Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

Purpose: To assess long-term outcomes of vesicostomy on bladder capacity (BC) and voiding function in non-neurogenic bladder, and explore the association between kidney ultrasonographic findings and renal function. Materials and Methods: Thirty-four patients under 2 years at the time of vesicostomy formation (2005–2020) with ≥3 years of follow-up were reviewed. Patients were further stratified based on neurogenic bladder status. Twenty-one patients were nonneurogenic. A subgroup analysis of 7 patients under 3 months with primary vesicoureteral reflux (VUR) and compromised renal function was conducted. Results: The median age at vesicostomy formation was 1.0 months (interquartile range [IQR] 0.0–3.5); the median duration of vesicostomy was 16.0 months (IQR 8.0–21.0). At a median age of 93.0 months (IQR 59.5–117.5), all patients achieved spontaneous micturition and continence. Eleven patients (52.4%) showed bell-shaped voiding patterns. Five patients showed interrupted (n=2) or plateau (n=3) patterns. With the exemption one patient, all patients with primary VUR showed bell-shaped curves. None initiated clean intermittent catheterization during follow-up. The median BC-to-estimated BC in patients with non-neurogenic bladder and primary VUR was 0.9 (IQR 0.7–1.1) and 0.9 (IQR 0.8–1.1), respectively. Three patients underwent revision due to prolapse. The glomerular filtration rate (GFR) was improved by 68.9% compared to the baseline (p=0.045). Parenchymal abnormalities on kidney ultrasonography were associated with decrease in GFR. Conclusions Vesicostomy in non-neurogenic bladder patients was associated with recovery of BC, preservation of continence, and improved renal function. Parenchymal abnormalities on ultrasonography predicted lower GFR.

Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

Accurate and early identification of stroke and large vessel occlusion (LVO) in emergency settings is essential for improving patient outcomes and ensuring the efficient allocation of medical resources. This clinical practice guideline systematically reviews domestic and international literature and conducts meta-analyses to evaluate the utility and diagnostic accuracy of stroke assessment tools used in prehospital emergency medical services (EMS). We developed a guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted to evaluate the usefulness of diagnostic EMS assessment tools for diagnosing stroke and LVO. Overall, 70 non-randomized control studies were selected for this study. A meta-analysis was conducted with a subgroup analysis to distinguish between patients with stroke and those with LVO. EMS tools demonstrated high sensitivity but low specificity for diagnosing stroke. In the prehospital setting, using validated EMS stroke assessment tools is recommended for the early identification of stroke and LVO. Upon hospital arrival, stroke specialists should conduct further evaluation and triage to confirm the diagnosis and guide appropriate management. Delays in diagnosing LVO are frequently unacceptable. While experts advocate for the use of EMS assessment tools to facilitate early identification of LVO, these tools alone lack adequate sensitivity. Therefore, further diagnostic evaluations and consultation with stroke specialists upon hospital arrival are recommended.

The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.

With a solitary remaining tooth in the mandible, restoration with a conventional removable partial denture is often associated with insufficient retention, support, and stability, as well as excessive stress concentration on the remaining tooth, leading to an unfavorable prognosis. Recently, treatment plans involving the placement of a small number of strategically positioned implants to fabricate removable partial dentures have been adopted to overcome these limitations.The use of implant surveyed crowns is considered to offer superior long-term outcomes compared with implant attachments. This report describes the restoration of a partially edentulous mandible with a single remaining tooth using an implant-assisted removable partial denture assisted by a surveyed fixed partial denture following bilateral posterior implant placement, achieving favorable clinical results.

BACKGROUND: Implant supporting materials are currently used in breast reconstruction. However, when used in humans, they are associated with several problems. To address these issues, a new mesh called TissueDerm was created by combining a collagen sponge with a 3D printed polycaprolactone (PCL) mesh. It has shown promising results in pig experiments and could potentially replace the most commonly used acellular dermal matrix (ADM) for breast reconstruction. METHODS: Four 12-month-old minipigs were used in this experiment. Silicone implants were wrapped with ADM or TissueDerm, and the breast tissue was excised and implanted along with the wrapped implants. Three months later, the minipigs were sacrificed and the skin and mammary gland tissue surrounding the implants were harvested for further analysis. Histological analyses and immunostaining were performed. RESULTS: Although there was no significant difference in capsule thickness between the ADM and TissueDerm groups, collagen was more involved in TissueDerm, leading to better tissue regeneration. TissueDerm also induced lower levels of inflammatory markers TNF-a and IL-6 compared to ADM. However, capsules induced with ADM had significantly higher collagen fiber alignment and alpha-smooth muscle actin (a-SMA) positive immunoreactivity, suggesting that TissueDerm may be less likely to cause spherical contractures in the porcine model compared to ADM. CONCLUSIONS The study found that TissueDerm has advantages over ADM in terms of easier tissue invasion and reduced spheroidization in a porcine model. The results showed that TissueDerm is a promising new mesh for implantbased breast reconstruction (IBBR) and could potentially replace ADM.

Background: Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are effective treatments for non-small cell lung cancer (NSCLC), but their use can lead to severe pneumonitis. This study aims to evaluate the utility of Krebs von den Lungen-6 (KL-6) for predicting and diagnosing PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients. Methods: We conducted a prospective observational study at a university-affiliated tertiary hospital in Korea from February 2022 to June 2023. Baseline KL-6 levels were measured immediately before initiating PD-1/PD-L1 inhibitor therapy. In patients who developed pneumonitis, KL-6 levels were monitored every 1–2 weeks from the onset of pneumonitis. For patients without pneumonitis, KL-6 levels were measured every 6 weeks. We compared clinical characteristics and serial KL-6 levels between the pneumonitis and non-pneumonitis groups. Results: Eighteen patients were enrolled, with 11 developing pneumonitis. Baseline KL-6 levels did not significantly differ between the two groups (261 U/mL in the pneumonitis group vs. 373 U/mL in the non-pneumonitis group, p=0.375). In the pneumonitis group, KL-6 levels generally showed an upward trend, with a median of 412 U/mL at pneumonitis onset. Conversely, KL-6 levels in the non-pneumonitis group showed no clear overall change. Conclusion In this pilot study, baseline KL-6 was not clearly linked to PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients. However, increases in KL-6 levels post-baseline were more frequently observed in patients who developed pneumonitis, including cases of all-cause pneumonitis.

Purpose: To investigate whether serum levels of Dickkopf-related protein-1 (DKK1) are clinically useful in estimating cross-sectional vasculitis activity and predicting future prognosis in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 76 patients with AAV. Their clinical data were retrospectively reviewed and serum DKK1 levels were measured in blood samples collected and stored at diagnosis. At diagnosis, the Birmingham vasculitis activity score (BVAS) and the five-factor score (FFS) were assessed as AAV activity indices, and the erythrocyte sedimentation rate and Creactive protein (CRP) level were recorded as acute-phase reactants. All-cause mortality and end-stage kidney disease (ESKD) were investigated as poor outcomes during follow-up. Results: Among the 76 patients with AAV (31 males, and 45 females), the median age was 63.5 years. At diagnosis, serum DKK1 levels were significantly correlated with BVAS, FFS, CRP, serum albumin, and serum creatinine levels. Using receiver operating characteristic curve analysis, the cut-off serum DKK1 level for predicting ESKD was determined to be 3925.0 pg/mL. Patients with serum DKK1 levels ≥3925.0 pg/mL at diagnosis displayed a significantly higher risk of ESKD progression (relative risk 5.357) and exhibited a significantly lower cumulative ESKD-free survival rate during follow-up than those with lower levels. Conclusion The present study is the first to demonstrate that serum DKK1 levels at diagnosis are useful in assessing vasculitis activity at diagnosis and predicting future ESKD progression in patients with AAV.