Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: Researchers have proposed that there is a potential link between folliclestimulating hormone (FSH) and cognitive function, yet the evidence remains inconclusive.The current study aims to identify the association between serum FSH levels and cognitive performance, and to examine whether this association varies by cognitive diagnosis, serum estradiol (E2) levels, or cognitive domain. Methods: This multicenter cross-sectional study used a clinical database comprising female visitors to memory clinics at three referral hospitals in Korea. Venous blood samples were collected to determine serum FSH and E2 concentrations via immunoradiometric assay.Cognitive performance was evaluated using either the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease or the Seoul Neuropsychological Screening Battery, while cognitive diagnoses were made via clinical diagnostic interviews. Results: Among the 159 participants (normal cognition [NC], n = 70; mild cognitive impairment [MCI], n = 52; Alzheimer’s disease [AD] dementia, n = 37), there were no significant differences in serum FSH levels associated with cognitive diagnosis. In women with NC, serum FSH levels were found to be positively correlated with cognitive performance in global cognition, nonverbal memory, and executive function, even after adjusting for serum E2 level and its interaction with serum FSH level. However, no significant correlations were observed in women with MCI and AD dementia. Conclusion The association between circulating FSH and cognition may be independent from circulating E2, but it may depend on disease progression or cognitive domains. This suggests a potential role of gonadotropin in cognitive decline in elderly women.

Background: Researchers have proposed that there is a potential link between folliclestimulating hormone (FSH) and cognitive function, yet the evidence remains inconclusive.The current study aims to identify the association between serum FSH levels and cognitive performance, and to examine whether this association varies by cognitive diagnosis, serum estradiol (E2) levels, or cognitive domain. Methods: This multicenter cross-sectional study used a clinical database comprising female visitors to memory clinics at three referral hospitals in Korea. Venous blood samples were collected to determine serum FSH and E2 concentrations via immunoradiometric assay.Cognitive performance was evaluated using either the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease or the Seoul Neuropsychological Screening Battery, while cognitive diagnoses were made via clinical diagnostic interviews. Results: Among the 159 participants (normal cognition [NC], n = 70; mild cognitive impairment [MCI], n = 52; Alzheimer’s disease [AD] dementia, n = 37), there were no significant differences in serum FSH levels associated with cognitive diagnosis. In women with NC, serum FSH levels were found to be positively correlated with cognitive performance in global cognition, nonverbal memory, and executive function, even after adjusting for serum E2 level and its interaction with serum FSH level. However, no significant correlations were observed in women with MCI and AD dementia. Conclusion The association between circulating FSH and cognition may be independent from circulating E2, but it may depend on disease progression or cognitive domains. This suggests a potential role of gonadotropin in cognitive decline in elderly women.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background/Aims: We investigated the clinical practice patterns of Korean endoscopists for the endoscopic resection of colorectal polyps. Methods: From September to November 2021, an online survey was conducted regarding the preferred resection methods for colorectal polyps, and responses were compared with the international guidelines. Results: Among 246 respondents, those with <4 years, 4–9 years, and ≥10 years of experiencein colonoscopy practices accounted for 25.6%, 34.1%, and 40.2% of endoscopists, respectively. The most preferred resection methods for non-pedunculated lesions were cold forceps polypectomy for ≤3 mm lesions (81.7%), cold snare polypectomy for 4–5 mm (61.0%) and 6–9 mm (43.5%) lesions, hot endoscopic mucosal resection (EMR) for 10–19 mm lesions (72.0%), precut EMR for 20–25 mm lesions (22.0%), and endoscopic submucosal dissection (ESD) for ≥26 mm lesions (29.3%). Hot EMR was favored for pedunculated lesions with a head size <20 mm and stalk size <10 mm (75.6%) and for those with a head size ≥20 mm or stalk size ≥10 mm (58.5%). For suspected superficial and deep submucosal lesions measuring 10–19 mm and ≥20 mm, ESD (26.0% and 38.6%) and surgery (36.6% and 46.3%) were preferred, respectively. The adherence rate to the guidelines ranged from 11.2% to 96.9%, depending on the size, shape, and histology of the lesions. Conclusions Adherence to the guidelines for endoscopic resection techniques varied depend-ing on the characteristics of colorectal polyps. Thus, an individualized approach is required to increase adherence to the guidelines.

Background/Aims: We investigated the clinical practice patterns of Korean endoscopists for the endoscopic resection of colorectal polyps. Methods: From September to November 2021, an online survey was conducted regarding the preferred resection methods for colorectal polyps, and responses were compared with the international guidelines. Results: Among 246 respondents, those with <4 years, 4–9 years, and ≥10 years of experiencein colonoscopy practices accounted for 25.6%, 34.1%, and 40.2% of endoscopists, respectively. The most preferred resection methods for non-pedunculated lesions were cold forceps polypectomy for ≤3 mm lesions (81.7%), cold snare polypectomy for 4–5 mm (61.0%) and 6–9 mm (43.5%) lesions, hot endoscopic mucosal resection (EMR) for 10–19 mm lesions (72.0%), precut EMR for 20–25 mm lesions (22.0%), and endoscopic submucosal dissection (ESD) for ≥26 mm lesions (29.3%). Hot EMR was favored for pedunculated lesions with a head size <20 mm and stalk size <10 mm (75.6%) and for those with a head size ≥20 mm or stalk size ≥10 mm (58.5%). For suspected superficial and deep submucosal lesions measuring 10–19 mm and ≥20 mm, ESD (26.0% and 38.6%) and surgery (36.6% and 46.3%) were preferred, respectively. The adherence rate to the guidelines ranged from 11.2% to 96.9%, depending on the size, shape, and histology of the lesions. Conclusions Adherence to the guidelines for endoscopic resection techniques varied depend-ing on the characteristics of colorectal polyps. Thus, an individualized approach is required to increase adherence to the guidelines.

Background: Researchers have proposed that there is a potential link between folliclestimulating hormone (FSH) and cognitive function, yet the evidence remains inconclusive.The current study aims to identify the association between serum FSH levels and cognitive performance, and to examine whether this association varies by cognitive diagnosis, serum estradiol (E2) levels, or cognitive domain. Methods: This multicenter cross-sectional study used a clinical database comprising female visitors to memory clinics at three referral hospitals in Korea. Venous blood samples were collected to determine serum FSH and E2 concentrations via immunoradiometric assay.Cognitive performance was evaluated using either the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease or the Seoul Neuropsychological Screening Battery, while cognitive diagnoses were made via clinical diagnostic interviews. Results: Among the 159 participants (normal cognition [NC], n = 70; mild cognitive impairment [MCI], n = 52; Alzheimer’s disease [AD] dementia, n = 37), there were no significant differences in serum FSH levels associated with cognitive diagnosis. In women with NC, serum FSH levels were found to be positively correlated with cognitive performance in global cognition, nonverbal memory, and executive function, even after adjusting for serum E2 level and its interaction with serum FSH level. However, no significant correlations were observed in women with MCI and AD dementia. Conclusion The association between circulating FSH and cognition may be independent from circulating E2, but it may depend on disease progression or cognitive domains. This suggests a potential role of gonadotropin in cognitive decline in elderly women.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.