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The association between residing in regions with population decline and receiving management education or treatment in patients with hypertension
No full textBACKGROUND: Many districts in rural areas of Korea are facing population decline due to the aging population phenomenon. This study examined the associations of rural residency with the likelihood of receiving hypertension management education and nonpharmacological and pharmacological treatment. METHODS: Data from the 2022 Korea Community Health Survey were used to identify individuals aged 19 years or above diagnosed with hypertension. Rural residency was defined based on the population decline index, which categorizes districts into those with, at risk of, or without population decline. The association between rurality and the likelihood of receiving hypertension management education, with nonpharmacological treatment, and with pharmacological treatment were analyzed using multilevel logistic regression. RESULTS: Of the 68 183 individuals diagnosed with hypertension, 13 246 (19.4%) received hypertension management education, 17 488 (25.6%) received nonpharmacological treatment, and 65 418 (95.9%) received pharmacological treatment. Individuals residing in areas with population decline were less likely to receive hypertension management education [odds ratio (OR), 0.74; 95% confidence interval (CI), 0.59-0.94] and nonpharmacological treatment (OR, 0.54; 95% CI, 0.42-0.69), but more likely to receive pharmacological treatment (OR, 1.39; 95% CI, 1.17-1.64). CONCLUSIONS: The findings highlight the importance of providing adequate hypertension management education and nonpharmacological treatment to patients residing in rural areas
Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion
No full textBACKGROUND CONTEXT: Laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF) are three techniques for posterior cervical decompression. LF can provide stability, but postoperative dural membrane adhesion and fusion failure can occur. LP can prevent postoperative dural membrane adhesion, but it can lead to kyphotic change. To address the disadvantages and further enhance the strengths of each, the LPF technique can be a good option. PURPOSE: This study aimed to confirm whether LPF can overcome the disadvantages of LF and LP. STUDY DESIGN: Single-center, retrospective cohort study. PATIENT SAMPLE: A total of 20 patients for each technique were randomly selected. OUTCOME MEASURES: Delta C2-7 sagittal vertical axis (SVA), Delta T1 slope, Delta C2-7 Cobb's angle, Delta spinal canal length, and fusion success rate were measured for radiologic outcomes. Preoperative and postoperative Japanese Orthopedic Association (JOA) scores and recovery rates (RRs) were measured for clinical outcomes. METHODS: Patients who underwent LF, LP, or LPF between 2012 and 2023 were enrolled, and 20 patients for each technique were randomly selected. Delta C2-7 sagittal vertical axis (SVA), Delta T1 slope, Delta C2-7 Cobb's angle, Delta spinal canal length, fusion success rate, complications, operation time, blood loss, JOA scores, visual analog scale (VAS) scores, and RRs were measured. RESULTS: Delta C2-7 Cobb's angle (LPF, -2.62+/-5.0; LP, -6.43+/-4.9; p=.020) and Delta C2-7 SVA (LPF, 6.48+/-8.3; LP, 13.84+/-9.9; p=.015) were significantly different between LPF and LP. No significant changes in Delta spinal canal length between LPF and LP were observed (LPF, 2.93+/-1.3; LP, 3.05+/-1.5; p=.780). The fusion success rate with LPF was higher than that with LF (LPF, 80.0%; LF, 45.0%; p=.027). The JOA RR was the highest with LPF (LPF, 49.96%+/-24.7; LF, 31.70%+/-27.8; LP, 29.31%+/-30.8, p=.045). CONCLUSIONS: LPF can overcome the disadvantages of LF and LP while retaining their benefits
An Overview of Chronic Spontaneous Urticaria: Diagnosis, Management, and Treatment
No full textChronic spontaneous urticaria (CSU) is a complex mast cell-driven disorder characterized by recurrent pruritic wheals and/or angioedema lasting over 6 weeks. This condition affects women more frequently than men, particularly between the ages of 20 and 40, and imposes considerable physical, psychological, and economic burdens, with annual healthcare costs in the U.S exceeding $200 million. Current management strategies emphasize a stepwise approach, initiating with the escalating doses of second-generation antihistamines, followed by biologics such as omalizumab or now dupilumab, and prescribing cyclosporine to refractory cases. Emerging therapies targeting specific endotypes of CSU, including Bruton's tyrosine kinase inhibitors and mast cell depleting agents, present new avenues for personalized treatment. Furthermore, validated patient-reported outcome measures and digital tools like the CRUSE application enhance symptom tracking and facilitate patient-physician communication. As the therapeutic landscape for CSU evolves, a focus on individualized, evidence-based care approaches is critical to optimizing patient outcomes. Future research priorities include identifying biomarkers predictive of treatment response, conducting long-term outcome studies, and evaluating treatment tapering strategies to achieve sustained remission. Addressing cost-effectiveness and accessibility of new therapies will be pivotal in ensuring equitable management of CSU across diverse populations. Ultimately, it is the goal that a comprehensive understanding of CSU's heterogeneity, with tailored therapeutic strategies, will significantly improve patient quality of life and outcomes
Effect of anti-S antibody titers on newly confirmed cases of COVID-19 in Korea: a community-based cohort study (K-SEROSMART Wave 2)
No full textBACKGROUND: Coronavirus disease 2019 (COVID-19) continues to impact populations globally, raising concerns about immunity levels and risks to high-risk groups despite the lifting of the global health emergency in May 2023. While studies have tracked seroprevalence, few have comprehensively assessed long-term antibody persistence and COVID-19 risk, particularly regarding immunity changes due to vaccination and infection. This study aimed to estimate the population prevalence of SARS-CoV-2-specific antibodies, including anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies, and to assess the risk of newly confirmed COVID-19 infections in Korea in December 2022. We conducted a follow-up survey and blood testing of 9,945 participants in the Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) Wave 1. METHODS: The K-SEROSMART Wave 2 study employed a staged approach through public health centers nationwide, using mobile web, telephone, and face-to-face surveys. The follow-up survey (Wave 2) was conducted between December 6 and 27, 2022, four months after the initial survey (Wave 1) conducted in August 2022. Participants self-reported sociodemographic characteristics and health status and provided blood samples for the analysis of anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies via electrochemiluminescence immunoassay. Population prevalence estimates were weighted for demographic data. Multivariate Cox proportional hazards regression was used to assess the relationship between anti-S antibody titers from Wave 1 and new COVID-19 cases, adjusting for age and sex. RESULTS: A total of 7,528 individuals participated, yielding a follow-up rate of 74.9%. The population-adjusted prevalence rates of anti-S and anti-N antibodies were 98.5% and 70.0%, respectively. The percentage of newly confirmed COVID-19 cases was significantly higher in individuals with anti-S antibody titers below 2,000 U/mL, 2,000-3,999 U/mL, 4,000-5,999 U/mL, 6,000-7,999 U/mL, and 8,000-9,999 U/mL than in those with titers above 18,000 U/mL (hazard ratio [HR] = 9.9, 95% confidence interval [CI] = 7.2-13.5; HR = 8.1, 95% CI = 5.8-11.3; HR = 7.1, 95% CI = 5.0-10.1; HR = 4.2, 95% CI = 2.8-6.3; HR = 2.0, 95% CI = 1.2-3.3, respectively). CONCLUSIONS: This study demonstrated the feasibility of conducting a seroepidemiological cohort survey on COVID-19 using a nationally representative sample. Additionally, this study quantified anti-S antibody titer levels that are associated with reduced risk of new infections within a community
Clinical reasoning from real-world oncology reports using large language models
No full textOBJECTIVE: To evaluate the ability of large language models (LLMs) to perform structured information extraction and guideline-based clinical inferences from radiology and pathology reports in real-world oncology. METHODS: We constructed a Question Answering (Q&A) benchmark dataset using 3650 radiological and 588 pathological reports from 1632 patients. The tasks included direct extraction of genomic and histological findings, as well as clinical reasoning tasks, such as Response Evaluation Criteria in Solid Tumors (RECIST)-based tumor response classification and American Joint Committee on Cancer (AJCC)-based tumor-node-metastasis (TNM) staging. We compared the performance of the Gemma family of open-source LLMs (Gemma 4B, a lightweight 4-billion parameter model, and Gemma 12B, a larger 12-billion parameter model) with and without structured reasoning prompts designed according to clinical guidelines. RESULTS: The 12B model achieved high performance in direct extraction tasks from pathology reports, with F1-score ranging from 92.6 to 93.3 across genomic and histological variables. Furthermore, when guided by structured reasoning prompts, it also showed substantial improvements in reasoning tasks, achieving an F1-score of 81.5 (95% CI: 79.8-83.3) for tumor response, 74.3 (95% CI: 70.8-77.8) for T-stage, 87.1 (95% CI: 85.1-89.0) for N-stage, and 90.8 (95% CI: 89.1-92.2) for M-stage. In contrast, the 4B model showed inconsistent performance and was sometimes degraded under reasoning prompts. CONCLUSION: This study shows that LLMs can perform complex guideline-based clinical reasoning using real-world radiology reports. By combining the RECIST/AJCC criteria with structured prompts, we demonstrated how LLMs can move beyond surface-level extraction to support nuanced inference in oncology, with implications for future clinical applications
Comprehensive Single-Cell Transcriptomic Atlas of the Mouse Pons and Medulla
No full textThe pons and medulla, key regions of the hindbrain within the brainstem, regulate a wide range of complex behaviors, ranging from motor control to autonomic regulation and reflexes. As the central hub of neural projections and gut-to-brain communication, the cellular diversity that supports these functions remains ambiguous. To address this, we integrated eight single-cell and single-nucleus RNA sequencing (sc/snRNA-seq) datasets from mouse brains. We constructed a large-scale single-cell atlas encompassing 318,522 single cells from different sub-regions of the pons and medulla. Using a rigorous metadata standardization and annotation approach, we identified 45 cell types that span major populations and exhibit subtype-specific variability. We observed high diversity among neuronal populations, while non-neuronal cells were dominated by glial and vascular cells, each with unique transcriptional profiles. This atlas serves as the foundational resource for exploring region-specific cellular diversity in the pons and medulla, enabling comparative analyses for future studies
Aortic regurgitation and combined ventricular tachycardia due to IgG4-related disease
No full textIgG4-related disease (IgG4-RD) is a systemic immune-mediated disorder that causes tissue inflammation and fibrosis in affected organs. A 68-year-old woman underwent aortic valve replacement due to severe aortic regurgitation. Aortic valve leaflets showed abnormal thickening, and fibrosclerosis of the subvalvular structure was observed. Histopathology revealed fibromyxoid degeneration with multifocal dense infiltration of IgG4-positive plasma cells and immunostaining confirmed IgG4-positive plasma cells, therefore the patient was clinically diagnosed with IgG4-RD. After discharge, she underwent implantable cardioverter defibrillator implantation and radiofrequency catheter ablation for refractory ventricular tachycardia. If a patient with underlying IgG4-RD develops a valvular disease or arrythmia, it is necessary to consider the possibility that IgG4-RD is the cause and pre/postoperative systemic inflammation control and thorough evaluation must be performed
허혈성 뇌졸중 환자의 자가간호 이행 영향요인
No full textMasterⅠ. 서론 1
A. 연구의 필요성 1
B. 연구 목적 5
C. 용어 정의 6
Ⅱ. 문헌 고찰 8
A. 허혈성 뇌졸중 환자의 자가간호 이행 8
B. 허혈성 뇌졸중 환자의 자가간호 이행에 영향을 미치는 요인 10
1. 우울 10
2. 사회적 지지 12
3. 자기효능감 14
4. 인구사회학적 특성 및 질병관련 특성 16
Ⅲ. 연구방법 17
A. 연구설계 17
B. 연구 대상 17
C. 연구 도구 19
D. 자료수집방법 및 절차 22
E. 자료 분석 방법 23
Ⅳ. 연구결과 24
A. 대상자의 인구사회학적 특성과 질병관련 특성 24
B. 대상자의 우울, 사회적 지지, 자기효능감과 자가간호 이행 26
C. 대상자의 인구사회학적, 질병관련 특성에 따른 자가간호 이행 차이 28
D. 대상자의 우울, 사회적 지지, 자기효능감과 자가간호 이행 간의 관계 30
E. 대상자의 자가간호 이행에 미치는 영향요인 32
Ⅴ. 논의 34
Ⅵ. 결론 및 제언 43
참고문헌 45
부 록 52
ABSTRACT 6
고위험 신생아 부모가 지각한 스트레스와 간호사의 의사소통 기술이 간호서비스 만족도에 미치는 영향
No full textMasterⅠ. 서론 1
A. 연구의 필요성 1
B. 연구의 목적 4
C. 용어의 정의 5
Ⅱ. 문헌고찰 7
A. 고위험신생아 부모가 지각한 스트레스와 간호서비스 만족도의 관계 7
B. 고위험신생아 부모가 지각한 간호사의 의사소통 기술과 간호서비스 만족도의 관계 10
Ⅲ. 연구방법 13
A. 연구설계 13
B. 연구대상 13
C. 연구도구 15
D. 자료수집방법 17
E. 윤리적 고려 17
F. 자료분석방법 18
Ⅳ. 연구결과 19
A. 대상자의 일반적 특성 19
B. 고위험 신생아 부모가 지각한 스트레스, 간호사의 의사소통기술과 간호서비스 만족도 23
C. 고위험 신생아 부모의 일반적 특성에 따른 간호서비스 만족도의 차이 25
D. 고위험 신생아의 일반적 특성에 따른 간호서비스 만족도의 차이 27
E. 고위험 신생아 부모가 지각한 스트레스, 간호사의 의사소통 기술과 간호서비스 만족도의 관계 29
F. 고위험 신생아 부모의 간호서비스 만족도에 영향을 미치는 요인 31
Ⅴ. 논의 34
Ⅵ. 결론 및 제언 41
A. 결론 41
B. 제언 42
참고문헌 4
노인 폐암 환자의 성공적 노화에 영향을 미치는 요인
No full textMasterⅠ. 서론 1
A. 연구의 필요성 1
B. 연구 목적 5
C. 용어 정의 6
Ⅱ. 문헌 고찰 8
A. 노인 폐암 환자의 성공적 노화 8
B. 성공적 노화에 영향을 미치는 요인 11
Ⅲ. 연구 방법 17
A. 연구 설계 17
B. 연구 대상 17
C. 연구 도구 18
D. 자료 수집 방법 20
E. 자료 분석 방법 21
F. 윤리적 고려 22
Ⅳ. 연구 결과 23
A. 대상자의 일반적 특성 23
B. 대상자의 증상 경험, 영성, 사회적 지지와 성공적 노화 25
C. 대상자의 일반적 특성에 따른 성공적 노화 차이 27
D. 대상자의 증상 경험, 영성, 사회적 지지와 성공적 노화 간의 관계 29
E. 대상자의 성공적 노화에 미치는 영향 요인 31
V. 논의 34
A. 노인 폐암 환자의 증상 경험, 영성, 사회적 지지와 성공적 노화 34
B. 노인 폐암 환자의 성공적 노화에 영향을 미치는 요인 40
C. 연구의 제한점 및 의의 44
Ⅵ. 결론 및 제언 45
A. 결론 45
B. 제언 46
참고문헌 47
부 록 56
ABSTRACT 6