HCC : Clinical Outcomes of the Second Treatments in Patients with Progression of Hepatocellular Carcinoma after Initial Treatments

( Young Il Kim ),( Joong Won Park ),( Hee Won Kwak ),( Bo Hyun Kim ),( Tae Hyun Kim ),( Seong Hoon Kim ),( Young Hwan Koh ),( Hyun Beom Kim ),( Chang Min Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: All of outcome studies for hepatocellular carcinoma (HCC) treatments have been based on initial treatments. However, in most patients with HCC, recurrence or progression after initial treatment frequently occurs, and succeeding treatments are necessary for control of disease. In this study, we analyzed the clinical outcomes of patients with HCC based on the second treatment. Methods: A cohort of 1,972 patients newly diagnosed with HCC and treated at the National Cancer Center, Korea between January 2004 and December 2009 was used for this study. After exclusion of supportive care cases, 1,687 patients were studied for progression-free survival (PFS), recorded second treatments after progression, and overall survival (OS) after the second treatment. Results: Median age of patients was 57 years. OS of these patients was 26.9 months. Among 1,687 patients, 1,359 patients (80.6%) had disease progression after initial treatments. Initial treatment was resection (21.6%), transplantation (1.8%), locoregional treatments including radiofrequency ablation or percutaneous ethanol injection therapy (4.5%), transarterial chemoembolization (TACE) (64.6%), external radiotherapy (RT) (3.2%), or systemic chemotherapy (4.3%). Median PFS was 21.2 months. In these patients with progression, resection (2.3%), transplantation (1.3%), locoregional treatments (5.0%), TACE (51.6%), RT (3.7%), systemic chemotherapy (12.5%), or supportive care only (22.7%) was performed as the second treatment. Median OS after the second treatment was 15.6 months. According to each second treatment, median OS were 35.0 months in resection, 47.5 months in locoregional treatments, 17.9 months in TACE, 19.1 months in RT, 7.9 months in systemic chemotherapy, and 9.7 months in supportive care, respectively (P< 0.001, log-rank test). Further outcome analysis in each second treatment will be presented. Conclusions: This observational study provides insights into HCC disease characteristics and clinical outcomes after the first and the second treatments for the first time and may be useful in future research of HCC treatment strategies.

Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome

Amit Kumar Deb,Rakesh Singh,Subashini Kaliaperumal,Arun Alexander,Tanmay Gokhale,Sandip Sarkar 대한안과학회 2022 Korean Journal of Ophthalmology Vol.36 No.4

Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM. Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome. Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009). Conclusions: The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

Outcomes of comprehensive fixed appliance orthodontic treatment

Spyridon N. Papageorgiou,Damian Hochli,Theodore Eliades 대한치과교정학회 2017 대한치과교정학회지 Vol.47 No.6

Objective: The aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics. Methods: Nine databases were searched up to October 2016 for prospective/retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated. Results: A total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3–30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6–25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results. Conclusions: The findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances.

Outcome of endodontic treatments performed by Brazilian undergraduate students: 3- to 8-year follow up

da Rocha Jéssica Gabriele,Lena Isabella Marian,Trindade Jéssica Lopes,Liedke Gabriela Salatino,Morgental Renata Dornelles,Bier Carlos Alexandre Souza 대한치과보존학회 2022 Restorative Dentistry & Endodontics Vol.47 No.3

Objectives This study aimed to evaluate the success rate of endodontic treatments performed by undergraduate students and the factors associated with the outcome. Materials and Methods A follow-up of 3 to 8 years after root canal filling was carried out in 91 patients. At the follow-up visits, medical and dental history questionnaires were applied along with clinical and radiographic examinations. Data collected in the clinical exam included: the presence of pain, swelling, sinus tract, mobility, tenderness to palpation and percussion, periodontal probing profile, and type/quality of coronal restoration. Postoperative and follow-up radiographs were digitalized and analyzed by 2 trained and calibrated examiners to assess periapical healing. The treatment outcome was based on strict clinical and radiographic criteria and classified as success (absence of any clinical and radiographic sign of apical periodontitis) or failure (other combination). Logistic regression was used to investigate the impact of clinical and radiographic variables on endodontic treatment outcomes at a 5% significance level. Results The success rate of endodontic treatments was 60.7%. The only risk factor significantly associated with failure was the presence of a periapical lesion on the postoperative radiograph (odds ratio, 3.35; 95% confidence interval, 1.17–9.54). Conclusions The success rate of endodontic treatments performed by undergraduate students was low and was jeopardized by the presence of a periapical lesion on the postoperative radiograph. Objectives This study aimed to evaluate the success rate of endodontic treatments performed by undergraduate students and the factors associated with the outcome. Materials and Methods A follow-up of 3 to 8 years after root canal filling was carried out in 91 patients. At the follow-up visits, medical and dental history questionnaires were applied along with clinical and radiographic examinations. Data collected in the clinical exam included: the presence of pain, swelling, sinus tract, mobility, tenderness to palpation and percussion, periodontal probing profile, and type/quality of coronal restoration. Postoperative and follow-up radiographs were digitalized and analyzed by 2 trained and calibrated examiners to assess periapical healing. The treatment outcome was based on strict clinical and radiographic criteria and classified as success (absence of any clinical and radiographic sign of apical periodontitis) or failure (other combination). Logistic regression was used to investigate the impact of clinical and radiographic variables on endodontic treatment outcomes at a 5% significance level. Results The success rate of endodontic treatments was 60.7%. The only risk factor significantly associated with failure was the presence of a periapical lesion on the postoperative radiograph (odds ratio, 3.35; 95% confidence interval, 1.17–9.54). Conclusions The success rate of endodontic treatments performed by undergraduate students was low and was jeopardized by the presence of a periapical lesion on the postoperative radiograph.

All-treatment array of hepatocellular carcinoma from initial diagnosis to death: observation of cumulative treatments

Moon, Hae,Choi, Ji Eun,Lee, In Joon,Kim, Tae Hyun,Kim, Seong Hoon,Ko, Young Hwan,Kim, Hyun Boem,Nam, Byung-Ho,Park, Joong-Won Springer Berlin Heidelberg 2017 JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY Vol.143 No.11

<P><B>Purpose</B></P><P>In clinical practice, most patients with hepatocellular carcinoma require subsequent treatments for remaining, progressing, or recurring tumors. We investigated all-treatment array and outcomes in an HCC cohort from initial diagnosis to death.</P><P><B>Methods</B></P><P>We enrolled 1687 consecutive patients with HCC who underwent initial diagnosis and treatment at the National Cancer Center, Korea, from January 2004 to December 2009.</P><P><B>Results</B></P><P>In total, 1357 patients (80.4%) showed RPRTs during median 20.4-month follow-up. Initial transplantation resulted in the least rate (32.3%) of RPRTs. Median treatment frequency was 3.0 times (range 1–20) and 382 patients (27.3%) received treatments ≥6 times. The median treatment frequency was different based on four factors (<I>p</I> < 0.05): age, tumor stage, tumor type and initial treatment modality. Patients with Barcelona Clinic Liver Cancer stage 0 received less frequent treatments. As the stage progressed from 0 to B, the median treatment frequency increased. Radiofrequency ablation as initial treatment was associated with the longest median treatment interval at 19.0 weeks, followed by resection at 14.1 weeks. The median treatment interval was significantly shorter as the stage progressed (<I>p</I> < 0.01). TACE was most frequently performed for RPRTs; the median number of subsequent TACE was 3 (range 1–19). Subsequent treatment array was very heterogeneous, and no certain pattern was found.</P><P><B>Conclusions</B></P><P>Our findings suggest that the survival outcome of patients with HCC is based on the results of cumulative multiple treatments rather than an initial treatment. It is time to consider prospective studies evaluating sequential treatment array of HCC.</P>

Mycobacterium abscessus 폐질환 치료의 장기 성적

조경욱 ( Kyung Uk Jo ),박수정 ( Soo Jung Park ),홍석찬 ( Seok Chan Hong ),오연목 ( Yeon Mok Oh ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),심태선 ( Tae Sun Shim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.2

연구배경: M. abscessus 폐질환은 최근 우리나라에서 유병률이 증가하는 질환이다. 국내 M. abscessus 폐감염증에 대한 치료성적 및 치료 후 장기결과에 대해서 알아보고자 의무기록을 후향적으로 분석하였다. 방법: 1996년부터 2003년까지 서울아산병원에서 미국흉부학회진단기준에 부합하는 35명의 M. abscessus 폐질환 환자 중 치료를 받은 29명의 환자를 대상으로 임상적 특징과 치료, 치료 후 추적결과에 대해 분석하였다. 결과: 29명의 평균 나이는 56.1세(± 13.6)였고 여성이 76% 이었으며(22/29), 20명(69%)에서 결절 기관지확장증형이었다. 29명 중 19명(65.5%)에서 치료성공하였고 9명(31%)은 치료실패하였다. 1명은 약물부작용으로 치료를 중단하였다. 치료성공군은 중앙값 543일(범위 176 - 1,160)동안 치료를 받았고, 균배양 음전까지의 기간은 중앙값 42일(범위 15-362)이었다. 수술은 5명에서 시행되었으며 한 엽에만 국한된 병변을 가진 두 환자에서 치료성공하였다. 치료 완료 후 중앙값 931일 (범위 230-2294일)동안 추적관찰이 이루어졌고, 19명 중 1명(5.3%)이 재발하였다. 결론: M. abscessus 폐질환의 세균학적 치료 성적은 외국의 보고에 비하여 우수한 편이며 치료성공 후 재발률은 낮았다. Background: Although there is an increasing incidence of Mycobacterium abscessus pulmonary disease in Korea, the optimal therapeutic regimen has not yet been established and there are no reports of the long-term treatment outcomes. This study examined the long-term treatment outcomes of M. abscessus pulmonary disease. Methods: Twenty-nine patients diagnosed with M. abscessus pulmonary according to the American Thoracic Society criteria and treated from January 1996 to December 2003 were enrolled in ghis study. The clinical characteristics, radiological findings, treatment outcome, and follow up data were analyzed retrospectively. Results: The mean age of the 29 patients was 56.1 (± 13.6) years and there was a female (22/29) dominance. The chest radiography revealed the nodular bronchiectatic type to be dominant (69%, 20/29). Twenty-seven (93.1%) were prescribed clarithromycin-containing regimens, and injectable drugs, mainly aminoglycosides, were included in the regimen of nineteen patients. The most predominant regimen (48.3%) consisted of clarithromycin and amikacin. The treatment success, failure, and default were achieved in 19(65.5%), 9(31.0%), and 1(3.4%), respectively. The median duration to culture conversion was 42 days (range 15-362) and the median duration of treatment in the success group was 543 days (range 176-1,160). An adjunctive surgical resection was performed in five patients, which resulted in treatment success in two patients. After the completion of treatment, nineteen patients were followed up for a median duration of 931 days (range 230-2,294). Only one (5.3%) patient relapsed 45 days after completing treatment. Conclusion: Treatment with clarithromycin-containing regimens resulted in a successful treatment in approximately two thirds of patients with M. abscessus pulmonary disease. The long-term relapse rate was also quite low. (Tuberc Respir Dis 2007; 62: 98-104)

Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control

Zhang Jing,Shen Xin,Yang Chongguang,Chen Yue,Guo Juntao,Wang Decheng,Zhang Jun,Lynn Henry,Hu Yi,Pan Qichao,Zhang Zhijie 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.METHODS: We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.RESULTS: Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.CONCLUSIONS: Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.

뇌성마비환아와 발달장애아의 조기치료 효과

박창일,박은숙,신지철,김성우,최은희 大韓再活醫學會 1999 Annals of Rehabilitation Medicine Vol.23 No.6

Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients

( Ryoung-eun Ko ),( Kyeongman Jeon ),( Soo Jin Na ),( Kyungmin Huh ),( Gee Young Suh ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Pneumocystis pneumonia (PCP) with hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, there is no study evaluating the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and clinical outcomes in HIV-negative patients with PCP presented with hypoxemic respiratory failure. A retrospective observational study was performed of 51 HIV-negative patients with PCP presented with respiratory failure and admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between time to anti-PCP treatment and in hospital mortality. All patients were treated with appropriate anti-PCP treatment, primarily with trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0 - 97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to microbiological diagnosis confirmed. However, hospital mortality rates were not associated with increasing quartiles of time to anti-PCP treatment (P = 0.818, test for trend). All patients who applied high-flow nasal cannula for respiratory support on ICU admission day survived. In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01 - 1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34 - 72.65) were independently associated with increased mortality. In conclusion, there was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP presented with hypoxemic respiratory failure. Higher mortality rate was independently associated with respiratory failure requiring mechanical ventilation support, age, and failure of the initial anti-PCP treatment.

Factors Affecting Treatment Discontinuation and Treatment Outcome in Patients with Schizophrenia in Korea: 10-Year Follow-Up Study

SeungHo Jung,WonHyung Kim,HyeJin Choi,MinHee Kang,JeongSeop Lee,JaeNam Bae,ChulEung Kim 대한신경정신의학회 2011 PSYCHIATRY INVESTIGATION Vol.8 No.1

Objective-There have been few long-term studies that have assessed factors influencing treatment discontinuation and long-term outcome of schizophrenia in Korea. The present study aimed to evaluate factors affecting treatment discontinuation and treatment outcome, after 10 years, in patients with schizophrenia. Methods-Among hospitalized patients between 1997 and 1999, 191 patients were given continuous follow-up service. We examined the clinical characteristics and outcome of patients who remained in treatment. Regression analyses were used to find any clinical factors affecting treatment discontinuation. Results-One hundred thirty-three patients (71.12%) discontinued the treatment. The treatment retention group contained more female patients, paranoid-type patients, patients who had shown self-harming behavior, patients receiving clozapine, and patients with good medication compliance. The recovery rate was 25%. However, 42.3% did not have gainful employment. Further, most patients couldn’t live independently. Conclusion-The results show the importance of gender, patient behavior, medication, and medication compliance in predicting treatment discontinuation in patients with schizophrenia.