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.

Purpose: This study aimed to develop and evaluate the effectiveness of the Trauma-nursing Education and Skill Support (TESS) program based on the ADDIE model (Analysis, Design, Development, Implementation, Evaluation model). The program was designed to enhance trauma nurses’ clinical competencies, including trauma-related knowledge, self-efficacy, and problem-solving ability, through the integration of theoretical education and simulation-based practice. Methods: A quasi-experimental study using a non-equivalent control group pretest–posttest design was conducted. Participants included 108 trauma nurses from regional trauma centers, military trauma centers, and emergency care facilities, who were assigned to an experimental group (n=52) or a control group (n=56). The TESS program consisted of a 2-day, 14-hour blended-learning course that included eight lecture sessions and four simulation-based practice stations. Data were collected at baseline, immediately after the intervention, and at 6 months using validated instruments measuring trauma-related knowledge, self-efficacy, and problem-solving ability. Two-way repeated-measures analysis of variance was used for data analysis. Results: The experimental group demonstrated significant improvements in trauma-related knowledge, self-efficacy, and problem-solving ability compared with baseline (all p<.001). These improvements were sustained at 6 months, although trauma-related knowledge scores showed a slight decline compared with immediate posttest levels. Between-group analyses confirmed significant group-by-time interaction effects for all outcomes: trauma-related knowledge (η2=0.12, p<.001), self-efficacy (η2=0.09, p=.002), and problem-solving ability (η2=0.08, p=.003). Conclusion The TESS program effectively enhanced trauma nurses’ trauma-related knowledge, self-efficacy, and problem-solving ability, with effects sustained for up to 6 months. Incorporating blended learning and simulation-based training into standardized trauma nursing education may strengthen clinical competencies and ultimately contribute to improved patient outcomes.

Objective: To investigate whether breast tissue composition on preoperative automated breast ultrasound (ABUS) is associated with the accuracy of cancer multiplicity evaluation and postoperative recurrence-free survival (RFS) in patients with early-stage breast cancer. Materials and Methods: This retrospective analysis included women with early-stage breast cancer (clinical Tis, T1–2/N0) who underwent ABUS and digital mammography (DM) between October 2019 and April 2021. Tissue composition on ABUS was assessed using the Breast Imaging Reporting and Data System background echotexture (BE) (homogeneous-fat, homogeneous-fibroglandular, or heterogeneous). In a subgroup of patients with mammographically dense breasts, the glandular tissue component (GTC) on ABUS were further stratified into high (moderate or marked) or low (minimal or mild).Multivariable logistic and Cox regression analyses were used to identify factors associated with accurate cancer multiplicity categorization (unifocal, multifocal/multicentric, or bilateral) using ABUS + DM, and with RFS, respectively. Results: Among 409 women (mean age ± standard deviation, 50.2 ± 8.7 years), ABUS combined with DM yielded accurate cancer multiplicity categorization in 368 patients (90.0%). Neither BE nor GTC on ABUS affected the accuracy of categorization when ABUS was combined with DM. Over a median postoperative follow-up of 3.5 years, 11 recurrences occurred. Heterogeneous BE on ABUS (hazard ratio [HR] 11.24 [95% confidence interval [CI]: 2.82–44.92]; P = 0.001), BRCA mutation (HR 15.94 [2.47–102.97]; P = 0.004), and pathologic index cancer size (HR per 1-cm increase 1.91 [1.13–3.23];P = 0.02) was independently associated with RFS. In patients with dense breasts, heterogeneous BE (HR 14.17 [95% CI:2.69–74.60]; P = 0.002) and high GTC (HR 10.32 [2.35–45.28]; P = 0.002) on ABUS, BRCA mutation (HR 24.34 [2.75– 215.06]; P = 0.004), and pathologic cancer size (HR per 1-cm increase 2.62 [1.50–4.59]; P = 0.001) was independently associated with RFS. Conclusion In patients with early-stage breast cancer, heterogeneous BE and high GTC on preoperative ABUS, along with larger cancer size and BRCA mutation, was associated with worse RFS. However, BE and GTC did not affect cancer multiplicity evaluation when ABUS was used in combination with DM.

Background: Various strategies are being explored to improve outcomes in advanced ovarian cancer. This study evaluated the survival outcomes of a sequential treatment strategy comprising dose-dense weekly chemotherapy, selective adjuvant radiotherapy, and poly(ADP-ribose) polymerase (PARP) inhibitor maintenance following primary debulking surgery. Methods: We retrospectively reviewed 12 patients with newly diagnosed advanced high-grade serous ovarian cancer (HGSOC) who underwent a sequential treatment strategy (debulking surgery followed by dose-dense chemotherapy, selective adjuvant radiotherapy, and PARP inhibitor maintenance) at Kosin University Gospel Hospital between December 2019 and March 2023. Survival outcomes were analyzed using the Kaplan-Meier method, and treatment-related adverse effects were evaluated. Results: All 12 patients achieved complete remission after the sequential treatment strategy. At the cutoff date (June 20, 2025), all patients were alive, with a median follow-up duration of 48.1 months (range, 28.7–66.5 months). The median progression-free survival (PFS) was 43.8 months. Acute toxicities, including bone marrow suppression and alopecia, were transient and manageable. Peripheral neuropathy and extremity edema were observed as persistent late toxicities. Conclusions This study highlights promising outcomes with a multimodal sequential treatment strategy in newly diagnosed advanced HGSOC. All patients remained alive at the time of analysis, and the median PFS reached 43.8 months, suggesting a potential benefit of this sequential approach compared with conventional treatment strategies. Prospective studies are warranted to validate these findings.

Objectives: . Obstructive sleep apnea (OSA) is associated with chronic intermittent hypoxia and systemic inflammation, both of which contribute to vascular and metabolic complications. Monocytes, as key immune cells of innate immunity, have been implicated in this inflammatory state. However, the effect of OSA treatment on monocyte function and inflammatory phenotype remains poorly understood. Methods: . In this prospective cohort study, OSA patients were evaluated before and after 3 months of continuous positive airway pressure (CPAP) therapy. Circulating monocytes were isolated, and inflammatory cytokine production (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, and IL-6) was assessed at baseline and post-treatment, both at rest and after lipopolysaccharide (LPS) stimulation. Monocyte polarization (M1/M2-like marker expression) was measured by flow cytometry. Clinical severity parameters, including the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), were correlated with immune changes. Results: . Following CPAP treatment, LPS-induced inflammatory cytokine secretion and LPS responsiveness, defined as the increase in cytokine levels upon stimulation, both declined after CPAP in proportion to baseline ODI, but not AHI. Apart from TNF-α, baseline IL-1β and IL-6 levels were below the quantifiable range of the assay, which precluded reliable comparison after treatment. This effect may be explained by a parallel post-treatment shift in monocyte phenotype toward an anti-inflammatory M2-like (CD163+CD206+) profile, as demonstrated by our flow cytometry data, which was also significantly associated with baseline ODI. Conclusion . CPAP alleviates systemic inflammation in OSA by reducing hypoxic burden and reprogramming monocytes toward an anti-inflammatory phenotype. The magnitude of immune modulation was more closely linked to ODI than AHI, suggesting that oxygen desaturation burden serves as a meaningful adjunct to AHI in assessing monocyte-driven immune dysregulation in OSA.

Autonomic dysfunction is a common but frequently overlooked manifestation of systemic diseases. Because early manifestations are often nonspecific, including dizziness, fatigue, palpitations, exercise intolerance, and gastrointestinal dysmotility, clinicians need a structured approach to support timely recognition and risk stratification.Current concepts: Systemic disorders affect autonomic regulation through overlapping mechanisms, including metabolic injury, microvascular dysfunction, chronic inflammation, and impaired cardiovascular reflex control. In diabetes, autonomic nerve injury accumulates over time, and cardiovascular autonomic neuropathy is associated with increased cardiovascular events and mortality. In chronic kidney disease, persistent sympathetic activation, reduced vagal modulation, and baroreflex impairment contribute to hypertension, intradialytic hypotension, and arrhythmic risk. In heart failure and ischemic heart disease, sympathetic predominance and vagal withdrawal accelerate disease progression and are associated with malignant ventricular arrhythmias and sudden cardiac death. Systemic autoimmune disorders are also associated with impaired cardiovascular reflex control and small-fiber neuropathy.Discussion and conclusion: A practical evaluation begins with symptom screening and review of medications and comorbidities, followed by standardized autonomic testing. Cardiovascular autonomic reflex tests, together with scoring tools such as the composite autonomic scoring scale, help quantify the distribution and severity of autonomic involvement and support longitudinal monitoring. Management should integrate optimal control of the underlying systemic disease, non-pharmacological measures for orthostatic intolerance, and symptom-directed treatment for orthostatic hypotension.

Objectives: This study examined factors associated with health-related quality of life (HRQoL) in Korean adults. Methods: Using data from 5,620 participants in the 9th Korea National Health and Nutrition Examination Survey, obesity was defined as body mass index ≥25 kg/m2 and HRQoL assessed by the health-related quality of life instrument with 8 items (HINT-8). Complex survey weights were applied. Results: General linear and multiple regression analyses showed that among women, obesity was significantly associated with lower HINT-8 scores (B=-0.008, p=0.032), while no association was found in men. Age, household income, education, perceived stress, and smoking were also significantly related to HRQoL in both sexes. Conclusions HRQoL in Korean adults is influenced by obesity, socioeconomic status, and mental health indicators. The adverse effect of obesity observed only in women highlights the need for sex-specific public health strategies and the relevance of culturally adapted tools such as the HINT-8.

Purpose: Hereditary spastic paraplegia (HSP) refers to a group of genetic neurodegenerative diseases marked by gradually worsening spasticity and hyperreflexia in the lower extremities. This study aimed to describe the clinical and genetic characteristics of Korean patients with spastic paraplegia. Materials and Methods: We retrospectively reviewed medical records of 69 patients with spastic paraplegia from 54 unrelated families between 2002 and 2024. Genetic, clinical, electrophysiological, and radiological features were comprehensively analyzed. Results: Causative genes were identified in 34 (63%) of 54 unrelated families; SPAST, detected in 26 families, was the most prevalent. Seven novel pathogenic variants were identified. Clinically, the median age of symptom onset was 25 years [14.0–37.0]. Out of 69 patients with spastic paraplegia, 51 (74%) presented with the pure form of spastic paraplegia, which included all patients with SPG4. Spastic gait was a universal feature in all patients. Urinary dysfunction was present in 42 (61%) patients. Additional neurologic manifestations included peripheral neuropathy 9 (13%), cognitive impairment 5 (7%), upper limb weakness 4 (6%), dysarthria 4 (6%), dysphagia 3 (4%), ataxia 3 (4%), and scoliosis 1 (3%). Brain MRI findings demonstrated a thin corpus callosum in two patients with SPG11; all patients with SPG4 had normal findings. Spine MRI revealed spinal cord atrophy in 16 (27%) patients, including 6 (21%) patients with SPG4. Conclusion The study comprehensively reviewed genetic and clinical spectra of spastic paraplegia in Korean patients, emphasizing the predominance of SPAST as the causative gene and underscoring the genetic and phenotypic heterogeneity of spastic paraplegia.

In patients with differentiated thyroid cancer (DTC), initial recurrence risk stratification based on clinical, histopathological, and perioperative data remains the key determinant for guiding management strategies during the first 1-2 years post-treatment. However, the adoption of ongoing risk stratification (ORS), which dynamically reassesses risk by integrating longitudinal clinical data and treatment response, enables more precise long-term prognostic assessment and facilitates highly individualized management. Building upon recent guidelines, the 2026 KTA guideline has been further refined by incorporating robust evidence from large-scale national cohorts and comprehensive systematic reviews. These updated recommendations outline contemporary concepts of ORS, risk-adapted TSH suppression targets, optimized surveillance modalities for recurrence detection, and disease-specific long-term follow-up strategies. Reflecting the paradigm shift toward de-escalated treatment, this revision integrates evolved perspectives on TSH suppression intensity, the clinical interpretation of thyroglobulin levels, and tailored follow-up intervals. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the large proportion of patients with excellent prognosis after initial therapy, while ensuring that each patient receives appropriately tailored and effective long-term management.

Background: and Purpose This study evaluated the diagnostic utility of an anti-signal-recognition particle 54 (anti-SRP54) antibody-based enzyme-linked immunosorbent assay (ELISA) as well as the clinical, serological, and pathological characteristics of patients with SRP immune-mediated necrotizing myopathy (IMNM). Methods: We evaluated 87 patients with idiopathic inflammatory myopathy and 107 healthy participants between January 2002 and December 2023. The sensitivity and specificity of the ELISA for anti-SRP54 antibodies were assessed, and the clinical profiles of patients with antiSRP54 antibodies were determined. Results: The ELISA for anti-SRP54 antibodies had a sensitivity and specificity of 88% and 99%, respectively, along with a test–retest reliability of 0.92 (p<0.001). The 32 patients diagnosed with anti-SRP IMNM using a line-blot immunoassay included 28 (88%) who tested positive for anti-SRP54 antibodies using the ELISA, comprising 12 (43%) males and 16 (57%) females whose median ages at symptom onset and diagnosis were 43.0 years and 43.5 years, respectively. Symptoms included proximal muscle weakness in all 28 (100%) patients, neck weakness in 9 (32%), myalgia in 15 (54%), dysphagia in 5 (18%), dyspnea in 4 (14%), dysarthria in 2 (7%), interstitial lung disease in 2 (7%), and myocarditis in 2 (7%). The median serum creatine kinase (CK) level was 7,261 U/L (interquartile range: 5,086–10,007 U/L), and the median anti-SRP54 antibody level was 2.0 U/mL (interquartile range: 1.0–5.6 U/mL). The serum CK level was significantly higher in patients with coexisting anti-Ro-52 antibodies. Conclusions This study has confirmed the reliability of the ELISA for anti-SRP54 antibodies and provided insights into the clinical, serological, and pathological characteristics of South Korean patients with anti-SRP IMNM.