Purpose: Diastasis recti abdominis (DRA) is a common issue among postpartum women, resulting in abdominal muscle weakness and associated problems such as back pain and urinary incontinence. However, compliance with exercise programs is often poor due to childcare demands. This study aims to assess changes in ultrasound parameters (inter-recti distance [IRD], shear wave elastography [SWE]) and patient-reported outcomes (PROs) related to DRA following an online exercise program. Methods: Sixty-seven women aged 25–35 years, who had undergone single vaginal delivery, participated in an8-week exercise program delivered via a mobile app. Pre- and post-intervention ultrasound parameters and clinical scores for low back pain (LBP) and urinary incontinence were compared. Results: After the 8-week program, IRD decreased and SWE increased significantly. PROs, including scores for LBP and urinary incontinence, showed significant improvement. Subgroup analysis based on initial IRD diagnostic criteria for DRA revealed significant improvements in ultrasound parameters and PROs in both groups, with greater improvements observed in those initially diagnosed with clinical DRA. Conclusion The 8-week online exercise program through mobile application reduced IRD, SWE, and LBP-related disability and stress urinary incontinence. In particular, IRD showed a larger decrease than the decrease reported in a recent meta-analysis. These results suggest that an online exercise program

Purpose: Diastasis recti abdominis (DRA) is a common issue among postpartum women, resulting in abdominal muscle weakness and associated problems such as back pain and urinary incontinence. However, compliance with exercise programs is often poor due to childcare demands. This study aims to assess changes in ultrasound parameters (inter-recti distance [IRD], shear wave elastography [SWE]) and patient-reported outcomes (PROs) related to DRA following an online exercise program. Methods: Sixty-seven women aged 25–35 years, who had undergone single vaginal delivery, participated in an8-week exercise program delivered via a mobile app. Pre- and post-intervention ultrasound parameters and clinical scores for low back pain (LBP) and urinary incontinence were compared. Results: After the 8-week program, IRD decreased and SWE increased significantly. PROs, including scores for LBP and urinary incontinence, showed significant improvement. Subgroup analysis based on initial IRD diagnostic criteria for DRA revealed significant improvements in ultrasound parameters and PROs in both groups, with greater improvements observed in those initially diagnosed with clinical DRA. Conclusion The 8-week online exercise program through mobile application reduced IRD, SWE, and LBP-related disability and stress urinary incontinence. In particular, IRD showed a larger decrease than the decrease reported in a recent meta-analysis. These results suggest that an online exercise program

Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background/Aims: This study investigated whether the personality traits of endoscopists are associated with the effect of interventions for the improvement of colonoscopy quality. Methods: This prospective, multicenter, single-blind study was performed with 13 endoscopists in three health screening centers over a 12-month period. Quality indicators (QIs), including adenoma detection rate (ADR), polyp detection rate (PDR), and withdrawal time, were measured every 3 months. Consecutive interventions for the improvement of colonoscopy quality were conducted every 3 months, which included the personal notification of QIs, the in-group notification of QIs, and finally a targeted “quality education” session. The personality traits of each endoscopist were evaluated for perfectionism, fear of negative evaluation, and cognitive flexibility after the last QI assessment. Results: A total of 4,095 colonoscopies were evaluated to measure the QIs of the individual endoscopists for 12 months. The mean ADR, PDR, and withdrawal time of the 13 endoscopists were 32.3%, 47.7%, and 394 seconds at baseline and increased to 39.0%, 55.1%, and 430 seconds by the end of the study (p=0.003, p=0.006, and p=0.004, respectively). Among the three interventions, only quality education significantly improved QIs: ADR, 36.0% to 39.0% (odds ratio, 1.28; 95% confidence interval, 1.01 to 1.63). The improvement of ADR and PDR by education was significantly associated with perfectionism (r=0.617, p=0.033 and r=0.635, p=0.027, respectively) and fear of negative evaluation (r=0.704, p=0.011 and r=0.761, p=0.004, respectively). Conclusions Education can improve colonoscopy quality, and its effect size is associated with an endoscopist’s personal traits such as perfectionism and fear of negative evaluation (ClinicalTrials.gov Registry NCT03796169).