Conectar
by Yuto Kimura, Takahiro Kozuka
This study examined the association between event-related disclosure and posttraumatic growth (PTG). Specifically, it targeted the Japanese adult, assessed attitudes toward event-related disclosure, and examined event-related rumination as a mediating variable. A cross-sectional online survey was conducted among Japanese adults aged 20–59. Participants completed measures of demographic characteristics, stressful life events attributes, attitudes toward disclosure, event-related rumination, and PTG. Analysis of data from 480 individuals revealed that neither willingness to disclose nor resistance to disclose was directly associated with PTG. However, both willingness to disclose and resistance to disclose were positively associated with PTG through deliberate rumination and negatively associated with PTG through intrusive rumination. The effect sizes for willingness to disclose were approximately three times greater than those for resistance to disclose. These findings suggest that event-related disclosure may enhance PTG by promoting deliberate meaning-making processes, while also potentially hindering it by reinforcing involuntary negative thinking. Furthermore, these effects may be stronger when individuals are more proactive and disclose more frequently. These results have important implications for interventions aimed at enhancing PTG through event-related disclosure.
by Jin-Hwa Kim, Ji-Soo Jeong, Jeong-Won Kim, Eun-Hye Chung, Su-Ha Lee, Je-Won Ko, Youn-Hwan Hwang, Tae-Won Kim
Moutan Cortex (MC), the dried root bark of Paeonia suffruticosa, is used in traditional Chinese and Korean medicine to treat enteritis for its anti-inflammatory properties. This study compared the pharmacokinetic (PK) profiles of paeonol and paeoniflorin in normal and dinitrobenzene sulfonic acid (DNBS)-induced colitis rats, and to determine how repeated low-dose MC [MC(L), 0.5 g/kg] or high-dose MC [MC(H), 2.5 g/kg] alters PK and disease severity. Using ultra-performance liquid chromatography–tandem mass spectrometry, we found that DNBS modestly increased paeonol AUClast (NC: 247.8 ± 63.7 vs DNBS: 337.0 ± 120.8 hr*ng/mL) and decreased paeoniflorin (NC: 474.1 ± 11.7 vs DNBS: 463.7 ± 106.8 hr*ng/mL) compared to controls (ns). After repeated dosing, the maximum plasma concentration (Cmax) of paeonol was higher in the MC(H) than that in the MC(L) group (MC(L): 63.81 ± 29.74 vs MC(H): 4221.5 ± 1579.2 ng/mL, p max in the MC(H) group was also higher than MC(L) group (MC(L): 60.5 ± 15.3 vs MC(H): 164.7 ± 74.7 ng/mL, p
by Suehyun Park, Sangho Lee, Hyeon Ju Kim, Hyung-Kee Kim, Seung Huh, Deokbi Hwang
ObjectiveRegarding revision of vascular access (VA), endovascular methods are commonly employed owing to their procedural simplicity, yet their durability remains uncertain. This study aimed to compare clinical outcomes of swing segment (SwS) revision of radiocephalic arteriovenous fistula (RC-AVF) between endovascular and surgical approaches.
Materials and methodsA retrospective cohort study comparing two groups was conducted at one tertiary hospital in South Korea. A total of 131 patients underwent endovascular or surgical revision of SwS in RC-AVF for the first time after AVF creation between 2016 and 2023. Endovascular and surgical revisions were performed in 114 and 17 patients, respectively (interposition, n = 10; patch angioplasty, n = 5; transposition, n = 1; proximalization, n = 1). Kaplan-Meier survival analysis was used to assess post-intervention primary patency (PP) and post-intervention secondary patency (SP). Multivariable Cox regression analysis was performed to adjust for potential confounders, and a subgroup analysis was conducted based on whether the SwS was in stenosis or occlusion.
ResultsThe median minimal diameter of SwS was 1.3 mm in the endovascular group and 1.4 mm in the surgical group, and the median lesion length was 2.5 cm and 4.0 cm, respectively. Twelve-month PP was 63.5% vs 73.7% (endo vs surgical, P = 0.79). While PP did not differ in the stenosis subgroup, the occlusion subgroup showed significantly higher PP after surgical revision (P = 0.002), with surgery associated with a markedly lower risk of loss of PP events (HR 0.073).
ConclusionSurgical revision may be preferentially considered for long-segment occlusive lesions, given its superior early PP and the longer lesions typically associated with occlusions, whereas percutaneous transluminal angioplasty (PTA) remains appropriate for focal or stenotic lesions within the SwS. Consistent follow-up is essential to enable timely interventions, thereby maximizing the functionality of RC-AVF.
by Mengsi Peng, Peng Shen, Kyung-In Joung, Kwang Joon Kim
BackgroundAlthough metformin is the first-line medicine for type 2 diabetes (T2D), its safety profile in adolescents remains poorly understood. This study seeks to investigate the adverse events linked to metformin use in adolescents diagnosed with T2D.
MethodsData from the Food and Drug Administration Adverse Event Reporting System (FAERS), spanning Q1 2004 to Q2 2024, were retrospectively analyzed in this study. Adverse reactions were standardized using the Medical Dictionary for Regulatory Activities, then significant adverse drug reaction signals were identified through disproportionality analysis employing reporting odds ratio (ROR) and information component (IC) methods.
ResultsOf 17,956,653 FAERS reports, 80,187 involved metformin, including 973 in adolescents (10–19 years), with 174 cases were identified with a T2D indication. Analysis at the system organ class level revealed that congenital, familial, and genetic disorders [ROR: 8.8 (4.0, 19.3); IC: 2.2 (1.1, 2.9)] and pregnancy conditions [ROR: 4.9 (2.5, 9.5); IC: 1.8 (0.8, 2.5)] showed the most significant signals. At the preferred term (PT) level, three signals were identified across all sexes and subgroups: treatment noncompliance [ROR: overall 4.14 (2.44, 7.02), male 4.27 (2.00, 9.12), and female 4.65 (2.22, 9.74); IC: overall 1.67 (0.88, 2.22), male 1.60 (0.46, 2.36), and female 1.74 (0.60, 2.50)], lactic acidosis [IC: overall 2.99 (1.91, 3.72), male 2.53 (0.76, 3.61), and female 2.76 (1.34, 3.67)], and gastrointestinal disorder [ROR: overall 13.09 (4.73, 36.23), male 54.33 (6.05, 487.96), female 5.34 (1.10, 25.84)]. Neurological disorders were observed only in males, while pregnancy-related adverse effects and renal disorders occurred exclusively in females. Additionally, the study identified potential new signals not documented in metformin labeling, including areflexia, muscle weakness, ataxia, decreased vibratory sense, rhabdomyolysis, substance use, and axillary pain.
ConclusionThe study reveals a complex safety profile of metformin in adolescents with T2D, warranting further research to confirm risks.
by Sang Ah Lee, Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Sung Shin, Young Hoon Kim, Sung-Han Kim, Hyunwook Kwon
PurposeOptimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
Materials and methodsWe retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
ResultsThe cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
ConclusionIn this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
by Yong Jae Lee, Nam Kyeong Kim, Kidong Kim, Chel Hun Choi, Keun Ho Lee, Jong-Min Lee, Kwang Beom Lee, Dong Hoon Suh, Sunghoon Kim, Min Kyu Kim, Seok Ju Seong, Myong Cheol Lim
ObjectiveTo identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.
MethodsIn this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI 2 and aged >18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.
ResultsOut of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p > 0.999) and 2-years (0.0% vs. 3.4%, p = 0.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.
ConclusionsFascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.
Trial registrationClinicalTrials.gov NCT04643197
by Yoo Kyung Choi, Seok Hyun Son, Hong Seok Jang, In-Ho Kim, Sea-Won Lee, Soo-Yoon Sung
BackgroundRadiotherapy for locally advanced esophageal cancer can induce lymphopenia, potentially worsening outcomes. This study examines the association between clinical outcomes and the effective dose to the immune cells (EDIC), a measure of lymphocyte radiation exposure.
MethodsWe retrospectively analyzed 107 patients with locally advanced esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy (CCRT). The EDIC was calculated based on the mean lung dose, mean heart dose, and integral total body dose using established models. Patients were stratified into high (n = 42) and low (n = 65) effective dose to the immune cells (EDIC) groups using a cut-off value of 4.28 Gy. Survival outcomes, including overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS), were assessed.
ResultsThe 5-year OS and PFS rates were significantly lower in the high EDIC group than in the low EDIC group (51.9% vs. 66.6%, p = 0.043; 20.8% vs. 31.8%, p = 0.002, respectively). Multivariate analysis identified high EDIC as an independent predictor of poorer OS (hazard ratio (HR): 2.06, 95% confidence interval (CI): 1.1–3.86, p = 0.024) and PFS (HR: 1.7, 95% CI: 1.04–2.78, p = 0.034). Similarly, the 5-year LRFS and DMFS rates were significantly lower in the high EDIC group than in the low EDIC group (24.1% vs. 34.9%, p = 0.003; 29.0% vs. 44.0%, p = 0.018, respectively).
ConclusionA higher EDIC is an independent predictor of poor survival in patients with esophageal squamous cell carcinoma undergoing CCRT. Reducing radiation exposure to the immune system through optimized radiation planning and lymphocyte-sparing techniques may improve patient outcomes.
by Sunghoon Jeon, Keunho Kim, Cheolwon Choe, Juil Choi, Gun Lee, Chung-Do Lee, Hyeon-Jeong Moon, Jun-Gyu Park, Jin-kyung Kim, Namsoon Lee, Dongwoo Chang
Quick-soluble gelatin microparticles (QS-GMP) are emerging embolic agents under investigation for temporary vascular occlusion, offering reduced ischemic risk compared to permanent materials. The aim of this preclinical study was to evaluate the safety and efficacy of QS-GMP for transarterial embolization in a rabbit model of urinary bladder embolization. Twelve male New Zealand White rabbits underwent bilateral umbilical artery embolization using QS-GMP. Animals were assigned to four time-points (immediately, 3, 7, and 14 days post-embolization), with comprehensive assessments including clinical observations, hematologic and serum biochemical analysis, angiography, and histopathology. The procedure was technically feasible in all animals without intraoperative complications. Temporary hematuria and a transient decrease in body weight were observed post-procedure, both of which resolved spontaneously. Complete occlusion of the cranial vesical artery and absence of bladder wall perfusion were achieved immediately after embolization, followed by full recanalization at 3 days. Angiographic imaging at 7 and 14 days revealed transient hypervascularization of the bladder wall. Histopathological analysis showed marked edema, epithelial necrosis, and inflammatory infiltration at 3 and 7 days, with full urothelial regeneration observed at 14 days. No signs of ureteral or renal injury, or adverse systemic responses were detected. These findings suggest that QS-GMP may serve as a feasible option for temporary arterial occlusion in future veterinary lower urinary tract applications, although further long-term evaluation is warranted.
by Karina Kouzaki, Mako Isemura, Yuki Tamura, Hiroyuki Uno, Shunta Tadano, Ryuji Akimoto, Katsu Hosoki, Koichi Nakazato
Cancer cachexia causes severe muscle wasting, and current treatments remain limited. Belt-type electrical muscle stimulation (bEMS) has emerged as a passive rehabilitation tool capable of activating multiple lower limb muscles simultaneously. We investigated whether bEMS prevents muscle wasting and improves functional outcomes in rats with cancer cachexia. Cancer cachexia was induced in male Sprague-Dawley rats by intraperitoneal injection of AH130 Yoshida hepatoma cells. Acute and chronic effects of bEMS were tested. Muscle protein synthesis was evaluated using the SUnSET method, and muscle fiber cross-sectional area (CSA) and ankle torque were measured after chronic stimulation. bEMS increased puromycin-labeled protein levels on day 3 post-injection (~1.5–2.0 fold; p
by Hanui Lee, Gyeong Han Jeong, Geun-Joong Kim, Seung Sik Lee, Byung Yeoup Chung, Hyoung-Woo Bai
Exosomes are cell-derived vesicles that play a crucial role in intracellular communication and are promising biomarkers for therapeutic applications. Despite their significant potential, the application of exosomes as biological therapeutics is limited by their low yield and inconsistent production quality. Ionizing radiation is known to enhance exosome release; however, this effect has been primarily studied in cancer cells. Given the critical role of macrophages in immune regulation and their potential for exosome-based therapies, we investigated the impact of gamma radiation on the secretion of macrophage-derived exosomes. This study demonstrated that gamma radiation significantly enhanced exosome release by both naïve and polarized macrophages. This effect was associated with the overexpression of Myh10 and Myo5b, the motor proteins that play crucial roles in exosome biogenesis and secretion. Furthermore, RNA sequencing and western blot analyses identified the EGFR/IGFR-MYC signaling axis as a key upstream pathway regulating the expression of Myh10 and Myo5b, thereby accelerating exosome secretion. These findings provide a deeper understanding of the molecular mechanisms underlying radiation-induced exosome secretion from macrophages and offer a novel strategy for optimizing exosome production to advance exosome-based therapeutic applications.
by Salman H. Choudhry, Keegan D’Mello, George Kim, Robin Mackin, Amrit Kirpalani
The study examines the influence of Asian sub-ethnic identity on the experiences of pre-medical students in the United States and Canada, aiming to understand how early interactions with the medical education system shape their pursuit of medicine. The researchers analyzed 132 discussion threads from popular online premedical school forums between June 2018 and 2023. The Asian Critical Theory framework guided the analysis along with cyclical inductive coding. Two major themes emerged: the homogenization of diverse Asian sub-ethnicities and external pressure related to sociocultural values. Terms like “over-represented minorities” contributed to the perception of Asians as a monolithic group, while expressions such as “Asian Parents” highlighted unique familial expectations. Non-Asian users often dismissed these barriers, reinforcing the model minority myth. The study emphasizes the negative consequences of framing Asians as a homogenous group in medical school admissions policies, perpetuating stereotypes, and overlooking the diversity within Asian sub-ethnic communities. The term “overrepresented” is critiqued for its role in homogenizing Asian identities and undermining the complexity of their experiences. These findings highlight the need for greater recognition of the nuanced challenges faced by Asian sub-ethnic medical trainees and the importance of dismantling stereotypes in medical education.
by Hana Wakasa, Satoshi Sunohara, Takashi Kimura, Takaya Ichikawa, Akiko Tamakoshi
Obesity is a growing global health concern and has been associated with increased mortality from various cancer types, including hematological malignancies. However, evidence for this association in Asian populations, particularly among Japanese adults, remains limited. Thus, this study aimed to examine the association between obesity and mortality due to hematological malignancies. Data from 97,073 participants in the Japan Collaborative Cohort (JACC) Study were analyzed. The participants were followed for a mean duration of 17 years. Body mass index (BMI) was calculated using self-reported height and weight and categorized as underweight (
by Anshu Parajulee, Abdo Souraya, Nancy Humber, Sean Ebert, Kim Williams, Tom Skinner, Jude Kornelsen
ObjectiveTo identify contextually relevant indicators to measure the quality of surgical and obstetrical care in low-volume rural hospitals using a consensus-based methodology.
MethodsA modified Delphi process was implemented in which participants were asked to rate the priority of proposed evaluation metrics over two rounds. Two Delphi surveys were electronically administered in 2019, approximately one month apart. Fifty-one health care professionals from across Canada, including rural proceduralists and quality improvement experts, were invited to participate. All quality measures in the first round were proposed by the study team. The second round included measures that did not reach consensus in the first round and measures suggested by respondents during the first round.
ResultsThirty individuals participated in Round 1 (59% response rate). Of the 30 respondents from Round 1, 23 participated in Round 2 (77% response rate). 115 of 177 proposed measures (65%) reached positive consensus in Round 1 or 2. Expert participants agreed that these measures should be prioritized/included when evaluating surgical and/or obstetrical quality in rural hospitals. No measure reached negative consensus in either round. Open-text comments offered practical guidance on how to interpret and use surgical and obstetrical quality data within a rural context. Many respondents believed that rare adverse outcomes have low relevance at rural hospitals where volumes are low, procedures are almost all lower complexity day cases (Cesarean section being the major exception), and patients are typically healthy.
ConclusionThe modified Delphi process resulted in the identification of surgical and obstetrical quality indicators that are contextually embedded in the realities of rural practice. The methodology allowed for the consideration of factors often overlooked by normative urban-based approaches, including team-based care characteristic of rural hospitals and limited access to specialist care and imaging services.
by Namhee Kim, Bo Gyeong Lee
PurposeSleep quality is a multidimensional construct encompassing the effectiveness and restorativeness of sleep. The pre-sleep arousal scale is a widely used instrument for evaluating aspects of arousal that are closely related to sleep quality. This study aimed to evaluate the psychometric properties of the Korean version of the pre-sleep arousal scale (K-PSAS).
MethodsWe performed a secondary analysis of cross-sectional data from 286 adults aged 19–70 years who used electronic cigarettes or heated tobacco products. The original PSAS was translated into Korean, with content validity assessed by experts. Construct validity was evaluated via exploratory factor analysis, and concurrent validity was assessed by correlating the K-PSAS with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Reliability was examined using Cronbach’s α, and split-half reliability coefficient.
ResultsBoth the item-level content validity index for all items and the scale-level content validity index average for the K-PSAS-16 were 1.0. After removing the survey item on “being mentally alert and active at bedtime” (item 13) due to low factor loading, the K-PSAS-15 demonstrated a two-factor structure, with somatic and cognitive arousal factors explaining 42.36% and 10.19% of the variance, respectively. A significant positive correlation was observed between the two factors (ρ = 0.61, p Conclusion
The K-PSAS-15, which excludes one poorly performing item from the original scale, is a reliable and valid tool for assessing pre-sleep arousal.
by Dong Min Jung, Yong Jae Kwon, Yong Wan Cho, Jong Geol Baek, Dong Jae Jang, Yongdo Yun, Seok-Ho Lee, Gahee Son, Hyunjong Yoo, Min Cheol Han, Jin Sung Kim
Volumetric modulated arc therapy (VMAT) for lung cancer involves complex multileaf collimator (MLC) motion, which increases sensitivity to interplay effects with tumour motion. Current dynamic conformal arc methods address this issue but may limit the achievable dose distribution optimisation compared with standard VMAT. This study examined the clinical utility of a VMAT technique with monitor unit limits (VMATliMU) to mimic conformal arc delivery and reduce interplay effects while maintaining plan quality. VMATliMU was implemented by applying monitor unit limitations during VMAT reoptimisation to minimise MLC encroachment into target volumes. Using mesh-type reference computational phantom CT images, treatment plans were generated for a simulated stage I lung cancer case prescribed to 45 Gy in three fractions. VMATliMU, conventional VMAT, VMAT with leaf speed limitations, dynamic conformal arc therapy, and constant dynamic conformal arc therapy were compared. Plans were optimised for multiple isodose line prescriptions (50%, 60%, 70%, 80%, and 90%) to investigate the impact of dose distribution. Evaluation parameters included MLC positional accuracy using area difference ratios, dosimetric indices, gradient metrics, and organ-at-risk doses. VMATliMU prevented MLC encroachment into the internal target volume across 60%–90% isodose lines, showing superior MLC accuracy compared with other methods. At the challenging 50% isodose line, VMATliMU had 4.5 times less intrusion than VMAT with leaf speed limits. VMAT plans had better dosimetric indices than dynamic conformal arc plans. VMATliMU reduced monitor units by 5.1%–19.2% across prescriptions. All plans met the clinical dose constraints, with the aortic arch below tolerance and acceptable lung doses. VMATliMU combines VMAT’s dosimetric benefits with the dynamic conformal arcs’s simplicity, minimising MLC encroachment while maintaining plan quality. Reduced monitor units lower low-dose exposure, treatment time, and interplay effects. VMATliMU is usable in existing planners with monitor unit limits, offering a practical solution for lung stereotactic body radiation therapy.
by Catherine Park, Namhee Kim, Miji Kim, Chang Won Won, Beom-Chan Lee
Falls are a critical concern in older adults with cognitive frailty (CF). However, previous studies have not fully examined whether machine learning models can predict falls in older individuals with CF. The 2-year longitudinal data set from the Korean Frailty and Aging Cohort Study and machine learning approach were utilized to predict fall risk. We analyzed multidimensional health data, including demographics, clinical conditions, as well as the physical and psychological health factors of 443 older adults with CF identified out of 2,404 older adults. For fall risk prediction, we developed a machine learning framework incorporating logistic regression, bootstrapping, and recursive feature elimination. Statistical analysis revealed significant differences between the non-faller and faller groups for nine clinical conditions as well as physical and psychological variables. Using nine significant variables, our machine-learning-based model demonstrated good predictive performance with an area under the curve (AUC) exceeding 80%. Furthermore, our machine learning framework identified four optimal variables: the number of Fried physical frailty (PF) phenotypes, PF-Mobility scores, scores from the Korean version of the Short Geriatric Depression Scale, and scores from SARC-F (consisting of five components: strength, assistance with walking, rising from a chair, climbing stairs, and experiencing falls). It demonstrated excellent predictive performance, with an AUC, sensitivity, specificity, and accuracy exceeding 95%. These variables reflect the critical association between physical and psychological health and fall risk. These findings underscore the importance of integrating multidimensional health data with machine learning methodologies to accurately predict fall risk in older adults with CF, design targeted interventions, and enable healthcare professionals to implement strategies to reduce and prevent such falls.
FreshRSS