Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.

Purpose: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard management for relapsed or high-risk non-Hodgkin’s lymphoma (NHL). We reported the busulfan, melphalan, and etoposide (BuME) conditioning regimen was effective in patients with relapsed or high-risk NHL. Moreover, the busulfan, cyclophosphamide, and etoposide (BuCE) conditioning regimen has been used widely in ASCT for NHL. Therefore, based on these encouraging results, this randomized phase II multicenter trial compared the outcomes of BuME and BuCE as conditioning therapies for ASCT in patients with NHL. Materials and Methods: Patients were randomly assigned to receive either BuME (n=36) or BuCE (n=39). The BuME regimen was comprised of busulfan (3.2 mg/kg/day, intravenously) administered on days –7, –6, and –5, etoposide (400 mg/m2 intravenously) on days –5 and –4, and melphalan (50 mg/m2/day intravenously) on days –3 and –2. The BuCE regimen was comprised of busulfan (3.2 mg/kg/day intravenously) on days –7, –6, and –5, etoposide (400 mg/m2/day intravenously) on days –5 and –4, and cyclophosphamide (50 mg/kg/day intravenously) on days –3 and –2. The primary endpoint was 2-year progression-free survival (PFS). Results: Seventy-five patients were enrolled. Eleven patients (30.5%) in the BuME group and 13 patients (33.3%) in the BuCE group had disease progression or died. The 2-year PFS rate was 65.4% in the BuME group and 60.6% in the BuCE group (p=0.746). There were no non-relapse mortalities within 100 days after transplantation. Conclusion There were no significant differences in PFS between the two groups. Therefore, busulfan-based conditioning regimens, BuME and BuCE, may be important treatment substitutes for the BCNU-containing regimens.

Background: Self-leadership, an action strategy that can maximize individual capabilities, can affect the organizational commitment of dental hygienists and ultimately improve the quality of medical services. This study aims to demonstrate the need for self-leadership and organizational commitment for dental hygienists and develop measures to improve the quality of medical services. Methods: An online survey of dental hygienists working at dental hospitals and clinics in Seoul and Gyeonggi province, Republic of Korea was conducted from March 28 to May 1, 2022. A total of 341 questionnaires were returned and analyzed. The measurement tools were modified and supplemented based on the theories and models developed by Manz for self-leadership, Mowday for organizational commitment, and Cronin and Taylor for medical services. Descriptive statistics, independent t-tests, ANOVA, simple regression, and multiple regression analyses were performed using SPSS 25.0. Results: In leadership education, self-leadership is based on participation experience, the number of participants, and when and where it is received. Organizational commitment comes from participation experience, and the quality of medical services has been found to affect participation experience and location. Self-leadership had an effect on the quality of medical services (β=0.497, t=10.551, p＜0.001; β =0.599, t=13.783, p＜0.001; β=0.353, t=7.601, p＜0.001) and organizational commitment was found to have a mediating effect. Conclusion Dental hygienists’ self-leadership has a positive effect on the quality of medical services through the formation of appropriate interrelationships within the organization. Therefore, self-leadership programs should be developed, participated in, and promoted to improve the self-leadership of dental hygienists. Moreover, hospitals should improve their environment to provide and improve self-leadership education.

Purpose: Breast cancer treatments, including chemotherapy, administered in combination with glucocorticoids can induce hyperglycemia. This study aimed to investigate the effect of hyperglycemia during adjuvant chemotherapy on the prognosis of breast cancer patients without a known history of diabetes. Methods: In this study, 936 patients who underwent breast cancer surgery from 2010 to 2015 were initially selected as participants. Chemotherapy-related hyperglycemia was defined as fasting plasma glucose levels ≥ 100 mg/dL or random blood glucose levels ≥ 140 mg/dL during 2 or more cycles of adjuvant chemotherapy. After dividing the patients into the euglycemia and hyperglycemia groups, univariate and multivariate analyses were performed, and survival outcomes were analyzed by propensity score matching. Results: The mean age of the patients was 47.4 ± 7.7 years, and the median follow-up period was 70.1 months. Eighty-two patients (19.4%) were diagnosed as having hyperglycemia.There were significant differences between the euglycemia and hyperglycemia groups with respect to age, hypertension, body mass index, axillary surgery extents, nodal stage, and total steroid dosage. T stage, vascular invasion, and hyperglycemia were identified as prognostic factors of relapse-free survival (RFS). The 5-year RFS rates were 92.0% and 82.3% in the euglycemia and hyperglycemia groups, respectively, and there was a statistically significant difference between the 2 groups (p = 0.011). The 5-year overall survival rates were 94.6% and 92.0% in the euglycemia and hyperglycemia groups, respectively, showing no statistically significant difference between the 2 groups (p = 0.113). Conclusion These data suggest that hyperglycemia during adjuvant chemotherapy is a prognostic factor for RFS in breast cancer patients without diabetes.

Purpose: Neoadjuvant chemotherapy (NACT) in breast cancer patients has the advantage of decreasing related morbidities by reducing the extent of axillary surgery. However, it remains a controversy with regards to the appropriate extent of axillary lymph node dissection after NACT. Therefore, this study aims to investigate the accuracy of breast ultrasonography (US) and breast magnetic resonance imaging (MRI) to assess the axillary nodal status after NACT. Methods: We reviewed pre- and post-NACT axillary imaging and clinicopathological data of patients who received NACT for primary breast cancer and underwent surgery. After NACT, accuracy of imaging modalities were evaluated through the comparison of pathologic lymph node (LN) status and imaging LN status. Results: Fifty seven patients completed NACT and underwent surgery. Breast US was found to have a sensitivity of 61.1%, specificity of 57.7%, negative predictive value (NPV) of 68.2%, and positive predictive value (PPV) of 50.0%. For breast MRI, sensitivity was 58.3%, specificity 75.8%, NPV 71.4%, and PPV 63.6%. For US combined with MRI, sensitivity was 66.7%, specificity 54.5%, NPV 69.2%, and PPV 51.6%. The accuracy of imaging modalities was 59.1% for US, 68.4% for MRI, and 59.6% for US combined with MRI. Conclusion In breast cancer patients who received NACT, MRI showed a higher specificity, NPV, and PPV than US, although it had a lower sensitivity. However, due to the low accuracy, breast MRI alone is not sufficient to determine the extent of axillary surgery. Therefore, determining the extent of axillary surgery based on the results of intraoperative sentinel lymph node biopsy may be the right method for accurate staging.

Purpose: We assessed the clinical utility of routine histopathological evaluation of the lacrimal sac during dacryocystorhinostomy. Methods: From April 2009 to April 2018, we included 1,619 eyes of 1,266 patients who underwent dacryocystorhinostomy in our hospital. All lacrimal sacs were histopathologically examined. We excluded cases in which malignant lacrimal sac tumors had been preoperatively diagnosed. We retrospectively analyzed the medical records in terms of clinical manifestations, histological findings after lacrimal sac biopsy, and malignant tumors. We recorded the age, extent of bone marrow involvement, stage, and prognosis of patients with malignancies. Results: We treated 217 males and 1,049 females of a mean age at diagnosis of 58.8 ± 12.3 years. The biopsy data showed that chronic inflammation with fibrosis (n = 1,026 [81.0%]) was the most common condition, followed by fibrosis (n = 133 [10.5%]), chronic inflammation (n = 94 [7.4%]), reactive lymphoid hyperplasia (n = 5 [0.4%]), malignant tumors (n = 4 [0.3%]), tubular adenomas (n = 2 [0.2%]), and papillomas (n = 2 [0.2%]). All malignant tumors were mucosal-associated lymphoid tissue lymphomas. Two of these four patients underwent additional imaging tests, but malignancies were not apparent. The other two had no specific complaints other than tearing. In addition, no abnormalities were evident on slit lamp examination or the syringing test. All four patients were cured by chemotherapy. Conclusions No clinical manifestation, physical examination or imaging data, or intraoperative finding in patients with nasolacrimal duct obstructions reliably identify a malignancy; but histological examination does.

Purpose: We assessed the clinical utility of routine histopathological evaluation of the lacrimal sac during dacryocystorhinostomy. Methods: From April 2009 to April 2018, we included 1,619 eyes of 1,266 patients who underwent dacryocystorhinostomy in our hospital. All lacrimal sacs were histopathologically examined. We excluded cases in which malignant lacrimal sac tumors had been preoperatively diagnosed. We retrospectively analyzed the medical records in terms of clinical manifestations, histological findings after lacrimal sac biopsy, and malignant tumors. We recorded the age, extent of bone marrow involvement, stage, and prognosis of patients with malignancies. Results: We treated 217 males and 1,049 females of a mean age at diagnosis of 58.8 ± 12.3 years. The biopsy data showed that chronic inflammation with fibrosis (n = 1,026 [81.0%]) was the most common condition, followed by fibrosis (n = 133 [10.5%]), chronic inflammation (n = 94 [7.4%]), reactive lymphoid hyperplasia (n = 5 [0.4%]), malignant tumors (n = 4 [0.3%]), tubular adenomas (n = 2 [0.2%]), and papillomas (n = 2 [0.2%]). All malignant tumors were mucosal-associated lymphoid tissue lymphomas. Two of these four patients underwent additional imaging tests, but malignancies were not apparent. The other two had no specific complaints other than tearing. In addition, no abnormalities were evident on slit lamp examination or the syringing test. All four patients were cured by chemotherapy. Conclusions No clinical manifestation, physical examination or imaging data, or intraoperative finding in patients with nasolacrimal duct obstructions reliably identify a malignancy; but histological examination does.

Purpose: The extent of surgery necessary in patients with unilateral papillary thyroid carcinoma (PTC) on preoperative radiologic imaging is still in doubt. In this study, we aimed to define risk factors that could be indicators for malignant nodules in the contralateral thyroid lobe. Methods: We included 438 patients who underwent total thyroidectomy between January 2011 and December 2014 at our institution. In this study, patients were divided into two groups according to the presence of contralateral occult carcinoma identified by postoperative pathological examination. We analyzed the clinicopathologic factors including characteristics of coexistent nodules in the contralateral lobe based on preoperative radiological imaging. Results: A total of 96 patients (21.9%) had PTC in the contralateral lobe. There were no significant differences between patients with or without contralateral occult carcinoma with respect to gender, age, primary tumor size, central lymph node metastasis, extrathyroidal extension and stage. The presence of Hashimoto’s thyroiditis was an independent predictive factor for contralateral occult carcinoma (P=0.01). Conclusion A risk factor for contralateral occult carcinoma in unilateral PTC patients is Hashimoto’s thyroiditis. Therefore, more caution is needed when determining optimal surgical methods for PTC patients with Hashimoto’s thyroiditis.

Objectives: The aim of this study was to investigate dietary intakes and nutritional status among Uganda primary school children from two selected schools in urban and rural areas. Methods: Data were collected from 350 pupils (6-14 years) in Mpigi district, Uganda. All participants were offered a school lunch meal (usually maize porridge and boiled beans). Dietary survey was conducted in October 2016. Data for dietary intake levels were collected by the 24-hour recall method with trained school staffs. The data were converted into nutrient intakes using the CAN-Pro 5.0 Program and compared with KDRIs to evaluate the nutritional status of the subjects. Diet quality indexes such as nutrient density, nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ) and a diet diversity index such as diet diversity score (DDS) were calculated to evaluate nutritional status among subjects. Data were analyzed using SPSS statistical programs. Results: Results show that the intakes of most nutrients were significantly different by schools. The nutritional status of micro-nutrients was very low in both schools according to analysis of nutritional indexes such as NARs and INQs. Students from both schools should improve intakes of micro-nutrients related to child growth such as calcium, Vitamin B6, zinc and folate. According to the analysis of dietary diversity, there was difference in dietary patterns by schools presumably due to their locations. Conclusions This suggests that current meals could not provide adequate nutrients for the subjects and urgent nutrition interventions for school food services are needed to improve their nutritional well-being. New foods supplements based on local cuisine are also needed to ensure dietary diversity and sustainable development plans.

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake. METHODS: Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors. RESULTS: Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9–8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122–8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404–7.228; P=0.47). CONCLUSIONS: Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.
Biopsy ; Carcinoma, Hepatocellular ; Fatty Liver ; Follow-Up Studies ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Incidence ; Liver ; Liver Neoplasms ; Non-alcoholic Fatty Liver Disease ; Propensity Score