Purpose: This study examined the status of arthroscopic shoulder surgery in ambulatory settings by analyzing a single institutional database. Materials and Methods: Three hundred and eight arthroscopic shoulder surgeries performed between June 2022 and March 2023 were reviewed retrospectively. Propensity score matching (1-to-2) was performed between the day surgery group and the inpatient group according to sex, age, tear size, and interscalene nerve block (ISNB). Finally, 59 patients in the day surgery group and 118 patients in the inpatient group were matched. The indications of the day surgery were pre-determined according to the American Society of Anesthesiologists classification I or II, and the patient's social, medical, and surgical factors were thoroughly analyzed to define the target group of the day surgery. Complications related to voiding difficulty were prevented by classifying the patients using the International Prostate Symptom Score (IPSS) before surgery, and preventive medications were prescribed in the higher-risk patients with an IPSS of more than 7. To reduce postoperative pain, ISNB and patient-controlled analgesia (PCA) were applied to all patients during the study period, while day surgery patients received an additional bolus injection (5 cc of 0.375% ropivacaine+5 cc of normal saline) before discharge instead of continuous ISNB PCA. This study compared the postoperative pain assessments at discharge and on postoperative days 1, 2, and 14, as well as the total volume of saline irrigation, surgical time, and complications between the day surgery and inpatient groups. Results: The visual analogue scale for pain (pVAS) at the time of surgery were comparable in the day surgery group (4.1±1.5) and inpatient surgery group (4.1±1.1), with no significant difference between them (p=0.35). Similarly, the postoperative pVAS at 1, 2, and 14 days postoperatively was similar in the two groups (all p>0.05). The surgical-related factors, such as the total volume of saline irrigation and surgical time, were similar in the two groups. Furthermore, there was no significant difference in postoperative complications between the two groups (all p>0.05). Conclusion These results show that arthroscopic shoulder surgery in ambulatory settings is a safe alternative to inpatient surgery.

Purpose: This study examined the status of arthroscopic shoulder surgery in ambulatory settings by analyzing a single institutional database. Materials and Methods: Three hundred and eight arthroscopic shoulder surgeries performed between June 2022 and March 2023 were reviewed retrospectively. Propensity score matching (1-to-2) was performed between the day surgery group and the inpatient group according to sex, age, tear size, and interscalene nerve block (ISNB). Finally, 59 patients in the day surgery group and 118 patients in the inpatient group were matched. The indications of the day surgery were pre-determined according to the American Society of Anesthesiologists classification I or II, and the patient's social, medical, and surgical factors were thoroughly analyzed to define the target group of the day surgery. Complications related to voiding difficulty were prevented by classifying the patients using the International Prostate Symptom Score (IPSS) before surgery, and preventive medications were prescribed in the higher-risk patients with an IPSS of more than 7. To reduce postoperative pain, ISNB and patient-controlled analgesia (PCA) were applied to all patients during the study period, while day surgery patients received an additional bolus injection (5 cc of 0.375% ropivacaine+5 cc of normal saline) before discharge instead of continuous ISNB PCA. This study compared the postoperative pain assessments at discharge and on postoperative days 1, 2, and 14, as well as the total volume of saline irrigation, surgical time, and complications between the day surgery and inpatient groups. Results: The visual analogue scale for pain (pVAS) at the time of surgery were comparable in the day surgery group (4.1±1.5) and inpatient surgery group (4.1±1.1), with no significant difference between them (p=0.35). Similarly, the postoperative pVAS at 1, 2, and 14 days postoperatively was similar in the two groups (all p>0.05). The surgical-related factors, such as the total volume of saline irrigation and surgical time, were similar in the two groups. Furthermore, there was no significant difference in postoperative complications between the two groups (all p>0.05). Conclusion These results show that arthroscopic shoulder surgery in ambulatory settings is a safe alternative to inpatient surgery.

Purpose: This study examined the status of arthroscopic shoulder surgery in ambulatory settings by analyzing a single institutional database. Materials and Methods: Three hundred and eight arthroscopic shoulder surgeries performed between June 2022 and March 2023 were reviewed retrospectively. Propensity score matching (1-to-2) was performed between the day surgery group and the inpatient group according to sex, age, tear size, and interscalene nerve block (ISNB). Finally, 59 patients in the day surgery group and 118 patients in the inpatient group were matched. The indications of the day surgery were pre-determined according to the American Society of Anesthesiologists classification I or II, and the patient's social, medical, and surgical factors were thoroughly analyzed to define the target group of the day surgery. Complications related to voiding difficulty were prevented by classifying the patients using the International Prostate Symptom Score (IPSS) before surgery, and preventive medications were prescribed in the higher-risk patients with an IPSS of more than 7. To reduce postoperative pain, ISNB and patient-controlled analgesia (PCA) were applied to all patients during the study period, while day surgery patients received an additional bolus injection (5 cc of 0.375% ropivacaine+5 cc of normal saline) before discharge instead of continuous ISNB PCA. This study compared the postoperative pain assessments at discharge and on postoperative days 1, 2, and 14, as well as the total volume of saline irrigation, surgical time, and complications between the day surgery and inpatient groups. Results: The visual analogue scale for pain (pVAS) at the time of surgery were comparable in the day surgery group (4.1±1.5) and inpatient surgery group (4.1±1.1), with no significant difference between them (p=0.35). Similarly, the postoperative pVAS at 1, 2, and 14 days postoperatively was similar in the two groups (all p>0.05). The surgical-related factors, such as the total volume of saline irrigation and surgical time, were similar in the two groups. Furthermore, there was no significant difference in postoperative complications between the two groups (all p>0.05). Conclusion These results show that arthroscopic shoulder surgery in ambulatory settings is a safe alternative to inpatient surgery.

Purpose: To evaluate whether extended pelvic lymph node dissection (PLND) improves survival outcomes compared with standard PLND in patients with bladder cancer (BCa) undergoing radical cystectomy (RC), and to assess its potential benefits in patients with prior or concurrent radical nephroureterectomy (p/cRNU). Materials and Methods: A multicenter analysis included 2202 patients with BCa undergoing RC with standard or extended PLND at 11 tertiary centers from 2003 to 2023. Following propensity score matching, 659 pairs (n=1,318), including 128 patients with p/cRNU, were analyzed. Recurrence-free survival (RFS) was the primary outcome, while overall survival (OS), cancer-specific survival (CSS), and readmission rates were secondary outcomes. Survival analyses performed using Kaplan-Meier methods and clustered Cox models. Results: Extended PLND yielded significantly more lymph nodes than standard PLND (median: 27.0 vs. 17.0, p<0.001) but did not improve RFS, CSS, or OS in the overall cohort (all p>0.05). Extended PLND increased readmission rates (28.4% vs. 20.2%, p=0.001) and readmission risk (odds ratio, 1.57; 95% confidence interval [CI], 1.15–2.16, p=0.005). However, subgroup analysis revealed extended PLND significantly improved RFS in patients with p/cRNU (hazard ratio, 0.54; 95% CI, 0.38–0.77; p<0.001). Conclusion Extended PLND does not provide survival benefits for overall patient population and increases readmission risk but significantly improves RFS in patients with p/cRNU. Tailoring PLND extent based on upper tract disease status is recommended.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Background: Spinal anesthesia-induced hypotension (SAH) frequently occurs in older patients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomatic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction. Methods: We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiography within 6 months before surgery revealed grade I LV diastolic dysfunction were recruited. SAH was investigated using the anesthesia records. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845–0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752–0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%. Conclusions The preoperative mitral inflow E velocity demonstrated the greatest predictability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identifying patients at high risk of SAH and guiding preventive strategies in the future.

Objective: Impulsivity is a multifaceted construct that plays an important role in various problem behaviors in children and adolescents. The purpose of this study was to validate a Korean version of the short UPPS-P Impulsive Behavior Scale for Children. Methods: Participants were 330 children (166 female) from 2 elementary schools in Korea and 94 attention deficit hyperactivity disorder (ADHD) children (23 female) from two major hospitals. The Korean short UPPS-P Impulsive Behavior Scale for Children (UPPS-P-C) (20 items), Child Behavior Checklist for Ages 6–18 (CBCL 6–18), and Barratt Impulsiveness Scale-11 (BIS-11) were administered. 107 children from the control group were retested 6 months later. Results: Confirmatory factor analysis (CFA) conducted in the control group supported a 5-factor hierarchical model in which 1) positive and negative urgency factors are loaded on a higher-order factor of general urgency; 2) lack of perseveration and lack of premeditation factors are loaded on a higher-order factor of lack of conscientiousness; and 3) sensation seeking remained as a separate dimension. Reliability analysis demonstrated that the 5 factors of the Korean short UPPS-P-C had acceptable internal consistency and test-retest reliability. Lack of premeditation and lack of perseveration subscales showed significant correlations with measures of problem behaviors in CBCL and all the subscales were correlated with the BIS-11. The ADHD group showed significantly higher scores in lack of premeditation, lack of perseveration, positive urgency, and negative urgency subscales. Conclusion This study indicates that the Korean version of short UPPS-P-C has adequate reliability and validity. It may be a valid tool to assess impulsivity of healthy children as well as ADHD.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.