Ectopic thyroid is thyroid tissue found in places other than the anterolateral aspect of the second to fourth tracheal ring. Mediastinal ectopic thyroid is rare and only few cases have been reported. The authors experienced a case of 41-year-old female patient with an anterior neck mass. The patient had mild chest discomfort when breathing with no other symptoms. Imaging studies suggested tumor of thymic tissue origin and surgical excision was done. The mass was successfully removed and histopathologically determined to be thyroid tissue. We hereby report with a review of literature a case of ectopic thyroid found in the mediastinum, which was successfully removed by transcervical incision.

Objectives: We analyzed the demographic and clinical characteristics of patients diagnosedwith coronavirus disease 2019 (COVID-19), focusing specifically on severe/critical cases, andassessed the trends and rates of severity and fatality among these patients in the Republic of Korea. Methods: Clinical data on patients with COVID-19 from January 20, 2020 to August 30, 2023were collected from the Korea Disease Control and Prevention Agency’s database. We identified patients who progressed to severe/critical conditions and analyzed their demographic and clinical profiles. Severity and fatality rates were calculated and compared annually to track thedisease progression over time. Results: During the surveillance period, 34,572,554 COVID-19 cases were confirmed, among whom 38,112 (0.11%) progressed to severe/critical conditions. Most severe/critical cases occurred in individuals aged ≥60 years, with a notable increase in patients aged ≥80 years from 2022.The overall severity rate was 0.19%, with a fatality rate of 0.10%. However, the severity of cases gradually diminished during the study period. In 2022, the severity and fatality rates decreased to 0.14% and 0.09%, respectively. In 2023, while the severity rate remained stable at 0.15%, thefatality rate further decreased to 0.06%. Notably, throughout the study period, individuals aged ≥80 years had a significantly higher severity rate (2.44%), with a fatality rate of 1.75%. Conclusion These findings underscore the importance of prioritizing protection and management strategies for older adults and high-risk groups to mitigate the impact ofCOVID-19. Continued surveillance and analysis are essential to effectively control COVID-19 and minimize its burden on public health.

Purpose: To identify the risk factors and effect of empirical glycopeptide on the failure of single arthroscopic debridement for septic knee arthritis in a native knee joint. Materials and Methods: Patients who underwent arthroscopic debridement for septic knee arthritis from March 2005 to December 2022 at one institution were included in this study. Demographic data, comorbidities, preoperative factors including history of previous surgery, history of injection, laboratory data including preoperative C-reactive protein (CRP) and white blood cell (WBC) count, isolated pathogens from synovial fluid culture, and Gachter stage were analyzed. Statistical analyses using univariate and logistic regression were performed. Results: Out of 132 patients, 17 patients (12.9%) had more than one additional arthroscopic debridement. History of diabetes mellitus (DM) (p<0.001), previous injection (p=0.041), isolated Staphylococcus aureus in synovial fluid (p=0.010), and high Gachter stage (p=0.002) were identified as risk factors, whereas age, history of previous knee surgery at the affected knee, CRP level, preoperative WBC, and preoperative neutrophil count of synovial fluid had no significant relation. Logistic regression analysis showed significant increase of risk in patients with DM [odds ratio (OR) 12.002, 95% confidence interval (CI) 3.243–44.418, p<0.001], previous injection history (OR 4.812, 95% CI 1.367–16.939, p=0.017), and isolation of Staphylococcus aureus in synovial fluid (OR 4.804, 95% CI 1.282–18.001, p=0.031) as independent risk factors for failure of infection eradication after single arthroscopic debridement. Conclusion Comorbidity of DM, history of previous injection, isolated Staphylococcus aureus in synovial fluid, and high Gachter stage were associated with a higher risk of failure to eradicate infection with a single arthroscopic procedure. Empirical glycopeptide administration also showed no significant benefit in reducing the risk of additional surgical procedures for infection control, suggesting against the routine administration of glycopeptide.

Background: Primary Merkel cell carcinoma of the salivary gland is currently not listed in the World Health Organization classification. However, cases of Merkel cell type neuroendocrine carcinomas of the salivary gland with perinuclear cytokeratin 20 positivity have been intermittently reported. We here investigated the clinicopathologic features of additional cases. Methods: Data of four cases of Merkel cell type small cell neuroendocrine carcinoma of the salivary gland were retrieved. To confirm the tumors’ primary nature, clinical records and pathologic materials were reviewed. Optimal immunohistochemical staining was performed to support the diagnosis. Results: All tumors were located in the parotid gland. Possibilities of metastasis were excluded in all cases through a meticulous clinicopathological review. Tumor histology was consistent with the diagnosis of small cell neuroendocrine carcinoma. Tumors’ immunohistochemical phenotypes were consistent with Merkel cell carcinoma, including Merkel cell polyomavirus large T antigen positivity in two of the four cases. Conclusions Merkel cell carcinomas can originate in salivary glands and are partly associated with Merkel cell polyomavirus infection as in cutaneous Merkel cell carcinomas.

Background: The World Health Organization has declared the end of the coronavirus disease 2019 (COVID-19) public health emergency. However, this did not indicate the end of COVID-19. Several months after the infection, numerous patients complain of respiratory or nonspecific symptoms; this condition is called long COVID. Even patients with mild COVID-19 can experience long COVID, thus the burden of long COVID remains considerable. Therefore, we conducted this study to comprehensively analyze the effects of long COVID using multi-faceted assessments. Materials and Methods: We conducted a prospective cohort study involving patients diagnosed with COVID-19 between February 2020 and September 2021 in six tertiary hospitals in Korea. Patients were followed up at 1, 3, 6, 12, 18, and 24 months after discharge. Long COVID was defined as the persistence of three or more COVID-19-related symptoms. The primary outcome of this study was the prevalence of long COVID after the period of COVID-19. Results: During the study period, 290 patients were enrolled. Among them, 54.5 and 34.6% experienced long COVID within 6 months and after more than 18 months, respectively. Several patients showed abnormal results when tested for post-traumatic stress disorder (17.4%) and anxiety (31.9%) after 18 months. In patients who underwent follow-up chest computed tomography 18 months after COVID-19, abnormal findings remained at 51.9%. Males (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.53; P=0.004) and elderly (OR, 1.04; 95% CI, 1.00–1.09; P=0.04) showed a significant association with long COVID after 12–18 months in a multivariable logistic regression analysis. Conclusion Many patients still showed long COVID after 18 months post SARS-CoV-2 infection. When managing these patients, the assessment of multiple aspects is necessary.

Background: This study aimed to assess the severity of postoperative delirium (PD) in elderly patients who underwent reverse total shoulder arthroplasty (rTSA) for irreparable massive rotator cuff tears (mRCTs) under general anesthesia (GA) compared to those under interscalene block (IB). Methods: Forty elderly patients aged 65 years or older diagnosed with an irreparable mRCT who underwent rTSA were included in the prospective case-controlled study. Of these, 20 patients were operated under GA and the other 20 under IB. The average age was 77.1 years (range, 65–95 years). The severity of delirious symptoms was evaluated by the Delirium Rating Scale–revised–98 (DRS) score from the patients or guardians before the surgery and at 0, 3, and 7 days and 1, 3, and 6 months after the surgery and compared between the 2 groups. Results: Immediately after surgery, the visual analog scale score difference between the groups was statistically significant, with the GA group at 6.25 (standard deviation, ± 0.85) and the IB group at 3.80 (± 0.62) (p < 0.001). On the day of operation, the mean DRS score in the GA and IB groups were 9.10 (± 5.63) and 6.60 (± 5.33), respectively (p = 0.157). On day 3 of surgery, the mean DRS score in the GA group peaked to 9.95 (± 8.73), while in the IB group, it declined to 6.40 (±5.81) (p = 0.138). After 3 days, DRS scores showed a decreasing trend in both groups. When comparing the mean change (∆) from the preoperative baseline scores to the postoperative values, the ∆DRS score was significantly higher with 4.15 (± 4.53) points in the GA group as compared to 1.30 (± 1.92) in the IB group (p = 0.014). Conclusions IB can be an attractive and efficient anesthetic choice in preventing PD for elderly patients undergoing rTSA for irreparable mRCTs. The IB group showed lower DRS scores and a peak on day 0 compared to the higher DRS scores and peak on day 3 in the GA group. Additionally, IB showed less pain than GA.

Background: Meniscal scaffold implantation has been introduced as a treatment for meniscal injuries, but there is still no clear consensus on its clinical impact, including its chondroprotective effect. This review aimed to assess the chondroprotective effects, clinical outcomes, and survivorship of meniscal scaffold implantation compared to meniscectomy, as well as among different types of scaffolds. Methods: A comprehensive search strategy was performed on the databases of PubMed, Embase, Cochrane Library, and Google Scholar, encompassing articles published until June 1, 2024. Randomized controlled trials (RCT) and comparative studies published in English that reported results using collagen meniscal implant (CMI) and polyurethane meniscal scaffold for meniscal tear were included. Results: A total of 421 studies were initially identified across databases, and a systematic review was conducted on 8 studies involving 596 patients. Among the 5 studies that addressed the chondroprotective effect, none found that meniscal scaffolds had a higher chondroprotective effect compared to meniscectomy. In studies comparing CMI and meniscectomy, the Lysholm score results showed a mean difference (MD) range between –5.90 and –4.40. In the case of visual analog scale score, the MD ranged from –1.0 to 1.0. In studies comparing polyurethane meniscal scaffolds and CMI, the Tegner score results showed an MD range of –2.0 to 0.4. Conclusions There was no superiority in chondroprotective effects for both CMI and polyurethane meniscal scaffolds compared to meniscectomy. Although meniscal scaffolds may provide improvements in clinical outcomes, no clinically relevant differences were observed in comparison to meniscectomy. There are no discernible differences between the 2 types of scaffolds.

Background/Aims: A clinical unmet need persists for medications capable of modulating the progression of primary sclerosing cholangitis (PSC). This study aimed to assess the clinical feasibility of HK-660S (beta-lapachone) in PSC. Methods: In this multicenter, randomized, double-blind, placebo-controlled, parallel-group phase 2 trial, participants were assigned in a 2:1 ratio to receive either 100 mg of HK-660S or a placebo twice daily for 12 weeks. The primary outcomes were the reduction in serum alkaline phosphatase (ALP) levels and the percentage of participants showing improvements in PSC severity, as determined by magnetic resonance cholangiopancreatography with the Anali score. Secondary endpoints included changes in liver stiffness and adverse events. Results: The analysis included 21 patients, 15 receiving HK-660S, and six receiving a placebo. Improvements in the Anali score were observed in 13.3% of the HK-660S group, with no improvements in the placebo group. HK-660S treatment resulted in a 15.2% reduction in mean ALP levels, compared to a 6.6% reduction in the placebo group. A stratified ad-hoc analysis based on baseline ALP levels showed a statistically significant response in the HK-660S group among those with ALP levels greater than twice the upper limit of normal, with a 50% responder rate (p=0.05). Additionally, 26.7% of the HK-660S group showed improvements in the enhanced liver fibrosis score, with no improvements in the placebo group. HK-660S was generally well tolerated. Conclusions HK-660S is well tolerated among patients with PSC and may improve bile duct strictures, decrease serum ALP levels, and reduce liver fibrosis (cris.nih.go.kr, Number KCT0006590).

Ectopic thyroid is thyroid tissue found in places other than the anterolateral aspect of the second to fourth tracheal ring. Mediastinal ectopic thyroid is rare and only few cases have been reported. The authors experienced a case of 41-year-old female patient with an anterior neck mass. The patient had mild chest discomfort when breathing with no other symptoms. Imaging studies suggested tumor of thymic tissue origin and surgical excision was done. The mass was successfully removed and histopathologically determined to be thyroid tissue. We hereby report with a review of literature a case of ectopic thyroid found in the mediastinum, which was successfully removed by transcervical incision.

Objectives: We analyzed the demographic and clinical characteristics of patients diagnosedwith coronavirus disease 2019 (COVID-19), focusing specifically on severe/critical cases, andassessed the trends and rates of severity and fatality among these patients in the Republic of Korea. Methods: Clinical data on patients with COVID-19 from January 20, 2020 to August 30, 2023were collected from the Korea Disease Control and Prevention Agency’s database. We identified patients who progressed to severe/critical conditions and analyzed their demographic and clinical profiles. Severity and fatality rates were calculated and compared annually to track thedisease progression over time. Results: During the surveillance period, 34,572,554 COVID-19 cases were confirmed, among whom 38,112 (0.11%) progressed to severe/critical conditions. Most severe/critical cases occurred in individuals aged ≥60 years, with a notable increase in patients aged ≥80 years from 2022.The overall severity rate was 0.19%, with a fatality rate of 0.10%. However, the severity of cases gradually diminished during the study period. In 2022, the severity and fatality rates decreased to 0.14% and 0.09%, respectively. In 2023, while the severity rate remained stable at 0.15%, thefatality rate further decreased to 0.06%. Notably, throughout the study period, individuals aged ≥80 years had a significantly higher severity rate (2.44%), with a fatality rate of 1.75%. Conclusion These findings underscore the importance of prioritizing protection and management strategies for older adults and high-risk groups to mitigate the impact ofCOVID-19. Continued surveillance and analysis are essential to effectively control COVID-19 and minimize its burden on public health.