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: 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: 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.

We report a rare case of gastric adenocarcinoma with enteroblastic differentiation (GAED) that was treated with endoscopic submucosal dissection followed by additional distal gastrectomy with lymph node dissection. A 67-year-old man underwent endoscopic submucosal dissection for a gastric lesion, which was diagnosed as GAED with submucosal and lymphatic invasion. Histologically, GAED is characterized by a tubulopapillary growth pattern and clear cells that resemble those of the primitive fetal gut. Immunohistochemically, GAED variably expresses oncofetal proteins such as glypican-3, alpha-fetoprotein, and spalt-like transcription factor 4. Despite negative margins, additional gastrectomy with lymph node dissection was performed due to submucosal and lymphatic invasion.No residual tumor or metastasis was detected, and the patient remained disease-free for 2 years before dying from causes unrelated to GAED. Given its aggressive nature, frequent lymphovascular invasion, and high metastatic potential, clinicians should recognize the histopathological diagnosis of this rare tumor and its propensity for aggressiveness.

Signet-ring cell carcinoma (SRCC) is a rare tumor that most commonly occurs in the stomach. Duodenal SRCCs are extremely uncommon and account for approximately 1% of duodenal adenocarcinomas. Although Brunner’s gland hyperplasia (BGH) is a benign duodenal condition, studies have reported several cases of adenocarcinoma originating in an area of BGH. We report a rare case of early-stage SRCC originating in an area of BGH that was successfully treated using endoscopic mucosal resection. Based on the mucin phenotype observed in this case, it is reasonable to conclude that SRCC originated from gastric metaplasia in the area of BGH. Although BGH is a benign condition, careful evaluation is warranted for early detection of combined neoplasms.

Background: There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric antipseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP. Methods: This multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019.Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups.Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias. Results: In total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286).There was no significant difference in 30-day mortality between the two groups (16.8% vs.18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782–3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups. Conclusion Empiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR.

Background: Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. Objective: This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. Methods: We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. Results: The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. Conclusion No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.

Background: and Purpose To identify sex differences in daytime sleepiness associated with apnea severity and periodic limb movements during sleep (PLMS) in subjects with obstructive sleep apnea (OSA). Methods: This study used the Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Sleep Hygiene Index (SHI) in logistic regression analyses with interaction terms. Severe OSA, excessive daytime sleepiness (EDS), and PLMS were defined as an apnea-hypopnea index of ≥30, an ESS score of ≥11, and a periodic limb movements index of >15, respectively. Results: The 1,624 subjects with OSA (males, 79.1%) comprised 45.3%, 38.2%, and 16.4% with severe OSA, EDS, and PLMS, respectively. Multiple logistic regression without interaction terms showed that sex, severe OSA, and PLMS were not significantly associated with EDS. However, significant interactions were noted between sex and severe OSA and PLMS in EDS in both crude and adjusted models (all p values<0.05). In the adjusted model, severe OSA was associated with EDS in males (p=0.009) but not in females. PLMS were more likely to be associated with EDS in females (p=0.013), whereas PLMS were less likely to be associated with EDS in males (p=0.041). The models were adjusted by the BDI score, SHI, and presence of medical comorbidities. Conclusions There are significant sex differences in subjective daytime sleepiness in subjects with severe OSA and PLMS. Severe OSA and PLMS may influence daytime sleepiness more in males and females, respectively.

A 65-year-old male patient with an end-stage renal disease was diagnosed with coronavirus disease 2019 (COVID-19) by reverse transcription polymerase chain reaction. The patient complained of cough, sputum, and respiratory distress that worsened three days ago. The patient required mechanical ventilation and extracorporeal mentrane oxygenation. On day 9, convalescent plasma collected from a 34-year old man who recovered from COVID-19 45 days ago was administered. The patient showed immediate clinical improvement. However, on day 14, the patient’s clinical course worsened again. On day 19 and day 24, vancomycin-resistant Enterococcus faecium bacteremia and methicillin-resistant Staphylococcus aureus pneumonia were found. After long-term supportive care, he slowly recovered. He was discharged on day 91 without any oxygen requirement. This case report suggests that convalescent plasma therapy might just provide a short-term relief and that persistent effort for critical care is necessary to save patients from severe COVID-19.