Clinical significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with stage III colon cancer who underwent surgery followed by FOLFOX chemotherapy

Local tumor immune response and host immunity have been suggested as important prognosticators respectively in colorectal cancer. However, the utility of combination of these parameters remains inconclusive. The aim of this study was to investigate the combinational impact of local and host tumor immune response, as determined by tumor-infiltrating lymphocytes (TILs) and neutrophil-to-lymphocyte ratio (NLR), in patients with stage III colon cancer. Patients with stage III colon cancer homogeneously treated with surgery followed by FOLFOX chemotherapy between Jan 2007 and Aug 2013 were included retrospectively. Hematoxylin and eosin (H&E) stained tumor sections of local inflammatory infiltrate (TILs) were classified as 0-3 by the Klintrup-Mäkinen grading method. NLR was measured within 1 month of surgery. The association of NLR and TILs with survival, alone or combined, were measured using multivariate Cox proportional hazard regression analysis. Among 137 patients, 75 (54.7%) were identified as the high TIL group (TILs 2 and 3) and 97 (70.8%) as the low NLR group (NLR < 3). Of the patients with high TILs, 51 (68%) had a low NLR. In univariate analysis, operation time, complications, lymph node ratio (LNR), stage, TILs, and high TILs with low NLR were significantly associated with overall survival(OS). Multivariate Cox regression identified operation time, stage, and TILs as independent risk factors for OS. When high TILs with low NLR vs. others was entered into multivariate analysis, this also proved to be a significant predictor of OS (HR 4.1, 95% CI 1.1-14.2, P = 0.025), with an increased C-index and lower AIC value compared to TILs. Measuring TILs using H&E stained sections could stratify the prognosis of stage III colon cancer. Considering host immunity, using the combination of TILs and NLR, allowed the prognosis to be stratified in more detail.ope

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.ope

Changes in Body Composition During Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer

The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), -19% (p < 0.001), -3.4% (p = 0.936), and -11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at -2% and -2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest χ2 on the Mantel-Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15-0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14-0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.ope

Clinical outcomes of complete cytoreduction with concurrent liver resection followed by hyperthermic intraperitoneal chemotherapy for synchronous peritoneal and liver metastatic colorectal cancer

BACKGROUND: This study aimed to evaluate the clinical outcomes of concurrent liver resection with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer patients with synchronous liver and peritoneal metastases. METHODS: Patients with colorectal liver and peritoneal metastasis who underwent complete cytoreduction and hyperthermic intraperitoneal chemotherapy with concurrent liver surgery between September 2014 and July 2018 were included. Perioperative outcomes, overall survival, and progression-free survival were analyzed retrospectively. RESULTS: In total, 22 patients were included. The median peritoneal cancer index was 13 (range, 0-26), and the median number of liver metastases was 3 (range, 1-13). The mean total operative time was 11.4 ± 2.6 h. Minor postoperative complications (Clavien-Dindo grade I-II) were reported in 10 patients (45.5%), and major postoperative complications (grade III-V) were reported in five patients (22.7%), including one mortality patient. The median overall survival since diagnosis with metastasis was 27.4 months. The median overall survival since surgical intervention and the progression-free survival were 16.7 months and 7.1 months, respectively. CONCLUSIONS: This short-term follow-up study showed that, in an experienced center, combined resection with hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases was feasible and safe with acceptable oncologic outcomes.ope

Eosinophilic encephalomyelitis in horses caused by protostrongylid parasites

Four thoroughbred horses showing lameness, ataxia, circling, depression, recumbency, and seizures, were examined. The horses had gross, pale- to dark-red manifestations and foci in the central nervous system (CNS). Multifocal to coalescing eosinophilic necrotizing encephalomyelitis was observed histologically in the CNS along with intact or degenerated nematodes. Nematodes had polymyarian-coelomyarian musculature, a smooth thin cuticle, and intestines lined by multinucleated cells with microvilli. These traits suggested the nematodes belonged to the family Protostrongylidae, which includes Parelaphostrongylus tenuis. It was concluded that the horses were infected by nematodes, presumably Parelaphostrongylus tenuis, resulting in eosinophilic necrotizing encephalomyelitis.ope

Tailoring strategies for colorectal cancer screening and treatment based on age in colorectal cancer patients

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Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy

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Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort

Background: Since novel strategies for prevention and treatment of metachronous peritoneal metastases (mPM) are under study, it appears crucial to identify their risk factors. Our aim is to establish the incidence of mPM after surgery for colon cancer (CC) and to build a statistical model to predict the risk of recurrence. Patients and methods: Retrospective analysis of consecutive pT3-4 CC operated at five referral centers (2014-2018). Patients who developed mPM were compared with patients who were PM-free at follow-up. A scoring system was built on the basis of a logistic regression model. Results: Of the 1423 included patients, 74 (5.2%) developed mPM. Patients in the PM group presented higher preoperative carcinoembryonic antigen (CEA) [median (IQR): 4.5 (2.5-13.0) vs. 2.7 (1.5-5.9), P = 0.001] and CA 19-9 [median (IQR): 17.7 (12.0-37.0) vs. 10.8 (5.0-21.0), P = 0.001], advanced disease (pT4a 42.6% vs. 13.5%; pT4b 16.2% vs. 3.2%; P < 0.001), and negative pathological characteristics. Multivariate logistic regression identified CA 19-9, pT stage, pN stage, extent of lymphadenectomy, and lymphovascular invasion as significant predictors, and individual risk scores were calculated for each patient. The risk of recurrence increased remarkably with score values, and the model demonstrated a high negative predictive value (98.8%) and accuracy (83.9%) for scores below five. Conclusions: Besides confirming incidence and risk factors for mPM, our study developed a useful clinical tool for prediction of mPM risk. After external validation, this scoring system may guide personalized decision-making for patients with locally advanced CC.ope

Short-Term Event Prediction in the Operating Room (STEP-OP) of Five-Minute Intraoperative Hypotension Using Hybrid Deep Learning: Retrospective Observational Study and Model Development

Background: Intraoperative hypotension has an adverse impact on postoperative outcomes. However, it is difficult to predict and treat intraoperative hypotension in advance according to individual clinical parameters. Objective: The aim of this study was to develop a prediction model to forecast 5-minute intraoperative hypotension based on the weighted average ensemble of individual neural networks, utilizing the biosignals recorded during noncardiac surgery. Methods: In this retrospective observational study, arterial waveforms were recorded during noncardiac operations performed between August 2016 and December 2019, at Seoul National University Hospital, Seoul, South Korea. We analyzed the arterial waveforms from the big data in the VitalDB repository of electronic health records. We defined 2s hypotension as the moving average of arterial pressure under 65 mmHg for 2 seconds, and intraoperative hypotensive events were defined when the 2s hypotension lasted for at least 60 seconds. We developed an artificial intelligence-enabled process, named short-term event prediction in the operating room (STEP-OP), for predicting short-term intraoperative hypotension. Results: The study was performed on 18,813 subjects undergoing noncardiac surgeries. Deep-learning algorithms (convolutional neural network [CNN] and recurrent neural network [RNN]) using raw waveforms as input showed greater area under the precision-recall curve (AUPRC) scores (0.698, 95% CI 0.690-0.705 and 0.706, 95% CI 0.698-0.715, respectively) than that of the logistic regression algorithm (0.673, 95% CI 0.665-0.682). STEP-OP performed better and had greater AUPRC values than those of the RNN and CNN algorithms (0.716, 95% CI 0.708-0.723). Conclusions: We developed STEP-OP as a weighted average of deep-learning models. STEP-OP predicts intraoperative hypotension more accurately than the CNN, RNN, and logistic regression models. Trial registration: ClinicalTrials.gov NCT02914444; https://clinicaltrials.gov/ct2/show/NCT02914444.ope

성과주의 인사제도의 도입 결정요인 분석

학위논문 (석사)-- 서울대학교 행정대학원 : 정책학과, 2014. 2. 김병섭.본 연구는 성과주의 인사제도의 도입에 미치는 결정요인이 민간부문과 공공부문 간에 어떠한 차이를 갖고 나타나는지를 비교 분석하고자 하였다. 많은 선행연구들은 성과주의 인사제도의 도입 결정요인을 분석함에 있어서 민간/공공부문을 구분하지 않고 전체를 대상으로 분석하거나, 민간부문 또는 공공부문만을 대상으로 분석하고 있다. 또한 성과주의 인사제도와 관련하여 공공부문과 민간부문을 비교한 연구들은 대부분 성과주의 인사제도의 운영 실태를 분석함에 그칠 뿐, 그 도입과정에 영향을 미치는 요인까지 분석하지는 않고 있다. 이와 더불어, 여러 성과주의 인사제도들의 도입 여부의 총합 건수를 종속변수로 하여 분석하거나 특정 제도 한 두개만을 대상으로 분석하고 있는 것이 일반적이다. 따라서 본 연구는 공공부문과 민간부문 간의 조직 차이에 따라 성과주의 인사제도의 도입 수준과 결정요인이 달라지며, 개별 제도의 특성에 따라서도 그 제도의 도입 여부에 영향을 미치는 요인이 달라질 것이라는 가정에서 출발하였다. 본 연구의 종속변수는 연봉제, 성과배분제, 목표관리제, 다면평가제, 발탁승진제 등 대표적인 성과주의 인사제도의 도입 여부를 나타내는 더미변수이다. 한편, 제도 도입에 영향을 미치는 결정요인이 크게 합리성 관점과 정당성 관점으로 구분된다고 보는 기존 선행연구들을 따라, 합리성 관점에서 시장경쟁수준, 차별화전략 채택여부를, 정당성 관점에서 공공부문 여부, 조직규모, 인사부서의 전문성을 독립변수로 채택하였다. 마지막으로 통제변수는 조직연령과 노동조합 유무로 설정하였다. 본 연구에서는 2009년 사업체패널데이터에서 민간부문 1,621개 기업, 공공부문 116개 기업 총 1,737개의 기업을 대상으로 하여 분석하였다. 이들을 대상으로, 다중회귀분석과 로지스틱 회귀분석을 실시하였다. 본 연구의 주요 결과를 정리하면 다음과 같다. 첫째, 성과주의 인사제도는 대부분 공공부문에서 도입이 더 적극적이나, 목표관리제나 발탁승진제처럼 개별 제도의 특성에 따라 민간부문과 공공부문 간에 큰 차이가 없는 것으로 나타나기도 한다. 둘째, 합리성 관점보다는 조직규모, 인사부서의 전문성과 같은 정당성 관점의 요인들이 성과주의 인사제도 도입에 유의한 정(+)의 영향을 크게 미치며, 특히 공공부문에서 그러한 경향이 더욱 두드러지는 것으로 확인되었다. 그러나 이 역시 개별제도의 특성에 따라, 특히 민간/공공의 조직문화 차이에 따라 영향요인이 달라질 수 있는 것으로 나타났다. 결론적으로, 본 연구에서는 성과주의 인사제도는 민간/공공부문 간 조직정체성 및 내외부 환경에 의해 도입 여부에 영향을 받으며, 이는 다양한 성과주의 인사제도에 따라 서로 다르게 나타날 수 있다는 점을 발견할 수 있었다. 이는 향후 민간 또는 공공부문의 어느 기업이 성과주의 인사제도를 도입, 운영하는 과정에서 고려해야 할 핵심 요인들을 파악하는 데 하나의 방향성을 제시할 수 있을 것이다.목 차 제 1 장 서론 7 제 1 절 연구목적 및 필요성 7 제 2 절 연구의 대상과 방법 10 제 2 장 이론적 논의와 선행연구 검토 12 제 1 절 성과주의 인사제도에 관한 이론적 논의 12 1. 성과주의 인사제도의 개념 및 구성요소 12 2. 공공기관의 성과주의 인사제도 19 제 2 절 제도 도입 결정요인에 관한 이론적 논의 24 1. 합리성 관점 24 2. 정당성 관점 25 제 3 절 선행연구 검토 28 제 3 장 연구설계 및 분석방법 40 제 1 절 변수의 조작적 정의와 가설설정 40 1. 성과주의 인사제도 도입 결정요인 (독립변수) 40 2. 성과주의 인사제도 도입 여부 (종속변수) 48 3. 통제변수 48 제 2 절 연구의 분석틀 51 제 4 장 실증 분석 53 제 1 절 기술통계 분석 53 1. 종속변수 53 2. 독립변수 55 3. 통제변수 59 제 2 절 상관분석 61 제 3 절 성과주의 인사제도의 도입 결정요인 분석 64 1. 성과주의 인사제도 도입 지수의 결정요인 분석 64 가. OLS 회귀모형 기본가정의 검증 64 나. 회귀분석 결과 68 2. 개별 성과주의 인사제도 도입의 결정요인 분석 74 가. 연봉제 75 나. 성과배분제 78 다. 목표관리제 81 라. 다면평가제 84 마. 발탁승진제 87 제 4 절 소결 91 제 5 장 결론 98 제 1 절 연구결과의 요약 및 정책적 시사점 98 제 2 절 연구의 한계 및 향후 연구과제 103 참 고 문 헌 105 Abstract 111 표 차례 표 1 성과주의 인사제도에 대한 다양한 정의들 15 표 2 합리성 이론과 정당성 이론의 비교 28 표 3 선행연구 제도 도입 결정요인 분류 32 표 4 선행연구 분석결과 종합 34 표 5 변수명과 변수의 측정방법 50 표 6 성과주의 인사제도 도입 현황 53 표 7 민간․공공부문의 성과주의 인사제도 도입 현황 54 표 8 종속변수 기초통계량 55 표 9 시장의 경쟁수준과 차별화전략 채택 여부 현황 56 표 10 조직규모에 따른 성과주의 인사제도 도입 실태 57 표 11 인사부서의 전문성 현황 58 표 12 독립변수 기초통계량 59 표 13 조직연령 현황 59 표 14 노동조합 유무 현황 60 표 15 통제변수 기초통계량 60 표 16 상관분석 결과 63 표 17 성과주의 인사제도 도입지수에 대한 회귀분석 결과 70 표 18 민간․공공부문의 성과주의 인사제도 도입지수에 대한 회귀분석 결과 72 표 19 연봉제 로지스틱 회귀분석 결과 76 표 20 민간부문과 공공부문의 연봉제 로지스틱 회귀분석 결과 77 표 21 성과배분제 로지스틱 회귀분석 결과 80 표 22 민간부문과 공공부문의 성과배분제 로지스틱 회귀분석 결과 81 표 23 목표관리제 로지스틱 회귀분석 결과 83 표 24 민간부문과 공공부문의 목표관리제 로지스틱 회귀분석 결과 84 표 25 다면평가제 로지스틱 회귀분석 결과 86 표 26 민간부문과 공공부문의 다면평가제 로지스틱 회귀분석 결과 87 표 27 발탁승진제 로지스틱 회귀분석 결과 89 표 28 민간부문과 공공부문의 발탁승진제 로지스틱 회귀분석 결과 90 표 29 분석결과 종합 91 표 30 민간부문과 공공부문 간 분석결과 차이 94 표 31 본 연구의 가설 채택 여부 97 그림 차례 그림 1 성과주의 인사제도 도입지수의 회귀 스튜던트화 잔차산점도 66 그림 2 성과주의 인사제도 도입 건수의 회귀 표준화 잔차 정규 P-P 도표 67 그림 3 성과주의 인사제도 도입 건수의 회귀 표준화 잔차 히스토그램 68Maste