Objective: Tacrolimus intrapatient variability (Tac IPV) has been considered a marker for post-graft risk. We investigated pre-transplant psychometric testing to predict Tac IPV after living kidney transplantation. Methods: Minnesota Multiphasic Personality Inventory-2 (MMPI-2) examined during pre-transplant evaluation by 102 recipients were analyzed. Subjects were divided into two groups, low IPV (L-IPV) and high IPV (H-IPV), by cutoffs of Tac IPV: median of 24 and value of 30. T-scores of MMPI-2 scales were used to analyze difference between L-IPV and H-IPV using independent t-tests. Stepwise multiple logistic regression was used to test whether MMPI-2 scales affected Tac IPV. Confusion matrix of logistic regression was used to explain statistical power. Cutoff values of significant scales for H-IPV were analyzed by constructing receiver operating characteristic curves. Results: Hysteria (Hy) and depression (D) scale scores and Tac IPV were associated in IPV 24 (odds ratio [OR]: 1.08, p<0.01 for Hy; OR: 0.93, p<0.01 for D) and IPV 30 models (OR: 1.09, p<0.01 for Hy; OR: 0.92, p<0.01 for D). Paranoia (Pa) scale scores were associated with Tac IPV in IPV 24 model (OR=1.10, p<0.01) and were significantly higher in H-IPV 24 (p<0.01). F1 scores of confusion matrix in IPV 24 and 30 models were 0.70 and 0.71, respectively. Cutoffs of Hy, D, and Pa scales were 51, 57, and 47, respectively. Conclusion MMPI-2 profile is suggested as a predictor for high Tac IPV after living kidney transplantation.

This article provides an annual update of Korean breast cancer statistics, including the incidence, tumor stage, type of surgical treatment, and mortality. The data was collected from the Korean Breast Cancer Society registry system and Korean Central Cancer Registry.In 2019, 29,729 women were newly diagnosed with breast cancer. Breast cancer has continued to increase in incidence since 2002 and been the most common cancer in Korean women since 2019. Of the newly diagnosed cases in 2019, 24,820 (83.5%) were of invasive carcinomas, and 4,909 (16.5%) were of carcinoma in situ. The median age of women with breast cancer was 52.8 years, and breast cancer was most commonly diagnosed in the age group of 40–49 years. The number of patients who have undergone breast conserving surgery has continued to increase since 2016, with 68.6% of patients undergoing breast conserving surgery in 2019. The incidence of early-stage breast cancer continues to increase, with stage 0 or I breast cancer accounting for 61.6% of cases. The most common subtype of breast cancer is the hormone receptor-positive human epidermal growth factor receptor 2-negative subtype (63.1%). The 5-year relative survival rate of patients with breast cancer from 2015 to 2019 was 93.6%, with an increase of 14.3% compared to that from 1993 to 1995. This report improves our understanding of breast cancer characteristics in South Korea.

Objectives: ：Cancer diagnosis causes significant distress while it may also bring positive change: post-traumatic growth. This study was conducted to analyze factors that affect post-traumatic growth. Methods: ：Medical records of 52 cancer patients who received psychiatric treatment at a university hospital in Seoul were reviewed and the correlation between post-traumatic growth and following factors were analyzed: Resilience, Anxious thoughts and tendencies, Mindful attention awareness, Acceptance attitude Results: ：Using Multiple Generalized Linear model, a positive correlation was found between post-traumatic growth and resilience (B=1.45, p<0.0001), mindful attention awareness (B=0.58, p=0.0030) and acceptance attitude (B=1.29, p=0.0003), while anxious thoughts and tendencies (B=-0.84, p<0.0001) had negative association. Conclusions ：Factors that have a positive impact on post-traumatic growth were resilience, mindful attention awareness, acceptance attitude and a factor with a negative impact was anxious thoughts and tendencies; Factors that impact post-traumatic growth need to be taken into account, when approaching the treatment of cancer patients.

In Korea, the dependence on living donations is high due to the shortage of organs available for donation compared to the number of people waiting for transplants and the number of living organ donations continues to increase. In particular, the number of living-donor transplantations is high worldwide, highlighting the importance of pre-transplant psychosocial evaluation of living kidney donors. According to previous studies, when evaluating living organ donors before transplantation, it is crucial to determine whether the donor can give informed consent and be aware of the risks after surgery. Pre-transplant evaluation tests such as ELPAT living organ donor Psychological Assessment Tool (EPAT), Live Donor Assessment Tool (LDAT), Living Donation Expectancies Questionnaire (LDEQ), Minnesota Multiphasic Personality Inventory-2 questionnaire (MMPI-2) and Temperament and Character Inventory (TCI) are conducted for donors. After reviewing the literature on these pre-transplant psychosocial assessment tools, we will also look at legal considerations for living kidney donors in Korea and suggest an effective and essential pre-transplant screening evaluation method for living kidney transplant donors.

Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. Materials and Methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery. Results: The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. Conclusion C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.

Objectives: Sleep is fundamental to maintaining homeostatic control and has behavioral and psychological effects on humans. To better understand the function and pathophysiology of sleep, specific gene expressions in reference to sleep deprivation have been studied. In this study, we investigated the gene expression of peripheral blood mononuclear cells after sleep deprivation to better understand the functional consequence of sleep. Methods: In eight healthy men, 24 h sleep deprivation was induced. Blood was sampled at 14:00, before and after sleep deprivation.mRNA was isolated and analyzed via microarrays. cDNAs before and after sleep deprivation were coupled to Cy3 or Cy5, respectively, and normalized cDNAs were selected with a ratio greater than two as a significant gene. Results are expressed as mean. Results: Among 41174 transcripts, 38852 genes were selected as reliable, and only a small minority (< 1%) of the genes were up-or down-regulated. Total six and eleven genes were selected as significant upregulated and downregulated genes, respectively. Protein tyrosine phosphatase receptor type O was most upregulated (6.9-fold), and low-density lipoprotein receptor-related protein 5-like protein showed the most substantial inhibition (0.06-fold). Conclusions This study showed significant associations between sleep deprivation and the immune system. Acute sleep deprivation affects pathways in proinflammatory cytokines as well as metabolic pathways of glutamate and purine, neurotransmitters related to sleep and wake cycle.

Patients with lumbar spinal stenosis (LSS) may experience neuropathic symptoms, such as back pain, radiating pain, and neurogenic claudication. Although the long-term outcomes of both nonsurgical and surgical treatments are similar, surgery may provide shortterm benefits, including improved symptoms and lower risk of falling. Decompression is mainly used for surgical treatment, and depending on the decompression degree and associated instability, combination therapy may be given. Minimally invasive surgery has been demonstrated to produce excellent results in the treatment of LSS. Thus, an approach aimed at understanding the overall pathophysiology and treatment methods of LSS is expected to have a better therapeutic effect.

Objective: The effectiveness of music therapy programs for the elderly with dementia has been verified through several studies, but there is a limitation in that most of them are compared with a single group, no treatment group or waiting group. In this study, to overcome this problem, the two groups that performed similar interventions were selected and compared retrospectively. Methods: For 37 people who participated in the treatment programs for the elderly with dementia at Dongdaemun Center for De-mentia and its branch center, we retrospectively analyzed the changes in Korean version of Geriatric Depression Scale and GeriatricQuality of Life Scale-Dementia scores measured before and after treatment. Results: Prior to treatment, there is no significant difference between the groups in the demographic variables and the depression and quality of life scores. The difference between pre- and post-scores was not significant in the group at the branch center without a music therapy, but depression was significantly reduced and quality of life had improved in the group at Dongdaemun center with the music therapy program. Conclusion It was confirmed that participation in the structured music therapy program had a positive effect on the improve-ment of depression and quality of life in the elderly with dementia compared to other similar interventions.

Objective: The effectiveness of music therapy programs for the elderly with dementia has been verified through several studies, but there is a limitation in that most of them are compared with a single group, no treatment group or waiting group. In this study, to overcome this problem, the two groups that performed similar interventions were selected and compared retrospectively. Methods: For 37 people who participated in the treatment programs for the elderly with dementia at Dongdaemun Center for De-mentia and its branch center, we retrospectively analyzed the changes in Korean version of Geriatric Depression Scale and GeriatricQuality of Life Scale-Dementia scores measured before and after treatment. Results: Prior to treatment, there is no significant difference between the groups in the demographic variables and the depression and quality of life scores. The difference between pre- and post-scores was not significant in the group at the branch center without a music therapy, but depression was significantly reduced and quality of life had improved in the group at Dongdaemun center with the music therapy program. Conclusion It was confirmed that participation in the structured music therapy program had a positive effect on the improve-ment of depression and quality of life in the elderly with dementia compared to other similar interventions.

Objective: Muscle quantity and quality can be measured with an automated system on CT. However, the effects of contrast phases on the muscle measurements have not been established, which we aimed to investigate in this study. Materials and Methods: Muscle quantity was measured according to the skeletal muscle area (SMA) measured by a convolutional neural network-based automated system at the L3 level in 89 subjects undergoing multiphasic abdominal CT comprising unenhanced phase, arterial phase, portal venous phase (PVP), or delayed phase imaging. Muscle quality was analyzed using the mean muscle density and the muscle quality map, which comprises normal and low-attenuation muscle areas (NAMA and LAMA, respectively) based on the muscle attenuation threshold. The SMA, mean muscle density, NAMA, and LAMA were compared between PVP and other phases using paired t tests. Bland-Altman analysis was used to evaluate the inter-phase variability between PVP and other phases. Based on the cutoffs for low muscle quantity and quality, the counts of individuals who scored lower than the cutoff values were compared between PVP and other phases. Results: All indices showed significant differences between PVP and other phases (p < 0.001 for all). The SMA, mean muscle density, and NAMA increased during the later phases, whereas LAMA decreased during the later phases. Bland-Altman analysis showed that the mean differences between PVP and other phases ranged -2.1 to 0.3 cm2 for SMA, -12.0 to 2.6 cm2 for NAMA, and -2.2 to 9.9 cm2 for LAMA.The number of patients who were categorized as low muscle quantity did not significant differ between PVP and other phases (p ≥ 0.5), whereas the number of patients with low muscle quality significantly differed (p ≤ 0.002). Conclusion SMA was less affected by the contrast phases. However, the muscle quality measurements changed with the contrast phases to greater extents and would require a standardization of the contrast phase for reliable measurement.