Purpose: This study was performed to compare clinical features and emergency department (ED) outcomes between children and adults with non‑typhoidal Salmonella (NTS) gastroenteritis in a single‑center cohort. Methods: We retrospectively reviewed electronic medical records of ED patients with stool multiplex polymerase chain reaction-confirmed NTS at CHA Bundang Medical Center from January 2016 through December 2021. Demographics, presentation, laboratory and imaging findings, microbiology, and treatments were abstracted. Primary outcomes were the high acuity (a Korean Triage and Acuity Scale level 1-2), ED length of stay, and disposition. Results: Of 189 patients, 134 were children and 55 adults. The children had fewer comorbidities (5.2% vs. 56.4%; P < 0.001) and high acuity (children, 0% vs. adults, 14.5%), shorter median ED length of stay (237.0 minutes [interquartile range, 188.0-336.0] vs. 360.0 minutes [335.0-569.0]; difference, 123.0 minutes [95% confidence interval, 85.0-328.0]; P < 0.001), and less frequent hospitalizations to the intensive care unit (children, 0% vs. adults, 14.5%; P < 0.001). Fever (94.8% vs. 63.6%) and hematochezia (37.3% vs. 0%) were more common in the children (Ps < 0.001), while adults had higher frequencies of abdominal pain (87.3% vs. 71.6%; P = 0.020) and enteritis/ileus on radiography (63.3% vs. 45.3%; P = 0.033), and higher median values of segmented white blood cells (79.0% vs. 69.4%; P = 0.010) and C‑reactive protein concentration (7.2 vs. 6.3mg/dL; P < 0.001). Ceftriaxone was more commonly used in the children (children, 72.7% vs. adults, 51.9%; P < 0.001). Conclusion Compared with the adults, the children with NTS gastroenteritis presented with lower clinical acuity, shorter ED stays, and no hospitalizations to the intensive care unit, despite more common fever and hematochezia. These findings may support a conservative ED approach in children with careful, indication‑based antibiotic use and highlight opportunities for antimicrobial stewardship.

Purpose: Children with tic disorders/Tourette syndrome (TD/TS) frequently present with co-occurring neuropsychiatric conditions, such as obsessive-compulsive disorder and a range of behavioral issues. However, these accompanying problems may be overlooked during diagnosis. This study aimed to investigate the neurocognitive and behavioral characteristics of children with TD/TS who visited a pediatric clinic. Methods: We retrospectively reviewed medical records of children diagnosed with TD/TS at a secondary referral center in Korea. A subset of these data was statistically compared with those from healthy controls. To minimize confounding factors, only children with cognitive development within the normal range were included. Results: Data from 36 children with TD/TS (27 males, nine females; ages 6 to 14 years, mean 9.5±2.1) were analyzed. The mean Full Scale Intelligence Quotient (FSIQ) on the Korean–Wechsler Intelligence Scales for Children (K-WISC) was 98.8±11.7 (n=24). Compared with healthy controls (n=38), the TD/TS group (n=13) scored significantly lower on the Perceptual Reasoning Index, despite no group difference in overall FSIQ (K-WISC-IV). On the Korean Child Behavior Checklist, the TD/TS group showed significantly higher rates of clinical-range scores in multiple domains, including anxiety, somatic complaints, attention problems, and obsessive-compulsive behaviors (P<0.05). The mean Korean-attention-deficit/hyperactivity disorder Rating Scale-IV (K-ARS-IV) score was 11.3±7.7, with 17.1% of participants exceeding the clinical threshold. Conclusion Children with TD/TS and normal cognitive development demonstrate specific neurocognitive weaknesses and elevated behavioral/emotional problems. Early behavioral and cognitive assessments should be incorporated into the initial evaluation.

Background: The accurate laboratory-based detection of respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is essential for effective patient management and infection control in the post–coronavirus disease 2019 era. In this study, the performance of the PowerChek Respiratory Virus Panels 1–4 assay (Kogene Biotech) in detecting non-SARS-CoV-2 respiratory viruses and SARS-CoV-2 was compared with those of two established commercial assays. Methods: Residual clinical respiratory specimens collected between December 2023 and February 2024 were retested using the PowerChek assay. Of the 129 specimens retested, 80 had tested positive for 14 non-SARS-CoV-2 respiratory virus targets in the Allplex Respiratory Panels 1–3 assay (Seegene) and 49 had been tested using the Alinity m SARS-CoV-2 assay (Abbott; 20 positive and 29 negative for SARS-CoV-2). Agreement, Cohen’s kappa, and discordant results were assessed. Results: For the 14 non-SARS-CoV-2 respiratory virus targets, the virus-specific overall percent agreement (OPA) ranged from 95.0% to 100%, the positive percent agreement (PPA) ranged from 66.7% to 100%, and the negative percent agreement (NPA) ranged from 96.0% to 100%, with kappa values of 0.64–1.00. Lower agreements were observed for human coronavirus OC43 and influenza A virus. For SARS-CoV-2 detection, the OPA was 98.0% (PPA, 95.0%; NPA, 100%; kappa, 0.96). Conclusion The detection performance of the PowerChek assay was comparable to those of the established assays for most respiratory virus targets, with lower agreement observed for some targets. These features support its practical utility for the routine multiplex molecular detection of respiratory viruses, including SARS-CoV-2.

Background: Alitretinoin, a pan-retinoid receptor agonist approved for chronic hand eczema, exhibits immunomodulatory effects that may benefit alopecia areata (AA). However, clinical evidence for its use in AA is limited. Objective: To evaluate alitretinoin's clinical efficacy and immunological mechanism in patients with AA. Methods: We reviewed retrospectively twenty-one patients with AA who were treated with alitretinoin, either as monotherapy (n=9) or add-on therapy (n=12). Treatment response was assessed using the Severity of Alopecia Tool (SALT) scores, and in vitro studies used human outer root sheath cells stimulated with interferon-γ and polyinosinic:polycytidylic acid to investigate the drug’s effects on inflammatory pathways. Results: Both groups showed significant reductions in SALT scores (p=0.04 and p=0.02, respectively). Patients with baseline SALT scores below 50 demonstrated superior improvement.Adverse events were mild, with headache (33.3%) and cheilitis (4.8%) being the most common. In vitro, alitretinoin suppressed interleukin-6 and tumor necrosis factor-α expression, decreased phosphorylation of signal transducer and activator of transcription (STAT) 1/STAT3, and downregulated major histocompatibility complex class I expression, suggesting restoration of hair follicle immune privilege. Conclusion Alitretinoin appears to be a safe and potentially effective treatment for patients with mild to moderate AA unresponsive to conventional therapies. Its role as a monotherapy or adjunctive option in selected cases warrants further investigation through larger controlled studies.

Background: A novel botulinum toxin type A (Protoxin; Protox Inc.) has been developed. Objective: To evaluate the efficacy and safety of the newly developed Protoxin compared to the approved drug onabotulinumtoxinA (OBoNT) in moderate to severe glabellar lines. Methods: Adults with a glabellar line Facial Wrinkle Scale (FWS) score of 2 (moderate) or 3 (severe) were enrolled in the study. Subjects were randomized in a 1:1 ratio to receive either Protoxin or OBoNT. A total of 20 units of botulinum toxin was injected at five sites in the glabellar region (4 units at each site). FWS scores were assessed at baseline and at weeks 4, 8, 12, and 16 post-injection. The primary endpoint was the proportion of subjects at week 4 who had a reduction of 2 or more points in FWS and a final score of 0 (none) or 1 (mild). Results: A total of 274 subjects were randomized, of whom 78.1% were female. At week 4 post-treatment, the improvement rate of glabellar lines was 62.22% in the Protoxin group and 62.96% in the OBoNT group. The lower limit of the two-sided 95% confidence interval (−12.24%) exceeded the −15% margin, confirming the non-inferiority of the new drug. Safety profiles were comparable between the two groups. Conclusion Protoxin demonstrated efficacy and safety profiles comparable to those of OBoNT in the treatment of moderate to severe glabellar lines.

Background: The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort. Methods: We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups. Results: The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001). Conclusions The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.

Background: Cytomegalovirus (CMV) infection is prevalent worldwide. Although Korea has historically shown high CMV IgG seropositivity ( > 95%), declines have been reported recently. We assessed current CMV IgG seropositivity and analyzed prevailing trends in the Korean population. Methods: Residual samples from individuals undergoing regular health checkups were analyzed. We assessed 1,978 samples (from 937 men and 1,041 women) where the age group distribution was relatively balanced. CMV IgG levels were measured at two institutions using a commercial immunoassay (Alinity i CMV IgG Reagent Kit, Abbott) following the manufacturer’s instructions. Results were interpreted as “reactive” when the CMV IgGconcentration was ≥ 6.0 arbitrary units (AU)/mL or “nonreactive” when the CMV IgG con-centration was < 6.0 AU/mL. Seropositivity was compared by sex and across age groups (20–29, 30–39, 40–49, and 50–59 yrs). Results: The overall CMV IgG seropositivity was 89.9% (1,778/1,978) and was significantly higher in men (91.7%, 859/937) than in women (88.3%, 919/1,041) (difference:3.4%; 95% confidence interval: 0.8%–6.0%; P = 0.012, chi-square test). No significant differences with regard to sex were found within each age group. Seropositivity increased with age, from 76.3% (347/455, 20–29 yrs) to 99.8% (448/449, 50–59 yrs) (P for trend < 0.001), consistently in both sexes. Conclusions Our findings provide the most up-to-date estimate of CMV IgG seropositivity in the Korean adult population. Because of lower seropositivity in younger adults, continued monitoring and further education are essential for CMV control and prevention.

Background: Copy number variations (CNVs) play an important role in human genetic disorders. Detection of exon-level CNVs is crucial for accurate clinical diagnosis. The CytoScan XON Array, a high-resolution microarray, was recently developed to detect exonic CNVs of various genes. Methods: We evaluated the clinical performance of the CytoScan XON Array using 59 patient samples with previously identified CNVs, confirmed via methods including multiple ligation-dependent probe amplification (MLPA), gene-dose PCR, and mRNA assay. Concordance between CytoScan XON and orthogonal methods was evaluated in target regions, and diagnostic utility was compared with that of genome sequencing (GS)-based CNV calling tools through analysis of false-positive CNVs in non-target genomic regions. Results: For target regions, the CytoScan XON Array achieved concordance rates of 89.8% and 92.5% at the exon and gene levels, respectively, for all CNV calls. Concordance was higher for multi-exon CNVs (100%) than that for single-exon CNVs (82.6%, P = 0.03). For non-target regions, false-positive CNV calls were reduced to fewer than 0.01 per gene per person through filtering strategies. The array exhibited false-positive detection rates within dosage-sensitive genes comparable with those of GS-based tools. Conclusions The CytoScan XON Array, a reliable tool for detecting exon-level CNVs in target regions, can serve as a complementary approach to GS-based CNV calling tools for genome-wide CNV screening with high resolution. However, its performance for single-exon CNVs requires further optimization. Cross-validation with GS-based CNV calling tools is recommended to improve diagnostic accuracy.