Nomogram for Predicting Infectious Complications Following Curative Gastrectomy Using Clinical and Laboratory Parameters.

BACKGROUND/AIM: Postoperative infectious complications are prevalent and significantly impact the prognosis and hospital stay duration after curative gastrectomy. This study aimed to identify predictive factors and develop a nomogram for predicting infectious complications prior to patient discharge. PATIENTS AND METHODS: Between April 2019 and December 2023, clinicopathological data of 237 patients with gastric cancer who underwent curative gastrectomy at the Eunpyeong St. Mary's Hospital were retrospectively reviewed. C-reactive protein (CRP), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), and procalcitonin (PCT) levels were analyzed. RESULTS: Overall, 58 patients experienced postoperative complications, with 33 patients developing infectious complications. Univariate analysis revealed that the open approach, esophagus involving resection, advanced stage, and operation time were risk factors for infectious complications among clinicopathologic characteristics. Significant associations with laboratory parameters and body temperature (BT) were observed from postoperative day (POD) 1 to 5, with the highest area under the curve (AUC) observed for POD 5 data in receiver operating characteristic (ROC) analysis. Multivariate analysis incorporating clinicopathologic features and laboratory parameters on POD 5 identified age (OR=2.98), approach (OR=4.05), operation time (OR=2.74), WBC count (OR=4.09), NLR (OR=9.74), and CRP (OR=2.62) as selected factors. The developed nomogram stratified patients into low-risk (<10%), intermediate-risk (10~50%), and high-risk (≥50%) groups, corresponding to actual infectious complication rates of 1.84%, 28.3%, and 71.43%, respectively. CONCLUSION: This study presents a novel estimating model for infectious complications following curative gastrectomy. The utilization of this model in patient discharge planning can aid in identifying individuals who require additional treatment, thereby minimizing unexpected readmissions.

Plane heating with a transparent heater film in a fish tank.

The water temperature in a fish tank is important for fish health. A conventional aquarium heater produces localized heating that causes water temperature variation, resulting in thermal stress to fish. This study presents plane heating with a transparent heater film that is aesthetically attractive when applied to fish tanks. The transparent heater film comprises a metal mesh with an optical transparency of 81 %, sheet resistance of 0.6 Ω/□, and mean heating surface temperature of 57 °C at 20 W. In the test setup, 100 W is applied to compare an aquarium heater and a transparent heater film. Increasing the water temperature from 23 °C to 24 °C at the center of the fish tank needs 28 min with the transparent heater film operating at 33 °C, whereas the same temperature increase needs 50 min with an aquarium heater operating at 49 °C. The planar heater thus results in enhanced heat diffusion and reduced water temperature variation due to its extended heating surface area.

Present and Future of AI-IoT-Based Healthcare Services for Senior Citizens in Local Communities: A Review of a South Korean Government Digital Healthcare Initiatives.

South Korea is promoting digital healthcare services in the public sector. One notable initiative is the "artificial intelligence and the internet of things (AI-IoT)-based healthcare project for senior citizens", which was implemented by the Korea Health Promotion Institute (KHPI). This project utilized an IoT-based digital healthcare service that integrates information technology and screen-based AI speaker functions. Services through this project are intended for senior citizens aged 65 years (or older) who face challenges in visiting public healthcare institutions owing to limitations on outdoor activities, especially in the post-coronavirus 2019 era. This article shares the recent outcomes of this project and outlines the mid-to-long-term development strategies for this style of South Korean digital healthcare initiatives.

Refining gastric cancer staging: examining the interplay between number and anatomical location of metastatic lymph nodes - a retrospective multi-institutional study.

BACKGROUND: The current gastric cancer staging system relies on the number of metastatic lymph nodes (MLNs) for nodal stage determination. However, incorporating additional information such as topographic status may help address uncertainties. This study evaluated the appropriateness of the current staging system and relative significance of MLNs based on their anatomical location. METHODS: Patients who underwent curative gastrectomy for gastric cancer between 2000 and 2019 at six Catholic Medical Center-affiliated hospitals were included. Lymph node-positive patients were classified into the perigastric (stations 1-6, group P) or extragastric (stations 7-12) groups. The extragastric group was further subdivided into the near-extragastric (stations 7-9, group NE) and far-extragastric (stations 10-12, group FE) groups. RESULTS: We analyzed the data of 3,591 patients with positive lymph node metastases. No significant survival differences were found between group P and the extragastric group in each N stage. However, in N1 and N2, group FE showed significantly worse survival than the other groups (p = 0.013 for N1, p < 0.001 for N2), but not in N3. In the subgroup analysis, group FE had a significantly lower overall survival in N2, regardless of the cancer location. CONCLUSIONS: Our large-scale multi-institutional big data analysis confirmed the superiority of the current numerical nodal staging system for gastric cancer. Nonetheless, in N1 and N2 in which there is an upper limit on metastatic nodes, attention should be paid to the potential significance of topographic information for specific nodal stations.

An Analysis of the Demographics and Clinical Characteristics of Transgender and Intersex Populations in Korea: A Retrospective Study Using HIRA Database.

BACKGROUND: Transgender and intersex populations have long remained under-documented in South Korea, largely due to the absence of comprehensive epidemiological data. With increasing societal acknowledgment, there's an urgent need to understand the demographics and health challenges faced by these communities. METHODS: This retrospective, large-scale data study included people who received the F64 codes from the Korean Health Insurance Review & Assessment Service between January 2007 and December 2021. Demographics, gender-affirmative treatments, and psychiatric related medications were examined. RESULTS: Between 2007 and 2021, 8,602 patients were diagnosed with "gender identity disorder" and 45 with "intersex." A steadily increasing annual prevalence was observed, peaking at 986 cases in 2021. The majority (79.8%) were aged between 10 and 30. Nearly half (53.2%) exhibited mental and behavioral disorders. Two-thirds had been prescribed anxiolytics or sedatives either before or after diagnosis. Merely 12.1% received hormone therapy covered by health insurance. CONCLUSION: This is the first large-scale study highlighting the demographics and clinical characteristics of the transgender and intersex populations in Korea. The study reveals a consistent growth of these communities over the past 15 years, with a significant proportion under 30 years of age facing mental and behavioral challenges. Findings underscore the need for targeted healthcare interventions, early psychological support, and comprehensive insurance coverage tailored to the specific needs of these individuals in Korea.

A comprehensive evaluation of ChatGPT consultation quality for augmentation mammoplasty: A comparative analysis between plastic surgeons and laypersons.

OBJECTIVES: ChatGPT has gained significant popularity as a source of healthcare information among the general population. Evaluating the quality of chatbot responses is crucial, requiring comprehensive and qualitative analysis. This study aims to assess the answers provided by ChatGPT during hypothetical breast augmentation consultations across various categories and depths. The evaluation involves the utilization of validated tools and a comparison of scores between plastic surgeons and laypersons. METHODS: A panel consisting of five plastic surgeons and five laypersons evaluated ChatGPT's responses to 25 questions spanning consultation, procedure, recovery, and sentiment categories. The DISCERN and PEMAT tools were employed to assess the responses, while emotional context was examined through ten specific questions. Additionally, readability was measured using the Flesch Reading Ease score. Qualitative analysis was performed to identify the overall strengths and weaknesses. RESULTS: Plastic surgeons generally scored lower than laypersons across most domains. Scores for each evaluation domain varied by category, with the consultation category demonstrating lower scores in terms of DISCERN reliability, information quality, and DISCERN score. Plastic surgeons assigned significantly lower overall quality ratings to the procedure category compared to other question categories. They also gave lower emotion scores in the procedure category compared to laypersons. The depth of the questions did not impact the scoring. CONCLUSIONS: Existing health information evaluation tools may not be entirely suitable for comprehensively evaluating the quality of individual responses generated by ChatGPT. Consequently, the development and implementation of appropriate evaluation tools to assess the appropriateness and quality of AI consultations are necessary.

Impact of health disparities on national breast cancer screening participation rates in South Korea.

Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p = < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.

Case Report: Severe osteoporosis misunderstood by bone metastasis after total gastrectomy and multiple metastasectomy.

After radical gastrectomy for gastric cancer, patients should be monitored from two perspectives. One is local recurrence or metastasis, and the other is nutritional and metabolic side effects. Herein, we report a case of severe osteoporosis that was misunderstood for bone metastasis due to increased bone scan and positron emission tomography-computed tomography uptake in the patient who underwent total gastrectomy and consecutive multivisceral metastasectomy. She was administered bisphosphonates, calcium carbonate, and cholecalciferol. After 3 months, a follow-up bone scan revealed decreased intensity of hot-uptake lesions, healed fracture lesions, and eventually improved bone pain. This study supports the need for careful nutritional screening as well as cancer surveillance after gastrectomy for gastric cancer and the need for screening guidelines for bone metabolic diseases.

First experience of lymphaticovenular anastomosis using BHC RobotiScope: A case report.

RATIONALE: The RoboticScope (BHS Technologies GmbH, Innsbruck, Austria) is a robotic exoscope, which consists of a robotic arm that holds a 3-dimensional camera. It has an advantage that a surgeon can perform an operation comfortably with a favorable ergonomic position. Also, it allows the delivery of clear and high-quality visualization for surgeons. In this study, we would like to share our initial experience with this newly developed microscope technology in lymphaticovenular anastomosis (LVA). To the best of our knowledge, it is the first experience of LVA using this microscope in Asia. PATIENT CONCERNS: A 65-year-old woman presented with bilateral lower extremity lymphedema after a hysterectomy that was performed 25 years back. Despite complex decongestive physiotherapy, an edematous symptom in both legs worsened. DIAGNOSES: In lymphoscintigraphy, a decreased visualization of main lymphatic flow in both the lower extremities was evident which was further suggestive of lymphatic obstruction. INTERVENTION: Although both sides showed edematous symptoms, we decided to proceed with the surgery on the left side first, because of the worsened condition. Four LVAs were performed at the dorsum of the foot (×2), ankle, and the superior edge of the knee using RoboticScope. OUTCOMES: At 6-months follow-up after operation, the postoperative circumference diameters were improved than preoperative in 10 cm above the knee (45 cm vs 49 cm), 10cm below the knee (37 cm vs 41 cm) and lateral malleolus (25 cm vs 28 cm). The lower extremity lymphedema index was also improved from 346.7 to 287.4 postoperatively. The RoboticScope provided a high-resolution image and a favorable ergonomic position during an operation. LESSONS: The results represent the possibility of the application of a robotic microscope in the field of microsurgery, and further studies are necessitated to confirm the efficacy of this system.

Quantitative analysis of facial symmetry and animation following intraoral orthodromic temporalis transfer in facial paralysis.

This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured. Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 ± 7.0 mm, non-affected side: 115.2 ± 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 ± 3.4 mm, non-affected side: 34.5 ± 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 ± 5.8°, non-affected side: 118.4 ± 4.9°, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry.

A Nomogram for Predicting Extraperigastric Lymph Node Metastasis in Patients With Early Gastric Cancer.

BACKGROUND: There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). MATERIALS AND METHODS: Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. RESULTS: Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. CONCLUSIONS: A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

Erratum: Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach.

This corrects the article on p. 3 in vol. 23, PMID: 36750993.

Potassium Molten Salt-Mediated In Situ Structural Reconstruction of a Carbon Nitride Photocatalyst.

Metal-free polymeric carbon nitride (PCN) materials are at the forefront of photocatalytic applications. Nevertheless, the overall functionality and performance of bulk PCN are limited by rapid charge recombination, high chemical inertness, and inadequate surface-active sites. To address these, here, we employed potassium molten salts (K+X-, where X- is Cl-, Br-, and I-) as a template for the in situ generation of surface reactive sites in thermal pyrolyzed PCN. Theoretical calculations imply that addition of KX salts to PCN-forming monomers causes halogen ions to be doped into C or N sites of PCN with a relative trend of halogen ion doping being Cl < Br < I. The experimental results show that reconstructing C and N sites in PCN develops newer reactive sites that are beneficial for surface catalysis. Interestingly, the photocatalytic H2O2 generation rate of KBr-modified PCN was 199.0 µmol h-1, about three times that of bulk PCN. Owing to the simple and straightforward approach, we expect molten salt-assisted synthesis to have wide exploration in modifying PCN photocatalytic activity.

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Korean practice guidelines for gastric cancer 2022: an evidence-based, multidisciplinary approach

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Novel nanocomposite thin film in the efficient removal of antibiotics using visible light: Insights of photocatalytic reactions and stability of thin film in real water implications.

Novel clay (bentonite) supported Ag0 nanoparticles (NPs) doped TiO2 nanocomposite (Clay/TiO2/Ag0(NPs)) thin film was obtained by using template synthesis method. The nanocomposite material is decorated with cubical Ag0(NPs) and utilised successfully in the photocatalytic degradation of tetracycline (TC) and sulfamethazine (SMZ) from aqueous solutions utilizing visible light and UV-A radiations. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET), X-ray photoelectron spectroscopy (XPS) analyses were used to characterise the nanocomposite materials. Diffusion reflectance spectroscopy (DRS) was utilised to determine the bandgap energies of the materials and also to confirm that Ag0(NPs) was successfully doped with TiO2. The nanocomposite material showed highly efficient photocatalytic activity for the breaking down of TC/SMZ under visible light irradiation by the enhanced electron-hole separation and adsorption of antibiotics at the vicinity of the catalyst. The oxidative degradation of TC/SMZ were shown to be highly dependent on the pH, initial concentration of TC/SMZ, and various co-existing ions. Reusability test of Clay/Ag0(NPs)/TiO2 nanocomposite revealed that the activity did not decline with repeated use. Treatment of TC and SMZ in real water system further enhanced the application potential of the novel catalysts for the treatment of full-scale wastewater polluted with these antibiotics.

Efficient and selective use of functionalized material in the decontamination of water: removal of emerging micro-pollutants from aqueous wastes.

The contamination of the aquatic environment with emerging micro-pollutants is a serious global concern. The aim of this investigation was to synthesize novel functionalized material (BNAPTES) precursor to natural bentonite in a single pot facile synthetic route. The material was utilized for efficient and selective removal of tetracycline (TC) and triclosan (TCS) in aqueous wastes. The grafting of silane was confirmed with the FT-IR (Fourier Transform Infra-Red) analysis and the EDX (Energy Dispersive X-ray) analysis showed the incorporation of amino group with the bentonite. The structural changes of clay due to silane grafting were studied with the help of XRD (X-ray Diffraction) and BET (Brunner-Emmett-Teller) surface area analyses. Batch adsorption studies showed that functionalized clay significantly increased the selectivity and adsorption capacity of bentonite for TC and TCS. The Langmuir monolayer adsorption capacity was found to be 15.36 and 17.15 mg/g for TC and TCS, respectively. The rapid uptake of TC and TCS by functionalized material followed pseudo-second-rate kinetics. Further, a total of 78% of TC and 73% of TCS were removed within 5 min of contact and the adsorption equilibrium was achieved within 120  min. The influence of background electrolytes and co-existing ions indicated that TC and TCS were selective towards BNAPTES. The loading capacities of the column packed with BNAPTES were found to be 56.00 and 44.42 mg/g for TC and TCS, respectively. Further, BNAPTES was found efficient even in real water treatment since the attenuation of TC and TCS was not affected significantly in the real water matrix.