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Purpose : To compare the differences in visual quality and accommodative functions after wearing single and multiple front surface aspheric functional contact lenses in the twenties having sufficient accommodation. Methods : Thirteen subjects(21.38±0.65 years) were evaluated for visual acuity, contrast sensitivity, stray light, total higher order aberrations, spherical aberration, coma aberration, accommodative response, binocular accommodative facility and near point of accommodation after wearing two types of contact lenses, respectively. Results : There was no significant difference in visual acuity, contrast sensitivity, stray light, total high order aberration, spherical aberration and binocular accommodative facility. Coma aberration increased slightly in wearing multi front aspheric functional contact lenses at 4 and 5 mm pupil size(p=0.037). Accommodative response(p=0.006) and near point of accommodation(p=0.005) were significantly reduced and shorter in wearing multi front aspheric functional contact lens. Conclusion : There was no difference in visual quality in wearing multiple front aspheric functional contact lenses compared to in wearing single front aspheric contact lenses. But it is thought to be useful as a functional contact lens for young adults because it has the effect on reducing the accommodative burden.

Background: To analysis the role of gamma knife radiosurgery (GKRS) in treatment of the recurrent or residual World Health Organization (WHO) grade II and III meningiomas.Methods: Between 1995 and ...

Background A rosette-forming glioneuronal tumor (RGNT), a rare brain tumor, presents as a benign feature with a favorable outcome. To date, a few cases with aggressive behaviors, such as recurrence or dissemination, but none with malignant transformation, have been reported. We describe 1 case that recurred as glioblastoma after complete resection of the benign RGNT. Case Description A man aged 58 years presented with headache and dizziness without neurologic symptoms. Magnetic resonance imaging showed a 4 × 2.5 cm, well-demarcated mass in the left cerebellar hemisphere. The patient underwent gross total resection of the tumor and a diagnosis of RGNT was made. There was no evidence of recurrence on serial follow-up. However, a recurrent heterogeneous enhancing mass in the previous surgical cavity was observed on a 7-year postoperative magnetic resonance imaging scan. Reoperation was performed and a histopathological study revealed a glioblastoma. Conclusions To the best of our knowledge, this is the first case of spontaneous malignant transformation of an RGNT. Our case may be helpful in better understanding the biological behavior and clinical outcome of RGNT. We emphasize the malignant potential of this rare tumor and the necessity of future large-scaled research for most appropriate therapeutic strategies.

The growth rate and natural history of untreated hemangioblastomas remain unclear. This study investigated the natural history of untreated intracranial hemangioblastomas and predictors of tumor growth using volumetric assessment. This study retrospectively enrolled 31 patients with untreated hemangioblastomas between 2004 and 2017 who were followed up for at least 12 months. The 31 patients had a total of 52 hemangioblastomas. The 31 patients included 11 (35.5%) men and 20 (64.5%) women, of mean age 42.5 years. Seventeen (54.8%) patients were genetically diagnosed with Von Hippel-Lindau (VHL) disease. Of the 52 lesions, 33 (63.5%) grew during the follow-up period, whereas 19 (36.5%) remained stable. Overall mean actual growth rate (AGR) was 1.94 cm3/year, 2.38 cm3/year in the VHL and 1.79 cm3/year in the non-VHL group (p = 0.31). Overall mean relative growth rate (RGR) was 21%/year, 26%/year in the VHL and 19%/year in the non-VHL group. Time to 50% treatment probability was 34 months. The 1, 3, 5, and 7-year treatment probabilities were 11.5%, 50.1%, 52.7%, and 73%, respectively. The presence of only symptomatic lesions was significantly predictive of the growth of intracranial hemangioblastoma (odds ratio: 5.0, p = 0.02). The overall growth rate of intracranial hemangioblastoma was faster than that of other benign intracranial tumors, with symptomatic lesions being the only meaningful predictor of tumor growth. Because of their rapid growth rate and high probability of treatment, a wait and scan management strategy should be carefully applied to intracranial hemangioblastomas.

Gross total resection for glioblastoma (GBM) has been associated with better prognosis. However, it is not always feasible, and the threshold for the extent of resection required for better prognosis has been controversial. Therefore, we compared the survival and clinical outcomes of patients with GBM who had undergone partial resection (PR) or biopsy.Of the 110 patients, 32 and 78, who had undergone PR and biopsy, respectively, were enrolled to identify any differences in clinical outcomes. No differences were found in patient demographics between the 2 groups, except for tumor location and mean tumor volume (P = 0.02 and P0.01, respectively). Propensity score matching between the PR and biopsy groups was performed, in which 20 patients each in the PR and biopsy groups were matched.The overall survival (OS) and progression-free survival (PFS) did not differ significantly between the PR and biopsy groups (P = 0.84 and P = 0.48, respectively). After propensity score matching, the differences in OS and PFS between the 2 groups were still not statistically significant (P = 0.51 and P = 0.75, respectively). The hazard ratios for OS and PFS for the PR group compared with biopsy were 0.98 and 0.73, respectively; however, the difference was not statistically significant (P = 0.96 and P = 0.39, respectively). The surgical complication rate was greater in the PR group (14 of 32; 43.7%) than in the biopsy group (9 of 78; 11.5%; P0.01).PR failed to improve survival compared with biopsy for patients with GBM. Moreover, the surgical complication rate in the PR group was greater than that in the biopsy group.

HJURP is a key factor for CENP-A deposition and maintenance in centromeres. The role of mis-regulation of histone chaperones in cancer initiation and progression has been studied. However, its role in colorectal cancer is still unclear. In this study, we aimed to evaluate the expression of HJURP in 162 colorectal cancer tissue. To investigate the function of HJURP in the colorectal cancer cell, we suppressed HJURP expression by siRNA and confirmed proliferation, migration, invasion, and anchorage independent of colony forming ability. The association between HJURP expression levels and clinicopathological factors was evaluated in 162 CRC tissues using immunohistochemistry. The overall survival rate in patients of HJURP high expression was higher than those in HJURP low expression in CRC. Suppressing HJURP expression decreased cellular proliferation, invasion, and migration in four CRC cell lines: HT29, HCT116, SW480, SW620 in vitro study. Our findings revealed that the knockdown of HJURP suppressed the proliferation, migration, invasion, and tumorigenicity in CRC cells. Due to its strong association with CRC, HJURP could be a potential prognostic biomarker and a novel target for drug discovery.

Although stereotactic radiosurgery (SRS) has been proven to be effective and safe for treating intracranial meningiomas, concerns have been raised about the use of SRS for large-sized tumors involving the skull base that frequently encroach onto adjacent critical neural structures. The purpose of this study was to investigate the role of hypofractionated SRS as a therapeutic option for large-sized skull base meningiomas. Thirty-one consecutive patients (median age: 55 years, 9 men and 22 women) who had been treated with hypofractionated SRS using CyberKnife for large-sized skull base meningiomas (> 10 cm3 in volume, median of 18.9 cm3, range 11.6–58.2 cm3) were enrolled. All patients harbored middle or posterior skull base tumors, most frequently of cavernous sinus (n = 7, 22.6%), petroclival (n = 6, 19.4%), or tentorial edge (n = 6, 19.4%) locations. SRS was delivered in five daily fractions (range 3–5 fractions) with a median cumulative dose of 27.8 Gy (range 22.6–27.8 Gy). With a median follow-up of 57 months (range 9–98 months), tumor control was achieved for 28 (90.3%) of 31 patients. Treatment response on MRI included partial response (volume decrease > 20%) in 17 (54.8%) patients, stable in 11 (35.5%), and progression (volume increase > 20%) in 3 (9.7%). Of 21 patients with cranial neuropathy, 20 (95.2%) showed improved neurological status. Our current results suggest a promising role of hypofractionated SRS for large-sized skull base megningiomas in terms of tumor control and neurological outcomes. It is a reasonable therapeutic option for select patients.

Objective Although they are generally slow-growing benign tumors, meningiomas may recur after surgery with transformation into atypical meningiomas. The purpose of this study was to investigate the radiological and histopathological factors that predict the risk of tumor progression from a benign to an atypical meningioma. Patients and Methods All patients treated for recurrent meningiomas in whom the tumor showed histopathologically confirmed high-grade transformation (HGT) from a benign to an atypical meningioma between 2001 and 2017 were included. To evaluate the predictors of transformation, patient medical records documenting the diagnosis of a benign meningioma at the first surgery prior to second surgery with HGT were reviewed. Each patient was matched with four age- and sex-matched controls who were treated for a benign meningioma. The control group comprised all patients without any recurrence for at least 60 months. Results Fourteen patients with benign meningioma underwent HGT and were included. The median time interval of transformation was 63 months (range, 19–132 months). Multivariate analysis indicated that an increased mitotic index (odds ratio [OR], 10.409; 95 % confidence interval [CI], 1.297–83.549; P = 0.027) was a significant predictor of transformation. Prominent peritumoral edema (OR, 33.822; 95 % CI, 0.935–223.688; P = 0.054) did not reach the statistical significance. Conclusion An increased mitotic index may be used as the predictor for HGT of benign meningiomas. Although these tumors with a high risk for transformation do not meet the diagnostic criteria for atypical meningiomas, they may require more attentive observation and management than other benign meningiomas.

The purpose of this study is to explore the determinants affecting the disaster management budget, focusing on disaster-vulnerable groups in local autonomies. For this purpose, we analyzed the five-year panel data of 226 local governments in South Korea from 2012 to 2016 using the Panel Corrected Standard Error (PCSE) and Generalized Method of Moment (GMM) methods. The PCSE method showed that the ratio of elderly population and the number of businesses had a positive effect, while the ratio of basic livelihood security recipients and local share tax had a negative effect. However, the GMM method controlling endogeneity revealed that incrementalism was a positive factor but the ratio of elderly population and the ratio of basic livelihood security recipients were found insignificant. These results confirmed that the role of disaster- vulnerable groups as determinants of disaster management budget is unclear for local autonomies in South Korea.

OBJECTIVE We investigated the effect of optimization in dose-limiting shell method on the dosimetric quality of CyberKnife (CK) plans in treating brain metastases (BMs). METHODS We selected 19 BMs previously treated using CK between 2014 and 2015. The original CK plans (CKoriginal) had been produced using 1 to 3 dose-limiting shells : one at the prescription isodose level (PIDL) for dose conformity and the others at lowisodose levels (10-30% of prescription dose) for dose spillage. In each case, a modified CK plan (CKmodified) was generated using 5 dose-limiting shells : one at the PIDL, another at intermediate isodose level (50% of prescription dose) for steeper dose fall-off, and the others at low-isodose levels, with an optimized shell-dilation size based on our experience. A Gamma Knife (GK) plan was also produced using the original contour set. Thus, three data sets of dosimetric parameters were generated and compared. RESULTS There were no differences in the conformity indices among the CKoriginal, CKmodified, and GK plans (mean 1.22, 1.18, and 1.24, respectively; p=0.079) and tumor coverage (mean 99.5%, 99.5%, and 99.4%, respectively; p=0.177), whereas the CKmodified plans produced significantly smaller normal tissue volumes receiving 50% of prescription dose than those produced by the CKoriginal plans (p

Purpose : We investigated the effect of illumination-dependent pupil size on higher order aberration. Methods : Thirty five patients (mean age, 22.5 ± 1.04 years) who had no ocular or systemic disease and had no other relevant surgical experience were selected, and we measured aberration. Due to the property of i.Profiler plus instrument, it is assumed that the pupil size ʻ3 mmʼ under photopic vision is similar to photopic vision environment and pupil size ʻmaximumʼ under semidark room is similar to mesopic vision environment. Correlation analysis between pupil size and equivalent defocus and equivalent blur circle was performed. Results : RMS values were 0.30±0.13 ㎛ and 0.38±0.15 ㎛ when the pupil size was divided into 3 mm and maximum. The equivalent defocus of total high order aberration was 0.28±0.14 D at the pupil size of 3 mm and 0.41±0.16 D at the maximum, which are significant differences(p=0.000). The difference of equivalent defocus of spherical aberration, coma aberration, and trefoil aberration was 0.07 D, 0.04 D, and 0.02 D at 3 mm and maximum, respectively, and there were significant differences in the spherical(p=0.000) and coma aberration(p=0.000)). There were significant positive correlations between equivalent defocus and equivalent blur circle(total higher order aberrations (R2=0.7045, p < 0.01), spherical aberration(R2=0.9376, p < 0.01), coma aberration(R2=0.8429, p < 0.01) and, trefoil aberration(R2=0.7824, p < 0.01)). Conclusions : The result of the aberration measurement is expressed as equivalent defocus, so that the degree of required correction can be expressed as diopter. Unless the correction of high order aberrations is considered, it is valuable to study the visual discomfort of high order aberrations as there would be a change in the corrected visual acuity.

Objectives: Controversies regarding effectiveness of intraoperative neurophysiologic monitoring (IONM) in resection of brainstem cavernous malformations (CMs) have been argued. Immediate postoperative surgical outcomes, long term functional outcomes including cranial nerve deficits prognosis and modified Rankin Scale (mRS) were investigated. Methods: Total 47 patients of brainstem CMs who underwent surgery from January 2000 to November 2016 were identified and analyzed. All patients' clinical, radiological and surgical records were obtained and reviewed. Results: The incidence of aggravation of immediate postoperative pre-existing neurological deficits in surgery without IONM and with IONM group were 41.7% and 20%, respectively (p = 0.04). The incidence of newly developing postoperative neurological deficits in surgery without IONM and with IONM were 50% and 20%, respectively (p = 0.06). The postoperative surgical complications such as intracerebral hemorrhage/intraventricular hemorrhage, subdural hemorrhage, cerebrospinal fluid leakage, hydrocephalus were occurred 16.6% vs 8.7% in surgery without IONM and with IONM group, respectively (p = 0.06). The functional outcomes of each cranial nerve were not statistically significant. There was no statistically significant factor affecting immediate postoperative neurological deterioration in univariate analysis. The mRS after 1-year in surgery with IONM group showed statistically significant improvement compared to preoperative and 1-month postoperative period (from 3.4 to 1.87, p

Background Pleomorphic xanthoastrocytoma (PXA) is a very rare glial neoplasm. The clinical behavior of PXA is not uniform, and the purpose of this study was to investigate the clinical characteristics of adult PXA and identify prognostic factors. Methods Twenty-five patients aged 18 years or older who were diagnosed with PXA between 2002 and 2016 were analyzed. Results Twenty-one patients (84%) had PXA World Health Organization (WHO) grade II and 4 patients (16%) had anaplastic PXA (WHO grade III). The median overall survival of PXA WHO grade II and III was 97 and 56 months, respectively. The 3-year progression-free survival of PXA WHO grade II and III was 65.1% and 50%, respectively (P = 0.37 and 0.21). Diffusion-weighted imaging, perfusion-weighted imaging, and positron emission tomography findings failed to predict the histologic grade of PXA and recurrence of PXA WHO grade II. Tumor size >40 mm and presence of evident peritumoral edema (ePTE) were prognostic factors for poor progression-free survival (hazard ratios, 4.4 and 15.2, respectively; P = 0.03 and 0.01) according to a univariate analysis. In the recurrent and silent PXA grade II groups, ePTE was present in 87.5% and 23.1% of cases, respectively (P Conclusions The clinical and radiologic features of PXA are not uniform. Tumor size and ePTE are possible prognostic factors for adult PXA. Also, peritumoral edema may be associated with recurrence in PXA WHO grade II. PXA showed a high recurrence rate, and thus close follow-up is needed.

Objective Pituitary apoplexy can cause severe neuro-ophthalmologic or endocrinologic sequelae, requiring timely treatment. The present study was performed to evaluate postoperative neurologic outcomes and to identify their risk factors in patients who underwent transsphenoidal surgery for pituitary apoplexy. Methods Forty-one consecutive patients with pituitary apoplexy who underwent transsphenoidal surgery were reviewed retrospectively. The initial rates of visual acuity (VA) decrease, visual field (VF) defect, and ocular palsy were 34.1%, 46.3%, and 68.3%, respectively. The median maximal diameter and tumoral volume was 2.6 cm (range, 2.0–4.6 cm) and 5.3 cm3 (range, 2.4–38.8 cm3), respectively. Seventeen patients (41.5%) underwent surgery within 7 days. The median follow-up duration was 45 months (range, 12–196 months). Results At the last follow-up, 62.9% (22/35) of patients had made a full recovery from preoperative neurologic deficits, with partial recovery observed in the remaining patients. The rates of improvement and full recovery from VA decrease were 92.9% and 57.1%, respectively; those from VF defect were 94.7% and 36.8%, respectively; and those from ocular palsy were 100.0% and 96.4%, respectively. On multivariate analysis, initial visual impairment score (≥20) was the only significant risk factor for postoperative neurologic sequelae (P Conclusions Ocular palsy was fully recovered in 96.4% patients with pituitary apoplexy after transsphenoidal surgery. Initial visual impairment status was found to be more strongly associated with postoperative neurologic recovery than surgical timing.

Adjuvant chemotherapy (AC) is frequently considered in patients with high-risk stage II colorectal cancer (CRC). Among patients with stage II CRC who do not receive AC because they are not considered to be at high risk, 20–25% will develop recurrence and die from the disease. Elevated levels of KPNA2 have been observed in various cancers, and overexpression of KPNA2 is related to CRC progression. We examined the expression of KPNA2 using 293 CRC tissues, including 118 with stage II CRC, and investigated the applicability of KPNA2 as a biomarker to predict high-risk stage II CRC. Moreover, we further investigated the role of KPNA2 as an oncogene in CRC carcinogenesis using in vitro functional studies. High KPNA2 expression was associated with vascular (p = 0.027) and lymphatic invasion (p = 0.009) in patients with stage II CRC. On multivariate analysis, high KPNA2 expression (HR 3.174, 95% CI 2.060–4.889; p

Background Hypophysitis is a rare disease entity mimicking a pituitary adenoma. Despite crucial disease involving a pituitary gland which is a main component of the hormonal axis, there have been minimal researches regarding the hypophysitis. In this study, we described the constellation of the preoperative findings including clinical, radiologic, and endocrinologic features, as well as postoperative outcomes of the hypophysitis. Methods The authors reviewed the data retrospectively of a total of 2814 patients who underwent microsurgery at our institution to treat a pituitary mass lesion. Among them, the patients proven as hypophysitis in histologic examination were enrolled, followed by stratification into tumor-associated hypophysitis and isolated hypophysitis depending on the existence of associated tumor lesion. As a result, a total 21 cases were enrolled consisting of the 13 cases of tumor-associated and the 8 cases of isolated hypophysitis. In this study, the isolated hypophysitis was focused on the analysis. All patients with isolated hypophysitis were evaluated the clinical, radiologic, and endocrinologic tests preoperatively. After microsurgery, all patients had a minimum follow up of 6 months (6∼72 months). The clinical symptoms, endocrinologic tests, and brain MRI were checked at every 6 months during first 2 year, since then, at every 12 months. Results Among 2814 cases of pituitary mass lesion underwent microsurgery, the hypophysitis were found 21 cases (0.74 %). The 13 cases were the tumor-associated hypophysitis, consisting of rathke's cleft cyst (7 cases), craniopharyngioma (3 cases), pituitary adenoma (2 cases), and germinoma (1 case). The 8 cases were the isolated hypophysitis including lymphocytic (4 cases), granulomatous (3 cases), and IgG4-related (1 case) hypophysitis. The patients presented a wide range of clinical symptoms from general weakness to panhypopituitarism. In addition, the most remarkable radiologic features of the isolated hypophysitis were infundibular thickening and the low signal intensity in T1WI and T2WI. All 8 patients with isolated hypophysitis presented endocrinologic deficiency with various extent in a preoperative biochemistry. After surgery, the hormonal status were not changed in 4 patients (50%), however, aggravated in 4 patients (50%). The 3 patients (37.5%) complained visual field defects in preoperative ophthalmologic test, but improved all after surgery. Conclusion In this study, the preoperative clinical manifestations, radiologic and endocrinologic features of hypophysitis were described comprehensively. In addition, we also revealed the long-term outcomes of hypophysitis in the aspect of visual function and endocrinologic outcomes. Preexisting visual field defects were improved in all patients (3 cases). However, all patients presented endocrinologic deficiency in preoperative biochemistry, among them, the 4 patients (50 %) were unchanged and the 4 patients (50 %) were exacerbated after surgery. In conclusion, the visual outcomes were satisfactory, however, the endocrinologic outcomes were vice versa, because the preoperative endocrinologic deterioration was unchanged or even aggravated after surgery in some cases.

Pituitary metastases (PMs) are uncommon, representing only 1% of pituitary lesions. The diagnosis of PMs can be challenging and an optimal management remains to be determined. Here, we present a pilot clinical study on the efficacy and safety of hypofractionated stereotactic radiosurgery (SRS) with an optimized dosimetric plan in treating PMs. Between June 2013 and December 2014, seven consecutive patients (4 men and 3 women; median age 62 years) had been diagnosed with PMs based on their characteristic clinical and radiological features and subsequently treated using hypofractionated SRS. Primary cancers originated from the lung (n = 5) or the breast (n = 2). All patients presented with diabetes insipidus (DI). Anterior pituitary and visual dysfunction were combined in 4 and 3 patients, respectively. On magnetic resonance imaging (MRI), PMs involved the pituitary stalk and/or the posterior lobe in all patients. SRS of a cumulative marginal dose 31 Gy with dose-volume constraints for the optic apparatus was delivered in 5 daily fractions. As results, tumor was locally controlled in all patients with substantial responses on MRI (including complete remission in 4 patients). The median survival time was 14 months (range, 6-24 months) after SRS. DI and visual dysfunction improved in all patients, although anterior pituitary dysfunction did not recover. No patients experienced any deterioration in visual, pituitary, or other cranial nerve functions. These results suggest a promising role of hypofractionated SRS in treating PMs in terms of both tumor control and functional outcomes.

Electrowetting-on-dielectric (EWOD) is a mechanism that allows physical handling of liquids with only electrical signals, such as digitizing a liquid into tiny droplets and manipulating them on a chip, thus enabling “digital microfluidics”. As an elegantly simple platform free of pumps or valves, EWOD digital microfluidics has been attracting high research interest in the past two decades and has recently been transitioned to a few commercial products in displays and biochemistry. However, the number of labs utilizing this technology is still small, due to the difficulty in translating design intent to manufactured devices. Accordingly, in this paper, we propose a cloud-based open-source EWOD cybermanufacturing ecosystem that enables an automatic translation from user requirements to manufactured digital microfluidics. The incubation cyber ecosystem is to be accessible to a wide range of end users, allowing researchers, entrepreneurs, students, and hobbyists alike to focus on their own ideas and applications without having to master the subtleties of EWOD engineering and manufacturing. This can be thought of as an “operating system” for EWOD community, similar to Windows and macOS for people with no computer hardware background. The proposed cyber ecosystem aims to ease the process of designing and eliminate the burden of fabricating EWOD chips so that the user pool is increased and more applications found for EWOD digital microfluidics.

Several studies have reported the efficacy and safety of hypofractionated stereotactic radiosurgery (hSRS) in the treatment of benign perioptic tumors. This study went further and evaluated the feasibility of hSRS in the treatment of those causing compressive cranial neuropathies (CCNs) among perioptic tumors with special consideration of functional improvement. Twenty-six patients with CCNs (CN II = 19; CN III/IV/VI = 9; CN V = 3) caused by perioptic tumors underwent hSRS between 2011 and 2015. hSRS was delivered in five fractions with a median marginal dose of 27.8 Gy (≈14 Gy in a single fraction, assuming an α/β of three) to a tumor volume of 8.2 ± 8.3 cm3. All tumors except one shrank after treatment, with a mean volume decrease of 35 % (range 4−84 %) during the mean follow-up period of 20 months. In 19 patients (38 eyes) with compressive optic neuropathy, vision improved in 55.3 % of eyes (n = 21), was unchanged in 36.8 % (n = 14), and worsened in 7.9 % (n = 3) (2.6 % after excluding two eyes deteriorated due to transient tumor swelling). A higher conformity index (p = 0.034) and volume of the optic apparatus receiving >23.0 Gy (p = 0.019) were associated with greater tumor shrinkage. A greater decrease in tumor volume (p = 0.035) was associated with a better improvement in vision. Ophthalmoplegia and facial hypesthesia improved in six of nine (66.7 %) and three of three (100 %) patients, respectively. There was no newly developed neurological deficit. Decompressive SRS for benign perioptic tumors causing CCN is feasible using hypofractionation, representing a useful alternative to microsurgical resection.

Objective: Many studies have shown favorable outcome of Gamma knife radiosurgery (GKRS) for vestibular schwannomas (VSs). However, there have been few studies which have shown the treatment result of cystic VSs (CVSs) for GKRS. The aim of this study was to confirm whether GKRS for CVSs continues to be safe and effective. Methods: The study population consisted 511 patients (172 males, 339 females) with VSs treated with GKRS between May 1990 and December 2013. Group 1 defined as cyst/tumor volume >30%, group 2 was cyst/tumor volume >50%, and group 3 was solid tumor or cyst/tumor volume ≤30%. To analyze factors that correlated with treatment outcomes, the following factors were assessed: tumor volume, cyst volume, tumor/cyst ratio, cyst type (single vs. multicystic), previous resection history, marginal radiation dose. Results: The median follow up period was 52 months (range, 12-110 months). Tumor progression in group 1 was 5 (18.5%), group 2 was 1 (11.1%) and group 3 was 31 (6.4%). In group 1, 2 patients underwent delayed microsurgery at 31 and 36 months after GKRS. Conclusion: In this study we found that GKRS for large CVS was associated with poor treatment outcome. Further study is needed to identify the mechanism of the tumor progression of CVS after GKRS

Background Despite advances in skull base surgery, achieving effective surgical management of jugular foramen schwannomas (JFSs) that avoids postoperative cranial nerve (CN) deficits remains a challenge. Subtotal resection followed by radiosurgery (rather than radical resection) is increasingly being viewed as a better treatment strategy. Here, an institutional database was retrospectively analyzed for outcomes after surgical treatment of JFSs to evaluate the optimal strategy for managing JFSs. Methods Twenty-two patients with JFSs were operated on by either radical resection ( n = 13) or conservative resection plus radiosurgery ( n = 9). These 2 different groups were compared in terms of early (≤4 weeks after surgery) and late postoperative functional outcome and oncologic control. Results No deaths occurred in either group, but there were 3 surgery-related complications in the radical resection group. Postoperative CN deficits and additional procedures related to CN morbidity were generally higher in the radical resection group, but the differences were not statistically significant. The conservative surgery group showed a statistically significant improvement in the level of dysphagia and dysphagia-related functional state in the late postoperative period. There was 1 case of recurrence after radical resection over a mean follow-up period of 73 months. All tumors in the conservative surgery group were controlled over a mean period of 34 months. Conclusions Our results suggest that conservative resection of JFSs via a familiar intracranial approach plus radiosurgery may be an effective surgical alternative for improving functional outcome with adequate oncologic control.

Thermal conductance switches enable active and reconfigurable thermal control and management for a wide variety of applications. We demonstrate a thermal conductance switch based on the actuation of liquid droplets in a co-planar electro-wetting-on-dielectric (EWOD) configuration. By eliminating the need for relative motions of two heat transfer surfaces, the device provides a significant advantage in the mechanical design of adaptive thermal control systems. Proof-of-concept devices are constructed and characterized to confirm the mechanism of droplet detachment and attachment for thermal switching. Numerical simulation is performed to elucidate the experimentally measured thermal performance and identify thermocapillary flows as an important contributor to heat transfer for certain dielectric liquids. The present work provides a proof-of-concept demonstration of novel thermal conductance switches and offers physical insights to help systematically design the switches for practical applications.

Objective: EGFR genetic polymorphisms have been investigated for carcinogenesis in various tumors including lung cancer. We evaluated EGFR mutations in four exons, with an emphasis on the Q787Q EGFR polymorphism in non-small-cell lung cancer. Methods: To determine the presence of the Q787Q polymorphism in patients with lung cancer, we performed direct sequencing analyses of four exons for 83 squamous cell carcinomas and 80 adenocarcinomas untreated with EGFR tyrosine kinase inhibitors. Results: The Q787Q EGFR polymorphism was more frequently detected in squamous cell carcinoma patients than in adenocarcinoma patients (24 vs. 15.9%). The group of patients with the Q787Q EGFR polymorphism included more males and heavy smokers compared with other patient groups. The presence of the Q787Q EGFR polymorphism significantly and negatively affected the overall survival rate among patients with non-small-cell carcinoma (p = 0.011), particularly those with squamous cell carcinoma (p = 0.037). Among stage I and II squamous cell carcinoma patients, those with the Q787Q EGFR polymorphism had a poor prognosis (p = 0.032). Conclusions: The Q787Q EGFR polymorphism allows stratifying lung squamous cell carcinoma patients and could be an independent prognostic marker, particularly among those in stages I and II.

// So Hee Dho 1, 2 , Kwang-Pyo Lee 1 , Dongjun Jeong 3 , Chang-Jin Kim 3 , Kyung-Sook Chung 4 , Ji Young Kim 1 , Bum-Chan Park 1 , Sung Sup Park 1 , Seon-Young Kim 4, 5 , Ki-Sun Kwon 1, 5 1 Aging Research Institute, Korea Research Institute of Bioscience and Biotechnology, Daejeon 305-806, Republic of Korea 2 Radioisotope Research Division, Department of Research Reactor Utilization, Korea Atomic Energy Research Institute, Daejeon 305-353, Republic of Korea 3 Department of Pathology, College of Medicine Soonchunhyang University, Chonan 330-090, Republic of Korea 4 Genome Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon 305-806, Republic of Korea 5 Department of Functional Genomics, Korea University of Science and Technology (UST), Daejeon 305-333, Republic of Korea Correspondence to: Ki-Sun Kwon, e-mail: kwonks@kribb.re.kr Keywords: GPCR, GPR171, EGFR, lung cancer Received: August 03, 2015 Accepted: January 02, 2016 Published: January 09, 2016 ABSTRACT G protein-coupled receptors (GPCRs) are among the most significant therapeutic targets and some of them promote the growth and metastasis of cancer. Here, we show that an increase in the levels of GPR171 is crucial for lung cancer tumor progression in vitro and in vivo . Immunostaining of clinical samples indicated that GPR171 was overexpressed in 46.8% of lung carcinoma tissues. Depletion of GPR171 with an anti-GPR171 antibody decreased proliferation of lung carcinoma cells and attenuated tumor progression in a mouse xenograft model. Knockdown of GPR171 also inhibited migration and invasion of the lung cancer cell lines. Notably, inhibition of GPR171 synergistically enhanced the tumoricidal activity of an epidermal growth factor receptor (EGFR) inhibitor in lung cancer cells. These results indicate that GPR171 blockade is a promising antineoplastic strategy and provide a preclinical rationale for combined inhibition of GPR171 and EGFR.

microRNAs (miRNAs) are frequently dysregulated in many human cancers including colorectal cancer (CRC) and are useful candidate biomarkers in liquid biopsy of cancer for their stability in the blood.We compared the expression of microRNA-9 (miR-9) in tissues (n = 357) and sera (n = 109) of CRC patients to determine whether miR-9 in serum reflects that in the cancer tissue in parallel. Also, we examined the miR-9 role in CRC by in vitro functional studies in four CRC cell lines.On multivariate analysis of colorectal cancer tissues and sera, miR-9 low expressions were significantly associated pN stage (tissues; p 0.01, serum; p = 0.013), and clinical stage (tissues; p 0.01, serum; p = 0.031). Moreover, patients with low miR-9 expression had shorter survival than those with high miR-9 expression (log-rank test, tissue; p = 0.021, serum; p = 0.011). miR-9 level in serum reflects that in the tumor. The CRC cells with low miR-9 expression was significantly increased cell proliferation, migration, invasion and colony formation than cells with high miR-9 expression.Serum miR-9 is an useful early detection marker in liquid biopsy of CRC and overexpression of miR-9 in CRC may be a novel prognostic marker as well.

Central neurocytoma (CN) is a very rare neuronal neoplasm. The clinical implications of the potential prognostic factors for these lesions, including tumor atypia, have therefore not been clarified. Forty CN patients were enrolled and reclassified as typical or atypical in accordance with an MIB-1 labeling index (LI) of above and below 2%. We classified our retrospective study cohort as 21 (52.5%) typical and 19 (47.5%) atypical CN cases. No significant differences were found in terms of sex, mean age, mean tumor size or tumor location between these groups. Recurrences occurred in 2 (9.5%) typical and 6 (33.3%) atypical cases. The typical CN 2-,3- and 5-year PFS rates were 100%, 100%, 92.3%, and those for the atypical group were 93.8%, 78.1%, 65.1%, respectively (p = 0.02). The PFS rates did not statistically differ by treatment modality (gross total resection alone, subtotal resection (STR) alone and STR plus radiation therapy (RT) or radiosurgery (RS)) either in the whole cohort (p = 0.75) or in the typical CN and atypical CN subgroups (p = 0.45 and 0.98, respectively). An atypical histology was the only prognostic indicator of recurrence by univariate analysis (hazard ratio: 5.40, p = 0.04). An atypical lesion (MIB-LI > 2%) is an important prognostic indicator in CN. The clinical implications of the extent of resection for CN patients are still debatable. The use of STR plus RT or RS may be a viable treatment strategy for CN but different therapeutic and follow-up approaches for atypical CN will be needed.

Supratentorial extraventricular ependymoma (STEE) is an extremely rare central nervous system (CNS) neoplasm, the clinical characteristics and optimal treatment of which remain unclear. We retrospectively analyzed the clinical characteristics and treatment outcomes of 15 patients with STEE.Fifteen patients with STEE were identified, and their clinical, radiologic, and surgical records were reviewed.The 15 patients included 6 males (40%) and 9 females (60%), with a median age of 15 years. Nine patients (60%) underwent gross total resection, 5 patients (33.3%) underwent subtotal resection, and 1 patient (6.7%) underwent biopsy. Eight patients received adjuvant radiotherapy, and 3 received adjuvant chemotherapy. The 5-year overall survival (OS) rates of patients with World Health Organization (WHO) grade II and grade III STEE were 100% and 30%, respectively, and the corresponding 2-year progression-free survival (PFS) rates were 77.8% and 20%. The differences in OS and PFS rates between WHO grades II and III STEE were statistically significant (P0.01 and 0.02, respectively). Anaplastic histology (WHO grade III) was a poor prognostic factor for PFS (P = 0.04). The recurrence pattern was local recurrence in all patients; all cases were treated primarily by redo surgery. Three patients with recurrent WHO grade II STEE were alive at more than 64, 52, and 44 months after redo surgery.STEE is an extremely rare CNS neoplasm. The histological grade of STEE is an important prognostic factor. Microsurgical resection might play a major role in both initial treatment and treatment of recurrent tumors.

We propose a convenient method to detect the detailed wetting states of grating-type superhydrophobic (SHPo) surfaces under water. Although the silvery plastron makes the nonwetted state easily discernable from the wetted, which appears black, various sub-states of the nonwetted state have so far been indistinguishable without special techniques such as confocal microscopy. For certain applications, however, different sub-states within the nonwetted state may have dramatically different effects. Applied for drag reduction experiments, here we develop an observation strategy that reveals the sub-states of plastron on grating SHPo surface to naked eyes for the first time. The results are confirmed by visualizing the liquid-air interfaces on the submerged surface with optical microscope.

Purpose: To evaluate blue light hazards of LED lightings in an optical store with blue light radiance used as the quantitative indicators of photobiological hazard. Methods: The spectral radiance of each LED lightings was measured, and blue-light radiance and the corresponding maximum exposure time were calculated. Then each LED lighting was classified according to the risk group from IEC 62471 standard. Results: The yellow LED lightings used in showcases and white LED lightings used on ceilings and logo were classified into risk group RG0. But the white LED lightings used on showcases were classified into risk group RG1. The blue light radiances of white LED lightings used in showcases are dozens of times larger than that of fluorescent lamp. Conclusions: Using the value of the blue light radiance could quantitatively express the blue light hazard to various lightings. It was confirmed that white LED lightings for the showcases had high blue light hazards because of their high luminance and color temperature. Therefore, when replacing lightings in optical shop it is necessary to select the appropriate brightness and color temperature for eye health in the long term.

Tentorial meningiomas near the middle third of the medial tentorial edge with supratentorial extension are usually removed via the subtemporal approach. This approach, however, may not be practical, especially for huge tumors extending to the posterior subtemporal space. This study describes the use of the transzygomatic approach with anteriorly limited inferior temporal gyrectomy (TZ-AITG) to remove these large tumors. Between 2008 and 2012, five patients with symptomatic tentorial meningiomas (median diameter, 5.2 cm; range, 4.0–5.7 cm) near the middle third of the medial tentorial edge with supratentorial extension underwent TZ-AITG, consisting of zygomatic osteotomy, low-positioned craniotomy, and resection of the inferior temporal gyrus around 4 cm from the tip. Tumors were completely resected in all patients. Postoperatively, none had a newly developed neurological morbidity, and none died. Of three patients with preoperative hemianopia, two showed improvement and one remained stationary. One patient with preoperative hemiparesis recovered completely. All patients returned to their normal activities during the follow-up period. Surgical morbidities included epidural hematoma and chronic subdural hematoma in one patient each, with both requiring evacuation. TZ-AITG may be a good alternative to the subtemporal approach for large tentorial meningiomas near the middle third of the medial tentorial edge. TZ-AITG provides access to the lesions and visualization of the middle fossa, facilitating early feeder control while minimizing brain retraction, thus reducing potential injury to the vein of Labbe. TZ-AITG is also safe and feasible in minimizing neurological compromise.

Objectives Primary intracranial malignant melanoma (PIMM) is extremely rare central nervous system (CNS) tumor and known for only composed 0.07% of the CNS tumors. PIMM composed only 1% of malignant melanoma and accordingly their clinical behavior and prognosis are not well documented. So, herein, we report our experience of pathologically proven PIMM, and compared their clinical characteristics and outcome with metastatic intracranial malignant melanoma (MIMM). Patients and methods Our institutional database was reviewed for patients who diagnosed as PIMM and MIMM pathologically between 1996–2016. As a result, a total of 6 patients of PIMM and 18 patients of MIMM were identified and analyzed. All these patients’ clinical, radiological, histopathological and surgical records were obtained and reviewed. Results The median age of PIMM patients at initial surgery was 54.5 years (range, 30–60 years). During the mean follow-up of 12.8 months (range: 9–21 months), tumor recurrence occurred in 5 patients (83.3%). The overall survival rates of PIMM at 6, 9, 12 and 18 months were 100%, 83%, 50% and 25%. The PFS rates of PIMM at 3,6,9 and 12 months were 66.7%, 50%, 16.7% and 16.7%. The overall survival rates and progression-free survival rate difference between PIMM and MIMM were not statistically significant. (p = 0.723 and p = 0.6, respectively). Conclusion According to our experience, PIMM is very aggressive malignant tumor. Its median survival was less than 1 year. We suggest that maximal safe resection plus adjuvant RT and CTX for intracranial malignant melanoma considering highly aggressive clinical course of this tumors.

Purpose: This study was to investigate color distortion by colors and luminous transmittance of lenses with word-color test included in computerized neurocognitive function test (CNT). Methods: 32 subjects aged years with no ocular disease and color vision deficiency were selected. Four colors of tinted lenses, which were red, green and blue included in the primary colors of light and pink, and word-color test in CNT to evaluate changes in cognitive function by color distortion were used. Results: Response time was not significantly increased in green, blue, and pink among four colors, but significantly increased in only red color. And response time was significantly increased below 46% of luminous transmittance in red color. Conclusions: It should be cautious and careful of the red-tinted lens choice because red color with below 46% of luminous transmittance can distort colors of objects, and it could be related to safety problem. It is suggested that word-color test could be extensively used for further studies on color recognition.

ObjectBrain metastases from hepatocellular carcinoma (HCC) are rare, and the evidence of the effectiveness of Gamma Knife surgery (GKS) in this disease is lacking. The authors report their institutional experience with GKS in patients with brain metastases from HCCs.MethodsThe authors retrospectively reviewed the medical records of 73 consecutive patients who had a combined total of 141 brain metastases arising from HCCs and were treated with GKS. Sixty-four (87.7%) patients were male, and the mean age of the patients was 52.5 years (range 30–79 years). The mean tumor volume was 7.35 cm3 (range 0.19–33.7 cm3). The median margin dose prescribed was 23 Gy (range 15–32 Gy). Univariate and multivariate survival analyses were performed to identify possible prognostic factors of outcomes.ResultsThe estimated rate of local tumor control was 79.6% at 3 months after GKS. The median overall survival time after GKS was 16 weeks. The actuarial survival rates were 76.7%, 58.9%, and 26.0% at 4, 12, and 24 weeks after GKS, respectively. In the univariate analysis, an age of ≤ 65 years, Child-Pugh Class A (pertaining to liver function), high Karnofsky Performance Scale score (≥ 70), and low Radiation Therapy Oncology Group recursive partitioning analysis class (I or II) were positively associated with the survival times of patients. No statistically significant variable was identified in the multivariate analysis.ConclusionsAlthough survival was extremely poor in patients with brain metastases from HCCs, GKS showed acceptable local tumor control at 3 months after the treatment. The authors suggest that GKS represents a noninvasive approach that may provide a valuable option for treating patients with brain metastases from HCCs.

Background Comprehensive knowledge of the anatomical features of trigeminal schwannomas (TSs) is essential in planning surgery to achieve complete tumor resection. In the current report, we propose a modified classification of TSs according to their location of origin, shape, and extension into the adjacent compartment, and discuss appropriate surgical strategies with this classification. Methods We retrospectively analyzed 49 patients with TS who were treated surgically by a single neurosurgeon at the Asan Medical Center between 1993 and 2013. Results There were 22 males and 27 females, with the median age of 40 years (range, 21-75 years). Median tumor size was 4.0 cm in diameter (2.0-7.0 cm). Tumors were classified as follows: Type M (confined to the middle fossa; 8 cases, 19.0%), P (confined to the posterior fossa; 2 cases, 4.8%), MP (involving equally both middle and posterior fossae; 5 cases, 11.9%), Mp (predominantly middle fossa with posterior fossa extension; 6 cases, 14.3%), Pm (predominantly posterior fossa with middle fossa extension; 16 cases, 38.1%), Me (predominantly middle fossa with extracranial extension; 4 cases, 9.5%). Surgical approach was chosen depending on the tumor classification. More specifically, a frontotemporal craniotomy and extradural approach with or without zygomatic or orbitozygomatic osteotomy was applied to M- or Mp-type tumors; a lateral suboccipital craniotomy with or without suprameatal approach was applied to the majority of P- or Pm-type tumors; and a posterior transpetrosal approach was used in four tumors (three Pm and one MP). Gross total resection was achieved in 95.9% of patients, and the overall recurrence rate was 4.1% (2 patients). Postoperatively, trigeminal symptoms were improved or unchanged in 51.0% of cases (25 patients). Surgical complications included meningitis (5 patients) and cerebrospinal fluid leakage (3 patients). There was no mortality. Conclusion TSs are well to be classified with our modified classification and able to be removed effectively and safely by selecting appropriate surgical approaches.

Purpose: To evaluate the blue-light blocking ratio and luminous transmittance of blue-light blocking lenses using the blue-light hazard function as specified in international standard. Methods: In order to calculate the blue-light blocking ratio and luminous transmittance for a total of 41 blue-light blocking lenses from 8 manufacturers, UV-Vis spectrophotometer was used for measuring the spectral transmittance of wavelengths from 380 to 780 nm. Blue-light blocking ratio was calculated using blue-light hazard function as specified in ANSI Z80.3:2010 and ISO 13666(or Korean Standard KS B ISO 13666:2004). Results: The range of the blue-light blocking ratio was from 9.3 to 96.8%, the range of the transmittance from 53.5 to 92.7%, and the range of the luminous transmittance from 58.0% to 98.1%. In general the blue-light blocking lens prepared by coating tended to have a higher luminous transmittance, while those prepared by tinting a higher blue-light blocking ratio. Conclusions: The behavior of the spectral distribution of lenses showed the possibility of the performance improvement in the blue-light blocking lenses. Manufactures need to acquire their own technology that can evaluate the performance of blue-light blocking lens based in international standard.

Purpose: This study was conducted to compare and analyze the accommodative system (accommodative response and accommodative lag) according to the material and font size of near visual media that we often encounter in daily life. Methods: Forty adult men and women aged 20 to 30 who not had specific ocular diseases and refractive surgery experience were examined to measure and compare the accommodative response according to the material of near visual media (print paper, newspaper, magazine, the I-Phone, LCD monitor) and font size (6, 8, 10, 12) by using both eyes open-view auto-refractometer. Results: The accommodative stimulus was and the accommodative response was . The accommodative lag namely the difference between accommodative stimulus and accommodative response was . The accommodative response according to material of visual media using LCD monitor was (p=0.00) and using the I-Phone was (p=0.04). Both of them were statistically significant lower. The accommodative lag using LCD monitor was (p=0.00) and using the I-Phone was (p=0.04) and they were statistically significant higher. The accommodative response and accommodative lag according to font size were not statistically significant (p>0.05). Conclusions: During near working, the accommodative system was more affected by material than font size of visual media. Especially, visual media of non-luminous material (print paper, newspaper, magazine) are considered fewer burdens on eyes than luminous material (I-Phone, LCD monitor) in terms of accommodative system.

The purpose of this study was to analyze the characteristics of partially thrombosed intracranial aneurysms (PTIAs) in terms of location, shape, size, and symptoms, and to assess outcome according to the type of treatment. We reviewed the radiological and clinical findings of 35 cases of PTIAs followed in our institution between 2006 and 2011. We divided all treatment modalities into two groups. Patients in group A (n = 15) were treated by blood flow blockage from the lesion of the pathogenic segment of the parent where the PTIAs originated, and patients in group B (n = 20) were only treated with obliteration of the remnant perfused aneurysmal sac. Radiological and clinical outcomes of treatment were compared between the two groups. Group A showed complete occlusion in 15 cases (100 %) compared to six cases (30.0 %) in group B (p

Progress in the miniaturization of batteries has lagged well behind that of microelectronics. Although lithium-ion (Li-ion) battery technology has been vital in advancing portable consumer electronics, it is not clear whether future generations of microscale devices can be powered using traditional battery designs. In this paper, we report on the fabrication and properties of battery electrodes comprised of arrays of vertically aligned carbon rods. The electrodes exhibit good reversibility and represent the first carbon arrays to achieve areal capacities greater than 5 mAh cm−2 at relatively large current densities, although the capacity does fade with cycling. The 3D battery designs based on these architectures offer the promise of achieving high energy densities within small footprint areas.

Unplanned re-exploration of the craniotomy after surgical treatment of unruptured intracranial aneurysms (UIAs) is sometimes required, but the underlying causes and rates of these procedures are seldom reported. This study retrospectively analyzed the causes of such re-explorations to identify methods for decreasing their necessity. From January 2000 to December 2011, 1,720 patients with a total of 1,938 UIAs underwent surgical treatment at our institution. From this cohort, 26 patients (1.5 %) with 38 UIAs required re-exploration. Clinical data, aneurysm characteristics, treatment methods, and the incidence and causes of re-exploration of the craniotomy were analyzed for these 26 patients. Several causes of re-exploration were identified: compromised distal blood flow (eight patients, 0.47 %), hemorrhagic venous infarction (four patients, 0.23 %), brain retraction injury (three patients, 0.17 %), newly identified aneurysms (three patients, 0.17 %), bleeding from an incompletely clipped aneurysm (two patients, 0.12 %), epidural hematoma (two patients, 0.12 %), failed aneurysm clipping (two patients, 0.12 %) and other causes (two patients, 0.12 %). Annual re-exploration incidence rates ranged from 0 to 3.1 %. Annual incidence rates gradually decreased following the introduction of several intraoperative monitoring systems. Precise surgical planning and careful operative techniques can reduce the incidence of unplanned re-exploration of the craniotomy. The introduction of various intraoperative monitoring systems can also contribute to a reduction in this incidence.

We evaluated the relationship between interferon-induced transmembrane protein 1 (IFITM1) expression, epithelial-mesenchymal transition (EMT) signature and angiogenesis in lung adenocarcinoma. Additionally, we examined prognostic significance of IFITM1 according to pTNM stage to confirm that IFITM1 can serve as a complement to the pTNM stage. A total of 141 lung adenocarcinoma specimens were evaluated retrospectively by immunohistochemical staining for IFITM1, EMT markers (e-cadherin, β-catenin, and vimentin), and CD31 to measure microvessel density. IFITM1was expressed in 46.8% of the specimens. IFITM1 expression was significantly correlated with increased microvessel density (P = 0.048). However, IFITM1 expression was not associated with three EMT markers. In a multivariate analysis, IFITM1 was an independent prognostic factor for overall survival in a multivariate analysis (hazard ratio: 2.59, P = 0.01). Online database with data from 720 lung adenocarcinoma patients also revealed a negative prognostic significance of IFITM1 (P 0.001). Furthermore, high IFITM1 expression was significantly correlated with decreased OS rates in each pTNM stage. IFITM1 is significantly correlated with angiogenesis and it may be used as a useful additional prognostic marker to aid pTNM classification.

OBJECTIVE Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. METHODS From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. RESULTS In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 mm(3) (range, 4.5-27745 mm(3)) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 mm(3) was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p

OBJECTIVE Pleomorphic xanthoastrocytoma (PXA) is a rare primary low-grade astrocytic tumor classified as WHO II. It is generally benign, but disease progression and malignant transformation have been reported. Prognostic factors for PXA and optimal therapies are not well known. METHODS The study period was January 2000 to March 2012. Data on MR findings, histology, surgical extents and adjuvant therapies were reviewed in twenty-two patients diagnosed with PXA. RESULTS The frequent symptoms of PXA included seizures, headaches and neurologic deficits. Tumors were most common in the temporal lobe followed by frontal, parietal and occipital lobes. One patient who died from immediate post-operative complications was excluded from the statistical analysis. Of the remaining 21 patients, 3 (14%) died and 7 (33%) showed disease progression. Atypical tumor location (p

Objectives Surgical resection is a primary indication for intracranial meningioma. Radiosurgery is also an excellent treatment modality for postoperative residual tumors, or tumors in high-risk locations, such as the skull base. Despite multimodality treatments, there are some cases in which radiosurgery fails and surgical resection or re-radiosurgery is required. However, there has not been a comprehensive study focusing on the causes of secondary treatment for local recurrence or a new mass that develops outside the target area after radiosurgery. Hence, we analyzed the causes of radiosurgical failure in patients with meningioma. Methods From 2000 to 2015, we retrospectively reviewed 1086 patients who underwent gamma knife radiosurgery (GKRS) for intracranial meningioma at the Asan Medical Center. Multiple meningiomas or tumors with a volume greater than 7000mm 3 were excluded. All patients had a minimum follow-up of 12 months. Finally, 771 patients were enrolled in this study. Clinical symptoms and brain MRI findings were assessed by neurosurgeons. When the tumor size increased and was accompanied by newly developed neurological symptoms, further management was considered (e.g. microsurgical resection and stereotactic radiosurgery). Histological analyses of the resected tumors were performed by neuropathologists. Results Among the 771 patients, tumor growth was observed in 60 patients (7.78%). Seven patients showed transient tumor growth after GKRS. These patients have been under close observation without any further treatment. Thirty patients (3.89%) underwent re-radiosurgery for tumor control. Another 23 patients underwent procedures other than re-radiosurgery; 8 underwent microsurgical resection, 3 underwent cyber knife radiosurgery (CKRS), 1 underwent radiation therapy, and 8 were closely followed-up. Three patients visited other clinics or were lost to follow-up. Of the remaining 30 patients, 22 (group 1) underwent microsurgical resection prior to their initial course of GKRS and the other 8 (group 2) were treated only with re-radiosurgery. In group 1, recurrence rates after radiosurgery were 2.47% (n=19) and 0.39% (n=3) for local and distant recurrence, respectively. In group 2, recurrence rates after radiosurgery were 0.52% (n=4) and 0.52% (n=4) for local and distant recurrence, respectively. An analysis was performed to determine the factors that may result in differences between the two groups. Of the many variables, local recurrence ( p =0.0331, Fisher's exact test) was the only significant factor. Conclusion We analyzed the causes of radiosurgical failure in meningioma patients and observed that microsurgery before radiosurgery was significantly associated with a high local recurrence rate compared with primary radiosurgery. Furthermore, the percentage of local recurrence cases that required secondary radiosurgery was as low as 2.98%. This result is comparable with that of microsurgical resection, which is the mainstay of treatment for meningioma.

Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully. These symptoms could be confused with seizures or other medical conditions, leading to unnecessary treatment. Despite clinical significance of paroxysmal sympathetic hyperactivity (PSH), brain tumor-induced PSH has not been studied nearly. In this report, two cases of the PSH in patients with brainstem-compressing benign tumors were introduced. The most useful pharmacologic agents were opioid (e.g., fentanyl patch) in preventing PSH attack, and nonselective β-blocker (e.g., propranolol) in relieving the symptoms. Clinical experiences of the rare cases of benign tumor-induced PSH can be helpful as an essential basis for further research.

Background Mature cystic teratoma (MCT) of the ovary is benign germ cell tumor and shows the highest incidence in women of reproductive age. Histologically, it includes components derived from endoderm, mesoderm, and ectoderm. Although there have been many reports of MCT having small part of the intestinal component, ovarian MCT containing complete colon structure was very rare. Case presentation A 54-year-old woman underwent laparoscopic left salpingo-oophorectomy due to an incidentally found ovarian mass. The pathologic diagnosis of the ovary was MCT containing complete colonic structure. The colonic wall exhibited complete structure of the large intestine composed of mucosa, submucosa, proper muscle, subserosa and serosa. It also contained sebaceous gland, sweat glands, fat tissue, and bone. The patient recovered without any complications. Conclusion Immunohistochemical staining can be used for differential diagnosis between MCT with colonic wall and mucinous tumor. We report a very rare case of MCT that had complete colon structure with a brief literature review.

Intracranial extraskeletal myxoid chondrosarcoma is extremely rare, with only seven patients previously reported. We present a case report of a 21-year-old woman admitted for weakness in her right extremities and symptoms of increased intracranial pressure. Magnetic resonance imaging (MRI) revealed hydrocephalus and a well-enhanced large mass around her left thalamus. A left parietal craniotomy and a cortisectomy at the superior parietal lobule were performed. Total surgical resection was also performed, and pathology results confirmed an extraskeletal myxoid chondrosarcoma. Postoperative MRI showed no residual tumor, and the patient underwent radiotherapy. After six months of radiotherapy, the patient's headache and weakness had improved to grade IV. This malignant tumor showed high rates of recurrence in previous reports. We here report another occurrence of this highly malignant and rare tumor in a patient treated using total surgical excision and adjuvant radiotherapy.

Finding the size and distance of objects viewed through a single optical path-a typical endoscopic condition-is a challenge. Stereo imaging, which would provide the size and distance information, typically requires multiple optical channels or other elaborate techniques, increasing the endoscope diameter and system complexity. This paper reports the development of a miniature flipping disk device that enables stereo measurement, and demonstrates the operation of the device installed in an endoscope. The fabricated Pyrex disk (1.2 mm in diameter and 485 μm in thickness), anodically bonded to a 50-μm-thick silicon vertical comb-drive actuator, is flipped to ±10.7° at a resonant frequency of 414 Hz by 10 VAC of electrostatic actuation. The image shift made by such glass flipping provides a reference dimension, against which the real size and distance of objects seen through a standard single-channel endoscope can be estimated.