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The Social Security Information Service, a central government agency of South Korea, has implemented an information system using ML algorithms to identify social welfare blind spots. Social welfare blind spots refer to cases where individuals are eligible for social welfare benefits but are not current recipients for various reasons. Even though the ML-based model was performing well, the Korean government developed two additional methods, including a rule-based model and a human-driven heuristic method championed by local governments. This case study investigates why the ML-based method coexists with the other two methods and how they complement one another. We found that policymakers’ lack of understanding of ML, local government employees’ perception, and accountability concerns contributed to their coexistence. The three methods had different strengths and weaknesses. The government agencies orchestrated these methods to increase complementarities by leveraging and strengthening different problem-solving approaches. [ABSTRACT FROM AUTHOR]

An introduction for this special issue on digital technology and social justice is presented with an intention of including articles from diverse locations. There are articles from many areas of the world including the Global South, Nigeria and Germany. Topics include refugee aid, workers impacted by export of electronic waste, and hate speech.

Objective: This study aimed to compare laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS) for early gastric cancer (EGC) in terms of 5-year long-term oncologic outcomes. Background: The oncological safety of LSNNS for EGC has not been confirmed. Three-year disease-free survival (DFS), which is the primary endpoint of phase III multicenter randomized controlled clinical trial [SEntinel Node ORIented Tailored Approach (SENORITA) trial], did not show the noninferiority of LSNNS relative to LSG. Methods: The SENORITA trial, a multicenter randomized clinical trial, was designed to show that LSNNS is noninferior to LSG in terms of 3-year DFS. In the present study, we collected 5-year follow-up data from 527 patients recruited in the SENORITA trial as the full analysis set. DFS, overall survival (OS), disease-specific survival (DSS), and recurrence patterns were evaluated using the full analysis set of both LSG (n=269) and LSNNS (n=258). Results: The 5-year DFS was not significantly different between the LSG and LSNNS groups (P =0.0561). During the 5-year follow-up, gastric cancer–related events, such as metachronous cancer, were more frequent in the LSNNS group than in the LSG group. However, 10 recurrent cancers in the remnant stomach of both groups were curatively resected by additional gastrectomy and 1 by additional endoscopic resection. Two of the 198 patients who underwent local resection for stomach preservation based on the LSNNS results developed distant metastasis. However, there was no statistically significant difference in the 5-year OS and DSS (P =0.7403 and P =0.9586, respectively) between the two groups. Conclusions: The 5-year DFS, DSS, and OS did not differ significantly between the two groups. Considering the benefits of LSNNS on postoperative quality of life, LSNNS could be recommended as an alternative treatment option for EGC. [ABSTRACT FROM AUTHOR]

Recently developed artificial intelligence–based coronary angiography (AI-QCA, fully automated) provides real-time, objective, and reproducible quantitative analysis of coronary angiography without requiring additional time or labor. This study aimed to evaluate the efficacy of AI-QCA–assisted percutaneous coronary intervention (PCI) compared to optical coherence tomography (OCT)-guided PCI in terms of post-PCI results. This trial enrolled 400 patients with significant coronary artery disease undergoing PCI from 13 participating centers in South Korea. Patients were randomized in a 1:1 ratio to either AI-QCA–assisted or OCT-guided PCI. The primary endpoint was the post-PCI minimal stent area (MSA) assessed by OCT. The noninferiority of AI-QCA–assisted PCI to OCT-guided PCI regarding the post-PCI MSA was tested with a noninferiority margin of 0.8 mm2. A total of 395 patients (199 in the AI-QCA group and 196 in the OCT group) were included in the primary endpoint analysis. The post-PCI MSA was 6.3 ± 2.2 mm2 in the AI-QCA group and 6.2 ± 2.2 mm2 in the OCT group (difference, −0.16; 95% CI: −0.59 to 0.28; P for noninferiority < 0.001). Other OCT-defined endpoints, such as stent underexpansion (50.8% [101/199] vs 54.6% [107/196]; P = 0.48), dissection (15.6% [31/199] vs 12.8% [25/196]; P = 0.42), and untreated reference segment disease (15.1% [30/199] vs 13.3% [26/196]; P = 0.61), were not significantly different between groups, except for a higher incidence of stent malapposition in the AI-QCA group (13.6% [27/199] vs 5.6 [11/196]; P = 0.007). This study demonstrated the noninferiority of AI-QCA–assisted PCI to OCT-guided PCI in achieving MSA with comparable OCT-defined endpoints. (Fully Automated Quantitative Coronary Angiography Versus Optical Coherence Tomography Guidance for Coronary Stent Implantation [FLASH]; NCT05388357) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Syndesmotic impingement syndrome has been described to explain persistent lateral or anterolateral ankle pain. This condition is thought to often result from a rotational ankle injury. This study aimed to identify the type of syndesmotic impingement tissue according to arthroscopic and histologic findings and to analyze its association with lateral talar cartilage lesions. Methods: This retrospective study included 107 ankles in 105 patients who underwent arthroscopic surgery for syndesmotic impingement syndrome from January 2017 to August 2019. Histologic findings of biopsied impingement tissue were obtained in 59 ankles (55.1%) and compared with gross findings on arthroscopy. Cartilage lesions were evaluated using the International Cartilage Repair Society grading system. Risk factors associated with lateral talar cartilage injury were evaluated using multivariate logistic regression analysis. Results: Based on the histologic results, the most common pathology was fibrosis (24 ankles [22.4%]), followed by fatty degeneration (23 ankles [21.5%]), synovial hyperplasia (8 ankles [7.5%]), and inflammatory synovium (4 ankles [3.7%]). Interclass correlation coefficient was 0.841 (P =.001) between histologic results and arthroscopic findings. Patients with fibrotic impingement tissue had on average a significantly longer duration of symptoms (12 vs 48 months, P =.021). A lateral talar dome cartilage lesion was detected in 25 ankles (23.4%). Fibrotic impingement tissue was the only factor significantly associated with lateral talar dome lesion on multivariate logistic regression analysis (odds ratio 10.04; 95% CI 1.84-54.9; P =.008) Conclusion: Syndesmotic impingement with fibrotic tissue was often associated with cartilage lesions at the lateral talar dome. Patients with prolonged anterolateral or lateral ankle pain after a rotational ankle injury warrant careful assessment for possible syndesmotic impingement by fibrotic tissue and associated lateral talar cartilage injury. [ABSTRACT FROM AUTHOR]

To determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG). A cohort study was conducted between January 2006 and December 2019, with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27, 2023. A single tertiary center in Korea. Patients who underwent preoperative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG. None. The primary outcome was the incidence of MACCEs within 30 days of CABG. MACCEs included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. Secondary outcomes included each component of MACCEs and all-cause mortality at 5 years after surgery. Of the 2,476 study patients (median [interquartile range] age: 65 [58-71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCEs after CABG. After performing 1:4 propensity-score matching, 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCEs within 30 days was not significantly different between patients with covert brain infarction and those without (15.1% [32/212] v 15.6% [132/845]; risk difference: –0.5, 95% confidence interval: –5.6 to 4.4; risk ratio: 0.97, 95% confidence interval: 0.66 to 1.32, p = 0. 85). There were also no significant differences in each component of MACCEs within 30 days. There was no significant difference between the two groups regarding all-cause mortality at 5 years (18.7% v 17.0%, respectively, p for stratified log-rank test = 0.33). Among patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG. [ABSTRACT FROM AUTHOR]

This study evaluated the performances of the age, creatinine, and ejection fraction (ACEF) I and II scores and compare them with that of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II score in patients who underwent isolated off-pump coronary artery bypass grafting (OPCABG). Additionally, this study was designed to externally validate the performance of the updated ACEF II score. Retrospective observational study. A total of 936 patients who underwent OPCABG between January 1, 2013, and December 31, 2022, at a tertiary teaching center were included. None. Predicted operative mortality was calculated using a risk score model. The predictive performance of each score was evaluated using receiver operating characteristic curves and calibration plots. The ACEF II score demonstrated the highest C-statistic (area under the curve = 0.831, 95% confidence interval: 0.691-0.971), while the C-statistics for ACEF I, updated ACEF II, and EuroSCORE II were 0.793 (0.645-0.940), 0.698 (0.524-0.872), and 0.780 (0.606-0.954), respectively. The ACEF II score exhibited significantly better discriminative performance than the updated ACEF II score (p = 0.010); however, no significant differences were observed compared with the ACEF I and EuroSCORE II scores (p = 0.118 and 0.354, respectively). ACEF I and II scores are reliable risk stratification models with performances comparable to the EuroSCORE II score in patients undergoing isolated OPCABG. However, the updated ACEF II score failed to demonstrate improved performance. [ABSTRACT FROM AUTHOR]

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Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor originating from neural crest cells. Histologically resembling malignant melanoma but lacking cutaneous precursor lesions, CCS is characterized by a specific chromosomal translocation (t[12;22][q13;q12]). Primarily affecting young adults, this tumor typically arises in the extremities, especially the knee, foot, and ankle. To our knowledge, distal toe involvement is uncommon. Herein, we present a case initially diagnosed on magnetic resonance imaging as a superficial soft tissue tumor resembling malignant melanoma but subsequently confirmed as CCS of the great toe. [ABSTRACT FROM AUTHOR]

In the rapidly evolving healthcare environment, radiologists strive to establish their rightful place. Thus, there is a need for enhanced outpatient and clinical education within the Department of Radiology and exploration of its methodologies. Accordingly, the Korean Society of Radiology established a task force to investigate the clinical and outpatient practice status of radiologists overseas, current state of related education, involvement of other specialties in radiologic practices and education in Korea, and clinical and outpatient practice status among Korean radiologists. Furthermore, a survey on clinical competency enhancement was conducted among the members of the Korean Society of Radiology. These findings suggest the need for visibility and clinical competency enhancement in radiologists and methodologies for strengthening clinical competencies. [ABSTRACT FROM AUTHOR]

Local anesthetic infiltration at the surgical site has been studied in various surgical disciplines; however, its impact on deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously assessed. This study aimed to evaluate the effects of multiple intramuscular ropivacaine injections on donor site pain during DIEP flap breast reconstruction. The study included 65 patients who received local ropivacaine injections during DIEP reconstructions between March 2022 and February 2023, compared to 55 patients who underwent surgeries without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was evenly administered at 20 sites along the abdominal wall muscles. The effect of intramuscular ropivacaine injection on postoperative visual analog scale (VAS) was evaluated using linear mixed-effect model. Opioid consumption and hospital days were also compared. The daily median VAS score was lower in the ropivacaine group (all p-values < 0.001). When analyzed using a linear mixed-effects model, those who received ropivacaine had significantly lower VAS scores over the first 5 days postoperatively (p-value < 0.001). The rate of VAS score decline was also faster in the ropivacaine group over the first 24 h postoperative (p-value = 0.045). Although opioid consumption was comparable between the groups, those receiving ropivacaine had significantly shorter hospital stay (p-value = 0.001) and no complications related to the injections were observed. Multiple intramuscular injections of ropivacaine to the donor site may reduce postoperative pain and shorten hospital stays, without increasing opioid consumption. [ABSTRACT FROM AUTHOR]

Artificial intelligence-based quantitative coronary angiography (AI-QCA) has been developed to provide a more objective and reproducible data about the severity of coronary artery stenosis and the dimensions of the vessel for intervention in real-time, overcoming the limitations of significant inter- and intraobserver variability, and time-consuming nature of on-site QCA, without requiring extra time and effort. Compared with the subjective nature of visually estimated conventional CAG guidance, AI-QCA guidance provides a more practical and standardized angiography-based approach. Although the advantage of intravascular imaging-guided PCI is increasingly recognized, their broader adoption is limited by clinical and economic barriers in many catheterization laboratories. The FLASH (fully automated quantitative coronary angiography versus optical coherence tomography guidance for coronary stent implantation) trial is a randomized, investigator-initiated, multicenter, open-label, noninferiority trial comparing the AI-QCA-assisted PCI strategy with optical coherence tomography-guided PCI strategy in patients with significant coronary artery disease. All operators will utilize a novel, standardized AI-QCA software and PCI protocol in the AI-QCA-assisted group. A total of 400 patients will be randomized to either group at a 1:1 ratio. The primary endpoint is the minimal stent area (mm2), determined by the final OCT run after completion of PCI. Clinical follow-up and cost-effectiveness evaluations are planned at 1 month and 6 months for all patients enrolled in the study. Enrollment of a total of 400 patients from the 13 participating centers in South Korea will be completed in February 2024. Follow-up of the last enrolled patients will be completed in August 2024, and primary results will be available by late 2024. The FLASH is the first clinical trial to evaluate the feasibility of AI-QCA-assisted PCI, and will provide the clinical evidence on AI-QCA assistance in the field of coronary intervention. URL: https://www.clinicaltrials.gov. Unique identifier: NCT05388357. [Display omitted] [ABSTRACT FROM AUTHOR]

The extent of perfusion of a deep inferior epigastric artery perforator (DIEP) flap is a primary concern for surgeons. This study aimed to determine whether the flap area or volume can be estimated using perforator and flap characteristics. Intraoperative flap perfusion was assessed using indocyanine green angiography in patients who underwent DIEP flap breast reconstruction between November 2018 and February 2023. The area perfused by a single dominant perforator was delineated on the surface of the flap and measured using the ImageJ software. Multiple linear regression analysis was conducted to estimate the 'perfusion ratio,' defined as the perfused area divided by the total flap area. Potential predictor variables included flap size (cm2), flap thickness (mm), perforator diameter (mm), perforator rows (medial/lateral), vertical location of perforator (at or above/below the umbilicus), and perforator eccentricity (vertical distance from upper flap margin to perforator, cm). In total, 101 patients were included in this analysis. The mean 'perfusion ratio' was 67.8% ± 11.5%, predicted by perforator diameter (p = 0.022) and vertical location below umbilicus (p < 0.001) with positive correlations and negatively correlated with flap thickness (p = 0.003) in the multivariable analysis. Both perfusion area and weight were predicted by perforator diameter, vertical location of perforator, flap size, and flap thickness (p < 0.001). The coefficient of determination (adjusted R2) for prediction of perfusion weight was higher than that for the perfusion area (75.5% vs. 69.4%). Flap volume, rather than area, is determined by a perforator of a given diameter and location. [ABSTRACT FROM AUTHOR]

This study aims to assess the effectiveness of 5% dextrose (D5W) in comparison to corticosteroids for treating carpal tunnel syndrome (CTS). A comprehensive systematic search was conducted across MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials on November 13, 2023. These were supplemented by manual searches using Google Scholar. Two independent authors reviewed the literature, resolving any discrepancies through detailed discussions and consultation with a third author. Data on primary outcomes (pain assessment) and secondary outcomes (symptom severity and functional status using the Boston Carpal Tunnel Questionnaire, electrophysiologic measures, cross-sectional area, and adverse effects) were extracted independently by the 2 authors (M.W. and H.H.). The analysis included 4 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 212 patients (220 hands) with mild to moderate CTS. Within 3 months, the D5W injections showed a statistically significant improvement in functional status compared to the corticosteroids with a standard mean difference of −0.34 (95% CI, −0.62 to −0.05). D5W was associated with fewer adverse incidents than corticosteroids (risk ratio, 0.13; 95% CI: 0.03-0.51). No difference was observed between the 2 treatments in other areas. For patients with mild to moderate CTS, D5W injections were more effective than corticosteroid injections in improving functional status and demonstrated fewer adverse effects. D5W injections also paralleled corticosteroids in pain reduction, symptom severity, electrodiagnostic measures, and cross-sectional area of nerve, recommending D5W as a preferred treatment for mild to moderate CTS. [ABSTRACT FROM AUTHOR]

Antibiotic usage in early life has been proposed as a risk factor for inflammatory bowel disease, especially Crohn's disease. However, most studies were conducted in Western countries. We evaluated the association between antibiotic usage and the incidence of inflammatory bowel disease in the Asian population. This nationwide population-based retrospective cohort study included 2,941,889 South Korean infants born between 2007 and 2015, using the National Health Insurance Service database. We assessed whether antibiotic use was associated with the incidence of inflammatory bowel disease. Additionally, we conducted sensitivity analyses, considering protopathic bias and dietary variables. The Cox proportional hazards model was used. Among 2,941,889 infants, 2,566,390 (87 %) used antibiotics within a year after birth. Antibiotic usage within a year, number of antibiotic classes, and cumulative days of usage were shown to decrease the risk of ulcerative colitis. This association was particularly prominent with earlier antibiotic exposure. Penicillin was the only antibiotic class related to the reduced risk. The results were robust after adjusting for dietary variables and considering protopathic effect. Antibiotic exposure during the first year of life, particularly at a younger age, is linked to a reduced risk of early-onset ulcerative colitis in South Korea. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) risk persists in patients with chronic hepatitis B (CHB) despite antiviral therapy. The relationship between pre-treatment baseline hepatitis B virus (HBV) viral load and HCC risk during antiviral treatment remains uncertain. This multinational cohort study aimed to investigate the association between baseline HBV viral load and on-treatment HCC risk in 20,826 noncirrhotic, hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with baseline HBV DNA levels ≥2000 IU/mL (3.30 log 10 IU/mL) who initiated entecavir or tenofovir treatment. The primary outcome was on-treatment HCC incidence, stratified by baseline HBV viral load as a categorical variable. In total, 663 patients developed HCC over a median follow-up of 4.1 years, with an incidence rate of 0.81 per 100 person-years (95% confidence interval [CI], 0.75–0.87). Baseline HBV viral load was significantly associated with HCC risk in a non-linear parabolic pattern, independent of other factors. Patients with baseline viral load between 6.00 and 7.00 log 10 IU/mL had the highest on-treatment HCC risk (adjusted hazard ratio, 4.28; 95% CI, 2.15–8.52; P <.0001) compared with those with baseline viral load ≥8.00 log 10 IU/mL, who exhibited the lowest HCC risk. Baseline viral load showed a significant, non-linear, parabolic association with HCC risk during antiviral treatment in noncirrhotic patients with CHB. Early initiation of antiviral treatment based on HBV viral load may help prevent irreversible HCC risk accumulation in patients with CHB. [Display omitted] [ABSTRACT FROM AUTHOR]

Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG. The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease. This prespecified subgroup analysis compared the incidence of major adverse cardiac and cerebrovascular events (MACCE) according to sex, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years. Of 1,500 patients included in the FAME 3 trial, 265 (17.7%) were women. Women had a significantly higher risk of MACCE at 3 years compared with men after CABG (18.1% vs 11.7%; adjusted HR: 2.07; 95% CI: 1.19-3.60), whereas women had a similar risk of MACCE at 3 years compared with men after PCI (18.2% vs 19.1%; adjusted HR: 1.27; 95% CI: 0.79-2.03). Regarding treatment effects by sex, women undergoing PCI had a similar risk of MACCE at 3 years compared with CABG (adjusted HR: 1.15; 95% CI: 0.62-2.11). By contrast, men undergoing PCI had a higher risk of MACCE at 3 years compared with CABG (adjusted HR: 1.68; 95% CI: 1.25-2.25; P interaction = 0.142), which was mainly driven by a higher risk of myocardial infarction (adjusted HR: 2.11; 95% CI: 1.26-3.56; P interaction = 0.102) and repeat revascularization (adjusted HR: 2.26; 95% CI: 1.47-3.47; P interaction = 0.071). In the FAME 3 trial, at 3 years, women had similar outcomes with FFR-guided PCI compared with CABG, whereas men had improved outcomes with CABG. (A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease [FAME 3]; NCT02100722) [Display omitted] [ABSTRACT FROM AUTHOR]