Journal of Korean Medical Science最新文献

{"title":"Electroencephalogram Changes After Virtual Reality-Based Cognitive Behavioral Therapy for Panic Disorder.","authors":"Hyewon Park, Heekyung Hwang, Minjung Kim, Haein Park, Imhong Jeon, Young-Min Shon, SungJun Hong, Deokjong Lee","doi":"10.3346/jkms.2025.40.e185","DOIUrl":"10.3346/jkms.2025.40.e185","url":null,"abstract":"<p><strong>Background: </strong>Cognitive behavioral therapy (CBT) for panic disorder involves training to cope with anxiety and panic attacks effectively. Recently, CBT, when integrated with anxiety-inducing virtual reality (VR) scenarios, has been utilized to treat panic disorder. This study aimed to investigate the neurophysiological impacts of VR-enhanced CBT in the treatment of panic disorder.</p><p><strong>Materials: </strong>Nineteen patients (6 men and 13 women; average age: 36.0 ± 11.7 years) diagnosed with panic disorder participated in four sessions of VR-based CBT. The VR program included educational elements focusing on abdominal breathing and muscle relaxation and training components that utilized relaxation techniques during exposure to a VR environment. Psychometric assessments and electroencephalogram (EEG) readings were collected before and after the CBT sessions. The EEG studies were performed under two conditions: a resting state and while engaging in a visual working memory task.</p><p><strong>Results: </strong>The Panic Disorder Severity Scale for panic symptoms improved following VR-based CBT. Although error rates in the Stroop test did not change before and after CBT, reaction times improved. Additionally, several EEG indicators exhibited differences pre- and post-CBT, with increased left frontal beta and parietal theta power observed during a visual working memory task.</p><p><strong>Conclusion: </strong>This study indicated that VR-based CBT may alleviate panic symptoms and enhance cognitive functions, particularly executive control. Additionally, EEG results suggested that VR-based CBT could strengthen brain activity associated with working memory performance.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 31","pages":"e185"},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835322","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 <i>Clostridium difficile</i> Infection on Chemotherapy in Patients With Primary Ovarian Cancer.","authors":"Jaekyung Bae, Eun Young Park, Uisuk Kim, Junhwan Kim, Ji Hyun Kim, June Young Chun, Young Ju Choi, Myong Cheol Lim","doi":"10.3346/jkms.2025.40.e179","DOIUrl":"10.3346/jkms.2025.40.e179","url":null,"abstract":"<p><strong>Background: </strong>To investigate the impact of <i>Clostridium difficile</i> infection (CDI) on chemotherapy in patients with primary ovarian cancer.</p><p><strong>Methods: </strong>This retrospective study included patients with primary ovarian cancer diagnosed with CDI at the National Cancer Center, Korea, between January 2014 and December 2023. Patients with gastrointestinal symptoms and positive <i>C. difficile</i> stool tests were included. The primary objective was to assess the impact of CDI on chemotherapy, and the secondary objective was to evaluate other clinical outcomes and risk factors associated with CDI.</p><p><strong>Results: </strong>A total of 111 CDI episodes were identified in 90 patients, with 17 patients experiencing recurrent CDI. Among initial CDI episodes, 51.1% occurred during the first or second cycle of adjuvant chemotherapy after cytoreductive surgery. Adjuvant chemotherapy cycles were delayed in 81.1% of cases, with a median delay of 13 days. Additionally, 7.8% of patients discontinued chemotherapy, and CDI-related mortality was 2.2%. Severe or fulminant CDI was associated with higher rates of intensive care unit admission, bowel surgery, or death (38.9% vs. 4.2%; <i>P</i> < 0.001). Septic shock (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.54-45.74; <i>P</i> = 0.014) and prolonged post-CDI antibiotic treatment (OR, 1.08; 95% CI, 1.01-1.15; <i>P</i> = 0.016) were linked to severe outcomes.</p><p><strong>Conclusion: </strong>CDI can cause chemotherapy delays and severe adverse outcomes, such as septic shock or death. Early identification of CDI and a multidisciplinary approach are essential to minimize CDI-related complications in patients with ovarian cancer. Further research is needed to develop preventive strategies and evaluate the long-term impact of CDI on cancer prognosis.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 31","pages":"e179"},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835324","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":"Supply-Side Impact of Supporting Obstetrically Underserved Areas: A Nationwide Cross-Sectional Study.","authors":"Hansoo Ko, Minsu Ock, Sol Lee, Joo Won Park, Mi Young Kwak, Won Mo Jang","doi":"10.3346/jkms.2025.40.e186","DOIUrl":"10.3346/jkms.2025.40.e186","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on the effectiveness of financial incentives in improving the shortage of obstetrics/gynecology (OB/GYN) specialists in underserved areas. This study aimed to examine whether the financial incentives for OB/GYN clinics were associated with improved availability of OB/GYN specialists in obstetrically underserved areas (OUA) and potentially obstetrically underserved areas (POUA) in South Korea.</p><p><strong>Methods: </strong>A cross-sectional study design was employed to observe all cities (n = 240) in South Korea for a period of 10 years (2011-2020). The cities were divided into intervention groups (cities designated as OUA and POUA) and control groups (all other rural districts). A two-way fixed-effects linear regression was used to explore the policy's association with the number of specialists at the city level. The availability of OB/GYN specialists was evaluated based on the number of total/full-time/part-time OB/GYN specialists and facilities with full-time OB/GYN specialists per 1,000 females of reproductive age. The exposures considered were grant incentives for facility and equipment costs, human resources, and additional reimbursement rates for deliveries.</p><p><strong>Results: </strong>A total of 240 South Korean cities were identified as analytic samples from 2011 to 2020 (2,400 city-year observations). The number of total OB/GYN specialists decreased (-3.390 per 1,000 females of reproductive age; <i>P</i> < 0.001) in cities designated as OUA and POUA (intervention group) after the introduction of combined financial incentives (grant and additional reimbursement since 2016). Results showed that the number of full-time OB/GYN specialists increased (0.083 per 1,000 females of reproductive age; <i>P</i> = 0.007). However, that of part-time OB/GYN specialists decreased (-3.473 per 1,000 females of reproductive age; <i>P</i> < 0.001). The number of facilities with full-time OB/GYN specialists also increased (5.775 per 100,000 females of reproductive age; <i>P</i> = 0.036).</p><p><strong>Conclusion: </strong>This cross-sectional study revealed that financial incentives, including grants and reimbursement rates, were insufficient to improve the availability of OB/GYN specialists in underserved areas of South Korea. Therefore, multidimensional financial and nonfinancial approaches are required to ensure a stable supply of specialists at vulnerable sites.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 31","pages":"e186"},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835327","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":"Trends in Epidemiology, Clinical Characteristics, and Outcomes of Infective Endocarditis: A 16-Year Nationwide Cohort Study in Korea.","authors":"Kyung Eun Ha, William D Kim, Kyu-Yong Ko, Hasung Kim, Seo-Yeon Gwak, Kyu Kim, Hyun-Jung Lee, Chi Young Shim, Geu-Ru Hong, Jong-Won Ha, Ji-Won Hwang, Iksung Cho","doi":"10.3346/jkms.2025.40.e183","DOIUrl":"10.3346/jkms.2025.40.e183","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) is a life-threatening disease, the profile of which varies across countries. This nationwide cohort study aimed to assess the epidemiology, clinical characteristics, and outcomes of IE.</p><p><strong>Methods: </strong>Patients diagnosed with IE between 2003 and 2018 were included in this study based on data from the National Health Insurance System of South Korea. The patients' baseline characteristics, treatment modalities, and survival outcomes were analyzed. The incidence and in-hospital mortality rates were calculated and adjusted for age.</p><p><strong>Results: </strong>A total of 8,487 IE cases were included: 6,617 (78.0%), 1,678 (19.8%), and 192 (2.3%) cases of native valve IE, prosthetic valve IE, and cardiac device-related IE (CDRIE), respectively. The incidence rate (per 1,000,000) of IE increased from 7.24 in 2003 to 17.47 in 2018. Furthermore, the in-hospital mortality rate for IE (per 1,000,000 person-years) increased from 0.59 in 2003 to 2.76 in 2018. The proportions of prosthetic valve IE and CDRIE cases increased over time, whereas that of native valve IE cases decreased. The number of surgeries for IE showed a consistent upward trend, with a notable increase occurring from 2014 onward.</p><p><strong>Conclusion: </strong>IE is a health burden with an increasing incidence and high mortality rates. Understanding the epidemiology and characteristics of IE is crucial to establish future treatment strategies.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 31","pages":"e183"},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835328","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":"Epidemiology of Candidemia in Children and Neonates in Korea, 2009-2018: A Multi-Center Study.","authors":"Joon-Sik Choi, Sae Rom Choi, Soo-Han Choi, Jong Gyun Ahn, Ji-Man Kang, Seok-Jae Heo, Yoonsun Yoon, Yun-Kyung Kim, Hye-Kyung Cho, Yae-Jean Kim","doi":"10.3346/jkms.2025.40.e201","DOIUrl":"10.3346/jkms.2025.40.e201","url":null,"abstract":"<p><strong>Background: </strong>Invasive candidal infection is a serious health threat to high-risk pediatric populations. Data on pediatric epidemiology of candidemia in Korea are limited.</p><p><strong>Methods: </strong>A retrospective chart review was performed for patients aged 0-18 years who were diagnosed with candidemia from 2009 to 2018 in tertiary hospitals. Patients were divided into two groups; a neonatal group of babies with postnatal age 28 days or younger or any patients hospitalized in neonatal intensive care unit and a pediatric group of the rest of patients. Only the first candidemia episode for each patient was included. <i>Candida</i> species, antifungal sensitivity, underlying condition, and outcomes were investigated.</p><p><strong>Results: </strong>A total of 228 patients with candidemia were identified from five hospitals. Of them, 87 and 141 were assigned into the neonatal group and the pediatric group, respectively. The most common underlying condition was prematurity (88.5%) in the neonatal group and hematology-oncology diseases (49.6%) in the pediatric group. Non- <i>albicans Candida</i> spp. (65.4%) was more common than <i>C. albicans</i>. <i>C. parapsilosis</i> was the most commonly identified species (35.1%), followed by <i>C. albicans</i> (34.6%), <i>C. tropicalis</i> (9.6%), <i>C. glabrata</i> (9.6%), and <i>C. krusei</i> (2.2%) in all patients. <i>C. parapsilosis</i> was the most common pathogen in the neonatal group, while <i>C. albicans</i> was the most common pathogen in the pediatric group. Results of antifungal sensitivity to fluconazole were available for 160 patients. About 11.2% of isolates were either intermediate or resistant to fluconazole (10.0% for non-<i>albicans</i>, 1.2% for <i>C. albicans</i>) (<i>P</i> = 0.036). Overall mortality within 30 days after candidemia was 25.4%.</p><p><strong>Conclusion: </strong>Candidemia caused by non-<i>albicans Candida</i> was more common in pediatric patients during the study period. Resistance to antifungal agents was noted. Monitoring for epidemiologic change is warranted.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 31","pages":"e201"},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835323","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":"Non-Suicidal Self-Injury and Exercise: Associations With Addiction.","authors":"Han-Sung Lee, Sang Jin Rhee, Dae Hun Kang, Sooyeon Min, Minseok Hong, Hyunju Lee, Yong Min Ahn","doi":"10.3346/jkms.2025.40.e176","DOIUrl":"10.3346/jkms.2025.40.e176","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of addictive disorders has surged globally, exacerbated by the coronavirus disease 2019 pandemic, leading to increased consumption of alcohol, nicotine, and engagement in other addictive behaviors. Considering this alarming trend, this study examined the prevalence and associated factors of addictive disorders-specifically alcohol use disorder, tobacco use disorder, and internet gaming disorder-using data from the 2021 National Mental Health Survey of Korea.</p><p><strong>Methods: </strong>The study analyzed data from 5,511 adults aged 18-79, assessing socio-demographic information, mental diseases, physical activity levels, and non-suicidal self-injury (NSSI) through standardized interviews and self-reported questionnaires. Complex-sample logistic regression identified significant factors associated with addictive disorders.</p><p><strong>Results: </strong>NSSI emerged as the most significantly associated factor, increasing the likelihood of addiction over 9-fold (odds ratio [OR], 9.26; 95% confidence interval [CI], 4.52-18.93). While walking was associated with lower odds of addiction (OR, 0.98; 95% CI, 0.96-1.00), moderate-to-high exercise (OR, 1.01; 95% CI, 1.00-1.03) was linked to increased odds of addictive disorders.</p><p><strong>Conclusion: </strong>Addictive behaviors, such as NSSI and excessive exercise, are significantly associated with an increased risk of addictive disorders.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 30","pages":"e176"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784542","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":"Correlation of Income Instability With 12 Non-Communicable Disease Risks in Korea: A Prospective Cohort Study.","authors":"Jaehyeong Cho, Yejun Son, Soeun Kim, Jaeyu Park, Kyeongmin Lee, Hyesu Jo, Tae Hyeon Kim, Hayeon Lee, Sooji Lee, Jiyeon Oh, Hanseul Cho, Ho Geol Woo, Damiano Pizzol, Selin Woo, Dong Keon Yon","doi":"10.3346/jkms.2025.40.e180","DOIUrl":"10.3346/jkms.2025.40.e180","url":null,"abstract":"<p><strong>Background: </strong>Due to the lack of comprehensive longitudinal studies examining the impact of long-term volatility on health issues, existing research primarily focused on income levels rather than fluctuation. Thus, we aimed to investigate the relationship between income instability and a range of physical health conditions using an extensive longitudinal dataset.</p><p><strong>Methods: </strong>This study utilized data from the Korean Genome and Epidemiology Study (KoGES) Ansan-Anseong cohort (2001-2022), which includes valuable confounding factors such as demographic, socioeconomic, lifestyle, and clinical factors. Income volatility was calculated as the intra-individual standard deviation of income changes across study waves. A Cox proportional hazards model was employed to assess correlations between income volatility and the risk of 12 non-communicable diseases (NCDs; hypertension, myocardial infarction [MI], coronary artery disease [CAD], cerebrovascular disease, diabetes, hyperlipidemia, gout, gastric disease, renal disease, arthritis, allergic disease, and asthma).</p><p><strong>Results: </strong>A total of 9,185 participants (mean age, 52.21; male, 47.59%) were analyzed. In the fully adjusted model, medium volatility was correlated with a higher disease risk (hazard ratio, 1.14; 95% confidence interval, 1.07-1.21), as similar to high volatility (1.09; 1.03-1.16). The highest risk was observed in individuals experiencing income decreases (1.61; 1.13-2.28). All health conditions examined in this study showed an increased risk correlated with higher income volatility as follows: hypertension (1.13; 1.03-1.25); MI (2.15; 1.33-3.48); CAD (1.37; 1.04-3.48); cerebrovascular disease (1.69; 1.21-2.37); hyperlipidemia (1.14; 1.01-1.28); gout (2.11; 1.12-3.95); gastric disease (1.15; 1.01-1.32); renal disease (2.28; 1.22-4.25); arthritis (1.33; 1.04-1.70); allergic disease (1.54; 1.16-2.03); asthma (1.67; 1.04-1.67).</p><p><strong>Conclusion: </strong>Income volatility, particularly income decreases and fluctuations, is significantly correlated with higher risk of chronic NCDs in South Korea. These findings underscore the need to develop interventions to mitigate financial instability, thereby improving public health outcomes.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 30","pages":"e180"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784538","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":"Long-Term Neurodevelopmental Outcomes After Antenatal Corticosteroid Therapy in Late Preterm Twins: A Nationwide Retrospective Cohort Study.","authors":"Jeesun Lee, Young Mi Jung, Won Young Wi, Jihye Bae, Joong Shin Park, Jong Kwan Jun, Min-Jeong Oh, Seung Mi Lee, Geum Joon Cho","doi":"10.3346/jkms.2025.40.e174","DOIUrl":"10.3346/jkms.2025.40.e174","url":null,"abstract":"<p><strong>Background: </strong>In women with singleton pregnancy who are at risk of late preterm delivery, administration of antenatal corticosteroids is recommended to reduce neonatal respiratory complications. However, the adoption of this practice is not widely accepted in twin pregnancies because of a lack of evidence regarding both the effectiveness and long-term safety of corticosteroids. This study was conducted to evaluate the long-term neurodevelopmental outcomes of twins according to the administration of antenatal corticosteroid in late preterm.</p><p><strong>Methods: </strong>This nationwide population based retrospective cohort study included twins who were delivered late preterm (34+0-36+6 weeks) between 2007 and 2010. The study population were divided into 2 groups according to the administration of preterm antenatal corticosteroids. Group 1 included twins from mothers who were administered antenatal corticosteroids in late preterm (with late preterm corticosteroids), and group 2 included twins whose mothers were not administered antenatal corticosteroid (without corticosteroids). The risk of long-term adverse neurodevelopmental outcomes was compared between the 2 groups. The composite adverse neurodevelopmental outcome was defined as the occurrence of at least one of the following: autism, cerebral palsy, speech articulation disorder, developmental disorders of scholastic skills, or developmental disorders of motor function.</p><p><strong>Results: </strong>During the study period, 9,450 children met the inclusion criteria: 1,476 children in group 1 (with late preterm corticosteroids) and 7,974 children in group 2 (without corticosteroids). There was no statistically significant difference in the long-term adverse neurodevelopmental outcomes between the 2 groups. This result was consistent even after adjusting for covariates (adjusted hazard ratio 0.973 [95% confidence interval, 0.811-1.166]).</p><p><strong>Conclusion: </strong>The risk of long-term adverse neurodevelopmental outcomes did not increase after antenatal corticosteroid administration in twin children who were born in late preterm.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 30","pages":"e174"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784540","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":"Successful Intraluminal Administration of Tissue Plasminogen Activator for Life-Threatening Obstructive Hematoma in Extremely Preterm Infants.","authors":"Seung Hyun Kim, So Yoon Ahn, Hanna Kim, Jieun Hwang, Misun Yang, Se In Sung, Yun Sil Chang","doi":"10.3346/jkms.2025.40.e223","DOIUrl":"10.3346/jkms.2025.40.e223","url":null,"abstract":"<p><p>We report the cases of two extremely preterm infants who were successfully treated with tissue plasminogen activator (tPA) for a life-threatening obstructive intraluminal hematoma. One infant presented with bowel perforation and ileus resulting from a gastrointestinal (GI) hematoma, whereas the other experienced lung collapse due to an intratracheal hematoma. Direct administration of tPA to the GI tract and trachea, respectively, resulted in hematoma lysis and relief of the obstruction. For extremely preterm infants with limited viable treatment options, local tPA may be a valuable approach for managing severe obstructive intraluminal hematomas that lead to GI obstruction or lung collapse.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 30","pages":"e223"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784543","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":"National Wastewater Surveillance of SARS-CoV-2 Across Provinces and Regions in the Republic of Korea From January to August 2023.","authors":"You-Jung Choi, Lan Hee Kim, Jinhwa Jang, Shin Young Park, Sejin Jeong, Sungpyo Kim, Sangwon Lee, Seong-Sun Kim","doi":"10.3346/jkms.2025.40.e94","DOIUrl":"10.3346/jkms.2025.40.e94","url":null,"abstract":"<p><strong>Background: </strong>Wastewater surveillance (WS) technology has gained significant attention in many countries due to its role in the monitoring of infectious diseases within communities and complementing clinical testing to prevent coronavirus disease 2019 (COVID-19) outbreaks. In 2023, the Korea Disease Control and Prevention Agency (KDCA) launched the Korea Wastewater Surveillance (KOWAS) project in collaboration with 17 cities and provinces to track COVID-19 outbreaks.</p><p><strong>Methods: </strong>From January to August 2023, the concentrations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) E gene in wastewater were monitored in 19 institutes of health and environmental research, all within local governments. Influent samples were collected from 62 wastewater treatment plants (WWTPs) and weekly trends in SARS-CoV-2 E gene concentrations in wastewater were compared to those of new COVID-19 cases.</p><p><strong>Results: </strong>During 34 weeks, the concentration of SARS-CoV-2 in wastewater samples closely mirrored the trends in new COVID-19 cases, showing the effectiveness of WS in detecting the presence of the virus. However, the efficacy of the WS method varied between provinces. Although some provinces showed a significant positive correlation between new COVID-19 cases and SARS-CoV-2 E gene concentrations in wastewater, this correlation was inconsistent between all locations. However, when data were analyzed on a broader regional scale, defined as a grouping of multiple provinces, a higher proportion of regions showed significant correlations. This suggests that analyzing WS data on a broader scale, with larger aggregated populations and higher coverage rates, reduces the influence of local variabilities, such as the proportion of combined sewer types, WWTPs coverage rate, and foot traffic, which may affect alignment at the provincial level.</p><p><strong>Conclusion: </strong>The synchrony between trends in SARS-CoV-2 E gene concentrations in wastewater and new COVID-19 cases highlights the effectiveness of KOWAS in tracking new clinical cases. However, measured SARS-CoV-2 RNA concentrations can be affected by socioenvironmental factors (e.g., WWTP treatment capacity, sewer pipeline distances, and coverage populations). Further refinement will involve expanding the surveillance network to include additional WWTPs and a more comprehensive range of monitoring targets.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 30","pages":"e94"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784541","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}