Journal of Korean Medical Science最新文献

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.

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: 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.

Background: To investigate the long-term trends in prevalence and pandemic-related factors of unmet healthcare needs among a nationwide large-scale cohort with or without depressive symptoms from the Korea Community Health Survey.

Methods: We analyzed 2,850,315 Korean adults aged 19 years or older, including individuals with or without depressive symptoms. Our study investigated the trends and risk factors for unmet healthcare needs among individuals, stratified by the presence of depressive symptoms during the pre-pandemic (2009-2019) and pandemic era (2020-2022). Weighted odds ratios and weighted regression slope coefficients (β) with 95% confidence intervals (CIs) were employed to analyze the prevalence of unmet healthcare needs.

Results: Of a total of 2,850,315 individuals (mean ± standard deviation age, 53.04 ± 17.43 years; male, 44.81%). Unmet healthcare needs decreased in both groups during the observation period. Individuals with depressive symptoms had a 2-3 times higher prevalence of unmet healthcare needs. The downward trend for those with depressive symptoms, from 34.55% (95% CI, 33.77-35.34) in 2009-2010 to 21.50% (20.91-22.09) in 2017-2019, reversed during the pandemic, increasing from 13.82% (12.95-14.69) in 2020 to 14.37% (13.62-15.12) in 2022.

Conclusion: The study highlights increased unmet healthcare needs among individuals with depressive symptoms during the pandemic, emphasizing the necessity for tailored policies and effective healthcare distribution to reduce barriers for vulnerable populations during global crises.

Background: Diffuse panbronchiolitis (DPB) is a rare and progressive inflammatory lung disease affecting the small airways; however, it is often misdiagnosed as other respiratory conditions, such as nontuberculous mycobacterial infection or bronchiectasis. This study aimed to apply machine learning (ML) algorithms to improve early diagnostic accuracy for DPB.

Methods: ML algorithms were applied using clinical, laboratory, and radiological data from 99 patients with suspected DPB. Patients were categorized into two groups based on established diagnostic criteria and major diagnostic criteria for DPB without impaired lung function. Seven ML models were evaluated.

Results: The least absolute shrinkage and selection operator regression model demonstrated the highest predictive accuracy. The analysis identified two key diagnostic factors, allergic rhinitis and the presence of macronodules on computed tomography scans, both of which were strongly associated with DPB.

Conclusion: These results highlight the first application of ML in diagnosing DPB and underscore the significance of allergic rhinitis and macronodules as critical indicators for early detection. Incorporating ML techniques into clinical practice could improve the diagnostic accuracy and efficiency for rare diseases such as DPB. Further research involving larger patient datasets is recommended to validate these results and refine the diagnostic criteria for DPB.

Background: Trends in mental health-related emergency department (ED) use among adolescents and young adults in South Korea are largely unexplored. This study evaluated recent trends and characteristics of these ED visits.

Methods: This nationwide epidemiologic study used data from the National Emergency Department Information System in Korea, including patients who visited the ED to receive psychiatric consultation between 2017 and 2021. Adolescents and young adults were defined as 10-24 years old, and their characteristics and trends were compared with those of adult (≥ 25 years) patients.

Results: Among 117,997 patients, adolescents and young adults comprised 28.0% of the population. There was a significant increasing trend in ED visits between 2017 and 2021 among adolescents and young adults (4,737 to 8,787, P < 0.001), whereas the adult patient visits were stationary (16,798 to 16,313, P = 0.497). In the adolescents and young adults group, there was a greater predominance of females (67.1%), transfer from other facilities (10.8%), discharge to home after treatment (71.7%), and visits due to intentional self-harm (26.9%) than in the older age group. The most common diagnostic codes were F30-F39 (mood [affective] disorder; 43.2%), and the most common diagnosis was F32 (depressive episode), accounting for 17.7%. Diagnoses in the F30-39 category, especially F32, significantly increased each year (P < 0.001).

Conclusion: The study revealed that from 2017 to 2021, mental health-related ED visits for adolescents and young adults nearly doubled, especially for depression and mood disorders, with a significant increase among female patients. This highlights the need for tailored strategies and more psychiatric expertise in the ED.

Background: Isoniazid resistance is the most common type of ant-tuberculosis drug resistance, which is often neglected in clinical practice. This study aimed to evaluate the impact of isoniazid mono-resistant tuberculosis (Hr-TB) on the treatment outcomes of people with pulmonary tuberculosis.

Methods: People with pulmonary tuberculosis were enrolled from the Korea Tuberculosis Cohort (KTBC) registry and the multicenter prospective cohort study of pulmonary tuberculosis (COSMOTB). Isoniazid resistance was confirmed using drug susceptibility test results. The primary outcome was an unfavorable outcome, which defined as comprising death, failure, loss-to-follow-up, still-on-treatment, and not-evaluated. Logistic regression analysis was conducted to evaluate effect of isoniazid resistance on treatment outcomes. We also compared 2-month sputum negative culture conversion rate and incidence of adverse events between Hr-TB and drug-susceptible tuberculosis.

Results: From the KTBC and COSMOTB databases, 10,482 and 758 participants were included, respectively. Compared to drug-susceptible tuberculosis, Hr-TB had higher rates of unfavorable outcome in the KTBC (45.8% vs. 37.0%, P < 0.001) and COSMOTB (31.5% vs. 17.9%, P = 0.014). Multivariable logistic regression analysis showed significant association between isoniazid resistance and unfavorable outcome in the KTBC (adjusted odds ratio [aOR], 1.43; 95% confidence interval [CI], 1.24-1.65) and in the COSMOTB (aOR, 1.98; 95% CI, 1.02-3.85). Additional analyses on COSMOTB data showed that Hr-TB had more serious adverse drug reactions, while 2-month sputum culture conversion rates did not differ significantly.

Conclusion: Isoniazid resistance is significantly associated with unfavorable clinical outcomes.

Background: This study aimed to investigate the long-term clinical outcomes of ABO-incompatible kidney transplantation (ABO icKT) in patients with high baseline anti-A/B antibody titers.

Methods: This study included 271 cases of ABO icKT. Of these, 42 patients with a baseline antibody titer of ≥ 1:256 were assigned to the high-titer group, while the remaining 229 patients were categorized into the low-titer group. We compared the groups regarding the number of required pre-transplant plasmapheresis (PP) and intravenous immunoglobulin (IVIG) sessions. Clinical outcomes included post-operative bleeding, biopsy-proven acute rejection (BPAR), infectious complications, changes in allograft function, and long-term allograft and patient survival.

Results: The high-titer group required significantly more sessions of PP and IVIG than the low-titer group (8.74 ± 2.68 vs. 3.85 ± 1.64; P < 0.001). Following transplantation, anti-A/B antibody titers remained elevated in the high-titer group. There was no significant difference in post-operative bleeding between the two groups. However, the incidence of bacterial infection was higher in the high-titer group compared with the low-titer group (47.62% vs. 30.57%; P = 0.031), although this association was not significant in multivariable analysis. The incidence of total BPAR did not differ significantly; however, chronic active antibody-mediated rejection was more frequently observed in the high-titer group (7.14% vs. 0.87%; P = 0.028). Overall allograft and patient survival did not differ significantly between the two groups.

Conclusion: Patients with high baseline anti-A/B titers demonstrated comparable short-term and long-term patient and allograft outcomes to those in the low-titer group.