Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated remarkable efficacy in the management of diabetes and obesity; however, their potential association with acute pancreatitis has been debated since their early clinical use. Numerous cases of suspected GLP-1 RA-related pancreatitis have been reported in the literature and pharmacovigilance databases, raising concerns about their safety. This review aims to examine the clinical and mechanistic evidence linking GLP-1 RA use to acute pancreatitis, including recent clinical studies, meta-analyses, and pathophysiological investigations. Based on the latest clinical evidence and practice guidelines, we propose strategies for the safe and appropriate use of GLP-1 RAs in clinical practice.

Purpose: Esophagojejunostomy leakage (EJL) remains one of the most critical complications following total gastrectomy for gastric cancer. This study aimed to evaluate the evolving therapeutic approaches and clinical outcomes of EJL using data from a large-scale multicenter retrospective cohort. Methods: Among 6,577 patients who underwent total gastrectomy or proximal gastrectomy with double tract reconstruction at nine institutions from 2003 to 2024, 196 (3.0%) developed EJL. Of these, 162 patients with comprehensive clinical data were included in the final analysis. The study examined treatment modalities, changes in management over time, patient characteristics, surgical variables, and clinical outcomes. Four groups were defined according to treatment approach: conservative, endoscopic, reoperation, and multimodal (combined) therapy. Results: Endoscopic therapy was first introduced in 2011 and has progressively supplanted reoperation, now comprising 32.5% of cases. The average time to EJL diagnosis was 8.4 days after surgery. Overall in-hospital mortality was 6.1% (10/162). When conservative management was excluded, endoscopic treatment demonstrated the highest rate of therapeutic success (94.3%, p = 0.004). Both the duration until diet resumption and length of hospital stay were notably reduced in the endoscopic and conservative groups compared with reoperation and multimodal therapy (p < 0.001). Moreover, although the highest post-leakage hospitalization costs were observed with multimodal treatment (p < 0.001), overall hospitalization expenses were significantly lower for patients managed conservatively or with endoscopic intervention (p < 0.001). Conclusion Over the past two decades, management of EJL has shifted toward endoscopic approaches. Endoscopic therapies yield superior clinical outcomes and should be considered a primary option for appropriate candidates.

Hyperbaric oxygen therapy (HBOT) was conducted on two male patients with chronic prostatitis/chronic pelvic pain syndrome who were resistant to conventional medical therapies. Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 90 min/day, five days/week for four weeks) in a hyperbaric chamber. The follow-up period was three months. Although the patients reported a slight improvement in the pain domain of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) after HBOT, no changes were noted in the other domains of NIH-CPSI and International Prostate Symptom Score. No adverse events were encountered during or after HBOT.

Methods: The symptomatic PSTS group received intravenous (IV) administration of dexamethasone or furosemide. The asymptomatic PSTS group did not receive any medication. Patients were divided into the control (no medication, n=31), Dexa (IV dexamethasone, n=25), and Furo (IV furosemide, n=28) groups. PSTS was checked daily with simple radiographs and medication-induced reductions in PSTS from its peak or after medication. Results: The peak time (postoperative days) of PSTS in the control (2.27±0.47, p<0.05) and Dexa (1.91±0.54, p<0.01) groups were significantly later than that in the Furo group (1.38±0.74). PSTS was significantly lower in the Furo group than in the Dexa group from postoperative days 4 to 7 (p<0.05). PSTS reduction after the peak was significantly greater in the Furo group than in the control (p<0.01) and Dexa (p<0.01) groups. After starting the medication therapy, the Furo group showed a significantly greater reduction in PSTS than the Dexa group (p<0.01). No difference was found in symptom improvement among the three groups. Conclusions If furosemide is used to reduce PSTS after ACF, it can effectively reduce symptoms.

Hyperbaric oxygen therapy (HBOT) was conducted on two male patients with chronic prostatitis/chronic pelvic pain syndrome who were resistant to conventional medical therapies. Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 90 min/day, five days/week for four weeks) in a hyperbaric chamber. The follow-up period was three months. Although the patients reported a slight improvement in the pain domain of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) after HBOT, no changes were noted in the other domains of NIH-CPSI and International Prostate Symptom Score. No adverse events were encountered during or after HBOT.

Background: Islet transplantation holds promise for treating selected type 1 diabetes mellitus patients, yet the scarcity of human donor organs impedes widespread adoption. Porcine islets, deemed a viable alternative, recently demonstrated successful longterm survival without zoonotic risks in a clinically relevant pig-to-non-human primate islet transplantation model. This success prompted the development of a clinical trial protocol for porcine islet xenotransplantation in humans. Methods: A single-center, open-label clinical trial initiated by the sponsor will assess the safety and efficacy of porcine islet transplantation for diabetes patients at Gachon Hospital. The protocol received approval from the Gachon Hospital Institutional Review Board (IRB) and the Korean Ministry of Food and Drug Safety (MFDS) under the Investigational New Drug (IND) process. Two diabetic patients, experiencing inadequate glycemic control despite intensive insulin treatment and frequent hypoglycemic unawareness, will be enrolled. Participants and their family members will engage in deliberation before xenotransplantation during the screening period. Each patient will receive islets isolated from designated pathogen-free pigs. Immunosuppressants and systemic infection prophylaxis will follow the program schedule. The primary endpoint is to confirm the safety of porcine islets in patients, and the secondary endpoint is to assess whether porcine islets can reduce insulin dose and the frequency of hypoglycemic unawareness. Conclusion A clinical trial protocol adhering to global consensus guidelines for porcine islet xenotransplantation is presented, facilitating streamlined implementation of comparable human trials worldwide.

Purpose: Predicting improvements in voiding symptoms following deobstructive surgery for male lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is challenging when detrusor contractility is impaired. This study aimed to develop an artificial intelligence model that predicts symptom improvement after holmium laser enucleation of the prostate (HoLEP), focusing on changes in maximum flow rate (MFR) and voiding efficiency (VE) 1-month postsurgery. Methods: We reviewed 1,933 patients who underwent HoLEP at Samsung Medical Center from July 2008 to January 2024. The study employed a deep neural network (DNN) for multiclass classification to predict changes in MFR and VE, each divided into 3 categories. For comparison, additional machine learning (ML) models such as extreme gradient boosting, random forest classification, and support vector machine were utilized. To address class imbalance, we applied the least squares method and multitask learning. Results: A total of 1,142 patients with complete data were included in the study, with 992 allocated for model training and 150 for external validation. In predicting MFR, the DNN achieved a microaverage area under the receiver operating characteristic curve (AUC) of 0.884±0.006, sensitivity of 0.783±0.020, and specificity of 0.891±0.010. For VE prediction, the microaverage AUC was 0.817±0.007, with sensitivity and specificity values of 0.660±0.014 and 0.830±0.007, respectively. These results indicate that the DNN's predictive performance was superior to that of other ML models. Conclusions The DNN model provides detailed and accurate predictions for recovery after HoLEP, providing valuable insights for clinicians managing patients with LUTS/BPH.

Hyperbaric oxygen therapy (HBOT) was conducted on two male patients with chronic prostatitis/chronic pelvic pain syndrome who were resistant to conventional medical therapies. Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 90 min/day, five days/week for four weeks) in a hyperbaric chamber. The follow-up period was three months. Although the patients reported a slight improvement in the pain domain of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) after HBOT, no changes were noted in the other domains of NIH-CPSI and International Prostate Symptom Score. No adverse events were encountered during or after HBOT.

Purpose: Predicting improvements in voiding symptoms following deobstructive surgery for male lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is challenging when detrusor contractility is impaired. This study aimed to develop an artificial intelligence model that predicts symptom improvement after holmium laser enucleation of the prostate (HoLEP), focusing on changes in maximum flow rate (MFR) and voiding efficiency (VE) 1-month postsurgery. Methods: We reviewed 1,933 patients who underwent HoLEP at Samsung Medical Center from July 2008 to January 2024. The study employed a deep neural network (DNN) for multiclass classification to predict changes in MFR and VE, each divided into 3 categories. For comparison, additional machine learning (ML) models such as extreme gradient boosting, random forest classification, and support vector machine were utilized. To address class imbalance, we applied the least squares method and multitask learning. Results: A total of 1,142 patients with complete data were included in the study, with 992 allocated for model training and 150 for external validation. In predicting MFR, the DNN achieved a microaverage area under the receiver operating characteristic curve (AUC) of 0.884±0.006, sensitivity of 0.783±0.020, and specificity of 0.891±0.010. For VE prediction, the microaverage AUC was 0.817±0.007, with sensitivity and specificity values of 0.660±0.014 and 0.830±0.007, respectively. These results indicate that the DNN's predictive performance was superior to that of other ML models. Conclusions The DNN model provides detailed and accurate predictions for recovery after HoLEP, providing valuable insights for clinicians managing patients with LUTS/BPH.

Background: Islet transplantation holds promise for treating selected type 1 diabetes mellitus patients, yet the scarcity of human donor organs impedes widespread adoption. Porcine islets, deemed a viable alternative, recently demonstrated successful longterm survival without zoonotic risks in a clinically relevant pig-to-non-human primate islet transplantation model. This success prompted the development of a clinical trial protocol for porcine islet xenotransplantation in humans. Methods: A single-center, open-label clinical trial initiated by the sponsor will assess the safety and efficacy of porcine islet transplantation for diabetes patients at Gachon Hospital. The protocol received approval from the Gachon Hospital Institutional Review Board (IRB) and the Korean Ministry of Food and Drug Safety (MFDS) under the Investigational New Drug (IND) process. Two diabetic patients, experiencing inadequate glycemic control despite intensive insulin treatment and frequent hypoglycemic unawareness, will be enrolled. Participants and their family members will engage in deliberation before xenotransplantation during the screening period. Each patient will receive islets isolated from designated pathogen-free pigs. Immunosuppressants and systemic infection prophylaxis will follow the program schedule. The primary endpoint is to confirm the safety of porcine islets in patients, and the secondary endpoint is to assess whether porcine islets can reduce insulin dose and the frequency of hypoglycemic unawareness. Conclusion A clinical trial protocol adhering to global consensus guidelines for porcine islet xenotransplantation is presented, facilitating streamlined implementation of comparable human trials worldwide.