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Purpose: Endocrine therapy is the first-line treatment recommended for patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer without visceral crisis. However, this recommendation has not been followed clinically because of efficacy issues. In this study, the survival of patients with HR-positive/HER2-negative metastatic breast cancer was evaluated based on the following first-line treatment regimens: the combination of palbociclib plus letrozole, conventional endocrine therapy, or chemotherapy.Methods: Medical records were reviewed for this retrospective analysis. Patients with HR-positive/HER2-negative metastatic breast cancer were included. Progression-free survival (PFS) and overall survival (OS) were compared based on first-line treatment regimens.Results: A total of 184 patients were included in the analysis. The first-line treatments were palbociclib plus letrozole in 46 patients (25.0%), endocrine therapy in 40 patients (21.7%), and chemotherapy in 98 patients (53.3%). The PFS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=3.43, p

AIM This study identified and evaluated tested patient safety educational interventions. This study also described the content, curricular structures and teaching strategies of the educational interventions and determined the methods used for evaluating patient safety learning outcomes. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines directed this review. METHODS Searches for articles describing and evaluating patient safety educational interventions were conducted using four scholarly databases. Study quality was assessed using the McMaster Critical Review Form. RESULTS Seven studies met the inclusion criteria. Educational interventions were either presented as stand-alone courses or as lessons embedded in an existing course. All studies employed a mixture of various teaching modalities and several evaluation methods and outcomes. Mixed results were observed in terms of the effects of educational interventions. Future researchers should continue to develop patient safety curricula and examine their effect on student competencies with stronger methodological rigour.

Highlights • Enhanced solid-state synthesis of BaTiO3 by sonochemical activation in aqueous medium. • Investigations of physical and chemical effects of sonochemical activation. • Model proposal for the role of aqueous medium in solid-state synthesis. • Verification of the competitiveness of the resulting BaTiO3 powders and ceramics., BaTiO3-based oxide compounds are important ceramic materials for multilayer ceramic capacitors. In this paper, we report a sonochemical activation process of BaCO3 and TiO2 in an aqueous medium for the synthesis of BaTiO3 powders through a solid-state process. Owing to the physical and chemical effects of the ultrasonication in aqueous medium on the raw materials, BaTiO3 powders could be successfully synthesized at relatively low temperatures through a solid-state reaction, which was significantly enhanced as compared to the case in ethanol medium. Detailed investigations on the resulting BaTiO3 powders and ceramics were performed, and a model to understand the role of aqueous medium on the enhancement of the solid-state reaction was proposed in terms of Ba2+ ion leaching and zeta potential of TiO2, which are strongly affected by the pH of the aqueous medium. Our results are not only helpful for cost-effective synthesis of BaTiO3 through the highly reliable solid-state reaction process, but they also provide an understanding of the role of aqueous medium for the sonochemical process using raw materials with partial solubility in water.

Background There have been concerns over the long-term outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (UD EGC). We aimed to compare the long-term outcomes of ESD and surgery for patients with UD EGC. Methods We searched PubMed, Embase, and Cochrane Library databases through March 2021 to identify studies that compared the long-term outcomes of ESD and surgery for UD EGC meeting expanded criteria for curative resection. The risk of bias was assessed with the Cochrane tool for non-randomized studies. The risk ratio (RR) was estimated using a fixed-effect model. Results Overall, 1863 patients from five retrospective cohort studies, including 908 patients with propensity score matching (PSM), were eligible for meta-analysis. ESD was associated with inferior overall survival (OS) compared to surgery in the overall cohort (RR 2.11; 95% CI 1.26–3.55) but not in the PSM cohort (RR 1.18; 95% CI 0.60–2.32). In the PSM cohort, ESD had a lower disease-free survival (DFS) (RR 2.49; 95% CI 1.42–4.35) and higher recurrence (RR 12.61; 95% CI 3.43–46.37), gastric recurrence (RR 11.25; 95% CI 3.06–41.40), and extragastric recurrence (RR 4.23; 95% CI 0.47–37.93). Recurrence outcomes were similar between the overall and PSM cohorts. Disease-specific survival was not significantly different between the two groups in both the overall and PSM cohorts. Conclusion Although OS after curative ESD for UD EGC was not different from that after surgery in the PSM cohort, DFS and recurrence were inferior after ESD. Limitations included a lack of randomized trials. Further prospective studies comparing the long-term outcomes of ESD and surgery for UD EGC are needed (PROSPERO CRD 42021237097).

A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) has shown rather excellent efficacy in managing UGI defects. We conducted a systematic review and meta-analysis to synthesise the available evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT stricture. Methodological quality was assessed using the Newcastle-Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of EVT for successful closure was 0.85 (95% confidence interval [CI]: 0.81–0.88). The pooled estimate rate for mortality, complications, and post-EVT stricture was 0.11, 0.10, and 0.14, respectively. According to the aetiology of the transmural defect (perforation vs. leak and fistula), no significant difference was found in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45–4.67), mortality (OR: 0.77, 95% CI: 0.24–2.46), complications (OR: 0.94, 95% CI: 0.17–5.15), and post-EVT stricture (OR: 0.70, 95% CI: 0.12–4.24). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.52, 95% CI: 1.79–6.91). In conclusion, EVT is an effective and safe treatment for treating leaks and fistulae as well as perforations in UGI defects. Moreover, EVT seems to be a better treatment option than SEMS placement in healing UGI defects.

Background: Although sarcopenia has been reported to predict survival in cancer patients, its impact on patients who received immune checkpoint inhibitors (ICIs) has not been thoroughly investigated. This systematic review aimed to assess the long-term oncologic impact of sarcopenia on patients who received ICIs. Methods: A systematic review of studies indexed in the PubMed, Embase, and Cochrane databases, up to April 1, 2021, was conducted. Studies that reported hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on sarcopenia in patients treated with ICIs were included. The inverse variance method was used with a random-effects model for data analysis. Results: A total of 1284 patients from 14 studies were included. Among the patients who received ICIs, patients with sarcopenia had a significant increase in overall mortality compared to patients without sarcopenia in univariate analyses (HR = 1.66, 95% CI = 1.20–2.29, p = 0.002) and in adjusted HRs (HR = 1.55, 95% CI = 1.15–2.10, p = 0.004). The same results were obtained for PFS by both univariate analysis (HR = 1.75, 95% CI = 1.37–2.23, p < 0.001) and adjusted HRs (HR = 1.63, 95% CI 1.28–2.09, p < 0.001). Conclusions: Sarcopenia appears to be an effective biomarker for predicting long-term oncologic outcomes in patients receiving ICI therapy and hence plays an important role when making treatment decisions. However, the fundamental role of this association with survival should be further investigated in large cohorts and clinical trials.

The mainstream treatment for recurrent pancreatic cancer is potent chemotherapy or chemoradiotherapy. However, recent clinical investigations have suggested a potential oncologic role of local resection of recurrent pancreatic cancer. This systemic review with a pooled analysis aimed to assess the potential role of local repeated pancreatectomy with respect to the survival outcomes for patients with recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. The PubMed database was searched, and 15 articles reporting on repeated pancreatectomy for local recurrence of PDAC in the remnant pancreas were identified. The pooled individual data were examined for the clinical outcomes of repeated pancreatectomy for recurrent PDAC. The survival analysis was performed using the Kaplan–Meier method. In the pooled analysis, the mean time interval from initial pancreatectomy to repeated pancreatectomy was 41.3 months (standard deviation (SD), 29.09 months). Completion total pancreatectomy was most commonly performed as repeated pancreatectomy (46 patients, 92.0%), and partial pancreatic resection was performed for only 4 (10.3%) patients. Twenty (40.9%) patients received postoperative chemotherapy following repeated pancreatectomy. The median overall survival was 60 months (95% confidential interval (CI): 45.99–74.01) after repeated pancreatectomy for isolated local recurrence in the remnant pancreas. Overall survival was markedly longer considering the timing of the initial pancreatectomy for pancreatic cancer (median, 107 months (95% CI: 80.37–133.62). The time interval between the initial and subsequent repeated pancreatectomy for pancreatic cancer was not associated with long-term oncologic outcomes (p = 0.254). Repeated pancreatectomy cannot completely replace adjuvant chemotherapy but should be considered for patients with isolated local recurrent PDAC in the remnant pancreas.

Physicians have information needs related to academic research and clinical practice but encounter difficulties seeking appropriate medical resources and information. The goal of this study is to develop a search system to support Korean physicians’ information needs. To access sources to meet the identified need, in-depth interviews were conducted, and MediSearching, a new search system, was developed accordingly. To verify its usefulness and to obtain users’ suggestions, interviews were conducted and feedback was solicited via collected test searches. The initial set of interviews indicated that physicians’ information needs and search behaviors differed by type of hospital and clinical department. Physicians in university hospitals with a greater need for research materials searched for academic articles, whereas physicians in specialty hospitals or primary care clinics with a stronger need for materials related to clinical practice asked their colleagues for information. Consequently, MediSearching was designed to satisfy both groups’ needs, and the test search provided useful search results compared with existing services. Korean physicians have previously had to repeat their search process on separate sites that provide different services according to type of information and search method. MediSearching may reduce this inconvenience and add documents in various formats and languages.