Neuropathic pain markedly impairs quality of life and imposes a substantial socioeconomic burden, while available treatments often provide only partial relief and are limited by safety concerns. The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG-IASP) first published pharmacologic recommendations in 2007, followed by a major update in 2015 and a new guideline in 2025. This narrative review specifically compares the 2015 and 2025 NeuPSIG-IASP guidelines, outlining key methodological changes and therapeutic shifts. The 2025 guideline is based on a larger, more rigorous meta-analysis, maintains α2δ-ligands (adds mirogabalin), serotonin-noradrenaline reuptake inhibitors, and tricyclic antidepressants as first-line drugs, downgrades tramadol into the opioid third-line group. It also introduces high-frequency motor-cortex repetitive transcranial magnetic stimulation as a weakly recommended third-line option and discusses implications for Korean clinical practice.

Purpose: This study aimed to develop and evaluate the effectiveness of the Trauma-nursing Education and Skill Support (TESS) program based on the ADDIE model (Analysis, Design, Development, Implementation, Evaluation model). The program was designed to enhance trauma nurses’ clinical competencies, including trauma-related knowledge, self-efficacy, and problem-solving ability, through the integration of theoretical education and simulation-based practice. Methods: A quasi-experimental study using a non-equivalent control group pretest–posttest design was conducted. Participants included 108 trauma nurses from regional trauma centers, military trauma centers, and emergency care facilities, who were assigned to an experimental group (n=52) or a control group (n=56). The TESS program consisted of a 2-day, 14-hour blended-learning course that included eight lecture sessions and four simulation-based practice stations. Data were collected at baseline, immediately after the intervention, and at 6 months using validated instruments measuring trauma-related knowledge, self-efficacy, and problem-solving ability. Two-way repeated-measures analysis of variance was used for data analysis. Results: The experimental group demonstrated significant improvements in trauma-related knowledge, self-efficacy, and problem-solving ability compared with baseline (all p<.001). These improvements were sustained at 6 months, although trauma-related knowledge scores showed a slight decline compared with immediate posttest levels. Between-group analyses confirmed significant group-by-time interaction effects for all outcomes: trauma-related knowledge (η2=0.12, p<.001), self-efficacy (η2=0.09, p=.002), and problem-solving ability (η2=0.08, p=.003). Conclusion The TESS program effectively enhanced trauma nurses’ trauma-related knowledge, self-efficacy, and problem-solving ability, with effects sustained for up to 6 months. Incorporating blended learning and simulation-based training into standardized trauma nursing education may strengthen clinical competencies and ultimately contribute to improved patient outcomes.

Background: Hair drying is a routine cosmetic practice; however, excessive heat exposure and non-uniform airflow can compromise cuticle integrity, degrade hair sensory properties, and induce scalp discomfort. This study aimed to (i) identify a practical thermal window that minimizes perturbation of hair fiber surface and quantify late-stage thermal amplification during the drying process using percentage-based analysis. Methods: Temperature-dependent hair fiber surface morphology was examined by scanning electron microscopy (SEM) after controlled exposure to 41°C, 60°C, 80°C, and 90°C using virgin and chemically damaged hair. The drying efficacy was assessed using the surface and internal moisture indices under airflow shaping (test) and uniform airflow (control) conditions. Hair fluttering (maximum angular displacement) was evaluated before and after drying under warm-cool alternating (60°C-80°C) versus constant hot airflow (80°C). Results: SEM revealed temperature-dependent cuticle disruption, with markedly greater surface perturbation at 90°C than at 80°C. Infrared thermography demonstrated pronounced late-stage thermal amplification: at 150 seconds, the surface temperature increased by 295% (from 24.2°C to 72.0°C) at 90°C, compared with 207% (from 24.2°C to 50.7°C) at 80°C. Airflow shaping promoted preferential surface moisture removal (–13.6%) while limiting internal dehydration (–9.4%), whereas the control condition exhibited minimal surface drying (–4.6%) but substantial internal moisture loss (–22.2%). Warm-cool modulation increased hair fluttering by +11.0%, whereas constant hot airflow reduced it (–3.7%). Conclusion These findings indicate that spatial and temporal control of heat delivery represents a clinically relevant design strategy beyond the nominal temperature specification in hair-drying devices.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Background/Aims: Helicobacter pylori is a pathogen that causes chronic gastritis and peptic ulcer diseases and is a carcinogen responsible for the development of malignancies, including gastric cancer. In the current era of high antimicrobial resistance, rifabutin-based triple therapy is recommended as a salvage therapy. Bismuth has not only a strong bacteriostatic effect but also a synergic effect when combined with antibiotics. Our study aimed to compare and evaluate the eradication rates between rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy as salvage treatments. Methods: In this single-center study, patients who received rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy after failure of conventional therapy, including first- and second-line treatment, between January 2016 and July 2024, were retrospectively investigated. A total of 53 patients who received rifabutin-based triple therapy and 50 who received bismuth-containing quadruple therapy were included. Results: In the rifabutin-based triple therapy group, eradication was achieved in 32 out of 53 patients (60.4%; 95% confidence interval [CI], 46.8% to 74.0%). In the bismuth-containing quadruple therapy group, eradication was achieved in 40 out of 50 patients (80.0%; 95% CI, 68.5% to 91.5%), demonstrating significant therapeutic benefit (p=0.030). Adverse events, including nausea, epigastric discomfort, and lethargy, were significantly more frequent in the bismuth-containing quadruple therapy group (p=0.007), but they were mild and tolerable enough not to affect compliance (p=0.329). Conclusions Rifabutin with bismuth-containing quadruple regimen as a salvage treatment achieved significantly superior eradication efficacy over the rifabutin-based triple regimen. Further multicenter prospective studies are needed to provide additional supporting evidence.

Spinal cord infarction (SCI) is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO). We report the case of a 62-year-old man who developed paraplegia with sensory deficits following VA-ECMO for septic shock. Magnetic resonance imaging demonstrated posterior spinal artery (PSA) infarction at the T11–T12 level. Electrodiagnostic studies revealed atypical findings, including absent sensory nerve action potentials and compound muscle action potentials, along with denervation of the lumbar paraspinal muscles. These abnormalities are not fully explained by PSA infarction alone and suggest the coexistence of central and peripheral mechanisms. This case illustrates a rare presentation of posterior SCI following VA-ECMO with atypical neurophysiological features and highlights the importance of multimodal evaluation for accurate diagnosis and rehabilitation planning.

Perineural (Nabors type II) cysts are typically located at the dorsal root ganglion (DRG) and are rarely reported in the cervical spine. When present, they are usually solitary and confined to the DRG level. We report a rare case of cervical perineural cysts occurring both at the DRG and proximal to the DRG within the same nerve root sleeve. A 53-year-old woman presented with intermittent left arm pain and numbness involving the left thumb, index finger, and thenar region, suggestive of C6 radiculopathy. Magnetic resonance imaging revealed a central-to-left C5-C6 disc herniation that mildly indented the ventral epidural space without significant compression of the C6 nerve root, as well as a central C6–C7 disc herniation that did not narrow the neural foramen or contact the C7 nerve root. Notably, a perineural cyst proximal to the DRG directly compressed the left C6 dorsal nerve root. Electrodiagnostic studies were normal. This case demonstrates that perineural cysts can occur proximal to the DRG and may contribute to radicular symptoms. Recognition of atypical cyst locations may improve diagnostic accuracy.

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients. Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates. Results: Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively). Conclusion Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.