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   2018| March-April  | Volume 38 | Issue 2  
    Online since April 13, 2018

 
 
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ORIGINAL ARTICLES
Prognostic role of lymphovascular invasion and lymph node status among breast cancer subtypes
Guo-Shiou Liao, Huan-Ming Hsu, Chi-Hong Chu, Zhi-Jie Hong, Chun-Yu Fu, Yu-Ching Chou, Mehra Golshan, Ming-Shen Dai, Teng-Wei Chen, Chan De-Chian, Wan-Chen Tsai, Chao-Wen Pan, Kuo-Feng Hsu, En-Nung Kao, Yi-Chih Hsu, Tsun-Hou Chang, Jyh-Cherng Yu
March-April 2018, 38(2):54-61
DOI:10.4103/jmedsci.jmedsci_105_17  
Context: Breast cancer subtype (BCS) and lymphovascular invasion (LVI) have both been independently demonstrated as prognostic factors. Aims: The objective of this investigation was to evaluate the prognostic power of LVI among BCSs. Settings and Design: From an institutional database, 2017 women with a histopathologically confirmed the diagnosis of breast cancer treated between January 2006 and December 2014 were consecutively selected. Subjects and Methods: Information recorded for each patient included age at diagnosis, year of diagnosis, and date of death or last contact. Total incidences of recurrence or death from breast cancer were ascertained from follow-up lasting until 31 June 2013. Institutional review board approval was obtained through our institution's human investigations committee. Statistical Analysis Used: Univariate and multivariate survival analysis were performed using the Kaplan–Meier analysis and Cox proportional hazards model with a stepwise backward elimination to derive a final model of variables with a significant independent relationship with overall survival (OS) and recurrent-free survival (RFS). All statistical analyses were two-sided with significance defined as P < 0.05. Results: For the entire cohort, the median follow-up OS period was 43.2 months. Tumor size, LVI, lymph node status, and treatment factors (operation type, chemotherapy, and hormone therapy) differed among subtypes with respect to OS and RFS. The highest incidence of LVI positivity (26.4% vs. 26.9%, respectively) and lymph node involvement (39.7% vs. 36.4%, respectively) occurred in the luminal B and luminal HER2 subtypes. There were significant differences in the OS and RFS rates according the LVI among the BCS. On multivariate analysis, there were significant differences in OS according to the status of lymph node-negative and LVI-positive in the luminal HER2 subtype, as well as lymph node-positive and LVI-positive in the triple negative (TN) subtype. There were also significant differences in RFS according to the status of lymph node-negative and LVI-positive in the luminal A subgroup. Conclusions: LVI in BCS was an important prognostic factor for OS and RFS. LVI and lymph node status were important prognostic factor for OS and RFS among BCSs. There were significant differences in OS according to the lymph node-negative and LVI-positive in the distribution of luminal HER2, the lymph node-positive, and LVI-positive in the distribution of TN. There were also significant differences in the RFS according to the lymph node-negative and LVI-positive in the luminal A.
  3,765 233 1
REVIEW ARTICLE
Marine pharmacology: Potential, challenges, and future in India
Hemant R Kanase, Kritarth Naman M. Singh
March-April 2018, 38(2):49-53
DOI:10.4103/jmedsci.jmedsci_126_17  
More than 50% of the marketed drugs today are derived from natural sources. There are various cancers and diseases which cannot be managed well with the current available drugs. It is, therefore, important to identify new sources of drugs for the future. The biological diversity offered by the oceans shows promise in expressing some lead compounds for diseases which show a dearth of drug options for management. A handful of marine products have been approved by the United States – Food and Drug Administration (US-FDA) because of the involvement of academia and the pharmaceutical industry. However, there are many challenges involved which deter a better and faster process for drug development from marine sources. The current scenario in India is in a nascent phase, but steps are being taken in the right direction to develop a potential source of new drugs. In this review article, we try to give an overview over the history and impending potential of marine pharmacology, with an overlook on the current approved marine-sourced drugs by the US-FDA. We also take a brief look over the challenges involved in the field of marine pharmacology, its current progress in India and possible future scope.
  3,372 414 4
ORIGINAL ARTICLES
Model of coping strategies, resilience, psychological well-being, and perceived health among military personnel
Kuan-Jung Chen, Chia-Chen Yang, Hui-Hsun Chiang
March-April 2018, 38(2):73-80
DOI:10.4103/jmedsci.jmedsci_60_17  
Background: Military personnel are confronted with physiological and psychological changes caused by stress and exposure to trauma. Although resilience may be protective against psychopathology, very few studies have explored the relationships between the resilience and coping strategies. The study aims to assess how different coping strategies affect resilience, psychological well-being (PWB), and perceived health among military personnel. Subjects and Methods: This study was a cross-sectional survey. Nuclear, biological, and chemical (NBC) soldiers and nurses in the military medical center were recruited in Taiwan in November 2015. The survey comprised the Brief COPE Scale, Ryff's PWB Scale, and the Resilience Scale for Adults, which examined the relationships among coping strategies, PWB, resilience, and perceived health. Path analysis was applied. Results: We recruited 200 participants (145 male and 177 single) aged 24.6 ± 4.7 years (range, 18–46 years). Resilience (coefficient = 0.60, P < 0.001) and PWB (coefficient = 0.33, P < 0.001) were better when using more approach-oriented coping strategies and fewer avoidant coping strategies, whereas the opposite pattern was seen when using avoidant coping (coefficient = −0.31, P < 0.001 for resilience and coefficient = −.20, P < 0.1 for PWB). PWB significantly predicted perceived health (coefficient = 0.45, P < 0.001). Conclusions: Resilience is higher when positive approach-oriented coping strategies are used, which directly affects PWB, and in turn, predicts better-perceived health. Our conceptual model indicates that interventions designed to promote approach-oriented coping strategies may help military personnel develop improved resilience, PWB, and perceived health status.
  2,741 389 2
Flexible intramedullary nailing for fixation of displaced midshaft clavicle fractures
Hemant Kumar, Ravinder Kumar Banga, Ranjit Singh Boparai, Jaspal Singh
March-April 2018, 38(2):67-72
DOI:10.4103/jmedsci.jmedsci_51_17  
Introduction: Fracture of the clavicle is common in occurrence with incidence of approximately 5% of all fractures seen in hospital emergency. These fractures are generally managed conservatively. Titanium elastic nails are a promising minimally invasive treatment for displaced mid-clavicular fractures, which may be an alternative to plate fixation or even nonoperative treatment. Objective: The aim of this study was to assess the cosmetic outcome (malunion, asymmetry, and scar formation), rate of bone healing and alignment of the clavicle (<30° or > 30°) related to the flexible intramedullary nailing of midshaft fracture clavicle. Materials and Methods: Between June 2012 and June 2014 in GMC and Hospital Amritsar, 50 patients with displaced, noncomminuted fracture of midshaft clavicle of either side underwent flexible intramedullary nailing with titanium elastic nail. Implant removal was performed in 90% cases after the fracture united completely. Results: In this study, all fractures were united. Mean duration of radiological union was 10.3 weeks ranging from 6 to 20 weeks. Mean disabilities of arm shoulder and hand score after 6 months of follow-up was 7.7 ranging from 0.8 to 44.2. Mean constant self-evaluated score was 80.2 ranging from minimum 43 to maximum 98 after 6 months of follow-up. Conclusion: Flexible intramedullary nailing, a minimally invasive technique for stabilization of displaced midshaft clavicle fractures is a simple procedure with excellent functional outcome in terms of quick return to activities and a high patient satisfaction rate with very good cosmetic outcome.
  1,990 262 -
CASE REPORTS
Diagnose and management of ectopic complete molar pregnancy
Gabkika Bray Madoue, Foumsou Lhagadang, Dangar Daniel, Saleh Abdelsalam
March-April 2018, 38(2):85-87
DOI:10.4103/jmedsci.jmedsci_84_17  
We present a rare case of ectopic molar gestation presenting excessive vomiting, lower abdominal pain, and 15 weeks amenorrhea corresponding to her last menstrual period. The ultrasonography showed a right tubo-ovarian mass containing a sac with vesicules, cyst in the left ovary and an empty uterus. The quantitative β-human chorionic gonadotrophin (β-<hCGà) was 93,854 UI/L. The management was surgical. Right salpingectomy was done, and the specimen was sent for histopathological examination which later confirmed on the microscopy the presence of chorionic villi of variable sizes, some cystically dilated and focal trophoblastic proliferation. She was followed up with weekly then a monthly serum β-hCG measurements (1 year after negativation).
  1,813 147 -
ORIGINAL ARTICLES
The effects of dextromethorphan on the outcome of percutaneous coronary intervention with bare-metal stent implantation
Wen-Cheng Liu, Min-Chien Tsai, Cheng-Chung Cheng, Sy-Jou Chen, Han-Bin Huang, Jun-Ting Liou, Wei-Shiang Lin, Shu-Meng Cheng, Shih-Ping Yang, Tien-Ping Tsao
March-April 2018, 38(2):62-66
DOI:10.4103/jmedsci.jmedsci_145_17  
Background: In the era of drug-eluting stents, although bare-metal stent (BMS) remains an option for percutaneous coronary intervention (PCI), restenosis remains the Achilles' heel of BMS implantation. A recent study demonstrated several pleiotropic anti-inflammatory effects of dextromethorphan (DXM). This study aims to evaluate the effects of DXM on the outcome of PCI with BMS implantation. Methods: In this prospective, double-blind, randomized trial, we enrolled 55 patients who underwent PCI with BMS implantation from May 2006 to February 2009. The patients were divided into DXM (60 mg once daily) and placebo groups. We compared mortality rates, myocardial infarction (MI), target lesion revascularization (TLR), restenosis, stent thrombosis, and plasma levels of high-sensitivity C-reactive protein (hs-CRP) with repeated coronary angiography 6 months after the initial procedure. Results: During the 6-month follow-up period, no events of death, MI and stent thrombosis were reported in both groups. The TLR rate was 16.7% in patients receiving DXM compared to 24% receiving a placebo (P = 0.521). The restenosis rate was 30% in patients receiving DXM as compared to 40% receiving the placebo (P = 0.571). Although nonsignificant, the percentage of hs-CRP elevation was lower in the DXM group (20%) compared to the placebo group 32%; P = 0.363). Conclusions: DXM is safe to use in patients who underwent PCI. Although DXM therapy following BMS implantation did not significantly reduce the TLR and restenosis rates, it implied a trend toward a lower TLR and restenosis and reduced inflammation in the DXM group compared to the placebo group. Nonetheless, further extensive studies are warranted to elucidate the anti-restenosis effects of DXM.
  1,650 147 -
CASE REPORTS
Primary uterine primitive neuroectodermal tumor
Yen-Chang Chen, Yung-Hsiang Hsu, Yu-Chi Wei, Tang-Yuan Chu, Dah-Ching Ding
March-April 2018, 38(2):81-84
DOI:10.4103/jmedsci.jmedsci_88_17  
Primitive neuroectodermal tumors (PNETs) are rare malignant tumors and extremely rare in uterine corpus. We report a case of primary uterine PNET in Taiwan. A 68-year-old woman presented with vaginal bleeding and abdominal fullness for 2 weeks. Computed tomography revealed one 8.0 cm uterine corpus tumor with carcinomatosis peritonei and ascites. The cancer antigen 125 level was high (280.7 IU/ml). Pathology of endometrial biopsy diagnosed PNET according to the characteristic of small blue round cells with Homer-Wright rosettes and Friend leukemia integration 1 transcription factor (FLI-1) positive. She received dose-dense chemotherapy with paclitaxel and carboplatin, but the response was poor and the PENT metastasized to liver. PNETs belong to small blue round cell tumor group that is difficult to be diagnosed on histopathology. The immunohistochemistry for CD99 and FLI-1 provides high sensitivity and specificity for diagnosis, respectively. No optimal treatment is established due to rarity. The prognosis is poor, usually <3 years survival.
  1,144 120 -
Takotsubo cardiomyopathy in a young women after cosmetic laser treatment for facial mole removal
Peng Po-Sen, Liu Kai-Hsi, Lin Wei-Shiang
March-April 2018, 38(2):88-90
DOI:10.4103/jmedsci.jmedsci_59_17  
Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy, is a type of nonischemic cardiomyopathy, in which there is a sudden temporary weakening of the muscular portion of the heart. It is usually the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, or a serious accident. The most commonly discussed possible mechanism is stress-induced catecholamine release, with toxicity to and subsequent stunning of the myocardium. We describe a rare case of TCM in a young woman after receiving cosmetic facial mole removal under local laser therapy. She denied history of systemic disease. The patient had chest pain, shortness of breath, elevated cardiac enzymes, and ST-segment elevations in V1–V4. There is absence of significant coronary artery disease in emergent cardiac catheterization. Left ventriculography revealed apical ballooning akinesis with basal hyperkinesis during systole. Takotsubo cardiomyopathy was impressed under above findings. The patient was successfully treated with medical conservative treatment without complication.
  895 71 -
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