Background and Objectives: Pediatric chronic rhinosinusitis (CRS) significantly affects children’s quality of life and learning abilities. This study aimed to evaluate the postoperative outcomes in pediatric patients who underwent functional endoscopic sinus surgery (FESS) for CRS. Methods: A retrospective review was conducted on pediatric patients who underwent FESS for CRS at 11 university hospitals. The inclusion criteria were patients under 20 years old with bilateral disease who were operated on between January 2005 and December 2021. The data collected included demographics, clinical history, blood tests, preoperative computed tomography, and preoperative and postoperative symptom control. The Kruskal-Wallis and Fisher exact tests were used to compare the quantitative and qualitative data, respectively. Results: In total, 213 patients were enrolled. The mean age was 13.4±3.0 years, and 145 (68.1%) were male. One hundred sixty-four patients (77.0%) had nasal polyps and 33 patients (15.5%) underwent revision FESS. The preoperative symptoms, in order of prevalence, included nasal obstruction (87.8%), rhinorrhea (71.8%), a sense of postnasal drip (58.2%), hyposmia (44.6%), cough (24.4%), and facial fullness (18.3%). These symptoms were significantly alleviated for up to 3 years after surgery (p<0.001). At the time of the last follow-up, 121 patients (56.8%) were controlled, 80 (37.6%) were partly controlled, and 12 (5.6%) were uncontrolled. Patients in the uncontrolled group had higher Lund-Mackay scores, longer follow-up durations, and more instances of revision surgery compared to those in the controlled and partly controlled groups. When age was categorized into three groups, those aged 16 years or older tended to have lower Lund-Mackay scores and better control. Conclusion FESS significantly improves both the postoperative symptoms and the long-term quality of life in pediatric CRS patients. Better symptom control is associated with older age and a lower disease burden.

Background and Objectives: SH3 and multiple ankyrin repeat domains 3 (Shank3) proteins play crucial roles as neuronal postsynaptic scaffolds. Alongside neuropsychiatric symptoms, individuals with SHANK3 mutations often exhibit symptoms related to dysfunctions in other organs, including the heart. However, detailed insights into the cardiac functions of Shank3 remain limited. This study aimed to characterize the cardiac phenotypes of Shank3-overexpressing transgenic mice and explore the underlying mechanisms. Methods: Cardiac histological analysis, electrocardiogram and echocardiogram recordings were conducted on Shank3-overexpressing transgenic mice. Electrophysiological properties, including action potentials and L-type Ca2+ channel (LTCC) currents, were measured in isolated cardiomyocytes. Ca2+ homeostasis was assessed by analyzing cytosolic Ca2+transients and sarcoplasmic reticulum Ca2+ contents. Depolarization-induced cell shortening was examined in cardiomyocytes. Immunoprecipitation followed by mass spectrometrybased identification was employed to identify proteins in the cardiac Shank3 interactome.Western blot and immunocytochemical analyses were conducted to identify changes in protein expression in Shank3-overexpressing transgenic cardiomyocytes. Results: The hearts of Shank3-overexpressing transgenic mice displayed reduced weight and increased fibrosis. In vivo, sudden cardiac death, arrhythmia, and contractility impairments were identified. Shank3-overexpressing transgenic cardiomyocytes showed prolonged action potential duration and increased LTCC current density. Cytosolic Ca2+ transients were increased with prolonged decay time, while sarcoplasmic reticulum Ca2+ contents remained normal. Cell shortening was augmented in Shank3-overexpressing transgenic cardiomyocytes. The cardiac Shank3 interactome comprised 78 proteins with various functions. Troponin I levels were down-regulated in Shank3-overexpressing transgenic cardiomyocytes. Conclusions This study revealed cardiac dysfunction in Shank3-overexpressing transgenic mice, potentially attributed to changes in Ca2+ homeostasis and contraction, with a notable reduction in troponin I.

Background and Objectives: SH3 and multiple ankyrin repeat domains 3 (Shank3) proteins play crucial roles as neuronal postsynaptic scaffolds. Alongside neuropsychiatric symptoms, individuals with SHANK3 mutations often exhibit symptoms related to dysfunctions in other organs, including the heart. However, detailed insights into the cardiac functions of Shank3 remain limited. This study aimed to characterize the cardiac phenotypes of Shank3-overexpressing transgenic mice and explore the underlying mechanisms. Methods: Cardiac histological analysis, electrocardiogram and echocardiogram recordings were conducted on Shank3-overexpressing transgenic mice. Electrophysiological properties, including action potentials and L-type Ca2+ channel (LTCC) currents, were measured in isolated cardiomyocytes. Ca2+ homeostasis was assessed by analyzing cytosolic Ca2+transients and sarcoplasmic reticulum Ca2+ contents. Depolarization-induced cell shortening was examined in cardiomyocytes. Immunoprecipitation followed by mass spectrometrybased identification was employed to identify proteins in the cardiac Shank3 interactome.Western blot and immunocytochemical analyses were conducted to identify changes in protein expression in Shank3-overexpressing transgenic cardiomyocytes. Results: The hearts of Shank3-overexpressing transgenic mice displayed reduced weight and increased fibrosis. In vivo, sudden cardiac death, arrhythmia, and contractility impairments were identified. Shank3-overexpressing transgenic cardiomyocytes showed prolonged action potential duration and increased LTCC current density. Cytosolic Ca2+ transients were increased with prolonged decay time, while sarcoplasmic reticulum Ca2+ contents remained normal. Cell shortening was augmented in Shank3-overexpressing transgenic cardiomyocytes. The cardiac Shank3 interactome comprised 78 proteins with various functions. Troponin I levels were down-regulated in Shank3-overexpressing transgenic cardiomyocytes. Conclusions This study revealed cardiac dysfunction in Shank3-overexpressing transgenic mice, potentially attributed to changes in Ca2+ homeostasis and contraction, with a notable reduction in troponin I.

In general cases, tooth wear often requires no treatment, but severe wear exceeding physiological limits can lead to permanent occlusal disharmony and necessitate comprehensive restorative intervention. Patients with non-functional mandibular movements, such as bruxism, are at greater risk of early failure of restorations making careful management essential. In this case, a 50-year-old male patient with a history of severe nocturnal bruxism presented with significant tooth wear and an unstable maxillomandibular relationship, and after centric relation guidance and diagnostic wax-up evaluation, full-mouth rehabilitation was performed. To restore the morphology of the worn teeth and reposition the displaced mandible to a centric relation, the patient had 12 weeks of provisional restoration usage and successfully adapted to the altered vertical dimension and maxillomandibular relationship before the final prostheses were fabricated. The functionally generated path (FGP) technique was used to create metal occlusal surfaces for the upper posterior teeth, ensuring precise group function during eccentric movements and preventing further failure. The patient experienced improved comfort, function, and aesthetics, with stable occlusion and no complications during the 4-month follow-up period. Regular follow-up and protective measures, such as night guards, are recommended to ensure long-term success.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Screening tests for specific immunoglobulin E (sIgE) to food allergens, such as the multiple allergen simultaneous test (MAST), are widely used in patients with suspected food allergies in South Korea. We evaluated whether MAST could effectively screen wheatdependent exercise-induced anaphylaxis (WDEIA) and α-gal syndrome (AGS). We retrospectively reviewed patients with WDEIA and AGS diagnosed with unequivocal history and positive sIgE results for omega-5 gliadin and α-gal using ImmunoCAP, respectively. The clinical manifestations and results of MAST and ImmunoCAP (sIgE to wheat for WDEIA and beef/pork for AGS) were reviewed. In the MAST and ImmunoCAP results, class 0 (<0.35 units in each test) was considered negative. Medical records of 45 patients with WDEIA and 39 patients with AGS were reviewed. For WDEIA, 37 (82.2%) of patients had a history of anaphylaxis.Among those positive for omega-5 gliadin sIgE, 39 (87.7%) and 25 (55.6%) tested positive for gluten- and wheat-sIgE using ImmunoCAP, respectively. MAST performed on 15 patients yielded positive results for wheat-sIgE in 5 (33.3%). For AGS, 23 (59.0%) of patients had a history of anaphylaxis. Among those positive for α-gal sIgE, 32 (85.7%) and 37 (96.4%) tested positive for pork- and beefsIgE using ImmunoCAP, respectively, whereas MAST could not detect sIgE for pork and beef (0%, 0/17). MAST for sIgE to food allergens cannot screen WDEIA and AGS. The tests for sIgE to a specific component of food allergen, such as omega-5 gliadin for WDEIA and α-gal for AGS, should be used to screen WDEIA and AGS.

Background: This study explores effective fixation methods for Pauwel type III femoral neck fractures by evaluating the biomechanical benefits of adding a screw to the Femoral Neck System (FNS). Methods: Computed tomography (CT) scans of an 82-year-old female patient with an intertrochanteric fracture were used to establish a finite element femur model with heterogeneous material properties. Finite element models of Pauwel type III fractures were created with and without an additional screw. The central and inferior trajectories of the FNS bolt were examined separately and combined with an additional screw for virtual fixation. Walking and stair-climbing loads were applied. Results: With the addition of a screw, both peak maximum and minimum principal strains consistently stayed comparable or decreased in models with both central and inferior bolt trajectories, while the volume of elements with principal strain exceeding 1% decreased by more than half. The peak von Mises stress observed in the implants ranged from 215.7 to 359.3 MPa, remaining below the titanium alloy's yield strength of 800 MPa. For normal walking, the addition of a screw to the central bolt trajectory model decreased the fracture gap by 50.6% and reduced sliding distance by 8.6%. For the inferior bolt trajectory, the gap was reduced by 57.9% and sliding distance by 25.0%.Under stair-climbing conditions, these improvements were also evident; the central trajectory model saw a halved fracture gap and a 7.9% decrease in sliding distance, while the inferior trajectory model experienced a 55.7% gap reduction and a 27.2% decrease in sliding distance. The additional screw increased the area ratio of the fracture site experiencing interfragmentary compression 34%–39%, while the additional screw alleviated peak interfragmentary compression by 12%–18% under both normal walking and stair-climbing conditions. Conclusions The addition of a screw reduced the fracture gap, sliding distance, and peak interfragmentary compression, while increasing the area ratio of interfragmentary compression under both walking and stair-climbing loads, regardless of the FNS bolt trajectory, suggesting a better mechanical environment for fracture healing.

Background: The removal of a well-fixed acetabular cup is a challenging, labor-intensive, and time-consuming step during revision hip arthroplasty. Although the advent of the manual osteotome, Explant, has simplified the procedure, it is still a stressful process as it dissipates the surgeon’s strength and time and risks an iatrogenic pelvic fracture. Recently, EZX, a powered tool for extraction of well-fixed acetabular cups with semicircular blade was invented. This study aimed to compare Explant and EZX in an experimental condition for their efficacy and safety. Methods: Cementless acetabular cups were press-fitted to 20 hemipelvic polyurethane models using foam adhesives. Ten cups were removed with each tool for comparison of the elapsed time, loads on the entire hemipelvis, periacetabular strain and temperature, volume of periacetabular bone removed, and diameter of the remaining acetabular rim. Strains and loads were quantitatively assessed using strain gauges and load cells for precise and reliable measurements. Results: The mean duration required to remove a well-fixed cup with EZX was 38.5 seconds (range, 25–55), whereas that with Explant was 543.7 seconds (range, 214–1,051) (p < 0.001). The load on the entire hemipelvis with EZX (mean, 9.1 kgf; range, 6.4–11.3) was 33% lower than that with Explant (mean, 13.6 kgf; range, 9.2–17.1) (p < 0.001). The periacetabular peak strains at the 3 positions with EZX were significantly lower than those with Explant (p < 0.001). The temperature during the removal did not differ significantly between the 2 tools. Although the mean volume of bone loss with Explant was 2.4 mL more than that with EZX (p < 0.001), the mean diameters of the remaining acetabular rim were not significantly different, measuring 54.1 mm with both tools. Conclusions The present experiment revealed that a well-fixed cup could be removed using a powered tool with less strength and time and less load on the entire pelvis. Although the powered tool removed a larger volume of bone, the diameters of the remaining acetabular rims were equivalent. This tool may help surgeons remove well-fixed cups in a short time and reduce the deforming load on the bone around the cup without increasing the size of the subsequent reconstruction cup.

Background: and Purpose: This clinical practice guideline provides evidence-based recommendations for treatment of dementia, focusing on cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists for Alzheimer’s disease (AD) and other types of dementia. Methods: Using the Population, Intervention, Comparison, Outcomes (PICO) framework, we developed key clinical questions and conducted systematic literature reviews. A multidisciplinary panel of experts, organized by the Korean Dementia Association, evaluated randomized controlled trials and observational studies. Recommendations were graded for evidence quality and strength using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Three main recommendations are presented: (1) For AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) are strongly recommended for improving cognition and daily function based on moderate evidence; (2) Cholinesterase inhibitors are conditionally recommended for vascular dementia and Parkinson’s disease dementia, with a strong recommendation for Lewy body dementia; (3) For moderate to severe AD, NMDA receptor antagonist (memantine) is strongly recommended, demonstrating significant cognitive and functional improvements. Both drug classes showed favorable safety profiles with manageable side effects. Conclusions This guideline offers standardized, evidence-based pharmacologic recommendations for dementia management, with specific guidance on cholinesterase inhibitors and NMDA receptor antagonists. It aims to support clinical decision-making and improve patient outcomes in dementia care. Further updates will address emerging treatments, including amyloid-targeting therapies, to reflect advances in dementia management.