Background: According to international pediatric urinary tract infection (UTI) guidelines, selecting ampicillin/ sulbactam or amoxicillin/clavulanate is recommended as the first-line treatment for pediatric UTI. In Korea, elevated resistance to ampicillin and ampicillin/sulbactam has resulted in the widespread use of third-generation cephalosporins for treating pediatric UTIs. This study aims to compare the efficacy of piperacillin-tazobactam (TZP) and cefotaxime (CTX) as first-line treatments in hospitalized children with UTIs. Materials and Methods: The study, conducted at Jeju National University Hospital, retrospectively analyzed medical records of children hospitalized for febrile UTIs between 2014 and 2017. UTI diagnosis included unexplained fever, abnormal urinalysis, and the presence of significant uropathogens. Treatment responses, recurrence, and antimicrobial susceptibility were assessed. Results: Out of 323 patients, 220 met the inclusion criteria. Demographics and clinical characteristics were similar between TZP and CTX groups. For children aged ≥3 months, no significant differences were found in treatment responses and recurrence. Extended-spectrum beta-lactamase (ESBL)-positive strains were associated with recurrence in those <3 months. Conclusion In Korea, escalating resistance to empirical antibiotics has led to the adoption of broad-spectrum empirical treatment. TZP emerged as a viable alternative to CTX for hospitalized children aged ≥3 months with UTIs.Consideration of ESBL-positive strains and individualized approaches for those <3 months are crucial.

Purpose: Posterior synechiae can occur as a complication following vitrectomy. This study analyzes the changes in patients before and after surgical synechiolysis. Methods: A retrospective chart review was conducted of 34 patients who underwent surgical synechiolysis after cataract surgery and vitrectomy from January 2020 to February 2023 at a single institution, along with a control group of 30 patients. Surgery was indicated for patients experiencing dysphotopsia due to posterior synechiae, specifically those with iridocapsular adhesions exceeding one quadrant. Visual acuity and spherical equivalent were measured before and after surgery. The degree of dysphotopsia was assessed using the Leiden Visual Sensitivity Scale (L-VISS) which includes questions on sensitivity to light and patterns and a comparative analysis with the control group was conducted. Results: An increase in best-corrected visual acuity was observed in 5 of 34 eyes (14.7%) which was not statistically significantly different from the control (p = 0.550). Hyphema occurred in 24 eyes (70.6%), and iridodialysis in 1 eye (2.9%), during surgery. No cases of persistent intraocular pressure elevation or recurrence of synechiae were reported after surgery. No significant difference in spherical equivalent (p = 0.376) was observed pre- versus post-surgery, but there was a statistically significant improvement in the L-VISS score at 6 months after surgery (11.88 ± 3.06) compared to before surgery (14.88 ± 3.44, p < 0.001). Conclusions Surgical synechiolysis is associated with a low risk of complications after surgery. Although no significant improvement in visual acuity was noted, the surgery effectively improved dysphotopsia in patients.

The continuous emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants has provided insights for updating current coronavirus disease 2019 (COVID-19) vaccines. We examined the neutralizing activity of Abs induced by a BA.4/5-containing bivalent mRNA vaccine against Omicron subvariants BN.1 and XBB.1.5. We recruited 40 individuals who had received a monovalent COVID-19 booster dose after a primary series of COVID-19 vaccinations and will be vaccinated with a BA.4/5-containing bivalent vaccine. Sera were collected before vaccination, one month after, and three months after a bivalent booster.Neutralizing Ab (nAb) titers were measured against ancestral SARS-CoV-2 and Omicron subvariants BA.5, BN.1, and XBB.1.5. BA.4/5-containing bivalent vaccination significantly boosted nAb levels against both ancestral SARS-CoV-2 and Omicron subvariants. Participants with a history of SARS-CoV-2 infection had higher nAb titers against all examined strains than the infection-naïve group. NAb titers against BN.1 and XBB.1.5 were lower than those against the ancestral SARS-CoV-2 and BA.5 strains. These results suggest that COVID-19 vaccinations specifically targeting emerging Omicron subvariants, such as XBB.1.5, may be required to ensure better protection against SARS-CoV-2 infection, especially in high-risk groups.

Purpose: Using a new robotic endoscopic platform system developed for retrograde intrarenal surgery (RIRS) called easyUretero (ROEN Surgical Inc.), we evaluated the feasibility and safety of renal stone retrieval in a porcine model. Materials and Methods: Six female pigs were used for our in vivo study. First, 0.3-cm-sized phantom stones were inserted into the kidneys of each pig via the ureteral access sheath. Next, renal stone retrieval was attempted using manual RIRS in three pigs and robotic RIRS in three pigs. Three surgeons performed extraction of 10 stones in each session. Results: The mean stone retrieval time by manual RIRS was significantly shorter than that by robotic RIRS (399.9±185.4 sec vs. 1127.6±374.5 sec, p=0.001). In contrast, the questionnaire regarding usability showed high satisfaction in the surgeons’ fatigue category for surgeons using robotic RIRS. The radiation exposure dose was also lower in robotic RIRS than in manual RIRS (0.14 μSv vs. 45.5 μSv). Postoperative ureteral injury assessment revealed Grade 0 in manual RIRS cases and Grades 0, 1, and 2 in robotic RIRS cases. Conclusion The easyUretero system is a new robotic RIRS system that was developed in Korea. The results of the present study suggest that using easyUretero for stone retrieval during RIRS is safe and ergonomic.

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

BACKGROUND: Diabetes is a chronic disease that cause premature death worldwide. The rate of testing for diabetes among mentally ill patients is 1.5 times that of the general population, and intervention in diabetes care is needed for patient with severe mental illness and diabetes.METHODS: This study was conducted using cross-sectional surveys distributed to patient with severe mental illness (n=54) among those who visited and were hospitalized at the National Mental Health Center.RESULTS: According to the assessment of the knowledge level of diabetes in patient with severe mental illness accompanied by type 2 diabetes, the correct answer rate was lower than that in the general population. Education and income affected the level of diabetes knowledge, and as diabetes knowledge level increased, blood sugar level were observed to decrease. The linear regression model showed that self-efficacy and education level were found to be predictors of diabetes knowledge, and diabetes knowledge level were predictors of fasting blood sugar levels.CONCLUSION: The results of this study showed that the higher education level and self-efficacy of the patient with severe mental illness and diabetes increased the diabetes knowledge and affecting glycemic control.
Blood Glucose ; Chronic Disease ; Comorbidity ; Cross-Sectional Studies ; Diabetes Mellitus ; Education ; Fasting ; Humans ; Linear Models ; Mental Disorders ; Mental Health ; Mentally Ill Persons ; Mortality, Premature

The purpose of this research is to introduce the best practice of the Japanese national dementia strategy and explore implications to the Korean national dementia strategy. Interview was conducted among professions those who is in charge of Kumamoto dementia care practice in Kumamoto province, upon review of related literature and public documents. The Kumamoto model is implemented by the department of neuropsychiatry in public university hospitals, which can offer dementia-specialized medical services. Medical centers for dementia in public university hospitals play a leading role for managing practice and training local dementia centers specialist, coordinating medical services among medical institutions and community welfare facilities. In reference to the Kumamoto model, the Korean national dementia strategy can find implications in the direction of current system, specifically its approaches toward policy governance.
Asian Continental Ancestry Group ; Dementia ; Hospitals, University ; Humans ; Japan ; Neuropsychiatry ; Practice Guidelines as Topic ; Specialization

BACKGROUND: Patient-centered care (PCC) and integrative care approach are widely advocated. However, their implementation usually requires an extended consultation time. Despite significant advances in medical diagnosis and treatment, no studies have examined consultation time and patient centeredness in Korea. METHODS: We conducted a “15-Minute Consultation” for first-time patients in outpatient clinics of 13 departments. A control group was selected from the same physicians' first-time patients, adjusting for age and gender. A total of 275 patients were selected for receiving in-depth consultation and 141 control patients were selected for regular consultation. Data were collected from patients using a questionnaire comprising a patient-centeredness scale and items on potential predictors such as socio-demographic and clinical factors. We also investigated the participating physician's professionalism. RESULTS: As compared to the control group, the in-depth consultation group scored higher on 5 variables associated with PCC, including (patients' perception of) medical professionals, wait and consultation times, treatment, patient advocacy, and patient satisfaction. While 92.4% of patients in the in-depth consultation group reported that the consultation time was sufficient, only 69.0% of those in the control group reported the same (P < 0.01). In the in-depth consultation group, scores on satisfaction level were the highest for the department of internal medicine, followed by departments of surgery and pediatrics. Participating physicians' improved satisfaction following the intervention proved that in-depth consultation facilitated building a rapport with patients. CONCLUSION: This study illustrated that the provision of sufficiently long consultation for serious and rare diseases could improve PCC and physicians' professionalism. Health authorities should reshuffle the healthcare delivery system and provide sufficient consultation time to ensure PCC and medical professionalism.
Ambulatory Care Facilities ; Delivery of Health Care ; Diagnosis ; Humans ; Internal Medicine ; Korea ; Outpatients ; Patient Advocacy ; Patient Satisfaction ; Patient-Centered Care ; Pediatrics ; Professionalism ; Rare Diseases ; Tertiary Care Centers

OBJECTIVES: As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. METHODS: Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. RESULTS: Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. CONCLUSION: Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
Child ; Cholesteatoma* ; Ear* ; Ear, Middle ; Endoscopy ; Follow-Up Studies ; Humans ; Minimally Invasive Surgical Procedures ; Recurrence