Objectives: This study was performed to quantify the impact of coronavirus disease 2019 (COVID-19) on hospital profitability in Korea by analyzing changes in the medical revenue-to-profit ratio (MRPR) and net income before reserve fund allocation (NIBR) before and after the pandemic onset. Additionally, it examined how financial outcomes varied by hospital ownership, geographic location, and type (secondary or tertiary), providing insights into the financial resilience of various hospital types during public health crises. Methods: We conducted a longitudinal analysis using publicly available financial disclosure data from 243 general hospitals in Korea (2016–2022). We then performed a quadrant analysis to classify hospitals based on changes in MRPR and NIBR, identifying patterns of financial impact. For inferential analysis, we employed linear mixed-effects models incorporating a difference-in-differences framework, enabling estimation of both time-varying and hospital-specific effects. Results: Following the onset of COVID-19, MRPR declined significantly, reaching −10.62% in 2020. NIBR initially dropped but later increased, reaching 21.09 billion Korean won per 100 beds in 2022. Quadrant analysis revealed substantial heterogeneity in financial responses, with national/public hospitals experiencing the most severe MRPR decline, whereas educational foundation and medical corporation hospitals displayed stronger financial recovery. Regression results confirmed significant interactions between outcomes after COVID-19 onset and hospital ownership type, indicating differential financial impacts across hospital categories. Conclusions The findings highlight the uneven financial effects of COVID-19 on Korean hospitals, emphasizing the importance of targeted government financial support. Policy measures should prioritize structural financial reforms to ensure hospital sustainability beyond short-term crisis management.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Objective: The study explores the long-term impacts of traumatic brain injury (TBI) on neuroinflammation and neuronal apoptosis in pediatric and adult mice, focusing on how age at injury influences these processes. Methods: Controlled cortical impacts were used to induce TBI in pediatric (21–25 days old) and adult (8–12 weeks old) C57BL/6 male mice. Neuroinflammation was evaluated by measuring immunoreactivity for allograft inflammatory factor 1 (AIF-1)/ionized calcium-binding adaptor molecule 1 (Iba-1) and glial fibrillary acidic protein (GFAP), while apoptosis was assessed using markers such as B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax), Bcl-2, and procaspase-3. Additionally, heat shock protein 70 (HSP70) expression was measured to understand the stress response. Results: Following controlled cortical impacts, pediatric mice exhibited a significant reduction in expression of neuronal nuclei (P<0.001), and significant increases in expression of GFAP (P<0.01) and AIF-1/Iba-1 (P<0.05) at 3 days post-injury (DPI) compared with sham controls. In contrast, adult mice exhibited no significant change in AIF-1/Iba-1 expression and a less pronounced increase in GFAP (P<0.05) at 3 DPI compared with sham controls. A more significant increase in Bax/Bcl-2 ratio at 7 DPI (P<0.01) was seen in pediatric mice, while a weak but significant increase in Bax/Bcl-2 ratio at 7 DPI (P<0.05) was evident in adults. Both age groups showed a significant but transient increase in HSP70 levels at 7 DPI, which normalized by 90 DPI. Conclusion Pediatric and adult mice exhibited significant time-dependent differences in neuroinflammation and apoptosis following TBI, with pediatric mice showing more intense early responses indicative of age-specific vulnerabilities in post-injury outcomes. Both age groups showed a significant but transient increase in HSP70 expression, suggesting an acute response to stress post-injury.

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: For the treatment of locally advanced rectal cancer (LARC), research on primary lesions with mesorectal fascia (MRF) involvement is lacking. This study analyzed the clinical outcomes and efficacy of dose-escalated neoadjuvant concurrent chemoradiotherapy (NCRT) to patients with LARC involving MRF. Materials and Methods: We retrospectively reviewed 301 patients who were diagnosed with LARC involving MRF and underwent NCRT followed by total mesorectal excision (TME). Patients who received radiotherapy (RT) doses of ≤50.4 Gy were defined as the non-boost group, while ≥54.0 Gy as the boost group. Pathological tumor response and survival outcomes, including intrapelvic recurrence-free survival (IPRFS), distant metastases-free survival (DMFS) and overall survival (OS), were analyzed. Results: A total of 269 patients (89.4%) achieved a negative pathological circumferential resection margin and 104 (34.6%) had good pathological tumor regression grades. With a median follow-up of 32.4 months, IPRFS, DMFS, and OS rates at 5-years were 88.6%, 78.0%, and 91.2%, respectively. In the subgroup analysis by RT dose, the boost group included more advanced clinical stages of patients. For the non-boost group and boost group, 5-year IPRFS rates were 90.3% and 87.0% (p = 0.242), 5-year DMFS rates were 82.0% and 71.3% (p = 0.105), and 5-year OS rates were 93.0% and 80.6% (p = 0.439), respectively. Treatment related toxicity was comparable between the two groups (p = 0.211). Conclusion Although this retrospective study failed to confirm the efficacy of dose-escalated NCRT, favorable IPRFS and pathological complete response was achieved with NCRT followed by TME. Further studies combining patient customized RT dose with systemic therapies are needed.