Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) can range from mild cutaneous symptoms to life-threatening anaphylaxis. In patients with a history of ICM hypersensitivity, avoidance of the culprit agent is generally recommended. This case report describes a successful desensitization in a 56-year-old man with recurrent HSRs to multiple agents including ioversol, iohexol, iobitridol, and iopamidol. Intradermal testing was performed to identify potentially safe alternatives; however, all tested agents, including iohexol, ioversol, iobitridol, iopamidol, iodixanol, iomeprol, and iopromide, yielded positive results. Given the clinical necessity of transcatheter arterial chemoembolization, a 13-step rapid desensitization protocol with iodixanol was implemented. The procedure was completed without any breakthrough reactions. This case highlights desensitization as a feasible and effective strategy for patients with hypersensitivity to multiple ICM agents.

Purpose: Brain magnetic resonance imaging (MRI) is commonly performed to exclude secondary causes of pediatric headache. Incidental findings are detected in approximately one-fifth of scans, and nonspecific white matter lesions (WMLs) have been reported in 0.7% to 47% of pediatric patients with headache. However, the natural history of these lesions remains unclear. This study aimed to determine the prevalence and radiologic course of WMLs in pediatric patients with headache. Methods: We retrospectively reviewed the clinical and MRI data of pediatric patients who underwent brain MRI for headache at a single tertiary-care center between September 2006 and July 2023. Patients with neurological or systemic conditions known to cause WMLs were excluded. MRI findings and clinical characteristics were analyzed descriptively. Results: Among the 515 enrolled patients (mean age, 10.7 years), abnormal MRI findings were observed in 126 (24.5%), including nonspecific WMLs in eight (1.6%). Most lesions were supratentorial (seven of eight), with a mean maximum diameter of 10.0 mm (range, 4.3 to 24.9). Follow-up MRI was available for three patients; two demonstrated interval increases in lesion extent on repeat imaging. During the same period, headache frequency or severity also increased, but no new neurological deficits were documented. Conclusion Nonspecific WMLs were rare in pediatric patients with headache. In a small subset with limited follow-up, interval radiologic changes were observed without neurological deterioration. Larger prospective studies are needed to clarify the natural history and clinical significance of WMLs in pediatric headache.

Purpose: Autism spectrum disorder (ASD) exhibits heterogeneous developmental trajectories; however, longitudinal studies using the Korean Childhood Autism Rating Scale (K-CARS) are scarce. This study examined diagnostic changes and related developmental characteristics through repeated K-CARS assessments. Methods: We retrospectively reviewed the medical records of children who underwent repeated K-CARS assessments between May 2021 and December 2024 at Gyeongsang National University Hospital. Based on diagnostic status at the initial (T1) and follow-up (T2) evaluations, participants were classified as having persistent ASD (ASD at T1 and T2), emerging ASD (non-ASD at T1 but ASD at T2), or desisting ASD (ASD at T1 but non-ASD at T2). Developmental profiles were evaluated using the social quotient (SQ), visual-motor integration (VMI), and language quotients. Results: Forty-three children (32 boys; median age, 2.9 years at T1 and 4.3 years at T2) were included. Twenty-two met ASD criteria at T1, and 15 (68%) retained the diagnosis at T2. Across the cohort, 15 (35%) had persistent ASD, 21 (49%) had emerging ASD, and seven (16%) had desisting ASD. The desisting group showed higher baseline VMI and better outcomes at follow-up. The emerging group initially had higher SQ and VMI than the persistent group, but these differences disappeared over time. Higher baseline VMI was associated with desisting status and higher baseline SQ with emerging ASD (odds ratios, 3.14 and 2.59 per standard deviation increase, respectively; P=0.06 and P=0.07). Conclusion Early ASD diagnoses were generally stable yet variable, supporting repeated assessment. Baseline VMI and SQ may relate to later diagnostic changes.

Purpose: Exanthem subitum (ES), most commonly caused by human herpesvirus 6B (HHV-6B), is a prevalent febrile illness in infants and toddlers. Previous studies have suggested a possible association between HHV-6B infection and an increased risk of complex febrile seizures (CFS). Given that CFS may prompt additional diagnostic procedures to rule out serious neurological disorders, we compared the clinical characteristics and management of patients with and without ES. Methods: We retrospectively reviewed the medical records of 141 children younger than two years of age who experienced their first febrile seizure between March 2013 and August 2024 at a tertiary medical center. We collected demographic, clinical, and laboratory data and compared clinical profiles between children diagnosed with ES and those without ES. Results: Twenty-eight children (19.9%) were clinically diagnosed with ES. Although the frequency of CFS did not significantly differ between the ES and non-ES groups (42.9% vs. 28.3%, P=0.172), children with ES were more likely to undergo lumbar puncture (42.9% vs. 11.5%, P<0.001) and receive empiric intravenous antibiotics for suspected central nervous system infection (39.3% vs. 10.6%, P<0.001). Conclusion Despite the typically benign and self-limiting nature of ES, febrile seizures occurring in the context of ES appear to be associated with more aggressive diagnostic and therapeutic interventions. The development of rapid, noninvasive diagnostic assays for HHV-6B may help reduce unnecessary procedures and promote more judicious management.

Background: This study investigated the prognostic value of bilaterality and multifocality in papillary thyroid carcinoma (PTC) recurrence, aiming to inform optimal surgical strategies. Methods: In this retrospective cohort, 1,966 patients who underwent total thyroidectomy for PTC (2011–2014) were categorized into four groups according to tumor multifocality and bilaterality confirmed by postoperative histopathology: group 1, unilateral solitary; group 2, unilateral multifocal; group 3, bilateral solitary; group 4, bilateral multifocal. Clinicopathologic features and clinical outcomes were compared across these groups. Results: Group 4 exhibited the highest prevalence of BRAFV600E positivity, nodal metastases, and recurrence. Both bilaterality and multifocality were associated with more aggressive clinicopathologic characteristics. Recurrence risk increased with the number of tumor foci, with the odds ratio (OR) significantly elevated for more than five foci. Satellite pattern was strongly linked to recurrence (OR, 19.49; P<0.001). While tumor multifocality (≥5 foci) and bilaterality were associated with recurrence in univariate analyses, these associations were not independent after adjustment. Kaplan-Meier analysis demonstrated the lowest recurrence-free survival (RFS) in group 4. Patients with bilateral disease had significantly lower RFS than those with unilateral disease (P=0.003), whereas multifocality did not significantly affect RFS compared to solitary disease (P=0.095). Conclusion Tumor bilaterality, multifocality (≥5 foci), and satellite pattern were associated with aggressive features and higher recurrence risk. Although not independent predictors, these factors may serve as useful surrogate markers of aggressive disease biology and help guide personalized surgical strategies in patients with PTC.

Heart failure (HF) prevalence and associated socio-economic costs have risen rapidly in Korea, creating urgent demand for a national, standardized prospective registry to support quality monitoring, outcome comparison, and real-world evidence. Standardized data definitions are essential for valid comparisons across studies and healthcare settings. We created a unified national HF cohort by integrating the two largest Korean registries, KorAHF (2011–2014;n=5,625) and KorHF III (2018–2023; n=7,351), yielding 12,976 hospitalized HF patients. Because heterogeneous variable definitions impeded direct comparisons, we implemented a harmonization pipeline across demographic, clinical, imaging, biomarker, therapeutic, and outcome domains, aligned with international standards and reinforced by systematic data quality checks.A multidisciplinary panel then conducted a structured decision process to produce the Korean HF Standard Dataset, a tiered and interoperable variable set spanning six domains: demographics, presentation at admission, in-hospital events and comorbidities, discharge status, outpatient follow-up, and readmission events. This integrated platform and standardized variables enable precise identification of HF patient phenotypes and prognostic factors, establishing an evidence-based foundation for disease management. This supports an analysis of temporal changes in treatment patterns and outcomes, generates data to inform future clinical practice guidelines, and provides a practical basis for planning large, continuous, prospective HF registries. Furthermore, it also facilitates pragmatic, registry-based randomized clinical trials and unmet-needs assessments that can guide national health policy. Establishing a foundation for future linkage with national health databases, this platform will allow for enhanced accuracy, comparability, and representativeness, powering quality improvement initiatives and population-level monitoring of Korea’s growing HF burden.

Background and Objectives: Heart failure (HF) imposes a significant global burden, yet awareness and implementation of guideline-directed management remain suboptimal. This study evaluated HF awareness, diagnostic patterns, and therapeutic strategies among physicians in Korea. Methods: A nationwide online survey was conducted from July to August 2019, targeting primary care physicians (PCPs; n=8,000) and hospital-based cardiology specialists (n=1,339) across Korea. The questionnaire comprised 23 items covering baseline characteristics, perceptions of HF prognosis, diagnostic approaches, and treatment practices. Results: A total of 543 physicians responded (209 PCPs and 334 cardiology specialists). While the majority correctly defined HF, a substantial proportion underestimated the lifetime risk and poor prognosis. Cardiology specialists were more likely than PCPs to use objective diagnostic tools, including echocardiography (97% vs. 61%, p<0.001) and natriuretic peptide testing (90% vs. 57%, p<0.001). Among PCPs, 29% reported diagnosing HF based on symptoms and physical findings without objective testing, and 27% reported referring patients to general hospitals for diagnostic evaluation. Prescription rates for guideline-directed medical therapies, including renin-angiotensin system blockers and beta-blockers, were consistently higher among cardiology specialists.PCPs more frequently cited advanced age as a barrier to prescribing evidence-based medications. Conclusions Physicians’ awareness and clinical practices regarding HF in Korea remain suboptimal. Given the growing burden, high mortality, and substantial costs of HF, early detection, appropriate diagnostic evaluation, and timely referral are essential. Targeted education and system-level strategies to improve guideline implementation, particularly in primary care settings, are warranted.

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: Cognitive interventions (CIs) are recognized for enhancing cognition and mitigating cognitive decline in dementia patients. Our study assessed the effects of a 12-week, home-based, robot-assisted CI on cognition and brain function in patients with mild Alzheimer’s disease (AD) dementia. Methods: In this single-blind randomized controlled trial, 51 patients with mild AD dementia were assigned to either a robot-assisted CI group (n=27) or a waitlist control group (n=24). The CI was conducted for 60 minutes per day over 12 weeks. The primary outcome was brain function, measured by resting-state electroencephalogram (EEG) using a 19-channel wireless EEG device and the secondary outcome was cognitive function, measured using the Cambridge Neuropsychological Test Automated Battery. No significant baseline demographic or clinical differences were observed between the groups. Eighteen participants in the robot group and 19 in the control group completed the study. Results: EEG analysis revealed a decrease in theta band activity in the mid-frontal area for the robot group, while the control group exhibited an increase in this area. In addition, the robot group showed significant cognitive improvements in working memory, visual association memory, and reaction time after the 12-week CIs. Conclusion These findings suggest that robot-assisted CIs may be associated with enhanced cognitive and brain function in patients with mild AD dementia.

Purpose: Neuro-oncological ventral antigen 1 (NOVA1), a neuron-specific pre-mRNA splicing factor, is involved in neuronal development and oncogenesis. NOVA1 overexpression is associated with favorable prognosis in head and neck squamous cell carcinoma (HNSCC) and gastric adenocarcinoma, whereas its downregulation correlates with poor outcomes. High NOVA1 levels in these cancers correlate with increased CD3+ and CD8+ T lymphocyte densities, suggesting involvement in tumor immune-inflammatory signals. This study explores NOVA1's role in regulating the immune-inflammatory cGAS-STING pathway in HNSCC cells and clinical tissues. Materials and Methods: HNSCC cell lines (FaDu, YD-10B, SNU-1066, and SNU-1076) were transfected with NOVA1 and poly(dA:dT). Quantitative real-time polymerase chain reaction and Western blot analysis were used to assess gene/protein expression. Enzymelinked immunosorbent assay quantified cytokine levels, and immunoprecipitation assessed protein interactions. Clinical tissue samples from 234 HNSCC patients were analyzed using immunohistochemistry to correlate NOVA1 and STING pathway markers with immune cell infiltration. Results: NOVA1 overexpression in HNSCC cells increased phosphorylation of STING (p-STING) without altering cGAS or TBK1. Immunoprecipitation showed an interaction between NOVA1 and p-STING. Overexpression of NOVA1, particularly with poly(dA:dT) treatment, tended to elevate CCL5 and CXCL10 expression. In clinical samples, NOVA1 expression strongly correlated with p-STING levels (r=0.749, p<0.001). Higher NOVA1 and p-STING expressions were linked to increased infiltration of CD3+ T cells, CD8+ T cells, and FOXP3+ regulatory T cells. Conclusion NOVA1 modulates the cGAS-STING pathway through STING phosphorylation and associated immune responses in HNSCC, providing a potential therapeutic target for enhancing anti-tumor immunity.