Background: The management of sexually transmitted infections (STIs) at the national level is necessary for the health and well-being of individuals in society. The purpose of this study was to propose a redesign of the STI surveillance system by collecting opinions from experts. Methods: After the major STIs were reviewed, 1) gonorrhea, 2) chancroid, 3) Mycoplasma genitalium infection, and 4) trichomoniasis were selected as diseases requiring a redesign of the surveillance system through the Delphi method, a technique for solving problems by collecting opinions from experts. The expert panel was selected from experts on STIs (n = 17) and included members of the Korean Association of Urogenital Tract Infection and Inflammation, the Korean Society of Infectious Diseases, and the 3rd advisory committee on STIs. Results: The experts agreed upon the exclusion of surveillance for chancroid on the basis of the low incidence, with an agreement rate of 83%. The experts agreed upon the inclusion of M. genitalium in the surveillance system, with a high agreement rate of 88%. However, there was disagreement among the experts on whether to include trichomoniasis in the surveillance system and whether to switch to a mandatory surveillance system for gonorrhea. Conclusion Although a consensus was not reached in some of the surveys in this study, it involved the collection of various expert opinions. Therefore, policies should be promoted with a prioritized focus on items with high agreement, but items for which no consensus was reached need to be reviewed in greater depth through additional research and investigation.

Background: Mycobacterium avium complex (MAC) is a major cause of pulmonary nontuberculous mycobacterial disease; however, treatment outcomes remain suboptimal.Phenotypic drug susceptibility testing (DST) is conditionally recommended; however, conventional broth microdilution is labor-intensive. The Sensititre SLOMYCO® panel offers a standardized platform for DST of slowly growing mycobacteria. Methods: Eighty-six clinical MAC isolates (48 M. avium and 38 M. intracellulare) from respiratory specimens were tested for 13 antimicrobials using the SLOMYCO panel and reference Clinical and Laboratory Standards Institute (CLSI) broth microdilution methods at the Korean Institute of Tuberculosis. Essential agreement (EA) was defined as minimum inhibitory concentrations within ± 1 dilution, and categorical agreement (CA) was based on CLSI 2018 breakpoints for clarithromycin, amikacin, moxifloxacin, and linezolid. Results: The EA was high for amikacin (90%), moxifloxacin (92%), linezolid (92%), and ethambutol (98%). Moderate EA was observed for clarithromycin (79%), ciprofloxacin (67%), and doxycycline (63%), and low EA was observed for trimethoprim-sulfamethoxazole (34%).The CA values were 100%, 77.9%, 69.8%, and 47.7% for clarithromycin, amikacin, moxifloxacin, and linezolid, respectively. All isolates were clarithromycin-susceptible according to both methods, and no clarithromycin- or amikacin-resistant isolates were detected. Conclusion The SLOMYCO DST system demonstrated high agreement with the reference methods for clarithromycin and amikacin in the tested susceptible population. The variability in the results for moxifloxacin and linezolid highlights the need for refined breakpoints. The validation of resistant isolates is essential before the SLOMYCO system can be recommended for comprehensive clinical applications.

Background: The increasing rate of cesarean delivery (CD) is a significant concern in many societies worldwide. Vaginal delivery (VD) is preferred over CD for subsequent pregnancies after successful VD, for women with no specific obstetrical indications, primarily because of concerns about potential complications arising from the surgical procedure. However, the factors that influence the decision of requesting a CD have not yet been thoroughly investigated. This study aimed to examine the underlying reasons that lead mothers to choose CDs in subsequent pregnancies following a VD. Methods: This retrospective study included women who underwent VD in their first pregnancy between 2011 and 2020 and had a second pregnancy and childbirth within the study period. The analysis focused on women eligible for a trial of labor (TOL) in their second pregnancy, excluding those with conditions necessitating a CD. The study defined two groups: the TOL in second pregnancy (TOLS) group, consisting of women with one previous VD who attempted a VD in their subsequent pregnancy; and the CD on maternal request in second pregnancy (CDRS) group, comprising women with one past VD who opted for a CD in their second pregnancy without medical indication. The TOLS and CDRS groups were compared regarding obstetric and neonatal outcomes. Results: During the study period, 372,749 women met the inclusion criteria: 368,311 women in TOLS group and 4,438 women in CDRS group. In the regression analysis for the CDRS, several factors were identified as increasing the risk of choosing CD, including age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.05–1.07), interval between the first and second pregnancies (aOR, 1.32; 95% CI 1.29–1.35), a history of pre-existing hypertension (aOR, 1.76; 95% CI, 1.17–2.65), gestational diabetes mellitus (GDM) during the first pregnancy (aOR, 1.19; 95% CI, 1.05–1.36), hypertensive disease during pregnancy (HDP) (aOR, 1.33; 95% CI, 1.06–1.67), preterm labor during the first pregnancy (aOR, 1.57;95% CI, 1.32–1.86), postpartum hemorrhage (aOR, 1.33; 95% CI, 1.21–1.47), traumatic event during delivery (aOR, 1.19; 95% CI, 1.12–1.28), surgical VD (aOR, 1.29; 95% CI, 1.19–1.40), and pregnancies with abortive outcomes between the first and second pregnancies (aOR, 1.18; 95% CI, 1.08–1.29). Additionally, women with pre-existing diabetes (aOR, 1.53; 95% CI, 1.24–1.89), pre-existing hypertension (aOR, 1.69; 95% CI, 1.26–2.26), GDM (aOR, 1.23; 95% CI, 1.11–1.37), or HDP (aOR, 2.57; 95% CI, 2.24–2.94) during the second pregnancy continued to exhibit an increased risk of opting for CD even after adjustment. Conclusion CD after VD was more prevalent among women with certain demographic characteristics and obstetric histories. Investigating the factors influencing women to request CD can be helpful in making informed decisions about safe delivery methods and may also affect the CD rate.

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs). Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters. Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36. Conclusion Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs). Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters. Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36. Conclusion Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.