Purpose: We compared short-term clinical outcomes after cataract surgery with implantation of a novel refractive extended depth-of-focus TECNIS PureSee intraocular lens (IOL) between patients with stage 1 epiretinal membrane (ERM)—characterized by a thin membrane over the macula with preserved foveal depression―and those with a normal retina. Methods: This retrospective study included 60 eyes of 60 patients who underwent cataract surgery with implantation of the TECNIS PureSee IOL between January 2024 and January 2025: 30 eyes with stage 1 ERM and 30 eyes with a normal retina. Preoperative characteristics, including age, sex distribution, cataract severity, corrected distance visual acuity (CDVA), and higher-order aberrations, were compared between groups, as were IOL power and target refraction. Postoperative outcomes at 1 month―including CDVA, uncorrected distance, intermediate, and near visual acuity, ocular aberrations, and contrast sensitivity―were evaluated. Results: There were no significant differences in preoperative characteristics, such as age, sex distribution, cataract grade, CDVA, higher-order aberrations, IOL power, or target refraction between the two groups. At 1 month postoperatively, CDVA, uncorrected distance, intermediate, and near visual acuity, higher-order aberrations, and contrast sensitivity exhibited no significant differences between groups. Conclusions In this short-term analysis, the PureSee IOL demonstrated comparable efficacy and safety in cataract patients with stage 1 ERM to those with a normal retina.

Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and nonhospice patients with cancer at the end of life using nationwide data from Korea. Methods: In this retrospective cohort study, we analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. We applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. Results: After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospiceand 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P＜0.001).The proportion of patients receiving broad-spectrum antibiotics was generally lower amonghospice users across all time intervals (P＜0.001), and the number of days of therapy wasalso lower, with the largest differences observed during the final week and last 3 days of life.Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group. Conclusion Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.

The recent approval of trastuzumab deruxtecan for human epidermal growth factor receptor 2 (HER2)–low and HER2-ultralow breast cancer mandates an adequate assessment of these categories. Methods: Seven breast pathologists from the Breast Pathology Study Group of the Korean Society of Pathologists held an on-site expert consensus meeting. Fifteen sets of virtual whole slide images (WSI) of hematoxylin and eosin stain and HER2 immunohistochemistry were provided. The pathologists were given 60 minutes to submit their diagnosis of HER2 expression into null, ultralow, 1+, 2+, or 3+. Afterwards, in-depth discussion and consensus diagnoses were made by real-time visualization of the WSI. Results: After the consensus meeting, unanimous 100% agreements were seen only in five (33.3%) of the examined cases, which consisted of three 1+ cases and two 2+ cases. Two cases (13.3%) had mild disagreement, with only one pathologist’s disagreement. Of note, eight cases (53.3%) showed significant disagreement, defined by more than two pathologists’ disagreement. All HER2-null cases were reclassified as ultralow after consensus review, suggesting potential widespread underclassification of ultralow cases in clinical practice. Conclusions: Experts had significant discrepancies in interpreting HER2-low/ultralow status. It is important to assess if the distinction between HER2-low and ultralow is strictly required and if HER2-null breast cancer exists in reality.

Objective: This study aimed to evaluate the feasibility, safety, and oncologic outcomes of irreversible electroporation (IRE) using a clustered electrode in patients with locally advanced pancreatic cancer (LAPC). Materials and Methods: In this single-center prospective cohort study, 13 patients with LAPC (median age, 60 years; range, 48–78 years) underwent clustered electrode IRE between September 2022 and September 2024. Patient characteristics, procedural details, and clinical outcomes were recorded. Endpoints included technical success, procedure-related complications, overall survival (OS), and progression-free survival (PFS). Results: Tumors were located in the pancreatic head in four patients (30.8%) and in the body/tail in nine (69.2%). The median tumor size was 2.4 cm (1.5–4.0 cm), and vascular invasion was present in all patients. Technical success was achieved in all patients. Intraoperative IRE was performed in 11 (84.6%) patients, and 2 (15.4%) patients underwent percutaneous IRE. Gastrointestinal bleeding events as major complications occurred in two patients (15.4%) and, both were successfully controlled by embolization. No 60-day mortality was observed. At a median follow-up of 24.5 months (range, 9.9–33.4 months) after IRE, median OS and PFS from IRE were 20.1 and 14.5 months, respectively. Conclusion IRE using clustered electrodes for LAPC appears to be a feasible therapeutic approach, offering reliable technical success and acceptable safety. Survival outcomes are encouraging; however, larger, controlled studies are required.

Purpose: Human epidermal growth factor receptor 2 (HER2) is amplified or overexpressed in various malignancies, including breast and gastric cancers, and is associated with poor prognosis. Although HER2-targeted therapies, such as trastuzumab, improve outcomes in HER2-positive tumors, resistance often develops, and HER2-low tumors remain largely untargeted. Trastuzumab deruxtecan (T-DXd; DS-8201a) is a HER2-targeted antibody-drug conjugate with potent activity in HER2-positive and HER2-low tumors. This study evaluates its antitumor mechanisms and efficacy in HER2-positive, HER2-low, and homologous recombination deficiency (HRD)–associated models. Materials and Methods: Effects of T-DXd were assessed in cancer cell lines with diverse HER2 expression and HRD status. In vivo efficacy was evaluated using a xenograft model derived from HER2-low SNU-601 gastric cancer cells. Results: T-DXd reduced HER2 phosphorylation and downstream signaling (AKT, ERK) in HER2-positive cells. It induced DNA damage accumulation, as evidenced by increased γH2AX and p-Chk1 expression, and triggered apoptosis through cleaved poly(ADP-ribose) polymerase and caspase-3 activation, confirmed by annexin V staining. Similar effects were observed in HER2-low cells, with greater sensitivity in HRD cells. In xenografts, T-DXd reduced tumor volume by up to 80% at 4 mg/kg and 10 mg/kg. Histological analyses showed decreased Ki-67 and increased apoptosis. Furthermore, T-DXd induced G2/M cell cycle arrest and nuclear anaplasia, suggesting disruption of chromosomal stability as a potential antitumor mechanism. No significant toxicity, including body weight loss, was observed. Conclusion These findings highlight T-DXd’s effectiveness in HER2-low and HRD tumors, supporting its broader clinical application, including strategies targeting DNA damage repair pathways.

Purpose: Medical artificial intelligence (AI) is rapidly being integrated into clinical practice and healthcare systems, raising concerns regarding safety, accountability, and governance. Despite its increasing importance, empirical comparative studies examining differences in perceptions of medical AI among key expert groups remain limited. This study aimed to compare and analyze perceptions of medical AI among medical and non-medical professionals and to systematically identify commonalities and differences across policy- and governance-relevant domains. Methods: Focus group interviews using open-ended questions were conducted with 30 experts (15 medical and 15 non-medical professionals) who had direct experience with medical AI. Data were analyzed using inductive thematic analysis combined with qualitative comparative analysis. Analytical rigor was strengthened through independent coding and consensus-based discussions. Results: Both groups recognized the potential of medical AI to bring meaningful changes to healthcare systems. However, medical professionals primarily evaluated medical AI in terms of clinical applicability, patient safety, explainability, and accountability. In contrast, non-medical professionals emphasized technological maturity, scalability, data infrastructure, standardization, and system-integration potential. Group-specific patterns also emerged regarding perceived limitations, autonomy, educational priorities, and classification frameworks, particularly in relation to clinical risk management versus system-level design and governance considerations. Conclusion: Differences in perceptions of medical AI are systematically associated with distinct interpretive frames shaped by professional roles and responsibility structures. Effective implementation and policy design for medical AI therefore require an integrated approach that accounts for these structural differences. This study provides empirical evidence and a conceptual foundation for future quantitative and mixed-methods research on medical AI governance.

Background: Opioids remain widely used for postoperative pain control after total knee arthroplasty (TKA); however, concerns about adverse effects and dependency drive interest in opioid-sparing alternatives. This study evaluated the efficacy and safety of opioid-sparing patient-controlled analgesia (PCA) after TKA. Methods: In this prospective, randomized, double-blind, non-inferiority study, 98 patients undergoing TKA under spinal anesthesia received either opioid-based PCA (continuous infusion of 1200 μg fentanyl, n = 49) or opioid-sparing PCA (continuous infusion of 150 mg ketorolac tromethamine and 100 mg nefopam hydrochloride, n = 49). Both groups received patient-controlled boluses of 300 μg fentanyl. The primary endpoint was the visual analog scale (VAS) pain score at rest on postoperative day (POD) 1, assessed using a 1.5-point non-inferiority margin. Secondary endpoints included additional analgesics, mobility, postoperative pain at rest and during ambulation, and adverse effects on PODs 1 and 2. Results: The mean VAS score at rest on POD 1 was 5.45 ± 2.48 in the opioid-based PCA group and 5.90 ± 2.31 in the opioid-sparing PCA group. The mean difference was 0.45 points (95% CI, −0.36 to 1.25), within the prespecified non-inferiority margin. Pain scores at each time point were non-inferior in the opioid-sparing group, whereas rescue analgesic requirements were significantly reduced on POD 2 (P = 0.006). Nausea and vomiting on POD 1 were more frequent with opioid-based group (34.7% vs. 12.2%, P = 0.009). Conclusions Opioid-sparing PCA with ketorolac and nefopam provides non-inferior analgesia to opioid-based PCA, while reducing opioid consumption and drug-related adverse effects after TKA.

Background/Aims: Although metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) represent the updated nomenclature and diagnostic criteria for nonalcoholic fatty liver disease, studies comparing the prognostic implications of these conditions remain limited. This meta-analysis aimed to quantify the associations among MAFLD, MASLD, and long-term clinical outcomes. Methods: A comprehensive literature search was performed to identify cohort studies that assessed the association of MASLD and MAFLD with all-cause mortality, cause-specific (cardiovascular and cancer-related) mortality, and the incidence of cardiovascular disease in the PubMed, Embase, Web of Science, CINAHL, and CENTRAL databases from inception through October 31, 2024. Pooled hazard ratios (HRs) were calculated for relevant outcomes. Results: We identified 18 cohort studies, comprising 10,653,666 patients with MAFLD from 13 studies and 3,202,447 patients with MASLD from nine studies. MAFLD was significantly associated with an increased risk of overall mortality (pooled HR [95% confidence interval], 1.30 [1.16 to 1.47]) and cardiovascular mortality (1.31 [1.08 to 1.60]; both p<0.01), but not with cancer-related mortality (1.10 [0.97 to 1.24]; p=0.130). Conversely, MASLD was associated with a higher risk for all mortality outcomes: overall mortality (1.34 [1.12 to 1.61]), cardiovascular mortality (1.17 [1.07 to 1.27]), and cancer-related mortality (1.24 [1.19 to 1.29]; all p<0.01). The risk of cardiovascular disease was increased in patients with both MAFLD (1.48 [1.31 to 1.66]) and MASLD (1.33 [1.21 to 1.46]; both p<0.001). Conclusions MAFLD and MASLD were both associated with increased risks of mortality and cardiovascular outcomes. Notably, a significant association with cancer-related mortality was observed for MASLD, but not for MAFLD.

Extraskeletal Ewing sarcoma (EES) is a rare, malignant small round-cell tumor, and involvement of the spinal epidural space is unusual. Here, we report a case of spinal epidural EES in a 46-year-old man who presented with back pain. Magnetic resonance imaging revealed a dumbbell-shaped right paravertebral mass extending through the ipsilateral neural foramen, with focal bone marrow infiltration. After surgical resection and adjuvant chemoradiotherapy, progressive bone marrow involvement and vertebral metastasis were observed on follow-up imaging. This case highlights the diagnostic challenges of epidural EES and underscores the importance of recognizing bone marrow involvement, which is rare in EES.

The adhesion of arteries to aneurysm domes can pose significant technical challenges during surgical clipping. Dissection of these vessels carries a risk of iatrogenic wall damage and subsequent complications. We present the case of a 67-year-old woman with three unruptured intracranial aneurysms. Following successful coil embolization of a right posterior communicating artery aneurysm, surgical clipping was planned for the remaining left middle cerebral artery and anterior choroidal artery aneurysms. Intraoperatively, the M2 inferior division was found to be densely adherent to an aneurysm located at the bifurcation of the M2 superior division. After temporary clipping of the parent artery, careful dissection was performed, and the aneurysm was successfully clipped. Postoperatively, the patient failed to regain consciousness. A computed tomography scan revealed diffuse subarachnoid hemorrhage, and subsequent angiography confirmed active contrast extravasation from the dissected M2 inferior division. The family declined reoperation, and the patient subsequently expired after brain death was declared. This case illustrates that in instances of strong arterial adhesion, extreme caution is warranted during dissection. Even without evident intraoperative bleeding, subtle vessel wall injury can lead to fatal delayed rupture. Meticulous inspection and, when necessary, reinforcement of dissected arterial segments is crucial to prevent such devastating outcomes.