Objective: Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy (ET) constitute the standard systemic treatment for estrogen receptor-positive, human epidermal growth factor 2-negative (ER+/HER2-) metastatic breast cancer (MBC). However, treatment responses remain heterogeneous, highlighting the need for reliable prognostic markers. This study aimed to evaluate the prognostic significance of 18F-fluorodeoxyglucose (FDG) PET/CT findings in this setting. Materials and Methods: This retrospective single-center cohort study included patients with ER+/HER2- MBC who underwent18F-FDG PET/CT before initiating CDK4/6 inhibitors plus ET between 2018 and 2023. Maximum standardized uptake value(SUVmax), whole-body metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Progression-free survival (PFS) and overall survival (OS) were evaluated as the primary and secondary outcomes, respectively, using multivariable Cox models. PET parameters (SUVmax, MTV, and TLG) were analyzed as both continuous and dichotomized variables based on median values, adjusting for relevant clinical covariates. Results: Among the 374 patients, 82 (21.9%) presented with de novo metastatic disease, and 357 (95.5%) received CDK4/6 inhibitors as first-line therapy. In multivariable Cox analysis, all continuous PET parameters were independently associated with PFS (adjusted hazard ratio for SUVmax 1.05 [95% confidence interval 1.02–1.08]; log-transformed MTV 1.16 [1.08–1.25]; and log-transformed TLG 1.14 [1.07–1.23]) and OS (SUVmax 1.08 [1.04–1.11]; log-transformed MTV 1.24 [1.12–1.38]; and log-transformed TLG 1.22 [1.11–1.34]) with all P < 0.001. Results based on dichotomized PET parameters were similar to those obtained with continuous values: PFS (adjusted hazard ratio for SUVmax ≥ 7.6, 1.41 [1.08–1.85]; MTV ≥ 21.2 cm 3 , 1.41 [1.08–1.86]; and TLG ≥ 78.9, 1.51 [1.14–1.99]) with P ≤ 0.013 and OS (1.43 [1.01–2.04]; 1.84 [1.28– 2.66]; and 1.73 [1.20–2.50], respectively) with P ≤ 0.046. Conclusion Pretreatment 18F-FDG PET/CT parameters are independent prognostic markers in patients with ER+/HER2- MBC receiving CDK4/6 inhibitors with ET, supporting their potential utility in risk stratification.

An unfolded helix is an auricular deformity that has garnered relatively little research focus. This study introduces a surgical technique designed to correct flat helix deformities. A 22-year-old male with bilateral unfolded helixes and prominent ears underwent this procedure under local anesthesia. The surgery employed a posterior auricular approach, with incisions extending from the upper pole of the ear to the concha. Along the helical rim, four radiating incisions were made, followed by oblique cuts in the cartilage and the creation of triangular flaps through advancement. The free edges of the cartilage were then overlapped and sutured together. Post-surgery, the patient experienced a successful recovery, evidenced by the curling of the helix and the absence of complications. This surgical technique is not only effective for correcting unfolded helixes but can also be efficiently performed under local anesthesia.

An unfolded helix is an auricular deformity that has garnered relatively little research focus. This study introduces a surgical technique designed to correct flat helix deformities. A 22-year-old male with bilateral unfolded helixes and prominent ears underwent this procedure under local anesthesia. The surgery employed a posterior auricular approach, with incisions extending from the upper pole of the ear to the concha. Along the helical rim, four radiating incisions were made, followed by oblique cuts in the cartilage and the creation of triangular flaps through advancement. The free edges of the cartilage were then overlapped and sutured together. Post-surgery, the patient experienced a successful recovery, evidenced by the curling of the helix and the absence of complications. This surgical technique is not only effective for correcting unfolded helixes but can also be efficiently performed under local anesthesia.

An unfolded helix is an auricular deformity that has garnered relatively little research focus. This study introduces a surgical technique designed to correct flat helix deformities. A 22-year-old male with bilateral unfolded helixes and prominent ears underwent this procedure under local anesthesia. The surgery employed a posterior auricular approach, with incisions extending from the upper pole of the ear to the concha. Along the helical rim, four radiating incisions were made, followed by oblique cuts in the cartilage and the creation of triangular flaps through advancement. The free edges of the cartilage were then overlapped and sutured together. Post-surgery, the patient experienced a successful recovery, evidenced by the curling of the helix and the absence of complications. This surgical technique is not only effective for correcting unfolded helixes but can also be efficiently performed under local anesthesia.

Background and Objectives: There is limited evidence regarding machine-learning prediction for the recurrence of atrial fibrillation (AF) after electrical cardioversion (ECV).This study aimed to predict the recurrence of AF after ECV using machine learning of clinical features and electrocardiograms (ECGs) in persistent AF patients. Methods: We analyzed patients who underwent successful ECV for persistent AF. Machine learning was designed to predict patients with 1-month recurrence. Individual 12-lead ECGs were collected before and after ECV. Various clinical features were collected and trained the extreme gradient boost (XGBoost)-based model. Ten-fold cross-validation was used to evaluate the performance of the model. The performance was compared to the C-statistics of the selected clinical features. Results: Among 718 patients (mean age 63.5±9.3 years, men 78.8%), AF recurred in 435(60.6%) patients after 1 month. With the XGBoost-based model, the areas under the receiver operating characteristic curves (AUROCs) were 0.57, 0.60, and 0.63 if the model was trained by clinical features, ECGs, and both (the final model), respectively. For the final model, the sensitivity, specificity, and F1-score were 84.7%, 28.2%, and 0.73, respectively. Although the AF duration showed the best predictive performance (AUROC, 0.58) among the clinical features, it was significantly lower than that of the final machine-learning model (p<0.001).Additional training of extended monitoring data of 15-minute single-lead ECG and photoplethysmography in available patients (n=261) did not significantly improve the model’s performance. Conclusions Machine learning showed modest performance in predicting AF recurrence after ECV in persistent AF patients, warranting further validation studies.

As the number of dementia patients increases due to rapid aging, the burden of dementia becomes a big social problem. In response to this, various policies have been introduced in Korea. In particular, as the new policy of national responsibility for dementia care has been implemented in 2017, detailed plans for improving health care and long-term care support for dementia patients and their caregivers have been introduced. The most important thing in carrying out the comprehensive government plan will be securing sufficient the professional health and social care workforce. However, the number of neurologists to play an important role in the management of dementia will be more and more insufficient. Therefore, the need to supply an adequate number of neurologists in Korea should be discussed.
Aging ; Caregivers ; Delivery of Health Care ; Dementia ; Humans ; Korea ; Long-Term Care ; Social Problems

PURPOSE: Carpal tunnel syndrome (CTS) has become increasingly recognized as a complication of long-term hemodialysis. This study evaluated the clinical characteristics and compared the results of carpal tunnel release for CTS patients with or without hemodialysis. METHODS: We retrospectively reviewed the clinical characteristics and surgical outcomes of 49 chronic hemodialysis patients with 83 CTS hands. Also, 100 patients were selected for the control group. Patient characteristics, accompanying systemic conditions, operative outcomes were compared. RESULTS: In hemodialysis group, the mean age and hemodialysis duration were 59.5+/-10.5 years and 4.1+/-2.5 years, respectively. Of the 83 hands with CTS, 45 (54.2%) had arteriovenous fistulas, while 38 (45.7%) did not (p=0.02). Most (81.6%) of the patients reported symptom improvement after surgical treatment, and the remaining patients (18.4%) reported persistent and recurrent symptoms. Rates of remaining symptoms and reoperations were significantly higher in the CTS patients with hemodialysis group. CONCLUSION: Majority of CTS patients with hemodialysis have much improved after transverse carpal ligament release. However, they showed higher recurrence than idiopathic CTS patients. In recurrent patients, use of the extended carpal tunnel release is effective in symptom relief.
Arteriovenous Fistula ; Carpal Tunnel Syndrome* ; Hand ; Humans ; Kidney Failure, Chronic ; Ligaments ; Recurrence ; Renal Dialysis* ; Retrospective Studies

Paraganglioma is an uncommon and slowly-growing benign neuro-endocrine tumor originating from the extra-adrenal paraganglia. The most common site of head and neck paraganglioma is the carotid body. Paraganglioma of thyroid gland is a rare disease, and is hard to diagnose preoperatively since the pathologic features are similar to thyroid neoplasm, especially to medullary carcinoma. Occasionally, multiple paragangliomas can be found in the body. To our knowledge, there are two cases of synchronous carotid body tumor with thyroid paraganglioma that have been reported to date. We report a case of 34-year-old female with carotid body paraganglioma synchronous with intra-thyroid paragangloma, which was misdiagnosed as papillary thyroid carcinoma in the preoperative evaluation. After the tumors were successfully excised, there were no signs of complications and the patient has survived the 2-year-follow-up period without recurrence.
Adult ; Carcinoma, Medullary ; Carotid Body ; Carotid Body Tumor* ; Female ; Head ; Humans ; Neck ; Paraganglioma* ; Rare Diseases ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

For treatment of Total Skin Electron beam Therapy (TSET), measurement of dose at various conditions is need on the contrary to usual radiotherapy. When treating TSET with modified Stanford technique based on linear accelerator, the energy of treatment electron beam, the spatial dose distribution and the actual doses deposited on the surface of the patient were measured by using EBT2. The measured energy of the electron beam was agreed with the value that measured by ionization chamber, and the spatial dose distribution at the patient position and the doses at several point on the patient's skin could be easily measured by EBT2 film. The dose on the patient that was measured by EBT2 film showed good agreement with the data measured simultaneously by TLD. With the results of this study, it was proven that the EBT2 film can be one of the useful dosimeter for TSET.
Electrons ; Humans ; Particle Accelerators ; Skin

Absorbed dose to water based protocols recommended that plane-parallel chambers be calibrated against calibrated cylindrical chambers in a high energy electron beam with R50>7 g/cm2 (E> or =16 MeV). However, such high-energy electron beams are not available at all radiotherapy centers. In this study, we are compared the absorbed dose to water determined according to cross-calibration method in a high energy electron beam of 16 MeV and in electron beam energies of 12 MeV below the cross-calibration quality remark. Absorbed dose were performed for PTW 30013, Wellhofer FC65G Farmer type cylindrical chamber and for PTW 34001, Wellhofer PPC40 Roos type plane-parallel chamber. The cylindrical and the plane-parallel chamber to be calibrated are compared by alternately positioning each at reference depth, zref=0.6R50-0.1 in water phantom. The DW of plane-parallel chamber are derived using across-calibration method at high-energy electron beams of 16, 20 MeV. Then a good agreement is obtained the DW of plane-parallel chamber in 12 MeV. The agreement between 20 MeV and 12 MeV are within 0.2% for IAEA TRS-398.
Electrons ; Water