The sixth edition of the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was published in 2025. This review compared KMAP-DD 2025 with four major international clinical practice guidelines: Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Major Depressive Disorders, National Institute for Health and Care Excellence Depression Guideline, Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders, and British Association for Psychopharmacology Guideline. While KMAP-DD is based on expert consensus, and others on evidence-based methods, overall treatment strategies for depressive episodes were fairly consistent. Especially, KMAP-DD 2025 offers more structured recommendations in areas lacking strong evidence, such as premenstrual dysphoric disorder, perinatal depression, and depression with medical comorbidities. KMAP-DD 2025 also reflected Korean clinical practice patterns emphasizing rapid symptom relief and early use of combination strategies. Despite limitations as a consensus-based guideline, KMAP-DD 2025 complements evidence-based approaches and provides practical, situation-specific guidance for real-world clinical decision-making in Korea.

Objective: This study aimed to assess the prevalence of drug use-related problems in a Korean community sample and to examine the association between drug use-related problems and health-related quality of life (HRQOL). Methods: Data were collected from 500 community-dwelling adults residing in Jeju, Korea. Drug use-related problems were assessed using the Drug Abuse Screening Test–10, and HRQOL was measured using the 26-item abbreviated version of the World Health Organization Quality of Life instrument. Results: A total of 25 participants (5.0%) reported experiencing drug use–related problems in the previous 12 months.Multivariate analysis revealed that drug use-related problems were significantly associated with lower scores in all HRQOL domains, i.e., physical health, psychological health, social relationships, and environment, even after adjusting for relevant covariates. Conclusion Drug use-related problems were strongly associated with poorer HRQOL. These findings imply that clinicians should pay close attention to HRQOL when evaluating and treating individuals with illicit drug use.

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.

Confounding and the healthy worker survivor effect (HWSE) represent major methodological challenges in epidemiology, particularly in studies of low-dose exposures, where effect sizes are small and risk estimates can be readily distorted by bias. This systematic review aimed to summarize the methods used to adjust for confounding and the HWSE in studies of medical radiation workers. We systematically searched PubMed and Embase for studies of medical radiation workers from inception through June 30, 2025. Studies reporting excess risk estimates for any health outcomes associated with occupational radiation exposure were included. Study selection followed the PECO (Population, Exposure, Comparator, Outcome) criteria, and data were synthesized descriptively. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024589851). Sixteen eligible studies from 3 countries were identified, all of which were rated as high quality. To control for confounding, regression was used in all studies, followed by stratification (62.5%) and restriction (18.8%). Age, sex, and birth year were adjusted for in all models, with smoking being the next most frequently controlled variable. To mitigate the HWSE, only a single approach, adjustment for employment characteristics, was identified, and it was applied in 3 studies (18.8%). No other approaches, including restriction or g-methods, were employed. Although confounding is generally addressed using conventional analytical approaches, the HWSE has rarely been considered in studies of medical radiation workers. More comprehensive strategies that explicitly account for the HWSE are needed to improve the validity of risk estimates, particularly in low-dose occupational studies.

In patients with differentiated thyroid cancer (DTC), initial recurrence risk stratification based on clinical, histopathological, and perioperative data remains the key determinant for guiding management strategies during the first 1-2 years post-treatment. However, the adoption of ongoing risk stratification (ORS), which dynamically reassesses risk by integrating longitudinal clinical data and treatment response, enables more precise long-term prognostic assessment and facilitates highly individualized management. Building upon recent guidelines, the 2026 KTA guideline has been further refined by incorporating robust evidence from large-scale national cohorts and comprehensive systematic reviews. These updated recommendations outline contemporary concepts of ORS, risk-adapted TSH suppression targets, optimized surveillance modalities for recurrence detection, and disease-specific long-term follow-up strategies. Reflecting the paradigm shift toward de-escalated treatment, this revision integrates evolved perspectives on TSH suppression intensity, the clinical interpretation of thyroglobulin levels, and tailored follow-up intervals. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the large proportion of patients with excellent prognosis after initial therapy, while ensuring that each patient receives appropriately tailored and effective long-term management.

Purpose: Exosome-surface enhanced Raman spectroscopy-artificial intelligence platform (exosome-SERS-AI) is an innovative liquid biopsy method that acquires SERS signals from plasma exosomes and analyzes them using deep learning models to diagnose cancer. This study aimed to evaluate whether exosome-SERS-AI could increase the diagnostic accuracy of ultrasonography (US) for suspicious breast lesions. Methods This prospective multicenter study enrolled 500 patients between November 2024 and December 2025. Eligible participants will be women aged ≥ 40 years who will undergo US performed by specialized breast radiologists and have suspicious breast lesions assigned to a Breast Imaging Reporting and Data System (BI-RADS) category 3–5 assessment. A 6 mL whole blood sample was collected from each participant. After plasma separation, SERS, which is highly sensitive to exosomes, was employed to measure Raman signals, and the acquired data were processed using artificial intelligence algorithms. Following sampling, all patients underwent US-guided core needle biopsy for breast lesions classified as BI-RADS category 4 and 5, and 12-months of follow-up US for lesions classified as BIRADS category 3. Histopathological examination was used as the reference standard for BIRADS 4 and 5 lesions, whereas stability on 12-month follow-up US was used as the reference standard for BI-RADS 3 lesions. The cohort is expected to have an equal distribution of benign and malignant cases. The following outcome measures were compared between US alone and the combination of exosome-SERS-AI with US: sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve. Enrollment is expected to be completed by 2025, and the study results are expected to be presented in 2026.Discussion: This prospective multicenter study will evaluate the performance of exosome-SERSAI compared to US in women with BI-RADS categories 3–5. Participant enrollment is ongoing.

suggest that some reproductive factors associated with BC differ across ethnicities and time trends, perhaps due to the prevalence of reproductive factors and the baseline hazard of BC.

This study examined the mediating effect of empowerment on the relationship between nursing professionalism and job satisfaction, with the goal of informing strategies to enhance job satisfaction among insurance review nurses. Methods: A total of 165 insurance review nurses with more than 1 year of work experience in 12 general hospitals (≥500 beds) participated in this study. Data were analyzed using descriptive statistics, t-tests, analysis of variance, Pearson correlation analysis, and multiple regression analysis. The mediating effect was tested using the PROCESS Macro (model 4) in SPSS version 26.0 with 10,000bootstrap samples. Results: The mean scores for nursing professionalism, empowerment, and job satisfaction were 100.37 (standard deviation [SD], 17.03), 86.24 (SD, 17.70), and 45.44 (SD, 9.17), respectively. Significant positive correlations were observed between nursing professionalism and job satisfaction (r=.64, p<.001), empowerment and job satisfaction (r=.77, p<.001), and nursing professionalism and empowerment. Empowerment was found to partially mediate the relationship between nursing professionalism and job satisfaction (95% CI, .20–.44). Conclusion: Enhancing empowerment and strengthening nursing professionalism are essential for improving job satisfaction among insurance review nurses. Institutional interventions that promote professional identity and provide structural empowerment may increase job satisfaction and support retention within this specialized nursing workforce.

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.

Objectives: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes. Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5460 ESD cases from 5250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.