Ansan University

BackgroundDespite guideline recommendations, evidence from randomized trials evaluating the appropriate low-density lipoprotein (LDL) cholesterol target for secondary prevention in patients with atherosclerotic cardiovascular disease remains limited.MethodsIn this open-label superiority trial conducted in South Korea, we randomly assigned patients with atherosclerotic cardiovascular disease in a 1:1 ratio to a target LDL cholesterol level of less than 55 mg per deciliter (1.4 mmol per liter) (intensive-targeting group) or less than 70 mg per deciliter (1.8 mmol per liter) (conventional-targeting group). The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or hospitalization for unstable angina at 3 years. Safety was also assessed.ResultsOf 3048 patients who underwent randomization, 1526 were assigned to the intensive-targeting group and 1522 to the conventional-targeting group. The median follow-up was 3.0 years. The median LDL cholesterol level during the trial was 56 mg per deciliter (1.4 mmol per liter) in the intensive-targeting group and 66 mg per deciliter (1.7 mmol per liter) in the conventional-targeting group. A primary end-point event occurred in 100 patients (Kaplan–Meier estimate of cumulative incidence, 6.6%) in the intensive-targeting group and in 147 patients (Kaplan–Meier estimate of cumulative incidence, 9.7%) in the conventional-targeting group (hazard ratio, 0.67; 95% confidence interval, 0.52 to 0.86; P=0.002). The incidence of prespecified safety end points was similar in the two trial groups, except for a lower incidence of creatinine elevation in the intensive-targeting group.ConclusionsAmong patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level of less than 55 mg per deciliter resulted in a lower risk of cardiovascular events at 3 years than targeting a level of less than 70 mg per deciliter. (Funded by the Cardiovascular Research Center and Yuhan; Ez-PAVE ClinicalTrials.gov number, NCT04626973.)

There is limited large-scale evidence to guide the optimal mode of birth for patients with moyamoya disease (MMD). To evaluate whether the mode of birth (cesarean vs vaginal) is associated with stroke risk after childbirth for women with MMD. This cohort study evaluated stroke outcomes up to 3 years after childbirth. A nationwide, population-based analysis was performed using data from the Health Insurance Review and Assessment Service of South Korea. Individuals with MMD from January 1, 2002, to December 31, 2023 were identified. Among 31 750 patients, those with birth-related procedure codes were selected. The study population was restricted to women aged 19 to 49 years, and those with a diagnosis of malignant neoplasm within 3 years before the index date (date of childbirth) were excluded. Data were analyzed from June 11 to September 8, 2025. Mode of birth. The primary outcome was any stroke, defined as a composite of ischemic or hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, and transient ischemic attack. Of 1683 women analyzed (mean [SD] age, 33.6 [7.8] years), 1077 (64.0%) had cesarean births, and 606 (36.0%) had vaginal births. Post partum (3 months), any stroke incidence was 63.49 and 33.33 per 1000 person-years for cesarean and vaginal births, respectively. Multivariable analyses showed no significant risk differences for any stroke by birth mode at 3 months (adjusted hazard ratio [aHR], 0.71 [95% CI, 0.26-1.97]; P = .52) or 3 years (aHR, 0.90 [95% CI, 0.55-1.47]; P = .67). A significant interaction was observed between the mode of birth and the clinical onset type of MMD for the risk of any stroke (interaction P = .04 after Bonferroni correction); the adjusted HR for vaginal vs cesarean birth was 0.10 (95% CI, 0.01-0.79) in the asymptomatic or nonvascular onset subgroup, 1.49 (95% CI, 0.73-3.03) in the ischemic onset subgroup, and 0.94 (95% CI, 0.50-1.77) in the hemorrhagic onset subgroup. Notably, stroke incidence peaked in the early postpartum period (≤6 months: 35.7 per 1000 person-years), decreased at 1 year, and thereafter remained at a similar level. In this cohort study of women with MMD, MMD itself was not found to be an absolute indication for cesarean birth; birth planning should be individualized based on obstetric factors and clinical onset type rather than routine preference for cesarean birth. In addition, vigilant monitoring and preventive strategies during the early postpartum period are warranted.

Trigeminal trophic syndrome (TTS) is a rare neurocutaneous disorder defined by trigeminal anesthesia, facial paresthesia, and crescentic ulceration of the nasal ala. We describe an 86-year-old woman with long-standing trigeminal neuralgia who developed a suspicious ulcerated lesion on the left nasal ala. Although the initial biopsy showed atypical squamous cells suggestive of squamous cell carcinoma, the combined histopathologic, radiologic, and clinical findings supported a diagnosis of TTS. This case underscores the need to distinguish TTS from malignancy, particularly in elderly patients with neurologic comorbidities. Early recognition may prevent unnecessary invasive procedures and improve outcomes.

Imaging in thick biological tissues is often degraded by sample-induced aberrations, which reduce resolution and contrast, particularly in super-resolution techniques. While hardware-based adaptive optics (AO) using wavefront shaping can correct these aberrations, their complexity and cost hinder widespread adoption. Here, we present a computational AO framework for multiphoton structured illumination microscopy, enabling deep-tissue super-resolution imaging with minimal hardware modifications. By replacing the photodetector with a camera from the conventional laser-scanning multiphoton microscope, we capture a sequence of scanned images. Using virtual structured illumination, we develop a dual deconvolution algorithm that independently corrects excitation and emission aberrations, recovering an aberration-free object spectrum with an extended spatial frequency bandwidth. We experimentally validate this framework through two-photon super-resolution imaging, achieving a lateral resolution of 130 nm-one-fourth of the emission wavelength-at a depth of 180 μm in thick mouse brain tissue, where conventional deconvolution fails to maintain super-resolution capability. This approach provides a cost-effective and accessible alternative to hardware-based AO, expanding the potential for high-resolution deep-tissue imaging in biological research.

This study aimed to summarize the current clinical evidence, technical advances, and practical insights related to robotic thyroidectomy using the da Vinci SP (Single-Port) surgical system, with an emphasis on the evolution of surgical approaches and outcomes based on the author's institutional experience and literature review. A focused narrative review of studies published between 2019 and 2025 was conducted to evaluate the safety, feasibility, and clinical performance of single-port robotic thyroidectomy. Five representative SP approaches (single-port transoral robotic thyroidectomy [SP-TORT], single-port transaxillary robotic thyroidectomy [SP-TART/START], retroauricular approach using the da Vinci SP system [RA-SP], single-port robotic areolar approach [SPRA], and gas-insufflation one-step single-port transaxillary [GOSTA]) were compared in terms of operative technique, ergonomics, and postoperative outcomes. Across multiple institutions, SP robotic thyroidectomy demonstrated operative times, complication rates, and lymph node yields comparable to those of conventional multi-port or open surgery while providing distinct cosmetic and ergonomic advantages. Transient recurrent laryngeal nerve palsy and hypocalcemia were the most common complications, with low overall morbidity. Recent reports have extended the SP technology to modified radical neck dissection (MRND) through the START, SPRA, and GOSTA approaches, confirming the oncologic feasibility of comprehensive nodal dissection within a confined workspace. The da Vinci SP system represents a meaningful advancement in minimally invasive endocrine surgery by enabling single-port robotic thyroidectomy through various remote-access approaches. Current evidence supports its safety, feasibility, and favorable cosmetic outcomes when applied to appropriately selected patients. However, further refinement of instrumentation, optimization of surgical techniques, and accumulation of long-term clinical data are required to expand its indications and to define its role in advanced thyroid diseases more clearly.

Persistent symptoms after SARS-CoV-2 infection (PASC, long COVID) remain a major public-health concern. We developed a data-driven definition and static and dynamic PASC scoring systems in a multicenter, prospective-retrospective observational cohort across 12 South Korean institutions. Adults enrolled December 2022-March 2025 were followed up to 24 months; 8761 were recruited (7208 infected; 1553 controls) and 4668 met analysis criteria (4388 infected; 280 controls). Using participant-reported symptoms, surveys, and laboratory data, we identified nine symptoms robustly associated with PASC, with anosmia/ageusia and fatigue most influential. A static score integrating indicators observed within 24 months yielded an optimal threshold of 13, classifying 19% of infected participants and 4% of controls as PASC positive. A dynamic score tracking six-month intervals showed symptom burdens peaking at 0-5 months post-infection and declining thereafter; at the same threshold, 33% of infected participants were classified as PASC positive, reflecting temporal fluctuation. These data establish a quantitative definition of PASC and introduce a dynamic scoring framework to identify and monitor PASC, supporting future clinical research and practice.

Progressive collapse is characterized by disproportionate structural failure triggered by localized damage, such as column loss under extreme loading conditions. The objective of this study is to develop a simplified analytical model that is applicable in engineering practice without the need for high-fidelity nonlinear finite element analysis. Although current design guidelines (GSA and DoD) provide analytical procedures and acceptance criteria, they do not explicitly address the tensile resistance of girders after the acceptance criteria are satisfied, particularly under large deformation and connection failure. To address this limitation, this study proposes a simplified theoretical load–displacement model for a fixed-end girder subjected to three concentrated loads, considering the effects of secondary beams and focusing on the local girder response under a column-removal scenario. The proposed model incorporates moment–axial force interactions at plastic sections in the large-deformation range. Based on one-dimensional finite element analysis results, an early-developed axial force of 0.15Fₚ at the onset of the transition stage and a residual bending moment of 0.3Mₚ during the catenary action stage are explicitly introduced to better represent actual structural behavior. The girder response is idealized using five characteristic points: yielding (Y), full plasticity (P), transition initiation (T), pure catenary action initiation (C), and collapse governed by connection failure (Fconn). Stress distributions at plastic sections are analyzed using three-dimensional finite element models to establish stress-based formulations and a rational procedure for estimating axial force at collapse. The validity of the proposed model is verified through comparisons with finite element analysis results for girders with different span-to-depth ratios. The results demonstrate reasonable agreement in terms of collapse load and displacement, particularly for slender girders, confirming the applicability of the proposed model for progressive collapse assessment.