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본 연구의 목적은 간호현장에서 활용할 수 있는 생명윤리의 한 실천 방안으로써 간호사의 생명윤리의식 훈련 프로그램을 설계하는 것이다. 본 연구자는 존재론적 인격주의 생명윤리를 이론적 배경으로 삼아 인격주의 생명윤리 개념과 특성을 이해하고 성찰하는 학습 과정으로, 주 1회 2시간씩, 4주간의 인격주의 생명윤리 교육 프로그램(Personalist Bioethics Education Program, PBEP)을 설계하였다. 구체적 교육 목표는 1차시 ‘생명윤리와 인격주의 생명윤리의 개념을 이해한다.’, 2차시 ‘생명의 시작과 생명존중윤리 개념을 이해하고 성찰한다.’, 3차시 ‘생명의 끝과 생명의료윤리 개념을 이해하고 성찰한다.’, 4차시 ‘생명의 과정과 생명공학윤리의 개념을 이해하고 성찰한다.’이다. 교수학습 방법은 성인을 대상으로 진행하는 워크숍으로 강의 및 리뷰, 활동, 성찰 등이 포함되며 시작(20분), 전개(90분), 종료(10분)로 구성하였다. 그리고 최종적으로 설계된 간호사의 생명윤리의식 훈련 프로그램은 5명의 생명윤리 관련 전문가에게 타당도를 검정 받았다(내용타당도 계수 CVI=1). 추후 본 연구에서 설계한 간호사의 생명윤리의식 훈련 프로그램의 적용은 간호사의 생명윤리의식 확립 및 증진에 기여할 것이며, 특히 인격주의 생명윤리에 관한 앎의 지평을 확대하는데 도움이 될 것이다.

World Malaria Day 2021 coincides with the 15th anniversary of the United States President’s Malaria Initiative (PMI) and follows the first anniversary of the declaration of the coronavirus disease (COVID-19) pandemic. From 2006 to the present, the PMI has led to considerable country-managed progress in malaria prevention, care, and treatment in 24 of the highest-burden countries in sub-Saharan Africa and three countries in the Southeast Asia Greater Mekong subregion. Furthermore, it has contributed to a 29% reduction in malaria cases and a 60% reduction in the death rates in sub-Saharan Africa. In this context of progress, substantial heterogeneity persists within and between countries, such that malaria control programs can seek subnational elimination in some populations but others still experience substantial malaria disease and death. During the COVID-19 pandemic, most malaria programs have shown resilience in delivering prevention campaigns, but many experienced important disruptions in their care and treatment of malaria illness. Confronting the COVID-19 pandemic and building on the progress against malaria will require fortitude, including strengthening the quality and ensuring the safety and resiliency of the existing programs, extending services to those currently not reached, and supporting the people and partners closest to those in need.

Scalable and economical methods for the production of optically pure amino acids, both natural and unnatural, are essential for their use as synthetic building blocks. Currently, enzymatic dynamic kinetic resolution (DKR) underpins some of the most effective processes. Here we report the development of enantioselective extraction coupled with racemization (EECR) for the chirality conversion of underivatized amino acids. In this process, the catalytic racemization of amino acids in a basic aqueous solution is coupled with the selective extraction of one enantiomer into an organic layer. Back-extraction from the organic layer to an acidic aqueous solution then completes the deracemization of the amino acid. The automation of the EECR process in a recycling flow reactor is also demonstrated. Continuous EECR is made possible by the sterically hindered chiral ketone extractant 5, which prevents the coextraction of the copper racemization catalyst because of its nonplanar geometry. Furthermore, the extractant 5 unexpectedly forms imines with amino acids faster and with greater enantioselectivity than less bulky derivatives, even though 5 cannot participate in intramolecular resonance-assisted hydrogen bonding. These features may allow EECR to challenge the preponderance of enzymatic DKR in the production of enantiomerically enriched amino acids., Dynamic kinetic resolution is a common approach for the preparation of optically pure amino acids using enzymes. Here the authors report an alternative method based on enantioselective extraction coupled with racemization, in which a bulky extractant affords hydrophobic extractable imines with amino acids rapidly, reversibly and enantioselectively.

The value of tumor-infiltrating lymphocytes (TILs) for prediction of pathologic complete response (pCR) in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NAC) has received increasing attention. In human epidermal growth factor receptor 2 (HER2)-positive BC, advances in HER2-targeted therapy have not yet clarified the clinical implications of pre-NAC TILs. Likewise, the prognostic role of TILs for long-term survival is not well established. Pre- and post-NAC TIL levels were evaluated in 248 pair-matched pre-NAC biopsy and post-NAC resection samples, and analyzed for predictive and prognostic significance with other clinicopathologic parameters. Additional 60 pre-NAC biopsy samples of HER2-positive BC treated with a TCHP regimen (docetaxel, carboplatin, and a combination of trastuzumab and pertuzumab) were also assessed. High pre-NAC TILs, clinical nodal stage 0–1 (cN0–1), and negative ER expression were shown to be strong predictive markers for pCR. A nomogram based on these significant clinicopathologic predictors was developed, providing integrated probability of achieving pCR after NAC. The association between high pre-NAC TIL levels and significantly increased pCR rate was also confirmed in HER2-positive BC patients treated with a TCHP regimen. After chemotherapy, increased quantity of post-NAC TILs was shown to have extended BC-specific survival and disease-free survival in univariable and multivariable analyses. High pre-NAC TIL levels were significantly predictive of pCR in BC, and can act as a surrogate marker for predicting therapeutic effects of a TCHP regimen for HER2-positive BC. Post-NAC TILs in residual disease were a new prognostic marker of risk stratification for long-term survival.

Background Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with favorable clinical outcome in breast cancer patients. However, the possibility that the prognostic significance of pCR differs among various definitions has not been established. Methods We retrospectively evaluated the pathologic response after NAC in 353 breast cancer patients and compared the prognoses after applying the following different definitions of pCR: ypT0/is, ypT0, ypT0/is ypN0, and ypT0 ypN0. Results pCR was significantly associated with improved distant disease-free survival (DDFS) regardless of the definition (ypT0/is, p = .002; ypT0, p = .008; ypT0/is ypN0, p < .001; ypT0 ypN0, p = .003). Presence of tumor deposits of any size in the lymph nodes (LNs; ypN ≥ 0(i+)) was associated with worse DDFS (ypT0 ypN0 vs ypT0 ypN ≥ 0(i+), p = .036 and ypT0/is ypN0 vs ypT0/is ypN ≥ 0(i+), p = .015), and presence of isolated tumor cells was associated with decreased overall survival (OS; ypT0/is ypN0 vs ypT0/is ypN0(i+), p = .013). Residual ductal carcinoma in situ regardless of LN status showed no significant difference in DDFS or OS (DDFS: ypT0 vs ypTis, p = .373 and ypT0 ypN0 vs ypTis ypN0, p = .462; OS: ypT0 vs ypTis, p = .441 and ypT0 ypN0 vs ypTis ypN0, p = .758). In subsequent analysis using ypT0/is ypN0, pCR was associated with improved DDFS and OS in triple-negative tumors (p < .001 and p = .003, respectively). Conclusions Based on our study results, the prognosis and rate of pCR differ according to the definition of pCR and ypT0/is ypN0 might be considered a more preferable definition of pCR.

Acute placental villitis is very rare and believed to reflect overwhelming fetal sepsis in utero, commonly caused by Escherichia coli or group B streptococci. We present a case of intrauterine fetal death associated with acute placental villitis and acute necrotizing chorioamnionitis by early-onset group B streptococcal infection. A 36-year-old woman presented with decreased fetal movement and fever at 21 weeks of gestation. ultrasound demonstrated intrauterine fetal death. After delivery, the placenta revealed multifocal neutrophilic infiltration in chorionic villi, most prominently beneath the trophoblast basement membrane, which was also accompanied by acute necrotizing chorioamnionitis. Gram-positive microorganisms were detected in villous vessels as well as in the major organs of the fetus, which was consistent with Streptococcus agalactiae (group B) cultured from maternal blood. Acute placental villitis should be recognized as evidence of fetal sepsis that often has lethal clinical outcome, as compared to intra-amniotic infection associated with acute chorioamnionitis alone.

Purpose High proliferation rate is a hallmark of cancer. The mitotic index is a useful and simple method for analysis of cell proliferation. However, the practical utility of mitotic index as a predictor of prognosis in patients with hepatocellular carcinoma (HCC) has not been determined. Therefore, we examined mitotic index as a prognostic marker in HCC patients. Materials and Methods We counted the number of mitotic cells in 10 high-power fields of the tumor area on hematoxylin and eosin–stained slides representing 282 surgically resected HCCs. The highest number of mitotic cells was defined as the mitotic index. Results High mitotic index was observed in 127 of 282 HCCs. High mitotic index showed significant association with younger age, larger tumor size, higher Edmondson grade, microvascular invasion, major portal vein invasion, intrahepatic metastasis, higher American Joint Committee on Cancer (AJCC) T-stage, higher Barcelona Clinic Liver Cancer (BCLC) stage, higher alpha-fetoprotein level, hepatitis B virus etiology, and liver cirrhosis. Patients with high mitotic index had shorter disease-specific survival (DSS) (p < 0.001) and tended to have shorter recurrence-free survival (p=0.112). In subgroup analysis among patients with a larger tumor size, microvascular invasion, intrahepatic metastasis, higher AJCC T-stage, and higher BLCL stage, high mitotic index showed unfavorable influences on DSS (p=0.001, p=0.008, p=0.003, p=0.012, and p < 0.001, respectively). In addition, high mitotic index was an independent predictor of shorter DSS (p=0.004). Conclusion High mitotic index may be a novel predictor of DSS in patients with HCC and may have utility as an auxiliary prognostic factor in HCC.

A binaphthol aldehyde with phenyl ether linkage, compound 2, has been synthesized starting from binaphthol-3-carboxylic acid. The axially chiral binaphthol ring was racemized during the synthesis due to high temperatures required in O-phenylation reaction. The enantiomerically pure form of 2 was obtained from the resolution of the diastereomeric imine of 2. Optically pure compound (S)-2 was applied to the enantioselective liquid–liquid extraction of amino acid between CH2Cl2 and aqueous layers. The stereoselectivities, that is, d/l ratio of the amino acid extracted, ranged from 3.57 to 11.1. One carbon was absent in compound (S)-2 compared to the compound (S)-1 with benzyl ether linkage, which differentiated the conformations of their imines formed with amino acids.

Background: The aim of this study was to investigate the role of human epidermal growth factor receptor (HER3) and PTEN expression in patients with HER2-overexpressing metastatic breast cancer (MBC). Methods: One hundred twenty-five MBC patients who were treated with taxane plus trastuzumab chemotherapy as first-line therapy were included in this analysis. Immunohistochemical (IHC) staining with HER3 and PTEN antibodies were conducted retrospectively. Results: Patients who had negative HER3 staining (62.4%) had a better progression-free survival (PFS) than did those who had positive HER3 staining (P=0.001; median PFS, 21 vs 11 months). Patients who had a PTEN score >20 (78.1%) showed longer PFS than did those with a PTEN score ⩽20 (P=0.006; median PFS, 13 vs 9 months). Patients who had a PTEN score >20 exhibited a longer overall survival (OS) than did those with a PTEN score ⩽20 (P=0.005; median OS, 48 vs 25 months). HER3 negativity and PTEN loss were identified as independent risk factors for PFS. PTEN loss was identified as an independent risk factor for OS. Conclusion: HER3 and PTEN expressions may be predictive markers, and PTEN expression may be a predictive and prognostic biomarker for trastuzumab treatment in HER2-positive MBCs.

The chiral ketone (S)-3 shows high kinetic enantioselectivities toward the L form for general underivatized amino acids with hydrophobic side chains and a high thermodynamic enantioselectivity toward the D form for cysteine with its -SH polar side chain when used as an extractant in enantioselective liquid-liquid extractions in the presence of Aliquat 336. Consecutive extractions by imine formation and hydrolysis increase the enantiopurity of the amino acid, as both of these reactions are L-form-selective.

Several pathologic classification systems have been developed to evaluate tumor response after neoadjuvant chemotherapy (NAC) for breast cancer. We aimed to compare pathologic classification systems and to investigate prognostic factors and risk stratification according to molecular subtype in relation to survival. We retrospectively evaluated pathologic response after NAC in 485 breast cancer patients by applying the National Surgical Adjuvant Breast and Bowel Project B18 trial (NSABP-B18), Miller and Payne system, Chevallier’s classification, Sataloff’s classification, residual cancer burden (RCB), residual disease in breast and nodes (RDBN), and clinical–pathologic stage + estrogen receptor status and grade staging system (CPS + EG). All seven classification systems were significantly associated with overall survival (OS) and distant disease-free survival (DDFS). Regarding intrinsic subtypes, all systems were significantly associated with OS and DDFS for triple-negative tumors. Only RCB had prognostic significance for all four subtypes in relation to both OS and DDFS, and RDBN in DDFS only for all subtypes. In risk factor analyses, lymphovascular invasion (LVI), as well as other classic pathologic prognostic factors such as tumor size, lymph node status, and hormonal receptor status, was significantly associated with both OS and DDFS for the entire study group. Regarding subtypes, LVI was associated with DDFS for each subtype except Luminal B-like tumors. Our results suggest that pathologic classification systems that evaluate residual tumors in both breast and lymph nodes after NAC show better association with clinical outcome. Furthermore, combining LVI with other classic prognostic factors might have prognostic value for the assessment of treatment response after NAC.

대두는 여러 종류의 파이토케미컬을 함유하고 있으며 이에 의한 항산화, 항염증, 항비만 효능 등이 있음이 잘 알려져 있다. 대두 부산물 성분의 비만억제효능을 확인하기 위하여 Oil-Red O 염색법과 정량 PCR을 통하여 지방세포분화억제 및 지방생성억제 효능을 분석하였다. 분화유도물질인 isobutylmethylanthine (IBMX), ...

The hydroxyphenyl chiral ketone, (S)-3, reacts with D-amino acids bearing hydrophobic side chains exclusively over the L-amino acids in a two-phase liquid-liquid extraction, and thus acts as a highly stereoselective extractant. Calculations for the energy-minimized structures for the imine diastereomers and the comparison of the selectivities with other phenyl ketones, (S)-4 and (S)-5, demonstrate that the hydrogen bond between the carboxylate group and the phenolic hydroxyl group contributes to the remarkable enantioselectivities. The multiple hydrogen bonds present in the imine of (S)-3 reinforce the rigidity, and results in the difference between the stabilities of the imine diastereomers. The imine could be hydrolyzed in methanolic HCl solution, and the extraction of the evaporated residues revived the organic layer of (S)-3, which could enter into a new extractive cycle and leaves the D-amino acid with enantiomeric excess (ee) values of over 97 % in the aqueous layer.

Inhibition of cyclooxygenase-2 (COX-2) pathways may have significant implications for the prevention and treatment of head and neck squamous cell carcinoma (HNSCC). COX-2 is overexpressed in both premalignant lesions and invasive HNSCC. We examined COX-2 expression by immunohistochemistry in normal tissues, different stages of premalignant lesions, and carcinoma in situ (CIS). We also evaluated the correlation between COX-2 expression and clinical characteristics of HNSCC patients. Tissue specimens were obtained from the following: premalignant lesions from 25 subjects enrolled in a biochemoprevention trial, tumor samples collected at diagnosis from 38 HNSCC patients enrolled in an induction chemotherapy trial, and normal control tissues from 10 noncancer, nonsmoking subjects. COX-2 was expressed in early and intermediate stages of premalignant lesions, increasing first in the basal and parabasal layers, then lower spinous, and upper spinous layers. This correlation was noted in normal epithelium (P < 0.0001), histologically normal in-field samples (P < 0.0001), low-grade dysplasia (P = 0.024), and moderate-grade dysplasia (P = 0.009), but was lost in the majority of high-grade dysplasia/CIS (P = 0.896). COX-2 expression was also noted to increase progressively through the early stages of premalignancy, and to decrease in severe/CIS stage and invasive carcinoma. COX-2 expression in tumors from patients treated with induction chemotherapy was correlated with overall survival after controlling for clinical variables. These findings elucidate the differential expression pattern of COX-2 in stages of head and neck premalignant lesions and invasive carcinoma, supporting the rationale for COX-2 inhibition as an important strategy for cancer chemoprevention. Further validation of COX-2 expression is needed in prospective ongoing chemoprevention trials.

Hepatitis B virus X protein (HBx) is essential for viral replication and plays an important role in viral pathogenesis. HBx transactivates many viral and cellular genes and participates in cellular signal transduction pathways, proliferation, and apoptosis. In the present study, we report that HBx induces apoptosis by enhancing the translocation of Bax to mitochondria, followed by inducing the loss of mitochondrial membrane potential and release of cytochrome C. In addition, Bcl-2, inhibitor of Bax, rescues the disruption of mitochondrial membrane potential and DNA fragmentation induced by serum starvation in HepG2-X cells expressing HBx. We also found that HBx binds directly to Bax and interferes with the interaction between Bax and 14-3-3epsilon to enhance the translocation of Bax to mitochondria. Taken together, our data suggest that HBx induces apoptosis by interacting with Bax and enhancing its translocation to mitochondria.

The incidence of lung cancer in patients with interstitial lung disease (ILD) is higher than in the general population. However, the clinical benefit of chemotherapy for lung cancer patients with ILD still remains unclear. This study was conducted to elucidate the efficacy and tolerability of palliative chemotherapy of lung cancer patients with ILD. Advanced or recurrent lung cancer patients with ILD who received palliative chemotherapy were analyzed. Between January 2001 and December 2010, 59 patients were analyzed. The median age was 64. Fifty-one patients have non-small cell lung cancer (NSCLC) and 8 with small cell lung cancer (SCLC). With respect to the types of ILD, idiopathic interstitial pneumonia (IIP) and non-IIP were observed in 46 (78.0%) and 13 (22.0%) patients, respectively. The overall response rate offirst-line regimen was 37.3% (95% CI 25.0-49.6). The median overall survival (OS) was 7.9 months (95% CI 4.6-11.2) and the median progression-free survival (PFS) was 5.0 months (95% CI 4.2-5.8 ). In NSCLC, the median OS was 5.6 months (95% CI 1.7-9.5) and the median PFS was 4.9 months (95% CI 4.1-5.7). In SCLC, the median OS was 9.4 months (95% CI 6.6-12.2) and the median PFS was 5.4 months (95% CI 3.0-7.8). Multivariate analysis demonstrated that a prior lung resection, an elevated serum LDH level were independent adverse prognostic factors for OS. The acute exacerbation of ILD caused by chemotherapy was noted in 6.8%.Our results suggest that palliative chemotherapy could be a feasible option for SCLC with ILD. However, in NSCLC, there is a need to establish appropriate regimens and patient selection in cases with ILD, especially the use of EGFR TKI. To establish the efficacy of palliative chemotherapy for lung cancer with ILD, further well-controlled prospective studies should be needed in a larger patient population.

In the January 2007 Bulletin, Forsberg et al. present an elegant analysis of the trends in diarrhoea case management using data from national Demographic and Health Surveys (DHS) from 1986 to 2003.1 They conclude that despite global efforts to promote appropriate diarrhoea management during this time, only slow progress has been made in the proportion of children treated with oral rehydration salts (ORS), recommended home fluids (RHF) or increased fluids. The proportion of children given continued feeding during diarrhoea episodes actually decreased.