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Leptomeningeal disease is rare in pancreatic cancer and prognosis remains poor. Mutation profiles are now directing therapy to improve survival. We describe a case of leptomeningeal and brain metastasis in BRCA1 interacting protein 1, or BRIP1-mutated pancreatic adenocarcinoma with progression through several lines of chemotherapy and immunotherapy. A woman in her late 50s presented with metastatic pancreatic adenocarcinoma on liver biopsy. She achieved complete response after modified FOLFIRINOX and started a poly (ADP-ribose) polymerase (PARP) inhibitor for a BRIP1 mutation. She had recurrence at 9 months and started pembrolizumab (programmed cell death protein 1, or PD-1receptor antibody) for tumour mutational burden of 10 muts/Mb. At 10 months, she presented with lower extremity weakness and back pain. MRI revealed leptomeningeal metastases from T11 to cauda equina roots and right occipital metastasis. Cerebrospinal fluid studies revealed elevated pressure (290 mm H2O) and protein (73 mg/dL) with negative cytology. Leptomeningeal carcinomatosis was diagnosed. She began palliative radiation but died at 11 months from initial diagnosis.

Background/Aims: Sarcopenia negatively affects the prognosis of cirrhotic patients, but clinical implications of changes in muscle mass remain unclear. We aimed to elucidate its role in the prognosis of outpatients with cirrhosis.Methods: Patients with cirrhosis who underwent annual abdominal computed tomography (CT) for hepatocellular carcinoma surveillance were included in the prospective cohort. The L3 skeletal muscle index (SMI) was adopted as a proxy for the amount of skeletal muscle, and the rate of SMI change between inclusion and after 1 year (ΔSMI/yr%) was calculated.Results: In total, 595 patients underwent a second CT after 1 year. Among them, 109 and 64 patients had sarcopenia and Child-Pugh class B/C decompensation at inclusion, which changed to 103 and 45 at the 1-year follow-up, respectively. During a median follow-up of 30.1 months after 1 year, 86 patients had at least one cirrhosis complication, and 18 died or received liver transplantation. In the development of cirrhosis complications, ΔSMI/yr% was independently associated, even after adjusting for the Child-Pugh and model for end stage liver disease (MELD)-Na scores. In addition, ΔSMI/yr% showed a good predictive performance for the development of cirrhosis complications within 6 months after 1-year follow-up in all subgroups, with a cut-off of -2.62 (sensitivity, 83.9%; specificity, 74.5%) in the overall population. SMI at 1-year and Child-Pugh score were independent factors associated with survival. In addition, changes in sarcopenia status significantly stratified survival.Conclusion: ΔSMI/yr% was a good predictor of the development of cirrhosis complications in outpatients with cirrhosis, independent of Child-Pugh and MELD scores.

BACKGROUND: The severity of non-tuberculous mycobacterial pulmonary disease (NTM-PD) can be classified based on an assessment of the patient´s body mass index, age, presence of cavity, erythrocyte sediment rate and sex (BACES). In this study, changes in lung function according to disease severity were analysed.METHODS: Patients with NTM-PD who underwent at least two lung function tests between 1 January 2011 and 31 December 2021, were classified according to their BACES score into mild (0–1), moderate (2–3) and severe (4–5) groups, and changes in lung function were assessed using BACES scores.RESULTS: A total of 354 patients were divided into three groups: mild (n = 108), moderate (n = 216) and severe (n = 30). As disease severity increased, the decrease in forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) was greater: respectively 26.4 mL/year, 31.3 mL/year and 35.7 mL/year in case of FEV1 (P for trend = 0.002); 18.9 mL/year, 25.5 mL/year and 48.9 mL/year in case of FVC (P for trend = 0.002); and 0.7%/year, 1.3%/year and 2.5%/year for DLCO (P for trend = 0.023) in the mild, moderate and severe groups.CONCLUSION: The decrease in lung function in NTM-PD was correlated with disease severity.

La toxoplasmosis es una de las zoonosis parasitarias más difundidas en el mundo y representa el segundo agente etiológico más producida por Toxoplasma gondii. La infección se puede adquirir por vía oral, vía transplacentario o por contacto con materiales potencialmente contaminados como heces de gatos. El objetivo fue describir sobre toxoplasmosis congénita: epidemiología, manifestaciones clínicas y diagnóstico de laboratorio. La metodología fue una revisión sistemática de diseño documental de tipo descriptivo. Se realizó la búsqueda de artículos científicos en bases de datos como PubMed, Google Académico, Redalyc y Medigraphic, Pediactric Infect, Journal of American Health, Med. Exp donde se utilizaron los términos MeSH: “Toxoplasmosis congénita”, “tasa de morbilidad”, “manifestaciones clínicas”, “diagnóstico de laboratorio”. Entre los criterios de inclusión están artículos de diferentes países publicados en español, inglés y portugués. Resultados, en cuanto a tasa de morbilidad y mortalidad de toxoplasma congénito en recién nacidos la prevalencia fue del 45%, la exposición mundial a T. gondii es alta (30 % en EE. UU. y 50-80 % en Europa). Las manifestaciones clínicas principales fueron hidrocefalia, riesgo de aborto espontáneo, partos prematuros, las pruebas diagnósticas fueron: inmunoenzimático o ELISA Ig M, IgG; hemaglutinación indirecta HAI e Inmunofluorescencia IFI; case pruebas rápidas IgM, IgG; técnica de Sabin Feldman para IgG; (ISAGA). En conclusión, La toxoplasmosis es una de las infecciones crónicas comunes causadas por el parásito Toxoplasma gondii, la prevención primaria sigue siendo la intervención clave para evitar la infección y, por tanto, la educación del paciente es un aspecto importante del tratamiento.

This article uses personal family photographs to explore a framework of speculative looking. I begin by considering the category of Asian/American woman not as a knowable entity but as an analytic. I then consider family photographs and alternate modes of speculation to further consider Asian/American gendered subject formation. Using photography, I autoethnographically close read images while thinking about the many afterlives of the Korean War in relation to gendered migration, assimilation, and family formation. I argue for a speculative looking that creates new bonds and possibilities for care by insisting on alternate temporal knowledges across time, allowing visibility to become a site of contestation and possibility. Photography has historically functioned to discipline Asian bodies into racialized and gendered subjectivities to monitor citizenship. The ephemerality of family photographs offers a way to think about the nonlinearity of memory and the everyday presence of violence alongside enduring forms of care.

Background and Objectives Tinnitus retraining therapy (TRT) is a well-known effective method for tinnitus management by retraining the brain to achieve habituation of tinnitus. The mobile device based TRT can let both clinicians and patients be free from time and space limitations and secure cost-effectiveness. The study aimed to investigate whether the mobile-based TRT is inferior or not to the conventional TRT in treatment outcomes for chronic subjective tinnitus.Subjects and Method A prospective randomized controlled trial was conducted in a single tertiary hospital. Adult patients with chronic subjective tinnitus were enrolled. Pure tone audiometry, State-Trait Anxiety Inventory [(STAI), axis1 and axis2], Beck Depression Inventory, Pittsburgh Sleep Quality Index, and a survey for TRT were evaluated. Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) of tinnitus, and Tnnitogram were compared at the start, then at one month and three months of the treatment. The mobile group was subdivided into the treatment effective group and the refractory group. Demographics, baseline tinnitus severity, and therapy compliance were comparatively analyzed.Results A total of 19 patients for the mobile-based TRT and 21 patients for the conventional TRT were enrolled. THI scores and Tinnitus scores using VAS were significantly reduced in the mobile group after the treatment. Furthermore, THI and STAI were significantly more improved in the conventional group than in the mobile-based TRT at one and three months of the treatment. Also, the effective group of the mobile device based TRT was statistically younger than the refractory group and had a higher understanding of the treatment method.Conclusion The mobile-based TRT could improve THI and VAS scores of tinnitus at one and three months of treatment. However, the conventional TRT showed better outcome than the Mobile-based TRT with respect to THI scores. The mobile-based TRT can be one of different potential options that clinicians can apply to tinnitus patients who cannot follow the conventional TRT or limited candidate. Further improvement of the mobile device based TRT would be needed.

Objective: Many scientists have investigated solutions to reduce microbiological risks in dry-aged meat after the dry-aging technology was revived for high quality and value-added premium meat product in the market. This study aimed to investigate the effect of scoria powder in onggi (Korean earthenware) on the meat quality of pork loins during 21 days of dry aging and to elucidate its mechanism of action.Methods: The pork loins were randomly divided into three groups: aged in vacuum-packaging, onggi containing red clay only (OR), and onggi containing 30% red clay and 70% scoria powder (OS). Microbial analyses (total plate count and Lactobacillus spp.) and physicochemical analyses (pH, shear force, volatile basic nitrogen [VBN], water activity, 2-thiobarbituric acid reactive substances, water content, water holding capacity, cooking loss, and color analysis) of aged meat were conducted. Far-infrared ray emission, quantification of immobilized L. sakei and microstructure of onggi were investigated to understand the mechanism.Results: On day 21, the meat aged in OS exhibited lower pH, shear force, VBN, and water activity than those aged in OR, along with an increase in the number of Lactobacillus spp. OS had a smaller pore diameter than OR, implying lower gas permeability, which could promote the growth of L. sakei.Conclusion: OS improved the microbiological safety and storage stability of pork loin during dry aging by increasing number of Lactobacillus spp. possibly due to low permeability of OS.

Background: Aneurysmal subarachnoid hemorrhage is associated with high rate of morbidity and mortality. We aimed to assess prognostic impact of sex, race, and ethnicity in these patients. Methods: Nationwide Inpatient Sample (2000–2019) was used to identify patients presenting with aneurysmal subarachnoid hemorrhage as primary diagnosis. Patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities, type of the hospital, and treatment modality used for aneurysm repair were extracted. The previously validated Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale was used to estimate the clinical severity. Discharge destination and in-hospital mortality was used as outcome measured. The impact of race/ethnicity and sex on clinical outcome was analyzed using multivariate regression models. Results: A total of 161 086 patients with aneurysmal subarachnoid hemorrhage were identified. Mean age was 55.0±13.8 years. Sixty-nine percent of the patients were female, 60% White patients, and 17% Black patients. There was no difference in the Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale score between the 2 sexes. Women had significantly lower odds of good clinical outcome (defined as discharge to home or acute rehabilitation facility; RR, 0.83 [95% CI, 0.74–0.94]; P =0.004). Hispanic patients (RR, 1.12 [95% CI, 1.07–1.17]; P Conclusions: In this nationally representative study, women were less likely to have excellent outcomes following aneurysmal subarachnoid hemorrhage, and White patients had disproportionately higher likelihood of worse clinical outcomes. Lower rates of mortality were seen among Black and Hispanic patients.

Aims Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients’ experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. Results The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. ‘Request’ was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. Clinical implications The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

In this manuscript, we propose a new effective method for eigenpair reanalysis of large-scale finite element (FE) models. Our method utilizes the matrix block-partitioning algorithm in the Rayleigh–Ritz approach and expresses the Ritz basis matrix using thousands of block matrices of very small size. To avoid significant computational costs from the projection procedure, we derive a new formulation that uses tiny block computations instead of global matrix computations. Additionally, we present an algorithm that recognizes which blocks are changed in the modified FE model to achieve computational cost savings when computing new eigenpairs. Through selective updating for the recognized blocks, we can effectively construct the new Ritz basis matrix and the new reduced mass and stiffness matrices corresponding to the modified FE model. To demonstrate the performance of our proposed method, we solve several practical engineering problems and compare the results with those of the combined approximation method, the most well-known eigenpair reanalysis method, and ARPACK, an eigenvalue solver embedded in many numerical programs.

Objectives: The purpose of this study was to examine the differences in early vocabulary acquisition between toddlers with cochlear implants (CI) and toddlers with normal hearing (NH) , and to identify the differences in early vocabulary acquisition according to CI activation period (< 12 months vs. ≥ 12 months) within CI group. In areas in which the difference between groups was significant, we attempted to determine whether the ‘age at implantation’ of the CI group played a role as a moderator.Methods: Nine papers were selected by applying inclusion and exclusion criteria among papers published for about 15 years (2007-2022) and found through searching three databases (Academic Search Complete, PubMed, Google Scholar).Results: There was no significant difference in receptive vocabulary measured by the MacArthur-Bates Communicative Development Inventories (MB-CDI) in CI and NH children, but there was a significant difference in expressive vocabulary. In addition, within the CI group, there was a significant difference in expressive vocabulary according to CI activation period (< 12 months vs. ≥ 12 months).Conclusion: This study confirmed that the expressive vocabulary measured by the MB-CDI may be limited in very young children with CI when compared to their NH peers. In addition, children with CI showed significant changes in expressive vocabulary acquisition despite a relatively short CI activation period of about a year.

Background/Aim: Abdominal ultrasonography (USG) is recommended as a surveillance test for high-risk groups for hepatocellular carcinoma (HCC). This study aimed to analyze the current status of the national cancer surveillance program for HCC in South Korea and investigate the effects of patient-, physician-, and machine-related factors on HCC detection sensitivity.Methods: This multicenter retrospective cohort study collected surveillance USG data from the high-risk group for HCC (liver cirrhosis or chronic hepatitis B or C >40 years of age) at eight South Korean tertiary hospitals in 2017.Results: In 2017, 45 experienced hepatologists or radiologists performed 8,512 USG examinations. The physicians had a mean 15.0±8.3 years of experience; more hepatologists (61.4%) than radiologists (38.6%) participated. Each USG scan took a mean 12.2±3.4 minutes. The HCC detection rate by surveillance USG was 0.3% (n=23). Over 27 months of follow-up, an additional 135 patients (0.7%) developed new HCC. The patients were classified into three groups based on timing of HCC diagnosis since the 1st surveillance USG, and no significant intergroup difference in HCC characteristics was noted. HCC detection was significantly associated with patient-related factors, such as old age and advanced fibrosis, but not with physician- or machine-related factors.Conclusions: This is the first study of the current status of USG as a surveillance method for HCC at tertiary hospitals in South Korea. It is necessary to develop quality indicators and quality assessment procedures for USG to improve the detection rate of HCC.