Purpose: Notable effectiveness of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 (HER2)–low advanced breast cancer (BC) has focused pathologists’ attention. We studied the incidence and clinicopathologic characteristics of HER2-low BC, and the effects of immunohistochemistry (IHC) associated factors on HER2 IHC results. Materials and Methods: The Breast Pathology Study Group of the Korean Society of Pathologists conducted a nationwide study using real-world data on HER2 status generated between January 2022 and December 2022. Information on HER2 IHC protocols at each participating institution was also collected. Results: Total 11,416 patients from 25 institutions included in this study. Of these patients, 40.7% (range, 6.0% to 76.3%) were classified as HER2-zero, 41.7% (range, 10.5% to 69.1%) as HER2-low, and 17.5% (range, 6.7% to 34.0%) as HER2-positive. HER2-low tumors were associated with positive estrogen receptor and progesterone receptor statuses (p < 0.001 and p < 0.001, respectively). Antigen retrieval times (≥ 36 minutes vs. < 36 minutes) and antibody incubation times (≥ 12 minutes vs. < 12 minutes) affected on the frequency of HER2 IHC 1+ BC at institutions using the PATHWAY HER2 (4B5) IHC assay and BenchMark XT or Ultra staining instruments. Furthermore, discordant results between core needle biopsy and subsequent resection specimen HER2 statuses were observed in 24.1% (787/3,259) of the patients. Conclusion The overall incidence of HER2-low BC in South Korea concurs with those reported in previously published studies. Significant inter-institutional differences in HER2 IHC protocols were observed, and it may have impact on HER2-low status. Thus, we recommend standardizing HER2 IHC conditions to ensure precise patient selection for targeted therapy.

Background: Enlarged perivascular space (ePVS) is recently reported to be associated with cerebral small vessel disease (SVD) and Alzheimer’s disease (AD). The topographical location of ePVS may relate to the underlying pathology; basal ganglia (BG)-ePVS has been associated with cerebral vascular diseases and centrum semi-ovale (CSO)-ePVS associated with cerebral amyloid angiopathy (CAA). However, the effects of ePVS on various neurological conditions remain still controversial. To investigate the clinical relevance of ePVS in neurodegenerative diseases, we tested relationships between ePVS and cognition, markers of SVD, vascular risk factors, or amyloid pathology. Methods: We retrospectively reviewed 292 patients (133 AD dementia, 106 mild cognitive impairment, 39 other neurodegenerative diseases, 14 subjective cognitive decline) who underwent both amyloid positron emission tomography and brain magnetic resonance imaging. Vascular risk factors and cognitive tests results were collected. The ePVS in the BG and CSO, SVD markers and the volume of white matter hyperintensities were measured. Results: There were no significant differences in the severity and distribution of ePVS among clinical syndromes. Both BG- and CSO-ePVS were not related to cognitive function. Patients with lacunes were more likely to have high-degree BG-ePVS. High degree CSO-ePVS had an odds ratio (OR) for amyloid positive of 2.351, while BG-ePVS was a negative predictor for amyloid pathology (OR, 0.336). Conclusions Our findings support that ePVS has different underlying pathologies according to the cerebral topography. BG-ePVS would be attributed to hypertensive angiopathy considering the relation with SVD markers, whereas and CSO-ePVS would be attributed to CAA considering the association with amyloid pathology.

Periodontitis is a bacteria-induced inflammatory disease associated with alveolar bone loss. Osteoclast is a macrophage-lineage cell that exhibits phagocytic activity; however, osteoclast phagocytic activity has not been demonstrated under pathological conditions. Diabetes is a pathological condition that exacerbates alveolar bone loss via periodontitis; therefore, we examined phagocytic osteoclasts in diabetic rats that had periodontitis. The rats were divided into the control (C), periodontitis (P), and diabetes with periodontitis (DP) groups. Diabetes and periodontitis were induced by streptozotocin injection and ligature of the mandibular first molars, respectively. On days 3 and 20 after the ligature, the rats were sacrificed, and osteoclasts containing inclusions were quantified by tartrate-resistant acid phosphatase staining. On day 3, there were more osteoclasts containing inclusions in the DP group than in the C group. Among inclusions, osteocyte-like cells and dense bodies were more frequently observed in the DP group than in the C group. Cytoplasm-like structures were elevated more in the DP group than in the C and P groups. However, no differences were observed on day 20. Interestingly, some osteoclasts were in contact with the osteocytes within the exposed lacunae and contained several inclusions within a large vacuole. Thus, the elevation of phagocytic osteoclasts in rats with diabetes and periodontitis provides insight into the role of osteoclast phagocytic activity under pathological conditions.

The purpose of this study was to investigate the feasibility and therapeutic effects of a novel concept hand rehabilitation device based on magnetics for subacute stroke patients with hand motor impairment. We developed an end effector type device that can induce various movements of the fingers in accordance with a magnetic field direction using electromagnets and permanent magnets. Subacute stroke patients with hand motor impairments were recruited and divided into two rehabilitation groups. Conventional rehabilitation therapies were also conducted equally in both groups. Active-assisted training of the affected hand was additionally administered for 30 minutes per day for 4 weeks using the developed equipment in the intervention group. Hand motor function and the activities of daily living were evaluated before and after the intervention. The Manual Function Test score significantly increased in the intervention group after 4 weeks of treatment (p = 0.039), and there was a significant difference in the degree of improvement between the two groups (p = 0.016). The scores of the motor Fugl-Meyer Assessment of the upper limb, the Wolf Motor Function Test score and time, and the motor Functional Independence Measure also improved in both groups (all p < 0.05). In addition, the patients in the intervention group showed greater improvements in these outcome measures than those in the control group did (all p < 0.05). An adjuvant rehabilitation therapy using a magnetic based device can be helpful to improve the hand motor function and activities of daily life in subacute stroke patients.
Activities of Daily Living ; Fingers ; Hand ; Humans ; Magnetic Fields ; Magnets ; Outcome Assessment (Health Care) ; Pilot Projects ; Rehabilitation ; Robotics ; Stroke ; Therapeutic Uses ; Upper Extremity ; Wolves

Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.
Adult ; Ammonia ; Atrophy ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Cerebral Infarction ; Consciousness ; Hepatic Encephalopathy* ; Humans ; Liver Diseases ; Liver Failure ; Liver Failure, Acute* ; Liver Transplantation* ; Liver* ; Mortality ; Muscle, Smooth ; Pupil ; Reflex ; Seizures ; Tissue Donors

PURPOSE: The study was done to analyze attributes of emotional labor experienced by clinical nurses working in domestic hospitals and to develop tools for measurement. METHODS: The concept of nurse emotional labor was verified through concept analysis based on Hybrid model. The preliminary Nurse Emotional Labor Scale were examined for content validity, reliability and validity. The scale was verified with 500 nurses working in general hospitals located in Kangwon-do. RESULTS: Attributes of the nurse emotional labor concept were derived from three types: surface type, internalize type and control behaviors and identified as having six constitutive factors: conscious surface behaviors, casual behaviors, empathy effort, repress, solve and endure. The results of the construct validity test of the tool showed 8 factors. The Nurse Emotional Labor Measurement Tool had a significant correlation (r=.35, p < .001) with the Scale of Morris & Felman in result of criterion-related validity. And the internal consistency reliability Cronbach's α coefficient was .93. CONCLUSION: The development process showed that to accurately describe emotional labor of nurses, it is necessary to consider not only quantitative aspects but also qualitative aspects and content aspects.
Empathy ; Factor Analysis, Statistical ; Gangwon-do ; Hospitals, General ; Reproducibility of Results

To determine the effect of the tumor necrosis factor-α (TNF-α) in odontoclast formation, we administrated a TNF-α inhibitor in rats with diabetes rats with periodontitis. The rats included in the study were divided into three groups: control rats without diabetes or periodontitis (the C group), rats with periodontitis and diabetes (the PD group), and rats with periodontitis and diabetes treated by infliximab, the TNF inhibitor (the PD+infliximab group). The PD and PD+ infliximab groups received intravenous administrations of streptozotocin (STZ, 50 mg/kg) to induce diabetes. After 7 days of STZ injections, the mandibular first molars were ligatured to induce periodontitis. The PD+infliximab group was intrapenitoneally administrated by infliximab (5 mg/kg). On days 3 and 20 after the ligature administration, odontoclast formation along root surfaces was evaluated by tartrate resistant acid phosphatase (TRAP) staining and cathepsin K immunohistochemistry. On day 3, the number of TRAP- and cathepsin K-positive cells increased more so in the PD group than in the C group. The PD+infliximab group showed a lower number of positive cells than the PD group. There was no difference in all the groups on day 20. On day 3, the cathepsin-K positive multinucleated and mononucleated cells were higher in the PD group than in the C group. The number of cathepsin-K positive multinucleated cells was lower in the PD+infliximab group than in the PD group. The PD group showed more cathepsin K-positive cells in the furcation and distal surfaces than the c group. The Cathepsin K-positive cells of the PD+infliximab group were lower than that of the PD group in furcation. These results suggest that TNF-α stimulates odontoclast formation in diabetes with periodontitis.
Acid Phosphatase ; Administration, Intravenous ; Animals ; Cathepsin K ; Cathepsins ; Immunohistochemistry ; Infliximab ; Ligation ; Molar ; Necrosis ; Osteoclasts* ; Periodontitis* ; Rats* ; Streptozocin

PURPOSE: To evaluate the effects of exclusive breast milk feeding (BMF) on the incidence of necrotizing enterocolitis (NEC) in preterm infants. METHODS: All newborn infants, born at <32 weeks of gestation and weighing <1,500 g, admitted to the neonatal intensive care center at Seoul National University Bundang Hospital during the study period, were included. The study was divided into period I: pre-exclusive BMF (January 2010–March 2014) and period II: exclusive BMF (April 2014–December 2016). RESULTS: A total of 374 infants were enrolled in this study, with 174 in period I and 174 in period II. The incidence of NEC was 11.5% in period I and 3.4% in period II. As the mean gestational age and birth weight were significantly greater in infants in period II, the difference in the incidence of NEC between the two periods was adjusted by gestational age. After adjustment, the incidence of NEC in period II was significantly lower than in period I (P=0.024). CONCLUSION: Exclusive BMF significantly reduced the incidence of NEC in a single neonatal intensive care center.
Birth Weight ; Breast* ; Enterocolitis, Necrotizing* ; Gestational Age ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal* ; Milk, Human* ; Pregnancy ; Seoul

OBJECTIVES: The Behavioral Activation of Depression Scale (BADS) has been reported to be a valid tool for assessing the different behavioral aspects of depression, such as activation, rumination or avoidance, and functional impairment. The aim of this study was to assess the reliability and validity of the Korean version of BADS (K-BADS). METHODS: A sample of 196 outpatients completed the K-BADS and the data were analyzed for internal consistency and factor structures. An additional 51 outpatients re-filled the K-BADS after two weeks for the test-retest reliability. To test for the validity, the Hospital Anxiety and Depression Scale (HADS), Working Alliance Inventory (WAI), Drug Attitude Inventory-10 (DAI-10), and Mindfulness Attention Awareness Scale (MAAS) were administered. RESULTS: Internal consistency of K-BADS was good (Cronbach's alpha=0.843) and principal component factor analysis revealed the four-factor structure. The K-BADS showed a reasonable test-retest reliability (r=0.863, p<0.001). The total score of K-BADS correlated significantly with the total scores of the HADS depression (r=−0.694) and HADS anxiety (r=−0.681). No correlations were found between the K-BADS and the K-WAI (r=0.170) and between the K-BADS and the K-DAI-10 (r=0.311). CONCLUSION: The K-BADS is a reliable and valid instrument for measuring the behavioral activation for depression in Korean patients with depressive symptoms.
Anxiety ; Depression* ; Humans ; Mindfulness ; Outpatients ; Reproducibility of Results*

BACKGROUND: Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. METHODS: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. RESULTS: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). CONCLUSIONS: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.
Acute Kidney Injury* ; Body Mass Index* ; Classification ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Liver Transplantation* ; Liver* ; Logistic Models ; Mortality ; Retrospective Studies* ; Thinness