Background: Providing optimal nutrition to patients with acute respiratory failure is difficult because nutritional requirements vary according to disease severity and comorbidities. In 2021, the National Medical Center initiated a protocol for screening upon admission and regular monitoring by a multidisciplinary nutritional support team (NST), for all patients in the medical intensive care unit (ICU). This study aimed to evaluate the effects of routine NST monitoring and active intervention on the clinical outcomes of patients with acute respiratory failure. Methods: Patients with acute respiratory failure requiring high-flow nasal cannula, non-invasive ventilation, or mechanical ventilation were included. The primary outcome was 28-day mortality after ICU admission. Secondary outcomes included the supplied/target calorie ratio, supplied/target protein ratio on day 7, and complications. Results: In total, 152 patients were included in the analysis. The patients were divided into a pre-monitoring (n=96) and post-monitoring groups (n=56). More patients in the post-monitoring group received NST intervention and had earlier initiation of enteral feeding. In survival analysis, 28-day mortality was significantly lower in post-monitoring group (adjusted hazard ratio, 0.42; 95% CI, 0.24–0.74). The ratio of achievement for required calories and protein on day 7 was higher, but not significantly, in the post-monitoring group. No significant differences were observed in the incidence of complications. Conclusions Regular NST monitoring in the ICU could have contributed to a reduced risk of 28-day mortality in critically ill patients with acute respiratory failure.

This study aimed to evaluate the effect of different remineralization agents on the shear bond strength (SBS) on enamel and to confirm remineralization capacity through quantitative light-induced fluorescence (QLF). Sixty non-carious human third molars were divided into eight groups based on remineralization agents agents (control, Tooth Mousse plusTM, Apapro, BGS-7 bioglass) and application time (24 h, 2 weeks). Enamel surfaces were prepared and treated with agents, followed by demineralization and remineralization. Quantitative Light-induced Fluorescence (QLF) assessed fluorescence loss and recovery. After adhesive application and composite restoration, shear bond strength (SBS) was measured. Statistical analysis included Shapiro-Wilk, ANOVA, Kruskal-Wallis, paired t-tests, Wilcoxon rank tests, and multiple comparison tests. SBS values did not show a significant difference between the groups according to the type and application time of the remineralization agents. QLF measurement, in the 24 h groups, showed no significant difference in the recovery amount between the groups. In the 2 week groups, a statistically significant difference was observed and the value was significantly higher in the BG group than that in the control group. There were no significant differences in the values based on the application time. Within the limitations of this study, bioactive glass showed higher remineralization ability than all the other experimental agents. The SBS was not affected by the remineralizing agent.

Distant metastasis to the spleen is extremely rare. To the best of our knowledge, metastasis to the accessory spleen based on pathological findings has only been reported in four patients in the English literature, including one each of ovarian cancer, transitional cell carcinoma, breast cancer, and uterine carcinosarcoma after surgery. Furthermore, among these reported cases, only two reports (one each of transitional cell carcinoma and uterine carcinosarcoma) presented imaging findings. In this study, we report a case of colon cancer metastasis to the accessory spleen without involvement of the spleen in a 58-year-old male patient, providing imaging findings. This case emphasized the importance of considering the possibility of metastasis to the accessory spleen in patients with malignancy.

Purpose: This study investigated the use of synthetic computed tomography (CT) images derived from cone beam CT (CBCT) scans to analyze dose changes in breast cancer patients undergoing treatment and to evaluate the optimal timing for implementing adaptive radiotherapy. Methods: A retrospective analysis was conducted on five breast cancer patients treated with tomotherapy-based volumetric-modulated arc therapy at Yongin Severance Hospital. Each patient received 15 fractions, with doses of 320 centigray (cGy) to the high-dose planning target volume (PTV) and 267 cGy to the low-dose PTV. Planning CT images were acquired using the Aquilion scanner, andCBCT images were captured with the VersaHD linear accelerator’s on-board imager. These imageswere registered in RayStation using a hybrid deformable image registration method to generate synthetic CT images. Dose distributions were reanalyzed using the synthetic CT images, and dose-volume histogram parameters, including the dose to 95% of the volume (D95 ) and mean dose (Dmean ) for the PTV, as well as D95 , Dmean , the percentage of the volume receiving at least 5 Gy (V5 ) and 10 Gy (V10 )for organs-at-risk (OARs), were extracted using MATLAB to assess dose changes during treatment. Results: For the original plans, the mean D95 for PTV high across all patients was 287.13±31.32cGy, while for PTV low, it was 245.53±6.21 cGy. In contrast, the adaptive plans yielded a mean D95of 298.17±12.37 cGy for PTV High and 247.25±4.23 cGy for PTV low. The ART Plan may lead to increased dose exposure in certain structures, such as the spinal cord, while providing targeted improvements in reducing radiation exposure in specific OARs (e.g., contralateral breast and esophagus). Conclusions Synthetic CT images generated from CBCT scans provide a fast and efficient means of quantifying dose changes, supporting precise patient care through interfractional evaluation.Future studies will aim to apply this method to other organs and larger patient cohorts.

Background: Solid-organ transplant recipients (SOTRs) receiving immunosuppressive therapy are expected to have worse clinical outcomes from coronavirus disease 2019 (COVID-19). However, published studies have shown mixed results, depending on adjustment for important confounders such as age, variants, and vaccination status. Materials and Methods: We retrospectively collected the data on 7,327 patients hospitalized with COVID-19 from two tertiary hospitals with government-designated COVID-19 regional centers. We compared clinical outcomes between SOTRs and non-SOTRs by a propensity score-matched analysis (1:2) based on age, gender, and the date of COVID-19 diagnosis. We also performed a multivariate logistic regression analysis to adjust other important confounders such as vaccination status and the Charlson comorbidity index. Results: After matching, SOTRs (n=83) had a significantly higher risk of high-flow nasal cannula use, mechanical ventilation, acute kidney injury, and a composite of COVID-19 severity outcomes than non-SOTRs (n=160) (all P <0.05). The National Early Warning Score was significantly higher in SOTRs than in non-SOTRs from day 1 to 7 of hospitalization ( P for interaction=0.008 by generalized estimating equation). In multivariate logistic regression analysis, SOTRs (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.12–4.11) and male gender (OR, 2.62; 95% CI, 1.26– 5.45) were associated with worse outcomes, and receiving two to three doses of COVID-19 vaccine (OR, 0.43; 95% CI, 0.24–0.79) was associated with better outcomes. Conclusion Hospitalized SOTRs with COVID-19 had a worse prognosis than non-SOTRs. COVID-19 vaccination should be implemented appropriately to prevent severe COVID-19 progression in this population.