Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective

The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST).

Methods

A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted.

Results

The internal consistency (Cronbach's alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r = -0.771), WHOQOL-BREF (r = -0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078).

Conclusion

The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Voluntary running attenuates behavioural signs of low back pain: dimorphic regulation of intervertebral disc inflammation in male and female SPARC-null mice

OBJECTIVE

To examine the effect of running exercise on behavioral measures of pain and intervertebral disc (IVD) inflammation in the SPARC-null mouse model.

METHODS

Male and female 8-month old SPARC-null and age-matched control mice received a home cage running wheel or a control, fixed wheel for 6 months. Behavioral assays were performed to assess axial discomfort (grip test) and radiating leg pain (von Frey, acetone tests) and voluntary running was confirmed. Expression of inflammatory mediators (TNF-α, IL-1β, IL-2, IL-10, CCL5, CXCL1, CXCL5, RANKL, M-CSF, and VEGF) in IVDs was determined. Additional inflammatory (IL-1β, IL-1Ra, CXCR1, CXCR2) and macrophage phenotypic markers (ITGAM, CD80, CD86, CD206, Arg1) in IVDs were investigated by qPCR.

RESULTS

Voluntary running attenuated behavioral measures of pain in male and female SPARC-null mice. Increases in mediators including IL-1β, CXCL1 and CXCL5 were observed in SPARC-null compared to control IVDs. After 6 months of running, increases in M-CSF and VEGF were observed in male SPARC-null IVDs. In females, pro-inflammatory mediators, including CXCL1 and CXCL5 were downregulated by running in SPARC-null mice. qPCR analysis further confirmed the anti-inflammatory effect of running in female IVDs with increased IL-1Ra mRNA. Running induced upregulation of the macrophage marker ITGAM mRNA in males.

CONCLUSIONS

Voluntary running reversed behavioral signs of pain in male and female mice and reduced inflammatory mediators in females, but not males. Thus, the therapeutic mechanism of action may be sex-specific.

Impact of COVID-19 on TB epidemiology in South Korea

SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.

The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis

BACKGROUND AND PURPOSE

The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA.

MATERIALS AND METHODS

Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders.

RESULTS

Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P = .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P = .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P = .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P = .099).

CONCLUSIONS

Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.

Metformin and tuberculosis risk in elderly patients with diabetes mellitus

SETTING: Tuberculosis (TB) and diabetes mellitus (DM) remain global health concerns. Metformin has recently received attention for its anti-tuberculosis effects.OBJECTIVE: To evaluate the risk of TB development in elderly DM patients treated with metformin compared with sulfonylureas.DESIGN: We performed a retrospective cohort study using the National Health Insurance Service-Senior database. The participants were type-2 DM (T2DM) patients aged ≥60 years between 1 January 2003 and 31 December 2013. We matched each metformin user to a sulfonylurea user using a propensity score. A Cox proportional hazards model was used to compare the risk of TB in metformin and sulfonylurea users.RESULTS: After propensity score matching, 12,582 patients were in each group. The TB incidence was 280.2/100 000 person-years (py) for metformin users and 394.5/100 000 py for sulfonylurea users. Metformin users had a lower risk of TB development than sulfonylurea users (adjusted hazard ratio 0.74, 95%CI 0.58-0.95), and the results were stronger for male participants. A dose-response relationship between metformin use and TB development was found in both sexes.CONCLUSION: Metformin use was associated with a decreased risk of TB development among elderly T2DM patients compared with sulfonylurea use.

Validation of the Korean Version of the Depression in Old Age Scale and Comparison with Other Depression Screening Questionnaires Used in Elderly Patients in Medical Settings

Objective

The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings.

Methods

A total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery–Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically.

Results

The K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cut-off point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For “any depressive disorder”, the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033).

Conclusion

The present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.

Switching Antipsychotics to Blonanserin in Patients with Schizophrenia: An Open-label, Prospective, Multicenter Study

Objective

This study was performed to investigate the efficacy and tolerability of blonanserin in schizophrenic patients who were previously treated with other antipsychotics but, due to insufficient response, were switched to blonanserin.

Methods

A total of 52 patients with schizophrenia who were unresponsive to treatment with antipsychotic monotherapy or combination therapy were recruited into this 12-week, open-label, prospective, multicenter study. Patients were switched to blonanserin from their existing antipsychotics over a maximum 2-week tapering-off period. Efficacy was primarily evaluated using the 18-item Brief Psychiatric Rating Scale (BPRS). Assessments were performed at baseline, and at weeks 1, 2, 4, 8, and 12.

Results

Switching to blonanserin resulted in a significant decrease in the mean total score on the BPRS from baseline (56.8 ± 9.4) to week 12 (42.1 ± 13.8, p < 0.001). The most common adverse events were extrapyramidal symptoms (n = 12, 23.1%), insomnia (n = 10, 19.2%), and emotional arousal (n = 6, 11.5%). Overweight or obese patients (body mass index ≥ 23 kg/m², n = 33) who switched to blonanserin exhibited significant weight loss from 75.2 ± 9.3 kg at baseline to 73.5 ± 9.2 kg at week 12 (p = 0.006). The total cholesterol (baseline, 236.1 ± 47.6 mg/dl; endpoint [week 12], 209.9 ± 28.0 mg/dl; p = 0.005) and prolactin levels (baseline, 80.0 ± 85.2 ng/ml; endpoint [week 12], 63.2 ± 88.9 ng/ml; p = 0.003) were also significantly improved in patients with hypercholesterolemia or hyperprolactinemia.

Conclusion

The results of the present study suggest that switching to blonanserin may be an effective strategy for schizophrenic patients unresponsive to other antipsychotic treatments.

Screening with the Korean Version of the Mood Disorder Questionnaire for Bipolar Disorders in Adolescents: Korean Validity and Reliability Study

Objective

This study aimed to evaluate the validity and reliability of a Korean version of the Mood Disorder Questionnaire-Adolescent version (K-MDQ-A) as a screening instrument for bipolar disorders in adolescents.

Methods

One hundred two adolescents with bipolar disorders and their parents were recruited from November 2014 to November 2016 at 7 training hospitals. One hundred six controls were recruited from each middle school in two cities of South Korea. The parent version of the original MDQ-A was translated into Korean. The parents of all participants completed the K-MDQ-A. The diagnoses of bipolar disorders were determined based on the Korean version of K-SADS-PL. The test-retest reliability with a 10-month interval was investigated in 33 bipolar adolescents.

Results

K-MDQ-A yielded a sensitivity of 0.90 and a specificity of 0.92 when using a cut-off score of endorsement of 5 items, indicating that symptoms occurred in the same time period and caused moderate or serious problems. The internal consistency of the K-MDQ-A was good. The correlations between each item and the total score ranged from 0.40 to 0.76 and were all statistically significant. Factor analysis revealed 3 factors that explained 61.25% of the total variance. The mean total score was significantly higher in bipolar adolescents (7.29) than in controls (1.32). The Pearson correlation coefficient for the total test-retest score was 0.59 (p＜0.001).

Conclusion

The K-MDQ-A completed by parents showed the excellent validity and reliability and may be a useful screening tool for adolescents with bipolar disorders attending in- and outpatient psychiatric clinics.

Times to Discontinue Antidepressants Over 6 Months in Patients with Major Depressive Disorder

OBJECTIVE

The aim of the present study was to investigate differences in discontinuation time among antidepressants and total antidepressant discontinuation rate of patients with depression over a 6 month period in a naturalistic treatment setting.

METHODS

We reviewed the medical records of 900 patients with major depressive disorder who were initially prescribed only one kind of antidepressant. The prescribed antidepressants and the reasons for discontinuation were surveyed at baseline and every 4 weeks during the 24 week study. We investigated the discontinuation rate and the mean time to discontinuation among six antidepressants groups.

RESULTS

Mean and median overall discontinuation times were 13.8 and 12 weeks, respectively. Sertraline and escitalopram had longer discontinuation times than that of fluoxetine, and patients who used sertraline discontinued use significantly later than those taking mirtazapine. No differences in discontinuation rate were observed after 24 weeks among these antidepressants. About 73% of patients discontinued antidepressant treatment after 24 weeks.

CONCLUSION

Sertraline and escitalopram tended to have longer mean times to discontinuation, although no difference in discontinuation rate was detected between antidepressants after 24 weeks. About three-quarters of patients discontinued antidepressant maintenance therapy after 24 weeks.

Differential expression of two C-type lectins in grass carp Ctenopharyngodon idella and their response to grass carp reovirus

The cDNAs of two C-type lectins in grass carp Ctenopharyngodon idella, galactose-binding lectin (galbl) and mannose-binding lectin (mbl), were cloned and analysed in this study. Both of them exhibited the highest expression level in liver, whereas their expression pattern differed in early phase of embryonic development. Following exposure to grass carp reovirus (GCRV), the mRNA expression level of galbl and mbl was significantly up-regulated in liver and intestine.

Cultivation of a bacterial consortium with the potential to degrade total petroleum hydrocarbon using waste activated sludge

Waste activated sludge was aerobically treated to demonstrate multiple uses such as cultivating an oil degrading bacterial consortium; studying the influence of a bulking agent (peat moss) and total petroleum hydrocarbon concentration on bacterial growth and producing a soil conditioner using waste activated sludge. After 30 days of incubation, the concentration of oil-degrading bacteria was 4.3 x 10(8) CFU g(-1) and 4.5 x 10(8) CFU g(-1) for 5 and 10 g of total petroleum hydrocarbon, respectively, in a mixture of waste activated sludge (1 kg) and peat moss (0.1 kg). This accounts for approximately 88.4 and 91.1%, respectively, of the total heterotrophic bacteria (total-HB). The addition of bulking agent enhanced total-HB population and total petroleum hydrocarbon-degrading bacterial population. Over 90% of total petroleum hydrocarbon degradation was achieved by the mixture of waste activated sludge, bulking agent and total petroleum hydrocarbon. The results of physico-chemical parameters of the compost (waste activated sludge with and without added peat moss compost) and a substantial reduction in E. coli showed that the use of this final product did not exhibit risk when used as soil conditioner. Finally, the present study demonstrated that cultivation of total petroleum hydrocarbon-degrading bacterial consortium and production of compost from waste activated sludge by aerobic treatment was feasible.

The influence of the earthworm Lampito mauritii (Kinberg) on the activity of selected soil enzymes in cadmium-amended soil

The effects of cadmium (CdCl2·7H2O) on cellulase, urease, amylase, invertase and phosphatase were assessed for a period of 45 days in the presence and absence of earthworms [Lampito mauritii (Kinberg)] in alfisol soil. The activities of all enzymes significantly increased with longer incubation times (45 days) under laboratory conditions in both control and Cd-amended soils (both with and without earthworm incubation). However, the activities of all enzymes decreased with increasing Cd concentrations under laboratory conditions, both in the presence and absence of earthworms. In the presence of earthworms, cellulase, urease, invertase and amylase activities increased. However, phosphatase activity was lower in most of the Cd-amended soils in the presence of earthworms compared to its activity levels in soils lacking earthworms. These results show that earthworms modulated the stress imposed by Cd by providing suitable substrates, which in turn acted as stimulants for extracellular enzyme secretion by microbes, and by removing Cd through its accumulation in the tissues of the earthworms.

Aneurysmal subarachnoid hemorrhage causes injury of the ascending reticular activating system: relation to consciousness

BACKGROUND AND PURPOSE

Little is known about the pathogenetic mechanism of impaired consciousness following subarachnoid hemorrhage. Using diffusion tensor imaging, we attempted to investigate the presence of injury of the lower portion of the ascending reticular activating system between the pontine reticular formation and the intralaminar thalamic nuclei, and the relation between this injury and consciousness level in patients with SAH.

MATERIALS AND METHODS

We recruited 24 consecutive patients with spontaneous SAH following aneurysmal rupture and 21 healthy control subjects. Consciousness level was rated by using the Glasgow Coma Scale. Using diffusion tensor tractography, we reconstructed the lower portion of the ascending reticular activating system between the pontine reticular formation and the intralaminar thalamic nuclei. Values of fractional anisotropy, apparent diffusion coefficient, and tract number of the ascending reticular activating system were measured.

RESULTS

A significant difference in the tract number was observed between the patient and control groups (P < .05); however, there was no significant difference in terms of fractional anisotropy and apparent diffusion coefficient values (P > .05). In addition, regarding the tract number of the patient group, the Glasgow Coma Scale showed strong positive correlations with the tract number on the more affected side (r = 0.890, P < .05), the less affected side (r = 0.798, P < .05), and both sides (r = 0.919, P < .05), respectively.

CONCLUSIONS

We found injury of the lower portion of the ascending reticular activating system between the pontine reticular formation and the thalamus in patients with SAH. In addition, we observed a close association between injury of the lower portion of the ascending reticular activating system and impaired consciousness in patients with SAH.

Lichen planus pemphigoides associated with chronic hepatitis B virus infection

Lichen planus pemphigoides (LPP) is a rare autoimmune dermatosis with the features of both lichen planus (LP) and bullous pemphigoid (BP). Although in rare cases, LPP has been associated with several medications and conditions, it is generally considered an idiopathic disorder, and its pathogenesis remains uncertain. We report a 56-year-old woman who presented with a 2-year history of flat-topped, polygonal, violaceous-colored papules and some bullae. She was diagnosed with chronic hepatitis B virus (HBV) infection, which had been treated intermittently with entecavir. Histopathological examination showed the typical features of LP with subepidermal blisters, and with linear deposits of IgG along the basement membrane zone on direct immunofluorescence. Immunoblotting revealed antibodies directed at the BP180 and BP230 antigens. We diagnosed the patient with LPP, and treated the condition with systemic steroids and dapsone. To our knowledge, this is the first report of LPP in a patient with chronic HBV infection.

Different characteristics of the corticospinal tract according to the cerebral origin: DTI study

BACKGROUND AND PURPOSE

Little is known about differences in corticospinal tract fibers according to cerebral origin. Using diffusion tensor tractography, we attempted to investigate the characteristics of the CST according to the cerebral origin in the human brain.

MATERIALS AND METHODS

Thirty-six healthy subjects were recruited for this study. A 1.5T Gyroscan Intera system was used for acquisition of DTI. CSTs were reconstructed by selection of fibers passing through seed and target ROIs: seed ROIs, the area of the CST at the pontomedullary junction; target ROIs, the primary motor cortex, the primary somatosensory cortex, the dorsal premotor cortex, and the supplementary motor area.

RESULTS

A significant difference in tract volume was observed in each ROI (P < .05): M1 (2373.6, 36.9%), S1 (2037.7, 31.7%), SMA (1588.0, 24.7%), and dPMC (429.8, 6.7%). Regarding fractional anisotropy values, the dPMC or SMA showed higher values than the M1 or S1; however, the opposite occurred in terms of the mean diffusivity value (P < .05). In addition, fractional anisotropy and mean diffusivity values of the dPMC differed from those of the SMA (P < .05); in contrast, no significant difference was observed between the M1 and S1 (P > .05).

CONCLUSIONS

Tract volume was found to differ according to cerebral origin and was, in descending order, M1, S1, SMA, and dPMC. In addition, the directionality and diffusivity of CST fibers in the SMA and the dPMC differed from those of the M1 and S1, which showed similar characteristics.

Prediction of aphasia outcome using diffusion tensor tractography for arcuate fasciculus in stroke

BACKGROUND AND PURPOSE

The AF is an important neural tract in language function. We investigated aphasia outcome according to DTT findings for AF in the early stage of stroke.

MATERIALS AND METHODS

Twenty-five consecutive patients with aphasia and stroke and 12 control subjects were recruited. The AQ of K-WAB was used for the assessment of aphasia in the early stage of stroke (10-30 days) and at approximately 6 months after onset. We classified the patients into 3 groups according to the severity of left AF injury: type A, the AF was not reconstructed; type B, the AF was disrupted; and type C, the AF was preserved around the lesion.

RESULTS

When comparing AQ among AF types at early evaluation, the type C score (32.84±18.05) was significantly higher than type A (3.60±2.73) (P<.05). However, no significant difference was observed between types A and B (18.02±17.19) or between types B and C (P>.05). At late evaluation, the AQ values of types B (52.43±25.75) and C (68.08±15.76) were higher than that of type A (10.98±3.90) (P<.05). However, there was no significant difference between types B and C.

CONCLUSIONS

The aphasia outcome of the patients whose left AF could be reconstructed was better than that in patients whose left AF could not be reconstructed, irrespective of its integrity. We believe that evaluation of the left AF by using DTT in the early stage of stroke could be helpful in predicting aphasia outcome in patients with stroke.

The fate of injured corticospinal tracts in patients with intracerebral hemorrhage: diffusion tensor imaging study

BACKGROUND AND PURPOSE

Little is known about the fate of the injured CST for a large number of patients with ICH. Using DTT, we investigated the longitudinal changes of injured CSTs in patients with an ICH.

MATERIALS AND METHODS

We recruited 45 patients with CST injury by an ICH in the supratentorial subcortical area. Two longitudinal DTTs were acquired: 1 within 30 days and the other after 3 months from onset. DTTs for the CST were classified into 3 types: type A, the CST was preserved around the hematoma; type B, the CST was interrupted around the hematoma; and type C, the CST did not reach the hematoma.

RESULTS

At the first DTT, the motor functions of type C were worse than those of types A and B (P < .01), and motor functions of type A were better than those of type C at the second DTT (P < .01). Of 14 type A, 2 changed to type B (14.3%) and 12 did not change (85.7%); of 12 type B, 11 changed to type A (91.7%) and 1 changed to type C (8.3%); of 19 type C, 3 changed to type A (15.8%) and 16 did not change (84.2%).

CONCLUSIONS

We found that the injured CST could change from the early stage to the chronic stage during the motor recovery phase in patients with an ICH. These results would be helpful in prediction of longitudinal DTT changes from the early stage to the chronic stage following ICH.

Diffusion tensor imaging-demonstrated differences between hemiplegic and diplegic cerebral palsy with symmetric periventricular leukomalacia

BACKGROUND AND PURPOSE

Patients with cerebral palsy have variable clinical presentations such as hemiplegic, diplegic, or quadriplegic patterns though they have PVL on conventional MR images. The authors investigated whether DTT can differentiate between hemiplegic and diplegic CP in patients presenting with symmetric PVL on conventional MR images.

MATERIALS AND METHODS

One hundred thirteen consecutive pediatric patients with definite hemiplegic (59 patients; 30 boys, 29 girls; mean age, 34.19 months; range, 24-52 months) or diplegic (54 patients; 27 boys, 27 girls; mean age, 31.07 months; range, 24-48 months) symptoms and bilateral symmetric PVL on conventional brain MR imaging were recruited. The states of CSTs were examined by using DTT, and the asymmetries of right and left CSTs in the hemiplegic and diplegic groups were compared by using asymmetric anisotropy indexes and asymmetric mean diffusivity indexes.

RESULTS

All patients in the hemiplegic group with asymmetric results exhibited disrupted integrities of more affected CSTs and sparing of less affected CSTs. However, diplegic patients revealed symmetric disrupted findings of the right and left CSTs at the upper periventricular level. Asymmetric anisotropy index and asymmetric mean diffusivity index values were significantly higher in the hemiplegic group than in the diplegic group (P < .05), and these results of DTT significantly corresponded with their typical clinical manifestation.

CONCLUSIONS

DTT may be very useful for the detailed estimation of the CST state in patients with bilateral symmetric PVL.

Proteins involved in DNA damage response pathways and survival of stage I non-small-cell lung cancer patients

BACKGROUND

Biological complexity leads to significant variation in the survival of patients with stage I non-small-cell lung cancer (NSCLC). DNA damage response (DDR) pathways play a critical role in maintaining genomic stability and in the progression of NSCLC. Therefore, the development of a prognostic biomarker focusing on DDR pathways is an intriguing issue.

PATIENTS AND METHODS

Expression of several proteins (ATM, ATMpS1981, γH2AX, 53BP1, 53BP1pS25, Chk2, Chk2pT68, MDC1, MDC1pS964, BRCA1pS1423, and ERCC1) and overall survival were investigated in 889 pathological stage I NSCLC patients.

RESULTS

Low expression of BRCA1pS1423 or ERCC1 was significantly associated with worse survival in the whole cohort of patients. Analysis performed based on histology revealed that low expression of γH2AX, Chk2pT68, or ERCC1 was a poor prognostic factor in squamous cell carcinoma patients [adjusted hazard ratio (aHR), Cox P: 1.544, 0.012 for γH2AX; 1.624, 0.010 for Chk2pT68; 1.569, 0.011 for ERCC1]. The analysis of the interaction between two proteins showed that this effect was more pronounced in squamous cell carcinoma patients. However, these effects were not detected in adenocarcinoma patients.

CONCLUSIONS

The proteins involved in DDR pathways exhibited differential expression between squamous cell carcinoma and adenocarcinoma and were important determinants of survival in stage I squamous cell carcinoma patients.

Electrical properties of 10-nm-radius n-type gate all around twin Si nanowire field effect transistors

The electrical properties of 10-nm-radius n-type gate all around (GAA) twin Si nanowire field effect transistors (TSNWFETs) and field effect transistors (FETs) without nanowires were investigated to understand their device characteristics. The electrical characteristics of the GAA TSNWFETs and FETs with bulk boron concentrations of 1 x 10(18) and 1 x 10(16) cm(-3) were simulated by using three-dimensional technology computer-aided design simulation tools of sentaurus taking into account quantum effects. The simulation results showed that the on-current level of the TSNWFETs was larger than that of FETs, and the subthreshold swing and the drain induced barrier lowing of the TSNWFETs were smaller than those of FETs. The current density and conduction band edge profiles in the TSNWFETs clarified the dominant current paths. The simulation results showed that the on-current/off-current ratio increased with increasing bulk boron concentration, and the stand-by current level decreased.

The Symptom Frequency Characteristics of the Hamilton Depression Rating Scale and Possible Symptom Clusters of Depressive Disorders in Korea: The CRESCEND Study

OBJECTIVE

This study analyzed the symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) to understand the characteristics of each item and to propose the possible symptoms clusters.

METHODS

From psychiatric clinics of 18 Hospitals in Korea, 1,183 patients, diagnosed with major depressive disorder (psychotic or non-psychotic), dysthymia or depressive disorder not otherwise specified. according to DSM-IV criteria, participated in this study from January 2006 to August 2008. The frequencies of each item of HDRS-17 were analyzed according to sex and severity. In addition, we compared this study with a previous study performed in England by Hamilton and with two studies performed in Korea by Kim et al.

RESULTS

The frequencies of HDRS-17 items varied widely in this study, ranging from 95.8% in work and activities to 37.4% in loss of weight. But, depressed mood, psychic anxiety and work and activities items exhibited constant and higher frequency or rank regardless of study, the severity of depression or sex. Insomnia early, somatic gastrointestinal, genital symptoms and insight showed relatively constant but lower frequency or rank in disregard of studies or the clinical variables. Other symptoms had variable frequencies or ranks according to the variable clinical situations (culture, time, sex, severity of depression).

CONCLUSION

WE PROPOSE THREE CLUSTERS OF SYMPTOMS IN DEPRESSIVE DISORDERS: core symptoms cluster, an associated symptoms, and a situation-specific symptoms. We can use these possible symptom clusters of depression in simplifying diagnosis of depression, increasing diagnostic specificity in special situation and indexing disease severity.

Anatomic location and somatotopic arrangement of the corticospinal tract at the cerebral peduncle in the human brain

BACKGROUND AND PURPOSE

Little is known about the detailed anatomic location and somatotopic arrangement at the CP. Using DTT with FSL tools, we conducted an investigation of the anatomic location and somatotopic arrangement of the CST at the CP in the human brain.

MATERIALS AND METHODS

We recruited 43 healthy volunteers for this study. DTI was obtained by using 1.5T, and CSTs for the hand and leg were obtained by using the FSL tool. The somatotopic location of the CST was evaluated as the highest probabilistic location at the upper and lower midbrain. The posterior boundary was determined as the line between the interpeduncular fossa and the lateral sulcus; we then drew a rectangle on the basis of the boundary of the CP.

RESULTS

In the mediolateral direction, the highest probabilistic locations for the hand and leg were an average of 60.46% and 69.98% from the medial boundary at the upper midbrain level and 53.44% and 62.76% at the lower midbrain level, respectively. As for the anteroposterior direction, the highest probabilistic locations for the hand and leg were an average of 28.26% and 32.03% from the anterior boundary at the upper midbrain level and 30.19% and 33.59% at the lower midbrain level, respectively.

CONCLUSIONS

We found that the hand somatotopy for the CST is located at the middle portion of the CP and the leg somatotopy is located lateral to the hand somatotopy.

Probabilistic somatotopy of the spinothalamic pathway at the ventroposterolateral nucleus of the thalamus in the human brain

BACKGROUND AND PURPOSE

The STP has been regarded as the most plausible neural tract responsible for pathogenesis of central poststroke pain. The VPL nucleus has been a target for neurosurgical procedures for control of central poststroke pain. However, to our knowledge, no DTI studies have been conducted to investigate the somatotopic location of the STP at the VPL nucleus of the thalamus. In the current study, we attempted to investigate this location in the human brain by using a probabilistic tractography technique of DTI.

MATERIALS AND METHODS

DTI was performed at 1.5T by using a Synergy-L SENSE head coil. STPs for both the hand and leg were obtained by selection of fibers passing through 2 regions of interest (the area of the spinothalamic tract in the posterolateral medulla and the postcentral gyrus) for 41 healthy volunteers. Somatotopic mapping was obtained from the highest probabilistic location at the ACPC level.

RESULTS

The highest probabilistic locations for the hand and leg were an average of 16.86 and 16.37 mm lateral to the ACPC line and 7.53 and 8.71 mm posterior to the midpoint of the ACPC line, respectively. Somatotopic locations for the hand and leg were different in the anteroposterior direction (P < .05); however, no difference was observed in the mediolateral direction (P > .05).

CONCLUSIONS

We found the somatotopic locations for hand and leg of the STP at the VPL nucleus; these somatotopies were arranged in the anteroposterior direction.

Clinical characteristics and outcomes of H1N1-associated pneumonia among adults in South Korea

BACKGROUND

Pneumonia has been reported to be the most life-threatening complication of influenza virus infection.

OBJECTIVE

to describe clinical characteristics and determine risk factors for death among patients with H1N1-associated pneumonia.

DESIGN

A retrospective cohort study included all adult patients diagnosed and treated with H1N1-associated pneumonia in 14 participating institutions between 1 May 2009 and 28 February 2010 in South Korea. Clinical outcomes were summarised and predictors for death evaluated through univariate and multivariate analysis.

RESULTS

A total of 269 adult patients with H1N1-associated pneumonia were diagnosed and treated. Hospital visits or admissions peaked in November 2009, coinciding with the peak in the 2009 H1N1 epidemic in South Korea. The patients' median age was 48 years; 143 were male. Most (n = 266, 98.9%) were admitted for treatment: 97 (36.1%) required intensive care and 28 (10.4%) needed mechanical ventilation. Despite the use of antiviral and antibacterial agents, 19 patients (7.1%) died. Risk factors predictive of death included presence of malignancy (aOR 12.0, 95%CI 2.8-51.5), and pneumonia severity index (PSI) score (aOR 1.03, 95%CI 1.01-1.04).

CONCLUSION

Deaths among adult patients with H1N1-associated pneumonia were not rare. Clinicians should be aware of the possibility of a poor prognosis among H1N1-associated pneumonia patients with underlying malignancy or high PSI score.

Exposure-response of posaconazole used for prophylaxis against invasive fungal infections: evaluating the need to adjust doses based on drug concentrations in plasma

The purpose of this article is to report the exposure-response (E-R) relationship of posaconazole oral suspension (POS) for prophylaxis against invasive fungal infections (IFIs), on the basis of the US Food and Drug Administration (FDA) clinical pharmacology review of two randomized, active-controlled clinical studies. Posaconazole average steady state plasma concentrations (C(avg)) ranged from 22 to 3,650 ng/ml after administration of POS 200 mg three times daily (t.i.d.). In a double-blind, randomized clinical trial, the quartile ranges of C(avg) with midpoint values of 289, 736, 1,239, and 2,607 ng/ml had clinical failure rates of 44, 21, 18, and 18%, respectively, indicating an inverse association between C(avg) and clinical failure rate. There were no significant relationships between C(avg) and posaconazole-related major adverse events. Determining posaconazole concentrations in plasma will aid in assessing the need for either POS dose adjustment (e.g., increasing the POS dose) or switching to another systemic antifungal drug, thereby improving the effectiveness of prophylaxis against IFIs.

Beta-carotene inhibits Helicobacter pylori-induced expression of inducible nitric oxide synthase and cyclooxygenase-2 in human gastric epithelial AGS cells

Reactive oxygen species (ROS) play critical roles in Helicobacter pylori (H. pylori)-associated gastric ulceration and carcinogenesis. Inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) are involved in H. pylori-induced gastric diseases. Previously we demonstrated that H. pylori in Korean isolates induced the activation of mitogen-activated protein kinases (MAPK) and oxidant-sensitive transcription factors NF-kappaB and AP-1 which mediates the expression of iNOS and COX-2 in gastric epithelial AGS cells. beta-Carotene shows antioxidant activity and inhibits NF-kappaB-dependent gene expression in various cells. Present study aims to investigate whether beta-carotene inhibits H. pylori-induced expression of iNOS and COX-2 by suppressing the activation of MAPK, NF-kappaB, and AP-1 in gastric epithelial AGS cells. HP99 (H. pylori in Korean isolates) was added to AGS cells at the ratio of bacterium/cell, 300/1. beta-carotene inhibited H. pylori-induced increase in ROS level, the activation of MAPK (p38, the c-Jun NH2-terminal protein kinases, the extracellular signal-regulated kinases), NF-kappaB, and AP-1 and the expression of iNOS and COX-2 in AGS cells.

CONCLUSION

beta-carotene inhibits oxidant-mediated activation of inflammatory signaling and suppresses the expression of iNOS and COX-2 in gastric epithelial AGS cells infected with H. pylori.

The effect of cationic polymer treatment on adhesion of iron oxide to eyelashes

The aim of this study was to investigate the effect of iron oxide application on improving the volume of eyelashes. Iron oxide, having a negative surface charge in its natural form, was coated with commercial cationic polymers to increase its adhesion. The iron oxides coated with different types and concentrations of these polymers were incorporated into a basic mascara formula to test their volume effects by means of the weight difference of eyelashes.The results indicated that the type and concentration of coating materials affect the surface zeta potential and particle cluster size of iron oxides. The type of cationic polymer, especially, was shown to modify both factors of iron oxide. The obtained results also suggested that the volume effect of mascara increases with a higher positive surface zeta potential and a smaller particle cluster size of the coated iron oxides.

The land use plan and water quality prediction for the Saemangeum reclamation project

As the final closure of the world's longest sea dike of 33 km, the use of the Saemangeum reclaimed land becomes an issue in Korea. The Korean government has proclaimed that the Saemangeum Reclamation Project will be handled in an environmentally friendly manner but its effect on the water quality of reservoirs has always been controversial. This study was conducted to estimate the water quality of the Saemangeum reservoir using WASP5 according to the new land use plan adopted in 2007. Predictions on water quality shows that Dongjin reservoir would meet the standards for COD, T-P, and Chl-a if the wastewater from the Dongjin region was properly managed. However, T-P and Chl-a in Mangyeong reservoir would exceed the standards even without releasing the treated wastewater into the reservoir. With further reductions of 20% for T-P and Chl-a from the mouth of Mangyeong river, the water quality standards in the reservoir were achieved. This means that additional schemes, as well as water quality management programs established in the Government Master Plan in 2001, should be considered. Although the Saemangeum reservoir would manage to achieve the standards, it will enter a eutrophic state due to the high concentration of nutrients.

Kernohan's notch phenomenon demonstrated by diffusion tensor imaging and transcranial magnetic stimulation

Kernohan's notch phenomenon is the ipsilateral hemiplegia caused by compression of the contralateral cerebral peduncle against the tentorial edge by a supratentorial mass. Diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) could be useful for exploring the state of the corticospinal tract (CST). This report attempts to demonstrate Kernohan's notch phenomenon in a patient with subdural haematoma by using DTI and TMS. One patient and six normal control subjects were recruited. The patient showed severe right hemiplegia even though the subdural haematoma was located in the right hemisphere. Brain CT at the time of onset showed right transtentorial herniation, and T2 weighted images at 6 weeks after onset showed a leucomalacic lesion on the left cerebral peduncle. DTI and TMS were performed at 6 weeks after onset. The fractional anisotrophy value of the left midbrain and medulla of the patient was found to be decreased in comparison with that of the control subjects. On fibre tractography for the CST, an interruption was observed in the left midbrain and medulla. The motor evoked potential obtained from the right hand muscle showed delayed latency, low amplitude and a higher excitatory threshold, thus indicating that the CST of the left hemisphere had been damaged. It seems that the CST had been damaged at the left midbrain, although subdural haematoma and transtentorial herniation had occurred in the right hemisphere in this patient. This report demonstrates Kernohan's notch phenomenon in this patient using DTI and TMS.

Impact of Pharmacometric Reviews on New Drug Approval and Labeling Decisions—a Survey of 31 New Drug Applications Submitted Between 2005 and 2006

Exploratory analyses of data pertaining to pharmacokinetic, pharmacodynamic, and disease progression are often referred to as the pharmacometrics (PM) analyses. The objective of the current report is to assess the role of PM, at the Food and Drug Administration (FDA), in drug approval and labeling decisions. We surveyed the impact of PM analyses on New Drug Applications (NDAs) reviewed over 15 months in 2005-2006. The survey focused on both the approval and labeling decisions through four perspectives: clinical pharmacology primary reviewer, their team leader, the clinical team member, and the PM reviewer. A total of 31 NDAs included a PM review component. Review of NDAs involved independent quantitative evaluation by FDA pharmacometricians. PM analyses were ranked as important in regulatory decision making in over 85% of the 31 NDAs. Case studies are presented to demonstrate the applications of PM analysis.

Longitudinal fMRI study for locomotor recovery in patients with stroke

The authors investigated bihemispheric motor network reorganization supporting locomotor recovery after stroke over time. They determined longitudinal changes in locomotor function and fMRI in 10 stroke patients at the subacute stage and the chronic stage. The results suggest that the bihemispheric reorganization mechanism underlying locomotor recovery evolved from the ipsilateral (contralesional) primary sensorimotor cortex (SM1) activation at the subacute stage to the contralateral (ipsilesional) SM1 activation at the chronic stage.

Atomic Structures of Benzene and Pyridine on Si(5 5 12)-2 × 1

The adsorption structures of benzene and pyridine on Si(5 5 12)-2 x 1 were studied at 80 K by using a low-temperature scanning tunneling microscope and density functional theory calculations. These structures are different from those observed on low-index Si surfaces: benzene molecules exclusively bind to two adatoms, that is, with di-sigma bonds between carbon atoms and silicon adatoms, leading to the loss of benzene aromaticity; in contrast, pyridine molecules interact with adatom(s) through either Si-N dative bonding or di-sigma bonds. Dative bonding configurations with pyridine aromaticity are the dominant adsorption features and are more stable than di-sigma bonding configurations. Thus the dative bonding of nitrogen-containing heteroaromatic molecules provides a strategy for the controlled attachment of aromatic molecules to high-index surfaces.

Combined functional magnetic resonance imaging and transcranial magnetic stimulation evidence of ipsilateral motor pathway with congenital brain disorder: a case report

We present the case of 28-year-old man with schizencephaly who had mild left hemiparesis with mirror movement. Brain mapping using functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) for both hand muscles was done to evaluate his neurologic state. Motor evoked potential (MEP) from both abductor pollicis brevis (APB) muscles was obtained simultaneously. fMRI showed that the left primary sensorimotor cortex became active when the right fingers performed the flexion-extension exercise. The left primary sensorimotor cortex, left prefrontal area, and both supplementary motor areas were activated with flexion-extension exercise of the left hand. Brain mapping for both APB muscles using TMS showed that no MEP was evoked in the right hemisphere, but a APB total of 5 sites were evoked in the left hemisphere simultaneously. The optimal scalp site for both APB muscles was present at the same site. The MEPs of both muscles which were evoked by stimulation of the optimal scalp site, showed similar latencies, amplitudes, and figures of potential. The similarities in both MEPs and the same optimal scalp site support the assumption that MEPs of both APB muscles are produced by the corticospinal tract originating from the same motor cortex. Our results showed that the ipsilateral motor pathway extended from the unaffected left hemisphere to both hand muscles. This finding may reflect functional reorganization of motor area in a patient with congenital brain disorder.

Transduction of human catalase mediated by an HIV-1 TAT protein basic domain and arginine-rich peptides into mammalian cells

Antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) have been considered to have a beneficial effect against various diseases mediated by reactive oxygen species (ROS). Although a variety of modified recombinant antioxidant enzymes have been generated to protect against the oxidative stresses, the lack of their transduction ability into cells resulted in limited ability to detoxify intracellular ROS. To render the catalase enzyme capable of detoxifying intracellular ROS when added extracellularly, cell-permeable recombinant catalase proteins were generated. A human liver catalase gene was cloned and fused with a gene fragment encoding the HIV-1 Tat protein transduction domain (RKKRRQRRR) and arginine-rich peptides (RRRRRRRRR) in a bacterial expression vector to produce genetic in-frame Tat-CAT and 9Arg-CAT fusion proteins, respectively. The expressed and purified fusion proteins can be transduced into mammalian cells (HeLa and PC12 cells) in a time- and dose-dependent manner when added exogenously in culture medium, and transduced fusion proteins were enzymatically active and stable for 60 h. When exposed to H(2)O(2), the viability of HeLa cells transduced with Tat-CAT or 9Arg-CAT fusion proteins was significantly increased. In combination with transduced SOD, transduced catalase also resulted in a cooperative increase in cell viability when the cells were treated with paraquat, an intracellular antioxide anion generator. We then evaluated the ability of the catalase fusion proteins to transduce into animal skin. This analysis showed that Tat-CAT and 9Arg-CAT fusion proteins efficiently penetrated the epidermis as well as the dermis of the subcutaneous layer when sprayed on animal skin, as judged by immunohistochemistry and specific enzyme activities. These results suggest that Tat-CAT and 9Arg-CAT fusion proteins can be used in protein therapy for various disorders related to this antioxidant enzyme.

Therapeutic trial in the first three Asian cases of ethylmalonic encephalopathy: response to riboflavin

Three Korean girls with ethylmalonic encephalopathy, the first Asian cases, were identified. In all three cases, we observed slight improvement in motor functions, cognitive behaviours and chronic mucoid diarrhoea after treatment with riboflavin and/or coenzyme Q10 treatment. The precise pathogenesis of ethylmalonic encephalopathy has not been fully elucidated, but riboflavin treatment may be helpful.

A case of spontaneous pneumomediastinum and pneumopericardium in a young adult

Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.

Kinetics of P-glycoprotein-mediated efflux of paclitaxel

Paclitaxel is a substrate of the mdr1 P-glycoprotein (Pgp). The objective of the present study was to determine the kinetics of the Pgp-mediated efflux and its contribution to the overall efflux of paclitaxel at the clinically achievable concentration range of 1 to 1500 nM. Human breast carcinoma BC19 cells that were derived from MCF7 cells by mdr1 transfection and show a >10-fold higher level of the Pgp protein were used to measure the uptake and efflux of [(3)H]paclitaxel. A computational model of intracellular paclitaxel pharmacokinetics was developed to analyze for the Pgp efflux parameters. The results show a saturable Pgp-mediated efflux in BC19 cells; the dissociation constant was 14 nM, and the maximal efflux rate was 2.8 x 10(-4) pmol/h/cell. The contribution of Pgp-mediated efflux to the total efflux decreased with increasing extracellular drug concentrations; the Pgp efflux accounted for 86 and 34% of total efflux at 1 and 1500 nM, respectively. The validity of the model was confirmed by the close agreement between the model-predicted data and the experimentally obtained data (approximately 6% deviation) describing the effect of cell density and intracellular-to-extracellular concentration gradient on the kinetics of drug accumulation and efflux. In conclusion, our results indicate that the Pgp-mediated efflux represents a major efflux mechanism of paclitaxel at the low end of the clinically observed drug concentration range, but accounts for only a minor part of the efflux at higher concentrations in BC19 cells.

Molecular cloning and functional expression of bovine brain GABA transaminase

We isolated a cDNA that encodes the bovine brain gamma-aminobutyrate transaminase (GABA-T; EC 2.6.1.19) from the lambda gt 11 cDNA library, which showed a high degree of sequence similarity to the corresponding enzymes from various sources. Northern blot analysis revealed two differentially expressed GABA-T transcripts of approximately 2.0 and 6.0 kb in the bovine tissues. Southern blot analysis indicates that the two GABA-T transcripts are encoded in a greater-than 10-kb, single-copy gene. Bovine GABA-T cDNA was expressed in E. coli using the pGEX bacterial- expression vector system. The overexpressed GABA-T was enzymatically active after purification, and it had very similar kinetic parameters when compared with those of other mammalian GABA-Ts.

Clinical application of continent anal plug in bedridden patients with intractable diarrhea

PURPOSE

Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device.

METHODS

A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days.

RESULTS

The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days.

CONCLUSIONS

The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

Determinants of drug delivery and transport to solid tumors

This presentation addresses the barriers and determinants and the importance of drug-induced apoptosis in drug transport and delivery to organs and solid tumors. In particular, we examined the roles of interstitial space, drug removal by capillaries, tissue structure and tissue composition on drug distribution. Drug transport in bladder tissues is described by the distributed model which combined monodimensional Fickian diffusion and first order removal of drug by the perfusing blood. Microscopic evaluation of the spatial drug distribution in bladder, prostate and tongue indicates heterogeneous drug distribution with large and erratic concentration gradient. In general, drug distribution favors interstitial space and vasculature, with little penetration in muscles. Drug penetration into 3-dimensional solid tumors is typically 5- to 10-fold slower than in monolayer cultures. The transport of highly protein-bound drugs such as paclitaxel and doxorubicin in a solid tumor is retarded by a high tumor cell density and enhanced by drug-induced apoptosis. Accordingly, the delivery of a highly protein-bound drug to cells in a solid tumor is affected by its apoptotic effects and is therefore determined by the drug concentration and the treatment duration, i.e. treatment schedule. Under in vitro and in vivo conditions, the delivery of highly protein-bound drugs to tumor can be enhanced by using a pretreatment that induces apoptosis and reduction in cell density, and by using treatment schedules designed to take advantage of these drug-induced changes in tumor tissue composition. In conclusion, in addition to the usual processes involved in drug transport such as distribution through vascular space, transport across microvessel walls, and diffusion through interstitial space in tumor tissue, other factors including tissue structure and composition and alteration by drug-induced apoptosis are important determinants of drug distribution in organs and solid tumors.