Dual-Energy CT Angiography Improves Accuracy of Spot Sign for Predicting Hematoma Expansion in Intracerebral Hemorrhage

Michaël T.J. Peeters,Kim J.D. de Kort,Rik Houben,Wouter J.P. Henneman,Robert J. van Oostenbrugge,Julie Staals,Alida A. Postma 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.1

Background and Purpose: Spot sign (SS) on computed tomography angiography (CTA) is associated with hematoma expansion (HE) and poor outcome after intracerebral hemorrhage (ICH). However, its predictive performance varies across studies, possibly because differentiating hyperdense hemorrhage from contrast media is difficult. We investigated whether dual-energy-CTA (DE-CTA),which can separate hemorrhage from iodinated contrast, improves the diagnostic accuracy of SS for predicting HE. Methods: Primary ICH patients undergoing DE-CTA (both arterial as well as delayed venous phase) and follow-up computed tomography were prospectively included between 2014 and 2019. SS was assessed on both arterial and delayed phase images of the different DE-CTA datasets, i.e., conventional-like mixed images, iodine images, and fusion images. Diagnostic accuracy of SS for prediction of HE was determined on all datasets. The association between SS and HE, and between SS and poor outcome (modified Rankin Scale at 3 months ≥3) was assessed with multivariable logistic regression, using the dataset with highest diagnostic accuracy. Results: Of 139 included patients, 47 showed HE (33.8%). Sensitivity of SS for HE was 32% (accuracy 0.72) on conventional-like mixed arterial images which increased to 76% (accuracy 0.80) on delayed fusion images. Presence of SS on delayed fusion images was independently associated with HE (odds ratio [OR], 17.5; 95% confidence interval [CI], 6.14 to 49.82) and poor outcome (OR, 3.84;95% CI, 1.16 to 12.73). Conclusions: Presence of SS on DE-CTA, in particular on delayed phase fusion images, demonstrates higher diagnostic performance in predicting HE compared to conventional-like mixed imaging, and it is associated with poor outcome.

A phase II, open-label, non-randomized, prospective study assessing paclitaxel, carboplatin and metformin in the treatment of advanced stage ovarian carcinoma

John P. Micha,Mark A. Rettenmaier,Randy D. Bohart,Bram H. Goldstein 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.2

Objective: The purpose of this study was to assess the efficacy and tolerability of a paclitaxel, carboplatin and metformin regimen in the first-line treatment of advanced-stage ovarian, fallopian tube, and primary peritoneal carcinoma. Methods: Eligible subjects underwent surgery and 6 cycles of neoadjuvant or adjuvant dose-dense intravenous paclitaxel (80 mg/m2), carboplatin (area under the curve 5 or 6 on Day 1), and oral metformin (850 mg daily). Study participants who completed their primary therapy and attained a clinically defined complete or partial response (PR) were treated with a planned 12 cycles of paclitaxel (135 mg/m2 every 21 days) and metformin (850 mg twice daily) maintenance therapy. Results: Thirty subjects received a median of 6 cycles (range, 5–6) of primary induction chemotherapy and were eligible for response evaluation; twenty-three patients exhibited a complete response, while 3 study patients obtained a PR (an overall response rate of 86.7%). Grade 3–4 hematological toxicity included neutropenia (43.3%), thrombocytopenia (10%) and anemia (36.7%). There was no incidence of grade 3–4 neuropathy although 15 patients (50%) developed grade ≤2 neurotoxicity. Additionally, we observed grade ≤2 diarrhea in 20 (66.7%) subjects. The median progression-free survival was 21 months (range, 3–52) and overall median survival was 35 months (range, 15–61). The subjects also received an aggregate 103 cycles (median, 12; range, 6–12) of maintenance chemotherapy. Conclusion: The study results suggest that the combination of paclitaxel, carboplatin and metformin is associated with moderate efficacy and a reasonable toxicity profile.

Chemotherapy and patient co-morbidity in ventral site hernia development

Mark A. Rettenmaier,Lisa N. Abaid,John V. Brown III,John P. Micha,Bram H. Goldstein 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.4

Objective: The risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence. Methods: We analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay. Results: Twenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient group’s overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p>0.05). Conclusion: In the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition. Objective: The risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence. Methods: We analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay. Results: Twenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient group’s overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p>0.05). Conclusion: In the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition.

Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer

Lisa N. Abaid,Mark A. Rettenmaier,John V. Brown III,John P. Micha,Alberto A. Mendivil,Marie A. Wabe,Bram H. Goldstein 대한부인종양학회 2012 Journal of Gynecologic Oncology Vol.23 No.1

Objective: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary. Objective: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.

Microporous Ceramic Membranes - on the Way to Large Scale Application

H. Richter,U. Lubenau,P. Puhlfürß,Ch. Pflieger,M. Weyd,R. Mothes,D. Worch,I. Voigt,A. Michaelis 한국막학회 2017 한국막학회 총회 및 학술발표회 Vol.2017 No.11

High membrane costs hinders large scale application of microporous ceramic membranes. Preparation on elements of large specific membrane area are a prospective strategy to overcome this problem. NF membranes with a cut-off of 450 Da were produced for first time in a 163-channel tube geometry of 1.25 m². The membranes were successful tested in drink water production and in treatment of produced water from oil production. Zeolite-NaA-membranes were prepared for the first time inside of 1.2 m long tubes in four channel geometry of 0.9 m². Natural gas is dried by stripping with triethylene glycol (TEG). TEG will be regenerated by distillation at 190°C to 205°C. A pilot plant for TEG drying with Zeolite-NaAmembranes at 120°C for a capacity of 10.000 m³/h natural gas and is running since October 2016.

Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy

Muhannad A. Abbasi,Allison M. Blake,Roberto Sarnari,Daniel Lee,Allen S. Anderson,Kambiz Ghafourian,Sadiya S. Khan,Esther E. Vorovich,Jonathan D. Rich,Jane E. Wilcox,Clyde W. Yancy,James C. Carr,Michae 한국심초음파학회 2022 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.30 No.4

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS: Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0–3) based on coronary angiography. RESULTS: The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS: Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.

FAMILY PLANNING OPINION LEADERSHIP IN KOREA : 1971

PALMORE,JAMES A,BUCHMEIER,FRANCIS X,FURLONG,MICHAE J,PARK,HAN INSOOK,SOUDER,LAURA M 연세대학교 동서문제연구소 1975 東西硏究 JOURNAL OF EAST AND WEST STUDIES Vol.4 No.2

In effect, what characterized Korean family planning opinion leaders in 1971 was a rather rational and democratic model. Those who had had actually tried methods, discussed them, and knew a lot about them played the leadership role more than others. Place of residence, education, and other such variables mattered relatively little unless the woman had the credibility imparted by actual use and the knowledge imparted by use or discussions with family planning professionals.

Hormone Therapy and Risk of Breast Cancer: Where Are We Now?

John P. Micha,Mark A. Rettenmaier,Randy D. Bohart,Bram H. Goldstein 대한폐경학회 2022 대한폐경학회지 Vol.28 No.2

Several studies have examined the clinical benefits of hormone replacement therapy (HRT). However, because long-term use of HRT has been implicated as a risk factor for the development of breast cancer, some women remain skeptical when considering this therapy to address their vasomotor symptoms. Hence, physicians and nurses should actively engage in constructive discourse with their patients regarding HRT while specifically reviewing the potential risks of its extended use as well as provide the available medical alternatives the patients could potentially use.

Rotational State Distribution of NO after Collisions with Fast Hydrogen Atom

김유항,Kim, Yu Hang,David A. Micha Korean Chemical Society 1995 Bulletin of the Korean Chemical Society Vol.16 No.5

Based on the collisional time-correlation function approach a general analytical expression has been derived for the double differential cross-section with respect to the scattering angle and the final rotational energy, which can be applied to molecules with non-zero electronic orbital angular momentum after collision with fast hydrogen atoms. By integrating this expression another very simple expression, which gives the final rotational distribution as a function of the rotational quantum number, has also been derived. When this expression is applied to NO(2Π1/2, v'=1) and NO(2Π3/2, v'=1, 2, 3), it can reproduce the experimental rotational distribution after collision with fast H atom very well. The average rotational quantum number and average rotational energy using this expression are also in good agreement with those deduced from the experimental distributions.

Automatic categorization of chloride migration into concrete modified with CFBC ash

Maria Marks,Daria Józwiak-Niedzwiedzka,Micha A. Glinicki 사단법인 한국계산역학회 2012 Computers and Concrete, An International Journal Vol.9 No.5

The objective of this investigation was to develop rules for automatic categorization of concrete quality using selected artificial intelligence methods based on machine learning. The range of tested materials included concrete containing a new waste material - solid residue from coal combustion in fluidized bed boilers (CFBC fly ash) used as additive. The rapid chloride permeability test - Nordtest Method BUILD 492 method was used for determining chloride ions penetration in concrete. Performed experimental tests on obtained chloride migration provided data for learning and testing of rules discovered by machine learning techniques. It has been found that machine learning is a tool which can be applied to determine concrete durability. The rules generated by computer programs AQ21 and WEKA using J48 algorithm provided means for adequate categorization of plain concrete and concrete modified with CFBC fly ash as materials of good and acceptable resistance to chloride penetration.