Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Purpose: Whether celiac plexus neurolysis (CPN) retains opioid-sparing efficacy in palliative care patients receiving modern extended-release opioids remains uncertain after a recent randomized trial that reported no benefit. We describe fluoroscopy-guided CPN in such patients. Methods: Thirteen consecutive palliative care patients with unresectable or metastatic upper abdominal cancer (seven pancreatic, five hepatobiliary, one gastric) on strong opioid therapy underwent posterior fluoroscopy-guided CPN with absolute ethanol after a diagnostic lidocaine block. Daily oral morphine equivalent (OME) and Numeric Rating Scale (NRS) pain scores were recorded at baseline and 1, 2, and 4 weeks. Pain response was defined a priori as ≥30% NRS reduction. Results: Median age was 67 years, baseline median OME 86.5 mg/day (range, 15~215), and median NRS 6. Median OME decreased to 72, 60, and 57.5 mg/day at 1, 2, and 4 weeks (median reductions 46.5%, 26.7%, 43.5%;all P≤0.002), and median NRS improved to 3, 4, and 4 (all P≤0.001). A pain responsewas achieved in 8/13 (61.5%) at 1 week, 7/13 (53.8%) at 2 weeks, and 5/12 (41.7%) at 4weeks. Opioid-related adverse events declined numerically (nausea, 7/13→3/12; constipation, 4→2; somnolence, 2→0; all McNemar P>0.10). No procedural complication occurred(0/13). Conclusion CPN was followed by reduction in opioid use and pain scores, withresolution of opioid-related symptoms and no complications. Although limited by the smallsample size, these findings suggest a potential role for CPN in palliative care patients receiving extended-release opioids and warrant prospective investigation.

Purpose: This study aimed to evaluate the effects of a practitioner-led empowerment program on self-sufficiency motivation, self-esteem, and self-efficacy among low-income service recipients at self-sufficiency centers. Methods: A quasi-experimental repeated-measures design was used. Participants were recipients of social services from 11 local self-sufficiency centers in Gyeonggi-do, South Korea. In total, 100 participants were recruited, with 51 assigned to the experimental group and 49 assigned to the control group. The experimental group received an eight-session program delivered by center practitioners who had been trained by mental health nurses, whereas the control group received usual services. Self-sufficiency motivation, self-esteem, and self-efficacy were assessed at three time points: baseline (pretest: T0), immediately after the intervention (post-test: T1), and 4 weeks after the intervention (follow-up: T2). Results: Using generalized estimating equations, participants in the experimental group showed significantly greater improvements than those in the control group at both T1 and T2 in self-sufficiency motivation (T1: B=1.61, p=.030; T2: B=2.88, p<.001), self-esteem (T1: B=2.77, p<.001; T2: B=2.78, p<.001), and self-efficacy (T1: B=3.95, p=.004; T2: B=4.19, p<.001). Conclusion The practitioner-led program is associated with significant short-term improvements in psychosocial determinants of self-sufficiency among low-income service recipients. These findings may inform the development of community nursing interventions that support the psychosocial foundations of independent living in this population and provide a basis for training programs designed to strengthen the capacity of practitioners at local self-sufficiency centers (Clinical Research Information Service of Korea registration number: KCT0010027; registration date: December 12, 2024).

Purpose: This study aimed to develop and evaluate the Climate and Health Action Mitigation Program (CHAMP), a health education intervention designed to enhance middle school students’ competencies for practicing climate adaptation behaviors in response to the health impacts of climate change. Methods: A quasi-experimental pretest-posttest nonequivalent control group design was employed. Data were collected from October to December 2024. A total of 3rd-year middle school students; 9th grade equivalent, aged 14-15 students were assigned to either an experimental group that received the CHAMP intervention or a control group that received conventional health education. The CHAMP curriculum comprised six sessions developed using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instructional design model and was aligned with the 2022 revised national health curriculum and the instructional hours stipulated in the School Health Act. Climate adaptation competency and its seven subdomains—climate-change knowledge, climate sensitivity, reflective thinking, integrative thinking, communication skills, decision-making ability, and willingness to act—were assessed before and after the intervention. Results: Compared with the control group, the experimental group demonstrated statistically significant improvements (p<.01) in overall climate adaptation competency as well as in all seven subdomains. The largest improvements were observed in willingness to act, climate sensitivity, and climate-change knowledge. The CHAMP intervention was associated with meaningful improvements in students’ climate adaptation competencies, encompassing cognitive, behavioral, and attitudinal domains. Conclusion These findings support the feasibility and educational value of integrating climate–health content into the national curriculum. Future research should examine the scalability of CHAMP and evaluate its long-term sustainability and effects across diverse educational settings.

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.

Popliteal artery entrapment syndrome (PAES) can mimic ankle pathology in young athletes and may lead to irreversible ischemia if a diagnosis is delayed. A 13-year-old Taekwondo athlete had exertional ankle pain unresponsive to synovectomy. Computed tomography angiography revealed a 5-cm popliteal artery occlusion. The patient underwent decompression surgery, but the arterial occlusion persisted, and bypass surgery was planned. This case highlights the importance of considering PAES as part of a differential diagnosis in young athletes presenting with persistent ankle pain, particularly when symptoms persist despite appropriate orthopedic treatment.

Objective: Thoracic pedicle screw fixation is technically demanding because of the natural variability in pedicle anatomy, a challenge that is further exacerbated in patients with spinal tumors who often have compromised pedicles. The L-point entry, juxtapedicular, and endplate-parallel trajectory (L-JET) technique was developed to provide a uniform entry point, a predictable screw trajectory, and the capacity to accommodate larger-diameter screws at levels T3–10. This study aimed to evaluate the safety and feasibility of the L-JET technique in comparison with the conventional transpedicular method. Methods: A comparative analysis of consecutively collected data was performed to evaluate outcomes associated with the L-JET technique in patients undergoing surgery for thoracic extradural spinal tumors. The L-point was defined as the intersection of a vertical line along the lateral margin of the facet joint and a horizontal line along the upper edge of the transverse process. The screw trajectory was planned with 30° of medial convergence in the axial plane, creating a juxtapedicular path, and a straightforward trajectory in the sagittal plane. Primary outcome measures included screw diameter, screw length, cortical breach rate, and the need for revision surgery, as assessed using computed tomography scans and medical records. Results: A total of 108 screws were placed in 22 patients using the L-JET technique, while 98 screws were placed in 18 patients using the conventional technique. The L-JET group used significantly larger-diameter screws (6.06±0.65 mm) than the conventional group (5.74±0.80 mm, p=0.02), with no significant difference observed in screw length between groups. Medial cortical breach occurred in one screw in each group, and no supra- or infrapedicular breaches were identified. No screw-related neurovascular complications or revision surgeries occurred in either group. Conclusion The L-JET technique enables consistent screw placement with larger-diameter screws, even in compromised pedicles associated with thoracic spinal tumors, without increasing the risk of complications or the need for revision surgery.

This study aimed to describe the technical feasibility and clinical outcome of unilateral biportal endoscopy (UBE)-assisted posterior C1–2 fusion for irreducible traumatic atlantoaxial rotatory dislocation (AARD) with facet fracture and locking. A 67-year-old man presented with severe neck pain following a motor vehicle accident. Computed tomography revealed C1–2 rotatory dislocation with a right C2 facet fracture and locking, while magnetic resonance imaging demonstrated left vertebral artery hypoplasia without cord compression. Traction for 3 days failed to achieve reduction. Surgery was subsequently performed using UBE under continuous saline irrigation. Following muscle-splitting exposure, facet release and reduction were achieved with a curette. Because the bulky right C2 nerve root obstructed access, it was transected proximal to the dorsal root ganglion. Facet distraction was then performed, the articular cartilage removed, and the subchondral bone prepared. Bilateral screws were inserted, and a polyether ether ketone cage filled with demineralized bone matrix was placed for fusion. The procedure was completed successfully without complications. Blood loss was minimal. The patient’s visual analogue scale score improved from 8 preoperatively to 2 on postoperative day 1. He was discharged uneventfully on postoperative day 7. At the 3-month follow-up, he remained pain-free with stable fixation and no loss of reduction on imaging. UBE-assisted posterior C1–2 fusion enables precise facet release, safe instrumentation, and minimal tissue trauma in irreducible AARD with facet fracture and locking. This minimally invasive approach may yield favorable short-term outcomes and represents a viable alternative to conventional open posterior fusion techniques.

This study aimed to describe the technical feasibility and clinical outcome of endoscope-assisted anterior odontoid lag screw fixation in a patient with ankylosing spondylitis, in whom the conventional open anterior approach was limited due to cervical rigidity. A 56-year-old man with longstanding ankylosing spondylitis presented with severe neck pain and right-sided tingling sensations following trauma. Imaging revealed a type III odontoid fracture. Because of rigid cervical alignment, adequate neck extension required for the conventional open anterior approach was not achievable. Endoscope-assisted anterior odontoid screw fixation was performed using a biplane C-arm. The procedure involved endoscopic dissection of the prevertebral corridor and insertion of the cannulated lag screw under fluoroscopic guidance. The screw was successfully placed across the fracture site without intraoperative complications. Postoperative imaging confirmed appropriate screw trajectory and fracture reduction. The patient’s pain improved immediately, allowing early ambulation. He was discharged uneventfully, and follow-up examinations demonstrated stable fixation. Endoscope-assisted anterior odontoid lag screw fixation appears to be a safe and effective alternative for treating odontoid fractures in patients with ankylosing spondylitis. This technique minimizes soft-tissue injury and facilitates optimal screw trajectory in cases where rigid cervical alignment precludes the conventional open approach.

Radical cholecystectomy is the standard procedure for gallbladder (GB) cancer, offering the possibility of cure. Many surgeons have increasingly expanded surgical indications following the growing trend of robotic surgery in hepatobiliary and pancreatic surgery. This study presents our experience with several robotic single-port (SP) plus one-port radical cholecystectomies using the da Vinci system (Intuitive Surgical). Data from five patients who underwent robotic SP radical cholecystectomy for GB cancer between April 2024 and December 2024 were retrospectively reviewed. All patients presented with imaging findings suggestive of localized GB cancer (T2 or lower). The median operative time was 145 minutes (range, 121–153 minutes), and the median number of harvested lymph nodes was five (range, five to eight). The median hospital stay after surgery was 6 days (range, 6–7 days), with no major complications reported. Robotic SP radical cholecystectomy is a safe and feasible option for GB cancer.