Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and nonhospice patients with cancer at the end of life using nationwide data from Korea. Methods: In this retrospective cohort study, we analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. We applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. Results: After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospiceand 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P＜0.001).The proportion of patients receiving broad-spectrum antibiotics was generally lower amonghospice users across all time intervals (P＜0.001), and the number of days of therapy wasalso lower, with the largest differences observed during the final week and last 3 days of life.Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group. Conclusion Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.

Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.

Machine learning (ML) is currently being widely studied and applied in data analysis and prediction in various fields, including laboratory medicine. To comprehensively evaluate the application of ML in laboratory medicine, we reviewed the literature on ML applications in laboratory medicine published between February 2014 and March 2024. A PubMed search using a search string yielded 779 articles on the topic, among which 144 articles were selected for this review. These articles were analyzed to extract and categorize related fields within laboratory medicine, research objectives, specimen types, data types, ML models, evaluation metrics, and sample sizes. Sankey diagrams and pie charts were used to illustrate the relationships between categories and the proportions within each category. We found that most studies involving the application of ML in laboratory medicine were designed to improve efficiency through automation or expand the roles of clinical laboratories. The most common ML models used are convolutional neural networks, multilayer perceptrons, and tree-based models, which are primarily selected based on the type of input data. Our findings suggest that, as the technology evolves, ML will rise in prominence in laboratory medicine as a tool for expanding research activities. Nonetheless, expertise in ML applications should be improved to effectively utilize this technology.

D-dimer testing has long been established as a cornerstone in the diagnostic evaluation of suspected venous thromboembolism (VTE), offering a high negative predictive value when combined with clinical probability assessment. However, its performance and interpretation remain challenging in real-world practice, particularly among patients with high baseline thrombotic risk or a history of previous deep vein thrombosis (DVT). This review summarizes recent advances and practice patterns concerning Ddimer-based diagnostic algorithms, with an emphasis on their application in complex clinical settings. Recent evidence demonstrates that D-dimer retains diagnostic value in low- and intermediate-probability patients but loses specificity in the presence of active malignancy, postoperative inflammation, or chronic vascular disease. In individuals with prior DVT, baseline elevation and residual thrombus often lead to false-positive results, underscoring the need for integrated diagnostic strategies combining D-dimer testing with compression ultrasonography and validated clinical scores. Despite the availability of refined approaches, such as age-adjusted or pretest-probability-adjusted thresholds, their implementation in routine care remains limited. Real-world data reveal frequent test overuse, variable assay interpretation, and inconsistent adherence to guidelinerecommended diagnostic pathways. Understanding these limitations and contextual factors is essential to enhance diagnostic precision and resource utilization. Future directions include improved algorithm adherence through electronic decision-support systems, harmonization of assay reporting standards, and further validation of D-dimer– based models in diverse patient populations.

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, remains a major cause of morbidity and mortality. In carefully selected patients, evaluation for inherited or acquired thrombophilia can offer valuable insights for individualized management and recurrence prevention. Current international guidelines recommend targeted thrombophilia testing only in cases of unprovoked or recurrent VTE, early-onset disease, strong family history, or thrombosis at unusual sites.Clinically relevant tests include Factor V Leiden, Prothrombin G20210A, and deficiencies of antithrombin, protein C, and protein S, as well as antiphospholipid antibodies. The prevalence and clinical impact of inherited thrombophilias differ across populations;mutations such as Factor V Leiden and Prothrombin G20210A are rare in East Asians, whereas natural anticoagulant deficiencies and antiphospholipid syndrome are more significant. Thrombophilia testing should therefore be individualized and guided by clinical context, ensuring that results meaningfully influence management decisions.Recognition of ethnic variation and adherence to evidence-based diagnostic strategies can enhance precision in the prevention and treatment of VTE.

Purpose: The study aimed to investigate the recruiting of T lymphocytes including IL-7Rαlow CX3CR1+ effector memory (EM) CD8+ T cells and α4β7 integrin tagged T cells to inflamed intestinal mucosa. Methods: Whole blood and mucosal tissues of intestine were collected from 40 children with or without inflammatory bowel disease (IBD). T cell surface staining and immunohistochemistry were done with several antibodies in peripheral blood mononuclear cells (PBMCs) and intestinal mucosa, respectively. Serum levels of cytokines were measured by ELISA. Results: The frequency of IL-7Rαlow CX3CR1+ EM CD8+ T cells in the PBMC was significantly higher in the ulcerative colitis group than in the control group (57.9±17.80% vs. 33.9±15.70%, p=0.021). The frequency of integrin α4β7+ CD4+ T cells in the PBMC was significantly lower in the ulcerative colitis group than in the control group (53.2±27.6% vs. 63.9±13.2%, p=0.022). Serum concentration of TNF-α was higher in the Crohn’s disease group than in the control group (26.13±5.01 pg/mL vs. 19.65±6.07 pg/mL, p=0.008). Of the three groups, the ulcerative colitis group had the highest frequency of integrin α4β7+ T cells based on immunohistochemistry analyses for intestinal tissues, followed by the Crohn’s disease group and the control group (4.63±1.29 cells vs. 2.0±0.57 cells vs. 0.84±0.52 cells, p<0.001). Conclusion Trafficking immune cells with effector memory CD8+ T cells clarified by IL-7Rαlow CX3CR1+ and integrin α4β7+ CD4+ T cells might be highly associated with the pathogenesis of ulcerative colitis.

Objectives: The association between statin use and depression is well studied, but the studies on the association of statin use and bipolar disorders are limited. Thus, we aimed to investigate the effects of taking statin on risk of bipolar disorder using national claims data of South Korea. Methods: A total of 5713871 subjects who did not take statin and were not diagnosed with bipolar disorder before the health examination were included. Among eligible subjects, 315537 subjects started taking statin within 1 year after taking the health examination and 5398334 subjects did not. After 9 years of follow-up, the incidence of bipolar disorder was determined for each group. Results: Compared to subjects who were not exposed to statin, subjects who were exposed to statin showed a greater incidence of bipolar disorder and an increased risk of bipolar disorder (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.58 to 1.75), and after adjusting for age, sex, low income, regular exercise, smoking, drinking, diabetes mellitus, hypertension, body mass index, cholesterol and depression (adjusted HR: 1.32; 95% CI: 1.24 to 1.40). Conclusions This result showed an increased risk of bipolar disorder after taking statin, but the underlying biological mechanism needs further investigations. This study has clinical implications for patients taking statins, which require early assessment and response in addition to drug treatment and lifestyle modification, considering the possibility that unhealthy lifestyle habits may appear as part of the mood symptoms of bipolar disorder.

Purpose: The study aimed to investigate the recruiting of T lymphocytes including IL-7Rαlow CX3CR1+ effector memory (EM) CD8+ T cells and α4β7 integrin tagged T cells to inflamed intestinal mucosa. Methods: Whole blood and mucosal tissues of intestine were collected from 40 children with or without inflammatory bowel disease (IBD). T cell surface staining and immunohistochemistry were done with several antibodies in peripheral blood mononuclear cells (PBMCs) and intestinal mucosa, respectively. Serum levels of cytokines were measured by ELISA. Results: The frequency of IL-7Rαlow CX3CR1+ EM CD8+ T cells in the PBMC was significantly higher in the ulcerative colitis group than in the control group (57.9±17.80% vs. 33.9±15.70%, p=0.021). The frequency of integrin α4β7+ CD4+ T cells in the PBMC was significantly lower in the ulcerative colitis group than in the control group (53.2±27.6% vs. 63.9±13.2%, p=0.022). Serum concentration of TNF-α was higher in the Crohn’s disease group than in the control group (26.13±5.01 pg/mL vs. 19.65±6.07 pg/mL, p=0.008). Of the three groups, the ulcerative colitis group had the highest frequency of integrin α4β7+ T cells based on immunohistochemistry analyses for intestinal tissues, followed by the Crohn’s disease group and the control group (4.63±1.29 cells vs. 2.0±0.57 cells vs. 0.84±0.52 cells, p<0.001). Conclusion Trafficking immune cells with effector memory CD8+ T cells clarified by IL-7Rαlow CX3CR1+ and integrin α4β7+ CD4+ T cells might be highly associated with the pathogenesis of ulcerative colitis.

Objectives: The association between statin use and depression is well studied, but the studies on the association of statin use and bipolar disorders are limited. Thus, we aimed to investigate the effects of taking statin on risk of bipolar disorder using national claims data of South Korea. Methods: A total of 5713871 subjects who did not take statin and were not diagnosed with bipolar disorder before the health examination were included. Among eligible subjects, 315537 subjects started taking statin within 1 year after taking the health examination and 5398334 subjects did not. After 9 years of follow-up, the incidence of bipolar disorder was determined for each group. Results: Compared to subjects who were not exposed to statin, subjects who were exposed to statin showed a greater incidence of bipolar disorder and an increased risk of bipolar disorder (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.58 to 1.75), and after adjusting for age, sex, low income, regular exercise, smoking, drinking, diabetes mellitus, hypertension, body mass index, cholesterol and depression (adjusted HR: 1.32; 95% CI: 1.24 to 1.40). Conclusions This result showed an increased risk of bipolar disorder after taking statin, but the underlying biological mechanism needs further investigations. This study has clinical implications for patients taking statins, which require early assessment and response in addition to drug treatment and lifestyle modification, considering the possibility that unhealthy lifestyle habits may appear as part of the mood symptoms of bipolar disorder.

Purpose: The study aimed to investigate the recruiting of T lymphocytes including IL-7Rαlow CX3CR1+ effector memory (EM) CD8+ T cells and α4β7 integrin tagged T cells to inflamed intestinal mucosa. Methods: Whole blood and mucosal tissues of intestine were collected from 40 children with or without inflammatory bowel disease (IBD). T cell surface staining and immunohistochemistry were done with several antibodies in peripheral blood mononuclear cells (PBMCs) and intestinal mucosa, respectively. Serum levels of cytokines were measured by ELISA. Results: The frequency of IL-7Rαlow CX3CR1+ EM CD8+ T cells in the PBMC was significantly higher in the ulcerative colitis group than in the control group (57.9±17.80% vs. 33.9±15.70%, p=0.021). The frequency of integrin α4β7+ CD4+ T cells in the PBMC was significantly lower in the ulcerative colitis group than in the control group (53.2±27.6% vs. 63.9±13.2%, p=0.022). Serum concentration of TNF-α was higher in the Crohn’s disease group than in the control group (26.13±5.01 pg/mL vs. 19.65±6.07 pg/mL, p=0.008). Of the three groups, the ulcerative colitis group had the highest frequency of integrin α4β7+ T cells based on immunohistochemistry analyses for intestinal tissues, followed by the Crohn’s disease group and the control group (4.63±1.29 cells vs. 2.0±0.57 cells vs. 0.84±0.52 cells, p<0.001). Conclusion Trafficking immune cells with effector memory CD8+ T cells clarified by IL-7Rαlow CX3CR1+ and integrin α4β7+ CD4+ T cells might be highly associated with the pathogenesis of ulcerative colitis.