Journal of Korean Medical Science最新文献

{"title":"Validation of the Phoenix Criteria for Sepsis and Septic Shock in a Pediatric Intensive Care Unit.","authors":"Chang Hoon Han, Hamin Kim, Mireu Park, Soo Yeon Kim, Jong Deok Kim, Myung Hyun Sohn, Seng Chan You, Kyung Won Kim","doi":"10.3346/jkms.2025.40.e106","DOIUrl":"10.3346/jkms.2025.40.e106","url":null,"abstract":"<p><p>The applicability of the Phoenix criteria and Phoenix Sepsis Score in higher-resource pediatric intensive care units (PICUs) outside the United States requires further validation. A retrospective cohort study analyzed electronic health records of 1,304 PICU admissions under 18 years old with suspected infection between February 2017 and December 2023. The score was calculated using two methods: 24-hour assessment, based on worst sub-scores within 24 hours of admission, and prompt assessment, using values closest to admission within 6 hours before or after. Based on the 24-hour assessment, in-hospital mortality was 8.3% for sepsis and 10.3% for septic shock. The score demonstrated an area under the precision-recall curve of 0.42 (95% confidence interval, 0.31-0.55) for in-hospital mortality. Results were consistent across both assessment methods. The Phoenix criteria and the Phoenix Sepsis Score are reliable predictors of mortality outcomes. Further investigation in diverse clinical settings is warranted.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e106"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Monitoring and Supporting Living Donors in Korea: An Expert Position Paper.","authors":"Eunjeong Kang, Hye Young Woo, Su Young Hong, Hajeong Lee, Sangil Min, Jongwon Ha","doi":"10.3346/jkms.2025.40.e33","DOIUrl":"10.3346/jkms.2025.40.e33","url":null,"abstract":"<p><strong>Background: </strong>The number of organ transplants in South Korea has increased, with a notable rise in living donor transplants. Ensuring their long-term health and well-being is critical to address potential complications and maintain the success of the transplant programs.</p><p><strong>Methods: </strong>A diverse advisory panel, including transplant experts and coordinators, was established to evaluate the follow-up care for living donors. The panel reviewed the results of a brief survey of donors regarding their donation experience, follow-up programs, guidelines, and policies from South Korea and other countries, aiming to identify best practices and recommend improvements.</p><p><strong>Results: </strong>The study found that follow-up care for living donors in South Korea is inconsistent and lacks standardization. Significant variability exists in follow-up practices across different institutions, and comprehensive data on donor health pre- and post-donation are scarce. The need for continuous, systematic follow-up, encompassing both medical and psychological support, is emphasized to ensure donor well-being.</p><p><strong>Conclusion: </strong>Improving follow-up care for living donors is essential. Establishing a national registry and increasing donor advocacy teams are meaningful steps to enhance donor care, ensure long-term health, and maintain ethical standards in organ donation.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e33"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Serum Follicle-Stimulating Hormone Levels and Cognitive Function in Middle-Aged and Older Women.","authors":"Dae Jong Oh, Ki-Hyun Baek, Dong Woo Kang, Yun Jeong Hong, Chaiho Jeong","doi":"10.3346/jkms.2025.40.e15","DOIUrl":"10.3346/jkms.2025.40.e15","url":null,"abstract":"<p><strong>Background: </strong>Researchers have proposed that there is a potential link between follicle-stimulating hormone (FSH) and cognitive function, yet the evidence remains inconclusive. The current study aims to identify the association between serum FSH levels and cognitive performance, and to examine whether this association varies by cognitive diagnosis, serum estradiol (E2) levels, or cognitive domain.</p><p><strong>Methods: </strong>This multicenter cross-sectional study used a clinical database comprising female visitors to memory clinics at three referral hospitals in Korea. Venous blood samples were collected to determine serum FSH and E2 concentrations via immunoradiometric assay. Cognitive performance was evaluated using either the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease or the Seoul Neuropsychological Screening Battery, while cognitive diagnoses were made via clinical diagnostic interviews.</p><p><strong>Results: </strong>Among the 159 participants (normal cognition [NC], n = 70; mild cognitive impairment [MCI], n = 52; Alzheimer's disease [AD] dementia, n = 37), there were no significant differences in serum FSH levels associated with cognitive diagnosis. In women with NC, serum FSH levels were found to be positively correlated with cognitive performance in global cognition, nonverbal memory, and executive function, even after adjusting for serum E2 level and its interaction with serum FSH level. However, no significant correlations were observed in women with MCI and AD dementia.</p><p><strong>Conclusion: </strong>The association between circulating FSH and cognition may be independent from circulating E2, but it may depend on disease progression or cognitive domains. This suggests a potential role of gonadotropin in cognitive decline in elderly women.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e15"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Allogeneic Hematopoietic Cell Transplantation Following Graft Failure in Children.","authors":"Eun Sang Yi, Hee Young Ju, Ji Won Lee, Ki Woong Sung, Jin Hur, Keon Hee Yoo","doi":"10.3346/jkms.2025.40.e48","DOIUrl":"10.3346/jkms.2025.40.e48","url":null,"abstract":"<p><strong>Background: </strong>Graft failure (GF) is a major complication of allogeneic hematopoietic cell transplantation (allo-HCT). Secondary transplantation has been recognized as a potential curative intervention.</p><p><strong>Methods: </strong>This study aimed to investigate the characteristics and outcomes of salvage transplantation by analyzing the patients who underwent a second HCT for GF following the initial allo-HCT between 1998 and 2020.</p><p><strong>Results: </strong>Overall, 23 recipients were identified, including 14 and 9 individuals with primary and secondary GF, respectively. Nine recipients underwent a second transplant from the same donor. Familial mismatched donors predominated in the second HCT (86.9%), with reduced-intensity conditioning as the prevailing approach (60.9%). Neutrophil engraftment occurred in 17 patients (73.9%) following the second HCT at a median of 17 days (range: 9-58 days) post-transplantation. However, secondary GF subsequently occurred in 5 patients, and successful engraftment following salvage transplantation was achieved in 12 (52.2%) patients. In the entire study population, the estimated 5-year probability of overall survival (OS) and treatment-related mortality (TRM) were 30.4% and 58.5%, respectively. Among patients who achieved successful engraftment following a second transplantation, the OS and TRM rates were 41.7% and 33.3%, respectively, indicating a trend toward better OS and significantly lower TRM compared to those with GF. Notably, 17 patients died, with infection being the most common cause (n = 12), irrespective of the engraftment status.</p><p><strong>Conclusion: </strong>A successful engraftment following a second allo-HCT reduced the TRM; however, the OS remained suboptimal. The effective control of infectious diseases remains crucial for patients with GF, regardless of the engraftment status following salvage transplantation.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e48"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Vaccine Cold Chain in North Korea: Assessing the Capacity to Store Routine Vaccines and Potential to Support Pandemic Vaccination Activities.","authors":"Joshua Kirabo Sempungu, Minjae Choi, Eun Hae Lee, Mi-Hyui Kim, Joon Hee Han, Yo Han Lee","doi":"10.3346/jkms.2025.40.e36","DOIUrl":"10.3346/jkms.2025.40.e36","url":null,"abstract":"<p><strong>Background: </strong>The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country's successful routine immunization program.</p><p><strong>Methods: </strong>We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)' Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization's Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage.</p><p><strong>Results: </strong>We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively.</p><p><strong>Conclusion: </strong>As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e36"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In This Issue on 17-March-2025.","authors":"Jin-Hong Yoo","doi":"10.3346/jkms.2025.40.e119","DOIUrl":"https://doi.org/10.3346/jkms.2025.40.e119","url":null,"abstract":"","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 10","pages":"e119"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2024 Revision of the Declaration of Helsinki and the Future Directions of Korea's Bioethics and Safety Act.","authors":"Ock-Joo Kim","doi":"10.3346/jkms.2025.40.e99","DOIUrl":"10.3346/jkms.2025.40.e99","url":null,"abstract":"<p><p>In October 2024, the World Medical Association's Declaration of Helsinki (DoH) underwent comprehensive updates that incorporated feedback from global experts and stakeholders. The revised DoH continues to serve as a cornerstone for international and national regulations on medical research ethics. This paper aims to delve into the 2024 amendments to DoH and assesses their impact on South Korea's Bioethics and Safety Act (Bioethics Act). This paper analyses the congruences and gaps between the revised DoH and the current Bioethics Act, examining the alignment and gaps between the current Bioethics Act and the revised DoH. This study identified necessary revisions to enhance the ethical conduct of medical research in Korea in accordance with international standards. A comparison between the principles of the revised DoH and the provisions of the Bioethics Act revealed essential adjustments required to align the Bioethics Act with updated ethical guidelines. These findings underscore the broader implications for Korea's regulatory framework on human research ethics, emphasizing the need for a strategic integration of global ethical standards into the country's legal structure. The revised DoH emphasizes the active role of research participants and the fair inclusion of vulnerable groups. In Korea, the Bioethics Act, last revised in 2013, aligns closely with the DoH but requires further updates to reflect the 2024 amendments.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 9","pages":"e99"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia Overdiagnosis in Younger, Higher Educated Individuals Based on MMSE Alone: Analysis Using Deep Learning Technology.","authors":"Hye-Geum Kim, Dai-Seg Bai, Bon-Hoon Koo, Eun-Jin Cheon, Seokho Yun, So Hye Jo, Byoungyoung Gu","doi":"10.3346/jkms.2025.40.e20","DOIUrl":"10.3346/jkms.2025.40.e20","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia.</p><p><strong>Methods: </strong>A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests. These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split.</p><p><strong>Results: </strong>The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934. Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts.</p><p><strong>Conclusion: </strong>The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 9","pages":"e20"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Radiographic Trajectory and Clinical Outcomes in COVID-19 Pneumonia: A Longitudinal Study.","authors":"Dong-Won Ahn, Yeonju Seo, Taewan Goo, Ji Bong Jeong, Taesung Park, Soon Ho Yoon","doi":"10.3346/jkms.2025.40.e25","DOIUrl":"10.3346/jkms.2025.40.e25","url":null,"abstract":"<p><strong>Background: </strong>Currently, little is known about the relationship between the temporal radiographic latent trajectories, which are based on the extent of coronavirus disease 2019 (COVID-19) pneumonia and clinical outcomes. This study aimed to elucidate the differences in the temporal trends of critical laboratory biomarkers, utilization of critical care support, and clinical outcomes according to temporal radiographic latent trajectories.</p><p><strong>Methods: </strong>We enrolled 2,385 patients who were hospitalized with COVID-19 and underwent serial chest radiographs from December 2019 to March 2022. The extent of radiographic pneumonia was quantified as a percentage using a previously developed deep-learning algorithm. A latent class growth model was used to identify the trajectories of the longitudinal changes of COVID-19 pneumonia extents during hospitalization. We investigated the differences in the temporal trends of critical laboratory biomarkers among the temporal radiographic trajectory groups. Cox regression analyses were conducted to investigate differences in the utilization of critical care supports and clinical outcomes among the temporal radiographic trajectory groups.</p><p><strong>Results: </strong>The mean age of the enrolled patients was 58.0 ± 16.9 years old, with 1,149 (48.2%) being male. Radiographic pneumonia trajectories were classified into three groups: The steady group (n = 1,925, 80.7%) exhibited stable minimal pneumonia, the downhill group (n = 135, 5.7%) exhibited initial worsening followed by improving pneumonia, and the uphill group (n = 325, 13.6%) exhibited progressive deterioration of pneumonia. There were distinct differences in the patterns of temporal blood urea nitrogen (BUN) and C-reactive protein (CRP) levels between the uphill group and the other two groups. Cox regression analyses revealed that the hazard ratios (HRs) for the need for critical care support and the risk of intensive care unit admission were significantly higher in both the downhill and uphill groups compared to the steady group. However, regarding in-hospital mortality, only the uphill group demonstrated a significantly higher risk than the steady group (HR, 8.2; 95% confidence interval, 3.08-21.98).</p><p><strong>Conclusion: </strong>Stratified pneumonia trajectories, identified through serial chest radiographs, are linked to different patterns of temporal changes in BUN and CRP levels. These changes can predict the need for critical care support and clinical outcomes in COVID-19 pneumonia. Appropriate therapeutic strategies should be tailored based on these disease trajectories.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 9","pages":"e25"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In This Issue on 10-March-2025.","authors":"Jin-Hong Yoo","doi":"10.3346/jkms.2025.40.e103","DOIUrl":"https://doi.org/10.3346/jkms.2025.40.e103","url":null,"abstract":"","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 9","pages":"e103"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}