OBJECTIVES: As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. METHODS: Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. RESULTS: Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. CONCLUSION: Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
Child ; Cholesteatoma* ; Ear* ; Ear, Middle ; Endoscopy ; Follow-Up Studies ; Humans ; Minimally Invasive Surgical Procedures ; Recurrence

Creation of guidelines and education on digital professionalism have been sluggish despite the ever-increasing use of social media by digitally native medical students, who are at risk of blurring the line between their professional and personal lives online. A qualitative thematic analysis was applied on 79 videos extracted from 70,154 YouTube videos uploaded by Korean medical students between March and April 2020. We found 20% contained at least one concerning behavior themed under ‘failure to engage,’ ‘disrespectful behaviors,’ or ‘poor selfawareness.’ Professional lapses identified were classified into seriousness levels. Mostly were “controversial’ or ‘concerning’ but some ‘highly concerning’ contents were also found. This is the first study on digital professionalism behavior on medical students' YouTube videos. The potential negative impact on the medical profession of the easily accessible public online videos cannot be ignored and thus we suggest the need for them to be taken more seriously.

BACKGROUND/OBJECTIVES: Poly-γ-glutamic acid (γ-PGA), a natural polymer found in fermented soybean products, has been reported to play a prebiotic role in the gut. This intervention study investigated the effects of γ-PGA-containing supplement consumption on urinary microbiota in healthy adults because of limited data on such investigation. SUBJECTS/METHODS: A 4-week parallel trial including 39 male and female Korean adults, who were free of chronic diseases and infection, was designed as a randomized, doubleblinded, placebo-controlled study. A total of 30 participants completed the study wherein the intervention group (n = 17) received a mixture supplement containing 600 mg/day of γ-PGA and 100 mg/day of vitamin B6, while the control group (n = 13) received a placebo.Paired datasets (baseline and endpoint data) of microbiota profiles, which were constructed via urinary assays of microbe-derived extracellular vesicles, were analyzed and compared between the two groups. RESULTS: Only the intervention group yielded significant results for the Bray-Curtis and Jaccard dissimilarity indices between baseline and endpoint data (P < 0.05). In the phylumlevel analysis of microbial composition, the Firmicutes to Bacteroidetes ratio (FB ratio) tended to decrease from baseline in the intervention group; however, it increased in the control group.Differences between the baseline and endpoint FB ratios were significant between the two groups (P < 0.05). CONCLUSION This study’s findings suggest that γ-PGA-vitamin B6 supplementation potentially alters the microbial community composition of a host. Further investigation into the biological consequences of commensal microbiota alteration by γ-PGA-containing supplement consumption is warranted.

BACKGROUND/OBJECTIVES: Poly-γ-glutamic acid (γ-PGA), a natural polymer found in fermented soybean products, has been reported to play a prebiotic role in the gut. This intervention study investigated the effects of γ-PGA-containing supplement consumption on urinary microbiota in healthy adults because of limited data on such investigation. SUBJECTS/METHODS: A 4-week parallel trial including 39 male and female Korean adults, who were free of chronic diseases and infection, was designed as a randomized, doubleblinded, placebo-controlled study. A total of 30 participants completed the study wherein the intervention group (n = 17) received a mixture supplement containing 600 mg/day of γ-PGA and 100 mg/day of vitamin B6, while the control group (n = 13) received a placebo.Paired datasets (baseline and endpoint data) of microbiota profiles, which were constructed via urinary assays of microbe-derived extracellular vesicles, were analyzed and compared between the two groups. RESULTS: Only the intervention group yielded significant results for the Bray-Curtis and Jaccard dissimilarity indices between baseline and endpoint data (P < 0.05). In the phylumlevel analysis of microbial composition, the Firmicutes to Bacteroidetes ratio (FB ratio) tended to decrease from baseline in the intervention group; however, it increased in the control group.Differences between the baseline and endpoint FB ratios were significant between the two groups (P < 0.05). CONCLUSION This study’s findings suggest that γ-PGA-vitamin B6 supplementation potentially alters the microbial community composition of a host. Further investigation into the biological consequences of commensal microbiota alteration by γ-PGA-containing supplement consumption is warranted.

BACKGROUND/OBJECTIVES: Poly-γ-glutamic acid (γ-PGA), a natural polymer found in fermented soybean products, has been reported to play a prebiotic role in the gut. This intervention study investigated the effects of γ-PGA-containing supplement consumption on urinary microbiota in healthy adults because of limited data on such investigation. SUBJECTS/METHODS: A 4-week parallel trial including 39 male and female Korean adults, who were free of chronic diseases and infection, was designed as a randomized, doubleblinded, placebo-controlled study. A total of 30 participants completed the study wherein the intervention group (n = 17) received a mixture supplement containing 600 mg/day of γ-PGA and 100 mg/day of vitamin B6, while the control group (n = 13) received a placebo.Paired datasets (baseline and endpoint data) of microbiota profiles, which were constructed via urinary assays of microbe-derived extracellular vesicles, were analyzed and compared between the two groups. RESULTS: Only the intervention group yielded significant results for the Bray-Curtis and Jaccard dissimilarity indices between baseline and endpoint data (P < 0.05). In the phylumlevel analysis of microbial composition, the Firmicutes to Bacteroidetes ratio (FB ratio) tended to decrease from baseline in the intervention group; however, it increased in the control group.Differences between the baseline and endpoint FB ratios were significant between the two groups (P < 0.05). CONCLUSION This study’s findings suggest that γ-PGA-vitamin B6 supplementation potentially alters the microbial community composition of a host. Further investigation into the biological consequences of commensal microbiota alteration by γ-PGA-containing supplement consumption is warranted.

BACKGROUND/OBJECTIVES: Poly-γ-glutamic acid (γ-PGA), a natural polymer found in fermented soybean products, has been reported to play a prebiotic role in the gut. This intervention study investigated the effects of γ-PGA-containing supplement consumption on urinary microbiota in healthy adults because of limited data on such investigation. SUBJECTS/METHODS: A 4-week parallel trial including 39 male and female Korean adults, who were free of chronic diseases and infection, was designed as a randomized, doubleblinded, placebo-controlled study. A total of 30 participants completed the study wherein the intervention group (n = 17) received a mixture supplement containing 600 mg/day of γ-PGA and 100 mg/day of vitamin B6, while the control group (n = 13) received a placebo.Paired datasets (baseline and endpoint data) of microbiota profiles, which were constructed via urinary assays of microbe-derived extracellular vesicles, were analyzed and compared between the two groups. RESULTS: Only the intervention group yielded significant results for the Bray-Curtis and Jaccard dissimilarity indices between baseline and endpoint data (P < 0.05). In the phylumlevel analysis of microbial composition, the Firmicutes to Bacteroidetes ratio (FB ratio) tended to decrease from baseline in the intervention group; however, it increased in the control group.Differences between the baseline and endpoint FB ratios were significant between the two groups (P < 0.05). CONCLUSION This study’s findings suggest that γ-PGA-vitamin B6 supplementation potentially alters the microbial community composition of a host. Further investigation into the biological consequences of commensal microbiota alteration by γ-PGA-containing supplement consumption is warranted.

OBJECTIVES: It is necessary to improve the pathology workflow. A workflow task analysis was performed using a pathology picture archiving and communication system (pathology PACS) in order to propose a user interface for the Pathology PACS considering user experience. METHODS: An interface analysis of the Pathology PACS in Seoul National University Hospital and a task analysis of the pathology workflow were performed by observing recorded video. Based on obtained results, a user interface for the Pathology PACS was proposed. RESULTS: Hierarchical task analysis of Pathology PACS was classified into 17 tasks including 1) pre-operation, 2) text, 3) images, 4) medical record viewer, 5) screen transition, 6) pathology identification number input, 7) admission date input, 8) diagnosis doctor, 9) diagnosis code, 10) diagnosis, 11) pathology identification number check box, 12) presence or absence of images, 13) search, 14) clear, 15) Excel save, 16) search results, and 17) re-search. And frequently used menu items were identified and schematized. CONCLUSIONS: A user interface for the Pathology PACS considering user experience could be proposed as a preliminary step, and this study may contribute to the development of medical information systems based on user experience and usability.
Diagnosis ; Information Systems ; Medical Records ; Pathology* ; Radiology Information Systems ; Seoul ; Task Performance and Analysis ; User-Computer Interface ; Workflow

Objective: Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma. Methods: This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30-day mortality. Results: In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality. Conclusion Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.

Lipoma is a common benign tumor found at various sites in the body, but it is rarely encountered in the middle ear. We report a case of a 5-month-old girl who presented a middle ear lipoma, which was successfully removed by canal wall up mastoidectomy. To the best our knowledge, this is the youngest case of rare middle ear lipoma, which has ever been reported in the literature.

Lipoma is a common benign tumor found at various sites in the body, but it is rarely encountered in the middle ear. We report a case of a 5-month-old girl who presented a middle ear lipoma, which was successfully removed by canal wall up mastoidectomy. To the best our knowledge, this is the youngest case of rare middle ear lipoma, which has ever been reported in the literature.
Ear, Middle ; Female ; Humans ; Infant ; Lipoma ; Otitis Media