Objective: This study aimed to evaluate reproductive outcomes according to the timing of testicular sperm retrieval. Methods: The study included 282 infertile couples divided into three groups: group A (freeze-thawed testicular sperm extraction [TESE] sperm, n=233), group B (fresh TESE sperm collected 1 day before ovum pickup, n=22), and group C (fresh TESE sperm collected on the same day as ovum pickup, n=27). The indications for TESE were surgically uncorrectable azoospermia or ejaculation failure, often accompanied by medical comorbidities such as diabetes mellitus and spinal cord injury. The outcome parameters assessed were fertilization rates, embryo quality, and clinical pregnancy rates. Results: The mean paternal age was 36.8±5.7 years, and the mean maternal age was 32.6±3.5 years. The mean duration of infertility was 2.9±1.8 years. The fertilization rates were 70.7%, 78.9%, and 73.0% for groups A, B, and C, respectively (p=0.047). The percentages of good-quality embryos were 68.2%, 65.3%, and 48.4%, respectively (p=0.007); specifically, the percentage of good-quality embryos was significantly lower in group C compared with the other two groups. Clinical pregnancy rates per transfer were similar at 51.1%, 50.0%, and 48.1% (p=0.958), with no differences observed in miscarriage rates. Conclusion Testicular sperm retrieval can be safely performed 1 day before ovum pickup, resulting in favorable fertility outcomes.

Background: The conventional magnetic resonance imaging (MRI) grading system for foraminal stenosis (FS), known as the Lee classification, was introduced in 2010 and is widely utilized in clinical practice. Previous studies have reported that the conventional grading system for FS lacks prediction ability for surgical treatment. The purpose of this study was to develop a novel MRI grading system for lumbar FS with improved prediction ability for surgical treatment by incorporating facet effusion to indicate segmental instability. Methods: We retrospectively reviewed patients diagnosed with lumbar FS between 2011 and 2017 who had a follow-up period of at least 5 years. The FS severity was assessed using a conventional MRI grading system developed by Lee et al. We recorded whether the patient underwent surgical treatment for FS during the follow-up period and the time from the initial diagnosis to surgery. Survival analysis using a Kaplan-Meier curve and log-rank test was performed to verify the impact of FS severity on the surgical treatment. We performed additional survival analysis after modifying the grading system by incorporating the presence of excessive facet joint effusion assessed using axial MRI. We also compared the discrimination ability of the modified and conventional grading systems using Uno’s concordance index (C-index). Results: In total, 235 patients with a mean age of 63.7 years were included in this study. During the mean follow-up period of 8.1 years, 63 patients underwent surgical treatment for FS. The conventional grading system revealed no significant difference in survival between the grade 2 and 3 groups (p = 0.104). Conversely, the modified grading system revealed a significant difference in survival between the new grade 2 and 3 groups (p < 0.001). After modification, the discrimination ability, assessed using Uno’s Cindex, significantly improved from 0.69 to 0.73. Conclusions The Facet Effusion-Incorporating Grading System, which adds excessive facet joint effusion to the conventional MRI grading framework, demonstrated improved predictive value for surgical treatment and better discriminatory ability compared with the original system.

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.

Background: When positioning the acetabular component for total hip arthroplasty (THA) in patients with sequelae of LeggCalvé-Perthes disease (LCPD), elevating the center of rotation (COR) of the hip is often unavoidable. We aimed to compare the outcomes between the preserved and elevated COR groups in patients with sequelae of LCPD. Methods: We enrolled 53 patients who underwent primary THA for sequelae of LCPD between 2006 and 2019. Patients were divided into 2 groups based on the postoperative COR position: 19 in the preserved COR group and 34 in the elevated COR group.The mean elevation of COR was 2.7 mm (range, 0–5.0 mm) in the preserved COR group and 8.1 mm (range, 6.0–12.0 mm) in the elevated COR group. Radiological outcomes, such as osteolysis and implant loosening, were evaluated. Additionally, reoperation, perioperative complications, limping gait, pelvic obliquity, and the modified Harris hip score (mHHS) were assessed. Results: There were no significant differences in radiological or clinical outcomes between the 2 groups. Neither osteolysis nor implant loosening was observed, and no reoperations were required. Intraoperative periprosthetic femoral fractures occurred in 3 cases (6%), but no cases of sciatic nerve palsy were observed. Residual limping gait was noted in 10 patients (19%), and pelvic obliquity persisted in 8 patients (15%). At the last follow-up, the mean mHHS was 89.2. Conclusions The 5–17-year follow-up results of primary cementless THA in patients with sequelae of LCPD were satisfactory.Furthermore, a moderate elevation of the COR, with a mean of 8.1 mm (range, 6.0–12.0 mm), did not significantly affect the outcomes of THA in these patients. Therefore, a moderate elevation of the COR can be considered an acceptable option for patients undergoing THA with sequelae of LCPD.

Background: and Purpose: Clinicians typically use 2 methods to determine impairment in a specific cognitive domain based on the Seoul Neuropsychological Screening Battery, 2nd Edition: (1) identifying impairment when one or more subtests fall below the normal range (< mean −1.5 standard deviation), and (2) using the cognitive domain score. Because agreement between these methods may differ by the severity of cognitive impairment, this study examined their concordance in the overall sample and across Clinical Dementia Rating (CDR) levels. Methods: A total of 1,086 patients (age 74.27±9.62 years; education 9.07±4.77 years) were included. Concordance between subtest-based and domain score-based classifications was assessed for each cognitive domain using cross-tabulation analyses and Cohen’s kappa statistics. To assess the influence of the severity of cognitive impairment, analyses were conducted across CDR levels. Results: When impairment was defined as having at least one abnormal subtest, concordance rates were 90.8% for Attention, 88.8% for Language, 84.6% for Visuospatial Function, 74.3% for Memory, and 73.6% for Frontal/Executive Function. In the Frontal/ Executive Function domain, requiring 2 or more abnormal subtests increased concordance to 90.9%. CDR subgroup analyses showed that Memory concordance was particularly low in the CDR 0.5 group (65.8%) compared with the CDR 1 (85.5%) and CDR 2 (98.5%) groups. Conclusions Concordance between the 2 classification methods was moderately high for Attention, Language, and Visuospatial Function but substantially lower for Memory and Frontal/Executive Function, especially in individuals with mild cognitive impairment. These findings highlight the need to consider both subtest-level performance and domain scores when determining impairment in memory or frontal/executive function.

Background: Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking. Methods: This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM. Results: In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs. Conclusion ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Background/Aims: Early detection and removal of colon polyps are critical for preventing colorectal cancer. Computer-aided detection (CADe) systems have been introduced to increase the polyp detection rate (PDR) during colonoscopy, potentially enhancing its effectiveness. This study aimed to evaluate the efficacy of a CADe system in colorectal neoplasm detection. Methods: This prospective, randomized controlled trial was conducted at two tertiary centers (May 2023 to April 2025). Patients were randomly assigned to CADe or conventional colonoscopy and underwent screening, surveillance, or diagnostic colonoscopy. The primary endpoint was the adenoma detection rate (ADR), while the secondary endpoints were the PDR, relative risk (RR) of polyp detection, adenomas per colonoscopy (APC), and factors influencing adenoma detection. Results: Of 1,004 enrolled patients, 998 were randomly allocated into CADe and conventional colonoscopy groups (497 CADe system and 501 conventional colonoscopy). The CADe group had greater polyp counts (2.2 per colonoscopy vs 1.4 per colonoscopy; p<0.001) and APC values (1.2 vs 0.8; p<0.001). The CADe group showed significantly higher PDRs (72.2% vs 54.5%;p<0.001; RR, 2.173; 95% confidence interval [CI], 1.669 to 2.828) and ADRs (52.3% vs 36.1%;p<0.001; RR, 1.940; 95% CI, 1.505 to 2.499). CADe also significantly increased the detection rate of hyperplastic polyps (p=0.007; RR, 1.474; 95% CI, 1.113 to 1.952) and increased the detection rates across all sizes and locations. In multivariable analysis, CADe use was the strongest independent predictor of adenoma detection (odds ratio, 1.914; 95% CI, 1.467 to 2.496), outweighing male sex, older age, diagnostic indication, and withdrawal time. Conclusions Real-time CADe-assisted colonoscopy significantly increased PDR and ADR and proved to be a strong independent predictor of adenoma detection (cris.nih.go.kr, KCT0009664).

Background/Aims: Accurate diagnosis of and timely eradication therapy for Helicobacter pylori are crucial for managing and preventing adverse clinical outcomes associated with H. pylori infection. H. pylori infection is typically diagnosed using endoscopic biopsy-based tests such as the rapid urease test (RUT). In this study, we investigated the usefulness of mucosal brush sampling for H. pylori detection using the RUT and culture. Methods: Twenty patients with H. pylori infection underwent endoscopy, and specimens were collected from the greater curvature of the gastric corpus via both mucosal brush and biopsy sampling methods. Brushing was performed using a disposable cytology brush, and the brush specimen was used for the RUT (brush-RUT) and then for culture. Two biopsies were obtained for the RUT (biopsy-RUT) and culture. H. pylori detection rates using RUT and culture yields from brush and biopsy samples were compared. Results: The H. pyloridetection rate was 100% with the brush-RUT, whereas it was 75% with the biopsy-RUT. Notably, among patients taking acid-suppressive agents, the sensitivity of the biopsy-RUT decreased to 66.7%, whereas that of the brush-RUT remained at 100%. The biopsy-RUT yield was also associated with the delta over baseline value determined by the urea breath test.H. pylori was successfully isolated from all the biopsy specimens and 95% of the brush samples, and all H. pylori isolates were tested for antimicrobial susceptibility. No significant procedurerelated adverse events occurred with either sampling method. Conclusions Mucosal brushing is a simple, effective, and highly sensitive diagnostic method for H. pylori infection. The mucosal brush method is a practical alternative to biopsy, expanding the diagnostic capabilities while minimizing invasiveness.

Purpose: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases. Materials and Methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre–COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed. Results: The patients’ median age was from 13 years (range, 1–19 years) to 13 years (range, 1–16 years) between the pre–COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre–COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7–120.0] vs. 20.0 hours [1.3–288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5–124.3] vs. 28.5 hours [6.1–293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0–13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1–7.3 mL) in pre–COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes. Conclusions The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.