Purpose: The objective of this study was to assess the frequency and management protocols for malignant tumors among cases referred for aeromedical consultation. Methods: The research analyzed data ...collected from aeromedical consultations conducted between January 2014 and December 2022. Parameters examined included demographic information such as sex, age, flight crew classification, and diagnosis. Results: Out of the cases reviewed, 31 patients were diagnosed with malignant tumors, with an average age at diagnosis of 38.5 years, and a male predominance of 26 cases. The most commonly diagnosed malignancies were thyroid cancer, lung cancer, kidney cancer, stomach cancer, and colon cancer. During the initial aeromedical consultation, 22 cases were temporarily grounded while 8 received waivers. Conclusion: Given the potential rise in malignant tumor incidence among flight crews due to advancements in medical technology facilitating early detection, it is imperative to emphasize regular check-ups and carefully evaluate aeromedical suitability for flying.
Background
Epstein–Barr virus (EBV)-associated gastric cancer (EBVaGC) has been reported to account for approximately 5–16% of all GCs with good prognosis compared to EBV-negative GC. We evaluated ...the clinicopathological characteristics of EBVaGC including survival rate in South Korea.
Methods
A total of 4,587 patients with GC who underwent EBV in situ hybridization (EBV–ISH) were prospectively enrolled at the Seoul National University Bundang Hospital from 2003 to 2021. Age, sex, smoking status, cancer type and stage, tumor size and location, histological type, molecular features and survival information were analyzed.
Results
A total of 456 patients with GC (9.9%) were positive for EBV. The EBVaGC group displayed a higher proportion of males (
P
< 0.001), a predominant presence in the proximal stomach (
P
< 0.001), a higher proportion of undifferentiated cancer (
P
< 0.001), and a lower cancer stage (
P
= 0.004) than the EBV-negative group. Cox multivariate analyses revealed age (hazard ratio HR = 1.025,
P
< 0.001), tumor size (HR = 1.109,
P
< 0.001), and cancer stage (stage2 HR = 4.761,
P
< 0.001; stage3 HR = 13.286,
P
< 0.001; stage4 HR = 42.528,
P
< 0.001) as significant risk factors for GC-specific mortality, whereas EBV positivity was inversely correlated (HR = 0.620,
P
= 0.022). Furthermore, the EBVaGC group displayed statistically significant survival advantages over the EBV-negative cancer group in terms of both overall (
P
= 0.021) and GC-specific survival (
P
= 0.007) on the Kaplan–Meier survival curve. However, this effect was evident only in males.
Conclusions
EBVaGC patients showed better prognoses despite their association with proximal location and poorly differentiated histology in male, probably due to the difference in immunity between males and females.
Synchronous multiple gastric cancer (SMGC) accounts for approximately 6% to 14% of gastric cancer (GC) cases. This study aimed to identify risk factors for SMGC.
A total of 14,603 patients diagnosed ...with GC were prospectively enrolled. Data including age, sex, body mass index, smoking, alcohol consumption, family history, p53 expression, microsatellite instability, cancer classification, lymph node metastasis, and treatment were collected. Risk factors were analyzed using logistic regression analysis between a single GC and SMGC.
The incidence of SMGC was 4.04%, and that of early GC (EGC) and advanced GC (AGC) was 5.43% and 3.11%, respectively. Patients with SMGC were older (65.33 years vs 61.75 years, p<0.001) and more likely to be male. Lymph node metastasis was found in 27% of patients with SMGC and 32% of patients with single GC. Multivariate analysis showed that SMGC was associated with sex (male odds ratio OR, 1.669; 95% confidence interval CI, 1.223 to 2.278; p=0.001), age (≥65 years OR, 1.532; 95% CI, 1.169 to 2.008; p=0.002), and EGC (OR, 1.929; 95% CI, 1.432 to 2.600; p<0.001). Survival rates were affected by Lauren classification, sex, tumor size, cancer type, distant metastasis, and venous invasion but were not related to the number of GCs. However, the survival rate of AGC with SMGC was very high.
SMGC had unique characteristics such as male sex, older age, and EGC, and the survival rate of AGC, in which the intestinal type was much more frequent, was very good (Trial registration number: NCT04973631).
•Fifteen phenolics were identified in wheat seedlings via NMR and HPLC-Orbitrap-MS/MS.•Phenolics in wheat seedlings showed remarkable differences in cultivars and growth times.•The highest average ...phenolics exhibited 420.8 mg/100 g on 7 days of growth times.•Isoorientin (6) was the predominant component (99.3 mg/100 g, 28 %) in wheat seedlings.•Antioxidant effects of wheat seedlings showed considerable variations in growth times.
The current research was characterized on phenolic metabolite profile including six chemical structures (phenolic acid, luteolin, orientin, apigenin, isoscoparin, and tricin) in wheat seedlings using HPLC-Q-Orbitrap-MS/MS and NMR techniques. Our study was also was the first to demonstrate fluctuations of isolated nine phenolic contents and antioxidant properties in various cultivars of this species with different growth times. The antioxidant abilities differed significantly in the 80 % methanol extracts (600 μg/mL) according to cultivar and growth time, with the highest average activities (DPPH: 82 %; ABTS: 87 %) observed after 7 days. The isolated nine compositions exhibited considerable differences in cultivars and growth times, specifically, isoorientin (6) and isochaftoside (8) were observed the most abundant average contents (99.3; 64.3 mg/100 g), representing approximately 28.3 and 18.3 % (total content: 350.8 mg/100 g). Their total phenolics showed the highest rates (420.8 mg/100 g) at 7 days, followed by 9 → 5 → 12 → 14 days with 374.6 → 366.7 → 350.7 → 241.1 mg/100 g, as the rank orders of antioxidant effects. These findings suggest that wheat seedlings may be a potent source of functional agents.
N-glycans influence the activity of antibody drugs such as antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC). Thus, glycan profiling is considered a ...critical quality attribute (CQA) and requires routine and comprehensive monitoring. In this report, we validate the new glycan profiling method called Rapi-Fluor method, which reduced the sample preparation time and increased the FLR and MS intensities compared with conventional 2-AB method. Optimized glycan release, labeling, hydrophilic interaction liquid chromatography (HILIC) enrichment, and HILIC separation resulted in low variation and short preparation time. The method evaluated for human IgG standard varied from 100 µg/mL to 4000 µg/mL in 25 µL of water. The determination of coefficient (r2 > 0.9992), recovery (88.992% ~ 111.198%), limit of detection (LOD < 193.274 µg/mL), limit of quantification (LOQ < 585.679 µg/mL), and precision (Intra-day < 2.317%RSD and Inter-day < 4.287%RSD) were evaluated with four major glycans from antibody drugs. In addition, the method was used for glycan profiling of five different commercial antibodies. The method yielded precise results for IgG glycan analysis and demonstrated effective glycan profiling of commercial antibody drugs.
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•This paper reports validation of Rapi-Flour method for glycan profiling of antibody.•The method requires short preparation time and gives high signal compared to conventional method.•The method was applied to commercial antibody drugs and showed easier way to profile the glycan from antibody drugs.
Abstract Background Fine-grained classification deals with data with a large degree of similarity, such as cat or bird species, and similarly, knee osteoarthritis severity classification ...Kellgren–Lawrence (KL) grading is one such fine-grained classification task. Recently, a plug-in module (PIM) that can be integrated into convolutional neural-network-based or transformer-based networks has been shown to provide strong discriminative regions for fine-grained classification, with results that outperformed the previous deep learning models. PIM utilizes each pixel of an image as an independent feature and can subsequently better classify images with minor differences. It was hypothesized that, as a fine-grained classification task, knee osteoarthritis severity may be classified well using PIMs. The aim of the study was to develop this automated knee osteoarthritis classification model. Methods A deep learning model that classifies knee osteoarthritis severity of a radiograph was developed utilizing PIMs. A retrospective analysis on prospectively collected data was performed. The model was trained and developed using the Osteoarthritis Initiative dataset and was subsequently tested on an independent dataset, the Multicenter Osteoarthritis Study (test set size: 17,040). The final deep learning model was designed through an ensemble of four different PIMs. Results The accuracy of the model was 84%, 43%, 70%, 81%, and 96% for KL grade 0, 1, 2, 3, and 4, respectively, with an overall accuracy of 75.7%. Conclusions The ensemble of PIMs could classify knee osteoarthritis severity using simple radiographs with a fine accuracy. Although improvements will be needed in the future, the model has been proven to have the potential to be clinically useful.
Delirium is a neuropsychiatric condition strongly associated with poor clinical outcomes such as high mortality and long hospitalization. In the patients with Coronavirus disease 2019 (COVID-19), ...delirium is common and it is considered as one of the risk factors for mortality. For those admitted to negative-pressure isolation units, a reliable, validated and contact-free delirium screening tool is required.
We prospectively recruited eligible patients from multiple medical centers in South Korea. Delirium was evaluated using the Confusion Assessment Method (CAM) and 4'A's Test (4AT). The attentional component of the 4AT was modified such that respondents are required to count days, rather than months, backward in Korean. Blinded medical staff evaluated all patients and determined whether their symptoms met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). An independent population of COVID-19 patients was used to validate the 4AT as a remote delirium screening tool. We calculated the area under the receiver operating characteristic curve (AUC).
Out of 286 general inpatients, 28 (9.8%) inpatients had delirium. In this population, the patients with delirium were significantly older (
= 0.018) than the patients without delirium, and higher proportion of males were included in the delirium group (
< 0.001). The AUC of the 4AT was 0.992 95% confidence interval (CI) 0.983-1.000 and the optimal cutoff was at 3. Of the independent COVID-19 patients, 13 of 108 (12.0%) had delirium. Demographically, the COVID-19 patients who had delirium only differed in employment status (
= 0.047) from the COVID-19 patients who did not have delirium. The AUC for remote screening using the 4AT was 0.996 (0.989-1.000). The optimal cutoff of this population was also at 3.
The modified K-4AT had acceptable reliability and validity when used to screen inpatients for delirium. More importantly, the 4AT efficiently screened for delirium during remote evaluations of COVID-19 patients, and the optimal cutoff was 3. The protocol presented herein can be used for remote screening of delirium using the 4AT.
Even today, total knee arthroplasty (TKA) is associated with venous thromboembolism (VTE). The purpose of our study is to report the incidence of postoperative VTE and to compare the efficacy of ...commonly used orally administered antithrombotic agents.
Seven hundred ad ninety-nine patients who underwent primary TKA were retrospectively reviewed. The patients were prescribed one of three antithrombotic agents: aspirin (n = 168), rivaroxaban (n = 117), or apixaban (n = 514). Before surgery, patient demographics and risk factors were matched via propensity scoring. After surgery, all three groups took the agent for 7 days and underwent ultrasonography to check for VTE.
The overall incidence of postoperative VTE was 15.4% (123/799). Only one patient developed symptomatic VTE. Female sex and staged bilateral TKA were risk factors for postoperative VTE. The postoperative VTE rates in the aspirin, rivaroxaban, and apixaban groups were 16.2%, 6.0%, and 17.1%, respectively, significantly lower in the rivaroxaban group (p < 0.02). The majority of VTEs in all three groups were calf-vein thromboses.
All agents showed enough efficacy as antithrombotic agents. Considering that aspirin is inexpensive, aspirin is a cost-effective option for preventing postoperative VTE.
There are few reports regarding mixed carcinoma, defined as a mixture of glandular and poorly cohesive components, in patients with gastric cancer (GC). The aim of this study was to evaluate the ...proportion and characteristics of mixed carcinoma in GC patients.
A total of 7,215 patients diagnosed with GC at Seoul National University Bundang Hospital were enrolled from March 2011 to February 2020. GC was divided into four groups (well-moderately differentiated GC, poorly differentiated GC, poorly cohesive carcinoma, and mixed carcinoma). The proportion of each GC type and the clinicopathological features were analyzed and divided into early GC and advanced GC.
The proportion of mixed carcinoma was 10.9% (n=787). In early GC, submucosal invasion was the most common in poorly differentiated (53.7%), and mixed carcinoma ranked second (41.1%). Mixed carcinoma showed the highest proportion of lymph node metastasis in early GC (23.0%) and advanced GC (78.3%). In advanced GC, the rate of distant metastasis was 3.6% and 3.9% in well-moderately differentiated GC and mixed carcinoma, respectively, lower than that in poorly differentiated GC (6.4%) and poorly cohesive carcinoma (5.7%), without statistical significance.
Mixed carcinoma was associated with lymph node metastasis compared to other histological GC subtypes. And it showed relatively common submucosal invasion in early GC, but the rates of venous invasion and distant metastasis were lower in advanced GC. Further research is needed to uncover the mechanism underlying these characteristics of mixed carcinoma (Trial registration number: NCT04973631).
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