Purpose: To report a case of recurrent hypotony and exudative choroidal detachment in a patient with pseudoexfoliation glaucoma following the use of a topical preservative-free prostaglandin–timolol fixed combination eye drop.Case summary: A 74-year-old diabetic patient with a history of trabeculectomy for pseudoexfoliation glaucoma presented with conjunctival hyperemia, ocular pain, and blurred vision 3 months after using a preservative free prostaglandin-timolol fixed combination. Intraocular pressure (IOP) was markedly reduced to 6 mmHg and fundus examination revealed severe exudative choroidal detachment involving three quadrants. Treatment with oral and topical corticosteroids, cycloplegics, and non-steroidal anti-inflammatory drugs normalized his IOP to 15 mmHg and resolved the detachment within 3 weeks. Two weeks later, the patient inadvertently reused the same medication mistaking it for artificial tears. Symptoms recurred the following day with his IOP dropping to 2 mmHg and choroidal detachment affecting all four quadrants. Re-treatment led to full recovery within 3 weeks. Conclusions Choroidal detachment following use of combination therapy with a prostaglandin analog and an aqueous suppressant is a rare complication. Patients with pseudoexfoliation syndrome and diabetes may be particularly susceptible. Vigilant monitoring of IOP and fundus status is recommended when prescribing these agents to individuals with multiple risk factors.

Background: Current guidelines recommend factor IIa- or Xa-specific inhibitors over warfarin analogs for preventing thromboembolic stroke in patients with atrial fibrillation (AF).However, their plasma concentrations in Korean patients are not well understood. Methods: We conducted a single-center laboratory study to determine the distribution ranges of peak and trough concentrations of three factor Xa inhibitors (apixaban, edoxaban, and rivaroxaban) prescribed for preventing strokes in patients with AF. Patients receiving one of these drugs and undergoing blood specimen collection for laboratory tests were screened. Blood specimens were obtained from patients who had adhered to the prescribed drug regimen consistently for at least 1 week. Drug plasma concentrations were measured using heparin liquid-reagent technology-based anti-Xa chromogenic assays. Results: We selected 459 patients who were taking standard or on-label-reduced doses of apixaban (N = 252), edoxaban (N = 182), or rivaroxaban (N = 25). The 5th–95th percentile ranges of the peak concentrations were 84–414 ng/mL (apixaban), 72–424 ng/mL (edoxaban), and 97–517 ng/mL (rivaroxaban). The respective 5th–95th percentile ranges of the trough concentrations were 44–237 ng/mL, 23–93 ng/mL, and 13–219 ng/mL. Approximately 19.6% (apixaban), 33.3% (edoxaban), and 64.0% (rivaroxaban) of patients in each group had peak concentrations out of the predicted distribution ranges based on pharmacokinetic data. Approximately 7.3%, 52.8%, and 8.3% of patients had trough concentrations out of the predicted distribution ranges. Conclusions A considerable proportion of Korean patients with AF taking factor Xa inhibitors may require population-specific reference ranges to guide therapeutic monitoring.

The global shortage of healthcare personnel, especially in low- and middle-income countries, has raised concerns about the quality and availability of medical education across these economies. Therefore, standardization and accreditation of medical education are essential to ensure the competence of healthcare professionals. This study reports the first-ever application of the set of standards developed by the Korean Institute of Medical Education and Evaluation (KIMEE) to assess a Vietnamese medical school. Under this initiative, the Accreditation Standards of KIMEE 2019 (ASK 2019) was implemented under the auspices of a Korea International Cooperation Agency Development Project. This study compared the evaluation results of a Vietnamese medical school’s performance with that of accredited Korean medical schools. The findings revealed both strengths and areas requiring significant improvement and underscore the need for Vietnam to develop its own contextually appropriate accreditation system.

Background: Healthcare-associated infections impose a significant burden on antibiotic usage, healthcare expenditures, and morbidity. Therefore, it is crucial to revise policies to minimize such losses. This nationwide survey aimed to evaluate infection prevention and control (IPC) components in healthcare facilities and encourage improvements in acute care hospitals with inadequate infection prevention settings. This study aims to enhance the infection control capabilities of healthcare facilities. Methods: From December 27, 2021, to May 13, 2022, we conducted a survey of 1,767 acute care hospitals in the Republic of Korea. A survey was conducted to evaluate the infection control components in 1,767 acute care hospitals. Infection control officers provided direct responses to a systematically developed questionnaire. Subsequently, 10% of the respondents were randomly selected for the site investigation. Results: Overall, 1,197 (67.7%) hospitals responded to the online survey. On-site investigations were conducted at 125 hospitals. Hospitals with ≥ 150 beds are advised to have an IPC team under Article 3 of the Medical Service Act; however, only 87.0% (598/687) of hospitals with ≥ 100 beds had one. Conversely, 22.7% (116/510) of hospitals with < 100 beds had an IPC team. Regulations for hand hygiene, waste management, healthcare worker protection and safety, environmental cleaning, standard precautions, and prevention of the transmission of multidrug-resistant pathogens were present in 84.2%, 80.1%, 77.4%, 76.2%, 75.8%, and 63.5% of the hospitals, respectively. Hospitals with < 100 beds had low availability of all categories of standard operating procedures. Conclusion This study is the first national survey of acute care hospitals in the Republic of Korea. The data presented in the current study will improve the understanding of IPC status and will help establish a survey system. Our survey provides a basis for improving policies related to IPC in healthcare facilities.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Objective: To assess the performance of novel qualitative diagnostic criteria using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) to identify the pathologic complete response (pCR) of primary tumors in esophageal cancer after neoadjuvant chemoradiation (nCRT). Materials and Methods: Patients who underwent nCRT, subsequent MRI, positron emission tomography/computed tomography (PET/CT), endoscopy, or esophagectomy for esophageal cancer between October 2021 and October 2023 were retrospectively analyzed. The DCE-MRI response of primary tumors was interpreted using five grades by thoracic radiologists as follows: G1 (compatible with CR), G2 (probable CR), G3 (probable partial response [PR]), G4 (compatible with PR), and G5 (stable or progressive disease). The performances of MRI, PET/CT, endoscopy, and their combinations in diagnosing pCR in primary tumors were calculated. Results: A total of 52 patients (male:female, 46:6; age, 61.2 ± 8.0 years) were included. Surgical specimens revealed pCR (ypT0) in 34 patients. G1 as the MRI criterion for pCR of primary tumors yielded a positive predictive value (PPV), specificity of 100% (18/18), and low sensitivity (23.5% [8/34]). Combining G1 and G2 as the MRI criteria increased the sensitivity to 73.5% (25/34), with a specificity of 88.9% (16/18), accuracy of 78.8% (41/52), and PPV of 92.6% (25/27). Adding the DCEMRI results (G1-2) significantly improved accuracy for both PET/CT (from 65.4% [34/52] to 80.8% [42/52], P = 0.03) and endoscopy (from 55.8% [29/52] to 76.9% [40/52], P = 0.005), with increase in sensitivity (from 55.9% [19/34] to 82.4% [28/34] for PET/CT-based evaluation [P = 0.008] and from 47.1% [16/34] to 82.4% [28/34] for endoscopy-based evaluation [P = 0.001]). Conclusion DCE-MRI-based grading shows high diagnostic performance for identifying pCR in primary tumors, particularly in terms of PPV and specificity, and enhances response evaluation when combined with PET/CT and endoscopy.

Purpose: 11C-Methionine PET/CT is a promising method for detecting parathyroid lesions in patients with primary hyperparathyroidism (PHPT). We aimed to determine the diagnostic ability and correlation of digital 11C-Methionine PET/CT for parathyroid lesions in patients with PHPT, particularly in cases where standard imaging methods yielded inconclusive results. Methods: This retrospective analysis was conducted on patients diagnosed with PHPT who underwent digital 11C-Methionine PET/CT imaging because of ambiguous results on standard imaging work-up ( 99m Tc-MIBI parathyroid scan and/or neck ultrasonography). Quantitative 11C-Methionine PET/CT parameters, including maximum standardized uptake value (SUVmax), mean SUV (SUVmean), peak SUV (SUVpeak), parathyroid methionine volume (PMV), and whole methionine uptake(WMU: PMV multiplied by SUVmean) were calculated with various thresholds, and their correlations with biochemical andpathologic parameters were investigated. Results: This study included 22 consecutive patients (10 men and 12 women) with a median age of 64.0 years. The lesion detection rate and sensitivity of digital 11C-Methionine PET/CT were 81.8% (18/22) and 100.0% (18/18), respectively.Quantitative analysis revealed that serum PTH (r = 0.490, P = 0.039) and serum calcium (r = 0.583, P = 0.011) were signifi-cantly correlated with PMV50%. Conclusion Digital 11C-Methionine PET/CT offers good performance in the detection of parathyroid lesions in PHPT patients with inconclusive standard imaging work-up. The volume parameter of PMV50% significantly correlated biochemi-cal parameters and can serve as a complementary diagnostic tool.

Synthetic data, generated using advanced artificial intelligence (AI) techniques, replicates the statistical properties of real-world datasets while excluding identifiable information.Although synthetic data does not consist of actual data points, it is derived from original datasets, thereby enabling analyses that yield results comparable to those obtained with real data. Synthetic datasets are evaluated based on their utility—a measure of how effectively they mirror real data for analytical purposes. This paper presents the generation of synthetic datasets through the Healthcare Big Data Showcase Project (2019–2023). The original dataset comprises comprehensive multi-omics data from 400 individuals, including cancer survivors, chronic disease patients, and healthy participants. Synthetic data facilitates efficient access and robust analyses, serving as a practical tool for research and education. It addresses privacy concerns, supports AI research, and provides a foundation for innovative applications across diverse fields, such as public health and precision medicine.

Purpose: This study aimed to evaluate the lives of small independent restaurant owners during the COVID-19 pandemic. Methods: The participants were 15 small independent restaurant owners operating independent small restaurants during the COVID-19 pandemic. Data were collected individually through in-depth interviews from September 30, 2022, to January 20, 2023. The transcribed interview content analyzed using Corbin and Strauss’s grounded theory approach. Results: Analysis of the psychological resistance experience of small independent restaurant owners with the COVID-19 pandemic resulted in 6 themes, 15 sub-themes, and 40 codes. The core category is revealed as the struggle for survival under the blind spot of uncertainty and helplessness. As a result of axial coding based on the paradigm model, the casual condition was operational difficulties in restaurants affected by the impact of COVID-19, and the contextual condition was bewilderment due to unprecedented circumstances. The central phenomenon was a life shattered by the COVID-19 pandemic. The intervening condition was enduring adversity with hope. The action/interaction strategies to control the phenomenon revealed ongoing struggles in the face of the hardships. In consequence, fostering resilience amid grappling with feelings of helplessness was revealed. Conclusion This study lays the groundwork for designing successful COVID-19 rehabilitation programs. This study shows that the improved climate of the small restaurant industry plays an important role in alleviating the burden of small independent restaurant owners.

The prevalence of postpartum depression (PPD) in Asia is reported to range from 13.53% to 22.31%. However, there remains a gap in the identification of PPD, particularly regarding cultural cutoff points. Therefore, the purpose of this scoping review was to determine the prevalence and associated factors of PPD in Eastern, South-eastern, Western, and Southern Asian countries and analyze the cutoff points of the Edinburgh Postnatal Depression Scale (EPDS) used across these countries. Following Arksey and O'Malley’s five-step scoping review framework, the population was defined as mothers, the concept as the EPDS, and the context as the Asian region. A literature search was conducted using PubMed, Embase, CINAHL, PsycINFO, and Web of Science. The data analysis focused on demographic characteristics, EPDS cutoffs and features, PPD prevalence, and its associated factors. Nineteen studies were selected. Most countries used translated versions of the EPDS with demonstrated reliability and validity. The cutoff scores varied, with most using scores of 10 or higher. The prevalence of PPD ranged from 5.1% to 78.7%. Key associated factors for PPD included cultural factors such as relationships with in-laws and preferences for the newborn’s sex. To improve the accuracy of PPD screening in Asia, the EPDS should be used consistently, and appropriate cutoff criteria must be established. In addition, prevention strategies and programs that reflect the cultural characteristics and social context of Asia need to be developed for the early detection and prevention of PPD.