Although venous invasion (VI) is associated with distant metastasis and observed in >50% of pT2–4 colorectal cancers (CRCs), the role of VI in pT1 CRCs is not well-defined. Methods: Thirty-four surgically resected pT1 CRCs were reevaluated for 2-dimensional (2D) VI using hematoxylin and eosin (H&E)–stained slides with additional elastic and desmin immunohistochemical staining (cohort A). Additionally, 27 pT1 CRCs without knowing VI status were selected for 3-dimensional (3D) VI evaluation only (cohort B). All 61 cases (cohorts A and B) were studied in 3D using tissue clearing. Results: VI was detected more commonly in 3D (17/34, 50.0%) than in 2D H&E slide evaluation (9/34, 26.5%, p = .047). When VI was identified in 3D (27/61, 44.3%), the most common phase was that of intraluminal growth (22/27, 81.5%), followed by intravasation (7/27, 25.9%) and extravasation (5/27, 18.5%). E-cadherin expression was characterized in 3D in foci of VI and varied in each phase of invasion. Conclusions: All three phases were observed in VI of pT1 CRCs. The extravasation of neoplastic cells from foci of VI in pT1 CRC suggests that VI could be a route of intratumoral spreading in a subset of pT1 CRCs.

Gout is the most prevalent inflammatory arthritis worldwide and represents a growing global health burden. It arises from hyperuricemia resulting from disordered purine metabolism, leading to monosodium urate (MSU) crystal deposition and recurrent inflammatory arthritis. Although hyperuricemia is the principal risk factor, genetic susceptibility, impaired urate transport, and emerging factors such as the gut microbiota also contribute to disease development. Acute flares are mediated by MSU crystal-induced activation of the NLRP3 inflammasome and subsequent interleukin-1β production, whereas chronic inflammation results in tophus formation and structural joint damage. Gout is closely associated with metabolic syndrome, chronic kidney disease, and cardiovascular disease, which contribute to persistently elevated mortality. Although advances in imaging and pharmacologic therapy have improved diagnosis and management, the real-world use of urate-lowering therapy remains suboptimal. Further research and sustained efforts by healthcare professionals are needed to improve long-term disease control.

Background: Lapsi (Choerospondias axillaris), a plant native to Nepal, has been traditionally used in Asian countries to treat cardiovascular conditions. However, its effects on immune regulatory function remain largely unexplored.This study aimed to in vivo evaluate the immunoregulatory properties of Lapsi fruit extract in mice on immunotoxic responses with analysis on in vitro mechanism for immune suppression, oxidative stress, and inflammatory response.Male Balb/c mice were intragastrically administered various doses of the extract for 21 days. In some mice, immune suppression was induced with cyclophosphamide, and subsequent immune recovery was assessed. In addition, RAW264.7 cells and THP-1-derived macrophages were treated in vitro with lipopolysaccharide and different concentrations of the extract. Results: Administration of extract increased the IgG2a/IgG1 ratio while reducing serum IgE and IgG1 level compared with control mice. Tumor necrosis factor (TNF)-α and interleukin (IL)-17 levels were lower in splenic culture supernatants of mice administered extract. Lapsi extract also effectively reversed cyclophosphamide (CP)-induced immunosuppression by enhancing serum levels of IgA and IgG2a, of interferon-γ and interleukin (IL)-4 secreted by splenic T cells, and of IgG1 and IgG2a secreted by B cells, as well as by increasing immune cell counts. In cell cultures, the extract decreased the levels of inflammation markers, including nitric oxide, reactive oxygen species, prostaglandin E2, and pro-inflammatory cytokines (IL-6, TNF-α, and IL-1β). Mechanistic analysis showed that Lapsi extract modulated the NF-κB p65, MAPK, and inflammasome pathways. Conclusions Lapsi extract may act as both an immunostimulatory and anti-inflammatory agent, indicating its potential as a candidate immunomodulatory activity under polyclonal and CP-suppressed conditions; however, further disease-specific studies, along with isolation and characterization of active phytochemicals, are warranted to evaluate its therapeutic applicability.

Purpose: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, necessitating the identification of novel therapeutic targets. The E3 ubiquitin ligase WW domain-containing E3 ubiquitin protein ligase 2 (WWP2) has been implicated in various cancers, yet its specific role and underlying molecular mechanisms in CRC are poorly understood. This study aimed to investigate the functional role of WWP2 in CRC progression and to elucidate its regulatory mechanisms. Methods: WWP2 expression was evaluated in CRC patient tissues and cell lines using immunohistochemistry, quantitative real-time polymerase chain reaction, and western blotting. The biological functions of WWP2 were assessed using in vitro assays for cell proliferation, migration, and invasion following adenovirus-mediated overexpression. The molecular mechanism was investigated by analyzing the protein expression levels of p53 and its downstream target, p21, via western blot. An in vivo xenograft mouse model was used to confirm the oncogenic role of WWP2. Results: WWP2 expression was significantly upregulated in CRC tissues. Overexpression of WWP2 promoted CRC cell proliferation, migration, and invasion. Mechanistically, increased WWP2 expression led to a marked reduction in the protein levels of the tumor suppressor p53. Consequently, the expression of the p53 downstream target, the cell cycle inhibitor p21, was also suppressed. In the xenograft model, WWP2 overexpression significantly enhanced tumor growth. Conclusion Our findings demonstrate that WWP2 functions as an oncogene in CRC. It promotes cancer progression by destabilizing the tumor suppressor p53 and downregulating p21. This study highlights the WWP2-p53-p21 axis as a potential novel therapeutic target for CRC.

Purpose: Malignant hepatocellular neoplasm, not otherwise specified (HCN-NOS) is a provisional diagnostic entity, characterised by intermediate or a combination of hepatoblastoma and pediatric hepatocellular carcinoma (p-HCC) features. We compared the characteristics of HCN-NOS with hepatoblastoma and p-HCC. Materials and Methods: The records of 148 pediatric patients diagnosed with hepatocellular malignancy after resection were retrieved from the institutional database. Clinical parameters and histopathology slides were reviewed to re-establish each patient’s diagnosis. Molecular analyses were conducted in 37 patients. Results: Patients were profiled as 21 (14.2%) with HCN-NOS, 109 (73.6%) with hepatoblastoma, and 18 (12.2%) with p-HCC. The median age was 8.6 years in HCN-NOS, 1.2 years in hepatoblastoma, and 7.9 years in p-HCC. Background liver disease was frequently observed in p-HCC (11/18, 61%) but infrequent in HCN-NOS (4/21, 19%) and hepatoblastoma (4/109, 3.7%). HCN-NOS presented with a more advanced PRETEXT stage (p=0.012), metastasis (p < 0.001), and lymphovascular invasion (p < 0.001) than hepatoblastoma and p-HCC. Patients with HCN-NOS received longer cycles of preoperative chemotherapy; however, they reported a lower decrease in serum alpha-fetoprotein and tumor size than hepatoblastoma (p=0.043, p=0.004, and p=0.044, respectively). HCN-NOS was an independent poor prognostic factor for event-free survival (hazard ratio, 4.968; 95% confidence interval, 2.004 to 12.32; p < 0.001). Conclusion The possibility of HCN-NOS should be considered in pediatric patients with liver cancer, especially those ≥ 5 years old with no background liver disease. Because HCN-NOS exhibits poor chemoresponsiveness and unfavourable postoperative prognosis, liver transplantation should be strongly considered.

Purpose: This study aimed to investigate the impact of physical activity on dementia risk among cancer survivors in South Korea. Materials and Methods: This retrospective, population-based cohort study included 344,152 cancer survivors identified from the National Health Insurance Service database in South Korea. The mean follow-up time was 5.81 years. Different levels of physical activity post-cancer diagnosis, ranging from inactive to highly active, were assessed. The primary outcome was the incidence of overall dementia, Alzheimer’s disease, and vascular dementia. Secondary outcomes included dementia risk stratified by cancer type and treatment (chemotherapy and radiation). Results: Of the total participants, 24,363 (7.08%) developed dementia. The risk of overall dementia decreased sequentially across the exercise groups compared to the inactive group: insufficiently active (adjusted hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.86 to 0.92), active (adjusted HR, 0.85; 95% CI, 0.83 to 0.88), and highly active (adjusted HR, 0.79; 95% CI, 0.76 to 0.82). This inverse relationship between exercise and dementia risk was statistically significant across various cancer types and was consistent regardless of age, comorbidities, and whether or not excluding the first 1, 2 years. Conclusion Among cancer survivors in South Korea, increased physical activity post-diagnosis was associated with a significantly lower risk of dementia. These findings underscore the importance of promoting physical activity in cancer survivors for cognitive health.

Background and Objectives: Inconsistencies in nasal nitric oxide (nNO) values, due to anatomical variations and comorbidities, challenge the accurate assessment of upper airway inflammation severity. We hypothesized that changes in nNO levels following treatment for chronic rhinitis would be consistent and provide relative value. This study aimed to evaluate the correlation between changes in nNO levels and symptomatic improvements following treatment for chronic rhinitis. Methods: This prospective observational study included 46 participants diagnosed with chronic rhinitis between December 2021 and November 2023. nNO measurements, evaluations of four nasal and two ocular symptoms, and quality of life questionnaires were conducted at baseline and after one month of treatment. Baseline laboratory tests included serum total immunoglobulin E levels, blood eosinophil percentages, and skin prick tests. Results: The Total Nasal Symptom Score (TNSS), TNSS with ocular symptoms (TNSS eye), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores significantly decreased following treatment (all p<0.001). nNO levels also decreased significantly after treatment (p=0.036). Moreover, changes in nNO were significantly correlated with changes in TNSS, TNSS eye, and RQLQ scores (p=0.047, r=0.294; p=0.021, r=0.340; and p=0.004, r=0.419, respectively). Conclusion In patients with chronic rhinitis, changes in TNSS, TNSS eye, and RQLQ scores were correlated with changes in nNO levels after treatment. nNO may serve as a potential objective evaluation tool for chronic rhinitis, particularly in patients who have difficulty reporting symptoms.

Purpose: This study aimed to provide a theoretical basis for the handoff communication of operating room (OR) nurses by defining and organizing the concept behind it. Methods: For this study, we analyzed five articles found through a literature search using Walker and Avant’s conceptual analysis. Results: An analysis of OR nurses’ handoff communication shows that its antecedents include individual competencies, performance experience, improving interpersonal relationships, securing the OR environment, and the existence of relevant protocols. Additionally, effective handoff communication possesses attributes such as conciseness and accuracy of verbal communication, the ability to convey information concisely and accurately, OR resource availability and risk factors, timeliness of communication, and structured handoff communication protocols related to surgeries. These factors improve patient safety and result in the consistent communication of patient information, improved teamwork, and increased work efficiency. Conclusion This study can enhance the understanding of handoff communication among perioperative nurses and be used to help develop a systematic protocol. Additionally, it can serve as a foundation for constructing a theory of handoff communication and for formulating guidelines specific to the OR.

The heel is the second most common area for pressure injuries, which can lead to serious and threatening extremity infections. The late stages of deep hindfoot ulcers, where osteomyelitis commonly coexists, can result in an extended therapeutic window. Standard treatments for hindfoot ulcers complicated by osteomyelitis encompass debridement and flap surgery. In severe cases, below-knee amputation is also considered. Recent studies have reported the efficacy of negative pressure wound therapy (NPWT) in addressing refractory foot ulcers. The authors developed a temporary tension suture (TTS) in combination with NPWT to shorten the treatment duration of refractory foot ulcers, providing additional appropriate tension for wound coverage. The authors report for the first time a case of a 73-year-old female patient who had been experiencing an intractable hindfoot ulcer with chronic osteomyelitis for 18 months. NPWT and TTSs were applied concurrently with favorable outcomes.

Background: In 2023, we experienced an outbreak from a case of undiagnosed crusted scabies, resulting in a significant number of exposed individuals and secondary cases. In this report, we describe the outbreak control measures, the attack rate, and the risk factors for acquisition of scabies among healthcare workers (HCWs). Methods: This study was conducted in a 2,700-bed tertiary care hospital in Seoul, South Korea. The attack rate was defined both for microscopic proven cases per exposed individuals and as the sum of proven and probable cases per exposed individuals. Outbreak control measures included identifying and treating all potentially exposed individuals with or without symptoms, as well as environmental disinfection. Results: From the index, there was potential quinary transmission resulting in 63 proven cases, 142 probable cases, and a total of 1,820 exposed individuals, including 734 contacts from the index case. The attack rate from the index was 7% (50/734) based on proven cases and 19% (138/734) based on proven and probable cases. Among the 526 HCWs who received preemptive topical treatment with permethrin applied once, 21 (4%) were later diagnosed as scabies. In addition, 5 of 20 HCWs (25%) with initial proven scabies had a persistent positive microscopic exam after four permethrin treatments. In the case group, there were significantly more nurses (60% vs. 43%, P = 0.007) and nurse assistants (20% vs. 9%, P = 0.006). There were significantly more cases than controls involving direct contact with the index case (94% vs. 64%, P < 0.001). Conclusion Lowering the threshold for suspicion of crusted scabies is important, as a single missed case could lead to a large outbreak. Simultaneously applying preemptive permethrin cream to all potentially exposed individuals might have been effective in preventing further transmission. However, caution is needed because the development of scabies or persistent scabies is possible even with preemptive or therapeutic treatment.