Asan 医疗中心

Cervical myelopathy with rigid kyphosis often requires multilevel decompression and realignment. Although 540° surgery—posterior decompression with screw fixation, anterior decompression and fusion, and posterior rod connection—can achieve adequate neural decompression and sagittal correction, it involves substantial surgical burden. This study compared vertebral body sliding osteotomy (VBSO), an anterior-based technique, with 540° surgery for multilevel cervical myelopathy with rigid kyphosis. A retrospective cohort of 57 patients treated between 2015 and 2022 was analyzed, including 38 who underwent VBSO and 19 who underwent 540° surgery. All patients required fusion across three or more levels and had a minimum of two years of follow-up. Selective ACDF was added to VBSO when pathology extended across disc spaces. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck pain. Radiological parameters included C2–7 lordosis, segmental lordosis, and canal occupying ratio. Operative time, estimated blood loss (EBL), and complications were also evaluated. Improvements in JOA, NDI, and neck pain VAS were comparable between groups (all p > 0.05). Postoperative C2–7 lordosis was similarly restored, and complication rates showed no significant differences. VBSO demonstrated a markedly shorter operative time (262.1 vs. 440.4 minutes, p < 0.001) and lower EBL (100.4 vs. 272.2 mL, p < 0.001). VBSO achieved clinical and radiological improvement with reduced surgical burden relative to 540° surgery. These findings suggest that VBSO may be considered a reasonable and efficient alternative for treating cervical myelopathy with rigid kyphosis.

To prospectively evaluate positional variability in quantitative CT (qCT)-derived measurements of interstitial lung abnormality (ILA) using the same-day supine and prone CT. In this prospective study (February 2024–February 2025), participants with ILA underwent sequential non-contrast supine and prone CT scans using identical acquisition parameters. A commercially available deep learning-based software quantified fibrotic (reticulation and honeycombing) and nonfibrotic (ground-glass opacity) ILA components in accordance with Fleischner Society definitions. qCT differences between supine and prone measurements were assessed using paired t tests, Bland–Altman analysis with 95

PURPOSE:To develop the REporting checklist for FoundatIon and large laNguagE models (REFINE), an international reporting guideline for transparent and reproducible reporting of foundation model (FM) and large language model (LLM) studies in medical research, including imaging artificial intelligence (AI) applications. METHODS:The protocol was prespecified and publicly archived. A modified Delphi process was conducted to establish reporting standards for unimodal and multimodal FM and LLM applications involving text, imaging, and structured data. The steering committee coordinated protocol development, expert recruitment, all Delphi rounds, and the harmonization phase. Decisions were made based on predefined consensus thresholds. In Rounds 1 and 2, structured ratings and free-text feedback informed iterative revisions. In the post-Delphi harmonization phase, terminology was standardized, and detailed reporting instructions were finalized. RESULTS:The REFINE development group comprised 57 contributors from 17 countries, and 54 panelists from 16 countries completed Rounds 1 and 2. The harmonization phase was completed by three expert panelists and the steering committee. The entire process produced a 44-item, six-section framework with standardized terminology and detailed reporting instructions, supported by an online platform for practical use (https://refinechecklist.github.io/refine/checklist.html). CONCLUSION:The REFINE provides a comprehensive, consensus-based reporting standard for medical FM and LLM research, including imaging AI studies. The online version facilitates practical implementation. CLINICAL SIGNIFICANCE:The REFINE enables transparent, comparable, and reproducible reporting of FM and LLM studies, supporting reliable evidence synthesis in medical and imaging-focused AI studies.

BACKGROUND:The timing of surgery in asymptomatic severe mitral regurgitation remains controversial. This observational study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation. METHODS:From 1996 to 2016, a total of 1063 consecutive asymptomatic patients (673 men; mean±SD age, 51±14 years) with severe degenerative mitral regurgitation and preserved left ventricular function were enrolled, and followed prospectively for a median of 12 years (interquartile range, 8-17 years). Early surgery was performed on 545 patients and the conventional treatment strategy was chosen for 518 patients. We compared overall and cardiac mortality rates between these 2 treatment strategies using propensity score adjustment. RESULTS:In the early surgery group, no operative deaths occurred, and mitral valve repair was successfully performed in 97% of patients. During follow-up, 8 (1.5%) patients in the early surgery group and 54 (10.4%) in the conventional management group died from cardiovascular causes (hazard ratio, 0.17 [95% CI, 0.07-0.40]; P<0.001). A total of 74 (13.6%) deaths from any cause occurred in the early surgery group, whereas 116 (22.4%) occurred in the conventional management group (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.046). For the 358 propensity score matched pairs, the early surgery group had a significantly lower risk of cardiac mortality than the conventional treatment group (hazard ratio, 0.18 [95% CI, 0.08-0.43]; P<0.001) and significantly lower cardiac mortality rates (5.6% versus 17.4% at 20 years; P=0.002). Compared with the conventional treatment group, the early surgery group also had a significantly lower risk of overall mortality (hazard ratio, 0.66 [95% CI, 0.47-0.93]; P=0.018) and significantly lower overall mortality rates (28.2% versus 33.9% at 20 years; P=0.015). CONCLUSIONS:Compared with conventional management, early surgery is associated with better long-term outcomes among asymptomatic patients with severe mitral regurgitation and preserved left ventricular function. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01703806.

BACKGROUND AND AIMS:The 2024 European Society of Cardiology (ESC) guidelines introduced 'elevated blood pressure' [systolic blood pressure (SBP) 120-139 mmHg or diastolic blood pressure (DBP) 70-89 mmHg] as a new category positioned between non-elevated blood pressure (BP) and hypertension. The dementia risk associated with this reclassification remains unclear. METHODS:A nationwide Korean cohort of 2.8 million adults aged ≥40 years who underwent health screening in 2009 was analysed. Participants with prior dementia or dementia diagnosed within 1 year after cohort entry were excluded. Blood pressure was classified as non-elevated BP, elevated BP, or hypertension according to the 2024 ESC definitions. Incident dementia-including Alzheimer's disease (AD) dementia, vascular dementia (VaD), and all-cause dementia-was tracked until 2018. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS:During a mean follow-up of 8.1 years, 121 223 dementia cases occurred. Compared with the non-elevated BP group, dementia risk was modestly increased in the elevated BP group [aHR 1.016; 95% confidence interval (CI) 0.996-1.037] and significantly higher in the hypertension group (aHR 1.029; 95% CI 1.006-1.051). The associations were particularly pronounced for VaD (elevated BP: aHR 1.159; hypertension: aHR 1.372), whereas they were not significant for AD dementia. These associations were more pronounced among midlife adults and women. CONCLUSIONS:Based on the 2024 ESC BP classification, both elevated BP and hypertension were associated with an increased risk of dementia, especially VaD. These findings support the clinical relevance of 2024 ESC criteria and highlight midlife adults and women as potential priority targets for early BP management to preserve cognitive health.