Respiratory syncytial virus (RSV) constitutes a significant cause of respiratory illness and mortality among older adults, a demographic that is expanding with considerable impact on healthcare systems worldwide. The actual burden of RSV in this population may still be underestimated, owing to factors such as low awareness and suboptimal diagnostic sensitivity in adults, the lack of robust RSV surveillance systems, and the infrequent use of diagnostic testing. Recent advancements in respiratory virus detection have spurred further exploration into appropriate preventive and therapeutic strategies. The recent approval of two vaccines highlights the critical need for the precise estimation of the RSV disease burden to optimize the effectiveness and cost-efficiency of immunization programs.This narrative review aimed to summarize the existing knowledge of the RSV burden in adults with a particular focus on older adults, incorporating data from Korea. Overall, current estimates indicate that the annual RSV attack rate in the general adult population ranges from 1 - 7%, increasing to approximately 4 - 10% among elderly and high-risk groups. The in-hospital mortality rate can be estimated to be around 7 - 10%, rising up to 40% among intensive care unit-admitted patients. To elucidate RSV’s disease burden, further continuing research, including population-based studies, is necessary.

Purpose: To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision. Methods: The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of –0.3 diopters [D] in dominant eye and –0.6 D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery. Results: This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was –0.31 ± 0.38 in the dominant eye and –0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and –0.38 ± 0.43 in the dominant eye and –0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery. Conclusions The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

Background: The presence of telomerase reverse transcriptase (TERT) promoter mutations have been associated with a poor prognosis in patients with papillary thyroid carcinomas (PTC). The frequency of TERT promoter mutations varies widely depending on the population and the nature of the study. Methods: Data were prospectively collected in 724 consecutive patients who underwent thyroidectomy for PTC from 2018 to 2019. Molecular testing for BRAF V600E and TERT promoter mutations was performed in all cases. Results: TERT promoter alterations in two hotspots (C228T and C250T) and C216T were found in 16 (2.2%) and 4 (0.6%) of all PTCs, respectively. The hotspot mutations were significantly associated with older age at diagnosis, larger tumor size, extrathyroidal extension, higher pathologic T category, lateral lymph node metastasis, and higher American Thyroid Association recurrence risk. The patients with C216T variant were younger and had a lower American Thyroid Association recurrence risk than those with hotspot mutations. Concurrent BRAF V600E was found in 19 of 20 cases with TERT promoter mutations. Of 518 microcarcinomas measuring ≤1.0 cm in size, hotspot mutations and C216T variants were detected in five (1.0%) and three (0.6%) cases, respectively. Conclusions Our study indicates a low frequency of TERT promoter mutations in Korean patients with PTC and supports previous findings that TERT promoter mutations are more common in older patients with unfavorable clinicopathologic features and BRAF V600E. TERT promoter mutations in patients with microcarcinoma are uncommon and may have a limited role in risk stratification. The C216T variant seems to have no clinicopathologic effect on PTC.

Primary acinic cell carcinoma (ACC) of the lung is very rare and this tumor is thought to arise from pluripotent cells of the submucosal glands of the tracheobronchial tree. We report here on a case of primary ACC of the lung in a 68-year-old man who had a solitary pulmonary nodule in the left lower lobe. The patient was symptomless and the lesion was found on a chest X-ray taken during a regular health checkup. The video assisted thoracoscopic surgery wedge resection revealed an ovoid yellow tan solid mass that was 1.8 cm at the largest diameter. Microscopically, the neoplastic cells grew in solid sheets of round cells with eccentric nuclei and abundant basophilic granular cytoplasm. There were no mitotic figures or areas of pleomorphic or anaplastic cells. Immunohistochemical staining for cytokeratin (AE1/AE3) was positive, but the staining for chromogranin A and CD56 was negative. Ultrastructural examination revealed polyhedral cells with many zymogen granules of varying electron density. The patient is well 4 months postoperatively.
Acinar Cells ; Aged ; Basophils ; Carcinoma, Acinar Cell ; Chromogranin A ; Cytoplasm ; Electrons ; Humans ; Keratins ; Lung ; Lung Neoplasms ; Secretory Vesicles ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Thorax ; Triacetoneamine-N-Oxyl

A Yorkshire terrier (case 1) and a Miniature Schnauzer (case 2) were diagnosed with pylorogastric intussusceptions (PGIs). Both cases showed acute vomiting and had previous histories of laparotomy. In case 1, the invaginated pyloric wall was thickened unevenly containing multiple hypoechoic areas and had indistinct wall layering on ultrasonography. PGI with diffuse gastric edema and necrosis was confirmed on laparotomy. The dog recovered completely after gastrectomy and a Y-U plasty. Case 2 had uniformly thickened walls of invaginated gastric pylorus with the distinct wall layering. PGI was reduced spontaneously the next day.
Animals ; Dog Diseases/pathology/surgery/*ultrasonography ; Dogs ; Female ; Intussusception/surgery/ultrasonography/*veterinary ; Pylorus/*pathology/surgery

BACKGROUND: Metaplastic carcinoma of the breast is a rare subtype of breast cancer, which is characterized by estrogen receptor/progesterone receptor and HER2 negativity. METHODS: Tissue specimens from 60 metaplastic breast cancer and 60 triple-negative breast cancer patients diagnosed at a single institution between 1995 and 2009 were analyzed. Immunohistochemistry for caveolin-1 (CAV-1), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), c-kit, p53, Ki-67, breast cancer type 1 susceptibility protein (BRCA1), cytokeratin (CK)14, and CK17 were performed on both retained tissue sets. RESULTS: Of the 60 metaplastic carcinomas, 15 tumors (25%) exhibited spindle cell component, 27 (45%) exhibited chondroid differentiation, and 18 (30%) exhibited squamous areas. Compared to triple-negative carcinomas, metaplastic carcinomas significantly more frequently expressed CK14 (p < 0.0001), CK17 (p = 0.002), EGFR (p < 0.0001), CAV-1 (p < 0.0001), and VEGF (p = 0.029). However, expressions of BRCA1, p53, c-kit, and Ki-67 were not significantly different between both groups. CONCLUSIONS: The expression profile of metaplastic carcinoma of the breast is more homogeneous than that of other triple-negative tumors and frequently over-expresses basal markers, CAV-1, and VEGF. A typical "basal-like" phenotype and frequent expressions of CAV-1 and VEGF may justify specific therapeutic approaches.
Breast ; Breast Neoplasms ; Caveolin 1 ; Cellular Structures ; Estrogens ; Humans ; Immunohistochemistry ; Keratins ; Phenotype ; Receptor, Epidermal Growth Factor ; Vascular Endothelial Growth Factor A

Background: There have been some domestic and overseas cases of anti-D alloimmunization caused by the transfusion of serologically D-negative blood. However, it is difficult to distinguish between true D-negative and DEL variants using conventional serologic typing. Therefore, we established the RHD genotyping algorithm for the detection of DEL variants and applied this algorithm to serologic D negative donors who voluntarily consented to testing. Methods: From September 2016 to December 2020, 216 RHD negative donors who were C＋ and/or E+ in previous serologic typing were recruited. The screening test was PCR amplification of the RHD exons 4, 7, 10, and a promotor. Based on the results of PCR screening, true D-negative samples and RHD variants (including DEL) were discriminated. When the result was a RHD variant, exon 9 was sequenced to identify the nucleotide changes. Full sequencing was performed if no mutations were detected at exon 9. Results: Among the 216 participants, 39 cases with the C−E−c＋e＋ phenotypes that did not meet the recruitment criteria were excluded from data analysis. Among the remaining 177 samples, 68 cases (38.4%) were RHD total deletions, 35 cases (19.8%) were RHD-CE-D hybrids, and 74 cases (41.8%) were RHD variants. Among the cases of RHD variants, 73 cases (98.6%) had c.1227G＞A substitutions and were confirmed as Asian-type DEL. Conclusion Seventy-four cases of serologic D negative donors were reclassified as RHD variants by RHD genotyping. This is believed to have contributed to the improvement of transfusion safety by lowering the risk of anti-D alloimmunization in D-negative patients.

Background: There have been some domestic and overseas cases of anti-D alloimmunization caused by the transfusion of serologically D-negative blood. However, it is difficult to distinguish between true D-negative and DEL variants using conventional serologic typing. Therefore, we established the RHD genotyping algorithm for the detection of DEL variants and applied this algorithm to serologic D negative donors who voluntarily consented to testing. Methods: From September 2016 to December 2020, 216 RHD negative donors who were C＋ and/or E+ in previous serologic typing were recruited. The screening test was PCR amplification of the RHD exons 4, 7, 10, and a promotor. Based on the results of PCR screening, true D-negative samples and RHD variants (including DEL) were discriminated. When the result was a RHD variant, exon 9 was sequenced to identify the nucleotide changes. Full sequencing was performed if no mutations were detected at exon 9. Results: Among the 216 participants, 39 cases with the C−E−c＋e＋ phenotypes that did not meet the recruitment criteria were excluded from data analysis. Among the remaining 177 samples, 68 cases (38.4%) were RHD total deletions, 35 cases (19.8%) were RHD-CE-D hybrids, and 74 cases (41.8%) were RHD variants. Among the cases of RHD variants, 73 cases (98.6%) had c.1227G＞A substitutions and were confirmed as Asian-type DEL. Conclusion Seventy-four cases of serologic D negative donors were reclassified as RHD variants by RHD genotyping. This is believed to have contributed to the improvement of transfusion safety by lowering the risk of anti-D alloimmunization in D-negative patients.

A gossypiboma is an inflammatory pseudotumor that forms when a surgical sponge or gauze is accidentally left behind during surgery, triggering a foreign body reaction. This condition can lead to complications in nearby tissues. Gossypibomas are most commonly found in the abdomen, pelvis, or thorax. However, they are extremely rare in the extremities, making them difficult to diagnose. As a result, they can be mistaken for soft tissue tumors in these areas. This paper presents the case of a 12-year-old boy with a solid mass in his right anterior thigh, later identified as a gossypiboma with characteristic magnetic resonance imaging findings. When evaluating patients with a soft tissue mass and a history of surgery, gossypiboma should be included in the differential diagnosis.

BACKGROUND: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). METHODS: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. RESULTS: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. CONCLUSION: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.
Bronchoalveolar Lavage ; Bronchoalveolar Lavage Fluid ; Exudates and Transudates ; Fungi ; Humans ; Immunocompromised Host ; Neutrophils ; Opportunistic Infections ; Pneumocystis ; Pneumocystis carinii ; Pneumocystis jirovecii ; Pneumonia