Papillary adenocarcinoma is a histological type of gastric adenocarcinoma with a very low incidence; therefore, little research has been conducted into this tumor type and no clear treatment guidelines have been developed. Papillary adenocarcinoma is classified as a differentiated-type gastric cancer, according to the Japanese guidelines, but is known to have a high risk of lymph node metastasis. Although the use of endoscopic submucosal dissection in the treatment of early gastric cancer is gradually expanding, its application in patients with papillary early gastric cancer remains controversial. This study helps to identify appropriate indications for endoscopic submucosal dissection in patients with papillary early gastric cancer.

Background/Aims: The kidneys and retina are highly vascularized organs that frequently exhibit shared pathologies, with nephropathy often associated with retinopathy. Previous studies have successfully predicted estimated glomerular filtration rates (eGFRs) using fundus photographs. We evaluated the performance of the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas in eGFR prediction. Methods: We enrolled patients with fundus photographs and corresponding creatinine measurements taken on the same date. One photograph per eye was randomly selected, resulting in a final dataset of 45,108 patients (88,260 photographs). Data including sex, age, and blood creatinine levels were collected for eGFR calculation using the MDRD and CKD-EPI formulas. EfficientNet B3 models were used to predict each parameter. Results: Deep neural network models accurately predicted age and sex using fundus photographs. Sex was identified as a confounding variable in creatinine prediction. The MDRD formula was more susceptible to this confounding effect than the CKD-EPI formula. Notably, the CKD-EPI formula demonstrated superior performance compared to the MDRD formula (area under the curve 0.864 vs. 0.802). Conclusions Fundus photographs are a valuable tool for screening renal function using deep neural network models, demonstrating the role of noninvasive imaging in medical diagnostics. However, these models are susceptible to the influence of sex, a potential confounding factor. The CKD-EPI formula, less susceptible to sex bias, is recommended to obtain more reliable results.

Schwann cells are the most abundant cells in the peripheral nervous system, maintaining the development, function and regeneration of peripheral nerves. Defects in these Schwann cells injury response potentially contribute to the pathogenesis of diabetic peripheral neuropathy (DPN), a common complication of diabetes mellitus. The protein p66shc is essential in regulating oxidative stress responses, autophagy induction and cell survival, and is also vital in the development of DPN. In this study, we hypothesized that p66shc mediates high glucose-induced oxidative stress and autophagic dysfunction. In Schwann cells treated with high glucose; p66shc expression, levels of reactive oxygen species, autophagy impairment, and early apoptosis were elevated. Inhibition of p66shc gene expression by siRNA reversed high glucose-induced oxidative stress, autophagy impairment, and early apoptosis. We also demonstrated that the levels of p66shc was increased, while autophagy-related proteins p62 and LC3 (LC3-II/I) were suppressed in the sciatic nerve of streptozotocin-induced diabetes mice. P66shc-deficient mice exhibited the improvement in autophagy impairment after diabetes onset. Our findings suggest that the p66 plays a crucial role in Schwann cell dysfunction, identifying its potential as a therapeutic target.

The role of acetylated apurinic/apyrimidinic endonuclease 1/redox factor 1 (APE1/Ref-1) in ovarian cancer remains poorly understood. Therefore, this study aimed to investigate the combined effect of recombinant human APE1/Ref-1 (rhAPE1/Ref-1) and aspirin (ASA) on two ovarian cancer cells, PEO-14, and CAOV3.The viability and apoptosis of ovarian cancer cells treated with rhAPE1/Ref-1 or ASA were assessed. Our results demonstrated that ASA induced rhAPE1/Ref-1 acetylation and widespread hyperacetylation in PEO-14 cells. Additionally, co-treatment with rhAPE1/Ref-1 and ASA substantially reduced cell viability and induced PEO-14 cell apoptosis, not CAOV3, in a dose-dependent manner. ASA increased the expression and membrane localization of the receptor for advanced glycation endproducts (RAGEs). Acetylated APE1/Ref-1 showed enhanced binding to RAGEs. In contrast, RAGE knockdown reduced cell death and poly(ADP-ribose) polymerase cleavage caused by rhAPE1/Ref-1 and ASA combination treatment, highlighting the importance of the APE1/Ref-1-RAGE interaction in triggering apoptosis. Moreover, combination treatment with rhAPE1/Ref-1 and ASA effectively induced apoptosis in 3D spheroid cultures of PEO-14 cells, a model that better mimics the tumor microenvironment. These results demonstrate that acetylated APE1/Ref-1 and its interaction with RAGE is a potential therapeutic target for ovarian cancer. Thus, the combination of ASA and APE1/Ref-1 may offer a promising new strategy for inducing cancer cell death.

Anaplastic thyroid carcinoma (ATC) is a rare and highly aggressive malignancy typically associated with dismal outcomes. Most patients present with advanced disease, often precluding curative resection. We report a case of intrathyroidal ATC incidentally identified in a 72-year-old male who underwent diagnostic lobectomy for a low-suspicion, predominantly cystic huge thyroid nodule. Final pathology revealed a completely resected, intrathyroidal ATC without extrathyroidal extension. Postoperative imaging showed no evidence of residual or metastatic disease. Based on multidisciplinary discussion, the patient underwent completion thyroidectomy and central neck dissection without adjuvant therapy. No residual malignancy was identified, and the patient remains recurrence-free at six months. This case highlights that early-stage intrathyroidal ATC may present without overt malignant features and can be curatively treated with complete surgical excision. Careful evaluation and multidisciplinary decision-making are essential in managing rapidly enlarging thyroid nodules with atypical features.

Purpose: This study analyzed the career paths of medical school graduates in the Daejeon, Sejong, and Chungcheongnam-do (DSC) region of South Korea, focusing on career choice factors at each career path. The ultimate goal was to derive practical insights to improve career guidance in the medical field and enhance professionalism. Methods: Data were collected through in-depth interviews with 10 medical school graduates working in the DSC region. A semi-structured questionnaire was used to explore their career paths, and factors influencing their career decisions. The collected qualitative data were analyzed using the constant comparative method to identify themes and categories. Results: The study results categorized career stages into three phases: “entering medical school,” “choosing a specialty after graduation,” and “choosing a workplace after training.” Career choice factors were classified into “personal factors,” “social factors,” and “job and work environment factors.” The factors influencing career choices differed across each career path. Conclusion This study holds significance in its in-depth analysis of career choice factors across different career paths from a long-term perspective. The findings suggest that effective support for career decision-making in the medical field requires a tailored approach that considers the distinct needs and influencing factors at each career path.

In frontal sinus surgery, stenosis of the frontal sinus opening after surgery remains a challenge for many surgeons. Different surgical approaches such as Lynch procedure, Draf type II, and extended modified Lothrop procedure may decrease adverse surgical results but also accompany inherent complications. The use of various kinds of stents have been also suggested to prolong the patency of the frontal sinus opening. However, no definite consensus has been reached about frontal stents use. Here we introduce the experience of using a new omega shaped silicon stent, which has shown promising results in keeping the frontal sinus opening patent.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.

Papillary adenocarcinoma is a histological type of gastric adenocarcinoma with a very low incidence; therefore, little research has been conducted into this tumor type and no clear treatment guidelines have been developed. Papillary adenocarcinoma is classified as a differentiated-type gastric cancer, according to the Japanese guidelines, but is known to have a high risk of lymph node metastasis. Although the use of endoscopic submucosal dissection in the treatment of early gastric cancer is gradually expanding, its application in patients with papillary early gastric cancer remains controversial. This study helps to identify appropriate indications for endoscopic submucosal dissection in patients with papillary early gastric cancer.

Background/Aims: The kidneys and retina are highly vascularized organs that frequently exhibit shared pathologies, with nephropathy often associated with retinopathy. Previous studies have successfully predicted estimated glomerular filtration rates (eGFRs) using fundus photographs. We evaluated the performance of the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas in eGFR prediction. Methods: We enrolled patients with fundus photographs and corresponding creatinine measurements taken on the same date. One photograph per eye was randomly selected, resulting in a final dataset of 45,108 patients (88,260 photographs). Data including sex, age, and blood creatinine levels were collected for eGFR calculation using the MDRD and CKD-EPI formulas. EfficientNet B3 models were used to predict each parameter. Results: Deep neural network models accurately predicted age and sex using fundus photographs. Sex was identified as a confounding variable in creatinine prediction. The MDRD formula was more susceptible to this confounding effect than the CKD-EPI formula. Notably, the CKD-EPI formula demonstrated superior performance compared to the MDRD formula (area under the curve 0.864 vs. 0.802). Conclusions Fundus photographs are a valuable tool for screening renal function using deep neural network models, demonstrating the role of noninvasive imaging in medical diagnostics. However, these models are susceptible to the influence of sex, a potential confounding factor. The CKD-EPI formula, less susceptible to sex bias, is recommended to obtain more reliable results.