Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Background and Objectives: Flexible laryngoscopes are indispensable tools in otolaryngology, but their frequent use makes them vulnerable to contamination, thus posing a risk of cross-infection. Unlike gastrointestinal endoscopes, flexible laryngoscopes currently lack standardized disinfection protocols. This study evaluates the efficacy of Cidex OPA (0.55% ortho-phthalaldehyde) to establish an effective, practical disinfection protocol for flexible laryngoscopes.Materials and Method This multicenter study involved the use of flexible laryngoscopes in otolaryngology outpatient clinics across five university hospitals. Laryngoscopes were immersed in Cidex OPA for 1, 5, or 12 minutes, with an additional group treated using Tristel wipes and foam after a 12-minute immersion. Swab samples were collected from the distal 15 cm of each laryngoscope following disinfection and cultured on blood agar plates under aerobic conditions at 35°C–37°C with 5% CO2 for 72 hours. Positive controls included laryngoscopes directly contaminated with saliva or laryngeal secretions. Results: Six out of ten positive control samples demonstrated bacterial growth. However, no bacterial growth was observed in any sample from the Cidex OPA immersion groups (1, 5, or 12 minutes), including the group treated with Tristel. These findings indicate that even a 1-minute immersion in Cidex OPA effectively eliminates bacterial contamination. Conclusion This study provides evidence supporting an efficient disinfection method that can enhance infection control and streamline clinical workflow. Further research with a larger sample size and varied disinfection techniques is needed to establish comprehensive disinfection guidelines for flexible laryngoscopes.

Objectives: . This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and investigate their prognostic factors and recurrence patterns. Methods: . The medical records of 77 patients with T1–2 primary parotid malignancies between May 2003 and March 2022 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the prognostic factors associated with overall survival, disease-free survival, and local and distant recurrence. Results: . The average follow-up duration was 70.2 months (range, 12–202 months). The 5-year overall and disease-free survival rates were 88.7% and 77.1%, respectively. Twenty-two patients underwent partial parotidectomy, and 55 underwent superficial or total parotidectomy. There were no significant differences in the disease recurrence (P=0.320) and mortality rates (P=0.884) of the partial and superficial or total parotidectomy groups. The mean duration of surgery was shorter and the overall complication rates were significantly lower in the partial group than in the superficial or total parotidectomy group (P=0.049). Sixteen cases of recurrence occurred during the study period (20.8%). Univariate analyses showed that high-grade tumors (P=0.006), lymphovascular invasion (P=0.046), and regional lymph node metastasis (P=0.010) were significant risk factors for disease recurrence. Multivariate analysis identified regional lymph node metastasis as an independent prognostic factor for disease recurrence (P=0.027), and lymphovascular invasion as an independent prognostic factor for overall survival (P=0.033). Conclusion . The conservative surgical approach of partial parotidectomy can yield oncological outcomes comparable to those of superficial or total parotidectomy with careful patient selection in T1-2 parotid cancers.

Purpose: This study aimed to evaluate the feasibility of measuring liver fat using the volumetric measurement method (Fatvol) by comparing it with the conventional 27-regions of interest drawing method (Fatroi). Materials and Methods: This retrospective study included 67 patients who underwent liver magnetic resonance imaging with fat quantification in August or September 2020.Two experienced abdominal radiologists measured the proton density fat fraction (PDFF) of the liver using the mDIXON-Quant sequence for each of two methods. The PDFF was measured twice with each method at intervals of at least 4 weeks to avoid recall bias. Measurement times were recorded. The intra-class correlation coefficient (ICC) was calculated for intra-exam repeatability, inter-reviewer reproducibility, and inter-exam agreement. Results: Measurement times for Fatvol were significantly shorter than for Fatroi. Measurement times for Fatroi and Fatvol, respectively, for reviewer A were 209.4 ± 55.1 s and 137.2 ± 51.5 s in session 1, and 180.9 ± 37.3 s and 127.0 ± 46.1 s in session 2. For reviewer B, the times were 190.7 ± 30.1 s and 74.8 ± 27.4 s in session 1, and 174.6 ± 21.8 s and 64.1 ± 17.5 s in session 2. In all cases, p < 0.001. The mean PDFF values were 7.2% ± 6.4% and 7.2% ± 6.5% (sessions 1 and 2, respectively) for Fatroi and 7.4% ± 6.0% and 7.3% ± 6.1% for Fatvol for reviewer A. For reviewer B, they were 7.1% ± 6.6% and 7.1% ± 6.6% for Fatroi and 7.4% ± 5.8% and 7.4% ± 5.8% for Fatvol. The ICCs between measurement methods (0.998 and 0.995 for reviewers A and B, respectively), for Fatvol within each reviewer (0.999 and 1.000 in sessions 1 and 2, respectively), and between reviewers (0.999) were excellent. Conclusion The measurement time could be significantly reduced using Fatvol compared to Fatroi while maintaining the consistency of the liver fat measurement values.

In South Korea, deaths caused by poisoning are mostly suicides due to drug overdoses, or agrochemical poisonings. Even though the latter is becoming less frequent, they are still occurring in large numbers across the country. In some cases, deaths result from toxicity of organic solvents contained in the agrochemical products. In this study, we identified organic solvents in post-mortem blood of acute agrochemical poisoning cases using solid phase microextraction-gas chromatography/mass spectrometry with black fiber. Out of 42 cases, organic solvents were detected in 29, with toluene and butanol detected simultaneously in 13 cases. In these 13 cases, the original pesticides were of various types, including organophosphorus compounds, carbamate, nicotine, and oxadiazine. Xylene and ethyl benzene were simultaneously detected six times. In these six cases, the original pesticides were mainly pyrethroid-based pesticides, such as cypermethrin and deltamethrin. Methoxypropanol was detected in five cases in which the water-soluble pesticide glufosinate was detected. These organic solvents may cause acute poisoning and even death in some agrochemical poisoning cases.

Objective: To investigate molecular and functional consequences of additional exposures to iodine- or gadolinium-based contrast agents within 24 hours from the initial intravenous administration of iodine-based contrast agents through an animal study. Materials and Methods: Fifty-six Sprague–Dawley male rats were equally divided into eight groups: negative control, positive control (PC) with single-dose administration of CT contrast agent, and additional administration of either CT or MR contrast agents 2, 4, or 24 hours from initial CT contrast agent injection. A 12 µL/g of iodinated contrast agent or a 0.47 µL/g of gadoliniumbased contrast agent were injected into the tail vein. Serum levels of blood urea nitrogen, creatinine, cystatin C (Cys C), and malondialdehyde (MDA) were measured. mRNA and protein levels of kidney injury molecule-1 (KIM-1) and neutrophil gelatinaseassociated lipocalin (NGAL) were evaluated. Results: Levels of serum creatinine (SCr) were significantly higher in repeated CT contrast agent injection groups than in PC (0.21 ± 0.02 mg/dL for PC; 0.40 ± 0.02, 0.34 ± 0.03, and 0.41 ± 0.10 mg/dL for 2-, 4-, and 24-hour interval groups, respectively; P < 0.001). There was no significant difference in the average Cys C and MDA levels between PC and repeated CT contrast agent injection groups (Cys C, P = 0.256–0.362; MDA, P > 0.99). Additional doses of MR contrast agent did not make significant changes compared to PC in SCr (P > 0.99), Cys C (P = 0.262), and MDA (P = 0.139–0.771) levels. mRNA and protein levels of KIM-1 and NGAL were not significantly different among additional CT or MR contrast agent groups (P > 0.05). Conclusion A sufficient time interval, probably more than 24 hours, between repeated contrast-enhanced CT examinations may be necessary to avoid deterioration in renal function. However, conducting contrast-enhanced MRI on the same day as contrast-enhanced CT may not induce clinically significant kidney injury.

Purpose: We aimed to investigate changes in visiting patterns after the lifting of mask mandates in a single pediatric emergency medical center in Seoul, Korea. Methods: This retrospective study was based on the data of patients’ (≤ 18 years) visits to the emergency department (ED) of the center from January 1, 2022 through June 30, 2023. Clinical characteristics, Korean Triage and Acuity Scale (KTAS) level, ED outcomes, and length of stay were compared between before (March 20-June 30, 2022) and after (March 20-June 30, 2023) the lifting of mask mandates. The comparisons were iterated in the patients with infectious disease. Results: During the study period, a total of 18,654 children visited the ED. After the lifting of mask mandates, ED visits increased from 7,146 to 11,508 (61.0%; 95% confidence interval, 59.5-62.6; P < 0.001). The increase was more prominent in the age of 2-5 years (82.9%), infectious diseases (175.3%), KTAS level 3 (127.7%), and length of stay shorter than 3 hours (78.8%-92.6%). The number of patients per hour increased by 151.2% for 5 patients or more and over 3,000% for 10 or more. Median length of stay decreased (2.3 hours [interquartile range, 1.2-4.1] to 1.9 hours [1.1-3.5]; P < 0.001). The patients with infectious disease (n = 7,139) showed similar patterns of increase in the age of 2-5 years, KTAS level 3, and length of stay shorter than 3 hours, with an additional increase in the age of 6-18 years. Conclusion After the lifting of mask mandates, pediatric visits increased by 61%, with the highest increase in children with mild infectious diseases on weekends and at night, and the proportion of more than 10 visits per hour significantly increased. We need urgent and realistic support measures from health authorities.

Objective: Vulnerability to internet gaming disorder (IGD) has increased as internet gaming continues to grow. Cocaine- and amphetamine-regulated transcript (CART) is a hormone that plays a role in reward, anxiety, and stress. The purpose of this study was to identify the role of CART in the pathophysiology of IGD. Methods: The serum CART levels were measured by enzyme-linked immunosorbent assay, and the associations of the serum CART level with psychological variables were analyzed in patients with IGD (n=31) and healthy controls (HC) (n=42). Results: The serum CART level was significantly lower in the IGD than HC group. The IGD group scored significantly higher than the HC group on the psychological domains of depression, anxiety, the reward response in the Behavioral Activation System and Behavioral Inhibition System. There were no significant correlations between serum CART level and other psychological variables in the IGD group. Conclusion Our results indicate that a decrease in the expression of the serum CART level is associated with the vulnerability of developing IGD. This study supports the possibility that CART is a biomarker in the pathophysiology of IGD.

Background/Aims: Chronic hepatitis B (CHB) is a risk factor for non-Hodgkin lymphoma (NHL). Our recent study suggested that antiviral treatment may reduce the incidence of NHL in CHB patients. This study compared the prognoses of hepatitis B virus (HBV)-associated diffuse large B-cell lymphoma (DLBCL) patients receiving antiviral treatment and HBV-unassociated DLBCL patients. Methods: This study comprised 928 DLBCL patients who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at two referral centers in Korea. All patients with CHB received antiviral treatment. Time-to-progression (TTP) and overall survival (OS) were the primary and secondary endpoints, respectively. Results: Among the 928 patients in this study, 82 were hepatitis B surface antigen (HBsAg)-positive (the CHB group) and 846 were HBsAg-negative (the non-CHB group). The median follow-up time was 50.5 months (interquartile range [IQR]=25.6–69.7 months). Multivariable analyses showed longer TTP in the CHB group than the non-CHB group both before inverse probability of treatment weighting (IPTW; adjusted hazard ratio [aHR]=0.49, 95% confidence interval [CI]=0.29–0.82, p=0.007) and after IPTW (aHR=0.42, 95% CI=0.26–0.70, p<0.001). The CHB group also had a longer OS than the non-CHB group both before IPTW (HR=0.55, 95% CI=0.33–0.92, log-rank p=0.02) and after IPTW (HR=0.53, 95% CI=0.32–0.99, log-rank p=0.02). Although liver-related deaths did not occur in the non-CHB group, two deaths occurred in the CHB group due to hepatocellular carcinoma and acute liver failure, respectively. Conclusions Our findings indicate that HBV-associated DLBCL patients receiving antiviral treatment have significantly longer TTP and OS after R-CHOP treatment than HBV-unassociated DLBCL patients.