Objective: This study assessed the usefulness of contrast-enhanced computed tomography (CT) in identifying the focus of gastrointestinal (GI) hemorrhage and investigated the predictive factors associated with the detection of suspected bleeding focus of CT in the emergency department (ED). Methods: A retrospective analysis was conducted on patients who visited the ED with GI hemorrhage symptoms and underwent contrast-enhanced CT scans from January 2016 to December 2020. The patients were divided into two groups depending on whether suspected bleeding foci were identified on CT scans. Multivariate logistic regression was performed to examine the predictive factors for detecting a suspected bleeding focus by CT. Results: A total of 1,554 patients were included, and suspected bleeding foci were detected on CT scans in 573 patients. The diagnostic accuracy of the CT scan was 84.1% (482 of 573). Multivariate logistic regression analysis revealed age, malignancy, hypotension event during the ED stay, etiology of varix, and tumor to be associated with the detection of suspected bleeding focus on CT scan. Conclusion Contrast-enhanced CT in patients with a GI hemorrhage showed high diagnostic accuracy for evaluating bleeding foci. A CT scan is particularly useful for patients with old age, malignancy, variceal disease, and patients with hypotension events during an ED stay.

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 heterogeneity of chronic kidney disease (CKD) and fragmented analysis methods hinder the precise identification of novel biomarkers. We addressed this challenge using two independent cohorts to integrate genomics and metabolomics, aiming to identify cause-specific biomarkers for CKD in the Korean population. Methods: A longitudinal genome-wide association study using the Cox proportional hazards model was conducted using the Ansan and Ansung cohort. To validate these genomic biomarkers and integrate them with plasma metabolomics biomarkers, we utilized a hospital-based biopsy cohort to identify cause-specific CKD biomarkers. Within the biopsy cohort, we analyzed four disease subsets, including type 2 diabetic kidney disease (DKD), hypertensive nephropathy (HN), immunoglobulin A nephropathy (IgAN), and membranous nephropathy (MN), and compared them with healthy individuals. Significant single nucleotide polymorphisms(SNPs) and metabolites for each CKD subset were identified through logistic regression and correlation-based network analyses. Subsequently, we analyzed the risk of disease progression associated with the identified pairs. Results: A total of 448 variants associated with CKD occurrence were identified, with significant differences in several genetic variants and metabolites observed among patients with DKD, HN, IgAN, and MN compared to healthy individuals. Among 36 SNP-metabolite pairs, those involing FOXB1 and ZFP42 were associated with DKD, whereas pairs involving MMRN1 and SYNJ2 were linked to MN. Notably, the rs1025170 variant in FOXB1 and tyrosine pair was correlated with DKD progression. Conclusion Integrating genomics and metabolomics across independent cohorts enables the discovery of cause-specific biomarkers for the occurrence and progression of CKD in the Korean population.

Background: One-lung ventilation (OLV) during thoracic surgery frequently requires approximately 100% oxygen, imposing the risk of hyperoxemia. This study aimed to assess whether oxygen reserve index (ORI)-guided fraction of inspired oxygen (FiO2) adjustment can reduce the incidence of hyperoxemia in children undergoing lung resection. Methods: This prospective, randomized controlled trial enrolled children aged < 7 years scheduled for thoracoscopic lung resection. The participants were randomly assigned to either a conventional group (FiO2 adjusted based on arterial blood gas analysis [ABGA]) or an ORI group (FiO2 titrated to maintain an ORI target of 0.15). ABGA was performed 10 and 30 min after the start of OLV (T1 and T2). The primary outcome was the incidence of hyperoxemia 30 min after OLV (T2). Results: Data from 64 children (31 conventional, 33 ORI groups) were analyzed. The incidence rate of hyperoxemia at T2 was similar between the conventional and ORI groups (54.8% vs. 60.6%, P = 0.801). However, partial pressure of arterial oxygen at T1 was significantly lower in the ORI group than in the conventional group (214.6 ± 65.5 mmHg vs. 268.8 ± 92.7 mmHg, P = 0.014). The ORI group demonstrated a lower time-weighted average FiO2 during OLV (0.79 ± 0.12 vs. 0.87 ± 0.09, P = 0.004). The ORI group required more rescue interventions than the conventional group and experienced fewer episodes of hypoxia. Conclusions ORI-guided FiO2 adjustment does not significantly reduce the incidence of hyperoxemia in children undergoing OLV but reduces time-weighted FiO2 and hypoxic events.

Background: Pediatric hospice and palliative care (PHPC) in South Korea remains in its early stages, influenced by cultural taboos surrounding death and its frequent association with geriatric care. While focusing on South Korean parents, this study also provides insights into cultural barriers common among Asian families with collectivist values. This qualitative study explored parental perceptions and cultural barriers to address the current evidence gap and to inform the development of culturally sensitive PHPC models in South Korea. Methods: Semi-structured interviews were conducted with 13 participants (12 parents and one patient) recruited from a tertiary hospital in South Korea. Participants were caregivers of children with serious chronic complex illnesses, including both malignant and non-malignant serious chronic or potentially life-limiting conditions. Data collection continued until pragmatic thematic saturation was achieved, and transcripts were analyzed using Krippendorff’s content analysis with an inductive coding approach. Results: Four overarching themes emerged: (1) cognitive and emotional barriers related to stigma and misconceptions; (2) perceived multidimensional benefits beyond clinical care; (3) family-centered support needs; and (4) strategies to optimize PHPC delivery. Many parents described experiences consistent with transgenerational guilt, reflecting feelings of guilt about passing an illness or vulnerability to their child, which emerged as a potential psychological barrier to PHPC engagement. Conclusion A substantial gap exists between recognition of PHPC and parental willingness to utilize services. Reframing PHPC as an early, concurrent support system led by healthcare professionals and supported by culturally sensitive communication may reduce parental guilt and improve access to family-centered palliative care services.

Secondary rhabdoid tumors (RTs) with atypical teratoid/rhabdoid tumor-like features rarely arise from, or coexist with, pleomorphic xanthoastrocytomas (PXAs), and their clinicopathological and molecular characteristics remain poorly understood. We report a 17-year-old girl with a temporal lobe mass that, upon gross total resection, pathologically contained both RT and PXA components. Immunohistochemistry revealed loss of INI1 expression restricted to the RT component, while the PXA area retained INI1. Next-generation sequencing identified a shared BRAF::TRIM24 fusion and homozygous deletion of CDKN2A/2B in both components, indicating a shared clonal origin. Additionally, a germline ATM frameshift mutation (c.5288_5289insGA) was identified in both tumor components, making the first such report in central nervous system tumors. SMARCB1 loss was confined to the RT component, further supporting the hypotheses of clonal evolution and secondary transformation. Despite gross total resection, craniospinal irradiation, and chemotherapy, the patient developed rapid leptomeningeal dissemination and died 5 months after surgery. This case provides clinicopathological and molecular evidence for clonal evolution and secondary transformation of PXA into an RT. The presence of germline ATM mutation may have therapeutic and biological relevance. Further studies are required to clarify the pathogenesis and optimal management of these rare and aggressive tumors.

Background: Degenerative lumbar scoliosis (DLS) alters spinal anatomy, impacting the feasibility and dimensions of surgical corridors for oblique lumbar interbody fusion (OLIF). This study aimed to compare the morphometric characteristics of OLIF corridors between patients with left- and right-apex curves, focusing on corridor dimensions, psoas muscle asymmetry, and segmental artery positioning. Methods: A retrospective analysis of 80 patients with DLS (left apex: n = 43; right apex: n = 37) was conducted. Corridor angles and distances, psoas muscle cross-sectional areas, and segmental artery locations were measured at L2–3, L3–4, and L4–5 using T2-weighted magnetic resonance imaging (MRI). Multivariate regression analysis identified key anatomical predictors of corridor variation at L2–3. Results: Regardless of the apex direction, the left-sided corridor was consistently larger across all levels. Corridor angles were significantly greater on the left side in both groups (left apex: L2–3, 39.7° vs. 13.5°; L3–4, 38.3° vs. 11.9°; L4–5, 38.6° vs. 6.9°;right apex: L2–3, 53.7° vs. 18.1°; L3–4, 43.1° vs. 18.5°; L4–5, 28.6° vs. 11.9°). Psoas muscle areas were larger on the concave side of the curve (left apex: 125.7 mm2 vs. 67.9 mm2 ; right apex: 125.4 mm2 vs. 77.4 mm2 ). Segmental artery positioning exhibited curvedependent asymmetry at L2–3 (left apex: 8.8 mm vs. 7.9 mm; right apex: 9.6 mm vs. 8.0 mm). Multivariate regression analysis revealed that in the left apex group, the left psoas area (β = −0.132) and segmental artery distances were significant predictors of corridor angle variation (R2 = 0.517). In the right apex group, psoas asymmetry (β = 0.123) and sagittal alignment (β = −0.851) were associated with corridor differences. Conclusions OLIF corridors in DLS patients demonstrate consistent left-sided dominance, regardless of apex direction. Psoas muscle asymmetry and segmental artery positioning contribute to corridor variations. While the left-sided approach remains standard, right-sided access may be feasible in select cases, particularly at L4–5. These findings provide insights for optimizing preoperative planning and surgical decision-making in DLS patients.

Background: The etiology of adolescent idiopathic scoliosis is multifactorial, and the influence of lifestyle factors such as sleep is not clearly understood. Differences in scoliosis incidence between urban and rural areas have been reported, but the contributing factors remain unclear. Therefore, this study investigated the association between sleep patterns and the incidence of idiopathic scoliosis and explored whether these patterns contribute to the observed urban-rural disparity. Methods: This retrospective study utilized data from the Korea Children and Youth Panel Survey (2010–2016) and the Health Insurance Review and Assessment Service for 4,693 students (age, 7–18 years). Various lifestyle factors including sleep patterns, learning time, and activity times, were compared between urban and rural areas, and a correlation analysis was performed between these factors and the age-specific incidence of idiopathic scoliosis. Results: Urban students, who exhibited higher idiopathic scoliosis incidence rates, tended to have later bedtimes and shorter total sleep durations than rural students. Longer learning hours were also observed in urban areas. Significant correlations were found between idiopathic scoliosis incidence and bedtime (p = 0.031), total sleep time (p = 0.026), and changes in total sleep time (p = 0.011). Conclusions Our findings indicate that later bedtimes and shorter sleep durations may contribute to idiopathic scoliosis development in children and adolescents. The higher idiopathic scoliosis incidence in urban students than in rural students could be partially explained by these sleep pattern differences, highlighting the need for further research into the role of sleep in scoliosis onset and prevention.

Background: Menopausal status can increase the risk of cardiocerebrovascular diseases (CCVDs) in women with type 2 diabetes mellitus (T2DM). Regular exercise is well-known to reduce this risk. This study explored the impact of exercise on CCVD and mortality in women with T2DM according to their menopausal status. Methods: A total of 32,477 premenopausal and 53,690 postmenopausal Korean women with T2DM aged 40 to 60 years from a national health examination cohort (2009 to 2018) were included. We evaluated risks for stroke, myocardial infarction (MI), and mortality based on exercise intensity. Cox proportional hazard regression analyses were performed to obtain the adjusted hazard ratio (aHR) and 95% confidence interval. Results: Exercise reduced stroke, MI, and mortality risks in women with T2DM, regardless of menopausal status. The highest effects of aHR compared to the sedentary group were 0.68 for stroke, 0.66 for MI, and 0.81 for mortality. Postmenopausal women experienced significant MI risk reductions at most exercise intensities, with the greatest reduction in the ≥1,500 metabolic equivalent of task score group unlike premenopausal women. However, stroke and mortality risk reductions in postmenopausal women were less pronounced compared to premenopausal women. Conclusion Exercise reduces CCVD risk in women with T2DM across menopausal status. Postmenopausal women with T2DM had more benefits from exercise on MI but fewer benefits on stroke and mortality than premenopausal women. In premenopausal women with T2DM, exercise was not associated with a lower MI risk.