Publications by authors named "Eun Kyoung Hong"

27 Publications

  • Page 1 of 1

CT for lymph node staging of Colon cancer: not only size but also location and number of lymph node count.

Abdom Radiol (NY) 2021 09 27;46(9):4096-4105. Epub 2021 Apr 27.

Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.

Purpose: To evaluate the diagnostic accuracy of imaging features to predict lymph node status of colon cancer using CT.

Methods: This was a retrospective study from 2 tertiary hospitals in South Korea and Netherlands. 317 Colon cancer patients who underwent primary surgical treatment were included. Number of lymph nodes according to the anatomical location, size, cluster, degree of attenuation, shape, presence of internal heterogeneity and ill-defined margin of the lymph node were assessed and compared according to histological lymph node status.

Results: The largest short diameter of lymph node and presence of internal heterogeneity of lymph node showed significant association with malignant lymph node status (P < 0.001 and P = 0.041, respectively). The ROC curve analysis revealed AUC of 0.703 for the largest short diameter of lymph node (P < 0.001), and AUC of the presence of internal heterogeneity was 0.630 (P < 0.001). In addition, our study showed that a total number of lymph nodes, regardless of size, (P = 0.022) and number of lymph nodes in peritumoral area (P < 0.001) and along the mesenteric vessels (P < 0.001) on CT demonstrated significant association with malignant status of lymph nodes in colon cancer.

Conclusions: There were significant associations between lymph node status and imaging features of lymph nodes on CT in colon cancer patients. The largest short diameter of lymph node and presence of internal heterogeneity can be used to predict the malignant status of lymph node in colon cancer patients. Also, the number of lymph nodes near the colonic tumor should be considered in assessment of colon cancer lymph node involvement on CT.
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http://dx.doi.org/10.1007/s00261-021-03057-0DOI Listing
September 2021

Comparison of Genetic Profiles and Prognosis of High-Grade Gliomas Using Quantitative and Qualitative MRI Features: A Focus on G3 Gliomas.

Korean J Radiol 2021 02 10;22(2):233-242. Epub 2020 Sep 10.

Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.

Objective: To evaluate the association of MRI features with the major genomic profiles and prognosis of World Health Organization grade III (G3) gliomas compared with those of glioblastomas (GBMs).

Materials And Methods: We enrolled 76 G3 glioma and 155 GBM patients with pathologically confirmed disease who had pretreatment brain MRI and major genetic information of tumors. Qualitative and quantitative imaging features, including volumetrics and histogram parameters, such as normalized cerebral blood volume (nCBV), cerebral blood flow (nCBF), and apparent diffusion coefficient (nADC) were evaluated. The G3 gliomas were divided into three groups for the analysis: with this isocitrate dehydrogenase ()-mutation, mutation and a -codeleted (IDHmut1p/19qdel), mutation, -nondeleted (IDHmut1p/19qnondel), and wildtype (IDHwt). A prediction model for the genetic profiles of G3 gliomas was developed and validated on a separate cohort. Both the quantitative and qualitative imaging parameters and progression-free survival (PFS) of G3 gliomas were compared and survival analysis was performed. Moreover, the imaging parameters and PFS between IDHwt G3 gliomas and GBMs were compared.

Results: IDHmut G3 gliomas showed a larger volume ( = 0.017), lower nCBF ( = 0.048), and higher nADC ( = 0.007) than IDHwt. Between the IDHmut tumors, IDHmut1p/19qdel G3 gliomas had higher nCBV ( = 0.024) and lower nADC ( = 0.002) than IDHmut1p/19qnondel G3 gliomas. Moreover, IDHmut1p/19qdel tumors had the best prognosis and IDHwt tumors had the worst prognosis among G3 gliomas ( < 0.001). PFS was significantly associated with the 95th percentile values of nCBV and nCBF in G3 gliomas. There was no significant difference in neither PFS nor imaging features between IDHwt G3 gliomas and IDHwt GBMs.

Conclusion: We found significant differences in MRI features, including volumetrics, CBV, and ADC, in G3 gliomas, according to mutation and codeletion status, which can be utilized for the prediction of genomic profiles and the prognosis of G3 glioma patients. The MRI signatures and prognosis of IDHwt G3 gliomas tend to follow those of IDHwt GBMs.
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http://dx.doi.org/10.3348/kjr.2020.0011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817637PMC
February 2021

Locoregional CT staging of colon cancer: does a learning curve exist?

Abdom Radiol (NY) 2021 02 30;46(2):476-485. Epub 2020 Jul 30.

Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands.

Purpose: To evaluate the learning curve for locoreginal staging of colon cancer in radiologist trainees.

Methods: Eighty-eight cases of colon cancer CT were included in this retrospective study. Four senior radiology residents staged the CTs according to TNM classification. Two out of four radiologists received feedback after reading every 20 cases. Radiologic staging was compared with pathologic staging and the learning curve, diagnostic performance, reader confidence and reading time were evaluated and compared between the two groups (feedback vs. no feedback). Generalized estimating equations logistic regression, QICu statistic, ANOVA and t test/Mann-Whitney test were utilized.

Results: Radiologists demonstrated a significant increase in their performance to distinguish between ≤ T2 and ≥ T3 and reached an inflection point at 38 cases, with a significant association with increased number of cases reviewed (P < 0.001). Sensitivity (P < 0.001), specificity (P = 0.030) and NPV (P = 0.002) demonstrated significant associations with increased experience. The overall reader's confidence was significantly higher in the group which received feedback (P < 0.001). There was no significant improvement in performance nor in reader's confidence for N staging (N0 vs. ≥ N1) for all readers. Reading time decreased with experience and showed a significant negative association with experience (P < 0.001).

Conclusion: Diagnostic performance of senior radiology trainees in differentiating between T2 and T3 colon cancer on CTs improved with increased experience. In contrast, evaluation of lymph node involvement did not improve with more experience. Feedback had no significant effect on improvement of diagnostic performances.
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http://dx.doi.org/10.1007/s00261-020-02672-7DOI Listing
February 2021

Prognostic Value of Dynamic Contrast-Enhanced MRI-Derived Pharmacokinetic Variables in Glioblastoma Patients: Analysis of Contrast-Enhancing Lesions and Non-Enhancing T2 High-Signal Intensity Lesions.

Korean J Radiol 2020 06;21(6):707-716

Department of Radiology, Seoul National University Hospital, Seoul, Korea.

Objective: To evaluate pharmacokinetic variables from contrast-enhancing lesions (CELs) and non-enhancing T2 high signal intensity lesions (NE-T2HSILs) on dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for predicting progression-free survival (PFS) in glioblastoma (GBM) patients.

Materials And Methods: Sixty-four GBM patients who had undergone preoperative DCE MR imaging and received standard treatment were retrospectively included. We analyzed the pharmacokinetic variables of the volume transfer constant (Ktrans) and volume fraction of extravascular extracellular space within the CEL and NE-T2HSIL of the entire tumor. Univariate and multivariate Cox regression analyses were performed using preoperative clinical characteristics, pharmacokinetic variables of DCE MR imaging, and postoperative molecular biomarkers to predict PFS.

Results: The increased mean Ktrans of the CEL, increased 95th percentile Ktrans of the CELs, and absence of methylated O⁶-methylguanine-DNA methyltransferase promoter were relevant adverse variables for PFS in the univariate analysis ( = 0.041, = 0.032, and = 0.083, respectively). The Kaplan-Meier survival curves demonstrated that PFS was significantly shorter in patients with a mean Ktrans of the CEL > 0.068 and 95th percentile Ktrans of the CEL>0.223 (log-rank = 0.038 and = 0.041, respectively). However, only mean Ktrans of the CEL was significantly associated with PFS ( = 0.024; hazard ratio, 553.08; 95% confidence interval, 2.27-134756.74) in the multivariate Cox proportional hazard analysis. None of the pharmacokinetic variables from NE-T2HSILs were significantly related to PFS.

Conclusion: Among the pharmacokinetic variables extracted from CELs and NE-T2HSILs on preoperative DCE MR imaging, the mean Ktrans of CELs exhibits potential as a useful imaging predictor of PFS in GBM patients.
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http://dx.doi.org/10.3348/kjr.2019.0629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231611PMC
June 2020

Deep Learning for Chest Radiograph Diagnosis in the Emergency Department.

Radiology 2019 12 22;293(3):573-580. Epub 2019 Oct 22.

From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.).

BackgroundThe performance of a deep learning (DL) algorithm should be validated in actual clinical situations, before its clinical implementation.PurposeTo evaluate the performance of a DL algorithm for identifying chest radiographs with clinically relevant abnormalities in the emergency department (ED) setting.Materials and MethodsThis single-center retrospective study included consecutive patients who visited the ED and underwent initial chest radiography between January 1 and March 31, 2017. Chest radiographs were analyzed with a commercially available DL algorithm. The performance of the algorithm was evaluated by determining the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity at predefined operating cutoffs (high-sensitivity and high-specificity cutoffs). The sensitivities and specificities of the algorithm were compared with those of the on-call radiology residents who interpreted the chest radiographs in the actual practice by using McNemar tests. If there were discordant findings between the algorithm and resident, the residents reinterpreted the chest radiographs by using the algorithm's output.ResultsA total of 1135 patients (mean age, 53 years ± 18; 582 men) were evaluated. In the identification of abnormal chest radiographs, the algorithm showed an AUC of 0.95 (95% confidence interval [CI]: 0.93, 0.96), a sensitivity of 88.7% (227 of 256 radiographs; 95% CI: 84.1%, 92.3%), and a specificity of 69.6% (612 of 879 radiographs; 95% CI: 66.5%, 72.7%) at the high-sensitivity cutoff and a sensitivity of 81.6% (209 of 256 radiographs; 95% CI: 76.3%, 86.2%) and specificity of 90.3% (794 of 879 radiographs; 95% CI: 88.2%, 92.2%) at the high-specificity cutoff. Radiology residents showed lower sensitivity (65.6% [168 of 256 radiographs; 95% CI: 59.5%, 71.4%], < .001) and higher specificity (98.1% [862 of 879 radiographs; 95% CI: 96.9%, 98.9%], < .001) compared with the algorithm. After reinterpretation of chest radiographs with use of the algorithm's outputs, the sensitivity of the residents improved (73.4% [188 of 256 radiographs; 95% CI: 68.0%, 78.8%], = .003), whereas specificity was reduced (94.3% [829 of 879 radiographs; 95% CI: 92.8%, 95.8%], < .001).ConclusionA deep learning algorithm used with emergency department chest radiographs showed diagnostic performance for identifying clinically relevant abnormalities and helped improve the sensitivity of radiology residents' evaluation.Published under a CC BY 4.0 license.See also the editorial by Munera and Infante in this issue.
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http://dx.doi.org/10.1148/radiol.2019191225DOI Listing
December 2019

Arterial spin labeling perfusion-weighted imaging aids in prediction of molecular biomarkers and survival in glioblastomas.

Eur Radiol 2020 Feb 29;30(2):1202-1211. Epub 2019 Aug 29.

Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.

Objectives: Prediction of progression-free survival (PFS) and overall survival (OS) and early identification of molecular biomarkers with prognostic information are clinically important in glioblastoma (GBM) patients. We aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI) in the prediction of molecular biomarkers and survival in GBM patients.

Methods: We retrospectively analyzed 149 consecutive GBM patients, who had undergone maximal surgical resection or biopsy followed by concurrent chemoradiotherapy and adjuvant chemotherapy using temozolomide between November 2010 and June 2016. On preoperative ASL-PWI, cerebral blood flow (CBF) within contrast-enhancing (CE) and nonenhancing (NE) portions were evaluated both qualitatively (perfusion pattern and perfusion pattern) and quantitatively (nCBF and nCBF). ASL-PWI findings were correlated with molecular biomarkers, including isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT) methylation statuses, and survival, using the Mann-Whitney U-test, Spearman rank correlation, Kaplan-Meier analysis, and receiver operating characteristics analysis.

Results: nCBF was significantly higher in the IDH wild-type group than in the IDH mutant group (p = .013) and in the MGMT unmethylated group than in the methylated group (p = .047). Areas under the receiver operating characteristic curve were 0.678 for IDH mutation (p = .022) and 0.601 for MGMT promoter methylation (p = .043). Hyperperfusion was associated with the shortest median PFS for both perfusion pattern (7.6 months) and perfusion pattern (4.0 months). The perfusion pattern remained an independent predictor for PFS and OS even after adjusting for clinical and molecular predictors, unlike perfusion pattern.

Conclusions: ASL-PWI can aid to predict survival and molecular biomarkers including IDH mutation and MGMT promoter methylation statuses in GBM patients.

Key Points: • ASL-PWI can aid to predict survival in GBM patients. • ASL-PWI can aid to predict IDH and MGMT promoter methylation statuses in GBM.
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http://dx.doi.org/10.1007/s00330-019-06379-2DOI Listing
February 2020

Assessment of hepatic sinusoidal obstruction syndrome with intravoxel incoherent motion diffusion-weighted imaging: An experimental study in a rat model.

J Magn Reson Imaging 2020 01 15;51(1):81-89. Epub 2019 May 15.

Department of Pathology, Seoul National University Hospital, Seoul, Korea.

Background: Intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters may reflect perfusion and diffusion changes in hepatic sinusoidal obstruction syndrome (SOS).

Purpose: To investigate the feasibility of IVIM-DWI in the noninvasive assessment of hepatic SOS in an experimental rat model.

Study Type: Animal study.

Population/subjects: Forty-four rats were administered different doses (90 or 160 mg/kg) of monocrotaline by gavage either 48 or 72 hours before MRI to induce different degrees of hepatic SOS, and another 10 rats served as controls.

Field Strength/sequence: 3T scanner, IVIM-DWI using nine b values (0-800 sec/mm ).

Assessment: Histologically, rats were classified as having none (n = 10), mild (n = 8), moderate (n = 19), or severe SOS (n = 17). The apparent diffusion coefficient (ADC) and IVIM-derived parameters (D: true diffusion coefficient, D*: pseudo-diffusion coefficient, and f: perfusion fraction) of the liver parenchyma were measured.

Statistical Tests: IVIM-DWI parameters were compared according to histologic grades of SOS (none, mild, moderate, and severe), and receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy.

Results: ADC, D, and f of the liver parenchyma were significantly different according to SOS severity groups (Ps < 0.01) and significantly decreased as SOS severity increased (rho = -0.323, -0.313, and -0.700; P = 0.017, 0.021, and <0.001, respectively). Means of f in none, mild, moderate, and severe SOS were 17.2%, 13.3%, 12.3%, and 11.1%, respectively. Among ADC and IVIM-derived parameters, f provided the highest area under the ROC curves for detecting ≥mild, ≥moderate, and severe SOS (0.991, 0.890, and 0.803, respectively).

Data Conclusion: IVIM-DWI may be useful in the diagnosis and severity assessment of hepatic SOS.

Level Of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:81-89.
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http://dx.doi.org/10.1002/jmri.26790DOI Listing
January 2020

Diagnostic value of computed tomography combined with ultrasonography in detecting cervical recurrence in patients with thyroid cancer.

Head Neck 2019 05 14;41(5):1206-1212. Epub 2018 Dec 14.

Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.

Background: To determine the diagnostic role of CT added to ultrasound for the diagnosis of recurrent differentiated thyroid cancer (DTC) and to evaluate potential benefits for patients.

Methods: A total of 193 patients with recurrent DTC were retrospectively included. The diagnostic performances of ultrasound and combination of ultrasound and CT (ultrasound/CT) in detecting recurrence were compared. Benefits of CT were assessed based on the presence of any recurrence detected only with additional CT.

Results: In detecting cervical recurrence, ultrasound/CT showed higher sensitivity (P = .001) and lower specificity (P < .001) than ultrasound alone, overall resulting in higher area under the curve (P < .001). Seventy-nine patients (40.9%) benefited from additional CT in detecting recurrence.

Conclusion: For reoperation of cervical recurrence in patients with DTC, addition of CT to ultrasound offers better surgical planning by enhancing detection of recurrent cancers that were overlooked with ultrasound alone.
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http://dx.doi.org/10.1002/hed.25538DOI Listing
May 2019

Persistent/Recurrent Differentiated Thyroid Cancer: Clinical and Radiological Characteristics of Persistent Disease and Clinical Recurrence Based on Computed Tomography Analysis.

Thyroid 2018 11 16;28(11):1490-1499. Epub 2018 Oct 16.

7 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea.

Background: The natural course of persistent/recurrent differentiated thyroid cancer (DTC) has not been fully elucidated. The purpose of this study was to assess the relative incidence and clinico-radiological characteristics of persistent disease and clinical recurrence based on computed tomography (CT) analysis in patients with persistent/recurrent DTC.

Methods: From January 2005 to December 2016, this retrospective study included 107 patients (M:F = 28:79; M = 53.5 years) with surgically proven cervical locoregional recurrence of DTC. Two neck CT examinations (median interval 1.92 years; range 0.17-7.58 years) before the last thyroid cancer surgery within the study period were reevaluated. Based on the presence of the lesion on the first CT and its progression on the second CT, the locoregional recurrence was classified into the following categories: stable persistence (decrease, no change, or increase by <2 mm in short dimension on the second CT), progressive persistence (increase by ≥2 mm), and clinical recurrence (newly appeared on the second CT). Clinical and radiological characteristics of the three groups were compared using univariate and multivariate logistic regression analyses.

Results: The relative incidences of stable persistence, progressive persistence, and clinical recurrence were 56.1% (60/107), 15.0% (16/107), and 29.0% (31/107), respectively. Multivariate analysis between the clinical recurrence (29.0%) and persistence (71.0%) groups revealed various independent factors for prediction of clinical recurrence. These included longer interval between the two CT examinations (median 2.67 vs. 1.79 years; p = 0.021), a smaller number of thyroid surgeries (1.16 ± 0.45 vs. 1.55 ± 0.81; p = 0.002), and a history of neck dissection at the location of the largest locoregional recurrence (70.0% vs. 31.4%; p < 0.001). There was no significant independent factor for differentiation between the stable persistence (78.9%; 60/76) and progressive persistence (21.1%; 16/76) groups. The results may have been influenced by selection bias because this study included only surgically proven cases.

Conclusions: With regard to cervical locoregional recurrence of DTC, active surveillance may be favored because more than a half of the cases are structurally persistent and stable. However, meticulous evaluation is necessary to detect progressive persistence and clinical recurrence, considering various clinical factors.
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http://dx.doi.org/10.1089/thy.2018.0151DOI Listing
November 2018

Radiogenomics correlation between MR imaging features and major genetic profiles in glioblastoma.

Eur Radiol 2018 Oct 2;28(10):4350-4361. Epub 2018 May 2.

Department of Neurology, Seoul National University Hospital, Seoul, Korea.

Objectives: To assess the association between MR imaging features and major genomic profiles in glioblastoma.

Methods: Qualitative and quantitative imaging features such as volumetrics and histogram analysis from normalised CBV (nCBV) and ADC (nADC) were evaluated based on both T2WI and CET1WI. The imaging parameters of different genetic profile groups were compared and regression analyses were used for identifying imaging-molecular associations. Progression-free survival (PFS) was analysed by a Kaplan-Meier test and Cox proportional hazards model.

Results: An IDH mutation was observed in 18/176 patients, and ATRX loss was positive in 17/158 of the IDH-wt cases. The IDH-mut group showed a larger volume on T2WI and a higher volume ratio between T2WI and CET1WI than the IDH-wt group (p < 0.05). In the IDH-mut group, higher mean nADC values were observed compared with the IDH-wt tumours (p < 0.05). Among the IDH-wt tumours, IDH-wt, ATRX-loss tumours revealed higher 5th percentile nADC values than the IDH-wt, ATRX-noloss tumours (p = 0.03). PFS was the longest in the IDH-mut group, followed by the IDH-wt, ATRX-loss groups and the IDH-wt, ATRX-noloss groups, consecutively (p < 0.05). We found significant associations of PFS with the genetic profiles and imaging parameters.

Conclusion: Major genetic profiles of glioblastoma showed a significant association with MR imaging features, along with some genetic profiles, which are independent prognostic parameters for GBM.

Key Points: • Significant correlation exists between radiological parameters such as volumetric and ADC values and major genomic profiles such as IDH mutation and ATRX loss status • Radiological parameters such as the ADC value were feasible predictors of glioblastoma patients' prognosis • Imaging features can predict major genomic profiles of the tumours and the prognosis of glioblastoma patients.
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http://dx.doi.org/10.1007/s00330-018-5400-8DOI Listing
October 2018

Accurate measurements of liver stiffness using shear wave elastography in children and young adults and the role of the stability index.

Ultrasonography 2018 Jul 19;37(3):226-232. Epub 2017 Aug 19.

Department of Clinical Ultrasound, DongSeo Medicare Co., Ltd., Seongnam, Korea.

Purpose: The purpose of this study was to evaluate the usefulness of the stability index (SI) in liver stiffness measurements using shear wave elastography (SWE) in children.

Methods: A total of 29 children and young adults (mean age, 16.1 years; range, 8 to 28 years; 11 boys and 18 girls) who underwent liver stiffness measurements using SWE under free-breathing and breath-holding conditions were included in our study. Ten SWE measurements were acquired in each of four groups: free-breathing and breath-holding, and with and without using the SI. The failure rate of acquisition of SI values over 90% was calculated in each group. To evaluate variability in the SWE measurements, the standard deviation, coefficient of variation, and percentage of unreliable measurements were compared. Intraobserver agreement and the optimal minimal number of measurements were calculated using intraclass correlation coefficients.

Results: A failure to acquire SI values over 90% was observed in 17% of the scans in the free-breathing group and in 7% of the scans in the breath-holding group. In both groups, utilizing the SI led to a significantly lower standard deviation and coefficient of variation. When using the SI, the percentage of unreliable measurements decreased from 16.7% to 8.3% in the free-breathing group and 14.8% to 0% in the breath-holding group. With the use of the SI, intraobserver agreement increased and the optimal minimal number of repeated measurements decreased in both the free-breathing and breath-holding groups.

Conclusion: Utilization of the SI in the measurement of liver SWE in children reduced measurement variability and increased reliability in both free-breathing and breath-holding conditions.
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http://dx.doi.org/10.14366/usg.17025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044215PMC
July 2018

Identifying characteristic back shapes from anatomical scans of wheelchair users to improve seating design.

Med Eng Phys 2016 09 15;38(9):999-1007. Epub 2016 Jul 15.

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206, United States ; Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, United States . Electronic address:

Spinal deformities are common in people who require the use of a wheelchair for mobility as a result of spinal cord injuries and other disabilities. Sitting positions vary between individuals with disabilities who use wheelchairs and individuals without disabilities. In individuals with spinal cord injury, spinal deformities can result in the development of back contours that deviate from the shape of standard rigid back support shells. The purpose of this study was to distinguish and classify various back contours of wheelchair users by utilizing digital anatomic scanning technology in order to inform the future development of back supports that would enhance postural support for those with spinal deformities. The three dimensional (3D) locations of bony landmarks were digitized when participants were in position, using a mechanical wand linked to the FastScan(tm) system commonly used to measure surface contours. Raw FastScan(tm) data were transformed according to bony landmarks. A total of 129 individuals participated in this study. A wide range of back contours were identified and categorized. Although participant characteristics (e.g., gender, diagnosis) were similar amongst the contour groups; no one characteristic explained the contours. Participants who were seated in a forward lean position had a higher amount of pelvic obliquity compared to those seated in an upright position; however, participants' back contour was not correlated with pelvic obliquity. In conclusion, an array of different back shapes were classified in our cohort through 3D laser scanning technology. The methods and technology applied in this study could be replicated in future studies to categorize ranges of back shapes in larger populations of people with spinal cord injuries. Preliminary evidence indicates that customized postural support may be warranted to optimize positioning and posture when a standard rigid shell does not align with contours of a person's back. To optimize positioning, a range of contoured rigid backrests as well as height and angle adjustability are likely needed.
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http://dx.doi.org/10.1016/j.medengphy.2016.06.017DOI Listing
September 2016

Comfort and stability of wheelchair backrests according to the TAWC (tool for assessing wheelchair discomfort).

Disabil Rehabil Assist Technol 2016 18;11(3):223-7. Epub 2014 Jul 18.

a Human Engineering Research Laboratories , VA Pittsburgh Healthcare System , Pittsburgh , PA , USA .

Purpose: The goal of this study was thus to determine if people with different types of wheelchair backrests on their personal wheelchairs reported different levels of comfort as measured by the Tool for Assessing Wheelchair disComfort (TAWC).

Methods: Participants were between 18 and 80 years of age and were manual wheelchair users. The TAWC was used to assess the participants' wheelchair seating discomfort levels with the wheelchair and seating systems.

Results: We surveyed 131 wheelchair users to assess the comfort of their backrests on their personal wheelchairs and found a trend suggesting that rigid backrests are were less comfortable as compared with sling backrests. This finding was statistically significant in a subgroup of participants with tetraplegia.

Conclusions: Although many clinicians expect rigid backrests to be more comfortable because they may provide more support, the higher discomfort ratings among rigid backrest users with tetraplegia may be due to sub-optimal shape, fit, adjustment or user preferences. Implications for Rehabilitation Development of a measure for long-term seating discomfort is needed. Design and development of better rigid backrests that are functional but provide adequate comfort are in need.
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http://dx.doi.org/10.3109/17483107.2014.938365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152044PMC
October 2016

Design, testing and evaluation of angle-adjustable backrest hardware.

Disabil Rehabil Assist Technol 2016 7;11(4):325-32. Epub 2014 Jul 7.

c Accessible Designs, Inc. , San Antonio , Tx , USA.

Purpose: The purpose of this study was to design and evaluate a final design prototype of angle-adjustable backrest hardware.

Methods: A traditional iterative design development protocol was undertaken and completed. Before evaluation by a focus group, testing of the prototype was performed in strict accordance with ISO standards. Focus group participants were between 18 and 80 years of age, used a manual wheelchair as their primary means of mobility, and transferred independently. Individuals with pressure sores or who required of the use of specialized or custom seating for trunk support were excluded from the study. A questionnaire was administered to elicit participants' opinions on the adjustability, function and appearance of the angle-adjustable backrest device.

Results: The prototype successfully met the ISO testing standards. Wheelchair users (n = 8) who evaluated the device in a focus group had an overall positive response. Things they most liked about the prototype were comfort, support (function/activities) and adjustability, while things they most disliked about the prototype were problems with string and reaching back position to adjust.

Conclusions: The prototype had a positive impression from participants, however, improvements on the operation method and usability were suggested. Implications for Rehabilitation The adjustable backrest is in need of development to provide function, comfort and support for manual wheelchair users. Manual wheelchair users will benefit by using the angle adjustment as they maintain their active lifestyles. Balance control while performing pressure relief in a wheelchair would be increased.
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http://dx.doi.org/10.3109/17483107.2014.938364DOI Listing
January 2017

Non small cell carcinoma metastasis to meningioma.

J Korean Neurosurg Soc 2013 Jan 31;53(1):43-5. Epub 2013 Jan 31.

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.

"Tumor-to-tumor" metastasis is a rare event; meningioma has been reported as the most common primary intracranial tumor to harbor cancer metastases. Several hypotheses have been previously proposed to explain this occurrence, but the exact mechanism by which these metastases develop into meningiomas is not yet understood. Magnetic resonance imaging and spectroscopy have been valuable diagnostic tools, but preoperative diagnosis of metastasis to meningioma remains highly difficult. We present a case report of a metastasis of non-small cell lung cancer into an intracranial meningioma.
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http://dx.doi.org/10.3340/jkns.2013.53.1.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579081PMC
January 2013

Evaluation of aluminum ultralight rigid wheelchairs versus other ultralight wheelchairs using ANSI/RESNA standards.

J Rehabil Res Dev 2010 ;47(5):441-55

Human Engineering Research Laboratories, Department of Veterans Affairs (VA), Rehabilitation Research & Development Service, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.

Previous studies found that select titanium ultralight rigid wheelchairs (TURWs) had fewer equivalent cycles and less value than select aluminum ultralight folding wheelchairs (AUFWs). The causes of premature failure of TURWs were not clear because the TURWs had different frame material and design than the AUFWs. We tested 12 aluminum ultralight rigid wheelchairs (AURWs) with similar frame designs and dimensions as the TURWs using the American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America and International Organization for Standardization wheelchair standards and hypothesized that the AURWs would be more durable than the TURWs. Across wheelchair models, no significant differences were found in the test results between the AURWs and TURWs, except in their overall length. Tire pressure, tube-wall thickness, and tube manufacturing were proposed to be the factors affecting wheelchair durability through comparison of the failure modes, frames, and components. The frame material did not directly affect the performance of AURWs and TURWs, but proper wheelchair manufacture and design based on mechanical properties are important.
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http://dx.doi.org/10.1682/jrrd.2009.08.0137DOI Listing
December 2010

Cytogenetic study of glioneuronal tumor with neuropil-like islands: a case report.

Neuropathology 2010 Aug 21;30(4):420-6. Epub 2009 Oct 21.

Department of Pathology, National Cancer Center, Goyang, Gyeonggi, South Korea.

Glioneuronal tumor with neuropil-like islands (GTNI) is a recently recognized glioneuronal neoplasm but it was classified as an astrocytic tumor by the World Health Organization (WHO) in 2007. We performed a cytogenetic study in a case of GTNI arising in a 55-year-old man and analyzed its genetic alteration. It presented as a heterogeneously enhancing, multi-lobulating solid mass on MRI. Histopathologically, the tumor showed the biphasic feature of the predominating micronodular neuropil-like islands and the diffusely infiltrating glial component. In addition, the prominent blood vessels with perivascular hyalinization were observed. On cytogenetic study, loss of 4q, 5q, 11p and gain of 6p, 7, 8, 11q, 12p, 15q were found. The remaining tumor after subtotal resection progressed 7 months later, despite combined chemo- and radiotherapy. From the results, it seems that GTNI does not share pathologic or genetic features with conventional astrocytoma, suggesting a unique entity with aggressive behavior.
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http://dx.doi.org/10.1111/j.1440-1789.2009.01066.xDOI Listing
August 2010

Various liver resections using hanging maneuver by three glisson's pedicles and three hepatic veins.

Ann Surg 2007 Feb;245(2):201-5

National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.

Objective: To introduce a simple and effective technique for various kinds of anatomic liver resection using the hanging maneuver by 3 Glisson's pedicles and 3 hepatic veins.

Summary Background Data: The advantages of the liver-hanging maneuver described by Belghiti et al and the anatomic characteristics peculiar to the liver induced us to devise another new approach to the use of a hanging technique applied to various kinds of anatomic liver resection.

Methods: The hanging tape is located along the anteromedian surface of the retrohepatic IVC or the ligamentum venosum with its upper end among 3 hepatic veins and with its lower end among 3 Glisson's pedicles. With both ends of the tape pulled up, the hepatic parenchymal transection is performed aiming at the tape.

Results: From March 2003 to October 2005, this technique was used in 187 anatomic liver resections. Three (1.6%) of the patients required blood transfusion during or after surgery. There was no operative mortality or major morbidity and no reoperation.

Conclusions: This technique has the advantages of hanging maneuver based on the anatomic considerations of the liver and needs minimal mobilization of the remaining liver. The hanging maneuver can be a key technique for anatomic liver resection.
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http://dx.doi.org/10.1097/01.sla.0000245516.10349.c5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876991PMC
February 2007

[The adverse effect of indirectly diagnosed portal hypertension on the complications and prognosis after hepatic resection of hepatocellular carcinoma].

Korean J Hepatol 2006 Dec;12(4):553-61

Center for Liver Cancer Center, National Cancer Center, Goyang, Korea.

Backgrounds/aims: Surgical resection is considered as a curative treatment modality for patient with hepatocellular carcinoma (HCC). Since HCC often occurs in chronic liver disease, selecting optimal candidates based on the hepatic function reserve and the risk of hepatic decompensation after resection is important. In recent studies, clinically relevant portal hypertension including hepatic venous pressure gradient (HVPG) is considered as the best predictor of postoperative hepatic decompensation. However, since measuring HVPG requires an invasive procedure it is not widely used in practice. We aimed to evaluate whether the portal hypertension diagnosed indirectly could be a useful parameter for predicting postoperative prognosis.

Methods: A total of 142 patients with HCC who had endoscopic examination, computed tomography and surgical resection from January 2001 to June 2004 were included in the study. We diagnosed portal hypertension indirectly by the presence of varices or splenomegaly with thrmobocytopenia. Postoperative complications and survival rate according to the presence of portal hypertension was studied.

Results: The postoperative morbidity rate was 42.2%. The incidence of ascites and prolonged hyperbilirubinemia were significantly higher in portal hypertension group (ascites 43.8 vs. 10.3%, hyperbilirubinemia 20.3 vs. 1.3%, respectively, P<0.01). The cumulative 3-year recurrence-free survival rate showed no statistical difference between the two groups. However, the cumulative 3-year survival rate was significantly higher in the non-portal hypertension group (82.8% vs. 53%, respectively, P=0.014).

Conclusion: Indirectly diagnosed portal hypertension is correlated with the development of complications and poor prognosis after the surgical resection of HCC.
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December 2006

[Survival analysis for patients with hepatocellular carcinoma according to stage, liver function and treatment modalities].

Korean J Hepatol 2006 Mar;12(1):41-54

Center for Liver Cancer, National Cancer Center, Goyang, Korea.

Background/aims: Hepatocellular carcinoma (HCC) is 3rd leading cause of cancer in Korea and the prognosis for HCC patients is poor. For assessing the present treatment outcome, this study analyzed the three-year survival rate (3-YSR) and the prognostic factors for patients with HCC in Korea.

Methods: Between November 2000 and December 2003, 905 patients with HCC who were diagnosed and treated at the National Cancer Center Korea were enrolled in this study. The clinical variables, tumor characteristics and survival periods were analyzed.

Results: The mean age of all patients was 56.2+/-10.3 years and 732 (80.9%) patients were male (M:F=4.2:1). 508 (56.1%) patients died and the median survival period was 15.3 months. The overall 3-YSR of the patients with modified UICC stage I, II, III, IVa and IVb were 67.4%, 65.2%, 30.7%, 9.0% and 5.0%, respectively. The modified UICC stage could not differentiate stage I from II, and stage IVa from IVb, on the 3-YSR. The 3-YSR of the Child-Pugh class A patients with modified UICC stage I or II was 85.4% by surgical resection and it was 69.6% by transcatheter chemoembolization (TACE), respectively (P= .461), and those values for patients with stage III were 49.2% and 36.8%, respectively (P=.081). As compared with systemic chemotherapy or conservative therapy, TACE increased the survival rate more for the Child-Pugh class A patients with stage IV. The independent prognostic factors were serum AFP, portal vein thrombosis, the Child-Pugh classification and the stage of HCC.

Conclusions: This follow-up study will be helpful in assessing the results of treatments for HCC and it will provide data for the establishment of a more effective treatment strategy.
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http://dx.doi.org/10.5045/kjh.2006.41.1.41DOI Listing
March 2006

Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study.

Eur J Cancer 2005 Sep;41(14):2086-92

Research Institute and Hospital, National Cancer Center, 809, Madu-dong, Ilsan, Goyang, Gyeonggi, Korea.

We evaluated the accuracy of FDG-PET in diagnosing metastatic para-aortic and pelvic lymph nodes in patients with cervical cancer by comparing this noninvasive imaging technique with surgicopathologic results. We performed FDG-PET in 54 patients with cervical cancer at FIGO stages IB-IVA who were about to undergo lymphadenectomy. For region-specific comparisons, we divided the nodes into eight regions (four on each side: para-aortic, common iliac, external iliac, and internal iliac/obturator). Histological examination revealed metastases in 15 (28%) of the patients, with region-specific analysis identifying 37 (8.6%) metastases in 432 regions. The region-specific findings of FDG-PET exhibited a sensitivity of 38% and a positive predictive value (PPV) of 56%. The sensitivity increased to 52% and 65% when we restricted the pathologic criterion for metastases to tumour-invasion diameters of >5 and >10 mm, respectively. These results indicate that FDG-PET exhibited low sensitivity and PPV (especially for microscopic metastases) and hence cannot replace surgical staging, although it might still be useful for detecting metastases in patients with clinical conditions that make surgical staging inappropriate.
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http://dx.doi.org/10.1016/j.ejca.2005.05.013DOI Listing
September 2005

Dose-volumetric parameters of acute esophageal toxicity in patients with lung cancer treated with three-dimensional conformal radiotherapy.

Int J Radiat Oncol Biol Phys 2005 Jul;62(4):995-1002

Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsan-gu, Goyang, Gyeonggi 411-769, South Korea.

Purpose: To retrospectively evaluate which dose-volumetric parameters are associated with the risk of > or = Grade 3 acute esophageal toxicity (AET) in lung cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT).

Methods And Materials: One hundred twenty-four lung cancer patients treated curatively with 3D-CRT were retrospectively analyzed. All patients received conventionally fractionated radiotherapy (RT) with median dose of 60 Gy (range, 54-66 Gy) delivered in 30 fractions (range, 27-33 fractions). Thirty-one patients underwent curative surgery before RT. Ninety-two patients received chemotherapy (induction, 18; concurrent +/- induction, 74). Acute esophageal toxicity was scored by Radiation Therapy Oncology Group criteria. The parameters analyzed included sex; age; Karnofsky performance score; weight loss; surgery; concurrent chemotherapy; the percentages of organ volume receiving > or =20 Gy (V20), > or =30 Gy (V30), > or =40 Gy (V40), > or =50 Gy (V50), > or =55 Gy (V55), > or = 58 Gy (V58), > or =60 Gy (V60), and > or =63 Gy (V63); the percent and absolute length of the esophagus irradiated; the maximum and mean dose to the esophagus; and normal tissue complication probability.

Results: Of the 124 patients, 15 patients (12.1%) had Grade 3 AET, and 1 (0.8%) patient had Grade 4 AET. There was no fatal Grade 5 AET. In univariate and multivariate logistic regression analyses, concurrent chemotherapy and V60 were significantly associated with the development of severe (> or = Grade 3) AET (p < 0.05). Severe AET was observed in 15 of 74 patients (20.3%) who received concurrent chemotherapy, and in 1 of 50 patients (2.0%) who did not (p = 0.002). Severe AET was observed in 5 of 87 patients (5.7%) with V60 < or = 30% and in 11 of 37 patients (29.7%) with V60 > 30% (p < 0.001). Among 50 patients who did not receive concurrent chemotherapy, severe AET was observed in 0 of 43 patients (0%) with V60 < or = 30% and in 1 of 7 patients (14.2%) with V60 > 30% (p = 0.140). Among 74 patients who received concurrent chemotherapy, severe AET was observed in 5 of 44 patients (11.4%) with V60 < or = 30% and in 10 of 30 patients (33.3%) with V60 > 30% (p = 0.037).

Conclusions: Concurrent chemotherapy and V60 were associated with the development of severe AET > or = Grade 3. For patients being treated with concurrent chemotherapy, V60 is considered to be a useful parameter predicting the risk of severe AET after conventionally fractionated 3D-CRT for lung cancer.
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http://dx.doi.org/10.1016/j.ijrobp.2004.12.025DOI Listing
July 2005

Introduction of tyramide signal amplification (TSA) to pre-embedding nanogold-silver staining at the electron microscopic level.

J Histochem Cytochem 2005 Feb;53(2):249-52

Department of Anatomy, Chonnam National University Medical School, Gwangju, Korea.

The tyramide signal amplification (TSA) technique has been shown to detect scarce tissue antigens in light and electron microscopy. In this study we applied the TSA technique at the electron microscopic level to pre-embedding immunocytochemistry. This protocol was compared to the non-amplified protocol. With the TSA protocol, the labeling of GM130, a cis-Golgi matrix protein, was tested in a cell line and found to be highly sensitive and more enhanced than that with the simple protocol. Moreover, the gold particles were well localized to the cis-side of the Golgi apparatus in both the TSA and the simple protocol.
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http://dx.doi.org/10.1369/jhc.3B6194.2005DOI Listing
February 2005

[The clinical report of 1,078 cases of hepatocellular carcinomas: National Cancer Center experience].

Korean J Hepatol 2004 Dec;10(4):288-97

Center for Liver Cancer, National Cancer Center, Goyang, Korea.

Background/aims: Hepatocellular carcinoma (HCC) is the third leading cause of cancer and the 5 year survival rate is 9.6% in Korea. To develop a strategy for surveillance and treatments, we studied the recent clinical characteristics of HCC diagnosed at single institution in Korea, where is in an endemic area of chronic hepatitis B.

Methods: One thousand and seventy eight patients with HCC who visited the National Cancer Center between June 2001 and December 2003 were retrospectively studied.

Results: The male/female ratio was 4.5:1. The mean age of the patients was 56.3 years. 74.2% of patient had hepatitis B virus (HBV) infections, 8.6% had hepatitis C virus (HCV) infections, 6.9% of the patients abused alcohol and 10.3% of the patients had non-B non-C considered as the etiologic factors of their HCC. Only 10.0% of patients had a tumor sized 2 cm or less and 53.3% of patients had a large tumor over 5 cm in diameter. 33.2% of patients had a single tumor. At the time of diagnosis, the modified UICC staging was as follows: 6.5%, 20.1%, 30.9%, 25.2% and 17.3% in stages I, II, III, IVa and IVb, respectively. The initial treatment performed was transcatheter arterial chemoembolization (48.2%), radiofrequency ablation (1.5%), hepatic resection (11.2%), systemic chemotherapy (7.5%), radiotherapy (2.1%), and conservative medical treatments (29.5%). The mean number of treatments was 1.65. The response rates to the initial treatments were 27.9% (complete response), 23.6% (partial response), 7.5% (minimal response), 14.2% (stable disease), and 30.4% (progressive disease).

Conclusions: HBV infection is a major etiologic factor for Korean HCC patients. Most cases are still in advanced stages and these cases responded poorly to any treatments. The national surveillance program and its guideline for HCC are expected to improve the survival of HCC patients.
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December 2004

[Extrahepatic metastasis of hepatocellular carcinoma to the nasal cavity manifested as massive epistaxis: a case report].

Korean J Hepatol 2004 Sep;10(3):228-32

Center for Liver Cancer, National Cancer Center, Goyang, Korea.

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is not infrequently found during the later stage, regarding that the autopsy report described its prevalence to be up to 50%. The most frequent sites are known to be the abdominal lymph nodes, lung and bone. However, metastasis to the nasal cavity and paranasal sinuses has been seldom reported, and to out knowledge, there is no Korean report describing extrahepatic metastasis of HCC to these sites. Recently we experienced a case of extrahepatic metastasis of HCC to the nasal cavity in a 50 year-old man with massive epistaxis refractory to conservative treatment. He was found to have a mass of soft tissue attenuation occupying the right nasal cavity at CT, which was biopsy-proven as metastatic HCC. Epistaxis was successfully treated by transcatheter arterial embolization.
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September 2004

[A case of primary leiomyosarcoma of the inferior vena cava treated by surgical resection and reconstruction with synthetic graft replacement].

Korean J Gastroenterol 2003 Sep;42(3):249-54

Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi, Korea.

Leimyosarcoma of the inferior vena cava (IVC) is a rare tumor, with about 200 cases reported in the world literature. There were 5 cases reported in Korea. We report a case of primary leiomyosarcoma of the inferior vena cava in a 50 year-old woman who presented with a heterogenous enhancing mass within IVC on CT scan and MRI scan. The tumor expanded the IVC with displacement of the adjacent structures. The patient underwent ultrasound guided percutaneous biopsy which was consistent with leiomyosarcoma. The patient was treated by surgical resection and synthetic graft replacement of the inferior vena cava and postoperative external beam radiation therapy. We report the case of leiomyosarcoma of the inferior vena cava with a review of relevant literatures.
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September 2003

Voltage-dependent ion channel currents in putative neuroendocrine cells dissociated from the ventral prostate of rat.

Pflugers Arch 2003 Apr 21;446(1):88-99. Epub 2003 Feb 21.

Department of Physiology Sungkyunkwan University School of Medicine, 440-746, Suwon, Korea.

Prostate neuroendocrine (NE) cells play important roles in the growth and differentiation of the prostate. Following enzymatic digestion of rat ventral prostate, the whole-cell patch-clamp technique was applied to dark, round cells that exhibited chromogranin-A immunoreactivity, a representative marker of NE cells. Under zero current-clamp conditions, putative NE cells showed hyperpolarized resting membrane potentials of some -70 mV, and spontaneous action potentials were induced by an increase in external [K+] or by the injection of current. Using a CsCl pipette solution, step-like depolarization activated high-voltage-activated Ca2+ current (HVA I(Ca)) and tetrodotoxin-resistant voltage-activated Na+ current. The HVA I(Ca) was blocked by nifedipine and omega-conotoxin GVIA, L-type and N-type Ca2+ channel blockers, respectively. Using a KCl pipette solution, the transient outward K+ current (I(to)), Ca2+ -activated K+ currents (I(K,Ca)), the non-inactivating outward current and an inwardly rectifying K+ current (I(Kir)) were identified. I(K,Ca) was suppressed by charybdotoxin (50 nM), iberiotoxin (10 nM) or clotrimazol (1 microM), but not by apamine (100 nM). I(to) was inhibited by 4-aminopyridine (5 mM). I(Kir) was identified as a Ba2+ -sensitive inwardly rectifying current in the presence of a high-K+ bath solution. The voltage- and Ca2+ -activated ion channels could play significant roles in the regulation of neurohormonal secretion in the prostate.
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http://dx.doi.org/10.1007/s00424-002-0995-6DOI Listing
April 2003
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