1.Arteriovenous fistulas are associated with superior outcomes in very elderly hemodialysis patients: a nationwide cohort study
Hyung Duk KIM ; Do Hyoung KIM ; Hyangkyoung KIM ; Hyung-Seok LEE ; Seung Boo YANG ; Seok Joon SHIN ; Hoon Suk PARK ;
The Korean Journal of Internal Medicine 2026;41(1):152-162
Background/Aims:
The optimal vascular access strategy for very elderly patients initiating hemodialysis (HD) remains unclear. Arteriovenous fistulas (AVFs) offer long-term benefits but may be limited due to vascular aging. This study evaluated vascular access outcomes in patients aged ≥ 80 years.
Methods:
We conducted a retrospective cohort study using data from the Korean National Health Insurance Service between 2008 and 2019. Patients aged ≥ 80 years who initiated HD with a newly created AVF or arteriovenous graft (AVG) were included. Primary outcomes were primary, assisted primary, and secondary patency. The secondary outcome was all-cause mortality. Outcomes were compared using Kaplan–Meier analysis and multivariable Cox regression.
Results:
Among 8,487 patients, 5,124 (60.4%) received AVFs (AVF group) and 3,363 (39.6%) received AVGs (AVG group). AVFs were associated with significantly lower rates of patency loss across all definitions. The adjusted hazard ratios (HRs) for AVG vs. AVF were 1.76 (95% confidence interval [CI], 1.67–1.86) for primary patency loss, 1.90 (95% CI, 1.77–2.03) for assisted primary, and 3.18 (95% CI, 2.81–3.61) for secondary patency loss. All-cause mortality was also higher in the AVG group (adjusted HR, 1.24; 95% CI, 1.17–1.30).
Conclusions
In this large-scale study, AVF use was associated with superior patency and lower mortality compared with AVG in patients aged ≥ 80 years. These findings suggest that AVF remains a beneficial option for appropriately selected elderly patients and that age alone should not be a primary barrier to its creation.
2.Clinical practice guidelines for ovarian cancer: an update to the Korean Society of Gynecologic Oncology guidelines
Banghyun LEE ; Suk-Joon CHANG ; Byung Su KWON ; Joo-Hyuk SON ; Myong Cheol LIM ; Yun Hwan KIM ; Shin-Wha LEE ; Chel Hun CHOI ; Kyung Jin EOH ; Jung-Yun LEE ; Yoo-Young LEE ; Dong Hoon SUH ; Yong Beom KIM
Journal of Gynecologic Oncology 2025;36(1):e69-
We updated the Korean Society of Gynecologic Oncology (KSGO) practice guideline for the management of ovarian cancer as version 5.1. The ovarian cancer guideline team of the KSGO published announced the fifth version (version 5.0) of its clinical practice guidelines for the management of ovarian cancer in December 2023. In version 5.0, the selection of the key questions and the systematic reviews were based on the data available up to December 2022.Therefore, we updated the guidelines version 5.0 with newly accumulated clinical data and added 5 new key questions reflecting the latest insights in the field of ovarian cancer between 2023 and 2024. For each question, recommendation was provided together with corresponding level of evidence and grade of recommendation, all established through expert consensus.
3.Clinical practice guidelines for ovarian cancer: an update to the Korean Society of Gynecologic Oncology guidelines
Banghyun LEE ; Suk-Joon CHANG ; Byung Su KWON ; Joo-Hyuk SON ; Myong Cheol LIM ; Yun Hwan KIM ; Shin-Wha LEE ; Chel Hun CHOI ; Kyung Jin EOH ; Jung-Yun LEE ; Yoo-Young LEE ; Dong Hoon SUH ; Yong Beom KIM
Journal of Gynecologic Oncology 2025;36(1):e69-
We updated the Korean Society of Gynecologic Oncology (KSGO) practice guideline for the management of ovarian cancer as version 5.1. The ovarian cancer guideline team of the KSGO published announced the fifth version (version 5.0) of its clinical practice guidelines for the management of ovarian cancer in December 2023. In version 5.0, the selection of the key questions and the systematic reviews were based on the data available up to December 2022.Therefore, we updated the guidelines version 5.0 with newly accumulated clinical data and added 5 new key questions reflecting the latest insights in the field of ovarian cancer between 2023 and 2024. For each question, recommendation was provided together with corresponding level of evidence and grade of recommendation, all established through expert consensus.
4.Clinical practice guidelines for ovarian cancer: an update to the Korean Society of Gynecologic Oncology guidelines
Banghyun LEE ; Suk-Joon CHANG ; Byung Su KWON ; Joo-Hyuk SON ; Myong Cheol LIM ; Yun Hwan KIM ; Shin-Wha LEE ; Chel Hun CHOI ; Kyung Jin EOH ; Jung-Yun LEE ; Yoo-Young LEE ; Dong Hoon SUH ; Yong Beom KIM
Journal of Gynecologic Oncology 2025;36(1):e69-
We updated the Korean Society of Gynecologic Oncology (KSGO) practice guideline for the management of ovarian cancer as version 5.1. The ovarian cancer guideline team of the KSGO published announced the fifth version (version 5.0) of its clinical practice guidelines for the management of ovarian cancer in December 2023. In version 5.0, the selection of the key questions and the systematic reviews were based on the data available up to December 2022.Therefore, we updated the guidelines version 5.0 with newly accumulated clinical data and added 5 new key questions reflecting the latest insights in the field of ovarian cancer between 2023 and 2024. For each question, recommendation was provided together with corresponding level of evidence and grade of recommendation, all established through expert consensus.
5.Management of high-flow arteriovenous access
Hoon Suk PARK ; Seok Joon SHIN
Kidney Research and Clinical Practice 2025;44(1):58-68
An arteriovenous fistula or graft is essential for hemodialysis (HD). It involves connecting a high-resistance artery to a low-resistance vein, which increases cardiac output (CO). In the early days of HD, patients with end-stage kidney disease (ESKD) were typically younger, and their HD access was located in the distal forearm. However, in the modern era, ESKD patients are often the elderly, with many being the very elderly (over 80 years old). These elderly patients often have poor vessel quality, making distal forearm access unsuitable. As a result, upper arm access, which is more prone to high-flow access, is commonly used. The cardiac status of these modern elderly ESKD patients is vulnerable to high-flow access. High-flow HD access can lead to high-output cardiac failure in ESKD patients. Initial evaluation for high-flow access involves measuring the flow volume using Doppler ultrasound. If the HD access flow volume exceeds 2,000 mL/min, further assessments, including CO and cardiopulmonary recirculation ratio caused by the HD access, should be strongly considered. Treatment for high-flow access involves reducing the flow. There are several surgical and endovascular methods for flow reduction, such as aneurysmorrhaphy, short segment small-diameter graft interposition at the inflow area of the HD access, and banding. Patients with high-flow access are generally asymptomatic. Therefore, nephrologists as primary care physicians for HD patients should provide detailed explanations to patients with high-flow access and high-output cardiac failure and ensure that they understand the prognosis of these conditions. Nephrologists need increased attention to high-flow HD access.
6.Understanding the pathogenicity of Naegleria fowleri in association with N. fowleri antigen-1 (Nfa1)
Jong-Hyun KIM ; Hae-Jin SOHN ; Ho-Joon SHIN ; Stacy E. WALZ ; Suk-Yul JUNG
Parasites, Hosts and Diseases 2024;62(4):385-398
Naegleria fowleri, a brain-eating amoeba, thrives in lakes and rivers with aquatic vegetation and causes primary amoebic meningoencephalitis (PAM) in humans. Most recently, it has become such a serious problem that N. fowleri was detected in tap water in Houston, USA. Several pathogenic factors are considered very important to destroy target cells in the brain. In particular, the food-cup where N. fowleri antigen-1 (Nfa1) is located, is strongly expressed in pseudopodia involved in the movement of N. fowleri, and is involved in phagocytosis by attaching to target cells. In this article, we reviewed the role of the Nfa1 protein and its associated pathogenicity. The nfa1 gene was cloned by cDNA library immunoscreening using infection serum and immune serum. Nfa1 protein is mainly distributed in pseudopodia important to movement and vacuoles. Moreover, heat shock protein 70, cathepsin-like proteare and Nf-actin are also associated with pseudopodia in which Nfa1 is localized. Interestingly, the amount of the nfa1 gene changed as N. fowleri trophozoites transformed into cysts. Polyclonal antiserum against Nfa1 showed a protective effect against cytotoxicity of approximately 19.7%. Nfa1-specific IgA antibodies prevent N. fowleri trophozoites from adhering to the nasal mucosa, delaying invasion. The nfa1-vaccinated mice showed significantly higher levels of Nfa1-specific antibody. The duration of anti-Nfa1 IgG in the vaccinated mice lasted 12 weeks, strongly suggesting that nfa1 is a significant pathogenic gene and that Nfa1 is a pathogenic protein. Several factors related to pseudopodia and locomotion have been linked to Nfa1. A clearer function of N. fowleri targeting nfa1 with other genes might enable target-based inhibition of N. fowleri pathogenicity.
7.Understanding the pathogenicity of Naegleria fowleri in association with N. fowleri antigen-1 (Nfa1)
Jong-Hyun KIM ; Hae-Jin SOHN ; Ho-Joon SHIN ; Stacy E. WALZ ; Suk-Yul JUNG
Parasites, Hosts and Diseases 2024;62(4):385-398
Naegleria fowleri, a brain-eating amoeba, thrives in lakes and rivers with aquatic vegetation and causes primary amoebic meningoencephalitis (PAM) in humans. Most recently, it has become such a serious problem that N. fowleri was detected in tap water in Houston, USA. Several pathogenic factors are considered very important to destroy target cells in the brain. In particular, the food-cup where N. fowleri antigen-1 (Nfa1) is located, is strongly expressed in pseudopodia involved in the movement of N. fowleri, and is involved in phagocytosis by attaching to target cells. In this article, we reviewed the role of the Nfa1 protein and its associated pathogenicity. The nfa1 gene was cloned by cDNA library immunoscreening using infection serum and immune serum. Nfa1 protein is mainly distributed in pseudopodia important to movement and vacuoles. Moreover, heat shock protein 70, cathepsin-like proteare and Nf-actin are also associated with pseudopodia in which Nfa1 is localized. Interestingly, the amount of the nfa1 gene changed as N. fowleri trophozoites transformed into cysts. Polyclonal antiserum against Nfa1 showed a protective effect against cytotoxicity of approximately 19.7%. Nfa1-specific IgA antibodies prevent N. fowleri trophozoites from adhering to the nasal mucosa, delaying invasion. The nfa1-vaccinated mice showed significantly higher levels of Nfa1-specific antibody. The duration of anti-Nfa1 IgG in the vaccinated mice lasted 12 weeks, strongly suggesting that nfa1 is a significant pathogenic gene and that Nfa1 is a pathogenic protein. Several factors related to pseudopodia and locomotion have been linked to Nfa1. A clearer function of N. fowleri targeting nfa1 with other genes might enable target-based inhibition of N. fowleri pathogenicity.
8.Clinical guidelines for ovarian cancer:the Korean Society of Gynecologic Oncology guidelines
Banghyun LEE ; Suk-Joon CHANG ; Byung Su KWON ; Joo-Hyuk SON ; Myong Cheol LIM ; Yun Hwan KIM ; Shin-Wha LEE ; Chel Hun CHOI ; Kyung Jin EOH ; Jung-Yun LEE ; Dong Hoon SUH ; Yong Beom KIM
Journal of Gynecologic Oncology 2024;35(1):e43-
Since the latest practice guidelines for ovarian cancer were developed by the Korean Society of Gynecologic Oncology (KSGO) in 2021, many studies have examined the efficacy and safety of various treatments for epithelial ovarian cancer (EOC). Therefore, the need to develop recommendations for EOC treatments has been raised. This study searched the literature using 4 key items and the Population, Intervention, Comparison, and Outcome: the efficacy and safety of poly-ADP ribose polymerase inhibitors in newly diagnosed advanced EOC; the efficacy and safety of intraperitoneal plus intravenous chemotherapy in optimally debulked advanced EOC; the efficacy and safety of secondary cytoreductive surgery in platinumsensitive recurrent ovarian cancer; and the efficacy and safety of the addition of bevacizumab to platinum-based chemotherapy in first platinum-sensitive recurrent EOC patients who received prior bevacizumab. The evidence for these recommendations, according to each key question, was evaluated using a systematic review and meta-analysis. The committee of ovarian cancer of the KSGO developed updated guidelines for treatments of EOC.
9.Understanding the pathogenicity of Naegleria fowleri in association with N. fowleri antigen-1 (Nfa1)
Jong-Hyun KIM ; Hae-Jin SOHN ; Ho-Joon SHIN ; Stacy E. WALZ ; Suk-Yul JUNG
Parasites, Hosts and Diseases 2024;62(4):385-398
Naegleria fowleri, a brain-eating amoeba, thrives in lakes and rivers with aquatic vegetation and causes primary amoebic meningoencephalitis (PAM) in humans. Most recently, it has become such a serious problem that N. fowleri was detected in tap water in Houston, USA. Several pathogenic factors are considered very important to destroy target cells in the brain. In particular, the food-cup where N. fowleri antigen-1 (Nfa1) is located, is strongly expressed in pseudopodia involved in the movement of N. fowleri, and is involved in phagocytosis by attaching to target cells. In this article, we reviewed the role of the Nfa1 protein and its associated pathogenicity. The nfa1 gene was cloned by cDNA library immunoscreening using infection serum and immune serum. Nfa1 protein is mainly distributed in pseudopodia important to movement and vacuoles. Moreover, heat shock protein 70, cathepsin-like proteare and Nf-actin are also associated with pseudopodia in which Nfa1 is localized. Interestingly, the amount of the nfa1 gene changed as N. fowleri trophozoites transformed into cysts. Polyclonal antiserum against Nfa1 showed a protective effect against cytotoxicity of approximately 19.7%. Nfa1-specific IgA antibodies prevent N. fowleri trophozoites from adhering to the nasal mucosa, delaying invasion. The nfa1-vaccinated mice showed significantly higher levels of Nfa1-specific antibody. The duration of anti-Nfa1 IgG in the vaccinated mice lasted 12 weeks, strongly suggesting that nfa1 is a significant pathogenic gene and that Nfa1 is a pathogenic protein. Several factors related to pseudopodia and locomotion have been linked to Nfa1. A clearer function of N. fowleri targeting nfa1 with other genes might enable target-based inhibition of N. fowleri pathogenicity.
10.Practice guidelines for managing extrahepatic biliary tract cancers
Hyung Sun KIM ; Mee Joo KANG ; Jingu KANG ; Kyubo KIM ; Bohyun KIM ; Seong-Hun KIM ; Soo Jin KIM ; Yong-Il KIM ; Joo Young KIM ; Jin Sil KIM ; Haeryoung KIM ; Hyo Jung KIM ; Ji Hae NAHM ; Won Suk PARK ; Eunkyu PARK ; Joo Kyung PARK ; Jin Myung PARK ; Byeong Jun SONG ; Yong Chan SHIN ; Keun Soo AHN ; Sang Myung WOO ; Jeong Il YU ; Changhoon YOO ; Kyoungbun LEE ; Dong Ho LEE ; Myung Ah LEE ; Seung Eun LEE ; Ik Jae LEE ; Huisong LEE ; Jung Ho IM ; Kee-Taek JANG ; Hye Young JANG ; Sun-Young JUN ; Hong Jae CHON ; Min Kyu JUNG ; Yong Eun CHUNG ; Jae Uk CHONG ; Eunae CHO ; Eui Kyu CHIE ; Sae Byeol CHOI ; Seo-Yeon CHOI ; Seong Ji CHOI ; Joon Young CHOI ; Hye-Jeong CHOI ; Seung-Mo HONG ; Ji Hyung HONG ; Tae Ho HONG ; Shin Hye HWANG ; In Gyu HWANG ; Joon Seong PARK
Annals of Hepato-Biliary-Pancreatic Surgery 2024;28(2):161-202
Background:
s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021.
Methods:
Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop.
Results:
In November 2021, the finalized draft was presented for public scrutiny during a formal hearing.
Conclusions
The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

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