Purpose: Cannabidiol (CBD) is a promising treatment option for pediatric drug-resistant epilepsy (DRE). The aim of this study was to assess the tolerability and safety of CBD in a single-center retrospective cohort based on real-world clinical experience. Methods: This study included 71 pediatric patients (median age, 8.9 years; interquartile range [IQR], 6.2 to 14.0) with Lennox–Gastaut syndrome who received purified CBD (Epidiolex, GW Pharmaceuticals) between March 2019 and July 2024. All patients had previously failed treatment with more than five anti-seizure medications (ASMs). Responder rate (≥50% seizure frequency reduction), retention rate, adverse effects (AEs), and predictors of favorable treatment response were analyzed over a median follow-up of 21.3 months (IQR, 2.8 to 38.5). Results: The initial responder rate during the first 3 months was 45.1%, which increased to 70.8% at 18 months and 63.0% at 24 months. The retention rate at 24 months was 52.4% (33/71). Seven patients (9.9%) achieved seizure freedom beyond 24 months of CBD therapy, and five of these patients were able to reduce their concomitant ASM burden. AEs were observed in 39.4% (28/71) of patients, with the most frequent being somnolence (20 cases) and increased seizure frequency (six cases); 92.9% of AEs occurred within the first 3 months of treatment. No serious AEs requiring treatment discontinuation were identified. Conclusion In this real-world study, CBD demonstrated potential as an adjunctive therapy with manageable AEs. These findings highlight that CBD can reduce seizure frequency while maintaining tolerability in pediatric patients with DRE.

Objective: This study aimed to describe the technique and outcomes of transforaminal endoscopic lumbar discectomy (TELD) for bilateral disc herniation. Methods: This retrospective review analyzed prospectively collected data. Patients who underwent single-level TELD for bilateral lumbar disc herniation with bilateral radiculopathy were included. The transforaminal entry approach utilized a 15° angle, compared to the conventional 30°. The disc space was approached from the side with the annular tear rather than the side with more severe symptoms. After introducing the working cannula and endoscope, the ipsilateral herniated disc was identified and removed. The approach angle was then adjusted to a more horizontal orientation to allow central decompression. The route to the contralateral herniated disc was identified, and the fragment was excised. Adequate decompression was confirmed by observing epidural pulsations, after which closure was performed. Operative time, length of hospital stay, patient-reported outcome measures, including the visual analogue scale (VAS) for back and leg pain and Oswestry Disability Index (ODI), and complications were analyzed. Results: Thirty-four patients were included, with a mean age of 41.6 years. The mean operative time was 58 minutes, and the mean hospital stay was 1.2 days. Significant postoperative improvement was observed in VAS back, VAS leg, and ODI scores. No intraoperative complications occurred. One patient (2.9%) developed postoperative dysesthesia, which resolved with conservative management. Another patient (2.9%) experienced reherniation, requiring revision endoscopic discectomy. Conclusion TELD for bilateral lumbar disc herniation with bilateral radiculopathy resulted in favorable clinical outcomes and minimal complications.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Purpose: The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex. Materials and Methods: Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed. Results: Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males. Conclusion Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.

Purpose: To evaluate the relationship between distal fusion level in correction and fusion surgery for adolescent idiopathic scoliosis (AIS) and radiologic changes in the sacroiliac (SI) joint. Materials and Methods: This retrospective cohort study evaluated patients who underwent correction and fusion for AIS between 2005 and 2017 with at least 5 years of follow-up. We categorized patients into two groups: Group 1 (distal fusion above L2, 74 patients) and Group 2 (distal fusion at L3 and below, 52 patients). Radiologic parameters and SI joint changes were evaluated on plain radiographs obtained from preoperative to 5 years postoperatively. We also investigated other risk factors for SI joint change. Results: Analysis of demographic factors revealed no significant difference between the two groups. There was a significant difference in the incidence of SI joint change between Group 1 (5 patients, 6.75%) and Group 2 (18 patients, 34.61%), with Group 2 showing a faster increase in incidence according to the Kaplan-Meier method (p<0.0001). Preoperative lumbar lordosis (LL) and ΔLL had a significant relationship with SI joint changes [preoperative LL, hazard ratio (HR)=0.77, 95% confidence interval (CI)=0.64– 0.93, p=0.008; ΔLL, HR=0.79, 95% CI=0.67–0.95, p=0.01). Conclusion After AIS surgery, patients who had fusion to the lower lumbar vertebrae (L3 or L4) experienced a higher incidence and faster progression of degenerative changes in the SI joint. Low preoperative LL and inadequate correction of LL during the operation were also risk factors for SI joint degeneration.

Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Purpose: This study aims to investigate and compare the incidence, demographic characteristics, clinical manifestations, preoperative diagnostic methods, anatomical classifications, associated anomalies, operative treatments, and postoperative outcomes of patients with intestinal atresia treated by the members of the Korean Association of Pediatric Surgeons (KAPS) through three nationwide surveys. Methods: KAPS conducted 3 national surveys in 1998, 2010, and 2024 to examine the patients diagnosed with intestinal atresia. In preparation for the survey, we developed a customized case registration form to obtain data on patient sex, birth weight, gestational age, clinical manifestations, preoperative diagnostic methods, anatomical types, associated anomalies, operative treatments, and postoperative outcomes. Authorized KAPS members completed the case registration form. Results: The first, second, and third national surveys included 218, 222, and 236 individuals diagnosed with intestinal atresia, respectively. The male-to-female ratios were 1.5:1, 1.1:1, and 1.1:1, respectively. The first, second, and third national surveys revealed that 34.3%, 43.3%, and 53.4% of patients were born before 37 weeks of gestation, respectively. Additionally, 28.7%, 32.0%, and 40.7% of patients had a birth weight under 2,500 g. In the third national survey, duodenoduodenostomy was the most common procedure, performed in 70 out of 82 patients diagnosed with duodenal atresia. Resection and anastomosis were the main surgical procedures conducted in 47 out of 54 cases of jejunal atresia and 74 out of 92 cases of ileal atresia. The mortality rates in the first, second, and third national surveys were 13.8%, 3.6%, and 1.3% respectively, with the lowest rate observed in the third national survey. Conclusion These national surveys offer valuable insights into the current state of intestinal atresia, including specific surgical interventions and postoperative outcomes in South Korea. For pediatric surgeons aiming to enhance their understanding of intestinal atresia and its treatment options, these surveys could be an indispensable resource and guide.

Full-endoscopic surgery for highly upmigrated lumbar disc herniation often requires foraminotomy or laminotomy. However, in the presence of lytic spondylolisthesis, the “laminar lifting” technique can be used to directly access the highly upmigrated fragment without bone removal. We report 3 cases of recent-onset radiculopathy caused by highly upmigrated disc herniation with concurrent lytic spondylolisthesis. The affected level was L5–S1 in two cases and L4–5 in one case. Interlaminar endoscopic lumbar discectomy was performed at L5–S1, and transforaminal endoscopic lumbar discectomy at L4–5. After gaining access to the epidural space, the working cannula was depressed at its proximal end, thereby elevating its distal end. This maneuver produced a levering effect that lifted the lamina and created additional space in the epidural area. The working cannula could then be advanced further superiorly, allowing removal of the highly upmigrated disc fragment with endoscopic forceps. All patients had excellent outcomes without complications. These findings demonstrate that the “laminar lifting” technique is a safe and effective method for full-endoscopic removal of highly upmigrated disc herniation in the setting of lytic spondylolisthesis. It eliminates the need for bone removal and helps prevent further instability in lytic spondylolisthesis.

BACKGROUND/OBJECTIVES: Aging is often accompanied by chronic oxidative stress, contributing to the progression of metabolic disorders. A previous study reported that supplementation with collagen tripeptide (CTP) inhibits fatty liver and lipid hypertrophy, but the mechanism is unclear.MATERIALS/METHODS: This study examined the effects of 12-week CTP supplementation on oxidative stress, insulin resistance, and adenosine monophosphate-activated protein kinase (AMPK) α activation, key factors in metabolic disorders in aged mice. Thirty-eight male C57BL/6J mice (58 weeks old) were assigned to 4 groups: aging control, 0.03% Gly-Pro-Hyp, 0.9% CTP, and 0.9% granulated collagen tripeptide (gCTP) supplementation. A group of young mice (YC, n = 8) served as the positive control. RESULTS: The results showed that CTP and gCTP enhance antioxidant capacity by reducing thiobarbituric acid reactive substances and H 2 O 2 and improving the antioxidant enzyme activities, including superoxide dismutase and glutathione peroxidase. CTP also improved insulin sensitivity by increasing the expression of insulin receptors and glucose transporters in the liver and white adipose tissue. Furthermore, CTP and gCTP improved energy metabolism and mitochondrial function via AMPKα activation. CONCLUSION CTP supplementation is a promising intervention to mitigate comorbidities in older adults, such as obesity and fatty liver disease. CTP and gCTP supplementation may serve as functional ingredients to improve energy metabolism and mitochondrial function.Their potential to reduce oxidative stress, improve insulin resistance, and enhance AMPKα expression supports their use in managing obesity and fatty liver disease, particularly in older adults.

This retrospective study aims to evaluate the clinical outcomes of tracheal stent placement in dogs with tracheal collapse, identifying factors associated with success rates and adverse effects. Thirty-one dogs treated with intraluminal self-expanding nitinol stents for tracheal collapse at Smart Animal Hospital from 2018 to 2023 were analyzed. The investigation focused on median follow-up time (MFT), clinical outcomes, and factors affecting success and complications, including age at the time of stent placement, presence of stent-related complications, and concurrent bronchial collapse. The average follow-up time was 592 days, ranging from 35 to 2,189 days. As of December 31, 2023, 11 dogs were alive, 10 had died, and 10 were lost to follow-up. Excluding those lost to follow-up, 80% survived more than a year post-procedure. Yorkshire Terriers were the most common breed, followed by Pomeranians. The average age at the time of stent placement was around 9 years, with an average body weight of approximately 3 kg. There were no notable differences in MFT across age groups, indicating that age at the time of stent placement did not significantly affect survival outcomes. Postoperative outcomes were categorized as "Good" in 51.6% of cases, "Fair" in 32.3%, and "Poor" in 16.1%. Complications, including stent fracture, malposition, and migration, were observed in 23% of the dogs. The majority (83.9%) had concurrent bronchial collapse, which correlated with certain complications but did not significantly affect MFT. Overall, tracheal stent placement is a viable treatment option for canine tracheal collapse, demonstrating significant survival rates and manageable complications. This study underscores the importance of comprehensive postoperative monitoring and highlights the need for further research to optimize treatment strategies and improve patient outcomes in veterinary medicine.