Purpose: This study aimed to analyze changes in plantar pressure distribution at the fifth metatarsal (M5) during running with different foot strike patterns. Methods: Thirty-five healthy adults ran barefoot over a foot scan pressure plate installed in a 10-m shuttle walkway.Each participant completed 10 trials per strike pattern and mean peak pressures at M1–M5 heads and M5 base of the dominant foot was analyzed. Results: The mean peak pressures at M2– M5 heads increased progressively from heel to midfoot to forefoot strike (p＜ 0.05). Significant differences among strike patterns were found at M2–M5 heads (p＜ 0.05). Post hoc analysis showed that forefoot strike produced significantly higher pressures at M2–M5 heads than heel and midfoot strikes (p＜ 0.001). At M5, peak pressure at the head increased from heel (14.54±7.82) to midfoot (15.54±7.75) to forefoot strike (19.37±7.37), whereas peak pressure at the base decreased from heel (6.27±1.69) and midfoot strikes (5.85±1.94) to forefoot strike (4.35±1.79). At M5, both the head and base demonstrated significant differences according to strike pattern. Conclusion Plantar pressure patterns vary across foot strike types, with forefoot strike producing greater M5 head loading but lower base loading. These findings suggest that forefoot-based low-intensity running may be considered as an early loading option during rehabilitation after Jones fractures, although further clinical studies are needed to confirm its clinical benefits.

Objective: To investigate the incidence and risk factors of cardiovascular disease (CVD) in adolescent and young adult survivors of cervical cancer. Methods: This retrospective cohort study used data from the Korean National Health Insurance Service. Adolescent and young adult (AYA) cervical cancer survivors (n=7,803) were matched with non-cancer controls (n=23,327) using 1:3 propensity score matching, and hazard ratios (HRs) for CVD were determined using Cox regression models. Multivariable Cox regressions were used to assess CVD incidence according to cancer treatment and identify risk factors. Results: A total of 7,803 AYA survivors with cervical cancer were analyzed in this study during a median 8.9 years of follow-up. They developed any CVD with an adjusted HR of 1.47 (95% confidence interval [CI]=1.33–1.62) compared with the non-cancer controls. Those who underwent concurrent chemoradiotherapy had markedly elevated risks of heart failure (subHR=2.66; 95% CI=1.24–5.72), ischemic heart disease (subHR=1.78, 95% CI=1.11–2.86), deep vein thrombosis (subHR=15.32; 95% CI=9.16–25.63), and pulmonary embolism (subHR=14.99; 95% CI=6.31–35.62). Diabetes, hypertension and chemoradiation therapy were identified as potential risk factors that increase the risk of CVD by 1.55-fold, 1.62-fold and 2.64-fold, respectively. Conclusion These findings indicate a need to pay increased attention to cardiovascular health management in adolescent and young adult cervical cancer survivors, particularly those treated with chemoradiotherapy.

Background and Objectives: Direct head-to-head comparisons between the PolarX and the Arctic Front Advance Pro (AFA-Pro) system remain limited. This study aimed to assess whether the PolarX offers better clinical outcome compared to the AFA-Pro, particularly in patients with persistent AF. Methods: We performed a retrospective study of 306 patients undergoing cryoballoon ablation from March 2023 to August 2024. This population was divided into two groups based on the duration of AF episode: the paroxysmal AF group (n = 206) and the persistent AF group (n = 100). Among those with persistent AF, there were 47 in the AFA-Pro group and 53 in the PolarX group. The primary outcome was freedom from AF/atrial tachycardia (AT). Results: In patients with paroxysmal and persistent AF, the mean follow-up durations were 347.1 ± 156.0 days (median, 350.5 days; interquartile range [IQR], 201.8 to 482.5) and 345.5 ± 166.5 days (median, 331.0; IQR, 184.3 to 495.5), respectively. In patients with paroxysmal AF, the PolarX did not improve freedom from AF/AT compared to the AFA-Pro (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.63 to 2.42; P = 0.546). However, in patients with persistent AF, the PolarX showed a difference in freedom from AF/AT compared to the AFAPro (HR, 0.45; 95% CI, 0.24 to 0.99; P = 0.022). Conclusions The use of the PolarX showed a difference in freedom from AF/AT recurrence in patients with persistent AF, which reached statistical significance.

Background: This report presents annual data from the surgical site infection (SSI) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2021 to June 2022. Methods: Surveillance of 20 surgeries (e.g., stomach, colon, rectal, gallbladder surgery, knee replacement, hip replacement, craniotomy, ventricular shunts, spinal fusion, laminectomy, cardiac artery bypass grafting - incision in the chest site only and incisions both the chest and donor site, cardiac, prostatectomy, abdominal hysterectomy, vaginal hysterectomy, appendectomy, thoracic, cesarean section, and head and neck surgeries) associated with SSI was performed between July 1, 2021, and June 30, 2022, according to the KONIS Manual 2020. Results: A total of 133,281 surgical cases were collected and 1,100 SSIs were identified, resulting in a SSI rate of 0.83%. The SSI rates for 30-day surveillance surgeries were 1.9% for stomach, 2.82% for colon, 1.88% for rectal, 0.29% for gallbladder, 0.25% for lumbar laminectomy, 0.33% for cesarean section, 0.67% for abdominal hysterectomy, 0.74% for vaginal hysterectomy, 0.23% for prostatectomy, 1.39% for appendectomy, and 0.06% for thoracic surgeries. Neck surgery could not be analyzed due to no reported cases. The SSI rates for the 90-day surveillance surgeries were 0.16% for knee replacement, 0.54% for hip replacement, 0.89% for spinal fusion, 0.70% for craniotomy, 0.92% for ventricular shunt, 1.13% for cardiac, 1.80% for cardiac artery bypass grafting (chest only incision), and 1.64% for cardiac artery bypass grafting (chest and leg incision) surgeries. In total, 608 strains were isolated and cultured from 1,286 infections. Conclusion Compared with the incidence of SSI (1.06%) in 2018, the overall incidence decreased, and most site-specific infection rates decreased or remained the same.

Background: While Korea maintains a low prevalence of human immunodeficiency virus (HIV), the number of newly diagnosed cases has been steadily rising, reaching approximately 1,000 annually in recent years. The 2022 annual report from the Korea Disease Control and Prevention Agency revealed that women living with HIV (WLWH) constitute 6.4% of the total confirmed people living with the HIV population, totaling 1,219 individuals. Despite this, only a few studies have focused on WLWH in Korea. This study aims to analyze the epidemiological and clinical characteristics of WLWH in Korea. Materials and Methods: We retrospectively collected data by reviewing the medical records of all WLWH who visited 10 urban referral hospitals across Korea between January 2005 and May 2023. Results: A total of 443 WLWH were enrolled in this study. The predominant risk exposure was heterosexual contact, with 235 (53%) participants either married or cohabiting with a male partner at their initial clinic visit. Among the participants, 334 (77.7%) were Korean, 27 (6.1%) were Southeast Asian, and 19 (4.3%) were African. Antiretroviral therapy was initiated by 404 WLWH (91.2%). We observed 118 pregnancies in WLWH following their HIV diagnosis, resulting in 78 live births (66.1%), 18 induced abortions (15.2%), 10 pre-viable fetal losses (8.5%), and four stillbirths (3.4%). Over a cumulative follow-up duration of 3,202.1 years, the incidence rates of breast and cervical cancers were both 2.18 per 1,000 person-years. Additionally, the incidence rates of pelvic inflammatory disease, cervical intraepithelial neoplasm (above grade II), and osteoporosis were 4.67, 11.21, and 13.39 per 1,000 patient-years, respectively. Conclusion This is the first multicenter study to investigate the clinical and epidemiological characteristics of WLWH in Korea. The incidence and prevalence of diseases in women, including breast cancer, cervical cancer, and chronic comorbidities, are high in WLWH in Korea; therefore, further research and efforts are needed to manage these diseases.

The pathophysiology of sepsis is characterized by a systemic inflammatory response to infection; however, the cytokine blockade that targets a specific early inflammatory mediator, such as tumor necrosis factor, has shown disappointing results in clinical trials. During sepsis, excessive endotoxins are internalized into the cytoplasm of immune cells, resulting in dysregulated pyroptotic cell death, which induces the leakage of late mediator alarmins such as HMGB1 and PTX3. As late mediators of lethal sepsis, overwhelming amounts of alarmins bind to high-affinity TLR4/MD2 and low-affinity RAGE receptors, thereby amplifying inflammation during early-stage sepsis. In this study, we developed a novel alarmin/receptor-targeting system using a TLR4/MD2/RAGE-blocking peptide (TMR peptide) derived from the HMGB1/PTX3-receptors interacting motifs. The TMR peptide successfully attenuated HMGB1/PTX3- and LPS-mediated inflammatory cytokine production by impairing its interactions with TLR4 and RAGE. Moreover, we developed TMR peptide-conjugated liposomes (TMR-Lipo) to improve the peptide pharmacokinetics. In combination therapy, moderately antibiotic-loaded TMR-Lipo demonstrated a significant therapeutic effect in a mouse model of cecal ligation- and puncture-induced sepsis. The identification of these peptides will pave the way for the development of novel pharmacological tools for sepsis therapy.

Objective: Spinal stenosis is a prevalent condition; however, the optimal surgical treatment for central lumbar stenosis remains controversial. This study compared the clinical outcomes and radiological parameters of 3 surgical methods: unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (ULBD-UBE), conventional subtotal laminectomy (STL), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: This retrospective study included 86 patients, divided into ULBD-UBE (n=34), STL (n=24), and MIS-TLIF (n=28) groups. We evaluated demographics and perioperative factors and assessed clinical outcomes using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and neurogenic intermittent claudication (NIC). Radiological parameters assessed included lumbar lordosis, L4S1 Cobb angle (L4S1), T12S1 Cobb angle (T12S1), increased cross-sectional dural area (CSA), dynamic angulation (DA), dynamic slip (DS), and development of postoperative instability. Results: The ULBD-UBE group showed a significantly shorter hospital stay duration and operation time and reduced blood loss than the other groups (p<0.001). ULBD-UBE group showed a trend towards greater VAS and ODI improvement at 1 month and postoperative NIC symptom relief. Radiologically, MIS-TLIF group exhibited lower postoperative DA and DS (p<0.001), indicating higher postoperative stability. Postoperative instability was lower in the ULBD-UBE group (2.9%) than in the STL group (16.7%) and similar to the MIS-TLIF group (0.0%) (p=0.028). The CSA was highest in the MIS-TLIF group (295.5%) compared to that in the other groups (ULBD-UBE, 216.3%; STL, 245.2%) (p<0.001). Conclusion Compared to other procedures, ULBD-UBE is a safe, effective, and viable surgical procedure for treating lumbar central stenosis.

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs). Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters. Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36. Conclusion Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.

Purpose: The female sex is reported to have a higher risk of adverse events (AEs) from cytotoxic chemotherapy. Few studies examined the sex differences in AEs and their impact on the use of medical services during adjuvant chemotherapy. This sub-study aimed to compare the incidence of any grade and grade ≥ 3 AEs, healthcare utilization, chemotherapy completion rate, and dose intensity according to sex. Materials and Methods: This is a sub-study of a multicenter cohort conducted in Korea that evaluated the impact of healthcare reimbursement on AE evaluation in patients who received adjuvant chemotherapy between September 2013 and December 2016 at four hospitals in Korea. Results: A total of 1,170 patients with colorectal, gastric, or non–small cell lung cancer were included in the study. Female patients were younger, had fewer comorbidities, and experienced less postoperative weight loss of > 10%. Females had significantly higher rates of any grade AEs including nausea, abdominal pain, stomatitis, vomiting, and neutropenia, and experienced more grade ≥ 3 neutropenia, nausea, and vomiting. The dose intensity of chemotherapy was significantly lower in females, and they also experienced more frequent dose reduction after the first cycle. Moreover, female patients receiving platinum-containing regimens had significantly higher rates of unscheduled outpatient visits. Conclusion Our study found that females experienced a higher incidence of multiple any-grade AEs and severe neutropenia, nausea, and vomiting, across various cancer types, leading to more frequent dose reductions. Physicians should be aware of sex differences in AEs for chemotherapy decisions.

There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270).Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients.