ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

Blood standardization is a crucial means of promoting the healthy and sustainable development of China's blood industry. The construction of a blood standard system serves as the foundational work for blood standardization. To facilitate the continuous improvement of blood standardization efforts, this paper begins by describing the current status and analyzing the issues within China's blood standard system. Through systematic research, it proposes a framework for constructing a blood standard system and offers revision recommendations for its enhancement. Based on the first five editions of the blood standard system developed by Sub-Committee of Blood Standards of National Committee of Health Standards, this study further refines the revision and detailed construction of the standards framework—the primary task in establishing the blood standard system. It provides specific guidance for both the construction and application of the blood standard system. This work serves as a reference and basis for the reasonable and standardized formulation and revision of blood standards, as well as for the management and implementation of blood standardization efforts.

Objective: To analyze the demographic characteristics, return donation patterns, and risk of adverse reactions among donors temporarily deferred due to blood pressure abnormalities, so as to provide an evidence-based foundation for optimizing pre-donation blood pressure screening strategies, enhancing donor retention, and ensuring blood supply safety. Methods: Data from 2.939 million donor instances were collected through the Information Management System at the Beijing Red Cross Blood Center between January 2015 and August 2025. The analysis specifically focused on the 11 600 instances of donors temporarily deferred due to abnormal blood pressure, examining demographic characteristics (age, and gender) and donation-related features (number of donations, donation site, and type of donation). Further analysis was conducted on the return donation patterns, including the return rate, time interval to return, and the incidence, type, and severity of adverse reactions among returned donors. Results: Distribution of abnormal blood pressure: Among the 11 600 instances of abnormal blood pressure, the prevalence was significantly higher in males (0.48%, 10 111/2 086 909) than in females (0.17%, 1 465/852 090). The 46-55 age group had the highest prevalence (0.88%, 2 925/329 235), and the differences across age groups were statistically significant. The prevalence was, higher among repeat donors (0.41%, 5 242/1 276 452) than first-time donors (0.38%, 6 334/1 662 547). The prevalence at mobile donation sites outside the blood center (0.06%, 350/596 104) was higher than fixed donor centers (0.50%, 10 225/2 052 290) and group donation drives (0.34%, 1 001/290 608). Return donations: A total of 19.49% (2 256 out of 11 576) deferred donors returner and successfully donated. Among these donors, 36.17% (816 out of 2 256) returned within 7 days, while the highest proportion of returns was observed within 31-182 days (25.44%, 574/2 256). A higher return rate was observed among male donors (20.17%, 2 039/1 0111) compared to female donors (14.81%, 217/1 465). The return rate for repeat donors (43.02%, 2 255/5 242) was significantly higher than that of first-time donors (0.02%, 1/6 334). Individual donors showed a higher return rate (20.95%, 1 986/9 479) than group donors (12.88%, 270/2 097), with all differences being statistically significant (P<0.05). The differences in return rates across age groups were not statistically significant (P>0.05). Adverse reactions: The incidence of adverse reactions after return was 0.09% (2/2 256), significantly lower than the overall adverse reaction incidence during the same period (0.20%, 5 981/2 938 999). Both adverse reactions were local reaction (category A1, pain or bruising at the puncture site), with no reported cases of systemic vasovagal reactions (VR) or severe adverse events. Conclusion: The current blood pressure screening criteria may lead to the unnecessary deferral of eligible donors. The risk of adverse reactions is extremely low among returned donors who were deferred for abnormal blood pressure. A relaxation of the blood pressure screening criteria is therefore suggested, coupled with the optimization of donation site environment and blood pressure measurement procedure with reference to expert consensus to enhance donor retention and blood supply safety.

Purpose: The clinical utility of routine repeat computed tomography (CT) in pediatric patients with mild traumatic brain injury (TBI) remains controversial. We aimed to identify factors associated with worsening intracranial injury (ICI) on repeat CT in pediatric patients with mild TBI. Methods: This retrospective study included patients aged 0–18 years with mild TBI (Glasgow Coma Scale score 13–15) who presented to an emergency department in South Korea from January 2017 through December 2023. Patients were included if they underwent an initial CT within 24 hours of injury and a repeat CT within 72 hours. Worsening ICI was defined as an increase in hemorrhage size or the development of new lesions on repeat CT. Clinical characteristics, injury mechanisms, and CT findings were compared between patients with and without the worsening ICI. Multivariable logistic regression was performed to identify independent predictors of worsening ICI on repeat CT. Results: A total of 212 patients were included, of whom 48 (22.6%) showed worsening ICIs on repeat CT (i.e., worsening group). The worsening group showed higher median values of age and length of hospital stay, as well as higher percentages of initial Glasgow Coma Scale of 14, motorcycle/bicycle injury, intensive care unit hospitalization, and abnormalities on initial CT (including skull fracture, epidural hemorrhage, subdural hemorrhage, and pneumocephalus), compared with their counterparts. The regression model showed subdural hemorrhage (odds ratio, 4.99 [95% confidence interval, 2.08–11.96]), epidural hemorrhage (4.04 [1.73–9.44]), and motorcycle/bicycle as the injury mechanism (2.94 [1.14–7.59]) as the predictors. Conclusion In pediatric mild TBI, motorcycle/bicycle accidents and the presence of hemorrhages on initial CT may be associated with worsening ICI on repeat CT. These findings support a risk-stratified approach, in which repeat imaging is selectively considered for high-risk patients to reduce unnecessary radiation exposure.

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.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Purpose: Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy. Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited. This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size. Materials and Methods: This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024. Patients were categorized into four groups:conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery. The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization. Subgroup analyses were performed according to defect size. Results: Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years. Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%). In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029) compared with endoscopic treatment.Among those with defects ≥2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size. Conclusions Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm. For larger defects (≥2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy. These findings highlight the importance of individualized treatment selection based on defect size.

Medial opening wedge supramalleolar osteotomy (SMO) is a representative joint-preserving surgical procedure for varus ankle osteoarthritis, based on the principle of load redistribution, with favorable radiologic and clinical outcomes. This procedure is indicated for patients with Takakura stage 2 or 3A arthritis, whereas severe vascular or neurological impairment and osteomyelitis are considered absolute contraindications. Although SMO is generally limited to patients younger than 70 years because of the risk of delayed or nonunion in elderly individuals, few reports on the outcomes in elderly patients have been published. This paper reports two cases of varus ankle osteoarthritis in patients over 75 years of age who underwent SMO after failed conservative treatment, with a follow-up exceeding 2 years, along with a review of the relevant literature. Both cases achieved successful bone union without delayed healing. At the final follow-up, the foot and ankle ability measure (FAAM)–activities of daily living and FAAM-sport scores showed marked improvement compared with the preoperative values. In conclusion, SMO may be a viable joint-preserving treatment option, even in elderly patients, provided that their general health is favorable.

Menopause is a normative midlife transition characterized by profound endocrine remodeling and a high burden of symptoms and functional change. Accumulating epidemiologic and translational evidence links menopausal transition with shifts in cardiometabolic risk, musculoskeletal health, sleep, mood, and perceived cognitive function. However, most data support association rather than definitive causal acceleration of aging independent of chronological time. This narrative review proposes a menopause-centered healthspan framework that integrates biological, neurocognitive, and psychosocial domains and translates evidence into pragmatic clinical pathway tools. To inform topic selection and prioritize higher-level evidence, including guidelines, randomized trials, meta-analyses, and large cohort studies, a structured evidence scan utilizing PubMed and targeted citation tracking was performed. The evidence scan identified 256 citations. After duplicate removal, titles/abstracts of 162 unique records were reviewed, of which 102 citations informed the final narrative synthesis. The results emphasize that menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and an evidence-based option for reducing fracture risk in appropriate candidates. However, it is not indicated for the primary prevention of cardiovascular disease or dementia. Absolute risks and benefits vary by age, time since menopause, and formulation/route. The neurocognitive section distinguishes common, often transient midlife cognitive complaints from long-term neurodegenerative outcomes, highlighting that menopause is not established as an independent dementia risk factor in the general population. Overall, the framework aims to support individualized, equity-informed care during menopausal transition.

This study aimed to describe a facet-preserving modified transpedicular unilateral biportal endoscopic (UBE) approach for upwardly migrated thoracic disc herniation that allows safe decompression without spinal cord retraction or postoperative instability. Thoracic disc herniation is rare but often symptomatic, producing myelopathy that typically necessitates surgical intervention. Because of the spinal cord’s close proximity, traditional discectomy approaches carry a high risk of neural injury, and achieving complete disc removal without cord manipulation remains a significant surgical challenge. Although several techniques have been proposed, many are limited by the potential for incomplete decompression or iatrogenic instability. A facet-preserving modified transpedicular UBE approach may overcome these limitations by offering a minimally invasive surgical corridor while maintaining spinal stability. A 76-year-old woman presented with progressive bilateral lower extremity weakness and numbness over 6 months, with rapid deterioration during the past month. Magnetic resonance imaging (MRI) revealed an upwardly migrated thoracic disc herniation at T10–11 compressing the spinal cord. A UBE discectomy using a facet-preserving modified transpedicular approach was performed. The herniated fragment was completely removed without spinal cord retraction. Postoperatively, the patient demonstrated neurological improvement without complications. MRI confirmed complete decompression of the cord, and computed tomography verified preservation of the facet joint. This video article introduces the modified transpedicular UBE approach as a safe and precise minimally invasive technique for thoracic ventral pathologies. By enabling direct ventral decompression while preserving spinal stability, it broadens the scope of endoscopic spine surgery and warrants further clinical validation.