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Sang Yull Kang,Seon Kwang Kim,Hyun Jo Youn,Sung Hoo Jung 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.1
A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable riskfor iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrentlaryngeal nerve that went unnoticed on preoperative imaging but was discoveredincidentally during robotic thyroidectomy. A 44 year old woman presented at ourdepartment with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guidedfine needle aspiration cytology. During robotic right thyroidectomy and central lymphnode dissection, we could not detect any structure resembling the recurrent laryngeal nervearound the inferior thyroid artery. Thus, we suspected the existence of a non-recurrentlaryngeal nerve, and successfully identified a nerve entering the larynx directly from thevagus nerve without recurring. A three-dimensional high magnification view via a roboticendoscope can aid thyroid surgeons to safely identify and preserve a non-recurrentlaryngeal nerve.
Hyun Jo Youn,Sung Hoo Jung 한국유방암학회 2011 Journal of breast cancer Vol.14 No.1
Tight junctions (TJs) contribute to the paracellular barrier, which is a fence that divides plasma membranes and signal transduction, acting as a multifunctional complex in vertebrate epithelial and endothelial cells [1]. The morphological features of TJs fits well with their functions. The TJ core is a fibril-like proteinaceous structure within the lipid bilayer, the so-called TJ strands [2]. Identification and characterization of TJs-associated proteins during the last two decades has unveiled the nature of TJ strands and how they are spatially organized. The interplay between integral membrane proteins, claudins, and cytoplasmic plaque proteins, ZO-1/ZO-2, is critical for TJ formation and function [3]. Among the TJ-associated proteins, the claudin family of membrane proteins, identified in 1998 by the Tsukita group, are key molecules in the architecture and barrier function of TJs [4]. Claudins maintain cell polarity and are involved in recruiting signaling proteins. Claudins are also hypothesized to be involved in the regulation of proliferation, differentiation, and other cellular functions [5]. TJ dysfunction has been presumed as a mechanism for the loss of cell adhesion and an important step in the progression of cancer to metastasis. Because claudin expression patterns are tissue- and cell-specific, recent studies have suggested that claudins might be useful molecular markers for many different cancers [6,7]. Moreover, claudins are a potential target for novel antibody-based therapies of diverse cancers [8]. Until now, 24 members of the claudin family have been identified. The role of claudins in breast cancer is unknown and not well-explored, but recent reports have shown that claudins 3 and 4 are overexpressed in breast cancer, whereas claudins 1 and 7 are downregulated or completely absent [9-11]. Furthermore, Szasz et al. [12] indicated that the loss of claudins might contribute to breast cancer progression, and that certain claudin expression patterns might be of prognostic relevance. These results suggest that claudin subtypes may have different roles during different stages of breast cancer. Claudin-6 is expressed during the early stage of epidermal morphogenesis and is crucial to epidermal differentiation and barrier formation [13]. A recent report showed that claudin-6 is preferentially expressed in mammary epithelial cells and functions as a breast cancer tumor suppressor [14]. Additionally, Osanai et al. [15] suggested that the claudin-6 methylator phenotype might contribute to enhance tumorigenic and invasive properties of breast cancer cells. However, no information is available on the regulating mechanism of claudin-6 expression in breast cancer. In this study by Yafang et al. [16], authors demonstrated that estrogen induces claudin-6 expression through an estrogen receptor (ER) α pathway in MCF-7 cells. The data are clear, and this is the first report showing that claudin-6 expression was associated with ERα in breast cancer cells. However, first of all, authors had to indicate how claudin-6 expression is related to ERs. It was necessary to study claudin-6 expression in ER (+) and ER (-) breast cancer (prior to ERα and ERβ cells). Authors described in their previous studies that no significant association was found between claudin-6 expression and ER (+) breast cancer (even ERs). It is well accepted that the MCF-7 cell line may vary depending on in vitro culture conditions. Therefore, disparate results may occur during in vitro selection conditions. Although results from a laboratory setting may not exactly correlate with in vivo results, there is little significance to a research finding that only has significance in vitro. Because claudin-6 expression was also observed in ERβ (+) breast cancer cells, authors must show that claudin-6 is expressed in the MDA-MB-231 cancer cell line and demonstrate that the ERβ pathway is not associated with this protein expression. But this was also omitted. Th...
Hyun Jo Youn,Ha Rim Ahn,Sang Yull Kang,Sung Hoo Jung 대한외과초음파학회 2021 대한외과초음파학회지 Vol.8 No.1
Ultrasonography is mandatory for the evaluation of thyroid nodules. Although B-mode and Doppler ultrasonography are both sensitive for the diagnosis of thyroid lesions, they lack specificity in differentiating benign from malignant nodules. Elastography has been described as an accurate predictor of malignancy by determining tissue elasticity. There are several methods utilized to evaluate the stiffness of normal tissue and the thyroid nodule, such as strain elastography, acoustic radiation force impulse, and shear wave elastography. Many studies show that elastography has both high sensitivity and specificity that approaches 100% for the determination of thyroid carcinoma. In addition, elastography also has a very high negative predictive value and thus, may also be helpful in the identification of thyroid nodules that do not need further diagnostic evaluation, including fine needle aspiration cytology. However, in the light of current evidence, there is a need for standardization and consensus on the most optimum elastography acquisition process. The purpose of this review is to provide a comprehensive summary of the use of elastography in the evaluation of thyroid nodules.
윤현조 ( Hyun Jo Youn ),정성후 ( Sung Hoo Jung ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1
Chemotherapy induced alopecia (CIA) is one of the most common and emotionally traumatic side effects in cancer patient care. CIA occurs with an estimated incidence of 65% and negatively affects a patient°Øs perception of appearance, body image, attractiveness, and self-esteem. Patient who fear CIA may select regimens with less favorable outcomes or may refuse treatment. CIA is caused by certain chemotherapeutics such as anthracyclines and taxanes. The incidence and severity of CIA depends on dose, administration route, rate, schedule, and peak blood level of the drug. The keratinocytes of hair follicle are susceptible to apoptosis induced by chemotherapeutics. Fortunately, CIA is usually reversible but permanent CIA also has been reported. The major approaches to prevent or minimize CIA are by physical and pharmacological means. Several experimental studies to the development of pharmacological agents to overcome CIA are under evaluation. However, effective methods for preventing CIA are currently unavailable. The management of CIA must be individualized based on the needs of each patient. An effective CIA treatment would likely require agents that are effective for chemotherapeutics with different action mechanisms and selective to hair follicles.
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윤현조(Hyun Jo Youn),정성후(Sung Hoo Jung) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3
Purpose: Sentinel lymph node biopsy (SLNB) is a minimally invasive procedure to avoid axillary dissection in breast cancer patients without axillary lymph node involvement, although there is no standardization of the technique. The aims of this study were to evaluate the efficacy of SLNB using radioisotopes in predicting axillary lymph node status, and to asses the clinical indications of SLNB. Methods: We conducted a prospective study of SLNB performed at Chonbuk National University Hospital between February 2000 and August 2005. All patients underwent SLNB, followed by planned completion axillary dissection regardless of the SLNB results. For identification of SLN, a radioisotope was used as a tracer with a peritumoral or subareolar injection, and SLNB using a gamma probe was performed after preoperative lymphoscintigraphy. Results: The sentinel lymph nodes were identified in 68 of the 70 patients (97.1%), with a mean of 2.84 sentinel nodes per patient. Overall, sensitivity was 83.3% (30/36), specificity 100% (32/32), accuracy 91.2% (62/68), and negative predictive value 84.2% (32/38). The false negative rate was 16.7% (6/36), and there was a significant difference in preoperative radiologic findings for axillary lymph node status (P=0.005). Conclusion: Compared with peritumoral injection, SLNB using a subareolar injection of a radioisotope was an accurate alternative to complete axillary dissection. SLNB may be indicated when there is no evidence of axillary lymph node metastasis in the preoperative radiologic examination.