Background: We developed a simplified variant of the ADV score, the AFP-PIVKAII (AP) score for post-transplant hepatocellular carcinoma (HCC) prognosis, which considers only AFP and PIVKA-II levels excluding morphometric tumor size information from the ADV score. This study investigated the prognostic performance of the AP score in predicting HCC recurrence and overall survival (OS) after living donor liver transplantation (LDLT). Methods: We analyzed 843 patients with HCC who underwent LDLT between 2006 and 2015, assessing HCC recurrence and OS in relation to AP score. Results: The median pretransplant AFP and PIVKA-II levels were 12.8 ng/mL and 27 mAU/mL, respectively. The median and mean AP scores were 2.6 log (range: 0.6–9.2 log) and 2.9±1.1 log, respectively. The 5-year time-dependent area under the receiver operating characteristic curve for the AP score in predicting post-transplant HCC recurrence was 0.672 (p<0.001). HCC recurrence and OS curves along AP score intervals of 1.0 log showed statistical differences in accordance with the AP scores (both p<0.001). Using a Youden index J-derived AP score cutoff of 4.0 log, two-tiered groups (ADV <4.0 log vs. ADV ≥4.0 log) showed statistically significant differences in HCC recurrence and OS (both p<0.001). Harrell’s c-indices for AP score with cutoff of 4.0 log and ADV scores with cutoff of 5.0 log regarding HCC recurrence and OS were similar. Conclusion The AP score functions as an integrated surrogate marker for predicting post-transplant outcomes in patients with HCC undergoing LDLT. It may serve as a simplified alternative to the ADV score, particularly in patients with small HCCs.

Subglottic stenosis (SGS) and tracheal stenosis (TS) are rare conditions that can cause significant breathing difficulties and, if not properly managed, may lead to life-threatening complications. Despite their clinical importance, debate continues regarding the optimal management of adult SGS and TS, and no comprehensive guidelines have been established to date. The Korean Bronchoesophagological Society appointed a task force to develop clinical practice guidelines with the goal of providing evidence-based recommendations for managing SGS and TS in adults. The task force conducted a systematic review of the relevant literature by searching PubMed, Embase, and the Cochrane Library using predefined search terms aligned with key clinical questions. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, which also informed the formulation and reporting of the recommendations. The strength of each recommendation reflects the guideline panel’s confidence that the benefits of an intervention outweigh its risks for eligible patients. After drafting the guidelines, feedback was obtained through Delphi questionnaires completed by members of the Korean Bronchoesophagological Society. Ultimately, the committee developed 17 evidence-based recommendations across four categories: initial evaluation, medical management, surgical treatment, and postoperative management and rehabilitation. These guidelines aim to support clinicians in delivering optimal care to adult patients with SGS and TS.

Background: Studies on whether donor-to-recipient sex match status affects long-term survival after liver transplantation (LT) have yielded contradictory results. This study evaluated whether donor-to-recipient sex match status influenced long-term survival after living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT) at a high-volume center. Methods: The study included 6,664 patients who underwent primary LT between January 2000 and December 2022 at our institution. Patients were divided into four groups according to donor-to-recipient sex match status: male-to-male (n=3,427 [51.4%]), male-to-female (n=1,152 [17.3%]), female-to-male (n=1,385 [20.8%]), and female-to-female (n=700 [10.5%]). Results: Regarding clinical characteristics, the four groups differed significantly regarding background liver disease (P<0.001), model for end-stage liver disease score (P<0.001), serum protein induced by vitamin K absence or antagonist II level (P=0.003), presence of concurrent hepatocellular carcinoma (HCC; P<0.001), and type of LT (P=0.003). Overall survival (OS) of all LT recipients did not differ significantly among the groups (P=0.377). Donor-to-recipient sex match status did not affect long-term OS in either LDLT (P=0.176) or DDLT (P=0.220) groups. In addition, sex match status did not significantly influence posttransplant OS among patients who underwent LDLT without HCC (P=0.464), LDLT with HCC (P=0.236), DDLT without HCC (P=0.338), or DDLT with HCC (P=0.818). Conclusions Donor-to-recipient sex match status does not significantly affect posttransplant patient survival or HCC prognosis after LDLT or DDLT.

Purpose: Robotic adrenalectomy was developed to address the limitations of laparoscopic adrenalectomy and enhance the visualization, dexterity, and control of surgeons performing this beneficial minimally invasive technique. This study compared the clinical and perioperative outcomes of lateral transperitoneal adrenalectomy using da Vinci SP and Xi robotic systems (Intuitive Surgical). Methods: We retrospectively analyzed 84 patients who underwent robotic adrenalectomies at a single institution between January 2019 and July 2024. Sixty-two and 22 patients were treated with da Vinci Xi and SP systems, respectively. Results: No significant differences in patient demographics, tumor size, or postoperative hospital stay between the 2 groups were observed. The SP system demonstrated significantly shorter operative times for right-sided adrenalectomy (81.0 ± 17.1 minutes vs. 113.3 ± 26.2 minutes, P < 0.001), whereas no significant differences were observed in overall operative time (104.9 ± 28.2 minutes for Xi vs. 93.5 ± 23.2 minutes for SP, P = 0.094) or left adrenalectomy (99.9 ± 28.4 minutes for Xi vs. 104.0 ± 23.0 minutes for SP, P = 0.253). Conclusion The da Vinci Xi and SP systems are both effective for robotic adrenalectomy, with the SP system showing particular advantages in right-sided procedures.

The modified Phemister technique, which fixes the acromioclavicular joint with a k-wire and fixes the coronoid process and clavicle with a sling, has often been used as surgical treatment for dislocation of the acromioclavicular joint. This technique has the advantage of allowing early rehabilitation exercises with accurate anatomical reduction and firm fixation. On the other hand, some complications have been reported, such as infection, deformation recurrence, fixation complications, erosion of the distal clavicle or fracture of the sling, and secondary arthritis. This study presents a patient who experienced shoulder pain and functional impairment after conservative treatment for a sling area insufficiency fracture that arose from using the modified Phemister technique. Locking screw plate fixation with tricortical iliac bone grafting and matchstick-shaped cancellous bone grafting were used, and successful outcomes were achieved. This paper reports this case with a review of the relevant literature.

Objective: To evaluate and assesse useful factors in predicting early preterm birth (PTB) and de termined the increased risks of early PTB for the combinations of these factors compared to late PTB. Methods: The 77 singleton pregnancies with PTL were enrolled. They had undergone examinations including cervical length (CL) and fetal fibronectin (fFN), polymerase chain reaction for sexually transmitted disease, and cervical culture. We first evaluated the statistical significance of the primary predictors (known risk factors before pregnancy) and secondary predictors (fFN, CL, high-sensitivity C-reactive protein [hsCRP] and cervical bacterial analysis). Next, we analyzed the various combinations of meaningful factors. Results: CL <2.5 cm (P=0.007; odds ratio [OR], 3.598), hsCRP ≥0.9 mg/dL (P=0.011; OR, 3.79), and fFN ≥50 ng/mL (P=0.035; OR, 2.75) were more predictive of early PTB than late PTB. The highest OR was observed for the combination of all 3 factors (P=0.039; OR, 7.75). The fFN positivity and hsCRP ≥0.9 mg/dL was in OR 6.094 (P=0.013). The CL<2.5 cm and hsCRP ≥0.9 mg/dL was in OR 5.333 (P=0.009). Finally, the CL <2.5 cm and fFN positivity was in OR 3.946 (P=0.013). The interval between diagnosis and delivery in women with all 3 factors was 8 days shorter than that for women without these factors (P=0.04). Conclusion Our study is the first to demonstrate the potential risks of PTB using the combination of commonly used in clinical factors, and revealed quantification by the ORs. We will be useful reference value for patients counselling for prediction of early PTB.

Objective: To evaluate and assesse useful factors in predicting early preterm birth (PTB) and de termined the increased risks of early PTB for the combinations of these factors compared to late PTB. Methods: The 77 singleton pregnancies with PTL were enrolled. They had undergone examinations including cervical length (CL) and fetal fibronectin (fFN), polymerase chain reaction for sexually transmitted disease, and cervical culture. We first evaluated the statistical significance of the primary predictors (known risk factors before pregnancy) and secondary predictors (fFN, CL, high-sensitivity C-reactive protein [hsCRP] and cervical bacterial analysis). Next, we analyzed the various combinations of meaningful factors. Results: CL <2.5 cm (P=0.007; odds ratio [OR], 3.598), hsCRP ≥0.9 mg/dL (P=0.011; OR, 3.79), and fFN ≥50 ng/mL (P=0.035; OR, 2.75) were more predictive of early PTB than late PTB. The highest OR was observed for the combination of all 3 factors (P=0.039; OR, 7.75). The fFN positivity and hsCRP ≥0.9 mg/dL was in OR 6.094 (P=0.013). The CL<2.5 cm and hsCRP ≥0.9 mg/dL was in OR 5.333 (P=0.009). Finally, the CL <2.5 cm and fFN positivity was in OR 3.946 (P=0.013). The interval between diagnosis and delivery in women with all 3 factors was 8 days shorter than that for women without these factors (P=0.04). Conclusion Our study is the first to demonstrate the potential risks of PTB using the combination of commonly used in clinical factors, and revealed quantification by the ORs. We will be useful reference value for patients counselling for prediction of early PTB.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Background: Malignant mixed mullerian tumor (MMMT), a carcinoma of the uterus, is a bi-phasic tumor composed of malignant epithelial and mesenchymal components. The treatment of MMMT remains a challenge despite advances in technology. This study is a preliminary investigation of the potential use of high power lightemitting diode (HPLED) modules as an alternative to laser therapy for cancer treatment. Methods: This study used 656 and 850 nm HPLEDs at 50 mW power output within a non-thermal range duration. The viability and proliferation of the cells were analyzed after irradiation with the HPLEDs. Results: A significant reduction in cancer cell viability was observed after irradiation with either the 656 or 850 nm HPLED. Conclusion This study shows the potential use of HPLEDs for cancer treatment.