Background: s/Aims: Microwave ablation (MWA) is an emerging ablative therapy that surpasses previous methods by achieving higher temperatures and creating larger ablation zones within shorter periods. This study compared the therapeutic outcomes of MWA with those of liver resection in real-world clinical practice. Methods: A total of 178 patients with 259 nodules who underwent MWA or liver resection between January 2015 and July 2023 were enrolled. Local tumor progression (LTP)-free survival, overall progression (OP)-free survival, and overall survival (OS) were assessed based on the treatment modality for the index nodule. Results: Of the 178 patients, 134 with 214 nodules underwent MWA, and 44 with 45 nodules underwent liver resection. The median follow-up period was 2.0±1.5 years. The annual incidence of LTP was 3.7% for MWA and 1.4% for liver resection. Treatment modality did not significantly affect LTP-free survival (hazard ratio, 0.61; 95% confidence interval, 0.14-2.69; P=0.511). For nodules larger than 3 cm, LTP-free survival was not affected by the treatment modality. Similarly, OP-free survival and OS were not influenced by treatment modality. Conclusions MWA and liver resection demonstrated comparable treatment outcomes in terms of local tumor control, overall recurrence, and survival. MWA may be an alternative treatment option for select patients; however, further studies are necessary to generalize these findings.

Background: Metabolic syndrome (MetS) refers to a group of risk factors that cause health problems, such as obesity, diabetes, dyslipidemia, and hyperglycemia. MetS is characterized by insulin resistance, which leads to abnormal insulin sensitivity. Cirsium japonicum var. maackii (CJ) is perennial herbaceous species found in Asia that exhibits antioxidant, antidiabetic, antitumor, antifungal, and anti-inflammatory activities. In this study, we aimed to measure the effects of CJ on MetS by improving insulin resistance in a db/db type 2 diabetes mouse model. After administrating CJ extract (CJE) for db/db mouse for 6 weeks, we measured with the evaluation of Insulin resistance, lipid profiles, histological analysis of liver, damage of liver and kideny. Results: The results showed that CJE was effective in reducing body weight and fat mas and showed a positive effect on lowering blood glucose and improving insulin sensitivity. CJE improved dyslipidemia by increasing serum-HDL levels and decreasing serum-LDL levels. In addition, CJE reduced liver and kidney damage in histological analysis. Conclusions These results demonstrate the anti-diabetic effects of CJE and suggest its potential for improving MetS.Therefore, CJE may have potential values as a functional food material for managing MetS.

Purpose: Pulmonary hypertension (PH) associated with bronchopulmonary dysplasia presents a significant clinical challenge in premature infants, often complicated by concurrent patent ductus arteriosus (PDA). The absence of age-specific treatments complicates disease management and outcome optimization. This study aimed to evaluate the impact of PH and PDA on mortality in premature infants and assess treatment outcomes of various treatment modalities, including pharmacological and procedural interventions. Methods: This retrospective cohort study included 1,708 premature infants (born at <37 weeks of gestation) treated at Jeonbuk National University Children’s Hospital between January 2013 and August 2023. All infants included in the analysis underwent echocardiographic evaluation. Patients were grouped based on PH and PDA diagnoses, and clinical outcomes, such as mortality, were compared. Statistical analyses, including receiver operating characteristic curves and logistic regression, were conducted. Results: PH and PDA were diagnosed in 46 (2.7%) and 257 (15.0%) patients, respectively. Patients with PH had lower mean gestational ages and birth weights than those of patients with PDA. The mortality rates were 21.7% in patients with PH and 8.2% in those with moderate-to-large PDA. Multivariate analysis identified PH as a significant predictor of mortality. There were no significant differences in mortality between the PDA-treated and untreated groups. Although iloprost use was initially associated with increased mortality, this association was not statistically significant after adjusting for gestational age and birth weight Conclusion PH significantly impacts mortality in premature infants, highlighting the need for early diagnosis and tailored treatments. Continued research is pertinent for enhancing outcomes and the quality of care.

Background/Aims: This study aimed to evaluate the impact of steatotic liver disease severity on the cumulative incidence of lung cancer utilizing data from the Korea National Health Insurance Service (NHIS). Methods: This study examined the risk of lung cancer in the general population in conjunction with the incidence of steatotic liver disease. The study population consisted of 3,261,438 individuals aged 20 years or older who underwent a general health examination in 2009. Results: Individuals with fatty liver index (FLI) of 30–59 exhibited a 1.08-fold increased risk of lung cancer (95% CI: 1.04–1.11), while FLI ≥ 60 was associated with a 1.22-fold elevated risk of lung cancer (95% CI: 1.17–1.28) compared to those with FLI < 30. The risk varied with smoking status; in current smokers, the adjusted HR for the FLI 30–59 group was 1.05 (95% CI: 1.00–1.10), while that in the FLI ≥ 60 group was 1.11 (95% CI: 1.04–1.18). In never- or past-smokers, the adjusted HR for the FLI 30–59 group was 1.10, and that for the FLI ≥ 60 group was 1.31. Subgroup analysis revealed an incidence rate of 1.06 per 1,000 person-years in the consistently high FLI group compared to 1.15 in those with improved FLI. Improving FLI over time was associated with a 0.93-fold decrease in lung cancer risk. Conclusions Our study demonstrated a correlational relationship between lung cancer incidence and the severity of steatotic liver disease as measured by FLI.

Purpose: The COVID-19 (coronavirus disease 2019) pandemic led to significant changes in clinical clerkships, including reduced ward rounds. We aimed to determine how the pandemic–induced changes in the clinical practice environment affect the clinical performance of medical students. Methods: We analyzed objective structured clinical examination scores of third- and fourth-year medical students from 2019–2020 and 2020–2021 across six stations by the Seoul–Gyeonggi Consortium. Clinical, communication, and ability scores were measured and analyzed using repeated-measures multivariate analysis of variance. Results: The interaction between clinical practice progress and pandemic-induced changes significantly affected physical examination and medical history scores, though the differences were not substantial. Patient-physician interaction significance varied by measurement period. Clinical communication ability also showed significant differences based on the measurement period and practical experience. Conclusion During the pandemic, alternative learning methods, including self–learning, simulation/practice, and peer role–play, helped improve medical competency in areas such as history–taking and physical examination. However, these were less effective in improving patient–physician interactions or clinical communication efficacy. Alternative learning methods have limitations, and they cannot replace direct patient encounters in clinical practice.

Background: Osteoporosis is a significant public health issue in aging populations. Despite advances in pharmacotherapy, underdiagnosis and undertreatment remain prevalent even in patients with recent fractures. This study examined 20-year trends (2002– 2022) in anti-osteoporotic medication (AOM) usage in South Korea. Methods: Data from the Korean National Health Information Database were retrospectively analyzed. The study included individuals aged ≥50 years and analyzed prescription trends, medication adherence, measured by the medication possession ratio (MPR), and treatment initiation rates post-fracture. The AOMs examined included bisphosphonates, selective estrogen receptor modulators, denosumab (DMAB), teriparatide (TPTD), and romosozumab (ROMO). Results: Over two decades, AOM use has shifted significantly from oral to injectable formulations, with injectables surpassing oral medications in 2020; from 397,440 prescriptions in 2016 to 1,162,779 in 2022. Prescriptions for DMAB surged following its approval as a first-line therapy in 2019, increasing 2.65 times from 217,606 in 2019 to 575,595 in 2022. The MPR improved from 35.4% in 2003 to 73.2% in 2021, with females demonstrating higher adherence than males. Post-fracture treatment rates increased from 31.1% in 2006 to 39.9% in 2021 but remained below 50%. Vertebral fractures had the highest treatment initiation rates, while anabolic agents, such as TPTD and ROMO were underprescribed despite their efficacy. Conclusions This 20-year analysis highlights significant progress in osteoporosis management in South Korea, including a shift towards injectable therapies and improved adherence. However, the persistent undertreatment of high-risk patients underscores the requirement for enhanced access to anabolic agents, clinician education, and policy reforms to optimize post-fracture care.

Background/Aims: This study aimed to evaluate the performance of the Model for End-Stage Liver Disease (MELD) 3.0 for predicting mortality and liver-related complications compared with the Child-Pugh classification, albumin-bilirubin (ALBI) grade, the MELD, and the MELD sodium (MELDNa) score. Methods: We evaluated a multicenter retrospective cohort of incorporated patients with cirrhosis between 2013 and 2019. We conducted comparisons of the area under the receiver operating characteristic curve (AUROC) of the MELD3.0 and other models for predicting 3-month mortality. Additionally, we assessed the risk of cirrhosis-related complications according to the MELD3.0 score. Results: A total of 3,314 patients were included. The mean age was 55.9±11.3 years, and 70.2% of the patients were male. Within the initial 3 months, 220 patients (6.6%) died, and the MELD3.0had the best predictive performance among the tested models, with an AUROC of 0.851, outperforming the Child-Pugh classification, ALBI grade, MELD, and MELDNa. A high MELD3.0score was associated with an increased risk of mortality. Compared with that of the group with a MELD3.0 score <10 points, the adjusted hazard ratio of the group with a score of 10–20 pointswas 2.176, and that for the group with a score of ≥20 points was 4.892. Each 1-point increase inthe MELD3.0 score increased the risk of cirrhosis-related complications by 1.033-fold. The risk of hepatorenal syndrome showed the highest increase, with an adjusted hazard ratio of 1.149, followed by hepatic encephalopathy and ascites. Conclusions The MELD3.0 demonstrated robust prognostic performance in predicting mortality in patients with cirrhosis. Moreover, the MELD3.0 score was linked to cirrhosis-related complications, particularly those involving kidney function, such as hepatorenal syndrome and ascites.

Purpose: Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) are increasingly used as initial therapies for brain metastases (BM). We aimed to assess the outcomes of SRS/FSRT in patients aged ≥ 65 years who had 1-10 BM from non–small cell lung cancer (NSCLC). Materials and Methods: We retrospectively reviewed 91 elderly NSCLC patients with 222 BM who were treated with SRS/FSRT at two institutions between 2010 and 2020. The primary endpoint was overall survival (OS) after SRS/FSRT. In addition, in-field local control (IFLC) within the treated field was evaluated. Statistical analysis was performed to identify the prognostic factors affecting OS and IFLC. Results: During a median follow-up of 18 months, the median OS was 32 months. The 1- and 2-year survival rates were 69.8% and 56.1%, respectively. In multivariate analysis, the NSCLC-specific graded prognostic assessment (GPA) score (p=0.007) and administration of systemic therapy (p=0.039) were defined as prognosticators affecting OS. The median IFLC period was 31 months, and the 1- and 2-year IFLC rates were 75.9% and 57.6%, respectively. The total BM volume (p=0.042) significantly affected IFLC. No severe adverse events were reported after SRS/FSRT. Conclusion SRS/FSRT is an effective upfront treatment option for BM arising from NSCLC in elderly patients, with a good OS without severe side effects. Higher GPA score and active systemic treatment were associated with improved OS, indicating that elderly patients are significant candidates for SRS/FSRT.