Background: Renal function declines with age as the kidneys become more vulnerable to inflammation and cellular senescence. This study examined gene expression changes linked to renal aging and assessed whether short-term calorie restriction (CR), a known anti-aging intervention, could reverse these alterations. Methods: Using RNA-seq data, we applied bioinformatics, systems biology, and molecular biology approaches to identify differentially expressed genes during aging and under CR. Gene Ontology and pathway analyses revealed that both aging and CR altered the expression of key senescence-associated secretory phenotype (SASP) genes, including cytokines and chemokines (Il1b, Ccl3, Ccl5, Il19, and Il24) and growth factors (Timp1 and Mmp12). Results: Renal aging is also associated with an increased expression of cell cycle arrest markers (p15INK4B (Cdkn2b), p16INK4A (Cdkn2a), and p21 (Cdkn1a)), which are suppressed by CR, suggesting a link to cellular senescence. Quantitative analysis of renal tissue samples confirmed the age-associated upregulation of these genes at the transcriptional level, and CR effectively attenuated these changes. Among these genes, we focused on the members of the interleukin 20 (IL-20) family, particularly Il19 and Il24. Furthermore, experimental induction of cellular senescence using H2O2 resulted in elevated Il19 and Il24 expression alongside other senescence markers. These findings suggest that aging and short-term CR regulate the IL-20 family expression, potentially influencing cellular senescence. Conclusion Our study suggests that Il19 and Il24 are associated with age-related renal decline and may represent hypothesis-generating candidates, highlighting potential molecular targets for future mechanistic and therapeutic investigations.

BACKGROUND/OBJECTIVES: Postpartum bone metabolism undergoes substantial alterations based on breastfeeding status. Research on maternal calcium intake and bone recovery, particularly among Asian women, remains limited. This study investigated postpartum change in bone mineral density (BMD) and its association with calcium intake during late pregnancy and post-delivery according to breastfeeding status. SUBJECTS/METHODS: Thirty-six women (22 breastfeeding, 14 non-breastfeeding) underwent dual-energy X-ray absorptiometry 3 times: 1) within 3 days of delivery, 2) at 6 mon postpartum for non-breastfeeding women or within 1 mon of weaning for breastfeeding women, and 3) at 12 mon postpartum. Dietary calcium intake was evaluated using a food frequency questionnaire and dietary supplement survey at all visits. Association between calcium intake with percentage change in BMD (%ΔBMD) was assessed by linear regression. RESULTS: The BMD at the lumbar spine, total hip, femoral neck, and trochanter significantly decreased during breastfeeding, whereas non-breastfeeding women displayed increased BMD at the femoral neck at 6 mon postpartum. In non-breastfeeding women, postpartum calcium intake was positively associated with %ΔBMD at the total hip, femoral neck, and intertrochanter (P < 0.05). Few significant associations were observed between %ΔBMD and late pregnancy intakes across all women, regardless of breastfeeding status. At 12 mon, BMD in breastfeeding women recovered to delivery levels, while non-breastfeeding women maintained their BMD observed at 6 mon postpartum. CONCLUSION Postpartum calcium intake is positively associated with bone recovery in non-breastfeeding women, suggesting that its effects on bone recovery potentially vary with lactation status.

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.

Optimal vascular access and effective closure are fundamental for ensuring the safety and success of percutaneous cardiovascular interventions. As procedural complexity has increased, various access and closure devices have been developed to enhance efficacy and minimize complications. Radial artery access is favored for coronary interventions because it is associated with a lower risk of bleeding and fewer access site complications. However, femoral access remains indispensable for large-bore procedures. Large-bore sheaths are required for endovascular treatments of peripheral artery disease and structural heart interventions. Ultrasound-guided arterial and venous access has become essential for minimizing complications, especially with femoral access. Despite significant advances in closure techniques, complications such as retroperitoneal hemorrhage, pseudoaneurysm, and arteriovenous fistula remain challenging and can adversely affect patient outcomes. This review presents state-of-the-art strategies for the prevention and management of vascular access complications in cardiovascular intervention.

Objective: This study compared clinical and cosmetic outcomes of cranioplasty using customized three-dimensional (3-D) printed implants versus autologous bone in patients with aneurysmal subarachnoid hemorrhage (aSAH) after decompressive craniectomy (DC). Methods: We retrospectively reviewed 50 patients who underwent cranioplasty after DC for aSAH between July 2018 and December 2023. Patients were divided into the three-dimensional cranioplasty(3-DC, n=26) and autologous bone cranioplasty (AC, n=24) groups. Demographics, aneurysm characteristics, surgical parameters, morphometric analysis of defect coverage, complications, and functional outcomes assessed by the modified Rankin Scale (mRS) were compared. Results: A total of 54 hemispheres underwent cranioplasty. Compared with AC, the 3-DC group had larger defects but achieved higher coverage (96.7% vs. 93.4%, p=0.044) and smaller residual defects (338.7±274.2 mm² vs. 528.5±331.3 mm², p=0.049). Complication rates were lower in 3-DC (9 cases) than AC (15 cases, p=0.0994). Wound dehiscence and fluid collection were more frequent with 3-DC, while bone flap resorption and epidural abscess occurred only with AC. Revision surgery was required in six patients, five initially treated with autologous bone. Neurological outcomes (mRS) were maintained or improved in both groups. Conclusions In aSAH patients undergoing cranioplasty after DC, customized 3-D printed implants achieved significantly better anatomical restoration and showed a numerical trend toward fewer complications compared with autologous bone. While AC remains feasible, its risks of resorption and infection often necessitate revision. 3-D printed implants may be considered a reasonable alternative, particularly in aSAH patients at higher risk of complications.

Objective: Adolescent depressive symptoms are increasingly recognized as a global concern for youth mental health. Female adolescents consistently report higher levels of depressive symptoms than their male counterparts, yet the psychological mechanisms underlying depressive symptoms remain insufficiently understood. Our longitudinal study examined the relationship between loneliness and depressive symptoms in female adolescents and investigated the mediating effect of subjective well-being (SWB) and the moderating influence of the parental relationship. Methods: Data were drawn from the Korean Study of Adolescent Health, a longitudinal study on adolescent mental health. The sample included 104 female high school students (mean age=15.33 years) who completed self-report surveys at three time points between April 2022 and July 2023. Measures assessed loneliness, SWB, depressive symptoms, and relationships with mothers and fathers. Mediation and moderated mediation analyses were conducted using SPSS PROCESS (Models 4 and 14), controlling for age, socioeconomic status, and baseline depressive symptoms. Results: Mediation analyses indicated that SWB fully mediated the longitudinal association between loneliness and depressive symptoms. Loneliness predicted lower SWB, which subsequently predicted more depressive symptoms. Moderated mediation analysis revealed that maternal, but not paternal, relationship quality significantly moderated the SWB-depressive symptoms link. The indirect effect was significant only among adolescents reporting stronger maternal relationships. Conclusion These findings underscore the importance of SWB in the link between loneliness and depressive symptoms among female adolescents and highlight the protective role of a positive maternal relationship. The results have implications for targeted prevention and intervention strategies to enhance emotional well-being in female adolescents.

Purpose: Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that can significantly diminish quality of life. Although some patients have reported persistent pelvic pain after radical prostatectomy (RP), the prevalence and direct causal relationship between CPPS and RP remain unclear. This multicenter prospective study aimed to evaluate the efficacy of Urovaxom for improving CPPS symptoms. Materials and Methods: A total of 52 prostate cancer patients who underwent RP were enrolled and administered Urovaxom (60 mg/day) for 12 weeks. Changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and inflammation markers (white blood cell [WBC], C-reactive protein [CRP]) were analyzed using the Wilcoxon signed-rank test. Results: After 12 weeks of treatment, the NIH-CPSI total score significantly decreased from 19 (interquartile range [IQR], 16–23) to 12.5 (IQR, 8.0–16.8) (p<0.001). The OABSS total score decreased from 8 (IQR, 4–11) to 5 (IQR, 3.0–7.8), and the IPSS total score decreased from 13.5 (IQR, 10.0–22.8) to 10.5 (IQR, 5.0–17.0) (p<0.001). WBC levels showed a slight increase (p=0.028), but the clinical relevance of this change is uncertain and warrants further investigation. CRP changes were not statistically significant (p=0.274). Conclusions Urovaxom demonstrated significant efficacy in improving CPPS symptoms, particularly pain and reduced quality of life, in patients following RP. These findings suggest Urovaxom as a potential therapeutic option for CPPS after management using RP.

Aortic regurgitation (AR) in children is usually caused by congenital valve anomalies, and Behçet syndrome (BS) can be suspected in cases of isolated AR. Patients with BS undergoing aortic valve surgery due to aortic valve invasion have a high risk of complications, such as leakage around the valve and dehiscence. Cardiovascular involvement occurs in 7%–46% of adult patients with BS and is the main cause of mortality; however, its prevalence is unclear and rare in children. A 12-year-old boy was diagnosed with severe AR associated with BS. A progressive subaortic pseudoaneurysm was observed after aortic valve replacement. The periaortic intracardiac pouch was at risk of rupture; therefore, the patient underwent a Bentall operation. After the Bentall procedure, a newly developed subaortic pseudoaneurysm was detected below the prosthetic valve. However, the risk of rupture reduced as the subaortic pseudoaneurysm regressed with anti-inflammatory drugs alone without reoperation. Repeated surgery is inevitable in patients with BS undergoing aortic valve surgery due to the progressive chronic inflammatory reactions that present with a pseudoaneurysm. Here, we report an 8-year follow-up of a pediatric case of BS with subaortic pseudoaneurysm, highlighting the importance of close follow-up, medical management, and early diagnosis in treating this condition.

Background/Aims: Gastric neuroendocrine tumors (GNETs), once rare, have become more prevalent due to the increased use of endoscopy and increased physician awareness. The clinical characteristics and long-term outcomes of GNET management were explored in this study. Methods: The clinical data of 69 patients who treated at Seoul National University Hospital between January 2013 and October 2023 were retrospectively studied. Baseline characteristics, recurrence rates, associated factors, and overall survival rates were analyzed. Results: Of the tumors, 71.0% were grade 1, 24.6% were grade 2, 1.4% were grade 3, and 2.9% were poorly differentiated. In terms of tumor type, 69.6% were type I, 1.4% were type II, and 29.0% were type III. A significant proportion of patients with grade 1 tumors received more endoscopic treatment, whereas a significant proportion of patients with grade 2 tumors underwent surgery or chemotherapy (p=0.015). The overall 5-year survival and recurrence rates were 93.8% and 7.25% (5/69), respectively. Among five patients who experienced recurrence, three had metachronous recurrence, all of which were type I; the remaining two patients exhibited distant hepatic metastasis, encompassing types I and III. The time to recurrence was 1 to 9.8 years.Margin positivity (p=0.002) and invasion deeper than the submucosal layer (p=0.007) were associated with higher recurrence rates. However, there was no significant association between recurrence and intestinal metaplasia, atrophic gastritis, or Helicobacter pylori infection. Conclusions Most patients with GNETs in this study had grade I and type I tumors, and the overall prognosis was favorable. Patients with risk factors for recurrence warrant further investigation. Those presenting margin positivity or deep invasion after resection should be closely monitored and undergo follow-up examinations, as necessary.

Background/Aims: Gastric neuroendocrine tumors (GNETs), once rare, have become more prevalent due to the increased use of endoscopy and increased physician awareness. The clinical characteristics and long-term outcomes of GNET management were explored in this study. Methods: The clinical data of 69 patients who treated at Seoul National University Hospital between January 2013 and October 2023 were retrospectively studied. Baseline characteristics, recurrence rates, associated factors, and overall survival rates were analyzed. Results: Of the tumors, 71.0% were grade 1, 24.6% were grade 2, 1.4% were grade 3, and 2.9% were poorly differentiated. In terms of tumor type, 69.6% were type I, 1.4% were type II, and 29.0% were type III. A significant proportion of patients with grade 1 tumors received more endoscopic treatment, whereas a significant proportion of patients with grade 2 tumors underwent surgery or chemotherapy (p=0.015). The overall 5-year survival and recurrence rates were 93.8% and 7.25% (5/69), respectively. Among five patients who experienced recurrence, three had metachronous recurrence, all of which were type I; the remaining two patients exhibited distant hepatic metastasis, encompassing types I and III. The time to recurrence was 1 to 9.8 years.Margin positivity (p=0.002) and invasion deeper than the submucosal layer (p=0.007) were associated with higher recurrence rates. However, there was no significant association between recurrence and intestinal metaplasia, atrophic gastritis, or Helicobacter pylori infection. Conclusions Most patients with GNETs in this study had grade I and type I tumors, and the overall prognosis was favorable. Patients with risk factors for recurrence warrant further investigation. Those presenting margin positivity or deep invasion after resection should be closely monitored and undergo follow-up examinations, as necessary.