Background: Atherosclerotic cardiovascular disease (ASCVD) is a major health concern, and lipoprotein(a) (Lp(a)) is an independent risk factor. However, there is limited evidence regarding Lp(a) and the risk of ASCVD in Asian populations. This study aimed to assess the predictive value of changes in coronary artery calcification (CAC) for ASCVD risk associated with Lp(a) level. Methods: Participants (n=2,750) were grouped according to their Lp(a) levels, and the association between Lp(a) and CAC progression was examined. CAC progression was defined as the occurrence of incident CAC or a difference ≥2.5 between the square root (√) of baseline and follow-up coronary artery calcium scores (CACSs) (Δ√transformed CACS). To adjust for differences in follow-up periods, Δ√transformed CACS was divided by the follow- up period (in years). Results: Over an average follow-up of 3.07 years, 18.98% of participants experienced CAC progression. Those with disease progression had notably higher Lp(a) levels. Higher Lp(a) tertiles correlated with increased baseline and follow-up CACS, CAC progression (%), and Δ√transformed CACS. Even after adjustment, higher Lp(a) levels were associated with CAC progression. However, annualized Δ√transformed CACS analysis yielded no significant results. Conclusion This study demonstrated an association between elevated Lp(a) levels and CAC progression in a general population without ASCVD. However, longer-term follow-up studies are needed to obtain meaningful results regarding CAC progression. Further research is necessary to utilize Lp(a) level as a predictor of cardiovascular disease and to establish clinically relevant thresholds specific to the Korean population.

The use of miniscrew-assisted rapid palatal expansion (MARPE) has yielded successful outcomes in late adolescence and early adulthood, particularly in correcting transverse maxillary discrepancies and enhancing airway expansion. This report presents three cases of children at different dentition stages treated with MARPE. In one patient with severe crowding, MARPE enabled dental alignment without the need for premolar extractions. Additionally, MARPE combined with facemask therapy improved the patient’s facial profile, resulting in high patient and guardian satisfaction. These cases highlight MARPE’s potential as an effective treatment for maxillary discrepancies and severe arch length discrepancies in children.

Postoperative pain management is a critical component of perioperative care in pediatric patients. Adequate pain control not only improves patient comfort, but also mitigates adverse physiological responses such as tachycardia, hypertension, immunosuppression, and impaired wound healing. With the growing emphasis on opioid-sparing strategies due to concerns over opioid dependency and misuse, regional analgesia has emerged as a key element of multimodal analgesia protocols. Concerns regarding opioid dependence and misuse have positioned regional analgesia as an essential part of multimodal analgesia, helping to reduce opioid consumption and its associated side effects in pediatric patients.Current Concepts: Regional analgesia includes a range of techniques such as neuraxial, peripheral nerve, and fascial plane blocks. These methods have proven highly effective in reducing postoperative pain and the need for opioids in children. The advent of ultrasound-guided regional anesthesia has greatly improved the safety and accuracy of these techniques. Pediatric-specific anatomical and physiological factors, including immature descending pain modulation pathways and heightened sensitivity to local anesthetics, highlight the importance of customized approaches to regional anesthesia in this demographic.Discussion and Conclusion: Regional analgesia is a cornerstone of multimodal analgesia in pediatric patients, effectively reducing opioid consumption and promoting recovery. Despite challenges such as provider expertise and anatomical considerations, advancements in ultrasound-guided techniques have increased safety and improved precision. Future directions should focus on expanding education and training in pediatric regional anesthesia, as well as conducting high-quality studies to further refine best practices.

Purpose: This study examined the status of arthroscopic shoulder surgery in ambulatory settings by analyzing a single institutional database. Materials and Methods: Three hundred and eight arthroscopic shoulder surgeries performed between June 2022 and March 2023 were reviewed retrospectively. Propensity score matching (1-to-2) was performed between the day surgery group and the inpatient group according to sex, age, tear size, and interscalene nerve block (ISNB). Finally, 59 patients in the day surgery group and 118 patients in the inpatient group were matched. The indications of the day surgery were pre-determined according to the American Society of Anesthesiologists classification I or II, and the patient's social, medical, and surgical factors were thoroughly analyzed to define the target group of the day surgery. Complications related to voiding difficulty were prevented by classifying the patients using the International Prostate Symptom Score (IPSS) before surgery, and preventive medications were prescribed in the higher-risk patients with an IPSS of more than 7. To reduce postoperative pain, ISNB and patient-controlled analgesia (PCA) were applied to all patients during the study period, while day surgery patients received an additional bolus injection (5 cc of 0.375% ropivacaine+5 cc of normal saline) before discharge instead of continuous ISNB PCA. This study compared the postoperative pain assessments at discharge and on postoperative days 1, 2, and 14, as well as the total volume of saline irrigation, surgical time, and complications between the day surgery and inpatient groups. Results: The visual analogue scale for pain (pVAS) at the time of surgery were comparable in the day surgery group (4.1±1.5) and inpatient surgery group (4.1±1.1), with no significant difference between them (p=0.35). Similarly, the postoperative pVAS at 1, 2, and 14 days postoperatively was similar in the two groups (all p>0.05). The surgical-related factors, such as the total volume of saline irrigation and surgical time, were similar in the two groups. Furthermore, there was no significant difference in postoperative complications between the two groups (all p>0.05). Conclusion These results show that arthroscopic shoulder surgery in ambulatory settings is a safe alternative to inpatient surgery.

Purpose: This study aimed to perform a genome characterization of Streptococcus mitis KHUD 011, a strain isolated from the oral microbiome of a healthy Korean individual, and to compare its genomic features with other S. mitis strains. Materials and Methods: The strain was identified through 16S rRNA gene sequencing, and its genome was sequenced using the PacBio Sequel II platform. De novo assembly and annotation were performed, followed by comparative genomic analysis with three additional strains (S. mitis NCTC 12261, S022-V3-A4, and B6). Pan-genome and phylogenetic analyses were conducted to identify strain-specific genes and assess inter-strain genomic diversity. Results: The genome of S. mitis KHUD 011 consisted of 1,782 protein-coding genes, with a G+C content of 40.24%. Pan-genome analysis identified 1,263 core gene clusters (50.0%), 496 dispensable clusters (19.7%), and 763 strain-specific clusters (30.3%). KHUD 011 displayed 88 strain-specific genes, particularly associated with cell wall/membrane biogenesis, transcriptional regulation, and carbohydrate metabolism. Phylogenetic analysis placed KHUD 011 closely with NCTC 12261, forming a distinct cluster apart from other strains. Conclusion The genome characterization of S. mitis KHUD 011 underscores substantial inter-strain genomic diversity influenced by host interactions, ecological niches, and health status. The identified strain-specific genes, particularly those associated with cell wall/ membrane biogenesis, transcriptional regulation, and carbohydrate metabolism, suggest adaptations to the oral microbiome and its interaction with the host. These findings highlight the ecological versatility of S. mitis and the importance of exploring strains from diverse environments to better understand their role within the host and the broader microbiome.

The use of miniscrew-assisted rapid palatal expansion (MARPE) has yielded successful outcomes in late adolescence and early adulthood, particularly in correcting transverse maxillary discrepancies and enhancing airway expansion. This report presents three cases of children at different dentition stages treated with MARPE. In one patient with severe crowding, MARPE enabled dental alignment without the need for premolar extractions. Additionally, MARPE combined with facemask therapy improved the patient’s facial profile, resulting in high patient and guardian satisfaction. These cases highlight MARPE’s potential as an effective treatment for maxillary discrepancies and severe arch length discrepancies in children.

Postoperative pain management is a critical component of perioperative care in pediatric patients. Adequate pain control not only improves patient comfort, but also mitigates adverse physiological responses such as tachycardia, hypertension, immunosuppression, and impaired wound healing. With the growing emphasis on opioid-sparing strategies due to concerns over opioid dependency and misuse, regional analgesia has emerged as a key element of multimodal analgesia protocols. Concerns regarding opioid dependence and misuse have positioned regional analgesia as an essential part of multimodal analgesia, helping to reduce opioid consumption and its associated side effects in pediatric patients.Current Concepts: Regional analgesia includes a range of techniques such as neuraxial, peripheral nerve, and fascial plane blocks. These methods have proven highly effective in reducing postoperative pain and the need for opioids in children. The advent of ultrasound-guided regional anesthesia has greatly improved the safety and accuracy of these techniques. Pediatric-specific anatomical and physiological factors, including immature descending pain modulation pathways and heightened sensitivity to local anesthetics, highlight the importance of customized approaches to regional anesthesia in this demographic.Discussion and Conclusion: Regional analgesia is a cornerstone of multimodal analgesia in pediatric patients, effectively reducing opioid consumption and promoting recovery. Despite challenges such as provider expertise and anatomical considerations, advancements in ultrasound-guided techniques have increased safety and improved precision. Future directions should focus on expanding education and training in pediatric regional anesthesia, as well as conducting high-quality studies to further refine best practices.

Purpose: This study examined the status of arthroscopic shoulder surgery in ambulatory settings by analyzing a single institutional database. Materials and Methods: Three hundred and eight arthroscopic shoulder surgeries performed between June 2022 and March 2023 were reviewed retrospectively. Propensity score matching (1-to-2) was performed between the day surgery group and the inpatient group according to sex, age, tear size, and interscalene nerve block (ISNB). Finally, 59 patients in the day surgery group and 118 patients in the inpatient group were matched. The indications of the day surgery were pre-determined according to the American Society of Anesthesiologists classification I or II, and the patient's social, medical, and surgical factors were thoroughly analyzed to define the target group of the day surgery. Complications related to voiding difficulty were prevented by classifying the patients using the International Prostate Symptom Score (IPSS) before surgery, and preventive medications were prescribed in the higher-risk patients with an IPSS of more than 7. To reduce postoperative pain, ISNB and patient-controlled analgesia (PCA) were applied to all patients during the study period, while day surgery patients received an additional bolus injection (5 cc of 0.375% ropivacaine+5 cc of normal saline) before discharge instead of continuous ISNB PCA. This study compared the postoperative pain assessments at discharge and on postoperative days 1, 2, and 14, as well as the total volume of saline irrigation, surgical time, and complications between the day surgery and inpatient groups. Results: The visual analogue scale for pain (pVAS) at the time of surgery were comparable in the day surgery group (4.1±1.5) and inpatient surgery group (4.1±1.1), with no significant difference between them (p=0.35). Similarly, the postoperative pVAS at 1, 2, and 14 days postoperatively was similar in the two groups (all p>0.05). The surgical-related factors, such as the total volume of saline irrigation and surgical time, were similar in the two groups. Furthermore, there was no significant difference in postoperative complications between the two groups (all p>0.05). Conclusion These results show that arthroscopic shoulder surgery in ambulatory settings is a safe alternative to inpatient surgery.

Background: We hypothesized that intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) (IN DEXKET) improves the success rate of sedation in pediatric patients compared with chloral hydrate (CH; 50 mg/kg). Methods: This prospective, two-center, single-blinded, randomized controlled trial involved 136 pediatric patients (aged < 7 years) requiring procedural sedation. The participants were randomized to receive CH or IN DEXKET via a mucosal atomizer device. The primary outcome was the success rate of sedation (Pediatric Sedation State Scale, scores 1–3) within 15 min. The secondary outcomes included sedation failure at 30 min and overall complications of first-attempt sedation. Results: After excluding eight patients, 128 were included (CH = 66, IN DEXKET = 62). IN DEXKET showed a similar sedation success rate (75.8% [47/62] vs. 66.7% [44/66]; P = 0.330) but a lower complication rate (3.2% [2/62] vs. 16.7% [11/66]; P = 0.017) than CH. In the subgroup analysis for patients aged < 1 year, IN DEXKET showed a reduced complication rate than CH (2.6% [1/38] vs. 22.9% [8/35]; P = 0.012). In the subgroup analysis of children aged 1–7 years, IN DEXKET showed a higher sedation success rate within 15 min (79.2% [19/24] vs. 51.6% [16/31]; P = 0.049) and a lower sedation failure after 30 min (0% vs. 29.0% [9/31]; P = 0.003) than CH. Conclusions The intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) is a safe and effective alternative to CH (50 mg/kg) for sedation in pediatric patients aged < 7 years.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major health concern, and lipoprotein(a) (Lp(a)) is an independent risk factor. However, there is limited evidence regarding Lp(a) and the risk of ASCVD in Asian populations. This study aimed to assess the predictive value of changes in coronary artery calcification (CAC) for ASCVD risk associated with Lp(a) level. Methods: Participants (n=2,750) were grouped according to their Lp(a) levels, and the association between Lp(a) and CAC progression was examined. CAC progression was defined as the occurrence of incident CAC or a difference ≥2.5 between the square root (√) of baseline and follow-up coronary artery calcium scores (CACSs) (Δ√transformed CACS). To adjust for differences in follow-up periods, Δ√transformed CACS was divided by the follow- up period (in years). Results: Over an average follow-up of 3.07 years, 18.98% of participants experienced CAC progression. Those with disease progression had notably higher Lp(a) levels. Higher Lp(a) tertiles correlated with increased baseline and follow-up CACS, CAC progression (%), and Δ√transformed CACS. Even after adjustment, higher Lp(a) levels were associated with CAC progression. However, annualized Δ√transformed CACS analysis yielded no significant results. Conclusion This study demonstrated an association between elevated Lp(a) levels and CAC progression in a general population without ASCVD. However, longer-term follow-up studies are needed to obtain meaningful results regarding CAC progression. Further research is necessary to utilize Lp(a) level as a predictor of cardiovascular disease and to establish clinically relevant thresholds specific to the Korean population.