify the effect of prenatal exposure to home renovation on CB IgE levels, and to investigate whether this exposure interacts with neonatal genes and whether the effect can be modified by maternal atopy. METHODS: This study included 1,002 mother-neonate pairs from the COhort for Childhood Origin of Asthma and allergic diseases (COCOA). Prenatal environmental factors were collected using a questionnaire. The levels of CB IgE were measured by the ImmunoCAP system, and DNA was extracted from CB. RESULTS: Exposure to home renovation during the prenatal period was associated with significantly higher levels of CB IgE only in neonates from atopic mothers, and the effect of renovation exposure on CB IgE levels persisted from 31 months before birth. Furthermore, prenatal exposure to home renovation increased the risk of CB IgE response interacting with polymorphisms of NRF2 and GSTP1 genes only in neonates from atopic mothers. CONCLUSIONS: Maternal atopy modified the effect of prenatal exposure to home renovation on CB serum IgE response as well as the interaction between the exposure and neonatal genes involved in the oxidative stress pathway. These findings suggest that the genetically susceptible offspring of atopic mothers may be more vulnerable to the effect of prenatal exposure to home renovation on the development of allergy.
Asthma ; Cohort Studies ; DNA ; Fetal Blood* ; Gene-Environment Interaction ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Infant, Newborn ; Mothers ; Oxidative Stress ; Parturition ; Polymorphism, Single Nucleotide ; Reactive Oxygen Species* ; Risk Factors

PURPOSE: To investigate whether prenatal exposure to indoor fine particulate matter (PM2.5) and environmental tobacco smoke (ETS) affects susceptibility to respiratory tract infections (RTIs) in infancy, to compare their effects between prenatal and postnatal exposure, and to determine whether genetic factors modify these environmental effects. METHODS: The study population consisted of 307 birth cohort infants. A diagnosis of RTIs was based on parental report of a physician's diagnosis. Indoor PM2.5 and ETS levels were measured during pregnancy and infancy. TaqMan was used for genotyping of nuclear factor erythroid 2-related factor (Nrf2) (rs6726395), glutathione-S-transferase-pi (GSTP) 1 (rs1695), and glutathione-S-transferase-mu (GSTM) 1. Microarrays were used for genome-wide methylation analysis. RESULTS: Prenatal exposure to indoor PM2.5 increased the susceptibility of lower RTIs (LRTIs) in infancy (adjusted odds ratio [aOR]=2.11). In terms of combined exposure to both indoor PM2.5 and ETS, prenatal exposure to both pollutants increased susceptibility to LRTIs (aOR=6.56); however, this association was not found for postnatal exposure. The Nrf2 GG (aOR=23.69), GSTM1 null (aOR=8.18), and GSTP1 AG or GG (aOR=7.37) genotypes increased the combined LRTIs-promoting effects of prenatal exposure to the 2 indoor pollutants. Such effects of prenatal indoor PM2.5 and ETS exposure were not found for upper RTIs. CONCLUSIONS: Prenatal exposure to both indoor PM2.5 and ETS may increase susceptibility to LRTIs. This effect can be modified by polymorphisms in reactive oxygen species-related genes.
Cacao* ; Cohort Studies ; Diagnosis ; Genotype ; Humans ; Infant ; Methylation ; Odds Ratio ; Oxygen ; Parents ; Particulate Matter ; Parturition ; Pregnancy ; Respiratory Tract Infections* ; Smoke* ; Tobacco

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.
Anger ; Anxiety Disorders ; Depression ; Depressive Disorder ; Humans ; Paroxetine ; Somatoform Disorders

PURPOSE: To conduct a nationwide survey on the principles in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. MATERIASL AND METHODS: We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were inputted to the web based PCS system by each investigators in 19 institutions. RESULTS: Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum (46%). Preoperative CEA was checked in 79% of cases and its value was higher than 6 ng/ml in 32%. Pathologic stage were I in 1.6%, II in 32%, III in 63%, and IV in 1.6%. Low anterior resection was the most common type of surgery and complete resection was performed in 95% of cases. Distal resection margin was less than 2 cm in 30%, and number of lymph node dissected was less than 12 in 31%. Chemotherapy was performed in 91% and most common regimen was 5-FU and leucovorine (69%). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique (65.0%), and there was no AP-PA parallel opposing field used. Patient position was prone in 81.2%, and the boost field was used in 61.8%. To displace bowel outward, pressure modulating devices or bladder filling was used in 40.1%. Radiation dose was prescribed to isocenter in 45.3% and to isodose line in 123 cases (39.8%). Percent delivered dose over 90% was achieved in 92.9%. CONCLUSION: We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.
Drug Therapy ; Female ; Fluorouracil ; Humans ; Leucovorin ; Lymph Nodes ; Male ; Neoplasm, Residual ; Pelvis ; Radiotherapy* ; Rectal Neoplasms* ; Rectum ; Research Personnel ; Urinary Bladder

PURPOSE: Coiling or infusion of embolic materials into a wide necked aneurysm can be performed with stenting. The purpose of our study is to assess the technical feasibility of aneurysm treatment with glue embolization after stenting. MATERIALS AND METHODS: We used four Wallstents for surgically repairing eight canine carotid aneurysms. After confirmation of the aneurysms on the angiogram, we introduced a 6-7 F guiding catheter in order to deploy the stents. After stenting, we passed a microcatheter into the aneurysm lumen through the stent mesh. 28% glue was slowly injected until the glue cast completely filled the lumen. We evaluated the passage of a microcatheter through the stent meshwork, formation of the glue cast and the stents' ability to protection for any leakage of glue. The follow-up angiogram was obtained for two dogs, one to three times until 8 weeks, and then we sacrificed the dogs and performed pathologic examinations. RESULTS: Stenting was successful in all cases except one in which the vessel was occluded because the stent was not completely expanded within the lumen. The microcatheter could not pass through the stent mesh in one aneurysm. The two week follow-up angiogram showed complete occlusion of the aneurysm and a patent carotid lumen in a case after successful stenting and glue embolization without distal migration of glue. Tungsten in the glue was noted to migrate out of aneurysm into the soft tissue of the neck. Histopathologic examination showed successful obliteration and stable organization of the aneurysmal lumen with ingrowth of fibroblasts and a foreign body reaction. In contrast, the aneurysms without the glue embolization being performed showed partially thrombosed aneurysmal lumens that became smaller and indistinct on the 8 week follow-up angiograms. Histopathologic examination showed a disorganized thrombus with numerous recanalizations. CONCLUSION: Glue embolization after stenting could be performed for aneurysm without distal migration of the glue or gluing of the catheter. This concept appears to be useful for applications to the further research and the treatment of aneurysm.
Adhesives* ; Aneurysm* ; Animals ; Carotid Arteries* ; Catheters ; Dogs ; Fibroblasts ; Follow-Up Studies ; Foreign-Body Reaction ; Intracranial Aneurysm ; Neck ; Stents* ; Thrombosis ; Tungsten

No abstract available.
Alzheimer Disease*

OBJECTIVE: To evaluate the benefits of laparoscopic surgery compare with laparotomy in the surgical management of adnexal tumors during pregnancy. METHODS: Operating time, hospital stays, complications and pregnancy outcome were analyzed in 18 patients who underwent laparoscopic surgery and 30 patients who underwent laparotomy due to adnexal tumors discovered during pregnancy at Chungnam National University Hospital from January 1993 to June 2000. RESULTS: Mean age of the patients was 27.1 years and mean gestational age was not significantly different between the two groups. Tumor size was larger in laparotomy group (8.4 vs 6.4 cm in diameter). Unilateral salpingo-oophorectomy was most common operative procedures and cystic teratoma was most common histologic findings in both groups. Operating time was not significantly different between the two groups. Blood loss (43.2 vs 18.3 mL) and hospital stay (7.1 vs 5.7 days) was significantly less in laparscopy group. CONCLUSIONS: Laparoscopic surgery may be an effective treatment of adnexal tumors during pregnancy.
Chungcheongnam-do ; Female ; Gestational Age ; Humans ; Laparoscopy* ; Laparotomy* ; Length of Stay ; Ovarian Cysts ; Pregnancy Outcome ; Pregnancy* ; Surgical Procedures, Operative ; Teratoma

PURPOSE: To evaluate the utility of signal intensity differences between in- and opposed-phase MRI and the lipid peak ratio in in-vivo proton MR spectroscopy of the gallbladder as diagnostic tools for measuring the lipid content of gallbladder bile. MATERIALS AND METHODS: Twenty-six normal volunteers underwent MR imaging (FMPSPGR) and in-vivo proton MR spectroscopy of the gallbladder. In all cases the results of liver function tests were normal, as were cholesterol levels, and ultrasonography of the gaubladder revealed nothing unusual. For MRI and MRS a 1.5T unit (Signa Horizon; GE Medical Systems, Milwaukee, U.S.A.) was used. In-phase and opposed-phase coronal-section MR images(FMPSPGR; TR=125 msec, TE=1.8, 4.2 msec) of the gallbladder were obtained, and differences in signal intensity thus determined. For proton MR spectroscopy of the gallbladder, a localized proton STEAM sequence was employed. A single voxel of 1-8 cm3 was placed at the center of the gallbladder cavity, peak areas at 0.8-1.6 ppm (lipid), 2.0-2.4 ppm, 3.2-3.4 ppm, 3.9-4.1 ppm, and 5.2-5.4 ppm were measured by proton MRS and the relative peak area ratios of peak 0.8-1.6 ppm/other peaks were calculated. The degree of correlation between signal intensity differences at MRI and the relative peak area ratio of lipid in proton MRS was estimated using the p-value and Pearson's correlation coefficient. RESULTS: Signal intensity differences ranged from 11.3 to 43.4% (mean, 26+/-8.9%), and the range of lipid peak area ratio at MRS was 0.10-0.97 (mean, 0.66+/-0.21). There was significant correlation between the two measured values (p=0.014, Pearson's correlation coefficient=0.478). CONCLUSION: In normal cystic bile, signal intensity differences at in- and opposed-phase MRI and relative lipid peak area ratios at MRS varied, though both methods could be used diagnostically for measuring the lipid contents of body tissue.
Bile* ; Cholesterol ; Gallbladder* ; Healthy Volunteers ; Liver Function Tests ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy* ; Protons* ; Steam ; Ultrasonography