Enterococcus faecium, particularly in its multidrug-resistant forms, causes invasive nosocomial infections. Given the limited data comparing the effectiveness of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the CLSI clinical breakpoints (CBPs) for quinupristin–dalfopristin (QD) resistance and the need to evaluate their practical application, we retrospectively investigated the susceptibility patterns of 287 E.faecium bloodstream isolates from Korean hospitals to QD using the updated EUCAST and CLSI CBPs and two antimicrobial susceptibility testing methods: disk diffusion (DD) and Sensititre broth microdilution (Sensititre). QD resistance rates were 5.9% (CLSI) and 18.8% (EUCAST) for DD and 22.6% (CLSI) and 28.2% (EUCAST) for Sensititre. The most prevalent QD resistance gene types among QD-resistant isolates were ermB+msrC+ or ermB– msrC+. Categorical agreement between DD and Sensititre ranged from 77.7% to 90.7%, depending on the testing method and CBPs applied. The EUCAST zone diameter CBPs more effectively help identify QD-resistant E. faecium isolates using the DD method than the CLSI zone diameter CBPs. In comparison, the CLSI minimum inhibitory concentration (MIC) CBPs provide more reliable results for resistance classification in the Sensititre method than EUCAST MIC CBPs. These findings would help improve clinical decision-making for treating multidrug-resistant E. faecium infections.

Background/Aims: Besifovir dipivoxil maleate (BSV) and tenofovir alafenamide fumarate (TAF) have been recently approved in Korea as the initial antiviral agents for chronic hepatitis B (CHB).However, the real-world outcome data for these drugs remain limited. Therefore, we conducted a noninferiority analysis using real-world data to compare the clinical outcomes of the two nucleotide analogs in treatment-naïve patients with CHB. Methods: We retrospectively investigated a cohort of patients with CHB who received BSV or TAF as first-line antiviral agents. The endpoints were virological response (VR) and liver-related clinical outcomes. Results: A total of 537 patients, consisting of 202 and 335 patients administered BSV and TAF, respectively, were followed up for 42 months. No significant difference was observed between the VRs of the patients from the two groups. The rates of biochemical response, virologic breakthrough, and incidence rates of hepatocellular carcinoma did not differ between the groups. However, the hepatitis B e antigen seroclearance rate was higher and the renal function declined less in the BSV group. Multivariable analysis indicated older age, alcohol abuse, cirrhosis and ascites, and lower serum HBV DNA level to be independently associated with increased hepatocellular carcinoma risk. The 1:1 propensity score-matched analysis with 400 patients showed VR rates of 85.0% and 88.7% in the BSV and TAF group patients, respectively, at 2 years. The absolute value of the 95% confidence interval for the difference (–0.04 to 0.12) satisfied the a priori limit of a noninferiority of 0.15. Conclusions BSV is noninferior to TAF in terms of VR, and their clinical outcomes are comparable to CHB.

Background: Over the last decade, extracorporeal membrane oxygenation (ECMO) use in critically ill children has increased and is associated with favorable outcomes. Our study aims to evaluate the current status of pediatric ECMO in Korea, with a specific focus on its volume and changes in survival rates based on diagnostic indications. Methods: This multicenter study retrospectively analyzed the indications and outcomes of pediatric ECMO over 10 years in patients at 14 hospitals in Korea from January 2012 to December 2021. Four diagnostic categories (neonatal respiratory, pediatric respiratory, postcardiotomy, and cardiac-medical) and trends were compared between periods 1 (2012–2016) and 2 (2017–2021). Results: Overall, 1065 ECMO runs were performed on 1032 patients, with the annual number of cases remaining unchanged over the 10 years. ECMO was most frequently used for post-cardiotomy (42.4%), cardiac-medical (31.8%), pediatric respiratory (17.5%), and neonatal respiratory (8.2%) cases. A 3.7% increase and 6.1% decrease in pediatric respiratory and post-cardiotomy cases, respectively, were noted between periods 1 and 2.Among the four groups, the cardiac-medical group had the highest survival rate (51.2%), followed by the pediatric respiratory (46.4%), post-cardiotomy (36.5%), and neonatal respiratory (29.4%) groups. A consistent improvement was noted in patient survival over the 10 years, with a significant increase between the two periods from 38.2% to 47.1% (P = 0.004). Improvement in survival was evident in post-cardiotomy cases (30–45%, P = 0.002).Significant associations with mortality were observed in neonates, patients requiring dialysis, and those treated with extracorporeal cardiopulmonary resuscitation (P < 0.001). In pediatric respiratory ECMO, immunocompromised patients also showed a significant correlation with mortality (P < 0.001). Conclusion Pediatric ECMO demonstrated a steady increase in overall survival in Korea;however, further efforts are needed since the outcomes remain suboptimal compared with global outcomes.

Vestibular schwannoma is a benign tumor that arises from the eighth cranial nerve and is the most common neoplasm in the internal auditory canal (IAC). It typically arises in the cerebellopontine angle or in IAC; however, in rare cases, they can arise within the labyrinth. These tumors arising in the labyrinth have been termed intra-labyrinthine schwannomas (ILS) and have different clinical features than the typical vestibular schwannomas. Clinical manifestations of an ILS typically include hearing loss, tinnitus, and vertigo, with unusual symptoms including a sense of fullness or imbalance. Temporal bone MRI is considered the most important test for diagnosing ILS. Tumors show nodular enhancement on T1-weighted images and filling defects on T2-weighted images. Treatment of ILS may include observation, microsurgical resection, and stereotactic radiosurgery depending on the location, size, and clinical presentation. In this paper, we present two cases diagnosed as ILS with different treatment options and provide a literature review for each case.

Purpose: This study evaluated the nutrition and food intake status among adults in Jeju, Republic of Korea, based on their sociodemographic characteristics and obesity. Methods: Nine hundred and forty-nine adults aged 19 years or older were included based on the 2022 Jeju Nutrition and Physical Activity Survey data. A dietary assessment was conducted using a one-day, 24-hour recall method, and the nutrition status was evaluated using the 2020 Dietary Reference Intakes for Koreans. The sociodemographic status included sex, age, education, and household income, and obesity was defined as a body mass index (BMI) of ≥ 25 kg/m 2 . Results: The mean age of the subjects was 49.8 years, and the overall prevalence of obesity was 48.4% (59.5% for males and 37.2% for females). The top three insufficient nutrients consumed at less than the estimated average requirement were calcium (77.7%), vitamin A (77.3%), and vitamin C (61.3%), while 40.9% of the subjects consumed fat as more than 30% of their total energy intake. The sodium intake was approximately 1.5 times higher than the chronic disease risk reduction intake level. In terms of food groups, the participants consumed more meat (148.2 g/day), seafood (69.0 g/day), potatoes, and starches (41.6 g/day) but consumed fewer vegetables (214.3 g/day) and less dairy (62.0 g/day) than Korean adults. The nutritional status and food intake patterns differed by the sociodemographic status. In addition, the obese group consumed more poultry and beverages than the non-obese group (p < 0.05 for all). Conclusion Adults in Jeju under-consume essential nutrients while over-consuming certain nutrients, such as fat and sodium. The nutritional status also varied according to the sociodemographic characteristics. These findings suggest that sociodemographic factors should be considered carefully when developing nutritional policies and programs to improve the nutritional status and address obesity among adults in Jeju.

Purpose: This study evaluated the nutrition and food intake status among adults in Jeju, Republic of Korea, based on their sociodemographic characteristics and obesity. Methods: Nine hundred and forty-nine adults aged 19 years or older were included based on the 2022 Jeju Nutrition and Physical Activity Survey data. A dietary assessment was conducted using a one-day, 24-hour recall method, and the nutrition status was evaluated using the 2020 Dietary Reference Intakes for Koreans. The sociodemographic status included sex, age, education, and household income, and obesity was defined as a body mass index (BMI) of ≥ 25 kg/m 2 . Results: The mean age of the subjects was 49.8 years, and the overall prevalence of obesity was 48.4% (59.5% for males and 37.2% for females). The top three insufficient nutrients consumed at less than the estimated average requirement were calcium (77.7%), vitamin A (77.3%), and vitamin C (61.3%), while 40.9% of the subjects consumed fat as more than 30% of their total energy intake. The sodium intake was approximately 1.5 times higher than the chronic disease risk reduction intake level. In terms of food groups, the participants consumed more meat (148.2 g/day), seafood (69.0 g/day), potatoes, and starches (41.6 g/day) but consumed fewer vegetables (214.3 g/day) and less dairy (62.0 g/day) than Korean adults. The nutritional status and food intake patterns differed by the sociodemographic status. In addition, the obese group consumed more poultry and beverages than the non-obese group (p < 0.05 for all). Conclusion Adults in Jeju under-consume essential nutrients while over-consuming certain nutrients, such as fat and sodium. The nutritional status also varied according to the sociodemographic characteristics. These findings suggest that sociodemographic factors should be considered carefully when developing nutritional policies and programs to improve the nutritional status and address obesity among adults in Jeju.

Purpose: This study evaluated the nutrition and food intake status among adults in Jeju, Republic of Korea, based on their sociodemographic characteristics and obesity. Methods: Nine hundred and forty-nine adults aged 19 years or older were included based on the 2022 Jeju Nutrition and Physical Activity Survey data. A dietary assessment was conducted using a one-day, 24-hour recall method, and the nutrition status was evaluated using the 2020 Dietary Reference Intakes for Koreans. The sociodemographic status included sex, age, education, and household income, and obesity was defined as a body mass index (BMI) of ≥ 25 kg/m 2 . Results: The mean age of the subjects was 49.8 years, and the overall prevalence of obesity was 48.4% (59.5% for males and 37.2% for females). The top three insufficient nutrients consumed at less than the estimated average requirement were calcium (77.7%), vitamin A (77.3%), and vitamin C (61.3%), while 40.9% of the subjects consumed fat as more than 30% of their total energy intake. The sodium intake was approximately 1.5 times higher than the chronic disease risk reduction intake level. In terms of food groups, the participants consumed more meat (148.2 g/day), seafood (69.0 g/day), potatoes, and starches (41.6 g/day) but consumed fewer vegetables (214.3 g/day) and less dairy (62.0 g/day) than Korean adults. The nutritional status and food intake patterns differed by the sociodemographic status. In addition, the obese group consumed more poultry and beverages than the non-obese group (p < 0.05 for all). Conclusion Adults in Jeju under-consume essential nutrients while over-consuming certain nutrients, such as fat and sodium. The nutritional status also varied according to the sociodemographic characteristics. These findings suggest that sociodemographic factors should be considered carefully when developing nutritional policies and programs to improve the nutritional status and address obesity among adults in Jeju.

Objective: Spontaneous intracerebral hemorrhage is a serious type of stroke with high mortality and disability rates. Surgical treatment options vary; however, predicting edema aggravation is crucial when choosing the optimal approach. We propose using the sphericity index, a measure of roundness, to predict the aggravation of edema and guide surgical decisions. Methods: We analyzed 56 cases of craniotomy and hematoma evacuation to investigate the correlation between the sphericity index and patient outcomes, including the need for salvage decompressive craniectomy (DC). Results: The patients included 35 (62.5%) men and 21 (37.5%) women, with a median age of 62.5 years. The basal ganglia was the most common location of hemorrhage (50.0%). The mean hematoma volume was 86.3 cc, with 10 (17.9%) instances of hematoma expansion.Cerebral herniation was observed in 44 (78.6%) patients, intraventricular hemorrhage in 34 (60.7%), and spot signs in 9 (16.1%). Salvage DC was performed in 13 (23.6%) patients to relieve intracranial pressure. The median follow-up duration was 6 months, with a mortality rate of 12.5%. The sphericity index was significantly correlated with delayed swelling and hematoma expansion but not salvage DC. Conclusions The sphericity index is a promising predictor of delayed swelling and hematoma expansion that may aid in the development of surgical guidelines and medication strategies. Further large-scale studies are required to explore these aspects and establish comprehensive guidelines.

Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.

Purpose: Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy. Materials and Methods: Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level. Results: Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250–0.890; P=0.020). Conclusions After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS.