Objectives: . A substantial proportion of patients with head and neck cancer (HNC) require emergency room (ER) visits or unplanned hospitalizations during or after treatment with various modalities. We investigated HNC cases that necessitated ER visitation after cancer treatment, aiming to identify potential risk factors in the context of the Korean healthcare system. Methods: . This single-center cohort study examined patients with HNC who received cancer treatments at Samsung Medical Center in 2019 (n=566). Treatment modalities included surgery alone (n=184), surgery and adjuvant therapy (n=138), curative non-surgical treatment such as radiation or chemoradiation (n=209), and palliative treatments (n=35). We followed these cases for up to 3 years, focusing on those who visited the ER during or after cancer treatment, and analyzed the primary reasons and risk factors associated with these visits. Results: . The ER visitation rate was 8.0% (n=45) among patients with HNC, with a total of 70 ER visits (12.4%; mean, 1.56; range, 1–4). The rate of treatment-related ER visitation was 4.6%. Common reasons for ER visits included surgical site or wound complications (31.1% of patients visiting the ER, 22.9% of ER visits) and issues with oral intake or feeding (22.2% of patients, 31.4% of visits). Significant risk factors for ER visits included tumor subsite (with hypopharyngeal cancer associated with a 17.9% rate of treatment-related ER visits), tumor stage (T2–4, 8.6%–12.2%; N+ status, 6.7%), and treatment modality (surgery with adjuvant chemoradiation, 19.4%). Patient age and comorbidities did not represent significant factors. Conclusion . The most frequent reasons for ER visits among patients with HNC included complications with wounds and feeding. Additionally, tumor characteristics and treatment modality were independent risk factors for ER visits. Adequate planning and management to address these issues could potentially decrease the number of ER visits, lower costs, and improve patient care.

Background/Aims: Hepatocellular carcinoma (HCC) exhibits significant sex disparities in incidence, yet its molecular mechanisms remain unclear. We explored the role of telomerase reverse transcriptase (TERT) genetic alterations and hepatitis B virus (HBV) integration, both known major contributors to HCC, in sex-specific risk for HBV-related HCC. Methods: We examined 310 HBV-related HCC tissues to investigate sex-specific TERT promoter (TERT-pro) mutations and HBV integration profiles, stratified by sex and age, and validated with single-cell RNA sequencing (scRNA-seq) data. Results: Tumors predominantly exhibited TERT-pro mutations (26.0% vs. 0%) and HBV-TERT integration (37.0% vs. 3.0%) compared to non-tumorous tissues. While TERT-pro mutations increased with age in both sexes, younger males (≤60 years) showed marked predominance compared to younger females. Males had significantly more HBV integrations at younger ages, while females initially had fewer integrations that gradually increased with age. Younger males' integrations showed significantly greater enrichment in the TERT locus compared to younger females, alongside a preference for promoters, PreS/S regions, and CpG islands. Overall, TERT genetic alterations were significantly sex-differential in younger individuals (75.3% in males vs. 23.1% in females) but not in older individuals (76.9% vs. 83.3%, respectively). These alterations were associated with increased TERT expression. The skewed TERT abnormalities in younger males were further corroborated by independent scRNA-seq data. Conclusions Our findings highlight the critical role of TERT alterations and HBV integration patterns in the male predominance of HCC incidence among younger HBV carriers, offering insights for future exploration to optimize sex-specific patient care and HCC surveillance strategies.

Background/Aims: Hepatocellular carcinoma (HCC) exhibits high de novo recurrence rates post-resection. Current post-surgery recurrence prediction methods are limited, emphasizing the need for reliable biomarkers to assess recurrence risk. We aimed to develop methylation-based markers for classifying HCC patients and predicting their risk of de novo recurrence post-surgery. Methods: In this retrospective cohort study, we analyzed data from HCC patients who underwent surgical resection in Korea, excluding those with recurrence within one year post-surgery. Using the Infinium Methylation EPIC array on 140 samples in the discovery cohort, we classified patients into low- and high-risk groups based on methylation profiles. Distinctive markers were identified through random forest analysis. These markers were validated in the cancer genome atlas (n=217), Validation cohort 1 (n=63) and experimental Validation using a methylation-sensitive high-resolution melting (MS-HRM) assay in Validation cohort 1 and Validation cohort 2 (n=63). Results: The low-risk recurrence group (methylation group 1; MG1) showed a methylation average of 0.73 (95% confidence interval [CI] 0.69–0.77) with a 23.5% recurrence rate, while the high-risk group (MG2) had an average of 0.17 (95% CI 0.14–0.20) with a 44.1% recurrence rate (P<0.03). Validation confirmed the applicability of methylation markers across diverse populations, showing high accuracy in predicting the probability of HCC recurrence risk (area under the curve 96.8%). The MS-HRM assay confirmed its effectiveness in predicting de novo recurrence with 95.5% sensitivity, 89.7% specificity, and 92.2% accuracy. Conclusions Methylation markers effectively classified HCC patients by de novo recurrence risk, enhancing prediction accuracy and potentially offering personalized management strategies.

Background/Aims: A clinical unmet need persists for medications capable of modulating the progression of primary sclerosing cholangitis (PSC). This study aimed to assess the clinical feasibility of HK-660S (beta-lapachone) in PSC. Methods: In this multicenter, randomized, double-blind, placebo-controlled, parallel-group phase 2 trial, participants were assigned in a 2:1 ratio to receive either 100 mg of HK-660S or a placebo twice daily for 12 weeks. The primary outcomes were the reduction in serum alkaline phosphatase (ALP) levels and the percentage of participants showing improvements in PSC severity, as determined by magnetic resonance cholangiopancreatography with the Anali score. Secondary endpoints included changes in liver stiffness and adverse events. Results: The analysis included 21 patients, 15 receiving HK-660S, and six receiving a placebo. Improvements in the Anali score were observed in 13.3% of the HK-660S group, with no improvements in the placebo group. HK-660S treatment resulted in a 15.2% reduction in mean ALP levels, compared to a 6.6% reduction in the placebo group. A stratified ad-hoc analysis based on baseline ALP levels showed a statistically significant response in the HK-660S group among those with ALP levels greater than twice the upper limit of normal, with a 50% responder rate (p=0.05). Additionally, 26.7% of the HK-660S group showed improvements in the enhanced liver fibrosis score, with no improvements in the placebo group. HK-660S was generally well tolerated. Conclusions HK-660S is well tolerated among patients with PSC and may improve bile duct strictures, decrease serum ALP levels, and reduce liver fibrosis (cris.nih.go.kr, Number KCT0006590).

Purpose: Pancreatic cancer has a poor prognosis; however, the implementation of neoadjuvant treatment enables borderline resectable cases to undergo curative resection and improves the overall survival rate. Attempts have been made to expand the eligibility criteria for neoadjuvant treatment, even in resectable cases. Some studies have suggested a correlation between vein abutment and poor prognosis or that the abutment angle may affect prognosis. This study investigated the anatomical factors affecting the vessel abutment angle and its prognostic value in pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who underwent surgery between 2012 and 2017 were included in this study. Patients who underwent neoadjuvant treatment were excluded. Data from only the intent-to-treat pancreaticoduodenectomy group were included in the analysis. Clinicopathological characteristics; preoperative factors such as CA 19-9, preoperative biliary drainage, American Society of Anesthesiologists physical status classification, portal vein/superior mesenteric vein contact angle measured via CT scan; and intraoperative factors were collected for analysis. Results: A total of 365 patients were included in this study, and the abutment group included 92 patients (25.2%). The abutment and no-contact groups did not show any significant differences in terms of the overall survival or diseasefree survival rate. Among the abutment groups, patients with less than 90° and 90°–180° did not show any significant differences. In the multivariate analysis, the only preoperative factor that had a prognostic effect was CA 19-9, a biological factor. Conclusion When there is no vessel invasion in the abutment group, upfront surgery should be considered because the angle does not affect the overall prognosis.

Methods: The UBE approach targeted the ventral part of the superior articular process in the transforaminal UBE setup, specifically for upper lumbar disc herniation, with an approach angle of approximately 30º on the axial plane. Intraoperative navigation was employed to improve puncture accuracy for this relatively unfamiliar surgical technique. Navigation-assisted transforaminal UBE lumbar discectomy was performed on four patients presenting with back or leg discomfort due to disc herniation at the L1–L2 or L2–L3 levels. Results: All patients experienced symptom relief and were discharged on postoperative day 2. Conclusions Transforaminal UBE lumbar discectomy is a viable therapeutic option for upper lumbar paracentral disc herniation, which is typically associated with poor prognosis. Integrating navigation integration into this novel approach enhances precision and safety.

Methods: Twelve consecutive patients underwent single-level BELIF for lumbar degenerative disease. The technique involves two small portals, one each for endoscopy and instruments. A large PEEK cage was inserted through a posterolateral approach. Clinical outcomes, including a Visual Analog Scale for back and leg pain, the Oswestry Disability Index, and the European Quality of Life-5 Dimensions, were assessed preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was evaluated using computed tomography (CT) at 12 months. Results: The mean patient age was 69.1±7.2 years, with operations predominantly at the L4–5 level (83%). The mean operation time was 149.7±37.4 minutes, and the average surgical drainage was 201.4±59.7 mL. All clinical outcome measures showed significant improvement at 12 months (p<0.05). Fusion was achieved in 83.3% of patients. Cage subsidence (>1 mm) occurred in one patient (8.3%). Complications included one case each of incidental durotomy, wrong-site surgery, and wound dehiscence and three cases of asymptomatic hematoma. Conclusions BELIF using a large PEEK cage demonstrated promising clinical outcomes and fusion rates. The technique offers enhanced visualization and enables direct neural decompression while minimizing tissue trauma. The use of a large PEEK cage may contribute to improved stability and reduced subsidence risk.

Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%–6.4%) and hematomas (1.4%–4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.

Background and Objectives: Inconsistencies in nasal nitric oxide (nNO) values, due to anatomical variations and comorbidities, challenge the accurate assessment of upper airway inflammation severity. We hypothesized that changes in nNO levels following treatment for chronic rhinitis would be consistent and provide relative value. This study aimed to evaluate the correlation between changes in nNO levels and symptomatic improvements following treatment for chronic rhinitis. Methods: This prospective observational study included 46 participants diagnosed with chronic rhinitis between December 2021 and November 2023. nNO measurements, evaluations of four nasal and two ocular symptoms, and quality of life questionnaires were conducted at baseline and after one month of treatment. Baseline laboratory tests included serum total immunoglobulin E levels, blood eosinophil percentages, and skin prick tests. Results: The Total Nasal Symptom Score (TNSS), TNSS with ocular symptoms (TNSS eye), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores significantly decreased following treatment (all p<0.001). nNO levels also decreased significantly after treatment (p=0.036). Moreover, changes in nNO were significantly correlated with changes in TNSS, TNSS eye, and RQLQ scores (p=0.047, r=0.294; p=0.021, r=0.340; and p=0.004, r=0.419, respectively). Conclusion In patients with chronic rhinitis, changes in TNSS, TNSS eye, and RQLQ scores were correlated with changes in nNO levels after treatment. nNO may serve as a potential objective evaluation tool for chronic rhinitis, particularly in patients who have difficulty reporting symptoms.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.