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Charcot Spinal Arthropathy without Any Risk Factors: A Case Report
Oh Jihyun,Kim Soo Yeon,Choe Woo Jin 대한말초신경학회 2020 The Nerve Vol.6 No.2
Charcot spinal arthropathy (CSA) is a rare progressive disorder that occurs after the loss of neuroprotective sensation and proprioceptive perception. Although its etiology is unclear, studies have suggested that it is primarily caused by spinal cord injuries, and diabetes mellitus, syringomyelia, tertiary syphilis, and Parkinson’s disease. Here, we describe a case of a 71-year-old woman with CSA without any risk factors. We report that CSA could occur without any prominent presentations or risk factors and may initially be misdiagnosed as pyogenic spondylitis.
( Jihyun An ),( Hyo Jeong Kang ),( Ju Hyun Shim ),( Gi-won Song ),( Gwang Hyun Choi ),( Han Chu Lee ),( Bora Oh ),( Naomi Park ),( Jihyun ),( Song Eunsil Yu ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Immune checkpoint proteins regulating T-cell mediated anti-tumor immunity have been reported to affect clinical outcomes in multiple malignancies. This study aimed to investigate the prognostic effect of histological expression of immune checkpoint proteins in patients with resected hepatocellular carcinoma (HCC). Methods: A total of 221 patients with HCC who underwent curative resection were included. Expression of Programmed-cell death ligand- 1 in tumor cells (tPD-L1) and tumor infiltrating mononuclear cells (TIMCs) (iPD-L1), Programmed-cell death-1 in TIMCs (iPD-1), and cytotoxic T lymphocyte antigen-4 in TIMCs (iCTLA-4) were measured immunohistochemically. Results: Among the 221 patients, histo-positivity for iCTLA-4, iPD-1, iPD-L1, and tPD-L1 was 32.1% (n=71), 42.5% (n=94), 35.3% (n=78), and 14.9% (n=33), respectively. Multivariate logistic analyses revealed that male sex and tumor >5cm were variables related to iCTLA-4 positivity (odds ratios [ORs] 0.46 and 1.94 respectively; Ps<0.05). Poor differentiation was related to PD-L1 expression in both tumor cells and TIMCs (ORs 2.88 and 3.46, respectively; Ps<0.05). Microvascular invasion was significantly associated only with iPD-L1, whereas tPD-L1 was positively correlated with baseline elevation of serum alpha-fetoprotein (≥200 ng/ml) (ORs 2.24 and 2.45; Ps<0.05). In time-dependent outcome analyses, expression of immune checkpoint proteins in TIMCs (i.e., iCTLA-4, iPD-1, and iPD-L1) was significantly related to longer overall survival and non-cancer-related survival (all Ps< 0.05), but not to time-to-recurrence or cancer-specific deaths (all Ps >0.05). Concurrent activation of the PD-1:PD-L1 and CTLA-4 pathways predicted improved outcomes in terms of overall survival and non-cancer related survival (P=0.06 and P=0.03, respectively). Conclusions: Immune checkpoint proteins upregulated in TIMCs in HCC tissues have individual and additive effects in prolonging the survival of patients, specifically in terms of survival not related to cancer recurrence.