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Oblique lateral interbody fusion using angle-adjustable cage
No full textPURPOSE: Orthogonal cage rotation is an essential technique in oblique lateral interbody fusion (OLIF). However, during OLIF at L4-5, this is often limited due to iliac crest. Angle-adjustable cages are designed to insert cages without interference from iliac crest, but there are few studies on whether they are useful. We aimed to compare the radiological outcomes between the conventional cage and angle-adjustable cage inOLIF at L4-5. METHODS: This study involved 90 consecutive patients with degenerative lumbar disease who underwent OLIF at L4-5 with a minimum one-year follow-up. The previous 41 patients used conventional cage (group I), and then 49 patients used angleadjustable cage (group II). Radiological outcomes including cage obliquity, cage position, foraminal height, fusion rate, and cage subsidence were compared between the two groups. RESULTS: There were no differences in the mean iliac crest height between the two groups. The cage obliquity was greater in the group I than group II (12.1 +/- 7.4 degrees vs. 8.3 +/- 7.0 degrees , P = 0.015), and so were the mean cage position from the anterior margin of the L5 vertebra (6.3 +/- 3.9 mm vs. 4.7 +/- 3.6 mm, P = 0.043). Other than that, there was no significant difference in radiological outcomes between the two groups. CONCLUSION: Our study demonstrated that using an angle-adjustable cage at L4-5 OLIF is more advantageous for orthogonal cage rotation and anterior cage positioning. In L4-5 OLIF, an angle-adjustable cage system is a particularly good option for patients with a high iliac crest
Longitudinal quality of life assessment after laparoscopic colorectal cancer surgery using the Gastrointestinal Quality of Life Index questionnaire: A multicentre prospective study
No full textAIM: The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) and assess its effectiveness in measuring changes in postoperative quality of life (QOL) after laparoscopic colorectal cancer surgery, including factors affecting early QOL impairment. METHOD: This multicentre prospective study enrolled patients who underwent laparoscopic colorectal cancer surgery between November 2021 and February 2023. Participants completed the GIQLI and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Colorectal Cancer (EORTC QLQ-CR29) questionnaires preoperatively and at 1 and 3 weeks, 6 months and 1 year postoperatively. We evaluated GIQLI reliability, identified risk factors associated with early postoperative QOL impairment and assessed longitudinal changes in QOL to determine the timing of postoperative recovery. RESULTS: The GIQLI showed high reliability, with a preoperative intraclass correlation coefficient of 0.930 (95% CI 0.899-0.951) and Cronbach alpha values >0.9 at all time points. The mean global GIQLI score decreased from 106.2 +/- 14.7 preoperatively to 92.7 +/- 15.2 at 1 week postoperatively (p < 0.001), recovered to 104.6 +/- 13.8 at 6 months postoperatively (versus preoperatively, p > 0.99) and increased to 113.4 +/- 13.3 at 1 year postoperatively (versus preoperatively, p < 0.001). Early T-stage (T1-2; OR 2.82, 95% CI 1.25-6.40, p = 0.013) and intra-abdominal drain use (OR 3.95, 95% CI 1.09-14.28, p = 0.036) were significant risk factors for substantial impairment of QOL at 1 week postoperatively. The predicted recovery period to 95% of preoperative QOL was 6.4 weeks (95% CI 6.00-8.30 weeks). CONCLUSION: The GIQLI reliably assessed longitudinal changes in QOL after laparoscopic colorectal cancer surgery and demonstrated QOL recovery within 2 months postoperatively, providing guidance for patient counselling and optimizing postoperative care
Epidemiological study of DSM-5 mental disorders: National mental health survey of Korea - child and adolescent 2022
No full textEffective mental health policies for children and adolescents rely on accurate evaluations of psychiatric disorder prevalence; however, no nationally representative epidemiological studies on psychiatric disorders among children and adolescents have been conducted in South Korea. This study examined the prevalence and socio-demographic factors of mental disorders among Korean children and adolescents aged 6-17 years using web-based DSM-5 diagnostic tools, the computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia. Between September 2022 and February 2023, 142 interviewers visited houses with tablet PCs in each national census tract by stratified cluster sampling (N = 6275; response rate: 59.94 %). The lifetime prevalence of mental disorders, combining past and current rates, was 16.1 % overall. The highest psychiatric disorders were anxiety disorders (9.6 %), followed by disruptive, impulse control, and conduct disorders (4.4 %), and eating disorders (1.7 %). Substance use disorder among adolescents was 3.1 %, adolescent depressive disorder was 1.5 %, and childhood ADHD was 0.6 %. Parental education and household income influenced mental disorders. This first national-level prevalence can help improve our understanding of child and adolescent mental health in Korea and inform early detection and intervention efforts
Real-world comparative effectiveness study of Janus kinase inhibitors compared to biologic disease-modifying antirheumatic drugs in Korean patients with rheumatoid arthritis
No full textOBJECTIVES: To evaluate the real-world effectiveness and safety of Janus kinase inhibitors (JAKis) compared to biologic disease-modifying antirheumatic drugs (bDMARDs) in Korean patients with rheumatoid arthritis (RA) who have not previously been treated with either JAKis or bDMARDs. METHODS: This prospective, multicenter, observational study was conducted at 17 centres in the Republic of Korea. Patients with an inadequate response to methotrexate were enrolled and started treatment with either JAKis or bDMARDs. The primary endpoint was the proportion of patients achieving low disease activity (LDA) at 24 weeks, measured by the disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR). Secondary endpoints included the remission rate at 24 weeks, and LDA and remission rates at 48 weeks. Safety was assessed by the exposure-adjusted event rate (EAER) of adverse events (AEs), adjusted for length of the follow-up period and presented per 100 person-years. RESULTS: A total of 506 patients were enrolled, with 253 patients in each group. Among bDMARD users, 60.1 % received tumour necrosis factor inhibitors (TNFis; n = 152) and 39.9 % received non-TNFis (n = 101). At 24 weeks, 48.2 % of the JAKi group achieved LDA, as did 42.7 % of the bDMARD group. Remission rates at 24 weeks were 28.9 % for the JAKi group and 27.3 % for the bDMARD group. At 48 weeks, there were no significant intergroup differences in the EAER of overall AEs. CONCLUSIONS: In this observational real-world study of Korean patients with RA who were eligible for targeted therapy, JAKis demonstrated comparable effectiveness and safety to bDMARDs
Effects of indoor environments and outdoor air pollutants in residential areas on acute exacerbation in patients with severe asthma
No full textThis study aimed to determine the effects of indoor environment (IE) and outdoor air pollutants (OAPs) in residential areas on acute exacerbation (AE) in patients with severe asthma. A total of 115 participants were recruited. To characterize IE, we used structured questionnaires and estimated OAP concentrations using a land-use regression model. Participants who were exposed to passive smoking and lived in houses where the kitchen and living room were not separated showed a significantly higher rate of AE (p = 0.014 and 0.0016, respectively). The mean concentration of PM(2.5) in residential areas during the last 3 years was significantly higher in participants with AE than that in those without AE (19.8 +/- 3.1 vs. 21.0 +/- 2.5 microg/m(3), p = 0.033). Moreover, the serum level of 8-hydroxy-2'-deoxyguanosine significantly increased in participants with AE compared to those without AE (56.9 +/- 30.0 vs. 94.7 +/- 44.5 ng/mL, p = 0.0047) suggesting enhanced oxidative stress in those with AE
Discrepancies in Dapagliflozin Response in Terms of Glycemic Control and Body Weight Reduction
No full textBACKGRUOUND: Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduces hyperglycemia and obesity by inhibiting renal glucose reabsorption. This post hoc study evaluated clinical factors influencing patient response to dapagliflozin. METHODS: The analysis focused on patients treated with dapagliflozin (10 mg/day for 52 weeks) within the randomized, double-blind, parallel-group BEYOND trial. Adequate glycemic control (GC) was defined as a reduction in glycated hemoglobin (HbA1c) of >/= 1.0% or the achievement of an HbA1c level <7.0% at week 52. Significant weight loss (WL) referred to a reduction in body weight of >/=3.0% at week 52. Participants were classified into four groups based on their GC and WL responses: GC+/WL+, GC+/WL-, GC-/WL+, and GC-/WL-. RESULTS: Among dapagliflozin recipients (n=56), at 52 weeks, HbA1c had decreased by 1.0%+/-0.8% from baseline, while body weight had declined by 2.4+/-3.1 kg. Overall, 69.6% of participants achieved GC+, and 57.1% achieved WL+. Male sex and shorter diabetes duration were significantly associated with achieving GC+. Conversely, higher estimated glomerular filtration rate was significantly linked to WL+. The only factor significantly associated with both GC+ and WL+ was shorter diabetes duration (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97; P=0.023). The GC+ and WL+ groups exhibited favorable responses beginning soon after dapagliflozin therapy was initiated. Furthermore, HbA1c decline was more strongly associated with reduction in visceral fat than with WL. CONCLUSION: A short duration of diabetes and early response to treatment appear to represent key factors in maximizing the benefits of dapagliflozin for blood glucose and weight management
Inhibitory effects of kukoamine B on adipogenesis and lipid accumulation in vitro and obesity in vivo
No full textObesity, characterized by excessive adipose tissue accumulation, is an important risk factor for the development of several chronic conditions, including cardiovascular disease, type 2 diabetes mellitus, and hypertension. The present study aimed to investigate the effects of kukoamine B (KB), a major component of the Lycii Radicis Cortex (LRC), on adipogenesis and lipid accumulation in vitro and further assess its role in obesity in vivo. For the in vitro experiments, 3T3-L1 cells and primary-cultured adipose-derived stem cells were used. Lipid accumulation was measured using Oil Red O staining, and adipogenesis-related gene expression was assessed using quantitative reverse transcription polymerase chain reaction. For the in vivo experiments, LRC or KB was orally administered to ovariectomized and high-fat diet-induced obese mice. LRC exhibited antiadipogenic and antiobesity effects in vitro and in vivo experiments. Fractionation of the LRC extract identified KB as a bio-active component. KB treatment resulted in a dose-dependent reduction in lipid droplet formation and downregulation of adipogenesis-related genes, including Pparg, Cebpa, Srebp1, Fasn, and Plin2, in both cell types. Western blot analysis revealed that KB significantly suppressed the protein expression of key adipogenic factors, including phosphorylated CREB, CEBPB, PPARG, and CEBPA. In vivo, KB administration significantly reduced body weight gain, hepatic steatosis, and adipocyte hypertrophy in both mouse models. These results suggest that KB is a potential therapeutic agent for the prevention and treatment of obesity. Further rigorous investigations, including human clinical trials, are necessary to fully elucidate the safety profile, optimal dosing regimens, and long-term effects of KB
Normative data for age-specific skeletal muscle area based on computed tomography in Korean population
No full textBACKGROUND: Sarcopenia, a progressive loss of muscle mass and function, increases health risks in older adults, especially in rapidly ageing populations like Korea. Computed tomography (CT) imaging at the third lumbar vertebra (L3) level is a gold standard for assessing skeletal muscle area (SMA) and indices (SMIs), yet age- and sex-specific reference values are limited. This multicentre study aimed to establish these values for improved sarcopenia diagnosis. METHODS: We conducted a retrospective study with 2637 healthy Korean adults (1366 men, 1271 women) aged 20 and older, using abdominal CT scans from routine health check-ups at four centres. SMA and SMIs were measured at L3, and T-scores were calculated by comparing participants' values with a healthy young reference group (ages 20-39). Sarcopenia was classified into Classes I and II using standardised cutoffs. RESULTS: An age-related SMA decline was observed in both sexes, with a more significant reduction in men. Sarcopenia prevalence was higher in men based on the SMA index, while SMA/body mass index (BMI) was more sensitive in women. Class I sarcopenia ranged from 10.1% to 21.3% in men and 10.6% to 23.6% in women, with Class II prevalence between 1.0% and 5.5% in men and 1.3% and 8.3% in women. CONCLUSION: This study establishes CT-based reference values for SMA and SMIs, supporting early sarcopenia detection, with the SMA/BMI index proving valuable for both men and women
Economic Evaluation of Rituximab Versus Corticosteroid-Cyclophosphamide or Cyclosporine in Patients With Membranous Nephropathy in Republic of Korea
No full textBACKGROUND: Cyclic corticosteroid-cyclophosphamide or cyclosporine is a well-known membranous nephropathy (MN) treatment but has high risks of adverse drug reactions (ADRs). Rituximab has a non-inferior effect compared to previous treatments, with fewer ADRs. However, the high cost of rituximab is a pharmacoeconomic disincentive. METHODS: We conducted a cost-minimisation analysis to evaluate the relative and absolute costs of rituximab versus corticosteroid-cyclophosphamide or cyclosporine in patients with MN over 2 years using a decision-tree model based on ADRs from two pivotal trials (RI-CYCLO and MENTOR). We included costs of medication, time, transportation, and ADRs. Deterministic sensitivity analysis and threshold analysis were performed to assess the uncertainty of the model input parameters and estimate the appropriate price of rituximab. RESULTS: The total expected cost for rituximab was 2684 for the comparators, with an expected incremental cost of 223), time costs by 31.1% (180). A 46.9% price reduction of rituximab would make it an economically favourable option for treating MN compared to comparators. CONCLUSIONS: If the price of rituximab is reduced, it can be a good alternative to corticosteroid-cyclophosphamide or cyclosporine for MN in the Republic of Korea
Immunologic responses to an extracellular vesicle-based vaccine expressing the full suite of SARS-CoV-2 structural proteins
No full textIn an attempt to develop a novel extracellular vesicles (EVs)-based vaccine against COVID-19, we designed EVs harboring a full set of SARS-CoV-2 structural proteins. Thus, the receptor-binding domain (RBD) of spike protein (S) of SARS-CoV-2 variant BA.2 or BA.4/5 with the stabilized wild type spike protein backbone, nucleocapsid protein (N) C-terminally fused with CD63, membrane (M), and envelope (E) proteins were stably expressed in 293T cells. Then, cell death-associated EVs were collected from the cells and evaluated for the expression of SARS-CoV-2 structural proteins. As a result, it was confirmed that trimers of spike fusion protein, N, M, and E were successfully loaded in the EVs. In an intramuscular injection model of mice, the inoculation of 50 mug EVs resulted in significant IgG antibody responses to S after the booster injection and neutralized the entry of S-pseudotyped VSVs. Anti-nucleocapsid antibodies were efficiently increased in mice primarily injected with 25 or 50 mug EVs, showing further increased values after booster dosages. Memory CD4(+) T(H1) cells and CD8(+) T(C) cells against S and N proteins was generated in mice that received a booster-immunization with all dosages (10, 25, or 50 mug) of EVs. Additionally, T cells responses against M and E peptides were increased in booster-immunized mice that received 50 mug of EVs. Taken together, this work proved feasibility of EVs expressing SARS-CoV-2 proteins as a universal vaccine candidate, potentially offering protection against emerging SARS-CoV-2 variants and future pandemics