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.

Objective: To evaluate the feasibility of cerebral computed tomography angiography (CTA) obtained with reduced iodine and low radiation at 70 kVp and the effect of deep learning-based augmented contrast enhancement (DL-ACE) and denoising (DL-DN) algorithms on the CTA quality. Materials and Methods: In this prospective study, 47 healthy volunteers (male:female, 31:16; mean age ± standard deviation, 57.8 ± 10.9 years) were randomly assigned to one of three CTA protocols: Group A (n = 16; 100 kVp, 40 mL of 350 mgI/mL), Group B (n = 16; 70 kVp, 40 mL of 270 mgI/mL), and Group C (n = 15; 70 kVp, 28 mL of 270 mgI/mL [ultralow iodine]), with an injection rate of 2.5 mL/s for all. Images were reconstructed using filtered back projection (FBP), and images in Groups B and C were additionally reconstructed using DL-ACE and DL-DN. Arterial attenuation, image noise, contrast-to-noise ratio (CNR), and subjective image quality were compared among five image sets. Results: Compared with Group A, Groups B and C received 23.7% lower radiation doses. With FBP, arterial attenuation was significantly higher in Groups B (435.8 ± 50.2 Hounsfield units [HU]) and C (391.8 ± 52.1 HU) than in Group A (321.1 ± 47.4 HU) (P < 0.001), while CNR did not differ significantly (Group A, 19.9 ± 4.7; Group B, 20.3 ± 3.8; and Group C, 18.4 ± 4.6) due to higher image noise in Groups B and C. After applying DL-ACE and DL-DN in Groups B and C, arterial attenuation increased by 45.4% and image noise decreased by 34.5%, resulting in significantly higher arterial attenuation, CNR, and subjective image quality compared with Group A (P < 0.001). Conclusion Cerebral CTA at 70-kVp using ultralow iodine enhanced arterial attenuation but increased image noise compared with the 100-kVp CTA protocol. DL-ACE and DL-DN significantly increased arterial attenuation and reduced image noise, resulting in higher CNR and better subjective image quality.

BACKGROUND/OBJECTIVES: Artificially sweetened beverages (ASBs) consumption has been increasing globally, including Korea, but detailed data on the intake levels and consumers’ characteristics are limited. This study examined sociodemographic, lifestyles, and dietary characteristics among ASBs consumers in Korea. SUBJECTS/METHODS: Three hundred and twenty adults (≥ 18 yrs) who reported consuming ASBs in the 2021–2023 Korea National Health and Nutrition Examination Surveys were selected. Based on the 24-h dietary recall data, ASBs were classified using food codes and names, and further categorized according to the product name. The daily ASBs consumption (g/day) was calculated for each participant, and the participants were divided into 2 groups based on the median value (372.8 g/day). The general characteristics, lifestyles, and dietary characteristics were compared between the 2 consumption groups. RESULTS: The average daily ASBs consumption was 432.5 g (SD = 283.2) for men and 361.4 g (SD = 265.4) for women. ASBs consumption was 424.6 g (SD = 259.5) for individuals aged 18– 29 yrs, 400.2 g (SD = 320.0) for those aged 30–39 yrs, and 360.5 g (SD = 249.3) for those aged ≥ 40 yrs. ASBs consumption was higher among overweight/obese individuals (body mass index [BMI] ≥ 23 kg/m2 ) (427.2 g, SD = 296.3) compared to non-overweight/obese individuals (361.0 g, SD = 241.8). The group with higher ASBs consumption was younger (P < 0.001), had a higher proportion of men (P = 0.013), and had a higher BMI (P = 0.007). The higher consumption group had a greater proportion of individuals attempting to lose or maintain weight (P = 0.016), higher energy intake (P = 0.032), lower frequency of fruits consumption (P = 0.005), and a higher frequency of dinner consumption (P = 0.034). CONCLUSION These findings may serve as baseline data for future research and programs related to ASBs consumption.

Objective: This study aimed to evaluate reproductive outcomes according to the timing of testicular sperm retrieval. Methods: The study included 282 infertile couples divided into three groups: group A (freeze-thawed testicular sperm extraction [TESE] sperm, n=233), group B (fresh TESE sperm collected 1 day before ovum pickup, n=22), and group C (fresh TESE sperm collected on the same day as ovum pickup, n=27). The indications for TESE were surgically uncorrectable azoospermia or ejaculation failure, often accompanied by medical comorbidities such as diabetes mellitus and spinal cord injury. The outcome parameters assessed were fertilization rates, embryo quality, and clinical pregnancy rates. Results: The mean paternal age was 36.8±5.7 years, and the mean maternal age was 32.6±3.5 years. The mean duration of infertility was 2.9±1.8 years. The fertilization rates were 70.7%, 78.9%, and 73.0% for groups A, B, and C, respectively (p=0.047). The percentages of good-quality embryos were 68.2%, 65.3%, and 48.4%, respectively (p=0.007); specifically, the percentage of good-quality embryos was significantly lower in group C compared with the other two groups. Clinical pregnancy rates per transfer were similar at 51.1%, 50.0%, and 48.1% (p=0.958), with no differences observed in miscarriage rates. Conclusion Testicular sperm retrieval can be safely performed 1 day before ovum pickup, resulting in favorable fertility outcomes.

Objectives: This study evaluated the educational effectiveness of the Loving Life TokTok 65+, a suicide prevention gatekeeper education program for the elderly developed by the Jeju Special Self-Governing Province Mental Health Welfare Center. Methods: Community-dwelling adults aged ≥65 years (n=125) were assigned randomly to an intervention group (n=61) or a control group (n=64). The intervention group received the Loving Life TokTok 65+ program, while the control group received no education during the study period. The outcomes were assessed immediately before and after the intervention using validated self-report measures of gatekeeper behavior, preparedness to help, suicide prevention literacy, and attitudes toward suicide. Results: Post-intervention, the intervention group showed significant improvement in overall gatekeeper behavior (all p<0.001), particularly in readiness and self-efficacy, compared with the baseline, whereas the control group showed no significant change. Conclusion The Loving Life TokTok 65+ program effectively enhanced suicide-prevention–related behavioral competencies among the elderly.

Background: Lung ultrasound (LUS) has proven valuable in the initial assessment of coronavirus disease 2019 (COVID-19), but its role in detecting pulmonary fibrosis following intensive care remains unclear. This study aims to assess the presence of pulmonary sequelae and fibrosis-like changes using LUS in survivors of severe COVID-19 pneumonia one month after discharge. Methods: We prospectively enrolled patients with severe COVID-19 who required mechanical ventilation in the intensive care unit (ICU) and conducted LUS assessments from admission to the outpatient visit after discharge. We tracked changes in key LUS findings and applied our proprietary LUS scoring system. To evaluate LUS accuracy, we correlated measured LUS values with computed tomography scores. Results: We evaluated B-line presence, pleural thickness, and consolidation in 14 eligible patients. The LUS scores exhibited minimal changes, with values of 19.1, 19.2, and 17.5 at admission, discharge, and the outpatient visit, respectively. Notably, the number of B-lines decreased significantly, from 1.92 at admission to 0.56 at the outpatient visit (p<0.05), while pleural thickness increased significantly, from 2.05 at admission to 2.48 at the outpatient visit (p≤0.05). Conclusion This study demonstrates that LUS can track changes in lung abnormalities in severe COVID-19 patients from ICU admission through to outpatient follow-up. While pleural thickening and B-line patterns showed significant changes, no correlation was found between LUS and high-resolution computed tomography fibrosis scores. These findings suggest that LUS may serve as a supplementary tool for assessing pulmonary recovery in severe COVID-19 cases.

Purpose: Pediatric papillary thyroid cancer (PTC) is recommended to perform aggressive surgery to reduce the risk of recurrence.This study was designed to evaluate the concurrent association between multifocality, bilaterality, and the risk of recurrence in pediatric PTC. Materials and Methods: This retrospective cohort study included pediatric patients (age <19 years) who underwent total thyroidectomy for PTC between 1996 and 2014 in a single tertiary center. Clinicopathological parameters were analyzed to evaluate the prevalence of multifocality, bilaterality, recurrence, and their association. Results: We analyzed 58 pediatric patients with PTC. There was no factor related to the presence of multifocality or bilaterality in multivariate analysis. Also, in univariate analysis, multifocality and bilaterality were not independent risk factors of each other’s presentation (p=0.061 and p=0.061, respectively). Recurrence was observed in 19 (32.8%) patients. In multivariate analysis of recurrence, clear cell subtype, multifocality, and gross extrathyroidal extension (ETE) were independent risk factors (p=0.027, p=0.035, and p=0.038, respectively). Most recurrences (68.4%) happened during the first 4 years of follow-up after the initial thyroidectomy. Conclusion Multifocality and bilaterality were not independent risk factors of each other’s presentation; however, multifocality was the risk factor for recurrence in pediatric PTC. For pediatric PTC, close monitoring for recurrence within the initial 4 years is recommended, particularly in patients with clear cell subtype, multifocality, and gross ETE.

Background: s/Aims: Hepatocellular carcinoma (HCC) is the sixth most common cancer and second leading cause of cancer-related deaths in South Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2016-2018. Methods: Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative database of patients newly diagnosed with HCC in South Korea, were analyzed. This study investigated 4,462 patients with HCC registered in the KPLCR in 2016-2018. Results: The median patient age was 63 years (interquartile range, 55-72). 79.7% of patients were male. Hepatitis B infection was the most common underlying liver disease (54.5%). The Barcelona Clinic Liver Cancer (BCLC) staging system classified patients as follows: stage 0 (14.9%), A (28.8%), B (7.5%), C (39.0%), and D (9.8%). The median overall survival was 3.72 years (95% confidence interval, 3.47-4.14), with 1-, 3-, and 5-year overall survival rates of 71.3%, 54.1%, and 44.3%, respectively. In 2016-2018, there was a significant shift toward BCLC stage 0-A and Child-Turcotte-Pugh liver function class A (P<0.05), although survival rates did not differ by diagnosis year. In the treatment group (n=4,389), the most common initial treatments were transarterial therapy (31.7%), surgical resection (24.9%), best supportive care (18.9%), and local ablation therapy (10.5%). Conclusions Between 2016 and 2018, HCC tended to be diagnosed at earlier stages, with better liver function in later years. However, since approximately half of the patients remained diagnosed at an advanced stage, more rigorous and optimized HCC screening strategies should be implemented.