Bundang Jesaeng Hospital

PurposeSmall cell lung cancer (SCLC) is an aggressive malignancy with poor survival. Existing prognostic models provide limited patient-level risk stratification and often overlook accessible clinical and imaging data. There remains a need for refined tools to support individualized prognostication in SCLC.Patients and MethodsWe retrospectively analyzed 149 SCLC patients diagnosed between 2010 and 2014, representing a pre-immunotherapy era cohort. Demographics, CT scans, and treatment details were reviewed. Emphysema burden was quantified using an AI-based automated tool that segmented the lungs and calculated the percentage of low-attenuation areas (< −950 Hounsfield Units). Multivariate Cox regression identified predictors for overall survival (OS), informing nomogram construction. Performance was measured by Harrell’s C-index and calibration plots. Validation included bootstrap resampling and a 3:1 data split. Decision curve analysis (DCA) evaluated clinical utility.ResultsAge, emphysema, and treatment modality were independently associated with OS. The nomogram demonstrated excellent discrimination (C-index = 0.807; 95% confidence interval [CI], 0.771–0.843) and good calibration for 1- and 3-year survival. Internal validity was high, with a bootstrap-adjusted C-index of 0.805 (95% CI, 0.779–0.845), and performance remained robust in the validation subset (C-index = 0.740; 95% CI, 0.668–0.812). Stratification by nomogram-derived risk quartiles significantly differentiated survival (log-rank p < 0.001). DCA demonstrated superior net clinical benefit compared to treat-all or treat-none strategies across clinically relevant thresholds.ConclusionThis validated nomogram, based on three readily available variables, provides accurate survival predictions for patients with SCLC. It may assist clinicians in refining treatment strategies and enhancing shared decision-making. External validation is warranted.

, (reasonable functional result) . 1) . 2)

ObjectiveTo compare the effects of high-intensity interval training (HIIT) andmoderate-intensity continuous training (MICT) on cardiovascular function,gait ability, and hematological variables in chronic stroke survivors.MethodsTwenty-nine higher-functioning, ambulatory chronic stroke survivors wererandomized to HIIT (n=15) or MICT (n=14). Participantsunderwent supervised training three times weekly for six weeks, consistingof 30 minutes conventional therapy followed by 40 minutes aerobic exercise(HIIT: six 1-minute high-intensity intervals at 80%–100% maximumheart rate (HRmax) with 4-minute active recovery; MICT: continuous exerciseat 60%–80% HRmax). Outcomes included cardiovascular function(maximal oxygen uptake [VO2max], HRmax, walking heart rate), gait(10-Meter Walk Test, Timed Up and Go test, 6-Minute Walk Test), and lipidprofiles (low-density lipoprotein, high-density lipoprotein,triglycerides).ResultsIn this higher-functioning cohort (n=29), HIIT showed significantlygreater improvements than MICT in VO2max (F=40.574,p=0.001), HR_max (F=24.661, p=0.001),walking heart rate (F=11.277, p=0.002), 10-Meter Walk Test(F=20.865, p=0.001), Timed Up and Go test (F=12.317,p=0.002), and 6-Minute Walk Test (F=9.742, p=0.004).Lipid profiles improved significantly within the HIIT group only(p<0.05), no between-group differences were observed.ConclusionIn higher-functioning chronic stroke survivors, HIIT was superior to MICT forcardiovascular fitness and functional mobility under a matched exposure;lipid changes occurred within HIIT only without between-group effects. Thesefindings support incorporating HIIT into stroke rehabilitation programs toenhance recovery outcomes.

PurposeEndoscopically identifying eosinophilic esophagitis (EoE) is difficult due to its rare incidence and subtle morphology. We aimed to develop a robust and accurate convolutional neural network (CNN) model for EoE identification and classification in endoscopic images.Materials and MethodsWe collected 548 endoscopic images from 81 patients with EoE and 297 images from 37 normal patients. These datasets were labeled according to the four eosinophilic esophagitis endoscopic reference score (EREFS) features: edema, rings, exudates, and furrows. A multi-task U-Net with an auxiliary classifier on various levels of skip connections (scaU-Net) was proposed. Then, scaU-Net was compared with VGG19, ResNet50, EfficientNet-B3, and a typical multi-task U-Net CNN. The performances of each model were evaluated quantitatively and qualitatively based on accuracy (ACC), area under the receiver operating characteristics (AUROC), and gradient-weighted class activation map (Grad-CAM), and were also compared with those of 25 human endoscopists.ResultsOur sca4U-Net with 4th-level skip connection showed the best performances in ACC (86.9%), AUROC (0.93), and outstanding Grad-CAM results compared to other models, reflecting the importance of utilizing the deepest skip connection. Moreover, the sca4U-Net showed generally better performance when compared with endoscopists with various levels of experience.ConclusionOur method showed robust performance compared to expert endoscopists and could assist endoscopists of all experience levels in the early detection of EoE–a rare but clinically important condition.

A fixed-dose combination of rosuvastatin and amlodipine (Ros/Aml) offers a simplified approach to simultaneously address hypertension and dyslipidemia. While pivotal trials have demonstrated the efficacy and safety of this regimen, real-world evidence on its clinical outcomes related to major adverse cardiovascular and cerebrovascular events (MACCE) had been limited. This multicenter, prospective, non-interventional study was conducted across 39 sites in South Korea (2020-2024) to evaluate the 12-month effectiveness and safety of Ros/Aml in adults with coexisting hypertension and dyslipidemia. The primary endpoint was the incidence of MACCE. Secondary endpoints included changes in blood pressure, lipid profiles, and safety outcomes. A total of 5018 patients were enrolled, with 5009 (99.82%) included in the Safety and Efficacy Sets. The mean age was 66.80 years, and 60.39% were male. In the efficacy set, the 12-month MACCE incidence was 0.54% [95% CI: 0.36-0.78], with no significant differences among four dose groups. Ros/Aml significantly reduced systolic and diastolic blood pressure at 6 and 12 months (both P < 0.001), and LDL-C levels (P < 0.0001). Adverse drug reactions were reported in 3.11% of patients; with only 0.06% experiencing serious ADRs and no ADR-related deaths occurred, suggesting a tolerable safety profile. In this large real-world study, Ros/Aml demonstrated a favorable safety profile and was effective in reducing MACCE risk, blood pressure, and lipid levels over 12 months. These findings in patients with hypertension and dyslipidemia support its use as a viable strategy for integrated cardiovascular risk management in clinical practice.

Eosinophilic chronic rhinosinusitis (ECRS) is a severe form of chronic rhinosinusitis characterized by type 2 inflammation, tissue remodeling, and bone thickening, known as osteitis. Periostin, a matricellular protein involved in extracellular matrix (ECM) regulation and T helper 2 (Th2)-mediated inflammation, is markedly elevated in patients with ECRS; however, its pathophysiological role remains unclear. We investigated the role of periostin in inflammation and tissue remodeling in ECRS using samples from ECRS patients, human nasal epithelial cells and fibroblasts, as well as an ECRS mouse model including periostin knockout mice. Periostin levels were elevated in ECRS tissues and modestly correlated with osteitis scores. Th2 cytokines increased periostin expression, particularly in nasal fibroblasts. Conditioned medium containing periostin promoted osteogenic differentiation in vitro, whereas neutralizing antibodies reduced the expression of osteogenic markers. In an ECRS mouse model, periostin deficiency led to reduced bone thickening and lower expression of osteogenic markers despite similar eosinophil infiltration. Furthermore, periostin-deficient mice exhibited greater epithelial collapse and reduced fibronectin levels, indicating compromised ECM integrity. These findings demonstrate that periostin contributes to osteogenesis and maintenance of structural stability in the inflamed sinonasal mucosa. Periostin may be a potential therapeutic target for controlling chronic inflammation and tissue remodeling in ECRS.

Abstract BackgroundStroke survivors usually have many vascular risk factors (VRFs), and recent studies have reported the association of VRFs with cognitive decline among stroke survivors, which are also associated with PD risk. Therefore, we aimed to investigate how VRFs influenced the risk of PD occurrence in individuals with stroke.MethodsThe Korean National Health Insurance Service database was used. We selected individuals who experienced new-onset stroke (ICD-10: I60-I64) between 2008 and 2016 and followed up until 2019. PD was diagnosed according to ICD-10 code G20 and rare and intractable disease registration code V124. Lifestyle factors were collected using self-reported questionnaires, and comorbidities were defined based on ICD-10 codes, medication, and laboratory and anthropometric findings. Cox proportional hazard analyses were conducted to evaluate the association of VRFs with PD incidence among stroke survivors.ResultsAmong 284,799 stroke survivors, 3,274 cases of PD were reported over a median follow-up period of 5.04 years. In individuals with a history of stroke, smoking (former smoking, hazard ratio (HR) = 0.80, 95% confidence interval (CI), 0.72–0.88; current smoking, HR = 0.66, 95% CI, 0.58–0.76) and alcohol consumption (moderate drinking, HR = 0.83, 95% CI, 0.75–0.91; heavy drinking, HR = 0.74, 95% CI, 0.59–0.94) were associated with a decreased risk of PD. Physically active individuals who had a stroke showed a reduced trend for PD occurrence (P= 0.0508). As for the association between comorbidities and the PD risk, the PD risk increased among stroke survivors with diabetes mellitus (P for trend &lt;.001), particularly in those with a duration of diabetes mellitus of ≥5 years (HR = 1.38, 95% CI, 1.25–1.52).ConclusionsOur results suggest that VRFs are associated with PD occurrence among stroke survivors. Understanding and managing VRFs in relation to PD risk is needed for disease management after stroke.

Timely and accurate diagnosis of nasal bone fractures (NBFs) is crucial for preserving the cosmetic and functional aspects of the nose. This study aims to identify factors influencing radiographic and computed tomography (CT) diagnosis of NBF in patients with nasal trauma. Two hundred six patients with acute nasal trauma underwent both conventional radiography and facial bone CT. An experienced otorhinolaryngologist independently interpreted images. Results were categorized into "Concordance" or "Discrepancy" groups, with demographic and clinical data compared. The study classified 167 patients into "Concordance" and 39 into "Discrepancy" groups based on radiography and CT interpretations. The "discrepancy group" showed higher rates of previous nasal bone fractures (P=0.044), rhinoplasty history (P=0.044), and concomitant facial bone fractures (P=0.001). Adjusted odds ratios revealed significant associations between discrepancies and a history of nasal bone fracture (OR=5.197, 95% CI 1.165-23.171), rhinoplasty (OR=6.114, 95% CI 1.393-26.847), and concomitant facial bone fractures (OR=3.765, 95% CI 1.663-8.523). This study highlights the impact of facial trauma, including rhinoplasty, on the radiological diagnosis of NBF. Consequently, in the presence of signs of concurrent facial trauma, previous nasal trauma, or rhinoplasty history, a prompt CT scan and comprehensive evaluation are recommended for accurate diagnosis and timely treatment, ultimately improving the patient's prognosis.

Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. 4 (case-control study).