Objectives: We aimed to characterize the effect of electroconvulsive therapy (ECT) on mismatch negativity (MMN), an event-related potential suggested as a biomarker of cortical dysfunction and illness progression in psychosis, and its association with improvement in positive symptoms. Methods: MMN was calculated from electroencephalogram recorded during a passive auditory oddball paradigm before and after ECT in psychosis patients receiving both ECT and medication, at matched intervals in patients receiving medication only, and at baseline in healthy controls (HCs). In patient groups, group-time interaction on MMN amplitudes was analyzed using mixed models for repeated measures. In the ECT group, correlations between MMN amplitude and Positive and Negative Syndrome Scale (PANSS) subscales were assessed. Results: Data from 26 ECT-treated patients, 23 medication-only patients, and 50 HCs were analyzed. At baseline, MMN amplitude and latency differed among groups. A significant group-time interaction indicated differential MMN amplitude change between the ECT group and the medication-only group. In the ECT group, a positive repeated-measure correlation was observed between MMN amplitude and PANSS positive score. Conclusion Our results demonstrate a normalizing effect of ECT on MMN amplitude and its relationship with improvement of positive symptoms. They imply that ECT modulates neurophysiological mechanisms underlying MMN generation.

Objectives: Management strategies for subepithelial lesions (SELs) measuring 1–2 cm remain undefined in most guidelines due to limited data. We aimed to establish a practical clinical approach by analyzing the long-term outcomes of SELs in this size range. Methods: We retrospectively reviewed cases of gastric SELs measuring 1–2 cm between 2011 and 2023. We reviewed esophagogastroduodenoscopy and endoscopic ultrasound images, alongside data from abdominal computed tomography, biopsy results, and long-term follow-up records. Results: Gastric SELs were initially identified in 648 patients. Of these, 88 patients (mean age, 57.1±10.6 years; 60% women) had lesions measuring 1–2 cm and underwent further evaluation or surveillance. The mean lesion size determined by endoscopy was 13.7±3.3 mm. Among the 52 patients with histological confirmation, 24 (46%) were diagnosed with gastrointestinal stromal tumors (GISTs), whereas the remainder had benign lesions. Most gastric SELs were located in the fundus and upper body. Pathological analysis indicated that the majority of GISTs were low-risk. Three GISTs were stratified as moderate-to-high risk; notably, one measured 0.9 cm upon pathological examination. The median surveillance period for the 28 patients without histological confirmation was 55 months (range, 43–115 months). Two of these patients underwent endoscopic or wedge resection due to tumor enlargement; both lesions were histologically confirmed as low-risk. Conclusions Approximately half of the gastric SELs measuring 1–2 cm were GISTs, representing an intermediate- to high-risk tumors. Given that GISTs in the upper stomach were associated with elevated risk even when smaller than 2 cm, we recommend strict short-term surveillance for such lesions.

Background: A new diagnostic framework for clinical obesity, proposed by the Lancet Commission, defines obesity as excess adiposity with organ dysfunction, offering a more functional assessment than traditional body mass index (BMI)-based classification. However, it has not been applied to Asian populations, where obesity-related complications arise at lower BMI thresholds. Methods: We analyzed 57,863 Korean adults aged ≥20 years from the 2014 to 2023 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative, cross-sectional dataset. Clinical obesity was defined as excess adiposity with ≥1 obesity-related complication or functional limitation; preclinical obesity was defined as excess adiposity without complications. Age, sex, and temporal trends were examined and compared with BMI-based classifications using complex sampling weights and age-standardization. Results: The prevalence of clinical obesity and preclinical obesity was 31.2% and 8.1%, respectively. Among those with BMI-defined obesity (≥25.0 kg/m²), 20.1% had no complications, while 19.4% of overweight individuals (BMI 23.0–24.9 kg/m²) met clinical obesity criteria. Clinical obesity increased with age despite stable BMI, driven by metabolic and functional decline. Cancer prevalence was highest among individuals with clinical obesity (1.77%). Applying Western waist circumference cutoffs drastically reduced the estimated prevalence of clinical obesity to 13.1%. Longitudinal analyses showed a rising trend in clinical obesity over ime. Conclusion This is the first large-scale study to apply the clinical obesity framework in an Asian population. The framework identifies high-risk individuals missed by BMI al

Purpose: The purpose of this study was to develop an approach to alleviate the discomfort caused by sandbag compression after a bone marrow examination. This research examined the effects of applying a pressure hemostasis band on bleeding, pain, and discomfort at the bone marrow examination site. Methods: This study was conducted with a nonequivalent control group non-synchronized design. For 74 patients under evaluation who underwent bone marrow examination, sandbag compression was applied to the examination site in the control group (n=37), and a pressure hemostasis band was applied to the intervention group (n=37). In both groups, absolute bed rest was performed for two hours, and bleeding, pain, and discomfort at the examination site were measured. Results: After two hours of the bone marrow examination, there was no difference in bleeding on the gauze between the two groups (F=0.59, p=.444). Bleeding occurred in three patients in the intervention group and six in the control group (χ 2 =1.14, p=.479), with no cases of hematoma detected in either group. One hour post-examination, the control group experienced significantly higher pain (F=5.45, p=.022) and discomfort (F=5.68, p=.020) than the intervention group. However, pain and discomfort levels were similar between groups after two hours. Conclusion Compared to the sandbag compression group, the band application group showed no difference in bleeding and experienced less pain and discomfort at the examination site. This confirms that the pressure hemostasis band is a suitable alternative to sandbag compression in post-examination care.

Purpose: The purpose of this study was to develop an approach to alleviate the discomfort caused by sandbag compression after a bone marrow examination. This research examined the effects of applying a pressure hemostasis band on bleeding, pain, and discomfort at the bone marrow examination site. Methods: This study was conducted with a nonequivalent control group non-synchronized design. For 74 patients under evaluation who underwent bone marrow examination, sandbag compression was applied to the examination site in the control group (n=37), and a pressure hemostasis band was applied to the intervention group (n=37). In both groups, absolute bed rest was performed for two hours, and bleeding, pain, and discomfort at the examination site were measured. Results: After two hours of the bone marrow examination, there was no difference in bleeding on the gauze between the two groups (F=0.59, p=.444). Bleeding occurred in three patients in the intervention group and six in the control group (χ 2 =1.14, p=.479), with no cases of hematoma detected in either group. One hour post-examination, the control group experienced significantly higher pain (F=5.45, p=.022) and discomfort (F=5.68, p=.020) than the intervention group. However, pain and discomfort levels were similar between groups after two hours. Conclusion Compared to the sandbag compression group, the band application group showed no difference in bleeding and experienced less pain and discomfort at the examination site. This confirms that the pressure hemostasis band is a suitable alternative to sandbag compression in post-examination care.

Radiation-induced cavernous malformations (RICMs) are rare but significant late complications of highdose radiation therapy, particularly in young survivors of brain tumors. This report presents two cases of RICMs following aggressive multimodal treatment, including surgery, chemotherapy, and radiation therapy. Case 1 was a 22-year-old male patient with medulloblastoma treated with craniospinal irradiation, tumor bed boost, and tandem autologous peripheral blood stem cell transplantation. Approximately 8 years after treatment completion, routine follow-up imaging revealed a small focal hemorrhage in the right cerebellum, consistent with an RICM. The lesion was asymptomatic and managed conservatively with regular imaging, showing spontaneous resolution over time, with a significant size reduction noted 9 years post-treatment. Case 2 describes a 32-year-old male with an intracranial germinoma treated with whole-ventricular irradiation. Three years after treatment, the patient developed a symptomatic hemorrhagic RICM near a pre-existing developmental venous anomaly. Surgical resection and Gamma Knife Surgery stabilized the lesion; however, residual symptoms, including tremors and gait disturbances, persisted, affecting the patient’s daily activities. These cases illustrate the diverse clinical courses of RICMs, ranging from spontaneous resolution to the necessity of surgical intervention, and emphasize the importance of long-term surveillance and tailored management strategies for late-onset complications.

Background: This study analyzed the epidemiology and treatment outcomes of germ cell tumorpatients at a single institution. Methods: A retrospective analysis was conducted on intracranial germ cell tumor (iGCT) pa-tients treated at a single tertiary hospital from 2004 to 2019. Patients were categorized based on treatment modality: Korean Society for Pediatric Neuro-Oncology (KSPNO) protocol or bleomycin, etoposide, and cisplatin with radiation therapy. Results: Forty-nine iGCT patients treated with combined chemotherapy and radiotherapywere analyzed. The median age was 19 years (range: 6–40), with a median follow-up duration of 148.0 months (range: 10.5–265.5). Tumors were most common in the pineal gland (51.0%). Although no significant differences in outcomes were observed between treatment modalities, outcomes varied significantly by pathological type. The 10-year progression-free survival rates for germinoma and non-germinomatous germ cell tumors (NGGCTs) were 88.1% and 32.7%, respectively (p=0.003), while the 10-year overall survival rates were 92.9% and 67.5%, respectively (p<0.001). Fourteen patients experienced CTCAE (Common Terminology Criteria for Adverse Events) grade ≥3 adverse events, with one eventrelated death. Conclusion Pure germinoma demonstrated higher survival and lower recurrence rates comparedto NGGCT. The KSPNO protocol appears to be an acceptable and safe treatment option for iGCT patients. Further multi-institutional studies with larger cohorts are warranted.

Radiation-induced cavernous malformations (RICMs) are rare but significant late complications of highdose radiation therapy, particularly in young survivors of brain tumors. This report presents two cases of RICMs following aggressive multimodal treatment, including surgery, chemotherapy, and radiation therapy. Case 1 was a 22-year-old male patient with medulloblastoma treated with craniospinal irradiation, tumor bed boost, and tandem autologous peripheral blood stem cell transplantation. Approximately 8 years after treatment completion, routine follow-up imaging revealed a small focal hemorrhage in the right cerebellum, consistent with an RICM. The lesion was asymptomatic and managed conservatively with regular imaging, showing spontaneous resolution over time, with a significant size reduction noted 9 years post-treatment. Case 2 describes a 32-year-old male with an intracranial germinoma treated with whole-ventricular irradiation. Three years after treatment, the patient developed a symptomatic hemorrhagic RICM near a pre-existing developmental venous anomaly. Surgical resection and Gamma Knife Surgery stabilized the lesion; however, residual symptoms, including tremors and gait disturbances, persisted, affecting the patient’s daily activities. These cases illustrate the diverse clinical courses of RICMs, ranging from spontaneous resolution to the necessity of surgical intervention, and emphasize the importance of long-term surveillance and tailored management strategies for late-onset complications.

Background: This study analyzed the epidemiology and treatment outcomes of germ cell tumorpatients at a single institution. Methods: A retrospective analysis was conducted on intracranial germ cell tumor (iGCT) pa-tients treated at a single tertiary hospital from 2004 to 2019. Patients were categorized based on treatment modality: Korean Society for Pediatric Neuro-Oncology (KSPNO) protocol or bleomycin, etoposide, and cisplatin with radiation therapy. Results: Forty-nine iGCT patients treated with combined chemotherapy and radiotherapywere analyzed. The median age was 19 years (range: 6–40), with a median follow-up duration of 148.0 months (range: 10.5–265.5). Tumors were most common in the pineal gland (51.0%). Although no significant differences in outcomes were observed between treatment modalities, outcomes varied significantly by pathological type. The 10-year progression-free survival rates for germinoma and non-germinomatous germ cell tumors (NGGCTs) were 88.1% and 32.7%, respectively (p=0.003), while the 10-year overall survival rates were 92.9% and 67.5%, respectively (p<0.001). Fourteen patients experienced CTCAE (Common Terminology Criteria for Adverse Events) grade ≥3 adverse events, with one eventrelated death. Conclusion Pure germinoma demonstrated higher survival and lower recurrence rates comparedto NGGCT. The KSPNO protocol appears to be an acceptable and safe treatment option for iGCT patients. Further multi-institutional studies with larger cohorts are warranted.

Purpose: The purpose of this study was to develop an approach to alleviate the discomfort caused by sandbag compression after a bone marrow examination. This research examined the effects of applying a pressure hemostasis band on bleeding, pain, and discomfort at the bone marrow examination site. Methods: This study was conducted with a nonequivalent control group non-synchronized design. For 74 patients under evaluation who underwent bone marrow examination, sandbag compression was applied to the examination site in the control group (n=37), and a pressure hemostasis band was applied to the intervention group (n=37). In both groups, absolute bed rest was performed for two hours, and bleeding, pain, and discomfort at the examination site were measured. Results: After two hours of the bone marrow examination, there was no difference in bleeding on the gauze between the two groups (F=0.59, p=.444). Bleeding occurred in three patients in the intervention group and six in the control group (χ 2 =1.14, p=.479), with no cases of hematoma detected in either group. One hour post-examination, the control group experienced significantly higher pain (F=5.45, p=.022) and discomfort (F=5.68, p=.020) than the intervention group. However, pain and discomfort levels were similar between groups after two hours. Conclusion Compared to the sandbag compression group, the band application group showed no difference in bleeding and experienced less pain and discomfort at the examination site. This confirms that the pressure hemostasis band is a suitable alternative to sandbag compression in post-examination care.