Background: The Act on Decisions on Life-Sustaining Treatment (LST) has been implemented in Korea since 2018, yet data on its application in neurocritical care units remain scarce. This study aimed to evaluate the clinical characteristics and outcomes of LST withdrawal or withholding in the neurocritical care unit. Methods: This study was a retrospective analysis conducted at a tertiary university hospital in Busan, South Korea. Among patients admitted to the neurocritical care unit between February 2018 and August 2023, those with documented decisions for LST withdrawal or withholding were enrolled. Demographic and clinical characteristics, underlying and combined conditions, reasons for LST decisions, measures taken, and time from LST withdrawal to death were extracted from medical records. Results: A total of 69 patients were included, with a median age of 67 years, and 38 (55%) were male. Cerebrovascular disease (62%) and traumatic brain injury (22%) were the most common underlying diagnoses. The primary reason for LST decisions was irreversible neurological damage (71%), followed by systemic complications (19%). Mechanical ventilation cessation (91%) and extubation (86%) were most frequently used measures for LST withdrawal. The median time from LST withdrawal to death was 22 minutes. Conclusions Our study demonstrates that LST decisions in the neurocritical care unit predominantly occur among patients with cerebrovascular disease or traumatic brain injury, mostly triggered by neurological deterioration. Most patients died shortly after withdrawal. These findings provide important insight into current LST withdrawal practices in neurocritical care and may assist clinical and ethical decision making in similar settings.

Purpose: To compare the clinical outcomes of early pars plana vitrectomy versus intravitreal antibiotic injection in patients who developed infectious endophthalmitis after cataract surgery. Methods: The medical records of patients diagnosed with infectious endophthalmitis following cataract surgery between 2006 and 2023, whose initial best-corrected visual acuity (BCVA) values were 0.48 to 2.3 in LogMAR units, were retrospectively reviewed. Final BCVA and the degree of visual improvement were compared between early vitrectomy and intravitreal antibiotic injection-only groups. Additionally, patients who underwent delayed vitrectomy within 3 days after the initial intravitreal antibiotic injection (delayed vitrectomy group) were separately analyzed and compared. Results: At 6 months post-treatment, the mean BCVA values were significantly better in the early vitrectomy group (0.37 ± 0.27) than in the injection group (1.02 ± 0.81) (p = 0.004); the early vitrectomy group also had greater visual improvement at both 1 week and 6 months after treatment (p = 0.004, p < 0.001). Compared to the delayed vitrectomy group, the early group demonstrated significantly greater visual improvement at both time points (p = 0.010, p = 0.001). The retreatment rate was higher in the injection group than in the early vitrectomy group. Conclusions In patients who developed infectious endophthalmitis after cataract surgery and had an initial visual acuity between light perception or better and 20/60, early vitrectomy resulted in better visual outcomes compared to intravitreal antibiotic injection alone or delayed vitrectomy.

The recent approval of trastuzumab deruxtecan for human epidermal growth factor receptor 2 (HER2)–low and HER2-ultralow breast cancer mandates an adequate assessment of these categories. Methods: Seven breast pathologists from the Breast Pathology Study Group of the Korean Society of Pathologists held an on-site expert consensus meeting. Fifteen sets of virtual whole slide images (WSI) of hematoxylin and eosin stain and HER2 immunohistochemistry were provided. The pathologists were given 60 minutes to submit their diagnosis of HER2 expression into null, ultralow, 1+, 2+, or 3+. Afterwards, in-depth discussion and consensus diagnoses were made by real-time visualization of the WSI. Results: After the consensus meeting, unanimous 100% agreements were seen only in five (33.3%) of the examined cases, which consisted of three 1+ cases and two 2+ cases. Two cases (13.3%) had mild disagreement, with only one pathologist’s disagreement. Of note, eight cases (53.3%) showed significant disagreement, defined by more than two pathologists’ disagreement. All HER2-null cases were reclassified as ultralow after consensus review, suggesting potential widespread underclassification of ultralow cases in clinical practice. Conclusions: Experts had significant discrepancies in interpreting HER2-low/ultralow status. It is important to assess if the distinction between HER2-low and ultralow is strictly required and if HER2-null breast cancer exists in reality.

Myiasis, a parasitic infestation caused by dipteran larvae in living humans or animals, is rarely encountered postmortem. Here, we report a case of myiasis identified during postmortem inspection in a 40-year-old man with a 10-year history of untreated schizophrenia. During the winter between late 2022 and early 2023, the decedent walked outdoors barefoot and sustained frostbite and was advised to undergo limb amputation at a university hospital in March 2024. He died at home in late May 2024. At the scene, the body showed displaceable livor mortis and absence of rigor mortis, suggesting a short postmortem interval. Severe necrosis was present below the knees, and numerous third-instar larvae without postfeeding stage were observed within the necrotic tissue, suggesting myiasis development at the frostbite sites. Species identification via larval sampling was not possible; thus, photographic analysis was attempted. The larva at the most advanced developmental stage was most likely a third-instar Lucilia sericata, the most common species causing myiasis in Korea. Assuming a skin temperature of 34°C under blanket coverage, the estimated post-oviposition interval ranged from 38.9–71.7 hours. Considering the estimated postmortem interval, the oviposition may have occurred antemortem. Since myiasis can indicate neglect or contribute to death, forensic pathologist should assess whether the postmortem interval aligns with the developmental stage of the larvae. For accurate forensic entomological analysis, adequate sampling of larvae is essential during postmortem inspections.

Metastatic spine cancer (MSC), a common complication of advanced malignancies, poses significant challenges due to pain, neurological deficits, and mechanical instability. While radiation therapy is a cornerstone of treatment, the role of spine surgery is evolving, fueled by advances in surgical techniques and radiation modalities such as stereotactic body radiation therapy (SBRT). This review examines the evolving role of spine surgery in MSC management, focusing on separation surgery, surgical innovations, and future directions. The treatment paradigm for MSC shifted with the advent of SBRT, which delivers high-dose precision radiation, improving local control even in radioresistant tumors. This advancement enabled the adoption of separation surgery, a technique aimed at creating a safe margin between the tumor and neural structures without extensive tumor resection, followed by SBRT to achieve tumor regression. Separation surgery reduces morbidity, shortens operative times, and achieves comparable local control rates to traditional corpectomy procedures. Innovations like minimally invasive surgery, stereotactic navigation, and cement-augmented instrumentation have improved surgical safety and outcomes. Emerging technologies, such as machine learning for predictive modeling and augmented reality for surgical navigation, hold potential for improving decision-making and procedural accuracy. Spine surgery remains integral to MSC treatment, especially for high-grade metastatic epidural spinal cord compression and mechanical instability. Integrating advanced technologies and multidisciplinary collaboration is key to optimizing patient outcomes. Comprehensive, patient-centered strategies addressing both oncological and mechanical aspects can improve survival and quality of life for patients with MSC.

Myofibromas are rare mesenchymal neoplasms that primarily affect infants and young children, most commonly arising in the skin, subcutaneous tissue, muscle, or bone. These tumors present with a broad clinical spectrum, ranging from self-limiting lesions to disseminated and fatal cases. In adults, the solitary form is encountered more frequently than the multicentric type. Although myofibromas may occur in the oral region of the head and neck, isolated cases involving the nasal septum are exceedingly rare. Here, we describe a case of solitary adult-onset myofibroma of the nasal septum that was successfully excised through transnasal endoscopic surgery.

Background and Objectives: Differentiating inverted papilloma (IP) from squamous cell carcinoma arising in IP (IP+SCC) is challenging when computed tomography (CT) demonstrates no bone destruction. This study aimed to identify CT and magnetic resonance imaging (MRI) features that distinguish IP from IP+SCC in cases without bone destruction on CT. Methods: We retrospectively reviewed 30 patients with histologically confirmed sinonasal IP (n=15) or IP+SCC (n=15) who underwent preoperative CT and MRI between 2010 and 2023. Imaging variables assessed included tumor origin, tumor volume, CT enhancement pattern, signal intensity on T2-weighted and contrast-enhanced T1-weighted images, apparent diffusion coefficient (ADC), and the presence or loss of the convoluted cerebriform pattern (CCP). Group differences were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant. Results: There was no statistically significant difference in tumor origin between the IP and IP+SCC groups. Tumor volume and CT enhancement patterns also did not differ significantly between the groups. On MRI, IP+SCC more frequently demonstrated intermediate signal intensity on both T2-weighted and contrast-enhanced T1-weighted images compared with IP (p=0.025 and p=0.029, respectively). Median ADC values were significantly lower in the IP+SCC group than in the IP group (0.99×10-3 vs. 1.20×10-3 mm2/s; p=0.026). Loss of the CCP was more common in the IP+SCC group, although the difference did not reach statistical significance. Conclusion In sinonasal IP without bone destruction on CT, MRI appears to be more informative than CT for distinguishing IP+SCC from IP. Intermediate signal intensity on T2-weighted and contrast-enhanced T1-weighted images, along with lower ADC values, supports malignant transformation, whereas tumor size, CT enhancement, and CCP alone are less reliable discriminators.

Objectives: This study examined factors associated with health-related quality of life (HRQoL) in Korean adults. Methods: Using data from 5,620 participants in the 9th Korea National Health and Nutrition Examination Survey, obesity was defined as body mass index ≥25 kg/m2 and HRQoL assessed by the health-related quality of life instrument with 8 items (HINT-8). Complex survey weights were applied. Results: General linear and multiple regression analyses showed that among women, obesity was significantly associated with lower HINT-8 scores (B=-0.008, p=0.032), while no association was found in men. Age, household income, education, perceived stress, and smoking were also significantly related to HRQoL in both sexes. Conclusions HRQoL in Korean adults is influenced by obesity, socioeconomic status, and mental health indicators. The adverse effect of obesity observed only in women highlights the need for sex-specific public health strategies and the relevance of culturally adapted tools such as the HINT-8.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.

Background: Degenerative lumbar scoliosis (DLS) alters spinal anatomy, impacting the feasibility and dimensions of surgical corridors for oblique lumbar interbody fusion (OLIF). This study aimed to compare the morphometric characteristics of OLIF corridors between patients with left- and right-apex curves, focusing on corridor dimensions, psoas muscle asymmetry, and segmental artery positioning. Methods: A retrospective analysis of 80 patients with DLS (left apex: n = 43; right apex: n = 37) was conducted. Corridor angles and distances, psoas muscle cross-sectional areas, and segmental artery locations were measured at L2–3, L3–4, and L4–5 using T2-weighted magnetic resonance imaging (MRI). Multivariate regression analysis identified key anatomical predictors of corridor variation at L2–3. Results: Regardless of the apex direction, the left-sided corridor was consistently larger across all levels. Corridor angles were significantly greater on the left side in both groups (left apex: L2–3, 39.7° vs. 13.5°; L3–4, 38.3° vs. 11.9°; L4–5, 38.6° vs. 6.9°;right apex: L2–3, 53.7° vs. 18.1°; L3–4, 43.1° vs. 18.5°; L4–5, 28.6° vs. 11.9°). Psoas muscle areas were larger on the concave side of the curve (left apex: 125.7 mm2 vs. 67.9 mm2 ; right apex: 125.4 mm2 vs. 77.4 mm2 ). Segmental artery positioning exhibited curvedependent asymmetry at L2–3 (left apex: 8.8 mm vs. 7.9 mm; right apex: 9.6 mm vs. 8.0 mm). Multivariate regression analysis revealed that in the left apex group, the left psoas area (β = −0.132) and segmental artery distances were significant predictors of corridor angle variation (R2 = 0.517). In the right apex group, psoas asymmetry (β = 0.123) and sagittal alignment (β = −0.851) were associated with corridor differences. Conclusions OLIF corridors in DLS patients demonstrate consistent left-sided dominance, regardless of apex direction. Psoas muscle asymmetry and segmental artery positioning contribute to corridor variations. While the left-sided approach remains standard, right-sided access may be feasible in select cases, particularly at L4–5. These findings provide insights for optimizing preoperative planning and surgical decision-making in DLS patients.