Arterial pH reflects both metabolic and respiratory distress in cardiac arrest and has prognostic implications. However, it was excluded from the 2024 update of the Utstein out-of-hospital cardiac arrest (OHCA) registry template. We investigated the rationale for including arterial pH into models predicting clinical outcomes. Methods: Data were sourced from the Korean Cardiac Arrest Research Consortium, a nationwide OHCA registry (NCT03222999). Prediction models were constructed using logistic regression, random forest, and eXtreme Gradient Boosting frameworks. Each framework included three model types: pH, low-flow time, and combined models. Then the area under the receiver operating characteristic curve (AUROC) of each predicting model was compared. The primary outcome was 30- day death or neurologically unfavorable status (cerebral performance category ≥3). Results: Among the 15,765 patients analyzed, 92.2% experienced death or unfavorable neurological outcomes. The predicting performance of the models including pH (AUROC, 0.92–0.94) were comparable to the models including low-flow time in all frameworks (0.93–0.94) (all P>0.05). Inclusion of pH into low-flow time models consistently showed higher AUROCs than individual models in all frameworks (AUROC, 0.93–0.95; all P<0.05). Conclusions: The predicting performance of models including arterial pH was comparable to models including low-flow time, and addition of arterial pH into low-flow time models could increase the performance of the models. Key Words: blood pH; hydrogen-ion con

Background: The clinical manifestations of metastatic brachial plexopathy include pain, sensory loss, paresthesia, weakness, and reduced range of motion. These symptoms closely resemble those of shoulder disorders and peripheral nerve entrapment, which are commonly diagnosed in pain clinics, increasing the risk of misdiagnosis or delayed diagnosis, particularly in patients with a history of malignancy.Case: A 51-year-old woman with a history of breast cancer in complete remission for 19 years presented with shoulder pain, arm weakness, and tingling in the fingers. Initial treatments for suspected cervical radiculopathy, shoulder disorders, and nerve entrapment were ineffective. Electromyography and nerve conduction studies revealed electrophysiological abnormalities consistent with left brachial plexopathy. Magnetic resonance imaging of the brachial plexus confirmed metastatic involvement. The patient is currently undergoing chemotherapy. Conclusions Clinicians must be vigilant of the possibility of malignancy in patients with a history of cancer and should pursue comprehensive diagnostic evaluations to exclude cancer recurrence.

Background: Bullous pemphigoid (BP) is an autoimmune blistering disease driven by autoantibodies against BP180 and BP230. While type 2 inflammation plays a key role, the precise immune cell alterations and transcriptomic changes remain unclear. Objective: To characterize immune cell composition and transcriptomic changes in BP patients using fluorescence-activated cell sorting (FACS)-based immunophenotyping and RNA sequencing. Methods: A case-control study was conducted on 10 newly diagnosed, treatment-naive BP patients and six healthy controls. Disease activity was assessed using the Bullous Pemphigoid Disease Area Index (BPDAI). Peripheral blood mononuclear cells were isolated for FACS analysis to determine immune cell subsets. RNA sequencing was performed to identify differentially expressed genes (DEGs) and enriched pathways. Statistical analyses included t-tests, Mann-Whitney U tests, and correlation analysis. Results: FACS analysis revealed a reduction in CD4 + T cells, T helper 2 (Th2), and B cells in BP patients (p<0.05), alongside an increase in M2a-like monocytes (p<0.001). RNA sequencing identified 262 DEGs, with secretory leukocyte peptidase inhibitor (SLPI) and transmembrane protein 237 being the most significantly upregulated. Proline-serine-threonine phosphatase interacting protein 2 (PSTPIP2) and SAM domain, SH3 domain, and nuclear localization signals 1 (SAMSN1) positively correlated with BPDAI (p<0.001). Gene ontology analysis highlighted enrichment in inflammatory responses and neutrophil degranulation pathways. Conclusion BP patients show distinct immune dysregulation, including decreased CD4 + T cells, Th2, and B cells, increased M2a-like monocytes, altered gene expression profiles, and correlations between PSTPIP2, SAMSN1 and disease activity. These findings provide insights into pathogenesis and potential therapeutic targets of BP.

Background: Skin rejuvenation has become an increasingly popular noninvasive approach to address age-related changes such as sagging, wrinkles, and skin laxity. Energy-based devices (EBDs) and injectables are widely used, but their application requires careful customization based on individual patient characteristics to optimize outcomes and minimize potential adverse effects. Objective: This study aimed to explore clinical practice patterns among board-certified dermatologists in South Korea, focusing on their strategies for tailoring skin rejuvenation treatments to individual patients, including the integration of EBDs, injectables, and senotherapeutics. Methods: A structured survey comprising 10 questions was administered to 13 experienced dermatologists specializing in skin rejuvenation. The survey covered treatment strategies for patients with varying facial fat volumes, pain management approaches, and the use of EBDs, injectables and senotherapeutics. Results: High-intensity focused ultrasound (HIFU) and radiofrequency (RF) were the most employed EBDs, often combined with injectables for enhanced outcomes. For patients with higher facial fat, HIFU and deoxycholic acid injections were preferred for contouring and tightening. For those with lower facial fat, biostimulatory agents such as poly-D, L-lactic acid and microneedle RF were favored to restore volume and elasticity. Pain management strategies included topical anesthetics and stepwise protocols. Although less commonly used, senotherapeutics were occasionally prescribed for specific conditions, such as melasma and extensive photoaging. Conclusion Dermatologists in South Korea employ a variety of patient-specific strategies for skin rejuvenation, combining various EBDs, injectables, and senotherapeutics. These findings highlight the importance of personalized treatment protocols and the need for further research to optimize treatment efficacy and safety.

Background: Chromosomal alterations serve as diagnostic and prognostic markers in acute leukemia. Given the evolving landscape of chromosomal abnormalities in acute leukemia, we previously studied these over two periods. In this study, we investigated the frequency of these abnormalities and clinical trends in acute leukemia in Korea across three time periods. Methods: We retrospectively analyzed data from 1,787 patients with acute leukemia (319 children and 1,468 adults) diagnosed between 2006 and 2020. Conventional cytogenetics, FISH, and multiplex quantitative PCR were used for analysis. The patient groups were divided according to the following three study periods: 2006–2009 (I), 2010–2015 (II), and 2016–2020 (III). Results: Chromosomal aberrations were detected in 92% of patients. The PML::RARA translocation was the most frequent. Over the 15-yr period, chromosomal aberrations showed minimal changes, with specific fusion transcripts being common among patients.ALL was more prevalent in children than in adults and correlated significantly with the ETV6::RUNX1 and RUNX1::RUNX1T1 aberrations. The incidence of ALL increased during the three periods, with PML::RARA remaining common. Conclusions The frequency of chromosomal abnormalities in acute leukemia has changed subtly over time. Notably, the age of onset of adult AML has continuously increased. Our results may help in establishing diagnoses and clinical treatment strategies and developing various molecular diagnostic platforms.

Background: Circulating tumor DNA (ctDNA) profiling from peripheral blood allows relatively noninvasive monitoring of solid tumors; however, its utility post-surgery or chemotherapy in colorectal cancer remains underexplored. We evaluated the clinical implications of a ctDNA next-generation sequencing (NGS) panel post-surgery or chemotherapy in patients with colorectal cancer. Methods: We collected samples from 23 patients with colorectal cancer (17 men, median age 65 yrs) at baseline and post-surgery or chemotherapy at the National Cancer Center, Korea, between January 2021 and September 2023. ctDNA was analyzed using an NGS panel including 46 genes, and variant allele frequencies (VAFs) were determined. Followup samples were analyzed using the NGS panel or droplet digital PCR (ddPCR) when probes were available. Clinical status was compared with ctDNA results, and survival was analyzed using a time-dependent Cox model. Results: Mutations were identified in 13 out of 14 patients (92.8%) with stage II/III cancer and in all nine patients (100%) with stage IV cancer. Mutations were detected in KRAS (N = 15, 65%), APC (N = 8, 35%), TP53 (N = 7, 30%), PIK3CA (N = 5, 22%), and RET (N = 4, 17%). A 1% increase in KRAS and TP53 VAFs was associated with 48% and 32% increased mortality risk, respectively. Changes in VAF correlated well with clinical findings. Conclusions The detection of and an increase in KRAS and TP53 VAFs were associated with poor prognosis. ddPCR-based ctDNA monitoring results were comparable to those obtained with the NGS panel. ctDNA monitoring during treatment is clinically informative in managing colorectal cancer.

Background: This study aimed to develop standard job categories for constructing a job-exposure matrix (JEM) for police officers in South Korea and to evaluate their applicability. Methods: We examined standard job codes related to police personnel management and compared them with job classifications from police publications. Using R Shiny, we developed a web-based search tool for standard codes. A pilot survey of 130 police officers assessed the codes' applicability and relevance to health-related hazardous factors. Results: Eighty-seven standard functional codes used in the police personnel management system POOL were organized into minor categories as the basic units of standard jobs. These were grouped into 20 sub-major categories and further consolidated into 10 major categories to develop the standard job codes. The responses to the standard job codes in the pilot survey were 75% accurate compared with the final expert evaluation results and 99.2% accurate compared with the algorithm-based automatic allocation results. The results of the job-hazardous factor network analysis revealed that the most frequently reported hazardous factor was emotional labor, followed by night shifts and electromagnetic waves. Emotional labor was identified as the top hazardous factor in six out of the nine standard job categories. Conclusions The standard job codes developed in this study were designed in connection with the personnel management system for police officers, making them well-suited for constructing a comprehensive JEM for the entire police force.

A comprehensive list of occupational diseases among farmers is crucial for both compensation and prevention efforts. In Korea, most farmers are self-employed, and some occupational diseases are compensated through farmer safety insurance. However, it is not harmonized with industrial accident compensation insurance and does not adequately reflect the true burden of occupational diseases among farmers. To address this gap, the authors compiled a list of occupational diseases tailored to Korean farmers by reviewing the International Labor Organization’s list of occupational diseases, the Korean Industrial Accident Compensation Insurance List, the occupational disease lists of other countries, and relevant literature on farmers’ work-related diseases.

Objective: To analyze costs and cost-effectiveness of transforaminal endoscopic thoracic discectomy (TETD) for the treatment of symptomatic thoracic disc herniation (TDH) and compare it with open microdiscectomy (MD). Methods: This retrospective cohort study included patients who underwent TETD or MD for symptomatic TDH and had a minimum follow-up of 1 year. Cost analysis included direct costs (primary and secondary hospital costs), indirect costs (lost wages due to work absence), total costs (direct + indirect), and cost-effectiveness (cost per quality-adjusted life year [QALY] and incremental cost-effectiveness ratio [ICER]). Clinical outcomes included patient-reported outcome measures (Oswestry Disability Index [ODI], 36-item Short Form health survey [SF-36]), QALY gained, and reoperation and readmission rates at 1 year. TETD and MD groups were compared for outcome measures. Results: A total of 111 patients (57 TETD, 54 MD) were included. The direct ($6,270 TETD vs. $7,410 MD, p < 0.01), indirect costs ($1,250 TETD vs. $1,450 MD, p < 0.01), total costs ($7,520 TETD vs. $8,860 MD, p < 0.01), and cost per QALY ($31,333 TETD vs. $44,300 MD, p < 0.01) were significantly lower for TETD compared to MD. ICER of TETD was found to be -$33,500. At 1 year, TETD group showed significantly greater improvement in ODI (46% vs. 36%, p < 0.01) and SF-36 (64% vs. 53%, p < 0.01) and significantly greater QALY gained (0.24 vs. 0.2, p < 0.01) compared to MD group. No significant difference was found in reoperation and readmission rates. Conclusion TETD demonstrated significantly better clinical outcomes, lower overall costs, and better cost-effectiveness than MD in appropriately selected patients of symptomatic TDH.