Objective: Given the long-term and severe distress experienced during breast cancer treatment, detecting depression among breast cancer patients is clinically crucial. This study aimed to explore a machine-learning model using self-report questionnaires to screen for depression in patients with breast cancer. Methods: A total of 327 patients who visited the breast cancer clinic were included in this study. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). The depression was evaluated according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The prediction model’s performance based on supervised machine learning was conducted using MATLAB2022. Results: The BDI showed an area under the curve (AUC) of 0.785 when using the logistic regression (LR) classifier.The HADS and PHQ-9 showed an AUC of 0.784 and 0.756 when using the linear discriminant analysis, respectively.The combinations of BDI and HADS showed an AUC of 0.812 when using the LR. The combinations of PHQ-9, BDI, and HADS showed an AUC of 0.807 when using LR. Conclusion The combination model with BDI and HADS in breast cancer patients might be better than the method using a single scale. In future studies, it is necessary to explore strategies that can improve the performance of the model by integrating the method using questionnaires and other methods.

Purpose: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.

Objective: Due to the high frequency of depressive symptoms associated with breast cancer, it is crucial to screen for depression in breast cancer patients. While numerous screening tools are available for depression in this population, there is a need for a brief and convenient tool to enhance clinical use. This study aims to investigate the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) in patients with breast cancer. Methods: Patients with breast cancer (n=327) who visited the Breast Cancer Clinic were included in this study. The reliability of the PHQ-9 was analyzed by Cronbach’s α, and the construct validity of the PHQ-9 was explored by factor analysis. The concurrent validity of the PHQ-9 was evaluated by Pearson correlation analysis with the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Results: The values of Cronbach’s α ranged from 0.800 to 0.879 was acceptable. The exploratory factor analysis revealed that the one-factor model and two-factor model of the PHQ-9 explained 46% and 57% of the variance, respectively. The PHQ-9 were significantly correlated with those of HADS (r=0.702, p<0.001) and PSS (r=0.466, p<0.001). Consequently, the PHQ-9 demonstrated acceptable reliability and validity in breast cancer patients. Conclusion The findings of this study indicate that the PHQ-9 exhibits acceptable reliability and validity in patients with breast cancer. The convenience of this brief self-report questionnaire suggests its potential as a reliable and valid tool for assessing depression in breast cancer clinics.

This paper analyzes the motivations of the British biochemist Joseph Needham for participating in ‘the International Scientific Commission for the Investigation of the Facts Concerning Bacterial Warfare in Korea and China (ISC)’ and his major roles within it during the Korean War. Needham stayed in China for four years starting in 1942 as a scientific counselor and director of the British Scientific Mission in China, which enabled him to interact with many Chinese scientists and politicians. Surprisingly, during this period (1944), Needham conducted an investigation into the Japanese military’s use of bacterial warfare. Through his personal records, Needham repeatedly stated that his experience with bacterial warfare research in 1944 was one of the most important reasons for his participation in ISC activities. In addition, Needham secretly but very actively sought to recruit other investigators within Britain. Needham repeatedly tried to persuade fellow professors at Cambridge University, William Thorpe and Vincent Wigglesworth, to be included in the investigation team. Although Needham had doubts about his own expertise in investigative activities, he actively expressed his desire to become a member of the investigative team through various channels. Primary documents show that he actively and voluntarily led the investigation activities after joining the team in professional discussions, document analysis, and witness interrogations. Needham’s passion and sincerity demonstrated in internal meeting minutes dispel some misunderstandings that the investigation team’s activities were limited to passively approving Chinese data.

Purpose: Assessing the metastasis status of the sentinel lymph nodes (SLNs) for hematoxylin and eosin–stained frozen tissue sections by pathologists is an essential but tedious and time-consuming task that contributes to accurate breast cancer staging. This study aimed to review a challenge competition (HeLP 2019) for the development of automated solutions for classifying the metastasis status of breast cancer patients. Materials and Methods: A total of 524 digital slides were obtained from frozen SLN sections: 297 (56.7%) from Asan Medical Center (AMC) and 227 (43.4%) from Seoul National University Bundang Hospital (SNUBH), South Korea. The slides were divided into training, development, and validation sets, where the development set comprised slides from both institutions and training and validation set included slides from only AMC and SNUBH, respectively. The algorithms were assessed for area under the receiver operating characteristic curve (AUC) and measurement of the longest metastatic tumor diameter. The final total scores were calculated as the mean of the two metrics, and the three teams with AUC values greater than 0.500 were selected for review and analysis in this study. Results: The top three teams showed AUC values of 0.891, 0.809, and 0.736 and major axis prediction scores of 0.525, 0.459, and 0.387 for the validation set. The major factor that lowered the diagnostic accuracy was micro-metastasis. Conclusion In this challenge competition, accurate deep learning algorithms were developed that can be helpful for making a diagnosis on intraoperative SLN biopsy. The clinical utility of this approach was evaluated by including an external validation set from SNUBH.

Objective: Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients. Methods: This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework. Results: Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS. Conclusion This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.

In 1946, the U.S. Army established the 406th Medical General Laboratory as the central medical research institute for their new Asia-Pacific-occupied area. The primary mission of the 406th medical laboratory was to supplement the epidemiologic, sanitary, and diagnostic services available in other medical facilities and hospitals, and to investigate outbreaks of disease and conditions which affect or may affect the health of the people in the occupied area. At the time of its establishment, the 406th laboratory had considerable difficulties securing researchers, but it solved the related problems by actively cooperating with Japanese medical researchers and research institutes. According to the statistics in 1947, the 406th laboratory consisted of 46% of its total research personnel, Japanese researchers. The 406th medical laboratory’s professional research departments included the department of Pathology, Serology, Bacteriology, Medical Zoology, Chemistry, Virus and Ricketts, Entomology (established in 1949), and Epidemiology (established in 1951). All research departments played a central role in the Asia-Pacific region in their professional fields. For example, the department of Pathology functioned as the “histopathology center of all hospitals in Japan, Korea, and the Mariana-Bonin Command” under the provision of “Army Regulation 40-410,” and the department of Chemistry was called an “analytical chemistry laboratory for the Far East Command” because it performed various chemical experiments for many medical facilities in the area with insufficient research facilities.

Plastic surgery around the eyes is usually performed under local anesthesia, using a mixture of lidocaine and epinephrine. Blindness is a rare but devastating complication after the injection of local anesthesia in this region. Most cases reported to date have been caused by occlusion of the ophthalmic artery or central retinal artery. In this case report, however, we present a highly unusual case of blindness caused by corneal edema after a local anesthetic injection. A patient visited the emergency room with a laceration on the eyebrow, and local anesthesia was injected before suturing. Immediately after the injection, severe corneal edema developed, making it impossible to observe the structures in the anterior chamber in detail or check the light reflex and visual acuity of the naked eye. An antibiotic (moxifloxacin hydrochloride) and high-concentration steroid eyedrops were promptly applied. High-concentration steroids were also administered orally. On day 13 post-injury, the visual acuity of the naked eye improved to 1.0, and no recurrence of corneal lesions was observed. Although the cause of corneal edema after the local injection could not be conclusively identified, we hope that this report will help raise clinicians’ awareness of this complication and appropriate treatment methods.

The development of lab-on-a-chip technology based on microfluidics has been used from diagnostic test to drug screening in biomedical science. Lab-on-a-chip technology is also being expanded to the concept of an organ-on-a-chip with the development of cell biology and biocompatible material development. In addition, artificial intelligence (AI) has brought dramatic changes over the past few years in science, industry, defense, science and healthcare. AI-generated output is beginning to prove comparable or even superior to that of human experts. Lab-on-a-chip technology in specific microfluidic devices can overcome the above bottlenecks as a platform for building and implementing AI in a large-scale, cost-effective, high-throughput, automated and multiplexed manner. This platform, high-throughput imaging, becomes an important tool because it can generate high-content information which are too complex to analyze with conventional computational tools. In addition to the capabilities of a data provider, lab-on-a-chip technology can also be leveraged to enable AI developed for the accurate identification, characterization, classification and prediction of objects in heterogeneous samples. AI will provide quantitative and qualitative analysis results close to human in the urology field with lab-on-a-chip.