Background and Objectives: Acute decompensated heart failure (ADHF) often necessitates invasive mechanical ventilation (MV) due to respiratory failure. Positive end-expiratory pressure (PEEP) is a critical component in MV management; however, the optimal PEEP level for patients with ADHF remains unclear. The High vErsus Low Positive end-expiratory pressure in mechanically ventilated patients with Acute Heart Failure (HELP-AHF) trial is a multicenter, open-label, randomized controlled study designed to compare the efficacy and safety of high versus low PEEP strategies in this population. Methods: A total of 120 patients with ADHF requiring MV within 24 hours of initiation will be randomized 1:1 to a high PEEP group (target: 10 cmH2 O) or a low PEEP group (target: 3 cmH2 O). Results: The primary outcome is ventilator-free days at day 28. Key secondary outcomes include in-hospital mortality, duration of intensive care unit and hospital stay, vasoactive-inotropic support, and rates of heart transplantation or left ventricular assist device implantation. Safety outcomes include hemodynamic instability requiring mechanical circulatory support, pulmonary complications, and weaning-related adverse events. Conclusions This HELP-AHF trial aims to provide valuable insights into optimal PEEP strategies in ADHF patients receiving invasive MV. Findings from this study have the potential to inform ventilatory management practices and improve outcomes in this high-risk population.

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: This study aims to develop and implement an economic evaluation using a micro-costing approach to provide a precise and transparent analysis of the direct costs of cystoscopic procedures in Korean hospitals. The study seeks to identify key cost components and evaluate whether current reimbursement rates accurately reflect these direct costs. Materials and Methods: Significant variations in cost items were identified across different studies. An economic evaluation was conducted using a micro-costing methodology for the cost analysis of cystoscopic procedures, developed through literature review, data collection from studies, and expert consultations. Results: Gangnam Severance Hospital (GSH) performed 2,188 cystoscopic procedures, including 1,847 cystoscopies and 341 JJ stent removals, with average costs of $100.8 and $110.6, respectively. At National Health Insurance Service Ilsan Hospital (NHIMC), 1,463 procedures were performed, including 1,167 cystoscopies and 296 JJ stent removals, with average costs of $119.2 and $125.3. Cystoscopy costs at GSH were driven by reprocessing ($45.8, 45.4%) and equipment ($33.1, 32.9%), while NHIMC’s were $52.5 (44.0%) for equipment and $48.7 (40.8%) for reprocessing. Both hospitals incurred financial losses, with NHIS (National Health Insurance Service) covering only about 71.7% and 60.6% of costs for cystoscopy, and 71.0% and 62.7% for JJ stent removal. Conclusions The significant discrepancy between HIRA (Health Insurance Review & Assessment Service)’s estimated costs and those identified here suggests that current fees for cystoscopic procedures may be underestimated and require reassessment.Given the results, reevaluating these rates is essential to ensure fair compensation for healthcare providers and to deliver optimal patient care.

Purpose: Temporomandibular disorder (TMD) is a multifactorial condition influenced by biological, psychological, and social factors. Some patients perceive dental treatment as the cause of their TMD, which may impact symptom perception and treatment response.This study aims to compare the psychosocial and clinical characteristics of patients who attribute their TMD onset to prior dental treatment (DT group) with those who do not (NT group). Methods: A total of 250 patients diagnosed with TMD at Pusan National University Dental Hospital between January and October 2024 were included. Patients were classified into the DT group (n=92) if they attributed their symptoms to previous dental procedures, while the remaining NT group (n=158) consisted of patients with other primary complaints. Patients were additionally categorized into Generation X (1965-1980), Generation Y (1981-1999), and Generation Z (2000-2012). Clinical assessments were conducted following the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and psychosocial factors were evaluated using the Oral Behaviors Checklist (OBC), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-15 (PHQ-15). Results: The DT group had a significantly higher mean age (54.16±16.87 years) compared to the NT group (39.71±19.12 years, p<0.001). Psychological distress scores (PHQ-9, GAD-7, and PHQ-15) were significantly higher in the DT group, particularly among Generation X patients (p<0.05). Muscle-related pain was more prevalent in the DT group (75%) than in the NT group. Interestingly, OBC scores were higher in the NT group (p<0.05). Conclusions Patients who attributed their TMD onset to dental treatment reported higher psychological distress and a greater prevalence of muscle-related pain, underscoring the need for a biopsychosocial approach to TMD management. Clinicians should consider the impact of patient perception on TMD symptoms and integrate psychological assessment and counseling to enhance treatment efficacy and patient adherence.

Vaccine-induced hypermetabolic lymph nodes have been clinically observed following coronavirus disease 2019 (COVID-19) mRNA vaccination. Specifically, the booster dose of the mRNA vaccines, produced by Pfizer and Moderna, has been linked to a relatively high incidence of lymphadenopathy. We present the case of a kidney transplant recipient who developed an enlarged abdominal mass after receiving a booster dose of the COVID-19 mRNA vaccine. This mass occupied the retroperitoneal space, infiltrated the psoas muscle, and resulted in ureteric compression and hydronephrosis. Percutaneous drainage and analysis of the perirenal fluid revealed the presence of lymphatic fluid. In summary, lymphadenopathy is a recognized adverse reaction to the Pfizer and Moderna vaccines. Patients with compromised immune systems should be informed about the incidence and potential severity of lymphadenopathy following booster vaccination.

Background: Lipohemarthrosis in the hip joint, a critical indicator for detecting occult femoral neck or acetabular fractures, has not been reported in cases of isolated greater trochanter (IGT) fractures. This study retrospectively reviewed 3-dimensional computed tomography (3D-CT) images of what appeared to be IGT fractures to find out the frequency of lipohemarthrosis and its implication for the necessity of internal fixation. Methods: From October 2004 to December 2019, 90 cases of suspected IGT fractures were evaluated using 3D-CT. After excluding 6 cases due to inadequate follow-up and 8 cases with poor imaging quality caused by metallic implants, 76 cases were included in the final analysis. The cohort consisted of 48 women and 28 men, with a mean age of 77 years (range, 39–97 years). The 3D-CT images were meticulously reviewed to identify lipohemarthrosis in the affected hip joints. Additionally, magnetic resonance (MR) images were available for 13 cases. Results: Sixty-three cases were IGT fractures; no cortical disruption was detected in the intertrochanteric area on CT images. Of these, 56 cases were successfully treated conservatively. Lipohemarthrosis was detected in 5 cases (7.9%), of which 2 were successfully managed with conservative treatment. The remaining 13 cases were classified as incomplete intertrochanteric fractures, with anterior cortical disruption identified in the intertrochanteric area on CT images. Lipohemarthrosis was observed in 3 of these cases (21.3%). In all cases evaluated with MR imaging (10 IGT fractures and 3 incomplete intertrochanteric fractures), varying degrees of intramedullary intertrochanteric extension were observed. Among these, lipohemarthrosis was detected in only 2 cases of IGT fracture, where the intramedullary extension did not cross the midline on mid-coronal images. One case was surgically fixed, but the other case was treated conservatively with success. Notably, 4 cases with intertrochanteric extension crossing the midline did not exhibit lipohemarthrosis. Conclusions Lipohemarthrosis was more frequently observed in incomplete intertrochanteric fractures than in IGT fractures.However, the presence of lipohemarthrosis alone should not be regarded as an indication for internal fixation.

Background: and Purpose: This clinical practice guideline provides evidence-based recommendations for treatment of dementia, focusing on cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists for Alzheimer’s disease (AD) and other types of dementia. Methods: Using the Population, Intervention, Comparison, Outcomes (PICO) framework, we developed key clinical questions and conducted systematic literature reviews. A multidisciplinary panel of experts, organized by the Korean Dementia Association, evaluated randomized controlled trials and observational studies. Recommendations were graded for evidence quality and strength using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Three main recommendations are presented: (1) For AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) are strongly recommended for improving cognition and daily function based on moderate evidence; (2) Cholinesterase inhibitors are conditionally recommended for vascular dementia and Parkinson’s disease dementia, with a strong recommendation for Lewy body dementia; (3) For moderate to severe AD, NMDA receptor antagonist (memantine) is strongly recommended, demonstrating significant cognitive and functional improvements. Both drug classes showed favorable safety profiles with manageable side effects. Conclusions This guideline offers standardized, evidence-based pharmacologic recommendations for dementia management, with specific guidance on cholinesterase inhibitors and NMDA receptor antagonists. It aims to support clinical decision-making and improve patient outcomes in dementia care. Further updates will address emerging treatments, including amyloid-targeting therapies, to reflect advances in dementia management.

Purpose: The purpose of this study was to develop an approach to alleviate the discomfort caused by sandbag compression after a bone marrow examination. This research examined the effects of applying a pressure hemostasis band on bleeding, pain, and discomfort at the bone marrow examination site. Methods: This study was conducted with a nonequivalent control group non-synchronized design. For 74 patients under evaluation who underwent bone marrow examination, sandbag compression was applied to the examination site in the control group (n=37), and a pressure hemostasis band was applied to the intervention group (n=37). In both groups, absolute bed rest was performed for two hours, and bleeding, pain, and discomfort at the examination site were measured. Results: After two hours of the bone marrow examination, there was no difference in bleeding on the gauze between the two groups (F=0.59, p=.444). Bleeding occurred in three patients in the intervention group and six in the control group (χ 2 =1.14, p=.479), with no cases of hematoma detected in either group. One hour post-examination, the control group experienced significantly higher pain (F=5.45, p=.022) and discomfort (F=5.68, p=.020) than the intervention group. However, pain and discomfort levels were similar between groups after two hours. Conclusion Compared to the sandbag compression group, the band application group showed no difference in bleeding and experienced less pain and discomfort at the examination site. This confirms that the pressure hemostasis band is a suitable alternative to sandbag compression in post-examination care.

Background and Objectives: Hearing loss significantly affects communication, psychosocial well-being, and quality of life. This study analyzes the National Health Insurance Service database to assess the trends and characteristics of hearing loss in South Korea from 2010 to 2020.Subjects and Method The database encompasses 97% of the Korean population, providing comprehensive data on medical history, prescriptions, and health examinations. The analysis used the World Health Organization’s ICD-10 definitions to categorize hearing loss types and examine their prevalence and incidence across various demographics over 11 years. Results: There was an overall annual increase of 4.62% in diagnosed cases of hearing loss, with the most significant rise among the elderly. The rate of increase accelerated from 3.32% between 2010 and 2014 to 6.49% between 2014 and 2020, corresponding with the improved hearing aid access facilitated by policy changes. Women showed a slightly higher increase than men. The data also indicated a consistent rise in abnormal hearing test results during health examinations, especially in older adults. Conclusion The study highlights an increasing trend in hearing loss diagnoses, driven by an aging population and enhanced detection facilitated by policy changes. These findings emphasize the need for continuous monitoring and targeted health policies to manage hearing loss effectively, offering valuable insights for global health management and policy development.