Objective: To evaluate the performance of supplemental automated breast ultrasound (ABUS) added to mammography-based breast cancer screening for women with nondense breasts. Materials and Methods: A retrospective search of radiology databases at two tertiary institutions identified asymptomatic women with nondense breasts who underwent breast cancer screening using both digital mammography (DM) and supplemental ABUS between January 2020 and December 2023. We excluded women without sufficient follow-up data or those without an established final diagnosis, including histopathologic results. The performance measures of DM alone and ABUS combined with DM (ABUS plus DM) were compared. The primary outcome was the cancer detection rate (CDR), and the secondary outcomes were sensitivity and specificity. Subgroup analyses were performed for women with scattered fibroglandular density and almost entirely fatty breasts. Results: A total of 2,904 pairs of screening examinations were performed in 1,683 women (59 ± 10 years), detecting 26 cancers. In comparison with DM alone, ABUS plus DM showed higher CDR (9.0 vs. 7.9 per 1,000 examinations, P < 0.001), higher sensitivity (100% [26/26] vs. 88.5% [23/26], P < 0.001), and lower specificity (95.0% [2,735/2,878] vs. 97.9% [2,817/2,878], P < 0.001). In women with scattered fibroglandular density, ABUS increased the CDR from 7.4 to 8.5 per 1,000 examinations and improved the sensitivity from 87.0% [20/23] to 100% [23/23] (P < 0.001). In women with almost entirely fatty breasts, ABUS plus DM showed the same CDR (16.4 per 1,000 examinations) and sensitivity (100% [3/3]) as DM alone. Three cancers (11.5% [3/26]), all of which were stage T1N0, were detected only by supplemental ABUS. Conclusion Supplemental ABUS improved cancer detection and sensitivity in women with nondense breasts, with the benefits primarily observed in those with scattered fibroglandular density.

Objective: Lipopolysaccharide (LPS), derived from various infectious bacteria in the uterus, interferes with communication between embryonic trophoblasts and endometrial cells, thereby inhibiting successful embryo implantation. This study aimed to investigate the effects of LPS and the anti-inflammatory compound nicotinamide (NAM) on early embryo implantation processes, focusing on the adhesion and outgrowth between trophoblast spheroids and endometrial cells. Methods: We used JAr mixed JEG-3 (JmJ) spheroids, prepared by combining JAr and JEG-3 cells in a 1:1 ratio. Following treatment with LPS with or without NAM, the attachment and outgrowth of JmJ spheroids on endometrial epithelial cells (ECC-1) were assessed. Additionally, changes in the gene expression of inflammatory cytokines (chemokine (C-X-C motif) ligand 1 [CXCL1], interleukin 8 [IL-8], and IL-33) and cell adhesion molecules (integrin alpha-V [ITGαV], integrin beta 3 [ITGβ3], and integrin beta 5 [ITGβ5]) in ECC-1 cells following LPS and/or NAM treatment were evaluated using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blot analysis. Results: Decreased attachment rates and reduced outgrowth areas caused by LPS treatment were significantly restored by NAM. These restorative effects of NAM were associated with the modulation of inflammatory cytokines—specifically CXCL1 and IL-33, as shown by qRT-PCR—and expression of the cell adhesion molecule ITGβ3, as indicated by Western blot analysis. Conclusion Our study confirmed that LPS-induced endometrial infection may inhibit embryo implantation. NAM treatment ameliorated the detrimental effects of LPS by modulating the expression of inflammatory cytokines and adhesion molecules. Further studies are needed to explore the potential use of NAM as an effective additive to improve embryo implantation rates in human in vitro fertilization-embryo transfer programs.

Purpose: Laparoscopic appendectomy, a routine surgical procedure for acute appendicitis, is commonly performed in general hospitals. However, postoperative outcomes based on surgical subspecialty have not been well established. This study aimed to compare surgical outcomes of laparoscopic appendectomy across different surgical subspecialties using risk-adjusted cumulative summation (RA-CUSUM) analysis. Methods: A retrospective analysis was conducted on 631 patients undergoing laparoscopic appendectomy between July 2020 and December 2022. Surgeons were categorized into gastrointestinal (GI) or non-GI groups and senior or young groups. Surgical failure was defined as operation time exceeding the mean plus 2 standard deviations, presence of postoperative complications, or readmission within 30 days after surgery. RA-CUSUM analysis was employed to evaluate surgical failure within each group. Results: The GI group performed more partial cecectomies (P = 0.017) and had longer operation times (P = 0.019) than the non-GI group. The senior group exhibited shorter operation time (P < 0.001), reduced length of stay (P = 0.011), and a higher complication rate (P < 0.001) than the young group. RA-CUSUM analysis indicated a decrease in surgical failure as accumulation progressed in both senior and young groups, as well as in the GI and non-GI groups. Conclusion Outcomes of laparoscopic appendectomy varied by subspecialty and length of experience. However, each surgeon showed trends of decreasing surgical failure over time. These results suggest that the surgeon’s subspecialty minimally affects the outcomes of laparoscopic appendectomy, reflecting its fundamental nature within general surgery.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objective: Nicotinamide mononucleotide (NMN) is extensively utilized as an anti-aging agent and possesses anti-inflammatory properties. Lipopolysaccharide (LPS) activates Toll-like receptor 4, a process modulated by intracellular signaling pathways such as the Wnt/β-catenin pathway. This study investigated the impact of NMN on osteogenesis in the presence of LPS. Methods: To elucidate the role of NMN in osteogenesis in the context of Gram-negative bacterial infection after LPS treatment, we cultured a mouse pre-osteoblast cell line (MC3T3-E1) and subsequently incubated it with NMN and/or LPS. We then evaluated osteogenic activity by measuring alkaline phosphatase activity, assessing gene expression and protein levels, and performing Alizarin Red S staining and immunocytochemistry. Results: MC3T3-E1 cells underwent successful differentiation into osteoblasts following treatment with osteogenic induction medium. LPS diminished features related to osteogenic differentiation, which were subsequently partially reversed by treatment with NMN. The restorative effects of NMN on LPS-exposed MC3T3-E1 cells were further substantiated by elucidating the role of Wnt/β-catenin signaling, as confirmed through immunocytochemistry. Conclusion This study showed that infection with Gram-negative bacteria disrupted the osteogenic differentiation of MC3T3-E1 cells. This adverse effect was partially reversed by administering a high-dose of NMN. Drawing on these results, we propose that NMN could serve as a viable therapeutic strategy to preserve bone homeostasis in elderly and immunocompromised patients.

Background: and Purpose Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. Methods: A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. Results: Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period.The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. Conclusions During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportivecare program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm 2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive.The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4–79.9), 90.8% (95% CI: 85.6–94.2), and 83.5% (95% CI: 78.6–87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8–97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9–89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1–79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52–0.63) before training and 0.68 (95% CI: 0.62–0.74) after training, with a difference of 0.11 (95% CI: 0.02–0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69–0.74) before training and 0.79 (95% CI: 0.76–0.80) after training (P = 0.002). Conclusion Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.