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Background The increasing rate of excess body weight (EBW) in the global population has led to growing health concerns, including cancer-related EBW. We aimed to estimate the population attributable fraction (PAF) of cancer incidence and deaths linked to EBW in Korean individuals from 2015 to 2030 and to compare its value with various body mass index cutoffs. Methods Levin’s formula was used to calculate the PAF; the prevalence rates were computed using the Korean National Health and Nutrition Examination Survey data, while the relative risks of specific cancers related to EBW were estimated based on the results of Korean cohort studies. To account for the 15-year latency period when estimating the PAF in 2020, the prevalence rates from 2015 and attributable cases or deaths from 2020 were used. Results The PAF attributed to EBW was similar for both cancer incidence and deaths using either the World Health Organization (WHO) Asian-Pacific region standard or a modified Asian standard, with the WHO standard yielding the lowest values. In the Korean population, the PAFs of EBW for cancer incidence were 2.96% in men and 3.61% in women, while those for cancer deaths were 0.67% in men and 3.06% in women in 2020. Additionally, PAFs showed a gradual increase in both sexes until 2030. Conclusion The EBW continues to have a significant impact on cancer incidence and deaths in Korea. Effective prevention strategies targeting the reduction of this modifiable risk factor can substantially decrease the cancer burden.

Abstract The need for basement membrane extract (BME) with undefined constituents, such as Matrigel, for intestinal stem cell (ISC) culture in traditional systems poses a significant barrier that must be overcome for the development of clinical-grade, scalable, ready-to-use ISCs. Here, we propose a functional polymer-based xenogeneic-free dish for the culture of intestinal stem cells (XF-DISC), ensuring substantially prolonged maintenance of ISCs derived from 3-dimensional human intestinal organoids (ISCs3D-hIO). XF-DISC enables remarkable expandability, exhibiting a 24-fold increase in cell numbers within 30 days, with long-term maintenance of ISCs3D-hIO for more than 30 consecutive passages (>210 days). In addition, XF-DISC is fully compatible with a cell banking system. Notably, human pluripotent stem cell-derived ISCs3D-hIO cultured on XF-DISC are successfully transplanted into intestinal injury and inflammation mouse models, leading to engraftment and regeneration of damaged mouse intestinal epithelium. As a reliable and scalable xenogeneic-free ISC3D-hIO culture method, XF-DISC is highly promising for the development of regenerative ISC therapy for human intestinal diseases.

Abstract Background This study explored the career development experiences of Korean medical educators who have forged their paths amid dynamic medical education landscapes. Additionally, it explored their career development process by introducing a protean career theoretical framework, that is, an individual-led career development theory. Methods This study employed Interpretative Phenomenological Analysis (IPA) to gather in-depth insights regarding the experiences of medical educators who have successfully built their careers in Korea. Semi-structured interviews were conducted with nine medical educators to investigate the significance of these experiences. The emerging themes were categorised based on the protean career theory during data analysis. Results The findings revealed that medical educators navigated their careers in line with the protean career development model, characterised by protean career orientation, process and outcomes. Their experiences in the medical education domain were aligned with eight factors of the protean career model – self-direction, intrinsic work values, awareness, adaptability, agency, subjective career success, objective career success and organisational commitment. Conclusion In the context of less structured career pathways and a rapidly evolving regional environment, medical educators have developed individual-driven careers with self-direction and intrinsic values, formed their identities and demonstrated flexibility and proactive strategies. Hence, the protean career model successfully explains the characteristics of self-directed career development for medical educators, while emphasising the need for organisational support.

Introduction: Multiciliated cells (MCCs) have been identified in the proximal tubules of patients with kidney disease; however, their clinical significance is unknown. We aimed to investigate whether MCCs are associated with clinical outcomes in patients with glomerular diseases. Methods: Between August 2012 and April 2021, 134 patients (including 126 with glomerular disease patients and 8 controls) who were hospitalized at Seoul National University Boramae Medical Center and Seoul National University Hospital were included in this study. The ratio of MCCs to total proximal tubular cells was calculated using immunohistochemistry. The relationship between the MCC ratio and kidney disease-related clinical features was then analyzed. Results: MCCs were exclusively detected in patients with glomerular diseases (68.3 %), not those in the control group. Patients with diabetic kidney disease (88.9 %) or antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN, 86.4 %) had higher MCC ratios. MCC-positivity and MCC ratios were significantly associated with increased age and proteinuria, and a decreased estimated glomerular filtration rate (eGFR). Patients with higher MCC ratios had a significantly higher risk of end-stage kidney disease (ESKD) and composite outcomes with death. In multivariable analysis, MCC ratios were significantly correlated with an increased risk of ESKD (hazard ratio [HR], 1.413; 95 % confidence interval [CI], 1.012–1.972) and composite outcome (HR, 1.401; 95 % CI, 1.028–1.909). Conclusion: Higher MCC ratios were correlated with poorer prognosis; therefore, quantification of MCCs in the proximal tubules can serve as a valuable prognostic marker in clinical practice.

Abstract Background Accurate estimation of implant size before surgery is crucial in preparing for total knee arthroplasty. However, this task is time-consuming and labor-intensive. To alleviate this burden on surgeons, we developed a reliable artificial intelligence (AI) model to predict implant size. Methods We enrolled 714 patients with knee osteoarthritis who underwent total knee arthroplasty from March 2010 to February 2014. All surgeries were performed by the same surgeon using implants from the same manufacturer. We collected 1412 knee anteroposterior (AP) and lateral view x-ray images and retrospectively investigated the implant size. We trained the AI model using both AP and lateral images without any clinical or demographic information and performed data augmentation to resolve issues of uneven distribution and insufficient data. Using data augmentation techniques, we generated 500 images for each size of the femur and tibia, which were then used to train the model. Using data augmentation techniques, we generated 500 images for each size of the femur and tibia, which were then used to train the model. We used ResNet-101 and optimized the model with the aim of minimizing the cross-entropy loss function using both the Stochastic Gradient Descent (SGD) and Adam optimizer. Results The SGD optimizer achieved the best performance in internal validation. The model showed micro F1-score 0.91 for femur and 0.87 for tibia. For predicting within ± one size, micro F1-score was 0.99 for femur and 0.98 for tibia. Conclusion We developed a deep learning model with high predictive power for implant size using only simple x-ray images. This could help surgeons reduce the time and labor required for preoperative preparation in total knee arthroplasty. While similar studies have been conducted, our work is unique in its use of simple x-ray images without any other data, like demographic features, to achieve a model with strong predictive power.

Abstract Introduction Although the risk of CVD is increased in cancer survivors, few studies have investigated the CVD risk in survivors of gastrointestinal (GI) cancer. Therefore, we evaluated the CVD risk using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score for GI cancer survivors and associated physical activity factors. Methods Using the 2014–2019 Korean National Health and Nutrition Examination Surveys, data were collected for 262 GI cancer survivors and 1,310 cancer-free controls matched at a 1:5 ratio based on age and sex. The International Physical Activity Questionnaire Short-Form was used to assess physical activity, and the Euro QoL Questionnaire 5-Dimensional Classification (EQ-5D) was used to assess the health-related quality of life. Results A multiple logistic regression analysis demonstrated a lower risk of ASCVD in GI cancer survivors than in controls (adjusted odds ratio [aOR] = 0.73, 95% confidence interval [CI] = 0.55-0.97). Moreover, the risk of having a high ASCVD score was significantly lower in individuals who performed sufficient aerobic physical activity (aOR = 0.59, 95% CI = 0.47-0.75) and those with an EQ-5D score 1 or 2 (aOR = 0.36, 95% CI = 0.20-0.65 and aOR = 0.31, 95% CI = 0.16-0.58, respectively). Conclusions This population-based study demonstrated that engaging in sufficient physical activity can reduce the ASCVD risk among GI cancer survivors.

Abstract Exposure and damage caused by noise have been reported in many countries around the world. However, few nationwide studies explored the association of residential environmental noise with depressive symptoms, this study aims to examine this association. The Korean Community Health Survey at the individual-level and the Korean Environmental Noise Measurement Database at the regional-level were used. A total of 30,630 individuals were eligible for the analysis. Multilevel model framework was applied to account for the clustered structure of the regional-level data in which individual-level data containing demographic characteristics and health information were nested. As a result of the analysis, Individuals living in the highest environmental noise area had a 1.55 times higher likelihood of experiencing depressive symptoms than those living in the lowest environmental noise area (95% CI, 1.04–2.31). After stratified analysis according to depressive symptom severity, individuals residing in areas with the highest environmental noise exposure had significantly higher odds of mild (aOR, 1.46; 95% CI, 1.02–2.07) and moderate symptoms (aOR, 1.70; 95% CI, 1.00–2.91). In conclusion, the higher the residential environmental noise, the higher the possibility of mild-to-moderate depressive symptoms. Our findings suggest the need for continued attention to and management of noise pollution, which has the potential to adversely affect individual’s mental health.

Abstract Akkermansia muciniphila has received great attention because of its beneficial roles in gut health by regulating gut immunity, promoting intestinal epithelial development, and improving barrier integrity. However, A. muciniphila-derived functional molecules regulating gut health are not well understood. Microbiome-secreted proteins act as key arbitrators of host-microbiome crosstalk through interactions with host cells in the gut and are important for understanding host-microbiome relationships. Herein, we report the biological function of Amuc_1409, a previously uncharacterised A. muciniphila-secreted protein. Amuc_1409 increased intestinal stem cell (ISC) proliferation and regeneration in ex vivo intestinal organoids and in vivo models of radiation- or chemotherapeutic drug-induced intestinal injury and natural aging with male mice. Mechanistically, Amuc_1409 promoted E-cadherin/β-catenin complex dissociation via interaction with E-cadherin, resulting in the activation of Wnt/β-catenin signaling. Our results demonstrate that Amuc_1409 plays a crucial role in intestinal homeostasis by regulating ISC activity in an E-cadherin-dependent manner and is a promising biomolecule for improving and maintaining gut health.

Open source software (OSS) projects rely on voluntary contributions, but their long-term survivability depends on sustained community engagement and effective problem-solving. Survivability, critical for maintaining project quality and trustworthiness, is closely linked to issue activity, as unresolved issues reflect a decline in maintenance capacity and problem-solving ability. Thus, analyzing issue retention rates provides valuable insights into a project’s health. This study evaluates OSS survivability by identifying the features that influence issue activity and analyzing their relationships with survivability. Kaplan–Meier survival analysis is employed to quantify issue activity and visualize trends in unresolved issue rates, providing a measure of project maintenance dynamics. A random forest model is used to examine the relationships between project features—such as popularity metrics, community engagement, code complexity, and project age—and issue retention rates. The results show that stars significantly reduce issue retention rates, with rates dropping from 0.62 to 0.52 as stars increase to 4000, while larger codebases, higher cyclomatic complexity, and older project age are associated with unresolved issue rates, rising by up to 15%. Forks also have a nonlinear impact, initially stabilizing retention rates but increasing unresolved issues as contributions became unmanageable. By identifying these critical factors and quantifying their impacts, this research offers actionable insights for OSS project managers to enhance project survivability and address key maintenance challenges, ensuring sustainable long-term success.

Hikikomori syndrome (HS), a phenomenon characterized by social withdrawal and isolation, has attracted significant attention in both academic and clinical settings. However, understanding the diverse nature of HS remains a challenge due to its multifaceted etiology and presentation. This paper aims to shed light on this phenomenon by examining three representative typologies of HS in clinical settings. Through detailed case analyses, we categorize HS into three main types: HS associated with neurodevelopmental disorders; HS triggered by the onset of mental illness; and HS emerging gradually with age-related challenges. By elucidating these typologies, we provide insights into the complex interplay of psychological, social, and developmental factors contributing to HS, thereby facilitating more tailored approaches for the evaluation of and intervention into this syndrome in clinical practice.

Abstract Background Unmet health needs are particularly important to people with disabilities; however, these unmet needs owing to limitations in daily life have been under-researched thus far. This study examined the effects of disability-related limitations in daily life on unmet needs. Methods This study included 5,074 adults with disabilities from the 2018–2020 Korea Disability and Life Dynamics Panel. We analyzed the effects of disability-related limitations in daily life on unmet needs using logistic regression with a generalized estimating equation model. Results Overall, 4.8% men and 4.6% women with disabilities had unmet needs. For men, unmet needs were 1.46 times (95% confidence interval [CI] 1.09–1.96) higher for those with moderate limitations in daily life. For women, unmet needs were 1.79 times (95% CI 1.22–2.39) higher when there were moderate limitations in daily life. The prominent factors causing this effect were physical or brain lesion disability for men and internal or facial disability and burden of medical expenses for women. Conclusions Limitations in daily life due to disability increase the risk of having unmet needs, an effect that is significantly more pronounced in men. These unmet needs differ depending on an individual’s sex, disability type, limited body parts, and other specific causes. Efforts are required to reduce the unmet needs of people with disabilities by considering the type of disability, impaired body parts, and causes of unmet needs in daily life.

Objective Gender incongruence (GI) is a condition in which an individual’s gender identity, role, and expression differ from their assigned sex. This study aimed to evaluate when GI first arises in transgender and non-binary individuals seeking hormone therapy and their years living untreated in South Korea. Methods This retrospective study analyzed GI patients seeking gender-affirming hormone therapy (GAHT) or surgery between 2015 and 2021. The recorded data included gender identity, legal transition status, age of onset of GI, age at the initiation of therapy, and total therapy duration. Results In total, 337 patients were enrolled, including 149 (44.2%) transgender men, 153 (45.4%) transgender women, and 35 (10.4%) non-binary individuals. The mean age of onset of GI was 10.6 years (standard deviation, 5.1). Of the total patients, 29% had an onset of GI before age 6 years (preschool), 61% before age 12 (elementary-school), and 87% before age 15 (middle-school). Patients lived with GI for almost 14 years before GAHT initiation at a median age of 23.0 years. 90% of transgender men, 82.3% of transgender women, and 85% of non-binary patients disclosed their gender identities to their families. Regarding social transition, 31.5% of transgender men, 16.3% of transgender women, and none of the non-binary patients (P

Reinforcement learning (RL) is rapidly used in safety-centric applications. However, many studies focus on generating optimal policy that achieves maximum rewards. While maximum rewards are beneficial, safety constraints and non-functional requirements must also be considered in safety-centric applications to avoid dangerous situations. For example, in the case of food delivery robots in restaurants, RL should be used not only to find optimal policy that response to all customer requests through maximum rewards but also to consider safety constraints such as collision avoidance and non-functional requirements such as battery saving. In this paper, we investigated the fulfillment of safety constraints and non-functional requirements of learning models generated through RL with quantitative model checking. We experimented with various time steps and learning rates required for RL, targeting restaurant delivery robots. The functional requirement of these robots is to process all customer order requests, and the non-functional requirements are the number of steps and battery consumption to complete the task. Safety constraints include the amount of collision and the probability of collision. Through these experiments, we made three important findings. First, learning models that obtain maximum rewards may have a low degree of achievement of non-functional requirements and safety constraints. Second, as safety constraints are met, the degree of achievement of non-functional requirements may be low. Third, even if the maximum reward is not obtained, sacrificing non-functional requirements can maximize the achievement of safety constraints. These results show that learning models generated through RL can trade off rewards to achieve safety constraints. In conclusion, our work can contribute to selecting suitable hyperparameters and optimal learning models during RL.

Objective To investigate the risk of cardiovascular events associated with commonly used dual and triple therapies of evogliptin, a recently introduced dipeptidyl peptidase-4 inhibitor (DPP4i), for managing type 2 diabetes in routine clinical practice.Design A retrospective cohort study.Setting Korean Health Insurance Review and Assessment database.Participants Patients who initiated metformin-based dual therapy and metformin+sulfonylurea-based triple therapy in South Korea from 2014 to 2018.Interventions Initiation of combination therapy with evogliptin.Primary and secondary outcome measures Hazards of cardiovascular events, a composite endpoint of myocardial infarction, heart failure and cerebrovascular events, and its individual components. Cox proportional hazards model with propensity score-based inverse probability of treatment weighting were used to estimate HRs and 95% CIs.Results From the dual and triple therapy cohorts, 5830 metformin+evogliptin users and 2198 metformin+sulfonylurea+evogliptin users were identified, respectively. Metformin+evogliptin users, as compared with metformin+non-DPP4i, had a 29% reduced risk of cardiovascular events (HR 0.71, 95% CI 0.62 to 0.82); HRs for individual outcomes were cerebrovascular events (0.71, 95% CI 0.53 to 0.95), heart failure (0.70, 95% CI 0.59 to 0.82), myocardial infarction (0.89, 95% CI 0.60 to 1.31). Metformin+sulfonylurea+evogliptin users, compared with metformin+sulfonylurea+non-DPP4i, had a 24% reduced risk of cardiovascular events (0.76, 95% CI 0.59 to 0.97); HRs for individual outcomes were myocardial infarction (0.57, 95% CI 0.27 to 1.19), heart failure (0.74, 95% CI 0.55 to 1.01), cerebrovascular events (0.96, 95% CI 0.61 to 1.51).Conclusions These findings suggest that dual or triple therapies of evogliptin for the management of type 2 diabetes in routine clinical practice present no cardiovascular harms, but could alternatively offer cardiovascular benefits in this patient population.

Abstract Background Emulating randomized controlled trials (RCTs) by real-world evidence (RWE) studies would benefit future clinical and regulatory decision-making by balancing the limitations of RCT. We aimed to evaluate whether the findings from RWE studies can support regulatory decisions derived from RCTs of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with venous thromboembolism (VTE). Methods Five landmark trials (AMPLIFY, RE-COVER II, Hokusai-VTE, EINSTEIN-DVT, and EINSTEIN-PE) of NOACs were emulated using the South Korean nationwide claims database (January 2012 to August 2020). We applied an active comparator and new-user design to include patients who initiated oral anticoagulants within 28 days from their VTE diagnoses. The prespecified eligibility criteria, exposure (each NOAC, such as apixaban, rivaroxaban, dabigatran, and edoxaban), comparator (conventional therapy, defined as subcutaneous heparin followed by warfarin), and the definition of outcomes from RCTs were emulated as closely as possible in each separate emulation cohort. The primary outcome was identical to each trial, which was defined as recurrent VTE or VTE-related death. The safety outcome was major bleeding. Propensity score matching was conducted to balance 69 covariates between the exposure groups. Effect estimates for outcomes were estimated using the Mantel–Haenszel method and Cox proportional hazards model and subsequently compared with the corresponding RCT estimates. Results Compared to trial populations, real-world study populations were older (range: 63–69 years [RWE] vs. 54–59 years [RCT]), with more females (55–60.5% vs. 39–48.3%) and had a higher prevalence of active cancer (4.2–15.4% vs. 2.5–9.5%). The emulated estimates for effectiveness outcomes showed superior effectiveness of NOAC (AMPLIFY: relative risk 0.81, 95% confidence interval 0.70–0.94; RE-COVER II: hazard ratio [HR] 0.60, 0.37–0.96; Hokusai-VTE: 0.49, 0.31–0.78; EINSTEIN-DVT: 0.54, 0.33–0.89; EINSTEIN-PE: 0.50, 0.34–0.74), when contrasted with trials that showed non-inferiority. For safety outcomes, all emulations except for AMPLIFY and EINSTEIN-DVT yielded results consistent with their corresponding RCTs. Conclusions This study revealed the feasibility of complementing RCTs with RWE studies by using claims data in patients with VTE. Future studies to consider the different demographic characteristics between RCT and RWE populations are needed.

Abstract Purpose It is necessary to estimate the hospice usage and hospice-related cost for entire cancer patients using nationwide cohort data to establish a suitable ethical and cultural infrastructure. This study aims to show the effects of hospital hospice care on healthcare expenditure among South Korean cancer patients. Methods This study is a retrospective cohort study using customized health information data provided by the National Health Insurance Service. Individuals who were diagnosed with stomach, colorectal, or lung cancer between 2003 and 2012 were defined as new cancer patients, which included 7,176 subjects. Patients who died under hospital-based hospice care during the follow-up period from January 2016 to December 2018 comprised the treatment group. Healthcare expenditure was the dependent variable. Generalized estimating equations was used. Results Among the subjects, 2,219 (30.9%) had used hospice care at an average total cost of 948,771 (± 3,417,384) won. Individuals who had used hospice care had a lower odds ratio (EXP(β)) of healthcare expenditure than those who did not (Total cost: EXP(β) = 0.27, 95% confidence intervals (CI) = 0.25–0.30; Hospitalization cost: EXP(β) = 0.32, 95% CI = 0.29–0.35; Outpatient cost: EXP(β) = 0.02, 95% CI = 0.02–0.02). Conclusion Healthcare expenditure was reduced among those cancer patients in South Korea who used hospice care compared with among those who did not. This emphasizes the importance of using hospice care and encourages those hesitant to use hospice care. The results provide useful insights into both official policy and the existing practices of healthcare systems.

Abstract Background Given the cumulative evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on chronic heart failure, demand is emerging for further information on their effects in patients who are hospitalized for acute heart failure. However, there is still limited evidence about the class effect of SGLT2is on acute heart failure. We investigated whether initiating treatment with SGLT2is after an episode of acute heart failure reduces the risks of post-discharge heart failure readmission or cardiovascular mortality among patients with type 2 diabetes. Methods A retrospective cohort study was conducted in a cohort of patients with type 2 diabetes who hospitalized for heart failure, using Korean Health Insurance Review & Assessment database (2015–2020). The exposure was defined as initiation of SGLT2is during hospitalization or at discharge. We assessed hazards of post-discharge heart failure readmission and cardiovascular death at 1-year, and 30-, 60-, and 90-day from the date of discharge in the SGLT2is users and non-users. Cox proportional hazards models with propensity score-based inverse probability of treatment weighting were used to estimate hazard ratios and 95% confidence intervals. Results Among 56,343 patients with type 2 diabetes hospitalized for heart failure, 29,290 patients were included in the study cohort (mean [SD] age, 74.1 [10.8] years; 56.1% women); 818 patients (2.8%) were prescribed SGLT2is during index hospitalization or at discharge. Patients with a prescription for SGLT2i vs. those without prescription had lower rates of heart failure readmission or cardiovascular death at 1 year (22.4% vs. 25.3%; adjusted hazard ratio, 0.90 [95% confidence interval, 0.87–0.93]), and also at 30 days (7.0% vs. 7.7%%; 0.74 [0.69–0.79]). Conclusions Among patients with type 2 diabetes, initiating SGLT2i treatment after an episode of acute heart failure was significantly associated with a reduced combined risk of heart failure readmission and cardiovascular mortality in a nationwide cohort reflecting routine clinical practice.

A survey of plant parasitic nematodes was carried out in 650 garlic fields in Korea from 2020 to 2022. Migratory endoparasite nematodes (Ditylenchus sp.) were recovered from 6% of the garlic samples, with an average density of 494 individuals per garlic bulb. The morphological characteristics of males and females from the 2022 survey were very similar to D. destructor, but D. dipsaci was not found. The Korean population traits have a lateral field containing six incisures, and the posterior esophagus part overlaps the intestine dorsally. PCR and DNA sequencing were performed for the D2/D3 region of the ribosomal DNA 28S and the ITS region, and the phylogenetic analysis strongly supports the monophyly of D. destructor. This is the first report of D. destructor parasitizing garlic in the Republic of Korea. In Korea, due to changes in agricultural or environmental conditions, the most damaging potential PPNs changed from D. dipsaci to D. destructor in garlic cultivation.

Abstract Background Impaired respiratory function remains underrecognized in patients with type 2 diabetes (T2D), despite common pulmonary impairment. Meanwhile, there is little data available on the respiratory effects of sodium glucose cotransporter 2 inhibitors (SGLT2i). Hence, we examined the association between SGLT2i use and the risk of adverse respiratory events in a real-world setting. Methods We conducted a population-based, nationwide cohort study using an active-comparator new-user design and nationwide claims data of South Korea from January 2015 to December 2020. Among individuals aged 18 years or older, propensity score matching was done to match each new user of SGLT2is with dipeptidyl peptidase 4 inhibitors (DPP4is), with patients followed up according to an as-treated definition. The primary outcome was respiratory events, a composite endpoint of acute pulmonary edema, acute respiratory distress syndrome (ARDS), pneumonia, and respiratory failure. Secondary outcomes were the individual components of the primary outcome and in-hospital death. Cox models were used to estimate hazard ratios (HRs) and 95% CIs. Results Of 205,534 patient pairs in the propensity score matched cohort, the mean age of the entire cohort was 53.8 years and 59% were men, with a median follow-up of 0.66 years; all baseline covariates achieved balance between the two groups. Incidence rates for overall respiratory events were 4.54 and 7.54 per 1000 person-years among SGLT2i and DPP4i users, respectively, corresponding to a rate difference of 3 less events per 1000 person-years (95% CI − 3.44 to − 2.55). HRs (95% CIs) were 0.60 (0.55 to 0.64) for the composite respiratory endpoint, 0.35 (0.23 to 0.55) for acute pulmonary edema, 0.44 (0.18 to 1.05) for ARDS, 0.61 (0.56 to 0.66) for pneumonia, 0.49 (0.31 to 0.76) for respiratory failure, and 0.46 (0.41 to 0.51) for in-hospital death. Similar trends were found across individual SGLT2is, subgroup analyses of age, sex, history of comorbidities, and a range of sensitivity analyses. Conclusions These findings suggest a lower risk of adverse respiratory events associated with patients with T2D initiating SGLT2is versus DPP4is. This real-world evidence helps inform patients, clinicians, and guideline writers regarding the respiratory effects of SGLT2i in routine practice.

OBJECTIVES The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review. METHODS We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm-identified events. RESULTS We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively. CONCLUSIONS We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.

Abstract Despite the emerging scientific interest in polymer‐based stretchable electronics, the trade‐off between the crystallinity and stretchability of intrinsically stretchable polymer semiconductors—charge‐carrier mobility increases as crystallinity increases while stretchability decreases—hinders the development of high‐performance stretchable electronics. Herein, a highly stretchable polymer semiconductor is reported that shows concurrently improved thin film crystallinity and stretchability upon thermal annealing. The polymer thin films annealed at temperatures higher than their crystallization temperatures exhibit substantially improved thin film stretchability (> 200%) and hole mobility (≥ 0.2 cm2 V−1 s−1). The simultaneous enhancement of the crystallinity and stretchability is attributed to the thermally‐assisted structural phase transition that allows the formation of edge‐on crystallites and reinforces interchain noncovalent interactions. These results provide new insights into how the current crystallinity–stretchability limitation can be overcome. Furthermore, the results will facilitate the design of high‐mobility stretchable polymer semiconductors for high‐performance stretchable electronics.

PurposeGastrointestinal (GI) cancer occurs in digestive organs such as the stomach, colon, liver, esophagus, and pancreas. About 83,034 cases occurred in Korea alone in 2020. Dietary factors, alcohol consumption, Helicobacter pylori (H. pylori), and lifestyle factors increase the incidence of diseases such as gastritis, peptic ulcer, pancreatitis, and gastroesophageal reflux disease (GERD), which can develop into GI cancer. However, in 2019, the US Food and Drug Administration announced that the drugs ranitidine and nizatidine, which are used for digestive disorders, contain carcinogens. In this study, we investigated the effects of ranitidine and nizatidine on the development of GI cancer.Materials and methodsIn this study, using National Health Insurance Service–National Sample Cohort (NHIS-NSC) version 2.5 (updated from 2002 to 2019), subjects who developed GI cancer were enrolled in the case group, and those who were at risk of, but did not develop, cancer were enrolled in the control group. Thereafter, risk-set matching was performed (1:3 ratio) by sex and age at the time of diagnosis of cancer in the case group. Through this procedure, 22,931 cases and 68,793 controls were identified. The associations of ranitidine and/or nizatidine with GI cancer were confirmed by adjusted odds ratios (aORs) and 95% confidence intervals (CIs) calculated through conditional logistic regression analysis.ResultsThe aORs of ranitidine and/or nizatidine users were lower than those of nonusers in all average prescription days groups (< 30 days/year: aOR [95% CI] = 0.79 [0.75-0.82]; 30–59 days/year: aOR [95% CI] = 0.66 [0.59-0.73]; 60–89 days/year: aOR [95% CI] = 0.69 [0.59-0.81]; ≥ 90 days/year: aOR [95% CI] = 0.69 [0.59-0.79]). Sensitivity analyses were conducted with different lag periods for the onset of GI cancer after drug administration, and these analyses yielded consistent results. Additional analyses were also performed by dividing subjects into groups based on cancer types and CCI scores, and these analyses produced the same results.ConclusionOur study, using nationwide retrospective cohort data, did not find evidence suggesting that ranitidine and nizatidine increase the risk of GI cancer. In fact, we observed that the incidence of GI cancer was lower in individuals who used the drugs compared to nonusers. These findings suggest a potential beneficial effect of these drugs on cancer risk, likely attributed to their ability to improve digestive function.

Abstract Considering the rapid growth in the number of cancer survivors, the successful management of their health behaviors requires further attention. However, there are lack of information about cancer survivors’ health behaviors and the risk of mortality using Korean cohort data. This study aimed to examine the effects of health behavior changes on mortality among cancer survivors and to develop a validated nomogram. This cohort study was conducted using claims data. Data from adult cancer survivors from the National Health Insurance Service–National Sample Cohort, conducted between 2002 and 2015, were included. Individuals who were alive for five years after their cancer diagnosis were defined as cancer survivors. Cox proportional-hazards regression was used to estimate the target associations. Discrimination (Harrell’s C-index) and calibration (Hosmer–Lemeshow test) were employed to validate the nomogram. Data from 9300 cancer survivors were used for analysis. Compared to non-smokers, those who started or quit smoking had a higher risk of all-cause mortality. Those who were physically inactive had a higher risk of all-cause mortality than those who were continuously active. In the nomogram, the C-index value was 0.79 in the training data and 0.81 in the testing data. Hosmer–Lemeshow test was not significant, demonstrating a good fit. We found that individuals with unhealthy behaviors had a higher risk of mortality, thereby highlighting the importance of managing health behaviors among cancer survivors. The development of a validated nomogram may provide useful insights regarding official policies and existing practices in healthcare systems, which would benefit cancer survivors. Our study could provide the evidence to inform the priority of guideline for managing the health behavior among cancer survivors.

Abstract In many complex oxides, the oxygen vacancy formation is a promising route to modify the material properties such as a superconductivity and an oxygen diffusivity. Cation substitutions and external strain have been utilized to control the concentration and diffusion of oxygen vacancies, but the mechanisms behind the controls are not fully understood. Using first-principles calculations, we find how Sr doping and external strain greatly enhances the diffusivity of oxygen vacancies in La2−x Sr x CuO4−δ (LSCO) in the atomic level. In hole-doped case (2x > δ), the formation energy of an apical vacancy in the LaO layer is larger than its equatorial counterpart by 0.2 eV that the bottleneck of diffusion process is for oxygen vacancies to escape equatorial sites. Such an energy difference can be reduced and even reversed by either small strain (

Abstract Past studies of emotion and mood on memory have mostly focused on the learning of emotional material in the laboratory or on the consequences of a punctate catastrophic event. However, the influence of a long-lasting global condition on memory and learning has not been studied. The COVID-19 pandemic unfortunately offered a unique situation to observe the effects of prolonged, negative events on human memory for visual information. One thousand online subjects were asked to remember the details of real-world photographs of objects to enable fine-grained visual discriminations from novel within-category foils. Visual memory performance was invariant across time, regardless of the infection rate in the local or national population, or the subjects’ self-reported affective state using the Positive and Negative Affect Schedule (PANAS). Thus, visual memory provides the human brain with storage that is particularly resilient to changes in emotional state, even when those changes are experienced for months longer than any imaginable laboratory procedure.

Abstract In South Korea, public–private mix (PPM) was launched in 2011. This retrospective cohort study sought to determine the rate of loss to follow-up (LTFU) among drug-susceptible tuberculosis (DS-TB) patients in all nationwide PPM institutions, and the risk factors for LTFU. National notification data for DS-TB patients diagnosed between August 2011 and July 2014 in PPM institutions were analysed. Determination of LTFU included detection of instances where patients were transferred out, but when they did not attend at other TB centres in the following two months. Univariable and multivariable competing risk models were used to determine risk factors for LTFU. 73,046 patients with 78,485 records were enrolled. Nominally, 3426 (4.4%) of records were LTFU. However, after linking the multiple records in each patient, the percentage of LTFU was 12.3% (9004/73,046). Risk factors for LTFU were: being foreign-born (3.13 (95% CI 2.77–3.53)), prior LTFU (2.31 (2.06–2.59)) and greater distance between the patient’s home and the TB centre (4.27 (4.03–4.53)). ‘Transfer-out’ was a risk factor in patients managed by treatment centres close to home (1.65 (1.49–1.83)), but protective for those attending centres further (0.77 (0.66–0.89)) or far-away (0.52 (0.46–0.59)) from home. By considering the complete picture of a patient’s interactions with healthcare, we identified a much higher level of LTFU than previously documented. This has implications for how outcomes of treatment are reported and argues for a joined-up national approach for the management and surveillance of TB patients, in nations with similar healthcare systems.

In modern software development, OSS (Open Source Software) has become a crucial element. However, if OSS have few contributors and are lacking in maintenance activities, such as bug fixes, are used, it can lead to significant costs and resource allocation due to maintenance discontinuation. Since OSS are developed by a diverse group of contributors, the consistency of their involvement may vary, making continuous support and maintenance unpredictable. Therefore, it is necessary to identify the status of each OSS to avoid increased maintenance costs when selecting OSS for use. To address these issues, we use polynomial regression to predict trends in bug-fixing activities and evaluate the survivability of OSS accordingly. We predict the trend of bug-fixing activities in OSS, using factors such as popularity, number of contributors, and code complexity. A lower trend value indicates more vigorous activity. In this paper, we conduct data collection and extraction, generating model, and model testing and evaluation to predict survivability using these data. After collecting data through various tools, the models of different degrees are generated using K-fold cross-validation. The model with the highest performance is selected based on the RMSE (Root Mean Squared Error) and RSE (Residual Standard Error). Then, the chosen model is employed to predict the survivability of OSS and compare it with actual outcomes. This method is experimented with on OSS used in the KakaoTalk commercial messenger app. As a result, several OSS are predicted to have low survivability, and among them, five are analyzed. It is observed that, in reality, activities such as delayed or discontinued release updates occurred. These findings can support OSS users in selecting OSS for cost-saving purposes and alert OSS administrators to the need for solutions to ensure project survival.

The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia two years after the onset of the COVID-19 pandemic. Given the existing transgenerational war trauma and associated psychiatric consequences in Croatian population, a significant pandemic-related deterioration of mental health was expected. Recent studies suggest that after an initial increase in psychiatric disorders during the pandemic in Croatia, depression, stress, and anxiety rapidly declined. These findings highlight the role of social connectedness and resilience in the face of the global pandemic. We examined resilience and psychiatric disorder risk in 377 Croatian adults using an anonymous online mental health survey. Results indicate that there was an exacerbation of all mental ill health variables, including depression, anxiety, stress, and a doubled risk for psychosis outcome post-COVID pandemic. Stress decreased levels of resilience, however, those exposed to previous traumatic experience and greater social connectedness had higher resilience levels. These findings suggest that individual differences in underlying stress sensitization of Croatian population due to past trauma may continue to influence mental health consequences two years after COVID-19 pandemic. It is essential to promote the importance of social connectedness and resilience in preventing the development of variety of mental health disorders.

BackgroundDisembodiment and socio-emotional deficits are core features of the schizophrenia spectrum from the prodromal stages to chronic illness. A recent study documented anomalous emotional embodiment in individuals with schizophrenia. Although bodily self disturbances have been shown to precede and predict psychosis onset in at-risk populations, the etiology of anomalous emotional embodiment remains largely unexplored. The present study investigated bodily maps of emotions in relation to schizotypy to extend our understanding of embodied emotions in the schizophrenia spectrum.MethodsA total of 419 participants (312 female; 19.50 ± 1.22 years) completed a topographical body mapping task where they reported patterns of embodiment experienced in the context of eleven different emotions and a neutral state (EmBODY). Embodied emotions were investigated in relation to multidimensional schizotypy.ResultsIndividuals with elevated negative schizotypy experienced embodied emotions with higher intensity (r = 0.16, p = 0.003) but lower clarity (i.e., endorsing activation and deactivation in the same bodily location; β = −0.28, 95% CI [−0.54, −0.03], Z = 2.25, p=0.02) and endorsed more incongruent bodily sensations of emotions (i.e., reporting bodily activation in the context of a low-arousal emotion, r = 0.12, p = 0.05; reporting bodily deactivation in the context of high-arousal emotions, r = 0.13, p = 0.02). In line with the anomalous emotional embodiment documented in individuals with schizophrenia, some of these differences were particularly notable for low-arousal emotions.DiscussionThese results reveal negative schizotypy as a significant correlate of differences in emotional embodiment. More work is needed to link these differences to the anomalous bodily sensations of emotions documented in schizophrenia and assess their functional impact.

Abstract Insulin resistance can be affected directly or indirectly by smoking. This cross-sectional study aimed at examining the association between smoking patterns and insulin resistance using objective biomarkers. Data from 4043 participants sourced from the Korea National Health and Nutrition Examination Survey, conducted from 2016 to 2018, were examined. Short-term smoking patterns were used to classify participants according to urine levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and cotinine as continuous-smokers, past-smokers, current-smokers, and non-smokers. Insulin resistance was calculated using the triglyceride-glucose index from blood samples and was defined as either high or low. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Men and women who were continuous-smokers (men: odds ratio [OR] = 1.74, p = 0.001; women: OR = 2.01, p = 0.001) and past-smokers (men: OR = 1.47, p = 0.033; women: OR = 1.37, p = 0.050) were more likely to have high insulin resistance than their non-smoking counterparts. Long-term smokers (≥ 40 days) are at an increased risk of insulin resistance in short-term smoking patterns. Smoking cessation may protect against insulin resistance. Therefore, first-time smokers should be educated about the health benefits of quitting smoking.

Abstract We conducted a longitudinal online study to examine attenuated psychotic symptoms (APS) over time in a sample of locked-down individuals. We used (i) questionnaires and (ii) the automatic analysis of the emotional content of narratives. Participants (N = 162) were recruited to complete an online survey 4 times between March and June 2020 (T1, T2, T3, T4). T1 completion coincided with the beginning of the lockdown, and T4 with the pandemic trough. Depression, anxiety, and stress were assessed with the DASS-42 and APS with the PQ-16. Psychosocial data such as the feeling of loneliness and social network size were also collected. The participants wrote daily narratives during the lockdown period. Anxiety and APS were the highest at T1 and decreased over time. APS and APS-associated distress were correlated with the DASS-42 at all times. APS arose acutely at the beginning of the pandemic, despite participants being socio-economically advantaged, and were related with negative emotions.

Abstract Cation–π interactions are considered to be among the most important strong noncovalent interactions in aqueous solutions and as regulators of various biological phenomena, including biological adhesion, signal transduction, and liquid–liquid phase separation (LLPS). Despite their significant roles, cation–π interactions in aqueous environments are not systematically and experimentally understood. Here, we directly experimentally examined cation–π interactions between cationic and aromatic moieties common to biological systems using a surface forces apparatus (SFA) augmented by computational methods. Specifically, we chose cationic and aromatic moieties with different levels of hydration and observed how the molecular hydration of these moieties affects the formation and strengths of cation–π bonds. To date, the charge densities of the interacting moieties are primarily considered to modulate the interaction strength; however, it is experimentally and computationally revealed that the hydration strengths (or hydrophobic properties) of the interacting moieties are more important for controlling in underwater interactions.

PurposeAs older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters.Materials and methodsA nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005–2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed.ResultsThe mean age of patients was 76.4, and 60.4% were males. Most patients had 0–1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005–2006 to 69.6% in 2011–2012. The proportion of surgery-including active treatment increased to over 70% in the 70–74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70–84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing “chronological” age but varied quite randomly, especially among female patients.ConclusionOur study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, “functional” age rather than “chronological” age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.

Abstract Background The effect of menopausal hormone therapy (MHT) on gastrointestinal (GI) cancers is controversial, and no research has been conducted in the East. This study investigates the association between MHT and GI cancer risks in South Korea. Methods A prescription-based cohort study was conducted using the NHIS Sample Cohort (2002–2013) of Korea. We used 1:5 propensity score matching, and 22,577 MHT users and 111,113 non-users were selected. Kaplan–Meier survival curves with log-rank tests were used. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Landmark analysis was used to determine dose–response relationship. Results The median follow-up was 79.6 of months. Kaplan–Meier survival curve showed less frequent GI cancer diagnoses in MHT users compared to non-users (0.13 vs. 0.16 per 100,000 person-years). Menopausal hormone therapy was associated with decreased incidence of GI cancer (HR = 0.809, 95%CI = 0.691–0.946) and colorectal cancer (CRC) (HR = 0.757, 95%CI = 0.577–0.995). Gastric cancer (GC) incidence showed marginal significance (HR = 0.787, 95%CI = 0.605–1.023). The mortality from GI cancer was lower in MHT users than in non-users (HR = 0.737, 95%CI = 0.547–0.993). The relationship between MHT and GI cancer was stronger with increasing MHT dose in terms of both incidence (P trend = 0.0002) and mortality (P trend = 0.0064). Conclusions The association between MHT use and reduced risks of GI cancers was attributed to CRC and GC and showed a dose–response relationship in a population-based cohort study.

Schizophrenia is associated with self-disturbances and anomalous embodiment of emotion such that the distinct patterns of bodily sensations that typically accompany specific emotions are disrupted. Previous evidence indicated that cultural factors might shape the embodiment of emotion and therefore influence the subjective experience of schizophrenia.We investigated embodiment of emotion in individuals with schizophrenia (SZ) and matched control participants (CO) from Korea (26 ​K-SZ and 26 ​K–CO) and the USA (26 US-SZ and US-26 CO), using a topographical mapping task that requires participants to indicate the locations of bodily sensations that accompany 14 distinct emotions. We found that emotion-related bodily sensations, especially for low-arousal emotions, were diminished in SZ compared to CO in both cultures. Cultural differences emerged in the embodiment of sadness, shame and disgust such that the patterns of bodily sensations associated with these emotions were more similar between SZ and CO in the Korean sample than in the US sample.These findings suggest that emotional embodiment anomalies are present in SZ regardless of culture, supporting the universality of bodily self-disturbances in this population. However, there are culture-specific features of embodied emotional experiences that may be important to consider for future research and treatment.

The Barnett critique states that there is an internal inconsistency between the theory that is implied by simple sum monetary aggregation (perfect substitutability among components) and the economic theory that produces the models within which those aggregates are used. That inconsistency causes the appearance of unstable demand and supply for money. The incorrect inference of unstable money demand has caused serious harm to the field of monetary economics.

Abstract Recent data on non-B subtypes’ epidemiology among patients infected with human immunodeficiency virus-1 (HIV-1) in Korea are lacking. We aimed to assess the changing trends in the epidemiology of non-B subtypes of HIV-1 in Korea using phyloepidemiological analyses. We analyzed the demographic records and sequencing data obtained from genotypic drug resistance tests between 2005 and 2019 from 517 patients infected with HIV attending a tertiary care hospital in Busan, Korea. Subtyping and phylogenetic analyses with reference sequences were performed. Additionally, transmission clusters were identified via maximum-likelihood trees. Non-B subtypes accounted for 21.3% of the 517 sequences. CRF01_AE (52.7%) was the most common non-B subtype, followed by CRF02_AG (16.4%), A1 (11.8%), and C (5.5%). The prevalence of non-B subtypes decreased from 36.4 to 13.4% by 2009, while it increased to 27.4% between 2015 and 2019. Among patients with non-B subtypes, the proportion of overseas sailors decreased from 66.7 to 7.5%; contrarily, the proportion of men-who-have-sex-with-men (MSM) increased from 0 to 46.9% over the study period. We identified 8 transmission clusters involving non-B subtypes, with sizes ranging from 2 to 4 patients, including 3 clusters containing MSM. Our results highlight the changes in the epidemiological trends of non-B subtypes of HIV-1 in Korea.

Bodily self disturbances are core features of schizophrenia. Body ownership, one component of the bodily self, can be assessed with the Rubber Hand Illusion (RHI), which is induced by a synchronous brushing of a visible fake hand and one's own occluded hand. Schizophrenia is associated with increased RHI strength and diminished body ownership. This study examined RHI in relation to schizotypy to extend our understanding of self-disturbances in the schizophrenia-spectrum.Ninety-seven college students completed the RHI task and self-report questionnaires. Regressions were used to assess the RHI strength in relation to the 3 schizotypy factors (positive, negative, disorganized). We also examined the correlations between self-reported bodily self disturbances and RHI strength.Positive schizotypy predicted a stronger subjective experience of the RHI, whereas negative schizotypy predicted weakened RHI susceptibility. Questionnaire measures of self-disturbances correlated with stronger RHI. In sum, we confirmed the link between positive schizotypy and the subjective experience of the RHI, which suggests a weakened sense of body ownership. Interestingly, we also found a relationship between negative schizotypy and reduced RHI, which implies strengthened body ownership. These results also underscore the complexity of the link between the phenomenological experience of bodily disturbances and the experimentally measured sense of body ownership.

BackgroundNorth Korean defectors (NKDs) are known to be vulnerable to depression due to the influence of various psychosocial factors during their settlement process. Therefore, this study aimed to explore different trajectories of depressive symptoms in NKDs and identify predictors of the worsening of depressive symptoms. In particular, the focus was on whether posttraumatic stress disorder (PTSD) functions as a significant predictor.MethodsParticipants consisted of 300 NKDs who settled in South Korea within 3 years of entering in the country. Five waves of longitudinal data collected from 2016 to 2019 were used. In this study, the North Korean Composite International Diagnostic Interview (NK-CIDI), a diagnostic interview tool, was conducted at baseline and depressive symptoms were measured at each wave. Trajectory identification was based on latent class mixed modeling. Logistic regression was used to extract the significant factors predicting a high/increasing depressive symptom trajectory.ResultsTwo trajectories of depressive symptoms were identified: “low/stable symptom” (76.7% of participants) and “high/increasing symptom” (23.3% of participants). Predictors of the high/increasing symptom group were being female and a low use of mental health services. Generalized anxiety disorder, social phobia, and alcohol dependence acted as significant predictors. Although PTSD was not a significant predictor, self-reported PTSD symptom scores were high in the high/increasing symptom group.ConclusionsIdentifying the trajectories of depressive symptoms in NKDs helps identify the risk factors of clinically vulnerable groups. In the process of establishing government-level interventions, it may be helpful to create a therapeutic environment. In addition, when evaluating initial psychiatric problems, it is important to primarily consider NKDs' anxiety levels and alcohol problems. There should also be an appropriate consideration of PTSD symptoms.

Background: Many studies have reported noticeable increases in the proportion of employees working either relatively short or relatively long hours. Such trends have been accompanied by an increasing concern regarding work hour mismatches defined as a discrepancy between actual and preferred work hours. The aim of this study was to investigate association between work hour mismatch and depression. Methods: Data regarding work hour mismatches for 47,551 adults were extracted from the 2017 Korean Working Conditions Survey. The World Health Organization-Five Well-Being Index was used to measure depression. Multiple logistic regression analyses were performed to examine the association between work hour mismatch and depression. Results: Men and women workers with work hour mismatch were more likely to have depression [underemployed males: odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14–1.49, overemployed males: OR = 1.28, 95% CI = 1.18–1.40; underemployed females: OR = 1.37, 95% CI = 1.20–1.56, overemployed females: OR = 1.12, 95% CI = 1.02–1.23]. Underemployed workers, workers who worked more than 52 hours per week, and workers with a high income level, all had higher ORs for depression. The greater the discrepancy between actual and preferred work hours, the higher OR for depression among both underemployed and overemployed workers. Conclusions: A difference between actual and preferred work hours was associated with depression. Underemployed workers had a higher risk of depression than that of overemployed workers. As a work hour mismatch negatively affected workers' mental health, it is important to reduce work hours mismatches as well as shorten the absolute number of work hours.

Background/Aims: Data on the comparative effectiveness of infliximab (IFX) or adalimumab (ADA) in patients with Crohn’s disease (CD) are rare, particularly for Asian patients. We compared the key clinical outcomes (surgery, hospitalization, and corticosteroid use) of use of these two drugs in biologic-naive Korean patients with CD. Methods: Using National Health Insurance claims, we collected data on patients who were diagnosed with CD and exposed to IFX or ADA between 2010 and 2016. Results: We included 1,488 new users of biologics (1,000 IFX users and 488 ADA users). Over a median follow-up period of 2.1 years after starting biological therapy, no significant differences were found between IFX and ADA users in the risks for surgery (ADA vs IFX: adjusted hazard ratio [aHR], 1.22; 95% confidence interval [CI], 0.81 to 1.84), hospitalization (aHR, 1.02; 95% CI, 0.81 to 1.28), and corticosteroid use (aHR, 0.82; 95% CI, 0.56 to 1.19). These results were unchanged even when only patients who used biologics for over 6 months were analyzed (aHR [95% CI]: surgery, 1.31 [0.82 to 2.11]; hospitalization, 1.02 [0.80 to 1.30]; corticosteroid use, 0.80 [0.54 to 1.18]). Additionally, these results were unchanged in patients treated with biologics as monotherapy or in combination with immunomodulators. Conclusions: In this nationwide population-based study, no significant difference was found in the long-term effectiveness of IFX and ADA in the real-world setting of biologic-naive Korean patients with CD. In the absence of trials to directly compare IFX and ADA, our study indicates that the selection of one of these two biologics can be determined by patient and/or physician preference.

The severe lettuce damage caused by Paratylenchus projectus was first reported in 2019 in Korea. To find high-value rotation crops for the control of P. projectus, nine vegetables, Brassica juncea (leaf mustard), B. rapa subsp. nipposinica (kyona), B. oleracea var. italica (broccoli), B. rapa subsp. chinensis (bok choy), B. oleracea var. viridis (kale), B. oleracea var. gongylodes (kohlrabi), Cichorium endivia (endive), C. intybus (chicory), Ipomoea aquatica (morning glory) were planted in d-10-cm clay pots in greenhouse. The growth of vegetables was compared between inoculated with 3,000 P. projectus per 100 cm3 of soil and non-inoculated. Treatments were replicated 10 times. After 100 days, the reduction of fresh top weight was 30.4% in C. intybus, 35.1% in I. aquatica, 36.9% in B. oleracea var. acephala, 40.5% in C. endivia, 42.1% in B. rapa, 47.5% in B. rapa subsp. nipposinica, 50.4% in B. oleracea var. gonglodes, 56.3% in B. oleracea var. italica, and 66.0% in B. juncea. Nematode multiplication rates (Pf/Pi) were lower in I. aquatica (0.64) and C. endivia (1.1), but higher in B. oleracea var. gongylodes (2.54). Considering these results, I. aquatica is suitable for the rotation crop with lettuce until better rotation crops developed.

Background/Aims The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn’s disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients. Methods Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use. Results Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators. Conclusions Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease.

Background/Aims: Little is known about the national colonoscopy volume in Asian countries. This study aimed to assess the national colonoscopy volume in Korea over a 12-year period on the basis of a nationwide population-based database. Methods: We conducted a population-based study for colonoscopy claims (14,511,158 colonoscopies performed on 13,219,781 patients) on the basis of the Korean National Health Insurance Service database from 2002 to 2013. The 12-year national colonoscopy burden was analyzed according to patient age, patient sex, and healthcare facility type. Results: The overall volume of colonoscopy increased 8-fold over the 12-year period. The annual colonoscopic polypectomy rate significantly increased in all patient sex and age groups over the 12-years period (all p

Abstract Background Preoperative chemoradiotherapy (PCRT) followed by surgery and adjuvant chemotherapy is the current standard treatment for stage II/III rectal cancer. However, radiotherapy in the pelvic area is commonly associated with complications such as anastomotic leakage, sexual dysfunction, and fecal incontinence. Recently, the MERCURY study showed that preoperative high-resolution magnetic resonance imaging (MRI) helped to selectively avoid PCRT. It remains unclear whether PCRT is necessary in patients who can achieve a negative circumferential resection margin (CRM) with surgery alone and in patients with cT1–2N1 or cT3N0 without CRM involvement and lateral lymph node metastasis. This study aims to evaluate the efficacy of upfront radical surgery with total mesorectal excision (TME) followed by adjuvant chemotherapy with folinic acid (or leucovorin), fluorouracil, and oxaliplatin (FOLFOX) versus the current standard treatment in patients with surgically resectable, locally advanced rectal cancer. Methods This study, named TME-FOLFOX, is a prospective, open-label, multicenter, phase II randomized trial. Patients with locally advanced rectal cancer will be randomized to receive PCRT followed by TME and adjuvant chemotherapy (arm A) or upfront radical surgery with TME followed by adjuvant FOLFOX chemotherapy (arm B). Clinical stage II/III rectal cancer without CRM involvement and lateral lymph node metastasis will be defined using preoperative MRI. The primary endpoint is 3-year disease-free survival (DFS). Secondary endpoints include 5-year DFS, local recurrence rate, systemic recurrence rate, cost-effectiveness, and overall survival. We hypothesized that our experimental group (arm B) will have a 3-year DFS of 75% and a non-inferiority margin of 15%. Discussion Identifying whether patients require PCRT is one of the critical issues in locally advanced rectal cancer. This study aims to elucidate whether PCRT may not be required for all patients with stage II/III rectal cancer, especially for the MRI-based intermediate-risk group (with cT1–2N1 or cT3N0) without CRM involvement and lateral lymph node metastasis. If the findings indicate that our proposed treatment, which omits PCRT, is non-inferior to the standard treatment, then patients may avoid unnecessary radiation-related toxicity, have a shorter treatment duration, and save on medical costs. Trial registration ClinicalTrials.gov , NCT02167321. Registered on 19 June 2014.

The Tol-Pal system is a transenvelope complex widely conserved among Gram-negative bacteria. It is recruited to the septal ring during cytokinesis, and its inactivation causes pleiotropic phenotypes mainly associated with the division process. From our genetic screen to identify factors required for delaying lysis upon treatment of beta lactams, we discovered that the tol-pal mutant shares similar defects with mutants of the major class A PBP system (PBP1b-LpoB) in terms of lysis prevention. Further phenotypic analyses revealed that the Tol-Pal system plays an important role in maintaining cell integrity not only during septation, but also during cell elongation. Simultaneous inactivation of the Tol-Pal system and the PBP1b-LpoB system leads to lysis during cell elongation as well as during division. Moreover, production of the Lpo activator-bypass PBP1b, but not wild-type PBP1b, partially suppressed the Tol-Pal defect in maintaining cell integrity upon treatment of mecillinam specific for the Rod system, suggesting that the Tol-Pal system is likely to be involved in the activation of aPBP by Lpo factors. Overall, our results indicate that the Tol-Pal system plays an important role in maintaining cell wall integrity during elongation in addition to its multifaceted roles during cytokinesis.

This study investigated the developmental trajectory of inattention symptoms as a predictor of later depressive symptoms in adolescence, and examined potential mediating role of peer relationships in this process. Participants were adolescents who were part of the large longitudinal panel study on Korean Youths, Korean Children & Youth Panel Survey 2010 (KCYPS 2010) of the National Youth Policy Institute (NYPI). Specifically, data were drawn from two cohorts of KCYPS that differed in participant age (Panel 1: 2003 birth cohort, n = 2,342, 48.2% girls; Panel 2: 2000 birth cohorts, n = 2,378, 40.0% girls). We analyzed data collected from 2010 to 2016 when children in panel 1 were 6–7 to 12–13 years old, and children in panel 2 were 9–10 to 15–16 years old. Results of latent growth modeling (LGM) were as follows. In Panel 1, the inattention symptoms increased from 9–10 to 12–13 years. Otherwise, the inattention symptoms decreased from 11–12 to 15–16 years in panel 2. Additionally, in both panels, initial status and slope of inattention significantly predicted later levels of depressive symptoms, and peer relationships partly mediated the association between inattention trajectory and depressive symptoms. The findings are discussed with respect to considering the growth of inattention and the quality of peer relationships as promising targets for early identification and intervention of depression in adolescents.