Journal Of Korean Medical Science[JOURNAL]
Sun
200 papers
Multi-Omics and Machine Learning Analyses Reveal PIK3CG, PRKCD, and TRIM22 as Potential Markers of Poor Prognosis and Immune Activation in Glioblastoma.
Han MH, Noh YK, Kim H … +7 more , Kim KS, Kim DH, Jung US, Lee KS, Kwon MJ, Chae SW, Min KW
J Korean Med Sci · 2026 Apr · PMID 42046521 · Full text
BACKGROUND: Glioblastoma (GBM) is one of the most aggressive brain tumors with a poor prognosis despite current treatment modalities. This study aimed to identify genes whose high expression is paradoxically associated w...
BACKGROUND: Glioblastoma (GBM) is one of the most aggressive brain tumors with a poor prognosis despite current treatment modalities. This study aimed to identify genes whose high expression is paradoxically associated with both poor survival and enhanced immune activity, as potential targets for combination chemotherapeutic and immunotherapeutic strategies. METHODS: Transcriptomic data from patients with central nervous system World Health Organization (WHO) grade IV gliomas (based on the 2016 WHO classification) were analyzed, using datasets from The Cancer Genome Atlas (525 cases), the Chinese Glioma Genome Atlas (250 cases), and the Genotype-Tissue Expression (1,152 normal samples). We initially screened 12,041 genes, prioritizing those showing a paradoxical association with prognosis and immune activation. Key genes were selected through rank statistics, machine-learning-based survival modeling, and pathway network analysis. Further subgroup validation was performed using only isocitrate dehydrogenase (IDH)-wildtype GBM cases, in line with the 2021 WHO classification. RESULTS: Among the 12,041 candidate genes analyzed, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit gamma (PIK3CG), protein kinase C delta type (PRKCD), and tripartite motif-containing protein 22 (TRIM22) were identified as key biomarkers whose elevated expression was significantly associated with poorer overall and disease-specific survival in IDH-wildtype GBM. These genes also correlated with enhanced immune activity, including increased tumor-infiltrating lymphocytes and elevated expression of programmed death-ligand 1. Pathway network analysis revealed indirect associations with critical immune markers such as CD8A and CD4, suggesting potential immunomodulatory functions. Additionally, differential gene expression and disease ontology analyses demonstrated their relevance across various cancer types. Drug sensitivity profiling using the Genomics of Drug Sensitivity in Cancer database identified AGI-6780, linsitinib, and Nutlin-3a as potential therapeutic agents targeting these genes. CONCLUSION: This study identifies PIK3CG, PRKCD, and TRIM22 as potential biomarkers and therapeutic targets in IDH-wildtype GBM. Their paradoxical association with poor survival and immune activation may inform personalized treatment strategies that combine conventional chemotherapy with immune-based therapies. While our findings are robust across both mixed and IDH-wildtype-focused cohorts, further mechanistic validation is warranted.
Association Between Colorectal Neoplasia and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals.
Park GM, Lim S, Jeon YJ … +4 more , Kwon WJ, Choi SH, Kim S, Lee SB
J Korean Med Sci · 2026 Apr · PMID 42046520 · Full text
BACKGROUND: Advanced colorectal neoplasia (CRN) and coronary artery disease (CAD) are major health problems with common underlying pathogenic mechanisms. This study sought to investigate the association between the prese...
BACKGROUND: Advanced colorectal neoplasia (CRN) and coronary artery disease (CAD) are major health problems with common underlying pathogenic mechanisms. This study sought to investigate the association between the presence of advanced CRN and subclinical coronary atherosclerosis through a large cohort of asymptomatic Korean individuals who voluntarily underwent colonoscopy and coronary computed tomography angiography (CCTA) as routine health screening tests. METHODS: A total of 6,044 Korean individuals aged ≥ 20 years who underwent a general health examination at the Health Promotion Center of Ulsan University Hospital between January 2009 and March 2020 were retrospectively analyzed. Advanced CRN was defined as the presence of invasive cancer or adenoma with a villous component, high-grade dysplasia, and/or a size of ≥ 1 cm. Subclinical coronary atherosclerosis was evaluated by CCTA. RESULTS: Participants with any CRN (n = 1,916, 31.7%) or advanced CRN (n = 240, 4.0%) had a higher coronary artery calcium score and a higher prevalence of any coronary, calcified, mixed, and non-calcified plaques, and obstructive CAD (≥ 50% diameter stenosis) on CCTA compared with participants with non-CRN (n = 4,128, 68.3%) (all < 0.05). In the multivariable analysis to evaluate the association between CRN and CCTA findings, the advanced CRN group showed a statistically significant association with obstructive CAD (odds ratio, 1.65; 95% confidence interval, 1.09-2.50; = 0.019). CONCLUSION: Asymptomatic subjects with CRN showed a higher prevalence of subclinical coronary atherosclerosis compared to those with non-CRN. Advanced CRN was independently associated with obstructive CAD on CCTA.
Evaluation of Team-Based Genetic Counseling Services in Korea.
Choi IH, Ji SM, Yang SY … +4 more , Kim GH, Lee J, Choi S, Lee BH
J Korean Med Sci · 2026 Apr · PMID 42046519 · Full text
BACKGROUND: Despite growing interest in genetic counseling services in South Korea, limited studies have evaluated their effectiveness. Ongoing discussions in South Korea are examining the integration of team-based genet...
BACKGROUND: Despite growing interest in genetic counseling services in South Korea, limited studies have evaluated their effectiveness. Ongoing discussions in South Korea are examining the integration of team-based genetic counseling services into the Korean healthcare system. This study aimed to provide evidence for the integration of genetic counseling services into the healthcare system by evaluating genetic counseling outcomes and satisfaction after services were jointly provided by a medical geneticist and certified genetic counselors. METHODS: From February to June 2023, we conducted a survey using the Korean version of the Genetic Counseling Outcome Scale (K-GCOS) and the Genetic Counseling Satisfaction Scale (GCSS) among 102 patients with genetic disorders and their families who received genetic counseling services provided by the genetics team. RESULTS: The average time spent on genetic counseling was 43.9 minutes per patient, with preparation time of 59.9 minutes. The satisfaction scores for the genetic counseling services were overall high, specifically for the following items: "My genetic counselor helped me to identify what I needed to know to make decisions about what would happen to me (86.3%)," "The genetic counseling session was valuable to me (85.3%)," and "The genetic counseling session was about the right length of time I needed (83.3%)." Patients who received genetic counseling within 6 months of diagnosis had significantly higher K-GCOS scores than those who received counseling after 6 months (102.88 vs. 95.00, = 2.607, = 0.011), indicating that earlier counseling is more effective following a diagnosis. No significant difference was observed between the two groups in terms of the GCSS ( = 0.983, = 0.328). Additionally, a significant positive correlation was observed between GCSS and K-GCOS ( = 0.204, = 0.040), indicating that genetic counseling can not only provide information but also offer psychological support to patients. CONCLUSION: This study proposes a healthcare system in which a genetics team works collaboratively to provide genetic counseling. It also offers evidence for effectively integrating genetic counselors into the Korean healthcare system by evaluating the outcomes and satisfaction associated with team-based genetic counseling services.
Increased Surgical Risks in Hepatobiliary and Pancreatic Surgery Following the Shift to Single-Surgeon Practice Triggered by Trainee Resignations.
Jo SJ, Chong EH, Kang I … +2 more , Yang SJ, Lee SH
J Korean Med Sci · 2026 Apr · PMID 42046518 · Full text
BACKGROUND: The availability of assistive surgical personnel plays a crucial role in optimizing patient outcomes and operational efficiency. In March 2024, South Korea experienced a significant shift in surgical practice...
BACKGROUND: The availability of assistive surgical personnel plays a crucial role in optimizing patient outcomes and operational efficiency. In March 2024, South Korea experienced a significant shift in surgical practices due to a nationwide trainee strike, necessitating single-surgeon procedures in most hospitals. This study examines the impact of this transition on surgical outcomes. METHODS: This study used prospectively collected surgical records at CHA Bundang Medical Center. Patients who underwent hepatobiliary and pancreatic surgery between August 2023 and September 2024 were divided into two groups consecutively (Group 1: August 2023 to February 2024, surgeries performed with an assistant doctor vs. Group 2: March 2024 to September 2024, solo-surgeon surgeries). After propensity score matching, surgical outcomes and prognostic factors were compared. RESULTS: A total of 995 patients were included (499 in the assistant surgeon group, 496 in the solo surgeon group). After propensity score matching, 388 matched pairs were analyzed. While overall complication rates did not significantly differ between groups (3.6% vs. 6.7%, = 0.074), major complications were significantly more frequent in the solo-surgeon group (1.8% vs. 4.6%, = 0.042). Hospital length of stay and operative time were comparable between groups. Subgroup analysis suggested a trend toward increased major complications in open surgery and elderly patients, though statistical significance was not reached. CONCLUSION: The transition to solo-surgeon practice in gallbladder-centric hepatobiliary and pancreatic surgery may be associated with a higher incidence of major complications, particularly in complex cases. Further studies are needed, but a team-based surgical approach may improve outcomes in select patient populations.
Comparative Associations of Aerobic Exercise and Resistance Exercise With Depression and Anxiety in Korean Adults: A Nationwide Propensity Score Matching Analysis.
Yun YJ, Lee Y, Kwon YJ … +1 more , Lee JW
J Korean Med Sci · 2026 Apr · PMID 42046517 · Full text
BACKGROUND: Depression and anxiety are psychiatric disorders that significantly affect patients' well-being, morbidity, and mortality. Aerobic exercise (AE) and resistance exercise (RE) have been proposed as intervention...
BACKGROUND: Depression and anxiety are psychiatric disorders that significantly affect patients' well-being, morbidity, and mortality. Aerobic exercise (AE) and resistance exercise (RE) have been proposed as interventions to alleviate depressive and anxiety symptoms; however, their comparative effectiveness remains unclear. This study compared the associations of AE, RE, and their combination (total exercise; TE) with depression and anxiety in a large representative sample of the Korean population. METHODS: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used to analyze 21,298 participants for depression (measured using the Patient Health Questionnaire-9) and 8,707 participants for anxiety (measured using the Generalized Anxiety Disorder-7). The participants were divided into four exercise groups: TE, AE, RE, and non-AE-RE. Propensity score based exact matching was applied using a 1:1:1:1 ratio across the four exercise groups to control for confounding factors such as age and sex. Multivariate linear and logistic regression analyses were conducted to evaluate the effects of each exercise type on depression and anxiety. RESULTS: After propensity score matching, the RE group had the lowest depression (β = -0.534; 95% confidence interval [CI], -0.765 to -0.303; < 0.001) and anxiety (β = -0.459; 95% CI, -0.808 to -0.110; = 0.010) scores compared with the non-AE-RE group. The TE group also showed favorable associations with depression (β = -0.473; 95% CI, -0.706 to -0.241; < 0.001), although to a lesser extent than the RE group. AE was not significantly associated with either of the outcomes. Subgroup analyses indicated stronger associations of RE in women and older adults. CONCLUSION: RE was more strongly associated with lower depression and anxiety levels than AE, particularly in women and older adults. This study underscores the importance of incorporating resistance training into exercise prescriptions and public health interventions to enhance mental health outcomes.
Comparison of Clinical and Radiological Outcomes Between Suction Aspiration and Combination Methods of Mechanical Thrombectomy in Patients With Acute Cerebral Infarction: The COMPETE Trial.
Lee J, Sheen SH, Jin SC … +28 more , Choi Y, Hyun D, Shim YS, Kim T, Bae J, Kim CH, Kwon MY, Choi YJ, Hong D, Kim Y, Jeong EO, Kwon HJ, Lee Y, Lee J, Ryu S, Goh DH, Kim SY, Kwon SC, Lee JM, Koo HW, Jung Y, Kim J, Chang CH, Oh JS, Kim YW, Baek J, Kim KW, COMPETE Trials Investigators
J Korean Med Sci · 2026 Apr · PMID 42011003 · Full text
BACKGROUND: Recent advances in suction catheter technology suggest that suction aspiration may prevent thrombus fragmentation during mechanical thrombectomy. We therefore hypothesize that the radiological outcomes of suc...
BACKGROUND: Recent advances in suction catheter technology suggest that suction aspiration may prevent thrombus fragmentation during mechanical thrombectomy. We therefore hypothesize that the radiological outcomes of suction aspiration as a first-line treatment would not be inferior to those of the combination technique. This study aims to evaluate the radiological and clinical outcomes of first-line suction aspiration compared with those of the first-line combination technique for large artery occlusion amenable to both modalities. METHODS: The COMPETE trial is a prospective, randomized, multicenter, noninferiority, open-label trial. A total of 1,136 patients will be randomized at a 1:1 ratio to either the suction aspiration or combination technique groups. RESULTS: The primary endpoints are successful recanalization (modified Thrombolysis in Cerebral Infarction scale score ≥ 2b) and a good clinical outcome (modified Rankin Scale score of 0-2) at 90 days after thrombectomy. The technical outcome is the switching rate from the combination technique to suction aspiration and from suction aspiration to the combination technique. The safety outcomes include procedural morbidity, nonprocedural morbidity, procedural mortality, and nonprocedural mortality. CONCLUSION: The COMPETE trial is expected to determine whether the use of suction aspiration as a first-line approach in patients with acute ischemic stroke is noninferior to the combination technique in achieving successful radiological and good clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06254755; CRIS (KCT0007726).
Comparison of the Hearing Benefits and User Satisfaction With Hearing Aids and Personal Sound Amplification Products: A Multicenter Prospective Randomized Crossover Trial.
Han JS, Seo JH, Lee S … +4 more , Song JJ, Moon IJ, Park MK, Park YH
J Korean Med Sci · 2026 Apr · PMID 42011002 · Full text
BACKGROUND: While hearing aids (HAs) remain the primary intervention for hearing loss, their high cost creates barriers to access. Personal sound amplification products (PSAPs) are a more affordable alternative, but few...
BACKGROUND: While hearing aids (HAs) remain the primary intervention for hearing loss, their high cost creates barriers to access. Personal sound amplification products (PSAPs) are a more affordable alternative, but few studies have compared their efficacy to those of HAs. This multicenter, prospective, randomized, crossover trial was conducted to compare audiologic performance and user satisfaction between HAs and PSAPs to evaluate PSAP potential as alternatives for hearing rehabilitation. METHODS: A total of 73 participants with sensorineural hearing loss was enrolled. Participants used one hearing device (HA or PSAP) for 3 months before changing to the other for 3 months. Outcome measures were pure-tone audiometry, word recognition score, and Hearing in Noise Test score. Subjective satisfaction was measured using standardized questionnaires-the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids-and two custom surveys. RESULTS: HAs showed superior performance in high-frequency functional gain, speech perception in noise, and user satisfaction compared to PSAPs. Premium HAs demonstrated better performance than basic HAs, while basic HAs significantly outperformed both high-end and basic PSAPs. No significant differences were found between high-end and basic PSAPs. CONCLUSION: The superior audiologic performance of and user satisfaction with HAs compared to PSAPs support their continued preference for hearing rehabilitation. Although PSAPs offer a more affordable option, they may not meet the needs of individuals with hearing loss, particularly in terms of high-frequency gain and speech perception. TRIAL REGISTRATION: iCreaT Identifier: C220078.
Association Between Changes in Socioeconomic Status Before and After Human Immunodeficiency Virus Infection Diagnosis and Mortality Rates in Korea.
Jang Y, Kim T, Seong H … +5 more , Kim JH, Kim SW, Kim YJ, Nguyen THT, Park B
J Korean Med Sci · 2026 Apr · PMID 42011001 · Full text
BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people...
BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people living with HIV in Korea. METHODS: This study included 13,112 individuals newly diagnosed with HIV between 2004 and 2018, identified from the claims data of the National Health Insurance System-National Health Information Database. Participants' medical insurance status was categorized into National Health Insurance (NHI) and medical aid (MA). Using the Cox proportional hazards model, the association between mortality and changes in medical insurance status before and after HIV infection diagnosis was assessed using hazard ratios (HRs) and confidence intervals (CIs). RESULTS: The insurance coverage rates before HIV diagnosis were 95.1% and 4.9% for NHI and MA recipients, respectively. After diagnosis, the insurance coverage rates were 13.4% and 86.6% for MA and NHI recipients, respectively, demonstrating a threefold increase in the proportion of MA recipients. The conversion rate from NHI to MA was highest in the 35-44 and 45-54-year age groups at HIV infection diagnosis (32.9% and 29.4%, respectively). Compared with NHI recipients, the HR was significantly higher among individuals that transitioned from NHI to MA (HR, 1.66; 95% CI, 1.39-1.97) and individuals that remained on MA (HR, 1.74; 95% CI, 1.40-2.18), suggesting a higher mortality rate in these groups. CONCLUSION: In Korea, where highly active antiretroviral therapy is essentially free of charge, a significant association was observed between a decline in medical insurance status following HIV diagnosis and increased mortality.
Time Trends in the Comorbid Psychiatric Disorders Among Children and Adolescents With Intellectual Disability in Korea: A Nationwide Study From 2012-2021.
Joo MA, Kang NR, Kim JY … +1 more , Lee HJ
J Korean Med Sci · 2026 Apr · PMID 42011000 · Full text
BACKGROUND: Children and adolescents with intellectual disability (ID) frequently experience various comorbid psychiatric symptoms. However, research on the comorbidity of psychiatric disorders in this population remains...
BACKGROUND: Children and adolescents with intellectual disability (ID) frequently experience various comorbid psychiatric symptoms. However, research on the comorbidity of psychiatric disorders in this population remains limited. In this study, we aimed to comprehensively examine the prevalence of psychiatric disorders among children and adolescents with ID in South Korea from 2012 to 2021. METHODS: We obtained data from the National Health Insurance Service-National Health Information Database (NHIS-NHID) on individuals aged 2-18 years who were diagnosed with ID (F70-F79.9) between 2012 and 2021. Psychiatric disorders were identified using the following the International Classification of Diseases, 10th Edition codes: attention-deficit/hyperactivity disorder (ADHD) (F90), autism spectrum disorder (ASD) (F84), language disorder (F80), tic disorders (F95), anxiety disorders (F401-F402, F410-F411, F930-F932), depressive disorder (F32, F33), conduct disorder (F918, F928, F911), and oppositional defiant disorder (ODD) (F913). We analyzed the annual prevalence of comorbid psychiatric disorders. RESULTS: Throughout the study period, males consistently outnumbered females (62.6-65.5% vs. 34.5-37.4%). ADHD had the highest prevalence among psychiatric disorders, increasing from 30.23% in 2012 to 41.77% in 2021. Similar increasing trends were observed for ASD (10.95-15.46%) and depression (10.46-19.37%). Significant sex differences were observed in most disorders: ADHD, ASD, tic disorders, language disorder, conduct disorder, and ODD showed male predominance ( < 0.001), while depressive disorder showed female predominance ( < 0.01). Anxiety disorders showed no significant sex differences. CONCLUSION: This study enhances our understanding of the epidemiology of psychiatric comorbidities in South Korean children and adolescents with ID. The evaluation of comorbid psychiatric disorders in this population is crucial for prognosis, with particular attention needed for ADHD and depressive disorder due to their relatively high prevalence. Future research should focus on preventing and treating psychiatric comorbidities in children and adolescents with ID.
Cross-Cultural Adaptation and Translation of the Modified Short QUestionnaire to ASsess Health-Enhancing Physical Activity (mSQUASH) Into Korean for Use in Patients With Axial Spondyloarthritis.
Kang JH, Kook HY, Choi AR … +8 more , Kim NI, Ahn MJ, Kim S, Jeong A, Shim SC, Kim TH, Arends S, Kim TJ
J Korean Med Sci · 2026 Apr · PMID 42010999 · Full text
BACKGROUND: This study aimed to translate and cross-culturally adapt the modified Short QUestionnaire to ASsess Health-enhancing physical activity (mSQUASH) into Korean for use in patients with axial spondyloarthritis (a...
BACKGROUND: This study aimed to translate and cross-culturally adapt the modified Short QUestionnaire to ASsess Health-enhancing physical activity (mSQUASH) into Korean for use in patients with axial spondyloarthritis (axSpA). METHODS: The mSQUASH was translated into Korean and subsequently back-translated into English by two independent translators per phase. An expert committee, comprising translators, two patients, and the research team, reviewed and refined the translation to produce a pre-final version. A field test, including cognitive debriefing interviews, was conducted with 30 patients diagnosed with axSpA. Their feedback was used to finalize the Korean version of the mSQUASH. RESULTS: The translation process was smooth, with minor discrepancies resolved through expert consensus. Cognitive debriefing confirmed that the questionnaire items were clear, relevant, and easy to understand and complete. No essential aspects of physical activity were reported as missing. However, participants suggested modifying certain sport examples to better reflect Korean cultural practices. CONCLUSION: The final Korean version of the mSQUASH demonstrated both linguistic accuracy and cultural appropriateness, supporting its suitability for use in clinical practice and research involving Korean patients with axSpA.
Severe Fever With Thrombocytopenia Syndrome in Korea: Assessing the Impact of Hospital Patient Volume on Care Quality and Policy Implications.
Lee M, Kim N, Shin DH … +3 more , Oh HS, Park SW, Korea SFTS Clinical Network
J Korean Med Sci · 2026 Apr · PMID 42010998 · Full text
BACKGROUND: The case fatality rate of severe fever with thrombocytopenia syndrome (SFTS) in South Korea remains high. We aimed to assess whether hospital patient volume affects the quality of care and clinical outcomes,...
BACKGROUND: The case fatality rate of severe fever with thrombocytopenia syndrome (SFTS) in South Korea remains high. We aimed to assess whether hospital patient volume affects the quality of care and clinical outcomes, to provide policy-relevant insights for improving SFTS management. METHODS: We retrospectively analyzed all SFTS patients reported to the Korea Disease Control and Prevention Agency (KDCA) from 2016 to 2021. Detailed clinical variables were collected from patients treated at 28 participating hospitals. SFTS management was compared according to hospital patient volume. The infectious disease physicians at the study hospitals were surveyed about their unmet needs in SFTS care. RESULTS: A total of 1,328 SFTS patients from 163 hospitals were reported during the study period. Of these, 60.7% (99/163) treated fewer than one patient per year. The distribution of patients was uneven across the country, with the highest annual incidence of 1.91 cases per 100,000 population in Gangwon province. From 657 patients across 28 study hospitals, five high-volume hospitals were compared with 12 low-volume hospitals to evaluate differences between the two extremes of hospital volume. High-volume hospitals had a shorter median turn-around time for formal results compared to low-volume hospitals (4 days [interquartile range, IQR 2-6] vs. 7 days [IQR 4-13], < 0.001). Among three testing institutions, the turn-around time for formal results was shortest for in-house testing, followed by the Health and Environment Research Institutes, and then KDCA (3 days [IQR 1.5-4] vs. 5 days [IQR 3-7] vs. 18.5 days [IQR 12-22.25], all post hoc ≤ 0.007). The case fatality rate was not significantly different between the groups (16.9%, 42/248 vs. 13.8%, 17/123; = 0.440). The survey showed that among 27 responders, the most commonly reported difficulty in SFTS care was delayed turn-around time of diagnostic tests (85.2%). CONCLUSION: SFTS cases occurred sporadically and rarely across the country, and the level of clinical expertise in managing SFTS varied between hospitals depending on patient volume. However, the case fatality rate showed no significant difference. Regional centralization of SFTS patients may be helpful in terms of improving quality of care and facilitating clinical trials for experimental therapeutics.
Correction: Funding in "Physician-Scientist Training System and Development Strategies in Korea".
Eom GH, Kim J, Kim JI … +2 more , Choi HY, Lee DH
J Korean Med Sci · 2026 Apr · PMID 41978928 · Full text
This corrects the article on p. e140 in vol. 40, PMID: 40259725.
This corrects the article on p. e140 in vol. 40, PMID: 40259725.
Comparative Renal Safety of Tenofovir Alafenamide vs. Tenofovir Disoproxil Fumarate in Chronic Hepatitis B: A Korean Nationwide Study.
Lim J, Yang J, Kim YJ … +2 more , Kim HJ, Choi J
J Korean Med Sci · 2026 Apr · PMID 41978927 · Full text
BACKGROUND: The long-term renal safety of tenofovir-based therapy in patients with chronic hepatitis B virus (HBV) infection remains uncertain, particularly regarding end-stage kidney disease requiring renal replacement...
BACKGROUND: The long-term renal safety of tenofovir-based therapy in patients with chronic hepatitis B virus (HBV) infection remains uncertain, particularly regarding end-stage kidney disease requiring renal replacement therapy (RRT). We investigated the comparative risk of renal dysfunction between tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF). METHODS: We identified treatment-naïve adult patients with chronic HBV infection who initiated TAF or TDF between 2017 and 2020 from the Korean National Health Insurance Service. After 1:1 propensity score (PS) matching, we compared the incidence of RRT and chronic kidney disease (CKD) between the two groups. RESULTS: Among 46,663 eligible patients (TAF, n = 16,885; TDF, n = 29,778), the median follow-up was 2.61 years. The incidence of RRT were 0.56 and 0.96 per 1,000 person-years in the TAF and TDF groups, respectively (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.47-1.16). In the PS-matched cohort (n = 31,218), the adjusted HR for RRT was 0.67 (95% CI, 0.40-1.10) in TAF compared to TDF. Male sex, older age, hypertension, cirrhosis and current smoking were associated with the increased risk of RRT. CONCLUSION: In this nationwide claims-based cohort, TAF and TDF showed comparable renal safety with respect to RRT and the development of CKD. Male sex, older age, hypertension, and liver cirrhosis were associated with increased renal risk and warrant close monitoring.
Clinical Characteristics and Risk Factors for Syphilis Among People Living With Human Immunodeficiency Virus: A Nationwide Population-Based Cohort Study in Korea.
Kim S, Baek YJ, Lee E … +5 more , Choi Y, Jeong O, Jung J, Kim TH, Choi JY
J Korean Med Sci · 2026 Apr · PMID 41978926 · Full text
BACKGROUND: The incidence of syphilis, a re-emerging infection linked to human immunodeficiency virus (HIV) through shared transmission routes, is increasing among people living with human immunodeficiency virus (PLH) in...
BACKGROUND: The incidence of syphilis, a re-emerging infection linked to human immunodeficiency virus (HIV) through shared transmission routes, is increasing among people living with human immunodeficiency virus (PLH) in Korea. This study evaluate the prevalence, temporal trends, and risk factors for syphilis among PLH in the Republic of Korea. METHODS: Data from the National Health Insurance Service of Korea between 2002 and 2021 were analyzed to determine the incidence of syphilis in PLH. Syphilis was defined by the assigned Korean Standard Classification of Diseases code, with prescription codes for benzathine penicillin G, ceftriaxone, and doxycycline. Syphilis was classified as early or late based on the antibiotic dose. Multivariable logistic regression analysis was performed to assess risk factors for syphilis among PLH. RESULTS: The prevalence of syphilis in PLH was 25.53% (4,193/16,422 patients). Early syphilis accounted for 85.19% (3,572/4,193) of cases, and 34.80% of PLH with syphilis experienced multiple episodes. Additionally, 23.73% of PLH with syphilis received treatment for syphilis before HIV diagnosis. In the multivariable analysis, male sex (adjusted odds ratio [aOR], 10.78; 95% confidence interval [CI], 7.87-14.78), living in the Seoul metropolitan area (comprising Seoul, Incheon, and Gyeonggi-do) (aOR, 1.24; 95% CI, 1.15-1.34), the presence of acquired immunodeficiency syndrome-related cancer (aOR, 1.36; 95% CI, 1.24-1.48), longer duration of HIV diagnosis (pre-2009 vs. 2019-2021: aOR, 1.94; 95% CI, 1.71-2.20), and the lowest economic status (aOR, 1.35; 95% CI, 1.18-1.54) were associated with higher risks of syphilis. New PLH cases and early syphilis among PLH revealed correlated trends over the study period (Spearman's ρ = 0.71, < 0.01). CONCLUSION: Syphilis is highly prevalent among PLH, particularly low-income males in the Seoul metropolitan area with longer HIV disease duration. Enhanced surveillance and targeted interventions are urgently needed to control syphilis transmission among high-risk PLH.
Trends in Acute Care and Rehabilitation for First-Ever Stroke Patients: A 12-Year Perspective, the KOSCO Study.
Kim DH, Sohn MK, Lee J … +12 more , Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee HS, Kim YH, Chang WH
J Korean Med Sci · 2026 Apr · PMID 41978925 · Full text
BACKGROUND: Updated data on stroke care trends are crucial for advancing stroke treatment. This study aimed to assess trends in inpatient care for first-ever stroke patients in South Korea over a 12-year period, focusing...
BACKGROUND: Updated data on stroke care trends are crucial for advancing stroke treatment. This study aimed to assess trends in inpatient care for first-ever stroke patients in South Korea over a 12-year period, focusing on demographic shifts and acute treatments including rehabilitation. METHODS: This multicenter cohort study analyzed first-ever stroke patients admitted to three representative hospitals in South Korea during 2008 (n = 911), 2014 (n = 1,489), and 2020 (n = 1,434). The 2008 data were collected retrospectively, while 2014 and 2020 data were obtained from a prospective cohort study. Data included demographics, risk factors, stroke characteristics, hospital course, and rehabilitation treatments. RESULTS: From 2008 to 2020, the mean age of stroke patients increased from 62.0 to 66.2 years. The proportion of ischemic stroke cases increased markedly from 47.3% to 74.5% while risk factors such as diabetes mellitus and hyperlipidemia showed increasing prevalence. Mechanical thrombectomy increased from 0% to 3.3%. Mean hospital stay decreased from 25.2 to 14.9 days, while in-hospital mortality declined from 5.9% to 3.7%. Rehabilitation consultations increased from 27.8% to 80.6%, occurring earlier during hospitalization. Rehabilitation therapy during hospitalization increased from 23.7% to 55.8%, and transfers to rehabilitation medicine rose from 12.8% to 19.1%. Home discharge increased from 34.8% to 60.0%. CONCLUSION: Management of first-ever stroke patients in Korea improved substantially over 12 years, reflecting positive impacts of national quality initiatives and advancing stroke care.
Comparison of Vaccine Adverse Events Between Zoster Vaccine Live and Recombinant Zoster Vaccine: A Prospective Multicenter Survey.
Yoon JG, Nham E, Choi YJ … +9 more , Choi WS, Choi MJ, Seo YB, Lee J, Hyun H, Heo JY, Noh JY, Song JY, Cheong HJ
J Korean Med Sci · 2026 Apr · PMID 41978924 · Full text
BACKGROUND: The burden of herpes zoster has been mitigated through the introduction of two types of vaccines, including zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV). We aimed to compare the occurrence o...
BACKGROUND: The burden of herpes zoster has been mitigated through the introduction of two types of vaccines, including zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV). We aimed to compare the occurrence of adverse events within 90 days of vaccination. METHODS: We prospectively enrolled participants who received ZVL or RZV between October 2022 and November 2024 at five tertiary hospitals and nine primary care clinics in South Korea. Data on solicited and unsolicited adverse events were collected using questionnaires at 1, 3, 7, 28, and 90 days after vaccination. Demographic and clinical data including vaccination history, previous episodes of herpes zoster, underlying diseases, and immune status were also collected. Multivariable logistic regression analysis was conducted to assess the risk of solicited adverse events according to clinical variables. RESULTS: In total, 1,527 participants were enrolled, with 487 receiving ZVL, 632 receiving the first RZV dose, and 408 receiving the second RZV dose. In multivariable logistic regression analysis after adjusting clinical variables, the adjusted odds ratios (ORs) for the risk of solicited adverse events at day 1 were significantly lower in 11 categories for the ZVL group compared to the first-dose RZV group. However, for the second-dose RZV group, the adjusted ORs were significantly higher in 9 categories when compared to the first-dose RZV group. No life-threatening vaccine-related events occurred in the unsolicited adverse event reports between days 8 and 90. CONCLUSION: After adjusting for clinical variables, the risks of many solicited adverse events were highest in the second-dose RZV group, followed by the first-dose RZV group, and were lowest in the ZVL group. However, the differences in risk diminished from day 1 to day 7. No fatal events occurred in either group. Clinicians should be aware of early reactogenicity of RZV.
Real-World Outcomes of Hybrid Closed-Loop System Use in Korean Youth With Childhood-Onset Type 1 Diabetes.
Woo HA, Jeong SJ, Lee YJ … +6 more , Kim HY, Gu M, Kim JY, Kim J, Shin CH, Lee YA
J Korean Med Sci · 2026 Apr · PMID 41978923 · Full text
BACKGROUND: Hybrid closed-loop (HCL) systems adjust basal insulin levels using real-time glucose levels obtained from continuous glucose monitors (CGM). This study evaluated the MiniMed 770G system in Korean youths with...
BACKGROUND: Hybrid closed-loop (HCL) systems adjust basal insulin levels using real-time glucose levels obtained from continuous glucose monitors (CGM). This study evaluated the MiniMed 770G system in Korean youths with childhood-onset type 1 diabetes (T1D). METHODS: Of the 457 patients followed-up for childhood-onset T1D for > 1 year at Seoul National University Children's Hospital and Seoul National University Bundang Hospital between February 2022 and May 2023, 20 patients (10 boys, 10 girls) who used a MiniMed 770G system for ≥ 3 months with a CGM active time of > 70% were enrolled. Glycemic outcomes, including glycated hemoglobin A1c (HbA1c), and CGM-derived metrics (time in range [TIR], time below range, time above range > 180 mg/dL and > 250 mg/dL [TAR 180 and TAR 250], and coefficient of variation [CV]) were analyzed. Generalized estimating equation (GEE) analysis compared glycemic outcomes between auto-mode users (> 85% and ≤ 85%) during the 1-year follow-up. RESULTS: The median age at HCL initiation was 14.0 years (interquartile range [IQR], 11.2, 17.9), with a median diabetes duration of 6.5 years (IQR, 5.7, 8.9). The numbers of auto-mode (> 85%) users at 3, 6, 9, and 12 months were 10, 9, 9, and 7, respectively. Compared to auto-mode (≤ 85%) users, auto-mode (> 85%) users demonstrated 0.75 lower HbA1c ( = 0.037), 7.0 higher TIR ( = 0.015), 6.7 lower TAR 180 ( = 0.031), and 3.2 lower CV ( = 0.001) during the year using GEE analysis. In an analysis of auto-mode (> 85%) users, the median TIR, TAR, and CV significantly improved from 59% at baseline to 74.5% at 3 months ( = 0.008), and from 65% at baseline to 73% at 6 months ( = 0.012). Neither severe hypoglycemia nor diabetic ketoacidosis was observed throughout the year. The most common reasons for auto-mode exit were hyperglycemia and a lack of calibration. CONCLUSION: Use of HCL system with auto-mode (> 85%) enhanced glycemic control in youth with childhood-onset T1D during the study period.
Incidence of High-Risk Prostate Cancer in Korea: Insights From Real-World Data Between 2010 and 2020.
Ko YH, Kim SW, Son NH
J Korean Med Sci · 2026 Apr · PMID 41978922 · Full text
BACKGROUND: This study aims to report the nationwide risk stratification of prostate cancer (PCa) over the past decade-an analysis that has not been previously conducted, as such data are not available through the medica...
BACKGROUND: This study aims to report the nationwide risk stratification of prostate cancer (PCa) over the past decade-an analysis that has not been previously conducted, as such data are not available through the medical insurance-based big data registry of South Korea. METHODS: Nationwide data on the clinicopathologic variables of PCa at the time of diagnosis through biopsy, prostate-specific antigen (PSA) levels, clinical stage, Gleason grade, and residential area of the patient were obtained from 51 general hospitals (with ≥ 200 beds) across South Korea in 2010, 2012, 2014, 2016, 2018, and 2020. The risk criteria were based on universal guidelines defined in the 2010s, with high risk defined as PSA levels > 20 ng/mL, clinical stage ≥ cT3a, and Gleason group (GG) ≥ 4; low risk was defined as PSA levels < 10 ng/mL, clinical stage ≤ cT2a, and GG < 1. RESULTS: Data from 27,075 cases, representing 37.9% of the 71,403 patients registered in the National Cancer Statistics during the study period, were obtained from 51 hospitals. High-risk PCa (50.6%) was the most prevalent disease during the study period, while the proportion of low-risk diseases, including potential low-risk cases, decreased from 11.4% in 2010 to 7.6% in 2020. High-risk PCa was most prevalent in 9 of the 17 administrative regions, with 55.4% of high-risk cancer cases originating in rural areas compared to 47.7% from urban areas ( < 0.001). CONCLUSION: Approximately 50% of the patients with PCa detected in South Korea in the 2010s had high-risk disease, which was a consistent nationwide. The higher prevalence of low-risk disease among residents of the capital metropolitan area, compared to the higher frequency of high-risk disease among rural residents, suggests disparities in access to early PCa detection and diagnosis.
Effect of Workplace Bullying on Depressive Symptoms Among Newly Hired Hospital Nurses: A Cross-Sectional and Prospective Observational Study.
Chung Y, Kim H, Ryu J … +1 more , Yoon S
J Korean Med Sci · 2026 Mar · PMID 41943277 · Full text
BACKGROUND: Workplace bullying (WB) among hospital nurses in Korea is a growing issue that affects their physical and mental health and safety. Thus, we aimed to identify the association between WB and depressive symptom...
BACKGROUND: Workplace bullying (WB) among hospital nurses in Korea is a growing issue that affects their physical and mental health and safety. Thus, we aimed to identify the association between WB and depressive symptoms in newly hired hospital nurses. METHODS: We enrolled 508 nurses for the cross-sectional study and 311 nurses for the prospective observational study. In both studies, we conducted multiple logistic regression analyses controlling for age, gender, education level, living status (alone or not), alcohol consumption, exercise, department, and workplace. For the cross-sectional study, WB scores were categorized into three groups: "low," "intermediate," and "high." In the prospective observational study, WB levels were classified as "absent" or "present," based on the median score. Using the combination of WB status at baseline and follow-up, we categorized cases into four groups: "both absent," "present to absent," "both present," and "absent to present." RESULTS: In the cross-sectional study, nurses with intermediate WB scores had an increased risk of depressive symptoms (odds ratio [OR], 2.080; 95% confidence interval [CI], 0.791-5.472), and those with high WB scores showed an even greater risk (OR, 6.606; 95% CI, 2.926-14.915) compared to nurses with low WB scores. In the prospective observational study, the risk of depressive symptoms was found to increase among nurses. After adjusting for confounding variables, the ORs for the "both present" group and the "absent to present" group were 4.308 (95% CI, 1.449-12.806) and 7.647 (95% CI, 2.639-11.157), respectively, compared to the "both absent" group. CONCLUSION: WB among newly hired hospital nurses likely causes significant depressive symptoms. Therefore, organizational interventions should be considered to prevent depressive symptoms.
Ocular Injury in Korea: Epidemiological Analysis and Risk Assessment Based on Nationwide Emergency Department Data (2016-2022).
Lee KS, Min HS, Moon J … +1 more , Kim YT
J Korean Med Sci · 2026 Mar · PMID 41943276 · Full text
BACKGROUND: Ocular injury is a significant public health concern, which may threaten vision and impose a heavy burden on healthcare systems. In South Korea, understanding the epidemiology of ocular injury is critical for...
BACKGROUND: Ocular injury is a significant public health concern, which may threaten vision and impose a heavy burden on healthcare systems. In South Korea, understanding the epidemiology of ocular injury is critical for developing effective prevention strategies. METHODS: This study utilized data from the National Emergency Department Information System from 2016 to 2022. Patients presenting with ocular injury to emergency departments (EDs) nationwide were analyzed. We categorized ED visits based on the types of injury and the risk of vision loss by a modified Delphi process. Multivariate logistic regression was performed to identify factors associated with a high risk of vision loss. RESULTS: A total of 581,264 cases of ocular injury were analyzed. Majority of cases occurred in males (72.3%) and individuals aged 40-64 years (37.02%). The elderly (≥ 65 years) exhibited an increasing trend in ocular injury, rising from 9.41% in 2016 to 17.82% in 2022. Individuals covered by industrial accident compensation insurance showed a significantly higher risk of vision loss, particularly among males aged 20-39 years (adjusted odds ratio [aOR], 5.55; 95% confidence interval [CI], 4.25-7.26) and 40-64 years (aOR, 2.94; 95% CI, 2.41-3.59). Machinery-related injuries were also identified as a major risk factor for severe vision loss, with an aOR of 4.83 (95% CI, 3.27-7.14) in males aged 40-64 years. Residents in low-populated areas showed significantly greater risks of severe vision loss compared to those in high-populated areas. CONCLUSION: This study provides a comprehensive epidemiological overview of ocular injury in South Korea, suggesting the need for a more detailed understanding of the mechanisms underlying these injuries, promoting the use of appropriate eye protective gear, and improving access to emergency care in low population density areas.
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