Objective: Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score. Methods: We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Results: Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0. Conclusion We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Purpose: Recently, deep learning techniques have been introduced for age estimation, with automated methods based on radiographic analysis demonstrating high accuracy. In this study, we applied convolutional neural network (CNN) techniques to the lower dentition area on orthopantomograms (OPGs) of children to develop an automated age estimation model and evaluate its accuracy for use in forensic dentistry. Methods: In this study, OPGs of 2,856 subjects aged 3-14 years were analyzed. The You Only Look Once (YOLO) V8 object detection technique was applied to extract the mandibular dentition area on OPGs, designating it as the region of interest (ROI). First, 200 radiographs were randomly selected, and were used to train a model for extracting the ROI. The trained model was then applied to the entire dataset. For the CNN image classification task, 80% of OPGs were allocated to the training set, while the remaining 20% were used as the test set. A transfer learning approach was employed using the ResNet50 and VGG19 backbone models, with an ensemble technique combining these models to improve performance. The mean absolute error (MAE) on the test set was used as the validation metric, and the model with the lowest MAE was selected. Results: In this study, the age estimation model developed using mandibular dentition region from OPGs achieved MAE and root mean squared error (RMSE) values of 0.501 and 0.742, respectively, on the test set, and MAE and RMSE values of 0.273 and 0.354, respectively, on the training set. Conclusions The automated age estimation model developed in this study demonstrated accuracy comparable to that of previous research and shows potential for applications in forensic investigations. Increasing the sample size and incorporating diverse deep learning techniques are expected to further enhance the accuracy of future age estimation models.

Objective: Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score. Methods: We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Results: Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0. Conclusion We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Objective: Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score. Methods: We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Results: Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0. Conclusion We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Purpose: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.

An herbal medicinal product consisting of three kinds of herbal materials, Prunella vulgaris L. (Lamiaceae), Clematis chinensis Osbeck (Ranunculaceae) and Trichosanthes kirilowii Max. (Cucurbitaceae) has been prescribed in the clinic for treating rheumatoid arthritis in Korea. In the present study, we investigated the antidepressive effect of this herbal complex extract (HCE) on lipopolysaccharide (LPS)-induced depression-like behavior. The effects of HCE on LPSinduced depressive-like behaviors were evaluated using a forced swimming test (FST) and splash test. In addition, we also evaluated locomotor activity and anxiety-like behaviors using the open field test and elevated plus-maze (EPM) test.Inflammatory cytokines were evaluated in the cortical regions. HCE attenuated anxiety-like behavior in the EPM test and depressive- and anhedonia-like behaviors induced by LPS in the FST and splash test. In addition, LPS-induced increases in the phosphorylation levels of protein kinase B (Akt) and glycogen synthase kinase 3 beta (GSK-3β) and expression levels of proinflammatory factors in the cortex were normalized by HCE. Moreover, decreases in the level of BDNF in the cortex were attenuated by HCE. These results suggest that HCE attenuates inflammation-induced depression-like behaviors through its normalization of Akt-GSK-3β signaling and proinflammatory factors and its upregulation of BDNF in the cortex and that HCE has therapeutic potential for depressive disorders in inflammatory states.