Purpose: Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy. Materials and Methods: Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level. Results: Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250–0.890; P=0.020). Conclusions After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS.

Pleurisy is an inflammation of the parietal pleura and is characterized by pleuritic pain. The most common cause of pleurisy is infection; other causes include rheumatoidarthritis, malignancy, rib fractures, or trauma. Possible causes of chest pain associated withgolf include costochondritis, stress fractures of the ribs, intercostal muscle strain, or, rarely,Tietze’s syndrome and slipping rib syndrome.Case: A 64-year-old female presented with intractable chest pain that began 4 months priorwhile playing golf. No specific cause was found after various examinations. There was persistent pain despite medical treatment. Ultrasonography (US) was performed over the painful areas, which revealed focal pleural effusions. A mixture of ropivacaine and triamcinolonewas injected into the focal pleural effusions using US guidance, which dramatically relievedher pain.Conclusions: This case demonstrates that US can be used as a diagnostic and therapeuticmodality for intractable chest pain with an undetected pathology.

Precise allergy diagnosis and effective allergen specific immunotherapy are largely dependent on the quality of allergen extract. A new extract of Dermatophagoides farinae was commercially developed by Prolagen. The allergenic properties of the new extract were compared with those of other commercial products. The allergenic properties of the new extract were compared according to protein concentration, protein profiles, major allergen (Der f 1) contents, and allergenic potency to those for three commercially available extracts imported in Korea (Jubilant HollisterStier Allergy, Lofarma S.p.A., and Stallergenes Greer). Protein concentrations varied up to 2.62-fold (0.404 to 1.057 mg/mL), and Der f 1 contents varied up to 11.3-fold (3.597 to 40.688 μg/mL). Protein profiles of the extracts showed no major discrepancies, although there were some differences in SDS-PAGE band intensities, reflecting protein concentrations. Allergen potency ranged from 37038 to 60491 PAU/mL. The Prolagen product was highest in terms of protein concentration and allergen potency. The Lofarma product displayed Der f 1 content similar to that in Prolagen (19.4 μg/mg vs. 19.3 μg/mg). Endotoxin levels varied 8.9-fold (1020 to 8985 EU/mL). The newly developed house dust mite extract showed equal or better allergenic properties than available commercial extracts. This new product may be useful for better diagnostics and allergen-specific immunotherapeutics.

Background/Aims: Lymphocytes are an important component of the cell-mediated immune system. As lymphopenia is reportedly associated with poor prognoses in patients with various cancers, we investigated this notion in patients who underwent curative gastrectomy. Methods: We retrospectively analyzed the association between absolute lymphocyte count (ALC) and prognosis in patients with stage I–III gastric cancer who underwent curative surgical resection. Ever lymphopenic patients were defined as those with ALCs < 1,000/μL at any time post-diagnosis except within 30 days post-surgery. Adjusted multivariable regression models were used to evaluate the associations between lymphopenia and overall mortality, gastric cancer-specific mortality, and disease-free survival. Results: We investigated 1,222 patients diagnosed between January 2011 and December 2015. Fifty-six patients (4.6%) were lymphopenic at diagnosis and nearly one-quarter (24.8%) were ever lymphopenic with a mean minimum ALC of 640/μL. Older age (odds ratio [OR], 1.02) and higher stage (stage III vs. I; OR, 3.01) were positively associated with ever lymphopenia. On multivariable analysis, ever lymphopenia predicted higher overall mortality (hazard ratio [HR], 1.83; p = 0.008), higher gastric cancer-specific mortality (HR, 1.58; p = 0.048), and shorter disease-free survival (HR, 1.83; p = 0.006). The 5-year gastric cancer-specific mortality rates for ever- and never lymphopenic patients were 10.9% and 3.7%, respectively; their 5-year cumulative recurrence rates were 15.1% and 4.6%, respectively. Conclusions This study demonstrate that ever lymphopenia is independent prognostic factor for overall mortality and recurrence in patients with potentially curable gastric cancer; hence, ALCs may be a biomarker for predicting the prognoses of patients with stage I–III gastric cancer who had curative gastrectomy.

Background/Aims: Lymphocytes are an important component of the cell-mediated immune system. As lymphopenia is reportedly associated with poor prognoses in patients with various cancers, we investigated this notion in patients who underwent curative gastrectomy. Methods: We retrospectively analyzed the association between absolute lymphocyte count (ALC) and prognosis in patients with stage I–III gastric cancer who underwent curative surgical resection. Ever lymphopenic patients were defined as those with ALCs < 1,000/μL at any time post-diagnosis except within 30 days post-surgery. Adjusted multivariable regression models were used to evaluate the associations between lymphopenia and overall mortality, gastric cancer-specific mortality, and disease-free survival. Results: We investigated 1,222 patients diagnosed between January 2011 and December 2015. Fifty-six patients (4.6%) were lymphopenic at diagnosis and nearly one-quarter (24.8%) were ever lymphopenic with a mean minimum ALC of 640/μL. Older age (odds ratio [OR], 1.02) and higher stage (stage III vs. I; OR, 3.01) were positively associated with ever lymphopenia. On multivariable analysis, ever lymphopenia predicted higher overall mortality (hazard ratio [HR], 1.83; p = 0.008), higher gastric cancer-specific mortality (HR, 1.58; p = 0.048), and shorter disease-free survival (HR, 1.83; p = 0.006). The 5-year gastric cancer-specific mortality rates for ever- and never lymphopenic patients were 10.9% and 3.7%, respectively; their 5-year cumulative recurrence rates were 15.1% and 4.6%, respectively. Conclusions This study demonstrate that ever lymphopenia is independent prognostic factor for overall mortality and recurrence in patients with potentially curable gastric cancer; hence, ALCs may be a biomarker for predicting the prognoses of patients with stage I–III gastric cancer who had curative gastrectomy.

Masseter muscle rigidity (MMR), known as the ‘jaw of steel’, sometimes makes laryngoscope unusable due to the stiffness of the jaw. MMR during general anesthesia was previously considered as an early episode of malignant hyperthermia (MH). Generally, MMR occurs in the pediatric patients after induction with succinylcholine and volatile agents. However, MMR following the administration of non-depolarizing muscle relaxants is uncommon, although described in some reports. We report a case of 62-year-old male patient which developed MMR following intravenous administration of rocuronium during induction of anesthesia. Our patient was not found to be vulnerable to MH. Although fiberoptic nasotracheal intubation had been successfully performed in our case, an unanticipated difficult airway due to MMR can be experienced at any time. Therefore, we should be aware that, although rare, MMR can occur after using non-depolarizing muscle relaxant. Additionally, in case of any incident of MMR, anesthesiologists need to recognize the management of a difficult airway and to maintain adequate oxygenation in a variety of methods according to a difficult airway algorithm.

Masseter muscle rigidity (MMR), known as the ‘jaw of steel’, sometimes makes laryngoscope unusable due to the stiffness of the jaw. MMR during general anesthesia was previously considered as an early episode of malignant hyperthermia (MH). Generally, MMR occurs in the pediatric patients after induction with succinylcholine and volatile agents. However, MMR following the administration of non-depolarizing muscle relaxants is uncommon, although described in some reports. We report a case of 62-year-old male patient which developed MMR following intravenous administration of rocuronium during induction of anesthesia. Our patient was not found to be vulnerable to MH. Although fiberoptic nasotracheal intubation had been successfully performed in our case, an unanticipated difficult airway due to MMR can be experienced at any time. Therefore, we should be aware that, although rare, MMR can occur after using non-depolarizing muscle relaxant. Additionally, in case of any incident of MMR, anesthesiologists need to recognize the management of a difficult airway and to maintain adequate oxygenation in a variety of methods according to a difficult airway algorithm.

OBJECTIVE: To retrospectively assess the effect of CT slice thickness on the reproducibility of radiomic features (RFs) of lung cancer, and to investigate whether convolutional neural network (CNN)-based super-resolution (SR) algorithms can improve the reproducibility of RFs obtained from images with different slice thicknesses. MATERIALS AND METHODS: CT images with 1-, 3-, and 5-mm slice thicknesses obtained from 100 pathologically proven lung cancers between July 2017 and December 2017 were evaluated. CNN-based SR algorithms using residual learning were developed to convert thick-slice images into 1-mm slices. Lung cancers were semi-automatically segmented and a total of 702 RFs (tumor intensity, texture, and wavelet features) were extracted from 1-, 3-, and 5-mm slices, as well as the 1-mm slices generated from the 3- and 5-mm images. The stabilities of the RFs were evaluated using concordance correlation coefficients (CCCs). RESULTS: The mean CCCs for the comparisons of original 1 mm vs. 3 mm, 1 mm vs. 5 mm, and 3 mm vs. 5 mm images were 0.41, 0.27, and 0.65, respectively (p < 0.001 for all comparisons). Tumor intensity features showed the best reproducibility while wavelets showed the lowest reproducibility. The majority of RFs failed to achieve reproducibility (CCC ≥ 0.85; 3.6%, 1.0%, and 21.5%, respectively). After applying the CNN-based SR algorithms, the reproducibility significantly improved in all three pairings (mean CCCs: 0.58, 0.45, and 0.72; p < 0.001 for all comparisons). The reproducible RFs also increased (36.3%, 17.4%, and 36.9%, respectively). CONCLUSION: The reproducibility of RFs in lung cancer is significantly influenced by CT slice thickness, which can be improved by the CNN-based SR algorithms.
Learning ; Lung Neoplasms ; Lung ; Retrospective Studies

Recent advances in deep learning have brought many breakthroughs in medical image analysis by providing more robust and consistent tools for the detection, classification and quantification of patterns in medical images. Specifically, analysis of advanced modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) has benefited most from the data-driven nature of deep learning. This is because the need of knowledge and experience-oriented feature engineering process can be circumvented by automatically deriving representative features from the complex high dimensional medical images with respect to the target tasks. In this paper, we will review recent applications of deep learning in the analysis of CT and MR images in a range of tasks and target organs. While most applications are focused on the enhancement of the productivity and accuracy of current diagnostic analysis, we will also introduce some promising applications which will significantly change the current workflow of medical imaging. We will conclude by discussing opportunities and challenges of applying deep learning to advanced imaging and suggest future directions in this domain.
Classification ; Diagnostic Imaging ; Efficiency ; Learning* ; Magnetic Resonance Imaging*

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
Body Temperature ; Child ; Coronavirus Infections* ; Disease Outbreaks ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Humans ; Information Systems ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Overall