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교대근무자의 여가제약이 삶의 질에 미치는 영향
No full textMasterⅠ. 서론 1
1. 연구의 필요성 1
2. 연구목적 3
3. 용어정의 4
Ⅱ. 문헌고찰 6
Ⅲ. 연구방법 11
1. 연구설계 11
2. 연구대상자 및 표본크기 11
3. 자료수집과정 12
4. 측정도구 12
5. 분석방법 14
6. 연구윤리 14
Ⅳ. 결과 15
Ⅴ. 논의 46
Ⅵ. 결론 52
참고문헌 54
부록 59
ABSTRACT 7
여성 환자에서 마취각성 시 기침을 예방하기 위한 레미펜타닐 필요량에 대한 라모세트론의 효과
No full textDoctorⅠ. INTRODUCTION 1
Ⅱ. MATERIALS AND METHODS 2
STUDY POPULATION 2
ANESTHETIC MANAGEMENT 2
STUDY PROTOCOL AND OUTCOME MEASUREMENT 3
STATISTICAL ANALYSIS 4
Ⅲ. RESULTS 5
Ⅳ. DISCUSSION 13
Ⅴ. CONCLUSION 18
REFERENCES 19
국문요약 2
Target-Enhanced Whole-Genome Sequencing Shows Clinical Validity Equivalent to Commercially Available Targeted Oncology Panel
No full textPURPOSE: Cancer poses a significant global health challenge, demanding precise genomic testing for individualized treatment strategies. Targeted-panel sequencing (TPS) has improved personalized oncology but often lacks comprehensive coverage of crucial cancer alterations. Whole-genome sequencing (WGS) addresses this gap, offering extensive genomic testing. This study demonstrates the medical potential of WGS. MATERIALS AND METHODS: This study evaluates target-enhanced WGS (TE-WGS), a clinical-grade WGS method sequencing both cancer and matched normal tissues. Forty-nine patients with various solid cancer types underwent both TE-WGS and TruSight Oncology 500 (TSO500), one of the mainstream TPS approaches. RESULTS: TE-WGS detected all variants reported by TSO500 (100%, 498/498). A high correlation in variant allele fractions was observed between TE-WGS and TSO500 (r=0.978). Notably, 223 variants (44.8%) within the common set were discerned exclusively by TE-WGS in peripheral blood, suggesting their germline origin. Conversely, the remaining subset of 275 variants (55.2%) were not detected in peripheral blood using the TE-WGS, signifying them as bona fide somatic variants. Further, TE-WGS provided accurate copy number profiles, fusion genes, microsatellite instability, and homologous recombination deficiency scores, which were essential for clinical decision-making. CONCLUSION: TE-WGS is a comprehensive approach in personalized oncology, matching TSO500's key biomarker detection capabilities. It uniquely identifies germline variants and genomic instability markers, offering additional clinical actions. Its adaptability and cost-effectiveness underscore its clinical utility, making TE-WGS a valuable tool in personalized cancer treatment
Coactosin-like F-actin binding protein (Cotl1) plays a key role in adipocyte differentiation and obesity
No full textActin dynamics, mediated by various actin-binding proteins, plays an important role in adipocyte differentiation. We investigated the role of coactosin-like F-actin binding protein (Cotl1) in adipocyte differentiation in vitro and in vivo. Cotl1 expression level was increased during adipocyte differentiation in mouse 3T3-L1 cells and primary cultured adipose-derived stem cells (ADSCs) and during weight gain in adipose tissues. However, Cotl1 deficient in 3T3-L1 and ADSCs inhibited adipocyte differentiation, and Cotl1(-/-) mice displayed resistance to high-fat diet (HFD)-induced weight gain, hepatic steatosis and adipocyte enlargement compared to HFD-fed wild type (WT) mice. Ingenuity Pathway Analysis of RNA-sequencing in adipose tissues of HFD-WT and HFD-Cotl1(-/-) mice predicted complicated relationships between Cotl1, differentiation of adipocytes, obesity and organization of actin cytoskeleton. Particularly, peroxisome proliferator-activated receptor gamma (Pparg) emerged as a central player, with Cotl1 influencing Pparg expression, consequently regulating adipocyte differentiation. These findings suggest Cotl1 as a pivotal regulator of terminal adipocyte differentiation by modulating adipogenic genes
Age-associated interplay between zinc deficiency and Golgi stress hinders microtubule-dependent cellular signaling and epigenetic control
No full textGolgi abnormalities have been linked to aging and age-related diseases, yet the underlying causes and functional consequences remain poorly understood. This study identifies the interaction between age-associated zinc deficiency and Golgi stress as a critical factor in cellular aging. Senescent Golgi bodies from human fibroblasts show a fragmented Golgi structure, associated with a decreased interaction of the zinc-dependent Golgi-stacking protein complex Golgin45-GRASP55. Golgi stress is increased, and functions such as glycosylation and vesicle transport are impaired. These disturbances promote Golgi and perinuclear microtubule disassembly and subsequent mislocalization of intracellular proteins associated with cellular signaling and epigenetic control. Pharmacological induction of Golgi stress or zinc deficiency, or ablation of the Golgi-associated zinc transporter gene Zip13 in mouse fibroblasts, replicate the characteristics of cellular senescence, emphasizing the critical role of Golgi-zinc homeostasis. These findings highlight the importance of adequate zinc intake and suggest targeting Golgi dysfunction as a therapeutic strategy for alleviating age-related cellular decline
Steerable Conditional Diffusion for Out-of-Distribution Adaptation in Medical Image Reconstruction
No full textDenoising diffusion models have emerged as the go-to generative framework for solving inverse problems in imaging. A critical concern regarding these models is their performance on out-of-distribution tasks, which remains an under-explored challenge. Using a diffusion model on an out-of-distribution dataset, realistic reconstructions can be generated, but with hallucinating image features that are uniquely present in the training dataset. To address this discrepancy and improve reconstruction accuracy, we introduce a novel test-time adaptation sampling framework called Steerable Conditional Diffusion. Specifically, this framework adapts the diffusion model, concurrently with image reconstruction, based solely on the information provided by the available measurement. Utilising the proposed method, we achieve substantial enhancements in out-of-distribution performance across diverse imaging modalities, advancing the robust deployment of denoising diffusion models in real-world applications
Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021
No full textBACKGROUND: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. METHODS: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990-2011, 2011-19, and 2019-21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. FINDINGS: All countries showed mean annual improvements in life expectancy in both 1990-2011 (overall mean 0.23 years [95% uncertainty interval [UI] 0.23 to 0.24]) and 2011-19 (overall mean 0.15 years [0.13 to 0.16]). The rate of improvement was lower in 2011-19 than in 1990-2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0.21 years (95% UI 0.20 to 0.22) in 1990-2011 to 0.23 years (0.21 to 0.26) in 2011-19 (difference of 0.03 years). In other countries, the difference in mean annual improvement between these periods ranged from -0.01 years in Iceland (0.19 years [95% UI 0.16 to 0.21] vs 0.18 years [0.09 to 0.26]), to -0.18 years in England (0.25 years [0.24 to 0.25] vs 0.07 years [0.06 to 0.08]). In 2019-21, there was an overall decrease in mean annual life expectancy across all countries (overall mean -0.18 years [95% UI -0.22 to -0.13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011-19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019-21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990-2021. INTERPRETATION: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019-21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019-21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. FUNDING: Gates Foundation
Digital Media Usage Trends Among Children Aged 8–11 Years Before and After the COVID-19
No full textOBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic has significantly altered daily life, potentially impacting children's digital media usage. This study investigates changes in smart device usage among children in South Korea, considering the pandemic's effects. METHODS: A longitudinal analysis was conducted on a cohort of 313 children aged 8-11 years from 2018 to 2021. The study measured weekly usage of personal computers (PCs), tablet PCs, and smartphones, comparing pre-pandemic (up to 2020) and post-pandemic periods. Partial correlation analysis was employed to assess the impact of COVID-19, controlling for covariates such as age, household income, and parental education. RESULTS: The analysis revealed a significant increase in smart device usage time following the onset of the pandemic. This increase remained statistically significant even after accounting for covariates. Notably, both age and maternal education level were significant factors influencing device usage. CONCLUSION: This study demonstrates a significant shift in the digital behavior of children aged 8-11 in the context of the COVID-19 pandemic. The increase in smart device usage underscores the pandemic's far-reaching impact on children's daily routines and suggests a need for further research into its long-term effects. The findings highlight the importance of considering external societal changes when analyzing trends in digital media usage among children
Talar Allografts in Tibiotalocalcaneal Arthrodesis: A Salvage Approach for Complex Hindfoot Pathologies
No full textBackground: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24-50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes
Sentinel Safety Monitoring System for Adverse Events of Special Interest Associated With Non-NIP Vaccines in Korea
No full textSouth Korea's current vaccination policies leave a surveillance gap for non-National Immunization Program (NIP) vaccines. In this study, we proposed a sentinel surveillance approach for monitoring the safety of non-NIP vaccines. Vaccination data were collected retrospectively among patients hospitalized with pre-defined adverse events of special interest (AESI) by reviewing electronic medical records in five university hospitals. This approach incorporates expert assessment to determine the causal relationship. We confirmed that 16 patients had received non-NIP vaccines among 860 patients diagnosed with AESI. We concluded one case of preeclampsia was possibly related to tetanus-diphtheria-pertussis vaccination. We propose a multi-hospital-based, retrospective assessment system for pre-defined AESIs as an alternative to active vaccine safety monitoring method. These efforts are expected to enhance both the accuracy and timeliness of safety monitoring in South Korea