Background and Objectives: Clinical characteristics and outcomes in acute heart failure (AHF) vary by phenotype. We assessed phenotype-specific features, treatment patterns, and outcomes in a nationwide Korean cohort. Methods: The Korean Heart Failure III registry prospectively enrolled 7,351 AHF admissions at 47 hospitals. Among 6,777 patients with available left ventricular ejection fraction (EF), phenotypes were defined as heart failure with reduced EF (HFrEF, ≤40%), mildly reduced EF (HFmrEF,41–49%), or preserved EF (HFpEF, ≥50%). The primary endpoint was a 12-month composite of all-cause death or heart transplantation, evaluated from index admission and, among hospital survivors, from discharge. We used inverse probability weighting (multinomial generalized boosted models with stabilized, trimmed weights) and weighted Cox proportional-hazards models to estimate hazard ratios (HRs). Results: Phenotype distribution was 58.9% HFrEF, 13.6% HFmrEF, and 27.5% HFpEF. Crude 12-month composite rates from index admission were 13.4% (HFrEF), 12.7% (HFmrEF), and 16.8% (HFpEF). After weighting, from index admission, HFmrEF (HR, 0.892; 95% confidence interval [CI], 0.731–1.088) and HFpEF (HR, 1.101; 95% CI, 0.939–1.291) did not differ from HFrEF; from discharge, HFpEF had modestly higher risk (HR, 1.207; 95% CI, 1.008–1.445) whereas HFmrEF did not (HR, 1.039; 95% CI, 0.844–1.279). Hyponatremia and chronic kidney disease were consistent adverse markers, while angiotensin-converting enzyme inhibitor/ angiotensin II receptor blocker use at discharge was protective. Conclusions Across the EF spectrum, phenotypes showed distinct profiles and risk. Postdischarge risk was modestly higher in HFpEF, supporting phenotype-tailored care and systematic discharge optimization in Korean patients with AHF.

Purpose: To evaluate the clinical characteristics, etiologies, and treatment outcomes of pediatric macular holes (MHs). Methods: The medical records of pediatric patients under 18 years of age diagnosed with MHs at Severance Hospital between January 2005 and December 2022 were retrospectively reviewed. Data regarding etiology, MH diameter, treatment methods, and both visual and anatomical outcomes were analyzed. Results: Among 15 patients (16 eyes), traumatic MHs were identified in 7 cases (46.7%), while non-traumatic causes included Stargardt disease, familial exudative vitreoretinopathy, and vitreomacular traction. No statistically significant differences were observed between the traumatic and non-traumatic groups in terms of age, MH diameter, or initial and final best-corrected visual acuity (BCVA). However, there was a significant difference in sex distribution, with all traumatic cases occurring in males, whereas only 3 of the 9 non-traumatic eyes were male (p = 0.01). Surgical intervention was performed in 13 eyes, achieving anatomical closure in 62.5% (10 eyes). The three eyes without closure (37.5%) were all non-traumatic cases. BCVA (logMAR) significantly improved from a median of 1.00 preoperatively to 0.70 postoperatively (p = 0.013). Among the three eyes that did not undergo surgery, one demonstrated spontaneous closure, and another achieved closure following medical treatment. Conclusions Pediatric MHs may arise from various ocular conditions beyond trauma. Surgical intervention was effective, particularly for traumatic MHs, while non-traumatic cases demonstrated a lower closure rate. In some instances, spontaneous or medically induced closure occurred without surgical management. Further multicenter studies with larger cohorts are warranted to establish definitive management guidelines for pediatric MHs.

Objective: Non-pharmacological interventions (NPIs) are effective in treating gaming disorder (GD). However, studies have not comprehensively evaluated the most effective NPIs. This systematic review and meta-analysis aimed to evaluate the effects of NPIs on the prevention and reduction of GD in the general population with GD. Methods: We searched five databases (MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL) for English-language randomized controlled trials (RCTs) published till May 12, 2024, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two independent reviewers selected studies, extracted data, and assessed quality using the Cochrane Risk of Bias Tool (RoB2). Meta-analyses were conducted using a random-effect model, with effect sizes calculated using Hedges’s g and heterogeneity assessed using I2 statistics. Results: A total of 18 RCTs involving 1,950 participants were included. The NPIs included psychotherapy, behavioral interventions, and other strategies. The pooled analysis showed a significant reduction in GD severity (Hedges’s g=-0.82; 95% confidence interval, -1.23 to -0.52; I2=90.36%). Psychotherapy, particularly cognitive-behavioral therapy, showed the most substantial effect (10 studies, 1,036 participants; Hedges’s g=-1.34). Behavioral interventions (4 studies, 456 participants) and prevention-focused interventions (6 studies, 1,164 participants) had smaller but positive effects. Subgroup analyses revealed greater effectiveness of treatment interventions in adults than in adolescents. Sensitivity analyses confirmed the robustness of these results despite high heterogeneity (I2=90.36%). Conclusion NPIs, particularly psychotherapy, are effective in reducing GD severity. However, more high-quality RCTs are needed robust, evidence-based treatment guidelines.

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.

Objective: Non-pharmacological interventions (NPIs) are effective in treating gaming disorder (GD). However, studies have not comprehensively evaluated the most effective NPIs. This systematic review and meta-analysis aimed to evaluate the effects of NPIs on the prevention and reduction of GD in the general population with GD. Methods: We searched five databases (MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL) for English-language randomized controlled trials (RCTs) published till May 12, 2024, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two independent reviewers selected studies, extracted data, and assessed quality using the Cochrane Risk of Bias Tool (RoB2). Meta-analyses were conducted using a random-effect model, with effect sizes calculated using Hedges’s g and heterogeneity assessed using I2 statistics. Results: A total of 18 RCTs involving 1,950 participants were included. The NPIs included psychotherapy, behavioral interventions, and other strategies. The pooled analysis showed a significant reduction in GD severity (Hedges’s g=-0.82; 95% confidence interval, -1.23 to -0.52; I2=90.36%). Psychotherapy, particularly cognitive-behavioral therapy, showed the most substantial effect (10 studies, 1,036 participants; Hedges’s g=-1.34). Behavioral interventions (4 studies, 456 participants) and prevention-focused interventions (6 studies, 1,164 participants) had smaller but positive effects. Subgroup analyses revealed greater effectiveness of treatment interventions in adults than in adolescents. Sensitivity analyses confirmed the robustness of these results despite high heterogeneity (I2=90.36%). Conclusion NPIs, particularly psychotherapy, are effective in reducing GD severity. However, more high-quality RCTs are needed robust, evidence-based treatment guidelines.

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.

Background/Aims: Inaccurate prediction of lymph node metastasis (LNM) may lead to unnecessary surgery following endoscopic resection of T1 colorectal cancer (CRC). We aimed to validate the usefulness of artificial intelligence (AI) models for predicting LNM in patients with T1 CRC. Methods: We analyzed the clinical data, laboratory results, pathological reports, and endoscopic findings of patients who underwent radical surgery for T1 CRC. We developed AI models to predict LNM using four algorithms: regularized logistic regression classifier (RLRC), random forest classifier (RFC), CatBoost classifier (CBC), and the voting classifier (VC). Four histological factors and four endoscopic findings were included to develop AI models. Areas under the receiver operating characteristics curves (AUROCs) were measured to distinguish AI model performance in accordance with the Japanese Society for Cancer of the Colon and Rectum guidelines. Results: Among 1,386 patients with T1 CRC, 173 patients (12.5%) had LNM. The AUROC values of the RLRC, RFC, CBC, and VC models for LNM prediction were significantly higher (0.673, 0.640, 0.679, and 0.677, respectively) than the 0.525 suggested in accordance with the Japanese Society for Cancer of the Colon and Rectum guidelines (vs RLRC, p<0.001; vs RFC, p=0.001; vs CBC, p<0.001; vs VC, p<0.001). The AUROC value was similar between T1 colon versus T1 rectal cancers (0.718 vs 0.615, p=0.700). The AUROC value was also similar between the initial endoscopic resection and initial surgery groups (0.581 vs 0.746, p=0.845). Conclusions AI models trained on the basis of endoscopic findings and pathological features performed well in predicting LNM in patients with T1 CRC regardless of tumor location and initial treatment method.

Background/Aims: The study investigated the incidence, risk factors, and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with ulcerative colitis (UC). Methods: This single-center retrospective study included patients with UC who underwent total proctocolectomy with ileal pouch-anal anastomosis at the Asan Medical Center in Korea between January 1987 and December 2022. The primary outcomes were endoscopic remission and pouch failure. The Cox’s proportional hazard model was used to identify the risk factors for CARP. Results: The clinical data of 232 patients were analyzed. The most common cause of surgery was steroid refractoriness (50.9%), followed by dysplasia/colorectal cancer (26.7%). Among 74 patients (31.9%) with chronic pouchitis (CP), 31 (13.4%) had CARP, and 43 (18.5%) had chronic antibiotic-dependent pouchitis (CADP). The most frequent endoscopic phenotype was focal inflammation of the pouch (CP, 47.3%; CARP, 35.5%; CADP, 55.8%). Patients with CARP were less likely to use concomitant probiotics than patients with CADP (29.0% vs 72.1%, p<0.01). The endoscopic remission rate of CP, CARP, and CADP was 14.9%, 9.7%, and 18.6%, respectively.The pouch failure rate associated with CP, CARP, and CADP was 13.5%, 16.1%, and 11.6%, respectively. Current smoking status (adjusted hazard ratio [aHR], 2.96; 95% confidence interval [CI], 1.27 to 6.90; p=0.01) and previous use of biologics/small molecules (aHR, 2.40; 95% CI, 1.05 to 5.53; p=0.04) were significantly associated with CARP development. Conclusions UC patients who were current smokers and previously used biologics/small molecules had a higher risk of developing CARP. Concomitant use of probiotics was less likely to be associated with CARP development.

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.