Background: We compared the immunoglobulin (IG) heavy chain (IGH) leader and FR1 primer sets to measure clone sizes and detect immunoglobulin heavy chain variable (IGHV) region somatic hypermutations (SHMs) in Korean patients with chronic lymphocytic leukemia (CLL). We also analyzed IGH and immunoglobulin kappa (IGK) to identify Korean-specific IGs in CLL. Methods: Next-generation sequencing (NGS)–based gene rearrangements and IGHV SHMs were assessed in 40 patients using IGH leader, IGH FR1, and IGK primers. Flow cytometry, karyotyping, interphase FISH, and NGS-based variant analyses were performed for 165 genes. Results: Clonal IGH and IGK rearrangements were detected in 100.0% and 97.5% of patients, respectively. Clonal size was generally smaller per NGS than per flow cytometry, particularly when using the IGH leader (median: 52.5%) versus the IGH FR1 primer set (73.2%). IGHV SHMs occurred in approximately 70% of patients; 10% showed primer set discrepancies. The incidence of IGHV SHMs was low in patients at high risk (i.e., with TP53 abnormalities; complex karyotypes; and ATM, NOTCH1, SF3B1, or BIRC3 variants). IGHV3 was the most common IGHV (58.3%), and IGHV4-34 was most frequently identified (14.6%). IGHV1 and IGHV1-69 usage differed significantly between Koreans and westerners. IGHJ4 was the most common IGHJ (56.3%). A single IGKV–IGKJ gene rearrangement was most frequently observed (18.9%), whereas intron-KDE was the most common rearrangement (30.6%). Conclusions NGS may underestimate CLL clonal size, particularly when using the IGH leader primer set. IGHV SHMs were inversely associated with negative prognostic factors.Our data suggest ethnic differences in CLL pathogenesis.

During pregnancy, various physiological and metabolic changes occur throughout the female body, including in the retina. In particular, women at high risk, such as those with gestational diabetes or pregnancy-induced hypertension, often present with ocular symptoms.The major retinal disorders associated with pregnancy include diabetic retinopathy, hypertensive retinopathy, central serous chorioretinopathy, and retinal vascular occlusions. In this review, we provide an in-depth overview of recent studies investigating the impact of pregnancy on the retina and highlight the importance of retinal screening in pregnant women.

Purpose: To determine how cataract-related image-quality improvement and region of interest (ROI) definition affect the reproducibility of optical coherence tomography (OCT) radiomics features. Methods: This retrospective study included 50 eyes from 46 patients who underwent cataract surgery. Preoperative and postoperative OCT images were acquired using a standardized protocol. Radiomics features (n = 93) were extracted from two ROI configurations: retina ROI (Rr; retina only) and full ROI (Rf; retina, choroid, vitreous). Preoperative versus postoperative differences were tested with the Wilcoxon signed-rank test and Cohen’s d; repeatability was assessed with the intraclass correlation coefficient (ICC). Agreement between ROIs was evaluated with Wilcoxon statistics, Spearman correlation, the concordance correlation coefficient (CCC) and Bland-Altman plots. The influence of signal strength was analyzed with paired t-tests and Spearman correlation. Results: Postoperative signal strength significantly improved from 28.24 ± 3.16 to 31.40 ± 3.06 dB (p < 0.001). Significant preoperative/ postoperative changes occurred in 49 / 93 features (52.7%) within Rr and in 81 / 93 (87.1%) within Rf. ICC showed good-to-excellent repeatability in 51.6% of Rr features and 87.1% of Rf features, yet 29.0% of Rr features still demonstrated poor reliability. Across ROI methods, 94.6% of feature pairs differed significantly between Rr and Rf, and no feature achieved CCC ≥0.85. Only two descriptors—first-order statistics 10th percentile and GLDM (gray level dependence matrix) gray level variance—showed no significant change with surgery and minimal dependence on signal strength. Conclusions Radiomics features in OCT respond variably to media opacity, signal-to-noise ratio, and ROI definition: most are susceptible to these factors, yet a small subset remains stable across them. Limiting analysis to an anatomically precise retina- bounded ROI and enrolling eyes with comparable cataract status and signal-strength scores may therefore improve reproducibility. Implementing these standardizations will help future OCT-radiomics studies identify the most reliable biomarkers for clinical use.

Background: and Purpose Although blood pressure (BP) elevation is common in acute ischemic stroke, and guidelines recommend reducing systolic BP to <185 mm Hg prior to reperfusion therapy, the safety and efficacy of active BP lowering in the hyperacute phase before endovascular thrombectomy (EVT) remain uncertain. Methods: We conducted a retrospective analysis of a prospective hospital-based registry that included consecutive patients with anterior circulation large-vessel occlusion who underwent EVT between 2016 and 2024. Patients were categorized into the active BP lowering in the emergency department (ED) group or the absence of BP lowering in the ED group based on whether they received intravenous antihypertensive treatment prior to EVT. The primary outcome was the distribution of the modified Rankin Scale (mRS) scores at 3 months. Propensity score matching and multivariable regression analyses were also performed. Results: Of the 492 included patients, 53 (10.8%) received active BP lowering in the ED. After propensity score matching, patients who underwent active BP lowering showed a worse distribution of 3-month mRS scores compared with those who did not receive BP lowering (adjusted odds ratio, 0.38; 95% confidence interval [CI], 0.18 to 0.80; p=0.013). The active BP lowering group exhibited greater infarct volume growth (adjusted β coefficient, 33.4; 95% CI, 18.2 to 48.7; p<0.001), whereas the incidence of symptomatic intracerebral hemorrhage did not differ between groups. Conclusions Active BP lowering in the ED before EVT was associated with worse functional outcomes and increased infarct growth without a corresponding reduction in the occurrence of symptomatic intracerebral hemorrhage. These findings highlight the need for caution in initiating antihypertensive therapy before reperfusion and support further investigations to define optimal pre-EVT BP management.

Background: and Purpose The relationship between thrombus histology and long-term stroke patient outcomes remains unexplored. We aimed to determine whether the histological characteristics of thrombi are associated with long-term outcomes in stroke patients and to identify the thrombus features linked to these outcomes. Methods: This retrospective multicenter cohort study included 512 patients with ischemic stroke who underwent endovascular thrombectomy between July 2017 and July 2023. Patients were followed up for long-term major adverse cardiovascular events occurrence. Thrombus histology was assessed using immunohistochemistry, including the proportion of fibrin, red blood cells, and platelets, as well as the distribution patterns categorized as layered, erythrocytic, diffuse platelet, and mixed. Results: During a median follow-up of 38.1 months, 164 patients experienced major adverse cardiovascular events, with an incidence rate of 3.02 per 100 person-years. Major adverse cardiovascular events occurrence was associated with the diffuse platelet pattern and proportion of platelets and red blood cells within the thrombus. After adjusting for confounders, the diffuse platelet pattern independently predicted major adverse cardiovascular events, including mortality and stroke recurrence. Subgroup analysis also demonstrated that the association between the diffuse platelet pattern and major adverse cardiovascular events was consistent across key clinical subgroups based on age (≥65 vs. <65 yr), atrial fibrillation, cancer status, and discharge medications. Conclusions Thrombus histology could provide predictive value for long-term prognosis. In particular, histological distribution patterns may be more important than simple composition in thrombus research, including in the prediction of prognosis.

Background: and Purpose Patients with ischemic stroke with both atrial fibrillation (AF) and large artery atherosclerosis (LAA) represent therapeutic challenges, and the optimal antithrombotic regimen remains uncertain. We conducted a meta-analysis comparing oral anticoagulant (OAC) monotherapy with OAC plus antiplatelet therapy in this population. Methods: PubMed and EMBASE were searched through June 30, 2025, for studies enrolling patients with ischemic stroke and evidence of both AF and LAA. Outcomes included recurrent ischemic stroke, major bleeding, all-cause mortality, and a composite outcome. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Peto method, with random-effects sensitivity analyses, stratified by short-term (<3 months) and long-term (≥1 year) follow-up. Results: Eight cohort studies were analyzed. In the short-term, combination therapy was associated with a reduced risk of recurrent ischemic stroke (OR, 0.37; 95% CI, 0.14–0.97; p=0.043), without a significant increase in major bleeding, although this association did not persist under random-effects sensitivity analysis (OR, 0.37; 95% CI, 0.13–1.07; p=0.067). Conversely, long-term combination therapy was associated with higher risks of major bleeding (OR, 1.25; 95% CI, 1.08–1.45; p=0.002), all-cause mortality (OR, 1.25; 95% CI, 1.01–1.54; p=0.039), and composite outcome (OR, 1.49; 95% CI, 1.27–1.74; p<0.001), without reducing recurrent ischemic stroke (OR, 1.12; 95% CI, 1.00–1.26; p=0.054). Conclusions While long-term OAC plus antiplatelet therapy increases bleeding risk without preventing recurrent stroke, short-term combination therapy may offer benefits in selected patients with concomitant LAA, though this early efficacy signal should be interpreted with caution.

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Purpose: This study aimed to evaluate the predictive value of apparent diffusion coefficient (ADC) values from magnetic resonance imaging (MRI) in assessing pathologic response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC) and the optimal cutoff value of ADC for predicting NAC response. Materials and Methods: Among 582 patients who underwent radical cystectomy between December 2011 and December 2024, we included 146 patients who received preoperative NAC and pretreatment MRI. Pathologic response was determined based on the surgical pathology results: patients with pathologic stage >pT2 and/or presence of nodal involvement (N+) were classified as nonresponders, while those with ≤pT2 and no nodal involvement (N0) were classified as responders. MRI-derived ADC values were compared between the 2 groups. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for predicting NAC response. Multivariate logistic regression analysis using preoperative parameter was performed and Kaplan-Meier survival analysis were utilized to assess overall survival (OS) and cancer-specific survival (CSS) according to NAC response. Results: Among the 146 patients, 90 (61.6%) were classified as responders, 56 (38.4%) were nonresponders. The mean ADC value was significantly higher in responders (1,100.35±249.12 mm2/sec) than in nonresponders (763.95±118.97 mm2/sec, p<0.001). ROC analysis demonstrated an area under the curve of 0.69, with an optimal cutoff value of 845.0 mm2/sec. Multivariate logistic regression identified ADC value as an independent predictor of NAC response (odds ratio, 1.025; 95% confidence interval, 1.006–1.043; p=0.008). During median follow-up 30.3 months, Kaplan-Meier analysis revealed that responders had significantly better 5-year OS (80.8% vs. 45.9%) and 5-year CSS (92.6% vs. 54.5%), with log-rank test p<0.001. Conclusion MRI-derived ADC values are a reliable imaging biomarker for predicting pathologic response to NAC in MIBC. Further validation in large-scale prospective studies is required to confirm these findings.

Purpose: We evaluated factors predicting the recurrence of macular edema in patients with branch retinal vein occlusion using optical coherence tomography (OCT). Methods: This study enrolled 55 patients diagnosed with branch retinal vein occlusion who presented to the outpatient clinic between March 2022 and March 2023. A retrospective analysis categorized patients into non-recurrence and recurrence groups. Data on visual acuity, spherical equivalent, intraocular pressure, number of injections, and follow-up duration were collected from medical records. OCT images were obtained before and 6 months after intravitreal injection to measure and analyze central retinal thickness, subfoveal choroidal thickness, and disorganization of retinal inner layers. Results: No statistically significant difference was observed in the central retinal thickness change before and after treatment between the groups. Although no significant differences were observed in visual acuity between the two groups before treatment, significant improvement in visual acuity was observed in the non-recurrence group after 6 months of treatment. The non-recurrence group was younger compared to the recurrence group; moreover, the intraocular pressure in non-recurrence patients decreased significantly during the 6-month treatment period. In addition, a decrease in subfoveal choroidal thickness before and after treatment, the difference in subfoveal choroidal thickness between the affected eye and the fellow eye before treatment, and the reduction in disorganization of retinal inner layers before and after treatment were associated with a favorable prognosis without recurrence. Conclusions Changes in subfoveal choroidal thickness before and after treatment, variations in subfoveal choroidal thickness between the affected and fellow eyes before treatment, and the degree of disorganization of retinal inner layers exhibited significant associations with the recurrence of macular edema. This is significant because it allows for predictions based on baseline OCT images.

Purpose: To identify initial factors contributing to the resistance against intravitreal aflibercept treatment in polypoidal choroidal vasculopathy (PCV) patients. Methods: This study included PCV patients initially treated with aflibercept. Resistance was defined when treatment did not reduce subretinal fluid (SRF) or intraretinal fluid (IRF) by 100 μm or more after three consecutive 4-week intervals, and the treatment interval could not be extended beyond 8 weeks. To identify initial factors associated with resistance to aflibercept treatment, we examined visual acuity and central choroidal thickness before initial treatment and after three treatments. Choroidal thickness was divided into the thickness of the large choroidal vessel layer and the layer that includes choriocapillaris and medium choroidal vessel thickness (termed medium choroidal vessel/choriocapillaris layer thickness, MCCT). Additionally, the volume of SRF, IRF, subretinal hyperreflective material, and pigment epithelial detachment in optical coherence tomography (OCT) images was investigated. The statistical significance of each factor was assessed through logistic regression analysis. Results: The study included 39 eyes showing no resistance to aflibercept and 37 eyes that exhibited resistance. Multiple logistic regression analysis, adjusted for age and sex, indicated that a lower initial ratio of MCCT to choroidal thickness at the fovea was associated with resistance to aflibercept. Conclusions In patients with PCV treated with aflibercept, early OCT anatomical structures, such as the initial MCCT-choroidal thickness ratio at the fovea, may predict response to treatment injections.