Background: This study aimed to identify the clinical characteristics of multidrug-resistant/ rifampicin-resistant tuberculosis (MDR/RR-TB) in the Republic of Korea. Methods: Data of notified people with tuberculosis between July 2018 and December 2021 were retrieved from the Korea Tuberculosis Cohort database. MDR/RR-TB was further categorized according to isoniazid susceptibility as follows: multidrug-resistant tuberculosis (MDR-TB), rifampicin-monoresistant tuberculosis (RMR-TB), and RR-TB if susceptibility to isoniazid was unknown. Multivariable logistic regression analysis was conducted to identify the factors associated with MDR/RR-TB. Results: Between 2018 and 2021, the proportion of MDR/RR-TB cases among all TB cases and TB cases with known drug susceptibility test results was 2.1% (502/24,447). The proportions of MDR/RR-TB and MDR-TB cases among TB cases with known drug susceptibility test results were 3.3% (502/15,071) and 1.9% (292/15,071), respectively. Among all cases of rifampicin resistance, 31.7% (159/502) were RMR-TB and 10.2% (51/502) were RR-TB. Multivariable logistic regression analyses revealed that younger age, foreigners, and prior tuberculosis history were significantly associated with MDR/ RR-TB. Conclusion Rapid identification of rifampicin resistance targeting the high-risk populations, such as younger generations, foreign-born individuals, and previously treated patients are necessary for patient-centered care.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Background: The tibiofibular syndesmosis is essential for preserving the stability of the ankle. Acute syndesmotic injuries with evident or latent instability usually warrant surgical interventions. This cadaveric study examines and compares biomechanical characteristics between the following treatments for syndesmosis injuries: suture-button fixation plus syndesmotic repair and screw fixation. Methods: The lower extremities of 10 cadavers disarticulated at the knee joints were used, yielding 20 feet. Ten feet underwent surgery using the suture-button fixation with syndesmotic repair, while the remaining 10 feet underwent surgery using screw fixation. Before surgical treatment of syndesmosis injuries, each cadaveric lower limb underwent preliminary physiological cyclic loading, which was followed by a series of postfixation cyclic loading tests after the surgical procedure. Results: Our principal finding is that suture-button fixation with syndesmotic repair provided torsional strength comparable to that of screw fixation. The mean failure torque did not differ between the 2 groups, but the rotational stiffness was significantly lower in the suture-button fixation/augmentation group. Conclusions Suture-button fixation/augmentation facilitates flexible (physiological) syndesmosis movement and may be a useful alternative treatment for ankle syndesmosis injury.

Background: Not reducing the posterior malleolar fragment could have an impact on the alignment and stability of syndesmosis since the posterior inferior tibiofibular ligament (PITFL) originates at the posterior malleolar fragment. Given that these alignment and stability changes may contribute to discomfort and pain, further research may be required. We think that our new classification method will be able to help improve understanding of treatment methods for posterior malleolar fractures. Methods: We retrospectively analyzed 206 patients who underwent surgeries for ankle fractures in our orthopedic clinic between April 2014 and December 2022 and were verified to have posterior malleolar fractures in plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). We performed a probing test to determine whether syndesmosis was stable. Results: We were able to classify the 206 cases into the following 5 types: type 1 (31 cases, 15.0%), extraincisural fragment with an intact fibular notch; type 2 (98 cases, 47.5%), posterolateral fragment extending into the fibular notch; type 3 (37 cases, 17.9%), posteromedial 2-part fragment involving the medial malleolus; type 4 (19 cases, 9.2%), large posterolateral triangular fragment;and type 5 (21 cases, 10.1%), shell-like PITFL avulsion (< 2 mm) in a CT axial view or PITFL periosteal sleeve avulsion (PITPSA) in arthroscopic or MRI findings. Conclusions This new system that adds the PITPSA type for the classification of posterior malleolar fractures may be a useful approach to managing these injuries and may aid in treatment decision-making. It could be important to consider ligament surgery when treating PITPSA.

Purpose: Cancer poses a significant global health challenge, demanding precise genomic testing for individualized treatment strategies. Targeted-panel sequencing (TPS) has improved personalized oncology but often lacks comprehensive coverage of crucial cancer alterations. Whole-genome sequencing (WGS) addresses this gap, offering extensive genomic testing. This study demonstrates the medical potential of WGS. Materials and Methods: This study evaluates target-enhanced WGS (TE-WGS), a clinical-grade WGS method sequencing both cancer and matched normal tissues. Forty-nine patients with various solid cancer types underwent both TE-WGS and TruSight Oncology 500 (TSO500), one of the mainstream TPS approaches. Results: TE-WGS detected all variants reported by TSO500 (100%, 498/498). A high correlation in variant allele fractions was observed between TE-WGS and TSO500 (r=0.978). Notably, 223 variants (44.8%) within the common set were discerned exclusively by TE-WGS in peripheral blood, suggesting their germline origin. Conversely, the remaining subset of 275 variants (55.2%) were not detected in peripheral blood using the TE-WGS, signifying them as bona fide somatic variants. Further, TE-WGS provided accurate copy number profiles, fusion genes, microsatellite instability, and homologous recombination deficiency scores, which were essential for clinical decision-making. Conclusion TE-WGS is a comprehensive approach in personalized oncology, matching TSO500’s key biomarker detection capabilities. It uniquely identifies germline variants and genomic instability markers, offering additional clinical actions. Its adaptability and cost-effectiveness underscore its clinical utility, making TE-WGS a valuable tool in personalized cancer treatment.

Purpose: Hematopoietic stem cell transplantation (HSCT) has been an important method of treatment in the advance of pediatric acute lymphoblastic leukemia (ALL). The indications for HSCT are evolving and require updated establishment. In this study, we aimed to investigate the efficacy of HSCT on the treatment outcome of pediatric ALL, considering the indications for HSCT and subgroups. Materials and Methods: A retrospective analysis was conducted on ALL patients diagnosed and treated at a single center. Risk groups were categorized based on age at diagnosis, initial white blood cell count, disease lineage (B/T), and cytogenetic study results. Data on the patients’ disease status at HSCT and indications of HSCT were collected. Indications for HSCT were categorized as upfront HSCT at 1st complete remission, relapse, and refractory disease. Results: Among the 549 screened patients, a total of 418 patients were included in the study; B-cell ALL (n=379) and T-cell ALL (T-ALL) (n=39). HSCT was conducted on a total of 106 patients (25.4%), with a higher frequency as upfront HSCT in higher-risk groups and specific cytogenetics. The overall survival (OS) was significantly better when done upfront than in relapsed or refractory state in T-ALL patients (p=0.002). The KMT2A-rearranged ALL patients showed superior event-free survival (p=0.002) and OS (p=0.022) when HSCT was done as upfront treatment. Conclusion HSCT had a substantial positive effect in a specific subset of pediatric ALL. In particular, frontline HSCT for T-ALL and KMT2A-rearranged ALL offered a better prognosis than when HSCT was conducted in a relapsed or refractory setting.

Background: This study aimed to identify the clinical characteristics of multidrug-resistant/ rifampicin-resistant tuberculosis (MDR/RR-TB) in the Republic of Korea. Methods: Data of notified people with tuberculosis between July 2018 and December 2021 were retrieved from the Korea Tuberculosis Cohort database. MDR/RR-TB was further categorized according to isoniazid susceptibility as follows: multidrug-resistant tuberculosis (MDR-TB), rifampicin-monoresistant tuberculosis (RMR-TB), and RR-TB if susceptibility to isoniazid was unknown. Multivariable logistic regression analysis was conducted to identify the factors associated with MDR/RR-TB. Results: Between 2018 and 2021, the proportion of MDR/RR-TB cases among all TB cases and TB cases with known drug susceptibility test results was 2.1% (502/24,447). The proportions of MDR/RR-TB and MDR-TB cases among TB cases with known drug susceptibility test results were 3.3% (502/15,071) and 1.9% (292/15,071), respectively. Among all cases of rifampicin resistance, 31.7% (159/502) were RMR-TB and 10.2% (51/502) were RR-TB. Multivariable logistic regression analyses revealed that younger age, foreigners, and prior tuberculosis history were significantly associated with MDR/ RR-TB. Conclusion Rapid identification of rifampicin resistance targeting the high-risk populations, such as younger generations, foreign-born individuals, and previously treated patients are necessary for patient-centered care.

Background: This study aimed to identify the clinical characteristics of multidrug-resistant/ rifampicin-resistant tuberculosis (MDR/RR-TB) in the Republic of Korea. Methods: Data of notified people with tuberculosis between July 2018 and December 2021 were retrieved from the Korea Tuberculosis Cohort database. MDR/RR-TB was further categorized according to isoniazid susceptibility as follows: multidrug-resistant tuberculosis (MDR-TB), rifampicin-monoresistant tuberculosis (RMR-TB), and RR-TB if susceptibility to isoniazid was unknown. Multivariable logistic regression analysis was conducted to identify the factors associated with MDR/RR-TB. Results: Between 2018 and 2021, the proportion of MDR/RR-TB cases among all TB cases and TB cases with known drug susceptibility test results was 2.1% (502/24,447). The proportions of MDR/RR-TB and MDR-TB cases among TB cases with known drug susceptibility test results were 3.3% (502/15,071) and 1.9% (292/15,071), respectively. Among all cases of rifampicin resistance, 31.7% (159/502) were RMR-TB and 10.2% (51/502) were RR-TB. Multivariable logistic regression analyses revealed that younger age, foreigners, and prior tuberculosis history were significantly associated with MDR/ RR-TB. Conclusion Rapid identification of rifampicin resistance targeting the high-risk populations, such as younger generations, foreign-born individuals, and previously treated patients are necessary for patient-centered care.

This study explored the evolving trends in pediatric dentistry research, focusing on the changes in research trends in the Journal of the Korean Academy of Pediatric Dentistry (JKAPD) and comparing them with those in other international journals and previous studies. We selected the JKAPD (Korea), Pediatric Dentistry (PD, USA), European Archives of Paediatric Dentistry (EAPD, Europe), and The Japanese Journal of Pediatric Dentistry (JJPD, Japan) as subjects for this study, as each one is considered the core academic journals of the corresponding region. Data from the four journals were collected by reviewing articles published over 20 years from 2004 to 2023. Sixteen classification criteria were established, and 4,231 papers were assigned a classification number. This study included 1,205 studies from the JKAPD, 1,320 from the PD, 1,070 from the EAPD, and 636 from the JJPD. Publication trends were similar across the pediatric dental journals; however, the JJPD showed no correlation with other journals. Dental caries and prevention of dental caries were the most published topics in all journals (15.4%), followed by systemic diseases or patients with special health care needs (9.9%), conservative treatment and restorative materials (9.2%), and dental growth and developmental disturbances (8.8%). The thematic distribution of articles in the JKAPD observed in this study is consistent with that of previous studies. Although there were regional variations, the distribution of publication trends did not significantly change before or after the 21st century. This study offers valuable insights for comparing and analyzing trends in domestic and international research and providing an opportunity to examine which social and environmental changes have influenced these trends.

Background: Despite the critical importance of sleep medicine within neurology, notable gaps in education and clinical practice persist among neurologists. This study aims to explore the extent of involvement and the challenges faced by Korean neurologists in sleep medicine, focusing on awareness of polysomnography training program, the operation of sleep study facilities, and educational exposure. Methods: An online survey collected responses from 233 neurologists, focusing on their demographics, knowledge of and involvement in sleep medicine, operation of sleep study facilities, and participation in residency training. Results: The findings indicated that 84.9% of neurologists were aware of polysomnography training program, primarily through professional societies. Nonetheless, 15.1% reported unfamiliarity with these initiatives, with 72.7% of this subgroup expressing interest in sleep medicine yet lacking access to information. In terms of clinical practice, 74 neurologists operated sleep study facilities, with 63% intending to expand. Key operational challenges included staff management, maintaining patient volumes, and inadequate institutional support. Among respondents from teaching hospitals, only 36 out of 114 reported active resident involvement in sleep study interpretations, predominantly hindered by excessive workloads and insufficient staffing. Conclusions A significant number of neurologists have an interest in sleep medicine; however, substantial challenges impede effective education and clinical practice. These results underscore the need for improved educational resources and institutional support to enhance the growth and effectiveness of sleep medicine practices among neurologists.