Inje University Busan Paik Hospital

The relationship between body mass index (BMI) and cardiovascular outcomes in chronic kidney disease (CKD) remains controversial. While the obesity paradox has been observed in this population, the impact of longitudinal BMI patterns over time is not well established. In this study, we investigated the association between BMI trajectories and the risk of cardiovascular events (CVEs) using data from 1061 patients enrolled in the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). BMI was categorized as high (≥ 23 kg/m2) or low (< 23 kg/m2), and assessed at three time points over a 7-year period. We applied targeted maximum likelihood estimation (TMLE) and marginal structural models (MSMs) to adjust for time-varying covariates, including estimated glomerular filtration rate, blood pressure, hemoglobin, albumin, and C-reactive protein, as well as baseline demographic and clinical characteristics. Patients with persistently high BMI had a significantly reduced risk of CVEs (relative risk 0.279; 95% CI 0.143–0.546; P < 0.001) compared to those with consistently low BMI. Transient increases or decreases in BMI did not show the same benefit. Our findings suggest that sustained high BMI may be protective against cardiovascular events in patients with CKD, challenging current weight management recommendations and supporting individualized approaches based on long-term risk profiles.

Chronic lymphocytic leukemia (CLL) is uncommon in Asia, and longitudinal genomic data from Asian cohorts are limited. We conducted serial whole-exome sequencing (WES) in a multicenter Korean cohort of newly diagnosed, elderly CLL treated with chlorambucil-obinutuzumab to evaluate mutational heterogeneity and clonal hematopoiesis of indeterminate potential (CHIP) during treatment and follow-up. Tumor-only variants were filtered, restricted to nonsynonymous or loss-of-function coding/splice-site mutations, and summarized as a binary patient-by-gene matrix for principal component analysis (PCA), trajectory analysis, and k-means clustering. CHIP was defined as ≥1 qualifying mutation in a prespecified CHIP gene set. Baseline PCA was more compact in patients with complete response at end of treatment, whereas partial response or progressive disease cases were more dispersed. PCA trajectories were compact and directionally consistent in complete responders, more dispersed in partial responders, and highly heterogeneous without a dominant direction in progressive disease. Clustering identified dispersed and compact clusters, and CHIP-associated mutations were enriched in the dispersed cluster (55.6% vs. 8.3%, Fisher's exact p = 0.0086). In paired samples collected 3-5 months after end of treatment, CHIP status changed in some patients. Serial WES may provide complementary information to treatment response, although these observations require confirmation in larger cohorts.

Introduction: Despite previous studies suggesting an association between venous outflow (VO) and clinical outcomes, the relationship between VO status and comprehensive efficacy and safety outcomes after endovascular thrombectomy (EVT), including the influence of systolic blood pressure variability (BPV), remains unclear. Patients and Methods: We performed a secondary analysis of the OPTIMAL-BP trial. Patients were categorized into unfavorable VO (cortical vein opacification score (CVOS) &lt;3) or favorable VO (CVOS ≥3). Efficacy outcomes included modified Rankin Scale (mRS) scores of 0–2 and 0–3 at three months, excellent NIHSS recovery, and final infarction volume (FIV). Safety outcomes consisted of any intracerebral hemorrhage (ICH), symptomatic ICH, any parenchymal hemorrhage (PH), PH type 2, and subarachnoid hemorrhage (SAH). BPV parameters, including time rate (TR), standard deviation, coefficient of variation, and variation independent of mean, were calculated within the first 24 hours after randomization. Results: Among 226 patients, unfavorable VO significantly correlated with lower odds of achieving mRS 0–2 (adjusted odds ratio [aOR], 0.44 [95% CI, 0.22–0.87]), mRS 0–3 (aOR, 0.39 [0.20–0.73]), excellent NIHSS recovery (aOR, 0.40 [0.15–0.95]), and increased FIV (adjusted coefficient, 37.18 [14.81–59.55]). It was also associated with increased odds of any ICH (aOR, 2.28 [1.20–4.39]), symptomatic ICH (aOR, 9.82 [3.12–39.40]), any PH (aOR, 6.08 [2.76–14.07]), PH type 2 (aOR, 174.59 [14.41–7276.24]), and SAH (aOR, 2.44 [1.13–5.29]). Only increased systolic BPV TR correlated significantly with poorer efficacy outcomes in unfavorable VO group. Sensitivity analyses using a Bayesian approach yielded results consistent with the primary analysis Conclusion: Unfavorable VO was associated with poorer clinical and safety outcomes after successful recanalization following EVT and increased post-EVT BPV further worsened clinical outcomes only in unfavorable group. These finding suggest that BPV modulation may improve prognosis in stroke patients with unfavorable VO.

Necrotizing enterocolitis (NEC) is a severe inflammatory disorder of the intestine that affects neonatal babies, with a mortality rate of 30-50%. Despite the severe nature of the disease, its rare incidence and early onset prevent further understanding of its etiology and the development of treatment strategies. To further understand the pathogenic mechanism of this disease, we subjected intestinal tissues from ten NEC patients and three control individuals to RNA-sequencing. Clustering of the affected tissues revealed three clusters, each with a distinct transcriptional profile characterized by the expression of genes enriched in inflammatory pathways related to lipid binding and no obvious expression signature. The three subtypes displayed distinct gene expression patterns specific to the cell types composing the small intestine layers. Our results elucidate the genetic rationale underlying patient-specific symptoms, prognosis.

As breast cancer survival rates improve, attention is shifting toward long-term health outcomes, including oral health. This study evaluated the dental prosthesis needs of breast cancer survivors using a nationally representative sample and examined variations by menopausal status at diagnosis. This nationwide cross-sectional study analyzed data from 14,886 Korean women aged ≥ 19years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 to 2021. Among these, 214 participants reported a history of breast cancer. Multivariable logistic regression was used to compare prosthetic needs and dental care utilization between breast cancer survivors and non-cancer controls, with subgroup analyses stratified by menopausal status at diagnosis. Breast cancer survivors had significantly greater needs for fixed prostheses than the non-breast cancer controls (OR 1.102, 95% CI 1.018-1.194). Postmenopausal survivors were more likely to require fixed prostheses (OR 1.56, p < 0.001), while premenopausal survivors had greater partial denture needs (OR 5.549, p = 0.009) than the non-breast cancer controls. No significant differences in dental visit frequency or self-perceived oral health were observed between groups. Breast cancer diagnosis was significantly associated with higher prosthetic needs, though survivors did not perceive their oral health as worse and demonstrated dental care behaviors comparable to non-cancer individuals. These findings highlight a potential gap in survivor awareness and underscore the need for integrating oral health assessment into survivorship care planning. Targeted dental interventions and awareness programs may improve quality of life for breast cancer survivors.

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.

BackgroundRecent studies have suggested pre-pregnancy body weight plays a role in women’s health-related quality of life (HRQOL) during pregnancy. However, the mechanisms underlying this relationship remain unclear. This study aims to explore the associations between pre-pregnancy body mass index (BMI) and HRQOL during pregnancy, focusing on the potential mediating roles of depressive symptoms, sleep disturbances, and general health perception.MethodsA cross-sectional correlational study was conducted with 240 pregnant Korean women using self-report questionnaires. A multi-mediation path model was developed to assess the interrelationships among variables. Path analysis was performed using AMOS 26.0, and serial multiple mediation analysis with phantom variables was used to evaluate the mediating roles of sleep disturbances, depressive symptoms, and health perception.ResultsThe proposed path model demonstrated a good fit, explaining 56.8% of the variance in pregnant women’s HRQOL. Pre-pregnancy BMI showed relationships with HRQOL indirectly through sleep disturbances, depressive symptoms, and general health perception, indicating no direct association between pre-pregnancy BMI and HRQOL during pregnancy. Among the hypothesized paths, however, the path of sleep disturbance → HRQOL and the sequential path of pre-pregnancy BMI → sleep disturbance → HRQOL were not significant. These findings suggest that although sleep disturbance does influence HRQOL, its effect is largely mediated through depressive symptoms and general health perception.ConclusionsTo promote HRQOL during pregnancy, healthcare professionals should educate women of reproductive age on the importance of maintaining a healthy BMI before conception. Additionally, prenatal care should incorporate simultaneous screening for sleep disturbances and depressive symptoms, particularly among women with elevated pre-pregnancy BMI.

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.