Incheon St. Mary's Hospital

Healthcare workers (HCWs) face higher tuberculosis (TB) risk from occupational exposure. Whether their risk exceeds that of nonclinical institutional workers when matched on key factors is unclear. We compared HCWs with educational workers in South Korea while controlling for age, sex and TB infection (TBI). A retrospective cohort was conducted using national TBI screening data linked with the Korean National Health Insurance Service (NHIS) and TB Surveillance System. After 1:1 propensity score matching on age, sex and interferon-γ release assay (IGRA), 203 959 HCWs and 203 959 educational workers were included. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for TB incidence for at least 2 years. Additive interaction between IGRA positivity and healthcare employment was assessed. TB incidence was highest in untreated IGRA-positive HCWs (245.5 per 100 000), whereas untreated IGRA-positive educational workers had a lower incidence of 77.0 per 100 000. Among IGRA-positive participants, untreated HCWs had a significantly higher risk of developing TB than untreated educational workers (aHR 2.18, 95% CI 1.56-3.06). Even IGRA-negative HCWs demonstrated elevated risk compared with IGRA-negative educational workers (aHR 1.76, 95% CI 1.10-2.83). HCWs are at elevated risk of TB incidence, even after adjusting for infection status and demographics, most likely reflecting ongoing occupational exposure during follow-up. The simultaneous presence of two risk factors, employment in healthcare and IGRA positivity, substantially increased the incidence of TB. These findings highlight the need for targeted infection control, improved TBI treatment adherence and early detection strategies in healthcare settings.

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.

BackgroundThe epidemiology of native valve infective endocarditis (IE) has shifted toward older adults with substantial comorbidity burdens, yet contemporary nationwide data on outcomes and surgical impact remain limited.MethodsWe conducted an 18-year nationwide cohort study of adults hospitalised with native valve IE in Korea (2006–2023). Outcomes included in-hospital and 5-year all-cause mortality, IE relapse and a composite of death or relapse. Temporal trends, mortality predictors and surgical associations across age strata were evaluated using multivariable Cox models and stratified survival analyses.ResultsAmong 18 402 patients (mean age 63.7 years), incidence declined in individuals <45 years but increased in those ≥65 years. In-hospital mortality was 25.5%, and 5-year mortality exceeded 50% overall. Advanced age, dialysis dependence, cancer and major complications predicted mortality. Valve surgery, performed in 29.1% of patients, was consistently associated with lower short- and long-term mortality across age groups, with no evidence of age-by-treatment interaction. Both early (≤7 days) and late (>7 days) surgery showed reduced mortality versus medical therapy. IE relapse was more frequent in older adults, and surgery was associated with a lower relapse risk. In the composite outcome of death or relapse, older adults had a higher event burden, whereas surgery remained associated with fewer composite events.ConclusionsNative valve IE in Korea has shifted toward an elderly, multimorbid population with persistently high mortality. Despite declining utilisation, the survival benefit of surgery was preserved across the age spectrum, supporting operative consideration in appropriately selected older adults.

Background: The contribution of adiposity and metabolic syndrome (MetS) to thyroid cancer risk in late life, particularly among the elderly, is unclear. Methods: We conducted a nationwide cohort study of Korean adults aged ≥75 years who underwent standardized health screening. Exposures were body mass index (BMI), waist circumference (WC), and MetS defined by standard clinical criteria. The incidence of thyroid cancer was determined using administrative data. Fine-Gray sub-distribution hazard models estimated adjusted hazard ratios (HRs) with prespecified stratification by sex and age (75-84 vs. ≥85 years). Results: Among 1,164,707 participants (60.3% women), 2645 incident cases were identified. In the fully adjusted models, obesity (BMI ≥ 25 kg/m2) was associated with a 37% higher hazard (HR, 1.37; 95% confidence interval [CI], 1.27-1.49) and MetS with an 18% higher hazard (HR, 1.18; 95% CI, 1.09-1.28). In sex-stratified models, MetS was associated with thyroid cancer in women (HR 1.19; 95% CI, 1.08-1.31) and showed a similar direction of association in men (HR 1.16; 95% CI, 1.00-1.35), with overlapping CIs. By age, associations were evident at 75-84 years (MetS: HR, 1.18; obesity: HR, 1.36), whereas at ≥85 years, only obesity remained significant (HR, 1.90; 95% CI, 1.13-3.18). Among MetS components, high WC showed the most consistent association (HR, 1.31; 95% CI, 1.21-1.42). Conclusions: In adults aged ≥75 years, general obesity and, in particular, central adiposity are robustly associated with incident thyroid cancer, whereas metabolic syndrome confers a more modest and mainly age- and sex-specific additional risk.

BackgroundPostoperative kinking of a stent graft following total arch replacement using a frozen elephant trunk technique (TARFET) is a rare but significant complication. Such kinking can lead to serious issues, including heart failure, hemolysis, graft thrombosis, and significant upper and lower limb blood pressure difference. Although several cases involving various frozen elephant trunk (FET) devices have been documented, this report presents a potentially novel instance of stent graft kinking following implantation of an E-Vita Open Neo prosthesis.Case presentationA 48-year-old female with a complex cardiac history including previous coarctation repair, aortic valve replacement (AVR), and aortic root enlargement presented with mild hemoptysis, chest, and back pain. Imaging test revealed a growing aortic aneurysm (5.5 cm) at the anastomosis site, severe aortic arch angulation (55°), and prosthesis-patient mismatch with mitral regurgitation. She underwent total arch replacement with the frozen elephant trunk technique and double valve replacement. Postoperatively, she developed stent graft kinking and a significant systolic pressure gradient between upper and lower extremities, along with microangiopathic hemolytic anemia (MAHA) and elevated lactate dehydrogenase (LDH). Balloon dilatation and stent graft relining reduced the pressure gradient from 80 mmHg to 20 mmHg and resolved her symptoms. Follow-up computed tomography angiography (CTA) showed slight improvement in arch lumen size, while microangiopathic hemolytic anemia and lactate dehydrogenase levels normalized.ConclusionsStent graft kinking after total arch replacement with the frozen elephant trunk technique is a rare but potentially severe complication requiring prompt intervention when symptomatic. In the present case, the kinking was likely due to severe aortic arch angulation and fibrotic changes from prior surgeries. To reduce the risk of kinking in patients with significant aortic arch angulation, conventional total arch replacement or performing the distal anastomosis beyond the angulation should be considered during total arch replacement with the frozen elephant trunk procedure.

To develop a smartphone-based pupillometry using deep learning and evaluate its accuracy compared to a commercial pupillometer, the NPi-300. 336 pupillary light reflex (PLR) exams from 158 volunteers were analyzed using deep learning models (UNet, UNet++, DeepLabV3, DeepLabV3+, and Mask R-CNN) with different backbones (ResNet50, Swin Transformer, and ConvNeXt V2). Once the best combination was identified, image data was filtered according to the degree of eyelid opening and image blurriness. The maximum-minimum pupil size difference, constriction velocity (CV), and percentage change in pupil size (CP) were compared between our application and the NPi-300 gold standard. The kernel density estimation and Bhattacharyya Distance were used to develop a scoring method to classify pupil reactivity: SmartPLR. Mask R-CNN (ConvNeXt V2 backbone), which showed a mean intersection over union of 0.9177, segmentation mean average precision (mAP) of 0.8670, and bounding box mAP of 0.8663, was selected for our application. The Pearson correlation values comparing our application to the NPi-300 for pupil size difference, CV, and CP were 0.77, 0.77, and 0.74, respectively. The SmartPLR formula was defined as [Formula: see text], and sluggish pupils were defined as [Formula: see text] and [Formula: see text], and urgent pupils were defined as [Formula: see text] and [Formula: see text]. Despite various smartphone applications developed to evaluate the PLR, they rely on additional add-ons or infrared light source. This prevents such applications from being completely commercialized. Our novel smartphone application, built on deep learning and not requiring infrared or additional devices, demonstrated high accuracy compared to the NPi-300.

The long-term prognosis of immune tolerant (IT) phase patients remains unclear. This study aimed to identify true IT-phase patients with favourable outcomes and distinguish grey-zone IT patients. We retrospectively analysed 1064 chronic hepatitis B (CHB) patients (516 clinically inclusive IT, 548 antiviral-treated immune active [AVT-IA]). Clinically inclusive IT-phase was defined as HBeAg-positive, no cirrhosis, HBV DNA ≥ 10^6 IU/mL, and ALT < 80 U/L. Favourable prognosis was defined as the absence of HCC development and IA progression during follow-up. IT-phase patients had significantly lower 10-year HCC rates compared to AVT-IA patients (1.7% vs. 2.7%). Among the clinically inclusive IT group, favourable prognosis was associated with younger age (< 35 years), female gender, stringent low ALT (< 35 U/L for males, < 25 U/L for females), high HBV DNA (> 10^8 IU/mL), and no family history of HCC. Patients meeting these criteria showed no HCC cases and had a lower likelihood of progression to IA (~50%) within 10 years. The strict criteria demonstrated 90.3% specificity for identifying true IT-phase patients within the clinically inclusive IT group. Family history of HCC was an independent risk factor for HCC development (HR 6.059, p = 0.019), while stringent low ALT, younger age, and female gender were linked to lower IA progression risk (HR 0.32, p ≤ 0.001). This study highlights the importance of applying strict criteria in distinguishing true IT-phase patients from grey-zone patients. True IT patients are at minimal risk of HCC or progression to IA, while identifying grey-zone patients is crucial, as they may require early antiviral therapy.

HighlightsWhat are the main findings?The Korean version of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) demonstrated excellent inter-rater reliability between caregivers and clinicians.Construct validity was supported by significant correlations between Mini-EDACS levels and other functional classification systems (GMFCS, Mini-MACS, CFCS, VFCS, and FOIS-C).What is the implication of the main finding?The Korean Mini-EDACS provides a reliable and valid framework to classify feeding and swallowing abilities in children with cerebral palsy aged 18–36 months.This tool enables standardized communication between clinicians and caregivers and may guide early identification of children needing feeding support.Background/Objectives: Feeding and swallowing difficulties are common in young children with cerebral palsy (CP), yet no validated tool has been available in Korea for those under 3 years. The Mini-Eating and Drinking Ability Classification System (Mini-EDACS) was designed for children aged 18–36 months. This study aimed to translate the Mini-EDACS into Korean and evaluate its reliability and validity. Methods: Translation followed international guidelines, including forward–backward translation and Delphi consensus with experts in pediatric dysphagia. Forty-eight children with CP (mean age 27.1 ± 5.0 months) were assessed. Caregivers and speech–language pathologists (SLPs) independently rated Mini-EDACS and assistance levels. Inter-rater reliability was examined using Cohen’s κ. Construct validity was tested by Spearman’s correlations with the Gross Motor Function Classification System (GMFCS), Mini-MACS, the Communication Function Classification System (CFCS), the Visual Function Classification System (VFCS), and the Functional Oral Intake Scale for Children (FOIS-C). Results: Agreement between caregivers and SLPs was excellent (κ = 0.90; weighted κ = 0.98). Assistance-level ratings also showed almost perfect concordance (κ = 0.97). Mini-EDACS correlated strongly with FOIS-C (ρ = −0.86, p < 0.001) and with assistance levels (ρ = 0.81, p < 0.001). Moderate-to-strong positive correlations were observed with GMFCS (ρ = 0.56), Mini-MACS (ρ = 0.64), CFCS (ρ = 0.61), and VFCS (ρ = 0.61), supporting construct validity. Conclusions: The Korean Mini-EDACS is a reliable and valid tool for classifying eating and drinking abilities in children with CP under 3 years. It enables standardized communication between caregivers and clinicians, complements existing functional classification systems, and may facilitate earlier identification and intervention for feeding difficulties.

Background and aim Direct oral anticoagulants (DOACs) carry a risk of gastrointestinal bleeding (GIB). We aimed to develop and validate machine learning (ML) models to predict GIB in DOAC users and compare them with conventional risk scores. Methods We retrospectively analyzed 4,494 patients aged ≥18 years prescribed DOACs from December 2014 to October 2020. Patients were allocated to the training (n = 3,147), internal (n = 677), and external (n = 670) validation cohorts. Three ML algorithms, Gradient Boosting Machine (GBM), XGBoost, and Generalized Linear Model (GLM), predicted GIB at 12 and 24 months. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and specificity at 100% sensitivity, compared with the HAS-BLED, ATRIA, VTE-BLEED, and ORBIT scores. Results At 24 months, XGBoost achieved the AUCs in the training (0.862), internal validation (0.819), and external validation (0.905) sets. At 12 months, XGBoost performed with AUCs of 0.917, 0.839, and 0.948, respectively. XGBoost exceeded the conventional scores, although ORBIT was the best among the latter (AUC 0.780 at 24 months, 0.728 at 12 months). The ML models also achieved higher specificity at 100% sensitivity. At 12 months, XGBoost and GB model demonstrated 79.8% specificity at 100% sensitivity, whereas GLM showed 67.8%. The conventional models were lower, with an ORBIT of 39.8%. By 24 months, GLM and ORBIT specificities were 43.8% and 40.0%, respectively. Conclusions ML models, particularly XGBoost, outperformed traditional bleeding risk scores in predicting GIB in DOAC users. However, the performance of the ML models was unsatisfactory. Further research is warranted to achieve a better performance.