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Visit-to-visit variability in blood pressure and the risk of open-angle glaucoma in individuals without systemic hypertension: a nationwide population-based cohort study
No full textPurpose: We aimed to evaluate the effect of visit-to-visit variability in blood pressure (BP) on the risk of open-angle glaucoma (OAG) in individuals without systemic hypertension using a population-based retrospective cohort study design.
Methods: The Korean National Health Insurance Service-National Health Screening Cohort database, which collected data of 209,226 individuals between 2002 and 2015, was used to analyze the data of 140,910 eligible participants. The mean follow-up duration was 8.3 years. Visit-to-visit BP variability was assessed using standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM). Participants were categorized into four groups according to BP variability quartiles. We verified the effect of BP variability by comparing participants of the first to third quartiles of BP variability groups with those belonging to the fourth quartile group. A Cox proportional hazards model was used to determine the hazard ratio (HR) of BP variability in cases of newly diagnosed OAG. Moreover, we conducted subgroup analyses using baseline characteristics.
Results: In the multivariable analyses, BP variability did not significantly increase the risk of OAG development. However, subgroup analyses revealed significant interactions between age and systolic BP variability in the development of OAG (CV: p = 0.008; SD: p = 0.007). For participants aged <60 years, the risk of OAG development significantly increased with high systolic BP variability (CV: HR, 1.18; 95% confidence interval [CI], 1.00-1.39; p = 0.049). We observed a similar trend using the SD and VIM as the parameters for systolic BP variability.
Conclusion: Higher visit-to-visit systolic BP variability was associated with an increased risk of OAG development in participants younger than 60 years of age without systemic hypertension. These results suggest that BP variability can be the considerable factor when assessing the risk of OAG, especially in relatively young people without systemic hypertension
Radiofrequency Ablation for the Treatment of Benign Thyroid Nodules: 10-Year Experience
No full textBackground: Longer follow-up after radiofrequency ablation (RFA) of benign thyroid nodules is needed to understand regrowth and other causes of delayed surgery and long-term complications. Methods: This retrospective study included consecutive patients treated with RFA for symptomatic benign nonfunctioning thyroid nodules between March 2007 and December 2010. RFA was performed according to the standard protocol. We followed up patients at 1, 6, and 12 months, then yearly, until August 2022, and calculated the volume reduction ratio (VRR) at each follow-up. We assessed the incidence of regrowth according to three published criteria, delayed surgery, and complications. The Kaplan-Meier method was used to evaluate the cumulative incidence of regrowth, and univariable and multivariable Cox regression analyses were performed to identify risk factors for regrowth. Results: This study included 421 patients (mean age, 47 ± 13 years; 372 women) with 456 nodules (mean volume, 21 ± 23 mL). The median follow-up period was 90 months (interquartile range, 24-143 months). The mean VRR was 81% at 2 years, 90% at 5 years, and 94% at ≥10 years. Overall regrowth was noted in 12% (53/456) of nodules and was treated with repeat RFA (n = 33) or surgery (n = 4) or left under observation (n = 16). Thyroid nodules with ≥20 mL initial volume had significantly higher risk of regrowth compared with nodules with <10 mL initial volume (hazard ratio, 2.315 [95% confidence interval, 1.183-4.530]; p = 0.014 on multivariable Cox regression analysis). Delayed surgery was performed in 6% (26/421) of patients because of regrowth and/or persistent symptoms (n = 4) or newly detected thyroid tumors (n = 22), one benign and 21 malignant. The overall complication rate was 2.4% (10/421), with no procedure-related deaths or long-term complications. Conclusion: RFA is safe and effective for treating benign thyroid nodules, with a high VRR at long-term follow-up. Regular follow-up after initial success is warranted because of the possibility of regrowth of ablated nodules and the need for delayed surgery in some patients
A Hermeneutic Phenomenological Study of the Violence Process of Domestic Violence Perpetrators
No full text가정폭력 가해자의 폭력 과정에 관한 해석학적 현상학 연구 아동·가정복지학 전공 석미진 지도교수 정민자 본 연구의 목적은 가정폭력 피해를 경험한 가정폭력 가해자들이 어떠한 심리적 변화 과정과 가정의 구조적 역동성에 의해 가정폭력 가해자가 되는지 그 경험을 심 층적으로 분석하여 심리 구조적인 의미를 밝히는 것이다. 이에 본 연구의 연구문제 는 ‘가정폭력 가해자의 어린 시절 폭력피해의 경험은 어떠하였는가?’, ‘가정폭력 가 해자의 폭력 과정에 대한 배경은 무엇인가?’, ‘가정폭력 가해행위의 해석학적 현상 은 무엇인가?’ 이다. 본 연구의 연구 참여자와 연구방법 및 절차는 다음과 같다. 연구 참여자는 00시 에 거주하는 가정폭력 보호관찰 대상자, 검찰 기소 단계 대상자, 경찰조사 단계에 있는 대상자로 한정하였다. 연구대상자는 연구 목적에 동의한 남녀 10명이며, 심층 인터뷰는 2022년 10월부터 2023년 10월까지 총 13개월로, 참여자 한 명당 2~3 시간 정도 진행되었다. 연구방법은 질적 연구방법인 Van Manen의 해석학적 현상 학 연구방법으로 진행되었고, 심층인터뷰 자료는 질적 자료분석 프로그램인 파랑새 2.0(2016)을 사용하여 분석하였다. 신체성에 대한 근본적 본질은 가정폭력 가해행위이며, 본질적 주제는 4가지로 아 동학대 피해자가 가정폭력 가해자가 됨, 속마음과 감정을 말로 표현하지 못함, 배우 자의 성관계 거부, 나와 나의 주변인 무시하는 것으로 나타났다. 하위범주는 14가 지로 어른이 되면 나도 때릴 수 있어, 나도 맞고 배웠는데, 너도 맞아야지, 맞는데 이유 없어, 손에 잡히는 데로 부숨, 밖에서는 좋은 사람, 집에서는 폭군, 술을 먹어 야 용기가 생김, 성행위 중독증, 배우자의 외도 확인, 나에게 순종하지 않음, 나의 지인 무시, 나를 투명 인간 취급, 먹는 것으로 나를 챙기지 않음, 돈이 필요할 때만 나를 찾음, 나를 찾지 않음으로 나타났다. 공간성에 대한 근본적 본질은 가정이며, 본질적 주제는 3가지로 집은 내가 왕이 다, 집이 지옥, 가정이 무엇인지 모른다로 나타났다. 하위범주는 11가지로 내 집에 서 내가 뭘 하든 무슨 상관이야, 내 집에서 내가 하는 말을 듣기 싫으면 나가, 밥도 못 먹여 주는 곳에서 나는 나갈 거야, ‘자식이 죽었는데, 집에서 내가 뭘 하겠나’, 나는 언제나 외롭고 혼자다, 배우자도, 자식도 없는 집, 자식이 죽어 나간 집, 한 번 도 따뜻한 말 한마디 들어본 적 없다, 이슬 피하고 잠만 자고 나오는 곳, 언제나 나 에게 돈과 희생 강요, 부모가 뭐 하는 사람인지 모른다, 내가 집 한구석에 죽어도 몰랐을 것이다로 나타났다. 시간성에 대한 근본적 본질은 내면아이이며, 본질적 주제는 4가지로 강하고 싶은 나, 가족을 책임지는 사람, 고독한 나, 상처받은 내면아이로 나타났다. 하위범주는 17가지로 내가 우리 집에서 가장 힘센 사람이 되고 싶다, 나는 우리 가족이 힘들지 않게 살게 해야 한다, 나는 누구처럼 절대 안 그럴 거야, 나는 언제나 혼자인 사람, 늘 그리운 엄마, 나만 참으면 돼, 서로 의존적인 관계, 공격적인 행동, 자기애성 성 격장애, 신뢰에 문제, 표출된 행동의 내면적 행동, 마술적 믿음, 친 감 장애, 무질 서한 행동, 중독적이고 강박적인 행동, 사고의 왜곡, 공허감, 무관심, 우울로 나타났 다. 관계성에 대한 근본적 본질은 가족의 역동성이며, 본질적 주제는 4가지로 먹을 때마다 전쟁, 전부 가족 탓, 전부 내 탓, 부모 역할을 하지 못함으로 나타났다. 하위 범주는 7가지로 나를 챙기지 않음, 술만 먹고 가정을 돌보지 않음, 내가 능력이 없 고, 자상하지도 않음, 힘들다고 자식을 친척 집으로 보냄, 엄마가 나를 데리고 도망 이라도 가지, 자식이 나 때문에 자살, 경제적 지원 못함으로 나타났다. 본 연구의 의의 및 제언점은 다음과 같다. 첫째, 가정폭력 가해자가 경험한 가정폭력 피해 경험은 이들의 타고난 고유의 잠재력에 심각한 트라우마를 입혀 상처받은 내면아이를 가진 채 성장하였고, 친 한 관계의 가족 구성원과의 갈등 상황이 왔을 때 갈등 해소 방법으로 폭력적인 대 처방식을 사용하여 해결하려는 점을 밝혔다는 것에 의의를 둘 수 있다. 둘째, 과거의 가정폭력 피해자가 현재의 가정폭력 가해자가 되는 현상은 개인별 특성이 상당히 복잡하고 다양한 양상을 띄기 때문에 가정폭력 범죄 행위에 대한 처 벌과 처분을 결정하기 전에 개별적으로 가정폭력의 원인을 다방면으로 살펴보는 폭 력의 민감성과 다양한 심리 정서를 알아보고 지원할 수 있는 상담시스템을 국가적 으로 체계화하는 것이 필요하다. 마지막으로 가정폭력 가해자 일방의 진술로 연구가 진행된 점에서 전체 가정폭 력 가해행위를 일반화하기에는 한계가 있다. 따라서 가정폭력의 피해자와 가해자를 함께 연구하여, 가정폭력 재발에 영향을 미치는 원인과 과정에 대한 심층적인 연구 와 상담이 필요함을 제언한다. 주제어: 가정폭력, 사군자 성격 기질, 내면아이, 상처받은 내면아이, 가족의 역동성Docto
Trends in Healthy Life Expectancy (HALE) and Disparities by Income and Region in Korea (2008-2020): Analysis of a Nationwide Claims Database
No full textBackground: Healthy life expectancy is a well-recognized indicator for establishing health policy goals used in Korea's Health Plan. This study aimed to explore Koreans' healthy life expectancy and its gender, income, and regional disparities from 2008 to 2020.
Methods: This study was conducted on the entire population covered by health insurance and medical aid program in Korea. The incidence-based "years lived with disability" for 260 disease groups by gender, income level, and region was calculated employing the methodology developed in the Korean National Burden of Disease Study, and it was used as the number of healthy years lost to calculate health-adjusted life expectancy (HALE).
Results: Koreans' HALE increased from 68.89 years in 2008 to 71.82 years in 2020. Although the gender disparity in HALE had been decreasing, it increased to 4.55 years in 2020. As of 2020, 5.90 years out of 8.67 years of the income disparity (Q5-Q1) in HALE were due to the disparity between Q1 and Q2, the low-income groups. Income and regional disparities in HALE exhibited an increasing trend, and these disparities were higher in men than in women.
Conclusion: A subgroup with a low health level was identified through the HALE results, and it was confirmed that improving the health level of this population can reduce health inequalities and improve health at the national level. Further exploration of the HALE calculation methodology may help in the development of effective policies such as prioritizing interventions for health risk factors
Core-shell structured Ag-HAp@Bi2S3 as effective S-scheme heterojunction photocatalyst: Induced with internal polarization electric field effect and co-catalyst fashions
No full textConsidering the utilization of solar energy, the low efficiency of photocatalytic reactions is a crucial factor to take into account. One effective solution to this issue is the heterojunction method, deemed as an efficient approach for enhancing photocatalyst performance via optimal sunlight utilization. In this study, a HAp@Bi2S3 core-shell structure was synthesized using a simple microemulsion method, and subsequently, Ag nanoparticles were systematically anchored onto its surface. The Ag-HAp@Bi2S3 nanocomposite was utilized to concurrently achieve the photocatalytic degradation of Bis-phenol A (BPA) and the reduction of Cr6+ ions. The findings indicate that the heterojunction S-scheme and co-catalyst Ag have a significant role in charge separation and accelerating the photocatalytic reaction. Moreover, the presence of HAp as a polarizing substrate in this composite can create an internal polarized electric field, in addition to the electric field generated by the S-scheme heterojunction. This proposed nanocomposite exhibits potential in addressing the challenge of achieving rapid and simultaneous pollutant degradation
Comparison of digital and analog [68Ga]Ga-PSMA-11 PET/CT for detecting post-prostatectomy biochemical recurrence in prostate cancer patients: a prospective study
No full textDigital positron emission tomography/computed tomography (PET/CT) has shown enhanced sensitivity and spatial resolution compared with analog PET/CT. The present study compared the diagnostic performance of digital and analog PET/CT with [68Ga]Ga-PSMA-11 in prostate cancer patients who experienced biochemical recurrence (BCR) after prostatectomy. Forty prostate cancer patients who experienced BCR, defined as serum prostate-specific antigen (PSA) concentrations exceeding 0.2 ng/mL after prostatectomy, were prospectively recruited. These patients were stratified into three groups based on their serum PSA levels. [68Ga]Ga-PSMA-11 was injected into each patient, and images were acquired using both analog and digital PET/CT scanners. Analog and digital PET/CT showed comparable lesion detection rate (71.8% vs. 74.4%), sensitivity (85.0% vs. 90.0%), and positive predictive value (PPV, 100.0% vs. 100.0%). However, digital PET/CT detected more lesions (139 vs. 111) and had higher maximum standardized uptake values (SUVmax, 14.3 vs. 10.3) and higher kappa index (0.657 vs. 0.502) than analog PET/CT, regardless of serum PSA levels. On both analog and digital PET/CT, lesion detection rates and interrater agreement increased with increasing serum PSA levels. Compared with analog PET/CT, digital PET/CT detected more lesions with a higher SUVmax and better interrater agreement in prostate cancer patients who experienced BCR after prostatectomy
Exploring Factors Affecting Academic Achievement in Medical School TBL Classes
No full textTeam based learning (TBL) has emerged as a learning strategy in Korean medical schools since the early 2000s. However, there is a lack of research on the impact of TBL class on the academic achievement of medical students. This study aimed to examine the relationship between self-efficacy, team efficacy, engagement, perceived effectiveness, and academic achievement and identify factors that influence academic achievement in a medical school TBL class. The Cell Metabolism course was conducted in TBL for five weeks. This study involved 43 second-year premedical students in the Cell Metabolism course who signed the informed consent form and completed the survey. Data were collected using instruments that measured self-efficacy, team efficacy, engagement, effective perception, and academic achievement. Descriptive statistics, reliability tests, correlation analyses, and regression analyses were used to analyze the data. Results of the study showed that academic achievement in a medical school TBL class is positively associated with engagement and effective perception. Among these, engagement was identified as the primary factor influencing academic achievement, with more active student participation resulting in higher academic success. TBL are more meaningful as a team activity than as an individual activity. In the future, there is a need to explore different variables that can predict the effectiveness of TBL based on small group learning rather than teaching methods such as lecture
Intraoperative Hypotension Prediction Based on Features Automatically Generated Within an Interpretable Deep Learning Model
No full textThe monitoring of arterial blood pressure (ABP) in anesthetized patients is crucial for preventing hypotension, which can lead to adverse clinical outcomes. Several efforts have been devoted to develop artificial intelligence-based hypotension prediction indices. However, the use of such indices is limited because they may not provide a compelling interpretation of the association between the predictors and hypotension. Herein, an interpretable deep learning model is developed that forecasts hypotension occurrence 10 min before a given 90-s ABP record. Internal and external validations of the model performance show the area under the receiver operating characteristic curves of 0.9145 and 0.9035, respectively. Furthermore, the hypotension prediction mechanism can be physiologically interpreted using the predictors automatically generated from the proposed model for representing ABP trends. Finally, the applicability of a deep learning model with high accuracy is demonstrated, thus providing an interpretation of the association between ABP trends and hypotension in clinical practice
Epidemiology of sepsis-associated acute kidney injury in critically ill patients: a multicenter, prospective, observational cohort study in South Korea
No full textBackground: Despite the clinical importance of sepsis-associated acute kidney injury (SA-AKI), little is known about its epidemiology. We aimed to investigate the incidence and outcomes of SA-AKI, as well as the risk factors for mortality among patients with severe SA-AKI in critically ill patients.
Methods: This secondary multicenter, observational, prospective cohort analysis of sepsis in South Korea evaluated patients aged ≥ 19 years admitted to intensive care units with a diagnosis of sepsis. The primary outcome was the incidence of SA-AKI, defined using the new consensus definition of the Acute Disease Quality Initiative 28 Workgroup. Secondary outcomes were in-hospital mortality and risk factors for in-hospital mortality.
Results: Between September 2019 and December 2022, 5100 patients were admitted to intensive care units with a diagnosis of sepsis, and 3177 (62.3%) developed SA-AKI. A total of 613 (19.3%), 721 (22.7%), and 1843 (58.0%) patients had stage 1, 2, and 3 SA-AKI, respectively. Severe SA-AKI (stages 2 and 3 combined) was associated with an increased risk of in-hospital mortality. Adherence to the fluid resuscitation component of the one-hour sepsis bundle was associated with a decreased risk of in-hospital mortality in severe SA-AKI (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.79; P < 0.001).
Conclusions: Of the patients admitted to the intensive care unit for sepsis, 62.3% developed SA-AKI. Severe SA-AKI was associated with an increased risk of mortality. Adherence to the fluid resuscitation component of the one-hour sepsis bundle can potentially improve outcomes in these patients
Bay 11-7082의 멜라닌생성 저해 효과
No full textPost-inflammatory hyperpigmentation (PIH) refers to an acquired pigmentation disorder that causes pigmentation due to inflammation of the skin due to external causes such as injury or skin disease. It is a serious problem that affects skin health and appearance. Various treatments have been developed to deal with this problem, but there is still no complete cure. Additionally, there is a lack of understanding of the occurrence mechanism and underlying physiological causal relationship of PIH. The molecular understanding of how inflammation affects melanogenesis and how melanin production changes after inflammation is still unknown territory. Therefore, by analyzing the mechanism of PIH, we aim to understand the interaction between inflammation and melanin production and develop an effective treatment that simultaneously controls inflammation and melanin production. UVB is one of the ultraviolet rays emitted from sunlight and activates the MAPK pathway, promoting MITF and its subordinate genes Tyrosinase, Trp1, and DCT, which are involved in melanin production. This study confirmed that Bay 11-7082 inhibits melanin increased by Forskolin (FSK) or UVB in melanocytes, mouse skin, and ex vivo human skin. Bay 11-7082 inhibits cellular tyrosinase activity increased by FSK and MAPK, it was confirmed that the levels of MITF, Tyrosinase, DCT, and Trp1 were reduced. In addition, it suppressed the levels of cytokines IL-1a, IL-1b, IL-6, TNF-a, COX-2, and MCP-1, and induced inflammation in mice with DNFB, causing pigmentation and inflammation and inflammation by Bay 11-7082. It was confirmed that melanin was reduced. As a result, Bay 11-7082 is an NF-κB inhibitor that reduces inflammation by suppressing cytokines and suppresses melanin through the MAPK/MITF pathway, so it can simultaneously suppress inflammation and melanin in the development of a treatment for PIH. It is judged to have great potential as a functional raw material. (Keywords) Post-inflammatory hyperpigmentation (PIH), Bay 11-7082, MAPK/MITF pathway, melanogenesis.Maste