Purpose: In this study, we evaluated 66 patients diagnosed with adenoid cystic carcinoma (ACC) enrolled in two Korean Cancer Study Group trials to investigate the response and progression patterns in recurrent and/or metastatic ACC treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs). Materials and Methods: We evaluated 66 patients diagnosed with ACC who were enrolled in the Korean Cancer Study Group trials. The tumor measurements, clinical data, treatment outcomes, and progression patterns of therapy were analyzed. Results: In the 66 patients (53 receiving axitinib and 13 receiving nintedanib), the disease control rate was 61%, and three patients achieved partial response. The median follow-up, median progression-free survival (PFS), overall survival, and 6-month PFS rate were 27.6%, 12.4%, and 18.1% months and 62.1%, respectively. Among 42 patients who experienced progression, 27 (64.3%) showed target lesion progression. Bone metastasis was an independent poor prognostic factor. Conclusion Overall, most patients demonstrated stable disease with prolonged PFS; however, prominent target lesion progression occurred in some patients. Thus, PFS may capture VEGFR-TKI efficacy better than the objective response rate.

Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir for 12 weeks in HCV-infected Korean adults. Methods: This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir–velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir–velpatasvir–voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. Results: Of 53 participants receiving sofosbuvir–velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir–velpatasvir–voxilaprevir achieved SVR 12. Overall, sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. Conclusions: Treatment with sofosbuvir–velpatasvir or sofosbuvir–velpatasvir–voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.

Background: We used machine learning and population-based data for analyzing the determinants of sarcopenia in adult women and developing its decision support systems for various subgroups. Methods: All data was acquired from the Korea National Health and Nutrition Examination Survey, and women 18 years and older were included in this research. The variables were selected based on female characteristics and the ability to be acquired in a survey format, and were ranked by importance using Random Forest. From this ranking, four main variables were selected, age, menopause age, menarche age and number of pregnancy. A decision supporting system was constructed based on a tree randomly selected from Random Forest. Results: We defined sarcopenia as -2SD below the appendicular skeletal mass (ASM) index reference of 0.5136, and 89.87% (n = 8,610) were found non-sarcopenic and 10.13% (n = 971) were found sarcopenic. The subjects were divided into 6 groups based on menopausal status and BMI. The obese postmenopausal women had the highest number of sarcopenia, whereas the non-obese premenopausal women had the least number of sarcopenic subjects. In non-obese premenopausal women, which was considered to be at the lowest risk for sarcopenia, the most determining variable was the menarche age, followed by age and number of pregnancies. In obese and postmenopausal women, which was considered to be at the highest risk for sarcopenia, the most influential factor was the menopausal age, followed by age and menarche age. Conclusions We identified the major determinants of sarcopenia using machine learning and population-based data. This study demonstrated the strengths of the random forest as an effective decision support system for each stratified subgroup to find its own optimal cut-off points for the major variables of sarcopenia.

Objective: To evaluate the association between vasomotor symptoms, skeletal muscle index, and sarcopenia in menopausal women. Methods: This cross-sectional study included 295 Korean menopausal women aged 40–65 years who underwent abdominal computed tomography during routine health checkups between January 2014 and May 2016. The cross-sectional areas of adipose and skeletal muscles were measured at the L3 level using computed tomography. The skeletal muscle index is defined as the sum of the skeletal muscle area (cm2 )/height 2 (m2). Sarcopenia was identified by a skeletal muscle index of ＜ 34.9 cm2 /m2 . Vasomotor symptoms were assessed using the Menopause Rating Scale. Results: The mean age of the participants was 54.93 ± 6.20 years. Vasomotor symptoms were reported in 160 women (54.2%). Sarcopenia was more prevalent in women without vasomotor symptoms (18.5%) than in those with (6.9%). Multivariate logistic regression showed that the prevalence of sarcopenia was inversely associated with the prevalence of vasomotor symptoms (odds ratio, 0.32; 95% confidence interval, 0.15–0.67). Moreover, the paraspinal muscle index was positively associated with the prevalence of vasomotor symptoms (odds ratio, 1.06; 95% confidence interval, 1.01–1.11) after adjusting for age, body mass index, waist circumference, adipose tissue area, history of hormone therapy, systolic and diastolic blood pressures, total cholesterol, insulin resistance, alcohol intake, and exercise. Conclusions Vasomotor symptoms are less common in women with sarcopenia than in those without, and are positively associated with paraspinal muscle mass in Korean menopausal women. Further longitudinal studies are required to investigate the causal relationships and underlying mechanisms.

Background: Hodgkin's lymphoma (HL) constitutes 10%–20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. Methods: We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. Results: A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype.Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, highrisk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level.In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. Conclusion This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.

OBJECTIVES: Due to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account. METHODS: By using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury. RESULTS: The mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high. CONCLUSIONS: The main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.
Adolescent* ; Cause of Death ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Humans ; Information Systems ; Intention ; Mortality ; Motor Vehicles ; Violence

BackgroundUntil now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.

MethodsBetween June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher's exact test, and regression analysis.

ResultsHBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 logU/ml vs. 7.5 logU/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 logU/ml vs. 4.0 logU/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.

ConclusionsThe current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.

Trial RegistrationClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.

Recurrent ectopic pregnancy of cesarean scar is very rare and its therapeutic management is still not established. We reported the first case of recurrent cesarean scar pregnancy that was successfully treated with concomitant intra-gestational sac methotrexate-potassium chloride injection and systemic methotrexate injection. This case study provides physicians with a safe and effective minimally invasive treatment option for recurrent cesarean scar pregnancy.
Cicatrix* ; Female ; Methotrexate* ; Potassium Chloride ; Pregnancy* ; Pregnancy, Ectopic

The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22+/-4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79+/-0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (beta=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders.
Cross-Sectional Studies ; Female ; Humans ; Insulin Resistance ; Korea ; Logistic Models ; Menopause