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코로나19유행시기 한국 성인의 일자리 변화와 우울의 연관성 : 2021년 지역사회건강조사 기반 분석
No full textMasterI. 서 론 1
1. 연구의 배경 및 필요성 1
2. 연구 목적 4
II. 연구 방법 5
1. 연구 설계 5
2. 연구 대상 6
3. 연구 변수 7
A. 코로나 일자리 변화 7
B. 우울 7
C. 인구사회학적 특성 8
D. 건강행태 특성 9
E. 주관적 건강수준 9
4. 자료 분석 방법 10
III. 연구 결과 11
1. 연구대상자의 인구사회학적 특성, 건강행태 특성 및 주관적 건강수준 11
A. 연구대상자의 인구사회학적 특성 빈도분석 11
B. 연구대상자의 건강행태 빈도분석 13
C. 연구대상자의 주관적 건강수준 빈도분석 13
D. 연구대상자의 코로나 일자리 변화 및 우울의 빈도분석 14
2. 연구대상자의 인구사회학적 특성, 주관적 건강수준, 건강행태에 따른 코로나 일자리 변화 차이 15
A. 연구대상자의 인구사회학적 특성에 따른 코로나 일자리 변화 차이 15
B. 연구대상자의 주관적 건강수준에 따른 코로나 일자리 변화 차이 19
C. 연구대상자의 건강행태에 따른 코로나 일자리 변화 차이 20
3. 연구대상자의 인구사회학적 특성, 주관적 건강수준, 건강행태에 따른 우울정도 차이 21
A. 연구대상자의 인구사회학적 특성에 따른 우울의 차이 21
B. 연구대상자의 주관적 건강수준에 따른 우울의 차이 24
C. 연구대상자의 건강행태에 따른 우울의 차이 24
D. 연구대상자의 코로나 일자리 변화에 따른 우울의 차이 26
4. 연구대상자의 코로나 일자리 변화와 우울과의 연관성 26
5. 직업분류별 코로나 일자리 변화와 우울과의 연관성 30
A. 화이트컬러 직종의 코로나 일자리 변화와 우울과의 연관성 30
B. 블루컬러 직종의 코로나 일자리 변화와 우울과의 연관성 32
C 핑크컬러 직종의 코로나 일자리 변화와 우울과의 연관성 35
6. 종사상 지위별 코로나 일자리 변화와 우울과의 연관성 38
A. 자영업자의 코로나 일자리 변화와 우울과의 연관성 38
B. 임금근로자의 코로나 일자리 변화와 우울과의 연관성 41
IV. 고찰 44
V. 결 론 51
참고문헌 53
[ABSTRACT] 5
대기오염물질 노출과 수면부족 연관성 분석: 국민건강영양조사제8기 자료를 중심으로
No full textMasterⅠ. 서론 1
1. 연구 배경 및 필요성 1
2. 연구 목적 10
Ⅱ. 연구 방법 11
1. 연구 설계 11
2. 연구 대상 14
3. 연구 변수 15
4. 자료 분석 방법 18
Ⅲ. 연구 결과 21
1. 연구 대상자의 대기오염물질 노출 평균 농도 21
2. 연구 대상자의 수면부족 여부 23
3. 수면부족 여부에 따른 대기오염물질 노출 평균 24
4. 연구 대상자의 일반적 특성 25
5. 연구 대상자의 건강 관련 특성 27
6. 연구 대상자의 일반적 특성에 따른 수면부족 여부 29
7. 연구 대상자의 건강 관련 특성에 따른 수면부족 여부 31
8. 대기오염물질 노출과 수면부족의 연관성 33
9. 성별에 따른 대기오염물질 노출과 수면부족의 연관성 36
10. 연령에 따른 대기오염물질 노출과 수면부족의 연관성 38
11. 도시/농촌 구분에 따른 대기오염물질 노출과 수면부족의 연관성 40
12. 흡연에 따른 대기오염물질 노출과 수면부족의 연관성 42
13. 음주에 따른 대기오염물질 노출과 수면부족의 연관성 44
Ⅳ. 고찰 46
1. 대기오염물질 노출과 수면부족 주요 분석 결과 46
2. 대기오염물질 노출과 수면부족 하위 분석 결과 50
Ⅴ. 결론 56
참고문헌 58
부록 64
ABSTRACT 6
Senescence cell signature associated with poor prognosis, epithelial–mesenchymal transition, solid histology, and spread through air spaces in lung adenocarcinoma
No full textCellular senescence is involved in critical processes in tumor progression. Despite this potential relationship, the relationship between tumor cell senescence, prognostic significance, spread through air spaces (STAS), and tumor histology has not been investigated in lung adenocarcinoma (LUAD). We used the LUAD PanCancer Atlas dataset to assess senescence cell signature (SCS) based on the SenMayo gene set. We examined the relationship between SCS, prognostic significance, STAS, and tumor histology. This relationship was confirmed in independent LUAD datasets by validation using immunohistochemical senescence markers. In the LUAD PanCancer Atlas dataset, patients with high SCS expression had a higher prevalence of solid histology and STAS patterns than those with low SCS expression. In the independent LUAD datasets, high p21 expression and low HMGB1 expression were correlated with solid histology or STAS patterns. SCS level was also independent prognostic factor in four different LUAD datasets. The HMGB1 expression was an independent prognostic factor in the independent LUAD dataset in multivariate analysis. The expression of p21 and the presence of solid histology were linked to the epithelial-mesenchymal transition (EMT) phenotype. In LUAD cell lines, inducing senescence with a DNA-damaging agent led to an increase in EMT marker expression. Our findings suggest a strong link between senescence, EMT, and solid histology, offering valuable insight into how cancer cell senescence may promote tumor progression through particular pathways
Therapeutic Potential of Arginine-Loaded Red Blood Cell Nanovesicles Targeting Obese Asthma
No full textPurpose: The role of the gut microbiomes has been emphasized in the pathogenesis of obese asthma (OA). However, the molecular mechanism of airway dysfunction underlying OA has not yet been fully elucidated. The effects of microbiomes on arginine metabolism in relation to lung functions and a novel method for delivering arginine to lung tissue based on arginine-loaded red blood cell (RBC)-derived nanovesicles (NVs) (NV(Arg)) will be investigated. Materials and Methods: Inflammatory status, amino acid profiles, and microbial diversity were evaluated in 20 adult patients with OA compared to 30 adult patients with non-OA (NOA) and 10 healthy control (HC) groups. Changes in gut or lung microbial composition that altered arginine metabolism in relation to airway inflammation were investigated in an OA mouse model in vivo. Additionally, this study evaluated the delivery of arginine to lung tissue utilizing NV(Arg) in vivo and in vitro. Results: Significantly increased Bacteroides abundance but decreased serum arginine concentration with lower forced exhaled volume at 1 s (FEV(1)) (%) was noted in the OA group compared to the NOA and HC groups. In mouse experiments, when OA mice were given living bacteria from normal control (NC) mice, lung arginine concentration and airway resistance were restored. However, the administration of arginine or its metabolite (citrulline) did not increase the arginine levels in the lung tissues. We therefore created NV(Arg), which successfully delivered arginine into the cytoplasm of the airway epithelial cell line in vitro. Oral administration of NV(Arg) for OA mice significantly induced the AMP-activated protein kinase (AMPK) and endothelial nitric oxide synthase (eNOS) pathways in airway epithelial cells, which reduced airway resistance and inflammation. Conclusion: These findings suggest that microbiomes contribute to airway dysfunction by regulating arginine metabolism, whereas NV(Arg) treatment may be a potential option for managing OA
Laparoscopic Pylorus-preserving Gastrectomy Versus Distal Gastrectomy for Early Gastric Cancer: A Multicenter Randomized Controlled Trial (KLASS-04)
No full textOBJECTIVE: To evaluate the long-term outcomes of laparoscopic pylorus-preserving gastrectomy (LPPG) with laparoscopic distal gastrectomy (LDG) for early gastric cancer. BACKGROUND: Pylorus-preserving gastrectomy is considered a function-preserving surgery for early gastric cancer. However, there has been no multicenter randomized controlled trial comparing pylorus-preserving gastrectomy with distal gastrectomy until now. METHODS: A multicenter randomized controlled trial (KLASS-04) with 256 patients with cT1N0M0 gastric cancer located in the mid portion of the stomach was conducted. The primary endpoint was the incidence of dumping syndrome at postoperative 1 year. Secondary endpoints included survival and recurrence, gallstone formation, nutritional parameters, gastroscopic findings, and quality of life for 3 years. RESULTS: In the intention-to-treat analyses, there was no difference in the incidence of dumping syndrome at 1 year postoperatively (13.2% in LPPG vs 15.8% in LDG, P = 0.622). Gallstone formation after surgery was significantly lower in LPPG than in LDG (2.33% vs 8.66%, P = 0.026). Hemoglobin (+0.01 vs -0.76 gm/dL, P < 0.001) and serum protein (-0.15 vs -0.35 gm/dL, P = 0.002) were significantly preserved after LPPG. However, reflux esophagitis (17.8% vs 6.3%, P = 0.005) and grade IV delayed gastric emptying (16.3% vs 3.9%, P = 0.001) were more common in LPPG. Changes in body weight and postoperative quality of life were not significantly different between groups. Three-year overall survival and disease-free survival were not different (1 case of recurrence in each group, P = 0.98). CONCLUSIONS: LPPG can be used as an alternative surgical option for cT1N0M0 gastric cancer in the mid portion of the stomach
Nelonemdaz Treatment for Patients With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
No full textOBJECTIVES: Nelonemdaz is a N-methyl d-aspartate receptor subtype 2B-selective N-methyl-D-aspartate receptor antagonist and a potent free-radical scavenger that might ameliorate hypoxic-ischemic brain injury after out-of-hospital cardiac arrest (OHCA). We investigated the efficacy of nelonemdaz for patients with OHCA. DESIGN: A double-blind, placebo-controlled, randomized, multicenter phase II trial. SETTING: This trial enrolled 105 patients at five sites in South Korea between November 18, 2018, and February 23, 2023. PARTICIPANTS: OHCA patients undergoing targeted temperature management. INTERVENTIONS: Patients were randomly assigned to high-dose (5250 mg), low-dose (3250 mg), and placebo groups at a 1:1:1 ratio. MEASUREMENTS AND MAIN RESULTS: Patients with a median age of 61 years (82% male) were assigned to the high-dose (n = 37), low-dose (n = 35), and placebo (n = 33) groups. The primary outcome, the serum level of neuron-specific enolase (NSE) at 48-52 hours, was evaluated in 93 patients. There was no difference in serum NSE between high-dose (median and interquartile range; 23.7, 15.0-69.9) and placebo (17.5, 13.6-113.0) groups, or between low-dose (26.6, 16.2-83.4) and placebo groups (all p > 0.05). Brain MRI fractional anisotropy was significantly higher in the high-dose group compared with the placebo group (0.465, 0.449-0.485 vs. 0.441, 0.431-0.464; p = 0.028), but not between low-dose (0.462, 0.439-0.480) and placebo groups (p > 0.05). At day 90, the common odds ratio (95% CI) indicating a numerically favorable shift in the modified Rankin Scale was 1.25 (0.48-3.24) and 1.22 (0.47-3.20) in the high-dose and low-dose groups, respectively, compared with placebo group (all p > 0.05). No serious adverse events were reported. CONCLUSIONS: Nelonemdaz treatment of patients after OHCA did not reduce serum NSE levels compared with controls. Patients treated with high-dose nelonemdaz showed higher brain MRI fractional anisotropy suggesting less cerebral white matter damage
Aspirin and Clinical Outcomes in Individuals with Incidentally Diagnosed Coronary Artery Stenosis
No full textBACKGROUND: The widespread use of coronary computed tomographic angiography has increased the number of cases of coronary stenosis in asymptomatic individuals. In this population, we aimed to analyze the net benefit of aspirin, which is currently recommended for secondary cardiovascular prevention. METHODS: This propensity score-matching study screened 41,441 asymptomatic individuals who underwent coronary computed tomographic angiography during health checkups between 2007 and 2022. Ultimately, 1483 patients with incidentally diagnosed coronary stenosis were enrolled after excluding ineligible individuals. Using a 1:1 propensity score matching, data from 636 individuals (318 new aspirin users and 318 controls) were analyzed. The primary outcome variable was composite cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke/transient ischemic attack), with/without major bleeding. RESULTS: At a median follow-up of 6.3 years, 11 and 18 individuals experienced composite events in the aspirin and control groups (2.1 and 3.2/1000 person-years; hazard ratio 0.62; P = .20), respectively. Conversely, composite events and major bleeding occurred in 26 and 23 individuals in the aspirin and control groups (4.9 and 4.1/1000 person-years; hazard ratio 1.16; P = .60), with a higher bleeding risk in the aspirin group. Kaplan-Meier curves demonstrated no significant difference in composite events without (log-rank P = .21) or with major bleeding (P = .61). Furthermore, age, chronic kidney disease, and low high-density lipoprotein cholesterol were identified as predictors of composite events and bleeding. CONCLUSIONS: Aspirin showed no benefit for composite events and bleeding in asymptomatic individuals with coronary stenosis. Thus, personalized aspirin use rather than universal aspirin use may be more appropriate for this population
Potassium-competitive acid blocker vs proton-pump inhibitor in patients receiving antithrombotic therapy who are at high risk for gastrointestinal bleeding: Rationale and design of the randomized PROTECT- HBR trial
No full textBACKGROUND: Concomitant use of proton pump inhibitor (PPI) is recommended in patients receiving chronic antithrombotic therapy who are at high risk of gastrointestinal (GI) bleeding. However, long-term safety and efficacy of chronic PPI use have been concerned. Potassium-competitive acid blocker (P-CAB) is a novel class of acid suppressants, providing more acid stability, rapid onset of action, less variability with CYP2C19 polymorphisms, and longer duration of action than PPI. DESIGN: The PROTECT-HBR trial is a multicenter, randomized, double-blind, double-dummy, parallel-group clinical trial. Approximately 3320 patients with known cardiac or vascular disease receiving antithrombotic drugs (either antiplatelet or anticoagulant agents) and who are at high risk of GI bleeding will be randomized to P-CAB (tegoprazan 50mg once daily) or PPI (rabeprazole 20mg once daily) for up to 12 months. The primary endpoint is a composite outcome of upper GI clinical events, including overt or occult GI bleeding, symptomatic gastroduodenal ulcers or erosions, obstruction, or perforation, at 12 months. Secondary endpoints also included cardiovascular events and safety outcomes. RESULTS: As of December 2024, approximately 1460 patients were enrolled from 32 participating sites in South Korea. The complete enrollment is anticipated at the mid- or late-term of 2025, and the primary results will be available by 2027. CONCLUSION: PROTECT-HBR is a large-scale, multicenter, clinical trial, which will provide a pivotal comparison of the efficacy and safety of novel P-CAB, tegoprazan with those of PPI, rabeprazole in patients with documented cardiac or vascular disease receiving chronic antithrombotic drugs and at high risk of GI bleeding. CLINICAL TRIAL REGISTRATION: Potassium-Competitive Acid Blocker versus pROton-Pump Inhibitor for GastroproTECTion Strategies In Patients at High GastroIntestinal Bleeding Risk Receiving Antithrombotic Therapy (PROTECT-HBR): NCT04416581
Review learning: Real world validation of privacy preserving continual learning across medical institutions
No full textWhen a deep learning model is trained sequentially on different datasets, it often forgets the knowledge learned from previous data, a problem known as catastrophic forgetting. This damages the model's performance on diverse datasets, which is critical in privacy-preserving deep learning (PPDL) applications based on transfer learning (TL). To overcome this, we introduce "review learning" (RevL), a low cost continual learning algorithm for diagnosis prediction using electronic health records (EHR) within a PPDL framework. RevL generates data samples from the model which are used to review knowledge from previous datasets. Six simulated institutional experiments and one real-world experiment involving three medical institutions were conducted to validate RevL, using three binary classification EHR data. In the real-world experiment with data from 106,508 patients, the mean global area under the receiver operating curve was 0.710 for RevL and 0.655 for TL. These results demonstrate RevL's ability to retain previously learned knowledge and its effectiveness in real-world PPDL scenarios. Our work establishes a realistic pipeline for PPDL research based on model transfers across institutions and highlights the practicality of continual learning in real-world medical settings using private EHR data
Matrix-bound nanovesicles recapitulate tissue-specific angiogenic properties of parent extracellular matrix with distinct miRNA profiles
No full textDecellularized extracellular matrix (dECM) exhibits tissue-specific pro- or anti-angiogenic effects. Previous studies have demonstrated that matrix-bound nanovesicles (MBVs) act as key bioactive components of dECM, replicating various biological functions such as anti-inflammatory and immunomodulatory effects. Building on this evidence, this study hypothesized that MBVs derived from cartilage and small intestinal submucosa (SIS) modulate angiogenesis through the selective packaging of miRNAs. Cartilage-derived MBVs (cMBVs) and SIS-derived MBVs (sMBVs) were isolated, characterized, and analyzed for their miRNA profiles using RNA sequencing and RT-qPCR validation. The interactions between MBVs and human umbilical vein endothelial cells (HUVECs) were assessed by examining proliferation, adhesion, migration, and tube formation in comparison to the parent ECM. Angiogenic modulation was further evaluated using a mouse Matrigel plug assay and a rabbit corneal neovascularization (NV) model. Our results demonstrated that anti-angiogenic miRNAs (e.g., miR-140-3p, miR-455-5p, and miR-148a-5p) were predominant in cMBVs, suppressing endothelial cell activity and angiogenesis, while pro-angiogenic miRNAs (e.g., miR-143-3p, miR-181a, and miR-21-5p) were prevalent in sMBVs, enhancing vessel formation. In vivo, cMBVs significantly inhibited vascular invasion and neovessel formation, whereas sMBVs promoted angiogenesis in both models. These findings confirm that MBVs reflect the tissue-specific angiogenic regulatory functions of their parent ECM, and highlight their potential as therapeutic tools for targeted modulation of angiogenesis in regenerative medicine and tissue engineering