Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: and Purpose Visual perceptual learning (VPL) may improve visual field defects (VFDs) after chronic stroke, but the optimal training duration and location remain unknown. This prospective study aimed to determine the efficacy of 8 weeks of VFD-customized visual discrimination training in improving poststroke VFDs. Methods: Prospectively enrolled patients with poststroke VFDs initially received no training for 8 weeks (no-training phase). They subsequently underwent our customized VPL program that included orientation-discrimination tasks in individualized blind fields and central letterdiscrimination tasks three times per week for 8 weeks (training phase). We analyzed the luminance detection sensitivity and deviation as measured using Humphrey visual field tests before and after the no-training and training phases. The vision-related quality of life was assessed at baseline and at a 16-week follow-up using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Results: Changes in mean total deviation (MTD) scores were greater during the training phase than during the no-training phase (defective hemifield, p=0.002; whole field, p=0.004). The MTD scores improved during the training phase (defective hemifield, p=0.004; whole field, p=0.016), but not during the no-training phase (defective hemifield, p=0.178; whole field, p=0.178). The difference between the improved and worsened areas (≥6 dB changes in luminance detection sensitivity) was greater during the training phase than during the no-training phase (p=0.009). The vision-specific social functioning subscore of the NEI-VFQ-25 improved after the 16-week study period (p=0.040). Conclusions Our 8-week VFD-customized visual discrimination training protocol may effectively improve VFDs and vision-specific social functioning in chronic stroke patients.

BACKGROUND: Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. METHODS: Full-thickness human skin xenografts were transplanted into the backs of Sprague–Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC 9 1 group), and triple injections of ADSCs (ADSC 9 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. RESULTS: Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC 9 1 groups. The vascularization and collagen type 1–3 ratios in the ADSC 9 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC 9 3 group. Furthermore, in the ADSC 9 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-c) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. CONCLUSION This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-c and upregulation of PGES in skin xenografts and lymph nodes.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

Background: and purpose Whether pharmacologically altered high-density lipoprotein cholesterol (HDL-C) affects the risk of cardiovascular events is unknown. Recently, we have reported the Prevention of Cardiovascular Events in Asian Patients with Ischaemic Stroke at High Risk of Cerebral Haemorrhage (PICASSO) trial that demonstrated the non-inferiority of cilostazol to aspirin and superiority of probucol to non-probucol for cardiovascular prevention in ischemic stroke patients (clinicaltrials.gov: NCT01013532). We aimed to determine whether on-treatment HDL-C changes by cilostazol and probucol influence the treatment effect of each study medication during the PICASSO study. Methods: Of the 1,534 randomized patients, 1,373 (89.5%) with baseline cholesterol parameters were analyzed. Efficacy endpoint was the composite of stroke, myocardial infarction, and cardiovascular death. Cox proportional hazards regression analysis examined an interaction between the treatment effect and changes in HDL-C levels from randomization to 1 month for each study arm. Results: One-month post-randomization mean HDL-C level was significantly higher in the cilostazol group than in the aspirin group (1.08 mmol/L vs. 1.00 mmol/L, P<0.001). The mean HDL-C level was significantly lower in the probucol group than in the non-probucol group (0.86 mmol/L vs. 1.22 mmol/L, P<0.001). These trends persisted throughout the study. In both study arms, no significant interaction was observed between HDL-C changes and the assigned treatment regarding the risk of the efficacy endpoint. Conclusions Despite significant HDL-C changes, the effects of cilostazol and probucol treatment on the risk of cardiovascular events were insignificant. Pharmacologically altered HDL-C levels may not be reliable prognostic markers for cardiovascular risk.