Vertebral artery (VA) occlusion is often managed conservatively, but anterior spinal artery (ASA) involvement may cause rapid neurological deterioration. We report two contrasting cases of VA occlusion with ASA compromise. One patient achieved complete recovery after timely endovascular treatment (EVT) restoring ASA flow, whereas the other developed severe bilateral medial medullary infarctions following unsuccessful EVT. These cases highlight the prognostic importance of ASA involvement and suggest that EVT should be considered when ASA perfusion is threatened.

Purpose: Stress radiographs have long been used to evaluate chronic lateral ankle instability. Several measurement methods exist, but their diagnostic value remains controversial. This paper introduces a new measurement method for stress radiographs, the fibular tip to talar neck (FTN) method, and compares it with established methods to assess its diagnostic accuracy and reliability. Materials and Methods: Forty-one patients who underwent a modified Broström procedure for chronic lateral ankle instability were included. Lateral standing and anterior drawer radiographs were analyzed using two conventional methods (methods I and II) and the novel FTN method. The contralateral unaffected side served as an internal control. The diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The intra-observer and inter-observer reliability were assessed using intraclass correlation coefficients (ICCs). Results: Using the FTN method, the mean gap on the affected side (14.39±4.79 mm) was significantly greater than on the contralateral side (10.24±4.19 mm, p<0.001). The side-to-side difference (SSD) was significantly higher in the FTN method (4.14±2.94 mm) compared to methods I (0.89±1.94 mm) and II (0.91±1.78 mm, p<0.001). The FTN method showed a balanced diagnostic performance with an area under the curve of 0.743 and an optimal cut-off of 13.5 mm. The intra-observer and inter-observer reliability were good for all methods. The intra-observer and inter-observer ICCs for the FTN method were 0.858 and 0.783, respectively. Conclusion The FTN method provides a reliable and reproducible measure of chronic lateral ankle instability. The method facilitates a more intuitive diagnosis compared to conventional techniques by providing a larger numerical differentiation (SSD) and a statistically balanced threshold.

Endoscopic surgery has emerged as a viable treatment option for cervical stenotic myelopathy, offering several advantages over conventional approaches. In multilevel cervical myelopathy, traditional microscopic laminoplasty via the posterior approach requires muscle dissection along the spinous process, which serves as the insertion point for stabilizing muscles, thereby disrupting the posterior tension band. Recently, endoscopic laminoplasty techniques have been explored; however, these often involve detaching the spinous tip from the lamina, compromising the cervical fulcrum. In this report, we introduce a novel surgical technique using a unilateral biportal endoscopy (UBE) system that preserves key cervical structures typically damaged by prior open or endoscopic laminoplasty methods. An 82-year-old man presented with bilateral lower-extremity weakness. Imaging revealed stenosis at C3–4–5 with associated cord signal changes. Maintain anatomy laminoplasty was performed using the UBE system, preserving both the posterior tension band and the spinous process fulcrum. Postoperatively, the modified Japanese Orthopaedic Association and Numeric Rating Scale scores improved. The patient was discharged on postoperative day 4. This new unilateral biportal endoscopic cervical laminoplasty is a safe, effective, and minimally invasive technique that achieves complete decompression in multilevel cervical stenotic myelopathy while maintaining critical anatomical structures.

Background/Aims: Endoscopic anti-reflux therapy is a therapeutic option for gastroesophageal reflux disease (GERD), providing durable effects. However, clinical data from Korea remain limited. This study evaluates the clinical outcomes of endoscopic radiofrequency Stretta therapy in Korean patients. Methods: A retrospective analysis was conducted on 71 patients with GERD who underwent Stretta therapy at 2 tertiary hospitals in Korea between November 2015 and July 2021. Clinical outcomes, including patient satisfaction, medication cessation or reduction, and complications, were evaluated. Pre- and post-procedural esophageal manometry and 24-hour pH monitoring test results were also analyzed. Results: Patient satisfaction rates at 1, 6, and 12 months post-procedure were 54.7% (35/64), 70.0% (28/40), and 75.0% (21/28), respectively. Medication cessation or reduction was achieved in 31.2% (20/64) at 1 month, 70.0% (28/40) at 6 months, and 67.9% (19/28) at 12 months. Esophageal manometry (n = 21) showed no significant changes in mean lower esophageal sphincter pressure (18.7 mmHg [2.5-52.9] vs 17.4 mmHg [0.0-43.0], P = 0.702) or mean integrated relaxation pressure (8.2 mmHg [0.0-28.0] vs 10.1 mmHg [0.0-31.0], P = 0.840). The 24-hour pH monitoring (n = 18) demonstrated a nonsignificant decrease in acid exposure time (pH < 4) from 2.3% (0.0-8.4) to 1.6% (0.0-7.3) (P = 0.182). Similarly, the DeMeester score decreased non-significantly from 8.4 (0.8-27.7) to 6.6 (0.8-21.8) (P = 0.352). No procedure-related complications occurred. Conclusion Endoscopic radiofrequency Stretta therapy appears to be a safe treatment option for GERD and may provide favorable patient satisfaction and medication reduction.

Purpose: Due to its rarity, treatment guidelines for appendiceal cancer have traditionally followed those established for colorectal cancer, despite showing distinct histologic and clinical features. This study aimed to compare the clinicopathologic characteristics and long-term oncologic outcomes of appendiceal cancer with those of right-sided colon cancers. Methods: We retrospectively reviewed the records of patients with stage I–III appendiceal, cecal, or ascending colon cancer who underwent curative resection between 2010 and 2020 at our center. A 1:3:3 exact matching for age, sex, TNM stage, and adjuvant chemotherapy was performed. Survival outcomes were analyzed using the Kaplan-Meier and Cox regression methods. Results: Overall, 245 patients with appendiceal cancer (n = 35), ascending colon cancer (n = 105), and cecal cancer (n = 105) were analyzed. Appendiceal cancer exhibited a higher proportion of T4 tumors and fewer harvested lymph nodes compared with ascending or cecal cancers. The mean follow-up duration was 9.5 years. The 5- and 10-year overall survival rates were lower in appendiceal cancer (66.2% and 52.9%) than in ascending (91.2% and 78.4%) or cecal cancer (88.5% and 78.3%). Similarly, the 10-year disease-free survival rate was lower in appendiceal cancer (59.2%) compared with ascending (83.1%) and cecal cancers (78.4%). Cox regression analysis identified age (≥65 years), perforation, nodal metastasis, and lymphovascular invasion as independent predictors of poor prognosis. Conclusion Appendiceal cancer exhibited significantly worse long-term survival compared to cecal or ascending colon cancer. Tumor perforation, nodal metastasis, and lymphovascular invasion were adverse prognostic factors for overall and disease-free survival.

Endocrine-disrupting chemicals (EDCs) and persistent organic pollutants (POPs) cross the placenta and accumulate during gestation and early postnatal life, periods of heightened hormonal and neurodevelopmental plasticity. Exposure to contaminants such as bisphenol A (BPA), phthalates, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) during these critical windows can reprogram endocrine and neural circuits, resulting in persistent behavioral alterations. This review synthesizes mechanistic evidence from animal models and epidemiological studies linking developmental EDC/POP exposure to attention deficits, impulsivity, anxiety and altered reward sensitivity—phenotypes defined here as addiction vulnerability (addiction-relevant endophenotypes) rather than clinically diagnosed substance-use disorder (SUD). We propose a two-hit, adverse outcome pathway (AOP)-informed model in which prenatal EDC/POP exposure induces endocrine-related perturbations that prime reward and stress circuitry. Subsequent exposure to psychoactive drugs and/or chronic stress then acts on these sensitized systems to increase the probability of maladaptive reinforcement learning and impaired behavioral control. Mechanistically, early-life exposures disrupt thyroid and sex-steroid signaling, dysregulate the hypothalamic–pituitary–adrenal axis, and alter dopaminergic, serotonergic, and glutamatergic neurotransmission with additional modulation by epigenetic reprogramming, oxidative stress, and neuroinflammation. Human cohort studies consistently associate prenatal BPA and phthalate exposures with adverse neurobehavioral and externalizing symptoms in children, supporting this framework while underscoring the limited availability of longitudinal data linking early exposure to SUD outcomes. Integrating these findings within an AOP perspective highlights the importance of developmental timing, sex, dose, genetic background, and co-exposures, and supports risk-assessment strategies that account for sequential environmental and drug exposures.

Subglottic stenosis (SGS) and tracheal stenosis (TS) are rare conditions that can cause significant breathing difficulties and, if not properly managed, may lead to life-threatening complications. Despite their clinical importance, debate continues regarding the optimal management of adult SGS and TS, and no comprehensive guidelines have been established to date. The Korean Bronchoesophagological Society appointed a task force to develop clinical practice guidelines with the goal of providing evidence-based recommendations for managing SGS and TS in adults. The task force conducted a systematic review of the relevant literature by searching PubMed, Embase, and the Cochrane Library using predefined search terms aligned with key clinical questions. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, which also informed the formulation and reporting of the recommendations. The strength of each recommendation reflects the guideline panel’s confidence that the benefits of an intervention outweigh its risks for eligible patients. After drafting the guidelines, feedback was obtained through Delphi questionnaires completed by members of the Korean Bronchoesophagological Society. Ultimately, the committee developed 17 evidence-based recommendations across four categories: initial evaluation, medical management, surgical treatment, and postoperative management and rehabilitation. These guidelines aim to support clinicians in delivering optimal care to adult patients with SGS and TS.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.