Objective: This study aimed to describe the technique and outcomes of transforaminal endoscopic lumbar discectomy (TELD) for bilateral disc herniation. Methods: This retrospective review analyzed prospectively collected data. Patients who underwent single-level TELD for bilateral lumbar disc herniation with bilateral radiculopathy were included. The transforaminal entry approach utilized a 15° angle, compared to the conventional 30°. The disc space was approached from the side with the annular tear rather than the side with more severe symptoms. After introducing the working cannula and endoscope, the ipsilateral herniated disc was identified and removed. The approach angle was then adjusted to a more horizontal orientation to allow central decompression. The route to the contralateral herniated disc was identified, and the fragment was excised. Adequate decompression was confirmed by observing epidural pulsations, after which closure was performed. Operative time, length of hospital stay, patient-reported outcome measures, including the visual analogue scale (VAS) for back and leg pain and Oswestry Disability Index (ODI), and complications were analyzed. Results: Thirty-four patients were included, with a mean age of 41.6 years. The mean operative time was 58 minutes, and the mean hospital stay was 1.2 days. Significant postoperative improvement was observed in VAS back, VAS leg, and ODI scores. No intraoperative complications occurred. One patient (2.9%) developed postoperative dysesthesia, which resolved with conservative management. Another patient (2.9%) experienced reherniation, requiring revision endoscopic discectomy. Conclusion TELD for bilateral lumbar disc herniation with bilateral radiculopathy resulted in favorable clinical outcomes and minimal complications.

Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

Objective: Patients with panic disorder (PD) are approximately four times more likely than the general population to exhibit suicidal ideation (SI) and suicide attempts. Although prolonged duration of untreated illness (DUI) is a known risk factor for adverse outcomes in mood disorders, its impact on suicidality among patients with PD has not been well established. This study investigated whether prolonged DUI is associated with heightened SI among patients with PD, considering sociodemographic and clinical factors. Methods: A total of 804 patients with PD were recruited. DUI was defined as the time between symptom onset and the initiation of psychiatric treatment. Clinical assessments included the Scale for Suicide Ideation (SSI), Beck Depression Inventory-II (BDI-II), and Panic Disorder Severity Scale. Sociodemographic and clinical predictors of SI were examined using independent t-tests, Pearson’s correlations, and multiple regression analysis. Results: In patients with PD, the mean DUI was 41.56 months. Longer DUI was positively correlated with higher SSI total scores, along with greater depression severity. Gender women, unmarried status, and elevated BDI-II scores were significantly predicted higher SSI total scores. In the multiple regression model, prolonged DUI remained an independent predictor of SSI (B=0.116, p=0.012) after adjusting for other variables. Conclusion These findings indicate that delayed treatment contributes to increased suicidality in PD, beyond demographic and depressive risk factors. Therefore, early detection and timely intervention using treatment strategies that enhance awareness, improve the accessibility of psychiatric services, and provide social support may reduce DUI and mitigate suicide risk among patients with PD.

Informed consent is a fundamental aspect of surgical care, designed to reinforce patient autonomy, promote shared decision-making, and potentially mitigate legal conflicts by ensuring the provision of comprehensive and consistent information in clinical practice. The Korean Society of Gynecologic Oncology (KSGO) previously published detailed informed consent documents for cervical, endometrial, and ovarian cancer surgery. However, standardized consent forms remain relatively lacking for laparoscopic-robotic hysterectomy performed for non-malignant indications, as well as for vulvar cancer surgery. Hence, the KSGO subcommittee collected, reviewed, and discussed consent forms from domestic medical institutions and subsequently developed informed consent for laparoscopic-robotic hysterectomy and vulvar cancer surgery, aiming to build patient trust and understanding.

Full-endoscopic surgery for highly upmigrated lumbar disc herniation often requires foraminotomy or laminotomy. However, in the presence of lytic spondylolisthesis, the “laminar lifting” technique can be used to directly access the highly upmigrated fragment without bone removal. We report 3 cases of recent-onset radiculopathy caused by highly upmigrated disc herniation with concurrent lytic spondylolisthesis. The affected level was L5–S1 in two cases and L4–5 in one case. Interlaminar endoscopic lumbar discectomy was performed at L5–S1, and transforaminal endoscopic lumbar discectomy at L4–5. After gaining access to the epidural space, the working cannula was depressed at its proximal end, thereby elevating its distal end. This maneuver produced a levering effect that lifted the lamina and created additional space in the epidural area. The working cannula could then be advanced further superiorly, allowing removal of the highly upmigrated disc fragment with endoscopic forceps. All patients had excellent outcomes without complications. These findings demonstrate that the “laminar lifting” technique is a safe and effective method for full-endoscopic removal of highly upmigrated disc herniation in the setting of lytic spondylolisthesis. It eliminates the need for bone removal and helps prevent further instability in lytic spondylolisthesis.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. Methods: A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model’s variables. Results: In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. Conclusion Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.

Cellular senescence causes cell cycle arrest and promotes permanent cessation of proliferation. Since the senescence of mesenchymal stem cells (MSCs) reduces proliferation and multipotency and increases immunogenicity, aged MSCs are not suitable for cell therapy. Therefore, it is important to inhibit cellular senescence in MSCs. It has recently been reported that metabolites can control aging diseases. Therefore, we aimed to identify novel metabolites that regulate the replicative senescence in MSCs. Using a fecal metabolites library, we identified nervonic acid (NA) as a candidate metabolite for replicative senescence regulation. In replicative senescent MSCs, NA reduced senescence-associated β-galactosidase positive cells, the expression of senescence-related genes, as well as increased stemness and adipogenesis. Moreover, in non-senescent MSCs, NA treatment delayed senescence caused by sequential subculture and promoted proliferation. We confirmed, for the first time, that NA delayed and inhibited cellular senescence.Considering optimal concentration, duration, and timing of drug treatment, NA is a novel potential metabolite that can be used in the development of technologies that regulate cellular senescence.