Background: Whether anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels post-third coronavirus disease (COVID-19) vaccination correlate with worse outcomes due to breakthrough infection is unclear. We evaluated the association between anti-SARS-CoV-2 antibody levels and symptomatic breakthrough infection or hospitalization during the Omicron surge in kidney transplant recipients. Methods: In total, 287 kidney transplant recipients expected to receive a third vaccination were enrolled between November 2021 and February 2022. The Abbott SARS-CoV-2 IgG II Quant test (Abbott, Chicago, IL, USA) was performed within three weeks before and four weeks after the third vaccination. The incidence of symptomatic breakthrough infection and hospitalization from two weeks to four months post-third vaccination was recorded. Results: After the third vaccination, the seropositive rate and median antibody titer of the 287 patients increased from 57.1% to 82.2% and from 71.7 (interquartile range [IQR] 7.2– 402.8) to 1,612.1 (IQR 153.9–5,489.1) AU/mL, respectively. Sixty-four (22.3%) patients had symptomatic breakthrough infections, of whom 12 required hospitalization. Lower anti-receptor-binding domain (RBD) IgG levels ( < 400 AU/mL) post-third vaccination were a risk factor for symptomatic breakthrough infection (hazard ratio [HR] = 3.46, P < 0.001).Anti-RBD IgG levels < 200 AU/mL were a critical risk factor for hospitalization (HR = 36.4, P = 0.007). Conclusions Low anti-spike IgG levels after third vaccination in kidney transplant recipients were associated with symptomatic breakthrough infection and, particularly, with hospitalization during the Omicron surge. These data can be used to identify patients requiring additional protective measures, such as passive immunization using monoclonal antibodies.

Background: Transfusion reactions have been under-reported, and the laboratory tests to evaluate the causes of the reactions are unfamiliar to physicians other than transfusion specialists. The paper-based transfusion reaction reporting system previously used in our hospital was one-way, with physicians submitting it to the Department of Transfusion Management. To address this, we developed an electronic reporting system that improves communication with physicians to identify the cause of transfusion reactions and recommend appropriate blood components. Methods: To assess the status of transfusion reaction reporting, transfusion reaction reports and transfusion nursing records of 5 years from 2019 to 2023 were analyzed. The transfusion reaction reporting system comprises two parts: the physician's report and the response from the Department of Transfusion Management. If physicians order blood products for patients with a history of prior transfusion reactions, a pop-up alert appears, warning them to check the details of the previous report. Results: From 2019 to 2023, 2.5% cases of transfusion-related symptoms occurred annually and only 2.6% of transfusion reactions were reported. In 21 out of the 31 cases, the cause was difficult to determine due to inadequate laboratory tests.The attending physicians of 12 cases were given a recommendation to use blood products or to conduct further laboratory tests by the Department of Transfusion Management to reduce recurrence, but the advice was followed only in 4 cases. Conclusion The electronic transfusion reaction reporting system could help physicians conduct appropriate investigations for transfusion reactions and inform physicians regarding the laboratory tests required to be undertaken. It is expected to enhance blood transfusion safety and management by improving communication with physicians.

Background: Transfusion reactions have been under-reported, and the laboratory tests to evaluate the causes of the reactions are unfamiliar to physicians other than transfusion specialists. The paper-based transfusion reaction reporting system previously used in our hospital was one-way, with physicians submitting it to the Department of Transfusion Management. To address this, we developed an electronic reporting system that improves communication with physicians to identify the cause of transfusion reactions and recommend appropriate blood components. Methods: To assess the status of transfusion reaction reporting, transfusion reaction reports and transfusion nursing records of 5 years from 2019 to 2023 were analyzed. The transfusion reaction reporting system comprises two parts: the physician's report and the response from the Department of Transfusion Management. If physicians order blood products for patients with a history of prior transfusion reactions, a pop-up alert appears, warning them to check the details of the previous report. Results: From 2019 to 2023, 2.5% cases of transfusion-related symptoms occurred annually and only 2.6% of transfusion reactions were reported. In 21 out of the 31 cases, the cause was difficult to determine due to inadequate laboratory tests.The attending physicians of 12 cases were given a recommendation to use blood products or to conduct further laboratory tests by the Department of Transfusion Management to reduce recurrence, but the advice was followed only in 4 cases. Conclusion The electronic transfusion reaction reporting system could help physicians conduct appropriate investigations for transfusion reactions and inform physicians regarding the laboratory tests required to be undertaken. It is expected to enhance blood transfusion safety and management by improving communication with physicians.

Background: Transfusion reactions have been under-reported, and the laboratory tests to evaluate the causes of the reactions are unfamiliar to physicians other than transfusion specialists. The paper-based transfusion reaction reporting system previously used in our hospital was one-way, with physicians submitting it to the Department of Transfusion Management. To address this, we developed an electronic reporting system that improves communication with physicians to identify the cause of transfusion reactions and recommend appropriate blood components. Methods: To assess the status of transfusion reaction reporting, transfusion reaction reports and transfusion nursing records of 5 years from 2019 to 2023 were analyzed. The transfusion reaction reporting system comprises two parts: the physician's report and the response from the Department of Transfusion Management. If physicians order blood products for patients with a history of prior transfusion reactions, a pop-up alert appears, warning them to check the details of the previous report. Results: From 2019 to 2023, 2.5% cases of transfusion-related symptoms occurred annually and only 2.6% of transfusion reactions were reported. In 21 out of the 31 cases, the cause was difficult to determine due to inadequate laboratory tests.The attending physicians of 12 cases were given a recommendation to use blood products or to conduct further laboratory tests by the Department of Transfusion Management to reduce recurrence, but the advice was followed only in 4 cases. Conclusion The electronic transfusion reaction reporting system could help physicians conduct appropriate investigations for transfusion reactions and inform physicians regarding the laboratory tests required to be undertaken. It is expected to enhance blood transfusion safety and management by improving communication with physicians.

Background: Transfusion reactions have been under-reported, and the laboratory tests to evaluate the causes of the reactions are unfamiliar to physicians other than transfusion specialists. The paper-based transfusion reaction reporting system previously used in our hospital was one-way, with physicians submitting it to the Department of Transfusion Management. To address this, we developed an electronic reporting system that improves communication with physicians to identify the cause of transfusion reactions and recommend appropriate blood components. Methods: To assess the status of transfusion reaction reporting, transfusion reaction reports and transfusion nursing records of 5 years from 2019 to 2023 were analyzed. The transfusion reaction reporting system comprises two parts: the physician's report and the response from the Department of Transfusion Management. If physicians order blood products for patients with a history of prior transfusion reactions, a pop-up alert appears, warning them to check the details of the previous report. Results: From 2019 to 2023, 2.5% cases of transfusion-related symptoms occurred annually and only 2.6% of transfusion reactions were reported. In 21 out of the 31 cases, the cause was difficult to determine due to inadequate laboratory tests.The attending physicians of 12 cases were given a recommendation to use blood products or to conduct further laboratory tests by the Department of Transfusion Management to reduce recurrence, but the advice was followed only in 4 cases. Conclusion The electronic transfusion reaction reporting system could help physicians conduct appropriate investigations for transfusion reactions and inform physicians regarding the laboratory tests required to be undertaken. It is expected to enhance blood transfusion safety and management by improving communication with physicians.

PURPOSE: The present experiment aimed to evaluate the placement accuracy of fully guided implant surgery using a mucosa-supported surgical guide when the protocol of osteotomy and installation was modified (MP) compared to when the protocol was sequentially and conventionally carried out (CP). MATERIALS AND METHODS: For 24 mandibular dentiform models, 12 dentists (6 experts and 6 beginners) performed fully guided implant placements two times at the right first and second molar sites using a mucosa-supported surgical guide, once by the CP (CP group) and at the other time by the MP (MP group). The presurgical and postsurgical stereolithographic images were superimposed, and the deviations between the virtually planned and actually placed implant positions and the procedure time were compared statistically (P < .05). RESULTS: The accuracies were similar in the CP and MP groups. In the CP group, the mean platform and apex deviations at the second molar site for the beginners were +0.75 mm and +1.14 mm, respectively, which were significantly larger than those for the experts (P < .05). In the MP group, only the mean vertical deviation at the second molar site for the beginners (+0.53 mm) was significantly larger than that for the experts (P < .05). The procedure time was significantly longer for the MP group (+94.0 sec) than for the CP group (P < .05). CONCLUSION In fully guided implant surgery using a mucosa-supported guide, the MP may improve the placement accuracy when compared to the CP, especially at sites farther from the most-posterior natural tooth.

Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent dysphagia. The cause was initially diagnosed as a 10 cm pedunculated lesion extending from the upper esophageal sphincter to the mid-esophagus. An ESD was chosen over traditional surgery because it is less invasive. The procedure involved a precise submucosal injection and excision with special techniques to manage bleeding from a central vessel.Despite the extraction challenges owing to the size of the lesion, it was successfully removed orally. A histopathological examination of the 8.3×4.2×2.3 cm specimen revealed the characteristic features of a well-differentiated liposarcoma, including MDM2 and CDK4 positivity. The follow-up revealed no recurrence, and active surveillance has been performed since. This report highlights the versatility of ESD in treating significant esophageal tumors and provides evidence for its efficacy as a minimally invasive alternative.

Background/Aims: The Gout Impact Scale (GIS), a part of the Gout Assessment Questionnaire 2.0, is used to measure gout-specific health-related quality of life (HRQOL). Although several studies have been conducted on the factors affecting the HRQOL of patients with gout, few have focused on lifestyle factors. This study aimed to investigate the correlation between lifestyle habits and HRQOL using the GIS in patients with gout. Methods: We used data from the Urate-Lowering TheRApy in Gout (ULTRA) registry, a prospective cohort of Korean patients with gout treated at multiple centers nationwide. The patients were aged ≥18 years and met the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria. They were asked to complete a GIS and questions regarding their lifestyle habits at enrollment. Results: The study included 232 patients. ‘Gout concern overall’ scores in the GIS were significantly lower in patients who exercised more frequently and consumed soft drinks and meat less, and ‘well-being during attack’ scores were significantly lower in patients who consumed vegetables and exercised more frequently. The frequency of vegetable consumption had a negative linear relationship with the ‘well-being during attack’ and ‘gout concern during attack’ scores (p = 0.01, p = 0.001, respectively). The frequency of exercise had a negative linear relationship with the ‘gout concern overall’ and ‘gout concern during attack’ scores (p = 0.04 and p = 0.002, respectively). Conclusions Patients with gout who frequently consumed vegetables and exercised regularly experienced less impact of gout, exhibiting a better GIS that represented HRQOL.

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.