Purpose: To compare the anatomical and clinical outcomes based on the distance from the corneal limbus to the scleral tunnel in flanged intrascleral intraocular lens (IOL) fixation. Methods: We retrospectively analyzed the medical records of patients who underwent scleral fixation of flanged IOLs. Group 1 (54 eyes) had a distance of 2.1 mm from the corneal limbus to the scleral tunnel, and Group 2 (48 eyes) had a distance of 2.8 mm. We evaluated the best corrected visual acuity (BCVA), postoperative complications, IOL tilt and decentration, refractive prediction error (RPE), effective lens position, and iris-IOL distance. Results: The BCVA, postoperative complications, IOL tilt, and IOL decentration did not differ between the two groups (p > 0.05). The RPE showed a hyperopic shift in Group 1 and a myopic shift in Group 2 (Group 1: +0.24 ± 0.68 D, Group 2: -0.03 ± 0.43 D, p = 0.03). The iris-IOL distance was statistically longer in Group 1 compared to Group 2 (Group 1: 1.02 ± 0.40 mm, Group 2: 0.57 ± 0.32 mm, p = 0.02). The incidence of pupillary optic capture was significantly higher in Group 2 compared to Group 1 (Group 1; 0%, Group 2; 8.3%, p = 0.03). Conclusions It should be considered that a shorter distance from the corneal limbus to the scleral tunnel results in a postoperative hyperopic shift and reduces the incidence of pupillary optic capture when performing flanged intrascleral IOLs fixation.

Developmental dyslexia is one of the most common neurodevelopmental disorders, defined by persistent difficulties in accurate and fluent word reading despite adequate intelligence and educational opportunities. Advances in neuroimaging, genetics, and cognitive neuroscience indicate that dyslexia primarily arises from deficits in phonological processing and inefficient activation of the left-hemisphere reading network, particularly the occipito-temporal and temporo-parietal regions. White-matter studies further implicate reduced integrity of the arcuate fasciculus and related tracts, while genetic research has identified genes with susceptibility loci such as doublecortin domain containing 2 (DCDC2), KIAA0319, and roundabout guidance receptor 1 (ROBO1). Beyond phonological deficits, impairments in rapid automatized naming, working memory, and visual attention are common, and comorbidities with attention deficit/hyperactivity disorder and developmental language disorder complicate assessment. Nevertheless, higher-order language and semantic systems remain relatively preserved, allowing affected individuals to leverage intact comprehension abilities once decoding is supported. Recent studies have also emphasized potential cognitive strengths associated with dyslexia, including creativity, visuospatial reasoning, and narrative thinking, reframing the condition as a neurocognitive profile encompassing both vulnerabilities and assets. Clinically, early identification and intensive, systematic interventions, such as structured, phonologically based literacy programs, are critical for improving outcomes and preventing secondary emotional consequences such as low self-esteem, anxiety, and depression. Intervention studies demonstrate not only behavioral gains but also neuroplastic changes, including normalization of activity in the visual word form area and enhanced white-matter integrity. These findings underscore the importance of timely, individualized, and multidisciplinary approaches to diagnosis, treatment, and educational policy.

Purpose: Although gastric cancer (GC) exhibits significant genomic heterogeneity, the clinical implications of its immune microenvironment remain poorly understood. Materials and Methods: We retrospectively evaluated patients with GC who underwent gastrectomies between 2011 and 2014. The tumors were analyzed for Epstein–Barr virus (EBV), microsatellite instability-high (MSI-H), tumor-infiltrating lymphocytes (CD3), tumor-associated macrophages (CD68 and CD163), and programmed death-ligand 1 (PD-L1) expression. Tumors were classified using the modified The Cancer Genome Atlas scheme, and their clinical characteristics were compared. Results: A total of 567 patients were classified into EBV (6%), MSI-H (10%), chromosomal instability-like (36%), and genomically stable-like (48%) subtypes. EBV tumors exhibited the highest PD-L1 expression (85%) and immune infiltration by CD3+ T cells (86%), CD68+ macrophages (58%), and CD163+ macrophages (40%). High CD68+ macrophage tumors were associated with advanced stages and worse 5-year disease-free survival (83% vs. 95%; P<0.001);however, this association was not independently significant after adjusting for the tumor-nodemetastasis stage. PD-L1 expression did not significantly affect the survival outcomes. Conclusions GC subtypes have distinct immune microenvironments that influence prognosis. Our findings highlight the prognostic and therapeutic potential of immune profiling in GC.

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.

Objectives: Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators. Methods: We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages. Results: Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages. Conclusions Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.

Objective: In this study, we aimed to investigate the incidence and risk factors for interstitial nephritis in patients with ankylosing spondylitis (AS). Methods: We retrospectively analyzed the claims records of patients diagnosed with AS in Korea’s Health Insurance Review and Assessment Service Database between 2016 and 2019. The Assessment of Spondyloarthritis International Society nonsteroidal anti-inflammatory drugs (NSAIDs) intake score was used to calculate the NSAID dosage over 1 year after AS diagnosis. The incidence rate of interstitial kidney disease was calculated as the number of events per 1,000 person-years. The risks associated with sex, age, Charlson Comorbidity Index, comorbidities, and concomitant medications were assessed using the Cox proportional hazards model, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results: In total, 11,749 patients with AS were included in this study. Of these, 79 patients had interstitial nephritis, with an incidence rate of 2.50 per 1,000 person-years. In multivariable analysis, female sex (HR, 2.44; 95% CI, 1.56~3.83), hypertension (HR, 2.08; 95% CI, 1.15~3.76), and renal failure (HR, 3.70; 95% CI, 1.30~10.55) showed significant associations. However, NSAID use in the first year after AS diagnosis was not associated with interstitial nephritis occurrence. Conclusion The incidence of interstitial nephritis in patients with AS was 2.50 per 1,000 person-years, with female sex and comorbidities identified as significant risk factors. However, NSAID use during the first year after AS diagnosis was not associated with interstitial nephritis development.

Objective: This study aimed to assess the association between exposure to gadolinium-based contrast agents (GBCAs) and the risk of parkinsonism according to the GBCA type. Materials and Methods: Individuals aged ≥40 years who underwent first-ever magnetic resonance imaging (MRI) examinations between 2011 and 2014 were identified from the Korean nationwide population-based health insurance claims database and followed up until 2022. Individuals were divided into those who underwent at least one GBCA-enhanced MRI, and those who underwent only non-enhanced MRI. GBCA-exposed individuals were further categorized into those exposed only to linear or macrocyclic GBCAs, after excluding those exposed to both types. The primary event of interest was allcause parkinsonism. Secondary events included all-cause parkinsonism requiring medication, Parkinson’s disease (PD), atypical parkinsonism, and secondary parkinsonism. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazard regression models for exposure to linear and macrocyclic GBCAs, with the non-enhanced MRI group serving as a reference. The models were adjusted for age, sex, smoking status, alcohol consumption, regular exercise, body mass index, estimated glomerular filtration rate, and comorbidities. Subgroup analyses were performed according to age, sex, renal function, and history of cancer. Results: A total of 222,977 individuals were included in this study. Among them, 92,230, 48,335, and 82,412 individuals underwent non-enhanced, linear GBCA-enhanced, and macrocyclic GBCA-enhanced MRI, respectively. Exposure to linear GBCAs slightly increased the risk of all-cause parkinsonism (adjusted HR, 1.13 [97.5% confidence interval, 1.08–1.19]), while exposure to macrocyclic GBCAs did not increase the risk (adjusted HR, 1.00 [97.5% confidence interval, 0.95–1.05]).The results were similar for all-cause parkinsonism requiring medication, PD, and secondary parkinsonism, whereas no significant association was observed for atypical parkinsonism. Conclusion Exposure to linear GBCAs may slightly increase the risk of parkinsonism in adults, whereas exposure to macrocyclic GBCAs may not. Caution should be exercised when using linear GBCAs until further evidence emerges.

Buttock augmentation is an increasingly popular cosmetic procedure designed to enhance buttock contour, size, and shape. However, the safety profile of this procedure remains insufficiently established, and it carries risks of complications, including foreign body reactions and infections. These complications may be exacerbated by filler migration, resulting in large soft-tissue cavities that resemble pseudocysts. In this study, we describe two patients who developed severe complications following massive filler injections to the buttocks. A 56-year-old female patient presented with a 6×5 cm soft-tissue defect associated with an extensive underlying dead space, sinus tract formation, and a large pocket extending across the buttock. Additionally, a 50-year-old female patient developed diffuse cellulitis and multiple abscesses secondary to migration of an infected filler-related pseudocyst. Both patients underwent successful en bloc capsulectomy, resulting in marked clinical improvement without recurrence or postoperative complications. These cases underscore the serious complications associated with large-volume filler injections and highlight the importance of comprehensive surgical management in addressing late-stage adverse outcomes.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection that rarely involves the periorbital region. We report an unusual case of periorbital NF caused by methicillin-sensitive Staphylococcus aureus (MSSA) in a previously healthy 48-year-old woman, originating from a neglected, recurrent hordeolum—an otherwise benign eyelid condition. The infection resulted in an extensive fullthickness defect of the upper eyelid and adjacent temporal area, presenting major reconstructive challenges. Reconstruction was performed using a radial forearm free flap combined with a buccal mucosal graft to restore both anterior and posterior lamellae, achieving functional eyelid protection and improved visual acuity. This case highlights the potential for seemingly minor, recurrent eyelid infections to progress rapidly to devastating NF even in the absence of systemic symptoms or risk factors. Early recognition and multidisciplinary management were critical to preventing further morbidity. To our knowledge, MSSA has not previously been reported as a causative agent of periorbital NF, underscoring the need for clinical vigilance and timely intervention in common eyelid conditions to avoid catastrophic complications.