Objectives: The aim of this study was to evaluate the effectiveness of aripiprazole long-acting injection in patients with schizophrenia undergoing antipsychotics combination therapy. Methods: We conducted a retrospective analysis using electronic medical records of patients with schizophrenia who initiated aripiprazole long-acting injectable and were treated with antipsychotics combination therapy. These patients were either admitted to a psychiatric hospital or treated as outpatients between June, 2019 and December, 2019. Results: Seventeen patients met the inclusion criteria. The mean number of antipsychotics significantly decreased from 2.53 use to 1.81 at month 12 (p=0.018). Total antipsychotics olanzapine equivalent dose significantly decreased from 46.96 to 27.54 at month 12 (p=0.005). The number of combined medications including antidepressants, mood stabilizers, anxiolytics, and anticholinergics did not significantly change. Both the Positive and Negative Syndrome Scale (PANSS) score and The Global Assessment of Functioning (GAF) score significantly improved until month 24 (p=0.004, 0.038; respectively). Conclusions This observational study confirmed that aripiprazole long-acting injection is an effective treatment option for patients with schizophrenia undergoing antipsychotic combination therapy. Well-controlled clinical trials are necessary in the near future.

Objectives: The aim of this study was to evaluate the effectiveness of aripiprazole long-acting injection in patients with schizophrenia undergoing antipsychotics combination therapy. Methods: We conducted a retrospective analysis using electronic medical records of patients with schizophrenia who initiated aripiprazole long-acting injectable and were treated with antipsychotics combination therapy. These patients were either admitted to a psychiatric hospital or treated as outpatients between June, 2019 and December, 2019. Results: Seventeen patients met the inclusion criteria. The mean number of antipsychotics significantly decreased from 2.53 use to 1.81 at month 12 (p=0.018). Total antipsychotics olanzapine equivalent dose significantly decreased from 46.96 to 27.54 at month 12 (p=0.005). The number of combined medications including antidepressants, mood stabilizers, anxiolytics, and anticholinergics did not significantly change. Both the Positive and Negative Syndrome Scale (PANSS) score and The Global Assessment of Functioning (GAF) score significantly improved until month 24 (p=0.004, 0.038; respectively). Conclusions This observational study confirmed that aripiprazole long-acting injection is an effective treatment option for patients with schizophrenia undergoing antipsychotic combination therapy. Well-controlled clinical trials are necessary in the near future.

Objectives: The aim of this study was to evaluate the effectiveness of aripiprazole long-acting injection in patients with schizophrenia undergoing antipsychotics combination therapy. Methods: We conducted a retrospective analysis using electronic medical records of patients with schizophrenia who initiated aripiprazole long-acting injectable and were treated with antipsychotics combination therapy. These patients were either admitted to a psychiatric hospital or treated as outpatients between June, 2019 and December, 2019. Results: Seventeen patients met the inclusion criteria. The mean number of antipsychotics significantly decreased from 2.53 use to 1.81 at month 12 (p=0.018). Total antipsychotics olanzapine equivalent dose significantly decreased from 46.96 to 27.54 at month 12 (p=0.005). The number of combined medications including antidepressants, mood stabilizers, anxiolytics, and anticholinergics did not significantly change. Both the Positive and Negative Syndrome Scale (PANSS) score and The Global Assessment of Functioning (GAF) score significantly improved until month 24 (p=0.004, 0.038; respectively). Conclusions This observational study confirmed that aripiprazole long-acting injection is an effective treatment option for patients with schizophrenia undergoing antipsychotic combination therapy. Well-controlled clinical trials are necessary in the near future.

Viral load and the duration of viral shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are important determinants of the transmission of coronavirus disease 2019.In this study, we examined the effects of viral doses on the lung and spleen of K18-hACE2 transgenic mice by temporal histological and transcriptional analyses. Approximately, 1×105 plaque-forming units (PFU) of SARS-CoV-2 induced strong host responses in the lungs from 2 days post inoculation (dpi) which did not recover until the mice died, whereas responses to the virus were obvious at 5 days, recovering to the basal state by 14 dpi at 1×102 PFU. Further, flow cytometry showed that number of CD8+ T cells continuously increased in 1×102 PFU-virusinfected lungs from 2 dpi, but not in 1×105 PFU-virus-infected lungs. In spleens, responses to the virus were prominent from 2 dpi, and number of B cells was significantly decreased at 1×105PFU; however, 1×102 PFU of virus induced very weak responses from 2 dpi which recovered by 10 dpi. Although the defense responses returned to normal and the mice survived, lung histology showed evidence of fibrosis, suggesting sequelae of SARS-CoV-2 infection. Our findings indicate that specific effectors of the immune response in the lung and spleen were either increased or depleted in response to doses of SARS-CoV-2. This study demonstrated that the response of local and systemic immune effectors to a viral infection varies with viral dose, which either exacerbates the severity of the infection or accelerates its elimination.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a shortage of medical resources and the need for proper treatment guidelines for brain tumor patients became more pressing. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. As part II of the guideline, this consensus survey is to suggest management options in specific clinical scenarios during the crisis period. Methods: The KSNO Guideline Working Group consisted of 22 multidisciplinary experts on neuro-oncology in Korea. In order to confirm a consensus reached by the experts, opinions on 5 specific clinical scenarios about the management of brain tumor patients during the crisis period were devised and asked. To build-up the consensus process, Delphi method was employed. Results: The summary of the final consensus from each scenario are as follows. For patients with newly diagnosed astrocytoma with isocitrate dehydrogenase (IDH)-mutant and oligodendroglioma with IDH-mutant/1p19q codeleted, observation was preferred for patients with low-risk, World Health Organization (WHO) grade 2, and Karnofsky Performance Scale (KPS) ≥60, while adjuvant radiotherapy alone was preferred for patients with high-risk, WHO grade 2, and KPS ≥60. For newly diagnosed patients with glioblastoma, the most preferred adjuvant treatment strategy after surgery was radiotherapy plus temozolomide except for patients aged ≥70 years with KPS of 60 and unmethylated MGMT promoters. In patients with symptomatic brain metastasis, the preferred treatment differed according to the number of brain metastasis and performance status. For patients with newly diagnosed atypical meningioma, adjuvant radiation was deferred in patients with older age, poor performance status, complete resection, or low mitotic count. Conclusion It is imperative that proper medical care for brain tumor patients be sustained and provided, even during the crisis period. The findings of this consensus survey will be a useful reference in determining appropriate treatment options for brain tumor patients in the specific clinical scenarios covered by the survey during the future crisis.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the need for appropriate treatment guidelines for patients with brain tumors was indispensable due to the lack and limitations of medical resources. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. Methods: The KSNO Guideline Working Group was composed of 22 multidisciplinary experts on neuro-oncology in Korea. In order to reach consensus among the experts, the Delphi method was used to build up the final recommendations. Results: All participating experts completed the series of surveys, and the results of final survey were used to draft the current consensus recommendations. Priority levels of surgery and radiotherapy during crises were proposed using appropriate time window-based criteria for management outcome. The highest priority for surgery is assigned to patients who are life-threatening or have a risk of significant impact on a patient’s prognosis unless immediate intervention is given within 24–48 hours. As for the radiotherapy, patients who are at risk of compromising their overall survival or neurological status within 4–6 weeks are assigned to the highest priority. Curative-intent chemotherapy has the highest priority, followed by neoadjuvant/adjuvant and palliative chemotherapy during a crisis period. Telemedicine should be actively considered as a management tool for brain tumor patients during the mass infection crises such as the COVID-19 pandemic. Conclusion It is crucial that adequate medical care for patients with brain tumors is maintained and provided, even during times of crisis. This guideline will serve as a valuable resource, assisting in the delivery of treatment to brain tumor patients in the event of any future crisis.

Background/Aims: We performed a prospective study to determine the efficacy and safety of rituximab including chemotherapy in CD20-positive acute lymphoblastic leukemia (ALL). Methods: Patients with newly diagnosed ALL, aged ≥ 15 years, were eligible for the study if their leukemic blast cells in bone marrow expressed CD20 ≥ 20% at the time of diagnosis. Patients received multiagent chemotherapy with rituximab. After achieving complete remission (CR), patients received five cycles of consolidation with concomitant rituximab. Rituximab was administered monthly from day 90 of transplantation for patients who received allogeneic hematopoietic cell transplantation. Results: In patients with Philadelphia (Ph)-negative ALL, 39 of 41 achieved CR (95.1%), the 2- and 4-year relapse-free survival (RFS) rates were 50.4% and 35.7%, and the 2- and 4-year overall survival (OS) rates were 51.5% and 43.2%, respectively. In the group with Ph-positive ALL, all 32 patients achieved CR, the 2- and 4-year RFS rates were 60.7% and 52.1%, and the 2- and 4-year OS rates were 73.3% and 52.3%, respectively. In the Ph-negative ALL group, patients with higher CD20 positivity experienced more favorable RFS (p < 0.001) and OS (p = 0.06) than those with lower CD20 positivity. Patients who received ≥ 2 cycles of rituximab after transplantation had significantly improved RFS (hazard ratio [HR], 0.31; p = 0.049) and OS (HR, 0.29; p = 0.021) compared with those who received < 2 cycles. Conclusions The addition of rituximab to conventional chemotherapy for CD20-positive ALL is effective and tolerable (Clinicaltrials. gov NCT01429610).

Background: As the number of large-scale studies involving multiple organizations producing data has steadily increased, an integrated system for a common interoperable format is needed. In response to the coronavirus disease 2019 (COVID-19) pandemic, a number of global efforts are underway to develop vaccines and therapeutics. We are therefore observing an explosion in the proliferation of COVID-19 data, and interoperability is highly requested in multiple institutions participating simultaneously in COVID-19 pandemic research. Results: In this study, a laboratory information management system (LIMS) approach has been adopted to systemically manage various COVID-19 non-clinical trial data, including mortality, clinical signs, body weight, body temperature, organ weights, viral titer (viral replication and viral RNA), and multiorgan histopathology, from multiple institutions based on a web interface. The main aim of the implemented system is to integrate, standardize, and organize data collected from laboratories in multiple institutes for COVID-19 non-clinical efficacy testings. Six animal biosafety level 3 institutions proved the feasibility of our system. Substantial benefits were shown by maximizing collaborative high-quality non-clinical research. Conclusions This LIMS platform can be used for future outbreaks, leading to accelerated medical product development through the systematic management of extensive data from non-clinical animal studies.

Objectives: Hikikomori is a social condition characterized by social withdrawal. It is essential to develop an objective indicator to screen for this condition and provide early intervention. Therefore, this study verified the validity and reliability of a Korean version of the 25-item Hikikomori Questionnaire (HQ-25). Methods: Semi-structured interviews were conducted with participants at high risk of feeling loneliness and who were recruited through online and offline methods. Data based on clinical scales were collected, and after four weeks, a self-report questionnaire was administered to a few participants to confirm the degree of agreement. Results: One hundred forty-three people were enrolled, out of which 45 were identified as hikikomori. There was a significant difference in scores between the hikikomori group and the unaffected group (64.44 and 39.30, respectively; p<0.01). Convergent diversity and test-retest reliability were satisfactory. The area under the receiver operating characteristic curve was 0.817. Based on confirmatory factor analysis, the existing model was found suitable. In this study, sensitivity and specificity were 88.9% and 52.0% at 40.5 points, and 84.4% and 49.0% at 41.5 points, respectively. Conclusion The Korean version of the HQ-25 has secure validity and reliability. This scale can be beneficial in the screening and early intervention of hikikomori.

Background/Aims: South Korean soldiers are exposed to similar environmental factors. In this study, we sought to evaluate the gut microbiome of healthy young male soldiers (HYMS) and to identify the primary factors influencing the microbiome composition. Methods: We prospectively collected stool from 100 HYMS and performed next-generation sequencing of the 16S rRNA genes of fecal bacteria. Clinical data, including data relating to the diet, smoking, drinking, and exercise, were collected. Results: The relative abundances of the bacterial phyla Firmicutes, Actinobacteria, Bacteroidetes, and Proteobacteria were 72.3%, 14.5%, 8.9%, and 4.0%, respectively. Fifteen species, most of which belonged to Firmicutes (87%), were detected in all examined subjects. Using cluster analysis, we found that the subjects could be divided into the two enterotypes based on the gut microbiome bacterial composition. Compared with enterotype 2 subjects, subjects classified as enterotype 1 tended to be characterized by higher frequencies of potentially harmful lifestyle habits (current smoker: 55.6% vs 36.6%, p=0.222; heavy drinker: 16.7% vs 3.7%, p=0.120; insufficient physical activity: 27.8% vs 14.6%, p=0.318). We identified a significant difference in the microbiome compositions of current and noncurrent smokers (p=0.008); the former differed from the latter mainly in a relatively lower abundance of Bifidobacterium species and a higher abundance of Negativicutes. Conclusions A high abundance of Actinobacteria and low abundance of Bacteroidetes