Purpose: The clinical utility of routine repeat computed tomography (CT) in pediatric patients with mild traumatic brain injury (TBI) remains controversial. We aimed to identify factors associated with worsening intracranial injury (ICI) on repeat CT in pediatric patients with mild TBI. Methods: This retrospective study included patients aged 0–18 years with mild TBI (Glasgow Coma Scale score 13–15) who presented to an emergency department in South Korea from January 2017 through December 2023. Patients were included if they underwent an initial CT within 24 hours of injury and a repeat CT within 72 hours. Worsening ICI was defined as an increase in hemorrhage size or the development of new lesions on repeat CT. Clinical characteristics, injury mechanisms, and CT findings were compared between patients with and without the worsening ICI. Multivariable logistic regression was performed to identify independent predictors of worsening ICI on repeat CT. Results: A total of 212 patients were included, of whom 48 (22.6%) showed worsening ICIs on repeat CT (i.e., worsening group). The worsening group showed higher median values of age and length of hospital stay, as well as higher percentages of initial Glasgow Coma Scale of 14, motorcycle/bicycle injury, intensive care unit hospitalization, and abnormalities on initial CT (including skull fracture, epidural hemorrhage, subdural hemorrhage, and pneumocephalus), compared with their counterparts. The regression model showed subdural hemorrhage (odds ratio, 4.99 [95% confidence interval, 2.08–11.96]), epidural hemorrhage (4.04 [1.73–9.44]), and motorcycle/bicycle as the injury mechanism (2.94 [1.14–7.59]) as the predictors. Conclusion In pediatric mild TBI, motorcycle/bicycle accidents and the presence of hemorrhages on initial CT may be associated with worsening ICI on repeat CT. These findings support a risk-stratified approach, in which repeat imaging is selectively considered for high-risk patients to reduce unnecessary radiation exposure.

Background: Rural areas in Korea are experiencing both super-aging and depopulation, creating critical gaps in health and social care. Using a citizen participatory approach, we sought to address the care gaps for older adults in rural areas. This study examined the changes in frailty and depressive symptoms observed during a citizen-led intervention. Methods: This study is a single- arm pre–post quasi-experimental design. A 12-week intervention was implemented using local citizens as care providers. Intervention components included identifying and planning individual care needs, providing health education, organizing tailored community activities, and conducting AI-assisted weekly check-up calls to monitor health status. Results: Changes appeared more pronounced among vulnerable subgroups. Older adults with frailty showed an observed decrease in depressive symptoms compared to those with prefrailty or robust status. Conversely, among those with depressive symptoms, frailty levels appeared to increase more slowly than those without depressive symptoms. These patterns are consistent with the previously reported bidirectional associations between frailty and depression and may reflect the tendency for changes in one domain to coincide with changes in the other, rather than indicating a causal influence. Conclusion This citizen-led care intervention showed more noticeable short-term changes among older adults with higher vulnerability, particularly those with frailty or depressive symptoms. These findings indicate potential roles for citizen participation in enhancing social support and supporting ongoing monitoring in rural depopulation areas. The results suggest that citizen participation is a potentially feasible and sustainable approach to care systems in aging, resource-limited communities.

Background: s/Aims: Phase angle (PhA), as measured by bioelectrical impedance analysis, provides insights into hydration and nutritional status, making it a prognostic indicator of frailty. While low preoperative PhA has been linked to postoperative complications in cancer patients, its predictive value in individuals undergoing pancreaticoduodenectomy (PD) has not been thoroughly investigated.This study aims to evaluate the clinical utility of preoperative PhA in predicting postoperative complications for patients undergoing PD. Methods: Among 41 patients who underwent PD at Seoul National University Hospital between September and December 2024, 35 were included in the analysis after excluding 6 patients who had concomitant blood vessel or other organ resections. Patients were divided into low (Comprehensive Complication Index [CCI] ≤ 20) and high (CCI > 20) complication groups based on the CCI, derived from the Clavien–Dindo classification. The differences in PhA between the two groups were analyzed, and logistic regression was performed to assess the relationship between PhA and CCI. Results: The mean PhA was significantly lower in the high-CCI group compared to the low-CCI group (5.7° vs. 6.7°, p = 0.025). Multivariate logistic regression analysis indicated that PhA (odds ratio: 0.17; 95% confidence interval: 0.04–0.68; p = 0.012) was an independent predictor of high CCI. A low preoperative PhA was associated with an increased risk of postoperative complications following PD. Conclusions Preoperative PhA may serve as a valuable predictive indicator of postoperative complications after PD, enabling the identification of patients who could benefit from preoperative prehabilitation, including nutritional support.

Purpose: This study aimed to develop and evaluate the effectiveness of the Trauma-nursing Education and Skill Support (TESS) program based on the ADDIE model (Analysis, Design, Development, Implementation, Evaluation model). The program was designed to enhance trauma nurses’ clinical competencies, including trauma-related knowledge, self-efficacy, and problem-solving ability, through the integration of theoretical education and simulation-based practice. Methods: A quasi-experimental study using a non-equivalent control group pretest–posttest design was conducted. Participants included 108 trauma nurses from regional trauma centers, military trauma centers, and emergency care facilities, who were assigned to an experimental group (n=52) or a control group (n=56). The TESS program consisted of a 2-day, 14-hour blended-learning course that included eight lecture sessions and four simulation-based practice stations. Data were collected at baseline, immediately after the intervention, and at 6 months using validated instruments measuring trauma-related knowledge, self-efficacy, and problem-solving ability. Two-way repeated-measures analysis of variance was used for data analysis. Results: The experimental group demonstrated significant improvements in trauma-related knowledge, self-efficacy, and problem-solving ability compared with baseline (all p<.001). These improvements were sustained at 6 months, although trauma-related knowledge scores showed a slight decline compared with immediate posttest levels. Between-group analyses confirmed significant group-by-time interaction effects for all outcomes: trauma-related knowledge (η2=0.12, p<.001), self-efficacy (η2=0.09, p=.002), and problem-solving ability (η2=0.08, p=.003). Conclusion The TESS program effectively enhanced trauma nurses’ trauma-related knowledge, self-efficacy, and problem-solving ability, with effects sustained for up to 6 months. Incorporating blended learning and simulation-based training into standardized trauma nursing education may strengthen clinical competencies and ultimately contribute to improved patient outcomes.

Endoscopic spine surgery has rapidly evolved as a minimally invasive technique for treating various spinal pathologies. However, its use in removing epidural metastatic tumors remains insufficiently explored. This video article presents 2 cases utilizing unilateral biportal endoscopic spine surgery for resection of epidural metastatic tumors causing spinal cord compression. The first case involved a 63-year-old woman with metastatic non-small cell lung cancer at T4–5, and the second case an 86-year-old man with prostate cancer metastases at T6–9. Both patients presented with motor weakness (American Spinal Injury Association [ASIA] grade C) and potential spinal instability (SINS [Spinal Instability Neoplastic Scale] score 7). The surgical techniques emphasized precise identification and dissection of the tumor–dura interface to minimize dural injury and bleeding—an essential consideration when managing vascular lesions, particularly under antiplatelet therapy. Both cases achieved complete tumor resection with minimal blood loss (60–90 mL) and operative times of 71 and 109 minutes, respectively. Postoperatively, both patients improved to ASIA grade D and began early radiotherapy, underscoring the advantages of this minimally invasive approach in enabling prompt adjuvant treatment. Endoscopic epidural tumor removal represents a safe and less invasive alternative to open surgery for selected patients, though further long-term evaluation is warranted.

Chiari malformation, when accompanied by progressive neurological symptoms or syringomyelia, often necessitates surgical decompression. Although endoscopic spinal surgery continues to advance, its application in foramen magnum decompression remains limited. This video article demonstrates the biportal endoscopic foramen magnum decompression technique for Chiari type I malformation. We present the case of a 19-year-old female patient with progressive headache, motor weakness, and radiological evidence of 7-mm tonsillar descent with C2–7 syringomyelia. She successfully underwent biportal endoscopic foramen magnum decompression with C1 laminectomy. The procedure employed a triportal approach with safe docking on the C2 spinous process, allowing a minimally invasive C1 laminectomy and foramen magnum decompression extended to the suboccipital area. Postoperatively, computed tomography confirmed adequate decompression, and magnetic resonance imaging revealed expansion of the posterior fossa with resolution of tonsillar herniation. The patient experienced no complications or symptom recurrence at the 3-month follow-up. Despite a minor intraoperative–postoperative measurement discrepancy, which highlights the anatomical considerations required to achieve sufficient decompression, this video supports the feasibility of biportal endoscopic surgery. This approach may provide comparable clinical outcomes to conventional open surgery while offering minimally invasive advantages, though long-term follow-up remains essential.

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.

Objective: To evaluate the diagnostic performance of the “probable hepatocellular carcinoma (HCC)” category in the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) v2022 guidelines. Materials and Methods: This multicenter retrospective study included patients at risk of HCC who underwent gadoxetic acid-enhanced MRI between January 2015 and June 2018; a subgroup of these patients also underwent liver CT. Eligible patients had at least one non-cystic lesion (≥10 mm) with a reference standard. Four radiologists interpreted the images independently and the results were pooled. The performance of “definite HCC” and “probable HCC” together and “probable HCC” alone were compared between v2018 and v2022. Results: A total of 2,237 patients (1,666 men; mean age, 59 ± 11 years) with 2,445 lesions were included. In v2022, 1.5% (143/9,780) of the lesions were additionally categorized as “probable HCC” by four reviewers on MRI; among these, 104 lesions were not HCCs. Focal nodular hyperplasia (FNH) or FNH-like nodules constituted 90.4% (94/104) of the false positives. When “definite HCC” and “probable HCC” were combined, v2022 showed higher sensitivity (83.7% [5,670/6,776] vs. 83.1% [5,631/6,776]) but lower specificity (77.1% [2,316/3,004] vs. 80.6% [2,420/3,004]) than v2018 (P < 0.001). For “probable HCC” alone, v2022 showed a lower positive predictive value (PPV) than v2018 (64.1% [373/582] vs. 76.1% [334/439], P < 0.001). In v2022, lesions with non-rim arterial-phase hyperenhancement (APHE) showed a lower PPV than those without APHE (42.3% [91/215] vs. 76.8% [282/367], P < 0.001). In the CT subgroup (n = 1,590), 1.6% (99/6,360) of the lesions were reassessed as “probable HCC,” and its PPV was 83.8% (83/99) in v2022 whereas no lesions were classified as “probable HCC” under v2018. Conclusion The revised “probable HCC” category in the KLCA-NCC v2022 aligns with updates in the diagnostic flow, demonstrating acceptable performance on MRI and CT. Notably, FNH or FNH-like nodules can be misclassified as “probable HCC” when MRI is used.

Background: Rosacea is a chronic inflammatory disorder characterized by flushing, erythema, papules/pustules, and telangiectasia. Several clinical studies have investigated the efficacy of botulinum neurotoxin A (BoNT/A) in the treatment of rosacea, but its mechanism of action remains unclear. Objective: This study aims to examine the potential role of BoNT/A in a mouse model of rosacea-like skin lesions induced by the 37-amino acid C-terminal cathelicidin peptide (LL-37). Methods: Mice were randomly divided into 4 groups: Control, LL-37, LL-37 + BoNT/A, and LL-37 + dexamethasone. Results: BoNT/A treatment alleviated skin damage, reduced skin thickness, and decreased mast cell infiltration. Furthermore, BoNT/A improved redness score severity and redness area while enhancing skin barrier function by suppressing transepidermal water loss and increasing skin hydration. At the molecular level, BoNT/A decreased the mRNA levels of interleukin (IL)-6 and tumor necrosis factor-α, which are known as pro-inflammatory cytokines. It also downregulated the expression of pyrin domain-containing protein 3, caspase-1, and IL-1 beta in the LL-37-injected dorsal skin. Furthermore, BoNT/A prevented LL-37-mediated upregulation of neurovascular-associated factors, including CD31, transient receptor potential vanilloid 1, calcitonin-related polypeptide alpha, vascular endothelial growth factor, chymase 1, and tryptase alpha/beta 1. Conclusion These results indicate that BoNT/A effectively alleviates inflammatory and vascular responses in a rosacea mouse model, highlighting its potential as a promising preventive approach for rosacea.

Purpose: The effect of behavior changes in alcohol drinking on gastric cancer (GC) development, and the sex differences in those effects have not yet been fully elucidated. This study investigated the effect of behavior changes in alcohol drinking on the GC risk by sex. Materials and Methods: The cohort consisted of 310,192 Koreans (≥ 40 years) from the National Health Insurance Service–Health Screening Cohort with a median follow-up period of 12 years. Subjects were classified according to alcohol consumption behavior changes (non-drinker, quitter, reducer, sustainer, and increaser). The independent effect of changes in alcohol drinking patterns or concurrent effect of alcohol on GC risk were evaluated using the Cox proportional hazard regression. Results: In males, non-drinkers showed a lower risk of developing GC (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.84 to 0.98), whereas increasers showed a higher risk of GC than sustainers (HR, 1.11; 95% CI, 1.02 to 1.20). Starting to drink alcohol, even at a mild level, was associated with an increased GC risk, while a decreased GC risk was induced when alcohol consumption dose decreases to a mild from a moderate level among males. However, in females, only substantial change of alcohol consumption dose from non- to heavy-drinking was associated with increased GC risk (HR, 1.97; 95% CI, 0.98 to 3.96). Conclusion These results suggest that alcohol abstinence can reduce the risk of developing GC, particularly among males.