Objective: Increased fast food consumption can have adverse effects on health and well-being among adolescents, posing a significant public health concern. The school closures due to the coronavirus disease-2019 (COVID-19) pandemic have led to changes in eating patterns and disrupted a balance diet among adolescents. This study explored the factors associated with fast food consumption among adolescents during school closures due to the COVID-19 pandemic. Methods: A total of 1,710 middle and high school students in Gwangju, South Korea participated in a cross-sectional survey. The self-administered questionnaire included items assessing dietary intake, physical activity, sleep, media use, and sociodemographic information. The Patient Health Questonnaire-9, Generalized Anxiety Disorder-7, and three item version of the UCLA Loneliness Scale were also administered. Multivariable logistic regression was used to examine the factors associated with increased fast food consumption. Results: Approximately 34.6% of the surveyed adolescents reported increased fast food consumption during school closures, as well as increased sleep duration, increased sedentary behaviors including watching TV and using the internet, and reduced physical activity. Multivariable logistic regression analysis revealed that fast food consumption during school closures was associated with irregular patterns of main meals and sleep, decreased physical activity, increased internet use, and a lack of daytime adult supervision. Conclusion Our results highlight the need for dietary and lifestyle monitoring and guidelines to promote health among adolescents, especially during school closures. In conclusion, nutrition intervention programs aiming to limit fast food consumption and enhance healthy dietary habits among adolescents during long-term school closures are warranted.

Purpose: The modified Bröstrom operation (MBO) is a prominent surgical treatment for patients with chronic lateral ankle instability. This study examined the improvement of functional instability by quantitatively assessing the changes in postural control using pedobarography after MBO and proprioceptive exercises. Materials and Methods: This study was conducted on 38 patients who underwent MBO for chronic lateral ankle instability from May 2015 to December 2021. The mechanical instability was evaluated pre- and post-operatively using the Manual-Anterior Drawer Test, and the clinical outcomes were assessed using the AOFAS-AHFS (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale).Pedobarography was used to evaluate postural control measuring foot pressure center variables, specifically the envelope area (ENV) of the pressure center trajectory and the sway velocity (SV) of the pressure center movement. The improvement of postural balance ability was evaluated according to age by classifying the participants into young adult and middle-aged adult groups based on a threshold of 40 years.They were further analyzed by dividing into groups according to sex. Results: The AOFAS-AHFS and Manual-Anterior Drawer Test improved significantly when the pre-surgery and post-surgery final followup assessments were compared (69.2 to 86.3, p<0.001; 2.3 to 0.2, p<0.001; respectively). When comparing pre-surgery and post-surgery final follow-up assessments with the eyes open, the ENV of the pressure center trajectory and SV significantly decreased (108.0 to 66.3, p=0.010; 23.0 to 18.8, p=0.030; respectively). When classified according to age, patients under 40 years showed a significant decrease in SV when measured with the eyes open post-surgery (20.5 to 18.0, p=0.030), while patients over 40 years showed a significant decrease in both ENV and SV when measured with eyes open post-surgery (149.7 to 84.7, p<0.01; 37.7 to 20.9, p=0.020; respectively). The male and female groups showed a significant decrease in SV when measured with the eyes open post-surgery (21.0 to 18.7 and p<0.01 vs. 25.5 to 18.9 and p=0.020, respectively). Conclusion The postural control changes were quantitatively evaluated using pedobarography after MBO and proprioceptive exercises, showing that the functional ankle instability improved regardless of age or sex.

Purpose: The modified Bröstrom operation (MBO) is a prominent surgical treatment for patients with chronic lateral ankle instability. This study examined the improvement of functional instability by quantitatively assessing the changes in postural control using pedobarography after MBO and proprioceptive exercises. Materials and Methods: This study was conducted on 38 patients who underwent MBO for chronic lateral ankle instability from May 2015 to December 2021. The mechanical instability was evaluated pre- and post-operatively using the Manual-Anterior Drawer Test, and the clinical outcomes were assessed using the AOFAS-AHFS (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale).Pedobarography was used to evaluate postural control measuring foot pressure center variables, specifically the envelope area (ENV) of the pressure center trajectory and the sway velocity (SV) of the pressure center movement. The improvement of postural balance ability was evaluated according to age by classifying the participants into young adult and middle-aged adult groups based on a threshold of 40 years.They were further analyzed by dividing into groups according to sex. Results: The AOFAS-AHFS and Manual-Anterior Drawer Test improved significantly when the pre-surgery and post-surgery final followup assessments were compared (69.2 to 86.3, p<0.001; 2.3 to 0.2, p<0.001; respectively). When comparing pre-surgery and post-surgery final follow-up assessments with the eyes open, the ENV of the pressure center trajectory and SV significantly decreased (108.0 to 66.3, p=0.010; 23.0 to 18.8, p=0.030; respectively). When classified according to age, patients under 40 years showed a significant decrease in SV when measured with the eyes open post-surgery (20.5 to 18.0, p=0.030), while patients over 40 years showed a significant decrease in both ENV and SV when measured with eyes open post-surgery (149.7 to 84.7, p<0.01; 37.7 to 20.9, p=0.020; respectively). The male and female groups showed a significant decrease in SV when measured with the eyes open post-surgery (21.0 to 18.7 and p<0.01 vs. 25.5 to 18.9 and p=0.020, respectively). Conclusion The postural control changes were quantitatively evaluated using pedobarography after MBO and proprioceptive exercises, showing that the functional ankle instability improved regardless of age or sex.

Purpose: The modified Bröstrom operation (MBO) is a prominent surgical treatment for patients with chronic lateral ankle instability. This study examined the improvement of functional instability by quantitatively assessing the changes in postural control using pedobarography after MBO and proprioceptive exercises. Materials and Methods: This study was conducted on 38 patients who underwent MBO for chronic lateral ankle instability from May 2015 to December 2021. The mechanical instability was evaluated pre- and post-operatively using the Manual-Anterior Drawer Test, and the clinical outcomes were assessed using the AOFAS-AHFS (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale).Pedobarography was used to evaluate postural control measuring foot pressure center variables, specifically the envelope area (ENV) of the pressure center trajectory and the sway velocity (SV) of the pressure center movement. The improvement of postural balance ability was evaluated according to age by classifying the participants into young adult and middle-aged adult groups based on a threshold of 40 years.They were further analyzed by dividing into groups according to sex. Results: The AOFAS-AHFS and Manual-Anterior Drawer Test improved significantly when the pre-surgery and post-surgery final followup assessments were compared (69.2 to 86.3, p<0.001; 2.3 to 0.2, p<0.001; respectively). When comparing pre-surgery and post-surgery final follow-up assessments with the eyes open, the ENV of the pressure center trajectory and SV significantly decreased (108.0 to 66.3, p=0.010; 23.0 to 18.8, p=0.030; respectively). When classified according to age, patients under 40 years showed a significant decrease in SV when measured with the eyes open post-surgery (20.5 to 18.0, p=0.030), while patients over 40 years showed a significant decrease in both ENV and SV when measured with eyes open post-surgery (149.7 to 84.7, p<0.01; 37.7 to 20.9, p=0.020; respectively). The male and female groups showed a significant decrease in SV when measured with the eyes open post-surgery (21.0 to 18.7 and p<0.01 vs. 25.5 to 18.9 and p=0.020, respectively). Conclusion The postural control changes were quantitatively evaluated using pedobarography after MBO and proprioceptive exercises, showing that the functional ankle instability improved regardless of age or sex.

Purpose: This subgroup analysis of the Korean subset of patients in the phase 3 LASER301 trial evaluated the efficacy and safety of lazertinib versus gefitinib as first-line therapy for epidermal growth factor receptor mutated (EGFRm) non–small cell lung cancer (NSCLC). Materials and Methods: Patients with locally advanced or metastatic EGFRm NSCLC were randomized 1:1 to lazertinib (240 mg/day) or gefitinib (250 mg/day). The primary endpoint was investigator-assessed progression-free survival (PFS). Results: In total, 172 Korean patients were enrolled (lazertinib, n=87; gefitinib, n=85). Baseline characteristics were balanced between the treatment groups. One-third of patients had brain metastases (BM) at baseline. Median PFS was 20.8 months (95% confidence interval [CI], 16.7 to 26.1) for lazertinib and 9.6 months (95% CI, 8.2 to 12.3) for gefitinib (hazard ratio [HR], 0.41; 95% CI, 0.28 to 0.60). This was supported by PFS analysis based on blinded independent central review. Significant PFS benefit with lazertinib was consistently observed across predefined subgroups, including patients with BM (HR, 0.28; 95% CI, 0.15 to 0.53) and those with L858R mutations (HR, 0.36; 95% CI, 0.20 to 0.63). Lazertinib safety data were consistent with its previously reported safety profile. Common adverse events (AEs) in both groups included rash, pruritus, and diarrhoea. Numerically fewer severe AEs and severe treatment–related AEs occurred with lazertinib than gefitinib. Conclusion Consistent with results for the overall LASER301 population, this analysis showed significant PFS benefit with lazertinib versus gefitinib with comparable safety in Korean patients with untreated EGFRm NSCLC, supporting lazertinib as a new potential treatment option for this patient population.

Purpose: Notable effectiveness of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 (HER2)–low advanced breast cancer (BC) has focused pathologists’ attention. We studied the incidence and clinicopathologic characteristics of HER2-low BC, and the effects of immunohistochemistry (IHC) associated factors on HER2 IHC results. Materials and Methods: The Breast Pathology Study Group of the Korean Society of Pathologists conducted a nationwide study using real-world data on HER2 status generated between January 2022 and December 2022. Information on HER2 IHC protocols at each participating institution was also collected. Results: Total 11,416 patients from 25 institutions included in this study. Of these patients, 40.7% (range, 6.0% to 76.3%) were classified as HER2-zero, 41.7% (range, 10.5% to 69.1%) as HER2-low, and 17.5% (range, 6.7% to 34.0%) as HER2-positive. HER2-low tumors were associated with positive estrogen receptor and progesterone receptor statuses (p < 0.001 and p < 0.001, respectively). Antigen retrieval times (≥ 36 minutes vs. < 36 minutes) and antibody incubation times (≥ 12 minutes vs. < 12 minutes) affected on the frequency of HER2 IHC 1+ BC at institutions using the PATHWAY HER2 (4B5) IHC assay and BenchMark XT or Ultra staining instruments. Furthermore, discordant results between core needle biopsy and subsequent resection specimen HER2 statuses were observed in 24.1% (787/3,259) of the patients. Conclusion The overall incidence of HER2-low BC in South Korea concurs with those reported in previously published studies. Significant inter-institutional differences in HER2 IHC protocols were observed, and it may have impact on HER2-low status. Thus, we recommend standardizing HER2 IHC conditions to ensure precise patient selection for targeted therapy.

Purpose: The original eCura system was designed to stratify the risk of lymph node metastasis (LNM) after endoscopic resection (ER) in patients with early gastric cancer (EGC).We assessed the effectiveness of a modified eCura system for reflecting the characteristics of undifferentiated-type (UD)-EGC. Materials and Methods: Six hundred thirty-four patients who underwent non-curative ER for UD-EGC and received either additional surgery (radical surgery group; n=270) or no further treatment (no additional treatment group; n=364) from 18 institutions between 2005 and 2015 were retrospectively included in this study. The eCuraU system assigned 1 point each for tumors >20 mm in size, ulceration, positive vertical margin, and submucosal invasion <500 µm; 2 points for submucosal invasion ≥500 µm; and 3 points for lymphovascular invasion. Results: LNM rates in the radical surgery group were 1.1%, 5.4%, and 13.3% for the low-(0–1 point), intermediate- (2–3 points), and high-risk (4–8 points), respectively (P-fortrend<0.001). The eCuraU system showed a significantly higher probability of identifying patients with LNM as high-risk than the eCura system (66.7% vs. 22.2%; McNemar P<0.001).In the no additional treatment group, overall survival (93.4%, 87.2%, and 67.6% at 5 years) and cancer-specific survival (99.6%, 98.9%, and 92.9% at 5 years) differed significantly among the low-, intermediate-, and high-risk categories, respectively (both P<0.001). In the high-risk category, surgery outperformed no treatment in terms of overall mortality (hazard ratio, 3.26; P=0.015). Conclusions The eCuraU system stratified the risk of LNM in patients with UD-EGC after ER. It is strongly recommended that high-risk patients undergo additional surgery.

Objectives: This study aimed to investigate factors associated with depression among elderly living alone and those living with a spouse in an urban area. Methods: This study was a community-based, cross-sectional study that included 384 elderly aged 60 years or older.The subjects completed a questionnaire that covered sociodemographic characteristics and chronic medical illnesses.The Korean version of the Short Form of the Geriatric Depression Scale, the Korean version of the Quality of Life-Alzheimer’s Disease (KQOL-AD), and the Korean Mini Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet were also performed. Results: The participants were divided into two groups: 137 elderly individuals living alone and 247 elderly individuals living with a spouse. Heart disease (odds ratio [OR]=13.099, 95% confidence interval [CI]=1.892-90.697, p=0.009) was identified as a risk factor for depression, while the religion (OR=0.137, 95% CI=0.028-0.668, p=0.014) was found to be a protective factor against depression among elderly individuals living alone. Higher scores on the KQOL-AD scale were found to be protective factors against depression for both elderly individuals living alone (OR=0.742, 95% CI= 0.636-0.867, p<0.001) and those living with a spouse (OR=0.664, 95% CI=0.573-0.771, p<0.001). Conclusions Among elderly living alone in an urban area, heart disease, religion, and the quality of life appear to have an impact on depression. To reduce the risk of depression in the elderly, it is necessary to properly manage heart disease, encourage religious participation, and enhance the quality of life.

Background: The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods: We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease. Results: During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups. Conclusion This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.

Background/Aims: The eCura system, a scoring model for stratifying the lymph node metastasis risk after noncurative endoscopic resection for early gastric cancer (EGC), has been internally validated, primarily for differentiated-type EGC. We aimed to externally validate this model for undifferentiated-type EGC. Methods: This multicenter, retrospective cohort study included 634 patients who underwent additional surgery (radical surgery group, n=270) or were followed up without additional treatment (no additional treatment group, n=364) after noncurative endoscopic resection for undifferentiated-type EGC between 2005 and 2015. The lymph node metastasis and survival rates were compared according to the risk categories. Results: For the radical surgery group, the lymph node metastasis rates were 2.6%, 10.9%, and 14.8% for the low-, intermediate-, and high-risk eCura categories, respectively (p for trend=0.003). For the low-, intermediate-, and high-risk categories in the no additional treatment group, the overall survival (92.7%, 68.9%, and 80.0% at 5 years, respectively, p<0.001) and cancer-specific survival rates (99.7%, 94.7%, and 80.0% at 5 years, respectively, p<0.001) differed significantly. In the multivariate analysis, the hazard ratios (95% confidence interval) in the no additional treatment group relative to the radical surgery group were 3.18 (1.41 to 7.17; p=0.005) for overall mortality and 2.60 (0.46 to 14.66; p=0.280) for cancer-specific mortality in the intermediate-tohigh risk category. No such differences were noted in the low-risk category. Conclusions The eCura system can be applied to undifferentiated-type EGC. Close follow-up without additional treatment might be considered for low-risk patients, while additional surgery is recommended for intermediate- and high-risk patients.