Purpose: This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model. Methods: This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival.Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules. Results: The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size. Conclusion The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.

Purpose: Postoperative complications following gastric cancer surgery significantly impact patient outcomes, yet standardized definitions for these events have not been consistently applied across institutions in Korea. This study aimed to develop a consensus-based, standardized complication classification system specific to gastrectomy for gastric cancer as part of the Korean Quality Improvement Platform in Surgery (K-QIPS) initiative. Methods: As part of K-QIPS, a dedicated task force team (TFT) was formed with surgical experts from fourteen high-volume hospitals across Korea. The TFT conducted ten formal meetings to review existing literature and international guidelines, and incorporated findings from randomized controlled trials. The final complication list was developed through expert consensus and structured into a standardized framework. A Data Entry Manual was created to support consistent data collection by surgical clinical reviewers. Results: The TFT defined specific postoperative complications following gastrectomy for gastric cancer, including anastomotic leakage, duodenal stump leakage, pancreatic fistula, intra-abdominal and luminal bleeding, delayed gastric emptying, and internal hernia. Notably, internal hernia was described in standardized form for the first time. General complications were developed first and overlapped in part with the gastric cancer-specific list. The task force also produced a Data Entry Manual that provides practical instructions to ensure consistency and accuracy in complication reporting. Conclusion This nationwide consensus initiative established the first standardized complication classification system for gastric cancer surgery in Korea. The proposed definitions and data entry system are expected to improve complication reporting, enable multicenter research, support surgical quality benchmarking, and ultimately enhance patient outcomes.

Lycium Radicis Cortex (LRC), derived from the root bark of Lycium chinense Mill., has traditionally been used in East Asian medicine to mitigate heat in the blood and consumptive fever. This study investigates LRC’s effects on skeletal muscle in aged mice subjected to forced exercise and examines the protective properties of its primary constituents, kukoamines A (KA) and B (KB), against dexamethasone (DEX)-induced muscle atrophy. Sixteen-month-old male C57BL/6 mice underwent regular swimming and received oral LRC supplementation for 8 weeks. The effects of KA and KB on muscle atrophy were further explored using C2C12 myotubes treated with DEX. LRC administration significantly enhanced muscle mass, strength, and endurance, while reducing plasma lactate and creatinine levels compared to the control group. LRC also upregulated mRNA expression of MyoD, myogenin, MHC, Akt, and mTOR, and downregulated myostatin, FoxO3a, MuRF1, and atrogin-1 in gastrocnemius and soleus muscles. Furthermore, KA and KB alleviated DEX-induced muscle atrophy in C2C12 myotubes by reducing proteolysis and ROS production, enhancing SOD activity, and improving mitochondrial function. Taken together, LRC may be a useful supplement in exercise-based muscle strengthening and amelioration of muscle disorders, and KA and KB have shown potential as preventive and therapeutic agents for muscle atrophy, indirectly suggesting that the efficacy of LRC is attributed to KA and KB.

Purpose: The triggering receptor expressed on myeloid cells 2 (TREM2) creates an immunosuppressive environment, but the effects of anticancer treatment on TREM2 and the tumor microenvironment (TME) are not well established. This study investigates the impact of chemotherapy on TREM2-expressing macrophages within the lung adenocarcinoma TME. Materials and Methods: Using single-cell RNA sequencing datasets of paired normal-appearing lung tissue (NL) and tumor (Tu), human and mouse lung cancer tissue, and THP-1 cells, we observed the effects of anticancer drugs on them. Results: Myeloid cells (MY) were the second-most abundant non-epithelial component in the Tu, though less prevalent than in NL. Specific MY subclusters abundant in Tu showed overexpression of TREM2. In lung cancer-induced Kras-G12D mice, M2 proportion increased in Tu compared to NL; cisplatin increased TREM2+ M2 proportion in Tu. TREM2+ cells in Tu showed interactions with cell clusters showing characteristics of interstitial macrophage such as mo-lineage, mono-Mc, and CD163/LGMN cells via FN:CD44 and MIF:CD74+CXCR4, suggesting that they influence the recruitment of those cells to Tu and TME reshape. In M0-state THP-1 cells, cisplatin and osimertinib treatments induced polarization towards M1 and M2 states and increased TREM2 expression. Cisplatin promoted uptake of phosphatidylserine-coated latex beads by M0 cells, whereas osimertinib reduced uptake by polarized macrophages. These findings suggest anticancer treatments impact the lung immune microenvironment by altering the TREM2+ cells. Conclusion Given TREM2’s central inhibitory role in the tumor immune environment, effects of chemotherapeutic agents should be considered in developing TREM2-targeting therapies.

Background: Combined pelvic ring and acetabular fractures are complex injuries associated with high morbidity. Despite advancements in surgical techniques, limited data are available on the long-term functional outcomes and associated factors. This study aimed to identify the factors associated with functional outcomes in surgically treated patients with combined pelvic ring and acetabular fractures. Methods: This retrospective study included 25 adult patients who underwent definitive surgical fixation for radiologically confirmed combined pelvic ring and acetabular fractures at a Level I trauma center between 2005 and 2021, with a minimum clinical and radiological follow-up of 24 months. Surgical approaches included the Kocher–Langenbeck or modified Stoppa methods, tailored to fracture morphology. Matta–Saucedo and Matta criteria assessed the pelvic ring and acetabular reduction quality, respectively. Functional outcomes at 2 years were evaluated using the Rommens–Hessmann criteria. Neurological recovery was assessed clinically and by electromyography where indicated. The association between the injury characteristics and functional recovery was evaluated using t-tests and Fisher’s exact test. Results: The mean patient age was 40.4 years, and 72% were male. Transverse acetabular fractures (58.6%) and anteroposterior compression pelvic ring injuries (64%) were the most common injuries. Anatomic or congruent acetabular reduction (within 2–3 mm) was achieved in 89.6% of fractures and was significantly associated with superior functional outcomes (p = 0.002). Conversely, the pelvic ring reduction quality did not significantly correlate with functional outcomes (p = 0.314). Transverse acetabular fractures (p = 0.046) and initial neurological deficits (p = 0.032) were associated with poorer recovery. Among the patients with neurological injury, 60% achieved partial or full recovery. Overall, bony union occurred in 96% of cases, with a mean time to union of 14.3 weeks. Reported complications included neurological deficits (40%) and infections (8%). Conclusions Functional outcomes following the surgical fixation of combined pelvic and acetabular fractures are primarily influenced by the acetabular reduction quality and neurological status at presentation. Transverse fracture patterns are complex and associated with nerve injuries, posing additional challenges. These findings emphasize the importance of precise joint reduction and early neuroassessment. Further multicenter, prospective studies are warranted to optimize the management of these complex injuries.

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.

This study aimed to assess the utilization trends of pulmonary rehabilitation (PR) among lung cancer patients in Korea using the National Health Insurance Service (NHIS) database (2017 to 2021). PR was introduced and covered under the NHIS in 2016, primarily for chronic obstructive pulmonary disease, but recent evidence suggests its benefits for lung cancer patients. Data extraction was based on Korea Informative Classification of Diseases 8th revision codes C33 and C34, with PR prescriptions identified by codes MM440 and MM290.Descriptive statistical analysis was performed, and propensity score matching was used for comparison between PR and non-PR groups. Results showed a significant increase in PR utilization, with the number of patients receiving PR (MM440) rising from 1,002 in 2017 to 3,723 in 2021, indicating a 3.7-fold increase. However, the proportion of patients receiving PR remained low at 2.9% in 2021. Enhanced access to PR services and improved evaluation strategies are essential for optimizing patient outcomes.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) represents a devastating and growing global threat, calling for new antibiotic treatments. In Korea, the challenge of treating CRAB is compounded by high nosocomial acquisition rates and limited availability of novel antibiotics. Minocycline, a semisynthetic tetracycline derivative, has been proposed as a therapeutic option for CRAB infections. Nonsusceptibility to minocycline may occur through the efflux pump, TetB. The prevalence of tetB in A. baumannii has increased, along with higher minocycline minimum inhibitory concentrations (MICs). We aimed to evaluate minocycline susceptibility rates in clinical strains of CRAB, and the association between tetB carriage and minocycline susceptibility across different genotypes. Materials and Methods: Representative CRAB blood isolates were collected from Asan Medical Center, Seoul.Minocycline susceptibility was assessed using the Clinical and Laboratory Standards Institute (CLSI) breakpoint (≤4 mg/L) and the proposed pharmacokinetics (PK)/pharmacodynamics (PD) breakpoint (≤1 mg/L). Tigecycline was used as a comparator, and its susceptibility breakpoint for Enterobacterales defined by EUCAST was applied (≤0.5 mg/L).The presence of tetB was detected by PCR, and multilocus sequence typing (MLST) was performed using seven housekeeping genes. Results: Of the 160 CRAB blood isolates, 83.8% were susceptible to minocycline by the CLSI criteria, and 50.6% were PK-PD susceptible by the PK-PD criteria. The minocycline minimum inhibitory concentration (MIC)50 /MIC90 was 1/8 mg/L. tetB was present in 49% of isolates and was associated with a higher minocycline MIC (MIC50/90 2/8 mg/L vs. 1/2 mg/L). No clear correlation was observed between tetB positivity and tigecycline MIC. Nine MLSTs were identified, with significant differences in tetB carriage rates between the major sequence types. Notably, ST191, associated with non-tetB carriage and greater susceptibility to minocycline, declined over the study period (P=0.004), while ST451, associated with tetB carriage, increased. Conclusion tetB was present in 49% of CRAB isolates and was associated with higher MICs and non-susceptibility by both CLSI and PK-PD criteria. However, absence of tetB was not a reliable predictor of minocycline PK-PD susceptibility. Additionally, shifts over time towards genotypes with reduced minocycline susceptibility were observed. Further research is needed to correlate these findings with clinical outcomes and identify additional resistance mechanisms.

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.