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Revisiting the Cardiac Safety of Dose-Dense Chemotherapy: Encouraging Outcomes From Long-Term Follow-Up
No full textGlobal, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021
No full textBACKGROUND: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. METHODS: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. FINDINGS: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1.00 billion (95% uncertainty interval [UI] 0.989-1.01) adult males and 1.11 billion (1.10-1.12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155.1% (149.8-160.3) in males and 104.9% (95% UI 100.9-108.8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3.80 billion (95% UI 3.39-4.04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254.8% (234.4-269.5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity. INTERPRETATION: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. FUNDING: Bill & Melinda Gates Foundation
ACTION Teens: Perceptions and attitudes towards obesity among adolescents living with obesity, caregivers and healthcare professionals in South Korea
No full textBackground: In South Korea, the prevalence of adolescents living with obesity (ALwO) is rising.
Objectives: To evaluate perceptions, attitudes, behaviors, and obstacles to effective obesity care among ALwO, caregivers, and healthcare professionals (HCPs) in South Korea.
Methods: ACTION Teens (NCT05013359) was a multinational, cross-sectional survey conducted in 2021. Data from South Korean participants are reported (476 ALwO, 523 caregivers, 200 HCPs).
Results: Most ALwO/caregivers acknowledged that they/their ALwO had overweight, obesity or severe obesity (95 %/88 %, respectively) and were concerned about weight impacting their/their ALwO's future health (94 %/91 %, respectively). The predominant information source on weight management for ALwO/caregivers was YouTube (62 %/35 %, respectively). Most HCPs (87 %) indicated obesity had a strong impact on overall health; fewer ALwO (70 %) and caregivers (62 %) provided the same responses. ALwO recognized the societal challenges associated with overweight/obesity (versus healthy weight), with 50 %, 37 %, and 36 % reporting that overweight/obesity makes it harder to get a job, make friends, and perform well at school, respectively (compared with 41 %, 28 %, and 26 % of caregivers). A higher proportion of ALwO (80 %) than caregivers (45 %) thought weight loss was completely the ALwO's responsibility. While 82 % of ALwO reported they had made a recent weight-loss attempt, only 60 % of caregivers reported that their ALwO had made a recent weight-loss attempt; HCPs thought that, on average, 35 % of their ALwO patients had attempted to lose weight.
Conclusions: Disparities in respondents' perceptions and attitudes toward obesity underscore the need for enhanced communication and increased understanding of obesity to improve healthcare strategies for South Korean ALwO
Pretrained patient trajectories for adverse drug event prediction using common data model-based electronic health records
No full textBACKGROUND: Pretraining electronic health record (EHR) data using language models has enhanced performance across various medical tasks. Despite the potential of EHR pretraining models, predicting adverse drug events (ADEs) using EHR pretraining models has not been explored. METHODS: We used observational medical outcomes partnership common data model (CDM)-based EHR data from Seoul National University Hospital (SNUH) between January 2001 and December 2023 and Ajou University Medical Center (AUMC) between January 2004 and December 2023. In total 510,879 and 419,505 adult inpatients from SNUH and AUMC are included in internal and external datasets. For pretraining, the model was trained to infer randomly masked tokens using preceding and following history. In this process, we introduced domain embedding (DE) to provide information about the domain of masked tokens, preventing the model from finding codes from irrelevant domains. For qualitative analysis, we identified important features using the attention matrix from each finetuned model. RESULTS: Here we show that EHR pretraining models with DE outperform the models without pretraining and DE in predicting various ADEs, with the average area under the receiver operating characteristic curve (AUROC) of 0.958 and 0.964 in internal and external validations, respectively. For feature importance analysis, we demonstrate that the results are consistent with priorly reported background clinical knowledge. In addition to cohort-level interpretation, patient-level interpretation is also available. CONCLUSIONS: The CDM-based EHR pretraining model with DE can improve prediction performance for various ADEs and can provide proper explanation at cohort and patient level. Our model has the potential to serve as a foundation model due to its strong prediction performance, interpretability, and compatibility
CTC-537E7.3 as a Liver-Specific Biomarker for Hepatocellular Carcinoma: Diagnostic and Prognostic Implications
No full textHepatocellular carcinoma (HCC) critically lacks reliable biomarkers for early detection. By mining the TCGA_LIHC and two GEO cohorts, we identified the liver-specific long non-coding RNA CTC-537E7.3 as the most consistently down-regulated transcript in tumors. This finding was validated in 97 paired tissues, with CTC-537E7.3 expression lost in 95% of cases (*** p < 0.0001). It demonstrated excellent diagnostic performance in discriminating tumor from non-tumor tissue (AUC = 0.95), which was maintained in early-stage (I/II) disease. Low CTC-537E7.3 expression correlated with shorter overall and disease-free survival and was inversely associated with serum alpha-fetoprotein (AFP) levels, highlighting its complementary clinical value. Mechanistic investigation revealed a potential competing endogenous RNA (ceRNA) axis. The microRNA miR-190b-5p was highly expressed in tumors and predicted to bind CTC-537E7.3, while its target, PLGLB1, was significantly suppressed. Survival analysis confirmed that concurrent high expression of CTC-537E7.3 and PLGLB1 conferred superior outcomes. These findings establish CTC-537E7.3 as a liver-specific, ceRNA-mediated tumor suppressor with robust diagnostic and prognostic potential. It represents a promising adjunct to existing HCC surveillance strategies, such as ultrasound and AFP measurement, for high-risk populations
Associations between Meal Frequency and Cardiometabolic Risk Factors (Diabetes Metab J 2025;49:311-20)
No full textEvaluation of Medical Device Aging and Replacement Decisions within Hospital Environments: A User-Centered Approach
No full textPURPOSE: This study aims to evaluate the factors influencing medical device replacement decisions from a user-centered perspective: medical technicians, engineers, and healthcare professionals. We seek to prioritize criteria for medical device replacement and develop feasible strategies applicable to real-world healthcare settings. METHODS: This analysis was conducted by reviewing previous studies to identify the key factors in medical device replacements. The key variables were selected from the review, and the significant factors for analysis were determined. RESULTS: An analytic hierarchy process (AHP) analysis was used to compare and analyze the priority of medical device replacement, which revealed that clinical factors emerged as the crucial in medical device replacement decisions. Additionally, unlike medical technicians, doctors, nurses, and pharmacists, for whom clinical factors are the primary considerations when replacing medical devices, safety is the most important factor for medical engineers. CONCLUSION: Medical device obsolescence significantly affects patient safety and healthcare operations. Therefore, the maintenance plans for medical devices should focus on clinical factors. Moreover, a more systematic medical device replacement system must be established, prioritizing the factors according to the occupations of medical workers
Lateral pelvic lymph node dissection based on nodal response to neoadjuvant chemoradiotherapy in mid/low rectal cancer: a retrospective comparative cohort study
No full textPURPOSE: Total mesorectal excision (TME) without lateral pelvic lymph node (LPN) dissection (LPND) is feasible in patients with mid/low rectal cancer showing a reduction in LPN size to 5 mm before nCRT were included and classified based on nCRT response (post-nCRT LPN size 5 mm [persistent]) and surgical procedure (TME alone vs. TME + LPND). In the responsive group, LPND was selectively performed only if morphologic predictors of LPN metastasis were present. Clinical outcomes were analyzed across subgroups. RESULTS: Of 122 patients, 82 were in the responsive group. Within this group, 61 underwent TME alone and 21 underwent TME + LPND. No locoregional recurrence was observed in either subgroup of the responsive group, with similar systemic metastasis rates (13.1% vs. 14.3%, P > 0.99). The TME alone subgroup showed significantly smaller post-nCRT LPN sizes (1.7 +/- 2.1 mm vs. 3.9 +/- 1.8 mm, P < 0.001) and lower ycN positivity rates (31.1% vs. 71.4%, P = 0.001). CONCLUSION: Selective LPND based on post-nCRT LPN siz
Recommendations for Influenza Vaccination in Immunocompromised Patients
No full textAnnual influenza vaccination is strongly recommended for immunocompromised individuals, who are at a higher risk of severe infection. The Korean Society of Infectious Diseases has revised its influenza vaccination recommendations for solid organ transplant recipients, advocating for the use of highly immunogenic vaccines, such as high-dose inactivated influenza vaccines or MF59-adjuvanted inactivated influenza vaccines, to enhance vaccine efficacy. While further research is needed to extend these recommendations to other immunocompromised populations, these vaccines have demonstrated improved immunogenicity without compromising safety. Expanding vaccination guidelines to additional immunocompromised groups should be considered as more evidence emerges
TBK1 is a signaling hub in coordinating stress-adaptive mechanisms in head and neck cancer progression
No full textTumorigenesis is closely linked to the ability of cancer cells to activate stress-adaptive mechanisms in response to various cellular stressors. Stress granules (SGs) play a crucial role in promoting cancer cell survival, invasion, and treatment resistance, and influence tumor immune escape by protecting essential mRNAs involved in cell metabolism, signaling, and stress responses. TBK1 (TANK binding kinase 1) functions in antiviral innate immunity, cell survival, and proliferation in both the tumor microenvironment and tumor cells. Here, we report that MUL1 loss results in the hyperactivation of TBK1 in both HNC cells and tissues. Mechanistically, under proteotoxic stress induced by proteasomal inhibition, HSP90 inhibition, or Ub(+) stress, MUL1 promotes the degradation of active TBK1 through K48-linked ubiquitination at lysine 584. Furthermore, TBK1 facilitates autophagosome-lysosome fusion and phosphorylates SQSTM1, regulating selective macroautophagic/autophagic clearance in HNC cells. TBK1 is required for SG formation and cellular protection. Moreover, we found that MAP1LC3B is partially localized within SGs. TBK1 depletion enhances the sensitivity of HNC cells to cisplatin-induced cell death. GSK8612, a novel TBK1 inhibitor, significantly inhibits HNC tumorigenesis in xenografts. In summary, our study reveals that TBK1 facilitates the rapid removal of ubiquitinated proteins within the cell through protective autophagy under stress conditions and assists SG formation through the use of the autophagy machinery. These findings highlight the potential of TBK1 as a therapeutic target in HNC treatment.Abbreviations: ALP: autophagy-lysosomal pathway; AMBRA1: autophagy and beclin 1 regulator 1; BaF: bafilomycin A(1); CC: coiled-coil; CD274/PDL-1: CD274 molecule; CHX: cycloheximide; CQ: chloroquine; DNP: dinitrophenol; EGFR: epidermal growth factor receptor; ESCC: esophageal squamous cell carcinoma; G3BP1: G3BP stress granule assembly factor 1; HNC: head and neck cancer; HPV: human papillomavirus; IFN: interferon; IGFBP3: insulin like growth factor binding protein 3; IRF: interferon-regulatory factor 3; KO: knockout; LAMP1: lysosomal associated membrane protein 1; MAP1LC3B: microtubule associated protein 1 light chain 3 beta; NPC: nasopharyngeal carcinoma; PABP: poly(A) binding protein; PI: proteasome inhibitor; PQC: protein quality control; PROTAC: proteolysis-targeting chimera; PURA/PURalpha: purine rich element binding protein A; RIGI: RNA sensor RIG-I; SD: standard deviation; SG: stress granule; SQSTM1: sequestosome 1; STING1: stimulator of interferon response cGAMP interactor 1; TBK1: TANK binding kinase 1; UPS: ubiquitin-proteasome system; USP10: ubiquitin specific peptidase 10; VCP: valosin containing protein; VHL: von Hippel-Lindau tumor suppressor; WT: wild type