Armed Forces Capital Hospital

BackgroundAortic diameter (AoD) changes with age and can decrease in shock states. Accurate AoD assessment is crucial for managing hypovolemic shock and guiding interventions such as resuscitative endovascular balloon occlusion of the aorta. This study hypothesized that clinical factors (eg, initial hemodynamic parameters, trauma severity, and laboratory results) would have a greater impact on the AoD than would age- or anthropometric-related factors in traumatic massive hemorrhage patients. We aimed to identify significant predictors of the descending AoD across two age groups (18–60 years and 61–91 years).MethodsA retrospective analysis was conducted on 243 massive hemorrhage patients at a level I trauma center. The aorta was automatically segmented in CT images via a deep learning architecture based on a Shallow Attention Network to obtain diaphragm-level AoD values. 152 patients were assigned to the younger group and 91 to the senior group. A random forest model was used to incorporate various clinical factors.ResultsIn the younger group, age and body surface area were the most important features (root mean square error (RMSE): train, 1.03; test, 2.70). In the senior group, hemoglobin, arterial pH, and heart rate were the most significant indicators (RMSE: train, 1.19; test, 3.95). The importance of age diminished in the senior group, whereas vital signs and laboratory values gained prominence.ConclusionOur findings reveal age-specific differences in factors influencing the AoD during traumatic hemorrhage. The results highlight the limitations of traditional methods for AoD estimation, especially in senior patients in whom dynamic physiological factors may play a major role. These insights can improve the accuracy of AoD assessment and management in hemorrhage patients across different age groups. The findings may contribute to developing an artificial intelligence-derived score that estimates the AoD, incorporating static and dynamic physiological factors.Level of evidenceIV, retrospective study having more than one negative criterion.

BackgroundIn Korea, rheumatic mitral valve (MV) disease remains relatively prevalent compared with Western countries. Given this demographic profile, we aimed to evaluate long-term rhythm and clinical outcomes of surgical ablation of atrial fibrillation (AF) during MV surgery in patients with degenerative versus rheumatic MV disease, using the data from the nation’s highest-volume center.MethodsWe retrospectively analyzed consecutive patients with AF who underwent MV surgery with concomitant surgical ablation between 2001 and 2020 at a high-volume center in Korea. Patients were categorized by MV etiology (rheumatic vs. degenerative). The primary outcome was AF recurrence after a 3-month blanking period. Secondary outcomes included all-cause mortality, stroke, and permanent pacemaker (PPM) implantation. The probability of AF recurrence was estimated using logistic regression with generalized estimating equations, and competing risk models were used to assess stroke and PPM implantation.ResultsAmong 1,872 patients (mean age 58.7±11.5 years; 56.9% women), 1,157 (61.8%) had rheumatic MV disease, and 715 (38.2%) had degenerative disease. Compared with patients with degenerative disease, those with rheumatic disease were younger, more often female, had more persistent AF, larger left atrial dimensions, and a higher likelihood of undergoing MV replacement. The adjusted probability of AF recurrence at 3, 5, and 10 years was 23.6%, 28.6%, and 40.1%, respectively, and did not significantly differ between rheumatic and degenerative groups (10-year: 39.8% vs. 40.6%; P=0.746). Rheumatic etiology was not associated with an increased risk of death (P=0.518), stroke (P=0.520), or PPM implantation (P=0.052).ConclusionsIn a contemporary Korean cohort, surgical ablation during MV surgery provided sustained rhythm control and favorable clinical outcomes in patients with both degenerative and rheumatic disease. Given the continued burden of rheumatic heart disease in Korea, these findings support the routine application of surgical ablation during MV surgery, regardless of underlying etiology.

Perihilar cholangiocarcinoma (CCA) often requires extended hepatectomy for curative treatment, especially in Bismuth type III–IV. However, the risk of post-hepatectomy liver failure (PHLF) cannot be ignored. Portal vein embolization (PVE) is a preoperative optimization method that reduces risk of PHLF, and improves surgical safety. This study investigated the impact of PVE on surgical outcomes and long-term survival in patients with Bismuth type III-IV perihilar CCA. We retrospectively reviewed the data of 137 patients diagnosed with Bismuth type III–IV perihilar CCA between April 2011 and August 2021. Among 137 patients, 88 were included in the analyses and divided into three groups: resection without PVE (group A); resection after PVE (group B); and no resection after PVE (group C). The main outcomes of this study were surgical outcomes and long-term survival outcomes of each group. Survival analyses were performed using inverse probability treatment weighting (IPTW) and Cox regression analysis stratified by surgical resection. Among 88 patients, 18 underwent resection without PVE (group A), 55 underwent resection after PVE (group B), and 15 did not proceed to surgery after PVE (group C). There was no significant difference in median recurrence-free survival (RFS) and overall survival (OS) between groups A and B (mRFS 11.9 vs. 18.1 months, P = 0.099; mOS 18.9 vs. 24.8 months; P = 0.454) after IPTW. However, a significant difference was found in median OS between groups B and C (25.9 vs. 10.2 months; P = 0.002). In the stratified Cox regression analysis in groups B and C, age (adjusted hazard ratio [aHR] 1.979ㅡ13.208), and percentage of future liver remnant after PVE (post-PVE FLR; aHR 0.160ㅡ0.744) were associated with OS regardless of surgical resection. PVE reduces the risk of post-hepatectomy liver failure and enables extended hepatectomy without comparing oncologic outcomes. Furthermore, in groups that underwent PVE, post-PVE measured FLR was an independent prognostic factor of OS, regardless of surgical resection.

In 1573, Paolo Veronese unveiled his monumental painting The Feast in the House of Levi. Among the crowded banquet scene, a small but remarkable figure in the lower right foreground is depicted suffering from epistaxis. This incidental detail, rendered with striking realism, highlights the timelessness of a condition still familiar to modern trauma and ENT surgeons. In the sixteenth century, epistaxis was interpreted through humoral theory and treated with a mixture of practical and superstitious remedies, including vinegar-soaked compresses, charms, and heated cautery. The vascular anatomy of the nasal septum, including Kiesselbach's plexus, would not be described until centuries later. Today, however, the management of epistaxis follows well-established protocols: upright positioning with the head forward, direct pressure, topical vasoconstrictors, cauterization, nasal packing, and, in refractory cases, endoscopic or interventional radiologic procedures. The juxtaposition of Veronese's bleeding figure with contemporary clinical practice underscores both the continuity of human vulnerability and the evolution of anatomic knowledge and surgical precision. This historical and artistic perspective reminds physicians that, despite advances in medicine, the same ordinary disorders that challenged past generations continue to resonate in modern trauma rooms.

Wilhelm Jensen Gradiva (1903) and Freud 1907 interpretation reveal how repression, delusion, and recollection shape the psychic transformation of desire. This triadic process offers valuable insight into the hidden emotional dynamics that often underlie aesthetic motivation in plastic-surgery patients, where the pursuit of beauty may reflect unresolved inner conflict. A hermeneutic-conceptual analysis was conducted on Freud Delusion and Dream in Jensen's Gradiva, complemented by reflective observation of aesthetic-surgery consultations. Theoretical correspondences were drawn between Freud psychoanalytic stages-repression, delusion, and recall-and the patient's emotional trajectory before and after cosmetic procedures. Each stage was examined as both a symbolic and clinical process revealing the aesthetic unconscious. In the stage of repression, emotional wounds are displaced into bodily dissatisfaction, where the perceived defect symbolizes unspoken trauma. During delusion, patients idealize a perfected self-image, denying vulnerability and temporal change. Finally, through recall and healing, satisfaction emerges when the altered appearance is integrated into the self, transforming aesthetic modification into psychic reconciliation. This mirrors Norbert Hanold recovery in Gradiva when his delusional image becomes embodied in the living Zoë Bertgang. The Gradiva narrative provides a metaphor for the aesthetic unconscious-the interplay between visible form, memory, and desire. For plastic surgeons, understanding this process enriches empathy, enhances patient communication, and promotes postoperative adaptation. Surgery, when guided by psychological insight, becomes not a mere reconstruction of form but a therapeutic act of recollection and renewed identity.

Introduction: This study aimed to evaluate the long-term risk of stroke following dementia diagnosis and compare stroke risk across dementia subtypes using nationwide cohort data. Methods: We performed a retrospective cohort study using Korean National Health Insurance Service data (2002–2013). Patients with newly diagnosed dementia (n = 2,820) were matched 1:10 with controls (n = 28,200) by age, sex, and health screening year. Stroke incidence was evaluated over up to 10 years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression. Results: During a mean follow-up of 2.49 years (median, 1.99; standard deviation, 2.07; interquartile range, 2.66), dementia was significantly associated with increased stroke risk (aHR, 3.19; 95% confidence interval, 2.84–3.57). The highest risk was observed in patients with vascular dementia (VaD; aHR, 3.58), followed by Alzheimer’s disease (AD; aHR, 2.73) and other dementias (aHR, 2.61). Ischemic stroke (IS) was more common than hemorrhagic stroke (HS) across all subtypes. The relative risk was greater in individuals aged <60 years and in males with AD or other dementias, whereas sex differences were not evident in VaD. Conclusion: Dementia, especially VaD, is a strong risk factor for both IS and HS. These findings support the need for dementia subtype-specific cerebrovascular risk assessment and long-term prevention strategies.

In Korea and Japan, widespread negative perceptions of the elderly reflect deep-seated intergenerational tensions, cultural shifts, and societal inequities.This study explores gerontophobia-a fear or hatred of aging-through Yamano Sharin's manga, The Era of Young Slavery, Youth as Meat, the Old Consume.The manga's striking visual and narrative elements portray exaggerated caricatures of elderly individuals exploiting younger generations, representing systemic inequities in resource allocation, societal burden-sharing, and fractured intergenerational dynamics.The elderly are depicted with distorted, almost monstrous features, reinforcing stereotypes of greed, entitlement, selfishness, and resource dependence.In contrast, the youth are portrayed as physically and emotionally drained, emphasizing their vulnerability, oppression, and exhaustion as laborers in an inequitable system.This artistic inversion critiques societal ideals by questioning the obsessive value placed on youthful beauty and the consequences of an aging population clinging to longevity at the expense of younger generations.Socially, the manga reflects Japan's demographic challenges, depicting the elderly as beneficiaries of disproportionate resources while the youth struggle under economic and emotional exploitation.Ethically, the manga provokes discomfort by portraying aging individuals as dependent stereotypes, prompting readers to reconsider societal values surrounding aging, dignity, and generational equity.From a plastic surgery perspective, the manga critiques the unrealistic pursuit of perpetual youth, urging practitioners to balance aesthetic ideals with authenticity, dignity, and respect for the aging process.This study highlights the urgent need for equitable intergenerational relationships, systemic reform, and a cultural shift valuing aging and youth equitably, rejecting harmful narratives and fostering inclusivity.

Oyster hatcheries suffer significant mortality caused by members of the bacterial genus Vibrio, which infect Crassostrea gigas larvae. Bacteriophages present a potential alternative to antibiotics, with N4-like phages showing promise against vibriosis. We investigated the adsorption properties and determined the complete genome sequence of phage pVco-7 and performed phylogenetic and comparative analysis with other N4-like Vibrio phages to gain insights into phage resistance mechanisms and infection strategies. The phage has a linear dsDNA genome with 126 genes and a typical N4-like organization. Tail fiber variations were identified that could potentially influence host recognition, providing insights into how phages of the genus Vicoquintavirus interact with their host as well as their evolutionary relationships. These findings will contribute to the development effective biocontrol strategies against vibriosis in commercially important bivalve aquaculture.