Purpose: Methacholine bronchial provocation tests (MBPTs) are commonly used to assess airway hyperresponsiveness, but some patients show no significant response. This study aimed to compare the clinical characteristics of asthmatic patients based on their sensitivity to MBPTs. Methods: We conducted a retrospective cross-sectional study involving adult asthmatic patients from 6 university hospitals in South Korea. Patients were categorized into 2 groups: those with MBPT sensitivity (the provocative concentration of methacholine that leads to a 20% reduction in forced expiratory volume in 1 second [PC20]≤ 16 mg/mL) and those with lower sensitivity (PC 20 > 16 mg/mL). Clinical characteristics were compared between the 2 groups. Results: Among 346 patients, 213 had PC 20 ≤ 16 mg/mL and 133 had PC 20 > 16 mg/mL. The PC20> 16 mg/mL group had a higher prevalence of late-onset asthma (P= 0.024) and obesity (P= 0.045). While no significant differences in immunoglobulin E (≥ 200 IU/mL) were found, the PC 20 ≤ 16 mg/mL group had greater T2-high inflammation, such as elevated eosinophil counts and fractional exhaled nitric oxide (P< 0.001 and P= 0.004, respectively). Asthma exacerbations requiring emergency visits or hospitalizations were more frequent in the PC 20 > 16 mg/mL group, despite a lower proportion of patients on higher-step treatments according to Global Initiative for Asthma guidelines. Conclusion Asthmatic patients with PC 20 > 16 mg/mL tend to present with late-onset asthma, less T2-high inflammation, and higher rates of asthma exacerbations. Further studies are needed to clarify the clinical features of asthma patients with PC 20 > 16 mg/mL and assess the long-term significance of these findings.

Purpose: Many studies using a common data model (CDM) have recently been reported. This study aims to determine the prevalence and clinical characteristics of vancomycin-associated adverse drug reactions (ADRs) using CDM and to identify its usefulness in ADRs. Methods: This study was conducted from the OMOP-CDM (Observational Medical Outcomes Partnership-CDM) version 5.3 database of Convergence Medical Institute of Technology, Pusan National University Hospital. The study cohort was defined as patients who had taken vancomycin for more than 7 days and had normal blood tests within 1 week before administration. ADRs included neutropenia, eosinophilia, thrombocytopenia, drug-induced liver injury, and acute kidney injury. Results: The most frequent ADR to vancomycin was thrombocytopenia (18.32%), followed by neutropenia (7.81%), acute kidney injury (5.85%), eosinophilia (5.32%), and drug-induced liver injury (4.15%). The baseline hematologic values were closer to the reference value of ADR definition in patients who developed ADRs than those without ADRs, even though the values were within the normal range. Acute kidney injury was common in males and the patients had high vancomycin trough concentrations. The period of vancomycin exposure was longer in the ADR groups. The incidence of new adverse reactions was highest for thrombocytopenia, and it was higher in males than in females, except for neutrophilia. Conclusion This study examined the prevalence, incidence rates, and clinical features of vancomycin-associated ADR using CDM. A CDM could serve as a significant data source for monitoring ADRs.

Atopic dermatitis is the most common chronic inflammatory skin disease in children and adolescents. The Korean Academy of Pediatric Allergy and Respiratory Disease published the Atopic Dermatitis Treatment Guideline in 2008, which has been helpful in atopic dermatitis treatment until now. Various reports on the development and effectiveness of new drugs have suggested that there is a need to develop and revise old treatment guidelines. Part 1 aimed to provide evidence-based recommendations for skin care management and topical treatment for atopic dermatitis. Part 2 focuses on systemic treatment, novel therapeutics, and adjuvant therapy. The goal of this guideline is intended to assist front-line doctors treating pediatric and adolescent atopic dermatitis patients make safer, more effective, and more rational decisions regarding systemic treatment, novel therapeutics, and adjuvant therapy by providing evidence-based recommendations with a clear level of evidence and benefit regarding treatment.

Purpose: The human gut mycobiome comprises diverse fungal species and plays a crucial role in health and disease, despite its relatively low abundance compared to bacterial populations. This review provides an overview of the mycobiome’s composition, developmental patterns, and dysbiosis in various pathological conditions. As well, the complex interactions of fungal communities within the gut microbiome are discussed.Current content: The development of the gut mycobiome follows patterns similar to those of the bacterial microbiome, with birth mode, diet, and age being key determinants. In contrast to the bacterial trends, mycobiome diversity increases during childhood and old age. Recent studies have revealed variations in the mycobiome composition across different ethnic groups. Mycobiome dysbiosis is associated with autoimmune, gastrointestinal, and cardiovascular diseases. Certain fungi, notably Candida albicans, are relatively more abundant in pathological states. Fungal metabolic activity, particularly secondary metabolite production, can significantly affect disease progression. Bacterial–fungal interactions in the gut microbiome are complex and modulated by environmental factors, such as diet and antibiotic use. Moreover, the gut mycobiome modulates therapeutic efficacy. Gut fungi enhance the bioactivity of compounds derived from natural products through biotransformation, including their anticancer and anti-inflammatory effects. This suggests the potential of the gut mycobiome to optimize the therapeutic efficacy of natural products. Conclusion This review highlights the relevance of the gut mycobiome as both a diagnostic biomarker and a therapeutic target. Future research should focus on elucidating the causal relationships between mycobiome alterations and disease states, and further explore bacterial–fungal interactions within the gut ecosystem.

Purpose: This study aimed to develop a comprehensive practical guide for enteral nutrition (EN) designed to enhance patient safety and reduce complications in Korea. Under the leadership of the Korean Society for Parenteral and Enteral Nutrition (KSPEN), the initiative sought to standardize EN procedures, improve decision-making, and promote effective multidisciplinary communication. Methods: The KSPEN EN committee identified key questions related to EN practices and organized them into seven sections such as prescribing, delivery route selection, formula preparation, administration, and quality management. Twenty-one experts, selected based on their expertise, conducted a thorough literature review to formulate evidence-based recommendations. Drafts underwent peer review both within and across disciplines, with final revisions completed by the KSPEN Guideline Committee. The guide, which will be published in three installments, addresses critical elements of EN therapy and safety protocols. Results: The practical guide recommends that EN orders include detailed elements and advocates the use of electronic medical records for communication. Standardized prescription forms and supplementary safety measures are outlined. Review frequency is adjusted according to patient condition—daily for critically ill or unstable patients and as dictated by institutional protocols for stable patients. Evidence indicates that adherence to these protocols reduces mortality, complications, and prescription errors. Conclusion The KSPEN practical guide offers a robust framework for the safe delivery of EN tailored to Korea’s healthcare context. It emphasizes standardized protocols and interdisciplinary collaboration to improve nutritional outcomes, patient safety, and operational efficiency. Rigorous implementation and monitoring of adherence are critical for its success.

Purpose: Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation. Methods: A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus. Results: The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements. Conclusion This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

Purpose: The long-term outcomes and efficacy of partial stapled hemorrhoidopexy (PSH) compared with those of conventional hemorrhoidectomy (CH) are not fully understood. This study aimed to introduce a modified PSH (mPSH) and compare its clinical efficacy and safety with those of CH. Methods: A prospective randomized controlled trial was conducted. This study was performed at a single hospital and involved 6 colorectal surgeons. In total, 110 patients were enrolled between July 2019 and September 2020. Patients were randomly assigned to undergo either mPSH group (n=55) or CH group (n=55). The primary outcome was to compare postoperative average pain and postoperative peak pain using visual analog scale score between the 2 groups. Results: The required duration of analgesia was shorter in the mPSH group than in the CH group, although the difference was not statistically significant (P=0.096). However, the laxative requirement duration (P<0.010), return to work (P<0.010), satisfaction score (P<0.010), and Vaizey score (P=0.014) were significantly better in the mPSH group. The average and peak postoperative pain scores were significantly lower in the mPSH group during the 15 days after surgery (P<0.001). The overall complication rate in both groups was 9.1%, with no significant difference between the groups (P=0.867). Conclusion The mPSH group demonstrated better improvement in symptoms, lower pain scores, and greater patient early satisfaction after surgery than the CH group. Therefore, this surgical technique appears to be a safe and effective alternative for CH.

Purpose: Methacholine bronchial provocation tests (MBPTs) are commonly used to assess airway hyperresponsiveness, but some patients show no significant response. This study aimed to compare the clinical characteristics of asthmatic patients based on their sensitivity to MBPTs. Methods: We conducted a retrospective cross-sectional study involving adult asthmatic patients from 6 university hospitals in South Korea. Patients were categorized into 2 groups: those with MBPT sensitivity (the provocative concentration of methacholine that leads to a 20% reduction in forced expiratory volume in 1 second [PC20]≤ 16 mg/mL) and those with lower sensitivity (PC 20 > 16 mg/mL). Clinical characteristics were compared between the 2 groups. Results: Among 346 patients, 213 had PC 20 ≤ 16 mg/mL and 133 had PC 20 > 16 mg/mL. The PC20> 16 mg/mL group had a higher prevalence of late-onset asthma (P= 0.024) and obesity (P= 0.045). While no significant differences in immunoglobulin E (≥ 200 IU/mL) were found, the PC 20 ≤ 16 mg/mL group had greater T2-high inflammation, such as elevated eosinophil counts and fractional exhaled nitric oxide (P< 0.001 and P= 0.004, respectively). Asthma exacerbations requiring emergency visits or hospitalizations were more frequent in the PC 20 > 16 mg/mL group, despite a lower proportion of patients on higher-step treatments according to Global Initiative for Asthma guidelines. Conclusion Asthmatic patients with PC 20 > 16 mg/mL tend to present with late-onset asthma, less T2-high inflammation, and higher rates of asthma exacerbations. Further studies are needed to clarify the clinical features of asthma patients with PC 20 > 16 mg/mL and assess the long-term significance of these findings.

Purpose: Many studies using a common data model (CDM) have recently been reported. This study aims to determine the prevalence and clinical characteristics of vancomycin-associated adverse drug reactions (ADRs) using CDM and to identify its usefulness in ADRs. Methods: This study was conducted from the OMOP-CDM (Observational Medical Outcomes Partnership-CDM) version 5.3 database of Convergence Medical Institute of Technology, Pusan National University Hospital. The study cohort was defined as patients who had taken vancomycin for more than 7 days and had normal blood tests within 1 week before administration. ADRs included neutropenia, eosinophilia, thrombocytopenia, drug-induced liver injury, and acute kidney injury. Results: The most frequent ADR to vancomycin was thrombocytopenia (18.32%), followed by neutropenia (7.81%), acute kidney injury (5.85%), eosinophilia (5.32%), and drug-induced liver injury (4.15%). The baseline hematologic values were closer to the reference value of ADR definition in patients who developed ADRs than those without ADRs, even though the values were within the normal range. Acute kidney injury was common in males and the patients had high vancomycin trough concentrations. The period of vancomycin exposure was longer in the ADR groups. The incidence of new adverse reactions was highest for thrombocytopenia, and it was higher in males than in females, except for neutrophilia. Conclusion This study examined the prevalence, incidence rates, and clinical features of vancomycin-associated ADR using CDM. A CDM could serve as a significant data source for monitoring ADRs.

Atopic dermatitis is the most common chronic inflammatory skin disease in children and adolescents. The Korean Academy of Pediatric Allergy and Respiratory Disease published the Atopic Dermatitis Treatment Guideline in 2008, which has been helpful in atopic dermatitis treatment until now. Various reports on the development and effectiveness of new drugs have suggested that there is a need to develop and revise old treatment guidelines. Part 1 aimed to provide evidence-based recommendations for skin care management and topical treatment for atopic dermatitis. Part 2 focuses on systemic treatment, novel therapeutics, and adjuvant therapy. The goal of this guideline is intended to assist front-line doctors treating pediatric and adolescent atopic dermatitis patients make safer, more effective, and more rational decisions regarding systemic treatment, novel therapeutics, and adjuvant therapy by providing evidence-based recommendations with a clear level of evidence and benefit regarding treatment.