Amputation in the context of infectious and ischemic foot and ankle diseases, including diabetic foot, Buerger’s disease, arteriosclerosis obliterans, and frostbite, demands a reconstructive approach aimed at functional restoration rather than mere disease removal. Surgical success depends on meticulous debridement, tension-free closure, strategic determination of the amputation level based on vascular assessment, and staged management of concurrent infection. Proper tourniquet use, preservation of viable soft tissue, including plantar skin flaps, appropriate wound closure, and the judicious use of skin grafts and flap surgery are fundamental principles. Vascular evaluation, including Doppler ultrasonography and transcutaneous oxygen pressure measurement, guides the amputation plane. Optimizing the nutritional status and glycemic control is critical in the diabetic population. Beyond the surgical technique, the psychosocial burden on patients and caregivers demands a multidisciplinary approach incorporating psychological support and social services. Clear, documented informed consent that specifically addresses the intraoperative level change and re-amputation risk is an ethical obligation and an essential legal safeguard. A successful outcome requires balancing limb salvage with functional restoration while addressing the clinical, psychological, and legal complexities of these cases.

Purpose: The Dietary Reference Intakes for Koreans (KDRIs) serve as a foundation for nutrition policy, nutrition education, and dietary intake evaluation among healthy Koreans.The KDRIs are revised every five years to ensure that the guidelines are based on a robust and up-to-date scientific foundation. For the 2025 KDRIs for calcium, the 2020 KDRIs were revisited, and references were critically evaluated. Methods: All references cited in the 2020 KDRIs were extracted, reviewed, and organized according to the framework for the estimated average requirement (EAR). Each reference was evaluated based on the participant characteristics, including age, race/ethnicity, and health status, as well as study design, exposure, and outcomes. In addition, calculations for the EAR and Recommended Nutritient Intakes were re-examined for each sex and age group and compared with the current literature. Results: Major revisions in the 2025 KDRIs were driven by updates in the reference bodyweight, improved consistency in rounding and coefficients of variation, inclusion of studies in East Asian populations, and clarification of the use of calcium balance studies.Nevertheless, further studies in Koreans, particularly in pregnant and lactating women, are needed to strengthen the scientific evidence for the calcium DRI. Conclusion The 2025 KDRIs for calcium were revised to be based on more robust logical reasoning and calculation methods. Future research conducted on Korean populations is necessary to define the calcium requirements for Koreans more accurately.

Buttock augmentation is an increasingly popular cosmetic procedure designed to enhance buttock contour, size, and shape. However, the safety profile of this procedure remains insufficiently established, and it carries risks of complications, including foreign body reactions and infections. These complications may be exacerbated by filler migration, resulting in large soft-tissue cavities that resemble pseudocysts. In this study, we describe two patients who developed severe complications following massive filler injections to the buttocks. A 56-year-old female patient presented with a 6×5 cm soft-tissue defect associated with an extensive underlying dead space, sinus tract formation, and a large pocket extending across the buttock. Additionally, a 50-year-old female patient developed diffuse cellulitis and multiple abscesses secondary to migration of an infected filler-related pseudocyst. Both patients underwent successful en bloc capsulectomy, resulting in marked clinical improvement without recurrence or postoperative complications. These cases underscore the serious complications associated with large-volume filler injections and highlight the importance of comprehensive surgical management in addressing late-stage adverse outcomes.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Purpose: There have been efforts to find alternative samples other than standard samples of tissue or plasma for mutational analyses for lung cancer patients. However, no other sample or technique has replaced the mutational analyses using standard samples. In this prospective study, we assessed a novel bronchoscopy method, named as targeted washing technique, for detecting the epidermal growth factor receptor (EGFR) mutation. Materials and Methods: A 3.0-mm ultrathin bronchoscope was precisely navigated to the target lung lesion with the assistance of virtual bronchoscopic navigation and fluoroscopy. Once the bronchoscope is placed in front of target lung lesion, 0.9% normal saline was instilled for targeted washing. EGFR testing using targeted washing fluid (TWF) was compared to standard methods using plasma or tumor tissue. Results: In 41 TWF samples, the T790M mutation was detected in tissue, plasma, and TWF samples at rates of 22.0%, 9.8%, and 29.3%, respectively. The overall EGFR T790M detection rate using tissue, plasma, or TWF samples was 36.6%, with TWF samples increasing the T790M mutation detection rate by up to 10%. The accuracy of T790M mutation detection using TWF sample was 82.9% compared with standard samples. Four patients were found to have the EGFR T790M mutation solely through EGFR testing using TWF, which repeated rebiopsies using either plasma or tissue finally confirmed to have the T790M mutation. Conclusion We demonstrated the clinical potential of targeted washing technique for molecular testing, which can be a good option to overcome spatial heterogeneity, low sensitivity of plasma sample or technical limitations in collecting tumor tissues.

Objective: To explain process of developing basic veterinary clinical performance guidelines, based on frequently observable clinical manifestations, thereby supporting competencybased veterinary education in Korea. Methods: A structured review of learning outcomes established by Korean Association of Veterinary Medical Colleges (KAVMC) was conducted by a planning committee including veterinary educators, practitioners, and advisory members. Owner-oriented descriptions were used to frame each performance task, and each was mapped to corresponding learning outcomes. These tasks were aligned with learning outcomes recommended by the KAVMC to support the development of communication, clinical reasoning, and performance-related competencies among veterinary students, thereby enhancing day-one clinical readiness. Results: In total, 63 clinical manifestations for a guidebook format that can be used for clinical education were identified and categorized by organ systems that are described in language understandable to animal owners. Conclusions and Relevance: The basic veterinary clinical performance guidelines based on common clinical manifestations would serve as a vital component in veterinary education to reinforce core graduation competencies.

Background: Intradialytic hypotension (IDH) is a critical complication related to worse outcomes in patients undergoing maintenance hemodialysis. Herein, we addressed the impact of IDH on mortality and other outcomes in patients with severe acute kidney injury (AKI) requiring intermittent hemodialysis. Methods: We retrospectively reviewed 1,009 patients who underwent intermittent hemodialysis due to severe AKI. IDH was defined as either dialysis discontinuation due to hemodynamic instability or a decrease in systolic blood pressure (BP) of ≥30 mmHg, with or without a nadir systolic BP of <90 mmHg during the first session. The primary outcome was all-cause mortality, and transfer to the intensive care unit (ICU) due to unstable status was additionally analyzed. Hazard ratios (HRs) of outcomes were calculated using a Cox regression model after adjusting for multiple variables. Risk factors for IDH were evaluated using a logistic regression model. Results: IDH occurred in 449 patients (44.5%) during the first hemodialysis session. Patients with IDH had a higher mortality rate than those without IDH (40% vs. 23%; HR, 1.30; 95% confidence interval [CI], 1.02–1.65). The rate of ICU transfer was higher in patients experiencing IDH than in those without IDH (17% vs. 11%; HR, 1.43; 95% CI, 1.02–2.02). Factors such as old age, high BP and pulse rate, active malignancy, cirrhosis, and hypoalbuminemia were associated with an increased risk of IDH episodes. Conclusion The occurrence of IDH is associated with worse outcomes in patients with AKI requiring intermittent hemodialysis. Therefore, careful monitoring and early intervention of IDH may be necessary in this patient subset.

Hepatocellular carcinoma (HCC) is a highly invasive tumor with a strong tendency for metastasis. The most common sites of metastasis are the lungs, followed by lymph nodes, adrenal glands, and bones. However, metastasis of HCC to the small bowel is extremely rare. A 42-yearold female with HCC secondary to chronic hepatitis B and lung metastasis underwent a right hepatic lobectomy, followed by two wedge resections performed via video-assisted thoracic surgery, four sessions of transcatheter arterial chemoembolization, and stereotactic body radiation therapy. She was under regular follow-up for HCC, during which her alpha-fetoprotein level increased to 722.2 IU/ml. Abdominal computed tomography (CT) revealed segmental wall thickening and aneurysmal dilatation of the small bowel loops. An 18 F-fluorodeoxyglucose positron emission tomography/CT scan demonstrated a 3.3-cm hypermetabolic mass-like lesion (standardized uptake value: 11.3) in the small bowel. Surgical resection of the affected small bowel segment was performed. Histopathological examination of the specimen confirmed metastatic HCC, with immunohistochemical positivity for hepatocyte-specific antigen. The patient has remained cancer-free for 60 months post-operatively. Surgical intervention may offer favorable long-term outcomes in patients with small bowel metastasis from HCC.

Rheumatoid neutrophilic dermatitis (RND) is a rare extra-articular skin lesion associated with rheumatoid arthritis (RA). Lesions typically occur symmetrically on the extensor surfaces of the extremities and present with variable clinical features. A 78-year-old female with a 2-month history of skin rash on the right forearm and left lower leg, with no other systemic symptoms, visited the dermatology department of our hospital. She had been diagnosed with seropositive RA approximately 20 years ago. The skin rash was asymmetrically distributed and presented with localized pustules, purpura, and edema. The biopsy specimen showed dermal infiltration by neutrophils, leukocytoclasia without vasculitis, and a neutrophilic dermal abscess. No fungi or bacteria were detected on any of the stains. The patient was diagnosed with RND. Clinical improvement was noted after treatment with dapsone, followed by colchicine and methylprednisolone. In this case report, we described the case of a female patient with atypically presented RND and conducted a literature review.

Objective: : In 2006, the Korean Neurotraumatology Society (KNTS) established the 1st Korean Neurotrauma Data Bank Committee (KNTDBC) and developed the Korean Neurotrauma Data Bank System (KNTDBS). Full-scale registration of traumatic brain injury (TBI) patient data began in September 2010. Since then, KNTS has conducted two trauma-related data registration projects and is now in its 5th term of the KNTDBC. This study aimed to introduce the KNTDBS of the KNTS and report the results of the second project. Methods: : Between January 2018 and June 2021, 1109 TBI patients were registered from 18 hospitals. The inclusion criteria were 1) patients who visited the hospital with TBI, 2) patients with severe TBI with a Glasgow coma scale (GCS) score of 8 or lower, and 3) adult patients aged 19 years or older. Exclusion criteria were 1) patients under 18 years of age, 2) patients with a GCS score of 9 or higher, and 3) patients with a history of previous craniotomy or craniectomy. Data from the second project were registered into seven major categories : patient registration, neuroimaging, neuromonitoring, hypothermia, surgical treatment, medical treatment, and patient evaluation. Results: : The characteristics of TBI patients in this study were not significantly different from those in previous studies, including the 1st project of KNTS. The GCS had a large number of severe patients with scores of 3 and 4, which was associated with the highest proportion of patients having bilateral pupils with unrecordable responses. Most TBI patients had severe or critical injuries (score 4 or 5) concentrated in the Abbreviated incentive scale head but had minor injuries to other regions of the body. Rotterdam computed tomography scores of 5 and 6 primarily indicated acute subdural hematomas. Surgical treatment was performed in 36.2% of all TBI cases. Most hospitals used levetiracetam and valproate as prophylactic antiepileptic drugs. Neuromonitoring, hypothermia, and coma therapy were not actively performed. The overall mortality rate was 33.3%, and among 740 survivors, 3.9% underwent shunt surgery. Conclusion : The creation of a database for TBI patient data facilitated the collection of objective and valid information on trauma. Utilizing data from the KNTDBS will significantly aid in the treatment and prevention of TBI and contribute to the improvement of healthcare in the country.