Journal Of Korean Medical Science[JOURNAL]
Sun
200 papers
Impact of the 2024 Korean Healthcare Crisis on Foot and Ankle Surgery in Single Tertiary Medical Center: A Retrospective Study.
Moon SJ, Heo YM, Hwang SJ … +3 more , Jeon JH, Kang DH, Song J
J Korean Med Sci · 2026 Mar · PMID 41844140 · Full text
BACKGROUND: The 2024 healthcare crisis in South Korea, triggered by mass resignations of residents, caused widespread disruptions in healthcare services. This study investigates the impact of this crisis on foot and ankl...
BACKGROUND: The 2024 healthcare crisis in South Korea, triggered by mass resignations of residents, caused widespread disruptions in healthcare services. This study investigates the impact of this crisis on foot and ankle surgery at a tertiary medical center in South Korea. METHODS: A retrospective analysis was conducted on patients who underwent foot and ankle surgeries at a tertiary center. The study population was divided into pre-crisis and post-crisis groups. Data on demographics, surgery types, anesthesia methods, and clinical outcomes were analyzed. RESULTS: The total number of surgeries decreased after healthcare crisis (from 181 to 109 cases). No significant differences were found between the pre- and post-crisis periods in demographics ( > 0.05). However, the proportion of major amputations for infection significantly increased after the crisis compared to before ( = 0.033). Additionally, C-reactive protein levels and white blood cell count upon admission for infection surgeries were significantly higher post-crisis than pre-crisis ( = 0.028 and < 0.001, respectively). In terms of anesthesia, general anesthesia decreased from 58.0% pre-crisis to 35.8% post-crisis ( < 0.001), while spinal anesthesia increased from 6.1% to 26.6% ( < 0.001), and local anesthesia increased from 1.7% to 9.2% ( = 0.006). CONCLUSION: Based on the present study conducted at a single tertiary medical center, the shortage of medical personnel due to resident resignations during South Korea's medical crisis led to a reduction in total surgical volume, an increase in infection severity, and a shift in anesthesia techniques.
Risk Factors and Quality of Life in Patients With Geographic Atrophy, a Late Stage of Age-Related Macular Degeneration: Findings From the Korea National Health and Nutrition Examination Survey.
Kim Y, Kim YT, Kong M … +1 more , Kim JH
J Korean Med Sci · 2026 Mar · PMID 41844139 · Full text
BACKGROUND: To evaluate the risk factors and quality of life (QoL) in geographic atrophy (GA) in a Korean population. METHODS: This cross-sectional study, based on data from the Korea National Health and Nutrition Examin...
BACKGROUND: To evaluate the risk factors and quality of life (QoL) in geographic atrophy (GA) in a Korean population. METHODS: This cross-sectional study, based on data from the Korea National Health and Nutrition Examination Survey (2017-2021), included 15,030 subjects aged ≥ 40 years. Participants were classified into four categories: early age-related macular degeneration (AMD) (n = 2,068), wet AMD (n = 94), GA (n = 36), and no AMD (n = 12,832). Demographics and activity limitations were compared across these groups. Additionally, the subjects' QoL was assessed using the EuroQoL-5 Dimension (EQ-5D) and Health-Related Quality of Life Instrument with 8 Items (HINT-8) methods. RESULTS: Among the four groups, the GA group showed highest mean age (72.47 ± 7.45 years), prevalence of current smokers (61.11%), and prevalence of diabetes (41.67%). GA group reported activity limitations (16.67%) and vision problems (5.56%) at relatively higher rates compared to other groups. In the QoL assessment, the EQ-5D evaluation showed that the GA group experienced a similar decline in QoL as the wet AMD group (0.93 ± 0.02 vs. 0.93 ± 0.01; = 0.971), while the HINT-8 evaluation indicated a relatively more severe QoL decline in GA group compared to wet AMD group (22.74 ± 3.70 vs. 20.35 ± 3.33; = 0.007). GA group frequently reported difficulties with mobility (27.27%), usual activities (15.15%), and climbing stairs (61.54%), which were comparable to the frequencies observed in patients with wet AMD. CONCLUSION: In South Korea, patients with GA tended to have relatively higher rates of current smoking and diabetes compared to individuals without GA. A decline in QoL in these patients was primarily associated with activity limitations. To improve patients' QoL, social support is needed to help overcome these activity limitations. Furthermore, it will be necessary to introduce therapeutic interventions to slow the progression of GA.
Case 22: A 65-Year-Old-Woman With Neutropenia.
Kang MG, Chung Y, Kim J … +1 more , Min KI
J Korean Med Sci · 2026 Mar · PMID 41807029 · Full text
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Randomized, Double-Blind, Multicenter, Phase 3 Study of AG NPP709 Compared With Ivy Leaf Extract in Patients With Acute or Chronic Respiratory Symptoms.
Cho YJ, Yoon HJ, Lim DH … +3 more , Yoo KH, Choi SH, Rha YH
J Korean Med Sci · 2026 Mar · PMID 41807028 · Full text
BACKGROUND: AG NPP709, formulated with extracts of ivy leaves and rhizomes, has antitussive and expectorant effects in preclinical rodent studies. We conducted a clinical trial to establish the efficacy and safety of th...
BACKGROUND: AG NPP709, formulated with extracts of ivy leaves and rhizomes, has antitussive and expectorant effects in preclinical rodent studies. We conducted a clinical trial to establish the efficacy and safety of the product compared with a widely prescribed ivy leaf extract product for the treatment of respiratory symptoms. METHODS: In this randomized, double-blind, active-controlled, non-inferiority phase 3 trial, conducted in six hospitals in South Korea, symptomatic patients with acute upper respiratory infections (URIs) or chronic inflammatory bronchitis were randomized to receive either AG NPP709 or ivy leaf extract (control drug) for 5 days (n = 118 in each group). The primary efficacy endpoint was the clinical improvement rate, defined as the percentage of patients with symptoms evaluated as the top two scores on a five-point Likert scale at the end of the study (with a non-inferiority margin set at -15.0%). RESULTS: The overall patient age ranged from 2 to 70 years, with a mean age of 24.9 years in the AG NPP709 group and 21.7 years in the control group. No statistical difference was observed in the clinical improvement rate, with a between-group difference of 4.3% (95% confidence interval: -8.9, 17.5). The symptom clearance rates (AG NPP709 vs. control) for cough and sputum were 43.0% vs. 40.0% ( = 0.655) and 34.6% vs. 25.5% ( = 0.142), respectively. The incidence of adverse events was similar in both groups (11.0% vs. 11.1%, = 0.982), with most events being grade 1 or 2. CONCLUSION: AG NPP709 was non-inferior to ivy leaf extract and had an acceptable safety profile. AG NPP709 could be an alternative treatment option for alleviating the symptoms associated with acute URI and chronic bronchitis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01151202.
High-Grade Astrocytoma With Piloid Features: An Aggressive Clinicogenomic Entity Distinct From Pilocytic Astrocytoma.
Kang J, Kim EE, Lee K … +8 more , Kim SI, Park JW, Won JK, Phi JH, Kim SK, Park CK, Lee H, Park SH
J Korean Med Sci · 2026 Mar · PMID 41807027 · Full text
BACKGROUND: High-grade astrocytoma with piloid features (HGAP) has recently emerged as an aggressive glioma entity with distinct molecular alterations, yet its clinicogenomic distinction from pilocytic astrocytoma (PA) r...
BACKGROUND: High-grade astrocytoma with piloid features (HGAP) has recently emerged as an aggressive glioma entity with distinct molecular alterations, yet its clinicogenomic distinction from pilocytic astrocytoma (PA) remains to be fully elucidated. This study aims to clarify the clinical, pathological, and genomic differences between pediatric PA, adult PA, and HGAP, and to provide evidence supporting the recognition of HGAP as a new, aggressive entity. METHODS: We retrospectively analyzed 100 genetically and histopathologically confirmed PA cases (87 pediatric, 13 adult) and 25 HGAP cases (all > 19 years old) diagnosed at Seoul National University Hospital between 2015 and 2024. Next-generation sequencing using a brain tumor-specific gene panel and immunohistochemistry evaluation. RESULTS: Pediatric PAs (median age 7 years) were predominantly cerebellar (61%) and showed classic biphasic histology (72%) with frequent fusion (72%) and V600E mutations (13%) and rarely KRAS mutation (2.3%). Adult PAs (median age 35 years), when HGAP was excluded, were less often cerebellar (53.8%) and rarely KRAS mutation (2.3%), more frequently supratentorial (23%) or spinal (15%) than pediatric PAs, and showed a higher incidence of mutations (23.1%), and more patternless or diffuse oligoastrocytic histology (31%), but did not differ in recurrence rate or prognosis compared to pediatric PA. In contrast, HGAPs predominantly affected adults (median age 53 years, ranges: 19-87 years), frequently involved cerebellum (40%), and exhibited high-grade histopathological features. Molecular profiling revealed HGAPs harbored frequent deletions (76%) and mutations of (64%), (52%), (28%), (20%), (16%), and (16%). Patients with HGAP had significantly shorter progression-free and overall survival compared to both pediatric and adult PA. CONCLUSION: HGAP represents a clinically aggressive and molecularly distinct high-grade glioma, clearly separable from pediatric and adult PA. Its poor prognosis and unique genetic drivers justify its recognition as a new entity. Accurate molecular profiling is essential for diagnosis and management of these tumors, and the poor survival outcomes observed in HGAP highlight the need for further larger cohort studies to identify optimal therapeutic strategies.
Dynamics of Varicella Zoster Virus-Specific Immune Reconstitution and Impact of Varicella Vaccination in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients.
Kim G, Lee S, Lee Y … +7 more , Yoo R, Kim JH, Kang SH, Kim H, Koh KN, Im HJ, Lee J
J Korean Med Sci · 2026 Mar · PMID 41807026 · Full text
BACKGROUND: Varicella-zoster virus infection poses a significant risk to pediatric hematopoietic stem cell transplant recipients owing to compromised T-cell-mediated immunity. Although varicella-zoster virus-specific T-c...
BACKGROUND: Varicella-zoster virus infection poses a significant risk to pediatric hematopoietic stem cell transplant recipients owing to compromised T-cell-mediated immunity. Although varicella-zoster virus-specific T-cell-mediated immunity is crucial for preventing reactivation, its reconstitution following allogeneic hematopoietic stem cell transplant in pediatric patients remains poorly characterized. METHODS: This prospective study assessed varicella-zoster virus-specific T-cell-mediated immunity in 32 pediatric allogeneic hematopoietic stem cell transplant recipients pre-transplant and 1 and 3 months post-transplant using enzyme-linked immune absorbent spot assays. An extension study assessed varicella-zoster virus-specific T-cell-mediated immunity 2 years post-transplant in 15 recipients, including 8 after a single dose of varicella vaccination. RESULTS: Among the 32 recipients (median age, 10.5 years), only one experienced post-hematopoietic stem cell transplant varicella-zoster virus infection. Median varicella-zoster virus-specific spot-forming cells were low during the first 3 months but increased significantly at 2 years (0 vs. 5.0/2.0 × 10⁵ peripheral blood mononuclear cells; = 0.005), more evident in recipients with pre-hematopoietic stem cell transplant varicella-zoster virus R⁺ serostatus ( = 0.006) and no prior varicella-zoster virus infection ( < 0.001). The presence of varicella-zoster virus-specific T-cell-mediated immunity (≥ 1.0 spot-forming cells/2.0 × 10⁵ peripheral blood mononuclear cells) did not differ significantly by pre-hematopoietic stem cell transplant T-cell-mediated immunity status, serostatus, or vaccination history. Among seven recipients assessed at all five time points, recovery-level responses (≥ 5.0 spot-forming cells) increased from 28.6% pre-vaccination to 71.4% post-vaccination. CONCLUSION: Varicella-zoster virus-specific T-cell-mediated immunity in pediatric hematopoietic stem cell transplant recipients remained low in the first 3 months but recovered significantly by 2 years post-hematopoietic stem cell transplant, with a boosting effect from varicella vaccination. Further studies are needed to assess the clinical significance of T-cell-mediated immunity and to guide personalized prevention strategies.
Effectiveness and Safety of Biodegradable Polymer-Coated Everolimus-Eluting Stent in Multivessel Coronary Artery Disease in Routine Clinical Practice: A Korean Multicenter, Prospective, and Observational Study.
Park S, Kim W, Rha SW … +28 more , Choi BG, Hahn JY, Park SH, Lee HC, Cho JH, Bong JM, Hwang BH, Seo JB, Jeong YH, Park HB, Jeong MH, Choi BJ, Choi KY, Lee SU, Cho YH, Hwang SH, Park K, Choi YJ, Her AY, Lee JB, Hwang JY, Choi JH, Sinurat MR, Choi SY, Cha JA, Hyun SJ, Choi CU, Park CG
J Korean Med Sci · 2026 Mar · PMID 41807025 · Full text
BACKGROUND: Multivessel coronary artery disease (CAD) poses a significant challenge in interventional cardiology due to its complexity and association with adverse clinical outcomes. Real-world data on the clinical perfo...
BACKGROUND: Multivessel coronary artery disease (CAD) poses a significant challenge in interventional cardiology due to its complexity and association with adverse clinical outcomes. Real-world data on the clinical performance of drug-eluting stents in Korean patients with multivessel disease (MVD) are limited. This study aimed to evaluate the efficacy and safety of the biodegradable polymer-coated everolimus-eluting stents (SYNERGY™, Boston Scientific Corporation, Natick, MA, USA) in treating patients with MVD in real-world clinical setting. METHODS: This multicenter, prospective, observational registry involved 22 hospitals in the Republic of Korea. Eligible patients presented with ≥ 70% stenosis in at least two vessels and were amenable for receiving percutaneous coronary intervention (PCI). The primary endpoint was target lesion failure ([TLF], the composite of cardiac death; target vessel myocardial infarction [MI]; and target lesion revascularization [TLR]) at 1 year. RESULTS: Between August 2016 and September 2018, 542 patients were enrolled. The mean age of the patients was 66.2 ± 10.4 years, and most of them were male (73.7%). Diabetes mellitus (DM) was present in 40.8% of patients, while 68.2% had acute coronary syndrome (ACS). The 1-year TLF was in 2.1%, with incidences of cardiac death 0.9%, MI 0.3%, TLR 0.9%, and stent thrombosis 0.3%. Subgroup analysis revealed no significant differences in the primary endpoint between patients with or without ACS, and DM. In-stent restenosis (hazard ratio [HR], 11.20; 95% confidence interval [CI], 2.20-56.91) and total stent length (HR, 1.02; 95% CI, 1.01-1.03) were identified as independent predictors of TLF. CONCLUSION: The 1-year TLF rate observed in our cohort (2.1%) was comparable to or lower than rates previously reported in studies evaluating drug-eluting stents in patients undergoing multivessel PCI. These results suggest that the biodegradable polymer-coated everolimus-eluting stents provide favorable clinical outcomes for this patient population in real-world clinical practice.
Altmetric Activity and Scientific Integrity: A Retraction Analysis of PubMed-Indexed Social Media-Related Publications.
Mukhamediyarov M, Zimba O, Yessirkepov M … +1 more , Kocyigit BF
J Korean Med Sci · 2026 Mar · PMID 41807024 · Full text
BACKGROUND: Social media is an essential tool for the dissemination of scientific information. The growing number of publications related to social media raises concerns about the proliferation of misleading information...
BACKGROUND: Social media is an essential tool for the dissemination of scientific information. The growing number of publications related to social media raises concerns about the proliferation of misleading information in the scientific literature. Retractions act as a crucial corrective mechanism in scholarly publishing; however, their relationship with social media visibility has not been thoroughly examined. METHODS: As part of our descriptive research, 55 retracted social media-related publications indexed in the PubMed database were analyzed. Such characteristics as the number of authors, the time from the date of publication to the retraction, the indexing of publications in the Web of Science, Scopus, and Directory of Open Access Journals databases, the country of the authors of correspondence, the reasons for the retraction, and Altmetric Attention Score (AAS) were analyzed. The data on citations and mentions in various social media platforms were analyzed. RESULTS: The highest number of retracted publications was published in 2023 (n = 39), and the median time from publication date to retraction amounted to 541 (28-912) days. China and India were the leading countries for corresponding authorship and international collaborations. The leading causes of retractions were Investigation by Journal/Publisher (n = 45), Unreliable Results and/or Conclusions (n = 41), Concerns/Issues about Referencing/Attributions (n = 37), Concerns/Issues with Peer Review (n = 35), and Concerns/Issues about Results and/or Conclusions (n = 35). The median AAS of retracted publications was 1.5 (1-1,627). A positive correlation was found between the number of citations and AAS (rho = 0.562, < 0.001). CONCLUSION: Retracted social media-related papers can gain substantial digital circulation before formal retraction, highlighting vulnerabilities in the current scientific interaction ecosystem. These findings urge more post-publication supervision, timely retraction notices, and international collaboration to enhance research integrity, especially in the rapid, decentralized digital distribution age.
Free Water Elevation in Alzheimer's Disease: Influence of Amyloid-Beta Deposition Beyond Brain Cell Loss.
Park J, Kwon MJ, Jo S … +5 more , Kim JS, Kim HI, Kim Y, Han JW, Kim KW
J Korean Med Sci · 2026 Mar · PMID 41807023 · Full text
BACKGROUND: To investigate whether amyloid-beta (Aβ) deposition in Alzheimer's disease (AD) increases free water (FW) before cell loss, we examined regional Aβ levels, volume, and FW of the posterior cingulate cortex (PC...
BACKGROUND: To investigate whether amyloid-beta (Aβ) deposition in Alzheimer's disease (AD) increases free water (FW) before cell loss, we examined regional Aβ levels, volume, and FW of the posterior cingulate cortex (PCC) and medial and inferior temporal cortex (MITC) across AD stages. METHODS: Aβ, volume, and FW in PCC and MITC were compared between normal cognition (NC), preclinical AD, prodromal AD, and dementia due to Alzheimer's disease (DEMAD) groups. Multiple linear regression was used to analyze the effect of Aβ and volume on FW. RESULTS: Continuous increases were observed in the regional standardized uptake value ratio of ¹⁸F-Florbetaben (SUVR) and regional volume loss in all regions of interest. Also, there was a consistent rise in the MITC FW. However, in PCC volume, only DEMAD showed a significant decrease. In the context of multiple linear regression, the study found that both SUVR and volume were significant predictors of FW in the MITC. However, in PCC, only SUVR was able to predict FW without considering volume. CONCLUSION: This study demonstrated that after Aβ deposition in AD, an increase in FW can occur not only due to brain cell loss but also through other Aβ-induced mechanisms, even in cases where brain cell loss has not yet occurred.
Harnessing Cytomegalovirus DNAemia and CMV-Specific Cell-Mediated Immunity in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients.
Lee S, Kim G, Kim JH … +6 more , Choi ES, Kang SH, Kim H, Koh KN, Im HJ, Lee J
J Korean Med Sci · 2026 Mar · PMID 41775280 · Full text
BACKGROUND: Recovery via cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in pediatric hematopoietic stem cell transplantation (HSCT) recipients is associated with a lower incidence of significant CMV DNAemia...
BACKGROUND: Recovery via cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in pediatric hematopoietic stem cell transplantation (HSCT) recipients is associated with a lower incidence of significant CMV DNAemia and disease. This study aimed to determine whether early post-HSCT CMI monitoring could predict CMV infection outcomes and identify factors that influence CMI recovery. METHODS: Pediatric patients (≤ 19 years) undergoing allogeneic HSCT at Asan Medical Center Children's Hospital between August 2018 and February 2020 were prospectively enrolled. CMV-specific CMI was assessed using the enzyme-linked immunospot assay for phosphoprotein 65 (pp65) or immediate-early protein 1 (IE-1) antigens at pre-transplantation, and 1 and 3 months post-transplantation. Plasma CMV polymerase chain reaction monitoring was conducted regularly, and the incidence of CMV DNAemia and CMV disease was evaluated over a two-year follow-up period. RESULTS: Of the 55 enrolled pediatric recipients, CMV DNAemia occurred in 74.5%, with 21.8% of cases progressing to significant CMV DNAemia. Cumulative CMI recovery rates at 3 months were 61.8% for pp65 and 43.6% for IE-1. Recipients with a cumulative recovery of pp65-specific CMI exhibited a significantly lower incidence of significant CMV DNAemia and CMV disease. In contrast, the cumulative recovery of IE-1-specific CMI was not associated with CMV outcomes. In the multivariate analysis, haploidentical donor status and post-HSCT CMV DNAemia were independently associated with impaired cumulative recovery of both pp65- and IE-1-specific CMI. CONCLUSION: Monitoring pp65-specific CMI recovery within three months post-HSCT is valuable for predicting significant CMV infection in pediatric recipients. Haploidentical HSCT recipients demonstrated impaired CMI recovery, highlighting the need for careful monitoring and tailored prophylactic strategies.
Application of a Natural Language Processing Framework for Data Extraction From Pathology Reports Across Multiple Cancer Types.
Park P, Choi Y, Han N … +6 more , Park S, Park YL, Hwang J, Choi KS, Yoo CW, Kim HJ
J Korean Med Sci · 2026 Mar · PMID 41775279 · Full text
BACKGROUND: Pathological reports provide comprehensive insights into the clinical and pathological features of different cancer types. However, extraction of this semi-structured data for research is challenging. To bett...
BACKGROUND: Pathological reports provide comprehensive insights into the clinical and pathological features of different cancer types. However, extraction of this semi-structured data for research is challenging. To better utilize pathology reports in cancer studies, we developed an efficient natural language processing (NLP) system to automate the extraction of items from pathology reports, facilitating streamlined storage, retrieval, and analysis of clinical data in a centralized database. METHODS: To determine the optimal model for our study, we conducted a comparative analysis of various deep learning architectures, including long short-term memory, convolutional neural network, and transformer-based models such as bidirectional encoder representations from transformers (BERT), BioBERT, and ClinicalBERT. The proficiency of the ClinicalBERT model in medical terminology and context significantly enhanced the accuracy and efficiency of data extraction from these reports. RESULTS: Among the aforementioned models, ClinicalBERT exhibited the best performance and was selected as the base model. The ClinicalBERT model demonstrated an exceptional performance in accurately classifying variables across multiple cancer types. Regarding stomach cancer, F1 scores (F1 = 1.0) were achieved for variables such as angiolymphatic invasion, and operation name (F1 = 1.0); however, a lower performance was observed for distant metastasis (F1 = 0.3889). Regarding liver cancer, high performance was consistently observed for most variables, with F1 scores above 0.99. Regarding colorectal cancer, F1 scores were achieved for variables such as Dworak's grade, lymph node, operation name, and total mesorectal excision (F1 = 1.0), while slightly lower but acceptable performance was noted for surgical margin (F1 = 0.9259). Regarding breast cancer, F1 scores were achieved for several variables including nipple margin, organ, and superficial margin (F1 = 1.0), while strong performances were noted for lateral and medial margins (F1 > 0.94). CONCLUSION: This study underscores the efficacy of NLP systems, specifically the ClinicalBERT model, in automating the extraction of important clinical data from pathology reports across various cancer types. This approach can not only simplify the process but also enhance the accuracy of the extracted information.
Role of Gut Microbiota in Psychiatric Disorders: From Mechanistic Insights to Therapeutic Strategies.
Kim YS, Woo SY, Ha E … +5 more , Ahn SH, Kim E, Kim SI, Lim WJ, Kim SY
J Korean Med Sci · 2026 Mar · PMID 41775278 · Full text
Mental health disorders are a global health challenge, and the underlying biological mechanisms remain unclear. Recent evidence has linked gut microbiota to psychiatric symptoms through complex bidirectional interactions...
Mental health disorders are a global health challenge, and the underlying biological mechanisms remain unclear. Recent evidence has linked gut microbiota to psychiatric symptoms through complex bidirectional interactions along the gut-brain axis, which involve neural, endocrine, and immune pathways. This narrative review aims to synthesize current findings on how gut microbiota contributes to the pathophysiology of major psychiatric disorders, and explore microbiota-based therapeutic interventions, and discusses emerging strategies for personalized treatment. Relevant literature up to July 2025 was reviewed using targeted keywords in major databases, including PubMed and Google Scholar. Rather than applying formal systematic review criteria, we focused on selecting influential and high-impact studies, and the findings were synthesized thematically to provide a comprehensive overview. Consistent findings across psychiatric conditions include a decreased abundance of short-chain fatty acid-producing bacteria and an increased presence of pro-inflammatory taxa. These shifts correlate with heightened systemic inflammation, disrupted neurotransmitter synthesis, and dysregulation of the hypothalamic-pituitary-adrenal axis. Thus, the gut microbiota is increasingly recognized as playing a potential role in the pathophysiology of psychiatric disorders through multifaceted mechanisms involving the gut-brain axis. Probiotics, prebiotics, and dietary modifications show promise in modulating gut microbiota and alleviating psychiatric symptoms, although clinical outcomes remain heterogeneous. Emerging precision medicine strategies indicate promising potential for personalized microbiota-based treatments. Although microbiota-targeted therapies offer promising adjunctive strategies, large-scale, mechanistically informed clinical trials remain warranted. Future research should leverage artificial intelligence and multi-omics tools to develop personalized interventions tailored to individual microbiome profiles.
Physician Disagreement With Guidelines as a Critical Barrier to Achieving LDL-C Targets in Very High-Risk Patients: An Implementation Science Study.
Cho KH, Cho YR, Lee SR … +13 more , Bae JW, Nam CW, Park Y, Hwang JY, Yun KH, Kim W, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Hahn JY, Jeong MH
J Korean Med Sci · 2026 Mar · PMID 41775277 · Full text
BACKGROUND: We aimed to investigate the challenges Korean physicians face in assisting their high-risk atherosclerotic cardiovascular disease (ASCVD) patients in achieving guideline-recommended low-density lipoprotein ch...
BACKGROUND: We aimed to investigate the challenges Korean physicians face in assisting their high-risk atherosclerotic cardiovascular disease (ASCVD) patients in achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) levels. METHODS: We performed a prospective, implementation science study including 704 patients at very high risk of ASCVD with baseline LDL-C ≥ 70 mg/dL (1.8 mmol/L) while receiving maximally tolerated statins and/or ezetimibe for secondary prevention between 2020 and 2022. The primary evaluation criteria were the proportions of participants achieving LDL-C < 70 mg/dL at each visit. The secondary evaluation criteria included the proportions of participants in diverse situations associated with guideline adoption. RESULTS: The proportions of participants achieving LDL-C < 70 mg/dL at visits 2 (week 6-16) and 3 (week 18-30) were 56.3% and 58.7%, respectively. Among 307 patients on maximally tolerated statins and 397 patients on maximally tolerated statins and ezetimibe at baseline, physicians did not have an intention to intensify the lipid-lowering treatment regimen of 171 patients (55.7%) and 299 patients (75.3%) at visit 1, respectively. In both groups, physician disagreement with the guidelines was the major reason for not adopting the recommended therapy (70.8% and 46.2%, respectively), followed by patient refusal for reasons other than the cost, medical limitations such as comorbidities, and drug costs. CONCLUSION: This implementation science study for secondary prevention involving very high-risk ASCVD patients revealed that the proportion of patients achieving LDL-C < 70 mg/dL via lipid-lowering therapy was less than 60%. The main reason for not adopting the recommended LDL-C-lowering therapy was physician disagreement with the guidelines. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0005488.
Delayed at the Door: Impact of Pandemic Response Policies on Emergency and Critical Care in Korea: An Interrupted Time-Series Analysis.
Sung HK, Lee KS, Lee J … +4 more , Oh MH, Kim JY, Choi YK, Moon JY
J Korean Med Sci · 2026 Mar · PMID 41775276 · Full text
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic strained emergency and critical care systems globally, limiting access. Although Korea has been recognized for effective containment, the impact of the pandemi...
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic strained emergency and critical care systems globally, limiting access. Although Korea has been recognized for effective containment, the impact of the pandemic and its response policies on critical care accessibility remains unclear. METHODS: We conducted a nationwide interrupted time-series analysis of patients admitted from emergency department (ED) to intensive care unit (ICU) in Korea (January 2015-December 2023). The study period was divided into pre-pandemic, pandemic phase 1 (January 2020-March 2022; strict infection control with segregated COVID-19 care), and pandemic phase 2 (April 2022 onwards; reintegration of COVID-19 care). Negative binomial regression was used for ED-to-ICU admissions, and seasonal autoregressive integrated moving average models for the proportion of ED length of stay (EDLOS) ≥ 6 hours and in-hospital mortality. RESULTS: At pandemic onset, ED-to-ICU admissions declined immediately by 6.66% (95% confidence interval [CI], -9.25 to -3.98) and continued to fall by 0.54% per month (95% CI, -0.69 to -0.39) throughout phase I. Despite this, in-hospital mortality rose by 0.08% monthly (95% CI, 0.02 to 0.14), while EDLOS ≥ 6 hours increased by 0.35% per month (95% CI, 0.24 to 0.47). In phase 2, ED-to-ICU admissions rebounded with a 1.22% monthly increase (95% CI, 0.96 to 1.48), while mortality (-0.10% monthly, 95% CI, -0.20 to -0.01) and EDLOS ≥ 6 hours (-0.98% monthly, 95% CI, -1.18 to -0.77) declined. CONCLUSION: During the COVID-19 pandemic, marked changes in Korea's ED-to-ICU admission and in-hospital mortality were observed, reflecting the consequence of pandemic response policies. While infection control was essential, strict segregated COVID-19 care system likely limited ICU access for non-COVID patients, contributing to reduced admissions and increased mortality. These findings underscore the need for policies that balance rigorous infection control with flexible ICU management and effective patient flow strategies during public health emergencies.
Association Between Plant-Based Diet Index and Breast Cancer Risk Stratified by Menopausal and Hormone Receptor Status: A Case-Control Study Among Korean Women.
Lee J, Lee H, Gunathilake M … +2 more , Jung SY, Kim J
J Korean Med Sci · 2026 Mar · PMID 41775275 · Full text
BACKGROUND: This study aims to examine the association between a plant-based diet index (PDI) and the risk of breast cancer in Korean women. Additionally, we aim to assess whether the associations differ by menopausal st...
BACKGROUND: This study aims to examine the association between a plant-based diet index (PDI) and the risk of breast cancer in Korean women. Additionally, we aim to assess whether the associations differ by menopausal status and in estrogen receptor (ER) and progesterone receptor (PR) status. METHODS: In this case-control study, we included 395 breast cancer patients and 395 age-matched controls from the National Cancer Center Hospital. The overall PDI, healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) were calculated based on dietary intake assessed using a 106-item semi-quantitative food frequency questionnaire. Logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between plant-based diets and breast cancer, adjusting for potential confounders. RESULTS: We found that PDI was inversely associated with breast cancer, while uPDI was positively associated. However, hPDI was not significantly associated with breast cancer after multivariable adjustment. In analyses stratified by menopausal status, PDI showed an inverse association with breast cancer in premenopausal women, while uPDI was positively associated with breast cancer in both pre- and postmenopausal women. Additionally, when stratified by ER and PR status, we observed that both PDI and uPDI showed stronger associations in the ER+/PR+ group, whereas hPDI remained non-significant in both the ER+/PR+ and ER-/PR- groups. CONCLUSION: A higher PDI was associated with lower odds of breast cancer, supporting the recommendation to increase plant-based food intake and reduce animal food intake as part of dietary guidance for breast cancer prevention.
Evaluating the Efficacy of AI-Assisted Quantitative Coronary Angiography in Reducing Procedural Time for Primary PCI in STEMI Patients: A Retrospective Analysis.
Ahn JH, Park S, Lee SH … +9 more , Oh S, Lim Y, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim J, Ahn Y
J Korean Med Sci · 2026 Mar · PMID 41775274 · Full text
BACKGROUND: Rapid reperfusion is crucial in ST-elevation myocardial infarction (STEMI). We investigated whether AI-assisted quantitative coronary angiography (QCA) can reduce the procedure time for primary percutaneous c...
BACKGROUND: Rapid reperfusion is crucial in ST-elevation myocardial infarction (STEMI). We investigated whether AI-assisted quantitative coronary angiography (QCA) can reduce the procedure time for primary percutaneous coronary intervention (PCI) in patients with STEMI. METHODS: This single-center, retrospective study compared primary PCI assisted by MPXA, an AI-based QCA software, with angiography-guided PCI in 1,041 patients with STEMI. To minimize potential bias, a 1:3 propensity score matching was performed between the treatment and control groups. The primary endpoint was the time from coronary angiography to PCI completion. The secondary endpoints included total contrast media volume during the procedure, in-hospital mortality, and in-hospital cardiac death. RESULTS: After propensity score matching, 164 and 492 patients in the AI-QCA-assisted and angiography-guided groups, respectively, were analyzed. The AI-QCA-assisted PCI group showed significant reduction in procedure time than the angiography-guided PCI group (34.9 ± 13.9 vs. 39.5 ± 17.1 minutes, < 0.001). There was no significant difference in contrast media volume between the two groups (132.0 ± 42.2 vs. 135.8 ± 48.0 mL, = 0.354). Furthermore, no significant differences were observed in in-hospital mortality (2.4% vs. 3.0%, = 0.692) or cardiac mortality (2.4% vs. 2.8%, = 0.786) between the AI-QCA-assisted PCI and control groups. CONCLUSION: AI-assisted QCA significantly reduced the overall procedure time of primary PCI for STEMI, primarily by streamlining stent sizing and optimization processes without decreasing contrast use. Given that STEMI procedures typically begin with small-diameter balloon inflation to maintain blood flow and minimize complications, the time saved by optimal stent deployment could be clinically beneficial by allowing faster complete reperfusion. Larger studies are needed to confirm the potential clinical benefit of reducing the procedure time using AI-QCA in STEMI treatment.
When Did the Term "Translational Research" Emerge-and Why?
Jeon JH
J Korean Med Sci · 2026 Feb · PMID 41732049 · Full text
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Occupational Physical Activity and Blood Pressure: The Role of Leisure Time Physical Activity and Sex Differences.
Kim SH, Cho S, Kim H … +1 more , Park WJ
J Korean Med Sci · 2026 Feb · PMID 41732048 · Full text
BACKGROUND: This study examined the association between occupational physical activity (OPA) and blood pressure (BP), with particular emphasis on sex differences and the moderating role of leisure-time physical activity...
BACKGROUND: This study examined the association between occupational physical activity (OPA) and blood pressure (BP), with particular emphasis on sex differences and the moderating role of leisure-time physical activity (LTPA). Elucidating these relationships may support the development of tailored BP management strategies within occupational health contexts. METHODS: A total of 3,909 adults from the Korea National Health and Nutrition Examination Survey were included in the analysis. Propensity score matching was employed to balance covariates between groups. Linear regression analyses were conducted to examine interactions between OPA and both systolic and diastolic BP, accounting for sex differences and LTPA levels. RESULTS: Among males with insufficient LTPA, OPA was significantly associated with higher systolic BP (β = 1.944, = 0.004). In contrast, no significant association was observed in males with sufficient LTPA. Among females, OPA was significantly associated with lower systolic BP (β = -1.133, = 0.048), regardless of LTPA status. No significant associations were found between OPA and diastolic BP in either sex. CONCLUSION: The findings reveal sex-specific associations between OPA and BP. In males, OPA was linked to elevated systolic BP in the absence of sufficient LTPA, whereas in females, OPA was associated with lower systolic BP irrespective of LTPA levels. These results suggest a potential protective effect of OPA on systolic BP in females and underscore the need to consider sex, OPA, and LTPA collectively when developing BP management strategies.
Appreciation of Invisible Intellectual Contributions.
Yoo JH
J Korean Med Sci · 2026 Feb · PMID 41732047 · Full text
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Nocturnal Atrioventricular Block: Natural History and Clinical Implications.
Park S, Kim S, Kim HJ … +4 more , Choi Y, Oh YS, Kim DY, Kim SH
J Korean Med Sci · 2026 Feb · PMID 41732046 · Full text
BACKGROUND: Atrioventricular block (AVB) occurring exclusively at night has traditionally been considered a result of increased vagal tone and thought to have a favorable prognosis. While nocturnal AVB is generally not a...
BACKGROUND: Atrioventricular block (AVB) occurring exclusively at night has traditionally been considered a result of increased vagal tone and thought to have a favorable prognosis. While nocturnal AVB is generally not an indication for pacemaker implantation, supporting evidence remains limited. This study aimed to assess the natural history of nocturnal AVB. METHODS: Patients with 2:1, high-degree, or complete AVB (CAVB) detected exclusively during nighttime (21:00-07:00) on 24-hour electrocardiogram (ECG) monitoring were classified as having nocturnal AVB. The primary outcome was pacemaker implantation during the follow-up period. RESULTS: A total of 10,977 individuals underwent 24-hour ECG monitoring in Seoul St. Mary's Hospital between January 2000 and June 2020. Among them, 342 patients were diagnosed with CAVB, high-degree AVB, or 2:1 AVB, and 92 of these 342 patients had nocturnal AVB. Excluding 11 patients lost to follow-up, 81 patients were enrolled. Fourteen patients underwent immediate pacemaker implantation due to daytime bradycardia symptoms, while the remaining 67 patients underwent watchful waiting. During a median follow-up period of 2.4 years, 14 of these 67 patients received pacemaker implantation (n: CAVB 5/14, high-degree AVB 4/14, 2:1 AVB 5/14). The indications for pacemaker insertion included the development of bradycardia symptoms or signs (n = 13) and sick sinus syndrome (n = 1) during the daytime. CONCLUSION: Despite being asymptomatic during the daytime, 21% (14/67) of patients with nocturnal AVB required pacemaker implantation during a median follow-up period of 2.4 years. These findings suggest that active surveillance is needed even in patients with nocturnal AVB.
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