Mycophenolate mofetil (MMF) is usually prescribed with a reduced fixed dose in Asian kidney transplant recipients (KTRs). However, the clinical efficacy and safety of the fixed dose have not yet been investigated via therapeutic drug monitoring. We evaluated whether reduced fixed-dose MMF is an optimal dosing strategy to achieve the therapeutic target of mycophenolic acid (MPA) exposure in Korean KTRs. Methods: This open-label, prospective study enrolled 50 de novo KTRs prescribed with tacrolimus, corticosteroid, and fixed-dose MMF (1.0–1.5 g/day). The trough level (C0) and area under the curve (AUC0–12 hr) of MPA were measured at 1 and 24 weeks after kidney transplantation (KT). The relationship of body weight (BW)-adjusted MMF dose with MPA C0 and MPA AUC0–12 hr was assessed using linear regression analysis. Results: The initial fixed dose of MMF of 1.44 ± 0.16 g/day was adjusted in 24 patients (48.0%) and then reduced to a mean dose of 1.19 ± 0.31 g/day at 24 weeks after KT. Most patients (≥84.0%) attained the minimum required MPA C0 of 1.0 μg/mL and MPA AUC0–12 hr of 30 μg × hr/mL at 1 and 24 weeks. The BW-adjusted MMF dose demonstrated significant positive correlations with MPA C0 and MPA AUC0– 12 hr at 1 and 24 weeks after KT. Moreover, 14 patients (28.0%) reported MPA-related adverse events that were predictable based on MPA AUC0–12 hr (cutoff level, 46.4 μg × hr/mL). Conclusion: The current reduced fixed-dose MMF strategy can help achieve the therapeutic target of MPA exposure in tacrolimus- treated Korean KTRs during the early posttransplant period.

Purpose: This study aimed to evaluate the effect of prophylactic abdominal drainage (AD) in laparoscopic hemicolectomy, focusing on assessing postoperative pain outcomes. Methods: Patients were categorized into two groups: those with and without AD (AD group vs.no-AD group). A numerical rating scale (NRS) was used to assess postoperative pain on each postoperative day (POD). Further, the inverse probability of treatment weighting (IPTW) method was used to reduce intergroup bias. Results: In total, 204 patients who underwent laparoscopic hemicolectomies by a single surgeon between June 2013 and September 2022 at a single institution were retrospectively reviewed. After adjusting for IPTW, NRS scores on POD 2 were significantly lower in the no-AD group (3.2 ± 0.8 vs. 3.4 ± 0.8, p = 0.043). Further examination of postoperative outcomes showed no statistically significant differences in complications between the AD (17.3%) and no-AD (12.4%) groups (p = 0.170). The postoperative length of hospital stay was 7.3 ± 2.8 days in the AD group and 6.9 ± 3.0 days in the no-AD group, with no significant difference (p = 0.298). Time to first flatus was 3.0 ± 0.9 days in the AD group and 2.7 ± 0.9 days in the no-AD group, with no significant difference (p = 0.078). Regarding readmission within 1 month, there were four cases each in the AD (2.3%) and no-AD (1.7%) groups, with no significant difference (p = 0.733). Conclusion Laparoscopic hemicolectomy without AD resulted in no significant differences in postoperative clinical outcomes, except for postoperative pain. This finding suggests that prophylactic AD may exacerbate postoperative pain.

Purpose: Universal screening for Lynch syndrome (LS) refers to routine tumor testing for microsatellite instability (MSI) among all patients with colorectal cancer (CRC). Despite its widespread adoption, real-world data on the yield is lacking in Korean population. We studied the yield of adopting universal screening for LS in comparison with pedigree-based screening in a tertiary center. Materials and Methods: CRC patients from 2007-2018 were reviewed. Family histories were obtained and were evaluated for hereditary nonpolyposis colorectal cancer (HNPCC) using Amsterdam II criteria. Tumor testing for MSI began in 2007 and genetic testing was offered using all available clinicopathologic data. Yield of genetic testing for LS was compared for each approach and step. Results: Of the 5,520 patients, tumor testing was performed in 4,701 patients (85.2%) and family histories were obtained from 4,241 patients (76.8%). Hereditary CRC (LS or HNPCC) was present in 69 patients (1.3%). MSI-high was present in 6.9%, and 25 patients had confirmed LS. Genetic testing was performed in 41.2% (47/114) of MSI-high patients, out of which 40.4% (19/47) were diagnosed with LS. There were six additional LS patients found outside of tumor testing. For pedigree-based screening, Amsterdam II criteria diagnosed 55 patients with HNPCC. Fifteen of these patients underwent genetic testing, and 11 (73.3%) were diagnosed with LS. Two patients without prior family history were diagnosed with LS and relied solely on tumor testing results. Conclusion Despite widespread adoption of routine tumor testing for MSI, this is not a fail-safe approach to screen all LS patients. Obtaining a thorough family history in combination with universal screening provides a more comprehensive ‘universal’ screening method for LS.

Objectives: The purpose of this study was to investigate the effect of token economy intervention on the clinical characteristics and global function of patients with schizophrenia. Methods: From June 1, 2022 to September 1, 2022, token economy intervention was conducted for hospitalized patients with schizophrenia in a mental hospital. Assessments were conducted before and after the intervention. Clinical Global Impression-Schizophrenia scale (CGI-SCH), Schizophrenia Quality of Life Scale (SQLS), Insight Scale for Psychosis (ISP), and Apathy Evaluation Scale (AES) were used to evaluate clinical characteristics. World Health Organization Disability Assessment Schedule (WHODAS) was used for global functional assessment. Results: A total of 51 patients were included in the study. Through token economy intervention, depressive (p=0.001), cognitive symptom domain scores (p<0.001) in CGI-SCH, and SQLS score were significantly decreased (p=0.044). In the WHODAS evaluated by the clinician, the scores of self-care (p=0.012), life activities (p=0.006), and participation in society (p=0.040) decreased significantly. Conclusion It was confirmed that token economy intervention had a positive effect on depressive symptoms, cognitive symptoms, quality of life, self-care function, daily living function, and social participation function in hospitalized patients with schizophrenia.

Purpose: This study aimed to evaluate the safety and feasibility of single-port laparoscopic surgery (SLS) for appendiceal mucinous neoplasm (AMN) when compared with conventional laparoscopic surgery (CLS). Methods: This retrospective study enrolled patients who underwent surgery for AMN between July 2014 and June 2020 at Seoul National University Bundang Hospital. Patient demographics, surgical data, pathology, hospital stay, postoperative morbidity, and follow-up data were extracted from electronic records for analysis. Results: We enrolled 18 patients who underwent SLS and 22 who underwent CLS. The SLS group included patients who underwent partial cecectomy (14 patients), ileocecectomy (3 patients), and right hemicolectomy (1 patient). The CLS group included patients who underwent appendectomy (4 patients), partial cecectomy (11 patients), ileocecectomy (5 patients), and right hemicolectomy (2 patients). Operation type was not significantly different between groups (P = 0.213). No patient required open surgery in the SLS group in contrast to the CLS group (13.6%; P = 0.238). The operative time tended to be shorter in the SLS group than the CLS group (median [interquartile range]: 52.5 minutes [40–65.2 minutes] and 60 minutes [40–120 minutes], respectively; P = 0.251). Morbidity was 5.5% in the SLS group and 9.0% in the CLS group (P = 0.692). Surgical margins were clear in all cases. The median duration of postoperative hospital stay was 2.0 and 4.0 days in the SLS and CLS groups, respectively (P = 0.013). No recurrence occurred in either group during follow-up. Conclusion This study indicates that SLS is a safe and feasible surgical approach for AMN.

Purpose: This study aimed to evaluate the safety and feasibility of single-port laparoscopic surgery (SLS) for appendiceal mucinous neoplasm (AMN) when compared with conventional laparoscopic surgery (CLS). Methods: This retrospective study enrolled patients who underwent surgery for AMN between July 2014 and June 2020 at Seoul National University Bundang Hospital. Patient demographics, surgical data, pathology, hospital stay, postoperative morbidity, and follow-up data were extracted from electronic records for analysis. Results: We enrolled 18 patients who underwent SLS and 22 who underwent CLS. The SLS group included patients who underwent partial cecectomy (14 patients), ileocecectomy (3 patients), and right hemicolectomy (1 patient). The CLS group included patients who underwent appendectomy (4 patients), partial cecectomy (11 patients), ileocecectomy (5 patients), and right hemicolectomy (2 patients). Operation type was not significantly different between groups (P = 0.213). No patient required open surgery in the SLS group in contrast to the CLS group (13.6%; P = 0.238). The operative time tended to be shorter in the SLS group than the CLS group (median [interquartile range]: 52.5 minutes [40–65.2 minutes] and 60 minutes [40–120 minutes], respectively; P = 0.251). Morbidity was 5.5% in the SLS group and 9.0% in the CLS group (P = 0.692). Surgical margins were clear in all cases. The median duration of postoperative hospital stay was 2.0 and 4.0 days in the SLS and CLS groups, respectively (P = 0.013). No recurrence occurred in either group during follow-up. Conclusion This study indicates that SLS is a safe and feasible surgical approach for AMN.

Background: s/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

PURPOSE: Molecular treatments targeting epidermal growth factor receptors (EGFRs) are important strategies for advanced colorectal cancer (CRC). However, clinicopathologic implications of EGFRs and EGFR ligand signaling have not been fully evaluated. We evaluated the expression of EGFR ligands and correlation with their receptors, clinicopathologic factors, and patients’ survival with CRC. MATERIALS AND METHODS: The expression of EGFR ligands, including heparin binding epidermal growth factor-like growth factor (HBEGF), transforming growth factor (TGF), betacellulin, and epidermal growth factor (EGF), were evaluated in 331 consecutive CRC samples using mRNA in situ hybridization (ISH). We also evaluated the expression status of EGFR, human epidermal growth factor receptor 2 (HER2), HER3, and HER4 using immunohistochemistry and/or silver ISH. RESULTS: Unlike low incidences of TGF (38.1%), betacellulin (7.9%), and EGF (2.1%), HBEGF expression was noted in 62.2% of CRC samples. However, the expression of each EGFR ligand did not reveal significant correlations with survival. The combined analyses of EGFR ligands and EGFR expression indicated that the ligands–/EGFR+ group showed a significant association with the worst disease-free survival (DFS; p=0.018) and overall survival (OS; p=0.005). It was also an independent, unfavorable prognostic factor for DFS (p=0.026) and OS (p=0.007). Additionally, HER4 nuclear expression, regardless of ligand expression, was an independent, favorable prognostic factor for DFS (p=0.034) and OS (p=0.049), by multivariate analysis. CONCLUSION: Ligand-independent EGFR overexpression was suggested to have a significant prognostic impact; thus, the expression status of EGFR ligands, in addition to EGFR, might be necessary for predicting patients' outcome in CRC.
Betacellulin ; Colorectal Neoplasms* ; Disease-Free Survival ; Epidermal Growth Factor* ; Heparin ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Incidence ; Ligands ; Multivariate Analysis ; Prognosis* ; Receptor, Epidermal Growth Factor* ; RNA, Messenger ; Silver ; Transforming Growth Factors

OBJECTIVE: The study’s aim was to develop and standardize a Korean version of the University of California San Diego Performance-based Skills Assessment (K-UPSA), which is used to evaluate the daily living function of patients with schizophrenia. METHODS: Study participants were 78 patients with schizophrenia and 27 demographically matched healthy controls. We evaluated the clinical states and cognitive functions to verify K-UPSA’s reliability and validity. For clinical states, the Positive and Negative Syndrome Scale, Clinical Global Impression-Schizophrenia scale, and Social and Occupational Functioning Assessment Scale and Schizophrenia Quality of Life Scale-fourth revision were used. The Schizophrenia Cognition Rating Scale, Short-form of Korean-Wechsler Adult Intelligence Scale, and Wisconsin Card Sorting Test were used to assess cognitive function. RESULTS: The K-UPSA had statistically significant reliability and validity. The K-UPSA has high internal consistency (Cronbach’s alpha, 0.837) and test-retest reliability (intra-class correlation coefficient, 0.381–0.792; p<0.001). The K-UPSA had significant discriminant validity (p<0.001). Significant correlations between the K-UPSA’s scores and most of the scales and tests listed above demonstrated K-UPSA’s concurrent validity (p<0.001). CONCLUSION: The K-UPSA is useful to evaluate the daily living function in Korean patients with schizophrenia.
Adult ; California* ; Cognition ; Humans ; Intelligence ; Quality of Life ; Reproducibility of Results* ; Schizophrenia ; Weights and Measures ; Wisconsin

OBJECTIVE: This study's aim was to develop and standardize a Korean version (SCoRS-K) of the Schizophrenia Cognition Rating Scale (SCoRS), which is used to evaluate the degree of cognitive dysfunction affecting the everyday functioning of people with schizophrenia. METHODS: Eighty-four schizophrenia patients with stable symptoms who were receiving outpatient treatment and rehabilitation therapy, and 29 demographically matched non-patient controls, participated in the study. Demographic data were collected, and clinical symptoms, cognitive function, and social function were evaluated to verify SCoRS-K's reliability and validity. Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale and the Clinical Global Impression-Schizophrenia Scale. Cognitive function was evaluated using a short form of the Korean Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test (WCST). Social function was evaluated using the Social and Occupational Functioning Assessment Scale, the Schizophrenia Quality of Life Scale, and the Social Functioning Scale. RESULTS: Data analysis demonstrated SCoRS-K's statistically significant reliability and validity. SCoRS-K has high internal consistency (Cronbach's alpha; patient 0.941, informant 0.905, interviewer 0.964); test-retest reliability [patient 0.428 (p=0.003), informant 0.502 (p<0.001), interviewer 0.602 (p<0.001); and global rating 0.642 (p<0.001)]. The mean scores of subjects were significantly higher than those of the controls (p<0.001), demonstrating SCoRS-K's discriminant validity. Significant correlations between the total scores and global rating score of SCoRS-K and those of the scales and tests listed above (except WCST) support SCoRS-K's concurrent validity. CONCLUSION: SCoRS-K is a useful instrument for evaluating the degree of cognitive dysfunction in Korean schizophrenia patients.
Adult ; Cognition* ; Humans ; Intelligence ; Neurobehavioral Manifestations ; Outpatients ; Quality of Life ; Rehabilitation ; Reproducibility of Results* ; Schizophrenia* ; Statistics as Topic ; Weights and Measures ; Wisconsin