Purpose: Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that can significantly diminish quality of life. Although some patients have reported persistent pelvic pain after radical prostatectomy (RP), the prevalence and direct causal relationship between CPPS and RP remain unclear. This multicenter prospective study aimed to evaluate the efficacy of Urovaxom for improving CPPS symptoms. Materials and Methods: A total of 52 prostate cancer patients who underwent RP were enrolled and administered Urovaxom (60 mg/day) for 12 weeks. Changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and inflammation markers (white blood cell [WBC], C-reactive protein [CRP]) were analyzed using the Wilcoxon signed-rank test. Results: After 12 weeks of treatment, the NIH-CPSI total score significantly decreased from 19 (interquartile range [IQR], 16–23) to 12.5 (IQR, 8.0–16.8) (p<0.001). The OABSS total score decreased from 8 (IQR, 4–11) to 5 (IQR, 3.0–7.8), and the IPSS total score decreased from 13.5 (IQR, 10.0–22.8) to 10.5 (IQR, 5.0–17.0) (p<0.001). WBC levels showed a slight increase (p=0.028), but the clinical relevance of this change is uncertain and warrants further investigation. CRP changes were not statistically significant (p=0.274). Conclusions Urovaxom demonstrated significant efficacy in improving CPPS symptoms, particularly pain and reduced quality of life, in patients following RP. These findings suggest Urovaxom as a potential therapeutic option for CPPS after management using RP.

and Relevance: Severe necrosis and mild fibrosis were observed in the liver and forelimb skeletal muscles. Based on histological analysis, we diagnosed iron overload myopathy by secondary hemochromatosis. Secondary hemochromatosis with severe muscle atrophy and myositis is very rare, and this is the first report of iron-overload myopathy in a dog.

To investigate the relationship between depression and AD, water avoidance stress (WAS) was induced for 10 days in both Tg2576 mice and wild-type (WT) mice. After WAS, memory function and depressive-like behavior were investigated in Tg2576 mice. Tg2576 WAS mice exhibited more depressive-like behaviors than WT WAS and Tg2576 control (CON) mice. Strikingly, Tg2576 CON mice showed more depressive-like behaviors than WT mice. Moreover, corticosterone and phospho-glucocorticoid receptor (p-GR) levels were also higher in Tg2576 WAS mice in comparison to Tg2576 CON mice. Spinster homologue 2 (SPNS2) is a member of non-ATP-dependent transporter. The role of SPNS2 was widely known as a sphingosine-1-phosphate (S1P) transporter, which export intracellular S1P from cells. Using GEO database to analyze SPNS2 gene expression changes in patients with AD and depression, we show that SPNS2 gene expression correlates with AD and depression. Interestingly, Tg2576 WAS mice displayed significantly increased levels of SPNS2 w1hen compared to Tg2576 CON counterparts. SPNS2 levels were also higher in Tg2576 CON mice in comparison with WT CON mice. Remarkably, we found a decrease in S1P brain levels and an increase in S1P serum levels of Tg2576 WAS mice in comparison with Tg2576 CON mice. Accordingly, WAS induced group further decreased S1P levels in the brains. However, the level in the serum further increased in comparison with non-induced group. Therefore, these results suggest that AD and depression could be associated, and that Tg2576 transgenic mice are more susceptible to stress-induced depression through the release of S1P by SPNS2 up-regulation.

Purpose: Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world. Materials and Methods: We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis. Results: NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs. Conclusion Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

Purpose: The Korean Cancer Study Group (KCSG) is a nationwide cancer clinical trial group dedicated to advancing investigator-initiated trials (IITs) by conducting and supporting clinical trials. This study aims to review IITs conducted by KCSG and quantitatively evaluate the survival and financial benefits of IITs for patients. Materials and Methods: We reviewed IITs conducted by KCSG from 1998 to 2023, analyzing progression-free survival (PFS) and overall survival (OS) gains for participants. PFS and OS benefits were calculated as the difference in median survival times between the intervention and control groups, multiplied by the number of patients in the intervention group. Financial benefits were assessed based on the cost of investigational products provided. Results: From 1998 to 2023, KCSG conducted 310 IITs, with 133 completed and published. Of these, 21 were included in the survival analysis. The analysis revealed that 1,951 patients in the intervention groups gained a total of 2,558.4 months (213.2 years) of PFS and 2,501.6 months (208.5 years) of OS, with median gains of 1.31 months in PFS and 1.58 months in OS per patient. When analyzing only statistically significant results, PFS and OS gain per patients was 1.69 months and 3.02 months, respectively. Investigational drug cost analysis from six available IITs indicated that investigational products provided to 252 patients were valued at 10,400,077,294 won (approximately 8,046,481 US dollars), averaging about 41,270,148 won (approximately 31,930 US dollars) per patient. Conclusion Our findings, based on analysis of published research, suggest that IITs conducted by KCSG led to survival benefits for participants and, in some studies, may have provided financial benefits by providing investment drugs.

Purpose: This study aimed to develop a magnetic resonance imaging (MRI)–based radiomics model to predict high-risk pathologic features for lung adenocarcinoma: micropapillary and solid pattern (MPsol), spread through air space, and poorly differentiated patterns. Materials and Methods: As a prospective study, we screened clinical N0 lung cancer patients who were surgical candidates and had undergone both 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) and chest CT from August 2018 to January 2020. We recruited patients meeting our proposed imaging criteria indicating high-risk, that is, poorer prognosis of lung adenocarcinoma, using CT and FDG PET/CT. If possible, these patients underwent an MRI examination from which we extracted 77 radiomics features from T1-contrast-enhanced and T2-weighted images. Additionally, patient demographics, maximum standardized uptake value on FDG PET/CT, and the mean apparent diffusion coefficient value on diffusion-weighted image, were considered together to build prediction models for high-risk pathologic features. Results: Among 616 patients, 72 patients met the imaging criteria for high-risk lung cancer and underwent lung MRI. The magnetic resonance (MR)–eligible group showed a higher prevalence of nodal upstaging (29.2% vs. 4.2%, p < 0.001), vascular invasion (6.5% vs. 2.1%, p=0.011), high-grade pathologic features (p < 0.001), worse 4-year disease-free survival (p < 0.001) compared with non-MR-eligible group. The prediction power for MR-based radiomics model predicting high-risk pathologic features was good, with mean area under the receiver operating curve (AUC) value measuring 0.751-0.886 in test sets. Adding clinical variables increased the predictive performance for MPsol and the poorly differentiated pattern using the 2021 grading system (AUC, 0.860 and 0.907, respectively). Conclusion Our imaging criteria can effectively screen high-risk lung cancer patients and predict high-risk pathologic features by our MR-based prediction model using radiomics.

Purpose: In Korea, the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment (LST) was implemented on February 4, 2018. We aimed to investigate relevant factors and clinical changes associated with LST decisions after law enforcement. Materials and Methods: This single-center retrospective study included patients who completed LST documents using legal forms at Asan Medical Center from February 5, 2018, to June 30, 2020. Results: 5,896 patients completed LST documents, of which 2,704 (45.8%) signed the documents in person, while family members of 3,192 (54%) wrote the documents on behalf of the patients. Comparing first year and following year of implementation of the act, the self-documentation rate increased (43.9% to 47.2%, p=0.014). Moreover, the number of LST decisions made during or after intensive care unit admission decreased (37.8% vs. 35.2%, p=0.045), and the completion rate of LST documents during chemotherapy increased (6.6% vs. 8.9%, p=0.001). In multivariate analysis, age < 65 (odds ratio [OR], 1.724; 95% confidence interval [CI], 1.538 to 1.933; p < 0.001), unmarried status (OR, 1.309; 95% CI, 1.097 to 1.561; p=0.003), palliative care consultation (OR, 1.538; 95% CI, 1.340 to 1.765; p < 0.001), malignancy (OR, 1.864; 95% CI, 1.628 to 2.133; p < 0.001), and changes in timing on the first year versus following year (OR, 1.124; 95% CI, 1.003 to 1.260; p=0.045) were related to a higher self-documentation rate. Conclusion Age < 65 years, unmarried status, malignancy, and referral to a palliative care team were associated with patients making LST decisions themselves. Furthermore, the subject and timing of LST decisions have changed with the LST act.

Purpose: This study aimed to analyze whether the occurrence of complications increases if radiotherapy (RT) is administered after breast reconstructive surgery using implants. Methods: This retrospective study included 80 patients who underwent breast reconstruction using implants, of which 16 (20.0%) underwent RT. Most patients underwent conventional fractionated RT (n = 13), and hypofractionated RT was performed in 3 patients. Most patients (n = 51, 63.8%) underwent delayed reconstruction, which involved implant replacement after tissue expander insertion. Only 29 patients (36.3%) underwent immediate reconstruction simultaneously with breast cancer surgery. Results: The median postoperative follow-up was 39.9 months (range, 8.7–120.3 months). Complications occurred in 18 (22.5%); infectionecrosis (n = 8), leakage/rupture (n = 8), and capsular contracture (n = 2). Infectionecrosis is common in patients undergoing RT. Complications occurred in 4 patients (25.0%) who received RT and 14 (21.9%) who did not receive RT, and complications did not significantly increase with RT (P = 0.511). There was no overall difference in complications between the immediate (4 of 29) and delayed (14 of 51) reconstruction groups (P = 0.129). Nine patients underwent reoperation because of complications; 3 (18.8%) received RT and 6 (9.4%) did not receive RT. The reoperation rate did not increase significantly with RT (P = 0.254). There were 3 cases of recurrence, and patients who received RT had no recurrence. Conclusion RT did not significantly increase the complication or reoperation rates if reconstructive surgery was performed using implants. Therefore, RT should be performed in patients at a high risk of recurrence.

Purpose: Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that can significantly diminish quality of life. Although some patients have reported persistent pelvic pain after radical prostatectomy (RP), the prevalence and direct causal relationship between CPPS and RP remain unclear. This multicenter prospective study aimed to evaluate the efficacy of Urovaxom for improving CPPS symptoms. Materials and Methods: A total of 52 prostate cancer patients who underwent RP were enrolled and administered Urovaxom (60 mg/day) for 12 weeks. Changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and inflammation markers (white blood cell [WBC], C-reactive protein [CRP]) were analyzed using the Wilcoxon signed-rank test. Results: After 12 weeks of treatment, the NIH-CPSI total score significantly decreased from 19 (interquartile range [IQR], 16–23) to 12.5 (IQR, 8.0–16.8) (p<0.001). The OABSS total score decreased from 8 (IQR, 4–11) to 5 (IQR, 3.0–7.8), and the IPSS total score decreased from 13.5 (IQR, 10.0–22.8) to 10.5 (IQR, 5.0–17.0) (p<0.001). WBC levels showed a slight increase (p=0.028), but the clinical relevance of this change is uncertain and warrants further investigation. CRP changes were not statistically significant (p=0.274). Conclusions Urovaxom demonstrated significant efficacy in improving CPPS symptoms, particularly pain and reduced quality of life, in patients following RP. These findings suggest Urovaxom as a potential therapeutic option for CPPS after management using RP.

Purpose: Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that can significantly diminish quality of life. Although some patients have reported persistent pelvic pain after radical prostatectomy (RP), the prevalence and direct causal relationship between CPPS and RP remain unclear. This multicenter prospective study aimed to evaluate the efficacy of Urovaxom for improving CPPS symptoms. Materials and Methods: A total of 52 prostate cancer patients who underwent RP were enrolled and administered Urovaxom (60 mg/day) for 12 weeks. Changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and inflammation markers (white blood cell [WBC], C-reactive protein [CRP]) were analyzed using the Wilcoxon signed-rank test. Results: After 12 weeks of treatment, the NIH-CPSI total score significantly decreased from 19 (interquartile range [IQR], 16–23) to 12.5 (IQR, 8.0–16.8) (p<0.001). The OABSS total score decreased from 8 (IQR, 4–11) to 5 (IQR, 3.0–7.8), and the IPSS total score decreased from 13.5 (IQR, 10.0–22.8) to 10.5 (IQR, 5.0–17.0) (p<0.001). WBC levels showed a slight increase (p=0.028), but the clinical relevance of this change is uncertain and warrants further investigation. CRP changes were not statistically significant (p=0.274). Conclusions Urovaxom demonstrated significant efficacy in improving CPPS symptoms, particularly pain and reduced quality of life, in patients following RP. These findings suggest Urovaxom as a potential therapeutic option for CPPS after management using RP.