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Jun Y, Park YW, Shin H, Shin Y, Lee JR, Han K, Ahn SS, Lim SM, Hwang D, Lee SK. Intelligent noninvasive meningioma grading with a fully automatic segmentation using interpretable multiparametric deep learning. Eur Radiol 2023; 33:6124-6133. [PMID: 37052658 DOI: 10.1007/s00330-023-09590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To establish a robust interpretable multiparametric deep learning (DL) model for automatic noninvasive grading of meningiomas along with segmentation. METHODS In total, 257 patients with pathologically confirmed meningiomas (162 low-grade, 95 high-grade) who underwent a preoperative brain MRI, including T2-weighted (T2) and contrast-enhanced T1-weighted images (T1C), were included in the institutional training set. A two-stage DL grading model was constructed for segmentation and classification based on multiparametric three-dimensional U-net and ResNet. The models were validated in the external validation set consisting of 61 patients with meningiomas (46 low-grade, 15 high-grade). Relevance-weighted Class Activation Mapping (RCAM) method was used to interpret the DL features contributing to the prediction of the DL grading model. RESULTS On external validation, the combined T1C and T2 model showed a Dice coefficient of 0.910 in segmentation and the highest performance for meningioma grading compared to the T2 or T1C only models, with an area under the curve (AUC) of 0.770 (95% confidence interval: 0.644-0.895) and accuracy, sensitivity, and specificity of 72.1%, 73.3%, and 71.7%, respectively. The AUC and accuracy of the combined DL grading model were higher than those of the human readers (AUCs of 0.675-0.690 and accuracies of 65.6-68.9%, respectively). The RCAM of the DL grading model showed activated maps at the surface regions of meningiomas indicating that the model recognized the features at the tumor margin for grading. CONCLUSIONS An interpretable multiparametric DL model combining T1C and T2 can enable fully automatic grading of meningiomas along with segmentation. KEY POINTS • The multiparametric DL model showed robustness in grading and segmentation on external validation. • The diagnostic performance of the combined DL grading model was higher than that of the human readers. • The RCAM interpreted that DL grading model recognized the meaningful features at the tumor margin for grading.
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Affiliation(s)
- Yohan Jun
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyungseob Shin
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Yejee Shin
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jeong Ryong Lee
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dosik Hwang
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, Korea.
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea.
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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2
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Kim T, Shin Y, Kang K, Kim K, Kim G, Byeon Y, Kim H, Gao Y, Lee JR, Son G, Kim T, Jun Y, Kim J, Lee J, Um S, Kwon Y, Son BG, Cho M, Sang M, Shin J, Kim K, Suh J, Choi H, Hong S, Cheng H, Kang HG, Hwang D, Yu KJ. Ultrathin crystalline-silicon-based strain gauges with deep learning algorithms for silent speech interfaces. Nat Commun 2022; 13:5815. [PMID: 36192403 PMCID: PMC9530138 DOI: 10.1038/s41467-022-33457-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022] Open
Abstract
A wearable silent speech interface (SSI) is a promising platform that enables verbal communication without vocalization. The most widely studied methodology for SSI focuses on surface electromyography (sEMG). However, sEMG suffers from low scalability because of signal quality-related issues, including signal-to-noise ratio and interelectrode interference. Hence, here, we present a novel SSI by utilizing crystalline-silicon-based strain sensors combined with a 3D convolutional deep learning algorithm. Two perpendicularly placed strain gauges with minimized cell dimension (<0.1 mm2) could effectively capture the biaxial strain information with high reliability. We attached four strain sensors near the subject’s mouths and collected strain data of unprecedently large wordsets (100 words), which our SSI can classify at a high accuracy rate (87.53%). Several analysis methods were demonstrated to verify the system’s reliability, as well as the performance comparison with another SSI using sEMG electrodes with the same dimension, which exhibited a relatively low accuracy rate (42.60%). Designing an efficient platform that enables verbal communication without vocalization remains a challenge. Here, the authors propose a silent speech interface by utilizing a deep learning algorithm combined with strain sensors attached near the subject’s mouth, able to collect 100 words and classify at a high accuracy rate.
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Affiliation(s)
- Taemin Kim
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yejee Shin
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyowon Kang
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kiho Kim
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Gwanho Kim
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yunsu Byeon
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hwayeon Kim
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yuyan Gao
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Jeong Ryong Lee
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Geonhui Son
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Taeseong Kim
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yohan Jun
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Jihyun Kim
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jinyoung Lee
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seyun Um
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yoohwan Kwon
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Byung Gwan Son
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Myeongki Cho
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mingyu Sang
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jongwoon Shin
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyubeen Kim
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jungmin Suh
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Heekyeong Choi
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seokjun Hong
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Hong-Goo Kang
- Digital Signal Processing & Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Dosik Hwang
- Medical Artificial Intelligence Lab, School of Electrical and Electronic Engineering, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Department of Electrical and Electronic Engineering, YU-Korea Institute of Science and Technology (KIST) Institute, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Ki Jun Yu
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Department of Electrical and Electronic Engineering, YU-Korea Institute of Science and Technology (KIST) Institute, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Jeon KJ, Kim YH, Ha EG, Choi HS, Ahn HJ, Lee JR, Hwang D, Han SS. Quantitative analysis of the mouth opening movement of temporomandibular joint disorder patients according to disc position using computer vision: a pilot study. Quant Imaging Med Surg 2022; 12:1909-1918. [PMID: 35284273 PMCID: PMC8899952 DOI: 10.21037/qims-21-629] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/29/2021] [Indexed: 08/27/2023]
Abstract
BACKGROUND Temporomandibular joint disorder (TMD), which is a broad category encompassing disc displacement, is a common condition with an increasing prevalence. This study aimed to develop an automated movement tracing algorithm for mouth opening and closing videos, and to quantitatively analyze the relationship between the results obtained using this developed system and disc position on magnetic resonance imaging (MRI). METHODS Mouth opening and closing videos were obtained with a digital camera from 91 subjects, who underwent MRI. Before video acquisition, an 8.0-mm-diameter circular sticker was attached to the center of the subject's upper and lower lips. The automated mouth opening tracing system based on computer vision was developed in two parts: (I) automated landmark detection of the upper and lower lips in acquired videos, and (II) graphical presentation of the tracing results for detected landmarks and an automatically calculated graph height (mouth opening length) and width (sideways values). The graph paths were divided into three types: straight, sideways-skewed, and limited-straight line graphs. All traced results were evaluated according to disc position groups determined using MRI. Graph height and width were compared between groups using analysis of variance (SPSS version 25.0; IBM Corp., Armonk, NY, USA). RESULTS Subjects with a normal disc position predominantly (85.72%) showed straight line graphs. The other two types (sideways-skewed or limited-straight line graphs) were found in 85.0% and 89.47% in the anterior disc displacement with reduction group and in the anterior disc displacement without reduction group, respectively, reflecting a statistically significant correlation (χ2=38.113, P<0.001). A statistically significant difference in graph height was found between the normal group and the anterior disc displacement without reduction group, 44.90±9.61 and 35.78±10.24 mm, respectively (P<0.05). CONCLUSIONS The developed mouth opening tracing system was reliable. It presented objective and quantitative information about different trajectories from those associated with a normal disc position in mouth opening and closing movements. This system will be helpful to clinicians when it is difficult to obtain information through MRI.
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Affiliation(s)
- Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Young Hyun Kim
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Eun-Gyu Ha
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Han Seung Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung-Joon Ahn
- Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jeong Ryong Lee
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Dosik Hwang
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
- Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
- Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
- Department of Computer Science, Yonsei University, Seoul, Korea
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4
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Fong JYM, Tan VJH, Lee JR, Tong ZGM, Foong YK, Tan JME, Parolia A, Pau A. Clinical audit training improves undergraduates' performance in root canal therapy. Eur J Dent Educ 2018; 22:160-166. [PMID: 29266663 DOI: 10.1111/eje.12297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates. METHODS Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test. RESULTS Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001). CONCLUSION Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT.
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Affiliation(s)
- J Y M Fong
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - V J H Tan
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J R Lee
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Z G M Tong
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Y K Foong
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J M E Tan
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - A Parolia
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - A Pau
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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5
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Iwata H, Masuda N, Kim SB, Inoue K, Rai Y, Fujita T, Shen ZZ, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Abstract P1-13-11: Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current breast cancer knowledge is based largely on studies conducted in western populations. Their findings may not be generalizable to Asian women because of ethnic, genetic and lifestyle differences. Neratinib (N) is an irreversible tyrosine kinase inhibitor of HER1, 2 and 4. The international, randomized, placebo (P)-controlled phase III ExteNET trial showed that 1 year (yr) of N after trastuzumab (T)-based adjuvant therapy significantly improved 2-yr invasive disease-free survival (iDFS) in patients (pts) with early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with N was shown to be durable after 5 yrs' follow-up (HR 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. We report efficacy and safety findings from pts enrolled from Asian centers (China, Hong Kong, Japan, Korea, Malaysia, Singapore, and Taiwan) on the ExteNET trial to better characterize the effects of N in Asian women.
Methods: Pts with early-stage HER2+ breast cancer were randomly assigned to oral N 240 mg/day or P for 1 yr after standard primary therapy and T-based adjuvant therapy. Antidiarrheal prophylaxis was not required by protocol. Data concerning disease recurrences were collected prospectively during yr 1-2 post-randomization, and from medical records during yr 3–5 post-randomization. Primary endpoint: iDFS. HR (95% CI) estimated using Cox proportional-hazards models stratified by nodal status, hormone-receptor status and prior T regimen. Data cut-off: 2-yr analysis, July 2014; 5-yr analysis, March 2017. Clinicaltrials.gov:NCT00878709.
Results: Of 2840 randomized pts (N, n=1420; P, n=1420), 341 (12%) were enrolled from Asian centers (N, n=165; P, n=176). Baseline characteristics: median age 53 yr; hormone receptor-positive 48%. Median treatment duration was similar in both groups (N, 351 days; P, 352 days). iDFS events in Asian vs ITT populations are shown in the Table.
Primary 2-yr analysisa5-yr analysis NPNPAsian population, n165176165176iDFS events, n10151222HR (95% CI)b0.71 (0.31-1.57)0.54 (0.26-1.08)P-value (2-sided)0.4040.085ITT population, n1420142014201420iDFS events, n67106116163HR (95% CI)b0.66 (0.49-0.90)0.73 (0.57-0.92)P-value (2-sided)0.0080.008a. Primary study endpoint; b. Neratinib vs placebo
The incidence of grade 3/4 diarrhea with N was slightly higher in Asian pts (46.1% vs ITT, 39.8%). All other grade 3/4 adverse events with N were rare among Asian pts (elevated ALT, mucosal inflammation, 2 pts each; other events, 1 pt each). Compliance with N in Asian pts was also improved (71% vs ITT, 61%).
Conclusions: In Asian pts enrolled into ExteNET, compliance with N was better and the magnitude of N effect was similar or greater that that observed in the ITT population. Although N-related grade 3/4 diarrhea was more common in Asian pts than in the ITT population, all other grade 3/4 events were rare. Despite small pt numbers, our analyses suggest that the findings from ExteNET are applicable to Asian pts, and support the conclusion that N reduces disease recurrences in Asian pts with early-stage HER2+ breast cancer after T-based adjuvant therapy.
Citation Format: Iwata H, Masuda N, Kim S-B, Inoue K, Rai Y, Fujita T, Shen Z-Z, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-11.
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Affiliation(s)
- H Iwata
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Masuda
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S-B Kim
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - K Inoue
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Y Rai
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Fujita
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Z-Z Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JW Chiu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Ohtani
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Takahashi
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Yamamoto
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Miyaki
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Q Sun
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - L Yen-Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Xu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - YS Yap
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - AZ Bustam
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JR Lee
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Zhang
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - R Bryce
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Chan
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
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Xu B, Kim SB, Inoue K, Shen ZZ, Lee JR, Zhang B, Chow L. Abstract P5-21-17: Efficacy, safety and tolerability of neratinib-based therapy in patients from Asia with metastatic HER2+ breast cancer and other solid tumors: A pooled analysis of 6 clinical trials. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: HER2 overexpression/amplification occurs in ˜15–20% of primary breast cancers (BC) in western populations, although the incidence of HER2+ BC in Asia may be higher (20–44% depending on the country). Neratinib is an irreversible tyrosine kinase inhibitor of HER1, 2 and 4, with demonstrated efficacy in trastuzumab-pretreated and trastuzumab-naïve HER2+ metastatic BC. To better understand the effects of neratinib in Asian patients (pts), we performed a pooled analysis of 6 phase I/II clinical trials in pts with metastatic HER2+ BC or other solid tumors.
Methods: Six prospective phase I/II or II clinical studies of neratinib, alone or in combination with other targeted or chemotherapeutic agents, in pts with metastatic HER2+ BC or other solid tumors were included. A pooled analysis of data from these trials was performed to compare efficacy and safety outcomes with neratinib-based therapy in pts from centers in Asian countries (China, Hong Kong, Japan, Korea, Malaysia, Singapore, and Taiwan) vs pts from other regions (Europe, North/South America, Australasia). Analyses were descriptive in nature. All trials were registered (Clinicaltrials.gov identifiers: NCT00445458; NCT00706030; NCT00398567; NCT00915018; NCT00741260; NCT00300781).
Results: A total of 966 pts were included (Asia, n=329; other regions, n=637). Most pts had HER2+ BC (96.8%); the remaining pts had other solid tumors (3.2%). Baseline characteristics were similar in pts from Asia vs other regions: median age, 52 vs 53 years; ECOG performance status 0/1, 98% vs 97%; hormone receptor-positive, 50% vs 48%. Neratinib was given as monotherapy (n=136) or in combination with paclitaxel (n=352), capecitabine (n=105), vinorelbine (n=91) or trastuzumab (n=45). Median duration of neratinib treatment in pts from Asia vs other regions was 338 vs 213 days; 47.3% vs 26.5% of pts received treatment for >1 year. Efficacy outcomes in pts with HER2+ BC are summarized in the table.
AsiaOther regionsEndpoint(n=239)a(n=435)aORR, n (%)171 (71.5)243 (55.9)CBR, n (%)183 (76.6)275 (63.2)Median PFS (95% CI), weeks56.1 (48.0-67.7)39.3 (32.7-44.1)CBR, clinical benefit rate; ORR, objective response rate; PFS, progression-free survival; a. Excluded phase I, non-BC and non-neratinib–treated pts
Incidence rates of grade 3/4 adverse events (Asia, 62.4% vs other regions, 66.0%) and grade 3/4 diarrhea were similar in both cohorts (25.6% vs 27.2%), but pts from Asia appeared to experience more grade 3/4 hematological events (neutropenia: 21.4% vs 9.8%; leukopenia: 13.0% vs 4.9%). Dose modifications were similar between cohorts, but Asian pts were less likely to withdraw from therapy (2.1% vs other regions, 4.7%).
Conclusions: Asian pts in the pooled metastatic trials appeared to have better ORR, CBR and PFS with neratinib-based therapy than pts from other regions. The safety and tolerability profile of neratinib was broadly similar between regions, except for a higher rate of grade 3/4 hematological events among Asian pts; however, Asian pts were less likely to withdraw from neratinib and stayed on treatment longer, a possible contributing factor to the better clinical outcomes observed in this cohort.
Citation Format: Xu B, Kim S-B, Inoue K, Shen Z-Z, Lee JR, Zhang B, Chow L. Efficacy, safety and tolerability of neratinib-based therapy in patients from Asia with metastatic HER2+ breast cancer and other solid tumors: A pooled analysis of 6 clinical trials [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-17.
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Affiliation(s)
- B Xu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - S-B Kim
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - K Inoue
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - Z-Z Shen
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - JR Lee
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - B Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
| | - L Chow
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Asan Medical Centre; Saitama Cancer Center; Shanghai Cancer Center; Puma Biotechnology Inc; Unimed Medical Institute
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Lee JR, Kim HJ, Lee KB. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing. Orthop Traumatol Surg Res 2016; 102:175-81. [PMID: 26826804 DOI: 10.1016/j.otsr.2015.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. HYPOTHESIS The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. PATIENTS AND METHODS We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). RESULTS The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). CONCLUSION Non-union develops significantly more frequently in femoral shaft fractures with fragments 8cm or longer or when the displacement in the proximal area is 20mm or greater and 10mm or greater in the distal area during the intramedullary nailing procedure. Regarding union rate, the degree of displacement has more influence than the third fragment size in femoral shaft fractures. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- J R Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea
| | - H-J Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea
| | - K-B Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea.
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Pouch SM, Kubin CJ, Satlin MJ, Tsapepas DS, Lee JR, Dube G, Pereira MR. Epidemiology and outcomes of carbapenem-resistant Klebsiella pneumoniae bacteriuria in kidney transplant recipients. Transpl Infect Dis 2015; 17:800-9. [PMID: 26341757 DOI: 10.1111/tid.12450] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/10/2015] [Accepted: 08/13/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria following kidney transplantation. We determined the incidence of post-transplant CRKP bacteriuria in adults who underwent kidney transplant from 2007 to 2010 at 2 New York City centers. METHODS We conducted a case-control study to identify factors associated with CRKP bacteriuria compared with carbapenem-susceptible K. pneumoniae (CSKP) bacteriuria, assessed whether CRKP bacteriuria was associated with mortality or graft failure, and compared outcomes of treated episodes of CRKP and CSKP bacteriuria. RESULTS Of 1852 transplants, 20 (1.1%) patients developed CRKP bacteriuria. Factors associated with CRKP bacteriuria included receipt of multiple organs (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.1-20.4), deceased-donor allograft (OR 5.9, 95% CI 1.3-26.8), transplant admission length of stay (OR 1.1 per day, 95% CI 1.0-1.1), pre-transplant CRKP infection or colonization (OR 18.3, 95% CI 2.0-170.5), diabetes mellitus (OR 2.8, 95% CI 1.0-7.8), and receipt of antimicrobials other than trimethoprim-sulfamethoxazole (OR 4.3, 95% CI 1.6-11.2). CONCLUSION Compared to CSKP bacteriuria, CRKP bacteriuria was associated with increased mortality (30% vs. 10%, P = 0.03) but not graft failure. Treated episodes of CRKP bacteriuria were less likely to achieve microbiologic clearance (83% vs. 97%; P = 0.05) and more likely to recur within 3 months (50% vs. 22%, P = 0.02) than CSKP episodes. CRKP bacteriuria after kidney transplant is associated with mortality and antimicrobial failure after treatment.
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Affiliation(s)
- S M Pouch
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C J Kubin
- Department of Medicine, Columbia University Medical Center, New York, New York, USA.,NewYork-Presbyterian Hospital, New York, New York, USA
| | - M J Satlin
- NewYork-Presbyterian Hospital, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - D S Tsapepas
- NewYork-Presbyterian Hospital, New York, New York, USA
| | - J R Lee
- NewYork-Presbyterian Hospital, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - G Dube
- Department of Medicine, Columbia University Medical Center, New York, New York, USA.,NewYork-Presbyterian Hospital, New York, New York, USA
| | - M R Pereira
- Department of Medicine, Columbia University Medical Center, New York, New York, USA.,NewYork-Presbyterian Hospital, New York, New York, USA
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Kwon CH, Park HJ, Lee JR, Kim HK, Jeon TY, Jo HJ, Kim DH, Kim GH, Park DY. Serpin peptidase inhibitor clade A member 1 is a biomarker of poor prognosis in gastric cancer. Br J Cancer 2014; 111:1993-2002. [PMID: 25211665 PMCID: PMC4229634 DOI: 10.1038/bjc.2014.490] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/24/2014] [Accepted: 08/13/2014] [Indexed: 01/16/2023] Open
Abstract
Background: In a previous study, we reported that serpin peptidase inhibitor clade A member 1 (serpinA1) is upregulated in Snail-overexpressing gastric cancer. Although serpinA1 has been studied in several types of cancer, little is known about its roles and mechanisms of action. In this study, we examined the role of serpinA1 in the migration and invasion of gastric cancers and determined its underlying mechanism. Methods: Expression levels were assessed by western blot analyses and real-time PCR. Snail binding to serpinA1 promoter was analysed by chromatin immunoprecipitation (ChIP) assays. The roles of serpinA1 were studied using cell invasion and migration assays. In addition, the clinicopathologic and prognostic significance of serpinA1 expression were validated in 400 gastric cancer patients using immunohistochemical analysis. Results: Overexpression of Snail resulted in upregulation of serpinA1 in gastric cancer cell lines, AGS and MKN45, whereas knockdown of Snail inhibited serpinA1 expression. Chromatin immunoprecipitation analysis showed that overexpression of Snail increased Snail recruitment to the serpinA1 promoter. Overexpression of serpinA1 increased the migration and invasion of gastric cancer cells, whereas knockdown of serpinA1 decreased invasion and migration. Moreover, serpinA1 increased mRNA levels and release of metalloproteinase-8 in gastric cancer cells. Serpin peptidase inhibitor clade A member 1 was observed in the cytoplasm of tumour cells and the stroma by immunohistochemistry. Enhanced serpinA1 expression was significantly associated with increased tumour size, advanced T stage, perineural invasion, lymphovascular invasion, lymph node metastases, and shorter overall survival. Conclusions: Serpin peptidase inhibitor clade A member 1 induces the invasion and migration of gastric cancer cells and its expression is associated with the progression of gastric cancer. These results may provide a potential target to prevent invasion and metastasis in gastric cancer.
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Affiliation(s)
- C H Kwon
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H J Park
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - J R Lee
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H K Kim
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H-J Jo
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - D H Kim
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - G H Kim
- Department of Internal Medicine, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - D Y Park
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
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Kim SY, Huh KH, Lee JR, Kim SH, Jeong SH, Choi YS. Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods. Transplant Proc 2014; 45:2191-6. [PMID: 23953528 DOI: 10.1016/j.transproceed.2013.02.124] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/16/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods. METHODS Patients were randomized to an NS group (n = 30) or a Plasmalyte group (n = 30). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis. RESULTS Compared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl(-)], free-water corrected Cl(-), BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups. CONCLUSIONS Both NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation. However, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period.
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Affiliation(s)
- S Y Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim EM, Lee JR, Koo BN, Im YJ, Oh HJ, Lee JH. Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy. Br J Anaesth 2014; 112:885-91. [PMID: 24491414 DOI: 10.1093/bja/aet484] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Epidural administration of dexamethasone might reduce postoperative pain in adults. We evaluated whether a caudal block of 0.1 mg kg(-1) dexamethasone combined with ropivacaine improves analgesic efficacy in children undergoing day-case orchiopexy. METHODS This randomized, double-blind study included 80 children aged 6 months to 5 yr who underwent day-case, unilateral orchiopexy. Patients received either 1.5 ml kg(-1) of 0.15% ropivacaine (Group C) or 1.5 ml kg(-1) of 0.15% ropivacaine in which dexamethasone of 0.1 mg kg(-1) was mixed (Group D) for caudal analgesia. Postoperative pain scores, rescue analgesic consumption, and side-effects were evaluated 48 h after operation. RESULTS Postoperative pain scores at 6 and 24 h post-surgery were significantly lower in Group D than in Group C. Furthermore, the number of subjects who remained pain free up to 48 h after operation was significantly greater in Group D [19 of 38 (50%)] than in Group C [four of 37 (10.8%); P<0.001]. The number of subjects who received oral analgesic was significantly lower in Group D [11 of 38 (28.9%)] than in Group C [20 of 37 (54.1%); P=0.027]. Time to first oral analgesic administration after surgery was also significantly longer in Group D than in Group C (P=0.014). Adverse events after surgery including vomiting, fever, wound infection, and wound dehiscence were comparable between the two groups. CONCLUSIONS The addition of dexamethasone 0.1 mg kg(-1) to ropivacaine for caudal block can significantly improve analgesic efficacy in children undergoing orchiopexy. Clinical trial registration NCT01604915.
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Affiliation(s)
- E M Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Republic of Korea
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Oh YJ, Lee JR, Choi YS, Koh SO, Na S. Randomized controlled comparison of combined general and epidural anesthesia versus general anesthesia on diaphragmatic function after laparoscopic prostatectomy. Minerva Anestesiol 2013; 79:1371-1380. [PMID: 23857436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Little is known about the effect of anesthetic technique on postoperative diaphragmatic function, which is associated with postoperative morbidity and recovery in patients undergoing laparoscopic pelvic surgery. The aim of this trial was to study the effect of combined general and epidural anesthesia versus general anesthesia on postoperative diaphragmatic function measured by ultrasonography in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS Fifty-four patients undergoing RALRP were enrolled prospectively. Study population was randomized to receive general (group G, N.=27) or combined general and epidural (group GE, N.=27) anesthesia. Diaphragmatic inspiratory amplitude (DIA), and inspiration and expiration time (Ti and Te, respectively) were measured by M-mode ultrasonography during quiet/deep breathing and sniffing before the surgery and on postoperative days (POD) 1 and 2. Diaphragmatic inspiratory and expiratory velocities (DIV and DEV) were also calculated (DIA/Ti and DIA/Te, respectively). Spirometry was performed in addition to ultrasonography. RESULTS DIA during deep breathing and sniffing was significantly decreased on POD 1 in group G, while it was preserved in group GE. These reductions in diaphragmatic function were restored to preoperative values on POD 2 in both groups. Vital capacity and peak expiratory flow were diminished in group G on POD 1 and 2. However, spirometry revealed no impairment in group GE except for vital capacity on POD 1. The correlation coefficients (R2) between diaphragmatic function and spirometry variables ranged from 0.231 to 0.286. Postoperaitve pain was comparable. CONCLUSION Combined general and epidural anesthesia may attenuate the severity of postoperative diaphragmatic dysfunction after RALRP compared to conventional general anesthesia.
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Affiliation(s)
- Y J Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea -
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Yu JH, Shin MS, Kim DJ, Lee JR, Yoon SY, Kim SG, Koh EH, Lee WJ, Park JY, Kim MS. Enhanced carbohydrate craving in patients with poorly controlled Type 2 diabetes mellitus. Diabet Med 2013; 30:1080-6. [PMID: 23586900 DOI: 10.1111/dme.12209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/27/2022]
Abstract
AIMS Although hyperphagia is a common manifestation of diabetes mellitus, data on food craving in patients with diabetes are limited. This study compared food craving in patients with Type 2 diabetes mellitus and a control group without diabetes. METHODS A total of 210 subjects (105 with Type 2 diabetes and 105 age-, sex- and BMI-matched control subjects) participated in two food craving surveys. The surveys were as follows: the General Food Cravings Questionnaire--Trait, which assesses the general trait of food craving; and the Food Cravings Questionnaire--State, which assesses the state of food craving or current desire for high-carbohydrate or high-fat foods in response to pictures of food. Follow-up Food Cravings Questionnaire--State surveys were administered approximately 3 months later to the subjects with diabetes. Survey results were analysed to assess relationships between food craving and glycaemic control. RESULTS The General Food Cravings Questionnaire--Trait scores in the group with Type 2 diabetes and the control group were not significantly different. The group with Type 2 diabetes had higher carbohydrate craving scores, but lower fat craving scores, than the control group. Carbohydrate craving scores in subjects with diabetes were positively correlated with HbA(1c). In follow-up surveys, carbohydrate craving scores declined in patients with improved glycaemic control. CONCLUSIONS The surveys showed that patients with Type 2 diabetes had higher carbohydrate cravings and lower fat cravings than the age-, sex- and BMI-matched control group. Carbohydrate craving in patients with diabetes was associated with poor glycaemic control.
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Affiliation(s)
- J H Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Baek JO, Kang HK, Na SY, Lee JR, Roh JY, Lee JH, Kim HJ, Park S. N822K c-kit mutation in CD30-positive cutaneous pleomorphic mastocytosis after germ cell tumour of the ovary. Br J Dermatol 2012; 166:1370-3. [PMID: 22233328 DOI: 10.1111/j.1365-2133.2012.10816.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Jang EY, Hwang M, Yoon SS, Lee JR, Kim KJ, Kim HC, Yang CH. Liquiritigenin decreases selective molecular and behavioral effects of cocaine in rodents. Curr Neuropharmacol 2011; 9:30-4. [PMID: 21886557 PMCID: PMC3137196 DOI: 10.2174/157015911795017371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 04/17/2010] [Accepted: 05/26/2010] [Indexed: 11/30/2022] Open
Abstract
Cocaine, as an indirect dopamine agonist, induces selective behavioral and physiological events such as hyperlocomotion and dopamine release. These changes are considered as consequences of cocaine-induced molecular adaptation such as CREB and c-Fos. Recently, methanolic extracts from licorice was reported to decrease cocaine-induced dopamine release and c-Fos expression in the nucleus accumbens. In the present study, we investigated the effects of liquiritigenin (LQ), a main compound of licorice, on acute cocaine-induced behavioral and molecular changes in rats. LQ attenuated acute cocaine-induced hyperlocomotion in dose-dependent manner. In addition, LQ inhibited CREB phosphorylation and c-Fos expression in the striatum and the nucleus accumbens induced by acute cocaine. Results provide strong evidence that LQ effectively attenuates the acute behavioral effects of cocaine exposure and prevents the induction of selective neuroadaptive changes in dopaminergic signaling pathways. Further investigation of LQ from licorice extract might provide a novel therapeutic strategy for the treatment of cocaine addiction.
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Affiliation(s)
- E Y Jang
- Department of Physiology, College of Oriental Medicine, Daegu Haany University, Daegu 706-828, South Korea
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Kim HS, Park HJ, Kim CS, Lee JR. Combination of propofol and remifentanil target-controlled infusion for laryngeal mask airway insertion in children. Minerva Anestesiol 2011; 77:687-692. [PMID: 21364505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The addition of remifentanil to propofol administration can improve the conditions for insertion of laryngeal mask airways (LMAs). However, the extent to which remifentanil reduces propofol requirements when both drugs are administered concomitantly via target-controlled infusion (TCI) in pediatric patients has not been adequately demonstrated. The purpose of this study was to determine the target concentration of propofol that is required for LMA insertion at three different remifentanil target concentrations (0, 2.5, and 5 ng kg(-1) min(-1)) during TCI in children. METHODS A total of 67 children, aged 2 to 12 years, were included, and anesthesia was conducted with TCI of propofol and remifentanil using the STELPUMP program. The children were assigned to three groups in a randomized, double-blind manner: propofol with saline (control group), propofol with 2.5 ng mL(-1) of remifentanil (low-remifentanil group), and propofol with 5.0 ng ml(-1) of remifentanil (high-remifentanil group). The EC(50) of propofol for LMA insertion at each target-concentration of remifentanil was determined using Dixon's up-and-down method, and the EC(50) of propofol in each group was compared using the Kruskal-Wallis ANOVA by rank test. RESULTS The EC(50) for propofol was 5.18 mcg mL(-1) in the control group, 4.81 mcg ml(-1) in the low-remifentanil group, and 4.36 mcg mL(-1) in the high-remifentanil group, which was significantly different between the control group and the high-remifentanil group only (P<0.001). CONCLUSION A higher target concentration of remifentanil significantly reduced the propofol target concentration for LMA insertion during TCI of both drugs in children, but low concentrations of remifentanil failed to reduce the propofol requirement.
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Affiliation(s)
- H S Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim SM, Kim SH, Lee JR, Jee BC, Ku SY, Suh CS, Choi YM, Kim JG, Moon SY. The effects of hormone therapy on metabolic risk factors in postmenopausal Korean women. Climacteric 2010; 14:66-74. [PMID: 20649504 DOI: 10.3109/13697137.2010.498593] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We sought to assess the prevalence of metabolic syndrome (MetS) among Korean postmenopausal women and to investigate the effect of hormone therapy status and reproductive characteristics on body composition and MetS risk factors. STUDY DESIGN We performed a cross-sectional study involving a cohort of 2005 postmenopausal Korean women. We defined MetS using the modified National Cholesterol Education Program (NCEP) criteria proposed by the American Heart Association/National Heart, Lung, and Blood Institute guidelines. The criteria for abdominal obesity were adopted from the cut-offs suggested by the Korean Society for the Study of Obesity. Participants with three or more of the following conditions were classified as having MetS: waist circumference ≥ 85 cm; blood pressure ≥ 130/85 mmHg; fasting plasma triglycerides ≥ 150 mg/dl; high density lipoprotein cholesterol < 50 mg/dl; glucose ≥ 100 mg/dl and/or receiving treatment for their condition. RESULTS The prevalence of MetS was 22.1% in the study population and increased with age. After adjusting for age and related reproductive characteristics, it was found that ever-use of hormone therapy (prior or current) was associated with decreased risk of postmenopausal MetS. Among individual risk factors for MetS, current hormone therapy seemed to be associated with decreased prevalence of abdominal obesity and better glucose metabolism and prior use of hormone therapy were associated with lower risk of abdominal obesity and high blood pressure. CONCLUSION Postmenopausal hormone therapy is associated with decreased risk of MetS in postmenopausal Korean women.
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Affiliation(s)
- S M Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul, Korea
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Davis W, Andrews JC, Herb E, Lee JR, Latman NS, Bouma CL. Accuracy and Reliability of Consumer Breath Alcohol Analyzers. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.580.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - E Herb
- West Texas A&M UniversityCanyonTX
| | - J R Lee
- West Texas A&M UniversityCanyonTX
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Oh BC, Lee HM, Lim DP, Cho JJ, Lee G, Lee DS, Lee JR. Effect of immature dendritic cell injection before heterotropic cardiac allograft. Transplant Proc 2007; 38:3189-92. [PMID: 17175218 DOI: 10.1016/j.transproceed.2006.10.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Indexed: 11/17/2022]
Abstract
Although dendritic cells (DCs) are unrivaled for initiation of immune responses, the immunomodulatory capacity of chemically fixed DC has not been thoroughly evaluated. We monitored the tolerogenic capacity of chemically fixed DCs using allogeneic heart transplantations. Bone marrow progenitors were differentiated into immature DCs which were then chemically fixed and injected intravenously into recipient mice at 14 days before allogeneic heart transplantation. Chemically fixed DCs markedly prolonged graft survival in the major histocompatibility complex (MHC) I/II mismatch cardiac transplantation (B6 --> B10.A; median survival time [MST] 12.5 days vs >70 days). T cells that encountered chemically fixed DCs showed attenuated apoptotic cell death and inactivated phenotypes after allogeneic heterotropic heart transplantation. Furthermore, when DCs from interleukin (IL)-10-/- mice were treated, the in vitro T-cell response was greater than that from IL-12-/- mice. We have suggested that the chemically fixed DCs may mediate peripheral T-cell tolerance, with therapeutic potential for allogeneic transplantation.
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Affiliation(s)
- B C Oh
- Department of Immunology, Seoul National University, Seoul, Korea
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Abstract
During gynaecological laparoscopic surgery, alterations in cerebral blood flow and intracranial pressure are frequently reported. These changes affect cerebral perfusion pressure and thus may affect cerebral oxygenation. In this prospective study, the effect of gynaecological laparoscopic surgery on cerebral oxygenation was examined by following the changes in regional cerebral oxygen saturation (rSo2). Twenty-four female patients were enrolled. The mean rSo2 was 65.5 +/- 5.4% at baseline before surgery, 60.8 +/- 5.6% when the patient was placed in the Trendelenburg position, 57.1 +/- 9.3% after creation of pneumoperitoneum, and 64.0 +/- 7.3% after the completion of surgery. During the period of pneumoperitoneum, rSo2 fell below 50% in two hypercapnic patients. In comparison with baseline, rSo2 declined significantly in the Trendelenburg position. The creation of pneumoperitoneum itself did not decrease the average rSo2 value further unless the patients were hypercapnic.
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Affiliation(s)
- J R Lee
- Seoul National University Hospital, Seoul, Korea
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Abstract
OBJECTIVE The capacity for absorption of nutrients after small intestinal resection is related to the remaining length of intestine, and short bowel syndrome has major implications. Accurate pre-operative determination of bowel length may be useful in conditions where further resection of small bowel is contemplated. The aim of this study is to evaluate the accuracy of small bowel length measured by barium follow-through (BaFT) examination. PATIENTS AND METHODS Twenty-two patients underwent both intra-operative measurement of small bowel length, and BaFT examination where length was measured using an opisometer. RESULTS The difference between operative and radiological measurement (mean +/- standard deviation: 15.7 +/- 16 9%) was least in those with the shorter small intestine (overall variation: r = 0.703, P < 0.01, regression coefficient: -0.118, intercept: 15.1). There was no difference in whether BaFT was performed pre or postoperatively. CONCLUSION Assessment of small bowel length by BaFT radiography is accurate, particularly in those with shorter small bowel lengths.
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Affiliation(s)
- T Shatari
- Department of Surgery, University of Birmingham, Edgbaston, Birmingham, UK
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Lee JY, Noh CI, Bae EJ, Yun YS, Lee JR, Kim YJ. Preoperative left ventricular end systolic dimension as a predictor of postoperative ventricular dysfunction in children with mitral regurgitation. Heart 2003; 89:1243-4. [PMID: 12975431 PMCID: PMC1767890 DOI: 10.1136/heart.89.10.1243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee JR, Chang JM, Lee C, Kim CJ. Undifferentiated sarcoma of the mitral valve with unique clinicopathologic presentation. J Cardiovasc Surg (Torino) 2003; 44:621-3. [PMID: 14735050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
We report a case of undifferentiated sarcoma originating from the mitral valve in a 3-year-old boy who presented with embolic symptoms of the lower extremity. The tumor was demonstrated by echocardiography. The mass was removed under a mild hypothermic cardiopulmonary bypass with cold blood cardioplegia. Grossly, the mass was composed of multiple small nodules, and the histopathologic findings were compatible with an undifferentiated sarcoma. Postoperative chemotherapy was added. The patient remains without evidence of recurrence 18 months after surgery.
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Affiliation(s)
- J R Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Heart Research Institute, Chongro-gu, Seoul, Korea.
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Kim TW, Chang HM, Kang HJ, Lee JR, Ryu MH, Ahn JH, Kim JH, Lee JS, Kang YK. Phase II study of capecitabine plus cisplatin as first-line chemotherapy in advanced biliary cancer. Ann Oncol 2003; 14:1115-20. [PMID: 12853355 DOI: 10.1093/annonc/mdg281] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A phase II study was conducted to assess the efficacy and tolerability of substituting capecitabine for 5-fluorouracil in combination with cisplatin in patients with advanced biliary cancer. PATIENTS AND METHODS Patients with previously untreated metastatic or unresectable measurable biliary adenocarcinoma received oral capecitabine 1250 mg/m(2) twice daily on days 1-14, and intravenous cisplatin 60 mg/m(2) on day 1. This cycle was repeated every 21 days. RESULTS Forty-two patients were enrolled in this study. Of these, 38 were assessable for efficacy and 41 were assessable for safety. A median of three cycles of treatment (range one to eight) were administered. One patient achieved a complete response, and eight had partial responses, giving an overall response rate of 21.4% in the intention-to-treat population (95% confidence interval 9.1% to 33.9%). The median response duration was 5.1 months. The median time to progression and median overall survival were 3.7 and 9.1 months, respectively. The most common grade 3/4 adverse events were neutropenia (20% of patients), vomiting (12%), diarrhea (7%) and stomatitis (5%). There were no treatment-related deaths. CONCLUSIONS The combination of capecitabine and cisplatin has promising antitumor activity and is well tolerated in patients with advanced biliary cancer.
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Affiliation(s)
- T W Kim
- Section of Hematology-Oncology, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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Lee JR, Baker HJ, Friel GJ, Hilton GJ, Hall DR. High-average-power Nd:YAG planar waveguide laser that is face pumped by 10 laser diode bars. Opt Lett 2002; 27:524-526. [PMID: 18007853 DOI: 10.1364/ol.27.000524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A planar waveguide Nd:YAG laser is pumped with 430 W of power from 10 laser diode bars to produce a multimode output power of 150 W at an optical efficiency of 35%. Use of a hybrid resonator of the positive-branch confocal unstable type for the lateral axis and of one of the near-case I waveguide type for the transverse axis increased the laser brightness by a factor of ~26 with only 12% less power than in the multimode case.
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Lee JW, Lee EJ, Hong SH, Chung WH, Lee HT, Lee TW, Lee JR, Kim HT, Suh JG, Kim TY, Ryoo ZY. Circling mouse: possible animal model for deafness. Comp Med 2001; 51:550-4. [PMID: 11924819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Mutant mice with abnormalities are potentially useful as models for studying human defects. Here we report a group of mice with abnormal behavioral patterns. A new spontaneous mutant mouse exhibited hyperactive behavior at about seven days of age, followed by tight circling behavior. Breeding studies suggest that this mutation is caused by a single gene defect inherited in an autosomal recessive manner. Consequently, this mutation is referred to as a circling (cir) mouse mutation with the gene symbol cir. Auditory test results identified clearly the hearing loss of the cir, compared with wild-type mice. Pathologic studies confirmed developmental defects in cochlea and spiral ganglions that were correlated to the abnormal behavior observed in the cir mice. Thus, cir mice may be useful as a model for studying inner ear abnormalities and deafness in humans.
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Affiliation(s)
- J W Lee
- Department of Dermatology, Catholic Research Institutes of Medical Science, Catholic Medical College, Seoul, Korea
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Lee SJ, Kim B, Lee JR. Structural relaxation, self-diffusion, and kinetic heterogeneity in the two-dimensional lattice Coulomb gas. Phys Rev E Stat Nonlin Soft Matter Phys 2001; 64:066103. [PMID: 11736232 DOI: 10.1103/physreve.64.066103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2001] [Indexed: 05/23/2023]
Abstract
We present Monte Carlo simulation results on the equilibrium relaxation dynamics in the two-dimensional lattice Coulomb gas, where finite fractions f of the lattice sites are occupied by positive charges. In the case of high-order rational values of f close to the irrational number 1-g [g identical with (square root of 5-1)/2 is the golden mean], we find that the system exhibits, for a wide range of temperatures above the first-order transition, a glassy behavior resembling the primary relaxation of supercooled liquids. Single-particle diffusion and structural relaxation show that there exists a breakdown of proportionality between the time scale of diffusion and that of structural relaxation analogous to the violation of the Stokes-Einstein relation in supercooled liquids. Suitably defined dynamic cooperativity is calculated to exhibit the characteristic nature of dynamic heterogeneity present in the system.
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Affiliation(s)
- S J Lee
- Department of Physics, The University of Suwon, Hwasung-Gun, Kyunggi-Do 445-743, Korea
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Carroll FI, Lee JR, Navarro HA, Brieaddy LE, Abraham P, Damaj MI, Martin BR. Synthesis, nicotinic acetylcholine receptor binding, and antinociceptive properties of 2-exo-2-(2'-substituted-3'-phenyl-5'-pyridinyl)-7-azabicyclo[2.2.1]heptanes. Novel nicotinic antagonist. J Med Chem 2001; 44:4039-41. [PMID: 11708907 DOI: 10.1021/jm015561v] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A series of 2'-substituted-3'-phenyl epibatidine analogues were synthesized and evaluated for inhibition of binding at nicotine acetylcholine receptors and for antinociceptive properties in mice. The introduction of a bulky phenyl group at the 3'-position exerted a profound influence on both receptor binding and antinociceptive effects. Substitution of different groups at the 2'-position distinguished between agonist and antagonist properties. These results demonstrate that structural requirements for receptor activities and recognition are distinctively different.
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Affiliation(s)
- F I Carroll
- Chemistry and Life Sciences, Research Triangle Institute, P.O. Box 12194, Research Triangle Park, North Carolina 27709, USA.
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Pugh KR, Mencl WE, Jenner AR, Katz L, Frost SJ, Lee JR, Shaywitz SE, Shaywitz BA. Neurobiological studies of reading and reading disability. J Commun Disord 2001; 34:479-492. [PMID: 11725860 DOI: 10.1016/s0021-9924(01)00060-0] [Citation(s) in RCA: 302] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
UNLABELLED Evidence from neuroimaging studies, including our own, suggest that skilled word identification in reading is related to the functional integrity of two consolidated left hemisphere (LH) posterior systems: a dorsal (temporo-parietal) circuit and a ventral (occipito-temporal) circuit. This posterior system appears to be functionally disrupted in developmental dyslexia. Relative to nonimpaired readers, reading-disabled individuals demonstrate heightened reliance on both inferior frontal and right hemisphere posterior regions, presumably in compensation for the LH posterior difficulties. We propose a neurobiological account suggesting that for normally developing readers, the dorsal circuit predominates at first, and in conjunction with premotor systems, is associated with analytic processing necessary for learning to integrate orthographic with phonological and lexical semantic features of printed words. The ventral circuit constitutes a fast, late-developing, word form system, which underlies fluency in word recognition. LEARNING OUTCOMES As a result of this activity, (1) the participant will learn about a model of lexical processing involving specific cortical regions. (2) The participant will learn about evidence which supports the theory that two dorsal LH systems may be disrupted in developmental dyslexia. (3) The participant will learn that individuals with reading impairment may rely on other regions of the brain to compensate for the disruption of posterior function.
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Affiliation(s)
- K R Pugh
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510-8064, USA.
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Abstract
The membrane proteins Star and Rhomboid-1 have been genetically defined as the primary regulators of EGF receptor activation in Drosophila, but their molecular mechanisms have been elusive. Both Star and Rhomboid-1 have been assumed to work at the cell surface to control ligand activation. Here, we demonstrate that they control receptor signaling by regulating intracellular trafficking and proteolysis of the ligand Spitz. Star is present throughout the secretory pathway and is required to export Spitz from the endoplasmic reticulum to the Golgi apparatus. Rhomboid-1 is localized in the Golgi, where it promotes the cleavage of Spitz. This defines a novel growth factor release mechanism that is distinct from metalloprotease-dependent shedding from the cell surface.
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Affiliation(s)
- J R Lee
- MRC Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, United Kingdom
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Abstract
The polytopic membrane protein Rhomboid-1 promotes the cleavage of the membrane-anchored TGFalpha-like growth factor Spitz, allowing it to activate the Drosophila EGF receptor. Until now, the mechanism of this key signaling regulator has been obscure, but our analysis suggests that Rhomboid-1 is a novel intramembrane serine protease that directly cleaves Spitz. In accordance with the putative Rhomboid active site being in the membrane bilayer, Spitz is cleaved within its transmembrane domain, and thus is, to our knowledge, the first example of a growth factor activated by regulated intramembrane proteolysis. Rhomboid-1 is conserved throughout evolution from archaea to humans, and our results show that a human Rhomboid promotes Spitz cleavage by a similar mechanism. This growth factor activation mechanism may therefore be widespread.
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Affiliation(s)
- S Urban
- MRC Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, United Kingdom
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32
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Abstract
The epitope recognized by a mouse monoclonal antibody (MAb) to the crystalline surface layer protein of Rickettsia typhi, SRT10, was mapped to 10 amino acid residues (SRTag TFIGAIATDT). The oligonucleotide sequence covering the epitope recognized by SRT10 was inserted into a mammalian expression vector together with multiple cloning sites. When the SRTag was fused in frame to the coding region of the NCC27/CLIC1 gene and expressed in mammalian cells, the MAb SRT10 could detect the tagged protein by immunoblotting, immunocytochemistry, and immunoprecipitation. In addition to the SRT-NCC27/CLIC1, SRT10 could detect N-terminal-tagged MEF2D and C-terminal-tagged CD4 by immunocytochemistry. We suggest that this specific recognition of the SRTag by SRT10 is generally applicable to cellular and molecular biology research that requires the expression and detection of fusion proteins.
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Affiliation(s)
- J R Lee
- Sungkyunkwan University School of Medicine, Suwon, Korea
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Felz MW, Winburn GB, Kallab AM, Lee JR. Anal melanoma: an aggressive malignancy masquerading as hemorrhoids. South Med J 2001; 94:880-5. [PMID: 11592745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Anal melanoma is a devastating malignancy easily confused with benign hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion can lead to delays in diagnosis and therapy. Four cases of anal melanoma, all initially mistaken for hemorrhoids, have been documented in the past 4 years at our institution. Despite surgical intervention and chemoimmunotherapy, each patient succumbed to widely metastatic disease. Average survival was 15.2 months. The clinical, pathologic, surgical, and oncologic features of anal melanoma are reviewed to enhance physician recognition of this unusual anorectal disorder.
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Affiliation(s)
- M W Felz
- Department of Family Medicine, Surgery, and Medicine, (Section of Medical Oncology), Medical College of Georgia, Augusta 30912, USA
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Lee JR, Yang MS, Jang DS, Ha TJ, Park KM, Lee CH, Kho YH, Park KH. A new guaianolide as apoptosis inhibitor from Chrysanthemum boreale. Planta Med 2001; 67:585-587. [PMID: 11509991 DOI: 10.1055/s-2001-16477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The 8-O-acetyl-3,10-dihydroxy-4(15),11(13)-guaiadien-12,6-olide, named borenolide, was isolated from Chrysanthemum boreale M. Borenolide inhibits the etoposide-induced apoptosis in U937 cell with an IC(50) value of 6.2 microg/ml. Structural assignment was based on NMR-spectroscopic methods and X-ray crystallographic analysis.
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35
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Lee JR, Joshi V, Griffin JW, Lasota J, Miettinen M. Gastrointestinal autonomic nerve tumor: immunohistochemical and molecular identity with gastrointestinal stromal tumor. Am J Surg Pathol 2001; 25:979-87. [PMID: 11474281 DOI: 10.1097/00000478-200108000-00001] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Gastrointestinal autonomic nerve tumor (GANT) is a gastrointestinal neoplasm that ultrastructurally recapitulates the enteric neural plexus. This study identifies and defines the features of 10 cases of this rare mesenchymal tumor and compares its clinicopathologic and molecular genetic features with the data on gastrointestinal stromal tumor (GIST). The majority of patients in this series presented at an older age (mean 64 years). Tumors arose from the stomach (6), small intestine (2), and retroperitoneum (2). Mean tumor size was 14 cm; however, four neoplasms were <6 cm. Histologically, tumors were spindled or epithelioid; one epithelioid tumor demonstrated a previously undescribed rhabdoid histologic phenotype. All tumors were positive for CD117 (KIT), while eight of 10 were positive for CD34. In contrast, only two were positive for S-100, and all were negative for actin and desmin. Five GANTs demonstrated GIST-specific gain-of-function mutations in the juxtamembrane domain of the c-kit gene (50%). Three of 10 patients died of disease in 22-30 months, one patient died in the postoperative period, and one patient died of complications of CML. The clinicopathologic, histologic, immunohistologic, and molecular features of GANT are similar to GIST, indicating that GANT merely represents a phenotypic variant of GIST.
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Affiliation(s)
- J R Lee
- Veterans Affairs Medical Center, Department of Pathology, Institute of Molecular Medicine and Genetics, Medical College of Georgia, Augusta, Georgia 30904, USA.
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36
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Abstract
The heart transplantation-associated accelerated graft arteriosclerosis (AGAS) is one of the major causes of cardiac allograft failure. We investigated the early time-course of expresssion patterns of cytokines, transcription factor, and its inhibitor in the intraabdominally transplanted mice hearts that differed only in the D locus of class I histocompatibility antigen. The allograft hearts were harvested at 1-3, 5, 7, 14, 28, and 42 days after the transplantation, and the expressions of NF-kappaB/I-kappaB and cytokines (TNF-alpha, INF-gamma) were examined in these specimens. The expressions of TNF-alpha and INF-gamma were observed on day 1, peaking on day 5 and 7, respectively. Activated NF-kappaB (p65) expression was present on the cytoplasm and perinuclear area in the endothelial cells of coronary arteries on day 1. The peak of translocation of NF-B from cytoplasm to nucleus appeared on day 5 in the endothelial cells, myocytes, and leukocytes within the vessels, and remained elevated until day 42. The I-kappaB expression gradually increased from day 1 until day 5, but a remarkable decrease was detected on day 7. Our data suggest that the increased expressions of NF-kappaB/I-kappaB and cytokines (TNF-alpha, INF-gamma) play an important role in inducing immune responses in the donor allograft heart and hence the blockage of the expressions might be mandatory to avoid a potential graft failure.
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Affiliation(s)
- J R Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Chongro-gu, Seoul, Korea.
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37
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Abstract
BACKGROUND The Lecompte procedure for correcting transposition of the great arteries has an advantage because it obviates the need for an extracardiac conduit for the reconstruction of the pulmonary outflow tract. In this study, we evaluated the effectiveness and the application of the Lecompte procedure based on our experiences. METHODS A retrospective review was conducted of the records of 45 patients who underwent the Lecompte procedure during the past 11 years to achieve direct right ventricle to pulmonary artery continuity. Mean age at operation was 2.4+/-1.7 years (range 3.5 months to 6.9 years). The diagnoses involved anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction, such as transposition of the great arteries, double-outlet right ventricle, and double-outlet left ventricle. RESULTS Early mortality was 4.4% (2 of 45 patients) and late mortality was 4.7% (2 of 43). The mean follow-up was 4.9+/-3.1 years. Fourteen patients (34.1% of survivors, n = 41) had pulmonary stenosis (pressure gradient above 30 mm Hg), the main reason for which was a calcified monocusp valve (n = 10, 71.4%). Eight of 45 patients (17.8%) underwent reoperation: 2 for residual ventricular septal defect, 1 for recurrent septic vegetation, and 5 for pulmonary stenosis. The cumulative survival rates were 91.1%+/-4.2% at 10 years. The actuarial probabilities of freedom from reoperation for pulmonary stenosis were 93.8%+/-4.3% and 71.4%+/-11.8% at 5 and 10 years, respectively. CONCLUSIONS Our review suggests that the Lecompte procedure is an effective treatment modality for anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction. Repair in early age is possible with acceptable morbidity and mortality, but recurrent right ventricular outflow tract obstruction caused by degeneration of the monocusp valve is a problem that needs resolution.
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Affiliation(s)
- Y J Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Korea.
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38
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Lee JR, Hancock SM, Martindale RG. Solitary fibrous tumors arising in abdominal wall hernia sacs. Am Surg 2001; 67:577-81. [PMID: 11409807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Solitary fibrous tumor (SFT) of the peritoneum is an unusual spindle-cell neoplasm. SFT was originally described in the pleura; however it is now diagnosed in multiple extrathoracic sites. Most believe that the tumor is of mesenchymal origin and should be classified as a variant of fibroma. SFT of the pleura and peritoneum have also been called fibrous mesothelioma, and the cell of origin is felt to be a pluripotential submesothelial mesenchymal cell. Primary tumors arising in hernia sacs are rare, and we report on two patients with hernia SFT. The first is a 67-year-old man who had a diffusely thickened distal left inguinal hernia sac. Within the sac was copious myxoid material mimicking pseudomyxoma peritonei. Herniorrhaphy and orchiectomy were performed. The second is a 44-year-old woman with a midepigastric mass attached to a ventral hernia. Wide local excision was performed. Both tumors demonstrated plump spindle cells, one with myxoid background and the other with keloidal collagen. Calretinin immunostaining was positive in both tumors, whereas CD34 was negative. This suggests tumor origin from a submesothial pluripotential cell that maintains potential for mesothelial differentiation. Surgical excision is the treatment of choice with the degree of resectability being a powerful predictor of outcome.
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Affiliation(s)
- J R Lee
- Department of Pathology, Veterans Affairs Medical Center, and Institute of Molecular Medicine and Genetics, Medical College of Georgia, Augusta 30904, USA
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Lee JR, He ZX, Dakik H, Verani MS. Myocardial perfusion and angiographic correlations in patients with ST-segment elevation during dobutamine stress perfusion imaging. J Nucl Cardiol 2001; 8:365-70. [PMID: 11391307 DOI: 10.1067/mnc.2001.114236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is scanty information on the angiographic and myocardial perfusion correlates of dobutamine-induced ST-segment elevation. METHODS AND RESULTS We studied 39 patients who exhibited ST-segment elevation during dobutamine perfusion tomography and had recent coronary angiography performed (ie, within 3 months of the dobutamine study). Baseline characteristics, extent of coronary artery disease, relationship of Q waves to ST-segment elevation, ischemic burden, and angiographic findings were assessed. Twenty-nine patients (74%) had prior myocardial infarction, and 77% had abnormal Q waves at baseline. Ninety-three percent of patients had abnormal perfusion imaging. Eighty percent of patients had multivessel coronary artery disease. The left ventricular ejection fraction by contrast ventriculography was 35% +/- 7% (mean +/- SD), the perfusion defect size was 32% +/- 15%, and 73% of patients had some degree of myocardial ischemia. A predominance of ischemia (>50% reversibility) occurred in 38% of patients with Q waves and in 70% of those without Q waves. There was also good agreement between the site of ST-segment elevation and the site of ischemia by perfusion imaging (79%) and between the site of ST-segment elevation and the location of the vessel with significant coronary stenosis (95%). CONCLUSIONS Patients with dobutamine-induced ST-segment elevation have a depressed left ventricular ejection fraction, a high frequency of multivessel disease, and markedly abnormal myocardial perfusion tomography. In patients with ST-segment elevation and abnormal Q waves, substantial scarring and superimposed ischemia coexist, whereas in patients without Q waves, ST-segment elevation usually denotes severe ischemia.
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Affiliation(s)
- J R Lee
- Section of Cardiology, Baylor College of Medicine, and The Methodist Hospital, Houston, TX 77030, USA
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Lee JR, Lee ME, Meeks TJ. Future C.E.O.'s in year 2002. J Ment Health Adm 2001; 10:23-5. [PMID: 10268714 DOI: 10.1007/bf02830907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chief Executive Officers of mental health facilities have been interested civil leaders. Many doctors have accepted C.E.O. positions in our history. Today the competitions out to see who will be the future's C.E.O.'s. The rumors run from lawyers to clinicians from many of the hospital's disciplines and from purely administrative side of the hospitals management system. It will not be unusual to see more Ph.D., M.B.A.'s, or M.D., M.P.A. or M.S., M.H.A. degree combinations in year 2002.
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41
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Lee JR. Nuances for differences between future C.E.O.'s and middle managers' styles and training. J Ment Health Adm 2001; 10:43-5. [PMID: 10268737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The success of the administrators in the future depends on their ability to motivate people to do better with less. They will be required to promote a good work environment in the midst of cutbacks, layoffs, and continued threats of layoffs. To reach their goals, they will work with staff members that face day to day uncertainties regardless of how hard they work. C.E.O.'s must convince them to continue to do their best in these stressful environments.
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Abstract
Healthcare managers are debating whether marketing improves their ability to provide services. To reach both short and long range goals, marketing concepts can be useful management tools. Managers who understand the marketing process will be able to interpret their ability to use marketing to increase market share or to obtain greater resources from their governing boards.
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Sneed RJ, Lee JR. Issues of accountability in mental health administration. J Ment Health Adm 2001; 11:17-9. [PMID: 10269100 DOI: 10.1007/bf02829020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The issue of accountability in state hospitals and state schools-hospitals can be expected to remain paramount in the future. Almost all areas of mental health services are being scrutinized by consumers who are demanding more for their money. From the Perspective of the mental administrator consumers will have to become a more meaningful part of the decision making process to produce productive changes in these human service fields. Thus, to this end, human service institutions must have the ability to function as open systems and must develop a sense of responsiveness to their consumers' needs.
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44
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Affiliation(s)
- Y S Lee
- Department of Dermatology, Sanggye Paik Hospital, College of Medicine, Inje University, Nowon Gu, Seoul, South Korea.
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45
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Abstract
In this study, role involvement, role integration (including role stress and role satisfaction), and perceived health were examined in 50 Asian American women who were caregivers of aging parents in addition to being wives, mothers, and employees. Their mean age was 47.8 years. Twenty-nine of the participants were Chinese and 21 Filipino, with an average length of caregiving for each group of 11 years. All participants were born outside the United States. Instruments used in the study were translated and back-translated into Chinese and Tagalog and tested for validity and reliability. The association of role involvement, role integration, role stress, and role satisfaction with perceived physical and psychological health in the combined and separate groups was examined. Role involvement was not associated with health in the combined group of caregivers but was associated with overall health in the sample of Chinese women. Role integration was positively associated with all three perceived health measures in the Filipino group but not in the Chinese group. Role satisfaction was consistently high in both groups. Role satisfaction and psychological well-being were significantly correlated for the combined group and for the Filipino caregivers. Total role stress was significantly correlated with overall health and current health only in the combined group. Thus, support that helps to decrease role stress and to increase role satisfaction may be more effective than efforts to decrease the extent of role involvement.
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Affiliation(s)
- P S Jones
- School of Nursing, Loma Linda University, Loma Linda, CA 92350, USA
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46
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Lee KO, Jang HH, Jung BG, Chi YH, Lee JY, Choi YO, Lee JR, Lim CO, Cho MJ, Lee SY. Rice 1Cys-peroxiredoxin over-expressed in transgenic tobacco does not maintain dormancy but enhances antioxidant activity. FEBS Lett 2000; 486:103-6. [PMID: 11113447 DOI: 10.1016/s0014-5793(00)02230-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Possible functions that have been proposed for the plant 1Cys-peroxiredoxin, include activity as a dormancy regulator and as an antioxidant. The transcript level of rice 1Cys-peroxiredoxin (R1C-Prx) rapidly decreased after imbibition of rice seeds, but the protein was detected for 15 days after imbibition. To investigate the function of this protein, we generated transgenic tobacco plants constitutively expressing the R1C-Prx gene. The transgenic R1C-Prx plants showed a germination frequency similar to control plants. However, the transgenic lines exhibited higher resistance against oxidative stress, suggesting that antioxidant activity may be its primary function.
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Affiliation(s)
- K O Lee
- School of Applied Life Sciences, Gyeongsang National University, 660-701, Chinju, South Korea
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Abstract
BACKGROUND Reperfusion injury involves leukocyte-endothelial interaction mediated by cell adhesion molecules. This study was designed to determine the time course of intercellular adhesion molecule-1 (ICAM-1) expression and the functional recovery of myocardium when reperfused with leukocyte depleted whole blood. METHODS Sixteen neonatal piglet hearts were harvested and stored with 4 degrees C cold University of Wisconsin Solution (UWS) for 12 hours. An ex vivo model consisting of an isolated working heart perfusion circuit, roller pumps, and a membrane oxygenator, was used for reperfusion. Atrial tissues were taken for staining ICAM-1. The stroke work index (SWI) was calculated during 4 hours of reperfusion. Two groups (group 1: reperfused with whole blood, group 2: with leukocyte depleted blood) were compared. RESULTS The differences of ICAM-1 expression between group 1 and 2 were significant at 3 and 4 hours of reperfusion (p < 0.05). The differences of the mean stroke work indices were significant at 2, 3, and 4 hours after reperfusion (p < 0.05). CONCLUSIONS Leukocyte-depleted reperfusion attenuates the expression of ICAM-1 and reduces the time-dependent functional deterioration of the myocardium. These results suggest that adhesion molecule like ICAM-1 plays a major role in deteriorating myocardial function during the reperfusion, possibly by leukocyte-mediated inflammatory process.
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Affiliation(s)
- J R Lee
- Department of Thoracic and Cardiovascular Surgery, and Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul National University Medical Research Center, Heart Research Institute, Korea.
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Pugh KR, Mencl WE, Jenner AR, Katz L, Frost SJ, Lee JR, Shaywitz SE, Shaywitz BA. Functional neuroimaging studies of reading and reading disability (developmental dyslexia). Ment Retard Dev Disabil Res Rev 2000; 6:207-13. [PMID: 10982498 DOI: 10.1002/1098-2779(2000)6:3<207::aid-mrdd8>3.0.co;2-p] [Citation(s) in RCA: 417] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Converging evidence from a number of neuroimaging studies, including our own, suggest that fluent word identification in reading is related to the functional integrity of two consolidated left hemisphere (LH) posterior systems: a dorsal (temporo-parietal) circuit and a ventral (occipito-temporal) circuit. This posterior system is functionally disrupted in developmental dyslexia. Reading disabled readers, relative to nonimpaired readers, demonstrate heightened reliance on both inferior frontal and right hemisphere posterior regions, presumably in compensation for the LH posterior difficulties. We propose a neurobiological account suggesting that for normally developing readers the dorsal circuit predominates at first, and is associated with analytic processing necessary for learning to integrate orthographic features with phonological and lexical-semantic features of printed words. The ventral circuit constitutes a fast, late-developing, word identification system which underlies fluent word recognition in skilled readers.
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Affiliation(s)
- K R Pugh
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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49
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Park SJ, Kim MH, Lee JR, Choi S. Effect of Fiber-Polymer Interactions on Fracture Toughness Behavior of Carbon Fiber-Reinforced Epoxy Matrix Composites. J Colloid Interface Sci 2000; 228:287-291. [PMID: 10926468 DOI: 10.1006/jcis.2000.6953] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of anodic oxidation on high-strength polyacrylonitrile-based carbon fibers has been studied in terms of fiber surface energetics and fracture toughness of the composites. According to contact angle measurements based on the wicking rate of a test liquid, anodic oxidation leads to an increase in surface free energy, mainly due to the increase of its specific (or polar) component. For the carbon-fiber-reinforced epoxy resin matrix system, a direct linear relationship is shown between the specific component and the critical stress intensity factor measured by the single edge notched beam fracture toughness test. From a surface-energetic point of view, the anodic treatment may be suitable for carbon fibers incorporated in a polar organic matrix, resulting in an increased specific component of the surface free energy. Good wetting plays an important role in improving the degree of adhesion at interfaces between fibers and matrices of the resulting composites. Copyright 2000 Academic Press.
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Affiliation(s)
- SJ Park
- Advanced Materials Division, Korea Research Institute of Chemical Technology, Yusong, Taejon, 305-600, Korea
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50
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Abstract
Although standardized uptake values (SUV) are widely used to quantify the uptake of 18F-fluorodeoxyglucose (18F-FDG) in tumours, there are systematic differences in the way this index is applied by different investigators. The aims of this study were to compare the effects of using maximum or mean region counts in the calculation of SUV and to investigate an alternative technique based on a fixed fraction of the maximum counts. Simulated PET projections of the thorax were generated together with spherical lesions that varied in diameter from 1.6 to 4.8 cm with uptake values of 2, 4 and 8. The lesion SUVs were determined using either the maximum (SUVmax) or mean count (SUVmean) values found in regions circumscribing the lesion. In addition, average values were calculated that only included region pixels that exceeded a selected fraction of maximum value (SUV0.6max or SUV0.75max). These methods were also applied to six clinical 18F-FDG PET studies with a total of 12 lesions. The SUVs for these lesions were determined independently by four observers. Decreases with respect to SUVmax of 57%, 23% and 14% were found for SUVmean, SUV0.6max and SUV0.75max approaches respectively in the simulation study. The variation in SUVmean with region size was 35%, while the SUV0.6max and SUV0.75max was less than 3%. Similar results were obtained for the clinical data. We conclude that the proposed technique produces SUVs that are essentially independent of lesion region size and shape. It is expected that this will provide a more stable and reliable result than current approaches.
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Affiliation(s)
- J R Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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