Purpose: This study investigated the changes in gene expression in retinal ganglion cells (RGCs) following ciliary neurotrophic factor (CNTF) treatment to elucidate the underlying mechanisms contributing to its neuroprotective effects. Methods: RGCs isolated from Sprague-Dawley rat pups were treated with recombinant CNTF. Gene expression was analyzed via microarray. Differentially expressed genes (DEGs) were defined as those with a fold change greater than 2 or less than –2. The DEGs were further explored using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Results: Our analysis identified 71 upregulated and 58 downregulated genes. A2m exhibited the highest increase, with a fold change of 4.97, whereas Rho displayed the most significant decrease in expression, with a fold change of –6.38. GO and KEGG pathway analyses revealed substantial involvement in sensory organ development and the phototransduction pathway. Conclusions This study provides new insights into the impact of CNTF on gene expression in RGCs, suggesting broader neuroprotective mechanisms that could inform future therapeutic strategies for retinal degenerative diseases. Our findings emphasize the importance of further investigation into the complex gene network responses to CNTF treatment.

Purpose: To compare the clinical outcomes of XEN45 gel stent implantation surgery (ab externo, open conjunctiva) with those of trabeculectomy. Methods: We retrospectively reviewed electronic medical record of 57 patients (62 eyes) treated with XEN implantation surgery (ab externo, open conjunctival approach) between April 1, 2021, and July 31, 2023, by the same surgeon. Preoperative clinical data including intraocular pressure (IOP), the number of glaucoma medications, and visual acuity were collected from 1 day to 12 months postoperatively. These data were compared and analyzed with those of 67 patients (78 eyes) received trabeculectomy between February 1, 2017, and April 30, 2022, by the same surgeon. Statistical analyses were performed with p < 0.05 as significant. Results: Complete surgical success rate was 33.9% and 57.7% of the XEN and trabeculectomy groups, respectively (p = 0.005). The qualified success rate was 79.0% and 93.6%, respectively (p = 0.011). Postoperatively, the XEN group used more glaucoma medications than the trabeculectomy group (1.21 ± 1.05 vs. 0.69 ± 0.90, p = 0.003 at postoperative month 12). After postoperative month 1, the XEN group had a higher IOP (15.77 ± 5.07 mmHg vs. 13.17 ± 3.81 mmHg; at postoperative month 12, p = 0.001) and lower corneal astigmatism than the trabeculectomy group (1.32 ± 0.79 diopters vs. 1.88 ± 1.45 diopters, p = 0.020 at postoperative month 6). There was no significant difference in preoperative and postoperative best-corrected visual acuity (logMAR) between the groups at any of the follow-up period (favorable visual acuity subgroup; logMAR < 0.7). Postoperative complications were 0 cases of XEN group and 13 cases of trabeculectomy group (0% vs. 16.7%, p = 0.001). Also, XEN surgery (24 minutes 40 seconds ± 6 minutes 26 seconds) had a shorter operation time than the trabeculectomy (40 minutes 18 seconds ± 8 minutes 27 seconds, p < 0.001). Conclusions Compared to trabeculectomy, XEN surgery (ab externo, open conjunctiva) showed relatively lower effectiveness (surgical success rate, IOP reduction). However, it demonstrated advantages as a minimally invasive glaucoma surgery, including a surgical success rate approaching about 80%, stability in inducing corneal astigmatism, fewer postoperative complications, and shorter operation times.

Lazertinib is an oral, third-generation, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for the treatment of non-small cell lung cancer (NSCLC). This case report presents a rare instance of small cell carcinoma transformation in pancreatic metastasis in a patient with EGFR-mutated NSCLC undergoing treatment with lazertinib. Small cell carcinoma transformation indicates a mechanism of treatment resistance, and tissue biopsy is essential to confirm this. When isolated progression of a lesion is suspected during TKI therapy in EGFR-mutated NSCLC, histological evaluation is necessary to confirm the transformation for the treatment strategy.

Purpose: This study was conducted to update the practice guidelines for intravenous infusion therapy published in 2017, focusing on the most recent evidence for peripheral intravenous infusion therapy. Methods: The guideline update was conducted using the 22-step methodology. Results: The updated guidelines consist of 17 domains and 235 recommendations (including 284 sub-recommendations). The domains are as follows: general instructions (5 items), peripheral catheter selection (7), catheter insertion site selection (11), management during peripheral catheter insertion (10), post-insertion management (30), perfusion and locking (17), blood sampling via peripheral catheters(6), exchange and removal of peripheral catheters (6), infusion set management (14), add-on devices (32), complications (25), chemotherapy infusions (10), PCA infusions (7), parenteral nutrition (20), transfusion therapy (23), education (5), and documentation and reporting (7). The evidence levels for these recommendations are as follows: 27(9.5%) at level I, 3 (1.1%) at level I A/P, 118 (41.5%) at level II, and 136 (47.9%) at level III.Recommendation grades are categorized as follows: 30 (10.6%) at level A, 118 (41.5%) at level B, and 136(47.9%) at level C. Of these, 73 (25.7%) recommendations were newly developed, 49 (17.3%) underwent major revisions, and 147 (51.7%) underwent minor revisions. Conclusion The updated practice guideline, based on the latest evidence, is anticipated to enhance nursing practice related to peripheral intravenous infusion therapy.

Purpose: The opacity of zirconia sometimes requires a veneering material; thus lithium disilicate, a veneer material with excellent strength, can be used. This study investigated the fracture resistance of zirconia–lithium disilicate (Zr-LS2) bi-layered crowns according to the design of the substructure. Materials and Methods: Five groups of posterior Zr-LS2 restorations (Zirtooth and Amber LiSi-POZ) were fabricated with different zirconia substructure coverage (control group, groups half occlusal zirconia coverage; 1/2OZ, and three-quarter occlusal zirconia coverage; 3/4OZ) and margin designs (control group, groups collar margin; C-M, and collarless margin; Cl-M). All restorations were cemented with self-adhesive resin cement followed by 24-h water storage and thermocycling (10,000 cycles, 5°C and 55°C). The fracture load was measured, and failure mode analysis, fractography, and elemental analysis were performed. The one-way analysis of variance and Fisher’s exact test were performed for statistical analyses (α=.05). Results: A significant difference was found in the fracture load of Zr-LS2 restorations according to the zirconia coverage of the occlusal area and margin design (P<.05). Group 3/4OZ was significantly larger than the control group C and 1/2OZ (P<.05). The C-M group had greater fracture loads based on margin design than the control group C and Cl-M (P<.05). Conclusion The fracture resistance of posterior Zr-LS2 restorations increased with the zirconia coverage, occlusal thickness, and collar margin.

Echinococcosis, caused by the tapeworm Echinococcus, is rare in Korea and is primarily imported from endemic areas. We report a case of a 37-year-old Korean man with multiple large hepatic cysts, initially diagnosed as simple cysts at a local clinic in 2018. The patient had lived in Oman, an endemic area, for several months in 2016. Upon referral to a tertiary hospital in 2023, due to progressive cyst enlargement, liver magnetic resonance imaging revealed three large cysts with a water lily sign. Serum IgG against Echinococcus was positive by enzyme-linked immunosorbent assay. After diagnosis of echinococcosis, treatment with albendazole and puncture-aspiration-injection-reaspiration (PAIR) was performed.Microscopic and molecular analysis of cyst aspirates confirmed Echinococcus granulosus infection. Follow-up computed tomography demonstrated a reduction in cyst size, yet the emergence of a new right pleural effusion and consolidation in the left lower lobe of the lung necessitated the continuation of albendazole therapy. This case highlights the importance of thorough travel history, imaging findings, and the effectiveness of PAIR combined with albendazole in treating imported echinococcosis.

Background: This study aimed to identify key priorities for the development of guidelines for information and communication technology (ICT)-based patient education tailored to the needs of patients with rheumatic diseases (RDs) in the Republic of Korea, based on expert consensus. Methods: A two-round modified Delphi study was conducted with 20 rheumatology, patient education, and digital health literacy experts. A total of 35 items covering 7 domains and 18 subdomains were evaluated. Each item was evaluated for its level of importance, and the responses were rated on a 4-point Likert scale. Consensus levels were defined as “high” (interquartile range [IQR] ≤ 1, agreement ≥ 80%, content validity ratio [CVR] ≥ 0.7), "Moderate" (IQR ≥ 1, agreement 50–79%, CVR 0.5–0.7), and "Low" (IQR > 1, agreement < 50%, CVR < 0.5). Results: Strong consensus was reached for key priorities for developing guidelines in areas such as health literacy, digital health literacy, medical terminology, user interface, and user experience design for mobile apps. Chatbot use and video (e.g., YouTube) also achieved high consensus, whereas AI-powered platforms such as ChatGPT showed moderate-to-high agreement. Telemedicine was excluded because of insufficient consensus. Conclusion The key priorities identified in this study provide a foundation for the development of ICT-based patient education guidelines for RDs in the Republic of Korea.Future efforts should focus on integrating digital tools into clinical practice to enhance patient engagement and improve clinical outcomes.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

The applicability of the Phoenix criteria and Phoenix Sepsis Score in higher-resource pediatric intensive care units (PICUs) outside the United States requires further validation. A retrospective cohort study analyzed electronic health records of 1,304 PICU admissions under 18 years old with suspected infection between February 2017 and December 2023. The score was calculated using two methods: 24-hour assessment, based on worst sub-scores within 24 hours of admission, and prompt assessment, using values closest to admission within 6 hours before or after. Based on the 24-hour assessment, in-hospital mortality was 8.3% for sepsis and 10.3% for septic shock. The score demonstrated an area under the precision-recall curve of 0.42 (95% confidence interval, 0.31–0.55) for in-hospital mortality. Results were consistent across both assessment methods. The Phoenix criteria and the Phoenix Sepsis Score are reliable predictors of mortality outcomes. Further investigation in diverse clinical settings is warranted.

Background: There are few safe effective ways to relieve osteoarthritis (OA) pain; as a result, off-label psychotropic drug prescriptions have increased worldwide. This study examined the change in psychotropic drug prescriptions for patients with OA from 2011 to 2020 using the Korean National Health Insurance Service dataset. Methods: The study population consisted of patients with hip or knee OA aged ≥ 65 years.Psychotropic drugs included opioids, benzodiazepines, non-benzodiazepine hypnotics (Z-drugs), anti-epileptics, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), typical antipsychotics, atypical antipsychotics, and anxiolytics. The prevalence and long-term (> 3 months) prescription rates of psychotropic drugs in OA patients were calculated. Results: The study included 1,821,158 patients with OA (mean age 71.7 years; 65.32% female).Of the cohort, 49% had comorbidities for which psychotropics were indicated. The prevalence of psychotropic prescriptions decreased from 58.2% to 52.0% in 2018 and then leveled off.The long-term prescription rate remained constant until 2018 and then increased slightly.The most commonly prescribed psychotropics were opioids and long- and short-acting benzodiazepines. The prescription rates of opioids and long-acting benzodiazepines decreased from 2011 to 2020. For those with psychiatric co-morbidities, the prescription rates of anti-epileptics and SNRIs increased, while the prescription rates of anti-epileptics, SSRIs, other antidepressants, and atypical psychotropics increased for those without such co-morbidities. The most commonly prescribed psychotropics were diazepam and alprazolam, excluding tramadol and tramadol–acetaminophen combination. For those with psychiatric co-morbidities, the prescription rates of gabapentin and fentanyl increased, while for those without such co-morbidities, the prescription rates of lorazepam, fentanyl, escitalopram and quetiapine increased. Conclusion A significant number of older Korean patients with OA were prescribed psychotropic drugs in the absence of comorbidities requiring such drugs, including drugs that have little effect on OA and unfavorable safety profiles in older adults.