Journal Of Korean Medical Science[JOURNAL]
Sun
200 papers
Revolutionizing Sectioned Images of the Visible Korean: Achieving From 0.05 mm to 0.03 mm Sized Pixel.
Park JS, Kim SK
J Korean Med Sci · 2026 Jun · PMID 42261573 · Full text
BACKGROUND: The Visible Korean (VK) project aimed to overcome the limitations of traditional cadaver dissection by producing high-resolution sectioned images. This study compared a newly acquired 2024 dataset with a 2023...
BACKGROUND: The Visible Korean (VK) project aimed to overcome the limitations of traditional cadaver dissection by producing high-resolution sectioned images. This study compared a newly acquired 2024 dataset with a 2023 dataset to evaluate the feasibility of using sectioned images for clinical anatomical research. METHODS: Two female cadavers were frozen and serially milled at constant intervals. The sectioned surfaces were photographed using a digital single-lens reflex (DSLR) camera of 35 mm charge-coupled device (CCD) sensor for 2023 dataset and a DSLR of 44 mm medium-format CCD sensor for 2024 dataset. RESULTS: The 2024 dataset had 2.78 times higher pixel density (pixel size, 0.03 mm × 0.03 mm) than the 2023 dataset (pixel size, 0.05 mm × 0.05 mm), enabling clearer visualization of fine structures such as brain nuclei, fasciculi, vessel walls, meninges, and facial retaining ligaments. Pathological findings including cardiomegaly, vascular rupture, atherosclerosis, and endometrial neoplasm were clearly identified. The consistent intervals allowed accurate tracing of structures across multiple planes. The accumulated datasets from twelve cadavers now allow statistically reliable anatomical interpretation. CONCLUSION: Sectioned images produced with modern DSLR technology can reproduce anatomical structures at a level comparable to cadaveric dissection. Their high resolution, color fidelity, and digital format allow repeated analysis without damage. These datasets are now suitable not only for education but also for clinical anatomy research, potentially contributing to a paradigm shift from traditional to digital dissection.
Influence of Digital Literacy on Digital Health Usage Intention Among Patients With Cancer and Healthcare Providers.
Kim HR, Kim HJ, Yu ES … +9 more , Ahn HY, Park BK, Kim MK, Oh CR, Yoon DW, Kwak Y, Noh Y, Han DH, Kim SM
J Korean Med Sci · 2026 Jun · PMID 42261572 · Full text
BACKGROUND: Digital health has revolutionized oncology care by offering educational content for informed decisions, facilitating health monitoring, and enhancing access to psychological support. Understanding digital lit...
BACKGROUND: Digital health has revolutionized oncology care by offering educational content for informed decisions, facilitating health monitoring, and enhancing access to psychological support. Understanding digital literacy and the requirements of patients with cancer and healthcare providers (HCPs) are essential for developing effective digital health services. We explored the awareness of and demand for digital health and the factors influencing usage intention among patients with cancer and HCPs, focusing on digital literacy. METHODS: This cross-sectional study used data from the "Digital Health Awareness and Demand Survey," conducted between October 2023 and February 2024, involving 200 patients with cancer and 204 HCPs. We assessed digital health usage intention, awareness, understanding, and literacy. Digital literacy was measured using a self-assessment tool for Digital Literacy Competence (DLC). Hierarchical linear regression analysis determined the factors affecting digital health usage intentions. RESULTS: Both patients with cancer and HCPs exhibited strong willingness to use digital health services, scoring 4.03 ± 0.90 and 3.98 ± 0.67, respectively, on a 1-5 Likert scale. High digital literacy was positively associated with the intention to use digital health (DH-Intention to use), especially DLC-Value among patients with cancer ( = 0.09, = 0.002), and DLC-Value ( = 0.06, = 0.004) and DLC-Affect ( = 0.03, = 0.009) among all participants. A better understanding of digital health was correlated with increased DH-Intention to use among HCPs ( = 0.17, = 0.029) and all participants ( = 0.12, = 0.041). Patients with cancer reported the highest need for "family and social support" and "transportation and cost assistance service," while HCPs reported the highest need for "information and education" and "communication issues." The patient group reported a significantly greater need for "psychological issues," "family and social support," "hospital facilities and services," and "transportation and cost-assistance services." CONCLUSION: Digital literacy and understanding of digital health significantly affected the participants' willingness to use these services. Promoting digital literacy may encourage patients with cancer to adopt digital health, and its usefulness should be highlighted. HCPs can benefit from comprehensive education and training by integrating digital health into their specialties and practices.
Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study.
Yoo KH, Suh GJ, Kwon WY … +10 more , Choi SH, Chung SP, Kim WY, Kim K, Park YS, Shin TG, Ko BS, Lim TH, Cho Y, Korean Shock Society (KoSS) Investigators
J Korean Med Sci · 2026 Jun · PMID 42261571 · Full text
BACKGROUND: Few studies have examined real-world transfusion practices in patients with septic shock. It is unclear whether red blood cell (RBC) transfusion benefits patients with an elevated lactate level. This study in...
BACKGROUND: Few studies have examined real-world transfusion practices in patients with septic shock. It is unclear whether red blood cell (RBC) transfusion benefits patients with an elevated lactate level. This study investigated transfusion practices and explored lactate as a physiological marker for guiding transfusion decisions. METHODS: This observational study used data from a prospective, multicenter registry of patients with septic shock, provided by the Korean Shock Society, from November 2015 to December 2022. The initial hemoglobin (Hb) value and RBC transfusion status within six hours of emergency department visits were recorded. The in-hospital mortality rate was assessed based on the Hb level. The association between RBC transfusion and in-hospital mortality was analyzed using multivariable logistic regression, stratified by Hb groups and lactate level subgroups. RESULTS: Among the 8,711 patients included, 884 (10.1%) received an RBC transfusion. Of these, 510 patients (57.7%) received a transfusion at an Hb level ≥ 7 g/dL. In the Hb 7.0-8.9 g/dL and Hb ≥ 9.0 g/dL groups, the transfusion group had a higher heart rate and a greater percentage of patients meeting the Sepsis-3 criteria for shock compared to the non-transfusion group. The initial lactate level was significantly higher in the transfusion group compared to the non-transfusion group in the Hb ≥ 9.0 g/dL group (median 5.3 mmol/L vs. 3.5 mmol/L). No significant association was found between RBC transfusion and in-hospital mortality in the Hb < 7.0 g/dL group (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.54-1.37) and the Hb 7.0-8.9 g/dL group (aOR, 0.79; 95% CI, 0.59-1.06). However, in the Hb ≥ 9.0 g/dL group, RBC transfusion was associated with an increased in-hospital mortality rate (aOR, 1.99; 95% CI, 1.34-2.93). The benefits of transfusion were not confirmed by the analysis based on the lactate level. CONCLUSION: RBC transfusions were frequently administered beyond restrictive thresholds in patients with septic shock, particularly in those with an elevated lactate level. However, RBC transfusion in patients with an elevated lactate level was not associated with decreased in-hospital mortality.
Performance and Cost-Efficiency of an MPT64 Assay for Detecting Complex in a Setting With Frequent Nontuberculous Mycobacteria Isolation.
Yu HJ, Kim JA, Song HM … +5 more , Lee KA, Kim H, Yoo IY, Kim TY, Huh HJ
J Korean Med Sci · 2026 Jun · PMID 42261570 · Full text
BACKGROUND: Rapid and accurate detection of complex (MTBC) in acid-fast bacilli (AFB)-positive cultures is crucial for effective patient management and transmission control. This study assessed the diagnostic performanc...
BACKGROUND: Rapid and accurate detection of complex (MTBC) in acid-fast bacilli (AFB)-positive cultures is crucial for effective patient management and transmission control. This study assessed the diagnostic performance and cost-efficiency of the Bioline MPT64 assay for detecting MTBC in AFB-positive cultures in a setting with frequent nontuberculous mycobacteria (NTM) isolation. METHODS: Between August 2024 and February 2025, AFB-positive cultures were tested in parallel using the Bioline MPT64 assay and real-time polymerase chain reaction (PCR). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Bioline MPT64 assay were calculated using real-time PCR as the reference standard. Cost-efficiency of diagnostic strategies incorporating the Bioline MPT64 assay was also evaluated. RESULTS: Based on real-time PCR results, among 494 AFB-positive cultures, 192 (38.9%) were MTBC-positive, 299 (60.5%) were NTM-positive, 2 (0.4%) were positive for both MTBC and NTM, and 1 (0.2%) was negative for both. The Bioline MPT64 assay exhibited a sensitivity of 99.0% (192/194), specificity of 100% (300/300), PPV of 100% (192/192), and NPV of 99.3% (300/302). Two false-negative results occurred in MTBC-NTM co-positive cultures. Using the Bioline MPT64 assay alone could reduce costs by 66.7% compared to real-time PCR alone but carries a risk of missing approximately 1.0% of MTBC-positive cultures. A stepwise strategy-initial screening with the Bioline MPT64 assay followed by real-time PCR for MPT64-negative cultures-could offer diagnostic accuracy comparable to real-time PCR alone but result in only a modest 5.5% cost reduction. CONCLUSION: The Bioline MPT64 assay shows strong concordance with real-time PCR and offers substantial cost savings when used alone, though it may miss MTBC-NTM co-positive cultures. PCR confirmation of MPT64-negative results mitigates this risk but provides only modest cost savings in NTM-prevalent settings.
Salary and Support Continuity Influence Medical Students' Intentions to Pursue Physician-Scientist Careers: Results of an Experimental Survey.
Lee MH, Kim JI, Do YK
J Korean Med Sci · 2026 Jun · PMID 42237177 · Full text
Despite efforts to strengthen the physician-scientist workforce through South Korea's Physician-Scientist Training Program (PSTP), its impact on medical students' career intentions remains unclear. This study assessed wh...
Despite efforts to strengthen the physician-scientist workforce through South Korea's Physician-Scientist Training Program (PSTP), its impact on medical students' career intentions remains unclear. This study assessed whether information about the PSTP-specifically salary and support continuity-affects medical students' willingness to pursue physician-scientist careers. A total of 610 medical students nationwide were randomized to one of four hypothetical information scenarios varying by salary (50 million vs. 75 million KRW/year) and continuity of support. Willingness was measured before and after information provision, alongside perceived adequacy of the support and expected effectiveness of the program. Information provision increased willingness across all groups, with greater increases observed in the "75m KRW/y" and "75m KRW/y plus possible extension" groups. Perceived adequacy and expected effectiveness were likewise higher under enhanced salary scenarios. These findings suggest that PSTP design, particularly higher salary combined with guaranteed continuity, meaningfully shapes career intentions and may guide future policies aimed at strengthening the physician-scientist workforce.
Mental Health Outcomes After the Acute Phase of COVID-19: Factors Identified in a Korean Public Mental Health Service.
Kim H, Kwak E, Lee D … +7 more , Lee S, Lee D, Ko SJ, Baik M, Paik JW, Sim M, Jung SJ
J Korean Med Sci · 2026 Jun · PMID 42237176 · Full text
BACKGROUND: Sequelae following coronavirus disease 2019 (COVID-19) frequently include lasting neuropsychiatric symptoms; however, identifying predictors from the acute phase remains challenging due to limitations in coll...
BACKGROUND: Sequelae following coronavirus disease 2019 (COVID-19) frequently include lasting neuropsychiatric symptoms; however, identifying predictors from the acute phase remains challenging due to limitations in collecting prospective data during that time. METHODS: Data were obtained from electronic counseling records of 515 COVID-19 patients who received free services from the Korean National Center for Disaster and Trauma. The Clinical Global Impression Severity Scale (CGI-S) was used to repeatedly assess mental health at each counseling session. Baseline predictors included demographic characteristics, psychiatric and medical comorbidities, and psychological response, which was further divided into four sub-factors via factor analysis. Multivariate mixed effect models were used to explore the relationship between these predictors and mental health following the acute phase of COVID-19, with analyses stratified by gender. RESULTS: The most common post-COVID psychological responses were anxiety, depression, and sleep problems, with CGI-S scores dropping from 2.83 initially to 1 by the last observed session and averaging 2.38 at the third follow-up. Four sub-factors were identified through exploratory factor analysis, namely cognitive and physical exhaustion, emotional distress, self-destructive coping, and somatized anxiety. Baseline psychological responses (β = 0.06, < 0.001) and pre-existing psychiatric disorders (β = 0.37, < 0.001) were significantly associated with higher CGI-S scores over time; among psychological sub-factors, cognitive-physical exhaustion (β = 0.28, < 0.001), emotional distress (β = 0.32, < 0.001), and self-destructive coping (β = 0.12, < 0.001) were significant predictors, with emotional distress significant in men (β = 0.26, = 0.001) and both cognitive-physical exhaustion (β = 0.36, < 0.001) and emotional distress (β = 0.36, < 0.001) significant in women. CONCLUSION: Baseline psychological responses predict persistent mental health symptoms, and identified profiles may help early identification of high-risk groups during acute COVID-19.
Obstetric and Neonatal Outcomes Following Immediate Delivery Versus Expectant Management in Pregnant Women With Preterm Premature Rupture of Membranes During the Late Preterm Period in Korea.
Kwon H, Kwon JY, Kang S … +14 more , Ko HS, Kwon HS, Oh KJ, Oh SY, Lee MY, Choi SR, Han YJ, Sul AR, Jung Y, Kim J, Park JJ, Lee J, Kim YN, Yang JI
J Korean Med Sci · 2026 Jun · PMID 42237175 · Full text
BACKGROUND: This study aimed to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34⁺⁰-36⁺⁶ w...
BACKGROUND: This study aimed to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34⁺⁰-36⁺⁶ weeks of gestation. METHODS: We conducted a retrospective study of singleton pregnancies with PPROM during the late preterm period using medical records from 12 tertiary medical centers in the republic of Korea between January 2007 and December 2016. Demographic characteristics and outcome measures were also recorded. The primary outcomes were maternal sepsis, neonatal sepsis, and neonatal death for neonatal outcomes. RESULTS: Among 1,072 women with late PPROM, 782 (72.9%) underwent immediate delivery and 290 (27.1%) received expectant management. The incidence of clinical neonatal sepsis was significantly lower in the immediate delivery group than in the expectant management group (3.8% vs. 15.8%, < 0.001). There were no significant differences in culture-proven neonatal sepsis ( = 0.211), neonatal death ( = 0.390), or maternal sepsis ( = 0.542) between groups. Although antenatal corticosteroids were more frequently administered in the expectant management group, the need for mechanical ventilation was not significantly higher ( = 0.414). However, the need for surfactant administration was lower ( = 0.010). Expectant management was associated with a lower rate of primary cesarean section ( = 0.002) but a higher incidence of antepartum fever and elevated C-reactive protein levels ( = 0.048 and < 0.001, respectively). CONCLUSION: In women with late PPROM, expectant management does not increase the risk of severe maternal or neonatal morbidity or mortality compared to immediate delivery. Therefore, with close surveillance for complications, such as chorioamnionitis and fetal compromise, particularly clinical neonatal sepsis, expectant management can be a judicious treatment option in clinical practice.
Whole Genome Sequencing Analysis of Group A Isolates From Pediatric Patients in Korea From 2013 to 2024.
An S, Kim SJ, Shin JH … +10 more , Kim DR, Shin A, Baek JY, Park H, Kang M, Kim TY, Huh HJ, Lee NY, Ko KS, Kim YJ
J Korean Med Sci · 2026 Jun · PMID 42237174 · Full text
BACKGROUND: Group A (GAS) infections are a significant global health concern. A novel lineage of 1 strain (M1), responsible for invasive GAS (iGAS) infections, which are potentially life-threatening, has been reported...
BACKGROUND: Group A (GAS) infections are a significant global health concern. A novel lineage of 1 strain (M1), responsible for invasive GAS (iGAS) infections, which are potentially life-threatening, has been reported globally since 2019. Recent epidemiological studies on GAS using whole genome sequencing (WGS) revealed its usefulness for surveillance of transmission of GAS. METHODS: WGS analysis was performed using DNA extracted from cultured GAS isolates stored from 2013 to 2024 at a single center. Clinical data from patients with GAS infection were also analyzed. RESULTS: Fifteen GAS isolates were collected from 12 pediatric patients (median age 4 years, 41.6% male). In patients with iGAS infection, 1 (n = 3), 12 (n = 4), and 89 (n = 1) were identified. In patients with non-iGAS infection, 1 (n = 1), 4 (n = 1), 12 (n = 1), and 28 (n = 1) were identified. Phylogenetic analysis and single-nucleotide polymorphism pattern comparison revealed that all 1 strains corresponded to M1 rather than M1. Three patients (two iGAS and one non-iGAS) had isolates from two different sites, for which the type was the same. CONCLUSION: Continuous surveillance of GAS strains is necessary to monitor and respond to the introduction of toxic variants such as M1.
The Enactment and Implementation of Korea's Digital Medical Products Act: A Comparative Study Exploring Policy Implications.
Chung J, Shin Y, Kim G … +2 more , Lee M, Shin J
J Korean Med Sci · 2026 Jun · PMID 42237173 · Full text
BACKGROUND: With the rapid expansion of the digital healthcare industry, advanced medical technologies, including artificial intelligence-based diagnostic software and digital therapeutics, are being introduced at an unp...
BACKGROUND: With the rapid expansion of the digital healthcare industry, advanced medical technologies, including artificial intelligence-based diagnostic software and digital therapeutics, are being introduced at an unprecedented pace. However, existing regulatory frameworks have encountered substantial challenges in adequately addressing the unique characteristics of these products. In response, Republic of Korea (South Korea) has enacted the world's first "Digital Medical Products Act" and established an integrated regulatory system tailored to this emerging domain. METHODS: This study undertook a comparative analysis across three regulatory dimensions-scope of application, approval procedures, and reimbursement policies-by examining corresponding legal frameworks in the United States, Germany, the United Kingdom, and Japan. In addition, qualitative interviews were conducted with three experts, each possessing more than 10 years of experience in digital healthcare regulation, to capture early field-level perspectives and identify areas that require refinement. RESULTS: The findings demonstrated a generally positive assessment of the institutional significance of the new system, while also highlighting several limitations, including the absence of detailed evaluation criteria and the potential for confusion among stakeholders in practical implementation. CONCLUSION: Based on these results, this study provides policy implications to guide the future advancement and refinement of regulatory frameworks for digital medical products.
Clinical Approaches to Infection Management: Insights From a Nationwide Survey of Korean Physicians.
Moon JM, Kim SE, Kim J … +17 more , Cho YS, Kim H, Gweon TG, Kim KO, Kim KW, Kim K, Kim MC, Moon HW, Park SK, Bang CS, Yang YJ, Kim Y, Oh CK, Lee YJ, Lee JG, Chang JY, Chong YP
J Korean Med Sci · 2026 Jun · PMID 42237172 · Full text
BACKGROUND: infection (CDI) remains a significant public health challenge, with variable diagnostic and treatment practices. This study evaluated current clinical practices for CDI diagnosis and management in Korean phy...
BACKGROUND: infection (CDI) remains a significant public health challenge, with variable diagnostic and treatment practices. This study evaluated current clinical practices for CDI diagnosis and management in Korean physicians through a nationwide survey. METHODS: An online survey was conducted among physicians treating CDI, including gastroenterologists and infectious disease specialists. The survey covered diagnostic approaches, treatment regimens, and management strategies, including differentiation based on disease severity and recurrence. RESULTS: A total of 300 physicians responded. The most commonly reported indication for CDI testing was the occurrence of three or more diarrheal episodes within a 24-hour period. The majority of physicians (69.7%) preferred multiple diagnostic tests, favoring simultaneous testing (90.4%) over a stepwise approach. Preferred tests included nucleic acid amplification test (NAAT) (69%), glutamate dehydrogenase+toxin A/B combined assay (56%) and toxin enzyme immunoassay (EIA) (48%). Single-test users preferred toxin EIA (37.4%) and NAAT (29.7%). Treatment was primarily tailored to severity by 84.1% of physicians. For non-severe CDI, oral vancomycin (50.7%) and metronidazole (29%) were the main treatments, with 88% not recommending hospitalization. Severe CDI was treated with oral vancomycin (45.3%) or intravenous metronidazole in combination (44.9%), often for ≥ 14 days. For the first recurrence, 69.3% used oral vancomycin, with 22.6% opting for a tapered/pulsed regimen. Fecal microbiota transplantation use increased from 0.3% initially to 17.6% for multiple recurrences. In CDI with ileus, 64% preferred combination therapy, and 48% used vancomycin enemas. In inflammatory bowel disease patients, 99% underwent CDI testing for worsening diarrhea. Immunomodulators and biologics were continued in 79% and 73% of non-severe cases, respectively, but often paused during severe CDI. CONCLUSION: Korean physicians generally follow the recently developed Korean guideline for CDI practice, but certain gaps and inconsistencies in choices were observed in clinical situations. Further efforts are needed to monitor guideline implementation and to analyze gaps between guideline recommendations and real-world clinical practice to optimize CDI management in Korea.
Integrating Non-Invasive Physical and Behavioral Indicators Into Routine Health Check-ups for Detecting Early Depression in Older Adults Living Alone.
Jung HW, Kim JH, Lee JJ
J Korean Med Sci · 2026 Jun · PMID 42237171 · Full text
BACKGROUND: As South Korea faces a rapidly aging population, older adults living alone are becoming increasingly vulnerable to depression. This study aimed to identify non-invasive and easily measurable physical and beha...
BACKGROUND: As South Korea faces a rapidly aging population, older adults living alone are becoming increasingly vulnerable to depression. This study aimed to identify non-invasive and easily measurable physical and behavioral indicators that are associated with depression in this high-risk group. We proposed a novel screening framework-Depression Prediction based on Anthropometric and Clinical Signs-designed for integration into existing health check-ups to support early detection. METHODS: We conducted a cross-sectional study among 1,093 older adults living alone in South Korea. The Depression Prediction based on Anthropometric and Clinical Signs was developed by incorporating vital signs, anthropometric measures, physical function tests, and health behaviors. Multiple logistic regression analyses were used to examine the association between these indicators and depression, with subgroup analyses by sex. RESULTS: Several indicators of Depression Prediction based on Anthropometric and Clinical Signs were significantly associated with depression. Larger head circumference and sensory impairments were associated with a higher risk of depression. In contrast, better neurological gait performance, more frequent meals, and longer exercise duration were associated with lower risk. Sex-specific patterns were identified, among which visual, olfactory, and gustatory dysfunctions were notable predictors. Among men, elevated respiratory rate and gustatory dysfunction were prominent. Receiver operating characteristic curve analysis showed fair discrimination for pooled (area under the curve = 0.74, cut-off = 0.304) and female (area under the curve = 0.73) models, whereas the male model demonstrated lower performance (area under the curve = 0.62). CONCLUSION: Simple, non-invasive physical and behavioral measures may serve as effective indicators for identifying depression risk in older adults living alone. Incorporating these indicators into routine health check-ups could support early detection and referral, particularly for those who are unlikely to seek psychiatric care. The Depression Prediction based on Anthropometric and Clinical Signs model offers a feasible approach to enhance mental health screening in aging populations, although further validation and longitudinal studies are warranted.
Two-Step Ensemble Convolutional Neural Networks for Colonoscopic Biopsy Classification Resembling Pathologists' Process.
Yoon H, Alam MR, Thakur N … +4 more , Jeong S, Hwang G, Lee EJ, Chong Y
J Korean Med Sci · 2026 May · PMID 42190697 · Full text
BACKGROUND: Colorectal cancer (CRC) is a leading cause of mortality worldwide, and early examination via colonoscopy is increasingly used to prevent CRC mortality. Recently, studies have attempted utilizing artificial in...
BACKGROUND: Colorectal cancer (CRC) is a leading cause of mortality worldwide, and early examination via colonoscopy is increasingly used to prevent CRC mortality. Recently, studies have attempted utilizing artificial intelligence for the classification of CRC. However, datasets were limited in these studies, and the limited number of findings resulting from these studies are not specific to cancerous or noncancerous findings. We present a full pipeline of ensemble deep learning approach to classify five diagnostic categories. Through this pipeline, whole slide images (WSIs) exhibiting low quality can be filtered out before being processed by the computer-aided diagnosis system. METHODS: A dataset of 18,922 CRC WSIs collected and labeled as non-tumor, hyperplastic polyp, adenoma, adenocarcinoma, and neuroendocrine tumor (NET, carcinoid). We developed two models: clustering-constrained attention multiple instance learning model was used to classify adenocarcinomas, adenomas, NET, and non-dysplastic lesion classes. EfficientNet then distinguished between non-tumor and hyperplastic polyp for WSIs classified as non-dysplastic lesion class in the first step. RESULTS: The proposed ensemble pipeline, which resembles the process of analysis from the pathologists, showed better performance even with multiple classes CRC. The micro-, macro-, and weighted-F1-scores were 86.57%, 83.83%, and 86.86%, respectively. Notably, the NET classification tasks scored an F1-score of 87.18%. CONCLUSION: The proposed ensemble model addresses common challenges in automated CRC diagnosis, offering reliable solutions with safeguards for exceptional cases. It enhances clinical practice by accurately classifying multiple CRC types. In conclusion, this method is effective where scanned colorectal WSIs can be of low quality for real-world diagnosis.
Treatment Patterns and Outcomes of Anti-MuSK Antibody-Positive Myasthenia Gravis: A Retrospective Single-Center Study.
Seo D, Chung HY, Kim KH … +2 more , Kim SW, Shin HY
J Korean Med Sci · 2026 May · PMID 42190696 · Full text
BACKGROUND: There is limited knowledge regarding the real-world treatment status of muscle-specific tyrosine kinase antibody-positive myasthenia gravis (MuSK-MG) patients in clinical practice. The aim of this study was t...
BACKGROUND: There is limited knowledge regarding the real-world treatment status of muscle-specific tyrosine kinase antibody-positive myasthenia gravis (MuSK-MG) patients in clinical practice. The aim of this study was to analyze the overall treatment patterns and outcomes of MuSK-MG in Korea. METHODS: In this single-center cohort study, we retrospectively included patients diagnosed with MuSK-MG. We analyzed their demographic features, clinical characteristics, treatment patterns focusing on corticosteroids (CSs), non-steroidal immunosuppressants (NSISs), and rituximab, and treatment outcomes. Specifically, we investigated the achievement of minimal manifestation status with a prednisolone dose 5 mg/day or below (MM-5). RESULTS: The study included 30 patients with MuSK-MG, predominantly female (93.3%). The average age at time of diagnosis was 43.9 ± 16.0 years, with the onset age of 42.3 ± 16.2 years. All patients initially received CSs, and 24 patients (80%) were treated with NSISs. Tacrolimus was the most frequently prescribed NSIS, used in 70.8% of cases, followed by azathioprine (62.5%). All 10 patients who received rituximab therapy showed clinical improvement, with 5 patients (50%) achieving MM-5. CONCLUSION: This study summarized the treatment patterns and outcomes of patients with MuSK-MG in real-world clinical settings. As patients who received rituximab demonstrated a favorable prognosis, early administration of rituximab may be an effective treatment strategy for MuSK-MG, potentially reducing the adverse effects associated with long-term use of CSs and NSISs. Rituximab should be considered early in MuSK-MG patients who show insufficient response to initial immunosuppressive treatment.
Validity and Reliability of the InGrip Load-Cell Handgrip Dynamometer Compared With the Takei Handgrip Dynamometer in Healthy Adults and Patients With Stroke.
Lee BJ, Hong HT, Yu GH … +1 more , Kim KT
J Korean Med Sci · 2026 May · PMID 42190695 · Full text
BACKGROUND: To validate the InGrip load-cell handgrip dynamometer by comparing its performance with the Takei handgrip dynamometer in measuring handgrip strength (HGS) among healthy adults and patients with stroke. METHO...
BACKGROUND: To validate the InGrip load-cell handgrip dynamometer by comparing its performance with the Takei handgrip dynamometer in measuring handgrip strength (HGS) among healthy adults and patients with stroke. METHODS: This is a cross-sectional study conducted in community and outpatient clinics, involving 260 healthy adults aged ≥ 50 years and 50 patients with stroke (N = 310). HGS was assessed using the Takei and InGrip dynamometers following a standardized protocol. Correlation, agreement, and test-retest reliability were evaluated using Pearson's correlation coefficient, Bland-Altman plots, intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest real difference (SRD). RESULTS: No significant differences in HGS measurements were observed between the two dynamometers in any group. The correlation coefficients between the Takei and InGrip were strong for healthy adults ( = 0.944) and patients with stroke ( = 0.967). Bland-Altman plots demonstrated good agreement, with mean biases of -0.14 kg (healthy adults) and -0.87 kg (patients with stroke). The InGrip exhibited excellent test-retest reliability, with ICC values exceeding 0.9, SEM below 10%, and SRD under 30% across all groups. CONCLUSION: The InGrip load-cell dynamometer demonstrated a high correlation, strong agreement, and excellent test-retest reliability when compared to the Takei dynamometer in both healthy adults and patients with stroke. The InGrip dynamometer is a valid and reliable instrument for HGS assessment. Further research should explore its applicability across broader clinical and population-based settings.
Predictors of Massive Transfusion in Adult Blunt Trauma Patients: Analysis of a Nationwide Trauma Registry in Korea.
Seo D, Kim J, Jung K … +9 more , Park J, Kwon J, Sohn HM, Kim S, Yoo J, Kim JH, Cho H, Kim Y, Kim T
J Korean Med Sci · 2026 May · PMID 42190694 · Full text
BACKGROUND: Massive transfusion (MT) is critical for trauma patients with severe hemorrhage; however, predicting the need for MT upon hospital arrival remains challenging. Herein, we aimed to identify predictors of MT in...
BACKGROUND: Massive transfusion (MT) is critical for trauma patients with severe hemorrhage; however, predicting the need for MT upon hospital arrival remains challenging. Herein, we aimed to identify predictors of MT in adult blunt trauma patients using data from the Korean Trauma Data Bank (KTDB), a nationwide trauma registry in Korea. METHODS: We retrospectively analyzed data from patients registered in the KTDB from 2017 to 2021. Adult blunt trauma patients who received packed red blood cell (pRBC) transfusion within 24 hours of arrival were included. We divided the patients into the MT and non-MT groups, with MT defined as the administration of ≥ 10 units of pRBCs within 24 hours. We compared the characteristics of the two groups and performed multivariable logistic regression analysis to identify significant predictors of MT, using multiple imputation to address missing data. RESULTS: Among 12,145 patients registered in the KTDB, 2,098 (17.3%) received MT. Compared with the non-MT group, the MT group exhibited lower initial systolic blood pressure, lower Glasgow Coma Scale (GCS) scores, and higher heart rates compared to the non-MT group. Multivariable logistic regression analysis identified systolic blood pressure ≤ 90 mmHg (adjusted odds ratio [aOR], 2.34), heart rate ≥ 120 bpm (aOR, 2.15), respiratory rate < 10 or > 29 breaths per minute (aOR, 2.16), GCS < 13 (aOR, 2.45), and a positive Focused Assessment with Sonography for Trauma (FAST) result (aOR, 2.35) as significant predictors of MT upon arrival. CONCLUSION: We identified initial systolic blood pressure, heart rate, respiratory rate, GCS, and FAST results as significant predictors of MT in adult blunt trauma patients. These predictors may aid in the development of a Korea-specific MT prediction model, contributing to the timely activation of MT protocols and optimization of blood product utilization.
Pregnancy Outcomes in Women With Valvular Heart Disease: Insights From 30 Years of Single-Center Experience.
Shin H, Park SJ, Oh SY … +7 more , Son J, Lee J, Bang SH, Kim J, Kim EK, Lee SC, Park SW
J Korean Med Sci · 2026 May · PMID 42190693 · Full text
BACKGROUND: Valvular heart disease (VHD) during pregnancy is associated with significant maternal and neonatal risks. While large-scale cohort studies have documented these risks in western populations, evidence in Korea...
BACKGROUND: Valvular heart disease (VHD) during pregnancy is associated with significant maternal and neonatal risks. While large-scale cohort studies have documented these risks in western populations, evidence in Korean women remains limited. This study aimed to evaluate maternal and neonatal outcomes by VHD severity and identify predictors of adverse events to inform risk assessment. METHODS: This retrospective study included 138 pregnant women with VHD who delivered at Samsung Medical Center between December 1994 and June 2023. Patients were stratified by VHD severity. The primary outcomes were adverse maternal outcomes, defined as maternal death or pregnancy-related complications requiring hospitalization, and adverse neonatal events, defined as neonatal intensive care unit admission or fetal death. RESULTS: Mitral regurgitation was the most common lesion (47.8%). The incidence of adverse maternal outcomes increased with VHD severity ( = 0.007), mainly driven by heart failure hospitalizations. In age-adjusted Cox models, moderate (hazard ratio [HR], 3.6) and severe VHD (HR, 9.8) were associated with higher maternal risk. Independent predictors of adverse maternal outcomes in multivariable analysis included New York Heart Association (NYHA) ≥ 2 in the first trimester (odds ratio [OR], 3.27; = 0.028), prior hospitalization for acute decompensated heart failure (ADHF) before pregnancy (OR, 6.59; = 0.002), and moderate (OR, 6.27; = 0.019) or severe VHD (OR, 7.36; = 0.025). For neonatal outcomes, NYHA ≥ 2 (OR, 3.75; = 0.026) and ADHF hospitalization during pregnancy (OR, 3.87; = 0.029) were significant predictors. CONCLUSION: VHD severity was associated with maternal heart failure hospitalization, but functional status and prior decompensation were equally important. These findings highlight the importance of pre-pregnancy evaluation and structured perinatal care. Multidisciplinary management may reduce complications, even in high-risk patients.
The SHIPE Index: A Tertile-Based Approach to Predict End-Stage Kidney Disease in ANCA-Associated Vasculitis.
Do H, Lee LE, Ha JW … +3 more , Song JJ, Park YB, Lee SW
J Korean Med Sci · 2026 May · PMID 42190692 · Full text
BACKGROUND: This study aimed to develop a simple, robust, and ethnoregion-specific index for predicting progression to end-stage kidney disease (ESKD) in Korean patients with antineutrophil cytoplasmic antibody (ANCA)-as...
BACKGROUND: This study aimed to develop a simple, robust, and ethnoregion-specific index for predicting progression to end-stage kidney disease (ESKD) in Korean patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS: Baseline data from 239 Korean patients with AAV enrolled in a tertiary hospital cohort were analyzed to identify independent predictors of ESKD using univariable and multivariable Cox proportional hazards models. The SHIPE (Summation of the Highest tertiles of Independent Predictors of ESKD) index was constructed by summing the highest tertiles of the identified predictors: Five-Factor Score (≥ 2) and serum creatinine (≥ 1.3 mg/dL), with 1 point assigned to each criterion met. Cumulative ESKD-free survival rates across SHIPE index scores were compared using Kaplan-Meier analysis. RESULTS: A SHIPE index score of 2 was significantly associated with lower cumulative ESKD-free survival rate compared to scores of 0 or 1 ( < 0.001). By integrating two independent predictors, the SHIPE index provides a simple yet effective tool for risk stratification, demonstrating greater robustness against variability in single predictors such as serum creatinine. This index demonstrated clinical utility, providing a straightforward method for identifying high-risk patients in real-world settings. CONCLUSION: The SHIPE index is a novel, robust, and convenient tool for predicting ESKD progression in Korean patients with AAV. This study introduces a practical framework for developing tailored prediction indices that can be adapted for diverse ethnic and regional populations. Its simplicity and practical applicability make it well-suited for routine clinical use. Future prospective studies are needed to validate the SHIPE index in larger, multi-ethnic cohorts and ensure its broader applicability.
Comparison of the Prevalence of Obesity and Overweight Among Adults With HIV and the Adult General Population in Korea.
Jang Y, Kim T, Seong H … +8 more , Song JY, Kim JH, Choi JY, Kim SW, Kim YJ, Kim SI, Nguyen THT, Park B
J Korean Med Sci · 2026 May · PMID 42153232 · Full text
BACKGROUND: This study compared the prevalence of overweight and obesity in people living with human immunodeficiency virus (PLWH) with the general population and the trend of overweight/obesity in PLWH and the general p...
BACKGROUND: This study compared the prevalence of overweight and obesity in people living with human immunodeficiency virus (PLWH) with the general population and the trend of overweight/obesity in PLWH and the general population from 2009 to 2020. METHODS: A total of 10,980 PLWH aged ≥ 20 years with national health examination records and 76,783 adults in the general adult population of the Korea National Health and Nutrition Examination Survey were included. The overall and yearly obesity and overweight prevalence rates and standardized prevalence ratios are described. RESULTS: The prevalence of obesity and overweight in PLWH during 2009-2020 was 27.9% (95% confidence interval [CI], 27.0-28.7%) and 23.1% (95% CI, 22.3-23.9%), while those in the general population were 33.7% (95% CI, 33.7-33.7%) and 22.8% (95% CI, 22.8-22.8%), with identical bounds reflecting the high precision facilitated by the large sample size. During 2009-2020, the standardized prevalence ratio of obesity and overweight in the PLWH compared with that in the general population was 0.70 (95% CI, 0.68-0.73) and 0.92 (95% CI, 0.89-0.96). The annual percent change in obesity prevalence was 3.0% annually ( < 0.001) in PLWH and 1.4% ( < 0.001) annually in the general population between 2009 and 2020. Owing to the rapid increase, the prevalence of obesity was higher in PLWH than in the general population in 2019 and 2020. In contrast, the prevalence of overweight did not show a clear increasing or decreasing trend in either group between 2009 and 2020. CONCLUSION: The prevalence of obesity and overweight in PLWH was lower than that in the general population. However, the rate of increase in obesity prevalence was faster in PLWH than that in the general population. As obesity is associated with the onset of chronic diseases, pathological conditions, and various forms of cancer, more detailed obesity management for PLWH is warranted.
Seroprevalence of Japanese Encephalitis Virus, and Immunogenicity of the Vero-Cell Culture-Derived Vaccine in Hematopoietic Stem Cell Transplantation Recipients.
Lee H, Kang JM, Kim M … +8 more , Park H, Na B, Park Y, Ahn JG, Lee E, Lee H, Park HJ, Eom HS
J Korean Med Sci · 2026 May · PMID 42153231 · Full text
BACKGROUND: Revaccination against Japanese encephalitis virus (JEV) in adult hematopoietic stem cell transplantation (HSCT) recipients is not recommended because of insufficient data regarding its efficacy and immunogeni...
BACKGROUND: Revaccination against Japanese encephalitis virus (JEV) in adult hematopoietic stem cell transplantation (HSCT) recipients is not recommended because of insufficient data regarding its efficacy and immunogenicity. Therefore, we aimed to evaluate JEV seropositivity in adult HSCT recipients and explored the seroconversion rate in pediatric HSCT recipients after vaccination against JEV. METHODS: This prospective study was conducted at the National Cancer Center, Goyang, Korea. Adult HSCT recipients (n = 103) were enrolled who visited the outpatient clinic. Additionally, pediatric recipients (< 19 years old; n = 11) who received JEV vaccination were enrolled. We collected serum samples from these participants and healthy healthcare workers (n = 50) for comparison. The JEV seropositivity rates and anti-JEV antibody titers were evaluated using the plaque reduction neutralization test. RESULTS: The JEV seropositivity rates were significantly lower in adult HSCT recipients than in healthy healthcare workers (55% vs. 92%, < 0.001). In addition, only one out of nine pediatric recipients tested seropositive before JEV vaccination. However, six out of seven were seropositive after two doses of vaccination. Furthermore, all three recipients who completed the three-dose vaccination schedule turned seropositive. No significant seropositivity-related factors were identified in the multivariate analysis. CONCLUSION: The low anti-JEV antibody seropositivity rate in Korean adult HSCT recipients indicates an increased vulnerability to this virus. Our findings provide a theoretical basis for the potential establishment of appropriate prevention strategies targeting this high-risk group.
Comparative Network Structures of Hikikomori (Social Withdrawal) Symptoms in Korean and Japanese Psychiatric Patients Prescribed Antidepressants: Findings From the Research on Asian Psychotropic Patterns for Antidepressants, Phase 3.
Lee E, Kim E, Yoon J … +21 more , Yoon KS, Choi TY, Moon SW, Jung SW, Yoon HJ, Kim HS, Moon E, Kim Y, Yang HJ, Jeong N, Kim KW, Nakagami Y, Kyuragi S, Matsuo K, Matsushima T, Inada T, Lin SK, Sartorius N, Shinfuku N, Kato TA, Park SC
J Korean Med Sci · 2026 May · PMID 42153230 · Full text
BACKGROUND: This study aimed to compare the symptom structures of hikikomori in Korea and Japan through a network analysis approach, addressing the scarcity of comparative research and elucidating potential cross-cultura...
BACKGROUND: This study aimed to compare the symptom structures of hikikomori in Korea and Japan through a network analysis approach, addressing the scarcity of comparative research and elucidating potential cross-cultural differences in its manifestation. METHODS: Data were derived from the Research on Asian Psychotropic Prescription Patterns, Phase 3 (REAP-AD3) study, involving psychiatric patients in Korea and Japan. Social withdrawal symptoms were assessed using the one-month version of the 25-item Hikikomori Questionnaire (HQ-25M). Network analyses were performed to characterize symptom interconnections and centrality in both cohorts. Differences in network structure, edge strength, and global strength were evaluated using the network comparison test (NCT). RESULTS: The NCT indicated no statistically significant differences in network structure invariance between Korean and Japanese patients. Notably, the most frequently endorsed symptom among Korean psychiatric patients was "no one to discuss important matters with," whereas for Japanese psychiatric patients it was "difficulty enjoying social situations." CONCLUSION: Although overall network structures were largely comparable, the findings suggest subtle distinctions in the organization of social withdrawal symptoms between Korean and Japanese psychiatric patients. These differences underscore the importance of developing culturally tailored preventive and therapeutic strategies for hikikomori in these populations.
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