St. Mary's 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.

The effects of aspirin on hepatic steatosis and fibroinflammation are unclear. The study aimed to examine the association between aspirin use and liver magnetic resonance imaging (MRI)-derived liver fat and corrected T1 (cT1). We used UK Biobank imaging cohort data. Aspirin use was self-reported at baseline and imaging assessment, and the main exposures were aspirin use at imaging assessment and longitudinal aspirin use patterns (never users, initiators, discontinuers, vs. persistent users). Outcomes were MRI-derived liver fat (%) and cT1 (ms). Multivariable adjustment analyses and inverse probability of treatment weighting (IPTW) analyses were performed, accounting for demographic, lifestyle and clinical factors. We included 36 413 participants (mean age 64.6 years, 51.4% female). Aspirin use at imaging assessment was associated with lower liver fat (-0.35; 95% confidence interval [CI]: -0.51, -0.20) and slightly higher cT1 (5.13; 95% CI: 3.23, 7.03). Analyses on longitudinal aspirin use patterns showed that compared to never users, initiators and persistent users showed lower liver fat (-0.48; -0.69, -0.28) and (-0.24; -0.45, -0.02) and higher cT1 (2.94; 0.38, 5.49) and (8.31; 5.65, 10.97). IPTW analyses showed consistent results. In this large population-based cohort, aspirin use was linked to reduced liver fat, but a small, clinically insignificant (i.e., <80 ms) increase in cT1. These findings suggest aspirin may mitigate steatosis through metabolic pathways but does not necessarily rapidly reverse fibroinflammatory injury.

The association between kidney function and tuberculosis treatment outcomes remains uncertain. We analyzed a multicenter prospective cohort of adults with rifampicin-susceptible pulmonary tuberculosis enrolled in Korea between 2019 and 2021. Kidney function was categorized using baseline estimated glomerular filtration rate (eGFR) calculated with the 2021 CKD-EPI creatinine equation and grouped as preserved (eGFR ≥ 60 mL/min/1.73 m²) and reduced (eGFR < 60 mL/min/1.73 m²) kidney function. An additional analysis evaluated severely reduced kidney function (eGFR < 30 mL/min/1.73 m²). The primary endpoint was unfavorable outcome, defined as loss-to-follow-up, treatment failure, death, still-on-treatment, transfer to another treatment unit, or recurrence, analyzed using multivariable logistic regression. The secondary endpoint was failure to complete treatment within 9 months of initiation, analyzed by Cox proportional hazards model. All models adjusted for prespecified covariates, with age and sex included in all models. Among 966 participants, 89 (9%) had reduced kidney function. Unfavorable outcomes were more frequent among participants with reduced kidney function (41% vs. 19%; P < 0.001). After multivariable adjustment, reduced kidney function was independently associated with unfavorable outcomes (adjusted odds ratio [aOR], 2.46; 95% confidence interval [CI], 1.49–4.02). Severely reduced kidney function showed higher odds of unfavorable outcome (aOR, 5.52; 95% CI, 2.42–13.01). Reduced kidney function was associated with failure to complete treatment within 9 months (adjusted hazard ratio, 3.07; 95% CI, 1.69–5.59). Reduced kidney function was independently associated with unfavorable TB treatment outcomes. Patients with impaired kidney function at the time of tuberculosis diagnosis may require closer clinical monitoring during treatment.

Biologically active glasses (BG) are widely studied as potential materials for bone tissue engineering, owing to their capacity to form hydroxyapatite (HA) layers when exposed to body fluids. However, the demerit of BG is the slow deposition rate of calcium ions on the surface, a key factor in increasing the conversion rate to mineralization. The purpose of this study is to introduce phosphoryl group recognized as a trigger for the nucleation processes of apatite formation on the surface of BG. BG was coated with poly (2-methacryloyloxyethyl phosphorylcholine) (PMB) and characterized via Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and X-ray photoelectron spectroscopy (XPS). Biomimetic mineralization was evaluated through simulated body fluid (SBF) immersion, X-ray diffraction (XRD). In vitro MG-63 cell responses were assessed and compared among BG, BG/HA, BG/2%PMB, and BG/2%PMB/HA groups. Results demonstrated that the PMB coating successfully promoted mineralization by introducing negatively charged phosphate groups that enhanced crystallization. BG/2%PMB/HA significantly upregulated focal adhesion markers in MG-63 cells, likely due to improved fibronectin (Fn) deposition on the HA layer. Furthermore, the BG/2%PMB/HA surface enhanced cell survival and proliferation through crosstalk with integrin-mediated signaling pathways. PMB-coated BG effectively accelerates biomimetic mineralization and regulates cellular responses, making it a promising candidate for bone regeneration applications.

Alzheimer’s disease (AD) is a growing global health concern, and emerging evidence suggests that oral health—particularly tooth loss—may be linked to cognitive decline. While implant therapy effectively restores oral function, its systemic health implications in dementia patients have not been fully investigated. We retrospectively analyzed 1,445 dementia patients treated at two tertiary hospitals in Korea between 2011 and 2020. Clinical data, panoramic radiographs, and laboratory biomarkers were assessed to compare systemic and oral health outcomes between implant and non-implant groups. Statistical analyses included parametric and nonparametric tests with Bonferroni post-hoc validation. Baseline demographics were similar between groups. Mortality was lower in the implant group (10.6% vs. 15.6%, p = 0.014). Laboratory markers showed statistically significant but clinically modest differences in serum calcium (8.90 vs. 8.78 mg/dL) and C-reactive protein (1.94 vs. 2.17 mg/dL). Oral health outcomes were significantly superior in implant recipients, including more remaining teeth (23.4 vs. 19.7) and greater posterior occlusal support (all p < 0.05). Dental implant therapy in dementia patients was associated with lower mortality and superior oral health. However, these associations likely reflect inherent selection bias and better healthcare access among implant recipients rather than direct treatment effects. Prospective longitudinal studies with neurocognitive assessments are required to confirm potential causal relationships.

Reliable quantification of perivascular spaces (PVS) in the basal ganglia (BG) is of growing interest for understanding the glymphatic system but remains challenging in infants. To develop an automated deep learning method for BG and BG-PVS segmentation in infant brain MRI using an anatomy-informed pseudo-labeling approach. Retrospective, multi-cohort technical development, and validation study. Three cohorts: 150 neonates from the Developing Human Connectome Project (dHCP, 37-44 weeks of gestational age (GA); 76 males, 74 females), 133 infants from the Baby Connectome Project (BCP; ≤ 24 months; 70 males, 63 females) and 70 infants from an in-house dataset (30-41 weeks of GA; 36 males, 34 females). Manual ground-truth labels were generated by a trained researcher (dHCP, n = 150; BCP, n = 8; in-house, n = 10) and validated by a radiologist with 15 years of experience. Data included 3 T MRI with T1- and T2-weighted sequences: dHCP (inversion recovery turbo spin-echo [IR-TSE] and turbo spin-echo [TSE]), BCP (magnetization-prepared rapid gradient-echo [MPRAGE] and TSE), and in-house (MPRAGE and variable-flip-angle TSE). The proposed approach was compared with alternative automated approaches trained with different labeling strategies. Training/validation/test splits were 100/25/25 (dHCP), 100/25/8 (BCP), and 50/10/10 (in-house). Dice similarity coefficient (DSC), recall, positive predictive value, and Hausdorff distance were calculated for BG and BG-PVS quantification. Statistical significance was assessed using Wilcoxon signed-rank tests (p < 0.05), and quantification agreement was evaluated using Pearson's correlation, intraclass correlation coefficient (ICC), and mean absolute error (MAE). The proposed method improved accuracy (dHCP: BG DSC = 0.91 ± 0.03 and BG-PVS DSC = 0.78 ± 0.09; external datasets with fine-tuning: BG DSC = 0.86-0.89) and high agreement in PVS quantification with reference measurements (r = 0.90-0.99, ICC ≥ 0.96, MAE = 0.10). The proposed method seems to enable robust and annotation-efficient BG and BG-PVS segmentation in infants. 3. 1.

Background/Objectives: This study aimed to compare the surgical and reproductive outcomes between open and robot-assisted laparoscopic adenomyomectomy in women with symptomatic adenomyosis. Methods: This was a prospective cohort study conducted between 29 April 2017 and 21 December 2023 at a university-affiliated tertiary hospital in Seoul, Republic of Korea. The study included patients who underwent uterus-sparing adenomyomectomy for symptomatic adenomyosis. Eligible participants were premenopausal women seeking fertility preservation or symptomatic relief when medical therapy was ineffective and hysterectomy was not desired. Interventions consisted of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Results: A total of 76 patients were included: 21 underwent open adenomyomectomy (OA) and 55 received robot-assisted laparoscopic surgery (RLA). Patients in the OA group had larger adenomyotic lesions (7.1 ± 2.7 vs. 5.4 ± 1.7 cm, p = 0.001) and greater estimated blood loss (400 mL [200-700] vs. 300 mL [200-400], p = 0.05). Hospitalization was significantly shorter in the RLA group (β = -2.1 days, 95% CI -2.7 to -1.6, p < 0.001) after adjustment for lesion size. Overall delivery rates were comparable; however, the robotic cohort demonstrated fewer intraoperative endometrial exposures (10.0% vs. 55.6%, p = 0.033) and more favorable obstetric outcomes, with most deliveries reaching full term without postpartum complications. Conclusions: Compared with open surgery, robot-assisted laparoscopic adenomyomectomy was associated with reduced blood loss, shorter recovery, and favorable reproductive outcomes, supporting its value as a uterus-sparing treatment.

Varicella zoster virus (VZV) vasculopathy is a rare but severe neurological complication that frequently results in a reversible cerebral vasoconstriction syndrome (RCVS). Diagnosis is often delayed because early manifestations are nonspecific and radiologic findings often overlap with those of other cerebrovascular disorders. We describe the fatal case of a heavily pretreated 60-year-old man with refractory diffuse large B-cell lymphoma undergoing evaluation for chimeric antigen receptor (CAR) T-cell therapy. The patient developed multifocal intracranial arterial stenosis and an acute infarction during chemotherapy-induced immunosuppression. The initial radiological features suggested RCVS; however, cerebrospinal fluid (CSF) analysis using polymerase chain reaction (PCR) and anti-IgG antibodies confirmed the presence of VZV. Despite intravenous acyclovir and high-dose corticosteroids, the vasculopathy progressed rapidly, resulting in recurrent infarctions, seizures, and death. This case highlights the diagnostic complexity of VZV vasculopathy in immunocompromised patients and underscores the importance of early CSF evaluation, heightened clinical vigilance for opportunistic viral complications, and the potential diagnostic value of vessel wall magnetic resonance imaging (MRI) in differentiating VZV vasculopathy from mimicking conditions such as RCVS.

Low-grade B-cell lymphomas (LGBCLs) account for approximately 40% of non-Hodgkin lymphomas with low progression. LGBCL is divided into subgroups, which share common complications. Analyzing prognostic factors and mortality causes could improve patient survival; however, currently available models present limitations in discriminating the cause of death. Therefore, this study aimed to compare the prognostic factors and causes of death, such as secondary malignancies (SMs), aggressive histologic transformation (HT), and infectious complications, including coronavirus disease 2019 (COVID-19), in LGBCLs using a competing risk analysis. This retrospective analysis included 1,047 adults with LGBCLs (follicular lymphoma, 689; marginal zone lymphoma, 312; mantle cell lymphoma [MCL], 46) diagnosed between January 2011 and December 2022 across seven centers. Competing risk models were employed to estimate cumulative incidence rates of lymphoma progression-related and non-lymphoma-related mortality. Patients with SMs (3.8%) exhibited poorer overall survival than those without SMs, whereas HT and COVID-19 status did not impact survival outcomes in multivariate analysis. Analysis revealed an association of SMs, age > 60 years, male sex, pleural effusion, and elevated lactate dehydrogenase levels with worse non-lymphoma-related mortality. Moreover, age > 60 years, MCL, nodal MZL, and anemia were linked to poorer outcomes for lymphoma progression-related death. The management of non-lymphoma-related risk factors, such as through early SM detection, is crucial for improving the survival of patients with LGBCLs.