Purpose: To assess the effectiveness of the prostate health index (PHI) in patients with no index lesions on multiparametric magnetic resonance imaging (mpMRI) or with negative findings on past prostate biopsy if there was an index lesion on mpMRI. Materials and Methods: Patients without an index lesion on MRI or with a negative result on combined biopsy for index lesions were assessed. Patients who underwent transperineal mapping biopsy among those suspected of having prostate cancer (PCa) due to persistently elevated prostate-specific antigen (PSA) levels were analyzed. Results: Of the 291 patients, 82 (28.2%) were diagnosed with PCa. Sixty-five of 291 patients had negative finding in previous combined biopsy. In total, 226 patients did not have any index lesions. The mean age of the PCa group was 64.33±8.88 years and that of the non-cancer group was 59.88±10.26 years (p<0.001). The PHI was 46.75±28.22 in the PCa group and 37.74±17.37 in the noncancer group (p=0.001), and the prostate volume was 41.52±15.77 mL in the PCa group and 50.78±23.97 mL in the non-cancer group (p=0.001). In multivariate analysis, age (odds ratio [OR] 1.096, p<0.001), PHI (OR 1.021, p=0.005), and prostate volume (OR 0.954, p<0.001) were identified as significant factors for PCa detection. The optimal cutoff value of the PHI for PCa detection was 44.6 and the PHI density (PHID) was 0.88. Conclusions In patients with elevated PSA levels but no index lesions on mpMRI or negative biopsy findings, PHI and PHID demonstrated significant potential for improving PCa detection.

This study aimed to assess the prognostic role of body mass index (BMI) in patients with metastatic renal cell carcinoma (mRCC) treated with first-line immune checkpoint inhibitor (ICI)-based therapy. We searched for relevant studies in the MEDLINE, Embase, and Cochrane Library databases. The initial search yielded 599 records, of which seven articles (2,517 patients) were selected for analysis. Patients with a high BMI had a favorable overall survival (OS) based on hazard ratio (HR) (crude HR 0.69, 95% confidence interval [CI] 0.57–0.83, p<0.0001; adjusted (a)HR 0.75, 95% CI 0.59–0.95, p=0.02), but not relative risk (RR 0.88, 95% CI 0.67–1.16, p=0.37). In the subgroup analysis, patients with a high BMI had better OS in the ICI with tyrosine kinase inhibitor (TKI) subgroup (aHR 0.71, 95% CI 0.55–0.92, p=0.01), while no significant difference was found in the ICI-only subgroup (aHR 1.02, 95% CI 0.56–1.87, p=0.95). Adjusted statistics for progression-free survival (PFS) were assessable in predominantly ICI-only studies and demonstrated a favorable outcome for patients with a low BMI (aHR 1.67, 95% CI 1.14–2.45, p=0.01). In conclusion, the impact of high BMI varies depending on the treatment type, exhibiting a favorable correlation with OS within ICI with TKI subgroup, but indicating an adverse association with PFS in the ICI-only subgroup. Further research is needed to clarify the influence of BMI by stratifying patients into ICI-only and ICI with TKI treatment to provide more insights.

Background and Objectives: The serum galactomannan test (GM test) and the (1,3)-β-D-glucan test (G test) are utilized in diagnosing invasive fungal sinusitis. However, their effectiveness in detecting paranasal sinus fungus balls (FBs) has not been established. This study aimed to explore their diagnostic value in patients with FBs. Methods: We retrospectively reviewed the medical records of 105 patients (42 with FBs and 63 with chronic rhinosinusitis [CRS]) who underwent serum GM and G tests between June 2020 and May 2021. Olfactory test results and demographics were also analyzed. Results: There were 42 FB patients (10 men, 32 women) and 63 CRS patients (27 men, 36 women). The positivity rates for serum GM (7.1% in the FB group vs. 3.2% in the CRS group, p=0.640) and G test (9.5% in the FB group vs. 11.1% in the CRS group, p=0.482) did not differ significantly between groups. The sensitivities of the GM and G tests were 7.1% and 9.5%, respectively, and their specificities were 96.8% and 88.9%, respectively. The positive predictive values were 60.0% for the GM test and 36.3% for the G test, and the negative predictive values were 61.0% for the GM test and 59.6% for the G test. Conclusion Serum GM and G tests demonstrated low sensitivity and high specificity, indicating limited effectiveness in differentiating between patients with FBs and those with CRS. Histological examination remains the gold standard for the definitive diagnosis of FBs.

Purpose: To assess the feasibility and short-term efficacy of maintenance enzalutamide following first-line docetaxel plus androgen deprivation therapy (ADT) in patients with high-volume, metastatic castration-naive prostate cancer (mCNPC). Materials and Methods: The present study included 38 consecutive patients with mCNPC who did not have disease progression with ADT plus docetaxel between October 2022 and October 2023. Patients received a switch maintenance therapy with enzalutamide until progression, unacceptable toxicity, or patient withdrawal. Endpoints included time to prostate-specific antigen (PSA) progression and safety. Results: Among the 38 patients, the median age was 68 years, and the most frequently observed metastatic site was bone (n=36), followed by lymph nodes (n=28), lung (n=8), and liver (n=1). The median duration of firstline docetaxel was 2.8 months (range, 2.7–5.0 months). At the time of commencing maintenance enzalutamide, the median PSA was 3.2 ng/mL (range, 0.01–258 ng/mL). Maintenance enzalutamide was generally welltolerated. A total of 11 patients (28%) discontinued enzalutamide, and the main reasons included adverse events (prolonged fatigue of grade 1 or 2, n=6), disease progression (n=3) and financial burdens (n=2). Median time to PSA progression was not reached, and 93% were PSA progression-free at 12 months. Conclusions Maintenance enzalutamide is a feasible treatment option with potential clinical benefit for patients with high-volume mCNPC who were progression-free after first-line ADT+docetaxel.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Background: In patients with metastatic renal cell carcinoma (mRCC), sites of metastatic involvement have been reported to be associated with a difference in survival. However, the frequency and survival according to different sites of metastases in Korean patients with mRCC remain unclear. Therefore, this study aimed to assess the frequency of metastatic site involvement and the association between sites of metastatic involvement and survival in Korean patients with mRCC. Methods: This retrospective study used the multicenter cohort of the Korean Renal Cancer Study Group mRCC database to identify patients who started targeted therapy between December 2005 and March 2018. Data on the frequency of metastatic organ involvement at the time of mRCC diagnosis and oncologic outcomes according to different sites of metastasis were analyzed. Results: A total of 1,761 patients were eligible for analysis. Of the 1,761 patients, 1,564 (88.8%) had clear cell RCC, and 1,040 (59.1%) had synchronous metastasis. The median number of metastasis sites was 2 (interquartile range [IQR], 1–6). The median age at the initiation of systemic therapy was 60 years (IQR, 29–88), 1,380 (78.4%) were men, and 1,341 (76.1%) underwent nephrectomy. Based on the International Metastatic Renal Cell Carcinoma Database Consortium model, patients were stratified into favorable-, intermediate-, and poor-risk groups with 359 (20.4%), 1,092 (62.0%), and 310 (17.6%) patients, respectively. The lung (70.9%), lymph nodes (37.9%), bone (30.7%), liver (12.7%), adrenal gland (9.8%), and brain (8.2%) were the most common sites of metastasis, followed by the pancreas, pleura, peritoneum, spleen, thyroid, and bowel. Among the most common sites of metastasis (> 5%), the median cancer-specific survival (CSS) ranged from 13.9 (liver) to 29.1 months (lung). An association was observed between liver, bone, and pleural metastases and the shortest median CSS (< 19 months). Conclusion In Korean patients with mRCC, metastases to the lung, lymph nodes, bone, liver, adrenal gland, and brain were more frequent than those to other organs. Metastases to the liver, bone, and pleura were associated with poor CSS. The findings of this study may be valuable for patient counseling and guiding future study designs.

Background: In patients with metastatic renal cell carcinoma (mRCC), sites of metastatic involvement have been reported to be associated with a difference in survival. However, the frequency and survival according to different sites of metastases in Korean patients with mRCC remain unclear. Therefore, this study aimed to assess the frequency of metastatic site involvement and the association between sites of metastatic involvement and survival in Korean patients with mRCC. Methods: This retrospective study used the multicenter cohort of the Korean Renal Cancer Study Group mRCC database to identify patients who started targeted therapy between December 2005 and March 2018. Data on the frequency of metastatic organ involvement at the time of mRCC diagnosis and oncologic outcomes according to different sites of metastasis were analyzed. Results: A total of 1,761 patients were eligible for analysis. Of the 1,761 patients, 1,564 (88.8%) had clear cell RCC, and 1,040 (59.1%) had synchronous metastasis. The median number of metastasis sites was 2 (interquartile range [IQR], 1–6). The median age at the initiation of systemic therapy was 60 years (IQR, 29–88), 1,380 (78.4%) were men, and 1,341 (76.1%) underwent nephrectomy. Based on the International Metastatic Renal Cell Carcinoma Database Consortium model, patients were stratified into favorable-, intermediate-, and poor-risk groups with 359 (20.4%), 1,092 (62.0%), and 310 (17.6%) patients, respectively. The lung (70.9%), lymph nodes (37.9%), bone (30.7%), liver (12.7%), adrenal gland (9.8%), and brain (8.2%) were the most common sites of metastasis, followed by the pancreas, pleura, peritoneum, spleen, thyroid, and bowel. Among the most common sites of metastasis (> 5%), the median cancer-specific survival (CSS) ranged from 13.9 (liver) to 29.1 months (lung). An association was observed between liver, bone, and pleural metastases and the shortest median CSS (< 19 months). Conclusion In Korean patients with mRCC, metastases to the lung, lymph nodes, bone, liver, adrenal gland, and brain were more frequent than those to other organs. Metastases to the liver, bone, and pleura were associated with poor CSS. The findings of this study may be valuable for patient counseling and guiding future study designs.