Purpose: Claudin 18.2 (CLDN18.2) has emerged as a promising therapeutic target for CLDN18.2-expressing gastric cancer (GC). We sought to examine the heterogeneity of CLDN18.2 expression between primary GC (PGC) and metastatic GC (MGC) using various scoring methods. Materials and Methods: We retrospectively analyzed data from 102 patients with pathologically confirmed paired primary and metastatic gastric or gastroesophageal junction adenocarcinomas. CLDN18.2 expression was evaluated through immunohistochemistry on formalin-fixed paraffin-embedded tissue samples. We assessed CLDN18.2 positivity using multiple scoring approaches, including the immunoreactivity score, H-score, and the percentage of tumor cells showing moderate-to-strong staining intensity. We analyzed the concordance rates between PGC and MGC and the association of CLDN18.2 positivity with clinicopathological features. Results: CLDN18.2 positivity varied from 25% to 65% depending on the scoring method, with PGC consistently showing higher expression levels than MGC. Intratumoral heterogeneity was noted in 25.5% of PGCs and 19.6% of MGCs. Intertumoral heterogeneity, manifesting as discordance in CLDN18.2 positivity between PGC and MGC, was observed in about 20% of cases, with moderate agreement across scoring methods (κ=0.47 to 0.60).In PGC, higher CLDN18.2 positivity correlated with synchronous metastasis, presence of peritoneal metastasis, poorly differentiated grade, and biopsy specimens. In MGC, positivity was associated with synchronous metastasis, presence of peritoneal metastasis, and metastatic peritoneal tissues. Conclusions CLDN18.2 expression demonstrates significant heterogeneity between PGC and MGC, with a 20% discordance rate. Comprehensive tissue sampling and reassessment of CLDN18.2 status are crucial, especially before initiating CLDN18.2-targeted therapies.

Purpose: Claudin 18.2 (CLDN18.2) has emerged as a promising therapeutic target for CLDN18.2-expressing gastric cancer (GC). We sought to examine the heterogeneity of CLDN18.2 expression between primary GC (PGC) and metastatic GC (MGC) using various scoring methods. Materials and Methods: We retrospectively analyzed data from 102 patients with pathologically confirmed paired primary and metastatic gastric or gastroesophageal junction adenocarcinomas. CLDN18.2 expression was evaluated through immunohistochemistry on formalin-fixed paraffin-embedded tissue samples. We assessed CLDN18.2 positivity using multiple scoring approaches, including the immunoreactivity score, H-score, and the percentage of tumor cells showing moderate-to-strong staining intensity. We analyzed the concordance rates between PGC and MGC and the association of CLDN18.2 positivity with clinicopathological features. Results: CLDN18.2 positivity varied from 25% to 65% depending on the scoring method, with PGC consistently showing higher expression levels than MGC. Intratumoral heterogeneity was noted in 25.5% of PGCs and 19.6% of MGCs. Intertumoral heterogeneity, manifesting as discordance in CLDN18.2 positivity between PGC and MGC, was observed in about 20% of cases, with moderate agreement across scoring methods (κ=0.47 to 0.60).In PGC, higher CLDN18.2 positivity correlated with synchronous metastasis, presence of peritoneal metastasis, poorly differentiated grade, and biopsy specimens. In MGC, positivity was associated with synchronous metastasis, presence of peritoneal metastasis, and metastatic peritoneal tissues. Conclusions CLDN18.2 expression demonstrates significant heterogeneity between PGC and MGC, with a 20% discordance rate. Comprehensive tissue sampling and reassessment of CLDN18.2 status are crucial, especially before initiating CLDN18.2-targeted therapies.

Purpose: Claudin 18.2 (CLDN18.2) has emerged as a promising therapeutic target for CLDN18.2-expressing gastric cancer (GC). We sought to examine the heterogeneity of CLDN18.2 expression between primary GC (PGC) and metastatic GC (MGC) using various scoring methods. Materials and Methods: We retrospectively analyzed data from 102 patients with pathologically confirmed paired primary and metastatic gastric or gastroesophageal junction adenocarcinomas. CLDN18.2 expression was evaluated through immunohistochemistry on formalin-fixed paraffin-embedded tissue samples. We assessed CLDN18.2 positivity using multiple scoring approaches, including the immunoreactivity score, H-score, and the percentage of tumor cells showing moderate-to-strong staining intensity. We analyzed the concordance rates between PGC and MGC and the association of CLDN18.2 positivity with clinicopathological features. Results: CLDN18.2 positivity varied from 25% to 65% depending on the scoring method, with PGC consistently showing higher expression levels than MGC. Intratumoral heterogeneity was noted in 25.5% of PGCs and 19.6% of MGCs. Intertumoral heterogeneity, manifesting as discordance in CLDN18.2 positivity between PGC and MGC, was observed in about 20% of cases, with moderate agreement across scoring methods (κ=0.47 to 0.60).In PGC, higher CLDN18.2 positivity correlated with synchronous metastasis, presence of peritoneal metastasis, poorly differentiated grade, and biopsy specimens. In MGC, positivity was associated with synchronous metastasis, presence of peritoneal metastasis, and metastatic peritoneal tissues. Conclusions CLDN18.2 expression demonstrates significant heterogeneity between PGC and MGC, with a 20% discordance rate. Comprehensive tissue sampling and reassessment of CLDN18.2 status are crucial, especially before initiating CLDN18.2-targeted therapies.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

The purpose of this study is to identify the prevalence and risk factors of delirium of older adults after cardiac surgery at the intensive care unit (ICU). Methods: A retrospective descriptive correlational study design was used. Among 675 older adults who admitted to ICU after cardiac surgery in a tertiary hospital from May 2021 to April 2022, 528 were selected for data analysis. Data were collected through electronic medical records. Delirium and pain intensity were evaluated using the Confusion Assessment Method-Intensive Care Unit and Critical Care Non-verbal Pain Scale, respectively. Results: The incidence rate of delirium was 41.3% (n=218). Multivariate logistic regression analysis of the variables identified that ICU length of stay (odds ratio [OR]=1.77, p<.001), anesthesia time (OR=1.21, p=.016), pain intensity (OR=1.14, p=.044), and age (OR=1.07, p=.002) were identified as risk factors of delirium after cardiac surgery. Conclusion: ICU length of stay, anesthesia time, pain score, and advanced age should be considered as the prevention and management of delirium at the intensive care unit of older adults after cardiac surgery.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

Purpose: Headaches are common in childhood and adolescence and are often exacerbated by various triggers. The coronavirus disease 2019 (COVID-19) pandemic has profoundly altered daily life worldwide. In this study, we investigated potential behavioral and emotional changes among pediatric patients with headaches, treated either before or after the onset of the COVID-19 pandemic. Methods: We examined 162 patients who visited our pediatric headache clinic between March 2018 and August 2021. The study included patients with primary headaches who completed a questionnaire assessing behavioral and psychiatric characteristics. We reviewed their clinical features, imaging studies, and scores on the Korean Child Behavior Checklist (K-CBCL), State Anxiety Inventory for Children (SAIC), Trait Anxiety Inventory for Children, and Children’s Depression Inventory (CDI). Statistical analysis was conducted using the Mann-Whitney U test, among other methods. Results: The 162 patients (mean age, 11.7±3.3 years) were classified based on whether they visited before (n=81) or after (n=81) the onset of the COVID-19 pandemic. The average CDI and SAIC scores were significantly higher in those who presented after pandemic onset. In this group, the odds ratio for an abnormal CDI score was 4.971. A weak positive correlation was found between the CDI score and the K-CBCL total problem score, with a correlation coefficient of 0.297. Conclusion Pediatric patients visiting the headache clinic after the onset of the COVID-19 pandemic exhibited significantly higher levels of anxiety and depression compared to pre-pandemic visitors. Recognizing the considerable impact of the pandemic may help inform the management of pediatric headaches.

This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases.This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guide‑ lines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to pre‑ sent recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.

Background: Ischemic stroke is a serious neurological disorder caused by blockages in cerebral artery. Protein phosphatase 2A (PP2A) is a phosphatase that performs a critical role in cell signaling and growth. PP2A subunit B acts as a neuroprotective agent in the nerve system. Chlorogenic acid, which is mainly found in roasted coffee, has antioxi‑ dant, anti-inflammatory, and anti-apoptotic effects. We hypothesized that chlorogenic acid modulates PP2A subunit B expression in ischemic stroke models and glutamate-mediated neurons. Middle artery occlusion (MCAO) surgery was operated and chlorogenic acid (30 mg/kg) or phosphate buffer saline was treated 2 h after MCAO. The cerebral cortex was collected 24 h after surgery and the change of PP2A subunit B expression was analyzed. Glutamate and/ or chlorogenic acid were treated in cultured neurons, further study was performed. Results: A decrease in PP2A subunit B expression in MCAO animals was identified. Chlorogenic acid alleviated this decrease due to ischemic injury. Moreover, the number of PP2A subunit B-positive cells in the ischemic cerebral cortex was significantly decreased, chlorogenic acid alleviated this decrease. We also found protective effects of chlo‑ rogenic acid in neurons exposed to glutamate. Glutamate decreased the expression of PP2A subunit B and chloro‑ genic acid mitigated this decrease. Our results elucidated that chlorogenic acid performs neuroprotective functions and attenuates the reduction of PP2A subunit B by brain damage and glutamate-mediated excitotoxicity. Conclusions We showed that chlorogenic acid attenuated the decrease of PP2A subunit B in ischemic injury and neurons exposed to glutamate. Since PP2A subunit B contributes to the protection of brain tissue, we can sug‑ gest that chlorogenic acid preserves neurons by modulating PP2A subunit B during ischemic damage.