Diabetic foot ulcers (DFUs) are among the most serious and common complications of diabetes mellitus. They significantly affect patients’ quality of life and impose a substantial economic burden on healthcare systems worldwide. In Korea, the prevalence of diabetes and related complications, such as DFUs, has been increasing, reflecting a broader global trend. DFUs are associated with severe complications, including infections, neuropathy, and peripheral arterial disease, often leading to amputation. In Korea, diabetic foot complications are a major cause of non-traumatic lower-extremity amputations, with high mortality rates following amputation. DFUs also significantly reduce patients’ quality of life and increase healthcare costs. The management of DFUs requires a multidisciplinary approach that integrates medical, surgical, and advanced therapeutic interventions to prevent severe outcomes, such as amputation. This comprehensive review of DFU management in patients with diabetes was developed in collaboration with the Diabetic Study Group of the Korean Diabetes Association and Korean Society for Diabetic Foot. This review examines the epidemiology, clinical significance, diagnosis, and evidence-based treatment of DFUs.

Background: Non-thermal atmospheric pressure plasma (NTAP) generates reactive oxygen species, reactive nitrogen species, and ultraviolet radiation, which can inactivate microorganisms.Onychomycosis treatment is challenging, and its prognosis is poor owing to mixed infections and dermatophytosis. Although NTAP has shown in vitro antifungal effects against dermatophytes and yeast, its efficacy against non-dermatophyte molds (NDMs) and in clinical or nail model studies remains poorly understood. Objective: We evaluated the effects of NTAP on fungi, including NDMs, and infected nail plates. Methods: For the in vitro experiments, Trichophyton rubrum, Candida albicans, Aspergillus fumigatus, and Fusarium oxysporum strains were exposed to NTAP. After NTAP exposure (2,4 and 6 minutes), growth curve, cell viability, and biofilm biomass were assessed by absorbance wavelength of 600 nm, XTT assay, and crystal violet staining, respectively. For the ex vivo experiments, infected nail plates were analyzed using a scanning electron microscope. Results: T. rubrum and C. albicans showed greater growth inhibition with increasing NTAP exposure time, whereas A. fumigatus showed enhanced growth after 6 minutes exposure. Many fungal elements within the subungual hyperkeratosis of the ex vivo specimen were all damaged following NTAP exposure. Conclusion NTAP has antifungal effects on dermatophytes, yeast, and NDMs. We suggest that the intensity and time of NTAP application should be adjusted according to each strain and can be more effective when NTAP directly reaches the hyphae on the nail bed or subungual hyperkeratosis.

Background: Single nucleotide polymorphism-based chromosomal microarray analysis (CMA) can detect regions of homozygosity (ROHs), which may be associated with medical conditions; however, limited ROH data, especially in East Asians, complicates clinical interpretations. We characterized ROH distributions and frequencies in a Korean population using CMA, highlighting clinically relevant findings, including suspected uniparental disomy (UPD), using standardized criteria. Methods: We analyzed ROHs in 1,731 individuals who underwent postnatal CMA at a Ko-rean medical center. ROHs ≥ 3 Mb long were detected using the CytoScan Dx platform and Chromosome Analysis Suite Dx. Suspected UPD and consanguinity were assessed per the American College of Medical Genetics and Genomics technical standards. Results: We identified 3,962 ROHs, with 76.7% of patients carrying at least one. Common “hotspot” regions included 3p21.31p21.1 (20.3%), 11p11.2 (18.2%), 1q21.1q21.3(17.7%), and 1p33p32.3 (12.0%). Almost all ROHs observed in > 1% of patients had a median size of < 5 Mb. ROH frequencies correlated negatively with chromosomal recombina-tion rates and positively with gene densities. Additionally, 1.2% (N = 21) of patients exhib-ited ROH patterns suggestive of UPD or consanguinity (13 suspected UPDs on imprinted chromosomes, 6 on non-imprinted chromosomes, and 2 consanguinities); 8 of 13 patients with suspected UPD were diagnosed as having imprinting disorders, with no pathogenic copy number variations detected. Conclusions Our population-specific ROH data for Koreans improve clinical interpretations by minimizing the risk of overinterpreting benign variants and highlight the value of standardized criteria for reliably detecting UPD and consanguinity and integrating ROH analysis into routine CMA interpretations.

Purpose: Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy. Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited. This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size. Materials and Methods: This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024. Patients were categorized into four groups:conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery. The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization. Subgroup analyses were performed according to defect size. Results: Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years. Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%). In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029) compared with endoscopic treatment.Among those with defects ≥2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size. Conclusions Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm. For larger defects (≥2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy. These findings highlight the importance of individualized treatment selection based on defect size.

The gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the gastrointestinal tract. Between the 1990s and early 2000s, GIST was identified as a tumor characterized by KIT or PDGFRA mutations, resulting in imatinib being established as an effective targeted therapy. However, with advances in molecular diagnostics, approximately 10%–15% of GISTs have been reported to harbor alternative mutations, such as those in the succinate dehydrogenase subunit genes and BRAF, leading to the development of additional targeted therapies. GISTs exhibit a wide spectrum of clinical behaviors, ranging from indolent to highly aggressive, prompting the development of diverse risk classification systems. However, multiple systems remain in use, leading to inconsistent pathologic reports. Moreover, the mitotic counting method—a key factor in risk stratification—has become a major source of confusion among pathologists owing to the adoption of digital pathology and discrepancies between updated international guidelines and outdated reimbursement requirements. These inconsistencies have hindered pathologic reporting and communication between pathologists and clinicians. This review comprehensively overviews the historical background, molecular subtypes, and risk classification systems of GIST, focusing on evolving issues in mitotic rate evaluation and the application of risk classification systems in clinical practice.

Burning mouth syndrome remains a frequent source of diagnostic delay, repeated consultations, and fragmented care because it has long been treated as a “diagnosis of exclusion.” Recent updates in orofacial pain classification and research diagnostic frameworks support a practical shift: from an exclusionary label toward a structured diagnostic algorithm and staged, phenotype-guided management. This narrative, algorithm-focused clinical review aims to summarize clinically actionable evidence and to propose a “minimum sufficient workup” that prioritizes safety, efficiency, and patient-centered communication.We first outline pragmatic diagnostic criteria and key symptom patterns, then integrate current concepts of mixed mechanisms—peripheral neuropathic features, centralociplastic amplification, and psychosocial modulators—that account for symptom fluctuation and discordance between symptom severity and objective findings. The core of this review is a one-page stepwise algorithm: (1) confirm chronicity and absence of visible mucosal disease, (2) screen for red flags requiring urgent evaluation, (3) address common local contributors (e.g., candidiasis, irritants, contact allergy, xerostomia), (4) perform a targeted systemic/medication/deficiency panel, and (5) phenotype patients to guide staged treatment choices and follow-up. Finally, we provide a practical management framework emphasizing education, trigger control, and individualized combinations of topical, systemic, and behavioral interventions with predefined reassessment intervals. Future priorities include phenotype-stratified randomized trials and implementation outcomes that quantify reductions in diagnostic delay, misdiagnosis, and unnecessary testing.

Purpose: We report two individual rare cases of the simultaneous occurrence of retinal and choroidal macrovessels.Case summary: The first case involved a 39-year-old male who presented with a two-week history of metamorphopsia in his right eye.At the initial visit, visual acuity was 1.0 in both eyes. A choroidal macrovessel transversing the macula was observed in the right eye, and a vascular loop in the inferior retinal arcade and a retinal macrovessel crossing the macula were identified in the left eye. Optical coherence tomography (OCT) revealed bilateral pachyvessels and subretinal fluid in the right macula, which persisted after two months. The second case involved a 36-year-old male with a six-month history of decreased vision in his left eye. At the initial visit, visual acuity was 0.1 in the right eye and 1.0 in the left eye. Subretinal fluid and retinal macrovessel were observed in the left macula. Two months later, the subretinal fluid resolved spontaneously. At a seven-year follow-up, OCT demonstrated pachyvessels in both eyes. Conclusions Although retinal and choroidal macrovessels originated from distinct embryologic vascular systems and are unlikely to share a direct developmental pathway, both cases showed bilateral pachyvessels. Dysregulation of vascular signaling factors such as vascular endothelial growth factor and angiopoietin, which are involved in both retinal and choroidal vascular development, may contribute to the formation of these abnormal macrovessel structures.

Objective: Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in children, with an unknown cause and prolonged disease course. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) have improved outcomes in severe or refractory cases, but challenges remain due to disease heterogeneity and long-term management needs. Understanding treatment patterns of novel therapies is essential for optimizing care. This study aimed to investigate bDMARD treatment patterns in JIA patients using a real-world database. Methods: A retrospective analysis was conducted using Health Insurance Review and Assessment (HIRA) national claims data from 2007 to 2019. JIA patients were classified into bDMARDs and non-bDMARDs groups, with treatment patterns compared. Results: Among 1,728 JIA patients, 31.3% (n=541) received bDMARDs, with 15.5% (n=84) discontinuing treatment. The median time from diagnosis to first bDMARD was 36.7 (9.7~58.1) months, with a median treatment duration of 28.1 (11.5~54.4) months and follow-up of 24.3 (7.7~43.7) months post-discontinuation. In the non-bDMARDs group (68.7%, n=1,187), 68.7% (n=815) used conventional synthetic DMARDs (csDMARDs), with a 46.6% (n=380) discontinuation rate. Methotrexate, sulfasalazine, and hydroxychloroquine were the most prescribed csDMARDs. Etanercept (69.7%) was the most common first bDMARD, followed by adalimumab (19.0%) and tocilizumab (7.6%), with 14.8% switching to a second biologic. Discontinuation rates of csDMARDs were higher in the non-bDMARDs group (p<0.001). Conclusion This is the first comprehensive study profiling the treatment patterns of Korean patients with JIA using populationbased claims data. The findings enhance understanding of real-world treatment trends, aiding clinical decision-making.

Objective: In this study, we aimed to investigate the incidence and risk factors for interstitial nephritis in patients with ankylosing spondylitis (AS). Methods: We retrospectively analyzed the claims records of patients diagnosed with AS in Korea’s Health Insurance Review and Assessment Service Database between 2016 and 2019. The Assessment of Spondyloarthritis International Society nonsteroidal anti-inflammatory drugs (NSAIDs) intake score was used to calculate the NSAID dosage over 1 year after AS diagnosis. The incidence rate of interstitial kidney disease was calculated as the number of events per 1,000 person-years. The risks associated with sex, age, Charlson Comorbidity Index, comorbidities, and concomitant medications were assessed using the Cox proportional hazards model, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results: In total, 11,749 patients with AS were included in this study. Of these, 79 patients had interstitial nephritis, with an incidence rate of 2.50 per 1,000 person-years. In multivariable analysis, female sex (HR, 2.44; 95% CI, 1.56~3.83), hypertension (HR, 2.08; 95% CI, 1.15~3.76), and renal failure (HR, 3.70; 95% CI, 1.30~10.55) showed significant associations. However, NSAID use in the first year after AS diagnosis was not associated with interstitial nephritis occurrence. Conclusion The incidence of interstitial nephritis in patients with AS was 2.50 per 1,000 person-years, with female sex and comorbidities identified as significant risk factors. However, NSAID use during the first year after AS diagnosis was not associated with interstitial nephritis development.

Objective: Janus kinase (JAK) inhibitors are widely used to treat rheumatoid arthritis (RA); however, comparative analyses regarding their adverse events remain limited. This study aimed to compare the effects of different JAK inhibitors (tofacitinib, baricitinib, and upadacitinib) on hematological parameters in patients with RA in a real-world setting. Methods: This retrospective analysis included 552 patients with RA treated with JAK inhibitors between August 2015 and February 2024. Hematological parameters, including absolute neutrophil count (ANC) and platelet count, were assessed at baseline and after 6 months of treatment. Statistical analysis was performed to evaluate changes over time, and logistic regression analysis identified factors associated with hematologic alterations. Results: The 552 patients were divided into three groups: tofacitinib (n=264), baricitinib (n=143), and upadacitinib (n=145). No significant differences in baseline hematological parameters were observed across the groups. After 6 months, ANC decreased in all groups without significant differences among them (p=0.465). Patients receiving baricitinib had significantly higher platelet counts than those receiving tofacitinib (Pillai’s trace value of 0.063, p<0.001) or upadacitinib (Pillai’s trace value of 0.029, p<0.001).Multivariate analysis revealed that baricitinib was significantly associated with increased platelet counts (odds ratio, 2.009; 95% confidence interval, 1.212~3.331; p=0.007). Conclusion Although all three JAK inhibitors reduced ANC, baricitinib was associated with a substantial increase in platelet counts. These findings highlight the differences in adverse effect profiles among JAK inhibitors, emphasizing the importance of tailored monitoring in RA management.