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Incidence and risk factors of age-related macular degeneration in patients with Parkinson's disease: a population-based study
No full textBackground and objective: The association between age-related macular degeneration (AMD) and Parkinson' disease (PD) remains unclear. The aim of the present study was to assess the incidence of AMD in patients with PD, elucidate differences by age and sex, and investigate potential risk factors for AMD.
Methods: Data were extracted from the Korean National Health Insurance System database, which covers 97% of the Korean population (2002 through 2019). We calculated the incidence of newly diagnosed AMD in patients with PD and used Cox proportional-hazards models to estimate risk factors for AMD, presenting adjusted hazard ratios (aHR) with 95% confidence intervals (CI).
Results: Of 172,726 patients with PD, 15,800 were newly diagnosed with AMD during the follow-up, including 5,624 men and 10,176 women. The overall incidence of AMD in patients with PD was 13.59 per 1,000 person-years. Stratified by age group and sex, the incidence was higher in women aged 40-69, and conversely higher in men aged 70-89. Risk of AMD was high in older age groups (aHR = 4.36, 95% CI: 3.74-5.09 in the 70 s), female sex (aHR = 1.07, 95% CI: 1.04-1.11), patients with diabetes mellitus (DM) (aHR = 1.14, 95% CI: 1.10-1.18), and patients with hyperlipidemia (aHR = 1.17, 95% CI: 1.13-1.21).
Conclusion: Our findings suggest that the AMD incidence is higher in patients with PD than in the general population, with varying patterns of sex differences across age groups. Particularly, old age, female sex, presence of DM, and hyperlipidemia are potential risk factors. Therefore, clinicians should pay greater attention to AMD in patients with PD
Febuxostat dose requirement according to renal function in patients who achieve target serum urate levels: A retrospective cohort study
No full textObjectives
To determine the febuxostat dose requirement according to renal function in patients who achieve target serum urate (SU) levels.
Methods
Of 3153 gout patients who underwent febuxostat treatment, 873 patients with an initial SU level > 6 mg/dL were included and categorized by the estimated glomerular filtration rate: normal, chronic kidney disease (CKD) stage 3, and stages 4-5. Ninety-five patients with insufficient follow-up were further excluded. The dose of febuxostat in patients who achieved the SU target (< 6 mg/dL) was defined as the average daily dosage at the time of SU target achievement.
Results
The cohort of 778 gout patients had a median age of 52.0 years (IQR, 41.0-63.0) and comprised 711 (91.4%) men. The mean SU at febuxostat initiation was higher in the CKD 4-5 (9.6 [± 3.1] mg/dL) than in the other groups (CKD 3, 8.7 [± 1.7]; normal, 8.4 [± 1.7]; P < 0.001). Patients achieved target SU at a median of 4.0 (1.9-9.6) months and in those who achieved target SU, the dose of febuxostat at the time of SU target achievement was significantly lower in the CKD 4-5 group (50.0 [± 16.5] mg) than in the other groups (vs. CKD stage 3, 60.0 [± 19.5] mg; P < 0.01, vs. normal, 60.0 [± 19.8] mg; P < 0.01). Furthermore, CKD stage 4-5 had a negative correlation with the febuxostat dose requirement (Beta: -2.334, P < 0.05).
Conclusion
Among patients who achieved SU target, those with severely decreased renal function (CKD 4-5) required a lower febuxostat dose to achieve the target SU level compared to patients with normal or mild renal impairment
Development of a Reflective Functioning Questionnaire for Non-Clinical Adolescents Using Latent Profile Analysis
No full textAs interest in mentalization has grown, a recent study in Korea has focused on developing a counseling program that incorporates mentalization, responding to increasing demands for a comprehensive evaluation of mentalization abilities. Mentalization is a dynamic concept encompassing various interacting dimensions, as defined by Fonagy and colleagues who operationalized it through the concept of reflective functioning. This study respects their terminology and framework, particularly focusing on the reflective functioning's components as articulated by Fonagy et al. (2016), which include uncertainty and certainty regarding mental states.
However, recognizing the need for a more nuanced assessment beyond mere failure, this research draws from Park Min-kyung's work (2019) to expand the reflective functioning to include a third sub-factor: interest or curiosity about mental states. This addition reflects a broader view that considers not only shortcomings but also successes in mentalization. Importantly, while certainty has been noted to potentially manifest maladaptively in clinical contexts, its interpretation in non-clinical group of adolescents remains complex, potentially adaptive in some circumstances, thereby necessitating empirical investigation.
The primary objective of this study is to develop and validate a reflective functioning scale tailored for comprehensive non-clinical adolescents. Participants included individuals aged 14 to 24, encompassing middle and high school students as well as those in the early stages of adulthood, aligning with relevant youth legislation such as the Basic Youth Act and the Youth Welfare Act. The latent profile analysis was conducted by adding three sub-factors of the developed reflection function scale for non-clinical group adolescents and two sub-factors, borderline personality orientation and mindfulness. Through this, it is intented to verify the discrimination validity of the certainty factor and to confirm the possibility as a tool to identify the reflection ability of adolescents in the adult entry period. In addition, the influence of positive affect, negative affect, parent attachment, and adaptation to school life was analyzed to understand the characteristics of the classified potential group. The main research results shown in this study are as follows.
First, this study composed a total of 36 preliminary questions through review of previous studies, literature review, and expert's second content evaluation to develop and validate the reflective functioning scale. Through exploratory factor analysis, it was rearranged into three factors (certainty, uncertainty, interest/curiousity) and 34 questions, and the fitness index through confirmatory factor analysis was χ2=919.522, TLI=.902, CFI=.910, RMSEA=.050, and SRMR=.639, confirming that the overall measurement model was good. In addition, the reflective functioning scale for adolescents in the non-clinical group was found to be a valid tool through the results of convergence, discrimination validity, and coexistence validity. As a result of convergence and discrimination validity, uncertainty factors were found to be positively correlated with negative emotions (r=0.59, p<.01), interpersonal sensitivity (r=57, p<.01), paranoia (r=.54, p<.01), and somewhat negative correlation with mindfulness (r=-.29, p<.01), and school life adaptation (r=-.28, p<.01). The certainty factor was positively correlated with mindfulness (r=.30, p<.01). The factors of interest/curiousity were positively correlated with mindfulness (r=.41, p<.01) and school life adaptation (r=.24, p<.01). As a result of the coexistence validity, the uncertainty factor was found to have a somewhat high positive correlation with the borderline personality characteristics (r=.581, p<.01).
Second, in the study of Fonagy and colleagues, the certainty factor was developed as a construct to measure the failure of the reflective functioning targeting the clinical group. However, as a result of previous studies, the certainty factor showed little relationship with mentalization difficulty (MZQ) (Min-kyung Park, 2019), and showed a significant positive correlation with self- and other reflection factors corresponding to the success of mentalization (Se-mi Park, Nam-woon Jung, 2019). Judging from these findings, the need for empirical research on whether the certainty factor represents the adaptive aspect of the reflective functioning in the non-clinical group or reflects the maladaptive aspect. Accordingly, in order to closely grasp the characteristics of the certainty factor, a latent profile analysis was conducted by adding three factors of the reflective functioning and two sub-factors of borderline personality tendency and mindfulness. As a result of the latent profile analysis, it was confirmed that the certainty factor reflected the adaptive aspect in the non-clinical group of adolescents.
Third, latent profile analysis identified six distinct groups based on their levels of reflective functioning: Class 1 (insensitive isolation group), Class 2 (conformative adaptation group), Class 3 (certain adaptation group), Class 4 (uncertain confusion group), Class 5 (potential unstable control group), and Class 6 (unstable control group). Notably, findings suggest that appropriate attention and intervention are needed for adolescents in groups characterized by the unstable control group, the uncertain confusion control group, the potential unstable control group, and the insensitive isolation group.
Fourth, in order to understand the characteristics of the six potential groups classified, all four factors were found to be statistically significant as a result of analyzing the influence of positive affect, negative affect, parent attachment, and school life adaptation.It is expected that this study will contribute to advancing the understanding and application of mentalization concepts in Korean contexts, providing a foundation for tailored interventions aimed at supporting adolescents experiencing difficulties due to lack of reflection function.
Key words: Mentalization, Reflective Functioning Questionnaire(RFQ), certainty, uncertainty, interest/curiosity, non-clinical adolescents, LPA(Latent profile analysis)|정신화에 대한 관심이 증가하면서 최근 국내에서도 상담에 활용하기 위한 정신화 프로그램 등이 연구되고, 정신화 능력의 다각적인 평가에 대한 요구가 꾸준히 제기되고 있다. 정신화는 다양한 측면이 상호작용하는 역동적 차원의 개념으로, Fonagy와 동료연구자들은 정신화를 측정함에 있어 성찰기능이라는 용어를 조작적으로 사용하고 있다. 이에 본 연구에서도 원저자들의 뜻을 따라 성찰기능이라는 용어를 사용하고자 한다. Fonagy 등(2016)의 연구에서 성찰기능은 정신상태의 불확실성과 확실성이라는 성찰기능의 실패를 나타내는 2가지 하위 요인으로 구성되어 있다. 그러나 성찰기능의 복잡하고 다차원적 측면들을 포괄하여 측정하기 위해서는 ‘성찰기능의 실패’뿐만 아니라 ‘성찰기능의 성공(진정한 정신화하기)’이 어떠한 형태로 나타나는지에 대해서도 살펴볼 필요가 있을 것이다. 이에 본 연구에서는 박민경(2019)의 연구를 토대로 하여 성찰기능을 성찰기능의 실패에 해당하는 정신상태의 불확실성과 확실성의 2가지 하위요인에 진정한 성찰하기에 해당하는 정신상태에 대한 관심/호기심요인을 추가하여 3가지 하위요인으로 구성하였다. 특히 확실성요인은 임상군 집단에서 부적응적 측면을 반영하는 것으로 나타났으나, 비임상군 청소년집단에서는 그 자체로 좋고 나쁨을 판단하기 어렵고 경우에 따라 적응적으로 혹은 부적응적으로도 기능할 수 있어 이를 경험적으로 파악해야 할 필요성이 제기된다.
본 연구의 목적은 광범위한 비임상군 청소년들을 대상으로 한 성찰기능척도를 개발하고 타당화하기 위한 것이다. 연구대상은 14~24세까지의 학교 재학 중인 청소년으로 하였다. 이는 청소년기본법과 청소년복지법의 청소년 연령 범위를 고려하여 청소년의 범위를 중학생 및 고등학생, 성인진입기에 해당하는 대학생까지를 포함하여 선정한 것이다. 그리고 개발된 비임상군 청소년용 성찰기능척도의 3가지 하위요인과 경계선성격성향 및 마음챙김의 2가지 하위요인을 추가하여 잠재프로파일분석을 실시하였다. 이를 통해 확실성요인의 변별타당도를 검증하고, 성인진입기에 해당하는 청소년들의 성찰 능력을 식별하는 도구로써의 가능성을 확인하고자 하였다. 그리고 분류된 잠재집단의 특성파악을 위하여 정적 정서, 부적 정서, 부모애착, 학교생활적응과의 영향력을 분석하였다. 본 연구에서 나타난 주요 연구결과들은 다음과 같다.
첫째, 본 연구는 성찰기능척도개발 및 타당화를 위하여 선행연구검토 및 문헌고찰, 전문가의 2차 내용평정을 거쳐 총36개의 예비문항을 구성하였다. 탐색적 요인분석을 통해 3요인(확실성, 불확실성, 관심/호기심), 34문항으로 재정리되었으며, 확인적 요인분석을 통한 적합도 지수는 χ2=919.522, TLI=.902, CFI=.910, RMSEA=.050, SRMR=.639로 나타나 전반적으로 양호한 측정모형임을 확인할 수 있었다. 또한 비임상군 청소년용 성찰기능척도는 수렴 및 변별타당도, 공존타당도 결과를 통하여 타당한 도구로 판명되었다. 수렴 및 변별타당도 결과 불확실성요인은 부적정서(r=.59, p<.01), 대인예민증(r=57, p<.01), 편집증(r=.54, p<.01)과 다소 높은 정적상관, 마음챙김(r=-.29, p<.01), 학교생활적응(r=-.28, p<.01)과 부적상관으로 나타났다. 확실성요인은 마음챙김(r=.30, p<.01)과 정적 상관으로 나타났다. 관심/호기심 요인은 마음챙김(r=.41, p<.01), 학교생활적응(r=.24, p<.01)과 정적상관으로 나타났다. 공존타당도 결과 불확실성요인이 경계선 성격특성(r=.581, p<.01)과 다소 높은 정적 상관인 것으로 나타났다.
둘째, Fonagy와 동료연구자들의 연구에서 확실성요인은 임상군을 대상으로 하여 성찰기능의 실패를 측정하기 위한 구인으로 개발되었다. 하지만 선행연구결과 확실성요인은 정신화 곤란(MZQ)과의 관련성이 거의 나타나지 않았고(박민경, 2019), 정신화의 성공에 해당하는 자기 및 타인성찰 요인과 유의미한 정적 상관관계를 나타내었다(박세미, 정남운, 2019). 이러한 연구결과들로 미루어보아 확실성요인이 비임상군집단에서 성찰기능의 적응적 측면을 나타내는지 부적응적 측면을 반영하는지에 대한 경험적 연구의 필요성이 제기되었다. 이에 확실성 요인의 특성을 면밀히 파악하기 위하여 성찰기능의 3요인과 경계선 성격성향 및 마음챙김의 2가지 하위요인을 추가하여 잠재프로파일분석을 실시하였다. 잠재프로파일분석결과 확실성요인은 비임상군 청소년집단에서 적응적 측면을 반영하고 있음을 확인할 수 있었다.
셋째, 비임상군 청소년들의 성찰기능수준에 따른 잠재집단은 ‘Class 1(무감각 고립집단)’, ‘Class 2(순응적 적응집단)’, ‘Class 3(확신적 적응집단)’, ‘Class 4(불확실 혼란집단)’, ‘Class 5(잠재적 불안정집단)’, ‘Class 6(불안정 조절집단)’의 총6개 집단으로 분류되었다. 특히 이들 6개 집단 중에서 불안정 조절집단, 불확실 혼란집단, 잠재적 불안정집단, 무감각 고립집단에 해당하는 청소년들에 대한 적절한 관심과 개입이 필요할 것으로 예상된다.
넷째, 분류된 6개 잠재집단의 특성을 파악하기 위하여 정적 정서, 부적 정서, 부모 애착, 학교생활적응의 영향력을 분석한 결과, 4가지 요인 모두 통계적으로 유의한 것으로 나타났다.
본 연구를 통하여 국내 정신화와 성찰기능척도에 대한 연구 및 활용가능성을 향상시켜 나가는 한편, 성찰 기능의 결핍으로 인해 어려움을 경험하는 청소년들을 위한 다각적인 개입 방안을 모색할 수 있을 것으로 기대한다.Docto
Comparative risk of serious infections and tuberculosis in Korean patients with inflammatory bowel disease treated with non-anti-TNF biologics or anti-TNF-α agents: a nationwide population-based cohort study
No full textBackground: The risk of serious infection and active tuberculosis in patients with inflammatory bowel disease (IBD) has not been concurrently evaluated based on the use of anti-tumor necrosis factor (TNF)-α agents versus non-anti-TNF biologics (vedolizumab/ustekinumab) in the Korean population.
Objectives: We compared the risk of serious infection and active tuberculosis in Korean patients with IBD treated with non-anti-TNF biologics (vedolizumab/ustekinumab) or anti-TNF-α agents.
Design: This study was a population-based cohort analysis of nationwide administrative claims data.
Methods: Health Insurance Review and Assessment Service claims data (representing 97% of the South Korean population) from between January 2007 and February 2021 were reviewed, and adults with IBD who initiated vedolizumab/ustekinumab or anti-TNF-α treatment (n = 6123) between 2017 and 2020 were enrolled. Intergroup differences in the risk of serious infection requiring hospitalization/emergency department visits or active tuberculosis during the follow-up period were analyzed.
Results: In the patients treated with anti-TNF-α agents or vedolizumab/ustekinumab during a mean follow-up of 1.55 ± 1.05 and 0.84 ± 0.69 years, the incidence rates of serious infection were 9.43/100 and 6.87/100 person-years, respectively. Multivariable analysis showed no significant intergroup difference in the risk of serious infection with vedolizumab/ustekinumab or anti-TNF-α treatment; the adjusted relative risk of vedolizumab/ustekinumab compared with anti-TNF-α agents was 0.81 (95% confidence interval 0.46-1.44, p = 0.478). Among patients treated with anti-TNF-α agents and vedolizumab/ustekinumab, the incidence rates of active tuberculosis were 0.87 and 0.37 per 100 person-years, respectively. The relative risk of vedolizumab/ustekinumab compared with anti-TNF-α agents was 0.31 (95% confidence interval 0.07-1.26, p = 0.101). In a subset analysis comparing vedolizumab and ustekinumab with anti-TNF-α agents, similar results were observed.
Conclusion: In Korean patients with IBD, non-anti-TNF biologics (vedolizumab/ustekinumab) tended to be associated with a lower risk of serious infection or active tuberculosis than anti-TNF-α agents
Optimizing intrinsic cocatalyst activity and light absorption efficiency for efficient hydrogen evolution of 1D/2D ReS2-CdS photocatalysts via control of ReS2 nanosheet layer growth
No full textThe visible-light-driven hydrogen evolution is extremely important, but the poor charge transfer capability, a sluggish evolution rate of hydrogen, and severe photo-corrosion make photocatalytic hydrogen evolution impractical. In this study, we present 1D/2D ReS2-CdS hybrid nanorods for photocatalytic hydrogen evolution, comprised of a ReS2 nanosheet layer grown on CdS nanorods. We found that precise control of the contents of the ReS2 nanosheet layer allows for manipulating the electronic structure of Re in the ReS2-CdS hybrid nanorods. The ReS2-CdS hybrid nanorods with optimal ReS2 nanosheet layer content dramatically improve photocatalytic hydrogen evolution activity. Notably, photocatalytic hydrogen evolution activity (64.93 mmol g-1 h-1) of ReS2-CdS hybrid nanorods with ReS2 nanosheet layers (Re/Cd atomic ratio of 0.051) is approximately 136 times higher than that of pure CdS nanorods under visible light irradiation. Furthermore, intimated coupling of the ReS2 nanosheet layer with CdS nanorods reduced the surface trap-site of the CdS nanorods, resulting in enhanced photocatalytic stability. The detailed optical and electrical investigations demonstrate that the optimal ReS2 nanosheet layer contents in the ReS2-CdS hybrid nanorods can provide improved charge transfer capability, catalytic activity, and light absorption efficiency. This study sheds light on the development of photocatalysts for highly efficient photocatalytic hydrogen evolution
The Selective Removal of Bisphenol A Using a Magnetic Adsorbent Fused with Bisphenol A-Binding Peptides
No full textThe potential of bisphenol A (BPA)-binding peptides fused to magnetic beads is demonstrated as novel adsorbents that are reusable and highly selective for BPA removal from aqueous environments, in which various interfering substances coexist. Magnetic beads harboring peptides (peptide beads) showed a higher BPA removal capacity (8.6 mg/g) than that of bare beads without peptides (2.0 mg/g). The BPA adsorption capacity of peptide beads increased with the number of peptides fused onto the beads, where monomeric, dimeric, or trimeric repeats of a BPA-binding peptide were fused to magnetic beads. The BPA-adsorbing beads were regenerated using a methanol-acetic acid mixture, and after six regeneration cycles, the adsorption capacity remained above 87% of its initial capacity. The selective removal of BPA was confirmed in the presence of BPA analogs with high structural similarity (bisphenol F and bisphenol S) or in synthetic wastewater. The present work is a pioneering study that investigates the selective affinity of peptides to remove specific organics with high selectivity from complex environmental matrices
Effects of high-intensity interval robot-assisted gait training on cardiopulmonary function and walking ability in chronic stroke survivors: A multicenter single-blind randomized controlled trial
No full textBackground: Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments.
Objective: To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke.
Methods: A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose).
Results: RAGT significantly improved VO2max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers.
Conclusion: RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation
Genomic full-length sequence of the novel HLA-C*06:364 allele
No full textHLA-C*06:364 differs from HLA-C*06:02:01:01 by a non-synonymous nucleotide substitution in exon 3
Association of Age‐ and Body Mass Index‐Stratified High On‐Treatment Platelet Reactivity With Coronary Intervention Outcomes in East Asian Patients
No full textBackground
Although age and body mass index (BMI) significantly affect platelet reactivity units and clinical outcomes after percutaneous coronary intervention, there are limited data on the relationship between high on‐treatment platelet reactivity (HPR) and clinical outcomes on age and BMI differences. Thus, we investigated the association of HPR with clinical outcomes according to age and BMI.
Methods and Results
The study analyzed 11 714 patients who underwent platelet function tests after percutaneous coronary intervention. The primary end point was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), whereas the secondary end point was major bleeding. HPR was defined as platelet reactivity units ≥252. Patients were categorized by age (22.6 kg/m2). Patients 22.6 kg/m2 had increases in MACCEs (adjusted HR, 1.387 [95% CI, 1.140-1.688]; P=0.001). No differences were shown in major bleeding.
Conclusions
HPR was linked to an increase in MACCEs or a decrease in major bleeding in patients after percutaneous coronary intervention, depending on age and BMI. This study is the first to observe that clinical outcomes in patients with HPR after percutaneous coronary intervention may vary based on age and BMI. Because the study is observational, the results should be viewed as hypothesis generating and emphasize the need for randomized clinical trials
Lipid-coated gold nanorods for photoimmunotherapy of primary breast cancer and the prevention of metastasis
No full textNanomedicines hold promise for the treatment of various diseases. However, treating cancer metastasis remains highly challenging. In this study, we synthesized gold nanorods (AuNRs) containing (α-GC), an immune stimulator, for the treatment of primary cancer, metastasis, and recurrence of the cancer. Therefore, the AuNR were coated with lipid bilayers loaded with α-GC (α-LA). Upon irradiation with 808 nm light, α-LA showed a temperature increase. Intra-tumoral injection of α-LA in mice and local irradiation of the 4T1 breast cancer tumor effectively eliminated tumor growth. We found that the presence of α-GC in α-LA activated dendritic cells and T cells in the spleen, which completely blocked the development of lung metastasis. In mice injected with α-LA for primary breast cancer treatment, we observed antigen-specific T cell responses and increased cytotoxicity against 4T1 cells. We conclude that α-LA is promising for the treatment of both primary breast cancer and its metastasis