A prospective randomized trial comparing hypofractionation with conventional fractionation radiotherapy for T1-2 glottic squamous cell carcinomas: Results of a Korean Radiation Oncology Group (KROG-0201) study
Moon S.H.,Research Institute and Hospital |
Cho K.H.,Research Institute and Hospital |
Chung E.J.,Ilsan Hospital |
Lee C.G.,Yonsei University |
And 7 more authors.
Radiotherapy and Oncology | Year: 2014
Background and purpose To prospectively investigate the effect of radiotherapy fraction size on clinical outcomes in early glottic carcinoma Methods and materials Patients with T1-2 glottic carcinoma were eligible for the protocol. Although 282 patients were required, the study was closed prematurely due to poor accrual with only 156 patients. Of these, 82 patients were allocated to conventional fractionation (CONV) arm (66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2), with 74 patients to hypofractionation (HYPO) arm (63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2) the primary objective was local progression-free survival (LPFS). Results With a median follow-up of 67 months (range, 2-122 months), the 5-year LPFS was 77.8% for CONV arm and 88.5% for HYPO arm (HR 1.55, p = 0.213). No significant difference was observed in the toxicity profile between the two arms. In a subgroup exploratory analysis for T1a disease, the 5-year LPFS trended positively in HYPO arm (76.7% vs. 93.0%, HR 3.65, p = 0.056). Conclusions Given that HYPO is at least not inferior to CONV with a similar toxicity profile, the hypofractionation scheme used in this study can be offered to patients with T1-2 glottic carcinoma with potential advantages in terms of local control and a shortened overall treatment time. © 2013 Elsevier Ireland Ltd. All rights reserved.
Rim T.H.,Yonsei University |
Kim D.W.,Ilsan Hospital |
Han J.S.,Yonsei University |
Chung E.J.,Ilsan Hospital and 100 Ilsan ro
Ophthalmology | Year: 2015
Purpose To evaluate the risk of stroke development after retinal vein occlusion (RVO). Design Nationwide, population-based 9-year longitudinal study. Participants National registry data were collected from the Korean National Health Insurance Research Database, comprising 1 025 340 (∼2.2%) random subjects who were selected from 46 605 433 Korean residents in 2002. Methods Patients diagnosed with RVO or stroke in 2002 were excluded. The RVO group was composed of patients with an initial diagnosis of central or branch RVO between January 2003 and December 2005 (n = 344 in 2003, 375 in 2004, and 312 in 2005). The comparison group was composed of randomly selected patients (5 per patient with RVO; n = 1696 in 2003, 1854 in 2004, and 1524 in 2005) who were matched to the RVO group according to age, sex, residential area, household income, and year of RVO diagnosis. Each sampled patient was tracked until 2010. Cox proportional hazard regressions were used to calculate the overall survival rate for stroke development after adjusting for potential confounders, including hypertension, diabetes mellitus, and chronic kidney disease. Main Outcome Measures Retinal vein occlusion and ischemic or hemorrhagic stroke based on the International Classification of Disease codes. Results Stroke developed in 16.8% of the RVO group and in 10.7% of the comparison group. Retinal vein occlusion was associated with an increased risk of stroke development (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.76). Hypertension, diabetes mellitus, and chronic kidney disease also increased the risk of stroke development. In addition, RVO increased the risk of both ischemic stroke (HR, 1.51; 95% CI, 1.24-1.84) and hemorrhagic stroke (HR, 1.30; 95% CI, 0.83-2.05), although this result was not significant for hemorrhagic stroke. In terms of age, the effect size of the HR was largest among younger adults, aged <50 years (HR, 2.69), compared with middle-aged adults, aged 50 to 69 years (HR, 1.33), and older adults, aged ≥70 years (HR, 1.46). Conclusions Retinal vein occlusion was significantly associated with stroke development after adjusting for potential confounders. These findings are limited by uncontrolled confounding and need to be replicated by other observational studies. © 2015 American Academy of Ophthalmology.
Kwon O.,Yonsei University |
Song Y.D.,Ilsan Hospital |
Kim S.Y.,Seoul National University |
Lee E.J.,Yonsei University
Clinical Endocrinology | Year: 2013
Context It was previously reported in Korea that there were 1.4 case per million per year of acromegaly. This was low in comparison with the extrapolated values of Western European countries. We expected that the incidence of acromegaly would be much higher now because of recently improved medical facilities, diagnostic tools and coverage of medical insurance to all the population of South Korea. Objective The purpose of this nationwide survey was to examine the incidence and prevalence of patients with acromegaly, mode of treatment and outcome of surgical treatment of recent 5 years. Design and patients We requested and collected the medical records of all possible patients with acromegaly from 74 secondary or tertiary medical institutes in Korea from 2003 to 2007 retrospectively. Measurements Date of diagnosis and treatment, tumour size, pre- and postoperative hormonal level, treatment modality and usage of medication were collected. Results: During 5 years, 1350 patients with acromegaly had been registered. The average annual incidence was 3.9 cases per million during this period, and prevalence had increased up to 27.9 cases per million in 2007. Male/female ratio was 1:1.2, and mean age at diagnosis was 44.1 years. Macroadenoma was dominant (82.9%). Transsphenoidal adenoidectomy was used the most as primary treatment (90.4%). Conclusions: This Korean acromegaly survey offers a realistic overview of the predominant epidemiological characteristics of acromegaly in Korea. Annual incidence was at a similar level with western countries. Efforts to diagnose and control the disease earlier are recommended. © 2012 Blackwell Publishing Ltd.
Lee K.,Samsung |
Namkoong K.,Yonsei University |
Choi W.-J.,Yonsei University |
Choi W.-J.,Ilsan Hospital |
Park J.Y.,Yonsei University
Comprehensive Psychiatry | Year: 2014
Objective Suicide in adolescents is a major problem worldwide. The purpose of this study was to identify differences in suicidal behaviors with respect to parental marital status. Methods The data used in this study were obtained from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) of middle and high school students in 2010. Using a national representative sample, this study analyzed data from 73,238 subjects. With respect to gender, the odds ratios of suicidal behavior were calculated based on the parental marital status, living situation, and family affluence scale (FAS). Results After adjusting for age, achievement, sadness, and substance use, the prevalence of suicidal ideation in adolescents with a remarried parent significantly increased among boys to 1.364 [95% confidence interval (CI) = 1.027-1.813] and among girls to 1.511 (95% CI = 1.215-1.879). The odds ratio of suicide attempts increased to 1.808 (95% CI = 1.119-2.923) for adolescent boys and to 1.947 (95% CI = 1.609-2.356) for adolescent girls. However, having a single parent did not affect the prevalence of suicidal ideation in either gender. In girls, as family affluence decreased, the odds ratio of suicidal ideation notably increased. For girls whose families were in a low tier of the FAS, the odds ratio of both suicidal ideation and suicide attempts increased. Conclusions Both boys and girls were more likely to report suicidal ideation and attempts after a parent's remarriage, whereas family affluence was inversely related to suicidal ideation and attempts in girls. © 2014 Elsevier Inc.
Park S.H.,Catholic University of Korea |
Byun J.-H.,Catholic University of Korea |
Choi S.-M.,Catholic University of Korea |
Lee D.-G.,Catholic University of Korea |
And 5 more authors.
BMC Infectious Diseases | Year: 2012
Background: The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has been increased not only in the hospital but also in the community worldwide. This study was aimed to characterize ESBL- producing E. coli isolates and to investigate the molecular epidemiology of community isolates in comparison with hospital isolates at a single center in Korea.Methods: A total of 142 ESBL-producing E. coli isolates were collected at Daejeon St Mary's Hospital in Korea from January 2008 to September 2009. The ESBLs were characterized by PCR sequencing using specific primers. The genetic relatedness was determined by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).Results: Of 142 isolates, 139 were positive for CTX-M type ESBLs; CTX-M-14 (n = 69, 49.6 %), CTX-M-15 (n = 53, 38.1 %) and both CTX-M-14 and -15 (n = 17, 12.2 %). CTX-M-14 and CTX-M-15 were detected in both community and hospital isolates whereas isolates producing both CTX-M14 and-15 were mainly identified in the hospital. CTX-M producing E. coli isolates were genetically heterogeneous, revealing 75 distinct PFGE types. By MLST, 21 distinctive STs including 5 major STs (ST131, ST405, ST38, ST10, and ST648) were identified. Major STs were distributed in both community and hospital isolates, and ST131 was the predominant clone regardless of the locations of acquisition. No specific major STs were confined to a single type of ESBLs. However, ST131 clones were significantly associated with CTX-M-15 and the majority of them were multidrug-resistant. Distinctively, we identified a hospital epidemic caused by the dissemination of an epidemic strain, ST131-PFGE type 10, characterized by multidrug resistance and co-producing both CTX-Ms with OXA-1 or TEM-1b.Conclusions: The epidemiology of ESBL-producing E. coli is a complex and evolving phenomenon attributed to the horizontal transfer of genetic elements and clonal spread of major clones, predominantly ST131. The multidrug resistant ST131 clone producing CTX-M-15 has emerged as a major clone in both the community and hospital, suggesting the widespread of this epidemic clone in Korea. © 2012 Park et al.; licensee BioMed Central Ltd.
Lee Y.,University of Utah |
Nam H.Y.,University of Utah |
Kim J.,University of Utah |
Lee M.,University of Utah |
And 5 more authors.
Molecular Therapy | Year: 2012
Erythropoiesis-stimulating agents are widely used to treat anemia for chronic kidney disease (CKD) and cancer, however, several clinical limitations impede their effectiveness. Nonviral gene therapy systems are a novel solution to these problems as they provide stable and low immunogenic protein expression levels. Here, we show the application of an arginine-grafted bioreducible poly(disulfide amine) (ABP) polymer gene delivery system as a platform for in vivo transfer of human erythropoietin plasmid DNA (phEPO) to produce long-term, therapeutic erythropoiesis. A single systemic injection of phEPO/ABP polyplex led to higher hematocrit levels over a 60-day period accompanied with reticulocytosis and high hEPO protein expression. In addition, we found that the distinct temporal and spatial distribution of phEPO/ABP polyplexes contributed to increased erythropoietic effects compared to those of traditional EPO therapies. Overall, our study suggests that ABP polymer-based gene therapy provides a promising clinical strategy to reach effective therapeutic levels of hEPO gene. © The American Society of Gene & Cell Therapy.
Kim J.-K.,Yonsei University |
Kim J.H.,Ilsan Hospital |
Lee S.C.,Catholic Kwandong University |
Kang E.W.,Ilsan Hospital |
And 11 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2012
Background and objectives: Nephrotic syndrome (NS) is a raremanifestation of IgA nephropathy (IgAN). Clinical characteristics and long-term outcomes of this condition have not yet been explored. Design, setting, participants, & measurements: A multicenter observational study was conducted between January 2000 and September 2010 in 1076 patients with biopsy-proven IgANfromfourmedical centers in Korea. The primary outcome was a doubling of the baseline serum creatinine concentration. ResultsOf the 1076 patients, 100 (10.2%) presentedwithNS; complete remission (CR), partial remission (PR), and no response (NR) occurred in 48 (48%), 32 (32%), and 20 (20%) patients, respectively. During the median follow-up of 45.2 months, 24 patients (24%) in the NS group reached the primary endpoint compared with 63 (7.1%) in the non-NS group (P < 0.001). The risk of reaching the primary endpoint was significantly higher in the PR (P=0.04) and NR groups (P < 0.001) than in the CR group. Among patients with NS, 24 (24%) underwent spontaneous remission (SR). SR occurred more frequently in female patients and in patients with serum creatinine levels ≤1.2mg/dl and a >50%decrease in proteinuriawithin 3 months after NS onset.None of the patients with SR reached the primary endpoint and they had fewer relapses during follow-up. Conclusions: This study demonstrated that the prognosis of NS in IgAN was not favorable unless PR or CR was achieved. In addition, SR was more common than expected, particularly in patients with preserved kidney function and spontaneous decrease in proteinuria shortly after NS onset. © 2012 by the American Society of Nephrology.
Lee S.,Yonsei University |
Kim D.-K.,Ilsan Hospital |
Narm K.S.,Yonsei University |
Cho S.-H.,Yonsei University
Korean Journal of Thoracic and Cardiovascular Surgery | Year: 2011
A 43-year-old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment. Emergency one-stage operation for coincidental removal of intra-abdominal, right atrial, and intravenous masses were planned. Upon arriving at the operating room, she suffered a sudden onset of severe dyspnea and showed hemodynamic instability. Intraoperative TEE showed pulmonary embolization of a right atrial mass. Removal of the pulmonary artery mass and the intra-abdominal mass, and the cardiopulmonary bypass were performed without any complications. © The Korean Society for Thoracic and Cardiovascular Surgery. 2011.
Cho B.Y.,Ilsan Hospital |
Murovic J.,Stanford University |
Park K.W.,Kwanghye Hospital |
Park J.,Stanford University
Journal of Neurosurgery: Spine | Year: 2010
Biological attempts at disc regeneration are promising; however, disc degeneration is closely related to other predisposing factors such as alteration of disc height, intradiscal pressure, load distribution, and motion. The restoration of the physiological status of the affected spinal segment is thus necessary prior to attempts at disc regeneration. Dynamic stabilization systems now offer the potential of a mechanical approach to intervertebral disc regeneration. The authors used decompression and placement of the BioFlex dynamic stabilization device to treat a young male patient with disc degeneration. This patient underwent follow-up, and he was found to gradually improve both neurologically and radiographically. On MR imaging performed 1 year postoperatively, he had an increase in disc height and disc rehydration. This case and the concept of disc rehydration are presented in this paper.
Chang T.I.,Ilsan Hospital |
Kang E.W.,Ilsan Hospital |
Lee Y.K.,Ilsan Hospital |
Shin S.K.,Ilsan Hospital
PLoS ONE | Year: 2013
Background and Aims: Although a number of studies have been published on peritoneal protein clearance (PrCl) and its association with patient outcomes, the results have been inconsistent. Therefore, the intent of this study was to evaluate the impact of PrCl on cardiovascular disease (CVD) and mortality in peritoneal dialysis (PD) patients. Methods: This prospective observational study included a total of 540 incident patients who started PD at NHIC Ilsan Hospital, Korea from January 2000 to December 2009. Two different types of analyses such as intention-to-treat and as-treated were used. Results: Correlation analyses revealed that PrCl was positively correlated with diabetes, pulse pressure, C-reactive protein (CRP) level, dialysate/plasma creatinine ratio (D/P cr) at 4 h, and peritoneal Kt/V urea. PrCl was inversely correlated with serum albumin and triglyceride levels. On multivariate analysis, serum albumin, pulse pressure, D/P cr at 4 h, and peritoneal Kt/V urea were found to be independent determinants of PrCl. A total of 129 (23.9%) patients in intention-to-treat analysis and 117 (21.7%) patients in as-treated analysis developed new cardiovascular events. Time to occurrence of cardiovascular event was significantly longer in patients with a value of PrCl below the median (89.4 ml/day). In multivariate analysis, older age, presence of diabetes or previous CVD, and higher PrCl were independent predictors of cardiovascular events. Patients above the median value of PrCl had a significantly lower rate of survival than those below the median. However, a higher PrCl was not associated with increased mortality in multivariate Cox analysis. Conclusions: A higher PrCl is a risk for occurrence of cardiovascular event, but not mortality in PD patients. Large randomized clinical trials are warranted to confirm this finding. © 2013 Chang et al.