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Kyungdo Han,1,* Jae-Seung Yun,2,* Yong-Moon Park,3 Yu-Bae Ahn,2 Jae-Hyoung Cho,2 Seon-Ah Cha,2 Seung-Hyun Ko2 1Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 3Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA *These authors contributed equally to this work Purpose: There is a scarcity of long-term prediction models for severe hypoglycemia (SH) in subjects with type 2 diabetes mellitus (T2DM). In this study, a model was developed and validated to predict the risk of SH in adult patients with T2DM. Patients and methods: Baseline and follow-up data from patients with T2DM who received health evaluations from January 1, 2009, to December 31, 2010 (n=1,676,885) were analyzed as development (n=1,173,820) and validation (n=503,065) cohorts using the National Health Insurance Database (DB) in Korea. New SH episodes were identified using ICD-10 codes. A Cox proportional hazards regression model and Cox model coefficients were used to derive a risk scoring system, and 14 predictive variables were selected. A risk score nomogram based on the risk prediction model was created to estimate the 1-year risk of SH. Results: In the development cohort, a total of 5,325 (0.45%) patients experienced SH episodes during the follow-up period. After multivariable adjustment, older age, female sex, current smoker, drinking, low body mass index, lack of exercise, previous SH events, insulin or multiple oral hypoglycemic agent use, presence of hypertension or chronic kidney disease, longer duration of diabetes, low or high glucose level, and high Charlson Comorbidity Index score were found to be significant risk factors for the development of SH and were incorporated into the risk model. The concordance indices were 0.871 (95% confidence interval, 0.863–0.881) in development cohort and 0.866 (95% CI, 0.856–0.879) in the validation cohort. The calibration plot showed a nearly 45° line, which indicates that this model predicts well an absolute SH event. Conclusion: This 14-variable prediction model for SH events may be a useful tool to identify high-risk patients and guide prevention of SH in adult patients with T2DM. Keywords: type 2 diabetes, severe hypoglycemia, risk model, risk prediction

Introduction: Using a nationwide population-based cohort, we primarily investigated whether overall and site-specific cancer risk are increased in patients with acromegaly., Materials and Methods: The study included 2,382 patients with acromegaly and 11,910 controls aged above 20, from 2006 to 2016. Cox hazards regression analysis was used, adjusting for baseline covariates. To investigate the association between acromegaly and cancer risk, we conducted Cox proportional hazards regression analysis with adjustments for age, sex, hypertension, diabetes, and dyslipidemia, and stratified the analysis by age (<50 years, 50-64 years, ≥65 years), sex, and follow-up duration (<1 year, 1-4 years, ≥5 years)., Results: Among the 2,382 patients with acromegaly, overall cancer occurred in 244 (10.2%), while the 11,910 controls had 707 (5.9%) occurrences (HR: 1.90 (95% CI: 1.63-2.22). Patients with acromegaly had the highest relative risk for brain cancers with an HR of 6.80 (95% CI: 2.83-16.38) and significantly higher risk of lymphoma, thyroid cancer, multiple myeloma, pancreatic cancer, and colorectal cancer. Even five years after the diagnosis of acromegaly, patients continued to show a significantly higher incidence of cancer. The overall cancer risk, particularly for stomach cancer, was significantly higher in patients under the age of 50 compared to older patients. No significant difference was observed between sexes., Conclusions: This nationwide longitudinal cohort study shows an increased risk of cancer in patients with acromegaly Active and long-term cancer screening is necessary in patients with acromegaly., (© The Author(s) 2025. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The increased expression of programmed cell death ligand 1 (PD-L1) on a subset of immune cells in the peripheral blood has been frequently observed in patients with cancer, suggesting a relationship with PD-L1 expression in tumor tissues. In this study, we investigated the mechanisms underlying PD-L1 expression on various types of immune cells in the peripheral blood of patients with cancer., Methods: PD-L1 expression on various immune cell populations was analyzed in peripheral blood mononuclear cells of 112 patients with non-small cell lung cancer (NSCLC) using flow cytometry. A mouse model of X-ray-induced acute thrombocytopenia was used to investigate the relationship between thrombopoiesis and PD-L1-expressing platelet generation. The clinical significance of PD-L1-expressing platelets was analyzed in a cohort of patients with stage IV NSCLC who received a combination of anti-programmed cell death 1 (PD-1) therapy and chemotherapy., Results: All immune cell populations, including monocytes, T cells, B cells, and NK cells, showed higher PD-L1 expression in patients with cancer than in healthy controls. However, this increased frequency of PD-L1-expressing cells was not attributed to the expression of the cells themselves. Instead, it was entirely dependent on the direct interaction of the cells with PD-L1-expressing platelets. Notably, the platelet-dependent acquisition of PD-L1 on circulating immune cells of patients with lung cancer was observed in various other cancer types and was mechanistically associated with a surge in thrombopoiesis, resulting in the increased production of PD-L1-expressing reticulated platelets. Clinically, patients with enhanced thrombopoiesis and concurrently high PD-L1-expressing platelets exhibited a better response to anti-PD-1 therapy., Conclusions: These findings highlight the role of tumor-associated thrombopoiesis in generating PD-L1-expressing platelets that may serve as a resource for PD-L1-positive cells in the circulation and act as a predictive biomarker for anti-PD-1/PD-L1 therapy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background/Objectives: While gradient-echo (GRE)-based chemical shift-encoded magnetic resonance imaging (CSE-MRI) offers precise method for measuring adiposity in bone marrow, its limitation lies in the need for additional imaging. On the other hand, spin-echo (SE)-based CSE-MRI can seamlessly integrate into conventional protocols. Recently, a novel technique called the vertebral bone quality (VBQ) score has been introduced. The objective of this study was to investigate the association between fat fraction (FF) measured by GRE-based CSE-MRI (FF GRE ) and FF measured by SE-based CSE-MRI (FF SE ) or the VBQ score. Methods: A retrospective study with 344 patients assessed the correlation between FF and the VBQ score and each measurement's correlation with age using Pearson's correlation ( r ). Concordance between FF GRE and FF SE was assessed using Lin's concordance correlation coefficient (ρ c ). Vertebral lesions ( n = 41) were categorized as benign and malignant, and the Mann-Whitney U test was used for comparison. Results: FF GRE demonstrated strong positive correlations with FF SE and the VBQ score ( r = 0.861 and 0.708, respectively). However, the concordance between FF GRE and FF SE was poor (ρ c = 0.295). All measurements moderately correlated with age (FF GRE , r = 0.583; FF SE , r = 0.477; VBQ score, r = 0.468). FF was significantly higher in benign lesions (FF GRE , p = 0.004; FF SE , p = 0.007), while the VBQ score did not show statistically significant differences between the two groups ( p = 0.089). Conclusions: FF GRE exhibited a high correlation with the VBQ score. FF SE showed a strong correlation with FF GRE , but replacing FF GRE with FF SE may be challenging. Both FF and the VBQ score moderately correlated with age. FF demonstrated statistically significant differences between benign and malignant lesions, while the VBQ score did not provide a distinguishable separation.

Background: Most studies focus solely on the relationship between parity and type 2 diabetes mellitus (T2DM) risk, providing limited insights into other contributing or protective factors. This study aims to explore the complex relationship between parity and T2DM risk, considering additional factors such as obesity, race, and body composition., Methods: This prospective cohort study used data from 242,159 women aged 40 to 69 from the UK Biobank, none of whom had T2DM at baseline. Multivariable Cox proportional hazard models were applied to assess the association between parity and T2DM. Subgroup analyses were performed based on body mass index (BMI), waist circumference (WC), and race., Results: The hazard ratio for T2DM per additional child was 1.16 (95% confidence interval, 1.13 to 1.16). Subgroup analysis revealed that Asian women and those with obesity or abdominal obesity had a higher risk of T2DM associated with multiparity. No increased risk was observed in women with normal BMI or WC. Mediation analysis showed that WC and BMI significantly mediated the parity-T2DM relationship, accounting for 49% and 38% of the effect, respectively., Conclusion: There is a clear positive association between multiparity and T2DM risk, particularly in Asian women and those with obesity. Maintaining normal BMI and WC appears to mitigate this risk, highlighting the importance of weight management for women at higher parity levels. These findings offer crucial insights for public health interventions aimed at reducing T2DM risk among women.

The genetic risk for hypertensive disorders of pregnancy is linked with the development of atherosclerotic cardiovascular disease. However, the effects of lifestyle and metabolic syndrome on atherosclerotic cardiovascular disease have not been evaluated. Here, we assess the long-term association between these factors and atherosclerotic cardiovascular disease in women with genetic risk for hypertensive disorders of pregnancy. We evaluate the genetic risk for hypertensive disorders of pregnancy using a genome-wide polygenic risk score derived from a large-scale GWAS. The incidence of atherosclerotic cardiovascular disease is evaluated according to genetic risk, lifestyle, and metabolic syndrome. Individuals with a very high genetic risk for hypertensive disorders of pregnancy have a 53.0% higher chance of developing atherosclerotic cardiovascular disease than those with a low genetic risk. However, the risk of developing atherosclerotic cardiovascular disease is reduced by up to 64.6% through the maintenance of an ideal metabolic syndrome status and a healthy lifestyle in the high genetic risk group (top 20%), and by up to 65.4% in the low genetic risk group (bottom 20%). These findings emphasize that maintaining a healthy lifestyle in women is equally effective at reducing the risk of atherosclerotic cardiovascular disease independent of genetic risk for hypertensive disorders of pregnancy., Competing Interests: Competing interests: The authors declare no competing interest., (© 2025. The Author(s).)

Purpose: Postoperative adhesions following thyroid surgery can lead to multiple complications that significantly impact quality of life. The use of an acellular dermal matrix (ADM) adhesion barrier device has been proposed as a potential solution to reduce the risk of such adhesions. This study aimed to evaluate the safety and anti-adhesive effect of an ADM in patients undergoing thyroid surgery., Methods: In this multicenter randomized controlled trial, patients undergoing thyroid surgery were randomly assigned to receive either ADM (n = 42) or no ADM (n = 39) during surgery. The primary outcome was the Swallowing Impairment Score (SIS-6), measured 6 weeks after surgery and compared between groups. Secondary outcomes included intergroup comparisons of the SIS-6, the Voice Handicap Index (VHI)-10, and the Glasgow-Edinburgh Throat Scale (GETS) at baseline, and 2, 6, and 18 weeks after surgery., Results: At week 6, the mean SIS-6 scores were 4.0 ± 4.1 and 3.3 ± 4.2 in the ADM and control groups, respectively, which was not significantly different. Both groups showed similar postoperative improvements in SIS-6, VHI-10, and GETS scores over time, without significant differences between groups at any time point, indicating that the ADM did not reduce the incidence of postoperative adhesions or alter the course of recovery compared to the control group., Conclusion: Although application of the ADM is safe for use in patients undergoing thyroid surgery, it did not produce a clinically significant advantage in preventing postoperative adhesions. Future research should focus on identifying specific patient populations or surgical scenarios where the use of the ADM may be beneficial., Competing Interests: Conflicts of Interest: This study's protocol and test devices were supported by a research grant from CGBio Co., Ltd. In Seongnam, Korea. Young Jun Chai, serving as an member of the Editorial Board of Annals of Surgical Treatment and Research, did not participate in the review process of this article. No other potential conflicts of interest pertinent to this article were reported., (Copyright © 2025, the Korean Surgical Society.)

Introduction: The inadequate efficacy of the Bacillus Calmette-Guérin (BCG) vaccine against adult pulmonary tuberculosis (TB) necessitates the development of new and effective vaccines. Human adenovirus serotype 5 (Ad5), which induces T-cell response, is a widely used viral vector. In this study, we aimed to evaluate the efficacy of a multi-antigenic recombinant Ad5 vectored vaccine and determine the optimal immunization route for enhanced immune response against Mycobacterium tuberculosis ., Methods: We constructed a multi-antigenic recombinant Ad5 vectored vaccine expressing four antigens (Ag85B-ESAT6-MPT64-Rv2660c) of M. tuberculosis (rAd-TB4), immunized with rAd-TB4 (5 × 10 7 infectious virus units/mouse) twice at an interval of 4 weeks starting at 10 weeks after BCG priming, and evaluated its boosting efficacy in a BCG-primed mouse model, and determined the optimal immunization route., Results: Compared with the BCG-only (2 × 10 5 colony forming units/mouse), subcutaneous injection of rAd-TB4 (1 × 10 7 infectious virus units/mL; two doses) elicited a T-cell response and cytokine production in lung lymphocytes and splenocytes. rAd-TB4 immunization significantly reduced bacterial loads and inflamed lung areas compared to BCG immunization ( p < 0.01) and protected against the H37Rv challenge performed at 17 weeks of BCG priming. RNA sequencing of the whole blood of rAd-TB4-vaccinated mice collected pre- and, 1 and 4 weeks post-infection, identified differentially expressed genes associated with immune and inflammatory responses, especially those in the Wnt signaling pathway., Conclusion: Our results indicate that rAd-TB4 immunization enhances the immune response to the vaccine boosting antigens in BCG-primed mice, making it a potential adult pulmonary TB vaccine candidate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Yun, Shin, Lee, Lee, Lee, Kim, Shin, Ha, Lee, Kim, Yoo and Jeong.)

Background: Previous studies have shown that weight change has a reverse J-shape association with all-cause mortality. However, its association with suicide mortality remains undetermined. In this study, we investigated the association between weight change and suicide mortality using a large-scale, population-based cohort from the Korean National Health Insurance Service database., Methods: A total of 2,103,525 subjects aged ≥ 20 years who underwent a general health screening program twice in the 2-year interval between 2007 and 2009 were included. Subjects were categorized into five groups according to the percent weight change during this period: severe weight loss (< - 15.0%), moderate weight loss (- 15.0 to < - 5.0%), weight stable (- 5.0 to < 5.0%), moderate weight gain (5.0 to < 15.0%), and severe weight gain (≥ 15.0%)., Results: During a median follow-up of 11.3 years, 6,179 cases (0.3%) of suicide mortality occurred. Weight change was associated with increased suicide mortality in a reverse J-shaped curve, even after adjustment for covariates. In particular, those with severe weight loss or gain showed 1.8-fold or 1.6-fold increased risk of suicide mortality, respectively. This reverse J-shaped association was consistently observed in subgroup analyses considering age, sex, depression, cancer, and BMI category., Conclusions: Moderate to severe weight change within a 2-year interval is associated with increased risk of suicide mortality. To better understand the mechanisms through which weight change affects suicide mortality, studies incorporating information on weight change intentions, medications, weight change-related medical conditions are needed., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of The Catholic University of Korea, St. Vincent’s Hospital (VC23ZISE0218), and informed consent was waived. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Suicide is a significant yet preventable public health issue. Body mass index (BMI) is a readily measurable indicator associated with various health outcomes. However, the relationship between BMI and suicidal death risk is complex and warrants further investigation, particularly within contemporary, non-Western contexts with consideration of potential confounders. The purpose of this study was to investigate the relationship between BMI and the risk of suicidal death., Methods: This study was nationwide, retrospective, observational study based on Korean National Health Insurance Service database. We analyzed 4,045,081 participants who were aged > 19 years and underwent national health surveillance in 2009. The participants were categorized according to their BMI (underweight: < 18.5 kg/m², normal weight: 18.5-23 kg/m², overweight: 23-25 kg/m², class I obesity: 25-30 kg/m², and class II obesity: > 30 kg/m²). The primary outcome was the death events caused by suicide which was defined by International Classification of Disorders (ICD-10) codes (X60-X84) and death records documented by the Korea National Statistical Office. Multivariate Cox proportional hazard regression analysis was performed to estimate the risk of suicidal death with respect to BMI categories after adjusting for potential confounders (age, sex, income, diabetes, hypertension, dyslipidemia, smoking, drinking, exercise, self-abuse, waist circumference, schizophrenia, bipolar disorder, eating disorder, cancer, anxiety, and substance use disorder)., Results: Underweight individuals had an increased risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.57) while overweight (HR 0.79, 95% CI 0.76-0.83), class I (HR 0.76, 95% CI 0.71-0.80) and class II obesity (HR 0.71, 95% CI 0.63-0.81) were associated with decreased risks of suicidal deaths compared to those of the normal weight individuals (BMI 18.5-23). This trend was consistent regardless of the presence of major depressive disorder (MDD) or the type of living arrangements of the participants., Conclusions: Suicidal death risk was inversely correlated with BMI categories, independent of MDD or living arrangements. Our data suggests the importance of physiological factors associated with body mass in understanding suicidal death risk. Furthermore, these data provide valuable insights to where the public health resources should be invested to reduce suicidal death rates., Competing Interests: Declarations. Ethics approval and consent to participate: Since the personal information of the participants was de-identified, the requirement for written informed consent was waived. This study was reviewed and approved by the Institutional Review Board of the Catholic University of Korea (no. KC23ZISI0809). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background/Objectives: This study investigated the diagnostic capabilities of two AI-based tools, M4CXR (research-only version) and ChatGPT-4o, in chest X-ray interpretation. M4CXR is a specialized cloud-based system using advanced large language models (LLMs) for generating comprehensive radiology reports, while ChatGPT, built on the GPT-4 architecture, offers potential in settings with limited radiological expertise. Methods: This study evaluated 826 anonymized chest X-ray images from Inha University Hospital. Two experienced radiologists independently assessed the performance of M4CXR and ChatGPT across multiple diagnostic parameters. The evaluation focused on diagnostic accuracy, false findings, location accuracy, count accuracy, and the presence of hallucinations. Interobserver agreement was quantified using Cohen's kappa coefficient. Results: M4CXR consistently demonstrated superior performance compared to ChatGPT across all evaluation metrics. For diagnostic accuracy, M4CXR achieved approximately 60-62% acceptability ratings compared to ChatGPT's 42-45%. Both systems showed high interobserver agreement rates, with M4CXR generally displaying stronger consistency. Notably, M4CXR showed better performance in anatomical localization (76-77.5% accuracy) compared to ChatGPT (36-36.5%) and demonstrated fewer instances of hallucination. Conclusions: The findings highlight the complementary potential of these AI technologies in medical diagnostics. While M4CXR shows stronger performance in specialized radiological analysis, the integration of both systems could potentially optimize diagnostic workflows. This study emphasizes the role of AI in augmenting human expertise rather than replacing it, suggesting that a combined approach leveraging both AI capabilities and clinical judgment could enhance patient care outcomes.

Objectives: To evaluate whether the application of deep learning (DL) could achieve high diagnostic accuracy in differentiating between green colour coding, indicative of tophi, and clumpy artifacts observed in dual-energy computed tomography (DECT) scans., Methods: A comprehensive analysis of 18 704 regions of interest (ROIs) extracted from green foci in DECT scans obtained from 47 patients with gout and 27 gout-free controls was performed. The ROIs were categorized into three size groups: small, medium, and large. Convolutional neural network (CNN) analysis on a per-lesion basis and support vector machine (SVM) analysis on a per-patient basis were performed. The area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of the models were compared., Results: For small ROIs, the sensitivity and specificity of the CNN model were 81.5% and 96.1%, respectively; for medium ROIs, 82.7% and 96.1%, respectively; for large ROIs, 91.8% and 86.9%, respectively. Additionally, the DL algorithm exhibited accuracies of 88.5%, 88.6%, and 91.0% for small, medium, and large ROIs, respectively. In the per-patient analysis, the SVM approach demonstrated a sensitivity of 87.2%, a specificity of 100%, and an accuracy of 91.8% in distinguishing between patients with gout and gout-free controls., Conclusion: Our study demonstrates the effectiveness of the DL algorithm in differentiating between green colour coding indicative of crystal deposition and clumpy artifacts in DECT scans. With high sensitivity, specificity, and accuracy, the utilization of DL in DECT for diagnosing gout enables precise lesion classification, facilitating early-stage diagnosis and promoting timely intervention approaches., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

As Bacille Calmette-Guérin (BCG) vaccine's effectiveness is limited to only children, the development of new tuberculosis (TB) vaccines is being studied using several platforms, and a novel TB vaccine that overcomes this limitation is required. In this study, we designed an effective multi-epitope vaccine against Mycobacterium tuberculosis using immunoinformatic analysis. First, we selected 11 highly antigenic proteins based on previous research: Ag85A, Ag85B, Ag85C, ESAT-6, MPT64, Rv2660c, TB10.4, HspX, GlfT2, Fas, and IniB. Among these antigens, 10 linear B-cell epitopes, 9 helper T-cell epitopes, and 16 cytotoxic T-cell epitopes were predicted to design the multi-epitope vaccine. To improve the immunogenicity of the candidate vaccine, three different adjuvants, griselimycin, human beta-defensin 3 (HBD3), and 50s ribosomal protein (50sRP), were attached with linker sequences to the vaccine model. The immunogenic, antigenic, allergenic, and physicochemical properties of the resulting designed multi-epitope vaccines were predicted in silico . Moreover, 3D structural modeling, refinement, and validation were used to select a model for further evaluation. Molecular docking analysis revealed a consistent and significant binding affinity of the candidate vaccine for toll-like receptors (TLRs), TLR-2, -3, and -4. Immune simulation performed using C-ImmSim demonstrated that three rounds of immunization with multi-epitope vaccines induced a high production of cytokines and immunoglobulins related with both cellular and humoral immune response. Moreover, we constructed vaccine candidate composed of 50sRP and evaluated its immunogenicity in a mouse model. Consequently, this in silico -engineered multi-epitope structure can elicit adaptive immune responses and represents a promising novel candidate for TB vaccine development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yun, Kim, Kim, Shin, Ha, Kim and Jeong.)

Quasi-2D layered halide perovskites (quasi-2DLPs) have emerged as promising materials for photovoltaic (PV) applications owing to their advantageous bandgap for absorbing visible light and the improved stability they enable. Their charge transport mechanism is heavily influenced by the grain orientation of their crystals as well as their nanostructures, such as grain boundaries (GBs) and edge states─the formation of which is inevitable in polycrystalline quasi-2DLP thin films. Despite their importance, the impact of these features on charge transport remains unexplored. In this study, we conduct a detailed investigation on polycrystalline quasi-2DLP thin films and devices, carefully analyzing how grain orientation and nanostructures influence charge transport. Employing nondestructive atomic force microscopy (AFM) topography, along with transient absorption spectroscopy (TAS) and grazing-incidence wide-angle X-ray scattering (GIWAXS), we obtained significant insights regarding the phase purity, crystallographic information, and morphologies of these films. Moreover, our systematic investigation using AFM-based techniques, including Kelvin probe force microscopy (KPFM) and conductive AFM (c-AFM), elucidates the roles played by GBs and edge states in shaping charge transport behavior. In particular, the local band structure along the GBs and edge states within both vertical and parallel grains was found to selectively repel electrons and holes, thus facilitating charge carrier separation. These findings provide perspectives for the development of high-performance quasi-2DLP PV devices and highlight potential approaches that can leverage the intrinsic properties of quasi-2DLPs to advance the performance of perovskite solar cells.

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease significantly impacting global health. Early and accurate diagnosis is crucial for effective management, but traditional methods often rely on subjective assessments. This study evaluates the efficacy of a deep learning model implemented through a no-code AI platform for diagnosing and grading knee OA from plain radiographs. Methods: We utilized the Osteoarthritis Initiative (OAI) dataset, comprising knee X-ray data from 1526 patients. The data were split into training (47.0%), validation (26.5%), and test (26.5%) sets. We employed a ResNet101 model on the DEEP:PHI no-code AI platform for image analysis. The model was trained to classify knee OA into five grades (0-4) based on the Kellgren-Lawrence scale. Results: Our AI model demonstrated high accuracy in distinguishing between different OA grades, with particular strength in early-stage detection. The model achieved optimal performance at 20 epochs, suggesting efficient learning dynamics. Grad-CAM visualizations were used to enhance the interpretability of the model's decision-making process. Conclusions: This study demonstrates the potential of AI, implemented through a no-code platform, to accurately diagnose and grade knee OA from radiographs. The use of a no-code AI platform such as DEEP:PHI represents a step towards democratizing AI in healthcare, enabling the rapid development and deployment of sophisticated medical AI applications without extensive coding expertise. This approach could significantly enhance the early detection and management of knee OA, potentially improving patient outcomes and streamlining clinical workflows.

Aims: The rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database., Methods: A total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model., Results: During a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18-1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA., Conclusions: The elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Genetic testing is recommended for all patients with pheochromocytomas and paragangliomas (PPGL) to establish genotype-phenotype associations. We investigated germline mutations in 59 patients with PPGL at six Korean university hospitals using next-generation sequencing (NGS) targeting 38 PPGL-associated genes, including those recommended by the Korean PPGL Task Force. Germline mutations were identified in 13 patients (22%), and affected four genes: RET , NF1 , VHL , and SDHD . Germline mutations were significantly associated with a family history of PPGL, smaller tumor size, and the presence of other types of tumors. Using 95 Korean PPGL cases with germline mutations identified through a literature review and 13 cases from our cohort, we characterized genotype-phenotype correlations. Mutation hotspots were identified in specific codons of RET (codons 631 and 634), VHL (157 and 167), and SDHB (131 and 253). NF1 mutations varied, indicating the absence of common hotspots. These findings highlight the efficacy of the recommended NGS panel for Korean patients with PPGL and the importance of genetic testing in establishing clinical management and personalized therapeutic strategies.

Objective: Recent studies have reported that gout is associated with a risk of cardiovascular disease (CVD) later in life. However, the predictive value of genetic predisposition to gout combined with lifestyle habits for CVD risk remains unclear. This study aimed to examine the association between genetic predisposition to gout and lifestyle habits and the risk of developing CVD in two diverse prospective cohorts from different ancestries., Methods: A total of 224 689 participants of European descent from the UK Biobank and 50 364 participants of East Asian descent from the Korean Genome and Epidemiology Study were included. The genetic risk for gout was assessed using a polygenic risk score (PRS) derived from a meta-genome-wide association study (n=444 533). The incident CVD risk was evaluated according to genetic risk, lifestyle and metabolic syndrome (MetS)., Results: Individuals at high genetic risk for gout had a higher risk of incident CVD than those with low genetic risk across ancestry. Notably, a reduction in CVD risk by up to 62% (HR 0.38; 95% CI 0.31 to 0.46; p <0.001) was observed in individuals at both low and high genetic risk for gout when they maintained ideal MetS and favourable lifestyle habits., Conclusions: Our findings indicate that a higher genetic risk of gout is significantly associated with an increased risk of CVD. Moreover, adherence to a favourable lifestyle can significantly reduce CVD risk, particularly in individuals with high genetic risk. These results underscore the potential of PRS-based risk assessment to improve clinical outcomes through tailored preventative strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Reducing non-radiative recombination and addressing band alignment mismatches at interfaces remain major challenges in achieving high-performance wide-bandgap perovskite solar cells. This study proposes the self-organization of a thin two-dimensional (2D) perovskite BA 2 PbBr 4 layer beneath a wide-bandgap three-dimensional (3D) perovskite Cs 0.17 FA 0.83 Pb(I 0.6 Br 0.4 ) 3 , forming a 2D/3D bilayer structure on a tin oxide (SnO 2 ) layer. This process is driven by interactions between the oxygen vacancies on the SnO 2 surface and hydrogen atoms of the n-butylammonium cation, aiding the self-assembly of the BA 2 PbBr 4 2D layer. The 2D perovskite acts as a tunneling layer between SnO 2 and the 3D perovskite, neutralizing the energy level mismatch and reducing non-radiative recombination. This results in high power conversion efficiencies of 21.54% and 19.16% for wide-bandgap perovskite solar cells with bandgaps of 1.7 and 1.8 eV, with open-circuit voltages over 1.3 V under 1-Sun illumination. Furthermore, an impressive efficiency of over 43% is achieved under indoor conditions, specifically under 200 lux white light-emitting diode light, yielding an output voltage exceeding 1 V. The device also demonstrates enhanced stability, lasting up to 1,200 hours., (© 2024 The Author(s). Advanced Materials published by Wiley‐VCH GmbH.)

Scanning probe microscopy (SPM) has enabled significant new insights into the nanoscale and microscale properties of solar cell materials and underlying working principles of photovoltaic and optoelectronic technology. Various SPM modes, including atomic force microscopy, Kelvin probe force microscopy, conductive atomic force microscopy, piezoresponse force microscopy, and scanning near-field optical microscopy, can be used for the investigation of electrical, optical and chemical properties of associated functional materials. A large body of work has improved the understanding of solar cell device processing and synthesis in close synergy with SPM investigations in recent years. This review provides an overview of SPM measurement capabilities and attainable insight with a focus on recently widely investigated halide perovskite materials., (© 2024 The Author(s). Advanced Materials published by Wiley‐VCH GmbH.)

Although rare, radiotherapy can induce secondary malignancies, such as radiation-induced angiosarcoma (RIAS), which is associated with a poor prognosis. Early detection is crucial for improving outcomes. The modified Cahan criteria are instrumental in diagnosing RIAS, which is ultimately confirmed through histological examination. We present a case of a middle-aged woman who developed RIAS after undergoing radiotherapy post-surgery and adjuvant chemotherapy for right-sided breast cancer. The patient presented with a rapidly reaccumulating right-sided pleural effusion, and RIAS was confirmed through pleural biopsy and aspirate. This case report highlights the pathway for establishing a diagnosis of RIAS and the need for early detection through clinical examination and surveillance imaging for patients following radiotherapy., Competing Interests: None declared., (© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Solitary fibrous tumors (SFTs) are rare neoplasms arising from mesenchymal cells. Although most SFTs are benign, rare cases of metastasis have been reported at various sites. Complete surgical resection is the mainstay of treatment for both primary and recurrent or metastatic SFTs. Herein, we present a case of an SFT initially identified in the anterior mediastinum that later developed multiple metastases, even to the thyroid gland. The patient underwent repeated surgical resection and is currently being followed up in an outpatient setting.

Objective: This study aimed to evaluate the prevalence of urinary incontinence (UI) and its associated risk factors among pregnant Korean women, as UI significantly impacts their quality of life., Methods: A cross-sectional study involving singleton pregnant women was conducted between April and December 2023. Data were collected using a questionnaire assessing demographic information and UI symptoms. The International Consultation on Incontinence Questionnaire-UI short form was used to diagnose UI., Results: A total of 824 pregnant women from three centers participated, with an overall prenatal UI prevalence of 40.2% (331/824). Stress UI was most common (77.1%), followed by mixed UI (16.9%), and urgency UI (6.0%). Risk factors for UI included prior delivery mode, specifically vaginal delivery (adjusted odds ratio [aOR], 5.61; 95% confidence interval [CI], 1.40-22.50; P=0.015) and combined vaginal and cesarean delivery (aOR, 23.14; 95% CI, 1.77-302.74; P=0.017). Additionally, second trimester (aOR, 1.99; 95% CI, 1.19-3.32; P=0.009) and third trimester (aOR, 4.44; 95% CI, 2.65-7.40; P<0.001) were associated with increased UI risk. Conversely, drinking alcohol before pregnancy was a protective factor (aOR, 0.72; 95% CI, 0.53-0.99; P=0.046)., Conclusion: Approximately 40% of Korean pregnant women experience prenatal UI. Prior delivery mode and advanced gastrointestinal age are significant risk factors. Further research with postpartum and long-term follow-ups is needed.

Genomic alterations in tumors play a pivotal role in determining their clinical trajectory and responsiveness to treatment. Targeted panel sequencing (TPS) has served as a key clinical tool over the past decade, but advancements in sequencing costs and bioinformatics have now made whole-genome sequencing (WGS) a feasible single-assay approach for almost all cancer genomes in clinical settings. This paper reports on the findings of a prospective, single-center study exploring the real-world clinical utility of WGS (tumor and matched normal tissues) and has two primary objectives: (1) assessing actionability for therapeutic options and (2) providing clarity for clinical questions. Of the 120 patients with various solid cancers who were enrolled, 95 (79%) successfully received genomic reports within a median of 11 working days from sampling to reporting. Analysis of these 95 WGS reports revealed that 72% (68/95) yielded clinically relevant insights, with 69% (55/79) pertaining to therapeutic actionability and 81% (13/16) pertaining to clinical clarity. These benefits include the selection of informed therapeutics and/or active clinical trials based on the identification of driver mutations, tumor mutational burden (TMB) and mutational signatures, pathogenic germline variants that warrant genetic counseling, and information helpful for inferring cancer origin. Our findings highlight the potential of WGS as a comprehensive tool in precision oncology and suggests that it should be integrated into routine clinical practice to provide a complete image of the genomic landscape to enable tailored cancer management., (© 2024. The Author(s).)

The exposure of workers to propylene glycol monomethyl ether acetate (PGMEA) in manufacturing environments can result in potential health risks. Therefore, systems for PGMEA removal are required for indoor air quality control. In this study, core-shell zeolite socony mobil-5 (ZSM-5)/polyvinylpyrrolidone-polyvinylidene fluoride nanofibers were directly electrospun and partially wet-etched on a mesh substrate to develop a cover-free compact PGMEA air filter. The electrospinning behaviors of the core-shell nanofibers were investigated to optimize the electrospinning time and humidity and to enable the manufacture of thin and light air-filter layers. The partial wet etching of the nanofibers was undertaken using different etching solvents and times to ensure the exposure of the active sites of ZSM-5. The performances of the ZSM-5/PVDF nanofiber air filters were assessed by measuring five consecutive PGMEA adsorption-desorption cycles at different desorption temperatures. The synthesized material remained stable upon repeated adsorption-desorption cycles and could be regenerated at a low desorption temperature (80 °C), demonstrating a consistent adsorption performance upon prolonged adsorption-desorption cycling and low energy consumption during regeneration. The results of this study provide new insights into the design of industrial air filters using functional ceramic/polymer nanofibers and the application of these filters.

Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.

Aims: Gout is associated with a significant burden of cardiovascular disease. The aim of this study was to evaluate the impact of a favorable lifestyle on incident cardiovascular events in patients with gout., Methods: We identified 9 110 patients with gout from the UK Biobank cohort based on self-report and/or hospital diagnostic codes. Lifestyle behaviors, including smoking status, physical activity, obesity, and diet, were categorized into three patterns: favorable (3-4 healthy factors), intermediate (2 healthy factors), and unfavorable (0-1 healthy factor). The cardiovascular risk of participants with and without gout was estimated based on their serum uric acid levels and lifestyle patterns., Results: Among 9 110 patients with gout and 457 596 participants without gout, the median follow-up duration was 8.9 years. The incidence rate of cardiovascular disease was significantly higher in the gout population than in the non-gout population (11.38 vs 5.49 per 1000 person-years). The gout population consistently exhibited a high cardiovascular risk, irrespective of uric acid levels, whereas a positive correlation was observed between uric acid levels and cardiovascular risk in the non-gout population. Adopting a favorable lifestyle pattern was associated with a lower risk of cardiovascular disease in both gout and non-gout populations. Across all categories of uric acid, a favorable lifestyle was found to reduce cardiovascular risk in patients with gout., Conclusion: Patients with gout remain at high risk of developing cardiovascular disease despite having normal uric acid levels. Lifestyle modifications may represent an effective and cost-efficient therapeutic approach for preventing cardiovascular events in this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background and Objectives : Despite high incidences of cognitive impairment with aging, evidence on the prevalence and the seriousness of drug-induced cognitive impairment is limited. This study aims to evaluate the prevalence and the severity of drug-induced cognitive impairment and to investigate the clinical predictors of increased hospitalization risk from serious drug-induced cognitive impairment. Materials and Methods : Adverse drug events (ADEs) regarding drug-induced cognitive impairment reported to the Korean Adverse Event Reporting System Database (KAERS DB) from January 2012 to December 2021 were included (KIDS KAERS DB 2212A0073). The association between the etiologic classes and the reporting serious adverse events (SAEs) was evaluated using disproportionality analysis, and the effect was estimated with reporting odds ratio (ROR). Clinical predictors associated with increased risk of hospitalization from SAEs were identified via multivariate logistic analysis, and the effect was estimated with odds ratio (OR). Results : The most etiologic medication class for drug-induced cognitive impairment ADEs was analgesics, followed by sedative-hypnotics. Anticancer (ROR 57.105, 95% CI 15.174-214.909) and anti-Parkinson agents (ROR 4.057, 95% CI 1.121-14.688) were more likely to report serious drug-induced cognitive impairments. Male sex (OR 19.540, 95% CI 2.440-156.647) and cancer diagnosis (OR 18.115, 95% CI 3.246-101.101) are the major clinical predictors for increased risk of hospitalizations due to serious drug-induced cognitive impairment. Conclusions : This study highlights the significant prevalence and severity of drug-induced cognitive impairment with cancer diagnosis and anticancer agents. However, further large-scaled studies are required because of the potential underreporting of drug-induced cognitive impairments in real practice settings, which is further contributed to by the complexity of multiple contributing factors such as comorbidities.