Purpose: : Teamwork and perceptions of patient safety culture are positive factors in operating room (OR) nurses’ patient safety management activities. Distractions in the OR may negatively impact OR nurses’ patient safety management activities; however, the relationship between these variables has not yet been explored. This study aimed to determine the relationships among teamwork, perception of patient safety culture, distractions in the OR, and patient safety management activities among OR nurses. Methods: : A descriptive cross-sectional study was conducted with 149 OR nurses from U Metropolitan City. Structured questionnaires were used to assess teamwork, perceptions of patient safety culture, distractions in the OR, and patient safety management activities. T-tests, one-way analysis of variance, Pearson’s correlation analysis, and hierarchical linear regression were used for data analysis. Results: : Positive correlations were found among teamwork, perception of the patient safety culture, and patient safety management activities (all p ＜.001). Auditory distractions in the OR were negatively correlated with patient safety management activities (r = -0.21, p = .011). Hierarchical linear regression revealed that teamwork (β = 0.28, p = .007), perception of patient safety culture (β = 0.24, p = .016), and visual (β = -0.22, p = .023) and communication distractions (β = -0.26, p = .002) were associated with patient safety management activities. Conclusion : Strategic interventions are thus needed to strengthen teamwork, foster a positive patient safety culture, and minimize distractions in the OR to enhance patient safety management activities among OR nurses.

Objective: : This study aims to evaluate and compare the clinical and radiographic outcomes of patients with metastatic spinal tumors who underwent either short-segment fixation with anterior support or long-segment fixation with a separation surgery in the thoracic or lumbar spine. Methods: : We conducted a retrospective analysis of adult patients who were treated surgically for spinal metastases in the thoracic or lumbar spine at a single tertiary referral center between April 2014 and December 2022. Surgical treatments included spinal cord decompression, short-segment fixation with maximal circumferential debulking of the lytic tumor portion and anterior support, or longsegment fixation without anterior support, followed by separation surgery and posterolateral fusion. We compared the two fixation strategies based on patient demographics, preoperative diagnoses, surgical data, neurological assessments, and changes in segmental Cobb angles immediately after surgery, and at the final follow-up. Results: : A total of 91 patients were included (short-segment, 44; long-segment, 47). No significant differences were observed between the groups regarding age, sex, comorbidities, primary cancer location, postoperative complications, or reoperation rates. Furthermore, no significant differences in the sagittal Cobb angles, including global angle (thoracic kyphosis, lumbar lordosis) and segmental angle were noted from the preop to the final follow-up. Compared to traditional long-segment fixation, short-segment fixation with anterior support significantly improved neurological outcomes in the thoracic region and reduced the length of hospital stay. No significant differences were observed between the two groups regarding complications or other clinical outcomes. Conclusion : Short-segment fixation is comparable to long-segment fixation in the management of thoracolumbar metastatic spinal tumors, with no significant differences in radiographic outcomes. However, short-segment fixation provides the added advantages of improved neurological outcomes in the thoracic region and shorter hospital stays.

Objective: This study investigated the associations of changes in metabolic syndrome status and the number of metabolic syndrome risk factors after cancer diagnosis with the incidence of cardiovascular disease (CVD) events among cancer survivors. Methods: Using nationwide health screening data, we identified 344,681 individuals diagnosed with cancer at age ≥19 years from 2012 to 2017, who survived for at least 3 years without CVD events. Participants were classified according to their metabolic syndrome status and risk factor count both before and after cancer diagnosis. A CVD event was defined as a composite of myocardial infarction, stroke, or cardiovascular death. Results: During a median follow-up period of 5.0 years after surviving cancer for 3 years, 7,529 CVD events occurred. The cumulative incidence of CVD was highest among participants with persistent metabolic syndrome. Compared to participants consistently free of metabolic syndrome, the multivariable-adjusted hazard ratios (HRs) for CVD were 1.21 (95% confidence interval [CI], 1.13–1.30) for newly developed metabolic syndrome, 1.19 (95% CI, 1.10–1.27) for recovered metabolic syndrome, and 1.37 (95% CI, 1.30–1.45) for persistent metabolic syndrome. Participants who recovered from metabolic syndrome exhibited a lower risk compared to those with persistent metabolic syndrome (HR, 0.86; 95% CI, 0.80–0.93).Each +1 increase in risk factor count after cancer diagnosis was associated with increased CVD risk (HR, 1.09; 95% CI, 1.07–1.11). Conclusion Changes in metabolic syndrome status and metabolic syndrome risk factor count after cancer diagnosis were significantly associated with CVD risk among cancer survivors.

Objective: The NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome has been proposed to be a downstream mediator of neuroinflammation in individuals with Parkinson’s disease (PD). However, its involvement across disease stages and related synucleinopathies, such as multiple system atrophy (MSA), remains unclear. We aimed to analyze the peripheral mRNA expression of NLRP3-related genes and cytokines across individuals with isolated REM sleep behavior disorder (iRBD), early-stage PD, late-stage PD, and MSA. Methods: Peripheral blood mononuclear cells (PBMCs) were collected from 151 participants: 35 healthy controls (HCs), 31 patients with iRBD, 41 patients with early-stage PD, 21 patients with late-stage PD, and 23 patients with MSA. mRNA expression was measured using quantitative real-time polymerase chain reaction. Statistical comparisons were performed using analysis of variance (ANOVA) or Welch’s ANOVA, and associations with clinical variables were analyzed through stepwise multiple linear regression. Results: NLRP3 expression was significantly lower in patients with iRBD (p=0.0263) and patients with early-stage PD (p= 0.0101) than in HCs. NIMA-related kinase 7 (NEK7) expression progressively decreased across the disease spectrum (HCs vs. patients with early-stage PD, p=0.0008; vs. patients with late-stage PD, p<0.0001). In contrast, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) and caspase-1 were elevated in patients with PD, especially those in the late stages. Levels of patients with MSA resembled those of HCs but differed from those of patients with PD. Interleukin (IL)-1β and IL-18 levels were not significantly different. In patients with early-stage PD, NLRP3 expression was negatively correlated with disease duration, the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Part II score, and the cognitive score. Conclusion Our findings challenge the prevailing hypothesis that NLRP3 inflammasome activation directly contributes to PD pathogenesis. Instead, the observed increase in ASC and caspase-1 expression suggests the potential involvement of alternative inflammasome pathways during disease progression.

Although aspartate aminotransferase (AST) is a serum marker of hepatocellular damage in chronic hepatitis, it is difficult to interpret very high AST levels with concurrent low alanine aminotransferase (ALT) levels. Macro-AST is an immunoglobulin-AST complex that can present as aberrant high enzymatic activity without significant inflammation in the liver. Two patients with chronic hepatitis B presented with disproportionate AST elevations. Their plasma samples were precipitated with polyethylene glycol (PEG) and stored at 4°C for macro-AST determinations. In Case 1, PEG precipitation showed 100% removal of AST activity, and refrigerated storage resulted in a ~70% decline over seven days, confirming macro-AST. In Case 2, both tests showed minimal changes, suggesting that macro-AST was unlikely. The AST levels normalized after antiviral therapy, suggesting immune-active hepatitis as the probable cause, but the other contributing factors could not be completely excluded. The abrupt decrease in AST activity after PEG precipitation and during refrigeration storage suggests that relatively high AST values compared to ALT might be attributed to the presence of macro-AST.These non-invasive methods for detecting macroenzymes might help the patient avoid unnecessary further work-ups.

Immune checkpoint inhibitors have transformed the treatment landscape of non-small cell lung cancer (NSCLC), extending their role from metastatic to resectable disease. While neoadjuvant and adjuvant immunotherapies have each shown clinical value, recent evidence suggests that a perioperative strategy—incorporating both preoperative and postoperative immune-based treatment—may provide more consistent and durable survival benefits, especially in stage IIIA and high programmed death-ligand 1 (PD-L1)–expressing tumors. Despite concerns about feasibility and immune-related adverse events, phase III trials such as CheckMate 816, KEYNOTE-671, and AEGEAN have demonstrated that perioperative chemoimmunotherapy is both effective and tolerable in real-world practice. This review examines the rationale, clinical trial data, patient selection criteria, and safety profile of perioperative immunotherapy, and argues for its increasing adoption as a strategic standard in eligible NSCLC patients. Additionally, emerging biomarkers and circulating tumor DNA-based minimal residual disease surveillance hold promise for refining precision of perioperative treatment. Taken together, the evidence supports perioperative immunotherapy as a forward-looking, evidence-based approach to improving outcomes in resectable NSCLC.

Purpose: Bronchiolitis obliterans syndrome (BOS) can develop as a manifestation of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (allo-HSCT), and may ultimately require lung transplantation (LT). However, reports on LT outcomes for BOS after allo-HSCT are limited. This study aimed to compare the outcomes of LT for BOS following allo-HSCT with those for idiopathic pulmonary fibrosis (IPF). Materials and Methods: A total of 487 patients underwent LT between January 2010 and August 2023. Among them, the baseline characteristics and outcomes of 35 patients with BOS following allo-HSCT and 216 patients with IPF were analyzed. Results: The BOS group was younger and had a lower body mass index (BMI) compared to the IPF group (33.7±11.9 years vs.59.7±7.3 years, p<0.001; 17.6±3.7 kg/m2 vs. 22.0±3.6 kg/m2 , p<0.001, respectively). The proportion of male patients was lower in the BOS group than in the IPF group (54.3% vs. 84.3%, p<0.001). Preoperative ventilator support was more common in the BOS group compared to the IPF group (62.9% vs. 32.4%, p=0.001). In Kaplan–Meier survival analysis, the 5-year survival rate was significantly higher in the BOS group than in the IPF group (71.0% vs. 44.9%, p=0.022). In the Cox proportional hazards model, age was the only factor significantly associated with survival [hazard ratio (95% confidence interval): 1.04 (1.02–1.07), p<0.001]. Conclusion The survival rate of the BOS group was not inferior to that of the IPF group after adjusting for sex, age, and BMI. Therefore, LT should be actively considered as a treatment option for patients with BOS following allo-HSCT.

Rhinoviruses are the most prevalent respiratory viruses across age groups, responsible for a wide spectrum of illnesses ranging from mild upper respiratory symptoms to lower airway involvement. Moreover, rhinovirus infection is also a major driver of asthma exacerbation and development, imposing a substantial disease burden. Rhinoviruses are classified into three species: Rhinovirus A, Rhinovirus B, and Rhinovirus C, each utilizing distinct host cell receptors and exhibiting different clinical patterns. Rhinovirus A and Rhinovirus C are more frequently associated with clinically significant disease outcomes compared to Rhinovirus B. Rhinovirus C binds to cadherin-related family member 3 (CDHR3), and a missense variant in CDHR3 (rs6967330) increases epithelial expression of the receptor, enhancing susceptibility to infection and severe illness, particularly in early life. Rhinovirus infection induces complex immune responses, characterized by impaired interferon signaling, type 2 inflammation, and epithelial barrier disruption. In individuals with asthma, altered interferon responses and T2-high immune profiles are closely linked to rhinovirus-induced exacerbations.In infants with atopic traits, such as eosinophilia, allergen sensitization, or a family history of allergic diseases, rhinovirus infection is strongly associated with subsequent development of asthma. Rhinovirus vaccine is needed to prevent severe respiratory infections and asthma exacerbations, particularly in vulnerable populations. Rhinovirus vaccine development has been challenging due to extensive antigenic diversity and limited cross-protective immunity. Recent progress in high-valency inactivated vaccines has demonstrated the feasibility of eliciting broad neutralizing responses. Prioritizing rhinovirus types linked to greater clinical severity may enable targeted vaccine strategies for high-risk populations, offering a promising approach to reducing the global burden of rhinovirus-associated illnesses.

Purpose: Asthma is characterized by chronic type 2/eosinophilic inflammation in the airway mucosa. This study aimed to explore the clinical value of 2 cutoffs of blood eosinophil counts (≥ 300/μL and ≥ 150/μL) in eosinophilic asthma, with relation to eosinophilderived neurotoxin (EDN), a surrogate marker of eosinophilic activity. Methods: To compare clinical features and eosinophil-related mediators according to 2 cutoffs of peripheral blood eosinophil counts (≥ 300/μL and ≥ 150/μL), 137 adult asthmatics who had maintained antiasthmatic medications, including inhaled corticosteroid and long-acting beta 2 agonist, without biologics, were enrolled. EDN levels in serum, urine and sputum were measured by enzymelinked immunosorbent assay. Results: Patients with asthma and higher blood eosinophil counts ( ≥ 300/μL) had a higher prevalence of severe asthma, chronic rhinosinusitis, partly controlled/uncontrolled status, and higher levels of sputum eosinophils and EDN in serum/sputum than those with lower blood eosinophil counts (< 300/μL). When compared between patients with asthma having higher blood eosinophils ( ≥ 150/μL) and those with lower eosinophils ( < 150/μL), there were no differences in symptom severity, control status or lung function parameters. Conclusion These findings suggest that blood eosinophil count ≥ 300/μL may identify asthma patients at higher risk for severity and heightened eosinophil activity, supporting its utility as a biomarker in a real clinical setting.

Purpose: Treatment responses to Mycoplasma pneumoniae (MP) pneumonia in children exhibit considerable variability. It is essential to identify predictive indicators and elucidate mechanisms associated with treatment responses. This study aimed to characterize the clinical, radiological, laboratory, and cytokine profiles associated with treatment responses in pediatric MP pneumonia. Methods: A retrospective analysis was performed in 85 children hospitalized with MP pneumonia between May 2019 and March 2020.Patients were categorized into the good response group (n=74) or the poor response group (n=11) based on clinical responses to step-wise treatment. Clinical characteristics, radiological findings, laboratory parameters, and serum levels of 27 cytokines obtained at admission were compared between the groups. Results: Compared to the good response group, the poor response group exhibited significantly longer fever duration (11.36 ± 5.33 days vs. 5.77 ± 3.95 days, P = 0.006), more frequent lobar consolidation (63.6% vs. 20.3%, P = 0.043), and higher lactate dehydrogenase levels (1,146±505 IU/L vs. 731±231 IU/L, P=0.008) and MP-specific immunoglobulin M index (6.49±3.01 vs. 3.85±3.28, P=0.014).Among the cytokines assessed, IL-21, IL-22, and IL-31 levels were significantly elevated in the good response group. IL-17A levels were also higher in this group, albeit not statistically significant. Conclusion Early identification of clinical, laboratory, and radiologic markers may facilitate early prediction of treatment response in pediatric MP pneumonia. Elevated IL-21, IL-22, and IL-31 levels in the good response group suggest a potential role for Th17-related cytokine activity in favorable treatment outcomes, warranting further investigation in larger cohorts.