Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

Background: Bladder cancer is characterized by frequent mutations, which provide potential therapeutic targets for most patients. The effectiveness of emerging personalized therapies depends on an accurate molecular diagnosis, for which the accurate estimation of the neoplastic cell percentage (NCP) is a crucial initial step. However, the established method for determining the NCP, manual counting by a pathologist, is time-consuming and not easily executable. Methods: To address this, artificial intelligence (AI) models were developed to estimate the NCP using nine convolutional neural networks and the scanned images of 39 cases of urinary tract cancer. The performance of the AI models was compared to that of six pathologists for 119 cases in the validation cohort. The ground truth value was obtained through multiplexed immunofluorescence. The AI model was then applied to 41 cases in the application cohort that underwent next-generation sequencing testing, and its impact on the copy number variation (CNV) was analyzed. Results: Each AI model demonstrated high reliability, with intraclass correlation coefficients (ICCs) ranging from 0.82 to 0.88. These values were comparable or better to those of pathologists, whose ICCs ranged from 0.78 to 0.91 in urothelial carcinoma cases, both with and without divergent differentiation/ subtypes. After applying AI-driven NCP, 190 CNV (24.2%) were reclassified with 66 (8.4%) and 78 (9.9%) moved to amplification and loss, respectively, from neutral/minor CNV. The neutral/minor CNV proportion decreased by 6%. Conclusions These results suggest that AI models could assist human pathologists in repetitive and cumbersome NCP calculations.

Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Background/Aims: The etiology of irritable bowel syndrome (IBS) is associated with intestinal mucosal barrier damage. However, changes in the tight junction (TJ) proteins in IBS have not been fully elucidated. This study aimed to evaluate TJ protein changes in IBS patients and the relationship between aging and disease severity. Methods: Thirty-six patients with IBS fulfilling the Rome IV criteria and twenty-four controls were included. To evaluate the change of TJ in the colonic mucosa, quantitative reverse transcription polymerase chain reaction, western blot, and immunohistochemistry (IHC) were performed, respectively. Results: The entire IBS group (n = 36) exhibited decreased levels of claudin-1 and -2 mRNA compared to the control group (n = 24), with statistical significance (p < 0.05). Additionally, in western blot analyses, both claudin-1 and ZO-1 levels were significantly reduced in the IBS group compared to the control group (n = 24) (p < 0.05). IHC analysis further revealed that ZO-1 expression was significantly lower in the IBS group than in the control group (p < 0.001). This trend of reduced ZO-1 expression was also observed in the moderate-to-severe IBS subgroup (p < 0.001). Significantly, ZO-1 expression was notably lower in both the young- (p = 0.036) and old-aged (p = 0.039) IBS groups compared to their respective age-matched control groups. Subtype analysis indicated a more pronounced decrease in ZO-1 expression with advancing age. Conclusions ZO-1 expression was especially decreased in the aged IBS group. These results suggest that ZO-1 might be the prominent TJ protein causing IBS in the aging population.

Objective: : To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. Methods: : The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. Results: : In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. Conclusion : The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians’ experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

Background: Psoriasis imposes a significant treatment burden on patients, particularly impacting well-being and quality of life (QoL). The psychosocial impact of psoriasis treatments remains unexplored in most patient populations. Objective: To assess the impact of adalimumab on health-related QoL (HRQoL) in Korean patients with psoriasis. Methods: This 24-week, multicenter, observational study, assessed HRQoL in Korean patients treated with adalimumab in a real-world setting. Patient-reported outcomes (PROs) including European Quality of Life-5 Dimension scale (EQ-5D), EQ-5D VAS, SF-36, and DLQI were evaluated at week 16 and 24, versus baseline. Patient satisfaction was assessed using TSQM. Results: Among 97 enrolled patients, 77 were assessed for treatment effectiveness. Most patients were male (52, 67.5%) and mean age was 45.4 years. Median baseline body surface area and Psoriasis Area and Severity Index (PASI) scores were 15.00 (range 4.00~80.00) and 12.40 (range 2.70~39.40), respectively. Statistically significant improvements in all PROs were observed between baseline and week 24. Mean EQ-5D score improved from 0.88 (standard deviation [SD], 0.14) at baseline to 0.91 (SD, 0.17) at week 24 (p=0.0067). The number of patients with changes in PASI 75, 90, or 100 from baseline to week 16 and 24 were 65 (84.4%), 17 (22.1%), and 1 (1.3%); and 64 (83.1%), 21 (27.3%), and 2 (2.6%), respectively. Overall treatment satisfaction was reported, including effectiveness and convenience. No unexpected safety findings were noted. Conclusion Adalimumab improved QoL and was well-tolerated in Korean patients with moderate to severe psoriasis, as demonstrated in a real-world setting. Clinical trial registration number (clinicaltrials.gov: NCT03099083).

Plasmacytoma is a rare hematolymphoid malignancy. The three types of plasmacytoma, according to clinical features and morphological characteristics, include solitary bone plasmacytoma, extramedullary plasmacytoma (EMP), and multiple myeloma (MM). Although EMP of the head and neck region accounts for approximately 3% of all plasma cell tumors, the involvement of both paranasal sinuses is extremely rare. Herein, we describe a rare case of EMP involving both maxillary sinuses in a 73-year-old male patient who had achieved complete remission from MM following chemotherapy 2 years ago. The EMP was treated successfully with radiotherapy.

Purpose: The purpose of study was to compare oncologic outcomes (recurrence-free survival [RFS], cancer-specific survival [CSS], and overall survival [OS]) and early complication (within 30 days) after radical cystectomy (RC) between old patients (70–79 aged) and oldest-old patients (above 80). Materials and Methods: This retrospective study reviewed total 340 patients with urothelial carcinoma of bladder who received RC between November 1996 and December 2018. The patients were divided into 2 groups by age, 307 patients aged 70–79 and 33 patients aged above 80. Baseline characteristics, perioperative outcomes and early complication were compared between the 2 groups. Kaplan–Meier (K-M) survival analysis was used to estimate RFS, CSS, OS, and multivariable Cox proportional hazard models were used to identify factors predicting RFS, CSS, OS. Results: The results of both groups did not statistically differ from each other in most clinicopathologic baseline characteristics and perioperative information. Both groups showed similar 30-day complication rates (59.3% vs. 60.3%, p=0.210). K-M showed 3-year survival rate, RFS was shorter in oldest-old group (41.4% vs. 56.7%) but not statistically different (p=0.063). Oldest-old group showed similar 3-year CSS (78.1% vs. 74.6%, p=0.779) but worse OS (51% vs. 58%, p=0.047) compared with the old group. Common factor affecting RFS, CSS, and OS were T stage and N stage (all p<0.05). Age is not factor affecting RFS, CSS, and OS. Conclusions Oldest-old who received RC had similar perioperative, oncologic outcome and complication compared with the seventies. RC could be considered treatment option for selected oldest-old patients.