Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: Psoriasis is acknowledged for its association with diabetes and obesity. However, the comprehension of the correlation between obesity and psoriasis risk in individuals with diabetes remains limited. Objective: We aimed to examine the association of body mass index and waist circumference (WC) with the risk of developing psoriasis in individuals with type 2 diabetes mellitus (T2DM). Methods: This retrospective cohort study utilized nationwide data for exploratory analysis.A total of 2,480,489 participants, all diagnosed with T2DM, were included. Results: Over a 6.77±1.69-year follow-up, 71,514 patients (2.88%) were diagnosed with psoriasis. Adjusting for multiple variables, the study revealed a J-shaped pattern association between BMI levels and the hazard ratio (HR) for psoriasis in patients with T2DM. A linear pattern relationship was observed regarding WC, with the highest WC group showing the most elevated HR (HR, 1.123; 95% confidence interval, 1.091–1.156). Conclusion Understanding the relationship between psoriasis risk and obesity in diabetic individuals holds the potential to enhance the management of patients with T2DM.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Pediatric kidney disease has a relatively lower prevalence than do other pediatric conditions and has a notably different etiology from kidney diseases observed in adults. Furthermore, the pediatric population is unique in that they experience ongoing growth and development, distinguishing them from adult patients. Consequently, pediatric patients with kidney disease require more specialized and meticulous nutritional management than do adults. To address this need and promote optimal dietary practices for pediatric patients with kidney disease, pediatric nephrologists from the Korean Society of Pediatric Nephrology and nutritionists from the Korean Society of Clinical Nutrition have collaborated to establish nutritional guidelines specifically tailored to Korean dietary patterns. These guidelines offer detailed, nutrient-specific recommendations covering energy, protein, calcium, phosphorus, and potassium consumption while providing practical, culturally relevant guidance intended to support both pediatric patients and their caregivers.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.

Background: The objective of this study was to investigate sequential changes in range of motion (ROM) and histopathology of the joint capsule after remobilization in a rat adhesive capsulitis (AC) model using cast immobilization. Methods: Thirty-five 6-week-old Sprague-Dawley rats were immobilized with casting of the left shoulder. After 4 weeks, the rats were randomly divided into 7 groups (n = 5 per group) according to the duration of remobilization following cast removal: 0 (D0), 1 (W1), 2 (W2), 3 (W3), 4 (W4), 5 (W5), and 6 (W6) weeks. At each time point, 5 rats were euthanized for measurement of the glenohumeral abduction angle and evaluation of capsular thickness in the axillary recess. Results: Abduction angle was sequentially increased at each time point after remobilization with cast removal. Significant differences between immobilized and non-immobilized shoulders were observed at D0 (130.4° vs 161.3°), W1 (144.7° vs 160.7°), and W2 (142.3° vs 161.3°). Significant differences in capsular thickness of the axillary recess were observed between immobilized and non-immobilized shoulders at all time periods including D0 (98.0 μm vs. 12.9 μm), W1 (117.7 μm vs. 12.2 μm), W2 (115.7 μm vs.13.1 μm), W3 (54.1 μm vs. 14.9 μm), W4 (54.5 μm vs. 13.4 μm), W5 (23.8 μm vs. 13.5 μm), and W6 (19.8 μm vs. 12.4 μm). Significant differences in capsular fibrosis scores were observed between immobilized and non-immobilized shoulders at W1 (2.2 vs. 0.2) and W2 (2.2 vs. 0.0). Conclusions Our study showed that ROM increased sequentially after remobilization in a rat AC model using cast immobilization, and it was normalized at 6 weeks after cast removal. Capsular thickening decreased sequentially, but remained at 6 weeks after cast removal. These findings may provide useful information for further research into verifying potential therapeutic targets using a rat AC model with cast immobilization.

Background: Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking. Methods: This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM. Results: In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs. Conclusion ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Delirium is a common acute neuropsychiatric syndrome, and its early detection may improve clinical outcomes. This narrative review synthesized findings from 11 original studies and two systematic reviews that employed wearable sensors (actigraphy) to predict or detect delirium. In surgical, intensive care unit, and geriatric populations, delirium has consistently been associated with disrupted rest–activity rhythms, including lower daytime activity, increased nighttime activity, and fragmented sleep–wake cycles. Characteristic motor patterns also differed based on the motor subtype (hyperactive vs. hypoactive). Several studies have demonstrated that continuous wrist accelerometry can objectively detect the onset of delirium and classify motor subtypes. Notably, one machine learning model showed improved prediction accuracy, increasing from approximately 62% to 74% when motion features were included. Overall, continuous motion monitoring appears feasible and may serve as a promising non-invasive tool for early delirium detection and risk stratification. However, the findings remain heterogeneous, and motion-based algorithms alone show only moderate sensitivity. Further validation in larger and more diverse cohorts, as well as integration with clinical risk factors, is required before clinical implementation.

Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.