Major depressive disorder (MDD) is a psychiatric disorder that leads to reduced quality of life and poses a significant societal burden; however, its diagnosis still relies on subjective evaluation. Consequently, task-based functional magnetic resonance imaging (fMRI) has emerged as a crucial tool for exploring the neurobiological mechanisms of MDD and identifying objective biomarkers. This review systematically examines fMRI studies on cognitive dysfunction in patients with MDD, summarizing the representative tasks and associated functional abnormalities in neural circuits across three core domains: executive function, negative bias, and reward processing. Deficits in executive function manifest as inefficiency in the fronto-parietal network and failure to suppress the default mode network during n-back and Stroop tasks. Negative bias was identified through the Self-Referent Encoding Task and Autobiographical Memory Test, revealing hyperactivity in bottom-up emotional responses and failure of top-down regulation. In the domain of reward processing, studies using Monetary Incentive Delay and reinforcement learning tasks have consistently reported that blunted reward prediction error signals and hypoactivation of the thalamo-striatal-prefrontal circuitry are associated with anhedonia. By integrating these findings from task-based fMRI research, this review aimed to define the neurocognitive characteristics that distinguish MDD and provide practical guidance for future studies.

Acute lymphoblastic leukemia (ALL) primarily affects the bone marrow and peripheral blood. Extramedullary manifestations, especially in the sinonasal cavity, are rare and difficult to diagnose. We report a case of B-cell ALL in a 4-year-old girl who initially presented with a sinonasal mass mimicking a primary malignant neoplasm. The patient developed right eye protrusion upon nasal blowing over a period of 2 weeks. Imaging studies revealed an aggressive-appearing mass in the right maxillary sinus with extensive local invasion. The radiologic differential diagnosis included rhabdomyosarcoma, lymphoma, and other pediatric sinonasal malignancies. Histopathologic examination of the biopsy specimen and subsequent bone marrow evaluation established the diagnosis of B-cell ALL with BCR/ABL1 fusion. This case highlights the importance of including ALL in the differential diagnosis of sinonasal masses in pediatric patients, particularly when imaging features suggest an aggressive malignancy accompanied by hematologic abnormalities. A comprehensive evaluation, including imaging studies, routine laboratory tests, tissue biopsy, and bone marrow examination, is crucial for establishing an accurate diagnosis and initiating appropriate treatment.

Background: Although various surface modifications enhance titanium (Ti) implant osseointegration, achieving rapid bone formation comparable to native healing remains challenging. Current strategies primarily focus on micro-scale topography, often overlooking the critical role of macroscopic three-dimensional (3D) architecture in osteoconduction. Methods: We hypothesized that mimicking native bone’s porous architecture is key to accelerating osseointegration. First, we verified the impact of structural continuity by comparing standard Ti implants with decellularized bone grafts in a mouse calvaria defect model. Subsequently, we developed a biomimetic polycaprolactone (PCL)-based 3D architectural cover (Cover-type) and evaluated its osseointegration efficacy in a rat femur model against conventional Ti implants. Results: The mouse study confirmed that decellularized bone integrated significantly faster than Ti, highlighting the necessity of 3D continuity. In the rat model, micro-computed tomography analysis indicated a clear trend of increased bone formation in the Cover-type group, though statistical significance was limited by sample size. However, histological analysis confirmed a statistically significant enhancement in bone-to-implant contact compared to controls (P<0.05). The PCL structure served as a scaffold for cell migration, effectively bridging the implant-bone gap. Conclusions These findings suggest that providing a bone-like 3D environment via a PCL cover may enhance histological osseointegration, rather than relying solely on surface chemistry.

Survival rates of breast cancer, which is the most common cancer among women, continue to improve. Diet after diagnosis has become an area of interest regarding breast cancer survival, and evidence has accumulated over past decades. Although earlier studies did not offer recommendations beyond general cancer prevention guidelines, more recent findings suggest a potential role of dietary factors in breast cancer prognosis. Healthy dietary patterns have been associated with reduced mortality from non-breast cancer causes. However, associations with breast cancer-specific mortality were less consistent in cohort studies of survivors, most of which were conducted in Western populations. Two randomized intervention trials on the effect of low-fat dietary patterns yielded inconsistent findings, with one study reporting a lower risk of breast cancer recurrence and the other showing no association. Because reduced fat intake is often accompanied by weight loss and increased intake of other dietary components, such as higher vegetable consumption, these factors need to be considered when interpreting the results. Both soy food and dietary fiber intakes have been shown to reduce the risk of all-cause mortality after breast cancer diagnosis. High circulating vitamin D levels may confer benefits, particularly among women with suboptimal vitamin D status. However, the current evidence does not support the protective effect of other individual micronutrients or dietary supplements. Sugar and carbohydrate intake, and coffee consumption remain areas of emerging research interest. In addition, the role of dietary factors should be investigated in specific subgroups, such as premenopausal women, users of antihormone therapy, and those with estrogen receptor-positive or -negative tumors.Importantly, most associations were observed predominantly in Western or postmenopausal populations and may not be generalizable to Asian or younger women. Further studies are needed to clarify the population-specific effects and strengthen the evidence base for dietary recommendations for breast cancer survivors.

Purpose: While the benefit of neoadjuvant chemotherapy (NAC) has been established in human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancers, its effectiveness in achieving pathological complete response (pCR) and optimal patient selection in estrogen receptor (ER)-positive, HER2-negative breast cancers remain less clearly defined. This study aimed to identify immunohistochemistry (IHC)-based predictors of pCR and to develop a scoring model for ER-strong positive/HER2-negative breast cancer. Methods: Data from a prospective cohort were retrospectively analyzed. We included 522 patients with ER-strong positive/HER2-negative tumors who received NAC and surgery between 2008 and 2021. IHC markers including progesterone receptor (PR), Ki-67, epidermal growth factor receptor (EGFR), cytokeratin 5/6 (CK5/6), and p53 were evaluated to identify predictors of pCR. Independent predictors of pCR from multivariate logistic regression were used to develop a weighted 4-point model. Model performance was assessed using receiver operating characteristic analysis. The prognostic impact of pCR was evaluated using KaplanMeier and Cox regression analyses. Results: Independent predictors of pCR included PR-negative status, positivity for basallike markers (EGFR or CK5/6), and Ki-67 ≥ 50%. The scoring model demonstrated good discrimination for pCR (area under the curve = 0.754). pCR rates increased stepwise, with scores of 4.9% (low), 10.7% (intermediate), and 36.2% (high). In the high-score group, pCR was significantly associated with improved disease-free survival (hazard ratio [HR], 0.09; p = 0.023) and distant metastasis-free survival (HR, 0.11; p = 0.035), whereas no significant survival differences according to pCR status were observed in the low and intermediate score groups. Conclusion This IHC-based model predicts pCR and helps identify subgroups in which pCR is associated with meaningful survival benefit following NAC in ER-positive/HER2-negative breast cancers. High-scoring patients may benefit from NAC, while patients with low- or intermediatescores may be better managed with surgery and endocrine therapy. This model may support personalized treatment decisions regarding NAC.

Purpose: Lobular carcinoma In Situ (LCIS) is a noninvasive lesion associated with an increased risk of invasive cancer. Since its removal from the tumor, node, metastasis classification in the 8th edition of the American Joint Committee on Cancer (AJCC) guidelines, the clinical management of LCIS has shifted from surgery to surveillance. However, studies focusing on the risk and associated factors for invasive cancer development in pure LCIS without ductal carcinoma In Situ (DCIS) or invasive cancer remain limited. Methods: We retrospectively analyzed 106 patients diagnosed with pure LCIS between 2008 and 2018. This study evaluated the effect of tamoxifen use and histologic type on the development of invasive cancer. Results: All 106 patients underwent surgery, and nine (8.5%) developed invasive cancer over a median follow-up of 67.5 months. The incidence of invasive cancer was lower in the tamoxifen group (6.3%, n = 4) than in the non-tamoxifen group (11.9%, n = 5), although this difference was not statistically significant (p = 0.266). Pleomorphic LCIS had a significantly higher incidence of invasive cancer (30.0%, n = 3) than classic LCIS (6.3%, n = 6) (p = 0.045).Multivariable Cox regression analysis showed no significant difference in the risk of invasive cancer according to tamoxifen use (hazard ratio [HR], 2.031; 95% confidence interval [CI], 0.544–7.579; p = 0.292). However, pleomorphic LCIS showed a trend toward an increased risk of invasive cancer compared to classic LCIS (HR, 3.856; 95% CI, 0.922–16.126; p = 0.064). Conclusion Postoperative tamoxifen did not significantly lower invasive cancer development in patients with pure LCIS. Pleomorphic LCIS may carry a higher risk than classic LCIS. These findings require tailored follow-up and treatment strategies based on the histologic subtype of LCIS.

suggest that some reproductive factors associated with BC differ across ethnicities and time trends, perhaps due to the prevalence of reproductive factors and the baseline hazard of BC.

Background: There are limited long-term clinical outcome data comparing first-generation (1G) versus second-generation (2G) drug-eluting stents (DES) in patients with single-vessel disease (SVD). We sought to compare the efficacy and safety of 1G- and 2G-DES in SVD patients who underwent successful percutaneous coronary intervention (PCI) over 10 years of clinical follow-up. Methods: A total of 2,312 consecutive patients with SVD who underwent PCI with 1G-DES (paclitaxel- or sirolimus-eluting stents, n = 811) or 2G-DES (zotarolimus [Endeavor, Endeavor Resolute]- or everolimus-eluting stents [Promus Element, Xience], n = 1,082) were enrolled.After propensity score matching, 2 matched groups (538 pairs) were generated. Study endpoints included individual and composite clinical outcomes through 10 years. Results: During the 10-year follow-up, the 2G-DES group had lower incidences of myocardial infarction (MI; hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.22–0.92; P = 0.028) and target lesion revascularization (TLR; HR, 0.54; 95% CI, 0.32–0.91; P = 0.021) than the 1G-DES group. Rates of total death, cardiac death, non-target vessel revascularization, stroke, major adverse cardiac events, and major adverse cardiac and cerebrovascular events were similar between groups. Conclusions In our single-center, all-comer registry, 2G-DES were associated with lower incidence rates of MI and TLR compared to 1G-DES in SVD patients over 10 years of followup, indicating a safer and more durable effect than 1G-DES.

Hepatocellular carcinoma (HCC) is a highly invasive tumor with a strong tendency for metastasis. The most common sites of metastasis are the lungs, followed by lymph nodes, adrenal glands, and bones. However, metastasis of HCC to the small bowel is extremely rare. A 42-yearold female with HCC secondary to chronic hepatitis B and lung metastasis underwent a right hepatic lobectomy, followed by two wedge resections performed via video-assisted thoracic surgery, four sessions of transcatheter arterial chemoembolization, and stereotactic body radiation therapy. She was under regular follow-up for HCC, during which her alpha-fetoprotein level increased to 722.2 IU/ml. Abdominal computed tomography (CT) revealed segmental wall thickening and aneurysmal dilatation of the small bowel loops. An 18 F-fluorodeoxyglucose positron emission tomography/CT scan demonstrated a 3.3-cm hypermetabolic mass-like lesion (standardized uptake value: 11.3) in the small bowel. Surgical resection of the affected small bowel segment was performed. Histopathological examination of the specimen confirmed metastatic HCC, with immunohistochemical positivity for hepatocyte-specific antigen. The patient has remained cancer-free for 60 months post-operatively. Surgical intervention may offer favorable long-term outcomes in patients with small bowel metastasis from HCC.

Purpose: This study aimed to develop and implement an antimicrobial stewardship education program for physician assistant nurses and to evaluate its effects on their knowledge and clinical performance. Methods: A quasi-experimental, single-group pre-post design was conducted with 50 physician assistant nurses at a university hospital in Seoul, Republic of Korea. The antimicrobial stewardship education program, developed using the ADDIE model, consisted of 12 sessions including lectures and case-based learning (CBL)-based discussions.Knowledge was measured before and immediately after the intervention, while performance was assessed pre-intervention and four weeks post-program. Data were analyzed using paired t-tests, Wilcoxon signed-rank tests, and analysis of covariance (ANCOVA). Results: Knowledge scores significantly improved from 44.65±7.45 to 58.50±10.11 (p<.001), and all subdomains showed significant increases (p<.001). Performance scores increased from 3.68±0.77 to 4.28±0.68 (p<.001). Knowledge gain did not differ significantly between the medical and surgical departments (p=.710). Likewise, after adjusting for pre-test scores, no significant difference in performance improvement was observed between the two departments (ANCOVA, p=.170). These results indicate that the program was effective across both departments regardless of their characteristics. Conclusion The antimicrobial stewardship education program improved both knowledge and performance among physician assistant nurses. This program may contribute to the standardization of antimicrobial stewardship education and to appropriate antimicrobial use and the reduction of antimicrobial resistance.