Ultrasonography is a valuable tool in the diagnosis and management of peripheral neuropathies. This non-invasive imaging modality offers real-time visualization of the peripheral nerves, allowing for accurate assessments of the nerve morphology and pathology. Ultrasound can detect various abnormalities, including nerve enlargement, focal constriction, and intra- and extra-neural lesions. In particular, this modality has proven useful in evaluating compressive neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome. Despite its several advantages, ultrasound should be used in conjunction with other diagnostic modalities, such as physical examinations or electromyography, to confirm the diagnosis and guide treatment.

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems worldwide, leading to increased mortality rates across various conditions. This study assessed the impact of COVID-19 on excess in-hospital mortality among emergency department patients and examined variations by community income levels, thereby highlighting socioeconomic disparities. Methods: This retrospective cross-sectional study used data from the National Emergency Department Information System in Korea. Cancer patients who visited emergency departments between January 27 and December 31 in 2019 (pre-COVID) and 2020 (during COVID) were included. The primary outcome was in-hospital mortality. The main exposure was the COVID-19 outbreak, with county per capita income tax serving as the interaction variable. The risk-adjusted in-hospital mortality rates were calculated. A multilevel linear regression model with an interaction term was used to estimate the difference-in-difference between the periods based on county income tax. Results: A total of 206,400 cancer patients were included 110,879 pre-COVID and 95,521 during COVID with an unadjusted in-hospital mortality rate of 1.0%. The risk-adjusted mortality rate was significantly higher during COVID than pre-COVID (1.2% vs. 0.9%, P<0.01). Using the highest socioeconomic status group (Q1) as the reference, the excess inhospital mortality odds during COVID were higher in Q3 (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.17-1.54) and Q4 (aOR, 1.43; 95% CI, 1.15-1.77). Conclusion The COVID-19 pandemic exacerbated in-hospital mortality disparities among cancer patients, imposing a greater burden on lower socioeconomic groups. These findings highlight the importance of implementing equitable healthcare strategies to protect vulnerable populations during health emergencies.

Objective: To identify clinical factors associated with in-hospital mortality among patients presenting to the emergency department (ED) with nontraumatic myocardial injury. Methods: This retrospective observational study included adult patients who visited a single ED from January to December 2022 and had elevated high-sensitive troponin I levels above the 99th percentile. Patients with trauma, cardiac arrest, transfers, or do-not-resuscitate status were excluded. Data on the demographics, vital signs, mental status, comorbidities, and final ED diagnoses were analyzed using multivariable logistic regression analysis. Results: Among 989 patients, 117 (11.8%) died during hospitalization. The respiratory rate ≥25/min (adjusted odds ratio [aOR], 5.39; 95% confidence interval [CI], 1.65-6.59), respiratory rate 21-24/min (aOR, 3.30; 95% CI, 2.64-11.02), and SpO2 <91% (aOR, 5.47; 95% CI, 2.73-10.95) were significantly associated with mortality. Comorbidities, including coronary artery disease (aOR, 2.78; 95% CI, 1.47-5.26), respiratory disease (aOR, 2.89; 95% CI, 1.18-7.15), and malignancy (aOR, 2.91; 95% CI, 1.18-7.15), were also independent predictors. Compared to a type 1 myocardial infarction, the final ED diagnoses of infectious diseases (aOR, 31.88; 95% CI, 11.59-87.72), neoplasms (aOR, 6.71; 95% CI, 2.51-17.94), and cerebrovascular diseases (aOR, 4.76; 95% CI, 1.75-11.46) were associated with higher mortality. Conclusion In patients with nontraumatic myocardial injury presenting to the ED, respiratory abnormalities, coronary artery diseases, respiratory diseases and malignancy were independently associated with in-hospital mortality, while final ED diagnoses of infection, neoplasm, and cerebrovascular disease were associated with a higher risk of mortality compared to type 1 myocardial infarction.

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.

Purpose: Radical cystectomy (RC) is associated with substantial postoperative morbidity, and unplanned readmission remains common despite advances in perioperative management. However, the association between postoperative readmission due to complications and oncologic outcomes after RC for bladder cancer has not been clearly defined. We evaluated the impact of postoperative readmission on overall survival (OS) and cancer-specific survival (CSS) after RC for bladder cancer. Materials and Methods: We retrospectively analyzed 3,972 patients who underwent RC for bladder cancer in a multicenter cohort. Postoperative readmission was defined as unplanned hospitalization within 90 days postsurgery due to surgery-related complications. Survival outcomes were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify independent predictors of OS and CSS. Results: Among the study population, 916 patients (23.1%) experienced postoperative readmission. Baseline and perioperative characteristics were generally comparable between patients with and without readmission. Kaplan-Meier analyses demonstrated significantly worse OS and CSS among patients who experienced postoperative readmission (both log-rank p<0.001). In multivariable analyses adjusting for clinicopathological factors, postoperative readmission remained independently associated with worse OS (hazard ratio [HR], 1.654; 95% confidence interval [CI], 1.464–1.868; p<0.001) and CSS (HR, 1.761; 95% CI, 1.509–2.055; p<0.001). Conclusion Postoperative readmission within 90 days after RC was independently associated with inferior long-term oncologic outcomes. These findings suggest the importance of strategies aimed at preventing postoperative complications and subsequent readmission.

Purpose: This study evaluated the feasibility of radical nephrectomy and thrombectomy without cardiopulmonary bypass (CPB) in patients with renal cell carcinoma (RCC) and level IV venous tumor thrombus, compared with CPB-assisted surgery. Materials and Methods: This retrospective cohort study analyzed patients with RCC and level IV venous tumor thrombus who underwent surgery at a single center between 2014 and 2020. Feasibility of non-CPB surgery was assessed by comparing perioperative safety-related outcomes, overall survival (OS), and progression-free survival (PFS) between the non-CPB and CPB groups. Perioperative outcomes included operative time, blood loss, severe complications (Clavien-Dindo classification grade ≥III), intensive care unit (ICU) stay, and mortality. Kaplan-Meier analysis and generalized Wilcoxon tests were used to compare survival outcomes. Results: A total of 16 patients met eligibility criteria: 5 underwent surgery without CPB, and 11 underwent CPB-assisted surgery. Median operative time was similar between the CPB and non-CPB groups (490 minutes vs. 480 minutes, p=0.650). Compared with the CPB group, blood loss was lower in the non-CPB group (4000 mL vs. 1080 mL, p=0.333). Severe complications occurred in 36.4% of CPB patients and 0% of non-CPB patients (p=0.245). ICU stay was comparable between the non-CPB and CPB groups (2 days vs. 3 days, p=0.356). OS did not differ significantly between groups (p=0.180), whereas PFS was longer in the non-CPB group (p=0.041). Conclusions Radical nephrectomy and thrombectomy without CPB appears feasible and may be associated with lower perioperative morbidity and blood loss without compromising oncologic outcomes. Non-CPB surgery should be considered in selected patients with level IV venous tumor thrombus when technically feasible.

Objective: This study aimed to determine whether a multiacquisition variable-resonance image combination-selective (MAVRIC-SL) sequence, which reduces susceptibility artifacts, is useful for postoperative evaluation. Methods: MRI was performed on four dogs that underwent CCLR correction using metallic implants. Imaging was performed with MAVRIC-SL and two-dimensional fast spin echo (2D-FSE) sequences, including proton density (PD), PD fat-suppressed (F/S), and T2-weighted F/S. The artifact area for each sequence was quantitatively analyzed. A four-level qualitative image analysis was performed to assess image artifacts, cartilage delineation, and visualization of the cranial cruciate ligament and bone. Results: The artifact area was significantly reduced with MAVRIC-SL than with 2D-FSE, regardless of the metal materials used. In addition, the amount of artifact, cartilage delineation, and visualization of the bone were significantly improved with MAVRIC-SL compared with 2D-FSE. Conclusions and Relevance: In this preliminary study, the MAVRIC-SL sequence improves postoperative MRI evaluation by reducing susceptibility artifacts in dogs with CCLR treated with metallic implants.

Pressure sores are frequently observed in chronically bedridden patients. When body position is not changed regularly, a single ulcer may develop in the area subjected to constant pressure, such as the sacral or trochanteric region; one habitual position usually results in one sore. The simultaneous presence of pressure sores on the sacrum and both trochanteric regions in a single patient is uncommon, and their reconstruction is challenging. A 48-year-old male paraplegic patient with three pressure sores on the pelvis was referred. The sores involved the sacral and bilateral trochanteric regions and were complicated by infection, including osteomyelitis. Serial flap coverage was staged according to wound readiness and the resolution of infection. First, the right trochanteric sore was reconstructed using a perforator-based island flap (PBIF). After 9 days, the sacral sore was reconstructed with another PBIF. After an additional 20 days, the left trochanteric sore was covered using a pedicled anterolateral thigh musculocutaneous flap. All flaps were selected based on lesion size and condition and survived without major complications. When reconstructing multiple sores in one patient, establishing a clear strategy is essential. The order of reconstruction, appropriate intervals between procedures, and optimal flap selection are key considerations.

The reconstruction of bilateral ischial pressure sores presents a formidable challenge in reconstructive plastic surgery. Adequate padding over the ischial tuberosity and proper resurfacing of the defect are critical in preventing recurrence after reconstruction. We present a case of bilateral ischial sores reconstructed using two different approaches. A 62-year-old paraplegic man with bilateral ischial sores and osteomyelitis of both ischial tuberosities presented to the plastic surgery department. After serial debridement, the 6×4 cm ischial sore on the left side was reconstructed using dual-plane flaps—two independent flaps consisting of a biceps femoris muscle flap and a perforator-based fasciocutaneous island flap. The 7×4 cm ischial sore on the right side was reconstructed using a single hamstring flap, a composite flap consisting of a semitendinosus muscle flap with a distally linked skin flap. Both defects were successfully reconstructed, and the patient regained wheelchair ambulation. Both approaches—the dual-plane flaps and the single hamstring flap—are effective options for ischial sore reconstruction, as they provide sufficient volume and adequate resurfacing. Given the hamstring flap’s capacity to significantly reduce operative duration, it may be considered the primary surgical option. However, in the absence of a reliable perforator between the hamstring muscle and the overlying skin, dual-plane flaps should be selected.