Background and Objectives: There are various methods used to histologically assess the cell count of neutrophils in nasal polyps. With various classification of neutrophilic nasal polyps, determining the appropriate staining techniques and criteria is deemed important for the diagnosis of neutrophilic nasal polyps by assessing neutrophil cell counts. In this study, we tried to optimize different methods of neutrophil counting and staining by comparing clinical outcomes.Subjects and Method We studied 207 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyp from August 2014 to September 2018. Patients’ nasal polyp were taken to make following three slide sections: hematoxylin and eosin, human neutrophil elastase (HNE), myeloperoxidase. After staining, microscope picture (×400) was taken and neutrophils were counted. Neutrophil polyp (NP) was classified either by the tissue neutrophil count (20/HPF) or by the neutrophil percentage (1%/total cell) for clinical outcome comparison. Results: Two groups were made after HNE staining: the NP and the non-NP groups. The L-K scores and delta showed significant differences between each group while neutrophil was defined based on 20 counts/HPF (p<0.001). By Kaplan-Meier estimation, there was no statistical meaning between the two groups. But the NP group had a tendency to recur more than the non-NP group while 20 counts/HPF definition was used (p>0.05). Conclusion HNE staining and 20 counts/HPF were the most specific for neutrophil counting. Analyzing the nasal polyp into two groups due to histologic types showed that the NP group had worse prognosis than the non-NP group. In conclusion, neutrophils in the nasal polyp might be considered seriously for clinical outcomes.

Background and Objectives: The aim of this study was to examine the clinical characteristics and prognosis of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS), focusing on distinct histological endotypes characterized by eosinophil and neutrophil infiltration.Subjects and Method A total of 207 patients diagnosed with CRSwNP who underwent ESS between August 2014 and September 2018 were included in the study. Patients were categorized into different groups based on eosinophil and neutrophil counts in the tissues. The demographic data, Lund-Mackay score, Lund-Kennedy (L-K) endoscopic score, Sino-Nasal Outcome Test-22 and Kaplan-Meier estimation were analyzed according to different histologic endotypes. Results: The histologic types were divided into four groups: the eosinophilic polyp (EP)+ neutrophlic polyp (NP) group, the EP group, the NP group, and the nonEP+nonNP group. Among the groups, the highest level of inflammation (L-K score, p<0.05) was observed in the EP+NP group, and the worst prognosis was observed in the EP+NP group according to the results of the Kaplan-Meier analysis (p<0.001). Conclusion Compared to non-neutrophil-infiltration polyps, neutrophil infiltration was associated with worse outcome when it was accompanied with eosinophilic infiltration. This discovery underlines how crucial it is to take neutrophils in nasal polyps into account in order to better understand their clinical behavior and maybe design customized treatments for better patient outcomes.

Purpose: This study aimed to evaluate the use of active surgical co-management (SCM) by medical hospitalists for urology inpatient care. Materials and Methods: Since March 2019, a hospitalist-SCM program was implemented at a tertiary-care medical center, and a retrospective cohort study was conducted among co-managed urology inpatients. We assessed the clinical outcomes of urology inpatients who received SCM and compared passive SCM (co-management of patients by hospitalists only on request; March 2019 to June 2020) with active SCM (co-management of patients based on active screening by hospitalists; July 2020 to October 2021). We also evaluated the perceptions of patients who received SCM toward inpatient care quality, safety, and subjective satisfaction with inpatient care at discharge or when transferred to other wards. Results: We assessed 525 patients. Compared with the passive SCM group (n=205), patients in the active SCM group (n=320) required co-management for a significantly shorter duration (p=0.012) and tended to have a shorter length of stay at the urology ward (p=0.062) and less frequent unplanned readmissions within 30 days of discharge (p=0.095) while triggering significantly fewer events of rapid response team activation (p=0.002). No differences were found in the proportion of patients transferred to the intensive care unit, in-hospital mortality rates, or inpatient care questionnaire scores. Conclusion Active surveillance and co-management of urology inpatients by medical hospitalists can improve the quality and efficacy of inpatient care without compromising subjective inpatient satisfaction.

Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.

Purpose: This study investigates the impact of self-myofascial release using a foam roller on the quadriceps femoris for pelvic stability.We further compare the effects of a GRID surface Foam Roller (GFR), a Non-Vibration Foam Roller (NVFR), and a Vibration Foam Roller (VFR). Methods: Thirty healthy adults (15 males, 15 females) participated in this study and were randomly assigned to one of three conditions:GFR, NVFR, or VFR. Participants walked at self-selected speeds with an arm sling before and after foam roller stretching. The analyzed gait parameters included pelvic tilt, pelvic obliquity, and pelvic rotation. Results: In the NVFR and VFR groups, there was a Significant differences were obtained in the pelvic tilt between pre-test and post-test values (p< 0.05) in the NVFR and VFR groups, but no significant difference was observed in the GFR group (p> 0.05). Comparing the amount of change between the three groups exhibited a significant decrease in pelvic tilt in the NVFR and VFR groups compared to the GFR group (p< 0.017). No significant differences were found in pelvic obliquity and pelvic rotation (p> 0.05) in all groups. Conclusion While walking, the use of a VFR for self-myofascial release results in pelvic alteration by reducing the anterior pelvic tilt. We propose that a foam roller can be utilized to enhance pelvic stability during gait.

This study aimed to examine the distribution of gastrointestinal parasitic infections in domestic pigs in the Republic of Korea. From May 2020 to October 2021, 364 pig fecal samples were collected from 75 farms in 7 Provinces and microscopically examined. A total of 170 (46.7%) pigs were infected with at least one of the following parasites: Balantioides coli, strongyles, Ascaris suum, Trichuris suis, and coccidia. By parasite species, B. coli, strongyles, A. suum, T. suis, and coccidia oocysts or eggs were detected in 144 (39.6%), 24 (6.6%), 14 (3.8%), 4 (1.1%), and 1 (0.3%) samples, respectively. One hundred fifty-four, 15, and 1 cases showed single, double, and triple infections, respectively. Of the swine fecal samples from 75 farms, 69 specimens (92.0%) were infected with 1 or more parasites. All surveyed farms across the country exhibited a positive rate of over 30%, among which the highest positive rate was 65.0% in Chungcheongnam-do, and Jeollabuk-do was followed by 61.9%. Winter showed a statistically lower prevalence than other seasons. This study showed that gastrointestinal parasites are prevalent in pigs in Korea, although the diversity of parasites is low.

Background: In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). Objective: We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. Methods: We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. Results: We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. Conclusion We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.

Purpose: According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories. Methods: A total of 145 High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results. Results: After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies. Conclusion In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.

Background and Objectives: Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs. Results: A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (p=0.007) and took longer time to completely recover (p<0.001). Conclusion Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.