Purpose: We present a rare case of acute visual acuity loss following intravitreal ganciclovir injection for the treatment of cytomegalovirus (CMV) retinitis.Case summary: A 35-year-old woman receiving immunosuppressive therapy for systemic lupus erythematosus developed CMV retinitis in the left eye. Oral valganciclovir was initiated but discontinued due to cytopenia and treatment was switched to intravitreal ganciclovir injections (2 mg/0.04 mL). One year later, CMV retinitis developed in the right eye and the same regimen was initiated. Although receiving bilateral injections at two-week intervals, the patient experienced a sudden decrease in visual acuity in the right eye one day after injection, 10 months after treatment initiation. Optical coherence tomography and fluorescein angiography revealed inner retinal edema and focal macular leakage. Treatment was switched to intravenous foscarnet resulting in resolution of macular edema; however, central retinal thinning persisted. Owing to recurrent retinitis, intravitreal ganciclovir injections are currently being continued at a reduced dose (1 mg/0.02 mL). Conclusions Acute visual acuity loss may rarely occur following intravitreal ganciclovir injection in patients with CMV retinitis. Careful consideration of potential mechanical injury and drug-induced retinal toxicity is needed during treatment.

Purpose: To compare the anatomical and clinical outcomes based on the distance from the corneal limbus to the scleral tunnel in flanged intrascleral intraocular lens (IOL) fixation. Methods: We retrospectively analyzed the medical records of patients who underwent scleral fixation of flanged IOLs. Group 1 (54 eyes) had a distance of 2.1 mm from the corneal limbus to the scleral tunnel, and Group 2 (48 eyes) had a distance of 2.8 mm. We evaluated the best corrected visual acuity (BCVA), postoperative complications, IOL tilt and decentration, refractive prediction error (RPE), effective lens position, and iris-IOL distance. Results: The BCVA, postoperative complications, IOL tilt, and IOL decentration did not differ between the two groups (p > 0.05). The RPE showed a hyperopic shift in Group 1 and a myopic shift in Group 2 (Group 1: +0.24 ± 0.68 D, Group 2: -0.03 ± 0.43 D, p = 0.03). The iris-IOL distance was statistically longer in Group 1 compared to Group 2 (Group 1: 1.02 ± 0.40 mm, Group 2: 0.57 ± 0.32 mm, p = 0.02). The incidence of pupillary optic capture was significantly higher in Group 2 compared to Group 1 (Group 1; 0%, Group 2; 8.3%, p = 0.03). Conclusions It should be considered that a shorter distance from the corneal limbus to the scleral tunnel results in a postoperative hyperopic shift and reduces the incidence of pupillary optic capture when performing flanged intrascleral IOLs fixation.

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.

Background: Perfluoroalkyl substances (PFAS) are used in various products, and PFAS have been detected in outdoor clothing. PFAS can be absorbed into the human body via oral ingestion, inhalation, and dermal contact. In this study, we examined the association between the frequency of using outdoor clothing and serum PFAS concentrations in the Korean population using data from cycle 4 (2018–2020) of the Korean National Environmental Health Survey. Methods: Data from 2,993 adult participants were analyzed. The participants were classified into low-concentration and high-concentration groups based on the 75th percentile concentration of serum PFAS. The use of outdoor clothing was categorized into three groups: non-use, <4 times a week, and ≥4 times a week. The odds ratio (OR) for serum PFAS levels associated with use of outdoor clothing was determined through logistic regression analysis, adjusted for demographic characteristics, health-related factors, PFAS-treated items, dietary factors, and ventilation time. Results: ORs for high serum PFAS were higher in groups using outdoor clothing compared to the non-user group. In males, the adjusted ORs for the < 4 times a week and ≥ 4 times a week outdoor clothing usage group were as follows: perfluorooctanoic acid (PFOA), 1.26 (95% confidence interval [CI]: 1.10–1.44) and 1.70 (1.40–2.07); perfluorohexanesulfonic acid (PFHxS), 1.49 (1.16–1.92) and 1.70 (1.22–2.37); and perfluorononanoic acid (PFNA), 1.34 (1.19–1.51) and 1.68 (1.38–2.05), respectively. In females, the respective ORs were as follows: PFOA 1.32 (95% CI: 1.19–1.46) and 1.53 (1.01–2.32); PFHxS, 1.46 (1.08–1.96) and 2.63 (2.10–3.29); PFNA, 1.38 (1.22–1.55) and 1.45 (1.07–1.96). Conclusions In adults, elevated serum PFAS levels were associated with increased frequency of using outdoor clothing.

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.

Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex and age difference of immunology supports the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient's characteristics, or patient’s sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.

Objectives: This pilot study examined the preliminary findings associated with a cognitive-load-controlled structured psychodrama program on affect, fear of negative evaluation, and general psychopathology in long-term psychiatric inpatients, most of whom had schizophrenia spectrum disorders. Methods: A single-group pre-post design was used. A total of 125 stabilized long-term psychiatric inpatients participated in a 25-session structured psychodrama program. To enhance measurement validity in consideration of participants’ cognitive characteristics, self-report measures were administered in small-group sessions with individualized explanation. Primary outcomes (Positive and Negative Affect Schedule [PANAS], Affect Balance Scale [ABS], and Brief Fear of Negative Evaluation [BFNE]) were assessed in 125 participants, and the secondary outcome (Brief Psychiatric Rating Scale [BPRS]) was assessed in a randomly selected subgroup of 53 participants. Results: After the intervention, positive affect significantly increased, whereas negative affect significantly decreased on both the PANAS and ABS (all p＜0.001). BFNE scores significantly decreased from 43.14 to 28.94 (p＜0.001). Total BPRS scores also significantly decreased from 47.49 to 34.76 (p＜0.001), with notable improvements in depressive mood, anxiety, tension, somatic concern, and emotional withdrawal. Conclusion A structured psychodrama program may be a feasible and potentially beneficial psychosocial intervention for long-term psychiatric inpatients. However, given the single-group pre-post design and other methodological limitations, the magnitude of the observed changes should be interpreted cautiously. These findings may serve as preliminary data for future controlled trials.

Objectives: This study investigated medication perceptions, adherence patterns, self-discontinuation experiences, and information sources among psychiatric outpatients to provide evidence for improving adherence strategies. Methods: A cross-sectional survey was conducted with 79 outpatients from a University Hospital, Department of Psychiatry. Self-administered questionnaires assessed diagnostic awareness, medication perceptions, adherence behaviors, discontinuation experiences, side effects, and information sources. Results: Overall, 89.7% knew their psychiatric diagnosis and 88.2% perceived medication as effective. While 73.1% rarely forgot medication, 35.9% had previously self-discontinued treatment. Medication adherence was significantly associated with previous discontinuation experience (p=0.006), whereas diagnostic awareness and efficacy perception were not. Primary discontinuation reasons were symptom improvement (53.6%) and physical discomfort (35.7%). Common side effects included weight gain (n=31), daytime drowsiness (n=26), memory impairment (n=24), and concentration problems (n=22). Patients primarily obtained side effect information from TV/internet (27.8%) rather than healthcare providers (20.3%). Most patients desired additional information about side effects (57.0%) and medication effects (54.4%). Conclusion Daily medication-taking behaviors were more predictive of treatment discontinuation than cognitive factors in this outpatient sample. Discontinuation due to symptom improvement and reliance on non-medical information sources highlights the need for enhanced patient education regarding relapse risks and systematic provision of accurate medication information.

BACKGROUND/OBJECTIVES: The microbiota present in human milk (HM) plays a crucial role in infant health and development. Maintaining it during storage and thawing is vital for preserving its beneficial properties; however, the effects of storage period, temperature, and thawing conditions on HM are not well understood. SUBJECTS/METHODS: HM samples from lactating mothers were collected and stored under different temperature conditions (room temperature [RT], refrigeration, and −20°C) for different durations (1 week and 4 weeks), and thawed using different methods (RT, bottle warmer, and microwave), followed by analysis of their microbiota. RESULTS: Storing HM samples at RT for a week and at −20°C for four weeks resulted in a significant reduction in microbiota diversity, whereas the other treatments did not lead to a significant change in beta diversity. In the microbiota distance analysis, HM samples stored at −20°C for a week showed the highest similarity to the initial microbiota compared to those after one week of storage at RT or in a refrigerator. Microwave thawing after 1 week of freezing resulted in the greatest alteration in the initial microbiota composition, whereas thawing at RT or with a bottle warmer showed comparable microbial profiles. CONCLUSION The most suitable method for storing and thawing HM while preserving the microbiota is to store it at −20°C for up to one week and thaw it using a bottle warmer.

Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex- and age-related immunologic differences support the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient characteristics and sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.