Dankook University Hospital

BackgroundThe clinical and prognostic implications of asymptomatic tuberculosis remain poorly understood.MethodsWe conducted a multicentre prospective cohort study to evaluate the association between asymptomatic tuberculosis (TB) and treatment outcomes. Individuals with rifampicin-susceptible pulmonary TB were enrolled from the Cohort Study of Pulmonary Tuberculosis. Asymptomatic TB was defined as the absence of any TB-related symptoms at diagnosis. The primary outcome was a favourable outcome, defined as treatment success without recurrence. Multivariable logistic regression models were used to assess associations between asymptomatic TB and favourable outcomes. The Cox proportional hazards model was applied to evaluate effect of asymptomatic TB on failure to complete treatment within 1 year. Stratified analyses by symptom status and mode of detection were performed to examine stratum-specific effects.ResultsOf 1071 individuals with pulmonary TB, 32.7% were asymptomatic. Compared to symptomatic patients, asymptomatic individuals were younger, less likely to be underweight and more often diagnosed through population health screening rather than clinical presentation or opportunistic testing. Asymptomatic TB was associated with higher likelihood of favourable outcome in multivariable models (adjusted odds ratio (aOR) 1.50, 95% CI 1.04–2.20) and a reduced risk of failing to complete treatment within one year in survival analyses (adjusted hazard ratio 0.66, 95% CI 0.45–0.95). Asymptomatic TB detected through health screening had the most favourable outcomes (aOR 2.41, 95% CI 1.34–4.66).ConclusionAsymptomatic TB was significantly associated with treatment success without recurrence and particularly in patients identified through health screening. Our results support symptom-agnostic screening in TB control programmes.

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.

Objective: This in vitro study aimed to compare changes in tooth lightness following repeated application of a whitening toothpaste and a whitening gel containing different concentrations of hydrogen peroxide.Methods: Ninety enamel specimens were prepared from extracted bovine incisors and artificially stained using black tea.The specimens were randomly allocated into three groups: a negative control group using a general toothpaste, a positive control group using a whitening toothpaste containing 0.75% hydrogen peroxide, and an experimental group using a whitening gel containing 2.8% hydrogen peroxide (n=30 per group).Each whitening agent was mixed with distilled water at a 1:2 ratio and applied by tooth brushing three times daily for 15 seconds over a 30-day period.Tooth color was measured at baseline and at 3-day intervals using a dental spectrophotometer (VITA Easyshade Advance V) based on the VITA classical A1-D4 and VITA SYSTEM 3D-MASTER shade systems.Data were analyzed using one-way ANOVA and paired t-tests.Results: Both hydrogen peroxide-containing whitening products demonstrated significantly greater improvements in tooth lightness compared with the general toothpaste (p<0.05).Significant intergroup differences were observed between the negative control group and the hydrogen peroxide-containing groups; however, no statistically significant differences were found between the whitening toothpaste and the whitening gel throughout the experimental period (p0.05). Conclusion:Hydrogen peroxide-containing over-the-counter whitening products were effective in improving tooth lightness compared with a conventional toothpaste.However, differences in hydrogen peroxide concentration and formulation did not result in significant differences in whitening efficacy under the experimental conditions used in this study.

This study aimed to assess how the anteroposterior position of the miniscrew-assisted rapid palatal expansion (MARPE) appliance influences maxillary skeletal expansion and to propose a reference point for optimal placement. Thirty-two skeletally mature patients treated with MARPE were retrospectively assigned to an anterior group (anterior miniscrews ≥ 5 mm anterior to the centre of the maxilla (CM)) or a posterior group (≤ 2 mm from or posterior to CM). Pre- and post-expansion cone-beam computed tomography scans were used to measure skeletal, dental, and paramaxillary changes. Independent t-tests following data normality, linear regression with validated model assumptions, and Bayesian mediation analyses evaluated direct and indirect effects of appliance position and bicortical engagement. The anteroposterior appliance position significantly affected expansion outcomes. Posterior placement yielded greater skeletal expansion and a more parallel pattern (p = 0.008), especially in the posterior maxilla (p = 0.001). Anterior positioning produced reduced skeletal effects and a V-shaped expansion (p = 0.001). Molar tipping increased both directly with anterior positioning (p = 0.002) and indirectly through reduced bicortical engagements. Miniscrew movement, indicating activation loss, was likewise indirectly mediated by fewer bicortical engagements (95% highest density interval: [-0.140, -0.009]). The posterior group exhibited significantly greater paramaxillary expansion, especially in the posterior regions of the jugale and zygoma (p = 0.011). Anteroposterior MARPE position significantly impacts skeletal expansion results. Positioning near or posterior to the centre of the maxilla point enhances parallel skeletal expansion and minimizes undesirable dental effects. This reference point can serve as a practical reference to optimize MARPE placement for mature patients.

BRCA1 is a tumor suppressor gene encoding a protein which plays an essential role in the repair of DNA double strand break. Approximately 40% of its introns are composed of Alu elements. It is known that retrotransposons create an environment prone to non-allelic recombination (NAHR) between homologous sequences, which frequently cause deletion or duplication of exon(s) resulting in structural variations in the gene. Some mutations can directly impact protein function by causing frameshifts, the deletion of key domains, and abnormal RNA processing, possibly increasing tumorigenicity. Indeed, large-scale BRCA1 rearrangements caused by Alu elements have been observed in approximately 10-15% of hereditary breast cancer patients, most notably deletions of exons 5 through 7. Occasionally, mutated exons are excluded from splicing, resulting in protein isoforms with a limited function, which may be associated with drug resistance during treatment. Tumors with BRCA1 mutations exhibit homologous recombination deficiency (HRD), resulting in high sensitivity to PARP inhibitors and platinum-based chemotherapy. However, in some tumors, gene function may be partially restored through subsequent secondary rearrangements, which can lead to long-term drug resistance, demanding continuous molecular surveillance. It has been difficult to detect mutations in the BRCA gene caused by Alu elements using conventional PCR-based analysis or short-read next-generation sequencing (NGS) technologies. However, the recent introduction of MLPA and long-read NGS technologies has significantly improved a detection rate of Alu-involved mutations in the BRCA gene. Advances in long-read sequencing technologies, such as Oxford Nanopore and PacBio, and in optical genome mapping tools provide the capability to analyze complex structural mutations. Furthermore, machine learning-based prediction tools, such as HRDetect and SVScore, have been developed to analyze genome-wide structural mutation patterns and HRD indicators more comprehensively, thereby contributing to the prediction of BRCA1/2 defects and treatment responses. The integration of these technologies is expected to enhance our comprehension of BRCA1-related structural mutations and serve as an important foundation for developing personalized treatment strategies for patients.

BackgroundThe COVID-19 pandemic has intensified mental health issues globally, highlighting the urgent need for remote mental health monitoring. Digital phenotyping using smart devices has emerged as a promising approach, but it remains unclear which features are essential for predicting depression and anxiety.ObjectiveThis study aimed to identify the types of features collected through smart packages—integrated systems combining smartphones with wearable devices such as Actiwatches, smart bands, and smartwatches—and to determine which features should be considered essential for mental health monitoring based on the type of device used.MethodsA systematic review was conducted. Searches were performed across Web of Science, PubMed, and Scopus on February 5, 2025. Inclusion criteria comprised quantitative studies involving adults (≥19 years) using smart devices to predict depression or anxiety based on passive data collection. Studies focusing solely on smartphones or qualitative designs were excluded. Risk of bias was assessed using the Mixed Methods Appraisal Tool and the Quality Criteria Checklist. Data were synthesized descriptively, and the relative contribution of each feature was further assessed by calculating coverage (proportion of studies using a feature) and importance among used (proportion identifying it as important when used). These metrics were visualized in quadrant-based scatter plots to identify consistently important features across devices.ResultsFrom 1382 records, 22 studies across 11 countries were included. The overall synthesis identified a core feature package—accelerometer, steps, heart rate (HR), and sleep. Device-specific analyses revealed further nuances: in Actiwatch studies, accelerometer and activity were consistently important, but sleep features were rarely examined. In smart band studies, HR, steps, sleep, and phone usage were essential, while GPS, electrodermal activity (EDA), and skin temperature showed high importance when used, suggesting opportunities for broader adoption. In smartwatch studies, sleep and HR emerged as core features, whereas steps and accelerometer were widely used but often not identified as important.ConclusionsThis systematic review identified a core feature package comprising accelerometer, steps, HR, and sleep that consistently contributes to mood disorder prediction across devices. At the same time, device-specific differences were observed: Actiwatch studies mainly emphasized accelerometer and activity but underused sleep features; smart bands highlighted HR, steps, sleep, and phone usage, with EDA, skin temperature, and GPS showing additional promise; and smartwatches most reliably leveraged sleep and HR, while steps and accelerometer were widely used yet less effective. These findings suggest that while a shared core set of features exists, optimizing digital phenotyping requires tailoring feature selection to the characteristics of each device type. To advance this field, improving data accessibility, particularly in smartwatch ecosystems, and adopting standardized reporting frameworks will be essential to enhance comparability, reproducibility, and future meta-analytic integration.

BackgroundHuman papillomavirus (HPV) independent cervical malignancies (HPV-IDCMs) have recently been classified by the World Health Organization (WHO) 5th edition. These malignancies have historically received limited attention due to their rarity and the potential for evasion of HPV-based screening.MethodsWe retrospectively reviewed 5,854 biopsy-confirmed cervical malignancies from 22 institutions over 3 years (July 2020–June 2023). Histologic classification followed the WHO guidelines. HPV independence was confirmed by dual negativity for p16 and HPV; discordant cases (p16-positive/HPV-negative) underwent additional HPV testing using paraffin-embedded tissue. Cytological results were matched sequentially to histological confirmation.ResultsThe prevalence of HPV-IDCM was 4.4% (257/5,854) overall and was 3.6% (208/5,805 cases) among primary cervical malignancy. Patient age of HPV-IDCM was 29 to 89 years (median, 57.79). Its histologic subtypes included primary adenocarcinoma (n = 116), endometrial adenocarcinoma (n = 35), squamous cell carcinoma (n = 72), metastatic carcinoma (n = 14), carcinoma, not otherwise specified (n = 10), neuroendocrine carcinoma (n = 3), and others (n = 7). Among 155 cytology-histological matched cases, the overall and primary Pap test detection rates were 85.2% (132/155) and 83.2% (104/125), respectively. The interval between cytology and histologic confirmation extended up to 38 months.ConclusionsHPV-IDCMs comprised 3.6% of primary cervical malignancies with a high detection rate via cytology (83.2%). These findings affirm the value of cytological screening, particularly in patients with limited screening history or at risk for HPV-independent lesions, and may guide future screening protocols.

Elderly patients with severe osteoporosis present significant challenges in managing multiple concomitant upper extremity fractures, especially when high-energy trauma is involved. The rarity of such cases necessitates a structured approach to achieve optimal outcomes, balancing surgical intervention and early rehabilitation. A 79-year-old woman presented to the emergency department following a severe car accident. She had multiple concomitant fractures, including those of the proximal humerus, proximal ulna, and open fractures of the radius in the ipsilateral upper extremity, as well as multiple organ injuries involving the brain, lung, and liver. The patient was diagnosed with an open fracture of the right proximal radius, a comminuted intra-articular fracture of the proximal ulna, and comminuted intra-articular fractures of the right proximal humerus involving the glenoid and coracoid. Additionally, non-displaced fractures of the left distal clavicle and left sacral body, and minimally displaced fractures of both the superior and inferior rami of the pelvis were confirmed. The patient underwent hemiarthroplasty for the shoulder fracture due to severe comminution, open reduction and internal fixation for the proximal ulna, and intramedullary nailing for the radius. Post-operative management included the sequential administration of teriparatide and denosumab to support bone healing and facilitate early rehabilitation. The patient had a relatively short hospital stay of 5 days and showed favorable outcomes, with early callus formation and bone union confirmed at 6 months. At the 1-year follow-up, the patient demonstrated satisfactory joint stability and improved bone mineral density. This case highlights the potential of combined surgical approaches and bone-strengthening therapies in achieving effective outcomes in elderly polytraumatized patients. Sequential administration of teriparatide and denosumab may be beneficial for promoting bone healing in severe osteoporotic fractures.Level of evidence: Level V, case report.

Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Materials and Methods: We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. Results: These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively (p < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. Conclusions: The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications.