Korea’s healthcare system is at a critical juncture as rapid population aging, rising chronic disease burdens, and fragmented care expose the limits of a hospital-centered, fee-for-service model. Although policy discussions have long emphasized strengthening primary care and introducing a “family doctor” system, past reforms have focused mainly on expanding services or redefining professional roles, without establishing clear accountability, care continuity, or aligned payment mechanisms. Consequently, primary care remains weak and responsibility for comprehensive patient management is diffuse. This article argues that meaningful reform requires redefining the primary physician as an accountable manager of longitudinal, coordinated care within an integrated delivery and payment framework. Drawing on experiences from the United States, the United Kingdom, and several European countries, it identifies common features of successful primary care–oriented systems, including patient registration, team-based care, risk-adjusted payment, and explicit outcome accountability. Based on these insights, the authors propose a Korean primary physician model tailored to solo and small-group practices while fostering regional collaboration. Core elements include voluntary patient registration, multidisciplinary primary care teams, risk-stratified care management, regional care networks, and a mixed payment model combining per-member-per-month payments, shared savings, and performance-based incentives. The article emphasizes phased pilot testing focused on operational feasibility. Ultimately, transitioning to a primary care–centered system is presented as a strategic necessity for sustainability and improved care continuity.

South Korea’s current healthcare system stands at a critical crossroads that will determine whether it can progress in a better direction over the next decade. Behind the relatively stable level of population health that has been maintained until now, it has become clear that the deterioration of patient experiences, the risk of collapse in critical emergency medical services, the burnout of healthcare providers, and the crisis in the sustainability of healthcare finances have all accumulated simultaneously. This crisis can no longer be overcome by partial fixes or short-term measures alone. The answer to what needs to change first must begin with a reaffirmation of what the healthcare system should aim for. Ultimately, what needs to be changed now is not an individual policy, but the criteria and priorities through which we view healthcare. The focus must shift from what to provide more of, to questioning what holds greater social value. If such a shift does not begin now, in ten years we won’t face a better healthcare system, but care enmeshed in a deeper crisis. Now is precisely the time to fundamentally define the direction of the healthcare system.

Background: Postoperative liver regeneration is essential for maintaining hepatic function. This study evaluated the rate, determinants, and volumetric patterns of early liver regeneration after hemihepatectomy. Methods: A retrospective review was conducted of 50 patients who underwent right or left hemihepatectomy between April 2019 and March 2025. Liver and spleen volumes (SV) were assessed preoperatively, at postoperative day (POD) 1 week, and at POD 3 months. Early liver regeneration rate (LRR) was defined as the percentage increase in remnant liver volume at POD 1 week relative to the preoperative future liver remnant (FLR), and patients were categorized into low (<50%) and high (≥50%) LRR groups. Clinical, biochemical, and volumetric variables were compared, and predictors of regeneration were identified using multivariable analyses. Regeneration patterns were also examined according to whether the FLR/standard liver volume (SLV) ratio was <50% or ≥50%. Results: FLR/SLV was the strongest independent predictor of rapid early liver regeneration (p<0.001). Remnants with FLR/SLV <50% exhibited rapid and sustained regeneration, whereas those with FLR/SLV ≥50% showed slower regrowth that plateaued after reaching approximately 90% of SLV. SV increased at POD 1 week in all patients; however, only the FLR/SLV ≥50% group showed a reduction by POD 3 months, whereas the <50% group maintained elevated volumes. Conclusions FLR/SLV reliably predicts early postoperative liver regeneration. Smaller remnants regenerate more rapidly, whereas persistent splenic enlargement suggests a sustained portal hemodynamic burden. Combined evaluation of FLR/SLV and SV may enhance perioperative risk assessment and surgical planning.

Purpose: This study aimed to report the real-world outcomes of intravesical gemcitabine for bacillus Calmette–Guérin (BCG)–unresponsive, high-risk, non–muscle-invasive bladder cancer (HR-NMIBC) in Korean patients who were unable or unwilling to undergo radical cystectomy (RC). Materials and Methods: This retrospective study included 131 patients (median age, 69 years; 88.5% men) treated with intravesical gemcitabine for BCG-unresponsive HR-NMIBC at nine centers between May 2019 and April 2022. The primary endpoint was 1-year recurrence-free survival (RFS). The secondary endpoints included factors influencing RFS, progression-free survival (PFS), cystectomy- free survival, cancer-specific survival (CSS), overall survival (OS), and safety. Survival analysis was performed using the Kaplan-Meier method, and risk factors for recurrence were assessed using Cox regression models. Results: Patients were followed up for a median duration of 25 months, with carcinoma in situ (CIS) in 41.9% of the patients. The 1-year and 2-year RFS rates were 68% and 42%, while the 1-year and 2-year PFS rates were 87% and 77%, respectively. No significant factors influencing RFS were identified. Seventeen patients underwent RC during a median follow-up of 16 months, with the condition in three patients progressing to muscle-invasive disease on final pathological analysis. The 2-year CSS and OS rates were 98% and 97%, respectively. Intravesical gemcitabine was well-tolerated, with only seven patients (5.3%) unable to complete the full induction course. Conclusion Our research highlights the potential of intravesical gemcitabine as a viable bladder-sparing treatment option for BCG-unresponsive HR-NMIBC, providing real-world evidence on its safety, efficacy, and tolerability.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

Objective: This study performed a longitudinal molecular characterization of P. multocidaisolates from pigs with respiratory lesions in South Korea (2016–2023), including subspecies identification, capsular serogrouping, virulence gene profiling, and multilocus sequence typing (MLST). Methods: A total of 1,358 pneumonic lung samples were collected from 960 pig farms between 2016 and 2023, yielding 169 P. multocida isolates. Subspecies were assigned by 16S rRNA gene sequencing. Capsular serogroups were determined using multiplex Virulence genes (pfhA, hgbB, tbpA, and toxA) were detected by PCR assays. MLST was conducted using the RIRDC scheme, and phylogenetic analysis of concatenated loci assessed clonal relationships. Results: Serogroup A predominated (109/169, 64.5%), followed by D (47/169, 27.8%) and B (3/169, 1.8%). Serogroups F and A/D were each detected once (0.6%), and 8 isolates were untypable (4.7%). Co-detection of hgbB and pfhA occurred in multiple isolates. Notably, two serogroup B isolates carried both genes, representing the first such finding in Korea and suggesting enhanced virulence potential. MLST identified 5 clonal complexes and 15 sequence types, including ST9 linked to serogroup B. Conclusions and Relevance: The emergence of serogroup B/ST9 isolates co-harboring hgbB and pfhA highlights evolving virulence patterns in Korean swine and supports continued molecular and genomic surveillance to guide control strategies and reduce health risks.

Objective: To provide a decade-long molecular and phenotypic characterization of APP isolates from Korean pig farms, focusing on the serovar distribution, apx-based toxingene profiles, and antimicrobial susceptibility. Methods: Between 2015 and 2025, 1,215 pneumonic lung samples from 965 pig farms yielded 132 APP isolates. The species identity was confirmed by 16S rRNA sequencing. The serovars were determined using capsule polysaccharide (CPS) gene-based multiplex polymerase chain reaction (PCR). Toxin genes (apxIA–apxIVA) were profiled, and the antimicrobial susceptibility to 29 agents was assessed by broth microdilution according to the Clinical and Laboratory Standards Institute guidelines. Results: Serovar 1 was predominant (66.7%), followed by serovars 5 (17.4%) and 2 (6.8%).CPS multiplex PCR identified three isolates (2.3%) as serovar 15, which displayed heterogeneous toxin gene profiles, including apxIICA-deficient profiles. Most isolates exhibited classical repeats-in-toxin operon arrangements, suggesting ongoing diversification of toxin gene profiles. High resistance rates were observed for oxytetracycline (90.9%) and florfenicol (50.8%), and recurrent multidrug-resistant combinations were frequently detected. Conclusions and Relevance: Serovar 1 is dominant in Korea, but the emergence of atypical toxin gene profiles in serovar 15 may carry immunological implications. Persistent resistance to older drug classes underscores the necessity for long-term molecular surveillance, evaluation of vaccine coverage against evolving strains, and enhanced antimicrobial stewardship to strengthen the control efforts for porcine pleuropneumonia in Korea.

Background: The exposome encompasses all factors people encounter through life, with the skin constantly exposed. While particulate matter (PM) and sleep deprivation are known to contribute to barrier dysfunction, their combined effects remain unclear. Objective: To evaluate the independent and combined effects of PM exposure and short-term sleep deprivation on skin barrier function. Methods: Forty healthy Korean women (aged 24–58 years) were enrolled in this study. Forearms were divided into 4 sites: control, PM exposure, sleep deprivation, and PM plus sleep deprivation. Parameters such as trans-epidermal water loss (TEWL), hydration, elasticity, roughness, and redness were measured at baseline and post-exposure. RNA sequencing and reverse transcription-polymerase chain reaction were conducted on tape-stripped skin samples. Results: PM exposure significantly increased TEWL (+25.59%, p<0.01), roughness (+21.9%, p<0.01), and redness (+13.7%, p<0.0001) while reducing elasticity (−3.98%, p<0.01). Sleep deprivation modestly reduced elasticity (−1.39%, p<0.05) without affecting other parameters.Combined PM and sleep deprivation did not further exacerbate barrier dysfunction compared to PM alone. RNA sequencing revealed reduced FLG and LORICRIN expression and upregulated endoplasmic reticulum (ER) stress markers (HSP90B1, CANX) in both PM and sleep deprivation conditions. Conclusion PM exposure impaired skin barrier function, while short-term sleep deprivation alone did not significantly affect the barrier, either independently or in combination with PM.However, it was observed that the sleep deprivation-only, while not directly causing barrier damage, induced changes in ER stress-related gene expression in tape-stripped skin samples, like the PM exposure-only. This suggests that such signaling pathways could potentially exacerbate skin barrier deterioration.

Background: Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better. Methods: We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year. Results: After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different. Conclusion There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.

Purpose: To investigate the outcomes of brolucizumab reinjection after intraocular inflammation (IOI) development. Methods: This retrospective study analyzed patients with brolucizumab injections from April 2021 to January 2024. Patients who developed IOI after brolucizumab were included and categorized into subgroups depending on reinjection, discontinuation, and further IOI development. Results: A total of 472 eyes of 432 patients received brolucizumab injections. Thirty-eight cases developed IOI at least once, and 25 continued brolucizumab. Sixteen cases had no more IOI events, and nine experienced a second or more IOI events. Among the nine cases, three maintained brolucizumab injections despite IOI recurrence. The incidence of IOI was 8.1% based on the number of eyes (38 of 472 eyes) and 2.0% based on the number of brolucizumab injections (50 of 2,468 injections). The incidence of occlusive retinal vasculitis was 0.2% (1 of 472 eyes). The recurrence rate was 23.7% (9 of 38 eyes). The average number of injections between the first brolucizumab injection and the injection date on which IOI first developed was 2.15 times in the no-reinjection group, 3.44 times in the no-IOI-recurrence group, and 2.0 times in the second-IOI-episode group. Time to IOI occurrence in cases with first IOI episode was 18.60 ± 16.73 days, with 15 cases developing IOI within 1 week. Conclusions This study elucidates the real-world incidence of brolucizumab associated IOIs, with a description of information related to reinjections after the IOI episodes. A comprehensive understanding of brolucizumab reinjection is essential for its optimal utilization.