Purpose: To evaluate the efficacy and safety of modified four-flanged intrascleral fixation of foldable intraocular lenses (IOLs) using a 1-inch 30-gauge needle for extraocular suture threading. Methods: This retrospective case series included 20 eyes of 20 patients who underwent four-flanged intrascleral IOL fixation using a 1-inch 30-gauge needle, with at least 6 months of follow-up. We modified the original Canabrava technique by inserting a foldable IOL through a 2.4-mm clear corneal incision with a standard injector and performing extraocular suture threading with a 1-inch 30-gauge needle. Collected data included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent (SE), prediction error (PE), and corneal and lens astigmatism. Postoperative complications and IOL centration were also evaluated. Results: Visual acuity improved significantly over the 6-month follow-up; mean preoperative logMAR UCVA was 1.25 ± 0.66 (Snellen equivalent, 20 / 355) and improved to 0.35 ± 0.19 (20 / 45), and logMAR BCVA improved from 0.53 ± 0.38 (20 / 70) to 0.15 ± 0.09 (20 / 30) (p < 0.05). The mean postoperative SE at 6 months was –0.61 ± 1.08 diopters, and PE was –0.25 ± 0.86 diopters. No significant changes in endothelial cell density were observed. Corneal astigmatism remained stable, and lens astigmatism was reduced after surgery, although not significantly. Postoperative complications included one case each of hypotony and vitreous hemorrhage, both resolved with medical therapy. No IOL redislocation, decentration, tilt, or flange-related issues occurred. Conclusions Modified four-flanged intrascleral IOL fixation using a 1-inch 30-gauge needle provides stable IOL fixation by pairing a robust suture with the smallest suitable needle. Extraocular suture threading reduces intraocular manipulation, simplifying the procedure and resulting in favorable visual outcomes and low complication rates.

Purpose: To report the findings of a perception survey on intestinal malrotation conducted by the Korean Association of Pediatric Surgeons (KAPS) in 2021. Methods: The perceptions on intestinal malrotation regarding clinical decision making of the KAPS members were collected through web-based survey. Results: A total of 22 surgeons were answered for this study. The results were presented and discussed at the 37th annual meeting of KAPS, which was held in Seoul on June 18, 2021. Conclusion This study provides the clinical decisions of the KAPS members on the intestinal malrotation. The study is expected to be an important reference for improving pediatric surgeons’ understanding and treatment of intestinal malrotation.

Purpose: Aggressive natural killer cell leukemia (ANKL) is a rare malignancy with poor prognosis and unclear treatment strategies. Given the poor prognosis and lack of a standardized treatment for ANKL, this study aimed to evaluate the clinical outcomes of L-asparaginase (L-ASNase)-based chemotherapy and hematopoietic stem cell transplantation (HCT). Methods: This retrospective study analyzed 51 patients with ANKL (2000–2023) to assess the clinical outcomes and efficacy of L-ASNase-based chemotherapy. Results: Among the study patients, 18 (36.7%) had poor performance status (ECOG-PS ≥ 3) and 7 (13.7%) died before initiating chemotherapy. Of the 44 treated patients, 30 (58.9%) received L-ASNase-based regimens, showing higher response rates (46.7% vs. 21.4%) and a slightly longer median duration of response (4.5 vs 4.2 months) than non-L-ASNase regimens. Complete administration of L-ASNase in the first cycle improved response rates (p = 0.019), but poor performance led to premature discontinuation (p = 0.011). Among the responders, those who subsequently underwent HCT demonstrated prolonged survival compared to those who did not. Median progression-free survival and overall survival were 0.8 and 1.6 months, respectively. Conclusion HCT was associated with improved survival, particularly among patients who responded to initial therapy. However, given the high frequency of poor performance status at diagnosis, a stepwise approach, including early supportive care, careful chemotherapy administration, and timely HCT, is crucial for optimizing ANKL outcomes.

Purpose: With the emergence of next-generation therapies, real-world evaluation of current treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC) is essential. This study aimed to investigate the clinical characteristics, primary treatment patterns, and survival outcomes of Korean patients with mHSPC. Materials and Methods: A nationwide, population-based retrospective cohort study was conducted using National Health Insurance claims data from 2011 to 2020, encompassing all Korean patients diagnosed with prostate cancer (n=217,895). Patient demographics, initial treatment patterns within 3 months of mHSPC diagnosis, time to initiation of metastatic castration-resistant prostate cancer (mCRPC) therapy, and survival outcomes were analyzed. Results: Primary treatment patterns for 10,821 newly diagnosed mHSPC patients were generally similar. Approximately half received first-line androgen deprivation therapy (ADT). Most (68.8%–76.3%) were treated with combination therapy consisting of a luteinizing hormone-releasing hormone (LHRH) agonist and a first-generation antiandrogen, while 5.8%–8.0% received ADT alone. Among 1,418 patients diagnosed in 2015, 20.9% initiated mCRPC therapy at a median of 14.6 months. Median times to initial mCRPC drug use were 14.7 months for those on combination therapy and 19.7 months for those on LHRH agonists alone. Median overall survival (OS) was 61.3 months for all patients, 37.0 months for combination therapy, 51.5 months for LHRH agonists, and 25.5 months for patients with visceral metastases. Conclusion Most patients with newly diagnosed mHSPC received combination therapy with LHRH agonists and first-generation antiandrogens. In this real-world cohort, patients treated with LHRH agonists demonstrated longer OS and delayed initiation of mCRPC-directed therapy compared with those receiving combination therapy.

Background: Type 2 diabetes mellitus (T2DM) is a significant risk factor for hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease; however, surveillance strategies for patients with T2DM, especially without cirrhosis, are inadequate. This study examined whether the fatty liver index (FLI) and its dynamic changes can effectively identify patients with T2DM at increased risk for HCC. Methods: Data from 92,761 individuals with T2DM aged 40 to 79 who underwent two health screenings (2012 to 2015) were analyzed. The FLI, calculated using waist circumference, body mass index, triglycerides, and gamma-glutamyl transferase, was used to stratify patients by baseline FLI and FLI changes between screenings. HCC cases were identified via International Classification of Diseases codes and reimbursement records (2016 to 2020). Results: Patients with baseline FLI of 30 to 59.9 had a 1.90-fold higher risk (P<0.01) and those with FLI ≥60 had a 2.94-fold higher risk (P<0.01) of developing HCC compared to those with FLI <30. An increase in FLI from <30 to ≥30 resulted in a 2.10-fold higher risk of HCC (P<0.01), while a reduction in FLI from ≥30 to <30 led to a 0.64-fold lower risk (P=0.03). Protective benefits of FLI reduction took approximately 3 years to manifest. Conclusion Baseline and dynamic monitoring of FLI effectively identified HCC risk in T2DM patients with non-cirrhotic livers, supporting early detection and intervention.

Background: Diabetic nephropathy (DN) is a progressive complication among patients with diabetes and the most common cause of end-stage kidney disease. Neutrophil extracellular traps (NETs) are known to play a role in kidney disease, thus this study aimed to determine their role in the development of diabetic kidney disease using diabetic murine models. Results: Protein and histological analyses revealed that db/db mice and streptozotocin DN models expressed no significant NET-related proteins, myeloperoxidase, citrullinated histone H3 (citH3), neutrophil elastase, and lymphocyte antigen 6 complex locus G6D (Ly6G). However, the inflamed individuals in the DN model showed that citH3 and Ly6G were highly deposited in the renal system based on immunohistochemistry images. In vitro, NET treatment did not induce apoptosis in glomerular endothelial and renal tubular epithelial cells. NET inhibition by DNase administration demonstrated no significant changes in cell apoptosis. Conclusions NET-related proteins were only expressed in the DN model with tubulointerstitial inflammation. Our study revealed that NETs are only induced in mice with hyperglycemia-induced inflammation.

Background: Diabetic nephropathy (DN) is a progressive complication among patients with diabetes and the most common cause of end-stage kidney disease. Neutrophil extracellular traps (NETs) are known to play a role in kidney disease, thus this study aimed to determine their role in the development of diabetic kidney disease using diabetic murine models. Results: Protein and histological analyses revealed that db/db mice and streptozotocin DN models expressed no significant NET-related proteins, myeloperoxidase, citrullinated histone H3 (citH3), neutrophil elastase, and lymphocyte antigen 6 complex locus G6D (Ly6G). However, the inflamed individuals in the DN model showed that citH3 and Ly6G were highly deposited in the renal system based on immunohistochemistry images. In vitro, NET treatment did not induce apoptosis in glomerular endothelial and renal tubular epithelial cells. NET inhibition by DNase administration demonstrated no significant changes in cell apoptosis. Conclusions NET-related proteins were only expressed in the DN model with tubulointerstitial inflammation. Our study revealed that NETs are only induced in mice with hyperglycemia-induced inflammation.

Background and Objectives: Oropharyngeal squamous cell carcinoma (OPSCC) can be caused by human papilloma virus (HPV) infection or other factors like smoking. The 8th Edition of the AJCC Cancer Staging Manual recommends different staging and treatment approaches based on etiology. Despite criticisms of its low specificity, the current guidelines suggest using p16 immunohistochemistry (IHC) as a surrogate marker for the HPV-related OPSCC. This study assessed the reliability of p16 as a surrogate marker by correlating the survival rates of OPSCC patients with the results of p16 IHC and HPV-DNA testing.Subjects and Method A retrospective analysis was performed on patients treated for tonsil squamous cell carcinoma at a tertiary medical institution between 1994 and 2018. All patients underwent p16 immunostaining and HPV-DNA chip tests. Out of 88 patients, 17 were excluded due to insufficient data or secondary primary cancer, leaving 71 patients. Results: Among the 71 patients, 51 were p16 positive and 49 were HPV-DNA positive; both tests were associated with extended survival. However, discrepancies were noted in 18 patients: specifically, 11 patients were p16 positive but HPV-DNA negative, displaying a different survival pattern compared to HPV-associated and non-HPV-associated patients. Conclusion Both p16 immunostaining and HPV-DNA testing have their pros and cons. p16 immunostaining is cost-effective but has lower specificity. The study found discrepancies in 18 patients, suggesting that relying solely on p16 immunostaining may have limitations. It would be advisable to complement it with additional tests like the HPV-DNA chip test to predict the disease’s prognosis more accurately.

Purpose: Moderate-intensity continuous training (MICT) improves exercise capacity with vascular benefits, but time constraints hinder consistent adherence. High-intensity interval training (HIIT) has emerged as a time-efficient alternative, with repeated sprint training (RST) being the shortest format. We hypothesized that RST would be as effective as MICT in improving vascular function and exercise capacity in young adults. Methods: Twenty-three adults (mean age, 26.2±3.8 years) were randomly assigned to either RST or MICT. RST involved 20 sets of 4-second cycling sprints followed by 30-second active recovery, totaling 11 minutes. MICT consisted of 30-minute cycling at 50% to 60% of heart rate reserve. Vascular function evaluated via brachial artery flow-mediated dilation. Exercise capacity (maximum oxygen uptake, total exercise load test time) and anaerobic capacity (maximum power, anaerobic threshold) were measured using maximum exercise tests. These variables were measured befre and after a 6-week training. Results: Both groups showed comparable improvements in flow-mediated dilation (p＜ 0.05). Maximum oxygen intake slightly improved, while total exercise time significantly increased for both (p＜ 0.05). Anaerobic threshold unchanged, while maximum power improved (p＜ 0.05). Conclusion These findings underscore that RST is a time-efficient exercise strategy, which improves vascular function and exercise capacity as effectively as MICT in young adults.

Purpose: Isometric handgrip exercise (IHE) has a favorable cardiovascular effect and improves hemodynamic responses. Whether IHE attenuates stress-related hemodynamic reactivity assessed during a sympathetic challenge remains unexplored. We tested the hypothesis that an acute bout of IHE would improve carotid arterial function and attenuate cardiovascular vasoreactivity response to sympathetic stress in healthy adults. Methods: In a randomized cross-over design, sixteen healthy adults (aged 21.8±3.1 years) were enrolled. Participants completed two testing sessions, separated by 1 week. Trials were either a control trial or performed IHE for two sets of 2 minutes at 30% of maximal voluntary contraction for each hand. The participant’s hand was immersed in an ice water bath (4 ℃ ) up to the wrist for 2 minutes. Carotid artery diameter, β-stiffness index, and compliance using ultrasound machine and brachial blood pressure (BP), heart rate (HR) were measured as indices of vasoreactivity at baseline, during, and recovery from cold pressor testing (CPT). Results: The BP, HR, carotid artery diameter, and β-stiffness index increased similarly during CPT in both trials (p＜ 0.001), without any interaction effect. Compared with the IHE trial, arterial compliance decreased in the control groups at 120 seconds during recovery with a significant interaction effect (p=0.02). Conclusion These findings suggest that an acute IHE did not attenuate BP, HR, carotid artery diameter and β-stiffness index vasoreactivity, but improved carotid artery compliance to sympathetic activation in healthy young adults.