Background: The diagnosis of tuberculous pleural effusion (TPE) often relies on pleural fluid adenosine deaminase (ADA) levels. The diagnostic utility of ADA, however, is influenced by the prevalence of tuberculosis (TB) in local populations. Malignant pleural effusion (MPE) cases can exhibit moderately elevated ADA levels comparable to those seen in TPE. As population aging potentially impacts ADA levels, global TB incidence is decreasing whereas the burden of malignancy is on the rise. Consequently, epidemiological shifts and temporal changes in ADA distribution complicate the differential diagnosis between TPE and MPE when ADA levels are within the 40–70 IU/L range. Nonetheless, data specific to this subset are scarce. Methods: This retrospective study included consecutive patients aged > 18 years with confirmed TPE and MPE, spanning from 2012 to 2023. ADA levels in pleural fluid were categorized into three groups: < 40 IU/L, 40–70 IU/L, and > 70 IU/L. The study examined annual trends in the frequency of new cases and ADA level distributions over time and identified discriminating factors between TPE and MPE in cases with ADA levels of 40–70 IU/L. Results: In total, 297 TPE and 369 MPE cases were included in this study. Over the study period, the frequency of TPE progressively declined, while that of MPE increased. In the most recent four-year period, new TPE and MPE cases with ADA levels of 40–70 IU/L occurred at comparable numbers. Multivariable analysis identified pleural fluid carcinoembryonic antigen (CEA) levels and the number of focal pleural nodules as independent predictors for MPE. Specifically, the presence of either CEA levels > 15.7 ng/mL or more than eight pleural nodules yielded the highest diagnostic accuracy with a sensitivity of 88%, specificity of 100%, and an area under the curve of 0.95. Conclusion The differential diagnosis between TPE and MPE with pleural ADA levels of 40–70 IU/L has become increasingly critical due to evolving epidemiological patterns and ADA distribution changes over time. Pleural fluid CEA levels and the characteristics of pleural nodules may offer valuable guidance in distinguishing between TPE and MPE within this diagnostic gray zone.

Background/Aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). Conclusions We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.

Background/Aims: Cytomegalovirus (CMV) disease in the upper gastrointestinal (UGI) tract frequently occurs in immunocompromised patients. However, data regarding UGI CMV disease in non-transplant patients compared with those in transplant recipients are limited. Therefore, we compared the clinical characteristics, endoscopic findings, and outcomes of UGI CMV disease in non-transplant patients with those in transplant recipients. Methods: We reviewed the medical records of patients diagnosed with UGI CMV disease between May 1999 and January 2022. UGI CMV disease was defined as symptoms or signs of gastrointestinal disease with typical findings of CMV inclusion body and positive immunochemistry stain or CMV polymerase chain reaction from the endoscopic biopsy specimen. Results: Among the 219 eligible patients, 132 (60.3%) were transplant patients. Age, male sex, and Charlson Comorbidity Index were significantly higher in the non-transplant group than in the transplant group. The most common symptoms were pain and odynophagia (43.8%). Transplant recipients more frequently experienced UGI CMV disease in the stomach than non-transplant patients, typically presenting as erosions or mucosal hyperemia. However, non-transplant patients more commonly experienced UGI CMV disease in the esophagus than transplant recipients, typically presenting as ulcers. The transplant group had a significantly higher clinical response than the non-transplant group. Conclusions UGI CMV disease in transplant patients can be present in the stomach in various forms, including ulcers or erosions. In transplant patients suspected of UGI CMV disease, conducting an esophagogastroduodenoscopy with tissue biopsy in any area where even the slightest mucosal abnormality is observed is essential to facilitate a prompt diagnosis.

Background/Aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). Conclusions We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.

Background/Aims: Cytomegalovirus (CMV) disease in the upper gastrointestinal (UGI) tract frequently occurs in immunocompromised patients. However, data regarding UGI CMV disease in non-transplant patients compared with those in transplant recipients are limited. Therefore, we compared the clinical characteristics, endoscopic findings, and outcomes of UGI CMV disease in non-transplant patients with those in transplant recipients. Methods: We reviewed the medical records of patients diagnosed with UGI CMV disease between May 1999 and January 2022. UGI CMV disease was defined as symptoms or signs of gastrointestinal disease with typical findings of CMV inclusion body and positive immunochemistry stain or CMV polymerase chain reaction from the endoscopic biopsy specimen. Results: Among the 219 eligible patients, 132 (60.3%) were transplant patients. Age, male sex, and Charlson Comorbidity Index were significantly higher in the non-transplant group than in the transplant group. The most common symptoms were pain and odynophagia (43.8%). Transplant recipients more frequently experienced UGI CMV disease in the stomach than non-transplant patients, typically presenting as erosions or mucosal hyperemia. However, non-transplant patients more commonly experienced UGI CMV disease in the esophagus than transplant recipients, typically presenting as ulcers. The transplant group had a significantly higher clinical response than the non-transplant group. Conclusions UGI CMV disease in transplant patients can be present in the stomach in various forms, including ulcers or erosions. In transplant patients suspected of UGI CMV disease, conducting an esophagogastroduodenoscopy with tissue biopsy in any area where even the slightest mucosal abnormality is observed is essential to facilitate a prompt diagnosis.

Purpose: Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world. Materials and Methods: We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis. Results: NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs. Conclusion Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

Background/Aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). Conclusions We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.

Background/Aims: Cytomegalovirus (CMV) disease in the upper gastrointestinal (UGI) tract frequently occurs in immunocompromised patients. However, data regarding UGI CMV disease in non-transplant patients compared with those in transplant recipients are limited. Therefore, we compared the clinical characteristics, endoscopic findings, and outcomes of UGI CMV disease in non-transplant patients with those in transplant recipients. Methods: We reviewed the medical records of patients diagnosed with UGI CMV disease between May 1999 and January 2022. UGI CMV disease was defined as symptoms or signs of gastrointestinal disease with typical findings of CMV inclusion body and positive immunochemistry stain or CMV polymerase chain reaction from the endoscopic biopsy specimen. Results: Among the 219 eligible patients, 132 (60.3%) were transplant patients. Age, male sex, and Charlson Comorbidity Index were significantly higher in the non-transplant group than in the transplant group. The most common symptoms were pain and odynophagia (43.8%). Transplant recipients more frequently experienced UGI CMV disease in the stomach than non-transplant patients, typically presenting as erosions or mucosal hyperemia. However, non-transplant patients more commonly experienced UGI CMV disease in the esophagus than transplant recipients, typically presenting as ulcers. The transplant group had a significantly higher clinical response than the non-transplant group. Conclusions UGI CMV disease in transplant patients can be present in the stomach in various forms, including ulcers or erosions. In transplant patients suspected of UGI CMV disease, conducting an esophagogastroduodenoscopy with tissue biopsy in any area where even the slightest mucosal abnormality is observed is essential to facilitate a prompt diagnosis.