Background: The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort. Methods: We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups. Results: The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001). Conclusions The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.

Background: Korea National Health and Nutrition Examination Survey (KNHANES) triglyceride testing changed from the glycerol blanking method (2005–2021) to the glycerol nonblanking method (2022). We converted triglyceride data from 2005–2021 to that obtained since 2022 with different analytical methods. Methods: To develop a conversion equation, 98 fresh serum specimen pairs were compared using Passing–Bablok regression analysis. Implications of the conversion equation on epidemiological data were evaluated using KNHANES data from 2019–2021. Bias estimations determined using the Lipid Standardization Program (LSP) of the United States Centers for Disease Control and Prevention (CDC) enhanced the accuracy and comparability of the triglyceride results. Results: Triglyceride concentrations measured via the glycerol non-blanking method were 10.7 mg/dL (0.12 mmol/L, 10.0%) higher than those from the glycerol blanking method, with a 9.9 mg/dL (0.11 mmol/L, 5.0%) difference at a concentration of 200 mg/dL (2.26 mmol/L, N = 98). The conversion equation y (glycerol non-blanking, 2022) = 11.94+0.99x (glycerol blanking, 2005–2021) changed the mean triglyceride concentrations of the KNHANES 2019–2021 data (N = 16,015) from 123.7 mg/dL (1.40 mmol/L, 95% confidence interval [CI]: 122.2–125.1 mg/dL [1.38–1.41 mmol/L]) to 134.3 mg/dL (1.52 mmol/L, 95% CI: 132.9–135.8 mg/dL [1.50–1.53 mmol/L]). Since 2022, bias monitoring using the CDC’s LSP has remained within a 5.0% limit. Conclusions KNHANES triglyceride values in 2022 (non-blanking) were substantially higher than those from 2005–2021 (blanking). Conversion equations helped effectively adjust 2005–2021 data. Researchers should consider adjusting the KNHANES triglyceride data based on their study characteristics.

Background: Ensuring reference material (RM) commutability is crucial for evaluating measurement traceability in order to standardize laboratory tests. However, commutability assessment is not routinely performed. We assessed whether RMs prepared following CLSI C37-A guidelines could be used without assessing commutability by evaluating their commutability for four lipid measurements using the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and CLSI EP14 protocols. Methods: We analyzed total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in frozen sera from 20 individuals and 11 RMs, prepared by the Korea Disease Control and Prevention AgencyLaboratory Standardization Project (per CLSI C37-A), using six routine measurement procedures (MPs). Regression equations and 95% prediction intervals derived from single-donor sera were analyzed following CLSI EP14. The IFCC protocol was used to assess differences in inter-MP biases between RM and clinical samples. The effect of the TG concentration on commutability was evaluated by analyzing biases between MP results and reference procedure-assigned values. Results: RMs were commutable for most MP pairs for TC and TG. Commutability for HDL-C and LDL-C varied across RMs, with RM10 and RM11 showing higher TG levels (2.38 and 2.95 mmol/L, respectively) and lower commutability. Increased bias percentages from assigned values were observed for RMs with higher TG levels. Conclusions RMs prepared per CLSI C37-A were commutable with most MP pairs for TC and TG. Elevated TG levels affected HDL-C and LDL-C commutability, highlighting the need to consider TG concentrations during RM preparation and assess commutability to standardize laboratory tests.

Background: This study aimed to investigate the erosive potential of powdered vitamin C on the bovine enamel tooth surface. Methods: The experiment included five groups: Lemona, Vitagran, Korea Eundan, Coca-Cola (positive controls), and artificialsaliva (negative controls). The pH and titratable acidity were measured. Bovine enamel specimens were immersed in the experimental solutions for 15 minutes each day for 7 days. The surface microhardness was measured using the Vickers hardness number before immersion and on the 1st, 3rd, 5th, and 7th days. The surfaces of the bovine enamel specimens were observed by scanning electron microscopy (SEM). Results: The pH of the experimental groups was as follows: Lemona (2.04±0.04) had the lowest pH, followed by Vitagran(2.56±0.01), the positive control group Coca-Cola (2.60±0.03), Korea Eundan (3.14±0.02), and the negative control group artificial saliva (7.06±0.05). Surface microhardness decreased significantly during the immersion period (p＜0.001). The largest surface microhardness reduction value was shown in Lemona (–201.22±20.60), followed by Vitagran (–190.02±14.73), Korea Eundan (–189.27±27.14), Coca-Cola (–99.28±17.21), artificial saliva (–10.99±9.94). According to the SEM findings, the experimental and positive control groups exhibited rough surfaces with micropores, whereas the negative control group exhibited smooth surfaces before specimen immersion. Conclusion Consuming powdered vitamin C at a low pH may degrade the enamel surface. To reduce the erosive effect, it isrecommended to rinse the mouth with water and brush the teeth after an hour.

Background: Commutability refers to the consistency of results from different measurement procedures in regards to a reference material (RM) and representative samples. In this study, we evaluated the commutability of laboratory-prepared pooled sera and commercial quality control materials in the thyroid-stimulating hormone (TSH) proficiency testing program of the Korean Association of External Quality Assessment Service. Methods: Serum TSH from 30 patients was measured in triplicate. Two levels of lab-prepared pooled sera and three levels of commercial materials (Bio-Rad Liquichek Immunoassay Plus) were tested in triplicate at five positions per immunoassay platform (Beckman Coulter UniCel DxI 800, Abbott Alinity i, Roche Cobas e801, Siemens Atellica IM 1600). Commutability was assessed by comparing method differences in patient samples to RMs using the ‘International Federation of Clinical Chemistry and Laboratory Medicine’ protocol with a desirable bias of 10% based on biological variation. Results: The median TSH level for the 30 patient samples was 2.51–3.07 μIU/mL, with a coefficient of variation ranging from 1.51% to 4.32%.The median TSH levels of the in-house prepared materials were 0.912– 1.01 μIU/mL for RM2 and 9.10–10.9 μIU/mL for RM4. The median TSH levels of the commercial materials were 0.391–0.464 μIU/mL for RM1, 4.39–5.24 μIU/mL for RM3, and 28.2–35.5 μIU/mL for RM5. The in-house prepared materials (RM2, RM4) demonstrated commutability across all six method combinations. Among the commercial materials, RM1 and RM3 showed commutability in four method combinations, while RM5 showed commutability in three method combinations. Conclusions The evaluation results for the TSH proficiency testing materials showed that the in-house prepared materials had higher commutability than the commercial materials.

Background: Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. Methods: We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method. Results: Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). Conclusion Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.

Dysphagia frequently presents in patients with a cervical spinal cord injury following anterior cervical spine fusion (ACSF). However, it is essential to identify the cause of dysphagia because it can occur due to a variety of reasons, such as structural lesions, psychiatric problems, as well as neurologic impairment. We report two cases of dysphagia as secondary postoperative complications after ACSF. The first case was a 60-year-old male who experienced pain while swallowing, having undergone C3/4 ACSF due to traumatic retrolisthesis at C3/4. A videofluoroscopic swallowing study (VFSS) demonstrated a delayed swallowing reflex and liquid penetration. A cervical spine magnetic resonance imaging (MRI) showed a deep neck infection at the C4-7 level. Following intravenous antibiotic administration, the patient’s pain significantly improved. The second case was that of a 74-year-old female who underwent C3/4 ACSF due to an accidental fall. A VFSS demonstrated post-swallowing liquid aspiration. However, she complained of a foreign sensation in the throat and aspiration. A cervical spine computed tomography (CT) showed a suspected hardware loosening, which interfered with the passage of food. In patients with a cervical spinal cord injury, mechanical problems related to the surgery can be a cause of swallowing difficulty. Prompt identification and treatment of these complications are essential for patient recovery.

Purpose: The Korean Society of Medical Education (KSME) was founded in 1983 and celebrated its 40th anniversary in 2023. This study examines the evolution of topics discussed at KSME conferences from 1971 through 2023, highlighting shifts in the focus of medical education. Methods: We analyzed 90 KSME conferences over 5 decades (1970s, 1980s, 1990s, 2000s, and 2010s), categorizing the topics into three eras based on emerging themes and continuity. Results: Consequently, 37 topics covered at the conference were categorized. Ten topics continuously appeared from the 1970s to the 2010s, including future directions of medical education, teaching methods, faculty development, and curriculum. The topics from the 1970s to the 1990s included 14 areas, such as medical education evaluation, non-undergraduate curriculum, community-related, and research. Thirteen new topics emerged after the 2000s, such as social accountability, student support, professionalism, and quality improvements. The most common topics under innovations in medical education, a case of curriculum innovation at universities that began after 2000, were clinical clerkship, curriculum development, and medical humanities. Conclusion KSME’s selection of conference topics has been strategically aligned with societal needs and the evolving landscape of medical education. Future topics should continue to address relevant societal and educational challenges.

Background: This study aimed to investigate the erosive potential of powdered vitamin C on the bovine enamel tooth surface. Methods: The experiment included five groups: Lemona, Vitagran, Korea Eundan, Coca-Cola (positive controls), and artificialsaliva (negative controls). The pH and titratable acidity were measured. Bovine enamel specimens were immersed in the experimental solutions for 15 minutes each day for 7 days. The surface microhardness was measured using the Vickers hardness number before immersion and on the 1st, 3rd, 5th, and 7th days. The surfaces of the bovine enamel specimens were observed by scanning electron microscopy (SEM). Results: The pH of the experimental groups was as follows: Lemona (2.04±0.04) had the lowest pH, followed by Vitagran(2.56±0.01), the positive control group Coca-Cola (2.60±0.03), Korea Eundan (3.14±0.02), and the negative control group artificial saliva (7.06±0.05). Surface microhardness decreased significantly during the immersion period (p＜0.001). The largest surface microhardness reduction value was shown in Lemona (–201.22±20.60), followed by Vitagran (–190.02±14.73), Korea Eundan (–189.27±27.14), Coca-Cola (–99.28±17.21), artificial saliva (–10.99±9.94). According to the SEM findings, the experimental and positive control groups exhibited rough surfaces with micropores, whereas the negative control group exhibited smooth surfaces before specimen immersion. Conclusion Consuming powdered vitamin C at a low pH may degrade the enamel surface. To reduce the erosive effect, it isrecommended to rinse the mouth with water and brush the teeth after an hour.

Background: Commutability refers to the consistency of results from different measurement procedures in regards to a reference material (RM) and representative samples. In this study, we evaluated the commutability of laboratory-prepared pooled sera and commercial quality control materials in the thyroid-stimulating hormone (TSH) proficiency testing program of the Korean Association of External Quality Assessment Service. Methods: Serum TSH from 30 patients was measured in triplicate. Two levels of lab-prepared pooled sera and three levels of commercial materials (Bio-Rad Liquichek Immunoassay Plus) were tested in triplicate at five positions per immunoassay platform (Beckman Coulter UniCel DxI 800, Abbott Alinity i, Roche Cobas e801, Siemens Atellica IM 1600). Commutability was assessed by comparing method differences in patient samples to RMs using the ‘International Federation of Clinical Chemistry and Laboratory Medicine’ protocol with a desirable bias of 10% based on biological variation. Results: The median TSH level for the 30 patient samples was 2.51–3.07 μIU/mL, with a coefficient of variation ranging from 1.51% to 4.32%.The median TSH levels of the in-house prepared materials were 0.912– 1.01 μIU/mL for RM2 and 9.10–10.9 μIU/mL for RM4. The median TSH levels of the commercial materials were 0.391–0.464 μIU/mL for RM1, 4.39–5.24 μIU/mL for RM3, and 28.2–35.5 μIU/mL for RM5. The in-house prepared materials (RM2, RM4) demonstrated commutability across all six method combinations. Among the commercial materials, RM1 and RM3 showed commutability in four method combinations, while RM5 showed commutability in three method combinations. Conclusions The evaluation results for the TSH proficiency testing materials showed that the in-house prepared materials had higher commutability than the commercial materials.