Background: Combined pelvic ring and acetabular fractures are complex injuries associated with high morbidity. Despite advancements in surgical techniques, limited data are available on the long-term functional outcomes and associated factors. This study aimed to identify the factors associated with functional outcomes in surgically treated patients with combined pelvic ring and acetabular fractures. Methods: This retrospective study included 25 adult patients who underwent definitive surgical fixation for radiologically confirmed combined pelvic ring and acetabular fractures at a Level I trauma center between 2005 and 2021, with a minimum clinical and radiological follow-up of 24 months. Surgical approaches included the Kocher–Langenbeck or modified Stoppa methods, tailored to fracture morphology. Matta–Saucedo and Matta criteria assessed the pelvic ring and acetabular reduction quality, respectively. Functional outcomes at 2 years were evaluated using the Rommens–Hessmann criteria. Neurological recovery was assessed clinically and by electromyography where indicated. The association between the injury characteristics and functional recovery was evaluated using t-tests and Fisher’s exact test. Results: The mean patient age was 40.4 years, and 72% were male. Transverse acetabular fractures (58.6%) and anteroposterior compression pelvic ring injuries (64%) were the most common injuries. Anatomic or congruent acetabular reduction (within 2–3 mm) was achieved in 89.6% of fractures and was significantly associated with superior functional outcomes (p = 0.002). Conversely, the pelvic ring reduction quality did not significantly correlate with functional outcomes (p = 0.314). Transverse acetabular fractures (p = 0.046) and initial neurological deficits (p = 0.032) were associated with poorer recovery. Among the patients with neurological injury, 60% achieved partial or full recovery. Overall, bony union occurred in 96% of cases, with a mean time to union of 14.3 weeks. Reported complications included neurological deficits (40%) and infections (8%). Conclusions Functional outcomes following the surgical fixation of combined pelvic and acetabular fractures are primarily influenced by the acetabular reduction quality and neurological status at presentation. Transverse fracture patterns are complex and associated with nerve injuries, posing additional challenges. These findings emphasize the importance of precise joint reduction and early neuroassessment. Further multicenter, prospective studies are warranted to optimize the management of these complex injuries.

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: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases. Materials and Methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre–COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed. Results: The patients’ median age was from 13 years (range, 1–19 years) to 13 years (range, 1–16 years) between the pre–COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre–COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7–120.0] vs. 20.0 hours [1.3–288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5–124.3] vs. 28.5 hours [6.1–293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0–13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1–7.3 mL) in pre–COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes. Conclusions The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.

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.

Background/Aims: Helicobacter pylori may protect against immune-mediated disorders such as inflammatory bowel disease (IBD) and asthma. This study evaluated whether eradication was associated with IBD and asthma in Korean children. Methods: Data were collected from the Korean National Health Insurance information on patients younger than 18 years and without a prior diagnosis of IBD or asthma from January 2007 to September 2020. Patients confirmed with H. pylori infection were divided into the eradication and non-eradication group. We compared the incidence of IBD and asthma in infected patients with an age, and sex-matched control group. Results: In total, 979,663 patients were selected based on the inclusion criteria and 2,779 patients were included based on the exclusion criteria. The occurrence of IBD in infected patients was statistically significant (p < 0.05) but there was no association of infection with asthma. There was no association with eradication and the development of IBD and asthma. The infected group had a shorter duration till diagnosis of IBD than the control group. Conclusions Our study found H. pylori infection to be associated with the development of IBD in children. However, eradication does not increase IBD and asthma in children.

Objectives: This study was performed to quantify the impact of coronavirus disease 2019 (COVID-19) on hospital profitability in Korea by analyzing changes in the medical revenue-to-profit ratio (MRPR) and net income before reserve fund allocation (NIBR) before and after the pandemic onset. Additionally, it examined how financial outcomes varied by hospital ownership, geographic location, and type (secondary or tertiary), providing insights into the financial resilience of various hospital types during public health crises. Methods: We conducted a longitudinal analysis using publicly available financial disclosure data from 243 general hospitals in Korea (2016–2022). We then performed a quadrant analysis to classify hospitals based on changes in MRPR and NIBR, identifying patterns of financial impact. For inferential analysis, we employed linear mixed-effects models incorporating a difference-in-differences framework, enabling estimation of both time-varying and hospital-specific effects. Results: Following the onset of COVID-19, MRPR declined significantly, reaching −10.62% in 2020. NIBR initially dropped but later increased, reaching 21.09 billion Korean won per 100 beds in 2022. Quadrant analysis revealed substantial heterogeneity in financial responses, with national/public hospitals experiencing the most severe MRPR decline, whereas educational foundation and medical corporation hospitals displayed stronger financial recovery. Regression results confirmed significant interactions between outcomes after COVID-19 onset and hospital ownership type, indicating differential financial impacts across hospital categories. Conclusions The findings highlight the uneven financial effects of COVID-19 on Korean hospitals, emphasizing the importance of targeted government financial support. Policy measures should prioritize structural financial reforms to ensure hospital sustainability beyond short-term crisis management.

Objectives: Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators. Methods: We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages. Results: Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages. Conclusions Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.

Purpose: This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model. Methods: This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival.Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules. Results: The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size. Conclusion The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.