Journal of Korean Medical Science最新文献

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; P = 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; P = 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.

Background: Intracranial aneurysm (IA) is the most common cause of subarachnoid hemorrhage (SAH), causing high morbidity and mortality. Experimental data have shown that metformin, an antidiabetic agent, has protective effects against IA rupture. This study assessed the effect of metformin on the long-term prognosis of diabetic patients treated for IA.

Methods: This retrospective cohort study included diabetic patients who underwent surgical clipping or endovascular coiling for IA between January 2009 and December 2020, based on Korean health insurance claims data. The primary outcome was the development of SAH. The risk associated with metformin use was evaluated using a multivariable Cox proportional hazards model supplemented with subgroup, propensity score matching, and time-varying Cox regression analyses.

Results: Of 14,086 diabetic patients treated for IA, 9,612 (68.2%) were metformin users. During a mean follow-up of 4.6 years, 120 (0.9%) patients experienced SAH. Metformin use was associated with a reduced risk of SAH (adjusted hazards ratio, 0.63; 95% confidence interval, 0.41-0.95; P = 0.028). This finding was consistent in subgroup, propensity score matching, and time-varying Cox regression analyses.

Conclusion: Metformin use in diabetic patients treated with clipping or coiling for IA was associated with reduced risk of SAH. These findings support the use of metformin as the preferred antidiabetic agent for such patients considering these benefits.

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, P < 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.

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; P = 0.005), more evident in recipients with pre-hematopoietic stem cell transplant varicella-zoster virus R⁺ serostatus (P = 0.006) and no prior varicella-zoster virus infection (P < 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.

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 KIAA1549-BRAF fusion (72%) and BRAF 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 KRAS 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 CDKN2A/B deletions (76%) and mutations of NF1 (64%), ATRX (52%), PTPN11 (28%), FGFR1/FGFR4 (20%), TERTp (16%), and TP53 (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.

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.

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.

Background: AG NPP709, formulated with extracts of ivy leaves and Coptis chinensis 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% (P = 0.655) and 34.6% vs. 25.5% (P = 0.142), respectively. The incidence of adverse events was similar in both groups (11.0% vs. 11.1%, P = 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.

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.