Purpose: While MRI-based tumor regression grade (mrTRG) has shown promise in evaluating pathologic response to concurrent chemoradiotherapy (CCRT) in rectal cancer, its ability to predict pathologic complete response remains limited.This study aimed to enhance mrTRG’s diagnostic performance in predicting ypT0–1N0 status, a key factor in considering non-radical management after CCRT for locally advanced rectal cancer (LARC). Methods: This retrospective study included 430 patients with LARC who underwent radical resection following CCRT at a single referral hospital between April 2018 and September 2024. Multivariable logistic regression was used to identify predictive factors associated with achieving ypT0–1N0 status. The diagnostic performances of mrTRG1–2 alone and in combination with other factors were assessed by comparing sensitivity, specificity, positive-predictive value (PPV), negative-predictive value, and area under the curve (AUC). Results: Ninety-three patients (21.6%) achieved ypT0–1N0. In the multivariable analysis, fungating type, cT1–2, and mrTRG1–2 were independent predictors for ypT0–1N0. Integrating mrTRG with gross tumor type yielded the highest AUC of 0.689 among the combined models. For predicting ypT0–1N0, the combination of mrTRG and gross tumor type improved PPV (79.2% vs. 41.5% for mrTRG alone) while also demonstrating enhanced sensitivity compared with ycT0–1N0, the conventional MRI-based predictor (40.9% vs. 22.6%). Conclusion This study demonstrated that combining mrTRG and gross tumor type improved the PPV of mrTRG in predicting ypT0–1N0 after CCRT in LARC. Further studies are warranted to validate the role of gross tumor type in refining predictive systems for selecting candidates for non-radical treatment.

Purpose: Atherosclerotic plaques in peripheral arterial disease (PAD) include fatty, mixed, and calcified types. Plaque burden is significantly associated with restenosis, reintervention, and amputation-free survival. Rotational and aspirational atherectomy (RAA) may effectively remove such plaques. This study aimed to evaluate long-term outcomes of RAA for infrainguinal PAD. Methods: Patients with infrainguinal lesions underwent revascularization using the Jetstream Atherectomy System (Boston Scientific). This 60-month extension assessed primary patency rate (PPR) and clinically driven target lesion revascularization (CD-TLR). Kaplan-Meier curves were used for survival analysis; P < 0.05 was considered statistically significant. Results: A total of 150 patients (mean age, 70.9 years; male, 86.0%; 65.4% with diabetes) were enrolled. The mean lesion length was 15.8 cm, with 74.0% occlusions and 47.3% severe calcification. Lesions were sclerotic (72.4%), thrombosclerotic (13.4%), thrombotic (9.4%), or in-stent (4.7%). A drug-coated balloon (DCB) was used in 85.5% of cases. PPR at 1, 3, and 5 years was 84.1%, 68.1%, and 58.5%, respectively. CD-TLR rates were 93.0%, 81.5%, and 67.4%, respectively. The benefit of DCB was sustained through 3 years but attenuated thereafter, highlighting the need for extended follow-up in infrainguinal interventions. Conclusion RAA demonstrated durable 5-year patency and safety outcomes. Device type, DCB use, lesion morphology, and calcium grade did not significantly influence long-term results. Lesion complexity remains the primary predictor of clinical outcome. Despite the complexity of infrainguinal lesions, the use of RAA demonstrated sustained patency through 3 years, with lesion complexity (particularly TASC classification) emerging as the most critical predictor of long-term success.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.

Purpose: Botulinum toxin type A (BoNT-A) injections are used to manage spasticity in children with low-functioning cerebral palsy (CP), particularly in cases involving the hip adductor muscles. Despite their widespread use, research on the impact of BoNT-A injections on gross motor function in children with CP within Gross Motor Function Classification System (GMFCS) levels III–V remains limited, prompting us to evaluate their effectiveness in this population. Materials and Methods: This retrospective study included 100 preschool children (mean age, 3.9 years) with CP (GMFCS levels III–V) who received BoNT-A injections targeting the adductor muscles at a tertiary hospital (2006–2024). Gross motor function was assessed using the Gross Motor Function Measure (GMFM) within 1 month before injection and between 3 weeks and 4 months post-injection. Subgroup analyses were conducted by GMFCS level and by injection site. Pre- and post-injection assessments were compared using the Wilcoxon signed-rank test. Results: GMFM scores improved significantly across all GMFCS levels (p<0.05). Children at GMFCS levels III and IV demonstrated improvements across all domains (A–E), whereas those at GMFCS level V showed significant gains in domains A, B, and C (p<0.05).Further analyses showed significant improvements in all three groups: adductors alone, adductors and hamstrings, and adductors and distal muscles (p<0.05). Conclusion BoNT-A injections into hip adductor muscles improved gross motor function in children with low-functioning CP, affecting both overall and specific functional domains. This effect was observed in children who received injections into the adductors alone, as well as in combination with injections into the hamstrings or distal muscles.

In patients with differentiated thyroid cancer (DTC), initial recurrence risk stratification based on clinical, histopathological, and perioperative data remains the key determinant for guiding management strategies during the first 1-2 years post-treatment. However, the adoption of ongoing risk stratification (ORS), which dynamically reassesses risk by integrating longitudinal clinical data and treatment response, enables more precise long-term prognostic assessment and facilitates highly individualized management. Building upon recent guidelines, the 2026 KTA guideline has been further refined by incorporating robust evidence from large-scale national cohorts and comprehensive systematic reviews. These updated recommendations outline contemporary concepts of ORS, risk-adapted TSH suppression targets, optimized surveillance modalities for recurrence detection, and disease-specific long-term follow-up strategies. Reflecting the paradigm shift toward de-escalated treatment, this revision integrates evolved perspectives on TSH suppression intensity, the clinical interpretation of thyroglobulin levels, and tailored follow-up intervals. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the large proportion of patients with excellent prognosis after initial therapy, while ensuring that each patient receives appropriately tailored and effective long-term management.

Objective: Objective of this study is to evaluate the association between high risk of depression and metabolic diseases such as hypertension, diabetes, and dyslipidemia in Korean cervical cancer patients. Methods: A total of 330 women with cervical cancer were included in this study, using data from the Korea National Health and Nutrition Examination Survey from 2010 to 2021. Participants were categorized into two groups—high risk of depression and non-depression—based on their answers to survey items related to depression. A multivariate logistic regression analysis was used to evaluate the influence of metabolic diseases on high risk of depression in patients with cervical cancer. Results: A total of 78 (23.64%) and 252 (76.36%) women were classified into the high risk of depression and non-depression groups, respectively. In multivariate logistic regression analysis adjusting for age, menopausal status, and smoking status, diabetes was associated with an odds ratio of 2.47 (95% confidence interval: 1.205, 5.071) for high risk of depression in cervical cancer patients. However, among the metabolic diseases, hypertension, and dyslipidemia were not associated with high risk of depression in patients with cervical cancer. Conclusion This study suggests that diabetes may be associated with a increased risk of high risk of depression in cervical cancer patients. Therefore, appropriate treatment of diabetes in cervical cancer patients may contribute to lowering the risk of depression in the future.

Purpose: Cystic duct cancers (CDCs) have been classified as extrahepatic bile duct cancers or gallbladder cancers (GBCs); however, it is unclear whether their clinical behavior is similar to that of distal extrahepatic bile duct cancers (DBDCs) or GBCs. Materials and Methods: T category of the CDCs was classified using current T category scheme of the GBCs and DBDCs, and clinicopathological factors were compared among 38 CDCs, 345 GBCs, and 349 DBDCs. We modified Nakata’s classifications (type 1, confined within cystic duct [CD]; combined types 2-4, extension beyond CD) and compared them. Results: No significant overall survival (OS) difference was observed between the patients with CDC, GBC, and DBDC. The T category of GBC staging was more accurate at distinguishing OS in patients with CDC than the DBDC staging. Patients with T3 CDC and GBC showed a significant OS difference when using the T category for GBC staging, while those with T1-T2 CDC and GBC showed no significant difference. In contrast, the T category of DBDC staging did not show any significant OS difference between patients with T1-T2 CDC and DBDC or T3 CDC and DBDC. Patients with type 1 CDC had significantly better OS than those with combined types. Conclusion Unlike GBCs and DBDCs, CDCs exhibit distinct clinicopathological characteristics. The OS is better when the CDC confines within the CD, compared to when it extends beyond it. Therefore, we propose a new T category scheme (T1, confined to CD; T2, invaded beyond CD) for better classifying CDCs.

Background: Several studies have investigated the morphological risk factors contributing to posterior cruciate ligament (PCL) injury. However, no study has focused on the injury patterns of intrasubstance tears or tibial avulsion fractures in relation to morphologies and regional bone quality. This study aimed to investigate the impact of the knee morphology and regional bone quality of the proximal tibia on the PCL injury pattern. Methods: This retrospective study compared the radiological features of 76 patients with PCL injuries (PI group) and 76 matched patients with normal PCL (control group). The PI group was divided into 2 subgroups: PCL avulsion fracture (PAF subgroup; n = 43) and PCL intrasubstance tear (PIT subgroup; n = 33). Measurements included the coronal notch width index, coronal tibial slope, medial and lateral posterior tibial slopes, and medial tibial depth. Three Hounsfield unit average measurements were taken from the proximal tibia around the PCL insertion site to create a summative measure of overall bone quality. Results: The medial tibial depth and coronal notch width index were significantly lower in the PI group than those in the control group (medial tibial depth: 2.04 ± 0.77 vs. 3.02 ± 1.04, p = 0.017; coronal notch width index: 0.21 ± 0.03 vs. 0.24 ± 0.03, p = 0.041). In the subgroup analysis, medial tibial depth and Hounsfield unit were significantly lower in the PAF subgroup than in the PIT subgroup (medial tibial depth: 1.74 ± 0.66 vs. 2.43 ± 0.77, p = 0.008, Hounsfield unit: 89.48 ± 31.73 vs. 120.15 ± 29.24, p = 0.004). Binary logistic regression analysis showed that medial tibial depth (odds ratio [OR], 0.161; p < 0.001) and Hounsfield unit (OR, 0.950;p < 0.001) were independent risk factors for PCL tibial avulsion fractures. Conclusions Lower notch width index and medial tibial depth are associated with PCL injuries. Shallower medial tibial depth and lower Hounsfield unit measurements around the PCL insertion site were associated with an increased incidence of PCL avulsion fractures. These findings may assist clinicians in identifying patients at risk of distinct PCL injury patterns.

OBJECTIVES: This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services. METHODS: This study was conducted in Seoul, Korea, where the country’s first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed. RESULTS: Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values <0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p<0.001). No significant differences were observed in the acceptance, organization, or involvement subscales of the K‑IT‑HOME (all p-values >0.05). CONCLUSIONS This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.