In recent years, next-generation sequencing (NGS)–based genetic testing has become crucial in cancer care. While its primary objective is to identify actionable genetic alterations to guide treatment decisions, its scope has broadened to encompass aiding in pathological diagnosis and exploring resistance mechanisms. With the ongoing expansion in NGS application and reliance, a compelling necessity arises for expert consensus on its application in solid cancers. To address this demand, the forthcoming recommendations not only provide pragmatic guidance for the clinical use of NGS but also systematically classify actionable genes based on specific cancer types. Additionally, these recommendations will incorporate expert perspectives on crucial biomarkers, ensuring informed decisions regarding circulating tumor DNA panel testing.

In recent years, next-generation sequencing (NGS)–based genetic testing has become crucial in cancer care. While its primary objective is to identify actionable genetic alterations to guide treatment decisions, its scope has broadened to encompass aiding in pathological diagnosis and exploring resistance mechanisms. With the ongoing expansion in NGS application and reliance, a compelling necessity arises for expert consensus on its application in solid cancers. To address this demand, the forthcoming recommendations not only provide pragmatic guidance for the clinical use of NGS but also systematically classify actionable genes based on specific cancer types. Additionally, these recommendations will incorporate expert perspectives on crucial biomarkers, ensuring informed decisions regarding circulating tumor DNA panel testing.

Tuberculosis is an adverse event in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn’s disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient’s condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

Background/Aims: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver func-tion, ascites, hepatic encephalopathy, and especially esopha-geal varix (EV) after PARTO. Methods: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. Results: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33±2.96, p=0.021).Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure mea-sured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). Conclusions The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pres-sure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome.

BACKGROUND: Atrial fibrillation (AF) can be a risk factor for development of significant tricuspid regurgitation (TR). We investigated which clinical and echocardiographic parameters were related to severity of functional TR in patients with lone AF. METHODS: A total of 89 patients with lone AF were enrolled (75 +/- 11 years; 48% male): 13 patients with severe TR, 36 patients with moderate TR, and 40 consecutive patients with less than mild TR. Clinical parameters and echocardiographic measurements including right ventricular (RV) remodeling and function were evaluated. RESULTS: Patients with more severe TR were older and had more frequently persistent AF (each p < 0.001). TR severity was related to right atrial area and tricuspid annular systolic diameter (all p < 0.001). The patients with moderate or severe TR had larger left atrial (LA) volume and increased systolic pulmonary artery pressure (SPAP) than the patients with mild TR (p = 0.04 for LA volume; p < 0.001 for SPAP). RV remodeling represented by enlarged RV area and increased tenting height was more prominent in severe TR than mild or moderate TR (all p < 0.001). Multivariate analysis showed type of AF, LA volume, tricuspid annular diameter and tenting height remained as a significant determinants of severe TR. In addition, tenting height was independently associated with the presence of severe TR (p = 0.04). CONCLUSION: In patients with lone AF, TR was related to type of AF, LA volume, tricuspid annular diameter and RV remodeling. Especially, tricuspid valvular tethering seemed to be independently associated with development of severe functional TR.
Atrial Fibrillation* ; Echocardiography* ; Humans ; Multivariate Analysis ; Pulmonary Artery ; Risk Factors ; Tricuspid Valve Insufficiency*

We investigated the risk factors for resistance to ciprofloxacin, cefazolin, ampicillin and co-trimoxazole in Escherichia coli isolates from urine of Korean female patients with acute uncomplicated cystitis (AUC). A total of 225 patients and their E. coli isolates were prospectively and nationwidely enrolled between May and October, 2006. All the antimicrobials did not show any differences according to the age group. A higher rate of ciprofloxacin resistance was observed in the south (OR: 3.04, 95% CI: 1.19-7.80 for Chungcheong-do & Jeolla-do; OR: 3.04, 95% CI: 1.22-7.58 for Gyeongsang-do) compared to Gyeonggi-do. Two recurrences of AUC in the past year was an important risk factor for antimicrobial resistance (ciprofloxacin; OR: 6.71, 95% CI: 1.86-24.11 and cefazolin; OR: 5.72, 95% CI: 1.20-27.25). However, the resistance to co-trimoxazole and ampicillin was not associated with any of the risk factors. This study also revealed the pattern of multi-drugs resistance in ciprofloxacin resistant E. coli strains. In conclusion, for Korean patients with two more recurrences of AUC in the past year, it is strongly recommended to perform an antimicrobial sensitivity test with a urine sample before empirical treatment.
Acute Disease ; Adolescent ; Adult ; Aged ; Ampicillin/pharmacology ; Anti-Bacterial Agents/pharmacology ; Cefazolin/pharmacology ; Ciprofloxacin/pharmacology ; Cystitis/*microbiology ; *Drug Resistance, Bacterial ; Escherichia coli/*drug effects/isolation & purification ; Female ; Humans ; Microbial Sensitivity Tests ; Middle Aged ; Prospective Studies ; Republic of Korea ; Risk Factors ; Trimethoprim-Sulfamethoxazole Combination/pharmacology

PURPOSE: The renal histological and hemodynamic changes and the expressions of hypoxia inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) were evaluated according to the differential renal function (DRF) during total ureteral obstruction (TUO) in a rabbit model. MATERIALS AND METHODS: In forty-nine control (5) and 16 experimental rabbits (16 in TUO 3 days, 13 in TUO 7 days and 15 in TUO 14 days), the renal blood flow (RBF) and 99mTc-DTPA renal scan were measured both before and after TUO. The cut-off of the DRF group was 40%. The histological changes and expressions of HIF-1alpha and VEGF were evaluated using H&E and immunohistochemical stain, respectively. RESULTS: The entire control group demonstrated more than 40% DRF. Contrary to the control group, the DRF was less than 40% in 4 (25%), 7 (53%) and 6 rabbits (40%) in TUO 3, 7 and 14 day groups, respectively. The postobstructive compared to preobstructive RBF was decreased in each group. The RBF was more decreased in the lower than the higher DRF group (more than 40%) in all of the experimental groups. Abnormal histological changes were more prominent in the experimental groups, and increased with the obstruction time. However, there was no difference in relation to the DRF. The expressions of HIF-1alpha and VEGF were more prominent in the experimental and lower DRF groups. CONCLUSIONS: During acute TUO, the decreased RBF and hypoxia may play a role in preservation of the DRF.
Anoxia* ; Hemodynamics ; Hypoxia-Inducible Factor 1 ; Rabbits ; Renal Circulation ; Ureter* ; Ureteral Obstruction* ; Vascular Endothelial Growth Factor A*

Small bowel diseases are uncommon and difficult to be diagnosed by conventional methods such as endoscopy and radiologic study. Recently, wireless capsule endoscopy has been known as a new diagnostic method to detect the small bowel diseases, especially in patients with obscure gastrointestinal bleeding. A 48-year-old male patient admitted our hospital with signs of gastrointestinal bleeding and iron deficiency anemia. There was no evidence of bleeding in upper and lower endoscopic exams. Finally, wireless capsule endoscopy demonstrated small bowel polyp as a cause of obscure gastrointestinal bleeding. We report a case of small bowel polyp bleeding diagnosed by wireless capsule endoscopy with a review of relevant literatures.
Anemia, Iron-Deficiency ; Capsule Endoscopy* ; Endoscopy ; Hemorrhage* ; Humans ; Male ; Middle Aged ; Polyps*

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome

PURPOSE: Injury to articular cartilage is likely progressive to develop arthritis and dysfunction of joint because its regeneration is limited. Transplantation of cultured autologous chondrocytes was proved to be a satisfactory treatment method and could prevent a dysfunction of joint. However chondrocytes propagated in monolayer culture lose their original characteristics by assuming a morphologic shift to fibroblast like cell and biosynthetic shift to production of collagen type I from type II and to decrease in synthesis of DNA and proteoglycans. A three dimensional culture of articular chondrocytes using microcarrier was performed to overcome disadvantages of phenotypic changes in monolayer culture. MATERIALS & METHODS: Cultured articular chondrocytes, 6 times passed in 13 weeks, were innoculated and propagated in flasks for monolayer culture and spinner flasks for three dimensional culture respectively for 2 weeks. RESULTS: Cells in three dimensional culture proliferated faster and showed more markedly increase in cell number than those in monolayer culture. Expression of type II collagen was observed in three dimensional culture, but was hardly observed in monolayer culture. CONCLUSION: Degree of synthesis of DNA and proteoglycans also more markedly increase in three dimensional culture than in monolayer culture. Our experiments demonstrate that three dimensional culture of articular chondrocyte using microcarrier provides increase in growth and reexpression of phenotype of chondrocytes.
Arthritis ; Cartilage, Articular ; Cell Count ; Chondrocytes* ; Collagen Type I ; Collagen Type II ; DNA ; Fibroblasts ; Joints ; Phenotype ; Proteoglycans ; Regeneration