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Summary: Purpose: This study aimed to adapt and validate the Korean version of the Caregiver Burden Questionnaire for Family Caregivers of Hemodialysis Patients, originally developed by Hejazi et al. in 2022, to ensure its applicability and validity in Korea. Methods: Using both online and offline approaches, this study included 230 family caregivers. Data analysis was performed with SPSS AMOS version 29.0 using the Korean version of the Caregiver Burden Questionnaire for Family Caregivers of Hemodialysis Patients and the Korean version of the Zarit Burden Interview as the primary instruments. Results: The findings confirmed the high content validity of the questionnaire (scale-level content validity index = .99), and confirmatory factor analysis established its construct validity. Convergent validity was confirmed with average variance extracted values ranging from .43 to .87, and composite reliability scores ranging from .80 to .91. A significant positive correlation with the Korean version of the Zarit Burden Interview (r = .81) demonstrated concurrent validity. The tool consists of 21 items across four factors on a 5-point Likert scale, exhibiting excellent internal consistency (Cronbach's α = .91) and good test-retest reliability (intraclass correlation coefficient = .79). Conclusion: This study validated a reliable instrument for assessing caregiver burden in families of hemodialysis patients in Korea. This tool accurately measures caregiver challenges and has the potential to enhance societal health and welfare.

Purpose It is important to understand changes in energy requirements in critically ill patients with sepsis. This study investigates alterations in energy requirements based on the clinical course of sepsis in patients admitted to the surgical intensive care unit (SICU) using indirect calorimetry. Methods In this prospective study, 36 patients admitted to the surgical intensive care unit with sepsis were analyzed. Using indirect calorimetry, the resting energy expenditure (REE) and respiratory quotient (RQ) were assessed on the 1st, 3rd, and 7th day of Intensive Care Unit admission. Measured REE through indirect calorimetry was compared with the predictive equations (Weight-based, Harris-Benedict, Ireton-Jones, and Penn state 2003) using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results Measured REE was highest on Day 1 and remained unchanged on Day 3 and 7 (Day 1 vs. Day 3 vs. Day 7: 24.29 ± 3.72 kcal/kg vs. 22.42 ± 3.72 kcal/kg vs. 23.26 ± 5.78 kcal/kg). RQ decreased on Day 3 but increased on Day 7 after caloric intake (Day 1 vs. Day 3 vs. Day 7: 0.69 ± 0.06 vs. 0.67 ± 0.05 vs. 0.71 ± 0.06). Comparing the correlation between the 4 predictive equations and the measured REE, the Penn state 2003 equation demonstrated the highest correlation at each time point, although it showed a decreasing trend over time (Penn state equation ICC: Day 1-0.71, Day 3-0.65, Day 7-0.53). Conclusion In sepsis patients, it is necessary to understand metabolic changes according to the clinical course and provide appropriate calories as determined by using indirect calorimetry when the patients enter the stable phase.

Due to a worldwide paradigm shift from a medical-centered system to patient-centered care, there is a need to recognize actual (practical) medical service from laypeople. In South Korea, intrinsic healthcare use characteristics such as the “Herd Behavior” have led to waiting many hours for a short treatment time at metropolitan-based major hospitals. Illustrating individual perceptions of an ideal healthcare system should take precedence when defining this issue. This study aimed to explore and describe laypeople in South Korea’s perceptions of ideal healthcare services based on their utilization of medical services. This qualitative study was conducted with 13 members of the National Participation Committee using semi-structured interviews. Qualitative data were analyzed using the thematic analysis method and visualized through a word cloud generated with MAXQDA software. Six themes were derived from the visualized words and an incremental analysis to explore perceptions of desirable medical services. Participants struggled to find a suitable hospital without expert guidance and felt objectified for their money. They distrusted and didn’t want to speak in front of medical professionals. They wanted their essential needs to be met regardless of their economic status. This study provides a description portrait of laypeople’s experiences related to healthcare services in South Korea, where medical services are predominantly provided by private hospitals with public insurance coverage. Users’ desire for tailored information through an integrated medical system that has a strong emphasis on people-centeredness must be embraced.

Abstract Background Mitochondria are known to synthesize adenosine triphosphate (ATP) through oxidative phosphorylation. Understanding and accurately measuring mitochondrial ATP synthesis rate can provide insights into the functional status of mitochondria and how it contributes to overall cellular energy homeostasis. Traditional methods only estimate mitochondrial function by measuring ATP levels at a single point in time or through oxygen consumption rates. This study introduced the relative mitochondrial ATP synthesis response against inhibiting and stimulating substrates (MitoRAISE), designed to detect real-time changes in ATP levels as the cells respond to substrates. Methods The sensitivity and specificity of the MitoRAISE assay were verified under various conditions, including the isolation of mitochondria, variations in cell numbers, cells exhibiting mitochondrial damage, and heterogeneous mixtures. Using peripheral blood mononuclear cells (PBMCs), we analyzed MitoRAISE data from 19 patients with breast cancer and 23 healthy women. Results The parameters observed in the MitoRAISE data increased depending on the quantity of isolated mitochondria and cell count, whereas it remained unmeasured in mitochondrial-damaged cell lines. Basal ATP, rotenone response, malonate response, and mitochondrial DNA copy numbers were lower in PBMCs from patients with breast cancer than in those from healthy women. Conclusions The MitoRAISE assay has demonstrated its sensitivity and specificity by measuring relative ATP synthesis rates under various conditions. We propose MitoRAISE assay as a potential tool for monitoring changes in the mitochondrial metabolic status associated with various diseases.

Abstract Genomic analysis of structural variants(SVs) in breast cancer (BC) patients has been conducted, but the relationship between genomic alterations and BC prognosis remains unclear. We performed RNA sequencing of 297 early BC fresh-frozen tissues. We identified SVs using three tools (STAR.Arriba, STAR.fusion, and STAR.SEQR) with the COSMIC and Mitelman databases as guide references. We found a median of five to eight fusions per sample. In BC intrinsic subtypes, normal subtype had the fewest fusions (median: 1, interquartile range [IQR]: 0, 3) followed by luminal A (median: 5.5, IQR: 2.75, 10.25), luminal B (median: 9, IQR: 6, 16.5), HER2-enriched (median: 9, IQR: 6, 16.5) and basal (median 10, IQR: 6, 15.5) subtypes (p

In Korea, there are cases where nurses use abusive language while teaching new nurses. Nursing students who observe and experience this kind of violence question themselves if they will be able to perform well in such an environment. This descriptive research study examined the mediating effect of negative emotions and the regulated mediating effect of resilience in the relationship between indirect experiences of violence and career identity. Junior- and senior-year students in the nursing departments of nine universities located in Gyeonggi Province and Seoul were recruited using snowball sampling from August 1st to August 31st, 2021. A total of 254 participants completed the questionnaire. Data were analyzed using the SPSS PROCESS macro. The factors that affected career identity were indirect experience of violence (β = −.1978, p = .0001), negative emotions (β = −.2364, p

Abstract Background Endocrine therapy resistance in hormone receptor-positive/HER2-negative (HR+/HER2−) breast cancer (BC) is a significant clinical challenge that poses several unmet needs in the management of the disease. This study aimed to investigate the prognostic value of c-MET-positive circulating tumor cells (cMET+ CTCs), ESR1/PIK3CA mutations, and cell-free DNA (cfDNA) concentrations in patients with hormone receptor-positive (HR+) metastatic breast cancer (mBC). Methods Ninety-seven patients with HR+ mBC were prospectively enrolled during standard treatment at Samsung Medical Center. CTCs were isolated from blood using GenoCTC® and EpCAM or c-MET CTC isolation kits. PIK3CA and ESR1 hotspot mutations were analyzed using droplet digital PCR. CfDNA concentrations were calculated using internal control copies from the ESR1 mutation test. Immunocytochemistry was performed to compare c-MET overexpression between primary and metastatic sites. Results The proportion of c-MET overexpression was significantly higher in metastatic sites than in primary sites (p = 0.00002). Survival analysis showed that c-MET+ CTC, cfDNA concentration, and ESR1 mutations were significantly associated with poor prognosis (p = 0.0026, 0.0021, and 0.0064, respectively) in HR+/HER2− mBC. By contrast, EpCAM-positive CTC (EpCAM+ CTC) and PIK3CA mutations were not associated with progression-free survival (PFS) in HR+/HER2− mBC. Multivariate analyses revealed that c-MET+ CTCs and cfDNA concentration were independent predictors of PFS in HR+/HER2− mBC. Conclusions Monitoring c-MET+ CTC, rather than assessing c-MET expression in the primary BC site, could provide valuable information for predicting disease progression, as c-MET expression can change during treatment. The c-MET+ CTC count and cfDNA concentration could provide complementary information on disease progression in HR+ /HER2− mBC, highlighting the importance of integrated liquid biopsy.

Purpose This study aimed to compare the resting energy expenditure (REE) measured using indirect calorimetry with that estimated using predictive equations in severe trauma patients to determine the appropriate caloric requirements. Methods Patients admitted to the surgical intensive care unit between January 2020 and March 2023 were included in this study. Indirect calorimetry was used to measure the patients’ REE values. These values were subsequently compared with those estimated using predictive equations: the weight-based equation (rule of thumb, 25 kcal/kg/day), Harris-Benedict, Ireton-Jones, and the Penn State 2003 equations. Results A total of 27 severe trauma patients were included in this study, and 47 indirect calorimetric measurements were conducted. The weight-based equation (mean difference [MD], –28.96±303.58 kcal) and the Penn State 2003 equation (MD, –3.56±270.39 kcal) showed the closest results to REE measured by indirect calorimetry. However, the REE values estimated using the Harris-Benedict equation (MD, 156.64±276.54 kcal) and Ireton-Jones equation (MD, 250.87±332.54 kcal) displayed significant differences from those measured using indirect calorimetry. The concordance rate, which the predictive REE differs from the measured REE value within 10%, was up to 36.2%. Conclusions The REE values estimated using predictive equations exhibited substantial differences from those measured via indirect calorimetry. Therefore, it is necessary to measure the REE value through indirect calorimetry in severe trauma patients.

Abstract In the ongoing global fight against coronavirus disease 2019 (COVID-19), the sample preparation process for real-time reverse transcription polymerase chain reaction (rRT-PCR) faces challenges due to time-consuming steps, labor-intensive procedures, contamination risks, resource demands, and environmental implications. However, optimized strategies for sample preparation have been poorly investigated, and the combination of RNase inhibitors and Proteinase K has been rarely considered. Hence, we investigated combinations of several extraction-free protocols incorporating heat treatment, sample dilution, and Proteinase K and RNase inhibitors, and validated the effectiveness using 120 SARS-CoV-2 positive and 62 negative clinical samples. Combining sample dilution and heat treatment with Proteinase K and RNase inhibitors addition exhibited the highest sensitivity (84.26%) with a mean increase in cycle threshold (Ct) value of + 3.8. Meanwhile, combined sample dilution and heat treatment exhibited a sensitivity of 79.63%, accounting for a 38% increase compared to heat treatment alone. Our findings highlight that the incorporation of Proteinase K and RNase inhibitors with sample dilution and heat treatment contributed only marginally to the improvement without yielding statistically significant differences. Sample dilution significantly impacts SARS-CoV-2 detection, and sample conditions play a crucial role in the efficiency of extraction-free methods. Our findings may provide insights for streamlining diagnostic testing, enhancing its accessibility, cost-effectiveness, and sustainability.

Abstract Aim Patients with locoregionally uncontrolled breast tumors are frequently referred for breast palliative radiotherapy (PRT) to mitigate symptoms. We analyzed the outcomes following breast PRT to optimize PRT according to risk groups. Methods We reviewed 133 patients who underwent breast PRT. A median total dose of 45 Gy was prescribed with an equivalent dose in 2 Gy fractions (EQD2, α/β = 3.5) of 53 Gy. The Cox proportional hazards model was used to analyze the prognostic factors of local control (LC). Results Most (90.2%) had polymetastatic disease (> 5 lesions), and 48.9% had bone metastasis. With a median follow-up of 17.2 months, the 2-year LC and overall survival (OS) rates were 49.4%, and 48.3%, respectively. Multivariable analyses demonstrated progressive or mixed responses outside the breast and > 2 lines of previous therapy as adverse features for clinical outcomes. Group 1 (0 risk factors) showed favorable 2-year LC and OS of 63.9%, and 72.8%, respectively, whereas group 3 (2 risk factors) showed the worst outcomes of 0%, and 6.8%, respectively. Breast PRT with EQD2 ≥ 63 Gy showed a significant benefit in LC for group 1 and marginal benefit (p = 0.055) for group 2, but no improvement for group 3 (p = 0.300). Conclusion Breast PRT showed favorable LC outcomes in patients with stable disease outside the breast and treated with ≤ 2 lines of systemic treatment. Our findings warrant future clinical trials investigating the role of higher than palliative dose and early intervention of PRT in stage IV patients.

A solar-driven photoelectrochemical (PEC) cell is emerging as one of the promising clean hydrogen generation systems. Engineering of semiconductor heterojunctions and surface morphologies of photoelectrodes in a PEC cell has been a primitive approach to boost its performance. This study presents that a molybdenum disulfide (MoS2) nanoflakes photoanode on 3-dimensional (3D) porous carbon spun fabric (CSF) as a substrate effectively enhances hydrogen generations due to sufficiently enlarged surface area. MoS2 is grown on CSFs utilizing a hydrothermal method. Among three different MoS2 coating morphologies depending on the amount of MoS2 precursor and hydrothermal growth time, film shape MoS2 on CSFs had the largest surface area, exhibiting the highest photocurrent density of 26.48 mA/cm2 and the highest applied bias photon-to-current efficiency (ABPE) efficiency of 5.32% at 0.43 VRHE. Furthermore, with a two-step growth method of sputtering and a subsequent hydrothermal coating, continuous TiO2/MoS2 heterojunctions on a porous CSF further promoted the photoelectrochemical performances due to their optimized bandgap alignments. Enlarged surface area, enhanced charge transfer, and utilization of visible light enable a highly efficient MoS2/TiO2/CSF photoanode with a photocurrent density of 33.81 mA/cm2 and an ABPE of 6.97 % at 0.87 VRHE. The hydrogen generation amount of the PEC cell with MoS2/TiO2/CSF photoanode is 225.4 μmol/L after light irradiation of 60 s.

Abstract Background Cyclin-dependent kinase 4/6 inhibitor (CDK4/6) therapy plus endocrine therapy (ET) is an effective treatment for patients with hormone receptor-positive/human epidermal receptor 2-negative metastatic breast cancer (HR+/HER2− MBC); however, resistance is common and poorly understood. A comprehensive genomic and transcriptomic analysis of pretreatment and post-treatment tumors from patients receiving palbociclib plus ET was performed to delineate molecular mechanisms of drug resistance. Methods Tissue was collected from 89 patients with HR+/HER2− MBC, including those with recurrent and/or metastatic disease, receiving palbociclib plus an aromatase inhibitor or fulvestrant at Samsung Medical Center and Seoul National University Hospital from 2017 to 2020. Tumor biopsy and blood samples obtained at pretreatment, on-treatment (6 weeks and/or 12 weeks), and post-progression underwent RNA sequencing and whole-exome sequencing. Cox regression analysis was performed to identify the clinical and genomic variables associated with progression-free survival. Results Novel markers associated with poor prognosis, including genomic scar features caused by homologous repair deficiency (HRD), estrogen response signatures, and four prognostic clusters with distinct molecular features were identified. Tumors with TP53 mutations co-occurring with a unique HRD-high cluster responded poorly to palbociclib plus ET. Comparisons of paired pre- and post-treatment samples revealed that tumors became enriched in APOBEC mutation signatures, and many switched to aggressive molecular subtypes with estrogen-independent characteristics. We identified frequent genomic alterations upon disease progression in RB1, ESR1, PTEN, and KMT2C. Conclusions We identified novel molecular features associated with poor prognosis and molecular mechanisms that could be targeted to overcome resistance to CKD4/6 plus ET. Trial registration ClinicalTrials.gov, NCT03401359. The trial was posted on 18 January 2018 and registered prospectively.

Abstract Apocrine carcinoma is a rare breast cancer subtype. As such, the genomic characteristics of apocrine carcinoma with triple negative immunohistochemical results (TNAC), which has been treated as triple negative breast cancer (TNBC), have not been revealed. In this study, we evaluated the genomic characteristics of TNAC compared to TNBC with low Ki-67 (LK-TNBC). In the genetic analysis of 73 TNACs and 32 LK-TNBCs, the most frequently mutated driver gene in TNAC was TP53 (16/56, 28.6%), followed by PIK3CA (9/56, 16.1%), ZNF717 (8/56, 14.3%), and PIK3R1 (6/56, 10.71%). Mutational signature analysis showed enrichment of defective DNA mismatch repair (MMR)-related signatures (SBS6 and SBS21) and the SBS5 signature in TNAC, whereas an APOBEC activity-associated mutational signature (SBS13) was more prominent in LK-TNBC (Student’s t test, p

Abstract Background TP53 is the most commonly mutated gene across all cancer types. R175H mutation was considered structural mutation where the mutation causes misfolding of the protein and leads to a significant conformational alterations within p53's DNA binding domain. The aim of this study was to explain the reason why R175H worse the response to immunotherapy by analyzing tumor immune microenvironment through the expression of immune cells and PD‐1. Materials and Methods Patients diagnosed with metastatic carcinoma, including colorectal cancer (CRC), breast cancer (BRCA), gastric cancer (GC), non‐small cell lung cancer (NSCLC), and 20 other cancer types, treated in a palliative setting at Samsung Medical Center between October 2019 and April 2021, were enrolled. Of these patients, those who underwent TDS analysis (TruSight™ Oncology 500 assay [TSO 500]) were finally analyzed. Results Of 1770 patients, 1012 (57.2%) harbored genetic alterations in TP53. All mutations were single nucleotide variants (SNVs), and the most frequent SNV was R175H (n = 84, 7.5%) which was known as one of the most common hotspot TP53 mutation. The overall survival of patients with TP53 R175H mutations was significantly worse following chemotherapy (606 vs. 456 days, p

Agricultural antibiotics are widely used to inhibit the growth of phytopathogenic bacteria involved in plant diseases. However, continuous antibiotic overuse in crop production may lead to the development of antibiotic resistance in phytopathogenic bacteria. This study was conducted to evaluate the resistance to three different agricultural antibiotics (oxytetracycline+streptomycin, streptomycin, and validamycin A) in 91 strains of phytopathogenic bacteria including Pectobacterium carotovorum, Pseudomonas syringae pv. actinidiae, Clavibacter michiganensis subsp. michiganensis, C. michiganensis subsp. capsici, and Xanthomonas arboricola pv. pruni. Bacterial growth in the presence of various concentrations of validamycin A was also assessed spectrophotometrically by analyzing the optical density. All strains did not grow when the cells were exposed to oxytetracycline+streptomycin or 100× of streptomycin. However, among the 91 strains, 4% and 2% strains showed bacterial growth at the concentrations of 1× and 10× of streptomycin, respectively. Furthermore, 97%, 93%, and 73% strains were resistant to the 1×, 10×, and 100× of validamycin A, respectively, and especially, P. carotovorum contained the highest resistance to the validamycin A. Minimum bactericidal concentration values of validamycin A did not correlate with the patterns of agricultural antibiotic resistance. Further studies are needed to understand the incidence and development of antibiotic resistance in phytopathogenic bacteria.

Aim: The role of regional nodal irradiation (RNI) after preoperative systemic treatment (PST) with targeted therapy for HER2-positive breast cancer remains uncertain. This study aimed to investigate the impact of RNI on locoregional recurrence (LRR) and disease-free survival (DFS) outcomes after docetaxel/carboplatin/trastuzumab/pertuzumab (TCHP) for PST. Methods: We retrospectively analyzed 255 patients who were treated with six cycles of TCHP between 2016 and 2019. The patients were divided into four groups based on clinical nodal involvement: group A, with no nodal disease; group B, with axillary lymph node (AXL) level I; group C, with AXL level I with II/III; and group D, with supraclavicular or internal mammary nodes. Results: The RNI group had more advanced nodal disease (C/D) than the no RNI group (56.9 % vs. 6.8 %). With a median follow-up of 51.3 months, there were two (0.8 %), three (1.2 %), and 15 (5.9 %) local, regional, and distant metastases, respectively. LRR did not differ significantly according to the RNI (2.6 % vs. 1.0 %, p = 0.651). Group D had the most frequent distant metastases (17.5 %; p = 0.005). The 4-year DFS rate was 92.7 %, and DFS did not improve significantly after RNI (p = 0.074). When stratified by clinical nodal groups and pathological axillary response, RNI had no effect on LRR/DFS outcomes. Conclusion: With a rare incidence of LRR, RNI did not significantly affect LRR or DFS in patients with HER2-positive breast cancer after with PST-TCHP. However, intensive systemic treatment is required for advanced diseases (C/D). Selective de-intensified RNI and intensified systemic treatment should be investigated in future studies.

This paper proposes an evolved quasi-3D analysis method (EQAM) that can extremely reduce analysis time by applying it to models where 3D analysis is essential. The conventional quasi-3D analysis is a method that can equalize a 3D analysis with multiple 2D analyses and is widely used for 3D models that take a long analysis time. However, the quasi-3D method still has the problem of taking a long time to interpret because it requires increasing the number of quasi segments to obtain accurate results. Therefore, this paper proposes a method of deriving a magnetic flux linkage, torque, voltage, torque-current phase angle curve (T- $\beta $ curve) by interpreting only one step rather than all steps in multiple quasi segments. Compared to the 3D analysis, the EQAM reduced the T- $\beta $ curve extraction time by 99.1% and reduced the capacity of the analysis file by 99.6%. In terms of analysis accuracy, the average torque error rate is 0.20% and the voltage error rate is 2.88% at the operating point. The validity of the proposed method was verified by confirming that the analysis time and file capacity reduction rate were significantly higher than the error rate. Therefore, EQAM is expected to be of great help to researchers facing time problems by being applied to various fields and studies that require 3D finite element analysis.

Background: Pretreatment endocrine symptoms in premenopausal patients might be considered as a potential marker of poor prognosis. We conducted a cohort study to evaluate the association between endocrine symptoms prior to treatment and recurrence-free survival (RFS) among premenopausal patients with breast cancer aged ⩽40 years. Methods: Data were obtained from a prospective cohort study (NCT03131089) conducted at the Samsung Medical Center from 2013 to 2021. We included patients aged ⩽40 years who had been diagnosed with breast cancer. The primary outcome measure was RFS. Endocrine symptoms were measured using the Functional Assessment of Cancer Therapy – Endocrine Symptoms (FACT-ES). We also calculated the hazard ratio (HR) for recurrence or all-cause mortality by comparing the tertiles of the FACT-ES score at diagnosis. Results: Among the 977 participants, the mean (standard deviation) age was 35.3 (3.9) years. At diagnosis, 17.2% of the patients had at least one severe endocrine symptom. During 3512 person-years of follow-up, the high symptom group had a worse RFS than the low-symptom group [HR = 2.05; 95% confidence interval (CI) = 1.19–3.54]. In particular, hot flashes (HR = 5.59; 95% CI = 1.96–15.93) and breast sensitivity (HR = 1.82; 95% CI = 1.00–3.32) were associated with reduced RFS. Conclusion: Close monitoring of pretreatment endocrine symptoms may be important in patients diagnosed with breast cancer at a young age.

We designed and constructed a whole-cell biosensor capable of detecting the presence and quantity of carbon monoxide (CO) using the CO regulatory transcription factor. This biosensor utilizes CooA, a CO-sensing transcription regulator that activates the expression of carbon monoxide dehydrogenase (CODH), to detect the presence of CO and respond by triggering the expression of a GUS reporter protein (β-glucuronidase). The GUS reporter protein is expressed from a CO-induced CooA-binding promoter (PcooF) by CooA and enables the effective colorimetric detection of CO. An Escherichia coli strain used to validate the biosensor showed growth and GUS activity under anaerobic conditions; this study used the inert gas (Ar) to create anaerobic conditions. The pBRCO biosensor could successfully detect the presence of CO in the headspace. Moreover, the GUS-specific activity of pBRCO according to the CO strength as partial pressure followed Michaelis-Menten kinetics (R2 = 0.98). It was confirmed that the GUS-specific activity of pBRCO increased linearly up to 30.39 kPa (R2 = 0.98), and thus, a quantitative analysis of CO concentration (i.e., partial pressure) was possible.

Background/Aims: The objective of this study was to determine the more appropriate wound-closure method by comparing the effectiveness of two methods in a group of patients who underwent ileostomy repair. Methods: The study conducted after obtaining the approval of the Institutional Review Board (IRB) included 58 patients ≥19 years of age who underwent ileostomy at the Department of Surgery at the Presbyterian Medical Center. This was a retrospective, single-center trial. Patients who underwent ileostomy closure between January 2011 and September 2017 were assigned to the primary wound-closure (PC, n=25) group and the purse-string wound-closure (PSC, n=33) group. Post-repair complications, such as wound infection, delayed healing, and patient satisfaction related to wound management, were investigated and compared according to the wound-closure method. Results: The PSC group had a significantly lower surgical site infection rate than the PC group (0% vs. 44%, p30 days was not significantly different (39% vs. 20%, p=0.114). In addition, there were no significant differences in the response to questionnaires on patient satisfaction between the two groups. Conclusions: PSC has a lower surgical site infection rate and the wound-healing delay was not very different from that of PC. Therefore, if patients are at risk of wound infection, such as in severe wound contamination, long operating time, and immunocompromised conditions, we should consider PSC as a wound closure method of choice.

IntroductionImmune checkpoint inhibitor (ICI) is one of the standard treatment strategies in triple negative breast cancer (TNBC). However, the benefit of ICI with chemotherapy is limited in metastatic TNBC. In this study, we evaluated the effect of PD-L1 and LAG-3 expression on tissue microenvironment of mTNBC treated with ICI.MethodsWe reviewed representative formalin-fixed paraffin embedded specimens from metastatic or archival tumor tissues of TNBCs who treated with PD-1/PD-L1 inhibitors in metastatic setting. We used the Opal multiplex Detection kit with six antibodies (anti-PD-L1, anti-LAG-3, anti-CD68, anti-panCK, anti-CD8, anti-CD107a/LAMP antibody).ResultsWe evaluated the association between LAG-3+cells and survival outcome regarding CK expression. Stromal LAG-3+/CK+ and LAG-3+/CK- cells were not associated with ICI-progression free survival(PFS) (P=0.16). However, LAG-3+ cell distributions in the tumor area impacted on ICI-PFS. A high density of LAG-3+CK+ cells was associated with shorter ICI-PFS compared with low densities of both LAG-3+CK+ and LAG-3+CK- cells (1.9 vs. 3.5 months). In addition, a high density of LAG-3+CK- cells had a relatively longer ICI-PFS compared with other groups (P=0.01). In terms of total area, the pattern of densities of LAG-3+CK+ cells and LAG-3+CK- cells were similar to those in the tumor area In addition, ICI-PFS of LAG-3+CK- and LAG-3+CK+ cell densities in the total area was equal to that in the tumor area.DiscussionIn conclusion, our findings revealed tumor-intrinsic LAG-3 expression was the resistance mechanism toward PD-1/PD-L1 inhibitors in mTNBCs. Multivariate analysis also suggested that LAG-3 expression in tumor cells was an independent predictive biomarker.

This paper proposes a method for enhancing the performance of an interior permanent magnet synchronous motor (IPMSM) using grain-oriented electrical steel (GO) and design optimization. As the GO has superior magnetic characteristics in the rolling direction, the GO is applied to the stator teeth to increase the torque and reduce the iron loss of the IPMSM. However, such an approach leads to higher saturation on the core, resulting in worse pulsation characteristics. To handle with pulsation problem on the IPMSM, design optimization is conducted. In this paper, the interpolation multi-objective robust optimization algorithm (IMROA) was proposed. The IMROA can reduce the calculation time by interpolating the objective region and utilizing a stepwise sampling strategy. Moreover, the IMROA considers the robustness of the found solution and can derive a robust global solution that has robustness on the manufacturing tolerance and deformation during the operation and prevents unexpected results on the IPMSM.

Pediatric anesthesia requires the rapid creation, communication, and execution of anesthesia orders, and there is a risk of human error. The authors developed an order-assisted mobile application (app) to reduce human error during pediatric anesthesia preparation. The authors conducted an observational study that compared the effects of the application by comparing anesthesiologists’ errors, nurses’ errors, nurses leaving the operating room, and delays in surgery, between the Conventional group (n = 101) and the App group (n = 101). The app was associated with reduced human error by anesthesiologists and nurses, and it lowered the frequency and duration of nurses leaving the operating room during anesthesia. In addition, the authors surveyed anesthesia nurses regarding the effectiveness of the app. The nurses confirmed that the app was convenient and reduced human error. This study revealed that the order-assisted mobile app developed by a pediatric anesthesiologist could reduce human errors by anesthesiologists and nurses during pediatric anesthesia preparation.

Abstract The achievement of the pathologic complete response (pCR) has been considered a metric for the success of neoadjuvant chemotherapy (NAC) and a powerful surrogate indicator of the risk of recurrence and long-term survival. This study aimed to develop a multimodal deep learning model that combined clinical information and pretreatment MR images for predicting pCR to NAC in patients with breast cancer. The retrospective study cohort consisted of 536 patients with invasive breast cancer who underwent pre-operative NAC. We developed a deep learning model to fuse high-dimensional MR image features and the clinical information for the pretreatment prediction of pCR to NAC in breast cancer. The proposed deep learning model trained on all datasets as clinical information, T1-weighted subtraction images, and T2-weighted images shows better performance with area under the curve (AUC) of 0.888 as compared to the model using only clinical information (AUC = 0.827, P

PURPOSE The aim of this study was to investigate the effects of 12-week instrumental pilates exercise on isokinetic muscle function and body composition of healthy college women. METHODS Twenty-four college women (aged 21.6±1.3yrs) were recruited to the study. The participants were divided into two groups, as the instrumental pilates group (IPG, n=12) and the control group (CG, n=12). The springboard pilates exercise was conducted 3 times a week for 40~60 minutes during 12 weeks. RESULTS There was significant interaction effects in the right knee and left · right elbow extensor muscles (60°/sec) and left knee flexor and right elbow extensor · flexor muscles (180°/sec)(p

Older adults show a lack of knowledge about dementia, treatments, and management although they are fearful of developing dementia. The purpose of this study was to examine the effects of a 6-week intervention on knowledge, attitude, fear, and prevention behaviors concerning dementia among older adults who resided in community. The study used a pretest-posttest design with nonequivalent control group. A total of 40 participants completed the study. The intervention group showed a significant decrease in the fear of dementia scores compared to the control group after the intervention( p

We developed a model for improving the prediction of survival outcome using postoperative Ki-67 value in combination with residual cancer burden (RCB) in patients with breast cancer (BC) who underwent neoadjuvant chemotherapy (NAC). We analyzed the data from BC patients who underwent NAC between 2010 and 2019 at Samsung Medical Center and developed our residual proliferative cancer burden (RPCB) model using semi-quantitative Ki-67 value and RCB class. The Cox proportional hazard model was used to develop our RPCB model according to disease free survival (DFS) and overall survival (OS). In total, 1,959 patients were included in this analysis. Of 1,959 patients, 905 patients were excluded due to RCB class 0, and 32 were due to a lack of Ki-67 data. Finally, an RPCB model was developed using data from 1,022 patients. The RPCB score was calculated for DFS and OS outcomes, respectively (RPCB-DFS and RPCB-OS). For further survival analysis, we divided the population into 3 classes according to the RPCB score. In the prediction of DFS, C-indices were 0.751 vs 0.670 and time-dependent areas under the receiver operating characteristic curves (AUCs) at 3-year were 0.740 vs 0.669 for RPCB-DFS and RCB models, respectively. In the prediction of OS, C-indices were 0.819 vs 0.720 and time-dependent AUCs at 3-year were 0.875 vs 0.747 for RPCB-OS and RCB models, respectively. The RPCB model developed using RCB class and semi-quantitative Ki-67 had superior predictive value for DFS and OS compared with that of RCB class. This prediction model could provide the basis to decide risk-stratified treatment plan for BC patients who had residual disease after NAC.

Purpose There is no clear evidence of the benefit of adjuvant chemotherapy (AC) in stage IIA colon cancer. Therefore, we aimed to evaluate the prognostic factors and survival benefit of AC in this disease. Methods A retrospective data collection for patients who underwent radical surgery for colon cancer between January 2008 and December 2015 was undertaken. The cohort was divided into the no-AC and AC groups. Results We included 227 patients with stage IIA colon cancer in our study cohort, including 67 and 160 patients in the no-AC and AC groups, respectively. The number of retrieved lymph nodes and the presence of tumor complications as obstruction or perforation were independent risk factors for survival. In the no-AC group, there was a significant difference in survival according to the number of retrieved lymph nodes. In the AC group, there were significant differences in survival according to sidedness and preoperative carcinoembryonic antigen (CEA). There was no significant difference in survival between the no-AC and the AC groups. Conclusion The number of retrieved lymph nodes and the presence of tumor complications were prognostic factors for stage IIA colon cancer but lymphovascular and perineural invasion were not. Sidedness and preoperative CEA could be used as factors to predict the benefit of adjuvant chemotherapy. Currently, it is believed that there is no benefit of AC for stage IIA colon cancer. Further studies are needed to determine the survival benefit of adjuvant chemotherapy in stage IIA colon cancer.

Recently, the number of patients with coronavirus disease 2019 (COVID-19) who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), via the reverse transcription polymerase chain reaction (RT-PCR) test, after recovery has increased; this has caused a dilemma regarding the medical measures and policies. We evaluated the dynamics of viral load and anti-SARS-CoV-2 antibodies in four patients with positive RT-PCR results after recovery. In all patients, the highest levels of immunoglobulin G (IgG) and IgM antibodies were reached after about a month of the onset of the initial symptoms. Then, the IgG titers plateaued, and the IgM titers decreased, regardless of RT-PCR results. The IgG and IgM levels did not increase after the post-negative positive RT-PCR results in any of the patients. Our results reinforced that the post-negative positive RT-PCR results may be due to the detection of RNA particles rather than reinfection in individuals who have recovered from COVID-19.

Neoadjuvant chemotherapy is a therapeutic option for the treatment of breast cancer. Here, the authors characterize changes in the gene expression profiles and immune microenvironment in serial breast cancer biopsies taken before, during and after neoadjuvant chemotherapy.

Key message We recommend that even in immunocompetent patients, tuberculosis should be considered in the diagnosis of isolated slow‐growing inflammatory lesion of chest wall.

Reports detailing the clinical characteristics, viral load, and outcomes of patients with normal initial chest CT findings are lacking. We sought to compare the differences in clinical findings, viral loads, and outcomes between patients with confirmed COVID-19 who initially tested negative on chest CT (CT negative) with patients who tested initially positive on chest CT (CT positive). The clinical data, viral loads, and outcomes of initial CT-positive and CT-negative patients examined between January 2020 and April 2020 were retrospectively compared. The efficacy of viral load (cyclic threshold value [Ct value]) in predicting pneumonia was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). In total, 128 patients underwent initial chest CT (mean age, 54.3 ± 19.0 years, 50% male). Of those, 36 were initially CT negative, and 92 were CT positive. The CT-positive patients were significantly older (P < .001) than the CT-negative patients. Only age was significantly associated with the initial presence of pneumonia (odds ratio, 1.060; confidence interval (CI), 1.020-1-102; P = .003). In addition, age (OR, 1.062; CI, 1.014-1.112; P = .011), fever at diagnosis (OR, 6.689; CI, 1.715-26.096; P = .006), and CRP level (OR, 1.393; CI, 1.150-1.687; P = .001) were significantly associated with the need for O2 therapy. Viral load was significantly higher in the CT-positive group than in the CT-negative group (P = .017). The cutoff Ct value for predicting the presence of pneumonia was 27.71. Outcomes including the mean hospital stay, intensive care unit admission, and O2 therapy were significantly worse in the CT-positive group than in the CT-negative group (all P < .05). In conclusion, initially CT-negative patients showed better outcomes than initially CT-positive patients. Age was significantly associated with the initial presence of pneumonia, and viral load may help in predicting the initial presence of pneumonia.

Alpha-1,6-mannosyl-glycoprotein 2-β-N-acetylglucosaminyltransferase [EC 2.4.1.143, N-acetylglucosaminyltransferase II (GnTII)] catalyzes the transfer of N-acetylglucosamine (GlcNAc) residue from the nucleotide sugar donor UDP-GlcNAc to the α1,6-mannose residue of the di-antennary N-glycan acceptor GlcNAc(Xyl)Man3(Fuc)GlcNAc2 in the Golgi apparatus. Although the formation of the GlcNAc2(Xyl)Man3(Fuc)GlcNAc2 N-glycan is known to be associated with GnTII activity in Arabidopsis thaliana, its physiological significance is still not fully understood in plants. To address the physiological importance of the GlcNAc2(Xyl)Man3(Fuc)GlcNAc2 N-glycan, we examined the phenotypic effects of loss-of-function mutations in GnTII in the presence and absence of stress, and responsiveness to phytohormones. Prolonged stress induced by tunicamycin (TM) or sodium chloride (NaCl) treatment increased GnTII expression in wild-type Arabidopsis (ecotype Col-0) but caused severe developmental damage in GnTII loss-of-function mutants (gnt2-1 and gnt2-2). The absence of the 6-arm GlcNAc residue in the N-glycans in gnt2-1 facilitated the TM-induced unfolded protein response, accelerated dark-induced leaf senescence, and reduced cytokinin signaling, as well as susceptibility to cytokinin-induced root growth inhibition. Furthermore, gnt2-1 and gnt2-2 seedlings exhibited enhanced N-1-naphthylphthalamic acid-induced inhibition of tropic growth and development. Thus, GnTII’s promotion of the 6-arm GlcNAc addition to N-glycans is important for plant growth and development under stress conditions, possibly via affecting glycoprotein folding and/or distribution.

In this study, we evaluated clinical parameters to predict the primary resistance of palbociclib in combination with endocrine therapy as the first-line treatment in patients with hormone receptor (HR)+, human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer (MBC). We performed a data analysis of patients diagnosed with HR+, HER2-MBC who received palbociclib plus letrozole as the first-line treatment in the metastatic setting from the clinical data warehouse in Samsung Medical Center. In this study, 305 patients were included in the final data analysis. The median follow-up duration was 31 months, and we observed 123 cases of disease progression. The median progression-free survival (PFS) was 28.7 months, and 38 patients (12.5%) had less than a 6-month PFS. The multivariate analysis suggested that primary resistance to adjuvant endocrine therapy (ET) (hazard ratio: 1.91), presence of liver metastasis (hazard ratio: 2.17), initial elevation of serum CA-15-3 (hazard ratio: 1.99), weak positivity of estrogen receptor (ER) (hazard ratio: 2.28), Ki-67 3+ or 4+ (hazard ratios: 2.58 and 10.28), and presence of mutation (hazard ratio: 9.59) were associated with a short PFS duration. A further prediction model was developed with data from 256 patients and 33 cases of disease progression in 6 months. This model included five factors—primary resistance to adjuvant ET (odds ratio, OR: 1.14), liver metastasis (OR: 1.56), initial CA-15-3 elevation (OR: 1.51), weak ER expression (OR: 2.22), and BRCA2 mutation (OR: 2.85)—and the area under the receiver operating characteristic curve was 0.842 (95% CI: 0.775, 0.909; p < 0.001). Finally, we divided them into four risk groups according to the prediction model with the five risk factors. These four groups had different PFS (p < 0.001) and primary resistance of palbociclib with letrozole [OR of group 2 vs. group 1 (ref): 2.18 (p = 0.002), OR of group 3: 3.91 (p < 0.001), and OR of group 4: 4.25 (p < 0.001)]. We developed a prediction model of primary resistance to palbociclib with letrozole as the first-line treatment for HR+, HER2-MBC. Our prediction model might be helpful for considering the first-line treatment strategies. Further well-designed clinical trials would be warranted to validate our prediction model.

Background/Aims We conducted a retrospective analysis of the clinical activity of fulvestrant in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) previously treated with endocrine therapy and/or chemotherapy. Methods We reviewed the medical records of all patients with MBC treated at Samsung Medical Center between January 2009 and August 2016. Patients received fulvestrant 250 mg intramuscularly every 28 days (from January 2009 to November 2010) or 500 mg intramuscularly every 28 days (from December 2010 to August 2016). Tumor responses were assessed every 8 weeks and at the end of treatment, as well as when disease progression was suspected. Results A total of 84 patients were included in this study. A median of two previous endocrine treatments had been performed; 79% of the patients had received two or more endocrine treatments. Forty-five patients (54%) had been treated with chemotherapy for MBC before the fulvestrant treatment course. Visceral metastasis was found in 49 patients (58%). The estimated median progression-free survival and overall survival were 4.4 months (95% confidence interval [CI], 3.4 to 5.5) and 32.5 months (95% CI, 17.6 to 47.4), respectively. The disease control rate was 40.5% (95% CI, 30.5 to 51.5); partial response was observed in 16% of the patients and stable disease was observed in 25% of the patients. The most frequently reported adverse reactions were mild-to-moderate grade myalgia (10.5% of the patients), injection site pain (7%), and fatigue (7%). Fulvestrant was generally well tolerated. Conclusions Fulvestrant showed encouraging clinical activity and favorable feasibility in postmenopausal women with MBC who had been treated with multiple endocrine therapies and/or cytotoxic chemotherapies.

PURPOSE: We evaluated the clinical features and outcomes of invasive breast cancer (BC) among different age groups by analyzing a modern BC registry including subtypes and treatment information. METHODS: This was a retrospective cohort study of 6,405 women aged 18 years or older with pathologically confirmed stage I, II, or III BC who underwent curative surgery followed by adjuvant therapy at a university-based hospital in Seoul, South Korea, between January 2003 and December 2011. The study end point was all-cause mortality. We used Cox proportional hazards models and hazard ratios (HRs) with 95% CIs calculated after adjusting for age, body mass index, stage, subtype, and treatment, including type of surgery and use of chemotherapy, radiation therapy, hormone therapy, and targeted therapy. RESULTS: During 36,360 person-years of follow-up (median follow-up: 5.45 years; interquartile range, 4.3-7.1), 256 deaths were reported (mortality rate, 7.0/1,000 person-years). The adjusted HR for all-cause mortality was higher in patients older than 40 years (HR, 2.03; 95% CI, 1.44 to 2.87) and older than 60 years (HR, 2.35; 95% CI, 1.63 to 3.39) than in patients aged 40 to 49 years. Across age groups, advanced stage at diagnosis, luminal type as well as triple-negative BC, and not receiving adjuvant treatment were associated with increased risk of mortality. CONCLUSION: A strong J-shaped relationship was observed between age and mortality, indicating worse clinical outcomes in young and old patients. This study suggested a possible benefit of personalized BC screening examination and precise and active treatment strategies to reduce BC-related mortality.

Abstract Background Although β-lactam monotherapy may be sufficient in non-critically ill patients with community-acquired pneumonia, the value of combination antibiotic regimens in community-onset neutropenic pneumonia remains unclear. Methods A retrospective cohort study was conducted to compare the effects of combination antibiotic regimens to those of β-lactam monotherapy in cancer patients with community-onset neutropenic pneumonia. Electronic medical records of patients diagnosed with community-onset neutropenic pneumonia between March 1995 and February 2015 at a tertiary care center were reviewed. Results During the study period, 165 cancer patients with community-onset neutropenic pneumonia were identified. Seventy-two patients received β-lactam monotherapy and 93 received combination therapy (β-lactam plus either a macrolide or fluoroquinolone). Causative pathogens were identified in 27.9% of the patients, and only two were positive for atypical pathogens. Although 30-day mortality was higher in the β-lactam group (15.3% versus 4.3%; P = 0.015), combination therapy was not associated with a statistically significant survival benefit in the multivariate analysis (hazard ratio 0.85, 95% confidence interval 0.20–3.67; P = 0.827). Duration of neutropenia, C-reactive protein level, and Multinational Association for Supportive Care in Cancer risk index were significant factors for 30-day mortality. In a subgroup analysis of patients treated with cefepime, the most frequently used β-lactam (63.0%), combination therapy also showed no significant survival benefit. Conclusions Combination antibiotic regimens were not associated with a survival benefit over β-lactam monotherapy in the treatment of community-onset neutropenic pneumonia. Unnecessary combination therapy should be reconsidered in cancer patients who are at high risk for adverse drug reactions and colonization with multi-drug resistant organisms.

Abstract Background A phase II clinical trial of the comparison between eribulin plus gemcitabine (EG) and paclitaxel plus gemcitabine (PG) as first-line chemotherapy for patients with metastatic breast cancer (MBC) found that the EG regimen was less neurotoxic, but was similar in efficacy to the PG regimen. In the present study, we analyzed functional assessment of cancer therapy-taxane (FACT-Taxane) questionnaires from patients in this clinical trial to determine their quality of life (QoL). Methods QoL was assessed using the Korean version of the FACT-Taxane questionnaires. After baseline assessment, QoL was assessed every 2 cycles for 12 cycles and every 3 cycles thereafter. The linear mixed model was used to evaluate the difference in QoL between the EG and PG arms. Results Of the 118 enrolled patients, 117 responded to the FACT-Taxane questionnaires at baseline, 1 in the PG arm did not. Baseline QoL scores were not different between the EG and PG arms. During treatment, taxane subscale scores were significantly higher in the PG arm than in the EG arm after 2–13 cycles of chemotherapy (all P

Several prognosis prediction models have been developed for breast cancer (BC) patients with curative surgery, but there is still an unmet need to precisely determine BC prognosis for individual BC patients in real time. This is a retrospectively collected data analysis from adjuvant BC registry at Samsung Medical Center between January 2000 and December 2016. The initial data set contained 325 clinical data elements: baseline characteristics with demographics, clinical and pathologic information, and follow-up clinical information including laboratory and imaging data during surveillance. Weibull Time To Event Recurrent Neural Network (WTTE-RNN) by Martinsson was implemented for machine learning. We searched for the optimal window size as time-stamped inputs. To develop the prediction model, data from 13,117 patients were split into training (60%), validation (20%), and test (20%) sets. The median follow-up duration was 4.7 years and the median number of visits was 8.4. We identified 32 features related to BC recurrence and considered them in further analyses. Performance at a point of statistics was calculated using Harrell's C-index and area under the curve (AUC) at each 2-, 5-, and 7-year points. After 200 training epochs with a batch size of 100, the C-index reached 0.92 for the training data set and 0.89 for the validation and test data sets. The AUC values were 0.90 at 2-year point, 0.91 at 5-year point, and 0.91 at 7-year point. The deep learning-based final model outperformed three other machine learning-based models. In terms of pathologic characteristics, the median absolute error (MAE) and weighted mean absolute error (wMAE) showed great results of as little as 3.5%. This BC prognosis model to determine the probability of BC recurrence in real time was developed using information from the time of BC diagnosis and the follow-up period in RNN machine learning model.

Introduction: There is paucity of literature on application of endoscopic spine surgery in thoracic spine for ossified ligamentum flavum. We aim to evaluate the clinical and radiological outcomes Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression Using One Block Resection Technique (TE-ULBD) for Thoracic Ossified Ligamentum Flavum in our cohort of patients. Methods: Retrospective evaluation performed for all patients who underwent TE-ULBD for thoracic ossified ligamentum flavum. Pre and postoperative parameters of axial cut spinal canal area in upper, middle and lower disc, VAS, ODI and JOA at preoperative, postoperative 1 week, 6 months and final follow up were compared. Results: 35 levels of TE-ULBD performed in 28 patients. The complication rate of TE-ULBD was 2.8%. In our TE-ULBD cohort there was significant clinical improvement in VAS, ODI and JOA score in postoperative 1 week, 6 months and final score. The mean difference as compared to preoperative VAS in postoperative final follow up 4.80, p

Background: The role of chemotherapy for isolated locoregional recurrence (iLRR) of breast cancer has not been firmly established after local therapies.Methods: We performed a multicenter, retrospective analysis to evaluate the clinical implications of chemotherapy in breast cancer patients with HER2-negative iLRR.Results: Of a total of 277 patients, 146 (52.7%) received chemotherapy for iLRR. Median follow-up duration was 56.1 months. Eighty-six (31.0%) patients had luminal B-like and 100 (36.1%) had TNBC iLRR. There was a trend of longer disease free survival (DFS) in the chemotherapy group (4-year DFS: 70.4 vs. 59.5%, HR = 0.68, 95% CI 0.45–1.02, log-rank p = 0.059). When adjusted with clinically relevant factors, DFS was significantly prolonged with chemotherapy (adjusted HR = 0.61, 95% CI 0.40–0.94, p = 0.023). Subgroup analyses for DFS showed patients with disease free interval (DFI)

Background Tumor mutational burden (TMB) measurement is limited by low tumor purity of samples, which can influence prediction of the immunotherapy response, particularly when using whole-exome sequencing-based TMB (wTMB). This issue could be overcome by targeted panel sequencing-based TMB (pTMB) with higher depth of coverage, which remains unexplored.Methods We comprehensively reanalyzed four public datasets of immune checkpoint inhibitor (ICI)-treated cohorts (adopting pTMB or wTMB) to test each biomarker’s predictive ability for low purity samples (cut-off: 30%). For validation, paired genomic profiling with the same tumor specimens was performed to directly compare wTMB and pTMB in patients with breast cancer (paired-BRCA, n=165) and ICI-treated patients with advanced non-small-cell lung cancer (paired-NSCLC, n=156).Results Low tumor purity was common (range 30%–45%) in real-world samples from ICI-treated patients. In the survival analyzes of public cohorts, wTMB could not predict the clinical benefit of immunotherapy when tumor purity was low (log-rank p=0.874), whereas pTMB could effectively stratify the survival outcome (log-rank p=0.020). In the paired-BRCA and paired-NSCLC cohorts, pTMB was less affected by tumor purity, with significantly more somatic variants identified at low allele frequency (p

Background: It is important to identify factors predicting successful ovarian protection using gonadotropin-releasing hormone (GnRH) agonists during chemotherapy. However, only a few studies have prospectively assessed this issue in young breast cancer patients.Objective: This study evaluated the predictive factors for successful ovarian protection with GnRH agonists during chemotherapy in young estrogen receptor-negative breast cancer patients.Materials and Methods: This prospective study analyzed 67 estrogen receptor-negative breast cancer patients ≤40 years of age who were longitudinally assessed after receiving GnRH agonists during cyclophosphamide-based chemotherapy for ovarian protection. Associations between clinical characteristics or pretreatment hormones and successful ovarian protection [resumption of menstruation and anti-Müllerian hormone (AMH) ≥1 ng/ml].Results: The mean age and pretreatment serum level of AMH were 33.2 years and 4.57 ng/ml, respectively. At 12 months after the completion of chemotherapy, most women (97%) experienced the resumption of menstruation. However, the proportion of patients with AMH ≥1 ng/ml at 12 months was 70.1%. In multivariate analyses, only the pretreatment serum AMH level (P < 0.001) was predictive for AMH ≥1 ng/ml at 12 months. Receiver operating characteristic curve analyses of pretreatment AMH exhibited an area under the curve of 0.866 (95% CI = 0.777–0.955) for AMH ≥1 ng/ml at 12 months. The cutoff value for the prediction of AMH concentration ≥1 ng/ml at 12 months was 2.87 ng/ml of pretreatment AMH with a sensitivity of 0.87 and a specificity of 0.75.Conclusions: Pretreatment AMH (2.87 ng/ml) is a useful predictor for AMH ≥1 ng/ml at 12 months after receiving GnRH agonists in young estrogen receptor-negative breast cancer patients. This finding can help improve decision-making regarding fertility preservation.

Abstract Background In this study, we observe the patterns initial palliative treatment for premenopausal patients with HR-positive/HER2-negative MBC and determine if nonadherence to clinical guidelines are associated with worse clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) in the South Korean population. Methods A retrospective review was performed for premenopausal patients diagnosed with HR-positive/HER2-negative MBC between October 1997 and May 2016 who received palliative systemic treatments at a large tertiary medical center. Survival outcomes were analyzed according to the palliative treatment received prior to disease progression. Results The review identified a total of 272 premenopausal patients meeting study criteria, whose median age was 39 years. Endocrine therapy was the initial treatment in 137 patients (Group 1) with chemotherapy as initial treatment in 135 patients. In the latter group, chemotherapy was continued in 78 patients (Group 2), whereas chemotherapy was switched to endocrine treatment in 57 patients prior to any disease progression (Group 3). Both PFS and OS were significantly longer for chemotherapy-endocrine therapy (median PFS 18.2 months and OS 85.2 months) than for chemotherapy-alone (median PFS 12.6 months and OS 45.5 months) or endocrine therapy-alone (median PFS 7.0 months and OS 57.3 months) (all p values

PURPOSE The purpose of this study was to examine the effects of acute exercise with difference Intensitis on RANKL/RANK/OPG pathway and bone metabolic markers in healthy college female. METHODS Ten healthy college females (aged 21.5±1.84 years; VO2max 37.69±3.74 mL/kg/min) examined bone metabolic markers and RANKL/RANK/OPG pathway responses to acute exercise of high (80% VO2max; HIGH group), moderate (60% VO2max; MOD group) intensity with a treadmill ergometer, and sedentary rest (CON group) in a randomized, cross-over repeated measures design. The serum concentrations of bone metabolic markers such as OC and CTx, and RANKL, OPG measured at before, immediately after and then recovery 90 minutes after exercise. mRNA expressions of RANKL and RANK, OPG from PBMC were also measured at same times. RESULTS There were no significant differences in the serum OC, CTx concentrations among different exercise intensities (CON, MOD, HIGH) and over time (before, after and recovery) (NS). Also no significant differences were found in the serum RANKL, OPG concentrations and all RANKL/RANK/OPG pathway mRNA expression (NS). CONCLUSIONS These results suggested that acute exercise does not disrupted the RANKL/RANK/OPG pathway and bone metabolic markers in a short time. A follow-up studies are required that tracking for long term from 3 days to 1 week.

While breast cancer incidence in the Asia Pacific region is rising, the molecular basis remains poorly characterized. Here the authors perform genomic screening of 187 Korean breast cancer patients and find differences in molecular subtype distribution, mutation pattern and prevalence, and gene expression signature when compared to TCGA.

PURPOSE: Phyllodes tumors (PTs) of the breast are rare, accounting for less than 1% of all breast tumors. Among PTs, malignant PTs (MPTs) have malignant characteristics and distant metastases occur in about 20% to 30% of MPTs. However, there is no effective treatment for MPTs with distant metastasis, resulting in an abject prognosis. We performed targeted deep sequencing on PTs to identify the associations between genetic alterations and clinical prognosis. METHODS: We performed targeted deep sequencing to evaluate the genetic characteristics of PTs and analyzed the relationships between clinical and genetic characteristics. RESULTS: A total of 17 PTs were collected between 2001 and 2012. Histologic review was performed by pathologists. The samples included three benign PTs, one borderline PT, and 13 MPTs. The most frequently detected genetic alteration occurred in the TERT promoter region (70.6%), followed by MED12 (64.7%). EGFR amplification and TP53 alteration were detected in four MPTs without genetic alterations in MED12 and TERT promoter regions. Genetic alterations of RARA and ZNF703 were repeatedly found in PTs with local recurrence, and genetic alterations of SETD2, BRCA2, and TSC1 were detected in PTs with distant metastasis. Especially, MPT harboring PTEN and RB1 copy number deletion showed rapid disease progression. CONCLUSIONS: In this study, we provide genetic characterization and potential therapeutic target for this rare, potentially lethal disease. Further large-scale comprehensive genetic study and functional validation are warranted.

PURPOSE This study examined blood lactate concentration and removal rate after aerobic and anaerobic maximal exercise test in sedentary middle-age women. METHODS Ten sedentary middle-age women (aged 52.7±3.3 years) were performed after aerobic (Aero group) and anaerobic maximal exercise (Anaero group) test, VO2max test and Wingate test, by cross-over repeated design with biweekly. The blood was collected from cardinal veins at before and immediately after test for measurement of lactate and lactate dehydrogenase (LDH). And it was also collected from fingertip at before, immediately after and then recovery 5, 10, 15, 30 minutes after each maximal test. Lactate removal rate (%) were calculated by bellow formulas: ={1-[(Lactate at 30 minutes. after test-Resting lactate)/Increased lactate]}×100. RESULTS The blood lactate concentration from fingertip after both maximal test significantly increased immediately after test (p.05). There are positive correlationship among muscle mass and blood maximum lactate and increased lactate concentration (p

Cardiac hemangiomas are very rare benign neoplasms that are usually asymptomatic. Although there are often found incidentally during echocardiography, other imaging modalities such as computed tomography, magnetic resonance imaging, and coronary angiography are needed to establish a diagnosis. Surgical excision is therefore recommended to confirm the diagnosis and avoid potential complications. We report a case of asymptomatic cardiac hemangioma that was discovered incidentally during echocardiography.