Objective: To identify the risk factors for pregnancy loss at different gestational stages, before and after 60 days of gestation when the placentation is firmly established and quantify the subsequent reproductive performance. Methods: This study analyzed the records from 6,444 pregnancies confirmed by transrectal ultrasonography 31 days after artificial insemination. Pregnancy loss between 31–61 days was categorized as late embryonic or early fetal loss (LEL–EFL), and losses between 62–260 days were categorized as mid-to-late fetal loss (M–LFL). Multivariable logistic regression was used to assess the risk factors. Survival analysis was performed to assess the probability of becoming pregnant again by 400 days postpartum. Results: The cumulative incidence of pregnancy loss was 5.8% for LEL–EFL and 7.7% for M–LFL; LEL–EFL accounted for 43.2% of all losses. A higher body condition score at calving tended to reduce the risk of early loss (p < 0.1), whereas the synchronization protocols (p < 0.0001), first postpartum service (p < 0.0001), and summer insemination (p < 0.1) increased it. Peripartum disorders increased the risk at both stages (odds ratio: 1.30–1.72, p < 0.05– 0.0001), and twin pregnancies increased M–LFL (p < 0.0001). Cows with pregnancy loss had a lower probability of becoming pregnant again by 400 days postpartum and longer calvingto-pregnancy intervals than unaffected cows (227.1–376.3 days vs. 107.3 days). Conclusions and Relevance: The patterns of pregnancy loss were stage-specific, and early and later losses had distinct and progressively more adverse effects on reproductive performance.Optimizing the body condition at calving, refining breeding management, and improving peripartum health may reduce pregnancy loss and improve reproductive outcomes.

Purpose: With the emergence of next-generation therapies, real-world evaluation of current treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC) is essential. This study aimed to investigate the clinical characteristics, primary treatment patterns, and survival outcomes of Korean patients with mHSPC. Materials and Methods: A nationwide, population-based retrospective cohort study was conducted using National Health Insurance claims data from 2011 to 2020, encompassing all Korean patients diagnosed with prostate cancer (n=217,895). Patient demographics, initial treatment patterns within 3 months of mHSPC diagnosis, time to initiation of metastatic castration-resistant prostate cancer (mCRPC) therapy, and survival outcomes were analyzed. Results: Primary treatment patterns for 10,821 newly diagnosed mHSPC patients were generally similar. Approximately half received first-line androgen deprivation therapy (ADT). Most (68.8%–76.3%) were treated with combination therapy consisting of a luteinizing hormone-releasing hormone (LHRH) agonist and a first-generation antiandrogen, while 5.8%–8.0% received ADT alone. Among 1,418 patients diagnosed in 2015, 20.9% initiated mCRPC therapy at a median of 14.6 months. Median times to initial mCRPC drug use were 14.7 months for those on combination therapy and 19.7 months for those on LHRH agonists alone. Median overall survival (OS) was 61.3 months for all patients, 37.0 months for combination therapy, 51.5 months for LHRH agonists, and 25.5 months for patients with visceral metastases. Conclusion Most patients with newly diagnosed mHSPC received combination therapy with LHRH agonists and first-generation antiandrogens. In this real-world cohort, patients treated with LHRH agonists demonstrated longer OS and delayed initiation of mCRPC-directed therapy compared with those receiving combination therapy.

Background: Hypersensitivity pneumonitis (HP) is a condition with an uncertain global incidence, and information on its diagnosis and management is limited. This study aimed to address these knowledge gaps. Methods: This study utilized customized claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea from January 2010, to December 2021. Patients with HP were identified based on the diagnosis code (International Classification of Diseases, 10th Revision, J67) between 2011 and 2020. Incident HP cases were defined as new HP claims, excluding those with claims in the previous year. The study examined various factors such as age, sex, comorbidities, diagnostic methods, and treatment patterns. Additionally, multivariate logistic regression analysis was performed to identify risk factors associated with treatment initiation. Results: A total of 8,678 HP incident cases were confirmed, with age- and sex-adjusted annual incidence rates ranging from 1.14/100,000 in 2020 to 2.16/100,000 in 2012. The mean age of patients with incident HP was 52 years, with a higher incidence observed among males. Additionally, the most common comorbidity was asthma. Bronchoscopy was performed on 16.9% of patients, and 25.4% of patients did not receive treatment within 1 year of diagnosis. Among those who received treatment, prednisone was the most used systemic steroid, and azathioprine was the most commonly used second-line immunosuppressant.Factors associated with treatment initiation included the female sex, having asthma or gastroesophageal reflux disease (GERD), and undergoing bronchoscopy. Conclusion This study provides valuable insights into the incidence, diagnosis, and treatment patterns of HP in South Korea using nationwide medical claims data.

Purpose: To evaluate the changes in injection frequency based on the diagnosis year in neovascular age-related macular degeneration (AMD) and the differences in visual outcomes associated with these changes. Methods: This retrospective study included 667 patients (667 eyes) diagnosed with treatment-naïve neovascular AMD and polypoidal choroidal vasculopathy in 2013, 2015, 2017, and 2019. The number of anti-vascular endothelial growth factor (VEGF) injections and degree of changes in visual acuity during the first 24 months after diagnosis were compared among the 4 years. Results: The 2013, 2015, 2017, and 2019 groups had a mean of 5.7 ± 2.7, 6.0 ± 2.8, 6.6 ± 3.0, and 6.9 ± 3.3 anti-VEGF injections, respectively. The number of injections was significantly higher in 2019 than in 2013 and 2015 (p < 0.001). The mean degree of visual change during the 24-month follow-up period was 0.07 ± 0.55, 0.01 ± 0.51, 0.08 ± 0.50, and 0.04 ± 0.48 in 2013, 2015, 2017, and 2019, respectively. There was a significant difference in the degree of visual change among the four groups (p = 0.020). Conclusions Patients diagnosed more recently tend to receive more injections and have better visual outcomes. We speculate that more injections contributed to these results. This trend should be considered when predicting the future socioeconomic burden of neovascular AMD.

Objective: The purpose of this study was to identify prognostic factors related to outcomes of out-of-hospital cardiac arrest caused by pesticide poisoning. Methods: This retrospective observational study used countrywide population-based data from the Out-of-Hospital Cardiac Arrest Surveillance of the Korean Centers for Disease Control and Prevention from January 2008 to December 2018. Adult out-of-hospital cardiac arrest (OHCA) patients (over the age of 18) poisoned by a pesticide who experienced cardiac arrest and a subsequent return of spontaneous circulation (ROSC) were included in the study. The primary outcome variables were prognostic factors related to survival at hospital discharge, and the secondary outcome variable was good neurological outcome (Cerebral Performance Categories 1 or 2) at hospital discharge. Results: Three hundred and three patients were enrolled in the study, and 48 (15.8%) survived until hospital discharge (the hospital discharge group), and 255 (84.2%) died in hospital (the in-hospital death group). Fifteen (4.9%) of the 303 study subjects had a good neurological outcome, and 288 (95.1%) had a poor neurological outcome. Multivariate logistic regression showed that sustained pre-hospital ROSC was significantly associated with survival to discharge (adjusted odds ratio [AOR]=3.186; 95% confidence interval [CI], 1.436-7.068; P=0.004) and good neurological outcome (AOR=8.945; 95% CI, 2.974-26.907; P≤0.001). Conclusion Sustained pre-hospital ROSC is associated with a favorable outcome in cases of OHCA induced by pesticide poisoning.

Background/Aims: Chronic obstructive pulmonary disease (COPD) is less prevalent in females than males, but it affects mortality in females. There may be sex differences in the clinical characteristics of COPD. Methods: We analyzed the Korea National Health and Nutrition Examination Survey dataset from 2007 to 2018. We compared the clinical characteristics and comorbidities in subjects with COPD according to sex. We adjusted the multivariate logistic regression of lung cancer prevalence according to COPD and sex by age and smoking amount. Results: Females with COPD tended to be older than males with COPD (64.1 ± 0.4 yr vs. 62.3 ± 0.2 yr, respectively, p < 0.001). Approximately 89% of males with COPD had a smoking history, while 86% of females with COPD were non-smokers (p < 0.001). Household income was lower (p < 0.001) and asthma and overall malignancy were more prevalent in females with COPD than males with COPD (25.5 vs. 11.6%, respectively, p < 0.001; (6.3 vs. 5.4%, respectively, p < 0.001). However, lung cancer was more common in males with COPD than females with COPD (0.9 vs. 0.1%, respectively, p < 0.001). Lung cancer prevalence increased in males with moderate COPD compared to subjects without COPD (OR, 4.409; 95% CI, 1.741–9.419). Conclusions Females with COPD had a lower smoking rate, household income, and lung cancer prevalence than males with COPD. More active COPD screening is needed for women of low socioeconomic status, even if they do not smoke.

Background: Patients with chronic obstructive pulmonary disease (COPD) expressing eosinophilia experience slightly fewer episodes of community-acquired pneumonia (CAP), than those without eosinophilia. However, the severity and burden of hospitalized pneumonia patients with COPD involving eosinophilia have not been assessed. Methods: We evaluated the differences in clinical characteristics between patients with CAP and COPD with or without eosinophilia by a post hoc analysis of a prospective, multi-center, cohort study data. Results: Of 349 CAP patients with COPD, 45 (12.9%) had eosinophilia (blood eosinophil ≥300 cells/μL). Patients with eosinophilia had a lower sputum culture percentile (8.1% vs. 23.4%, p<0.05), a lower percentile of neutrophils (70.3% vs. 80.2%, p<0.05), reduced C-reactive protein levels (30.6 mg/L vs. 86.6 mg/L, p<0.05), and a lower pneumonia severity index score (82.5 vs. 90.0, p<0.05), than those without eosinophilia. The duration of antibiotic treatment (8.0 days vs. 10.0 days, p<0.05) and hospitalization (7.0 days vs. 9.0 days, p<0.05) were shorter in eosinophilic patients. The cost of medical care per day (256.4 US$ vs. 291.0 US$, p<0.05), cost for the medication (276.4 US$ vs. 349.9 US$, p<0.05), and cost for examination (685.5 US$ vs. 958.1 US$, p<0.05) were lower in patients with eosinophilia than those without eosinophilia. Conclusion Eosinophilia serves as a favorable marker for the severity of pneumonia, health-care consumption, and cost of medical care in patients with CAP and COPD.

Objectives: This study aimed to explore whether there are differences in smoking status between two regions of Wonju-City and Chuncheon-City, Gangwon State, and to determine whether the experience of smoking cessation programs in the region affects quit attempts. Methods: The study design was a cross-sectional study in which adults aged 19 and older living in two cities were surveyed using a pre-developed mobile app to investigate social capital for smoking cessation, and a total of 600 citizens were participated, including 310 in Wonju-City and 290 in Chuncheon-City.The statistical analysis was conducted using chi-square test and logistic regression analysis. Results: Wonju-City had a higher prevalence of current smoking than Chuncheon-City. Among smoking cessation programs operated by local public health centers, Wonju-City had a lower odds ratio for experience with smoking cessation education than Chuncheon-City (OR=0.52, 95% CI=0.33 to 0.81). When examining the effect of smoking cessation program experience on quit attempts, in Wonju-City, citizens who had completed smoking cessation education and used a smoking cessation clinic were more likely to attempt to quit than those who had not (OR=2.31 and OR=2.29, respectively). In Chuncheon-City, citizens who were aware of smoking cessation support services were 2.26 times more likely to attempt to quit smoking than those who were not, but statistical significance was not reached due to the small sample size. Conclusion Therefore, healthcare organizations in both regions should develop more practical intervention strategies to increase smokers' quit attempts, reduce smoking rates in the community, and address regional disparities.

Purpose: This study evaluates the viability of a new method that employs transperineal targeted biopsy with frozen section analysis immediately followed by robot-assisted radical prostatectomy (RARP), bypassing the traditional systematic biopsy deemed essential by current guidelines. Materials and Methods: Patient selection was based on the following inclusion criteria: those who underwent magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy with frozen section analysis and concurrent RARP. Eligibility also required features indicative of Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on multiparametric MRI, along with one of these additional criteria: (1) MRI evidence suggesting extracapsular extension (ECE) with a prostate-specific antigen (PSA) level >10 ng/mL, or (2) a PSA level > 20 ng/mL. Results: Twelve patients were enrolled in this study according to inclusion criteria. The median age (interquartile range) was 73.5 (69.5–75.3) years and PSA was 22.9 (17.0–29.9) ng/mL. Three patients had PI-RADS 5 lesions, and 9 had PI-RADS 5 lesions with findings of ECE. In all cases, the diagnosis based on frozen sections confirmed adenocarcinoma. Following confirmation, each patient underwent immediate RARP. According to the final pathology report, 2 patients had International Society of Urological Pathology (ISUP) grade 2 disease, 7 patients had ISUP grade 3, 1 had ISUP grade 4, and 2 had ISUP grade 5 disease. Four patients had stage pT2 disease, 3 had stage pT3a, and 5 had stage pT3b. The median immediate reporting time of the target biopsy frozen section was 20 (19.3–24.5) minutes. No perioperative complications related to target biopsy were observed. Conclusion For patients with a strong suspicion of prostate cancer and a PI-RADS 5 lesion, integrating simultaneous prostate frozen target biopsy with radical prostatectomy may offer a feasible treatment alternative, obviating the necessity for a preoperative systematic biopsy.

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.