Purpose: This study developed a thermoelectric element (TEE) tourniquet integrating a tourniquet with a temperature control device capable of delivering heat or cold therapy. A randomized controlled trial was conducted to evaluate the effects of the TEE tourniquet on pain, stress, and satisfaction during venipuncture. Methods: In total, 118 hospitalized adults were randomly assigned to heat therapy (40~45°C), cold therapy (0~10°C), thermal grill illusion therapy (alternating heat and cold), or the control group. The TEE tourniquet was applied 10 cm above the puncture site. A temperature intervention began 5 seconds before cannulation and was maintained during the procedure, typically lasting 10 to 30 seconds. The control group received the TEE tourniquet without temperature activation. Outcomes included perceived pain and stress (numerical rating scale), observed pain (Wong-Baker FACES), SpO2, stress index, and participant satisfaction. Results: Significant differences were found among groups in perceived pain (F = 4.82, p = .003), observed pain (F = 5.50, p = .001), and perceived stress (F = 4.72, p = .004). The heat therapy group reported significantly lower pain and stress than the control group. No significant differences were found in SpO₂, the stress index, or satisfaction. Conclusion Heat therapy via the TEE tourniquet significantly reduced venipuncture-related pain and stress. Given its short application time and usability, this device may serve as a clinically useful nursing intervention to improve comfort during invasive procedures.

Purpose: This study aimed to evaluate the effects of an intervention combining warm therapy (via a thermoelectric-element tourniquet) and a distraction-based approach (via an augmented reality-based app known as TWINKLE) on pain, stress, and satisfaction during intravenous catheterization in adults. Methods: A randomized controlled trial was conducted in South Korea with 93 healthy adults who were randomly assigned to one of three groups: the experimental group (TWINKLE app with warm therapy), the comparison group (warm therapy only), and the control group (no treatment). Participants’ pain, stress, and satisfaction, as well as practitioner satisfaction, were measured after the intervention. Results: Pain scores differed significantly among the three groups (F = 5.68, p = .005), with the experimental group showing significantly lower scores than the control group (p = .003). Stress levels were also significantly lower in the experimental group than in the other groups (F = 9.42, p < .001). Participant satisfaction was highest in the experimental group (F = 17.65, p < .001), while nurse satisfaction was significantly higher in the comparison group than in the experimental and control groups (F = 67.91, p < .001), suggesting that the additional distraction intervention may have increased nurses’ workload. Conclusion Combining digital distraction with warm therapy using a thermoelectric-element tourniquet effectively reduces pain and stress while improving patient satisfaction during intravenous catheterization. Further research is needed to optimize this approach, with a particular focus on targeting digital distraction interventions to patients with higher levels of procedural anxiety and finding ways to minimize practitioner workload.

Background: Clostridioides difficile infection (CDI) is one of the most common hospitalacquired infections, with its incidence and disease burden increasing markedly worldwide over the past decade. Methods: To assess the attributable costs of CDI in Korea, the expenses related to hospital management of CDI cases were computed. This analysis used data from the National Health Insurance Service–National Sample Cohort spanning a decade (2010–2019). The annual national burden of CDI was determined by combining the attributable cost per CDI case with the number of patients with CDI obtained from the Health Insurance Review and Assessment Service data. Results: The attributable costs of CDI were determined based on variations in the length of hospital stay and medical costs between patients with CDI and control patients. The mean length of hospital stay was significantly longer for patients with CDI than that for control patients: 43.06 vs. 14.76 days (a difference of 28.30 days, P < 0.001). The adjusted medical costs (2019 = 100) for cases of CDI and controls were 11,162 USD and 3,318 USD, respectively, with a significant difference of 7,843 USD (P < 0.001). The cost of CDI per case exhibited a noticeable annual increase from 2010 to 2019, despite an annual decreasing trend in length of hospital stay. The estimated national cost attributed to CDI was $28.9 million in 2010; however, it increased gradually each year, reaching $205.6 million in 2019 (a 600% increase over 10 years). Conclusion CDI is associated with substantial healthcare costs in Korea. The economic burden of CDI has gradually increased in South Korea.

This study aimed to assess the utilization trends of pulmonary rehabilitation (PR) among lung cancer patients in Korea using the National Health Insurance Service (NHIS) database (2017 to 2021). PR was introduced and covered under the NHIS in 2016, primarily for chronic obstructive pulmonary disease, but recent evidence suggests its benefits for lung cancer patients. Data extraction was based on Korea Informative Classification of Diseases 8th revision codes C33 and C34, with PR prescriptions identified by codes MM440 and MM290.Descriptive statistical analysis was performed, and propensity score matching was used for comparison between PR and non-PR groups. Results showed a significant increase in PR utilization, with the number of patients receiving PR (MM440) rising from 1,002 in 2017 to 3,723 in 2021, indicating a 3.7-fold increase. However, the proportion of patients receiving PR remained low at 2.9% in 2021. Enhanced access to PR services and improved evaluation strategies are essential for optimizing patient outcomes.

Background/Aims: Fexuprazan, a novel potassium-competitive acid blocker, was developed for treating acid-related disorders. Pharmacokinetic and pharmacodynamic properties of fexuprazan, unlike those of proton pump inhibitors, are independent of food effect. This study aims to evaluate differences in efficacy and safety of fexuprazan in patients with erosive esophagitis (EE) according to the timing of dosing. Methods: In this multicenter, open-label noninferiority study, patients who had typical reflux symptoms with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg daily 30 minutes before or after meal. Treatment was completed after 2 weeks or 4 weeks when healing was endoscopically confirmed. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy up to week 4. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In the prior-to-meal group (n = 89) and after-meal group (n = 86), 4-week EE healing rates were 98.77% and 100.00% (difference, 0.01%; 95% CI, –0.01% to 0.04%) and 2-week EE healing rates were 95.77% and 97.14% (difference, 0.01%; 95% CI, –0.05% to 0.07%), respectively. TEAEs were 9.78% and 8.70% in the prior-to-meal group and the after-meal group, respectively. Conclusions Non-inferiority analysis revealed that taking fexuprazan after meal was non-inferior to taking fexuprazan before meals in patients with EE. The frequency of adverse events was similar between the 2 study groups. The drug is safe and effective for healing EE regardless of the timing of dosing.

Background: Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Results: Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]= –0.40 g/cm2 ; 95% confidence interval [CI], –0.73 to –0.07; I2 = 0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of –3.14 (95% CI, –3.82 to –2.47). Conclusion This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

Silver diamine fluoride (SDF) is recognized as a reliable option for inhibiting caries progression without tooth removal and for preventing new lesions. However, most studies have focused on the management of dentin caries, and few studies have explored the use of SDF in conjunction with light curing for enamel caries. This study evaluated the effects of SDF and potassium iodide (KI) with additional light curing on the remineralization of artificially induced enamel caries. Sixty-four specimens were prepared from 32 primary molars. Of these, two were used to observe polished sound enamel surfaces, whereas the remaining 62 were demineralized to artificially induce caries. After excluding two specimens to observe the carious enamel surface, 60 specimens were randomly divided into four groups: Group I (SDF for 60 s), Group II (SDF for 10 s), Group III (SDF for 10 s + light curing for 3 s), and Group IV (SDF for 10 s + KI + light curing for 3 s). After the allocated interventions, all specimens were subjected to pH cycling for 8 days. The Vickers microhardness, surface morphology, and chemical composition of enamel were analyzed using a microhardness tester, field-emission scanning electron microscopy (FE-SEM), and energy dispersive X-ray spectroscopy (EDS), respectively. Group IV exhibited the greatest increase in microhardness, followed by Group III, with significant differences between the groups. Groups I and II showed smaller increases, without significant differences between the groups. SEM-EDS analysis revealed higher silver deposition in the lightcured groups, and iodine peaks were observed in Group IV, confirming the formation of silver iodide. The combination of SDF, KI, and light curing could enhance enamel remineralization and shorten the application time compared with that for SDF alone.

Purpose: We investigated the changes in ocular higher-order aberrations (HOAs) between sutured scleral fixation and modified Yamane sutureless scleral fixation. Methods: We retrospectively reviewed 20 patients (20 eyes) who underwent sutured scleral fixation and 22 patients (22 eyes) who underwent modified Yamane sutureless scleral fixation. The best corrected visual acuity (BCVA) and HOAs were measured preoperatively, and at 3 months postoperatively, and the two groups were compared. Results: BCVA was significantly improved in both sutured scleral fixation and modified Yamane sutureless scleral fixation (p = 0.038, 0.015, respectively). The internal optic HOAs decreased significantly after scleral fixation both in both groups (p = 0.012, 0.033, respectively). Postoperative internal optic HOAs were significantly higher in modified Yamane sutureless scleral fixation group than in sutured scleral fixation group. (p = 0.034) Postoperative third-order aberrations, coma-like aberrations were significantly higher in modified Yamane sutureless scleral fixation group than in sutured scleral fixation group. (p = 0.032, 0.038, respectively) Conclusions Sutured scleral fixation showed more effectively decreased internal optics HOAs. IOL tilt and decentrations correlated with internal HOAs and thus should be avoided particularly in modified Yamane sutureless scleral fixation.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

Background: F-18-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) can be used to measure bone mineral density (BMD), cross-sectional muscle area (CSMA), Hounsfield units (HU) of liver and muscle, subcutaneous adipose tissue (SAT), abdominal visceral adipose tissue (VAT), and glucose metabolism. The present study aimed to identify age-related changes in body composition and glucose metabolism in Korean using opportunistic FDG-PET/CT imaging. Methods: We analyzed FDG-PET/CT, clinical history, and laboratory data abstracted from the medical records of patients who underwent health screening at a single institute between 2017 and 2022. Results: In total, 278 patients were included in the analysis (male:female=140:138). Age and body mass index were positively correlated in female, but negatively correlated in male. BMD decreased with age more in female, and CSMA decreased with age more in male. Muscle HU decreased with age for both sexes. In female, SAT and VAT increased with age; and in male, SAT decreased slightly while VAT remained stable. Muscle glucose metabolism showed no association with age in male but increased with age in female. CSMA correlated positively with BMD overall; and positively correlated with VAT and SAT in male only. In female only, both SAT and VAT showed negative correlations with glucose metabolism and correlated positively with muscle glucose metabolism. Liver HU values were inversely correlated with VAT, especially in female; and positively correlated with muscle glucose metabolism in female only. Conclusion FDG-PET/CT demonstrated distinct patterns of age-related changes in body composition and glucose metabolism, with significant differences between sexes.