Purpose: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases. Materials and Methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre–COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed. Results: The patients’ median age was from 13 years (range, 1–19 years) to 13 years (range, 1–16 years) between the pre–COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre–COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7–120.0] vs. 20.0 hours [1.3–288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5–124.3] vs. 28.5 hours [6.1–293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0–13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1–7.3 mL) in pre–COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes. Conclusions The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.

Background: Poor outcomes after acute ischemic stroke (AIS) revascularization are anticipated in patients with dementia due to advanced age, comorbidities, and reduced disease awareness. This study investigated clinical characteristics and short-term outcomes of AIS revascularization in patients undergoing dementia treatment. Methods: We retrospectively reviewed patients who underwent AIS revascularization therapy at eight centers of the Catholic University of Korea. Patients receiving anti-dementia medication for cognitive impairment before stroke onset were analyzed. Clinical characteristics and outcomes, including the modified Rankin Scale (mRS) score, hemorrhagic transformation, and mortality, were collected. Results: Among 1,379 patients who received AIS revascularization over 5 years, 13 (0.94%; mean age 83 years; 8 females) had a preexisting diagnosis of dementia (Alzheimer’s disease in 11, mild cognitive impairment in 2) and were on anti-dementia medication. Two patients underwent intravenous thrombolysis combined with endovascular therapy, whereas 11 underwent endovascular therapy alone. Most patients (11/13, 84.6%) presented with an unclear onset time. Stroke lesions were located in the right middle cerebral artery (MCA) in seven cases, left MCA in three, bilateral MCAs in one, and posterior circulation in two. Hemorrhagic transformation occurred in six patients (46%), of whom three (23%) were symptomatic. The mRS scores at discharge were 6 in two patients, 5 in one patient, 4 in nine patients, and 3 in one patient. Four patients died within 3 months of stroke onset. Conclusion The proportion of patients with cognitive impairment receiving anti-dementia medication among those undergoing stroke revascularization therapy was very small. The rates of hemorrhagic transformation and mortality were high. None of the patients achieved favorable outcomes at discharge.

As human space exploration extends beyond low Earth orbit, the demand for comprehensive medical and pharmaceutical sup-port is increasing. The extreme conditions of space significantly alter drug stability, pharmacokinetics, and pharmacodynamics.Although the role of clinical pharmacists in space missions has not been extensively studied, this review aims to analyze existing literature to identify their contributions and potential applications in space pharmacy. A scoping review was conducted following Arksey and O’Malley’s framework. Relevant literature published up to December 7, 2024, was retrieved from PubMed usingpredefined search terms related to clinical pharmacy, pharmaceutical care, space medicine, and microgravity. Articles discussingpharmaceutical challenges in space and the potential contributions of clinical pharmacists were included. Data was extracted and thematically analyzed. A total of 26 studies were reviewed. Clinical pharmacists play critical roles in three main domains: (1) medication management and supply, including drug stability and quality control, selection and inventory management of essential medicines, and on-site manufacturing; (2) clinical pharmacy services, such as pharmacotherapy optimization under altered physiological conditions, therapeutic drug monitoring, adverse event and drug interaction surveillance, and education and counselingfor astronauts; and (3) research and development, encompassing the design of space-specific clinical trials and innovation in drugdelivery systems. The complexity of space environments demands new professional competencies from clinical pharmacists. Thisreview demonstrates that clinical pharmacists play essential roles in space missions. Future research should focus on refining space-specific pharmaceutical guidelines and enhancing training programs to ensure the safe and effective use of medications inextraterrestrial settings.

BACKGROUND: The skin, a vital organ protecting against microorganisms and dehydration, undergoes structural decline with aging, leading to visible issues such as wrinkles and sagging. Reduced blood vessels exacerbate vulnerability, hindering optimal cellular function and compromising skin health. Polydioxanone (PDO) biomaterials address aging concerns but produce acidic byproducts, causing inflammation. Inorganic particles and nitric oxide (NO) play crucial roles in inhibiting inflammation and promoting skin regeneration. Stem cell-derived extracellular vesicles (EVs) contribute to intercellular communication, offering the potential to enhance cell functions. The study proposes a method to enhance PDO-based medical devices by incorporating inorganic particles and immobilizing EVs, focusing on facial rejuvenation, anti-inflammatory response, collagen formation, and angiogenesis.METHOD: PDO composites with inorganic particles such as magnesium hydroxide (MH) and zinc oxide (ZO) were prepared and followed by EV immobilization. Comprehensive characterization included biocompatibility, anti-inflammation, collagen formation ability, and angiogenesis ability. RESULTS: Bulk-modified PDO composites demonstrated even dispersion of inorganic particles, pH neutralization, and enhanced biocompatibility. EVs immobilized on the composite surface exhibited spherical morphology. Inflammationrelated gene expressions decreased, emphasizing anti-inflammatory effects. Collagen-related gene and protein expressions increased, showcasing collagen formation ability. In addition, angiogenic capabilities were notably improved, indicating potential for skin rejuvenation. CONCLUSION The study successfully developed and characterized PDO composites with inorganic particles and EVs, demonstrating promising attributes for medical applications. These composites exhibit biocompatibility, anti-inflammatory properties, collagen formation ability, and angiogenic potential, suggesting their utility in skin rejuvenation and tissue engineering. Further research and clinical validation are essential.

BACKGROUND: Exosomes, nano-sized vesicles ranging between 30 and 150 nm secreted by human cells, play a pivotal role in long-range intercellular communication and have attracted significant attention in the field of regenerative medicine. Nevertheless, their limited productivity and cost-effectiveness pose challenges for clinical applications. These issues have recently been addressed by cell-derived nanovesicles (CDNs), which are physically synthesized exosome-mimetic nanovesicles from parent cells, as a promising alternative to exosomes. CDNs exhibit structural, physical, and biological properties similar to exosomes, containing intracellular protein and genetic components encapsulated by the cell plasma membrane. These characteristics allow CDNs to be used as regenerative medicine and therapeutics on their own, or as a drug delivery system. METHODS: The paper reviews diverse methods for CDN synthesis, current analysis techniques, and presents engineering strategies to improve lesion targeting efficiency and/or therapeutic efficacy. RESULTS: CDNs, with their properties similar to those of exosomes, offer a cost-effective and highly productive alternative due to their non-living biomaterial nature, nano-size, and readiness for use, allowing them to overcome several limitations of conventional cell therapy methods. CONCLUSION Ongoing research and enhancement of CDNs engineering, along with comprehensive safety assessments and stability analysis, exhibit vast potential to advance regenerative medicine by enabling the development of efficient therapeutic interventions.

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Ephedra is a genus of the Ephedraceae family and is found in temperate regions, such as Central Asia and Europe. Among the various ephedra species, Ma Huang (Ephedra herb) is derived from the aerial parts of Ephedra sinica Stapf, Ephedra equisetina Bunge, and Ephedra intermedia Schrenk & C.A. Mey. Ma Huang contains various ephedra alkaloids, including (-)-ephedrine, (+)-pseudoephedrine, (-)-norephedrine, (+)-norpseudoephedrine, (-)-methylephedrine, and (+)-methylpseudoephedrine, which are found naturally as single enantiomers, although they can be prepared as racemates. Although the use of Ma Huang in foods is prohibited in Korea, products containing Ma Huang can be imported, and so it is necessary to develop a suitable analytical technique for the detection of Ma Huang in foods. Herein, we report the development of analytical methods for the detection of ephedra alkaloids in products containing Ma Huang. Following sample purification by solid phase extraction, quantitative analysis was performed using ultra-performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MS/MS). Additionally, the enantiomers were successfully separated using HPLC-DAD. We successfully analyzed various food samples, where the ephedra alkaloids were qualitatively and quantitatively determined, and the enantiomers were separated. It is expected that these methods may contribute toward preventing the distribution of illegal products containing Ma Huang.