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.

Objective: To identify the risk factors for pregnancy loss at different gestational stages, before and after 60 days of gestation when the placentation is firmly established and quantify the subsequent reproductive performance. Methods: This study analyzed the records from 6,444 pregnancies confirmed by transrectal ultrasonography 31 days after artificial insemination. Pregnancy loss between 31–61 days was categorized as late embryonic or early fetal loss (LEL–EFL), and losses between 62–260 days were categorized as mid-to-late fetal loss (M–LFL). Multivariable logistic regression was used to assess the risk factors. Survival analysis was performed to assess the probability of becoming pregnant again by 400 days postpartum. Results: The cumulative incidence of pregnancy loss was 5.8% for LEL–EFL and 7.7% for M–LFL; LEL–EFL accounted for 43.2% of all losses. A higher body condition score at calving tended to reduce the risk of early loss (p < 0.1), whereas the synchronization protocols (p < 0.0001), first postpartum service (p < 0.0001), and summer insemination (p < 0.1) increased it. Peripartum disorders increased the risk at both stages (odds ratio: 1.30–1.72, p < 0.05– 0.0001), and twin pregnancies increased M–LFL (p < 0.0001). Cows with pregnancy loss had a lower probability of becoming pregnant again by 400 days postpartum and longer calvingto-pregnancy intervals than unaffected cows (227.1–376.3 days vs. 107.3 days). Conclusions and Relevance: The patterns of pregnancy loss were stage-specific, and early and later losses had distinct and progressively more adverse effects on reproductive performance.Optimizing the body condition at calving, refining breeding management, and improving peripartum health may reduce pregnancy loss and improve reproductive outcomes.

This paper reports two clinical cases of men in their twenties who presented with compulsive sexual behaviors characterized by excessive pornography use and illegal voyeuristic activities. Although both individuals maintained otherwise adequate social and academic functioning, they experienced psychological distress and faced legal consequences stemming from their inability to control their sexual impulses. Pharmacological treatment with naltrexone and fluoxetine was associated with a reduction in their compulsive urges. Compulsive sexual behavior disorder (CSBD) has not yet been formally included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and its status as a potential behavioral addiction remains under debate. Voyeuristic behavior is classified within paraphilic disorders, which are considered diagnostically separate from CSBD despite substantial clinical overlap. These cases contribute to the ongoing discussions regarding the conceptualization of CSBD and highlight the importance of recognizing and expanding the therapeutic approaches for individuals struggling with impaired sexual impulse control.

Suicide prevention remains one of the most complex and important tasks in psychiatric practice.Lithium and clozapine have long been considered potential anti-suicidal agents, but the strength and scope of their evidence are largely diagnosis-specific. In clinical settings, however, these drugs are occasionally used in broader contexts, including cases where suicidal ideation itself becomes the primary indication. This raises the need to critically examine how pharmacologic interventions should be applied within appropriate diagnostic and therapeutic frameworks. This review synthesizes existing evidence on lithium and clozapine and discusses their roles within the broader landscape of suicide prevention. Suicide is not a unitary symptom but a multifactorial outcome shaped by biological, psychological, and social determinants. Accordingly, pharmacologic treatment should be understood as one component of a multidimensional strategy that integrates psychotherapy, crisis intervention, and social support systems. From an interpretive standpoint, this review highlights the importance of aligning medication use with established evidence while maintaining clinical flexibility and individualized care. The goal was not to depreciate the therapeutic value of lithium or clozapine but to contextualize their use within a rational, diagnosis-informed, and ethically grounded framework. This paper contributes to a more nuanced and evidence-based model of suicide prevention in psychiatric practice by reinforcing such an integrative approach.

Microglial activation during aging is associated with neuroinflammation and cognitive impairment. Galectin-3 plays a crucial role in microglial activation and phagocytosis. However, the role of galectin-3 in the aged brain is not completely understood. In the present study, we investigated aging-related mechanisms and microglial galectin-3 expression in the mouse hippocampus using female 6-, 12-, and 24-month-old C57BL/6 mice. Western blot analysis revealed neurodegeneration, blood-brain barrier leakage, and increased levels of neuroinflammation-related proteins in 24-month-old mice compared to 6- and 12-month-old mice. Immunohistochemistry revealed an increase in activated microglia in the hippocampus of 24-month-old mice compared to 6- and 12-month-old mice. Furthermore, we found more galectin-3 and triggering receptor expressed on myeloid cells-2-positive microglia in 24-month-old mice compared to 6- and 12-month-old mice. Using primary mouse microglial cells, galectin -3 was also increased by lipopolysaccharide treatment. These findings suggest that galectin-3 may play an important role in microglial activation and neuroinflammation during brain aging.

Purpose: Adjuvant treatment for craniopharyngioma after surgery is controversial. Adjuvant external beam radiation therapy (EBRT) can increase the risk of long-term sequelae. Stereotactic radiosurgery (SRS) is used to reduce treatment-related toxicity.In this study, we compared the treatment outcomes and toxicities of adjuvant therapies for craniopharyngioma. Materials and Methods: We analyzed patients who underwent craniopharyngioma tumor removal between 2000 and 2017. Of the 153 patients, 27 and 20 received adjuvant fractionated EBRT and SRS, respectively. We compared the local control (LC), progression-free survival (PFS), and overall survival between groups that received adjuvant fractionated EBRT, SRS, and surveillance. Results: The median follow-up period was 77.7 months. For SRS and surveillance, the 10-year LC was 57.2% and 57.4%, respectively. No local progression was observed after adjuvant fractionated EBRT. One patient in the adjuvant fractionated EBRT group died owing to glioma 94 months after receiving radiotherapy (10-year PFS: 80%). The 10-year PFS was 43.6% and 50.7% in the SRS and surveillance groups, respectively. The treatment outcomes significantly differed according to adjuvant treatment in nongross total resection (GTR) patients. Additional treatment-related toxicity was comparable in the adjuvant fractionated EBRT and other groups. Conclusion Adjuvant fractionated EBRT could be effective in controlling local failure, especially in patients with non-GTR, while maintaining acceptable treatment-related toxicity.

Background: Post-transplantation cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are common pro‑ phylactic strategies for graft-versus-host disease (GVHD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Interleukin (IL)-6 is a surrogate marker for cytokine release syndrome (CRS) and acute GVHD.Method The clinical outcomes and complications of haplo-HSCT with PTCy plus ATG versus PTCy monotherapy were compared according to serum IL-6 levels at Chungnam National University Hospital (Daejeon, South Korea) from Jan‑ uary 2019 to February 2023. Results: Forty patients who underwent haplo-HSCT were analyzed. A significant difference in IL-6 levels was observed between the PTCy plus ATG and PTCy alone groups (7.47 ± 10.55 vs. 117.65 ± 127.67; p = 0.003). More patients in the PTCy plus ATG group had a CRS grade of 0 than in the PTCy alone group (p < 0.001). Serum IL-6 levels were associated with grades II–IV acute GVHD (r = 0.547, p < 0.001). The cumulative incidence (CI) of grades II–IV acute GVHD was significantly higher in the PTCy alone group (67.9% vs. 4.8%; p < 0.001). No significant difference in the CI for chronic GVHD was detected between the PTCy plus ATG and PTCy alone groups (72.1% vs. 82.0%; p = 0.730). The CI of 1-year non-relapse mortality was significantly higher in the PTCy alone group than in the PTCy plus ATG group (42.2% vs. 15.9%; p = 0.022). The 1-year overall survival (OS) was significantly better in the PTCy plus ATG group (75.9% vs. 35.3%; p = 0.011). The 1-year GVHD-free, relapse-free survival rate was 29.4% in the PTCy alone group and 54.0% in the PTCy plus ATG group (p = 0.038). Conclusion Serum IL-6 levels were higher in the PTCy alone group than in the PTCy plus ATG group. The addition of ATG before stem cell infusion affected IL-6 levels and reduced the incidences of CRS and grade II–IV acute GVHD in haplo-HSCT patients. This study suggests that PTCy plus ATG as GVHD prophylaxis in haplo-HSCT is beneficial in terms of clinical outcomes and complications of HSCT.

Background: To investigate the clinicopathologic pattern of prostate cancer (PCa) in elderly patients compared with their younger counterparts with a prostate-specific antigen (PSA) level below the low-risk threshold (< 10 ng/mL), which is often a deciding factor for biopsy. Methods: A nationwide database of PCa at the time of biopsy from 2010 to 2020 was constructed from 39 hospitals. Patients were categorized into age groups of < 64 years, 65–69 years, 70–74 years, and ≥ 75 years considering guidelines that recommend PSA testing only for those aged 55–69 years during the study period, the average age of Korean PCa registrants of 70.3 years (2010–2020), and the average life expectancy of Korean males of 80.3 years (2020). Results: The mean ± standard deviation age was 70.3 ± 8.2 years, which was normally distributed (kurtosis = 0.095). Among 14,548 subjects, 54.1%, 39.5%, and 6.4% of them had high-risk disease, intermediate-risk disease, and low-risk disease, respectively. Based on three risk parameters, a marked increase in high-risk cancer was observed in the oldest age group (linear combination, P < 0.001). The same pattern was observed among patients with low-risk disease (PSA < 10 ng/mL), who were divided into PSA tiers as follows: 4–5 ng/mL (P < 0.001), 5–6 ng/mL (P < 0.001), 6–7 ng/mL (P < 0.001), 7–8 ng/mL (P < 0.001), 8–9 ng/mL (P = 0.009), and 9–10 ng/mL (P < 0.001). In all PSA tiers between 4 and 10 ng/mL, multivariate analysis demonstrated a significantly higher prevalence of high-risk cancer in the oldest age group than in the youngest age group. In the lowest tier (4–5 ng/mL), 35.2% of those aged over 75 years had high-risk PCa. Conclusion The older the patient, the more aggressive the PCa. Moreover, there was an increase in high-risk PCa in older males compared with younger males even with a PSA level below the low-risk threshold of 10 ng/mL, suggesting the need to strengthen cancer screening policies in the older population.

Bipolar disorder is the main approved indication of mood stabilizers. In clinical practice, however, they are commonly used for 1) patients showing aggressive behavior regardless of the diagnosis and 2) schizophrenia patients. A literature review was performed to find evidence supporting this clinical “common sense.” The authors found no sufficient evidence supporting the efficacy of mood stabilizers either for aggressive behavior or for schizophrenia. The authors suggest that off-label use of mood stabilizers should be based on judicious clinical judgment, based on the understanding “what particular treatment for this patient does the behavior warrant at this time?”