Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background/Aims: Fexuprazan, a novel potassium-competitive acid blocker, was developed for treating acid-related disorders. Pharmacokinetic and pharmacodynamic properties of fexuprazan, unlike those of proton pump inhibitors, are independent of food effect. This study aims to evaluate differences in efficacy and safety of fexuprazan in patients with erosive esophagitis (EE) according to the timing of dosing. Methods: In this multicenter, open-label noninferiority study, patients who had typical reflux symptoms with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg daily 30 minutes before or after meal. Treatment was completed after 2 weeks or 4 weeks when healing was endoscopically confirmed. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy up to week 4. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In the prior-to-meal group (n = 89) and after-meal group (n = 86), 4-week EE healing rates were 98.77% and 100.00% (difference, 0.01%; 95% CI, –0.01% to 0.04%) and 2-week EE healing rates were 95.77% and 97.14% (difference, 0.01%; 95% CI, –0.05% to 0.07%), respectively. TEAEs were 9.78% and 8.70% in the prior-to-meal group and the after-meal group, respectively. Conclusions Non-inferiority analysis revealed that taking fexuprazan after meal was non-inferior to taking fexuprazan before meals in patients with EE. The frequency of adverse events was similar between the 2 study groups. The drug is safe and effective for healing EE regardless of the timing of dosing.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder characterized by the presence of eosinophilic nuclear inclusions in neurons and somatic cells. It clinically manifests as cognitive decline, seizures, and autonomic dysfunction. A 44-year-old man presented with a transient visual field defect and hemiparesis. Based on characteristic imaging findings and pathological findings, NIID was suspected and diagnosed through genetic testing. This case emphasizes the importance of comprehensive clinical phenotype analysis and accurate genetic diagnosis.

Purpose: This study evaluated the therapeutic efficacy of intravitreal methotrexate (MTX) injections in patients diagnosed with intraocular lymphoma via vitrectomy and immunocytochemical staining. Methods: In a retrospective analysis of medical records, we reviewed data from four patients (six eyes) diagnosed with intraocular lymphoma cytologically after undergoing vitrectomy at our hospital between December 2021 and December 2023. Each case was followed for a minimum of 6 months after treatment, with comparisons made between pre- and post-treatment observations Results: The mean age of the patients was 63.5 ± 9.8 years, with an average interval of 29.3 ± 32.0 months from initial symptom onset to intraocular lymphoma diagnosis. Diagnosis was confirmed through cytological and immunocytochemical analysis of vitreous specimens, identifying diffuse large B-cell lymphoma in four eyes and atypical lymphoid cells in two eyes. On average, 14.0 ± 1.7 intravitreal MTX injections were administered per eye. The mean best-corrected visual acuity improved from 1.18 ± 0.90 pre-treatment to 0.37 ± 0.70 post-treatment. Ophthalmic complications included toxic keratopathy in three eyes and retinal hemorrhage in one eye. Additionally, nasal cavity lymphoma was diagnosed in two patients. Conclusions Diagnostic vitrectomy combined with cytology and immunocytochemical staining is essential for the early diagnosis of intraocular lymphoma and differentiation from inflammatory diseases, such as uveitis. Intravitreal MTX injections can induce clinical remission in intraocular lymphoma cases.

Background: Human herpesvirus 6 (HHV-6) encephalitis is a rare but serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study investigated the incidence, clinical features, and long-term neurological sequelae of HHV-6 encephalitis in pediatric and adolescent HSCT recipients. Methods: We retrospectively reviewed 92 patients who were younger than 20 years of age at the time of undergoing allogeneic HSCT between January 2015 and December 2024. HHV-6 encephalitis was diagnosed based on neurological symptoms and the detection of HHV-6 DNA in cerebrospinal fluid using multiplex polymerase chain reaction. Patients with HHV-6 encephalitis were followed for a median of six years (range, 4.5-8.5 years) to assess long-term neurological outcomes. Results: Three patients (3.2%) developed HHV-6 encephalitis between 15 and 26 days post-transplantation, coinciding with neutrophil engraftment. Clinical presentation included fever, seizures, altered consciousness, and short-term memory loss.Neuroimaging revealed high signal intensity lesions in the limbic system. Despite prompt antiviral therapy with foscarnet and initial viral clearance, all patients developed significant long-term neurological sequelae, including persistent cognitive impairment, epilepsy (two with refractory seizures), and memory disturbances. One patient continues to require assistance with activities of daily living, while two others face challenges reintegrating into school and society. Conclusion HHV-6 encephalitis following allogeneic HSCT in pediatric and adolescent patients can lead to severe and lasting neurological impairment, despite timely antiviral therapy. These long-term sequelae substantially affect quality of life and impose ongoing healthcare and societal burdens. Multidisciplinary long-term care is essential, and further research is warranted to improve prevention and treatment strategies.

Background: Varus malalignment is a risk factor for nonunion and mechanical complications in subtrochanteric femoral fractures (SFFs). Although various reduction techniques have been reported to avoid varus malalignment in SFFs, achieving anatomic reduction remains challenging, often resulting in residual varus alignment (RVA) after reduction. This study aimed to investigate the radiographic and clinical outcomes of a novel method resolving RVA by abducting the ipsilateral hip after cephalomedullary fixation with an intramedullary nail and subsequently inserting distal interlocking screws. Methods: This retrospective study, conducted between March 2016 and March 2022, included patients who underwent hip abduction during intramedullary nailing due to RVA. Demographics and fracture patterns (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA]) and types (typical or atypical) were analyzed. Radiographic outcomes included Baumgaertner reduction quality criteria (BRQC), tip-apex distance (TAD), neck-shaft angle (NSA), lateral cortex residual gap, union, and time to union. Clinical outcomes included ambulatory level using the Palmer-Parker Mobility Score (PPM), complications, and reoperation. Results: This study included 45 patients (mean age, 65.8 years; mean follow-up period, 18.4 months). The most common fracture pattern was 32A2 in 15 patients and 29 were typical and 16 were atypical fractures. The BRQC was good in 36 patients, and TAD was < 25 mm in 43 patients. Pre-abduction NSA (126.0° ± 3.8°) was significantly smaller than post-abduction NSA (129.9° ± 3.4°, p < 0.001). Post-abduction NSA was comparable to contralateral NSA of 128.9° ± 2.8° (p = 0.155). Residual gap was significantly reduced from 6.1 ± 2.9 mm pre-abduction to 1.7 ± 1.0 mm post-abduction (p < 0.001). Union was achieved in 44 patients (97.8%;mean duration, 5.9 months). PPM decreased from 7.8 ± 2.0 pre-injury to 7.0 ± 2.1 1-year postoperatively. One nonunion case required reoperation. Radiographic outcomes did not significantly differ by fracture pattern (p = 0.470 for NSA and p = 0.334 for residual gap). Conclusions Hip abduction during intramedullary nailing corrects alignment and reduces the gap in SFFs with residual varus alignment. This method can be applied to various fracture patterns in a straightforward manner and considered valuable for managing SFFs.

Allogeneic stem cell transplantation (allo-SCT) is a salvage treatment option for patients with relapsed or refractory lymphoid malignancies. However, the clinical variables impacting outcomes in these patients remain unclear. We analyzed 58 patients who underwent allo-SCT for lymphoid malignancies, including B-cell lymphoma (BCL, n = 20), Hodgkin’s disease (n = 3), multiple myeloma (n = 9), natural killer/T-cell lymphoma (NK/TCL, n = 4), and TCL (n = 22).The median progression-free survival (PFS) was 27.4 months, while the median overall survival (OS) was 30.6 months.In univariate analysis, human leukocyte antigen (HLA) matching and complete remission status post-transplantation were associated with improved PFS and OS. However, only post-transplant response remained significant for both sur‑ vival outcomes in the multivariate analysis. Moreover, HLA matching was associated with a significantly improved PFS in patients with BCL and NK/TCL, but with better OS only in those with BCL. Complete remission after transplantation was associated with better PFS and OS in patients with BCL, NK/TCL, and TCL. Our results indicate that post-transplant response is an important prognostic indicator in allo-SCT for lymphoid malignancies and may guide clinical decisions and additional treatment.

We report a case of complete remission in anaplastic oligodendroglioma following adoptive cell therapy (ACT) with autologous Wilms tumor 1 (WT-1)-specific CD8+ T cells. A 40-year-old woman referred to our hospital for adjuvant chemotherapy after recurrent anaplastic oligodendroglioma initially presented with a left frontal tumor, diagnosed through seizure onset, and subtotal resection confirmed oligodendroglioma (WHO grade 2). Radiation therapy treated the residual tumor, achieving partial remission until recurrence 2.5 years later when malignant transformation to anaplastic oligodendroglioma (WHO grade 3) occurred following a second craniotomy. After three cycles of procarbazine, lomustine, and vincristine chemotherapy, the residual tumor stabilized for 3 years. However, follow-up MRI identified a new enhancing lesion, prompting a third craniotomy. Recurrent anaplastic oligodendroglioma was confirmed, and adjuvant proton beam therapy and temozolomide chemotherapy were initiated. Two years later, another enhancing lesion appeared on the adjacent medial frontal lobe. Following multidisciplinary review, we introduced WT-1-specific ACT. Although transient swelling was observed 1 month post-therapy, the tumor demonstrated a response within 3–9 months. Continued regression led to complete remission—confirmed via MRI at the 15-month follow-up and sustained for 4.7 years. The patient’s peripheral blood monocyte profiles and immune-associated cytokine analysis indicated T-cell activation following WT-1 sensitization.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.