Vertebral artery (VA) occlusion is often managed conservatively, but anterior spinal artery (ASA) involvement may cause rapid neurological deterioration. We report two contrasting cases of VA occlusion with ASA compromise. One patient achieved complete recovery after timely endovascular treatment (EVT) restoring ASA flow, whereas the other developed severe bilateral medial medullary infarctions following unsuccessful EVT. These cases highlight the prognostic importance of ASA involvement and suggest that EVT should be considered when ASA perfusion is threatened.

Background: Environmental contamination with multidrug-resistant organisms (MDROs), including carbapenem-resistant Acinetobacter baumannii (CRAB) and multidrug-resistant Pseudomonas aeruginosa (MRPA), remains a major challenge in healthcare facilities.Hypochlorous acid water (HOCl) has emerged as a promising disinfectant owing to its strong antimicrobial activity and favorable safety profile. This study aimed to evaluate the bactericidal efficacy of atomized HOCl against CRAB and MRPA in a hospital room. Methods: An atomization experiment was conducted in a two-bed room. CRAB and MRPA were prepared using drying and non-drying methods, respectively. HOCl (CLFine) at concentration of 40 and 300 ppm was atomized using ultrasonic humidifiers. Bacterial samples were collected at 0, 1, 3, and 5 h after atomization. Viable bacterial counts were determined by culture, and bactericidal efficacy was evaluated. Results: Atomized HOCl exhibited time- and concentration-dependent bactericidal effects against CRAB and MRPA. CRAB and MRPA reached their limits of detection at 3 and 5 h postatomization at 40 ppm, and at 1 and 3 h at 300 ppm, respectively. Conclusion Atomized HOCl effectively inactivated CRAB and MRPA in a hospital room within 3–5 h. These findings support the potential application of HOCl atomization as an adjunctive environmental disinfection strategy for controlling MDRO contamination in healthcare facilities.

Objective: To evaluate the effects of reduced kVp and reduced iodinated contrast volume on radiation dose and image quality in canine abdominal CT. Methods: A phantom study (0%–10% iodine dilutions) at 120, 100, and 80 kVp quantified the relationship between iodine concentration and CT attenuation. Eight healthy Beagle dogs underwent multiphase abdominal CT at 120, 100, and 80 kVp (1-week intervals) with weightbased contrast volumes adjusted using phantom-derived slope ratios. Radiation output (CTDIvol , dose-length product) and quantitative image quality (attenuation, background noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) were assessed, along with blinded qualitative scoring by 2 readers. Results: Compared with 120 kVp, CTDIvol decreased by 41% at 100 kVp and 74% at 80 kVp, with similar proportional decreases in dose-length product. Lower kVp increased iodinerelated attenuation, permitting iodine-dose reductions (17% at 100 kVp; 34% at 80 kVp).Quantitative noise increased and SNR decreased at 80 kVp, particularly in delayed-phase images; qualitative noise scores were significantly worse at 80 kVp, whereas overall qualitative image quality did not differ across protocols. Conclusions and Relevance: In dogs, a 100 kVp protocol reduced radiation output and iodine dose while maintaining diagnostic image quality, supporting 100 kVp as a practical optimization strategy for clinical abdominal CT.

Objective: To investigate prevalence of BLV and its association with hematological alterations in targeted dairy farms experiencing productivity issues in Korea. Methods: This study investigated five dairy farms reporting decreased milk yield, recurrent mastitis, poor conception rates, and delayed postpartum recovery. Eighty lactating cows underwent physical examination, body condition scoring, hematological and biochemical analyses, and polymerase chain reaction testing for BLV. Results: Overall BLV detection rate among these herds was 70% (56/80), with intra-herd positivity ranging from 57.1 to 90.0%. Lymphocytosis was observed in 31% of the cows.Multivariable generalized estimating equations analysis confirmed that higher lymphocyte counts were the strongest independent predictor of BLV status (adjusted odds ratio, 2.70;p = 0.005), demonstrating a robust association between hematological alterations and BLV positivity. Conclusions and Relevance: BLV infection is highly prevalent in the investigated Korean dairy farms with productivity problems. While these results may not represent the nationwide average due to selection bias, they emphasize the need for nationwide BLV surveillance and implementation of control measures in Korea.

Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.

Background: and Purpose Parkinson’s disease (PD) significantly impacts the quality of life via both motor and nonmotor symptoms. Exercise is a valuable nonpharmacological intervention that can alleviate PD symptoms and slow disease progression. Understanding the factors that motivate and restrict exercise in PD patients is essential for promoting engagement.This study aimed to identify the motivators and barriers affecting exercise in PD patients. Methods: This cross-sectional study assessed exercise habits, motivators, and barriers among PD patients with a modified Hoehn and Yahr stage of ≤2.5. Participants were categorized into non-, low-, and high-exercise groups based on the World Health Organization guidelines. The International Physical Activity Questionnaire, the Korean version of the Sport Motivation Scale, and a barriers-to-exercise questionnaire were utilized. Results: Data from 165 of 196 enrolled patients were analyzed: 28 (17.0%), 88 (53.3%), and 49 (29.7%) in the non-, low-, and high-exercise groups, respectively. The nonexercise group demonstrated higher levels of fatigue and apathy, and more-severe cardiovascular, mood, intellectual, attention, gastrointestinal, and urinary symptoms. While all groups recognized the benefit of exercise, those in the nonexercise group viewed PD symptoms and depressive mood as major barriers, whereas those in the high-exercise group were primarily motivated by personal satisfaction. Conclusions This study highlights the importance of enjoyment and personal satisfaction to the maintenance of exercise habits among PD patients. By enhancing specific motivators and overcoming barriers, particularly PD symptoms and related nonmotor symptoms, tailored interventions can be implemented to increase exercise adherence and, eventually, improve the quality of life of PD patients.

Purpose: This study aimed to assess the impact of aerobic exercise at different intensities over an eight-week period on the expression and activation of cortical synaptic proteins, with the potential to reduce anxiety and improve memory in young mice. Methods: Seven-week-old C57BL/6 mice were subjected to treadmill exercises at low (n = 10), moderate (n = 10), and high intensity (n = 10) for eight weeks. Behavioral assessments were conducted to evaluate anxiety and cognitive function. To explore the underlying mechanisms, we measured the phosphorylated levels of extracellular signal-regulated kinase (ERK), cyclic adenosine monophosphate response-binding protein (CREB), protein kinase (AKT), adenosine monophosphate activated protein kinase (AMPK), synapsin (S9, S549, S609), and PSD-95 in the cortex, as these are associated with synaptic strength. Additionally, the expression of doublecortin (DCX), a neurogenic factor, was analyzed in the hippocampus. Results: Exercise led to reductions in depressive and anxiety-related behaviors and elevated the levels of phosphorylated ERK, CREB, AKT, AMPK, synapsin (S9, S549, S609), and PSD-95 in the cortex of young mice. Furthermore, exercise increased DCX expression in the hippocampus. Moderate-intensity exercise yielded more pronounced effects than other intensities. Conclusion The findings of this research indicate that consistent moderate-intensity exercise increases synaptic strength and reduces depression and anxiety in young mice by activating multiple factors.

The utilization of health insurance claims data has expanded significantly, enabling researchers to conduct epidemiological studies on a large scale. This review examines key statistical methods for addressing baseline differences and conducting cohort analyses using Korean National Health Insurance claims data. Propensity score matching and inverse probability of treatment weighting are widely used to mitigate selection bias and enhance causal inference in observational studies. These methods help improve study validity by balancing covariates between treatment and control groups. Additionally, survival analysis techniques, such as the Cox proportional hazards model, are essential for assessing time-toevent outcomes and estimating hazard ratios while accounting for censoring. However, the application of these statistical methods is accompanied by challenges, including unmeasured confounding, instability in weight estimation, and violations of model assumptions.To address these limitations, emerging approaches, such as Doubly robust estimation, machine learning-based causal inference, and the marginal structural model, have gained prominence. These techniques offer greater flexibility and robustness in real-world data analysis. Future research should focus on refining methodologies for integrating highdimensional health datasets and leveraging artificial intelligence to enhance predictive modeling and causal inference. Furthermore, the expansion of international collaborations and the adoption of standardized data models will facilitate large-scale multi-center studies.Ethical considerations, including data privacy and algorithmic transparency, should also be prioritized to ensure responsible data use. Maximizing the utility of health insurance claims data requires interdisciplinary collaboration, methodological advancements, and the implementation of rigorous statistical techniques to support evidence-based healthcare policy and improve public health outcomes.

Purpose: We present a case of equatorial and posterior zonular weakness observed during cataract surgery in both eyes with no prior history of trauma or surgery.Case summary: A 73-year-old woman visited out clinic and reported decreased visual acuity. She was found to have a best corrected visual acuity of 0.5 in both eyes. Cataracts were noted during a slit lamp examination and cataract surgery was subsequently performed. During the left eye surgery, although there was no evident weakening during the anterior capsulotomy, the equatorial and posterior zonules were damaged during phacoemulsification. This led to consistent aspiration of the equatorial and posterior capsule (PC) into the phaco-handpiece tip during epinucleus and cortex removal. The PC eventually ruptured necessitating anterior vitrectomy and a 3-piece intraocular lens insertion into the ciliary sulcus. Two weeks later, the right eye surgery encountered similar challenges in removing the epinucleus and cortex. The surgery was completed successfully by elevating the irrigation bottle, frequently injecting an ophthalmic viscoelastic device (OVD), and removing the remaining lens material using a bimanual irrigator/aspirator. Conclusions This case highlights that equatorial and posterior zonular weakness can occur in the absence of trauma or prior to surgery. To manage such cases, it is advisable to elevate the irrigation bottle height, continuously inject OVD during surgery, and use a bimanual irrigator/aspirator.