We report on a PET system that has been recently completed after the last several years of development work. The PET system is a sub-component of PET/EPR hybrid imaging system for investigating tumor hypoxia in small animal, and will be deployed to replace the current PET subsystem of the PET/EPR imager. The new PET system possesses several superior features over the existing system for small animal imaging: the axial field-of-view is increased 4 times from $\sim 25$ mm to $\sim 106 \mathrm{~mm}$, and constituent scintillator pixel size is reduced from 3.0 mm to 1.0 mm to achieve sub-millimeter image resolution. The PET system is modularized and built by using 14 detector modules (DM). Each DM consists of 8 detector units (DU) in a row, and each DU in turn is a 12 x 12 array of $1 \mathrm{x} 1 \mathrm{x} 10 \mathrm{~mm}^{3}$ LYSO crystals coupled to a Hamamastu 14161-3050HS-04 MPPC array. The PET system employs a new signal readout method to efficiently handle a greatly increased number of detector outputs by combining a conventional resistive network (RN) and a strip-line (SL) method. Due to the highly multiplexing feature of the readout, each DM generates the total of 6 outputs only (2 SLs and 4 RNs) for digitization. After the evaluation test, BASP-10011 readout board (Brightonix Imaging, Korea) was adopted for high throughput and performance data acquisition needed for routine animal imaging studies, and was incorporated into the PET system. Following successful development and integration of all components, we started to conduct phantom imaging for performance evaluation of the PET system before installing it inside the EPR magnets. $\mathrm{A}^{22} \mathrm{Na}$ point source image shows 0.8 mm FWHM resolution in both transverse and axial direction. Image of a NEMA image quality phantom was acquired to assess the imaging performance of the PET system. We present the completed PET system and initial results on phantom imaging. More thorough performance results from on-going systematic evaluation will be reported at the conference.

The primary analysis of the STAMP trial demonstrated that adjuvant GemCis did not improve disease-free survival (DFS) compared to CAP in patients (pts) with resected, lymph node (LN)-positive extrahepatic CCA. As overall survival (OS) data were not matured at primary analysis, we report the updated analysis with an additional 19 months (mo) of follow-up. Pts with adenocarcinoma of perihilar/distal bile duct with regional LN metastasis who underwent curative-intent surgery was randomized to receive GemCis (Gem 1000 mg/m2, Cis 25 mg/m2 on days 1, 8) or CAP (1250 mg/m2 twice daily on days 1–14) every 3 weeks for 8 cycles. Primary endpoint was DFS. Secondary endpoints were OS and safety. All P values were one-sided and considered significant if < 0.1. A total of 101 pts (50 in the GemCis and 51 in the CAP group) were included in the intention-to-treat population. The median follow-up duration was 52.8 mo (one-sided 90% CI, 50.1-58.2). In the GemCis and CAP groups, the median DFS was 14.6 mo (10.7-16.5) and 11.1 mo (8.4-12.7), respectively, and the 4-year DFS rates were 15.9% (9.4-24.0) and 19.4% (12.4-27.5) respectively (HR = 1.02 [0.76-1.37], P = 0.47). Median OS was 35.0 mo (29.5-42.7) and 32.3 mo (28.3-45.6), respectively, and the 4-year OS rates were 35.7% (26.5-45.1) and 38.4% (29.2-47.5), respectively (HR = 1.04 [0.75-1.44], P = 0.43). Subgroup analyses showed consistent results without significant interactions in the DFS and OS between groups, except that pts with R1 resection favored CAP in DFS and OS, and females favored GemCis in OS.Table: 104PGemCisCAPHR (CI) and P-valueDFS events/pts40/5041/51Median DFS (months) (CI)14.6 (10.7-16.5)11.1 (8.4-12.7)1.02 (0.76-1.37) P = 0.474Y DFS rates (%) (CI)15.9 (9.4-24.0)19.4 (12.4-27.5)Deaths/pts33/5033/51Median OS (months) (CI)35.0 (29.5-42.7)32.3 (28.3-45.6)1.04 (0.75-1.44) P = 0.434Y OS rates (%) (CI)35.7 (26.5-45.1)38.4 (29.2-47.5) Open table in a new tab In this final analysis of the STAMP trial, adjuvant GemCis did not improve OS compared with CAP in LN-positive extrahepatic CCA. Biomarker analyses, including ctDNA-guided minimal residual disease (MRD), are currently underway.

The advancement of AI technology has led to its widespread adoption in a variety of fields. However, in the edge environment, there is currently no AI chip that effectively meets the market’s demands for performance, power efficiency, and price. As a result, AI applications have not been fully realized in edge contexts. To address this gap, we present ARIES, an innovative AI chip developed by Mobilint, a fabless company headquartered in South Korea. ARIES embodies superior performance, high power efficiency, and competitive pricing. Mobilint offers ARIES in two distinct forms: the PCIe card MLA100 and the AI box MLX-A1, each designed to maximize utility. To further enhance user engagement, a user-friendly software development kit (SDK) named qb is also provided to simplify deployment.

Previously, we reported a PET/EPR hybrid imaging system aiming to study and improve the efficacy of PET hypoxic tumor imaging using EPR oxygen imaging as a ground truth. Encouraged by the successful results with this exploratory system, we launched a PET subsystem development for the next generation PET/EPR scanner that has more suitable features for small animal imaging. The distinctive features of the new PET system include an ~4 times larger axial field-of-view (~106 mm) to allow whole body imaging of rodents, and a potentially sub-millimeter resolution by use of ~1 mm width LYSO scintillators. We devised a new signal multiplexing method to efficiently handle the significantly increased number of silicon photomultiplier outputs of this new system. The design of the detector module (DM) of the system has undergone several iterations. In the final design, the DM consists of 8 detector units (DU) on a 175mm x 20 mm printed circuit board, and each DU is made of a 12x12 LYSO crystals (1x1x10 mm 3 ) coupled to a Hamamatsu 14161-3050HS-04 MPPC array (4x4 3.2 mm pitch). The new signal multiplexing method produces only 6 outputs for each DM: two outputs for coincidence time and DU identification, and four outputs for pixel crystal identification within a DU. Fourteen (14) DMs have been developed and successfully assembled into a PET ring whose inner and outer diameters are 60 mm and 115 mm, respectively. Evaluation tests were conducted by using a Brightonix BASP-10011 data acquisition board that provides high-throughput 16 12-bit 80 MSPS analog-to-digital converter (ADC) and 16 time-to-digital converter (TDC) channels. The initial results indicate that when using the BASP-10011 resulting DM performance properties were as good as those obtained by using the CAEN 5742 waveform sampler operating at 0.7 GSPS. At the meeting, we will present the development of the PET system employing the BASP-10011 DAQ and its performance measurement result.

For patients (pts) with advanced BTC with progression on gemcitabine plus cisplatin (GemCis), fluoropyrimidine-based chemotherapy, including liposomal irinotecan (nal-IRI) plus fluorouracil and leucovorin (5-FU/LV) and 5-FU/LV plus oxaliplatin (FOLFOX) showed clinical benefit in prior randomized trials (NIFTY and ABC-06). However, there is no trial for head-to-head comparison among these agents. We performed IPD meta-analysis of two multicenter, randomized trials performed in South Korea, which compared efficacy of second-line chemotherapy for advanced BTC after progression on GemCis, including the phase 2b NIFTY trial (nal-IRI plus 5-FU/LV vs. 5-FU/LV, NCT03524508) and the phase 2 FIReFOX trial (modified FOLFOX [mFOLFOX] vs. modified 5-FU/LV plus irinotecan [mFOLFIRI], NCT03464968). ITT population of the two trials were included and survival outcomes were compared between the 4 treatment groups by pairwise log-rank test. Hazards ratio (HR) adjusted by potential prognostic variables was estimated by Cox proportional hazards modeling with shared frailty to account for the trials effect. A total of 278 pts were included in this analysis (178 pts from the NIFTY trial and 99 pts from the FIReFOX trial). The nal-IRI plus 5-FU/LV group (n=88) showed significantly better overall survival compared to the mFOLFOX group (n=49, p = 0.02), mFOLFIRI group (n=50, p = 0.03), and 5-FU/LV group (n=90, p = 0.008). Multivariable analysis showed consistent trends with adjusted HR of 1.44 (95% CI 0.93-2.07, p = 0.11), 1.36 (95% CI 0.92-2.03, p = 0.13), and 1.52 (95% CI 1.37-1.09-2.10, p = 0.01), respectively. Also, nal-IRI plus 5-FU/LV group showed trends toward better progression-free survival compared to the other 3 groups with adjusted HR of 1.44 (95% CI 0.98-2.11, p = 0.06), 1.29 (95% CI 0.87-1.89, p = 0.20), and 1.88 (1.38-2.55, p < 0.001), respectively. Nal-IRI plus 5-FU/LV showed better survival outcomes when compared to mFOLFOX, mFOLFIRI, or 5-FU/LV alone. Nal-IRI plus 5-FU/LV may be a preferable second-line regimen for advanced BTC pts without targetable genetic alterations.

Hepatocellular carcinoma (HCC) is lethal malignancy showing high relapse rates after curative resection in early-stage. Genomic features of stem cell-like cancer cells contributing aggressive tumor biology in HCC remains unclear. The aim of this study is to understand underlying biology associated with HCC stemness to apply precise therapeutic strategies for resectable early-stage hepatocellular carcinoma. Using human fetal liver signatures, Multi-omics dataset from multiple clinical HCC cohorts were analyzed comprehensively to reveal molecular mechanisms for HCC stemness as well as potential biomarkers to enhance therapeutic efficacy for molecular targeted therapy or immunotherapy in stem cell-like HCC subtypes. The patients predicted to the hepatic stem cell (HS) subtype showed aggressive tumor features including large tumor size, high AFP, vascular invasion, and extrahepatic metastasis as well as worst prognosis with early recurrence even in early-stage. The oncogenic pathways in terms of cell cycle, epithelial-mesenchymal transition, and TGF-beta pathway were highly upregulated in the HS subtype. Higher mutations of TP53, RB1 with PTEN deletion were significantly identified in the HS subtype. We also demonstrated subtype-specific tissue biomarkers as well as serum biomarkers for the HS subtype. Predicted responders for immunotherapy were significantly lower in stem cell-like subtypes due to higher accumulation of tumor-associated macrophages and myleolid-derived suppressor cells. The HS subtype showed potential higher response to multi-tyrosine kinase inhibitors, especially sorafenib and lenvatinib. Stem cell-like HCC is not only associated with a significantly higher relapse rate after curative resection but also with molecular biology for the aggressive subtype of HCC. We identified subtype-specific serum and tissue biomarkers for the stem cell-like subtypes and precise therapeutic strategies for each subtype regarding immunotherapy and molecular-targeted treatment. Our findings may offer the theoretical foundation of biomarker-based clinical trials for new therapeutic approaches to resectable early-stage HCC patients.

We aim to uncover robust subtypes having distinct biological characteristics associated with clinical outcome and identify subtype-specific therapeutic targets. Genomic data from 2527 gastric tumors are used to uncover clinically relevant molecular subtypes. Cluster of clusters assignment (COCA) approach was applied to integrate 8 genomic subtypes and uncover consensus subtypes. For validation, we identified 120 genes whose expression is highly specific to each subtype and used them to construct gastric cancer predictor of integrated consensus subtype with 120 genes (GPICS120). Analysis of genomic data revealed 6 consensus subtypes that showed marked interconnectivity among 8 independent classification systems. Consensus genomic subtype 1 (CGS1) is characterized by poorest prognosis, very high stem cell characteristics, and high IGF1 expression, but low genomic alterations. CGS2 showed canonical epithelial gene expression patterns. CGS3 and CGS4 are characterized by high copy number alterations and low immune activity. However, CGS3 and CGS4 are different in high HER2 activity (CGS3) and high lipid metabolic activity (CSG4). CGS5 has highest mutation rates and moderately high immune activity that is characteristics of MSI-high tumors. Most of CGS6 tumors are EBV-positive and shows extremely high methylation and high immune activity. Clinically, CGS1 and CGS4 are poor prognostic while prognosis of CGS2, CGS4, CGS5, and CGS6 is good. Interestingly, patients in CGS4 have very poor survival rate after relapse. By applying systematic analysis of genomic and proteomic data, we estimated potential response rate of each subtype to standard and experimental treatments such as chemoradiation therapy, target therapy, and immunotherapy. Importantly, association of subtype CGS3 with response to chemoradiation therapy was further validated with samples from phase III clinical trial and in experiments with cell lines. Consensus subtype is robust classification system and can be the basis for future clinical investigation of subtype-based targeted interventions.

Background Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function. Methods The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis. Results We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated. Conclusions In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.

Background: Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease. Objectives: The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX. Methods: The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor. Results: We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g. Conclusion: Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX. Disclosure of Interests: None declared

Background: Rheumatoid arthritis (RA) patients need to undergo screening and receive treatment for latent tuberculosis infection (LTBI) before starting tofacitinib, which is primarily metabolized by cytochrome P450 (CYP) 3A4. Among chemoprophylactic agents, rifampin is known to be a potent CYP3A4 inducer; therefore, it is expected to decrease the efficacy of tofacitinib. However, tofacitinib and rifampin have been co-administered practically because of the short duration of chemoprophylaxis. Objectives: The aim of this study was to determine the efficacy of tofacitinib on co-administration with rifampin. Methods: Biologic-naïve RA patients treated with tofacitinib were selected, and electronic medical reports were reviewed retrospectively. All patients underwent screening for LTBI before starting tofacitinib, and patients with positive results were treated to prevent progression to active tuberculosis. To evaluate the efficacy of tofacitinib with or without rifampin, the discontinuation rates of tofacitinib were examined during the first 6 months. Kaplan–Meier analysis was used to construct cumulative discontinuation curves, and comparisons were performed using the log-rank test. Results: Among 81 patients who started tofacitinib, 21 (25.9%) were LTBI-positive and 18 (22.2%) were administered rifampin concomitantly with tofacitinib. The median follow-up time was 6 months in both patients who received rifampin (interquartile range [IQR] 2.21, 6.00) and those who did not receive rifampin (IQR 5.97, 6.00) (p = 0.083). There were no significant differences between patients who received rifampin and those who did not receive rifampin in all baseline characteristics, except the swollen joint count (3.00 [1.75, 5.25] vs. 5.00 [4.00, 7.00]; p = 0.025), at the time of starting tofacitinib. In patients who received rifampin at the time of starting tofacitinib, the mean duration of co-administration was 47.00 ± 23.54 days (median 56; IQR 28.75, 59.00). During follow-up, 14 of the 81 patients (17.3%) discontinued tofacitinib. As shown in the Figures 1 and 2, the discontinuation rate of tofacitinib within the first 6 months was significantly higher among patients who received rifampin for LTBI than among those who did not receive rifampin (lack of efficacy: 24.7% vs. 5.1%, p = 0.008; all causes: 38.9% vs. 11.2%, p = 0.002). Seven patients discontinued tofacitinib because of uncontrolled RA activity, and rifampin had been administered concomitantly in four of these seven patients. Of the four patients, three stopped taking tofacitinib in the middle of LTBI treatment, and the DAS28-ESR scores of these patients were higher at discontinuation than at baseline. Conclusion: Discontinuation rates were higher in RA patients who started tofacitinib during chemoprophylaxis involving rifampin than in those who did not receive rifampin. Physicians should be aware that the efficacy of tofacitinib could be decreased by the chemoprophylactic regimen for tuberculosis. Disclosure of Interests:None declared

Background: Bilirubin is an antioxidant with anti-inflammatory properties. In previous reports, serum bilirubin levels were correlated with disease activity of autoimmune diseases including rheumatoid arthritis (RA). Various molecular-targeted agents have been developed for RA, and targets, such as IL-6 and TNFα, are associated with liver function. However, the association between serum bilirubin and treatment response in RA patients treated with molecular-targeted agents is still unknown. Objectives: We aimed to evaluate the role of serum bilirubin in the prediction of the early treatment response in RA patients who initiated molecular-targeted agents. Methods: We retrospectively recruited biologic naïve RA patients (n=292) with moderate-to-high disease activity from a tertiary hospital between Jan 2013 and Dec 2019. Patients with viral hepatitis, drug-induced hepatitis, or alcoholic liver disease were excluded. Molecular-targeted agents included tocilizumab (TCZ, n=40), adalimumab (ADA, n=59), etanercept (ETN, n=66), golimumab (GOL, n=60), abatacept (ABA, n=31), and tofacitinib (TOF, n=36). Clinical and laboratory data were collected from electronic medical records. Patients were categorised into an increased bilirubin group (higher serum bilirubin at 3 months than at baseline) and decreased bilirubin group (equal or lower serum bilirubin at 3 months than at baseline). At 6 months of treatment, good response (defined as a DAS28 score ≤3.2) was evaluated. Multivariate logistic regression analysis and multiple linear regression analysis were used to evaluate the association between serum bilirubin and treatment response. The variables included in the multiple logistic and linear regression analyses were age, female sex, rheumatoid factor, prednisolone, DMARDs, baseline liver enzymes, baseline DAS28 score, and components. Results: The mean serum bilirubin level at baseline was 4.7±1.8 mg/L. After 6 months of treatment, 180 (61.6%) patients achieved good responses. The mean serum bilirubin levels at 3 and 6 months were 5.3±2.3 and 5.5±2.2 mg/L, respectively. At 6 months, a good response was more frequent in the increased bilirubin group than in the decreased bilirubin group (71.2% [99/139] vs. 52.9% [81/153], p=0.001). In multivariate logistic regression analysis, the ORs among good responders at 6 months were 1.221 (95% CI 1.014–1.471, p=0.036) for baseline serum bilirubin and 1.377 (95% CI 1.146–1.654, p=0.001) for the change in serum bilirubin at 3 months. According to target agents, the mean changes in serum bilirubin from baseline to 6 months were 1.9±2.5 for TCZ, 1.0±1.5 for ADA, 0.7±1.9 for ETN, 0.6±2.2 for GOL, 0.3±1.2 for ABA, and 0.4±2.2 for TOF (Figure 1). Among the target agents, TCZ showed a significant increase in the mean serum bilirubin level at 3 and 6 months from baseline. In multiple linear regression analysis performed on TCZ, the change in bilirubin at 3 months was associated with the DAS28 score at 6 months (β=−0.349, p=0.020). Figure 1. Change in serum bilirubin during treatment with molecular-targeted agents in rheumatoid arthritis patients Conclusion: High baseline serum bilirubin and an increase in serum bilirubin during treatment are helpful to predict a good response to molecular-targeted agents, especially TCZ. Disclosure of Interests: None declared

Background: Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless it is resolved. Pathological confirmation can help to identify the aetiology of the disease and determine the treatment strategy. But, in most cases, it is difficult to obtain sufficient tissue due to the location of fibrosis. In a recent study, parts of iRPF are correlated with IgG4-related disease characterised by elevated serum IgG4 levels (>135 mg/dL). Normal serum IgG3 level (21–176 mg/dL) has been known to be higher than normal serum IgG4 level (4–86 mg/dL). The reverse IgG4/IgG3 ratio has been suggested to be an IgG4-related disease component that distinguishes it from primary sclerosing cholangitis [1]. However, the ratio of IgG3 and IgG4 may be reversed in iRPF patients with hydronephrosis. Objectives: We aimed to investigate the ratio of IgG subclasses as a predictive factor associated with treatment response of hydronephrosis in patients with iRPF. Methods: We retrospectively recruited 19 iRPF patients with hydronephrosis who evaluated serum IgG subclasses in a tertiary hospital between 2004 and 2019. Hydronephrosis was evaluated on the basis of imaging findings. Medications and clinical and laboratory findings, including IgG subclasses, were reviewed following the diagnosis of hydronephrosis. Hydronephrosis improvement on subsequent images was evaluated to assess treatment response. Categorised data were compared using chi-square or Fisher’s exact test. Continuous variables were compared using Mann–Whitney U test. Results: At baseline, median serum IgG3 and IgG4 levels were 64 (IQR 37–82) mg/dL and 71 (IQR 40–171) mg/dL. Five patients had serum IgG4 levels > 135 mg/dL and 11 patients had the reverse serum level of IgG4/IgG3. On subsequent images (median follow-up at 3.2 [IQR 1.7–4.0] months), 11 patients showed hydronephrosis improvement. The proportions of positive ratio of serum IgG4/IgG3 (81.8% vs. 25%, p = 0.024), periaortic involvement (81.8% vs. 25%, p = 0.024) and high-dose glucocorticoid treatment (45.5% vs. 0%, p = 0.045) were significantly higher in patients with improvement than in those without improvement (Table 1). Interestingly, even in cases with normal serum IgG4 levels, patients with improvement showed a higher serum IgG4/IgG3 ratio than in those without improvement (median 1.5 vs. 0.7, p = 0.038). Table 1. Clinical characteristics and treatment according to the shortterm outcome of hydronephrosis Improvement (n = 11) No improvement (n = 8) p-value Time to subsequent imaging (months) a 2.2 (1.3–4.2) 3.2 (2.0–3.8) 0.778 Males (n, %) 8 (72.7%) 7 (87.5%) 0.603 Periaortic involvement (n, %) 9 (81.8%) 2 (25%) 0.024 Impaired renal function (n, %) b 5 (45.5%) 2 (25%) 0.633 Serum IgG4 (mg/dL) a 114 (59–172) 43 (35–109) 0.152 Elevated serum IgG4 (n, %) 4 (36.4%) 1 (12.5%) 0.338 Serum IgG4/IgG3 ratio a 2.1 (1.2–4.9) 0.8 (0.4–1.0) 0.041 Positive ratio of serum IgG4/IgG3 (n, %) 9 (81.8%) 2 (25%) 0.024 Medical treatment (n, %) 7 (63.6%) 1 (12.5%) 0.059 High-dose glucocorticoid treatment (n, %) 5 (45.5%) 0 (0%) 0.045 Surgical intervention (n, %) 8 (72.7%) 4 (50%) 0.377 a Values are median and interquartile range (25 th –75 th percentile) b Defined as serum creatinine level > 1.24 mg/dL Conclusion: The reverse ratio of serum IgG4/IgG3 was associated with hydronephrosis treatment response, thus suggesting favourable responses to high-dose corticosteroid. References: [1]Boonstra K, Culver EL, de Buy Wenniger LM, et al. Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014;59:1954-63. Disclosure of Interests: None declared

Purpose of Investigation: This study aimed to compare pregnancy outcomes based on parity in women older than 40 years. Materials and Methods: This retrospective cohort study included women older than 40 years with singleton pregnancy, who delivered after 24 weeks of gestation. They were divided into two groups on the basis of parity, and maternal and perinatal outcomes were compared. Results: This study included 432 women, with primiparous women (n=111) comprising a quarter among them. The mean parity of multiparous women was 1.8, and the mean interval from the previous pregnancy was 9.5 years. On analyzing multivariable logistic regression-adjusted confounding factors, small for gestational age (SGA) neonates (OR, 2.525; 95% CI, 11.407-4.529) were associated with primiparous women. The occurrence of preterm birth before 37 weeks of gestation (OR, 1.783; 95% confidence CI, 1.080-2.942) was increased in multiparous women. Conclusion: There are different pregnancy outcomes between primiparous and multiparous women. Preterm birth is more frequent in multiparous women, with an extremely long interval to subsequent pregnancy. The incidence of SGA newborns was higher among primiparous women.

BACKGROUND AND PURPOSE:This work investigated alterations in functional connectivity (FC) and associated structures in patients with Angelman syndrome (AS) by using integrated quantitative imaging analysis and connectivity measures.MATERIALS AND METHODS:We obtained 3T brain MR imaging, including resting-state functional MR imaging, diffusion tensor imaging, and 3D T1-weighted imaging from children with AS (n = 14) and age- and sex-matched controls (n = 28). The brains of patients with AS were analyzed by measuring FC, white matter microstructural analysis, cortical thickness, and brain volumes; these were compared with brains of controls.RESULTS:Interregional FC analysis revealed significantly reduced intra- and interhemispheric FC, especially in the basal ganglia and thalamus, in patients with AS. Significant reductions in fractional anisotropy were found in the corpus callosum, cingulum, posterior limb of the internal capsules, and arcuate fasciculus in patients with AS. Quantitative structural analysis also showed gray matter volume loss of the basal ganglia and diffuse WM volume reduction in AS compared with the control group.CONCLUSIONS:This integrated quantitative MR imaging analysis demonstrated poor functional and structural connectivity, as well as brain volume reduction, in children with AS, which may explain the motor and language dysfunction observed in this well-characterized neurobehavioral phenotype.

There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.

Introduction Penile length is an important indicator of male sexual development. Scarce data were reported on penile length measurements in children comparing changes between prepuberty and puberty for the small penile issue with long-term follow-up. Objective The purpose of this study was to investigate the possibility of catch-up growth of the penile length of boys with a small penis in the long-term follow-up. Study design From April 2001 to December 2016, 27 boys who visited the outpatient clinic owing to a small penis, without any chromosomal anomalies and other genital disorder, were investigated retrospectively. Micropenis is defined as 2.5 standard deviations less than the mean stretched penile length (SPL) of age. Periodic penile length, testicular volume, hormonal levels (serum testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)), and bone age were measured. Pubertal development was recorded by using the Tanner scale. The effect of hormonal therapy and the factors attributable to the increment of the penile length were evaluated. Results The mean age at the first visit was 9.8 years (5-12 years) and that at puberty was 12.6 years (10-16 years). The length of the penis at the initial visit was 4.0 +/- 0.8 cm (2.5-6.0) and at puberty, 7.3 +/- 1.8 cm (4.0-12.0). Nine patients diagnosed with micropenis no longer had a micropenis in puberty. The less the age-matched SPL, the more the increment of SPL that was observed (rho = - 0.548, P = 0.003). The mean increment of SPL in the hormonal therapy group (11 boys) and the non-hormonal therapy group (16 boys) was not statistically different (43.5 +/- 22. 9% vs 41.5 +/- 21.6%, respectively, P = 0.497). Discussion This study explains how much the growth of a small penis catches up in puberty. From the point of view of the increment of SPL, the increment was higher in boys who belonged to the smaller penis group. Hormonal therapy does not attribute to an increase in the length after long-term follow-up. Limitations of this study were its retrospective origin with a small number of patients in a single center. Conclusion Catch-up growth of the small penis at puberty was accomplished in most children with a small penis before puberty. Hormonal treatment was not significantly correlated with the penile length increment in the long-term follow-up.

Introduction: Although major standard pancreatic resection can be performed with low morbidity and mortality rate, resection of a large amount of normal pancreas can be associated with an increased risk of endocrine or exocrine insufficiency. Compared with major pancreatic resections, pancreatic enucleation leads to less morbidity and preserves normal parenchyma as well as pancreatic function. Therefore, the purpose of this study was to present our experience and to evaluate the clinical outcomes after pancreatic enucleation. Method: Between May 2005 and June 2017, 22 patients who underwent pancreatic enucleation were analyzed through a retrospective review of medical records. Results: The patients comprised 17 women and 5 men, with a median age of 49 years (range 19–67 years), all of whom were treated by pancreatic enucleation (eleven open/eleven laparoscopic). The median diameter of tumor was 3.1 cm (range 1.2–12.5 cm) and all cases had benign tumors at the final pathologic diagnosis. Two patients (9%) developed pancreatic fistula. There were no differences of clinical outcomes between open and laparoscopic enucleation groups. During follow-up period (median, 80 months), all patients were alive with no recurrence or new onset of diabetes. Conclusion: Excellent result was achieved after pancreatic enucleation, supporting the consideration as the treatment option for benign and borderline pancreatic neoplasms.