Objective: This study aimed to compare aneuploidy rates and clinical outcomes between trophectoderm biopsy at fresh blastocyst (biopsy-fresh) followed by vitrification and biopsy at vitrified-warmed blastocyst (biopsy-vitri) followed by next day transfer (without re-vitrification). Methods: This retrospective study included 844 patients undergoing 844 cycles conducted from August 2019 to December 2023. Preimplantation genetic testing for aneuploidy (PGT-A) was performed via trophectoderm biopsy using array comparative genomic hybridization or next-generation sequencing for comprehensive 24-chromosome screening. Patients were divided into two groups based on the blastocyst status at the time of biopsy: the biopsy-fresh group (531 patients) and the biopsy-vitri group (313 patients). Results: The clinical pregnancy rate was significantly higher in the biopsy-fresh group compared to the biopsy-vitri group (58.7% vs. 45.6%; odds ratio [OR], 1.695; 95% confidence interval [CI], 1.215 to 2.364; p=0.002). Furthermore, the biopsy-fresh group showed higher implantation rates (45.6% vs. 32.1%; OR, 1.767; 95% CI, 1.274 to 2.451; p=0.002), ongoing pregnancy or live birth rates per cycle (48.0% vs. 35.8%; OR, 1.652; 95% CI, 1.177 to 2.319; p=0.004), and rates of good-quality blastocysts (57.1% vs. 32.1%, p<0.001) compared with the biopsy-vitri group. Miscarriage rates did not differ significantly between the groups (18.2% vs. 21.4%; OR, 0.818; 95% CI, 0.457 to 1.465; p=0.501). Conclusion Biopsy at fresh blastocyst demonstrated superior clinical outcomes compared with biopsy at vitrified-warmed blastocyst, likely due to better embryo quality. Both biopsy at fresh blastocyst and vitrified-warmed blastocyst remain viable options for PGT-A, with biopsy at vitrified-warmed blastocyst serving as a practical alternative. Embryo quality and euploid status continue to be critical considerations for embryo transfer selection.

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: Although several reports have addressed tendinous mallet finger (TMF), they have not identified which method best informs surgeons about the extent of residual extension lag in these patients. We aimed to assess the association between sonographic classification of acute TMF and the degree of extension lag remaining at the final follow-up. Methods: The inclusion criterion was acute TMF with symptom onset within 2 weeks. Thirty-eight patients (23 male and 15 female) participated, with a mean follow-up of 17.1 months (range, 12.3–23.5 months). Range of motion, including extension lag, was measured at both the initial presentation and the final follow-up. All patients were managed conservatively using a finger splint for a period exceeding 6 weeks. Ultrasonography was performed for all participants to assess the severity of terminal extensor tendon injury. Statistical analyses examined the relationship between sonographic type and extension lag at final follow-up. Results: At initial presentation, the mean extension lag was 46.0°, which improved to 17.5° at the last follow-up. TMF cases were categorized into 3 sonographic types (hypo-echoic, thinned, and wavy) based on ultrasound characteristics. A significant difference in extension lag at final follow-up was observed among the TMF groups (p = 0.005). Patients with the wavy type had the greatest mean extension lag, whereas those with the hypo-echoic type had the least mean extension lag, with statistical significance. Conclusions Sonographic assessment of TMF can aid in predicting residual extension lag in patients with TMF undergoing conservative treatment with a finger splint.

Background: and Purpose: To assess the long-term effectiveness, safety, and economic viability of recently approved Alzheimer’s disease (AD) therapies, as well as to evaluate the real-world application of novel diagnostics among AD patients with diverse comorbidities, comprehensive real-world data (RWD) analysis is essential. The Korean JOint RegistrY for ALZheimer’s Treatment and Diagnostics (JOY-ALZ) endeavors to create a registry of RWD derived from clinical practice on new diagnostic methods and therapeutic agents for AD introduced in Korea since 2021. Methods: Participants must fulfill all the following: 1) be at least 19 years old; 2) be actively receiving, scheduled to initiate, or undergoing evaluation for any AD disease-modifying treatment; 3) have completed amyloid positron emission tomography or cerebrospinal fluid AD immunoassay (a positive result is not essential for participation); 4) have a clinical classification of cognitively unimpaired, mild cognitive impairment, or probable AD dementia. Data generated during routine care is segmented into a minimum dataset, extended dataset, and research-only dataset requiring extra consent. Assessments encompass clinical, cognitive, functional, neurobehavioral, neuroimaging, and biomarker evaluations, in addition to systematic monitoring of new AD treatments and their safety.Data are collected and monitored at baseline, at semiannual intervals during the initial 2 years, and then annually up to 2034. To date, 46 medical centers will participate in JOY-ALZ. Conclusions JOY-ALZ is expected to promote understanding of the long-term clinical outcomes, safety, and cost-effectiveness of recently introduced diagnostics and treatments for AD, thereby supporting the progress of precision medicine in AD care and diagnosis.

Objectives: This study evaluated the feasibility of voice recognition-based electronic medical record (EMR) documentation for periodontal probing in dentistry, particularly emphasizing Korean-English bilingual speech patterns and real-world clinical conditions. Methods: Experiments were conducted in a dental chair setting during routine clinical hours. Environmental noise levels were measured, and two microphone types (stationary and pin-type) were evaluated. Periodontal probing phrases composed of three-digit numbers and positional terms were used for speech recognition. Consistent with common clinical practice in Korea, numerical values were spoken in Korean, whereas positional terms were spoken in English. Two speech-to-text application programming interfaces, Google Cloud Speech-to-Text and Naver Clova Speech Recognition, were assessed. Recognition accuracy was evaluated for both numerical components and complete bilingual phrases. Results: The mean environmental noise level was 60.65 dB and was minimally influenced by activity at adjacent dental chairs. The stationary microphone failed to capture speech effectively, whereas the pin-type microphone demonstrated stable recognition performance. For three-digit number recognition, accuracy was 88.3% with Google and 96.8% with Naver. For full-phrase recognition, complete matching was achieved in 36.7% of cases for Google and 52.5% for Naver. Partial recognition occurred more frequently for numerical components than for English positional terms. Conclusions Voice recognition-based EMR documentation for periodontal probing demonstrated preliminary feasibility in a dental clinical environment; however, performance was influenced by Korean-English bilingual speech patterns. These findings suggest that bilingual speech characteristics should be considered when implementing voice recognition systems in dental EMR workflows. Further optimization is required before routine clinical application.

Purpose: To investigate the association between metabolic syndrome (MetS) and nocturia in a nationally representative U.S. adult population, focusing on individual metabolic components and subgroup differences by age and sex. Materials and Methods: We analyzed data from 8,518 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2014. Nocturia was defined as ≥2 nighttime voids. MetS was defined by the presence of ≥3 National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to assess associations, adjusting for demographic and behavioral covariates. Results: Overall, 23.3% of participants had MetS and 29.6% reported nocturia. MetS was independently associated with nocturia (adjusted odds ratio [OR] 1.387, 95% confidence interval 1.236–1.557). A dose–response relationship was observed, with nocturia risk increasing. Central obesity (OR 1.564), elevated fasting glucose (OR 1.397), and elevated blood pressure (OR 1.311) showed the strongest associations. RCS analyses revealed linear associations for waist circumference and systolic blood pressure, and nonlinear associations for diastolic blood pressure and glucose. Sex-specific analyses revealed distinct nonlinear patterns, particularly for waist circumference among male participants and triglyceride levels among female participants. The association remained consistent across most age and sex groups, except in males aged 20–40 years. Conclusions MetS and its components are independently associated with nocturia. The observed sex-specific differences suggest that metabolic contributors to nocturia may differ by sex supporting nocturia as a potential clinical marker of underlying cardiometabolic dysfunction.

Background: and Purpose To compare the epidemiological and clinical features of the rare patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with age- and sex-matched controls in a nationwide cohort from South Korea. Methods: This observational cohort study analyzed newly diagnosed CADASIL patients aged at least 20 years and matched controls using data from the National Health Information Database for 2004–2022. The cumulative incidence of CADASIL was assessed by age and sex, and compared between regions. Neurologic and systemic diseases were compared between the CADASIL and control groups. Results: The study analyzed 816 CADASIL patients and 816 age- and sex-matched controls aged 56.8±15.2 years (mean±standard deviation), among whom 48.3% were male. The cumulative incidence of CADASIL was 1.86 per 100,000 people (95% confidence interval [CI]=1.85– 1.87 per 100,000), and peaked at 60–69 years of age. In terms of regional distribution, the incidence was highest for Jeju, at 39.67 per 100,000 (95% CI 37.84–41.49 per 100,000). Neurologic diseases were more frequent in CADASIL patients, including Alzheimer’s disease (33.1% vs.20.0%), vascular dementia (84.9% vs. 5.0%), epilepsy (34.6% vs. 15.9%), stroke (70.7% vs. 27.6%), parkinsonism (18.9% vs. 11.0%), and depression (60.8% vs. 44.9%). Systemic diseases such as diabetes mellitus (78.9% vs. 68.9%) were also more common in CADASIL patients, while cancer (27.9% vs. 38.7%) and myocardial infarction (10.0% vs. 13.6%) were less common than in controls. The onset ages of all diseases were lower in CADASIL patients. Conclusions This study has provided a precise nationwide estimate of the CADASIL incidence and its regional distribution in South Korea. CADASIL patients showed higher incidence rates and earlier onsets of diverse clinical manifestations.

Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

Objective: : This study investigated the relationship between arterial partial pressure of oxygen (PaO2) levels in the first 24 hours of intensive care unit (ICU) admission and clinical outcomes in neurocritically ill brain tumor patients. Methods: : In this single-center retrospective study of 2123 brain tumor patients, we analyzed PaO2 levels from arterial blood gas samples within 24 hours of ICU admission. The primary endpoint was 28-day mortality. Analysis utilized multivariable logistic regression and inverse probability of treatment weighting (IPTW). Results: : PaO2 exceeding 91.5 mmHg was defined as hyperoxia. The non-hyperoxia group showed higher 28-day mortality than the hyperoxia group (15.5% vs. 6.0%, p<0.002), a trend that persisted after IPTW adjustment (10.7% vs. 6.6%, p=0.019). In IPTW-adjusted regression, non-hyperoxia remained significant (adjusted odds ratio [OR], 3.24; 95% confidence interval [CI], 1.82–5.77). Survival analysis demonstrated significantly higher survival rates in the hyperoxia group (p<0.001). Subgroup analysis revealed significant heterogeneity across tumor types (p for interaction <0.001), with protective effects observed in malignant brain tumors (adjusted OR, 3.5; 95% CI, 1.88– 6.51) and brain metastases (adjusted OR, 3.86; 95% CI, 2.31–6.44), but not in benign tumors (adjusted OR, 1.14; 95% CI, 0.22–5.87). Conclusion : Elevated PaO2 levels within the first 24 hours of ICU admission were associated with decreased mortality rates, suggesting oxygenation as a potential therapeutic target in brain tumor patients. The protective effects were most pronounced in patients with malignant brain tumors and brain metastases, supporting a tumor type-specific approach to oxygenation management.