Tumor Mutational Burden and Efficacy of Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Tumor mutational burden (TMB) is a genomic biomarker that predicts favorable responses to immune checkpoint inhibitors (ICIs). Here, we set out to assess the predictive value of TMB on long-term survival outcomes in patients undergoing ICIs. We systematically searched PubMed, Embase, CENTRAL and clinicaltrials.gov from inception to 6 August 2019. We included retrospective studies or clinical trials of ICIs that reported hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) according to TMB. Data on 5712 patients from 26 studies were included. Among patients who received ICIs, high TMB groups showed better OS (HR 0.53, 95% CI 0.42 to 0.67) and PFS (HR 0.52, 95% CI 0.40 to 0.67) compared to low TMB groups. In patients with high TMB, those who received ICIs had a better OS (HR 0.69, 95% CI 0.50 to 0.95) and PFS (HR = 0.66, 95% CI = 0.47 to 0.92) compared to those who received chemotherapy alone, while in patients with low TMB, such ICI benefits of OS or PFS were not statistically significant. In conclusion, TMB may be an effective biomarker to predict survival in patients undergoing ICI treatment. The role of TMB in identifying patient groups who may benefit from ICIs should be determined in future randomized controlled trials.ope

Comparison of Early Clinical Outcomes Between ALTA (Aluminum Potassium Sulfate and Tannic Acid, Ziohn®) Injection Therapy and a Submucosal Hemorrhoidectomy in Patients with Internal Hemorrhoids

Purpose: The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid, Ziohn®) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids. Methods: From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV) were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared. Results: The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P<0.001). However, there was no significant difference in the satisfaction level between two groups. One case of treatment failure was found in the ALTA injection group. There was no difference in complications between the injection group (n=4) and the operation group (n=5) (P=0.725). Conclusion: When compared with a submucosal hemorrhoidectomy, ALTA injection showed less post-treatment pain and less analgesics use. Overall complication rates were not different between the two groups. We found the early outcomes of ALTA injection for the treatment of internal hemorrhoids to be comparable to those of surgery. Thus, large-scale and long-term follow-up studies are needed to clarify the proper indications for ALTA injection.ope

Changes in Body Composition During Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer

The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), -19% (p < 0.001), -3.4% (p = 0.936), and -11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at -2% and -2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest χ2 on the Mantel-Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15-0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14-0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.ope

악성 림프종에 의한 성인에서의 회맹부 장중첩증

Adult intussusception is rare but can prove to be challenging surgical situation. The etiology of adult intussusception is different from that of children, and because of the possibility of malignancy, surgical treatment is highly recommended. We present a case report of malignant lymphoma that caused ileocolic and colocolic intussusception in an adult. At first event of intussusception, the patient refused to undergo additional treatments due to improved symptoms. Three months later, the patient was transferred to our hospital due to recurrent and unresolved abdominal pain. The patient underwent a right hemicolectomy and was diagnosed with malignant B-cell lymphoma that involved the ileocecal valve. Physicians should consider malignancy as a potential cause of intussusception in adult, and should quickly provide adequate surgical intervention.ope

Long acupuncture needle broken in the abdomen

ope

Relationships between oral MUC1 expression and salivary hormones in burning mouth syndrome

학위논문 (박사)-- 서울대학교 대학원 치의학대학원 치의과학과, 2017. 8. 고홍섭.Objectives: Burning mouth syndrome (BMS) is a complex disease whose etiopathophysiology is still vague, but dysregulated psychoendocrinological mechanisms and altered oral mucosal integrity have been regarded as significant factors. The aim of this study was to investigate the relationships among oral mucosal epithelial MUC1 expression, salivary female gonadal hormones, stress markers, and oral symptoms in BMS patients. Materials and Methods: Thirty post-menopausal female patients with BMS (60.0 ± 5.0 years) were included. Clinical and psychological evaluations were performed and the expression level of oral mucosal epithelial MUC1 was analyzed. The levels of cortisol, dehydroepiandrosterone (DHEA), 17β-estradiol, progesterone, chromogranin A, and blood contamination were determined from unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) samples. Results: Salivary progesterone level had significant positive correlations with oral mucosal epithelial MUC1 expression level and with salivary cortisol and DHEA levels. The salivary level of 17β-estradiol showed significant positive correlations with period of symptom duration, severity of effects of oral complaints on daily life, and results from psychological evaluations. Cortisol level in UWS and cortisol/DHEA ratio in UWS and SWS had negative correlations with severity of oral burning sensation significantly. The severity of taste disturbance had positive correlations with results from psychometry significantly. Conclusions: Dysregulated psychoendocrinological interactions might affect oral mucosal MUC1 expression and severity of oral burning sensation in post-menopausal BMS patients.I. Introduction 1 II. Literature Review 3 III. Materials and methods 16 IV. Results 22 V. Discussion 26 References 33 Tables 55 Korean abstract 65Docto

Investigation of awareness with respect to hospitalist based on questionnaire by surgical residents and fellows in a single center

Purpose: Although the hospitalist which was first defined in USA at 1996 has been incorporated into a clinical activity in South Korea, adequate role of hospitalist is not established yet especially in the department of surgery. It is evident that the role of surgical residents or fellows are most influenced by the introduction of surgical hospitalist. However, the expectations of surgical residents or fellows on the role of the hospitalist has not been evaluated. Methods: This study was based on the questionnaire from surgical residents and fellows working at a single large center. Results: A total of 64 responders participated in this study. Most of the responders believe that certificate of internal medicine or family medicine is fit for the hospitalist. Most of the responders believe the obligatory limitation law of working hours for residents has not been kept well. The main reasons are overloading of working of residents or sustained operation schedules. They think that nurse practitioners or physical assistants may be of a help in partially, but, could not fully compensate for the work loading of residents. The most expected role of surgical hospitalist by residents or fellows is to replace the role of duty especially at night. The willingness to apply for surgical hospitalist after cessation of the training is low. This observation may suggest the concern of current uncertain surgical hospitalist’s role. Conclusion: This study demonstrates that the most expected role for surgical hospitalist by surgical residents and fellows is to replace the duty of night time.ope

Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.ope

Spontaneous reduction of small bowel herniation through the foramen of Winslow: importance of a timely approach

We present the case of young female patient presenting with acute onset abdominal pain. Abdominopelvic CT revealed herniation through the foramen of Winslow. The patient was transferred to our hospital and underwent laparoscopic exploration. Though spontaneous reduction was detected, segmental resection of the impacted small bowel was inevitable due to ischemic change. Our case suggests that reducing the time until surgery is very important to lower the probability of bowel resection in case of small bowel herniation through the foramen of Winslow.ope

임베디드 시스템 상의실시간 물체 인식을 위한동적 네트워크 선택 기법

학위논문 (석사)-- 서울대학교 대학원 : 공과대학 컴퓨터공학부, 2018. 8. 유승주.최근 딥러닝 기술이 비약적으로 발전함에 따라, 컴퓨터 비전 분야에 딥러닝 기술을 적용하여 큰 성공을 거두고 있다. 특히 이 중에서도 물체 인식의 경우 자율주행 자동차를 비롯한 다양한 임베디드 제품군에서 수요가 있어 각광을 받고 있다. 이에 따라 온-보드 물체 인식 기술은 최근 매우 중요한 이슈로 떠올랐다. 임베디드 시스템은 비용과 전력의 문제 때문에 컴퓨팅 파워가 적고, 메모리 크기가 작다는 제한점이 있다. 기존의 물체 인식 네트워크들의 경우 파라미터와 계산량이 많아 임베디드 시스템에 적합하지 않고, 따라서 이런 제약 조건 하에서 딥러닝을 이용한 물체 인식을 수행하기는 매우 어렵다. 본 논문은 딥러닝을 이용한 물체 인식 기술의 계산량을 줄이고, 임베디드 시스템 상에서 동작할 수 있도록 하는 동적 네트워크 선택 기법을 제안한다. 이미지와 영상 물체 인식 네트워크 각각에 대해 서로 다른 Q 학습 방법을 이용해 동적 네트워크 선택 기법을 학습시킴으로써 물체 인식 기술의 계산량을 줄였다. 그 결과 이미지, 영상 물체 인식의 두 가지 경우 각각 2.75, 2.5의 mAP 손실로 JETSON TX-2 상에서 2배의 속도 향상을 달성하였다.제 1장 서론 1 제 2장 관련연구 4 2.1 CNN 계산 최적화 4 2.2 기존 물체 인식 네트워크 6 2.3 Q 학습 8 제 3장 초소형 물체 인식 네트워크 생성 10 제 4장 강화 학습 기반 동적 네트워크 선택 기법 13 4.1 단순 Q 학습을 이용한 동적 네트워크 선택 기법 13 4.2 심층 Q 학습을 이용한 동적 네트워크 선택 기법 15 제 5 장 실험 및 결과 18 5.1 물체 인식 네트워크 학습 결과 18 5.2 단순 Q 학습 실험 결과 22 5.3 심층 Q 학습 실험 결과 22 제 6장 결론 26 참고 문헌 27 Abstact 30Maste