The global increase in obesity highlights the need for accurate tools to assess body composition and monitor treatment efficacy.Traditional metrics, including body mass index and waist circumference, offer limited precision for fat quantification. Imagingbased techniques capable of visualizing internal structures are increasingly being recognized for their ability to provide comprehensive fat assessment. This review outlines the principles, strengths, and limitations of key modalities, including dualenergy X-ray absorptiometry (DXA), CT, MRI, and bioelectrical impedance analysis (BIA). DXA is cost-effective and accessible for population-level screening, whereas CT and MRI offer higher precision, particularly for visceral fat assessment. BIA is a practical, low-cost alternative, but it is limited by variability and lack of standardization. Regulatory agencies, including the US Food and Drug Administration and the Korean Ministry of Food and Drug Safety, are increasingly supporting imaging-based endpoints in clinical trials of anti-obesity drugs because these methods capture fat mass reduction beyond total weight loss. Recent phase III trials of semaglutide and tirzepatide have underscored the utility of DXA and CT in quantifying fat loss and preserving lean mass. Selecting appropriate imaging modalities based on technical capabilities and regulatory considerations can improve the evaluation of obesity treatments and strengthen the design of anti-obesity drug trials.

Purpose: The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex. Materials and Methods: Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed. Results: Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males. Conclusion Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.

Background: Although symptomatic local recurrence (SLR) of spinal metastasis is relatively common after aggressive surgery, there have been few studies on SLR according to the extent of tumor removal. This study aimed to evaluate the incidence of SLR after surgery in spinal metastasis and analyze the risk factors of SLR. Methods: This study included patients with spinal metastasis to all 3 vertebral columns. SLR was defined as the occurrence of new symptoms, confirmed by radiologic regrowth of tumor. The extent of tumor removal was classified into 3 types (corpectomy, separation surgery, and only posterior column removal). The Kaplan-Meier method was used to analyze the SLR rate after surgery.The presumed risk factors of SLR were evaluated using log-rank test and Cox regression analysis. Results: This study included 102 patients with a mean follow-up period of 17.7 months (range, 3–84 months). After surgical treatment, SLR was confirmed in 35 patients (34.3%). Kaplan-Meier analysis predicted that the incidence of SLR was 4.4% at 6 months, 21.5% at 12 months, 34.0% at 18 months, and 42.7% at 24 months. In the univariate analysis, the primary malignancy site, number of vertebral metastases, and surgery for progressed tumor after previous radiation therapy were significant (p = 0.042, p = 0.048, and p = 0.008, respectively). No significant differences were observed in the extent of tumor removal (p = 0.536). In the multivariate analysis, the significant risk factors of SLR included only previous radiation therapy (p = 0.012). The risk of SLR was 2.8 times higher in patients who received surgery for progressed tumor after previous radiation therapy than in those without it. Conclusions The SLR of spinal metastasis was predicted in 21.5% of patients at 1 year after surgical treatment. The extent of tumor removal did not seem to affect SLR. Surgery for progressed tumor after previous radiation therapy was confirmed as the only substantial risk factor. Therefore, the tumor's response to preoperative radiation therapy is the most important factor in determining SLR.

Purpose: With the revision of the Organ and Transplantation Act in 2018, the hand has become legal as an area of transplantable organs in Korea. In January 2021, the first hand allotransplantation since legalization was successfully performed, and we have performed a total of three successful hand transplantation since then. By comparing and incorporating our experiences, this study aimed to provide a comprehensive reconstructive solution for hand amputation in Korea. Materials and Methods: Recipients were selected through a structured preoperative evaluation, and hand transplantations were performed at the distal forearm level. Postoperatively, patients were treated with three-drug immunosuppressive regimen, and functional outcomes were monitored. Results: The hand transplantations were performed without intraoperative complications. All patients had partial skin necrosis and underwent additional surgical procedures in 2 months after transplantation. After additional operations, no further severe complications were observed. Also, patients developed acute rejection within 3 months of surgery, but all resolved within 2 weeks after steroid pulse therapy. Motor and sensory function improved dramatically, and patients were very satisfied with the appearance and function of their transplanted hands. Conclusion Hand transplantation is a viable reconstructive option, and patients have shown positive functional and psychological outcomes. Although this study has limitations, such as the small number of patients and short follow-up period, we should focus on continued recovery of hand function, and be careful not to develop side effects from immunosuppressive drugs. Through the present study, we will continue to strive for a bright future regarding hand transplantation in Korea.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

Background: Although symptomatic local recurrence (SLR) of spinal metastasis is relatively common after aggressive surgery, there have been few studies on SLR according to the extent of tumor removal. This study aimed to evaluate the incidence of SLR after surgery in spinal metastasis and analyze the risk factors of SLR. Methods: This study included patients with spinal metastasis to all 3 vertebral columns. SLR was defined as the occurrence of new symptoms, confirmed by radiologic regrowth of tumor. The extent of tumor removal was classified into 3 types (corpectomy, separation surgery, and only posterior column removal). The Kaplan-Meier method was used to analyze the SLR rate after surgery.The presumed risk factors of SLR were evaluated using log-rank test and Cox regression analysis. Results: This study included 102 patients with a mean follow-up period of 17.7 months (range, 3–84 months). After surgical treatment, SLR was confirmed in 35 patients (34.3%). Kaplan-Meier analysis predicted that the incidence of SLR was 4.4% at 6 months, 21.5% at 12 months, 34.0% at 18 months, and 42.7% at 24 months. In the univariate analysis, the primary malignancy site, number of vertebral metastases, and surgery for progressed tumor after previous radiation therapy were significant (p = 0.042, p = 0.048, and p = 0.008, respectively). No significant differences were observed in the extent of tumor removal (p = 0.536). In the multivariate analysis, the significant risk factors of SLR included only previous radiation therapy (p = 0.012). The risk of SLR was 2.8 times higher in patients who received surgery for progressed tumor after previous radiation therapy than in those without it. Conclusions The SLR of spinal metastasis was predicted in 21.5% of patients at 1 year after surgical treatment. The extent of tumor removal did not seem to affect SLR. Surgery for progressed tumor after previous radiation therapy was confirmed as the only substantial risk factor. Therefore, the tumor's response to preoperative radiation therapy is the most important factor in determining SLR.

This fifth revised version of the Korean Society of Gynecologic Oncology practice guidelines for the management of cervical cancer incorporates recent research findings and changes in treatment strategies based on version 4.0 released in 2020. Each key question was developed by focusing on recent notable insights and crucial contemporary issues in the field of cervical cancer. These questions were evaluated for their significance and impact on the current treatment and were finalized through voting by the development committee. The selected key questions were as follows: the efficacy and safety of immune checkpoint inhibitors as firstor second-line treatment for recurrent or metastatic cervical cancer; the oncologic safety of minimally invasive radical hysterectomy in early stage cervical cancer; the efficacy and safety of adjuvant systemic treatment after concurrent chemoradiotherapy in locally advanced cervical cancer; and the oncologic safety of sentinel lymph node mapping compared to pelvic lymph node dissection. The recommendations, directions, and strengths of this guideline were based on systematic reviews and meta-analyses, and were finally confirmed through public hearings and external reviews. In this study, we describe the revised practice guidelines for the management of cervical cancer.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

Background/Aims: Synchronous multiple gastric cancer (SMGC) accounts for approximately 6% to 14% of gastric cancer (GC) cases. This study aimed to identify risk factors for SMGC. Methods: A total of 14,603 patients diagnosed with GC were prospectively enrolled. Data including age, sex, body mass index, smoking, alcohol consumption, family history, p53 expression, microsatellite instability, cancer classification, lymph node metastasis, and treatment were collected. Risk factors were analyzed using logistic regression analysis between a single GC and SMGC. Results: The incidence of SMGC was 4.04%, and that of early GC (EGC) and advanced GC (AGC) was 5.43% and 3.11%, respectively. Patients with SMGC were older (65.33 years vs 61.75 years, p<0.001) and more likely to be male. Lymph node metastasis was found in 27% of patients with SMGC and 32% of patients with single GC. Multivariate analysis showed that SMGC was associated with sex (male odds ratio [OR], 1.669; 95% confidence interval [CI], 1.223 to 2.278; p=0.001), age (≥65 years OR, 1.532; 95% CI, 1.169 to 2.008; p=0.002), and EGC (OR, 1.929; 95% CI, 1.432 to 2.600; p<0.001). Survival rates were affected by Lauren classification, sex, tumor size, cancer type, distant metastasis, and venous invasion but were not related to the number of GCs. However, the survival rate of AGC with SMGC was very high. Conclusions SMGC had unique characteristics such as male sex, older age, and EGC, and the survival rate of AGC, in which the intestinal type was much more frequent, was very good (Trial registration number: NCT04973631).

Background: Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. Methods: From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y 12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3–5. Results: A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85–2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39–2.78).The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group,P <0.01, 95% CI 2.51–3.91). The frequency of major bleeding was not associated with the HPR in either group. Conclusion LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial Registration: ClinicalTrials.gov Identifier: NCT04734028