Background/Aims: To determine the effectiveness of tyrosine kinase inhibitor (TKI) plus reduced-intensity therapy in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL), this retrospective study compared treatment outcomes and induction mortality according to backbone regimen intensity. Methods: The data of 132 patients diagnosed with Ph-positive ALL were retrospectively collected from five centers. Patients received imatinib plus intensive chemotherapy (modified VPD, KALLA1407, or hyper-CVAD) or reduced-intensity chemotherapy (EWALL) for curative purposes. This study analyzed 117 patients, of which 35,22,46, and 14 received modified VPD, KALLA1407, hyper-CVAD, and EWALL, respectively. All patients used imatinib as a TKI. Results: The median age of the patients who received reduced-intensity chemotherapy was 64.4 years, while that of the patients with intensive regimens was 47.5 years. There was no induction death in the reduced-intensity group, while nine patients died in the intensive therapy group. Major molecular response achievement tended to be higher in the intensive chemotherapy group than in the reduced-intensity group. More patients in the intensive chemotherapy group received allogeneic stem cell transplantation (allo-SCT). There was no statistically significant difference in long-term survival between the two groups in terms of relapse-free survival and overall survival rates. Conclusions When imatinib plus reduced-intensity therapy was used as a frontline treatment, there was no inferiority in obtaining complete remission compared to imatinib plus intensive chemotherapy or significant difference in long-term survival. Since imatinib plus reduced-intensity therapy has limitations in obtaining a deep molecular response, proceeding to allo-SCT should be considered.

Background/Aims: Multiple myeloma (MM) predominantly affects elderly individuals, but studies on older patients with MM are limited. The clinical characteristics and survival outcomes of patients with MM aged 80 years or over were retrospectively analyzed. Methods: This retrospective multicenter study was conducted to investigate the clinical characteristics, treatment patterns, and survival outcomes of patients aged 80 years or over who were newly diagnosed with MM at five academic hospitals in Daegu, Korea, between 2010 and 2019. Results: A total of 127 patients with a median age of 83 years (range, 80–93 yr) were enrolled: 52 (40.9%) with Eastern Cooperative Oncology Group Performance Status (ECOG PS) > 2, 84 (66.1%) with International Staging System (ISS) stage III disease, and 93 (73.2%) with a Charlson comorbidity index (CCI) > 4. Chemotherapy was administered to 86 patients (67.7%). The median overall survival was 9.3 months. Overall survival was significantly associated with ECOG PS > 2 (HR 2.26, 95% CI 1.43–3.59), ISS stage III (HR 1.99, 95% CI 1.18–3.34), and chemotherapy (HR 0.34, 95% CI 0.21–0.55). There was no statistically significant difference in event-free survival according to the type of anti-myeloma chemotherapy administered. The early mortality (EM) rate was 28.3%. Conclusions Even in patients with MM aged 80 years or over, chemotherapy can result in better survival outcomes than supportive care. Patients aged ≥ 80 years should not be excluded from chemotherapy based on age alone. However, reducing EM in elderly patients with newly diagnosed MM remains challenging.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Background: We investigated whether nutritional intake is associated with physical activity (PA) and handgrip strength (HGS) in individuals with airflow limitation. Methods: This study analyzed data from the 2014 and 2016 Korean National Health and Nutrition Examination Survey. We assessed total protein intake (g/day), caloric intake (kcal/day), and other nutritional intakes, using a 24-hour dietary recall questionnaire. HGS was measured three times for each hand using a digital grip strength dynamometer, and PA was assessed as health-enhancing PA. Airflow limitation was defined as a forced expiratory volume/forced vital capacity ratio of 0.7 in individuals over 40 years of age. Participants were categorized into groups based on their PA levels and HGS measurements: active aerobic PA vs. non-active aerobic PA, and normal HGS vs. low HGS. Results: Among the 622 individuals with airflow limitation, those involved in active aerobic PA and those with higher HGS had notably higher total food, calorie, water, protein, and lipid intake. The correlations between protein and caloric intake with HGS were strong (correlation coefficients=0.344 and 0.346, respectively). The forest plots show that higher intakes of food, water, calories, protein, and lipids are positively associated with active aerobic PA, while higher intakes of these nutrients are inversely associated with low HGS. However, in the multivariate logistic regression analysis, no significant associations were observed between nutritional intake and active aerobic PA or HGS. Conclusion Nutritional intake was found to not be an independent factor associated with PA and HGS. However, the observed correlations suggest potential indirect effects that warrant further investigation.

Purpose: This study compared the diagnostic performance of two attenuation imaging (ATI) modes—low-frequency (3 MHz) and high-frequency (4 MHz)—for assessing hepatic steatosis, with histopathological hepatic fat fraction (HFF) as the reference standard. Methods: This prospective single-center study enrolled participants with suspected metabolic dysfunction-associated steatotic liver disease (MASLD) scheduled for liver biopsy or surgery between June 2023 and June 2024. Attenuation coefficient (AC) values were consecutively measured using low- and high-frequency ATI modes, while the skin-to-region of interest distance (SRD) was measured simultaneously. Spearman correlation analysis evaluated the relationships of AC with HFF and SRD, and linear regression identified factors affecting AC. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Results: In total, 119 participants (mean age, 37.2±12.0 years; 87 men) were included, with 73 (61.3%) diagnosed with MASLD. HFF ranged from 0% to 50%. The AC values in the lowfrequency mode were significantly higher than those in the high-frequency mode (0.61 vs. 0.54 dB/cm/MHz, P<0.001). HFF significantly influenced AC in both modes, whereas SRD affected AC only in the high-frequency mode (P<0.001). AC correlated positively with HFF in both modes (r_s≥0.514, P<0.001) and negatively with SRD in the high-frequency mode (r_s=-0.338, P<0.001). The AUROC for hepatic steatosis did not differ significantly between the two modes (0.751 vs. 0.771; P=0.609). Conclusion The low-frequency mode produced higher AC values than the high-frequency mode and demonstrated comparable diagnostic accuracy for assessing hepatic steatosis. Unlike the high-frequency mode, the low-frequency mode was not influenced by SRD.

There is no established treatment for severe fever with thrombocytopenia syndrome (SFTS). However, the potential role of tocilizumab (TCZ) in cytokine storm modulation warrants further investigation. In this study, we aimed to investigate the therapeutic potential of TCZ in adult patients with SFTS and provide valuable insights into the development of effective treatment strategies for this challenging infectious disease by assessing the impact of TCZ on cytokine dynamics and patient outcomes. This prospective longitudinal observational study included adult patients with SFTS at a teaching hospital in Korea between April 2013 and December 2023. Patients with SFTS and interleukin (IL)-6 levels ≥30 ng/mL received TCZ. The 14- and 28-day mortality rates were compared between the TCZ and therapeutic plasma exchange (TPE) groups during the study period. Among the total of 97 patients, the clinical characteristics showed no significant differences between the TCZ (n=10) and TPE groups (n=30). Compared with TPE, TCZ treatment showed a trend towards lower mortality rate (14-day mortality rate: 10.0% vs. 16.7%, p=0.608; 28-day mortality rate:10.0% vs. 20.0%, p=0.480). Both treatments showed the potential to reduce the viral load and IL-6 levels, indicating their efficacy in managing the disease course. TCZ is a potential therapeutic option for SFTS as it modulates IL-6 levels and improves clinical outcomes.

Purpose: This study aimed to identify independent risk factors for middle ear barotrauma (MEB) symptoms in patients undergoing monoplace hyperbaric oxygen therapy (HBOT). Materials and Methods: We analyzed data from a single-center study involving 296 patients who received monoplace HBOT.Through multivariable logistic regression analysis, we examined the relationship between various factors and the occurrence of MEB to identify significant independent risk factors. Results: The multivariable logistic regression analysis indicated that an altered mental state was associated with increased odds of MEB occurrence [odds ratio (OR) 2.50; 95% confidence interval (CI): 1.13–5.51]. Furthermore, patients in the emergency treatment group for HBOT, as defined by the national health insurance in Korea, were found to be 6.75 times more likely to experience MEB (95% CI: 1.33–34.20). Conclusion This study identified altered mental status and classification in the emergency treatment group for monoplace HBOT as independent risk factors for MEB. These findings can aid in developing safer protocols for monoplace HBOT chamber operations.

Objective: To evaluate the adherence of large language model (LLM)-based healthcare research to the Minimum Reporting Items for Clear Evaluation of Accuracy Reports of Large Language Models in Healthcare (MI-CLEAR-LLM) checklist, a framework designed to enhance the transparency and reproducibility of studies on the accuracy of LLMs for medical applications. Materials and Methods: A systematic PubMed search was conducted to identify articles on LLM performance published in high-ranking clinical medicine journals (the top 10% in each of the 59 specialties according to the 2023 Journal Impact Factor) from November 30, 2022, through June 25, 2024. Data on the six MI-CLEAR-LLM checklist items: 1) identification and specification of the LLM used, 2) stochasticity handling, 3) prompt wording and syntax, 4) prompt structuring, 5) prompt testing and optimization, and 6) independence of the test data—were independently extracted by two reviewers, and adherence was calculated for each item. Results: Of 159 studies, 100% (159/159) reported the name of the LLM, 96.9% (154/159) reported the version, and 91.8% (146/159) reported the manufacturer. However, only 54.1% (86/159) reported the training data cutoff date, 6.3% (10/159) documented access to web-based information, and 50.9% (81/159) provided the date of the query attempts. Clear documentation regarding stochasticity management was provided in 15.1% (24/159) of the studies. Regarding prompt details, 49.1% (78/159) provided exact prompt wording and syntax but only 34.0% (54/159) documented prompt-structuring practices. While 46.5% (74/159) of the studies detailed prompt testing, only 15.7% (25/159) explained the rationale for specific word choices. Test data independence was reported for only 13.2% (21/159) of the studies, and 56.6% (43/76) provided URLs for internet-sourced test data. Conclusion Although basic LLM identification details were relatively well reported, other key aspects, including stochasticity, prompts, and test data, were frequently underreported. Enhancing adherence to the MI-CLEAR-LLM checklist will allow LLM research to achieve greater transparency and will foster more credible and reliable future studies.