Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

The first human immunodeficiency virus (HIV) infection was reported in Korea in 1985. The number of HIV-infected persons domestically increased in the 1990s showing epidemic indigenousization. Since then, the number of new infections gradually increased every year, and recently more than 1,000 newly infected cases were reported per year. A total of 12,522 infected individuals have been reported up to 2015, of which 2,020 died. The male to female ratio was 15.4:1, and 34.2% of them were under 30 years old. The infection route was homosexual and bisexual contact in 60.1% of cases and heterosexual contact in 34.6% of cases. Candidiasis, Pneumocystis pneumonia, tuberculosis were common as a AIDS (acquired immune deficiency syndrome)-defining illness. But with the introduction of antiretroviral therapy in the late 1990s, non-AIDS defining illnesses such as metabolic complications, cardiovascular diseases, bone diseases, and neuropsychiatric disorders such as neurocognitive dysfunction, depression, and anxiety are emerging as new health problems. The management policy switched its focus from regulating and monitoring of HIV-infected persons to ensuring access to treatment and promotion of voluntary HIV testing in high-risk groups. Also as the age of the infected persons increases, a need for various supports such as social rehabilitation, life counseling, and welfare has emerged.

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) has been reported as an effective treatment for advanced hepatocellular carcinoma. The aim of this study is to compare the effect and safety between a high-dose regimen (750 mg/m2 5-fluorouracil [FU] and 25 mg/m2 cisplatin on day 1–4) and a low-dose regimen (500 mg/m2 5-FU on day 1–3 with 60 mg/m2 cisplatin on day 2). METHODS: A total of 48 patients undergoing HAIC were retrospectively analyzed. Thirty-two patients were treated with the high-dose and 16 patients with the low-dose regimen. RESULTS: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease were noted in one (3.1%), 15 (46.9%), three (9.4%), and 13 patients (40.6%) in the highdose group, and 0 (0%), one (6.3%), eight (50%), and seven patients (43.8%) in the low-dose group (P=0.002). The disease control rate (CR, PR, and SD) did not differ between groups (59.4% vs. 56.3%, P=1.000), but the objective response rate (CR and PR) was significantly higher in the high-dose group (50.0% vs. 6.3%, P=0.003). The median progression free survival did not differ between groups (4.0 vs. 6.0, P=0.734), but overall survival was significantly longer in the high-dose group (not reached vs. 16.0, P=0.028). Fourteen (43.8%) patients in the high-dose group and two patients (12.5%) in the low-dose group experienced grade 3–4 toxicities (P=0.050). CONCLUSIONS: High dose HAIC may achieve better tumor response and may improve overall survival compared to a low-dose regimen. However, the high-dose regimen should be administered cautiously because of the higher incidence of adverse events.
Administration, Metronomic ; Carcinoma, Hepatocellular ; Chemotherapy, Cancer, Regional Perfusion ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Humans ; Incidence ; Retrospective Studies

PURPOSE: This study aimed to investigate bicycle injury patients who suffered orthopedic injuries. METHODS: From January 1, 2010 to December 31, 2014, 1,664 people visited the emergency room due to a bicycle accident. Among them, 385 patients were found to have orthopedic injuries through physical examination and imaging evaluation. Intending to evaluate whether the number of bicycle injury patients is increasing or decreasing yearly, we investigated the rate of orthopedic injuries among bicycle injury patients, the damaged areas and the extent of damage, and also investigated whether changes in frequency were correlated with sex, age, or season. RESULTS: From January 1, 2010 to December 31, 2014, a total of 237,533 people came to the emergency room. Among them, the number of bicycle injuries was 1,664 (0.7%), and 23% of the bicycle injuries (385 people) were orthopedic injuries. Among these, 77.4% were men, 44.5% were less than 20 years old, and 20% were more than 61 years old. Damage to the forearm (n=82, 21.3%) and the shoulder (n=71, 18.4%) were the most common injuries, and simple fractures affected 274 patients (71.1%), overwhelmingly more common than other patterns of damage. In combination, simple fracture and dislocations occurred in 279 cases (72.5%). CONCLUSION: Most bicycle injuries occur in young and elderly people. Fractures of the forearm and shoulder were the most common orthopedic injuries. We expect that this study will be helpful in providing information about the orthopedic characteristics of bike injuries.
Aged ; Dislocations ; Emergency Service, Hospital ; Forearm ; Humans ; Incidence ; Male ; Orthopedics* ; Physical Examination ; Seasons ; Shoulder

Posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) is uncommon because of anatomical barriers. It is difficult to diagnose PEMLIF definitively because of its relatively rare incidence and the ambiguity of radiological findings resembling spinal tumors. This case report describes a 76-year-old man with sudden-onset weakness and pain in both legs. Electromyography revealed bilateral lumbosacral polyradiculopathy with a mass-like lesion in L2-3 dorsal epidural space on lumbosacral magnetic resonance imaging (MRI). The lesion showed peripheral rim enhancement on T1-weighted MRI with gadolinium administration. The patient underwent decompressive L2-3 central laminectomy, to remove the mass-like lesion. The excised lesion was confirmed as an intervertebral disc. The possibility of PEMLIF should be considered when rim enhancement is observed in the epidural space on MRI scans and electrodiagnostic features of polyradiculopathy with sudden symptoms of cauda equina syndrome.
Aged ; Electromyography ; Epidural Space ; Gadolinium ; Humans ; Incidence ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Polyradiculopathy

OBJECTIVE: To evaluate the effectiveness of intensive neurodevelopmental treatment (NDT) on gross motor function for the children having developmental delay (DD), with or without cerebral palsy (CP). METHODS: Forty-two children had intensive NDT three times weekly, 60 minutes a day, for 3 months, immediately followed by conventional NDT once or twice a week, 30 minutes a day, for another 3 months. We assessed Gross Motor Function Measure (GMFM) over three time points: before conventional NDT, before and after intensive NDT, and after 3 months of additional conventional NDT. RESULTS: The GMFM score in DD children significantly improved after intensive NDT, and the improvement maintained after 3 months of conventional NDT (p<0.05). The children were further divided into two groups: DD with CP and DD without CP. Both groups showed significant improvement and maintained the improvements, after intensive NDT (p<0.05). Also, there was no significant difference in treatment efficacy between the two groups. When we calculate the absence rate for comparing the compliance between intensive and conventional NDT, the absence rate was lower during the intensive NDT. CONCLUSION: Intensive NDT showed significantly improved gross motor function and higher compliance than conventional NDT. Additionally, all improvements were maintained through subsequent short-term conventional NDT. Thus, we recommend the intensive NDT program by day-hospital centers for children with DD, irrespective of accompanying CP.
Cerebral Palsy* ; Child* ; Compliance ; Developmental Disabilities ; Disability Evaluation ; Humans ; Rehabilitation ; Treatment Outcome

Acute pulmonary infarction by tumoral thromboemboli is an extremely rare fatal complication as the first clinical manifestation of hepatocellular carcinoma (HCC) patient with tumoral thrombi in the inferior vena cava. The treatment method has not been established and shown to very poor prognosis despite of trying various modalities such as anticoagulation, radiotherapy and thromboembolectomy. Here, we describe a 74-year-old man who was diagnosed with HCC that presented as pulmonary thromboembolism and subsequent pulmonary infarction as the first manifestation.
Aged ; Carcinoma, Hepatocellular* ; Humans ; Infarction ; Methods ; Prognosis ; Pulmonary Embolism ; Pulmonary Infarction* ; Radiotherapy ; Thromboembolism* ; Vena Cava, Inferior

Panner's disease, osteonecrosis of the capitellum of the elbow, was first reported by Panner in 1927. The disease occurs mainly in boys between 6 and 15 years old and shows unilateral distribution. Pain, stiffness, localized tenderness over the lateral condyle of the elbow, and decreased range of motion are the typical clinical symptoms. Conservative treatment is generally recommended for patients in the early stage of this disease. A few cases of Panner's disease have been reported and few are related to long-term follow-up results. To the best of our knowledge, all reported cases were over six years. Therefore, we report on a five-year-old boy diagnosed as Panner's disease that showed resorption and regeneration of the humeral capitellum with no limitation of motion over three years. The current study was exempted from review by the institutional review board because it was a single retrospective case report. Informed consent was obtained from the patient's guardian.
Child* ; Elbow ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Informed Consent ; Male ; Osteochondrosis ; Osteonecrosis ; Range of Motion, Articular ; Regeneration ; Retrospective Studies

STUDY DESIGN: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity OBJECTIVES: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. SUMMARY OF LITERATURE REVIEW: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. MATERIALS AND METHODS: Review of the literature. RESULTS: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. CONCLUSIONS: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.
Congenital Abnormalities ; Diagnosis ; Spinal Diseases ; Spine

Panner's disease, osteonecrosis of the capitellum of the elbow, was first reported by Panner in 1927. The disease occurs mainly in boys between 6 and 15 years old and shows unilateral distribution. Pain, stiffness, localized tenderness over the lateral condyle of the elbow, and decreased range of motion are the typical clinical symptoms. Conservative treatment is generally recommended for patients in the early stage of this disease. A few cases of Panner's disease have been reported and few are related to long-term follow-up results. To the best of our knowledge, all reported cases were over six years. Therefore, we report on a five-year-old boy diagnosed as Panner's disease that showed resorption and regeneration of the humeral capitellum with no limitation of motion over three years. The current study was exempted from review by the institutional review board because it was a single retrospective case report. Informed consent was obtained from the patient's guardian.
Child ; Elbow ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Informed Consent ; Male ; Osteochondrosis ; Osteonecrosis ; Range of Motion, Articular ; Regeneration ; Retrospective Studies