Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

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.

Background: Studies on whether donor-to-recipient sex match status affects long-term survival after liver transplantation (LT) have yielded contradictory results. This study evaluated whether donor-to-recipient sex match status influenced long-term survival after living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT) at a high-volume center. Methods: The study included 6,664 patients who underwent primary LT between January 2000 and December 2022 at our institution. Patients were divided into four groups according to donor-to-recipient sex match status: male-to-male (n=3,427 [51.4%]), male-to-female (n=1,152 [17.3%]), female-to-male (n=1,385 [20.8%]), and female-to-female (n=700 [10.5%]). Results: Regarding clinical characteristics, the four groups differed significantly regarding background liver disease (P<0.001), model for end-stage liver disease score (P<0.001), serum protein induced by vitamin K absence or antagonist II level (P=0.003), presence of concurrent hepatocellular carcinoma (HCC; P<0.001), and type of LT (P=0.003). Overall survival (OS) of all LT recipients did not differ significantly among the groups (P=0.377). Donor-to-recipient sex match status did not affect long-term OS in either LDLT (P=0.176) or DDLT (P=0.220) groups. In addition, sex match status did not significantly influence posttransplant OS among patients who underwent LDLT without HCC (P=0.464), LDLT with HCC (P=0.236), DDLT without HCC (P=0.338), or DDLT with HCC (P=0.818). Conclusions Donor-to-recipient sex match status does not significantly affect posttransplant patient survival or HCC prognosis after LDLT or DDLT.

Purpose: This study aimed to compare the acute effects of isometric handgrip (IHG) and wall squat (IWS) exercise on 24-hour ambulatory blood pressure (BP) and related indices in young men with prehypertension. Methods: Ten young men with prehypertension (aged 25.0±2.3 years) completed three randomized crossover conditions: IHG, IWS, and control. Twenty-four-hour ambulatory BP monitoring was used to assess 24-hour, daytime, and nighttime mean BP, BP variability (BPV; average real variability and standard deviation), morning BP, and nocturnal dipping pattern. Office BP was measured at baseline, 30 minutes, and 90 minutes after each condition. Results: Twenty-four hour, daytime, and nighttime systolic and diastolic BP did not differ significantly among conditions. BPV indices also showed no significant between-condition differences across 24-hour, daytime, or nighttime periods. Nocturnal systolic BP dipping averaged 5%–8% and did not differ among conditions, indicating a nondipper pattern in all trials. Morning systolic BP, sleep-trough surge, and prewaking surge were similar across conditions. Office BP showed no significant condition or interaction effects; however, both IHG and IWS tended to lower BP at 90 minutes compared with control session. Conclusion A single bout of IHG or IWS did not elicit significant changes in 24-hour ambulatory BP, BPV, morning BP, or dipping pattern in young men with prehypertension. Nonetheless, the small acute reductions in office and morning BP suggest that isometric exercise may have potential as a time-efficient adjunctive strategy for early BP management. Larger and longer-term studies are needed to confirm these findings.

Purpose: Inspiratory muscle strength training is a time-efficient strategy for lowering blood pressure, but the acute vascular effects and its hemodynamic characteristics remain unclear. This study aimed to determine the acute effects of inspiratory muscle strength exercise (IMSE) on vascular function and shear patterns. Methods: In a single-arm acute trial, 12 young adults (aged 26±2 years) performed a single bout of IMSE (about 8 minutes) consisting of 30 breaths (6 breaths×5 sets) at 60% of maximal inspiratory pressure. Vascular function indices were assessed as endothelial function and arterial stiffness. Measurements of endothelial function via flow-mediated dilation (FMD) in the brachial artery and arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) were taken at baseline, 10 minutes, and 40 minutes post-IMSE. Shear rate (SR) responses were continuously obtained throughout the IMSE session at the brachial artery and were analyzed as mean SR, anterograde SR, and retrograde SR. Results: Compared to baseline, cfPWV significantly decreased (7.95±0.9 m/sec to 7.49±0.9 m/sec, p=0.033) and FMD increased (4.76%±1.0% to 6.26%±1.1%, p＜ 0.001) at post-10 min. Both cfPWV and FMD returned to baseline levels at post-40 min. During IMSE, mean SR and anterograde SR significantly increased (both, p＜ 0.05), whereas retrograde SR decreased (p=0.032) during inter-set rest periods. In addition, rhythmic fluctuations in SR were observed corresponding to inspiration and expiration phases. Conclusion These findings suggest that an acute bout of IMSE is associated with improved endothelial function and arterial stiffness. IMSE may elicit distinct hemodynamic responses during exercise, which may be linked to improvements in vascular function.

Purpose: Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world. Materials and Methods: We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis. Results: NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs. Conclusion Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

It is difficult to determine a cause of bile duct stricture and dilatation. Eosinophilic cholangitis, a rare benign condition, may be one cause of bile duct stricture and dilatation. It can be evaluated using various methods of histopathology, radiographs, endoscopy, and hematologic findings. Treatment generally involves steroid therapy which can lead to improvement. This case report will discuss eosinophilic cholangitis, emphasizing that while it can easily be overlooked but should be considered in differential diagnoses.

This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.