Journal of Korean Medical Science最新文献

Choosing the right statistical tests is essential for reliable results, but errors, like picking the wrong test or misinterpreting data, can easily lead to incorrect conclusions. Research integrity implies presenting research that is honest, clear, and uses correct statistics. By identifying statistical errors, artificial intelligence (AI) systems such as Statcheck and GRIM-Test increase the reliability of research and assist reviewers. AI helps non-experts analyze data, but it can be unpredictable for experts dealing with complex data analysis. Still, its ease of use and growing abilities show promise. Recent studies show that AI is increasingly helpful in research, assisting in spotting errors in methodology, citations, and statistical analyses. Tools like LLMs, Black Spatula, YesNoError, and GRIM-Test improve accuracy, but they need good data and human checks. AI has moderate accuracy overall but performs better in controlled settings. The Statcheck and GRIM-Test are especially good at spotting statistical errors. As more studies are retracted, AI offers helpful, albeit imperfect, support. It can speed up peer review and reduce reviewer workload, but it still has limits, such as bias and a lack of expert judgment. AI also brings risks like misreading results, ethical issues, and privacy concerns, so editors must make final decisions. To use AI safely and effectively, large, well-labeled datasets, teamwork across fields, and secure systems are required. Human oversight is always necessary to review research processes and ensure their reliability; humans must make the final decision and utilize AI responsibly.

Background: This study aimed to develop evaluation criteria for assessing a large-scale enterprise's occupational health management system (OHMS).

Methods: A literature review was conducted, and the OHMS evaluation criteria were selected. A two-round Delphi survey was conducted with 20 panelists in the fields of occupational and environmental medicine and industrial hygiene. The evaluation items were formulated based on the results of the first-round Delphi survey, written opinions submitted by experts, and focus group interviews with company health management managers. If the content validity ratio (CVR) of each evaluation item was less than 0.42, the item was rejected.

Results: The first Delphi survey questionnaire consisted of 36 evaluation criteria in 5 areas according to the Plan-Do-Check-Act cycle based on the literature review. These areas included 5 plan items, 6 do items, 4 check items, 3 action items, and 12 occupational health service items. From the first Delphi survey, out of the 36 evaluation items, 10 exhibited excellent content validity with a score of 0.7 or higher, and 25 demonstrated good content validity with a score lower than 0.7, but higher than 0.474. The evaluation items underwent significant revisions by incorporating written opinions from experts and feedback obtained from focus group interviews with health managers. The second Delphi survey questionnaire presented 31 evaluation criteria across four domains. Three criteria did not meet the CVR standards, and 28 items in four domains were finally selected.

Conclusion: Using this evaluation tool, the company's health management director will be able to continuously monitor and improve the system by evaluating the system that produces performance rather than evaluating performance.

Background: Antiplatelet agents are widely prescribed to prevent cardiovascular events, with cardiovascular disease being the leading global cause of death and the second most common in Korea. As the demand for antiplatelets increases, understanding real-world prescribing patterns is essential.

Methods: This study analyzed antiplatelet prescription trends for patients with first-ever ischemic stroke (IS) using 11 Korean observational databases transformed to a Common Data Model, spanning 1995-2023. Prescription shifts were assessed in relation to the 2013 CHANCE trial.

Results: The analysis included 162,361 patients with first-ever IS who had no prior antiplatelet therapy. Aspirin was the most commonly prescribed initial medication (39.4%), followed by aspirin-clopidogrel combination (28.2%), clopidogrel alone (13.7%), and cilostazol (5.0%). Initial medication were typically maintained: however, some patients initially on aspirin or clopidogrel switched to dual antiplatelet therapy (DAPT; aspirin and clopidogrel), while those on initial DAPT primarily transitioned to clopidogrel, then to aspirin. Following the CHANCE trial, a marked shift in prescription patterns was observed. Before CHANCE, aspirin was predominant (45.7%), followed by aspirin-clopidogrel (19.2%), and clopidogrel (15.5%). Post-CHANCE, aspirin-clopidogrel became the leading therapy (40.6%), with aspirin (30.3%) and clopidogrel (11.3%) monotherapy.

Conclusion: While aspirin remains the mainstay for secondary prevention of IS, the CHANCE trial significantly influenced increased use of DAPT. As evidence continues to grow for P2Y12 inhibitors in the IS context, analyzing antiplatelet prescription patterns is vital for evaluating the implementation of guidelines in clinical practice.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication after coronavirus disease 2019. In South Korea, the Korea Disease Control and Prevention Agency has conducted national surveillance of MIS-C from May 2020 to March 2023. This project was carried out during the second phase of the surveillance, which included enhancements to the reporting system starting in August 2022. In addition to monitoring the epidemiological and clinical characteristics, we analyzed cytokine changes and genetic factors.

Methods: A user-friendly web-based reporting system using an electronic case report form (e-CRF) was established to provide clinicians in the field with easy access to reports. Cases collected from August 2022 to March 2023 were evaluated to confirm diagnoses, and unclassified cases from the prior research period were also reviewed. For patients who provided consent, serum cytokine measurements and whole-genome sequence analyses were conducted.

Results: In this study, 55 cases were confirmed as MIS-C. Of the 32 cases reported via e-CRF in the second period, 28 were confirmed as MIS-C. Among 31 cases reported but unclassified in the first period, 27 were subsequently confirmed as MIS-C. The median patient age was 7.8 years (range: 2 months to 16 years), with 54.5% (30/55) male. Clinically, 15 patients (27%) had abnormal echocardiography findings, and 5 (9.1%) required intensive care unit care. Steroids were administered to 45 patients (81.8%) and intravenous immunoglobulin to 46 (83.6%). No mortality occurred. In two patients, 17 serum cytokines were measured pre- and post-treatment, with interleukin (IL)-6, IL-17/IL-17A, IL-1ra/IL-1F3, IL-10, and CXC motif chemokine ligand 10 (CXCL10)/inducible protein 10 kDa (IP-10) peaking before treatment and decreasing afterward. Whole-genome sequencing in 6 patients revealed no previously reported MIS-C-associated genetic variants.

Conclusion: Continuous monitoring of MIS-C cases is essential, as some may develop serious complications. Clinicians should remain vigilant in diagnosing MIS-C, and further research is needed to elucidate its pathogenesis.

Background: North Korea took strong border closure measures for about three years before and during the coronavirus disease 2019 (COVID-19) epidemic, and responded without diagnostic equipment and vaccines. This study systematically organizes the characteristics of North Korea's COVID-19 epidemic and response, and explores unanswered questions and policy implications.

Methods: The study used reports from North Korea's two official media outlets, the Chosen Central News Agency and Rodong Sinmun, data submitted to the World Health Organization South-East Asia Region, and academic papers. To estimate and evaluate the number of COVID-19 cases and deaths in North Korea, the epidemiological data from other countries were used.

Results: Faced with a severe shortage of appropriate diagnostic and therapeutic drugs and equipment, North Korea responded with prolonged, strict border closures, self-quarantines, restrictions on movement, and surveillance by identifying people with fever, without mass vaccination. The cumulative number of people with fever announced by North Korean authorities on August 4, 2022, just before the end of the outbreak, was 4,772,813, and the number of deaths from COVID-19 was 74. After the pandemic, efforts are underway to restore the healthcare system, including 'catch-up immunizations.' However, major controversies have been identified in the pandemic response process, such as 1) the initial inflow and spread route, 2) the final number of deaths, 3) the reason for refusing to provide vaccines to the COVAX facility, and 4) the success of North Korea's COVID-19 response.

Conclusion: Identifying North Korea's response, outcomes, and key controversies to the COVID-19 epidemic can provide important information not only for North Korea but also for countries with similar political and economic situations and the international community to better respond to the next pandemic.

Artificial intelligence (AI) tools employ prompts and algorithms to perform tasks that typically require human expertise, hypothesis formulation, and critical evaluation. AI enables rapid analysis of complex imaging data, automates segmentation and lesion detection, and supports real-time image-guided interventions. Deep learning architectures (CNNs, RNNs, U-Net, and transformer-based models) facilitate advanced image classification, reconstruction, and interpretation, achieving clinical accuracies above 90% in multiple domains, including coronavirus disease 2019, oncology, and rheumatology. Generative AI platforms (MedGAN, StyleGAN, CycleGAN, SinGAN-Seg) further support synthetic image creation and dataset augmentation, mitigating data scarcity while preserving patient privacy. However, the integration of AI in healthcare presents significant ethical challenges. Key concerns include algorithmic bias, patient privacy, transparency, accountability, and equitable access. Biases-such as annotation, automation, confirmation, demographic, and feedback-loop bias-can compromise diagnostic reliability and patient outcomes. Ethical deployment requires rigorous data governance, informed consent, anonymization, standardized validation frameworks, human oversight, and regulatory compliance. Maintaining interpretability and transparency of AI outputs is essential for clinical decision-making, while professional training and AI literacy are critical to mitigate overreliance and ensure patient safety.

Background: The relationship between cancer and the use of systemic immunosuppressants in psoriasis treatment has not well established. The aim of this study was to evaluate the association between the systemic immunosuppressants used in the treatment for psoriasis and the risk of certain cancers in Korean patients with moderate to severe psoriasis.

Methods: A retrospective cohort study was conducted involving 93,152 patients with moderate to severe psoriasis and 205,850 matched controls in Korea, using merged data from the National Health Insurance System, Health Insurance Review & Assessment Service, and Korea National Cancer Incidence Database from 2008 to 2018.

Results: The study observed a lower incidence of any cancer in moderate to severe psoriasis patients (2.4%) compared to the general population (2.99%). However, there was a higher risk of hematologic cancers, particularly Hodgkin's lymphoma, non-Hodgkin's lymphoma, leukemia, and cutaneous T cell lymphoma. Notably, methotrexate doses of ≥ 17.5 mg/week increased the risk of hematologic cancer risk by 7.546 times and cutaneous T cell lymphoma risk by 9.038 times, but cyclosporine and corticosteroids use did not show a significant association with increased incidence of hematologic cancers. Meanwhile, use of cyclosporine, methotrexate and corticosteroid did not significantly affect the risk of skin cancer among patients with psoriasis.

Conclusion: This study reveals an increased risk of hematologic cancers, such as cutaneous T cell lymphomas, associated with high-dose immunosuppressant use in moderate to severe psoriasis, underscoring the need for careful treatment management.

Background: Coal-powered electrical plant workers are exposed to coal dust in the entire work process. In South Korea, the processes with relatively high exposure to hazardous substances are mainly conducted by subcontractor employees. The harmful substances may cause pneumoconiosis, lung cancer, as well as a decrease in lung function. However, few studies have investigated changes in lung function among plant workers. The current study hypothesizes that the lung function of workers would be reduced by dust exposure and these reductions differ by employment status.

Methods: This study was conducted on 1,108 workers in coal-powered electrical plants who underwent lung function tests as a special health check-up from 2013 to 2018. The study population was divided into three groups according to the work they mainly perform. These groups were the contractor operator, subcontractor operator, and subcontractor maintenance worker. To compare the exposure level to hazardous substances, the exposure index was calculated with using the measurement data for the workplace environment. To confirm the change of lung function, this study used the repeated-measure analysis of variance.

Results: The subcontractor and the contractor had the highest and lowest exposure indices at 4.5 and 1.7, respectively. The lung function indicators significantly decreased among the subcontractor maintenance and operating workers compared with the contractor workers after 5 years. The pulmonary function with forced vital capacity (in liters) in subcontractors 1 and 2 decreased by 0.1 and 0.2 L, respectively. Forced expiratory volume in 1 second (in liters) also decreased in the subcontractors. In addition, the decrease in pulmonary function level over time differed according to each group because the interaction between time and employment status was statistically significant (P < 0.01).

Conclusion: These results suggest an association between coal dust and lung function deterioration. Also, differences in exposure can cause disparities in health outcomes even for workers in the same workplace.

Background: The skin microbiome plays a crucial role in defending against pathogens and modulating immunity, and its dysregulation is linked to various skin conditions, including acne.

Methods: In this study, four previously identified strains-Staphylococcus epidermidis B424F-5, S. epidermidis BS47C-1, Dermacoccus profundi BS35F-3, and Streptococcus salivarius BS320F-4- were selected from a skin microbiome database of healthy individuals. The efficacy and safety of these strains against acne-related inflammation were evaluated using in vitro and in vivo animal model experiments.

Results: Cutibacterium acnes exposure increased the expression of acne-associated inflammatory mediators-such as IL-1β, IL-6, IL-8, COX-2, iNOS, and TNF-α-particularly in keratinocytes, without inducing cytotoxicity. Treatment with heat-killed S. epidermidis BS47C-1 (SE2), D. profundi BS35F-3 (DP), and S. salivarius BS320F-4 (SS) significantly reduced these markers in vitro. In vivo, topical application of the strains alleviated inflammation in a C. acnes-induced mouse model, with histological evidence of reduced erythema and immune cell infiltration. Bulk RNA sequencing of keratinocytes showed that SE2 and DP downregulated cytokine and interferon signaling while enhancing skin barrier and antimicrobial gene expression, suggesting a dual anti-inflammatory and barrier-supporting mechanism.

Conclusion: These results provide compelling evidence of the efficacy and safety of human skin microbiome-derived strains as potential topical treatments for acne. By targeting both microbial colonization and inflammatory pathways, these strains offer a promising avenue for the development of novel acne therapeutics.

Background: Clear cell renal cell carcinoma (ccRCC) is the most aggressive subtype of renal cancer, characterized by profound metabolic reprogramming and lipid accumulation. Despite therapeutic advancements, reliable prognostic biomarkers remain limited. This study investigates the prognostic and functional relevance of nicotinamide N-methyltransferase (NNMT), and hypoxia inducible lipid droplet associated (HILPDA) in ccRCC.

Methods: RNA sequencing was performed on tumor and matched normal tissues from 14 ccRCC patients. Differential gene expression and pathway enrichment analyses were conducted. Receiver operating characteristic (ROC) curves were generated to assess diagnostic value. Kaplan-Meier survival analysis using The Cancer Genome Atlas data evaluated prognostic significance. NNMT knockdown experiments were conducted in ccRCC cell lines (SNU1272 and Caki-1) to assess functional relevance.

Results: NNMT and HILPDA were significantly upregulated in tumor tissues. Pathway analyses revealed associations with lipid metabolism and biosynthesis. ROC analysis showed high diagnostic accuracy (NNMT area under the curve [AUC], 0.923; HILPDA AUC, 0.943). Kaplan-Meier analysis demonstrated that high NNMT expression correlated with worse overall and disease-specific survival (P < 0.001), whereas HILPDA expression showed no prognostic impact. NNMT knockdown significantly reduced cell viability (P < 0.001), supporting its role in tumor progression.

Conclusion: NNMT is a promising prognostic biomarker and potential therapeutic target in ccRCC, supported by transcriptomic, clinical, and functional validation. While the prognostic relevance of HILPDA remains inconclusive, its metabolic associations suggest potential biological significance. Further studies with larger cohorts and in vivo validation are warranted.