Background: The discovery and evaluation of reliable biomarkers of vitiligo are important;however, no clinically established serological markers exist for predicting the clinical prognosis of vitiligo. Objective: To investigate the levels of SOX10 and lamin A/C antibodies in the serum of patients diagnosed with vitiligo. Methods: In this multicenter prospective study, blood serum samples were collected from adult vitiligo patients. The levels of SOX10 and lamin A/C antibodies were analyzed by direct sandwich enzyme-linked immunosorbent assay. Antibody levels between the groups were compared according to disease activity and subtype. Results: A total of 80 patients (46 females; median age 60 years) were enrolled, including 56 (70%) with nonsegmental vitiligo and 27 (33.7%) with active disease. Positivity for SOX10 and lamin A/C antibodies was observed in 35.0% and 71.3% of patients, respectively. SOX10 positivity was significantly higher in active vitiligo than in stable vitiligo (59.3% vs. 24.5%; p=0.003), whereas lamin A/C positivity did not show significant difference (77.8% vs. 69.8%; p=0.60).No significant associations were found between SOX10 or lamin A/C status and the subtype, extent, or the presence of antinuclear antibody, anti-thyroid peroxidase, or anti-thyroglobulin (all p>0.05). Conclusion SOX10 antibody could be a potential marker for assessing disease activity in vitiligo. The increased production of SOX10 antibodies in the serum may be due to the underlying death or turnover of SOX10 containing cells under active autoimmune response.

Objective: We aimed to identify the main oncogenic pathway by histological type of ovarian cancer based on Next-generation sequencing (NGS) test and to determine the correlation with clinical prognosis. Methods: We conducted a retrospective review of 420 patients with ovarian cancer who underwent NGS testing at Asan Medical Center from June 1, 2017, to May 31, 2021. Identified mutations were categorized into seven oncogenic pathways that are most frequently associated with ovarian cancer. Results: The average number of oncogenic pathways involved in each cancer patient was 1.76 (range, 0–6). TP53 mutation was the primary oncogenic pathway in patients with high-grade serous carcinoma (HGSC) (92.8%) and carcinosarcoma (87.5%). MAP kinase signaling was the primary oncogenic pathway in low-grade serous carcinoma (58.3%) and mucinous carcinoma (54.5%). The involvement of more diverse oncogenic pathways has been identified in patients with endometrioid carcinoma and clear cell carcinoma and PI3KAKT-mTOR signaling and SWI/SNF family pathways were the most common in both groups.The involvement of the DNA damage response pathway showed an association with better progression free survival (PFS), but not with overall survival (OS) in patients with HGSC. On the other hand, the involvement of the RTK signaling family pathway showed an association with better OS despite no association with PFS in patients with HGSC. Conclusion The clinical prognosis may be improved by implementing targeted treatment tailored to the patient's genetic profile through NGS. Additional research is needed to determine whether the involvement of the RTK signaling family pathway is indeed associated with better OS and to identify the underlying reasons for this association.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: Sunitinib, commonly used for metastatic renal cell carcinoma (mRCC), often induces hypothyroidism, affecting 27 to85% of patients. There are clues suggesting an association between sunitinib-induced hypothyroidism and improved survival outcomes. This study aims to identify the predictive factors of sunitinib-induced hypothyroidism and evaluate whether the occurrence of overt or subclinical hypothyroidism predicts tumor outcome in patients with mRCC. Methods: Patients administered to sunitinib for mRCC was included in this retrospective study. Log-rank test and Cox proportional hazards model were conducted to identify predictive factors of hypothyroidism and prognostic factors of progression-free survival (PFS) and overall survival (OS). Results: A total of 156 patients with mRCC treated with sunitinib were included. Predictive factors of sunitinib-induced hypothyroidism werefemale (odds ratio (OR), 2.77), sunitinib-induced hypertension (OR, 2.99) and dose reduction of sunitinib due to intolerance (OR, 3.57). Sunitinib-induced overt hypothyroidism was a significant prognostic factor in predicting PFS and OS (hazard ratio, 0.38 and 0.23, respectively). Thyroid hormone replacement did not have an influence on PFS and OS. Conclusions Female patients, patients who experienced sunitinib-induced hypertension and sunitinib dose reduction are at higher risk of hypothyroidism and need close monitoring. Overt hypothyroidism is a strong prognostic factor of sunitinib treatment outcome in mRCC patients and thyroid hor-mone replacement does not have a negative effect on tumor outcome.

Background: and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). Methods: This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. Results: Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. Conclusion Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

Background/Aims: Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods: Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results: Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Background: The use of newly developed mixed-dilution hemodiafiltration (HDF) can supplement the weaknesses of pre- and postdilution HDF. However, it is unclear whether mixed-HDF performs well compared to predilution HDF. Methods: We conducted a prospective, open-labeled, randomized controlled trial from two hemodialysis centers in Korea. Between January 2017 and September 2019, 60 patients who underwent chronic hemodialysis were randomly assigned at a 1:1 ratio to receive either predilution HDF (n = 30) or mixed-HDF (n = 30) for 6 months. We compared convection volume, changes in small- and medium-sized molecule clearance, high-sensitive C-reactive protein (hs-CRP) level, and dialysis-related parameters between the two dialysis modalities. Results: A mean effective convection volume of 41.0 ± 10.3 L/session in the predilution HDF group and 51.5 ± 9.0 L/session in the mixed-HDF group was obtained by averaging values of three time-points. The difference in effective convection volume between the groups was 10.5 ± 1.3 L/session. This met the preset noninferiority criteria, suggesting that mixed-HDF was noninferior to predilution HDF. Moreover, the β2-microglobulin reduction rate was greater in the mixed-HDF group than in the predilution HDF group, while mixed-HDF provided greater transmembrane pressure. There were no significant between-group differences in Kt/V urea levels, changes in predialysis hs-CRP levels, proportions of overhydration, or blood pressure values. Symptomatic intradialytic hypotension episodes and other adverse events occurred similarly in the two groups. Conclusion Use of mixed-HDF was comparable to predilution HDF in terms of delivered convection volume and clinical parameters. Moreover, mixed-HDF provided better β2-microglobulin clearance than predilution HDF.