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국내 임금근로자의 업무 외 활동에 영향을 미치는 요인 연구 : 근로환경특성을 중심으로
No full textMasterI. 장 서론 1
A. 연구배경 및 필요성 1
B. 연구목적 5
Ⅱ. 연구대상 및 방법 6
A. 연구설계 6
B. 연구대상 6
C. 변수정의 8
D. 자료원 및 분석 9
Ⅲ. 연구결과 10
Ⅳ. 고찰 25
Ⅴ. 결론 31
참고문헌 33
ABSTRACT 4
Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants : The Korean Neonatal Network cohort study
No full textMasterⅠ. Introduction 1
Ⅱ. Material and methods 2
A. Study population 2
B. Definitions 2
C. Data analysis 3
D. Statistical analysis 3
E. Statement of ethics 3
Ⅲ. Results 4
Ⅳ. Discussion 6
A. Limitation 8
Ⅴ. Conclusions 8
Reference
통증과 소화불량을 중심으로 살펴본 담석증의 임상 양상
No full textMasterⅠ. INTRODUCTION 1
Ⅱ. MATERIALS AND METHODS 4
A. Study population 4
B. Questionnaire 4
C. Statistical analysis 7
Ⅲ. RESULTS 8
A. Subject of study 8
B. Clinical manifestations of biliary pain 10
C. Clinical manifestations of biliary dyspepsia 14
D. Temporal relationship between pain and dyspepsia 17
E. Symptom improvement after CBD stone removal 17
Ⅳ. DISCUSSION 19
Ⅴ. CONCLUSION 25
REFERENCES 26
SUPPLEMENT FILE 30
국문 요약 3
Incidence of hypothyroidism in girls with Turner syndrome in Korea on the basis of real-world evidence from the Korean National Health Insurance Service database
No full textOBJECTIVE: Hypothyroidism is the most commonly observed autoimmune disorder in individuals with Turner syndrome. The aim of this study was to determine the risk of hypothyroidism in patients with Turner syndrome by comparing its incidence in this patient population to that in the general population. DESIGN: In this retrospective cohort study, patients in South Korea were followed for 10 years, and claims data from the National Health Insurance Service database were collected between 2007 and 2019. METHODS: The incidence of hypothyroidism among patients with Turner syndrome and in the general population under 65 years of age was determined. Turner syndrome was identified by at least 2 diagnosis codes, and hypothyroidism was defined by the prescription of thyroid hormone analogs lasting 180 days or more, accompanied by a hypothyroidism diagnosis code. Subscribers who had records related to medical conditions that required thyroid hormone replacement were excluded from the cohort. RESULTS: The cohort included 2973 patients with Turner syndrome and 21 239 127 females. Hypothyroidism developed in 11.4% of the patients with Turner syndrome and in 2.9% of the general population. The incidence rates per 10 000 person-years among patients with Turner syndrome were 86.9 (95% CI, 64.5-114.6), 101.0 (95% CI, 82.2-122.9), 139.6 (95% CI, 113.3-170.1), and 139.4 (95% CI, 112.1-171.3) in the groups aged 0-9, 10-19, 20-29, and 30-65 years, respectively, and those in the general population were 1.7 (95% CI, 1.6-1.7), 5.0 (95% CI, 5.0-5.1), 29.7 (95% CI, 29.5-29.9), and 39.1 (95% CI, 39.0-39.2), respectively. The risk of hypothyroidism in patients with Turner syndrome was approximately 45 times greater than that in the general population before 10 years of age. CONCLUSIONS: Regular thyroid function testing and antibody screening should be initiated early in life to facilitate the early detection of hypothyroidism in patients with Turner syndrome
Explainable multiplex graph propagational network with multimodal neuroimage integration for dementia subtype diagnosis
No full textDementia encompasses diverse subtypes with distinct characteristics, including cognitive functions, cerebrospinal fluid biomarkers, and neuroimages. Neuroimaging-based diagnosis is advantageous due to low variability and minimal invasiveness, ensuring safe and accurate outcomes. Recently, integrating multimodal neuroimages with machine learning techniques has enhanced diagnostic precision. Especially, graph neural network (GNN) has emerged as promising models by considering connectivity between brain regions. However, current GNN-based methods are limited by focusing solely on local connectivity, failing to adequately capture global interactions crucial to structural pathways and functional brain activities. Additionally, existing methods pose a trade-off between improving diagnostic performance and maintaining explainability, as complex feature transformations across hidden layers obscure model explanations. This limitation is especially critical in clinical settings, where transparent decision-making directly impacts patient outcomes. Motivated by these limitations, we propose a novel method for diagnosing dementia subtypes by integrating multimodal neuroimages, called Explainable Multiplex Graph Propagational Network (EMGPN). Our method employs multiplex graphs derived from multiple neuroimaging modalities, propagating features across brain regions to concurrently represent local and global connectivity. EMGPN subsequently integrates these multimodal features through region-specific, probabilistically derived parameters, thus preserving individual modality characteristics. Crucially, EMGPN maintains explainability through a transparent architecture without hidden layers, allowing clinicians to clearly understand model outcomes. We validated EMGPN using an elderly South Korean cohort across various dementia subtypes. The results indicated that EMGPN achieved an average performance improvement of 8.6 % compared to existing methods, while generating explainable outputs, including region-specific modality contributions and subtype-specific brain region importance maps. These findings underscore EMGPN's significant potential as a clinically applicable, explainable, and robust tool for neuroimaging-based dementia diagnosis
DNMT1-mediated SPINT2 expression drives early senescence by suppressing c-Met signaling in human fibroblasts
No full textCellular senescence is a critical process involved in aging and related disorders, yet the molecular triggers of early senescence remain elusive. Here, we identify DNA methyltransferase 1 (DNMT1) downregulation as a key trigger of early senescence and establish serine protease inhibitor Kunitz type 2 (SPINT2) as its critical downstream effector. Using replicative and oxidative stress-induced senescence models of primary human diploid fibroblast, we observed persistent upregulation of SPINT2 and inverse downregulation of DNMT1, preceding senescence-associated beta-galactosidase activity, a conventional senescence marker. Pharmacological inhibition and siRNA-mediated knockdown of DNMT1 significantly increased SPINT2 expression and induced senescence, showing mitigated effects by SPINT2 knockdown. Furthermore, SPINT2 overexpression alone induced senescence. Methylation-specific sequencing identified four CpG sites in SPINT2 promoter, that became hypomethylated at early transition of senescence and upon DNMT1 suppression. Functional analyses revealed that DNMT1-mediated SPINT2 expression induced c-Met inhibition, triggering senescence. Transcriptomic profiling identified 17 commonly deregulated c-Met signaling genes in both senescence models, with COL27A1, STAM2, and CBL validated as key downstream targets of SPINT2/c-Met signaling. These findings establish DNMT1-mediated SPINT2 upregulation as a novel epigenetic mechanism driving senescence initiation via c-Met inhibition, providing insights into the early stage of senescence and potential therapeutic targets for aging-related diseases
Biomechanical Analysis of Fixation Strength in Unstable Intertrochanteric Femoral Fracture Models Based on the Caput–Collum–Diaphyseal Angle of Cephalomedullary Nails and Position of Lag Screws
No full textBackground/Objectives: The combined effect of femoral neck-shaft angle and lag screw position on unstable intertrochanteric fracture fixation has not been well established. This biomechanical study evaluated the effects of two caput-collum-diaphyseal (CCD) angles and two lag screw positions on construct stability. Methods: Twenty-four synthetic femurs with identical AO/OTA 31-A2.2 fracture gaps (2 mm) were fixed using cephalomedullary nails with CCD angles of either 125 degrees or 130 degrees , each with a central or inferior (calcar) lag screw (n = 6/group). Constructs were tested in a single-leg stance under preloading, cyclic loading (75-750 N, 10,000 cycles, and 2 Hz), and axial loading to failure. Lag screw migration was measured radiographically, and femoral head rotation was recorded using a three-dimensional coordinate-measuring device. Stiffness, failure load, and rotations were compared using the Kruskal-Wallis and Bonferroni post hoc tests. Results: The 125 degrees inferior configuration showed the highest stiffness (188 +/- 15 N/mm, p = 0.038) and failure load (1350 +/- 97 N, p = 0.047), with the least screw migration (0.54 +/- 0.11 mm, p = 0.003), significantly outperforming the 125 degrees central and 130 degrees central constructs. However, it exhibited greater varus collapse (2.25 +/- 0.27 degrees , p = 0.013) and axial rotation (~20-30% higher than others, p = 0.025). Screw position had a stronger effect on stability than the CCD angle, although the 130 degrees inferior construct showed slightly less varus deformation. Conclusions: An inferior calcar-guided lag screw improves fixation strength and stiffness in unstable intertrochanteric fractures, particularly in those with a 125 degrees nail. However, this configuration increases varus and rotational displacement, warranting adjunct measures to enhance rotational control in clinical applications
Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes
No full textThis Korean Diabetes Association (KDA) consensus statement bridges global evidence with the Korean clinical context, where large randomized and real-world data remain limited. Recommendations required >/=80% agreement by the committee of clinical practice guideline and approval by the board of directors. The statement comprises three domains: diabetes screening aligned with Korean epidemiology; pharmacologic management guided by pathophysiology and comorbidities; and a severity construct of "severe diabetes mellitus" that links complication-based staging with metabolic grading to match therapeutic intensity to disease complexity. Compared with prior KDA guidelines, this statement introduces substantive advances in three areas. First, screening recommendations are streamlined to emphasize risk-aligned, practical implementation rather than prescriptive test sequences. Second, pharmacologic management applies an individualized framework for drug selection that jointly considers pathophysiology and comorbidities. It operationalizes individualized selection by dominant pathophysiology (insulin resistance vs. insulin insufficiency) and coexisting conditions, and formalizes treatment dynamics-early combination, timely initiation of injectables, avoidance of overbasalization, and structured deintensification. It also prioritizes agents with proven cardiovascular and renal protection and elevates management of obesity and metabolic dysfunction-associated steatotic liver disease as central goals; clinically, insulin should be initiated promptly in hypercatabolic states or suspected islet failure, and technology-enabled care-including continuous glucose monitoring and automated insulin delivery-are integral across all stages. Third, the newly introduced severity construct underpins treatment-intensity decisions across domains without reiterating prescriptive algorithms. Collectively, these recommendations provide a coherent, context-appropriate framework for diabetes screening and management in Korea and identify priorities for future evidence generation