Uijeongbu St. Mary's Hospital

Survival outcomes for infants born at 22–23 weeks’ gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22–23 weeks’ gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care—including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration—was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49–0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22–23 weeks’ gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28428-1.

Objective: In this systematic review and meta-analysis, we aimed to evaluate the effectiveness of backward walking training (BWT) in improving balance and mobility in older adults.Design: Systematic review and meta-analysis.Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library CENTRAL databases for articles published between January 2010 and July 2025.Randomized controlled trials (RCTs) involving adults aged 60 years who underwent BWT were included.The primary outcome was balance ability assessed using the Berg Balance Scale (BBS).Exclusion criteria were non-English language articles, inaccessible full texts, and non-RCT designs.Two independent reviewers screened the articles and assessed risk of bias using the Cochrane tool.Meta-analyses were performed using Review Manager (RevMan) 5.4 with a random-effects model.Heterogeneity was assessed using 2 and I statistics.Results: Five RCTs with 208 participants were included.Three studies reported BBS-based outcomes, showing a significant overall mean difference of 4.75 points (95% confidence interval (CI): 1.48-8.02;Z = 2.85, p = 0.004).Individual effects included improvements ranging from approximately 1.7 to 7.0 points.However, heterogeneity was high (I = 97%), and the pooled estimate should be interpreted cautiously.Conclusions: BWT significantly improved balance and may be considered a useful intervention to enhance balance and functional mobility in older adults.

PurposeSingle-incision laparoscopic totally extraperitoneal hernia repair (SILTEP) is a minimally invasive technique for inguinal hernia that promotes faster recovery. Advanced bipolar (AB) energy devices have recently emerged, offering several benefits in surgical outcomes. This study aimed to compare AB and conventional monopolar (CM) energy devices to assess their impact on surgical outcomes in SILTEP and to evaluate the necessity of using AB devices.MethodsA retrospective comparative analysis was conducted involving 304 patients who underwent SILTEP, divided into the CM and AB groups based on the energy device used. Patient characteristics, operative details, and postoperative outcomes were compared between the groups.ResultsThe AB group exhibited longer operation times but similar morbidity rates compared to the CM group (53.5 ± 21.0 minutes vs. 42.9 ± 14.5 minutes, P < 0.001; 8.1% vs. 11.2%, P = 0.618). There was a significant difference in intraoperative blood loss (CM group: 7.2 ± 4.1 mL vs. AB group: 3.3 ± 5.0 mL, P < 0.001). Although statistically non-significant, a lower trend of seroma formation was observed in the AB group than in the CM group (7.4% vs. 10.7%). Similar early postoperative pain scores were observed in both groups of patients using patient-controlled analgesia; no significant differences in chronic pain were observed between the groups.ConclusionAB energy devices may offer advantages for SILTEP, including reduced intraoperative blood loss. AB energy devices may be useful and viable options for SILTEP. Further prospective studies are warranted to validate these findings.

The long-term prognosis of immune tolerant (IT) phase patients remains unclear. This study aimed to identify true IT-phase patients with favourable outcomes and distinguish grey-zone IT patients. We retrospectively analysed 1064 chronic hepatitis B (CHB) patients (516 clinically inclusive IT, 548 antiviral-treated immune active [AVT-IA]). Clinically inclusive IT-phase was defined as HBeAg-positive, no cirrhosis, HBV DNA ≥ 10^6 IU/mL, and ALT < 80 U/L. Favourable prognosis was defined as the absence of HCC development and IA progression during follow-up. IT-phase patients had significantly lower 10-year HCC rates compared to AVT-IA patients (1.7% vs. 2.7%). Among the clinically inclusive IT group, favourable prognosis was associated with younger age (< 35 years), female gender, stringent low ALT (< 35 U/L for males, < 25 U/L for females), high HBV DNA (> 10^8 IU/mL), and no family history of HCC. Patients meeting these criteria showed no HCC cases and had a lower likelihood of progression to IA (~50%) within 10 years. The strict criteria demonstrated 90.3% specificity for identifying true IT-phase patients within the clinically inclusive IT group. Family history of HCC was an independent risk factor for HCC development (HR 6.059, p = 0.019), while stringent low ALT, younger age, and female gender were linked to lower IA progression risk (HR 0.32, p ≤ 0.001). This study highlights the importance of applying strict criteria in distinguishing true IT-phase patients from grey-zone patients. True IT patients are at minimal risk of HCC or progression to IA, while identifying grey-zone patients is crucial, as they may require early antiviral therapy.

Cerebral fat embolism (CFE) is a rare but severe complication of trauma, most often linked to long bone or pelvic fractures. We report a 71-year-old woman who developed severe CFE after a pelvic fracture, resulting in profound coma despite early supportive treatment. Brain MRI showed the characteristic “starfield” pattern confirming the diagnosis. A systematic literature review identified 12 cases of severe CFE (Glasgow Coma Scale [GCS] ≤9) reported since 2010, including the present case. Initial GCS ranged from 3 to 9, with lower scores generally predicting poorer outcomes. Although some patients recovered after deep coma, no consistent prognostic factor—such as GCS score, corticosteroid therapy, or timing of orthopedic surgery—was identified. However, early diagnosis, aggressive supportive management, and timely fracture fixation were repeatedly emphasized as essential to improving outcomes. Multidisciplinary care involving neurologists, intensivists, and orthopedic surgeons was critical. Severe CFE remains an uncommon but often devastating condition with high morbidity. Prognosis is variable but tends to correlate with initial neurological status. Greater awareness and early intervention may enhance survival and neurological recovery, while further studies are needed to clarify prognostic determinants and establish standardized management strategies.

Data on long-term prognostic factors in patients with cancer-related stroke are limited. The purpose of this study was to evaluate long-term outcomes and investigate prognostic factors of cancer-related stroke using a linked data set. Between January 2008 and December 2014, patients with cancer-related stroke (n=690) were included in a linked data set comprising the Health Insurance Review and Assessment Service claims database and the Clinical Research Center for Stroke registry data. Outcomes were long-term mortality, major bleeding including intracerebral hemorrhage and gastrointestinal bleeding, and recurrent ischemic stroke after ischemic stroke. Clinical factors related to outcomes after ischemic stroke, including vascular risk factors, acute stroke management, and types of cancer, were evaluated. Of the 690 patients with cancer-related stroke (mean age, 68.5 years and 61.7% male) during a median 1.7 year period, 401 (58.1%) patients died during follow-up duration. Multivariate Cox regression analysis revealed that old age (hazard ratio [HR], 1.30 per 10 years [95% CI, 1.17-1.45]), stroke severity (HR, 1.05 [95% CI, 1.03-1.06]), anticoagulation at discharge (HR, 1.67 [95% CI, 1.02-2.74]), and types of cancer, such as pancreatic (HR, 3.73 [95% CI, 2.70-5.16]), hepatobiliary (HR, 2.31 [95% CI, 1.78-3.00]), and lung cancers (HR, 1.73 [95% CI, 1.33-2.25]), were significantly associated with long-term mortality. Major bleeding occurred in 42 patients (6.1%), and recurrent ischemic stroke was observed in 89 patients (12.9%) during the follow-up period. Long-term outcomes of cancer-related stroke are poor. Treatment at discharge and cancer type are crucial factors associated with long-term mortality.

Heart failure (HF) is a major global health burden. Building on 2 previous national registries, the Korean Heart Failure III (KorHF III) registry provides a contemporary evaluation of clinical characteristics, treatment patterns, and outcomes in patients hospitalized with acute HF (AHF) in Korea. KorHF III prospectively enrolled 7351 patients with AHF from 47 tertiary hospitals between March 2018 and December 2022, with a 2-year follow-up. HF with reduced ejection fraction accounted for 57.3% of all cases. Common comorbidities included hypertension (59.5%) and diabetes (40.0%). The most frequent etiologies were ischemic heart disease (27.7%) and dilated cardiomyopathy (24.9%). At discharge, 74.3% of patients received angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; 68.5% received beta-blockers; and 57.4% received mineralocorticoid receptor antagonists. Prescriptions of sodium-glucose cotransporter 2 inhibitor were 15.8%. In-hospital mortality was 2.2%, and 2-year mortality was 20.9%, greatest among patients with HF with preserved ejection fraction (24.6%). Hyponatremia was independently associated with in-hospital (hazard ratio 2.50, P < .001) and postdischarge mortality (HR 1.72, P < .001). KorHF III provides the most comprehensive and current assessment of AHF in Korea. Despite high prescription rates of guideline-directed medical therapy and low in-hospital mortality, long-term mortality is substantial. These findings emphasize the need for improved postdischarge care and highlight hyponatremia as a key prognostic factor in AHF management.

6501 Background: ASC, the first BCR::ABL1 inhibitor to Specifically Target the ABL Myristoyl Pocket, recently received FDA Accelerated Approval for newly diagnosed CML-CP based on major molecular response (MMR) rates in the ASC4FIRST trial (NCT04971226). We present results from ASC4START (NCT05456191), with the primary objective of assessing the tolerability of ASC vs second-generation tyrosine kinase inhibitor NIL in patients (pts) with newly diagnosed CML-CP. Methods: Adults were randomized 1:1 to receive ASC 80 mg once daily or NIL 300 mg twice daily, stratified by ELTS risk category. The primary endpoint is TTDAE. Events included AEs leading to treatment (tx) discontinuation and deaths due to AEs. Secondary endpoints include molecular response and safety. Results: Pts were recruited by 120 participating sites across 24 countries and randomized to ASC (n=284) or NIL (n=284). Two pts who did not receive NIL were excluded from safety analyses. Median follow-up was 9.7 mo. At cutoff (Sep 3, 2024), 10.9% and 17.3% of pts discontinued ASC and NIL, respectively, most commonly due AEs (4.9% vs 11.6%) and unsatisfactory therapeutic effect (2.5% vs 2.8%). The study met its primary endpoint, showing statistically significant difference in TTDAE in favor of ASC with a cause-specific hazard ratio of 0.45 (95% CI, 0.25-0.81; P =.004). Fewer pts discontinued due to AEs with ASC (16/284 [5.6%]) vs NIL (34/282 [12.1%]). There were 3 deaths on study due to AEs (ASC: cardiac arrest and suicide, n=1 each; NIL: cardiac arrest, n=1). Median duration of exposure was 39.1 wk with ASC vs 38.0 wk with NIL. Mean relative dose intensity was 94.8% vs 92.6%, respectively. Any-grade AEs occurred in 80.3% of pts with ASC vs 86.5% with NIL. Grade ≥3 AEs occurred in 25.0% and 31.9% of pts, respectively. AEs leading to dose adjustment/interruption occurred in 24.3% of pts with ASC vs 30.1% with NIL. Most frequent any-grade AEs (≥10%) with ASC vs NIL were thrombocytopenia (15.1% vs 13.8%), headache (10.2% vs 13.1%), myalgia (10.2% vs 8.2%), rash (8.5% vs 16.3%) and increased alanine aminotransferase (3.2% vs 12.4%). AEs of special interest included arterial occlusive events (0.7% vs 2.1%), acute pancreatitis (clinical events; 0.4% vs 2.5%), and hepatotoxicity (including laboratory terms; 8.1% vs 24.8%). BCR::ABL1 IS ≤10% (89.8% vs 82.0%), BCR::ABL1 IS ≤1% (69.0% vs 52.5%), MMR (22.9% vs 10.2%), MR 4 (4.6% vs 1.1%), and MR 4.5 (2.5% vs 0.4%) rates by wk 12 were higher with ASC vs NIL. Conclusions: The study met the primary endpoint with ASC showing significantly superior tolerability vs NIL based on TTDAE. The study is ongoing with additional analyses planned for tolerability and efficacy. The findings further support the potential for ASC to be a preferred therapy for newly diagnosed CML-CP, allowing more pts to meet tx goals without requiring tx switch. Clinical trial information: NCT05456191 .

Abstract Purpose The use of fixation and arthroplasty in treating elderly patients with nondisplaced femoral neck fracture (FNF) remains controversial. The femoral neck system (FNS) is known to have relatively stronger axial and rotational stability compared with cancellous screw fixation. This study aimed to evaluate how effective internal fixation using a FNS is for non-displaced FNF in elderly patients. Methods All patients with nondisplaced (Garden I and II) FNF between July 2019 and November 2023 were eligible for osteosynthesis surgery at three institutions. Ninety-five patients (50 under 75 years of age and 45 over 75 years of age) who were treated with FNS with a follow-up period of more than 1 year were included. Clinical data (age, sex, direction, body mass index, injury mechanism, bone mineral density (BMD), and time to operation) were extracted from patient records. Institutional imaging software was used for radiographic analysis to evaluate surgical site complications at 1 year. Multivariate logistic regression analysis was performed to identify independent risk factors for reoperation. Results The mean age of the younger group was 61.0 years, whereas that of the elderly group was 81.2 years. No significant differences were observed between the two groups except for BMD and time to operation. Three reoperations were observed in the younger group (6%), and four cases were observed in the elderly group (8.9%) (p = 0.894), and no significant difference in other surgical complications was observed between the two groups. BMD was identified as an independent risk factor for reoperation. Conclusion FNS may be used as an alternative to elderly and younger patients with nondisplaced FNFs. However, the reoperation rate may increase in severe osteoporosis patients with very low hip BMD.

Abstract Extended treatment is recommended for patients with pulmonary tuberculosis (TB) and cavitary lesions or positive culture at 2 months, but evidence remains limited. A retrospective analysis across 18 Korean institutions compared recurrence between standard (≤ 200 days) and extended treatment (&gt; 200 days) in patients with drug-susceptible TB and cavitary lesions on chest radiography or positive sputum cultures at 2 months. Among 173 patients, 65 (37.6%) received standard and 108 (62.4%) extended treatment. Recurrence rates were similar (3.1% vs. 1.9%, p = 0.60), even after propensity score matching (4.7% vs. 2.3%, p = 0.56). Logistic regression analysis of all 854 patients with drug-susceptible TB with treatment success revealed chronic lung disease (OR 6.49, CI: 2.21–19.10, p &lt; 0.01) and medication interruption exceeding 7 days (OR 4.43, CI: 1.63–12.03, p &lt; 0.01) as significant predictors of recurrence. Positive culture at 2 months (OR 0.85, CI: 0.11–6.87, p = 0.88), cavitary lesions (OR 0.94, CI: 0.31–2.83, p = 0.91), either factors (OR 0.98, CI: 0.39–2.47, p = 0.99), and extended treatment (OR 1.17, CI: 0.49–2.81, p = 0.72) were not significant. Extended treatment did not reduce recurrence in patients with drug-susceptible TB and cavitary lesion or positive culture at 2 months.