Background: The coronavirus disease 2019 (COVID-19) pandemic has caused the death of thousands of patients worldwide. Although age is known to be a risk factor for morbidity and mortality in COVID-19 patients, critical illness or death is occurring even in the younger age group as the epidemic spreads. In early 2022, omicron became the dominant variant of the COVID-19 virus in South Korea, and the epidemic proceeded on a large scale. Accordingly, this study aimed to determine whether young adults (aged ≤ 50 years) with critical COVID-19 infection during the omicron period had different characteristics from older patients and to determine the risk factors for mortality in this specific age group. Methods: We evaluated 213 critical adult patients (high flow nasal cannula or higher respiratory support) hospitalized for polymerase chain reaction-confirmed COVID-19 in nine hospitals in South Korea between February 1, 2022 and April 30, 2022. Demographic characteristics, including body mass index (BMI) and vaccination status; underlying diseases; clinical features and laboratory findings; clinical course; treatment received; and outcomes were collected from electronic medical records (EMRs) and analyzed according to age and mortality. Results: Overall, 71 critically ill patients aged ≤ 50 years were enrolled, and 142 critically ill patients aged over 50 years were selected through 1:2 matching based on the date of diagnosis. The most frequent underlying diseases among those aged ≤ 50 years were diabetes and hypertension, and all 14 patients who died had either a BMI ≥ 25 kg/m 2 or an underlying disease. The total case fatality rate among severe patients (S-CFR) was 31.0%, and the S-CFR differed according to age and was higher than that during the delta period. The S-CFR was 19.7% for those aged ≤ 50 years, 36.6% for those aged > 50 years, and 38.1% for those aged ≥ 65 years. In multivariate analysis, age (odds ratio [OR], 1.084; 95% confidence interval [CI], 1.043–1.127), initial low-density lipoprotein > 600 IU/L (OR, 4.782; 95% CI, 1.584–14.434), initial C-reactive protein > 8 mg/dL (OR, 2.940; 95% CI, 1.042–8.293), highest aspartate aminotransferase > 200 IU/L (OR, 12.931; 95% CI, 1.691–98.908), and mechanical ventilation implementation (OR, 3.671; 95% CI, 1.294–10.420) were significant independent predictors of mortality in critical COVID-19 patients during the omicron wave. A similar pattern was shown when analyzing the data by age group, but most had no statistical significance owing to the small number of deaths in the young critical group. Although the vaccination completion rate of all the patients (31.0%) was higher than that in the delta wave period (13.6%), it was still lower than that of the general population. Further, only 15 (21.1%) critically ill patients aged ≤ 50 years were fully vaccinated. Overall, the severity of hospitalized critical patients was significantly higher than that in the delta period, indicating that it was difficult to find common risk factors in the two periods only with a simple comparison. Conclusion Overall, the S-CFR of critically ill COVID-19 patients in the omicron period was higher than that in the delta period, especially in those aged ≤ 50 years. All of the patients who died had an underlying disease or obesity. In the same population, the vaccination rate was very low compared to that in the delta wave, indicating that non-vaccination significantly affected the progression to critical illness. Notably, there was a lack of prescription for Paxlovid for these patients although they satisfied the prescription criteria. Early diagnosis and active initial treatment was necessary, along with the proven methods of vaccination and personal hygiene. Further studies are needed to determine how each variant affects critically ill patients.

Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

Recently, a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (B.1.1.529) Omicron variant originated from South Africa in the middle of November 2021. SARS-CoV-2 is also called coronavirus disease 2019 (COVID-19) since SARS-CoV-2 is the causative agent of COVID-19. Several studies already suggested that the SARS-CoV-2 Omicron variant would be the fastest transmissible variant compared to the previous 10 SARS-CoV-2 variants of concern, interest, and alert. Few clinical studies reported the high transmissibility of the Omicron variant but there is insufficient time to perform actual experiments to prove it, since the spread is so fast. We analyzed the SARS-CoV-2 Omicron variant, which revealed a very high rate of mutation at amino acid residues that interact with angiostatin-converting enzyme 2. The mutation rate of COVID-19 is faster than what we prepared vaccine program, antibody therapy, lockdown, and quarantine against COVID-19 so far. Thus, it is necessary to find better strategies to overcome the current crisis of COVID-19 pandemic.

In published article by Li et al., an author's name was misspelled.

Cheek ; Facial Bones ; Fibrous Dysplasia, Polyostotic ; Patient Rights ; Pliability ; Skeleton ; Zygoma

Anti-Bacterial Agents ; Bone Marrow ; Drug Delivery Systems ; Inflammation ; Ischemia ; Mandible ; Necrosis ; Osteomyelitis ; Oxygen ; Plasma ; Polymethyl Methacrylate

PURPOSE: This study was aimed to compare the margin and internal fitness of single anterior all-ceramic crown zirconia core made by three deferent CAD/CAM systems. MATERIAL AND METHODS: Five single zirconia cores were manufactured by three deferent CAD/CAM systems(Cerasys(R)system, KaVo Everest(R)system, Lava(TM) system). The manufactured zirconia cores were duplicated through the use of replica technique, and a replicated sample was sectioned in the center of bucolingual and mesiodistal direction to measure the marginal and internal gap. Measurement was carried out by using measuring microscope (AXIO(R)) and I-Solution(R) and analysed through the use of ANOVA. RESULTS: As for the mean marginal fitness of the zirconia core, it was 84.74 +/- 27.57 micrometer, in Cerasys(R), 80.23 +/- 21.07 micrometer in KaVo Everest(R) and 96.37 +/- 11.45 micrometer in Lava(TM), and as for the mean internal gap, it was 94.11 +/- 30.07 micrometer in Cerasys(R), 92.31 +/- 25.18 micrometer in KaVo Everest(R), and 94.99 +/- 18.74 micrometer in Lava(TM). There was no significant statistically deference among the total average gap of three systems. The internal gap in KaVo Everest(R) seemed to be smaller than Lava(TM) (P < .05). The internal gap in the incisal area was larger in all of the three systems. CONCLUSION: There was no difference in marginal fitness in Cerasys(R), KaVo Everest(R) and Lava(TM). As for the internal fitness, it was smaller in KaVo Everest(R) system than Lava(TM)system. In all of the three systems, there was a larger gap in incisal area. The marginal and internal gap was within the clinically allowed range in all of the three systems.
Crowns ; Replica Techniques ; Zirconium

OBJECTIVE: We wanted to describe the characteristic ultrasonography (US) features and clinical findings for making the diagnosis of subacute granulomatous thyroiditis. MATERIALS AND METHODS: A total of 31 lesions from 27 patients were confirmed as subacute granulomatous thyroiditis by US-guided fine needle aspiration biopsy. We analyzed the ultrasonographic findings such as the lesion's size, margin and shape, the discrepancy between length and breadth and the vascularity. The clinical findings such as acute neck pain or fever were reviewed. The follow-up clinical and ultrasonographic data were reviewed for 15 patients. RESULTS: The thyroid gland was found to be enlarged in five patients, it was normal size in 20 patients and it was smaller in two patients. All the lesions had focally ill-defined hypoechogenicity. Hypervascularity was not noted in any of the lesions. Painful neck swelling was present in 18 patients. An accompanying fever was documented in nine of the 18 patients. Twelve patients showed disappearance (n = 3) or a decreased size (n = 9) of their lesions on follow-up US. CONCLUSION: The presence of ill-defined hypoechoic thyroid lesions without a discrete round or oval shape is characteristic for subacute granulomatous thyroiditis, and particularly when this is associated with painful neck swelling and/or fever.
Ultrasonography, Interventional ; Thyroiditis, Subacute/pathology/*ultrasonography ; Middle Aged ; Male ; Humans ; Granuloma/pathology/*ultrasonography ; Female ; Biopsy, Fine-Needle ; Aged ; Adult

The coexistence of polymyositis and primary biliary cirrhosis is rare. Both are characterized by chronic inflammation and immunological abnormalities. We report a case of 54-year-old female patient presenting with these two autoimmune diseases. She exhibited symmetrical proximal muscle weakness and elevated serum levels of muscle enzymes. Polymyositis was confirmed by electromyography and muscle biopsy. The diagnosis of primary biliary cirrhosis was based on increased serum levels of alkaline phosphatase, IgM immunoglobulin, presence of antimitochodrial antibody and characteristic liver biopy findings. This is the first case who manifest polymyositis and primary biliary cirrhosis simultaneously in Korea.
Alkaline Phosphatase ; Autoimmune Diseases ; Biopsy ; Diagnosis ; Electromyography ; Female ; Humans ; Immunoglobulin M ; Immunoglobulins ; Inflammation ; Korea ; Liver ; Liver Cirrhosis, Biliary* ; Middle Aged ; Muscle Weakness ; Polymyositis*