Purpose: Due to its rarity, treatment guidelines for appendiceal cancer have traditionally followed those established for colorectal cancer, despite showing distinct histologic and clinical features. This study aimed to compare the clinicopathologic characteristics and long-term oncologic outcomes of appendiceal cancer with those of right-sided colon cancers. Methods: We retrospectively reviewed the records of patients with stage I–III appendiceal, cecal, or ascending colon cancer who underwent curative resection between 2010 and 2020 at our center. A 1:3:3 exact matching for age, sex, TNM stage, and adjuvant chemotherapy was performed. Survival outcomes were analyzed using the Kaplan-Meier and Cox regression methods. Results: Overall, 245 patients with appendiceal cancer (n = 35), ascending colon cancer (n = 105), and cecal cancer (n = 105) were analyzed. Appendiceal cancer exhibited a higher proportion of T4 tumors and fewer harvested lymph nodes compared with ascending or cecal cancers. The mean follow-up duration was 9.5 years. The 5- and 10-year overall survival rates were lower in appendiceal cancer (66.2% and 52.9%) than in ascending (91.2% and 78.4%) or cecal cancer (88.5% and 78.3%). Similarly, the 10-year disease-free survival rate was lower in appendiceal cancer (59.2%) compared with ascending (83.1%) and cecal cancers (78.4%). Cox regression analysis identified age (≥65 years), perforation, nodal metastasis, and lymphovascular invasion as independent predictors of poor prognosis. Conclusion Appendiceal cancer exhibited significantly worse long-term survival compared to cecal or ascending colon cancer. Tumor perforation, nodal metastasis, and lymphovascular invasion were adverse prognostic factors for overall and disease-free survival.

Purpose: Neoadjuvant treatment (NAT) is now the standard for borderline resectable pancreatic cancer (RPC) and is being considered for RPC. Early recurrence after curative surgery in RPC is often seen as a treatment failure, prompting considerations for NAT. Our goal was to develop an artificial intelligence (AI)-based predictive model utilizing preoperatively available factors to forecast early recurrences of resected RPC. Methods: This study included 469 patients who underwent surgery for RPC between 2011 and 2019. Clinicopathologic and oncologic data were retrospectively reviewed. Preoperative variables, including laboratory data and imaging findings, were collected. Early recurrence was defined as recurrence occurring within a year after surgery. Deep neural networks were then used to select variables by assessing their importance. A new model predicting early recurrence of RPC was subsequently developed. Results: Of the patients evaluated, 199 (42.4%) experienced early recurrence. The predictive model included 14 preoperative variables: CA 19-9, preoperative pancreatitis, serum albumin, platelet count, lymphocyte count, the American Society of Anesthesiologists physical status classification, tumor size, monocyte count, age, body mass index, CRP, hemoglobin, WBC count, and CEA. The area under the curve for the model was 0.786 in the training set and 0.734 in the test set. Conclusion We developed an AI-based model to predict the early recurrence of RPC using preoperative parameters. By identifying patients at risk of early recurrence, optimal individualized treatments such as NAT can be considered. Future prospective studies are crucial to establish clear indications for NAT in RPC.

Purpose: Postoperative complications following gastric cancer surgery significantly impact patient outcomes, yet standardized definitions for these events have not been consistently applied across institutions in Korea. This study aimed to develop a consensus-based, standardized complication classification system specific to gastrectomy for gastric cancer as part of the Korean Quality Improvement Platform in Surgery (K-QIPS) initiative. Methods: As part of K-QIPS, a dedicated task force team (TFT) was formed with surgical experts from fourteen high-volume hospitals across Korea. The TFT conducted ten formal meetings to review existing literature and international guidelines, and incorporated findings from randomized controlled trials. The final complication list was developed through expert consensus and structured into a standardized framework. A Data Entry Manual was created to support consistent data collection by surgical clinical reviewers. Results: The TFT defined specific postoperative complications following gastrectomy for gastric cancer, including anastomotic leakage, duodenal stump leakage, pancreatic fistula, intra-abdominal and luminal bleeding, delayed gastric emptying, and internal hernia. Notably, internal hernia was described in standardized form for the first time. General complications were developed first and overlapped in part with the gastric cancer-specific list. The task force also produced a Data Entry Manual that provides practical instructions to ensure consistency and accuracy in complication reporting. Conclusion This nationwide consensus initiative established the first standardized complication classification system for gastric cancer surgery in Korea. The proposed definitions and data entry system are expected to improve complication reporting, enable multicenter research, support surgical quality benchmarking, and ultimately enhance patient outcomes.

Objective: To classify life stages for companion dogs and cats by identifying clusters in age-specific disease proportions derived from medical records, providing a data-driven foundation for health examination programs. Methods: We collected 505,667 medical records from 82 veterinary facilities in South Korea between 2020 and 2023. Diagnoses were standardized using GPT-4o and S-BioBERT. Following preprocessing, data from 27 facilities yielded 222,706 canine and 39,910 feline records for the final analysis. Principal component analysis and K-means clustering (K = 4) were applied to age-specific disease proportions to identify life stages.The 10 most highest-proportion diagnoses diseases were determined for each cluster. Results: Canine life stages were classified as ≤ 1 year, 2–5 years, 6–10 years, and 11–15+ years.Feline life stages were 1–2 years, 3–8 years, 9–12 years, and 13–15+ years. In dogs, developmental diseases were common in the youngest age group, while chronic diseases were more prevalent in older groups. In cats, oral and urinary diseases were high-ranking, conjunctivitis was most common in the early stage, and chronic diseases increased with age. Conclusions and Relevance: Age-specific diagnosis patterns support four practical life stages for dogs and cats in South Korea. These boundaries can inform evidence-based preventive examination schedules, animal health policy, and pet insurance product design.

Background/Aims: Despite numerous global changes in Helicobacter pylori treatment guidelines over the past decade, no comprehensive nationwide trend analysis has been conducted.We aimed to investigate the annual trends in the use of H. pylori treatment regimens on the basis of hospital type and region to identify whether changes in prescription patterns aligned with the Korean guidelines updated in 2013 and 2020. Methods: Using data from Korean Health Insurance Review and Assessment database spanning from January 2010 to December 2022, we extracted the performance code for H. pylori diagnosis along with the drug combination code for H. pylori treatment. Results: We analyzed the annual trends in standard triple therapy (STT; n=664,748), bismuth quadruple therapy (BQT; n=151,828), concomitant therapy (CT; n=3,034), sequential therapy (SEQ; n=1,612), and salvage treatment. Overall, STT use declined, with the use of 7-day STT decreasing but the use of 10- and 14-day STT increasing. The use of BQT as a first-line treatment consistently increased, and non-BQT (i.e., CT and SEQ) use also increased sharply since 2019.The tendency to adhere to the guideline changes was more pronounced in primary care clinics.Salvage treatment with BQT after STT failure exhibited a declining trend from 2010 to 2017, followed by an increase since 2018. Salvage treatment with levofloxacin triple therapy after BQT failure increased over time. Conclusions This long-term nationwide trend analysis revealed that real-world prescriptions for H. pylori treatment generally corresponded to the updated guidelines. Efforts are needed to disseminate the revised guidelines to achieve higher compliance rates.

Purpose: This study assesses preoperative prognostic factors in intrahepatic cholangiocarcinoma (ICC) to improve risk assessment and inform clinical decisions, focusing on the role of lymph node dissection (LND). Methods: We conducted a retrospective analysis of 234 patients who underwent surgery for ICC at a single institution between 2010 and 2019. Prognostic factors affecting overall survival (OS) were identified through univariate and multivariable logistic regression analyses. Patients were categorized into high-, intermediate-, and low-risk groups based on the number of adverse prognostic factors. Survival curves were compared between the groups that underwent LND and those that did not within each risk category. Results: Of the 234 patients, 138 (59.0%) underwent LND, and 96 (41.0%) did not (non-LND). Significant prognostic factors included preoperative elevation of CEA (>5 ng/mL), CA 19-9 (>37 U/mL), tumor multiplicity, tumor size >5 cm, and extrahepatic invasion. These factors were associated with adverse OS (hazard ratio ranging from 1.69 to 2.54). High-risk patients had significantly lower median OS compared to intermediate and low-risk groups in both LND and non-LND cohorts, but no significant difference in median OS between LND and non-LND groups within each risk category was observed. Conclusion Preoperative prognostic factors such as CEA, CA 19-9, tumor size, and multiplicity are vital for assessing patient risk in ICC. These factors guide clinical decision-making and emphasize the need for targeted treatment strategies, including the consideration of LND, particularly in high-risk patients. The study underscores the importance of these prognostic indicators in enhancing treatment outcomes.

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. Using data from the Korean Renal Data System (2001–2022), we analyzed 66,129 HD patients, stratified into young (<65 years, n = 24,589), younger-old (65–74 years, n = 17,732), and older-old (≥75 years, n = 23,808) groups. Patients were categorized into BMI quartiles, and survival outcomes were evaluated using Kaplan-Meier curves and event time ratios for the relative change in the survival time. During the follow-up period, 14,360 of the patients (21.7%) died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after a BMI of 25 kg/m2. Lower BMI correlates with higher mortality, particularly in younger HD patients.

Objective: The escalating global mental health crisis necessitates innovative solutions to address traditional service limitations such as high costs and professional shortages. This review examines the emerging role of artificial intelligence (AI) chatbots in digital psychiatry, analyzing their clinical efficacy, ethical challenges, and future directions. Methods: This narrative review synthesizes evidence from recent randomized controlled trials, meta-analyses, and scholarly publications on AI chatbots for mental health. It also discusses the ethical and social implications, including data privacy, algorithmic bias, and cognitive effects, and provides a forward-looking roadmap for regulation and development. Results: Chatbots grounded in evidence-based principles like cognitive-behavioral therapy demonstrate clinical effectiveness in reducing symptoms of depression and anxiety, with some studies reporting a strong “therapeutic alliance” comparable to that with human therapists. AI models also show promise in diagnostic and predictive roles by analyzing selfreport questionnaires and physiological data. However, critical risks include inappropriate responses in crisis situations, potential for AI psychosis, and the erosion of cognitive abilities due to over-reliance. Conclusion The future of digital psychiatry lies in a blended care model that combines the accessibility of AI with the indispensable empathy and professional judgment of human clinicians. A collaborative roadmap is essential, mandating safety protocols, strengthened data governance, expert involvement, and ethical design to ensure AI acts as a transformative and responsible tool.

Purpose: This study assessed the neuromodulatory effect of transcranial direct current stimulation (tDCS) in internet gaming disorder (IGD), using source-level electroencephalography (EEG) to measure functional connectivity within the default mode network (DMN) and reward/salience network (RSN). Methods: Thirty-one patients with IGD participated in the study. After excluding five dropouts, 26 individuals (tDCS group n= 14; sham group n= 12) completed 10 sessions of either tDCS or sham stimulation. Resting-state EEG, IGD severity, and craving were measured before and 1 month after the intervention. Changes in connectivity within the DMN and RSN were assessed at each frequency band. Post hoc analysis was used to investigate the correlation between tDCS-induced connectivity changes and clinical improvement. Results: In the DMN, tDCS decreased delta and theta connectivity, and suppressed the increase in beta connectivity. Neural connections between the prefrontal cortex and parietal lobe were the main regions affected. In the RSN, tDCS increased neural connectivity in the theta and beta bands. The connections between the right dorsolateral prefrontal cortex (DLPFC) and cingulate cortex were the main regions affected. Post hoc analysis revealed a significant correlation between changes in right DLPFC connectivity and reduced craving. Conclusion tDCS induces neural connectivity changes in the DMN and RSN. These findings support the potential use of tDCS as a neuromodulatory treatment for IGD, particularly in individuals with altered DLPFC connectivity patterns.