Purpose: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.

On May 1, 2024, the Republic of Korea lifted the infectious disease crisis alert for mpox, almost two years after the first case was reported. The Korea Disease Control and Prevention Agency (KDCA) has led the response, which included diagnosis, epidemiological investigations, treatment, and vaccination. This article particularly reviews the vaccination strategy implemented and proposes suggestions for enhancing future response efforts. Initially, the KDCA recommended pre-exposure prophylaxis for high-risk groups, later expanding to include broader demographics as domestic cases rose. By April 2024, a total of 6,863 individuals had received their first vaccine dose, with 3,875 completing the second dose of third-generation vaccines. Strategies to improve future responses include addressing stigma, securing nationally representative safety data, and conducting vaccine cost-benefit analyses.These measures will help ensure a robust and effective response to future outbreaks.

Background: The increasing number of vaccines and the complexity of immunization programs, along with continuous changes in the epidemiology of infectious diseases, necessitate a systematic approach to vaccine effectiveness (VE) evaluation. This study presents a preliminary survey to establish a VE evaluation framework in Korea, focusing on the National Immunization Program. Methods: Experts’ opinions were collected through a two-round online survey targeting key stakeholders. The first round consisted of two multiple-choice questions and two openended questions. The second round was a quantitative survey with 17 questionnaires based on five domains derived by analyzing the results of the first-round survey. Results: The results emphasize the necessity and urgency of a government-led VE evaluation system and the establishment of a multidisciplinary evaluation organization. Key considerations include personnel, budget, data integration, legal standards, and surveillance system enhancements. Conclusion These findings provide valuable insights for policymakers, emphasizing the need for collaboration, financial support, and robust data management in developing evidence-based vaccination policies.

We conducted a cohort study to assess vaccine effectiveness (VE) of coronavirus disease 2019 vaccine combinations on severe acute respirator y syndrome coronavirus 2 critical infection and death among elderly population in Korea. From Januar y to August 2022, VE against death for 4 doses mRNA recipients was 96.1%, whereas 1-dose viral vector + 3-dose mRNA recipients had VE of 90.8%.

In June 2022, the first monkeypox case was reported as imported into Korea. The general public asked whether they should get vaccinated against monkeypox because of the recent COVID-19 vaccination experience. As of the current monkeypox outbreak situation, a ring vaccination strategy for the high-risk group is more appropriate than the mass population vaccination with smallpox vaccines. Therefore, identifying the proper target group by available vaccines based on the risk and benefit analysis is a key issue of the vaccination program. In addition, the target group should be reviewed by the epidemiological situation of the jurisdiction along with the updated evidence of the monkeypox virus on transmission dynamics, severity, and fatality.

Objectives: The aim of this study was to provide baseline data for the assessment of exposure to indium and to prevent adverse health effects among workers engaged in the electronics and related industries in Republic of Korea. Methods: Total (n = 369) and respirable (n = 384) indium concentrations were monitored using personal air sampling in workers at the following 19 workplaces: six sputtering target manufacturing companies, four manufacturing companies of panel displays, two companies engaged in cleaning of sputtering components, two companies dedicated to the cleaning of sputtering target, and five indium recycling companies. Results: The level of exposure to total indium ranged from 0.9 to 609.3 μg/m3 for the sputtering target companies; from 0.2 to 2,782.0 μg/m3 for the panel display companies and from 0.5 to 2,089.9 μg/m3 for the indium recycling companies. The level of exposure to respirable indium was in the range of 0.02 to 448.6 μg/m3 for the sputtering target companies; 0.01 to 419.5 μg/m3 for the panel display companies; and 0.5 to 436.3 μg/m3 for the indium recycling companies. The indium recycling companies had the most samples exceeding the exposure standard for indium, followed by sputtering target companies and panel display companies. Conclusions The main finding from this exposure assessment is that many workers who handle indium compounds in the electronics industry are exposed to indium levels that exceed the exposure standards for indium. Hence, it is necessary to continuously monitor the indium exposure of this workforce and take measures to reduce its exposure levels.

Objectives: The aim of this study was to provide baseline data for the assessment of exposure to indium and to prevent adverse health effects among workers engaged in the electronics and related industries in Republic of Korea. Methods: Total (n = 369) and respirable (n = 384) indium concentrations were monitored using personal air sampling in workers at the following 19 workplaces: six sputtering target manufacturing companies, four manufacturing companies of panel displays, two companies engaged in cleaning of sputtering components, two companies dedicated to the cleaning of sputtering target, and five indium recycling companies. Results: The level of exposure to total indium ranged from 0.9 to 609.3 μg/m3 for the sputtering target companies; from 0.2 to 2,782.0 μg/m3 for the panel display companies and from 0.5 to 2,089.9 μg/m3 for the indium recycling companies. The level of exposure to respirable indium was in the range of 0.02 to 448.6 μg/m3 for the sputtering target companies; 0.01 to 419.5 μg/m3 for the panel display companies; and 0.5 to 436.3 μg/m3 for the indium recycling companies. The indium recycling companies had the most samples exceeding the exposure standard for indium, followed by sputtering target companies and panel display companies. Conclusions The main finding from this exposure assessment is that many workers who handle indium compounds in the electronics industry are exposed to indium levels that exceed the exposure standards for indium. Hence, it is necessary to continuously monitor the indium exposure of this workforce and take measures to reduce its exposure levels.

BACKGROUND/AIMS: When determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status.METHODS: We examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years.RESULTS: According to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist’s opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09–91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28–56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76–106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21–17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18–22.34).CONCLUSIONS: Subsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.
Colon ; Colonic Neoplasms ; Humans

BACKGROUND/AIMS: This study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS). METHODS: A prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups. RESULTS: This study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P>0.05). The mean total BBPS score (7.95 vs. 8.11, P>0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P>0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008). CONCLUSIONS: Bowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS.
Adenoma ; Citric Acid ; Colonoscopy ; Compliance ; Humans ; Magnesium ; Nausea ; Patient Satisfaction ; Prospective Studies ; Sodium ; Visual Analog Scale ; Water

PURPOSE: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1–3 positive nodes and a tumor size of <5 cm. MATERIALS AND METHODS: We retrospectively analyzed data of 133 female breast cancer patients with 1–3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). RESULTS: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. CONCLUSION: Our study showed a very low local recurrence in patients with 1–3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient’s given risk for local and regional recurrence, and possible radiation-related toxicities.
Breast Neoplasms ; Breast ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Mastectomy ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Trastuzumab