Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Objective: To investigate which types of environmental exposure during pregnancy are risk and protective factors for cleft lip with or without cleft palate (CL/P). Methods: This case-control study included 278 orthodontic patients with CL/P (CL/P group) and 51 without CL/P (non-CL/P group). Demographic and environmental exposure data were collected using questionnaires completed by the parents. Statistical analyses were performed to identify the potential risk and protective factors for CL/P. Results The two groups did not show significant difference in (1) body weight at birth and number of previous births;(2) fathers’ ages at birth and occupation; (3) parents’ chronic diseases, alcohol consumption, and exposure to harmful substances; and (4) mothers’ smoking, secondhand smoking, and vitamin and calcium intake. Most patients with CL/ P were born at normal term (≥ 37 weeks, 93.2%) with normal body weight (2.9–3.7 kg, 63.7%) and as either the first or second child (90.3%). In the CL/ P group, the percentages of mothers who were very young or old (≤ 19 years, ≥ 40 years) and with physical labor in their occupation were low (1.8% and 2.2%, respectively). Compared with the non-CL/P group, the CL/P group showed a lower percentage of maternal folic acid intake (68.6% vs. 20.9%, odds ratio [OR] = 0.121; P < 0.001) and higher percentages of mothers’ drug intake and fathers’ smoking habits (3.9% vs. 16.2%, OR = 4.73, P < 0.05; 39.2% vs. 61.2%, OR = 2.44, P < 0.01). Conclusions: The findings of this study may explain the association between environmental factors and CL/P risk.

Background/Aims: Since the coronavirus disease 2019 (COVID-19) outbreak, hospitals have implemented infection control measures to minimize the spread of the virus within facilities. This study aimed to investigate the impact of COVID-19 on the incidence of healthcare-associated infections (HCAIs) and common respiratory virus (cRV) infections in hematology units. Methods: This retrospective study included all patients hospitalized in Catholic Hematology Hospital between 2019 and 2020. Patients infected with vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacterales (CPE), Clostridium difficile infection (CDI), and cRV were analyzed. The incidence rate ratio (IRR) methods and interrupted time series analyses were performed to compare the incidence rates before and after the pandemic. Results: The incidence rates of CPE and VRE did not differ between the two periods. However, the incidence of CDI increased significantly (IRR: 1.41 [p = 0.002]) after the COVID-19 pandemic. The incidence of cRV infection decreased by 76% after the COVID-19 outbreak (IRR: 0.240 [p < 0.001]). The incidence of adenovirus, parainfluenza virus, and rhinovirus infection significantly decreased in the COVID-19 period (IRRs: 0.087 [p = 0.003], 0.031 [p < 0.001], and 0.149 [p < 0.001], respectively). Conclusions The implementation of COVID-19 infection control measures reduced the incidence of cRV infection. However, CDI increased significantly and incidence rates of CPE and VRE remained unchanged in hematological patients after the pandemic. Infection control measures suitable for each type of HCAI, such as stringent hand washing for CDI and enough isolation capacities, should be implemented and maintained in future pandemics, especially in immunocompromised patients.

Background/Aims: We evaluated the role of next-generation sequencing (NGS)-based disease monitoring for elderly patients diagnosed with acute myeloid leukemia (AML) who received decitabine therapy. Methods: A total of 123 patients aged > 65 years with AML who received decitabine were eligible. We analyzed the dynamics of variant allele frequency (VAF) in 49 available follow-up samples after the fourth cycle of decitabine. The 58.6% VAF clearance (Δ, [VAF at diagnosis − VAF at follow-up] × 100 / VAF at diagnosis) was the optimal cut-off for predicting overall survival (OS). Results: The overall response rate was 34.1% (eight patients with complete remission [CR], six of CR with incomplete hematologic recovery, 22 with partial responses, and six with morphologic leukemia-free status). Responders (n = 42) had significantly better OS compared with non-responders (n = 42) (median, 15.3 months vs. 6.5 months; p < 0.001). Of the 49 patients available for follow-up targeted NGS analysis, 44 had trackable gene mutations. The median OS of patients with ΔVAF ≥ 58.6% (n=24) was significantly better than that of patients with ΔVAF < 58.6% (n = 19) (20.5 months vs. 9.8 months, p = 0.010). Moreover, responders with ΔVAF ≥ 58.6% (n = 20) had a significantly longer median OS compared with responders with VAF < 58.6% (n = 11) (22.5 months vs. 9.8 months, p = 0.004). Conclusions This study suggested that combining ΔVAF ≥ 58.6%, a molecular response, with morphologic and hematologic responses can more accurately predict OS in elderly AML patients after decitabine therapy.

Objective: The purpose of this study was to investigate the accuracy of one-step automated orthodontic diagnosis of skeletodental discrepancies using a convolutional neural network (CNN) and lateral cephalogram images with different qualities from nationwide multi-hospitals. Methods: Among 2,174 lateral cephalograms, 1,993 cephalograms from two hospitals were used for training and internal test sets and 181 cephalograms from eight other hospitals were used for an external test set. They were divided into three classification groups according to anteroposterior skeletal discrepancies (Class I, II, and III), vertical skeletal discrepancies (normodivergent, hypodivergent, and hyperdivergent patterns), and vertical dental discrepancies (normal overbite, deep bite, and open bite) as a gold standard. Pre-trained DenseNet-169 was used as a CNN classifier model. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, t-stochastic neighbor embedding (t-SNE), and gradientweighted class activation mapping (Grad-CAM). Results: In the ROC analysis, the mean area under the curve and the mean accuracy of all classifications were high with both internal and external test sets (all, > 0.89 and > 0.80). In the t-SNE analysis, our model succeeded in creating good separation between three classification groups. Grad-CAM figures showed differences in the location and size of the focus areas between three classification groups in each diagnosis. Conclusions Since the accuracy of our model was validated with both internal and external test sets, it shows the possible usefulness of a one-step automated orthodontic diagnosis tool using a CNN model. However, it still needs technical improvement in terms of classifying vertical dental discrepancies.

Background: South Korea has been experiencing a third wave of coronavirus disease 2019 (COVID-19) since mid-November 2020. Our hospital in Gwangju metropolitan city experienced a healthcare-associated COVID-19 outbreak early in the third wave. The first confirmed COVID-19 patient was a symptomatic neurosurgery resident with high mobility throughout the hospital. We analyzed the transmission routes of nosocomial COVID-19 and discussed infection control strategies. Methods: We retrospectively analyzed the severe acute respiratory syndrome coronavirus 2 reverse transcription-polymerase chain reaction (RT-PCR) testing results according to time point and evaluated transmission routes. Results: Since COVID-19 was first confirmed in a healthcare worker (HCW) on 11/13/2020, we performed RT-PCR tests for all patients and caregivers and four complete enumeration surveys for all HCWs. We detected three clusters of nosocomial spread and several sporadic cases. The first cluster originated from the community outbreak spot, where an asymptomatic HCW visited, which led to a total of 22 cases. The second cluster, which included patient-to-patient transmission, originated from a COVID-19 positive caregiver before diagnosis and the third cluster involved a radiologist and a banker. We took measures to isolate Building 1 of the hospital for 17 days and controlled the outbreak during a period of increasing community COVID-19 prevalence. Universal screening of all inpatients upon admission and resident caregivers was made mandatory and hospital-related employees are now screened monthly. Conclusion Infection control strategies to prevent the nosocomial transmission of emerging infectious diseases must correspond with community disease prevalence. Our data reinforce the importance of multi-time point surveillance of asymptomatic HCWs and routine surveillance of patients and caregivers during an epidemic.

Background: South Korea has been experiencing a third wave of coronavirus disease 2019 (COVID-19) since mid-November 2020. Our hospital in Gwangju metropolitan city experienced a healthcare-associated COVID-19 outbreak early in the third wave. The first confirmed COVID-19 patient was a symptomatic neurosurgery resident with high mobility throughout the hospital. We analyzed the transmission routes of nosocomial COVID-19 and discussed infection control strategies. Methods: We retrospectively analyzed the severe acute respiratory syndrome coronavirus 2 reverse transcription-polymerase chain reaction (RT-PCR) testing results according to time point and evaluated transmission routes. Results: Since COVID-19 was first confirmed in a healthcare worker (HCW) on 11/13/2020, we performed RT-PCR tests for all patients and caregivers and four complete enumeration surveys for all HCWs. We detected three clusters of nosocomial spread and several sporadic cases. The first cluster originated from the community outbreak spot, where an asymptomatic HCW visited, which led to a total of 22 cases. The second cluster, which included patient-to-patient transmission, originated from a COVID-19 positive caregiver before diagnosis and the third cluster involved a radiologist and a banker. We took measures to isolate Building 1 of the hospital for 17 days and controlled the outbreak during a period of increasing community COVID-19 prevalence. Universal screening of all inpatients upon admission and resident caregivers was made mandatory and hospital-related employees are now screened monthly. Conclusion Infection control strategies to prevent the nosocomial transmission of emerging infectious diseases must correspond with community disease prevalence. Our data reinforce the importance of multi-time point surveillance of asymptomatic HCWs and routine surveillance of patients and caregivers during an epidemic.