Purpose: To present a case of recurrent Nocardia keratitis following the use of topical steroids.Case summary: A 57-year-old man presented with decreased visual acuity and conjunctival injection in the right eye which began 15 days prior. Slit-lamp examination revealed epithelial defects smaller than the circular infiltrate and empirical topical treatment was initiated. Since the corneal lesion improved with a therapeutic contact lens and topical antibiotics, a steroid eye drop was added. After 7 days, the corneal infiltrate worsened in a wreath-like pattern with a positive result on a KOH (potassium hydroxide) smear, and antifungal eye drops were started. However, Nocardia species was confirmed on the 9th day of culture. While complete epithelial regeneration was achieved after 10 days using amikacin eye drops, steroid eye drops were reused to reduce the corneal haze. Twenty days later, the corneal infiltrate and epithelial defects reappeared adjacent to the initial opacity, and a culture confirmed Nocardia. Gradual improvement was achieved with amikacin eye drops and oral Septrin. Ultimately, a combination of moxifloxacin, tobramycin, and bromfenac eye drops was tapered over several months, resulting in healing with mild opacity. Conclusions Nocardia keratitis commonly arises from trauma involving soil, progresses slowly, and is often misdiagnosed as a fungal infection. While amikacin eye drops proved effective, prolonged topical treatment is essential. Early steroid use should be considered cautiously, as it may lead to recurrence and worsening of the corneal lesion.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Purpose: To present a case of recurrent Nocardia keratitis following the use of topical steroids.Case summary: A 57-year-old man presented with decreased visual acuity and conjunctival injection in the right eye which began 15 days prior. Slit-lamp examination revealed epithelial defects smaller than the circular infiltrate and empirical topical treatment was initiated. Since the corneal lesion improved with a therapeutic contact lens and topical antibiotics, a steroid eye drop was added. After 7 days, the corneal infiltrate worsened in a wreath-like pattern with a positive result on a KOH (potassium hydroxide) smear, and antifungal eye drops were started. However, Nocardia species was confirmed on the 9th day of culture. While complete epithelial regeneration was achieved after 10 days using amikacin eye drops, steroid eye drops were reused to reduce the corneal haze. Twenty days later, the corneal infiltrate and epithelial defects reappeared adjacent to the initial opacity, and a culture confirmed Nocardia. Gradual improvement was achieved with amikacin eye drops and oral Septrin. Ultimately, a combination of moxifloxacin, tobramycin, and bromfenac eye drops was tapered over several months, resulting in healing with mild opacity. Conclusions Nocardia keratitis commonly arises from trauma involving soil, progresses slowly, and is often misdiagnosed as a fungal infection. While amikacin eye drops proved effective, prolonged topical treatment is essential. Early steroid use should be considered cautiously, as it may lead to recurrence and worsening of the corneal lesion.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Purpose: To present a case of recurrent Nocardia keratitis following the use of topical steroids.Case summary: A 57-year-old man presented with decreased visual acuity and conjunctival injection in the right eye which began 15 days prior. Slit-lamp examination revealed epithelial defects smaller than the circular infiltrate and empirical topical treatment was initiated. Since the corneal lesion improved with a therapeutic contact lens and topical antibiotics, a steroid eye drop was added. After 7 days, the corneal infiltrate worsened in a wreath-like pattern with a positive result on a KOH (potassium hydroxide) smear, and antifungal eye drops were started. However, Nocardia species was confirmed on the 9th day of culture. While complete epithelial regeneration was achieved after 10 days using amikacin eye drops, steroid eye drops were reused to reduce the corneal haze. Twenty days later, the corneal infiltrate and epithelial defects reappeared adjacent to the initial opacity, and a culture confirmed Nocardia. Gradual improvement was achieved with amikacin eye drops and oral Septrin. Ultimately, a combination of moxifloxacin, tobramycin, and bromfenac eye drops was tapered over several months, resulting in healing with mild opacity. Conclusions Nocardia keratitis commonly arises from trauma involving soil, progresses slowly, and is often misdiagnosed as a fungal infection. While amikacin eye drops proved effective, prolonged topical treatment is essential. Early steroid use should be considered cautiously, as it may lead to recurrence and worsening of the corneal lesion.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Since the role of the liver in metabolic dysfunction, including type 2 diabetes mellitus, was demonstrated, studies on non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) have shown associations between fatty liver disease and other metabolic diseases. Unlike the exclusionary diagnostic criteria of NAFLD, MAFLD diagnosis is based on the presence of metabolic dysregulation in fatty liver disease. Renaming NAFLD as MAFLD also introduced simpler diagnostic criteria. In 2023, a new nomenclature, steatotic liver disease (SLD), was proposed. Similar to MAFLD, SLD diagnosis is based on the presence of hepatic steatosis with at least one cardiometabolic dysfunction. SLD is categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related/-associated liver disease, alcoholrelated liver disease, specific etiology SLD, and cryptogenic SLD. The term MASLD has been adopted by a number of leading national and international societies due to its concise diagnostic criteria, exclusion of other concomitant liver diseases, and lack of stigmatizing terms. This article reviews the diagnostic criteria, clinical relevance, and differences among NAFLD, MAFLD, and MASLD from a diabetologist’s perspective and provides a rationale for adopting SLD/MASLD in the Fatty Liver Research Group of the Korean Diabetes Association.

The spleen is occasionally referred to as the ‘forgotten organ’ because splenic lesions are less common and encountered rarely compared to pathologies of other abdominal solid organs. Therefore, although well-demonstrated using various abdominal imaging modalities, radiologists tend to be less familiar with splenic diseases, making interpretation challenging. This study aimed to review common and uncommon splenic diseases and illustrate the multimodal imaging (including ultrasonography, CT, MRI, and PET/CT) features of these lesions in correlation with their histopathology. Recognizing the radiological findings of various splenic lesions helps narrow down the differential diagnosis and guide appropriate clinical decision-making for radiologists.

Hepatocellular carcinoma (HCC) is the most common and lethal type of primary liver cancer, frequently arising from chronic liver injury and inflammation. Despite treatment advancements, HCC prognosis remains poor, emphasizing the need for effective preventive and therapeutic strategies. This study investigates the hepatoprotective and anti-tumor effects of Hongjam, a steamed freeze-dried silkworm powder, in a diethylnitrosamine (DEN) and thioacetamide (TAA)-induced HCC mouse model. Mice were administered DEN intraperitoneally for 8 weeks, followed by TAA in drinking water for 9 weeks, with Hongjam supplementation (0.01, 0.1, and 1 g/kg) provided daily through food. Hongjam markedly reduced the tumor incidence, the size, and the histological lesions compared to the DEN/TAA group. Serum biochemical analysis revealed reduction in liver damage markers, including alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin, with a notable decrease in total bilirubin surpassing. Immunohistochemical and Western blot analyses demonstrated that Hongjam downregulated expression of proliferation markers, including Ki67, phosphorylation of protein kinase B, and proliferating cell nuclear antigen, while upregulating the pro-apoptotic protein Bcl-2-associated X protein, indicating its dual role in suppressing proliferation and promoting apoptosis. Furthermore, Hongjam inhibited angiogenesis by suppressing the expression of key markers, including interleukin 6, VEGF, hypoxia-inducible factor-1 subunit alpha, platelet-derived growth factor subunit beta, matrix metalloproteinase-2, and cluster of differentiation 31, thereby disrupting the tumor microenvironment. These findings suggest that Hongjam exerts multifaceted protective effects against HCC by targeting proliferation, apoptosis, and angiogenesis pathways, while also mitigating liver damage. This study highlights the potential of Hongjam as a functional food or a complementary therapeutic agent for HCC prevention and management.