Background/Aims: Spinal cord injury (SCI) frequently impairs defecation, severely affecting the quality of life. This study examines compensatory neural remodeling after SCI, focusing on basal colonic contractility, neural responses to electrical field stimulation, and alterations in excitatory cholinergic and inhibitory nitrergic pathways. Methods: Female Sprague–Dawley rats underwent either sham surgery or T10 spinal cord transection and were categorized into 3 groups: sham, 1-week post-SCI (acute), and 4-week post-SCI (chronic). Colonic contractility was assessed in an organ bath using electrical field stimulation in the presence of a nitric oxide synthase inhibitor. Neural protein expression was analyzed by immunofluorescence and Western blotting. Results: SCI produced region- and time-dependent impairments in colonic contractility, with distinct alterations in the proximal circular and longitudinal muscles across acute and chronic phases. Neural excitability shifted dynamically, showing enhanced excitatory activity in the proximal longitudinal muscle at 1-week and the distal circular muscle at 4-week post-SCI. Protein analysis revealed increased neuronal nitric oxide synthase in the proximal colon, decreasedsoluble guanylyl cyclase in the distal colon, upregulated muscarinic M3 receptor in the proximal colon, and reduced vaso-active intestinal peptide receptor 1 in both proximal and distal regions. Conclusion SCI induces spatiotemporal remodeling of excitatory and inhibitory neural pathways, contributing to colonic dysmotility and revealing potential targets for therapeutic intervention.

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. Conclusion ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. Conclusion ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. Conclusion ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. Conclusion ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Novel strategies are required to reduce the risk of developing diabetes and/or clinical outcomes and complications of diabetes. In this regard, the role of the circadian system may be a potential candidate for the prevention of diabetes. We reviewed evidence from animal, clinical, and epidemiological studies linking the circadian system to various aspects of the pathophysiology and clinical outcomes of diabetes. The circadian clock governs genetic, metabolic, hormonal, and behavioral signals in anticipation of cyclic 24-hour events through interactions between a “central clock” in the suprachiasmatic nucleus and “peripheral clocks” in the whole body. Currently, circadian rhythmicity in humans can be subjectively or objectively assessed by measuring melatonin and glucocorticoid levels, core body temperature, peripheral blood, oral mucosa, hair follicles, rest-activity cycles, sleep diaries, and circadian chronotypes. In this review, we summarized various circadian misalignments, such as altered light-dark, sleep-wake, rest-activity, fasting-feeding, shift work, evening chronotype, and social jetlag, as well as mutations in clock genes that could contribute to the development of diabetes and poor glycemic status in patients with diabetes. Targeting critical components of the circadian system could deliver potential candidates for the treatment and prevention of type 2 diabetes mellitus in the future.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Background: There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM). Methods: This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. Results: Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. Conclusion We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV.