Purpose: To report a case of infectious keratitis and endophthalmitis caused by two types of antibiotic-resistant bacteria.Case summary: A 62-year-old female patient presented to our clinic with left ocular pain for 2 weeks and was diagnosed with herpetic keratitis and anterior uveitis. At the initial presentation, slit lamp biomicroscopy revealed round stromal infiltration and edema in the paracentral part of the cornea, a 2 × 2-mm epithelial defect, and hypopyon. Ocular ultrasonography showed vitreous opacities. She was empirically treated with topical 0.5% moxifloxacin, 2% tobramycin, and 5% ceftazidime administered hourly. Intravitreal vancomycin/ceftazidime administration was performed on days 2 and 7 following treatment. Corneal culture revealed extended-spectrum β-lactamase-producing Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus on day 4 after treatment. Consequently, 2% tobramycin was replaced with 1% vancomycin. The corneal lesion gradually improved and healed completely with a residual corneal opacity at 4 weeks after treatment. Conclusions Polymicrobial bacterial keratitis caused by antibiotic-resistant bacteria represents a treatment challenge. Therefore, culture is essential to obtain microbiological evidence and guide appropriate antibiotic selection.

Background: Tinnitus is a multifactorial condition with no universally accepted assessment guidelines. The Korean Tinnitus Study Group previously established consensus statements on the definition, classification, and diagnostic tests for tinnitus. As a continuation of this effort, this study aims to establish expert consensus on tinnitus assessment and treatment outcome evaluation, specifically tailored to the Korean clinical context. Methods: A modified Delphi method involving 26 otology experts from across Korea was used. A two-round Delphi survey was conducted to evaluate statements related to tinnitus assessment before and after treatment. Statements were rated on a scale of 1 to 9 for the level of agreement. Consensus was defined as ≥ 70% agreement (score of 7–9) and ≤ 15% disagreement (score of 1–3). Statistical measures such as content validity ratio and Kendall’s coefficient of concordance (W) were calculated to assess agreement levels. Results: Of the 46 assessment-related statements, 17 (37%) reached consensus, though overall pre-treatment assessments showed weak agreement (Kendall’s W = 0.319). Key areas of agreement included the use of the visual analogue scale, numeric rating scale, and validated questionnaires for pre-treatment evaluation. Five statements, such as the use of computed tomography, magnetic resonance imaging, and angiography for diagnosing pulsatile tinnitus, achieved over 90% agreement. For treatment outcome measurements, 8 of 12 statements (67%) reached a consensus, with moderate agreement (Kendall’s W = 0.513). Validated questionnaires and psychoacoustic tests were recommended for evaluating treatment effects within 12 weeks. While standardized imaging for pulsatile tinnitus and additional clinical tests were strongly recommended, full consensus was not achieved across all imaging modalities. Conclusion This study provides actionable recommendations for tinnitus assessment and treatment evaluation, emphasizing the use of standardized tools and individualized approaches based on patient needs. These findings offer a practical framework to enhance consistency and effectiveness in tinnitus management within Korean clinical settings.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Purpose: To report a case of infectious keratitis and endophthalmitis caused by two types of antibiotic-resistant bacteria.Case summary: A 62-year-old female patient presented to our clinic with left ocular pain for 2 weeks and was diagnosed with herpetic keratitis and anterior uveitis. At the initial presentation, slit lamp biomicroscopy revealed round stromal infiltration and edema in the paracentral part of the cornea, a 2 × 2-mm epithelial defect, and hypopyon. Ocular ultrasonography showed vitreous opacities. She was empirically treated with topical 0.5% moxifloxacin, 2% tobramycin, and 5% ceftazidime administered hourly. Intravitreal vancomycin/ceftazidime administration was performed on days 2 and 7 following treatment. Corneal culture revealed extended-spectrum β-lactamase-producing Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus on day 4 after treatment. Consequently, 2% tobramycin was replaced with 1% vancomycin. The corneal lesion gradually improved and healed completely with a residual corneal opacity at 4 weeks after treatment. Conclusions Polymicrobial bacterial keratitis caused by antibiotic-resistant bacteria represents a treatment challenge. Therefore, culture is essential to obtain microbiological evidence and guide appropriate antibiotic selection.

Purpose: This study aims to evaluate a new method for the five times sit to stand test (FTSST), crucial for addressing frailty in an aging population. It utilizes a smart insole for plantar pressure analysis and a marker-less motion capture device for head height analysis. Materials and Methods: Thirty-five participants aged 50 years or older underwent FTSST assessment using three methods: manual measurement with a stopwatch (FTSST-M), plantar pressure analysis with smart insoles (FTSST-P), and head height analysis with a marker-less motion capture device (FTSST-H). Simultaneous measurements using three methods were done. Correlation between results of these methods were analyzed using intraclass correlation coefficient (ICC) and κ coefficient. Comprehensive clinical examinations were conducted with ethical approval. Results: Participants’ mean scores for FTSST-M, FTSST-P, and FTSST-H were 2.43±1.20, 2.43±1.29, and 2.37±1.31, respectively. Correlations of the times and corresponding scores between FTSST-P and FTSST-M, as well as FTSST-H and FTSST-M, exceeded 0.9 (ICC and κ coefficients, p<0.001). Using an FTSST score of 3 or less to indicate vulnerability, the κ value for vulnerability classification between two measurements was 0.886 (p<0.001). Conclusion This study showed strong correlation between FTSST results using smart insoles and marker-less motion capture, compared to conventional methods. These findings highlight the potential of these technologies for precise FTSST measurements, offering convenience and cost-effectiveness. Simultaneous use of these devices enables diverse analyses, enhancing our understanding of frailty.

Background/Aims: Fexuprazan, a novel potassium-competitive acid blocker, was developed for treating acid-related disorders. Pharmacokinetic and pharmacodynamic properties of fexuprazan, unlike those of proton pump inhibitors, are independent of food effect. This study aims to evaluate differences in efficacy and safety of fexuprazan in patients with erosive esophagitis (EE) according to the timing of dosing. Methods: In this multicenter, open-label noninferiority study, patients who had typical reflux symptoms with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg daily 30 minutes before or after meal. Treatment was completed after 2 weeks or 4 weeks when healing was endoscopically confirmed. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy up to week 4. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In the prior-to-meal group (n = 89) and after-meal group (n = 86), 4-week EE healing rates were 98.77% and 100.00% (difference, 0.01%; 95% CI, –0.01% to 0.04%) and 2-week EE healing rates were 95.77% and 97.14% (difference, 0.01%; 95% CI, –0.05% to 0.07%), respectively. TEAEs were 9.78% and 8.70% in the prior-to-meal group and the after-meal group, respectively. Conclusions Non-inferiority analysis revealed that taking fexuprazan after meal was non-inferior to taking fexuprazan before meals in patients with EE. The frequency of adverse events was similar between the 2 study groups. The drug is safe and effective for healing EE regardless of the timing of dosing.

Background and Objectives: The purpose of this study was to compare and analyze the 18- year change in the relative value scale (RVS) in otolaryngology in relation to other surgical departments so as to help make future policy decisions.Subjects and Method Data on RVSs and addition rates, the deparments of main managed care, frequency of practice, and number of specialists were collected for all surgeries and procedures conducted in 2004, 2008, 2013, 2018, and 2022. Among these, an analysis was conducted for nine surgical departments. The number of surgeries and procedure items, the median value of the RVS, and the usage amount (i.e., RVS of all items multiplied by the frequency of surgeries and procedures) were calculated. Results: Over the past 18 years, the increase in the number of surgeries, procedure items and RVS in otolaryngology has grown smaller than that in other surgical departments, and the usage has decreased very sharply; in essence, the usage per specialist has actually decreased compared to 18 years ago. Conclusion Compared to other departments, RVS in otorhinolaryngology has shown very little change over the past period of 18 years. It is necessary to reasonably increase the currently undervalued RVS in otorhinolaryngology, particularly focusing on surgeries and procedures.

Lazertinib is an oral, third-generation, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for the treatment of non-small cell lung cancer (NSCLC). This case report presents a rare instance of small cell carcinoma transformation in pancreatic metastasis in a patient with EGFR-mutated NSCLC undergoing treatment with lazertinib. Small cell carcinoma transformation indicates a mechanism of treatment resistance, and tissue biopsy is essential to confirm this. When isolated progression of a lesion is suspected during TKI therapy in EGFR-mutated NSCLC, histological evaluation is necessary to confirm the transformation for the treatment strategy.

Objective: Previous studies have reported an association between cancer-related symptoms and perceived social support (PSS). The objective of this study was to analyze whether Chemotherapy-Induced Peripheral Neuropathy (CIPN), a prevalent side effect of chemotherapy, varies according to PSS level using a validated tool for CIPN at prospective follow-up. Methods: A total of 39 breast cancer patients were evaluated for PSS using the Multidimensional Scale of Perceived Social Support (MSPSS) prior to chemotherapy and were subsequently grouped into one of two categories for each subscale: low-to-moderate PSS and high PSS. CIPN was prospectively evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 (CIPN20) at five time points. A linear mixed-effects model with square root transformation was employed to investigate whether the CIPN20 scales varied by PSS level and time point. Results: Statistical analysis of the MSPSS total scale and subscales revealed a significant effect of the friends subscale group and time point on the CIPN20 sensory scale. The sensory scale score of CIPN20 was found to be lower in participants with high PSS from friends in comparison to those with low-to-moderate PSS at 1 month post-chemotherapy (p=0.010). Conclusion This is the first study to prospectively follow the long-term effect of pre-treatment PSS from friends on CIPN. Further studies based on larger samples are required to analyze the effects of PSS on the pathophysiology of CIPN.

Patients with ectodermal dysplasia often have atrophied alveolar bone and an inadequate maxillomandibular relationship owing to congenital edentulism.Accurate implant placement that can overcomes anatomical limitations and orthognathic surgery to improve the maxillomandibular relationship is necessary for creating implant-supported prosthesis for these patients. Implant placement and provisional prosthesis fabrication before orthognathic surgery can provide critical fixed reference points and ensure accuracy during orthognathic surgery.In our patient, a digital system was used to design a surgical guide that considered the predictable position of the definitive prosthesis, allowing the placement of implants to overcome anatomical limitations and the creation of fixed reference points via the delivery of a provisional prosthesis for effective orthognathic surgery. The lack of compensation during orthognathic surgery was considered in the definitive prosthesis. As a result, a prosthesis with a minimal anterior cantilever was fabricated. This study aimed to determine the appropriate sequence of multidisciplinary collaborations that would, result in the best functional and aesthetic outcomes.