Purpose: Radical cystectomy (RC), which is the standard of care for muscle-invasive and high-grade noninvasive bladder cancer, is accompanied by postoperative renal function deterioration. We aimed to evaluate the effect of serum albumin level on postoperative renal function decline after RC. Materials and Methods: A total of 272 patients with estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m 2 who underwent RC between October 2003 and December 2020 were included. Acute kidney injury (AKI) was defined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria, while postoperative chronic kidney disease (CKD) progression was defined as an eGFR <60 mL/minute/1.73 m 2 at ≥3 months after RC. Results: In our cohort, 20 (7.4%) and 99 (36.4%) patients experienced postoperative AKI and CKD progression, respectively, with a median follow-up period of 51.5 months. The median preoperative serum albumin level and eGFR were 4.1 g/dL and 82.0 mL/minute/1.73 m 2 , respectively. Preoperative serum albumin less than the median (4.1 g/dL) was associated with postoperative AKI (odds ratio [OR] 3.76, p=0.027) and CKD progression (OR 2.87, p<0.001) after adjusting for other factors. Conclusions Serum albumin level <4.1 g/dL was associated with short- and long-term renal function decline after RC, suggesting that close monitoring of renal function after RC might be considered in these patients.

Background: s/Aims: The patatin-like phospholipase domain-containing protein 3 (PNPLA3) I148M variant has been implicated in metabolic dysfunction-associated steatotic liver disease (MASLD), but its role in hepatocellular carcinoma (HCC) development is unclear. This study examines the association between the PNPLA3 I148M variant and HCC occurrence. Methods: A total of 562 MASLD patients, with and without HCC, were prospectively and consecutively enrolled at two universityaffiliated hospital between June 2024 and June 2025. Genomic DNA was extracted from buccal swabs or liver biopsy samples, and single nucleotide polymorphism genotyping was performed to determine the rs738409 genotype at codon 148 of PNPLA3. The histological grade of HCC was assessed using the Edmondson-Steiner (ES) grading system in patients who underwent core-needle liver biopsy. Results: Among 474 non-HCC patients, the GG genotype was found in 39.9%, GC in 37.1%, and CC in 23.0%. In 88 HCC patients, these frequencies were 45.5%, 36.4%, and 18.2%, respectively. No significant differences in GG genotype distribution were observed between HCC and non-HCC groups (P=0.509), nor in subgroups by sex, age, obesity status, cirrhosis status, fibrosis-4 index, or liver stiffness measurement. However, among HCC patients with histological grading, the GG genotype was significantly associated with higher ES grades (P=0.0076). Conclusions The PNPLA3 I148M GG genotype was not significantly associated with increased HCC occurrence in Korean MASLD patients within the present cohort. Although the GG genotype is known to play a role in development and progression of MASLD, further studies are warranted to clarify its contribution to tumor initiation and dedifferentiation.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Enterococcus faecium, particularly in its multidrug-resistant forms, causes invasive nosocomial infections. Given the limited data comparing the effectiveness of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the CLSI clinical breakpoints (CBPs) for quinupristin–dalfopristin (QD) resistance and the need to evaluate their practical application, we retrospectively investigated the susceptibility patterns of 287 E.faecium bloodstream isolates from Korean hospitals to QD using the updated EUCAST and CLSI CBPs and two antimicrobial susceptibility testing methods: disk diffusion (DD) and Sensititre broth microdilution (Sensititre). QD resistance rates were 5.9% (CLSI) and 18.8% (EUCAST) for DD and 22.6% (CLSI) and 28.2% (EUCAST) for Sensititre. The most prevalent QD resistance gene types among QD-resistant isolates were ermB+msrC+ or ermB– msrC+. Categorical agreement between DD and Sensititre ranged from 77.7% to 90.7%, depending on the testing method and CBPs applied. The EUCAST zone diameter CBPs more effectively help identify QD-resistant E. faecium isolates using the DD method than the CLSI zone diameter CBPs. In comparison, the CLSI minimum inhibitory concentration (MIC) CBPs provide more reliable results for resistance classification in the Sensititre method than EUCAST MIC CBPs. These findings would help improve clinical decision-making for treating multidrug-resistant E. faecium infections.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Purpose: This study aimed to evaluate the predictive value of apparent diffusion coefficient (ADC) values from magnetic resonance imaging (MRI) in assessing pathologic response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC) and the optimal cutoff value of ADC for predicting NAC response. Materials and Methods: Among 582 patients who underwent radical cystectomy between December 2011 and December 2024, we included 146 patients who received preoperative NAC and pretreatment MRI. Pathologic response was determined based on the surgical pathology results: patients with pathologic stage >pT2 and/or presence of nodal involvement (N+) were classified as nonresponders, while those with ≤pT2 and no nodal involvement (N0) were classified as responders. MRI-derived ADC values were compared between the 2 groups. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for predicting NAC response. Multivariate logistic regression analysis using preoperative parameter was performed and Kaplan-Meier survival analysis were utilized to assess overall survival (OS) and cancer-specific survival (CSS) according to NAC response. Results: Among the 146 patients, 90 (61.6%) were classified as responders, 56 (38.4%) were nonresponders. The mean ADC value was significantly higher in responders (1,100.35±249.12 mm2/sec) than in nonresponders (763.95±118.97 mm2/sec, p<0.001). ROC analysis demonstrated an area under the curve of 0.69, with an optimal cutoff value of 845.0 mm2/sec. Multivariate logistic regression identified ADC value as an independent predictor of NAC response (odds ratio, 1.025; 95% confidence interval, 1.006–1.043; p=0.008). During median follow-up 30.3 months, Kaplan-Meier analysis revealed that responders had significantly better 5-year OS (80.8% vs. 45.9%) and 5-year CSS (92.6% vs. 54.5%), with log-rank test p<0.001. Conclusion MRI-derived ADC values are a reliable imaging biomarker for predicting pathologic response to NAC in MIBC. Further validation in large-scale prospective studies is required to confirm these findings.

Purpose: This study aimed to assess the rate of germline variant detection following targeted cascade genetic testing among family members of prostate cancer (PCa) probands. Materials and Methods: Records of PCa patients with confirmed germline mutations and their family members recommended for cascade testing were retrospectively reviewed. Cascade testing for germline mutations identified in PCa probands was conducted among first-degree relatives (FDRs) and second-degree relatives. The rate of counseled family members who proceeded to actual testing, the proportion of mutation carriers detected, and the reasons for test refusal were analyzed. Clinical variables, including family history of malignancy and variant type, were also collected. Results: A total of 15 PCa patients and 44 eligible relatives were included in the final analysis. Eleven probands (73.3%) had a positive family history of cancer across 22 family members (18 FDRs). Among FDRs, breast/ovarian cancer (27.8%) and gastric cancer (22.2%) were the most common, followed by lymphoma, prostate, esophageal, and lung cancer (each 11.1%). Among probands, BRCA2 variants were predominant (80%, 12 of 15), followed by BRCA1 (n=2) and MLH1 (n=1) mutations. Of 41 eligible FDRs, 21 (51.2%) underwent genetic testing, and 61.9% (13 of 21) were found to carry identical germline mutations. Approximately half of the counseled family members declined testing due to concerns regarding privacy and disclosure, travel distance to the clinic, or loss to follow-up. Conclusion Over half of the FDRs who underwent cascade testing were confirmed to carry pathogenic germline variants. As the first study to evaluate cascade testing in family members of PCa probands in Korea, these findings underscore the strong heritable component of PCa and highlight the need to enhance participation in familial genetic screening.

Objectives: . Although mandibular advancement device (MAD) treatment is effective for obstructive sleep apnea (OSA), some concerns remain regarding its potential therapeutic impact and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. We conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Methods: . Fourteen patients diagnosed with OSA participated in this study. Polysomnography (PSG) was performed at the beginning of the clinical trial, and after 3 months of treatment, PSG with AMAD in situ was conducted. Results: . The mean scores for the Epworth Sleepiness Scale (ESS) and STOP-Bang were 8.21±4.21 and 5.00±1.00, respectively. After 3 months of AMAD treatment, the STOP-Bang scores improved to 3.75±1.06; however, the ESS scores did not show a significant change. Additionally, we observed statistically significant improvements in several respiratory parameters in the PSG data following AMAD treatment. These included reductions in the apnea-hypopnea index (AHI) (from 32.85±21.71 to 12.93±10.70), supine AHI (from 45.91±23.58 to 15.59±12.76), and lateral AHI (from 13.94±10.95 to 5.49±7.40). Improvements were also noted in the lowest O2 saturation (from 79.71±6.22 to 84.00± 5.71), total arousal number (from 191.14±112.07 to 86.57±48.80), and arousal index (from 33.76±21.00 to 15.05± 8.42). However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, no major side effects were observed during treatment, specifically related to tooth or jaw pain. Conclusion . Our clinical trial found that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Purpose: Bladder cancer is a common genitourinary malignant disease worldwide. Dasatinib is a small molecule inhibitor of Src family kinases. We investigated the anticancer effect and putative molecular mechanisms of dasatinib on T24 and cisplatin-resistant T24R2 human bladder cancer cells. Materials and Methods: Cell proliferation was measured using Cell Counting Kit-8 (CCK-8) and colony formation in dasatinib treated bladder cancer cells. Flow cytometry was used to determined cell cycle arrest and apoptosis. The expression of apoptosis and autophagy related proteins were detected by western blot analysis. Results: In bladder cancer cells, dasatinib significantly reduced cell proliferation, colony formation, and induced G1-phase arrest.Dasatinib triggered apoptosis along with an increased expression of apoptosis-related genes (caspases, PARP, and cytochrome c).Down-regulation of Bcl-2 and up-regulation of Bad, which are hallmarks of apoptosis, were found to play a dominant role in mediating the effects of dasatinib treatment. We further showed that dasatinib inhibits p-Src, p-PI3K, p-Akt, and p-mTOR in bladder cancer cells. Dasatinib also increased the expression of markers of autophagy flux such as LC3-II and p62. Conclusions These results confirmed that dasatinib is a potent chemotherapeutic drug which induces apoptosis and autophagy by suppressing the PI3K/Akt/mTOR pathway in bladder cancer cells.