Purpose: T1 high grade (T1HG) bladder cancer (BC) is a type of non-muscle invasive BC (NMIBC) that is recognized as an aggressive subtype with a heightened propensity for progression. Current risk stratification methods for NMIBC rely on clinicopathological indicators; however, these approaches do not adequately capture the aggressive nature of T1HG BC. Thus, new, more accurate biomarkers for T1HG risk stratification are needed. Here, we enrolled three different patient cohorts and investigated expression of collagen type VI alpha 1 (COL6A1), a key component of the extracellular matrix, at different stages and grades of BC, with a specific focus on T1HG BC. Materials and Methods: Samples from 298 BC patients were subjected to RNA sequencing and real-time polymerase chain reaction. Results: We found that T1HG BC and muscle invasive BC (MIBC) exhibited comparable expression of COL6A1, which was significantly higher than that by other NMIBC subtypes. In particular, T1HG patients who later progressed to MIBC had considerably higher expression of COL6A1 than Ta, T1 low grade patients, and patients that did not progress, highlighting the aggressive nature and higher risk of progression associated with T1HG BC. Moreover, Cox and Kaplan–Meier survival analyses revealed a significant association between elevated expression of COL6A1 and poor progression-free survival of T1HG BC patients (multivariate Cox hazard ratio, 16.812; 95% confidence interval, 3.283–86.095; p=0.001 and p=0.0002 [log-rank test]). Conclusions These findings suggest that COL6A1 may be a promising biomarker for risk stratification of T1HG BC, offering valuable insight into disease prognosis and guidance of personalized treatment decisions.

OBJECTIVE: To develop and standardize the Limb and Oral Apraxia Test (LOAT) for Korean patients and investigate its reliability, validity, and clinical usefulness for patients with stroke. METHODS: We developed the LOAT according to a cognitive neuropsychological model of limb and oral praxis. The test included meaningless, intransitive, transitive, and oral praxis composed of 72 items (56 items on limb praxis and 16 items on oral praxis; maximum score 216). We standardized the LOAT in a nationwide sample of 324 healthy adults. Intra-rater and inter-rater reliability and concurrent validity tests were performed in patients with stroke. We prospectively applied the LOAT in 80 patients and analyzed the incidence of apraxia. We also compared the clinical characteristics between the apraxia and non-apraxia groups. RESULTS: The internal consistency was high (Cronbach’s alpha=0.952). The inter-rater and intra-rater reliability and concurrent validity were also high (r=0.924–0.992, 0.961–0.999, and 0.830, respectively; p<0.001). The mean total, limb, and oral scores were not significantly different according to age and education (p>0.05). Among the 80 patients with stroke, 19 (23.8%) had limb apraxia and 21 (26.3%) had oral apraxia. Left hemispheric lesions and aphasia were significantly more frequently observed in the limb/oral apraxia group than in the non-apraxia group (p<0.001). CONCLUSION: The LOAT is a newly developed comprehensive test for limb and oral apraxia for Korean patients with stroke. It has high internal consistency, reliability, and validity and is a useful apraxia test for patients with stroke.
Adult ; Aphasia ; Apraxias ; Dominance, Cerebral ; Education ; Extremities ; Humans ; Incidence ; Prospective Studies ; Psychometrics ; Reproducibility of Results ; Stroke

OBJECTIVE: To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke. METHODS: A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase. RESULTS: Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002–1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002–1.016; p=0.017). CONCLUSION: Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.
Cognition Disorders ; Cognition* ; Crows ; Deglutition ; Deglutition Disorders* ; Executive Function ; Humans ; Retrospective Studies ; Stroke* ; Trail Making Test

BACKGROUND: As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). METHODS: We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. RESULTS: Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). CONCLUSIONS: We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; *Learning Curve ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/adverse effects/methods ; Retrospective Studies ; Spinal Diseases/*surgery ; Spinal Fusion/*adverse effects/methods ; Young Adult

OBJECTIVE: To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP). METHODS: We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD. RESULTS: The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (DeltaVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (DeltaODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012). CONCLUSION: PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP.
Decompression* ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Leg ; Logistic Models ; Radiculopathy ; Regression Analysis ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: This research is a basic investigation of collecting experts' opinions for constructing the national cancer expert network. The objective of this research is to evaluate present situation and to use it for the planning of future korean cancer network in the cancer-related area. METHODS: We analyzed the need of the network and degree of information demand for constructing the network from Clinicians and Basic researchers(n=376) who answered themselves 'cancer expert'. The questionnaire consists of 9 questions and it was analyzed by using frequence, t-test and Chi-square. RESULTS: 53.7 percents of respondents answered they are already recognized cancer expert network and 93.5 percents of respondents answered that they need the network. Among the services that would be served by the network, the demand of cancer statistics, development and evaluation of cancer policy, and cancer clinical trials were listed in the high priorities. And recognized societies included in the high priorities were Korean Cancer Study Group, Korean Cancer Association, Korean Association for the Study of Lung Cancer. CONCLUSION: We are going to develop a database and network for the experts to generate, evaluate and verify cancer-related information based on evidence-based cancer information infrastructure. Hence, this research will be contributed to provide fundamental data for activating cancer-related research through joint studies with experts.
Surveys and Questionnaires ; Joints ; Lung Neoplasms

Primary urethral carcinoma accounts for less than 1% of the malignancies in males and adenocarcinoma accounts for 5% of all urethral carcinomas. A 36-year-old man with a history suggestive of urethral stricture was scheduled to undergo retrograde urethrography and visual urethrotomy. On urethroscopic examination, an abnormal polypoid mass was found in the proximal bulbous urethra, so transurethral resection biopsy was added to the urethrotomy. Histopathologic examination demonstrated urethral adenocarcinoma with no invasion to the corpus spongiosum and cavernosa on the magnetic resonance imaging. There was no evidence of metastasis and the search for the primary focus of adenocarcinoma revealed that the tumor originated from the urethra. The patient underwent segmental urethral resection and there has been no recurrence for 1-year follow-up.
Adenocarcinoma* ; Adult ; Biopsy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Recurrence ; Urethra ; Urethral Stricture

The purpose of this study was to investigate the stress distribution in the periodontal tissue and the displacement of teeth when active torque was applied to the maxillary incisors by three-dimensional finite element analysis. A three-dimensional finite element model consisted of the maxillary teeth and surrounding periodontal membrane, .022 x .028 Roth prescription bracket and stainless steel, NiTi and TMA rectangular ideal arch wires which were modeled by hexahedron elements. Applied active torques were 2, 5 and 10 degrees. The findings of this study showed that the reaction force acting on the bracket was the extrusion force on the mesial side of the incisors and canine and the intrusion force on the distal side of the incisors and canine. The amount of force and moment was greatest at the lateral incisor. When active anterior labial crown torque was applied, labial crown and distal tipping and intrusion of the incisors took place, and lingual crown distal tipping and extrusion of the canine occured. An excessive force was concentrated on the lateral incisor, when the stainless steel wire was used. NiTi or TMA wire is desirable for torque control.
Crowns ; Finite Element Analysis* ; Incisor* ; Membranes ; Prescriptions ; Stainless Steel ; Tooth ; Torque*

Age Distribution ; Dentistry ; Dentofacial Deformities ; Diagnosis ; Facial Asymmetry ; Female ; Genioplasty ; Humans ; Inpatients ; Jeollabuk-do ; Male ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Prognathism ; Retrognathia ; Surgery, Oral

BACKGROUND AND OBJECTIVES: The prevalence of coronary disease in Korea, with the consequent morbidity and mortality, has rapidly risen during the last two decades. This study aimed to describe the changing pattern in the demographic composition during the 1990s of patients presenting with acute myocardial infarction (AMI) in Korean metropolitan cities. SUBJECTS AND METHODS: Data from the medical record of patients with AMI, admitted to five University Hospitals in Busan and Daegu between January 1990 and December 1999, were sorted according to their age (<30, 3044, 4559, 6074, >75 years) and gender. RESULTS: During the last decade, the number of cases of AMI increased from 283 in 1990, to 988 by 1999 (ratio of AMI/medical patients admitted; 1.68% in 1990 to 2.52% in 1999). The most prevalent age group was 6074 yrs (46.1%), followed by 4559 yrs (34.2%). Generally, the male cases were twice as prevalent as female (68.2% : 31.8%), but the gender ratio was reversed in the highest age group (>75 yrs) (44.6% : 55.4%). During the period in question, the gender ratio and age distribution remained reasonably constant throughout. The proportion of younger AMI patients (<45 yrs) did not increase. CONCLUSION: Admissions due to AMI increased substantially during the 1990s. Almost half the cases were from the 6074 yrs age group, and two third were male. There were little changes in the compositions of age and gender of the AMI cases during this period.
Age Distribution ; Busan ; Coronary Disease ; Daegu ; Female ; Hospitals, University* ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Myocardial Infarction* ; Prevalence