Objective: This study aims to compare the incidence of active tuberculosis (TB) among Korean patients with rheumatoid arthritis (RA) initiating treatment with tumor necrosis factor inhibitors (TNFi) or tofacitinib. Methods: Using the Korean National Health Insurance database, we conducted a nationwide, retrospective cohort study of RA patients who started TNFi or tofacitinib therapy between 2015 and 2018. We calculated the incidence rates of active TB based on the treatment type and results from latent tuberculosis infection (LTBI) screening tests. A multivariable Cox proportional hazards model was employed to evaluate the risk of active TB in RA patients beginning TNFi or tofacitinib treatment. Results: Among 3,382 RA patients (596 on tofacitinib and 2,786 on TNFi), LTBI screening was predominantly conducted using the IGRA (interferon-gamma release assays) test. Of these patients, 624 (18.5%) with a positive LTBI test received prophylactic treatment. No cases of active TB occurred in tofacitinib users, while 32 cases were observed in TNFi users. The adjusted hazard ratio for active TB in LTBI-positive patients was 5.47 (95% confidence interval 2.74 to 10.92) compared to LTBI-negative patients.In subgroup analyses, TB incidence was significantly higher among individuals aged over 65 years. Conclusion Despite LTBI treatment, active TB remains prevalent among RA patients on TNFi therapy and in those with positive LTBI tests.

Purpose: To introduce subepithelial pterygium pedicle (SPP) and to investigate the effect of SPP length on the anterior corneal curvature including keratometry and aberrations. Methods: In this single-center retrospective cohort, 72 eyes of 72 patients with primary nasal pterygium were analyzed using anterior segment (AS) swept-source optical coherence tomography (SS-OCT; Anterion). We evaluated SPP length, horizontal invasion length (HIL), and corneal profiles including keratometry, root mean square values for lower- and higher-order aberrations, and first- to fourth-order wavefront aberrations. Correlations between SPP length and these parameters were assessed after adjusting for HIL. The SPP cutoff for significant anterior horizontal tilt deterioration was determined using receiver operating characteristic (ROC) analysis and validated by analysis of covariance controlling for HIL. Results: SPP was detected in 57 of 72 eyes (79.2%), with a mean length of 842.3 ± 408.1 μm. A significant positive correlation was found between SPP length and HIL (r = 0.376, p = 0.001). After adjusting for HIL, SPP length remained significantly associated with anterior corneal horizontal tilt (p = 0.026), whereas no significant correlations were observed with other refractive or aberration parameters. ROC curve analysis identified an SPP length of approximately 850 μm as the threshold for predicting anterior horizontal tilt ≥3.65 μm. Consequently, this cutoff significantly differentiated subgroups after adjusting for HIL, showing a marked increase in horizontal tilt in eyes with SPP ≥850 μm (p = 0.016), indicating mechanical distortion. Conclusions SPP length, a subepithelial microstructural parameter visualized by AS SS-OCT, independently correlates with anterior horizontal tilt after adjustment for HIL. This finding suggests that SPP length serves as a microstructural indicator of horizontal mechanical corneal distortion in eyes with pterygium.

Purpose: To characterize perioperative changes in posterior corneal curvature (PCC) following pterygium excision using anterior segment (AS) swept-source optical coherence tomography (SS-OCT), and to identify the critical threshold of horizontal invasion length (HIL) predicting significant PCC alterations. Methods: This retrospective cohort study included 85 eyes of 77 patients with primary nasal pterygium. PCC parameters, including posterior keratometry (K) average, posterior steep K, posterior flat K and posterior corneal astigmatism, were measured preoperatively and postoperatively using AS SS-OCT (Anterion). Perioperative PCC changes were analyzed in relation to HIL and postoperative duration. Subgroup analyses were performed to identify the HIL cutoff value associated with statistically significant changes in posterior K average. Results: Significant postoperative flattening was observed in both posterior K average (from –6.27 ± 0.24 to –6.23 ± 0.23 diopters [D], p < 0.001) and posterior flat K (from –6.14 ± 0.23 to –6.09 ± 0.23 D, p < 0.001), accompanied by a significant increase in posterior corneal astigmatism (from –0.25 ± 0.12 to –0.29 ± 0.17 D, p = 0.003). The magnitude of posterior flattening showed a significant positive correlation with HIL (r = 0.384, p < 0.001) but was not correlated with postoperative duration (p = 0.428). In subgroup analysis, eyes with HIL ≥3.5 mm exhibited a significant change in posterior K average (p < 0.001), whereas those with HIL <3.0 mm and HIL <3.5 mm showed no significant change (p = 0.065 and p = 0.443, respectively). Conclusions Pterygium excision leads to significant posterior corneal flattening proportional to HIL, with 3.5 mm identified as a clinically relevant cutoff. Although the refractive impact may be subtle, surgeons should be aware of these posterior corneal changes as a consistent morphological response, especially in eyes with HIL ≥3.5 mm.

Purpose: To determine the corneal stabilization timeline after pterygium excision adjusted for horizontal invasion length (HIL). Methods: In this single-center retrospective cohort study, we analyzed 88 eyes of 80 patients with nasal or temporal primary pterygium who underwent excision and perioperative evaluation with anterior segment (AS) swept-source optical coherence tomography (SS-OCT; Anterion). Anterior simulated mean keratometry (SimKmean; 3-mm ring) and HIL were measured on AS SS-OCT. Keratometric stabilization was assessed at postoperative cutoffs of 8, 12, 16, 20, and 24 weeks using analysis of covariance (ANCOVA) with HIL as a covariate. Subgroup analysis was performed after stratifying by the median HIL (3.82 mm). Results: Mean anterior SimKmean increased from 42.95 ± 1.79 diopters (D) preoperatively to 43.73 ± 1.53 D postoperatively (p < 0.001). Preoperative HIL correlated positively with the perioperative SimKmean change (r = 0.728, p < 0.001). While postoperative duration showed no significant unadjusted correlation with keratometric change (r = −0.133, p = 0.218), partial correlation controlling for HIL was negative (r = −0.248, p = 0.021), indicating diminishing change over time after severity adjustment. ANCOVA demonstrated significant stabilization at 16 weeks (p = 0.036). In the HIL ≥3.82 mm subgroup, SimKmean change was greater before 20 weeks than after 20 weeks (1.73 ± 1.59 D vs. 0.59 ± 0.74 D, p = 0.030), whereas no significant time-point differences were found for HIL <3.82 mm. Conclusions Corneal keratometric stabilization after pterygium excision depends on preoperative HIL. A minimum of 16 weeks is recommended before cataract surgery planning, with at least 20 weeks for eyes with HIL ≥3.82 mm.

Purpose: This study aims to determine whether the translucency-based clinical grade of pterygium shows independent relationships with anterior and posterior corneal curvature and anterior wavefront aberrations, with adjustment for horizontal invasion length (HIL) measured by anterior segment (AS) swept-source optical coherence tomography (SS-OCT). Methods: This study involved 53 eyes from 51 patients diagnosed with primary nasal pterygium. The clinical grade of the pterygium was evaluated using T grade based on the fibrovascular translucency. AS SS-OCT (Anterion, Heidelberg Engineering) provided HIL (in millimeters), thickness (in micrometers), anterior/posterior keratometry at the 3.0-mm ring, and anterior corneal wavefront metrics within a 6.0-mm zone. The device was also used to evaluate the magnitudes for the individual first-to fourth-order aberrations of the anterior corneal fields. Also, the fourth- to seventh-order root mean square (RMS), RMS lower-order aberration (LoA), and RMS higher-order aberration (HoA) values were collected. For statistical analysis, Spearman rank correlation test and Pearson correlation test were performed, along with partial correlation test adjusted for HIL. Results: The mean age of subjects was 59.3 ± 11.4 years, and 51.0% were female. T grade correlated positively with HIL. HIL showed strong associations with anterior simulated keratometry (Sim K) average, anterior Sim K steep, anterior Sim K flat, and anterior corneal astigmatism—but not with posterior corneal parameters. HIL also showed significant correlations with multiple anterior corneal wavefront parameters. After adjustment for HIL, T grade remained independently correlated with anterior Sim K flat, RMS LoA, and defocus; no significant relationships were observed with other Zernike terms or posterior metrics. Additionally, T grade was positively correlated with pterygium thickness. Conclusions T grade adds independent, complementary information (associations with flat keratometry, LoA RMS, and defocus) even after controlling for HIL. Incorporating T grade into preoperative assessment may improve estimation of optical burden and surgical prognosis.

Objective: This study aimed to evaluate the feasibility, safety, and oncologic outcomes of irreversible electroporation (IRE) using a clustered electrode in patients with locally advanced pancreatic cancer (LAPC). Materials and Methods: In this single-center prospective cohort study, 13 patients with LAPC (median age, 60 years; range, 48–78 years) underwent clustered electrode IRE between September 2022 and September 2024. Patient characteristics, procedural details, and clinical outcomes were recorded. Endpoints included technical success, procedure-related complications, overall survival (OS), and progression-free survival (PFS). Results: Tumors were located in the pancreatic head in four patients (30.8%) and in the body/tail in nine (69.2%). The median tumor size was 2.4 cm (1.5–4.0 cm), and vascular invasion was present in all patients. Technical success was achieved in all patients. Intraoperative IRE was performed in 11 (84.6%) patients, and 2 (15.4%) patients underwent percutaneous IRE. Gastrointestinal bleeding events as major complications occurred in two patients (15.4%) and, both were successfully controlled by embolization. No 60-day mortality was observed. At a median follow-up of 24.5 months (range, 9.9–33.4 months) after IRE, median OS and PFS from IRE were 20.1 and 14.5 months, respectively. Conclusion IRE using clustered electrodes for LAPC appears to be a feasible therapeutic approach, offering reliable technical success and acceptable safety. Survival outcomes are encouraging; however, larger, controlled studies are required.

BACKGROUND/OBJECTIVES: Lutein, a dietary carotenoid, plays a crucial role in protecting eye health as an anti-inflammatory agent and antioxidant. Green leafy vegetables constitute a major source of lutein; however, comparative studies on different consumption methods are limited. Therefore, this study aimed to evaluate the bioavailability of lutein from lutein-rich foods, namely, raw vegetables and raw vegetable juice. SUBJECTS/METHODS: In this study, 18 adults were recruited. They were randomly divided into three groups: commercial lutein supplement (LUT, 20 mg), raw vegetable (RV), and raw vegetable juice (RVJ) groups. Blood was collected at 0-, 4-, 6-, 8-, 12-, 24-, and 30-h intervals after the consumption of each test meal. Participants’ serum lutein levels were analyzed using high-performance liquid chromatography (HPLC). Considering lutein’s wellestablished anti-inflammatory properties, changes in inflammatory status were assessed by measuring serum high-sensitivity C-reactive protein (hs-CRP) levels. Furthermore, urinary metabolomic profiling was conducted using 1 H nuclear magnetic resonance spectroscopy to evaluate metabolic alterations. RESULTS: After consuming each lutein-rich food, participants’ blood lutein levels were analyzed, and the serum concentration peaked at 12 h (0.37 ± 0.13 μg/mL), 24 h (0.61 ± 0.18 μg/mL), and 30 h (0.42 ± 0.16 μg/mL) after RV, LUT, and RVJ consumption, respectively.Additionally, hs-CRP levels decreased following lutein-rich food consumption. Twelve hours after consumption, hs-CRP levels decreased to 0.81 and 0.83 mg/L in the RV and RVJ groups, respectively. Twenty-four hours after consumption, they further decreased to 0.68 and 0.74 mg/L in the LUT and RVJ groups, respectively. Thirty hours after consumption, a reduction to 0.61 mg/L was observed in the RVJ group. Furthermore, after consuming each luteinrich food, N-acetyl glycoprotein levels decreased at 24 h, reflecting metabolic alterations potentially associated with lutein metabolism. CONCLUSION These findings suggest that the short-term consumption of lutein-rich foods, regardless of their type or source, potentially yields health benefits.

Purpose: Neoadjuvant treatment (NAT) is now the standard for borderline resectable pancreatic cancer (RPC) and is being considered for RPC. Early recurrence after curative surgery in RPC is often seen as a treatment failure, prompting considerations for NAT. Our goal was to develop an artificial intelligence (AI)-based predictive model utilizing preoperatively available factors to forecast early recurrences of resected RPC. Methods: This study included 469 patients who underwent surgery for RPC between 2011 and 2019. Clinicopathologic and oncologic data were retrospectively reviewed. Preoperative variables, including laboratory data and imaging findings, were collected. Early recurrence was defined as recurrence occurring within a year after surgery. Deep neural networks were then used to select variables by assessing their importance. A new model predicting early recurrence of RPC was subsequently developed. Results: Of the patients evaluated, 199 (42.4%) experienced early recurrence. The predictive model included 14 preoperative variables: CA 19-9, preoperative pancreatitis, serum albumin, platelet count, lymphocyte count, the American Society of Anesthesiologists physical status classification, tumor size, monocyte count, age, body mass index, CRP, hemoglobin, WBC count, and CEA. The area under the curve for the model was 0.786 in the training set and 0.734 in the test set. Conclusion We developed an AI-based model to predict the early recurrence of RPC using preoperative parameters. By identifying patients at risk of early recurrence, optimal individualized treatments such as NAT can be considered. Future prospective studies are crucial to establish clear indications for NAT in RPC.

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.

Objectives: . Obstructive sleep apnea (OSA) is associated with chronic intermittent hypoxia and systemic inflammation, both of which contribute to vascular and metabolic complications. Monocytes, as key immune cells of innate immunity, have been implicated in this inflammatory state. However, the effect of OSA treatment on monocyte function and inflammatory phenotype remains poorly understood. Methods: . In this prospective cohort study, OSA patients were evaluated before and after 3 months of continuous positive airway pressure (CPAP) therapy. Circulating monocytes were isolated, and inflammatory cytokine production (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, and IL-6) was assessed at baseline and post-treatment, both at rest and after lipopolysaccharide (LPS) stimulation. Monocyte polarization (M1/M2-like marker expression) was measured by flow cytometry. Clinical severity parameters, including the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), were correlated with immune changes. Results: . Following CPAP treatment, LPS-induced inflammatory cytokine secretion and LPS responsiveness, defined as the increase in cytokine levels upon stimulation, both declined after CPAP in proportion to baseline ODI, but not AHI. Apart from TNF-α, baseline IL-1β and IL-6 levels were below the quantifiable range of the assay, which precluded reliable comparison after treatment. This effect may be explained by a parallel post-treatment shift in monocyte phenotype toward an anti-inflammatory M2-like (CD163+CD206+) profile, as demonstrated by our flow cytometry data, which was also significantly associated with baseline ODI. Conclusion . CPAP alleviates systemic inflammation in OSA by reducing hypoxic burden and reprogramming monocytes toward an anti-inflammatory phenotype. The magnitude of immune modulation was more closely linked to ODI than AHI, suggesting that oxygen desaturation burden serves as a meaningful adjunct to AHI in assessing monocyte-driven immune dysregulation in OSA.