Objective: Internet gaming disorder (IGD) is a growing problem, particularly among adolescents. Although cocaine- and amphetamine- regulated transcript (CART) has been explored as a potential biomarker for addictive disorders, its relationship with IGD remains poorly understood. This study investigated the differences in serum CART levels between adolescents with IGD and healthy controls (HCs) in order to find potential biomarkers as a therapeutic target in IGD. Additionally, we investigated correlations of serum CART levels with personality traits within the IGD group. Methods: A total of 114 adolescents participated in this study (43 in the IGD group and 71 in the HC group). Blood samples (10 mL) were collected and serum CART concentrations were determined using an enzyme-linked immunosorbent assay. Participants also completed the Junior Temperament and Character Inventory. Results: Serum CART levels in the IGD group were significantly lower than those in the HC group (p<0.05). IGD participants had higher novelty-seeking and harm-avoidance traits, accompanied by reduced persistence, self-directedness, and cooperativeness. Notably, a significant correlation emerged between serum CART levels and cooperativeness within the IGD group. Lower cooperativeness trait scores could indicate reduced social interaction. Conclusion The present findings suggest serum CART levels might serve as a neurobiological marker for cooperativeness function in adolescents with IGD.

Objective: Vulnerability to internet gaming disorder (IGD) has increased as internet gaming continues to grow. Cocaine- and amphetamine-regulated transcript (CART) is a hormone that plays a role in reward, anxiety, and stress. The purpose of this study was to identify the role of CART in the pathophysiology of IGD. Methods: The serum CART levels were measured by enzyme-linked immunosorbent assay, and the associations of the serum CART level with psychological variables were analyzed in patients with IGD (n=31) and healthy controls (HC) (n=42). Results: The serum CART level was significantly lower in the IGD than HC group. The IGD group scored significantly higher than the HC group on the psychological domains of depression, anxiety, the reward response in the Behavioral Activation System and Behavioral Inhibition System. There were no significant correlations between serum CART level and other psychological variables in the IGD group. Conclusion Our results indicate that a decrease in the expression of the serum CART level is associated with the vulnerability of developing IGD. This study supports the possibility that CART is a biomarker in the pathophysiology of IGD.

Purpose: Considering the risk of coronavirus disease (COVID-19) transmission through infected droplets, emergency department (ED) operations in response to febrile patients should be planned. We investigated the general and clinical characteristics of febrile patients visiting the ED and changes in admission rates via the ED during the COVID-19 outbreak. Materials and Methods: We performed a retrospective analysis of prospectively collected patients who visited 402 EDs in the Republic of Korea with febrile symptoms between January 27 and May 31, 2020 and compared them to those enrolled before the COVID-19 outbreak. The primary outcome was admission rate; the secondary outcome was length of stay (LOS) in the ED. Results: In total, 266519 patients had febrile symptoms at ED presentation after the COVID-19 outbreak. In 2019, before the outbreak, there were 437762 patients. The rate of ED visits among pediatric patients (aged <15 years) decreased to 21.4% after the COVID-19 outbreak, compared with 41.8% in 2019. The proportion of patients admitted after ED management was higher after the outbreak (31.3%) than before (25.2%). The adjusted odds ratio for admission was 1.04 (95% confidence interval: 1.02–1.05) after the outbreak. Compared to before the COVID-19 outbreak, the median ED LOS increased by 16 min after the outbreak. Conclusion This study confirmed that admission rates and ED LOS increased for febrile patients visiting the ED after the COVID-19 outbreak. This could provide evidence for developing ED-related strategies in response to the ongoing COVID-19 outbreak and other infectious disease pandemics.