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Hye-Jin Seo,1 Young-Eun Jung,2 Moon-Doo Kim,2 Won-Myong Bahk3 1Department of Psychiatry, Ansan Shinwoo Hospital, Ansan, 2Department of Psychiatry, School of Medicine, Jeju National University, Jeju, 3Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Objectives: The aims of the present study were to assess the prevalence of bullying victimization among Korean adolescents by sex and age and to investigate the correlates of this phenomenon. Methods: Of 3,200 eligible subjects, 2,936 (91.8%) adolescents were recruited from four elementary schools (6th grade, age range: 10–12 years), five middle schools (8th grade, age range: 13–14 years), and three high schools (10th grade, age range: 15–17 years) located in the Jeju Special Self-Governing Province, Republic of Korea. This study used a self-administered questionnaire to collect data on sociodemographic characteristics and experiences of bullying victimization and employed the Korean form of the Children’s Depression Inventory to evaluate depressive symptoms. Results: Of the total sample of 2,936 students, 1,689 were boys (57.5%) and 1,247 were girls (42.5%). The prevalence of bullying victimization by age group was as follows: 10–12 years, 9.5%; 13–14 years, 8.3%; and 15–17 years, 6.4%. A significant difference in the prevalence of bullying victimization was observed by sex (boys: 45.0%, girls: 55.0%). Overall, the prevalence decreased with age. After adjusting for age and sex, bullying victimization was significantly associated with lower socioeconomic status (odds ratio [OR] =1.67; 95% confidence interval [CI] 1.04–2.67), lower than average academic achievement (OR =1.77; 95% CI 1.25–2.50), more depressive symptoms (OR =1.88; 95% CI 1.38–2.55), and poorer perceived relationship with parents (OR =1.46; 95% CI 1.00–2.14). Conclusion: Our findings will provide researchers and public health practitioners with data on the prevalence of bullying victimization and help to identify the risk factors for later behavioral and emotional problems. Keywords: bullying, adolescent, risk factors, Korea, students

Idiopathic hemiazygos vein aneurysm is a rare lesion that can be difficult to diagnose. Here we report a case of asymptomatic idiopathic hemiazygos vein aneurysm (HAVA) that was incidentally discovered on chest computed tomography (CT) and mistaken for enlarged lymph nodes. The patient underwent thoracoscopic surgery for a biopsy, which confirmed that he had an idiopathic hemiazygos aneurysm. Delayed contrast-enhanced CT was performed after surgery, and it was confirmed that the hemiazygos vein aneurysm was connected to the adjacent vessel.

Background: Vitiligo may impact psychosocial development, especially among African American pediatric patients, given heightened visibility and increasing rates of anxiety and depression in this subpopulation. Objective: Evaluate psychiatric comorbidities and treatment initiation in African American pediatric patients. Methods: A total of 327 African American pediatric patients with vitiligo were each matched to 3 patients without vitiligo by age, race, and sex in this case-control study. Prevalence of psychiatric conditions and subsequent initiation of pharmacotherapy and/or psychotherapy were analyzed. Results: Compared to controls, pediatric African American patients with vitiligo were significantly more likely to be diagnosed with depression (P

Left ventricular pseudoaneurysm is a serious and rare disorder that usually develops after acute myocardial infarction. It can lead to potentially lethal mechanical complications, such as acute left ventricular free wall rupture. This report presents the case of a 64-year-old man with a left ventricular pseudoaneurysm and myocardial rupture that was managed by left ventricular restoration with aneurysmectomy and coronary artery bypass with 2 grafts.

Objectives: The aims of this study were (1) to compare computed tomography–derived fractional flow reserve (CT-FFR) values with graft patency and (2) to establish the cut-off value of CT-FFR for predicting competitive graft flow after coronary artery bypass grafting (CABG). Methods: Of the 77 patients who underwent isolated CABG with an in situ internal thoracic artery (ITA)-based composite graft and who were also evaluated by preoperative cardiac CT, CT-FFR values were obtained in 74 patients. Early postoperative angiograms were performed in all 74 patients. Angiograms were performed to evaluate the grafts as well as the native coronary arteries to find any competitive flow present. Postoperative angiographic findings of graft flow were categorized as perfectly patent, bidirectionally competitive, unidirectionally competitive, and occluded. Receiver operating characteristic curve analysis of preoperative CT-FFR values for predicting postoperative angiographic competition was performed, and cutoff values of CT-FFR and area under the curve were identified. Results: In total, 234 anastomoses were performed in 74 patients (median 3 [interquartile range, 2, 4] anastomoses per patient). Postoperative (median 1 [interquartile range, 1, 2] day) angiograms showed that 196 (83.8%) anastomoses were perfectly patent, 25 (10.7%) anastomoses were bidirectionally competitive, 12 (5.1%) anastomoses were unidirectionally competitive, and 1 (0.4%) anastomosis was occluded. Median CT-FFR values of the coronary arteries with perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts were 0.658 (interquartile range, 0.500, 0.725), 0.809 (interquartile range, 0.789, 0.855), and 0.849 (interquartile range, 0.833, 0.865), respectively. The cutoff value of CT-FFR predicting competitive graft flow was 0.774 (sensitivity, 97.4%; specificity, 98.5% [area under the curve 0.977; P

Jong-Hyun Jeong,1 Won-Myong Bahk,1 Young Sup Woo,1 Kyung-Uk Lee,1 Do Hoon Kim,2 Moon-Doo Kim,3 Won Kim,4 Jong-Chul Yang,5 Kwang Heun Lee6 1Department of Psychiatry, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, 3Department of Psychiatry, Jeju National University Hospital, Jeju, 4Department of Psychiatry, Stress Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, 5Department of Psychiatry, Chonbuk National University Medical School, Jeonju, 6Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, South Korea Objectives: The primary aim of this non-inferiority study was to investigate the clinical effectiveness and safety of generic escitalopram (Lexacure®) versus branded escitalopram (Lexapro®) for patients with major depressive disorder (MDD).Methods: The present study included 158 patients, who were randomized (1:1) to receive a flexible dose of generic escitalopram (n=78) or branded escitalopram (n=80) over a 6-week single-blind treatment period. The clinical benefits in the two groups were evaluated using the Montgomery–Åsberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impressions-Severity scale (CGI-S), and the Clinical Global Impressions-Improvement scale (CGI-I) at baseline, week 1, week 2, week 4, and week 6. The frequency of adverse events (AEs) was also assessed to determine safety at each follow-up visit.Results: During the 6-week study period, 30 patients (38.5%) from the generic escitalopram group and 28 patients (30.0%) from the branded escitalopram group dropped out of the study (P=0.727). The MADRS, HDRS, CGI-S, and CGI-I scores significantly decreased in both groups, and there were no significant differences between the groups. At week 6, 28 patients (57.1%) in the generic escitalopram group and 35 patients (67.3%) in the branded escitalopram group had responded to treatment (as indicated by a ≥50% decrease from the baseline MADRS score; P=0.126), and the remission rates (MADRS score: ≤10) were 42.9% (n=21) in generic escitalopram group and 53.8% (n=28) in the branded escitalopram group (P=0.135). The most frequently reported AEs were nausea (17.9%), sleepiness/somnolence (7.7%), weight gain (3.8%), and dry mouth (2.6%) in the generic escitalopram group and nausea (20.0%), sleepiness/somnolence (3.8%), weight gain (2.5%), and dry mouth (2.5%) in the branded escitalopram group.Conclusion: The present non-inferiority study demonstrated that generic escitalopram is a safe and an effective initial treatment for patients with MDD and may also be considered as an additional therapeutic option for this population. Keywords: depression, branded escitalopram, Lexapro®, generic escitalopram, Lexacure®

Jong-Hyun Jeong,1 Jeong Goo Lee,2,3 Moon-Doo Kim,4 Inki Sohn,5 Se-Hoon Shim,6 Hee Ryung Wang,1 Young Sup Woo,1 Duk-In Jon,7 Jeong Seok Seo,8 Young-Chul Shin,9 Kyung Joon Min,10 Bo-Hyun Yoon,11 Won-Myong Bahk1 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Paik Institute for Clinical Research, Inje University, 3Department of Health Science and Technology, Graduate School of Inje University, Busan, 4Department of Psychiatry, Jeju National University Hospital, Jeju, 5Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, 7Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, 8Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, 9Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, 10Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, 11Department of Psychiatry, Naju National Hospital, Naju, Korea Abstract: Our goal was to compare the recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2014 (KMAP-BP 2014) with other recently published guidelines for the treatment of bipolar disorder. We reviewed a total of four recently published global treatment guidelines and compared each treatment recommendation of the KMAP-BP 2014 with those in other guidelines. For the initial treatment of mania, there were no significant differences across treatment guidelines. All recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or the combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2014 did not prefer monotherapy with MS or AAP for dysphoric/psychotic mania. Aripiprazole, olanzapine, quetiapine, and risperidone were the first-line AAPs in nearly all of the phases of bipolar disorder across the guidelines. Most guidelines advocated newer AAPs as first-line treatment options in all phases, and lamotrigine in depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs – such as asenapine, paliperidone, lurasidone, and long-acting injectable risperidone – became prominent. This comparison identifies that the treatment recommendations of the KMAP-BP 2014 are similar to those of other treatment guidelines and reflect current changes in prescription patterns for bipolar disorder based on accumulated research data. Further studies are needed to address several issues identified in our review. Keywords: bipolar disorder, pharmacotherapy, treatment algorithm, guideline comparison, KMAP-2014

Seong-Chul Hong,1 Young-Eun Jung,2 Moon-Doo Kim,2 Chang-In Lee,2 Mi-Yeul Hyun,3 Won-Myong Bahk,4 Bo-Hyun Yoon,5 Kwang Heun Lee6 1Department of Preventive Medicine, 2Department of Psychiatry, School of Medicine, 3College of Nursing, Jeju National University, Jeju, Republic of Korea; 4Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 5Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea; 6Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Republic of Korea Purpose: To define the prevalence of distorted body image in 10–24-year-old Koreans and determine its relationship with sex, age, body weight status, and disordered eating behaviors.Methods: A total of 3,227 young Koreans were recruited from elementary, middle, and high schools, as well as from universities. The participants completed a self-reported questionnaire on body image, eating behaviors (Eating Attitude Test-26), and body weight status.Results: The prevalence of a distorted body image in males was 49.7% and that in females was 51.2%. Distorted body image was more frequent in adolescents (age, 10–17 years) than in young adults (age, 18–24 years). The highest prevalence (55.3%) was reported in female elementary school students (age, 10–12 years). Distorted body image was associated with disordered eating behaviors and abnormal body weight status.Conclusion: These results suggest that distorted body image is a public health problem, given its high frequency in young Koreans, and that it is associated with abnormal body weight status and disordered eating behaviors. Keywords: distorted body image, weight status, disordered eating behaviors, young Koreans, Eating Attitude Test, BMI

Young-Sook Kwak, Young-Eun Jung, Moon-Doo Kim Department of Psychiatry, School of Medicine, Jeju National University, Jeju, South Korea Background: Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in a high proportion of cases, causing social difficulties and affective problems. We evaluated the prevalence of symptoms of ADHD and the correlates thereof in Korean college students. Methods: A total of 2,172 college students, stratified to reflect geographical differences, were asked to complete self-report questionnaires on ADHD symptoms, depression, and related factors. Results: ADHD symptoms were found in 7.6% of college students. Univariate analysis revealed that younger students had higher rates of ADHD symptoms than did older students. We found significant associations between ADHD symptoms and problematic alcohol use, depression, and lifetime suicidal behavior. Multivariate analysis revealed that ADHD symptoms in adults were significantly associated with depression (odds ratio [OR] =4.69; 95% confidence interval [CI] 3.23–6.80; P

Introduction: The role of maintenance durvalumab after definitive concurrent chemoradiotherapy (CCRT) in unresectable locally advanced NSCLC with EGFR mutation or ALK translocation remains unclear. We compared the effectiveness of durvalumab maintenance therapy in groups with EGFR and ALK wild-type versus those with EGFR or ALK mutations. Methods: In this retrospective multicenter observational study, patients with locally advanced NSCLC without progression after CCRT followed by maintenance durvalumab and available molecular test results (EGFR and ALK) were eligible. The primary objective was to compare progression-free survival (PFS) between EGFR and ALK wild-type and EGFR or ALK mutant NSCLC. Secondary objectives include overall survival according to EGFR or ALK mutation and programmed death-ligand 1 (PD-L1) expression. Results: Among 339 patients, 279 had wild-type EGFR/ALK, 41 had EGFR mutations and 19 had ALK translocations. The median age was 68 years with 276 male individuals (81.4%) and 63 female individuals (18.6%), 165 (49.3%) had adenocarcinoma, 149 (44.5%) had squamous cell carcinoma, and 21 (6.3%) had other histologic types, 120 (35.4%) had stage IIIA, 168 (49.6%) stage IIIB, and 51 (15.0%) had stage IIIC. Most of the patients (n = 288, 85%) achieved partial response to CCRT, two (0.6%) had a complete response, and 49 patients (14.4%) had stable disease. Excluding four patients with unknown PD-L1 tumor proportion score (TPS), 16 (4.8%) had a PD-L1 TPS of 0, 168 (50.1%) had 1 to 49, and 151 (45.1%) had 50 or higher. The median PFS was 21.4 months (95% confidence interval [CI]: 17.3–25.3) for the EGFR/ALK wild-type group and 21.0 months (95% CI: 15.7–not available [NA]) for the EGFR or ALK mutant group with no difference (p = 0.74). Significant differences occurred in PFS on the basis of PD-L1 expression with values of 13.6 (95% CI: 10.5–NA), 18.7 (95% CI: 15.1–26.9), and 24.7 (95% CI: 20.7–NA) months for TPS of 0, 1–49, and 50 or higher, respectively (p = 0.02). Conclusions: Durvalumab maintenance therapy after definitive CCRT in unresectable locally advanced NSCLC patients with EGFR or ALK mutation demonstrates comparable clinical outcomes to those with wild-type EGFR/ALK when PD-L1 expression is present.

Intussusception is the telescoping of bowel into an adjacent segment of bowel and has an associated risk for bowel ischemia and perforation. The classic triad of abdominal pain, blood in stool, and an abdominal mass is present in less than 40% of pediatric cases and is less common in older children.1 Ultrasound has a high sensitivity and specificity for the diagnosis of intussusception, and once diagnosed, treatment modalities include reduction by either ultrasound or fluoroscopic guided air or hydrostatic enema. The risk of recurrence after successful reduction occurs in up to 12% of pediatric patients and occurs more frequently in older children and children with a pathologic lead point.2 We present a case of a 6-year-old child with colocolic intussusception that was successfully reduced and recurred within five days due to a large colonic polyp.Topics: Intussusception, lead point, pediatrics.

Young Sup Woo,1 Jung Goo Lee,2,3 Jong-Hyun Jeong,1 Moon-Doo Kim,4 Inki Sohn,5 Se-Hoon Shim,6 Duk-In Jon,7 Jeong Seok Seo,8 Young-Chul Shin,9 Kyung Joon Min,10 Bo-Hyun Yoon,11 Won-Myong Bahk1 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea; 2Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea;3Paik Institute for Clinical Research, Inje Univeristy, Busan, South Korea; 4Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea; 5Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, South Korea; 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, South Korea; 7Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, South Korea; 8Department of Psychiatry, School of Medicine, Konkuk University, Chungju, South Korea; 9Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea; 10Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, South Korea; 11Department of Psychiatry, Naju National Hospital, Naju, South Korea Objective: To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014). Methods: A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey. Results: The treatment of choice (TOC) for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP); the TOC for acute mild depression was monotherapy with MS or AAP; and the TOC for moderate or severe depression was MS plus AAP/antidepressant. The first-line maintenance treatment following mania or depression was MS monotherapy or MS plus AAP; the first-line treatment after mania was AAP monotherapy; and the first-line treatment after depression was lamotrigine (LTG) monotherapy, LTG plus MS/AAP, or MS plus AAP plus LTG. The first-line treatment strategy for mania in children and adolescents was MS plus AAP or AAP monotherapy. For geriatric bipolar patients, the TOC for mania was AAP/MS monotherapy, and the TOC for depression was AAP plus MS or AAP monotherapy. Conclusion: The expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for AAP was increased in the treatment of acute mania, depression, and maintenance treatment. There was increased expert preference for the use of AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence. Keywords: pharmacological treatment, treatment guideline, expert consensus

Chul Min Park,1 Hye-Jin Seo,2 Young-Eun Jung,3 Moon-Doo Kim,3 Seong-Chul Hong,4 Won-Myong Bahk,5 Bo-Hyun Yoon,6 Min Hee Hur,7 Jae Min Song31Department of Obstetrics and Gynecology, School of Medicine, Jeju National University, Jeju, 2Department of Psychiatry, Yeonkang Hospital, Jeju, 3Department of Psychiatry, 4Department of Preventive Medicine, School of Medicine, Jeju National University, Jeju, 5Department of Psychiatry, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 6Department of Psychiatry, Naju National Hospital, Naju, 7School of Medicine, Jeju National University, Jeju, KoreaBackground: This cross-sectional study sought to identify factors associated with antenatal depression in pregnant Korean females, including sociodemographic parameters, social support, social conflict, and bipolarity.Methods: Eighty-four pregnant women were recruited to complete questionnaires on sociodemographic factors, obstetric history, depressive symptoms, and bipolarity. Depressive symptoms were assessed using the Korean version of the Edinburgh Postnatal Depression Scale. Bipolarity was assessed using the Korean version of the Mood Disorder Questionnaire.Results: Nineteen participants (22.6%) had positive Mood Disorder Questionnaire scores, suggesting the presence of bipolarity, and were significantly more likely to score high on the Edinburgh Postnatal Depression Scale. Antenatal depression was associated with bad marital communication and marital dissatisfaction.Conclusion: These results suggest that spousal interactions play a significant role in antenatal depression, and pregnant women with bipolarity may be more depressed than those without bipolarity.Keywords: antenatal depression, bipolarity, pregnancy, Korea

Objective: To determine factors significantly associated with alternative discharge destination (ADCD) following lobectomy, including the modified 5-item Frailty Index (mFI-5). Methods: Patients in the 2017-2020 NSQIP who underwent elective lobectomy and were admitted from home were included, with ADCD defined as a patient who was discharged to any nonhome location. Four multivariable logistic regression models for ADCD were evaluated for predictive power. Model A was created from backward selection of variables significantly associated with ADCD in bivariate analyses, model B was the mFI-5, model C was mFI-5 and a minimally invasive approach, and model D was mFI-5 and age group. Results: Among the 15,868 patients, 687 (4.3%) experienced ADCD. Model A identified older age, hypertension, dyspnea, history of chronic obstructive pulmonary disease, and increased length of stay as significantly associated with ADCD. A minimally invasive approach was significantly protective of ADCD. Model A had the best predictive power of the models tested (C-statistic = 0.785). Model B, which assessed mFI-5 alone, had fair predictive power (C-statistic = 0.637). Adding surgical approach (C-statistic = 0.673; model C) or age group (C-statistic = 0.682; model D) as independent variables with mFI-5 improved model fit. Conclusions: Patients who were frail or age >75 years were more likely to have postlobectomy ADCD. Although the variables identified in model A better predict ADCD, consideration of surgical approach or age with mFI-5 can help surgeons anticipate discharge destination following lobectomy.

Background: Phase 3 PRIME/PRIME2 trials independently demonstrated efficacy and an acceptable safety profile of dupilumab adults with moderate-to-severe prurigo nodularis. Objective: To obtain a more precise estimate of onset and magnitude of treatment effect using PRIME/PRIME2 pooled data. Methods: In PRIME/PRIME2, patients were randomized to dupilumab or placebo for 24 weeks. Pooled analysis assessed proportion of patients achieving clinically meaningful improvement in itch, clear/almost-clear skin, or both; at weeks 12 and 24; overall and by demographic subgroups and changes from baseline to week 24 in symptoms, signs, and quality of life. Results: Patients receiving dupilumab (n = 153) vs placebo (n = 158) experienced significant improvements in all tested endpoints. At week 24, 90 (58.8%) dupilumab-treated vs 30 (19.0%) placebo-treated patients achieved clinically meaningful improvement in itch, 71 (46.4%) vs 27 (17.1%) clear/almost clear skin, and 54 (35.3%) vs 14 (8.9%) achieved both (P

Rosai-Dorfman disease (RDD) is a nonmalignant disease of histiocyte proliferation. RDD usually presents with painless cervical lymphadenopathy, although extranodal involvement can occur. Cardiac involvement was reported in

Seung Oh Bae,1 Moon Doo Kim,2 Jung Goo Lee,3 Jeong-Suk Seo,4 Seung-Hee Won,5 Young Sup Woo,6 Jeong-Ho Seok,7 Won Kim,8 Se Joo Kim,7 Kyung Joon Min,9 Duk-In Jon,10 Young Chul Shin,11 Won Myong Bahk,6 Bo-Hyun Yoon121Hangang Mental Clinic, Kimpo, 2Department of Psychiatry, School of Medicine, Jeju National University, Jeju, 3Department of Psychiatry, College of Medicine, Inje University Haeundae Paik Hospital and Paik Institute for Clinical Research, Busan, 4Department of Psychiatry, College of Medicine, Konkuk University, Chungju, 5Department of Psychiatry, College of Medicine, Kyungpook National University, Daegu, 6Department of Psychiatry, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 7Department of Psychiatry, Yonsei University, College of Medicine, Seoul, 8Department of Psychiatry, College of Medicine, Inje University, Seoul, 9Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, 10Department of Psychiatry, College of Medicine, Hallym University, Anyang, 11Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, 12Naju National Hospital, Naju, KoreaBackground: The purpose of this study was to assess the prevalence of bipolar spectrum disorder (BSD) in the general Korean population.Methods: A sample of college students (n = 1026) was stratified to reflect geographical differences accurately in Korean college students. The Korean version of the Mood Disorder Questionnaire (K-MDQ) was administered and an epidemiological survey carried out between November 2006 and February 2007. BSD was defined as a score of at least seven K-MDQ symptoms that co-occurred and resulted in minimal or more functional impairment.Results: The prevalence of BSD was 18.6% (95% confidence interval [CI] 16.2–21.0) in total, being 19.8% (95% CI 16.3–23.2) in men and 17.5% (95% CI 14.2–20.8) in women. The prevalence of BSD was more common in rural dwellers than in urban dwellers (P = 0.008, chi-square test). Univariate and multivariate regression models showed that rural residence was a significant factor associated with BSD. There were significant relationships between BSD and gender, age, and socioeconomic status.Conclusion: The prevalence of BSD found in the present study is higher than that reported by other epidemiological studies in Korea and in international studies.Keywords: general population, bipolar disorder, epidemiological study, Mood Disorder Questionnaire

Pulmonary arteriovenous malformations create continuous shunting of unoxygenated blood through the lungs into the systemic circulation. These malformations are asymptomatic if small, but cause serious symptoms as they grow in size. Treatment primarily consists of endovascular embolization; lobectomy is preserved for recurring or endovascularly untreatable cases. We describe a case of a 24-year-old man who was first treated with coil embolization 10 years previously, with complete symptom resolution. However, more recently he noted recurrent exercise intolerance, with shortness of breath and hypoxemia. After repeat re-embolization, a computed tomography scan noted some persistent flow. Given the patient's young age, we considered resection as a definite therapy. The patient underwent an uncomplicated robot-assisted right lower lobectomy. Afterward, his symptoms resolved completely. In selected cases, robotic lobectomy for pulmonary arteriovenous malformation is feasible and safe.

Introduction: SCLC has traditionally been considered to arise from toxic exposure factors, such as smoking. Recent evidence has revealed that germline mutations may also affect the development of SCLC; however, these alterations remain understudied. We sought to identify novel germline mutations in SCLC including germline copy number variations (CNVs) in our cohort of patients. Methods: We designed a custom hybrid-capture gene panel to evaluate germline alterations in 192 cancer-predisposition and frequently mutated genes in SCLC. We applied this panel to germline analysis of a treatment-naive cohort of 67 patients with SCLC at our institution. Subsequently, we annotated the variants using the American College of Medical Genetics criteria and further classified variants of uncertain significance using a set of in silico tools, including DeepMind AlphaMissense, MutationTaster, SIFT, and Polyphen2. Results: We identified American College of Medical Genetics pathogenic or likely pathogenic alterations in seven of 67 patients. Five (71%) were novel alterations (BCORL1, FANCC, ATR, and BBC3) and a novel CNV (SLFN11) with two (29%) previously described mutations (CHEK1 and BRIP1). We also identified 191 variants of uncertain significance in 60 of 67 patients, of which, depending on the in silico tool, 5% to 14% were predicted to be pathogenic. Patients with SCLC with the seven pathogenic alterations were observed to have a numerically longer overall survival (hazard ratio = 0.50) and progression-free survival (hazard ratio = 0.45) though not statistically significant compared with the remaining cohort. Conclusions: Our study identifies novel germline alterations, including a CNV, and provides additional evidence that germline factors could be important contributing factors to the development of SCLC.

Background. Kidney transplantation significantly improves the quality of life for those with end-stage renal failure, yet allograft rejection resulting from immune cell interactions remains a persistent challenge. Although T cell–directed immunosuppressive drugs effectively contain graft rejection in most patients, a notable proportion still experiences acute T cell–mediated rejection (TCMR). Despite an emphasis on suppressing T cell–mediated immune responses, successful control over TCMR is not always achieved, suggesting the potential involvement of factors beyond T cells. Methods. Biopsy samples from suspicious (borderline) for acute TCMR (borderline TCMR) and non-TCMR patients were obtained 9 d postsurgery, and spatial transcriptomics profiling was conducted using the GeoMx Digital Spatial Profiler platform. Regions of interest in the glomerulus and interstitium were selected on the basis of immunohistochemistry staining anti-CD3 to identify areas with T-lymphocyte infiltration. Differential gene expression analysis was performed using unpaired t tests. Results. Unbiased clustering of transcriptional profiles across all regions of interest showed distinct transcriptional profiles between glomeruli and interstitium in non-TCMR samples, whereas borderline TCMR samples displayed no distinct transcriptional profiles between these regions. Contrary to the prevailing T cell–centric view, we observed pathways and genes associated with innate immunity-related inflammatory conditions expressed in glomerular regions of borderline TCMR biopsies. Immunofluorescence staining for CD68 confirmed the presence of macrophages in the glomeruli of the post-TCMR sample in a validation cohort, indicating macrophage involvement in the glomerular response after TCMR. Conclusions. Activation of the innate immune response in borderline TCMR appears to impact not only the interstitium but also the glomerulus. Glomerulus-specific immune signatures suggest the role of the innate immune system in rejection. This nuanced understanding proposes the necessity for tailored therapeutic interventions targeting both innate and adaptive immune pathways to enhance transplant outcomes.

Background: Anti-type 2 (T2) biologic therapies (biologics) improve exacerbation rates, lung function, and asthma-related quality of life (QoL) in patients with severe T2 asthma. However, studies comparing different biologics are lacking. We evaluated the QoL in patients with severe asthma comprehensively and compare the efficacy of different T2-directed biologics using QoL questionnaires. Methods: We compared the QoL between severe and mild-to-moderate asthma and between severe asthma with and without biologics treatment. Data of mild-to-moderate were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea, and data of severe asthma were collected from the Precision Medicine Intervention in Severe Asthma. We included 183 patients with severe asthma treated with T2 biologics or conventional therapy between April 2020 and May 2021 and assessed QoL of them using the Questionnaire for Adult Korean Asthmatics (QLQAKA), Severe Asthma Questionnaire (SAQ), and EuroQoL-5Dimensions (EQ-5D) at baseline and 6 months. Results: The EQ-5D index (0.803) of severe asthma was lower than that of other chronic diseases representing a worse QoL. The scores for all questions of QLQAKA, except “cough,” were lower (less control) in the severe asthma group than in the mild-to-moderate asthma group at baseline and 6 months (P 0.05). Conclusion: QoL was worse in severe asthma than in mild-to-moderate asthma and other chronic diseases. T2 biologics equally improved QoL in patients with severe asthma.

Azygos lobe is an uncommon anatomic variant that is widely recognized, but rarely associated with pneumothorax. We present a successful surgical management of a spontaneous pneumothorax resulting from rupture of a bulla in an incidentally discovered azygos lobe. The patient is a 73-year-old man who presented with the first-time occurrence of a spontaneous right pneumothorax. The patient did not tolerate nonoperative management and underwent a right thoracotomy with bullae resection in the azygos and right lower lobes for definitive management. Our treatment highlights several considerations during operative management of azygos lobe pathology.

Tracheobronchopathia osteoplastica is a rare condition involving large airways with multiple bone and cartilage nodules in the tracheobronchial submucosa. This can cause tracheal stenosis, leading to difficulty in endotracheal intubation. A 79-year-old female patient, who had a history of successful endotracheal intubation for general anesthesia 8 years prior, was scheduled for abdominal surgery. Preoperative chest computed tomography and bronchoscopy revealed slight progression of tracheobronchopathia osteoplastica. Attempts to intubate with a smaller endotracheal tube failed; even the smaller endotracheal tube could barely pass. Mechanical ventilation was successfully administered and the surgery was completed without complications. The use of a smaller endotracheal tube may be beneficial for managing difficult airways in patients with tracheobronchopathia osteoplastica. Chest CT and bronchoscopic examination may be beneficial for evaluating the airway and determining the most appropriate airway management strategy. However, relying solely on these measures may lead to unexpected challenges because there is no established method to evaluate airway in patient with tracheobronchopathia osteoplastica. It is crucial for anesthesiologists to be aware of the potential existence of rare conditions such as tracheobronchopathia osteoplastica and be prepared to handle anticipated or unanticipated difficult airway management.

Esophagojejunal varices occurring after total gastrectomy are rare but potentially fatal in cases of variceal bleeding. Owing to their rarity, treatment strategies for this condition are not well established. Here, we describe the case of a 48-year-old woman who presented with hematemesis and melena. Four years prior, she underwent a total gastrectomy for gastric cancer. Esophagojejunal variceal bleeding supplied by a dilated jejunal vein, along with liver cirrhosis, was diagnosed as per endoscopy and computed tomography findings. Initial attempts at endoscopic therapy were unsuccessful. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed to reduce the portal pressure gradient, resulting in the cessation of bleeding. At the 1-month follow-up endoscopy, the varices had resolved, and no rebleeding occurred during 6 months of follow-up. Transjugular intrahepatic portosystemic shunt placement may be considered as an effective treatment option for esophagojejunal variceal bleeding.

Objective: We aimed to determine if machine learning can predict acute brain injury and to identify modifiable risk factors for acute brain injury in patients receiving venoarterial extracorporeal membrane oxygenation. Methods: We included adults (age ≥18 years) receiving venoarterial extracorporeal membrane oxygenation or extracorporeal cardiopulmonary resuscitation in the Extracorporeal Life Support Organization Registry (2009-2021). Our primary outcome was acute brain injury: central nervous system ischemia, intracranial hemorrhage, brain death, and seizures. We used Random Forest, CatBoost, LightGBM, and XGBoost machine learning algorithms (10-fold leave-1-out cross-validation) to predict and identify features most important for acute brain injury. We extracted 65 total features: demographics, pre-extracorporeal membrane oxygenation/on-extracorporeal membrane oxygenation laboratory values, and pre-extracorporeal membrane oxygenation/on-extracorporeal membrane oxygenation settings. Results: Of 35,855 patients receiving venoarterial extracorporeal membrane oxygenation (nonextracorporeal cardiopulmonary resuscitation) (median age of 57.8 years, 66% were male), 7.7% (n = 2769) experienced acute brain injury. In venoarterial extracorporeal membrane oxygenation (nonextracorporeal cardiopulmonary resuscitation), the area under the receiver operator characteristic curves to predict acute brain injury, central nervous system ischemia, and intracranial hemorrhage were 0.67, 0.67, and 0.62, respectively. The true-positive, true-negative, false-positive, false-negative, positive, and negative predictive values were 33%, 88%, 12%, 67%, 18%, and 94%, respectively, for acute brain injury. Longer extracorporeal membrane oxygenation duration, higher 24-hour extracorporeal membrane oxygenation pump flow, and higher on-extracorporeal membrane oxygenation partial pressure of oxygen were associated with acute brain injury. Of 10,775 patients receiving extracorporeal cardiopulmonary resuscitation (median age of 57.1 years, 68% were male), 16.5% (n = 1787) experienced acute brain injury. The area under the receiver operator characteristic curves for acute brain injury, central nervous system ischemia, and intracranial hemorrhage were 0.72, 0.73, and 0.69, respectively. Longer extracorporeal membrane oxygenation duration, older age, and higher 24-hour extracorporeal membrane oxygenation pump flow were associated with acute brain injury. Conclusions: In the largest study predicting neurological complications with machine learning in extracorporeal membrane oxygenation, longer extracorporeal membrane oxygenation duration and higher 24-hour pump flow were associated with acute brain injury in nonextracorporeal cardiopulmonary resuscitation and extracorporeal cardiopulmonary resuscitation venoarterial extracorporeal membrane oxygenation.

Gradenigo's syndrome, a rare but serious complication of otitis media, encompasses a triad of symptoms including otalgia, facial palsy, and abducens nerve palsy, pointing to the involvement of the petrous apex. This case report presents an 11-year-old boy with an atypical manifestation of Gradenigo's syndrome, characterized by the absence of classic features such as abducens nerve palsy and purulent otorrhea. MRI findings were significant for petrous apicitis extending to Meckel's cave and the cavernous sinus, along with abscess formation and clivus osteomyelitis. The report highlights the critical role of advanced neuroimaging, particularly MRI, in the diagnosis and management of this condition. It underscores the importance of recognizing atypical presentations of Gradenigo's syndrome and the effectiveness of imaging-guided conservative treatment strategies in pediatric otological cases.

Soft tissue myxomas are benign mesenchymal neoplasms typically found in the intramuscular components of the proximal extremities. However, soft tissue myxomas in the chest wall are rare. We report the case of a 41-year-old woman with soft tissue myxoma who presented with a slowly growing, palpable lump on her left anterior chest wall that has been present for several years. Mammography revealed an oval, circumscribed, and hyperdense mass in the retromammary fat layer of the upper inner quadrant of the left breast. Ultrasonography revealed an oval, circumscribed, and hypoechoic mass with internal echoes and multiple microcystic spaces. A triangular hyperechoic area adjacent to the pole of the mass and peripheral hyperechoic rim were also detected. The patient underwent surgical excision and was diagnosed with soft tissue myxoma with subcutaneous manifestation.

Background: The conventional 20% threshold for hair diameter diversity (HDD), widely accepted for diagnosing androgenetic alopecia (AGA) in the vertex area, has not quantitatively analyzed. Objective: To validate the HDD 20% threshold for AGA and develop a refined, Korean-specific criterion. Methods: This study involved 240 male patients with AGA, categorized by the V stages of the basic and specific classification. Phototrichogram images of the vertex region were analyzed using Image J software for hair thickness measurement. Results: Receiver operating characteristic curve analysis determined the 45 μm hair diameter threshold as the most diagnostic for AGA, with an area under the curve value of 0.884 and a Youden index of 0.659. Optimal AGA diagnosis was achieved when over 21% of hair had a diameter of ≤45 μm. Limitations: Restriction to Korean male limits its applicability to a broader population, and using a specific hair diameter threshold does not account for individual variations in hair characteristics. Conclusion: The study validates the conventional HDD 20% threshold and proposes a more appropriate 45 μm threshold for Korean males, beyond the 40 μm. It concludes that while the HDD 20% remains a key method for early detection of vertex AGA, the definition of thin hair should be ethnicity-specific.

Background: Operative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery. Study design: This prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events. Results: Across 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, P = .66) for patients undergoing cancer operations. Conclusion: Across three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.ClinicalTrials.gov Identifier: NCT02359994

Background: Periostin and human chitinase-3-like protein 1 (YKL-40) have been suggested to be involved in the development of airway fibrosis and remodeling. This study aimed to investigate the relationship between serum periostin levels and airway hyperresponsiveness (AHR) and between serum YKL-40 levels and AHR in children with asthma, comparing periostin as a marker for Th2 inflammation and atopy with YKL-40. Methods: The study involved children aged 6–15 years, comprising 75 with asthma and 29 healthy controls. We measured serum periostin and YKL-40 levels and performed exercise bronchial provocation tests, methacholine challenge tests, spirometry, and FeNO measurements. Results: Compared to the healthy controls, asthmatic children exhibited significantly elevated levels of periostin (86.7 [71.0–104.0] vs 68.3 [56.0–82.0] ng/mL; P = 0.006) and YKL-40 (29.0 [15.0–39.5] vs 27.7 [14.0–34.1] ng/mL; P = 0.034). The subgroup analysis revealed that periostin levels were significantly higher in the atopic asthma group than in the healthy controls (P = 0.003), but not in the non-atopic asthma group. YKL-40 levels were elevated in both the atopic and non-atopic asthma groups compared to healthy controls (P = 0.012 and P = 0.001, respectively). Serum periostin levels were significantly correlated with the postexerceise maximum percentage decrease in forced expiratory volume (FEV1), as well as with fractional exhaled nitric oxide (FeNO) and blood eosinophil counts, but showed no significant correlation with overall lung function. Conversely, serum YKL-40 levels were significantly linked to the Z score of FEV1 and AHR to methacholine but not with AHR to exercise or FeNO or blood eosinophil count. Conclusions: Periostin is linked to atopic asthma and correlates with exercise-induced bronchoconstriction, FeNO, and eosinophil counts, highlighting its role in Th2 inflammation. YKL-40 is a general asthma marker, indicating airway remodeling. These findings suggest that targeting these markers can improve personalized treatment strategies for pediatric asthma.

Background: Right heart catheterization (RHC) is the gold standard for diagnosing pulmonary hypertension (PH) in patients with interstitial lung disease (ILD). However, discrepancies between pulmonary arterial wedge pressure (PAWP) and left ventricular end-diastolic pressure (LVEDP) remain understudied in this population. Methods: We conducted a retrospective analysis of data from ILD patients who underwent RHC and had concomitant LVEDP measurements. Pulmonary vascular resistance (PVR) was calculated using both PAWP and LVEDP. Patients were categorized based on PAWP and LVEDP values using a threshold of 15 mmHg and PVR values using a threshold of 2 or 3 Wood Units. After that patients were categorized as concordant or discordant if both values were on the same or opposite sides of these thresholds, respectively. A discordantly higher PAWP group (left atrial dysfunction, LAD) was defined as patients with a PAWP-LVEDP difference of more than 3 mmHg. Results: Among 87 ILD patients, 9 patients (10.3%) showed discordance between PAWP and LVEDP. LAD was observed in 12 patients (13.8%) and was associated with lower forced vital capacity (Odd ratio [OR]: 0.956, p = 0.049) and a larger left atrium diameter (OR: 3.205, p = 0.033). Discordance in PVR values was also noted, with potential treatment targets for PH-specific therapy differing in 9 patients (22.0%) depending on whether PAWP or LVEDP was used. Conclusions: This study highlights the clinical significance of PAWP-LVEDP discrepancies in suspected PH-ILD patients, emphasizing the need for comprehensive assessments incorporating LVEDP and clinical context for accurate diagnosis, risk stratification, and treatment decisions.

Background: Atherosclerotic cardiovascular disease (ASCVD) risk estimation based on the pooled cohort equation (PCE) overestimates in population-based cohorts. Whether it performs equally across disaggregated demographics in health care populations is less known. Objectives: The purpose of the study was to recalibrate PCE and rederive prevention thresholds in a contemporary health care system and evaluate its performance across sociodemographics. Methods: We retrospectively inspected electronic health records between 2010 to 2012 and 2020 to 2022 within Mass General Brigham health care in New England region. We compared performance of the original vs recalibrated PCE measured by calibration, discrimination, reclassification rate, and net benefit among 160,926 patients aged 40 to 79 years and without prior ASCVD or lipid-lowering medication. Results: Of the 160,926 patients (mean age: 54.6 ± 8.6 years; 61.4% female), 20,373 (12.7%) developed ASCVD over 10 years. The original PCE globally underestimated ASCVD risk (observed vs predicted incidence rate: 0.13 vs 0.05). Recalibration upclassified risk primarily among individuals with low-to-borderline risk by the original PCE and additionally identified 40% of patients who had undergone ASCVD events yet deemed statin-ineligible based on the original PCE. Treatment thresholds yielding the greatest net benefit were ≥24.0% for women (+23.3%) vs ≥26.0% for men (+18.7%), whereas ≥26.0% for White or other race (+24.7%) vs ≥14.0% Black or African American (+12.5%), respectively. Specifically, Hispanic or Latino and non-Hispanic Black patients conferred the greatest sensitivity improvement at ≥12.3% threshold compared to higher ≥23.6% among non-Hispanic Asian or Pacific Islanders. Generally, lower thresholds earlier in life were optimal. Conclusions: Recalibration and personalized treatment thresholds derived within a health system may improve prevention treatment allocation efficiency.

Cryptococcal meningitis (CM) is a severe and often fatal infection of the central nervous system that is caused by Cryptococcus spp. Cryptococcal meningitis mainly affects immunocompromised individuals such as those with AIDS, organ transplantation recipients, and those with conditions requiring prolonged immunosuppressive therapy. Infection typically begins with the inhalation of cryptococcal spores, often from bird droppings, which can remain dormant in the lungs and lymph nodes before disseminating to the central nervous system. Signs and symptoms include headache, nausea, and cognitive impairment, which can progress to severe neurological complications if not promptly treated. Even in the era of antifungal and antiretroviral therapies, CM remains a public health challenge with substantial morbidity and mortality. Although rare, sporadic cases of cryptococcal neoformans/gattii coinfection with Mycobacterium tuberculosis, Streptococcus pneumoniae , and Treponema pallidum have been reported in the literature. Herein, we describe an extremely rare case of fulminant meningitis due to herpes simplex virus (HSV)-2 and Cryptococcal neoformans coinfection. Our patient also had cryptococcemia, which is known to increase acute mortality rates in patients with CM.

Background: The posterior tibial tendon (PTT), deltoid ligament, and spring ligament are often torn or attenuated in patients with progressive collapsing foot deformity. The goal of this pilot study was to measure the ultrasound shear wave velocity (SWV) of these arch-supporting structures in feet with varying degrees of deformity to improve our understanding of their role in the progression of deformity. Methods: Two observers measured the SWV of the supramalleolar and inframalleolar PTT in long and short axes, in the tibiospring portion of the deltoid ligament, and in the superomedial band of the spring ligament in 8 neutrally aligned feet, 5 asymptomatic flatfeet, and 7 symptomatic flatfeet. Each measurement was repeated 3 times both with and without an applied eversion stress. Results: Average SWV was lower at all locations in the symptomatic flatfeet compared with normal feet, but these differences were statistically significant only for the inframalleolar PTT and the spring ligament. Externally applied stress led to an increase in the SWV of the ligaments but a paradoxical decrease in the SWV in the supramalleolar PTT. The SWV of the PTT was lower along the short axis compared with the long axis. Conclusion: SWV may be useful in evaluating the severity of degenerative disease of arch-supporting structures, but further study is needed before this technique can be applied clinically. Level of Evidence: Level III, case-control study.

Background: Measuring passive hip flexion range of motion (ROM) is challenging due to compensatory movements. Despite the interest in using functional lateral radiographs for assessing hip mobility, the relationship with passive hip flexion ROM remains unclear. This study aims to elucidate this relationship and clarify spinopelvic parameters and mobility factors influencing variations in passive and radiographic hip flexion ROM. Methods: A retrospective cross-sectional study was conducted on 154 preoperative patients undergoing primary total hip arthroplasty. Passive and radiographic hip flexion ROM were assessed to clarify these relationships, and these differences were classified into 3 groups (O, A and U). Spinopelvic and hip parameters were assessed in standing, relaxed-seated and flexed-seated positions, as well as lumbar, pelvis, and hip mobility between each position to identify factors influencing differences. Results: There was a moderate correlation between passive and radiographic hip flexion ROM (R2 = 0.48, P < .01). A significant difference was found in pelvic and hip alignment in the flexed-seated position between all groups. In postural changes, the O group, which had more patients with relatively low hip mobility, showed greater lumbar spine and pelvic movement, while the U group, which had more patients with relatively high hip mobility, showed less lumbar spine and pelvic movement. Conclusions: This study confirmed that passive hip flexion ROM and radiographic hip flexion ROM correlate and that spinopelvic and hip alignment and mobility influence these differences. This result suggests that clinicians should consider lumbar and pelvic alignment and mobility in clinical practice to improve the accuracy of passive hip flexion ROM measurements.

CONTEXT:. Conventional MRI is incompatible with extracorporeal membrane oxygenation (ECMO) cannulas and pumps. Ultra-low-field portable MRI (ULF-pMRI) with 0.064 Tesla may provide a solution, but its safety and compatibility is unknown. HYPOTHESIS:. ULF-pMRI does not cause significant displacement and heating of ECMO cannulas and does not affect ECMO pump function. METHODS AND MODELS:. ECMO cannulas in various sizes were tested ex vivo using phantom models to assess displacement force and heating according to the American Society for Testing and Materials criteria. ECMO pump function was assessed by pump flow and power consumption. In vivo studies involved five female domestic pigs (20–42 kg) undergoing different ECMO configurations (peripheral and central cannulation) and types of cannulas with an imaging protocol consisting of T2-weighted, T1-weighted, FLuid-Attenuated Inversion Recovery, and diffusion-weighted imaging sequences. RESULTS:. Phantom models demonstrated that ECMO cannulas, both single lumen with various sizes (15–24-Fr) and double lumen cannula, had average displacement force less than gravitational force within 5 gauss safety line of ULF-pMRI and temperature changes less than 1°C over 15 minutes of scanning and ECMO pump maintained stable flow and power consumption immediately outside of the 5 gauss line. All pig models showed no visible motion due to displacement force or heating of the cannulas. ECMO flow and the animals’ hemodynamic status maintained stability, with no changes greater than 10%, respectively. INTERPRETATION AND CONCLUSIONS:. ULF-pMRI is safe and feasible for use with standard ECMO configurations, supporting its clinical application as a neuroimaging modality in ECMO patients.

Background:. This investigation delves deep into the lifting degree for each area of noninvasive facial rejuvenation through high-intensity focused ultrasound (HIFU). The study meticulously examines the lifting effects of HIFU treatment across seven distinct facial aesthetic-units, using advanced three-dimensional scanner analysis. Methods:. The study examined a cohort of 50 patients treated with HIFU. Pre- and immediate posttreatment evaluations were conducted using three-dimensional scanner analysis, allowing for precise quantification of lifting effects across seven aesthetic units. Treatment protocols were tailored to leverage five cartridges with micropulsed mode options, optimizing outcomes based on sonographic anatomy. Results:. The forehead was lifted by 1.24 mm; crow’s feet, 2.25; malar region, 2.46; posterior cheek, 3.40; jowl, 2.90; mandible, 3.09; and neck, 3.53. Conclusions:. The forehead showed a lift of 1.24 mm, attributed to the thin tissue requiring a cautious approach to avoid discomfort. A lift of 2.25 mm in the crow’s feet area demonstrated the efficacy of HIFU in addressing fine lines and wrinkles. Significant lift of 2.47 mm in the malar region highlights HIFU’s effectiveness in addressing mid-face laxity and restoring volume to the cheeks. The most substantial lift of 3.38 mm in the posterior cheek underscores targeted energy application for enhanced lifting and contouring. Notable lifting effect of 2.90 mm in the jowl area benefits sagging along the jawline, refining facial contour. Lift of 3.10 mm in the mandible shows improvement of lower facial laxity, defining the jawline. The highest lift of 3.55 mm in the neck region addresses laxity and sagging for a defined neck profile.

Background. The global surge in aging has intensified debates on liver transplantation (LT) for candidates aged 75 y and older, given the prevalent donor scarcity. This study examined both the survival benefits and organ utility of LT for this age group. Methods. A total of 178 469 adult LT candidates from the United Network for Organ Sharing database (2003–2022) were analyzed, with 112 266 undergoing LT. Post-LT survival outcomes and waitlist dropout rates were monitored across varying age brackets. Multivariable Cox regression analysis determined prognostic indicators. The 5-y survival benefit was assessed by comparing LT recipients to waitlist candidates using hazard ratios. Organ utility was evaluated through a simulation model across various donor classifications. Results. Among candidates aged 75 y and older, 343 received LT. The 90-d graft and patient survival rates for these patients were comparable with those in other age categories; however, differences emerged at 1 and 3 y. Age of 75 y or older was identified as a significant negative prognostic indicator for 3-y graft survival (hazard ratio: 1.72 [1.20-2.42], P

Background: Several biologics have been developed and used to treat severe asthma. However, commercialized biologics have limitations in treating T2-low asthma because their main target is the T2 inflammation marker. Therefore, there is an unmet need for treating T2-low severe asthma. Aminoacyl-tRNA synthetase-interacting multifunctional protein 1 (AIMP1) is an auxiliary protein in the mammalian multi-aminoacyl-tRNA synthetase complex. AIMP1 also acts as a cytokine and induces the secretion of proinflammatory cytokines. Since anti-AIMP1 has been shown to reduce interleukin (IL)-6, tumor necrosis factor-α, and IL-17A levels in a mouse model, it could be effective in the treatment of T2-low severe asthma. Methods: Wild-type BALB/c mice were sensitized and challenged with intranasal inoculation of a crude HDM extract. Atliximab, a chimeric AIMP1 antibody, was administered once (20 μg, 40 μg, 100 μg) on Day 14. We evaluated airway hyperresponsiveness (AHR), performed cellular analyses of the bronchoalveolar lavage fluid (BALF), measured inflammatory cytokine levels, and examined peribronchial histological features. Results: Atliximab reduced AIMP1 levels in asthmatic mice in a dose-dependent manner. AHR and Inflammatory cells such as neutrophils and eosinophils in the BALF decreased in asthmatic mice treated with atliximab. The levels of IL-6, IL-13, and transforming growth factor-β (TGF-β) in the lung tissue decreased in asthmatic mice treated with a high dose of atliximab (100 μg). Atliximab also reduced goblet cell hyperplasia and peribronchial fibrosis. Conclusions: Atliximab improved asthmatic airway inflammation including neutrophilic inflammation in HDM-induced asthma mice. These data suggest that anti-AIMP1 plays an important role in the treatment of severe T2-low asthma.

ABSTRACT: Background: Successful treatments for intractable chronic low back pain (CLBP) in patients who are not eligible for surgical interventions are scarce. The superior efficacy of differential target multiplexed spinal cord stimulation (DTM SCS) to conventional SCS (Conv-SCS) on the treatment of CLBP in patients with persistent spinal pain syndrome (PSPS) who have failed surgical interventions (PSPS-T2) motivated the evaluation of DTM SCS versus Conv-SCS on PSPS patients who are non-surgical candidates (PSPS-T1). Methods: This is a prospective, open label, crossover, post-market randomized controlled trial in 20 centers across the United States. Eligible patients were randomized to either DTM SCS or Conv-SCS in a 1:1 ratio. Primary endpoint was CLBP responder rate (percentage of subjects with ≥50% CLBP relief) at 3-month in randomized subjects who completed trialing (modified intention-to-treat population). Patients were followed up to 12 months. Secondary endpoints included change of CLBP and leg pain, responder rates, changes in disability, quality of life, patient satisfaction and global impression of change, and safety profile. An optional crossover was available at 6-month to all patients. Results: About 121 PSPS-T1 subjects with CLBP and leg pain mostly associated with degenerative disc disease and radiculopathy and who were not eligible for spine surgery were randomized. CLBP responder rate with DTM SCS (93.5%) was superior to Conv-SCS (36.4%) at the primary endpoint. Superior CLBP responder rates (88.1%–90.5%) were obtained with DTM SCS at all other timepoints. Mean CLBP reduction with DTM SCS (6.52 cm) was superior to that with Conv-SCS (3.01 cm) at the primary endpoint. Similar CLBP reductions (6.23–6.43 cm) were obtained with DTM SCS at other timepoints. DTM SCS provided significantly better leg pain reduction and responder rate, improvement of disability and quality of life, and better patient satisfaction and global impression of change. 90.9% of Conv-SCS subjects who crossed over were CLBP responders at completion of the study. Similar safety profiles were observed between the two groups. Conclusion: DTM SCS for chronic CLBP in nonsurgical candidates is superior to Conv-SCS. Improvements were sustained and provided significant benefits on the management of these patients.

Introduction: Previous results from the phase 3 ALESIA study (NCT02838420) revealed that alectinib (a central nervous system [CNS]-active, ALK inhibitor) had clinical benefits in treatment-naïve Asian patients with advanced ALK-positive NSCLC, consistent with the global ALEX study. We present updated data after more than or equal to 5 years of follow-up from the “last patient in” date. Methods: Adult patients with treatment-naïve, advanced ALK-positive NSCLC from mainland China, South Korea, and Thailand were randomized 2:1 to receive twice-daily 600 mg alectinib (n = 125) or 250 mg crizotinib (n = 62). The primary endpoint was investigator-assessed progression-free survival. Secondary or exploratory endpoints included overall survival, objective response rate, time to CNS progression, and safety. Results: At the data cutoff (May 16, 2022), the median survival follow-up was 61 and 51 months in the alectinib and crizotinib arms, respectively. Median progression-free survival was 41.6 months with alectinib versus 11.1 months with crizotinib (stratified hazard ratio = 0.33, 95% confidence interval: 0.23–0.49). Overall survival data remain immature; 5-year overall survival rates were 66.4% (alectinib arm) versus 56.1% (crizotinib arm). Objective response rate was 91.2% versus 77.4% with alectinib and crizotinib, respectively. CNS progression was delayed with alectinib versus crizotinib (cause-specific hazard ratio = 0.16, 95% confidence interval: 0.08–0.32). Median treatment duration was longer with alectinib versus crizotinib (42.3 versus 12.6 mo). No new safety signals were observed. Conclusions: With four additional years of follow-up, these updated results confirm the clinical benefit and manageable safety of alectinib in Asian patients with advanced ALK-positive NSCLC, and confirm alectinib as a standard-of-care treatment for patients with advanced ALK-positive NSCLC.

Background:. Modern aesthetic trends favor noninvasive facelift procedures, shifting away from traditional surgery. This study explores the three-dimensional evaluation of facial lifting across aesthetic units using the VolNewMer (VNM) device after continuous 115-W 6.78-MHz monopolar radiofrequency (RF) therapy. Methods:. A cohort of 30 Korean women underwent VNM treatment with a detailed protocol, including energy levels, cooling techniques, and stem cell media application. Lifting amount was analyzed using a three-dimensional scanner with computer program in five specific areas, including the forehead, lateral orbital rim, mid-face, low-face, and neck areas. The changes in Global Aesthetic Improvement Scale for skin texture, tightening, and lifting were surveyed. Results:. Immediate and sustained improvement was observed in the mid-cheeks and lower face area. The lifting amount of facial mid-cheek areas was 1.88 ± 0.76 mm, whereas the lifting amount of lower face areas was 1.79 ± 0.91, lateral orbital rim areas was 1.62 ± 0.99, forehead areas was 1.46 ± 1.26, and neck areas was 2.66 ± 1.40 mm immediately after the procedure. The lifting amount of mid-cheek areas was 1.93 ± 0.90 mm, whereas lower face areas was 1.67 ± 1.04, lateral orbital rim areas was 1.58 ± .072, forehead areas was 1.31 ± 0.73, and neck areas was 2.80 ± 0.78 mm 1 month after the procedure. Conclusions:. RF treatment is emerging as a recommended noninvasive procedure for facial lifting. VNM-RF treatment showed a significant lifting effect immediately after the procedure, and the lifting effect continued 1 month later (P < 0.05). Global Aesthetic Improvement Scale skin texture was more satisfying 1 month later than immediately after, suggesting a potential correlation with collagen regeneration, indicating a lasting effect over time.

Background:. Successful aesthetic interventions in upper-face aging require a profound understanding of the intricate anatomy of temporal. This study aimed to comprehensively evaluate the effect of hyaluronic acid (HA) injection in temple areas by combining quantitative analysis with detailed anatomical insights. Methods:. Twenty-five women received HA injections for temple hollowness. The injections targeted the interfacial layer between superficial and deep temporal fascia. Three-dimensional scanning, hollowness examination, and sonographic measurements were conducted 3 and 6 months postprocedure. Results:. Sonography identified 17 soft tissue layers in the temple, each with distinct characteristics. The notable layers include the epidermis, dermis, superficial and deep temporal fasciae, innominate fasciae, and superficial and deep temporal fat compartments. Three-dimensional volume was 0.86 mL at 3 months and 0.72 mL at 6 months. The average thickness of HA was 3.82 mm (immediately), 3.00 mm (3 mo), and 2.51 mm (6 mo). The depression on the temple was 4.33 mm (preprocedure), 0.71 mm (3 mo), and 1.62 mm (6 mo). The grade improved by 2.41 and 1.74 levels at 3 and 6 months. Conclusions:. Identifying detailed superficial and deep layers of the deep temporal fascia challenged traditional descriptions, with detailed dividing of superficial and deep temporal fascia in sonography. Innominate fascia was also distinguished. This study provided a comprehensive evaluation of the effects of HA injections in temple areas. Precise anatomical insights and quantitative assessments contribute to a deeper understanding of the structural changes induced by this procedure. Sonography is valuable for delineating distinct layers and guiding aesthetic interventions in the temporal region.

Background: Lung cancer, especially non-small cell lung cancer (NSCLC), poses a significant health challenge globally due to its high mortality. Afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has shown superior efficacy over traditional chemotherapy in NSCLC treatment. However, issues like secondary resistance and adverse effects call for alternative therapies. HAD-B1, comprising 4 herbal medicines, has shown promise in lung cancer treatment in both preclinical and clinical settings. This study assesses the combination of HAD-B1 and Afatinib in advanced NSCLC patients to potentially improve outcomes by addressing the limitations of current EGFR-TKI therapies. Method: A randomized, open-label trial evaluated the efficacy and safety of HAD-B1 with Afatinib in 90 EGFR-mutation-positive NSCLC patients. Participants were divided into treatment and control groups, receiving Afatinib with or without HAD-B1. The study focused on the initial dose maintenance rate and disease control rate (DCR) of Afatinib, alongside secondary outcomes like survival rates and quality of life, under continuous safety monitoring. Results: Among the 90 participants, no significant difference was found in initial dose maintenance (60.98% in the treatment group vs 52.50% in the control, P = .4414) or DCR (80.49% vs 90.00%, P = .2283). Secondary outcomes like PFS, TTP, and OS showed no notable differences. However, physical functioning significantly improved in the treatment group ( P = .0475, PPS group). The control group experienced higher rates of adverse events of special interest and adverse drug reactions ( P = .01), suggesting HAD-B1 with Afatinib might enhance physical function without increasing adverse effects. Conclusion: Combining HAD-B1 with Afatinib potentially improves quality of life and reduces adverse events in advanced NSCLC patients. Further research is necessary to confirm the long-term benefits of this combination therapy, aiming to advance NSCLC treatment outcomes. Trial registration: Clinical Research Information Service (CRIS) of the Republic of Korea, https://cris.nih.go.kr/ (ID: KCT0005414).