Chemotherapy of Cholangiocarcinoma: Current Management and Future Directions

Cholangiocarcinoma is a relatively rare form of gastroenterological cancer that divided into intrahepatic, perihilar, and distal bile duct cancer. Approximately, 10,000 new cases are diagnosed annually in the United States, and a 5-year survival rate is below 20%. While only surgical resection can provide a cure, most of cholangiocarcinomas are detected at inoperable stage and associated with poor prognosis. Moreover, cholangiocarcinoma has a high recurrence rate, even after curative surgery. Therefore, chemotherapy has an important role in the treatment of patients with cholangiocarcinoma. International efforts by physicians and researchers are revealing genetic factors of cholangiocarcinoma progression, which will identify early diagnostic markers and novel therapeutic targets. In this chapter, current strategies of adjuvant, neoadjuvant, and palliative chemotherapy will be discussed, as well as expectant future therapeutic targets and development of individualized therapies

The uncalibrated pulse contour cardiac output during off-pump coronary bypass surgery: performance in patients with a low cardiac output status and a reduced left ventricular function

BACKGROUND: We compared the continuous cardiac index measured by the FloTrac/Vigileo™ system (FCI) to that measured by a pulmonary artery catheter (CCI) with emphasis on the accuracy of the FCI in patients with a decreased left ventricular ejection fraction (LVEF) and a low cardiac output status during off-pump coronary bypass surgery (OPCAB). We also assessed the influence of several factors affecting the pulse contour, such as the mean arterial pressure (MAP), the systemic vascular resistance index (SVRI) and the use of norepinephrine. METHODS: Fifty patients who were undergoing OPCAB (30 patients with a LVEF ≥ 40%, 20 patients with a LVEF < 40%) were enrolled. The FCI and CCI were measured and we performed a Bland-Altman analysis. Subgroup analyses were done according to the LVEF (< 40%), the CCI (≤ 2.4 L/min/m), the MAP (60-80 mmHg), the SVRI (1,600-2,600 dyne/s/cm(5)/m(2)) and the use of norepinephrine. RESULTS: The FCI was reliable at all the time points of measurement with an overall bias and limit of agreement of -0.07 and 0.67 L/min/m(2), respectively, resulting in a percentage error of 26.9%. The percentage errors in the patients with a decreased LVEF and in a low cardiac output status were 28.2% and 22.3%, respectively. However, the percentage error in the 91 data pairs outside the normal range of the SVRI was 40.2%. CONCLUSIONS: The cardiac output measured by the FloTrac/Vigileo™ system was reliable even in patients with a decreased LVEF and in a low cardiac output status during OPCAB. Acceptable agreement was also noted during the period of heart displacement and grafting of the obtuse marginalis branch.ope

Subpleural Pulmonary Hyalinizing Granuloma Presenting as a Solitary Pulmonary Nodule

AbstractWe introduce a case of pulmonary hyalinizing granuloma presented as a solitary pulmonary nodule located subpleurally. The patient was a 57-year-old man who had abnormal chest roentgenograms showing a solitary pulmonary nodule in the right lower lung field. The nodule was resected for definitive diagnosis and histopathologically proved to be pulmonary hyalinizing granuloma. In previously reported cases, most patients had ill-defined margins and usually bilateral, multiple lesions radiographically. In our case, the subpleural location is an uncommon location of this rare entity

Sensitivity of Simulated PM2.5 Concentrations over Northeast Asia to Different Secondary Organic Aerosol Modules during the KORUS-AQ Campaign

A numerical sensitivity study on secondary organic aerosol formation has been carried out by employing the WRF-Chem (Weather Research and Forecasting model coupled with Chemistry). Two secondary organic aerosol formation modules, the Modal Aerosol Dynamics model for Europe/Volatility Basis Set (MADE/VBS) and the Modal Aerosol Dynamics model for Europe/Secondary Organic Aerosol Model (MADE/SORGAM) were employed in the WRF-Chem model, and surface PM2.5 (particulate matter less than 2.5 mu m in size) mass concentration and the composition of its relevant chemical sources, i.e., SO42-, NO3-, NH4+, and organic carbon (OC) were simulated during the Korea-United States Air Quality (KORUS-AQ) campaign period (1 May to 12 June 2016). We classified the KORUS-AQ period into two cases, the stagnant period (16-21 May) which was dominated by local emission and the long-range transport period (25-31 May) which was affected by transport from the leeward direction, and focused on the differences in OC secondary aerosol formation between two modules over Northeast Asia. The simulated surface PM2.5 chemical components via the two modules showed the largest systematic biases in surface OC, with a mean bias of 4.5 mu g m(-3), and the second largest in SO42- abundance of 2.2 mu g m(-3) over Seoul. Compared with surface observations at two ground sites located near the western coastal Korean Peninsula, MADE/VBS exhibited the overpredictions in OC by 170-180%, whereas MADE/SORGAM showed underpredictions by 49-65%. OC and sulfate via MADE/VBS were simulated to be much higher than that simulated by MADE/SORGAM by a factor of 2.8-3.5 and 1.5-1.9, respectively. Model verification against KORUS-AQ aircraft measurements also showed large discrepancies in simulated non-surface OC between the two modules by a factor of five, with higher OC by MADE/VBS and lower IC by MADE/SORGAM, whereas much closer MADE/VBS simulations to the KORUS-AQ aircraft measurements were found. On the basis of the aircraft measurements, the aggregated bias (sum of four components) for PM2.5 mass concentrations from the MADE/VBS module indicated that the simulation was much closer to the measurements, nevertheless more elaborate analysis on the surface OC simulation performance would be needed to improve the ground results. Our findings show that significant inconsistencies are present in the secondary organic aerosol formation simulations, suggesting that PM2.5 forecasts should be considered with great caution, as well as in the context of policymaking in the Northeast Asia region

Development of Kinematic Ephemeris Generator for Korea Pathfinder Lunar Orbiter (KPLO)

This paper presents a kinematic ephemeris generator for Korea Pathfinder Lunar Orbiter (KPLO) and its performance test results. The kinematic ephemeris generator consists of a ground ephemeris compressor and an onboard ephemeris calculator. The ground ephemeris compressor has to compress desired orbit propagation data by using an interpolation method in a ground system. The onboard ephemeris calculator can generate spacecraft ephemeris and the Sun/Moon ephemeris in onboard computer of the KPLO. Among many interpolation methods, polynomial interpolation with uniform node, Chebyshev interpolation, Hermite interpolation are tested for their performances. As a result of the test, it is shown that all the methods have some cases that meet requirements but there are some performance differences. It is also confirmed that, the Chebyshev interpolation shows better performance than other methods for spacecraft ephemeris generation, and the polynomial interpolation with uniform nodes yields good performance for the Sun/Moon ephemeris generation. Based on these results, a Kinematic ephemeris generator is developed for the KPLO mission. Then, the developed ephemeris generator can find an approximating function using interpolation method considering the size and accuracy of the data to be transmitted

Impact of Socioeconomic Status on 30-Day and 1-Year Mortalities after Intensive Care Unit Admission in South Korea: A Retrospective Cohort Study

Background Socioeconomic status (SES) is closely associated with health outcomes, including mortality in critically ill patients admitted to intensive care unit (ICU). However, research regarding this issue is lacking, especially in countries where the National Health Insurance System is mainly responsible for health care. This study aimed to investigate how the SES of ICU patients in South Korea is associated with mortality. Methods This was a retrospective observational study of adult patients aged ≥20 years admitted to ICU. Associations between SES-related factors recorded at the time of ICU admission and 30-day and 1-year mortalities were analyzed using univariable and multivariable Cox regression analyses. Results A total of 6,008 patients were included. Of these, 394 (6.6%) died within 30 days of ICU admission, and 1,125 (18.7%) died within 1 year. Multivariable Cox regression analysis found no significant associations between 30-day mortality after ICU admission and SES factors (P>0.05). However, occupation was significantly associated with 1-year mortality after ICU admission. Conclusions Our study shows that 30-day mortality after ICU admission is not associated with SES in the National Health Insurance coverage setting. However, occupation was associated with 1-year mortality after ICU admission

Translation and validation of the Korean confusion assessment method for the intensive care unit

<p>Abstract</p> <p>Background</p> <p>Delirium is a common problem and associated with poor outcomes in intensive care unit (ICU) patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting.</p> <p>Methods</p> <p>Translation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV).</p> <p>Results</p> <p>Twenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7%) patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, <it>p </it>< 0.001).</p> <p>Conclusions</p> <p>The Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN50265663">ISRCTN50265663</a></p