Comparison of Oncologic Outcomes Between Two Alternative Sequences with Abiraterone Acetate and Enzalutamide in Patients with Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis

Sequential treatment of androgen receptor axis targeted agents (ARAT), abiraterone acetate (ABI) and enzalutamide (ENZA), in metastatic castration-resistant prostate cancer (mCRPC) demonstrated some positive effects, but cross-resistances between ABI and ENZA that reduce activity have been suggested. Therefore, we conducted a meta-analysis to compare oncologic outcomes between the treatment sequences of ABI-ENZA and ENZA-ABI in patients with mCRPC. The primary endpoint was a combined progression-free survival (PFS), and the secondary endpoint was overall survival (OS). A total of five trials on 553 patients were included in this study. Each of the included studies was retrospective. In two studies including both chemo-naïve and post-chemotherapy mCRPC patients, for ABI-ENZA compared with ENZA-ABI, pooled hazard ratios (HRs) for PFS and OS were 0.37 (p < 0.0001; 95% confidence intervals (CIs), 0.23-0.60) and 0.64 (p = 0.10; 95% CIs, 0.37-1.10), respectively. In three studies with chemo-naïve mCRPC patients only, for ABI-ENZA compared with ENZA-ABI, pooled HRs for PFS and OS were 0.57 (p = 0.02; 95% CIs, 0.35-0.92) and 0.86 (p = 0.39; 95% CIs, 0.61-1.21), respectively. The current meta-analysis revealed that ABI-ENZA had a significantly more favorable oncological outcome, but the level of evidence was low. Therefore, large-scale randomized trials may be needed.ope

트랜스포머의 어텐션 스코어 조작에 관한 연구

학위논문(석사) -- 서울대학교대학원 : 데이터사이언스대학원 데이터사이언스학과, 2023. 2. 이재진.Although Korean has distinctly different features from English, attempts to find a new Transformer model that more closely matches Korean by reflecting them are insufficient. Among the characteristics of the Korean language, we pay special attention to the role of postpositions. Agglutinative languages have more freedom in word order than inflectional languages, such as English, thanks to the postpositions. This study is based on the hypothesis that the current Transformer is challenging to learn the postpositions sufficiently, which play a significant role in agglutinative languages such as Korean. In Korean, the postpositions are paired with the substantives, so paying more attention to the corresponding substantives seems reasonable compared to other tokens in the sentence. However, the current Transformer learning algorithm has many limitations in doing so. Accordingly, it is shown that the performance of the natural language understanding (NLU) task can be improved by deliberatively changing the attention scores between the postpositions and the substantives. In addition, it is hoped that this study will stimulate the research on new learning methods that reflect the characteristics of Korean.한국어는 영어와 분명히 다른 특성을 갖고 있지만 이를 Transformer에 반영하여 한국어에 보다 부합하는 새로운 모델을 찾는 시도는 그리 충분하지 않다. 본 연구에서는 한국어 특성 중에 특히 조사의 역할에 주목한다. 조사 덕분에 영어와 같은 굴절어에 비해 문장 내 단어 순서의 자유도가 높은 교착어라는 특성을 반영하여 Transformer의 attention score 계산 방법의 변경을 제안한다. 본 연구는 한국어와 같은 교착어에서 매우 중요한 역할을 하는 조사가 현재의 Transformer에서는 충분히 학습되기 어렵다는 가설에 바탕을 둔다. 한국어에서 조사는 해당 체언과 쌍으로 묶이므로 문장 내의 다른 token에 비해 해당 체언을 좀더 attention하는 것이 타당해 보이지만 현재의 Transformer 학습 방법으로는 한계가 많다는 의미이다. 이에 조사-체언 간의 attention score를 인위적으로 변화시킴으로써 NLU(Natural Language Understanding) 관련 자연어 처리 task의 성능을 높일 수 있음을 보인다. 아울러 한글 특성을 반영한 새로운 학습 방법에 관한 연구에 자극이 될 수 있기를 기대한다.Chapter 1. Introduction 1 Chapter 2. Related work ５ Chapter 3. Korean and Transformer 7 Chapter 4. Methodology ９ Chapter 5. Results and Analysis 15 Chapter 6. Future work 20 Chapter 7. Conclusion 21 Bibliography 22 Abstract in Korean 26석

위암 환자에서 각 구역별 림프절 전이율 예측 모델 구축

학위논문 (박사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 2. 양한광.Background and Aim The prediction of lymph node metastasis (LNM) on each lymph node (LN) station is important for tailored surgery. The aim of this study was to develop a prediction program which can calculate the probability of LNM according to LN stations in gastric cancer patients. Methods We retrospectively analyzed 4,660 patients who underwent gastrectomy for primary gastric cancer from 2003 to 2013 and the LN status was well examined in according to the LN stations, at Seoul National University Hospital. We reviewed preoperative endoscopic findings and/or gross pathologic findings, and reclassified the tumor locations by the endoscopic terms. All of the involved locations were included into the analysis. The variables which can get preoperatively were evaluated. Multiple logistic regression analysis was used to develop a LNM prediction model using whole data for each LN station. The performance of the prediction model was validated in terms of discrimination and calibration using a total of 200 bootstrap samples. Results The multiple analysis identified depth of tumor, gross type, involved locations as covariates associated with LNM. But the significant factors were somewhat different according to the LN stations. In the validation, the prediction equation exhibited good discrimination. Calibration plot of the prediction equation predicted LNM rate corresponding closely with the actual rate. Conclusions We developed a LNM prediction program on each LN stations. Validation revealed good discrimination and calibration, suggesting good clinical utility. The LNM prediction program improved individualized predictions of LNM of each LN stations.Introduction 1 Patients and Methods 4 Results 9 Discussion 14 Reference 19 Tables 22 Figures 38 국문초록 57Docto

Does an Alternative Sunitinib Dosing Schedule Really Improve Survival Outcomes over a Conventional Dosing Schedule in Patients with Metastatic Renal Cell Carcinoma? An Updated Systematic Review and Meta-Analysis

Treatment-related adverse events (AEs) can obfuscate the maintenance of a conventional schedule of sunitinib in patients with metastatic renal cell carcinoma. Accordingly, alternative schedules seeking to improve the safety profile of sunitinib have been tested. Recently, two meta-analyses similarly described improved safety profiles favoring a two weeks on and one week off (2/1) schedule, but with conflicting results for survival outcomes. Therefore, we conducted an updated systematic review and meta-analysis, including all recently published studies and using complementary statistical methods. Endpoints included progression-free survival, overall survival, and AEs of 15 types. Eleven articles were included in this meta-analysis. Using adjusted findings, we noted statistically better results in progression-free survival (hazard ratio, 0.58; 95% confidence interval, 0.39-0.84; p = 0.005), but no difference in overall survival (hazard ratio, 0.66; 95% confidence interval, 0.42-1.04; p = 0.08). Moreover, the 2/1 schedule was beneficial for reducing the incidence of several AEs. Conclusively, our meta-analysis suggests that the 2/1 schedule holds promise as an alternative means of reducing AEs and maintaining patient quality of life. While the survival outcomes of the 2/1 schedule seem also to be favorable, the level of evidence for this was low, and the interpretation of these findings should warrant caution. Large scale randomized trials are needed to support these results.ope

Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis

This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3-4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52-5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10-3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13-9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72-1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21-1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.ope

A Study on the Insured Perils of Fishing Vessel Insurance Clauses

Fishing vessel insurance of National Federation of Fisheries Cooperatives indemnifies the assured against marine losses by reason of maritime perils. This insurance contract is to indemnify the losses incurred by reason of perils of the seas, that is to say, sinking, stranding, collision, extraordinary action of winds waves and fire, damage, salvage. Therefore this insurance is a rational protective measures for preserving fishermen's property by the exposure to maritime perils. This insurance contract is embodied in fishing vessel insurance clauses and is effected between the assured, the fishermen and the insured, National Federation of Fisheries Cooperatives. But there may be some problems on the perils covered by fishing vessel insurance clauses because these clauses are not clearly and accurately prescribed in part. Especially where the assured may claim payment from fortuitous accidents or casualties of the seas causing the loss, they used to raise a question in argument about the ambiguity of these clauses. So these problems may need to be reformed for the purpose of preventing or decreasing those of the assured, the fishermen. After drawing out some problems on the perils covered by fishing vessel insurance clauses, this thesis will suggest the improving schemes on the perils covered by these clauses with studying Marine Insurance Act, 1906, hereinafter called MIA, Institute Time Clauses-Hulls, 1983, hereinafter called ITC-Hulls and P&I insurance. To research this, papers and books published at home and overseas are referred to and the practical experiences of the writers' taking charge of fishing vessel insurance work for about 20 years are helpfully added. Problems on the perils covered by these clauses are divided into both those against the insurance theory and those in these clauses. Problems of these clauses against the insurance theory are as follows : First, as the problems regarding the perils covered principle by maritime perils, these clauses are seemed to be adopted through the named-perils. But these clauses are not specifically designated by the perils covered, so it is difficult to judge whether the perils are insured against. Second, as the problems regarding the proximate cause and the reasonable cause, the former is expressed as 'caused by' and the latter is expressed as 'attributable to'. But this is not specifically designated, so causes confusion for interpretation of these clauses. Third, as the problems regarding warranty of seaworthiness, these clauses are not a voyage policy but a time policy. So the provisions of this section seem not to be suitable for a time policy. So, problems in these clauses are summarized as follows : First, as the problems regarding the term 'damage', these are embraced in the scope of perils. So this is not only suitable for the insurance theory but also perils insured against unnecessary misunderstanding of the assured about payment of claims may occur. Second, as the problems regarding the term 'loss', this means marine loss. This is not suitable for the provisions of this section because this includes several meanings, such as physical loss, expenses and collision liability. Third, as the problems regarding salvage charges and sue and labour charges, these are used same meaning. So the former seems to be payed in addition to claims paid like the latter, the meaning of these terms is confused. Fourth, as the problems regarding faults in respect of unlicensed master and chief engineer, and fishing vessel under 29 gross tons and fishing vessel over 30 gross tons are equally dealt with even though the former are pooler than the latter. Improving schemes on the perils covered by these clauses is divided into improving schemes and defects in these clauses. Improving schemes in these clauses are as follows : First, as improving schemes regarding the perils covered by principles of maritime perils, this will be obviously specified like the perils clauses of ITC-Hulls and expanded to be of great advantage to the fishermen. Second, as improving schemes regarding the proximate cause and the reasonable cause, in practice the latter seems to be adopted. A standard for causation needs to be established to avoid the confusion for interpretation of these clauses or for practice. Third, as improving schemes regarding warranty of seaworthiness, the provisions of this section shall be revised into the provision of MIA because this is unsuitable for a time policy. Also Article 17.3.1 and Article 17.4.1 which are warranty of legality shall be embraced in Article 17.1. Therefore the strict regulations as an implied warranty will be consistently preserved. Fourth, as improving schemes regarding 'damage', this term will be revised or deleted because this is not to be embraced in the scope of perils. Fifth, as improving schemes regarding the term 'loss', this term will be revised as 'loss or damage' because this is not suitable for the provisions of this section. Sixth, as improving schemes regarding salvage charges and sue and labour charges, these will be obviously specified not only by the concept but also the measure of indemnity. Seventh, as improving schemes regarding faults in respect of unlicensed master and chief engineer, this will be adjusted to be an advantage to a smaller fishing vessel. Improving defects in these clauses are as follows : First, the damage for 'violent theft by persons from outside the vessel' will be covered. Second, P&I insurance will be carried out for fishing vessel. For example, liabilities for non-contact damage, wreck removal and oil pollution will be covered these clauses. The offshore fishing vessel shall be undertaken to be insured by fishing vessel insurance in the near future. Finally, regarding improving defects in these clauses and to undertake the offshore fishing vessel, government must play an important role for the fishermen.第 1 章 序論 = 1 第 1 節 硏究의 目的 = 1 第 2 節 硏究의 方法 및 範圍 = 4 第 2 章 海上危險에 관한 理論的 考察 = 6 第 1 節 海上危險의 意義 = 6 第 2 節 海上危險의 擔保原則 = 7 1. 包括責任主義 = 7 2. 列擧責任主義 = 8 第 3 節 擔保危險과 免責危險 = 9 1. 擔保危險 = 10 2. 免責危險 = 10 3. 非擔保危險 = 11 第 4 節 近因主義 = 12 1. 意義 = 12 2. MIA, 1906上의 近因主義 = 14 3. ITC-Hulls, 1983上의 近因主義 = 17 第 3 章 ITC-Hulls, 1983上의 擔保危險 = 18 第 1 節 意義 = 18 第 2 節 相當注意義務를 要件으로 하지 않은 擔保危險 = 20 1. 約款의 規定 = 20 2. 擔保危險의 內容 = 21 第 3 節 相當注意義務를 要件으로 하는 擔保危險 = 28 1. 約款의 規定 = 28 2. 擔保危險의 內容 = 30 第 4 節 ITC-Hulls, 1983上의 免責危險 = 34 1. 戰爭危險免責 = 35 2. 同盟罷業危險免責 = 36 3. 惡意行爲免責 = 36 4. 核危險免責 = 37 第 4 章 P&I保險上의 擔保危險 = 39 第 1 節 意義 = 39 第 2 節 P&I保險上의 擔保危險 = 40 1. 사람과 關聯된 責任 = 41 2. 船舶과 關聯된 責任 = 42 3. 海洋還境과 關聯된 責任 = 44 第 3 節 P&I保險上의 免責危險 = 45 1. 戰爭危險免責 = 45 2. 核危險免責 = 45 3. 其他 免責危險 = 46 第 5 章 漁船保險約款上의 擔保危險 = 47 第 1 節 意義 = 47 第 2 節 海上固有의 危險 = 48 1. 沈沒 = 49 2. 坐礁 = 49 3. 衝突 = 50 4. 風波의 異常한 作用 = 59 第 3 節 其他 危險 = 59 1. 火災 = 59 2. 損傷 = 60 3. 救助 = 60 第 4 節 漁船保險約款上의 免責危險 = 64 1. 約款의 規定 = 65 2. 免責危險의 內容 = 67 第 5 節 特別約款에 의한 擔保危險 = 77 1. 被擊, 捕獲, 拿捕, 抑留危險 = 78 2. 漁具危險 = 78 3. 漁獲物補償 = 79 4. 實損補償 = 79 5. 保險契約期間 終了日延長 = 81 6. 機關單獨事故補償 = 81 第 6 章 漁船保險約款上 擔保危險의 問題點 및 改善方案 = 83 第 1 節 漁船保險約款上 擔保危險의 問題點 = 83 1. 保險理論上의 問題點 = 83 2. 約款上의 問題點 = 94 第 2 節 漁船保險約款上 擔保危險의 改善方案 = 99 1. 約款上의 改善方案 = 99 2. 約款上의 未備點에 대한 改善方案 = 103 第 3 節 遠洋漁船에 대한 漁船保險 引受 = 109 第 7 章 結論 = 111 1. 硏究結果의 要約과 示唆點 = 111 2. 硏究의 限界와 向後 硏究方向 = 115 參考文獻 = 11

합리적 수자원 배분모형 설정에 관한 연구(Design of water allocation model)

노트 : 이 연구보고서의 내용은 국토연구원의 자체 연구물로서 정부의 정책이나 견해와는 상관없습니다

Prognostic factors of second and third line chemotherapy using 5-fu with platinum, irinotecan, and taxane for advanced gastric cancer.

PURPOSE: The aims of this study are to find out whether the sequence of chemotherapeutic regimens including second- and third-line taxane and irinotecan influences the survival of patients with unresectable gastric carcinoma and to identify clinical characteristics of patients with improved response. MATERIALS AND METHODS: Fifty gastric carcinoma patients who were treated by third-line sequential chemotherapy between November 2004 and July 2010 were enrolled in this study. Their overall survival (OS) and time to progression (TTP) were set up as primary and secondary end points. For the sequence of chemotherapy regimen, two arms were used. Arm A was defined as 5-fluorouracil (5-FU)+cisplatin (FP) or folinic acid, 5-FU and oxaliplati (FOLFOX), followed by folinic acid, 5-FU and irinotecan (FOLFIRI), and paclitaxel or docetaxel plus 5-FU, with or without epirubicin. Arm B was defined as FP or FOLFOX, followed by paclitaxel or docetaxel plus 5-FU, and FOLFIRI. RESULTS: The median OS of all patients was 16.0 months (95% confidence interval, 13.6 to 18.3 months), which is longer than historical control of patients who did not receive third-line chemotherapy. The sequence of second and third-line regimen, including irinotecan and taxane, did not present significant difference in OS or TTP after failure of 5-FU with platinum chemotherapy. In survival analysis of patients' clinicopathologic characteristics, poor prognosis was shown in patients with poorly differentiated histologic features, elevated serum carcinoembryonic level, and shorter TTP of first line chemotherapy. CONCLUSION: It is possible for patients to respond differently to chemotherapy due to differences in clinical features and underlying gene expression profiles. Development of individualized chemotherapy regimens based on gene expression profiles is warranted.ope