Purpose: Endocrine therapy is the first-line treatment recommended for patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer without visceral crisis. However, this recommendation has not been followed clinically because of efficacy issues. In this study, the survival of patients with HR-positive/HER2-negative metastatic breast cancer was evaluated based on the following first-line treatment regimens: the combination of palbociclib plus letrozole, conventional endocrine therapy, or chemotherapy. Methods: Medical records were reviewed for this retrospective analysis. Patients with HR-positive/HER2-negative metastatic breast cancer were included. Progression-free survival (PFS) and overall survival (OS) were compared based on first-line treatment regimens. Results: A total of 184 patients were included in the analysis. The first-line treatments were palbociclib plus letrozole in 46 patients (25.0%), endocrine therapy in 40 patients (21.7%), and chemotherapy in 98 patients (53.3%). The PFS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=3.43, p<0.001) and chemotherapy (hazard ratio=2.88, p=0.001) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.430). The OS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=5.34, p=0.009) and chemotherapy (hazard ratio 4.23, p=0.043) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.451). Conclusion The combination regimen of palbociclib and letrozole could be recommended as the first-line treatment of choice in patients with HR-positive/HER2-negative metastatic breast cancer.

In recent years, artificial intelligence (AI) technologies have greatly advanced and become a reality in many areas of our daily lives. In the health care field, numerous efforts are being made to implement the AI technology for practical medical treatments. With the rapid developments in machine learning algorithms and improvements in hardware performances, the AI technology is expected to play an important role in effectively analyzing and utilizing extensive amounts of health and medical data. However, the AI technology has various unique characteristics that are different from the existing health care technologies. Subsequently, there are a number of areas that need to be supplemented within the current health care system for the AI to be utilized more effectively and frequently in health care. In addition, the number of medical practitioners and public that accept AI in the health care is still low;moreover, there are various concerns regarding the safety and reliability of AI technologyimplementations. Therefore, this paper aims to introduce the current research and application status of AI technology in health care and discuss the issues that need to be resolved.

Primary thymic adenocarcinoma is a very rare malignancy of the anterior mediastinum with no standardized treatment. A 36-year-old male patient presented with hoarseness over the past 3 months. A chest computed tomography (CT) scan showed an infiltrative mass to the proximal vessels and aortic arch in left upper mediastinum (4.1x3.1x5.4 cm). Brain magnetic resonance imaging (MRI) showed focal lesions, suggesting metastasis in the left frontal lobe. A thoracoscopic biopsy of the mediastinal mass confirmed a primary thymic adenocarcinoma forming a glandular structure with atypia of tumor cells. The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions). A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion. We report a rare case of the primary thymic adenocarcinoma with a literature review.
Adenocarcinoma* ; Adult ; Aorta, Thoracic ; Biopsy ; Brain ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Frontal Lobe ; Hoarseness ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinum ; Neoplasm Metastasis ; Radiotherapy ; Small Cell Lung Carcinoma* ; Thorax ; Thymus Gland ; Tomography, X-Ray Computed

BACKGROUND: Aiming to improve outcome of lung transplantation (LTx) patients, we reviewed risk factors and treatment practices for the LTx recipients who experienced respiratory infection in the late post-LTx period (>1 month after LTx). METHODS: We analyzed the clinical data of 48 recipients and donors from 61 LTx, who experienced late respiratory infections. Late respiratory infections were classified according to the etiology, time of occurrence, and frequency of donor-to-host transmission or colonization of the recipient prior to transplantation. RESULTS: During the period of observation, 42 episodes of respiratory infections occurred. The organisms most frequently involved were gram (-) bacteria: Acinetobacter baumannii (n=13, 31.0%), Pseudomonas aeruginosa (n=7, 16.7%), and Klebsiella pneumoniae (n=4, 10.0%). Among the 42 episodes recorded, 14 occurred in the late post-LTx period. These were bacterial (n=6, 42.9%), fungal (n=2, 14.3%), viral (n=4, 28.5%), and mycobacterial (n=2, 14.3%) infections. Of 6 bacterial infections, 2 were from multidrug-resistant (MDR) A. baumannii and one from each of MDR P. aeruginosa, extended spectrum beta-lactamase (+) K. pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Infection-related death occurred in 6 of the 14 episodes (43%). CONCLUSION: Although the frequency of respiratory infection decreased sharply in the late post-LTx period, respiratory infection was still a major cause of mortality. Gram (-) MDR bacteria were the agents most commonly identified in these infections.
Acinetobacter baumannii ; Bacteria ; Bacterial Infections ; beta-Lactamases ; Colon ; Humans ; Klebsiella pneumoniae ; Lung ; Lung Transplantation ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pseudomonas aeruginosa ; Respiratory Tract Infections ; Risk Factors ; Streptococcus pneumoniae ; Tissue Donors

Leiomyosarcomas are uncommon malignant smooth muscle tumors, mainly derived from vessels or viscera. Superficial leiomyosarcomas are a rare soft tissue sarcoma arising from the dermis or subcutaneous tissue in the skin. According to tumor origin and location, they are divided into cutaneous and subcutaneous leiomyosarcoma. They have distinctly different histologic and prognostic features from each other. Superficial leiomyosarcomas show a predilection for the proximal extremities and tend to be slow growing. We report one rare case of superficial cutaneous leiomyosarcoma on the right temporal area of face, which showed an extremely rapid growing mass within 3 months.
Dermis ; Extremities ; Leiomyosarcoma ; Sarcoma ; Skin ; Smooth Muscle Tumor ; Subcutaneous Tissue ; Viscera

BACKGROUND: This study was conducted in order to evaluate the propriety of expanded donor criteria in Korea and to identify the preoperative factors influencing allograft survival and function. METHODS: We studied 404 patients who received deceased renal transplants from five transplantation centers of 2, 3 territory from 2000 to 2010. Differences in 1-year graft function, delayed graft function (DGF) rate, and graft survival rate between the standard criteria donor (SCD) and expanded criteria donor (ECD) were compared retrospectively. The preoperative factors influencing graft function and graft survival were analysed. RESULTS: SCD showed significantly better 1-year graft function than ECD (P=0.011). No differences in 1-year acute rejection rate were observed between SCD (13.2%) and ECD (16.9%) (P=0.449). Significantly higher DGF rate was observed for ECD (25.4%) than for SCD (14.1%) (P=0.022). Graft type had no significant influence on 5-year graft survival (SCD 94.5% vs. ECD 93.7%) (P =0.835). Advanced donor age (P=0.001), donor hypertension history (P=0.047), high serum creatinine (P=0.002), and cerebral infarction as cause of death (P=0.004) had a negative influence on 1-year allograft function. Significantly low graft survival was observed for advanced donor age (P =0.002). CONCLUSIONS: Graft function, DGF rates of ECD were poorer than those of SCD. Graft survival rate of ECD was comparable to that of SCD kidney. Korean Network for Organ Sharing expanded criteria may underestimate the organ quality of deceased kidney and modification may be needed in order to expand the potential donor pool through nationwide study.
Cause of Death ; Cerebral Infarction ; Creatinine ; Delayed Graft Function ; Graft Survival ; Humans ; Hypertension ; Kidney ; Kidney Transplantation* ; Korea ; Retrospective Studies ; Survival Rate ; Tissue Donors* ; Transplantation, Homologous ; Transplants

Low-dose thoracic computed tomography (CT) for the early diagnosis of lung cancer detects many solitary pulmonary nodules. Fine needle aspiration biopsy (FNAB) is the diagnostic method used most commonly in the diagnosis of solitary pulmonary nodules. Cerebral air embolism is a rare, fatal complication of FNAB. Hyperbaric oxygenation therapy within 6 hours of the event ensures a good prognosis with cerebral air embolisms. We present a case of cerebral air embolism that occurred during CT-guided lung FNAB biopsy that was treated with hyperbaric oxygenation within 6 hours. The patient recovered completely from the neurological deficit and had a favorable long-term outcome.
Biopsy ; Biopsy, Fine-Needle ; Early Diagnosis ; Embolism, Air ; Humans ; Hyperbaric Oxygenation ; Lung ; Lung Neoplasms ; Prognosis ; Solitary Pulmonary Nodule

Granular corneal dystrophy, type II (CGD2; Avellino corneal dystrophy) is the most common corneal dystrophy among Koreans, but its pathophysiology is still poorly understood. Many reports showed that even though the causative mutation is the same TGFBI R124H mutation, there are severe and mild phenotypes of the corneal dystrophy. We also observed the phenotype differences in our samples. For this reason, we focused our effort on the identification of unknown genetic factor related to phenotype variation. A total 551 individuals from 59 families were genotyped with SNP chip and used in genome-wide linkage analysis. From single-point linkage analyses, we confirmed the known 5q31 region for TGFBI gene, and selected novel nine candidate loci for CGD2. In simulation analysis, the only 3q26.3 region including neuroligin 1 gene (NLGN1) was supported by empirical statistic significance. To investigate the effect of genetic heterogeneity in linkage analysis, we classified CGD2 families into two subgroups. Although we could not find a significant evidence for correlation between the 3q26.3 region and CGD2 phenotypes, this first genome-wide analysis with CGD2 families in Korea has a very important value for offering insights in genetics of CGD2. In addition, the co-segregating loci with CGD2 including 3q26.3 would be a good target for further study to understand the pathophysiology of CGD2.
Cell Adhesion Molecules, Neuronal/genetics ; Chromosomes, Human, Pair 3/*genetics ; Chromosomes, Human, Pair 5/*genetics ; Computer Simulation ; Corneal Dystrophies, Hereditary/*genetics ; Female ; Genetic Linkage ; *Genetic Loci ; *Genome-Wide Association Study ; Genotype ; Humans ; Male ; Models, Genetic ; Polymorphism, Single Nucleotide ; Transforming Growth Factor beta1/genetics

BACKGROUND: The astrocyte elevated gene-1 (AEG-1) was cloned as a novel HIV-1 and tumor necrosis factor-alpha-induced transcript from primary human fetal astrocytes. It has been reported that the AEG-1 expression is elevated in subsets of breast cancer, glioblastoma multiforme and melanoma cells, and AEG-1 cooperates with Ha-ras to promote the transformation of immortalized melanocytes. AEG-1 is thought to play a role in promoting cancer development and/or its maintenance. OBJECTIVE: The aim of this study is to determine whether AEG-1 is related to the pathogenesis of melanoma and other melanocytic lesions. METHODS: The nine biopsy specimens each of melanoma, dysplastic nevus, Spitz nevus and compound nevus were studied using immunohistochemical staining. The expressions of AEG-1 were evaluated using an immunostaining-intensity-distribution index. RESULTS: The expression of AEG-1 was significantly higher in the melanoma and dysplastic nevus than in the compound nevus. The expression was also significantly higher in the melanoma than in the Spitz nevus. CONCLUSION: AEG-1 may be related to the pathogenesis of both dysplastic nevus and melanoma, but it may not be related to Spitz nevus.
Astrocytes ; Biopsy ; Breast Neoplasms ; Clone Cells ; Dysplastic Nevus Syndrome ; Glioblastoma ; HIV-1 ; Humans ; Melanocytes ; Melanoma ; Necrosis ; Nevus ; Nevus, Epithelioid and Spindle Cell