A unified consensus statement on medication-related osteonecrosis of the jaw (MRONJ) has not yet been established among the Asian member countries or regions of the Asian Federation of Osteoporosis Societies (AFOS). This study aimed to develop a consensus on MRONJ in patients with osteoporosis across these countries and regions. In this study, the term “Asia-Pacific” refers specifically to the Asian member countries and regions of AFOS. A structured survey consisting of nine MRONJ-related questions was distributed across 10 countries and regions to assess the level of agreement and summarize regional perspectives. In addition, a manual literature review and voting were conducted to evaluate the current evidence on MRONJ. The key aspects of MRONJ, including definition, staging, diagnosis, pathogenesis, risk factors, management, and prevention, were generally consistent among the AFOS countries and regions. The annual incidence and incidence rate of MRONJ associated with low-dose antiresorptive therapy in patients with osteoporosis ranged from 0.025% to 0.136% and 21 to 283 cases per 100,000 person-years, respectively. However, evidence regarding the benefits of drug discontinuation before dental surgery, such as tooth extraction, remains insufficient. Large-scale, multinational studies across AFOS countries and regions are warranted to determine the incidence of MRONJ better and evaluate the impact of antiresorptive drug discontinuation before dental procedures. These findings may contribute to the devel opment of effective evidence-based strategies for preventing MRONJ in patients with osteoporosis.

Dilated cardiomyopathy is the most common form of cardiomyopathy in children and often leads to irreversible myocardial dysfunction. To improve the prognosis, it is critical to identify rare but reversible causes. We report a 12-year-old girl referred to the emergency department for dyspnea on exertion and generalized edema that lasted for 1 month. She gained 20 kg over the past 3 years, which had gone uninvestigated. Transthoracic echocardiography demonstrated left ventricular dysfunction with pericardial effusion. Thyroid function tests revealed concentrations of free T4 and thyroid-stimulating hormone of 0.12 ng/dL (reference value, 0.93-1.7) and 86.9 µIU/mL (0.3-4.2), respectively, with anti-thyroid peroxidase and anti-thyroglobulin antibodies elevated, confirming the presence of autoimmune hypothyroidism. We initiated heart failure management alongside levothyroxine replacement therapy. After 5 months of treatment, a follow-up echocardiography showed improved left ventricular and thyroid function.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Purpose: This study explored the experiences of physicians and nurses providing end-oflife care in Korean acute care hospitals. It aimed to identify the challenges faced in caring for dying patients and to suggest strategies for improving hospital-based end-of-life care. Methods: A qualitative exploratory design was employed using focus group interviews.Eleven healthcare professionals (five physicians and six nurses) working in tertiary or general hospitals participated in the study between July and August 2018. The interviews were conducted using a semi-structured guide covering seven thematic areas. All sessions were audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Results: Six major themes emerged: (1) communication with patients and families, (2) physical care for dying patients, (3) psychological and spiritual support, (4) hospital environment and system constraints, (5) moral distress and emotional burden on healthcare providers, and (6) suggestions for improvement. The participants described difficulties in open communication, limited resources for comfort care, emotional strain from invasive treatment at the end of life, and the absence of standardized institutional protocols.They emphasized the need for structured communication training, multidisciplinary collaboration, and integration of palliative care principles into acute care practice. Conclusion Physicians and nurses play a pivotal yet emotionally demanding role in providing end-oflife care in acute hospitals. Institutional reforms, including education, protocol development, and supportive environments, are essential to ensuring dignified, patient-centered care and sustain healthcare providers in their professional roles.

Purpose: To introduce subepithelial pterygium pedicle (SPP) and to investigate the effect of SPP length on the anterior corneal curvature including keratometry and aberrations. Methods: In this single-center retrospective cohort, 72 eyes of 72 patients with primary nasal pterygium were analyzed using anterior segment (AS) swept-source optical coherence tomography (SS-OCT; Anterion). We evaluated SPP length, horizontal invasion length (HIL), and corneal profiles including keratometry, root mean square values for lower- and higher-order aberrations, and first- to fourth-order wavefront aberrations. Correlations between SPP length and these parameters were assessed after adjusting for HIL. The SPP cutoff for significant anterior horizontal tilt deterioration was determined using receiver operating characteristic (ROC) analysis and validated by analysis of covariance controlling for HIL. Results: SPP was detected in 57 of 72 eyes (79.2%), with a mean length of 842.3 ± 408.1 μm. A significant positive correlation was found between SPP length and HIL (r = 0.376, p = 0.001). After adjusting for HIL, SPP length remained significantly associated with anterior corneal horizontal tilt (p = 0.026), whereas no significant correlations were observed with other refractive or aberration parameters. ROC curve analysis identified an SPP length of approximately 850 μm as the threshold for predicting anterior horizontal tilt ≥3.65 μm. Consequently, this cutoff significantly differentiated subgroups after adjusting for HIL, showing a marked increase in horizontal tilt in eyes with SPP ≥850 μm (p = 0.016), indicating mechanical distortion. Conclusions SPP length, a subepithelial microstructural parameter visualized by AS SS-OCT, independently correlates with anterior horizontal tilt after adjustment for HIL. This finding suggests that SPP length serves as a microstructural indicator of horizontal mechanical corneal distortion in eyes with pterygium.

Purpose: To characterize perioperative changes in posterior corneal curvature (PCC) following pterygium excision using anterior segment (AS) swept-source optical coherence tomography (SS-OCT), and to identify the critical threshold of horizontal invasion length (HIL) predicting significant PCC alterations. Methods: This retrospective cohort study included 85 eyes of 77 patients with primary nasal pterygium. PCC parameters, including posterior keratometry (K) average, posterior steep K, posterior flat K and posterior corneal astigmatism, were measured preoperatively and postoperatively using AS SS-OCT (Anterion). Perioperative PCC changes were analyzed in relation to HIL and postoperative duration. Subgroup analyses were performed to identify the HIL cutoff value associated with statistically significant changes in posterior K average. Results: Significant postoperative flattening was observed in both posterior K average (from –6.27 ± 0.24 to –6.23 ± 0.23 diopters [D], p < 0.001) and posterior flat K (from –6.14 ± 0.23 to –6.09 ± 0.23 D, p < 0.001), accompanied by a significant increase in posterior corneal astigmatism (from –0.25 ± 0.12 to –0.29 ± 0.17 D, p = 0.003). The magnitude of posterior flattening showed a significant positive correlation with HIL (r = 0.384, p < 0.001) but was not correlated with postoperative duration (p = 0.428). In subgroup analysis, eyes with HIL ≥3.5 mm exhibited a significant change in posterior K average (p < 0.001), whereas those with HIL <3.0 mm and HIL <3.5 mm showed no significant change (p = 0.065 and p = 0.443, respectively). Conclusions Pterygium excision leads to significant posterior corneal flattening proportional to HIL, with 3.5 mm identified as a clinically relevant cutoff. Although the refractive impact may be subtle, surgeons should be aware of these posterior corneal changes as a consistent morphological response, especially in eyes with HIL ≥3.5 mm.

Purpose: To determine the corneal stabilization timeline after pterygium excision adjusted for horizontal invasion length (HIL). Methods: In this single-center retrospective cohort study, we analyzed 88 eyes of 80 patients with nasal or temporal primary pterygium who underwent excision and perioperative evaluation with anterior segment (AS) swept-source optical coherence tomography (SS-OCT; Anterion). Anterior simulated mean keratometry (SimKmean; 3-mm ring) and HIL were measured on AS SS-OCT. Keratometric stabilization was assessed at postoperative cutoffs of 8, 12, 16, 20, and 24 weeks using analysis of covariance (ANCOVA) with HIL as a covariate. Subgroup analysis was performed after stratifying by the median HIL (3.82 mm). Results: Mean anterior SimKmean increased from 42.95 ± 1.79 diopters (D) preoperatively to 43.73 ± 1.53 D postoperatively (p < 0.001). Preoperative HIL correlated positively with the perioperative SimKmean change (r = 0.728, p < 0.001). While postoperative duration showed no significant unadjusted correlation with keratometric change (r = −0.133, p = 0.218), partial correlation controlling for HIL was negative (r = −0.248, p = 0.021), indicating diminishing change over time after severity adjustment. ANCOVA demonstrated significant stabilization at 16 weeks (p = 0.036). In the HIL ≥3.82 mm subgroup, SimKmean change was greater before 20 weeks than after 20 weeks (1.73 ± 1.59 D vs. 0.59 ± 0.74 D, p = 0.030), whereas no significant time-point differences were found for HIL <3.82 mm. Conclusions Corneal keratometric stabilization after pterygium excision depends on preoperative HIL. A minimum of 16 weeks is recommended before cataract surgery planning, with at least 20 weeks for eyes with HIL ≥3.82 mm.

Purpose: This study aims to determine whether the translucency-based clinical grade of pterygium shows independent relationships with anterior and posterior corneal curvature and anterior wavefront aberrations, with adjustment for horizontal invasion length (HIL) measured by anterior segment (AS) swept-source optical coherence tomography (SS-OCT). Methods: This study involved 53 eyes from 51 patients diagnosed with primary nasal pterygium. The clinical grade of the pterygium was evaluated using T grade based on the fibrovascular translucency. AS SS-OCT (Anterion, Heidelberg Engineering) provided HIL (in millimeters), thickness (in micrometers), anterior/posterior keratometry at the 3.0-mm ring, and anterior corneal wavefront metrics within a 6.0-mm zone. The device was also used to evaluate the magnitudes for the individual first-to fourth-order aberrations of the anterior corneal fields. Also, the fourth- to seventh-order root mean square (RMS), RMS lower-order aberration (LoA), and RMS higher-order aberration (HoA) values were collected. For statistical analysis, Spearman rank correlation test and Pearson correlation test were performed, along with partial correlation test adjusted for HIL. Results: The mean age of subjects was 59.3 ± 11.4 years, and 51.0% were female. T grade correlated positively with HIL. HIL showed strong associations with anterior simulated keratometry (Sim K) average, anterior Sim K steep, anterior Sim K flat, and anterior corneal astigmatism—but not with posterior corneal parameters. HIL also showed significant correlations with multiple anterior corneal wavefront parameters. After adjustment for HIL, T grade remained independently correlated with anterior Sim K flat, RMS LoA, and defocus; no significant relationships were observed with other Zernike terms or posterior metrics. Additionally, T grade was positively correlated with pterygium thickness. Conclusions T grade adds independent, complementary information (associations with flat keratometry, LoA RMS, and defocus) even after controlling for HIL. Incorporating T grade into preoperative assessment may improve estimation of optical burden and surgical prognosis.

Purpose: While progesterone receptor (PR) negativity in luminal-type breast cancer is generally associated with worse oncologic outcomes, its prognostic role in estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-positive breast cancer remains underexplored. This study aimed to evaluate the prognostic significance of PR expression in ER-positive, HER2-positive breast cancer. Methods: A retrospective analysis was conducted on patients diagnosed with ER-positive, HER2-positive breast cancer who underwent primary surgery at Korea University Guro Hospital between January 2009 and December 2019. Patients were grouped by PR expression as negative/low (Allred score, 0–6) or strongly positive (Allred score,7 or 8). Prognostic outcomes, including disease-free survival (DFS), distant recurrence-free survival (DRFS), and breast cancer-specific survival (BCSS) were analyzed. Results: A total of 223 patients were included. Patients in the negative/low PR group were older compared to the strongly positive PR group. The negative/low PR group showed significantly worse DFS (P = 0.005) and DRFS (P = 0.014) but showed no significant difference in BCSS (P = 0.153). On multivariate analysis, negative or low PR expressions were linked to inferior DFS (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.34–7.16; P = 0.008) and DRFS (HR, 9.55; 95% CI, 1.22– 74.77; P = 0.032). Conclusion In ER-positive, HER2-positive breast cancer, negative or weak PR expression was associated with inferior DFS and DRFS compared to strong PR expression. These findings highlight the potential prognostic value of PR status in this group, underscoring its relevance in guiding treatment and follow-up strategies for more individualized patient care.

Skeletal muscle atrophy is a major complication associated with aging, chronic disease, and chemotherapy. Doxorubicin (Dox), a widely used anticancer agent, accelerates muscle wasting; however, the underlying cellular mechanisms remain poorly understood. In this study, we examined the effects of Dox on myogenic differentiation, senescence, and lipid metabolism using C2C12 myoblasts. Dox exposure impaired myotube formation without causing overt cytotoxicity. Mechanistically, Dox disrupted myogenic differentiation by inhibiting protein kinase B/mammalian target of rapamycin (AKT/mTOR) signaling, thereby de-repressing forkhead box O1/3 (FOXO1/3) and upregulating the muscle-specific ubiquitin ligases muscle atrophy F-box (MAFbx) and muscle RING finger 1 (MuRF1), which promote proteolysis. Dox also decreased glycogen synthase kinase 3β (GSK3β) phosphorylation while paradoxically increasing total and phosphorylated β-catenin, indicating dysregulated Wnt/β-catenin signaling. These alterations were accompanied by a senescence-like phenotype, characterized by elevated senescence-associated β-galactosidase (SA-β-gal) activity, increased phosphorylated histone variant γH2AX, and activation of the p53–p21 axis. Notably, cellular senescence coincided with excessive lipid accumulation in myotubes. Dox reduced phosphorylation of adenosine monophosphate-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) while enhancing expression of key lipogenic regulators, thereby creating a metabolic environment favoring lipid storage. Collectively, these findings demonstrate that Dox not only suppresses myogenic differentiation but also induces premature senescence and metabolic reprogramming toward lipid accumulation. Targeting these pathways through AMPK activation, FOXO inhibition, or senolytic interventions may offer therapeutic strategies to preserve skeletal muscle integrity in patients undergoing chemotherapy.