Purpose: Declines in masticatory function have been reported to be closely associated with cognitive impairment and reduced brain activity in older adults. This study aimed to investigate the effects of intraoral vibratory stimulation on masticatory function, cognitive performance, and brain activity in elderly individuals and to evaluate its potential efficacy. Materials and Methods: Participants were divided into a vibration-stimulation group (n=9) and a non-vibration control group (n=7). Baseline assessments were conducted at the first visit. Participants then received either vibratory stimulation or a wash-out (control) condition for two weeks, followed by the same assessments at the final visit. Evaluation measures were dental assessments (maximum bite force, masticatory performance, and salivary flow rate), cognitive tests (CANTAB, paper-based and computerized tests), quantitative electroencephalography (qEEG), and functional magnetic resonance imaging (fMRI) during a short-term memory task. Results: No significant long-term effects or statistically meaningful differences were observed between the two groups in cognitive performance or brain activity. Similarly, no pre- to post-intervention differences were found between groups in dental measures related to masticatory function (maximum bite force, masticatory performance, and salivary flow rate). Due to the limited sample size, this study functioned as a pilot study focusing on descriptive rather than inferential statistical analysis. Conclusion Intraoral vibratory stimulation did not demonstrate immediate or clear effects on cognitive function or brain activity in older adults, suggesting the need for optimization of stimulation parameters such as location and intensity. Future studies with larger sample sizes and improved stimulation methods replicating masticatory function are warranted to further explore the potential cognitive benefits.

Zelkova serrata (Thunb.) Makino is a deciduous tree commonly distributed in East Asia. Several investigations have documented the biological activity of extracts of this species, igniting increased interest in its therapeutic potential. However, the phytochemical constituents accountable for these activities remain largely unexplored. In this study, we focused on the antioxidant potential of the leaves and twigs, utilizing bioactivityguided fractionation combined with LC-QTOF-MS online DPPH screening to systematically identify the active compounds. This approach led to the isolation of eight compounds, three of which (compounds 1, 3, and 7) have not previously been documented in the genus Zelkova. Among the isolates, 4 emerged as the most potent antioxidant, exhibiting significant radical scavenging activity in both DPPH (IC 50 = 13.67 ± 1.21 μM) and ABTS (IC50 = 2.69 ± 0.48 μM) assays, exceeding ascorbic acid (IC 50 = 61.51 ± 10.22 μM) and trolox (IC50 = 8.22 ± 2.16 μM), respectively. Our findings not only enrich the phytochemical profile of Z. serrata but also highlight the effectiveness of LC-MS-DPPH as an effective approach for rapid antioxidant discovery.

Purpose: This study evaluates the Korean Cancer Study Group Geriatric Score-7 (KG-7) frailty screening tool’s effectiveness in elderly multiple myeloma (MM) patients to prevent under and overtreatment. Materials and Methods: This prospective pilot cohort study included 100 elderly patients aged 70 and older with newly diagnosed MM who had not undergone transplantation from August 2020 to January 2022. Results: The median age was 77 years, and 73.0% of patients were classified at International Staging System stages 2 or 3. Using a 5-point cutoff on the KG-7 index (non-frail, score ≥ 5; frail, score < 5), 31% were categorized as frail. After a median follow-up of 26.8 months, the 3-year overall survival rate was 73.0%. There was no statistically significant association between any frailty index and the risk of death. However, frail patients defined by the simplified frailty index (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.09 to 5.95; p=0.030) and by KG-7 (HR, 2.43; 95% CI, 1.03 to 5.86; p=0.043) had a significantly higher risk of grade 3-4 non-hematologic toxicity, whereas the International Myeloma Working Group definition did not. Over a 24-month tracking period, vulnerability as measured by KG-7 either improved or deteriorated. Conclusion The pilot study, which had a limited number of participants, did not demonstrate KG-7’s effectiveness in predicting survival; however, it successfully predicted severe non-hematologic toxicities. We plan to conduct larger studies in elderly MM patients to determine whether KG-7 can help tailor their treatment regimens.

Purpose: High-cost novel therapies for multiple myeloma (MM) require evaluation of efficacy and cost-effectiveness. Materials and Methods: This study developed a methodology to assess cost-effectiveness using nationwide data from 11,450 newly diagnosed MM patients. A novel algorithm was applied to identify lines of therapy (LoT). Results: The number of newly diagnosed MM patients increased significantly, from 873 in 2010 to 1,464 in 2019 (p < 0.001). Advancing LoT was associated with shorter time to next treatment (TTNT) and overall survival (OS) (p < 0.001), while all-cause medical costs increased with each LoT (p < 0.001). Bortezomib-melphalan-prednisolone was the most common frontline regimen for transplant-ineligible patients (29.2%), while bortezomib-thalidomide-dexamethasone was most used for transplant-eligible patients (11.3%). Daratumumab monotherapy demonstrated superior second TTNT (7.8 vs. 5.2 months) and OS (8.5 vs. 5.3 months) compared to standard care in heavily treated MM patients, with statistical significance maintained after cost adjustment. For subsequent therapies following daratumumab, a methodology was developed to estimate required medical costs using the incremental cost-effectiveness ratio (ICER): Expected cost ($)=ICER×(Expected life expectancy–0.567)+35,601. Conclusion This study provides a novel cost-effectiveness framework linking treatment efficacy and real-world costs, supporting predictions of societal costs for future MM therapies.

Narcolepsy significantly affects the daily life of individuals due to excessive daytime sleepiness and cataplexy, reducing the quality of life and increasing the risk of accidents and social difficulties. Despite its profound impact on daily life, only a few studies have investigated the specific difficulties and awareness of patients with narcolepsy. Therefore, in this study, we aimed to assess the daily challenges and disease awareness of patients with narcolepsy. Methods: We conducted an online survey of 299 patients with narcolepsy. The survey included questions on patient demographics, clinical characteristics, difficulties, and disease awareness. Results: The patients reported considerable difficulties in academic performance, memory, and driving, with those with narcolepsy type 1 reporting greater difficulties than those with narcolepsy type 2. Older age and depression were positively associated with higher difficulty scores, whereas female sex was associated with lower difficulty scores. Notably, disease awareness varied, with 30.4% and 5.4% of participants showing moderate and no awareness of narcolepsy, respectively. Conclusions: Overall, this study highlights the daily life challenges and varying disease awareness of patients with narcolepsy. Our findings emphasize the need for targeted education and effective policy interventions to reduce the difficulties and improve the quality of life of patients with narcolepsy.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Narcolepsy significantly affects the daily life of individuals due to excessive daytime sleepiness and cataplexy, reducing the quality of life and increasing the risk of accidents and social difficulties. Despite its profound impact on daily life, only a few studies have investigated the specific difficulties and awareness of patients with narcolepsy. Therefore, in this study, we aimed to assess the daily challenges and disease awareness of patients with narcolepsy. Methods: We conducted an online survey of 299 patients with narcolepsy. The survey included questions on patient demographics, clinical characteristics, difficulties, and disease awareness. Results: The patients reported considerable difficulties in academic performance, memory, and driving, with those with narcolepsy type 1 reporting greater difficulties than those with narcolepsy type 2. Older age and depression were positively associated with higher difficulty scores, whereas female sex was associated with lower difficulty scores. Notably, disease awareness varied, with 30.4% and 5.4% of participants showing moderate and no awareness of narcolepsy, respectively. Conclusions: Overall, this study highlights the daily life challenges and varying disease awareness of patients with narcolepsy. Our findings emphasize the need for targeted education and effective policy interventions to reduce the difficulties and improve the quality of life of patients with narcolepsy.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background/Aims: Portal vein thrombosis (PVT) frequently occurs in patients with inflammatory bowel disease (IBD), particularly when influenced by factors such as abdominal infections, IBD flare-ups, or surgical procedures. The implications of PVT range from immediate issues such as intestinal ischemia to long-term concerns including portal hypertension and its complications. However, there is a notable gap in comprehensive studies on PVT in IBD, especially with the increasing incidence of IBD in Asia. This research aimed to evaluate the clinical features and outcomes of PVT in patients with IBD at a leading hospital in South Korea. Methods: This retrospective analysis reviewed adult patients diagnosed with both IBD and PVT from 1989 to 2021 at a renowned South Korean medical center. The study focused on patient characteristics, specifics of PVT, administered treatments, and outcomes, all confirmed through enhanced CT scans. Results: A total of 78 patients met the study’s criteria. Notably, only 20.5% (16/78) were treated with oral anticoagulants; however, a vast majority (96.2%; 75/78) achieved complete radiographic resolution (CRR). When comparing patients receiving anticoagulants to those who did not, a significant preference for anticoagulant use was observed in cases where the main portal vein was affected, as opposed to just the left or right veins (p = 0.006). However, multivariable analysis indicated that neither anticoagulant use nor previous surgeries significantly impacted CRR. Conclusions Patients with IBD and PVT generally had favorable outcomes, regardless of anticoagulant use.

Aortic regurgitation (AR) in children is usually caused by congenital valve anomalies, and Behçet syndrome (BS) can be suspected in cases of isolated AR. Patients with BS undergoing aortic valve surgery due to aortic valve invasion have a high risk of complications, such as leakage around the valve and dehiscence. Cardiovascular involvement occurs in 7%–46% of adult patients with BS and is the main cause of mortality; however, its prevalence is unclear and rare in children. A 12-year-old boy was diagnosed with severe AR associated with BS. A progressive subaortic pseudoaneurysm was observed after aortic valve replacement. The periaortic intracardiac pouch was at risk of rupture; therefore, the patient underwent a Bentall operation. After the Bentall procedure, a newly developed subaortic pseudoaneurysm was detected below the prosthetic valve. However, the risk of rupture reduced as the subaortic pseudoaneurysm regressed with anti-inflammatory drugs alone without reoperation. Repeated surgery is inevitable in patients with BS undergoing aortic valve surgery due to the progressive chronic inflammatory reactions that present with a pseudoaneurysm. Here, we report an 8-year follow-up of a pediatric case of BS with subaortic pseudoaneurysm, highlighting the importance of close follow-up, medical management, and early diagnosis in treating this condition.