Background: Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data. Methods: We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset. Results: The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%. Conclusions Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI.

Purpose: Smoking is a risk factor for the development of asthma and worsens the long-term prognosis of asthma. This study investigated the effect of cigarette smoke extract (CSE) on innate immune cells such as innate lymphoid cells (ILCs) and macrophages in a murine model of induced asthma. Methods: Six-week-old female BALB/C mice were exposed to ovalbumin (OVA) via an intranasal route with or without CSE for 8 weeks to establish a chronic murine asthma model. Airway hyperresponsiveness (AHR), airway inflammatory cells from bronchoalveolar lavage fluid, and the population of CD4 + T cells, ILCs, and macrophages in the lungs were studied to evaluate the effect of chronic CSE exposure on asthma. Results: Mice intranasally exposed to CSE along with OVA treatment (CSE/OVA) had significantly enhanced AHR, eosinophilic inflammation, increased IL-13 and IL-17 producing CD4 + T cells compared to mice intranasally exposed to OVA only. On the contrary, the frequency of Foxp3 + in CD4 + T cells was reduced in the CSE/OVA group. CSE enhanced the dendritic cell (DC) population, especially MHCII + DC with antigen-presenting capacity. Among ILCs, the CSE/OVA group showed a significant increase of IL-13-producing type 2 ILCs, but not interferon-γ+ ILC1s and IL-17 + ILC3s. . Among macrophages, alveolar macrophage and Ym-1 and FIZZ1 positive M2 macrophage populations were significantly induced by CSE exposure alone and when combined with OVA treatment. Conclusion In this study, we showed that long-term exposure to cigarette smoke contributes to the inception and aggravation of asthmatic inflammation by enhancing DCs, ILC2, and M2 alveolar macrophage populations in the mouse model.

The omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to have high infectivity and is more likely to evade vaccine immunity. However, booster vaccination is expected to strengthen cross-reactive immunity, thereby increasing the vaccine effectiveness (VE). This study aimed to evaluate the relative VE of the 3-dose (booster) vaccination compared with the 2-dose primary series vaccination in healthcare workers during omicron variant-dominant periods. During the omicron-dominant period from February 1, 2022 to February 28, 2022, a 1:1 matched case-control study was conducted.Healthcare workers with positive SARS-CoV-2 test results were classified as positive cases, whereas those with negative results served as controls. Compared with the 2-dose primary series vaccination, booster vaccination with mRNA vaccine showed moderate VE (53.1%).However, in multivariate analysis including the time elapsed after vaccination, the significant VE disappeared, reflecting the impact of recent vaccination rather than the third dose itself.

Purpose: To report two cases of adult inclusion conjunctivitis masquerading as chronic conjunctivitis.Case summary: (Case 1) A 34-year-old man presented with a foreign body sensation in his right eye for 2 months. At the first visit, slit lamp examination showed follicles on the inferior palpebral conjunctiva. Chlamydia trachomatis immunoglobulin M (IgM) antibody and polymerase chain reaction (PCR) tests were positive. The patient was prescribed doxycycline for 1 week, which improved the symptoms, followed by gentamicin and levofloxacin for an additional 5 days, which further improved the clinical symptoms and conjunctivitis. (Case 2) A 39-year-old man presented with right eye pain and redness for 5 months. At the first visit, slit lamp examination showed follicles on the inferior palpebral conjunctiva. Chlamydia trachomatis IgM antibody and PCR tests were positive. After 1 week of doxycycline treatment, the clinical symptoms and conjunctivitis improved. Conclusions Because adult inclusion conjunctivitis caused by chlamydial infection has non-specific symptoms, it can be misdiagnosed as chronic conjunctivitis. A detailed medical history and appropriate diagnostic tests are necessary to make this diagnosis.

Background: Recently, microbiome research has been actively conducted for various skin areas. However, no study has yet compared the microbiome of bacteria and fungi in the ear canal of healthy individuals and patients with chronic otitis externa in Korea. Objective: This study aimed to investigate the difference in the distribution of fungal and bacterial microbial communities in ear canal samples of healthy individuals and patients with chronic otitis externa. Methods: In 24 patients with bilateral chronic otitis externa and 24 healthy controls, cotton swabs were used to obtain samples from the bilateral ear canal. To characterize the fungal and bacterial communities, we sequenced and analyzed the 16S rRNA V4–V5 and ITS1 regions using Quantitative Insights into Microbial Ecology 2, respectively. Results: The alpha diversity analysis for bacteria and fungi confirmed that both richness and evenness decreased in the patient group. The beta diversity analysis for bacteria confirmed that these parameters differed between the control and patient groups. The beta diversity analysis for fungi showed no difference between the groups. Conclusion We observed different skin microbiomes in the patients with chronic otitis externa compared with those in the healthy individuals.

Objectives: . In subset of patients, acinic cell carcinoma (AcCC) exhibits aggressive features such as recurrence, distant metastasis, and mortality. This study aimed to investigate clinicopathologic factors influencing patients’ prognosis and to identify adverse features predictive of an unfavorable prognosis. Methods: . Between January 2000 and December 2016, 59 patients with AcCC were enrolled in this study. Results: . The patients’ 5-year overall survival rate was 93.3%, and their 5-year recurrence-free survival rate was 80.5%. During the study period, recurrence occurred in 10 patients. The mean time to recurrence after surgery was 26 months (range, 5–60 months). During the study period, three patients died from the disease. Univariate analysis showed that sex, surgical extent, extranodal extension, T classification, and TNM stage were significantly associated with disease recurrence. Multivariate analysis showed that, among the clinicopathologic factors included in the analysis, only TNM stage displayed a statistically significant correlation with disease recurrence. Conclusion . Surgical treatment alone yielded good results for AcCC, and additional treatment did not affect the recurrence-free survival rate or the overall survival rate, even when the resection margin was less than 1 mm. Other pathologic factors did not show prognostic significance for disease recurrence or death.

Disseminated peritoneal leiomyomatosis (DPL) is a very rare benign disease, characterized by multiple solid subperitoneal or peritoneal smooth muscle nodules in abdominopelvic cavity and malignant transformation is extremely rare. Also, uterine smooth muscle tumors of unknown malignant potential (STUMP) is a rare tumor, which is regarded as subclassification in uterine smooth muscle tumors between benign and malignant criteria. Pathogenesis of DPL is uncertain, but increasing evidence of iatrogenic cause including laparoscopic myomectomy has been reported.We report a case of a 28-year-old female with previous history of laparoscopic myomectomy diagnosed with DPL with atypical feature and concurrent uterine STUMP using computed tomography (CT) and magnetic resonance imaging (MRI), as well as present a review of the literature.

Background: Although the consumption of vitamin beverages has increased because of the recent interest in health and beauty, guidelines addressing appropriate consumption habits are lacking. Thus, the aim of this study was to investigate the erosive potential of several vitamin beverages and to propose guidelines for the appropriate intake of these drinks. Methods: Five vitamin beverages were selected after a pre-investigation of the current beverage market. Coca-Cola and mineral water were selected as the control beverages. The pH of the beverages was measured with a calibrated pH meter, and the titratable acidity (TA) was determined by using 1 M sodium hydroxide to reach pH 5.5 (TA5.5) and 7.0 (TA7.0). The screening method suggested by the International Organization for Standardization was used to measure pH variation (pH) by using an under-saturated hydroxyapatite solution to determine the difference between the initial and final pH of the screening solution. All measurements were performed in triplicate. Results: All vitamin beverages tested in this study exhibited a low pH (2.53∼2.99), similar to Coca-Cola, which is known to be a highly acidic beverage. The highest TA5.5 and TA7.0 values of the vitamin beverages were 7.03 ml and 8.81 ml, respectively. The largest change in pH determined by using the screening solution was found in Bacchus D (pH 1.44±0.05). The mean pH of the vitamin beverages was 1.12±0.29, which was higher than that of Coca-Cola (positive control, pH 0.58±0.05). Conclusion Vitamin beverages exhibited an erosive potential capable of damaging enamel surfaces. Therefore, the frequency of vitamin beverage intake should be limited, and individuals consuming these drinks should try to restore normal oral pH as quickly as possible.

BACKGROUND: This study investigated the overall status of diabetes control and screening for diabetic microvascular complications in patients with type 2 diabetes mellitus attending primary care clinics in Korea. METHODS: In this cross-sectional observational study, 191 primary care clinics were randomly selected across Korea from 2015 to 2016. In total, 3,227 subjects were enrolled in the study. RESULTS: The patients followed at the primary care clinics were relatively young, with a mean age of 61.4±11.7 years, and had a relatively short duration of diabetes (mean duration, 7.6±6.5 years). Approximately 14% of subjects had diabetic microvascular complications. However, the patients treated at the primary care clinics had suboptimal control of hemoglobin A1c levels, blood pressure, and serum lipid levels, along with a metabolic target achievement rate of 5.9% according to the Korean Diabetes Association guidelines. The screening rates for diabetic nephropathy, retinopathy, and neuropathy within the past 12 months were 28.4%, 23.3%, and 13.3%, respectively. CONCLUSION: The overall status of diabetes management, including the frequency of screening for microvascular complications, was suboptimal in the primary care clinics. More efforts should be made and more resources need to be allocated for primary care physicians to promote adequate healthcare delivery, which would result in stricter diabetes control and improved management of diabetic complications.
Blood Pressure ; Delivery of Health Care ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Korea ; Mass Screening ; Observational Study ; Physicians, Primary Care ; Primary Health Care ; Tertiary Care Centers

Yolk sac tumors are rare malignant germ cell neoplasms that usually arise from the gonads. Extragonadal yolk sac tumors (EGYSTs) frequently occur in the mediastinum in post-pubertal females. EGYSTs in the pelvis are extremely rare, and to date, only thirteen cases have been reported in the English literature. Among them, the primary EGYST of the pelvic peritoneum in post-pubertal females has only been reported in ten cases. The present case describes a 26-year-old female diagnosed with primary peritoneal yolk sac tumor located in the rectouterine pouch. We report clinical and tumor imaging features, including ultrasound, computed tomography (CT), magnetic resonance images (MRI), positron emission tomography-computed tomography (PET-CT), and present a review of the literature.
Adult ; Douglas' Pouch ; Electrons ; Endodermal Sinus Tumor ; Female ; Gonads ; Humans ; Magnetic Resonance Imaging ; Mediastinum ; Neoplasms, Germ Cell and Embryonal ; Pelvis ; Peritoneum ; Ultrasonography ; Yolk Sac