Background: Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking. Methods: This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM. Results: In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs. Conclusion ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Purpose: To develop and validate an artificial intelligence (AI)-based personalized outcome prediction model for upper-urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy. Materials and Methods: Data from patients who underwent radical nephroureterectomy between 2010 and 2020 across three hospitals were retrospectively analyzed. A model was developed using one tertiary center’s data and externally validated with data from two other hospitals. An AI model using XGBoost as risk estimator and bootstrapped Weibull Accelerated Failure Time model for 10-year survival probability was employed. Hyperparameter tuning used Optuna method. Model efficacy was assessed using concordance index, average Brier score, D-calibration, and six-month interval time-dependent area under the curve (AUC). Results: Of 1,039 patients, 627 qualified after excluding 50 with neoadjuvant chemotherapy. Model development used 564 patients (507 training, 57 test) with 9:1 stratified random split, plus 63 for internal validation and 362 for external validation. Significant parameters included preoperative glomerular filtration rate (p<0.001), hydroureteronephrosis (p=0.013), pathological N stage (p<0.001), concurrent carcinoma in situ (p<0.001), disease progression (p<0.001), and survival rate (p<0.001). Disease-free survival (DFS) model’s concordance index: internal validation 0.789, external validations 0.734 and 0.771. Overall survival (OS) model’s concordance index: internal validation 0.819, external validations 0.780 and 0.771. Mean time-dependent AUC was 0.66–0.77 for DFS and 0.67–0.80 for OS during 10-year periods. Conclusions AI-based model effectively predicts disease-free and OS outcomes for upper-urinary tract urothelial carcinoma patients with post-radical nephroureterectomy, showcasing robust performance across multicenter settings.

Purpose: This study aimed to compare the acute effects of isometric handgrip (IHG) and wall squat (IWS) exercise on 24-hour ambulatory blood pressure (BP) and related indices in young men with prehypertension. Methods: Ten young men with prehypertension (aged 25.0±2.3 years) completed three randomized crossover conditions: IHG, IWS, and control. Twenty-four-hour ambulatory BP monitoring was used to assess 24-hour, daytime, and nighttime mean BP, BP variability (BPV; average real variability and standard deviation), morning BP, and nocturnal dipping pattern. Office BP was measured at baseline, 30 minutes, and 90 minutes after each condition. Results: Twenty-four hour, daytime, and nighttime systolic and diastolic BP did not differ significantly among conditions. BPV indices also showed no significant between-condition differences across 24-hour, daytime, or nighttime periods. Nocturnal systolic BP dipping averaged 5%–8% and did not differ among conditions, indicating a nondipper pattern in all trials. Morning systolic BP, sleep-trough surge, and prewaking surge were similar across conditions. Office BP showed no significant condition or interaction effects; however, both IHG and IWS tended to lower BP at 90 minutes compared with control session. Conclusion A single bout of IHG or IWS did not elicit significant changes in 24-hour ambulatory BP, BPV, morning BP, or dipping pattern in young men with prehypertension. Nonetheless, the small acute reductions in office and morning BP suggest that isometric exercise may have potential as a time-efficient adjunctive strategy for early BP management. Larger and longer-term studies are needed to confirm these findings.

Purpose: Inspiratory muscle strength training is a time-efficient strategy for lowering blood pressure, but the acute vascular effects and its hemodynamic characteristics remain unclear. This study aimed to determine the acute effects of inspiratory muscle strength exercise (IMSE) on vascular function and shear patterns. Methods: In a single-arm acute trial, 12 young adults (aged 26±2 years) performed a single bout of IMSE (about 8 minutes) consisting of 30 breaths (6 breaths×5 sets) at 60% of maximal inspiratory pressure. Vascular function indices were assessed as endothelial function and arterial stiffness. Measurements of endothelial function via flow-mediated dilation (FMD) in the brachial artery and arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) were taken at baseline, 10 minutes, and 40 minutes post-IMSE. Shear rate (SR) responses were continuously obtained throughout the IMSE session at the brachial artery and were analyzed as mean SR, anterograde SR, and retrograde SR. Results: Compared to baseline, cfPWV significantly decreased (7.95±0.9 m/sec to 7.49±0.9 m/sec, p=0.033) and FMD increased (4.76%±1.0% to 6.26%±1.1%, p＜ 0.001) at post-10 min. Both cfPWV and FMD returned to baseline levels at post-40 min. During IMSE, mean SR and anterograde SR significantly increased (both, p＜ 0.05), whereas retrograde SR decreased (p=0.032) during inter-set rest periods. In addition, rhythmic fluctuations in SR were observed corresponding to inspiration and expiration phases. Conclusion These findings suggest that an acute bout of IMSE is associated with improved endothelial function and arterial stiffness. IMSE may elicit distinct hemodynamic responses during exercise, which may be linked to improvements in vascular function.

Background/Aims: Gastric antral vascular ectasia (GAVE) is a rare but important cause of gastrointestinal (GI) bleeding. The clinical course of GAVE is not well-known, and recurrent bleeding from GAVE is a therapeutic challenge. Therefore, we investigated the clinical course of GAVE and identified the risk factors for bleeding from it. Methods: We retrospectively reviewed the records of patients diagnosed with GAVE using upper GI endoscopy at Asan Medical Center between January 2004 and December 2019 and evaluated the clinical course and risk factors for bleeding from GAVE. Results: Of the 348 patients (mean age, 62.3 ± 10.7 years; male, 62%), bleeding from GAVE occurred in 123 (35%) patients during follow-up (median, 17.3 months; interquartile range [IQR], 4.2–46.6). GI bleeding from GAVE was significantly associated with Child–Pugh class B or C liver cirrhosis (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57–4.16), chronic kidney disease (CKD) (OR, 2.77; 95% CI, 1.52–5.07), use of antithrombotic agents (OR, 2.34; 95% CI, 1.13–4.82), and involvement of the duodenal bulb (OR, 3.21; 95% CI, 1.76–5.86). Rebleeding occurred in 39 of 123 patients (32%), in whom CKD (OR, 2.55; 95% CI, 1.12–5.81) was significantly associated with rebleeding. Endoscopic hemostasis was most commonly performed using argon plasma coagulation, and the median number of endoscopic hemostasis performed was 2 (IQR, 1–3). Conclusions A careful follow-up for bleeding is needed in GAVE patients with liver cirrhosis, CKD, use of antithrombotic agents, and duodenal bulb involvement.

Flow cytometric lymphocyte subset analysis (FCLSA) is essential for assessing immune status across various diseases and clinical settings. We surveyed current clinical laboratory practices related to FCLSA to establish a baseline reference for future standardization in Korea. Nine university hospitals actively performing FCLSA responded to the 22-question survey, which covered seven categories of laboratory practice. These hospitals used commercial reagent antibody kits from either Beckton Dickinson Biosciences (N = 4) or Beckman Coulter Diagnostics (N = 5). Most hospitals performed daily instrument setup and scheduled maintenance every 2–6 months. Two levels of commercial quality control materials were routinely used each day. Sample and reagent antibody volumes varied across hospitals, even when the same reagent kit was used. Acquired cell counts ranged from 5 × 10 3 to 5 × 10 4 cells, with two hospitals adjusting counts based on the cell type analyzed. Most laboratories reported percentages and general opinions; some additionally reported white blood cell and lymphocyte counts, along with lymphocyte percentages. This is the first comprehensive survey on the clinical laboratory practice of FCLSA in Korea.Standardization of FCLSA should be accelerated to ensure reliable and reproducible results.

The recommendations for carbohydrate intake were revised in the 2025 Korean Dietary Reference Intakes to reflect updated evidence on chronic disease risk and to clarify the interpretation of the Estimated Average Requirement (EAR) and Recommended Nutrient Intake (RNI). These revisions aim to strengthen both the scientific basis and the practical interpretation of carbohydrate intake guidance across the life course of an individual. For individuals aged 1 year and older, the Acceptable Macronutrient Distribution Range for carbohydrates was lowered from 55–65% of total energy to 50–65%. This adjustment reflects accumulating evidence from prospective cohort studies and meta-analyses indicating that very high carbohydrate intake is associated with an increased risk of adverse health outcomes. In contrast, an intake of approximately 50–55% of total energy is associated with the lowest mortality risk. Importantly, this change does not imply a preference for low-carbohydrate diets, as overall dietary quality, including carbohydrate quality, remains a critical consideration. The EAR (100 g/day) and RNI (130 g/day) are derived from estimates of brain glucose utilization and metabolic adaptation and should be interpreted as physiological minimum intake levels rather than population-based intake targets. In addition, life-stage-specific recommendations were updated based on new evidence, including recalculating the Adequate Intake (AI) for infants (55 g/day for 0–5 months and 85 g/day for 6–11 months) and revising the additional requirements during pregnancy (+35 g/day) and lactation (+55 g/day).Because no Tolerable Upper Intake Level (UL) has been established for total carbohydrate intake, excess intake should be managed through dietary adjustments, including limiting added sugars and refined carbohydrates, ensuring adequate fiber intake, and maintaining overall macronutrient balance. Collectively, these revisions provide an updated evidencebased framework for carbohydrate intake guidance for the Korean population.

Sparganosis is a rare parasitic infection caused by Spirometra species. Although it was relatively common in the past, it is now often overlooked. In this study, we review cases diagnosed through histopathological examination at a single institution in recent years to raise awareness of this neglected parasitic disease. Methods: We retrospectively analyzed cases of human sparganosis identified in the pathology archives of a single institution in South Korea between 2004 and 2025. A comprehensive review was conducted, including demographic data, clinical features, lesion locations, imaging findings, exposure history (such as dietary habits), and histopathologic findings. Results: A total of 15 patients were identified, including 10 females and 5 males, with a mean age of 65.1 years. Lesions were most commonly located in the lower extremities and breast. Imaging findings were largely nonspecific, with ultrasonography being the most frequently used modality. In most cases, clinical suspicion of sparganosis was absent, and excision was performed under the impression of a benign or malignant tumor. Histologically, variably degenerated parasitic structures were identified within granulomatous inflammation. However, preserved features such as calcospherules and tegumental structures facilitated definitive diagnosis. Conclusions: This study underscores the importance of recognizing the characteristic histopathological features of sparganosis, which can allow for accurate diagnosis even in the absence of clinical suspicion. Although rare, sparganosis remains a relevant diagnostic consideration in endemic regions, particularly in East Asia.

Purpose: This study aimed to report the real-world outcomes of intravesical gemcitabine for bacillus Calmette–Guérin (BCG)–unresponsive, high-risk, non–muscle-invasive bladder cancer (HR-NMIBC) in Korean patients who were unable or unwilling to undergo radical cystectomy (RC). Materials and Methods: This retrospective study included 131 patients (median age, 69 years; 88.5% men) treated with intravesical gemcitabine for BCG-unresponsive HR-NMIBC at nine centers between May 2019 and April 2022. The primary endpoint was 1-year recurrence-free survival (RFS). The secondary endpoints included factors influencing RFS, progression-free survival (PFS), cystectomy- free survival, cancer-specific survival (CSS), overall survival (OS), and safety. Survival analysis was performed using the Kaplan-Meier method, and risk factors for recurrence were assessed using Cox regression models. Results: Patients were followed up for a median duration of 25 months, with carcinoma in situ (CIS) in 41.9% of the patients. The 1-year and 2-year RFS rates were 68% and 42%, while the 1-year and 2-year PFS rates were 87% and 77%, respectively. No significant factors influencing RFS were identified. Seventeen patients underwent RC during a median follow-up of 16 months, with the condition in three patients progressing to muscle-invasive disease on final pathological analysis. The 2-year CSS and OS rates were 98% and 97%, respectively. Intravesical gemcitabine was well-tolerated, with only seven patients (5.3%) unable to complete the full induction course. Conclusion Our research highlights the potential of intravesical gemcitabine as a viable bladder-sparing treatment option for BCG-unresponsive HR-NMIBC, providing real-world evidence on its safety, efficacy, and tolerability.

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.