Purpose: This study aimed to evaluate the feasibility, safety, and immunological outcomes of low-dose cow’s milk oral immunotherapy (CM OIT) in school-aged children and adolescents with severe, persistent cow’s milk allergy (CMA), a group typically considered at a high risk for OIT. Methods: We conducted a retrospective study involving 12 patients (median age, 11.4 years) with immunoglobulin E (IgE)-mediated CMA, who underwent individualized low-dose CM OIT in the outpatient setting at a single tertiary hospital. Baseline and longitudinal clinical and immunological data, including casein-specific IgE and immunoglobulin G4 (IgG4) levels, were analyzed. Patients were classified as either desensitized or unsuccessful based on treatment outcomes. Results: Of the 12 patients with severe CMA, 6 achieved desensitization up to the target dose, while the remaining 6 discontinued treatment because of intolerance or poor adherence. The desensitized and unsuccessful groups showed no significant differences in baseline age, OIT starting dose, or serum casein-specific IgE level. Immunological evaluation revealed a significantly greater increase in serum casein-specific IgG4 (0.87 vs. -0.37 mg/L, P = 0.004) and a significantly lower natural log-transformed fold change in the IgE/IgG4 ratio (-1.38 vs. 0.44, P = 0.008) in the desensitized group. None of the patients required epinephrine during OIT, and adverse events were generally mild. Conclusion In selected high-risk pediatric populations with severe CMA, outpatient-based low-dose OIT using individualized flexible protocols may provide a relatively safe approach that improves tolerability and adherence. Increased casein-specific IgG4 levels and a reduced casein-specific IgE/IgG4 ratio may serve as valuable biomarkers for treatment response.

Purpose: Radiotherapy is used to reduce the risk of breast cancer recurrence after surgery, but it is a potential cause of secondary cancer. We validated the risk of secondary cancer in primary breast cancer who received radiotherapy compared with those who did not from a matched cohort using a large-scale observational study of the Observational Health Data Sciences and Informatics (OHDSI) data network. Materials and Methods: A retrospective comparative cohort study using propensity score-matched cohorts was performed using two Observational Medical Outcome Partnership common data model databases, from tertiary general hospitals in South Korea. Among female patients who underwent surgery after the diagnosis of breast cancer, the risk of secondary primary malignant occurrence after 1:1 matching was analyzed. Results: Among 27,078 patients with breast cancer, there was no significant difference in the risk of secondary cancer following radiotherapy in 4,426 patients after 1:1 propensity-score matching. Further, there were no significant differences in the sensitivity analysis according to age, latency period, and number of radiation treatments. Conclusion There was no difference in the risk of secondary cancer in the patients diagnosed with breast cancer depending on whether or not radiotherapy was performed after surgery. In the future, it is necessary to analyze including data generated during cancer treatment.

Autonomic dysfunction is a common but frequently overlooked manifestation of systemic diseases. Because early manifestations are often nonspecific, including dizziness, fatigue, palpitations, exercise intolerance, and gastrointestinal dysmotility, clinicians need a structured approach to support timely recognition and risk stratification.Current concepts: Systemic disorders affect autonomic regulation through overlapping mechanisms, including metabolic injury, microvascular dysfunction, chronic inflammation, and impaired cardiovascular reflex control. In diabetes, autonomic nerve injury accumulates over time, and cardiovascular autonomic neuropathy is associated with increased cardiovascular events and mortality. In chronic kidney disease, persistent sympathetic activation, reduced vagal modulation, and baroreflex impairment contribute to hypertension, intradialytic hypotension, and arrhythmic risk. In heart failure and ischemic heart disease, sympathetic predominance and vagal withdrawal accelerate disease progression and are associated with malignant ventricular arrhythmias and sudden cardiac death. Systemic autoimmune disorders are also associated with impaired cardiovascular reflex control and small-fiber neuropathy.Discussion and conclusion: A practical evaluation begins with symptom screening and review of medications and comorbidities, followed by standardized autonomic testing. Cardiovascular autonomic reflex tests, together with scoring tools such as the composite autonomic scoring scale, help quantify the distribution and severity of autonomic involvement and support longitudinal monitoring. Management should integrate optimal control of the underlying systemic disease, non-pharmacological measures for orthostatic intolerance, and symptom-directed treatment for orthostatic hypotension.

Objective: To explain process of developing basic veterinary clinical performance guidelines, based on frequently observable clinical manifestations, thereby supporting competencybased veterinary education in Korea. Methods: A structured review of learning outcomes established by Korean Association of Veterinary Medical Colleges (KAVMC) was conducted by a planning committee including veterinary educators, practitioners, and advisory members. Owner-oriented descriptions were used to frame each performance task, and each was mapped to corresponding learning outcomes. These tasks were aligned with learning outcomes recommended by the KAVMC to support the development of communication, clinical reasoning, and performance-related competencies among veterinary students, thereby enhancing day-one clinical readiness. Results: In total, 63 clinical manifestations for a guidebook format that can be used for clinical education were identified and categorized by organ systems that are described in language understandable to animal owners. Conclusions and Relevance: The basic veterinary clinical performance guidelines based on common clinical manifestations would serve as a vital component in veterinary education to reinforce core graduation competencies.

Objective: This study aimed to compare aneuploidy rates and clinical outcomes between trophectoderm biopsy at fresh blastocyst (biopsy-fresh) followed by vitrification and biopsy at vitrified-warmed blastocyst (biopsy-vitri) followed by next day transfer (without re-vitrification). Methods: This retrospective study included 844 patients undergoing 844 cycles conducted from August 2019 to December 2023. Preimplantation genetic testing for aneuploidy (PGT-A) was performed via trophectoderm biopsy using array comparative genomic hybridization or next-generation sequencing for comprehensive 24-chromosome screening. Patients were divided into two groups based on the blastocyst status at the time of biopsy: the biopsy-fresh group (531 patients) and the biopsy-vitri group (313 patients). Results: The clinical pregnancy rate was significantly higher in the biopsy-fresh group compared to the biopsy-vitri group (58.7% vs. 45.6%; odds ratio [OR], 1.695; 95% confidence interval [CI], 1.215 to 2.364; p=0.002). Furthermore, the biopsy-fresh group showed higher implantation rates (45.6% vs. 32.1%; OR, 1.767; 95% CI, 1.274 to 2.451; p=0.002), ongoing pregnancy or live birth rates per cycle (48.0% vs. 35.8%; OR, 1.652; 95% CI, 1.177 to 2.319; p=0.004), and rates of good-quality blastocysts (57.1% vs. 32.1%, p<0.001) compared with the biopsy-vitri group. Miscarriage rates did not differ significantly between the groups (18.2% vs. 21.4%; OR, 0.818; 95% CI, 0.457 to 1.465; p=0.501). Conclusion Biopsy at fresh blastocyst demonstrated superior clinical outcomes compared with biopsy at vitrified-warmed blastocyst, likely due to better embryo quality. Both biopsy at fresh blastocyst and vitrified-warmed blastocyst remain viable options for PGT-A, with biopsy at vitrified-warmed blastocyst serving as a practical alternative. Embryo quality and euploid status continue to be critical considerations for embryo transfer selection.

Progressive spastic weakness of the lower limbs is a major feature of hereditary spastic paraplegia (HSP) and primary lateral sclerosis (PLS). The motor band sign (MBS) is characterized by a band-like hypointensity along the precentral gyrus in susceptibility-weighted image of brain magnetic resonance imaging. This sign has been reported in amyotrophic lateral sclerosis and is recognized as an indirect marker of upper motor neuron degeneration. The presence of MBS could serve as a marker for PLS but not for HSP.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic autoimmune disease of the peripheral nervous system, primarily treated with corticosteroids and intravenous immunoglobulin as first-line therapies. Early treatment yields better outcome before nerve damage caused by the immune response. Once axonal damage has progressed, immunotherapy becomes ineffective, making early intervention crucial. Additionally, as treatment responses vary among patients, it is essential to assess treatment efficacy objectively and tailor therapy accordingly. Since there are currently no biomarkers that accurately reflect disease status, regular physical examinations are necessary to evaluate treatment effectiveness and adjust maintenance therapy. This review outlines the current clinical guidelines for the treatment of CIDP and explores emerging therapeutic options, including neonatal Fc receptor inhibitors and complement pathway inhibitors.

Background: Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection. Methods: Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005–July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed. Results: Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/ bronchitis. Patients’ median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/ Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/ M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion). Conclusion In children with LRTI, various factors associated with viral or bacterial/ M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Background: Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection. Methods: Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005–July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed. Results: Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/ bronchitis. Patients’ median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/ Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/ M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion). Conclusion In children with LRTI, various factors associated with viral or bacterial/ M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.