Objective: This study examined the predictive values of presepsin compared with that of other biomarkers (C-reactive protein and procalcitonin) for intensive care unit (ICU) admission and the 28-day mortality in patients with a suspected infection presenting to the emergency department (ED). Methods: This single-center retrospective cohort study was conducted from January 2021 to December 2021 at the ED of a university hospital. The serum presepsin levels were obtained from adult patients suspected of having an infection based on the judgment of clinicians. Results: Of the 1,772 patients analyzed, 389 patients (22.0%) were admitted to the ICU, and 190 patients (10.7%) died within 28 days. The presepsin levels were significantly higher in the ICU admission group (P<0.001) and non-survivor group (P<0.001) than in the other patients. The receiver operating characteristic (ROC) curve for predicting ICU admission indicated an area under the curve (AUC) of 0.660 for presepsin (vs. 0.640 and 0.700 for the C-reactive protein and procalcitonin, respectively). The ROC curve for predicting the 28-day mortality indicated an AUC of 0.719 for presepsin (vs. 0.675 and 0.720 for C-reactive protein and procalcitonin, respectively). Conclusion The initial presepsin level might be useful for predicting ICU admission and 28-day mortality in patients with a suspected infection in the ED.

Objective: The frequency and severity of dog bite injuries were reported to increase during the coronavirus disease-19 (COVID-19) pandemic. This study examined the status of dog bite injuries in Korea and the changes during the COVID-19 pandemic. Methods: Patient information was obtained from in-depth research data on patients from January 1, 2019, to December 31, 2020, conducted by the Korea Centers for Disease Control and Prevention. The general characteristics, the situation and location at the time of the dog bite injury, severity, and the means of transport to the emergency department (ED) were evaluated, and the excess mortality ratio-adjusted injury severity score was determined to evaluate the severity. The differences between the pre-COVID pandemic (2019) and post-COVID pandemic (2020) were compared, and subgroups by age were also analyzed. Results: Under the COVID-19 pandemic, the number of patients decreased in all age groups. In contrast, the severity, especially in the under-19-year-old group, showed a slight but significant increase. In addition, dog bite injuries occurred most frequently in the home, particularly during the COVID-19 pandemic. Conclusion The severity of dog bites in those under the age of 19 was highest, which should be considered when setting more appropriate guidelines for the classification and treatment of dog-bite patients in an ED. Dog bite injuries occur most frequently during daily activity in the house. This tendency was further strengthened in the context of the COVID-19 pandemic.

Objective: This study examined the predictive values of presepsin compared with that of other biomarkers (C-reactive protein and procalcitonin) for intensive care unit (ICU) admission and the 28-day mortality in patients with a suspected infection presenting to the emergency department (ED). Methods: This single-center retrospective cohort study was conducted from January 2021 to December 2021 at the ED of a university hospital. The serum presepsin levels were obtained from adult patients suspected of having an infection based on the judgment of clinicians. Results: Of the 1,772 patients analyzed, 389 patients (22.0%) were admitted to the ICU, and 190 patients (10.7%) died within 28 days. The presepsin levels were significantly higher in the ICU admission group (P<0.001) and non-survivor group (P<0.001) than in the other patients. The receiver operating characteristic (ROC) curve for predicting ICU admission indicated an area under the curve (AUC) of 0.660 for presepsin (vs. 0.640 and 0.700 for the C-reactive protein and procalcitonin, respectively). The ROC curve for predicting the 28-day mortality indicated an AUC of 0.719 for presepsin (vs. 0.675 and 0.720 for C-reactive protein and procalcitonin, respectively). Conclusion The initial presepsin level might be useful for predicting ICU admission and 28-day mortality in patients with a suspected infection in the ED.

Objective: The frequency and severity of dog bite injuries were reported to increase during the coronavirus disease-19 (COVID-19) pandemic. This study examined the status of dog bite injuries in Korea and the changes during the COVID-19 pandemic. Methods: Patient information was obtained from in-depth research data on patients from January 1, 2019, to December 31, 2020, conducted by the Korea Centers for Disease Control and Prevention. The general characteristics, the situation and location at the time of the dog bite injury, severity, and the means of transport to the emergency department (ED) were evaluated, and the excess mortality ratio-adjusted injury severity score was determined to evaluate the severity. The differences between the pre-COVID pandemic (2019) and post-COVID pandemic (2020) were compared, and subgroups by age were also analyzed. Results: Under the COVID-19 pandemic, the number of patients decreased in all age groups. In contrast, the severity, especially in the under-19-year-old group, showed a slight but significant increase. In addition, dog bite injuries occurred most frequently in the home, particularly during the COVID-19 pandemic. Conclusion The severity of dog bites in those under the age of 19 was highest, which should be considered when setting more appropriate guidelines for the classification and treatment of dog-bite patients in an ED. Dog bite injuries occur most frequently during daily activity in the house. This tendency was further strengthened in the context of the COVID-19 pandemic.

Objective: This study examined the predictive values of presepsin compared with that of other biomarkers (C-reactive protein and procalcitonin) for intensive care unit (ICU) admission and the 28-day mortality in patients with a suspected infection presenting to the emergency department (ED). Methods: This single-center retrospective cohort study was conducted from January 2021 to December 2021 at the ED of a university hospital. The serum presepsin levels were obtained from adult patients suspected of having an infection based on the judgment of clinicians. Results: Of the 1,772 patients analyzed, 389 patients (22.0%) were admitted to the ICU, and 190 patients (10.7%) died within 28 days. The presepsin levels were significantly higher in the ICU admission group (P<0.001) and non-survivor group (P<0.001) than in the other patients. The receiver operating characteristic (ROC) curve for predicting ICU admission indicated an area under the curve (AUC) of 0.660 for presepsin (vs. 0.640 and 0.700 for the C-reactive protein and procalcitonin, respectively). The ROC curve for predicting the 28-day mortality indicated an AUC of 0.719 for presepsin (vs. 0.675 and 0.720 for C-reactive protein and procalcitonin, respectively). Conclusion The initial presepsin level might be useful for predicting ICU admission and 28-day mortality in patients with a suspected infection in the ED.

Objective: The frequency and severity of dog bite injuries were reported to increase during the coronavirus disease-19 (COVID-19) pandemic. This study examined the status of dog bite injuries in Korea and the changes during the COVID-19 pandemic. Methods: Patient information was obtained from in-depth research data on patients from January 1, 2019, to December 31, 2020, conducted by the Korea Centers for Disease Control and Prevention. The general characteristics, the situation and location at the time of the dog bite injury, severity, and the means of transport to the emergency department (ED) were evaluated, and the excess mortality ratio-adjusted injury severity score was determined to evaluate the severity. The differences between the pre-COVID pandemic (2019) and post-COVID pandemic (2020) were compared, and subgroups by age were also analyzed. Results: Under the COVID-19 pandemic, the number of patients decreased in all age groups. In contrast, the severity, especially in the under-19-year-old group, showed a slight but significant increase. In addition, dog bite injuries occurred most frequently in the home, particularly during the COVID-19 pandemic. Conclusion The severity of dog bites in those under the age of 19 was highest, which should be considered when setting more appropriate guidelines for the classification and treatment of dog-bite patients in an ED. Dog bite injuries occur most frequently during daily activity in the house. This tendency was further strengthened in the context of the COVID-19 pandemic.

Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Objective: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Pediatric differentiated thyroid cancers (DTCs), mostly papillary thyroid cancer (PTC, 80-90%), are diagnosed at more advanced stages with larger tumor sizes and higher rates of locoregional and/or lung metastasis. Despite the higher recurrence rates of pediatric cancers than of adult thyroid cancers, pediatric patients demonstrate a lower mortality rate and more favorable prognosis. Considering the more advanced stage at diagnosis in pediatric patients, preoperative evaluation is crucial to determine the extent of surgery required. Furthermore, if hereditary tumor syndrome is suspected, genetic testing is required. Recommendations for pediatric DTCs focus on the surgical principles, radioiodine therapy according to the postoperative risk level, treatment and follow-up of recurrent or persistent diseases, and treatment of patients with radioiodine-refractory PTCs on the basis of genetic drivers that are unique to pediatric patients.