Background: This study explores effective fixation methods for Pauwel type III femoral neck fractures by evaluating the biomechanical benefits of adding a screw to the Femoral Neck System (FNS). Methods: Computed tomography (CT) scans of an 82-year-old female patient with an intertrochanteric fracture were used to establish a finite element femur model with heterogeneous material properties. Finite element models of Pauwel type III fractures were created with and without an additional screw. The central and inferior trajectories of the FNS bolt were examined separately and combined with an additional screw for virtual fixation. Walking and stair-climbing loads were applied. Results: With the addition of a screw, both peak maximum and minimum principal strains consistently stayed comparable or decreased in models with both central and inferior bolt trajectories, while the volume of elements with principal strain exceeding 1% decreased by more than half. The peak von Mises stress observed in the implants ranged from 215.7 to 359.3 MPa, remaining below the titanium alloy's yield strength of 800 MPa. For normal walking, the addition of a screw to the central bolt trajectory model decreased the fracture gap by 50.6% and reduced sliding distance by 8.6%. For the inferior bolt trajectory, the gap was reduced by 57.9% and sliding distance by 25.0%.Under stair-climbing conditions, these improvements were also evident; the central trajectory model saw a halved fracture gap and a 7.9% decrease in sliding distance, while the inferior trajectory model experienced a 55.7% gap reduction and a 27.2% decrease in sliding distance. The additional screw increased the area ratio of the fracture site experiencing interfragmentary compression 34%–39%, while the additional screw alleviated peak interfragmentary compression by 12%–18% under both normal walking and stair-climbing conditions. Conclusions The addition of a screw reduced the fracture gap, sliding distance, and peak interfragmentary compression, while increasing the area ratio of interfragmentary compression under both walking and stair-climbing loads, regardless of the FNS bolt trajectory, suggesting a better mechanical environment for fracture healing.

Background/Aims: This study aimed to evaluate the performance of the Model for End-Stage Liver Disease (MELD) 3.0 for predicting mortality and liver-related complications compared with the Child-Pugh classification, albumin-bilirubin (ALBI) grade, the MELD, and the MELD sodium (MELDNa) score. Methods: We evaluated a multicenter retrospective cohort of incorporated patients with cirrhosis between 2013 and 2019. We conducted comparisons of the area under the receiver operating characteristic curve (AUROC) of the MELD3.0 and other models for predicting 3-month mortality. Additionally, we assessed the risk of cirrhosis-related complications according to the MELD3.0 score. Results: A total of 3,314 patients were included. The mean age was 55.9±11.3 years, and 70.2% of the patients were male. Within the initial 3 months, 220 patients (6.6%) died, and the MELD3.0had the best predictive performance among the tested models, with an AUROC of 0.851, outperforming the Child-Pugh classification, ALBI grade, MELD, and MELDNa. A high MELD3.0score was associated with an increased risk of mortality. Compared with that of the group with a MELD3.0 score <10 points, the adjusted hazard ratio of the group with a score of 10–20 pointswas 2.176, and that for the group with a score of ≥20 points was 4.892. Each 1-point increase inthe MELD3.0 score increased the risk of cirrhosis-related complications by 1.033-fold. The risk of hepatorenal syndrome showed the highest increase, with an adjusted hazard ratio of 1.149, followed by hepatic encephalopathy and ascites. Conclusions The MELD3.0 demonstrated robust prognostic performance in predicting mortality in patients with cirrhosis. Moreover, the MELD3.0 score was linked to cirrhosis-related complications, particularly those involving kidney function, such as hepatorenal syndrome and ascites.

Purpose: Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world. Materials and Methods: We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis. Results: NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs. Conclusion Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

Objective: To compare coronary artery dimension-adjusted subtended myocardial mass between patients with hypertrophic cardiomyopathy (HCM) and a normal population without detectable atherosclerosis, and between HCM patients with and without chest pain. Materials and Methods: Twenty-five patients with HCM but no detectable atherosclerosis on coronary computed tomography angiography (CCTA) were included in the study. This group comprised 14 patients with chest pain and 11 patients without chest pain. They were matched with 25 healthy participants based on sex, age, coronary dominance pattern, and body surface area. The minimal lumen area (MLA) and subtended myocardial volume (V sub) were assessed in the left main (LM), proximal left anterior descending (pLAD), proximal left circumflex (pLCx), and proximal right coronary (pRCA) arteries. Additionally, an index of the subtended myocardial mass adjusted for the MLA, calculated as V sub/MLA 2 , was determined. Results: MLA was significantly larger in patients with HCM compared to the control group in LM (20.93 ± 6.31 mm 2 vs.15.24 ± 3.90 mm 2 , P< 0.001), pLAD (14.28 ± 3.55 mm 2 vs. 11.36 ± 2.07 mm 2, P = 0.001), pLCx (10.94 ± 3.60 mm 2 vs. 9.15 ± 2.93 mm 2 , P = 0.045), and pRCA (13.41 ± 4.85 mm 2 vs. 11.22 ± 3.20 mm 2 , P = 0.018). Despite an increase in coronary luminal area, patients with HCM exhibited significantly higher V sub/MLA 2 compared to the control group in both the pLAD (403.56 ± 200.35 mm -1 vs. 241.70 ± 85.87 mm -1 , P < 0.001) and the pRCA (186.06 ± 95.07 mm -1 vs. 125.07 ± 70.18 mm -1 , P= 0.007). V sub/MLA 2 was significantly elevated in patients with chest pain compared to those without in the pLAD (473.75 ± 227.38 mm -1 vs. 314.24 ± 110.74 mm -1 , P = 0.018) and the pLCx (417.04 ± 182.65 mm -1 vs. 275.29 ± 112.97 mm -1 , P = 0.044). Conclusion CCTA-derived V sub/MLA 2 may more accurately reflect the balance between myocardial blood supply and demand, offering insights into the occurrence of demand angina in patients with HCM without obstructive coronary artery disease.

Objective: To compare coronary artery dimension-adjusted subtended myocardial mass between patients with hypertrophic cardiomyopathy (HCM) and a normal population without detectable atherosclerosis, and between HCM patients with and without chest pain. Materials and Methods: Twenty-five patients with HCM but no detectable atherosclerosis on coronary computed tomography angiography (CCTA) were included in the study. This group comprised 14 patients with chest pain and 11 patients without chest pain. They were matched with 25 healthy participants based on sex, age, coronary dominance pattern, and body surface area. The minimal lumen area (MLA) and subtended myocardial volume (V sub) were assessed in the left main (LM), proximal left anterior descending (pLAD), proximal left circumflex (pLCx), and proximal right coronary (pRCA) arteries. Additionally, an index of the subtended myocardial mass adjusted for the MLA, calculated as V sub/MLA 2 , was determined. Results: MLA was significantly larger in patients with HCM compared to the control group in LM (20.93 ± 6.31 mm 2 vs.15.24 ± 3.90 mm 2 , P< 0.001), pLAD (14.28 ± 3.55 mm 2 vs. 11.36 ± 2.07 mm 2, P = 0.001), pLCx (10.94 ± 3.60 mm 2 vs. 9.15 ± 2.93 mm 2 , P = 0.045), and pRCA (13.41 ± 4.85 mm 2 vs. 11.22 ± 3.20 mm 2 , P = 0.018). Despite an increase in coronary luminal area, patients with HCM exhibited significantly higher V sub/MLA 2 compared to the control group in both the pLAD (403.56 ± 200.35 mm -1 vs. 241.70 ± 85.87 mm -1 , P < 0.001) and the pRCA (186.06 ± 95.07 mm -1 vs. 125.07 ± 70.18 mm -1 , P= 0.007). V sub/MLA 2 was significantly elevated in patients with chest pain compared to those without in the pLAD (473.75 ± 227.38 mm -1 vs. 314.24 ± 110.74 mm -1 , P = 0.018) and the pLCx (417.04 ± 182.65 mm -1 vs. 275.29 ± 112.97 mm -1 , P = 0.044). Conclusion CCTA-derived V sub/MLA 2 may more accurately reflect the balance between myocardial blood supply and demand, offering insights into the occurrence of demand angina in patients with HCM without obstructive coronary artery disease.

Objective: To compare coronary artery dimension-adjusted subtended myocardial mass between patients with hypertrophic cardiomyopathy (HCM) and a normal population without detectable atherosclerosis, and between HCM patients with and without chest pain. Materials and Methods: Twenty-five patients with HCM but no detectable atherosclerosis on coronary computed tomography angiography (CCTA) were included in the study. This group comprised 14 patients with chest pain and 11 patients without chest pain. They were matched with 25 healthy participants based on sex, age, coronary dominance pattern, and body surface area. The minimal lumen area (MLA) and subtended myocardial volume (V sub) were assessed in the left main (LM), proximal left anterior descending (pLAD), proximal left circumflex (pLCx), and proximal right coronary (pRCA) arteries. Additionally, an index of the subtended myocardial mass adjusted for the MLA, calculated as V sub/MLA 2 , was determined. Results: MLA was significantly larger in patients with HCM compared to the control group in LM (20.93 ± 6.31 mm 2 vs.15.24 ± 3.90 mm 2 , P< 0.001), pLAD (14.28 ± 3.55 mm 2 vs. 11.36 ± 2.07 mm 2, P = 0.001), pLCx (10.94 ± 3.60 mm 2 vs. 9.15 ± 2.93 mm 2 , P = 0.045), and pRCA (13.41 ± 4.85 mm 2 vs. 11.22 ± 3.20 mm 2 , P = 0.018). Despite an increase in coronary luminal area, patients with HCM exhibited significantly higher V sub/MLA 2 compared to the control group in both the pLAD (403.56 ± 200.35 mm -1 vs. 241.70 ± 85.87 mm -1 , P < 0.001) and the pRCA (186.06 ± 95.07 mm -1 vs. 125.07 ± 70.18 mm -1 , P= 0.007). V sub/MLA 2 was significantly elevated in patients with chest pain compared to those without in the pLAD (473.75 ± 227.38 mm -1 vs. 314.24 ± 110.74 mm -1 , P = 0.018) and the pLCx (417.04 ± 182.65 mm -1 vs. 275.29 ± 112.97 mm -1 , P = 0.044). Conclusion CCTA-derived V sub/MLA 2 may more accurately reflect the balance between myocardial blood supply and demand, offering insights into the occurrence of demand angina in patients with HCM without obstructive coronary artery disease.

Objective: To compare coronary artery dimension-adjusted subtended myocardial mass between patients with hypertrophic cardiomyopathy (HCM) and a normal population without detectable atherosclerosis, and between HCM patients with and without chest pain. Materials and Methods: Twenty-five patients with HCM but no detectable atherosclerosis on coronary computed tomography angiography (CCTA) were included in the study. This group comprised 14 patients with chest pain and 11 patients without chest pain. They were matched with 25 healthy participants based on sex, age, coronary dominance pattern, and body surface area. The minimal lumen area (MLA) and subtended myocardial volume (V sub) were assessed in the left main (LM), proximal left anterior descending (pLAD), proximal left circumflex (pLCx), and proximal right coronary (pRCA) arteries. Additionally, an index of the subtended myocardial mass adjusted for the MLA, calculated as V sub/MLA 2 , was determined. Results: MLA was significantly larger in patients with HCM compared to the control group in LM (20.93 ± 6.31 mm 2 vs.15.24 ± 3.90 mm 2 , P< 0.001), pLAD (14.28 ± 3.55 mm 2 vs. 11.36 ± 2.07 mm 2, P = 0.001), pLCx (10.94 ± 3.60 mm 2 vs. 9.15 ± 2.93 mm 2 , P = 0.045), and pRCA (13.41 ± 4.85 mm 2 vs. 11.22 ± 3.20 mm 2 , P = 0.018). Despite an increase in coronary luminal area, patients with HCM exhibited significantly higher V sub/MLA 2 compared to the control group in both the pLAD (403.56 ± 200.35 mm -1 vs. 241.70 ± 85.87 mm -1 , P < 0.001) and the pRCA (186.06 ± 95.07 mm -1 vs. 125.07 ± 70.18 mm -1 , P= 0.007). V sub/MLA 2 was significantly elevated in patients with chest pain compared to those without in the pLAD (473.75 ± 227.38 mm -1 vs. 314.24 ± 110.74 mm -1 , P = 0.018) and the pLCx (417.04 ± 182.65 mm -1 vs. 275.29 ± 112.97 mm -1 , P = 0.044). Conclusion CCTA-derived V sub/MLA 2 may more accurately reflect the balance between myocardial blood supply and demand, offering insights into the occurrence of demand angina in patients with HCM without obstructive coronary artery disease.