Gastroesophageal reflux disease (GERD) is a chronic and relapsing gastrointestinal disorder characterized by the reflux of gastric contents into the esophagus, leading to troublesome symptoms and/or complications. Since the publication of the 2020 Seoul Consensus on GERD, significant new evidence has emerged, particularly regarding acid-suppressive therapies and diagnostic approaches. This 2025 focused update aims to refine GERD management strategies by incorporating the latest evidence on acid suppressive therapies and regional considerations in Asian populations. This study builds on the 2020 Seoul Consensus by integrating systematic reviews, meta-analyses, and expert consensuses to offer updated recommendations for the definition and medical treatment of GERD. These guidelines incorporate recent advances in acid-suppressive therapies, particularly potassium-competitive acid blockers, and adopt updated diagnostic frameworks in accordance with the Lyon Consensus 2.0. Key clinical questions were identified and structured using the following format: Population, Intervention, Comparator, Outcome. The resulting recommendations address the initial treatment, long-term maintenance strategies, and role of personalized therapy based on disease severity, such as the grade of reflux esophagitis. Six key statements are presented: updated definition and classification of GERD (Statement 1); initial and long-term treatment strategies tailored to GERD phenotypes, such as non-erosive reflux disease, mild erosive esophagitis, and severe erosive esophagitis (Statements 2-5); and dose optimization strategies for long-term safety (Statement 6). These guidelines aim to support gastroenterologists and general healthcare providers in making individualized evidence-based decisions for GERD management.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a global health issue due to its increasing prevalence associated with lifestyle changes and its strong correlation with metabolic syndrome. Farnesoid X receptor (FXR) is a nuclear receptor that plays a pivotal role in regulating bile acid, lipid, and glucose metabolism, making it an attractive therapeutic target for liver and metabolic diseases. In this study, we investigated the effects of MHY5456, a synthetic agonist of FXR, on hepatic metabolism and fibrosis. MHY5456 enhanced the transcriptional activity of FXR in a concentration-dependent manner.Treatment of AC2F rat liver-derived cells with MHY5456 resulted in the downregulation of genes involved in lipid accumulation and an upregulation of mitochondrial-related gene expression. Additionally, MHY5456 significantly reduced oleic acid (OA)-induced lipid accumulation. To assess its anti-fibrotic potential, we tested its effects on transforming growth factor-beta (TGF-β)-induced fibrosis in LX2 human hepatic stellate cells (HSCs). MHY5456 significantly suppressed the expression of fibrosis-related genes and proteins. In vivo, administration of MHY5456 to mice fed a methionine-choline-deficient (MCD) diet alleviated hepatic fibrosis, inflammation, and lipid accumulation. These results show that FXR activation by MHY5456 modulates lipid metabolism and fibrotic pathways, suggesting its potential as a pharmacological candidate for liver and metabolic disorders, including MASLD. Further pharmacological and toxicological studies are needed to confirm its therapeutic relevance.

Severe odontogenic deep neck infections (DNIs) can rapidly extend along cervical fascial planes and progress to descending necrotizing mediastinitis (DNM) with high mortality, requiring early diagnosis and multidisciplinary management, especially in elderly patients with comorbidities. We report two elderly patients with rapidly progressive odontogenic infections: one with DNM fulfilling Estrera’s criteria (Endo type IIA) and another with extensive DNI without mediastinal spread. Clinical features, serial contrast-enhanced computed tomography (CECT) findings, laboratory risk indicator for necrotizing fasciitis (LRINEC) score trends, microbiological results, surgical approaches were analyzed. Both patients presented withhigh LRINEC scores (≥8) and polymicrobial infections, involving multidrug-resistant organisms. Case 1 required five staged cervicothoracic debride-ments, negative pressure wound therapy, and delayed skin grafting. Case 2 underwent three surgeries with gland excision, hemorrhage control. Airway patency was maintained without tracheostomy through coordinated airway monitoring. Targeted antimicrobial adjustments and systemic optimization facilitated infection control. Both patients recovered fully without recurrence. These cases emphasize the importance of early CECT evaluation, cautious interpretation of LRINEC scores in patients with metabolic comorbidities, individualized surgical debridement tailored to anatomical spread, and multidisciplinary collaboration. Personalized reconstructive strategies based on defect size and tissue viability are essential for functional restoration and successful outcomes.

Purpose: This study aimed to develop a digital multimedia-based educational intervention for hematopoietic stem cell (HSC) donors and to evaluate its effects on anxiety, knowledge, attitudes toward hematopoietic stem cell donation, and educational satisfaction. Methods: This quasi-experimental study employed a nonequivalent control group non-synchronized pretest-posttest design. Participants were 60 HSC donors admitted to a general hospital in Seoul, Republic of Korea, between April and December 2024. The participants were assigned to an experimental group (n=30) and a control group (n=30). The experimental group received a digital multimediabased educational intervention in addition to the usual education using a standardized handout, whereas the control group received the usual education only. The intervention was provided in three sessions: on the day of admission (20 minutes), on the day of stem cell collection (10 minutes), and on the day of discharge (10 minutes). Data were collected at admission and discharge using structured questionnaires. Anxiety was analyzed using generalized estimating equations (GEE), knowledge and attitudes using mixed ANOVA, and educational satisfaction using an independent t-test. Results: The experimental group showed significantly lower anxiety (p=.048) and higher knowledge levels (p=.005) than the control group. No significant differences were found between the groups in attitudes toward donation or educational satisfaction. Conclusion The digital multimedia-based educational intervention was effective in reducing anxiety and improving knowledge among HSC donors. This intervention may enhance donors’ understanding of the donation process and support a more positive donation experience. Further multicenter studies with larger samples and longitudinal follow-up measurements are needed to verify the long-term effects and generalizability of the intervention.

Objective: Reliable staging of dementia is critical for both clinical practice and research. Although the Clinical Dementia Rating (CDR) is widely used to assess dementia severity, it is subject to subjectivity and inter-rater variability. Resting-state electroencephalography (EEG) may provide objective neurophysiological information associated with clinical severity. Methods: Resting-state EEG data from 600 adults aged ≥60 years in Korea were analyzed. Relative power spectral density was extracted from 19 electrodes across six frequency bands. Ordinal logistic regression and linear regression analyses exam-ined associations between resting-state EEG spectral features and CDR Global and CDR Sum of Boxes (CDR-SB) scores. All models adjusted for age, sex, education, and depressive symptoms, with false-discovery-rate correction. Results: Ordinal logistic regression demonstrated that higher resting-state theta-band EEG power was significantly associatedwith greater CDR Global severity, particularly in frontal, temporal, central, and parietal regions. Consistently, linear regressionanalyses revealed that higher CDR-SB scores were associated with increased theta in widespread cortical areas. No significantassociations were observed in other frequency bands. Conclusion EEG spectral slowing—marked by elevated theta power—was consistently related to CDR-defined dementia se-verity. Resting-state EEG can potentially serve as an objective neurophysiological correlate that informs clinician-rated staging and enhances the reliability of dementia severity assessment.

Tuberculous pericarditis is an extrapulmonary manifestation of tuberculosis that is most commonly associated with pericardial thickening, effusion, and calcification. We present a case of tuberculous pericarditis mimicking a malignant pericardial tumor in a 77-year-old male. CT revealed an irregular and nodular pericardial thickening. MRI revealed high signal intensity on T1-weighted fat-suppressed images and peripheral rim enhancement after gadolinium administration. MRI can be helpful in determining the differential diagnoses in cases of tuberculous pericarditis with nonspecific imaging findings.

Respiratory epithelial adenomatoid hamartoma (REAH) in the head and neck is a rare benign lesion containing glandular tissue covered with ciliated respiratory epithelium. In the head and neck, REAH of the nasal cavity, paranasal sinuses, and nasopharynx have been reported in literature. Due to rareness of REAH and insufficient knowledge of its imaging features, the diagnosis can be challenging when we encounter a non-specific cystic mass at an uncommon site in the head or neck. Here, we report the case of a pathologically confirmed REAH showing a cystic mass centered at the buccal space (retromaxillary fat pad) with CT and MRI findings.

Purpose: Human breast milk (HBM) contains immune components that produced and delivered from the mother along with nutrients necessary for the baby. MicroRNA (miRNA) is a small noncoding RNA molecule, that is used as an ideal biomarker for diagnosis and prognosis of various diseases and are more abundant in HBM. We analyzed and compared the immune components and miRNAs of HBM. Methods: HBM were collected from 20 healthy breastfeeding mothers. We measured the amount of lactoferrin, lysozyme, and immunoglobulin A (IgA) and extracted the miRNAs from each breast milk samples. Next, the top 5 and bottom 5 expressed miRNAs were compared and analyzed based on the amounts of the 3 immune components. Results: The mean levels and ranges of lactoferrin, lysozyme, and IgA were 6.33 (2.24–14.77)×106 ng/mL, 9.90 (1.42–17.59)×107 pg/mL, and 6.64 (0.48–20.01)×105 ng/mL, respectively. The miRNAs concentration per 1 mL of skim milk was 40.54 (14.95–110.01) ng/μL. Comparing the bottom 5 and top 5 groups of each immune component, 19 miRNAs were significantly upregulated (6, 9, and 4 targeting lactoferrin, lysozyme, and IgA, respectively) and 21 were significantly downregulated (4, 9, and 8 targeting lactoferrin, lysozyme, and IgA, respectively). There were no miRNAs that were expressed significantly higher or lower in common to all 3 components.However, 2 and 3 miRNAs were commonly overexpressed and underexpressed, in the top 5 groups of lysozyme and IgA concentrations. Conclusion We identified the immune components and miRNAs in breast milk and found that each individual has different ingredients.

Purpose: This study evaluated whether patient activation and nurse trust mediate the relationship between a person-centered climate and patient satisfaction in cancer patients. Methods: A total of 179 participants, who were admitted in a tertiary hospital of J city, were surveyed in a cross-sectional study. Data were collected from March 1 to June 10, 2023. The descriptive statistics and mediating effects were analyzed using SPSS/WIN 25.0 and PROCESS macro program. Results: A person-centered climate directly affected patient satisfaction (direct effect=0.21, p<.001; direct effect=0.34, p<.001). Patient activation had a mediating effect between a person-centered climate and patient satisfaction (indirect effect=0.31, 95% Boot confidence interval=0.24~0.39). Nurse trust had a mediating effect between a person-centered climate and patient satisfaction (indirect effect=0.19, 95% Boot confidence interval=0.10~0.27). Conclusion This indicates the importance of developing a person-centered climate, patient activation and nurse trust to improve satisfaction for cancer patients. Therefore, it is necessary to assess the level of trust in nurses to improve and strengthen trust in them and to develop various program to focus on patient activation in cancer patients.

Purpose: This study aimed to evaluate the effectiveness of exercise in patients with hemophilia. Methods: We carried out a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A literature search was conducted of published randomized controlled trials for exercise interventions from January 1, 2014 to March 15, 2023. To estimate the size of the effects of exercise, a meta-analysis was performed using the R package “meta.” Results: Five databases were searched to obtain articles published in Korean or English. Of 1,150 articles reviewed, 13 were included in the systematic review and 9 in the meta-analysis. The risk of bias was assessed using RoB 2.0. Results: The overall effect sizes of exercise interventions, calculated as the standardized mean difference, were -0.11 (95% confidence interval [CI] = -1.41 to –1.20) for pain, -2.13 (95% CI = -3.33 to -0.93) for joint health, 9.96 (95% CI = 7.51 to 12.28) for physical activity, and 0.59 (95% CI = -0.39 to -1.56) for quality of life. Conclusion These findings suggest that exercise is useful for improving the joint health and physical activity of patients with hemophilia. Thus, it is necessary to develop and apply exercise interventions for patients with hemophilia to reduce their pain and improve their quality of life.