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1.  Analysis and evaluation of relative positions of mandibular third molar and mandibular canal impacts 
Objectives
This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage.
Materials and Methods
Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimensional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated.
Results
When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the mandibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images.
Conclusion
The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage.
doi:10.5125/jkaoms.2014.40.6.278
PMCID: PMC4279971  PMID: 25551092
Paresthesia; Mandibular nerve; Third molars
2.  Prognostic Significance of Volume-Based FDG PET/CT Parameters in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation Therapy 
Yonsei Medical Journal  2014;55(6):1498-1506.
Purpose
We investigated the prognostic role of volume-based parameters measured on 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scans in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiation therapy (CRT).
Materials and Methods
We enrolled 60 patients with LAPC who underwent FDG PET/CT before CRT. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary pancreatic cancers were measured on FDG PET/CT scans. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard models were used to determine independent prognostic factors.
Results
The progression-free survival (PFS), locoregional progression-free survival (LRFPS), and overall survival (OS) for this population were 6.2, 10.9, and 13.2 months, respectively. The overall treatment response rate was 16.7% at 4 weeks after CRT, and the disease control rate (DCR) was 80.0%. DCR was significantly higher in patients with low SUVmax, MTV, or TLG, and showed strong correlation with longer survival times. On univariate analysis, MTV and TLG were significant prognostic factors for PFS, LRPFS, and OS, together with pre-CRT and post-CRT CA19-9 levels. Multivariate analyses demonstrated that MTV together with the pre-CRT CA19-9 level were independent prognostic factors for PFS, LRPFS, and OS, as was TLG for LRPFS and OS.
Conclusion
MTV and the pre-CRT CA19-9 level provided independent prognostic information in patients with LAPC treated with CRT. Volume-based PET/CT parameters may be useful in identifying which subgroup of patients would benefit from radiation therapy as a part of CRT.
doi:10.3349/ymj.2014.55.6.1498
PMCID: PMC4205688  PMID: 25323885
Locally advanced pancreatic cancer; FDG; PET; metabolic tumor volume; prognosis
3.  Comparative results of conventional and eversion carotid endarterectomy 
Purpose
Comparative results of conventional carotid endarterectomy (cCEA) and eversion carotid endarterectomy (eCEA) have been reported in many studies. But in Korea, there have been no reports to compare the outcome of the two techniques. Thus, we investigated the results of eCEA compared to cCEA in Yeungnam University Medical Center.
Methods
A total of 120 subjects who underwent CEA were included in this study. Of them, cCEAs were performed in 63 patients and eCEAs were performed in 57 patients. We analyzed the results divided into the early (within 30 days after surgery), midterm (from 30 days up to 1 year after surgery) and late (over 1 year after surgery).
Results
Mean age of the patients was 65.9 ± 7.1 years in cCEA group and 66.8 ± 7.7 years in eCEA group (P = 0.523). Carotid shunt frequency was higher in the cCEA group (39.7% vs. 19.3%, P = 0.015). There were no statistical differences in the early complications with the exception of a significantly higher risk for new brain lesions in the cCEA group (34.9% vs. 14.0%, P = 0.008). The frequency of complication was same between cCEA group and eCEA group in the midterm. Although there was no statistical significance, the frequency of late complications was higher in the cCEA group compared to eCEA group. Mean follow-up duration was 29.4 ± 23.5 months.
Conclusion
These data showed that eCEA was an acceptable procedure and had some advantage compared to cCEA in the aspect of the early and late complication.
doi:10.4174/astr.2014.87.4.192
PMCID: PMC4196435  PMID: 25317414
Carotid endarterectomy; Eversion endarterectomy; Carotid stenosis
4.  Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy 
Yonsei Medical Journal  2014;55(4):1106-1114.
Purpose
Epidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy.
Materials and Methods
Sixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated.
Results
This study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2±263.7 µg vs. 1048.9±71.7 µg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group.
Conclusion
ITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.
doi:10.3349/ymj.2014.55.4.1106
PMCID: PMC4075374  PMID: 24954344
Analgesia; epidural; gastrectomy; intrathecal; opioid; postoperative pain
5.  Risk factor analysis of new brain lesions associated with carotid endarterectmy 
Purpose
Carotid endarterectomy (CEA) is the standard treatment for carotid artery stenosis. New brain ischemia is a major concern associated with CEA and diffusion weighted imaging (DWI) is a good imaging modality for detecting early ischemic brain lesions. We aimed to investigate the surgical complications and identify the potential risk factors for the incidence of new brain lesions (NBL) on DWI after CEA.
Methods
From January 2006 to November 2011, 94 patients who had been studied by magnetic resonance imaging including DWI within 1 week after CEA were included in this study. Data were retrospectively investigated by review of vascular registry protocol. Seven clinical variables and three procedural variables were analyzed as risk factors for NBL after CEA.
Results
The incidence of periprocedural NBL on DWI was 27.7%. There were no fatal complications, such as ipsilateral disabling stroke, myocardial infarction or mortality. A significantly higher incidence of NBL was found in ulcer positive patients as opposed to ulcer negative patients (P = 0.029). The incidence of NBL after operation was significantly higher in patients treated with conventional technique than with eversion technique (P = 0.042).
Conclusion
Our data shows CEA has acceptable periprocedural complication rates and the existence of ulcerative plaque and conventional technique of endarterectomy are high risk factors for NBL development after CEA.
doi:10.4174/astr.2014.86.1.39
PMCID: PMC3994605  PMID: 24761406
Catorid endarterectomy; Complications; New brain lesions; Risk factors
6.  Prognostic Value of 18F-Fluorodeoxyglucose Positron Emission Tomography in Patients with Resectable Pancreatic Cancer 
Yonsei Medical Journal  2013;54(6):1377-1383.
Purpose
We evaluated the prognostic value of 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in patients with resectable pancreatic cancer.
Materials and Methods
We retrospectively reviewed the medical records of pancreatic cancer patients who underwent curative resection, which included 64 consecutive patients who had preoperative FDG PET scans. For statistical analysis, the maximal standardized uptake value (SUVmax) of primary pancreatic cancer was measured. Survival time was estimated by the Kaplan-Meier method, and Cox's proportional hazard model was used to determine whether SUVmax added new predictive information concerning survival together with known prognostic factors. p<0.05 indicated statistical significance.
Results
Overall survival (OS) and disease-free survival (DFS) were respectively 42.9 months (27.6-58.2; 95% CI) and 14.9 months (10.1-19.7; 95% CI). When subjects were divided into two groups according to SUVmax with a cutoff value of 3.5, the high SUVmax group (n=32; SUVmax >3.5) showed significantly shorter OS and DFS than the low SUVmax group. Multivariate analysis of OS and DFS showed that both high SUVmax and poor tumor differentiation were independent poor prognostic factors.
Conclusion
Our study showed that degree of FDG uptake was an independent prognostic factor in pancreatic cancer patients who underwent curative resection.
doi:10.3349/ymj.2013.54.6.1377
PMCID: PMC3809883  PMID: 24142641
FDG PET; pancreatic cancer; prognosis; curative resection
7.  Sensitivities of seasonal and pandemic rapid antigen tests differentiated by the level of immunofluorescence for the detection of pandemic influenza A/H1N1 2009 virus 
doi:10.3904/kjim.2013.28.4.507
PMCID: PMC3712163  PMID: 23864813
Influenza A virus; Fluorescent antibody technique, direct; Rapid antigen test
8.  A Novel Method for the Accurate Evaluation of Poisson's Ratio of Soft Polymer Materials 
The Scientific World Journal  2013;2013:930798.
A new method with a simple algorithm was developed to accurately measure Poisson's ratio of soft materials such as polyvinyl alcohol hydrogel (PVA-H) with a custom experimental apparatus consisting of a tension device, a micro X-Y stage, an optical microscope, and a charge-coupled device camera. In the proposed method, the initial positions of the four vertices of an arbitrarily selected quadrilateral from the sample surface were first measured to generate a 2D 1st-order 4-node quadrilateral element for finite element numerical analysis. Next, minimum and maximum principal strains were calculated from differences between the initial and deformed shapes of the quadrilateral under tension. Finally, Poisson's ratio of PVA-H was determined by the ratio of minimum principal strain to maximum principal strain. This novel method has an advantage in the accurate evaluation of Poisson's ratio despite misalignment between specimens and experimental devices. In this study, Poisson's ratio of PVA-H was 0.44 ± 0.025 (n = 6) for 2.6–47.0% elongations with a tendency to decrease with increasing elongation. The current evaluation method of Poisson's ratio with a simple measurement system can be employed to a real-time automated vision-tracking system which is used to accurately evaluate the material properties of various soft materials.
doi:10.1155/2013/930798
PMCID: PMC3655649  PMID: 23737733
9.  Design and Performance Evaluation of a Rotary Magnetorheological Damper for Unmanned Vehicle Suspension Systems 
The Scientific World Journal  2013;2013:894016.
We designed and validated a rotary magnetorheological (MR) damper with a specified damping torque capacity, an unsaturated magnetic flux density (MFD), and a high magnetic field intensity (MFI) for unmanned vehicle suspension systems. In this study, for the rotary type MR damper to have these satisfactory performances, the roles of the sealing location and the cover case curvature of the MR damper were investigated by using the detailed 3D finite element model to reflect asymmetrical shapes and sealing components. The current study also optimized the damper cover case curvature based on the MFD, the MFI, and the weight of the MR damper components. The damping torques, which were computed using the characteristic equation of the MR fluid and the MFI of the MR damper, were 239.2, 436.95, and 576.78 N·m at currents of 0.5, 1, and 1.5 A, respectively, at a disk rotating speed of 10 RPM. These predicted damping torques satisfied the specified damping torque of 475 N·m at 1.5 A and showed errors of less than 5% when compared to experimental measurements from the MR damper manufactured by the proposed design. The current study could play an important role in improving the performance of rotary type MR dampers.
doi:10.1155/2013/894016
PMCID: PMC3606766  PMID: 23533366
10.  Tumor cell nuclear diameter and CD30 expression as potential prognostic parameter in patients with extranodal NK/T-cell lymphoma, nasal type 
Extranodal natural killer/T-cell lymphoma, nasal type (nasal ENKTL) is a distinct clinicopathologic entity of lymphoid tumors with variable size and differentiation of tumor cells. Nasal ENKTL is related to infection of the tumor cells with Epstein-Barr virus (EBV) and virtually all cases contain monoclonal episomal EBV DNA and detectable EBV encoded small nuclear RNAs (EBERs). Several clinical factors are known for their relation to the prognosis, but histopathologic prognostic factors of nasal ENKTL have not yet been well established. We evaluated the prognostic value of the longest nuclear diameter of EBER+ tumor cells (NDTC) along with the result of CD30 expression. Twenty two patients with newly diagnosed nasal ENKTL were evaluated regarding clinicopathologic characteristics. NDTC was measured using a computerized image analysis system. The results were expressed as the mean diameter of ≥ 50 cells in a patient. Median of the mean NDTC of the patients was 7.32 μm (5.15-11.27). Patients with larger mean NDTC (≥ 7.35 μm) had a poorer event-free survival (EFS) than those with smaller mean NDTC (<7.35 μm; p = 0.024) and had a tendency of inferior overall survival (OS) (p = 0.08). Patients with CD30 expression had a inferior EFS (p = 0.018) and OS (p = 0.011) compared those without CD30 expression. The NDTC of EBV infected tumor cell and CD30 expression had relation to survival in the current exploratory analysis.
PMCID: PMC3484496  PMID: 23119111
Extranodal NK/T-cell lymphoma; nasal type; epstein-barr virus; CD30; prognosis; nuclear diameter
11.  Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques 
Clinics in Orthopedic Surgery  2012;4(1):72-76.
Background
The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone.
Methods
We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days.
Results
All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found.
Conclusions
Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.
doi:10.4055/cios.2012.4.1.72
PMCID: PMC3288497  PMID: 22379558
Mallet fractures; Extension block pinning; Intrafocal pinning technique
12.  An implant-supported removable partial denture for a patient with post-inflammatory scar contracture caused by burn complications: a clinical report 
The scars and contracture around the oral-facial region may cause difficulty in prosthodontic treatment to restore esthetics and function for the patients, who suffered severe burns. This article presents a technique that uses a fixed partial denture prepared with a conventional milling technique and an attachment to support anterior cantilever removable partial denture, thereby providing a more esthetically acceptable and functional result.
doi:10.4047/jap.2012.4.1.57
PMCID: PMC3303922  PMID: 22439102
Trismus; Burn scar; Implant; Removable partial denture; Milled bar; Implant and tooth supported
13.  Effect of Hyaluronic Acid-Carboxymethylcellulose Solution on Perineural Scar Formation after Sciatic Nerve Repair in Rats 
Clinics in Orthopedic Surgery  2011;3(4):315-324.
Background
Scar tissue formation is the major cause of failure in peripheral nerve surgery. Use of a hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane (Seprafilm) as a solid anti-adhesion barrier agent is one of the therapeutic approaches to reduce postoperative scar tissue formation. However, a solid membrane may not be suitable for repair of a weak peripheral nerve site. This study examined the effect of HA-CMC solution on perineural scar formation after peripheral nerve repair in rats.
Methods
The sciatic nerves of 40 rats were transected and then immediately repaired using 10-0 nylon. The nerves were divided randomly into two groups. Saline and HA-CMC solution were applied topically to the nerve repair sites in the control and experimental groups, respectively. Reoperation was performed at 3, 6, 9, and 12 weeks to assess scar tissue formation. The assessment included the quality of wound healing, presence of perinueral adhesion, cellular components of the scar tissue, thickness of the scar tissue and histomorphological organization of the repair site.
Results
Topical application of the HA-CMC solution significantly decreased the macroscopic nerve adherence score and the numbers of the cellular components such as fibroblasts and inflammatory cells (p < 0.05, Mann-Whitney U-test). The scar tissue formation index was significantly lower in the experimental group at 12 weeks than that in the control group (p < 0.05, Mann-Whitney U-test). The grading scores of the histomorphological axonal organization at the repair site were significantly higher in the experimental group than those in the control group at 12 weeks (p < 0.05, Mann-Whitney U-test). No evidence of wound dehiscence or inflammatory reactions against the HA-CMC solution was noted.
Conclusions
Topical application of a HA-CMC solution is effective in reducing the perineural scar formation and adhesion after sciatic nerve repair in rats, and is effective in promoting peripheral nerve regeneration at the repair site.
doi:10.4055/cios.2011.3.4.315
PMCID: PMC3232360  PMID: 22162795
Hyaluronic acid; Carboxymethylcellulose; Peripheral nerve; Scar formation; Adhesion
14.  Evaluation of Direct Immunofluorescence Test with PCR for Detection of Novel Influenza A (H1N1) Virus during 2009 Pandemic 
Yonsei Medical Journal  2011;52(4):680-682.
During the 2009 novel influenza (H1N1) pandemic, the sensitivity of direct immunofluorescence assay (DFA) for H1N1 infection was 62% (266/429) of that of the polymerase chain reaction (PCR) test. The sensitivity of the DFA differed significantly with the age of patients: the sensitivity was the highest (71.8%) for patients aged <10 years and the lowest for patients aged ≥30 years. The sensitivity of DFA in patients aged ≥30 years was 40.7%. Furthermore, the sensitivity (67.3%, 171/254) of DFA was higher for patients who had a high temperature at admission. An increase in the incidence of H1N1 infection did not influence the sensitivity of DFA (62.1% vs. 62%; p=0.984) test, but resulted in a decrease in the negative predictive value, from 92.4% (700/757) to 69.6% (247/355). PCR may be useful as the initial test for diagnosing H1N1 infection in patients aged ≥30 years with a normal temperature at presentation.
doi:10.3349/ymj.2011.52.4.680
PMCID: PMC3104445  PMID: 21623613
Influenza A (H1N1); direct immunofluorescence assay
15.  Efficacy of dog-appeasing pheromone (DAP) for ameliorating separation-related behavioral signs in hospitalized dogs 
The Canadian Veterinary Journal  2010;51(4):380-384.
Dogs hospitalized in veterinary clinics are likely to show signs of separation-induced anxiety from hospitalization. The study assessed the effect of dog-appeasing pheromone (DAP) on 10 typical separation-related behavioral signs in hospitalized dogs. A DAP treated group (n = 24) was compared with a placebo control group (n = 19). There was overall amelioration of the signs without ‘vigilance’ and ‘anorexia’ in the DAP-treated dogs; marked decreases were noted in elimination (P = 0.038), excessive licking (P = 0.005), and pacing (P = 0.017). The results suggest that the use of DAP could decrease separation-induced anxiety, distress, and fear in inpatients, and possibly facilitate recovery in hospitalized dogs.
PMCID: PMC2839826  PMID: 20592826
16.  An implant-supported removable partial denture on milled bars to compromise the inadequate treatment plan: a clinical report 
Presurgical prosthetic treatment planning is critical for the success of the implant prosthesis. Inadequate treatment plan, due to insufficient discussion between prosthodontist, and surgeon, may result in poor prognosis. A 26-year-old male patient was referred for prosthodontic treatment after implant was placed in the area of teeth #17, 16, 22, 25 and 27, without adequate discussion nor the treatment planning between oral surgeon and prosthodontist. It was found that the patient had two hopeless teeth, and a severely resorbed alveolar ridge. Additional tooth extraction was needed and the type of definitive prosthesis was shifted from fixed type to removable one. Proper pre-surgical treatment planning is essential for the good prognosis. Implant-supported removable prosthesis on milled bars may be a useful treatment option in patients with incorrect angled placement on severely resorbed alveolar ridge.
doi:10.4047/jap.2010.2.2.58
PMCID: PMC2984520  PMID: 21165190
Treatment plan; Discussion; Implant; Removable partial denture; Milled bar
17.  Low Frequency and Variability of FLT3 Mutations in Korean Patients with Acute Myeloid Leukemia 
Journal of Korean Medical Science  2008;23(5):833-837.
FLT3 mutations are common genetic changes, and are reported to have prognostic significance in acute myeloid leukemia (AML). The FLT3 internal tandem duplication (ITD) and the D835 activating mutation in the tyrosine kinase domain (TKD) were analyzed by polymerase chain reaction (PCR) in the genomic DNA of Korean patients with AML at diagnosis and during follow-up. There were 226 patients with AML enrolled between March 1996 and August 2005. The incidence of ITD and TKD at diagnosis was 13% (29/226) and 3% (6/226). When compared to Western and other Asian patients with AML, Korean patients had a lower frequency by about two-thirds of ITD and TKD. Among the non-M3 cases (N=203), the patients with an ITD had a significantly shorter event-free survival when compared with those without an ITD (p=0.0079). Among 54 relapsed patients, 9 patients had the FLT3 ITD at diagnosis. Six patients demonstrated a reappearance of the ITD and 3 patients remained negative at relapse. One patient, among 45 patients who relapsed, had a negative baseline ITD but acquired a de novo ITD at relapse. There were 101 samples from 93 patients in remission; they were all negative for an ITD. Among 34 patients who failed to achieve a remission, five patients had a persistent ITD and one patient had a de novo ITD. These results support the concept of resistance of FLT3 ITD leukemic clones to chemotherapy. Therefore, effective therapy with FLT3 targeting agents may improve the prognosis of non-M3 AML patients with the FLT3 mutation.
doi:10.3346/jkms.2008.23.5.833
PMCID: PMC2580007  PMID: 18955790
FLT3 Mutations; Internal Tandem Duplication; Tyrosine Kinase Domain Mutation; Leukemia, Myeloid, Acute
18.  Diagnostic Usefulness of the Janus Kinase 2 Mutation in non BCR/ABL Myeloproliferative Disorders 
Background
We investigated the Janus kinase 2 (JAK2) mutation and its diagnostic value in patients suffering with non BCR/ABL myeloproliferative diseases (nMPD) or other reactive conditions.
Methods
We reviewed the clinical records of 83 patients who underwent bone marrow (BM) examinations with suspect of nMPD. The diagnoses of nMPD were made based on the WHO criteria since 2001 and the PVSG criteria before 2001. The JAK2 mutation was examined by PCR in 54 patients whose BM samples were available.
Results
The JAK2 mutation was detected in 25 patients (46%); 12 of 26 patients with essential thrombocythemia (ET), 9 of 12 patients with polycyhtemia vera (PV), one of 7 patients with chronic idiopathic myelofibrosis (CIM) and one patient with unclassifiable MPD. Additionally, JAK2 mutation was detected in each one patient with secondary polycythemia and reactive thrombocytosis. These two patients and two other patients among the JAK2 mutated ET did not meet the WHO PV criteria due to their initial low hemoglobin levels. These patients had liver cirrhosis and hypersplenism due to Budd-Chiari syndrome (1), gastrointestinal bleeding (1) or the initial hemoglobin level was slightly below the level as provided by the criteria, but the level showed a rising pattern despite cytoreductive therapy (2). With the results of the JAK2 mutation available, 4 patients' disease could be re-diagnosed as PV. Finally, the positive rate of the JAK2 mutation was 81% in PV, 48% in ET and 14% in CIM. The presence of JAK2 mutation closely correlated with PV (p=0.001), leukocytosis (p=0.001) and an increased cellularity of BM (p=0.024).
Conclusions
The JAK2 mutation may help differentiate nMPD from secondary cytosis. Therefore, it should be incorporated into the guidelines for the nMPD work-up for making a more accurate diagnosis and administering proper treatment.
doi:10.3904/kjim.2006.21.4.219
PMCID: PMC3891025  PMID: 17249502
Janus kinase 2 mutation; Myeloproliferative disorders; Polycythemia vera; Essential thrombocythemia; Chronic idiopathic myelofibrosis
19.  The Role of 18 F-FDG PET/CT in Assessing Therapy Response in Cervix Cancer after Concurrent Chemoradiation Therapy 
Purpose
To determine whether persisting cervical fluorodeoxyglucose (FDG) uptake after concurrent chemoradiotherapy (CCRT) for cervical cancer can reflect residual malignancy.
Methods
F-FDG PET/CT was performed before and after CCRT in 136 patients with cervical cancer. The maximum and mean standardized uptake values (SUVmax and SUVmean) were recorded from PET/CT scans performed pre- and post-treatment. SUVs were correlated with treatment response after CCRT. Final treatment response was determined by MRI and further follow-up PET/CT. One hundred four of 136 patients underwent pelvic MRI, and 32 of 136 patients underwent further follow-up PET/CT. Patients were classified into two categories: patients with residual tumor or patients without residual tumor (complete responder). Pre- and post-treatment serum squamous cell carcinoma antigen (SCC) levels were also recorded for comparison. The optimal cutoff value of SUVmax for predicting residual cervical tumor was determined using receiver-operating characteristic (ROC) analysis.
Results
Of 136 patients, 124 showed complete response on further follow-up studies and 12 were confirmed to have residual tumor. The post-treatment SUVmax and pre-/post-treatment SUVmean of complete responders were significantly lower than those of patients with residual tumor: 2.5 ± 0.8 and 7.2 ± 4.2/1.9 ± 0.7 for complete responders and 5.7 ± 2.6 and 12.8 ± 6.9/3.7 ± 0.7 for patients with residual tumor (p < 0.05). The pre-treatment SUVmax and pre-/post-treatment serum SCC levels of the complete responders tended to be lower than those of patients with residual tumor, but this did not have statistical significance. Using ROC analysis, an optimal cutoff SUVmax of 4.0 on the post-treatment PET/CT yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 92 %, 94 %, 61 %, and 99 %, respectively (p < 0.001).
Conclusions
Persistent cervical FDG uptake in18F-FDG PET/CT after CCRT for cervical cancer may be caused by residual tumor or post-therapy inflammation. A higher cutoff SUVmax than conventional criteria for cervical cancer in post-CCRT PET/CT might help to detect residual tumor.
doi:10.1007/s13139-013-0248-y
PMCID: PMC4028477  PMID: 24900153
Cervical cancer; PET/CT; CCRT; Treatment response
20.  Prognostic Value of Metabolic Activity Measured by 18F-FDG PET/CT in Patients with Advanced Endometrial Cancer 
Purpose
We evaluated the potential prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with stage IIIC/IV endometrial cancer.
Methods
Patients with stage IIIC/IV endometrial cancer who had undergone FDG PET/CT workup for staging were enrolled. Maximum standardized uptake values (SUVmax) measured from regions of interest (ROIs) of the primary tumor (SUVt) and lymph nodes (SUVn) were correlated with overall survival (OS). The SUVn was defined as the highest SUVmax of the metastatic lymph nodes. Survival probability was assessed using the Kaplan-Meier method.
Results
A total of 42 patients with a median age of 55.5 years (range 32–76 years) were included. Twenty-nine percent (n = 12) of patients were premenopausal and 71 % (n = 30) were postmenopausal. The average SUVt was 12.9 (range 1.8–36.5), and the average SUVn was 7.3 (range 2.0–22.5). Median follow-up time was 25.9 months (range 1–84 months). Using a SUVt of 9.5 as a cutoff value, two groups with different rates were determined (P = 0.026). In addition, patients with a low SUVn had significantly better OS than those with a high SUVn (P = 0.003). Patients in the International Federation of Obstetrics and Gynecology (FIGO) stage IV group with SUVt ≥ 9.5 or SUVn ≥ 7.3 showed a significantly longer OS than the other groups.
Conclusions
FDG uptake of primary endometrial cancer and lymph nodes might be a prognostic factor in advanced endometrial cancer. More aggressive therapy could be considered in patients with stage IV endometrial cancer and high SUVt and/or high SUVn.
doi:10.1007/s13139-013-0228-2
PMCID: PMC4035175  PMID: 24900121
Endometrial cancer; Prognosis; PET; Fluorodeoxyglucose
21.  Surgeon Custom-Made Iliac Branch Device to Salvage Hypogastric Artery during Endovascular Aneurysm Repair 
Journal of Korean Medical Science  2014;29(12):1678-1683.
Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications.
doi:10.3346/jkms.2014.29.12.1678
PMCID: PMC4248590  PMID: 25469069
Iliac Branch Device; Custom-Made; Endovascular Aneurysm Repair
22.  The burden of nosocomial staphylococcus aureus bloodstream infection in South Korea: a prospective hospital-based nationwide study 
BMC Infectious Diseases  2014;14(1):590.
Background
We estimated the nationwide burden of nosocomial S. aureus bloodstream infection (SA-BSI), a major cause of nosocomial infection, in South Korea.
Methods
To evaluate the nationwide incidence of nosocomial SA-BSI, cases of SA-BSI were prospectively collected from 22 hospitals with over 500 beds over 4 months. Data on patient-days were obtained from a national health insurance database containing the claims data for all healthcare facilities in South Korea. The additional cost of SA-BSI was estimated through a matched case–control study. The economic burden was calculated from the sum of the medical costs, the costs of caregiving and loss of productivity.
Results
Three hundred and thirty nine cases of nosocomial SA-BSI were included in the study: 254 cases of methicillin-resistant SA-BSI (MRSA-BSI) and 85 cases of methicillin-susceptible SA-BSI (MSSA-BSI). Death related to BSI occurred in 81 cases (31.9%) of MRSA-BSI and 12 cases (14.1%) of MSSA-BSI. The estimated incidence of nosocomial MRSA-BSI was 0.12/1,000 patient-days and that of nosocomial MSSA-BSI, 0.04/1,000 patient-days. The estimated annual cases of nosocomial BSI were 2,946 for MRSA and 986 for MSSA in South Korea. The additional economic burden per case of nosocomial SA-BSI was US $20,494 for MRSA-BSI and $6,914 for MSSA-BSI. Total additional annual cost of nosocomial SA-BSI was $67,192,559.
Conclusion
In view of the burden of nosocomial SA-BSI, a national strategy for reducing nosocomial SA-BSI is urgently needed in South Korea.
doi:10.1186/s12879-014-0590-4
PMCID: PMC4247623
Staphylococcus aureus; Bacteremia; Incidence; Hospital infections
23.  Characterization of a Novel DWD Protein that Participates in Heat Stress Response in Arabidopsis 
Molecules and Cells  2014;37(11):833-840.
Cullin4-RING ubiquitin ligase (CRL4) is a family of multi-subunit E3 ligases. To investigate the possible involvement of CRL4 in heat stress response, we screened T-DNA insertion mutants of putative CRL4 substrate receptors that exhibited altered patterns in response to heat stress. One of the mutants exhibited heat stress tolerance and was named heat stress tolerant DWD1 (htd1). Introduction of HTD1 gene into htd1-1 led to recovery of heat sensitivity to the wild type level, confirming that the decrease of HTD1 transcripts resulted in heat tolerance. Therefore, HTD1 plays a negative role in thermotolerance in Arabidopsis. Additionally, HTD1 directly interacted with DDB1a in yeast two-hybrid assays and associated with DDB1b in vivo, supporting that it could be a part of a CRL4 complex. Various heat-inducible genes such as HSP14.7, HSP21, At2g03020 and WRKY28 were hyper-induced in htd1-1, indicating that HTD1 could function as a negative regulator for the expression of such genes and that these genes might contribute to thermotolerance of htd1-1, at least in part. HTD1 was associated with HSP90-1, a crucial regulator of thermotolerance, in vivo, even though the decrease of HTD1 did not affect the accumulation pattern of HSP90-1 in Arabidopsis. These findings indicate that a negative role of HTD1 in thermotolerance might be achieved through its association with HSP90-1, possibly by disturbing the action of HSP90-1, not by the degradation of HSP90-1. This study will serve as an important step toward understanding of the functional connection between CRL4-mediated processes and plant heat stress signaling.
doi:10.14348/molcells.2014.0224
PMCID: PMC4255104  PMID: 25358503
Arabidopsis; CRL4; heat stress; HSP; HTD1
24.  Risk of Progression and Survival in Multiple Myeloma Relapsing After Therapy with IMiDs and Bortezomib: A Multicenter International Myeloma Working Group Study 
Leukemia  2011;26(1):149-157.
Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed, refractory, or ineligible, to an IMiD (Immunomodulatory Drug), with measurable disease and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T0). The median age at diagnosis was 58 years and time from diagnosis to T0 was 3.3 years. Following T0, 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T0 in 94 patients (51%) including >=partial response in 69 (38%). The median overall survival and event free survival from T0 were 9 and 5 months respectively. This study confirms the poor outcome once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs.
doi:10.1038/leu.2011.196
PMCID: PMC4109061  PMID: 21799510
multiple Myeloma; relapse; natural history; survival
25.  The Role of 18 F-FDG PET/CT in Assessing Therapy Response in Cervix Cancer after Concurrent Chemoradiation Therapy 
Purpose
To determine whether persisting cervical fluorodeoxyglucose (FDG) uptake after concurrent chemoradiotherapy (CCRT) for cervical cancer can reflect residual malignancy.
Methods
F-FDG PET/CT was performed before and after CCRT in 136 patients with cervical cancer. The maximum and mean standardized uptake values (SUVmax and SUVmean) were recorded from PET/CT scans performed pre- and post-treatment. SUVs were correlated with treatment response after CCRT. Final treatment response was determined by MRI and further follow-up PET/CT. One hundred four of 136 patients underwent pelvic MRI, and 32 of 136 patients underwent further follow-up PET/CT. Patients were classified into two categories: patients with residual tumor or patients without residual tumor (complete responder). Pre- and post-treatment serum squamous cell carcinoma antigen (SCC) levels were also recorded for comparison. The optimal cutoff value of SUVmax for predicting residual cervical tumor was determined using receiver-operating characteristic (ROC) analysis.
Results
Of 136 patients, 124 showed complete response on further follow-up studies and 12 were confirmed to have residual tumor. The post-treatment SUVmax and pre-/post-treatment SUVmean of complete responders were significantly lower than those of patients with residual tumor: 2.5 ± 0.8 and 7.2 ± 4.2/1.9 ± 0.7 for complete responders and 5.7 ± 2.6 and 12.8 ± 6.9/3.7 ± 0.7 for patients with residual tumor (p < 0.05). The pre-treatment SUVmax and pre-/post-treatment serum SCC levels of the complete responders tended to be lower than those of patients with residual tumor, but this did not have statistical significance. Using ROC analysis, an optimal cutoff SUVmax of 4.0 on the post-treatment PET/CT yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 92 %, 94 %, 61 %, and 99 %, respectively (p < 0.001).
Conclusions
Persistent cervical FDG uptake in18F-FDG PET/CT after CCRT for cervical cancer may be caused by residual tumor or post-therapy inflammation. A higher cutoff SUVmax than conventional criteria for cervical cancer in post-CCRT PET/CT might help to detect residual tumor.
doi:10.1007/s13139-013-0248-y
PMCID: PMC4028477  PMID: 24900153
Cervical cancer; PET/CT; CCRT; Treatment response

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