Anomalous union of the pancreaticobiliary duct (AUPBD) is a congenital malformation in which the pancreatic and biliary ducts join outside the duodenal wall, forming an elongated common channel. Because sphincter action does not directly affect this junction, reciprocal reflux of pancreatic juice and bile occurs, increasing the risk of biliary tract cancer. AUPBD is frequently associated with choledochal cysts and is a known risk factor for biliary malignancies. We report a case of a 70-year-old woman diagnosed with gallbladder cancer with liver metastases, accompanied by AUPBD without choledochal cysts. She presented with upper abdominal pain, obstructive jaundice, and a large hepatic mass on imaging. Endoscopic retrograde cholangiopancreatography confirmed pancreatobiliary-type AUPBD. Despite biliary drainage, her condition rapidly deteriorated and she died soon after. This case underscores the role of AUPBD in carcinogenesis and the need for early recognition and management.

Objective: To explain process of developing basic veterinary clinical performance guidelines, based on frequently observable clinical manifestations, thereby supporting competencybased veterinary education in Korea. Methods: A structured review of learning outcomes established by Korean Association of Veterinary Medical Colleges (KAVMC) was conducted by a planning committee including veterinary educators, practitioners, and advisory members. Owner-oriented descriptions were used to frame each performance task, and each was mapped to corresponding learning outcomes. These tasks were aligned with learning outcomes recommended by the KAVMC to support the development of communication, clinical reasoning, and performance-related competencies among veterinary students, thereby enhancing day-one clinical readiness. Results: In total, 63 clinical manifestations for a guidebook format that can be used for clinical education were identified and categorized by organ systems that are described in language understandable to animal owners. Conclusions and Relevance: The basic veterinary clinical performance guidelines based on common clinical manifestations would serve as a vital component in veterinary education to reinforce core graduation competencies.

Background: The management of sexually transmitted infections (STIs) at the national level is necessary for the health and well-being of individuals in society. The purpose of this study was to propose a redesign of the STI surveillance system by collecting opinions from experts. Methods: After the major STIs were reviewed, 1) gonorrhea, 2) chancroid, 3) Mycoplasma genitalium infection, and 4) trichomoniasis were selected as diseases requiring a redesign of the surveillance system through the Delphi method, a technique for solving problems by collecting opinions from experts. The expert panel was selected from experts on STIs (n = 17) and included members of the Korean Association of Urogenital Tract Infection and Inflammation, the Korean Society of Infectious Diseases, and the 3rd advisory committee on STIs. Results: The experts agreed upon the exclusion of surveillance for chancroid on the basis of the low incidence, with an agreement rate of 83%. The experts agreed upon the inclusion of M. genitalium in the surveillance system, with a high agreement rate of 88%. However, there was disagreement among the experts on whether to include trichomoniasis in the surveillance system and whether to switch to a mandatory surveillance system for gonorrhea. Conclusion Although a consensus was not reached in some of the surveys in this study, it involved the collection of various expert opinions. Therefore, policies should be promoted with a prioritized focus on items with high agreement, but items for which no consensus was reached need to be reviewed in greater depth through additional research and investigation.

Background and Objectives: Metoclopramide is an antagonist of dopamine D2 receptor and is capable of alleviating chemotherapy-induced nausea and vomiting. However, its underlying mechanisms and function in improving the efficiency of chemotherapy are not fully understood. In this study, we investigated the sensitizing effect of metoclopramide on the platinum-based drugs-mediated apoptosis in human head and neck cancer cells.Subjects and Method Apoptosis was analyzed using a cell-based cytometer. The protein expression and messenger ribonucleic acid (mRNA) levels were assessed by Western blotting and real-time polymerase chain reaction, respectively. Results: Metoclopramide sensitized the platinum-based drug (cisplatin and oxaliplatin)-mediated apoptosis in AMC-HN4 cells, but not in normal cells. Mechanistically, we found that metoclopramide decreased Mcl-1 protein expression through post-translational regulation. Moreover, the overexpression of Mcl-1 prevented apoptosis by combined treatment of metoclopramide and platinum-based drugs. Conclusion Metoclopramide induced proteasome-mediated Mcl-1 downregulation, resulting in increased sensitivity to platinum-based drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for their anti-inflammatory and analgesic effects; however, their prolonged use significantly contributes to peptic ulcer disease (PUD) and its complications, such as bleeding and perforation. The pathogenesis primarily involves cyclooxygenase (COX) enzyme inhibition and direct mucosal injury, leading to impaired gastrointestinal defense mechanisms. Multiple risk factors, including advanced age, a history of ulcers, and the concurrent use of anticoagulants or corticosteroids, significantly increase the risk of ulcers and related complications. Global epidemiological studies demonstrate considerable geographical variation in prevalence rates. Despite higher NSAID usage, high-income countries exhibit relatively lower rates, primarily due to well-established preventive strategies. Prevention should be based on careful risk stratification that accounts for both gastrointestinal and cardiovascular factors. Proton pump inhibitors have demonstrated superior efficacy in both prevention and treatment, while selective COX-2 inhibitors offer an alternative strategy, though they require careful cardiovascular risk assessment. The synergistic interaction between NSAID use and Helicobacter pylori infection necessitates testing and eradication, particularly in high-risk patients. NSAID discontinuation remains the primary therapeutic strategy when feasible, with studies showing significantly improved healing rates compared with continued use. Recent advances include the emergence of potassium-competitive acid blockers, which provide rapid and sustained acid suppression, offering promising alternatives for both prevention and treatment. Continued research aimed at optimizing preventive strategies and developing novel therapeutic approaches remains essential for improving clinical outcomes in NSAID-induced PUD.

Background: Although total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used to optimize intraoperative neurophysiological monitoring (IONM), the exact effect of remimazolam on IONM remains unknown. Here, we compared the effects of propofol and remimazolam along with remifentanil on IONM during TIVA. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients requiring IONM during cervical spine surgery were administered either propofol (Group P) or remimazolam (Group R). The preoperative latencies of the somatosensory-evoked potentials (SEP; N20 for the median nerve and P37 for the tibial nerve) were measured. SEP latencies and amplitudes and motor-evoked potential (MEP) amplitudes were measured 30 min after anesthetic induction (T1), 30 min after surgical incision (T2), after laminectomy or discectomy (T3), immediately after plate insertion or pedicle screw fixation (T4), and before surgical wound closure (T5). The primary outcome was the between-group difference in the N20 latency changes measured at T1 and preoperatively. Results: The change in SEP latencies including N20 and P37 at T1 compared with preoperative time was not significantly different between Groups P and R. Except for the amplitude of the right abductor brevis, there was no significant group-by-time interaction effect for intraoperative MEP amplitudes or SEP latencies and amplitudes. Conclusions TIVA with remimazolam and remifentanil for cervical spine surgery yielded stable IONM, comparable to those observed with conventional TIVA with propofol and remifentanil. Further clinical trials are needed in other surgical contexts and with more diverse patient populations to determine the effects of remimazolam on IONM.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for their anti-inflammatory and analgesic effects; however, their prolonged use significantly contributes to peptic ulcer disease (PUD) and its complications, such as bleeding and perforation. The pathogenesis primarily involves cyclooxygenase (COX) enzyme inhibition and direct mucosal injury, leading to impaired gastrointestinal defense mechanisms. Multiple risk factors, including advanced age, a history of ulcers, and the concurrent use of anticoagulants or corticosteroids, significantly increase the risk of ulcers and related complications. Global epidemiological studies demonstrate considerable geographical variation in prevalence rates. Despite higher NSAID usage, high-income countries exhibit relatively lower rates, primarily due to well-established preventive strategies. Prevention should be based on careful risk stratification that accounts for both gastrointestinal and cardiovascular factors. Proton pump inhibitors have demonstrated superior efficacy in both prevention and treatment, while selective COX-2 inhibitors offer an alternative strategy, though they require careful cardiovascular risk assessment. The synergistic interaction between NSAID use and Helicobacter pylori infection necessitates testing and eradication, particularly in high-risk patients. NSAID discontinuation remains the primary therapeutic strategy when feasible, with studies showing significantly improved healing rates compared with continued use. Recent advances include the emergence of potassium-competitive acid blockers, which provide rapid and sustained acid suppression, offering promising alternatives for both prevention and treatment. Continued research aimed at optimizing preventive strategies and developing novel therapeutic approaches remains essential for improving clinical outcomes in NSAID-induced PUD.

Background and Objectives: Metoclopramide is an antagonist of dopamine D2 receptor and is capable of alleviating chemotherapy-induced nausea and vomiting. However, its underlying mechanisms and function in improving the efficiency of chemotherapy are not fully understood. In this study, we investigated the sensitizing effect of metoclopramide on the platinum-based drugs-mediated apoptosis in human head and neck cancer cells.Subjects and Method Apoptosis was analyzed using a cell-based cytometer. The protein expression and messenger ribonucleic acid (mRNA) levels were assessed by Western blotting and real-time polymerase chain reaction, respectively. Results: Metoclopramide sensitized the platinum-based drug (cisplatin and oxaliplatin)-mediated apoptosis in AMC-HN4 cells, but not in normal cells. Mechanistically, we found that metoclopramide decreased Mcl-1 protein expression through post-translational regulation. Moreover, the overexpression of Mcl-1 prevented apoptosis by combined treatment of metoclopramide and platinum-based drugs. Conclusion Metoclopramide induced proteasome-mediated Mcl-1 downregulation, resulting in increased sensitivity to platinum-based drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for their anti-inflammatory and analgesic effects; however, their prolonged use significantly contributes to peptic ulcer disease (PUD) and its complications, such as bleeding and perforation. The pathogenesis primarily involves cyclooxygenase (COX) enzyme inhibition and direct mucosal injury, leading to impaired gastrointestinal defense mechanisms. Multiple risk factors, including advanced age, a history of ulcers, and the concurrent use of anticoagulants or corticosteroids, significantly increase the risk of ulcers and related complications. Global epidemiological studies demonstrate considerable geographical variation in prevalence rates. Despite higher NSAID usage, high-income countries exhibit relatively lower rates, primarily due to well-established preventive strategies. Prevention should be based on careful risk stratification that accounts for both gastrointestinal and cardiovascular factors. Proton pump inhibitors have demonstrated superior efficacy in both prevention and treatment, while selective COX-2 inhibitors offer an alternative strategy, though they require careful cardiovascular risk assessment. The synergistic interaction between NSAID use and Helicobacter pylori infection necessitates testing and eradication, particularly in high-risk patients. NSAID discontinuation remains the primary therapeutic strategy when feasible, with studies showing significantly improved healing rates compared with continued use. Recent advances include the emergence of potassium-competitive acid blockers, which provide rapid and sustained acid suppression, offering promising alternatives for both prevention and treatment. Continued research aimed at optimizing preventive strategies and developing novel therapeutic approaches remains essential for improving clinical outcomes in NSAID-induced PUD.