Purpose: Although osimertinib is the standard-of-care treatment of epidermal growth factor receptor (EGFR) T790M mutation–positive non–small cell lung cancer, real-world evidence on the efficacy of osimertinib is not enough to reflect the complexity of the entire course of treatment. Herein, we report on the use of osimertinib in patients with EGFR T790M mutation–positive non–small cell lung cancer who had previously received EGFR tyrosine kinase inhibitor (TKI) treatment in Korea. Materials and Methods: Patients with confirmed EGFR T790M after disease progression of prior EGFR-TKI were enrolled and administered osimertinib 80 mg daily. The primary effectiveness outcome was progression-free survival, with time-to-treatment discontinuation, treatment and adverse effects leading to treatment discontinuation, and overall survival being the secondary endpoints. Results: A total of 558 individuals were enrolled, and 55.2% had investigator-assessed responses. The median progression-free survival was 14.2 months (95% confidence interval [CI], 13.0 to 16.4), and the median time-to-treatment discontinuation was 15.0 months (95% CI, 14.1 to 15.9). The median overall survival was 36.7 months (95% CI, 30.9 to not reached). The benefit with osimertinib was consistent regardless of the age, sex, smoking history, and primary EGFR mutation subtype. However, hepatic metastases at the time of diagnosis, the presence of plasma EGFR T790M, and the shorter duration of prior EGFR-TKI treatment were poor predictors of osimertinib treatment. Ten patients (1.8%), including three with pneumonitis, had to discontinue osimertinib due to severe adverse effects. Conclusion Osimertinib demonstrated its clinical effectiveness and survival benefit for EGFR T790M mutation–positive in Korean patients with no new safety signals.

Conventional dental resins for crown and bridge fulfill ISO 10477 and ISO 10993 before clinical application. Although 3D printing or rapid prototyping (RP) for the fabrication of temporary crown and bridge have been proposed, a little studies were reported for 3D printing resin for temporary crown and bridge. The purpose of this study was to evaluate the physical properties (such as water sorption and solubility, color stability and flexural strength) of the various 3D printing temporary crown and bridge resin following the ISO 10477:2018 and estimate the effect of chemical composition of resin on the physical properties. Four resins approved by KFDA and 4 experimental resins developed by different manufacturer were tested in this study. Samples were prepared with DLP typed 3D Printer (G-Printer) and post-cured using UV-light Cure Unit (Cure M). Proper 3D printing and post-curing conditions were selected for different 3D printing resins. Each test was performed according to the ISO 10477 and results were statistically analyzed using Tukey-multiple comparison test (p=0.05). Only group-B did not satisfied the ISO requirement (< 40 µg/ mm³) in water sorption test, but 3 groups (C, E and F) showed high solubility which exceeds the ISO requirement (< 7.5 µg/mm³). For color stability, the color difference were detected at 5 groups (A, E, F, G and H). Group-D and F showed the low flexural strength and some building direction did not satisfied the ISO requirement (> 60 MPa). Resin components may affect the flexural strength, then user should check the components of 3D printing resin. Deficient degree of polymerization may lead to large water sorption, water solubility and color changes. Further study should be done comparison between specimens printed with specific 3D printer recommended by manufacturer and specimens used in this study.
Crowns ; Polymerization ; Polymers ; Printing, Three-Dimensional ; Resins, Synthetic ; Solubility ; Water

The purpose of this study was to evaluate the effect of acid-treatment conditions on the surface properties of the RBM (Resorbable Blast Media) treated titanium. Disk typed cp-titanium specimens were prepared and RBM treatments was performed with calcium phosphate ceramic powder. Acid solution was mixed using HCl, H2SO4 and deionized water with 4 different volume fraction. The RBM treated titanium was acid treated with different acid solutions at 3 different temperatures and for 3 different periods. After acid-treatments, samples were cleaned with 1 % Solujet solution for 30 min and deionized water for 30 min using ultrasonic cleanser, then dried in the electrical oven (37℃). Weight of samples before and after acid-treatment were measured using electric balance. Surface roughness was estimated using a confocal laser scanning microscopy, crystal phase in the surface of sample was analyzed using X-ray diffractometer. Surface morphology and components were evaluated using Scanning Electron Microscope (SEM) with Energy Dispersive X-ray spectroscopy (EDX) and X-ray Photoemission Spectroscopy (XPS). Values of the weight changes and surface roughness were statistically analyzed using Tukey-multiple comparison test (p=0.05). Weight change after acid treatments were significantly increased with increasing the concentration of H₂SO₄ and temperature of acid-solution. Acid-treatment conditions (concentration of H₂SO₄, temperature and time) did not produce consistent effects on the surface roughness, it showed the scattered results. From XRD analysis, formation of titanium hydrides in the titanium surface were observed in all specimens treated with acid-solutions. From XPS analysis, thin titanium oxide layer in the acid-treated specimens could be evaluated. Acid solution with 90℃ showed the strong effect on the titanium surface, it should be treated with caution to avoid the over-etching process.
Calcium ; Ceramics ; Microscopy, Confocal ; Photoelectron Spectroscopy ; Spectrometry, X-Ray Emission ; Surface Properties ; Titanium ; Ultrasonics ; Water

No abstract available.
Cerebral Infarction

BACKGROUND: Hepatic steatosis measured with controlled attenuation parameter (CAP) using transient elastography predicts metabolic syndrome in the general population. We investigated whether CAP predicted metabolic syndrome in chronic kidney disease patients. METHODS: CAP was measured with transient elastography in 465 predialysis chronic kidney disease patients (mean age, 57.5 years). RESULTS: The median CAP value was 239 (202–274) dB/m. In 195 (41.9%) patients with metabolic syndrome, diabetes mellitus was more prevalent (105 [53.8%] vs. 71 [26.3%], P < 0.001), with significantly increased urine albumin-to-creatinine ratio (184 [38–706] vs. 56 [16–408] mg/g Cr, P = 0.003), high sensitivity C-reactive protein levels (5.4 [1.4–28.2] vs. 1.7 [0.6–9.9] mg/L, P < 0.001), and CAP (248 [210–302] vs. 226 [196–259] dB/m, P < 0.001). In multiple linear regression analysis, CAP was independently related to body mass index (β = 0.742, P < 0.001), triglyceride levels (β = 2.034, P < 0.001), estimated glomerular filtration rate (β = 0.316, P = 0.001), serum albumin (β = 1.386, P < 0.001), alanine aminotransferase (β = 0.064, P = 0.029), and total bilirubin (β = −0.881, P = 0.009). In multiple logistic regression analysis, increased CAP was independently associated with increased metabolic syndrome risk (per 10 dB/m increase; odds ratio, 1.093; 95% confidence interval, 1.009–1.183; P = 0.029) even after adjusting for multiple confounding factors. CONCLUSION: Increased CAP measured with transient elastography significantly correlated with and could predict increased metabolic syndrome risk in chronic kidney disease patients.
Alanine Transaminase ; Bilirubin ; Body Mass Index ; C-Reactive Protein ; Diabetes Mellitus ; Elasticity Imaging Techniques ; Fatty Liver* ; Glomerular Filtration Rate ; Humans ; Linear Models ; Logistic Models ; Odds Ratio ; Renal Insufficiency, Chronic* ; Serum Albumin ; Triglycerides

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients > or = 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cause of Death ; Cross Infection/diagnosis/drug therapy/microbiology/*mortality ; Female ; *Homes for the Aged ; *Hospitals ; Humans ; Inappropriate Prescribing ; Kaplan-Meier Estimate ; Male ; *Nursing Homes ; Pneumonia, Bacterial/diagnosis/drug therapy/microbiology/*mortality ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

Immunoglobulin G4-related disease is a recently recognized entity characterized by a mass-forming or regional lesion that contains an extensive infiltration of IgG4-producing plasma cells with dense fibrosis. Immunoglobulin G4-related disease can affect any organ system, but solitary hepatic lesion of Immunoglobulin G4-related disease is very rare. This entity mimics primary malignant hepatic tumor, such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma. We experienced a case of hepatic IgG4-related inflammatory pseudotumor in a 50-year-old woman, mimicking hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Female ; Fibrosis ; Granuloma, Plasma Cell* ; Humans ; Immunoglobulins* ; Middle Aged ; Plasma Cells

BACKGROUND/AIMS: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. METHODS: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0+/-11.0 years, mean+/-SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. RESULTS: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001). CONCLUSIONS: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Endoscopy ; Esophageal and Gastric Varices/*diagnosis/mortality/therapy ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prognosis ; Republic of Korea ; Retrospective Studies ; Sclerotherapy ; Severity of Illness Index ; Treatment Outcome ; Young Adult

Urothelial carcinomas (UCs) can occur in the upper urinary tract or lower urinary tract. Upper urinary tract urothelial carcinoma (UUT-UC) is relatively a rare disease and accounts for only about 5% of UC cases. Sporadic cases of late-onset metastasis, associated with UC of the bladder, have occasionally been reported. In contrast, no late-onset distant metastatic UUT-UC without local recurrence has, to the best of our knowledge, been reported in the English literature. We report an extremely rare case of distant metastatic UC, mimicking lung adenocarcinoma that originated from UUT-UC 12 years previously.
Adenocarcinoma ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Urinary Bladder ; Urinary Tract ; Urothelium