Heart failure (HF) is a major cause of mortality and morbidity in South Korea, imposing substantial physical, emotional, and financial burdens on patients and society. Despite the high burden of symptom and complex care needs of HF patients, palliative care and hospice services remain underutilized in South Korea due to cultural, institutional, and knowledge-related barriers. This position statement from the Korean Society of Heart Failure emphasizes the need for integrating palliative and hospice care into HF management to improve quality of life and support holistic care for patients and their families. By clarifying the role of palliative care in HF and proposing practical referral criteria, this position statement aims to bridge the gap between HF and palliative care services in South Korea, ultimately improving patient-centered outcomes and aligning treatment with the goals and values of HF patients.

Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Objective: As the coronavirus disease 2019 (COVID-19) pandemic has been prolonged, the pre-hospital screening test performed in hospitals has changed from polymerase chain reaction (PCR) to rapid antigen test (RAT). RAT has lower sensitivity than PCR, but a lower cost and shorter test time. In the hospital where this study was conducted, the preadmission COVID-19 test was changed from PCR to RAT on February 24, 2023. This study compared the efficacy of PCR and RAT as the pre-admission COVID-19 test. Methods: This was a retrospective observational study comparing two periods, 90 days from November 25, 2022 to February 23, 2023, and 90 days from February 28, 2023 to May 29, 2023. Patients hospitalized from the emergency medical center during these two periods were included. Binomial logistic regression was used to compare the emergency department length of stay (ED LOS) between the two groups (PCR vs. RAT). Logistic regression was used to compare the mortality. Results: Four thousand seven hundred and thirty-eight patients were admitted through the emergency room: 2,202 patients in the PCR group and 2,443 patients in the RAT group. No statistically significant differences in the characteristics and severity were observed between the two groups. The mean ED LOS of PCR 5.07 hours (interquartile range, 3.80-6.75) was longer than RAT 3.65 hours (interquartile range, 2.83-4.68) (P<0.001). Mortality was higher in PCR 8.9% than RAT 6.6% (P=0.005). Conclusion The study showed that ED LOS and mortality were reduced when using RAT rather than PCR as a preadmission COVID-19 test.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Since the role of the liver in metabolic dysfunction, including type 2 diabetes mellitus, was demonstrated, studies on non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) have shown associations between fatty liver disease and other metabolic diseases. Unlike the exclusionary diagnostic criteria of NAFLD, MAFLD diagnosis is based on the presence of metabolic dysregulation in fatty liver disease. Renaming NAFLD as MAFLD also introduced simpler diagnostic criteria. In 2023, a new nomenclature, steatotic liver disease (SLD), was proposed. Similar to MAFLD, SLD diagnosis is based on the presence of hepatic steatosis with at least one cardiometabolic dysfunction. SLD is categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related/-associated liver disease, alcoholrelated liver disease, specific etiology SLD, and cryptogenic SLD. The term MASLD has been adopted by a number of leading national and international societies due to its concise diagnostic criteria, exclusion of other concomitant liver diseases, and lack of stigmatizing terms. This article reviews the diagnostic criteria, clinical relevance, and differences among NAFLD, MAFLD, and MASLD from a diabetologist’s perspective and provides a rationale for adopting SLD/MASLD in the Fatty Liver Research Group of the Korean Diabetes Association.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Purpose: Results of initial endoscopic biopsy of gastric lesions often differ from those of the final pathological diagnosis. We evaluated whether an artificial intelligence-based gastric lesion detection and diagnostic system, ENdoscopy as AI-powered Device Computer Aided Diagnosis for Gastroscopy (ENAD CAD-G), could reduce this discrepancy. Materials and Methods: We retrospectively collected 24,948 endoscopic images of early gastric cancers (EGCs), dysplasia, and benign lesions from 9,892 patients who underwent esophagogastroduodenoscopy between 2011 and 2021. The diagnostic performance of ENAD CAD-G was evaluated using the following real-world datasets: patients referred from community clinics with initial biopsy results of atypia (n=154), participants who underwent endoscopic resection for neoplasms (Internal video set, n=140), and participants who underwent endoscopy for screening or suspicion of gastric neoplasm referred from community clinics (External video set, n=296). Results: ENAD CAD-G classified the referred gastric lesions of atypia into EGC (accuracy, 82.47%; 95% confidence interval [CI], 76.46%–88.47%), dysplasia (88.31%; 83.24%– 93.39%), and benign lesions (83.12%; 77.20%–89.03%). In the Internal video set, ENAD CAD-G identified dysplasia and EGC with diagnostic accuracies of 88.57% (95% CI, 83.30%– 93.84%) and 91.43% (86.79%–96.07%), respectively, compared with an accuracy of 60.71% (52.62%–68.80%) for the initial biopsy results (P<0.001). In the External video set, ENAD CAD-G classified EGC, dysplasia, and benign lesions with diagnostic accuracies of 87.50% (83.73%–91.27%), 90.54% (87.21%–93.87%), and 88.85% (85.27%–92.44%), respectively. Conclusions ENAD CAD-G is superior to initial biopsy for the detection and diagnosis of gastric lesions that require endoscopic resection. ENAD CAD-G can assist community endoscopists in identifying gastric lesions that require endoscopic resection.

Background: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. Methods: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Results: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). Conclusion There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.