Journal of Korean Medical Science最新文献

Background: Deep brain stimulation (DBS) is a well-established treatment for movement disorders, particularly Parkinson's disease (PD), where precise electrode placement is critical for optimal outcomes. With advances in robotic systems and imaging technologies, robot-assisted asleep DBS combined with microelectrode recording (MER) has emerged as a promising technique. This study aimed to evaluate the surgical accuracy and clinical outcomes of robot-assisted asleep DBS with MER in PD patients.

Methods: We conducted a retrospective review of PD patients who underwent either robot-assisted asleep DBS or conventional manual frame-based DBS at a single center between August 2021 and August 2024. Targeting accuracy was assessed using radial error measured on intraoperative computed tomography. Clinical outcomes were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), levodopa equivalent daily dose (LEDD), and the Parkinson's Disease Questionnaire-39 (PDQ-39) at baseline, 6 months, and 1 year postoperatively.

Results: A total of 51 patients underwent robot-assisted asleep DBS. This group demonstrated significantly higher targeting accuracy than the manual frame-based group (P = 0.001). Both surgical methods resulted in significant improvements in UPDRS, LEDD, and PDQ-39 scores over time, with no significant differences between groups. MER was successfully performed under general anesthesia using remimazolam, maintaining high-quality recordings and patient safety.

Conclusion: Robot-assisted asleep DBS significantly improves targeting accuracy while maintaining comparable clinical outcomes to manual frame-based DBS. Asleep DBS with MER is a safe and effective approach, enhancing patient comfort without compromising efficacy. These findings support the broader adoption of robotic techniques in DBS for PD.

Background: Studies that examine a link between long-term exposure to ambient particulate matter (PM) and atopic dermatitis (AD) in children are lacking. This longitudinal study aimed to investigate the effect of long-term exposure to PM on AD in infants.

Methods: We enrolled 150 infants aged 0-1 years with AD and followed them until age 3 in Seoul, Korea. We assessed long-term exposures to ambient particulate matter with an aerodiameter < 10 µm (PM₁₀) from birth to age 3 using a fusion model based on each individual's home address. Effects of long-term exposure to PM₁₀ on AD persistence and sensitization to aeroallergens were evaluated using Cox proportional hazard regression models after adjusting for potential confounders.

Results: Of the 150 infants, 54 (36.0%) showed remission of AD by age 3. Overall, long-term exposure to PM₁₀ was not significantly associated with AD persistence at age 3 (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.97-1.12; P = 0.267 per 1 µg/m³). However, when stratified by the baseline AD severity, increased exposure to PM₁₀ significantly elevated the risk of persistence in children with moderate AD at enrollment (HR, 1.19; 95% CI, 1.05-1.36; P = 0.007). Long-term exposure to PM₁₀ was also associated with an increased overall risk of sensitization to pollen (HR, 1.12; 95% CI, 1.00-1.24; P = 0.043), with a more pronounced effect in children with moderate AD (HR, 1.31; 95% CI, 1.08-1.58; P = 0.005). However, no significant association was observed between PM₁₀ exposure and sensitization to house dust mite or pet allergens.

Conclusion: An early-life long-term exposure to ambient PM₁₀ in infants with AD may decrease the remission and increase the sensitization to pollen at age 3.

Background: Community-acquired pneumonia (CAP) frequently requires empirical antibiotic treatment owing to its nonspecific symptoms and the need for urgent intervention. Understanding the epidemiology of patients hospitalized with CAP at a regional level is essential for developing effective treatment strategies. Therefore, this study aimed to assess the epidemiological and clinical characteristics of CAP in patients admitted to a tertiary care hospital in Korea.

Methods: Utilizing a common data model, we selected patients aged 18 years and older who were admitted to Seoul National University Bundang Hospital from January 2005 to July 31, 2019. These patients presented with pneumonia-related symptoms, such as fever or a respiratory symptom, and had a pneumonia diagnosis code within 7 days of admission. The medical records of these patients were retrospectively reviewed. Patients without pneumonia, who had been hospitalized within 14 days before the start of the study, and those with pulmonary tuberculosis were excluded.

Results: Out of 7,147 patients with pneumonia-related symptoms, 4,083 were included in the study. The mean age of the patients was 70.1 years, with 66.7% being male. The most prevalent comorbidities were chronic lung disease (42.6%), malignancy (24.4%), and immunocompromised conditions (26.5%). Klebsiella pneumoniae was the most commonly identified pathogen in sputum cultures, followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae. The overall in-hospital mortality rate was 3.9%. The factors significantly associated with increased in-hospital mortality were male sex, immunocompromised status, presence of dyspnea, unstable vital signs, low hemoglobin levels, and high C-reactive protein levels.

Conclusion: In patients hospitalized with CAP in a tertiary care center in this study, gram-negative bacteria and the traditionally known S. pneumoniae were commonly found. This finding appeared related to patient age and underlying conditions such as chronic lung disease. Furthermore, male sex and an immunocompromised state were found to be significant risk factors for in-hospital mortality along with worse clinical indices.

Background: In February 2024, a nationwide medical crisis erupted in South Korea following the mass resignation of over 90% of trainee physicians in protest against the government's healthcare reform policy. Amid the ongoing crisis, the government initiated a series of restructuring activities aimed at concentrating high-complexity surgeries and critical care at tertiary hospitals, while redistributing low-complexity procedures to hospitals and clinics. However, the nationwide impact of the reform policy on high-complexity surgical practices, particularly in terms of institutional type, departmental specialty, and regional distribution, has not yet been assessed.

Methods: Using national insurance claims data from the Korean Health Insurance Review and Assessment Service, we analyzed 914 high-complexity surgical procedures across tertiary hospitals (n = 47), general hospitals (n = 331), and hospitals/clinics (n = 37,888). Claims data from February to July 2023 (pre-crisis) were compared with those from February to July 2024 (post-crisis), stratified by institutional type, medical specialty, and geographic region.

Results: After the medical crisis, overall high-complexity surgical claims decreased by 10% (P < 0.001), with a 19% decrease in tertiary hospitals (P < 0.001), 6% increase in general hospitals (P = 0.115), and 27% increase in hospitals/clinics (P < 0.001). The decreased capacity for oncological surgery in tertiary hospitals by 16% (P < 0.001) was partly compensated by increased volume in general hospitals by 23% (P = 0.001). In terms of medical specialty, shifts from tertiary to general hospital in cardiothoracic surgery (1%, P = 0.636), neurosurgery (1%, P = 0.765), and interventional radiology (0%, P = 0.186) were negligible. Oncological surgery in the capital region, which is home to a higher concentration of tertiary hospitals, decreased by 17%, while oncological surgery in around-capital and non-capital regions increased by 11% and 5%, respectively.

Conclusion: During the Korean medical crisis in 2024, nationwide surgical capacity and systems for maintaining competency were significantly compromised. Although some procedures were offset by redistribution to lower-tier institutions or regional hospitals, most high-complexity surgeries-particularly those requiring critical care-did not recover.

Background: Enteric zoster, a rare herpes zoster manifestation, occurs when varicella-zoster virus (VZV) reactivates enteric nervous system neurons, leading to abdominal pain and gastrointestinal symptoms without a cutaneous rash. Due to absence of the skin lesion, diagnosis is challenging. Recently, salivary VZV DNA polymerase chain reaction (PCR) has been suggested as a diagnostic test for herpes zoster. This investigation aimed to assess the prevalence of salivary VZV DNA positivity among patients with acute abdominal pain and to evaluate its diagnostic value by comparing PCR results in patients undergoing intra-abdominal surgery.

Methods: We prospectively enrolled adult patients presenting to the emergency department with acute abdominal pain between June 2023 and April 2024 at a community-based university hospital. The patients underwent detailed history reviews, blood tests, and abdominal computed tomography (CT). Salivary VZV DNA PCR was performed. Additionally, to investigate subclinical VZV reactivation under acute gastrointestinal stress, salivary VZV DNA PCR was conducted within 48 hour post-abdominal surgery as a control. Enteric zoster was inferred in individuals exhibiting positive salivary VZV DNA, identified through real-time PCR.

Results: In total, 101 patients with abdominal pain were enrolled. Positive salivary VZV DNA PCR results were found in 5 (5.0%) patients. Two patients had acute cholecystitis, one had acute appendicitis, one had acute pancreatitis, and the remaining patient had no identifiable cause of abdominal pain on CT. All 19 patients tested negative for salivary VZV DNA PCR post-abdominal surgery within 48 hours.

Conclusion: About 5% of patients experiencing acute abdominal pain exhibited positive salivary VZV DNA PCR findings, indicating that enteric zoster may be a potential factor in both recognized and unidentified causes of acute abdominal pain. Further research is needed to determine if antiviral therapy guided by salivary VZV DNA PCR results can alleviate abdominal pain in this patient population.

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.