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.

Purpose: The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex. Materials and Methods: Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed. Results: Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males. Conclusion Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.

Objectives: Large language models (LLMs) demonstrate remarkable potential in healthcare communication. However, whether they can process complex, high-volume medical information, such as stroke-related content, remains insufficiently validated. This study aimed to evaluate the natural language processing capabilities of LLMs in handling such content and to develop an evaluation instrument. Methods: A survey compared educational materials generated by two LLMs (ChatGPT 4.0 and Claude 3) with neurologist-authored content on stroke. The materials were based on two clinical scenarios representing distinct stroke etiologies: cardioembolism and large-artery atherosclerosis. They were evaluated in terms of accuracy, legality, ethics, comprehensiveness, and information delivery. Scores for comprehensiveness and information delivery were compared according to participants’ agreement with the use of LLMs in healthcare. Results: ChatGPT received the highest scores across all domains, except for legality in Scenario 2. In Scenario 1, the ranking for accuracy and summarization of clinical information was, from highest to lowest, ChatGPT, Claude, and the neurologist (η2 = 0.140, p < 0.001; η2 = 0.175, p < 0.001). The same hierarchy was observed in Scenario 2 for accuracy (η2 = 0.077, p < 0.001) and summarization (η2 = 0.194, p < 0.001). Participants who agreed with the use of LLMs in healthcare assigned higher scores for the comprehensiveness (Scenario 1, p = 0.005; Scenario 2, p = 0.007) and information delivery (Scenario 1, p = 0.003; Scenario 2, p = 0.026) of ChatGPT-generated materials than participants who did not agree. Conclusions LLMs demonstrated adequate capability to convey complex content, such as stroke-related information, in an accessible and understandable manner for non-experts.

Background: This study aimed to report the radiological outcomes and risk factors for malalignment of fractures in the distal onefourth of the tibia treated with intramedullary nailing via the infrapatellar approach. Methods: This study retrospectively analyzed 60 patients (37 men and 23 women; mean age, 45.4 years) who had distal onefourth tibial fractures and were treated with intramedullary nailing using the infrapatellar approach. These patients were treated between January 2009 and December 2021, with a minimum follow-up of 1 year. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system: 25 were type 42A, 30 were type 42B, and 5 were type 43A. Radiographic outcomes focused on bone union and malalignment, defined as a valgus deviation greater than 5° compared to the unaffected side. Potential risk factors for malalignment, including open fractures (9 cases, 15%), distal tibial extension (20 cases, 33%), and distal fibular fractures (24 cases, 40%), were documented. Results: Bone union was achieved in all cases, with an average duration of 3.2 months (range, 3–5 months). No cases of postoperative wound infection or neurovascular damage were observed. The average coronal plane malalignment was 2.6° of valgus (range, 0°–9.3°), with significant malalignment (over 5°) occurring in 5 patients (8.3%). Comparison of the malalignment (n = 5) and normal (n = 55) groups showed a statistically significant difference in distal bone fragment length (average, 66.5 mm vs. 77.2 mm;p = 0.008) but no significant differences in other variables. A change-point analysis revealed that cases with a primary fracture line < 65 mm showed 4.5° of coronal malalignment, while those with > 65 mm showed 2.3°; the difference was statistically significant (p = 0.01). Conclusions Intramedullary nailing using the infrapatellar approach for distal one-fourth tibial fractures results in successful bone union with a low incidence of valgus malalignment. However, careful attention is necessary to prevent angular deformities, especially when the distal fragment is short.

Background: This study aimed to report the radiological outcomes and risk factors for malalignment of fractures in the distal onefourth of the tibia treated with intramedullary nailing via the infrapatellar approach. Methods: This study retrospectively analyzed 60 patients (37 men and 23 women; mean age, 45.4 years) who had distal onefourth tibial fractures and were treated with intramedullary nailing using the infrapatellar approach. These patients were treated between January 2009 and December 2021, with a minimum follow-up of 1 year. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system: 25 were type 42A, 30 were type 42B, and 5 were type 43A. Radiographic outcomes focused on bone union and malalignment, defined as a valgus deviation greater than 5° compared to the unaffected side. Potential risk factors for malalignment, including open fractures (9 cases, 15%), distal tibial extension (20 cases, 33%), and distal fibular fractures (24 cases, 40%), were documented. Results: Bone union was achieved in all cases, with an average duration of 3.2 months (range, 3–5 months). No cases of postoperative wound infection or neurovascular damage were observed. The average coronal plane malalignment was 2.6° of valgus (range, 0°–9.3°), with significant malalignment (over 5°) occurring in 5 patients (8.3%). Comparison of the malalignment (n = 5) and normal (n = 55) groups showed a statistically significant difference in distal bone fragment length (average, 66.5 mm vs. 77.2 mm;p = 0.008) but no significant differences in other variables. A change-point analysis revealed that cases with a primary fracture line < 65 mm showed 4.5° of coronal malalignment, while those with > 65 mm showed 2.3°; the difference was statistically significant (p = 0.01). Conclusions Intramedullary nailing using the infrapatellar approach for distal one-fourth tibial fractures results in successful bone union with a low incidence of valgus malalignment. However, careful attention is necessary to prevent angular deformities, especially when the distal fragment is short.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Background: This study aimed to report the radiological outcomes and risk factors for malalignment of fractures in the distal onefourth of the tibia treated with intramedullary nailing via the infrapatellar approach. Methods: This study retrospectively analyzed 60 patients (37 men and 23 women; mean age, 45.4 years) who had distal onefourth tibial fractures and were treated with intramedullary nailing using the infrapatellar approach. These patients were treated between January 2009 and December 2021, with a minimum follow-up of 1 year. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system: 25 were type 42A, 30 were type 42B, and 5 were type 43A. Radiographic outcomes focused on bone union and malalignment, defined as a valgus deviation greater than 5° compared to the unaffected side. Potential risk factors for malalignment, including open fractures (9 cases, 15%), distal tibial extension (20 cases, 33%), and distal fibular fractures (24 cases, 40%), were documented. Results: Bone union was achieved in all cases, with an average duration of 3.2 months (range, 3–5 months). No cases of postoperative wound infection or neurovascular damage were observed. The average coronal plane malalignment was 2.6° of valgus (range, 0°–9.3°), with significant malalignment (over 5°) occurring in 5 patients (8.3%). Comparison of the malalignment (n = 5) and normal (n = 55) groups showed a statistically significant difference in distal bone fragment length (average, 66.5 mm vs. 77.2 mm;p = 0.008) but no significant differences in other variables. A change-point analysis revealed that cases with a primary fracture line < 65 mm showed 4.5° of coronal malalignment, while those with > 65 mm showed 2.3°; the difference was statistically significant (p = 0.01). Conclusions Intramedullary nailing using the infrapatellar approach for distal one-fourth tibial fractures results in successful bone union with a low incidence of valgus malalignment. However, careful attention is necessary to prevent angular deformities, especially when the distal fragment is short.

Background: This study aimed to report the radiological outcomes and risk factors for malalignment of fractures in the distal onefourth of the tibia treated with intramedullary nailing via the infrapatellar approach. Methods: This study retrospectively analyzed 60 patients (37 men and 23 women; mean age, 45.4 years) who had distal onefourth tibial fractures and were treated with intramedullary nailing using the infrapatellar approach. These patients were treated between January 2009 and December 2021, with a minimum follow-up of 1 year. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system: 25 were type 42A, 30 were type 42B, and 5 were type 43A. Radiographic outcomes focused on bone union and malalignment, defined as a valgus deviation greater than 5° compared to the unaffected side. Potential risk factors for malalignment, including open fractures (9 cases, 15%), distal tibial extension (20 cases, 33%), and distal fibular fractures (24 cases, 40%), were documented. Results: Bone union was achieved in all cases, with an average duration of 3.2 months (range, 3–5 months). No cases of postoperative wound infection or neurovascular damage were observed. The average coronal plane malalignment was 2.6° of valgus (range, 0°–9.3°), with significant malalignment (over 5°) occurring in 5 patients (8.3%). Comparison of the malalignment (n = 5) and normal (n = 55) groups showed a statistically significant difference in distal bone fragment length (average, 66.5 mm vs. 77.2 mm;p = 0.008) but no significant differences in other variables. A change-point analysis revealed that cases with a primary fracture line < 65 mm showed 4.5° of coronal malalignment, while those with > 65 mm showed 2.3°; the difference was statistically significant (p = 0.01). Conclusions Intramedullary nailing using the infrapatellar approach for distal one-fourth tibial fractures results in successful bone union with a low incidence of valgus malalignment. However, careful attention is necessary to prevent angular deformities, especially when the distal fragment is short.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.