Background/Aims: The optimal treatment (Tx) for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains to be determined. Methods: A retrospective review was conducted on 77 NSCLC patients with synchronous BM who underwent first-line EGFR-tyrosine kinase inhibitor (TKI) Tx. The outcomes of patients were analyzed according to the clinicopathological characteristics including local Tx modalities. Results: Fifty-nine patients underwent local Tx for BM (gamma knife surgery [GKS], 37; whole brain radiotherapy [WBRT], 18; others, four) concurrently or sequentially with EGFR-TKI. Patients treated with TKI alone showed significantly lower incidence of central nervous system (CNS) symptoms. The median progression-free survival (PFS) and overall survival (OS) after the initiation of EGFR-TKI for all patients were 9 and 19 months, respectively. In 60 patients with follow-up brain imaging, the median time to CNS progression was 15 months. Patients with EGFR exon 19 deletion had a significantly longer median OS than those with other mutations including L858R (23 months vs. 17 months). Other clinical characteristics, including CNS symptoms, number of BM, and the use of local Tx were not associated with OS, as well as PFS. In terms of the local optimal Tx modality, no difference was found between GKS and WBRT in the OS and PFS. Conclusions This study suggests that EGFR-TKI may result in a favorable outcome in NSCLC patients with synchronous BM, especially in deletion 19 mutant, regardless of the extent of BM lesions or local Tx modalities. Patients with asymptomatic BM can be treated with EGFR-TKI and careful surveillance.

Purpose: To find biomarkers for disease, there have been constant attempts to investigate the genes that differ from those in the disease groups. However, the values that lie outside the overall pattern of a distribution, the outliers, are frequently excluded in traditional analytical methods as they are considered to be ‘some sort of problem.’ Such outliers may have a biologic role in the disease group. Thus, this study explored new biomarker using outlier analysis, and verified the suitability of therapeutic potential of two genes (TM4SF4 and LRRK2). Materials and Methods: Modified Tukey’s fences outlier analysis was carried out to identify new biomarkers using the public gene expression datasets. And we verified the presence of the selected biomarkers in other clinical samples via customized gene expression panels and tissue microarrays. Moreover, a siRNA-based knockdown test was performed to evaluate the impact of the biomarkers on oncogenic phenotypes. Results: TM4SF4 in lung cancer and LRRK2 in breast cancer were chosen as candidates among the genes derived from the analysis. TM4SF4 and LRRK2 were overexpressed in the small number of samples with lung cancer (4.20%) and breast cancer (2.42%), respectively. Knockdown of TM4SF4 and LRRK2 suppressed the growth of lung and breast cancer cell lines. The LRRK2 overexpressing cell lines were more sensitive to LRRK2-IN-1 than the LRRK2 under-expressing cell lines Conclusion Our modified outlier-based analysis method has proved to rescue biomarkers previously missed or unnoticed by traditional analysis showing TM4SF4 and LRRK2 are novel target candidates for lung and breast cancer, respectively.

BACKGROUND: In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. METHODS: The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. RESULTS: The mean age was 61.0+/-11.6 years, body mass index was 25.0+/-3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7+/-7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%+/-1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. CONCLUSION: The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.
Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol, LDL ; Diabetes Mellitus, Type 2* ; Diabetic Retinopathy ; Dyslipidemias ; Education ; Glucose ; Gyeonggi-do ; Hemoglobin A, Glycosylated ; Hospitals, General* ; Humans ; Hypertension ; Korea* ; Liver Diseases ; Mortality ; Policy Making ; Prevalence ; Seoul

Malignant mesothelioma is a rare aggressive tumor and arises from mesothelial cells in the pleural, peritoneal and pericardial cavities. Median survival is -1 year and the incidence is approximately 0.7 per million persons, and is increasing annually in Korea. It is difficult to diagnose malignant mesothelioma because of nonspecific symptoms, signs and laboratory findings. It needs to be confirmed by histological examination and immunohistochemistry. There is no case report of malignant mesothelioma of the peritoneum and pleura in Korea. We report a rare case of malignant mesothelioma with simultaneous involvement of the peritoneum and pleura in a 75-year-old man without evidence of asbestos exposure.
Aged ; Asbestos ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Mesothelioma* ; Peritoneum* ; Pleura*

PURPOSE: The study was to examine the relationships between stress, ways of coping and burnout among family caregivers of cancer patients. METHODS: Data were collected by self-reported questionnaires from 207 family caregivers of cancer patients at one university hospital and one general hospital in Busan, Korea. The instruments included a Stress Scale, a Ways of Coping Scale and a Burnout Scale. The collected data were analyzed using frequency, percentage, t-test, ANOVA, Scheffe's test, and Pearson's correlation coefficients with the SPSS WIN 19.0 program. RESULTS: Stress was found to have significant relationships with age, relation to the patient, education, monthly income, degree of care-giving, financial burden and activities of daily living of patient. In active coping, there were significant differences according to education and religion. Passive coping was significantly related to gender. In burnout, there were significant differences according to age, relation to the patient, education, occupational status, monthly income, degree of care-giving, financial burden and activities of daily living of patient. Stress and burnout showed a positive correlation, while there was a negative correlation between burnout and active coping. CONCLUSION: These results suggest that promoting active coping would better support family caregivers of cancer patients in managing burnout effectively.
Activities of Daily Living ; Caregivers ; Employment ; Hospitals, General ; Humans ; Korea ; Surveys and Questionnaires

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.
Airway Management ; Analgesia ; Anxiety ; Child ; Conscious Sedation ; Delivery of Health Care ; Dislocations ; Humans ; Immobilization ; Informed Consent ; Korea ; Oxygen ; Parents ; Pediatrics ; Spinal Puncture ; Writing

PURPOSE: This study was to investigate the effect of music therapy as intervention on peripheral neuropathic pain and anxiety of gynecologic cancer patients who were undergoing paclitaxel chemotherapy. METHODS: Hospitalized 62 patients were assigned to an experimental group (n=30) and a control group (n=33) in this quasi-experimental study. The experimental group participated in music therapy that includes listening, singing and song writing during 1 hour. The peripheral neuropathic pain, anxiety and depression were examined as pre-intervention evaluation by using pain scale, anxiety scale (20 questions) and depression scale (20 questions) in both groups. There were no further treatments for the control group while the experimental group involved in music therapy. The peripheral neuropathic pain and anxiety were evaluated in both groups as post-intervention evaluation. RESULTS: Outcomes were verified through hypothesis testing. The level of peripheral neuropathic pain and anxiety in the experimental group was decreased, compared to the control group. CONCLUSION: According to the study, music therapy is a beneficial intervention that reduces peripheral neuropathic pain and anxiety in gynecologic cancer patients. These findings are encouraging and suggest that music therapy can be applied as an effective intervention for minimizing chemotherapy related symptoms.
Anxiety ; Depression ; Humans ; Music ; Music Therapy ; Neuralgia ; Paclitaxel ; Singing ; Writing

OBJECTIVE: To evaluate the relationship of work departments, carotid IMT, and plaque formation as predictors of cardiovascular disease in white-collar and blue-collar workers. METHOD: A total of 201 workers from a metal agricultural equipment manufacturing plant near Daegu were administered questionnaires to obtain information on their general characteristics, their work-related factors. In addition, the workers were given a clinical examination, which included a carotid artery ultrasonography. In total, 193 (96.0%) of questionnaires were completed and analyzed for this study. Multiple regression analysis and multiple logistic regression analysis were performed on the data for analysis. RESULT: Blue-collar workers had thicker carotid artery IMT when compared to white-collar workers. After adjustment, the carotid IMT was affected by age, working department, hypertension, and diabetes; plaque formation was affected by age, hypertension, total cholesterol, and excessive drinking. CONCLUSION: This study suggests that carotid IMT is associated with working department. Therefore, we need to examine the effect that occupational health services has on cardiovascular disease, focusing on the characteristics of each department.
Atherosclerosis ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Cholesterol ; Hypertension ; Logistic Models ; Occupational Health Services ; Plants ; Questionnaires

BACKGROUND/AIMS: The purpose of this study was to evaluate clinical outcome of proximal and total gastrectomy regarding reflux esophagitis, nutritional state, and anemia in early gastric cancer. METHODS: 94 patients with early gastric cancer were included from January 2001 to January 2007 at Chungnam National University Hospital. Of whom 40 patients (31 men and 9 woman) had proximal gastrectomy (PG) and 54 patients (44 men and 10 woman) had total gastrectomy (TG). We reviewed all their medical and surgical record with surveying for gastrointestinal symptoms and reflux symptoms over the phone. RESULTS: There were no significant differences between basic, surgical, and histopathologic characteristics. Bile reflux symptoms and heart burn symptoms were more common and severe in the TG group. The incidences of endoscopically detected reflux esophagitis were about 60% in the TG group and about 30% in the PG group. The hemoglobin levels were significantly higher in the PG group after the operation and were gradually decreased in the TG as the time went. The levels of laboratory variables such as total protein, albumin, and total cholesterol were lower in the TG group than in the PG group after the operation. However, stoma stricture after operation developed in the PG group more often than in the TG group, and esophageal balloon dilatations were performed more frequently in the PG group. CONCLUSIONS: PG is favorable for proximal early gastric cancer in terms of reduced reflux esophagitis, anemia, and malnutrition except the stricture at esophagogastrostomy site.
Adult ; Aged ; Balloon Dilatation ; Esophagitis, Peptic/diagnosis ; Female ; *Gastrectomy ; Hemoglobins/analysis ; Humans ; Male ; Middle Aged ; Serum Albumin/analysis ; Sex Factors ; Stomach Neoplasms/*surgery

Tetrandrine (TET), a bis-benzylisoquinoline alkaloid from the root of Stephania tetrandra, is known to have anti-tumor activity in various malignant neoplasms. However, the precise mechanism by which TET inhibits tumor cell growth remains to be elucidated. The present studies were performed to characterize the potential effects of TET on phosphoinositide 3-kinase/Akt and extracellular signal-regulated kinase (ERK) pathways since these signaling pathways are known to be responsible for cell growth and survival. TET suppressed cell proliferation and induced apoptosis in A549 human lung carcinoma cells. TET treatment resulted in a down-regulation of Akt and ERK phosphorylation in both time-/concentration-dependent manners. The inhibition of ERK using PD98059 synergistically enhanced the TET-induced apoptosis of A549 cells whereas the inhibition of Akt using LY294002 had a less significant effect. Taken together, our results suggest that TET: i) selectively inhibits the proliferation of lung cancer cells by blocking Akt activation and ii) increases apoptosis by inhibiting ERK. The treatment of lung cancers with TET may enhance the efficacy of chemotherapy and radiotherapy and increase the apoptotic potential of lung cancer cells.
Antineoplastic Agents, Phytogenic/*pharmacology ; Apoptosis/drug effects ; Benzylisoquinolines/*pharmacology ; Carcinoma/*drug therapy ; Cell Line, Tumor ; Dose-Response Relationship, Drug ; Extracellular Signal-Regulated MAP Kinases/*antagonists & inhibitors ; Humans ; Lung Neoplasms/*drug therapy