Background: Menopausal status can increase the risk of cardiocerebrovascular diseases (CCVDs) in women with type 2 diabetes mellitus (T2DM). Regular exercise is well-known to reduce this risk. This study explored the impact of exercise on CCVD and mortality in women with T2DM according to their menopausal status. Methods: A total of 32,477 premenopausal and 53,690 postmenopausal Korean women with T2DM aged 40 to 60 years from a national health examination cohort (2009 to 2018) were included. We evaluated risks for stroke, myocardial infarction (MI), and mortality based on exercise intensity. Cox proportional hazard regression analyses were performed to obtain the adjusted hazard ratio (aHR) and 95% confidence interval. Results: Exercise reduced stroke, MI, and mortality risks in women with T2DM, regardless of menopausal status. The highest effects of aHR compared to the sedentary group were 0.68 for stroke, 0.66 for MI, and 0.81 for mortality. Postmenopausal women experienced significant MI risk reductions at most exercise intensities, with the greatest reduction in the ≥1,500 metabolic equivalent of task score group unlike premenopausal women. However, stroke and mortality risk reductions in postmenopausal women were less pronounced compared to premenopausal women. Conclusion Exercise reduces CCVD risk in women with T2DM across menopausal status. Postmenopausal women with T2DM had more benefits from exercise on MI but fewer benefits on stroke and mortality than premenopausal women. In premenopausal women with T2DM, exercise was not associated with a lower MI risk.

Background: and Purpose Intraoperative visual evoked potential (VEP) monitoring has been studied mainly in pituitary adenoma, while its role in nonpituitary suprasellar tumors has remained unclear. This study evaluated the predictive usefulness of intraoperative VEP monitoring during endoscopic endonasal surgery (EES) and aimed to identify optimal alarm criteria for visual outcomes. Methods: We retrospectively analyzed a cohort of 87 patients who underwent EES with intraoperative VEP monitoring between April 2021 and September 2023. Visual outcomes were evaluated preoperatively and at short-term (≤3 months) and long-term (12 months) followups, with visual deterioration at these time points defined as worsening of either visual acuity or the visual field. Reductions in the VEP amplitude were quantified using both the maximum intraoperative decrease and the final amplitude after recovery. Receiver operating characteristic (ROC) curve analyses were performed to identify the optimal alarm thresholds, and the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for short-term and long-term visual deteriorations. Results: Short-term and long-term visual deteriorations were detected in 12 (9.2%) and 5 (3.8%) of the 130 analyzed eyes, respectively. ROC curve analyses identified ≥40% and ≥30% reductions in the N75–P100 amplitude as optimal alarm criteria for short-term and long-term visual deteriorations, respectively. A 30% reduction without intraoperative recovery demonstrated markedly higher sensitivity than the conventional 50% alarm threshold for short-term (58.3% vs. 33.3%) and long-term (80.0% vs. 20.0%) outcomes, while maintaining acceptable specificity (82.2% and 80.8%, respectively). Conclusions A 30% reduction in amplitude represents a more-sensitive and clinically relevant alarm threshold than a 50% reduction for intraoperative VEP monitoring during EES for nonpituitary suprasellar tumors. Incorporating both the magnitude and recovery pattern of VEP amplitude changes may improve the accuracy of predictions of long-term visual deterioration. However, the potential for false positives warrants cautious interpretation, and further studies are needed to validate the impact of intraoperative VEP monitoring on visual outcomes.

Background: The prevalence of diabetes mellitus and early-onset dementia (EOD), defined as dementia diagnosed at an age <65 years, is increasing worldwide, with significant socioeconomic implications. We investigated the association between diabetes, prediabetes, and EOD, focusing on the influence of diabetes duration on EOD risk. Methods: Using the Korean National Health Insurance Service database, we analyzed data from 1,979,509 patients aged 40–60 years who underwent health checkups in 2009. Patients were categorized into five groups: normal, impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes duration <5 years, and diabetes duration ≥5 years. Cox proportional hazard models were used to estimate the adjusted hazard ratios (aHRs) for EOD after adjusting for demographic and clinical covariates. Results: During the observation period (mean 7.75 years), 8,921 patients with EOD were identified. The diabetes group demonstrated a significantly higher incidence of EOD compared to the normal group (aHR, 1.334; 95% confidence interval [CI], 1.226 to 1.451). EOD risk increased with longer diabetes duration, with the highest risk observed in patients with diabetes ≥5 years (aHR, 1.543; 95% CI, 1.368 to 1.741). No significant difference was observed between the IFG and normal groups (aHR, 0.989; 95% CI, 0.938 to 1.043). Additionally, the hypertension group exhibited a significantly higher incidence of EOD compared to the non-hypertension group (aHR, 1.364; 95% CI, 1.291 to 1.442). Conclusion Diabetes is independently associated with increased risk of EOD, and this risk increases with longer diabetes duration. This association remained significant regardless of the presence and duration of hypertension.

Background/Aims: The benefits of adjuvant therapy after curative resection (CR) have been demonstrated for bile duct cancer with lymph node (LN) metastasis. However, the putative benefits of adjuvant treatment for bile duct cancer without LN metastasis remain controversial.We aimed to identify recurrence risk factors for distal bile duct cancer (DBC) without LN metastasis following CR and high-risk groups that may benefit from adjuvant treatment. Methods: We retrospectively analyzed recurrence-related factors of patients who underwent surgical resection for DBC at Yonsei University Severance Hospital from January 2010 to June 2019. Results: Of 380 DBC cases receiving CR, 248 (62.8%) were pathologically confirmed as free from LN metastasis. The recurrence rates of all cases and LN metastasis-free cases were similar at 52.4% and 46.8%, respectively. Further, distant metastasis and local recurrence were about equally frequent. Involvement of adjacent organs, the presence of an R1 resection margin (cancer cells present microscopically), lymphovascular invasion (LVI), and perineural invasion (PNI) were identified as risk factors for recurrence (R1 margin OR: 1.642, 95% CI: 1.045–2.578, p = 0.031; LVI OR: 2.049, 95% CI: 1.347–3.115, p = 0.001; PNI OR: 1.901, 95% CI: 1.170–3.088, p = 0.009). Overall survival was also significantly reduced in patients with R1 resection margins (p = 0.018), LVI (p < 0.001), or PNI (p = 0.002). Conclusions The overall risk of LN-negative DBC recurrence remains high after CR. Aggressive systemic adjuvant treatment and active surveillance are required for patients with R1 resection margins, LVI, or PNI.

Objective: Disasters such as pandemics and natural catastrophes cause significant psychological distress, increasing the risk of depression, anxiety, and post-traumatic stress disorder (PTSD). This review aimed to evaluate the effectiveness of remote mental health interventions, such as telepsychiatry, online cognitive behavioral therapy (CBT), mobile applications, and artificial intelligence (AI)-based tools, during disasters. Methods: A comprehensive literature search was conducted using international databases (PubMed, EMBASE, PsycINFO, Web of Science, Scopus, CINAHL) and Korean domestic databases (KISS, RISS, DBpia, KMbase, KoreaMed). Studies published between January 2010 and February 2025 were screened following the PRISMA 2020 guidelines. Two board-certified psychiatrists independently reviewed titles, abstracts, and full texts. Peer-reviewed articles and relevant grey literature, including government manuals and expert guidelines, were included. Results: A total of 147 studies were synthesized, including randomized controlled trials, meta-analyses, observational studies, and policy documents. Evidence showed that remote interventions effectively reduced symptoms of depression, anxiety, and PTSD. Online CBT was beneficial for mild to moderate distress; mobile apps facilitated psychoeducation and symptom tracking; and telepsychiatry ensured care continuity, especially in underserved areas. AI tools showed promise in screening and triage but require better clinical integration. Effectiveness was highest when interventions were implemented early, integrated within stepped-care models, and guided by trained professionals. Conclusion Remote mental health interventions are practical and effective tools for bridging mental health care gaps during disasters. To ensure sustainability, these interventions should be integrated into national disaster mental health frameworks, accompanied by adequate funding, clinician training, legal safeguards, and cultural adaptation.

Objectives: In alignment with the World Health Organization’s goal of eliminating hepatitis C, this study assessed the current treatment status and reasons for non-treatment among patients with hepatitis C in Jeonbuk State, Republic of Korea, to inform strategies for improving care engagement. Methods: Among 311 individuals diagnosed with hepatitis C and reported through the NationalNotifiable Infectious Disease Surveillance system between January 2023 and June 2024, 208 patients were surveyed after excluding those who had died or could not be contacted.Statistical analyses included the chi-square test, the Cochran-Armitage test for trend, and logistic regression. Results: Overall, 116 participants (55.8%) reported having received antiviral therapy. Among the 92 untreated individuals, the most common reason for non-treatment was the absence of symptoms (n = 23; 25.0%), followed by the burden of drug costs (n = 21; 22.8%). Conclusion These findings highlight suboptimal treatment uptake and key barriers that may hinder progress toward hepatitis C elimination. Expanding screening and strengthening linkage-to-care strategies, while addressing financial barriers, will be essential to achievingnational elimination targets.

Background: The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort. Methods: We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups. Results: The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001). Conclusions The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.

Background: Cytomegalovirus (CMV) infection is prevalent worldwide. Although Korea has historically shown high CMV IgG seropositivity ( > 95%), declines have been reported recently. We assessed current CMV IgG seropositivity and analyzed prevailing trends in the Korean population. Methods: Residual samples from individuals undergoing regular health checkups were analyzed. We assessed 1,978 samples (from 937 men and 1,041 women) where the age group distribution was relatively balanced. CMV IgG levels were measured at two institutions using a commercial immunoassay (Alinity i CMV IgG Reagent Kit, Abbott) following the manufacturer’s instructions. Results were interpreted as “reactive” when the CMV IgGconcentration was ≥ 6.0 arbitrary units (AU)/mL or “nonreactive” when the CMV IgG con-centration was < 6.0 AU/mL. Seropositivity was compared by sex and across age groups (20–29, 30–39, 40–49, and 50–59 yrs). Results: The overall CMV IgG seropositivity was 89.9% (1,778/1,978) and was significantly higher in men (91.7%, 859/937) than in women (88.3%, 919/1,041) (difference:3.4%; 95% confidence interval: 0.8%–6.0%; P = 0.012, chi-square test). No significant differences with regard to sex were found within each age group. Seropositivity increased with age, from 76.3% (347/455, 20–29 yrs) to 99.8% (448/449, 50–59 yrs) (P for trend < 0.001), consistently in both sexes. Conclusions Our findings provide the most up-to-date estimate of CMV IgG seropositivity in the Korean adult population. Because of lower seropositivity in younger adults, continued monitoring and further education are essential for CMV control and prevention.

Purpose: Immune checkpoint inhibitor plus chemotherapy is the standard first-line treatment for advanced gastric cancer; however, predictive biomarkers for optimal patient selection remain unsatisfactory. This study was aimed at evaluating the predictive value of tumor mutational burden (TMB) and insertion/deletion (Indel) rate in patients with gastric cancer treated with nivolumab plus chemotherapy. Materials and Methods: This retrospective study included 132 patients with gastric cancer treated with first-line nivolumab plus chemotherapy and 185 patients treated with chemotherapy alone, all of whom had next-generation sequencing data available. The TMB and Indel cut-offs were set at 15.63 mutations per megabase and 18.19%, respectively, as determined based on their ability to best distinguish progression-free survival (PFS) among the patients who received nivolumab plus chemotherapy. Results: PFS was favorable for nivolumab and chemotherapy than for chemotherapy alone in both the high and low TMB groups; nevertheless, survival benefits were observed only in the high Indel group. Among the subgroups defined based on both TMB and Indel rates, the high TMB and high Indel rate subgroup showed the greatest benefit from nivolumab plus chemotherapy compared with that from chemotherapy alone. The benefit of this subgroup remained significant in patients with proficient mismatch repair (MMR) tumors, whose survival outcomes were comparable to those of patients with deficient MMR tumors.Among patients treated with nivolumab plus chemotherapy, high TMB and Indel rate were independently associated with favorable survival outcomes. Conclusions Thus, Indel rate, particularly in combination with TMB, may be a promising predictive biomarker for gastric cancer. However, further validation of their predictive value is warranted.

Purpose: Patient-derived cells (PDCs) and patient-derived organoids (PDOs) are complementary preclinical models widely used in translational cancer research. However, their molecular and functional differences have not been systematically characterized. This study established and analyzed paired PDC and PDO models derived from the same gastric cancer ascites to delineate platform-dependent molecular and functional profiles. Materials and Methods: Malignant ascites or pleural fluid obtained from 6 patients with advanced gastric cancer were used to establish paired PDC and PDO models. All pairs underwent comprehensive multi-omics profiling, integrating genomic, transcriptomic, and proteomic data. Phenotypic characterization included morphological, histological, proliferative, and cell cycle analyses. Drug sensitivity assays were performed using 4 chemotherapeutic agents commonly used to treat gastric cancer. Results: The 6 paired PDC and PDO models exhibited distinct morphological characteristics.Whole-genome analyses demonstrated high concordance among primary tumors, PDCs, and PDOs, confirming tumor representation across platforms. Multi-omics profiling identified platform-dependent molecular signatures; PDOs were enriched for extracellular matrix remodeling and stemness, whereas PDCs displayed proliferation- and immune-related signatures. Clinically relevant biomarkers, including HER2 and MET alterations, were concordant with primary tumors. Notably, drug responses differed between platforms and patients, indicating platform-dependent and patient-specific chemosensitivity. Conclusions Paired PDC and PDO models derived from the same patients preserved core patient-specific tumor characteristics while exhibiting distinct molecular and functional profiles. These findings underscore the culture platform as a critical determinant of experimental outcomes and therapeutic responses. Therefore, careful selection of an appropriate preclinical model is essential to accurately address biological questions and optimize precision oncology strategies.