Purpose: Laryngomalacia exhibits diverse morphological patterns, severities, and comorbidities. Defining clinical phenotypes could improve management and prognosis. This study aimed to identify and characterize phenotypes using cluster analysis and to evaluate prognostic factors. Methods: We retrospectively reviewed records of 195 children diagnosed with laryngomalacia between 2014 and 2023 using flexible laryngoscopy or bronchoscopy. Demographics, endoscopic findings, comorbidities, and outcomes up to 1 year of age were collected. Hierarchical cluster analysis was conducted using 10 clinical variables. Results: Four phenotypes emerged: cluster 1 (n= 75, 38.5%), Groningen Laryngomalacia Classification System (GLCS) type 1 dominant-mild; cluster 2 (n= 35, 17.9%), GLCS type 2 dominant-mild; cluster 3 (n= 40, 20.5%), severe with multiple comorbidities; and cluster 4 (n = 45, 23.1%), GLCS combined-type moderate. Distinct clinical courses were observed. Cluster 3 showed the highest rates of surgical intervention (32.5%, P < 0.001), pediatric intensive care unit admission (17.5%, P = 0.016), and Emergency Department (ED) visits (60.0%, P= 0.013) for respiratory problems during the first year. When stratified by comorbidities, children with multiple comorbidities, particularly those with major feeding problems had a higher risk of hospitalization (adjusted odds ratio [aOR], 2.65;95% confidence interval [CI], 1.11–6.33) and ED visits (aOR, 3.17; 95% CI, 1.39–7.23), even after adjusting for sex and severity. Conclusion Four clinically meaningful phenotypes of laryngomalacia were identified from the cluster analysis based on morphology, comorbidities, and disease severity. Children with multiple comorbidities accompanied by feeding problems had the greatest risk of hospitalization and ED visits for respiratory problems within the first year, even after adjusting for the severity of laryngomalacia.

Purpose: To report a case of recurrent hypotony and exudative choroidal detachment in a patient with pseudoexfoliation glaucoma following the use of a topical preservative-free prostaglandin–timolol fixed combination eye drop.Case summary: A 74-year-old diabetic patient with a history of trabeculectomy for pseudoexfoliation glaucoma presented with conjunctival hyperemia, ocular pain, and blurred vision 3 months after using a preservative free prostaglandin-timolol fixed combination. Intraocular pressure (IOP) was markedly reduced to 6 mmHg and fundus examination revealed severe exudative choroidal detachment involving three quadrants. Treatment with oral and topical corticosteroids, cycloplegics, and non-steroidal anti-inflammatory drugs normalized his IOP to 15 mmHg and resolved the detachment within 3 weeks. Two weeks later, the patient inadvertently reused the same medication mistaking it for artificial tears. Symptoms recurred the following day with his IOP dropping to 2 mmHg and choroidal detachment affecting all four quadrants. Re-treatment led to full recovery within 3 weeks. Conclusions Choroidal detachment following use of combination therapy with a prostaglandin analog and an aqueous suppressant is a rare complication. Patients with pseudoexfoliation syndrome and diabetes may be particularly susceptible. Vigilant monitoring of IOP and fundus status is recommended when prescribing these agents to individuals with multiple risk factors.

Purpose: This study evaluated the long-term clinical outcomes of silicone tube intubation using a Nunchaku® (FCI Ophthalmics Inc., Pembroke, MA, USA) tube in adult patients with epiphora. Methods: A prospective study was conducted on 42 eyes in 32 patients who underwent silicone tube intubation with a Nunchaku® tube between March 2023 and September 2023. Clinical manifestations, Munk scale scores, lacrimal syringing test results, and tear meniscus height were assessed before and after surgery. Surgical success was defined as a Munk score of ≤ 1. Results: The mean age of the participants was 56.2 years. Preoperative lacrimal irrigation testing revealed partial obstruction in 29 eyes (69.0%), patent passage in 11 eyes (26.2%), and punctal stenosis in 2 eyes (4.76%). The mean operative time was 6.4 minutes for monocular procedures and 9.7 minutes for binocular procedures. At three months postoperatively, 33 eyes (78.6%) in 28 patients achieved a Munk scale score of ≤ 1. No significant differences were observed between the surgical success and failure groups in terms of preoperative Munk scale scores, lacrimal syringing test results, or tear meniscus height. One patient who underwent binocular surgery experienced worsening symptoms in both eyes postoperatively with associated punctal inflammation and granuloma formation necessitating early silicone tube removal. Slit punctum was observed in 17 eyes across 11 patients, six of whom underwent a snip procedure during surgery. Conclusions Silicone tube intubation using the Nunchaku-style tube is a relatively simple and effective treatment for nasolacrimal duct obstruction. However, an increased incidence of lacrimal punctum-related complications was observed compared to previous studies, indicating the need for caution when performing the snip procedure concurrently.

Purpose: Autism spectrum disorder (ASD) exhibits heterogeneous developmental trajectories; however, longitudinal studies using the Korean Childhood Autism Rating Scale (K-CARS) are scarce. This study examined diagnostic changes and related developmental characteristics through repeated K-CARS assessments. Methods: We retrospectively reviewed the medical records of children who underwent repeated K-CARS assessments between May 2021 and December 2024 at Gyeongsang National University Hospital. Based on diagnostic status at the initial (T1) and follow-up (T2) evaluations, participants were classified as having persistent ASD (ASD at T1 and T2), emerging ASD (non-ASD at T1 but ASD at T2), or desisting ASD (ASD at T1 but non-ASD at T2). Developmental profiles were evaluated using the social quotient (SQ), visual-motor integration (VMI), and language quotients. Results: Forty-three children (32 boys; median age, 2.9 years at T1 and 4.3 years at T2) were included. Twenty-two met ASD criteria at T1, and 15 (68%) retained the diagnosis at T2. Across the cohort, 15 (35%) had persistent ASD, 21 (49%) had emerging ASD, and seven (16%) had desisting ASD. The desisting group showed higher baseline VMI and better outcomes at follow-up. The emerging group initially had higher SQ and VMI than the persistent group, but these differences disappeared over time. Higher baseline VMI was associated with desisting status and higher baseline SQ with emerging ASD (odds ratios, 3.14 and 2.59 per standard deviation increase, respectively; P=0.06 and P=0.07). Conclusion Early ASD diagnoses were generally stable yet variable, supporting repeated assessment. Baseline VMI and SQ may relate to later diagnostic changes.

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: Current guidelines recommend factor IIa- or Xa-specific inhibitors over warfarin analogs for preventing thromboembolic stroke in patients with atrial fibrillation (AF).However, their plasma concentrations in Korean patients are not well understood. Methods: We conducted a single-center laboratory study to determine the distribution ranges of peak and trough concentrations of three factor Xa inhibitors (apixaban, edoxaban, and rivaroxaban) prescribed for preventing strokes in patients with AF. Patients receiving one of these drugs and undergoing blood specimen collection for laboratory tests were screened. Blood specimens were obtained from patients who had adhered to the prescribed drug regimen consistently for at least 1 week. Drug plasma concentrations were measured using heparin liquid-reagent technology-based anti-Xa chromogenic assays. Results: We selected 459 patients who were taking standard or on-label-reduced doses of apixaban (N = 252), edoxaban (N = 182), or rivaroxaban (N = 25). The 5th–95th percentile ranges of the peak concentrations were 84–414 ng/mL (apixaban), 72–424 ng/mL (edoxaban), and 97–517 ng/mL (rivaroxaban). The respective 5th–95th percentile ranges of the trough concentrations were 44–237 ng/mL, 23–93 ng/mL, and 13–219 ng/mL. Approximately 19.6% (apixaban), 33.3% (edoxaban), and 64.0% (rivaroxaban) of patients in each group had peak concentrations out of the predicted distribution ranges based on pharmacokinetic data. Approximately 7.3%, 52.8%, and 8.3% of patients had trough concentrations out of the predicted distribution ranges. Conclusions A considerable proportion of Korean patients with AF taking factor Xa inhibitors may require population-specific reference ranges to guide therapeutic monitoring.

Conversion therapy enables curative-intent resection in patients with initially unresectable or metastatic cancers after effective systemic therapy. Recently, advances in systemic therapy with molecular targeted agents and immune checkpoint inhibitors (ICIs) have renewed clinical and research interest in this approach, particularly for metastatic gastric cancer (GC). This review aimed to summarize the international guidelines and expert consensus informed by contemporary evidence on conversion therapy for metastatic GC, emphasizing the central role of systemic therapy, the emergence of biomarker-driven strategies, and the optimal timing for surgical intervention. Key consensus statements (Bertinoro, OMEC, and KINGCA WEEK 2024) and pivotal studies covering the cytotoxic, targeted, and immunotherapy eras were reviewed, focusing on regimen selection, treatment duration, and prognostic determinants associated with surgical outcomes. According to global guidelines, conversion surgery is not yet standard of care but may be considered for biologically and clinically selected patients demonstrating a major response to systemic therapy. Retrospective and prospective studies have reported a median overall survival of 24–36 months in the cytotoxic era and >48 months in the ICI/targeted era among patients who underwent R0 resection. Emerging evidence supports approximately 6 months of preoperative systemic therapy, followed by R0 resection, and up to one year of postoperative maintenance therapy. Therefore, conversion surgery should be viewed as the culmination of effective systemic therapy rather than as a substitute. A biology-driven, multidisciplinary strategy integrating treatment response assessment and prognostic factor evaluation represents the next frontier in potentially curative management of metastatic GC.

Purpose: Early childhood dietary behaviors vary according to environmental and regional context, and evidence in rural preschool populations remains limited. Considering their persistence into adulthood and their association with health outcomes, understanding the dietary patterns among rural preschool children is important. This study examined the nutritional quotient scores and dietary behaviors according to the weight status among preschool-aged children in rural Korea. Methods: This cross-sectional study analyzed the secondary data from 233 preschool children aged 3–6 years, living in Changnyeong-gun, South Korea. The dietary behaviors were assessed using the Nutrition Quotient for Preschoolers (NQ-P), which comprises balance, moderation, and environmental domains. The anthropometric and body composition measurements were obtained using bioelectrical impedance analysis, and the weight status was defined using the age- and sex-specific body mass index percentiles. Results: The mean total NQ-P scores were comparable between non-obese children and obese children (56.0 and 56.3, respectively), with no significant differences observed in the total or domain-specific scores. The most common NQ-P grade was low among the non-obese children and medium-to-low among children with obesity, with no significant between-group differences in grade distribution. On the other hand, underweight and normal-weight children exhibited lower fruit and legume intake and were more likely to move around during meals. Conclusion The fruit and legume intake patterns and mealtime behaviors differed according to the weight status. These findings highlight the importance of nutrition and health promotion strategies tailored to the weight status and rural environment of preschool children.Nevertheless, further prospective studies will be needed to clarify the longitudinal relationships between regional factors, dietary behaviors, and growth patterns in early childhood.

Objective: To investigate whether breast tissue composition on preoperative automated breast ultrasound (ABUS) is associated with the accuracy of cancer multiplicity evaluation and postoperative recurrence-free survival (RFS) in patients with early-stage breast cancer. Materials and Methods: This retrospective analysis included women with early-stage breast cancer (clinical Tis, T1–2/N0) who underwent ABUS and digital mammography (DM) between October 2019 and April 2021. Tissue composition on ABUS was assessed using the Breast Imaging Reporting and Data System background echotexture (BE) (homogeneous-fat, homogeneous-fibroglandular, or heterogeneous). In a subgroup of patients with mammographically dense breasts, the glandular tissue component (GTC) on ABUS were further stratified into high (moderate or marked) or low (minimal or mild).Multivariable logistic and Cox regression analyses were used to identify factors associated with accurate cancer multiplicity categorization (unifocal, multifocal/multicentric, or bilateral) using ABUS + DM, and with RFS, respectively. Results: Among 409 women (mean age ± standard deviation, 50.2 ± 8.7 years), ABUS combined with DM yielded accurate cancer multiplicity categorization in 368 patients (90.0%). Neither BE nor GTC on ABUS affected the accuracy of categorization when ABUS was combined with DM. Over a median postoperative follow-up of 3.5 years, 11 recurrences occurred. Heterogeneous BE on ABUS (hazard ratio [HR] 11.24 [95% confidence interval [CI]: 2.82–44.92]; P = 0.001), BRCA mutation (HR 15.94 [2.47–102.97]; P = 0.004), and pathologic index cancer size (HR per 1-cm increase 1.91 [1.13–3.23];P = 0.02) was independently associated with RFS. In patients with dense breasts, heterogeneous BE (HR 14.17 [95% CI:2.69–74.60]; P = 0.002) and high GTC (HR 10.32 [2.35–45.28]; P = 0.002) on ABUS, BRCA mutation (HR 24.34 [2.75– 215.06]; P = 0.004), and pathologic cancer size (HR per 1-cm increase 2.62 [1.50–4.59]; P = 0.001) was independently associated with RFS. Conclusion In patients with early-stage breast cancer, heterogeneous BE and high GTC on preoperative ABUS, along with larger cancer size and BRCA mutation, was associated with worse RFS. However, BE and GTC did not affect cancer multiplicity evaluation when ABUS was used in combination with DM.