This study aimed to determine the prevalence of human epidermal growth factor receptor 2 (HER2)–ultralow breast cancer among cases initially classified as HER2 immunohistochemistry (IHC) 0 and assess interobserver variability in interpreting low-level HER2 expression. Methods: In this multicenter retrospective study, all invasive breast cancer cases diagnosed between January and December 2022 across 10 Korean institutions were retrieved. Institutional pathologists reexamined HER2 IHC slides originally reported as IHC 0 according to the 2018 American Society of Clinical Oncology/College of American Pathologists guidelines and reclassified them as HER2-null (0), HER2-ultralow (0+), or HER2-low (1+). Slides from 10% of HER2-null and HER2-ultralow cases were digitized for central review and independently assessed by two pathologists, with discrepancies resolved by consensus. Results: Among 8,026 cases, 2,836 cases (35.5%) were initially reported as IHC 0. Upon re-review, 1,673 (59.0%), 1,139 (40.2%), and 24 (0.8%) cases were reclassified as HER2-null, HER2-ultralow, and HER2-low, respectively. The prevalence of HER2-ultralow breast cancer varied considerably across institutions (23.7%–78.1%). Central review of 268 digitized cases showed concordance in 193 cases (72.0%). Among the 75 discordant cases, 54 tumors (72.0%) were upgraded from HER2-null to HER2-ultralow, and 18 (24.0%) tumors were upgraded from HER2-ultralow to HER2-low. Furthermore, two tumors (2.7%) were downgraded from HER2-ultralow to HER2-null. Conclusions: Approximately 40% of cases initially categorized as IHC 0 were reclassified as HER2-ultralow. The substantial inter-institutional variability observed in interpreting low-level HER2 expression highlights the need for standardized training and quality assurance to ensure accurate identification of patients eligible for HER2-targeted antibody–drug conjugates.

Methods: Fifty patients who underwent UBE-TLIF and 50 patients who underwent W-TLIF, each with >2 years of follow-up, were retrospectively analyzed. Outcomes included operative parameters, time to postoperative mobilization, paravertebral muscle atrophy and fat infiltration rates, clinical scores (Visual Analog Scale [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association [JOA]), modified Macnab criteria, fusion rates, and complications. Results: Compared with W-TLIF, the UBE-TLIF group had significantly less intraoperative blood loss, shorter operative times, and lower postoperative drainage volumes (p <0.05). The UBE-TLIF group showed faster postoperative recovery and shorter hospital stays. At 6 months, 1 year, and 2 years, W-TLIF patients had higher multifidus and erector spinae atrophy, and greater paravertebral muscle fat infiltration (p <0.05). The UBE-TLIF group also had lower VAS and ODI scores at 1 year and 2 years (p <0.05) and fewer surgical complications (6% vs. 10%). Fusion rates (94% vs. 92%) and modified Macnab outcomes (88% vs. 86%) were comparable (p >0.05). Conclusions UBE-TLIF is associated with reduced intraoperative trauma, quicker recovery, and fewer complications. In the long-term, it better preserves paravertebral muscle integrity and provides superior pain and functional outcomes.

In patients with differentiated thyroid cancer (DTC), initial recurrence risk stratification based on clinical, histopathological, and perioperative data remains the key determinant for guiding management strategies during the first 1-2 years post-treatment. However, the adoption of ongoing risk stratification (ORS), which dynamically reassesses risk by integrating longitudinal clinical data and treatment response, enables more precise long-term prognostic assessment and facilitates highly individualized management. Building upon recent guidelines, the 2026 KTA guideline has been further refined by incorporating robust evidence from large-scale national cohorts and comprehensive systematic reviews. These updated recommendations outline contemporary concepts of ORS, risk-adapted TSH suppression targets, optimized surveillance modalities for recurrence detection, and disease-specific long-term follow-up strategies. Reflecting the paradigm shift toward de-escalated treatment, this revision integrates evolved perspectives on TSH suppression intensity, the clinical interpretation of thyroglobulin levels, and tailored follow-up intervals. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the large proportion of patients with excellent prognosis after initial therapy, while ensuring that each patient receives appropriately tailored and effective long-term management.

Background: Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Methods: Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. Results: This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey.No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Conclusions Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.

Background: Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Methods: Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. Results: This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey.No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Conclusions Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.

Background: Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Methods: Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. Results: This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey.No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Conclusions Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.

Background: Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Methods: Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. Results: This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey.No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Conclusions Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.

Objective:To explore the relationship between monocyte-lymphocyte ratio(MLR),modified Glasgow prognostic score(mGPS)and the prognosis of patients with advanced gastric cancer after radical gastrectomy.Methods:A retrospective analysis was conducted on the data of 106 patients with advanced gastric cancer who underwent radical gastrectomy in our hospital from April 2018 to April 2021,the patients were followed up for 3 years after the operation.MLR and mGPS scores of patients with different clinical characteristics were compared.The Kaplan-Meier method was used to analyze the survival differences of patients in different MLR and mGPS groups,and the survival curves were plotted.The Cox regression model was used to analyze variables such as clinical characteristics,laboratory indicators,MLR and mGPS scores,and to screen out the independent factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was constructed to evaluate the efficacy of MLR,mGPS scores and their combination in predicting poor prognosis efficiency of patients,and the area under the curve(AUC),sensitivity and specificity were calculated.Results:MLR and mGPS scores were correlated with tumor TNM stage,degree of differentiation,tumor diameter,lymph node metastasis and postoperative chemotherapy(P＜0.05).The 3-year survival rates of the MLR ≥0.3 group and mGPS ≥ 1 group were 45.20％and 50.00％respectively,which were much lower than those in the low MLR group and mGPS group(78.40％and 82.40％,P＜0.05).The survival rate in the high-risk group(MLR ≥0.3 and mGPS ≥ 1)was 29.41％,significantly lower than those in the medium and low-risk groups(P＜0.05).Cox multivariate analysis showed that high clinical stage,lymph node metastasis,high degree of differentiation,high MLR and high mGPS scores were independent risk factors affecting the prognosis of patients.ROC curve showed that the AUC of MLR and mGPS scores alone in predicting poor prognosis of patients was 0.756 and 0.842,respectively,the AUC of combination detection the two was 0.909,the predictive efficacy of the combination detection was significantly better than that of the single detection.Conclusion:Elevated MLR and mGPS scores can be used as independent prognostic indicators after advanced gastric cancer,the combination in predicting is helpful to provide a more accurate basis for clinical prognosis assessment.

Objective:To explore the effect of bumetanide(BUM)on learning and memory in a rat model of hydro-cephalus induced by kaolin.Methods:A rat model of hydrocephalus was established by injecting kaolin into the lateral ventricle.Bumetanide was administered intranasally.The volume of the lateral ventricle was measured by magnetic resonance imaging,and changes in intracranial pressure were detected.The learning and memory ability of rats was evaluated by the novel object recognition test,and neuronal damage in the hippocampus was detected by Nissl staining.Results:Compared with the control group,the lateral ventricle expansion was more obvious,intracranial pressure was elevated,and the exploring novel object time was significantly decreased in the bumetanide treatment group.Nissl stai-ning showed neuronal damage.After bumetanide treatment,the volume of the lateral ventricle decreased,intracranial pressure decreased,the exploring novel object time increased,and neuronal damage was alleviated.Conclusion:Bu-metanide can alleviate kaolin-induced hydrocephalus in rats and improve learning and memory ability.

Objective To investigate the application effect of cold snare endoscopic mucosal resection(CS-EMR)in the treatment of 6 to 9 mm colorectal small polyps.Methods A total of 82 patients with small colonic polyps in our hospital from March 2022 to August 2023 were collected and divided into the observation group(45 cases received CS-EMR)and the control group[37 cases received hot snare endoscopic mucosal resection(HS-EMR)]according to different surgical methods.The clinical efficacy,polyp resection status,complete polyp resection rate,perioperative indicators and occurrence of complications were compared between the two groups.Results Follow-up for 1 month after operation,the effective rate of treatment in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the polyp resection status or perioperative indicators between the two groups(P>0.05).There was no statistically significant difference in the complete polyp resection rates of patients with different pathological types or total complete resection rate between the two groups(P>0.05).The incidence of delayed bleeding and endoscopic hemostasis rate in the observation group were lower than those in the control group(P<0.05).Conclusion The complete resection rate of 6～9 mm colorectal polyps through CS-EMR was comparable to that of HS-EMR,and CS-EMR has a better efficacy and lower risk of perioperative bleeding,along with higher safety.