Background: s/Aims: Phase angle (PhA), as measured by bioelectrical impedance analysis, provides insights into hydration and nutritional status, making it a prognostic indicator of frailty. While low preoperative PhA has been linked to postoperative complications in cancer patients, its predictive value in individuals undergoing pancreaticoduodenectomy (PD) has not been thoroughly investigated.This study aims to evaluate the clinical utility of preoperative PhA in predicting postoperative complications for patients undergoing PD. Methods: Among 41 patients who underwent PD at Seoul National University Hospital between September and December 2024, 35 were included in the analysis after excluding 6 patients who had concomitant blood vessel or other organ resections. Patients were divided into low (Comprehensive Complication Index [CCI] ≤ 20) and high (CCI > 20) complication groups based on the CCI, derived from the Clavien–Dindo classification. The differences in PhA between the two groups were analyzed, and logistic regression was performed to assess the relationship between PhA and CCI. Results: The mean PhA was significantly lower in the high-CCI group compared to the low-CCI group (5.7° vs. 6.7°, p = 0.025). Multivariate logistic regression analysis indicated that PhA (odds ratio: 0.17; 95% confidence interval: 0.04–0.68; p = 0.012) was an independent predictor of high CCI. A low preoperative PhA was associated with an increased risk of postoperative complications following PD. Conclusions Preoperative PhA may serve as a valuable predictive indicator of postoperative complications after PD, enabling the identification of patients who could benefit from preoperative prehabilitation, including nutritional support.

Background: Lithium hydroxide (LiOH) is increasingly used in electric vehicle battery production; however, its health effects in the work environment remain underreported. This study characterizes the acute health effects on workers following accidental occupational exposure to LiOH at a Korean lithium plant in March 2024. Methods: We analyzed health effects from two LiOH exposure accidents on March 6 and 9, 2024, involving 50–100 kg powder spills. Two datasets were examined: acute symptoms from 115 workers who visited hospitals immediately after exposure, and a symptom severity survey from 474 workers conducted 2 weeks post-exposure. Workers were stratified by distance from the leak source (<10 m, 10–20 m, >20 m) and respirator use. Univariate general linear modeling was applied to analyze the relationship between symptom occurrence and both the distance from the exposure source and respirator use. Results: Among workers visiting hospitals immediately, local irritation symptoms predominated: sore throat (58.3%), cough (28.7%), and skin dermatoses (17.4%). Systemic symptoms included headache (45.2%), nausea (18.3%), chest tightness (12.2%), and dizziness (9.6%). Two-week follow-up revealed overall symptom improvement; severe cough decreased from 22.2% to 10.1%. However, despite general improvement, a significant portion of workers reported persistent respiratory issues, including cough (28.7%) and sputum production (31.0%). Symptom severity showed a significant dose-response relationship with proximity to the source (p < 0.001). While respirator use offered initial protection (p = 0.021), this effect was not statistically significant after 2 weeks. Conclusions Occupational LiOH exposure caused acute irritation and systemic symptoms, demonstrating immediate tissue damage consistent with its alkalinity and systemic toxicity upon absorption. As lithium battery production expands globally, these results emphasize the necessity for developing specific occupational exposure limits and medical surveillance guidelines for lithium compounds.

Recent advancements in artificial intelligence have led to increased interest in predictive modeling across various domains, including medicine. Although numerous metrics have been established for binary classification, the growing adoption of multi-class systems necessitates robust evaluation measures. However, comprehensive simulation studies comparing the performance of existing multi-class metrics under diverse data conditions remain limited. In this study, we first provide a concise overview of commonly used accuracy metrics for multi-class classification. Then, we report a simulation study that systematically evaluates several diagnostic accuracy measures under a wide range of scenarios, including three- and five-class settings, balanced and imbalanced sample sizes, and different distributional assumptions for predictors. We assessed each metric’s performance in terms of bias and 95% confidence interval coverage. Under balanced conditions, most metrics demonstrated stable and unbiased performance, closely approximating the true values. However, under imbalanced conditions, greater bias was observed, with the M-index and polytomous discrimination index exhibiting comparatively more stable performance across various scenarios. The micro-averaged receiver operating characteristic curve area consistently showed higher bias under class imbalance. Finally, we applied these metrics to a glioma tumor grading task using external datasets. This study provides a systematic comparison of commonly used metrics and offers practical guidance for selecting appropriate measures in multi-class classification tasks.

Objective: Although most gallbladder polyps are benign, some neoplastic polyps may be malignant or may serve as precursors to malignancy. Distinguishing neoplastic and non-neoplastic polyps using imaging examinations remains a major challenge.This meta-analysis aimed to identify the ultrasound (US) features that are significantly associated with neoplastic polyps. Materials and Methods: The MEDLINE, EMBASE, Cochrane, and KoreaMed databases were searched for articles published up to August 31, 2025. Bivariate random-effects models were used to calculate the meta-analytic pooled diagnostic odds ratios (DORs), sensitivities, and specificities, along with their 95% confidence intervals (CIs), for each US imaging feature in the diagnosis of neoplastic polyps. Results: Thirty studies evaluating 8,953 patients, including 1,216 (13.6%) patients with neoplastic polyps, were included.Among the nine evaluated US imaging features, namely, size ≥10 mm, sessile morphology, single polyp, coexisting gallstones, hypoechogenicity, heterogeneous echogenicity, gallbladder wall thickening (GBWT), absence of hyperechoic spot, and vascularity, eight were significantly associated with neoplastic polyps: size ≥10 mm (DOR: 6.23 [95% CI: 1.86– 20.90]), sessile morphology (DOR: 3.54 [1.93–5.97]), single polyp (DOR: 2.21 [1.76–2.74]), coexisting gallstones (DOR:1.86 [1.29–2.60]), hypoechogenicity (DOR: 3.55 [1.47–7.30]), GBWT (DOR: 9.38 [1.47–32.20]), absence of hyperechoic spots (DOR: 4.23 [2.46–6.83]), and vascularity (DOR: 9.72 [5.81–15.30]). Of these, size ≥10 mm demonstrated the highest pooled sensitivity (0.79 [95% CI: 0.68–0.87]), whereas hypoechogenicity showed the highest pooled specificity (0.93 [95% CI: 0.82–0.98]). Conclusion Eight US imaging features (size ≥10 mm, sessile morphology, single polyp, coexisting gallstones, hypoechogenicity, GBWT, absence of hyperechoic spots, and vascularity) were significantly associated with the presence of neoplastic polyps.These features may facilitate the management of gallbladder polyps.

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.

Objective: Evidence remains limited regarding whether Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) or modified RECIST (mRECIST) more reliably assesses treatment response in patients with hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (Atezo/Bev). This study aimed to evaluate response patterns based on RECIST 1.1 and mRECIST, analyze inter-reader agreement, and assess their prognostic value for overall survival (OS) in patients with HCC receiving first-line Atezo/Bev. Materials and Methods: This retrospective study included patients with HCC treated with first-line Atezo/Bev between June 2020 and December 2022 at a tertiary center. Patients with at least one hypervascular hepatic target lesion were eligible. Two radiologists independently assessed treatment responses using RECIST 1.1 and mRECIST. Inter-reader agreement was evaluated using Cohen’s kappa coefficient. Time-dependent Cox regression analysis was performed, with radiologic response and progression treated as time-varying covariates. Prognostic discrimination was evaluated using Harrell’s concordance index (C-index). Results: A total of 207 patients were included (171 men; median age, 63 years; median follow-up, 10.7 months [range, 0.8– 46.4 months]; median OS, 10.7 months [95% confidence interval, 9.2–12.8 months]). mRECIST identified more responders than RECIST 1.1 (54.6% vs. 16.9%). RECIST 1.1 demonstrated excellent inter-reader agreement, whereas mRECIST showed substantial agreement (weighted kappa, 0.89 vs. 0.79). A significantly higher rate of dissociated responses was observed with mRECIST than with RECIST 1.1 (14.0% vs. 4.3%, P < 0.001). Both RECIST 1.1- and mRECIST-based responses and progression were independently associated with OS. Models incorporating RECIST 1.1 demonstrated slightly higher C-index values than those incorporating mRECIST (RECIST 1.1: 0.68 for response and 0.75 for progression; mRECIST: 0.65 and 0.70, respectively). Conclusion RECIST 1.1 is more reproducible and prognostically valuable for guiding treatment decisions in patients with HCC receiving first-line Atezo/Bev. However, this does not invalidate the use of mRECIST as a biological tumor response marker.

Background: We developed a simplified variant of the ADV score, the AFP-PIVKAII (AP) score for post-transplant hepatocellular carcinoma (HCC) prognosis, which considers only AFP and PIVKA-II levels excluding morphometric tumor size information from the ADV score. This study investigated the prognostic performance of the AP score in predicting HCC recurrence and overall survival (OS) after living donor liver transplantation (LDLT). Methods: We analyzed 843 patients with HCC who underwent LDLT between 2006 and 2015, assessing HCC recurrence and OS in relation to AP score. Results: The median pretransplant AFP and PIVKA-II levels were 12.8 ng/mL and 27 mAU/mL, respectively. The median and mean AP scores were 2.6 log (range: 0.6–9.2 log) and 2.9±1.1 log, respectively. The 5-year time-dependent area under the receiver operating characteristic curve for the AP score in predicting post-transplant HCC recurrence was 0.672 (p<0.001). HCC recurrence and OS curves along AP score intervals of 1.0 log showed statistical differences in accordance with the AP scores (both p<0.001). Using a Youden index J-derived AP score cutoff of 4.0 log, two-tiered groups (ADV <4.0 log vs. ADV ≥4.0 log) showed statistically significant differences in HCC recurrence and OS (both p<0.001). Harrell’s c-indices for AP score with cutoff of 4.0 log and ADV scores with cutoff of 5.0 log regarding HCC recurrence and OS were similar. Conclusion The AP score functions as an integrated surrogate marker for predicting post-transplant outcomes in patients with HCC undergoing LDLT. It may serve as a simplified alternative to the ADV score, particularly in patients with small HCCs.

Lumbar spinal stenosis (LSS) is a common degenerative spinal condition where spinal canal narrowing causes symptoms such as neurogenic claudication, radiculopathy, and lower back pain. While non-operative and surgical approaches yield similar long-term outcomes, surgical intervention—particularly decompression—can provide earlier symptom relief, functional recovery, and fall prevention in selected patients with refractory symptoms. Recent advancements in surgical technologies and image guidance have brought about a paradigm shift in LSS management. Biportal endoscopic spine surgery (BESS) has gained global traction as a minimally invasive alternative to traditional decompression methods, offering superior visualization, less soft tissue damage, shorter hospital stays, and faster recovery. High-quality studies, including randomized controlled trials, have shown promising outcomes for this technique. Furthermore, the integration of navigation systems, robot-assisted instrumentation, and artificial intelligence (AI)-driven diagnostics and surgical planning tools is transforming spinal surgery by enhancing precision in preoperative evaluation and intraoperative execution. These innovations enable accurate targeting, reduce complications, and improve reproducibility across diverse surgical settings. This review provides an updated overview of LSS, covering its pathophysiology, clinical assessment, diagnosis, and treatment. Special emphasis is placed on the growing role of BESS and the transformative impact of digital technologies such as navigation, robotics, and AI in the evolving landscape of spinal stenosis care.

This study examined the inhibitory effects of pluviatolide, a lignan derived from Podophyllum hexandrum, on mast cell activation and IgE-mediated type I hypersensitivity, focusing on FcεRI-dependent and calcium-mediated pathways. Using bone marrowderived mast cells (BMMCs) and rat basophilic leukemia (RBL)-2H3 cells, we found that pluviatolide significantly decreased β-hexosaminidase release and suppressed the expression and secretion of TNF-α and IL-6 in a concentration-dependent manner, without causing cytotoxicity. While we initially hypothesized that it would selectively modulate antigen-specific FcεRI signaling, pluviatolide also inhibited degranulation induced by calcium ionophore and thapsigargin, indicating its effects extend to receptorindependent, Ca2+-dependent activation mechanisms. Immunoblot analyses revealed decreased phosphorylation of proximal kinases (Lyn, Syk), adaptor proteins (LAT, PLCγ1), MAPKs (ERK1/2, JNK, p38), and NF-κB p65. In a passive cutaneous anaphylaxis (PCA) mouse model, oral administration of pluviatolide significantly reduced Evans blue extravasation and mast cell degranulation in ear tissues. These findings demonstrate that pluviatolide suppresses both early and late-phase mast cell responses through multi-nodal inhibition of activation pathways, highlighting its potential as a therapeutic candidate for both IgE-mediated and non-IgE-mediated allergic disorders.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a cytokine that selectively targets cancer cells and induces apoptosis. However, many cancers, including bladder cancer, develop resistance to TRAIL, limiting the efficacy of TRAIL-based therapies. This study investigated whether betulinic acid (BA), a pentacyclic triterpenoid with anticancer and chemosensitizing properties, increases TRAIL-mediated apoptosis in TRAIL-resistant human bladder cancer cells. Combination treatment with BA and TRAIL significantly increased cytotoxicity and apoptosis compared to either treatment alone. This combination treatment also increased reactive oxygen species (ROS) production, increased Bax expression and Bid cleavage (tBid formation), and downregulated Bcl-2 levels. These effects were accompanied by caspase activation via extrinsic and intrinsic pathways, leading to cytochrome c release via mitochondrial membrane destabilization, thereby contributing to increased apoptosis. Furthermore, the combination treatment inhibited phosphoinositide 3-kinase (PI3K) and Akt phosphorylation; this effect was amplified by a PI3K inhibitor but abrogated by ROS inhibition. Collectively, our results suggest that BA sensitizes bladder cancer cells to TRAILinduced apoptosis via ROS-dependent activation of the apoptotic pathway and inhibition of PI3K/Akt signaling. Therefore, the BA and TRAIL combination exhibits potential to overcome TRAIL resistance in human bladder cancer.