Journal of Korean Medical Science最新文献

Background: Mycoplasma genitalium is a sexually transmitted pathogen for which azithromycin is recommended as the first-line therapy. However, the prevalence of macrolide resistance has increased globally, reaching peak levels in Asia-Pacific countries. Macrolide resistance-guided therapy (MRT) is cost-effective, with minimal collateral damage and a high cure rate. We aimed to validate the performance of the Allplex™ MG & AziR Assay (AziR), which was designed to detect genetic variations in MRT.

Methods: Using 279 M. genitalium-positive genitourinary samples, the performance of the AziR assay was compared with that of Sanger sequencing of the 23S rRNA gene of M. genitalium.

Results: The AziR assay targeting positions 2058 and 2059 in the 23S rRNA gene revealed that 133 and 146 cases, respectively, carried the wild and mutant types of adenosine, while sequencing detected the wild and mutant types in 134 and 145 cases, respectively. The AziR assay demonstrated a sensitivity of 100% (95% confidence interval [CI], 0.968-1) and specificity of 99.254% (95% CI, 0.953-1) in distinguishing wild type from mutant variants. Of the 279 samples, only six showed genetic discrepancies between the two tests: one wild type by sequencing was found to have A2059G by the AziR assay, two A2059Gs were discordant as A2058Ts, one A2059G was discordant as A2058G, and two A2058Gs by sequencing were reported as A2059Gs by the AziR assay.

Conclusion: Our results show that the AziR assay can identify specific mutants in a single reaction and demonstrates high sensitivity and specificity for detecting macrolide resistant M. genitalium. Therefore, the AziR assay can be reliably used for MRT.

As the most rapidly aging nation, Korea offers a unique lens into the future of dementia, one of the most pressing global health challenges of the 21st century. The Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD), launched amid the country's rapid demographic transition, exemplifies how population-specific research can guide national policy and challenge universal assumptions in dementia science. More than a cohort study, KLOSCAD provides a methodological blueprint for identifying culturally relevant risk factors, testing the applicability of Western models, and shaping prevention strategies for local contexts. Its evolution from a national study to a globally recognized platform reflects the value of sustained governmental support, strategic design, and international collaboration. As the dementia epidemic's center shifts to Asia, the KLOSCAD experience underscores that diversity is not a confounder but a scientific opportunity, critical for building both universal and context-sensitive approaches to understanding and preventing dementia worldwide.

Background: Hearing loss (HL) is a prevalent public health issue that affects communication and quality of life. Hearing aids (HAs) are an effective rehabilitation tool, yet adoption rates remain low. To improve accessibility, South Korea revised its HA financial support policy in 2015. This study evaluates changes in HA adoption rates over the past decade and examines the impact of these policy modifications.

Methods: This study analyzed data from 9,994 (2020-2022) and 10,019 (2010-2012) individuals aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey. HL was categorized based on pure-tone average thresholds: mild (26-39 dB HL), unsupported disabling (≥ 40 dB HL but not meeting financial aid criteria), lowest-grade hearing disability (≥ 40 dB HL in the better ear and ≥ 80 dB HL in the worse ear), and supported disabling (≥ 60 dB HL, eligible for financial aid). HA adoption rates were compared between the survey periods.

Results: The overall HA adoption rate among individuals with HL significantly increased from 2.12% (2010-2012) to 4.73% (2020-2022) (P < 0.001). This increase was observed across all HL severities (mild: 0.30% → 0.64%; unsupported disabling: 4.23% → 9.42%; lowest-grade hearing disability group: 4.24% → 16.29%; supported disabling: 23.06% → 53.52%; all P < 0.001). The highest HA adoption rates were seen in individuals in their 70s, and the supported disabling HL group had adoption rates 5-6 times higher than the unsupported group. Multivariable analysis confirmed a significant association between increased HA adoption and survey period (adjusted odds ratio, 3.70, P < 0.001).

Conclusion: HA adoption rates have nearly doubled over the past decade, with the greatest increases observed among financially supported individuals and those in their 70s. Expanding financial support eligibility may further enhance HA adoption, particularly among those with disabling but unsupported HL, ensuring broader access to hearing rehabilitation.

The P value remains one of the most frequently reported statistical measures in biomedical literature, yet it is also one of the most widely misunderstood statistics. Introduced by Fisher as a measure of evidence against the null hypothesis, it was subsequently incorporated into the Neyman-Pearson decision framework, which emphasized long-run error rates and decision thresholds. Over the past decades, reliance on the conventional cut-off of P = 0.05 has fostered misconceptions, including the belief that the P value represents the probability that the null hypothesis is true or that statistical significance implies clinical importance. In this review, I examine the historical evolution of the P value, clarify the conceptual distinctions between evidential and decision-theoretic perspectives, and illustrate their implications through a case study. Common misinterpretations and the limitations of threshold-based inference are discussed, together with the consequences for reproducibility, statistical power, and interpretation of results. Recent recommendations from statistical associations and methodologists to move beyond dichotomous significance testing are highlighted. Complementary approaches, such as estimation of effect sizes with confidence intervals (CIs), likelihood ratios, and Bayesian inference, are briefly considered. I conclude that although the P value may provide useful information when properly interpreted, it should not be used as a sole criterion for inference. Transparent reporting of effect sizes, CIs, and contextual information offers a more reliable foundation for scientific interpretation and decision making.

Background: Fibrosis, caused by hepatic stellate cell (HSC) activation and resulting in extracellular matrix accumulation, cirrhosis, and ultimately liver failure, remains a critical challenge. Recent advances in exosome-based drug delivery systems offer an innovative approach by specifically targeting activated HSCs to combat fibrotic diseases. This study evaluated the anti-fibrotic potential of miR-150-loaded exosomes engineered with platelet-derived growth factor receptor (PDGFR)-targeting peptides for precise delivery to activated HSCs.

Methods: Adipose-derived stem cells were genetically engineered to express PDGFR-targeting peptides via pDisplay vectors, resulting in the production of targeted exosomes (tEx). Subsequently, miR-150 was loaded into the targeted exosomes, termed tEx. In vitro and in vivo studies were conducted using a thioacetamide-induced liver fibrosis model.

Results: Either real-time polymerase chain reaction or western blot analysis demonstrated that tEx significantly reduced fibrotic markers, including alpha-smooth muscle actin, collagen type I alpha 1 chain, and transforming growth factor beta 1, both in vitro and in vivo. Western blotting showed a 40% decrease in collagen deposition, while enzyme-linked immunosorbent assay indicated a 30% reduction in serum liver enzyme levels (aspartate transaminase and alanine aminotransferase) compared to controls. Immunohistochemical analysis demonstrated that tEx significantly reduced fibrosis markers and collagen deposition in liver tissues compared to controls, highlighting their strong anti-fibrotic and anti-inflammatory potential (P < 0.05).

Conclusion: The findings highlight the potential of PDGFR-tEx for efficient miR-150 delivery, demonstrating improved therapeutic efficacy with reduced systemic toxicity. This targeted approach may offer a more precise and effective treatment for liver fibrosis, surpassing conventional methods.

Background: Besifovir dipivoxil maleate (BSV) is a novel antiviral agent approved in Korea for chronic hepatitis B (CHB) treatment. While previous comparative studies between BSV and tenofovir disoproxil fumarate (TDF) have suggested lower renal toxicity in BSV, these findings were limited by small sample sizes. This study aimed to comprehensively assess the incidence of chronic kidney disease (CKD) in CHB patients treated with BSV versus TDF using a nationwide cohort.

Methods: In this retrospective cohort study, we analyzed treatment-naïve CHB patients who initiated BSV or TDF therapy between January 2018 and December 2022. Using the South Korean national health database, we created balanced cohorts of 19,959 patients in the BSV group and 19,991 patients in the TDF group through inverse probability of treatment weighting (IPTW). The primary outcome was determined by CKD incidence.

Results: The incidence rate (IR) of CKD was lower in the BSV group than in the TDF group (2.29 vs. 3.42 per 1,000 person-years; incidence rate ratio [IRR], 1.50; 95% confidence interval [CI], 1.18-1.89; P < 0.001). Using BSV as the reference, the adjusted hazard ratio (HR) for CKD in the TDF group was 1.36 (95% CI, 1.07-1.73; P = 0.012). In patients aged 60 years and older, the difference in CKD incidence and risk between the 2 groups was more pronounced than in patients under 60 (IR, 4.47 vs. 7.52 per 1,000 person-years; IRR, 1.68; 95% CI, 1.10-2.57; P = 0.017 and HR, 1.62; 95% CI, 1.04-2.51; P = 0.032).

Conclusion: BSV is linked to a lower incidence of CKD than TDF, particularly in patients aged 60 and older, suggesting BSV may be a safer treatment option in elderly patients at high risk of renal impairment.

Background: Whole blood viscosity (WBV) determines wall shear stress, representing dynamic force and contributing to aneurysmal remodeling. We hypothesized that administering balanced crystalloid (Group-C) or hydroxyethyl starch (HES) 130/0.4 (Group-HES) for IV fluid management would have a different impact on high-shear WBV during the endovascular detachable coiling (EDC).

Methods: Thirty EDC patients randomly got HES (Group-HES, n = 15) or crystalloid (Group-C, n = 15) as the main IV fluid resuscitation during the procedure. The WBV at a shear rate of 300 sec^-¹ of arterial blood samples (WBV₃₀₀), which depict WBV at a larger-sized artery, were determined and analyzed before and after the EDC procedure (Pre and Post). The changes in hematocrit (Hct) and arterial-to-inspired-fraction oxygen ratio (P/F-O₂ ratio) were determined as indices of the degrees of hemodilution and extravascular fluid shift, respectively.

Results: The median (25-75%) volume of infused crystalloid was 800 (700, 1,200) mL in Group-C and those of HES and crystalloid were 400 (150, 750) and of 500 (400, 600) mL in Group-HES, respectively. Pre-WBV₃₀₀ showed no significant inter-group difference. However, Post-WBV₃₀₀ in Group-HES was significantly lower than in Group-C (3.40 ± 0.33 vs. 3.95 ± 0.79 centipoise, P = 0.023). The Hct and P/F-O₂ ratios were comparable between the two groups.

Conclusion: Our study showed that HES infusion provided significantly lower WBV than crystalloid infusion during the EDC procedure. Further study is warranted to determine whether the lower WBV after HES infusion would enhance clinical outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT02700607.

Background: Artificial intelligence (AI) has promoted progress across various fields. The number of papers regarding AI has risen in recent years. This study examines retracted publications regarding AI by analyzing trends, journals, and reasons.

Methods: This descriptive cross-sectional study thoroughly investigated retracted AI-related papers listed in PubMed. The data extraction comprised bibliographic data, reasons for retraction, citation metrics, journal indexing status, and Altmetric Attention Scores (AASs). Retraction notices were classified according to particular reasons. Descriptive statistics were employed to evaluate retraction trends, geographic distribution, and citation impact.

Results: A total of 764 retracted AI-related papers were examined, with the most retractions occurring in 2023 (n = 667). China had the highest number (n = 551), followed by India (n = 40) and Bangladesh (n = 23). Journals focusing on mathematical and computational biology, neurosciences, and healthcare sciences had the most retractions. The most common retraction reasons were peer review issues (n = 716) and data concerns (n = 714), followed by irrelevant citations (n = 571) and unethical AI use (n = 238). The median time to retraction was 510 days (18-4,200). The median citation and AAS scores were (0-167) and 0 (0-191).

Conclusion: The high number of retractions from China highlights the need for higher research standards. Deficits in peer review and data issues emerged as the main reasons for retraction, underscoring persistent challenges in maintaining research integrity and quality assurance. For scientific literature integrity, academic institutions, publishers, and researchers should stress transparency, ethics, and rigorous post-publication inspection.

Background: This study provides a comprehensive review of studies comparing the effectiveness of varicella vaccinations and the duration of their protection.

Methods: We conducted a systematic literature review to identify comparative studies evaluating the effectiveness of the varicella vaccine. A meta-analysis was performed to assess the effectiveness of one-dose and two-dose vaccinations, as well as the outcomes for moderate and severe illness, and the duration of protection, using random effects models.

Results: Out of 66 studies, 57 reported the effectiveness of a single-dose varicella vaccine, 28 examined the two-dose vaccination, and 25 focused on effectiveness against moderate to severe disease. Of these, 59 were observational studies and 7 were trials. Thirteen studies reported the duration of protection. The overall vaccine effectiveness for a single dose was 79% (76-82%; I² = 97.2%), while for two doses, it was 94% (93-96%; I² = 90.8%). The overall effectiveness against moderate or severe illness was 92% (90-94%; I² = 90.3%). The duration of protection showed a slight decline over time. Evidence suggests that both one and two doses of the varicella vaccine offer short-term protection, though this protection wanes rapidly.

Conclusion: The two-dose vaccination demonstrated superior clinical efficacy compared to the one-dose vaccination, with protection slightly diminishing over time. These findings highlight the importance of implementing universal two-dose varicella vaccination programs in countries.

Trial registration: PROSPERO Identifier: CRD42024589864.

Background: Complex post-traumatic stress disorder (CPTSD) is characterized by the presence of post-traumatic stress disorder symptoms combined with disturbances in self-organization. However, treatment strategies for this newly defined condition remain lacking.

Methods: In this systematic review of international studies exploring psychological interventions for CPTSD in children, adolescents, and adults, we screened PubMed and Google Scholar for relevant literature while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: In total, 6 studies met our inclusion criteria. The psychological interventions explored in these studies encompassed a range of therapeutic modalities, including trauma-focused cognitive behavioral therapy, prolonged exposure therapy, skill training in affect and interpersonal regulation narrative therapy, mindfulness-based practices, and group therapies with a focus on somatic or body-oriented techniques. For children and adolescents with CPTSD, interventions were typically concise and followed a structured, phase-based approach, whereas adults often benefited from longer intervention durations that facilitated a more gradual and profound therapeutic process.

Conclusion: This review highlights the effectiveness of psychological interventions in addressing CPTSD symptoms. However, treatments specifically targeting CPTSD's unique symptom clusters, especially disturbances in self-organization, remain limited. Future research should prioritize the development of interventions tailored to address these distinct features.