Background: and Purpose To compare the epidemiological and clinical features of the rare patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with age- and sex-matched controls in a nationwide cohort from South Korea. Methods: This observational cohort study analyzed newly diagnosed CADASIL patients aged at least 20 years and matched controls using data from the National Health Information Database for 2004–2022. The cumulative incidence of CADASIL was assessed by age and sex, and compared between regions. Neurologic and systemic diseases were compared between the CADASIL and control groups. Results: The study analyzed 816 CADASIL patients and 816 age- and sex-matched controls aged 56.8±15.2 years (mean±standard deviation), among whom 48.3% were male. The cumulative incidence of CADASIL was 1.86 per 100,000 people (95% confidence interval [CI]=1.85– 1.87 per 100,000), and peaked at 60–69 years of age. In terms of regional distribution, the incidence was highest for Jeju, at 39.67 per 100,000 (95% CI 37.84–41.49 per 100,000). Neurologic diseases were more frequent in CADASIL patients, including Alzheimer’s disease (33.1% vs.20.0%), vascular dementia (84.9% vs. 5.0%), epilepsy (34.6% vs. 15.9%), stroke (70.7% vs. 27.6%), parkinsonism (18.9% vs. 11.0%), and depression (60.8% vs. 44.9%). Systemic diseases such as diabetes mellitus (78.9% vs. 68.9%) were also more common in CADASIL patients, while cancer (27.9% vs. 38.7%) and myocardial infarction (10.0% vs. 13.6%) were less common than in controls. The onset ages of all diseases were lower in CADASIL patients. Conclusions This study has provided a precise nationwide estimate of the CADASIL incidence and its regional distribution in South Korea. CADASIL patients showed higher incidence rates and earlier onsets of diverse clinical manifestations.

Background: Seborrheic dermatitis (SD) is a chronic inflammatory scalp disorder associated with Malassezia dysbiosis and increased sebum production. AMPamide has been suggested to have anti-inflammatory and sebum-regulating effects, but its clinical efficacy and microbiome-modulating effects in SD remain unclear. Objective: To evaluate the clinical efficacy and scalp microbiome changes following 4 weeks of use of an AMPamide-containing shampoo in patients with SD. Methods: In this observational study, 30 patients with SD applied an AMPamide-containing shampoo for 4 consecutive weeks. Clinical outcomes, including sebum levels and overall severity scores, were assessed. Scalp bacterial and fungal communities were analyzed to evaluate α- and β-diversity and changes in Malassezia composition. Results: Treatment resulted in significant reductions in sebum levels and clinical severity scores, particularly in erythema, dandruff, and pruritus. Bacterial community composition remained largely stable, while fungal α-diversity increased, and β-diversity analysis revealed a decrease in the ratio of Malassezia restricta to Malassezia globosa. Conclusion AMPamide-containing shampoo was associated with improved clinical symptoms and a shift toward a more balanced fungal community composition in patients with SD, supporting its potential as a non-steroidal therapeutic option for SD.

Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.

Background: Obesity is a well-known risk factor for chronic kidney disease and its progression. However, the impact of obesity on the renal function of the elderly population is uncertain. We investigated the association between obesity and renal outcomes in the elderly. Methods: We analyzed 130,504 participants from the Korean National Health Insurance Service-Senior cohort. Obesity was classified according to body mass index (BMI), sex-specific waist circumference (WC), and the presence of metabolic syndrome. The primary outcome was renal function decline, defined as a decline in the estimated glomerular filtration rate (eGFR) of at least 50% from baseline or new-onset end-stage renal disease. Results: During a follow-up period of 559,531.1 person-years (median, 4.3 years), 2,486 participants (19.0%; incidence rate of 4.44 per 1,000 person-years) showed renal function decline. A multivariate Cox proportional hazards model revealed that BMI/WC was not associated with renal function decline. However, the group with metabolic syndrome had a significantly increased risk of renal function decline compared to the group without metabolic syndrome (adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.13–1.36). Compared with the non-metabolic syndrome group, the adjusted HRs (95% CI) for participants with one through five components were 0.96 (0.84–1.11), 1.10 (0.96–1.27), 1.24 (1.06–1.45), 1.37 (1.12–1.66), and 1.99 (1.42–2.79), respectively (p for trend < 0.001). Conclusion In elderly Korean adults, metabolic syndrome and the number of its components were associated with a higher risk of renal function decline, but BMI or WC was not significant.

Objective: : A twig-like middle cerebral artery (T-MCA) is a rare condition characterized by steno-occlusion of the M1 segment of the middle cerebral artery (MCA) with nearby collateral arterial networks. Despite unclear pathophysiology, it is often classified as a congenital anomaly caused by failure of fusion of the plexiform MCA arterial plexus. We aimed to improve understanding of the pathophysiology of T-MCAs by analyzing incidental T-MCA findings and their natural history. Methods: : A retrospective chart review was performed between January 2011 and December 2023 at three medical centers treating both ischemic and hemorrhagic strokes. Patients with suspected MCA lesions were selected through radiology reports from computed tomography, magnetic resonance angiography, and digital subtraction imaging. Results: : We identified 51 T-MCA cases from a radiology report search spanning 13 years across three medical centers. The study included 9875 patients with ischemic stroke and 2097 with hemorrhagic stroke. Of the 51 T-MCA cases, incidental findings accounted for 25 (49.0%), ischemic stroke for 18 (35.3%), and hemorrhagic strokes accounted for eight cases (15.7%). T-MCA related ischemic and hemorrhagic strokes accounted for 0.18–0.38% of all strokes. The RNF213.R4810K mutation was identified in seven of 15 patients (46.7%) tested. We found three cases of a de-novo T-MCA that progressed from a normal MCA architecture. Conclusion : T-MCAs may represent an acquired secondary anomaly rather than a congenital lesion, followed by steno-occlusion of the focal MCA with new arterial network formation. Both Moyamoya angiopathy and chronic atherosclerosis likely contributed to disease progression. Formation of a microaneurysm, dilatation of the lenticulostriate artery, and hemodynamic stress can lead to stroke.

Background: This study was performed to establish a rabbit model for esophageal surgery in the treatment of cervical esophageal diseases. The necessary steps for postoperative treatment and esophageal examination were detailed. Methods: This study aimed to confirm the feasibility of the surgical procedure in rabbits and develop a postoperative management protocol. Six New Zealand White rabbits underwent esophagectomy and end-to-end anastomosis of the cervical esophagus under general anesthesia. Postoperatively, the rabbits were fed a specially formulated therapeutic liquid diet for 3 to 7 days. Recovery was monitored for 8 weeks, after which the rabbits were euthanized. Esophagography and endoscopy were conducted during the first postoperative week to assess healing. Results: Of the six rabbits that underwent surgery, two died from nonsurgical complications within 7 days after the operation. Of the remaining rabbits, two were diagnosed with esophageal stricture via esophagography and underwent endoscopy after the first postoperative week. The final two rabbits completed the 8-week postoperative period without complications. Conclusions Esophageal surgery and postoperative treatment in rabbits require careful attention. We anticipate that this study will provide valuable and practical information for researchers conducting esophageal studies using rabbits.

Background/Aims: Portal vein thrombosis (PVT) frequently occurs in patients with inflammatory bowel disease (IBD), particularly when influenced by factors such as abdominal infections, IBD flare-ups, or surgical procedures. The implications of PVT range from immediate issues such as intestinal ischemia to long-term concerns including portal hypertension and its complications. However, there is a notable gap in comprehensive studies on PVT in IBD, especially with the increasing incidence of IBD in Asia. This research aimed to evaluate the clinical features and outcomes of PVT in patients with IBD at a leading hospital in South Korea. Methods: This retrospective analysis reviewed adult patients diagnosed with both IBD and PVT from 1989 to 2021 at a renowned South Korean medical center. The study focused on patient characteristics, specifics of PVT, administered treatments, and outcomes, all confirmed through enhanced CT scans. Results: A total of 78 patients met the study’s criteria. Notably, only 20.5% (16/78) were treated with oral anticoagulants; however, a vast majority (96.2%; 75/78) achieved complete radiographic resolution (CRR). When comparing patients receiving anticoagulants to those who did not, a significant preference for anticoagulant use was observed in cases where the main portal vein was affected, as opposed to just the left or right veins (p = 0.006). However, multivariable analysis indicated that neither anticoagulant use nor previous surgeries significantly impacted CRR. Conclusions Patients with IBD and PVT generally had favorable outcomes, regardless of anticoagulant use.

Purpose: This study aimed to evaluate the effects of an intervention combining warm therapy (via a thermoelectric-element tourniquet) and a distraction-based approach (via an augmented reality-based app known as TWINKLE) on pain, stress, and satisfaction during intravenous catheterization in adults. Methods: A randomized controlled trial was conducted in South Korea with 93 healthy adults who were randomly assigned to one of three groups: the experimental group (TWINKLE app with warm therapy), the comparison group (warm therapy only), and the control group (no treatment). Participants’ pain, stress, and satisfaction, as well as practitioner satisfaction, were measured after the intervention. Results: Pain scores differed significantly among the three groups (F = 5.68, p = .005), with the experimental group showing significantly lower scores than the control group (p = .003). Stress levels were also significantly lower in the experimental group than in the other groups (F = 9.42, p < .001). Participant satisfaction was highest in the experimental group (F = 17.65, p < .001), while nurse satisfaction was significantly higher in the comparison group than in the experimental and control groups (F = 67.91, p < .001), suggesting that the additional distraction intervention may have increased nurses’ workload. Conclusion Combining digital distraction with warm therapy using a thermoelectric-element tourniquet effectively reduces pain and stress while improving patient satisfaction during intravenous catheterization. Further research is needed to optimize this approach, with a particular focus on targeting digital distraction interventions to patients with higher levels of procedural anxiety and finding ways to minimize practitioner workload.

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients. Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates. Results: Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively). Conclusion Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Purpose: This study aimed to evaluate the effects of an intervention combining warm therapy (via a thermoelectric-element tourniquet) and a distraction-based approach (via an augmented reality-based app known as TWINKLE) on pain, stress, and satisfaction during intravenous catheterization in adults. Methods: A randomized controlled trial was conducted in South Korea with 93 healthy adults who were randomly assigned to one of three groups: the experimental group (TWINKLE app with warm therapy), the comparison group (warm therapy only), and the control group (no treatment). Participants’ pain, stress, and satisfaction, as well as practitioner satisfaction, were measured after the intervention. Results: Pain scores differed significantly among the three groups (F = 5.68, p = .005), with the experimental group showing significantly lower scores than the control group (p = .003). Stress levels were also significantly lower in the experimental group than in the other groups (F = 9.42, p < .001). Participant satisfaction was highest in the experimental group (F = 17.65, p < .001), while nurse satisfaction was significantly higher in the comparison group than in the experimental and control groups (F = 67.91, p < .001), suggesting that the additional distraction intervention may have increased nurses’ workload. Conclusion Combining digital distraction with warm therapy using a thermoelectric-element tourniquet effectively reduces pain and stress while improving patient satisfaction during intravenous catheterization. Further research is needed to optimize this approach, with a particular focus on targeting digital distraction interventions to patients with higher levels of procedural anxiety and finding ways to minimize practitioner workload.