Kyungpook National University Research Articles

IMPROVEMENT OF INCEPTIONV3 MODEL CLASSIFICATION PERFORMANCE USING CHEST X-RAY IMAGES

In this study, we attempted to confirm whether the InceptionV3 model, which shows excellent performance in lung disease classification using chest X-ray images, is suitable for cardiac disease classification. In addition, we proposed a method for improving classification accuracy by improving the structure of the existing InceptionV3 model. The deep learning model used in this study was a modified version of the fully-connected hierarchical structure of InceptionV3. The proposed InceptionV3 model structure was constructed to differentiate between a normal heart and hypertrophic heart. The data used for model training were trained after data augmentation on 1026 chest X-ray images of patients diagnosed with normal heart and cardiac hypertrophy at Kyungpook National University Hospital. The experiment showed a learning classification accuracy of 99.57% and loss of 1.42% for the original InceptionV3 model. The accuracy and loss of the modified InceptionV3 model were 99.81% and 0.92%, respectively. Its classification performance was evaluated based on precision, recall, and F1 score. For a normal heart, precision, recall and F1 score were 78%, 100% and 88%, respectively. For cardiomegaly, classification accuracy, recall and F1 score were 78%, 100% and 88%, respectively. Conversely, the modified model showed 100% precision, 92% recall and 96% F1 score. For cardiomegaly, classification accuracy, recall rate and F1 score were 95, 100 and 97%, respectively. In conclusion, better classification can be achieved if the chest X-ray images for a normal heart and cardiomegaly are classified using the proposed model. Hence, the reliability of the classification performance gradually increases.

Comparison of carotid artery calcification between stroke and nonstroke patients using CT angiographic and panoramic images.

This study aimed to analyze the characteristics of carotid artery calcification (CAC) in stroke and nonstroke patients using computed tomography angiographic (CTA) and panoramic images. This is a retrospective study on patients who acquired both CTA and panoramic images at the Neurology Department of Kyungpook National University Hospital, Daegu, South Korea, between 2011 and 2016. The patients were divided into stroke (n = 109) and nonstroke (n = 355) groups based on the final diagnosis. CAC was analyzed in each group based on its presence, shape, and severity using the [Formula: see text]2 test. The differences in age and sex between the two groups were examined using a two-sample t-test. A measure of intraobserver reliability was obtained using Cohen's κ index. CAC was more frequently observed in the stroke group than in the nonstroke group using both CTA (stroke group, 100%; nonstroke group, 23.1%) and panoramic (stroke group, 83.5%; nonstroke group, 16.6%) images. Although scattered CAC shape and mild severity occupied the largest portion in both groups, vessel-outlined CAC was more common in nonstroke patients than in stroke patients. In age and sex analyses, only females patients in their 70 s showed significant differences in CAC shape between the stroke and nonstroke groups. On both CTA and panoramic images, although CAC is found more frequently in the stroke group, vessel-outlined-shaped CAC in the nonstorke group shows significant differences compared to other shapes.

Mammary Adenoma Associated with Chronic Mastitis in a Wild Boar (Sus Scrofa)

Abstract Mammary gland tumor is rare and only a few cases have been reported in wild animals. Moreover, most etiologies of the known cases in veterinary medicine are related to age, diet, obesity, and excessive sex hormones in domestic animals while few etiologies are reported in wild animals. An unknown-aged female wild boar was presented to the Department of Veterinary Pathology, Kyungpook National University with a well-demarcated, and firm-to-elastic mammary gland mass. The cut-surface of the mass was pink-reddish, and homogeneous. Microscopically, the mass was mainly composed of well-differentiated neoplastic glandular epithelial cells characterized by a single-layer, columnar to cuboidal shapes, and small and central nuclei and nucleoli. Any evidence of invasiveness or metastases of the neoplastic cells were not observed. Interestingly, infiltration of chronic inflammatory cells such as plasma cells and macrophages was observed along with a large quantity of gram-negative and positive bacterial colonies in the mammary glands. Moreover, accompanied fibrosis of stroma was observed, as well. Based on the gross and microscopic findings, the present case was diagnosed as mammary simple adenoma caused by chronic mastitis progressing to fibrotic condition. To the authors’ knowledge, this is the first study describing the histopathological aspects of mammary gland tumors associated with chronic mastitis accompanied by fibrosis in wild animals.

"예비 한국어 교원의 수업 발화 분석 - 교안과 모의수업에 나타난 교사 발화의 비교를 통해 -"

This study attempted to examine the relationship between teacher speech realized in the lesson plan and the teacher speech realized in the actual class by analyzing the teacher speech shown in the mock class of prospective Korean teachers. This study is meaningful in that it attempted to collect and analyze teacher speech in actual classes, and in particular, to reveal how teacher speech in the lesson plan is adjusted in the actual class. The types of linguistic modification shown in teacher speech of prospective Korean teachers were analyzed as first, when they spoke content that was not in the lesson plan, second, when they did not speak content in the lesson plan, and third, when they modified the contents of the lesson plan. Based on the analysis results, education plans for prospective Korean teachers were proposed in three aspects: lesson plan education, teacher speech education, and instructional diary writing education. The analysis results of this study are expected to help prospective Korean teachers write the lesson plan as perfectly as possible and realize the contents of the lesson plan in the actual class, thereby helping to realize modified and appropriate teacher speech. (Kyungpook National University)

Risk factors of trauma-induced thrombotic microangiopathy-like syndrome: A retrospective analysis.

Patients with trauma may develop thrombocytopenia. We encountered cases wherein patients experienced symptoms resembling thrombotic microangiopathies (TMAs) following severe trauma. As the condition of these patients did not meet the diagnostic criteria of thrombotic thrombocytopenic purpura and there was no mention of trauma among the several causes of TMAs, it was termed as “trauma-induced thrombotic microangiopathy-like syndrome” (t-TMAS). In this study, we aimed to analyze the risk factors that may affect the incidence of t-TMAS in patients with severe trauma. This retrospective study was conducted in the trauma intensive care unit at the Kyungpook National University Hospital between January 2018 and December 2019. The medical records of 1164 of the 1392 enrolled participants were analyzed. To assess the risk factors of t-TMAS, we analyzed age, sex, mechanism of trauma, abbreviated injury scale (AIS) score, injury severity score (ISS), hematological examination, and red blood cell volume transfused in 24 hours. Among the 1164 patients, 20 (1.7%) were diagnosed with t-TMAS. The univariate analysis revealed higher age, ISS, and myoglobin, lactate, creatine kinase-myocardial band (on admission), creatine phosphokinase, lactate dehydrogenase (LDH), and lactate (day 2) levels in the t-TMAS group than in the non-t-TMAS group. The red blood cell volume transfused in 24 hours was higher in the t-TMAS group than in the non-t-TMAS group. t-TMAS was more common in patients with injuries in the chest, abdomen, and pelvis (AIS score ≥3) than in those with head injuries (AIS score ≥3) alone. The higher the sum of AIS scores of the chest, abdomen, and pelvis injuries, the higher the incidence of t-TMAS. Multivariate analysis revealed age, ISS, and LDH level (day 2) to be independent predictors of t-TMAS. Trauma surgeons should consider the possibility of t-TMAS if thrombocytopenia persists without any evidence of bleeding, particularly among older patients with multiple severe torso injuries who have high LDH levels on day 2. Early diagnosis and treatment of t-TMAS could improve patients’ prognosis.

Emerging Research Trend in Chemical Technology Towards Sustainable Development

The rapid industrialization and urbanization as well as rising global transportation have induced numerous challenges regarding energy security, environmental protection, waste management, and greenhouse gas emissions across the world. Addressing these current issues is crucial to guarantee the sustainable development, green environment, and circular economy. The implementation of advanced chemical technology in industrial production, worldwide transportation, and environmental treatment could contribute to efficiently solve these global challenges. This special issue of Chemical Engineering & Technology highlights the recent research trends in chemical technology towards sustainable development such as advanced material synthesis from various waste sources, biological and thermochemical processes for alternative biofuels and chemicals production. In particular, the synthesis of polysulfide from waste cooking palm oil and the production of hybrid films reinforced with cellulose nanofibers used as packaging materials are thoroughly discussed. Additionally, a comprehensive review regarding waste biomasses transformation to value-added biofuels and biochemicals via thermochemical processes, namely, liquefaction, gasification, torrefaction, and pyrolysis, is presented in this special issue. The environmental benefits associated with these approaches are also underlined. Computer-aided methods including simulation, modeling, and optimization of different chemical engineering processes for energy and environmental applications are offered as well. The contribution from authors across the world to this thematic issue is highly appreciated. The guest editors also acknowledge the valuable effort and constructive comments from reviewers for manuscript assessment. Lastly, we would like to appreciate the Editor in Chief Dr. Barbara Böck and the entire editorial office for their valuable support and guidance during the completion of this topical issue. Dr. Dai-Viet N. Vo, Institute of Applied Technology and Sustainable Development, Nguyen Tat Thanh University, Vietnam Dr. Sumaiya Zainal Abidin, Department of Chemical Engineering, College of Engineering, Universiti Malaysia Pahang, Malaysia Dr. P. Senthil Kumar, Department of Chemical Engineering, Sri Sivasubramaniya Nadar College of Engineering, India Dr. Muthusamy Govarthanan, Department of Environmental Engineering, Kyungpook National University, South Korea Dai-Viet N. Vo Sumaiya Zainal Abidin P. Senthil Kumar Muthusamy Govarthanan

Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermal matrix

BackgroundSeveral studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermal matrix (ADM) prosthesis to achieve full coverage. However, methods for anterior coverage have rarely been reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and determine its functional and cosmetic outcomes as well as compare them with those of existing subpectoral DTI techniques.MethodsThis prospective comparative study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control group) and anterior coverage prepectoral implant insertion (anterior coverage group), respectively. Postoperative complications were noted, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) scale was used to assess the patient’s subjective satisfaction with the reconstruction and postoperative quality of life.ResultsNo remarkable differences in terms of complications (seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection) were noted in both groups. Compared with controls, considerably better results were observed among those in the anterior coverage group in terms of the mean drain removal period. Furthermore, those in the anterior coverage group showed greater symmetry on three-dimensional scans than the controls; however, this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different between both groups.ConclusionsConsidering its stability, faster recovery time, and cosmetic benefit, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good choice to perform breast reconstruction with implant insertion in patients who have undergone mastectomy.Level of evidence: II.

Do We Need Safety Nets for Outsourced Computer-Aided Orthognathic Planning? A Two-Center Analysis

While the accuracy, cost-effectiveness, and time-efficiency of computer-aided orthognathic surgical planning (CAOP) have been studied, little is known about the influence of logistical factors of outsourced CAOP (OS-CAOP) on patient care. The purpose of this study was to investigate the limitations of OS-CAOP and their effect on treatment planning workflow and surgical outcomes. A retrospective cross-sectional study was designed involving subjects who had undergone orthognathic surgery using CAOP from 2 academic oral and maxillofacial surgery centers in South Korea (Kyungpook National University, KNU) and the United States (University of Illinois Chicago, UIC) over an 8-year period. The primary predictor variable was use of modifications or alternatives to OS-CAOP. The primary outcome variable was the frequency of planning changes due to reasons that may have affected outcomes. Covariates included age and sex. Descriptive statistics was used, in addition to a chi-square test to analyze differences among categorical variables. Of a total of 642 eligible subjects in both centers, 5.8% used alternatives to OS-CAOP. 78.4% of these were due to reasons that may have affected outcomes (P<.001), representing 4.5% of all cases. The frequency of the need for OS-CAOP alternatives was identical in both centers (5.8%), but the specific reasons varied, with KNU having mostly plan-related changes (38.1% of alternatives), and UIC with more access and education-related reasons (68.8% of alternatives). At KNU, 71.4% of all alternatives were by repeat OS-CAOP, whereas at UIC, all were by in-house CAOP (IH-CAOP). In 2 major academic oral and maxillofacial surgery centers in South Korea and the United States, a substantial portion of OS-CAOP required pre-surgical modification, or use of alternatives. Most of the changes were for reasons that could potentially impact outcomes, prompting the need to consider establishing a "safety net" plan compatible with individual clinician's practice setting and healthcare system.

The impact of single dose intravenous dexamethasone as an adjunctive therapy for primary treatment on concentrations of inflammatory biomarkers in children with Kawasaki disease

Purpose: This study was performed to investigate the impact of single dose dexamethasone as an adjunctive therapy for primary treatment on values of inflammatory markers in children with Kawasaki disease (KD).Methods:We investigated inflammatory markers, including white blood cells, erythrocyte sedimentation rate, C-reactive protein (CRP), interleukin (IL)-6, and IL-10 in 42 children with complete KD who were hospitalized in the Kyungpook National University Children’s Hospital from March 2016 through April 2017. The children underwent primary treatment for KD with intravenous immunoglobulin (IVIG) and/or dexamethasone. They were divided into 2 groups according to the use of dexamethasone. To assess the change in values of inflammatory markers, the blood was drawn twice from each child; before and 24 hours after the administration of IVIG.Results: Of the 42 study children, 18 and 24 were classified as the dexamethasone and control groups, respectively. No significant differences were found between the 2 groups in terms of the length of hospital stay, duration of fever, and time required for IVIG administration. In both groups, white blood cells, CRP, IL-6, and IL-10 significantly decreased after the primary therapy. The delta scores of CRP, IL-6, and IL-10 were higher in the dexamethasone group (P = 0.015, P = 0.001, and P = 0.002, respectively). No coronary artery abnormalities were found in both groups.Conclusion: This study suggests an anti-inflammatory effect of single dose dexamethasone as an adjunctive therapy for primary treatment in children with KD without shortening the duration of fever and the length of hospital stay.

Demographic and Clinical Factors Associated With Anti–SARS-CoV-2 Antibody Levels After 2 BNT162b2 mRNA Vaccine Doses

The factors associated with long-term serum levels of anti-SARS-CoV-2 antibodies after COVID-19 vaccination in healthy individuals have rarely been investigated. To investigate factors associated with anti-SARS-CoV-2 antibody levels. This prospective cohort study included health care workers at Kyungpook National University Chilgok Hospital (Daegu, Korea) with no history of SARS-CoV-2 infection who received 2 doses of the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech; first dose, March 17-20, 2021; second dose, April 7-10, 2021). Serum samples were collected at 2, 4, and 6 months after the second injection. SARS-CoV-2 BNT162b2 mRNA vaccine. Anti-SARS-CoV-2 specific antibodies were measured using enzyme-linked immunosorbent assay kits up to 6 months after the receipt of 2 doses of the BNT162b2 mRNA COVID-19 vaccine. The main outcome was factors associated with anti-SARS-CoV-2 antibody levels at 6 months. All 50 participants (mean [SD] age, 34.7 [9.4] years; 10 [20.0%] male; mean [SD] body mass index, 21.8 [5.4]) acquired anti-SARS-CoV-2 antibodies and maintained positive antibody (cutoff ≥30%) up to 6 months. The mean serum antibody level decreased with time (91.9%, 89.3%, and 81.5% at 2, 4, and 6 months, respectively). Serum antibody levels at 6 months were correlated with antibody levels at 2 months (R = 0.944; P < .001). The anti-SARS-CoV-2-specific antibody level was inversely correlated with weight, body mass index, body fat amount, and body weight to height ratio in Spearman correlation analysis. A 1-SD increase in body weight, weight to height ratio, and body mass index was associated with a 4%- to 5%-decrease in anti-SARS-CoV-2 antibodies in multiple linear regression analysis for women. In multivariate analysis for categorized variables, lower serum level of antibody (ie, <81.5%) was associated with weight (weight ≥55 kg: odds ratio, 9.01; 95% CI, 1.44-56.40). The probabilities of less than 70% and less than 80% antibody at 6 months were 0% and 11% in participants weighing less than 55 kg, respectively, but 16% and 42% in participants weighing 55 kg or greater. In this study, the inverse correlation of anti-SARS-CoV-2-specific antibody levels with weight was sustained up to 6 months after vaccination. A booster shot of BNT162b2 mRNA vaccination may be given later than 6 months after the second dose in young and middle-aged healthy persons with low body weight.

Assessment of pharyngeal airway in Korean adolescents according to skeletal pattern, sex, and cervical vertebral maturation: A cross-sectional CBCT study.

ObjectiveTo investigate airway volumes using cone-beam computed tomography (CBCT) by skeletal patterns, sex, and cervical vertebral maturation (CVM) stages in Korean adolescents.MethodsThe sample consisted of pretreatment CBCT and cephalograms of 95 adolescents (aged 12–19) obtained out of 1,611 patients examined for orthodontic treatment from 2018 to 2020 in Kyungpook National University Dental Hospital. The samples were classified into two sex groups; three skeletal pattern groups, four chronological age groups and four CVM stages. Nasopharyngeal volumes (NPV), oropharyngeal volumes (OPV), total pharyngeal airway volume (TAV) and minimum cross-sectional area (MCA) measurements were taken from the CBCT. Multiple linear regression analyses to find out which one of the independent variables are good predictors for airway variables. Significant factors were analyzed by two-way multivariate analysis of variance (MANOVA) then multiple comparisons were analyzed using a t-test, and Fisher least significant difference.ResultsAge, sex, CVM, and Sella-Nasion-B point have significant influence on airway variable. Males and females showed similar patterns of change in chronological age groups 1–3; however, males had larger NPV, OPV, and MCA at CVM in group 4. According to CVM stages, males had larger OPV, TAV, and MCA at CVM stage 6 (p-value 0.019, 0.021, 0.015, respectively) and no sex differences at CVM stages 3, 4, and 5.ConclusionsSkeletal patterns have an effect on airway volume. Sex differences were found in CVM 6.

Development of Highly Reliable Secondary Batteries with Interfacial Ion Behaviour Control and Multivalent Ion Adoption – Project 2019R1A2C1009239

If the anode-electrolyte interface of lithium-ion (Li-ion) batteries or LIBs can be controlled to make the anode of the Li metal battery suitable for liquid or solid electrolytes it would lead to an expansion of possible applications. Assistant Professor Jeeyoung Yoo, School of Energy Engineering, Kyungpook National University, Korea, is experimenting with a layer called the solid electrolyte interphase (SEI). The Li metal anode has characteristics that make it suitable as an anode material for next-generation LIBS, but its SEI is unstable and Yoo wants to address this. To do this, Yoo is applying an interlayer while maintaining an existing structure with a liquid electrolyte, and she and the team have found that carbon with a conjugated structure is the most effective interlayer material. This represents the very first in-situ formation of a semi ionic CF (carbon-fluorine) bonding formation and suggests that the Li metal battery could be stabilised by simply applying a pencil to the separator. Yoo is also working to develop highly reliable secondary batteries with interfacial ion behaviour control and multivalent ion adoption. This research involves developing a part that controls the side reaction between the metal anode and the aqueous electrolyte interface, and a cathode material suitable for the metal anode. The aim of this work is to help improve the stability of the secondary batteries and also lower price and resolve supply issues.

Reviewer’s Recognition

The Editor-in-Chief and Editorial Board of the ASME Journal of Tribology would like to thank all of the reviewers for volunteering their expertise and time reviewing manuscripts in 2021. Serving as reviewers for the journal is a critical service necessary to maintain the quality of our publication and to provide the authors with a valuable peer review of their work. Below is a complete list of reviewers for 2021. We would also like to acknowledge three outstanding Reviewers of the Year.2021 Reviewers of the YearWassim Habchi — Lebanese American University, LebanonLi Chang — The University of Sydney, AustraliaHyun-Joon Kim — Kyungpook National University, South KoreaThe Reviewers of the Year Award is given to reviewers who have made an outstanding contribution to the journal in terms of the quantity, quality, and turnaround time of reviews completed during the past 12 months. The prize includes a Wall Plaque, 50 free downloads from the ASME Digital Collection, and a one year free subscription to the journal.

What makes acute cholecystitis recur after removing the percutaneous cholecystostomy tube?

Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter removal. This study aimed to evaluate the role of endoscopic sphincterotomy and other risk factors in reducing the recurrence of cholecystitis.We retrospectively analyzed data from 1088 patients who underwent PTGBD for cholecystitis at Kyungpook National University Hospital, Republic of Korea, between January 2011 and April 2018.A total of 115 patients were enrolled in the study. The recurrence rate of cholecystitis was 17.4% (n = 20) during a median follow-up period of 1159 (range, 369–2774) days. Endoscopic biliary sphincterotomy did not significantly affect the recurrence rate of cholecystitis (P = .561). In multivariable analysis, cystic duct stones (P = .013) and PTGBD catheter migration before the prescheduled removal time (P = .002) were identified as independent risk factors for cholecystitis recurrence after PTGBD.To reduce post-PTGBD recurrence in cholecystitis, caution must be exercised to avoid inadvertent dislodging of the PTGBD catheter. In cases of cholecystitis with cystic duct stones, cholecystectomy should be considered only after careful assessment of postoperative risks. Instead, transluminal endoscopic gallbladder drainage could represent a promising option for the prevention of recurrent cholecystitis.

Clinical implication of KRAS mutation variants in patients with resected colon cancer.

179 Background: This study evaluated the clinical implication of KRAS mutation variants in patients with resected colon cancer (CC). Methods: We retrospectively reviewed 482 patients diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: pathologically diagnosed with primary CC; stage I–III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Results: Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in Exon 2 Codon 12, 37/140 (26.4%) in Exon 2 Codon 13, 1/140 (0.1%) in Exon 3 Codon 59, 7/140 (5.0%) in Exon 3 Codon 61, and 5/140 (3.6%) in Exon 4 Codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival (DFS) or overall survival (OS). Although, there were no significant differences in survival between patients with Exon 2 Codon 12 and Exon 2 Codon 13 mutations, poorer DFS ( p = 0.085) and OS ( p = 0.005) were seen in those with Exon 3 Codon 61 mutation than in others. Conclusions: KRAS mutation status was not correlated with survival, but Exon 3 Codon 61 mutation might be a poor prognostic factor in resected CC patients.

Combined Endoscopy-Assisted Muscle-Sparing Latissimus Dorsi Flap Harvesting with Lipofilling Enhancement as a New Volume Replacement Technique in Breast Reconstruction.

Introduction This study evaluated the feasibility and patient satisfaction of combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting, with lipofilling enhancement for skin-preserving mastectomy. Methods This is a prospective study that included 21 female patients with small breasts (cup size A-B), subjected to skin-preserving mastectomy as a management of breast cancer. Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement was performed for immediate breast reconstruction. Patients were followed up for early and late postoperative complications including recurrence for at least 24 months. Postoperative patient satisfaction was assessed using the Kyungpook National University Hospital breast reconstruction satisfaction questionnaire. Results The study included 21 female patients with a mean age of 42.10 ± 8.46 years. Patients were followed up for 26.67 ± 3.38 months. The procedure was successful in all patients with a mean duration of 172.05 ± 28.22 minutes. Local recurrence was encountered in one patient (4.67%). Eighteen patients declared their satisfaction 6 months after the operation, while two patients were satisfied only after the second session of lipofilling. The overall postoperative patient satisfaction was 95.24%. The majority of the patients (93.3%) who underwent NSM surgery were satisfied, while only two-thirds (66.6%) of the patients who underwent SSM surgery were satisfied. Conclusions Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement seems to be a feasible and encouraging technique for the volume adjustment of small breasts, especially in nipple-sparing mastectomy. It leaves a minor back scar and has an acceptable rate of postoperative complications. The procedure showed high postoperative patient satisfaction.

Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea

BackgroundAs the coronavirus disease 2019 (COVID-19) pandemic continues to progress, awareness about its long-term impacts has been growing. To date, studies on the long-term course of symptoms, factors associated with persistent symptoms, and quality of life after 12 months since recovery from acute COVID-19 have been limited.MethodsA prospective online survey (First: September 8, 2020–September 10, 2020; Second: May 26, 2021–June 1, 2021) was conducted on recovered patients who were previously diagnosed with COVID-19 between February 13, 2020 and March 13, 2020 at Kyungpook National University Hospital. Responders aged between 17 and 70 years were included in the study. Overall, 900 and 241 responders were followed up at 6 and 12 months after recovery from COVID-19 in the first and second surveys, respectively. Clinical characteristics, self-reported persistent symptoms, and EuroQol-5-dimension (EQ5D) index score were investigated for evaluating quality of life.ResultsThe median period from the date of the first symptom onset or COVID-19 diagnosis to the time of the survey was 454 (interquartile range [IQR] 451–458) days. The median age of the responders was 37 (IQR 26.0–51.0) years, and 164 (68.0%) responders were women. Altogether, 11 (4.6%) responders were asymptomatic, and 194 (80.5%), 30 (12.4%), and 6 (2.5%) responders had mild, moderate, and severe illness, respectively. Overall, 127 (52.7%) responders still experienced COVID-19-related persistent symptoms and 12 (5.0%) were receiving outpatient treatment for such symptoms. The main symptoms were difficulty in concentration, cognitive dysfunction, amnesia, depression, fatigue, and anxiety. Considering the EQ5D index scores, only 59.3% of the responders did not have anxiety or depression. Older age, female sex, and disease severity were identified as risk factors for persistent neuropsychiatric symptoms.ConclusionCOVID-19-related persistent symptoms improved over time; however, neurological symptoms can last longer than other symptoms. Continuous careful observation of symptom improvement and multidisciplinary integrated research on recovered COVID-19 patients are required.

Immediate Lipo-Filling as a Novel Technique for Volume Replacement in Oncoplastic Breast Conservative Surgery.

We aimed to evaluate the feasibility of immediate lipofilling as a volume replacement technique in breast conservative surgery (BCS) in terms of the volume of fat graft resorption after radiotherapy, patient satisfaction, and oncological safety. This was a prospective study that included female patients with breast cancer, with small- or medium-sized breasts. The patients underwent BCS followed by lipofilling into the deformed areas away from the tumor site that resulted from direct closure of the tumor cavity. They were followed up for early and late postoperative complications, including recurrence. Volumetric computed tomography was performed before and after radiotherapy to determine percentage fat resorption. Postoperative patient satisfaction was assessed using the Kyungpook National University Hospital Breast Reconstruction Satisfaction Questionnaire. The study included 54 female patients with a mean age of 47.57 ± 9.26 years. The mean follow-up period was 31.02 ± 4.47 months. Local recurrence was observed in three patients (5.56%). The volume reduction of the injected fat graft ranged from 10.15% to 55.67%, with a mean of 29.27 ± 10.06%. Fifty-two patients (96.30%) reported postoperative satisfaction, and nine of them expressed satisfaction only after a second lipofilling session. Immediate lipofilling as a volume replacement technique in BCS is a safe and simple technique without major complications. It has a locoregional recurrence rate similar to BCS alone, with an acceptable fat resorption percentage and high postoperative patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Implication of KRAS Mutation Variants in Patients With Resected Colon Cancer.

This study evaluated the clinical implication of KRAS proto-oncogene, GTPase (KRAS) mutation variants in patients with resected colon cancer (CC). We retrospectively reviewed 482 patients diagnosed with CC who underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: Pathologically diagnosed with primary CC; stage I-III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in exon 2 codon 12, 37/140 (26.4%) in exon 2 codon 13, 1/140 (0.1%) in exon 3 codon 59, 7/140 (5.0%) in exon 3 codon 61, and 5/140 (3.6%) in exon 4 codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival or overall survival. Although there were no significant differences in survival between patients with exon 2 codon 12 and exon 2 codon 13 mutations, poorer disease-free survival (p=0.085) and overall survival (p=0.005) were seen in those with exon 3 codon 61 mutation than in others. KRAS mutation status was not correlated with survival, but exon 3 codon 61 mutation might be a factor for poor prognosis in patients after resection of CC.

Indocyanine Green Near-Infrared Fluorescence Cholangiogram During Pure Laparoscopic Living Donor hepatectomy For Optimal Bile Duct Division

Introduction: Biliary complications in living donor liver transplantation are most common and troubled problem to liver transplant surgeons, various method to decease biliary complications has been studied and determining the optimal bile duct division point is important to decrease complication rate. Intraoperative cholangiogram has been standard method to determine the optimal bile duct division point for conventional donor hepatectomy, but in laparoscopic donor hepatectomy, indocyanine green(ICG) near-infrared fluorescence cholangiogram is alternative option of intraoperative cholangiogram. We compared conventional cholangiogram and ICG near-infrared fluorescence cholangiogram to determine optimal bile duct division point in pure laparoscopic living donor hepatectomy. Method: From May 2016 to October 2019, 80 cases of pure laparoscopic donor hepatectomy has been performed in Kyungpook national university hospital. Conventional cholangiogram was used in 45 cases, ICG near-infrared fluorescence cholangiogram was used in 35 cases. We compared two groups in preoperative bile duct anomaly of donor, operative time and postoperative complications. Result: In bile duct anomaly of donors, there were no differences between two groups. Operative time was much longer in conventional cholangiogram group because conventional cholangiogram procedure itself was time consuming. In one donor of conventional group, biliary complication occurred. Bile leakage from the cutting edge of the remnant right hepatic duct was identified, resolved by ERBD insertion. Conclusion: ICG near-infrared fluorescence cholangiogram is more easier and convenient method to determine proper bile duct division point and is helpful to decrease biliary complications by confirming the real time fluorescence image of bile duct.