Red Ginseng (Korean)

Objective: This review is to systematically evaluate the clinical effectiveness and safety of acupuncture therapy for patients with post-stroke neurogenic bladder (PSNB). Methods: We included randomized controlled trials (RCTs) evaluating any type of acupuncture treatment for PSNB. Data extraction and quality assessment using Cochrane Risk of Bias 2.0 were performed. Meta-analysis was conducted for total effective rate (TER) and urodynamic parameters. Results: Ten RCTs involving 727 participants were included. Meta-analysis showed that acupuncture was associated with a reduction in residual urine volume (RUV), and increases in maximum cystometric capacity (MCC), and maximal urinary flow rate (Qmax). Acupuncture also showed a higher TER compared to control groups (RR = 1.23, 95% CI [1.15, 1.33], p < 0.001). However, wide 95% prediction intervals for urodynamic parameters indicated substantial uncertainty for future clinical applications. Adverse events were mild and infrequent, but only partly reported in two studies among included trials. Conclusions: Acupuncture as an adjunctive therapy suggests potential trends for improving clinical efficacy and urodynamic parameters in PSNB patients. However, no definitive conclusions can be drawn regarding its clinical efficacy or safety due to the very low certainty of evidence, high methodological heterogeneity, and limited reporting of adverse events. Therefore, these results must be interpreted with extreme caution. Further high-quality, large-scale randomized controlled trials with standardized protocols are essential to establish robust evidence regarding its clinical effectiveness and safety. Protocol registration: PROSPERO CRD42025643092.

Antibiotic-associated diarrhea (AAD) is primarily driven by disruption of the gut microbiota accompanied by intestinal mucosal injury. Although multiherb formulations are widely used in East Asian medicine, their collective ecological effects and integrated microbiome-host mechanisms have not been systematically synthesized. This systematic review included 17 preclinical studies that investigated multiherbal formulations in AAD models. Given the substantial heterogeneity in the formulation composition, experimental design, and analytical platforms, a descriptive synthesis was performed. The included formulations were categorized into four clusters based on their shared herbal composition: Qiwei Baizhu San (QWBZP), Lizhong Tang (LZT), Gegen Qinlian Tang (GQT), and other supportive multiherbal formulations. The cluster-based synthesis revealed distinct convergent therapeutic strategies. The QWBZP and LZT clusters primarily supported the restoration of host metabolic and digestive functions, whereas the GQT cluster exhibited potent pathogen control effects with the suppression of opportunistic taxa. Across all clusters, a convergent microbiome-host response emerged, characterized by enrichment of commensal bacteria (e.g., Lactobacillus), upregulation of tight junction proteins (e.g., ZO-1, occludin), and attenuation of pro-inflammatory mediators (e.g., TNF-α, myeloperoxidase). Multiherb formulations in AAD models not only act as microbial modulators but also function as host-directed modulators that stabilize the intestinal homeostatic niche. Botanical interventions may facilitate endogenous microbiome recovery by reinforcing mucosal integrity and reducing environmental resistance. This ecological framework provides a rationale for future translational studies evaluating integrated herbal-probiotic strategies and precise microbiome management for patients with AAD, while further clinical validation is warranted.

INTRODUCTION: As the Republic of Korea undergoes demographic transitions, exposure to climate-related health risks is intensifying. In response, the government has considered population aging as part of their national plans of climate adaptation and health, and local governments have also worked on age-friendly city plans aligned with WHO guidelines. However, evidence of interventions contributing to environmental sustainability and climate resilience remains limited and unclear. METHODS: Synthesizing Korean-language evidence, this review is the first to map how age-friendly interventions incorporate or miss climate resilience and environmental sustainability through a scoping review. RESULTS: Using three Korean search engines (DBpia, KCI, RISS) on June 3, 2024, 35 interventions were retrieved from the final 31 publication records. The review found that interventions for age-friendly cities and communities (AFCC) largely neglect environmental sustainability and climate resilience, with government-driven initiatives relying on limited indicators. The most popular AFCC domains that the reviewed interventions belong to were Domain 1 (Outdoor spaces and buildings), followed by 8 (Community support and health services) and 7 (Communication and information). No interventions were observed under Domain 5 (Civic participation and employment). DISCUSSION: Capturing limited comprehensiveness, predominance of government-driven interventions, and lack of robust evidence on their effectiveness, this review underscores the need to integrate climate change considerations into the under-addressed domains of the AFCC framework. At the policy level, the authors recommend promoting young older adults' community engagement, innovation through non-governmental sector, and development of indicators through implementation research.

BACKGROUND: Osteoarthritis (OA) is a degenerative joint condition mostly affecting the knees characterized by cartilage degradation, synovial inflammation, and chronic pain, with limited effective treatments with minimal side effects. Traditional, complementary, and integrative medicine (TCIM), such as numerous medicinal plants, acupuncture, and folk herbalism, among others, have been historically used to treat symptoms associated with OA, which include joint pain, stiffness, and inflammation. Several herbs and their bioactive constituents have shown potential to modulate key inflammatory pathways like the NLRP3 inflammasome, which is an important regulator of innate immune responses in OA pathophysiology. OBJECTIVE: This review aims to investigate the underlying mechanisms and potential of TCIM to alleviate OA-related pain by modulating the NLRP3 inflammasome. METHODS: A comprehensive literature search across multiple databases, including PubMed, Cochrane Library, Embase, Google Scholar, Scopus, and Web of Science by using a set of MESH and relevant keywords like "NLRP3", "TCIM", "OA", and "Animal" for articles published from January 2000 to August 2024. RESULTS: Twenty-two in vivo studies met the inclusion criteria for the systematic review, and 21 studies for the meta-analysis. Across these studies, TCIM interventions consistently reduced NLRP3, IL-1β, IL-18, and Caspase-1 expression compared with OA controls. Pooled effects were consistently moderate-to-large across all molecular, with low between-study heterogeneity (I² ≈ 0%). Subgroup analyses by OA model, intervention type, and species indicated broadly similar directions of effect. CONCLUSION: TCIM shows potential therapeutic approaches for managing OA-related pain by targeting the NLRP3 inflammasome in preclinical OA models. Further research should investigate the clinical translation of these findings to address the unmet need for effective analgesics in OA. © 2026. The Author(s), under exclusive licence to Tehran University of Medical Sciences.

AIMS: To evaluate the effect sizes of factors influencing quality of life among colorectal cancer survivors. DESIGN: This study was a systematic review and meta-analysis. METHODS: This study was conducted according to PRISMA guidelines. Ten international and Korean databases, including Web of Science, PubMed, SCOPUS, were searched from January 2000 to October 2024. Methodological quality was assessed using the JBI Critical Appraisal Checklist. Effect sizes (Esr) were calculated using Fisher's Z transformation. Publication bias was evaluated using Egger's test, funnel plots, and trim-and-fill methods. RESULTS: Physical factors included fatigue (ESr -0.567) and symptom experiences (ESr -0.474). Psychological distress showed the strongest negative association (ESr -0.737), followed by depression (ESr -0.590). Self-efficacy (ESr 0.640), resilience (ESr 0.439), and body image (ESr 0.412) demonstrated positive associations. Social support was positively associated (ESr 0.381). CONCLUSION: Quality of life among colorectal cancer survivors is associated with physical, psychological, and social factors including fatigue, symptoms, distress, depression, self-efficacy, resilience, body image, and social support. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in this systematic review and meta-analysis. © 2026 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.

Background and Aims: Egg-derived proteins and peptides have been investigated for various health outcomes, yet no comprehensive meta-analysis has synthesized this evidence to guide clinical practice. This study aimed to evaluate the efficacy of oral egg-derived protein and peptide supplementation on health outcomes, including serum albumin and phosphorus in dialysis patients, and visceral fat area, blood pressure, muscle protein synthesis, and cognitive function in adults. Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched through January 2026 for RCTs. Random-effect meta-analyses, sensitivity analyses, and publication bias assessments were performed. Risk of bias was evaluated using the RoB 2 tool. Evidence certainty was evaluated using GRADE. Results: Thirty RCTs (n = 1938) were included. In dialysis patients, egg white supplementation significantly increased serum albumin (MD: +0.42 g/dL [95% CI: 0.12-0.72]; I2 = 82.4%; four RCTs; GRADE: very low) and decreased serum phosphorus (MD: -2.04 mg/dL [-2.50, -1.58]; I2 = 22%; two RCTs; GRADE: low). Leave-one-out sensitivity analysis showed consistency. Lactic-fermented egg white peptide reduced the visceral fat area (MD: -11.6 cm2 [-18.5, -4.8]; two RCTs; GRADE: very low). NWT-03 egg protein hydrolysate showed no significant effect on blood pressure (MD: +0.5 mmHg [-1.8, +2.7]; two RCTs). Publication bias was not detected. Conclusions: Egg-derived protein supplementation provides clinical benefits in dialysis patients with hypoalbuminemia, but evidence is lacking supporting its routine use in healthy adults or other clinical populations.

Background: Since complex post-traumatic stress disorder (CPTSD) was incorporated to the International Classification of Diseases-11th revision (ICD-11), the construct has drawn increasing attention in clinical research due to its debilitating effects across multiple domains of functioning. However, whether stabilization (Phase 1) is necessary before exposure to traumatic memories (Phase 2) remains controversial.Objective: We examined whether phase-based interventions are more effective than non-phase-based interventions in reducing symptoms of CPTSD.Methods: On 17 June 2025, we searched the Cochrane Library, Embase, Medline, PTSDpubs, Scopus, and Web of Science as well as South Korean databases, including the Korean Citation Index, the Research Information Sharing Service, DataBase Periodical Information Academic (DBPia), and ScienceON. Randomized controlled trials of psychological interventions for individuals with clinically significant CPTSD symptoms or PTSD with at least two of the 'disturbances in self-organization' (DSO) symptom clusters were eligible. We used Hedges' g to pool effect sizes and performed subgroup analyses using Cochran's Q test. We assessed risk of bias using the Cochrane Risk-of-Bias Assessment 2 tool.Results: Across most outcomes, we observed no significant differences between phase- and non-phase-based interventions, between multi-phase and single-phase interventions, or between exposure and non-exposure interventions. However, multi-phase interventions had superior effects on PTSD, while phase-based, multi-phase, and exposure interventions showed greater improvements in DSO - affect regulation compared to their counterparts.Conclusions: This study was limited by the small number of available trials, single time-point, and heterogeneity in outcome measures, which constrained both the detection of subgroup differences and the precision of effect size estimates. Our findings provide empirical evidence for the current discourse, suggesting that non-phase-based and non-exposure-based interventions can be as effective as structured approaches in many contexts, while some outcomes may still benefit from phase-, multi-modular-, or exposure-ba

BACKGROUND: Digital biomarkers are increasingly being used to support depression assessment by providing objective, continuous, and real-time physiological and behavioral data. However, most existing studies have focused on individual biomarkers, such as sleep or cardiac parameters, while integrative evaluations that capture the multidimensional nature of depression remain limited. OBJECTIVE: This systematic review evaluated digital biomarkers for depression and synthesized evidence on differences between individuals with depression and controls. METHODS: Eligible studies included observational or interventional studies examining digital biomarkers for depression with validated outcome measures. We searched major international and Korean databases, including MEDLINE, PsycINFO, CINAHL, IEEE Xplore, Web of Science, Cochrane Library, KISS, RISS, KMbase, and KoreaMed, from inception to December 28, 2025. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Scottish Intercollegiate Guidelines Network checklist. Meta-analyses were conducted using random-effects models with the Hartung-Knapp-Sidik-Jonkman method, and other outcomes were narratively summarized. RESULTS: The search yielded 39,617 records, of which 132 studies involving 57,852 participants met the inclusion criteria. These studies encompassed various digital biomarkers, including sleep, physical activity, cardiac measures, smartphone-derived data, speech, GPS data, and circadian rhythms. A meta-analysis of 22 studies (6947 participants) revealed that individuals with depression had significantly longer sleep onset latency (5 studies; n=292; +4.75 min, 95% CI 2.46-7.04; P=.005; 95% prediction interval [PI] 0.01-10.27) and time in bed (3 studies; n=236; +31.81 min, 95% CI 18.22-45.39; P=.01; 95% PI 2.28-55.16). Physical activity counts were also significantly lower (5 studies; n=462; standardized mean difference -0.71, 95% CI -1.33 to -0.09; P=.03; 95% PI -2.18 to 0.71). Although individuals with depression showed a lower sleep efficiency, higher mean heart rate, and lower SD of normal-to-normal intervals, these differences were not statistically significant.

INTRODUCTION: This review synthesizes international evidence on occupational therapy (OT) interventions for total knee replacement (TKR) as part of the project "Developing Occupational Therapy Practice Guidelines for Total Knee Replacement," with the goal of informing practice within the Korean healthcare system. It evaluates OT interventions' effectiveness in enhancing recovery pathways amid an aging population, increasing healthcare costs, and the need for patient satisfaction and recovery. METHOD: Centering on OT interventions in Korea for adults with post-TKR, this review adhered to the Royal College of Occupational Therapists' guidelines and PRISMA standards and searched nine electronic databases for literature published between 2000 and November 2021. A broad stakeholder group, including medical professionals and social workers, contributed to refining the research scope of outcomes. RESULTS: From an initial pool of 10,749 articles, 51 studies were selected, predominantly cohort studies. Analysis identified key-OT interventions improving activities of daily living, mental health, community reintegration, patient satisfaction, and notably reducing hospital stay lengths. CONCLUSION: This review highlights the multifaceted contributions of OT in TKR rehabilitation, with benefits observed across physical, mental, and cognitive recovery. It supports the need for policy changes to broaden the role of OT. Future research, particularly high-quality and longitudinal studies, is warranted to further strengthen the evidence base and inform the ongoing development of OT practice across diverse healthcare systems.

BACKGROUND: Hypertensive patients tend to have an increased risk of hypotension during anesthesia induction, which can result in adverse outcomes. This study aimed to compare hemodynamic stability with remimazolam versus propofol in hypertensive patients. METHODS: This meta-analysis analyzed randomized controlled trials investigating the hemodynamic outcomes of remimazolam versus propofol during anesthesia induction in hypertensive adults. A systematic search of electronic databases was conducted in November 2024. RESULTS: Six studies were included in the final analysis. The administration of remimazolam significantly lowered the risk of hypotension (risk ratio [RR] = 0.711, 95% CI [0.545-0.929], I2 = 67.54%) and bradycardia (RR = 0.256, 95% CI [0.101-0.649], I2 = 0.0%). It also resulted in a higher minimum mean arterial pressure (mean difference [MD] = 9.023 mmHg, 95% CI [0.243-17.802], I2 = 97.50%) and higher minimum heart rate (MD = 7.200 beats/min, 95% CI [1.960-12.441], I2 = 86.40%). The trial sequential analysis revealed that none of the outcomes reached the required information size. CONCLUSIONS: The administration of remimazolam showed a trend toward superior hemodynamic stability compared with propofol during anesthesia induction in hypertensive patients, especially in minimizing the incidence of hypotension and bradycardia. However, the trial sequential analysis results remain inconclusive, the current evidence is limited by small sample sizes, and larger trials are needed to confirm our findings.

OBJECTIVE: To evaluate the feasibility of cerebral computed tomography angiography (CTA) obtained with reduced iodine and low radiation at 70 kVp and the effect of deep learning-based augmented contrast enhancement (DL-ACE) and denoising (DL-DN) algorithms on the CTA quality. MATERIALS AND METHODS: In this prospective study, 47 healthy volunteers (male:female, 31:16; mean age ± standard deviation, 57.8 ± 10.9 years) were randomly assigned to one of three CTA protocols: Group A (n = 16; 100 kVp, 40 mL of 350 mgI/mL), Group B (n = 16; 70 kVp, 40 mL of 270 mgI/mL), and Group C (n = 15; 70 kVp, 28 mL of 270 mgI/mL [ultralow iodine]), with an injection rate of 2.5 mL/s for all. Images were reconstructed using filtered back projection (FBP), and images in Groups B and C were additionally reconstructed using DL-ACE and DL-DN. Arterial attenuation, image noise, contrast-to-noise ratio (CNR), and subjective image quality were compared among five image sets. RESULTS: Compared with Group A, Groups B and C received 23.7% lower radiation doses. With FBP, arterial attenuation was significantly higher in Groups B (435.8 ± 50.2 Hounsfield units [HU]) and C (391.8 ± 52.1 HU) than in Group A (321.1 ± 47.4 HU) (P < 0.001), while CNR did not differ significantly (Group A, 19.9 ± 4.7; Group B, 20.3 ± 3.8; and Group C, 18.4 ± 4.6) due to higher image noise in Groups B and C. After applying DL-ACE and DL-DN in Groups B and C, arterial attenuation increased by 45.4% and image noise decreased by 34.5%, resulting in significantly higher arterial attenuation, CNR, and subjective image quality compared with Group A (P < 0.001). CONCLUSION: Cerebral CTA at 70-kVp using ultralow iodine enhanced arterial attenuation but increased image noise compared with the 100-kVp CTA protocol. DL-ACE and DL-DN significantly increased arterial attenuation and reduced image noise, resulting in higher CNR and better subjective image quality.

PURPOSE: To examine the safety and effectiveness of a novel psychotherapy based on imagery techniques, we conducted a randomized clinical trial comparing imagery stabilization and rescripting therapy (ISRT) with non-trauma-focused cognitive behavioral therapy (CBT) for adults with posttraumatic stress disorder (PTSD). MATERIALS AND METHODS: Eight sessions of 60-minute ISRT were conducted for the treatment condition (n=59), while the control group received eight sessions of 60 minutes of CBT (n=27). The Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were administered by clinicians, while self-questionnaires were administered at pretreatment, posttreatment, and the 6-month follow-up. RESULTS: Forty-two participants in the ISRT group and 20 participants in the CBT group completed more than six sessions; thus, dropout rates were not significantly different between the groups (17/59, 28.8% vs. 7/27, 25.9%, respectively). Although no statistical differences were found between conditions, both completer and intention-to-treatment analyses revealed that clinical status, PTSD symptoms, and quality of life favored ISRT after treatment and 6 months later. CONCLUSION: Our findings suggest that ISRT is a safe and effective treatment option for PTSD. © Copyright: Yonsei University College of Medicine 2026.

We aimed to evaluate the efficacy and safety of a spore-forming probiotic blend containing Clostridium butyricum IDCC 1301, Weizmannia coagulans IDCC 1201, and Bacillus subtilis IDCC 1101 for improving bowel function and well-being in adults with functional constipation (FC). In a randomized, double-blind, placebo-controlled trial, 78 adults with FC (Rome IV criteria) received either probiotic blend (n = 40) or placebo (n = 38) daily for 4 weeks. Primary outcomes were changes in weekly spontaneous bowel movements (WSBM) and stool form. Secondary outcomes included physical functioning scores from the 36-Item Short Form Health Survey. The probiotic blend group showed significant improvements in irritant bowel movements (p = 0.0458), incomplete evacuation (p = 0.0374), and abdominal pain before defecation (p = 0.0090). Stool consistency shifted toward normal types (Bristol types 3-4, p = 0.0176). Physical functioning improved only in the probiotic blend group (p = 0.0300). Probiotic blend effectively alleviated symptoms of FC and improved physical well-being. Trial registration: Clinical Research Information Service (CRIS), KCT0010085. Copyright: © 2026 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

BACKGROUND: Cardiac rehabilitation improves outcomes after percutaneous coronary intervention (PCI), but participation remains suboptimal due to barriers such as distance, cost, and lack of referral. Mobile health interventions may enhance accessibility and engagement. OBJECTIVE: This study evaluated the effectiveness and user acceptability of a smartphone messaging app (AnSim) in improving cardiovascular risk factors among patients who recently underwent PCI. METHODS: A 2-arm randomized controlled trial was conducted at 2 Korean hospitals; 120 patients who had undergone PCI within the prior month were randomized (1:1) to receive AnSim plus usual care (intervention) or usual care alone (control). The intervention comprised personalized messages tailored by behavioral stage and risk profile, delivered 6 times/week for 6 months. Outcomes were assessed at baseline, 6 months, and 9 months. The primary outcome was change in blood pressure (BP) at 6 and 9 months. Secondary outcomes were lipid profiles, hemoglobin A1c, BMI, smoking status, physical activity, and achievement of guideline-recommended risk-factor targets. User acceptability was assessed by questionnaire. RESULTS: Overall, 115 (95.8%; intervention: n=58, control: n=57) participants completed follow-up at 6 months and 110 (91.7%; intervention: n=54, control: n=56) at 9 months. At 6 months, systolic BP was 124.9 (SD 16.7) mmHg in the intervention group and 124.8 (SD 13.1) mmHg in the control group (between-group difference 0.1 mmHg, 95% CI -5.4 to 5.6), and diastolic BP was 80.2 (SD 11.4) mmHg vs 78.4 (SD 10.6) mmHg (difference 1.8 mmHg, 95% CI -2.3 to 5.9). At 9 months, systolic BP was 126 (SD 14.2) mmHg vs 128 (SD 15.4) mmHg (difference -2 mmHg, 95% CI -7.6 to 3.6), and diastolic BP was 80.8 (SD 13.2) mmHg vs 81.3 (SD 12.0) mmHg (difference -0.5 mmHg, 95% CI -5.3 to 4.3). No significant between-group differences were observed in secondary outcomes. In post hoc analyses, participants with above-median message reading were more likely to achieve ≥4 of 5 guideline-recommended risk-factor targets at 9 months (69% vs 19.2%; relative risk 3.59, 95% CI 1.57-8.18; P<.001) and logged more diary entries (mean differ

BACKGROUND: Recent advances in suction catheter technology suggest that suction aspiration may prevent thrombus fragmentation during mechanical thrombectomy. We therefore hypothesize that the radiological outcomes of suction aspiration as a first-line treatment would not be inferior to those of the combination technique. This study aims to evaluate the radiological and clinical outcomes of first-line suction aspiration compared with those of the first-line combination technique for large artery occlusion amenable to both modalities. METHODS: The COMPETE trial is a prospective, randomized, multicenter, noninferiority, open-label trial. A total of 1,136 patients will be randomized at a 1:1 ratio to either the suction aspiration or combination technique groups. RESULTS: The primary endpoints are successful recanalization (modified Thrombolysis in Cerebral Infarction scale score ≥ 2b) and a good clinical outcome (modified Rankin Scale score of 0-2) at 90 days after thrombectomy. The technical outcome is the switching rate from the combination technique to suction aspiration and from suction aspiration to the combination technique. The safety outcomes include procedural morbidity, nonprocedural morbidity, procedural mortality, and nonprocedural mortality. CONCLUSION: The COMPETE trial is expected to determine whether the use of suction aspiration as a first-line approach in patients with acute ischemic stroke is noninferior to the combination technique in achieving successful radiological and good clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06254755; CRIS (KCT0007726). © 2026 The Korean Academy of Medical Sciences.

BACKGROUND: While hearing aids (HAs) remain the primary intervention for hearing loss, their high cost creates barriers to access. Personal sound amplification products (PSAPs) are a more affordable alternative, but few studies have compared their efficacy to those of HAs. This multicenter, prospective, randomized, crossover trial was conducted to compare audiologic performance and user satisfaction between HAs and PSAPs to evaluate PSAP potential as alternatives for hearing rehabilitation. METHODS: A total of 73 participants with sensorineural hearing loss was enrolled. Participants used one hearing device (HA or PSAP) for 3 months before changing to the other for 3 months. Outcome measures were pure-tone audiometry, word recognition score, and Hearing in Noise Test score. Subjective satisfaction was measured using standardized questionnaires-the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids-and two custom surveys. RESULTS: HAs showed superior performance in high-frequency functional gain, speech perception in noise, and user satisfaction compared to PSAPs. Premium HAs demonstrated better performance than basic HAs, while basic HAs significantly outperformed both high-end and basic PSAPs. No significant differences were found between high-end and basic PSAPs. CONCLUSION: The superior audiologic performance of and user satisfaction with HAs compared to PSAPs support their continued preference for hearing rehabilitation. Although PSAPs offer a more affordable option, they may not meet the needs of individuals with hearing loss, particularly in terms of high-frequency gain and speech perception. TRIAL REGISTRATION: iCreaT Identifier: C220078. © 2026 The Korean Academy of Medical Sciences.

BackgroundDual antiplatelet therapy (DAPT) with aspirin and potent P2Y12 inhibitors such as ticagrelor effectively reduces ischemic events but increases bleeding risk. In patients requiring long-term DAPT, switching from ticagrelor to a thienopyridine is often considered to reduce bleeding risk or address other clinical concerns. However, such switching may cause a transient reduction in platelet inhibition, raising concerns about thrombotic complications. In particular, evidence is limited regarding the optimal loading dose strategy for East Asian patients undergoing this transition.MethodsIn this randomized, open-label trial, 43 patients with acute coronary syndrome (ACS) who had received ticagrelor-based DAPT for > 6 months after stent implantation were randomized to clopidogrel 600 mg loading/75 mg maintenance, clopidogrel 300 mg loading/75 mg maintenance, or prasugrel 30 mg loading/5 mg maintenance. Platelet reactivity and inflammatory markers (MMP-2, MMP-9, TNF-α) were assessed at baseline, 48 h, and 5 days after switching. The primary endpoint was the proportion of patients achieving optimal platelet reactivity (OPR).ResultsThe proportion of patients achieving OPR was similar among groups at baseline (p = 0.483), 48 h (p = 0.699), and 5 days (p = 0.729). No significant intergroup differences were observed in inflammatory marker levels at any time point. No major adverse cardiovascular events occurred during follow-up.ConclusionsIn stable ACS patients on long-term DAPT, switching from ticagrelor to either clopidogrel or prasugrel maintained consistent platelet inhibition and inflammatory profiles, indicating that these switching strategies produce comparable pharmacodynamic profiles in East Asian populations during the early post-switch period.Trial RegistrationThis investigator-initiated pharmacodynamic study was not prospectively registered.

TESTOPEAK™ (KGC08EA; Korea Ginseng Corporation, Daejeon, Korea) has been developed to improve the symptoms of andropause. This 8-week, randomized, double-blind, parallel-group, placebo-controlled study was conducted to assess its efficacy and safety in improving the symptoms of andropause in Korean men. The eligible subjects were randomized either to the trial group or the control group, followed by an 8-week treatment period. The subjects of the trial group (n = 48) and those of the control group (n = 48) were orally given a tablet of TESTOPEAK™ and its matching placebo, respectively, at a dose of 500 mg/day once daily in the morning within 30 min after meal during an 8-week treatment period. Efficacy outcome measures include differences in changes in the Aging Male's Symptoms (AMS) scores, the Androgen Deficiency in Aging Male (ADAM) scores, the International Index of Erectile Function (IIEF) scores, hormone biomarker levels, lipid biomarker levels and body compositions at 8 weeks from baseline between the two treatment arms. Incidences of adverse events (AEs) served as safety outcome measures. There were significant differences in changes in the AMS scores, the ADAM scores, the IIEF scores, total testosterone, free testosterone and sex hormone binding globulin (SHBG) levels, total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol levels and triglyceride levels and visceral and total fat area at 8 weeks from baseline between the two groups (p < .05). Moreover, there were no cases of AEs in each treatment group. TESTOPEAK™ is an effective, safe natural compound in alleviating symptoms of andropause in middle-aged or elderly men.

Objectives: This randomized, double-blind, placebo-controlled 12-week clinical trial evaluated the efficacy and safety of a standardized ethanol extract of purple perilla leaves (Perilla frutescens Britton var. acuta Kudo; PE) in adults with cognitive impairment. Methods: Subjects who met the inclusion criteria were randomly assigned in a 1:1 ratio to one of two groups and received PE (n = 50, 500 mg/day) or placebo (n = 50) for 12 weeks. The primary efficacy outcomes included cognitive function, which was assessed by the Korean mini-mental status examination-2 (K-MMSE-2) and the Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog), and plasma amyloid β (Aβ) and brain-derived neurotrophic factor (BDNF) levels, which were measured as secondary biochemical markers. The safety biomarkers were also assessed before and after the intervention. Results: After 12 weeks of intervention, the K-MMSE-2 total score, the K-MMSE-2 subdomain scores (attention and calculation and language), the ADAS-Cog total score, and the ADAS-Cog subscale scores (word recall, commands, delayed word recall, naming, word recognition, and recall instructions) showed statistically significant between-group improvements compared with the placebo group. Improvements were observed in both groups, whereas the magnitude of cognitive enhancement was greater in the PE group, indicating an effect beyond placebo-related responses. No statistically significant between-group differences were observed in plasma Aβ or BDNF levels. The safety evaluation found no clinically significant changes. Conclusions: Twelve-week administration of PE significantly improved cognitive outcomes without safety concerns, suggesting its potential as a standardized botanical ingredient for supporting cognitive function in individuals with early cognitive impairment.

PURPOSE: This study aimed to evaluate the feasibility and analgesic potential of a guided breathing virtual reality (VR) intervention for managing pain in patients with cancer undergoing percutaneous transhepatic biliary drainage (PTBD). METHODS: In a randomized, controlled design, patients were assigned to receive either VR with guided deep breathing (VRBG) or conventional VR without breath guidance (VROG). Each group experienced two 7-min VR sessions featuring calming visuals and narration, with the VRBG receiving additional prompts to induce slow, rhythmic breathing. RESULTS: A total of 45 patients (VRBG, 22; VROG, 23) were enrolled. On the day following PTBD, opioid consumption was significantly lower with VRBG than with VROG (20.25 vs. 56.61 morphine milligram equivalents; P = 0.044). No significant difference was observed in opioid use on the day of the procedure. Patient satisfaction and willingness to reuse VR were comparable between the groups. Mild adverse events were infrequent and self-limiting. CONCLUSION: The study findings suggest that incorporating structured breathing guidance into VR may enhance its analgesic effect and reduce reliance on opioids after invasive procedures. To our knowledge, this is the first prospective trial to combine VR and guided breathing for PTBD-related pain, and our findings support the potential of guided breathing VR as a non-pharmacological adjunct in cancer pain management. Trial Registration Clinical Research Information Service ( http://cris.nih.go.kr , KCT0006775). © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Later-life employment transitions have complex health implications, yet few studies examine the asymmetric effects of workforce entry and exit on frailty. Using seven waves of the Korean Longitudinal Study of Aging (KLoSA), this study analyzed 6,165 adults aged 65 and older to assess how employment transitions affect frailty and whether these effects differ by gender. Frailty was measured using a 41-item index, and asymmetric fixed effects models were applied to distinguish the health impacts of entering versus exiting the workforce. Gender-stratified models showed a positive association between employment and frailty only among women. Notably, asymmetric models revealed that exiting the workforce was associated with reduced frailty for women, while entering the workforce was not significantly linked to increased frailty. Gender interaction models confirmed these findings. The results underscore the importance of considering gender and asymmetry in employment transitions and suggest policies supporting better working conditions for older women.

Appropriate bowel cleansing is essential for successful and safe colonoscopy. Inadequate bowel cleansing can lead to poor visualization of the delicate mucosa, leading to missed precancerous lesions, increased risk of procedure-related complications, and increased medical costs due to re-examination. Several types of bowel cleansing agents that improve ease of administration have been developed in recent years, and the clinical outcomes have been published. Bowel cleansing efficiency can differ between races due to differences in socio-environmental factors, including dietary patterns. This paper is the first Korean clinical guideline for bowel preparation for colonoscopy, formulated by the Korean Society of Gastrointestinal Endoscopy. These guidelines were developed using adaptation methods and the findings of studies on Korean patients; recently published studies were considered to the extent possible. These guidelines will be revised as and when new data regarding bowel preparation are accumulated.

Search coil magnetometers (SCMs) are widely used in space science missions to measure time-varying magnetic fields. However, conventional SCM designs often increase sensor mass and electronic power consumption in order to meet mission-specific sensitivity requirements. This study presents the design and ground-based test results of a space search coil magnetometer (SSCM) concept aimed at reducing sensor mass and electronic power consumption while maintaining practical system operability for platform-constrained missions. Mass reduction was achieved by adopting a rolling-sheet core configuration. In addition, printed circuit board (PCB)-based interconnections between segmented windings were implemented to improve the reproducibility of assembly and mechanical robustness without additional structural complexity. Power reduction was achieved by employing an application-specific integrated circuit (ASIC)-based sensor amplifier and a compact control electronic unit implemented as a modular stack with a 1U CubeSat standard board form factor. Performance tests confirmed the stable operation of the integrated sensor-electronics chain over the target measurement band. The system-level noise-equivalent magnetic induction (NEMI) measured under laboratory conditions was 33 fT/√Hz at 1 kHz. Environmental tests including vibration and thermal cycling were performed to further verify the structural safety and functional stability of the sensor assembly under space-relevant conditions. The proposed SSCM architecture provides a practical approach for implementing low-mass and low-power magnetic field instruments for platform-constrained space missions.

Small-molecule immunomodulators have become important components of modern immunotherapy by targeting immune checkpoints, cytokine signaling pathways, metabolic enzymes, and intracellular kinases. Despite pharmacological rationale, many of these agents underperform clinically due to unfavorable physicochemical properties, rapid systemic clearance, limited target accumulation, and dose-limiting toxicities, reflecting inadequate exposure control rather than a lack of target validity. Polymeric micelles, formed through the self-assembly of amphiphilic block copolymers, offer a versatile delivery platform to address these challenges by enhancing solubility, modulating pharmacokinetics, enabling stimuli-responsive release, and facilitating targeted or synchronized co-delivery. In this review, we classify representative small-molecule immunomodulators according to their immunological targets and examine the delivery constraints that shape their therapeutic performance. We then discuss design principles of polymeric micelle systems, including solubilization-driven formulations, microenvironment-responsive architectures, spatial targeting strategies, and co-delivery approaches that align cytotoxic and immunomodulatory mechanisms. Attention is given to the distinction between direct immunomodulators and cytotoxic agents that induce immunogenic cell death, highlighting how micelle-based delivery can enhance efficacy through improved exposure control. By integrating immunopharmacology with formulation science, this review outlines how polymeric micelles may advance the efficacy and safety of small-molecule immunomodulators and identifies key considerations for future translational development.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is characterized by incomplete recovery of airflow blockage; however, effective therapeutic agents that can prevent lung function deterioration are limited. East Asian herbal treatments have gained attention for their potential benefits in managing COPD. This study aimed to evaluate the inhibitory effects of Gyeongok-go (GOG) on lung injury in a COPD mouse model. Methods: Lipopolysaccharide (LPS)-induced alveolar macrophage (MH-S) cells were treated with GOG (50, 100, 200, and 400 μg/mL), and analyzed using enzyme-linked immunosorbent assay (ELISA). C57BL/6 mice were challenged with cigarette smoke extract and LPS and then treated with vehicle only, dexamethasone (3 mg/kg), or GOG (100, 200, or 400 mg/kg). Bronchoalveolar lavage fluid (BALF) or lung tissues were analyzed using cytospin, ELISA, real-time PCR, flow cytometry, hematoxylin and eosin, and Masson's trichrome staining. Results: Treatment with GOG decreased tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 expression in LPS-challenged MH-S cells. In COPD mice, GOG significantly decreased the elevated numbers of neutrophils, total cells, macrophages, and Gr-1+/Siglec-F, Gr-1+/CD11b+, and CD44high/CD62L- cells. It also downregulated the expression of TNF-α, IL-17A, macrophage inflammatory protein-2 (MIP2), and CXC chemokine ligand-1 in BALF. GOG also inhibited the increase in Mip2, Cox-2, and Trpv1 mRNA expression. Moreover, GOG prevented the increase in the number of total cells, neutrophils, Gr-1+/Siglec-F, Gr-1+/CD11b+, CD44high/CD62L-, and CD21+/CD35+/B220+ cells in lung tissues. Notably, GOG decreased the severity of lung injury. Conclusions: Overall, these findings indicate that GOG alleviates lung injury, suggesting its potential in the treatment of COPD.

Background and Objectives: represents a major public health challenge in rapidly aging societies. While lifestyle behaviors are established modifiable risk factors for frailty, the longitudinal impact of composite lifestyle trajectories-particularly by sex-remains poorly understood. This study examined sex-stratified associations between Healthy Lifestyle Score Trajectories (HLSTs) and frailty among community-dwelling middle-aged and older adults in South Korea. Using 19 years of nationally representative panel data from the Korean Longitudinal Study of Aging (2006-2024), we analyzed 6603 participants (2684 males; 3919 females). Materials and Methods: Group-Based Trajectory Modeling was applied to Waves 1-6 to derive sex-specific HLSTs based on smoking, alcohol consumption, physical activity, and body mass index. Generalized Estimating Equations were used to assess longitudinal associations between HLSTs and Frailty Index (FI) scores across Waves 6-10, adjusting for sociodemographic covariates. Results: Five distinct HLSTs were identified in both sexes. In both males and females, persistently poor or deteriorating trajectories were independently associated with higher FI scores relative to the Favorable HLST reference group. The effect size for Poor HLST was more than twice as large in females (B = 0.039) than in males (B = 0.018), consistent with the sex-frailty paradox. Among females, the Improving HLST group did not demonstrate a statistically significant frailty benefit (B = 0.014, p = 0.091). Stratified analyses revealed that the lifestyle-frailty association among males was significant only in rural-dwelling participants, whereas in females the association was consistent across both urban and rural settings. Conclusions: Persistently unfavorable composite lifestyle trajectories were independently associated with higher frailty burden, with disproportionately greater impact in women. Late-life lifestyle improvement was not significantly associated with reduced frailty in women, reinforcing the importance of early and sustained behavioral maintenance. The rural-specific association in men highlights the role of structural disadvantage in amplifying lifestyle

Background and Objectives: Parkinson's disease (PD) entails the progressive degeneration of dopaminergic neurons in the substantia nigra (SN), accompanied by α-synuclein (α-syn)-enriched Lewy bodies. ITGA7 mediates cell-extracellular matrix adhesion and modulates apoptosis, though its involvement in PD pathogenesis warrants further investigation. Although acupuncture demonstrates neuroprotective effects in PD models, its precise molecular mechanisms remain incompletely understood; therefore, in this study, we explored the relationship between ITGA7 and α-synuclein expression in an MPTP-induced PD mouse model to determine the association between LR3/GB34 acupuncture-induced changes in α-synuclein levels and ITGA7 modulation. Materials and Methods: In the in vivo model, MPTP-induced PD mice underwent immunohistochemistry, immunofluorescence, and Western blotting to assess ITGA7, α-synuclein, and TH levels in the SN and striatal tissues following LR3/GB34 acupuncture. In parallel, for the in vitro mechanistic study, SH-SY5Y neuroblastoma cells treated with MPP+ and transfected with ITGA7-siRNA were utilized to examine the involvement of apoptosis-related signaling pathways. Results: In the in vivo model, MPTP administration downregulated ITGA7 and upregulated α-synuclein in SN tissues. Similarly, in vitro exposure of SH-SY5Y cells to MPP+ yielded comparable results, revealing an inverse correlation between ITGA7 and α-synuclein. LR3/GB34 acupuncture treatment in the mouse model significantly increased ITGA7 and TH expression while reducing α-synuclein accumulation. To further understand the specific role of ITGA7 observed in these animal findings, we silenced ITGA7 in the MPP+-treated cellular model. ITGA7 silencing exacerbated the neurotoxic effects, leading to further TH downregulation, α-synuclein upregulation, Bcl-2 reduction, and Bax/Bcl-2 ratio elevation. Conclusions: Collectively, the histological preservation of dopaminergic neurons following LR3/GB34 acupuncture in the PD mouse model appears to be linked to ITGA7 upregulation. Furthermore, our in vitro findings implicate ITGA7 in the regulation of apoptosis-related signaling cascades, supporting its potent

Scalp microbes are recognized as contributors to hair loss by influencing scalp homeostasis and hair growth. However, the in vitro anti-hair loss activity of microbial culture media derived from healthy scalps remains unclear. In this study, resident microbes from 20 Korean participants with healthy scalps and hair were isolated, and Staphylococcus capitis was used to produce S. capitis ferment filtrate (SCFF). SCFF anti-hair loss activity was evaluated in human follicle dermal papilla cells (HFDPCs) and human adult low-Calcium High-Temperature (HaCaT) keratinocytes via proliferation assays, qPCR, immunocytochemistry, and SA-β-gal staining at 250-1000 μg/mL. SCFF increased cell density after 48 h in a concentration-dependent manner. In HFDPCs, SCFF controlled growth (KGF, IGF-1, and HGF) and androgen (AR and TGF-β2) factors, regulating key mRNAs for hair growth. SCFF mitigated scalp and hair aging by promoting sirtuins 1 and 7 and collagen type 13, while suppressing p21 and X-Gal staining. In HaCaT cells, SCFF exhibited a scalp barrier-strengthening effect by significantly increasing filaggrin and involucrin levels. It suppressed reactive oxidative stress and exhibited DPPH and ABTS radical scavenging activity. These results suggest that SCFF may modulate key pathways associated with hair loss by promoting scalp and hair anti-aging, barrier strengthening, enhancing antioxidant activity, and supporting hair growth.

Background/Objectives: Korean traditional fermented foods may confer metabolic and anti-inflammatory benefits; however, their high sodium content raises concerns, particularly given age-related differences in sodium sensitivity. This study examined age-specific associations between fermented food intake and high-sensitivity C-reactive protein (hs-CRP), a marker of low-grade systemic inflammation, and assessed whether sodium intake modifies these associations. Methods: Data from KNHANES 2015-2018 were used to analyze 17,984 adults. Fermented foods were categorized into 10 groups (grains, jang, vinegars, vegetables, fish, fruits, dairy, alcoholic beverages, sauces, and tea/beverages). Intake (% of total energy) was classified into quartiles. Elevated hs-CRP was defined as ≥1 mg/L. Complex-sample multivariable logistic regression was used to assess age-stratified associations and interactions with total sodium and fermented food-derived sodium (SPSS 29.0; p < 0.05). Results: Fermented food intake decreased with age (p < 0.001). In adults aged 20-39, higher intake was associated with lower odds of elevated hs-CRP (Q4 vs. Q1: OR = 0.699, 95% CI 0.542-0.901; p for trend = 0.002). A similar inverse association was observed in those aged 40-64 (Q4: OR = 0.817, 95% CI 0.691-0.967; p for trend = 0.006), which remained significant after adjustment for fermented food-derived sodium. Among adults ≥65, significant interactions were observed for both fermented food-derived sodium (p = 0.040) and total sodium (p = 0.042), indicating variation across sodium intake levels. Conclusions: The association between fermented food intake and systemic inflammation differs by age. In older adults, this relationship appears to be modified by dietary sodium context, highlighting the importance of age-specific dietary considerations.

3-Nitrooxypropanol (3-NOP) has been recognized as an effective feed additive to reduce enteric methane (CH4) emissions in ruminants. The current experiment evaluated the effects of supplementation of Bovaer®10 (diluted preparation of 3-NOP, minimum 10% w/w) on enteric CH4 emissions in Hanwoo (Korean native cattle) steers. Twelve Hanwoo steers (average body weight 342 ± 17 kg) were divided into three groups of four steers balanced for body weight. Within each group, steers were randomly assigned to three dietary treatments in a crossover design, receiving each treatment in a different period of 32 d. The treatments were: 1) CON, 500 g/kg dry matter (DM) timothy hay and 500 g/kg DM commercial concentrate; 2) NOP100, CON diet supplemented with 100 mg of 3-NOP per kg dietary DM; 3) NOP150, CON diet supplemented with 150 mg of 3-NOP per kg dietary DM. Gas emissions (CH4 and carbon dioxide [CO2]) were measured using the whole-body respiratory chambers (RC). Compared to control, NOP100 and NOP150 decreased CH4 absolute emissions by 21.9% and 29.5% (P < 0.01) and CH4 yield (g/kg DM intake [DMI]) by 22.9% and 27.7% (P < 0.01), respectively. The proportion of gross energy intake lost as CH4 (Ym) decreased (P < 0.01) by 22.8% and 27.6% in NOP100 and NOP150, respectively. NOP150 diet slightly decreased DMI of the steers both in the barn (2.5%; P < 0.05) and in the RCs (3.3%; P = 0.06). However, no negative effect (P > 0.05) on final body weight, average daily gain, or gain-to-feed ratio was observed. Increased (P < 0.05) ruminal pH and decreased total volatile fatty acid and ammonia concentration was noted in 3-NOP fed animals in a dose-dependent manner after 2 h of feeding. The increase (P < 0.01) in molar proportions of butyrate and propionate and decrease (P < 0.01) in acetate: propionate ratio, respectively, clearly reflected a shift in the ruminal H2 sink in 3-NOP-fed animals. Overall, supplementing 3-NOP to ruminant diets decreased CH4 emissions without any adverse effects on the performance of Hanwoo steers at the tested levels. Plain Language Summary: This study evaluated the efficacy of 3-nitrooxypropanol (3-NOP), a feed additive marketed as Bovaer®10, on enteric