Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: and Purpose: Verbal and nonverbal fluency tests are the conventional methods for examining executive function in the elderly population. However, differences in impairments result in fluency tests in patients with mild cognitive impairments (MCIs) and Alzheimer’s disease (AD) and in neural correlates underlying the tests still necessitate concrete evidence. Methods: We compared the test performances in 27 normal controls, 28 patients with MCI, and 20 with AD, and investigated morphological changes in association with the test performances using structural magnetic imaging. Results: Patients with AD performed poorly across all the fluency tests, and a receiver operating characteristics curve analysis revealed that only category fluency test discriminated all the 3 groups. Association, category, and design fluency tests involved temporal and frontal regions, while letter fluency involved the cerebellum and caudate. Conclusions Category fluency is a reliable measure for screening patients with AD and MCI, and this efficacy might be related to morphological correlates that underlie semantic and executive processing.

OBJECTIVE: To determine whether fragment removal on in vitro fertilization (IVF) day 2 improved the subsequent development and pregnancy outcomes of fragmented embryos compared to similar-grade embryos without fragment removal. METHODS: This study was a retrospective analysis involving 191 IVF cycles in which all embryos had over 10% fragmentation (grade 3 or 4) on day 2 of the IVF-embryo transfer cycle from March 2015 to December 2017. IVF cycles were divided into the fragment removal group (n=87) and the no fragment removal group (n=104) as a control cohort. Before fragment removal, embryos with fragmentation on day 2 were incubated in Ca2+- and Mg2+-free biopsy medium under paraffin oil for 30 minutes. Microsurgical fragment removal was performed with later-assisted hatching and a handmade suction micropipette that had an outer diameter of 30 µm. RESULTS: There were no significant differences in the characteristics of the patients between the control and the fragment removal groups. After fragment removal and subsequent in vitro culture for 24 hours, the number of blastomeres (7.1±1.7 vs. 6.9±1.6) was comparable between the transferred embryos in the two groups, but the morphological grade of the embryos in the fragment removal group (1.9±0.7) was significantly higher than that of the control group (3.1±0.5, p < 0.01). The clinical pregnancy (43.7%) and implantation rates (25.8%) in the fragment removal group were significantly higher than those in the control group (28.8% and 14.0%, respectively; p < 0.05). CONCLUSION: Early fragment removal on day 2 significantly improved the subsequent development and pregnancy outcomes of fragmented embryos.
Biopsy ; Blastomeres ; Cohort Studies ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Humans* ; In Vitro Techniques* ; Paraffin ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Suction

OBJECTIVE: This study was carried out to investigate the correlations of the sperm DNA fragmentation index (DFI) with semen parameters and apoptosis, and to investigate the effects of density-gradient centrifugation (DGC) and magnetic-activated cell sorting (MACS) on reducing the proportion of sperm with DNA fragmentation and protamine deficiency. METHODS: Semen analysis and a sperm DNA fragmentation assay were performed to assess the correlations between semen parameters and the DFI in 458 semen samples. Sperm with progressive motility or non-apoptosis were isolated by DGC or MACS, respectively, in 29 normozoospermic semen samples. The effects of DGC or MACS alone and of DGC and MACS combined on reducing the amount of sperm in the sample with DNA fragmentation and protamine deficiency were investigated. RESULTS: The sperm DFI showed a significant correlation (r=–0.347, p<0.001) with sperm motility and morphology (r=–0.114, p<0.05) but not with other semen parameters. The DFI (11.5%±2.0%) of semen samples was significantly reduced by DGC (8.1%±4.1%) or MACS alone (7.4%±3.9%) (p<0.05). The DFI was significantly further reduced by a combination of DGC and MACS (4.1%±1.3%, p<0.05). Moreover, the combination of DGC and MACS (1.6%±1.1%, p<0.05) significantly reduced the protamine deficiency rate of semen samples compared to DGC (4.4%±3.2%) or MACS alone (3.4%±2.2%). CONCLUSION: The combination of DGC and MACS may be an effective method to isolate high-quality sperm with progressive motility, non-apoptosis, high DNA integrity, and low protamine deficiency in clinical use.
Apoptosis ; Centrifugation* ; Centrifugation, Density Gradient ; Chromatin* ; DNA Fragmentation ; DNA* ; Methods ; Product Packaging* ; Semen ; Semen Analysis ; Sperm Motility ; Spermatozoa*

The most common site of extrahepatic metastasis in cases of advanced hepatocellular carcinoma is the lung. A 60-year-old Korean male had been previously diagnosed with hepatocellular carcinoma and was treated several times with transcatheter arterial chemoembolization prior to a regime of sorafenib after multiple bone metastases were detected. Despite 2 months of systemic treatment, the disease progressed, and newly developed cavitary nodules and ground glass opacities were observed on a chest computed tomography scan. Initially the patient was diagnosed with septic pneumonia and was subsequently treated with antibiotics over 2 weeks, with no observable improvement. A percutaneous transthoracic needle aspiration biopsy was performed to ascertain the noninfectious origin of the lung lesions. As a result, a rare form of pulmonary metastasis from hepatocellular carcinoma was discovered. Unfortunately, there were no available treatment options for the patient and so end-of-life care was recommended.
Anti-Bacterial Agents ; Biopsy, Needle ; Carcinoma, Hepatocellular* ; Glass ; Humans ; Lung* ; Male ; Middle Aged ; Needles ; Neoplasm Metastasis* ; Pneumonia ; Thorax

Polyacrylamide hydrogel is used widely in plastic surgery due to its nontoxic, nonabsorbent nature. There have been reports of silicone leading to pulmonary embolism and acute respiratory distress syndrome with systemic adverse effects. However, there have been case reports only of local reactions involving polyacrylamide; systemic reactions appear to be rare. Furthermore, there has been no report of alveolar hemorrhage after polyacrylamide injection for breast augmentation. We treated a 53-year-old female with an alveolar hemorrhage that occurred 2 days after a polyacrylamide injection. On the day of admission, the patient had a fever with chills and dyspnea. The chest X-ray showed multiple infiltrations and chest computed tomography showed consolidation and a ground-glass appearance in both lung fields. The alveolar hemorrhage was confirmed at fiber-optic bronchoscopy and bronchoalveolar lavage. The symptoms and radiology findings improved after corticosteroid administration and conservative treatment. We report the first case of alveolar hemorrhage after a polyacrylamide injection for breast augmentation.
Breast* ; Bronchoalveolar Lavage ; Bronchoscopy ; Chills ; Dyspnea ; Female ; Fever ; Hemorrhage* ; Humans ; Hydrogel ; Lung ; Mammaplasty ; Middle Aged ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult ; Silicones ; Surgery, Plastic ; Thorax

Streptococcal toxic shock syndrome (TSS) is characterized clinically by shock and multiple organ failure, combined with invasive group A streptococcus (GAS) infection. Invasive GAS infection declined with the introduction of modern antibiotics, but has recently arisen again globally with severe presentations like TSS. Cases of streptococcal TSS have been reported in Korea since the 1990s and its prevalence may increase. We report the first case of GAS pneumonia initially presenting as streptococcal TSS, as a warning that this potentially fatal illness requires an early diagnosis and prompt treatment when patients with pneumonia develop shock and multiple organ failure.
Anti-Bacterial Agents ; Early Diagnosis ; Humans ; Korea ; Multiple Organ Failure ; Pneumonia* ; Prevalence ; Shock ; Shock, Septic* ; Streptococcus pyogenes ; Streptococcus*

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Endocarditis ; Endocarditis, Non-Infective ; Female ; Heart Failure ; Humans ; Infarction ; Lung ; Lung Neoplasms* ; Thrombophilia* ; Venous Thrombosis

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Endocarditis ; Endocarditis, Non-Infective ; Female ; Heart Failure ; Humans ; Infarction ; Lung ; Lung Neoplasms* ; Thrombophilia* ; Venous Thrombosis