Importance:Esophageal squamous cell carcinoma (ESCC) is highly prevalent in Asian populations and carries a poor prognosis. With growing numbers of cancer survivors, the prognostic impact of prior cancer in ESCC remains unclear. Most existing data are derived from Western cohorts dominated by adenocarcinoma, limiting generalizability to Asian populations. Objective:To evaluate whether prior cancer is associated with overall survival (OS) and esophageal cancer-specific mortality (ECSM) in a nationwide Korean ESCC cohort. Design, Setting, and Participants:A retrospective cohort study of patients with newly diagnosed ESCC across 19 tertiary hospitals in Korea from 2005 to 2017 was conducted. Follow-up was completed in 2017. Data were reanalyzed in August 2025. Exclusion criteria were nonsquamous histology (including adenocarcinoma), diagnosis of esophageal cancer within 6 months of a prior cancer, multiple prior cancers, and hematologic cancers. Exposures:History of cancer before the diagnosis of ESCC, classified by cancer type and latency (≤5 years vs >5 years). Main Outcomes and Measures:The primary outcome was OS, and the secondary outcome was esophageal cancer-specific mortality (ECSM). Hazard ratios (HRs) and cause-specific hazard ratios (CSHRs) were estimated after adjustment for clinicopathologic and treatment variables. Propensity score-adjusted Cox regression and competing risk regression models were used. Subgroup analyses were conducted by prior cancer type and latency period. Results:Of the 5557 patients (mean [SD] age, 64.7 [8.9] years; 5168 [93.0%] male), 368 (6.6%) had a prior cancer and were older and more often diagnosed at an earlier stage than those without prior cancer. Patients with a prior cancer had significantly poorer outcomes, with a median OS of 3.58 (95% CI, 2.50-4.92) vs 4.25 (95% CI, 3.83-4.58) years and a 3-year ECSM of 8.35% (95% CI, 4.42%-12.29%) vs 4.98% (95% CI, 4.17%-5.78%) compared with those without a prior cancer. Prior cancer was independently associated with worse OS (HR, 1.25; 95% CI, 1.07-1.47) and ECSM (CSHR, 1.89; 95% CI, 1.09-3.29). Among prior cancer types, patients with a history of stomach, head and neck, or lung cancer demonstrated poorer OS (HR, 1.63; 95% CI, 1.24-2.15; P < .001). A latency of 5 or more years was also associated with reduced OS (HR, 1.27; 95% CI, 1.03-1.57; P = .02). Conclusions and Relevance:In this nationwide Korean cohort study, prior cancer was an independent adverse prognostic factor in ESCC, with stomach, head and neck, and lung cancers associated with the poorest outcomes.
Background: Medication-related patient safety incidents are among the most common and preventable sources of harm in healthcare systems worldwide. In Korea, medication incidents have consistently ranked among the most frequently reported patient safety events since the implementation of the national patient safety reporting system. However, national-level evidence examining recent trends and factors associated with clinically significant harm remains limited. Methods: This retrospective observational study analyzed medication-related patient safety incidents reported to the Korea Patient Safety Reporting & Learning System (KOPS) from 2020 to 2024. KOPS operates as a hybrid system with voluntary reporting for general incidents and mandatory reporting for severe events since 2021. Harm severity was dichotomized into near-miss incidents and adverse/sentinel events. Of 36,281 reported incidents, 9495 were included after excluding cases with missing key variables. This dichotomization was applied to distinguish clinically meaningful harm and support robust statistical analysis. Results: Medication-related incidents showed an increasing trend in reported cases over time (annual percent change: 15.38%; 95% CI, 6.0-25.6%). Among the analyzed cases, 21.2% resulted in adverse/sentinel events. These events were more frequently observed in large hospitals, emergency and critical care settings, and during evening and nighttime periods. This increase may reflect changes in reporting practices following mandatory reporting policies, as well as potential changes in medication-related risks. Conclusions: Reported medication-related incidents are increasing, and a substantial proportion are associated with harm. However, these findings should be interpreted cautiously, as they reflect reported incidents rather than the true incidence of medication errors. Targeted strategies focusing on high-risk settings (emergency/critical care), vulnerable patient groups, and off-hour periods may be needed. Integrating risk-based approaches into national patient safety policies may help reduce preventable harm.
Background/Aims Left ventricular ejection fraction (LVEF) is a key echocardiographic parameter for assessing LV systolic function, guiding the management of many cardiovascular diseases, including heart failure (HF). While traditional electrocardiography (ECG) has been widely used in clinical practice, it has limitations in predicting LVEF. This study investigated the impact of integrating ECG data with metadata, such as age, N-terminal pro B-type natriuretic peptide (NT-proBNP), and sodium levels, to enhance the accuracy of LVEF prediction, especially in HF with reduced ejection fraction (HFrEF, LVEF ≤ 40%). Methods This retrospective study analyzed ECG and metadata from two tertiary teaching hospitals in Korea. A deep neural network (EfficientNet B3) was trained to predict LVEF, incorporating clinical metadata alongside ECG inputs. Model performance was assessed using the area under the curve (AUC) and the coefficient of determination (R2). Results The artificial intelligence (AI) model achieved an AUC of 0.95 when ECG data were combined with age, NT-proBNP, and sodium levels, outperforming models relying on ECG alone (AUC = 0.90). The integration of metadata significantly improved the prediction accuracy, particularly for HFrEF cases. The specificity of the model remained high (96.9%), but sensitivity was relatively low (54.8%), indicating its potential as a screening tool for HFrEF. Conclusions The combination of ECG and metadata results using AI enhances the predictive accuracy of HFrEF detection. This approach offers a scalable and noninvasive method for HF screening and risk stratification, particularly in resource-limited settings. Further validation in diverse populations is needed to confirm its clinical utility.
Background The clinical and prognostic implications of asymptomatic tuberculosis remain poorly understood. Methods We 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. Results Of 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). Conclusion Asymptomatic 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.
BACKGROUND:Although low-dose triple single-pill combination therapies show promising efficacy and safety, studies comparing them to standard-dose monotherapies remain limited. This phase III, randomized, double-blind trial evaluated the efficacy and safety of a low-dose single-pill combination of telmisartan, amlodipine, and chlorthalidone versus standard-dose telmisartan monotherapy in patients with essential hypertension. METHODS:After a 4-week placebo run-in period, 314 eligible subjects were randomized to either receive telmisartan/amlodipine/chlorthalidone 20/2.5/6.25 mg or telmisartan 40 mg for 8 weeks. The primary efficacy end point was the change in mean sitting systolic blood pressure from baseline to week 8, with noninferiority assessed in the per-protocol set (PPS), followed by superiority testing in the full analysis set using a gatekeeping approach to control for type I error. RESULTS:At week 8, the combination group demonstrated significant mean sitting systolic blood pressure reduction compared with monotherapy in the per-protocol set analysis (least squares mean difference, -3.8 mm Hg [95% CI: -6.7 to -0.9]; P=0.01), establishing its noninferiority. Furthermore, the superiority of the combination therapy was confirmed in the full analysis set (LS mean difference, -4.0 mm Hg [95% CI, -6.8 to -1.3]; P<0.01). Mean sitting diastolic BP, BP normalization rates, and response rates also favored the combination group at weeks 4 and 8 (all P<0.01). Subgroup analyses showed consistent efficacy across clinical strata, including age and prior antihypertensive treatment. The incidence of adverse events was comparable between groups, with no serious drug-related events reported. CONCLUSIONS:Low-dose triple single-pill combination of telmisartan/amlodipine/chlorthalidone demonstrated superior BP-lowering efficacy with well-tolerated and comparable safety to standard-dose telmisartan monotherapy. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06348576.
