Purpose: This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model. Methods: This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival.Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules. Results: The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size. Conclusion The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.

Background: Circulating tumor DNA (ctDNA) profiling from peripheral blood allows relatively noninvasive monitoring of solid tumors; however, its utility post-surgery or chemotherapy in colorectal cancer remains underexplored. We evaluated the clinical implications of a ctDNA next-generation sequencing (NGS) panel post-surgery or chemotherapy in patients with colorectal cancer. Methods: We collected samples from 23 patients with colorectal cancer (17 men, median age 65 yrs) at baseline and post-surgery or chemotherapy at the National Cancer Center, Korea, between January 2021 and September 2023. ctDNA was analyzed using an NGS panel including 46 genes, and variant allele frequencies (VAFs) were determined. Followup samples were analyzed using the NGS panel or droplet digital PCR (ddPCR) when probes were available. Clinical status was compared with ctDNA results, and survival was analyzed using a time-dependent Cox model. Results: Mutations were identified in 13 out of 14 patients (92.8%) with stage II/III cancer and in all nine patients (100%) with stage IV cancer. Mutations were detected in KRAS (N = 15, 65%), APC (N = 8, 35%), TP53 (N = 7, 30%), PIK3CA (N = 5, 22%), and RET (N = 4, 17%). A 1% increase in KRAS and TP53 VAFs was associated with 48% and 32% increased mortality risk, respectively. Changes in VAF correlated well with clinical findings. Conclusions The detection of and an increase in KRAS and TP53 VAFs were associated with poor prognosis. ddPCR-based ctDNA monitoring results were comparable to those obtained with the NGS panel. ctDNA monitoring during treatment is clinically informative in managing colorectal cancer.

Objective: This study aimed to examine morphological changes and changes in the extracellular signal-regulated kinase (ERK) and cyclic AMP response element-binding protein (CREB) activity in the testes of bulls with cryptorchidism. Methods: Testes from the 18-month-old unilateral cryptorchid bulls, including the descended (normal) and undescended (cryptorchid) testes from each animal, were analyzed through gross examination, histology, immunohistochemistry (Ki-67, phosphorylated p-ERK, p-CREB), and Western blotting. Results: Cryptorchid testes were smaller and exhibited reduced epithelial thickness, although seminiferous tubule area remained unchanged. Expression of Ki-67, p-ERK, and p-CREB was significantly decreased, indicating impaired cell proliferation and signaling.Total ERK and CREB protein levels were unchanged, but phosphorylation levels were notably reduced in cryptorchid samples. Conclusions and Relevance: Our findings demonstrate that cryptorchidism alters testicular morphology and disrupts key signaling pathways, particularly those involved in cell growth and function. Such alterations may contribute to infertility and highlight the importance of early diagnosis and intervention in the context of reproductive management in livestock.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Objective: This is the first prospective cohort study of Huntington’s disease (HD) in Korea. This study aimed to investigate the caregiver burden in relation to the characteristics of patients and caregivers. Methods: From August 2020 to February 2022, we enrolled patients with HD from 13 university hospitals in Korea. We used the 12-item Zarit Burden Interview (ZBI-12) to evaluate the caregiver burden. We evaluated the clinical associations of the ZBI-12 scores by linear regression analysis and investigated the differences between the low- and high-burden groups. Results: Sixty-five patients with HD and 45 caregivers were enrolled in this cohort study. The average age at onset of motor symptoms was 49.3 ± 12.3 years, with an average cytosine-adenine-guanine (CAG)n of 42.9 ± 4.0 (38–65). The median ZBI-12 score among our caregivers was 17.6 ± 14.2. A higher caregiver burden was associated with a more severe Shoulson–Fahn stage (p = 0.038) of the patients. A higher ZBI-12 score was also associated with lower independence scale (B = -0.154, p = 0.006) and functional capacity (B = -1.082, p = 0.002) scores of patients. The caregiving duration was longer in the high- than in the low-burden group. Caregivers’ demographics, blood relation, and marital and social status did not affect the burden significantly. Conclusion HD patients’ neurological status exerts an enormous impact on the caregiver burden regardless of the demographic or social status of the caregiver. This study emphasizes the need to establish an optimal support system for families dealing with HD in Korea. A future longitudinal analysis could help us understand how disease progression aggravates the caregiver burden throughout the entire disease course.

Objective: Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to highresolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA. Materials and Methods: In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.253 mm3 or 0.23 mm3 , respectively. A neurointerventionist established the gold standard with digital subtraction angiography.We compared the performance of HR-MRA, PD-MRA (0.253 -mm3 voxel), and PD-MRA (0.23 -mm3 voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement. Results: The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.253 -mm3voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%–91.0% versus 66.7%–70.5%; specificity from 93.7%–96.8% versus 58.7%–68.3%; and accuracy from 90.8%–92.9% versus 63.8%–69.5% (P ≤ 0.003). Furthermore, PD-MRA (0.253 -mm3 voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators (P ≤ 0.013). The diagnostic accuracy of PD-MRA (0.23 -mm3 voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.253 -mm3 voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820–0.938) than in HR-MRA (0.447–0.510). Conclusion PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.

Objective: To prospectively investigate the influence of the menstrual cycle on the background parenchymal signal (BPS) and apparent diffusion coefficient (ADC) of the breast on diffusion-weighted MRI (DW-MRI) in healthy premenopausal women. Materials and Methods: Seven healthy premenopausal women (median age, 37 years; range, 33–49 years) with regular menstrual cycles participated in this study. DW-MRI was performed during each of the four phases of the menstrual cycle (four examinations in total). Three radiologists independently assessed the BPS visual grade on images with b-values of 800 sec/mm2 (b800), 1200 sec/mm2 (b1200), and a synthetic 1500 sec/mm2 (sb1500). Additionally, one radiologist conducted a quantitative analysis to measure the BPS volume (%) and ADC values of the BPS (ADCBPS) and fibroglandular tissue (ADCFGT). Changes in the visual grade, BPS volume (%), ADCBPS, and ADCFGT during the menstrual cycle were descriptively analyzed. Results: The visual grade of BPS in seven women varied from mild to marked on b800 and from minimal to moderate on b1200 and sb1500. As the b-value increased, the visual grade of BPS decreased. On b800 and sb1500, two of the seven volunteers showed the highest visual grade in the early follicular phase (EFP). On b1200, three of the seven volunteers showed the highest visual grades in EFP. The BPS volume (%) on b800 and b1200 showed the highest value in three of the six volunteers with dense breasts in EFP. Three of the seven volunteers showed the lowest ADCBPS in the EFP. Four of the seven volunteers showed the highest ADCBPS in the early luteal phase (ELP) and the lowest ADCFGT in the late follicular phase (LFP). Conclusion Most volunteers did not exhibit specific BPS patterns during their menstrual cycles. However, the highest BPS and lowest ADCBPS were more frequently observed in EFP than in the other menstrual cycle phases, whereas the highest ADCBPS was more common in ELP. The lowest ADCFGT was more frequent in LFP.

An 82-year-old man diagnosed with supraglottic cancer sought a consultation for percutaneous endoscopic gastrostomy (PEG) placement. Preoperative chest radiography (posterior-anterior [PA] view) revealed no abnormalities, and PEG tube placement was performed using the “pull” method. Chest radiography (PA view) performed 3 days postoperatively showed free air that was not observed immediately after PEG tube placement; therefore, the patient was diagnosed with pneumoperitoneum. Abdominal computed tomography confirmed that the PEG tube was appropriately positioned within the stomach; however, the colon was observed between the abdominal wall and stomach, which indicated that the PEG tube had passed through the colon. Review of preoperative chest radiographs (PA views) confirmed that the colon was visualized in the area wherein usually stomach gas should have been observed. The patient was diagnosed with a gastro-colo-cutaneous fistula that occurred postoperatively, following a procedure that was performed without confirmation of anatomical variations. The PEG tube was removed surgically, and we performed percutaneous gastrostomy.

Objectives: Presenteeism is known to be a much more economically damaging social cost than disease rest while going to work despite physical pain. Since COVID-19, social discussions on the sickness benefit have been taking place as a countermeasure against presenteeism, and in particular, farmers and fishermen do not have an institutional mechanism for livelihood support when a disease other than work occurs. This study attempted to examine the relationship between agricultural, fishing, and forestry workers and presenteeism using the 6th Korean Work Conditions Survey. Methods: From October 2020 to January 2021, data from the 6th working conditions survey conducted on 17 cities and provinces in Korea were used, and a total of 34,981 people were studied. Control variables were gender, age, self-health assessment, education level, night work, shift work, monthly income, occupation, working hours per week, and employment status. Results: As a result of the analysis, farmers and fishermen showed the characteristics of the self-employed and the elderly, and as a result of the regression analysis, when farmers and fishermen analyzed the relationship with presenteeism tendency compared to other industry workers, farmers and fishermen increased by 23% compared to other industry groups. Conclusion This study is significant in that it has representation by utilizing the 6th working conditions survey and objectively suggests the need for a sickness benefit for farmers and fishermen who may be overlooked in the sickness benefit.