Purpose: To develop the 2025 update to the Korean colorectal cancer (CRC) screening guidelines by systematically evaluating recent evidence, integrating domestic data, and addressing changes since the 2015 guideline revision, thereby providing an evidence-based standard for clinicians and policymakers. Methods: A multidisciplinary committee developed the guidelines using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The process included formulation of three key questions addressing screening efficacy, diagnostic accuracy, and optimal screening age and interval. A systematic review of international guidelines and primary literature was conducted, yielding 327 eligible studies. In addition, a utility-based analysis using a Markov model was performed to determine optimal screening ages and intervals. Results: The evidence synthesis identified high-certainty evidence supporting the use of the fecal immunochemical test (FIT) for reducing CRC mortality and moderate-certainty evidence for colonoscopy. Evidence for computed tomographic colonography (CTC) and stool DNA testing was rated as very low certainty. Based on the evidence review and cost-utility analysis, the committee conditionally recommends CRC screening for asymptomatic, average-risk adults aged 45–74 years using either colonoscopy every 10 years or FIT every 1–2 years. CTC and stool DNA testing were not recommended owing to insufficient evidence. Conclusion The 2025 Korean Guidelines for Colorectal Cancer Screening present updated, evidence-based recommendations tailored to the domestic healthcare context. By conditionally endorsing both colonoscopy and FIT for individuals aged 45–74 years, these guidelines aim to improve population-level screening effectiveness and reduce the burden of CRC in South Korea.

Metaverse-based mental health interventions have recently emerged as an extension of telepsychiatry, digital therapeutics (DTx), and virtual reality (VR)–based treatments for children and adolescents. The coronavirus disease 2019 pandemic accelerated the adoption of remote psychological assessment and intervention, raising critical questions regarding their clinical validity, developmental appropriateness, and long-term applicability in youth populations. Accumulating evidence has demonstrated that remote assessments and internet-based interventions can achieve clinical outcomes comparable to face-to-face approaches in selected domains, particularly anxiety, depression, and social communication difficulties. In parallel, immersive technologies such as VR and metaverse-based platforms have been applied to exposure-based interventions, social skills training, and emotion regulation in controlled and repeatable environments. This narrative review examined 48 empirical and review studies on telepsychiatry, internet-based cognitive behavioral therapy, DTx, VR, and metaverse-based interventions for children and adolescents. Neurobiological mechanisms relevant to fear extinction, executive function, emotion regulation, and social cognition were critically reviewed. In addition, real-world implementation experiences from a hospital-based Wee Center in Korea were integrated to evaluate feasibility within school-linked mental health services. The findings suggested that metaverse-based counseling should not be conceptualized as a stand-alone replacement for face-to-face treatment, but rather as a complementary, hybrid platform linking remote screening, structured digital intervention, and in-person clinical care. While current evidence supported feasibility and conditional clinical utility, further longitudinal, controlled, and cost-effectiveness studies were required to establish its role in pediatric mental health.

Objective: To classify life stages for companion dogs and cats by identifying clusters in age-specific disease proportions derived from medical records, providing a data-driven foundation for health examination programs. Methods: We collected 505,667 medical records from 82 veterinary facilities in South Korea between 2020 and 2023. Diagnoses were standardized using GPT-4o and S-BioBERT. Following preprocessing, data from 27 facilities yielded 222,706 canine and 39,910 feline records for the final analysis. Principal component analysis and K-means clustering (K = 4) were applied to age-specific disease proportions to identify life stages.The 10 most highest-proportion diagnoses diseases were determined for each cluster. Results: Canine life stages were classified as ≤ 1 year, 2–5 years, 6–10 years, and 11–15+ years.Feline life stages were 1–2 years, 3–8 years, 9–12 years, and 13–15+ years. In dogs, developmental diseases were common in the youngest age group, while chronic diseases were more prevalent in older groups. In cats, oral and urinary diseases were high-ranking, conjunctivitis was most common in the early stage, and chronic diseases increased with age. Conclusions and Relevance: Age-specific diagnosis patterns support four practical life stages for dogs and cats in South Korea. These boundaries can inform evidence-based preventive examination schedules, animal health policy, and pet insurance product design.

Pediatric vulvar hematoma typically results from straddle-type injuries and is usually managed with nonoperative measures. However, rapid progression and the risk of complications in some cases, including tissue necrosis, infection, and urinary retention, necessitate surgical intervention. The highly vascularized anatomy of the vulva allows for rapid hematoma expansion, requiring careful assessment of hematoma size, progression, functional impairment, and hemodynamic stability when determining the treatment strategy. In addition, genital trauma during developmental periods can influence self-perception and psychosexual development, making timely intervention important to prevent aesthetic and functional sequelae. We present two pediatric patients with vulvar hematoma who underwent successful surgical treatment following careful evaluation of both physical and psychological factors. This report emphasizes the importance of a comprehensive, multifaceted approach to the management of pediatric vulvar hematomas.

Background: One-lung ventilation (OLV) during thoracic surgery frequently requires approximately 100% oxygen, imposing the risk of hyperoxemia. This study aimed to assess whether oxygen reserve index (ORI)-guided fraction of inspired oxygen (FiO2) adjustment can reduce the incidence of hyperoxemia in children undergoing lung resection. Methods: This prospective, randomized controlled trial enrolled children aged < 7 years scheduled for thoracoscopic lung resection. The participants were randomly assigned to either a conventional group (FiO2 adjusted based on arterial blood gas analysis [ABGA]) or an ORI group (FiO2 titrated to maintain an ORI target of 0.15). ABGA was performed 10 and 30 min after the start of OLV (T1 and T2). The primary outcome was the incidence of hyperoxemia 30 min after OLV (T2). Results: Data from 64 children (31 conventional, 33 ORI groups) were analyzed. The incidence rate of hyperoxemia at T2 was similar between the conventional and ORI groups (54.8% vs. 60.6%, P = 0.801). However, partial pressure of arterial oxygen at T1 was significantly lower in the ORI group than in the conventional group (214.6 ± 65.5 mmHg vs. 268.8 ± 92.7 mmHg, P = 0.014). The ORI group demonstrated a lower time-weighted average FiO2 during OLV (0.79 ± 0.12 vs. 0.87 ± 0.09, P = 0.004). The ORI group required more rescue interventions than the conventional group and experienced fewer episodes of hypoxia. Conclusions ORI-guided FiO2 adjustment does not significantly reduce the incidence of hyperoxemia in children undergoing OLV but reduces time-weighted FiO2 and hypoxic events.

Background: The pulse wave transit time (PWTT) increases with decreased vascular tone resulting from sympathetic blockade caused by regional anesthesia. It oscillates, exhibiting variability due to the interaction between the autonomic nervous and cardiovascular systems. We hypothesized that interscalene brachial plexus block (ISBPB) placement increases the PWTT and reduces the low-frequency power of PWTT variability (LF). Methods: Fifty-six patients receiving an ISBPB were analyzed. The PWTT was defined as the difference in milliseconds (ms) between the R peak of the electrocardiogram and the peak of the second-derivative photoplethysmographic waveform. The LF was calculated by integrating from 0.04 to 0.15 Hz on the power spectrum obtained from fast Fourier transform. The two variables were collected during the 5 min before the end of acclimatization (baseline), between 5 and 10 min after block needle insertion, and between 15 and 20 min after block needle insertion. Results: The PWTT increased significantly (P < 0.001) from baseline (mean [SD]: 155.3 [16.7] ms) to 5–10 min post-needle insertion (166.9 [15.4] ms) (mean difference [MD]: 11.6, 95% CI [9.2–14.0], P < 0.001) and 15–20 min post-needle insertion (165.6 [16.1] ms) (MD: 10.3, 95% CI [7.3–13.2], P < 0.001). The natural log-transformed LF (lnLF) decreased significantly (P < 0.01) from baseline (1.539 [0.560] ln[ms2/Hz]) to 5–10 min post-needle insertion (1.341 [0.617] ln[ms2/Hz]) (MD: –0.198, 95% CI [–0.356 to –0.040], P < 0.01) and 15–20 min post-needle insertion (1.396 [0.548] ln[ms2/Hz]) (MD: –0.144, 95% CI [–0.274 to –0.013], P = 0.03). Conclusions The post-ISBPB decrease in lnLF and increase in PWTT may be attributable to ISBPB-induced sympathectomy.

Background: Hypertensive patients tend to have an increased risk of hypotension during anesthesia induction, which can result in adverse outcomes. This study aimed to compare hemodynamic stability with remimazolam versus propofol in hypertensive patients. Methods: This meta-analysis analyzed randomized controlled trials investigating the hemodynamic outcomes of remimazolam versus propofol during anesthesia induction in hypertensive adults. A systematic search of electronic databases was conducted in November 2024. Results: Six studies were included in the final analysis. The administration of remimazolam significantly lowered the risk of hypotension (risk ratio [RR] = 0.711, 95% CI [0.545–0.929], I2 = 67.54%) and bradycardia (RR = 0.256, 95% CI [0.101–0.649], I2 = 0.0%). It also resulted in a higher minimum mean arterial pressure (mean difference [MD] = 9.023 mmHg, 95% CI [0.243–17.802], I2 = 97.50%) and higher minimum heart rate (MD = 7.200 beats/min, 95% CI [1.960–12.441], I2 = 86.40%). Despite these findings, substantial heterogeneity was observed in continuous outcomes. The trial sequential analysis revealed that none of the outcomes reached the required information size. Conclusions The administration of remimazolam showed a trend toward superior hemodynamic stability compared with propofol during anesthesia induction in hypertensive patients, especially in minimizing the incidence of hypotension and bradycardia. However, the trial sequential analysis results remain inconclusive, the current evidence is limited by small sample sizes, and larger trials are needed to confirm our findings.

Purpose: Atypical hyperplasia (AH) management remains controversial due to variable malignant disease progression rates. While Western studies report 10% to 25% upgrade rates, data from Asian populations, particularly from referral academic centers, are limited. We aimed to identify predictive factors for malignant upgrade in Korean women with AH at academic hospitals. Methods: This retrospective multi-institutional study analyzed 340 patients diagnosed with AH on initial biopsy who underwent subsequent excision at five Korean academic hospitals from 2000 to 2022. Malignant upgrade was defined as ductal carcinoma in situ or invasive cancer on the final pathology. Multivariate logistic regression was used to identify independent predictors of upgrades. Results: Among 340 patients (319 atypical ductal hyperplasia, 20 atypical lobular hyperplasia, and 1 mixed), 128 (37.6%) experienced a malignant upgrade, 98 (76.6%) to ductal carcinoma in situ, and 30 (23.4%) to invasive cancer. In multivariate analysis, multifocal atypia (odds ratio [OR], 25.61; 95% confidence interval [CI], 11.20–58.55; P<0.001) and Breast Imaging-Reporting and Data System 4c-5 lesions (OR, 11.02; 95% CI, 1.43–84.86; P=0.021) were significant predictors. Multifocal atypia showed an 84.4% upgrade rate. Core needle biopsy had higher upgrade rates than vacuum-assisted biopsy (45.2% vs. 20.0%; P<0.001). The upgrade rates decreased from 50% to 25% over the study period (P<0.05). Conclusion The 37.6% upgrade rate in this tertiary referral cohort exceeded that in Western reports, with multifocal atypia emerging as the strongest predictor. These findings support immediate excision for multifocal atypia while allowing individualized management for unifocal lesions with favorable imaging in Korean tertiary care settings.

Objectives: This study aimed to develop a NOVA-based scoring approach for evaluating ultra- processed food (UPF) intake among Korean adults and to examine its performance. Previous studies have reported that young adults have the highest levels of UPF consumption. Accordingly, this study focused on adults aged 19–40 years and developed scoring components reflecting dietary patterns specific to Korean eating habits. Methods: Using 24-hour dietary recall data from adults aged 19–40 years in the Korea National Health and Nutrition Examination Survey (2021–2023), foods were classified according to the Korean-adapted NOVA system. The top 10 food groups accounting for ≥ 80% of cumulative UPF-derived energy were selected to construct the scoring components. The tool was operationalized using food frequency questionnaire (FFQ) data from the Gangwon cohort study (2022–2024). Intake frequencies were converted into scores ranging from 0 (“rarely or never”) to 5 (“≥ 1 time/day”), and summed to generate the NOVA–UPF score (range: 0–50). Results: Among 237 young adults (aged 20–49 years), the mean NOVA–UPF score was 22.9 ± 8.3. A positive association was observed between the NOVA–UPF score and FFQbased UPF energy intake (Spearman’s ρ = 0.629, P < 0.001). Cross-classification showed that 51.9% were classified into the same tertile and 94.9% into the same or adjacent tertiles, with a weighted kappa coefficient of 0.279. Conclusion This NOVA-based scoring approach may serve as a preliminary tool for assessing UPF intake in Korean young adults. Further refinement and rigorous validation using quantitative dietary assessment methods and more diverse populations are required before broader application.

Objectives: This study aimed to evaluate the relationship between oxidative balance score (OBS), a metric indicating an individual’s oxidative balance status, and the number of teeth in a sample of Korean adults. Methods: This cross-sectional study included 13,199 adults aged 19 and older who participated in a health survey and oral examination. Subsequent to the adjustment for confounding factors, a logistic regression analysis was employed to evaluate the probability of a subject belonging to a number of teeth category based on OBS level. Results: In the group with OBS level T2, the likelihood of having NT1 (0–10 teeth) was found to be significant adjusted for all variables (odds ratios: 1.51, 95% confidence intervals: 1.195–1.908). In the multinomial model, a significant association was observed for the NT1 category, whereas no significant association was found for the NT2 (11–20 teeth) category after adjustment. Conclusion In the group with OBS level T2, the likelihood of having NT1 (0–10 teeth) was found to be significant. As this study examines cross-sectional associations, the necessity of conducting longitudinal research as subsequent studies is evident to ascertain the existence of causality.