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Additional Screw Added to the Femoral Neck System Could Enhance the Stability of Pauwel Type III Femoral Neck Fractures: a Finite Element Analysis
No full textBACKGROUD: This study explores effective fixation methods for Pauwel type III femoral neck fractures by evaluating the biomechanical benefits of adding a screw to the Femoral Neck System (FNS). METHODS: Computed tomography (CT) scans of an 82-year-old female patient with an intertrochanteric fracture were used to establish a finite element femur model with heterogeneous material properties. Finite element models of Pauwel type III fractures were created with and without an additional screw. The central and inferior trajectories of the FNS bolt were examined separately and combined with an additional screw for virtual fixation. Walking and stair-climbing loads were applied. RESULTS: With the addition of a screw, both peak maximum and minimum principal strains consistently stayed comparable or decreased in models with both central and inferior bolt trajectories, while the volume of elements with principal strain exceeding 1% decreased by more than half. The peak von Mises stress observed in the implants ranged from 215.7 to 359.3 MPa, remaining below the titanium alloy's yield strength of 800 MPa. For normal walking, the addition of a screw to the central bolt trajectory model decreased the fracture gap by 50.6% and reduced sliding distance by 8.6%. For the inferior bolt trajectory, the gap was reduced by 57.9% and sliding distance by 25.0%. Under stair-climbing conditions, these improvements were also evident; the central trajectory model saw a halved fracture gap and a 7.9% decrease in sliding distance, while the inferior trajectory model experienced a 55.7% gap reduction and a 27.2% decrease in sliding distance. The additional screw increased the area ratio of the fracture site experiencing interfragmentary compression 34%-39%, while the additional screw alleviated peak interfragmentary compression by 12%-18% under both normal walking and stair-climbing conditions. CONCLUSIONS: The addition of a screw reduced the fracture gap, sliding distance, and peak interfragmentary compression, while increasing the area ratio of interfragmentary compression under both walking and stair-climbing loads, regardless of the FNS bolt trajectory, suggesting a better mechanical environment for fracture healing
Erratum: Clinical Feasibility of Vascular Navigation System During Laparoscopic Gastrectomy for Gastric Cancer: A Retrospective Comparison With Propensity-Score Matching
No full textChanges of Clinical Practice Patterns of Allergen Immunotherapy in Korea
No full textThis study aimed to identify recent changes of AIT treatment behaviors in real-world clinical practice using a questionnaire survey in Korea. The questionnaire on AIT prescriptions and practical experiences was distributed to all members of the Korean Academy of Asthma Allergy and Clinical Immunology in June 2022. The responses were analyzed and compared with the results from 2009 and 2017. In total, 115 responses (10.1%) were collected; 58 (50.4%) from internal medicine, 34 (29.6%) from pediatricians, and 21 (18.3%) from otolaryngologists. The prescription rate for subcutaneous immunotherapy (SCIT) was 53.8%, showing a decrease from those in 2009 and 2017; however, that for sublingual immunotherapy (SLIT) increased steadily, reaching 17.9% in 2009, 40.3% in 2017, and 46.2% in 2022. The prescription rates for asthma and atopic dermatitis increased by 4.6% and 7.9%, respectively. The most frequently prescribed allergens for SCIT in 2022 were house dust mites (32.9%), pollen (30.6%), and animal dander (28.2%), with the rate for animal dander showing a significant increase from 10.3% in 2009. Most physicians (93%) used mixed allergens for SCIT, with 42.8% using a combination of 5 or more allergens. Fifty-eight (67.4%) respondents reported cases of anaphylaxis during SCIT and 36.2% reported systemic adverse reactions during SLIT. In conclusion, SLIT prescriptions, AIT for asthma and atopic dermatitis, and AIT with animal dander increased significantly from 2009 to 2022. Serial surveys of AIT practices are helpful in identifying the changes of real-world clinical practice of AIT
Comment on “Lower incidence of hepatocellular carcinoma with tenofovir alafenamide in chronic hepatitis B: Evidence from a large-scale cohort”
No full textC/EBPα activates Irf8 expression in myeloid progenitors at the +56-kb enhancer to initiate cDC1 development
No full textDevelopment of type 1 conventional dendritic cells (cDC1s) underlies the capacity to generate antiviral and antitumor immune responses. Here, we identify the basis for cDC1 development from its earliest progenitors, determining the hierarchy of several required transcription factors and uncovering a series of mandatory cis interactions between constituent enhancers within the Irf8 superenhancer. We produced in vivo mutations of two C/EBPalpha binding sites that comprise the Irf8 +56-kilobase (kb) enhancer that markedly reduced IRF8 expression in all myeloid progenitors and impaired cDC1 development. These sites did not bind RUNX1 or RUNX3, and C/EBPalpha expression was instead regulated by their action at the Cebpa +37-kb enhancer, placing RUNX factors upstream of Cebpa in regulating Irf8. Last, we demonstrate that cis interactions between the +56-kb Irf8 enhancer and the previously reported +41- and +32-kb Irf8 enhancers are mandatory in the sequential progression of these stage-specific constituent elements
TRIM22 functions as a scaffold protein for autophagy initiation
No full textTripartite motif (TRIM) family proteins are increasingly recognized as important regulators of autophagy under various physiological and pathological conditions. TRIM22 has been previously shown to mediate autophagosome-lysosome fusion, but its potential role in earlier stages of autophagy remained unexplored. In this study, we investigated the function of TRIM22 in autophagy initiation. Overexpression of TRIM22 increased LC3-II levels and enhanced autophagic flux without affecting mTOR and AMPK activity. We found that TRIM22 interacts with components of both the ULK1 complex and the class III PI3K complex through distinct domains, recruiting them into punctate structures that represent autophagosome formation sites. Domain mapping revealed that the SPRY domain mediates interactions with ATG13 and FIP200, while the N-terminal region interacts with ULK1 and ATG101. The B-box domain of TRIM22 was identified as crucial for its interaction with Beclin-1, a key component of the class III PI3K complex. Deletion of this domain impaired the ability of TRIM22 to assemble the class III PI3K complex and induce autophagic flux. Interestingly, competitive binding assays revealed that Beclin-1 and PLEKHM1 bind to the same region of TRIM22, suggesting a mechanism for coordinating different stages of autophagy. The Alzheimer's disease-associated TRIM22 variant R321K maintained autophagy initiation function in both cell lines and primary neurons. These findings demonstrate that TRIM22 acts as a scaffold protein to promote autophagy initiation, in addition to its previously described role in autophagosome-lysosome fusion. Our study provides new insights into the molecular mechanisms by which TRIM proteins regulate multiple stages of the autophagy process
Empagliflozin Alleviates Hepatic Steatosis and Oxidative Stress via the NRF1 Pathway in High-Fat Diet-Induced Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease
No full textEmpagliflozin (EMPA)-a sodium-glucose cotransporter type 2 inhibitor-reduces endoplasmic reticulum (ER) stress, oxidative stress, and inflammation during metabolic dysfunction-associated steatotic liver disease (MASLD) progression. However, the direct effects of EMPA on hepatic lipid metabolism and oxidative stress are unclear. Through the current study, we seek to explore the effects of EMPA on oxidative stress and related mechanisms in MASLD. To this end, MASLD was induced in C57BL/6J mice using a high-fat diet (HFD); nuclear respiratory factor 1 (NRF1) was downregulated via viral transduction (AAV8-shNrf1). Glucose homeostasis and liver histology were assessed, and oxidative stress and inflammation were measured. HFD-fed mice-derived liver tissue samples exhibited more lipid droplets, higher triglyceride levels, and elevated oxidative and ER stress than chow diet (CD)-fed mice. EMPA attenuated HFD-induced liver oxidative and ER stress. Additionally, the HFD significantly decreased NRF1 and Sirtuin (SIRT)7 expression compared with CD, which was rescued by EMPA treatment. However, these results did not affect insulin resistance or lipid synthesis-related changes upon EMPA treatment in the Nrf1-knockdown mice. Furthermore, EMPA alleviated HFD-induced hepatic steatosis and oxidative stress; however, these effects were lost in Nrf1-knockdown mice. Collectively, the results of this study suggest that EMPA ameliorates MASLD by reducing steatosis and attenuating oxidative stress via NRF1
Impact of the COVID-19 pandemic on the clinical performance of medical students: a retrospective study in Korea
No full textPURPOSE: The COVID-19 (coronavirus disease 2019) pandemic led to significant changes in clinical clerkships, including reduced ward rounds. We aimed to determine how the pandemic-induced changes in the clinical practice environment affect the clinical performance of medical students. METHODS: We analyzed objective structured clinical examination scores of third- and fourth-year medical students from 2019-2020 and 2020-2021 across six stations by the Seoul-Gyeonggi Consortium. Clinical, communication, and ability scores were measured and analyzed using repeated-measures multivariate analysis of variance. RESULTS: The interaction between clinical practice progress and pandemic-induced changes significantly affected physical examination and medical history scores, though the differences were not substantial. Patient-physician interaction significance varied by measurement period. Clinical communication ability also showed significant differences based on the measurement period and practical experience. CONCLUSION: During the pandemic, alternative learning methods, including self-learning, simulation/practice, and peer role-play, helped improve medical competency in areas such as history-taking and physical examination. However, these were less effective in improving patient-physician interactions or clinical communication efficacy. Alternative learning methods have limitations, and they cannot replace direct patient encounters in clinical practice
Identifying factors associated with mental health status following climate-related disasters: a nationwide longitudinal panel study in Korea
No full textOBJECTIVES: Despite the increasing frequency and intensity of climate-related disasters, identifying factors associated with mental health status remains challenging. This study aimed to determine the factors linked to symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) following heavy rainfall and typhoons. METHODS: National data on climate-related disaster victims (n=825 for heavy rainfall and n=1,220 for typhoon) from a longitudinal panel in Korea ("Long-term Survey on the Change of Life of Disaster Victims") and data from individuals unaffected by disasters (n=893) were used. Generalized linear mixed models were employed to evaluate the factors associated with mental health status following climate-related disasters. RESULTS: Greater disaster severity (e.g., experiencing casualties or asset loss) was associated with higher scores for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and PTSD (Impact Event Scale-Revised). The association between casualty experience and anxiety score was more pronounced among individuals over 65 years (beta [log-transformed score], 1.39; standard error [SE], 0.26; p<0.001), female respondents (beta, 1.20; SE, 0.20; p<0.001), those with a low education level (beta, 1.18; SE, 0.25; p<0.001), and those with a low income (beta, 1.45; SE, 0.26; p<0.001) compared to their counterparts. CONCLUSIONS: These findings may help guide targeted interventions and shape public health policies and disaster management strategies that prioritize mental health support for the most at-risk populations, ultimately increasing community resilience to climate-related challenges
Digital Mental Health Interventions for Adolescents: An Integrative Review Based on the Behavior Change Approach
No full textBackground: Adolescents are at a critical developmental stage marked by rapid cognitive, emotional, and social changes, making them highly susceptible to mental health issues. Recently, digital health interventions (DHIs) have emerged as innovative and scalable tools for promoting mental well-being in this population. Methods: This integrative review was conducted based on comprehensive literature searches of major academic databases, including PubMed, Scopus, Web of Science, and PsycINFO. Studies published between January 2010 and December 2024 were identified using keywords such as "adolescent mental health," "digital health intervention," "behavior change model," "e-health," "mobile mental health," and "digital therapeutics." The inclusion criteria comprised peer-reviewed studies on digital mental health interventions for adolescents that applied, fully or partially, a behavior change approach. Studies targeting adults, interventions without digital technology, the gray literature, and duplicate publications were excluded. Results: We examined intervention strategies based on developmental stage prevention, early intervention, and recovery and highlighted key digital components such as accessibility, anonymity, personalization, and continuous monitoring. Furthermore, we analyzed case studies from various countries, including Korea, the United Kingdom, Australia, and Japan, to identify best practices and contextual challenges. Conclusions: DHIs rooted in sound psychological theory and ethical design can complement school- and community-based interventions by offering effective personalized support. The practical implications and future directions are discussed