Conectar
by Hyun Ju Kim, Kyung-Ah Cho, So-Youn Woo
Skin inflammation arises from complex interactions among immune cells, particularly T cells and neutrophils. Mesenchymal stem cells (MSCs) exhibit potent immunomodulatory properties, but the specific roles of tonsil-derived MSCs (T-MSCs) in regulating neutrophil extracellular trap (NET) formation and cell death, as well as T cell migration in inflammatory skin conditions, remain poorly defined. In this study, the therapeutic effects and mechanisms of T-MSCs were investigated in a 2,4-dinitrochlorobenzene (DNCB)-induced skin inflammation model, with a focus on NET formation and T cell migration. T-MSCs were intravenously administered to mice with DNCB-induced skin inflammation; inflammation severity and immune cell dynamics were evaluated using histological analysis, flow cytometry, immunostaining, microarray profiling, NET assays, and T cell migration assays. T-MSC treatment reduced DNCB-induced skin inflammation, as demonstrated by decreased epidermal thickness and neutrophil infiltration. Although T-MSCs enhanced NET formation in vitro, they suppressed neutrophil accumulation in vivo. T-MSCs also modulated the distribution and activation of T cell subsets in the skin and secondary lymphoid organs. Gene expression profiling revealed that T-MSCs regulated pathways associated with inflammation and neutrophil activity, including those involved in immune cell trafficking and NET formation. Moreover, T-MSCs promoted T cell migration, although this effect was influenced by neutrophil presence, indicating complex interplay among immune cells. These findings demonstrate that T-MSCs exert anti-inflammatory effects in DNCB-induced skin inflammation by modulating NET formation and T cell migration, revealing a novel immunoregulatory mechanism and supporting their therapeutic potential for inflammatory skin diseases.by Boyoung Jeon, Boyoung Jung, Yun-Kyung Song
BackgroundMusculoskeletal surgery imposes extended recovery periods and significant financial burdens that can undermine individual and system-level health security. Patients undergoing musculoskeletal surgery often face prolonged recovery and substantial post-discharge costs, yet longitudinal evidence on their healthcare use remains limited.
MethodsThis study quantified two-year post-discharge utilization and identified predictors of high expenditure among Korean musculoskeletal surgery patients. A retrospective cohort was constructed from the 2019–2021 Korea Health Panel. Adults (n = 182) hospitalized for spinal, knee, shoulder or other musculoskeletal disorders between July 2019 and June 2020 were followed for 24 months. Outcomes were total healthcare expenditure (log-transformed) and in the top 25% cost group (“high-expenditure”) in the second post-discharge year.
ResultsAmong 182 adults hospitalized for musculoskeletal surgery, first-year post-discharge spending averaged US $848 but fell to US $487 in the second year. Readmission fell from 19.2% to 7.1%, and Western-medicine outpatient visits declined from 18.3 ± 25.9 to 13.6 ± 22.9 per person. By contrast, Traditional Korean Medicine (TKM) visits rose from 2.3 ± 6.5 to 3.3 ± 10.0. In multivariable models, metropolitan residence, obesity, additional chronic conditions, and heavier first-year inpatient and outpatient use independently predicted higher second-year costs. Lower household income was associated with lower spending. Index diagnoses were pivotal: spinal disorders and shoulder disorders markedly increased the odds of falling into the top-cost quartile. Among the first-year TKM, frequent chuna/manual therapy sessions were marginally associated with higher costs, suggesting these rehabilitative modalities may serve as proxies for underlying health complexity during the stabilization phase.
ConclusionsSpinal and shoulder disorders, metropolitan residence, obesity, multimorbidity, heavy inpatient and outpatient use during the first post-discharge year, and frequent TKM sessions, albeit marginally, jointly predicted the highest second-year expenditures. These findings highlight the value of early risk stratification and tightly coordinated Western-and-traditional care pathways that facilitate the shift from structural repair to functional restoration. From a policy perspective, these results suggest the need for integrated post-discharge care models and targeted financial support strategies to reduce avoidable costs and enhance equity in musculoskeletal rehabilitation.
by Yu-Ting Chi, Naomi C. Hamm, Shih-Hao Lee, Minkyung Shin, Yuki Liu, I-Fan Shih, Feibi Zheng, Ben Forrest, Peng-Lin Lin
IntroductionSurgical staplers are essential tools in minimally invasive surgery (MIS), enabling tissue division, hemostasis, and secure anastomoses. With the growth of robotic-assisted surgery, robotic staplers such as SureForm have recently become available. These staplers offer precise articulation and real-time tissue compression monitoring. However, the clinical advantages of robotic staplers over bedside staplers remain uncertain. Studies show mixed results across specialties, mainly due to small sample sizes, outdated data, and data heterogeneity. This study protocol proposes a series of future analyses that will evaluate the clinical outcomes and resource utilization of robotic versus bedside staplers in robotic-assisted surgeries across multiple specialties using recent real-world data.
Methods and analysisThis retrospective cohort study will use data from the Premier Healthcare Database (PHD), a large hospital-based database covering patients with varied payers across the United States. Adult patients (≥18 years) who underwent elective, fully robotic-assisted lung, colorectal, gastric, or bariatric surgeries from 2019 to 2023 will be included. Each surgical specialty will be analyzed in a separate paper. Patients will be categorized into two groups based on the type of surgical stapler used: robotic staplers (SureForm) and bedside staplers (manual or powered). The primary outcome will be postoperative leak (air leak for lung resection; anastomotic leak for colorectal, gastrectomy, and bariatric). Key secondary outcomes are other complications, conversion to open surgery, operative time, transfusion requirements, length of stay (LOS), and cost. Overlap weighting will be applied to minimize bias.
DisseminationResults will be disseminated through peer-reviewed surgical journals and presentations at relevant surgical meetings.
by Suehyun Park, Sangho Lee, Hyeon Ju Kim, Hyung-Kee Kim, Seung Huh, Deokbi Hwang
ObjectiveRegarding revision of vascular access (VA), endovascular methods are commonly employed owing to their procedural simplicity, yet their durability remains uncertain. This study aimed to compare clinical outcomes of swing segment (SwS) revision of radiocephalic arteriovenous fistula (RC-AVF) between endovascular and surgical approaches.
Materials and methodsA retrospective cohort study comparing two groups was conducted at one tertiary hospital in South Korea. A total of 131 patients underwent endovascular or surgical revision of SwS in RC-AVF for the first time after AVF creation between 2016 and 2023. Endovascular and surgical revisions were performed in 114 and 17 patients, respectively (interposition, n = 10; patch angioplasty, n = 5; transposition, n = 1; proximalization, n = 1). Kaplan-Meier survival analysis was used to assess post-intervention primary patency (PP) and post-intervention secondary patency (SP). Multivariable Cox regression analysis was performed to adjust for potential confounders, and a subgroup analysis was conducted based on whether the SwS was in stenosis or occlusion.
ResultsThe median minimal diameter of SwS was 1.3 mm in the endovascular group and 1.4 mm in the surgical group, and the median lesion length was 2.5 cm and 4.0 cm, respectively. Twelve-month PP was 63.5% vs 73.7% (endo vs surgical, P = 0.79). While PP did not differ in the stenosis subgroup, the occlusion subgroup showed significantly higher PP after surgical revision (P = 0.002), with surgery associated with a markedly lower risk of loss of PP events (HR 0.073).
ConclusionSurgical revision may be preferentially considered for long-segment occlusive lesions, given its superior early PP and the longer lesions typically associated with occlusions, whereas percutaneous transluminal angioplasty (PTA) remains appropriate for focal or stenotic lesions within the SwS. Consistent follow-up is essential to enable timely interventions, thereby maximizing the functionality of RC-AVF.
by Mengsi Peng, Peng Shen, Kyung-In Joung, Kwang Joon Kim
BackgroundAlthough metformin is the first-line medicine for type 2 diabetes (T2D), its safety profile in adolescents remains poorly understood. This study seeks to investigate the adverse events linked to metformin use in adolescents diagnosed with T2D.
MethodsData from the Food and Drug Administration Adverse Event Reporting System (FAERS), spanning Q1 2004 to Q2 2024, were retrospectively analyzed in this study. Adverse reactions were standardized using the Medical Dictionary for Regulatory Activities, then significant adverse drug reaction signals were identified through disproportionality analysis employing reporting odds ratio (ROR) and information component (IC) methods.
ResultsOf 17,956,653 FAERS reports, 80,187 involved metformin, including 973 in adolescents (10–19 years), with 174 cases were identified with a T2D indication. Analysis at the system organ class level revealed that congenital, familial, and genetic disorders [ROR: 8.8 (4.0, 19.3); IC: 2.2 (1.1, 2.9)] and pregnancy conditions [ROR: 4.9 (2.5, 9.5); IC: 1.8 (0.8, 2.5)] showed the most significant signals. At the preferred term (PT) level, three signals were identified across all sexes and subgroups: treatment noncompliance [ROR: overall 4.14 (2.44, 7.02), male 4.27 (2.00, 9.12), and female 4.65 (2.22, 9.74); IC: overall 1.67 (0.88, 2.22), male 1.60 (0.46, 2.36), and female 1.74 (0.60, 2.50)], lactic acidosis [IC: overall 2.99 (1.91, 3.72), male 2.53 (0.76, 3.61), and female 2.76 (1.34, 3.67)], and gastrointestinal disorder [ROR: overall 13.09 (4.73, 36.23), male 54.33 (6.05, 487.96), female 5.34 (1.10, 25.84)]. Neurological disorders were observed only in males, while pregnancy-related adverse effects and renal disorders occurred exclusively in females. Additionally, the study identified potential new signals not documented in metformin labeling, including areflexia, muscle weakness, ataxia, decreased vibratory sense, rhabdomyolysis, substance use, and axillary pain.
ConclusionThe study reveals a complex safety profile of metformin in adolescents with T2D, warranting further research to confirm risks.
by Sang Ah Lee, Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Sung Shin, Young Hoon Kim, Sung-Han Kim, Hyunwook Kwon
PurposeOptimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
Materials and methodsWe retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
ResultsThe cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
ConclusionIn this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
To explore the experiences of nurse leaders and managers in planning the hospital nursing workforce in accordance with the government-led response to the COVID-19 pandemic in South Korea.
Descriptive, qualitative study.
Semistructured interviews were conducted with 10 participants at three general hospitals in Seoul and Gyeonggi Province from August to October 2022. Eligible participants were nurse leaders and managers who were involved in decision making and management of the nursing workforce for the COVID-19 response or who served on a COVID-19 response team at each study hospital. Data were analysed using inductive content analysis.
Four main themes emerged from the interview data, each with subthemes: exacerbated inherent vulnerabilities, highlighting existing nursing shortages and financial constraints; delay to systematic response, with frequent government ad-hoc orders increasing disruptions to on-site operations and inefficiencies of the external workforce; creation of new conflicts, including those related to nursing staff deployment and compensation gaps and demands on new leadership, with the need for effective crisis management and visionary leadership.
The results indicate that nurse leaders and managers face unexpected challenges in effectively planning their nursing workforce during the pandemic. These challenges are further compounded by centralised ad-hoc government orders that prioritise the urgent demands of COVID-19 patient care, often overlooking the unique needs and circumstances of individual hospitals.
There is a need for more flexible and localised workforce planning strategies to better support nurse leaders and managers. Furthermore, ongoing collaboration between healthcare leaders and policymakers is crucial to address the disconnect between centralised government-led responses and hospital-specific needs, which could enhance the resilience of the nursing workforce and improve disaster and emergency preparedness in the future.
COREQ checklist was used.
No patient or public contribution. Data were obtained from healthcare professionals.
The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels.
A cross-sectional study was used.
This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool.
Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change–health-related information, and experience in setting climate change–health goals and strategies significantly influenced PBCH.
We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels.
By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients.
Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses.
This study adhered to the STROBE guidelines.
No Patient or Public Contribution.
by Yoo Kyung Choi, Seok Hyun Son, Hong Seok Jang, In-Ho Kim, Sea-Won Lee, Soo-Yoon Sung
BackgroundRadiotherapy for locally advanced esophageal cancer can induce lymphopenia, potentially worsening outcomes. This study examines the association between clinical outcomes and the effective dose to the immune cells (EDIC), a measure of lymphocyte radiation exposure.
MethodsWe retrospectively analyzed 107 patients with locally advanced esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy (CCRT). The EDIC was calculated based on the mean lung dose, mean heart dose, and integral total body dose using established models. Patients were stratified into high (n = 42) and low (n = 65) effective dose to the immune cells (EDIC) groups using a cut-off value of 4.28 Gy. Survival outcomes, including overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS), were assessed.
ResultsThe 5-year OS and PFS rates were significantly lower in the high EDIC group than in the low EDIC group (51.9% vs. 66.6%, p = 0.043; 20.8% vs. 31.8%, p = 0.002, respectively). Multivariate analysis identified high EDIC as an independent predictor of poorer OS (hazard ratio (HR): 2.06, 95% confidence interval (CI): 1.1–3.86, p = 0.024) and PFS (HR: 1.7, 95% CI: 1.04–2.78, p = 0.034). Similarly, the 5-year LRFS and DMFS rates were significantly lower in the high EDIC group than in the low EDIC group (24.1% vs. 34.9%, p = 0.003; 29.0% vs. 44.0%, p = 0.018, respectively).
ConclusionA higher EDIC is an independent predictor of poor survival in patients with esophageal squamous cell carcinoma undergoing CCRT. Reducing radiation exposure to the immune system through optimized radiation planning and lymphocyte-sparing techniques may improve patient outcomes.
by Sunghoon Jeon, Keunho Kim, Cheolwon Choe, Juil Choi, Gun Lee, Chung-Do Lee, Hyeon-Jeong Moon, Jun-Gyu Park, Jin-kyung Kim, Namsoon Lee, Dongwoo Chang
Quick-soluble gelatin microparticles (QS-GMP) are emerging embolic agents under investigation for temporary vascular occlusion, offering reduced ischemic risk compared to permanent materials. The aim of this preclinical study was to evaluate the safety and efficacy of QS-GMP for transarterial embolization in a rabbit model of urinary bladder embolization. Twelve male New Zealand White rabbits underwent bilateral umbilical artery embolization using QS-GMP. Animals were assigned to four time-points (immediately, 3, 7, and 14 days post-embolization), with comprehensive assessments including clinical observations, hematologic and serum biochemical analysis, angiography, and histopathology. The procedure was technically feasible in all animals without intraoperative complications. Temporary hematuria and a transient decrease in body weight were observed post-procedure, both of which resolved spontaneously. Complete occlusion of the cranial vesical artery and absence of bladder wall perfusion were achieved immediately after embolization, followed by full recanalization at 3 days. Angiographic imaging at 7 and 14 days revealed transient hypervascularization of the bladder wall. Histopathological analysis showed marked edema, epithelial necrosis, and inflammatory infiltration at 3 and 7 days, with full urothelial regeneration observed at 14 days. No signs of ureteral or renal injury, or adverse systemic responses were detected. These findings suggest that QS-GMP may serve as a feasible option for temporary arterial occlusion in future veterinary lower urinary tract applications, although further long-term evaluation is warranted.To investigate the clinical outcomes and predictors associated with the severity of new-onset pressure injuries in hospitalised patients with multiple comorbidities.
Retrospective cohort study.
We retrospectively collected data on hospitalized patients. The severity of pressure injury was defined as per the National Pressure Injury Advisory Panel. Outcome measures included short-term mortality and discharge to extended care facilities.
A total of 2150 hospitalised patients were screened, and 186 (8.7%) developed new-onset pressure injuries, including 84 classified as stage I and 102 as stage II. The Braden scale score and time from admission to pressure injury onset were significantly associated with new-onset stage II pressure injuries. Patients with stage II pressure injuries had a significantly higher risk of being discharged to extended care facilities compared to those with stage I pressure injuries (24% vs. 12%, p = 0.041). The short-term mortality rate was high in the total cohort (34%) but was not significantly different between the two groups. The worse Braden scale, lower body mass index, history of stroke and presence of stage II pressure injuries were significant predictors of discharge to extended care facilities.
New-onset Stage II pressure injuries significantly increased the risk of discharge to extended care facilities. Furthermore, this study expands the potential clinical utility of the Braden Scale by demonstrating its association not only with the risk of pressure injury development but also with the initial severity of injuries once they occur. These findings support its role in early risk stratification and targeted nursing interventions.
This study highlights the importance of early identification and prevention of pressure injuries and the potential role of the Braden scale in minimizing injury severity, reducing healthcare utilization, and improving quality of life.
STROBE guidelines.
None.
To investigate the frequency and associated factors of interruptions initiated by human and environmental sources during the medication administration process among nurses in South Korea.
A cross-sectional descriptive study.
Data were collected from January to March 2022 through an online survey administered to nurses working in tertiary hospitals in South Korea. The survey assessed interruptions during the medication administration process, nursing work environments and organisational culture. Descriptive statistics and regression analysis were used to identify factors associated with interruptions.
Human-initiated interruptions were more frequent than those initiated by environmental sources. Human-initiated interruptions increased with a higher patient load and a relation-oriented organisational culture but decreased with adequate staffing and resources, as well as an innovation-oriented culture. Environment-initiated interruptions were more frequent in settings with a task-oriented culture and less frequent among female nurses.
The findings highlight the importance of understanding the distinct characteristics of interruptions and developing targeted strategies based on their sources and contributing factors. Creating supportive environments and fostering an organisational culture that actively prevents unnecessary interruptions are essential for enhancing medication safety and workflow efficiency.
To apply these findings in clinical practice, it is necessary to allocate staffing resources appropriately to reduce interruptions. Providing education on the importance of maintaining uninterrupted medication administration processes is essential to reduce human-initiated interruptions.
This study provides practical evidence that organisational culture and staffing are associated with interruptions in clinical nursing practice. Nurse managers should apply these findings by promoting staffing adequacy and fostering a collaborative, innovative environment that encourages continuous improvement and openness to change. Tailored strategies that reflect the specific characteristics of different types of interruptions can help reduce their occurrence and improve medication safety.
STROBE checklist.
No patient or public contribution.
Cirrhosis is a major cause of morbidity and mortality. Patients with decompensated cirrhosis, or end-stage liver disease (ESLD), have a high symptom burden and an increased mortality risk. Yet, the uptake of palliative care in patients with ESLD remains low and variable. Despite robust evidence of the value of home palliative care in other advanced diseases, this has not been well studied in patients with ESLD. Hence, the primary aim of this study is to explore the implementation, feasibility and acceptability of home palliative care in patients with ESLD and healthcare professionals. We also aim to describe its impact on the quality of life (QoL), mood, symptom burden, caregiver burden and healthcare utilisation of patients with ESLD.
The study is a single-centre, mixed-methods feasibility study. Eligible patients include those with decompensated liver cirrhosis who are admitted under the gastroenterology and hepatology service and fulfil the Supportive and Palliative Care Indicator Tools (SPICT) criteria. Recruited patients will be followed up by a multi-disciplinary homecare team led by a palliative care physician for 6 months. Both qualitative and quantitative measures will be used to evaluate the primary aim and include the uptake of the service by both eligible patients and physicians. Semistructured interviews with key stakeholder groups will be conducted to determine their perspectives and experiences. Secondary outcome measures include changes in health-related QoL using the Chronic Liver Disease Questionnaire, depression severity, goals of care discussions, patient symptom burden, caregiver burden and healthcare utilisation.
This study will adhere to the Declaration of Helsinki and has been approved by the research ethics committee of the National Healthcare Group (DSRB (Domain Specific Review Board) reference: 2023/00852). Results will be submitted for publication in international peer-reviewed journals.
This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels. 
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