Purpose: The human gut mycobiome comprises diverse fungal species and plays a crucial role in health and disease, despite its relatively low abundance compared to bacterial populations. This review provides an overview of the mycobiome’s composition, developmental patterns, and dysbiosis in various pathological conditions. As well, the complex interactions of fungal communities within the gut microbiome are discussed.Current content: The development of the gut mycobiome follows patterns similar to those of the bacterial microbiome, with birth mode, diet, and age being key determinants. In contrast to the bacterial trends, mycobiome diversity increases during childhood and old age. Recent studies have revealed variations in the mycobiome composition across different ethnic groups. Mycobiome dysbiosis is associated with autoimmune, gastrointestinal, and cardiovascular diseases. Certain fungi, notably Candida albicans, are relatively more abundant in pathological states. Fungal metabolic activity, particularly secondary metabolite production, can significantly affect disease progression. Bacterial–fungal interactions in the gut microbiome are complex and modulated by environmental factors, such as diet and antibiotic use. Moreover, the gut mycobiome modulates therapeutic efficacy. Gut fungi enhance the bioactivity of compounds derived from natural products through biotransformation, including their anticancer and anti-inflammatory effects. This suggests the potential of the gut mycobiome to optimize the therapeutic efficacy of natural products. Conclusion This review highlights the relevance of the gut mycobiome as both a diagnostic biomarker and a therapeutic target. Future research should focus on elucidating the causal relationships between mycobiome alterations and disease states, and further explore bacterial–fungal interactions within the gut ecosystem.

Purpose: This study aimed to develop a comprehensive practical guide for enteral nutrition (EN) designed to enhance patient safety and reduce complications in Korea. Under the leadership of the Korean Society for Parenteral and Enteral Nutrition (KSPEN), the initiative sought to standardize EN procedures, improve decision-making, and promote effective multidisciplinary communication. Methods: The KSPEN EN committee identified key questions related to EN practices and organized them into seven sections such as prescribing, delivery route selection, formula preparation, administration, and quality management. Twenty-one experts, selected based on their expertise, conducted a thorough literature review to formulate evidence-based recommendations. Drafts underwent peer review both within and across disciplines, with final revisions completed by the KSPEN Guideline Committee. The guide, which will be published in three installments, addresses critical elements of EN therapy and safety protocols. Results: The practical guide recommends that EN orders include detailed elements and advocates the use of electronic medical records for communication. Standardized prescription forms and supplementary safety measures are outlined. Review frequency is adjusted according to patient condition—daily for critically ill or unstable patients and as dictated by institutional protocols for stable patients. Evidence indicates that adherence to these protocols reduces mortality, complications, and prescription errors. Conclusion The KSPEN practical guide offers a robust framework for the safe delivery of EN tailored to Korea’s healthcare context. It emphasizes standardized protocols and interdisciplinary collaboration to improve nutritional outcomes, patient safety, and operational efficiency. Rigorous implementation and monitoring of adherence are critical for its success.

Purpose: Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation. Methods: A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus. Results: The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements. Conclusion This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

Purpose: The long-term outcomes and efficacy of partial stapled hemorrhoidopexy (PSH) compared with those of conventional hemorrhoidectomy (CH) are not fully understood. This study aimed to introduce a modified PSH (mPSH) and compare its clinical efficacy and safety with those of CH. Methods: A prospective randomized controlled trial was conducted. This study was performed at a single hospital and involved 6 colorectal surgeons. In total, 110 patients were enrolled between July 2019 and September 2020. Patients were randomly assigned to undergo either mPSH group (n=55) or CH group (n=55). The primary outcome was to compare postoperative average pain and postoperative peak pain using visual analog scale score between the 2 groups. Results: The required duration of analgesia was shorter in the mPSH group than in the CH group, although the difference was not statistically significant (P=0.096). However, the laxative requirement duration (P<0.010), return to work (P<0.010), satisfaction score (P<0.010), and Vaizey score (P=0.014) were significantly better in the mPSH group. The average and peak postoperative pain scores were significantly lower in the mPSH group during the 15 days after surgery (P<0.001). The overall complication rate in both groups was 9.1%, with no significant difference between the groups (P=0.867). Conclusion The mPSH group demonstrated better improvement in symptoms, lower pain scores, and greater patient early satisfaction after surgery than the CH group. Therefore, this surgical technique appears to be a safe and effective alternative for CH.

Purpose: Despite the widespread use of liquid skin adhesives (LSA), concerns persist regarding the increase in wound care costs. This study aimed to investigate the cost-effectiveness of LSA for surgical wound management. Methods: In this prospective, open-label, single-center randomized controlled trial, adults aged 19 years and older who were scheduled for elective minimally invasive colorectal surgeries were included. The participants were randomly divided into 2 groups: an n-butyl cyanoacrylate skin adhesive was used in the experimental group (LSA group), while a surgical skin stapler was employed in the control group (stapler group). The primary outcome measure was the sum of the total time required for wound management. Results: A total of 58 patients were randomly assigned to 2 groups, with 29 patients in each group. The findings revealed comparable wound complication rates in the 2 groups (8 out of 29 in the LSA group vs. 5 out of 29 in the stapler group, P = 0.530). Notably, the LSA group had a significantly shorter wound management time (median 235 seconds vs. 1,201 seconds, P < 0.001) and similar wound management cost (median US dollar [USD] 50.6 vs. USD 54.6, P = 0.529) compared to the stapler group. Subgroup analysis showed that the LSA group had a shorter management time for uncomplicated wounds and a lower cost for complicated wounds. Conclusion LSA not only provides a safe alternative but also offers a resource-efficient option for wound management compared to staplers.

Purpose: Regenerative medicine is expected to offer an alternative to liver transplantation for treating liver diseases in the future, with one significant challenge being the establishment of an effective stem cell administration route. This study assessed the antifibrogenic effects of adipose-derived stem cells (ASCs) in a liver fibrosis mouse model, focusing on 2 methods of delivery: intravenous injection and scaffold implantation. Methods: An extracellular matrix mimic scaffold was utilized for culturing peroxisome proliferator-activated receptor gamma coactivator 1-alpha–overexpressing ASCs (tASCs). These scaffolds, laden with tASCs, were then implanted subcutaneously in mice exhibiting liver fibrosis. In contrast, the Cell groups received biweekly intravenous injections of tASCs for 4 weeks. After 4 weeks, tissue samples were harvested from the euthanized mice for subsequent analysis. Results: Real-time PCR and Western blot analyses on liver tissues, focusing on markers like alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2, and transforming growth factor-beta 1 (TGF-β1), showed that both delivery routes substantially lowered fibrotic and inflammatory markers compared to controls (P < 0.05), with no significant differences between the routes. Histological examinations, along with immunohistochemical analysis of α-SMA, collagen type I alpha, and TGF-β1, revealed that the scaffold implantation approach resulted in a greater reduction in fibrosis and lower immunoreactivity for fibrotic markers than intravenous delivery (P < 0.05). Conclusion These findings indicate that delivering tASCs via a scaffold could be more effective, or at least similarly effective, in treating liver fibrosis compared to intravenous delivery. Scaffold implantation could offer a beneficial alternative to frequent intravenous treatments, suggesting its potential utility in clinical applications for liver disease treatment.

Neurofibromas are benign neoplasms originating from neural tissues that rarely transform into malignancies. Approximately 25% to 45% of neurofibromas are located in the head and neck; the most common sites are the lateral cervical region and mouth. A 27-year-old female patient visited our hospital complaining of a painful brownish mass in the right elbow that had recently increased in size. She had no history of cancer and was otherwise in excellent health. This mass accounted for 80% of the total elbow circumference. Genetic mutation testing resulted in a diagnosis of neurofibromatosis type 1. A wide surgical excision was performed, and the area was repaired using a bilateral large superficial circumflex iliac artery perforator free flap. The flap survived well, with no partial necrosis. Histological findings showed a plexiform neurofibroma measuring 14×12×1.5 cm3. The patient’s postoperative course was uneventful; at an 18-month follow-up, she had good cosmetic and functional outcomes with no signs of relapse.

Large defects in the buttock region are uncommon and pose significant challenges for reconstruction. The skin in this area adheres firmly to the subcutaneous tissue, making mobilization difficult. Attempts to use local or regional flaps to cover defects in this region often result in flap necrosis, leading to an elevated risk of infection and unstable wounds. In addition to these intrinsic challenges, factors such as fecal contamination, difficulty in patient positioning, and suboptimal underlying patient conditions further complicate the reconstruction process. Furthermore, the lack of suitable recipient vessels often hinders free tissue transfer for complex wound coverage in the buttock area. Here, we present a case involving sequential latissimus dorsi and omental free flap coverage to address a large gluteal skin and soft-tissue defect. Our experience highlights the importance of meticulous reconstructive planning and the appropriate selection of recipient vessels for successful buttock reconstruction.