Immobilizing Bimetallic RuCo Nanoalloys on Few-Layered MXene as a Robust Bifunctional Electrocatalyst for Overall Water Splitting.

Doping Co atoms into Ru lattices can tune the electronic structure of active sites, and the conductive MXene can adjust the electrical conductivity of catalysts, which are both favorable for improving the electrocatalytic activity of the catalyst for water splitting. Here, ruthenium-cobalt bimetallic nanoalloys coupled with exfoliated Ti3 C2 Tx MXene (RuCo-Ti3 C2 Tx ) have been constructed by ice-templated and thermal activation. Due to the strong interaction between the RuCo nanoalloys and conductive MXene, RuCo-Ti3 C2 Tx not only exhibits an excellent hydrogen evolution reaction (HER) performance with a low overpotential and Tafel slope (60 mV, 34.8 mV dec-1 in 0.5 M H2 SO4 and 52 mV, 38.7 mV dec-1 in 1 M KOH), but also good oxygen evolution reaction (OER) performance in an alkaline electrolyte (266 mV, 111.1 mV dec-1 in 1 M KOH). The assembled RuCo-Ti3 C2 Tx ||RuCo-Ti3 C2 Tx electrolyzer requires a lower potential (1.56 V) than does the Pt/C||RuO2 electrolyzer at 10 mA cm-2 . A boosted catalytic HER activity from immobilizing the RuCo nanoalloys on MXene was unveiled by density functional theory calculations. This study provides a feasible and efficient strategy for developing MXene-based catalysts for overall water splitting.

The potentiating effect of hTFPI in the presence of hCD47 reduces the cytotoxicity of human macrophages.

BACKGROUND: In pig-to-human xenotransplantation, hyperacute rejection of pig organs could be overcome by the production of α1,3-galactosyltransferase knockout pigs. However, macrophage-mediated acute rejection is another obstacle that needs to be overcome. Among the various candidate genes involved in acute rejection, CD47 inhibits monocyte/macrophage-mediated phagocytosis by identifying the CD47 signal regulatory protein alpha (SIRP-α) as self/non-self. Tissue factor pathway inhibitor (TFPI) is involved in the regulation of the coagulation pathway and is able to bind to another ligand of CD47, thrombospondin-1 (TSP-1). When TSP-1 binds to CD47, phagocytosis in macrophages is increased. METHODS: The 2A peptide system was used to establish pig kidney cells (PK15) simultaneously expressing human CD47 and human TFPI, and they were cultured with activated THP-1 cells. After staining with 7-aminoactinomycin D, flow cytometry analysis was carried out. TFPI siRNA analysis and recombinant human TFPI (rhTFPI) treatment were performed to determine the potentiating effect of TFPI on pig cells for activated THP-1 cells in the presence of CD47. Related inflammatory cytokines produced by activated THP-1 cells were analyzed using qPCR and Western blot technique. In addition, the tyrosine phosphorylation level of SIRP-α in activated THP-1 cells was analyzed using immunoprecipitation and Western blot. RESULTS: hCD47/hTFPI-PK15 cells survived better than hCD47-PK15, hTFPI-PK15, or normal PK15 cells on cytotoxicity tests using activated THP-1 cells. TSP-1, derived from these activated THP-1 cells, served as a mediator for this enhancing effect, and it also played a role in activated adherent peripheral blood mononuclear cells (PBMCs). The tyrosine phosphorylation level of SIRP-α in activated THP-1 cells was further increased in the case of co-expression of CD47/TFPI than in individual non-expression or expression of CD47 or TFPI alone. CONCLUSIONS: When hCD47 was expressed, the expression of hTFPI leaded to tyrosine phosphorylation of SIRP-α in activated THP-1 cells via hTSP-1 inhibition, and consequently, it might improve the effect of hCD47-SIRP-a signaling.

Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors.

OBJECTIVE: To investigate the long-term oncologic outcomes and risk factors for adverse effects in right-sided colon cancer patients who underwent modified complete mesocolic excision (mCME). BACKGROUND: Complete mesocolic excision (CME) with central vascular ligation has recently been found to improve oncological outcomes in patients with colon cancer. Our institution has established mCME on the basis of the original concept of CME for the treatment of right-sided colon cancer. METHODS: Between January 2000 and July 2009, 773 patients who underwent mCME for right-sided colon cancer were eligible for this retrospective study. The prognostic factors for survival/recurrence and the risk factors for postoperative complications were investigated. RESULTS: The mean follow-up period was 61.9 ± 34.7 months. The 5-year overall survival and 5-year disease-free survival rates were 84.0% and 82.8%, respectively. Pathologic stage III disease, postoperative complications, age more than 60 years, and minimally invasive surgery were found to be independent prognostic factors. The 5-year locoregional recurrence (LRR) and 5-year systemic recurrence rates (SRRs) were 4.9% and 13.7%, respectively. The risk of LRR and SRR increased with pathologic stage III disease. An American Society of Anesthesiology score of higher than II was an independent predictive factor of postoperative complications. CONCLUSIONS: We have successfully established the mCME technique, on the basis of the same principle as CME, but with a more tailored approach. The long-term oncologic outcomes and risk of postoperative morbidity were found to be comparable with those seen with the original CME procedure.

Manipulating wettability of catalytic surface for improving ammonia production from electrochemical nitrogen reduction.

An electrochemical nitrogen reduction reaction (ENRR) is considered a promising alternative for the traditional Haber-Bosch process. In this study, we present a method for improving the ENRR by controlling the wettability of the catalyst surface, suppressing the hydrogen evolution reaction (HER) while facilitating N2 adsorption. Reduced-graphene oxide (rGO) with a hydrophobic surface property and a contact angle (C.A.) of 59° was synthesized through a high-density atmospheric plasma deposition. Two other hydrophilic and superhydrophobic surfaces with a C.A. of 15° and 150° were developed through additional argon plasma and heat treatment of as-deposited rGO, respectively. The ENRR results showed that the ammonia yield and Faradaic efficiency tended to increase with increasing hydrophobicity. Electrochemical measurements reveal that superhydrophobic rGO achieves a higher Faradaic efficiency (5.73 %) at -0.1 V (vs RHE) and a higher NH3 yield (9.77 µg h-1 cm-2) at -0.4 V (vs RHE) in a 0.1 M KOH electrolyte. In addition, the computational fluid dynamics simulation confirmed that the amount of time the N2 gas remains on the surface could increase by improving the hydrophobicity of the catalytic surface. This study inspires the development of the rGO electrocatalyst through surface wettability modification for boosting ammonia electrosynthesis.

Impact of the number of surface-attached tungsten diselenide layers on cadmium sulfide nanorods on the charge transfer and photocatalytic hydrogen evolution rate.

The selection of layered number and time-course destruction of layers may affect the charge transfer between 2D-to-1D heterostructure, making it possible to improve the efficiency of solar-to-hydrogen evolution. Herein, we demonstrate a simple, low-cost systematic protocol of 2D-WSe2 nanolayer numbers ranging from 7 to 60 aiding the ultrasonication time-course. The resultant nanolayers were assembled on the surface of 1D-CdS nanorods, which demonstrated an improved surface shuttling property. Consequently, a drastic improvement in photocatalytic solar-driven hydrogen evolution was observed (103.5 mmol h-1 g-1) with seven-layered WSe2 (few-layered WSe2) attached on CdS nanorods surface. This enhanced photocatalytic performance is attributed to the selection of layers on CdS surface that expose abundant active sites; along with suitable energy levels, this can facilitate increased charge transfer leading to feasible photocatalytic reactions. Significantly, the present study proposes an efficient and sustainable process to produce hydrogen and demonstrates the potential of numbered WSe2 nanosheets as a co-catalyst material.

Culturomic-, metagenomic-, and transcriptomic-based characterization of commensal lactic acid bacteria isolated from domestic dogs using Caenorhabditis elegans as a model for aging.

In tandem with the fast expansion of the pet-economy industry, the present aging research has been noticing the function of probiotics in extending the healthy lifetime of domestic animals. In this study, we aimed to understand the bacterial compositions of canine feces and isolating lactic acid bacteria (LAB) as commensal LAB as novel potential probiotics for the use of antiaging using Caenorhabditis elegans surrogate animal model. Under an anaerobic, culturomic, and metagenomic analysis, a total of 305 commensal LAB were isolated from diverse domestic dogs, and four strains, Lactobacillus amylolyticus, L. salivarius, Enterococcus hirae, and E. faecium, made prominence as commensal LAB by enhancing C. elegans life span and restored neuronal degeneration induced by aging by upregulating skn-1, ser-7, and odr-3, 7, 10. Importantly, whole transcriptome results and integrative network analysis revealed extensive mRNA encoding protein domains and functional pathways of naturally aging C. elegans were examined and we built the gene informatics basis. Taken together, our findings proposed that a specific gene network corresponding to the pathways differentially expressed during the aging and selected commensal LAB as potential probiotic strains could be provided beneficial effects in the aging of domestic animals by modulating the dynamics of gut microbiota.

In tandem with the fast expansion of the pet-economy industry, the present aging research has been noticing the function of probiotics in extending the healthy lifetime of domestic animals. In this study, collaborating with understanding the characteristics of gut microbiome from canine feces by multiomics approaches including culturomics, metagenomics, and transcriptomics, we isolate and identify commensal lactic acid bacteria (LAB) as novel potential probiotics for the use of antiaging using Caenorhabditis elegans surrogate animal model and multiomics analysis. The selected commensal LAB could be provided beneficial effects in the aging of domestic animals by modulating the dynamics of gut microbiome and applied in the future companion animal market by clarifying their purpose and function.

Uncloaking cell-impermeant gold nanorods via tumor microenvironmental cathepsin B facilitates cancer cell penetration and potent radiosensitization.

Major impediments to conveyance of intravenously administered drugs to tumors are biofouling, opsonization, and rapid clearance from the circulation by macrophages and reticuloendothelial phagocytes. Cloaking nanoparticles with stealth epilayers partly overcomes these hurdles but it also foils interactions with tumor cells. Here, we describe the synthesis, characterization, and validation of smart gold nanorods (GNRs) that spontaneously transform from inert passengers in the blood stream to active cell-penetrating nanoparticles within tumors to potently sensitize tumors to radiation therapy. Intrinsically cationic and cell-penetrating GNRs were shielded from phagocytosis with a cloaking polyethylene glycol epilayer containing an intervening cleavable peptide. In the absence of an external trigger, this epilayer is clipped off by the tumor microenvironmental protease, cathepsin B, in colorectal cancers to uncloak and expose the free-circulating native unPEGylated GNR that is readily internalized by cancer cells and turn into immovable small clusters of GNRs. Selective uncloaking of GNRs in the tumor reduced off-target toxicity confirmed by hematologic, biochemical, and histopathological analysis of blood, serum, and normal organs, respectively. Subsequent irradiation led to significant tumor growth delay and improved survival of mice. By addressing multiple barriers to efficient transport and cellular internalization of nanoparticles, our results demonstrate that clinically meaningful radiosensitization can be achieved with rationally designed GNRs.

Screening for latent tuberculosis infection in South Korean healthcare workers using a tuberculin skin test and whole blood interferon-gamma assay.

This study compared the results of a tuberculin skin test (TST) and a whole-blood interferon-gamma release assay (IGRA) to screen latent tuberculosis (TB) infection (LTBI) according to risk of TB exposure in South Korea. A cross-sectional comparison of 82 healthcare workers (HCWs) was performed from June 2009 to January 2010. Participants were grouped according to their risk for TB exposure: group 1, frequent and direct contact with active TB patients (n = 35); group 2, no known history of direct contact with active TB patients (n = 47). For the TST (10-mm induration cut-off), the positive response rate was 42.9% in group 1 and 34.0% in group 2 (p = 0.42). For the IGRA, the positive response rate was 40% in group 1 and 10.6% in group 2 (p = 0.002). Results obtained from the TST and the IGRA were not in significant agreement. The working duration of HCWs in TB-related departments was the only significant risk factor for LTBI (odds ratio 1.03; p = 0.031). Further, the IGRA can more accurately discriminate LTBI compared to the TST, based on the risk of TB exposure. These results suggest that the IGRA is diagnostically useful for LTBI in South Korean HCWs.

Nanogap biosensors for electrical and label-free detection of biomolecular interactions.

We demonstrate nanogap biosensors for electrical and label-free detection of biomolecular interactions. Parallel fabrication of nanometer distance gaps has been achieved using a silicon anisotropic wet etching technique on a silicon-on-insulator (SOI) wafer with a finely controllable silicon device layer. Since silicon anisotropic wet etching resulted in a trapezoid-shaped structure whose end became narrower during the etching, the nanogap structure was simply fabricated on the device layer of a SOI wafer. The nanogap devices were individually addressable and a gap size of less than 60 nm was obtained. We demonstrate that the nanogap biosensors can electrically detect biomolecular interactions such as biotin/streptavidin and antigen/antibody pairs. The nanogap devices show a current increase when the proteins are bound to the surface. The current increases proportionally depending upon the concentrations of the molecules in the range of 100 fg ml(-1)-100 ng ml(-1) at 1 V bias. It is expected that the nanogap developed here could be a highly sensitive biosensor platform for label-free detection of biomolecular interactions.

Brolucizumab Related Retinal Vasculitis Treated with Systemic and Local Steroid, and Vitrectomy

Purpose@#To describe a case of retinal vasculitis that followed intravitreal brolucizumab injections and its treatment using local and systemic steroid and vitrectomy.Case summary: An 80-year-old male diagnosed with wet age-related macular degeneration presented after experiencing redness, pain, and vision loss in his left eye following a switch in treatment from aflibercept to brolucizumab 2 weeks earlier. Before the switch, the patient’s best corrected visual acuity of the left eye was 0.4; however, on arrival at the clinic, it was finger count at 10 cm. Suspecting intraocular inflammation and retinal vasculitis caused by brolucizumab, he was treated with both local and systemic steroids and later underwent a vitrectomy. Post-surgery, the patient’s symptoms and vision improved and he received additional anti-vascular endothelial growth factor injections. One year after onset, the corrected vision of his left eye was 0.5 with no observed recurrence of intraocular inflammation. @*Conclusions@#When reactions related to intraocular inflammation associated with brolucizumab are identified, aggressive treatment is crucial. The present case report suggests that satisfactory anatomical and visual outcomes can be achieved.

What Laboratory Examinations for Open-angle Glaucoma Risk Stratification

Purpose@#We analyzed the laboratory examinations associated with open-angle glaucoma (OAG) using data from the Korea National Health and Nutrition Examination Survey (KNHANES) to enhance our understanding of OAG risk factors. @*Methods@#We categorized participants in KNHANES between 2008 and 2012 into OAG and non-glaucomatous groups. Next, we conducted a multivariate analysis, adjusting for age, sex, education level, and survey year. @*Results@#Significant differences were observed in age, sex, and educational levels between the two groups. After propensity score matching, the OAG group demonstrated a significantly elevated intraocular pressure (IOP), myopia prevalence, systolic blood pressure (SBP), and diastolic blood pressure (DBP). In addition, that group exhibited a significantly increased prevalence of hypertension and melancholic mood disorders and aspartate transaminase/alanine transaminase (AST/ALT) ratio. Multiple logistic regression revealed elevated IOP, SBP, DBP, AST/ALT ratio, and prevalence of hypertension, melancholic mood, and myopia as OAG risk factors. @*Conclusions@#Our study revealed several risk factors for OAG, including elevated IOP, SBP, DBP, AST/ALT ratio, and prevalence of hypertension, melancholic mood, and myopia. However, the mechanism underlying OAG remains uncertain. Notably, a positive correlation was observed between the AST/ALT ratio and OAG risk. Further studies are needed to evaluate this association.

Interpositional bone graft with cortical and cancellous calvarial bone for addressing the bone gap after reduction malarplasty: a case report

Asians typically exhibit prominent zygomas; therefore, several attempts have been made to reduce these structures to achieve a softer appearance. The intraoral approach is preferred because of its shorter surgical duration and lower invasiveness; however, it is associated with serious complications, such as nonunion. In revisional surgery, the intraoral approach poses limitations in accessing the upper part of the zygoma and the lateral orbital rim area due to its restricted operative field. Therefore, we developed an intraoral interpositional bone graft technique that enabled almost complete reconstruction. A 40-year-old woman presented with persistent depression in the left infraorbital and cheek regions after two revision operations after reduction malarplasty. Based on computed tomography (CT) scan findings, reconstruction using bone grafts was planned. Calvarial bone was harvested and divided into cortical and cancellous parts. The cortical bone was sculpted into an L-shape and inserted into the gap between the maxilla and the lower zygoma body. The hard-to-reach lateral orbital rim area was filled with cancellous bone without fixation. Follow-up CT scans showed that the cortical bone grafts were well-maintained and stabilized with titanium plates, while the cancellous bone had undergone significant resorption and was replaced by new bone, indicative of successful natural healing.

Subjective Visual Floaters after Intravitreal Injection and Effect of the Inverse Tapping Technique

Purpose@#To analyze the incidence of vitreous floaters after intravitreal antivascular endothelial growth factor injection and the effectiveness of the inverse tapping technique, which involves tapping the syringe with the needle downwards to prevent the entry of air bubbles during injection. @*Methods@#The study enrolled patients undergoing their first intravitreal injection for exudative age-related macular degeneration or diabetic macular edema. The patients were divided into two groups: those who received an injection after inverse tapping (IT group) and controls who received the injection without tapping. Patients who consented to the study were randomly assigned to the IT group and the control group through block randomization. One week after injection, a questionnaire was used to assess the presence of vitreous floaters; those who reported them were examined via optical coherence tomography and wide fundus photography. @*Results@#Of the 39 patients in the IT group, two (5.1%) reported floaters 1 week after injection. By contrast, eight (20.5%) of the 39 controls reported them, with a significant difference (p = 0.042). Patients with floaters were significantly younger. Posterior vitreous detachment, as evaluated by pre-injection optical coherence tomography, was observed in 10.0% of those with floaters and 76.5% of those without them. @*Conclusions@#The occurrence of vitreous floaters after intravitreal injection is related to age and the presence of posterior vitreous detachment. The use of the inverse tapping technique may help reduce these after intravitreal injection.

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study

Purpose@#Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer. @*Methods@#In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included. @*Results@#Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction. @*Conclusion@#Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Comparative profiling by data-independent acquisition mass spectrometry reveals featured plasma proteins in breast cancer: a pilot study

Purpose@#Breast cancer is known to be influenced by genetic and environmental factors, and several susceptibility genes have been discovered. Still, the majority of genetic contributors remain unknown. We aimed to analyze the plasma proteome of breast cancer patients in comparison to healthy individuals to identify differences in protein expression profiles and discover novel biomarkers. @*Methods@#This pilot study was conducted using bioresources from Seoul National University Bundang Hospital’s Human Bioresource Center. Serum samples from 10 breast cancer patients and 10 healthy controls were obtained. Liquid chromatography-mass spectrometry analysis was performed to identify differentially expressed proteins. @*Results@#We identified 891 proteins; 805 were expressed in the breast cancer group and 882 in the control group. Gene set enrichment and differential expression analysis identified 30 upregulated and 100 downregulated proteins in breast cancer. Among these, 10 proteins were selected as potential biomarkers. Three proteins were upregulated in breast cancer patients, including cluster of differentiation 44, eukaryotic translation initiation factor 2-α kinase 3, and fibronectin 1. Seven proteins downregulated in breast cancer patients were also selected: glyceraldehyde-3-phosphate dehydrogenase, α-enolase, heat shock protein member 8, integrin‑linked kinase, tissue inhibitor of metalloproteinases-1, vasodilatorstimulated phosphoprotein, and 14-3-3 protein gamma. All proteins had been previously reported to be related to tumor development and progression. @*Conclusion@#The findings suggest that plasma proteome profiling can reveal potential diagnostic biomarkers for breast cancer and may contribute to early detection and personalized treatment strategies. A further validation study with a larger sample cohort of breast cancer patients is planned.

Comparison between Onyx and coil embolization for persistent type 2 endoleaks after endovascular aneurysm repair

Purpose@#Type 2 endoleaks (T2EL) are the most common form of endoleaks after endovascular aneurysm repair (EVAR).Several studies on the feasibility of embolization using ethylene vinyl alcohol copolymer (Onyx, Medtronic) for T2EL have been reported. The purpose of this study was to compare coil and Onyx embolization for T2EL treatment after EVAR. @*Methods@#Between August 2005 and July 2022, 46 patients underwent endovascular embolization for treatment of T2EL (15 Onyx and 31 coils). The primary endpoint was endoleaks resolution or significant aneurysm sac growth of >5 mm in maximal diameter after T2EL embolization. In addition, periprocedural factors, reintervention, sac rupture, and survival analysis were assessed. @*Results@#The follow-up period after embolization was significantly shorter in the Onyx group (11.6 months vs. 34.7 months, P = 0.016), and there was no difference in aneurysm sac growth rate between both groups (20.0% vs. 51.6%; P = 0.472, logrank test). However, cases with multiple endoleak origins tended to be treated with Onyx (P = 0.002). When applying Onyx, there was no significant difference in results between the transarterial and translumbar approaches. @*Conclusion@#There appears to be no significant difference in the results of Onyx and coil embolization for T2EL treatment, although it is difficult to evaluate effectiveness due to the small number of cases and short follow-up period. However, in cases of multiple origin endoleaks or when the transarterial approach is not feasible, the Onyx by translumbar approach may be a more effective method.

Energy Metabolism in Human Pluripotent Stem and Differentiated Cells Compared Using a Seahorse XF96 Extracellular Flux Analyzer

Evaluating cell metabolism is crucial during pluripotent stem cell (PSC) differentiation and somatic cell reprogramming as it affects cell fate. As cultured stem cells are heterogeneous, a comparative analysis of relative metabolism using existing metabolic analysis methods is difficult, resulting in inaccuracies. In this study, we measured human PSC basal metabolic levels using a Seahorse analyzer. We used fibroblasts, human induced PSCs, and human embryonic stem cells to monitor changes in basal metabolic levels according to cell number and determine the number of cells suitable for analysis. We evaluated normalization methods using glucose and selected the most suitable for the metabolic analysis of heterogeneous PSCs during the reprogramming stage. The response of fibroblasts to glucose increased with starvation time, with oxygen consumption rate and extracellular acidification rate responding most effectively to glucose 4 hours after starvation and declining after 5 hours of starvation. Fibroblasts and PSCs achieved appropriate responses to glucose without damaging their metabolism 2∼4 and 2∼3 hours after starvation, respectively. We developed a novel method for comparing basal metabolic rates of fibroblasts and PSCs, focusing on quantitative analysis of glycolysis and oxidative phosphorylation using glucose without enzyme inhibitors. This protocol enables efficient comparison of energy metabolism among cell types, including undifferentiated PSCs, differentiated cells, and cells undergoing cellular reprogramming, and addresses critical issues, such as differences in basal metabolic levels and sensitivity to normalization, providing valuable insights into cellular energetics.

Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer

Objective@#Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. @*Materials and Methods@#We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017–May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. @*Results@#The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS–HHUS agreement was 95.9% (236/246; Cohen’s kappa = 0.883). @*Conclusion@#Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.

Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea

Background@#The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. @*Methods@#From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. @*Results@#Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6–73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. @*Conclusion@#This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.