Clinical and radiobiological consideration of cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin cancer disfiguring the face of a non-compliant patient who was refusing surgery and protracted radiation therapy: case report

Although surgery is the mainstay of local treatment for skin cancer, definitive radiation therapy (RT) has been also applied for patients who are unable to tolerate surgery. Definitive RT regimens usually consist of daily treatment for 4–7 weeks. Such protracted daily RT regimens, however, would not be feasible for non-compliant patients or patients who are unable to make multiple daily trips for weeks. Without treatment, however, skin cancers can continuously progress and cause distressing symptoms. A cyclical hypofractionated RT (QUAD Shot: 14 Gy in 4 fractions, twice-daily treatments with 6 hours interval on 2 consecutive days) can be a practical RT regimen for those patients. In this report, we present the successful treatment course of repeated QUAD Shots in a 79-year-old patient with neglected skin cancer that was disfiguring his face yet declined definitive surgery and protracted RT. We also evaluated and compared biologically equivalent doses between QUAD Shots and conventionally fractionated protracted RT regimens.

Screening study for genetic polymorphisms affecting pharmacokinetics of pioglitazone

Pioglitazone is known to have antidiabetic effects through decreasing peripheral, hepatic and vascular insulin resistance by the stimulation of PPAR gamma. To address the possible genetic factors affecting the pharmacokinetics (PK) of pioglitazone, 27 male Korean volunteers were enrolled from two separate bioequivalence studies. Each subject was administered 15 mg pioglitazone and reference drug PK parameters were used. We used Illumina Human610 Quad v1.0 DNA Analysis BeadChip for whole genome SNPs analysis and whole genome genotyping data was processed by linear regression analysis for PK parameters. We found 35 significant SNPs (P < 0.0001) in C(max), 1,118 significant SNPs (P < 0.0001) in T(max) and 1,259 significant SNPs (P < 0.0001) in AUC(inf) from whole genome analysis. For clinical pharmacological purpose, we selected SNPs from several phase I and II drug metabolizing enzyme and analyzed PK parameters with genotypes. Four SNPs (rs7761731 and rs3799872 from CYP39A1; rs156697 from GSTO2; rs1558139 from CYP4F2) showed significant associations with pioglitazone C(max). In the T(max) group, seven SNPs from 3 genes (rs3766198 from CYP4B1; rs2270422 from GSTZ1; rs2054675, rs10500282, rs3745274, rs8192719, and rs11673270 from CYP2B6) had significant associations. In the AUC(inf) group, seven SNPs from 4 genes (rs11572204 from CYP2J2; rs4148280 from UGT2A1, rs4646422 from CYP1A1; rs3745274, rs8192719, rs11673270, and rs707265 from CYP2B6) showed significant associations with pioglitazone absorption. These results showed that genetic makeup could affect the PK parameters and these informations could be provide information for personalized pioglitazone therapy.

Fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro / 대한치과교정학회지

OBJECTIVE: To analyze the fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro. METHODS: Roots of human mandibular central incisors were covered with silicone, mimicking the periodontal ligament, and embedded in polymethylmethacrylate. The specimens (N = 50), with two teeth each, were randomly divided into five groups (n = 10/group) according to the retainer materials: (1) Interlig (E-glass), (2) everStick Ortho (E-glass), (3) DentaPreg Splint (S2-glass), (4) Ribbond (polyethylene), and (5) Quad Cat wire (stainless steel). After the recommended adhesive procedures, the retainers were bonded to the teeth by using flowable composite resin (Tetric Flow). The teeth were subjected to 10,00,000 cyclic loads (8 Hz, 3 - 100 N, 45degrees angle, under 37 +/- 3degrees C water) at their incisoproximal contact, and debonding forces were measured with a universal testing machine (1 mm/min crosshead speed). Failure sites were examined under a stereomicroscope (x40 magnification). Data were analyzed by one-way analysis of variance. RESULTS: All the specimens survived the cyclic loading. Their mean debonding forces were not significantly different (p > 0.05). The DentaPreg Splint group (80%) showed the highest incidence of complete adhesive debonding, followed by the Interlig group (60%). The everStick Ortho group (80%) presented predominantly partial adhesive debonding. The Quad Cat wire group (50%) presented overlying composite detachment. CONCLUSIONS: Cyclic loading did not cause debonding. The retainers presented similar debonding forces but different failure types. Braided stainless steel wire retainers presented the most repairable failure type.

Monitor Preference for Electronic Medical Record in Outpatient Clinic / 대한의료정보학회지

OBJECTIVES: The objective of this paper is to assess which wide type monitor configurations are preferred when physicians use an Electronic Medical Record (EMR) system in an outpatient clinic setting. METHODS: We selected three kinds of monitor configurations available for adoption at outpatient clinics with reference to monitor market trends. Fifteen attending physicians of the Seoul National University Bundang Hospital used each monitor configuration in their outpatient clinics. After completing the outpatient sessions, they selected the best monitor configuration for criteria described in five questionnaire items. We counted the number of votes and reviewed opinions of participants. RESULTS: The Wide Quad High Definition (WQHD) 27-inch single monitor configuration was most preferred for all questionnaire items. All participants answered that the WQHD 27-inch single monitor configuration was the best for desk space utilization. Eleven out of fifteen participants chose the WQHD 27-inch single monitor configuration as the most suitable monitor for outpatient practice. CONCLUSIONS: This study found that physicians preferred the WQHD 27-inch single monitor configuration in outpatient clinic settings. Healthcare organizations need to consider this finding when they purchase wide type monitors for EMR systems instead of the standard type monitor.

The Differences in Second Trimester Quad Test Markers in Patients with Severe Preeclampsia Depending on the Disease Onset Time and the Presence of Fetal Growth Restriction / 대한주산의학회잡지

OBJECTIVE: To compare the differences in the second trimester Quad test markers in patients who subsequently developed preeclampsia depending on the disease onset time and the presence of fetal growth restriction (FGR). METHODS: A retrospective study was carried out on 66 women with severe preeclampsia and 345 controls who were delivered at Dong-A University hospital and Ilsin Christian Hospital from January 2006 to December 2008. Severe preeclampsia patients were grouped according to with (n=30) or without (n=36) FGR. Severe preeclampsia patients were also grouped according to early onset (n=16) or late onset (n=50) The levels of the second trimester human chorionic gonadotropin (hCG), inhibin-A, unconjugated estriol (uE3), alpha-fetoprotein (AFP) were compared in each group. RESULTS: In the pregnancies that subsequently developed severe preeclampsia, the second trimester hCG, inhibin-A and AFP were significantly higher than the controls. We found that levels of hCG, inhibin-A in severe preeclampsia complicated by FGR were significantly higher than those without FGR. We also found that levels of AFP and inhibin-A in early onset severe preeclampsia were significantly higher than late onset severe preeclampsia. CONCLUSION: The levels of second trimester Quad test markers in patients that subsequently developed severe preeclampsia were different according to with or without FGR and onset time.

Treatment of transverse deficiency with surgically assisted rapid palatal expansion in an open bite patient showing pseudomacroglossia

Anterior open bite is a condition in which maxillary and mandibular incisors do not occlude at central occlusion. It is a vertical discrepancy of the jaws and dental arches that has many etiologic factors making it difficult in diagnosis, treatment and prediction of prognosis. One of the causes of open bite is abnormal size and shape of the tongue. Macroglossia, a condition in which tongue is oversized, is caused by several factors which are not clearly identifiable, and it may be a major factor of anterior and posterior open bite. Macroglossia is subdivided into true, functional and pseudomacroglossia depending on its relative size in the oral cavity. In this case report, a patient was diagnosed as skeletal Class II with pseudomacroglossia, and was treated with SARPE in order to expand the narrowed maxillary arch and quad helix for the mandibular arch. As a result the transverse deficiency was treated. In the adult patients where no skeletal growth is expected, SARPE has shown to be effective in treating maxillomandibular transverse discrepancies in which macroglossia was accompanied as in this case.

The association between adverse pregnancy outcomes and the serum inhibin A levels in mid-trimester of gestation / 대한산부인과학회지

OBJECTIVES: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. METHODS: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. RESULTS: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. CONCLUSIONS: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.

The recent trend of prenatal screening

Twenty years have passed since a prenatal screening for Down syndrome and neural tube defect was applied to obstetric field. The Quad test (AFP, hCG, uE3, Inhibin-A) of the second trimester and the combination test (PAPP-A, hCG, NT) of the first trimester became popular now. The recent trend of prenatal screening is to combine these two screening tests together in order to increase a detection rate of Down syndrome. Three types of screening methods are introduced as follows; integrated test, sequential test and contingent test. In addition to combination of each test, an incorporation of characteristic ultrasound findings of Down syndrome is suggested for its risk calculation. The absence of fetal nasal bone would be a very useful marker especially in the first trimester screening test. According to a change of way calculating risk of Down syndrome, obstetrician's role will be more increased not by passive participation, but by active participation using ultrasound in risk calculation.

Angle's Class II Division 2 Malocclusion Treated by Bioprogressive Mechanism: Report of a Case / 영남의대학술지

A 25 year and 7 month old man patient who had Angle's class II division 2 malocclusion combined with anterior crowding of upper & lower part was treated by bioprogressive mechanism. After setting out objectives through the use of V. T. O., we programmed a sequence of mechanic. The possible objectives of treatment in the class II division 2 malocclusion can be listed as follows. 1) Relief of crowding & irregularities. 2) Relief of anterior gingival trauma & correction of interincisal inclination. 3) Correction of buccal segment relationship We'd applied the class II intermaxillary elastics, Quad helix, utility arch wire and sectional arch wire in order to achieve anticipated objectives. As compared with pre & post treatment cephalogram, the result accomplished by this mechanics showed to us that interincisal angle was improved and favorable molar relationship was achieved.