Purpose: Optimal treatment for stage IIIA/N2 non–small cell lung cancer (NSCLC) is controversial. We aimed to assess the efficacy and safety of adjuvant pembrolizumab for stage IIIA/N2 NSCLC completely resected after neoadjuvant concurrent chemoradiation therapy (CCRT). Materials and Methods: In this open-label, single-center, single-arm phase 2 trial, patients with stage IIIA/N2 NSCLC received adjuvant pembrolizumab for up to 2 years after complete resection following neoadjuvant CCRT. The primary endpoint was disease-free survival (DFS). Secondary endpoints included overall survival (OS) and safety. As an exploratory biomarker analysis, we evaluated the proliferative response of blood CD39+PD-1+CD8+ T cells using fold changes in the percentage of proliferating Ki-67+ cells from days 1 to 7 of cycle 1 (Ki-67D7/D1). Results: Between October 2017 and October 2018, 37 patients were enrolled. Twelve (32%) and three (8%) patients harbored EGFR and ALK alterations, respectively. Of 34 patients with programmed cell death ligand 1 assessment, 21 (62%), nine (26%), and four (12%) had a tumor proportion score of < 1%, 1%-50%, and ≥ 50%, respectively. The median follow-up was 71 months. The median DFS was 22.4 months in the overall population, with a 5-year DFS rate of 29%. The OS rate was 86% at 2 years and 76% at 5 years. Patients with tumor recurrence within 6 months had a significantly lower Ki-67D7/D1 among CD39+PD-1+CD8+ T cells than those without (p=0.036). No new safety signals were identified. Conclusion Adjuvant pembrolizumab may offer durable disease control in a subset of stage IIIA/N2 NSCLC patients after neoadjuvant CCRT and surgery.

Traditionally, pathologists microscopically examine tissue sections to detect pathological lesions; the many slides that must be evaluated impose severe work burdens. Also, diagnostic accuracy varies by pathologist training and experience; better diagnostic tools are required. Given the rapid development of computer vision, automated deep learning is now used to classify microscopic images, including medical images. Here, we used a Inception-v3 deep learning model to detect mouse lung metastatic tumors via whole slide imaging (WSI); we cropped the images to 151 by 151 pixels. The images were divided into training (53.8%) and test (46.2%) sets (21,017 and 18,016 images, respectively). When images from lung tissue containing tumor tissues were evaluated, the model accuracy was 98.76%. When images from normal lung tissue were evaluated, the model accuracy (“no tumor”) was 99.87%. Thus, the deep learning model distinguished metastatic lesions from normal lung tissue. Our approach will allow the rapid and accurate analysis of various tissues.

At an intensive care unit, four neonates died consecutively within 80 minutes. Citrobacter freundii was isolated from blood samples of the 4 patients. It was also cultured from the leftover SMOFlipid that had been infused intravenously into the patients. In this in vitro study, we evaluated the bacterial growth kinetics and change in size of fat globules in SMOFlipid contaminated with C. freundii. Following the growth of bacteria, pH of SMOFlipid decreased to < 6, and the number of fat globules larger than 5 µm increased. Pulmonary fat embolism is proposed as a possible cause of the sudden deaths as well as fulminant sepsis.
Bacteria ; Citrobacter freundii* ; Citrobacter* ; Death, Sudden* ; Embolism, Fat ; Fat Emulsions, Intravenous ; Humans ; Hydrogen-Ion Concentration ; In Vitro Techniques ; Infant, Newborn* ; Infusions, Intravenous* ; Intensive Care Units ; Kinetics ; Sepsis

In Republic of Korea, a 7-valent pneumococcal conjugated vaccine (PCV7) was licensed for use in infants in 2003, and 13-valent PCV (PCV13) replaced it since 2010. We investigated trends in serotype distribution and antibiotic susceptibility of pneumococcal isolates from adult patients with invasive pneumococcal diseases (IPD). Invasive pneumococcal isolates from adult patients of ≥ 16 years of age were collected from 1997 to 2012. Serotypes of the isolates were determined by the Quellung reaction. Distribution of serotypes was analyzed according to the vaccine types. Antibiotic susceptibility was tested by using E-test strips. A total of 272 invasive pneumococcal isolates were included. The most common serotypes were serotype 19F (8.5%, 23/272), and serotype 3 (8.1%, 22/272), and 24.6% (67/272) of the isolates were of non-vaccine serotypes. Of the 272 isolates, 2.6% (7/272) were penicillin MICs of ≥ 4 µg/mL. The proportion of the PCV13 serotypes decreased from 63.3% (50/79) in 1997-2003 to 48.6% (17/35) in 2011-2012, whereas that of non-vaccine serotypes was 26.6% (21/79) and 25.7% (9/35), respectively, for the same periods. The proportion of the PCV13 serotypes showed a decreasing trend among adult patients with IPD over the study period.
Adolescent ; Adult ; Aged ; Anti-Infective Agents/*pharmacology/therapeutic use ; Ceftriaxone/pharmacology/therapeutic use ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Penicillins/pharmacology/therapeutic use ; Pneumococcal Infections/drug therapy/*microbiology/mortality ; Republic of Korea ; Serogroup ; Serotyping ; Streptococcus pneumoniae/*drug effects/isolation & purification ; Young Adult

PURPOSE: To study the safety and efficacy of corneal reshaping and small-aperture inlays and compare the clinical results. METHODS: From February 2014 to November 2014, 22 corneal reshaping inlays were inserted at Asan Medical Center and from October 2012 to March 2013, 26 small-aperture inlay surgeries were performed: 6 eyes at Asan Medical Center and 20 eyes at Samsung Medical Center. The preoperative and postoperative parameters were reviewed retrospectively and included monocular uncorrected distance visual acuity (UDVA; log MAR), uncorrected near visual acuity (UNVA; log MAR), refraction and corneal curvature based on automated refractor keratometry, reading distance and patient satisfaction. RESULTS: In the hydrogel inlay group, preoperative mean monocular UNVA was 0.83 +/- 0.05 and monocular UDVA 0.07 +/- 0.03. At 6 months, mean monocular UNVA was 0.23 +/- 0.05 and UDVA 0.05 +/- 0.02. The most preferred mean reading distance in the hydrogel inlay group was 39.38 +/- 3.18 cm. In the small-aperture inlay group, preoperative mean monocular UNVA was 0.4 +/- 0.06 and monocular uncorrected visual acuity 0.27 +/- 0.04. At 6 months, mean monocular UNVA was 0.11 +/- 0.02 and UDVA 0.09 +/- 0.05 and the most preferred mean reading distance was 44.23 +/- 5.17 cm. Although 85% of patients in the corneal reshaping inlay group were satisfied or very satisfied, only 20% of patients in the small-aperture inlay group were satisfied. CONCLUSIONS: Both inlays are considered good options for correcting presbyopia. However, postoperative satisfaction score was higher and less glare symptoms were reported in the hydrogel inlay group.
Chungcheongnam-do ; Follow-Up Studies* ; Glare ; Humans ; Hydrogel* ; Inlays* ; Patient Satisfaction ; Presbyopia* ; Retrospective Studies ; Visual Acuity

Parricide, the crime of murdering a parent, accounts for about 5% of all homicides. Filicide is the crime of murdering one's own child. This study aimed to review demographic features and criminal characteristics of individuals who committed parricide and filicide in Republic of Korea (ROK). This study is based on data from the Korea Police Crime Analysis System, from 2006~2013. We assessed the diverse characteristics of both victims and perpetrators. Over the selected period, 381 parents were killed by their children and 230 children were killed by parents in the ROK. Parricides caused by schizophrenic murders accounted for 39.6% of all cases. Moreover, approximately 44.4% of the perpetrators attempted suicide following the maternal filicide. In our findings, psychiatric illness was a very important predictor in parricide, and these further suggest that young mothers with severe mental illness require careful monitoring by mental health support service.
Child ; Crime ; Criminals ; Homicide ; Humans ; Korea ; Mental Health ; Mothers ; Parents ; Police ; Republic of Korea ; Schizophrenia ; Suicide, Attempted

BACKGROUND: The aim of this study was to evaluate antibiotic consumption by adult patients at a single university hospital in Korea between 2001 and 2012. METHODS: We used the 2004 World Health Organization Anatomical Therapeutic Chemical Classification System definition of defined daily doses (DDD) per 1,000 patient-days to calculate the annual antibiotic consumption for 18 antibiotic groups. Chi-square linear-by-linear analysis was performed to evaluate antibiotic consumption trends for each group. RESULTS: Average annual antibiotic consumption during 2001-2012 was 644.6 DDD/1,000 patient-days (standard deviation, 33.3 DDD/1,000 patient-days). Although no statistically significant change was observed during the study period, consumption of first- and second-generation cephalosporins, and aminoglycosides was significantly decreased, while that of beta-lactam/beta-lactamase inhibitors, fourth-generation cephalosporins, carbapenem, glycopeptide, linezolid, colistin, and quinolone increased significantly. CONCLUSION: The total amount of prescribed antibiotics did not change, but the use of broad-spectrum antibiotics increased during the study period.
Adult ; Aminoglycosides ; Anti-Bacterial Agents ; Cephalosporins ; Classification ; Colistin ; Hospitals, University ; Humans ; Korea ; World Health Organization ; Linezolid

Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
Adult ; Ampicillin ; Bacteria, Anaerobic ; Discitis ; Female ; Humans ; Periodontal Diseases ; Spondylitis ; Sulbactam ; Vital Signs

Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
Adult ; Ampicillin ; Bacteria, Anaerobic ; Discitis ; Female ; Humans ; Periodontal Diseases ; Spondylitis ; Sulbactam ; Vital Signs

BACKGROUND: Local epidemiologic data on prevalent pathogens are important to guide empirical antibiotic therapy. In this study, we observed annual changes in frequency of occurrence and in vitro antimicrobial susceptibility of blood isolates over a period of 13 years. MATERIALS AND METHODS: We reviewed blood isolates identified during the period from 1998 to 2010 at Seoul National University Hospital. Only first isolates for each patient were included in the analysis. We analyzed the frequency of isolates and their trend with regard to in vitro antimicrobial susceptibility. Data were presented according to guidelines of the Clinical and Laboratory Standards Institute (CLSI) (2009). RESULTS: A total of 23,501 isolates were identified during the period from 1998 to 2010. Fifty-five percent of the isolates were gram-positive cocci, 38% were gram-negative rods, and 3% were fungi. Coagulase-negative Staphylococcus (CoNS) (24%), Escherichia coli (16%), Staphylococcus aureus (10%), and Klebsiella pneumoniae (8%) were the most commonly isolated bacteria, and Candida albicans (2%) was the most commonly isolated fungus. The frequency of CoNS increased from 18.0% to 26.8%, whereas the frequency of E. coli and K. pneumoniae decreased from 20.2% to 13.7% and from 11.7% to 6.7%, respectively. Overall, the proportion of methicillin-resistant S. aureus changed from 47.9% to 62.1%. In E. coli, the resistance rate of cefotaxime and ciprofloxacin increased over a period of 13 years. However, such an increase of resistance was not observed in K. pneumoniae. In P. aeruginosa, and particularly in A. baumannii, resistance to imipenem rose alarmingly (3% in 1998 to 27.8% in 2010, 5% in 1998 to 68.9% in 2010, respectively). CONCLUSIONS: Over the last 13 years, the proportion of CoNS in blood isolates increased, which led to a relative decrease of isolated gram-negative rods. Proportions of MRSA showed no significant change, whereas cefotaxime resistant and ciprofloxacin resistant E. coli increased. Imipenem resistant P. aeruginosa and A. baumannii also increased during the study period.
Bacteremia ; Bacteria ; Candida albicans ; Cefotaxime ; Ciprofloxacin ; Escherichia coli ; Fungi ; Gram-Positive Cocci ; Humans ; Imipenem ; Klebsiella pneumoniae ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Republic of Korea ; Staphylococcus ; Staphylococcus aureus