Shallow and reverse attention network for colon polyp segmentation.

Polyp segmentation is challenging because the boundary between polyps and mucosa is ambiguous. Several models have considered the use of attention mechanisms to solve this problem. However, these models use only finite information obtained from a single type of attention. We propose a new dual-attention network based on shallow and reverse attention modules for colon polyps segmentation called SRaNet. The shallow attention mechanism removes background noise while emphasizing the locality by focusing on the foreground. In contrast, reverse attention helps distinguish the boundary between polyps and mucous membranes more clearly by focusing on the background. The two attention mechanisms are adaptively fused using a "Softmax Gate". Combining the two types of attention enables the model to capture complementary foreground and boundary features. Therefore, the proposed model predicts the boundaries of polyps more accurately than other models. We present the results of extensive experiments on polyp benchmarks to show that the proposed method outperforms existing models on both seen and unseen data. Furthermore, the results show that the proposed dual attention module increases the explainability of the model.

Targeting RAF Isoforms and Tumor Microenvironments in RAS or BRAF Mutant Colorectal Cancers with SJ-C1044 for Anti-Tumor Activity.

Colorectal cancer (CRC) is a significant global health issue characterized by a high prevalence of KRAS gene mutations. The RAS/MAPK pathway, involving KRAS, plays a crucial role in CRC progression. Although some RAS inhibitors have been approved, their efficacy in CRC is limited. To overcome these limitations, pan-RAF inhibitors targeting A-Raf, B-Raf, and C-Raf have emerged as promising therapeutic strategies. However, resistance to RAF inhibition and the presence of an immunosuppressive tumor microenvironment (TME) pose additional obstacles to effective therapy. Here, we evaluated the potential of a novel pan-RAF inhibitor, SJ-C1044, for targeting mutant KRAS-mediated signaling and inhibiting CRC cell proliferation. Notably, SJ-C1044 also exhibited inhibitory effects on immunokinases, specifically, CSF1R, VEGFR2, and TIE2, which play crucial roles in immune suppression. SJ-C1044 demonstrated potent antitumor activity in xenograft models of CRC harboring KRAS or BRAF mutations. Importantly, treatment with SJ-C1044 resulted in increased infiltration of T cells and reduced presence of tumor-associated macrophages and regulatory T cells within the TME. Thus, SJ-C1044 shows immunomodulatory potential and the ability to enhance antitumor responses. The study underscores the therapeutic potential of SJ-C1044 as a novel pan-RAF inhibitor capable of targeting oncogenic signaling pathways and overcoming immune suppression in CRC.

An oncogenic CTNNB1 mutation is predictive of post-operative recurrence-free survival in an EGFR-mutant lung adenocarcinoma.

The Wnt/ß-catenin pathway is known to be frequently dysregulated in various human malignancies. Alterations in the genes encoding the components of Wnt/ß-catenin pathway have also been described in lung adenocarcinoma. Notably however, the clinical impacts of Wnt/ß-catenin pathway alterations in lung adenocarcinoma have not been fully evaluated to date. We here investigated the prognostic implications of single gene variations in 174 cases of surgically resected lung adenocarcinoma tested using targeted next-generation sequencing. Screening of the prognostic impact of single gene alterations identified an association between CTNNB1 mutation and poor recurrence-free survival in EGFR-mutant LUADs. Based on these results, the entire cohort was stratified into three groups in accordance with the mutational status of Wnt/ß-catenin pathway genes (i.e. oncogenic CTNNB1 mutation [CTNNB1-ONC], other Wnt/ß-catenin pathway gene mutations [Wnt/ß-catenin-OTHER], and wild type for Wnt/ß-catenin pathway genes [Wnt/ß-catenin-WT]). The clinicopathologic characteristics and survival outcomes of these groups were then compared. Oncogenic CTNNB1 and other Wnt/ß-catenin pathway gene mutations were identified in 10 (5.7%) and 14 cases (8.0%), respectively. The CTNNB1-ONC group cases displayed histopathologic features of conventional non-mucinous adenocarcinoma with no significant differences from those of the other groups. Using ß-catenin immunohistochemistry, we found that the CTNNB1-ONC group displayed aberrant nuclear staining more frequently, but only in 60% of the samples. The LUADs harboring a CTNNB1-ONC exhibited significantly poorer RFS outcomes than the other groups, regardless of the ß-catenin IHC status. This was a pronounced finding in the EGFR-mutant LUADs only in subgroup analysis, which was then confirmed by multivariate analysis. Nevertheless, no significant OS differences between these Wnt/ß-catenin groups were evident. Hence, oncogenic CTNNB1 mutations may be found in about 6% of lung adenocarcinomas and may predict post-operative recurrence in EGFR-mutant LUADs. Aberrant nuclear ß-catenin staining on IHC appears to be insufficient as a surrogate marker of an oncogenic CTNNB1 mutation.

Recent Advances in Water-Splitting Electrocatalysts Based on Electrodeposition.

Green hydrogen is being considered as a next-generation sustainable energy source. It is created electrochemically by water splitting with renewable electricity such as wind, geothermal, solar, and hydropower. The development of electrocatalysts is crucial for the practical production of green hydrogen in order to achieve highly efficient water-splitting systems. Due to its advantages of being environmentally friendly, economically advantageous, and scalable for practical application, electrodeposition is widely used to prepare electrocatalysts. There are still some restrictions on the ability to create highly effective electrocatalysts using electrodeposition owing to the extremely complicated variables required to deposit uniform and large numbers of catalytic active sites. In this review article, we focus on recent advancements in the field of electrodeposition for water splitting, as well as a number of strategies to address current issues. The highly catalytic electrodeposited catalyst systems, including nanostructured layered double hydroxides (LDHs), single-atom catalysts (SACs), high-entropy alloys (HEAs), and core-shell structures, are intensively discussed. Lastly, we offer solutions to current problems and the potential of electrodeposition in upcoming water-splitting electrocatalysts.

Multicomponent Metal Oxide- and Metal Hydroxide-Based Electrocatalysts for Alkaline Water Splitting.

Developing cost-effective, highly catalytic active, and stable electrocatalysts in alkaline electrolytes is important for the development of highly efficient anion-exchange membrane water electrolysis (AEMWE). To this end, metal oxides/hydroxides have attracted wide research interest for efficient electrocatalysts in water splitting owing to their abundance and tunable electronic properties. It is very challenging to achieve an efficient overall catalytic performance based on single metal oxide/hydroxide-based electrocatalysts due to low charge mobilities and limited stability. This review is mainly focused on the advanced strategies to synthesize the multicomponent metal oxide/hydroxide-based materials that include nanostructure engineering, heterointerface engineering, single-atom catalysts, and chemical modification. The state of the art of metal oxide/hydroxide-based heterostructures with various architectures is extensively discussed. Finally, this review provides the fundamental challenges and perspectives regarding the potential future direction of multicomponent metal oxide/hydroxide-based electrocatalysts.

Generation of Wheat Near-Isogenic Lines Overexpressing 1Bx7 Glutenin with Increased Protein Contents and SDS-Sedimentation Values.

Overexpression of Glu-1Bx7 via allele 1Bx7OE significantly contributes to high dough strength in some wheat varieties and is useful for improving wheat quality. However, the proportion of wheat varieties containing Bx7OE is quite low. In this study, four cultivars containing 1Bx7OE were selected, and among the selected varieties, Chisholm (1Ax2*, 1Bx7OE + 1By8*, and 1Dx5 + 1Dx10) was crossed with Keumkang, a wheat variety that contains 1Bx7 (1Ax2*, 1Bx7 + 1By8, and 1Dx5 + 1Dx10). SDS-PAGE and UPLC analyses showed that the expression of the high-molecular-weight glutenin subunit (HMW-GS) 1Bx7 was significantly higher in NILs (1Ax2*, 1Bx7OE + 1By8*, and 1Dx5 + 1Dx10) compared with that in Keumkang. Wheat quality was analyzed with near infrared reflectance spectroscopy by measuring the protein content and SDS-sedimentation of NILs. The protein content of NILs (12.94%) was 21.65% higher than that of Chisholm (10.63%) and 4.54% higher than that of Keumkang (12.37%). In addition, the SDS-sedimentation value of NILs (44.29 mL) was 14.97% and 16.44% higher than that of Keumkang (38.52 mL) and Chisholm (38.03 mL), respectively. This study predicts that the quality of domestic wheat can be improved by crossbreeding with 1Bx7OE-containing cultivars.

All polymeric conductive strain sensors with excellent skin adhesion, recovery, and long-term stability prepared from an anion-zwitterion based hydrogel.

Developing a high-performing hydrogel with long-lasting skin adhesion, high ionic conductivity, mechanical stability, and fatigue resistance is a crucial issue in the field of wearable electronic devices. Because of their weak mechanical properties, zwitterion-based hydrogels are not suitable for application in wearable strain sensors despite their excellent adhesion to the skin. In this study, a hydrogel of polymer without additive was prepared by using polymerizable monomers consisting of zwitterionic 3-(1-vinyl-3-imidazolio)propanesulfonate (VIPS), anionic 2-acrylamido-2-methyl-1-propanesulfonic acid sodium salt (AMPSs), and acrylamide (AAm); the hydrogel is abbreviated as P(AMPSs/VIPS-co-AAm). The P(AMPSs/VIPS-co-AAm) hydrogel shows exceptional adhesive strength, reaching up to 26.29 kPa (lap shear to porcine skin) and high stretchability (with a fracture strain of 1282% and stress of 40 kPa). The high polarity of the AMPSs/VIPS pair improves the interfacial adhesion to the skin, the internal cohesion and recovery tendency. Unique structural characteristics of the hydrogel impart excellent fatigue resistance, network toughening, and electrical stability after multiple deformations. Thus, the prepared hydrogel has an ionic conductivity (0.51 S m-1), strain sensitivity, and long-term skin adhesion, and it demonstrates potential to be applied for wearable strain sensors.

Regression Discontinuity for Binary Response and Local Maximum Likelihood Estimator to Extrapolate Treatment.

Regression discontinuity is popular in finding treatment/policy effects when the treatment is determined by a continuous variable crossing a cutoff. Typically, a local linear regression (LLR) estimator is used to find the effects. For binary response, however, LLR is not suitable in extrapolating the treatment, as in doubling/tripling the treatment dose/intensity. The reason is that doubling/tripling the LLR estimate can give a number out of the bound [-1, 1], despite that the effect should be a change in probability. We propose local maximum likelihood estimators which overcome these shortcomings, while giving almost the same estimates as the LLR estimator does for the original treatment. A simulation study and an empirical analysis for effects of an income subsidy program on religion demonstrate these points.

Clinicopathologic and genomic features of high-grade pattern and their subclasses in lung adenocarcinoma.

INTRODUCTION: Recent lung adenocarcinoma (LUAD) grading system proposed by the International Association for the Study of Lung Cancer (IASLC) has emphasized the proportion of high-grade patterns (HGPs). We aimed to evaluate the clinicopathologic and genomic characteristics associated with HGP which has not yet been fully investigated. METHODS: Tissue samples from 174 patients who underwent surgical resection of LUAD from January to December 2015 were histologically evaluated. Proportions of HGPs, including solid, micropapillary, cribriform, and complex glandular patterns, were individually quantified. Prognostic implications of HGP proportion, both as a continuous variable and as subclasses divided by cutoffs of 20%, 50%, and 90% (low-intermediate grade [LIG], HGP <20%; high grade 1 [HG1], 20-<50%, HG2, 50-<90%; HG3, ≥90%) were evaluated. Different clinicopathologic factors and genomic alterations according to the HGP subclasses were assessed. RESULTS: Relative hazards of the HGP gradually elevated as its proportion increased over 20%, the cut-off value established by the IASLC grading system, and the cancer-specific overall survival (OS) of HG1 subclass was not significantly decreased compared to the LIG subclass on univariate analysis. However, further subgrouping showed significantly increased frequencies of male, advanced stage tumors, lymphovascular invasion, and spread through alveolar space in higher HGP subclasses. Also, common LUAD driver mutations, particularly EGFR mutations, were less frequent, whereas alterations in TP53 and cell cycle pathway-related genes were more frequent. Higher HGP subclasses and TP53 gene alteration were associated with shorter cancer-specific OS and RFS in multivariate survival analysis. CONCLUSIONS: HGP subclasses of LUAD displayed distinct clinicopathological characteristics and genomic alterations, including TP53 and cell cycle pathway, emphasizing the clinical value of these subclasses in LUAD. Higher HGP subclass and alteration in TP53 may be markers of poor post-operative survival.

Blood Vessel Invasion Predicts Postoperative Survival Outcomes and Systemic Recurrence Regardless of Location or Blood Vessel Type in Patients with Lung Adenocarcinoma.

BACKGROUND: Presence of blood vessel invasion (BVI) is one of the prognostic indicators for lung cancer patients with surgical resection. However, prognostic roles of the location and the type of the involved blood vessel have not been fully evaluated yet. PATIENTS AND METHODS: We retrieved the data of 217 cases of surgically resected lung adenocarcinoma from Asan Medical Center. Clinicopathologic features, including BVI, were reassessed. The location (tumor center and/or periphery) and involved blood vessel types (large and/or small vessels; arteries and/or veins) of BVI were separately examined on standard hematoxylin-eosin slides and confirmed by van Gieson elastic staining. RESULTS: BVI was identified in 35% of cases (76/217), with the tumor center (intratumoral) as the location in more than half of the cases (42/76, 55.3%). The presence of BVI was significantly associated with higher pathologic stage, increased size of invasive components, frequent pleural invasion, lymphatic permeation, and spread through alveolar spaces. BVI was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) both in univariate and multivariate survival analyses [for OS, hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.06-3.48, P = 0.031; for RFS, HR 2.65, 95% CI 1.64-4.28; P < 0.001]. BVI subgroups, according to location and type of the involved blood vessels, invariably displayed significantly poor RFS; however, the results for OS varied. CONCLUSION: Regardless of their location or blood vessel type, presence of BVI is a useful predictor for postoperative survival outcomes, which should be carefully evaluated on pathologic examination.

Thermoelectric and Transport Properties of Permingeatite Cu3SbSe4 Prepared Using Mechanical Alloying and Hot Pressing.

Permingeatite (Cu3SbSe4) is a promising thermoelectric material because it has a narrow band gap, large carrier effective mass, and abundant and nontoxic components. Mechanical alloying (MA), which is a high-energy ball mill process, has various advantages, e.g., segregation/evaporation is not required and homogeneous powders can be prepared in a short time. In this study, the effects of MA and hot-pressing (HP) conditions on the synthesis of the Cu3SbSe4 phase and its thermoelectric properties were evaluated. The electrical conductivity decreased with increasing HP temperature, while the Seebeck coefficient increased. The power factor (PF) was 0.38-0.50 mW m-1 K-2 and the thermal conductivity was 0.76-0.78 W m-1 K-1 at 623 K. The dimensionless figure of merit, ZT, increased with increasing temperature, and a reliable and maximum ZT value of 0.39 was obtained at 623 K for Cu3SbSe4 prepared using MA at 350 rpm for 12 h and HP at 573 K for 2 h.

Large tumor size, lymphovascular invasion, and synchronous metastasis are associated with the recurrence of solid pseudopapillary neoplasms of the pancreas.

BACKGROUND: Solid pseudopapillary neoplasms (SPNs) of the pancreas have low malignant potential. However, malignant SPNs are not fully understood. METHODS: To evaluate risk factors affecting malignant potential, the clinicopathologic features of 375 surgically resected SPNs were compared. RESULTS: Fifty (13.3%) had malignant histologic features. Twenty-seven and 22 had perineural and lymphovascular invasions, respectively. Adjacent organ invasion was noted in 9 cases. Recurrence occurred in 8 cases. The median recurrence time after surgical resection was 67 months and was associated with a higher pT category (P = 0.001), lymphovascular invasion (P < 0.001), and synchronous metastasis (P < 0.001). SPN patients with malignant histologic features had worse recurrence-free survival (RFS; 10-year survival rate, 73.2%) than those without malignant histologic features (96.3%; P = 0.01). Patients with a higher pT category (P = 0.04), synchronous metastasis (P < 0.01), and lymphovascular invasion (P < 0.01) had worse RFS. Lymphovascular invasion (P = 0.042) and a higher T category (P = 0.002) were poor prognostic factors for recurrence. CONCLUSION: Lymphovascular invasion and a higher T category were worse prognostic factors for recurrence in SPN patients with malignant histologic features. For SPN patients with malignant histologic features, a longer follow-up may be required.

Effects and safety of intranasal phototherapy for allergic rhinitis: Study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated, pilot study.

INTRODUCTION: Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the available evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for a feasibility trial to assess the effects and safety of intranasal phototherapy for the treatment of AR. METHODS AND ANALYSIS: This is a study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated pilot study. A total of 40 patients with AR will be randomly assigned to the medical device or sham device group in a 1:1 ratio. The participants will receive intranasal phototherapy with a medical or sham device for 20 min 5 times a week for 2 weeks. The primary outcome will be the mean change in the Total Nasal Symptom Score (TNSS) from baseline to 2 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum Ig E level, and eosinophil count. DISCUSSION: The findings of this study will provide the basis for subsequent large-scale definitive RCTs to confirm the effects and safety of intranasal phototherapy for the treatment of nasal symptoms in patients with AR who do not respond well to conventional therapy. This study may assist in the development of noninvasive treatment for patients with AR. TRIAL REGISTRATION: This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003253).

Effects and safety of intranasal phototherapy for allergic rhinitis: Study protocol for a single-center, randomized, parallel (acupuncture-controlled), open-label, investigator-initiated, pilot study.

INTRODUCTION: Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for an RCT to assess the effects and safety of intranasal phototherapy for the treatment of AR. METHODS AND ANALYSIS: This is a study protocol for a single-center, randomized, parallel (acupuncture-controlled), open-label, investigator-initiated, pilot study. A total of 80 patients with AR will be randomly assigned to the intranasal phototherapy or acupuncture group at a 1:1 ratio. The participants will receive intranasal phototherapy with medical or acupuncture treatment for 20 minutes, 3 times a week for 4 weeks. The primary outcome will be the mean change in the total nasal symptom score (TNSS) from baseline to 4 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum immunoglobulin E (Ig E) level and eosinophil count. DISCUSSION: The findings of this study will provide the basis for the design and implementation of RCTs investigating the effects and safety of intranasal phototherapy for AR. Additionally, it will provide preliminary evidence of intranasal phototherapy for use in AR. TRIAL REGISTRATION: This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0004079).

Urothelial phase CT for assessment of pathologic complete response after neoadjuvant chemotherapy in muscle-invasive bladder cancer.

PURPOSE: To investigate the diagnostic performance of urothelial phase (UP) CT and identify the appropriate imaging criteria for assessment of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with bladder cancer. METHOD: Seventy-three patients who underwent NAC and subsequent radical or partial cystectomy between January 2017 and July 2019 were retrospectively analyzed. UP CT findings after NAC were divided into five grades as follows: grade 1, no wall thickening or inner-layer enhancement; grade 2, thin inner-layer enhancement without wall thickening; grade 3, inner-layer enhancement with low-attenuation wall thickening; grade 4, wall thickening with enhancement; and grade 5, nodular enhancement or enhanced soft tissue. Two radiologists independently evaluated these grades on the post-chemotherapy CT. The area under the ROC curve (AUC) was used to evaluate diagnostic performance for pCR. Inter-reader agreement was assessed using the κ coefficient. RESULTS: Twenty-seven patients (37 %) were confirmed with pCR. The AUCs for the assessment of pCR on UP CT were 0.85-0.86 for the two readers. Using absent or thin inner-layer enhancement as features to predict pCR, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.1-81.5 %, 80.4-84.8 %, 71.0-74.1 %, and 84.8-88.1 % for both readers. The inter-reader agreement for grades ≤2 was almost perfect (κ = 0.83). CONCLUSIONS: Absent or thin inner-layer enhancement on UP CT demonstrated high diagnostic performance and high inter-reader agreement for assessment of pCR after neoadjuvant chemotherapy in bladder cancer, and evaluation of this feature could improve the predictive ability of preoperative imaging for assessing pCR.

Scalp acupuncture for children with cerebral palsy: A protocol for a systematic review.

BACKGROUND: Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitations, leading the most common movement disorder to children. Scalp acupuncture (SA) is one of several specialized acupuncture techniques, and it has been used widely in China to alleviate several CP symptoms, despite the deficiency of high-quality evidence related to this practice. Therefore, we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of scalp acupuncture for treating CP in children. METHODS: The following electronic databases will be searched from inception to May 1, 2019 MEDLINE, PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang Database, and Chinese Biomedical Literature Database (CBM). All published English and Chinese articles randomized controlled trials (RTCs) will be included. All types of CP of children in the trials will be included in this study and these individuals will be involved as core searchers to evaluate the efficacy of scalp acupuncture. Rev Man V.5.3 software will be implemented for the assessment of bias risk, data synthesis, subgroup analysis, and meta-analyses if inclusion conditions are met. Continuous outcomes will be presented as mean difference (MD) or standard mean difference (SMD), while dichotomous data will be expressed as a relative risk. RESULTS: The systematic review will synthesize the available knowledge surrounding scalp acupuncture for children with CP. The findings will be synthesized to determine the efficacy and safety of scalp acupuncture for children with CP. CONCLUSION: This protocol will present the evidence of whether scalp acupuncture is an effective intervention for children with CP.

Validation of the Core Seven-Emotions Inventory - short form.

BACKGROUND: This study aimed to evaluate the reliability and validity of short form of the Core Seven Emotions Inventory (CSEI-s) scale. METHODS: The participants were third-grade Korean Medicine University students As with the original CSEI, the scales in the short form (CSEI-s) were composed of seven factors and consisted of 28 items in total. The internal consistency coefficient was calculated, and a confirmatory factor analysis was conducted to verify the reliability of the short form scale. Finally, to verify the validity of the abbreviated scale, a correlation analysis with the abbreviated scale and the CSEI-s scale was conducted. RESULTS: A 178 among 200 initial participants were included in the analysis (mean age: 24.5 years). The results of the exploratory factor analysis made from the 28 items of the seven factors of the CSEI-s showed that the factor loadings were as high as 0.64-0.89, excluding the tenth item of fear (0.52), and the model fit also had a good confirmatory factor with the analysis result. The results of the reliability verification showed that the Cronbach α values of all seven subscales of the short-form CSEI scale were 0.7 or higher, and the overall reliability was 0.83. A factor analysis revealed that the factor loadings were adequate, and their reliability and validity were confirmed for the CSEI-s scale, making it applicable to measuring the core seven emotions of patients in clinical practice. CONCLUSION: CSEI-s scale may apply to measure core emotions of the patient in a clinical setting.

Intralesional therapy for the treatment of keratoacanthoma.

Keratoacanthoma (KA) is a common epidermal tumor that originates from the hair follicle of the skin. It is generally considered as a benign neoplasm, but in rare cases, it can also transform into squamous cell carcinoma. Although surgical excision with a safety margin is considered to be the gold standard treatment for most subtypes of KA, several other treatment options are also available. Intralesional therapy is one of these options, which could be cosmetically and functionally a better alternative to surgical removal, while it provides similar outcomes. It is more effective than topical treatments, yet fewer side effects may be seen than in systemic treatments. Based on the literature, the most commonly used intralesional agent is methotrexate, followed by 5-fluorouracil and interferon alpha. Regardless of the advantages, which make intralesional therapy a desirable treatment alternative, guidelines for the intralesional treatment of KA are not yet established. A histopathological confirmation before the start of treatment is still recommended to prevent any possible misdiagnosis of KA for SCC. In our present study, we set out to review the current state of the art of the intralesional treatment of KA.

Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia: A protocol for a systematic review and meta-analysis.

INTRODUCTION: This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of mindfulness meditation and cognitive behavioral therapy programs as a psychological intervention for insomnia disorders. METHODS AND ANALYSIS: We will search the following 11 electronic databases without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. Furthermore, we will also search 5 Korean-language databases (Oriental Medicine Advanced Searching Integrated System, Korean studies Information Service System, Research Information Service System, Korean Medical Database, and Korea Citation Index). The study selection and data extraction will be performed independently by 2 authors. The study quality assessment and evaluation of the quality of evidence for the main findings will be performed independently by 2 authors using the Cochrane tool for assessing risk of bias and predefined criteria (the Grading of Recommendations Assessment, Development, and Evaluation approach). Data synthesis and analysis will be performed using RevMan Version 5.3. Data will be synthesized by either a fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. If any plan for documenting important protocol amendments changes, the researchers will have a revision agreement and then register the modification in the International Prospective Register of Systematic Reviews (PROSPERO). ETHICS AND DISSEMINATION: Ethical approval will not be required because individual patient data are not included and because this protocol is for a systematic review. The findings of this systematic review will be disseminated through conference presentations.PROSPERO registration number: CRD42018111217.

Meditation-based clinical study to determine the correlation of quantitative electroencephalogram (qEEG) and 24-hour EEG activity.

BACKGROUND: The heart continuously transmits information to the cerebrum during each pulse, and influences information processing such as perception, cognition, and emotion, which are processed in the cerebrum. This is the basis for the theory of oriental medicine widely used in psychiatric medicine and clinical practice, so-called Simjushinji (heart and brain) theory, that the heart controls the mind. The present study aims to analyze the correlation between heart and brain function by 24-hour active electrocardiogram and quantitative electroencephalogram (EEG) measurement under meditation. METHODS: This randomized, controlled, assessor-blinded, 2-armed, parallel, multicenter clinical trial will analyze a total of 50 subjects, including 25 each for the test group and the active control group. Subjects will be randomly allocated to the test group (performing resource mindfulness) and the control group (performing stress mindfulness) in a 1:1 ratio. The clinical trial consists of 3 stages. The first and third stages are stable states. The second stage is divided into the test and active comparator groups. Quantitative EEG (qEEG) measurements at stages 1 and 3 will be recorded for 10 minutes; measurements at stage 2 will be recorded for 20 minutes with the eyes closed. The 24-hour Holter Monitoring and heart rate variability will be evaluated at each stage. Before the beginning of stage 3, subjects will complete the questionnaires. The primary outcome will be analyzed by independent t tests of both groups. DISCUSSION: Scientific studies based on clinical epistemology are expected to serve as a basis for sustainable medical services in the field of psychiatric medicine in Korea. HRV, blood pressure index, and biometric index in qEEG, as determined by 24-hour Holter monitoring, will complement quantitative biomarkers and be useful in various fields.