Objectives: Patient blood management (PBM) is increasingly recognized as an essential strategy in obstetric care for reducing transfusion-related risks and improving maternal safety. Jehovah’s Witness (JW) women, who categorically refuse blood transfusion, represent a unique clinical population in which to evaluate the effectiveness of PBM. This study aimed to assess obstetric outcomes of JW women compared with non-JW women at a PBM-based center in Korea. Methods: We retrospectively reviewed delivery outcomes and PBM practices among JW women (n=205) with singleton pregnancies and non-JW women (n=601) who were matched at a 1:3 ratio using propensity scores at Soonchunhyang University Seoul Hospital between 2018 and 2023. The primary outcomes included obstetric morbidities, with particular attention to complications related to postpartum hemorrhage and the interventions used for its management. Results: JW women were more likely to receive intravenous iron administration (7.3 vs. 2.8%, p=0.008) and had higher hemoglobin (Hb) levels during the first trimester (12.6±1.1 vs. 11.8±3.4 g/dL, p=0.012) than non-JW women. Blood loss during cesarean section and the incidence of severe postpartum anemia (Hb <7 g/dL) were lower among JW women; however, these differences did not reach statistical significance. In the hemorrhage-related high-risk subgroup, JW women were managed according to PBM protocols without transfusion, and their obstetric outcomes were comparable to those observed in non-JW women. Conclusions This study identified no significant differences in hemorrhage-related obstetric outcomes between JW and non-JW women at a PBM-based center. The systematic application of PBM enables safe delivery in transfusion-restricted settings and may reduce reliance on blood transfusion while maintaining maternal safety.

Objective: To examine the risk of cardiovascular disease (CVD) associated with use of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS). Methods: This study used data from the Korean National Health Insurance database. Patients aged ≥18 years who were newly diagnosed with AS between 2010 and 2018 and did not suffer prior CVD were included. The primary outcome was a composite endpoint of myocardial infarction (MI) or stroke. The secondary outcomes were specific endpoints of MI, stroke, or congestive heart failure. TNFi use was evaluated as a time-dependent variable. Cox proportional hazard regression was used to examine the association between TNFi use and risk of incident CVD. Results: Of 19,775 patients (mean age, 36.1 years; 75% male), 5,978 (30.2%) were exposed to TNFi treatment during the study period. During a follow-up of 4.8 (interquartile range, 2.9~7.2) years, 522 events of MI or stroke occurred. TNFi use was associated with a lower risk of MI or stroke than no TNFi use after adjusting for traditional CV risk factors and medications (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.55~0.94). The lower risk of MI or stroke associated with TNFi use was consistently observed across subgroups. Risk of congestive heart failure did not differ between users and non-users of TNFi (aHR, 0.94; 95% CI, 0.75~1.18). Conclusion In a real-world AS cohort, TNFi treatment was associated with a reduced risk of atherosclerotic CVD. However, TNFi use was not associated with risk of congestive heart failure.

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: Adequate tissue oxygenation is a key determinant of diabetic foot ulcer (DFU) outcomes. Though transcutaneous oxygen pressure (TcPO2) is the gold standard for evaluating tissue oxygenation, its limited availability restricts routine clinical use. Consequently, toe pressure is frequently utilized as a practical surrogate; however, the direct correlation between these two modalities has yet to be rigorously investigated. This study aimed to assess the correlation and agreement between TcPO2 and toe pressure in patients with DFUs. Methods: A retrospective review was conducted on 837 DFU patients who received simultaneous TcPO2 and toe pressure assessments. The correlation between the two tests was analyzed using the Pearson correlation coefficient, and agreement was evaluated using Bland–Altman analysis. To aid interpretation, a scatterplot and Bland–Altman plot were generated. Results: TcPO2 and toe pressure demonstrated a strong correlation (R=0.66; 95% confidence interval, 0.62 to 0.70; P<0.001). Bland–Altman analysis showed a mean bias of 26.9 mmHg (standard deviation of differences, 28.8 mmHg; 95% limits of agreement, −28.9 to 82.6 mmHg) between toe pressure and TcPO2, reflecting limited agreement and increased variability at higher perfusion levels. Conclusion TcPO2 and toe pressure are strongly correlated. However, they are not interchangeable, particularly in DFU patients with high tissue perfusion.

Background/Aims: Fexuprazan, a novel potassium-competitive acid blocker, was developed for treating acid-related disorders. Pharmacokinetic and pharmacodynamic properties of fexuprazan, unlike those of proton pump inhibitors, are independent of food effect. This study aims to evaluate differences in efficacy and safety of fexuprazan in patients with erosive esophagitis (EE) according to the timing of dosing. Methods: In this multicenter, open-label noninferiority study, patients who had typical reflux symptoms with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg daily 30 minutes before or after meal. Treatment was completed after 2 weeks or 4 weeks when healing was endoscopically confirmed. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy up to week 4. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In the prior-to-meal group (n = 89) and after-meal group (n = 86), 4-week EE healing rates were 98.77% and 100.00% (difference, 0.01%; 95% CI, –0.01% to 0.04%) and 2-week EE healing rates were 95.77% and 97.14% (difference, 0.01%; 95% CI, –0.05% to 0.07%), respectively. TEAEs were 9.78% and 8.70% in the prior-to-meal group and the after-meal group, respectively. Conclusions Non-inferiority analysis revealed that taking fexuprazan after meal was non-inferior to taking fexuprazan before meals in patients with EE. The frequency of adverse events was similar between the 2 study groups. The drug is safe and effective for healing EE regardless of the timing of dosing.

This case report investigates the effects of semi-occluded vocal tract exercises (SOVTEs) on voice improvement in elderly female patients with presbyphonia. Elderly female patients with presbyphonia commonly present with symptoms such as hoarseness, decreased vocal intensity, and phonatory difficulties. These symptoms are often associated with age-related vocal fold atrophy, leading to compensatory muscle tension and inefficient phonation, which necessitate targeted therapeutic interventions. In this study, two elderly female patients, aged 73 years and 71 years, participated in a voice therapy program centered on SOVTEs designed to promote vocal fold vibration efficiency and reduce compensatory tension. Case 1 underwent five therapy sessions, while Case 2 completed sixteen sessions. Pre- and post-treatment voice assessments revealed notable improvements in vocal quality, suggesting that SOVTEs may be an effective therapeutic approach for managing presbyphonia in elderly women.

Background: Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better. Methods: We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year. Results: After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different. Conclusion There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.

Background and Objectives: Outcomes of deferring percutaneous coronary intervention (PCI) without invasive physiologic assessment for intermediate coronary lesions is uncertain.We sought to compare long-term outcomes between medical treatment and PCI of intermediate lesions without invasive physiologic assessment. Methods: A total of 899 patients with intermediate coronary lesions between 50% and 70% diameter-stenosis were randomized to the conservative group (n=449) or the aggressive group (n=450). For intermediate lesions, PCI was performed in the aggressive group, but was deferred in the conservative group. The primary endpoint was major adverse cardiac events (MACE, a composite of all-cause death, myocardial infarction [MI], or ischemia-driven any revascularization) at 3 years. Results: The number of treated lesions per patient was 0.8±0.9 in the conservative group and 1.7±0.9 in the aggressive group (p=0.001). At 3 years, the conservative group had a significantly higher incidence of MACE than the aggressive group (13.8% vs. 9.3%; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.00–2.21; p=0.049), mainly driven by revascularization of target intermediate lesion (6.5% vs. 1.1%; HR, 5.69; 95% CI, 2.20–14.73;p<0.001). Between 1 and 3 years after the index procedure, compared to the aggressive group, the conservative group had significantly higher incidence of cardiac death or MI (3.2% vs.0.7%; HR, 4.34; 95% CI, 1.24–15.22; p=0.022) and ischemia-driven any revascularization. Conclusions For intermediate lesions, medical therapy alone, guided only by angiography, was associated with a higher risk of MACE at 3 years compared with performing PCI, mainly due to increased revascularization.