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The role of targeted temperature management before organ transplantation
No full textThis study aimed to investigate the clinical course of brain death donors and admitted through the emergency department before organ procurement and early outcomes of kidney transplantation. We retrospectively reviewed the medical records of patients who visited a single tertiary emergency department with the final diagnosis of brain death and donor procurement between January 2013 and January 2022. Donors were categorized into 3 groups: brain hemorrhage, hanging, and other medical causes. The primary outcome was the variation in the intensive care unit length of stay (LOS) across these groups. Secondary outcomes included organ procurement rates and factors influencing transplantation protocols, such as transplanted organs, age, sex, body mass index, cardiac arrest events, laboratory findings, and serial recipient laboratory results after organ transplantation. Medical records of 257 donors and 94 recipients for kidney transplantations were collected. The brain hemorrhage, hanging and other medical causes groups comprised 173 (67.3%), 53 (20.6%), and 31 (12.1%) patients, respectively. Of these, 102 patients (39.7%) experienced cardiac arrest before brain death. Targeted temperature management (TTM) was performed in 53 patients (20.6%). The mean time to organ procurement was 8.8 +/- 6.4 days; the hemorrhage, hanging, and other medical causes groups averaged 6.9 +/- 6.1, 7.1 +/- 5.1, and 8.6 +/- 5.1 days, respectively, with no significant differences (P = .29). However, TTM and non-TTM groups differed, averaging 10.9 +/- 6.9 vs 8.2 +/- 6.1 days (P = .013). The Kaplan-Meier curve indicated significant differences in LOS between these groups (P < .001). Before organ procurement, the TTM group's donors' sodium levels were better controlled at 143.4 +/- 10.3 vs 150.1 +/- 19.9 (P < .05). Consequently, the recipients' creatinine levels were lower than the non-TTM group on postoperative day 7 (1.68 +/- 0.82 vs 2.67 +/- 2.57; P < .01). The time to organ transplantation did not differ between the groups. However, the TTM group had a 2.7-day longer intensive care unit LOS before organ procurement than the non-TTM group. Before organ procurement, the TTM groups showed well-controlled sodium levels, and the kidney recipient group that received kidneys from the TTM group showed lower creatinine levels on postoperative day 7. It may represent more precise electrolyte imbalance management in post-cardiac arrest care using TTM
Polygenic risk score of Alzheimer's disease is associated with cognitive trajectories and phenotypes of cerebral organoids
No full textINTRODUCTION: Polygenic risk score (PRS) identifies individuals at high genetic risk for Alzheimer's disease (AD), but its utility in predicting cognitive trajectories and AD pathologies remains unclear. We optimized PRS (optPRS) for AD, investigated its association with cognitive trajectories and AD phenotypes of cerebral organoids. METHODS: Using genome-wide association study (GWAS) summary statistics from a European population, we developed optPRS to predict AD in Korean individuals (n = 1634). We analyzed the association between optPRS and cognitive trajectories (n = 771). We generated induced pluripotent stem cell-derived cerebral organoids from patients with high (n = 3) and low (n = 4) optPRS to evaluate amyloid beta (Abeta) and phosphorylated tau (p-tau) levels. RESULTS: OptPRS predicted AD dementia and Abeta positivity, independent of apolipoprotein E (APOE). Higher optPRSs correlated with rapid cognitive decline. Cerebral organoids from the high optPRS group exhibited increased Abeta insolubility and p-tau levels. CONCLUSION: OptPRS predicted cognitive decline and AD phenotypes of cerebral organoids, supporting its use in risk assessments and drug-screening platform. HIGHLIGHTS: Optimized polygenic risk scores (optPRSs) improve the prediction of Alzheimer's disease (AD) dementia and amyloid beta positivity (Abeta+). High optPRS is associated with faster cognitive decline, particularly in Abeta+. Induced pluripotent stem cell (iPSC)-derived cerebral organoids from high optPRSs show high Abeta insolubility and phosphorylated tau (p-tau). PRS genetic risk stratification provides insight into AD progression and pathology
Levothyroxine supplementation after hemithyroidectomy in patients with low-risk differentiated thyroid cancer: risk factors and withdrawal strategy
No full textBACKGROUND: The American Thyroid Association guidelines recommend maintaining thyroid-stimulating hormone (TSH) levels < 2 mIU/L postoperatively in low-risk patients. Patients with low-risk differentiated thyroid cancer, defined as intrathyroidal tumors without vascular invasion, aggressive histology, or metastasis according to ATA criteria, were included. Many patients who undergo hemithyroidectomy often maintain normal TSH levels, i.e., a euthyroid status, without taking levothyroxine after surgery. However, some patients continue to receive levothyroxine supplementation post-surgery. In this study, we analyzed the risk factors and predictors of levothyroxine withdrawal. METHODS: The medical records of 132 patients who underwent hemithyroidectomy for thyroid cancer at Ajou University Hospital between February 2016 and February 2018 were reviewed. The medical records included data on demographics, type of operation, pathological findings, pre- and postoperative changes in TSH levels, levothyroxine dosage and discontinuation timing, and pre- to postoperative changes in thyroid gland volume. All patients were started on a fixed dose of levothyroxine immediately after surgery, which was subsequently tapered and withdrawn based on the TSH levels. RESULTS: Among 132 patients who underwent hemithyroidectomy, 67 (51%) eventually withdrew from postoperative levothyroxine. Of the many dependent variables, multivariate analysis revealed the statistical significance of preoperative TSH levels (P=0.014), preoperative thyroid volume measured by 3-dimensional (3D) CT, and the ratio of preoperative-to-postoperative residual thyroid volume (P=0.026 and P=0.012, respectively). In the subgroup analysis of the group that resumed levothyroxine administration after levothyroxine withdrawal, only the ratio of the preoperative to postoperative residual thyroid volume was statistically significant (P<0.043). CONCLUSION: Preoperative TSH level and thyroid volume were the most important predictors of successful postoperative levothyroxine withdrawal. The pre- to postoperative thyroid volume ratio may be affected by surgery and a ratio of <33% was significantly correlated with the ability to discontinue levothyroxine
Association of the Healthy Aging Index with all-cause mortality: Results from the Korean Frailty and Aging Cohort Study
No full textOBJECTIVE: This study investigated the association between the Healthy Aging Index (HAI) and all-cause mortality and its potential modification by sociodemographic or lifestyle factors. METHODS: We analyzed data from 2303 community-dwelling adults aged 70-84 years who participated in the Korean Frailty and Aging Cohort Study (2016-2023). The HAI was constructed using five domains-physical function, cognitive function, social well-being, psychological health, and physiological health-each scored from 0 to 3. The total HAI score (range: 0-15) was evaluated as a continuous variable and by tertiles (poor, 0-9; moderate, 10-11; high, 12-15 points). All-cause mortality was assessed biennially from 2018 to 2023 from family or neighbor interviews or electronic medical records. Cox proportional hazards regression models were used for statistical analyses. RESULTS: During the 6-year follow-up, 152 (6.6 %) participants died. After adjusting for covariates, each 1-point increase in HAI was associated with an 18 % lower risk of all-cause mortality (hazard ratio [HR], 0.82; 95 % confidence interval [CI]: 0.76-0.88). Compared with the high HAI group, the HRs for the moderate and poor HAI groups were 1.27 (95 % CI: 0.70-2.28) and 2.77 (95 % CI: 1.58-4.88), respectively (P for trend <0.001). HAI and educational level showed a significant interaction. CONCLUSIONS: Lower levels of healthy aging were associated with higher mortality, particularly among older adults with lower educational attainment. These findings highlight the need for targeted strategies to promote healthy aging, especially among those with lower levels of education
The Effect of Tegoprazan on Serum Gastrin Levels and the Development of Hypergastrinemia in the Maintenance Treatment for Gastroesophageal Reflux Disease: Comparison to Lansoprazole
No full textBACKGROUND/AIMS: Safety data on potassium-competitive acid blockers are limited. We aim to evaluate the effect of tegoprazan on serum gastrin levels during maintenance treatment for gastroesophageal reflux disease compared to lansoprazole. METHODS: In a prospective, randomized trial, patients who underwent initial treatment with a standard dose of a proton pump inhibitor (n = 121) or tegoprazan (n = 226) were randomized to receive a half-dose of tegoprazan (n = 173) or lansoprazole (n = 174) as maintenance treatment for up to 24 weeks. Serum gastrin levels were measured immediately after initial treatment and monitored throughout the maintenance treatment period. RESULTS: Baseline gastrin levels were similar between the tegoprazan and lansoprazole groups (P = 0.335). During maintenance treatment, gastrin levels were significantly lower in the tegoprazan group at week 16 (P = 0.001) and week 24 (P = 0.012) compared to the lansoprazole group. Although the proportion of hypergastrinemia (> 115 pg/mL) was similar at baseline between the tegoprazan and lansoprazole groups (P = 0.114), it was significantly lower in the tegoprazan group during maintenance treatment (P = 0.003, 0.033, and 0.039 at weeks 8, 16, and 24, respectively) than in the lansoprazole group. Multivariate analysis revealed that age, sex, baseline gastrin levels, Helicobacter pylori infection, and the drug group were independently associated with final gastrin levels. CONCLUSION: Tegoprazan has a smaller impact on increasing serum gastrin levels and the development of hypergastrinemia than lansoprazole, suggesting that tegoprazan may reduce safety concerns related to hypergastrinemia, particularly at half doses
대한소화기학회 윤리법제위원회의 역할과 활동: 의료감정과 의료분쟁사례집 소개
No full textThe increasing complexity of medical care and growing patient awareness have resulted in a consistent rise in the number of medical disputes, highlighting the urgent necessity for fair and expert medical evaluations. The Ethics and Legislation Committee of the Korean Society of Gastroenterology (KSG) is involved in the systematic management and evaluation of medico-legal cases in the field of gastroenterology. The committee is composed of a multidisciplinary group of experienced specialists and legal professionals and utilizes a thorough, multi-tiered review process appropriate to the seriousness of each case. The committee initiated the establishment of advanced educational programs in 2024 to facilitate the further development of the expertise of its members. Furthermore, the committee has been actively publishing casebooks on medical ethics and disputes to educate members of the KSG on how to prevent legal risks. This article provides a comprehensive overview of the core activities of the KSG Ethics and Legislation Committee, including its history, systematic appraisal process, educational programs, and publications. It illustrates how these integrated efforts help foster a safer and more trustworthy medical environment for physicians and the public
Pathogenesis of Chronic Spontaneous Urticaria With or Without Angioedema
No full textChronic spontaneous urticaria (CSU) is a complex, immune-mediated skin disorder characterized by the appearance of wheals and/or angioedema. Histopathologic analysis reveals skin mast cell degranulation and a perivascular infiltrate composed of lymphocytes, eosinophils, neutrophils, and basophils. Mast cells and basophils are key effector cells in the pathogenesis and severity of CSU, and both cells can be activated by IgE-dependent and independent mechanisms. The pathogenesis of CSU remains incompletely understood, though recent studies have highlighted autoimmune mechanisms involving both IgG and IgE autoantibodies. Two major autoimmune endotypes have emerged: type I (autoallergic), involving IgE autoantibodies to autoantigens like thyroid peroxidase, and type IIb (autoimmune), characterized by IgG autoantibodies targeting IgE or its high-affinity receptor (FcepsilonRI). Recently, it has been found that patients can co-express both endotypes and the disease implications are unclear. Diagnostic tools such as the autologous serum skin test, basophil histamine release assay, and detection of circulating autoantibodies aid in identifying these endotypes but lack standardized assays. In addition to IgE-dependent pathways, recent evidence implicates complement and mas-related G protein-coupled receptor X2 in non-IgE-mediated mast cell activation. Notably, endotype classification has been shown to predict therapeutic response, with type IIb patients often exhibiting lower responsiveness to antihistamines and omalizumab treatments
Low bone mineral density is associated with high-frequency hearing impairment in women over 50: an observational study in Korea
No full textBACKGROUND: Osteoporosis and hearing impairment are known to be associated, but specific data regarding gender, bone mineral density (BMD) measurement sites, and hearing frequency ranges remain unclear. This study aimed to clarify the relationship between hearing loss and BMD in adults over the age of 50. Additionally, the study sought to determine the frequency ranges of pure tone audiometry (PTA) related to osteoporosis, identify BMD measurement sites, and investigate gender differences. METHODS: A total of 1,523 adults (651 men and 872 women) over the age of 50, who participated in a medical health check-up at a university hospital, were included. PTA was conducted to assess hearing, and BMD was measured using dual-energy X-ray absorptiometry at the lumbar vertebrae (LV) and femur. RESULTS: In women over the age of 50, a significant association was observed between hearing impairment and osteoporosis (P<0.01), but no such association was found in men. Lumbar BMD (L1-4) in women was significantly associated with hearing loss at 4,000 and 8,000 Hz (both P<0.05), whereas femoral neck and total femur BMD showed no significant relationship. In multiple logistic regression analysis, the odds ratio (OR) between osteoporosis and hearing threshold at 4,000 Hz (OR, 2.078; 95% confidence interval [CI], 1.092-3.954) and 8,000 Hz (OR, 2.648; 95% CI, 1.543-4.544) remained statistically significant in women after adjusting for age and other risk factors. CONCLUSION: In women over the age of 50, low BMD at the LV is significantly associated with hearing impairment, particularly at the high frequencies of 4,000 and 8,000 Hz
Impact of the 2024 medical-policy conflict on hepatocellular carcinoma management in Korea
No full textIn 2024, a nationwide conflict between the South Korean government and the medical community, the medical-policy conflict, profoundly impacted healthcare delivery. This study aimed to evaluate the changes in the management of hepatocellular carcinoma (HCC) following this crisis. We analyzed retrospective real-world data from university hospitals in the Seoul Metropolitan Area, supplemented with national healthcare data from the Health Insurance Review and Assessment Service. The analytical variables included changes in workforce composition, initial treatment modalities, HCC stage distribution, quality indicators for HCC care, regional and institutional variations in care delivery, and liver transplantation (LT) volume. A comparison between 2023 and 2024 revealed a marked decline in the number of medical trainees, a rise in the proportion of physician assistants, a 28.9% reduction in newly initiated HCC treatments, and an increased rate of stage IV diagnoses. Several quality indicators, including rates of multidisciplinary care and patient education, declined. The volume of LTs decreased by approximately 20% nationwide, with some regions ceasing LT procedures. The results suggest that serious disruptions occurred in HCC care following the conflict. The significant decrease in initial treatment and number of LT procedures, more advanced stages at diagnosis, and declining quality metrics indicate the emergence of healthcare gaps. Without the recovery of the clinical workforce and the reestablishment of a stable healthcare delivery system, the management of serious diseases such as HCC will remain structurally vulnerable. National-level efforts are urgently required to address regional disparities and restore essential medical services
Linking the Supplementary Motor Network and Executive Function in Developing Brain
No full textOBJECTIVE: Essential development of the frontal lobe occurs during childhood and adolescence, affecting various executive function (EF) domains. Of the frontal areas, the supplementary motor area (SMA) located in the medial frontal cortex, is involved in various high-order EFs which include inhibition, working memory, and cognitive flexibility. However, it remains unclear how the functional network of the SMA is associated with EF development. METHODS: We assessed Wisconsin Card Sorting Test (WCST) score and resting state functional magnetic resonance imaging data from 6- to 17-year-old children and adolescents to identify age differences in SMA functional connectivity (FC) associated with EF. RESULTS: A total of 112 children and adolescents (62 males; mean [standard deviation] age, 12.21 [2.98] years) were included. After adjusting for sex, we discovered significant evidence in the older group that 300 FCs between the SMA and numerous regions of the brain, including the frontal, occipital, parietal, temporal, limbic, and cerebellar areas, were negatively correlated with the WCST subcategories (false discovery rate < 0.05). CONCLUSION: This finding underscores the SMA's pivotal role in executive dysfunction during developmental stages. Interestingly, this significant connectivity was absent in younger participants, highlighting the age range of 11-12 as a critical turning point for brain functional alterations involved in EF development. Since the crucial role of SMA in refining EF development has been underappreciated, this work has the potential to provide insight into both the nature of the functional alteration of SMA and the differences in individuals' EF development trajectories