Background/Aims: Gastric antral vascular ectasia (GAVE) is a rare but important cause of gastrointestinal (GI) bleeding. The clinical course of GAVE is not well-known, and recurrent bleeding from GAVE is a therapeutic challenge. Therefore, we investigated the clinical course of GAVE and identified the risk factors for bleeding from it. Methods: We retrospectively reviewed the records of patients diagnosed with GAVE using upper GI endoscopy at Asan Medical Center between January 2004 and December 2019 and evaluated the clinical course and risk factors for bleeding from GAVE. Results: Of the 348 patients (mean age, 62.3 ± 10.7 years; male, 62%), bleeding from GAVE occurred in 123 (35%) patients during follow-up (median, 17.3 months; interquartile range [IQR], 4.2–46.6). GI bleeding from GAVE was significantly associated with Child–Pugh class B or C liver cirrhosis (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57–4.16), chronic kidney disease (CKD) (OR, 2.77; 95% CI, 1.52–5.07), use of antithrombotic agents (OR, 2.34; 95% CI, 1.13–4.82), and involvement of the duodenal bulb (OR, 3.21; 95% CI, 1.76–5.86). Rebleeding occurred in 39 of 123 patients (32%), in whom CKD (OR, 2.55; 95% CI, 1.12–5.81) was significantly associated with rebleeding. Endoscopic hemostasis was most commonly performed using argon plasma coagulation, and the median number of endoscopic hemostasis performed was 2 (IQR, 1–3). Conclusions A careful follow-up for bleeding is needed in GAVE patients with liver cirrhosis, CKD, use of antithrombotic agents, and duodenal bulb involvement.

Purpose: Postoperative complications following gastric cancer surgery significantly impact patient outcomes, yet standardized definitions for these events have not been consistently applied across institutions in Korea. This study aimed to develop a consensus-based, standardized complication classification system specific to gastrectomy for gastric cancer as part of the Korean Quality Improvement Platform in Surgery (K-QIPS) initiative. Methods: As part of K-QIPS, a dedicated task force team (TFT) was formed with surgical experts from fourteen high-volume hospitals across Korea. The TFT conducted ten formal meetings to review existing literature and international guidelines, and incorporated findings from randomized controlled trials. The final complication list was developed through expert consensus and structured into a standardized framework. A Data Entry Manual was created to support consistent data collection by surgical clinical reviewers. Results: The TFT defined specific postoperative complications following gastrectomy for gastric cancer, including anastomotic leakage, duodenal stump leakage, pancreatic fistula, intra-abdominal and luminal bleeding, delayed gastric emptying, and internal hernia. Notably, internal hernia was described in standardized form for the first time. General complications were developed first and overlapped in part with the gastric cancer-specific list. The task force also produced a Data Entry Manual that provides practical instructions to ensure consistency and accuracy in complication reporting. Conclusion This nationwide consensus initiative established the first standardized complication classification system for gastric cancer surgery in Korea. The proposed definitions and data entry system are expected to improve complication reporting, enable multicenter research, support surgical quality benchmarking, and ultimately enhance patient outcomes.

Purpose: Although human epidermal growth factor receptor 2 (HER2) positivity is prevalent in microinvasive breast cancer (MIBC), data focused on HER2-positive MIBC are limited. We investigated the clinical course and long-term outcomes of HER2-positive MIBC and evaluated the role of adjuvant chemotherapy. Materials and Methods: The study included patients with curatively resected pT1mi pN0 HER2-positive breast cancer between January 2000 and January 2020. Treatments and survival outcomes, including invasive breast cancer-free survival (IBCFS), distant recurrence-free survival (DRFS), and overall survival (OS) were analyzed. Results: The analysis included 799 female patients. The median age was 51 years (range, 23 to 79 years), and 51.6% (n=412) were premenopausal. Multifocality was confirmed in 17.3% (n=138), and estrogen receptor (ER) positivity in 29.8% (n=238). Adjuvant chemotherapy was administered to 17.5% (n=140), with doxifluridine in 96.4% of cases. One patient (0.1%) received trastuzumab. With a median follow-up of 119.0 months (95% confidence interval [CI], 114.0 to 127.0), the 8-year IBCFS, DRFS, and OS were 91.2% (95% CI, 89.1 to 93.3), 97.5% (95% CI, 96.4 to 98.7), and 98.8% (95% CI, 98.0 to 99.6), respectively. No significant differences were observed between patients with and without adjuvant chemotherapy. The lack of differences in IBCFS by chemotherapy was consistent across subgroups, including pre-/postmenopausal patients, grade 1-2/3 tumors, and ER-negative disease. Conclusion A clinically meaningful proportion of HER2-positive MIBC patients experience IBCFS events with long-term follow-up. Adjuvant chemotherapy did not improve survival, potentially due to the use of an outdated, ineffective regimen. The role of modern adjuvant regimens, particularly those incorporating HER2-targeted therapy, warrants further exploration.

Purpose: Topical hemostatic powders may help limit blood loss when applied to a wound early in the course of bleeding. This study evaluated the effectiveness and safety of a hemostatic powder composed of carboxymethyl starch and calcium ions for reducing hemorrhagic complications (specifically hemoglobin loss) after transrectal prostate biopsy. Materials and Methods: In this randomized controlled trial, 95 patients undergoing transrectal prostate biopsy received either hemostatic powder with povidone-iodine–soaked gauze or povidone-iodine–soaked gauze alone. The primary outcome was hemoglobin level measured before biopsy and 1 day after biopsy. Secondary outcomes included the incidence of hematuria, hematochezia, infection, and other complications. Results: Postbiopsy hemoglobin levels did not differ significantly between the control (12.3±1.6 g/dL) and experimental (12.2±1.8 g/dL) groups (p=0.872). In both groups, hemoglobin level decreased significantly from 13.1±1.9 g/dL before biopsy to 12.2±1.8 g/dL after biopsy (p<0.001). Hematuria occurred in 95.1% of the experimental group and 87.2% of the control group (p=0.389). The incidence of hematochezia was significantly lower in the experimental group (18.8%) than in the control group (59.6%) (p<0.001). No significant differences were observed in other complications, including infection, urinary retention, and transfusion requirement. No severe adverse events were reported in either group. Conclusion Application of the hemostatic powder did not prevent postbiopsy hemoglobin decline; however, it significantly reduced the incidence of hematochezia. The procedure appeared safe in this trial, although further studies are needed to identify more effective strategies to prevent cumulative hemoglobin loss after transrectal prostate biopsy.

Purpose: Based on the KEYNOTE-522 study, neoadjuvant pembrolizumab plus chemotherapy has become the standard treatment for early-stage triple-negative breast cancer (TNBC).This study evaluated the real-world efficacy, safety, and predictors of pathologic complete response (pCR) in Korean patients. Methods: We conducted a retrospective cohort study of 174 patients with early-stage TNBC who received the KEYNOTE-522 regimen (neoadjuvant pembrolizumab plus paclitaxel and carboplatin, followed by doxorubicin and cyclophosphamide) at a tertiary cancer center between August 2022 and July 2024. We assessed the primary endpoints, including pCR rate and event-free survival (EFS). We performed univariable and multivariable logistic regression analyses to identify independent predictors of pCR. Results: The median patient age was 50 years (range, 24–74 years). The clinical stages were II and III in 79.3% and 20.1% of patients, respectively, and 10.9% had clinical N3 disease. The overall pCR rate was 62.1%, and the N3 subgroup had a pCR rate of 47.4%. On multivariable analysis, high baseline Ki-67 expression (≥ median, 75%) was significantly associated with pCR (odds ratio, 2.84; 95% confidence interval, 1.45 to 5.66; p = 0.002). At a median followup of 18.4 months, the 12-month EFS rate was 97.4%, with significantly superior outcomes observed in patients who achieved pCR compared with those who did not achieve pCR (100% vs. 93.1%, p = 0.007). The treatment completion rate was 92.0%, and immune-related adverse events occurred in 13.8% of patients. Conclusion In this real-world analysis of one of the largest Asian cohorts of patients with earlystage TNBC treated with neoadjuvant pembrolizumab, the KEYNOTE-522 regimen demonstrated substantial efficacy and manageable toxicity, consistent with the original trial findings.

Optimal vascular access and effective closure are fundamental for ensuring the safety and success of percutaneous cardiovascular interventions. As procedural complexity has increased, various access and closure devices have been developed to enhance efficacy and minimize complications. Radial artery access is favored for coronary interventions because it is associated with a lower risk of bleeding and fewer access site complications. However, femoral access remains indispensable for large-bore procedures. Large-bore sheaths are required for endovascular treatments of peripheral artery disease and structural heart interventions. Ultrasound-guided arterial and venous access has become essential for minimizing complications, especially with femoral access. Despite significant advances in closure techniques, complications such as retroperitoneal hemorrhage, pseudoaneurysm, and arteriovenous fistula remain challenging and can adversely affect patient outcomes. This review presents state-of-the-art strategies for the prevention and management of vascular access complications in cardiovascular intervention.

Background: The heart donor allocation system in South Korea is divided into three regions, with priority given to recipients within the same region over those in other regions of the same tier. It is commonly believed that heart transplantation (HT) within the same region can reduce ischemic time (IT), although its clinical impact remains unclear. The purpose of this study is to compare the characteristics and outcomes of intra-region HT and inter-region HT. Methods: From 2014 to 2022, a total of 115 adult patients underwent isolated HT at a tertiary hospital. Of these, 58 recipients (54.5 ± 10.3 years, female, 36.2%) underwent intra-region HT and 57 recipients (53.9 ± 14.1 years, female, 31.6%) underwent inter-region HT. Extracorporeal membrane oxygenation-bridged HTs accounted for 50.0% and 54.4% of cases, respectively (P = 0.638). There were no differences in preoperative characteristics between the two groups. Results: The median inter-hospital distance (38.0 [32.0–112.0] km vs. 351.0 [300.0–390.5] km, P < 0.001) and total IT (153 [123–170] minute vs. 265 [243–298] minute, P < 0.001) were longer in the inter-region group than intra-region group. Despite these differences, both groups showed similar clinical outcomes. The 30-day mortality rates were 5.2% and 5.3% (P < 0.99), respectively. There were no differences in postoperative cardiac index, early adverse outcomes, or long-term survival between the two groups. The inter-hospital distance and cold IT showed a strong positive correlation (time [minute] = 39.462 + 0.410 × distance [km]). Conclusion Despite the difference in IT, there was no difference in postoperative outcomes between the two groups. Based on these findings, the effect of donor location on the outcomes of HT in South Korea is not considered significant.

Objectives: Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea. Methods: We constructed a database of lonely death cases by linking data from the Korea Crime Scene Investigation Unit of the Korea National Police Agency with National Health Insurance Service (NHIS) records. A descriptive analysis was performed to evaluate the demographics, underlying diseases, and healthcare utilization patterns among lonely death cases. Results: Among the 3122 individuals identified as lonely death cases, 2621 (84.0%) were male and 501 (16.0%) were female. The most common age group was 50-59 years (n=930, 29.8%). The NHIS covered 2161 individuals (69.2%), whereas 961 individuals (30.8%) were enrolled in Medical Aid (MA). The highest number of lonely deaths occurred in Seoul areas, with 1468 cases (47.0%). Mood disorders were diagnosed in 1020 individuals (32.7%), and various alcohol-related diseases, including alcoholic liver disease, were also observed. Outpatient visits increased leading up to death but declined in the final 3 months, while hospitalizations decreased and emergency room visits slightly increased. Conclusions Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Purpose: Although upper eyelid retraction is commonly associated with thyroid eye disease, its etiology remains unclear. This study evaluated the clinical features and treatment outcomes of patients with upper eyelid retraction caused by idiopathic orbital myositis (IOM). Methods: We conducted a retrospective analysis of the medical records of patients who presented with unilateral upper eyelid retraction. IOM was diagnosed based on normal thyroid function tests (TFT), including thyroid-stimulating immunoglobulin (TSI). Orbital imaging demonstrated contrast-enhanced enlargement of the superior rectus-levator palpebrae superioris complex (SR-LC). Pre- and post-systemic steroid treatment, margin-reflex distance 1 (MRD1), MRD1 difference between affected and unaffected eyes, exophthalmos, and diplopia were assessed. Results: In total, five patients (male: 4, female: 1) with a median age of 36.4 years were diagnosed with IOM. Three patients presented with diplopia on upgaze and supraduction limitation. Orbital imaging revealed levator palpebrae superioris muscle enlargement with distinct borders and homogeneous contrast enhancement. All cases with superior rectus enlargement demonstrated tendon involvement. The median duration from symptom onset to treatment initiation was 2.2 months. Four patients received oral prednisolone, whereas one received intravenous methylprednisolone. Although no significant improvements were observed in MRD1, MRD1 difference, or exophthalmos post-treatment, diplopia resolved in all three patients. Conclusions IOM can present with upper eyelid retraction, emphasizing the importance of differentiating it from thyroid eye disease. TFT, including TSIs, and orbital imaging are essential diagnostic tools. These findings indicate that systemic corticosteroids can effectively manage diplopia associated with IOM, emphasizing the potential benefit of early and aggressive treatment.