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Purpose@#The integration of artificial intelligence (AI) and magnetic resonance imaging in rectal cancer has the potential to enhance diagnostic accuracy by identifying subtle patterns and aiding tumor delineation and lymph node assessment. According to our systematic review focusing on convolutional neural networks, AI-driven tumor staging and the prediction of treatment response facilitate tailored treatment strategies for patients with rectal cancer. @*Methods@#This paper summarizes the current landscape of AI in the imaging field of rectal cancer, emphasizing the performance reporting design based on the quality of the dataset, model performance, and external validation. @*Results@#AI-driven tumor segmentation has demonstrated promising results using various convolutional neural network models. AI-based predictions of staging and treatment response have exhibited potential as auxiliary tools for personalized treatment strategies. Some studies have indicated superior performance than conventional models in predicting microsatellite instability and KRAS status, offering noninvasive and cost-effective alternatives for identifying genetic mutations. @*Conclusion@#Image-based AI studies for rectal cancer have shown acceptable diagnostic performance but face several challenges, including limited dataset sizes with standardized data, the need for multicenter studies, and the absence of oncologic relevance and external validation for clinical implantation. Overcoming these pitfalls and hurdles is essential for the feasible integration of AI models in clinical settings for rectal cancer, warranting further research.
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Colorectal cancer (CRC) is a globally prevalent and challenging malignancy. Accurate prognosis prediction is essential for optimizing patient care. This comprehensive review discusses the intricate relationships between inflammatory response markers and CRC prognosis. Inflammatory response markers have gained prominence as a prognostic tool. Elevations in the preoperative neutrophillymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein-albumin ratio predict a poor prognosis for patients with CRC. A decreased lymphocyte-monocyte ratio is also a poor prognostic factor. A high Glasgow prognostic score and a high modified Glasgow prognostic score are associated with adverse outcomes, including reduced survival. While significant progress has been made, challenges remain in standardizing the clinical application of these inflammatory response markers.Prospective research and further investigations are warranted to refine the prognostic models.Enhanced understanding and utilization of these inflammatory response markers will help advance personalized treatment strategies, refine surveillance protocols, and improve the management of CRC.
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Objective@#The prognostic value of the volume and density of skeletal muscles in the abdominal waist of patients with colon cancer remains unclear. This study aimed to investigate the association between the automated computed tomography (CT)-based volume and density of the muscle in the abdominal waist and survival outcomes in patients with colon cancer. @*Materials and Methods@#We retrospectively evaluated 474 patients with colon cancer who underwent surgery with curative intent between January 2010 and October 2017. Volumetric skeletal muscle index and muscular density were measured at the abdominal waist using artificial intelligence (AI)-based volumetric segmentation of body composition on preoperative pre-contrast CT images. Patients were grouped based on their skeletal muscle index (sarcopenia vs. not) and muscular density (myosteatosis vs. not) values and combinations (normal, sarcopenia alone, myosteatosis alone, and combined sarcopenia and myosteatosis). Postsurgical disease-free survival (DFS) and overall survival (OS) were analyzed using univariable and multivariable analyses, including multivariable Cox proportional hazard regression. @*Results@#Univariable analysis showed that DFS and OS were significantly worse for the sarcopenia group than for the nonsarcopenia group (P = 0.044 and P = 0.003, respectively, by log-rank test) and for the myosteatosis group than for the nonmyosteatosis group (P < 0.001 by log-rank test for all). In the multivariable analysis, the myosteatotic muscle type was associated with worse DFS (adjusted hazard ratio [aHR], 1.89 [95% confidence interval, 1.25–2.86]; P = 0.003) and OS (aHR, 1.90 [95% confidence interval, 1.84–3.04]; P = 0.008) than the normal muscle type. The combined muscle type showed worse OS than the normal muscle type (aHR, 1.95 [95% confidence interval, 1.08–3.54]; P = 0.027). @*Conclusion@#Preoperative volumetric sarcopenia and myosteatosis, automatically assessed from pre-contrast CT scans using AI-based software, adversely affect survival outcomes in patients with colon cancer.
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Optical neuroimaging provides an effective neuroscience tool for multi-scale investigation of the neural structures and functions, ranging from molecular, cellular activities to the inter-regional connectivity assessment. Amongst experimental preparations, the implementation of an artificial window to the central nervous system (CNS) is primarily required for optical visualization of the CNS and associated brain activities through the opaque skin and bone. Either thinning down or removing portions of the skull or spine is necessary for unobstructed long-term in vivo observations, for which types of the cranial and spinal window and applied materials vary depending on the study objectives. As diversely useful, a window can be designed to accommodate other experimental methods such as electrophysiology or optogenetics. Moreover, auxiliary apparatuses would allow the recording in synchrony with behavior of large-scale brain connectivity signals across the CNS, such as olfactory bulb, cerebral cortex, cerebellum, and spinal cord. Such advancements in the cranial and spinal window have resulted in a paradigm shift in neuroscience, enabling in vivo investigation of the brain function and dysfunction at the microscopic, cellular level. This Review addresses the types and classifications of windows used in optical neuroimaging while describing how to perform in vivo studies using rodent models in combination with other experimental modalities during behavioral tests. The cranial and spinal window has enabled longitudinal examination of evolving neural mechanisms via in situ visualization of the brain. We expect transformable and multi-functional cranial and spinal windows to become commonplace in neuroscience laboratories, further facilitating advances in optical neuroimaging systems.
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The complexity in the molecular mechanism of the internal anal sphincter (IAS) limits preclinical or clinical outcomes of fecal incontinence (FI) treatment. So far, there are no systematic reviews of IAS translation and experimental studies that have been reported. This systematic review aims to provide a comprehensive understanding of IAS critical role in FI. Previous studies revealed the key pathway for basal tone and relaxation of IAS in different properties as follows; calcium, Rho-associated, coiled-coil containing serine/threonine kinase, aging-associated IAS dysfunction, oxidative stress, renin-angiotensin-aldosterone, cyclooxygenase, and inhibitory neurotransmitters. Previous studies have reported improved functional outcomes of cellular treatment for regeneration of dysfunctional IAS, using various stem cells, but did not demonstrate the interrelationship between those results and basal tone or relaxation-related molecular pathway of IAS. Furthermore, these results have lower specificity for IAS-incontinence due to the included external anal sphincter or nerve injury regardless of the cell type. An acellular approach using bioengineered IAS showed a physiologic response of basal tone and relaxation response similar to human IAS. However, in both cellular and acellular approaches, the lack of human IAS data still hampers clinical application. Therefore, the IAS regeneration presents more challenges and warrants more advances.
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Cancer immunotherapy, in the form of vaccination, adoptive cellular transfer, or immune checkpoint inhibitors, has emerged as a promising practice within the field of oncology. However, despite the developing field's potential to revolutionize cancer treatment, the presence of immunotherapeutic-resistant tumor cells in many patients present a challenge and limitation to these immunotherapies. These cells not only indicate immunotherapeutic resistance, but also show multi-modal resistance to conventional therapies, abnormal metabolism, stemness, and metastasis. How can immunotherapeutic-resistant tumor cells render multi-malignant phenotypes? We reasoned that the immune-refractory phenotype could be associated with multi-malignant phenotypes and that these phenotypes are linked together by a factor that acts as the master regulator. In this review, we discussed the role of the embryonic transcription factor NANOG as a crucial master regulator we named “common factor†in multi-malignant phenotypes and presented strategies to overcome multi-malignancy in immunotherapeutic-resistant cancer by restraining the NANOG-mediated multi-malignant signaling axis. Strategies that blunt the NANOG axis could improve the clinical management of therapy-refractory cancer.
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Cancer immunotherapy, in the form of vaccination, adoptive cellular transfer, or immune checkpoint inhibitors, has emerged as a promising practice within the field of oncology. However, despite the developing field's potential to revolutionize cancer treatment, the presence of immunotherapeutic-resistant tumor cells in many patients present a challenge and limitation to these immunotherapies. These cells not only indicate immunotherapeutic resistance, but also show multi-modal resistance to conventional therapies, abnormal metabolism, stemness, and metastasis. How can immunotherapeutic-resistant tumor cells render multi-malignant phenotypes? We reasoned that the immune-refractory phenotype could be associated with multi-malignant phenotypes and that these phenotypes are linked together by a factor that acts as the master regulator. In this review, we discussed the role of the embryonic transcription factor NANOG as a crucial master regulator we named “common factor†in multi-malignant phenotypes and presented strategies to overcome multi-malignancy in immunotherapeutic-resistant cancer by restraining the NANOG-mediated multi-malignant signaling axis. Strategies that blunt the NANOG axis could improve the clinical management of therapy-refractory cancer.
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Cancer immunotherapy, in the form of vaccination, adoptive cellular transfer, or immune checkpoint inhibitors, has emerged as a promising practice within the field of oncology. However, despite the developing field's potential to revolutionize cancer treatment, the presence of immunotherapeutic-resistant tumor cells in many patients present a challenge and limitation to these immunotherapies. These cells not only indicate immunotherapeutic resistance, but also show multi-modal resistance to conventional therapies, abnormal metabolism, stemness, and metastasis. How can immunotherapeutic-resistant tumor cells render multi-malignant phenotypes? We reasoned that the immune-refractory phenotype could be associated with multi-malignant phenotypes and that these phenotypes are linked together by a factor that acts as the master regulator. In this review, we discussed the role of the embryonic transcription factor NANOG as a crucial master regulator we named “common factor” in multi-malignant phenotypes and presented strategies to overcome multi-malignancy in immunotherapeutic-resistant cancer by restraining the NANOG-mediated multi-malignant signaling axis. Strategies that blunt the NANOG axis could improve the clinical management of therapy-refractory cancer.
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Humanos , Inmunoterapia , Metabolismo , Metástasis de la Neoplasia , Fenotipo , Factores de Transcripción , VacunaciónRESUMEN
BACKGROUND/AIMS@#We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern.@*METHODS@#All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively.@*RESULTS@#During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population.@*CONCLUSIONS@#Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.
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BACKGROUND/AIMS: We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern. METHODS: All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively. RESULTS: During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population. CONCLUSIONS: Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.
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Anciano , Humanos , Antibacterianos , Carbapenémicos , Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas , Hospitalización , Hospitales de Enseñanza , Cuidados a Largo Plazo , Mortalidad , Oportunidad Relativa , Prescripciones , República de Corea , Estudios Retrospectivos , Factores de Riesgo , SeúlRESUMEN
Streptococcus dysgalactiae has two main subspecies: S. dysgalactiae subsp. equisimilis (SDSE) and S. dysgalactiae subsp. dysgalactiae (SDSD). SDSE often colonizes and causes infections in humans; however, SDSD is an animal pathogen which often causes pyogenic infection in domestic animals. We present a case of meningitis with SDSD and herpes simplex virus in a 22-day-old newborn baby who had no exposure to animals.
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Animales , Humanos , Recién Nacido , Animales Domésticos , Bacterias , Colon , Herpes Simple , Meningitis , Simplexvirus , Infecciones Estreptocócicas , StreptococcusRESUMEN
Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.
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Humanos , Masculino , Persona de Mediana Edad , Aorta , Arterias , Atletas , Colágeno , Consenso , Extremidades , Dolor en el Flanco , Arteria Ilíaca , Historia Natural , Stents , Enfermedades VascularesRESUMEN
Even though several techniques are available for repairing lower extremity skin defects, it is hard to challenge the advantages of local flaps (advancement, rotation, or transposition) due to lack of skin laxity of lower extremities. Modified keystone flap (MKF) is a simple and effective method of closing a large skin defect. It is especially useful for wound closure in circumstances where the defects show limited skin laxity. Compared to the keystone flap (KF), MKF has many advantages, including quick healing time, high flap viability, minimal postoperative pain, and excellent aesthetic results. Here, we report two cases of reconstruction of large skin defects of the lower extremities using MKF with satisfactory results.
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Extremidad Inferior , Métodos , Dolor Postoperatorio , Piel , Heridas y LesionesRESUMEN
Cowden Syndrome (CS) is a rare genodermatosis of autosomal-dominant inheritance, with variable expressivity and multiple types of hamartomas. The most consistent features of CS are small wart-like papillomatous papules on the face, hands, and mouth. A 31-year-old woman presented with a history of pearly papules on the face, hand, and foot for several years. The lesions were initially diagnosed as warts, and treated accordingly, but they did not subside. There was a history of endometrial cancer, breast cancer, and thyroid nodule, and her father had a history of thyroid cancer. A biopsy specimen from the facial papule showed plate-like growth of anastomosing epithelial cords, extending parallel to the epidermis. It was diagnosed as a tumor of the follicular infundibulum (TFI). The patient refused further treatment. Here, we report a rare case of CS presenting with TFI.
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Adulto , Femenino , Humanos , Biopsia , Neoplasias de la Mama , Neoplasias Endometriales , Epidermis , Padre , Pie , Hamartoma , Síndrome de Hamartoma Múltiple , Mano , Boca , Hipófisis , Neoplasias de la Tiroides , Nódulo Tiroideo , Verrugas , TestamentosRESUMEN
PURPOSE: As 5-fluorouracil (5-FU) has previously exhibited antitumor activity and few adverse effects in the treatment of breast cancer, we aimed to specifically assess the benefits of orally administered 5-FU in hormone receptor-negative small breast cancer. METHODS: We retrospectively identified patients with pT1aN0 and hormone receptor-negative breast cancer who underwent surgery between 1993 and 2008 at Asan Medical Center. Patients were divided into two cohorts based on adjuvant doxifluridine (Didox; Shin Poong Pharm. Co., Ltd.) administration, and the disease-free survival (DFS) and cancer-specific survival (CSS) was assessed for each cohort. RESULTS: Both cohorts had similar ages and tumor sizes. The DFS and CSS did not significantly differ between the groups (p=0.399 and p=0.126, respectively). When the cohorts were assessed according to human epidermal growth factor receptor 2 (HER2) status, doxifluridine significantly improved DFS among patients with T1aN0 and HER2-positive breast cancer (p=0.037). CONCLUSION: Doxifluridine did not yield a significant reduction in DFS events in hormone receptor-negative early breast cancer. However, a clear benefit was observed in hormone receptor-negative, HER2-positive T1aN0 breast cancer patients.
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In patients with coronary artery disease, coronary stenting with a drug-eluting stent (DES) is associated with lower rates of in-stent restenosis and re-surgery for the target lesion compared with a bare metal stent, while late stent thrombosis has emerged as a life-threatening complication in patients treated with a first-generation DES. As no treatment has been established for potentially fatal late stent thrombosis associated with a first-generation DES, we perform drug balloon angioplasty for patients with stent thrombosis and in-stent restenosis associated with DES. Here, we reported the cases with normal coronary artery flow after a 2-year follow-up.
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Humanos , Angioplastia de Balón , Constricción Patológica , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Stents Liberadores de Fármacos , Estudios de Seguimiento , Stents , TrombosisRESUMEN
Central venous catheterization is frequently performed for perioperative management and intravenous access. However, the complications of central venous catheterization are numerous and include malposition, pneumothorax, hemothorax, chylothorax, thrombosis, extravasation of the infusate and infection. Although the malpositioning of the central venous catheter has been widely reported, there are few reports of ipsilateral subclavian vein catheterization via the right internal jugular venous route. In this case, we describe a misplacement of a right internal venous catheterization into the ipsilateral subclavian vein and suggest the possible causative factors.
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Cateterismo , Cateterismo Venoso Central , Catéteres , Catéteres Venosos Centrales , Quilotórax , Hemotórax , Neumotórax , Vena Subclavia , TrombosisRESUMEN
A 34-year-old female with multiple sclerosis (MS) was scheduled Cesarean section. She had been suffering from MS for 10 years and the symptoms of MS were paraplegia and urinary incontinence. After informed consent, anesthesia was induced with propofol and maintained with nitrous oxide, sevoflurane and fentanyl. Rocuronium was used for muscle relaxation and tracheal intubation. Train of four (TOF) ratio and bispectral index scale were monitored for adequate muscle relaxation and depth of anesthesia. She gave birth to a baby within 7 minutes after skin incision. When operation was over, TOF ratio was 0.8. She emerged from general anesthesia smoothly and was extubated. There was no febrile event or exacerbation of MS after Cesarean section under general anesthesia. We report a safe anesthetic management of the parturient with MS, using sevoflurane.