Severe odontogenic deep neck infections (DNIs) can rapidly extend along cervical fascial planes and progress to descending necrotizing mediastinitis (DNM) with high mortality, requiring early diagnosis and multidisciplinary management, especially in elderly patients with comorbidities. We report two elderly patients with rapidly progressive odontogenic infections: one with DNM fulfilling Estrera’s criteria (Endo type IIA) and another with extensive DNI without mediastinal spread. Clinical features, serial contrast-enhanced computed tomography (CECT) findings, laboratory risk indicator for necrotizing fasciitis (LRINEC) score trends, microbiological results, surgical approaches were analyzed. Both patients presented withhigh LRINEC scores (≥8) and polymicrobial infections, involving multidrug-resistant organisms. Case 1 required five staged cervicothoracic debride-ments, negative pressure wound therapy, and delayed skin grafting. Case 2 underwent three surgeries with gland excision, hemorrhage control. Airway patency was maintained without tracheostomy through coordinated airway monitoring. Targeted antimicrobial adjustments and systemic optimization facilitated infection control. Both patients recovered fully without recurrence. These cases emphasize the importance of early CECT evaluation, cautious interpretation of LRINEC scores in patients with metabolic comorbidities, individualized surgical debridement tailored to anatomical spread, and multidisciplinary collaboration. Personalized reconstructive strategies based on defect size and tissue viability are essential for functional restoration and successful outcomes.

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Background: The purpose of this study was to evaluate the effect of vanishing twin (VT) on maternal serum marker concentrations and nuchal translucency (NT). Methods: This is a secondary analysis of a multicenter prospective cohort study in 12 institutions. Serum concentrations of pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein (AFP), total human chorionic gonadotrophin, unconjugated estriol, and inhibin A in the second trimester were measured, and NT was measured between 10 and 14 weeks of gestation. Results: Among 6,793 pregnant women, 5,381 women were measured for serum markers in the first or second trimester, including 65 cases in the VT group and 5,316 cases in the normal singleton group. The cases in the VT group had a higher median multiple of the median value of AFP and inhibin A than the normal singleton group. The values of other serum markers and NT were not different between the two groups. After the permutation test with adjustment,AFP and inhibin A remained significant differences. The frequency of abnormally increased AFP was also higher in the VT group than in the normal singleton group. Conclusion VT can be considered as an adjustment factor for risk assessment in the secondtrimester serum screening test.

Vocal cord dysfunction is one of the causes of dyspnea and is characterized by paradoxical closure of the vocal cords. The paradoxical movement of the vocal cords produces the limitation of airflow, resulting dyspnea, chest tightening, hoarseness, stridor, or wheezing. These findings are similar to those of other upper airway obstruction diseases or asthma; therefore, a high index of suspicion and clear differential diagnosis are required. Here, we discuss a case of vocal cord dysfunction aged 10 years that presented recurrent wheezing and dyspnea. The abnormal movement of the vocal cords was observed by fiberoptic laryngotracheobronchoscopy, which was correlated with stridor during respiration. Repeated episodic symptoms were controlled by the multidisciplinary team approach; however, surgical treatment was needed to stabilize the symptom.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Background: Recently, microbiome research has been actively conducted for various skin areas. However, no study has yet compared the microbiome of bacteria and fungi in the ear canal of healthy individuals and patients with chronic otitis externa in Korea. Objective: This study aimed to investigate the difference in the distribution of fungal and bacterial microbial communities in ear canal samples of healthy individuals and patients with chronic otitis externa. Methods: In 24 patients with bilateral chronic otitis externa and 24 healthy controls, cotton swabs were used to obtain samples from the bilateral ear canal. To characterize the fungal and bacterial communities, we sequenced and analyzed the 16S rRNA V4–V5 and ITS1 regions using Quantitative Insights into Microbial Ecology 2, respectively. Results: The alpha diversity analysis for bacteria and fungi confirmed that both richness and evenness decreased in the patient group. The beta diversity analysis for bacteria confirmed that these parameters differed between the control and patient groups. The beta diversity analysis for fungi showed no difference between the groups. Conclusion We observed different skin microbiomes in the patients with chronic otitis externa compared with those in the healthy individuals.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Objective: To examine the concordance between the oropharyngeal flora and peristomal wound culture bacteria following percutaneous endoscopic gastrostomy (PEG) placement. Methods: Cultures of oropharyngeal flora before PEG placement and peristomal wound cultures after PEG placement were examined prospectively in patients who underwent PEG between June 1, 2017, and June 1, 2019, at a local rehabilitation center. Microorganisms in the oropharyngeal flora and peristomal wound culture were identified, and the relationship between them was examined. The risk factors that may increase the PEG infection rate were also examined. Results: The predominant bacterium identified in the oropharyngeal flora and peristomal wounds in patients who required PEG was Pseudomonas aeruginosa. The concordance between the oropharyngeal flora and peristomal wound culture bacteria in patients with PEG infections was confirmed. Different oropharyngeal flora was observed in patients with a prolonged hospital stay compared to that of healthy adults. The concordance between the oropharyngeal flora and peristomal wounds was also identified with a high prevalence of gram-negative bacilli. There was no potential risk factor, such as comorbidities or length of hospitalization of patients associated with PEG infections. Conclusion Because the oropharyngeal flora showed concordance with the bacteria found in the PEG stoma site, management of the oropharyngeal flora before PEG insertion should be considered for patients with dysphagia.

Objectives: ：The purpose of this study was to find out how demographic factors, suicide attempt patterns, psychiatric history and management of suicide attempters affect the completion of emergency department (ED) based case management program. Methods: ：Among the patients who attempted suicide and visited the emergency department of Chung-Ang University Hospital from June 1, 2018 to May 31, 2021, 661 patients who agreed to case management were studied. After being discharged from the emergency department, subjects were registered for an eight-week follow-up service program. Hierarchical logistic regression analysis was conducted with demographic factors, suicide attempt patterns, psychiatric history and management as independent variables, and completion of case program as dependent variables. Results: ：Suicide attempt pattern had the most significant influence on the completion of case management program, followed by demographic factors, psychiatric history and management. Those who completed the case management program were significantly more likely to have suicide plans in the future, more authentic in sui-cide attempts, and had higher proportion of past suicide attempts than those who did not complete the program. Conclusions ：To ensure that the subjects complete the follow-up project program and get connected to community services, an individualized approach with consideration of suicide attempt patterns, demographic factors, and psychiatric history is needed.