Korea Centers Research Articles

Correction to: Left Ventricular Diastolic Dysfunction and Progression of Chronic Kidney Disease: Analysis of KNOW-CKD Data.

HomeJournal of the American Heart AssociationAhead of PrintCorrection to: Left Ventricular Diastolic Dysfunction and Progression of Chronic Kidney Disease: Analysis of KNOW‐CKD Data Open AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessCorrectionPDF/EPUBCorrection to: Left Ventricular Diastolic Dysfunction and Progression of Chronic Kidney Disease: Analysis of KNOW‐CKD Data Originally published21 Feb 2023https://doi.org/10.1161/JAHA.122.027609Journal of the American Heart Association. 2023;0:e027609This article corrects the followingClinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality‐of‐Life Score: The CODE‐AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) RegistryIn the article Eunjeong Kang et al, “Left Ventricular Diastolic Dysfunction and Progression of Chronic Kidney Disease: Analysis of KNOW‐CKD Data,” which published online June 29, 2022 (J Am Heart Assoc. 2022;11:e025956. doi: 10.1161/JAHA.122.025956) and was included in the July 5, 2022 issue of the journal, a correction was needed.The authors mistakenly provided an incorrect grant number in their Sources of Funding statement. The correct grant number from the Bio and Medical Technology Development Program of the National Research Foundation, funded by the Korean government is 2017M3A9E4044649.The Sources of Funding statement now reads:“This study was supported by a Research Program funded by the Korea Center for Disease Control and Prevention (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, 2016E3300201, 2016E3300202, 2019E320100, 2019E320101, 2019E320102, and 2022‐11‐007) and the Bio and Medical Technology Development Program of the National Research Foundation, funded by the Korean government (No. 2017M3A9E4044649).”The authors regret the error.The online version of the article has been updated and is available here: https://www.ahajournals.org/doi/10.1161/JAHA.122.025554. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesClinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality‐of‐Life Score: The CODE‐AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) RegistryJu Youn Kim, et al. Journal of the American Heart Association. 2022;11 Article InformationMetrics Copyright © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.https://doi.org/10.1161/JAHA.122.027609PMID: 36802852 Originally publishedFebruary 21, 2023 PDF download

Association between dietary habits and incident thyroid cancer: A prospective cohort study.

In addition to the thyroid cancer (TC) risk from lifestyle and environmental factors such as radiation exposure, some studies have indicated that diet may affect TC development; however, previous findings are inconsistent. The objective of our study was to investigate the association between dietary habits and TC risk in a Korean population. A total of 13,973 participants were selected after excluding ineligible subjects from the Cancer Screenee Cohort at National Cancer Center in Korea from October 2007 to December 2021. Participants were followed until May 2022 to identify incident TC cases. Information on dietary habits and general characteristics was collected using a self-report questionnaire administered at enrollment without keeping track of changes in eating habits during the follow-up period. A Cox proportional hazards model was used to determine the hazard ratio (HR) and 95% confidence interval (CI) of TC risk for each dietary factor. A total of 138 incident TC cases were identified during the median follow-up period of 7.6 years. Of the 12 dietary habits evaluated, only two habits showed significant associations with TC. A significantly decreased TC risk was found among participants who consumed milk and/or dairy products 5 or more days a week [adjusted HR (aHR), 0.58; 95% CI, 0.39-0.85]. Notably, a stronger protective effect of dairy consumption was observed in participants aged ≥ 50 years (aHR, 0.44; 95% CI, 0.26-0.75), in women (aHR, 0.53; 95% CI, 0.35-0.81), and in non-smokers (aHR, 0.60; 95% CI, 0.39-0.92). There was a reduced risk of TC in participants with meal durations longer than 10 min (aHR, 0.58; 95% CI, 0.41-0.83). However, this association was limited to individuals aged ≥ 50 years (aHR, 0.49; 95% CI, 0.31-0.79), women (aHR, 0.61; 95% CI, 0.41-0.90), and non-smokers (aHR, 0.62; 95% CI, 0.41-0.92). Our findings suggest that consuming milk and/or dairy products 5 or more days a week and having a meal duration longer than 10 min could be protective factors against TC, especially in individuals aged ≥ 50 years, women and non-smokers. Further prospective studies are needed to investigate the association of dietary intake with specific types of TC.

Association between number of hyperbaric oxygen therapy sessions and neurocognitive outcomes of acute carbon monoxide poisoning.

Hyperbaric oxygen therapy (HBO2) is recommended for symptomatic patients within 24 h of carbon monoxide (CO) poisoning. Currently, there is no consensus on the number of HBO2 sessions within 24 h after arrival at the hospital. Therefore, we evaluated differences in the therapeutic effects according to the number of HBO2 sessions in acute CO poisoning. This cohort study included data collected from our CO poisoning registry and prospective cohorts between January 2006 and August 2021 in a single academic medical center in South Korea. Based on the number of HBO2 sessions performed within 24 h, we classified patients into one- and multiple- (two or three) session groups. We also compared mild (non-invasive mechanical ventilation) and severe (invasive mechanical ventilation) groups. CO-related neurocognitive outcomes were measured using the Global Deterioration Scale (GDS; stages: 1-7) combined with neurological impairment at 1 month after poisoning. We classified GDS stages as favorable (1-3 stages) and poor (4-7 stages) neurocognitive outcomes. Patients belonging to a favorable group based on GDS assessment, but with observable neurological impairment, were assigned to the poor outcome group. Propensity score matching (PSM) was performed to adjust for age, sex, and related variables to identify statistical differences between groups. We analyzed the data of 537 patients between ages 16 and 70 years treated with HBO2. After PSM, there was no significant difference in neurocognitive outcomes at 1 month among the two groups of patients (p = 0.869). Furthermore, there were no significant differences in neurocognitive outcomes between invasive mechanical ventilation and non-invasive mechanical ventilation patients in the three groups (p = 0.389 and p = 0.295). There were no significant differences in the reduction of poor neurocognitive outcomes according to the number of HBO2 sessions implemented within 24 h of CO exposure.

Effects of a cognitive-based intervention program using social robot PIO on cognitive function, depression, loneliness, and quality of life of older adults living alone.

Social robot interventions are being implemented to reduce cognitive decline, depression, and loneliness among older adults. However, the types, functions, and programs of effective social robots have not yet been confirmed. This study investigated whether a social robot intervention is effective in improving cognitive function, depression, loneliness, and quality of life in older adults living alone. This study used a non-equivalent control group pre-test-post-test design. It was conducted twice a week, with each session lasting 50 mi; twelve sessions were conducted over 6 weeks. This study was conducted at three senior welfare centers in Korea. In each group, 10 or fewer participants used the PIO social robot. The total participants included 64 people in the experimental (n = 31) and control groups (n = 33), and consisted of older people over 65 years of age living alone. There was a statistically significant difference in the pre-post values for cognitive function (z = 5.21, p < 0.001), depression (z = -2.99, p = 0.003), and loneliness (t = -4.27, p < 0.001) in the experimental and control groups. However, there was no statistically significant difference for quality of life (z = 1.84, p = 0.066). It was confirmed that a cognitive intervention program using the social robot PIO can improve cognitive function and reduce depression and loneliness in older adults living alone.

Surge of Chlamydia pneumoniae pneumonia in children hospitalized with community-acquired pneumonia at a single center in Korea in 2016

Community-acquired pneumonia (CAP) is a common cause of morbidity in children. Bacterial pathogens causing CAP in children, such as Streptococcus pneumoniae, are well known; however, pathogens responsible for atypical pneumonia, such as Chlamydia pneumoniae (C. pneumoniae), and excluding Mycoplasma pneumoniae (M. pneumoniae), are underestimated in children due to challenges with interpretation at diagnosis, varying prevalence, and disease severity [1].

Tumor mutational burden as a potential predictive marker for the efficacy of immunotherapy in advanced gastric cancer.

324 Background: Tumor mutational burden (TMB) is known as an independent predictive factor in predicting treatment response of immunotherapy. We aimed to evaluate the efficacy of immunotherapy in advanced gastric cancer (AGC) according to TMB and other markers. Methods: The patients with AGC, aged ≥ 18, who received pembrolizumab or nivolumab from October 1, 2020, to July 27, 2021, at Samsung medical center in Korea, were analyzed retrospectively. TMB was measured by next-generation sequencing-based assays, and PD-L1 is tested using immunohistochemical assay 22C3 pharmDx. Referring to the results of previous studies, TMB-high was defined as 14.31 mutations/megabase (mt/Mb) or above. Results: A total of 54 AGC patients who were treated with immunotherapy, pembrolizumab or nivolumab, were analyzed. Seven patients were TMB-high, and 47 patients were TMB-low. Compared to TMB-low group, TMB-high group showed higher overall response rate (ORR) (42.9% vs 6.4%, p=0.023), and disease control rate (66.7% vs. 22.9%; p=0.033). The median OS was longer in the TMB-high group with 22.4 months (95% CI, 19.738-25.115), while the TMB-low group with 3.6 months (95% CI, 2.109-5.104; p=0.020). In addition to TMB, microsatellite status was statistically significantly associated with the efficacy of immunotherapy in AGC. Microsatellite instability group had better ORR (n=3/4, 75%) compared to microsatellite stable group (n=4/50, 8.0%; p=0.005). Other than that, the ORR of the patients whose PD-L1 CPS was 1 or above did not differ from the patients whose PD-L1 CPS was lower than 1. Although there was no statistical significance, among TMB-low patients, PD-L1 CPS ≥1 group numerically exhibited a higher overall response rate (13.0% vs 4.0%; p=0.338). Conclusions: In our analysis, the cut-off value of TMB was set to 14.31mb/Mt, and TMB-high was associated with the better ORR and OS of immunotherapy in AGC. TMB could be a potential predicting marker for a therapeutic response of immunotherapy in AGC.[Table: see text]

Establishment and validation of reference intervals for tumor markers (AFP, CEA, CA19-9, CA15-3, CA125, PSA, HE4, Cyfra 21-1, and ProGRP) in primary care centers in Korea: A cross-sectional retrospective study.

The reference interval (RI) for a tumor marker may vary between populations, detection systems, and the methods used to obtain their values. The aims of this study were to establish age- and sex-specific RIs for the following nine common tumor markers and to validate the established RIs in Korean adults: alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), cancer antigen (CA)19-9, CA15-3, CA125, Human epididymis protein 4 (HE4), total prostate specific antigen, cytokeratin fragment (Cyfra) 21-1, and progastrin-releasing peptide (ProGRP). This cross-sectional study consecutively selected 214,159 individuals (aged 18-98 years) who underwent health checkups at 16 health-promotion centers in 13 Korean cities. Finally, 62,752 examinees were used to establish the RIs after removing outliers. RIs were established using an indirect method according to the CLSI EP28-A3C guideline. The established RIs were validated by calculating the proportion of individuals outside each RI. Sex-related differences were observed for AFP, CEA, CA19-9, Cyfra 21-1, and ProGRP (p < 0.05): AFP, CEA and Cyfra 21-1 were higher in males, and CA19-9 and proGRP were higher in females. Most of the tumor markers except CA15-3 and CA125 increased with age: CA125 decreased at ≥50 years of age (p < 0.05), while CA15-3 did not vary with age. Less than 5% of subjects were outside all RIs (the 2.5th and 97.5th percentiles) established in the present study. Meanwhile, less than 3% of the healthy reference subjects fell outside the current and manufacturers' RIs of all tumor markers except Cyfra 21-1. This study has determined age- and sex-specific RIs for nine common tumor markers in the healthy Korean population, which could be useful for clinicians making clinical decisions and assessments.

A phase II clinical trial to study the use of cabozantinib (cabo) in patients with hepatocellular carcinoma (HCC) post immunotherapy treatment.

571 Background: There has been a lack of prospective clinical trial data on subsequent treatment after immune checkpoint inhibitor (ICI)-based treatment in HCC. To address this question, we designed and completed a phase II multicentred study to evaluate the use of cabo in HCC after prior ICI-based treatment. Methods: This is an investigator-initiated clinical trial involving 3 academic centres in Hong Kong and Korea. Key eligibility criteria include confirmed diagnosis of HCC; refractoriness to prior ICI-based treatment; duration of prior ICI-based treatment ≥2 months; Child's A liver function; ECOG performance status 0-2; maximal 2 lines of therapy. All patients (pts) were started cabo at 60mg once daily to progressive disease or intolerable toxicity. The primary endpoint is progression-free survival (PFS). Other secondary endpoints including response rate (RR) according to the RECIST, overall survival (OS) and treatment-related adverse event (TRAE). Total sample size is 48 (one-sided alpha 0.05; power 80%). Results: Total 48 pts were recruited from Oct 2020 to May 2022. Data were frozen on 1 Aug 2022 for analyses. The median follow-up was 11.2m. Seven (14.9%) pts remained on treatment; 1pt was found to ineligible and excluded from the analysis. The median age is 61 (Range 36-83). Aetiology of HCC: HBV 34 (72.3%); HCV 2 (4.3%); alcoholic 8 (17%); Most pts have BCLC stage C (93.6%). All pts have Child’s A liver function. Total 39 (83%) pts receive ICI-based first-line therapy, and 19 (40.4%) pts have prior atezolizumab-bevacizumab (AB) treatment. The median PFS is 4.1m (95% CI 3.3-5.3). Regarding RR, PR and SD occurs in 3 (6.4%) and 36 (76.6%) pts, respectively. The median OS is 9.9m (95% CI 7.3-14.4) and the 1-year survival rate is 45.3%. Amongst the 19 pts receiving prior AB treatment, the median OS is 14.3m (95% CI: 5.5-14.4) with 1-year survival rate of 50.7%. For non-AB regimen, the median OS is 8.9m (95% CI 6.1-NR) with 1-year survival rate of 42.0%. Commonest G3-4 TRAE is thrombocytopenia (6%); hypertension (4%) and ALT elevation (4%).The median dose of cabo is 41.6mg per day (range: 24.3-60.0 mg). Conclusions: Post-ICI use of cabo is associated with a median PFS of 4.1m and median OS of 9.9m. AB-cabo sequence appears to have more favourable outcome than non-AB-cabo sequence. No new safety signals were observed. This clinical trial reports the first prospective post-ICI survival data on TKI. Clinical trial information: NCT04588051 .

The efficacy of capecitabine as a salvage treatment in metastatic colorectal cancer after prior 5-fluorouracil–included chemotherapies.

54 Background: We aimed to retrospectively analyze the efficacy and toxicity of capecitabine, as a salvage treatment, in metastatic colorectal cancer (mCRC) that progressed after prior standard 5FU included chemotherapies. Methods: From January 1, 2008, to December 31, 2017, patients with mCRC, age ≥ 18, who received capecitabine as third- or fourth-line treatment at five different centers in South Korea, were included. All had disease progression on prior palliative chemotherapies including 5FU, oxaliplatin, and/or irinotecan. Results: A total of 131 patients were analyzed with a median age of 62 (range, 35-87). Almost all patients were exposed to prior 5FU (100%), irinotecan (100%), and oxaliplatin (98.5%). Patients were treated with cetuximab (26.7%), or bevacizumab (45.8%) before capecitabine. The median and mean duration from the last 5FU exposure to capecitabine start were 21 and 67.3 days, respectively (range, 5-1322). The objective response rate (ORR) of capecitabine was 3.6%, and the disease control rate was 30.4%. The median progression free survival (mPFS) and median overall survival (mOS) was 2.77 (95% CI, 2.495-3.045) and 9.60 months (95% CI, 7.625-11.575), respectively. There was a significant difference in efficacy according to the duration from the last 5FU exposure to the time of starting capecitabine. Compared to patients who started capecitabine earlier than 67 days after the last 5-FU administration, those who started capecitabine later than that time showed higher ORR (11.1% vs 1.2%; p-value = 0.043), mPFS (4.430 (95% CI, 2.274-6.586) vs 2.570 months (95% CI, 2.326-2.814); p-value = 0.011), and mOS (14.070 (95% CI, 5.627-22.513) vs 9.500 months (95% CI, 7.370-11.630, p-value = 0.021) (Table). 68.7% patients experienced any grade of adverse events, but only 4.6% complained grade 3 or higher. There was no treatment related death. Conclusions: Capecitabine showed modest antitumor activity with good tolerability in mCRC patients whose disease progressed after oxaliplatin and/or irinotecan. It could be considered as an alternative treatment option for mCRC patients, especially for those who have longer treatment free interval after 5FU based chemotherapies. [Table: see text]

Short-Term Safety and Efficacy of Intravitreal Brolucizumab Injections for Neovascular Age-Related Macular Degeneration: A Multicenter Retrospective Real-World Study

Introduction: The aim of the study was to determine the short-term real-world safety and efficacy of intravitreal brolucizumab injections in Korean patients with neovascular age-related macular degeneration (nAMD). Methods: This multicenter retrospective study involved 294 eyes (treatment naïve 20 eye [6.8%] and nontreatment naïve 274 eyes [93.2%]) of 290 patients from 13 hospitals or retinal centers in South Korea. Patients with nAMD who received brolucizumab injection(s) between April 1 and November 30, 2021, with a follow-up ≥1 month, were included. Primary outcomes were safety, incidence of intraocular inflammation (IOI), and potential risk factors. The secondary outcome was efficacy, i.e., change in best-corrected visual acuity (BCVA) and optical coherence tomography-measured macular thickness and retinal fluid. Results: The mean age was 71.63 ± 8.66. The follow-up period was 2.38 ± 0.79 months. The mean number of brolucizumab injections during the follow-up was 1.52 ± 0.58. The overall incidence of IOI was 13.9% (n = 41 eyes). Most IOI cases were of anterior uveitis (8.8%, 26 eyes), followed by retinal vasculitis (2.4%, seven eyes) and occlusive retinal vasculitis (0.3%, one eye). Most eyes showed IOI resolution (n = 40, 97.5%) and BCVA restoration (n = 39, 95.1%) with or without corticosteroid treatment during the follow-up. Age, sex, IOI history, or other anti-vascular endothelial growth factor injection histories were not associated with the occurrence of IOI. However, only thin subfoveal choroidal thickness (SFCT) was associated with the occurrence of IOI (odds ratio = 0.995, p = 0.020). BCVA at 1 month improved from baseline (baseline 0.518 ± 0.356 vs. 1 month 0.503 ± 0.383, p = 0.023), but the improvement was not maintained. Anatomical improvement was significant after 3 months. Conclusion: In Korean patients with nAMD, the incidence of IOI following brolucizumab injections was 13.9%. IOI was well-controlled with or without steroid treatment. Most IOI eyes (95.1%) were restored to the level of vision before. IOI occurrence and occlusive vasculitis was rare. In the short term, brolucizumab injection effectively improved vision at 1 month and dried retinal fluid for 3 months.

DOP83 Proactive dosing is superior to clinically based dosing in terms of endoscopic healing in paediatric patients with Crohn’s disease receiving maintenance infliximab: A randomized controlled trial

Abstract Background Proactive dosing based on drug monitoring of adalimumab has been reported to be associated with higher rates of clinical remission in children with Crohn’s disease (CD). We aimed to investigate whether proactive drug monitoring of infliximab (IFX) is associated with higher rates of endoscopic healing (EH) in paediatric patients with CD. Methods We conducted a nonblinded, randomized controlled trial of 112 children with CD who were biologic naïve and had responded to induction treatment with IFX at 4 centers in South Korea from July 2017 to November 2020. Patients were randomly assigned to groups that received dosing based on proactive monitoring or clinically based dosing. The primary endpoint was EH at 1 year treatment. Results The primary endpoint was achieved in 80.0% (40/50) of the proactive dosing group and 57.1% (28/49) of the clinically based dosing group (P = 0.025). Transmural healing was achieved in 37.8% (17/45) of the proactive dosing group and 30.8% (12/39) of the clinically based dosing group (P = 0.657). Sustained corticosteroid-free clinical remission was achieved in 89.5% (51/57) of the proactive dosing group and 70.9% (39/55) of the clinically based dosing group (P = 0.025). Sustained durability of infliximab was observed in 94.7% (54/57) of the proactive dosing group and 92.7% (51/55) of the clinically based dosing group (P = 0.714). Conclusion Dosing based on proactive monitoring was superior to clinically based dosing in terms of endoscopic healing in a randomized controlled trial of paediatric CD.

Predictive role of absolute lymphocyte count in daratumumab-treated patients with relapsed/ refractory multiple myeloma.

Daratumumab has shown an encouraging antitumor effect in patients with multiple myeloma (MM), and was known to alter the immune properties by off-targeting immunosuppressive cells. Here, we aimed to evaluate the change in absolute lymphocyte count (ALC) as a surrogate marker for predicting survival outcomes of patients treated with daratumumab. Between 2018 and 2021, the medical records of patients with relapsed/refractory MM (RRMM) treated with daratumumab monotherapy at 10 centers in South Korea were reviewed. We collected the ALC data at pre-infusion (D0), day 2 after the first infusion (D2), and prior to the third cycle of daratumumab therapy (D56). Fifty patients who were administered at least two cycles of daratumumab were included. Overall response rate was 54.0% after two cycles of daratumumab treatment. On D2, almost all patients experienced a marked reduction in ALC. However, an increase in ALC on D56 (ALCD56) was observed in patients with non-progressive disease, whereas failure of ALC recovery was noted in those with progressive disease. Patients with ALCD56 > 700/μL (n = 39, 78.0%) had prolonged progression- free survival (PFS) and overall survival (OS) than those with ALCD56 ≤ 700/μL (median PFS: 5.8 months vs. 2.6 months, p = 0.025; median OS: 24.1 months vs. 6.1 months, p = 0.004). In addition, ALCD56 >700/μL was a significant favorable prognostic factor for PFS (hazard ratio [HR], 0.22; p = 0.003) and OS (HR, 0.23; p = 0.012). Increase in ALC during daratumumab treatment was significantly associated with prolonged survival outcomes in patients with RRMM. The ALC value can predict clinical outcomes in patients treated with daratumumab.

Comparison of cardiovascular mortality between MAFLD and NAFLD: A cohort study

Background and aimsA new diagnostic criterion of metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed. However, only few studies have shown that MAFLD predicts cardiovascular disease (CVD) mortality better than non-alcoholic fatty liver disease (NAFLD). Therefore, a cohort study was conducted to assess this relationship. Methods and resultsHealth examination data from health care centers in South Korea were assessed after excluding participants with missing covariates and cancer history (n = 701,664). Liver ultrasonography reports, laboratory and anthropometric data were extracted. Diagnoses of NAFLD and MAFLD were performed according to standard definitions. Participants were categorized based on the presence of NAFLD and MAFLD. In addition, participants were classified into five categories: no fatty liver disease (no FLD), NAFLD-only, MAFLD-only, both FLDs, and alcoholic FLD (AFLD) and non-MAFLD. Multivariable regression modeling was performed.The median follow-up duration was 8.77 years, and 52.56% of participants were men. After stratifying the cohort into no-MAFLD and MAFLD groups, MAFLD was associated with increased CVD mortality (adjusted HR 1.14, 95% CI 1.02–1.28). When participants were divided into no-NAFLD and NAFLD groups, there was a non-significant trend towards an increase in CVD mortality in NAFLD group (adjusted HR 1.07, 95% CI 0.95–1.21). When participants were divided into five categories, MAFLD-only group showed increased CVD mortality (adjusted HR 1.35, 95% CI 1.07–1.70) while NAFLD-only group showed no significant association with CVD mortality (adjusted HR 0.67, 95% CI 0.38–1.19). ConclusionsIn conclusion, MAFLD is associated with increased CVD mortality in a relatively young Korean population.

Design and Experiment of Satellite-Terrestrial Integrated Gateway with Dynamic Traffic Steering Capabilities for Maritime Communication.

This study presents the architectural design and implementation of a multi-RAT gateway (MRGW) supporting dual satellite and terrestrial connectivity that enables moving maritime vessels, such as autonomous surface ships, to be connected to multiple radio access networks in the maritime communication environment. We developed an MRGW combining LTE and very-small-aperture terminal (VSAT) access networks to realize access traffic steering, switching, and splitting functionalities between them. In addition, we developed communication interfaces between the MRGW and end-devices connecting to their corresponding radio access networks, as well as between the MRGW and the digital bridge system of an autonomous surface ship, enabling the MRGW to collect wireless channel information from each RAT end-device and provide the collected data to the digital bridge system to determine the optimal navigation route for the autonomous surface ship. Experiments on the MRGW with LTE and VSAT end-devices are conducted at sea near Ulsan city and the Kumsan satellite service center in Korea. Through validation experiments on a real maritime communication testbed, we demonstrate the feasibility of future maritime communication technologies capable of providing the minimum performance necessary for autonomous surface ships or digitized aids to navigation (A to N) systems.

Machine Learning-Based Mortality Prediction Model for Critically Ill Cancer Patients Admitted to the Intensive Care Unit (CanICU).

Although cancer patients are increasingly admitted to the intensive care unit (ICU) for cancer- or treatment-related complications, improved mortality prediction remains a big challenge. This study describes a new ML-based mortality prediction model for critically ill cancer patients admitted to ICU. We developed CanICU, a machine learning-based 28-day mortality prediction model for adult cancer patients admitted to ICU from Medical Information Mart for Intensive Care (MIMIC) database in the USA (n = 766), Yonsei Cancer Center (YCC, n = 3571), and Samsung Medical Center in Korea (SMC, n = 2563) from 2 January 2008 to 31 December 2017. The accuracy of CanICU was measured using sensitivity, specificity, and area under the receiver operating curve (AUROC). A total of 6900 patients were included, with a 28-day mortality of 10.2%/12.7%/36.6% and a 1-year mortality of 30.0%/36.6%/58.5% in the YCC, SMC, and MIMIC-III cohort. Nine clinical and laboratory factors were used to construct the classifier using a random forest machine-learning algorithm. CanICU had 96% sensitivity/73% specificity with the area under the receiver operating characteristic (AUROC) of 0.94 for 28-day, showing better performance than current prognostic models, including the Acute Physiology and Chronic Health Evaluation (APACHE) or Sequential Organ Failure Assessment (SOFA) score. Application of CanICU in two external data sets across the countries yielded 79-89% sensitivity, 58-59% specificity, and 0.75-0.78 AUROC for 28-day mortality. The CanICU score was also correlated with one-year mortality with 88-93% specificity. CanICU offers improved performance for predicting mortality in critically ill cancer patients admitted to ICU. A user-friendly online implementation is available and should be valuable for better mortality risk stratification to allocate ICU care for cancer patients.

Polygenic risk score for tumor aggressiveness and early-onset prostate cancer in Asians

We attempted to assess the performance of an ethnic-specific polygenic risk score (PRS) designed from a Korean population to predict aggressive prostate cancer (PCa) and early-onset (age < 60). A PRS score comprised of 22 SNPs was computed in 3695 patients gathered from one of 4 tertiary centers in Korea. Males with biopsy or radical prostatectomy-proven PCa were included for analysis, collecting additional clinical parameters such as age, BMI, PSA, Gleason Group (GG), and staging. Patients were divided into 4 groups of PRS quartiles. Intergroup differences were assessed, as well as risk ratio and predictive performance based on GG using logistic regression analysis and AUC. No significant intergroup differences were observed for BMI, PSA, and rate of ≥ T3a tumors on pathology. Rate of GG ≥ 2, GG ≥ 3, and GG ≥ 4 showed a significant pattern of increase by PRS quartile (p < 0.001, < 0.001, and 0.039, respectively). With the lowest PRS quartile as reference, higher PRS groups showed sequentially escalating risk for GG ≥ 2 and GG ≥ 3 pathology, with a 4.6-fold rise in GG ≥ 2 (p < 0.001) and 2.0-fold rise in GG ≥ 3 (p < 0.001) for the highest PRS quartiles. Combining PRS with PSA improved prediction of early onset csPCa (AUC 0.759) compared to PRS (AUC 0.627) and PSA alone (AUC 0.736). To conclude, an ethnic-specific PRS was found to predict susceptibility of aggressive PCa in addition to improving detection of csPCa when combined with PSA in early onset populations. PRS may have a role as a risk-stratification model in actual practice. Large scale, multi-ethnic trials are required to validate our results.

Comparisons of pathologic findings and outcomes of gastric cancer patients younger and older than 40: a propensity score matching study in a single center of Korea.

Gastric cancer (GC) is one of the most common cancers worldwide, with a high incidence rate in Korean men. However, comparative studies are scarce on the pathologic findings and treatment effects of GC in patients aged less than 40 years. We evaluated the characteristics and pathologic findings of GC patients aged younger and older than 40 years. We retrospectively analyzed 2307 patients diagnosed with GC between January 2010 and May 2018. Eighty-eight (3.8%) and 2219 (96.2%) patients were younger and older than 40 years, respectively. The patients were divided into younger (n=70) and older (n=62) age groups through propensity matching. Overall, compared to the younger group, the older group (n=2219) had a significantly higher proportion of male patients (66.7% vs 39.8%; P < 0.001) and patients who underwent endoscopic submucosal dissection (ESD) (2.3% vs 23.1%; P < 0.001). However, young patients more often underwent operations compared to older patients (78.4% vs 60.1%; P=0.001). In the propensity-matched group, older patients more often showed differentiated carcinoma, including well-differentiated (5.7% vs 11.3%) and moderately differentiated (1.4% vs 32.3%). However, younger patients more often showed signet ring cell carcinoma (SRC) (70.0% vs 25.8%). In multivariate analysis, Helicobacter pylori infection (odds ratio, 12.643; 95% confidence interval, 1.068-1449.665; P=0.044) independently correlated with SRC risk. Patients below 40 years were more likely to undergo surgery compared to ESD, and pathologic findings were more common in SRC. Therefore, more active screening and H. pylori eradication are needed even in patients aged less than 40 years.

Outcomes Following Carotid Endarterectomy and Carotid Artery Stenting in Patients with Carotid Artery Stenosis: A Retrospective Study from a Single Center in South Korea.

BACKGROUND Previous randomized controlled trials and meta-analyses comparing carotid endarterectomy (CEA) and carotid artery stenting (CAS) included a large number of patients, but the diagnosis, treatment selection, and performance were heterogeneous. This retrospective study from a single center in South Korea aimed to evaluate outcomes following CEA and CAS in patients with carotid artery stenosis. MATERIAL AND METHODS A retrospective analysis was performed using the data of patients who underwent carotid revascularization between September 2016 and June 2021 at a single institution. The primary outcomes were stroke, myocardial infarction (MI), and death during the periprocedural period. RESULTS We enrolled a total of 61 (44 symptomatic and 17 asymptomatic) patients who underwent CEA or CAS. Among them, 36 (59%) underwent CEA and 25 (41%) underwent CAS. Statistically significant differences were found between the groups in degree of carotid stenosis (CEA: 87.0±9.1, CAS: 80.5±9.3, P=0.007). All patients with confirmed plaque ulceration before carotid revascularization underwent CEA. Two (3.3%) periprocedural strokes occurred, 1 in each group, on the ipsilateral side. There were no significant differences between CEA and CAS in the event-free survival rate for stroke during the follow-up (log-rank test=0.806). CONCLUSIONS Favorable outcomes in terms of periprocedural stroke were observed. We found no significant difference between the 2 carotid revascularization techniques in the incidence of periprocedural stroke in symptomatic and asymptomatic patients. To confirm our findings, further studies involving a larger number of patients and continuous follow-up are necessary.

Impact of Left Atrial or Left Atrial Appendage Thrombus on Stroke Outcome: A Matched Control Analysis.

Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus. This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed. Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups. Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.

Draw and Tell: Uncovering Korean Infant Teachers' Play Experiences and Their Views in Supporting Infants' Play.

Using a drawing-based research approach, this qualitative study explored in-service infant teachers' reflections on their play experiences and ways of supporting and scaffolding infants' play at a childcare center in Korea. The participants engaged in a drawing task that illustrated their reflections and memories of their play. They then discussed their drawings by, answering semi-structured interview questions. An analysis of the images and comments depicted in the activity and shared in the interview revealed that participants recalled social and imaginative childhood play memories using natural objects and playing childhood games outdoors. Everyday activities were also regarded as play among the participants, and play activities changed depending on interests, personality, age, and societal situation, such as the Coronavirus pandemic. The findings revealed that infant teachers' interests and preferences influenced their decisions to structure and scaffold or discourage certain play activities in the classroom. Through play, both infants and infant teachers shared positive affect and playfulness. This study suggests a crucial need for early childhood professionals to self-reflect to understand their preferences and play experiences, contemplate how their preferences and experiences impact their teaching practice, and meaningfully integrate play activities in their classrooms.