Purpose: This study aimed to differentiate well-differentiated liposarcoma (WDLPS) from lipoma using the magnetic resonance imaging (MRI) findings and improve the preoperative diagnostic accuracy between the two tumors. Although lipoma is a benign tumor that does not necessarily require surgical intervention, WDLPS exhibits local aggressiveness and typically necessitates surgical excision, making its differentiation clinically significant. Materials and Methods: Among 363 patients diagnosed with lipoma or WDLPS at the authors’ institution between January 2013 and April 2022, 45 patients with lipoma and 15 with WDLPS were selected using propensity score matching based on age and sex. The following six MRI features were analyzed: tumor size, shape, septal thickness, tumor depth, fat content ratio, and the presence of nodular non-fatty tissue components. The sensitivity and specificity of each feature were evaluated. Results: Among the MRI features, the fat content ratio (specificity 95%) and the presence of nodular non-fatty tissue components (specificity 98%) were useful for excluding WDLPS, but their sensitivities were relatively low (46% and 27%). The sensitivities of other features, such as tumor size, shape, septal thickness, and depth, ranged from 47% to 67%, suggesting that MRI alone has limitations in reliably distinguishing the two tumors. In addition, fat content ratios below 75% and the presence of nodular non-fatty tissue components were significantly more common in WDLPS than in lipoma. Conclusion The MRI findings can serve as a useful tool for excluding WDLPS when differentiating it from lipoma. Nevertheless, MRI alone has limitations in achieving a definitive diagnosis because of the low sensitivity of individual features. Therefore, additional approaches such as radiomics analysis, artificial intelligence algorithms, and multicenter studies, are needed to improve the diagnostic accuracy and establish personalized treatment strategies.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.

Purpose: Radical cystectomy (RC) is associated with substantial postoperative morbidity, and unplanned readmission remains common despite advances in perioperative management. However, the association between postoperative readmission due to complications and oncologic outcomes after RC for bladder cancer has not been clearly defined. We evaluated the impact of postoperative readmission on overall survival (OS) and cancer-specific survival (CSS) after RC for bladder cancer. Materials and Methods: We retrospectively analyzed 3,972 patients who underwent RC for bladder cancer in a multicenter cohort. Postoperative readmission was defined as unplanned hospitalization within 90 days postsurgery due to surgery-related complications. Survival outcomes were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify independent predictors of OS and CSS. Results: Among the study population, 916 patients (23.1%) experienced postoperative readmission. Baseline and perioperative characteristics were generally comparable between patients with and without readmission. Kaplan-Meier analyses demonstrated significantly worse OS and CSS among patients who experienced postoperative readmission (both log-rank p<0.001). In multivariable analyses adjusting for clinicopathological factors, postoperative readmission remained independently associated with worse OS (hazard ratio [HR], 1.654; 95% confidence interval [CI], 1.464–1.868; p<0.001) and CSS (HR, 1.761; 95% CI, 1.509–2.055; p<0.001). Conclusion Postoperative readmission within 90 days after RC was independently associated with inferior long-term oncologic outcomes. These findings suggest the importance of strategies aimed at preventing postoperative complications and subsequent readmission.

Purpose: This study evaluated the feasibility of radical nephrectomy and thrombectomy without cardiopulmonary bypass (CPB) in patients with renal cell carcinoma (RCC) and level IV venous tumor thrombus, compared with CPB-assisted surgery. Materials and Methods: This retrospective cohort study analyzed patients with RCC and level IV venous tumor thrombus who underwent surgery at a single center between 2014 and 2020. Feasibility of non-CPB surgery was assessed by comparing perioperative safety-related outcomes, overall survival (OS), and progression-free survival (PFS) between the non-CPB and CPB groups. Perioperative outcomes included operative time, blood loss, severe complications (Clavien-Dindo classification grade ≥III), intensive care unit (ICU) stay, and mortality. Kaplan-Meier analysis and generalized Wilcoxon tests were used to compare survival outcomes. Results: A total of 16 patients met eligibility criteria: 5 underwent surgery without CPB, and 11 underwent CPB-assisted surgery. Median operative time was similar between the CPB and non-CPB groups (490 minutes vs. 480 minutes, p=0.650). Compared with the CPB group, blood loss was lower in the non-CPB group (4000 mL vs. 1080 mL, p=0.333). Severe complications occurred in 36.4% of CPB patients and 0% of non-CPB patients (p=0.245). ICU stay was comparable between the non-CPB and CPB groups (2 days vs. 3 days, p=0.356). OS did not differ significantly between groups (p=0.180), whereas PFS was longer in the non-CPB group (p=0.041). Conclusions Radical nephrectomy and thrombectomy without CPB appears feasible and may be associated with lower perioperative morbidity and blood loss without compromising oncologic outcomes. Non-CPB surgery should be considered in selected patients with level IV venous tumor thrombus when technically feasible.

Objective: To evaluate the efficacy of a high-pressure spray disinfection system using neutral electrolyzed water to reduce airborne bacterial concentrations in veterinary hospitals and to characterize clinically relevant airborne pathogens and antimicrobial resistance. Methods: Active air sampling was performed before and after disinfection in multiple room types across five small animal hospitals in South Korea. Total airborne bacterial concentrations were quantified as colony-forming units per cubic meter. Representative colonies were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, with confirmatory sequencing for selected isolates. Susceptibility testing was performed for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species using disk diffusion. Results: Mean airborne bacterial concentrations decreased from 358.2 to 150.6 colony-forming units per cubic meter (58% reduction; p < 0.05). Waiting rooms showed the highest predisinfection concentrations, and operating rooms the lowest. Among 848 isolates, Micrococcus luteus, staphylococci, and Bacillus species were most frequent. Eight isolates were clinically important pathogens; two met multidrug resistance criteria. No targeted pathogens were detected after disinfection. Conclusions and Relevance: High-pressure neutral electrolyzed water spraying significantly reduced airborne bacterial loads in veterinary clinical environments, supporting routine air disinfection and microbial surveillance as components of infection prevention programs.

and Relevance: Here, we report atypical clinicopathological features observed in the case of CEL. These findings have potential biological, diagnostic, and prognostic relevance, emphasizing the need for further studies to elucidate their clinical significance and to expand the understanding of this disease.

Objective: We investigated the distribution of AI viruses in fecal samples from wild bird habitats (and nearby poultry-farm areas) surveyed between September and March from 2019 to 2025 and identified associated epidemiological risk factors. Methods: Samples were screened for influenza A (M, H5, H7) genes using real-time reverse transcription polymerase chain reaction (PCR), subjected to virus isolation in embryonated chicken eggs, and subtyped by PCR and sequencing. Host species were identified through DNA barcoding. Relative risks (RRs) with 95% confidence intervals were estimated for province, month, and waterfowl density. Results: Overall prevalence of HPAI and low pathogenic AI (LPAI) virus was 0.10% and 3.21%, respectively. HPAI virus was continuously isolated since 2020–2021, except 2019– 2020, while LPAI prevalence steadily increased (3.01%–4.35%). Twelve hemagglutinin (H1–H12) subtypes were identified in 1,722 isolates, and H3 (16.5%) was the most prevalent, followed by H5 (11.1%) and H7 (5.2%). LPAI H5N3 (55.7%) and H7N7 (75.5%) were the predominant H5 and H7 subtypes, respectively. Detection was higher in western coastal provinces, and higher mallard/spot-billed duck density and sampling in September– December were associated with increased risk. Conclusions and Relevance: Continued surveillance of migratory-bird habitats can provide early warning of HPAIV incursions and support targeted biosecurity measures in high-risk regions and seasons.

Background: In February 2024, a sudden government policy to drastically increase medical school admissions triggered the mass resignations of medical trainees across South Korea, severely disrupting hospital operations. This study aimed to evaluate the impact of the resulting healthcare workforce disruptions on short-term clinical outcomes and the timing of colorectal cancer surgeries. Methods: This retrospective comparative study analyzed patients with colorectal cancer treated at two national university hospitals in Daegu and Gwangju, South Korea. Patients who first visited the colorectal surgery department between March and August of 2023 and 2024 were included. Data from 2020 to 2022 were used for extended comparisons. The primary outcome was the interval from initial outpatient visit to surgery. Secondary outcomes included treatment modality distribution, tumor staging, and postoperative complications. Results: A total of 895 patients in 2023 and 853 in 2024 were included. In 2024, only 39.5% of patients (337/853) underwent upfront surgery compared to 63.5% (569/895) in 2023. The median time to surgery increased from 30 days (interquartile range [IQR], 22–44 days) to 52 days (IQR, 30–72 days) (p=0.001). Clinical T3–4 tumors increased from 49.9% to 59.3% (p=0.018), lymph node-positive cases increased from 25.9% to 51.3% (p=0.001), and postoperative complication rates increased from 12.0% to 28.2% (p=0.001). Conclusion The abrupt healthcare workforce crisis in early 2024 significantly delayed colorectal cancer surgeries and was associated with worse short-term oncologic outcomes. These findings highlight the critical importance of maintaining a stable healthcare workforce to protect access to timely cancer care.

Background: Japan and South Korea, two advanced East Asian nations with universal health coverage and similar demographic challenges, have developed markedly different emergency medical services (EMS) systems. Despite growing interest in international benchmarking, structured, comparative studies that yield policy-relevant insights remain limited. Methods: We conducted a multisource comparative health-systems analysis using statutory laws, government publications, academic society reports, peer-reviewed literature, and national statistics. Key domains included EMS governance, workforce, prehospital organization, hospital-based emergency care, legal obligations for EMS patient transport and hospital acceptance, and governance and quality assurance mechanisms. Data were synthesized in comparative tables and narrative summaries to highlight structural and operational differences. Results: Japan’s EMS system operates under decentralized municipal control through 722 fire departments, serving 4,100 designated emergency institutions with 6,139 board-certified emergency physicians. In 2023, over 6.64 million ambulance dispatches occurred, and 8.6% were classified as critical cases (1.3% death and 7.3% severe). Korea’s EMS system is centrally governed with 412 designated facilities in a tiered system and 2,464 specialists. Annual ambulance activations exceeded 3.5 million, with severe cases accounting for approximately 5% to 10%. Japan employs a multilayered legal–institutional structure, primarily involving the Fire Service Act and the Medical Practitioners Act, allowing clinical discretion, whereas Korea enforces unified regulations with stricter obligations and criminal penalties for hospital refusal of emergency patients. Conclusion The contrasting systems suggest that hybrid governance that combines centralized standard settings with local operational flexibility may optimize EMS performance. These findings provide lessons for EMS reform, cross-border collaboration, and disaster preparedness in high-income nations facing similar demographic and healthcare challenges.

Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.