Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures. Methods: From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs. Results: The average patient age was 64.6 ± 15.1 years (range, 25–88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II). Conclusions When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Background: This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures. Methods: From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs. Results: The average patient age was 64.6 ± 15.1 years (range, 25–88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II). Conclusions When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Background: This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures. Methods: From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs. Results: The average patient age was 64.6 ± 15.1 years (range, 25–88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II). Conclusions When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Background: This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures. Methods: From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs. Results: The average patient age was 64.6 ± 15.1 years (range, 25–88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II). Conclusions When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Background: /Aim: Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT). Methods: We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1. Results: A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74). Conclusion The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

Purpose: Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. Materials and Methods: Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. Results: UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.