Background/Aims: Left ventricular ejection fraction (LVEF) is a key echocardiographic parameter for assessing LV systolic function, guiding the management of many cardiovascular diseases, including heart failure (HF). While traditional electrocardiography (ECG) has been widely used in clinical practice, it has limitations in predicting LVEF. This study investigated the impact of integrating ECG data with metadata, such as age, N-terminal pro B-type natriuretic peptide (NT-proBNP), and sodium levels, to enhance the accuracy of LVEF prediction, especially in HF with reduced ejection fraction (HFrEF, LVEF ≤ 40%). Methods: This retrospective study analyzed ECG and metadata from two tertiary teaching hospitals in Korea. A deep neural network (EfficientNet B3) was trained to predict LVEF, incorporating clinical metadata alongside ECG inputs. Model performance was assessed using the area under the curve (AUC) and the coefficient of determination (R2). Results: The artificial intelligence (AI) model achieved an AUC of 0.95 when ECG data were combined with age, NT-proBNP, and sodium levels, outperforming models relying on ECG alone (AUC = 0.90). The integration of metadata significantly improved the prediction accuracy, particularly for HFrEF cases. The specificity of the model remained high (96.9%), but sensitivity was relatively low (54.8%), indicating its potential as a screening tool for HFrEF. Conclusions The combination of ECG and metadata results using AI enhances the predictive accuracy of HFrEF detection. This approach offers a scalable and noninvasive method for HF screening and risk stratification, particularly in resource-limited settings. Further validation in diverse populations is needed to confirm its clinical utility.

Purpose: Spinal fusion, which is considered the standard treatment for segmental instability, carries an inherent risk of irreversible loss of spinal flexibility and the subsequent development of adjacent segment disease. Spinal dynamic stabilization has emerged as a motion-preserving alternative intended to mitigate these limitations. This study retrospectively compared clinical and radiological outcomes between the Spine Gold (SG) system and decompression alone in patients with single-level central stenosis accompanied by grade 1 spondylolisthesis. Methods: A total of 262 patients who underwent surgery between January 2013 and May 2024 were included in the analysis (SG fixation, n=161; decompression alone, n=101). All decompression procedures were performed using the unilateral laminectomy for bilateral decompression technique. Clinical outcomes were evaluated based on reoperation rates, time to reoperation, preoperative and 1-month postoperative visual analogue scale scores for back pain and radicular pain, and 1-month postoperative MacNab criteria. Radiological outcomes, including static slippage and dynamic instability at both the index and proximal adjacent levels, were assessed using preoperative radiographs and radiographs obtained at final follow-up. Results: Both treatment groups demonstrated significant postoperative improvement in pain outcomes. SG fixation was associated with significant reductions in static slippage and dynamic instability at the index level, along with a reduction in dynamic instability at the proximal adjacent level. In contrast, decompression alone resulted in postoperative increases in both static slippage and dynamic instability. The SG group also exhibited a significantly lower reoperation rate (10.6%) and a longer time to reoperation compared with the decompression-alone group (21.8%). All reoperations in the SG group occurred exclusively at the adjacent level, whereas reoperations in the decompression-alone group primarily involved recurrence or progression at the index level. Conclusion Dynamic stabilization using the SG system effectively stabilizes the index level while providing concomitant stabilization of the proximal segment. In carefully selected patients with single-level central stenosis and grade 1 spondylolisthesis, this approach may represent a viable alternative to fusion by offering improved long-term stability and lower reoperation rates, primarily through limiting progressive index-level instability compared with decompression alone.

Objective: To compare 1-year radiographic and clinical outcomes between expandable cages and polyetheretherketone (PEEK) cages in patients undergoing endoscopic transforaminal lumbar interbody fusion (TLIF). Methods: This retrospective, single-surgeon cohort study included 84 patients (32 expandable cage, 52 PEEK cage) with at least 1 year of radiographic and clinical follow-up. Radiographic parameters included disc height, foraminal height, segmental lordosis, subsidence, cage length, and the cage-to-vertebral body area ratio measured on computed tomography. Clinical outcomes were evaluated using Numerical Rating Scale (NRS) scores and Bridwell fusion grading. Group comparisons were performed using t-tests and chi-square tests, and multivariate regression analyses were conducted to identify independent predictors of subsidence and fusion. Results: PEEK cages demonstrated greater correction of segmental lordosis (2.6° vs -0.3°, p=0.003) and significantly lower total subsidence (2.2±1.7 mm vs. 4.6±2.4 mm, p=0.001) compared with expandable cages. In contrast, expandable cages were associated with significantly greater improvement in back pain at 1 year (β=1.71 NRS points, p=0.014). A larger cage-to-vertebral body area ratio independently reduced the risk of severe subsidence ≥5 mm (odds ratio, 0.34 per 0.1 increase; p=0.033). Fusion outcomes, defined as Bridwell grades 1–2, did not differ significantly between the 2 groups. Conclusion Expandable cages provided greater back pain relief despite a higher degree of subsidence, whereas PEEK cages offered superior radiographic stability. These findings highlight important radiographic-clinical trade-offs in cage selection for endoscopic TLIF and support individualized decision-making based on patient anatomy, alignment objectives, and symptom profile.

Soft tissue sarcomas (STSs), a diverse group of mesenchymal malignancies, are characterized primarily by copy-number alterations rather than a high tumor mutation burden. In this study, we sought to identify expression-based biomarkers in complex karyotype STS (CKS) with CDK4-amplification to support improved therapeutic strategies. Using transcriptome data from National Cancer Center (NCC)-CKS samples, we selected genes whose expression levels were more than two-fold higher or less than half in tumor tissues compared with normal tissues. These genes were further filtered by CDK4-amplification status, resulting in 30 candidates, which were refined to 14 differentially expressed genes (DEGs) based on false discovery rate (FDR) significance. Bioinformatics analyses revealed enriched pathways and gene–gene networks related to redox regulation and growth-factor–driven signal transduction, indicating metabolic alterations that may promote tumor survival in CDK4-amplified CKS. A subset of the 14 genes demonstrated prognostic significance in CDK4-amplified patients from the TCGA cohort. Additionally, immune cell marker analysis showed associations between CDK4-amplification and innate immune cell signatures. Together, our findings identify promising therapeutic and prognostic targets linked to CDK4-amplification in CKS. These biomarkers warrant further investigation and may ultimately contribute to improved clinical outcomes for patients with CKS.

The comprehensive in vitro proarrhythmia assay (CiPA) initiative, led by the U.S. Food and Drug Administration (FDA), provides a framework for predicting drug-induced arrhythmia risk. To support domestic CiPA implementation, we evaluated the proarrhythmic risk of sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor. Sildenafil has been misused recreationally, with reports of highdose non-medical intake. To simulate misuse, in vitro assays were conducted using concentrations up to 100× the maximum therapeutic plasma concentration (Cmax). The assessment followed the three core components of the CiPA paradigm. Patch clamp assays were conducted in Human Embryonic Kidney 293 (HEK293) and Chinese hamster ovary (CHO) cells transiently expressing Nav1.5, Cav1.2, and hERG ion channels. In silico modeling was performed using the CiPAORdv1.0 model based on IC₅₀ and Hill coefficient values. Functional evaluation included multi-electrode array (MEA) recordings in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), and in vivo electrocardiography (ECG) analysis in rats was performed to observe QT interval prolongation. Sildenafil significantly inhibited hERG currents by 40.5% at 100× Cmax. In silico modeling predicted a low Torsades de Pointes (TdP) risk based on qNet biomarkers. In contrast, MEA recordings showed a concentration-dependent prolongation of corrected field potential duration (FPDc), with a significant 13.3% increase at 100× Cmax. The TdP risk estimated from MEA modeling was 64%. In vivo ECG analysis revealed significant QT prolongation at 50× Cmax. Despite low in silico TdP predictions, functional assays suggest that high concentrations of sildenafil as in misuse may pose a clinically relevant risk of QT prolongation and arrhythmia.

Purpose: Radiotherapy is used to reduce the risk of breast cancer recurrence after surgery, but it is a potential cause of secondary cancer. We validated the risk of secondary cancer in primary breast cancer who received radiotherapy compared with those who did not from a matched cohort using a large-scale observational study of the Observational Health Data Sciences and Informatics (OHDSI) data network. Materials and Methods: A retrospective comparative cohort study using propensity score-matched cohorts was performed using two Observational Medical Outcome Partnership common data model databases, from tertiary general hospitals in South Korea. Among female patients who underwent surgery after the diagnosis of breast cancer, the risk of secondary primary malignant occurrence after 1:1 matching was analyzed. Results: Among 27,078 patients with breast cancer, there was no significant difference in the risk of secondary cancer following radiotherapy in 4,426 patients after 1:1 propensity-score matching. Further, there were no significant differences in the sensitivity analysis according to age, latency period, and number of radiation treatments. Conclusion There was no difference in the risk of secondary cancer in the patients diagnosed with breast cancer depending on whether or not radiotherapy was performed after surgery. In the future, it is necessary to analyze including data generated during cancer treatment.

Anterior cruciate ligament (ACL) injuries are common sports-related knee injuries, with surgical treatment being widely accepted as the standard approach. An ACL reconstruction aims to restore the knee function, prevent secondary meniscal tears, and cartilage damage caused by instability. Acute isolated ACL injuries account for approximately 3%–10% of all ACL injuries, making them relatively uncommon.Various treatment methods, ranging from conservative management to ACL reconstruction, have been used, but surgical treatment is often preferred, particularly in young and active individuals. Conservative treatment allows patients to return to their previous activities, and studies have shown that its outcomes in terms of patient assessment and osteoarthritis incidence are comparable to those of surgical treatment. Nevertheless, it has some drawbacks, including a higher risk of secondary meniscal tears and mild static knee instability compared to surgery. Therefore, selecting suitable patients for conservative treatment is crucial for achieving satisfactory results. Various selection criteria have been proposed. Recent reports suggest that even young, highly active patients can return to their pre-injury activity levels if they are carefully selected for conservative treatment. With the appropriate indications and functional rehabilitation tailored to the patient’s expectations, conservative treatment can be considered a viable standard option for managing acute isolated ACL injuries. This review summarizes the clinical outcomes of conservative treatment for such injuries, focusing on appropriate indications and rehabilitation strategies based on the literature.

Objective: To classify life stages for companion dogs and cats by identifying clusters in age-specific disease proportions derived from medical records, providing a data-driven foundation for health examination programs. Methods: We collected 505,667 medical records from 82 veterinary facilities in South Korea between 2020 and 2023. Diagnoses were standardized using GPT-4o and S-BioBERT. Following preprocessing, data from 27 facilities yielded 222,706 canine and 39,910 feline records for the final analysis. Principal component analysis and K-means clustering (K = 4) were applied to age-specific disease proportions to identify life stages.The 10 most highest-proportion diagnoses diseases were determined for each cluster. Results: Canine life stages were classified as ≤ 1 year, 2–5 years, 6–10 years, and 11–15+ years.Feline life stages were 1–2 years, 3–8 years, 9–12 years, and 13–15+ years. In dogs, developmental diseases were common in the youngest age group, while chronic diseases were more prevalent in older groups. In cats, oral and urinary diseases were high-ranking, conjunctivitis was most common in the early stage, and chronic diseases increased with age. Conclusions and Relevance: Age-specific diagnosis patterns support four practical life stages for dogs and cats in South Korea. These boundaries can inform evidence-based preventive examination schedules, animal health policy, and pet insurance product design.

Background: Impulse oscillometry (IOS) provides an effort-independent assessment of respiratory mechanics and is particularly sensitive to small airway dysfunction. Although IOS has been shown to complement spirometry in asthma, its association with exacerbation risk and its relationship with type 2 inflammatory biomarkers remain incompletely understood. Methods: In this retrospective cross-sectional study, 128 adult patients with physician-diagnosed asthma who underwent both spirometry and IOS at a tertiary hospital between January 2023 and July 2024 were analyzed. Exacerbation events during 1-year follow-up were identified from medical records. IOS parameters included resistance at 5 and 20 Hz (R5 and R20), reactance at 5 Hz (X5), resonant frequency (Fres), area under the reactance curve (AX), and frequency dependence of resistance between R5 and R20 (R5–R20). Correlations between spirometric indices and IOS parameters were assessed. Diagnostic performance for exacerbation events was evaluated using receiver operating characteristic (ROC) analysis. Exploratory analyses examined associations between IOS indices, fractional exhaled nitric oxide (FeNO), and blood eosinophil counts. Results: Thirty-three patients (25.8%) experienced exacerbations. AX showed the strongest correlations with forced expiratory volume in 1 second (FEV₁)% predicted (r=−0.51, p<0.001) and FEF25–75% predicted (r=−0.42, p<0.001). Patients with exacerbations exhibited significantly higher R5, Fres, AX, and R5–R20 compared with those without exacerbations, with AX demonstrating the largest effect size (Cohen’s d=0.91). In ROC analysis, AX showed the highest discriminative ability for exacerbation events (area under the curve=0.673). FeNO and blood eosinophil counts were not significantly correlated with IOS parameters and showed limited predictive performance when used alone; however, inclusion of AX significantly improved model discrimination. Conclusion IOS parameters, particularly AX, are significantly associated with asthma exacerbations and capture mechanical aspects of small airway dysfunction that are not fully reflected by spirometry or type 2 inflammatory biomarkers. IOS may provide clinically meaningful complementary information for risk stratification in asthma.