Kyungpook National University Hospital

Noise-induced hearing loss (NIHL) has been traditionally attributed to outer hair cell (OHC) damage, but synaptic injury at inner hair cell (IHC)–spiral ganglion neuron (SGN) junctions may better explain persistent functional deficits. To test whether IHC ribbon loss and functional synapse loss scale with pathological noise intensity and to define their longitudinal relationship to hearing function. A rodent NIHL model was exposed to 100 dB SPL for 2 h or 110 dB SPL for 4 h. Cochleae were immunolabeled for CtBP2 (presynaptic ribbons) and GluA2 (postsynaptic AMPA receptor puncta). Putative functional synapses were quantified as closely apposed CtBP2/GluA2 pairs. Hearing function was assessed longitudinally and correlated with synaptic measures. Both exposure conditions produced graded reductions in IHC ribbon counts and CtBP2/GluA2 pairs, with greater losses after 110 dB/4 h. The number of CtBP2/GluA2 apposed pairs closely tracked preserved hearing function, providing a stronger association with functional outcome than ribbon counts alone. Ribbon loss remained largely stable across post-exposure intervals, whereas functional synapse loss was disproportionately larger at early time points, consistent with transient pre–post misalignment. Over time, CtBP2/GluA2 pairing partially recovered toward levels predicted by surviving ribbons, suggesting re-alignment or reconnection of a subset of remaining synaptic elements. Pathological noise intensity drives exposure-dependent IHC synaptopathy in addition to OHC injury. Functional synapse counts (CtBP2/GluA2 pairs) sensitively reflect stored hearing function and indicate a potential post-exposure window for synaptic re-establishment.

Background and Objectives: Chronic kidney disease (CKD) is associated with severe coronary calcification and increased procedural risks. We aimed to evaluate the impact of CKD on contrast-induced nephropathy (CIN), bleeding, and clinical outcomes in patients undergoing rotational atherectomy (RA). Materials and Methods: This study retrospectively analyzed 652 patients who underwent RA for calcified coronary lesions from the multicenter ROCK registry and a single-center extension between 2010 and 2025. Patients were classified into CKD (eGFR < 60 mL/min/1.73 m2, n = 66) and non-CKD (n = 586) groups, excluding those on dialysis. The primary endpoint was a composite of CIN and in-hospital bleeding. Secondary endpoints included 3-year target vessel failure (TVF), myocardial infarction (MI), and total bleeding. Results: The primary composite outcome occurred more frequently in the CKD group (16.7% vs. 5.1%, p = 0.001). Specifically, CIN was significantly higher in CKD patients (15.2% vs. 1.7%, p < 0.001), while in-hospital bleeding did not differ significantly. In multivariate analysis, CKD was an independent predictor of the primary outcome (adjusted OR 3.02; 95% CI 1.36-6.69; p = 0.006). At 3-year follow-up, total bleeding (10.6% vs. 3.9%, p = 0.008) and MI (6.1% vs. 2.1%, p = 0.024) were higher in the CKD group, whereas TVF and cardiac death showed no significant difference. Conclusions: CKD is a robust independent risk factor for CIN and long-term bleeding in patients undergoing RA. However, comparable clinical efficacy outcomes suggest that RA remains a feasible strategy in CKD patients when early complications are carefully managed with contrast-minimizing strategies.

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08-0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50-0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27-0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39-0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60-0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53-84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14-5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04-1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08-1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support.

Gamma Knife radiosurgery (GKRS) is a widely accepted and precise treatment modality for brain neoplasms, and it primarily relies on accurate magnetic resonance imaging (MRI) for lesion localization.However, standard MRI techniques pose significant challenges in patients with severe cervical spine immobility.Here, we describe a case involving a 79-year-old patient with newly diagnosed lung cancer who presented with three metastatic brain lesions requiring GKRS.Because of severe neck stiffness caused by ankylosing spondylitis, the patient's head could not be adequately positioned within the MRI head coil, compromising image quality and localization precision.To address this limitation, computed tomography (CT) imaging was performed after MRI, and the magnetic resonance (MR)/ CT datasets were fused using GammaPlan software.Comparative analysis between MR-only imaging and MR/CT fusion imaging demonstrated notable improvements in lesion delineation accuracy based on the fused dataset, allowing more precise radiosurgical targeting.This case highlights the clinical utility and necessity of MR/CT fusion imaging to achieve accurate lesion targeting and treatment efficacy in patients with substantial cervical spine mobility restrictions.

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.

Abstract Background: Real-time artificial intelligence-based computer-aided detection/diagnosis (AI-CAD) for breast ultrasound enables immediate assessment of suspicious lesions with probability of malignancy (POM) outputs, potentially aiding in the differentiation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). Identifying ultrasonographic features with significant POM differences between DCIS and IDC may refine clinical triage. Methods: We retrospectively analyzed 34 cases (DCIS=12, IDC=22) assessed by a real-time AI solution (CadAI-B for Breast cancer) during breast ultrasound at a tertiary center. POM outputs and BI-RADS categorization were compared across ultrasonographic features including shape, margin, echo pattern, and orientation. Features demonstrating significant POM differences between DCIS and IDC were identified, and comparative analyses were performed to evaluate CadAI-B’s differential diagnostic utility. Results: Overall, IDC demonstrated a higher mean POM (0.365 ± 0.306) compared to DCIS (0.126 ± 0.196, p&amp;lt;0.001). Ultrasonographic features with significant POM differences included irregular shape (IDC: 0.344 vs DCIS: 0.135, p=0.002), indistinct margins (IDC: 0.318 vs DCIS: 0.012, p=0.014), microlobulated margins (IDC: 0.419 vs DCIS: 0.132, p=0.031), hypoechoic pattern (IDC: 0.345 vs DCIS: 0.135, p=0.018), and parallel orientation (IDC: 0.362 vs DCIS: 0.044, p=0.003). These features were associated with larger POM differentials between IDC and DCIS, suggesting enhanced discrimination capacity. Under CadAI-B, IDC cases were more frequently categorized into higher BI-RADS categories, with IDC cases showing a substantial shift towards BI-RADS 4B, 4C, and 5 with high POM outputs. Notably, DCIS cases retained lower POM even when categorized into BI-RADS 4A and 4B. Conclusions: CadAI-B may help distinguish IDC from DCIS during real-time breast ultrasound examinations by reflecting differences in probability of malignancy. This may assist clinical decision-making during scanning by providing consistent, objective data when evaluating suspicious breast lesions. Further studies are needed to confirm its diagnostic value in broader clinical settings. Citation Format: J. Moon, J. Lee, B. Kang, W. Kim, J. Kim, J. Baek, H. Park, H. Kim, G. Baek. Using a Real-Time Artificial Intelligence Ultrasound System with Computer-Aided Detection and Diagnosis to Distinguish Ductal Carcinoma In Situ and Invasive Ductal Carcinoma [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-04-09.