PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.
Academies and Institutes ; Asian Continental Ancestry Group ; DNA ; Humans ; Korea ; Methods ; Paraffin ; Point Mutation ; Precision Medicine ; Prevalence

Unlike class I patients, skeletal class II patients have unstable occlusion thus leading to instability of mandibular complete denture. Therefore, mandibular implant overdenture has been the standard of care due to its advantages in stability and retention. The types of attachments can be divided into two categories: solitary and bar type. The indications vary between two categories. In this clinical report, digital technology was utilized from the implant planning to the choice of appropriate attachment. Implants were placed at the desired location as previously planned in terms of angle and depth. Maxillary removable partial denture and mandibular implant overdenture are expected to have fair prognosis.
Denture, Complete ; Denture, Overlay ; Denture, Partial, Removable ; Humans ; Prognosis ; Spatial Analysis ; Standard of Care

OBJECTIVE: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. METHODS: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. RESULTS: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). CONCLUSION: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.
Angiotensins ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Heart ; Hospitals, Teaching ; Humans ; Hypertension ; Incidence ; Logistic Models ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prescriptions*

PURPOSE: The measurement of serum human epidermal growth factor receptor 2 (HER2) extracellular domain levels is a well-established method for evaluating whether a metastatic HER2-positive breast cancer patient will respond to HER2-targeted treatment. However, little is known about the value of serum HER2 for detecting disease relapse following curative surgical treatment in breast cancer patients. The purpose of this study was to evaluate the sensitivity of serum HER2, carcinoembryonic antigen (CEA), and carcinoma antigen 15-3 (CA 15-3) for the detection of disease recurrence in postoperative breast cancer patients with a primary HER2-positive tumor. METHODS: Serial measurements were taken of serum HER2, CEA, and CA 15-3 levels in patients with primary invasive HER2-positive breast cancer who underwent curative surgical treatment between January 2008 and December 2010. Following treatment, serum HER2 levels were monitored every 6 months using a chemiluminescence immunoassay. RESULTS: Overall, 264 patients were analyzed in this retrospective study. The median follow-up period was 27.7 months, and 24 patients relapsed during follow-up. The sensitivity of serum HER2, CEA, and CA 15-3 for the detection of disease recurrence was 37.5%, 25.1%, and 12.5%, respectively. Sensitivity increased to 45.8% when all three tumor markers were combined in the analysis. In a subgroup of patients without liver disease, the sensitivity of serum HER2, CEA, and CA 15-3 was 57.1%, 21.4%, and 14.3%, respectively. Of the 264 patients in this study, 80 patients had chronic hepatitis, liver cirrhosis, or abnormal aspartate aminotransferase or alanine aminotransferase levels during the follow-up period. Following the exclusion of these patients, the sensitivity of serum HER2 for the detection of disease recurrence increased to 57.1%. CONCLUSION: Serial serum HER2 measurement may be useful for the detection of disease relapse in patients with HER2-positive breast cancer. Abnormal liver function can result in elevated serum HER2 in the absence of disease recurrence.
Alanine Transaminase ; Aspartate Aminotransferases ; Breast Neoplasms* ; Breast* ; Carcinoembryonic Antigen ; Follow-Up Studies ; Hepatitis, Chronic ; Humans ; Immunoassay ; Liver ; Liver Cirrhosis ; Liver Diseases ; Luminescence ; Receptor, Epidermal Growth Factor ; Recurrence* ; Retrospective Studies ; Biomarkers, Tumor

PURPOSE: The renin-angiotensin-aldosterone system activation has been suggested as a potential risk factor for renal progression in autosomal dominant polycystic kidney disease (ADPKD). This study was performed to evaluate urinary angiotensinogen as a biomarker of renal progression in ADPKD. METHODS: Patients with estimated glomerular filtration rate (eGFR) > or =30 mL/min/1.73m2 were enrolled in the study. Specimens (blood and urine) and computed tomography (CT) were taken from each subject. The eGFR was calculated by 4-variable MDRD equation and total kidney volume (TKV) was measured from CT images by modified ellipsoid method. Urinary angiotensinogen (AGT) and neutrophil gelatinaseassociated lipocalin (NGAL) were measured by ELISA. The concentration of AGT was adjusted with random urine creatinine (Cr). The association between urinary biomarkers, TKV and eGFR were evaluated. RESULTS: A total of 59 (M:F=31:28) subjects were enrolled in the study and their mean age was 46 years. The eGFR and TKV at the enrollment were 77.3+/-15.6 mL/min/1.73m2 and 1389.8+/-925.1 mL, respectively. Log AGT/Cr was associated with TKV (r2=0.117, p=0.01) in the earlier stage of disease (TKV<3,000 mL). However, it did not show significant correlation with eGFR. Log NGAL was not associated with either TKV or eGFR. Urinary AGT/Cr was closely related to the number of anti-hypertensive medication, TKV, and the presence of albuminuria, although there was no correlation with plasma renin activity or aldosterone level. CONCLUSION: Urinary angiotensinogen may be a useful biomarker of disease progression in ADPKD patients.
Albuminuria ; Aldosterone ; Angiotensinogen ; Biomarkers ; Creatinine ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Glomerular Filtration Rate ; Humans ; Kidney ; Lipocalins ; Neutrophils ; Organ Size ; Plasma ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Renin ; Renin-Angiotensin System

OBJECTIVES: This clinical study evaluated the effect of light activation on the whitening efficacy and safety of in-office bleaching system containing 15% hydrogen peroxide gel. MATERIALS AND METHODS: Thirty-three volunteers were randomly treated with (n = 17, experimental group) or without light activation (n = 16, control group), using Zoom2 white gel (15% H2O2, Discus Dental) for a total treatment time of 45 min. Visual and instrumental color measurements were obtained using Vitapan Classical shade guide and Shadepilot (DeguDent) at screening test, after bleaching, and 1 month and 3 month after bleaching. Data were analyzed using t-test, repeated measure ANOVA, and chi-squared test. RESULTS: Zoom2 white gel produced significant shade changes in both experimental and control group when pre-treatment shade was compared with that after bleaching. However, shade difference between two groups was not statistically significant (p > 0.05). Tooth shade relapse was not detected at 3 months after bleaching. The incidence of transient tooth sensitivity was 39.4%, with being no differences between two groups. CONCLUSIONS: The application of light activation with Zoom2 white gel system neither achieved additional whitening effects nor showed more detrimental influences.
Humans ; Hydrogen ; Hydrogen Peroxide ; Hypersensitivity ; Incidence ; Light ; Mass Screening ; Recurrence ; Tooth ; Tooth Bleaching

BACKGROUND AND OBJECTIVES: The relative proportion of infective endocarditis (IE) with congenital heart disease (CHD) has increased because of improved survival with CHD. This may affect the current profile of IE with CHD. The aim of this study is to assess the changing profiles of IE with CHD. SUBJECTS AND METHODS: All cases diagnosed from January 1985 to May 2006 were retrospectively reviewed and were analyzed according to the diagnosed period (period I-prior to 1995, period II-after 1996). Duke criteria were used for the definition of diagnosis. RESULTS: As a whole, 121 episodes occurred (63 episodes in period I and 58 episodes in period II). Although the mean age was similar for patients diagnosed in the two periods, the proportion of younger age patients was larger during period II. During period II, the number of non-surgical ventricular septal defect (VSD) cases decreased and the number of Rastelli procedure cases increased. Negative blood cultures were similar in patients for both periods. S. viridans was the most common causative organism in patients during both periods. Post-surgical cases and IE after a dental procedure increased during period II. The in-hospital mortality rate, total complication rate, and proportion of IE requiring early surgery were not different for patients in either period. However, the interval to early surgery was shorter for patients during period II (period I 35+/-21.1 days, period II 22+/-16.5 days, p=0.041). CONCLUSION: Our study indicates that IE in CHD is still a major problem with similar clinical features exhibited during the two different periods. The presence of non-surgical VSD as a major underlying defect indicates that one needs to pay more attention to the education of the population at risk.
Diagnosis ; Education ; Endocarditis* ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Population Characteristics ; Retrospective Studies*

A duodenal diverticulum is common in the second portion of the duodenum and can occur at any age. An obstruction, bleeding, perforation, diverticulitis are not an uncommon complicationa of duodenal diverticulum. As a rare complication, bleeding in the duodenal diverticulum may be massive, and duodenal diverticulum is resected primarily as a result of the difficulty in determining the site of bleeding. However, there has been a recent increase in endoscopic diagnosis and the treatment of diverticular bleeding. Band ligation increases the risk of duodenal diverticular perforation because of the thin diverticular wall. An endoscopic hemoclip is a preferable method for endoscopic sclerotherapy. We report a 48- year-old man with a giant duodenal diverticulum that was treated with a hemoclip. The duodenal diverticular perforation was treated effectively with supportive care.
Diagnosis ; Diverticulitis ; Diverticulum* ; Duodenum* ; Hemorrhage ; Ligation ; Sclerotherapy

OBJECTIVE: To determine the effects of concentric isokinetic knee strength training on gait, balance and health related quality of life in chronic stroke patients. METHOD: Fifteen patients with chronic stroke participated in this study. All subjects were community ambulators and trained using Biodex System 3 isokinetic dynamometer three times a week for 6 weeks. The training program consisted of concentric isokinetic strengthening of both knee extensors and flexors. Peak torque of knee extensors and flexors, walking performance (temporospatial parameter of gait and stair climbing time), balance (overall balance index, anterior/ posterior index and medial/lateral index) and health-related quality of life measure (36-item short form health survey, SF-36) were evaluated before and after training period. RESULTS: Muscle strength improved significantly after training. Walking speed, stride length and stair climbing time improved significantly after training. Balance indices and SF-36 score also improved significantly after training. CONCLUSION: Gain in muscle strength appeared to be transferred to functional improvement. Therefore, isokinetic resistance training program would be one of the effective rehabilitation programs for chronic stroke survivors. Further investigations are required for long-term effect and development of strength-specific resistance training program.
Education ; Gait* ; Health Surveys ; Humans ; Knee* ; Muscle Strength ; Quality of Life* ; Rehabilitation ; Resistance Training* ; Stroke* ; Survivors ; Torque ; Walking

Purpose: No ideal method for subdividing and assessing changes in neurons of the spinal cord during specific conditions has been established. We attempted to develop a method for subdividing spinal neurons using immunohistochemical and fluorescent staining, which is an important key towards understanding the mechanism of reflex voiding. Materials and Methods: Thirty Sprague-Dawley rats, weighting 200-300g, were divided into five groups. A cystometrogram was performed during saline or acetic acid instillation. We identified the neuronal pathway associated with the detrusor by injecting a pseudorabies virus (PRV) into the detrusor muscle and inspecting the changes in relation to different time sequences. An immunohistochemical staining method was used to stain the fos-protein encoded by the c-fos gene. Immunofluorescent staining was performed to evaluate changes in the neurons in relation to the voiding reflex, and the neurons then subdivided. Results: We confirmed pseudorabies virus (PRV) infection of the cells in the sacral parasympathetic nucleus through immunohistochemical staining two days after injection. On detection of an increase in c-fos positive cells after dividing the c-fos positive area of the L6 and S1 spinal cord into 4 sections, significant increases were observed in the sacral parasympathetic nucleus (SPN) and dorsal commissure (DCM). Double staining was performed to detect the neurons associated with the voiding reflex in the SPN and DCM areas showing overexpression of c-fos. Conclusions: The establishment of a method for detecting morphological changes, and subdividing neurons by immunohistochemical and fluorescent staining, may provide an important key towards understanding the mechanism of various neuromodulations of clinically applied treatments. (Korean J Urol 2005;46:487-494)
Acetic Acid ; Genes, fos ; Herpesvirus 1, Suid ; Neurons* ; Proto-Oncogene Proteins c-fos ; Rats, Sprague-Dawley ; Reflex ; Spinal Cord