Background: Primary cutaneous CD30+ lymphoproliferative disorders (pcCD30-LPDs) are a diseases with various clinical and prognostic characteristics. Objective: Increasing our knowledge of the clinical characteristics of pcCD30-LPDs and identifying potential prognostic variables in an Asian population. Methods: Clinicopathological features and survival data of pcCD30-LPD cases obtained from 22 hospitals in South Korea were examined. Results: A total of 413 cases of pcCD30-LPDs (lymphomatoid papulosis [LYP], n=237; primary cutaneous anaplastic large cell lymphoma [C-ALCL], n=176) were included. Ninety percent of LYP patients and roughly 50% of C-ALCL patients presented with multiple skin lesions. Both LYP and C-ALCL affected the lower limbs most frequently. Multiplicity and advanced T stage of LYP lesions were associated with a chronic course longer than 6 months. Clinical morphology with patch lesions and elevated serum lactate dehydrogenase were significantly associated with LPDs during follow-up in LYP patients. Extracutaneous involvement of C-ALCL occurred in 13.2% of patients. Lesions larger than 5 cm and increased serum lactate dehydrogenase were associated with a poor prognosis in C-ALCL. The survival of patients with C-ALCL was unaffected by the anatomical locations of skin lesions or other pathological factors. Conclusion The multiplicity or size of skin lesions was associated with a chronic course of LYP and survival among patients with C-ALCL.

Background: Cutaneous angiosarcoma, a rare malignant tumor, is associated with high mortality and poor prognosis. Objective: This study aimed to analyze the clinicopathologic features of cutaneous angiosarcoma and identify the prognostic factors influencing survival. Methods: Medical records of patients diagnosed with cutaneous angiosarcoma between January 1995 and March 2023 were retrospectively reviewed. Demographic data, clinicopathologic features, and treatment modalities were analyzed to evaluate the correlation with overall survival (OS) and progression-free survival (PFS). A total of 70 patients were included in the study. Results: Their mean age at diagnosis was 71 years (range, 41–91 years). Of them, 57 (81.4%) were males. Five-year OS and PFS rates were 29.0% and 10.7%, respectively. In univariate analysis, a mass in the frontal area of the scalp showed significant associations with poorer PFS (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.07–3.55; p=0.029) and poorer OS (HR, 2.42; 95% CI, 1.22–4.80; p=0.011). Mass size exceeding 3 cm had a notable impact on PFS (HR, 3.41; 95% CI, 1.32–8.82; p=0.011) and remained a significant independent adverse prognosticator in multivariate analysis (HR, 4.55; 95% CI, 1.22–16.99; p=0.024). Conclusion Cutaneous angiosarcoma is characterized by an unfavorable prognosis, with a larger mass size identified as an independent prognostic factor.

Natural killer (NK) cells are pivotal innate immune system components that exhibit spontaneous cytolytic activity against abnormal cells, such as infected and tumor cells. NK cells have shown significant promise in adoptive cell therapy because of their favorable safety profiles and minimal toxicity in clinical settings. Despite their advantages, the therapeutic application of unmodified NK cells faces challenges, including limited in vivo persistence, particularly in the immunosuppressive tumor microenvironment. Recent advances in genetic engineering have enhanced the therapeutic potential of NK cells by addressing these limitations and improving their therapeutic efficacy. In this review, we have described various methodologies for the genetic modification of NK cells, including viral vectors, electroporation, and nanoparticle-based approaches. The ongoing research on nanomaterialbased approaches highlights their potential to overcome current limitations in NK cell therapy, paving the way for advanced cancer therapy and improved clinical outcomes. In this review, we also emphasize the potential of engineered NK cells in cancer immunotherapy and other clinical applications, highlighting the expanding scope of NK cell-based treatments and the critical role of innovative genetic engineering techniques.

Background: Emergency living donor liver transplantation (e-LDLT) is crucial for patients experiencing acute liver failure, acute-on-chronic liver failure, or severe, life-threatening cirrhosis. The purpose of this study was to determine the risk factors that affect the death rate of patients who are waiting for e-LDLT by analyzing data on the Korean Network for Organ Sharing (KONOS). Methods: A retrospective examination of KONOS data was performed, encompassing consecutive e-LDLT applications from 2017 to 2021. Exclusions were made for pediatric patients. The data were classified into two distinct groups. Patients who died before getting e-LDLT were classified as Group 1 (n=38), while patients who spontaneously recovered without liver transplantation, non-emergency LDLT, or deceased donor liver transplantation more than 14 days following e-LDLT treatment were classified as Group 2 (n=30). Results: Significantly greater rates of pre-transplant critical care unit stay, pre-transplant ventilator support, or continuous renal replacement treatment were observed in Group 1 compared to Group 2. In comparison to Group 2, Group 1 exhibited notably lower serum albumin levels and higher model for end-stage liver disease (MELD) scores. Significantly, the MELD score increased by more than 10% for 3 days preceding to e-LDLT applications in Group 1 compared to Group 2. The multivariate analysis revealed that the only factor that affected the death of patients waiting for LDLT after e-LDLT applications was pre-transplant ventilator support. Conclusion The present study suggested that patients receiving mechanical ventilator support in the pre-transplant period should be approached cautiously when deciding on e-LDLT.

Background: Deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) are employed to address highly urgent patients, including those with acute liver failure (ALF), acute-on-chronic liver failure (ACLF), or critical cirrhosis. This study compares outcomes between LDLT and DDLT patients with ALF, ACLF, or critical cirrhosis in highly urgent LDLT (HU-LDLT) applications. Methods: This study conducted a retrospective analysis of the Korean Network for Organ Sharing (KONOS) data, which included 391 consecutive HU-LDLT applications from 2017 to 2021. Results: The proportion of DDLT was 15.1% (n=59) within the cohort of HU-LDLT applications. The prevalence of hepatorenal syndrome, duration of pre-transplant intensive care unit (ICU) care, incidence of pre-transplant continuous renal replacement therapy, and median model for end-stage liver disease scores were significantly greater and prolonged in DDLT patients compared to LDLT patients. Statistical analysis revealed no significant differences in postoperative complications or overall survival between the two groups. In the multivariate analysis, only pre-transplant ventilator care emerged as a significant predisposing factor for mortality. Conclusion The present study indicates that LDLT is a viable option, yielding comparable perioperative and long-term outcomes to DDLT for HU patients, which can encourage living liver donation to overcome organ shortages in HU patients.

Background: PM2.5 (particulate matter less than 2.5 μm) causes various health problems. Recent studies suggest that long-term exposure to PM2.5 may have a negative impact on vision. This study examined the effects of long-term exposure to concentrations of PM2.5 exceeding Korean standards on myopia prevalence. Methods: This study was conducted on adults aged 40–69 years. The PM2.5 concentrations were calculated as the 1–5-year moving averages based on the participants' residential areas. The relationships between the PM2.5 levels, categorized by the annual average concentration standard in Korea, and the prevalence of myopia were analyzed using binary logistic regression. The results were evaluated using the 95% confidence interval. Results: PM2.5 concentrations averaged over 1–3 years were not significantly associated with the prevalence of myopia. On the other hand, the prevalence of myopia was significantly higher in areas where the 4–5-year moving average PM2.5 levels exceeded the Korean standards. These findings suggest that long-term exposure to PM2.5 may have a detrimental effect on vision. Conclusions This study revealed the impact of long-term PM2.5 exposure on the prevalence of myopia, highlighting the importance of managing PM2.5 levels. Nevertheless, further cohort studies focusing on adults and in-depth research into the effects of long-term exposure will be necessary.

Background: Humans are exposed to mercury primarily in its highly toxic form, methyl mercury, which is known to have adverse effects on various organs and systems. The negative impact of mercury exposure on the growth, development, and mental health of children, from infancy to adolescence, is well-documented. However, there are no internationally standardized safe limits for mercury exposure. This study investigated the impact of dietary habits and higher body mass index (BMI) on blood mercury levels in adolescents. Methods: This study analyzed the data from the 4th Korean National Environmental Health Survey (KoNEHS) 2018–2020. The focus was on 825 middle and high school students aged 13–18 years, whose blood mercury levels were measured. A survey on dietary and lifestyle habits was also conducted. Blood mercury levels were categorized by geometric median values, and associations with overweight status and seafood consumption were examined using a generalized linear model. Results: The geometric mean blood mercury level for the entire sample was 1.37 μg/L, with levels of 1.31 μg/L in normal-weight individuals and 1.43 μg/L in overweight individuals, showing a statistically significant difference between the two groups. After adjusting for other variables, blood mercury levels were significantly associated with overweight status (estimate: 0.084; p = 0.018; 95% confidence interval [CI]: 0.015–0.153), consumption of large fish and tuna more than once a week (estimate: 0.18; p = 0.001; 95% CI: 0.077–0.284), and consumption of fish once a week or more (estimate: 0.147; p = 0.004; 95% CI: 0.043–0.250). Conclusions In adolescents, a higher BMI and an increased consumption of large fish, tuna, and fish were associated with higher blood mercury levels. Notably, a stronger association was found between large fish consumption and blood mercury levels in the overweight group. These findings suggest the need to moderate seafood consumption and establish more proactive mercury exposure standards for adolescents.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.