Background: Preclinical studies have reported anticancer properties of sodium-glucose cotransporter 2 inhibitors (SGLT2is). We aimed to elucidate the association between the use of SGLT2is and the risk of prostate cancer among male patients with type 2 diabetes mellitus (T2DM). Methods: An active-comparator, new-user cohort design using a nationwide database between September 2014 and June 2020 was conducted on 45,601 new SGLT2i users and 205,395 new users of other glucose-lowering medications (oGLMs). In the following 1:1 propensity score matched (PSM) analysis, 35,371 SGLT2i users matched with an equivalent number of oGLM users were assessed. The hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer were calculated. Results: Among the cohort, prostate cancer was diagnosed in 210 out of 45,601 SGLT2i users, corresponding to a cumulative incidence of 1.0%, in contrast to 1,880 cases among 205,395 users of oGLMs, with a cumulative incidence of 1.5%. The use of SGLT2is was significantly correlated with a reduced risk of prostate cancer based on a multivariable-adjusted HR of 0.83 (95% CI, 0.71 to 0.98). PSM analysis affirmed 18% reduction in prostate cancer risk associated with SGLT2i use (HR, 0.82; 95% CI, 0.67 to 0.99). Subgroup analyses revealed that body mass index (BMI) significantly influenced the effect of SGLT2i on prostate cancer risk, with a more pronounced reduction in the subgroup with a BMI <25 kg/m2 (P=0.037). Conclusion The use of SGLT2is in Korean male patients with T2DM is associated with a lower risk of prostate cancer.

Background: Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Results: Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]= –0.40 g/cm2 ; 95% confidence interval [CI], –0.73 to –0.07; I2 = 0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of –3.14 (95% CI, –3.82 to –2.47). Conclusion This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) is difficult in patients who have difficulty communicating their symptoms.This study aimed to evaluate the diagnostic accuracy of urine leukocytes in distinguishing between UTI and ASB, and the clinical outcomes of patients with UTI according to the degree of pyuria. Methods: This retrospective cohort study included patients with positive urine cultures between July 2022 and June 2023 at two hospitals. UTI and ASB were diagnosed through a comprehensive review of medical records. We evaluated the differences in urine leukocyte counts between patients with UTI and ASB. The diagnostic performance of urine leukocytes to differentiate between UTI and ASB was evaluated. To investigate the clinical outcomes based on the degree of pyuria, we classified patients with upper UTI according to their urine leukocyte counts. Results: Of the 1,793 eligible patients with bacteriuria included, 1,464 had UTI and 329 had ASB. Patients with UTI had higher urinary leukocytes than patients with ASB did (490.4 vs.123.5 cells/µL; P < 0.001). The area under the receiver operating characteristic curve was 0.702 for discriminating between ASB and UTI. The optimal urine leukocyte cutoff was 195.35 cells/µL, with a sensitivity and specificity of 0.70 and 0.60, respectively. A sequential rise in secondary bacteremia rate was observed according to an increase in urine leukocytes in patients with upper UTI, whereas in-hospital mortality showed no corresponding trend. Conclusion Urine leukocyte counts could be used to predict UTI occurrence and bacteremia secondary to UTI. Higher degrees of pyuria were associated with bacteremia but not with mortality. Urine leukocyte counts can provide additive information for patients with bacteriuria with vague symptoms.

Background: Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Results: Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]= –0.40 g/cm2 ; 95% confidence interval [CI], –0.73 to –0.07; I2 = 0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of –3.14 (95% CI, –3.82 to –2.47). Conclusion This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) is difficult in patients who have difficulty communicating their symptoms.This study aimed to evaluate the diagnostic accuracy of urine leukocytes in distinguishing between UTI and ASB, and the clinical outcomes of patients with UTI according to the degree of pyuria. Methods: This retrospective cohort study included patients with positive urine cultures between July 2022 and June 2023 at two hospitals. UTI and ASB were diagnosed through a comprehensive review of medical records. We evaluated the differences in urine leukocyte counts between patients with UTI and ASB. The diagnostic performance of urine leukocytes to differentiate between UTI and ASB was evaluated. To investigate the clinical outcomes based on the degree of pyuria, we classified patients with upper UTI according to their urine leukocyte counts. Results: Of the 1,793 eligible patients with bacteriuria included, 1,464 had UTI and 329 had ASB. Patients with UTI had higher urinary leukocytes than patients with ASB did (490.4 vs.123.5 cells/µL; P < 0.001). The area under the receiver operating characteristic curve was 0.702 for discriminating between ASB and UTI. The optimal urine leukocyte cutoff was 195.35 cells/µL, with a sensitivity and specificity of 0.70 and 0.60, respectively. A sequential rise in secondary bacteremia rate was observed according to an increase in urine leukocytes in patients with upper UTI, whereas in-hospital mortality showed no corresponding trend. Conclusion Urine leukocyte counts could be used to predict UTI occurrence and bacteremia secondary to UTI. Higher degrees of pyuria were associated with bacteremia but not with mortality. Urine leukocyte counts can provide additive information for patients with bacteriuria with vague symptoms.

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) is difficult in patients who have difficulty communicating their symptoms.This study aimed to evaluate the diagnostic accuracy of urine leukocytes in distinguishing between UTI and ASB, and the clinical outcomes of patients with UTI according to the degree of pyuria. Methods: This retrospective cohort study included patients with positive urine cultures between July 2022 and June 2023 at two hospitals. UTI and ASB were diagnosed through a comprehensive review of medical records. We evaluated the differences in urine leukocyte counts between patients with UTI and ASB. The diagnostic performance of urine leukocytes to differentiate between UTI and ASB was evaluated. To investigate the clinical outcomes based on the degree of pyuria, we classified patients with upper UTI according to their urine leukocyte counts. Results: Of the 1,793 eligible patients with bacteriuria included, 1,464 had UTI and 329 had ASB. Patients with UTI had higher urinary leukocytes than patients with ASB did (490.4 vs.123.5 cells/µL; P < 0.001). The area under the receiver operating characteristic curve was 0.702 for discriminating between ASB and UTI. The optimal urine leukocyte cutoff was 195.35 cells/µL, with a sensitivity and specificity of 0.70 and 0.60, respectively. A sequential rise in secondary bacteremia rate was observed according to an increase in urine leukocytes in patients with upper UTI, whereas in-hospital mortality showed no corresponding trend. Conclusion Urine leukocyte counts could be used to predict UTI occurrence and bacteremia secondary to UTI. Higher degrees of pyuria were associated with bacteremia but not with mortality. Urine leukocyte counts can provide additive information for patients with bacteriuria with vague symptoms.

Background: Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry. Results: Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]= –0.40 g/cm2 ; 95% confidence interval [CI], –0.73 to –0.07; I2 = 0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of –3.14 (95% CI, –3.82 to –2.47). Conclusion This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) is difficult in patients who have difficulty communicating their symptoms.This study aimed to evaluate the diagnostic accuracy of urine leukocytes in distinguishing between UTI and ASB, and the clinical outcomes of patients with UTI according to the degree of pyuria. Methods: This retrospective cohort study included patients with positive urine cultures between July 2022 and June 2023 at two hospitals. UTI and ASB were diagnosed through a comprehensive review of medical records. We evaluated the differences in urine leukocyte counts between patients with UTI and ASB. The diagnostic performance of urine leukocytes to differentiate between UTI and ASB was evaluated. To investigate the clinical outcomes based on the degree of pyuria, we classified patients with upper UTI according to their urine leukocyte counts. Results: Of the 1,793 eligible patients with bacteriuria included, 1,464 had UTI and 329 had ASB. Patients with UTI had higher urinary leukocytes than patients with ASB did (490.4 vs.123.5 cells/µL; P < 0.001). The area under the receiver operating characteristic curve was 0.702 for discriminating between ASB and UTI. The optimal urine leukocyte cutoff was 195.35 cells/µL, with a sensitivity and specificity of 0.70 and 0.60, respectively. A sequential rise in secondary bacteremia rate was observed according to an increase in urine leukocytes in patients with upper UTI, whereas in-hospital mortality showed no corresponding trend. Conclusion Urine leukocyte counts could be used to predict UTI occurrence and bacteremia secondary to UTI. Higher degrees of pyuria were associated with bacteremia but not with mortality. Urine leukocyte counts can provide additive information for patients with bacteriuria with vague symptoms.

Background: Sepsis is a leading cause of intensive care unit (ICU) admission. However, few studies have evaluated how the ICU model affects the outcomes of patients with sepsis. Methods: This post hoc analysis of data from the Management of Severe Sepsis in Asia’s Intensive Care Units II study included 537 patients with sepsis admitted to 27 ICUs in Korea. The outcome measures of interest were compared between the closed ICU group, patients admitted under the full responsibility of an intensivist as the primary attending physician, and the open ICU group. The association between a closed ICU and ICU mortality was evaluated using a logistic regression analysis. Results: Altogether, 363 and 174 enrolled patients were treated in open and closed ICUs, respectively. Compliance with the sepsis bundles did not differ between the two groups; however, the closed ICU group had a higher rate of renal replacement therapy and shorter duration of ventilator support. The closed ICU group also had a lower ICU mortality rate than the open ICU group (24.7% vs. 33.1%). In a logistic regression analysis, management in the closed ICU was significantly associated with a decreased ICU mortality rate even after adjusting for potential confounding factors (adjusted odds ratio, 0.576; 95% CI, 0.342–0.970), and that association was observed for up to 90 days. Conclusions Sepsis management in closed ICUs was significantly associated with improved ICU survival and decreased length of ICU stay, even though the compliance rates for the sepsis bundles did not differ between open and closed ICUs.

Background: Primary cutaneous CD30+ lymphoproliferative disorders (pcCD30-LPDs) are a diseases with various clinical and prognostic characteristics. Objective: Increasing our knowledge of the clinical characteristics of pcCD30-LPDs and identifying potential prognostic variables in an Asian population. Methods: Clinicopathological features and survival data of pcCD30-LPD cases obtained from 22 hospitals in South Korea were examined. Results: A total of 413 cases of pcCD30-LPDs (lymphomatoid papulosis [LYP], n=237; primary cutaneous anaplastic large cell lymphoma [C-ALCL], n=176) were included. Ninety percent of LYP patients and roughly 50% of C-ALCL patients presented with multiple skin lesions. Both LYP and C-ALCL affected the lower limbs most frequently. Multiplicity and advanced T stage of LYP lesions were associated with a chronic course longer than 6 months. Clinical morphology with patch lesions and elevated serum lactate dehydrogenase were significantly associated with LPDs during follow-up in LYP patients. Extracutaneous involvement of C-ALCL occurred in 13.2% of patients. Lesions larger than 5 cm and increased serum lactate dehydrogenase were associated with a poor prognosis in C-ALCL. The survival of patients with C-ALCL was unaffected by the anatomical locations of skin lesions or other pathological factors. Conclusion The multiplicity or size of skin lesions was associated with a chronic course of LYP and survival among patients with C-ALCL.