Breast cancer is the second most common cancer in Korean women and its mortality rate has increased steadily. Although breast cancer is heterogeneous tumor, hormone receptor-positive tumors comprise about 75 percent of all breast cancers. Therefore endocrine therapy that works by targeting estrogen receptor is a pivotal treatment for breast cancers. There are selective estrogen receptor modulators, such as tamoxifen and raloxifene, aromatase inhibitors, such as anastrozole, letrozole and exemestane, fulvestrant and luteinizing hormone-releasing hormone agonists used in endocrine therapy. Endocrine therapy is effective in treating early breast cancer as an adjuvant therapy and metastatic breast cancer as a palliative therapy. Also in women who are at high risk for breast cancer, tamoxifen or raloxifene can prevent breast cancer. Studies for neoadjuvant endocrine therapy are emerging. Considering side effects of each drug and overcoming drug resistance are needed to maximize effectiveness of treatment and advance endocrine therapy.
Antineoplastic Agents, Hormonal ; Aromatase Inhibitors ; Breast ; Breast Neoplasms* ; Drug Resistance ; Drug Therapy ; Estrogens ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Mortality ; Palliative Care ; Raloxifene Hydrochloride ; Selective Estrogen Receptor Modulators ; Tamoxifen

Selenium is an essential microelement in animals including human. Selenium plays an important role in cellular functions such as deoxygenation and detoxification. Also, it can be used in treatment of cardiac disease, hepatic disease, AIDS and various cancers. Recent meta-analysis showed that high selenium exposure was associated with decreased risk of several cancers. Selenium has an effect on anticarcinogesis through several mechanisms, which are regulation of cell cycles, apoptosis, DNA damage and repair, inhibition of cellular adhesion and migration, anti-angiogenesis and immune modulation. Even though many laboratory studies have provided convincing evidence of these mechanisms, results from epidemiologic and clinical studies of selenium does not coincide with each other. Well-designed trials considering dosage and chemical form of selenium supplement as well as confounding factors and long-term follow-up of them would be needed to use selenium in chemoprevention and therapy of cancers.
Animals ; Apoptosis ; Cell Cycle ; Chemoprevention ; DNA Damage ; Follow-Up Studies ; Heart Diseases ; Humans ; Selenium*

Rehabilitation medicine in Korea has improved significantly; however, the rehabilitation medical delivery system still lacks well-established continuity and comprehensiveness. Since 2000, Japan has implemented a convalescent rehabilitation ward system, with continuous improvements in policies and criteria based on clinical needs. This study compared the rehabilitation systems of Korea and Japan, focusing on institutional standards and the scope of target patients in order to explore directions for enhancing the Korean system.Current Concepts: Japan applies a multi-tiered reporting system for rehabilitation wards, categorizing wards and adjusting reimbursements based on performance indicators such as functional improvement rates, discharge-tohome rates, and rehabilitation effectiveness indices. Additionally, Japan’s policies encompass a broad range of target diseases and flexible admission criteria, improving accessibility. In Korea, the scope of target diseases is relatively narrow, limiting opportunities for patients to receive appropriate rehabilitation treatment.Discussion and Conclusion: Korea could benefit from adopting a multitiered system and performance-based reimbursement structure, as seen in Japan’s model. Expanding the range of eligible conditions and reviewing certification requirements can enhance the accessibility and quality of rehabilitation services. These changes are expected to foster an environment in which patients can receive timely and comprehensive rehabilitation care, thereby facilitating physical recovery and reintegration into society.

Rehabilitation medicine in Korea has improved significantly; however, the rehabilitation medical delivery system still lacks well-established continuity and comprehensiveness. Since 2000, Japan has implemented a convalescent rehabilitation ward system, with continuous improvements in policies and criteria based on clinical needs. This study compared the rehabilitation systems of Korea and Japan, focusing on institutional standards and the scope of target patients in order to explore directions for enhancing the Korean system.Current Concepts: Japan applies a multi-tiered reporting system for rehabilitation wards, categorizing wards and adjusting reimbursements based on performance indicators such as functional improvement rates, discharge-tohome rates, and rehabilitation effectiveness indices. Additionally, Japan’s policies encompass a broad range of target diseases and flexible admission criteria, improving accessibility. In Korea, the scope of target diseases is relatively narrow, limiting opportunities for patients to receive appropriate rehabilitation treatment.Discussion and Conclusion: Korea could benefit from adopting a multitiered system and performance-based reimbursement structure, as seen in Japan’s model. Expanding the range of eligible conditions and reviewing certification requirements can enhance the accessibility and quality of rehabilitation services. These changes are expected to foster an environment in which patients can receive timely and comprehensive rehabilitation care, thereby facilitating physical recovery and reintegration into society.

Rehabilitation medicine in Korea has improved significantly; however, the rehabilitation medical delivery system still lacks well-established continuity and comprehensiveness. Since 2000, Japan has implemented a convalescent rehabilitation ward system, with continuous improvements in policies and criteria based on clinical needs. This study compared the rehabilitation systems of Korea and Japan, focusing on institutional standards and the scope of target patients in order to explore directions for enhancing the Korean system.Current Concepts: Japan applies a multi-tiered reporting system for rehabilitation wards, categorizing wards and adjusting reimbursements based on performance indicators such as functional improvement rates, discharge-tohome rates, and rehabilitation effectiveness indices. Additionally, Japan’s policies encompass a broad range of target diseases and flexible admission criteria, improving accessibility. In Korea, the scope of target diseases is relatively narrow, limiting opportunities for patients to receive appropriate rehabilitation treatment.Discussion and Conclusion: Korea could benefit from adopting a multitiered system and performance-based reimbursement structure, as seen in Japan’s model. Expanding the range of eligible conditions and reviewing certification requirements can enhance the accessibility and quality of rehabilitation services. These changes are expected to foster an environment in which patients can receive timely and comprehensive rehabilitation care, thereby facilitating physical recovery and reintegration into society.

PURPOSE: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience. METHODS: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed. RESULTS: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed. CONCLUSION Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM.

PURPOSE: Reactivation of hepatitis B virus (HBV) replication after hepatic resection might be a significant risk factor for prognosis in patients with chronic hepatitis B. The purpose of the present study was to investigate the changing pattern of serum HBV DNA titer after hepatic resection and to assess the incidence of reactivation of HBV replication. METHODS: Among HBV-positive patients who underwent hepatic resection for hepatocellular carcinoma, thirty-six patients with preoperative serum HBV DNA titer > or =3 log(10)copies/mL were enrolled. Serum DNA titers were examined before the operation, on the second and seventh postoperative days, and one month after the operation. RESULTS: The serum DNA titer decreased on the second postoperative day (p=0.078). The DNA level, however, had substantially returned to preoperative values by the seventh postoperative day (p<0.001). For most patients, the postoperative DNA titer reached its zenith on the seventh postoperative day or one month after the operation. The zenith level was higher (by 0.49+/-0.25 log10copies/mL) than preoperative levels although this difference just missed significance (p=0.068). Although postoperative reactivation of HBV replication emerged in 6 patients, only one of those patients developed postoperative hepatitis. Overall, four patients developed postoperative hepatitis and all of them had high postoperative HBV DNA levels (over 6 log(10)copies/mL). CONCLUSION: Although serum HBV DNA titers tended to increase postoperatively, routine antiviral therapy might be unnecessary because of the low incidence of postoperative hepatitis. High postoperative DNA levels, however, might be a risk factor for hepatitis, and postoperative follow-up of serum HBV DNA levels might be necessary in HBV-positive patients with hepatic resection.
Carcinoma, Hepatocellular ; DNA ; DNA Replication ; Follow-Up Studies ; Hepatectomy ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Incidence ; Prognosis ; Risk Factors

Objective: To demonstrate the noninferiority of the novel hemostatic agent, Hemofence (BMI Korea Co., Ltd., thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety. Methods: This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For noninferiority test, a 97.5% one-sided confidence interval (CI) was used; the test group was deemed noninferior if the lower limit exceeded -10%. Results: This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% CI (-4.90% to 7.44%) confirmed the test drug’s noninferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.000, p=0.243, and p=0.966, respectively). Conclusion A novel hemostatic agent, Hemofence, demonstrated an efficacy and safety profile comparable to that of Floseal.

Objective: To demonstrate the noninferiority of the novel hemostatic agent, Hemofence (BMI Korea Co., Ltd., thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety. Methods: This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For noninferiority test, a 97.5% one-sided confidence interval (CI) was used; the test group was deemed noninferior if the lower limit exceeded -10%. Results: This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% CI (-4.90% to 7.44%) confirmed the test drug’s noninferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.000, p=0.243, and p=0.966, respectively). Conclusion A novel hemostatic agent, Hemofence, demonstrated an efficacy and safety profile comparable to that of Floseal.

Objective: To demonstrate the noninferiority of the novel hemostatic agent, Hemofence (BMI Korea Co., Ltd., thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety. Methods: This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For noninferiority test, a 97.5% one-sided confidence interval (CI) was used; the test group was deemed noninferior if the lower limit exceeded -10%. Results: This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% CI (-4.90% to 7.44%) confirmed the test drug’s noninferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.000, p=0.243, and p=0.966, respectively). Conclusion A novel hemostatic agent, Hemofence, demonstrated an efficacy and safety profile comparable to that of Floseal.