Background and Objectives: The Valsalva test, although commonly utilized to assess the Eustachian tube function, is limited by drawbacks such as inconsistent pressure increases in the nasal cavity. Thus we introduced the “Popper test,” a tympanic membrane inflation test using the automatic middle ear inflation device known as middle ear inflation device (MEID), to explore its viability as an alternative to the Valsalva test.Subjects and Method We sampled 80 ears from patients between June 1, 2023, and August 1, 2023. Each patient underwent both the Valsalva and Popper tests using the MEID. Participants were divided into three categories: the “unable” group (patients who could not follow the Valsalva maneuver) and the “successful” and “unsuccessful” groups (patients whose attempts at the Valsalva or Popper tests either successed or failed). Success or failure was determined using an otoscope to assess the bulging of the tympanic membrane. Results: Of the 68 ears with normal middle ear pressure, 30.9% (21 ears) showed an inability to perform the Valsalva test, 45.6% (31 ears) successfully inflated the tympanic membrane via the Valsalva test, and 23.5% (16 ears) failed. Conversely, the Popper test resulted in an 88.2% (60 ears) success rate for inflating the tympanic membrane, with only 11.8% (8 ears) failing. Conclusion Variability observed in the Valsalva test outcomes may be attributed to individual differences and the instructor’s technique. MEID, as utilized in the Popper test, offers a promising alternative to the Valsalva test, potentially enhancing the reliability by minimizing individual variation. However, the diagnostic performance may be dependent on the properties of the MEID.

This study explores the development, roles, and key initiatives of the Regional Environmental Health Centers in Korea, detailing their evolution through four distinct phases and their impact on environmental health policy and local governance. It chronicles the establishment and transformation of these centers from their inception in May 2007, through four developmental stages. Originally named Environmental Disease Research Centers, they were subsequently renamed Environmental Health Centers following legislative changes. The analysis includes the expansion in the number of centers, the transfer of responsibilities to local governments, and the launch of significant projects such as the Korean Children’s Environmental Health Study (Ko-CHENS ). During the initial phase (May 2007–February 2009), the 10 centers concentrated on research-driven activities, shifting from a media-centered to a receptor-centered approach. In the second phase, prompted by the enactment of the Environmental Health Act, six additional centers were established, broadening their scope to address national environmental health issues. The third phase introduced Ko-CHENS, a 20-year national cohort project designed to influence environmental health policy by integrating research findings into policy frameworks. The fourth phase marked a decentralization of authority, empowering local governments and redefining the centers' roles to focus on regional environmental health challenges. The Regional Environmental Health Centers have significantly evolved and now play a crucial role in addressing local environmental health issues and supporting local government policies. Their capacity to adapt and respond to region-specific challenges is essential for the effective implementation of environmental health policies, reflecting geographical, socioeconomic, and demographic differences.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background and Objectives: Outcomes of deferring percutaneous coronary intervention (PCI) without invasive physiologic assessment for intermediate coronary lesions is uncertain.We sought to compare long-term outcomes between medical treatment and PCI of intermediate lesions without invasive physiologic assessment. Methods: A total of 899 patients with intermediate coronary lesions between 50% and 70% diameter-stenosis were randomized to the conservative group (n=449) or the aggressive group (n=450). For intermediate lesions, PCI was performed in the aggressive group, but was deferred in the conservative group. The primary endpoint was major adverse cardiac events (MACE, a composite of all-cause death, myocardial infarction [MI], or ischemia-driven any revascularization) at 3 years. Results: The number of treated lesions per patient was 0.8±0.9 in the conservative group and 1.7±0.9 in the aggressive group (p=0.001). At 3 years, the conservative group had a significantly higher incidence of MACE than the aggressive group (13.8% vs. 9.3%; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.00–2.21; p=0.049), mainly driven by revascularization of target intermediate lesion (6.5% vs. 1.1%; HR, 5.69; 95% CI, 2.20–14.73;p<0.001). Between 1 and 3 years after the index procedure, compared to the aggressive group, the conservative group had significantly higher incidence of cardiac death or MI (3.2% vs.0.7%; HR, 4.34; 95% CI, 1.24–15.22; p=0.022) and ischemia-driven any revascularization. Conclusions For intermediate lesions, medical therapy alone, guided only by angiography, was associated with a higher risk of MACE at 3 years compared with performing PCI, mainly due to increased revascularization.

Background/Aims: The Korean guidelines for Helicobacter pylori treatment were revised in 2020, however, the extent of adherence to these guidelines in clinical practice remains unclear. Herein, we initiated a prospective, nationwide, multicenter registry study in 2021 to evaluate the current management of H.pylori infection in Korea. Methods: This interim report describes the adherence to the revised guidelines and their impact on firstline eradication rates. Data on patient demographics, diagnoses, treatments, and eradication outcomes were collected using a web-based electronic case report form. Results: A total of 7,261 patients from 66 hospitals who received first-line treatment were analyzed.The modified intention-to-treat eradication rate for first-line treatment was 81.0%, with 80.4% of the prescriptions adhering to the revised guidelines. The most commonly prescribed regimen was the 14-day clarithromycin-based triple therapy (CTT; 42.0%), followed by tailored therapy (TT; 21.2%), 7-day CTT (14.1%), and 10-day concomitant therapy (CT; 10.1%). Time-trend analysis demonstrated significant increases in guideline adherence and the use of 10-day CT and TT, along with a decrease in the use of 7-day CTT (all p<0.001). Multivariate logistic regression analysis revealed that guideline adherence was significantly associated with first-line eradication success (odds ratio, 2.03; 95% confidence interval, 1.61 to 2.56; p<0.001). Conclusions The revised guidelines for the treatment of H. pylori infection have been increasingly adopted in routine clinical practice in Korea, which may have contributed to improved first-line eradication rates. Notably, the 14-day CTT, 10-day CT, and TT regimens are emerging as the preferred first-line treatment options among Korean physicians.

Purpose: The purpose of this study was to determine the characteristics of patients with failed initial Kasai portoenterostomy (KP) and to compare the long-term prognosis of redo-KP with that of liver transplantation (LT) in these patients. Methods: The medical records of patients with biliary atresia (BA) who failed initial KP from 2010 to 2021 at a single center were retrospectively analyzed. KP failure was defined as persistent jaundice (total bilirubin concentration, ≥2.0 mg/dL) after KP or the performance of LT. Results: During the study period, 32 patients experienced initial KP failure, with 10 undergoing redo-KP and 22 undergoing LT. Redo-KP was successful in a minority of patients with failed initial KP, but the complications, particularly cholangitis, were more frequent in the redo-KP group. The long-term prognosis of redo-KP compared to LT showed that while some patients benefited from native liver survival after redo-KP, LT remains the more definitive solution for sustained liver function and survival in patients with BA. Conclusion The only factor differing significantly between patients who underwent redo-KP and LT after failed initial KP was complications of cholangitis. Redo-KP was successful in 4 of 10 patients with failed initial KP, suggesting that redo-KP may be a treatment option in patients with BA and failed initial KP.

Background and Objectives: The Valsalva test, although commonly utilized to assess the Eustachian tube function, is limited by drawbacks such as inconsistent pressure increases in the nasal cavity. Thus we introduced the “Popper test,” a tympanic membrane inflation test using the automatic middle ear inflation device known as middle ear inflation device (MEID), to explore its viability as an alternative to the Valsalva test.Subjects and Method We sampled 80 ears from patients between June 1, 2023, and August 1, 2023. Each patient underwent both the Valsalva and Popper tests using the MEID. Participants were divided into three categories: the “unable” group (patients who could not follow the Valsalva maneuver) and the “successful” and “unsuccessful” groups (patients whose attempts at the Valsalva or Popper tests either successed or failed). Success or failure was determined using an otoscope to assess the bulging of the tympanic membrane. Results: Of the 68 ears with normal middle ear pressure, 30.9% (21 ears) showed an inability to perform the Valsalva test, 45.6% (31 ears) successfully inflated the tympanic membrane via the Valsalva test, and 23.5% (16 ears) failed. Conversely, the Popper test resulted in an 88.2% (60 ears) success rate for inflating the tympanic membrane, with only 11.8% (8 ears) failing. Conclusion Variability observed in the Valsalva test outcomes may be attributed to individual differences and the instructor’s technique. MEID, as utilized in the Popper test, offers a promising alternative to the Valsalva test, potentially enhancing the reliability by minimizing individual variation. However, the diagnostic performance may be dependent on the properties of the MEID.

This study explores the development, roles, and key initiatives of the Regional Environmental Health Centers in Korea, detailing their evolution through four distinct phases and their impact on environmental health policy and local governance. It chronicles the establishment and transformation of these centers from their inception in May 2007, through four developmental stages. Originally named Environmental Disease Research Centers, they were subsequently renamed Environmental Health Centers following legislative changes. The analysis includes the expansion in the number of centers, the transfer of responsibilities to local governments, and the launch of significant projects such as the Korean Children’s Environmental Health Study (Ko-CHENS ). During the initial phase (May 2007–February 2009), the 10 centers concentrated on research-driven activities, shifting from a media-centered to a receptor-centered approach. In the second phase, prompted by the enactment of the Environmental Health Act, six additional centers were established, broadening their scope to address national environmental health issues. The third phase introduced Ko-CHENS, a 20-year national cohort project designed to influence environmental health policy by integrating research findings into policy frameworks. The fourth phase marked a decentralization of authority, empowering local governments and redefining the centers' roles to focus on regional environmental health challenges. The Regional Environmental Health Centers have significantly evolved and now play a crucial role in addressing local environmental health issues and supporting local government policies. Their capacity to adapt and respond to region-specific challenges is essential for the effective implementation of environmental health policies, reflecting geographical, socioeconomic, and demographic differences.

Background and Objectives: The Valsalva test, although commonly utilized to assess the Eustachian tube function, is limited by drawbacks such as inconsistent pressure increases in the nasal cavity. Thus we introduced the “Popper test,” a tympanic membrane inflation test using the automatic middle ear inflation device known as middle ear inflation device (MEID), to explore its viability as an alternative to the Valsalva test.Subjects and Method We sampled 80 ears from patients between June 1, 2023, and August 1, 2023. Each patient underwent both the Valsalva and Popper tests using the MEID. Participants were divided into three categories: the “unable” group (patients who could not follow the Valsalva maneuver) and the “successful” and “unsuccessful” groups (patients whose attempts at the Valsalva or Popper tests either successed or failed). Success or failure was determined using an otoscope to assess the bulging of the tympanic membrane. Results: Of the 68 ears with normal middle ear pressure, 30.9% (21 ears) showed an inability to perform the Valsalva test, 45.6% (31 ears) successfully inflated the tympanic membrane via the Valsalva test, and 23.5% (16 ears) failed. Conversely, the Popper test resulted in an 88.2% (60 ears) success rate for inflating the tympanic membrane, with only 11.8% (8 ears) failing. Conclusion Variability observed in the Valsalva test outcomes may be attributed to individual differences and the instructor’s technique. MEID, as utilized in the Popper test, offers a promising alternative to the Valsalva test, potentially enhancing the reliability by minimizing individual variation. However, the diagnostic performance may be dependent on the properties of the MEID.