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Contemporary diagnosis and treatment of valvular heart disease in Korea: a nationwide hospital-based registry study
Get PDFBackground: This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea. Methods: A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocardiographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical outcome was in-hospital mortality. Results: Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall in-hospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regurgitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037). Conclusions: This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes
Linear Ablation Using a Contact Force-Sensing Catheter in Ablation for Persistent Atrial Fibrillation: A Prospective Randomized Trial
No full textBackground/Objectives: Pulmonary vein isolation (PVI) using radiofrequency catheter ablation with contact force (CF)-sensing technology has improved long-term outcomes in patients with atrial fibrillation. This prospective randomized study aimed to assess the efficacy and safety of CF-sensing technology for additional left atrial (LA) linear ablation of persistent AF (PerAF). Methods: After PVI, anteromitral (AM) line and roof line ablation were performed using a CF-sensing catheter. Patients were randomly assigned to either the CF-sensing (CFS) group or the CF-blind control (Blind) group. The primary endpoint was atrial arrhythmia recurrence. LA late gadolinium enhancement (LA-LGE) MRI was conducted at baseline and 1-year follow-up for long-term lesion evaluation. Results: A total of 62 patients with drug-refractory PerAF were enrolled (mean age: 58 ± 10 years; 77% male). The success rates of AM and roof line block were 97% and 100% in the CFS group (n = 33) and 93% and 90% in the Blind group (n = 29). The time to achieve block was reduced in the CFS group (AM: 36 ± 22 vs. 48 ± 28 min, p = 0.068; roof: 19 ± 14 vs. 27 ± 15 min, p = 0.031). The maximum CF for safety endpoints was significantly lower in the CFS group (AM: 42 vs. 69 g, p < 0.001; roof: 33 vs. 49 g, p = 0.003). Full linear LA-LGE formation on 1-year MRI did not differ significantly between the groups (AM: 17 vs. 36%; roof; 29 vs. 24%, both p = NS). Kaplan–Meier estimates of AF/AT-free survival after ablation procedures were 63.6% in the CFS group and 58.6% in the Blind group (log-rank p = 0.837). Conclusions: In patients with PerAF, additional LA linear ablation following PVI using CF-sensing technology improved procedural safety and reduced the time needed to achieve conduction block. However, it did not significantly influence clinical outcomes or the formation of permanent full linear lesions
Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050
Get PDFBackground: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings: In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. Funding: UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust
Sites of Metastasis and Survival in Metastatic Renal Cell Carcinoma: Results From the Korean Renal Cancer Study Group Database
Get PDFBackground: In patients with metastatic renal cell carcinoma (mRCC), sites of metastatic involvement have been reported to be associated with a difference in survival. However, the frequency and survival according to different sites of metastases in Korean patients with mRCC remain unclear. Therefore, this study aimed to assess the frequency of metastatic site involvement and the association between sites of metastatic involvement and survival in Korean patients with mRCC. Methods: This retrospective study used the multicenter cohort of the Korean Renal Cancer Study Group mRCC database to identify patients who started targeted therapy between December 2005 and March 2018. Data on the frequency of metastatic organ involvement at the time of mRCC diagnosis and oncologic outcomes according to different sites of metastasis were analyzed. Results: A total of 1,761 patients were eligible for analysis. Of the 1,761 patients, 1,564 (88.8%) had clear cell RCC, and 1,040 (59.1%) had synchronous metastasis. The median number of metastasis sites was 2 (interquartile range [IQR], 1–6). The median age at the initiation of systemic therapy was 60 years (IQR, 29–88), 1,380 (78.4%) were men, and 1,341 (76.1%) underwent nephrectomy. Based on the International Metastatic Renal Cell Carcinoma Database Consortium model, patients were stratified into favorable-, intermediate-, and poor-risk groups with 359 (20.4%), 1,092 (62.0%), and 310 (17.6%) patients, respectively. The lung (70.9%), lymph nodes (37.9%), bone (30.7%), liver (12.7%), adrenal gland (9.8%), and brain (8.2%) were the most common sites of metastasis, followed by the pancreas, pleura, peritoneum, spleen, thyroid, and bowel. Among the most common sites of metastasis (> 5%), the median cancer-specific survival (CSS) ranged from 13.9 (liver) to 29.1 months (lung). An association was observed between liver, bone, and pleural metastases and the shortest median CSS (< 19 months). Conclusion: In Korean patients with mRCC, metastases to the lung, lymph nodes, bone, liver, adrenal gland, and brain were more frequent than those to other organs. Metastases to the liver, bone, and pleura were associated with poor CSS. The findings of this study may be valuable for patient counseling and guiding future study designs
Correction: The LKB1–TSSK1B axis controls YAP phosphorylation to regulate the Hippo–YAP pathway
Get PDFPredictors of self-care performance in patients with unruptured intracranial aneurysms
Get PDFIn South Korea, there has been an increasing number of patients diagnosed with unruptured intracranial aneurysms (UIAs), requiring rigorous self-care to prevent rupture. This study aimed to identify predictors of self-care performance in patients with UIAs, focusing on illness perception and social support. A cross-sectional correlation design was employed. Data from 150 participants was analyzed. The Brief Illness Perception Questionnaire (B-IPQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Self-Care Performance Tool were used for measurement. Pearson correlation was used to analyze the correlation among the participants’ perceived illness perception, social support, and self-care performance. Differences in the level of self-care performance according to sociodemographic and clinical characteristics and correlations among continuous variables were identified using univariate statistics. Hierarchical multiple regression was used to identify predictors of self-care performance. The results showed that the self-care performance score was positively correlated with illness perception and social support. Regression analysis showed that being a non-smoker, not consuming alcohol, receiving social support from family, receiving social support from medical personnel, and strong illness perception positively affected the self-care performance score. Our findings should be considered when developing education and intervention programs to enhance self-care performance among patients with UIAs
Circadian regulation of endoplasmic reticulum calcium response in cultured mouse astrocytes
Get PDFThe circadian clock, an internal time-keeping system orchestrates 24 hr rhythms in physiology and behavior by regulating rhythmic transcription in cells. Astrocytes, the most abundant glial cells, play crucial roles in CNS functions, but the impact of the circadian clock on astrocyte functions remains largely unexplored. In this study, we identified 412 circadian rhythmic transcripts in cultured mouse cortical astrocytes through RNA sequencing. Gene Ontology analysis indicated that genes involved in Ca2+ homeostasis are under circadian control. Notably, Herpud1 (Herp) exhibited robust circadian rhythmicity at both mRNA and protein levels, a rhythm disrupted in astrocytes lacking the circadian transcription factor, BMAL1. HERP regulated endoplasmic reticulum (ER) Ca2+ release by modulating the degradation of inositol 1,4,5-trisphosphate receptors (ITPRs). ATP-stimulated ER Ca2+ release varied with the circadian phase, being more pronounced at subjective night phase, likely due to the rhythmic expression of ITPR2. Correspondingly, ATP-stimulated cytosolic Ca2+ increases were heightened at the subjective night phase. This rhythmic ER Ca2+ response led to circadian phase-dependent variations in the phosphorylation of Connexin 43 (Ser368) and gap junctional communication. Given the role of gap junction channel (GJC) in propagating Ca2+ signals, we suggest that this circadian regulation of ER Ca2+ responses could affect astrocytic modulation of synaptic activity according to the time of day. Overall, our study enhances the understanding of how the circadian clock influences astrocyte function in the CNS, shedding light on their potential role in daily variations of brain activity and health
Targeting Glucose Metabolism: A Novel Therapeutic Approach for Parkinson’s Disease
Get PDFGlucose metabolism is essential for the maintenance and function of the central nervous system. Although the brain constitutes only 2% of the body weight, it consumes approximately 20% of the body’s total energy, predominantly derived from glucose. This high energy demand of the brain underscores its reliance on glucose to fuel various functions, including neuronal activity, synaptic transmission, and the maintenance of ion gradients necessary for nerve impulse transmission. Increasing evidence shows that many neurodegenerative diseases, including Parkinson’s disease (PD), are associated with abnormalities in glucose metabolism. PD is characterized by the progressive loss of dopaminergic neurons in the substantia nigra, accompanied by the accumulation of α-synuclein protein aggregates. These pathological features are exacerbated by mitochondrial dysfunction, oxidative stress, and neuroinflammation, all of which are influenced by glucose metabolism disruptions. Emerging evidence suggests that targeting glucose metabolism could offer therapeutic benefits for PD. Several antidiabetic drugs have shown promise in animal models and clinical trials for mitigating the symptoms and progression of PD. This review explores the current understanding of the association between PD and glucose metabolism, emphasizing the potential of antidiabetic medications as a novel therapeutic approach. By improving glucose uptake and utilization, enhancing mitochondrial function, and reducing neuroinflammation, these drugs could address key pathophysiological mechanisms in PD, offering hope for more effective management of this debilitating disease
태아의 염색체 이수성 검출을 위한 전장유전체 분석방법과 분석도구
No full textMaster제1장 서론 1
제2장 구현 6
2-1. 알고리즘과 데이터 처리 6
2-2. 연구재료 및 방법 12
2-2-1. NGS 데이터 처리 방법과 파이프라인 13
2-2-2. NIPT 데이터 세트 개발 및 활용 23
2-2-3. fetal fraction (태아분획) 분석도구와 분석 성능 평가 31
제3장 결과 38
3-1. KF-NIPT의 염색체 이수성 분석과 성능 테스트 결과 38
제4장 고찰 48
제5장 결론 50
참고문헌 51
영문 요약 5
심부전 환자의 상황특수이론 기반 자가간호 이행 영향요인
No full textMasterⅠ. 서론 1
A. 연구의 필요성 1
B. 연구의 목적 6
C. 용어의 정의 7
Ⅱ. 문헌고찰 10
A. 심부전 환자의 자가간호 이행 10
B. 심부전 환자의 자가간호 이행 관련요인 13
Ⅲ. 연구방법 18
A. 연구설계 18
B. 연구대상 18
C. 연구 도구 20
D. 자료수집방법 및 절차 23
E. 자료 분석 방법 24
F. 윤리적 고려 25
Ⅳ. 연구결과 26
A. 연구대상자의 일반적 및 질병관련 특성 26
B. 연구대상자의 증상, 심부전 지식, 건강문해력, 자기효능감, 사회적지지 및 자가간호 이행 정도 30
C. 연구대상자의 일반적 및 질병관련 특성에 따른 자가간호 이행의 차이 34
D. 연구대상자의 자가간호 이행과 주요 변수들 간의 상관관계 38
E. 연구대상자의 자가간호 이행에 영향을 미치는 요인 40
Ⅴ. 논의 43
Ⅵ. 결론 및 제언 50
A. 결론 50
B. 제언 51
참고문헌 52
부록 71
ABSTRACT 8