Purpose: High-dose radiotherapy (RT) for localized prostate cancer requires careful consideration of target position changes and adjacent organs-at-risk (OARs), such as the rectum and bladder. Therefore, daily monitoring of target position and OAR changes is crucial in minimizing interfractional dosimetric uncertainties. For efficient monitoring of the internal condition of patients, we assessed the feasibility of an auto-segmentation of OARs on the daily acquired images, such as megavoltage computed tomography (MVCT), via a commercial artificial intelligence (AI)-based solution in this study. Materials and Methods: We collected MVCT images weekly during the entire course of RT for 100 prostate cancer patients treated with the helical TomoTherapy system. Based on the manually contoured body outline, the bladder including prostate area, and rectal balloon regions for the 100 MVCT images, we trained the commercially available fully convolutional (FC)-DenseNet model and tested its auto-contouring performance. Results: Based on the optimally determined hyperparameters, the FC-DenseNet model successfully auto-contoured all regions of interest showing high dice similarity coefficient (DSC) over 0.8 and a small mean surface distance (MSD) within 1.43 mm in reference to the manually contoured data. With this well-trained AI model, we have efficiently monitored the patient's internal condition through six MVCT scans, analyzing DSC, MSD, centroid, and volume differences. Conclusion We have verified the feasibility of utilizing a commercial AI-based model for auto-segmentation with low-quality daily MVCT images. In the future, we will establish a fast and accurate auto-segmentation and internal organ monitoring system for efficiently determining the time for adaptive replanning.

Aldose reductase (AR) protein, a member of the NADPH-dependent aldo-keto reductase family, reduces a wide range of aldehydes and enhances cell survival by inhibition of oxidative stress. Oxidative stress is known as one of the major pathological factor in ischemia. Since the precise function of AR protein in ischemic injury is fully unclear, we examined the function of AR protein in hippocampal neuronal (HT-22) cells and in an animal model of ischemia in this study. Cell permeable Tat-AR protein was produced by fusion of protein transduction domain in Tat for delivery into the cells. Tat-AR protein transduced into HT-22 cells and significantly inhibited cell death and regulated the mitogen-activate protein kinases (MAPKs), Bcl-2, Bax, and Caspase-3 under oxidative stress condition. In an ischemic animal model, Tat-AR protein transduced into the brain tissues through the blood-brain barrier (BBB) and drastically decreased neuronal cell death in hippocampal CA1 region. These results indicate that transduced Tat-AR protein has protective effects against oxidative stress-induced neuronal cell death in vitro and in vivo, suggesting that Tat-AR protein could be used as potential therapeutic agent in ischemic injury.
Aldehyde Reductase ; Aldehydes ; Blood-Brain Barrier ; Brain ; CA1 Region, Hippocampal ; Caspase 3 ; Cell Death ; Cell Survival ; Humans ; In Vitro Techniques ; Ischemia ; Models, Animal ; Neurons ; Oxidative Stress ; Oxidoreductases ; Protein Kinases

No abstract available.

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation

BACKGROUND: Previous studies have shown that kidney transplant recipients' quality of life depend on compliance of treatment, family support, socioeconomic status. The purpose of this study was to determine whether estimated glomerular filtration rate (GFR) by Modification of Diet in Renal Disease (MDRD) study as a index of graft function influence recipients' quality of life including above mentioned factors. METHODS: One hundred and ten patients who visited out-patient department at least 3 months after kidney transplantation were included in this study. A structured questionnaire was used to collect data. This tool included; quality of life, compliance and family support scale as well as medical record review. The analysing of data was performed with SPSS version 11.5 (SPSS Inc. Chicago, IL, USA). RESULTS: The mean score of the recipients' quality of life (3.59/5), compliance (3.81/5), the support of family (4.02/5) and GFR (63 ml/min/1.73 m2) were revealed respectively. The quality of life was correlated with compliance (r=.260, P<.001) and family support (r=.377, P<.001) statistically. and compliance and family support also revealed correlation (r=.452, P<.001). Family support was the most explainable factor for the quality of life (R2=.142). however, the quality of life was not correlated with recipients' GFR (r=.013 P=0.819). CONCLUSIONS: Results of this study showed that kidney transplant recipients had a moderate quality of life. These findings suggest that emotional aspect like family support is as important as clinical factors such as GFR or compliance for recipients' quality of life. To optimize post-transplant quality of life, implication for interventional programming should be focused on family support.
Chicago ; Compliance ; Diet ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Transplantation ; Medical Records ; Outpatients ; Quality of Life ; Surveys and Questionnaires ; Social Class ; Transplants

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.
Antacids ; Biopsy ; Bismuth ; Calcinosis* ; Calcium ; Eating ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastric Mucosa ; Gastritis ; Gastroesophageal Reflux ; Humans ; Hyperparathyroidism ; Renal Insufficiency ; Salts ; Stomach Neoplasms ; Sucralfate ; Transplants

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping.
Colon ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Rectum ; Stomach

BACKGROUND AND OBJECTIVES: Detailed information on how an epithelial differentiation and elastic structures occurred in the developing eustachian tube would be helpful in understanding both normal physiology and pathology of the tubotympanum. This study was undertaken to establish elastic structures such as cartilage, elastic fiber, and collagen fiber in the embryonic mouse eustachian tube at a stage when epithelial differentiation is taking place. MATERIALS AND METHOD: Thirty four mice (BALB/c mouse), aged from gestational day 11 to postnatal day 21, were investigated using Verhoeff stain, Masson trichrome stain and alpha-1 antitrypsin immunohistochemistry. RESULTS: The cartilage-like structures were first found after birth, however, matured cartilages appeared at postnatal day 7. The elastic fibers and collagen fibers surrounding cartilage were abundantly found about 5 days after birth. alpha-1 antitrypsin, which is an strong inhibitor of elastase, began to be immunolabelled at gestational day 16. Its expression has been significantly increased after birth. CONCLUSION: Although the epithelial differentiation and maturation in eustachian tube occured at late embryonal stage, the elastic structures have developed and matured after birth. These findings might be a explanation to why young children are highly susceptible to otitis media.
Animals ; Cartilage ; Child ; Collagen ; Elastic Cartilage ; Elastic Tissue ; Elasticity ; Eustachian Tube* ; Humans ; Immunohistochemistry ; Mice ; Otitis Media ; Pancreatic Elastase ; Parturition ; Pathology ; Physiology

Duodenal diverticulum appears in 6% of upper gastrointestinal examinations and up to 23% of endoscopic retrograde cholangiopancreaticographies and up to 22% at autopsy. Most of these patients are asymptomatic, but a small fraction develop complications including choledocholithiasis, cholangitis, pancreatitis, diverticulitis, perforation, fistular formation and bleeding. Among these complications, only a few documented cases of bleeding have been reported in the literature, and the experience of endoscopist to the sequence of diagnosis, endoscopic treatment, and subsequent relief of the symptoms remains limited. Aggressive but careful endoscopic examination can help diagnosis of the cases. Also, endoscopic treatment of duodenal diverticular bleeding is very effective and proved to be an effective alternative to surgery. We report 4 patients with duodenal diverticular bleeding in whom both diagnosis and definitive treatment were successful by endoscopy alone.
Autopsy ; Cholangitis ; Choledocholithiasis ; Diagnosis ; Diverticulitis ; Diverticulum ; Endoscopy ; Hemorrhage* ; Humans ; Pancreatitis

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.
Angiography ; Arteries ; Colon ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Hemorrhage* ; Intestine, Small ; Laparoscopy ; Laparotomy ; Rectum ; Rupture ; Stomach ; Thrombosis