The Usefulness of Quantitative Electroencephalography in Diagnosis and Severity Evaluation of Delirium: A Retrospective Study

Objective@#Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium. @*Methods@#This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes’ sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed. @*Results@#On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011). @*Conclusion@#Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.

Relative infectivity of the SARS-CoV-2 Omicron variant in human alveolar cells

With the emergence of multiple highly transmissible SARS-CoV-2 variants during the recent pandemic, the comparison of their infectivity has become a substantially critical issue for public health. However, a direct assessment of these viral characteristics has been challenging due to the lack of appropriate experimental models and efficient methods. Here, we integrated human alveolar organoids and single-cell transcriptome sequencing techniques to facilitate the evaluation. In a proof-of-concept study using the assay with four highly transmissible SARS-CoV-2 variants, including GR (B.1.1.119), Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (BA.1), a rapid evaluation of the relative infectivity was possible. Our results demonstrate that the Omicron (BA.1) variant is 3-5-fold more infectious to human alveolar cells than the other SARS-CoV-2 variants at the early phase of infection. To our knowledge, this study provides the first direct measurement of the infectivity of the Omicron variant and new experimental procedures that can be applied for monitoring newly emerging viral variants.

State and Trait Anxiety Related Gamma Oscillations in Patients With Anxiety Within the Research Domain Criteria Framework

Objective@#Diagnosis of anxiety has relied primarily on self-report. This study aimed to investigate the neural correlates of anxiety with quantitative electroencephalography (qEEG) focusing on the state and trait anxiety defined according to the Research Domain Criteria framework existing across the differential diagnosis, rather than focusing on the diagnosis. @*Methods@#A total of 41 participants who visited a psychiatric clinic underwent resting state EEG and completed the State-Trait Anxiety Inventory. The absolute power of six frequency bands were analyzed: delta (1–4 Hz), theta (4–8 Hz), alpha (8–10 Hz), fast alpha (10–13.5 Hz), beta (13.5–30 Hz), and gamma (30–80 Hz). @*Results@#State anxiety scores were significantly negatively correlated with absolute gamma power in frontal (Fz, r=-0.484) and central (Cz, r=-0.523) regions, while trait anxiety scores were significantly negatively correlated with absolute gamma power in frontal (Fz, r= -0.523), central (Cz, r=-0.568), parietal (P7, r=-0.500; P8, r=-0.541), and occipital (O1, r=-0.510; O2, r=-0.480) regions. @*Conclusion@#The present study identified the significantly negative correlations between the anxiety level and gamma band power in fronto-central and posterior regions assessed at resting status. Further studies to confirm our findings and identify the neural correlates of anxiety are needed.

Intraoperative Radiotherapy for Resectable Pancreatic Cancer Using a Low-Energy X-Ray Source:Postoperative Complications and Early Outcomes

Purpose@#We evaluated the safety, feasibility, and early treatment outcomes of intraoperative radiotherapy (IORT) using a lowenergy X-ray source. @*Materials and Methods@#Patients with resectable pancreatic cancer were enrolled in this single-institution, prospective, singlearm, phase II trial. Patients underwent surgery and IORT with 10 Gy prescribed at a 5-mm depth from the tumor bed using a 50 kV X-ray source (Intrabeam, Carl Zeiss). Six cycles of adjuvant gemcitabine-based chemotherapy were administered 8–12 weeks after surgery. @*Results@#A total of 41 patients were included. Thirty-one patients (75.6%) underwent wide R0 resection, while 5 (12.2%) underwent R1 resection and 5 (12.2%) underwent narrow R0 resection (retroperitoneal margin <1 mm). Grade 3 postoperative complications were reported in only one patient (4.9%) who needed additional surgery due to ulcer perforation. At a median follow-up of 9 months, four patients showed local-only recurrence, nine had distant metastases, and two showed both local and distant recurrence. The 1-year local control rate was 76.4%. @*Conclusion@#Our preliminary report suggests that IORT is well-tolerated and feasible in patients with resectable pancreatic cancer. Further follow-up is needed to confirm the clinical benefits of IORT in terms of local control and overall survival.Trial Registration: Clinical trial registration No. (NCT03273374).

The Psychological Impact of Quarantine during COVID-19 Pandemic: A Cross-Sectional Study / 생물치료정신의학

Objectives@#：This study assessed the psychological impact of quarantine during the coronavirus disease 2019 (COVID-19) outbreak. @*Methods@#：A total of 2080 participants filled the self-report questionnaire from March 17 to April 20, 2020 in Daegu, Republic of Korea. An online link was sent to currently or previously quarantined participants. The self-report questionnaire included patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), primary care post-traumatic stress disorder screen for diagnostic and statistical manual-5 (PTSD-PC), state-trait anger expression inventory (STAXI), and P4 suicidality screener scale (P4). PHQ-9 score of 5 or more and 9 or less indicates mild to moderate depressive symptoms, and 10 or more indicates severe depressive symptoms; A GAD-7 score of 5 or more and 14 or less indicates mild to moderate anxiety symptoms, and a score of 15 or more indicates severe anxiety symptoms; A PTSD-PC-5 score of 2 indicates mild to moderate PTSD; a score of 3 or higher indicates severe PTSD; A STAXI score of 14 or higher indicates severe anger symptoms; In P4, the cut-off points for each self-report questionnaire were set as mild suicidal thoughts at 1 point or more and 2 points or less, and severe suicide thoughts at 3 or more points. Logistic regression analyses were used to explore COVID-19-related risk factors. @*Results@#：The prevalence of mental health symptoms among the survey respondents was at 52.5% for depression, 44.5% for anxiety, 39.4% for post-traumatic stress, 31.6% for anger, and 10.9% for suicidal ideation. Participants with confirmed or suspected COVID-19 family members showed a high risk for symptoms of anxiety, posttraumatic stress, and anger. Participants with financial loss had increased symptoms of depression, anxiety, posttraumatic stress, anger, and suicidal ideation. Participants with a history of medical/psychiatric illnesses reported more symptoms of depression, anxiety, post-traumatic stress, anger, and suicidal ideation. Having inadequate basic supplies during quarantine was associated with negative mental health outcomes. @*Conclusions@#：Quarantine had a negative psychological impact on all five mental health factors. The risk of depression, anxiety, post-traumatic stress disorder, anger, and suicidality increased among those who suffered from financial losses due to COVID-19. The associated risk factors will help identify populations at risk for mental health problems and implement mental health intervention policies.

The in vitro and in vivo potency of CT-P59 against Delta and its associated variants of SARS-CoV-2

The Delta variant originally from India is rapidly spreading across the world and causes to resurge infections of SARS-CoV-2. We previously reported that CT-P59 presented its in vivo potency against Beta and Gamma variants, despite its reduced activity in cell experiments. Yet, it remains uncertain to exert the antiviral effect of CT-P59 on the Delta and its associated variants (L452R). To tackle this question, we carried out cell tests and animal study. CT-P59 showed reduced antiviral activity but enabled neutralization against Delta, Epsilon, and Kappa variants in cells. In line with in vitro results, the mouse challenge experiment with the Delta variant substantiated in vivo potency of CT-P59 showing symptom remission and virus abrogation in the respiratory tract. Collectively, cell and animal studies showed that CT-P59 is effective against the Delta variant infection, hinting that CT-P59 has therapeutic potency for patients infected with Delta and its associated variants. HighlightsO_LICT-P59 exerts the antiviral effect on authentic Delta, Epsilon and Kappa variants in cell-based experiments. C_LIO_LICT-P59 showed neutralizing potency against variants including Delta, Epsilon, Kappa, L452R, T478K and P681H pseudovirus variants. C_LIO_LIThe administration of clinically relevant dose of CT-P59 showed in vivo C_LIO_LIprotection against Delta variants in animal challenge experiment. C_LI

Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy

Objective@#Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy. @*Methods@#Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point. @*Results@#Patients’ diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R2=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R2=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R2=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R2=0.278, p=0.014). @*Conclusion@#Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.

Survey of radiation field and dose in human papillomavirus-positive oropharyngeal cancer: is de-escalation actually applied in clinical practice?

Purpose@#Studies on de-escalation in radiation therapy (RT) for human papillomavirus-related (HPV(+)) oropharyngeal cancer (OPC) are currently ongoing. This study investigated the current practice regarding the radiation dose and field in the treatment of HPV(+) OPC. @*Materials and Methods@#The Korean Society for Head and Neck Oncology conducted a questionnaire on the primary treatment policy. Among them, for HPV(+) OPC scenarios, radiation oncologists were questioned regarding the field and dose of RT. @*Results@#Forty-two radiation oncologists responded to the survey. In definitive concurrent chemoradiotherapy (CCRT) treatment for stage T2N1M0 OPC, most respondents prescribed a dose of >60 Gy to the primary tonsil and involved ipsilateral lymph nodes. However, eight of the respondents prescribed a relatively low dose of ≤54 Gy. For stage T2N1M0 OPC, postoperative adjuvant RT was prescribed by eight and nine respondents with a lower dose of ≤50 Gy for the ipsilateral tonsil and involved neck, respectively. In definitive CCRT in complete remission after induction chemotherapy for initial stage T2N3M0 OPC, de-escalation of the tonsil and involved neck were performed by eight and seven respondents, respectively. Regarding whether de-escalation is applied in radiotherapy for HPV(+) OPC, 27 (64.3%) did not do it at present, and 15 (35.7%) were doing or considering it. @*Conclusion@#The field and dose of prescribed treatment varied between institutions in Korea. Among them, dose de-escalation of RT in HPV(+) OPC was observed in approximately 20% of the respondents. Consensus guidelines will be set in the near future after the completion of ongoing prospective trials.

The Role of Quantitative Electroencephalogram in the Diagnosis and Subgrouping of Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) leads to functional decline in academic performance, interpersonal relationships, and development in school-aged children. Early diagnosis and appropriate intervention can significantly reduce the functional decline caused by ADHD. Currently, there is no established biological marker for ADHD. Some studies have suggested that various indicators from the quantitative electroencephalogram (QEEG) may be useful biological markers for the diagnosis of ADHD. Until the 2010s, theta/beta ratio (TBR) was a biomarker candidate for ADHD that consistently showed high diagnostic value. However, limitations of TBR have recently been reported. Studies have demonstrated that phase-amplitude coupling, especially theta phase-gamma amplitude coupling, are related to cognitive dysfunction and may assist in the diagnosis of ADHD. As yet, the underlying mechanism is not clearly established, and the clinical efficacy of these biomarkers needs to be proven through well-controlled studies. Based on the heterogeneous characteristics of ADHD, subgrouping through QEEG plays a key role in diagnosis and treatment planning. Sophisticated, welldesigned studies and meta-analyses are necessary to confirm these findings.

Survey of radiation field and dose in human papillomavirus-positive oropharyngeal cancer: is de-escalation actually applied in clinical practice?

Purpose@#Studies on de-escalation in radiation therapy (RT) for human papillomavirus-related (HPV(+)) oropharyngeal cancer (OPC) are currently ongoing. This study investigated the current practice regarding the radiation dose and field in the treatment of HPV(+) OPC. @*Materials and Methods@#The Korean Society for Head and Neck Oncology conducted a questionnaire on the primary treatment policy. Among them, for HPV(+) OPC scenarios, radiation oncologists were questioned regarding the field and dose of RT. @*Results@#Forty-two radiation oncologists responded to the survey. In definitive concurrent chemoradiotherapy (CCRT) treatment for stage T2N1M0 OPC, most respondents prescribed a dose of >60 Gy to the primary tonsil and involved ipsilateral lymph nodes. However, eight of the respondents prescribed a relatively low dose of ≤54 Gy. For stage T2N1M0 OPC, postoperative adjuvant RT was prescribed by eight and nine respondents with a lower dose of ≤50 Gy for the ipsilateral tonsil and involved neck, respectively. In definitive CCRT in complete remission after induction chemotherapy for initial stage T2N3M0 OPC, de-escalation of the tonsil and involved neck were performed by eight and seven respondents, respectively. Regarding whether de-escalation is applied in radiotherapy for HPV(+) OPC, 27 (64.3%) did not do it at present, and 15 (35.7%) were doing or considering it. @*Conclusion@#The field and dose of prescribed treatment varied between institutions in Korea. Among them, dose de-escalation of RT in HPV(+) OPC was observed in approximately 20% of the respondents. Consensus guidelines will be set in the near future after the completion of ongoing prospective trials.

The Role of Quantitative Electroencephalogram in the Diagnosis and Subgrouping of Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) leads to functional decline in academic performance, interpersonal relationships, and development in school-aged children. Early diagnosis and appropriate intervention can significantly reduce the functional decline caused by ADHD. Currently, there is no established biological marker for ADHD. Some studies have suggested that various indicators from the quantitative electroencephalogram (QEEG) may be useful biological markers for the diagnosis of ADHD. Until the 2010s, theta/beta ratio (TBR) was a biomarker candidate for ADHD that consistently showed high diagnostic value. However, limitations of TBR have recently been reported. Studies have demonstrated that phase-amplitude coupling, especially theta phase-gamma amplitude coupling, are related to cognitive dysfunction and may assist in the diagnosis of ADHD. As yet, the underlying mechanism is not clearly established, and the clinical efficacy of these biomarkers needs to be proven through well-controlled studies. Based on the heterogeneous characteristics of ADHD, subgrouping through QEEG plays a key role in diagnosis and treatment planning. Sophisticated, welldesigned studies and meta-analyses are necessary to confirm these findings.

The architecture of SARS-CoV-2 transcriptome

SARS-CoV-2 is a betacoronavirus that is responsible for the COVID-19 pandemic. The genome of SARS-CoV-2 was reported recently, but its transcriptomic architecture is unknown. Utilizing two complementary sequencing techniques, we here present a high-resolution map of the SARS-CoV-2 transcriptome and epitranscriptome. DNA nanoball sequencing shows that the transcriptome is highly complex owing to numerous recombination events, both canonical and noncanonical. In addition to the genomic RNA and subgenomic RNAs common in all coronaviruses, SARS-CoV-2 produces a large number of transcripts encoding unknown ORFs with fusion, deletion, and/or frameshift. Using nanopore direct RNA sequencing, we further find at least 41 RNA modification sites on viral transcripts, with the most frequent motif being AAGAA. Modified RNAs have shorter poly(A) tails than unmodified RNAs, suggesting a link between the internal modification and the 3' tail. Functional investigation of the unknown ORFs and RNA modifications discovered in this study will open new directions to our understanding of the life cycle and pathogenicity of SARS-CoV-2. HighlightsO_LIWe provide a high-resolution map of SARS-CoV-2 transcriptome and epitranscriptome using nanopore direct RNA sequencing and DNA nanoball sequencing. C_LIO_LIThe transcriptome is highly complex owing to numerous recombination events, both canonical and noncanonical. C_LIO_LIIn addition to the genomic and subgenomic RNAs common in all coronaviruses, SARS-CoV-2 produces transcripts encoding unknown ORFs. C_LIO_LIWe discover at least 41 potential RNA modification sites with an AAGAA motif. C_LI

Neurofeedback : Possibility of Alternative Non-Pharmaceutical Treatment for Children with ADHD / 생물치료정신의학

The treatment strategy for children with attention deficit/hyperactivity disorder (ADHD) mainly involves medication, although research on non-pharmaceutical treatments steadily continues. Neurofeedback is considered as a nonpharmacological treatment strategy for children with ADHD. In this review, the concept and principles of neurofeedback, the electroencephalography characteristics of children with ADHD, and the background for application of neurofeedback therapy in these subjects are described. The results of the latest studies are presented, showing that neurofeedback treatment seems to be effective in improving some symptoms, and that it can be useful as a complementary treatment. However, further research is needed to investigate whether neurofeedback alone may be as effective as drug treatments.

Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. MATERIALS AND METHODS: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy₁₀ (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy₁₀ (median, 56.0 Gy₁₀). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.

Radiotherapy for initial clinically positive internal mammary nodes in breast cancer

PURPOSE: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. MATERIALS AND METHODS: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. RESULTS: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. CONCLUSION: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.

Treatment outcomes of radiotherapy for anaplastic thyroid cancer

PURPOSE: Anaplastic thyroid cancer (ATC) is a rare tumor with a lethal clinical course despite aggressive multimodal therapy. Intensity-modulated radiotherapy (IMRT) may achieve a good therapeutic outcome in ATC patients, and the role of IMRT should be assessed. We retrospectively reviewed outcomes for ATC treated with three-dimensional conformal radiotherapy (3D-CRT) or IMRT to determine the optimal treatment option and explore the role of radiotherapy (RT). MATERIALS AND METHODS: Between December 2000 and December 2015, 41 patients with pathologically proven ATC received RT with a sufficient dose of ≥40 Gy. Among them, 21 patients (51%) underwent surgery before RT. Twenty-eight patients received IMRT, and 13 received 3D-CRT. Overall survival (OS) and progression-free survival (PFS), patterns of failure, and toxicity were examined. RESULTS: The median follow-up time for survivors was 38.0 months. The median and 1-year OS and PFS rates were 7.2 months and 29%, 4.5 months and 15%, respectively. Surgery significantly improved the prognosis (median OS: 10.7 vs. 3.9 months, p = 0.001; median PFS: 5.9 vs. 2.5 months, p = 0.007). IMRT showed significantly better PFS and OS than 3D-CRT, even in multivariate analysis (OS: hazard ratio [HR] = 0.30, p = 0.005; PFS: HR = 0.33, p = 0.005). Significantly higher radiation dose could be delivered with IMRT than 3D-CRT (EQD210 66 vs. 60 Gy, p = 0.005). Only 2 patients had grade III dermatitis after IMRT. No other severe toxicity ≥grade III occurred. CONCLUSION: Patients with ATC showed better prognosis through multimodal treatment. Furthermore, IMRT could achieve favorable survival rates by safely delivering higher dose than 3D-CRT.

Risk Factors for Smartphone Addiction in Korean Adolescents: Smartphone Use Patterns

With widespread use of the smartphone, clinical evidence for smartphone addiction remains unclear. Against this background, we analyzed the effect of smartphone use patterns on smartphone addiction in Korean adolescents. A total of 370 middle school students participated. The severity of smartphone addiction was measured through clinical interviews and the Korean Smartphone Addiction Proneness Scale. As a result, 50 (13.5%) were in the smartphone addiction group and 320 (86.5%) were in the healthy group. To investigate the effect of smartphone use patterns on smartphone addiction, we performed self-report questionnaires that assessed the following items: smartphone functions mostly used, purpose of use, problematic use, and parental attitude regarding smartphone use. For smartphone functions mostly used, the addiction group showed significantly higher scores in “Online chat.” For the purpose of use, the addiction group showed significantly higher “habitual use,”“pleasure,”“communication,”“games,”“stress relief,”“ubiquitous trait,” and “not to be left out.” For problematic use, the addiction group showed significantly higher scores on “preoccupation,”“tolerance,”“lack of control,”“withdrawal,”“mood modification,”“conflict,”“lies,”“excessive use,” and “loss of interest.” For parental attitude regarding children's smartphone use, the addiction group showed significantly higher scores in “parental punishment.” Binary logistic regression analysis indicated that “female,”“use for learning,”“use for ubiquitous trait,”“preoccupation,” and “conflict” were significantly correlated with smartphone addiction. This study demonstrated that the risk factors for smartphone addiction were being female, preoccupation, conflict, and use for ubiquitous trait; the protective factor was use for learning. Future studies will be required to reveal the additional clinical evidence of the disease entity for smartphone addiction.

Clinical Practice Patterns of Radiotherapy in Patients with Hepatocellular Carcinoma: A Korean Radiation Oncology Group Study (KROG 14-07) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to examine patterns of radiotherapy (RT) in Korean patients with hepatocellular carcinoma (HCC) according to the evolving guideline for HCC established by the Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC). MATERIALS AND METHODS: We reviewed 765 patients with HCC who were treated with RT between January 2011 and December 2012 in 12 institutions. RESULTS: The median follow-up period was 13.3 months (range, 0.2 to 51.7 months). Compared with previous data between 2004 and 2005, the use of RT as a first treatment has increased (9.0% vs. 40.8%). Increased application of intensity-modulated RT resulted in an increase in radiation dose (fractional dose, 1.8 Gy vs. 2.5 Gy; biologically effective dose, 53.1 Gy10 vs. 56.3 Gy10). Median overall survival was 16.2 months, which is longer than that reported in previous data (12 months). In subgroup analysis, treatments were significantly different according to stage (p < 0.001). Stereotactic body RT was used in patients with early HCC, and most patients with advanced stage were treated with three-dimensional conformal RT. CONCLUSION: Based on the evolving KLCSG-NCC practice guideline for HCC, clinical practice patterns of RT have changed. Although RT is still used mainly in advanced HCC, the number of patients with good performance status who were treated with RT as a first treatment has increased. This change in practice patterns could result in improvement in overall survival.

In vivo dosimetry and acute toxicity in breast cancer patients undergoing intraoperative radiotherapy as boost

PURPOSE: To report the results of a correlation analysis of skin dose assessed by in vivo dosimetry and the incidence of acute toxicity. This is a phase 2 trial evaluating the feasibility of intraoperative radiotherapy (IORT) as a boost for breast cancer patients. MATERIALS AND METHODS: Eligible patients were treated with IORT of 20 Gy followed by whole breast irradiation (WBI) of 46 Gy. A total of 55 patients with a minimum follow-up of 1 month after WBI were evaluated. Optically stimulated luminescence dosimeter (OSLD) detected radiation dose delivered to the skin during IORT. Acute toxicity was recorded according to the Common Terminology Criteria for Adverse Events v4.0. Clinical parameters were correlated with seroma formation and maximum skin dose. RESULTS: Median follow-up after IORT was 25.9 weeks (range, 12.7 to 50.3 weeks). Prior to WBI, only one patient developed acute toxicity. Following WBI, 30 patients experienced grade 1 skin toxicity and three patients had grade 2 skin toxicity. Skin dose during IORT exceeded 5 Gy in two patients: with grade 2 complications around the surgical scar in one patient who received 8.42 Gy. Breast volume on preoperative images (p = 0.001), ratio of applicator diameter and breast volume (p = 0.002), and distance between skin and tumor (p = 0.003) showed significant correlations with maximum skin dose. CONCLUSIONS: IORT as a boost was well-tolerated among Korean women without severe acute complication. In vivo dosimetry with OSLD can help ensure safe delivery of IORT as a boost.

Differences in Resting-state Quantitative Electroencephalography Patterns in Attention Deficit/Hyperactivity Disorder with or without Comorbid Symptoms

OBJECTIVE: The aim of the present study was to evaluate the role of comorbid psychiatric symptoms on quantitative electroencephalogram (QEEG) activities in boys with the attention deficit/hyperactivity disorder (ADHD). METHODS: All participants were male students in the second, third or fourth grade in elementary school. Therefore, there were no significant differences in age or sex. Participants with ADHD were assigned to one of three groups: pure ADHD (n=22), ADHD with depressive symptoms (n=11), or ADHD with problematic internet use (n=19). The Korean version of the Children’s Depression Inventory and the Korean Internet Addiction Self-scale were used to assess depressive symptoms and problematic internet use, respectively. Resting-state EEG during eyes closed was recorded, and the absolute power of five frequency bands was analyzed: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), and gamma (30–50 Hz). RESULTS: The ADHD with problematic internet use group showed decreased absolute theta power at the central and posterior region compared with the pure ADHD group. However, The ADHD with depressive symptoms group showed no significant differences compared with the other groups. CONCLUSION: These findings will contribute to a better understanding of brain-based electrophysiological changes in children with ADHD in accordance with comorbid psychiatric symptoms.