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Connection between trajectory of primary cancer monitoring indicators and mortality after cancer in South Korea
No full textBACKGROUND: Cancer remains a leading global cause of mortality, responsible for nearly 10 million deaths in 2020. Given the country's low birth rate and aging population, the escalating cancer burden poses significant challenges to its healthcare systems. This study aimed to investigate the relationship between lifestyle risk factors and cancer case fatality, emphasizing the collective impact of these factors through a prevention index at the regional level. METHODS: The study focused on ten cancer types, categorizing counties into three levels of cancer incidence rates using group-based trajectory modeling to identify disparities in patterns and levels among groups. Additionally, we segmented the proportions of obesity prevalence, average daily per capita smoking amount, prevalence of smoking, prevalence of high-risk alcohol consumption, prevalence of hypertension diagnosis, prevalence of diabetes diagnosis, and cancer case fatality into three groups through group-based trajectory modeling. Cox proportional hazard models were employed to evaluate the hazard ratios (HR) for cancer case fatality, adjusting for age, sex, income level, and cancer stage. RESULTS: The study population comprised 294,070 cancer patients, with thyroid, stomach, colorectal, breast, and lung cancers being the most common. The prevention index (PI) levels, calculated from six primary prevention indicators, were categorized into High, Medium, and Low grades. Counties with higher PI levels (H) exhibited significantly lower cancer case fatality among cancer patients compared to those with lower PI levels (L). Across all cancer types, females had lower cancer case fatality compared to males, higher age was linked to higher cancer case fatality, advanced stage cases had the highest cancer case fatality, and the highest income quintile consistently showed the lowest cancer case fatality. CONCLUSIONS: The study highlights the significant inverse relationship between primary prevention indicator levels and cancer case fatality. Higher scores on primary prevention indicators are associated with lower cancer mortality among cancer patients for various cancer types, underscoring the importance of comprehensive, community-based prevention strategies in mitigating cancer risk and improving public health outcomes in South Korea
Prediction of diabetic retinopathy using machine learning and its association with dementia risk in older adults with type 2 diabetes mellitus
No full textAIMS: Diabetic Retinopathy (DR), a common microvascular complication of diabetes, has been associated with an increased risk of dementia. This study aimed to develop Machine Learning (ML) models to predict DR occurrence and evaluate its potential as a prognostic biomarker for dementia. METHODS: We included 27,929 patients aged >/= 50 years newly diagnosed with type 2 diabetes mellitus without prior dementia or eye disease. Prediction models for DR within one year were developed using three ML algorithms: extreme gradient boosting (XGBoost), random forest, and least absolute shrinkage and selection operator. The best-performing model was externally validated across eight institutions. Patients were followed for three years to assess dementia incidence. Dementia risk between ML-predicted DR and non-DR groups was compared using Kaplan-Meier and Cox regression, with results pooled via meta-analysis. RESULTS: XGBoost demonstrated the best performance (AUROC: 0.746), with external validation AUROCs ranging from 0.555 to 0.620. Predicted DR was significantly associated with increased all-cause dementia risk (HR: 1.32, 95% confidence interval [CI] 1.12-1.56), Alzheimer's disease (HR: 1.30, 95% CI 1.07-1.58), and vascular dementia (HR: 1.38, 95% CI 1.12-1.69). CONCLUSIONS: ML-predicted DR was significantly associated with future dementia, highlighting its value in early risk stratification among patients with diabetes
First-year oral antidiabetic adherence and long-term complications in newly diagnosed type 2 diabetes
No full textAIMS: Type 2 diabetes (T2D) is a growing public health issue, with early treatment adherence potentially impacting long-term outcomes. This study assessed the association between adherence to oral antidiabetic drugs (OADs) during the first year after diagnosis and the risk of complications and mortality. METHODS: A retrospective cohort study was conducted using a nationally representative health claims database. Patients newly diagnosed with T2D in 2009 who initiated OAD monotherapy within 12 months were included. Follow-up continued from the adherence index date until death, loss of follow-up, or study end. Patients were categorized by adherence level during the first year: good (>/= 80 %) and poor (< 80 %). Outcomes included macrovascular events, diabetes-related hospitalizations, and all-cause mortality. Hazard ratios were estimated using Cox proportional hazards models with inverse probability of treatment weighting. RESULTS: Among 65,340 patients, 46.9 % (n = 30,657) showed good adherence. Compared to poor adherence, good adherence was associated with a 23 % lower risk of macrovascular events, an 8% lower risk of diabetes-related hospitalizations, and a 28 % lower risk of all-cause mortality. CONCLUSIONS: Early adherence to OADs was associated with a reduced risk of complications and mortality in T2D patients. Promoting adherence in newly diagnosed individuals is crucial for improving long-term outcomes
Impact of Type 1 Diabetes on Growth in Korean Pediatric Population: A Retrospective Cohort Study of Final Adult Heights
No full textThe impact of Type 1 diabetes mellitus (T1DM) on growth remains uncertain, with previous studies reporting mixed findings. This study aimed to evaluate whether T1DM affects final adult height (FAH) by comparing it to genetically predicted mid-parental height (MPH).This retrospective cohort study analyzed medical records of 91 individuals diagnosed with T1DM at Ajou University Hospital, Korea, between 2000 and 2024. All individuals were diagnosed at least one year before completing linear growth and continued receiving care until reaching FAH. FAH was compared with MPH, and multiple regression analysis was performed to identify factors influencing growth outcomes.FAH was 1.17 cm lower than MPH in males and 0.05 cm higher than MPH in females; however, neither difference reached statistically significance. Glycemic control (mean HbA1c) and pubertal status at diagnosis were not significantly associated with FAH standard deviation score (SDS) and FAH-MPH SDS. Multiple regression analysis identified height at diagnosis and parental height as significant predictors of FAH SDS, whereas a longer diabetes duration was significantly associated with a lower FAH SDS (B=- 0.058, 95% CI: - 0.111 to - 0.005, p=0.032).T1DM does not significantly impact FAH, but longer diabetes duration was negatively associated with final adult height. These findings emphasize the need for early growth monitoring and optimized diabetes management, particularly in individuals diagnosed at a younger age, to improve long-term outcomes
Long Term Outcomes of Non-operative Treatment for Popliteal Artery Entrapment Syndrome: A Multicentre Study
No full textOBJECTIVE: Surgical decompression is generally recommended for popliteal artery entrapment syndrome (PAES); however, many young patients are reluctant to undergo surgery. Additionally, there is no consensus on the management of asymptomatic or mildly symptomatic cases. This multicentre study investigated the prognosis of non-operated limbs with PAES and analysed outcomes in limbs undergoing delayed surgical intervention in order to refine management strategies. METHODS: Patients diagnosed with PAES and treated in three hospitals between January 1994 and October 2022 were included. Medical records and imaging data were reviewed retrospectively. Symptoms were classified into Rutherford categories, and the anatomical abnormality was classified after image review. Data analysis was performed using R software. RESULTS: Among 96 limbs diagnosed with PAES, 64 underwent surgery, while 32 received conservative treatment. There were no statistically significant differences in demographics or ankle brachial index between the surgery and no surgery groups; however, smoking and alcohol consumption rates were statistically significantly higher in the surgery group. Additionally, Rutherford classification and extent of arterial occlusion were statistically significantly more severe in the surgery group compared with the no surgery group (p < .001 and p = .015, respectively). Of the 32 limbs treated conservatively, 30 remained stable (94%), and two limbs (6%) underwent delayed surgery during a mean follow up of 68.9 months. None experienced severe complications of amputation, death, or distal embolism. CONCLUSION: Patients with PAES with no or mild symptoms who are reluctant to undergo surgery can be safely managed with regular follow up and conservative treatment. Monitoring symptoms through outpatient visits and imaging enables effective management. Surgical intervention can be safely performed if symptoms worsen over time
Tissue-Engineered Tracheal Reconstruction
No full textTracheal reconstruction remains a formidable clinical challenge, particularly for long-segment defects that are not amenable to standard surgical resection or primary anastomosis. Tissue engineering has emerged as a promising strategy for restoring the tracheal structure and function through the integration of biomaterials, stem cells, and bioactive molecules. This review provides a comprehensive overview of recent advances in tissue-engineered tracheal grafts, particularly in scaffold design, cellular sources, fabrication technologies, and early clinical experience. Innovations in biomaterial science, three-dimensional printing, and scaffold-free fabrication approaches have broadened the prospects for patient-specific airway reconstruction. However, persistent challenges, including incomplete epithelial regeneration and mechanical instability, have hindered its clinical translation. Future efforts should focus on the design of modular biomimetic scaffolds, the enhancement of immunomodulatory strategies, and preclinical validation using robust large animal models. Sustained interdisciplinary collaboration among surgical, engineering, and biological fields is crucial for advancing tissue-engineered tracheal grafts for routine clinical applications. Within this context, biomimetic approaches, including three-dimensional bioprinting, hybrid materials, and scaffold-free constructs, are gaining prominence as strategies to replicate the trachea's native architecture and improve graft integration
Safety and Efficacy of Reduced-Port Versus Conventional Laparoscopic Distal Gastrectomy for Early Gastric Cancer: A Multicenter, Randomized, Non-inferiority Trial (KLASS-12)
No full textPURPOSE: This trial (KLASS-12) compares the efficacy and safety of reduced-port laparoscopic gastrectomy (RPLG) versus conventional 5-port laparoscopic gastrectomy (CPLG) for early gastric cancer (EGC). MATERIALS AND METHODS: This multicenter, open-label, randomized controlled trial enrolled patients diagnosed with gastric adenocarcinoma (T1N0M0) at 15 university hospitals in Korea. Participants underwent RPLG or CPLG with at least D1+ lymph node dissection. The primary aim of this study was to verify the non-inferiority of RPLG to CPLG in terms of postoperative 30-day complications. RESULTS: From May 2022 to October 2023, 348 patients were randomly assigned to the RPLG and CPLG groups, with 174 patients in each group. After applying the exclusion criteria, 164 and 166 patients from the RPLG and CPLG groups, respectively, were analyzed. Complication rates were 10.4% and 9.2% for the RPLG and CPLG groups, in the intention-to-treat (ITT) population, and 10.4% vs. 7.2% in the per-protocol (PP) population. The risk difference was 0.012 (95% confidence interval [CI], -0.051 to 0.075) in the ITT population and 0.031 (95% CI, -0.030 to 0.093) in the PP population. These findings verified the non-inferiority of RPLG to CPLG, with a 10% margin. Additionally, the pain score on postoperative day 5 was significantly lower in the RPLG group (1.6% vs. 1.8%; P=0.028). The 2 groups showed no significant differences in the lymph node yield, conversion rate, or length of hospital stay. RPLG was not an independent risk factor for complications. CONCLUSIONS: RPLG is a feasible and safe alternative for patients with EGC, and its short-term outcomes are not inferior to those of CPLG. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0006935
Validation of criteria for frontotemporal dementia with right anterior temporal lobe predominance
No full textINTRODUCTION: Frontotemporal dementia (FTD) with right anterior temporal lobe (rATL) predominance lacks universally agreed-upon diagnostic criteria. This study validated the Amsterdam diagnostic tree (ADT) for right temporal variant FTD (rtvFTD) and the diagnostic criteria for semantic behavioral variant FTD (sbvFTD), examining clinical, behavioral, and imaging differences. METHODS: The study included 138 patients with behavioral variant FTD and 87 with semantic variant primary progressive aphasia who had 3D T1-weighted magnetic resonance imaging scans. The participants were grouped into rtvFTD and sbvFTD by respective imaging criteria. RESULTS: We identified 42 rtvFTD and 20 sbvFTD patients. ADT showed 81% sensitivity and 29% specificity, whereas sbvFTD criteria had 45% sensitivity and 55% specificity. DISCUSSION: The unfavorable validation of both diagnostic criteria in Korean FTD patients may result from socio-cultural differences, the lack of standardized tools for assessing abnormal behaviors, and the retrospective nature of the study. The perspectives on rATL also differed between the two studies. HIGHLIGHTS: Frontotemporal dementia (FTD) with right anterior temporal lobe (rATL) predominance is a controversial FTD syndrome, also referred to as right temporal variant FTD (rtvFTD), or right predominant semantic variant primary progressive aphasia. Two clinical criteria for rATL have been proposed: One is the Amsterdam diagnostic tree for rtvFTD and the other is for semantic behavioral variant FTD (sbvFTD). Our validation study suggested the need for standardized tools and highlighted theoretical distinctions between rtvFTD and sbvFTD
Angiogenic and Immunomodulatory effects of embryonic stem cell derived mesenchymal stem cells in a murine model of ischemic hindlimb
No full textIn critical limb-threatening ischemia (CLTI), failed revascularization and pharmacotherapy substantially increase amputation and mortality risks. Mesenchymal stem cells (MSCs) are a promising therapeutic option for CLTI. This study evaluated the therapeutic effects of embryonic stem cell-derived MSCs (E-MSCs) on inflammation and angiogenesis under ischemic conditions across different E-MSC doses. Hindlimb ischemia was induced in 85 BALB/c nude mice by cauterizing the femoral and branched arteries. The mice were divided into five groups: non-ischemia (G1); saline-treated ischemia (G2); and ischemia treated with E-MSCs at low, medium, and high doses (G3-G5). Therapeutic effects were assessed using the rotarod test, blood perfusion ratio, and histological and cytokine analyses. G1 exhibited normal blood perfusion and motor function, whereas E-MSC-treated groups (G3-G5) demonstrated improved perfusion compared to G2. Although the medium-dose group (G4) showed numerically greater recovery, differences between G3, G4, and G5 were not statistically significant, suggesting no dose-response. All E-MSC-treated groups exhibited reduced inflammation and increases in motor function and angiogenic factors. Histological analysis revealed enhanced myofiber regeneration, reduced inflammatory infiltration, and diminished collagen deposition in the ischemic muscle of G3-G5. These changes were observed across all dose groups without significant dose-dependent differences. These results suggest E-MSCs enhance blood perfusion and modulate inflammation and angiogenesis in ischemic limbs, regardless of dose. These findings support the therapeutic potential of E-MSCs in CLTI, although further investigation is needed to optimize dosing and elucidate the mechanisms involved
Comparative analysis of the tumor microenvironment in primary CNS and testicular large B-cell lymphomas using digital image analysis and its implications for immunotherapy
No full textPrimary large B-cell lymphomas of immune-privileged sites, including primary central nervous system lymphoma (PCNSL) and primary testicular lymphoma (PTL), exhibit distinct clinicopathologic features contributing to aggressive behavior and immune evasion. While the molecular characteristics of PCNSL and PTL have been extensively studied, the tumor microenvironment (TME) remains insufficiently understood. In particular, no study has directly compared the TME of PCNSL and PTL, highlighting a critical gap in understanding their immunobiology. We analyzed 55 cases of diffuse large B-cell lymphoma involving the central nervous system (CNS) and testis using deep learning-based digital image analysis. Immunohistochemical staining was performed for key immune markers, including CD3, CD4, CD8, FOXP3, PD-1, TIM-3, CD68, and CD163, to characterize TME composition. PTL exhibited significantly higher levels of tumor-infiltrating lymphocytes, including CD3(+) and CD8(+) T-cells, compared to PCNSL (P < 0.001). The T-cell exhaustion index was significantly lower in PTL (P < 0.001), while CD163(+) macrophages were more predominant in PCNSL, suggesting a more immunosuppressive TME in the CNS. Correlation analyses of TME factors revealed differences between the CNS and testis, with stronger interrelationships among immune markers in PCNSL. Our findings highlight distinct TME characteristics between PCNSL and PTL. The predominance of CD163(+) macrophages and higher T-cell exhaustion in PCNSL suggests potential benefits of macrophage-targeted therapies. In contrast, PTL, with a more active TME, may be more responsive to immune checkpoint blockade. This study provides novel insights into the immune landscape of primary large B-cell lymphomas of immune-privileged sites, emphasizing the need for site-specific treatment approaches