Purpose: To report the clinical utility of the Barrett True-K formula in predicting multifocal intraocular lens (IOL) power in a patient with corneal deformation caused by radial keratotomy (RK), where postoperative refractive power prediction is challenging.Case summary: A 61-year-old male who underwent RK 30 years ago presented for cataract surgery. Slit-lamp examination showed eight RK incisions in each eye. Refractive error was +3.25 D sph; -1.75 D cyl, axis 70 in the right eye and +2.75 D sph; -1.00 D cyl, axis 110 in the left. Uncorrected visual acuity was 0.32 in the right eye and 0.63 in the left. IOL power was calculated using the Barrett True-K formula on the IOLMaster 700, with a target refraction of -0.25 D, and a multifocal IOL was implanted. Six months after cataract surgery, both eyes achieved a fraction close to emmetropia, with best corrected visual acuity of 0.63 in the right eye and 1.0 in the left. No significant refractive shifts or other complications were observed during surgery or 6-month follow-up. Conclusions The Barrett True-K formula, which measures the actual corneal refractive power to compensate for corneal deformation, is expected to be clinically useful for multifocal IOL implantation during cataract surgery in eyes after RK.

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.

Purpose: This developmental study explored the conceptual feasibility and applicability of a metaverse-based clinical assessment platform as a complementary tool to conventional objective structured clinical examinations in undergraduate medical education. Methods: A targeted literature review and expert consensus process were conducted to identify domains of clinical competence in which metaverse technologies could provide added value. Based on these findings, prototype virtual patient simulations were developed within a metaverse environment. Large language models (LLMs) were integrated to support dynamic, interactive history-taking simulations, and pilot modules for physical examination were also created. Results: Integration of LLMs into virtual patient scenarios enabled realistic, context-sensitive medical interviews, facilitating interactive dialogue between examinees and simulated patients. In contrast, physical examination modules faced technical limitations, particularly in replicating procedures requiring tactile or haptic feedback, such as palpation and percussion. Nevertheless, the metaverse environment enabled delivery of consistent and reproducible scenarios, supporting objective assessment of communication and diagnostic reasoning skills. Conclusion Metaverse-based simulations augmented by LLMs offer a promising approach to scalable and standardized clinical assessment, particularly within cognitive and interpersonal competency domains. Although current technological constraints limit the fidelity of physical examination simulations, rapid advancements in immersive and haptic technologies may help overcome these barriers in the near future. Further research is needed to evaluate the educational efficacy, validity, and feasibility of deploying such platforms in summative, high-stakes assessment contexts.

Purpose: Alectinib has been approved for anaplastic lymphoma kinase (ALK)–positive non–small cell lung cancer (NSCLC) at 300 mg twice daily in Japan, lower than global standard of 600 mg twice daily. This study evaluated the clinical relevance of the reduced dose by comparing outcomes between the two doses. Materials and Methods: This study included patients with advanced ALK-positive NSCLC who received alectinib at Samsung Medical Center, Korea. The progression-free survival (PFS), overall survival, cumulative incidence of central nervous system (CNS) progression, and safety profiles were retrospectively reviewed and compared. Results: Among 306 patients, 32 and 274 received alectinib at either 300 or 600 mg twice daily, respectively. The 300 mg group showed a slight but not significant advantage in PFS (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.44 to 1.51; p=0.51) and overall survival (HR, 0.51; 95% CI, 0.20 to 1.21; p=0.13). Superior outcome with 300 mg was remarkable in patients with lower body weight (≤ 60 kg), but diminished in patients with higher body weights. Patients with baseline brain metastasis in the 300 mg group exhibited a slight increase in incidence of CNS failure (HR, 1.76; 95% CI, 0.53 to 5.8; p=0.36). Although the safety profiles were mostly mild, adverse events were more frequent in the 600 mg group, 50% of which requiring dose reduction. Conclusion Alectinib at 300 mg twice daily seems an acceptable dose in East Asians with ALK-positive NSCLC. Notably, our data favor 300 mg twice daily in patients with lower body weight and no baseline brain metastasis, considering the more tolerable safety profiles and the potential to reduce medical costs.

Limited data exist regarding the real-world practices and clinical outcomes in patients with ischemic heart failure with reduced left ventricular ejection fractions (LVEFs).Using nationwide registry data from South Korea, we aimed to investigate long-term outcomes and clinical practices, especially implantable cardioverter defibrillators (ICDs) implantation, in patients with reduced LVEFs at least 40 days after acute myocardial infarction (AMI). Of 13,056 patients with AMI between 2011 and 2015, we analyzed 350 (median age, 66 years [interquartile range, 56-75]) who had LVEFs <40% on follow-up transthoracic echocardiogram 40 days after the index event. The primary outcome was cardiac-cause mortality at 3 years. Secondary outcomes comprised major cardiovascular events as well as outcomes defined by the use of ICDs, cardiac resynchronization therapy defibrillators (CRT-Ds), and electrophysiology studies. Among 350 patients, 39 (11.1%) died from cardiac causes during 3 years of follow-up. Eleven (3.1%) were hospitalized for ventricular tachycardia. The rate of ICD or CRT-D implantation up to 3 years was 5.7% (20/350). Cox time-to-event analysis revealed older age, LVEF <30%, diabetes mellitus, and previous MI or revascularization as positively associated with cardiac death, whereas the use of statins and body weight <67 kg were negatively associated. This nationwide Korean registry demonstrated that only 5.7% of patients who had reduced LVEFs after 40 days of AMI underwent ICD implantations over 3 years. Considering the high mortality, concerted efforts are needed to improve clinical outcomes for patients who may have been candidates for ICD implantation.

Objective: Transpedicular intravertebral cage augmentation is a less invasive alternative to corpectomy for osteoporotic vertebral fractures (OVFs) with neurological deficits. However, because the intravertebral cage depends on the residual vertebral shell for support, objective criteria for patient selection remain undefined. This study aimed to identify preoperative cutoff values predictive of mechanical failure. Methods: Twenty-four patients who underwent transpedicular intravertebral cage insertion with posterior instrumentation for OVFs or Kümmell disease were divided into a mechanical complication (MC) group (n = 9) and a non-MC group (n = 15). Receiver operating characteristic curve analysis was performed to determine preoperative cutoff values. Results: The MC group had a lower preoperative index height (13.9 ± 4.2 mm vs. 16.5 ± 2.9 mm; p = 0.043) and a greater pelvic incidence (PI)–lumbar lordosis (LL) mismatch (33.1 ± 17.3° vs. 19.0 ± 11.7°; p = 0.026) than the non-MC group. A preoperative index height of ≤12.7 mm (area under the curve [AUC]= 0.756, specificity = 1.000, p = 0.003) and a PI–LL mismatch of ≥22.9° (AUC = 0.756, odds ratio, 12.0, p = 0.033) were significant predictors of mechanical failure. All patients with an index height of ≤12.7 mm experienced failure. The MC group achieved a greater height restoration ratio (47.4% vs. 22.7%; p = 0.017) but reached a similar postoperative height (~20 mm, p = 0.811), with a strong inverse correlation between preoperative height and restoration ratio (r = −0.804, p < 0.001). Only the MC group showed a significant loss of correction during follow-up (p = 0.020). Conclusion A preoperative index height of ≤12.7 mm and a PI–LL mismatch of ≥22.9° may serve as preliminary thresholds indicating the biomechanical limits of intravertebral cage augmentation. In severely collapsed vertebrae, the degree of correction required may exceed what the intravertebral cage can sustain, and these patients may therefore benefit from corpectomy.

Shoulder diseases, including adhesive capsulitis, rotator cuff tear, and osteoarthritis of the glenohumeral joint, can significantly impair daily activities in older adult patients. This review aims to examine the radiologic findings associated with these shoulder conditions in older patients, providing insights for accurate diagnosis and effective treatment. Adhesive capsulitis, commonly known as frozen shoulder, leads to pain and restricted movement, thereby causing shoulder dysfunction. Recent advances in diagnostic technology have greatly enhanced the sensitivity and accuracy of diagnosing this condition through radiologic evaluations, including MRI, magnetic resonance arthrography (MRA), and high-resolution ultrasound. Rotator cuff disease is another frequent issue in older adults, with full-thickness tears occurring in 50%–80% of cases. Both MRI and MRA are highly sensitive and specific in identifying rotator cuff tears. Additionally, ultrasonography is recognized for its high sensitivity and specificity in detecting tears of the supraspinatus tendon. Although osteoarthritis of the glenohumeral joint is less commonly prevalent, its advanced stages can severely affect the function of the upper extremity. Plain radiography is typically the first imaging technique used to assess this type of osteoarthritis. As the condition worsens, CT is utilized to measure glenoid bone loss, glenoid version, and inclination, which are crucial for accurate surgical planning. Each imaging modality provides distinct benefits: plain radiographs for initial structural assessment, ultrasonography for real-time evaluation of soft tissues, MRI/MRA for detailed visualization of capsular and tendinous lesions, and CT for precise bony analysis.

Background/Aims: Portal vein thrombosis (PVT) frequently occurs in patients with inflammatory bowel disease (IBD), particularly when influenced by factors such as abdominal infections, IBD flare-ups, or surgical procedures. The implications of PVT range from immediate issues such as intestinal ischemia to long-term concerns including portal hypertension and its complications. However, there is a notable gap in comprehensive studies on PVT in IBD, especially with the increasing incidence of IBD in Asia. This research aimed to evaluate the clinical features and outcomes of PVT in patients with IBD at a leading hospital in South Korea. Methods: This retrospective analysis reviewed adult patients diagnosed with both IBD and PVT from 1989 to 2021 at a renowned South Korean medical center. The study focused on patient characteristics, specifics of PVT, administered treatments, and outcomes, all confirmed through enhanced CT scans. Results: A total of 78 patients met the study’s criteria. Notably, only 20.5% (16/78) were treated with oral anticoagulants; however, a vast majority (96.2%; 75/78) achieved complete radiographic resolution (CRR). When comparing patients receiving anticoagulants to those who did not, a significant preference for anticoagulant use was observed in cases where the main portal vein was affected, as opposed to just the left or right veins (p = 0.006). However, multivariable analysis indicated that neither anticoagulant use nor previous surgeries significantly impacted CRR. Conclusions Patients with IBD and PVT generally had favorable outcomes, regardless of anticoagulant use.

Maigne syndrome, also known as thoracolumbar junction syndrome, is an underdiagnosed cause of low back pain that often involves superior cluneal nerve entrapment. This condition can overlap with osteoporotic vertebral compression fractures (OVCFs), complicating the diagnosis. We report two cases of elderly female patients with OVCFs and persistent buttock pain due to cluneal nerve entrapment. Both patients showed significant pain relief after undergoing L1 corpectomy and posterior pedicle screw fixation, with numeric rating scale scores dropping from 8 to 1-3. Early recognition of Maigne syndrome can improve outcomes in patients with atypical pain presentations.

Differentiating cervical radiculopathy from shoulder pathologies is challenging due to the overlap of symptoms such as pain, weakness, and paresthesia. This review highlights key aspects of cervical radiculopathy, including clinical history, neurological findings, and provocation tests, while also focusing on common shoulder conditions such as rotator cuff disorders, adhesive capsulitis, and calcific tendinitis. Cervical radiculopathy often presents with radiating pain, sensory disturbances, and motor weakness, which can easily be confused with symptoms stemming from shoulder pathologies. A detailed clinical history, including onset, duration, and aggravating or alleviating factors, plays a crucial role in distinguishing among these conditions. Neurological assessments, such as reflex testing and sensory evaluation, provide further insights into the nature of the symptoms and assist in identifying nerve root involvement.