Background/Aims: This study investigated the clinical efficacy of low-dose mepolizumab (100 mg) in controlling severe eosinophilic asthma, aiming to induce eosinophilic granulomatosis with polyangiitis (EGPA) remission and reduce systemic steroid usage. Additionally, we constructed a basic frame for our longitudinal EGPA cohort by collecting serial blood samples before, during, and after mepolizumab treatment in EGPA patients. Methods: We conducted a 2-year prospective observational cohort study in patients with uncontrolled severe eosinophilic asthma and refractory EGPA who used systemic steroids (≥ 7.5 mg/day of prednisolone) or other immunosuppressant drugs for at least 6 months. All patients were treated with 100 mg of mepolizumab every 4 weeks for 1 year to control severe eosinophilic asthma and then were followed for an additional 1 year to monitor their disease course. We analyzed total systemic steroid use and EGPA remission/relapse during the study period. Results: Three EGPA patients were included in this study and completed 16 study visits over a 2-year period. After 1 year of treatment with mepolizumab (100 mg monthly), all 3 patients were able to reduce their maintenance dose of systemic steroids, with 2 patients completely discontinuing use. These 2 patients achieved EGPA remission during mepolizumab treatment, and their remission status remained stable for 1 year after they stopped receiving the medication. Conclusions Low-dose mepolizumab treatment demonstrated clinical efficacy in reducing the maintenance dose of systemic steroids required for severe refractory EGPA. While not all patients achieved EGPA remission with low-dose mepolizumab, some did, and their remission persisted even after treatment discontinuation.

Spinal melanocytoma (SMC) is a rare, slow-growing tumor arising from melanocytes in the spinal cord. We report a patient with a cervical intra- and extradural spinal tumor causing progressive weakness and numbness. On magnetic resonance imaging (MRI), the lesion showed intense homogeneous enhancement, similar to that seen in common neurogenic spinal tumors. After complete resection, pathological examination confirmed melanocytoma. A review of previously reported cases identified 26 reports of this tumor in the cervical spine, most of which were treated with complete surgical resection. Gross total resection is the preferred treatment, although radiation therapy may be considered when residual tumor remains. We report a 25-year-old male patient who presented with progressive weakness and numbness in both the upper and lower extremities for 3 months. MRI showed homogeneous enhancement. The mass compressed the spinal cord at C6–7 and extended through the neural foramen. Based on the MRI findings, spinal schwannoma was suspected preoperatively. Surgical resection was performed with laminectomy, durotomy, and right facetectomy. A dark-colored mass with well-demarcated margins was exposed and removed. Postoperative MRI confirmed complete removal of the mass. The patient recovered well, and his preoperative myelopathic symptoms gradually improved. SMC is a rare benign tumor that may be mistaken for schwannoma. The treatment of choice is gross total resection.

Background: and Objective: Maternal hypothyroidism increases the risk of adverse pregnancy outcomes, making appropriate levothyroxine (LT4) replacement essential. However, the optimal initial LT4 dose for women newly diagnosed with subclinical hypothyroidism (SCH) or overt hypothyroidism (OH) during pregnancy remains unclear.This study evaluated the appropriate starting LT4 dose based on baseline thyroid-stimulating hormone (TSH) and body mass index (BMI). Materials and Methods: This single-center retrospective cohort study included 126 pregnant women from June 2018 to April 2025. After pregnancy was confirmed, all participants started LT4.Patients were categorized by baseline TSH (2.5-4, 4-10, and ＞10 mIU/L) and BMI (＜23, 23-＜25, and ≥25 kg/m2 ) to determine the appropriate LT4 dose. The treatment goal was a TSH level ＜2.5 mIU/L. Results: Among the 126 patients, 101 (80.2%) were diagnosed with SCH or OH in the first trimester. The mean baseline TSH was 5.19 mIU/L, and 29.4% had autoimmune thyroiditis. Baseline TSH (r=0.315, p＜0.001) was positively associated with weight-based LT4 dose, whereas body weight (r=−0.304, p＜0.001) and BMI (r=−0.248, p=0.005) were inversely associated. The median weight-based LT4 dose was 0.45 μg/kg/day for TSH 2.5-4.0 mIU/L, 0.71 μg/kg/day for TSH 4.0-10 mIU/L, and 1.34 μg/kg/day for TSH ＞10 mIU/L (p for trend ＜0.001). Patients with TSH ＞10 mIU/L required more time to achieve TSH ＜2.5 mIU/L, and those with BMI ≥25 kg/m2 received lower weight-based LT4 doses. Conclusion Initial LT4 dosing should be tailored based on baseline TSH and BMI.

Background: Transthoracic echocardiography (TTE) requires time-intensive integration of quantitative measure‑ ments and qualitative visual assessment. Fully automated artificial intelligence (AI)-based analysis may reduce total analysis time while preserving accuracy, but systematic real-world validation remains limited. Methods: This prospective, single-center pilot study enrolled 40 TTE examinations. Identical deidentified DICOM datasets were independently provided to a trained cardiac sonographer and a fully automated AI system comprising quantitative and qualitative visual interpretation modules. All outputs were compared with a cardiologist-adjudicated reference standard. Primary endpoints were total analysis time and noninferiority of AI-derived left ventricular ejection fraction (LVEF) versus the reference standard, with a prespecified margin of 3 percentage points (one-sided α = 0.025). Results: Median analysis time was 94 s (interquartile range [IQR], 82–106 s) for the AI workflow versus 490 s (IQR, 438–626 s) for the human workflow (P < 0.001). AI-derived LVEF met the noninferiority criterion (mean difference, 0.00 percentage points; upper one-sided 95% confidence bound, 1.41 percentage points; P < 0.001), with an intraclass correlation coefficient (ICC) of 0.902 (95% confidence interval, 0.822–0.947). ICCs for secondary quantitative indi‑ ces ranged from 0.625 to 0.989. For aortic regurgitation severity grading, AI’s overall accuracy was 75.0% (quadratic weighted κ = 0.762), compared with 82.5% for human interpretation (κ = 0.812, McNemar P = 0.579). Conclusions Fully automated AI-assisted TTE analysis substantially reduced total analysis time while maintaining noninferior LVEF accuracy and acceptable performance across secondary quantitative and qualitative indices. These findings support the use of AI as a practical workflow accelerator in routine echocardiography.

Objective: Depression involves mood-related behavioral changes typically monitored through subjective reports, which are limited by recall bias and low temporal resolution. Digital mental health tools offer objective, continuous monitoring, but prior studies have focused on outpatients subject to environmental variability. In this preliminary feasibility study, we examined psychiatric inpatients in a controlled setting to assess associations between behavioral regularity and depression severity, highlighting the clinical potential of digital phenotyping. Methods: Thirty-five adults from a closed psychiatric ward were recruited, and data from 10 inpatients with ≥7 days of valid monitoring were analyzed. Depression severity was assessed weekly using the Hamilton Depression Rating Scale (HAMD) and Dysfunctional Self-focus Attributes Scale, yielding 18 samples. Hourly accelerometer and location data from wearable devices and ward sensors were processed to generate digital phenotypes—interdaily stability (IS), intradaily variability (IV), ratio of IS to IV (ISV), entropy (EN), and normalized entropy (NE)—segmented into daytime and nighttime. Linear mixed models assessed group differences, and correlation and multiple regression examined associations with depression. Results: Patients with asymptomatic/mild depression showed significantly higher IS_day and ISV_day, and lower EN_night, and NE_night (all p<0.05). These four features correlated with HAMD after false discovery rate (all p<0.05) correction. A regression model including IS_day and NE_night explained 60.6% of HAMD variance (p<0.05). Conclusion Digital monitoring provides an objective and continuous method to assess depression severity. By capturing macro- and micro-level movement regularity across day and night in an inpatient environment, this approach offers practical relevance for psychiatric care. However, results should be considered preliminary due to the limited sample size.

Purpose: Older cancer patients face unique challenges due to age-related physiological changes, increasing their vulnerability to treatment-related toxicities. Geriatric assessment (GA) is a validated tool for optimizing care, yet there is no consensus on integrating geriatric interventions into oncology. This study evaluates the feasibility of a tailored onco-geriatric intervention model incorporating the KG-7 screening tool. Materials and Methods: This prospective study included 30 patients aged ≥ 70 years with solid tumors undergoing adjuvant or palliative chemotherapy. Patients scoring ≤ 5 of KG-7 were eligible. Tailored interventions incorporating KG-7 included polypharmacy, functional status, mobility, nutrition, cognition, emotional well-being, insomnia, social support, and medical problem. KG-7, GA, and quality of life (QoL) were followed at 12 weeks. Results: Participants (median age, 79.5 years) had colon (43.3%), pancreatic (23.3%), or gastric cancer (23.3%). At baseline, most patients showed independent activities of daily living (100%)/instrumental activities of daily living (90%). However, 93.3% had abnormal GA. Particularly, 86.7% were either malnourished or at risk of malnutrition. The most frequently identified intervention needs included polypharmacy (70.0%), nutritional support (60.0%), and emotional well-being (50.0%) with high adherence (100.0%, 88.9%, and 46.7%, respectively). At 12 weeks, KG-7 scores improved in 43.8% of patients, and 69.2% of GA domains were improved. QoL analysis revealed modest improvement in Global Health Status (mean difference, 6.3; p=0.176). One-year survival rates were 92.3% and 79.4% for adjuvant and palliative groups, respectively. Conclusion The onco-geriatric intervention model incorporating KG-7 demonstrated high feasibility and potential to enhance clinical outcomes. Future studies should validate this approach in randomized trials to optimize care for older cancer patients.

Purpose: The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex. Materials and Methods: Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed. Results: Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males. Conclusion Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.

Purpose: This study evaluates the Korean Cancer Study Group Geriatric Score-7 (KG-7) frailty screening tool’s effectiveness in elderly multiple myeloma (MM) patients to prevent under and overtreatment. Materials and Methods: This prospective pilot cohort study included 100 elderly patients aged 70 and older with newly diagnosed MM who had not undergone transplantation from August 2020 to January 2022. Results: The median age was 77 years, and 73.0% of patients were classified at International Staging System stages 2 or 3. Using a 5-point cutoff on the KG-7 index (non-frail, score ≥ 5; frail, score < 5), 31% were categorized as frail. After a median follow-up of 26.8 months, the 3-year overall survival rate was 73.0%. There was no statistically significant association between any frailty index and the risk of death. However, frail patients defined by the simplified frailty index (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.09 to 5.95; p=0.030) and by KG-7 (HR, 2.43; 95% CI, 1.03 to 5.86; p=0.043) had a significantly higher risk of grade 3-4 non-hematologic toxicity, whereas the International Myeloma Working Group definition did not. Over a 24-month tracking period, vulnerability as measured by KG-7 either improved or deteriorated. Conclusion The pilot study, which had a limited number of participants, did not demonstrate KG-7’s effectiveness in predicting survival; however, it successfully predicted severe non-hematologic toxicities. We plan to conduct larger studies in elderly MM patients to determine whether KG-7 can help tailor their treatment regimens.

Janus kinase inhibitors (JAKis) are associated with increased risk of Varicella-Zoster Virus reactivation, particularly in Asian populations. While reactivation of cytomegalovirus (CMV) is very rare in rheumatoid arthritis (RA) patients on JAKis, CMV retinitis (CMVR) is a sight-threatening infection primarily observed in immunocompromised individuals. We report the first Korean case of CMVR in a 75-year-old male with RA when taking upadacitinib. Upadacitinib was initiated due to refractory disease despite anti-tumor necrosis factor therapy, and methotrexate was tapered out over 3 months. During upadacitinib monotherapy, he developed subacute blurred vision in his right eye. Ophthalmologic examination showed mixed features suspicious of acute retinal necrosis and CMVR. CMVR was ultimately diagnosed through polymerase chain reaction testing of aqueous humor for CMV.Treatment with intravitreal ganciclovir alone led to the resolution of symptoms without major complications. A literature review identified seven reported cases of CMVR in RA patients, mostly in those treated with biologics or JAKis, with advanced age emerging as a key risk factor. Given the increasing use of JAKis, clinicians should maintain a high index of suspicion for CMVR in elderly RA patients taking JAKis when presenting with acute or subacute ocular symptoms.