Associations of the BRAFV600E Mutation with Sonographic Features and Clinicopathologic Characteristics in a Large Population with Conventional Papillary Thyroid Carcinoma

OBJECTIVE: To evaluate the association of the BRAFV600E mutation with sonographic features and clinicopathologic characteristics in a large population with conventional papillary thyroid carcinoma (PTC). METHODS: We retrospectively reviewed the sonographic features, clinicopathologic characteristics, and presence of the BRAFV600E mutation in 688 patients who underwent thyroidectomy for conventional PTC between January and July 2010 at a single institution. The incidence of the BRAFV600E mutation was calculated. The sonographic features and clinicopathologic characteristics were compared between BRAF-positive and BRAF-negative patients. BRAF-positive patients were subdivided into those with papillary thyroid microcarcinoma (the PTMC group) and those with PTC larger than 10 mm (the PTC>10 mm group), and their sonographic features were compared. RESULTS: The BRAFV600E mutation was detected in 69.2% of patients (476 of 688). Sonographic features were not significantly different between BRAF-positive and BRAF-negative PTC, nor between PTMC and PTC>10 mm groups. The BRAFV600E mutation was associated with male sex (P = 0.028), large tumor size, extrathyroidal extension, central and lateral lymph node metastasis, and advanced tumor stage (P<0.0001). CONCLUSION: The BRAFV600E mutation was significantly associated with several poor clinicopathologic characteristics, but was not associated with sonographic features, regardless of tumor size. We recommend that patients with a thyroid nodule with any suspicious sonographic feature undergo preoperative BRAFV600E testing for risk stratification and to guide the initial surgical approach in PTC.ope

Ⅲ급 부정교합 치료 증례의 치아치조보상기전 평가

Thesis(master`s)--서울대학교 대학원 :치의학과 치과교정학전공,2005.Maste

ES-알고리즘을 이용한 로버스트 주성분 분석

학위논문 (석사)-- 서울대학교 대학원 : 통계학과, 2011.2. 오희석.Maste

Efficacy of a herd specific mastitis vaccine against Staphylococcus aureus in dairy cows

학위논문(석사)--서울대학교 대학원 :수의학과 수의내과학전공, 2005.Maste

(The) CT characteristics of pulmonary embolism in cancer patients under chemotherapy evaluated by CT scan

의학과/석사[한글] 목적: 항암 화학 요법 환자에서 발생한 폐색전증의 해부학적 호발 혈관 위치 및 크기를 CT혈관 촬영 소견을 통해 분석한다. 대상 및 방법: 2005년 7월부터 2008년 2월까지 CT 혈관 촬영을 시행한 109명을 대상으로 하였다. 이 중 악성종양이 병리적으로 확진되었고 항암 화학 요법을 받은 과거력이 있거나 받고 있는 환자는 23명이었고 86명의 환자는 항암 화학 요법과는 관계가 없는 환자였다. 폐색전증의 위험인자 중 성별 및 폐색전증의 위험 인자 환자기록을 통하여 조사하였으며 색전의 위치 및 크기를 항암 화학 요법을 받는 환자와 받지 않는 환자, 항암 화학 요법을 받는 환자 중 증상이 있어서 CT를 시행한 환자와 정기 추적 관찰 중 우연히 폐색전증이 발견된 환자, 성별, 그 외 조사한 각 폐색전증의 위험인자가 있는 환자와 없는 환자, 전체 환자 중 암 환자 및 암 진단 받지 않은 환자, 항암 화학 요법을 받는 환자 중 폐암 환자 및 폐암 환자가 아닌 환자, 전체 환자 중 폐암 환자, 다른 암 환자 및 암 진단 받지 않은 환자, 폐혈관 위치 별로 나누어 CT혈관 촬영 소견을 통계 분석하였다. 색전의 해부학적 발생 위치는 주폐혈관, 엽성 폐혈관, 분절성 폐혈관 또는 세분절성 폐혈관으로 나누어 발생한 색전 중 가장 큰 폐혈관에 위치한 색전의 발생 위치를 분석하였다. 색전의 크기는 가장 큰 폐혈관에 위치한 색전의 부피 측정을 위해 3차원 재구성 소프트웨어VoxelPlus를 이용하였다. 색전의 위치는 Chi-square test를 이용하여 통계 분석하였으며 색전의 크기는 측정한 부피를 One-Way ANOVA 및t-test를 이용하였다. 통계학적 유의성은 p-value 0.05이하로 설정하였다. 결과: 항암 화학 요법을 받는 환자에서 발생한 폐색전증의 크기는 일반 인구에서 보다 통계학적으로 유의하게 상대적으로 작았으며 성별 및 조사한 폐색전증의 위험인자는 크기와 관련성이 없었다. 폐색전증의 해부학적 호발 위치는 항암 화학 요법을 받는 환자와 받지 않는 환자에서 통계학적으로 유의한 차이 없었다. 결론: 상대적으로 일반 인구에 비해 크기가 작고 무증상 발현을 잘하는 항암 화학 요법 환자에서의 폐색전증으로 인한 사망률을 감소시키기 위해 폐색전증의 진단률을 높이는 것이 필요하다. 이에는 얇은 절편의 CT혈관 촬영이 도움이 될 것이다. 특별히 호발 암인 폐암 및 상부 위장관 종양 환자에서 선별 검사가 유용할 것이며 호발 시기인 3번째 cycle(30.4%) 또는 항암 화학 요법 시작 후 4주(17.4%)가 선별검사의 적절한 시기로 생각된다. [영문] PURPOSE : To evaluate the anatomic location and size of pulmonary embolus(PE) in those receiving anti-cancer chemotherapy. MATERIALS AND METHODS : 109 patients who had pulmonary embolism on CT pulmonary angiography were review for medical records of pathologic report of cancer who are receiving anti-cancer chemotherapy and risk factors of pulmonary embolism. Among 109 patients 23 patients had history of anti-cancer chemotherapy. The anatomic location and size of the largest embolus on CT pulmonary angiography were evaluated. The anatomic location was classified as main, lobar, segmental, and subsegmental. The size of the embolus was evaluated by measuring the volume using 3-Dimensional reconstruction software. The anatomic location and the mean size of the pulmonary embolus was compared between anti-cancer chemotherapy patients and those not receiving anti-cancer chemotherapy and the groups with and without each risk factor by using Chi-square test, One-way ANOVA and t test, respectively. P < .05 indicated a significant difference. RESULTS: The anatomic location of pulmonary embolus showed no difference between anti-cancer chemotherapy patients and those not receiving chemotherapy. The size of the pulmonary embolus was smaller in anti-cancer chemotherapy patients than those not receiving anti-cancer chemotherapy. The risk factors of pulmonary embolism did not have any effect on the size of the pulmonary embolus. CONCLUSION: The size of the pulmonary embolus was smaller in anti-cancer chemotherapy patients. More caution should be taken for diagnosis and screening with thin-slice CT scan can be useful.ope

종양미세환경에서 골수유래면역억제세포를 조절하는 GRP78에 의한 전이성 암 진행

학위논문 (석사)-- 서울대학교 대학원 : 의과대학 의과학과, 2018. 2. 이동섭.Cancer cells create a cancer microenvironment for cancer growth and survival, and the interaction between cancer cells and cancer microenvionrment plays an important role in multiple aspects of cancer cells growth, invasion, metastasis, and the immune escape by the secretion of a variety of factors. We previously confirmed that metastatic murine breast cancer cells with high interleukin-6 (IL-6) expression recruited myeloid-derived suppressor cells (MDSCs) to the cancer site and the other metastatic organs, and recruited MDSCs induce metastasis to distant site through IL-6 trans-signaling. Cancer-derived IL-6 can recruit MDSCs to the cancer microenvironment of non-metastatic breast cancer cells, but it cannot induce MDSC-meditated metastasis. Therefore, I examined the additional cancer-derived factors that can activate MDSCs in the cancer microenvironment to induce metastasis to distant site. In this study, I characterized cancer-derived the 78 kDa glucose-regulated protein (GRP78) as additional MDSC-activating factors. Metastatic cancer cells expressed high levels of GRP78, and secreted GRP78 protein into the cancer microenvironment. Cancer-derived soluble GRP78 was accentuates the metastatic cancer progression via the modulation of MDSCs in cancer microenvironement. GRP78 stimulation showed the functional MDSCs which induced IL-6 production, up-regulated ER stress sensor proteins by ER stress, enhanced the immune suppressive functions, and increased the ADAM17 expression. When the metastatic cancer cells expressed low level of GRP78, these cells lose the aggressive phenotype, invasion, and drug resistance, and decreased cancer growth in vivo. Therefore, this study provides strong evidence that targeting GRP78 protein to inhibit the interaction of cancer cells and MDSCs in cancer microenvironment could be a novel approach to cancer therapy.INTRODUCTION 1 MATERIALS AND METHODS 6 RESULTS 12 DISCUSSION 32 REFERENCES 35 ABSTRACT IN KOREAN 41Maste

Quantitative Shear Wave Elastography as a Prognostic Implication of Papillary Thyroid Carcinoma (PTC): Elasticity Index Can Predict Extrathyroidal Extension (ETE)

Objective To investigate whether the quantitative elasticity index of shear wave elastography (SWE) can predict extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC) preoperatively. Methods A total of 208 patients with pathology confirmed PTC whom underwent SWE during preoperative staging US between April 2011 to June 2012 were included.SWE indices of E mean, E max, E min of the index malignancy, the ratios between E mean of the lesion and parenchyma (E ratio-P), and muscle (E ratio-M), and grayscale US findings, including ETE, multifocality, bilaterality, and central and lateral lymph node (LN) metastasis were evaluated. The correlations of SWE indices and grayscale US findings with pathologic prognostic factors of PTC were analyzed by Chi square or Fisher’s exact test, and multivariate regression analysis. Results ETE was associated with E mean, E max, E min, and E ratio-M (P = 0.005, 0.009, 0.016 and <0.001, respectively), multifocality was associated with E mean, E max, and E min (P = 0.028, 0.007, and 0.004, respectively), and central LN metastasis was associated with E ratio-M (P = 0.03). On multivariate analysis, E mean and E min were independent factors for predicting ETE (P = 0.032, 0.049, respectively). Conclusions Quantitative elasticity index of SWE could predict pathologic ETE, and SWE could be a complimentary method to grayscale US for preoperative prediction of prognostic factors of PTC.ope

Thyroid Nodules with Macrocalcification:Sonographic Findings Predictive of Malignancy

PURPOSE: To analyze which sonographic features of thyroid nodules with macrocalcifications were predictable of thyroid malignancy. MATERIALS AND METHODS: We reviewed sonographic findings of 854 macrocalcified thyroid nodules in patients who underwent fine needle aspiration biopsy between December 2009 and January 2011. There were 171 non-diagnostic aspirations, 34 nodules with category 3, 4, 5 based on Bethesda system, which were not confirmed by surgery, and these nodules were excluded from the analysis. Sonographic characteristics of the macrocalcifications including its thickness, interruption, and existence of soft tissue rim outside the macrocalcification were analyzed. Other sonographic characteristics of nodules such as shape, margin, composition, echo pattern, vascularity, and underlying parenchymal echogenicity were also evaluated. The correlation of sonographic features with cytopathologic results and the diagnostic performance of sonographic features for the prediction of malignancy were analyzed. RESULTS: Among 649 nodules, 179 (27.6%) nodules were malignant and 470 (72.4%) nodules were benign. Among the features of the macrocalcification, interruption, irregular thickness, or the presence of soft tissue outside calcification rim were associated with malignancy (p<0.001). A high sensitivity and negative predictive values for the prediction of malignancy was found in sonographic characteristics of irregular thickness (92.2% and 91.0%, respectively) and the presence of soft tissue (88.5% and 88.8%, respectively). CONCLUSION: Sonographic characteristics of macrocalcification such as interruption, irregular thickness and the presence of soft tissue rim were associated with malignancy in thyroid nodules with macrocalcifications.ope

Comparison of Strain and Shear Wave Elastography for the Differentiation of Benign From Malignant Breast Lesions, Combined With B-mode Ultrasonography: Qualitative and Quantitative Assessments

Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.ope

Mechanical properties and thermal stability of intermolecular-fitted poly (vinyl alcohol)/alpha-chitin nanofibrous mat

The major disadvantage of electrospun nanofibrous mats is their poor mechanical properties, which result from interfibrillar slips, porous structures, and the isotropic conformation of functional groups in fibers. In this work, we develop a tough electrospun mat without cost of both the stiffness and extensibility by combining two mutually exclusive polymers, i.e., generally "ductile" poly(vinyl alcohol) (PVA) and "stiff" alpha-chitin. The toughness of PVA/alpha-chitin is considerably higher (similar to 20 times) compared to PVA via intermolecular-fitted design and stoichiometric balance between hydrogen bonding donors and acceptors. Moreover, consistently oriented functional groups that are perpendicular to nanofibers improve mechanical properties. As a result, stiffness and extensibility are simultaneously increased by similar to 19.3 and similar to 3.8 times, respectively compared to PVA. The thermal stability with a 2.80-fold larger melting enthalpy of 823.95 +/- 7.05 J g(-1) than PVA. The great thermomechanical performance provides an insight for molecular design in electrospun nanofibers with chitin polymorphs.11Nsciescopu