Modified Rankin Scale disability status at day 4 poststroke is an informative predictor of long-term day 90 outcome.

BACKGROUND: Long-term disability after stroke is standardly assessed 3 months post-onset, using the modified Rankin Scale (mRS). The value of an early, day 4 mRS assessment for projecting the 3-month disability outcome has not been formally investigated. METHODS: In this cohort of patients with acute cerebral ischemia and intracranial hemorrhage, we analyzed day 4 and day 90 mRS assessments in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) Phase 3 trial. The performance of day 4 mRS, alone and as part of multivariate models, in predicting day 90 mRS was assessed using correlation coefficients, percent agreement, and the kappa statistics. RESULTS: Among the 1573 acute cerebrovascular disease (ACVD) patients, 1206 (76.7%) had acute cerebral ischemia (ACI), while 367 (23.3%) had intracranial hemorrhage. Among all 1573 ACVD patients, day 4 mRS and day 90 mRS correlated strongly, Spearman's rho=0.79, in unadjusted analysis with weighted kappa of 0.59. For dichotomized outcomes, simple carry-forward of the day 4 mRS performed fairly well in agreeing with day 90 mRS: mRS 0-1 (kappa=0.67), 85.4%; mRS 0-2 (k=0.59), 79.5%; fatal outcome, 88% (k=0.33). Correlations of 4d and 90d mRS were stronger for ACI than ICH patients, 0.76 vs 0.71. CONCLUSIONS: In this acute cerebrovascular disease patient cohort, assessment of global disability performed on day 4 is highly informative regarding long-term, 3-month mRS disability outcome, alone, and even more strongly in combination with baseline prognostic variables. The day 4 mRS is a useful measure for imputing the final patient disability outcome in clinical trials and quality improvement programs.

Study on Setting the Amount of Thickening Agent in Soup and Beverages as a Guide for Modifying the Viscosity of Dysphagia Diets

This study aimed to establish the optimal amount of thickening agent for the appropriate viscosity in soups and beverages, which are part of the dysphagia diet. The soups were bean sprout soup and soybean paste soup; the beverages were orange juice, regular milk, and low-fat milk; the thickening agent was one type of xanthan gum product. After adding the thickening agents (from 1 g to 5 g per 200 mL of the test food), syringe tests were conducted over time (5, 10 and 15 minutes) to verify the effects of the amount of thickening agent added per sample and the time between addition and achieving the resulting viscosity, and to establish the optimal addition conditions to reach IDDSI levels 1, 2, and 3 of the dysphagia diet. Water (based on 200 mL) was used as the standard control. These results provide a useful basis for customized diets based on the patient's dysphagia severity. On the other hand, this study is limited by including only liquid foods in the dysphagia diet and one type of xanthan gum-based thickening agent. Therefore, it is necessary to conduct continuous research, based on the study results, to modify the viscosity of the dysphagia diet using various thickening agents and foods and prevent nutritional deficiencies by managing the diet according to the patient's swallowing ability.

Diabetic Ketoacidosis Associated With Second Generation Antipsychotics: A Case Study and Review of Literature

Objective@#Second-generation antipsychotics (SGAs) have revolutionized the treatment of psychiatric disorders, but are associated with significant metabolic risks, including diabetes and hyperglycemic crises. This review explores the complex interplay between antipsychotics, diabetes, and hyperglycemic crises, highlighting the mechanisms underlying SGA-induced diabetes. @*Methods@#We present the case of a patient with schizophrenia who was taking antipsychotic medication and was admitted to the emergency room due to the sudden onset of diabetic ketoacidosis (DKA) without any history of diabetes. We extensively searched databases, including Elsevier, PubMed, IEEE, SpringerLink, and Google Scholar, for papers on the effects of antipsychotic drugs on DKA from 2002 to 2021. We focused on DKA, hyperglycemia, and atypical antipsychotics, and retrieved 117 papers. After full-text review, 32 papers were included in this comprehensive review. @*Results@#DKA was significantly more frequent in patients taking SGAs. Antipsychotics can induce insulin resistance either directly or through the onset of obesity. Antipsychotics can reduce insulin secretion from pancreatic β-cells, which is associated with absolute insulin deficiency. @*Conclusion@#As the use of antipsychotics continues to increase, understanding their risks and mechanisms is crucial for clinicians to enable informed treatment decisions and prevent potentially life-threatening complications.

Adverse Pregnancy and Child Outcomes in Oral Retinoid-Exposed Pregnancies: A Nationwide Population-Based Study

Background@#Oral retinoids are used to treat various dermatological conditions, and their use is increasing in women of childbearing age. However, there is limited knowledge on the incidence of adverse outcomes after retinoid exposure during pregnancy. We aimed to evaluate the risk of adverse outcomes associated with oral retinoid exposure during pregnancy. @*Methods@#We conducted a retrospective cohort study using the NHIS mother-child linked healthcare database in South Korea. We included all women who gave live birth from April 1, 2009 to December 31, 2020 and their children. The exposure was defined as having ≥ 1 prescription of isotretinoin, alitretinoin, and acitretin from one month before pregnancy to the delivery. The outcomes of interest were adverse child outcomes including major congenital malformations, low birth weight, and neurodevelopmental disorders (autism spectrum disorder and intellectual disorder), and adverse pregnancy outcomes including gestational diabetes mellitus, preeclampsia, and postpartum hemorrhage. Propensity score-based matching weights were used to control for various potential confounders. For congenital malformation, low birth weight, and adverse pregnancy outcomes, we calculated relative risk (RR) with 95% confidence interval (CI) using a generalized linear model and for neurodevelopmental disorders, we estimated hazard ratio (HR) with 95% CI using the Cox proportional hazard model. @*Results@#Of 3,894,184 pregnancies, we identified 720 pregnancies (0.02%) as the oral retinoid-exposed group. The incidence of major congenital malformation was 400.6 per 10,000 births for oral retinoid-exposed group and 357.9 per 10,000 births for unexposed group and the weighted RR was 1.10 (95% CI, 0.65–1.85) in oral retinoid-exposed group compared with unexposed group. The neurodevelopmental disorder showed a potential increased risk, with the weighted HR of 1.63 (95% CI, 0.60–4.41) for autism spectrum disorder and 1.71 (95% CI, 0.60–4.93) for the intellectual disorder, although it did not reach statistical significance. For low birth weight and adverse pregnancy outcomes, no association was observed with oral retinoid exposure during pregnancy. @*Conclusion@#This study found no significantly increased risk of congenital malformations, autism spectrum disorders, and intellectual disability associated with oral retinoid exposure during pregnancy; however, given the limitations such as including only the live births and increased point estimate, potential risk cannot be fully excluded.

Characteristics of patients with psoriatic arthritis in Korea: focusing on axial involvement

Background/Aims@#We aimed to clarify the clinical characteristics of psoriatic arthritis (PsA) in Korean patients focusing on PsA with axial involvement. @*Methods@#A retrospective medical chart review was performed to identify PsA patients at a single tertiary center. Cases of AS patients with psoriasis were recruited from a prospective AS registry of the same center. Demographics, laboratory findings, and radiologic characteristics were assessed. @*Results@#A total of 69 PsA patients were identified. In PsA patients, spondylitis (46.4%) was the most common form. Compared to AS patients with psoriasis, PsA patients with radiographic axial involvement were older (50.9 vs. 32.4 years; p < 0.001) and showed greater peripheral disease activity (peripheral arthritis 78.1 vs. 12.5%, p < 0.001; enthesitis 50.0 vs. 6.3%, p = 0.003). AS patients with psoriasis presented a higher rate of HLA-B*27 positivity (81.3 vs. 17.2%; p < 0.001) and a more frequent history of inflammatory back pain (100.0 vs. 75.0%; p = 0.039) than PsA patients with radiographic axial involvement. Significant proportions of PsA patients with radiographic axial involvement had cervical spine involvement (10/18, 55.6%) and spondylitis without sacroiliitis (10/23, 43.5%). @*Conclusions@#We demonstrate that axial involvement is common in Korean PsA patients, and its characteristics can be distinct from those of AS.

Automated Detection and Segmentation of Bone Metastases on Spine MRI Using U-Net:A Multicenter Study

Objective@#To develop and evaluate a deep learning model for automated segmentation and detection of bone metastasis on spinal MRI. @*Materials and Methods@#We included whole spine MRI scans of adult patients with bone metastasis: 662 MRI series from 302 patients (63.5 ± 11.5 years; male:female, 151:151) from three study centers obtained between January 2015 and August 2021 for training and internal testing (random split into 536 and 126 series, respectively) and 49 MRI series from 20 patients (65.9 ± 11.5 years; male:female, 11:9) from another center obtained between January 2018 and August 2020 for external testing. Three sagittal MRI sequences, including non-contrast T1-weighted image (T1), contrast-enhanced T1-weighted Dixon fat-only image (FO), and contrast-enhanced fat-suppressed T1-weighted image (CE), were used. Seven models trained using the 2D and 3D U-Nets were developed with different combinations (T1, FO, CE, T1 + FO, T1 + CE, FO + CE, and T1 + FO + CE). The segmentation performance was evaluated using Dice coefficient, pixel-wise recall, and pixel-wise precision. The detection performance was analyzed using per-lesion sensitivity and a free-response receiver operating characteristic curve. The performance of the model was compared with that of five radiologists using the external test set. @*Results@#The 2D U-Net T1 + CE model exhibited superior segmentation performance in the external test compared to the other models, with a Dice coefficient of 0.699 and pixel-wise recall of 0.653. The T1 + CE model achieved per-lesion sensitivities of 0.828 (497/600) and 0.857 (150/175) for metastases in the internal and external tests, respectively. The radiologists demonstrated a mean per-lesion sensitivity of 0.746 and a mean per-lesion positive predictive value of 0.701 in the external test. @*Conclusion@#The deep learning models proposed for automated segmentation and detection of bone metastases on spinal MRI demonstrated high diagnostic performance.

Pembrolizumab for Patients with Relapsed or Refractory Extranodal NK/T-Cell Lymphoma in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Programmed death-1 blockade with pembrolizumab has shown promising activity in relapsed/refractory (R/R) extranodal natural killer/T-cell lymphoma (NKTCL), but studies are limited, with small patient numbers. @*Materials and Methods@#Thirteen institutes involved with the Consortium for Improving Survival of Lymphoma, a Korean lymphoma study group, collected the clinical data of 59 patients treated with pembrolizumab as salvage therapy between 2016 and 2022. @*Results@#The median age of the patients was 60 years (range, 22 to 87 years), and 76.3% had advanced Ann Abor stage disease. Pembrolizumab was given to 35.6%, 40.7%, and 23.7% of the patients as second-, third-, and fourth- or higher-line chemotherapy, respectively. The overall response rate was 40.7%, with 28.8% having complete response. The estimated 2-year progression-free survival (PFS) and overall survival rates for all patients were 21.5% and 28.7%, respectively; for responders, the rates were 53.0% and 60.7%, respectively. Although not statistically significant, Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR], 1.91; 95% confidence interval [95% CI], 0.93 to 3.94; p=0.078) and stage III or IV disease (HR, 2.59; 95% CI, 0.96 to 6.96; p=0.060) were associated with a trend toward shorter PFS in multivariate analysis. Grade 3 or 4 adverse events (AEs) were noted in 12 patients (20.3%); neutropenia (10.2%), fatigue (6.8%), and pneumonitis (5.1%) were most common AEs. @*Conclusion@#In conclusion, while pembrolizumab had a modest effect on patients with R/R NKTCL, it may be a useful salvage therapy for patients with localized disease and good performance status.

Disease Awareness, Medical Use Behavior, Diagnosis and Treatment Status, Quality of Life and Comorbidities in Primary Cicatricial Alopecia Patients: A Multicenter Survey / 대한피부과학회지

Background@#Primary cicatricial alopecia (PCA) is a rare disease that causes irreversible destruction of hair follicles and affects the quality of life (QOL). @*Objective@#We aimed to investigate the disease awareness, medical use behavior, QOL, and real-world diagnosis and treatment status of patients with PCA. @*Methods@#A self-administered questionnaire was administered to patients with PCA and their dermatologists. Patients aged between 19 and 75 years who visited one of 27 dermatology departments between September 2021 and September 2022 were included. @*Results@#In total, 274 patients were included. The male-to-female ratio was 1:1.47, with a mean age of 45.7 years. Patients with neutrophilic and mixed PCA were predominantly male and younger than those with lymphocytic PCA. Among patients with lymphocytic PCA, lichen planopilaris was the most common type, and among those with neutrophilic PCA, folliculitis decalvans was the most common type. Among the total patients, 28.8% were previously diagnosed with PCA, 47.0% were diagnosed with PCA at least 6 months after their first hospital visit, 20.0% received early treatment within 3 months of disease onset, and 54.4% received steady treatment. More than half of the patients had a moderate to severe impairment in QOL. Topical/intralesional steroid injections were the most common treatment. Systemic immunosuppressants were frequently prescribed to patients with lymphocytic PCA, and antibiotics were mostly prescribed to patients with neutrophilic PCA. @*Conclusion@#This study provides information on the disease awareness, medical use behavior, QOL, diagnosis, and treatment status of Korean patients with PCA. This can help dermatologists educate patients with PCA to understand the necessity for early diagnosis and steady treatment.

A Generalized Lichen Planus Following COVID-19 Vaccination:A Case Report

As part of the efforts to overcome the ongoing coronavirus disease 2019 (COVID-19) pandemic, mass vaccination programs against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been initiated. Since then, an increasing number of cutaneous adverse events associated with the COVID-19 vaccines have been reported. Lichen planus (LP) is a rare inflammatory mucocutaneous disease with various clinical presentations, although uncommon, occurring following vaccination. There have been several cases of LP reported following COVID-19 vaccination. However, there has been no report of generalized LP following the COVID-19 vaccine to our knowledge. Herein, we report a case of generalized LP following the Oxford/AstraZeneca (AZD1222) vaccine. A 68-year-old female presented with widespread, erythematous pruritic papules and plaques on the trunk and both limbs, which developed 2 to 3 days after administration of the AZD1222 vaccine. Histopathological examinations revealed cellular interface dermatitis. The patient was diagnosed with generalized LP and was successfully treated with systemic corticosteroid and cyclosporine. As the vaccination campaign against COVID-19 is ongoing and early recognition and treatment are essential to reduce the morbidity of this condition, clinicians should be aware that LP could follow COVID-19 vaccination regardless of the type of vaccine administered.

A Case of Papulopustular Rosacea-Like Eruptions Following COVID-19 Vaccination / 대한피부과학회지

A few cases of rosacea-like eruptions associated with COVID-19 vaccination have been reported. Herein, we report a case of papulopustular rosacea-like eruption following COVID-19 vaccination in an Asian male. A 46-year-old male patient presented with pruritic and pricking erythematous papules, as well as pustules on the face for 6 months.The lesions developed 1 month after the second dose of the BNT162b2 COVID-19 vaccine and improved, but the lesion recurred 1 month after the third dose of vaccine. Histopathological examination revealed moderate perivascular lymphohistiocytic and a few eosinophilic infiltrates in the upper dermis. He was treated with oral triamcinolone and doxycycline, and the lesion improved gradually over 4 months. Although its exact etiology is unclear, the immune response after COVID-19 vaccination may play a role in the onset of rosacea-like eruption. Clinicians should be aware that rosacea-like eruption are a possible cutaneous reaction after COVID-19 vaccination.

Effects of Gamma-Linolenic Acid Adjuvant Therapy in Patients with Atopic Dermatitis:A Survey Study / 대한피부과학회지

Background@#Atopic dermatitis (AD) is a chronic pruritic inflammatory dermatosis. Whether gamma-linolenic acid (GLA) supplementation is beneficial in AD patients remains debatable. @*Objective@#This study investigated whether adjuvant GLA supplementation is associated with clinical improvement in AD patients receiving systemic treatment, as assessed by patient-reported outcome measures. @*Methods@#We enrolled 70 AD patients. Patients who received GLA at a dose of 80∼160 mg/d for over 1 month were included in the GLA group, while others were included in the non-GLA group. Each group was subgrouped into control, immunomodulator, and dupilumab groups based on treatment history. The patients evaluated their symptoms using the Atopic Dermatitis Control Tool (ADCT), Patient Global Assessment of Disease (PGA), and Dermatology Life Quality Index (DLQI). @*Results@#The Mann-Whitney U-test was used to compare differences in ADCT, PGA, and DLQI between both groups. The ADCT scores were significantly lower in the control and immunomodulatory group supplemented with GLA (control U=13.5, p=0.04; immunomodulatory U=28.0, p=0.01), but not in patients taking dupilumab (U=44.5, p=0.70). The PGA and DLQI scores also tended to be lower in the GLA group than those in the non-GLA group. @*Conclusion@#GLA supplementation is a potential adjuvant to systemic therapy may yield additional symptomatic relief in AD patients.

Association between Allergic Diseases and the Number of Persons per Household Using Data from the National Health and Nutrition Examination Survey / 대한피부과학회지

Background@#Atopic dermatitis (AD) and asthma are chronic allergic diseases that affect quality of life. @*Objective@#In this study, we analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) to determine the association between allergic diseases and number of household members living with the patient. @*Methods@#This study included 20,893 participants ＞19 years of age from the KNHANES (2010∼2013). Multiple logistic regression analysis was performed to evaluate the odds ratio (OR) for presence of AD or asthma according to number of household members. @*Results@#The OR of allergic diseases including AD and/or asthma increased as the number of household members decreased in the age ＜40 group after adjustments for age, sex, smoking status, drinking status, regular physical activity, education level, income level, and stress level (1 member: adjusted OR [aOR]=2.019, 95% confidence interval [CI]=1.256∼3.245; 2 or 3 members: aOR=1.3, 95% CI=1.031∼1.64; ≥4 members: reference). And those with an allergic disease were less likely to have a spouse and had a higher stress level compared to those without. @*Conclusion@#Based on a nationwide population-based survey, this study showed that the number of household members was significantly related to rates of AD and asthma. The prevalence of allergic diseases tended to be higher in households with fewer members.

Application of precision medicine based on next-generation sequencing and immunohistochemistry in ovarian cancer: a real-world experience / 부인종양

Objective@#To evaluate the landscape of gene alterations and immunohistochemistry (IHC) profiles of patients with ovarian cancer for targeted therapy and investigate the real-world experience of applying precision medicine. @*Methods@#Patients diagnosed with ovarian cancer between January 2015 and May 2021 at Severance Hospital and who underwent tumor next-generation sequencing (NGS) were reviewed. Data on germline mutation, IHC markers for mismatch repair deficiency (MMRd), programmed death ligand 1 (PD-L1) expression, and human epidermal growth factor receptor 2 (HER2) expression were acquired. The use of matched therapy and its clinical outcomes were evaluated. @*Results@#Of the 512 patients who underwent tumor NGS, 403 underwent panel-based germline testing. In patients who underwent both tests, tumor NGS identified 39 patients (9.7%) with BRCA mutations and 16 patients (4.0%) with other homologous recombination repair (HRR)-associated gene mutations, which were not found in germline testing. The most common single nucleotide variants were TP53 (82.2%), ARID1A (10.4%), PIK3CA (9.7%), and KRAS (8.4%). Copy number aberrations were found in 122 patients. MMRd was found in 3.2% of patients, high PD-L1 expression in 10.1%, and HER2 overexpression in 6.5%. Subsequently, 75 patients (14.6%) received a poly (ADP-ribose) polymerase inhibitor based on BRCA mutation and 11 patients (2.1%) based on other HRR-associated gene mutations. Six patients (1.2%) with MMRd underwent immunotherapy. Twenty-eight patients (5.5%) received other matched therapies targeting HER2, fibroblast growth factor receptor, folate receptor alpha, RAS, and PIK3CA. @*Conclusion@#A comprehensive review of germline mutation, IHC, and tumor NGS helped identify candidates for precision therapy in patients with ovarian cancer, a proportion of whom received matched therapy.

Hormone Replacement Therapy and Psoriasis Risk: A Nationwide Population-Based Cohort Study

Background@#Hormone replacement therapy (HRT) is used to relieve menopause symptoms, but has been reported to be associated with coronary heart disease and cancers in women.However, a link between HRT and psoriasis has yet to be established. The aim of this study was to determine the association between HRT and the risk of psoriasis. @*Methods@#We executed a nationwide population-based study. A total of 1,130,741 postmenopause women were enrolled in the national health care insurance database based on the enrollment criteria. The study population was classified into four groups based on the duration of the HRT, and the risk of psoriasis was analyzed. @*Results@#The incidence rates of psoriasis per 1,000 person-years were 3.36 and 4.09 in the no history of HRT and ≥ 5 years of HRT, respectively. After adjustment for age, smoking, alcohol intake, regular exercise, body mass index, diabetes mellitus, hypertension, and dyslipidemia, the most prolonged duration of the HRT group (≥ 5 years) exhibited significantly increased risk of developing psoriasis (hazard ratio, 1.22; 95% confidence interval, 1.16–1.29). @*Conclusion@#We propose that HRT in post-menopausal women is associated with an increased likelihood of psoriasis development.

Influence of depth of cavity on color blending effect of structurally colored resin / 대한치과재료학회지

Omnichroma (OMN) is a recently introduced structurally colored resin composite that expresses color based on the tooth structure surrounding the cavity. This study aims to investigate the effects of varying the cavity depth on the color blending of OMN.Conventional resin composite (Filtek Z250 in the A2, A3, and A4 shades) and structurally colored resin (Omnichroma) were used. Two types of specimens were prepared using custom silicone molds (diameter: 8 mm, thickness: 2, 3, 4 mm). Single specimens (diameter: 8 mm) comprised only Z250 in the A2, A3, A4 or OMN (n=10 each). Dual specimens comprised an outer ring (diameter : 8 mm) of Z250 in the A2, A3, or A4 and an inner hole (diameter: 4 mm) filled with OMN to different depths (1, 2, 3, or 4 mm, n=10 per shade per thickness). The colors were measuredusing the Commission Internationale d’Eclairage (CIE) L*a*b* system. Color differences (ΔE) according to the cavity depth and translucency parameter were measured.The ΔE values of dual specimens with the A2, A3, and A4 shades of Z250 were 1.66–5.07, 0.50–2.57, and 1.26– 3.48, respectively. At the same specimen thickness, ΔE increased with increasing cavity depth. At the same cavity depth, ΔE increased with decreasing thickness of the bottom of the restoration. The highest translucency parameterwas observed for 2 mm-thick OMN. The color blending of OMN increased with decreasing cavity depth in specimens of the same thickness, and with increasing bottom thickness of the restoration at the same cavity depth.

Intramuscular neural distribution of the teres minor muscle using Sihler’s stain: application to botulinum neurotoxin injection / 대한해부학회지

The aim of this study was to elucidate the intramuscular arborization of the teres minor muslce for effective botulinum neurotoxin injection. Twelve specimens from 6 adult Korean cadavers (3 males and 3 females, age ranging from 66 to 78 years) were used in the study. The reference line between the 2/3 point of the axillary border of the scapula (0/5), where the muscle originates ant the insertion point of the greater tubercle of the humerus (5/5). The most intramuscular neural distribution was located on 1/5–3/5 of the muscle. The tendinous portion was observed in the 3/5–5/5. The result suggests the botulinum neurotoxin should be delivered in the 1/5–3/5 area of the teres minor muscle.

Novel anatomical guidelines for botulinum neurotoxin injection in the mentalis muscle:a review / 대한해부학회지

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle.An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19

Background@#The perianesthetic morbidity, mortality risk and anesthesia-associated risk after preoperative coronavirus disease 2019 (COVID-19) omicron variant in pediatric patients have not been fully demonstrated. We examined the association between preoperative COVID-19 omicron diagnosis and the incidence of overall perioperative adverse events in pediatric patients who received general anesthesia. @*Methods@#This retrospective study included patients aged < 18 years who received general anesthesia between February 1 and June 10, 2022, in a single tertiary pediatric hospital.They were divided into two groups; patients in a COVID-19 group were matched to patients in a non-COVID-19 group during the omicron-predominant period in Korea. Data on patient characteristics, anesthesia records, post-anesthesia records, COVID-19-related history, symptoms, and mortality were collected. The primary outcomes were the overall perioperative adverse events, including perioperative respiratory adverse events (PRAEs), escalation of care, and mortality. @*Results@#In total, 992 patients were included in the data analysis (n = 496, COVID-19; n = 496, non-COVID-19) after matching. The overall incidence of perioperative adverse events was significantly higher in the COVID-19 group than in the non-COVID-19 group (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.89–1.94). The difference was significant for PRAEs (OR, 2.00; 95% CI, 1.96–2.02) but not in escalation of care or mortality. The most difference between the two groups was observed in instances of high peak inspiratory pressure ≥ 25 cmH 2 O during the intraoperative period (OR, 11.0; 95% CI, 10.5–11.4). Compared with the non-COVID-19 group, the risk of overall perioperative adverse events was higher in the COVID-19 group diagnosed 0–2 weeks before anesthesia (OR, 6.5; 95% CI, 2.1–20.4) or symptomatic on the anesthesia day (OR, 6.4; 95% CI, 3.30–12.4). @*Conclusion@#Pediatric patients with the preoperative COVID-19 omicron variant had increased risk of PRAEs. Patients within 2 weeks after COVID-19 or those with symptoms had a higher risk of PRAEs

Novel anatomical proposal for botulinum neurotoxin injection targeting depressor anguli oris for treating drooping mouth corner / 대한해부학회지

The depressor anguli oris (DAO) muscle is a thin, superficial muscle located below the corner of the mouth. It is the target for botulinum neurotoxin (BoNT) injection therapy, aimed at treating drooping mouth corners. Hyperactivity of the DAO muscle can lead to a sad, tired, or angry appearance in some patients. However, it is difficult to inject BoNT into the DAO muscle because its medial border overlaps with the depressor labii inferioris and its lateral border is adjacent to the risorius, zygomaticus major, and platysma muscles. Moreover, a lack of knowledge of the anatomy of the DAO muscle and the properties of BoNT can lead to side effects, such as asymmetrical smiles. Anatomical-based injection sites were provided for the DAO muscle, and the proper injection technique was reviewed. We proposed optimal injection sites based on the external anatomical landmarks of the face. The aim of these guidelines is to standardize the procedure and maximize the effects of BoNT injections while minimizing adverse events, all by reducing the dose unit and injection points.

Association of the perfusion index with postoperative acute kidney injury: a retrospective study / 대한마취과학회지

Background@#Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI) that has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence. @*Methods@#We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre- and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB. Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI. @*Results@#Overall, 2,554 patients were identified and 1,586 patients were included in our analysis. According to Kidney Disease Improving Global Outcomes (KDIGO) criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio: 2.00, 95% CI [1.16, 3.44], P = 0.012) when PPI was less than 0.5 for more than 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists physical status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation. @*Conclusions@#Low intraoperative PPI was independently associated with postoperative AKI.