Background: Lapsi (Choerospondias axillaris), a plant native to Nepal, has been traditionally used in Asian countries to treat cardiovascular conditions. However, its effects on immune regulatory function remain largely unexplored.This study aimed to in vivo evaluate the immunoregulatory properties of Lapsi fruit extract in mice on immunotoxic responses with analysis on in vitro mechanism for immune suppression, oxidative stress, and inflammatory response.Male Balb/c mice were intragastrically administered various doses of the extract for 21 days. In some mice, immune suppression was induced with cyclophosphamide, and subsequent immune recovery was assessed. In addition, RAW264.7 cells and THP-1-derived macrophages were treated in vitro with lipopolysaccharide and different concentrations of the extract. Results: Administration of extract increased the IgG2a/IgG1 ratio while reducing serum IgE and IgG1 level compared with control mice. Tumor necrosis factor (TNF)-α and interleukin (IL)-17 levels were lower in splenic culture supernatants of mice administered extract. Lapsi extract also effectively reversed cyclophosphamide (CP)-induced immunosuppression by enhancing serum levels of IgA and IgG2a, of interferon-γ and interleukin (IL)-4 secreted by splenic T cells, and of IgG1 and IgG2a secreted by B cells, as well as by increasing immune cell counts. In cell cultures, the extract decreased the levels of inflammation markers, including nitric oxide, reactive oxygen species, prostaglandin E2, and pro-inflammatory cytokines (IL-6, TNF-α, and IL-1β). Mechanistic analysis showed that Lapsi extract modulated the NF-κB p65, MAPK, and inflammasome pathways. Conclusions Lapsi extract may act as both an immunostimulatory and anti-inflammatory agent, indicating its potential as a candidate immunomodulatory activity under polyclonal and CP-suppressed conditions; however, further disease-specific studies, along with isolation and characterization of active phytochemicals, are warranted to evaluate its therapeutic applicability.

Objective: To evaluate the precision of a three-dimensional (3D)-printed percutaneous pinning guide (PPG) for Kirschner wire placement in the treatment of femoral fractures using canine cadavers. Methods: The PPG was designed using 3D computer-aided design software and fabricated using medical-grade resin. In part 1, Kirschner wires were inserted into the intact femurs.In part 2, simulated femoral neck fractures were created using a 3D-printed osteotomy guide.Three wires were inserted into each femur under fluoroscopic guidance. The number of insertion attempts, fluoroscopic images, procedure times, and ease of use were recorded.Post-procedural computed tomography was used to assess angular deviation from ideal trajectories and pin engagement in the proximal femur. Results: The PPG group required fewer insertion attempts (p < 0.01), fewer fluoroscopic images (p < 0.001), and had higher ease-of-use scores (p < 0.047) than the freehand pinning technique (FHPT) group; angular deviation was significantly smaller in the proximodistal (2.9 ± 6.5° vs. 10.7 ± 5.9°; p = 0.022) and craniocaudal (4.8 ± 3.0° vs. 12.3 ± 8.8°; p < 0.001) directions. In part 2, the PPG group showed lower angular variance and greater proximal pin engagement than the FHPT group (p = 0.011). Conclusions and Relevance: The PPG showed better pinning precision and procedural efficiency than the FHPT under intact and simulated fracture conditions. The PPG may enhance safety and consistency in the percutaneous pinning of canine femoral fractures.

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.

Although aspartate aminotransferase (AST) is a serum marker of hepatocellular damage in chronic hepatitis, it is difficult to interpret very high AST levels with concurrent low alanine aminotransferase (ALT) levels. Macro-AST is an immunoglobulin-AST complex that can present as aberrant high enzymatic activity without significant inflammation in the liver. Two patients with chronic hepatitis B presented with disproportionate AST elevations. Their plasma samples were precipitated with polyethylene glycol (PEG) and stored at 4°C for macro-AST determinations. In Case 1, PEG precipitation showed 100% removal of AST activity, and refrigerated storage resulted in a ~70% decline over seven days, confirming macro-AST. In Case 2, both tests showed minimal changes, suggesting that macro-AST was unlikely. The AST levels normalized after antiviral therapy, suggesting immune-active hepatitis as the probable cause, but the other contributing factors could not be completely excluded. The abrupt decrease in AST activity after PEG precipitation and during refrigeration storage suggests that relatively high AST values compared to ALT might be attributed to the presence of macro-AST.These non-invasive methods for detecting macroenzymes might help the patient avoid unnecessary further work-ups.

Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.

Objectives: Tegoprazan is an alternative to proton pump inhibitors (PPIs). This study evaluated the occurrence of upper gastrointestinal (GI) and cardiovascular (CV) complications in patients with ischemic heart disease undergoing antiplatelet therapy after percutaneous coronary intervention (PCI) who were treated with tegoprazan or PPIs. Methods: Data from 604 patients who received antiplatelet therapy with tegoprazan or PPIs for >6 months after PCI between March 2019 and November 2023 were retrospectively analyzed. The primary GI endpoints were symptomatic gastroduodenal ulcers and upper GI bleeding, while the primary CV endpoints comprised major adverse cardiac events (MACEs), nonfatal myocardial infarction (MI), target vessel revascularization, and death from CV-related causes. Results: Among the 604 patients, 265 received tegoprazan and 339 received PPIs. During a mean follow-up of 17 months, seven patients experienced a GI event (0.4% with tegoprazan vs. 1.8% with PPIs; p=0.112) and 12 experienced MACEs (1.1% with tegoprazan vs. 2.7% with PPIs; p=0.183). Subgroup analysis indicated that target vessel revascularization occurred in six patients, with event rates of 0.8% (n=2) for tegoprazan and 1.2% (n=4) for PPIs (p=0.598). Tegoprazan was associated with similar rates of nonfatal MI (0.8% vs. 2.4%; p=0.125) and death from CV-related causes (0.4% vs. 0%; p=0.258) as PPIs. Conclusions There were no significant differences in GI- or CV-related complications between patients treated with tegoprazan and those treated with PPIs.

Background: This study aimed to investigate the size and characteristics of pediatric clinic closure during the coronavirus disease 2019 (COVID-19) period and what career paths pediatricians chose after closure. Methods: This study utilized database of the Health Insurance Review and Assessment Service from 2013 to 2022. We examined the trend of the number of pediatric clinics in operation over the past 10 years. Additionally, the study identified factors associated with the closure of pediatric clinics during the COVID-19 pandemic. Furthermore, the affiliations of representatives who closed their clinics during the pandemic were tracked as of December 2022. Results: In 2019, there were 2,229 pediatric clinics. During the COVID-19 pandemic, 364 (16.3%) of these clinics closed. Factors associated with the closure of pediatric clinics included pediatricians over the age of 65, operational periods of less than 5 years, and lower levels of medical expenses. As of 2022, among the 364 clinics that closed, 108 pediatricians (29.7%) retired or ceased working, and 127 pediatricians (34.9%) still employed in pediatricrelated healthcare institutions. A concerning phenomenon is that the remaining 129 pediatricians (35.4%) transitioned to unrelated healthcare institutions. Conclusion We have identified the magnitude and factors contributing to pediatric clinic closures. A more pressing issue is that over one-third of the pediatricians have transitioned to non-specialty fields following the closure of their clinics. Pediatrics represents a critical and essential medical field. Health authorities must develop strategies to prevent the avoidable collapse and subsequent exodus of pediatricians.

Background and Objectives: Pediatric chronic rhinosinusitis (CRS) significantly affects children’s quality of life and learning abilities. This study aimed to evaluate the postoperative outcomes in pediatric patients who underwent functional endoscopic sinus surgery (FESS) for CRS. Methods: A retrospective review was conducted on pediatric patients who underwent FESS for CRS at 11 university hospitals. The inclusion criteria were patients under 20 years old with bilateral disease who were operated on between January 2005 and December 2021. The data collected included demographics, clinical history, blood tests, preoperative computed tomography, and preoperative and postoperative symptom control. The Kruskal-Wallis and Fisher exact tests were used to compare the quantitative and qualitative data, respectively. Results: In total, 213 patients were enrolled. The mean age was 13.4±3.0 years, and 145 (68.1%) were male. One hundred sixty-four patients (77.0%) had nasal polyps and 33 patients (15.5%) underwent revision FESS. The preoperative symptoms, in order of prevalence, included nasal obstruction (87.8%), rhinorrhea (71.8%), a sense of postnasal drip (58.2%), hyposmia (44.6%), cough (24.4%), and facial fullness (18.3%). These symptoms were significantly alleviated for up to 3 years after surgery (p<0.001). At the time of the last follow-up, 121 patients (56.8%) were controlled, 80 (37.6%) were partly controlled, and 12 (5.6%) were uncontrolled. Patients in the uncontrolled group had higher Lund-Mackay scores, longer follow-up durations, and more instances of revision surgery compared to those in the controlled and partly controlled groups. When age was categorized into three groups, those aged 16 years or older tended to have lower Lund-Mackay scores and better control. Conclusion FESS significantly improves both the postoperative symptoms and the long-term quality of life in pediatric CRS patients. Better symptom control is associated with older age and a lower disease burden.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.