Purpose: To evaluate the feasibility of robot-assisted ureteral reconstruction as a minimally invasive alternative to open surgery for managing ureteric complications in transplanted kidneys. Materials and Methods: From January 2020 to December 2023, robot-assisted ureteral reconstruction was performed on fifteen kidney transplant patients with vesicoureteral reflux (VUR) or ureteral stricture who had previously failed endoscopic treatments. Results: Twelve females and three males, with a mean age of 48.6±6.6 years, were included in the study. Nine patients (60.0%) underwent surgery due to VUR (grade III or higher) of the transplanted kidney, and six patients (40.0%) had transplanted ureteral strictures. Postoperative voiding cystourethrogram (VCUG) was performed at 3.2±1.6 months. Seven patients (77.8%) became VUR-free, while two patients (22.2%) had VUR regression from grade IV to I. All six patients who underwent reconstruction due to anastomosis site stricture became stenosis-free without the need for an indwelling ureteral catheter. In cases where the ureter was too short for reimplantation, a Boari flap or end-to-end anastomosis with the native ureter was performed. The mean hospital stay was 5.9±4.5 days. The urethral catheter was removed after 15.1±5.4 days, and the ureteral catheter was removed after 4.9±1.5 weeks. The mean follow-up period was 23.9±6.8 months, with no additional interventions required after surgery. No complications above Clavien-Dindo grade I were recorded. Conclusions Robotic ureteral reconstruction is technically feasible and offers an effective, minimally invasive treatment for ureteric complications in kidney transplant patients, serving as an alternative to open surgery.

Purpose: To compare encrustation resistance between silicon- and polytetrafluoroethylene (PTFE)-covered metallic ureteral stents (MUS) in an in vitro infection model and to determine the most effective material for reducing biofilm formation and encrustation. Materials and Methods: A total of 52 MUS were prepared: 26 silicon-covered and 26 PTFE-covered stents. Each sample was immersed in artificial urine inoculated with Proteus mirabilis in a biofilm reactor for 48 hours. After immersion, the stents were weighed to measure their encrustation level. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to assess the surface morphology and elemental composition of the encrustation deposits. Results: Silicon-covered stents showed a statistically significant reduction in weight gain due to encrustation compared to PTFE-co­vered stents (9.50±5.77 mg vs. 16.75±10.61 mg; p=0.004). Additionally, encrustation per unit length was lower in silicon-covered stents (0.76±0.45 mg/mm vs. 1.30±0.81 mg/mm; p=0.004). SEM and EDS analyses demonstrated lower calcium salt deposition on the silicon-co­vered stents, indicating greater resistance to encrustation. Conclusions Silicon-covered MUS demonstrated superior resistance to encrustation compared to PTFE-covered stents, supporting silicon as a more suitable covering material for long-term MUS applications. This finding may lead to extended stent lifespans and a reduced frequency of stent replacements, benefiting both patients and healthcare systems.

Background: This study focuses on the development of a hydrogel wound patch incorporating natural extracts, designed to function as a sun patch. By maintaining a moist environment and delivering bioactive compounds, the patch promotes wound healing while also providing cooling and ultraviolet (UV) protection. This dual-purpose approach enhances skin recovery and shields damaged areas from external stressors. The study aims to optimize the formulation and evaluate its efficacy for both therapeutic and cosmetic applications. Methods: Hydrogel solutions prepared using acrylamide, glycerol, and carboxymethyl cellulose were enriched with extracts from Saururus chinensis, Styrax japonicus, and Centella asiatica. The enriched solutions were processed into patches and tested for their adhesion, cooling effects, and UV protective abilities. Additionally, the wound healing efficacy was evaluated in a mouse model. Results: The hydrogel patches demonstrated comparable adhesion properties, effective skin cooling, and high UV protection rates similar to those of commercially available products. In the mouse model, the patches significantly improved wound closure and tissue regeneration in the experimental group as compared to the control group. Conclusion The study confirms that hydrogel sun patches enriched with natural extracts have the ability to effectively promote wound healing and offer substantial UV protection and cooling benefits, demonstrating their potential medical and cosmetic applications.

Carpal tunnel syndrome (CTS) is a common form of hand mononeuropathy that is typi-cally caused by median nerve compression. Although it is often idiopathic, CTS can also result from various conditions, including space-occupying lesions. Tumoral calcinosis, a rare condition characterized by periarticular deposition of calcified masses, is an un-common cause of secondary CTS. We present a case of a 78-year-old woman with idio-pathic tumoral calcinosis that caused secondary CTS. Despite conservative treatments, her symptoms persisted, and diagnostic imaging, including radiographs, computed to-mography, and magnetic resonance imaging, revealed a calcified mass in the carpal tun-nel. A surgical intervention involving carpal tunnel release and excisional biopsy con-firmed the diagnosis of tumoral calcinosis. Postoperatively, the patient showed complete resolution of symptoms, with no recurrence on follow-up radiographs. This case high-lights the importance of considering space-occupying lesions, such as tumoral calcinosis, as a rare but treatable cause of secondary CTS.

Background: The tibiofibular syndesmosis is essential for preserving the stability of the ankle. Acute syndesmotic injuries with evident or latent instability usually warrant surgical interventions. This cadaveric study examines and compares biomechanical characteristics between the following treatments for syndesmosis injuries: suture-button fixation plus syndesmotic repair and screw fixation. Methods: The lower extremities of 10 cadavers disarticulated at the knee joints were used, yielding 20 feet. Ten feet underwent surgery using the suture-button fixation with syndesmotic repair, while the remaining 10 feet underwent surgery using screw fixation. Before surgical treatment of syndesmosis injuries, each cadaveric lower limb underwent preliminary physiological cyclic loading, which was followed by a series of postfixation cyclic loading tests after the surgical procedure. Results: Our principal finding is that suture-button fixation with syndesmotic repair provided torsional strength comparable to that of screw fixation. The mean failure torque did not differ between the 2 groups, but the rotational stiffness was significantly lower in the suture-button fixation/augmentation group. Conclusions Suture-button fixation/augmentation facilitates flexible (physiological) syndesmosis movement and may be a useful alternative treatment for ankle syndesmosis injury.

Background: This study explores effective fixation methods for Pauwel type III femoral neck fractures by evaluating the biomechanical benefits of adding a screw to the Femoral Neck System (FNS). Methods: Computed tomography (CT) scans of an 82-year-old female patient with an intertrochanteric fracture were used to establish a finite element femur model with heterogeneous material properties. Finite element models of Pauwel type III fractures were created with and without an additional screw. The central and inferior trajectories of the FNS bolt were examined separately and combined with an additional screw for virtual fixation. Walking and stair-climbing loads were applied. Results: With the addition of a screw, both peak maximum and minimum principal strains consistently stayed comparable or decreased in models with both central and inferior bolt trajectories, while the volume of elements with principal strain exceeding 1% decreased by more than half. The peak von Mises stress observed in the implants ranged from 215.7 to 359.3 MPa, remaining below the titanium alloy's yield strength of 800 MPa. For normal walking, the addition of a screw to the central bolt trajectory model decreased the fracture gap by 50.6% and reduced sliding distance by 8.6%. For the inferior bolt trajectory, the gap was reduced by 57.9% and sliding distance by 25.0%.Under stair-climbing conditions, these improvements were also evident; the central trajectory model saw a halved fracture gap and a 7.9% decrease in sliding distance, while the inferior trajectory model experienced a 55.7% gap reduction and a 27.2% decrease in sliding distance. The additional screw increased the area ratio of the fracture site experiencing interfragmentary compression 34%–39%, while the additional screw alleviated peak interfragmentary compression by 12%–18% under both normal walking and stair-climbing conditions. Conclusions The addition of a screw reduced the fracture gap, sliding distance, and peak interfragmentary compression, while increasing the area ratio of interfragmentary compression under both walking and stair-climbing loads, regardless of the FNS bolt trajectory, suggesting a better mechanical environment for fracture healing.

Background: The removal of a well-fixed acetabular cup is a challenging, labor-intensive, and time-consuming step during revision hip arthroplasty. Although the advent of the manual osteotome, Explant, has simplified the procedure, it is still a stressful process as it dissipates the surgeon’s strength and time and risks an iatrogenic pelvic fracture. Recently, EZX, a powered tool for extraction of well-fixed acetabular cups with semicircular blade was invented. This study aimed to compare Explant and EZX in an experimental condition for their efficacy and safety. Methods: Cementless acetabular cups were press-fitted to 20 hemipelvic polyurethane models using foam adhesives. Ten cups were removed with each tool for comparison of the elapsed time, loads on the entire hemipelvis, periacetabular strain and temperature, volume of periacetabular bone removed, and diameter of the remaining acetabular rim. Strains and loads were quantitatively assessed using strain gauges and load cells for precise and reliable measurements. Results: The mean duration required to remove a well-fixed cup with EZX was 38.5 seconds (range, 25–55), whereas that with Explant was 543.7 seconds (range, 214–1,051) (p < 0.001). The load on the entire hemipelvis with EZX (mean, 9.1 kgf; range, 6.4–11.3) was 33% lower than that with Explant (mean, 13.6 kgf; range, 9.2–17.1) (p < 0.001). The periacetabular peak strains at the 3 positions with EZX were significantly lower than those with Explant (p < 0.001). The temperature during the removal did not differ significantly between the 2 tools. Although the mean volume of bone loss with Explant was 2.4 mL more than that with EZX (p < 0.001), the mean diameters of the remaining acetabular rim were not significantly different, measuring 54.1 mm with both tools. Conclusions The present experiment revealed that a well-fixed cup could be removed using a powered tool with less strength and time and less load on the entire pelvis. Although the powered tool removed a larger volume of bone, the diameters of the remaining acetabular rims were equivalent. This tool may help surgeons remove well-fixed cups in a short time and reduce the deforming load on the bone around the cup without increasing the size of the subsequent reconstruction cup.

Background: and Purpose: Plasma biomarkers, including phosphorylated tau (ptau217), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL), are promising tools for detecting Alzheimer’s disease (AD) pathology. However, cross-laboratory reproducibility remains a challenge, even when using identical analytical platforms such as single-molecule array (Simoa). This study aimed to compare plasma biomarker measurements (ptau217, GFAP, and NfL) between 2 laboratories, the University of Gothenburg (UGOT) and DNAlink, and evaluate their associations with amyloid positron emission tomography (PET) imaging. Methods: Plasma biomarkers were measured using Simoa platforms at both laboratories:the UGOT and DNAlink Incorporation. Diagnostic performance for predicting amyloid PET positivity, cross-laboratory agreement, and the impact of normalization techniques were assessed. Bland-Altman plots and correlation analyses were employed to evaluate agreement and variability. Results: Plasma ptau217 concentrations exhibited strong correlations with amyloid PET global centiloid values, with comparable diagnostic performance between laboratories (area under the curve=0.94 for UGOT and 0.95 for DNAlink). Cross-laboratory agreement for ptau217 was excellent (r=0.96), improving further after natural log transformation. GFAP and NfL also demonstrated moderate to strong correlations (r=0.86 for GFAP and r=0.99 for NfL), with normalization reducing variability. Conclusions Plasma biomarker measurements were consistent across laboratories using identical Simoa platforms, with strong diagnostic performance and improved agreement after normalization. These findings support the scalability of plasma biomarkers for multicenter studies and underscore their potential for standardized applications in AD research and clinical practice.

Background: and Purpose: This clinical practice guideline provides evidence-based recommendations for treatment of dementia, focusing on cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists for Alzheimer’s disease (AD) and other types of dementia. Methods: Using the Population, Intervention, Comparison, Outcomes (PICO) framework, we developed key clinical questions and conducted systematic literature reviews. A multidisciplinary panel of experts, organized by the Korean Dementia Association, evaluated randomized controlled trials and observational studies. Recommendations were graded for evidence quality and strength using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Three main recommendations are presented: (1) For AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) are strongly recommended for improving cognition and daily function based on moderate evidence; (2) Cholinesterase inhibitors are conditionally recommended for vascular dementia and Parkinson’s disease dementia, with a strong recommendation for Lewy body dementia; (3) For moderate to severe AD, NMDA receptor antagonist (memantine) is strongly recommended, demonstrating significant cognitive and functional improvements. Both drug classes showed favorable safety profiles with manageable side effects. Conclusions This guideline offers standardized, evidence-based pharmacologic recommendations for dementia management, with specific guidance on cholinesterase inhibitors and NMDA receptor antagonists. It aims to support clinical decision-making and improve patient outcomes in dementia care. Further updates will address emerging treatments, including amyloid-targeting therapies, to reflect advances in dementia management.

Purpose: Treatment options for hepatocellular carcinoma (HCC) vary according to known guidelines among liver resection (LR), liver transplantation (LT), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). This study aimed to compare the outcomes of initial treatment for patients with resectable HCC within Milan criteria (MC) via nationwide data. Methods: Patients with resectable HCC (Child-Pugh class A; platelet count, ≥100,000/μL) within MC from the Korean Liver Cancer Association databank were analyzed, retrospectively. Outcomes according to initial treatment and subgroups according to tumor size and number were analyzed. Overall survival (OS) rates after initial treatment were compared. Results: A total of 3,241 patients who underwent LR (n = 1,371), LT (n = 12), RFA (n = 679), or TACE (n = 1,179) were included. The 5-year OS rates differed significantly between the groups (P < 0.05), except for LT (LR, 84.9%; LT, 82.5%;RFA, 76.2%; and TACE, 59.9%). For patients with a single tumor of any size, the 5-year OS rates of the LR group were significantly higher than RFA and TACE groups. For patients with multiple tumors, the 5-year OS rates were 78.2%, 100%, 74.3%, and 53.0% for the LR, LT, RFA, and TACE groups, respectively, but without significant difference between LR and RFA (P = 0.86). Conclusion For resectable HCC within MC, the LR had the highest OS rate for a single tumor of any size. LR and RFA showed no significant differences in OS rate for multiple tumors. LR has a much more optimistic outlook for HCC within MC.