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Trends in prescribing sodium-glucose cotransporter 2 inhibitors for individuals with type 2 diabetes with and without cardiovascular-renal disease in South Korea, 2015–2021
No full textBACKGROUND: This study evaluates shifts in oral glucose-lowering drug prescription patterns and the adoption of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in South Korea. METHODS: A cross-sectional and retrospective cohort analysis of the Korean National Health Insurance database (2015-2021) assessed the prescription patterns of oral glucose-lowering drugs by therapy level, SGLT2i prescriptions by cardiovascular-renal disease (CVRD) status, and the mean duration for SGLT2i therapy initiation and intensification. RESULTS: From 2015 to 2021, the number of individuals prescribed oral glucose-lowering drugs across all regimen levels increased. However, the proportion of individuals receiving monotherapy or dual combination therapy decreased by 9.2 percentage points, whereas the proportion prescribed triple or more combination therapy increased. SGLT2i prescriptions increased from 2.5% in 2015 to 13.9% in 2021, marking an 11.4 percentage point growth. This trend was consistent among individuals with and without CVRD, with the most significant increase observed in individuals with heart failure-from 2.2% in 2015 to 16.6%. The mean time to SGLT2i initiation post-diagnosis was shortened from 249 days in 2015 to 158 days in 2019. CONCLUSIONS: The adoption of SGLT2i therapy was on the rise, especially among individuals with heart failure, accompanied by a notable decrease in time to treatment initiation. Despite these positive trends, the overall use of SGLT2i among individuals with CVRD remained limited
Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial
No full textBACKGROUND: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain. METHODS: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain. RESULTS: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p < 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group. CONCLUSIONS: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
Association between Exclusive Breastfeeding and the Incidence of Childhood Nephrotic Syndrome
No full textObjective: To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. Study design: This nationwide cohort study utilized data from the National Health Information Database and the National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, 8 years postindex date, death, or December 31, 2022, whichever was first. Results: The study population comprised 1 787 774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612 556 exclusively breastfed and 1 175 218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69-0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70-1.09). Sensitivity analysis confirmed these results. Conclusions: Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age
Improving functional correlation of quantification of interstitial lung disease by reducing the vendor difference of CT using generative adversarial network (GAN) style conversion
No full textObjective: To assess whether CT style conversion between different CT vendors using a routable generative adversarial network (RouteGAN) could minimize variation in ILD quantification, resulting in improved functional correlation of quantitative CT (QCT) measures. Methods: Patients with idiopathic pulmonary fibrosis (IPF) who underwent unenhanced chest CTs with vendor A and a pulmonary function test (PFT) were retrospectively evaluated. As deep-learning based ILD quantification software was mainly developed using vendor B CT, style-converted images from vendor A to B style were generated using RouteGAN. Quantification was performed in both original and converted images. Measurement variability in QCT between original and converted images was evaluated using the concordance correlation coefficient (CCC). Two radiologists visually evaluated quantification accuracy using original and converted images. Correlations between CT parameters and PFT measures were assessed. Results: Total 112 patients (mean age, 61; 82 men) were studied. Measurement variability between original and converted CT was a CCC of 0.20 for reticulation, 0.72 for honeycombing, and 0.59 for ground-glass opacity. The median visual accuracy scores were higher for the quantification using converted compared with the original images (P < 0.001). Correlation between fibrosis score increased significantly after CT conversion for both forced vital capacity (original vs. converted; −0.35 vs. −0.50; P = 0.005) and diffusing capacity of the lung for carbon monoxide (−0.50 vs. −0.66; P < 0.001). Conclusion: The improved accuracy in deep learning based ILD quantification after applying GAN-based CT style conversion can result in the improved functional correlation of QCT measurements in patients with IPF
Long-term outcomes of enzyme replacement therapy from a large cohort of Korean patients with mucopolysaccharidosis IVA (Morquio A syndrome)
No full textMucopolysaccharidosis (MPS) IVA (Morquio A syndrome) is an autosomal recessive lysosomal storage disorder caused by a mutation affecting the enzyme N-acetylgalactosamine-6-sulfatase (EC 3.1.6.4, GALNS). Enzyme replacement therapy (ERT) has been shown to improve physical performance, quality of life, and respiratory function in patients with MPS IVA; however, owing to the rarity of MPS IVA, data on Korean patient characteristics are limited. This retrospective study reports clinical, radiographic, biochemical, and molecular findings, and analyzes long-term clinical outcomes, from the largest cohort of Korean patients with MPS IVA in a single center. The analysis included 17 patients from 14 families (58.8 % females; median [range] age at diagnosis 5.2 [1.8–33.7] years). The majority of patients (64.7 %) were classified as having a severe phenotype, 23 % had an intermediate phenotype, and 11.8 % had an attenuated phenotype. Skeletal manifestations and radiologic abnormalities at initial diagnosis included gait abnormality (35.3 %), short stature (23.5 %), chest deformity (23.5 %), scoliosis (17.6 %), kyphosis (11.8 %), dysmorphic face (6 %), hip pain (6 %), and leg deformity (6 %). Twelve different GALNS mutations were identified. Patients received ERT for a median (range) 7.4 years (3.0–12.1). Twelve patients reached final adult height, and all patients with the severe/intermediate phenotype had short stature (<3rd percentile). Hemiepiphysiodesis was the most common surgical intervention among patients with the severe/intermediate phenotype. Drug-related adverse events (urticaria, rash, and anaphylaxis) were reported in four patients but were managed with antihistamines or desensitization. At follow-up, patients experienced improvements in functional independence measure score, ejection fraction, and the 6-min walk test compared with the pre-treatment baseline. This study provides real-world evidence for long-term stabilization of functional independence, endurance, and respiratory function among patients with MPS IVA treated with ERT, with no new safety concerns identified
Corrigendum to ‘Electrostatic attachment of exosome onto a 3D-fabricated calcium silicate/polycaprolactone for enhanced bone regeneration’ [Mater. Today Bio 29 (2024) 101283]
No full textComputed tomography-based measurements associated with rapid lung function decline in severe asthma
No full textBACKGROUND: Patients with severe asthma are susceptible to lung function decline (LFD), but biomarkers that reliably predict an accelerated LFD have not been fully recognized. OBJECTIVE: To identify variables associated with previous LFD occurrences in patients with severe asthma by exploring the computed tomography (CT) imaging features within predefined LFD groups. METHODS: We obtained inspiratory and expiratory CT images of 102 patients with severe asthma and derived 2 airway structural parameters (wall thickness [WT] and hydraulic diameter) and 2 parenchymal variables (functional small airway disease and emphysema). We retrospectively calculated the annual changes in forced expiratory volume in 1 second and grouped participants by their values determined. The 4-imaging metrics, along with levels of several biomarkers, were compared among the LFD groups. RESULTS: Patients with severe asthma with enhanced LFD exhibited significantly lower WT and smaller hydraulic diameter compared with those with minimal change or slight decline in lung function, after an adjustment of smoking status. Conversely, CT-based percentages of emphysema and functional small airway disease did not significantly differ according to LFD. Furthermore, fractional exhaled nitric oxide (FeNO) level and the blood matrix metalloproteinase-9/TIMP metallopeptidase inhibitor 1 ratio were significantly higher in patients with severe asthma with enhanced LFD compared with those in the others. CONCLUSION: Lower WT on CT scans with increased FeNO that may represent increased airway inflammation significantly correlated with enhanced LFD in patients with severe asthma. Consequently, active management plans may help to attenuate LFD for patients with severe asthma with lower WT and high FeNO
A Multicenter Investigation on the Incidence and Risk Factors of Wound Dehiscence Following Surgical Treatment of Metastatic Spinal Tumors: The Korean Society of Spinal Tumors Multicenter Study (KSST 2023-01)
No full textBackground: Wound dehiscence is a common complication in metastatic spinal tumor surgery, but its risk factors remain unclear. Methods: This retrospective, multicenter study included patients who underwent surgical treatment for metastatic spinal tumors between 2020 and 2022. Data on patient demographics, primary tumor type, comorbidities, laboratory values, surgical details, and the use of radiation therapy, chemotherapy, and steroids were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with wound dehiscence, and survival analysis was conducted based on wound dehiscence. Results: Among the 277 patients included, 32 (11.6%) experienced wound dehiscence, with an average time to onset of 37.1 +/- 24.3 days. Of these patients, 11 patients with wound infections required revision surgery under general anesthesia, whereas 21 patients underwent localized revision surgery. Univariate analysis identified diabetes (p = 0.002), hyperlipidemia (p = 0.026), surgical length (p = 0.008), and preoperative chemotherapy within 30 days before surgery (p = 0.007) as significant risk factors. On multivariate analysis, independent predictors included diabetes (OR: 4.02, 95% CI: 1.66-9.72, p = 0.002), surgical length (OR: 1.25, 95% CI: 1.02-1.52, p = 0.029), and preoperative chemotherapy within 30 days (OR: 3.75, 95% CI: 1.55-9.10, p = 0.003). Preoperative and postoperative radiation therapy did not significantly influence wound dehiscence. Additionally, there was no significant association between wound dehiscence and 90-day mortality or overall survival. Conclusions: This study highlights diabetes, surgical length, and preoperative chemotherapy within 30 days as significant predictors of wound dehiscence following metastatic spinal tumor surgery
Single-cell transcriptomics in a child with coenzyme Q10 nephropathy: potential of single-cell RNA sequencing in pediatric kidney disease
No full textBACKGROUND: Coenzyme Q10 (CoQ10) nephropathy is a well-known cause of hereditary steroid-resistant nephrotic syndrome, primarily impacting podocytes. This study aimed to elucidate variations in individual cell-level gene expression in CoQ10 nephropathy using single-cell transcriptomics. METHODS: We conducted single-cell sequencing of a kidney biopsy specimen from a 5-year-old boy diagnosed with a CoQ10 nephropathy caused by a compound heterozygous COQ2 mutation complicated with immune complex-mediated glomerulonephritis. The analysis focused on the proportion of cell types, differentially expressed genes in each cell type, and changes in gene expression related to mitochondrial function and oxidative phosphorylation (OXPHOS). RESULTS: Our findings revealed a uniform downregulation of mitochondrial gene expression across various cell types in the context of these mutations. Notably, there was a specific decrease in mitochondrial gene expression across all cell types. The study also highlighted an altered immune cell population proportion attributed to the COQ2 gene mutation. Pathway analysis indicated a downregulation in OXPHOS and an upregulation of various synthesis pathways, particularly in podocytes. CONCLUSIONS: This study improves our understanding of CoQ10 nephropathy's pathogenesis and highlights the potential applications of single-cell sequencing in pediatric hereditary kidney diseases
Effects of a mobile health coaching intervention on symptom experience, self-management, and quality of life in breast cancer survivors: A quasi-experimental study
No full textBACKGROUND: Patients diagnosed with breast cancer in South Korea have a longer post-diagnosis survival period compared to those in the United States and Europe. Therefore, it is essential to establish an effective posttreatment care system to enhance their quality of life (QOL). This study aimed to evaluate the effectiveness of a mobile health coaching intervention designed to improve symptom experience, self-management, and QOL in patients with breast cancer following the active phase of their treatment. METHODS: This study was a quasi-experimental, pre-post design conducted with breast cancer patients receiving treatment at a tertiary general hospital in Korea from July 2021 to June 2022. Participants were sequentially assigned to the control and intervention groups. Those in the intervention group participated in a 12-week mobile health coaching intervention comprising education sessions, peer support groups, and recording a health diary. The outcome variables were symptom experience, self-management, and QOL. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the intervention (T2) and compared using repeated analysis of variance. RESULTS: Seventy-four participants (mean age 46.93 years) who had completed the active phase of cancer treatment were included. The intervention group showed a significant decrease in symptom experience, from 1.57 +/- 0.46 (T0) to 1.03 +/- 0.46 (T1) (P = .006), and a decrease in psychological symptoms from 1.71 +/- 0.93 (T0) to 1.66 +/- 0.69 (T2) (P = .049). Self-management scores significantly increased from 74.43 +/- 10.72 (T0) to 76.90 +/- 11.99 (T2) (P = .028). QOL improved from 95.83 +/- 18.62 (T0) to 96.40 +/- 15.35 (T2) (P = .015), and emotional well-being increased from 17.42 +/- 4.91 (T0) to 17.50 +/- 3.63 (T2) (P < .001), with all showing significant group x time interactions. CONCLUSIONS: The 12-week mobile health coaching program significantly reduced symptoms, improved self-management, and enhanced overall QOL and emotional well-being in breast cancer survivors who had completed primary treatment. These findings highlight the program's potential to support posttreatment recovery. Further research is needed to assess its long-term effects across diverse patient populations and cancer types to validate its broader effectiveness