Objectives: Osteoporosis is a silent disease with low screening rates in many developing countries. This study aimed to evaluate the feasibility of using an artificial intelligence (AI)-based system to screen osteoporosis from pelvic and hip radiographs in Vietnam. Methods: We conducted a cross-sectional study at a tertiary medical center in Central Vietnam in 2023. A total of 2000 consecutive pelvic and hip radiographs from patients aged ≥ 40 years were collected. After excluding poorquality images, 1987 radiographs were analyzed using an AI-based software designed to estimate bone mineral density (BMD) from plain radiographs and derive T-scores. Osteoporosis was defined as a T-score ≤ − 2.5. Patient characteristics, radiographic findings, and risk factors for osteoporosis were analyzed. Results: Among 1987 patients (mean age 66.4 ± 15.1 years; 41.3% men), osteoporosis was identified in 872 patients (43.9%). The prevalence increased with age and was higher in women than in men (58.7% vs 22.8%, P < 0.001). Osteoporosis was associated with femoral neck (OR = 3.8, 95% CI: 2.7–5.2) and intertrochanteric fractures (OR = 7.0, 95% CI: 4.5–11.0). Patients with lower T-scores had a higher risk of hip fractures, especially those with T-scores ≤ − 3.0 (OR = 11.5, 95% CI: 5.5–24.5). Conclusions AI-based analysis of pelvic and hip radiographs is a feasible and effective tool for osteoporosis screening in Vietnam. The prevalence of osteoporosis in this hospital-based setting was high, particularly among elderly women.AI-assisted screening may offer an accessible strategy for early detection of osteoporosis in resource-limited settings.

Background: Carbon suspension with laser irradiation was used for facial melasma, but it produces harmful fumes. Gold and diamond are biocompatible and chemically inert, and expected to act as potent chromophores and microdermabrasion agents, respectively. Objective: This study aimed to evaluate the efficacy and safety of microgold and microdiamond suspensions with a 1,064 nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for melasma. Methods: Ten Korean patients received 2 laser sessions using gold and diamond suspension at 2-week intervals. Melasma area severity index (MASI), melanin index (MI), erythema index (EI), Physician/Subject global aesthetic improvement scale (PGAIS/SGAIS), and adverse events were assessed at baseline, week 2 and week 4. Results: MASI and MI scores significantly improved. EI score showed no significant changes.All patients showed aesthetic improvement by PGAIS and SGAIS. No severe or unexpected adverse events were reported. Conclusion The topical microgold and microdiamond suspension combined with a 1,064 nm picosecond Nd:YAG laser appears to be a safe and effective treatment option for facial melasma.

Purpose: Persistent hypercalcemia after parathyroidectomy (PTx) remains a significant concern in patients with tertiary hyperparathyroidism (THPT) following kidney transplant (KT). Complete resection of hyperfunctioning glands is challenging due to ectopic or intrathyroidal glands. This study evaluated whether intraoperative parathyroid hormone (ioPTH) monitoring during PTx in KT patients with THPT reduces the surgical failure rate. Methods: We retrospectively analyzed 111 patients with THPT who underwent PTx at a single tertiary center. Patients were divided into 2 groups: those without ioPTH monitoring (n=98) and those with ioPTH monitoring (n=13). Surgical procedures included less than subtotal, subtotal, or total PTx with autotransplantation. Surgical failure was defined as persistent hypercalcemia (serum calcium ≥10.3 mg/dL and intact parathyroid hormone [PTH] >65 pg/mL) on postoperative day 1 (POD1) or at ≥6 months postoperatively. Results: The ioPTH group demonstrated a significantly lower mean PTH level on POD1 (21±15.3 pg/mL vs. 39±39 pg/mL; P=0.006). Although not statistically significant, the ioPTH group showed a higher biochemical cure rate at 3 months (53.8% vs. 30.6%) and no cases of persistent hyperparathyroidism, compared to 15.3% in the non-ioPTH group.Despite adequate intraoperative PTH reduction, some patients in both groups exhibited isolated PTH elevation without hypercalcemia. Conclusion Although ioPTH monitoring did not significantly reduce the surgical failure rate in PTx for THPT, the use of ioPTH may meaningfully improve surgical completeness and reduce the risk of persistent or recurrent hyperparathyroidism, suggesting its substantial potential value as an intraoperative.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Purpose: The study was designed to evaluate the combined therapeutic effect of topical 2% rebamipide and 0.5% carboxymethylcellulose sodium (CMC) for managing dry eye following cataract surgery compared with 2% rebamipide monotherapy. Methods: We retrospectively analyzed medical records of patients who underwent cataract surgery and were diagnosed with dry eye one week postoperatively. Among these, patients who received combined therapy with 2% rebamipide and 0.5% carboxymethylcellulose (CMC) eye drops (combined therapy group), or 2% rebamipide alone (monotherapy group), for at least two months were included. Clinical data were collected at one and two months after surgery, including Schirmer’s test, tear break-up time (TBUT), ocular surface staining scores, tear film osmolarity, tear lipid layer thickness, and Ocular Surface Disease Index (OSDI) scores. Results: In the combined therapy group, we observed a significant improvement in Schirmer’s test, TBUT, and ocular surface staining scores at both one and two months post-surgery compared to baseline (1 month: p < 0.001, < 0.001, 0.005; 2 months: p < 0.001, respectively). OSDI remained unchanged throughout the entire follow-up period. The combined therapy group exhibited significantly longer Schirmer’s test results (p < 0.001, 0.003), longer TBUT (p = 0.022 at 1 month), and a lower ocular surface staining score (p < 0.001, respectively) compared to the monotherapy group. Conclusions Following cataract surgery, the combined use of rebamipide and CMC eye drops resulted in improvements in Schirmer’s test, TBUT, and ocular surface staining scores. This suggests that combination therapy may be a promising option for patients who do not achieve adequate relief with rebamipide eyedrops.

Purpose: Hungry bone syndrome (HBS) is a common and critical postoperative complication in patients undergoing parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT). We aimed to identify clinical predictors of HBS and assess its impact on bone mineral density (BMD) after PTX. Methods: We retrospectively analyzed data of patients with SHPT and THPT who underwent PTX at Asan Medical Center (2010–2022). Clinical characteristics, including biochemical markers and BMD, were investigated. HBS was defined as profound hypocalcemia of less than 8.4 mg/dL (2.1 mmol/L) or prolonged hypocalcemia for more than 4 days after PTX. Results: A total of 91 patients were included: 18 (19.8%) with SHPT and 73 (80.2%) with THPT. Subtotal PTX was performed in 80 patients (87.9%), while 11 patients (12.1%) underwent total PTX with autotransplantation (TPTX + AT). HBS occurred in 31 patients (34.1%), with a higher incidence in patients with SHPT (72.2%) and all patients who underwent TPTX + AT.Patients with HBS required more calcium supplementation and had higher ALP levels at all timepoints (P < 0.001). In the HBS group, BMD improved more significantly in the femur (P = 0.005) and showed a trend towards improvement in the spine (P = 0.059). Risk factors for HBS included younger age, SHPT, and elevated preoperative ALP and intact parathyroid hormone levels. Conclusion HBS is characterized by severe hypocalcemia due to calcium reabsorption into bone after PTX. Identifying risk factors for HBS may promote early risk stratification and tailored perioperative management, including surgical approach, especially for high-risk patients.

Purpose: Although human epidermal growth factor receptor 2 (HER2) positivity is prevalent in microinvasive breast cancer (MIBC), data focused on HER2-positive MIBC are limited. We investigated the clinical course and long-term outcomes of HER2-positive MIBC and evaluated the role of adjuvant chemotherapy. Materials and Methods: The study included patients with curatively resected pT1mi pN0 HER2-positive breast cancer between January 2000 and January 2020. Treatments and survival outcomes, including invasive breast cancer-free survival (IBCFS), distant recurrence-free survival (DRFS), and overall survival (OS) were analyzed. Results: The analysis included 799 female patients. The median age was 51 years (range, 23 to 79 years), and 51.6% (n=412) were premenopausal. Multifocality was confirmed in 17.3% (n=138), and estrogen receptor (ER) positivity in 29.8% (n=238). Adjuvant chemotherapy was administered to 17.5% (n=140), with doxifluridine in 96.4% of cases. One patient (0.1%) received trastuzumab. With a median follow-up of 119.0 months (95% confidence interval [CI], 114.0 to 127.0), the 8-year IBCFS, DRFS, and OS were 91.2% (95% CI, 89.1 to 93.3), 97.5% (95% CI, 96.4 to 98.7), and 98.8% (95% CI, 98.0 to 99.6), respectively. No significant differences were observed between patients with and without adjuvant chemotherapy. The lack of differences in IBCFS by chemotherapy was consistent across subgroups, including pre-/postmenopausal patients, grade 1-2/3 tumors, and ER-negative disease. Conclusion A clinically meaningful proportion of HER2-positive MIBC patients experience IBCFS events with long-term follow-up. Adjuvant chemotherapy did not improve survival, potentially due to the use of an outdated, ineffective regimen. The role of modern adjuvant regimens, particularly those incorporating HER2-targeted therapy, warrants further exploration.

Objectives: . Differentiated thyroid cancer (DTC) has a favorable prognosis. However, indeterminate lymph nodes (LNs) are common, making it challenging to distinguish recurrent from persistent DTC. Previous studies have not specifically compared the prognosis between recurrent and persistent DTC. Therefore, we aimed to compare prognosis and oncologic characteristics between these two groups. Methods: . This retrospective cohort study was conducted at a single tertiary care institution and included 265 patients with DTC (recurrent, 109; persistent, 156) who underwent reoperation between November 1, 1999, and August 31, 2018, for structural disease. Patients with distant metastasis at the time of initial diagnosis were excluded. Clinical and oncological characteristics, patterns of LN metastasis, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. For DFS, time zero was defined as the date of the second operation. Results: . Recurrent DTC had a higher incidence of central LN metastasis (P=0.003), infield recurrence (P<0.001), and distant metastasis (P<0.001). In contrast, persistent DTC more frequently exhibited lateral LN metastasis (P=0.003) and outfield recurrence (P<0.001). The most common site of neck LN metastasis was ipsilateral level VI/VII (51.4%) in recurrent DTC and ipsilateral level IV (43.0%) in persistent DTC. Ten-year DFS was significantly lower in recurrent DTC than in persistent DTC (41.0% vs. 67.9%; P<0.001). Recurrent DTC, older age, a higher number of metastatic LNs at the second operation (first reoperation), and R1/R2 resection at the second operation were associated with decreased DFS. OS did not significantly differ between recurrent and persistent DTC (P=0.160). Conclusion . Recurrent DTC is associated with poorer DFS than persistent DTC, although OS does not significantly differ between the two groups.

Rotator cuff tears are a common musculoskeletal disorder that significantly impairs shoulder function, especially in the elderly. Traditionally, mechanical wear and age-related degeneration have been considered the leading causes. Recent studies, however, emphasize that systemic metabolic disorders, such as diabetes mellitus, obesity, and dyslipidemia, play a crucial role in the development and healing of rotator cuff disease. This narrative review comprehensively examines the biological mechanisms and clinical outcomes associated with these metabolic comorbidities in rotator cuff degeneration and surgical repair failure. Based on relevant clinical and experimental studies, this study analyzed how each metabolic disease contributes to tendon injury and impaired regeneration. Diabetes mellitus induces chronic inflammation, inhibits collagen synthesis, and impairs microvascular perfusion, hindering tendon healing. Obesity increases the mechanical load on the shoulder and promotes systemic inflammation, exacerbating fatty infiltration of muscles and delaying tissue repair. Dyslipidemia accelerates tendon degeneration through the accumulation of fat, oxidative stress, and fatty infiltration of the rotator cuff muscles. These systemic factors are associated with higher re-tear rates, delayed functional recovery, and poorer surgical outcomes. As the prevalence of metabolic syndrome increases, precise assessment and perioperative management of these metabolic disorders are essential to improve patient outcomes and develop personalized treatment strategies for rotator cuff tears.

Rotator cuff (RC) injuries cause degenerative changes, including muscle atrophy and fatty infiltration, which remain key pathophysiological factors limiting functional recovery and increasing the risk of re-tears even after surgical repair. In particular, these changes tend to progress to fibrofatty replacement over time, highlighting the limitations of surgery-focused treatments alone. Recent research has addressed this by increasingly focusing on biological therapeutic strategies that directly target the degenerative pathology of the RC muscle. This review article examines the current trends in preclinical and clinical research on three main biological approaches: stem cell-based tissue regeneration, modulation of pathological signaling pathways, and metabolic reprogramming strategies that restore the pathological metabolic environment. Building upon these pathophysiological foundations, this review aims to develop recent biological treatment strategies and explore their potential clinical applications.