Explore the vast range of titles available.

Background: Pediatric cardiologists (PCs) and pediatric cardiac surgeons (PedCSs) in Korea face growing workforce shortages due to declining birth rates, decreasing interest among trainees, and increasing burnout.Purpose: This study investigated the working conditions, job satisfaction, and burnout levels among Korean PCs and PedCSs.Methods: In June 2023, the Korean Pediatric Heart Society distributed a structured questionnaire via email to 149 members actively practicing pediatric cardiac care (115 PCs, 34 PedCSs). Responses from 122 members were analyzed. Descriptive statistics and regression analyses were performed to identify the factors associated with burnout (P<0.05).Results: A total of 122 physicians (96 PCs, 26 PedCSs) completed the survey (response rates: overall, 81.9%; PCs, 83.5%; PedCSs, 76.5%). Among the PCs, 79.2% worked more than 51 hr/wk, 57.3% worked night shifts, and 70.8% experienced emergency callbacks at least once per month. PedCSs reported comparably heavy burdens, with 80.8% working >51 hr/wk and 88.5% experiencing monthly emergency callbacks. Regional disparities were notable: 48.2% of PCs in the Seoul metropolitan area (SMA) performed >51 catheterizations annually versus 7.1% in other regions, while 62.5% of PedCSs in the SMA performed >30 surgeries annually versus 20% elsewhere. Litigation, reported by 66.7% of PCs versus 84.6% of PedCSs, contributed to dissatisfaction and burnout. The key drivers included limited research time, legal risks, and nonspecialized duties. Overall, 64.0% of the PCs and 61.6% of the PedCSs reported experiencing burnout. In the multivariable analysis, answering ≥6 emergency callbacks/mo (adjusted odds ratio [aOR], 7.91; 95% confidence interval [CI], 1.28–48.79), occupational dissatisfaction (aOR, 2.57; 95% CI, 1.09–6.04), and work environment dissatisfaction (aOR, 2.74; 95% CI, 1.16–7.14) independently predicted burnout, whereas the working >51 hr/wk variable did not remain significant postadjustment.Conclusion: Excessive workload, frequent emergency callbacks, regional maldistribution of case volumes, litigation pressure, and occupational dissatisfaction drive high burnout among Korean pediatric cardiac specialists. These findings highlight persistent workforce challenges in Korea’s pediatric cardiac system. Regular surveys and ongoing research are essential to ensuring sustainable pediatric cardiac care.

As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.

Background The increasing hypertension (HTN) prevalence in children, largely driven by obesity, highlights the need to investigate its risk factors, including the role of abdominal obesity. Methods We analysed data from the Korea National Health and Nutrition Examination Survey (2007–2021) to assess the prevalence of overweight and obesity (OW-OB), elevated blood pressure (EBP), and HTN among 11,554 participants aged 10–18 years. EBP and HTN were defined according to the 2017 American Academy of Pediatrics guidelines, and abdominal obesity was defined as a waist-to-height ratio (WHtR) of ≥ 0.5. Secular trends in the prevalence of OW-OB and EBP-HTN were examined across five time periods, and risk factors for EBP-HTN were evaluated in OW-OB children stratified by abdominal obesity status. Results The prevalence of EBP, HTN, and OW-OB was 8.22% (95% confidence interval [CI], 7.60–8.86), 10.46% (95% CI, 9.72–11.20), and 25.11% (95% CI, 24.17–26.05), respectively. Among the 3,015 participants with OW-OB, 13.53% (95% CI, 12.03–15.04) and 17.64% (95% CI, 15.98–19.31) were diagnosed with EBP and HTN, respectively. Although the prevalence of OW-OB and EBP-HTN had increasing trends from 2007 to 2009 to 2019–2021, these trends were not statistically significant. In the children with OW-OB, obesity severity, male sex, older age, and paternal HTN were associated with EBP-HTN. The HTN risk factors differed according to abdominal obesity status. In participants with abdominal obesity, male sex (OR 2.32, 95% CI 1.643–3.299; p  < 0.0001), older age (OR 1.16, 95% CI 1.102–1.233; p  < 0.0001), and severe obesity (OR 3.12, 95% CI 1.991–4.895; p  < 0.0001) were significant risk factors; whereas, in those without abdominal obesity, paternal HTN (OR 1.66, 95% CI 1.207–2.303; p  = 0.0025), hypercholesterolemia (OR 1.85, 95% CI 1.114–3.083; p  = 0.0178), male sex (OR 1.83, 95% CI 1.329–2.530; p  = 0.0002), and older age (OR 1.11, 95% CI 1.036–1.198; p  = 0.0038) were significant risk factors. Conclusions In children with overweight or obesity, the risk factors for EBP-HTN vary depending on the presence of abdominal obesity. These findings highlight the need for differentiated surveillance and prevention strategies based on abdominal obesity status in this high-risk population. Clinical trial number Not applicable

A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO). This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.

The association between coronavirus disease 2019 (COVID-19) and Kawasaki disease (KD) remains controversial. Prior to the nationwide epidemic of COVID-19, there was a unique, large-scale, regional outbreak in Daegu and Gyeonsangbuk-do (DG) in Korea in the spring of 2020. We evaluated the impact of COVID-19 on KD by comparing the characteristics of KD incidence between epidemic and non-epidemic regions in Korea. We analyzed nationwide Health Insurance Review and Assessment (HIRA) data to estimate KD incidence from February 2019 to July 2020. Patients below 18 years who were admitted with KD and administered both intravenous immunoglobulin and aspirin (ICD-10 code M303 for KD) were included in the study. We compared the incidence of KD in DG and other regions by analyzing the period-specific incidence from February to May before and after the COVID-19 era. A total of 4461 patients were identified to have KD nationwide from February 2019 to July 2020. The nationwide incidence of KD was significantly reduced during this period compared with the period from February 2018 to July 2019 ( < 0.001). In the DG region, within the 0-4-years age group, there was no significant difference in the incidence of KD between periods ( = 0.714). In the 5-9 years age group, a significant decrease in KD incidence was observed in the DG region and all other regions from February 2019 to July 2020. There was a significant decrease in nationwide KD incidence during and until 2 months after the local epidemic in Korea. However, no significant decrease in KD incidence was observed in the 0-4 years age group in the DG region where the local COVID-19 outbreak occurred. A larger study is necessary to determine the correlation between KD in this age group and the COVID-19 outbreak.

We investigated whether nonpharmaceutical interventions (NPI) to reduce the spread of coronavirus disease 2019 (COVID-19) was associated with a change in the incidence of immune thrombocytopenia (ITP). Using the Korean Health Insurance Review and Assessment Services (HIRA) database, individuals newly diagnosed with ITP between January 2015 and December 2020 were identified. The NPI period was defined as February 2020 to December 2020. The ITP incidence in the NPI period was compared with the mean annual incidence during the same months in the pre-NPI period and the incidence predicted by the autoregressive integrated moving average model. In total, 25,723 patients were identified, and the overall annual incidence of ITP was 8.28 per 100,000 persons ([95% confidence interval (CI): 8.18-8.39]. The ITP incidence in the NPI period was 6.60 per 100,000 person-years (95% CI: 6.37-6.85), 0.77 times (95% CI: 0.74-0.80) lower than that during the pre-NPI period [8.62/100,000 (95% CI: 8.50-8.74)]. With the exception for patients aged ≥70 years, the ITP incidence was significantly lower in the NPI period than in the pre-NPI period. The most significant decline in the ITP incidence during the NPI period was observed in the 0-9 years age group [25.76/100,000 vs 14.01/100,000, <0.001; incidence rate ratio (IRR): 0.54 (95% CI: 0.51-0.58)]. The intravenous immunoglobulin-treated ITP incidence in the NPI period was 1.69/100,000 (95% CI: 1.58-1.81), 0.79 times (95% CI: 0.73-0.85) lower than that in the pre-NPI period 2.15/100,000 (95% CI: 2.09-2.21)]. The incidence of steroid-treated ITP was lower in the NPI period than in the pre-NPI period (2.73/100,000 vs 2.2/100,000, <0.001), with an IRR of 0.80 (95% CI: 0.76-0.83). This nationwide study revealed a significant decrease in ITP incidence, particularly among children, after the implementation of NPI.

Meanwhile, in Canberra, Opposition foreign affairs spokesman Kevin Rudd criticised Mr [Alexander Downer] over comments about what Australia would do if war broke out between China and Taiwan. In Beijing on Tuesday, Mr Downer said Australia would not be obliged to assist the US in a military defence of Taiwan. Mr Downer said the Australia/US treaty was invoked only if the Australian or American mainlands were attacked and did not automatically lock Australia into joining the US in military actions anywhere else. Mr Rudd said Mr Downer should have handled the issue differently. Australia, he said, had a long-standing bipartisan consensus not to comment on the prospect of future military action in the Taiwan Straits.

About 125 people were killed in South Korea and scores were missing after flames and smoke engulfed two crowded subway trains following an arson attack. Fire beginsSpreadsFire engulfs both trainsTrain 1080Train 1079SOUTH KOREASeoulDaegu; Photo: Photo: fire in subway train in daegu, south korea - women cryingMap: daegu, south koreaDiagram: train 1079 and train 1080

HORROR RIDE: A photograph taken by a subway passenger shows people struggling to breathe as smoke fills their carriage.AFTERMATH: The charred remains of the carriages, and relatives of the subway fire victims.; Photo: Photo (color): fire in subway train in daegu, south korea - carriage filing with smokePhoto (color): fire in subway train in daegu, south korea - burnt out remains of train carriagePhoto (color): fire in subway train in daegu, south korea - women crying

The human microbiome plays an essential role in the human immune system, food digestion, and protection from harmful bacteria by colonizing the human intestine. Recently, although the human microbiome affects colorectal cancer (CRC) treatment, the mode of action between the microbiome and CRC remains unclear. This study showed that propionate suppressed CRC growth by promoting the proteasomal degradation of euchromatic histone-lysine N-methyltransferase 2 (EHMT2) through HECT domain E3 ubiquitin protein ligase 2 (HECTD2) upregulation. In addition, EHMT2 downregulation reduced the H3K9me2 level on the promoter region of tumor necrosis factor α-induced protein 1 (TNFAIP1) as a novel direct target of EHMT2. Subsequently, TNFAIP1 upregulation induced the apoptosis of CRC cells. Furthermore, using Bacteroides thetaiotaomicron culture medium, we confirmed EHMT2 downregulation via upregulation of HECTD2 and TNFAIP1 upregulation. Finally, we observed the synergistic effect of propionate and an EHMT2 inhibitor (BIX01294) in 3D spheroid culture models. Thus, we suggest the anticancer effects of propionate and EHMT2 as therapeutic targets for colon cancer treatment and may provide the possibility for the synergistic effects of an EHMT2 inhibitor and microbiome in CRC treatment.