Journal Of Korean Medical Science[JOURNAL]
Sun
200 papers
The Impact of Early-Life, Long-Term Exposure to Ambient Particulate Matter on Atopic Dermatitis Remission and Sensitization in Infants.
Kim S, Oh I, Choi J … +5 more , Kim J, Kim J, Bang JH, Kim YM, Ahn K
J Korean Med Sci · 2025 Dec · PMID 41430750 · Full text
BACKGROUND: Studies that examine a link between long-term exposure to ambient particulate matter (PM) and atopic dermatitis (AD) in children are lacking. This longitudinal study aimed to investigate the effect of long-te...
BACKGROUND: Studies that examine a link between long-term exposure to ambient particulate matter (PM) and atopic dermatitis (AD) in children are lacking. This longitudinal study aimed to investigate the effect of long-term exposure to PM on AD in infants. METHODS: We enrolled 150 infants aged 0-1 years with AD and followed them until age 3 in Seoul, Korea. We assessed long-term exposures to ambient particulate matter with an aerodiameter < 10 µm (PM₁₀) from birth to age 3 using a fusion model based on each individual's home address. Effects of long-term exposure to PM₁₀ on AD persistence and sensitization to aeroallergens were evaluated using Cox proportional hazard regression models after adjusting for potential confounders. RESULTS: Of the 150 infants, 54 (36.0%) showed remission of AD by age 3. Overall, long-term exposure to PM₁₀ was not significantly associated with AD persistence at age 3 (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.97-1.12; = 0.267 per 1 µg/m³). However, when stratified by the baseline AD severity, increased exposure to PM₁₀ significantly elevated the risk of persistence in children with moderate AD at enrollment (HR, 1.19; 95% CI, 1.05-1.36; = 0.007). Long-term exposure to PM₁₀ was also associated with an increased overall risk of sensitization to pollen (HR, 1.12; 95% CI, 1.00-1.24; = 0.043), with a more pronounced effect in children with moderate AD (HR, 1.31; 95% CI, 1.08-1.58; = 0.005). However, no significant association was observed between PM₁₀ exposure and sensitization to house dust mite or pet allergens. CONCLUSION: An early-life long-term exposure to ambient PM₁₀ in infants with AD may decrease the remission and increase the sensitization to pollen at age 3.
Epidemiology and Clinical Characteristics of Community-Acquired Pneumonia in Hospitalized Patients at a Single Tertiary Center in Korea.
Ju KR, Lim SY, Jang Y … +8 more , Lee H, Jung SY, Yoo S, Lee JY, Kim K, Nam S, Lee HY, Kim ES
J Korean Med Sci · 2025 Dec · PMID 41430749 · Full text
BACKGROUND: Community-acquired pneumonia (CAP) frequently requires empirical antibiotic treatment owing to its nonspecific symptoms and the need for urgent intervention. Understanding the epidemiology of patients hospita...
BACKGROUND: Community-acquired pneumonia (CAP) frequently requires empirical antibiotic treatment owing to its nonspecific symptoms and the need for urgent intervention. Understanding the epidemiology of patients hospitalized with CAP at a regional level is essential for developing effective treatment strategies. Therefore, this study aimed to assess the epidemiological and clinical characteristics of CAP in patients admitted to a tertiary care hospital in Korea. METHODS: Utilizing a common data model, we selected patients aged 18 years and older who were admitted to Seoul National University Bundang Hospital from January 2005 to July 31, 2019. These patients presented with pneumonia-related symptoms, such as fever or a respiratory symptom, and had a pneumonia diagnosis code within 7 days of admission. The medical records of these patients were retrospectively reviewed. Patients without pneumonia, who had been hospitalized within 14 days before the start of the study, and those with pulmonary tuberculosis were excluded. RESULTS: Out of 7,147 patients with pneumonia-related symptoms, 4,083 were included in the study. The mean age of the patients was 70.1 years, with 66.7% being male. The most prevalent comorbidities were chronic lung disease (42.6%), malignancy (24.4%), and immunocompromised conditions (26.5%). was the most commonly identified pathogen in sputum cultures, followed by , , and . The overall in-hospital mortality rate was 3.9%. The factors significantly associated with increased in-hospital mortality were male sex, immunocompromised status, presence of dyspnea, unstable vital signs, low hemoglobin levels, and high C-reactive protein levels. CONCLUSION: In patients hospitalized with CAP in a tertiary care center in this study, gram-negative bacteria and the traditionally known were commonly found. This finding appeared related to patient age and underlying conditions such as chronic lung disease. Furthermore, male sex and an immunocompromised state were found to be significant risk factors for in-hospital mortality along with worse clinical indices.
Impact of Medical Crisis on the Competency of Surgical Conduct Regarding Departmental, Institutional and Regional Distribution in Korea: A National Insurance Claim Data Analysis.
Song J, Kang K, Cho J … +11 more , Kim WJ, Lee S, Jeong Y, Kim HJ, Lee IS, Lee JL, Kim JH, Lee GD, Kim SH, Song SH, Kim TW
J Korean Med Sci · 2025 Dec · PMID 41430748 · Full text
BACKGROUND: In February 2024, a nationwide medical crisis erupted in South Korea following the mass resignation of over 90% of trainee physicians in protest against the government's healthcare reform policy. Amid the ong...
BACKGROUND: In February 2024, a nationwide medical crisis erupted in South Korea following the mass resignation of over 90% of trainee physicians in protest against the government's healthcare reform policy. Amid the ongoing crisis, the government initiated a series of restructuring activities aimed at concentrating high-complexity surgeries and critical care at tertiary hospitals, while redistributing low-complexity procedures to hospitals and clinics. However, the nationwide impact of the reform policy on high-complexity surgical practices, particularly in terms of institutional type, departmental specialty, and regional distribution, has not yet been assessed. METHODS: Using national insurance claims data from the Korean Health Insurance Review and Assessment Service, we analyzed 914 high-complexity surgical procedures across tertiary hospitals (n = 47), general hospitals (n = 331), and hospitals/clinics (n = 37,888). Claims data from February to July 2023 (pre-crisis) were compared with those from February to July 2024 (post-crisis), stratified by institutional type, medical specialty, and geographic region. RESULTS: After the medical crisis, overall high-complexity surgical claims decreased by 10% ( < 0.001), with a 19% decrease in tertiary hospitals ( < 0.001), 6% increase in general hospitals ( = 0.115), and 27% increase in hospitals/clinics ( < 0.001). The decreased capacity for oncological surgery in tertiary hospitals by 16% ( < 0.001) was partly compensated by increased volume in general hospitals by 23% ( = 0.001). In terms of medical specialty, shifts from tertiary to general hospital in cardiothoracic surgery (1%, = 0.636), neurosurgery (1%, = 0.765), and interventional radiology (0%, = 0.186) were negligible. Oncological surgery in the capital region, which is home to a higher concentration of tertiary hospitals, decreased by 17%, while oncological surgery in around-capital and non-capital regions increased by 11% and 5%, respectively. CONCLUSION: During the Korean medical crisis in 2024, nationwide surgical capacity and systems for maintaining competency were significantly compromised. Although some procedures were offset by redistribution to lower-tier institutions or regional hospitals, most high-complexity surgeries-particularly those requiring critical care-did not recover.
Ethical Use of Artificial Intelligence for Processing Medical Images.
Fedorchenko Y, Zimba O
J Korean Med Sci · 2025 Dec · PMID 41399268 · Full text
Artificial intelligence (AI) tools employ prompts and algorithms to perform tasks that typically require human expertise, hypothesis formulation, and critical evaluation. AI enables rapid analysis of complex imaging data...
Artificial intelligence (AI) tools employ prompts and algorithms to perform tasks that typically require human expertise, hypothesis formulation, and critical evaluation. AI enables rapid analysis of complex imaging data, automates segmentation and lesion detection, and supports real-time image-guided interventions. Deep learning architectures (CNNs, RNNs, U-Net, and transformer-based models) facilitate advanced image classification, reconstruction, and interpretation, achieving clinical accuracies above 90% in multiple domains, including coronavirus disease 2019, oncology, and rheumatology. Generative AI platforms (MedGAN, StyleGAN, CycleGAN, SinGAN-Seg) further support synthetic image creation and dataset augmentation, mitigating data scarcity while preserving patient privacy. However, the integration of AI in healthcare presents significant ethical challenges. Key concerns include algorithmic bias, patient privacy, transparency, accountability, and equitable access. Biases-such as annotation, automation, confirmation, demographic, and feedback-loop bias-can compromise diagnostic reliability and patient outcomes. Ethical deployment requires rigorous data governance, informed consent, anonymization, standardized validation frameworks, human oversight, and regulatory compliance. Maintaining interpretability and transparency of AI outputs is essential for clinical decision-making, while professional training and AI literacy are critical to mitigate overreliance and ensure patient safety.
Prognostic and Therapeutic Potential of Nicotinamide N-Methyltransferase and Hypoxia Inducible Lipid Droplet Associated in Clear Cell Renal Cell Carcinoma.
Kim M, Song G, Joung JY … +3 more , Seo HK, Lee HH, Chung J
J Korean Med Sci · 2025 Dec · PMID 41399267 · Full text
BACKGROUND: Clear cell renal cell carcinoma (ccRCC) is the most aggressive subtype of renal cancer, characterized by profound metabolic reprogramming and lipid accumulation. Despite therapeutic advancements, reliable pro...
BACKGROUND: Clear cell renal cell carcinoma (ccRCC) is the most aggressive subtype of renal cancer, characterized by profound metabolic reprogramming and lipid accumulation. Despite therapeutic advancements, reliable prognostic biomarkers remain limited. This study investigates the prognostic and functional relevance of nicotinamide N-methyltransferase (NNMT), and hypoxia inducible lipid droplet associated (HILPDA) in ccRCC. METHODS: RNA sequencing was performed on tumor and matched normal tissues from 14 ccRCC patients. Differential gene expression and pathway enrichment analyses were conducted. Receiver operating characteristic (ROC) curves were generated to assess diagnostic value. Kaplan-Meier survival analysis using The Cancer Genome Atlas data evaluated prognostic significance. NNMT knockdown experiments were conducted in ccRCC cell lines (SNU1272 and Caki-1) to assess functional relevance. RESULTS: NNMT and HILPDA were significantly upregulated in tumor tissues. Pathway analyses revealed associations with lipid metabolism and biosynthesis. ROC analysis showed high diagnostic accuracy (NNMT area under the curve [AUC], 0.923; HILPDA AUC, 0.943). Kaplan-Meier analysis demonstrated that high NNMT expression correlated with worse overall and disease-specific survival ( < 0.001), whereas HILPDA expression showed no prognostic impact. NNMT knockdown significantly reduced cell viability ( < 0.001), supporting its role in tumor progression. CONCLUSION: NNMT is a promising prognostic biomarker and potential therapeutic target in ccRCC, supported by transcriptomic, clinical, and functional validation. While the prognostic relevance of HILPDA remains inconclusive, its metabolic associations suggest potential biological significance. Further studies with larger cohorts and in vivo validation are warranted.
Efficacy and Safety of Human Skin Microbiome-Derived Strains as Topical Treatment for Acne: An In Vitro and In Vivo Study.
Lee SG, Lee JH, Baek Y … +5 more , Chu J, Kim KH, Ham S, Shin CH, Lee YI
J Korean Med Sci · 2025 Dec · PMID 41399266 · Full text
BACKGROUND: The skin microbiome plays a crucial role in defending against pathogens and modulating immunity, and its dysregulation is linked to various skin conditions, including acne. METHODS: In this study, four previo...
BACKGROUND: The skin microbiome plays a crucial role in defending against pathogens and modulating immunity, and its dysregulation is linked to various skin conditions, including acne. METHODS: In this study, four previously identified strains- B424F-5, BS47C-1, BS35F-3, and BS320F-4- were selected from a skin microbiome database of healthy individuals. The efficacy and safety of these strains against acne-related inflammation were evaluated using in vitro and in vivo animal model experiments. RESULTS: exposure increased the expression of acne-associated inflammatory mediators-such as IL-1β, IL-6, IL-8, COX-2, iNOS, and TNF-α-particularly in keratinocytes, without inducing cytotoxicity. Treatment with heat-killed BS47C-1 (SE2), BS35F-3 (DP), and BS320F-4 (SS) significantly reduced these markers in vitro. In vivo, topical application of the strains alleviated inflammation in a -induced mouse model, with histological evidence of reduced erythema and immune cell infiltration. Bulk RNA sequencing of keratinocytes showed that SE2 and DP downregulated cytokine and interferon signaling while enhancing skin barrier and antimicrobial gene expression, suggesting a dual anti-inflammatory and barrier-supporting mechanism. CONCLUSION: These results provide compelling evidence of the efficacy and safety of human skin microbiome-derived strains as potential topical treatments for acne. By targeting both microbial colonization and inflammatory pathways, these strains offer a promising avenue for the development of novel acne therapeutics.
Employment Status and Lung Function Among Coal-Powered Electrical Plant Workers: A 5-Year Follow-up Study.
Ryu J, Kim EA, Park K … +2 more , Lee YK, Kim H
J Korean Med Sci · 2025 Dec · PMID 41399265 · Full text
BACKGROUND: Coal-powered electrical plant workers are exposed to coal dust in the entire work process. In South Korea, the processes with relatively high exposure to hazardous substances are mainly conducted by subcontra...
BACKGROUND: Coal-powered electrical plant workers are exposed to coal dust in the entire work process. In South Korea, the processes with relatively high exposure to hazardous substances are mainly conducted by subcontractor employees. The harmful substances may cause pneumoconiosis, lung cancer, as well as a decrease in lung function. However, few studies have investigated changes in lung function among plant workers. The current study hypothesizes that the lung function of workers would be reduced by dust exposure and these reductions differ by employment status. METHODS: This study was conducted on 1,108 workers in coal-powered electrical plants who underwent lung function tests as a special health check-up from 2013 to 2018. The study population was divided into three groups according to the work they mainly perform. These groups were the contractor operator, subcontractor operator, and subcontractor maintenance worker. To compare the exposure level to hazardous substances, the exposure index was calculated with using the measurement data for the workplace environment. To confirm the change of lung function, this study used the repeated-measure analysis of variance. RESULTS: The subcontractor and the contractor had the highest and lowest exposure indices at 4.5 and 1.7, respectively. The lung function indicators significantly decreased among the subcontractor maintenance and operating workers compared with the contractor workers after 5 years. The pulmonary function with forced vital capacity (in liters) in subcontractors 1 and 2 decreased by 0.1 and 0.2 L, respectively. Forced expiratory volume in 1 second (in liters) also decreased in the subcontractors. In addition, the decrease in pulmonary function level over time differed according to each group because the interaction between time and employment status was statistically significant ( < 0.01). CONCLUSION: These results suggest an association between coal dust and lung function deterioration. Also, differences in exposure can cause disparities in health outcomes even for workers in the same workplace.
Cytokine and Whole-Genome Sequence Analysis in Korean Patients With Multisystem Inflammatory Syndrome in Children.
Park H, Cho HK, Kim DR … +9 more , Shin A, Koh JY, Kim Y, Choe YJ, Choi EH, Choi JW, Lee H, Kim J, Kim YJ
J Korean Med Sci · 2025 Dec · PMID 41399264 · Full text
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication after coronavirus disease 2019. In South Korea, the Korea Disease Control and Prevention Agency has conducted national...
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication after coronavirus disease 2019. In South Korea, the Korea Disease Control and Prevention Agency has conducted national surveillance of MIS-C from May 2020 to March 2023. This project was carried out during the second phase of the surveillance, which included enhancements to the reporting system starting in August 2022. In addition to monitoring the epidemiological and clinical characteristics, we analyzed cytokine changes and genetic factors. METHODS: A user-friendly web-based reporting system using an electronic case report form (e-CRF) was established to provide clinicians in the field with easy access to reports. Cases collected from August 2022 to March 2023 were evaluated to confirm diagnoses, and unclassified cases from the prior research period were also reviewed. For patients who provided consent, serum cytokine measurements and whole-genome sequence analyses were conducted. RESULTS: In this study, 55 cases were confirmed as MIS-C. Of the 32 cases reported via e-CRF in the second period, 28 were confirmed as MIS-C. Among 31 cases reported but unclassified in the first period, 27 were subsequently confirmed as MIS-C. The median patient age was 7.8 years (range: 2 months to 16 years), with 54.5% (30/55) male. Clinically, 15 patients (27%) had abnormal echocardiography findings, and 5 (9.1%) required intensive care unit care. Steroids were administered to 45 patients (81.8%) and intravenous immunoglobulin to 46 (83.6%). No mortality occurred. In two patients, 17 serum cytokines were measured pre- and post-treatment, with interleukin (IL)-6, IL-17/IL-17A, IL-1ra/IL-1F3, IL-10, and CXC motif chemokine ligand 10 (CXCL10)/inducible protein 10 kDa (IP-10) peaking before treatment and decreasing afterward. Whole-genome sequencing in 6 patients revealed no previously reported MIS-C-associated genetic variants. CONCLUSION: Continuous monitoring of MIS-C cases is essential, as some may develop serious complications. Clinicians should remain vigilant in diagnosing MIS-C, and further research is needed to elucidate its pathogenesis.
Key Features and Controversies of the COVID-19 Epidemic and Response in North Korea.
Shin YJ
J Korean Med Sci · 2025 Dec · PMID 41399263 · Full text
BACKGROUND: North Korea took strong border closure measures for about three years before and during the coronavirus disease 2019 (COVID-19) epidemic, and responded without diagnostic equipment and vaccines. This study sy...
BACKGROUND: North Korea took strong border closure measures for about three years before and during the coronavirus disease 2019 (COVID-19) epidemic, and responded without diagnostic equipment and vaccines. This study systematically organizes the characteristics of North Korea's COVID-19 epidemic and response, and explores unanswered questions and policy implications. METHODS: The study used reports from North Korea's two official media outlets, the Chosen Central News Agency and , data submitted to the World Health Organization South-East Asia Region, and academic papers. To estimate and evaluate the number of COVID-19 cases and deaths in North Korea, the epidemiological data from other countries were used. RESULTS: Faced with a severe shortage of appropriate diagnostic and therapeutic drugs and equipment, North Korea responded with prolonged, strict border closures, self-quarantines, restrictions on movement, and surveillance by identifying people with fever, without mass vaccination. The cumulative number of people with fever announced by North Korean authorities on August 4, 2022, just before the end of the outbreak, was 4,772,813, and the number of deaths from COVID-19 was 74. After the pandemic, efforts are underway to restore the healthcare system, including 'catch-up immunizations.' However, major controversies have been identified in the pandemic response process, such as 1) the initial inflow and spread route, 2) the final number of deaths, 3) the reason for refusing to provide vaccines to the COVAX facility, and 4) the success of North Korea's COVID-19 response. CONCLUSION: Identifying North Korea's response, outcomes, and key controversies to the COVID-19 epidemic can provide important information not only for North Korea but also for countries with similar political and economic situations and the international community to better respond to the next pandemic.
Increased Risk of Hematologic Malignancy in Moderate to Severe Psoriasis in Relation to the Use of Systemic Immunosuppressants: A Nationwide Population-Based Matched Cohort Study.
Woo YR, Chae K, Song S … +5 more , Lee S, Lee YJ, Kang H, Kim S, Kim JE
J Korean Med Sci · 2025 Dec · PMID 41399262 · Full text
BACKGROUND: The relationship between cancer and the use of systemic immunosuppressants in psoriasis treatment has not well established. The aim of this study was to evaluate the association between the systemic immunosup...
BACKGROUND: The relationship between cancer and the use of systemic immunosuppressants in psoriasis treatment has not well established. The aim of this study was to evaluate the association between the systemic immunosuppressants used in the treatment for psoriasis and the risk of certain cancers in Korean patients with moderate to severe psoriasis. METHODS: A retrospective cohort study was conducted involving 93,152 patients with moderate to severe psoriasis and 205,850 matched controls in Korea, using merged data from the National Health Insurance System, Health Insurance Review & Assessment Service, and Korea National Cancer Incidence Database from 2008 to 2018. RESULTS: The study observed a lower incidence of any cancer in moderate to severe psoriasis patients (2.4%) compared to the general population (2.99%). However, there was a higher risk of hematologic cancers, particularly Hodgkin's lymphoma, non-Hodgkin's lymphoma, leukemia, and cutaneous T cell lymphoma. Notably, methotrexate doses of ≥ 17.5 mg/week increased the risk of hematologic cancer risk by 7.546 times and cutaneous T cell lymphoma risk by 9.038 times, but cyclosporine and corticosteroids use did not show a significant association with increased incidence of hematologic cancers. Meanwhile, use of cyclosporine, methotrexate and corticosteroid did not significantly affect the risk of skin cancer among patients with psoriasis. CONCLUSION: This study reveals an increased risk of hematologic cancers, such as cutaneous T cell lymphomas, associated with high-dose immunosuppressant use in moderate to severe psoriasis, underscoring the need for careful treatment management.
Trends in Mental Health-Related Emergency Department Visits Among Adolescents and Young Adults: A Nationwide, Population-Based Study in Korea, 2017-2021.
Park H, Oh MR, Roh EH … +4 more , Huh YJ, Hong SI, Kim YJ, Kim WY
J Korean Med Sci · 2025 Dec · PMID 41365554 · Full text
BACKGROUND: Trends in mental health-related emergency department (ED) use among adolescents and young adults in South Korea are largely unexplored. This study evaluated recent trends and characteristics of these ED visit...
BACKGROUND: Trends in mental health-related emergency department (ED) use among adolescents and young adults in South Korea are largely unexplored. This study evaluated recent trends and characteristics of these ED visits. METHODS: This nationwide epidemiologic study used data from the National Emergency Department Information System in Korea, including patients who visited the ED to receive psychiatric consultation between 2017 and 2021. Adolescents and young adults were defined as 10-24 years old, and their characteristics and trends were compared with those of adult (≥ 25 years) patients. RESULTS: Among 117,997 patients, adolescents and young adults comprised 28.0% of the population. There was a significant increasing trend in ED visits between 2017 and 2021 among adolescents and young adults (4,737 to 8,787, < 0.001), whereas the adult patient visits were stationary (16,798 to 16,313, = 0.497). In the adolescents and young adults group, there was a greater predominance of females (67.1%), transfer from other facilities (10.8%), discharge to home after treatment (71.7%), and visits due to intentional self-harm (26.9%) than in the older age group. The most common diagnostic codes were F30-F39 (mood [affective] disorder; 43.2%), and the most common diagnosis was F32 (depressive episode), accounting for 17.7%. Diagnoses in the F30-39 category, especially F32, significantly increased each year ( < 0.001). CONCLUSION: The study revealed that from 2017 to 2021, mental health-related ED visits for adolescents and young adults nearly doubled, especially for depression and mood disorders, with a significant increase among female patients. This highlights the need for tailored strategies and more psychiatric expertise in the ED.
Effect of Isoniazid Resistance on Treatment Outcome Among People With Pulmonary Tuberculosis in Korea.
Lee JM, Kim HW, Lee EG … +18 more , Park Y, Jung SS, Kim JW, Oh JY, Lee H, Kim SH, Kim SH, Lyu J, Kwon SJ, Jeong YJ, Kim D, Koo HK, Chae G, Kyung SY, Lee SS, Park JS, Kim JS, Min J
J Korean Med Sci · 2025 Dec · PMID 41365553 · Full text
BACKGROUND: Isoniazid resistance is the most common type of ant-tuberculosis drug resistance, which is often neglected in clinical practice. This study aimed to evaluate the impact of isoniazid mono-resistant tuberculosi...
BACKGROUND: Isoniazid resistance is the most common type of ant-tuberculosis drug resistance, which is often neglected in clinical practice. This study aimed to evaluate the impact of isoniazid mono-resistant tuberculosis (Hr-TB) on the treatment outcomes of people with pulmonary tuberculosis. METHODS: People with pulmonary tuberculosis were enrolled from the Korea Tuberculosis Cohort (KTBC) registry and the multicenter prospective cohort study of pulmonary tuberculosis (COSMOTB). Isoniazid resistance was confirmed using drug susceptibility test results. The primary outcome was an unfavorable outcome, which defined as comprising death, failure, loss-to-follow-up, still-on-treatment, and not-evaluated. Logistic regression analysis was conducted to evaluate effect of isoniazid resistance on treatment outcomes. We also compared 2-month sputum negative culture conversion rate and incidence of adverse events between Hr-TB and drug-susceptible tuberculosis. RESULTS: From the KTBC and COSMOTB databases, 10,482 and 758 participants were included, respectively. Compared to drug-susceptible tuberculosis, Hr-TB had higher rates of unfavorable outcome in the KTBC (45.8% vs. 37.0%, < 0.001) and COSMOTB (31.5% vs. 17.9%, = 0.014). Multivariable logistic regression analysis showed significant association between isoniazid resistance and unfavorable outcome in the KTBC (adjusted odds ratio [aOR], 1.43; 95% confidence interval [CI], 1.24-1.65) and in the COSMOTB (aOR, 1.98; 95% CI, 1.02-3.85). Additional analyses on COSMOTB data showed that Hr-TB had more serious adverse drug reactions, while 2-month sputum culture conversion rates did not differ significantly. CONCLUSION: Isoniazid resistance is significantly associated with unfavorable clinical outcomes.
Fatality Rate in Hospitalized Patients Due to Carbon Monoxide Poisoning in the Democratic People's Republic of Korea.
Kim Y, Kim JH
J Korean Med Sci · 2025 Dec · PMID 41365552 · Full text
BACKGROUND: The widespread use of polluting fuels for indoor heating in the Demographic People's Republic of Korea (DPRK, North Korea) poses a significant risk for unintentional carbon monoxide (CO) poisoning. Despite it...
BACKGROUND: The widespread use of polluting fuels for indoor heating in the Demographic People's Republic of Korea (DPRK, North Korea) poses a significant risk for unintentional carbon monoxide (CO) poisoning. Despite its public health impact, reliable national-level data on the burden of CO poisoning in the DPRK remain scarce. This study addresses the need for more accurate estimates by analyzing fatality rates among hospitalized patients. METHODS: A meta-analysis was conducted to estimate the fatality rate of hospitalized patients with unintentional CO poisoning in the DPRK and to compare it with historical data from the Republic of Korea (ROK, South Korea). In the DPRK, relevant publications were identified through a keyword search of the North Korean Materials Center, and studies reporting both hospital admissions and fatality outcomes were selected for analysis. In the ROK, seven hospital-based studies conducted between the 1960s and 1970s were analyzed and stratified by the use of hyperbaric oxygen therapy (HBOT). RESULTS: The fatality rate in hospitalized patients with unintentional CO poisoning in the DPRK was estimated at 6.49% (95% confidence interval [CI], 4.23-9.83%) using a random-effects model. This rate was 2.48 times higher (95% CI, 1.16-5.29) than that observed among ROK patients who received HBOT (2.62%; 95% CI, 1.38-4.91%). When compared to ROK patients who did not receive HBOT (6.26%; 95% CI, 4.10-9.42%), the DPRK fatality rate was 1.04 times higher (95% CI, 0.57-1.88), indicating comparable clinical outcomes in settings where advanced therapeutic interventions such as HBOT were not available. CONCLUSION: Accurate estimation of fatality rates among hospitalized patients with CO poisoning is essential to understanding its disease burden in the DPRK. The continued use of low-quality solid fuels for residential heating contributes substantially to the risk of unintentional CO poisoning. These findings highlight the urgent need for evidence-based public health interventions and international collaboration to improve heating practices and reduce preventable morbidity and mortality.
A Novel Machine Learning Approach to Assist Early Diagnosis of Diffuse Panbronchiolitis.
Lee HJ, Heo KJ, You YS … +4 more , Chae KJ, Kim JS, Jeong JS, Lee YC
J Korean Med Sci · 2025 Dec · PMID 41365551 · Full text
BACKGROUND: Diffuse panbronchiolitis (DPB) is a rare and progressive inflammatory lung disease affecting the small airways; however, it is often misdiagnosed as other respiratory conditions, such as nontuberculous mycoba...
BACKGROUND: Diffuse panbronchiolitis (DPB) is a rare and progressive inflammatory lung disease affecting the small airways; however, it is often misdiagnosed as other respiratory conditions, such as nontuberculous mycobacterial infection or bronchiectasis. This study aimed to apply machine learning (ML) algorithms to improve early diagnostic accuracy for DPB. METHODS: ML algorithms were applied using clinical, laboratory, and radiological data from 99 patients with suspected DPB. Patients were categorized into two groups based on established diagnostic criteria and major diagnostic criteria for DPB without impaired lung function. Seven ML models were evaluated. RESULTS: The least absolute shrinkage and selection operator regression model demonstrated the highest predictive accuracy. The analysis identified two key diagnostic factors, allergic rhinitis and the presence of macronodules on computed tomography scans, both of which were strongly associated with DPB. CONCLUSION: These results highlight the first application of ML in diagnosing DPB and underscore the significance of allergic rhinitis and macronodules as critical indicators for early detection. Incorporating ML techniques into clinical practice could improve the diagnostic accuracy and efficiency for rare diseases such as DPB. Further research involving larger patient datasets is recommended to validate these results and refine the diagnostic criteria for DPB.
Long-Term Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients With High Baseline Anti-A/B Antibody Titers.
Eum SH, Lee H, Ko EJ … +5 more , Min JW, Ban TH, Yoon HE, Shin SJ, Chung BH
J Korean Med Sci · 2025 Dec · PMID 41365550 · Full text
BACKGROUND: This study aimed to investigate the long-term clinical outcomes of ABO-incompatible kidney transplantation (ABO icKT) in patients with high baseline anti-A/B antibody titers. METHODS: This study included 271...
BACKGROUND: This study aimed to investigate the long-term clinical outcomes of ABO-incompatible kidney transplantation (ABO icKT) in patients with high baseline anti-A/B antibody titers. METHODS: This study included 271 cases of ABO icKT. Of these, 42 patients with a baseline antibody titer of ≥ 1:256 were assigned to the high-titer group, while the remaining 229 patients were categorized into the low-titer group. We compared the groups regarding the number of required pre-transplant plasmapheresis (PP) and intravenous immunoglobulin (IVIG) sessions. Clinical outcomes included post-operative bleeding, biopsy-proven acute rejection (BPAR), infectious complications, changes in allograft function, and long-term allograft and patient survival. RESULTS: The high-titer group required significantly more sessions of PP and IVIG than the low-titer group (8.74 ± 2.68 vs. 3.85 ± 1.64; < 0.001). Following transplantation, anti-A/B antibody titers remained elevated in the high-titer group. There was no significant difference in post-operative bleeding between the two groups. However, the incidence of bacterial infection was higher in the high-titer group compared with the low-titer group (47.62% vs. 30.57%; = 0.031), although this association was not significant in multivariable analysis. The incidence of total BPAR did not differ significantly; however, chronic active antibody-mediated rejection was more frequently observed in the high-titer group (7.14% vs. 0.87%; = 0.028). Overall allograft and patient survival did not differ significantly between the two groups. CONCLUSION: Patients with high baseline anti-A/B titers demonstrated comparable short-term and long-term patient and allograft outcomes to those in the low-titer group.
Association of Unmet Healthcare Needs With Depressive Symptoms and COVID-19 Pandemic-Related Factors Among Adults, 2009-2022: A Nationwide Study in Korea.
Kang J, Park J, Kim HJ … +7 more , Lee H, Fond G, Boyer L, Rahmati M, Nehs CJ, Smith L, Yon DK
J Korean Med Sci · 2025 Dec · PMID 41365549 · Full text
BACKGROUND: To investigate the long-term trends in prevalence and pandemic-related factors of unmet healthcare needs among a nationwide large-scale cohort with or without depressive symptoms from the Korea Community Heal...
BACKGROUND: To investigate the long-term trends in prevalence and pandemic-related factors of unmet healthcare needs among a nationwide large-scale cohort with or without depressive symptoms from the Korea Community Health Survey. METHODS: We analyzed 2,850,315 Korean adults aged 19 years or older, including individuals with or without depressive symptoms. Our study investigated the trends and risk factors for unmet healthcare needs among individuals, stratified by the presence of depressive symptoms during the pre-pandemic (2009-2019) and pandemic era (2020-2022). Weighted odds ratios and weighted regression slope coefficients (β) with 95% confidence intervals (CIs) were employed to analyze the prevalence of unmet healthcare needs. RESULTS: Of a total of 2,850,315 individuals (mean ± standard deviation age, 53.04 ± 17.43 years; male, 44.81%). Unmet healthcare needs decreased in both groups during the observation period. Individuals with depressive symptoms had a 2-3 times higher prevalence of unmet healthcare needs. The downward trend for those with depressive symptoms, from 34.55% (95% CI, 33.77-35.34) in 2009-2010 to 21.50% (20.91-22.09) in 2017-2019, reversed during the pandemic, increasing from 13.82% (12.95-14.69) in 2020 to 14.37% (13.62-15.12) in 2022. CONCLUSION: The study highlights increased unmet healthcare needs among individuals with depressive symptoms during the pandemic, emphasizing the necessity for tailored policies and effective healthcare distribution to reduce barriers for vulnerable populations during global crises.
Interpersonal Needs and Dysfunctional Self-Focus Mediate the Effect of Dysfunctional Pandemic Grief on Suicidality Among Nursing Professionals Who Witnessed Patients' Deaths.
Park CHK, Makhour H, Ahn J … +3 more , Jun JY, Park J, Chung S
J Korean Med Sci · 2025 Dec · PMID 41327927 · Full text
BACKGROUND: We aimed to explore whether the dysfunctional pandemic grief of nursing professionals who experienced a patient's death may be related with their suicidal ideation and examine whether their interpersonal prob...
BACKGROUND: We aimed to explore whether the dysfunctional pandemic grief of nursing professionals who experienced a patient's death may be related with their suicidal ideation and examine whether their interpersonal problems and dysfunctional self-focus mediate this association. METHODS: An anonymous online survey was conducted on November 16-18, 2023 among nurses in a tertiary hospital who witnessed people's death. Their psychological states were assessed using the Pandemic Grief Scale (PGS) for healthcare workers, Dysfunctional Self-focus Attributes Scale (DSAS), Interpersonal Needs Questionnaire (INQ), and Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). Linear regression analysis was conducted to explore the expecting variables for the DSI-SS. Mediation analysis was performed to examine the mediating effects of self-focus and interpersonal problems between grief reaction and suicidal ideation. RESULTS: The PGS (β = 0.18, = 0.005), INQ-Perceived Burdensomeness (INQ-PB; β = 0.51, < 0.001), and DSAS-Negatively Biased Focus (DSAS-NBF; β = 0.17, = 0.021) were significantly associated with the DSI-SS. Mediation analysis using these variables showed that the PGS directly influenced the DSI-SS, and the INQ-PB and DSAS-NBF partially mediated the influence of the PGS on DSI-SS. CONCLUSION: Dysfunctional grief experienced by nurses following the loss of patients during the pandemic exacerbated suicidal ideation by fostering a greater focus on negative outcomes and heightened feelings of being a burden. These findings underscore the need for targeted interventions to address these specific cognitive and emotional vulnerabilities to mitigate the risk of suicidal ideation.
Early Detection and Hearing Intervention in Infants With Bilateral Moderate Hearing Loss: Based on a Nationwide Infantile Hearing Aid Support Program in Korea.
Kim YS, Choo OS, Park SK … +4 more , Park E, Choi J, Im GJ, Chang J
J Korean Med Sci · 2025 Dec · PMID 41327926 · Full text
BACKGROUND: The aim of this study is to review data on infants who received hearing aid support through the Infantile Hearing Aid Support Program after the settlement of universal newborn hearing screening (NHS) in the c...
BACKGROUND: The aim of this study is to review data on infants who received hearing aid support through the Infantile Hearing Aid Support Program after the settlement of universal newborn hearing screening (NHS) in the country over the past five years in Korea. This study seeks to identify the characteristics of infants with bilateral moderate hearing loss and to explore effective strategies for auditory rehabilitation by analyzing the timing of hearing aid interventions and regional disparities. METHODS: We analyzed the National Health Insurance Service (NHIS) records and the Infantile Hearing Aid Support Program database between January 2019 and December 2023. Our analysis included the NHS performance rate, NHS results, diagnostic hearing test outcomes, types of hearing loss, and the relationship between NHS results and hearing loss risk factors. Additionally, we examined the submission dates for the program, hearing aid purchase dates, types of hearing aids, and whether the residential area, prescription area, and hearing aid purchase areas matched. RESULTS: In this period, a total of 1,318,551 neonates were born and 540 bilateral moderate hearing loss infants registered for the Infantile Hearing Aid Support Program. The NHS performance rate increased to 95.4% by 2023, while the proportion of infants receiving diagnostic hearing tests within three months was 46.2%. The rate of infants receiving hearing aids within six months for auditory rehabilitation was 22.4%. Although no correlation was found between risk factors for hearing loss and NHS results, it was observed that infants admitted to the neonatal intensive care unit or with other syndromes had a higher likelihood of being diagnosed with moderate hearing loss, even if they passed the NHS. Finally, there were regional disparities in access to hearing aid prescriptions and rehabilitation. CONCLUSION: Our findings suggest that auditory rehabilitation achieves greater focus following the implementation of NHS. This study also provides valuable insights into the hearing status and rehabilitation outcomes of infants with moderate hearing loss. Furthermore, we anticipate that these results will contribute to informing policies aimed at reducing regional disparities in access to auditory rehabilitation services.
Gemigliptin Alleviates Succinate Induced Endoplasmic Reticulum Stress and Activation of Hepatic Stellate Cells.
Do DV, Nguyen G, Park SY … +1 more , Cho EH
J Korean Med Sci · 2025 Dec · PMID 41327925 · Full text
BACKGROUND: Hepatic stellate cells (HSCs) activation is the principal event in the development of liver fibrosis in which succinate-G-protein coupled receptor 91 signaling has recently been shown to be a contributor. Mor...
BACKGROUND: Hepatic stellate cells (HSCs) activation is the principal event in the development of liver fibrosis in which succinate-G-protein coupled receptor 91 signaling has recently been shown to be a contributor. Moreover, endoplasmic reticulum (ER) stress has been reported to involve in HSC activation, but its association with succinate in pathogenesis of liver fibrosis remains scarce. In this study, we investigated the role of gemigliptin, an antidiabetic dipeptidyl peptidase-4 inhibitor, in the succinate-induced ER stress and activation of HSCs. METHODS: LX-2 cells, the immortalized human HSCs, were treated with succinate and gemigliptin. For animal experiments, C57BL/6N mice were divided into 3 groups: control diet, high-fat high-cholesterol (HFHC) diet, and HFHC diet mixed with gemigliptin. RESULTS: Succinate significantly induced HSC activation and increased expression of inflammatory markers and the increase in the migration of HSCs. The treatment of succinate also caused ER dilation and activated the unfolded protein response signaling as protein kinase RNA-like ER kinase, eIF2alpha, binding immunoglobulin protein, suggesting increasing ER stress in HSCs. All responses of HSCs to succinate were attenuated with the co-treatment of gemigliptin. Moreover, the exposure of HSCs to tunicamycin, an inducer of ER stress, promoted the expression of α-smooth muscle actin, proliferation and migration of HSCs. In vivo, the level of fibrotic and ER stress markers was increased in mice fed with HFHC diet and the administration of gemigliptin improved these changes in HFHC-induced mice. CONCLUSION: This study showed the involvement of ER stress in the activation of succinate-induced LX-2 HSCs and gemigliptin significantly reduced ER stress in HSC activation. Therefore, gemigliptin may become an anti-fibrotic agent and targeting to succinate and ER stress may be a promising therapeutic in the management of liver fibrosis.
Altered Body Composition in Dizziness and Vestibular Dysfunction: Insights From the Korean National Health and Nutrition Examination Survey.
Kim EJ, Kwon E, Jeong SH … +2 more , Jung S, Kim JS
J Korean Med Sci · 2025 Dec · PMID 41327924 · Full text
BACKGROUND: Body composition disorders such as sarcopenia, obesity, and osteoporosis are common; however, the body composition of patients with dizziness and vestibular dysfunction (VD) has not been thoroughly assessed....
BACKGROUND: Body composition disorders such as sarcopenia, obesity, and osteoporosis are common; however, the body composition of patients with dizziness and vestibular dysfunction (VD) has not been thoroughly assessed. METHODS: This cross-sectional study included 9,682 participants aged over 40. Based on the results of a dizziness questionnaire and modified Romberg test, they were classified into three groups: dizziness associated with VD, dizziness without VD, and controls. A body composition analysis focused on muscles, bones, and fats. RESULTS: Multivariate regression analysis revealed that sarcopenia was associated with a higher risk of dizziness with VD when compared to dizziness without VD (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09-2.49; = 0.017) and the control group (OR, 1.92; 95% CI, 1.28-2.88; = 0.002). The proportions of bone mineral and fat were comparable among the groups. CONCLUSION: Sarcopenia was found to be significantly associated with dizziness in the group with VD but not in those without it. While this study does not establish a causal relationship, maintaining muscle mass through proper diet and physical activity may be beneficial for individuals with VD. Such efforts could help manage overall health, potentially reducing risks associated with sarcopenia and improving balance. Further longitudinal studies are necessary to explore the potential causal pathways between VD and sarcopenia.
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