Purpose: This study analyzed the characteristics of pediatric patients’ (≤ 18 years) intentional injury-related visits to the emergency department (ED) using National Emergency Department Information System data from January 1 through December 31, 2023, providing foundational evidence for prevention strategies and policy development. Methods: The injuries were categorized into unintentional and intentional, and relevant characteristics were compared between the 2 categories. The intentional injuries were further divided into self-harm and violence. Percentages were calculated for each variable and compared using the chi-square or Fisher exact tests. Results: Among 301,852 pediatric patients, those with intentional injuries showed higher proportions of girls, adolescents, visits in the wee hours, visits via firehouse ambulances, injuries by collision, by penetration, or by poisoning, hospitalization, Korean Triage and Acuity Scale levels 1-3, an ED length of stay of 2 hours or longer, and primary care by psychiatrists, than those with unintentional injuries. The pediatric patients with self-harm injuries showed higher proportions of girls, adolescents, visits in the wee or morning hours, visits via firehouse ambulances, injuries by collision, by penetration, or by poisoning, hospitalization or inter-facility transfer, Korean Triage and Acuity Scale levels 1-3, an ED length of stay of 2 hours or longer, and primary care by psychiatrists as well as by orthopedic surgeons or pediatricians, than those with violence injuries. Conclusion This study highlights the need to develop strategies per age and sex for preventing self-harm among pediatric patients, and to ensure safe and effective psychiatric care in EDs. In addition, the prevention of child abuse requires a multidisciplinary approach that includes preventive education programs, mandatory reporting in EDs, and the adoption of screening tools such as the Finding Instrument for Non-accidental Deeds.

Background: and Purpose Although gastrointestinal (GI) surgery can affect drug efficacy, its impact on oral anticoagulants (OACs) remains unclear. This study investigated the impact of GI surgery on the comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation (AF). Methods: Using a nationwide South Korean claims database, AF patients prescribed OACs between 2015 and 2021 were analyzed. The primary outcome was ischemic stroke, and secondary outcomes were major bleeding, all-cause death, and composite outcome (ischemic stroke, major bleeding, all-cause death). Outcomes were compared by OAC type (DOAC vs. warfarin) and GI surgery status using inverse probability of treatment weighting and a Fine–Gray subdistribution hazard model with time-varying covariates. Results: Among 388,214 AF patients (mean age, 71.9 yr; 42.7% male), 6,907 (1.8%) underwent GI surgery. The effect of GI surgery differed between warfarin and DOACs for ischemic stroke (Pint= 0.018), with increased risk for warfarin (adjusted HR [aHR]: 2.32; 95% confidence interval [CI] 1.17–4.62), but not for DOACs (aHR: 0.97 [95% CI 0.77–1.22]) after surgery. Effects of surgery on major bleeding, all-cause death, and composite outcome did not differ. In post–GI surgery setting, DOACs demonstrated lower ischemic stroke risk (aHR: 0.35 [95% CI 0.17–0.72]) and comparable risks for other outcomes. Exploratory analyses by surgery location suggested a more favorable profile of DOACs after upper GI surgery. Conclusions In AF patients, GI surgery significantly increased ischemic stroke risk among warfarin users, but not among DOAC users. DOACs showed generally favorable profiles after GI surgery and may remain a reasonable anticoagulant, with potentially more favorable profile after upper GI surgery.

Objective: To investigate prevalence of BLV and its association with hematological alterations in targeted dairy farms experiencing productivity issues in Korea. Methods: This study investigated five dairy farms reporting decreased milk yield, recurrent mastitis, poor conception rates, and delayed postpartum recovery. Eighty lactating cows underwent physical examination, body condition scoring, hematological and biochemical analyses, and polymerase chain reaction testing for BLV. Results: Overall BLV detection rate among these herds was 70% (56/80), with intra-herd positivity ranging from 57.1 to 90.0%. Lymphocytosis was observed in 31% of the cows.Multivariable generalized estimating equations analysis confirmed that higher lymphocyte counts were the strongest independent predictor of BLV status (adjusted odds ratio, 2.70;p = 0.005), demonstrating a robust association between hematological alterations and BLV positivity. Conclusions and Relevance: BLV infection is highly prevalent in the investigated Korean dairy farms with productivity problems. While these results may not represent the nationwide average due to selection bias, they emphasize the need for nationwide BLV surveillance and implementation of control measures in Korea.

Purpose: : This retrospective study clarified the peripheral limb ischemiaincidence and examined the differences in demographic, clinical, and nursing care-related characteristics according to the presence of peripheral limb ischemia in intensive care unit (ICU) patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. Methods: : Participants were 170 patients who received ECMO therapy at a university hospital over a 10-year period (January 2013 to December 2022). Data, including general, clinical, and nursing care characteristics, were collected from electronic medical records. Data analysis was conducted using descriptive statistics, independent t-tests, χ2-tests, and Fisher’s exact tests. Results: : Participants’ mean age was 57.49 years, 125 (73.5%) were male, and the average duration of ECMO therapy was 7.22 days. Among them, 75 (44.1%) patients developed peripheral limb ischemia. Significant differences were found between the groups with and without peripheral limb ischemia in mean arterial pressure (t=6.19, p ‹.001), vasopressor use (χ2=8.54, p =.003), anticoagulant use (χ2=15.01, p ‹.001), use of clotting factors (χ2=5.84, p=.016), presence of abdominal distension (χ2=8.97, p=.003), insertion site bleeding (χ2=8.14, p =.004), and laboratory values including white blood cell count (t=2.65, p =.009), hemoglobin (t=2.71, p =.008), platelet count (t=2.88, p =.004), creatine kinase (t=-4.47, p ‹.001), prothrombin time (t=-4.22, p ‹.001), international normalized ratio (t=-4.29, p ‹.001), and frequency of lower limb monitoring (t=5.57, p ‹.001). Conclusion : This study explored the clinical and nursing care-related characteristics associated with peripheral limb ischemia in ICU patients undergoing ECMO therapy. The findings provide evidence to support future research focusing on the early detection and proactive nursing interventions to prevent peripheral limb ischemia in this high-risk population.

Background: Research on the relationship between the progression of interstitial lung abnormalities (ILA) and serum biomarkers, including white blood cell differential counts and Krebs von den Lungen-6 (KL-6), is limited. This study aimed to examine the clinical characteristics of patients with ILA and evaluate the association between disease progression and serum biomarkers. Methods: This retrospective cohort study analyzed data from 159 patients (63 with ILA and 74 with interstitial lung diseases) between October 2021 and September 2022. Data collected included clinical characteristics, pulmonary function tests, chest computed tomography (CT), complete blood cell counts, and KL-6 levels. In 52 of these patients who had previously undergone chest CT, the utility of serum biomarkers in reflecting radiologic progression was assessed using receiver operating characteristic curve analysis. Results: Patients with ILA exhibited clinical characteristics similar to those with idiopathic pulmonary fibrosis. Serum KL-6 levels did not correlate with forced vital capacity or diffusing capacity of the lung for carbon monoxide in patients with ILA. Among the 52 patients with ILA, 13 demonstrated radiologic progression. Serum KL-6 displayed moderate predictive performance, with area under the curves ranging from 0.57 to 0.89 (p=0.014) for radiologic progression. Levels of KL-6 greater than 400 U/mL were more frequently observed in patients with radiologic progression (61.5% vs. 20.5%, p=0.006). In multivariate analysis, age and KL-6 were independently associated with radiologic progression in patients with ILA. Conclusion Serum KL-6 levels may serve as a potential indicator of ILA progression in asymptomatic patients. Those with KL-6 levels exceeding 400 U/mL should be closely monitored for radiologic progression.

Background and Objectives: Graves’ ophthalmopathy (GO) is an autoimmune inflammatory disorder that can adversely affect quality of life in patients with Graves’ disease (GD). The objective of this study was to characterize the clinical features of patients with GO and to identify risk factors associated with its development and the need for anti-inflammatory treatment. Materials and Methods: In this multicenter, retrospective observational study, 818 patients with GD were identified via electronic medical record review. Clinical characteristics were assessed, and logistic regression analyses were performed to identify risk factors for GO development and the need for anti-inflammatory treatment. Results: Among the 818 patients with GD, 135 (16.5%) developed GO, and 60 (7.3%) of these patients received anti-inflammatory treatment. GO was diagnosed at the time of GD diagnosis in 54.8% of cases, and proptosis and eyelid/orbital swelling were the common presenting features. In multivariable analysis, female sex (odds ratio [OR]: 1.75, confidence interval [CI]: 1.02-3.03), goiter (OR: 1.71, CI: 1.08-2.71), and smoking (ex-smokers: OR, 2.18; 95% CI: 1.02-4.65; current smokers: OR, 3.11; CI, 1.78-5.44) were independently associated with GO development, whereas diabetes (OR: 0.35, CI: 0.14-0.89) was inversely associated. Higher total cholesterol (OR: 1.31, CI: 1.01-1.04) and elevated thyrotropin-binding inhibitory immunoglobulin levels (OR: 1.07, CI: 1.02-1.11) were also significantly associated with the need for anti-inflammatory treatment. Conclusion This study delineated the clinical features of GO and identified risk factors for its development and the need for anti-inflammatory treatment in patients with GD, providing valuable information for the management of GO in Korean patients.

Background: Transthoracic echocardiography (TTE) requires time-intensive integration of quantitative measure‑ ments and qualitative visual assessment. Fully automated artificial intelligence (AI)-based analysis may reduce total analysis time while preserving accuracy, but systematic real-world validation remains limited. Methods: This prospective, single-center pilot study enrolled 40 TTE examinations. Identical deidentified DICOM datasets were independently provided to a trained cardiac sonographer and a fully automated AI system comprising quantitative and qualitative visual interpretation modules. All outputs were compared with a cardiologist-adjudicated reference standard. Primary endpoints were total analysis time and noninferiority of AI-derived left ventricular ejection fraction (LVEF) versus the reference standard, with a prespecified margin of 3 percentage points (one-sided α = 0.025). Results: Median analysis time was 94 s (interquartile range [IQR], 82–106 s) for the AI workflow versus 490 s (IQR, 438–626 s) for the human workflow (P < 0.001). AI-derived LVEF met the noninferiority criterion (mean difference, 0.00 percentage points; upper one-sided 95% confidence bound, 1.41 percentage points; P < 0.001), with an intraclass correlation coefficient (ICC) of 0.902 (95% confidence interval, 0.822–0.947). ICCs for secondary quantitative indi‑ ces ranged from 0.625 to 0.989. For aortic regurgitation severity grading, AI’s overall accuracy was 75.0% (quadratic weighted κ = 0.762), compared with 82.5% for human interpretation (κ = 0.812, McNemar P = 0.579). Conclusions Fully automated AI-assisted TTE analysis substantially reduced total analysis time while maintaining noninferior LVEF accuracy and acceptable performance across secondary quantitative and qualitative indices. These findings support the use of AI as a practical workflow accelerator in routine echocardiography.

Purpose: This study aimed to identify the actor and partner effects of human papillomavirus (HPV) vaccination knowledge, health beliefs, and self-efficacy on parental intentions to vaccinate adolescent sons against HPV. Methods: The participants were 191 couples who met the eligibility criteria. Data were collected from June 2024 through internet communities in Gyeongsangnam Province. The actor-partner interdependence model was used to analyze the parent's actor and partner effects of HPV vaccination knowledge, health beliefs, and self-efficacy on parents' intentions to vaccinate their adolescent sons against HPV. Results: The actor effects of fathers' intentions to vaccinate their adolescent sons against HPV were perceived benefits and self-efficacy; however, the partner effect was not significant. The actor effects of mothers' intentions to vaccinate their adolescent sons against HPV were perceived susceptibility, perceived severity, perceived benefits, and self-efficacy, and the partner effects were fathers' perceived severity and benefits. Conclusion This study indicates that fathers' intentions to vaccinate their adolescent sons against HPV may play an essential role in increasing HPV vaccination rates among adolescent sons.

Purpose: : This study aimed to explore the essence and meaning of light sedation for patients in the intensive care unit (ICU). Methods: : Individual in-depth interviews were conducted with 10 patients receiving light sedation therapy in the cardiac ICU of a university hospital in South Korea. The content of the interviews was analyzed using Elo and Kyngäs’s inductive content analysis method. Data collection and analysis were performed iteratively to enable a continuous comparative analysis. Results: : The main category derived from the analysis was the “coexistence of partial consciousness and discomfort.” Three general categories were identified: (1) the state of being neither asleep nor awake, (2) persistent discomfort, and (3) ambivalence toward consciousness. The subcategories included a fragmented memory, disorientation, surreal experiences, brain fog, half-heard noises, physical discomfort, mental distress, preference for sleep, and preference for being awake. Conclusion : Patients in the ICU under light sedation experienced an incomplete state of consciousness while experiencing various types of discomfort. Nurses should understand the patients’ subjective experiences with light sedation to provide patient-centered care. Based on these findings, further research is required to develop and apply nursing interventions for patients under light sedation.