Journal of Korean Medical Science最新文献

{"title":"Assessing the Relationship Between Work-Related Factors and Mental Health in Public Health Doctors During National Health Emergencies.","authors":"Ji-Ae Yun, JinYoung Lee, Hyein Song, Sejin Choi, Sangyoon Han, Kyeong-Sook Choi","doi":"10.3346/jkms.2026.41.e191","DOIUrl":"10.3346/jkms.2026.41.e191","url":null,"abstract":"<p><strong>Background: </strong>South Korean public health doctors (PHDs) serve as frontline responders in underserved regions during national health crises, such as the COVID-19 pandemic. However, the system has not adapted to evolving healthcare needs and despite the essential roles of PHDs, little is known about the unique occupational stressors they face. We examined how work-related factors, especially national guidelines and policies, impact the mental health of PHDs during public health emergency deployments, providing evidence to inform policy and support systems for this workforce.</p><p><strong>Methods: </strong>An online cross-sectional survey of all PHDs serving between July and August 2021 was used to collect data on demographics, work-related stress, and mental health outcomes using validated questionnaires. Associations between work factors and mental health (depressive symptoms, embitterment, burnout) were analyzed using logistic regression.</p><p><strong>Results: </strong>Among 269 PHDs (mean age 29.7 years), 27.1% reported depressive symptoms, 9.3% embitterment, and 45.4% burnout. Dissatisfaction with financial compensation was associated with higher risks of depressive symptoms (adjusted odds ratio [aOR], 2.481), embitterment (aOR, 3.695), and burnout (aOR, 2.997). Deployment of 3-6 months increased embitterment (aOR, 3.770) and burnout (aOR, 2.469). Job demands predicted all outcomes (aOR, 1.033-1.040). National guidelines/policies and concerns related to work and environment were associated with depressive symptoms (aOR, 1.138, 1.056) and burnout (aOR, 1.105, 1.042).</p><p><strong>Conclusion: </strong>This study highlights the need for adequate compensation, manageable deployment duration, and strong organizational support, including clear national guidelines and policies to mitigate mental health risks, among PHDs during public health emergency deployments.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 28","pages":"e191"},"PeriodicalIF":3.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536107","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":"Systemic Inflammatory Indexes as Predictors of Delirium, Thromboembolic Events, and Mortality After Hip Fracture and Major Orthopedic Surgery: A Meta-Analysis.","authors":"Suyeon Park, Ki Tae Park, Naye Kang, Eunseo Joung, Nah Yon Kim, Byung-Ho Yoon","doi":"10.3346/jkms.2026.41.e180","DOIUrl":"10.3346/jkms.2026.41.e180","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures and other orthopedic surgeries are often associated with poor post-operative outcomes, including thrombus formation, delirium, and mortality. Systemic inflammatory markers, such as the systemic immune-inflammatory index (SII) and systemic inflammation response index (SIRI), have shown potential for predicting adverse outcomes in cancer and cardiovascular diseases. This meta-analysis evaluates the predictive value of SII and SIRI for complications following orthopedic surgeries, aiming to establish them as practical tools for risk stratification to assist the surgeons' decision for optimal treatments.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, and Web of Science through January 2025, adhering to PRISMA guidelines. Cohort studies reporting the relationship between pre-operative SII/SIRI and post-operative complications were included. Outcomes included thrombus formation, delirium, and mortality. Random-effects models were used for meta-analyses, and heterogeneity was assessed with I² statistics. Sensitivity analyses were performed to mitigate the heterogeneity.</p><p><strong>Results: </strong>Nineteen studies with 8,315 patients published up to January 2025 were included. High pre-operative SII was associated with post-operative delirium (standardized mean difference, 1.28; 95% confidence intervals, 0.25-2.32; I² = 96.5%; <i>P</i> = 0.015). Based on two studies, elevated pre-operative SIRI showed a trend toward higher delirium risk (pooled odds ratios, 3.07; 95% confidence intervals, 2.66-3.48; no heterogeneity; <i>P</i> < 0.001). Sensitivity analysis suggested a potential association, but statistical significance was not achieved.</p><p><strong>Conclusion: </strong>SII and SIRI show promise as predictors for post-operative delirium but have limited evidence for thrombus formation or mortality. Future research should focus on prospective studies with standardized cut-offs to validate their clinical utility.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e180"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436590","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":"Sex Differences in Treatment Response to Targeted Therapy in Rheumatoid Arthritis: A Post Hoc Analysis of a Prospective Observational Study.","authors":"Se Rim Choi, Eunwoo Nam, Yoon-Kyoung Sung, Soo-Kyung Cho","doi":"10.3346/jkms.2026.41.e190","DOIUrl":"10.3346/jkms.2026.41.e190","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in treatment outcomes for rheumatoid arthritis (RA) have been inconsistently reported. This study aimed to investigate whether male and female patients with RA have different treatment responses to their first-line targeted therapies.</p><p><strong>Methods: </strong>This post hoc analysis used data from a prospective multicenter observational study of patients with RA initiating biologic disease-modifying anti-rheumatic drugs or Janus kinase inhibitors for the first time. The primary outcome was remission measured by the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) at week 24. Remission rates were compared between male and female patients. Conditional logistic regression models, matched on RA disease duration and baseline disease activity, were used to analyze the independent effect of sex on remission.</p><p><strong>Results: </strong>Overall, 78 male and 428 female patients were included. In the per-protocol analysis, the DAS28-ESR remission rates at week 24 were higher in male patients (44.3%) than in female patients (28.9%) (<i>P</i> = 0.025). Conditional logistic regression showed that male sex was independently associated with achieving remission (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.25-6.08). In the subgroup of patients with early RA (disease duration ≤ 2 years), male patients had significantly higher odds of achieving remission than female patients (aOR, 11.59; 95% CI, 2.56-52.54). A similar trend was observed in the subgroup of patients who initiated Janus kinase inhibitors (aOR, 2.37; 95% CI, 1.02-5.52).</p><p><strong>Conclusion: </strong>Male patients with RA achieve higher remission rates than female patients when initiating first-line targeted therapies, particularly in early disease. These findings suggest the need for sex-specific strategies in RA management.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e190"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436544","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":"Impact of Kidney Function on the Treatment Effect of Multi-Arterial Grafting in CABG Patients.","authors":"Sung Jun Park, Kyung-Jong Yoo, Young-Nam Youn","doi":"10.3346/jkms.2026.41.e207","DOIUrl":"10.3346/jkms.2026.41.e207","url":null,"abstract":"<p><strong>Background: </strong>The adoption of multi-arterial grafting (MAG) remains limited in real-world coronary artery bypass grafting (CABG) practice. This study aimed to identify subsets of patients most likely to benefit clinically from MAG, and to explore potential effect modifiers of its treatment benefit, including renal function.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 3,244 isolated CABG patients from a prospectively maintained institutional registry (2006-2020). Patients were categorized into MAG (n = 1,868) and single-arterial grafting (SAG; n = 1,376) groups. Inverse probability treatment weighting was applied to adjust for baseline differences, and Cox proportional hazards models evaluated overall survival. Subgroup analyses assessed interactions between treatment effects and patient characteristics, particularly estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>Over a median follow-up of 7.1 years, MAG demonstrated significantly higher overall survival compared to SAG (<i>P</i> < 0.001). After adjustment, MAG still provided a significant survival advantage (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.65-0.92; <i>P</i> = 0.005). MAG consistently showed favorable outcomes across most patient subgroups regardless of age, sex, diabetes, peripheral arterial disease, smoking status, or left ventricular function. However, renal function significantly modified this effect (interaction <i>P</i> = 0.005); MAG conferred significant survival benefits in patients with eGFR ≥ 51 mL/min/1.73 m² (aHR, 0.51; 95% CI, 0.66-0.99; <i>P</i> = 0.044), whereas no difference was observed in those with eGFR < 51 (aHR, 1.00; 95% CI, 0.74-1.36; <i>P</i> = 0.999).</p><p><strong>Conclusion: </strong>MAG offers significant survival advantages for CABG patients with relatively preserved renal function (eGFR ≥ 51). Renal function should thus be considered when selecting arterial grafting strategies to optimize patient outcomes.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e207"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437053","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":"Epidemiological and Genotypic Trends of Enteric Adenovirus, Astrovirus, and Sapovirus in Gwangju, Korea, 2017-2023.","authors":"Mi Hyeon Lim, Min Ji Kim, Ji-Eun Lee, Da Jeong Hwang, Kwang Ho Lee, Yi-Deun Ha, Gyung-Li Gang, Jihyoun Seong, Jung-Mi Seo","doi":"10.3346/jkms.2026.41.e142","DOIUrl":"10.3346/jkms.2026.41.e142","url":null,"abstract":"<p><strong>Background: </strong>Acute gastroenteritis caused by enteric viruses remains a major public health concern, particularly in young children. While norovirus and group A rotavirus have been well investigated, data on enteric adenovirus, astrovirus, and sapovirus remain limited. This study aimed to investigate the long-term epidemiological and genotypic trends of enteric adenovirus (HAdV), astrovirus (HAstV), and sapovirus (SaV) in Gwangju, South Korea.</p><p><strong>Methods: </strong>A total of 16,531 stool samples were collected from patients with acute gastroenteritis between 2017 and 2023 through the national surveillance system. Viral detection and genotyping were performed using standardized molecular methods, and phylogenetic analysis was conducted for selected strains.</p><p><strong>Results: </strong>The overall positivity rates were 2.2% for HAdV, 2.5% for HAstV, and 1.0% for SaV. Detection dropped to the lowest levels in 2020 and increased sharply in 2021-2022, particularly in children aged 0-5 years. This pattern likely reflects the impact of COVID-19-related public health measures and their relaxation. Genotypic analysis revealed a predominance of HAdV-F41, HAstV type 1, and SaV GI.1. Notably, while HAstV and SaV exhibited genotype diversity before 2020, type 1 and GI.1 became dominant thereafter. Phylogenetic analysis demonstrated minimal genetic variation among dominant strains.</p><p><strong>Conclusion: </strong>This seven-year surveillance highlights significant shifts in the prevalence and genotype distribution of underrecognized enteric viruses. The findings underscore the importance of sustained epidemiological and molecular monitoring to inform future public health strategies targeting enteric virus transmission.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e142"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437021","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":"Nationwide Population-Based Cohort Study of Advanced Maternal Age and Obstetric Outcomes in Korean Women: Retrospective Cohort Study.","authors":"Seon Ui Lee, Jin Young Bae, Hyun Sun Ko, Subeen Hong, Hayan Kwon, Tae Gyu Ahn, You Jung Han, Won Joon Seong, Jae Eun Shin, Geum Joon Cho, In Yang Park","doi":"10.3346/jkms.2026.41.e170","DOIUrl":"10.3346/jkms.2026.41.e170","url":null,"abstract":"<p><strong>Background: </strong>The proportion of mothers older than 35 years is increasing; however, research examining the age at which pregnancy is considered high risk across different races and countries is limited. Therefore, this study aimed to determine the cut-off age at which adverse obstetric outcomes significantly increase by investigating age-specific incidence rates of major adverse obstetric outcomes in Republic of Korea (South Korea).</p><p><strong>Methods: </strong>We analyzed the Korean National Health Insurance claims database between 2015 and 2021, focusing on women with obstetric complications classified using the International Classification of Diseases, Tenth Edition. The maternal cut-off age was defined as the age at which the outcome was most predictive in receiver operating characteristic curve analysis. Multivariate logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between maternal age and adverse obstetric outcomes.</p><p><strong>Results: </strong>The study included 1,862,393 women with singleton pregnancies. Of these, 33.67% were aged ≥ 35 years and 5.07% were aged ≥ 40 years. The incidence of adverse obstetric outcomes increased linearly and positively with maternal age. The maternal cut-off age, determined using receiver operating characteristics analysis, was 35 years for pregnancy-induced hypertension (PIH), 33 for gestational diabetes mellitus (GDM), 33 for placenta previa, 32 for placental abruption, 34 for preterm delivery, and 34 for low birth weight (LBW). In multivariate analyses, adjusted OR revealed adverse obstetric outcomes: PIH (OR, 1.29; 95% CI, 1.27-1.32), GDM (OR, 1.73; 95% CI, 1.72-1.75), placenta previa (OR, 1.81; 95% CI, 1.78-1.85), placental abruption (OR, 1.30; 95% CI, 1.24-1.36), preterm delivery (OR, 1.32; 95% CI, 1.29-1.34), and LBW (OR, 1.33; 95% CI, 1.31-1.35). For the composite outcome, maternal cut-off age was found to be 33 years (OR, 1.57; 95% CI, 1.56-1.59), with an area under the curve of 0.573.</p><p><strong>Conclusion: </strong>This nationwide study defined the cut-off age for advanced maternal age in Korean women, showing that obstetric risks begin to increase in the early 30s. These population-specific thresholds may help guide clinical practice and improve maternal and perinatal outcomes.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e170"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435992","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":"Physician Consultation Time and Perceived Quality of Outpatient Care for New Cancer Patients in Korea: An Experimental Vignette Survey of the General Public and Physicians.","authors":"Ji Sun Park, Moo Hyuk Lee, Sun Young Kim, Young Kyung Do","doi":"10.3346/jkms.2026.41.e204","DOIUrl":"10.3346/jkms.2026.41.e204","url":null,"abstract":"<p><strong>Background: </strong>In the Republic of Korea, the limited outpatient consultation time for serious illnesses has been widely cited as a major concern for quality of care, often referred to as the \"3-minute consultation.\" Short consultations hinder essential clinical functions, weaken physician-patient communication, and may lead to inefficient healthcare utilization. However, little research has been conducted on whether consultation time affects the perceived quality of outpatient care, particularly from both the patient's and the physician's perspectives.</p><p><strong>Methods: </strong>An experimental vignette-based survey was conducted with 2,023 individuals from the general public and 324 junior physicians between August 5 and 26, 2024. Participants were randomly assigned to one of four consultation scenarios (3, 5, 10, or 15 minutes), each depicting an initial outpatient visit for a cancer patient at a tertiary hospital. Perceived quality of care was assessed using a 13-item questionnaire that covered key aspects of the patient experience, likely consequences of the consultation, and overall perceptions. Responses were measured on a 5-point Likert scale (1 for strongly disagree to 5 for strongly agree), except for the final item on overall rating. For each item, trend analysis was conducted to test whether a greater amount of consultation time is associated with higher perceived quality of care. Differences between the general public and physician samples were also examined.</p><p><strong>Results: </strong>Longer consultation times were associated with higher perceived quality of care across almost all items and groups (<i>P</i> for trend < 0.001). Scores for respect and courtesy increased from 1.93 (general public) and 2.06 (physicians) at 3 minutes to 4.16 and 4.59 at 15 minutes, respectively, with similar trends for attentiveness, information provision, explanation clarity, and patient participation. Trust in the physician and anxiety reduction also improved with longer consultations, while likelihoods of second-opinion visits and unnecessary testing decreased, though to a lesser extent. Physicians tended to rate the quality of care more favorably than the general public.</p><p><strong>Conclusion: </strong>Longer consultation times are likely to improve the quality of care in tertiary oncology outpatient settings, from both the patient and physician perspectives.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e204"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436000","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":"Case 24: A 42-Year-Old Woman With Fever and Shock.","authors":"Sangjun Bae, Jeongmin Lee, Jeonghoon Ha, Dong-Jun Lim, Jaekyung Lee","doi":"10.3346/jkms.2026.41.e195","DOIUrl":"10.3346/jkms.2026.41.e195","url":null,"abstract":"","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e195"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437068","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":"A Qualitative Study of Family Centrality in Modified Dignity Therapy Experiences Among Korean Patients With Advanced Cancer: KCSG-PC22-10.","authors":"Se-Ryun Park, Miyoung Cho, Hyun Yeb Jung, Seong-Hoon Shin, Yu-Jung Cha","doi":"10.3346/jkms.2026.41.e11","DOIUrl":"10.3346/jkms.2026.41.e11","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced cancer experience significant existential distress, necessitating culturally sensitive interventions to enhance psychological well-being. This study explored a modified form of dignity therapy (mDT) that incorporates a photo-collage intervention to address these needs considering the Korean cultural context, where family relationships fundamentally shape individual identity and coping processes.</p><p><strong>Methods: </strong>Thirteen Korean patients with advanced cancer participated in this qualitative study, which involved integrated reflexive thematic analysis of interview transcripts and participant-generated photo-collages. The intervention combined semi-structured interviews based on mDT protocols with autobiographical image collections reflecting meaningful life experiences. Data were analyzed using an integrated approach, systematically cross-referencing verbal narratives with visual expressions.</p><p><strong>Results: </strong>The analysis revealed that family serves as the central organizing principle through which Korean patients interpret illness experiences. Family provided the foundation of meaning and identity, with life values gained through familial roles and sacrifices, prominently represented in images of family members. Participants emphasized reluctance to burden loved ones, and treatment decisions were filtered by family considerations.</p><p><strong>Conclusion: </strong>Psychosocial interventions for Korean patients with advanced cancer benefit from addressing family dynamics as a core therapeutic component. Integrated analysis of textual and visual data revealed cultural themes not fully captured through interviews alone, supporting the development of family-centered therapeutic models tailored to Korean cultural values and collective identity structures.</p><p><strong>Trial registration: </strong>Clinical Research Information Service Identifier: KCT0009394.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 27","pages":"e11"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437012","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":"Preliminary Report of a Nationwide Prospective Cohort of Congenital Diaphragmatic Hernia in Korea.","authors":"Jiyoon Jeong, Byong Sop Lee, Hoseon Eun, Seung Han Shin, So Yoon Ahn, Shin Yun Byun, Eun Song Song","doi":"10.3346/jkms.2026.41.e188","DOIUrl":"10.3346/jkms.2026.41.e188","url":null,"abstract":"<p><strong>Background: </strong>Most congenital diaphragmatic hernia (CDH) cases are identified prenatally, enabling early multidisciplinary interventions, including maternal transfer and preparation for extracorporeal membrane oxygenation (ECMO). These strategies may improve the historically stagnant survival rates in Korea. However, multicenter studies on the epidemiology and treatment outcomes of CDH are lacking. This study introduces the Korean CDH cohort (K-CDH), a nationwide prospective registry, and presents interim findings.</p><p><strong>Methods: </strong>The cohort comprises data from 6 tertiary centers (4 in Seoul and 2 in other regions), all equipped with experienced neonatologists, pediatric surgeons, and ECMO support. Collected data include prenatal characteristics, postnatal management, surgical interventions, and follow-up outcomes. The primary outcome measured was survival to neonatal intensive care unit discharge. Risk factors for mortality or ECMO requirement were also analyzed.</p><p><strong>Results: </strong>Sixty newborns with CDH were enrolled between March 2023 and December 2024. Non-isolated CDH was identified in 16 cases (27%), including three with confirmed genetic syndromes. Sixteen infants (27%) required ECMO, with a mortality rate of 44% among them. In univariate analysis, mortality or ECMO requirement were associated with lower APGAR scores, liver herniation, lower observed-to-expected lung-to-head ratio, and initial PaCO₂, oxygenation index, alveolar-arterial oxygen difference and early severe pulmonary hypertension (PH). Multivariable analysis identified initial PaCO₂ and early severe PH as independent predictors of mortality or ECMO requirement. Among the 57 infants who underwent surgical repair (95%), most had left-sided Bochdalek hernias (n = 47), followed by right-sided (n = 7) and Morgagni-type (n = 3). The median time to surgery of 4 days and 23 (40.4%) required patch repair. Overall, 53% of patients (n = 32) received at least one medication for PH (25 received inhaled nitric oxide and 22 received milrinone). Seven infants were discharged on oral pulmonary vasodilators. The overall survival rate was 85%.</p><p><strong>Conclusion: </strong>The interim analysis of the K-CDH cohort demonstrates improved infant survival rates exceeding international benchmarks and confirm that the initial PaCO₂ and severe PH, consistent with previous studies, are predictors of mortality or ECMO. These findings underscore the importance of standardized perinatal care, early risk stratification, and coordinated efforts across multiple centers.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 26","pages":"e188"},"PeriodicalIF":3.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396757","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}