Stoma formation for fecal diversion is a common procedure in patients with various complicated conditions after colorectal surgery, such as anastomotic leakage. The singleincision laparoscopic approach for stoma creation offers several advantages, including a reduction in surgical wounds and related complications as well as optimal visualization of the surgical field. This video demonstrates a single-port–assisted diverting ileostomy in a 61-yearold man with anastomotic leakage following low anterior resection for advanced rectal cancer.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Stoma formation for fecal diversion is a common procedure in patients with various complicated conditions after colorectal surgery, such as anastomotic leakage. The singleincision laparoscopic approach for stoma creation offers several advantages, including a reduction in surgical wounds and related complications as well as optimal visualization of the surgical field. This video demonstrates a single-port–assisted diverting ileostomy in a 61-yearold man with anastomotic leakage following low anterior resection for advanced rectal cancer.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Stoma formation for fecal diversion is a common procedure in patients with various complicated conditions after colorectal surgery, such as anastomotic leakage. The singleincision laparoscopic approach for stoma creation offers several advantages, including a reduction in surgical wounds and related complications as well as optimal visualization of the surgical field. This video demonstrates a single-port–assisted diverting ileostomy in a 61-yearold man with anastomotic leakage following low anterior resection for advanced rectal cancer.

Objective: To evaluate the effects of microwave (MW) power and antenna approach methods on extrahepatic tumor seeding and ablation zone size using an ex vivo subcapsular tumor-mimic model. Materials and Methods: Forty-one subcapsular tumor mimics were prepared by injecting a mixture of contrast media into bovine liver blocks. Ablation was performed using low- and high-power protocols (75 W and 100 W for 4 and 3 minutes, respectively). The antenna approach was assessed in two directions: parallel and perpendicular to the capsule. CT scans were obtained before and after the ablation to detect contrast leakage on the hepatic surface. The presence of leakage, ablation zone size, and the timing of the first popping sound were compared between the two groups. Results: Five cases of contrast leakage were observed in the low-power group (n = 21) and 17 in the high-power group (n = 20) (23.8% vs. 85.0%, P < 0.001). Contrast leaks were less frequently observed in the low-power protocol compared to the high-power protocol, regardless of the antenna approach (18.2% [2/11] vs. 80.0% [8/10], P = 0.009 for parallel access;30.0% [3/10] vs. 90.0% [9/10], P = 0.020 for perpendicular access). The timing of the first popping sound was significantly delayed in the low-power group compared to the high-power group (137.7 ± 51.4 s vs. 77.8 ± 31.4 s, P < 0.001). The size of the ablation zone did not differ significantly between the two power groups (P = 0.415). The parallel and perpendicular antenna approaches did not show significant differences in the number of contrast leaks, popping sound timing, or ablationzone size (P = 0.536, 0.463, and 0.271, respectively). Conclusion Low-power MW ablation may be superior to a high-power protocol in reducing the risk of tumor seeding in subcapsular tumors, regardless of the antenna approach.

Background: Medullary thyroid carcinoma (MTC) has a poorer prognosis than differentiated thyroid cancers; however, comprehensive data on the long-term outcomes of MTC remain scarce. This study investigated the extended clinical outcomes of MTC and aimed to identify prognostic factors. Methods: Patients diagnosed with MTC between 1980 and 2020 were retrospectively reviewed. Their clinical characteristics, longterm clinical outcomes, and prognostic factors for recurrence and mortality were analyzed. Results: The study included 226 patients (144 women, 82 men). The disease-specific survival (DSS) rates for all MTC patients at 5-, 10-, 20-, and 30-year intervals were 92.7%, 89.4%, 74.3%, and 68.1%, respectively. The recurrence-free survival (RFS) rates were 71.1%, 56.1%, 40.2%, and 32.1% at these intervals. DSS was comparable between the groups from 1980–2009 and 2010–2020 (P=0.995); however, the 1980–2009 group had significantly lower RFS rates (P=0.031). The 2010–2020 group exhibited greater extents of surgical and lymph node dissection (P=0.003) and smaller tumors (P=0.003). Multivariate analysis identified extrathyroidal extension as the strongest prognostic factor for both RFS and DSS. Age >55 years and tumor size of ≥2 cm were also significant prognostic factors for DSS, while hereditary disease and lymph node metastasis were significant for RFS. Survival analysis after propensity-score matching of rearranged during transfection (RET)-negative and non-screened RET-positive groups showed comparable DSS but longer RFS in the RET-negative group. Conclusion Extrathyroidal extension was identified as the strongest prognostic factor for RFS and DSS. Older age and larger tumor size were associated with decreased DSS, while RET mutation and lymph node metastasis significantly impacted RFS.

Objective: To evaluate the effects of microwave (MW) power and antenna approach methods on extrahepatic tumor seeding and ablation zone size using an ex vivo subcapsular tumor-mimic model. Materials and Methods: Forty-one subcapsular tumor mimics were prepared by injecting a mixture of contrast media into bovine liver blocks. Ablation was performed using low- and high-power protocols (75 W and 100 W for 4 and 3 minutes, respectively). The antenna approach was assessed in two directions: parallel and perpendicular to the capsule. CT scans were obtained before and after the ablation to detect contrast leakage on the hepatic surface. The presence of leakage, ablation zone size, and the timing of the first popping sound were compared between the two groups. Results: Five cases of contrast leakage were observed in the low-power group (n = 21) and 17 in the high-power group (n = 20) (23.8% vs. 85.0%, P < 0.001). Contrast leaks were less frequently observed in the low-power protocol compared to the high-power protocol, regardless of the antenna approach (18.2% [2/11] vs. 80.0% [8/10], P = 0.009 for parallel access;30.0% [3/10] vs. 90.0% [9/10], P = 0.020 for perpendicular access). The timing of the first popping sound was significantly delayed in the low-power group compared to the high-power group (137.7 ± 51.4 s vs. 77.8 ± 31.4 s, P < 0.001). The size of the ablation zone did not differ significantly between the two power groups (P = 0.415). The parallel and perpendicular antenna approaches did not show significant differences in the number of contrast leaks, popping sound timing, or ablationzone size (P = 0.536, 0.463, and 0.271, respectively). Conclusion Low-power MW ablation may be superior to a high-power protocol in reducing the risk of tumor seeding in subcapsular tumors, regardless of the antenna approach.

Objective: To evaluate the effects of microwave (MW) power and antenna approach methods on extrahepatic tumor seeding and ablation zone size using an ex vivo subcapsular tumor-mimic model. Materials and Methods: Forty-one subcapsular tumor mimics were prepared by injecting a mixture of contrast media into bovine liver blocks. Ablation was performed using low- and high-power protocols (75 W and 100 W for 4 and 3 minutes, respectively). The antenna approach was assessed in two directions: parallel and perpendicular to the capsule. CT scans were obtained before and after the ablation to detect contrast leakage on the hepatic surface. The presence of leakage, ablation zone size, and the timing of the first popping sound were compared between the two groups. Results: Five cases of contrast leakage were observed in the low-power group (n = 21) and 17 in the high-power group (n = 20) (23.8% vs. 85.0%, P < 0.001). Contrast leaks were less frequently observed in the low-power protocol compared to the high-power protocol, regardless of the antenna approach (18.2% [2/11] vs. 80.0% [8/10], P = 0.009 for parallel access;30.0% [3/10] vs. 90.0% [9/10], P = 0.020 for perpendicular access). The timing of the first popping sound was significantly delayed in the low-power group compared to the high-power group (137.7 ± 51.4 s vs. 77.8 ± 31.4 s, P < 0.001). The size of the ablation zone did not differ significantly between the two power groups (P = 0.415). The parallel and perpendicular antenna approaches did not show significant differences in the number of contrast leaks, popping sound timing, or ablationzone size (P = 0.536, 0.463, and 0.271, respectively). Conclusion Low-power MW ablation may be superior to a high-power protocol in reducing the risk of tumor seeding in subcapsular tumors, regardless of the antenna approach.