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A graphene photodetector decorated with Bi2Te3 nanowires (NWs) with a high gain of up to 3 × 104 and wide bandwidth window (400–2200 nm) has been demonstrated. The photoconductive gain was improved by two orders of magnitude compared to the gain of a photodetector using a graphene/Bi2Te3 nanoplate junction. Additionally, the position of photocurrent generation was investigated at the graphene/Bi2Te3 NWs junction. Eventually, with low bandgap Bi2Te3 NWs and a graphene junction, the photoresponsivity improved by 200% at 2200 nm (~0.09 mA/W). [ABSTRACT FROM AUTHOR]

Introduction: Studies regarding the development of metallosis following open reduction and internal fixation (ORIF) of fractures are rarely found in orthopedic literature. The aim of the current study was to assess metallosis following ORIF using distal fibular locking plates to treat distal fibular fractures. Materials and methods: 69 patients who underwent surgery using locking compression plates to treat lateral malleolar fractures, with a minimum 1-year follow-up period and subsequent hardware removal were enrolled in our study. We divided the patients into 2 groups, to compare the complications and demographics: 38 patients, treated with ZPLP plate; 31 patients, treated with other plates. Results: During 1 year of postoperative follow-up, 20 complications developed: 6 superficial infections at the operative site, 1 case of nonunion, 3 cases of osteitis, 4 cases of hypaesthesia, 2 cases of peripheral neuropathy, and 4 cases of metallosis. No statistical difference was found in the rate of complications when comparing the treatment groups (Mann–Whitney U test, p <.05) except for metallosis. All 4 patients who developed metallosis were treated using a ZPLP plate, and metallosis did not develop at all in patients who underwent surgery using other plates. Conclusion: In our study, metallosis developed more than was previously known, particularly after using LCPs to treat lateral malleolar fractures. Our findings and those in recent publications support the possibility that metallosis can occur not only in patients with arthroplasties, but also in patients with open reduction and internal fixation with LCPs. Surgeons should be aware of such risk of metallosis and be careful to select proper plates for internal fixation. [ABSTRACT FROM AUTHOR]

• Semicircular tube manufactured with real shape of PCHE channel. • Local heat transfer coefficient near the critical point of CO 2 experimentally investigated. • Stratification of temperature along wall of semicircular tube cross section experimentally verified. • Heat transfer deterioration occurs, and it is larger at the top wall than at the bottom wall. To estimate the characteristics of local heat transfer in the channel of a printed circuit heat exchanger (PCHE), a semicircular channel (tube) was manufactured to replicate the channel shape of the PCHE. The heat transfer in a horizontal semicircular tube has different behaviors at the top and bottom walls. Buoyancy and flow acceleration have substantial influence on the convective heat transfer of a semicircular tube with supercritical pressure fluids. They are induced by a drastic variation in the thermophysical properties near the critical point, especially density. Thus, in this study, to investigate the effect of buoyancy and flow acceleration on the heat transfer of supercritical CO 2 , an experiment was conducted in a horizontal semicircular tube. The tube test section had a hydraulic diameter of 4.73 mm, width of 7.75 mm, depth of 3.88 mm, and a heated length of 1.0 m. The experimental variables were mass flux (70–200 kg/(m2·s)) and heat flux (14.6–50.7 kW/m2) with constant inlet temperature (30 °C) and pressure (7.7–7.8 MPa). The temperature of the outer wall was measured at four positions (top center (TC), top side (TS), bottom side (BS), and bottom center (BC)) in the cross section of the tube. The stratification of the temperature along the wall in the cross section of the semicircular tube was verified by the experimental results. The heat transfer deterioration at the top region (TC and TS) was greater than that at the bottom region (BS and BC). This difference in heat transfer deterioration was caused by the upward push of the buoyancy of the low-density fluid along the inner wall in the cross section of the tube. [ABSTRACT FROM AUTHOR]

The prefrontal lobe has been considered to be closely related to depression. This study examined the relationship between depression and three prefronto-thalamic tract (PF-TT) regions (the dorsolateral prefronto-thalamic tract [DLPF-TT], ventrolateral prefronto-thalamic tract [VLPF-TT], and the orbitofronto-thalamic tract [OF-TT]) in patients with mild traumatic brain injury (TBI), using diffusion tensor tractography (DTT). Thirty-seven patients with depression following mild TBI were recruited based on Beck Depression Inventory-II (BDI-II) scores. Thirty-one normal control subjects were also recruited. The three regions of the PF-TTs were reconstructed using probabilistic tractography and DTT parameters for each of the three PF-TT regions were determined. The tract volume of the DLPF-TT and OF-TT in the patient group showed a significant decrease compared to that of the control group (p < 0.05). The BDI-II score of the patient group showed a moderate negative correlation with the tract volume value of the right (r = − 0.33) and left (r = − 0.41) DLPF-TT (p < 0.05). On the other hand, no significant correlations were detected between the BDI-II score of the patient group and the values of the other DTT parameters values for the three PF-TT regions (p > 0.05). Using DTT, depression was found to be closely related to a DLPF-TT injury in patients with mild TBI. We believe that evaluation of the DLPF-TT using DTT would be helpful when assessing patients with depression following mild TBI. These results can provide useful information regarding the proper application of neuromodulation in the management of depression. [ABSTRACT FROM AUTHOR]

Zircon U-Pb geochronology and bulk-rock geochemistry analyses were carried out to investigate their relationship with depositional environments of the non-marine Neungju Basin sediments in South Korea. The Neungju Basin was formed in an active continental margin setting during the Late Cretaceous with associated volcanism. Detrital zircon age distributions of the Neungju Basin reveal that the source rocks surrounding the basin supplied sediments into the basin from all directions, making different zircon age populations according to the depositional environments. Mudstone geochemistry with support of detrital zircon U-Pb age data reveals how the heterogeneity affects the geochemical characteristics of tectonic setting and weathering intensity. The sediments in the proximal (alluvial fan to sandflat) and distal (playa lake) environments differ compositionally because sediment mixing occurred exclusively in the distal environment. The proximal deposits show a passive margin signature, reflecting their derivation from the adjacent metamorphic and granitic basement rocks. The distal deposits properly indicate an active continental margin setting due to the additional supply of reworked volcaniclastic sediments. The proximal deposits indicate a minor degree of chemical weathering corresponding to fossil and sedimentological records of the basin, whereas the distal deposits show lower weathering intensity by reworking of unaltered volcaniclastic detritus from unstable volcanic and volcaniclastic terranes. Overall, this study highlights that compositional data obtained from a specific location and depositional environments may not describe the overall characteristic of the basin. [ABSTRACT FROM AUTHOR]

• Experiments of sCO 2 integral loop were performed for straight PCHE. • Heat transfer performance of CO 2 was examined at the near critical point and far critical point. • Discretization method for PCHE near the critical point of CO 2 was investigated. The study presents an experimental examination of heat transfer of straight printed circuit heat exchanger (PCHE) for a precooler of supercritical carbon dioxide (sCO 2) Brayton cycle. To perform heat transfer experiment, experimental loop for thermal hydraulic of CO 2 in supercritical (ETHICS) was constructed at POSTECH. The straight PCHE was independently manufactured by photochemical etching and diffusion bonding process. An experiment for CO 2 cooling with water was conducted via the ETHICS. We focused on heat transfer and flow characteristics of CO 2 in the printed circuit heat exchanger. The experiments were conducted at three operating conditions for CO 2 cooling, namely the trans-critical case (cooling from supercritical state to subcooled liquid), near the critical case (cooling from gas-like supercritical state to liquid-like supercritical state), and far critical case (cooling just in gas-like supercritical state). Nusselt numbers for different pressure and different operating conditions were compared by following typical analysis used in previous which is using averaged enthalpy based on inlet and outlet data but we conclude that the method of average value using inlet and outlet data is not appropriate for data reduction due to significant changes in the properties of CO 2 near the critical point. Instead of that, we propose to use discretization method in data reduction of experimental data of CO 2 near the critical point. It is difficult to predict heat transfer performance near the critical point of CO 2 in PCHE. Hence, the data from this experiments and discretization method for data reduction are useful in designing a precooler for the sCO 2 Brayton cycle. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of opioid-free anesthesia (OFA) in laparoscopic gastrectomy and identify the psychological factors that could influence the efficacy of OFA. 120 patients undergoing laparoscopic gastrectomy were allocated to either the opioid-based anesthesia group (OA) (n = 60) or the OFA (n = 60) group. Remifentanil was administered to the OA group intraoperatively, whereas dexmedetomidine and lidocaine were administered to the OFA group. The interaction effect of the psychological factors on OFA was analyzed using the aligned rank transform for nonparametric factorial analyses. The opioid requirement for 24 h after surgery was lower in the OFA group than in the OA group (fentanyl equivalent dose 727 vs. 650 μg, p = 0.036). The effect of OFA was influenced by the pain catastrophizing scale (p = 0.041), temporal pain summation (p = 0.046), and pressure pain tolerance (p = 0.034). This indicates that patients with pain catastrophizing or high pain sensitivity significantly benefited from OFA, whereas patients without these characteristics did not. This study demonstrated that OFA with dexmedetomidine and lidocaine effectively reduced the postoperative 24-h opioid requirements following laparoscopic gastrectomy, which was modified by baseline pain catastrophizing and pain sensitivity. The study protocol was approved by the Institutional Review Board of Yonsei University Health System Gangnam Severance Hospital (#3–2021-0295) and registered at ClinicalTrials.gov (NCT05076903). [ABSTRACT FROM AUTHOR]

Simultaneous optimization of detectivity and dark current is successfully achieved by modulating the Schottky barrier height of a graphene/p‐type silicon photodetector from 0.42 to 0.68 eV by doping graphene with polyethyleneimine (PEI). At a barrier height modulation of 0.26 eV, the dark current is reduced by three orders of magnitude from 980 nA to 219 pA, and the detectivity is improved by 529% at 850 nm when compared to undoped graphene/p‐type silicon photodetectors. Such a significant performance enhancement confirms that the chemical doping of graphene before device fabrication is a simple yet highly efficient approach to improve the detectivity of heterojunction photodetectors. [ABSTRACT FROM AUTHOR]

The article offers information on a case study of a 56-year-old female who developed alien hand syndrome (AHS) after treatment for intracerebral hemorrhage (ICH) in fronto-temporal area. Topics discussed include unintentional movement of right third finger, development of corpus callosum (CC) after reports from diffusion tensor tractographies (DTTs) and fiber tracking, and disappearance of anterior portion of transcallosal fibers (axons) in the supplementary motor area (SMA).

Flexible wearable and implantable devices are contributing to the healthcare field by enabling intuitive interfaces with the tissues of human body through their thin form factors, which enable more accurate monitoring of signals and effective delivery of therapy. The development of such devices is accompanied with an increasing interest in strategies and technologies for conformally fixing and adhering flexible biomedical devices in place to acquire high‐quality biosignals over a long period, even with the subtle movements of the target. Owing to the various mechanical properties and wet or dynamic environments of human tissues, it is necessary to use different adhesion strategies that consider the biocompatibility and cohesive properties for each case. This paper provides an in‐depth analysis of recent bio‐adhesives technologies and their practical applications in the healthcare field by classifying them into: 1) Conventional Fixation, 2) Mechanical Fixation, and 3) Chemical Adhesion, based on the mechanism, and 4) Functional Adhesion and 5) Biomimetic Adhesion, based on the unique properties. Furthermore, the principles and detailed mechanisms of each adhesion strategy based on the design and characteristics of the bioadhesives are thoroughly reviewed to provide valuable insights and an overall summary of the prospects and challenges of future bioadhesives technology. [ABSTRACT FROM AUTHOR]

Diseases that occur in silkworms include soft rot, hardening disease, digestive diseases, and sepsis. However, research on the causes of bacterial diseases occurring in silkworms and the resulting changes in the microbial community is lacking. Therefore, we examined the morphological characteristics of sepsis and changes in the microbial community between silkworms that exhibit a unique odor and healthy silkworms; thus, we established a relationship between disease-causing microorganisms and sepsis. After producing a 16S rRNA amplicon library for samples showing sepsis, we obtained information on the microbial community present in silkworms using next-generation sequencing. Compared to that in healthy silkworms, in silkworms with sepsis, the abundance of the Firmicutes phylum was significantly reduced, while that of Proteobacteria was increased. Serratia sp. was dominant in silkworms with sepsis. After bacterial isolation, identification, and reinfection through the oral cavity, we confirmed this organism as the disease-causing agent; its mortality rate was 1.8 times higher than that caused by Serratia marcescens. In summary, we identified a new causative bacterium of silkworm sepsis through microbial community analysis and confirmed that the microbial community balance was disrupted by the aberrant proliferation of certain bacteria. [ABSTRACT FROM AUTHOR]

The enhanced recovery after surgery (ERAS) protocol, including prokinetic medications, is commonly used to prevent postoperative ileus. Prospective studies evaluating the effectiveness of mosapride citrate, a prokinetic 5-hydroxytryptamine 4 receptor agonist, in patients undergoing gastrectomy within the ERAS framework are lacking. This double-blind randomized trial included patients who were scheduled for laparoscopic or robotic gastrectomy for gastric cancer. Participants were randomly assigned to either a control (placebo) or experimental (mosapride citrate) group, with drugs administered on postoperative days 1–5. Bowel motility was evaluated based on bowel transit time measured using radiopaque markers, first-flatus time, and amount of food intake. No significant differences were observed in baseline characteristics between the two groups. On postoperative day 3, no significant difference was observed in the number of radiopaque markers visible in the colon between the groups. All factors associated with bowel recovery, including the time of first flatus, length of hospital stay, amount of food intake, and severity of abdominal discomfort, were similar between the two groups. Mosapride citrate does not benefit the recovery of intestinal motility after minimally invasive gastrectomy in patients with gastric cancer. Therefore, routine postoperative use of mosapride citrate is not recommended in such patients. [ABSTRACT FROM AUTHOR]

Objective A recent study reported on the relatively safe area in the frontal lobe for performance of neurological interventions; however, no study on the posterior safe area has been reported. In this study, using diffusion tensor tractography, we attempted to identify the safe area in the parieto-occipital lobe in healthy subjects. Methods A total of 47 healthy subjects were recruited for this study. Eleven neural tracts were reconstructed in and around the parieto-occipital area of the brain using diffusion tensor tractography. The safe area, which is free from any trajectory of 10 neural tracts, was measured anteriorly and medially from the line of the most posterior and lateral margin of the brain at 5 axial levels (from the cerebral cortex to the corona radiata). Results The anterior boundaries of the safe area in the upper cerebral cortex, lower cerebral cortex, centrum semiovale, upper corona radiata, and lower corona radiata levels were located at 31.0, 32.6, 32.7, 35.1, and 35.2 mm anteriorly from the line of the most posterior margin of the brain, respectively, and the medial boundaries were located at an average of 34.7, 38.1, 39.2, 36.1, and 33.6 mm medially from the line of the most lateral margin of the brain, respectively. Conclusions According to our findings, the safe area was located in the posterolateral portion of the parieto-occipital lobe in the shape of a triangle. However, we found no safe area in the deep white matter around the lateral ventricle. [ABSTRACT FROM AUTHOR]

Background: An aberrant left hepatic artery is frequently encountered during upper gastrointestinal surgery, and researchers have yet to propose optimal strategies with which to address this arterial variation. The objective of this study was to determine whether the areas perfused by an aberrant left hepatic artery can be visualized in real-time using near-infrared fluorescence imaging with indocyanine green. Methods: Patients with gastric adenocarcinoma who underwent minimally invasive radical gastrectomy from May 2018 to August 2019 were enrolled and retrospectively analyzed at a single-center. Patients with an aberrant left hepatic artery and normal preoperative liver function were examined. After the clamping of an aberrant left hepatic artery, indocyanine green was administered via a peripheral intravenous route during surgery. Fluorescence at the liver was visualized under near-infrared fluorescence imaging. Results: In 31 patients with aberrant left hepatic arteries, near-infrared fluorescence imaging was used without adverse events associated with indocyanine green. Six (19%) patients were reported to have an aberrant left hepatic artery upon preoperative CT imaging, while all other instances were detected during surgery. Fluorescence excitation on the liver was, on average, visible after 43 s (range, 25–65). Fluorescence across the entire surface of the liver was noted in 20 (65%) patients in whom the aberrant left hepatic artery could be ligated. Aberrant left hepatic arteries were safely preserved in 10 (32%) patients who showed areas of no or partial fluorescence excitation. Guided by near-infrared fluorescence imaging, ligation of aberrant left hepatic arteries elicited no significant changes in postoperative liver function. Conclusion: Near-infrared fluorescence imaging facilitates the identification of aberrant left hepatic arterial territories, guiding decisions on the preservation or ligation of this arterial variation. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Biopsy-based histologic diagnosis is important in determining the treatment strategy for early gastric cancer (EGC). However, there are few studies on how histologic discrepancy may affect patients' treatment outcomes. We aimed to investigate the impact of histopathologic differences between biopsy and final specimens from endoscopic resection (ER) or gastrectomy on treatment outcomes in patients with EGC. We also examined the predictive factors of histologic discrepancy.Patients and Methods: We analyzed the data of 1851 patients with EGC treated with ER or gastrectomy. We compared the histology between biopsies and final resected specimens from ER or gastrectomy. We also examined changes in treatment outcomes according to histologic differences.Results: Histologic discrepancy was observed in 11.9% of patients in the ER group and 10.7% of those in the gastrectomy group. In patients treated with ER who showed histologic discrepancy, 80.9% showed differentiated-type EGC (D-EGC) on biopsy but undifferentiated-type-EGC (UD-EGC) after ER, of which 78.9% were non-curative resection. In patients treated with gastrectomy who showed histologic discrepancy, 39% showed UD-EGC on biopsy but showed D-EGC after gastrectomy. A total of these patients had absolute and expanded indications for ER. Moderately differentiated and poorly differentiated adenocarcinoma on biopsy were predictive factors of histologic discrepancy in UD-EGC and D-EGC on final resection, respectively.Conclusions: About 10% of patients showed histologic discrepancy between biopsy and final resection with ER or gastrectomy. Histologic discrepancy can affect treatment outcomes, such as non-curative resection in ER or missing the opportunity for ER in gastrectomy. [ABSTRACT FROM AUTHOR]

Swallowing difficulties are best assessed by videofluoroscopic swallowing studies (VFSS). However, limiting radiation exposure is important, especially in young children. The purpose was to evaluate radiation dose in young children during VFSS, and to investigate factors associated with it. Children with swallowing difficulty who underwent VFSS from February 2012 to July 2014 were recruited. Dose area product (DAP) and screening time were offered by the fluoroscopy machine, and effective dose was calculated from the DAP using a conversion coefficient published by the National Radiological Protection Board (NRPB-R262). The age, gender, height, weight, body mass index (BMI), body surface area (BSA), underlying disease of the subject children, and results of VFSS were investigated. In 89 children (mean age 1.57 ± 2.17, 55 boys and 34 girls), mean effective dose was 0.29 ± 0.20 mSv, mean DAP was 2.41 ± 1.65 Gy cm2, and mean screening time was 2.24 ± 0.99 min. The effective dose correlated with the screening time (r = 0.598, p < 0.001), age (r = 0.210, p = 0.049), height (r = 0.521, p < 0.001), weight (r = 0.461, p < 0.001), and BSA (r = 0.493, p < 0.001). There was no such correlation with gender, BMI, underlying disease, or the results of VFSS. The effective dose during VFSS (0.29 mSv) in young children, which is affected by screening time, age, and body size, is considerably lower than the pediatric radiation exposure limit of 1 mSv per year. However more than 4 VFSS annually would exceed this limit. Our findings will help physicians to reduce the radiation exposure and provide a useful references for future pediatric VFSS guidelines. [ABSTRACT FROM AUTHOR]

• Exhaust gas CO 2 absorption (EGCA) system was installed on MW-scale marine engine. • EGCA performance was certified as per the test procedure described in NTC 2008. • 29/30 wt%(E2/E3 mode) of CO 2 absorption was obtained by EGCA system. • Pretreatment reactor needs to be combined for stable operation of EGCA system. The management of CO 2 emissions from fossil fuel-powered ships has been considered for complying with future enhancements in CO 2 emission regulations in the shipbuilding industry. These regulations are (or will be) enforced using indexes such as the energy efficiency design index, energy efficiency existing index, energy efficiency operational indicator, and carbon intensity indicator. Hence, developing technology for reducing CO 2 emissions from ships is necessary. This paper reports on the CO 2 absorption performance of a pilot-scale CO 2 capture system installed on a 1.075-MW HiMSEN 5H22CDF engine. The proposed technology is an exhaust gas CO 2 absorption (EGCA) system. Our CO 2 capture system is based on an exhaust gas cleaning system, which is already commercialized to reduce SO x emissions from ships that use heavy fuel oil. The CO 2 absorption performance of the EGCA system was evaluated following the test procedure described in the NO x Technical Code 2008 (NTC 2008). Under the certified test procedure described in NTC 2008, the EGCA system exhibited 29/30 wt% (E2/E3 test mode) of CO 2 absorption. On the basis of the test results, we expect that ships will be able to comply with future CO 2 emission regulations by using the proposed EGCA system. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to analyze the characteristics and outcomes of patients with an aortoduodenal fistula (ADF) who underwent surgical treatment at a single institution., Materials and Methods: The data of patients diagnosed with ADF at the Yonsei University Gangnam Severance Hospital, South Korea, between 2019 and 2022 were included. Primary repair and segmental resection of the duodenum with duodeno-jejunostomy were the two main methods used to repair ADF., Results: Among the 15 patients analyzed, most were male, and the median age was 68 years. Based on the cause of ADF, five patients had primary ADF, whereas the remaining had secondary ADF. The average duration from fistula diagnosis to surgery was 23.5 days (2.8 days in primary ADF cases and 33.8 days in secondary ADF cases). Primary repair of the ADF was performed for eight patients, and segmental resection of the duodenum with duodeno-jejunostomy was performed for the remaining patients. Omentopexy was performed for all patients. The median duration of hospital stay was 32.7 days. Three patients died after surgery; however, all 11 patients operated on by the single experienced surgeon survived until the last follow-up., Conclusion: To the best of our knowledge, this study is the first original article on ADF. Our findings suggest that ADF repairs performed by experienced surgeons would provide favorable results. Although primary repair is the first treatment choice, duodeno-jejunostomy is recommended when it is not feasible. By choosing the appropriate procedure depending on the case, favorable outcomes without any fatalities can be achieved., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2025.)

Purpose: The usability of a new surgical navigation system that provides patient-specific vascular information for robotic gastrectomy in gastric cancer remains unexplored for laparoscopic gastrectomy owing to differences in surgical environments. This study aimed to evaluate the applicability and safety of this navigation system in laparoscopic gastrectomy and to compare the post-operative outcomes between procedures with and without its use., Materials and Methods: Between June 2022 and July 2023, 38 patients across 2 institutions underwent laparoscopic gastrectomy using a navigation system (navigation group). The technical feasibility, safety, and accuracy of detecting variations in vascular anatomy were measured. The perioperative outcomes were compared with 114 patients who underwent laparoscopic gastrectomy without a navigation system (non-navigation group) using 1:3 propensity score matching during the same study period., Results: In all patients in the navigation group, no adverse events associated with the navigation system occurred during surgery in any patient in the navigation group. No accidental vessel injuries necessitate auxiliary procedures. All vessels encountered during the gastrectomy were successfully reconstructed and visualized. Patient demographics and operative data were comparable between the 2 groups. The navigation group exhibited a significantly lower overall complication rate (10.5%) than the non-navigation group (26.3%, P=0.043). Notably, pancreas-related complications were absent in the navigation group but occurred in eight cases in the non-navigation group (7.0%, P=0.093), although the difference was not statistically significant., Conclusions: The patient-specific surgical navigation system demonstrated clinical feasibility and safety for laparoscopic gastrectomy for gastric cancer, potentially reducing complication rates compared with laparoscopic gastrectomy without its use., Competing Interests: Dr. Han and Dr. Kwon had full access to all study data and ensured the integrity and accuracy of data analysis. The authors declare no potential conflicts of interest., (Copyright © 2024. Korean Gastric Cancer Association.)

Objective: Precision medicine approaches emphasize the importance of reliable prognostic tools for guiding individualized therapy decisions. In this study, we evaluated the clinical feasibility of the single patient classifier (SPC) test, a new clinical-grade prognostic assay, in stage II-III gastric cancer patients., Methods: A prospective multicenter study was conducted, involving 237 patients who underwent gastrectomy between September 2019 and August 2020 across nine hospitals. The SPC test was employed to stratify patients into risk groups, and its feasibility and performance were evaluated. The primary endpoint was the proportion of the cases in which the test results were timely delivered before selecting postoperative treatment. Furthermore, 3-year disease-free survivals of risk groups were analyzed., Results: The SPC test met the primary endpoint criteria. The 99.5% of SPC tests were timely delivered to hospitals before the postoperative treatment started. In a clinical setting, the median time from the specimen transfer to laboratory to the result delivery to hospital was 4 d. Furthermore, 3-year disease-free survivals were significantly different between risk groups classified with SPC tests., Conclusions: This study highlights the SPC test's feasibility in offering crucial information timely delivered for making informed decisions regarding postoperative treatment strategies. It also provides evidence to support the implementation of a future prospective clinical trial aimed at evaluating the clinical utility of the SPC test in guiding personalized treatment decisions for gastric cancer patients., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.Conflicts of Interest: The authors have no conflicts of interest to declare., (Copyright ©2024 Chinese Journal of Cancer Research. All rights reserved.)

Extragastric recurrence of early gastric cancer (EGC) after curative resection is rare, but prognosis has been poor in previous reports. Recently, single patient classifier (SPC) genes, such as secreted frizzled-related protein 4 (SFRP4) and caudal-type homeobox 1 (CDX1), were associated with prognosis and chemotherapy response in stage II-III gastric cancer. The aim of our study is, therefore, to elucidate predictive factors for extragastric recurrence of EGC after curative resection, including with the expression of SPC genes. We retrospectively reviewed electronic medical records of 1974 patients who underwent endoscopic or surgical curative resection for EGC. We analyzed clinicopathological characteristics to determine predictive factors for extragastric recurrence. Total RNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tumor tissue and amplified by real-time reverse transcription polymerase chain reaction to evaluate expression of SPC genes. Overall incidences of extragastric recurrence were 0.9%. In multivariate analysis, submucosal invasion (odds ratio [OR] = 6.351, p = 0.032) and N3 staging (OR = 171.512, p = 0.012) were independent predictive factors for extragastric recurrence. Mean expression of SFRP4 in extragastric recurrence (-2.8 ± 1.3) was significantly higher than in the control group (-4.3 ± 1.6) ( p = 0.047). Moreover, mean expression of CDX1 in extragastric recurrence (-4.6 ± 2.0) was significantly lower than in the control group (-2.4 ± 1.8) ( p = 0.025). Submucosal invasion and metastasis of more than seven lymph nodes were independent predictive factors for extragastric recurrence. In addition, SFRP4 and CDX1 may be novel predictive markers for extragastric recurrence of EGC after curative resection.

Background: The impact of postoperative complications on the prognosis of gastric cancer remains controversial. This study aimed to evaluate the relationship between postoperative complications and long-term survival in patients undergoing gastrectomy for stage II/III gastric cancer., Methods: Some 939 patients underwent curative gastrectomy for stage II/III gastric cancer were identified from real-world data prospectively collected between 2013 and 2015. We divided patients according to the presence of serious complications, specifically, Clavien-Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer., Results: Serious complications occurred in 125 (13.3%) patients. Patients without serious complications (64.3%) completed adjuvant chemotherapy significantly more than patients with serious complications (37.6%; p<0.001). The 5-year overall survival(OS) rate was 58.1% and recurrence-free survival(RFS) rate was 58.1% in patients with serious complications, which were significantly worse than those of patients without serious complications (73.4% and 74.7%, respectively; p<0.001 for both). In stage II, once patients completed adjuvant chemotherapy adequately, the OS and RFS of patients with serious complications did not differ from those without serious complications. However, in stage III, the patients with serious complications showed a worse OS even after completion of adequate adjuvant chemotherapy., Conclusion: Serious complications after gastrectomy had a negative impact on the prognosis of stage II/III gastric cancer patients. Serious complications worsen the survival in association with inadequate adjuvant chemotherapy. Efforts to reduce serious complications, as well as support adequate chemotherapy through proper management of serious complications, would improve the prognosis of stage II/III gastric cancer patients., Competing Interests: WH reports receiving research grants from the Medtronic and GC Pharma, is the chief executive officer of Hutom, and holds its stock. He provided consultancy services to Ethicon and Verb Surgical outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Song, Lee, Choi, Cho, Kwon, Kim, Son, Kim, Jung and Hyung.)

Background: Although gastrectomy induces weight loss and improves glucose homeostasis, the mechanism is not clearly elucidated., Objective: Weight loss after gastrectomy for gastric cancer may be the result from not only altered nutrition absorption but also systematic endocrinologic changes after bariatric-like surgery. No clinical studies have evaluated the altered glucose metabolism associated with postoperative weight loss in gastric cancer patients., Setting: A retrospective analysis of a tertiary medical center., Methods: We evaluated changes in 18 F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography and weight change in patients who underwent gastrectomy. Participants comprised initially overweight (body mass index ≥23 kg/m 2 ), who underwent 18 F-fluorodeoxyglucose positron emission tomography/computed tomography at 6 to 12 months after gastrectomy for early gastric cancer (n = 149). Small bowel, subcutaneous white adipose tissue (WAT), and skeletal muscle glycolysis were semiquantified using positron emission tomography/computed tomography. Measures were bifurcated or combined into values that correlated with ≥5% weight loss., Results: Weight (median decrement, -3.3 kg), cholesterol level (-15 mg/dL), and body fat (-26.1%) significantly decreased after surgery. Substantial weight loss was significantly correlated with increased small bowel uptake of 18 F-fluorodeoxyglucose (≥5% weight loss versus <5% weight loss: 1.91 versus 1.69). Patients with an increased bowel uptake showed an increase in WAT uptake (P = .01). Patients with both increased small bowel and WAT uptakes were significantly correlated with weight loss (odds ratio: 9.67, 95% confidence interval 2.65-35.22)., Conclusions: Patients with increased small bowel glycolysis and increased WAT uptake after gastrectomy are likely to lose weight. Altered glucose distribution contributes to improvement of the metabolic parameter after gastrectomy. We have shown evidence of bariatric surgery-like endocrinologic changes in gastric cancer patients who underwent gastrectomy., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Although various liver-directed treatment modalities, such as liver resection and radiofrequency ablation (RFA), have been applied to treat liver metastases from gastric cancer, optimal management of them remains controversial. In patients with liver metastasis from gastric cancer, we investigated the short- and long-term outcomes of liver resection and RFA and analyzed factors influencing survival., Methods: A total of 98 gastric cancer patients with liver metastasis and no extrahepatic disease were treated by liver resection (n = 68) or RFA (n = 30). Short- and long-term outcomes were evaluated retrospectively for each of the liver-directed treatments., Results: Severe complication rates did not differ between liver resection (18 %) and RFA (10 %) (p = 0.333). Only one treatment-related mortality occurred in the liver resection group. No statistically significant difference in survival was noted between the treatment groups. Median overall survival after liver resection was 24 months, with 3-year overall and progression-free survival rates of 40.6 % and 30.4 %, respectively. Median overall survival after RFA was 23 months, with 3-year overall and progression-free survival rates of 43.0 % and 37.4 %, respectively. Only the size of the metastases was shown to be an independent prognostic factor for gastric cancer patients with liver metastasis., Conclusions: In select patients with liver metastasis from gastric cancer, liver resection and RFA showed satisfactory and comparable short- and long-term results. Thus, systemic chemotherapy may not be the only therapeutic option for patients with liver metastasis, and possible liver-directed treatment options for such patients should be considered on an individual basis.

Background: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer., Methods: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area., Results: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95% confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95% confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001)., Conclusions: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.

Background: As life expectancy is increasing, the use of minimally invasive surgery (MIS) in the elderly is gaining interest. The aim of this study was to identify the impact of minimally invasive gastrectomy by comparing the procedure to open surgery in octogenarians. In addition, we also evaluated the role of gastrectomy in elderly gastric cancer patients by assessing long-term outcomes., Methods: We retrospectively analyzed data from 99 gastric cancer patients aged 80 years or older, who underwent gastrectomy by either MIS or open surgery from 2005 to 2010. Patient characteristics, operative outcomes, pathologic results, morbidity, mortality, and follow-up data (including survival) were compared., Results: Thirty patients underwent gastrectomy with MIS (19 laparoscopic and 11 robotic) and 69 patients underwent open gastrectomy. MIS demonstrated significantly less blood loss, lower analgesic consumption, faster time to first flatus and soft diet, and a shorter post-operative hospital stay. Multivariate analysis revealed that the type of operation had no effect on the occurrence of complications. There were two postoperative mortalities, both in the open group. Excluding these patients, the overall and disease-specific 5-year survival rates were 57.4 and 70.0 %, respectively. The overall (MIS 70.0 %; open 52.0 %) and disease-specific (MIS 81.8 %; open 65.1 %) 5-year survival rates were similar for the two groups. When we analyzed the 85 patients underwent curative resection only, the overall (MIS 71.4 %; open 58.4 %) and disease-specific (MIS 84.1 %; open 73.6 %) 5-year survival rates were similar for the two groups., Conclusions: MIS for gastric cancer may be performed safely and maintains the advantages of minimal invasiveness, even in extremely old patients. Furthermore, gastrectomy by either by MIS or open surgery can reduce gastric cancer-related deaths, even in patients 80 years or older.

Background: Surgical treatment for remnant gastric cancer is related to high mortality and morbidity. The aim of this study was to identify risk factors that predispose to postoperative complications after gastrectomy for remnant gastric cancer., Methods: A total of 210 patients who underwent a gastrectomy for remnant gastric cancer between January 1998 and December 2012 were retrospectively analyzed. Surgical complications were reviewed and graded using the Clavien-Dindo classification. Univariate and multivariate analysis was performed to identify the risk factors for development of complications., Results: The incidence of postoperative complications was 46% (96/210), and major complications occurred in 14% (30/210). The operation-related mortality rate was 1.0%. Multivariate analysis revealed that only a BMI ≥25 (P = 0.001) and blood transfusion (P < 0.001) were significant independent risk factors for major complication. Indication for the initial gastrectomy and previous anastomosis type were not related to the development of surgical complications., Conclusions: Although surgery for remnant gastric cancer is a complex procedure because of the previous operation, factors related to the previous operation do not affect the development of postoperative complications.

Background: The use of energy devices during laparoscopic gastrectomy for gastric cancer has increased as the frequency of laparoscopic surgery has increased. Our aim was to compare the perioperative surgical outcomes between using a bipolar device and an ultrasonic device during laparoscopic gastrectomy., Methods: Retrospective review of a prospectively maintained database identified 186 patients who underwent laparoscopic gastrectomy performed by a single surgeon between November 2010 and August 2013. A bipolar device was used for 116 patients, and an ultrasonic device was used for 70 patients. Patient characteristics and perioperative surgical outcomes were compared between groups., Results: Clinicopathologic characteristics were similar for both groups. The bipolar group had a significantly shorter operation time (154.9 vs. 167.8 min, p = 0.028) and higher rate of D2 lymph node dissection (29.3 vs. 15.7 %, p = 0.012). The bipolar device group experienced significantly less pain at 12 h [visual analog scale (VAS) pain score: 3.9 vs. 4.7, p = 0.027) and 18 h (VAS pain score: 3.5 vs. 4.1, p = 0.036) postoperatively. The bipolar group had earlier abdominal drain removal (p = 0.001) and a shorter hospital stay (p = 0.024). No significant differences in laboratory value changes, morbidity, or mortality were observed between the groups., Conclusion: Compared with the ultrasonic device, the bipolar device provided advantages in operation time, degree of postoperative pain, time of drain removal, and length of hospital stay. The bipolar device may be a useful and efficient energy device for laparoscopic gastrectomy. However, larger studies to confirm the safety of bipolar device during laparoscopic gastrectomy are warranted.

Jejunogastric intussusception (JGI) is a rare condition and less than 200 cases have been published since its first description in 1914. In addition, JGI is potentially lethal complication of gastrectomy or gastrojejunostomy. We report the case of a 73-year-old man with a history of a Billroth II procedure who presented to the emergency department after 6 hours of epigastric pain and hematemesis. Endoscopy and computed tomography showed intussuscepted jejunum through a gastrojejunostomy that required emergency operation. At laparotomy a retrograde type II, JGI was confirmed and managed by resection of involved intestine. Postoperative recovery was uneventful. This case presents the rare complication of acute jejunogastric intussusception more than 25 years after a Billroth II procedure.

Background: Currently, remnant gastric cancer (RGC) is uncommon compared with gastric stump cancer, but early detection of gastric cancer and improved postsurgical survival will lead to increased incidence of RGC. Therefore, the indication of endoscopic submucosal dissection (ESD) for RGC is now required, but there have been no reports about this because of the lack of information for RGC., Methods: A retrospective review was conducted on 105 patients who underwent completion total gastrectomy (CTG) and 5 patients who underwent ESD for RGC between January 1998 and December 2010 at Yonsei University Hospital., Results: Forty-one (39 %) of 105 patients were diagnosed with early RGC. Among these patients, 6 had an absolute indication for ESD, whereas 11 met expanded criteria for ESD. In these patients, there was no association between the severity of the former gastric cancer and the current RGC. Also, none of these 17 patients had LN metastasis after CTG, and only 1 (2.4 %) of 41 early RGC patients had LN metastasis. Median operative time was 216 min for CTG and median hospital stay was 8 days. There were two major and five minor complications. One splenectomy was performed because of injury that occurred during CTG., Conclusions: Applying the indication of ESD for primary gastric cancer to RGC would be possible, and it could be an alternative treatment option for selected patients with RGC.

Purpose: To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer., Materials and Methods: A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included., Results: The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression., Conclusion: If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.

Background: Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes., Methods: The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted., Results: The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3% in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups., Conclusions: We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon's preference.