Fournier gangrene (FG) is a rare life-threatening infection j that can occasionally extend beyond the perineum into the retroperitoneal space. Preperitoneal involvement in female patients is extremely rare. We report a unique case of a 59-year-old female with FG, characterized by atypical preperitoneal extension. Despite initial treatment failure, the patient recovered following emergency debridement, and targeted antibiotic therapy. This case underscores the importance of early diagnosis, timely surgical intervention, and multidisciplinary care in managing atypical FG presentations in female patients. It emphasizes the need for prompt and aggressive management to improve survival in these rare instances.

Purpose: Claudin 18.2 (CLDN18.2) has emerged as a promising therapeutic target for CLDN18.2-expressing gastric cancer (GC). We sought to examine the heterogeneity of CLDN18.2 expression between primary GC (PGC) and metastatic GC (MGC) using various scoring methods. Materials and Methods: We retrospectively analyzed data from 102 patients with pathologically confirmed paired primary and metastatic gastric or gastroesophageal junction adenocarcinomas. CLDN18.2 expression was evaluated through immunohistochemistry on formalin-fixed paraffin-embedded tissue samples. We assessed CLDN18.2 positivity using multiple scoring approaches, including the immunoreactivity score, H-score, and the percentage of tumor cells showing moderate-to-strong staining intensity. We analyzed the concordance rates between PGC and MGC and the association of CLDN18.2 positivity with clinicopathological features. Results: CLDN18.2 positivity varied from 25% to 65% depending on the scoring method, with PGC consistently showing higher expression levels than MGC. Intratumoral heterogeneity was noted in 25.5% of PGCs and 19.6% of MGCs. Intertumoral heterogeneity, manifesting as discordance in CLDN18.2 positivity between PGC and MGC, was observed in about 20% of cases, with moderate agreement across scoring methods (κ=0.47 to 0.60).In PGC, higher CLDN18.2 positivity correlated with synchronous metastasis, presence of peritoneal metastasis, poorly differentiated grade, and biopsy specimens. In MGC, positivity was associated with synchronous metastasis, presence of peritoneal metastasis, and metastatic peritoneal tissues. Conclusions CLDN18.2 expression demonstrates significant heterogeneity between PGC and MGC, with a 20% discordance rate. Comprehensive tissue sampling and reassessment of CLDN18.2 status are crucial, especially before initiating CLDN18.2-targeted therapies.

Dyslipidemia dramatically increases the risk of cardiovascular diseases, necessitating appropriate treatment techniques. Generative AI (GenAI), an advanced AI technology that can generate diverse content by learning from vast datasets, provides promising new opportunities to address this challenge. GenAI-powered frequently asked questions systems and chatbots offer continuous, personalized support by addressing lifestyle modifications and medication adherence, which is crucial for patients with dyslipidemia. These tools also help to promote health literacy by making information more accessible and reliable.GenAI helps healthcare providers construct clinical case scenarios, training materials, and evaluation tools, which supports professional development and evidence-based practice.Multimodal GenAI technology analyzes food images and nutritional content to deliver personalized dietary recommendations tailored to each patient's condition, improving long-term nutritional management for those with dyslipidemia. Moreover, using GenAI for image generation enhances the visual quality of educational materials for both patients and professionals, allowing healthcare providers to create real-time, customized visual aids. To apply successfully, healthcare providers must develop GenAI-related abilities, such as prompt engineering and critical evaluation of GenAI-generated data.

Background: s/Aims: Hepatocellular carcinoma (HCC) is the sixth most common cancer and second leading cause of cancer-related deaths in South Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2016-2018. Methods: Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative database of patients newly diagnosed with HCC in South Korea, were analyzed. This study investigated 4,462 patients with HCC registered in the KPLCR in 2016-2018. Results: The median patient age was 63 years (interquartile range, 55-72). 79.7% of patients were male. Hepatitis B infection was the most common underlying liver disease (54.5%). The Barcelona Clinic Liver Cancer (BCLC) staging system classified patients as follows: stage 0 (14.9%), A (28.8%), B (7.5%), C (39.0%), and D (9.8%). The median overall survival was 3.72 years (95% confidence interval, 3.47-4.14), with 1-, 3-, and 5-year overall survival rates of 71.3%, 54.1%, and 44.3%, respectively. In 2016-2018, there was a significant shift toward BCLC stage 0-A and Child-Turcotte-Pugh liver function class A (P<0.05), although survival rates did not differ by diagnosis year. In the treatment group (n=4,389), the most common initial treatments were transarterial therapy (31.7%), surgical resection (24.9%), best supportive care (18.9%), and local ablation therapy (10.5%). Conclusions Between 2016 and 2018, HCC tended to be diagnosed at earlier stages, with better liver function in later years. However, since approximately half of the patients remained diagnosed at an advanced stage, more rigorous and optimized HCC screening strategies should be implemented.

Polyetheretherketone (PEEK) crowns offer a provisional option for esthetic restorations in pediatric patients. PEEK has mechanical properties similar to dentin but exhibits low bond strength with luting cements. This study aimed to evaluate the effect of different surface treatments on the bond strength between PEEK and four luting cements by measuring shear bond strength (SBS). Sixty specimens were divided into three surface treatment groups: control, sandblast, and 98% sulfuric acid, and further divided into four cement subgroups: methyl methacrylate (MMA)-based resin cement, composite-based resin cement, resin-modified glass ionomer cement (RMGI), and glass ionomer cement (GI). Failure modes and treated surfaces were examined using scanning electron microscopy (SEM), and wettability was assessed through water contact angle. Both surface treatment methods showed significantly higher SBS than the control. The combination of sulfuric acid treatment with MMA-based resin cement demonstrated the highest bond strength (11.25 ± 1.86 MPa), while the second highest value was observed with sandblasting combined with MMA-based resin cement. These values were significantly higher than other groups and exceeded the clinically acceptable SBS threshold of 10 MPa. SEM analysis revealed that sandblasting created irregular fissures with large grooves and cracks for improved micro-retention, while sulfuric acid treatment produced a complex fiber network with sponge-like porosities. Within the limits of this in vitro study, MMA- and composite-based resin cement application with sandblast or sulfuric acid surface treatment proved effective bonding methods.

Purpose: To describe a case of posterior scleritis accompanied by optic disc edema following the surgical removal of a traumatic intraocular foreign body.Case Summary: A 32-year-old man presented to the hospital after suspecting that a foreign body had entered his left eye while nailing. Slit lamp examination revealed a 2-mm corneal laceration, iris defect, and lens opacity. Lensectomy, vitrectomy, and intraocular foreign body removal were subsequently performed. A magnetic foreign body approximately 1 mm in diameter was extracted from the vitreous cavity. One week after surgery, during an outpatient visit, optic disc swelling and retinal vessel thickening were observed. Oral steroids were initiated and tapered over 2 months. After discontinuing the medication, the patient experienced acute ocular pain and severe ciliary body hyperemia, and B-scan imaging showed thickening of the posterior ocular coat. The diagnosis was posterior scleritis with optic disc swelling, and oral steroids were prescribed and tapered over 12 weeks. Following the secondary intraocular lens scleral fixation, no recurrence of posterior scleritis was noted. Conclusions Posterior scleritis should be considered in cases presenting with ocular pain, ciliary body hyperemia, or optic nerve swelling after intraocular foreign body removal surgery.

Background: Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP. Here, we hypothesized that CCB would decrease the incidence of HDP compared to ISB while still providing effective pain relief after surgery. Methods: Seventy patients who underwent arthroscopic rotator cuff repair were randomly allocated to receive either ultrasound-guided CCB (n = 35) or ISB (n = 35). Each group received 0.2% ropivacaine (20 ml CCB, 10 ml ISB). The primary outcome was the incidence of HDP, as measured using M-mode ultrasound. Diaphragmatic excursion, pulmonary function test results, opioid consumption, and pain scores were evaluated. Results: Sixty-six patients were included. CCB group had a significantly lower incidence of HDP than those in the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.87 cm) group than in the CCB (0.25 cm) group (P < 0.001). The decrease in forced vital capacity and forced expiratory volume in 1 s from baseline was significantly greater in the ISB. There was no significant difference in opioid consumption between the two groups during the entire postoperative period. Conclusions Compared with ISB, CCB significantly reduced the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB may be a viable option for diaphragmatic-sparing analgesia after shoulder surgery.

Purpose: To evaluate the differences in the level of concerns regarding exotropia surgery according to the perspectives regarding surgery and basic characteristics of parents of pediatric patients with intermittent exotropia in South Korea. Methods: This study included the parents of pediatric patients with intermittent exotropia who underwent surgery at five hospitals, between June 2022 and February 2023. Parental perspectives, basic characteristics, and levels of concern regarding surgery were assessed using a questionnaire. We investigated the differences in concern levels according to perspectives regarding surgery and basic characteristics among parents, such as sex, age, residential area, and the most influential factors in the decision-making for surgery. Results: A total of 266 parents were included (228 mothers; age, 40.0±4.7 years). Parents who chose surgery for subjective symptoms had higher levels of concern about hemorrhage, conjunctival redness, and persistent overcorrection than did those who chose surgery for cosmetic reasons (all p < 0.05). Fathers were more concerned about postoperative pain, compared to mothers (p = 0.039). Parents in their 40s and 50s had higher levels of concern about the hospital environment compared with those in their 20s and 30s (p = 0.003). Concern did not significantly differ by residential area. Conclusions The level of concern regarding surgery differed according to the perspectives and characteristics of the parents of pediatric patients with intermittent exotropia. Parents who chose surgery for subjective symptoms of exotropia had a higher level of concern than did those who chose surgery for cosmetic reasons. The concern level differed according to the parents’ sex and age but not their residential area.

BACKGROUND/OBJECTIVES: Dietary supplements are popular among Korean consumers in the cross-border market. This study examined the cross-border shopping trends of dietary supplements in Korea, focusing on the major health functional foods.MATERIALS/METHODS: This study analyzed the customs clearance data provided by the Korea Customs Service, spanning 2019–2021. The term ‘health functional foods,’ which are manufactured with functional ingredients specified by law, was distinguished from the broader concept of ‘dietary supplements.’ The trends in dietary supplements and the major types of health functional foods in cross-border shopping were analyzed. The top 10 most purchased health functional foods were identified and analyzed by consumer gender and age group. RESULTS: Dietary supplements constituted 19.1% of all cross-border items, with the primary consumers being women aged 30 and 40 yrs. The most popular type of health functional foods was the ‘multi-nutrient product,’ comprising 14.5% of all health functional food items.‘Protein’ was popular among men and younger age groups, while ‘probiotics’ was favored by women. In particular, 32.3% of health functional food items were related to blood health. CONCLUSION The cross-border market for dietary supplements in Korea is experiencing growth, with consumer preferences varying by gender and age. These findings can assist in the development of regulatory policies that align with market trends and consumer needs in cross-border shopping for dietary supplements.

BACKGROUND/OBJECTIVES: This study examined the socio-demographic and dietary characteristics of the elderly in Seoul according to their food insecurity status and analyzed the characteristics associated with food insecurity. SUBJECTS/METHODS: The data from 513 elderly individuals aged 65 or older were analyzed using the raw data from the Seoul Food Survey 2023. The subjects were classified into food-secure or food-insecure groups. The socio-demographic and dietary characteristics of each group were analyzed. Logistic regression analysis was conducted to identify the characteristics associated with food insecurity among the elderly in Seoul. RESULTS: The proportion of the food-insecure group was 56.9% among the total elderly in Seoul. The main reasons for experiencing food insecurity were environmental (38.0%), followed by physical (37.5%) and financial (24.5%). The food-insecure group had a higher frequency of skipping breakfast and eating alone than the food-secure group while having lower dietary literacy and food environment satisfaction. Logistic regression analysis showed that the elderly living alone were approximately four times (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.52–8.51) more likely to suffer food insecurity than those living with others. Higher digital food literacy (OR, 0.63; 95% CI, 0.41–0.97) and food environment satisfaction (OR, 0.38; 95% CI, 0.20–0.74) were associated with a lower likelihood of food insecurity. CONCLUSION These results suggest that policies aimed at improving food security for the elderly in Seoul should prioritize those living alone. Educational programs designed to enhance the ability to purchase online food, use self-service kiosks in restaurants, and use food delivery apps would effectively decrease food insecurity among the elderly in Seoul.Furthermore, policies aimed at improving the food environment may also help reduce food insecurity among this population.