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Trends in Preventable Trauma Death Rates in Korea: A Follow-up Study of the Trauma System’s Performance
No full textBACKGROUND: The preventable trauma death rate (PTDR) is a key measure of trauma system performance. This study, the fourth follow-up since the implementation of trauma centers in South Korea, aimed to evaluate trends in PTDR and assess the mid-term performance of the trauma system. The study utilized consistent methods with previous analyses to ensure comparability and continuity. METHODS: A total of 8,490 trauma deaths occurred in 2021, and 1,688 patients from 265 medical institutions were included in the study. A multidisciplinary panel review was conducted to assess the preventability of mortality and identify opportunities for improvement. The results were compared with those from previous studies on the PTDR. RESULTS: Of the 1,688 sampled patients, the PTDR was calculated for 929. The overall PTDR was estimated at 13.9%, with a definitive preventable death rate of 2.9% and a potentially preventable death rate of 12.7%. The reduction in PTDR was not statistically significant compared to the 2019 study, which reported a rate of 15.7% (P = 0.261). Significant differences were observed between the preventable and non-preventable groups in terms of age, timing of death, level of medical institution, inter-hospital transfer, means of hospital admission, and time from accident to death. CONCLUSION: In 2021, the PTDR was 13.9%, showing a slight reduction compared to the 2019 study. This study primarily evaluated the performance of Korea's trauma system, with findings highlighting both progress and persistent challenges. Although the study was conducted during the coronavirus disease 2019 pandemic, its potential indirect impact on trauma care is acknowledged as an area for further research. Addressing systemic limitations remains essential for further reducing preventable trauma deaths
Tracking clonal dynamics of CD8 T cells and immune dysregulation in progression of systemic lupus erythematosus with nephritis
No full textThe fluctuating nature of disease activity in systemic lupus erythematosus (SLE), alternating between flares and remissions, poses substantial challenges for its effective management. The use of current biomarkers for monitoring SLE is limited in clinical settings owing to insufficient comprehension of the complex immune involvement underlying the disease course. Here, therefore, we profiled peripheral blood mononuclear cells at both stable and exacerbation states (total of n = 19) from six patients with SLE and 32 healthy donors using integrated single-cell RNA and T cell receptor (TCR) sequencing. To validate our findings, we analyzed two independent external datasets: bulk RNA sequencing and TCR data from 79 controls and 62 patients with SLE and single-cell RNA sequencing data from 99 healthy controls and 162 patients with SLE. Our analysis revealed cell type-specific activation of interferon-related genes in SLE grouped into four clusters, with elevated activity in disease-associated immune cells. Among these, atypical B cells associated with autoantibody production exhibited distinct differentiation patterns compared with conventional memory B cells, driven by heightened interferon signaling in SLE. Notably, clonal expansion of effector CD8 T cells emerged as a key driver of disease exacerbation, as indicated by reduced TCR diversity. Specific CD8 T cell clonotypes expanded during flare states, transitioning to effector phenotypes that exhibited heightened cytotoxicity and amplified interferon signaling, strongly correlating with tissue damage and flare severity. Our findings establish a critical link between interferon-driven mechanisms and cytotoxic T cell dysfunction in SLE flares, offering potential targets for therapeutic intervention and predictive biomarkers
A novel role of liquid plasma (LP) induced RONS triggers the endoplasmic reticulum stress response and is associated with GSDME-mediated pyroptosis in anaplastic thyroid cancer
No full textBACKGROUND: Anaplastic thyroid cancer (ATC) is an aggressive cancer with a poor prognosis and resistance to multimodal treatments. Various drugs have a short response time and are likely ineffective against ATC. Therefore, new molecular therapies and novel targets are needed. Recently, plasma medicine has been used in biomedical applications on skin, wound healing, and cancer treatment of the liver, colon, and head and neck. However, direct plasma has difficulty treating, sustaining, and permeating the various affected areas. In this study, we prepared Liquid-type plasma (LP) and investigated their effect on ATC cells. METHODS: The physicochemical properties and ion composition of liquid-type plasma (LP) were analyzed using ion chromatography, after which anaplastic thyroid cancer (ATC) cell lines, primary fibroblasts, and keratinocytes were employed to evaluate its biological effects. Cell viability, apoptosis/pyroptosis, and redox status were assessed by biochemical assays, flow cytometry, and Western blotting, while transcriptomic profiling (RNA-seq) with gene ontology analysis was performed to identify regulated pathways. Finally, an orthotopic ATC xenograft mouse model was used to validate the therapeutic efficacy of LP in vivo. RESULTS: The pH of LP decreased to 1.92 And remained stable for 14 days, while electrical conductivity was measured at 4.76 mS/cm without significant Change. Additionally, the oxidation-reduction potential was maintained at 652.2 mV for 14 days. Cl, NO2, and NO3 Anions were identified as 62 ppb, 12.6 ppm, And 1044 ppm, respectively, And Na, K, And Ca cations were measured as 169 ppb, 27 ppb, And 25 ppb, respectively. Therefore, a significant concentration of nitrogen species is involved in the LP, which is attributed to the secondary reaction of reactive oxygen species (ROS) formed during this treatment. LP reduced ATC cell viability, which exhibited cell swelling and bubble formation morphologically. Gasdermin E (GSDME) was cleaved by LP and induced pyroptosis in ATC cells. Inhibiting caspase activity and knock down of GSDME showed reduced caspase-3 dependent cleavage of GSDME, consequently increasing cell viability and decreasing lactate dehydrogenase release. LP enhanced the production of intracellular RONS and induced phosphorylation of IRE1alpha that is associated with endoplasmic reticulum (ER) stress. Therefore, GSDME-mediated LP induced pyroptosis downstream of the RONS/ER stress pathway and activated caspase-3. We then confirmed tumor shrinkage through in vivo and histological analysis, with a focus on the increasing GSDME-N terminal. CONCLUSION: LP induces pyroptosis via GSDME activation and RONS generation in vitro and in vivo in ATC models, suggesting a novel mechanism and indicating a potential chemotherapeutic approach for the treatment of ATC
Enhancing anti-tumor immunity through TIGIT blockade and tumor-directed targeting in pancreatic cancer
No full textPancreatic ductal adenocarcinoma (PDAC) exhibits profound resistance to immune checkpoint blockade, driven by a dense stroma, low immunogenicity, and an immunosuppressive tumor microenvironment. T cell immunoreceptor with Ig and ITIM domain (TIGIT) is an inhibitory receptor expressed on tumor-infiltrating lymphocytes and contributes to immune dysfunction in PDAC through its interaction with PVR. To selectively modulate the TIGIT axis within the tumor microenvironment, we developed a bispecific antibody (chi2B5x4F11) that targets TIGIT while anchoring to CUB domain-containing protein 1 (CDCP1), thereby enabling spatially confined immune activation in CDCP1-positive tumor niches. Functional characterization using in vitro NK-92 cell assays and in vivo studies using a humanized mouse model engrafted with CDCP1(+) PANC-1 cells demonstrated the efficacy of these antibodies. Parental chi4F11 effectively blocked the TIGIT-PVR axis, restoring AKT-FOXO1 signaling without altering CD226 expression. Chi2B5x4F11 further enhanced NK-92 cell-mediated cytotoxicity and induced the release of pro-inflammatory cytokines in vitro. In vivo, treatment with chi2B5x4F11 reduced the proportion of TIGIT(+) circulating immune subsets within the CD226(+) compartment, suggesting functional restoration of co-stimulatory signaling. These findings highlight TIGIT as a crucial therapeutic target and suggest a strategy to overcome the immune resistance of pancreatic cancer
Practical Guide of the Korean Association for Geriatric Psychiatry to Anti-Amyloid Monoclonal Antibody Therapy for Alzheimer's Disease: Focused on Lecanemab
No full textThe advent of anti-amyloid monoclonal antibody (mAb) therapies represents a paradigm shift in the treatment of Alzheimer's disease (AD), from symptomatic relief to disease modification. Lecanemab, a humanized mAb targeting soluble Abeta protofibrils and plaque, received regulatory approval in Korea in July 2024, following global randomized controlled trial data demonstrating its efficacy to reduce amyloid burden and slow cognitive decline. However, the introduction of such therapies into routine clinical realm presents several practical and systemic challenges, particularly in the context of Korea's unique healthcare infrastructure and reimbursement environment. In response, the Korean Association for Geriatric Psychiatry has developed the first comprehensive domestic guidance to facilitate the safe, evidence-based, and patient-centered use of anti-amyloid mAb therapies, first focused on lecanemab. This practical guide goes beyond simple eligibility criteria. It provides detailed recommendations on clinical and imaging-based candidate selection, amyloid-related imaging abnormalities (ARIA) risk stratification and monitoring protocols, infusion workflows, adverse event management strategies, and multidisciplinary coordination within hospital systems. It also emphasizes shared decision-making and outlines how to navigate situations where treatment is not appropriate, such as in patients with advanced dementia, high-risk magnetic resonance imaging findings, or poor treatment adherence, reinforcing that non-treatment can also represent a legitimate, evidence-based clinical decision. The guidance further highlights the urgent need to generate real-world data that reflect the treatment experiences of Korean patients. Multicenter collaboration will be essential for collecting data on adherence rates, ARIA incidence, cognitive outcomes, and functional trajectories, which in turn can inform policy decisions, insurance reimbursement models, and future updates to clinical guidelines. This publication represents the first nationwide roadmap in Korea to support clinicians in the appropriate integration of monoclonal antibody therapies for AD. By combining scientific rigor, operational feasibility, and ethical sensitivity, it aims to promote safe and responsible adoption of disease-modifying treatment across various clinical settings
The institutional impact of robotic surgery adoption: evidence from prostate and thyroid cancers in South Korea
No full textThe adoption of robotic surgery has significantly impacted various levels of the health system. However, previous studies lack evidence of causality regarding the impact at the institutional level. This study explores the effects of robotic surgery adoption on prostate and thyroid cancer treatments in South Korea, using the National Health Insurance Service (NHIS) data from 2005 to 2017. We applied interrupted time series analysis (ITSA) to examine changes in the number of inpatient admissions and volume of surgery at institutions before and after robotic surgery adoption. For prostate cancer, robotic surgery adoption resulted in an immediate increase of approximately 4.9 surgeries per quarter, with a substantial rise in inpatient admissions. For thyroid cancer, inpatient admissions showed a significant upward trend post-adoption. The increase in service volumes after the adoption of robotic surgery may reflect strategic institutional efforts to expand service delivery, supplier-induced demand to meet performance targets, or the advertising effects of robotic surgery adoption, which likely attracted patients from surrounding areas. This study highlights the broader implications of high-cost medical technologies on healthcare delivery, institutional strategies, and potential increases in healthcare costs. Future research should investigate other conditions treated with robotic surgery to fully understand its system-wide effects
Clinical Practice Guidelines for Diagnosis and Non-Surgical Treatment of Primary Frozen Shoulder
No full textOBJECTIVE: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. METHODS: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. RESULTS: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial. CONCLUSION: These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder
저항성 전분 섭취가 대사 위험이 있는 여성의 심박수 변이도에 미치는 영향: 이중맹검, 무작위 임상시험
No full textBackground: Heart rate variability (HRV) is a well-established marker of autonomic nervous system function and resistant starch (RS) is known to modulate gut microbiota and promote short-chain fatty acid production. This study aimed to investigate whether RS consumption improves HRV by modulating autonomic function in individuals with metabolic syndrome risks. Methods: This randomized controlled trial included 30 women with metabolic syndrome, recruited from a university hospital. Participants were randomly assigned to either the high-resistant starch (HRS) group or the low-resistant starch (LRS) group. The intervention lasted for 8 weeks. The primary analysis of this study focused on participants in the lower 50% of baseline total power (TP), assessing the differential effects of HRS intake on autonomic function in this subgroup. Statistical analyses, including the Wilcoxon rank-sum test, were performed to compare differences between groups. Results: In the subgroup with baseline TP in the lower 50%, the HRS group showed an increase in TP (median ΔTP: 435 ms², interquartile range [IQR]: 964 ms²), while the LRS group showed a decrease (-30.9 ms², IQR: 146 ms²). The between-group difference in TP change was statistically significant (P=0.03). Similarly, low frequency (LF) power increased significantly in the HRS group compared to the LRS group (P=0.03). Although high frequency and very low frequency also showed greater improvement in the HRS group, these changes did not reach statistical significance. Conclusion: RS intake was associated with significant improvements in TP and LF in individuals with lower baseline HRV, suggesting its potential role in autonomic nervous system modulation.연구 배경: 심박수 변이도(HRV)는 자율신경계 기능을 평가하는 대표적인 생리학적 지표이며, 저항성 전분(RS)은 장내 미생물총을 조절하고 단쇄지방산 생성을 촉진하는 것으로 알려져 있다. 본 연구는 고저항성 전분(HRS) 섭취가 자율신경 기능을 조절하여 HRV를 개선하는지 평가하는 것을 목적으로 하였다. 방법: 본 연구는 이중 맹검, 무작위 대조 임상시험으로, 경기도 소재 대학병원 가정의학과 외래에서 대사증후군 위험인자 2개 이상을 가진 여성 30명을 모집하여 8주간 고저항전분 식이 개입을 시행하였다. 참가자는 고저항성 전분(HRS) 섭취군과 저저항성 전분(LRS) 섭취군에 무작위로 배정되었다. 본 논문에서는 전체 대상자를 대상으로 한 1차 분석에서 통계적으로 유의한 차이가 확인되지 않아, 기저 총 파워(TP) 수치가 하위 50%에 해당하는 참가자를 대상으로 사후 하위 그룹 분석(post hoc subgroup analysis)을 수행하였다. 군 간 차이는 Wilcoxon rank-sum test 등 비모수 통계 방법을 사용하여 비교하였다. 결과: 기저 TP가 하위 50%인 하위 그룹에서, TP의 변화량은 HRS 섭취군에서 증가(ΔTP 중앙값: 435 ms², IQR: 964 ms²), LRS 섭취군에서 감소(-30.9 ms², IQR: 146 ms²)하였으며, 두 군 간 차이는 통계적으로 유의하였다(P=0.03). 또한, LF (저주파)도 HRS 섭취군에서 유의하게 증가하였으며, 두 그룹 간 차이가 통계적으로 유의하였다(P=0.03). 한편, HF (고주파) 및 VLF (초저주파) 역시 HRS 섭취군에서 더 큰 증가 경향을 보였으나, 통계적으로 유의하지 않았다. 결론: 저항성 전분(RS) 섭취는 HRV가 낮은 대상군에서 TP (총 전력) 및 LF (저주파) 파워를 유의하게 개선하는 것으로 나타났으며, 이는 저항성 전분 섭취가 자율신경계조절에 영향을 미칠 가능성을 시사한다
Generative AI-Based Nursing Diagnosis and Documentation Recommendation Using Virtual Patient Electronic Nursing Record Data
No full textOBJECTIVES: Nursing documentation consumes approximately 30% of nurses' professional time, making improvements in efficiency essential for patient safety and workflow optimization. This study compares traditional nursing documentation methods with a generative artificial intelligence (AI)-based system, evaluating its effectiveness in reducing documentation time and ensuring the accuracy of AI-suggested entries. Furthermore, the study aims to assess the system's impact on overall documentation efficiency and quality. METHODS: Forty nurses with a minimum of 6 months of clinical experience participated. In the pre-assessment phase, they documented a nursing scenario using traditional electronic nursing records (ENRs). In the post-assessment phase, they used the SmartENR AI version, developed with OpenAI's ChatGPT 4.0 API and customized for domestic nursing standards; it supports NANDA, SOAPIE, Focus DAR, and narrative formats. Documentation was evaluated on a 5-point scale for accuracy, comprehensiveness, usability, ease of use, and fluency. RESULTS: Participants averaged 64 months of clinical experience. Traditional documentation required 467.18 +/- 314.77 seconds, whereas AI-assisted documentation took 182.68 +/- 99.71 seconds, reducing documentation time by approximately 40%. AI-generated documentation received scores of 3.62 +/- 1.29 for accuracy, 4.13 +/- 1.07 for comprehensiveness, 3.50 +/- 0.93 for usability, 4.80 +/- 0.61 for ease of use, and 4.50 +/- 0.88 for fluency. CONCLUSIONS: Generative AI substantially reduces the nursing documentation workload and increases efficiency. Nevertheless, further refinement of AI models is necessary to improve accuracy and ensure seamless integration into clinical practice with minimal manual modifications. This study underscores AI's potential to improve nursing documentation efficiency and accuracy in future clinical settings
Impact of Diabetes on Long-Term Outcomes of Percutaneous Coronary Intervention for Coronary Bifurcation Lesions
No full textBACKGROUND: Diabetes mellitus (DM) is a well-known risk factor for cardiovascular diseases, including coronary artery diseases (CAD). Complex percutaneous coronary intervention (PCI) such as PCI for bifurcation lesions often yields poor outcomes, especially in DM patients. AIMS: The effect of DM on cardiovascular outcomes in bifurcation PCI was investigated in this retrospective, multicenter, observational, real-world registry of 2648 patients with coronary bifurcation lesions undergoing PCI with contemporary drug-eluting stents (DES). METHODS: The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction and target lesion revascularization. The adjusted outcomes were compared using 1:1 propensity score (PS) matching. RESULTS: Overall, DM patients were more likely to be older, female, and have hypertension or chronic kidney disease. After PS matching, the cumulative incidence of the primary outcome remained higher in the DM group (7.9% vs. 5.5%, log-rank p = 0.033). In multivariable analysis, DM (HR, 1.57; 95% CI, 1.02-2.43; p = 0.040), chronic kidney disease (HR, 2.62; 95% CI, 1.27-5.38; p = 0.008), low left ventricular ejection fraction (HR, 1.92; 95% CI, 1.10-3.35; p = 0.022) and the two-stent technique (HR, 2.18; 95% CI, 1.17-4.05; p = 0.013) were independent predictors of TLF. For patients with intravascular ultrasound-guided PCI, TLF rates were similar between DM and non-DM groups (9.1% vs. 7.3%, log-rank p = 0.347). CONCLUSION: For patients with coronary bifurcation lesions undergoing contemporary PCI, 5-year TLF rates were worse in DM patients. Careful planning and usage of imaging devices may help ameliorate outcomes for DM patients