Introduction: Itch, an uncomfortable sensation leading to the urge to scratch, is often inadequately managed by conventional antihistamine drugs, which can be ineffective in certain pruritic conditions and cause undesirable side effects. Therefore, there is a need to identify new pharmacologically potent antipruritic compounds with fewer side effects. A synthetic curcuminoid analogue, 2,6-bis-(4-hydroxy-3-methoxybenzylidene)-cyclohexanone (BHMC), a derivative of curcumin - a bioactive compound found in turmeric - has demonstrated various pharmacological ac-tivities. Previous studies have shown that BHMC possesses antinociceptive and anti-inflammatory properties. This study aimed to investigate the antipruritic effects of BHMC in mice models of induced pruritus. Materials and Meth-ods: The pruritus in mice was induced using compound 48/80, substance P, histamine, and serotonin to establish an itch-induced mouse model. BHMC was administered intraperitoneally (i.p.) at doses of 0.1, 0.3, and 1.0 mg/kg. Results: BHMC significantly reduced pruriceptive responses in all models tested and notably inhibited compound 48/80 and substance P-induced mast cell degranulation in skin tissues. Conclusions: These findings suggest that BHMC inhibits pruriceptive responses in mice, likely through the inhibition of mast cell degranulation and/or direct antagonism of peripheral histamine and serotonin receptors. This may warrant further exploration of the antipruritic effect of BHMC in clinical trials for the betterment of animal and human health.

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: This study investigated sensitization patterns and potential cross-sensitization among tree pollens of the Betulaceae (birch, alder, hazel) and Fagaceae (oak, beech) families, based on skin prick test results. Comparisons were also made with non-tree allergens, including mugwort, cat, and cockroach. Methods: We retrospectively analyzed skin prick test results of 1,812 patients evaluated between 2010 and 2013. A positive reaction was defined as an allergen-to-histamine wheal ratio of 1.0 or higher. Sensitization rates were calculated, and cross-sensitization was assessed by analyzing simultaneous positivity rates, conditional probabilities, and Pearson correlation coefficients based on raw skin prick test scores (0, 2, 3, and 4). Results: The sensitization rates were 12.4% for birch, 11.0% for alder, 11.1% for hazel, 14.6% for oak, and 14.1% for beech. Strong correlations were observed within Betulaceae (r= 0.78–0.85) and within Fagaceae (r= 0.76). Moderate to strong correlations were also found between Betulaceae and Fagaceae (r = 0.70–0.80), suggesting inter-family cross-sensitization. Simultaneous positivity and conditional probabilities were also high within and between Betulaceae and Fagaceae, reinforcing the observed cross-sensitization patterns. In contrast, mugwort, cat, and cockroach showed weak correlations (r = 0.35–0.37 for mugwort; r ≤ 0.26 for cat and cockroach) and low simultaneous positivity and conditional probabilities, indicating limited cross-reactivity. All correlations were statistically significant (P < 0.001). Conclusion These findings demonstrate strong associations among tree pollen allergens within and between Betulaceae and Fagaceae, reflecting molecular-level cross-reactivity, supporting their clinical relevance in allergy diagnosis and treatment planning.

Common variable immunodeficiency (CVID) is a heterogeneous primary immunodeficiency characterized by reduced levels of immunoglobulin (Ig)G, with or without IgA and/or IgM deficiency, and hypogammaglobulinemia. Clinical manifestations are diverse, ranging from recurrent infections to autoimmune and allergic diseases. While CVID has been rarely reported in the Korean population, particularly in adults, we report 2 adult cases of CVID comorbid with asthma and Behcet’s disease. The first case of a 53-year-old with severe allergic asthma and chronic rhinosinusitis experienced recurrent respiratory infections, stomatitis, and cystitis requiring frequent antibiotic treatment. Laboratory findings indicated a T2-high asthma phenotype, with elevated serum total IgE specific IgE to dog hair and fractional exhaled nitric oxide. Immunological evaluation revealed decreased serum IgG (including IgG1 and IgG2), along with hypogammaglobulinemia. She had been treated with regular anti-IgE antibody therapy and intravenous immunoglobulin replacement therapy (IVIGRT). The second case of a 38-year-old with Behçet’s disease and uveitis had bronchial asthma and rhinitis that were exacerbated by recurrent infections despite standard asthma therapy. Laboratory findings revealed a T2-low phenotype and a marked reduction in serum IgG (including IgG1, IgG2, and IgG4), and hypogammaglobulinemia, consistent with CVID.IVIGRT effectively reduced asthma exacerbations and infection episodes in both cases. These cases highlight the clinical heterogeneity of CVID and its potential overlap with allergic and autoimmune diseases. Immunological evaluation of underlying immunodeficiency should be considered in adult patients with asthma who present with frequent exacerbations and recurrent infections. Early diagnosis and IVIGRT can prevent complications and improve outcomes.

Background: The Act on Decisions on Life-Sustaining Treatment (LST) has been implemented in Korea since 2018, yet data on its application in neurocritical care units remain scarce. This study aimed to evaluate the clinical characteristics and outcomes of LST withdrawal or withholding in the neurocritical care unit. Methods: This study was a retrospective analysis conducted at a tertiary university hospital in Busan, South Korea. Among patients admitted to the neurocritical care unit between February 2018 and August 2023, those with documented decisions for LST withdrawal or withholding were enrolled. Demographic and clinical characteristics, underlying and combined conditions, reasons for LST decisions, measures taken, and time from LST withdrawal to death were extracted from medical records. Results: A total of 69 patients were included, with a median age of 67 years, and 38 (55%) were male. Cerebrovascular disease (62%) and traumatic brain injury (22%) were the most common underlying diagnoses. The primary reason for LST decisions was irreversible neurological damage (71%), followed by systemic complications (19%). Mechanical ventilation cessation (91%) and extubation (86%) were most frequently used measures for LST withdrawal. The median time from LST withdrawal to death was 22 minutes. Conclusions Our study demonstrates that LST decisions in the neurocritical care unit predominantly occur among patients with cerebrovascular disease or traumatic brain injury, mostly triggered by neurological deterioration. Most patients died shortly after withdrawal. These findings provide important insight into current LST withdrawal practices in neurocritical care and may assist clinical and ethical decision making in similar settings.

Neuropathic pain markedly impairs quality of life and imposes a substantial socioeconomic burden, while available treatments often provide only partial relief and are limited by safety concerns. The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG-IASP) first published pharmacologic recommendations in 2007, followed by a major update in 2015 and a new guideline in 2025. This narrative review specifically compares the 2015 and 2025 NeuPSIG-IASP guidelines, outlining key methodological changes and therapeutic shifts. The 2025 guideline is based on a larger, more rigorous meta-analysis, maintains α2δ-ligands (adds mirogabalin), serotonin-noradrenaline reuptake inhibitors, and tricyclic antidepressants as first-line drugs, downgrades tramadol into the opioid third-line group. It also introduces high-frequency motor-cortex repetitive transcranial magnetic stimulation as a weakly recommended third-line option and discusses implications for Korean clinical practice.

Acute symptomatic seizures are defined as seizures occurring in close temporal association with an identifiable precipitating insult, such as an acute structural lesion of the central nervous system, metabolic derangements, toxic exposures, infections, or systemic illnesses. Because acute symptomatic seizures differ fundamentally from unprovoked seizures in terms of pathophysiology, prognosis, and long-term risk of subsequent epilepsy, accurate differentiation is of substantial clinical importance. The most recent definition proposed by the International League Against Epilepsy has further refined etiological assessment and diagnostic criteria, thereby contributing to improved classification of acute-phase seizures and the development of appropriate treatment strategies. The cornerstone of management is the prompt correction of the underlying cause, while decisions regarding the initiation and duration of antiseizure medication should be individualized according to the etiology and estimated risk of recurrence. In particular, structural etiologies such as stroke, traumatic brain injury, and central nervous system infections have been associated with a relatively higher risk of later unprovoked seizures. In addition, drug-induced seizures caused by certain antibiotics and neuroactive agents represent an important and potentially preventable category of acute symptomatic seizures. Recently, prognostic prediction tools have been proposed, facilitating risk-stratified follow-up and clinical decision-making. This review summarizes the current evidence on the definition, etiological classification, diagnostic approach, and management strategies for acute symptomatic seizures, with particular emphasis on prognostic evaluation and medication-related seizure risk.

Purpose: We compared the surgical outcomes of medial rectus recession (MR Rc) and lateral rectus resection (LR Rs) in patients with divergence insufficiency esotropia, characterized by greater esotropia (ET) at distance than at near. Methods: This retrospective comparative study included 22 patients who underwent either MR Rc or LR Rs for divergence insufficiency esotropia, defined as comitant ET with >8 prism diopters (PD) difference between distance and near, with persistent diplopia at distance. Surgical success was defined as final deviation <8 PD with diplopia-free status at distance and near at 12 months postoperatively. The mean dose-response ratio (PD/mm) of each surgical technique was analyzed. Results: Of the 22 patients, 13 underwent MR Rc and 9 underwent LR Rs. The surgical success rate was higher in the LR Rs group than in the MR Rc group; however, the difference was not statistically significant (69% vs. 100%, p = 0.11). In the MR Rc group, three patients had under-correction and one had over-correction. The mean dose-response ratio for distance was 2.43 ± 0.51 PD/mm at 1 week and 2.15 ± 0.93 PD/mm at 12 months, whereas for near it was 1.89 ± 0.83 and 1.69 ± 1.06 PD/mm, respectively. In the LR Rs group, all patients achieved surgical success. The mean dose-response ratio for distance was 1.96 ± 0.46 and 1.91 ± 0.51 PD/mm at 1 week and 12 months, whereas for near it was 1.23 ± 0.42 and 1.13 ± 0.52 PD/mm, respectively. Conclusions Both surgical techniques demonstrated favorable outcomes for divergence insufficiency esotropia. However, the dose-response ratio was more predictable in LR Rs surgery. For MR Rc, augmented surgical approaches may be considered to improve predictability and success rates.