Journal of Korean Medical Science最新文献

Background: The widespread use of polluting fuels for indoor heating in the Demographic People's Republic of Korea (DPRK, North Korea) poses a significant risk for unintentional carbon monoxide (CO) poisoning. Despite its public health impact, reliable national-level data on the burden of CO poisoning in the DPRK remain scarce. This study addresses the need for more accurate estimates by analyzing fatality rates among hospitalized patients.

Methods: A meta-analysis was conducted to estimate the fatality rate of hospitalized patients with unintentional CO poisoning in the DPRK and to compare it with historical data from the Republic of Korea (ROK, South Korea). In the DPRK, relevant publications were identified through a keyword search of the North Korean Materials Center, and studies reporting both hospital admissions and fatality outcomes were selected for analysis. In the ROK, seven hospital-based studies conducted between the 1960s and 1970s were analyzed and stratified by the use of hyperbaric oxygen therapy (HBOT).

Results: The fatality rate in hospitalized patients with unintentional CO poisoning in the DPRK was estimated at 6.49% (95% confidence interval [CI], 4.23-9.83%) using a random-effects model. This rate was 2.48 times higher (95% CI, 1.16-5.29) than that observed among ROK patients who received HBOT (2.62%; 95% CI, 1.38-4.91%). When compared to ROK patients who did not receive HBOT (6.26%; 95% CI, 4.10-9.42%), the DPRK fatality rate was 1.04 times higher (95% CI, 0.57-1.88), indicating comparable clinical outcomes in settings where advanced therapeutic interventions such as HBOT were not available.

Conclusion: Accurate estimation of fatality rates among hospitalized patients with CO poisoning is essential to understanding its disease burden in the DPRK. The continued use of low-quality solid fuels for residential heating contributes substantially to the risk of unintentional CO poisoning. These findings highlight the urgent need for evidence-based public health interventions and international collaboration to improve heating practices and reduce preventable morbidity and mortality.

Background: Scientific medical research has progressed tremendously during the last 50 years, but concerns about research integrity, publishing ethics, and retraction trends have grown. Retractions are essential for revising the scientific record and maintaining credibility, yet an extensive long-term assessment of retracted medical publications is limited.

Methods: We performed a descriptive analysis of 50 years of retracted medical publications from the Retraction Watch Database. Data were refined to encompass solely medicine-related retractions, omitting corrections, expressions of concern, and reinstatements. We classified retraction reasons into 68 categories, emphasizing the top 10 most frequently encountered reasons. Temporal trends were evaluated employing semi-logarithmic linear regression models. The geographical distribution and journal-specific retractions were also examined.

Results: An analysis was conducted on 16,041 retracted medical documents from 1975 to 2024. The leading reasons for retraction included data concerns (31.47%), fraud (11.37%), peer review issues (11.21%), referencing issues (7.54%), and ethical violations (7.09%). The highest number of retractions was noted in Computational and Mathematical Methods in Medicine (5.91%), Journal of Healthcare Engineering (5.85%), and Evidence-Based Complementary and Alternative Medicine (4.36%). Approximately 45.28% of retracted papers included at least one author from China, followed by the United States and India. The medical subfields most impacted were oncology (19.87%), cardiovascular medicine (15.62%), and pharmacology (14.49%). Temporal analysis indicated a steady rise in retractions, with data concerns and fraud doubling typically every 5.5 and 5.2 years.

Conclusion: The rising amount of retractions underscores heightened scrutiny and enhanced detection techniques while highlighting ongoing research integrity issues. Data integrity, fraudulent activities, and compromised peer review are significant issues. Fortifying editorial policies, augmenting transparency, and bolstering research ethics education are essential for reducing misconduct and maintaining the integrity of medical papers.

Background: Body composition disorders such as sarcopenia, obesity, and osteoporosis are common; however, the body composition of patients with dizziness and vestibular dysfunction (VD) has not been thoroughly assessed.

Methods: This cross-sectional study included 9,682 participants aged over 40. Based on the results of a dizziness questionnaire and modified Romberg test, they were classified into three groups: dizziness associated with VD, dizziness without VD, and controls. A body composition analysis focused on muscles, bones, and fats.

Results: Multivariate regression analysis revealed that sarcopenia was associated with a higher risk of dizziness with VD when compared to dizziness without VD (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09-2.49; P = 0.017) and the control group (OR, 1.92; 95% CI, 1.28-2.88; P = 0.002). The proportions of bone mineral and fat were comparable among the groups.

Conclusion: Sarcopenia was found to be significantly associated with dizziness in the group with VD but not in those without it. While this study does not establish a causal relationship, maintaining muscle mass through proper diet and physical activity may be beneficial for individuals with VD. Such efforts could help manage overall health, potentially reducing risks associated with sarcopenia and improving balance. Further longitudinal studies are necessary to explore the potential causal pathways between VD and sarcopenia.

Background: We aimed to explore whether the dysfunctional pandemic grief of nursing professionals who experienced a patient's death may be related with their suicidal ideation and examine whether their interpersonal problems and dysfunctional self-focus mediate this association.

Methods: An anonymous online survey was conducted on November 16-18, 2023 among nurses in a tertiary hospital who witnessed people's death. Their psychological states were assessed using the Pandemic Grief Scale (PGS) for healthcare workers, Dysfunctional Self-focus Attributes Scale (DSAS), Interpersonal Needs Questionnaire (INQ), and Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). Linear regression analysis was conducted to explore the expecting variables for the DSI-SS. Mediation analysis was performed to examine the mediating effects of self-focus and interpersonal problems between grief reaction and suicidal ideation.

Results: The PGS (β = 0.18, P = 0.005), INQ-Perceived Burdensomeness (INQ-PB; β = 0.51, P < 0.001), and DSAS-Negatively Biased Focus (DSAS-NBF; β = 0.17, P = 0.021) were significantly associated with the DSI-SS. Mediation analysis using these variables showed that the PGS directly influenced the DSI-SS, and the INQ-PB and DSAS-NBF partially mediated the influence of the PGS on DSI-SS.

Conclusion: Dysfunctional grief experienced by nurses following the loss of patients during the pandemic exacerbated suicidal ideation by fostering a greater focus on negative outcomes and heightened feelings of being a burden. These findings underscore the need for targeted interventions to address these specific cognitive and emotional vulnerabilities to mitigate the risk of suicidal ideation.

Background: Pre-pregnancy blood pressure (BP) has gained attention as a potential predictor of adverse pregnancy outcomes. However, data on the impact of mildly elevated BP, particularly in women without overt hypertension, remain limited. In this study, we aimed to examine the association between pre-pregnancy BP and adverse pregnancy outcomes in women without a history of hypertension.

Methods: In this retrospective nationwide study, we included pregnant women with pre-pregnancy BP below 140/90 mmHg and no prior diagnosis of hypertension. Participants were categorized based on their pre-pregnancy BP into the normal BP (< 120/80 mmHg), elevated BP (120-129 and < 80 mmHg), and stage 1 hypertension (130-139 or 80-89 mmHg) groups. The following adverse pregnancy outcomes were recorded: preeclampsia, gestational diabetes, placental abruption, postpartum hemorrhage, preterm birth, and small or large for gestational age. Multivariable logistic regression was used to evaluate the associations between pre-pregnancy BP categories and adverse pregnancy outcomes.

Results: Among 298,433 women, 76.9% had normal BP, 8.7% had elevated BP, and 14.3% had stage 1 hypertension. The incidence of adverse outcomes significantly increased in groups with higher BP (normal BP, 24.8%; elevated BP, 27.1%, and stage 1 hypertension, 29.9%; P < 0.001). Compared to the normal BP group, adjusted odds ratios for adverse outcomes were 1.11 (95% confidence interval [CI], 1.07-1.14) for the elevated BP group and 1.24 (95% CI, 1.21-1.27) for the stage 1 hypertension group. A curvilinear relationship was observed between pre-pregnancy BP and the risk of adverse pregnancy outcomes.

Conclusion: Even modest increases in pre-pregnancy BP below the clinical threshold for hypertension were associated with a higher risk of adverse pregnancy outcomes. These findings highlight the need for early BP monitoring and management before pregnancy.

Background: Hepatic stellate cells (HSCs) activation is the principal event in the development of liver fibrosis in which succinate-G-protein coupled receptor 91 signaling has recently been shown to be a contributor. Moreover, endoplasmic reticulum (ER) stress has been reported to involve in HSC activation, but its association with succinate in pathogenesis of liver fibrosis remains scarce. In this study, we investigated the role of gemigliptin, an antidiabetic dipeptidyl peptidase-4 inhibitor, in the succinate-induced ER stress and activation of HSCs.

Methods: LX-2 cells, the immortalized human HSCs, were treated with succinate and gemigliptin. For animal experiments, C57BL/6N mice were divided into 3 groups: control diet, high-fat high-cholesterol (HFHC) diet, and HFHC diet mixed with gemigliptin.

Results: Succinate significantly induced HSC activation and increased expression of inflammatory markers and the increase in the migration of HSCs. The treatment of succinate also caused ER dilation and activated the unfolded protein response signaling as protein kinase RNA-like ER kinase, eIF2alpha, binding immunoglobulin protein, suggesting increasing ER stress in HSCs. All responses of HSCs to succinate were attenuated with the co-treatment of gemigliptin. Moreover, the exposure of HSCs to tunicamycin, an inducer of ER stress, promoted the expression of α-smooth muscle actin, proliferation and migration of HSCs. In vivo, the level of fibrotic and ER stress markers was increased in mice fed with HFHC diet and the administration of gemigliptin improved these changes in HFHC-induced mice.

Conclusion: This study showed the involvement of ER stress in the activation of succinate-induced LX-2 HSCs and gemigliptin significantly reduced ER stress in HSC activation. Therefore, gemigliptin may become an anti-fibrotic agent and targeting to succinate and ER stress may be a promising therapeutic in the management of liver fibrosis.

Background: The aim of this study is to review data on infants who received hearing aid support through the Infantile Hearing Aid Support Program after the settlement of universal newborn hearing screening (NHS) in the country over the past five years in Korea. This study seeks to identify the characteristics of infants with bilateral moderate hearing loss and to explore effective strategies for auditory rehabilitation by analyzing the timing of hearing aid interventions and regional disparities.

Methods: We analyzed the National Health Insurance Service (NHIS) records and the Infantile Hearing Aid Support Program database between January 2019 and December 2023. Our analysis included the NHS performance rate, NHS results, diagnostic hearing test outcomes, types of hearing loss, and the relationship between NHS results and hearing loss risk factors. Additionally, we examined the submission dates for the program, hearing aid purchase dates, types of hearing aids, and whether the residential area, prescription area, and hearing aid purchase areas matched.

Results: In this period, a total of 1,318,551 neonates were born and 540 bilateral moderate hearing loss infants registered for the Infantile Hearing Aid Support Program. The NHS performance rate increased to 95.4% by 2023, while the proportion of infants receiving diagnostic hearing tests within three months was 46.2%. The rate of infants receiving hearing aids within six months for auditory rehabilitation was 22.4%. Although no correlation was found between risk factors for hearing loss and NHS results, it was observed that infants admitted to the neonatal intensive care unit or with other syndromes had a higher likelihood of being diagnosed with moderate hearing loss, even if they passed the NHS. Finally, there were regional disparities in access to hearing aid prescriptions and rehabilitation.

Conclusion: Our findings suggest that auditory rehabilitation achieves greater focus following the implementation of NHS. This study also provides valuable insights into the hearing status and rehabilitation outcomes of infants with moderate hearing loss. Furthermore, we anticipate that these results will contribute to informing policies aimed at reducing regional disparities in access to auditory rehabilitation services.

This corrects the article on p. e317 in vol. 40, PMID: 41218593.

Background: Cervical cancer, one of the most prevalent cancers among women worldwidely, has seen improved survival rates due to advancements in pelvic radiation therapy (RT). Several risk factors for pelvic insufficiency fracture (PIF) have been reported in patients with cervical cancer. This study aimed to estimate the incidence of PIFs in patients with cervical cancer and assess the potential risk factors for PIF using a national claim database.

Methods: A total of 13,480 cervical cancer patients were identified during 2007 to 2016 from linkage between the Korea National Health Insurance Service and Korea Central Cancer Registry. Patients were identified and divided into PIF and non-PIF groups. The incidence of PIFs was estimated and risk factors for PIFs, including age, type of medical institution, residential area, insurance type, Surveillance, Epidemiology, and End Results summarized stage, RT and comorbidities, were assessed using multivariate Cox proportional hazards regression analysis.

Results: In a cohort of 13,480 patients diagnosed with cervical cancer, PIF occurred in 134 (1.0%). Among the variables, older age (adjusted hazard ratio [aHR], 1.063; 95% confidence interval [CI], 1.047-1.079; P < 0.001) and RT (aHR, 1.829; 95% CI, 1.235-2.710; P = 0.003) were significantly associated with occurrence of PIF.

Conclusion: The incidence of PIFs in cervical cancer survivors was 1.0% in this national claim database study and it demonstrated that RT and older age were significantly associated with an increased risk of PIF. Our findings suggest that clinicians should be aware of the risk of PIF, especially in older patients who underwent RT.

Background: Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database.

Methods: From 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups.

Results: Among the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group (P < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients (P = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients.

Conclusion: In patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR.