Long-Term Clinical Efficacy of Radiotherapy for Patients with Stage I-II Gastric Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue: A Retrospective Multi-Institutional Study.

Purpose: To evaluate long-term treatment outcomes in patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma treated with radiation therapy (RT). Materials and Methods: A total of 229 patients who received RT in ten tertiary hospitals between 2010 and 2019 were included in this multi-center analysis. Response after RT was based on esophagogastroduodenoscopy after RT. Locoregional relapse-free survival (LRFS) and disease-free survival (DFS) were evaluated. Results: After a median follow-up time of 93.2 months, 5-year LRFS, DFS, and OS rates were 92.8%, 90.4%, and 96.1%, respectively. LRFS, DFS, and OS rates at 10 years were 90.3%, 87.7%, and 92.8%, respectively. Of 229 patients, 228 (99.6%) patients achieved complete remission after RT. Five-year LRFS was significantly lower in patients with stage IIE than in those with stage IE (77.4% vs. 94.2%, p=0.047). Patients with age ≥ 60 had significantly lower LRFS than patients with age < 60 (89.3% vs. 95.1%, p=0.003). In the multivariate analysis, old age (≥ 60 years) was a prognostic factor for LRFS [hazard ratio (HR) of 3.72 and confidence interval (CI), 1.38-10.03; p=0.009). Grade 2 or higher gastritis was reported in 69 (30.1%) patients. Secondary malignancies including gastric adenocarcinoma, malignant lymphoma, lung cancer, breast cancer, and prostate cancer were observed in 11 (4.8%) patients after RT. Conclusion: Patients treated with RT for localized gastric MALT lymphoma showed favorable 10-year outcomes. Radiation therapy is an effective treatment without an increased risk of secondary cancer. The toxicity for radiotherapy to the stomach is not high.

Expression of claudin 18.2 in poorly cohesive carcinoma and its association with clinicopathologic parameters in East Asian patients.

BACKGROUND: Poorly cohesive carcinoma (PCC) is a distinct subtype of gastric cancer with limited therapeutic options. This study investigated claudin (CLDN) 18.2 expression status in PCCs using a 43-13 A clone. METHODS: We retrospectively collected 178 consecutive surgically resected stage Ⅱ-Ⅲ gastric cancer samples. Tissue microarray blocks were constructed for CLDN18.2 immunohistochemical staining. We studied CLDN18.2 expression and its association with clinicopathologic parameters. RESULTS: CLDN18.2 positivity (defined by ≥ 75 % of tumor cells showing moderate to strong membranous positivity) was found in 34.8 % of the PCC cases (62/178). Approximately half of the CLDN18.2 positive PCCs demonstrated heterogeneous expression (51.6 %, 32/62). CLDN18.2 positivity was not associated with any clinicopathologic parameters examined. However, CLDN18.2 positivity tended to be more frequent in E-cadherin-positive PCCs (no loss of expression) than in E-cadherin-negative PCCs (loss of expression) (50 % vs. 27.7 %). The CLDN18.2 expression level, represented by the H-score, gradually decreased as the paraffin block storage time increased (P = 0.046). Overall survival and disease-free survival analyses showed no significant difference between CLDN18.2-positive and negative PCCs. CONCLUSIONS: A significant portion of surgically resected PCC specimens showed CLDN18.2 positivity. Additionally, since the expression level of CLDN18.2 gradually decreases with increased paraffin block storage time, reflex testing can be considered at the time of the cancer diagnosis.

Recurrence pattern of glioblastoma treated with intensity-modulated radiation therapy versus three-dimensional conformal radiation therapy.

PURPOSE: To evaluate recurrence patterns of and survival outcomes in glioblastoma treated with intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3D-CRT). MATERIALS AND METHODS: We retrospectively examined 91 patients with glioblastoma treated with either IMRT (n = 60) or 3D-CRT (n = 31) between January 2013 and December 2019. Magnetic resonance imaging showing tumor recurrence and planning computed tomography scans were fused for analyzing recurrence patterns categorized as in-field, marginal, and out-of-field based on their relation to the initial radiation field. RESULTS: The median overall survival (OS) was 18.9 months, with no significant difference between the groups. The median progression-free survival (PFS) was 9.4 months, with no significant difference between the groups. Patients who underwent gross total resection (GTR) had higher OS and PFS than those who underwent less extensive surgery. Among 78 relapse cases, 67 were of in-field; 5, marginal; and 19, out-of-field recurrence. Among 3D-CRT-treated cases, 24 were of in-field; 1, marginal; and 9, out-of-field recurrence. Among IMRT-treated cases, 43 were of in-field; 4, marginal; and 10, out-of-field recurrence. In partial tumor removal or biopsy cases, out-of-field recurrence was less frequent in the IMRT (16.2%) than in the 3D-CRT (36.3%) group, with marginal significance (p = 0.079). CONCLUSION: IMRT and 3D-CRT effectively managed glioblastoma with no significant differences in OS and PFS. The survival benefit with GTR underscored the importance of maximal surgical resection. The reduced rate of out-of-field recurrence in IMRT-treated patients with partial resection highlights its potential utility in cases with unfeasible complete tumor removal.

Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 3. Genitourinary and gynecological cancers.

Hypofractionated radiotherapy (RT) has become a trend in the modern era, as advances in RT techniques, including intensity-modulated RT and image-guided RT, enable the precise and safe delivery of high-dose radiation. Hypofractionated RT offers convenience and can reduce the financial burden on patients by decreasing the number of fractions. Furthermore, hypofractionated RT is potentially more beneficial for tumors with a low α/ß ratio compared with conventional fractionation RT. Therefore, hypofractionated RT has been investigated for various primary cancers and has gained status as a standard treatment recommended in the guidelines. In genitourinary (GU) cancer, especially prostate cancer, the efficacy, and safety of various hypofractionated dose schemes have been evaluated in numerous prospective clinical studies, establishing the standard hypofractionated RT regimen. Hypofractionated RT has also been explored for gynecological (GY) cancer, yielding relevant evidence in recent years. In this review, we aimed to summarize the representative evidence and current trends in clinical studies on hypofractionated RT for GU and GY cancers addressing several key questions. In addition, the objective is to offer suggestions for the available dose regimens for hypofractionated RT by reviewing protocols from previous clinical studies.

Development and validation of a machine learning-based model for post-sepsis frailty.

Background: The development of post-sepsis frailty is a common and significant problem, but it is a challenge to predict. Methods: Data for deep learning were extracted from a national multicentre prospective observational cohort of patients with sepsis in Korea between September 2019 and December 2021. The primary outcome was frailty at survival discharge, defined as a clinical frailty score on the Clinical Frailty Scale ≥5. We developed a deep learning model for predicting frailty after sepsis by 10 variables routinely collected at the recognition of sepsis. With cross-validation, we trained and tuned six machine learning models, including four conventional and two neural network models. Moreover, we computed the importance of each predictor variable in the model. We measured the performance of these models using a temporal validation data set. Results: A total of 8518 patients were included in the analysis; 5463 (64.1%) were frail, and 3055 (35.9%) were non-frail at discharge. The Extreme Gradient Boosting (XGB) achieved the highest area under the receiver operating characteristic curve (AUC) (0.8175) and accuracy (0.7414). To confirm the generalisation performance of artificial intelligence in predicting frailty at discharge, we conducted external validation with the COVID-19 data set. The XGB still showed a good performance with an AUC of 0.7668. The machine learning model could predict frailty despite the disparity in data distribution. Conclusion: The machine learning-based model developed for predicting frailty after sepsis achieved high performance with limited baseline clinical parameters.

Transformable Gel-to-Nanovaccine Enhances Cancer Immunotherapy via Metronomic-Like Immunomodulation and Collagen-Mediated Paracortex Delivery.

The generation of non-exhausted effector T-cells depends on vaccine's spatiotemporal profile, and untimely delivery and low targeting to lymph node (LN) paracortex by standard bolus immunization show limited efficacy. By recapitulating the dynamic processes of acute infection, a bioadhesive immune niche domain (BIND) is developed that facilitates the delivery of timely-activating conjugated nanovaccine (t-CNV) in a metronomic-like manner and increased the accumulation and retention of TANNylated t-CNV (tannic acid coated t-CNV) in LN by specifically binding to collagen in subcapsular sinus where they gradually transformed into TANNylated antigen-adjuvant conjugate by proteolysis, inducing their penetration into paracortex through the collagen-binding in LN conduit and evoking durable antigen-specific CD8+ T-cell responses. The BIND combined with t-CNV, mRNA vaccine, IL-2, and anti-PD-1 antibody also significantly enhanced cancer immunotherapy by the dynamic modulation of immunological landscape of tumor microenvironment. The results provide material design strategy for dynamic immunomodulation that can potentiate non-exhausted T-cell-based immunotherapy.

A noninvasive method of diagnosing membranous nephropathy using exosomes derived from urine.

Background: Membranous nephropathy (MN) is a specific autoimmune disease affecting kidneys. It is characterized by the accumulation of immune complexes in the glomerular basement membrane. Renal biopsy is currently the standard procedure to confirm the diagnosis, although the presence of autoantibodies against the phospholipase A2 receptor (PLA2R) can also help diagnose. In this study, we aimed to investigate the potential of urinary exosomes as noninvasive markers for diagnosing MN. Methods: Exosomes were extracted from urine samples of five patients with MN and four healthy controls. The concentration of PLA2R was measured in both urine and isolated exosomes using enzyme-linked immunosorbent assay techniques. The measurements were adjusted based on the urine creatinine (UCr) level of each participant. Results: The levels of PLA2R/UCr were investigated in urine and urine-derived exosomes from patients and controls. Results of the analysis revealed significantly higher expression of PLA2R/UCr in patients compared to the control group (p < 0.05). Furthermore, the expression level of PLA2R/UCr was higher in urine-derived exosomes than in urine samples. Additionally, a positive correlation was observed between the expression levels of PLA2R/UCr and the urine protein-to-creatinine ratio, with urine-derived exosomes exhibiting a stronger correlation than urine samples. Conclusion: Studies have indicated that measuring exosomal PLA2R/UCr levels in urine could be a noninvasive method for diagnosing MN. Using urine-derived exosomes could also reduce the burden of performing a biopsy on patients and facilitate follow-up treatment, such as monitoring for future recurrence.

Effects of phytogenic feed additives in growing and finishing pigs under different stocking density.

This study was to investigate effects of different phytogenic feed additives (PFA) in grower finishing pigs with stressed by high stocking density. A total of 84 growing pigs ([Landrace × Yorkshire] × Duroc) with initial body weight (BW) of 28.23 ± 0.21 kg were used for 10 weeks (4 replicate pens with 3 pigs per pen). The dietary treatment consisted of basal diets in animal welfare density (positive control [PC]), basal diet in high stocking density (negative control [NC]), NC + 0.04% bitter citrus extract (PT1), NC + 0.01% microencapsulated blend of thymol & carvacrol (PT2), NC + 0.10% mixture of 40% bitter citrus extract and 10% microencapsulated blend of thymol and carvacrol (PT3), NC + 0.04% premixture of grape seed and grape marc extract, green tea and hops (PT4), and NC + 0.10% fenugreek seed powder (PT5). The reduction of space allowance significantly decreased (p < 0.05) growth performance (average daily gain, average daily feed intake, feed efficiency) and nutrient digestibility (dry matter, crude protein). Also, the fecal score of NC group increased (p < 0.05) compared with other groups. In blood profiles, lymphocyte decreased (p < 0.05), and neutrophil, cortisol, TNF-α increased (p < 0.05) when pigs were in high stocking density. Basic behaviors (feed intake, standing, lying) were inactive (p < 0.05) and singularity behavior (biting) were increased (p < 0.05) under high stocking density. However, PFA groups alleviated the negative effects such as reducing growth performance, nutrient digestibility, increasing stress indicators in blood and animal behavior. In conclusion, PFA groups improved the health of pigs with stressed by high stocking density and PT3 is the most effective.

Unveiling the role of transgelin as a prognostic and therapeutic target in kidney fibrosis via a proteomic approach.

Chronic kidney disease (CKD) progression involves tubulointerstitial fibrosis, a process characterized by excessive extracellular matrix accumulation. To identify potential biomarkers for kidney fibrosis, we performed mass spectrometry-based proteomic profiling of human kidney tubular epithelial cells and kidney tissue from a 5/6 nephrectomy rat model. Multidisciplinary analysis across kidney fibrosis models revealed 351 differentially expressed proteins associated with kidney fibrosis, and they were enriched in processes related to the extracellular matrix, kidney aging, and mitochondrial functions. Network analysis of the selected proteins revealed five crucial proteins, of which transgelin emerged as a candidate protein that interacts with known fibrosis-related proteins. Concordantly, the gene expression of transgelin in the kidney tissue from the 5/6 nephrectomy model was elevated. Transgelin expression in kidney tissue gradually increased from intermediate to advanced fibrosis stages in 5/6 Nx rats and mice with unilateral ureteral obstruction. Subsequent validation in kidney tissue and urine samples from patients with CKD confirmed the upregulation of transgelin, particularly under advanced disease stages. Moreover, we investigated whether blocking TAGLN ameliorated kidney fibrosis and reduced reactive oxygen species levels in cellular models. In conclusion, our proteomic approach identified TAGLN as a potential noninvasive biomarker and therapeutic target for CKD-associated kidney fibrosis, suggesting its role in modulating mitochondrial dysfunction and oxidative stress responses.

Determining ecological interactions of key dinoflagellate species using an intensive metabarcoding approach in a semi-closed coastal ecosystem of South Korea.

Marine phytoplankton communities are pivotal in biogeochemical cycles and impact global climate change. However, the dynamics of the dinoflagellate community, its co-occurrence relationship with other eukaryotic plankton communities, and environmental factors remain poorly understood. In this study, we aimed to analyze the temporal changes in the eukaryotic plankton community using a 18S rDNA metabarcoding approach. We performed intensive monitoring for 439 days at intervals of three days during the period from November 2018 to June 2020 (n = 260) in Jangmok Bay Time-series Monitoring Site in South Korea. Among the 16,224 amplicon sequence variants (ASVs) obtained, dinoflagellates were the most abundant in the plankton community (38 % of total relative abundance). The dinoflagellate community was divided into 21 groups via cluster analysis, which showed an annually similar distribution of low-temperature periods. Additionally, we selected 11 taxa that had an occurrence mean exceeding 1 % of the total dinoflagellate abundance, accounting for 93 % of the total dinoflagellate community: namely Heterocapsa rotundata, Gymnodinium sp., Akashiwo sanguinea, Amoebophrya sp., Euduboscquella sp., Spiniferites ramosus, Dissodinium pseudolunula, Sinophysis sp., Karlodinium veneficum, and Katodinium glaucum. The key dinoflagellate species were well represented at temporally variable levels over an entire year. Heterocapsa rotundata was not significantly affected by water temperature, whereas its dynamics were largely influenced by strong predation pressure, competition, and/or the supplementation of food sources. The growth of A. sanguinea was associated with dissolved inorganic phosphorus concentrations, while Euduboscquella sp. showed a significant relationship with D. pseudolunula and K. glaucum, largely representing a positive association that implies possible parasitic mechanisms. This study demonstrated interactions between key dinoflagellate species and the environment, as well as parasites, predators, competitors, and feeders.

The Effect of Strength and Balance Training on Kinesiophobia, Ankle Instability, Function, and Performance in Elite Adolescent Soccer Players with Functional Ankle Instability: A Prospective Cluster Randomized Controlled Trial.

We aimed to implement strength and balance training for elite adolescent male soccer players with functional ankle instability (FAI) to assess kinesiophobia, ankle instability, ankle function, and performance. This cluster randomized controlled trial comprised 51 elite adolescent male soccer players with FAI recruited from six different teams, divided into strength, balance, and control groups (SG, n = 17; BG, n = 17; and CG, n = 17, respectively). The SG and BG underwent strength and balance training sessions three times per week for 6 weeks. Primary outcomes were the Tampa scale for kinesiophobia-17 (TSK) and Cumberland ankle instability tool (CAIT) scores to assess kinesiophobia and FAI, respectively. Secondary outcomes were ankle strength (four directions), dynamic balance, static balance (ellipse, displacement, velocity), and performance (figure 8 and side-hop tests). A significant interaction effect was observed for both TSK and CAIT post-intervention (both, P < 0.01). In post hoc analyses, the BG had significantly better outcomes in reducing TSK. The SG and BG showed greater improvements in CAIT scores. Regression analysis indicated that CAIT severity correlated significantly with TSK (P = 0.039, R = 0.289). For secondary outcomes, the SG and BG were superior in terms of ankle dorsiflexion/inversion strength, static balance displacement, and figure-8 and side-hop tests (all, P < 0.05). The BG showed significantly better static balance ellipse results (P < 0.05). The 6-week intervention significantly enhanced kinesiophobia management, ankle stability, and performance. Balance training effectively mitigated kinesiophobia and improved balance, compared with strength training alone. Even small variations in CAIT severity can influence kinesiophobia, highlighting the potential benefits of balance training. Integrating balance training into training programs can address both physical and psychological aspects of ankle instability. Research is recommended to explore the longitudinal effects of these interventions and their potential to prevent injury recurrence.

Analysis of the waitlist performance and post-transplant outcomes of lung transplant in elderly recipients in Korea: A nationwide cohort study.

BACKGROUND: There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea. METHODS: We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023. RESULTS: In total, 2574 patients were listed for lung transplantation during the study period, with 511 (19.9%) of them being over 65 years of age. Among these, 188 patients (36.8%) underwent transplantation, while 184 patients (36%) passed away without undergoing transplantation at the time of data extraction. The most prevalent underlying disease on the waitlist was idiopathic pulmonary fibrosis, accounting for 68.1%. The 1-year survival rate was significantly lower in the elderly compared to that in the nonelderly (65.4 vs. 75.4%; p = .004). In the multivariate Cox analysis, elderly (hazard ratio [HR], 1.49; 95% CI, 1.14-1.97; p = .004) and a high urgent status at registration (HR, 1.83; 95% CI, 1.40-2.40; p < .001) were significantly associated with post-transplant 1-year mortality. Kaplan-Meier curves demonstrated a significant difference in post-transplant mortality based on the urgency status at enrollment (χ2 = 8.302, p = .016). Even with the same highly urgent condition at the time of transplantation, different prognoses were observed depending on the condition at listing (χ2 = 9.056, p = .029). CONCLUSION: The elderly exhibited worse transplant outcomes than nonelderly adults, with a highly urgent status at registration identified as a significant risk factor. Unprepared, highly urgent transplantation was associated with poor outcomes.

Beyond complete remission: A comparative analysis of long-term laryngeal function in patients with hypopharyngeal and laryngeal cancer following radiotherapy and concurrent chemoradiation.

BACKGROUND: This study evaluates functional larynx preservation in patients with hypopharyngeal cancer (HPC) and laryngeal cancer (LC) who achieved complete remission following radiotherapy (RT) or concurrent chemoradiation (CCRT). METHODS: HPC and LC patients treated with RT/CCRT from 1999 to 2017 were retrospectively analyzed. Severe late dysphagia and tracheostomy cases were assessed to determine laryngeal function. Long-term preservation rate of functional larynx and associated factors were evaluated. RESULTS: Of 152 patients (55 HPC, 97 LC), nine developed severe dysphagia, occurring on average 58.2 months post-treatment. HPC and cervical node metastasis significantly increased the risk of laryngeal function impairment (p < 0.001 and p = 0.014, respectively), presenting a continued decline in functional larynx preservation rate beyond 10 years. CONCLUSIONS: Patients with HPC and cervical node metastasis demonstrate an increased risk for long-term laryngeal function impairment despite successful oncologic outcomes. This risk extends beyond 10 years, underscoring the need for prolonged monitoring and comprehensive support.

Long-term acclimation to organic carbon enhances the production of loliolide from Scenedesmus deserticola.

Production of functional biocompounds from microalgae has garnered interest from different industrial sectors; however, their overall productivity must be substantially improved for commercialization. Herein, long-term acclimation of Scenedesmus deserticola was conducted using glucose as an organic carbon source to enhance its heterotrophic capabilities and the production potential of loliolide. A year-long acclimation on agar plates led to the selection of S. deserticola HS4, which exhibited at least 2-fold increase in loliolide production potential; S. deserticola HS4 was subjected to further screening of its cultivation conditions and fed-batch cultivation was subsequently performed in liter-scale reactors. While S. deserticola HS4 exhibited shifts in cellular morphology and biochemical composition, the results suggested a substantial increase in its loliolide productivity regardless of trophic modes. Collectively, these results highlight the potential of long-term acclimation as an effective strategy for improving microalgal crops to align with industrial production practices.

Liver-specific Coxsackievirus and adenovirus receptor deletion develop metabolic dysfunction-associated fatty liver disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common liver disease associated with obesity and is caused by the accumulation of ectopic fat without alcohol consumption. Coxsackievirus and adenovirus receptor (CAR) are vital for cardiac myocyte-intercalated discs and endothelial cell-to-cell tight junctions. CAR has also been reported to be associated with obesity and high blood pressure. However, its function in the liver is still not well understood. The liver of obese mice exhibit elevated CAR mRNA and protein levels. Furthermore, in the liver of patients with non-alcoholic steatohepatitis, CAR is reduced in hepatocyte cell-cell junctions compared to normal levels. We generated liver-specific CAR knockout (KO) mice to investigate the role of CAR in the liver. Body and liver weights were not different between wild-type (WT) and KO mice fed a paired or high-fat diet (HFD). However, HFD induced significant liver damage and lipid accumulation in CAR KO mice compared with WT mice. Additionally, inflammatory cytokines transcription, hepatic permeability, and macrophage recruitment considerably increased in CAR KO mice. We identified a new interaction partner of CAR using a protein pull-down assay and mass spectrometry. Apolipoprotein B mRNA editing enzyme catalytic polypeptide-like 3C (APOBEC3C) demonstrated a complex relationship with CAR, and hepatic CAR expression tightly regulated its level. Moreover, Apolipoprotein B (ApoB) and Low-density lipoprotein receptor (LDLR) levels correlated with APOBEC3C expression in the liver of CAR KO mice, suggesting that CAR may regulate lipid accumulation by controlling APOBEC3C activity. In this study, we showed that hepatic CAR deficiency increased cell-to-cell permeability. In addition, CAR deletion significantly increased hepatic lipid accumulation by inducing ApoB and LDLR expression. Although the underlying mechanism is unclear, CARs may be a target for the development of novel therapies for MAFLD.

The Effect of Transpedicular Injection of Recombinant Human Bone Morphogenetic Protein-2/Beta-Tricalcium Phosphate Carrier on the Prevention of Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery: A Pilot Study.

BACKGROUND AND OBJECTIVES: Several studies have explored strategies to prevent proximal junctional kyphosis (PJK) which is the unresolved issue in adult spinal deformity (ASD) surgery. This study aimed to investigate the preventive effects of upper instrumented vertebrae (UIV) recombinant human bone morphogenetic protein-2 (rhBMP-2) with beta-tricalcium phosphate (ß-TCP) carrier injection on PJK. METHODS: This study was conducted through a retrospective analysis of data collected both prospectively and retrospectively. In the rhBMP-2 group, consisting of 25 patients with ASD, rhBMP-2 along with ß-TCP carrier was administered to the UIV through the pedicle. To minimize time-related bias, control-1 included 66 patients who had undergone ASD surgery by the same surgeon in the year preceding the commencement of the study. Control-2 consisted of 63 patients who had undergone ASD surgery by the same surgeon during the year after the end of the study. The primary outcome is the occurrence of PJK within one year postsurgery, and the secondary outcome is the change in Hounsfield unit of the UIV one year after the surgery. RESULTS: When comparing baseline characteristics with control groups, a significant difference was observed only in body mass index, with control-1 (P = .006) and control-total (control-1 + control-2, P = .026) having a higher body mass index than the study group. In the rhBMP-2 group, there were 3 cases (PJK rate, 12.0%) of PJK, whereas control-1 and control-2 had 26 cases (PJK rate, 39.4%, P = .012) and 20 cases (PJK rate, 31.7%, P = .057), respectively. In the control-total, there were 46 cases (PJK rate, 35.7%, P = .020) of PJK. The UIV that received rhBMP-2 showed a statistically significant increase in Hounsfield unit measurements compared to preoperative values 1 year after surgery (P = .001). CONCLUSION: The transpedicular injection of rhBMP-2/ß-TCP carrier at the UIV significantly contributed to the prevention of PJK and effectively increased trabecular bone density at the UIV.

Cross-Modality Image Translation From Brain 18F-FDG PET/CT Images to Fluid-Attenuated Inversion Recovery Images Using the CypixGAN Framework.

PURPOSE: PET/CT and MRI can accurately diagnose dementia but are expensive and inconvenient for patients. Therefore, we aimed to generate synthetic fluid-attenuated inversion recovery (FLAIR) images from 18F-FDG PET and CT images of the human brain using a generative adversarial network (GAN)-based deep learning framework called the CypixGAN, which combined the CycleGAN framework with the L1 loss function of the pix2pix. PATIENTS AND METHODS: Data from 143 patients who underwent PET/CT and MRI were used for training (n = 79), validation (n = 20), and testing (n = 44) the deep learning frameworks. Synthetic FLAIR images were generated using the pix2pix, CycleGAN, and CypixGAN, and white matter hyperintensities (WMHs) were then segmented. The performance of CypixGAN was compared with that of the other frameworks. RESULTS: The CypixGAN outperformed the pix2pix and CycleGAN in generating synthetic FLAIR images with superior visual quality. Peak signal-to-noise ratio and structural similarity index (mean ± standard deviation) estimated using the CypixGAN (20.23 ± 1.31 and 0.80 ± 0.02, respectively) were significantly higher than those estimated using the pix2pix (19.35 ± 1.43 and 0.79 ± 0.02, respectively) and CycleGAN (18.74 ± 1.49 and 0.78 ± 0.02, respectively) (P < 0.001). WMHs in synthetic FLAIR images generated using the CypixGAN closely resembled those in ground-truth images, as indicated by the low absolute percentage volume differences and high dice similarity coefficients. CONCLUSIONS: The CypixGAN generated high-quality FLAIR images owing to the preservation of spatial information despite using unpaired images. This framework may help improve diagnostic performance and cost-effectiveness of PET/CT when MRI scan is unavailable.

Effectiveness of a protein-supplemented very-low-calorie diet program for weight loss: a randomized controlled trial in South Korea.

Introduction: Weight-loss strategies through meal replacements are effective and sustainable options. However, few studies have assessed their effects on weight loss including body composition through protein-supplemented meal replacements targeting the Asian population, including Koreans. This study aimed to assess the effectiveness and safety of a protein-supplemented very-low-calorie diet (PSVLCD) for weight reduction and changes in body composition in individuals with obesity over a 12-month long-term period. Methods: In total, 106 participants with obesity were randomly assigned to a PSVLCD or control group (food-based calorie-restricted diet). Body weight, waist circumference, body composition, and blood marker levels were measured throughout the study. Statistical analyses were performed to compare outcomes between the groups. Results: Among the 106 participants, 84 completed the 12-month follow-up. Intention-to-treat analysis showed that the mean weight loss from baseline to 12 months was -6.86 kg (8.21% of baseline weight) in the PSVLCD group and - 4.66 kg (5.47% of initial body weight) in the control group; the difference was -2.20 kg with a marginally significant interval (95% confidence interval [CI], -4.90; 0.50). Waist circumference (-8.35 cm vs. -4.85 cm; mean difference, -3.49 cm; 95% CI, -6.48 to -0.50) and visceral fat area (-28.28 cm2 vs. -13.26 cm2; mean difference, -15.03cm2; 95% CI, -29.01 to -1.04) also significantly decreased in the PSVLCD group at 12 months. Discussion: The PSVLCD group demonstrated a substantial initial reduction in waist circumference that was sustained over the study period, alongside a marginally significant decrease in weight. These findings suggest that a protein-supplemented very-low-calorie diet may be an effective strategy for long-term weight management and body composition improvement in individuals with obesity. Clinical trial registration: ClinicalTrials.gov, identififer NCT04597788.

High-Intensity focused ultrasound linear array and system for dermatology treatment.

Dermatological lesions are typically located just a few millimeters below the surface of the skin, which constrains the efficacy of optical-based therapeutic methods such as photothermal and photodynamic therapy due to limited therapeutic depth caused by optical scattering. As an alternative, high-intensity focused ultrasound (HIFU) has been explored for its potential to treat a variety of dermatological conditions because it offers greater flexibility in terms of treatment depth. Since dermatological lesions have a small thickness ranging from 1.5 to 2.0 mm, high-frequency ultrasound (3-10 MHz or higher) is preferred as the focal area is proportional to the operating frequency. However, due to the difficulty in fabricating HIFU array transducers at this frequency range, the majority of HIFU treatments for dermatology rely on single element transducers. Despite the advantages of HIFU, single-element-based HIFU systems are limited in prevalent use for dermatology treatment due to their fixed focal length and mechanical movement for treatment, which can be time-consuming and unsuitable for treating multiple lesions. To address this, we present a newly developed HIFU linear array and 128-channel driving electronics specifically designed for dermatology treatment. This array consists of 128 elements, has a center frequency of 3.7 MHz, an elevation focal length of 28 mm, and an F-number of 1.27 in the elevation direction. The array has a footprint of 71.6 mm by 22 mm. Experiments using a tissue-mimicking phantom have demonstrated that the HIFU linear array and system are capable of transmitting sufficient ultrasound energy to create coagulation inside the phantom.