Background: The Act on Decisions on Life-Sustaining Treatment (LST) has been implemented in Korea since 2018, yet data on its application in neurocritical care units remain scarce. This study aimed to evaluate the clinical characteristics and outcomes of LST withdrawal or withholding in the neurocritical care unit. Methods: This study was a retrospective analysis conducted at a tertiary university hospital in Busan, South Korea. Among patients admitted to the neurocritical care unit between February 2018 and August 2023, those with documented decisions for LST withdrawal or withholding were enrolled. Demographic and clinical characteristics, underlying and combined conditions, reasons for LST decisions, measures taken, and time from LST withdrawal to death were extracted from medical records. Results: A total of 69 patients were included, with a median age of 67 years, and 38 (55%) were male. Cerebrovascular disease (62%) and traumatic brain injury (22%) were the most common underlying diagnoses. The primary reason for LST decisions was irreversible neurological damage (71%), followed by systemic complications (19%). Mechanical ventilation cessation (91%) and extubation (86%) were most frequently used measures for LST withdrawal. The median time from LST withdrawal to death was 22 minutes. Conclusions Our study demonstrates that LST decisions in the neurocritical care unit predominantly occur among patients with cerebrovascular disease or traumatic brain injury, mostly triggered by neurological deterioration. Most patients died shortly after withdrawal. These findings provide important insight into current LST withdrawal practices in neurocritical care and may assist clinical and ethical decision making in similar settings.

Purpose: To compare the clinical outcomes of early pars plana vitrectomy versus intravitreal antibiotic injection in patients who developed infectious endophthalmitis after cataract surgery. Methods: The medical records of patients diagnosed with infectious endophthalmitis following cataract surgery between 2006 and 2023, whose initial best-corrected visual acuity (BCVA) values were 0.48 to 2.3 in LogMAR units, were retrospectively reviewed. Final BCVA and the degree of visual improvement were compared between early vitrectomy and intravitreal antibiotic injection-only groups. Additionally, patients who underwent delayed vitrectomy within 3 days after the initial intravitreal antibiotic injection (delayed vitrectomy group) were separately analyzed and compared. Results: At 6 months post-treatment, the mean BCVA values were significantly better in the early vitrectomy group (0.37 ± 0.27) than in the injection group (1.02 ± 0.81) (p = 0.004); the early vitrectomy group also had greater visual improvement at both 1 week and 6 months after treatment (p = 0.004, p < 0.001). Compared to the delayed vitrectomy group, the early group demonstrated significantly greater visual improvement at both time points (p = 0.010, p = 0.001). The retreatment rate was higher in the injection group than in the early vitrectomy group. Conclusions In patients who developed infectious endophthalmitis after cataract surgery and had an initial visual acuity between light perception or better and 20/60, early vitrectomy resulted in better visual outcomes compared to intravitreal antibiotic injection alone or delayed vitrectomy.

Metastatic spine cancer (MSC), a common complication of advanced malignancies, poses significant challenges due to pain, neurological deficits, and mechanical instability. While radiation therapy is a cornerstone of treatment, the role of spine surgery is evolving, fueled by advances in surgical techniques and radiation modalities such as stereotactic body radiation therapy (SBRT). This review examines the evolving role of spine surgery in MSC management, focusing on separation surgery, surgical innovations, and future directions. The treatment paradigm for MSC shifted with the advent of SBRT, which delivers high-dose precision radiation, improving local control even in radioresistant tumors. This advancement enabled the adoption of separation surgery, a technique aimed at creating a safe margin between the tumor and neural structures without extensive tumor resection, followed by SBRT to achieve tumor regression. Separation surgery reduces morbidity, shortens operative times, and achieves comparable local control rates to traditional corpectomy procedures. Innovations like minimally invasive surgery, stereotactic navigation, and cement-augmented instrumentation have improved surgical safety and outcomes. Emerging technologies, such as machine learning for predictive modeling and augmented reality for surgical navigation, hold potential for improving decision-making and procedural accuracy. Spine surgery remains integral to MSC treatment, especially for high-grade metastatic epidural spinal cord compression and mechanical instability. Integrating advanced technologies and multidisciplinary collaboration is key to optimizing patient outcomes. Comprehensive, patient-centered strategies addressing both oncological and mechanical aspects can improve survival and quality of life for patients with MSC.

Background and Objectives: Differentiating inverted papilloma (IP) from squamous cell carcinoma arising in IP (IP+SCC) is challenging when computed tomography (CT) demonstrates no bone destruction. This study aimed to identify CT and magnetic resonance imaging (MRI) features that distinguish IP from IP+SCC in cases without bone destruction on CT. Methods: We retrospectively reviewed 30 patients with histologically confirmed sinonasal IP (n=15) or IP+SCC (n=15) who underwent preoperative CT and MRI between 2010 and 2023. Imaging variables assessed included tumor origin, tumor volume, CT enhancement pattern, signal intensity on T2-weighted and contrast-enhanced T1-weighted images, apparent diffusion coefficient (ADC), and the presence or loss of the convoluted cerebriform pattern (CCP). Group differences were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant. Results: There was no statistically significant difference in tumor origin between the IP and IP+SCC groups. Tumor volume and CT enhancement patterns also did not differ significantly between the groups. On MRI, IP+SCC more frequently demonstrated intermediate signal intensity on both T2-weighted and contrast-enhanced T1-weighted images compared with IP (p=0.025 and p=0.029, respectively). Median ADC values were significantly lower in the IP+SCC group than in the IP group (0.99×10-3 vs. 1.20×10-3 mm2/s; p=0.026). Loss of the CCP was more common in the IP+SCC group, although the difference did not reach statistical significance. Conclusion In sinonasal IP without bone destruction on CT, MRI appears to be more informative than CT for distinguishing IP+SCC from IP. Intermediate signal intensity on T2-weighted and contrast-enhanced T1-weighted images, along with lower ADC values, supports malignant transformation, whereas tumor size, CT enhancement, and CCP alone are less reliable discriminators.

Background: Degenerative lumbar scoliosis (DLS) alters spinal anatomy, impacting the feasibility and dimensions of surgical corridors for oblique lumbar interbody fusion (OLIF). This study aimed to compare the morphometric characteristics of OLIF corridors between patients with left- and right-apex curves, focusing on corridor dimensions, psoas muscle asymmetry, and segmental artery positioning. Methods: A retrospective analysis of 80 patients with DLS (left apex: n = 43; right apex: n = 37) was conducted. Corridor angles and distances, psoas muscle cross-sectional areas, and segmental artery locations were measured at L2–3, L3–4, and L4–5 using T2-weighted magnetic resonance imaging (MRI). Multivariate regression analysis identified key anatomical predictors of corridor variation at L2–3. Results: Regardless of the apex direction, the left-sided corridor was consistently larger across all levels. Corridor angles were significantly greater on the left side in both groups (left apex: L2–3, 39.7° vs. 13.5°; L3–4, 38.3° vs. 11.9°; L4–5, 38.6° vs. 6.9°;right apex: L2–3, 53.7° vs. 18.1°; L3–4, 43.1° vs. 18.5°; L4–5, 28.6° vs. 11.9°). Psoas muscle areas were larger on the concave side of the curve (left apex: 125.7 mm2 vs. 67.9 mm2 ; right apex: 125.4 mm2 vs. 77.4 mm2 ). Segmental artery positioning exhibited curvedependent asymmetry at L2–3 (left apex: 8.8 mm vs. 7.9 mm; right apex: 9.6 mm vs. 8.0 mm). Multivariate regression analysis revealed that in the left apex group, the left psoas area (β = −0.132) and segmental artery distances were significant predictors of corridor angle variation (R2 = 0.517). In the right apex group, psoas asymmetry (β = 0.123) and sagittal alignment (β = −0.851) were associated with corridor differences. Conclusions OLIF corridors in DLS patients demonstrate consistent left-sided dominance, regardless of apex direction. Psoas muscle asymmetry and segmental artery positioning contribute to corridor variations. While the left-sided approach remains standard, right-sided access may be feasible in select cases, particularly at L4–5. These findings provide insights for optimizing preoperative planning and surgical decision-making in DLS patients.

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.

The multi-decade household humidifier disinfectant poisoning tragedy (HHDT) in South Korea highlights the importance of investigating government failures. This study aims to identify and discuss key failures and shortcomings in the South Korean authorities’ approach to regulating humidifier disinfectants (HDs) and monitoring cases of chemical poisoning. We reviewed both the HD risk prevention measures that the South Korean Ministry of Environment (KME) should have implemented under the Toxic Chemicals Control Act (TCCA) (1991–2013).Polyhexamethylene guanidine phosphate (PHMG), a new chemical, was approved for use as a disinfectant under the TCCA. KME declared PHMG non-hazardous based solely on preproduction documentation provided by the industry. In addition, the Korea Disease Control and Prevention Agency (KDCPA) failed to detect the HHDT that had accumulated each year for more than a decade. KME’s neglect of its responsibilities, coupled with KDCPA’s lack of chemical poisoning surveillance systems, led to the accumulation of widespread HHDT.

Background: Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF. Methods: Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups. Results: A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations. Conclusions Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.