Purpose: Prostate cancer ranks as the second most common cancer in men globally, representing a significant cause of cancer-related mortality. Metastasis, the spread of cancer cells from the primary site to distant organs, remains a major challenge in managing prostate cancer. Pyruvate dehydrogenase kinase 4 (PDK4) is implicated in the regulation of aerobic glycolysis, emerging as a potential player in various cancers. However, its role in prostate cancer remains unclear. This study aims to analyze PDK4 expression in prostate cancer cells and human samples, and to explore the gene's clinical significance. Materials and Methods: PDK4 expression was detected in cell lines and human tissue samples. Migration ability was analyzed using Matrigel-coated invasion chambers. Human samples were obtained from the Kyungpook National University Chilgok Hospital. Results: PDK4 expression was elevated in prostate cancer cell lines compared to normal prostate cells, with particularly high levels in DU145 and LnCap cell lines. PDK4 knockdown in these cell lines suppressed their invasion ability, indicating a potential role of PDK4 in prostate cancer metastasis. Furthermore, our results revealed alterations in epithelial-mesenchymal transition markers and downstream signaling molecules following PDK4 suppression, suggesting its involvement in the modulation of invasion-related pathways. Furthermore, PDK4 expression was increased in prostate cancer tissues, especially in castration-resistant prostate cancer, compared to normal prostate tissues, with PSA and PDK4 expression showing a significantly positive correlation. Conclusions PDK4 expression in prostate cancer is associated with tumor invasion and castration status. Further validation is needed to demonstrate its effectiveness as a therapeutic target.

Purpose: This study aims to explore the factors influencing nursing professionalism among nursing students, focusing on the image of nurses, satisfaction with their major, and career metacognition. Methods: We conducted a descriptive survey with 185 nursing students from D city and K region on June 10–30, 2024. Data were analyzed using IBM SPSS ver. 27.0 (IBM Corp.), employing descriptive statistics, t tests, one-way ANOVA, Scheffé tests, Pearson’s correlation coefficients, and regression analysis. Multiple linear regression analysis was used to identify factors affecting nursing professionalism among nursing students. Results: The regression analysis revealed that the image of nurses (β=.69, p<.001) and monitoring aspect of career metacognition (β=.13, p=.025) were significant predictors of nursing professionalism, accounting for 64.5% of the variance. Conclusion The findings indicate that the image of nurses and monitoring component of career metacognition are critical in shaping nursing professionalism among nursing students. Therefore, nursing education programs should aim to improve the image of nurses and promote self-reflective career practices as strategies to foster professionalism among nursing students.

Objectives: . The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status. Methods: . A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9–12 months) and delayed (CI at 12–18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles. Results: . Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language. Conclusion . CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).

Purpose: Patients experience severe physical trauma every year. However, studies on survivors’ experiences after severe injury are limited. Previous studies have mainly focused on time spans of trauma treatment. This study aimed to comprehensively explore survivors’ experiences to improve the current quality of trauma treatment and highlight the importance of patient-centered care. Materials and Methods: Structured, face-to-face interviews with six domains were conducted on survivors aged ≥18 years who were previously hospitalized in an intensive care unit due to traumatic injuries. Self-reported questionnaires were administered for a multidimensional assessment of participants’ conditions. Transcripts of each narrative were analyzed per grounded theory. Results: Fourteen participants were assessed. The median injury severity score was 25.5. The median elapsed time from injury to interview was 17.3 months. The physical and psychiatric difficulties of the participants remained unresolved even after completing rehabilitation. The main theme derived from the narratives were struggle with injury, consequences, and contributing factors, with the following subthemes: 1) suffering from injury and treatment, 2) psychological adaptation to the changed self and life after the accident, 3) significant family support, 4) gratitude to medical staff despite inadequacies in the healthcare system, and 5) legal and economic issues that impede recovery. Conclusion Increased efforts focusing on enabling survivors of severe injury to return to society and improve their quality of life are needed, including the establishment of patient-centered care in the trauma field, extended care for the survivors’ families, multidisciplinary treatment, and the collection of quantitative post-discharge data.

A 30-year-old Korean man with myelodysplastic syndrome admitted hospital due to undifferentiated fever and recurrent skin lesions. He received combination therapy with high doses of meropenem, tigecycline and amikacin, yielding carbapenem resistant Klebsiella pneumoniae (CRKP) harboring K. pneumoniae carbapenemase (KPC)-2 from blood cultures on hospital day (HD) 23. Ceftazidime/avibactam was started at HD 37 and CRKP was eradicated from blood cultures after 5 days. However, ceftazidime/avibactam-resistant CRKP carrying KPC-44 emerged after 26 days of ceftazidime/avibactam treatment and then ceftazidime/ avibactam-resistant, carbapenem-susceptible K. pneumoniae carrying KPC-135 was isolated on HD 65. The 3-D homology of KPC protein showed that hot spot changes in the omega loop could be attributed to ceftazidime/avibactam resistance and loss of carbapenem resistance.Whole genome sequencing of serial isolates supported that phenotypic variation was due to clonal evolution than clonal replacement. The treatment regimen was changed from CAZ/AVI to meropenem-based therapy (meropenem 1 g iv q 8 hours and amikacin 600 mg iv per day) starting with HD 72. CAZ/AVI-susceptible CRKP was presented again from blood cultures on HD 84, and the patient expired on HD 85. This is the first Korean report on the acquisition of ceftazidime/avibactam resistance through the emergence of blaKPC variants.

Purpose: Patients experience severe physical trauma every year. However, studies on survivors’ experiences after severe injury are limited. Previous studies have mainly focused on time spans of trauma treatment. This study aimed to comprehensively explore survivors’ experiences to improve the current quality of trauma treatment and highlight the importance of patient-centered care. Materials and Methods: Structured, face-to-face interviews with six domains were conducted on survivors aged ≥18 years who were previously hospitalized in an intensive care unit due to traumatic injuries. Self-reported questionnaires were administered for a multidimensional assessment of participants’ conditions. Transcripts of each narrative were analyzed per grounded theory. Results: Fourteen participants were assessed. The median injury severity score was 25.5. The median elapsed time from injury to interview was 17.3 months. The physical and psychiatric difficulties of the participants remained unresolved even after completing rehabilitation. The main theme derived from the narratives were struggle with injury, consequences, and contributing factors, with the following subthemes: 1) suffering from injury and treatment, 2) psychological adaptation to the changed self and life after the accident, 3) significant family support, 4) gratitude to medical staff despite inadequacies in the healthcare system, and 5) legal and economic issues that impede recovery. Conclusion Increased efforts focusing on enabling survivors of severe injury to return to society and improve their quality of life are needed, including the establishment of patient-centered care in the trauma field, extended care for the survivors’ families, multidisciplinary treatment, and the collection of quantitative post-discharge data.

Background and Objectives: Although various cardiac parameters on echocardiography have clinical importance, their measurement by conventional manual methods is time-consuming and subject to variability. We evaluated the feasibility, accuracy, and predictive value of an artificial intelligence (AI)-based automated system for echocardiographic analysis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The AI-based system was developed using a nationwide echocardiographic dataset from five tertiary hospitals, and automatically identified views, then segmented and tracked the left ventricle (LV) and left atrium (LA) to produce volume and strain values. Both conventional manual measurements and AI-based fully automated measurements of the LV ejection fraction and global longitudinal strain, and LA volume index and reservoir strain were performed in 632 patients with STEMI. Results: The AI-based system accurately identified necessary views (overall accuracy, 98.5%) and successfully measured LV and LA volumes and strains in all cases in which conventional methods were applicable. Inter-method analysis showed strong correlations between measurement methods, with Pearson coefficients ranging 0.81–0.92 and intraclass correlation coefficients ranging 0.74–0.90. For the prediction of clinical outcomes (composite of all-cause death, re-hospitalization due to heart failure, ventricular arrhythmia, and recurrent myocardial infarction), AI-derived measurements showed predictive value independent of clinical risk factors, comparable to those from conventional manual measurements. Conclusions Our fully automated AI-based approach for LV and LA analysis on echocardiography is feasible and provides accurate measurements, comparable to conventional methods, in patients with STEMI, offering a promising solution for comprehensive echocardiographic analysis, reduced workloads, and improved patient care.

Background: The Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the Ministry of Food and Drug Safety (MFDS) have been implementing the expedited programs that promote the innovative approval of new medications to be used for serious diseases. The authors comprehensively investigated, analyzed, and compared the regulations and guidelines associated with the expedited programs. Methods: The expedited programs for innovative drug development and approval were searched from the homepages of FDA, EMA and MFDS. The detailed information on the regulations and guidelines associated with the programs was comprehensively extracted from various electronic repositories of each regulatory authority. The informa-tion on each program was analyzed, categorized, and compared from the points of benefits, applicability with scientific rationale,application procedure, and maintenance. Results: FDA’s programs include Fast Track Designation, Breakthrough Therapy Designation, Priority Review Designation, and Accelerated Approval. EMA’s regulation implements PRIority MEdicines (PRIME), Accelerated Assessment, Marketing Authorization under Exceptional Circumstances (MAEC), and Conditional Marketing Authorization (CMA). MFDS has a single Expedited Program. These programs are broadly categorized into those that 1) facilitate early and proactive communication with regulatory authorities, 2) shorten the review time after submitting a marketing application, and 3) temporarily approve a marketing authorization under certain conditions. Conclusion Each expedited program requiresa different level and amount of safety and efficacy evidence to be submitted to each regulatory authority. This article will likely provide the comprehensive information on which program provides scientific and regulatory advantages to be taken for innova-tive medication development.

Purpose: Nutritional support for adult critically ill patients is essential due to the high risk of malnutrition, which can lead to severe complications. This paper aims to develop evidence-based guidelines to optimize nutritional support in intensive care units (ICUs). Methods: The Grading Recommendations, Assessment, Development and Evaluation process was used to develop and summarize the evidence on which the recommendations were based. Clinical outcomes were assessed for seven key questions. Results: We recommend the following: (1) initiate enteral nutrition (EN) within 48 hours after treatment as it is associated with improved outcomes, including reduced infection rates and shorter ICU stays; (2) early EN is preferred over early parenteral nutrition due to better clinical outcomes; (3) the use of supplementary parenteral nutrition to meet energy targets during the first week of ICU admission in patients receiving early EN is conditionally recommended based on patient-specific needs; (4) limited caloric support should be supplied to prevent overfeeding and related complications, particularly in the early phase of critical illness; (5) higher protein intake is suggested to improve clinical outcomes, such as muscle preservation and overall recovery; (6) additional enteral or parenteral glutamine is conditionally recommended against due to the lack of significant benefit and potential harm; and (7) fish oil-containing lipid emulsions is conditionally recommended due to their potential to enhance clinical outcomes, including reduced infection rates and shorter ICU stays. Conclusion These evidence-based recommendations can improve clinical outcomes and support healthcare providers in making informed decisions about nutritional interventions in the ICU.

Purpose: Patients experience severe physical trauma every year. However, studies on survivors’ experiences after severe injury are limited. Previous studies have mainly focused on time spans of trauma treatment. This study aimed to comprehensively explore survivors’ experiences to improve the current quality of trauma treatment and highlight the importance of patient-centered care. Materials and Methods: Structured, face-to-face interviews with six domains were conducted on survivors aged ≥18 years who were previously hospitalized in an intensive care unit due to traumatic injuries. Self-reported questionnaires were administered for a multidimensional assessment of participants’ conditions. Transcripts of each narrative were analyzed per grounded theory. Results: Fourteen participants were assessed. The median injury severity score was 25.5. The median elapsed time from injury to interview was 17.3 months. The physical and psychiatric difficulties of the participants remained unresolved even after completing rehabilitation. The main theme derived from the narratives were struggle with injury, consequences, and contributing factors, with the following subthemes: 1) suffering from injury and treatment, 2) psychological adaptation to the changed self and life after the accident, 3) significant family support, 4) gratitude to medical staff despite inadequacies in the healthcare system, and 5) legal and economic issues that impede recovery. Conclusion Increased efforts focusing on enabling survivors of severe injury to return to society and improve their quality of life are needed, including the establishment of patient-centered care in the trauma field, extended care for the survivors’ families, multidisciplinary treatment, and the collection of quantitative post-discharge data.