This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Purpose: We compared the surgical outcomes of radical nephrectomy (RN) and partial nephrectomy (PN) in adult patients with clinical T2 stage (cT2) renal cell carcinoma (RCC) by utilizing data from the Korean Renal Cell Carcinoma (KORCC) database. Materials and Methods: We retrospectively analyzed adult patients with cT2 RCC from 8 tertiary hospitals who were registered in the KORCC between 2003 and 2023. Patients with a solitary kidney or bilateral tumors were excluded. The patient cohort was divided into RN and PN arms, and propensity score matching (PSM) was conducted with a 1:3 ratio. Perioperative and survival outcomes were compared between arms. Results: After PSM, the PN and RN arms included 44 and 132 patients, respectively. No significant differences were observed in baseline characteristics, apart from laterality, following PSM. Regarding perioperative outcomes, complications of Clavien-Dindo classification grade III or higher (11.4%, p<0.001) and urological complications (9.1%, p=0.045) were more common in the PN arm than in the RN arm. Postoperative renal function was superior in the PN arm, whereas the incidence of de novo chronic kidney disease (CKD) at 6 months was higher among the recipients of RN (37.6%, p<0.001). Pathological examination indicated a higher pathological T stage in the RN arm. Overall, cancer-specific, and recurrence-free survival rates did not differ significantly between arms. Based on Cox regression analysis, the use of PN was not a significant predictor of recurrence-free survival (hazard ratio, 0.675; p=0.474). Conclusions In cT2 RCC, PN was associated with a lower incidence of de novo CKD than RN. No significant differences in survival outcomes were noted. PN may represent a viable alternative to RN for certain patients with cT2 RCC. Further research is warranted to explore the management of advanced RCC.

BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
Carcinoma, Renal Cell* ; Humans ; Kidney* ; Methods ; Nephrectomy* ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Survival Rate*

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.
Carcinoma, Renal Cell* ; Cohort Studies ; Diagnosis* ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Nephrectomy ; Recurrence ; Survival Rate

PURPOSE: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared to non-nerve-sparing radical prostatectomy (nnsRP) in patients with localized prostate cancer and preoperative erectile dysfunction. METHODS: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary's Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. RESULTS: Urinary continence recovered in 279 patients (77.5%) within the mean follow-up period of 22.5 months (range, 6-123 months). Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022). All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002-1.478; P=0.026) and nerve-sparing status (HR, 0.713; 95% CI, 0.548-0.929; P=0.012) were independently associated with recovery of urinary continence. CONCLUSIONS: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes.
Erectile Dysfunction* ; Follow-Up Studies ; Humans ; Male ; Multivariate Analysis ; Prostatectomy* ; Prostatic Neoplasms ; Seoul ; Urinary Incontinence

BACKGROUND/AIMS: There is increasing need for third-line therapy of Helicobacter pylori due to increasing level of antibiotics resistance. The aim of this study was to compare rifabutin and levofloxacin rescue regimens in patients with first- and second-line Helicobacter pylori eradication failures. METHODS: Patients, in whom a first treatment with proton pump inhibitor-clarithromycin-amoxicillin and a second trial with proton pump inhibitor-bismuth-tetracycline-metronidazole had failed, received treatment with either rifabutin or levofloxacin, plus amoxicillin (1 g twice daily) and standard dose proton pump inhibitor. Eradication rates were confirmed with 13C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Eradication rates were 71.4% in the rifabutin group, and 57.1% in the levofloxacin group, respectively. Although there was no significant difference in Helicobacter pylori eradication rates between two groups (p=0.656), rifabutin based regimen showed relatively higher eradication rate. CONCLUSIONS: Helicobacter pylori eradication rates of rifabutin- or levofloxacin-based triple therapy could not achieve enough eradication rate. Further studies would be needed on combination of levofloxacin and rifabutin-based regimen or culture based treatment.
Adult ; Aged ; Aged, 80 and over ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/*therapeutic use ; Breath Tests ; Drug Resistance, Bacterial/drug effects ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Ofloxacin/*therapeutic use ; Proton Pump Inhibitors/therapeutic use ; Rifabutin/*therapeutic use ; Salvage Therapy

Xanthohumol (XH), the principal prenylflavonoid of the hop plant (Humulus lupulus L.), dose-dependently inhibited isobutylmethylxanthine (IBMX)-induced melanogenesis in B16 melanoma cells, with little cytotoxicity at the effective concentrations. Decreased melanin content was accompanied by reduced tyrosinase enzyme activity, protein and mRNA expression. The levels of tyrosinase-related protein 1 and 2 mRNAs were decreased by XH. XH also inhibited alpha-melanocyte stimulating hormone- or forskolin-induced increases in melanogenesis, suggesting an action on the cAMP-dependent melanogenic pathway. XH downregulated the protein and mRNA expression of microphthalmia-associated transcription factor (MITF), a master transcriptional regulator of key melanogenic enzymes. These results suggest that XH might act as a hypo-pigmenting agent through the downregulation of MITF in the cAMP-dependent melanogenic pathway.
1-Methyl-3-isobutylxanthine/pharmacology ; Animals ; Cell Line ; Cell Survival/drug effects ; Dose-Response Relationship, Drug ; Down-Regulation ; Drug Antagonism ; Forskolin/pharmacology ; *Humulus ; Intramolecular Oxidoreductases/antagonists & inhibitors/biosynthesis ; Melanins/antagonists & inhibitors/*biosynthesis ; Melanocytes/*drug effects/*metabolism ; Melanoma, Experimental ; Membrane Glycoproteins/antagonists & inhibitors/biosynthesis ; Mice ; Microphthalmia-Associated Transcription Factor/antagonists & inhibitors ; Monophenol Monooxygenase/antagonists & inhibitors/biosynthesis/genetics ; Oxidoreductases/antagonists & inhibitors/biosynthesis ; Propiophenones/*pharmacology ; Signal Transduction/drug effects ; alpha-MSH/metabolism

To evaluate the nutritional status according to the degree of metabolic acidosis(MA) and determine that MA is a risk factor for malnutrition, we screened the laboratory data of 37 hemodialysis(HD) patients who were clinically stable for more than 6 months and taken bioelectrical impedence analysis(BIA) twice 6 months apart to check lean body mass (LBM). Mean age of patients was 49.1+/-15.0 years and sex ratio 1:2.4. Mean serum albumin level was 3.97+/-0.36g/dl and weekly Kt/V and normalized protein catabolic rate(nPCR) were 3.04+/-0.85 and 0.99+/-0.21g/kg/day. According to mean total CO2 content during the periods between BIA, the patients were divided to three groups[group 1(n=16):&18mEq/L, group 2(n=9):18< or =tCO2&21mEq/L, group 3(n=12):> or =21mEq/L). Group 1 had significantly higher body weight gain than group 2 and 3(1.82+/-1.62 vs. 0.77+/-3.13 and 1.35+/-3.85kg, P<0.05), and higher LBM gain(1.99+/-4.38 vs. 3.35+/-7.99kg, P<0.05), nPCR(1.05+/-0.20 vs. 0.91+/-0.13g/kg/day, P<0.05), intact parathyroid hormone(88.4+/-78.7 vs. 32.0+/-26.5pg/ml, P< 0.05), and phosphate(5.4+/-1.3 vs. 3.9+/-1.3mg/dl, P< 0.05) than group 3. There were no differences in age, serum albumin, BUN, creatinine and weekly Kt/V among three groups. Mean total CO2 level was inversely correlated with body weight gain and LBM gain. In conclusion, metabolic acidosis in stable HD patients may be the result of high protein intake and not related to decrease of body weight by protein catabolism.
Acidosis* ; Body Weight ; Creatinine ; Humans ; Malnutrition ; Metabolism ; Nutritional Status ; Renal Dialysis* ; Risk Factors ; Serum Albumin ; Sex Ratio

Although intussusception is primarily a disease of children, about 5 to 10 percent of cases occur in adults. The underlying causes of adult intussusception are tumor, postoperative complication, local bowel ischemia, abnormal motility and rarely intestinal tuberculosis. Recently, we experienced a 62-year-old man with intussusception underlying pulmonary tuberculosis. The postoperative pathologic finding was intestinal tuberculosis. For its rarity, we report this case with review of literatures.
Adult ; Child ; Humans ; Intussusception* ; Ischemia ; Middle Aged ; Postoperative Complications ; Tuberculosis* ; Tuberculosis, Pulmonary

A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue.
Adult ; Amylases ; Epithelium ; Female ; Fibrosis ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic