Objective: Perinatal depression often remains undertreated due to concerns about antidepressant exposure during fertility treatment, pregnancy, or breastfeeding. Non-pharmacological, home-based interventions such as transcranial direct current stimulation (tDCS) present a promising alternative; however, real-world evidence in perinatal populations remains limited. Methods: This prospective observational study included 38 women who received infertility, pregnancy, or postpartum treatment at four hospitals in South Korea. Participants self-administered anodal tDCS targeting the left dorsolateral prefrontal cortex for 20–28 sessions over 4 weeks. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and weeks 2, 4, and 8. Subjective health perception was measured at baseline using a 5-point Likert scale. Results: Time had a significant effect on depressive symptoms (Wald χ2=90.75, p<0.001), with the largest reduction observed during the first 2 weeks. The CES-D scores remained significantly lower than baseline at week 8, 4 weeks after treatment ended. Subjective health perception was significantly associated with baseline depression severity (Wald χ2=26.41, p<0.001), and its interaction with time was also significant (Wald χ2=320.18, p<0.001). Participants with poorer perceived health (scores 4–5) experienced greater depressive symptom reductions than those with more favorable perceptions (scores 1–2). Conclusion Home-based tDCS was feasible and associated with clinically meaningful improvement in depressive symptoms among perinatal women. Those who initially perceived their health more negatively showed greater response, suggesting subjective health perception may serve as a useful moderator and potential marker to inform personalized treatment strategies.

The impact of baseline estimated glomerular filtration rate (eGFR) on the risk of adverse outcomes according to metabolic parameter variabilities in chronic kidney disease has rarely been investigated. Methods: We conducted a retrospective nationwide cohort study using the National Health Insurance System data in Korea from 2007 to 2013 to identify individuals with three or more health screenings. The metabolic components variability was defined as intraindividual variability between measurements using the variability independent of the mean. The metabolic variability score was defined as the total number of high-variability metabolic components. Multivariable-adjusted Cox regression analysis was conducted to evaluate the risks of all-cause mortality, myocardial infarction, and ischemic stroke. Results: During a mean follow-up of 6.0 ± 0.7 years, 223,531 deaths, 107,140 myocardial infarctions, and 116,182 ischemic strokes were identified in 9,971,562 patients. Low eGFR categories and higher metabolic variability scores were associated with a higher risk of adverse outcomes. The degree of association between metabolic variability and adverse outcomes was significantly larger in those with low eGFR categories than in those with preserved eGFR (p for interaction < 0.001). Representatively, those with high metabolic variability in the eGFR of <15 mL/min/1.73 m2 group showed a prominently higher risk for all-cause mortality (adjusted hazard ratio [aHR], 5.28; 95% confidence interval [CI], 4.02–6.94) when the degree was compared to the findings in those with preserved (eGFR of ≥60 mL/min/1.73 m2) kidney function (aHR, 2.55; 95% CI, 2.41–2.69). Conclusion: The degree of adverse association between metabolic variability and poor prognosis is accentuated in patients with impaired kidney function.

Early-onset diabetes mellitus has a significant lifetime burden and is associated with higher morbidity and mortality. Since insulin resistance is one of the mechanisms of podocyte injury, we aimed to evaluate the effect of albuminuria on newly developed early-onset type 2 diabetes mellitus (T2DM). Methods: We screened 6,891,399 subjects aged ≥20 and <40 years without a history of prediabetes or diabetes from the Korean National Health Insurance Service database between 2009 and 2012. A multivariate Cox proportional hazard model was used to identify the impact of albuminuria on early-onset T2DM. Results: Among a total of 5,383,779 subjects, 62,148 subjects (1.2%) developed early-onset diabetes over 7.3 ± 1.2 years. Albuminuria was significantly associated with early-onset T2DM (adjusted hazard ratio [aHR], 1.62; 95% confidence interval [CI], 1.55–1.70) after adjustment for age, sex, anthropometric data, physical exercise status, serum glucose, and total cholesterol. The risk of early-onset T2DM increased more in subjects with more components of metabolic syndrome (MetS). Among each component of MetS, hypertriglyceridemia was prominently associated with early-onset T2DM (aHR, 2.02; 95% CI, 1.81–2.25) in subjects with albuminuria. Conclusion: Dipstick albuminuria was significantly associated with early-onset T2DM in young adult populations. Close monitoring of albuminuria is warranted for disease risk modification, especially in subjects with MetS.

Purpose: This study aimed to determine whether zero echo time magnetic resonance imaging (ZTE-MRI), as an alternative imaging modality, and conventional computed tomography (CT) have similar diagnostic qualities for assessing pediatric osseous pathologies. Materials and Methods: Twenty-six sets of pediatric musculoskeletal CT and MRI scans (15 boys and 11 girls; mean age, 12 ± 4 years; range, 5–23 years) acquired at Seoul National University Children’s Hospital (January 2021 to November 2023) were retrospectively evaluated. CT-like images from ZTE-MRI were generated using grayscale inversion. Two radiologists independently assessed ZTE-MRI image quality (S anat) on a 5-point scale (1 = nondiagnostic, 5 = excellent) and a comparative scale (–2 = CT greater, 0 = same, 2 = ZTE-MRI greater) for lesion delineation (Scomp). The confidence interval of proportions and intraclass correlation coefficient were calculated to assess inter-rater agreement, and Wilcoxon rank-sum test, Mann–Whitney U test, or paired t-test was used to compare image quality or cortical thickness between the modalities. Results: ZTE-MRI demonstrated diagnostic quality (S anat ≥ 3) in 85%–96% of the cases, 89%–96% for cortical delineation, 92%–100% for intramedullary cavity (IMC) delineation, and 92% for lesion delineation. Compared with conventional CT, ZTE-MRI showed comparable diagnostic power (Scomp ≥ –1) in 92%–96% of the cases, with Scomp scores indicating no significant difference in lesion delineation (p = 0.53 in reader 1 and p = 0.25 in reader 2). There was a preference for CT over ZTE-MRI in terms of overall image quality and delineation of the cortex and IMC (p < 0.001). Cortical thickness was not significantly different (p = 0.11) between ZTE-MRI and CT. Conclusion ZTE-MRI demonstrated diagnostic quality comparable to that of CT, particularly in lesion delineation. In addition to the unique information that conventional MRI can provide, ZTE-MRI can provide additional information about osseous structures similar to that provided by CT, which we believe will be valuable in the future.

Purpose: This study aimed to determine whether zero echo time magnetic resonance imaging (ZTE-MRI), as an alternative imaging modality, and conventional computed tomography (CT) have similar diagnostic qualities for assessing pediatric osseous pathologies. Materials and Methods: Twenty-six sets of pediatric musculoskeletal CT and MRI scans (15 boys and 11 girls; mean age, 12 ± 4 years; range, 5–23 years) acquired at Seoul National University Children’s Hospital (January 2021 to November 2023) were retrospectively evaluated. CT-like images from ZTE-MRI were generated using grayscale inversion. Two radiologists independently assessed ZTE-MRI image quality (S anat) on a 5-point scale (1 = nondiagnostic, 5 = excellent) and a comparative scale (–2 = CT greater, 0 = same, 2 = ZTE-MRI greater) for lesion delineation (Scomp). The confidence interval of proportions and intraclass correlation coefficient were calculated to assess inter-rater agreement, and Wilcoxon rank-sum test, Mann–Whitney U test, or paired t-test was used to compare image quality or cortical thickness between the modalities. Results: ZTE-MRI demonstrated diagnostic quality (S anat ≥ 3) in 85%–96% of the cases, 89%–96% for cortical delineation, 92%–100% for intramedullary cavity (IMC) delineation, and 92% for lesion delineation. Compared with conventional CT, ZTE-MRI showed comparable diagnostic power (Scomp ≥ –1) in 92%–96% of the cases, with Scomp scores indicating no significant difference in lesion delineation (p = 0.53 in reader 1 and p = 0.25 in reader 2). There was a preference for CT over ZTE-MRI in terms of overall image quality and delineation of the cortex and IMC (p < 0.001). Cortical thickness was not significantly different (p = 0.11) between ZTE-MRI and CT. Conclusion ZTE-MRI demonstrated diagnostic quality comparable to that of CT, particularly in lesion delineation. In addition to the unique information that conventional MRI can provide, ZTE-MRI can provide additional information about osseous structures similar to that provided by CT, which we believe will be valuable in the future.

The Korea Nurses’ Health Study (KNHS) is an ongoing, large-scale, prospective cohort study of women nurses, focusing on the effects of occupational, environmental, and lifestyle factors on the health of women. The first KNHS survey was performed in 2013-2014 (n=20,613). As of December 2023, 11 follow-up surveys have been conducted. Participants who were pregnant were asked to participate in the early pregnancy survey (n=2,179) and postpartum survey after giving birth (n=2,790). The main variables included socio-demographic, work-related, lifestyle, physical, mental, and women’s health factors. Blood, urine, and toenail samples were collected from a participant subgroup of the first survey (n=1,983). The subgroups of the second survey completed a food frequency questionnaire in 2019 (n=300) and 2021 (n=871). In 2020, a subgroup of the first survey answered a coronavirus disease 2019-related survey (n=975). To examine various health-related factors in young adults, new participants were added to the KNHS cohort in the 11th (n=1,000) and 12th (n=1,002) surveys. The KNHS cohort will help identify health and illness determinants in Korean women. Data can be accessed at https://coda.nih.go.kr/frt/index.do.

Purpose: This study aimed to determine whether zero echo time magnetic resonance imaging (ZTE-MRI), as an alternative imaging modality, and conventional computed tomography (CT) have similar diagnostic qualities for assessing pediatric osseous pathologies. Materials and Methods: Twenty-six sets of pediatric musculoskeletal CT and MRI scans (15 boys and 11 girls; mean age, 12 ± 4 years; range, 5–23 years) acquired at Seoul National University Children’s Hospital (January 2021 to November 2023) were retrospectively evaluated. CT-like images from ZTE-MRI were generated using grayscale inversion. Two radiologists independently assessed ZTE-MRI image quality (S anat) on a 5-point scale (1 = nondiagnostic, 5 = excellent) and a comparative scale (–2 = CT greater, 0 = same, 2 = ZTE-MRI greater) for lesion delineation (Scomp). The confidence interval of proportions and intraclass correlation coefficient were calculated to assess inter-rater agreement, and Wilcoxon rank-sum test, Mann–Whitney U test, or paired t-test was used to compare image quality or cortical thickness between the modalities. Results: ZTE-MRI demonstrated diagnostic quality (S anat ≥ 3) in 85%–96% of the cases, 89%–96% for cortical delineation, 92%–100% for intramedullary cavity (IMC) delineation, and 92% for lesion delineation. Compared with conventional CT, ZTE-MRI showed comparable diagnostic power (Scomp ≥ –1) in 92%–96% of the cases, with Scomp scores indicating no significant difference in lesion delineation (p = 0.53 in reader 1 and p = 0.25 in reader 2). There was a preference for CT over ZTE-MRI in terms of overall image quality and delineation of the cortex and IMC (p < 0.001). Cortical thickness was not significantly different (p = 0.11) between ZTE-MRI and CT. Conclusion ZTE-MRI demonstrated diagnostic quality comparable to that of CT, particularly in lesion delineation. In addition to the unique information that conventional MRI can provide, ZTE-MRI can provide additional information about osseous structures similar to that provided by CT, which we believe will be valuable in the future.

Further study is warranted to determine the association between estimated glomerular filtration rate (eGFR) or albuminuria and the risk of death from diverse causes. Methods: We screened >10 million general health screening examinees who received health examinations conducted in 2009 using the claims database of Korea. After the exclusion of those previously diagnosed with renal failure and those with missing data, 9,917,838 individuals with available baseline kidney function measurements were included. The primary outcome was mortality and cause-specific death between 2009 and 2019 identified through death certificates based on the diagnostic codes of International Classification of Diseases, 10th revision. Multivariable Cox regression analysis adjusted for various clinicodemographic and social characteristics was used to assess mortality risk. Results: The hazard ratio of death was significantly high in both the eGFR <60 mL/min/1.73 m2 and in the eGFR ≥120 mL/ min/1.73 m2 groups in univariable and multivariable regression analyses when compared to those within the reference range (eGFR of 90–120 mL/min/1.73 m2). The results were similar for death by cardiovascular, cancer, infection, endocrine, respiratory, and digestive causes. We also found that albuminuria was associated with higher risk of death regardless of eGFR range, and those in the higher categories of dipstick albuminuria showed higher risk. Conclusion: We reconfirmed the significant association between eGFR, albuminuria, and mortality. Healthcare providers should keep in mind that albuminuria and decreased eGFR as well as kidney hyperfiltration are independent predictors of mortality.

Background: The genetically predicted lipid-lowering effect of HMGCR or PCSK9 variant can be used to assess drug proxy effects on kidney function. Methods: Mendelian randomization (MR) analysis-identified HMGCR and PCSK9 genetic variants were used to predict the low-density lipoprotein (LDL) cholesterol-lowering effects of medications targeting related molecules. Primary summary-level outcome data for log-estimated glomerular filtration rate (eGFR; creatinine) were provided by the CKDGen Consortium (n = 1,004,040 European) from a meta-analysis of CKDGen and UK Biobank data. We also conducted a separate investigation of summary-level data from CKDGen (n = 567,460, log-eGFR [creatinine]) and UK Biobank (n = 436,581, log-eGFR [cystatin C]) samples. Summary-level MRs using an inverse variance weighted method and pleiotropy-robust methods were performed. Results: Summary-level MR analysis indicated that the LDL-lowering effect predicted genetically by HMGCR variants (50-mg/dL decrease) was significantly associated with a decrease in eGFR (–1.67%; 95% confidence interval [CI], –2.20% to –1.13%). Similar significance was found in results from the pleiotropy-robust MR methods when the CKDGen and UK Biobank data were analyzed separately. However, the LDL-lowering effect predicted genetically by PCSK9 variants was significantly associated with an increase in eGFR (+1.17%; 95% CI, 0.10%–2.25%). The results were similarly supported by the weighted median method and in each CKDGen and UK Biobank dataset, but the significance obtained by MR-Egger regression was attenuated. Conclusion Genetically predicted HMG-CoA reductase inhibition was associated with low eGFR, while genetically predicted PCSK9 inhibition was associated with high eGFR. Clinicians should consider that the direct effect of different types of lipid-lowering medication on kidney function can vary.