CHA Bundang Medical Center

This study aims to identify the optimal postnatal weight gain through age 6 to prevent obesity in preterm infants. Nested case-control study using a nationwide South Korean cohort (2008–2015) included preterm infants with obesity (cases) and those with BMI between the 5th–85th percentiles (controls) at age 6. Weight-for-age and BMI z-scores were compared using Cohen’s d. Logistic regression identified obesity risk factors, and net benefit analysis determined optimal intervention points by birth weight. Among 41,286 preterm infants, 3349 (8.1%) developed obesity. Birth weight z-score differences between cohorts were small (Cohen’s d = 0.115), but differences in weight-for-age z-scores emerged at 4–6 months (Cohen’s d = 0.474) and grew over time (3 years: Cohen’s d = 1.278). Risk factors included low gestational age, high birth weight, rural residence, lower socioeconomic status, and recent birth. Higher z-scores correlated with greater net benefit, with extremely low birth weight infants showing earlier increases. In conclusion, a rapid increase in z-scores from 4 to 6 months was strongly linked to obesity at 6 years. Optimal predictive values varied by birth weight, emphasizing the need for early monitoring and tailored cut-off values for z-scores based on corrected age to prevent obesity.

Survival outcomes for infants born at 22–23 weeks’ gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22–23 weeks’ gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care—including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration—was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49–0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22–23 weeks’ gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28428-1.

Hepatocellular carcinoma (HCC), the common liver cancer, exhibits higher incidence in males. Here, we report that mice lacking bile acid (BA) regulators, Farnesoid X Receptor (FXR also termed NR1H4) and Small Heterodimer Partner (SHP also termed NR0B2), recapitulate the sex difference in liver cancer risk. Since few therapeutic options are available, we focused on understanding the intrinsic protection afforded to female livers. Transcriptomic analysis in control and NR1H4 and NR0B2 double knockout livers identified female-specific changes in metabolism, including amino acids, lipids, and steroids. To assess translational relevance, we examined if transcriptomic signatures obtained from this murine HCC model correlate with survival outcomes for HCC patients. Gene signatures unique to the knockout females correspond with low-grade tumors and better survival. Ovariectomy blunts the metabolic changes and promotes liver tumorigenesis in females that, intriguingly, coincides with increased serum bile acid (BA) levels. Despite similar genetics, knockout male mice displayed higher serum BA concentrations, while female knockouts excreted more BAs. Decreasing enterohepatic BA recirculation using cholestyramine, an FDA-approved resin, dramatically reduced the liver cancer burden in male mice. Overall, we reveal that sex-specific BA metabolism leading to lower circulating BA concentration protects female livers from developing cancer. Thus, targeting BA excretion may be a promising therapeutic strategy against HCC.

<title>Abstract</title> Background Aminosalicylates (mesalazine, sulfasalazine) are used for mild Crohn’s disease, but real‑world comparative data are limited. Aim To compare the time to initiation of corticosteroids or immunosuppressants in Korean patients with Crohn’s disease treated with mesalazine versus sulfasalazine. Methods We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database from 2002 to 2022. Adults with Crohn’s disease who received mesalazine or sulfasalazine for more than 30 days were included. The primary outcome was the interval from aminosalicylate initiation to first corticosteroid or immunosuppressant prescription. Demographic and clinical variables were analysed, and multivariable Cox regression identified predictors of treatment escalation. Results Of 18,288 eligible patients, 17,217 (94.1%) received mesalazine and 1,071 (5.9%) received sulfasalazine. Mesalazine prescribing increased from 79.3% in 2002 to 98.9% in 2022, whereas sulfasalazine decreased from 20.7% to 1.1%. Median time to corticosteroid or immunosuppressant initiation was shorter with mesalazine (72.3 days) than with sulfasalazine (100.7 days; <italic>P</italic> = 0.0089). Earlier escalation was associated with male sex, younger age, metropolitan residence, and absence of hypertension or cerebrovascular disease. Conclusions In this nationwide cohort, mesalazine was the predominant aminosalicylate and was associated with earlier treatment escalation than sulfasalazine, alongside marked shifts in prescribing patterns over two decades. These findings describe real‑world associations from administrative data and may inform, but cannot determine, comparative effectiveness between aminosalicylate formulations.

Abstract Background This study aimed to describe the health-related quality of life of Korean patients with cervical cancer using the EuroQol of life five-dimensional five-level (EQ-5D-5L) index and to identify sociodemographic, clinical, and symptom-related factors that significantly influence their health-related quality of life. Methods A multicenter survey of 230 Korean patients was conducted between August 2023 and February 2024. health-related quality of life was assessed using the EQ-5D-5L. Non-parametric tests were used to compare health-related quality of life distributions, and regression analyses were used to identify the influencing factors. Results The average EQ-5D-5L index score for health-related quality of life was 0.85. Multiple regression analysis incorporating all candidate variables simultaneously explained 71.4% of the variance in health-related quality of life (R² = 0.689). Independent negative predictors of health-related quality of life included advanced FIGO stage—specifically stage II (β = − 0.17, P &lt; 0.001) and stage IV (β = − 0.12, P = 0.024), chemotherapy alone within one year (β = − 0.22, P = 0.026), and presence of dyspnea symptoms (β = − 0.05, P = 0.037). Conversely, living in households with two or more members was independently associated with better health-related quality of life (β = 0.10, P = 0.045). Conclusion Our results demonstrate that cervical cancer significantly impairs health-related quality of life compared with the general population, with advanced cancer stage, chemotherapy, and dyspnea symptoms being major independent negative predictors. Sociodemographic factors, particularly household composition, also play a significant role in patient well-being. These findings highlight the importance of incorporating patient-centered supportive care into cancer management, especially for those with advanced disease or those undergoing chemotherapy, to mitigate the symptom burden and improve the overall quality of life.

The mechanisms underlying gait function recovery in stroke remain uncertain. Biomechanical gait analysis has emerged as a promising approach to address this gap, offering essential information for developing tailored gait rehabilitation strategies in patients with stroke. However, few studies have investigated the gait biomechanics of dependent stroke ambulators, particularly for patients classified as level 3 in the Functional Ambulation Category (FAC), which refers to the ability to walk on a level surface under supervision. This prospective observational study recruited twelve patients with chronic stroke with an onset duration of more than six months, along with six healthy adults. The patients with stroke were grouped into FAC level 3 (N.=6) or FAC level 4 (N.=6) based on their level of independence. All participants performed level walking along a 7-meter walkway while three-dimensional motion capture was used to assess gait biomechanics. Seven functional assessments, including the Berg Balance Scale and Trunk Impairment Scale, were also conducted in patients with stroke. The Kruskal-Wallis test and one-way analysis of variance were used to compare gait parameters among groups, followed by Mann-Whitney and independent t-tests for post-hoc analyses. Both stroke groups showed significant differences in biomechanical parameters compared to the healthy group (p < 0.05). Compared to the FAC 4 group, the FAC 3 group exhibited significantly lower peak posterior ground reaction force on the affected side (p = 0.002); reduced hip range of motion (p = 0.047) and peak hip flexion moment (p = 0.044), and maximum knee flexion angle on the unaffected side (p = 0.026). Compared to the healthy group, the FAC 3 group demonstrated significantly reduced ankle range of motion on the affected side (p = 0.021), and lower maximum hip extension angle (p = 0.011), lower peak hip extension moment (p = 0.031) and peak ankle dorsiflexion moment lower maximum hip extension angle (p = 0.004) on the unaffected side, while no differences were observed between the FAC 4 and healthy groups (p > 0.05). Significant differences in biomechanical parameters, particularly those related to eccentric contraction in the proximal joints of the unaffected side, were observed between FAC 3 and FAC 4 groups. These disparities highlight the need for tailored gait rehabilitation strategies based on ambulation level. Clinical Trial No. NCT05908994, Date of registration: 23/05/2023.

BackgroundImportance: The neurodevelopmental outcomes of children born after medically assisted reproduction remain incompletely characterized on a population level. We were to assess the incidence and relative risk of neurodevelopmental delay in the children of infertile women born after unassisted conception, intrauterine insemination (IUI), and in vitro fertilization (IVF).MethodWe conducted a retrospective cohort study using the National Health Insurance Service database of South Korea from October 2017 through December 2023. The study included 115 839 singleton, full-term, non–low–birthweight children born to women aged 20–49 years with a diagnosis of female infertility. The exposure was mode of conception—spontaneous, IUI, or IVF—balanced by propensity score matching on preconceptional maternal factors. Outcome measure was neurodevelopmental delay, defined as scoring below the cutoff in any of six functional domains on the Korean Developmental Screening Test across six consecutive rounds. Crude incidence rate ratios (IRRs) and adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models.ResultsAmong 115 839 children, 6 575 (5.7%) exhibited delay in at least one domain. Crude IRRs for any delay were 1.19 (95% confidence interval [CI]: 1.07, 1.61) for IUI and 1.10 (95% CI: 1.03, 1.17) for IVF versus unassisted conception. In the survival models, higher risks persisted for both IUI (aHR = 1.19; 95% CI: 1.06, 1.34) and IVF (1.09, 95% CI: 1.02, 1.06) compared with unassisted conception. When comparing IVF and IUI, IVF conferred a lower risk of fine motor delay than IUI (0.84, 95% CI: 0.72, 0.99). Among IVF births, risk of developmental delay was similar across all six domains for frozen and fresh embryo transfers.ConclusionsChildren conceived via IUI or IVF demonstrated a modest but significant increase in screen-positive neurodevelopmental delay compared with those conceived spontaneously. These findings highlight the need for neurodevelopmental monitoring in this population.Supplementary InformationThe online version contains supplementary material available at 10.1186/s11689-025-09658-w.

The supraclavicular lateral incision approach offers a promising alternative to the conventional median incision in thyroid surgery, prioritizing cosmetic outcomes and quality of life (QoL) without compromising safety. This study evaluated its efficacy and impact on thyroid-specific QoL in patients undergoing thyroid lobectomy for unilateral papillary thyroid carcinoma (PTC). A prospective, nonrandomized study was conducted on 197 PTC patients, including 98 treated with the supraclavicular approach and 99 with the conventional approach. Demographic, clinicopathologic, operative, and postoperative data were collected. Cosmetic satisfaction was assessed at six months post-surgery using visual analog scales, while thyroid-specific QoL was evaluated with the validated T-QoL questionnaire. Statistical analyses compared outcomes between the two groups. Both approaches achieved comparable surgical outcomes, with no significant differences in operation time, blood loss, or complication rates. The supraclavicular approach demonstrated superior cosmetic satisfaction scores for incision scars (median 9 vs. 6, P = 0.001). Although overall T-QoL scores were similar, psychological well-being was significantly better in the supraclavicular group (P = 0.036), with a trend toward improved social well-being (P = 0.066). No recurrences were observed during a median follow-up of 28months. The supraclavicular lateral incision approach offers enhanced cosmetic outcomes and mitigates QoL decline without increasing surgical risks. It serves as a feasible, cost-effective alternative to conventional and remote-access techniques, aligning with contemporary trends in minimally invasive thyroid surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .