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This study proposes a markerless Augmented Reality (AR) surgical framework for breast lesion removal using a depth sensor and 3D breast Computed Tomography (CT) images. A patient mesh in the real coordinate system is acquired through a patient 3D scan using a depth sensor for registration. The patient mesh on the virtual coordinate system is obtained by contrast-based skin segmentation in 3D mesh generated from breast CT scans. Then, the nipple area is detected based on the gradient in the segmented skin area. The region of interest (ROI) is set based on the detection result to select the vertices in the virtual coordinate system. The mesh on the real and virtual coordinate systems is first aligned by matching the center of mass, and the Iterative Closest Point (ICP) method is applied to perform more precise registration. Experimental results of 20 patients' data showed 98.35 ± 0.71% skin segmentation accuracy in terms of Dice Similarity Coefficient (DSC) value, 2.79 ± 1.54 mm nipple detection error, and 4.69 ± 1.95 mm registration error. Experiments using phantom and patient data also confirmed high accuracy in AR visualization. The proposed method in this study showed that the 3D AR visualization of medical data on the patient's body is possible by using a single depth sensor without having to use markers. [ABSTRACT FROM AUTHOR]

Although CT radiomics has shown promising results in the evaluation of vertebral fractures, the need for manual segmentation of fractured vertebrae limited the routine clinical implementation of radiomics. Therefore, automated segmentation of fractured vertebrae is needed for successful clinical use of radiomics. In this study, we aimed to develop and validate an automated algorithm for segmentation of fractured vertebral bodies on CT, and to evaluate the applicability of the algorithm in a radiomics prediction model to differentiate benign and malignant fractures. A convolutional neural network was trained to perform automated segmentation of fractured vertebral bodies using 341 vertebrae with benign or malignant fractures from 158 patients, and was validated on independent test sets (internal test, 86 vertebrae [59 patients]; external test, 102 vertebrae [59 patients]). Then, a radiomics model predicting fracture malignancy on CT was constructed, and the prediction performance was compared between automated and human expert segmentations. The algorithm achieved good agreement with human expert segmentation at testing (Dice similarity coefficient, 0.93–0.94; cross-sectional area error, 2.66–2.97%; average surface distance, 0.40–0.54 mm). The radiomics model demonstrated good performance in the training set (AUC, 0.93). In the test sets, automated and human expert segmentations showed comparable prediction performances (AUC, internal test, 0.80 vs 0.87, p = 0.044; external test, 0.83 vs 0.80, p = 0.37). In summary, we developed and validated an automated segmentation algorithm that showed comparable performance to human expert segmentation in a CT radiomics model to predict fracture malignancy, which may enable more practical clinical utilization of radiomics. [ABSTRACT FROM AUTHOR]

Background: Intra-articular corticosteroid injection is an effective treatment for pain and to improve the range of motion (ROM) of the shoulder joint. However, consideration of when it would be effective to inject corticosteroids after rotator cuff repair is more limited. The purpose of this study was to compare the outcomes of corticosteroids injection given at 4 and 8 weeks after arthroscopic rotator cuff repair.Methods: Between December 2016 and January 2018, 42 patients who underwent arthroscopic supraspinatus tendon repair were enrolled. Nineteen patients received 40 mg of triamcinolone injection 4 weeks after surgery (group 1), while 23 patients received the same injection 8 weeks after surgery (group 2). Clinical outcome was evaluated using ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Korean Shoulder score, and a visual analog scale (VAS) score before surgery and at 3, 6, and 12 months after surgery. Tendon integrity was assessed with magnetic resonance imaging (MRI) and sonography at 12 months after surgery.Results: Significant improvements in pain and functional scores were observed at the last follow-up in both groups (p < 0.05). There was no significant difference in VAS pain score between the two groups at any time point after surgery (p > 0.05). Functional scores and ROM in all directions also showed no statistical difference between the two groups (p > 0.05). Retears of the repaired tendon, assessed at 12 months postoperatively, were observed in two patients from group 1 (10.5%) and two patients from group 2 (8.7%), thus indicating no significant difference between the two groups (p > 0.05).Conclusion: Since there was no significant difference in clinical outcomes and tendon integrity, postoperative corticosteroid injection can be individualized according to the patient for 4-8 weeks after the rotator cuff repair. [ABSTRACT FROM AUTHOR]

Although CT radiomics has shown promising results in the evaluation of vertebral fractures, the need for manual segmentation of fractured vertebrae limited the routine clinical implementation of radiomics. Therefore, automated segmentation of fractured vertebrae is needed for successful clinical use of radiomics. In this study, we aimed to develop and validate an automated algorithm for segmentation of fractured vertebral bodies on CT, and to evaluate the applicability of the algorithm in a radiomics prediction model to differentiate benign and malignant fractures. A convolutional neural network was trained to perform automated segmentation of fractured vertebral bodies using 341 vertebrae with benign or malignant fractures from 158 patients, and was validated on independent test sets (internal test, 86 vertebrae [59 patients]; external test, 102 vertebrae [59 patients]). Then, a radiomics model predicting fracture malignancy on CT was constructed, and the prediction performance was compared between automated and human expert segmentations. The algorithm achieved good agreement with human expert segmentation at testing (Dice similarity coefficient, 0.93–0.94; cross-sectional area error, 2.66–2.97%; average surface distance, 0.40–0.54 mm). The radiomics model demonstrated good performance in the training set (AUC, 0.93). In the test sets, automated and human expert segmentations showed comparable prediction performances (AUC, internal test, 0.80 vs 0.87, p = 0.044; external test, 0.83 vs 0.80, p = 0.37). In summary, we developed and validated an automated segmentation algorithm that showed comparable performance to human expert segmentation in a CT radiomics model to predict fracture malignancy, which may enable more practical clinical utilization of radiomics. [ABSTRACT FROM AUTHOR]

X-ray angiography is commonly used in the diagnosis and treatment of coronary artery disease with the advantage of visualization of the inside of blood vessels in real-time. However, it has several disadvantages that occur in the acquisition process, which causes inconvenience and difficulty. Here, we propose a novel segmentation and nonrigid registration method to provide useful real-time assistive images and information. A convolutional neural network is used for the segmentation of coronary arteries in 2D X-ray angiography acquired from various angles in real-time. To compensate for errors that occur during the 2D X-ray angiography acquisition process, 3D CT angiography is used to analyze the topological structure. A novel energy function-based 3D deformation and optimization is utilized to implement real-time registration. We evaluated the proposed method for 50 series from 38 patients by comparing the ground truth. The proposed segmentation method showed that Precision, Recall, and F1 score were 0.7563, 0.6922, and 0.7176 for all vessels, 0.8542, 0.6003, and 0.7035 for markers, and 0.8897, 0.6389, and 0.7386 for bifurcation points, respectively. In the nonrigid registration method, the average distance of 0.8705, 1.06, and 1. 5706 mm for all vessels, markers, and bifurcation points was achieved. The overall process execution time was 0.179 s. [ABSTRACT FROM AUTHOR]

As sarcopenia research has been gaining emphasis, the need for quantification of abdominal muscle on computed tomography (CT) is increasing. Thus, a fully automated system to select L3 slice and segment muscle in an end-to-end manner is demanded. We aimed to develop a deep learning model (DLM) to select the L3 slice with consideration of anatomic variations and to segment cross-sectional areas (CSAs) of abdominal muscle and fat. Our DLM, named L3SEG-net, was composed of a YOLOv3-based algorithm for selecting the L3 slice and a fully convolutional network (FCN)-based algorithm for segmentation. The YOLOv3-based algorithm was developed via supervised learning using a training dataset (n = 922), and the FCN-based algorithm was transferred from prior work. Our L3SEG-net was validated with internal (n = 496) and external validation (n = 586) datasets. Ground truth L3 level CT slice and anatomic variation were identified by a board-certified radiologist. L3 slice selection accuracy was evaluated by the distance difference between ground truths and DLM-derived results. Technical success for L3 slice selection was defined when the distance difference was < 10 mm. Overall segmentation accuracy was evaluated by CSA error and DSC value. The influence of anatomic variations on DLM performance was evaluated. In the internal and external validation datasets, the accuracy of automatic L3 slice selection was high, with mean distance differences of 3.7 ± 8.4 mm and 4.1 ± 8.3 mm, respectively, and with technical success rates of 93.1% and 92.3%, respectively. However, in the subgroup analysis of anatomic variations, the L3 slice selection accuracy decreased, with distance differences of 12.4 ± 15.4 mm and 12.1 ± 14.6 mm, respectively, and with technical success rates of 67.2% and 67.9%, respectively. The overall segmentation accuracy of abdominal muscle areas was excellent regardless of anatomic variation, with CSA errors of 1.38–3.10 cm2. A fully automatic system was developed for the selection of an exact axial CT slice at the L3 vertebral level and the segmentation of abdominal muscle areas. [ABSTRACT FROM AUTHOR]

How does local unemployment influence presidential elections? Some argue that, for voters, the state of the local economy is an afterthought to that of the national economy. On the other hand, those who argue that local unemployment matters fall into two camps. Recent research finds that local unemployment is a reputation issue that benefits Democratic candidates because voters believe they are the party best equipped to deal with the issue. Alternatively, others have posited that the local economy provides voters with information for evaluating the governing party's job performance. This view holds that the incumbent party, Democrat or Republican, will be punished when local unemployment is high. In this article, we investigate these distinct mechanisms jointly. In an individual-level mediation analysis of the 2008, 2012, and 2016 presidential elections, we present evidence that both mechanisms are at work. Rising local unemployment bolsters support for Democratic presidential candidates, but, through its influence on views of the national economy, drives down support for the incumbent, Democrat or Republican. [ABSTRACT FROM AUTHOR]

Protein–protein docking methods are spotlighted for their roles in providing insights into protein–protein interactions in the absence of full structural information by experiment. GalaxyTongDock is an ab initio protein–protein docking web server that performs rigid‐body docking just like ZDOCK but with improved energy parameters. The energy parameters were trained by iterative docking and parameter search so that more native‐like structures are selected as top rankers. GalaxyTongDock performs asymmetric docking of two different proteins (GalaxyTongDock_A) and symmetric docking of homo‐oligomeric proteins with Cn and Dn symmetries (GalaxyTongDock_C and GalaxyTongDock_D). Performance tests on an unbound docking benchmark set for asymmetric docking and a model docking benchmark set for symmetric docking showed that GalaxyTongDock is better or comparable to other state‐of‐the‐art methods. Experimental and/or evolutionary information on binding interfaces can be easily incorporated by using block and interface options. GalaxyTongDock web server is freely available at http://galaxy.seoklab.org/tongdock. © 2019 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In this paper, we propose a rapid rigid registration method for the fusion visualization of intraoperative 2D X-ray angiogram (XA) and preoperative 3D computed tomography angiography (CTA) images. First, we perform the cardiac cycle alignment of a patient's 2D XA and 3D CTA images obtained from a different apparatus. Subsequently, we perform the initial registration through alignment of the registration space and optimal boundary box. Finally, the two images are registered where the distance between two vascular structures is minimized by using the local distance map, selective distance measure, and optimization of transformation function. To improve the accuracy and robustness of the registration process, the normalized importance value based on the anatomical information of the coronary arteries is utilized. The experimental results showed fast, robust, and accurate registration using 10 cases, each of the left coronary artery (LCA) and right coronary artery (RCA). Our method can be used as a computer-aided technology for percutaneous coronary intervention (PCI). Our method can be applied to the study of other types of vessels. [ABSTRACT FROM AUTHOR]

[Display omitted] • Domain–domain docking can provide useful information when it is difficult to predict complete multidomain protein structures accurately and/or when multiple conformational states with different domain orientations are present. • GalaxyDomDock is an ab initio domain–domain docking web server that returns possible docked conformations of two given domain structures without relying on the availability of known structures or sequences of related proteins. • GalaxyDomDock utilizes an energy-based protein–protein docking method for initial sampling of possible domain orientations, Dijkstra's algorithm to filter out geometrically infeasible orientations for the given linker, and FALC loop sampling method for linker structure modeling. • GalaxyDomDock exhibits better performance than existing ab initio domain–domain docking methods such as AIDA and Rosetta. A significant proportion of proteins comprise multiple domains. Domain–domain docking is a tool that predicts multi-domain protein structures when individual domain structures can be accurately predicted but when domain orientations cannot be predicted accurately. GalaxyDomDock predicts an ensemble of domain orientations from given domain structures by docking. Such information would also be beneficial in elucidating the functions of proteins that have multiple states with different domain orientations. GalaxyDomDock is an ab initio domain–domain docking method based on GalaxyTongDock, a previously developed protein–protein docking method. Infeasible domain orientations for the given linker are effectively screened out from the docked conformations by a geometric filter, using the Dijkstra algorithm. In addition, domain linker conformations are predicted by adopting a loop sampling method FALC. The proposed GalaxyDomDock outperformed existing ab initio domain–domain docking methods, such as AIDA and Rosetta, in performance tests on the Rosetta benchmark set of two-domain proteins. GalaxyDomDock also performed better than or comparable to AIDA on the AIDA benchmark set of two-domain proteins and two-domain proteins containing discontinuous domains, including the benchmark set in which each domain of the set was modeled by the recent version of AlphaFold. The GalaxyDomDock web server is freely available as a part of GalaxyWEB at http://galaxy.seoklab.org/domdock. [ABSTRACT FROM AUTHOR]

The original article can be found online at https://doi.org/10.1038/s41598-022-10807-7. Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-10807-7, published online 25 April 2022 The original version of this Article contained an error in the spelling of the author Min A Yoon which was incorrectly given as Min A. Yoon. [Extracted from the article]

The ability to produce sufficient power is an important factor in assuring the success of the challenging and complex cube satellite (CubeSat) missions within an extremely small size. A CubeSat has only a limited surface area on which solar panels can be installed to generate power. The incidence angle of sunlight on the solar panels also varies according to the revolution and rotation of the satellite. These are important parameters for determining the amount of power that a CubeSat can generate. In this study, we propose a concentrating photovoltaic system for CubeSats that enhances the efficiency of power generation by effectively concentrating the solar energy on the solar panels by using a multi-array lens system under the worst condition for sun incidence angle. The feasibility of using the concentrating photovoltaic system for CubeSat applications is demonstrated by power measurement tests using a solar simulator and a commercial multi-array lens under various light source angles. [ABSTRACT FROM PUBLISHER]

Objectives: To determine risk factors for transient severe motion (TSM) artifact on arterial phase of gadoxetic acid–enhanced MRI using a large cohort. Methods: A total of 2230 patients who underwent gadoxetic acid–enhanced MRI was consecutively included. Two readers evaluated respiratory motion artifact on arterial phase images using a 5-point grading scale. Clinical factors including demographic data, underlying disease, laboratory data, presence of ascites and pleural effusion, and previous experience of gadoxetic acid–enhanced MRI were investigated. Univariable and multivariable logistic regression analyses were performed to determine significant risk factors for TSM. Predictive value of TSM was calculated according to the number of significant risk factors. Results: Overall incidence of TSM was 5.0% (111/2230). In the multivariable analysis, old age (≥ 65 years; odds ratio [OR] = 2.01 [95% CI, 1.31–3.07]), high body mass index (≥ 25 kg/m2; OR = 1.76 [1.18–2.63]), chronic obstructive pulmonary disease (OR = 6.11 [2.32–16.04]), and moderate to severe pleural effusion (OR = 3.55 [1.65–7.65]) were independent significant risk factors for TSM. Presence of hepatitis B (OR = 0.66 [0.43–0.99]) and previous experience of gadoxetic acid–enhanced MRI (OR = 0.52 [0.33–0.83]) were negative risk factors for TSM. When at least one of the significant factors was present, the predictive risk was 5.7% (109/1916), whereas it was 16.3% (17/104) when at least four factors were present. Conclusion: Knowing risk factors for transient severe motion artifact on gadoxetic acid–enhanced MRI can be clinically useful for providing diagnostic strategies more tailored to individual patients. Key Points: • Old age, high body mass index, chronic obstructive pulmonary disease, and moderate to severe pleural effusion were independent risk factors for transient severe motion artifact on gadoxetic acid–enhanced MRI. • Patients with hepatitis B or previous experience of gadoxetic acid–enhanced MRI were less likely to show transient severe motion artifact. • As the number of risk factors for transient severe motion artifact increased, the predicted risk for it also showed a tendency to increase. [ABSTRACT FROM AUTHOR]

The impact of myosteatosis on septic patients has not been fully revealed. The aim of the study was to evaluate the impact of the myosteatosis area and percentage on the 28-day mortality in patients with septic shock. We conducted a single center, retrospective study from a prospectively collected registry of adult patients with septic shock who presented to the emergency department and performed abdominal computed tomography (CT) from May 2016 to May 2020. The myosteatosis area defined as the sum of low attenuation muscle area and intramuscular adipose tissue at the level of the third lumbar vertebra was measured by CT. Myosteatosis percentages were calculated by dividing the myosteatosis area by the total abdominal muscle area. Of the 896 patients, 28-day mortality was 16.3%, and the abnormal myosteatosis area was commonly detected (81.7%). Among variables of body compositions, non-survivors had relatively lower normal attenuation muscle area, higher low attenuation muscle area, and higher myosteatosis area and percentage than that of survivors. Trends of myosteatosis according to age group were different between the male and female groups. In subgroup analysis with male patients, the multivariate model showed that the myosteatosis percentage (adjusted OR 1.02 [95% CI 1.01–1.03]) was an independent risk factor for 28-day mortality. However, this association was not evident in the female group. Myosteatosis was common and high myosteatosis percentage was associated with short-term mortality in patients with septic shock. Our results implied that abnormal fatty disposition in muscle could impact on increased mortality, and this effect was more prominent in male patients. [ABSTRACT FROM AUTHOR]

Background. The present study aimed to evaluate the correlation between hepatic steatosis (HS), determined by biopsy, and visceral adiposity, measured by computed tomography (CT), in overweight or obese potential living liver donors, and to investigate the risk factors for overweight or obese nonalcoholic fatty liver disease (NAFLD). Methods. This retrospective study included 375 overweight or obese (body mass index ≥23 kg/m2) potential living liver donors (mean age, 30.4 ± 9.5 years; 273 men) who underwent liver biopsies and abdominal CT examinations in 2017 and 2018. Anthropometry, laboratory parameters, body composition, and HS were assessed. Correlations were analyzed using Pearson's correlation coefficient, and logistic regression was used to identify independent predictors of overweight or obese NAFLD. Results. Visceral fat area (VFA) was positively correlated with the degree of HS in men (r = 0.307; P <.001) and women (r = 0.387; P <.001). Multivariable logistic regression analysis showed that alanine aminotransferase (odds ratio [OR], 1.017; 95% confidence interval [CI], 1.001-1.033; P =.033) and VFA (OR, 1.015; 95% CI, 1.008-1.022; P <.001) were independent risk factors for overweight or obese NAFLD in men, and VFA (OR, 1.029; 95% CI, 1.011-1.047; P =.002) was an independent risk factor for overweight or obese NAFLD in women. Conclusion. Visceral adiposity was positively correlated with the degree of HS in overweight or obese potential living liver donors. Additionally, visceral adiposity may be an independent risk factor for overweight or obese NAFLD in potential living liver donors. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aimed to investigate the relationship between hepatic steatosis (HS) evaluated by biopsy and visceral adiposity assessed by computed tomography in lean living liver donor candidates and to determine the risk factors for lean non‐alcoholic fatty liver disease (NAFLD). Methods: This retrospective study included 250 lean (body mass index, < 23 kg/m2) potential living liver donors (mean age, 31.1 ± 8.6 years; 141 men) who had undergone liver biopsy and abdominal computed tomography between 2017 and 2018. Anthropometry, laboratory parameters, body composition, and the degree of HS were evaluated. Logistic regression was used to identify independent predictors of lean NAFLD. Results: The visceral fat area (VFA) was significantly correlated with the degree of HS in men (r = 0.408; P < 0.001) and women (r = 0.360; P < 0.001). The subcutaneous fat area was significantly correlated with the degree of HS in men (r = 0.398; P < 0.001), but not in women. The skeletal muscle area did not correlate with the degree of HS in either men or women. In the multivariable logistic regression analysis, the VFA (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.013–1.044; P < 0.001) and subcutaneous fat area (OR, 1.016; 95% CI, 1.004–1.028; P = 0.009) were independent risk factors for lean NAFLD in men, and the VFA (OR, 1.036; 95% CI, 1.013–1.059; P = 0.002) was an independent risk factor for lean NAFLD in women. Conclusions: The severity of non‐alcoholic fatty liver was positively correlated with visceral fat accumulation in a lean Asian population. Visceral adiposity may be a risk factor for lean NAFLD in potential living liver donors. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the amount of decrease in coercive field of congruent lithium niobate during repeated poling and back-poling was measured. The polarization is reversed in 300ms and then back-poled during the rest period. The coercive field can be decreased around 1kV/mm with a repeated poling interval of 5s. As the interval prolonged, the poling field decrease became smaller, and a stretched exponential function is suggested for the experimental fitting resulting in a set of meaningful parameters. These values are essential for the design of high quality domain engineering. [Copyright &y& Elsevier]

Purpose: We aimed to evaluate changes in hepatic volume and hemiliver volume percentage in potential liver donors after hepatic steatosis (HS) reduction through lifestyle modification. Methods: Fifty liver donor candidates with HS (macrovesicular fat [MaF] ≥ 20%) underwent abdominal computed tomography (CT) and liver biopsy before (baseline) and after (follow-up) lifestyle modification. According to the change in MaF, subjects were classified as group A (MaF reduction ≥ 20%, n = 25), and group B (MaF reduction < 20%, n = 25). The hepatic volume and hemiliver volume percentage were measured using CT volumetric analysis. Results: Volume percentage of the left hemiliver + S1 (over the whole liver) significantly increased at follow-up in group A (P < 0.001) but not in group B (P = 0.598). The absolute volume change of the right hemiliver and its percentage change from the baseline were significantly greater than those of the left hemiliver + S1 in group A (P < 0.007). There were no significant differences in these values in group B (P = 0.064 and 0.507, respectively). The percentage of subjects that earned the benefit of becoming suitable donors from the change in hepatic volume distribution caused by HS improvement was 52.0% (13/25) and 40.0% (10/25) in group A and group B, respectively. Regarding posthepatectomy liver failure, none was identified in group A after donation, whereas 12% (3/25) was identified in group B. Conclusion: Hepatic volume profile may change considerably in potential liver donors with HS (MaF ≥ 20%) after HS reduction through lifestyle modification. Reevaluation of the hepatic volume is required before liver procurement after lifestyle modification in these subjects. [ABSTRACT FROM AUTHOR]

Background: Patients with gastric cancer have an increased nutritional risk and experience a significant skeletal muscle loss after surgery. We aimed to determine whether muscle loss during the first postoperative year and preoperative nutritional status are indicators for predicting prognosis.Methods: From a gastric cancer registry, a total of 958 patients who received curative gastrectomy followed by chemotherapy for stage 2 and 3 gastric cancer and survived longer than 1 year were investigated. Clinical and laboratory data were collected. Skeletal muscle index (SMI) was assessed based on the muscle area at the L3 level on abdominal computed tomography.Results: Preoperative nutritional risk index (NRI) and postoperative decrement of SMI (dSMI) were significantly associated with overall survival (hazards ratio: 0.976 [95% CI: 0.962-0.991] and 1.060 [95% CI: 1.035-1.085], respectively) in a multivariate Cox regression analysis. Recurrence, tumor stage, comorbidity index were also significant prognostic indicators. Kaplan-Meier analyses exhibited that patients with higher NRI had a significantly longer survival than those with lower NRI (5-year overall survival: 75.8% vs. 63.0%, P <  0.001). In addition, a significantly better prognosis was observed in a patient group with less decrease of SMI (5-year overall survival: 75.7% vs. 66.2%, P = 0.009). A logistic regression analysis demonstrated that the performance of preoperative NRI and dSMI in mortality prediction was quite significant (AUC: 0.63, P <  0.001) and the combination of clinical factors enhanced the predictive accuracy to the AUC of 0.90 (P <  0.001). This prognostic relevance of NRI and dSMI was maintained in patients experiencing tumor recurrence and highlighted in those with stage 3 gastric adenocarcinoma.Conclusions: Preoperative NRI is a predictor of overall survival in stage 2 or 3 gastric cancer patients and skeletal muscle loss during the first postoperative year was significantly associated with the prognosis regardless of relapse in stage 3 tumors. These factors could be valuable adjuncts for accurate prediction of prognosis in gastric cancer patients. [ABSTRACT FROM AUTHOR]

Simple Summary: The average human life expectancy is increasing worldwide, which is leading to increases in the proportion of elderly patients (≥80 years) with gastric cancer. Endoscopic submucosal dissection (ESD) is widely regarded as a safe and effective treatment for early gastric cancer (EGC), even in aged or high-risk patients. We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90–0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03–1.37; p = 0.018) showed that ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. Background/Aim: We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. Methods: Between 2005 and 2016, 280 patients aged ≥ 80 years with 289 EGCs underwent ESD at a tertiary care center. The short- and long-term survival outcomes were assessed. Cox regression analysis was used to identify factors associated with survival, including clinicopathologic factors and abdominal muscle area measured by computed tomography. Results: The rates of en bloc, R0, and, curative resection were 99.3%, 90.0%, and 69.2%, respectively. The rates of post-ESD bleeding and perforation rates were 2.1% and 3.1%, respectively, and no cases showed significant life-threatening adverse events. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90–0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03–1.37; p = 0.018) were significant factors associated with overall survival. Conclusions: ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. These results suggest the need for a possible extension of the curative criteria for ESD in elderly patients with EGC. [ABSTRACT FROM AUTHOR]