Objectives: This study investigated whether the coronavirus disease 2019 (COVID-19) pandemic affected quality of life (QOL) and whether its impact differed between individuals with and without suicidal ideation. Methods: A secondary analysis was performed using community-based cross-sectional survey data collected in Daegu, Republic of Korea, in 2018 (pre-pandemic phase), 2020 (pandemic phase), and 2022 (post-peak phase). Participants aged 18 years or older were recruited through stratified random sampling. Suicidal ideation over the past year was assessed using a single “yeso” question. QOL was measured using the Korean version of the abbreviated version of the World Health Organization Quality of Life Assessment, comprising physical, psychological, social, and environmental domains. A multivariate analysis of covariance was conducted to examine the main and interaction effects of suicidal ideation and the COVID-19 phase, adjusting for age, education, marital status, and income. Results: Suicidal ideation was significantly associated with lower QOL in all domains (p<0.001). QOL declined significantly during the pandemic compared with the pre-pandemic phase, especially in the physical, psychological, and social domains. A significant interaction between suicidal ideation and the COVID-19 phase was observed for physical health (p=0.03), driven by a decline in physical QOL among those without suicidal ideation during the pandemic. Conclusions The COVID-19 pandemic negatively impacted multiple domains of QOL, with differing patterns depending on suicidal ideation status. Continuous and adaptive mental health strategies developed according to individuals’ suicidality are needed during and beyond public health crises to mitigate pandemic-related declines in QOL.

Objective: This study aimed to evaluate reproductive outcomes according to the timing of testicular sperm retrieval. Methods: The study included 282 infertile couples divided into three groups: group A (freeze-thawed testicular sperm extraction [TESE] sperm, n=233), group B (fresh TESE sperm collected 1 day before ovum pickup, n=22), and group C (fresh TESE sperm collected on the same day as ovum pickup, n=27). The indications for TESE were surgically uncorrectable azoospermia or ejaculation failure, often accompanied by medical comorbidities such as diabetes mellitus and spinal cord injury. The outcome parameters assessed were fertilization rates, embryo quality, and clinical pregnancy rates. Results: The mean paternal age was 36.8±5.7 years, and the mean maternal age was 32.6±3.5 years. The mean duration of infertility was 2.9±1.8 years. The fertilization rates were 70.7%, 78.9%, and 73.0% for groups A, B, and C, respectively (p=0.047). The percentages of good-quality embryos were 68.2%, 65.3%, and 48.4%, respectively (p=0.007); specifically, the percentage of good-quality embryos was significantly lower in group C compared with the other two groups. Clinical pregnancy rates per transfer were similar at 51.1%, 50.0%, and 48.1% (p=0.958), with no differences observed in miscarriage rates. Conclusion Testicular sperm retrieval can be safely performed 1 day before ovum pickup, resulting in favorable fertility outcomes.

Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.

Spinal melanocytoma (SMC) is a rare, slow-growing tumor arising from melanocytes in the spinal cord. We report a patient with a cervical intra- and extradural spinal tumor causing progressive weakness and numbness. On magnetic resonance imaging (MRI), the lesion showed intense homogeneous enhancement, similar to that seen in common neurogenic spinal tumors. After complete resection, pathological examination confirmed melanocytoma. A review of previously reported cases identified 26 reports of this tumor in the cervical spine, most of which were treated with complete surgical resection. Gross total resection is the preferred treatment, although radiation therapy may be considered when residual tumor remains. We report a 25-year-old male patient who presented with progressive weakness and numbness in both the upper and lower extremities for 3 months. MRI showed homogeneous enhancement. The mass compressed the spinal cord at C6–7 and extended through the neural foramen. Based on the MRI findings, spinal schwannoma was suspected preoperatively. Surgical resection was performed with laminectomy, durotomy, and right facetectomy. A dark-colored mass with well-demarcated margins was exposed and removed. Postoperative MRI confirmed complete removal of the mass. The patient recovered well, and his preoperative myelopathic symptoms gradually improved. SMC is a rare benign tumor that may be mistaken for schwannoma. The treatment of choice is gross total resection.

Levothyroxine overdose is uncommon in adults and often presents with variable clinical severity, ranging from overt thyrotoxicosis to an entirely asymptomatic course. We report the case of a 47-year-old woman with a history of total thyroidectomy who intentionally ingested 10 mg of levothyroxine along with supratherapeutic doses of zolpidem and clonazepam at once in a suicide attempt. She presented three days later without adrenergic or gastrointestinal symptoms. Laboratory tests revealed markedly elevated free thyroxine and total triiodothyronine with suppressed thyroid stimulating hormone. She was treated with propranolol for heart rate control and empirical hydrocortisone in case of adrenal insufficiency. She remained asymptomatic with gradual biochemical improvement and normalization of thyroid function on follow-up. The protective effect of co-ingested supratherapeutic doses of gamma-aminobutyric acid (GABA)-ergic agents suggests a potential role for anti-anxiety medications in mitigating severe adrenergic symptoms in endogenous thyrotoxicosis, such as Graves’ disease.

Abrupt vessel closure (AVC) is a complication of percutaneous coronary intervention (PCI) and is defined as the sudden cessation of forward coronary blood flow due to a variety of mechanisms. The incidence of AVC has markedly decreased from approximately 3.0% in the early era to about 0.3% today. Nevertheless, cardiovascular interventionists must remain prepared to manage AVC effectively, given its significant impact on clinical outcomes.AVC can arise from several mechanisms, including dissection, intramural hematoma, intracoronary thrombosis, air embolism, vasospasm, and no-reflow. The clinical impact of AVC varies depending on the extent of myocardium affected, ranging from asymptomatic events or transient ischemic chest pain to cardiogenic shock or cardiac arrest. Both a general approach for stabilizing hemodynamic consequences and an etiology-specific management strategy are essential. Hasty decision-making may worsen the situation, whereas a structured approach—focused on hemodynamic stabilization, logical diagnostic processes, and targeted interventions—can improve outcomes. In this narrative review, we describe the mechanisms underlying each etiology, outline mechanism-specific management strategies, and discuss general approaches to managing patients with AVC through logical diagnostic and treatment processes. We hope this review offers valuable insights into this uncommon but significant complication and enhances readers’ skills in managing AVC more effectively during PCI.

Purpose: Fluid intelligence (FI), a core cognitive function involved in reasoning and problem-solving, has been linked to psychiatric outcomes in observational studies. However, causal inferences remain challenging due to confounding and reverse causation. This study aimed to investigate the causal effects of FI on 10 major psychiatric disorders using Mendelian randomization (MR). Methods: We performed a phenome-wide association study-based two-sample MR analysis to evaluate the effects of genetically proxied FI on 10 psychiatric disorders. Genome-wide association study summary statistics were obtained from large-scale European cohort studies. The inverse-variance-weighted method served as the primary analytical method, and complementary sensitivity analyses were conducted to assess pleiotropy and heterogeneity. Results: Higher FI was causally associated with a reduced risk of attention-deficit/hyperactivity disorder (ADHD) (odds ratio [OR], 0.72; P< 0.001), schizophrenia (OR, 0.69; P= 0.016), and post-traumatic stress disorder (PTSD) (OR, 0.93; P= 0.006). In contrast, FI was positively associated with an increased risk of autism spectrum disorder (ASD; OR, 1.43; P < 0.001) and anorexia nervosa (OR, 1.39; P= 0.005). No significant associations were observed for major depressive disorder, anxiety disorder, bipolar disorder, obsessive-compulsive disorder, or postpartum depression. Sensitivity analyses supported the robustness of these findings, with no evidence of directional pleiotropy or undue influence of individual single-nucleotide polymorphisms. Conclusion This study provides genetic evidence that higher FI exerts divergent causal effects across psychiatric disorders, protective in externalizing and stress-related conditions (ADHD, PTSD, and schizophrenia) but associated with an increased risk of neurodevelopmental and internalizing conditions (ASD and anorexia nervosa). These findings highlight the need for a nuanced understanding of cognitive capacity in psychiatric vulnerability and guide preventive strategies tailored to disorder-specific cognitive profiles.