Background: The advantages of using an acellular dermal matrix (ADM) for implantbased breast reconstruction in breast cancer patients are well-documented across multiple studies. However, there have been no previous instances of using multilayered ADM for reconstruction following breast-conserving surgery (BCS). This study evaluated the outcomes of breast reconstruction employing multilayered ADM for volume replacement using a local glandular flap post-BCS, and aims to underscore the advantages of this surgical approach. Methods: Breast cancer patients who underwent BCS using several layers of ADM from August 2016 to December 2019 were retrospectively reviewed. Only patients with at least 3 years of follow-up were included in this study. The anticipated postoperative complications were breast deformity, seroma, hematoma, and infection. Results: Seventy-four patients were included in this study. Most patients experienced symptoms of hard palpation at the reconstruction site, which indicated the surface of the ADM inserted into the breast. Ten patients developed breast deformities, accounting for 13.5% of the cases, and required surgical correction. Other complications were less frequent: four patients (5.3%) had a confirmed seroma for 6 months or longer, two patients (2.6%) experienced fat necrosis, and one patient (1.3%) underwent re-operation to remove the ADM. Conclusions Reconstruction with a glandular flap and ADM following BCS is generally simpler and requires less surgical time compared to using a latissimus dorsi flap or other local flaps. Additionally, it avoids complications at the donor site, presenting a feasible surgical alternative for BCS in breasts with small defects.

Background: The advantages of using an acellular dermal matrix (ADM) for implantbased breast reconstruction in breast cancer patients are well-documented across multiple studies. However, there have been no previous instances of using multilayered ADM for reconstruction following breast-conserving surgery (BCS). This study evaluated the outcomes of breast reconstruction employing multilayered ADM for volume replacement using a local glandular flap post-BCS, and aims to underscore the advantages of this surgical approach. Methods: Breast cancer patients who underwent BCS using several layers of ADM from August 2016 to December 2019 were retrospectively reviewed. Only patients with at least 3 years of follow-up were included in this study. The anticipated postoperative complications were breast deformity, seroma, hematoma, and infection. Results: Seventy-four patients were included in this study. Most patients experienced symptoms of hard palpation at the reconstruction site, which indicated the surface of the ADM inserted into the breast. Ten patients developed breast deformities, accounting for 13.5% of the cases, and required surgical correction. Other complications were less frequent: four patients (5.3%) had a confirmed seroma for 6 months or longer, two patients (2.6%) experienced fat necrosis, and one patient (1.3%) underwent re-operation to remove the ADM. Conclusions Reconstruction with a glandular flap and ADM following BCS is generally simpler and requires less surgical time compared to using a latissimus dorsi flap or other local flaps. Additionally, it avoids complications at the donor site, presenting a feasible surgical alternative for BCS in breasts with small defects.

Background: The advantages of using an acellular dermal matrix (ADM) for implantbased breast reconstruction in breast cancer patients are well-documented across multiple studies. However, there have been no previous instances of using multilayered ADM for reconstruction following breast-conserving surgery (BCS). This study evaluated the outcomes of breast reconstruction employing multilayered ADM for volume replacement using a local glandular flap post-BCS, and aims to underscore the advantages of this surgical approach. Methods: Breast cancer patients who underwent BCS using several layers of ADM from August 2016 to December 2019 were retrospectively reviewed. Only patients with at least 3 years of follow-up were included in this study. The anticipated postoperative complications were breast deformity, seroma, hematoma, and infection. Results: Seventy-four patients were included in this study. Most patients experienced symptoms of hard palpation at the reconstruction site, which indicated the surface of the ADM inserted into the breast. Ten patients developed breast deformities, accounting for 13.5% of the cases, and required surgical correction. Other complications were less frequent: four patients (5.3%) had a confirmed seroma for 6 months or longer, two patients (2.6%) experienced fat necrosis, and one patient (1.3%) underwent re-operation to remove the ADM. Conclusions Reconstruction with a glandular flap and ADM following BCS is generally simpler and requires less surgical time compared to using a latissimus dorsi flap or other local flaps. Additionally, it avoids complications at the donor site, presenting a feasible surgical alternative for BCS in breasts with small defects.

Background/Aims: We investigated sex- and stage-specific associations of body mass index (BMI), fasting glucose, and high-density lipoprotein cholesterol (HDL-C) with gastric cancer. Methods: In total, 3,382 patients with gastric cancer and 19,609 healthy controls were enrolled. BMI was categorized into five groups. HDL-C was classified as low (< 40 and < 50 mg/ dl in males and females, respectively) and normal (≥ 40 and ≥ 50 mg/dl in males and females, respectively). Logistic regression analysis was performed to calculate odd ratios (ORs) and 95% confidence intervals (CIs). Results: After adjustment, low BMI (OR, 1.44; 95% CI, 1.13–1.84), low HDL levels (OR, 2.28;95% CI, 2.07–2.50), and high fasting glucose levels (OR, 2.94; 95% CI, 2.22–2.99) were associated with gastric cancer, whereas high BMI (OR, 0.61–0.81) was inversely associated with gastric cancer. In sex-specific analysis, BMI was inversely associated with gastric cancer only in males (trend: p < 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in both males and females. The effect of high glucose content was more pronounced in females (OR, 4.02) than in males (OR, 2.58). BMI was inversely associated with both AGC (trend: p < 0.001) and EGC (trend: p = 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in EGC and AGC. Conclusions The effect of BMI on gastric cancer varies by sex and stage, whereas low HDL levels are associated with gastric cancer regardless of these factors.

Background/Aims: We investigated sex- and stage-specific associations of body mass index (BMI), fasting glucose, and high-density lipoprotein cholesterol (HDL-C) with gastric cancer. Methods: In total, 3,382 patients with gastric cancer and 19,609 healthy controls were enrolled. BMI was categorized into five groups. HDL-C was classified as low (< 40 and < 50 mg/ dl in males and females, respectively) and normal (≥ 40 and ≥ 50 mg/dl in males and females, respectively). Logistic regression analysis was performed to calculate odd ratios (ORs) and 95% confidence intervals (CIs). Results: After adjustment, low BMI (OR, 1.44; 95% CI, 1.13–1.84), low HDL levels (OR, 2.28;95% CI, 2.07–2.50), and high fasting glucose levels (OR, 2.94; 95% CI, 2.22–2.99) were associated with gastric cancer, whereas high BMI (OR, 0.61–0.81) was inversely associated with gastric cancer. In sex-specific analysis, BMI was inversely associated with gastric cancer only in males (trend: p < 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in both males and females. The effect of high glucose content was more pronounced in females (OR, 4.02) than in males (OR, 2.58). BMI was inversely associated with both AGC (trend: p < 0.001) and EGC (trend: p = 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in EGC and AGC. Conclusions The effect of BMI on gastric cancer varies by sex and stage, whereas low HDL levels are associated with gastric cancer regardless of these factors.

Background/Aims: We investigated sex- and stage-specific associations of body mass index (BMI), fasting glucose, and high-density lipoprotein cholesterol (HDL-C) with gastric cancer. Methods: In total, 3,382 patients with gastric cancer and 19,609 healthy controls were enrolled. BMI was categorized into five groups. HDL-C was classified as low (< 40 and < 50 mg/ dl in males and females, respectively) and normal (≥ 40 and ≥ 50 mg/dl in males and females, respectively). Logistic regression analysis was performed to calculate odd ratios (ORs) and 95% confidence intervals (CIs). Results: After adjustment, low BMI (OR, 1.44; 95% CI, 1.13–1.84), low HDL levels (OR, 2.28;95% CI, 2.07–2.50), and high fasting glucose levels (OR, 2.94; 95% CI, 2.22–2.99) were associated with gastric cancer, whereas high BMI (OR, 0.61–0.81) was inversely associated with gastric cancer. In sex-specific analysis, BMI was inversely associated with gastric cancer only in males (trend: p < 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in both males and females. The effect of high glucose content was more pronounced in females (OR, 4.02) than in males (OR, 2.58). BMI was inversely associated with both AGC (trend: p < 0.001) and EGC (trend: p = 0.001). Low serum HDL and high fasting glucose levels were strongly associated with gastric cancer in EGC and AGC. Conclusions The effect of BMI on gastric cancer varies by sex and stage, whereas low HDL levels are associated with gastric cancer regardless of these factors.

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.

Purpose: This study aims to explore the relationship between soy food consumption and gastric cancer (GC) risk, accounting for Helicobacter pylori infection status. Materials and Methods: We analyzed data from patients with GC and healthy individuals prospectively enrolled by 6 hospitals between 2016 and 2018. Dietary intake was evaluated using questionnaires that categorized seven dietary habits and 19 food groups. Multivariate logistic regression models were applied to examine associations. Model I adjusted for various epidemiological factors, while Model II included further adjustments for H. pylori infection.Primary exposures examined were consumption frequencies of nonfermented, unsalted soy foods (soybean/tofu) and fermented, salty soy foods (soybean paste stew). Results: A total of 5,535 participants were included, with 1,629 diagnosed with GC. In Model I, the frequency of soybean/tofu consumption was inversely related to GC risk; adjusted odd ratios (aORs) were 0.62 (95% confidence interval [CI], 0.48–0.8), 0.38 (95% CI, 0.3–0.49), 0.42 (95% CI, 0.33–0.53), and 0.33 (95% CI, 0.27–0.42) for 1 time/week, 2 times/week, 3 times/week, and ≥4 times/week. Consumption of 2 servings/week of soybean paste stew showed the lowest GC association, forming a V-shaped curve. Both low (aOR, 4.03; 95% CI, 3.09–5.26) and high serving frequencies of soybean paste stew (aOR, 2.23; 95% CI, 1.76–2.82) were associated with GC. The association between soy foods and GC in Model II was similar to that in Model I. The soy food-GC associations were consistent across sexes in Model I.Nonetheless, the positive correlation between frequent consumption of soybean paste stew (≥5 times/week) and GC was more pronounced in women (aOR, 7.58; 95% CI, 3.20–17.99) compared to men (aOR, 3.03; 95% CI, 1.61–5.88) in Model II. Subgroup analyses by H. pylori status and salty diet revealed a consistent inverse relationship between soybean/tofu and GC risk. In contrast, soybean paste stew showed a V-shaped relationship in H. pylori-positive or salty diet groups and no significant association in the H. pylori-negative group. Conclusions Soybean/tofu intake is consistently associated with a decreased risk of GC.However, the relationship between soybean paste stew consumption and GC risk varies, depending on H. pylori infection status and dietary salt intake.

Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.

Background/Aims: Tegoprazan, a novel potassium-competitive acid blocker, has shown rapid action and gastric acid inhibition. In this study, we evaluated the efficacy of a tegoprazan-based, nonbismuth-containing quadruple (concomitant) therapy for the primary eradication of Helicobacter pylori. Methods: We conducted a prospective, single-arm, single-center, primitive study to verify the efficacy of a 10-day tegoprazan- based (50-mg dose) concomitant therapy, including amoxicillin (1,000-mg dose), clarithromycin (CLA; 500-mg dose), and metronidazole (MET; 500-mg dose) twice daily as a first-line treatment for H. pylori eradication. Results: We tested consecutive cultures for antibiotic susceptibility and minimum inhibitory concentrations. We enrolled 84 participants; 79 (94.0%) completed first-line therapy. The overall intention-to-treat and per-protocol eradication rates were 90.5% (95% confidence interval [CI], 82.1−95.8) and 96.2% (95% CI, 83.4–97.6), respectively. Of the 73 participants evaluated for antibiotic resistance, 19 (26.0%), 32 (42.5%), and 8 (11.0%) exhibited CLA, MET, and CLA and MET dual resistance, respectively. Of these, 39 participants (66.1%) exhibited successful eradication after the therapeutic regimen despite antibiotic resistance. Conclusions The 10-day tegoprazan-based concomitant therapy may be an effective first-line treatment for eradicating H. pylori.