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만성질환 진단 경험자의 보건기관 이용 여부와 건강행태의 연관성
No full textMasterⅠ. 서론 1
1. 연구배경 및 필요성 1
2. 연구목적 4
Ⅱ. 문헌고찰 5
1. 보건기관의 건강행태 개선 사업 5
2. 흡연 7
3. 음주 7
4. 신체활동 8
5. 아침식사 8
6. 비만 9
7. 수면 9
Ⅲ. 연구방법 11
1. 연구대상 11
2. 연구모형 12
3. 연구에 사용된 변수 13
4. 분석방법 19
5. 연구윤리 20
Ⅳ. 연구결과 21
1. 연간 보건기관 이용 여부에 따른 인구사회학적 특성 21
2. 연간 보건기관 이용 여부에 따른 건강수준 및 관리 특성 23
3. 연간 보건기관 이용 여부와 건강행태 특성 비교 25
4. 연간 보건기관 이용 여부와 각 건강행태와의 연관성 27
5. 연간 보건기관 이용 여부와 건강행태지수의 연관성 29
Ⅴ. 고찰 32
Ⅵ. 결론 37
참고문헌 38
부록 43
ABSTRACT 6
Expanding current UKA indication through biomechanical test and novel surgical techniques
No full textDoctorBackground 1
CHAPTER I: Fixed-bearing unicompartmental knee arthroplasty in tibia vara knee 4
1.1 Introduction 5
1.2. Materials and Methods 8
1.2.1. Study Design 8
1.2.2. Demographics 8
1.2.3. Surgical Treatment 8
1.2.4. Radiographic Analyses 9
1.2.5. Functional Outcomes 12
1.2.6. Data Analyses 12
1.3. Results 14
1.3.1. Radiological Outcomes 14
1.3.2. Functional Outcomes 14
1.4. Discussion 19
CHAPTER II: Effect of concomitant lateral patellar retinacular release during medial unicompartmental knee arthroplasty through biomechanical test 23
2.1 Introduction 24
2.2. Materials and Methods 26
2.2.1. Study Design 26
2.2.2. Surgical Treatment 26
2.2.3. Clinical Outcomes 27
2.2.4. Radiographic Analyses 27
2.2.5. Intraoperative Patello-Femoral Pressure Measurements 30
2.2.6. Data Analyses 32
2.3. Results 33
2.4. Discussion 39
CHAPTER III: Novel surgical technique(controlled posterior condylar milling technique) for unicompartmental knee arthroplasty can minimize tibia resection during appropriate gap balancing 44
3.1 Introduction 45
3.2. Materials and Methods 46
3.2.1. Study Design 46
3.2.2. Surgical Technique 46
3.2.3. Radiographic Analyses 51
3.2.4. Clinical Outcomes 54
3.2.5. Data Analyses 54
3.3. Results 55
3.4. Discussion 59
Conclusion 64
References 6
Effectiveness of a Facet Joint Block Versus a Medial Branch Block in Spinal Pain Management: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: Facet joint injections (FJIs) and medial branch blocks (MBBs) are commonly used interventions for chronic spinal pain, but their comparative effectiveness remains unclear. This meta-analysis aimed to compare the pain relief, functional improvement, complications, and patient satisfaction associated with FJI and MBB. METHODS: A systematic review and meta-analysis of randomized controlled trials and observational studies were conducted. Primary outcomes included pain relief (numerical rating scale) and functional improvement (Oswestry Disability Index [ODI]/Neck Disability Index). Secondary outcomes assessed adverse effects and patient satisfaction. The differences in characteristics between patients who were readmitted and those who were not were identified and analyzed using the Review Manager software. RESULTS: FJI resulted in lower pain and ODI scores compared to MBB, but the differences were not statistically significant. However, patient satisfaction was significantly higher in the FJI group (odds ratio, 1.81; 95% confidence interval, 1.02-3.24; p=0.04). Additionally, FJI had fewer adverse effects than MBB. CONCLUSION: Both FJI and MBB are effective for chronic spinal pain, but FJI may be preferred for patients seeking immediate pain relief with fewer complications. Further high-quality studies are needed to refine treatment guidelines
Trends in incidence rates of micro-organisms among patients with bloodstream infections at intensive care units in South Korea from 2011 to 2022: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)
No full textBACKGROUND: Trends in the microbiological distribution and incidence rates of multi-drug-resistant pathogens in patients with bloodstream infections (BSIs) in intensive care units (ICUs) were evaluated. METHODS: This retrospective analysis was conducted using data from the Korean National Healthcare-Associated Infections Surveillance System. Annual trends in micro-organism distributions and multi-drug-resistant pathogens in patients with BSIs were investigated. RESULTS: The incidence rate of BSI due to Staphylococcus aureus decreased from 33.1 per 100,000 patient-days in 2011 to 9.7 per 100,000 patient-days in 2022. The incidence rate of BSI due to Klebsiella pneumoniae increased from 6.4 per 100,000 patient-days in 2015 to 12.1 per 100,000 patient-days in 2022. The incidence rate of BSI due to meticillin-resistant S. aureus (MRSA) (28.8/100.000 patient-days in 2011; 7.3/100,000 patient-days in 2022) and the percentage of MRSA strains (91.8% in 2011; 76.7% in 2022) decreased throughout the study period. The incidence rate of BSI due to imipenem-resistant K. pneumoniae increased significantly from 0.3 per 100,000 patient-days in 2011 to 6.1 per 100,000 patient-days in 2021, and the percentage of imipenem-resistant K. pneumoniae strains increased from 4.3% in 2011 to 48.5% in 2022. The incidence rate of BSI due to imipenem-resistant Pseudomonas aeruginosa showed an increasing trend from 2011 to 2021. CONCLUSION: The incidence rate of BSI due to MRSA in ICUs decreased, whereas the incidence rates of BSIs caused by imipenem-resistant K. pneumoniae and imipenem-resistant P. aeruginosa in ICUs showed an increasing trend. Over the past decades, there has been a significant shift from Gram-positive bacteria to Gram-negative bacteria in BSIs
High mobility group box 1 in the central nervous system: regeneration hidden beneath inflammation
No full textHigh-mobility group box 1 was first discovered in the calf thymus as a DNA-binding nuclear protein and has been widely studied in diverse fields, including neurology and neuroscience. High-mobility group box 1 in the extracellular space functions as a pro-inflammatory damage-associated molecular pattern, which has been proven to play an important role in a wide variety of central nervous system disorders such as ischemic stroke, Alzheimer's disease, frontotemporal dementia, Parkinson's disease, multiple sclerosis, epilepsy, and traumatic brain injury. Several drugs that inhibit high-mobility group box 1 as a damage-associated molecular pattern, such as glycyrrhizin, ethyl pyruvate, and neutralizing anti-high-mobility group box 1 antibodies, are commonly used to target high-mobility group box 1 activity in central nervous system disorders. Although it is commonly known for its detrimental inflammatory effect, high-mobility group box 1 has also been shown to have beneficial pro-regenerative roles in central nervous system disorders. In this narrative review, we provide a brief summary of the history of high-mobility group box 1 research and its characterization as a damage-associated molecular pattern, its downstream receptors, and intracellular signaling pathways, how high-mobility group box 1 exerts the repair-favoring roles in general and in the central nervous system, and clues on how to differentiate the pro-regenerative from the pro-inflammatory role. Research targeting high-mobility group box 1 in the central nervous system may benefit from differentiating between the two functions rather than overall suppression of high-mobility group box 1
Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage The Global Burden of Disease Study 2021
No full textIMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. OBJECTIVE: To estimate the worldwide burden of SAH. DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. EXPOSURES: SAH and 14 modifiable risk factors. MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs). RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH
Apical-out Tubuloids for Accurate Kidney Toxicity Studies
No full textIn kidney organoids, typically only the basal membrane is exposed, limiting toxicity assessments of apically transported drugs. Although the reversion of basal-out organoids has successfully created apical-out organoids of the intestine and airway, this method has not yet been applied to kidney organoids. Here, a technique to reverse tubuloid polarity is reported, enabling the apical surface to evert and face the medium by dissolving extracellular matrix proteins in the culture system. The resulting apical-out tubuloids maintain high viability, exhibit proper morphological characteristics, and express cell adhesion proteins and biomarkers appropriately. Further analyses, including RNA sequencing and scanning electron microscopy, confirm the presence of primary cilia on the outer surface, along with albumin receptors and Na+/K+-ATPase on the outer and inner surfaces, respectively, and apical proteins such as zonula occludens-1 on the lateral membrane, verifying the apical-out orientation. These apical-out tubuloids demonstrate selective albumin internalization, greater sensitivity to apically transported colistin, and reduced sensitivity to basally transported tenofovir, effectively mimicking drug transport mechanisms. This approach for generating apical-out tubuloids is a valuable tool for assessing drug efficacy and toxicity in physiologically relevant, tissue-like microenvironments, significantly advancing the field of nephrotoxicity research
Optogenetically Activatable MLKL as a Standalone Functional Module for Necroptosis and Therapeutic Applications in Antitumoral Immunity
No full textNecroptosis plays a crucial role in the progression of various diseases and has gained substantial attention for its potential to activate antitumor immunity. However, the complex signaling networks that regulate necroptosis have made it challenging to fully understand its mechanisms and translate this knowledge into therapeutic applications. To address these challenges, an optogenetically activatable necroptosis system is developed that allows for precise spatiotemporal control of key necroptosis regulators, bypassing complex upstream signaling processes. The system, specifically featuring optoMLKL, demonstrates that it can rapidly assemble into functional higher-order "hotspots" within cellular membrane compartments, independent of RIPK3-mediated phosphorylation. Moreover, the functional module of optoMLKL significantly enhances innate immune responses by promoting the release of iDAMPs and cDAMPs, which are critical for initiating antitumor immunity. Furthermore, optoMLKL exhibits antitumor effects when activated in patient-derived pancreatic cancer organoids, highlighting its potential for clinical application. These findings will pave the way for innovative cancer therapies by leveraging optogenetic approaches to precisely control and enhance necroptosis
Association of Proton Pump Inhibitor Use With Gastric Cancer in Regions With High Prevalence of Gastric Cancer: Systematic Review and Meta-analysis
No full textBACKGROUND/AIMS: Although the association between the use of proton pump inhibitors (PPIs) and the risk of gastric cancer has been postulated in casecontrol and cohort studies, it remains still controversial. We aim to evaluate association of PPI use with gastric cancer in regions with high prevalence of gastric cancer, particularly in patients who underwent eradication of Helicobacter pylori, by systemic review and meta-analysis. METHODS: Comprehensive literature search through the PubMed, Embase, and Cochrane database was performed in October 2023. We used random effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs) between PPI use and gastric cancer. The Cochran Q-statistic and the I(2) test were employed for evaluating potential heterogeneity between studies. RESULTS: Two case-control and 6 cohort studies were identified. PPI use was significantly associated with the development of gastric cancer (OR, 2.02; 95% CI, 1.35-3.01). In subgroup analysis carried out according to the study design, sample size, and adjustment of confounding factors (age, sex, and H. pylori), such association was significant. A meta-analysis of 4 studies performed in patients with H. pylori eradication history showed that the use of PPIs was significantly associated with an elevated incidence of gastric cancer (OR, 2.10; 95% CI, 1.48-2.97). CONCLUSIONS: Long-term use of PPIs is associated with an increased risk of gastric cancer in Asian regions with high prevalence of gastric cancer, particularly in subjects who have eradication history of H. pylori. Optimization of long-term PPI use seems to be necessary in regions where gastric cancer is prevalent
Prolonged Parenteral Nutrition Increases the Risk of Comorbidities in Very-Low-Birth-Weight Infants: A Prospective National Cohort Study in South Korea
No full textBackground/Objectives: There has been an increase in the incidence of comorbidities among very-low-birth-weight infants (VLBWIs), including periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Parenteral nutrition is essential for very-low-birth-weight infants (VLBWIs) who are born with a birth weight of less than 1500 g, but a longer duration of parenteral nutrition is known to have a risk of comorbidity, such as ROP. This study aims to investigate the relationship between the duration of parenteral nutrition and the comorbidities of the VLBWIs. Methods: Using the prospective cohort of Korean neonatal network, we analyzed the perinatal and postnatal data before discharge of the total 2490 subjects born in 2021 and 2022. The primary outcomes were the diagnoses of PVL, BPD, and ROP. The secondary outcomes were the severity of BPD and ROP, treatment of ROP, and proposing the predictive model of comorbidities using the duration of parenteral nutrition. Results: This study found that prolonged parenteral nutrition exceeding 28 days was associated with a higher risk of PVL (odds ratio [OR] 1.71, 95% confidence interval [CI] [1.11, 2.64], p = 0.002) and BPD (OR 1.51, 95% CI [1.10, 2.08], p = 0.011). Furthermore, an intermediate duration of parenteral nutrition was found to be significantly associated with an increased risk of ROP in male subjects. Additionally, a prolonged duration of parenteral nutrition was observed to be linked to greater severity of BPD. Predictive models incorporating the duration of parenteral nutrition demonstrated a high degree of explanatory power in relation to both BPD and ROP. Conclusions: Longer duration of parenteral nutrition has a risk of critical comorbidities in VLBWIs. The nutrition strategy for shorter parenteral nutrition should be encouraged for the prevention of comorbidities