Assessment of deep learning-based auto-contouring on interobserver consistency in target volume and organs-at-risk delineation for breast cancer: Implications for RTQA program in a multi-institutional study.

PURPOSE: To quantify interobserver variation (IOV) in target volume and organs-at-risk (OAR) contouring across 31 institutions in breast cancer cases and to explore the clinical utility of deep learning (DL)-based auto-contouring in reducing potential IOV. METHODS AND MATERIALS: In phase 1, two breast cancer cases were randomly selected and distributed to multiple institutions for contouring six clinical target volumes (CTVs) and eight OAR. In Phase 2, auto-contour sets were generated using a previously published DL Breast segmentation model and were made available for all participants. The difference in IOV of submitted contours in phases 1 and 2 was investigated quantitatively using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). The qualitative analysis involved using contour heat maps to visualize the extent and location of these variations and the required modification. RESULTS: Over 800 pairwise comparisons were analysed for each structure in each case. Quantitative phase 2 metrics showed significant improvement in the mean DSC (from 0.69 to 0.77) and HD (from 34.9 to 17.9 mm). Quantitative analysis showed increased interobserver agreement in phase 2, specifically for CTV structures (5-19 %), leading to fewer manual adjustments. Underlying IOV differences causes were reported using a questionnaire and hierarchical clustering analysis based on the volume of CTVs. CONCLUSION: DL-based auto-contours improved the contour agreement for OARs and CTVs significantly, both qualitatively and quantitatively, suggesting its potential role in minimizing radiation therapy protocol deviation.

Evaluating the Necessity of Adaptive RT and the Role of Deformable Image Registration in Lung Cancer with Different Pathologic Classifications.

BACKGROUND: This study aimed to analyze differential radiotherapy (RT) responses according to the pathological type of lung cancer to see the possibility of applying adaptive radiotherapy (ART). METHODS: ART planning with resampled-computed tomography was conducted for a total of 30 patients (20 non-small-cell lung cancer patients and 10 small-cell lung cancer patients) using a deformable image registration technique to reveal gross tumor volume (GTV) changes according to the duration of RT. RESULTS: The small-cell lung cancer group demonstrated an average GTV reduction of 20.95% after the first week of initial treatment (p = 0.001), whereas the adenocarcinoma and squamous cell carcinoma groups showed an average volume reduction of 20.47% (p = 0.015) and 12.68% in the second week. The application of ART according to the timing of GTV reduction has been shown to affect changes in radiation dose irradiated to normal tissues. This suggests that ART applications may have to be different depending on pathological differences in lung cancer. CONCLUSION: Through these results, the present study proposes the possibility of personalized treatment options for individual patients by individualizing ART based on specific radiation responses by pathologic types of lung cancer.

Stereotactic body radiotherapy versus radiofrequency ablation as initial treatment of small hepatocellular carcinoma.

BACKGROUND/AIM: Stereotactic body radiotherapy (SBRT) may be an alternative treatment for patients with small (≤3 cm) hepatocellular carcinomas (HCCs) who were not indicated for resection or local ablation therapy. This study compared the therapeutic effects of radiofrequency ablation (RFA) and SBRT in patients with small (≤3 cm) HCCs. METHODS: Data of HCC patients who underwent SBRT or RFA as an initial treatment at four tertiary referral hospitals between March 2011 and February 2017 were reviewed. The patient inclusion criteria were a single nodule measuring ≤3 cm in size and not suitable for resection. RESULTS: SBRT and RFA were performed for 72 (SBRT group) and 134 (RFA group) patients, respectively. The 1-, 3-, and 5-year overall survival (OS) rates were 97.0%, 80.3%, and 80.3%, respectively, in the SBRT group compared with 98.5%, 83.9%, and 80.8%, respectively, in the RFA group, with no significant differences between the groups (P = 0.81). The estimated five-year local control (LC) rate was 68.1% in the SBRT group and 73.1% in the RFA group (P = 0.81). In the SBRT group analysis, both SBRT alone (n = 34) and SBRT combined with transarterial chemoembolization (n = 38) showed no difference with RFA in OS (P = 0.72 and P = 0.90) or LC rate (P = 0.95 and P = 0.68), respectively. CONCLUSION: SBRT is an effective and safe treatment method for small HCCs, with survival and tumor recurrence rates similar to those of RFA.

Quantitative Scintigraphy Imaging of Lingual Raynaud's Phenomenon Using 3-Dimensional-Ring Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography/Computed Tomography.

Perfusion scintigraphy with the acquisition of planar blood flow and pool images of bilateral hands has been used to aid diagnosis and to evaluate treatment response to Raynaud's phenomenon (decreased blood flow to hand or foot). However, because of the difficulty in imaging the tongue area with a conventional gamma camera, perfusion scintigraphy imaging of patients with lingual Raynaud's phenomenon has yet to be reported. Here, we report the case of a 59-year-old man with lingual Raynaud's phenomenon in which blood pool imaging of the tongue was performed using three-dimensional (3D)-ring cadmium-zinc-telluride (CZT) single-photon emission computed tomography/computed tomography (SPECT/CT). During follow-up, the patient's lingual symptoms had worsened, and follow-up blood pool SPECT/CT images also revealed decreased blood pool uptake of the tongue, showing a decreased blood pool of more than 25% on quantitative analysis. This case suggests that blood pool imaging of the tongue using 3D-ring CZT SPECT/CT has clinical significance in evaluating patients with lingual Raynaud's phenomenon.

Different Prognostic Values of Dual-Time-Point FDG PET/CT Imaging Features According to Treatment Modality in Patients with Non-Small Cell Lung Cancer.

This study was aimed to investigate whether dual-time-point F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging features had different prognostic values according to the treatment modality in patients with non-small cell lung cancer (NSCLC). We retrospectively reviewed 121 NSCLC patients with surgical resection (surgery group) and 69 NSCLC patients with chemotherapy and/or radiotherapy (CRT group), who underwent pretreatment dual-time-point FDG PET/CT. The maximum standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUV histogram entropy of primary cancer, and the percent changes in these parameters (Δparameters) were measured. In multivariate analysis, MTV, TLG, and entropy on both early and delayed PET/CT scans were significantly associated with progression-free survival (PFS) in the surgery group, but all Δparameters failed to show a significant association. In the CRT group, TLG on the early PET, maximum SUV on the delayed PET, ΔMTV, and ΔTLG were significant independent predictors for PFS. In the surgery group, patients with high values of MTV, TLG, and entropy had worse survival, whereas, in the CRT group, patients with high values of ΔMTV and ΔTLG had better survival. Dual-time-point FDG PET/CT parameters showed different prognostic values between the surgery and CRT groups of NSCLC patients.

Prognostic Value of Dual-Time-Point [18F]FDG PET/CT for Predicting Distant Metastasis after Treatment in Patients with Non-Small Cell Lung Cancer.

This study aimed to evaluate the prognostic significance of 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in the bone marrow (BM) and primary tumors on dual-time-point (DTP) PET/CT for predicting progression-free survival (PFS) and distant metastasis-free survival (DMFS) in patients with non-small cell lung cancer (NSCLC). We retrospectively analyzed DTP [18F]FDG PET/CT images from 211 patients with NSCLC. The maximum standardized uptake value (SUV) of primary lung cancer and mean [18F]FDG uptake of the BM (BM SUV) were measured from early and delayed PET/CT images, and the percent changes in these parameters (∆maximum SUV and ∆BM SUV) were calculated. On multivariate survival analysis, the maximum SUV and BM SUV on both early and delayed PET/CT scans were significantly associated with PFS, while the ∆maximum SUV and ∆BM SUV failed to show statistical significance. For DMFS, the ∆maximum SUV and ∆BM SUV were independent predictors along with the TNM stage. Distant progression was observed only in 1.3% of patients with low ∆maximum SUV and ∆BM SUV, whereas 28.2% of patients with high ∆maximum SUV and ∆BM SUV experienced distant progression. The ∆maximum SUV and ∆BM SUV on DTP [18F]FDG PET/CT were significant independent predictors for DMFS in patients with NSCLC.

Stereotactic ablative radiotherapy for pulmonary oligometastases from primary hepatocellular carcinoma: a multicenter and retrospective analysis (KROG 17-08).

OBJECTIVE: Hypofractionated radiotherapy has recently been applied to treat pulmonary metastases of hepatocellular carcinoma. However, there is no definite evidence on its safety and efficacy. We evaluate the clinical outcomes of hypofractionated radiotherapy for oligo pulmonary metastases of hepatocellular carcinoma in the multicenter and retrospective study. METHODS: From March 2011 to February 2018, 58 patients with fewer than five pulmonary metastases of hepatocellular carcinoma who underwent hypofractionated radiotherapy in nine tertiary university hospitals were analyzed retrospectively. The primary endpoint was the local control rate. The secondary endpoints were overall survival, progression-free survival, prognostic factors affecting the treatment outcomes and treatment-related side effects. RESULTS: The local tumor response rate including complete and partial response was 77.6% at 3 months after hypofractionated radiotherapy. The median survival and progression-free survival times were 20.9 and 5.3 months, respectively. The 1-year overall survival and progression-free survival rates were 65.5 and 22.4%, respectively. The good treatment response after hypofractionated radiotherapy (P = 0.001), the absence of intrahepatic tumor (P = 0.004) and Child-Pugh class A (P = 0.010) were revealed as significant prognostic factors for overall survival in the multivariate analysis. A progression-free interval of <6 months (P = 0.009) was a negative prognostic factor for overall survival in the multivariate analysis. Of 58 patients, five (8.6%) had grade 2 or higher radiation pneumonitis after hypofractionated radiotherapy. CONCLUSIONS: The favorable local control rate and acceptable toxicity indicate the clinical usefulness of hypofractionated radiotherapy for hepatocellular carcinoma patients who have less than five pulmonary metastases.

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer.

This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast cancer. We retrospectively included 510 women with breast cancer who underwent surgical resection with adjuvant radiotherapy. The tumor-rib distance was measured using preoperative computed tomography (CT) images. Postoperative chest wall thickness and dose-dependent rib volumes, which are absolute rib volumes receiving >20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 45 Gy (V45), and 50 Gy (V50), were measured from the stimulation CT images for radiation treatment planning. We assessed the relationship of RIRF with tumor-rib distance, postoperative chest wall thickness, and dose-dependent rib volumes. Patients with high values of tumor-rib distance and postoperative chest wall thickness had significantly lower risks of RIRF than those with low values. Patients with high values of V20, V30, V40, V45, and V50 had significantly higher risks of RIRF than those with low values. In a multivariate analysis, tumor-rib distance and all five dose-dependent rib volumes, as well as osteoporosis and radiation field, were independent risk factors for RIRF. Tumor-rib distance and dose-dependent rib volume were independent risk factors for RIRF in patients with breast cancer.

Effect of Postoperative Radiotherapy after Primary Tumor Resection in De Novo Stage IV Breast Cancer: A Multicenter Retrospective Study (KROG 19-02).

PURPOSE: This study aimed to investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT. MATERIALS AND METHODS: This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively. RESULTS: The median follow-up time was 53.7 months (range, 3.1 to 194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 category, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio, 0.64; 95% confidence interval, 0.50 to 0.82; p < 0.001), in addition to T1/2 category, ≤ 5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups (group 1, T1/2 and non-TNBC [n=193]; group 2, T3/4 and non-TNBC [n=171]; and group 3, TNBC [n=49]), and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regarding PFS in groups 1 and 2, not in group 3. CONCLUSION: PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 category and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.

Clinical Significance of Peritumoral Adipose Tissue PET/CT Imaging Features for Predicting Axillary Lymph Node Metastasis in Patients with Breast Cancer.

We investigated whether textural parameters of peritumoral breast adipose tissue (AT) based on F-18 fluorodeoxyglucose (FDG) PET/CT could predict axillary lymph node metastasis in patients with breast cancer. A total of 326 breast cancer patients with preoperative FDG PET/CT were retrospectively enrolled. PET/CT images were visually assessed and the maximum FDG uptake of axillary lymph nodes (LN SUVmax) was measured. From peritumoral breast AT, 38 textural features of PET imaging were extracted. The diagnostic ability of PET based on visual analysis, LN SUVmax, and textural features of peritumoral breast AT for predicting axillary lymph node metastasis were assessed using the area under the receiver operating characteristic curve (AUC) values. Among the 38 peritumoral breast AT textural features, grey-level co-occurrence matrix (GLCM) entropy showed the highest AUC value (0.830) for predicting axillary lymph node metastasis. The value of GLCM entropy was higher than that of visual analysis (0.739; p < 0.05) and the AUC value was comparable to that of LN SUVmax (0.793; p > 0.05). In the subgroup analysis of patients with negative findings on visual analysis, GLCM entropy still showed a high diagnostic ability (AUC: 0.759) in predicting lymph node metastasis. The findings suggest a potential diagnostic role of PET/CT imaging features of peritumoral breast AT in predicting axillary lymph node metastasis in patients with breast cancer.

Choroid plexus carcinoma with leptomeningeal spread in an adult: a case report and review of the literature.

BACKGROUND: Choroid plexus carcinoma is an intraventricular neoplasm originating from the choroid plexus epithelium and is of rare occurrence in adults. However, owing to the low prevalence of choroid plexus carcinoma, there is very limited information about the disease entity and treatment. Here we report a rare case of choroid plexus carcinoma in an adult patient. CASE PRESENTATION: A 46-year-old South Korean (East Asian) male presented with low back pain, headache, and diplopia. Magnetic resonance imaging demonstrated enhancing mass lesion in the left trigone, cerebellar with leptomeningeal spread. Surgery was performed via left parietal craniotomy, and the lesion was histologically confirmed to be choroid plexus carcinoma. The patient received adjuvant craniospinal irradiation for remnant mass and leptomeningeal spread. Magnetic resonance imaging performed immediately after completion of the treatment revealed a partial decrease in the size of the tumor. However, the patient expired died as a result of acute respiratory distress syndrome before follow-up of long-term outcome. CONCLUSION: Choroid plexus carcinoma with leptomeningeal spread in adults is very important for rapid diagnosis and treatment. In the case of the presence of leptomeningeal spread, craniospinal irradiation can be considered as a treatment method, but may have serious complications. Hence, the technique should be applied with care.

Effects of Intensive Individualized Nutrition Counseling on Nutritional Status and Kidney Function in Patients With Stage 3 and 4 Chronic Kidney Disease.

OBJECTIVE: Although dietary modification is a critical component of chronic kidney disease (CKD) management, compliance with dietary recommendations is often suboptimal. This prospective intervention study was conducted to evaluate the effects and adherence of intensive, individualized nutrition counseling in CKD patients from a single nation Asian ethnic group. METHODS: Patients with Stages 3 and 4 CKD were recruited from a tertiary hospital outpatient clinic in Korea. The intensive group received 3 monthly sessions of individualized intensive nutrition counseling. The control group received a one-time group program. The intensive group was compared with the control group at 3 months. RESULTS: A total of 59 patients were enrolled, and 42 (71.2%) completed the study (23/32 of the intensive group; 19/27 of the control group). The mean age of the patients was 64.7 ± 12.5 years, and 81% were male. The most common nutritional diagnosis was an excessive intake of sodium (Na, 97.6%), followed by potassium (K, 78.6%), protein (52.4%), and phosphorus (P, 31.0%). After 3 months of nutrition counseling, K and P intakes decreased significantly in both the intensive group (K, 2,760.9 ± 677.4 vs. 1,500.7 ± 398.5 mg/d, P < .001; P, 1,010.5 ± 247.4 vs. 631.3 ± 178.1 mg/d, P < .001) and the control group (K, 2,090.8 ± 765.3 vs. 1,703.9 ± 490.0 mg/d, P = .036; P, 807.2 ± 163.8 vs. 679.1 ± 175.9 mg/d, P = .044). Meanwhile, protein (68.3 ± 21.8 vs. 45.4 ± 10.1 g/d, P = .001), Na (4,009.8 ± 1,418.2 vs. 2,224.6 ± 759.8 mg/d, P < .001), and energy intakes (1,857.1 ± 411.5 vs. 1,273.7 ± 231.5 kcal, P < .001) decreased in the intensive group, but were comparable in the control group. Notably, BMI decreased (BMI, 25.4 ± 2.5 vs. 24.9 ± 2.9 kg/m2, P = .014) while eGFR (43.1 ± 11.8 vs. 48.9 ± 13.7 mL/min/1.73m2, P = .002) improved significantly in the intensive group only. CONCLUSION: Intensive individualized nutrition counseling results in better adherence to dietary recommendations and improvement in kidney function in CKD patients.

Comparison of Dose Distribution in Regional Lymph Nodes in Whole-Breast Radiotherapy vs. Whole-Breast Plus Regional Lymph Node Irradiation: An In Silico Planning Study in Participating Institutions of the Phase III Randomized Trial (KROG 1701).

The purpose of the current in silico planning study is to compare radiation doses of whole-breast irradiation (WBI) and whole-breast plus regional lymph node irradiation (WBI+RNI) administered to the regional lymph nodes (RLN) in pN1 breast cancer. Twenty-four participating institutions were asked to create plans of WBI and WBI+RNI for two dummy cases. To compare target coverage between the participants, an isodose line equal to 90% of the prescribed dose was converted to an isodose contour (contour90% iso). The relative nodal dose (RND) was obtained using the ratio of RLN dose to the target dose. The Fleiss's kappa values which represent inter-observer agreement of contour90% iso were over 0.68. For RNI, 6 institutions included axillary lymph node (ALN), supraclavicular lymph node (SCN), and internal mammary lymph node (IMN), while 18 hospitals included only ALN and SCN. The median RND between the WBI and WBI+RNI were as follows: 0.64 vs. 1.05 (ALN level I), 0.27 vs. 1.08 (ALN level II), 0.02 vs. 1.12 (ALN level III), 0.01 vs. 1.12 (SCN), and 0.54 vs. 0.82 (IMN). In all nodal regions, the RND was significantly lower in WBI than in WBI+RNI (p < 0.01). In this study, we could identify the nodal dose difference between WBI and WBI+RNI.

Dosimetric comparison of incidental axillary irradiation between three-dimensional conformal and volumetric modulated arc techniques for breast cancer.

Radiotherapy techniques for breast cancer have evolved with efforts to reduce treatment-related side effects. In the present study, we conducted dosimetric analysis of incidental axillary irradiation between volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT). A total of 20 patients with early stage left breast cancer who underwent breast-conserving surgery followed by postoperative radiotherapy were analyzed. For VMAT plans, dose-volume constraints were not imposed on the axilla, as with 3D-CRT. We compared the dosimetric parameters of the planning target volumes, organs at risk and axillary level I-III of the two plans. VMAT showed better target coverage and a normal organ-sparing effect compared with 3D-CRT. The incidental axillary irradiation of VMAT was lower; the mean dose and the V40Gy were significantly reduced at all axillary levels, with the exception of no difference in the maximum dose to axillary level I. In conclusion, VMAT decreased incidental axillary irradiation, even in the absence of a dose-volume constraint on the axilla, and can, therefore, decrease the risk of radiotherapy-related lymphedema. However, caution is also required because it is unclear whether this incidental axillary irradiation is beneficial for reducing recurrence on the axilla.

Relationship Between Changes in Myocardial F-18 Fluorodeoxyglucose Uptake and Radiation Dose After Adjuvant Three-Dimensional Conformal Radiotherapy in Patients with Breast Cancer.

This study aimed to assess the relationship between radiation dose and changes in the irradiated myocardial F-18 fluorodeoxyglucose (FDG) uptake after radiotherapy (RT) in breast cancer patients. The data of 55 patients with left and 48 patients with right breast cancer who underwent curative surgical resection and adjuvant three-dimensional conformal RT and staging (PET1), post-adjuvant chemotherapy (PET2), post-RT (PET3), and surveillance (PET4) FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. The median interval between PET1 and curative surgical resection, between the end of adjuvant chemotherapy and PET2, between the end of RT and PET3, and between the end of RT and PET4 were five days, 13 days, 132 days, and 353 days, respectively. The myocardial-to-blood pool uptake ratio was measured in all patients. For patients with left breast cancer, the 30 Gy- (30 Gy) and 47.5 Gy-irradiated myocardium-to-low-irradiated myocardium (47.5 Gy) FDG uptake ratios were additionally measured. There were no differences in the myocardial-to-blood pool uptake ratios between left and right breast cancer on all PET scans. For left breast cancer, higher 30 Gy and 47.5 Gy uptake ratios were observed on PET3 than on PET1 and PET2. Both uptake ratios decreased on PET4 compared to PET3, but, were still higher compared to PET1. On PET3 and PET4, the 47.5 Gy were higher than the 30 Gy uptake ratios, while there were no differences between them on PET1 and PET2. Although the whole myocardium FDG uptake showed no significant change, the irradiated myocardium FDG uptake significantly increased after RT and was related to radiation dose to the myocardium in breast cancer patients. These results might be an imaging evidence that supports the increased risk of heart disease after RT in patients with left breast cancer.

Stereotactic body radiation therapy for pulmonary large cell neuroendocrine carcinoma: a case report.

The incidence of large cell neuroendocrine carcinoma (LCNEC) of the lung is rare, and the treatment methods and prognosis for such patients are still subjects of debate. We report a case of a 78-year-old male LCNEC patient for whom stereotactic body radiation therapy was performed. A four-dimensional computed tomography scan was used for simulation, and radiotherapy was planned using the volumetrically modulated arc technique. A total of 55 Gy was delivered in five daily fractions. The treatment was safely completed, and the patient did not report any discomfort. The only side-effect was an intermittent cough. Currently, the patient has received 18 months of outpatient follow-up care with no evidence of disease. In conclusion, stereotactic body radiation therapy can be a valuable treatment option for early stage LCNEC.

Lymphovascular Invasion Increases the Risk of Nodal and Distant Recurrence in Node-Negative Stage I-IIA Non-Small-Cell Lung Cancer.

OBJECTIVES: Despite complete surgical resection, 30-40% of patients with stage I-IIA non-small-cell lung cancer (NSCLC) have recurrences. We aimed to elucidate the effect of lymphovascular invasion (LVI) on the prognosis and patterns of recurrence in patients with pathologically confirmed T1-2N0 NSCLC. METHODS: We evaluated 381 patients who underwent complete resection and were diagnosed with pathologic T1-2N0 NSCLC between March 2000 and January 2012. Local recurrence, nodal recurrence, and distant metastasis were defined and analyzed. RESULTS: LVI was present in 72 patients (18.9%). The 5-year disease-free survival (DFS) for all patients was 69.9%. Patients with LVI showed a significant decrease in 5-year DFS (47.3 vs. 74.4%, p < 0.001). LVI was a significant prognostic predictor in multivariate analysis (p = 0.003). The patients with LVI showed a significantly increased 5-year cumulative incidence of nodal recurrence (22.5 vs. 8.7%, p < 0.001) and distant metastasis (30.4 vs. 14.9%, p = 0.004). However, no difference was shown between the two groups in the 5-year cumulative incidence of local recurrence (p = 0.416). CONCLUSIONS: LVI is a negative prognostic factor in patients with stage I-IIA NSCLC. The presence of LVI significantly increases the risk of nodal and distant recurrence.

Effect of Personalized Nutritional Counseling on the Nutritional Status of Hemodialysis Patients.

This study set out to evaluate the impact of personalized nutritional counseling (PNC) on the nutritional status of hemodialysis (HD) patients. This was an intervention study for 10 months at 2 hospitals. Anthropometric, biochemical, dietary, and body composition parameters were measured at baseline and after 3 and 6 months of PNC. A total of 42 patients (23 men and 19 women) were included. Intake of dietary protein, serum albumin, and cholesterol levels had increased significantly from baseline to month 6 (p < 0.05). Among the bioelectrical impedance analysis (BIA) parameters, both the body cell mass (BCM) and the fat free mass (FFM) had significantly reduced at month 3 compared to baseline (p < 0.05). However, there was no difference between baseline and month 6. We assessed the nutritional status of the subjects using the malnutrition inflammation score (MIS), and divided them into an adequately nourished (AN) and a malnourished (MN) group at baseline. In the subgroup analysis, serum levels of albumin and cholesterol had increased significantly, particularly from baseline to month 6 in the MN group (p < 0.05). This study suggests that consecutive PNC contributed to the improvement of the protein intake, serum levels of albumin, cholesterol and to the delay of muscle wasting, which could also have a positive impact on the nutritional status, particularly in malnourished patients receiving HD treatment.

Diabetes Management via a Mobile Application: a Case Report.

Recently, mobile health care has been applied to manage diabetes requiring self-management. Health care by mobile applications (apps) has a great advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be improved through mobile apps. The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes since 2010. However, mobile apps may not be effective for all patients. We here report the effect of use of mobile-based diabetes care app (Healthy-note app) for 2 patients with diabetes, and discuss issues and strategies for effective mobile intervention. Further study is needed on improving patient's participation to increase the effect of management via a mobile app.