Background: and Purpose: Given the irreversible nature of dementia, this study examined the effects of a 20-week exercise-based dementia prevention program in community-dwelling older adults, focusing on prior exercise experience and program adherence. Methods: In this exploratory, non-randomized trial, 55 older adults (65–79 years) were allocated to an intervention (n=26) or control (n=29) group, and blinding was not feasible.The intervention comprised supervised rhythmic aerobic exercise with cognitive-motor components performed three times per week. Cognition was the primary outcome, and secondary outcomes included physical fitness, blood pressure, and blood biomarkers.Subgroup analyses classified participants by prior exercise experience and intervention exposure: G1 and G2 comprised control subgroups with no intervention exposure, whereas G3 and G4 comprised intervention-exposed subgroups stratified by adherence. Results: No significant group-by-time interactions were observed for cognitive outcomes.Participants with prior exercise experience and low adherence (G2) showed significant improvement on the Korean Mini-Mental State Examination (β=1.66, p=0.024) despite declines in physical fitness, whereas higher adherence in G3–G4 was associated with stable or favorable physical performance, with G4 showing a positive trend in the 30-second sit-tostand test. Systolic blood pressure decreased significantly in G2–G4. Conclusions Although overall cognitive gains were modest and not group specific, prior exercise experience and sustained adherence were associated with favorable changes in physical fitness and vascular outcomes, suggesting that tailored multicomponent exercise programs and long-term engagement may help promote cognitive health in older adults.

Background: and Purpose: Tailored physical exercise interventions have the potential to promote cognitive health in older adults and offer significant advantages for those more vulnerable to decline. The specific relationship between physical fitness and cognition among the elderly has not been clearly established. The purpose of this investigation was to assess the relationship between physical fitness and cognitive function in older Korean adults. Methods: Eighty-four community-dwelling older adults (mean age: 70.7±5.3 years; 81.0% female) completed a standardized physical fitness battery assessing handgrip strength, sit-and-reach, 30-second sit-to-stand, 2-minute stationary march, 3-m sit-walk-and-return, figure-8-walk, and T-wall response time. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Descriptive statistics, partial correlation analyses, and stepwise multiple linear regression were conducted. Results: Slower T-wall response time was significantly correlated with lower RBANS total index, immediate memory, and delayed memory scores. In regression models, slower T-wall response time was independently associated with lower RBANS total index (β=−0.234, p=0.026) and delayed memory scores (β=−0.295, p=0.029). The regression model for immediate memory was not statistically significant overall; therefore, no predictive conclusion was drawn for this domain. Higher education showed a significant positive association with cognitive performance. Conclusions Coordination, as measured by T-wall response time, emerged as the only physical fitness component consistently associated with cognitive performance in older adults. Coordination-related fitness may be an important correlate of cognitive function in older adults and a promising target for future exercise interventions.

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: To develop and validate an artificial intelligence (AI)-based personalized outcome prediction model for upper-urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy. Materials and Methods: Data from patients who underwent radical nephroureterectomy between 2010 and 2020 across three hospitals were retrospectively analyzed. A model was developed using one tertiary center’s data and externally validated with data from two other hospitals. An AI model using XGBoost as risk estimator and bootstrapped Weibull Accelerated Failure Time model for 10-year survival probability was employed. Hyperparameter tuning used Optuna method. Model efficacy was assessed using concordance index, average Brier score, D-calibration, and six-month interval time-dependent area under the curve (AUC). Results: Of 1,039 patients, 627 qualified after excluding 50 with neoadjuvant chemotherapy. Model development used 564 patients (507 training, 57 test) with 9:1 stratified random split, plus 63 for internal validation and 362 for external validation. Significant parameters included preoperative glomerular filtration rate (p<0.001), hydroureteronephrosis (p=0.013), pathological N stage (p<0.001), concurrent carcinoma in situ (p<0.001), disease progression (p<0.001), and survival rate (p<0.001). Disease-free survival (DFS) model’s concordance index: internal validation 0.789, external validations 0.734 and 0.771. Overall survival (OS) model’s concordance index: internal validation 0.819, external validations 0.780 and 0.771. Mean time-dependent AUC was 0.66–0.77 for DFS and 0.67–0.80 for OS during 10-year periods. Conclusions AI-based model effectively predicts disease-free and OS outcomes for upper-urinary tract urothelial carcinoma patients with post-radical nephroureterectomy, showcasing robust performance across multicenter settings.

Carbon monoxide (CO) poisoning typically results in bilateral globus pallidus and subcortical white matter injuries, sometimes followed by delayed encephalopathy with white matter changes. This report describes a patient with CO poisoning who initially presented with isolated cerebellar lesions on imaging. Following recovery from the acute phase, the patient developed delayed encephalopathy, manifesting as Parkinsonism and akinetic mutism. This case highlights that isolated cerebellar involvement may represent an atypical radiological finding in CO poisoning.

Purpose: We compared patient characteristics and surgical outcomes of primary trabeculectomy procedures performed a decade apart to evaluate the long-term efficacy and safety profile of trabeculectomy. Methods: This retrospective comparative study analyzed two cohorts of patients who underwent primary trabeculectomy augmented with mitomycin C. Cohort 1 included 86 eyes of 71 patients operated on between 2007 and 2009, whereas Cohort 2 comprised 88 eyes of 76 patients treated between 2017 and 2019. Data included patient demographics, preoperative intraocular pressure (IOP), visual field mean deviation (MD), mitomycin C usage details, and postoperative surgical outcomes. Results: The interval between glaucoma diagnosis and surgery was significantly longer in Cohort 2 (7.7 ± 4.1 years) compared with Cohort 1 (3.5 ± 3.8 years) (p < 0.001). Preoperative IOP was significantly lower in Cohort 2 (p = 0.009). Visual field MD at diagnosis indicated less advanced visual field loss in Cohort 2 (p < 0.001). No statistically significant differences were observed between the two cohorts in terms of surgical success rates or complication rates. Among patients who did not undergo cataract surgery, visual field progression was slower in Cohort 2 than in Cohort 1 (˗0.78 vs. ˗0.04 dB/year, p = 0.009). Conclusions Although the two cohorts differed in preoperative IOP and the interval from diagnosis to surgery, trabeculectomy with mitomycin C demonstrated comparable success rates and a consistent safety profile over time.

Chronic lung diseases, including asthma, chronic obstructive pulmonary disease, and interstitial lung disease, contribute significantly to morbidity and mortality worldwide. Telemedicine has emerged as a promising approach for addressing these challenges by enabling remote patient monitoring, virtual consultations, and digital health interventions. Advances in home spirometry, wearable devices, and mobile health applications have improved early detection of disease exacerbations, medication adherence, and patient self-management of chronic lung diseases. Telerehabilitation programs have demonstrated their efficacy in enhancing exercise capacity and quality of life in patients with chronic lung diseases. Despite these advancements, challenges such as disparities in digital access, patient engagement, costs, and regulatory frameworks limit widespread adoption. As telemedicine has become an integral component of respiratory care, further research is required to optimize its implementation, evaluate long-term clinical outcomes, and ensure equitable access to all patients. This review explores the current state of telemedicine in chronic lung disease management, highlights technological innovations, and discusses future directions for enhancing its role in improving patient outcomes.

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: s/Aims: This study evaluated the feasibility and outcomes of surgical treatment for metachronous periampullary carcinoma following curative resection of primary extrahepatic bile duct cancer. Methods: A retrospective review was conducted of seven patients who underwent pancreaticoduodenectomy (PD) for metachronous periampullary cancer after prior curative surgery for extrahepatic bile duct cancer. Results: The mean age at the second surgery was 66.7 years (range, 43–81 years). Initial malignancies included three hilar cholangiocarcinomas, one middle bile duct cancer, and three gallbladder cancers. Subsequent primary tumors consisted of three distal bile duct cancers, three pancreatic head cancers, and one duodenal cancer. The mean interval between the first and second cancers was 47 months (range, 13–121 months). No perioperative deaths occurred. Postoperative complications developed in three patients (42.9%):chyle leakage (Clavien–Dindo grade II) in two (28.6%) and a grade C postoperative pancreatic fistula requiring reoperation (grade IIIb) in one (14.3%). Both chyle leaks were managed conservatively. During follow-up, four patients died of recurrence at 5, 12, 19, and 24 months postoperatively. One patient underwent video-assisted thoracoscopic surgery for pulmonary metastasis 2 months after PD and remains alive 22 months later without recurrence. Two patients are disease-free at 38 and 92 months of follow-up. Conclusions PD for second primary periampullary cancer after resection of extrahepatic bile duct cancer appears feasible and potentially effective. Although no perioperative mortality occurred, major complications were observed. Larger studies are needed to confirm these preliminary findings.

Purpose: We aimed to compare the final adult height (FAH) of male patients with central precocious puberty (CPP) after treatment with a gonadotropin-releasing hormone agonist (GnRHa). Specifically, we compared FAH with the target height (TH) and the predicted adult height (PAH) before and after GnRHa treatment to quantify height gain and identify predictive factors. Methods: We retrospectively reviewed the medical records of 92 male patients with CPP and known FAH after GnRHa treatment at the Department of Pediatrics of Severance Children’s Hospital between January 2000 and June 2024. Results: The mean duration of GnRHa treatment was 2.7±1.3 years. A significant 1.1±0.9 years narrowing was observed in the difference between bone age (BA) and chronological age (CA) during treatment (P<0.001). TH was 172.4±3.4 cm. FAH was 173.6±6.4 cm. FAH was greater than TH by 1.2±5.9 cm (P=0.047). PAH before and after treatment was 179.9±8.1 and 181.2±7.4 cm, respectively. PAH was increased by 1.3±4.9 cm (P=0.012) after treatment. As the PAH standard deviation score (SDS) before GnRHa treatment increased, FAH tended to exceed TH. In contrast, higher testosterone levels before treatment are associated with FAH falling below TH. A longer duration of treatment and taller TH are associated with an FAH SDS greater than height SDS before treatment. Conversely, a greater weight SDS, BA–CA difference, and testis size before treatment are associated with FAH SDS being less than height SDS before GnRHa treatment. Conclusion GnRHa treatment improved FAH and inhibited bone maturation in male patients with CPP.