Limb salvage surgery using a tumor prosthesis for the treatment of malignant bone tumors in the proximal femur is an effective method for preserving hip joint function. On the other hand, maintaining hip joint stability can be challenging because of the extensive resection of the bone and surrounding soft tissue. This paper reports an unusual case of hip dislocation in a patient with a proximal femoral osteosarcoma who underwent limb salvage surgery. Over six years, the tumor prosthesis gradually migrated posterosuperiorly above the iliac crest, resulting in 14 cm of lower limb shortening. The acetabular reconstruction was performed using an allograft, and the middle segment of the tumor prosthesis was removed to allow for hip reduction. Concurrent reconstruction of the hip abductor muscles was also carried out. No recurrence of the dislocation was observed during follow-up, and the patient could walk independently with the aid of an orthopedic brace, despite an 8 cm leg length discrepancy.

Objective: A simultaneous outbreak of coronavirus disease 2019 (COVID-19) and influenza occurred in the latter quarter of 2023. The study aimed to provide valuable data for patient care by comparing the clinical characteristics of those diagnosed with either COVID-19 or influenza in the emergency room. This information is intended to assist healthcare providers in managing cases where both diseases are encountered concurrently. Methods: The study involved 1,026 patients diagnosed with COVID-19 or influenza. The following were analyzed retrospectively: demographic information (age and sex), clinical symptoms (fever, fatigue, muscle pain, shortness of breath, sore throat, cough, sputum, runny nose, headache, and gastrointestinal symptoms), laboratory (white blood cell count, C-reactive protein) and imaging tests, and hospitalization rates. Results: COVID-19 patients were more likely to be older, experience fatigue and dyspnea, and require imaging tests and hospitalization than influenza patients. Influenza patients reported more fever, sore throat, cough, runny nose, and certain other symptoms. No significant differences were observed between the two groups regarding sex, myalgia, headache, and gastrointestinal symptoms. Conclusion Despite the significant differences in age, underlying conditions, clinical symptoms, imaging tests, and hospitalization rates between the two groups, distinguishing between COVID-19 and influenza based solely on these factors is challenging. Therefore, specific testing for each disease is essential during simultaneous outbreaks for an accurate diagnosis.

Objective: General weakness is a common symptom in elderly patients (≥65 years), but it is difficult to evaluate. This study focused on the characteristics of elderly patients presenting to the emergency department (ED) with general weakness after the coronavirus disease 2019 (COVID-19) pandemic. Methods: A retrospective study was conducted to analyze the medical records of 308 elderly patients (≥65 years) who visited the ED from June 2023 to November 2023. This study examined whether factors, including nursing facilities, economic status, and neurodegenerative diseases (NDDs), have different influences on the characteristics of general weakness and performed tests. Results: Poor oral intake and nonspecific weakness accounted for the majority of accompanying symptoms. The symptoms, diagnosis, admission, and the number of imaging tests were similar regardless of the nursing facilities or home, NDDs, or economic status. Infections other than COVID-19 accounted for 31.2%, with pneumonia and urinary tract infections being the most common. COVID-19 accounted for 10.7%. Brain imaging tests, including computed tomography (CT) and magnetic resonance imaging, were performed within 39.9% of patients. Chest or abdominal CT was performed in 45.8% of patients. The infection rate, except for COVID-19, was higher in patients from nursing facilities, while the COVID-19 rate in the two groups was similar (P=0.005). A more aggressive brain imaging test was conducted in patients with NDDs (P=0.04). Conclusion After the COVID-19 pandemic, infections other than COVID-19, especially pneumonia and urinary tract infection, were the most common medical causes of general weakness in the elderly, followed by COVID-19. The proportion of COVID-19 as a cause of general weakness was similar between groups.

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: Androgen deprivation therapy (ADT) is widely used to treat prostate cancer (PC). However, ADT has been associated with various adverse events (AEs) affecting the liver and kidneys. We aimed to evaluate the risk of liver- and kidney-related AEs after ADT. Materials and Methods: This retrospective cohort study used data from the National Health Insurance Database of Korea from 2007 to 2022 and included patients diagnosed with PC between 2013 and 2017. Patients who received ADT were matched 1:1 with those who did not using propensity score matching in the liver and kidney cohorts. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The study included 9,877 and 16,834 patients in the liver and kidney cohorts, respectively. The risk of hepatitis was higher among ADT users (adjusted HR [aHR], 1.27; 95% CI, 1.04–1.54), and the risk was even greater among patients aged ≥70 years (aHR, 1.37; 95% CI, 1.09–1.72). Longer ADT duration was associated with an increased risk of hepatitis (aHR, 1.32; 95% CI, 1.06–1.65). ADT use was not significantly associated with the risk of acute kidney injury (AKI) or chronic kidney disease (CKD) (AKI: aHR, 1.22; 95% CI, 0.92–1.64; CKD: aHR, 1.16; 95% CI, 0.97–1.38). Conclusion In patients with PC, ADT, particularly when used for an extended duration, was associated with an increased risk of hepatitis, but not with kidney-related AEs. Close monitoring for liver AEs is recommended in patients undergoing long-term ADT.

Objective: We investigated the distribution of AI viruses in fecal samples from wild bird habitats (and nearby poultry-farm areas) surveyed between September and March from 2019 to 2025 and identified associated epidemiological risk factors. Methods: Samples were screened for influenza A (M, H5, H7) genes using real-time reverse transcription polymerase chain reaction (PCR), subjected to virus isolation in embryonated chicken eggs, and subtyped by PCR and sequencing. Host species were identified through DNA barcoding. Relative risks (RRs) with 95% confidence intervals were estimated for province, month, and waterfowl density. Results: Overall prevalence of HPAI and low pathogenic AI (LPAI) virus was 0.10% and 3.21%, respectively. HPAI virus was continuously isolated since 2020–2021, except 2019– 2020, while LPAI prevalence steadily increased (3.01%–4.35%). Twelve hemagglutinin (H1–H12) subtypes were identified in 1,722 isolates, and H3 (16.5%) was the most prevalent, followed by H5 (11.1%) and H7 (5.2%). LPAI H5N3 (55.7%) and H7N7 (75.5%) were the predominant H5 and H7 subtypes, respectively. Detection was higher in western coastal provinces, and higher mallard/spot-billed duck density and sampling in September– December were associated with increased risk. Conclusions and Relevance: Continued surveillance of migratory-bird habitats can provide early warning of HPAIV incursions and support targeted biosecurity measures in high-risk regions and seasons.

Background: Cisplatin-based chemotherapy is a mainstay treatment for head and neck squamous cell carcinoma (HNSC); however, resistance to cisplatin contributes substantially to poor clinical outcomes. Identifying biomarkers associated with cisplatin response may improve prognostic assessment and treatment selection. Methods: We retrospectively analyzed The Cancer Genome Atlas (TCGA)-HNSC dataset to evaluate the association between microtubule associated scaffold protein 1 (MTUS1) expression and clinical outcomes, with particular emphasis on patients who were cisplatin-treated. Survival analysis was performed using the Kaplan-Meier curves, and differential expression analysis was conducted separately by comparing patients in disease-specific survival (DSS)-living and DSS-deceased groups. MTUS1 messenger RNA and protein levels were examined in cisplatin-sensitive oral cancer cell lines and their paired cisplatin-resistant counterparts using quantitative reverse transcription polymerase chain reaction and western blotting. Functional relevance was assessed by small interfering RNA-mediated MTUS1 knockdown in primary oral squamous cell carcinoma organoids. Results: MTUS1 protein expression was significantly lower in HNSC tumors than in non-tumor tissues. In the overall TCGA-HNSC cohort, MTUS1 expression was not significantly associated with survival. However, in patients who were cisplatin-treated, higher MTUS1 expression was significantly associated with more favorable DSS. MTUS1 expression was consistently lower in cisplatin-resistant oral cancer cell lines than in their paired cisplatin-sensitive counterparts. Functional experiments further suggested that reduced MTUS1 expression is associated with decreased cisplatin sensitivity and a resistant phenotype. Conclusion MTUS1 expression may be associated with clinical outcomes in patients with cisplatin-treated HNSC and is related to cisplatin responsiveness. These findings suggest a role for MTUS1 as a candidate treatment-relevant biomarker and highlight the value of integrating public omics data with experimental validation.

Background: Conventional machine learning (ML) models for predicting surgical outcomes have limitations in generalizability. We explored large language models (LLMs) as scalable alternatives to conventional ML models in predicting postoperative outcomes, including in-hospital 30-day mortality, intensive care unit (ICU) admission, and acute kidney injury (AKI). Methods: This study utilized the Informative Surgical Patient for Innovative Research Environment (INSPIRE) dataset (n = 80 985) from South Korea for model development and internal validation, and the Medical Informatics Operating Room Vitals and Events Repository (MOVER) dataset (n = 6265) from the United States for external validation. The study compared three different LLMs—Generative Pre-trained Transformer [GPT]-4o, Llama-3-70B, and OpenBioLLM-70B—against MLs using various prompt engineering approaches. LLMs were evaluated with different model parameter quantizations (4-bit normalized floating point vs. 16-bit brain floating point). Results: OpenBioLLM-70B was comparable to eXtreme Gradient Boosting (XGBoost) across all tasks (in-hospital 30-day mortality: area under receiver operating characteristic curve [AUROC] 0.782 [95% CI, 0.748–0.813] vs. 0.791 [95% CI, 0.753–0.825]; ICU admission: AUROC 0.595 [95% CI, 0.581–0.609] vs. 0.594 [95% CI, 0.580–0.608]; AKI: AUROC 0.830 [95% CI, 0.802–0.855] vs. 0.823 [95% CI, 0.792–0.851]) during external validation. Open-source LLMs maintained performance with 4-bit quantization, reducing computational requirements by 75%. Conclusions The findings support the versatility and efficiency of LLMs for clinical decision support through on-premises compatibility, addressing data privacy. Further validation with diverse datasets is needed to ensure their reliability and applicability across different perioperative settings.

Background: and Purpose: Tailored physical exercise interventions have the potential to promote cognitive health in older adults and offer significant advantages for those more vulnerable to decline. The specific relationship between physical fitness and cognition among the elderly has not been clearly established. The purpose of this investigation was to assess the relationship between physical fitness and cognitive function in older Korean adults. Methods: Eighty-four community-dwelling older adults (mean age: 70.7±5.3 years; 81.0% female) completed a standardized physical fitness battery assessing handgrip strength, sit-and-reach, 30-second sit-to-stand, 2-minute stationary march, 3-m sit-walk-and-return, figure-8-walk, and T-wall response time. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Descriptive statistics, partial correlation analyses, and stepwise multiple linear regression were conducted. Results: Slower T-wall response time was significantly correlated with lower RBANS total index, immediate memory, and delayed memory scores. In regression models, slower T-wall response time was independently associated with lower RBANS total index (β=−0.234, p=0.026) and delayed memory scores (β=−0.295, p=0.029). The regression model for immediate memory was not statistically significant overall; therefore, no predictive conclusion was drawn for this domain. Higher education showed a significant positive association with cognitive performance. Conclusions Coordination, as measured by T-wall response time, emerged as the only physical fitness component consistently associated with cognitive performance in older adults. Coordination-related fitness may be an important correlate of cognitive function in older adults and a promising target for future exercise interventions.