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In recent years, efforts to develop microrobots for medical applications have been expanding. One of the key design issues in such microrobots is to attain adequate frictional interaction between the robotic foot and the organ tissue. In particular, it is important to generate the necessary frictional force without damaging the tissue. In this work, a design for the robotic foot was proposed on the basis of the frictional behaviour of a tube structure. Fundamental experiments were initially performed to understand the biotribological behaviour of the tube and rod structures. The design was then modified to a multi-tube structure to achieve adequate frictional behaviour. Biotribological investigation of a multi-tube foot in contact with a small intestine specimen of a pig was conducted using a pin-on-reciprocator type biotribotester. It was found that there is an optimum number and arrangement of the tubes for generating high frictional force. Experimental results showed that a nine-tube foot had the highest initial friction coefficient of about 1.5. The major frictional mechanism was determined to be interlocking between the tubes and the surface structures of the intestine specimen. The results of this work will aid the optimum design of frictional surface for medical microrobots and other biological devices. [ABSTRACT FROM AUTHOR]

The effect of stem bark powder from paper mulberry (PMSB) on serum glucose, insulin, fructosamine, and lipid concentrations, as well as enzyme activities that serve as liver injury markers, was investigated in genetically diabetic Otsuka Long-Evans Tokushima fatty (OLETF) rats. Both nondiabetic Long-Evans Tokushima Otsuka (LETO) rats and diabetic OLETF rats (30 weeks old) were fed a semisynthetic diet with or without 50 g/kg PMSB for 8 weeks and then compared. The OLETF control rats showed a high amount of daily water intake in comparison to those in the LETO group. The concentrations of glucose, fructosamine, total lipid, triglyceride, total cholesterol, and high-density lipoprotein-cholesterol and the activities of aspartate aminotransferase and alanine aminotransferase (ALT) in serum were higher in the OLETF control rats than those in the LETO control rats. However, PMSB ingestion decreased the serum levels of glucose, fructosamine, triglyceride, and total cholesterol and the activity of ALT in the OLETF rats, but not in the LETO rats. The concentration of serum insulin was also significantly increased by PMSB consumption in the OLETF rats compared to the OLETF control rats. These results suggest that PMSB might have an antihyperglycemic effect in the OLETF rat and that the increased blood insulin level would be an important regulatory factor for improving hyperglycemia in the current animal model. [ABSTRACT FROM AUTHOR]

Background: The clinical significance of pulmonary nodular ground-glass opacities (NGGOs) in patients with extrapulmonary cancers is not known, although there is an urgent need for study on this topic. The purpose of this study, therefore, was to investigate the clinical significance of pulmonary NGGOs in these patients, and to develop a computerized scheme to distinguish malignant from benign NGGOs.Methods: Fifty-nine pathologically proven pulmonary NGGOs in 34 patients with a history of extrapulmonary cancer were studied. We reviewed the CT scan characteristics of NGGOs and the clinical features of these patients. Artificial neural networks (ANNs) were constructed and tested as a classifier distinguishing malignant from benign NGGOs. The performance of ANNs was evaluated with receiver operating characteristic analysis.Results: Twenty-eight patients (82.4%) were determined to have malignancies. Forty NGGOs (67.8%) were diagnosed as malignancies (adenocarcinomas, 24; bronchioloalveolar carcinomas, 16). Among the rest of the NGGOs, 14 were atypical adenomatous hyperplasias, 4 were focal fibrosis, and 1 was an inflammatory nodule. There were no cases of metastasis appearing as NGGOs. Between malignant and benign NGGOs, there were significant differences in lesion size; the presence of internal solid portion; the size and proportion of the internal solid portion; the lesion margin; and the presence of bubble lucency, air bronchogram, or pleural retraction (p < 0.05). Using these characteristics, ANNs showed excellent accuracy (z value, 0.973) in discriminating malignant from benign NGGOs.Conclusions: Pulmonary NGGOs in patients with extrapulmonary cancers tend to have high malignancy rates and are very often primary lung cancers. ANNs might be a useful tool in distinguishing malignant from benign NGGOs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to compare surgical and survival outcomes of laparoscopic radical hysterectomy (LRH) vs open radical hysterectomy (ORH) in elderly patients with early-stage cervical cancer. STUDY DESIGN: A retrospective analysis was performed on elderly patients (>=65 years) who underwent either LRH (n = 99) or ORH (n = 159) due to stage IA2-IIA2 cervical cancer. RESULTS: One patient (1%) in LRH group required conversion to laparotomy. Operating time (P = .035), estimated blood loss (P = .002), recovery of bowel movement (P < .001), and postoperative hospital stay (P < .001) were significantly shorter or lower in LRH group. Postoperative complications were significantly less frequent in LRH group (P = .026). After the median follow-up time of 45 months, the 5-year disease-free survival (95% vs 93%, P = .350) and overall survival (96% vs 95%, P = .361) did not differ between LRH and ORH groups. CONCLUSION: Elderly patients tolerated well both LRH and ORH. LRH was associated with better surgical outcomes compared to ORH without increasing intraoperative complications or decreasing survival. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study was to analyze the characteristics of cervical cancer associated with pregnancy. STUDY DESIGN: Forty patients with cervical cancer associated with pregnancy were retrospectively identified between 1995-2003. Three controls for each case were matched on the basis of age, stage, histology, and date of treatment. RESULTS: Sampling of cervical cytology after the second trimester was the most common cause of delayed diagnosis. Among 12 patients who delayed treatment for fetal maturity, 2 died of disease. There was no difference in overall survival between pregnant and nonpregnant patients with stage Ib tumors. In contrast to nonpregnant patients, the depth of stromal invasion was not correlated with the incidence of lymph vascular space involvement and lymph node metastasis in pregnant patients. CONCLUSION: Thorough evaluation is warranted before deciding whether to delay treatment until fetal maturity. Pregnancy does not adversely affect the prognosis of early-stage cervical cancer significantly. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was early prediction of postmolar gestational trophoblastic neoplasm (GTN) after evacuation of high-risk mole, by comparison of human chorionic gonadotrophin (hCG) regression rates. Study design: Fifty patients with a high-risk mole initially and spontaneously regressing after molar evacuation were selected from January 1, 1996 to May 31, 2010 (spontaneous regression group). Fifty patients with a high-risk mole initially and progressing to postmolar GTN after molar evacuation were selected (postmolar GTN group). hCG regression rates represented as hCG/initial hCG were compared between the two groups. The sensitivity and specificity of these rates for prediction of postmolar GTN were assessed using receiver operating characteristic curves. Multivariate analyses of associations between risk factors and postmolar GTN progression were performed. Results: The mean regression rate of hCG between the two groups was compared. hCG regression rates represented as hCG/initial hCG (%) were 0.36% in the spontaneous regression group and 1.45% in the postmolar GTN group in the second week (p =0.003). Prediction of postmolar GTN by hCG regression rate revealed a sensitivity of 48.0% and specificity of 89.5% with a cut-off value of 0.716% and area under the curve (AUC) of 0.759 in the 2nd week (p <0.001). In patients with an hCG regression rate over 0.716% in the 2nd week, the hazard ratio for progression to postmolar GTN was 3.00 by multivariate analysis (p <0.001). Conclusion: Differences in hCG regression rates between spontaneous regression and postmolar GTN groups became evident from the second week following molar evacuation. The occurrence of postmolar GTN could be predicted as early as the second week by comparing regression rates. hCG regression rate is easily obtainable and a predictive factor for postmolar GTN. [Copyright &y& Elsevier]

Superhydrophobic coatings have broad applications across various fields but often face challenges, such as complexity, high cost, low mechanical/thermal stability, toxicity, and environmental hazards. In this study, we demonstrate a simple, scalable, eco-friendly, and durable spray-coating method using bioadhesive shellac and octadecyltrichlorosilane (OTS)-modified silica nanoparticles to create superhydrophobic surfaces. The silica nanoparticles impart superhydrophobicity by forming hierarchical micro/nanostructures and reducing surface free energy, while shellac ensures strong adhesion of the nanoparticles to a wide range of substrates, including nonwoven polypropylene fibers, glass, plastic, metal, wood, cotton, and concrete. The coating exhibits excellent superhydrophobic performance with a large contact angle (162.1°), a small sliding angle (4°), and low contact angle hysteresis (4°). The coated surface retains its superhydrophobicity even after 50 cycles of sandpaper abrasion, heat exposure up to 150 °C, and contact with acidic environments (pH ∼4.2). These biocompatible and eco-friendly superhydrophobic coatings hold promise for use in applications where safety and environmental protection are critical, such as in antifouling, food packaging, and agricultural/biomedical fields.

Most studies on ammonia electrolysis have focused on anion exchange membranes (AEMs), which face limitations in operating conditions, such as pH and ammonia concentration. This study introduces a novel concept of an ammonia electrolysis cell (AEC) utilizing a Zirfon separator capable of operating under high pH and ammonia concentrations. The Zirfon-based AECs achieve a peak current density of 915 mA cm -2 , representing the highest reported value in AEC literature. Additionally, the Zirfon separator exhibits less conductivity degradation than AEMs during cycling tests (Zirfon 14.1%, AEMs 30.2%), demonstrating superior durability of the Zirfon-based AEC., (© 2025 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Background/aims: Evidence regarding the long-term association between hemoglobin (Hb) levels and lung function in individuals from the general population is scarce. This study aimed to determine the longitudinal association between Hb levels and lung function in a community-based population cohort in South Korea., Methods: We used linear mixed regression analysis to evaluate the longitudinal associations between Hb levels and lung function parameters, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1 ), and FEV 1 /FVC. Additionally, we used a generalized estimating equation to calculate the odds ratio (OR) of airflow obstruction (AO) according to the Hb level., Results: Over an 8-year biennial follow-up of 4,468 individuals (median age, 53.9 years; men, 49.0%), we observed that in men, Hb levels were positively associated with lung function (estimated values of FVC: 16.7 mL, FEV 1 : 15.5 mL, FEV 1 /FVC: 0.18%; all P < 0.001) and a decreased incidence of AO (OR = 0.83, P < 0.001). In women, Hb levels were positively associated with FVC but not with FEV 1 or FEV 1 /FVC (estimated values of FVC: 4.7 mL, P = 0.045; FEV 1 : 3.1 mL, P = 0.142; FEV 1 /FVC: 0.01%, P = 0.838). The incidence of AO was not significantly different among women (OR = 0.93, P = 0.568). In postmenopausal women, higher Hb levels were associated with increased lung function (estimated values of FVC: 11.8 mL, P < 0.001; FEV 1 : 9.8 mL, P < 0.001; FEV 1 /FVC: 0.09%, P = 0.052), but the incidence of AO was not statistically significant (OR = 0.82, P = 0.129)., Conclusions: A decreased Hb level was associated with reduced lung function and an increased incidence of AO in men., Competing Interests: Declarations. Ethics approval and consent to participate: The Korea Centers for Disease Control and Prevention obtained written informed consent from all participants regarding the collection of their data, and the Institutional Review Board of Severance Hospital approved the study protocol (4-2022-0558). The study was conducted in accordance with the Declaration of Helsinki (2013 revision). All methods complied with the approved protocol and with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: Interest in biological augmentation for improving bone-tendon interface (BTI) healing after arthroscopic rotator cuff repair (ARCR) is growing. Dermal fibroblasts, known for collagen synthesis similar to tenocytes, have shown effectiveness in BTI healing in chronic rotator cuff tear (RCT) models in rabbits. However, no human clinical trials have been conducted., Purpose: To evaluate the clinical efficacy of autologous dermal fibroblasts (ADFs) for BTI healing after ARCR in patients with full-thickness RCTs >2 cm., Study Design: Randomized controlled trial; Level of evidence, 2., Methods: A total of 86 patients were prospectively enrolled and randomized into 2 groups: an additional ADF injection between the bone and tendon during ARCR (ADF group) or ARCR alone (control group). A skin biopsy from the buttock was performed to obtain ADFs, which were cultured for approximately 4 weeks before surgery. ARCR was standardized to the double-row suture bridge technique to reduce the heterogeneity in different repair methods. The primary variable for evaluating ADF efficacy was the retear rate using magnetic resonance imaging at 6 months postoperatively. Secondary variables included range of motion, the American Shoulder and Elbow Surgeons score, the Constant score, and the Simple Shoulder Test score at baseline and at 6 and 12 months postoperatively., Results: Overall, 13 patients dropped out because of a subscapularis tendon tear, loss to follow-up, or the withdrawal of consent (7 in the ADF group and 6 in the control group). The retear rate was significantly lower in the ADF group (5.6% [2/36]) than in the control group (24.3% [9/37]) ( P = .025). The American Shoulder and Elbow Surgeons, Constant, and Simple Shoulder Test scores showed significant improvement after surgery in both groups (all P values <.001). Functional scores and range of motion did not significantly differ between the 2 groups at 6 and 12 months (all P values >.05)., Conclusion: ADF application into the BTI during ARCR significantly decreased the retear rate in patients with full-thickness RCTs >2 cm. Therefore, an ADF injection could be a promising biological supplement to enhance BTI healing in these patients. However, clinical outcomes showed no significant difference between the 2 groups at 6 months and 1 year postoperatively., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by the Advanced Technology Center Program (Development of Autologous and Allogenic Fibroblast Therapeutics for Treating Rotator Cuff Tears [10062289]; to S.J.), funded by the Ministry of Trade, Industry and Energy of the Republic of Korea, as well as the Korea Health Technology R&D Project (HI20C0645; to S.J.), funded by the Ministry of Health and Welfare of the Republic of Korea. S.T.H., J.H., and S.J. are employed by Tego Science and hold stocks in Tego Science. In addition, S.J.’s sibling is also employed by Tego Science and holds stocks in Tego Science. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objectives: Recently, sarcopenia has been linked to unfavorable outcomes in various surgical procedures, including lung cancer surgery. This study aimed to investigate the impact of respiratory sarcopenia (RS) on postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery., Methods: This retrospective study included patients aged 70 years and older who underwent lobectomy with curative intent for lung cancer between 2017 and 2019. RS was defined as having values below the median for both the L3 skeletal muscle index, measured from preoperative PET-CT images, and peak expiratory flow (PEF). An inverse probability of treatment weighting (IPTW) approach was applied to balance covariates between the RS and non-RS groups. Baseline characteristics and postoperative outcomes were compared between groups using t-tests and chi-square tests. Kaplan-Meier curves and log-rank tests were used to compare overall and recurrence-free survival. Multivariable logistic regression analysis incorporating IPTW weights was performed to assess the impact of RS on respiratory complications., Results: A total of 509 patients were included, of whom 123 (24.2%) had RS. After IPTW adjustment, baseline characteristics, including pulmonary function, were similar between the RS and non-RS groups. All patients underwent lobectomy, with 78.8% of the RS group and 80.9% of the non-RS group undergoing minimally invasive surgery. The RS group had a significantly higher rate of respiratory complications compared to the non-RS group (14.5% vs. 7.7%, p = 0.041). Multivariable logistic regression analysis showed that male sex (odds ratio = 15.2, p < 0.01) and lower D LCO (odds ratio = 0.96, p < 0.01) were significantly associated with respiratory complications, whereas RS did not show a significant association (p = 0.05). No significant differences were found in overall survival (p = 0.11) or recurrence-free survival (p = 0.51) between the groups., Conclusions: In this study, RS had a limited impact on both postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. These findings suggest that other factors, such as D LCO and male sex, may play a more prominent role in predicting respiratory complications., Competing Interests: Declarations. Ethics approval and consent to participate: Approval for this study was obtained from the institutional review board of Seoul National University Hospital (2022-02-22, H-2201-105-1291). The requirement for informed consent of participants was waived due to the retrospective nature of the study. Consent for publication: All co-authors have reviewed and agreed to the contents of this manuscript. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Lattice volume changes in Li-ion batteries active materials are unavoidable during electrochemical cycling, posing significant engineering challenges from the particle to the electrode level. In this study, we present an elastic framework coating designed to absorb and reversibly release strain energy associated with particle volume changes, thereby enhancing mechanical resilience at both the particle and electrode levels. This framework, composed of multiwalled carbon nanotubes (MWCNTs), is applied to nickel-rich LiNi 0.9 Co 0.05 Mn 0.05 O 2 (NCM9055) cathodes at a low loading of 0.5 wt %, effectively mitigating critical issues such as particle cracking, volume changes, and electrode thickness variations during cycling. Leveraging these advantages, an energy-dense electrode is achieved with a high active material loading of 20 mg cm -2 , without the need for additional carbon additives. Demonstrated in a pouch cell format, this electrode achieves an exceptional capacity retention of 77.7% after 1000 cycles. This approach provides a comprehensive solution for designing Li-ion batteries capable of withstanding lattice volume variations, offering valuable insights for next-generation batteries technologies.

Currently, it is a significant challenge to achieve long-term cyclability and fast chargeability in lithium-ion batteries, especially for the Ni-based oxide cathode, due to severe chemo-mechanical degradation. Despite its importance, the fast charging long-term cycling behaviour is not well understood. Therefore, we comprehensively evaluate the feasibility of fast charging applications for Co-free layered oxide cathodes, with a focus on the extractable capacity and cyclability. The cathodes with a Ni content of over 80% attain 80% of their nominal capacity, along with superior cyclability under fast charging due to the suppression of the following two mechanical failure modes: (i) Li-ion concentration shock fracture (CSF) and (ii) H2-H3 phase shock fracture (HSF). In particular, CSF produces stronger stress than HSF and causes severe crack penetration in mid-Ni cathodes under fast charging. Meanwhile, HSF induces mild internal stress, but prolonged exposure accelerates mechanical degradation. To maximize the fast charging application of high-Ni cathodes, we evaluated a 5C constant current constant voltage protocol to deliver 180 mAh g -1 in 35 min, improving the cycle life by up to 89% over 100 cycles with LiNi 0.90 Mn 0.10 O 2 . This study provides insights into the fast charging applications of high-Ni cathodes, thereby advancing the understanding of their behaviour and optimization.

Background: This study aimed to compare long-term clinical outcomes of percutaneous needle biopsy (PCNB) versus surgical biopsy in patients with peripheral, small-sized clinical stage 1 non-small cell lung cancer (NSCLC) with computed tomography (CT)-defined visceral pleural invasion (VPI)., Methods: We retrospectively analyzed patients who underwent surgery for NSCLC with CT-defined VPI between 2010 and 2017. We excluded patients with non-peripheral NSCLC, or cancers > 3 cm. Propensity score matching was carried out to adjust for confounding variables. The primary endpoint was ipsilateral pleural recurrence-free survival, while secondary endpoints included overall survival and recurrence-free survival., Results: Of the 1671 patients with peripheral, small-sized clinical stage 1 NSCLC with CT-defined VPI, 805 underwent PCNB, and 866 had a surgical biopsy. Propensity score matching assigned 562 patients to each group. Before matching, the PCNB group demonstrated worse baseline characteristics, including older age, higher smoking history, and more adverse pathological findings. After matching, the 5-year recurrence-free survival for ipsilateral pleural recurrence (98.6% vs. 96.0%, p = 0.002) and overall survival (93.8% vs. 90.2%, p = 0.003) were significantly higher in the surgical biopsy group compared with the PCNB group. Multivariable analysis revealed that PCNB significantly increased the risks of all-cause mortality and various recurrences before and after matching., Conclusions: Compared with surgery biopsy, PCNB was associated with higher risks of all-cause mortality and recurrences, including ipsilateral pleural recurrence. PCNB should be considered with caution in cases of peripheral stage 1 NSCLC where CT-defined VPI is suspected., (© 2024 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.)

Objectives: This study aimed to identify the risk factors for acute pancreatitis (AP) in young adults in their 20s based on data from the nationwide cohort in South Korea., Materials and Methods: From the 2009 national health examination database of South Korea, a total of 471,098 individuals between the ages of 20 and 29 were analyzed. To identify the newly developed AP, the linked claims database was used., Results: The incidence rates of AP were 18.8 and 9.8 per 100,000 person-years in male and female participants, respectively. Alcohol consumption and smoking were associated with the heightened risk of AP. The risk of AP development was increased as daily alcohol consumption increased. In addition, ex-smokers and current smokers showed higher AP risk than never smokers. Hypertriglyceridemia and obesity were associated with the increased AP risk as well. Compared with female participants, male participants showed a higher risk of AP in univariate analysis but showed a lower risk of AP in multivariate analysis., Conclusions: In the young adult population, alcohol consumption, smoking, hypertriglyceridemia, and obesity were associated with an elevated risk of developing AP. It is important to identify and manage the modifiable AP risk factors in young adults to minimize the socioeconomic burden of AP., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aimed to identify the recurrence and survival rates according to the mismatch repair (MMR), p53, and L1 cell adhesion molecule (L1CAM) status in patients with advanced and recurrent endometrial cancer (EC) receiving systemic chemotherapy., Methods: This single-center retrospective cohort study included chemotherapy-naïve patients with advanced-stage (III/IV) or recurrent EC between January 2015 and June 2022 (n = 156), who were administered chemotherapy as adjuvant therapy or first-line palliative treatment. MMR and p53 status were assessed, and L1CAM was tested using immunohistochemistry in the p53-wild and MMR-proficient (p53wt/pMMR) group. The primary outcomes were progression-free survival (PFS) and overall survival (OS)., Results: Of the 156 patients, 62 (39.7%), 53 (34.0%), and 41 (26.3%) had p53wt/pMMR, abnormal p53 (p53abn), and MMR-deficient (dMMR) tumors, respectively. PFS and OS were longest in dMMR, followed by p53wt/pMMR, and were the least in p53abn tumors (PFS: p = 0.0006, OS: p = 0.0013). After p53wt/pMMR was classified according to positive or negative L1CAM status, the L1CAM negative group exhibited significantly shorter survival rates than the L1CAM positive group (PFS: p = 0.0001, OS: p = 0.0027). p53abn tumors were independent prognostic factors for poor PFS (PFS: p = 0.039 on multivariable analysis)., Conclusion: In chemotherapy-naïve patients with advanced and recurrent EC, there was a better prognosis in the order of MMR-D, p53wt/pMMR, and p53abn tumors after chemotherapy. L1CAM status is useful as a new marker to stratify p53wt/pMMR in advanced and recurrent groups., Competing Interests: Declarations. Ethics approval and consent to participate: Because of the non-interventional, retrospective nature of analyzed data and because our analysis involved an anonymized dataset, neither ethical review nor informed consent of the patients was required. However, the study protocol was reviewed and approved by a scientific steering committee to which all the authors belonged. Moreover, the study protocol was reviewed and approved by the Yonsei University Health System, Severance Hospital, IRB (ref. 4–2023-0263). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background/objectives: Stressors occurring across the life course are considered to have a cumulative impact on health, but there is no instrument for assessing lifetime stressor exposure in Korea. Therefore, we validated the Stress and Adversity Inventory (Adult STRAIN) in Korean., Methods: We translated the Adult STRAIN into Korean and examined its concurrent, predictive, and comparative predictive validity in 218 Korean adults (79 men, 139 women; M age = 29.5; 19-50 years old) recruited from a psychiatric setting. We assessed concurrent validity using Pearson's correlations, predictive validity using multiple regression models, and comparative predictive validity using multivariate logistic regression to identify participants with lifetime psychiatric diagnoses., Results: The Korean STRAIN exhibited sufficient usability and acceptability; good concurrent validity with other measures of early adversity, life events, and perceived stress ( r s = 0.48-0.61); and strong predictive validity in relation to anxiety and depressive symptoms (β = 0.08-0.47; ΔR2 = 0.11-0.21). Each domain of Korean-style stress, based on the timing, type, life domain, and sociopsychological characteristics of stress exposure, showed a different distribution of lifetime psychiatric diagnosis probabilities (odds ratios = 1.20-4.85). Finally, the test-retest reliability for total lifetime stressor count and severity over four weeks was high., Conclusions: The Korean STRAIN is a practical, valid, and reliable instrument for researchers and clinicians to efficiently assess lifetime stressor exposure.

Purpose: This study aimed to evaluate the use of chatbot and video education to reduce anxiety in patients with breast cancer undergoing radiation therapy (RT)., Methods and Materials: This randomized controlled trial included patients with breast cancer scheduled for RT after surgery at an outpatient department of radiation oncology in a cancer center, randomly assigned to 4 groups: (1) video + chatbot, (2) video + paper, (3) paper + chatbot, and (4) paper + paper. In each group, patients received information regarding the treatment process and were frequently asked questions using the designated tool. Patient anxiety was evaluated using the Amsterdam preoperative anxiety and information scale (APAIS), state-trait anxiety inventory (STAI), and linear analog scale assessment (LASA) at 3 points: (1) initial outpatient visit (T0), (2) before the RT course (T1), and (3) after the RT course (T2). The primary endpoint was APAIS, and the secondaries were STAI and LASA. A mixed-model repeated-measures ANOVA was conducted with time as a within-group factor and treatment conditions as a between-group factor., Results: The final analysis included 145 patients. No significant interaction was observed between groups and time for the APAIS, STAI, or LASA. Although unplanned, analyses were conducted using the age of 50 years as the cutoff, based on a previous systematic review of digital literacy in the medical field. A trend toward reduced APAIS was found among patients aged ≤50 years who used the chatbot (per-protocol subgroup). In the video + chatbot group, the APAIS score decreased from 3.06 (T0) to 1.88 (T2); in contrast, in the paper + paper group, it decreased from 2.42 (T0) to 2.06 (T2). In contrast, no significant interaction was observed in the APAIS of per-protocol patients aged ≥50 years., Conclusions: Overall, no significant differences were found in the effectiveness of different types of educational media in reducing patients' anxiety. However, for young patients who actively use video or chatbot resources, education through digital media may meaningfully reduce their anxiety during the RT process., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Oxaliplatin is a commonly used platinum-based chemotherapy drug for patients with pancreatic cancer (PC). Drug resistance is a major challenge in PC treatment, underscoring the urgent need for new approaches. Targeting DNA damage repair, one of the factors responsible for platinum resistance, is an attractive strategy to overcome drug resistance. This study aimed to investigate the potential of the ATR inhibitor BAY 1895344 in improving the drug responsiveness of oxaliplatin-resistant PC., Methods: Oxaliplatin-resistant PC cells (CFPAC-1 and Capan-2) were selected and treated with oxaliplatin, BAY 1895344, or a combination of both in vivo and in vitro. Their combinatorial effects on the DNA damage response (DDR) signaling pathway, apoptosis, and extent of DNA damage were evaluated using appropriate methods. Patient response was predicted using organoid models., Results: Combination treatment with BAY 1895344 and oxaliplatin exhibited a synergistic effect on both PC cell lines, with the effect being more pronounced on Capan-2. Additionally, the combination treatment substantially suppressed phospho-Chk1, a coordinator of DDR and cell cycle checkpoints. Mechanistically, ATR inhibition augmented the DNA damage induced by oxaliplatin, leading to mitotic catastrophe and cell death. Furthermore, in an in vivo study using a tumor-bearing xenograft mouse model, the combination treatment markedly reduced tumor growth. This synergistic effect was confirmed in patient-derived organoids with poor response to oxaliplatin., Conclusion: ATR inhibition enhanced the anticancer effect of oxaliplatin, suggesting that this combination treatment could be an effective therapeutic strategy for overcoming platinum resistance in PC., Competing Interests: Declaration of competing interest The authors declare that there are no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

We report the exfoliation of ultrathin gallium oxide (Ga 2 O 3 ) films from liquid metal balloons, formed by injecting air into droplets of eutectic gallium-indium alloy (eGaIn). These Ga 2 O 3 films enable the selective adsorption of carbon nanotubes (CNTs) dispersed in water, resulting in the formation of a dense, percolating CNT network on their surface. The self-assembled CNT network on Ga 2 O 3 provides a versatile platform for device fabrication. As an example application, we fabricated a chemiresistive gas sensor for detecting simulants of chemical warfare agents (CWAs), including diisopropyl methylphosphonate (DIMP), dimethyl methylphosphonate (DMMP), and triethyl phosphate (TEP). The sensor exhibited reversible responses, high sensitivity, and low limits of detection (13 ppb for DIMP, 28 ppb for DMMP, and 53 ppb for TEP). These findings highlight the potential of Ga 2 O 3 films derived from liquid metal balloons for integrating CNTs into functional electronic devices.

Antibacterial packaging holds promise in addressing food spoilage by inactivating bacteria, but current antimicrobial packaging solutions face challenges like depletion of antibacterials and concerns of antibiotic abuse. In response to these limitations of existing packaging materials, we developed a novel antibacterial packaging film by incorporating titanium dioxide (TiO 2 )- tetra(4-carboxyphenyl) porphyrin (TcPP) conjugates into cellulose nanofibrils (CNF) films. Unlike conventional antimicrobial packaging, this film harnesses visible light energy to excite electrons from TcPP to TiO 2 , generating reactive oxygen species (ROS) that inactivate bacteria without relying on antibiotics. Results demonstrated that the film reduced 4.5, 4.6, 4.1, and 4.7-log Escherichia coli, Pseudomonas fluorescens, Leuconostoc lactis, and Listeria innocua, respectively, in phosphate-buffered saline within 72 h under 6000 lux light (3.13 mW/cm 2 ). The antimicrobial efficacy decreased as the light intensity decreased. Notably, it retains significant antimicrobial properties even under an extremely low light intensity of 600 lux (0.60 mW/cm 2 ). The analysis also revealed that singlet oxygen and hydrogen peroxide are the major generated ROS from the film under light exposure. When applied to cucumbers, the film reduced E. coli by 3.5 logs after 48-hour light exposure. The designed photocatalytic antibacterial film represents a major advancement in sustainable food preservation, reducing food waste by extending the shelf life of fresh produce., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Haibo Huang has patent #Photo-catalytic antimicrobial packaging films. Application No. 63/358,322 pending to Haibo Huang. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Paralabral cysts at the spinoglenoid notch are rare disorders that can potentially lead to compressive suprascapular neuropathy. Given their infrequency, a standard treatment protocol has not yet been established., Hypothesis/purpose: This study aimed to assess changes in the infraspinatus muscle using magnetic resonance imaging (MRI) and to compare the outcomes of 2 different surgical methods. It was hypothesized that surgical intervention could alleviate compressive neuropathy, with comparable outcomes between the 2 surgical approaches., Study Design: Cohort study; Level of evidence, 3., Methods: This retrospective review encompassed 43 patients undergoing arthroscopic labral repair for a paralabral cyst at the spinoglenoid notch, with cyst decompression (27 patients; labral repair with cyst decompression [LRCD] group) or without cyst decompression (16 patients; labral repair only [LRO] group). Preoperative MRI focused on evaluating the condition of the infraspinatus and teres minor muscles. Electromyography (EMG) was conducted on 36 patients (21 in LRCD and 15 in LRO) to assess suprascapular nerve function. Postoperative evaluations were performed in 35 patients at postoperative 1 year, excluding those lost to follow-up. Postoperative MRI findings (24 patients in LRCD and 11 patients in LRO) and functional outcome scores including recovery of external rotation power were compared with preoperative status in both groups., Results: Preoperative MRI revealed denervation changes or atrophy of the infraspinatus in 26 of the 43 patients (60.4%). Among the 36 patients who underwent preoperative EMG, 21 patients (58.3%; 13 patients in LRCD and 8 patients in LRO) showed evidence of suprascapular neuropathy. A discrepancy between EMG and MRI findings was noted in 10 patients, with 5 patients showing suprascapular neuropathy according to EMG despite normal muscle status on MRI scans, and the remaining 5 vice versa. Notable atrophy of the infraspinatus was seen in 6 patients and teres minor hypertrophy in 5 patients, all of whom exhibited concurrent infraspinatus atrophy. Postoperatively, cyst disappearance was observed in all cases in both LRCD (24 patients) and LRO (11 patients) groups. Denervation changes in the infraspinatus were resolved in all patients. In patients with infraspinatus atrophy, some improvement was noted. Teres minor hypertrophy persisted in 2 of 4 patients. Improvements were similar in both groups (all P > .05). External rotation power improved postoperatively in both groups (from 39.1 ± 18.6 to 50.6 ± 17.7 N in LRCD, P < .001; from 45.1 ± 16.0 to 54.2 ± 10.7 N in LRO, P = .025)., Conclusion: Both LRCD and LRO surgical approaches appear to be effective for paralabral cysts at the spinoglenoid notch. Suprascapular neuropathy can be successfully addressed by both methods. However, conditions with severe infraspinatus atrophy and teres minor hypertrophy warrant further investigation in larger series., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Approval was granted by the Seoul National University Hospital Institutional Review Board (H-2402-031-1507; February 14, 2024).

Background: The efficacy of adjuvant treatment (AT) in ampullary cancer (AmC) remains controversial. This systematic review and meta-analysis aimed to evaluate the role of AT for AmC., Data Sources: A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included., Results: A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768-1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764-1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451-0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563-1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642-1.214) showed any significant effect on the OS., Conclusions: The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies., (Copyright © 2024 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.)

Objective: To compare nutritional and postoperative outcomes between early oral feeding and late oral feeding with jejunostomy feeding support after esophagectomy., Background: Esophagectomy is associated with substantial body weight loss and malnutrition, impacting the prognosis of esophageal cancer patients. Despite many studies on postesophagectomy nutritional support, optimal strategies remain elusive. This study investigates the impact of jejunostomy feeding with late oral feeding compared to conventional oral feeding on nutritional and postoperative outcomes., Methods: We performed a single-center prospective open-labelled randomized controlled trial between 2020 and 2022. Patients aged 18 to 75 years with resectable esophageal cancer were randomly assigned to undergo either early oral feeding (early group) or late oral feeding with jejunostomy feeding support (late group) after esophagectomy. The primary endpoint was body weight loss from preoperative body weight at postoperative 4 to 5 weeks and 4 months. Other perioperative and nutritional outcomes were also evaluated., Results: We randomly assigned 29 patients to the early group and 29 patients to the late group. The late group exhibited significantly less body weight loss at both postoperative 4 to 5 weeks (8.3% vs. 5.6%; P =0.002) and 4 months (15.0% vs. 10.5%; P =0.003). The total calorie intake and protein intake were higher in the late group for both postoperative 4 to 5 weeks (1800 kcal/day vs. 1100 kcal/day; P <0.001) and 4 months (1565 kcal/day vs. 1200 kcal/day; P =0.010). Sixty percentage of the early group changed to malnutrition state, while 40% of the late group changed to malnutrition. The complication rate and length of hospital stays were similar., Conclusions: The late group demonstrated prevention of significant body weight loss, enhanced nutritional intake, and reduced malnutrition without compromising short-term surgical outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

We assessed the association between a genome-wide polygenic risk score (PRS) developed for lung adenocarcinoma (LUAD) risk and mutation on the EGFR gene in 998 East Asian never-smoking female LUAD cases (518 EGFR-positive; 480 EGFR-negative) and 4544 never-smoking controls using case-case and multinomial regression analyses. We found that the PRS was more strongly associated with EGFR-positive LUAD compared with EGFR-negative LUAD, where the association between the fourth quartile of the PRS and EGFR-positive LUAD (odds ratio = 8.63, 95% confidence interval: 5.67-13.14) was significantly higher than the association between the fourth quartile of the PRS with EGFR-negative LUAD (odds ratio = 3.50, 95% confidence interval: 2.44-5.00) (p-heterogeneity = 3.66 × 10 -3 ). Our findings suggest that germline genetic susceptibility may be differentially associated with LUAD in never-smoking female East Asian patients depending on the cancer's mutation status, which may have important public health and clinical implications., Competing Interests: Disclosure The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Lymph node (LN) metastasis is an important prognostic factor in the ampulla of Vater (AoV) adenocarcinoma. Various LN parameters have been proposed, but their prognostic efficacy has not been compared in the same population. We aimed to evaluate the prognostic values of LN parameters in AoV adenocarcinoma patients who underwent surgical resection and adjuvant treatment based on the long-term follow-up data., Methods: A total of 86 patients with surgically resected AoV adenocarcinoma followed by adjuvant treatment were analyzed. We evaluated the prognostic values of various LN parameters such as pathologic N stage, number of metastatic regional LN (LNN), LN ratio (LNR), and log odds of positive LNs (LODDS). Each LN parameter was separately analyzed using Cox regression models with the same confounders., Results: The median follow-up period was 69.4 months, and the median overall survival (OS) was 114 months. The median number of dissected LNs is 15, with an interquartile range of 8 to 25. In the univariable analyses, all LN parameters showed significant prognostic efficacy for OS, disease-free survival (DFS), and distant metastasis-free survival (DMFS). In the multivariable Cox regression analyses, LNN ≥ 2 was a statistically significant prognostic factor for OS (hazard ratio (HR) 2.10, 95% confidence interval (CI), 1.11-3.97; p = 0.022), DFS (HR 2.51, 95% CI 1.28-4.93; p = 0.007), and DMFS (HR 2.74, 95% CI 1.39-5.41; p = 0.004). LNR showed significant prognostic performance for DFS (HR 2.35, 95% CI 1.23-4.50; p = 0.010), and DMFS (HR 2.26, 95% CI 1.17-4.35; p = 0.015). N stage showed significant prognostic performance in DFS (HR 1.55 for pN1; p = 0.243 and HR 4.31 for pN2; p = 0.003), DMFS (HR 1.46 for pN1; p = 0.323 and 4.59 for pN2; p = 0.002). LODDS and the presence of LN metastasis, did not demonstrate significant prognostic value across survival outcomes., Conclusions: LN parameters showed good long-term predictive performance in AoV adenocarcinoma patients treated with curative resection and adjuvant treatments. Among LN parameters, LNN ≥ 2 showed better prognostic value than others. Further large-scale studies are needed to validate the clinical usefulness of various LN parameters., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the institutional review board of Seoul National University Hospital, and written informed consent was waived due to its retrospective nature. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Accurate measurement of the hip-knee-ankle (HKA) angle is essential for informed clinical decision-making in the management of knee osteoarthritis (OA). Knee OA is commonly associated with varus deformity, where the alignment of the knee shifts medially, leading to increased stress and deterioration of the medial compartment. The HKA angle, which quantifies this alignment, is a critical indicator of the severity of varus deformity and helps guide treatment strategies, including corrective surgeries. Current manual methods are labor-intensive, time-consuming, and prone to inter-observer variability. Developing an automated model for HKA angle measurement is challenging due to the elaborate process of generating handcrafted anatomical landmarks, which is more labor-intensive than the actual measurement. This study aims to develop a ResNet-based deep learning model that predicts the HKA angle without requiring explicit anatomical landmark annotations and to assess its accuracy and efficiency compared to conventional manual methods., Methods: We developed a deep learning model based on the variants of the ResNet architecture to process lower limb radiographs and predict HKA angles without explicit landmark annotations. The classification performance for the four stages of varus deformity (stage I: 0°-10°, stage II: 10°-20°, stage III: > 20°, others: genu valgum or normal alignment) was also evaluated. The model was trained and validated using a retrospective cohort of 300 knee OA patients (Kellgren-Lawrence grade 3 or higher), with horizontal flip augmentation applied to double the dataset to 600 samples, followed by fivefold cross-validation. An extended temporal validation was conducted on a separate cohort of 50 knee OA patients. The model's accuracy was assessed by calculating the mean absolute error between predicted and actual HKA angles. Additionally, the classification of varus deformity stages was conducted to evaluate the model's ability to provide clinically relevant categorizations. Time efficiency was compared between the automated model and manual measurements performed by an experienced orthopedic surgeon., Results: The ResNet-50 model achieved a bias of - 0.025° with a standard deviation of 1.422° in the retrospective cohort and a bias of - 0.008° with a standard deviation of 1.677° in the temporal validation cohort. Using the ResNet-152 model, it accurately classified the four stages of varus deformity with weighted F1-score of 0.878 and 0.859 in the retrospective and temporal validation cohorts, respectively. The automated model was 126.7 times faster than manual measurements, reducing the total time from 49.8 min to 23.6 sec for the temporal validation cohort., Conclusions: The proposed ResNet-based model provides an efficient and accurate method for measuring HKA angles and classifying varus deformity stages without the need for extensive landmark annotations. Its high accuracy and significant improvement in time efficiency make it a valuable tool for clinical practice, potentially enhancing decision-making and workflow efficiency in the management of knee OA., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Research and Ethics Board of Seoul Medical Center (SEOUL 2023-12-002-001), Republic of Korea. The study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki. No patient-identifiable information was included in the manuscript, and all data were anonymized to ensure confidentiality. As this was a retrospective study, informed consent was waived. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The increased usage of IoT networks brings about new privacy risks, especially when intrusion detection systems (IDSs) rely on large datasets for machine learning (ML) tasks and depend on third parties for storing and training the ML-based IDS. This study proposes a privacy-preserving synthetic data generation method using a conditional tabular generative adversarial network (CTGAN) aimed at maintaining the utility of IoT sensor network data for IDS while safeguarding privacy. We integrate differential privacy (DP) with CTGAN by employing controlled noise injection to mitigate privacy risks. The technique involves dynamic distribution adjustment and quantile matching to balance the utility-privacy tradeoff. The results indicate a significant improvement in data utility compared to the standard DP method, achieving a KS test score of 0.80 while minimizing privacy risks such as singling out, linkability, and inference attacks. This approach ensures that synthetic datasets can support intrusion detection without exposing sensitive information.

Background and Aims: Liver transplantation (LT) is a curative treatment for end-stage liver disease. Anastomotic biliary strictures (ABSs) are more common in living donor LT (LDLT). However, the success rate of ERCP for ABS remains unsatisfactory. In this study, we evaluated the efficacy of single-operator cholangioscopy (SOC) for ABS treatment in LDLT recipients where standard ERCP failed to access the stricture., Methods: This prospective study included 40 LDLT patients undergoing ERCP with SOC (SpyGlass DS II; Boston Scientific Corp, Natick, Mass, USA) to treat ABSs when guidewire placement across the ABS was difficult during conventional ERCP (cannulation time >10 minutes) between October 2021 and May 2023. Our primary endpoint was technical success, defined as successful guidewire placement across the ABS and/or subsequent treatment. Secondary endpoints were rates of clinical success, adverse events, and reintervention., Results: The mean patient age was 59.7 ± 7.2 years, and the mean time from LDLT to the occurrence of ABS was 212 ± 230 days. Technical and clinical success were achieved in 92.5% (37/40) and 82.5% (33/40) of patients, respectively. The rates of post-ERCP cholangitis, pancreatitis, and bleeding were 10.0%, 15.0%, and 2.5%, respectively. Intestinal perforation did not occur, and all adverse events were mild in severity. Early stent migration within 1 month occurred in 2 patients (5.4%), and 4 patients (10.8%) required reintervention within 1 month., Conclusions: This study shows the efficacy and safety of SOC-facilitated management for difficult ABSs in LDLT patients after failure of standard ERCP. (Clinical trial registration number: NCT05065125.)., Competing Interests: Disclosure All authors disclosed no financial relationships. Research support for this study was provided by Boston Scientific to the corresponding author (Grant ID: ISREND00106)., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Ischemic stroke (IS) accounts for most stroke incidents and causes intractable damage to brain tissue. This condition manifests as diverse aftereffects, such as motor impairment, emotional disturbances, and dementia. However, a fundamental approach to curing IS remains unclear. This study proposes a novel approach for treating IS by employing minimally invasive and injectable jammed gelatin-norbornene nanofibrous hydrogels (GNF) infused with growth factors (GFs). The developed GNF/GF hydrogels are administered to the motor cortex of a rat IS model to evaluate their therapeutic effects on IS-induced motor dysfunction. GNFs mimic a natural fibrous extracellular matrix architecture and can be precisely injected into a targeted brain area. The syringe-injectable jammed nanofibrous hydrogel system increased angiogenesis, inflammation, and sensorimotor function in the IS-affected brain. For clinical applications, the biocompatible GNF hydrogel has the potential to efficiently load disease-specific drugs, enabling targeted therapy for treating a wide range of neurological diseases., (© 2024 The Author(s). Advanced Healthcare Materials published by Wiley‐VCH GmbH.)

Polygenic risk scores (PRSs) are promising for risk stratification but have mainly been developed in European populations. This study developed single- and multi-ancestry PRSs for lung adenocarcinoma (LUAD) in East Asian (EAS) never-smokers using genome-wide association study summary statistics from EAS (8,002 cases; 20,782 controls) and European (2,058 cases; 5,575 controls) populations. A multi-ancestry PRS, developed using CT-SLEB, was strongly associated with LUAD risk (odds ratio=1.71, 95% confidence interval (CI):1.61,1.82), with an area under the receiver operating curve value of 0.640 (95% CI:0.629,0.653). Individuals in the highest 20% of the PRS had nearly four times the risk compared to the lowest 20%. Individuals in the 95 th percentile of the PRS had an estimated 6.69% lifetime absolute risk. Notably, this group reached the average population 10-year LUAD risk at age 50 (0.42%) by age 41. Our study underscores the potential of multi-ancestry PRS approaches to enhance LUAD risk stratification in EAS never-smokers.

Objective: The tumor immune microenvironment in ovarian clear cell carcinoma has not been clearly defined. We analyzed the immunological changes from treatment-naive to recurrence to correlate them with clinical outcomes., Method: We compared the changes in immune infiltration of advanced-stage ovarian clear cell carcinoma samples before treatment and at the time of recurrence via immunohistochemistry (Programmed Cell Death-ligand 1 (PD-L1), cluster of differentiation 8 (CD8+), forkhead box P3 (Foxp3+)), tumor-infiltrating lymphocytes (TIL), and next-generation sequencing (54 patients). We analyzed the association between platinum sensitivity status and tumor immune microenvironment., Results: Immunohistochemistry revealed significantly increased PD-L1 (p=0.048) and CD8+T cells (p=0.022) expression levels after recurrence. No significant differences were observed in TIL density or Foxp3+T cells. There was no significant correlation between TIL, PD-L1, CD8+T cell, and Foxp3+T cell levels in treatment-naive tumors and survival outcomes. The most common genomic alterations were PIK3CA (41.7%) and ARID1A (41.7%) mutations. There were no differences in the immunological changes or survival outcomes according to PIK3CA and ARID1A mutations. Patients with recurrent platinum-sensitive disease showed higher TIL expression levels. There were no significant differences in PD-L1, CD8+T cells, or Foxp3+T cells between platinum-sensitive and platinum-resistant diseases., Conclusion: We characterized the tumor immune microenvironment in patients with advanced-stage ovarian clear cell carcinoma. PD-L1 and CD8+T cell expression significantly increased after recurrence. Whether this could be used to select patients for immunotherapy in the recurrence setting should be investigated., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/objectives: Pancreatic cancer is characterized by tissue stiffness due to the high concentration of cancer-associated fibroblasts and extracellular matrix. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is performed to diagnose pancreatic cancer but yields false-negative results attributed to inadequate specimens. EUS-elastography is a real-time assessment method to pancreatic tissue stiffness. This study aims to investigate the correlation between diagnostic yield and the number of needle passes based on the stiffness measured by elastography., Methods: Patients who underwent EUS-TA for pancreatic solid mass were retrospectively reviewed and included in this study. The number of needle passes during EUS-TA was determined based on macroscopic on-site evaluation. Tissue stiffness measurements were taken using EUS-elastography. The primary study outcome was the diagnostic yield. The secondary outcome included the number of needle passes required for a diagnosis., Results: A total of 652 patients were included. The average stiffness differed depending on the location of the tumor, and high-stiffness group had more malignant lesions. Although the diagnostic yield was not significantly different between groups, the number of needle passes was significantly higher in the high-stiffness group (3.6 ± 1.0 vs. 3.2 ± 0.9, p < 0.001)., Conclusions: The higher the stiffness of the pancreatic mass in EUS-elastography, the more needle passes are required to achieve a comparable diagnostic yield., (Copyright © 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Metal ions play a pivotal role in maintaining optimal brain function within the human body. Nevertheless, the accumulation of these ions can result in irregularities that lead to brain damage and dysfunction. Disruptions of metal ion homeostasis can result in various pathologies, including inflammation, redox dysregulation, and blood-brain barrier disruption. While research on metal ions has chiefly focused on neurodegenerative diseases, little attention has been given to their involvement in the onset and progression of stroke. Recent studies have identified cuproptosis and confirmed ferroptosis as significant factors in stroke pathology, underscoring the importance of metal ions in stroke pathology, including abnormal ion transport, neurotoxicity, blood-brain barrier damage, and cell death. Additionally, it provides an overview of contemporary metal ion chelators and detection techniques, which may offer novel approaches to stroke treatment., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The performance of large language models (LLMs) and their potential utility in obstetric and gynecological education are topics of ongoing debate. This study aimed to contribute to this discussion by examining the recent advancements in LLM technology and their transformative potential in artificial intelligence., Methods: This study assessed the performance of generative pre-trained transformer (GPT)-3.5 and -4 in understanding clinical information, as well as its potential implications for obstetric and gynecological education. Obstetrics and gynecology residents at three hospitals underwent an annual promotional examination, from which 116 of the 170 questions over 4 years (2020-2023) were analyzed, excluding 54 questions with images. The scores achieved by GPT-3.5, -4, and the 100 residents were compared., Results: The average scores across all 4 years for GPT-3.5 and -4 were 38.79 (standard deviation [SD], 5.65) and 79.31 (SD, 3.67), respectively. For groups first-year resident, second-year resident, and third-year resident, the cumulative annual average scores were 79.12 (SD, 9.00), 80.95 (SD, 5.86), and 83.60 (SD, 6.82), respectively. No statistically significant differences were observed between the scores of GPT-4.0 and those of the residents. When analyzing questions specific to obstetrics, the average scores for GPT-3.5 and -4.0 were 33.44 (SD, 10.18) and 90.22 (SD, 7.68), respectively., Conclusion: GPT-4 demonstrated exceptional performance in obstetrics, different types of data interpretation, and problem solving, showcasing the potential utility of LLMs in these areas. However, acknowledging the constraints of LLMs is crucial and their utilization should augment human expertise and discernment.

Purpose: Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes., Methods: This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging., Results: From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% ( r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% ( P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement., Conclusions: Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate the efficacy of cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in predicting survival outcomes based on breast cancer gene (BRCA) mutational status in epithelial ovarian cancer., Methods: Medical records of 448 patients diagnosed with epithelial ovarian cancer at a single tertiary institution in Korea were retrospectively analyzed. Area under the curve, sensitivity, specificity, and accuracy were assessed using the CA125 and HE4 values after surgery and 3 cycles of chemotherapy to predict 1-year survival based on the BRCA mutational status. Kaplan-Meier analysis was used to obtain progression-free and overall survival to evaluate CA125 and HE4 effectiveness in predicting survival outcomes., Results: A total of 423 patients were analyzed, including 180 (42.6%) who underwent interval debulking surgery (IDS) and 243 (57.4%) who underwent primary debulking surgery (PDS). BRCA mutations were observed in 37 (15.2%) and 44 (22.4%) patients in the PDS and IDS groups, respectively. CA125 and HE4 normalization demonstrated the highest specificity in patients with or without BRCA mutations, with specificities of 97.1% and 99.1% in the PDS group and 78.6% and 86.2% in the IDS group, respectively. Normalizing HE4 alone may be an effective prognostic marker, with an area under the curve of 0.774 and specificity of 75.0%, in patients with BRCA mutations., Conclusion: Normalizing both biomarkers emerged as the most effective predictive marker for the 1-year recurrence rate, regardless of BRCA mutational status. A negative HE4 value can be a useful predictor for 1-year recurrence-free survival in patients with BRCA mutations., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.)

Robotic esophagectomy has improved early outcomes and enhanced the quality of lymphadenectomy for esophageal cancer surgery. This study aimed to determine risk factors for long-term survival following robotic esophagectomy and the causes of long-term mortality. We included patients who underwent robotic esophagectomy at our institute between 2010 and 2022. Robotic esophagectomy was defined as a surgical procedure performed robotically in both the abdomen and thorax. Robotic esophagectomy was performed in patients at all stages, including advanced stages, even in patients with stage IV and supraclavicular lymph node metastasis. A total of 340 patients underwent robotic esophagectomy during the study period. Ivor-Lewis operation and McKeown operation were performed on 153 (45.0%) and 187 (55.0%) patients, respectively. The five-year survival rates based on clinical stages were as follows: 85.2% in stage I, 62.0% in stage II, 54.5% in stage III, and 40.3% in stage IV. Risk factors for long-term survival included body mass index, Charlson comorbidity index, clinical stages, and postoperative complications of grade 4 or higher. Among the cases of long-term mortality, recurrence accounted for 42 patients (61.7%), while non-cancer-related death occurred in 26 patients (38.2%). The most common cause of non-cancer-related death was malnutrition and poor general condition, observed in 11 patients (16.2%). Robotic esophagectomy has demonstrated the ability to achieve acceptable long-term survival rates, even in patients with cervical lymph node metastasis. However, addressing high-grade postoperative complications and long-term malnutrition remains crucial for further improving the long-term survival outcomes of patients with esophageal cancer., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study aimed to develop a machine learning (ML) model for predicting pulmonary embolism (PE) in patients with gastrointestinal cancers, a group at increased risk for PE. We conducted a retrospective, multicenter study analyzing patients who underwent computed tomographic pulmonary angiography (CTPA) between 2010 and 2020. The study utilized demographic and clinical data, including the Wells score and D-dimer levels, to train a random forest ML model. The model's effectiveness was assessed using the area under the receiver operating curve (AUROC). In total, 446 patients from hospital A and 139 from hospital B were included. The training set consisted of 356 patients from hospital A, with internal validation on 90 and external validation on 139 patients from hospital B. The model achieved an AUROC of 0.736 in hospital A and 0.669 in hospital B. The ML model significantly reduced the number of patients recommended for CTPA compared to the conventional diagnostic strategy (hospital A; 100.0% vs. 91.1%, P < 0.001, hospital B; 100.0% vs. 93.5%, P = 0.003). The results indicate that an ML-based prediction model can reduce unnecessary CTPA procedures in gastrointestinal cancer patients, highlighting its potential to enhance diagnostic efficiency and reduce patient burden., (© 2024. The Author(s).)