Hallym University Sacred Heart Hospital

Persistent symptoms after SARS-CoV-2 infection (PASC, long COVID) remain a major public-health concern. We developed a data-driven definition and static and dynamic PASC scoring systems in a multicenter, prospective-retrospective observational cohort across 12 South Korean institutions. Adults enrolled December 2022-March 2025 were followed up to 24 months; 8761 were recruited (7208 infected; 1553 controls) and 4668 met analysis criteria (4388 infected; 280 controls). Using participant-reported symptoms, surveys, and laboratory data, we identified nine symptoms robustly associated with PASC, with anosmia/ageusia and fatigue most influential. A static score integrating indicators observed within 24 months yielded an optimal threshold of 13, classifying 19% of infected participants and 4% of controls as PASC positive. A dynamic score tracking six-month intervals showed symptom burdens peaking at 0-5 months post-infection and declining thereafter; at the same threshold, 33% of infected participants were classified as PASC positive, reflecting temporal fluctuation. These data establish a quantitative definition of PASC and introduce a dynamic scoring framework to identify and monitor PASC, supporting future clinical research and practice.

The management of gastrointestinal (GI) and cardiovascular (CV) complications in patients with ischemic heart disease (IHD) receiving long-term antiplatelet therapy remains a clinical challenge.Proton pump inhibitors (PPIs) have traditionally been the standard strategy to prevent upper GI complications in this high-risk population. 1 More recently, potassium-competitive acid blockers (P-CABs) have emerged as promising alternatives, offering rapid and potent acid suppression. 2Despite their growing use, real-world data directly comparing the clinical outcomes of P-CABs and PPIs-particularly in patients on antiplatelet therapy-have been limited.In this context, the recent study by Lee et al. 3 retrospectively evaluated the incidence of upper GI complications and CV events in 604 patients with IHD who received either tegoprazan or a PPI after percutaneous coronary intervention (PCI).The authors found no significant differences between the two treatment groups.Tegoprazan use was associated with a hazard ratio (HR) of 0.34 for GI complications compared with PPIs (95% confidence interval [CI], 0.04-2.97)and an HR of 0.57 for major adverse cardiovascular events (MACEs) (95% CI, 0.15-2.19),indicating no statistically significant differences.These findings reinforce the potential role of P-CABs as reliable agents for GI protection in patients exposed to antiplatelet therapy and contribute to ongoing efforts to address concerns about possible pharmacodynamic interactions-particularly those involving CYP450 pathways-between PPIs and clopidogrel. 2lthough the results are encouraging, they warrant cautious interpretation.The retrospective design introduces the possibility of unmeasured confounding, and the relatively small number of GI and CV events limits statistical power to detect treatment-related differences.Furthermore, long-term safety data for P-CABs remain insufficient; while shortterm studies demonstrate strong acid-suppressive effects, evidence regarding the safety of prolonged P-CAB use-especially in patients requiring lifelong antiplatelet therapy-remains limited.Despite these limitations, the study provides valuable exploratory evidence and establishes a foundation for future research.As P-CABs become increasingly integrated into clinical practice, rigorously designed prospective studies will be essential to establish their long-term safety, define optimal dosing strategies, and clarify their role in patients receiving complex antithrombotic regimens such as dual antiplatelet therapy.The present study offers meaningful early evidence supporting the comparable safety profiles of tegoprazan and PPIs after PCI and underscores

To evaluate the necessity of breast implant-inclusion (BII) views in breast cancer screening for women with breast implants. This retrospective study was conducted on patients who underwent full-field digital mammography, including four BII and four implant-displacement (BID) views, at three institutions in South Korea between January 2009 and December 2020. The true positive rate and radiologic findings were assessed and compared between BII and BID views. Factors associated with the change in suspicion level of malignancy and radiation dose were analyzed. Of the total 1470 patients (45.6 ± 8.4 years) evaluated, 215 were diagnosed with breast cancer (15%), and the cancer was not demonstrable in 37 cases in both BII and BID views. Thetrue positive rates of theBII and BID views were 54% (116/215) and 83% (178/215), respectively (p < 0.01). The suspicion level of malignancy increased in 72% (129/178) and remained unchanged in 28% (49/178) in BID view compared to BII view. The implant location and tumor size differed between the increased suspicion and unchanged groups (p = 0.01 and < 0.01, respectively). The radiation dose per breast was 1.2 ± 0.5 mGy and 1.1 ± 0.4 mGy in BII and BID views (p < 0.01), respectively. BID view alone may be sufficient for breast cancer screening in women with breast implants while minimizing radiation exposure, particularly in those with subpectoral implants. Question Does the implant-inclusion view provide additional diagnostic value over the implant-displacement view in breast cancer screening for women with breast implants? Findings Implant-displacement view demonstrated a higher true positive rate and lower radiation dose than implant-inclusion view, with no cancers detected exclusively by implant-inclusion view. Clinical relevance Screening with implant-displacement view alone in women with breast implants is sufficient for cancer detection while reducing radiation exposure-particularly in those with subpectoral implants, supporting a protocol that benefits patient safety and clinical efficiency.

Objective The aim of this study is to assess the predictive and prognostic value of p16 in recurrent/metastatic HNSCC patients treated with molecular targeted agents (MTAs) or immune checkpoint inhibitors (ICIs). Study design The TRIUMPH trial (NCT03292250) was a multi-arm phase II umbrella trial using next-generation sequencing for patients with HNSCC. Patients were assigned to specific treatment arms including PIK3CA, EGFR/HER2, FGFR, CDK4/6 inhibitors, and ICI based on their genomic profiles. We performed post hoc analysis using 86 patients who had available p16 immunohistochemistry results. ORR, PFS, and OS were analyzed by p16 positivity. Results The p16 positivity rate was 33.7%. ORR was 20.7% for p16 (+) compared to 8.8% for p16 (–) patients (P = 0.072). Median PFS was 3.8 months for p16 (+) and 1.8 months for p16 (–) (P = 0.030). Median OS was 12.9 months for p16 (+) and 6.2 months for p16 (–) (P = 0.100). Conclusion Patients with p16 (+) showed longer PFS and OS compared to p16 (–) patients. This suggests that p16 has prognostic and predictive values in HNSCC patients who are treated with MTAs or ICIs.

Acute kidney injury (AKI) remains a major clinical challenge resulting from the intertwined processes of oxidative stress and macrophage-driven inflammation, both converging on mitochondrial dysfunction. We developed a glucosylated albumin nanoplatform (Glc6-AD11-Alb) designed to exploit glucose transporter 1-mediated uptake in inflammatory M1 macrophages while preserving the intrinsic antioxidant properties of albumin. Physicochemical characterization confirmed reproducible synthesis with defined degrees of functionalization and stable physicochemical properties. In vitro, Glc6-AD11-Alb demonstrated selective uptake in M1 macrophages and significantly reduced intracellular reactive oxygen species, validating its dual role in immune modulation and redox regulation. Positron emission tomography imaging with Cu-64 radiolabeling revealed preferential renal accumulation in ischemia-reperfusion injury (IRI) models, supporting macrophage-targeted delivery. In vivo, administration of Glc6-AD11-Alb attenuated renal dysfunction, suppressed pro-inflammatory and oxidative markers, and promoted tubular regeneration in pre- and post-treatment settings. Importantly, Glc6-AD11-Alb directly protected renal tubular epithelial cells by restoring mitochondrial membrane potential under oxidative and hypoxic stress. Seahorse metabolic flux analysis further confirmed enhanced oxidative phosphorylation, reduced glycolytic dependency, and improved coupling efficiency, indicating recovery of mitochondrial bioenergetics. Transmission electron microscopy demonstrated preservation of mitochondrial ultrastructure, including intact cristae and elongated morphology, consistent with improved ATP synthesis capacity. Glc6-AD11-Alb acts through complementary mechanisms of macrophage-targeted immune modulation and mitochondrial protection, thereby disrupting the vicious cycle of inflammation and oxidative stress in AKI. This nanoplatform represents a clinically translatable therapeutic strategy with potential to improve outcomes in patients with ischemic kidney injury.

Sex disparities in stroke outcomes are well-recognized, but it remains unclear whether these disparities vary across stroke subtypes and how they relate to differences in acute care delivery. The aim of the study was to examine sex differences in long-term mortality, functional outcomes, and acute stroke management across stroke subtypes using a nationwide population-based cohort. This retrospective cohort study analyzed linked clinical audit and claims data from 58,429 patients with acute stroke admitted to 269 hospitals in South Korea between 2018 and 2021. Clinical data were derived from the national Acute Stroke Quality Assessment Program and linked to claims. The primary outcome was all-cause mortality. The secondary outcome was poor functional outcome at discharge. Multivariable Cox and logistic regression models were used to assess associations between sex and outcomes, stratified by stroke subtype and adjusted for age, stroke severity, and comorbidities. Differences in acute stroke care were also analyzed. Of 58,429 patients (mean [SD] age, 68.6 [13.8] years; 43.9% female), 76.1% had ischemic stroke (IS), 15.7% intracerebral hemorrhage (ICH), and 8.2% subarachnoid hemorrhage (SAH). Females were older than males across all subtypes and had different comorbidity profiles. After adjustment, females had significantly lower mortality in all subtypes (adjusted hazard ratios [95% CI]: IS, 0.77 [0.74-0.80]; ICH, 0.60 [0.56-0.64]; SAH, 0.60 [0.54-0.67]; all P < 0.001). Functional outcomes varied: females had worse outcomes in IS, better in ICH, and no difference in SAH. Males were more likely to receive reperfusion and surgical therapies; females were more likely to receive rehabilitation services. These care differences did not fully explain the observed disparities in outcomes. In this national cohort, sex disparities in stroke outcomes differed by subtype. Despite lower adjusted mortality in females, functional outcomes were not uniformly better. These findings underscore the importance of adopting sex- and subtype-specific approaches to stroke care, secondary prevention, and rehabilitation.

Abstract Background The Infectious Diseases Society of America guidelines recommend using group 2 carbapenems over ertapenem in critically ill or hypoalbuminemic patients for the treatment of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. However, clinical evidence supporting the cautious use of ertapenem in hypoalbuminemic patients remains limited. We aimed to assess whether the impact of carbapenem type on 30-day mortality differed by serum albumin level in patients with ESBL-producing bacteremia. Clinical Characteristics of Patients with ESBL-producing E. coli and K. pneumoniae Bacteremia in the Overall and Inverse Probability of Treatment Weighted cohort IPTW, inverse probability of treatment weigthed cohort; SMD, standardized mean difference; SD, standard deviation; BMI, body mass index; IQR, interquatile range; ICU, intensive care unit Table 2. Multivarite Cox regressoin for 30-day Mortality HR, hazard ratio; CI, confidence interval Methods We conducted a multicenter, retrospective cohort study at three university-affiliated hospitals, enrolling patients treated exclusively with either ertapenem or group 2 carbapenem due to ESBL-producing E. coli or K. pneumoniae bacteremia between 2013 and 2020. Baseline characteristics were balanced using inverse probability of treatment weighting (IPTW). Risk factors for 30-day mortality were identified with multivariate Cox regression. To explore potential effect modification, an interaction term between carbapenem type and serum albumin level was included in the model. IPTW-adjusted Predicted 30-day Mortality by Albumin IPTW, Inverse probability of treatment weighted Results A total of 566.2 weighted patients were analyzed (379.8 in ertapenem and 186.3 in group 2 carbapenems). After IPTW adjustment, baseline characteristics between the groups were well balanced. The overall 30-day mortality rate was 8.5% (47.9 deaths). Risk factors for 30-day mortality were lower body mass index (adjusted hazard ratio [aHR] 1.12, 95% confidence interval [CI] 1.02–1.23, p = 0.021), nosocomial infection (aHR 3.13, 95% CI 1.64–6.25, p = 0.001), higher Charlson comorbidity index score (aHR 1.27, 95% CI 1.10–1.49, p = 0.004), and infection source other than urinary or biliary tract (aHR 2.67, 95% CI 1.17–6.10, p = 0.019). Serum albumin was associated with 30-day mortality in group 2 carbapenem (aHR 0.34, 95% CI 0.13–0.87, p = 0.025), whereas such association was not observed in ertapenem (aHR 0.63, 95% CI 0.29–1.41, p = 0.24) in subgroup analyses. No significant interaction between carbapenem type and serum albumin level was found (p = 0.41). Conclusion Given the absence of a significant interaction between serum albumin level and carbapenem type, ertapenem can be used regardless of serum albumin levels in patients with ESBL-producing bacteremia. Disclosures All Authors: No reported disclosures

To assess the long-term effectiveness, safety, and economic viability of recently approved Alzheimer's disease (AD) therapies, as well as to evaluate the real-world application of novel diagnostics among AD patients with diverse comorbidities, comprehensive real-world data (RWD) analysis is essential. The Korean JOint RegistrY for ALZheimer's Treatment and Diagnostics (JOY-ALZ) endeavors to create a registry of RWD derived from clinical practice on new diagnostic methods and therapeutic agents for AD introduced in Korea since 2021. Participants must fulfill all the following: 1) be at least 19 years old; 2) be actively receiving, scheduled to initiate, or undergoing evaluation for any AD disease-modifying treatment; 3) have completed amyloid positron emission tomography or cerebrospinal fluid AD immunoassay (a positive result is not essential for participation); 4) have a clinical classification of cognitively unimpaired, mild cognitive impairment, or probable AD dementia. Data generated during routine care is segmented into a minimum dataset, extended dataset, and research-only dataset requiring extra consent. Assessments encompass clinical, cognitive, functional, neurobehavioral, neuroimaging, and biomarker evaluations, in addition to systematic monitoring of new AD treatments and their safety. Data are collected and monitored at baseline, at semiannual intervals during the initial 2 years, and then annually up to 2034. To date, 46 medical centers will participate in JOY-ALZ. JOY-ALZ is expected to promote understanding of the long-term clinical outcomes, safety, and cost-effectiveness of recently introduced diagnostics and treatments for AD, thereby supporting the progress of precision medicine in AD care and diagnosis. ClinicalTrials.gov Identifier: NCT06889818.