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.

Pharmacogenomic variations may significantly influence responses to commonly prescribed stroke medications. Despite accumulating evidence, genetic testing has not yet been widely integrated into stroke care. This review summarizes current evidence and provides practical guidance for clinical implementation. Pharmacogenomic studies and clinical guidelines related to antiplatelet agents, anticoagulants, and statins were reviewed, with particular emphasis on East Asian populations. Substantial evidence supports genotype-guided use of clopidogrel (CYP2C19), warfarin (CYP2C9, VKORC1, CYP4F2), and statins (SLCO1B1, ABCG2). For aspirin, PTGS1/2 and PEAR1 variants have been investigated; however, current data remain insufficient for clinical application. Regarding direct oral anticoagulants (DOACs), candidate genes such as ABCB1 and CES1 demonstrate pharmacokinetic associations, though robust clinical outcome data are lacking. Distinct allele frequencies in East Asians—such as higher prevalence of CYP2C19 and ABCG2 variants—underscore the need for population-specific strategies. Beyond single-gene approaches, polygenic risk scores, pharmacogenomic panels, and integration with multi-omics data and artificial intelligence represent promising directions for personalized therapy. Pharmacogenomic testing can enhance stroke pharmacotherapy, particularly in populations with high frequencies of actionable variants. Broader implementation requires rapid testing platforms, clinician education, tailored clinical guidelines, and real-world validation of aspirin, DOACs, and multi-gene approaches. Future research should expand population-specific studies and integrate pharmacogenomics within the broader framework of precision medicine to ensure equitable clinical benefit.

Background: Early oral switch (EOS) has been proposed as an alternative to prolonged intravenous (IV) therapy for Enterobacterales bacteremia; however, its safety and effectiveness have not been clearly established. This systematic review and meta-analysis evaluated whether EOS reduces treatment failure in uncomplicated Enterobacterales bacteremia and examined how the timing of switching affects outcomes. Methods: We conducted a systematic review and random-effects meta-analysis of randomized controlled trials and observational studies that compared EOS with continued IV therapy in adults with uncomplicated Enterobacterales bacteremia. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. The primary outcome was treatment failure by ≤90 days. Prespecified analyses evaluated the timing of the switch. Results: Across 10 studies that met the inclusion criteria, EOS was associated with lower treatment failure than continued IV therapy (RR, 0.72; 95% CI, 0.58–0.89; I²=26%). Switching within 4 days reduced the failure (RR, 0.58; 95% CI, 0.44–0.76; I²=0%), whereas switching after 4 days showed no clear advantage (RR, 0.87; 95% CI, 0.71–1.06; I²=0%). No evidence of small study effects was observed. Conclusion EOS was associated with a lower risk of treatment failure than prolonged IV therapy, with the greatest benefit observed when the switch occurred within 4 days. These findings should be interpreted with clinical caution given that most of the evidence is observational.

Background: Laparoscopic surgery in the lateral decubitus position can alter pulmonary mechanics and oxygenation. Although positive end-expiratory pressure (PEEP) may alleviate these effects, the optimal level remains unclear. This study evaluated whether electrical impedance tomography (EIT)–guided PEEP titration improves oxygenation compared to a fixed PEEP of 5 cmH2O. Methods: In this randomized controlled trial, 74 adult patients undergoing robot-assisted or laparoscopic urologic surgery in the lateral decubitus position were assigned to either the EIT-guided or standard care group. The EIT-guided group underwent decremental PEEP titration to determine and maintain optimal PEEP throughout surgery. The standard care group received a fixed PEEP of 5 cmH2O. The primary outcome was ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) at the end of surgery. Secondary outcomes included intraoperative respiratory mechanics and postoperative pulmonary complications (PPCs) until discharge. Results: Seventy-one patients completed the study (EIT-guided: 35, standard care: 36). The PaO2/FiO2 ratio at the end of surgery was higher in the EIT-guided group than in the standard care group (523.8 ± 82.4 vs. 414.6 ± 96.7 mmHg, P < 0.001). Driving pressure was lower in the EIT-guided group at 30 min after pneumoperitoneum initiation (15.8 [12.5, 17.4] vs. 19.9 [17.2, 22.5] cmH2O, P < 0.001) and at the end of surgery (9.1 [8.0, 10.4] vs. 10.0 [8.8, 12.6] cmH2O, P = 0.033). PPCs did not differ between groups. Conclusions EIT-guided PEEP titration improved intraoperative oxygenation. Further studies are needed to assess clinical outcomes.

Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: s/Aims: Phase angle (PhA), as measured by bioelectrical impedance analysis, provides insights into hydration and nutritional status, making it a prognostic indicator of frailty. While low preoperative PhA has been linked to postoperative complications in cancer patients, its predictive value in individuals undergoing pancreaticoduodenectomy (PD) has not been thoroughly investigated.This study aims to evaluate the clinical utility of preoperative PhA in predicting postoperative complications for patients undergoing PD. Methods: Among 41 patients who underwent PD at Seoul National University Hospital between September and December 2024, 35 were included in the analysis after excluding 6 patients who had concomitant blood vessel or other organ resections. Patients were divided into low (Comprehensive Complication Index [CCI] ≤ 20) and high (CCI > 20) complication groups based on the CCI, derived from the Clavien–Dindo classification. The differences in PhA between the two groups were analyzed, and logistic regression was performed to assess the relationship between PhA and CCI. Results: The mean PhA was significantly lower in the high-CCI group compared to the low-CCI group (5.7° vs. 6.7°, p = 0.025). Multivariate logistic regression analysis indicated that PhA (odds ratio: 0.17; 95% confidence interval: 0.04–0.68; p = 0.012) was an independent predictor of high CCI. A low preoperative PhA was associated with an increased risk of postoperative complications following PD. Conclusions Preoperative PhA may serve as a valuable predictive indicator of postoperative complications after PD, enabling the identification of patients who could benefit from preoperative prehabilitation, including nutritional support.

Background: Long working hours have been associated with adverse physical and mental health outcomes; however, evidence regarding their relationship with satisfaction with work environment remains limited, particularly when long working hours are defined using a specific daily threshold. This study examined the association between working ≥10 hours per day and satisfaction with work environment among Korean wage workers, focusing on the cumulative number of such workdays per month. Methods: This cross-sectional study analyzed data from the 7th Korean Working Conditions Survey. A total of 24,269 wage workers aged ≥18 years were included after excluding self-employed workers, unpaid family workers, shift workers, and respondents with missing data. Working ≥10 hours per day was categorized as 0, 1–9, and ≥10 days per month. Satisfaction with work environment was categorized as satisfied or dissatisfied. Multiple logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for dissatisfaction with work environment according to the number of long working days, adjusting for demographic and occupational characteristics. Results: Compared with workers who did not work ≥10 hours per day, those who worked 1–9 days and ≥10 days per month showed progressively higher levels of dissatisfaction with work environment. After adjustment for demographic and occupational factors, the odds of dissatisfaction with work environment were significantly higher among workers who worked ≥10 hours per day for 1–9 days per month (OR: 1.380; 95% CI: 1.145–1.665) and ≥10 days per month (OR: 2.106; 95% CI: 1.627–2.725), demonstrating a dose–response relationship. Conclusions Among the analytic sample of Korean wage workers included in this study, working ≥10 hours per day was associated with greater dissatisfaction with work environment, with a dose–response pattern according to the number of long working days per month.

Purpose: Patient-derived cells (PDCs) and patient-derived organoids (PDOs) are complementary preclinical models widely used in translational cancer research. However, their molecular and functional differences have not been systematically characterized. This study established and analyzed paired PDC and PDO models derived from the same gastric cancer ascites to delineate platform-dependent molecular and functional profiles. Materials and Methods: Malignant ascites or pleural fluid obtained from 6 patients with advanced gastric cancer were used to establish paired PDC and PDO models. All pairs underwent comprehensive multi-omics profiling, integrating genomic, transcriptomic, and proteomic data. Phenotypic characterization included morphological, histological, proliferative, and cell cycle analyses. Drug sensitivity assays were performed using 4 chemotherapeutic agents commonly used to treat gastric cancer. Results: The 6 paired PDC and PDO models exhibited distinct morphological characteristics.Whole-genome analyses demonstrated high concordance among primary tumors, PDCs, and PDOs, confirming tumor representation across platforms. Multi-omics profiling identified platform-dependent molecular signatures; PDOs were enriched for extracellular matrix remodeling and stemness, whereas PDCs displayed proliferation- and immune-related signatures. Clinically relevant biomarkers, including HER2 and MET alterations, were concordant with primary tumors. Notably, drug responses differed between platforms and patients, indicating platform-dependent and patient-specific chemosensitivity. Conclusions Paired PDC and PDO models derived from the same patients preserved core patient-specific tumor characteristics while exhibiting distinct molecular and functional profiles. These findings underscore the culture platform as a critical determinant of experimental outcomes and therapeutic responses. Therefore, careful selection of an appropriate preclinical model is essential to accurately address biological questions and optimize precision oncology strategies.

This study examined the associations of fall experiences with cognitive function and activities of daily living (ADL) disability among older adults. Methods: Using data from the 2023 National Survey of Older Koreans, a total of 9,816 individuals aged 65 years or older were analyzed. Independent samples t-tests, ANOVA, chi-square tests, linear regression, and logistic regression analyses were conducted. Additionally, subgroup regression analyses were conducted to identify socially vulnerable groups according to age group, education level, and caregiving expenses. Results: The analysis showed that cognitive function tended to be lower in individuals with fall experience (β=-0.44, p=.026), and the odds of ADL disability were higher among individuals with fall experience (odds ratio [OR]=2.04, 95% confidence interval [95% CI]=1.63~2.54). In addition, subgroup analyses showed that cognitive function was lower among individuals with fall experience in the ≥85 years group (β=- 1.30, p=.020) and among those with education at elementary school or below (β=-0.88, p=.001). The odds of ADL disability among those with fall experience were higher among those aged 65~74 years (vs. 75~84; OR=2.80, 95% CI=1.99~3.94) and ≥85 years (vs. 75~84; OR=2.59, 95% CI=1.38~4.84), those with higher education (vs. lower; OR=4.95, 95% CI=1.19~20.60), and those with no caregiving expenses (vs. any; OR=2.06, 95% CI=1.63~2.60). Conclusion: These findings provide important foundational data for both policy development and academic research. They highlight the need for a multifaceted approach to fall prevention and underscore its importance in enhancing the quality of life for the older adults.

In forensic medicine, age estimation commonly involves assessing age-related changes in teeth and skeletal structures. Vertebral morphological alterations, such as osteophyte formation, serve as age indicators. Recent studies using deep-learning techniques, such as neural networks, for age estimation from radiographic images have been conducted, reporting significantly higher accuracy than previous studies. This study aimed to estimate age using neural network-based deep-learning techniques applied to computed tomography (CT) cross-sectional images of the spine and evaluate its feasibility. Postmortem CT scans of 214 cadavers with varying decomposition levels were used. Coronal and sagittal cross-sectional images penetrating the center of each vertebral body were extracted for the 11th and 12th thoracic vertebrae and the first to fifth lumbar vertebrae. Using these images, along with the chronological ages of deceased individuals, an age estimation model was developed through regression analysis in PyTorch, employing a convolutional neural networks architecture with five-fold cross-validation. The model achieved a mean absolute error of 5.385 years, root mean squared error of 7.029 years, and coefficient of determination of 0.793. Although the sample size was relatively small, the results suggested the potential applicability of vertebral imagingbased age estimation in the Korean population. Further research using a larger dataset may improve the accuracy and reliability of the model.