Objective: This study evaluated a novel trivalent inactivated FAdV vaccine containing antigens from FAdV-4, 8b, and 11. Methods: An SD1356-like FAdV-8b strain, representing newly emerging variants in Asia and the Middle East, was included as an immunogen. Prior to vaccination-challenge trials, pathogenicity of FAdV-4, 8b, and 11 was assessed in chickens via oral, intramuscular, and intravenous routes. These models were used to determine the minimum protective dose.Cross-neutralization assays were performed using sera from monovalent vaccinations for each serotype. Duration of immunity was evaluated in specific pathogen-free chickens following a single vaccine dose. Results: Intravenous challenge produced the highest mortality across all serotypes, including the relatively low-pathogenic FAdV-11. A vaccine dose of 107.0TCID50 /bird induced strong neutralizing antibody responses and provided complete protection against virulent strains.Sera showed no cross-neutralization between heterologous serotypes, emphasizing the necessity of multivalent formulations. Protective antibody titers were maintained up to 78 weeks of age. Conclusions and Relevance: The trivalent vaccine provides effective protection against predominant FAdV-4, 8b, and 11 strains. These findings support the use of multivalent vaccines to achieve broad and sustained immunity against emerging FAdV infections in poultry.

Alterations in gait patterns often indicate health status, and their analysis enables the diagnosis and assessment of various health conditions. This study aimed to develop a noncontact gait analysis system using red, green, and blue-depth (RGB-D) cameras and to evaluate its potential clinical applicability. A single case study was conducted to assess changes in the gait patterns of a patient with stroke before and after the application of an ankle-foot orthosis. Twenty walking trials were recorded to evaluate the key gait parameters. The custom RGB-D camera-based gait analysis system demonstrated the potential to rapidly quantify key gait parameters in the patient. Compared with normative data, it effectively identified characteristic stroke-related gait impairments such as shorter step lengths and slower gait speeds. However, the intraclass correlation coefficient analysis indicated low measurement reliability. Although the stance time and minimum knee angle on the left and right sides exceeded the standard error of measurement (SEM), no changes exceeded the minimal detectable change (MDC) criteria. Moreover, other gait parameters did not show significant changes beyond SEM or MDC, limiting the interpretability of the results. Therefore, further technological developments and data collection are required to improve test-retest reliability and sensitivity to change.

Background: Combined pelvic ring and acetabular fractures are complex injuries associated with high morbidity. Despite advancements in surgical techniques, limited data are available on the long-term functional outcomes and associated factors. This study aimed to identify the factors associated with functional outcomes in surgically treated patients with combined pelvic ring and acetabular fractures. Methods: This retrospective study included 25 adult patients who underwent definitive surgical fixation for radiologically confirmed combined pelvic ring and acetabular fractures at a Level I trauma center between 2005 and 2021, with a minimum clinical and radiological follow-up of 24 months. Surgical approaches included the Kocher–Langenbeck or modified Stoppa methods, tailored to fracture morphology. Matta–Saucedo and Matta criteria assessed the pelvic ring and acetabular reduction quality, respectively. Functional outcomes at 2 years were evaluated using the Rommens–Hessmann criteria. Neurological recovery was assessed clinically and by electromyography where indicated. The association between the injury characteristics and functional recovery was evaluated using t-tests and Fisher’s exact test. Results: The mean patient age was 40.4 years, and 72% were male. Transverse acetabular fractures (58.6%) and anteroposterior compression pelvic ring injuries (64%) were the most common injuries. Anatomic or congruent acetabular reduction (within 2–3 mm) was achieved in 89.6% of fractures and was significantly associated with superior functional outcomes (p = 0.002). Conversely, the pelvic ring reduction quality did not significantly correlate with functional outcomes (p = 0.314). Transverse acetabular fractures (p = 0.046) and initial neurological deficits (p = 0.032) were associated with poorer recovery. Among the patients with neurological injury, 60% achieved partial or full recovery. Overall, bony union occurred in 96% of cases, with a mean time to union of 14.3 weeks. Reported complications included neurological deficits (40%) and infections (8%). Conclusions Functional outcomes following the surgical fixation of combined pelvic and acetabular fractures are primarily influenced by the acetabular reduction quality and neurological status at presentation. Transverse fracture patterns are complex and associated with nerve injuries, posing additional challenges. These findings emphasize the importance of precise joint reduction and early neuroassessment. Further multicenter, prospective studies are warranted to optimize the management of these complex injuries.

Objective: : Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical technique for treating cervical radiculopathy. Traditionally, PECF is performed under general anesthesia in the prone position, but concerns over anesthesia-related complications have led to the exploration of local anesthesia in the lateral decubitus position as an alternative. This study aims to compare the clinical outcomes, safety, and efficacy of PECF performed under local anesthesia in the lateral decubitus position versus general anesthesia in the prone position. Methods: : We conducted a retrospective analysis of 13 patients who underwent PECF under local anesthesia in the lateral decubitus position. The outcomes were compared with data from 357 patients across eight studies who underwent PECF under general anesthesia in the prone position. Outcomes measures included Visual analog scale (VAS) pain scores, Oswestry disability index (ODI), length of stay (LOS), minimally clinically important difference (MCID), and complications. Results: : Patients in the local anesthesia group demonstrated significant reductions in neck pain (VAS-N : 4.93±1.32 to 1.49±0.52, p<0.001) and arm pain (VAS-A : 8.69±0.75 to 1.85±1.46, p<0.001), achieving a mean pain reduction of 78.8%. These improvements were comparable to the general anesthesia group (VAS-N : 4.80 to 1.28; VAS-A : 6.71 to 1.23). Functional outcomes improved significantly in both groups, with ODI scores improving from 54.76% to 9.82% locally and from 39.92% to 9.62% in the general group. Although LOS was slightly longer for the local anesthesia group (5.85±3.20 vs. 4.81±2.17 days, p=0.18), post-procedure monitoring time was significantly shorter (3.2 vs. 7.4 hours, p<0.001). The local anesthesia group reported zero complications (0%; 95% confidence interval [CI], 0–22.8%) compared to an 8.68% complication rate (95% CI, 5.8–11.6%) in the general anesthesia cohort (p=0.612). Conclusion : PECF under local anesthesia in the lateral decubitus position provides comparably effective pain relief and functional improvement comparable to general anesthesia, though the difference in complication rates was not statistically significant and requires larger studies for confirmation. This technique may be particularly advantageous for patients at higher risk for anesthesia-related complications. Further research is warranted to validate these findings in larger, prospective studies.

Intrahepatic cholangiocarcinoma (CCA) is the second most common primary liver cancer after hepatocellular carcinoma (HCC). However, combined HCC-CCA is a rare malignancy exhibiting hepatocytic and cholangiocytic differentiation. For both tumors, R0 resection with regional lymph node dissection remains the only potentially curative treatment. Nevertheless, key aspects of surgical management remain controversial. In this narrative review, we synthesize contemporary evidence on the surgical management of intrahepatic CCA and combined HCC-CCA. We summarize current data on lymphadenectomy, safety, and oncologic comparability of minimally invasive vs. open surgery, and integration of liver hypertrophy techniques for major hepatectomy. We also review the emerging clinical experience with immune checkpoint inhibitor-based chemoimmunotherapy as a neoadjuvant treatment and conversion surgery for advanced disease. We highlight persisting knowledge gaps and propose practical perspectives to support individualized surgical planning for this heterogeneous disease.

Objectives: 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. 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 5460 ESD cases from 5250 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.

Composite gangliocytomaeuroma and neuroendocrine tumors (CoGNETs) are extremely rare periampullary neoplasms composed of neuroendocrine epithelial, Schwannian spindle, and ganglion cells. Although endoscopic papillectomy or surgery have been used to treat ampullary CoGNETs, underwater endoscopic mucosal resection (UEMR) for periampullary lesions has not been previously described. In this study, we present a case of a 53-year-old man referred to our hospital with an incidentally detected subepithelial tumor in the second portion of the duodenum. Endoscopic ultrasound revealed a 13×10-mm homogeneous, hypoechoic, and well-demarcated submucosal mass. UEMR was performed under conscious sedation without submucosal injection, achieving safe en bloc resection within 12 min. Histopathology revealed a 2.0×1.5×1.2-cm lesion composed of mixed neuroendocrine epithelial, Schwannian spindle, and ganglion cells. Immunohistochemical staining was positive for chromogranin A, synaptophysin, CD56, neuron-specific enolase, and S-100, confirming CoGNET with a Ki-67 index of <1% and no lymphovascular or perineural invasion. Follow-up endoscopy 3 months later revealed only a post-resection scar without residual or recurrent tumors. This appears to be the first reported case of periampullary CoGNET successfully treated with UEMR. Therefore, UEMR might represent a safe and effective therapeutic option for selected periampullary subepithelial tumors.