Yonsei Medical Journal最新文献

Purpose: Chronic diseases such as hypertension (HT), diabetes mellitus (DM), and dyslipidemia (LD) are leading contributors to healthcare expenditures globally, including in South Korea. This study aimed to analyze trends in health expenditures for managing these conditions, focusing on patient demographics, comorbidities, and complications, using real-world data from a tertiary care hospital.

Materials and methods: This retrospective study utilized clinical data from Severance Hospital's Severance Clinical Research Analysis Portal (SCRAP) system, covering 2013 to 2020. Patients diagnosed with HT, DM, and LD were identified using ICD-10 codes. Generalized linear mixed models were applied to evaluate trends in health expenditures, and a Sankey diagram was used to visualize expenditure flows by patient subgroups and care categories.

Results: Total health expenditures increased nearly threefold, from 157.2 billion KRW in 2013 to 444.8 billion KRW in 2020, driven primarily by rising reimbursable costs (67.1% to 84.1%). Per-patient expenditures decreased initially but stabilized by 2020. Patients with HT+DM incurred the highest per-patient costs, followed by those with HT alone. Complications, particularly cardiovascular and cerebrovascular diseases, significantly elevated costs, with inpatient care accounting for the largest expenditure share.

Conclusion: The economic burden of managing chronic diseases is substantial, particularly for patients with multiple conditions or complications. Strengthening preventive care and integrated management strategies, alongside sustained financial support, is crucial for improving cost-efficiency in chronic disease care.

Purpose: Sleep traits are suggested as risk factors for epilepsy, yet the extent of their shared biological basis and the causal direction between these traits are not well understood. Our goal was to assess the associations and establish causal relationships between sleep traits and epilepsy through Mendelian randomization (MR) analyses.

Materials and methods: Univariate and multivariate bidirectional MR analyses were used to assess the causal association between sleep traits and epilepsy. In this study, exposure factors of seven sleep traits and outcome variables related to epilepsy were obtained from the published Genome-Wide Association Study (GWAS). The major analysis utilized for MR was inverse-variance weighted.

Results: Univariable MR analysis indicated that both insomnia and chronotype were positively associated with the risk of generalized epilepsy (GE) [odds ratio (OR)=3.436, 95% confidence interval (CI): 1.081-10.919, p=0.036; OR=1.645, 95% CI: 1.054-2.566, p=0.028]. Additionally, a positive association was found between focal epilepsy (FE) and the risk of daytime napping (OR=1.003, 95% CI: 1.001-1.006, p=0.011). Multivariable MR analysis demonstrated that insomnia was causally and positively linked to GE (OR=5.214, 95% CI: 1.384-19.639, p=0.015). However, after adjusting for other sleep traits and potential confounders, chronotype was found to have no causal effect on GE. Similarly, no causal relationship was found from FE to daytime napping when adjusted for potential confounders.

Conclusion: Our results suggest a shared genetic foundation between sleep traits and epilepsy, indicating potential causal effect of insomnia on GE risk. Interventions targeting sleep disturbances could serve as therapeutic approaches in epilepsy management.

Purpose: CD138 is a cell surface proteoglycan involved in plasma cell survival and cell adhesion, and can be detected in serum via ectodomain shedding. This study aimed to investigate the clinical utility of circulating CD138 at diagnosis in predicting future progression to end-stage kidney disease (ESKD) in patients with microscopic polyangiitis (MPA).

Materials and methods: Sixty-five patients newly diagnosed with MPA were included. Antineutrophil cytoplasmic antibody-associated vasculitis-specific indices and clinical and laboratory data were collected. Circulating CD138 levels were measured from stored sera at the time of diagnosis and a cut-off value for predicting ESKD progression was determined using receiver operating characteristic curve analysis.

Results: The median circulating CD138 level at diagnosis was 62.8 ng/mL. Circulating CD138 at diagnosis showed positive correlations with the cross-sectional Birmingham Vasculitis Activity Score, Five-Factor Score, erythrocyte sedimentation rate, C-reactive protein level, and baseline serum creatinine level, while demonstrating a negative correlation with serum albumin level. Overall, 12 (18.5%) of 65 patients progressed to ESKD. The incidence of progression to ESKD was higher in patients with circulating CD138 ≥73.3 ng/mL at diagnosis than in those without (relative risk=10.588). Additionally, patients with circulating CD138 ≥73.3 ng/mL at diagnosis exhibited significantly lower ESKD-free survival rates than those without (p=0.002).

Conclusion: This study demonstrated that circulating CD138 measured at diagnosis has clinical utility as a biomarker for predicting future progression to ESKD in patients with MPA, and incorporating CD138 measurement at diagnosis may assist in identifying high-risk patients and guiding early therapeutic interventions in clinical practice.

Purpose: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening infection. The prevalence of PJP in patients without human immunodeficiency virus (HIV) (non-HIV-PJP) is increasing. Previous studies have separately evaluated the clinical characteristics of PJP patients with and without HIV infection. Therefore, this study aimed to comparatively analyze the clinical characteristics of PJP patients with and without HIV.

Materials and methods: We retrospectively reviewed patients with PJP who were admitted to a single tertiary center for 15 years. PJP patients were classified according to the presence or absence of HIV, and differences in their clinical characteristics and prognoses were analyzed. Forty-four HIV-PJP patients and 175 non-HIV-PJP patients were included.

Results: Cough, dyspnea, typical computed tomography findings of PJP, and cytomegalovirus (CMV) pneumonitis co-infection were more common in the HIV-PJP group. The durations from symptom onset to PJ polymerase chain reaction (PCR) testing and to the start of treatment were longer in the HIV-PJP group; however, the time from the PJ PCR test to antibiotic administration was shorter in the HIV-PJP group. The 28-day survival rates were 68.6% and 88.6% in the non-HIV-PJP and HIV-PJP groups, respectively (p=0.011). The survival rate of patients with CMV pneumonitis co-infection in the non-HIV-PJP group was significantly lower.

Conclusion: The clinical characteristics of patients with HIV-PJP and non-HIV-PJP were statistically different. The initial clinical features appeared to be worse in the HIV-PJP group; however, the 28-day mortality rate was higher in the non-HIV-PJP group.

Purpose: Oral branched-chain amino acids (BCAAs) may benefit patients with cirrhosis, especially those with hepatic encephalopathy (HE). We analyzed the cost-effectiveness of BCAAs in improving the prognosis of patients with HE.

Materials and methods: We compared the total costs and effectiveness of oral BCAA treatment (Scenario 1) versus no BCAA supplementation (Scenario 2) in a virtual cohort of 10000 patients who had experienced HE over a 5-year period. A nested Markov model consisting of four health states (remission, recurrence, stabilization after recurrence, and death) for decompensated cirrhosis was used. Effectiveness was estimated as the cumulative number of HE recurrences and deaths. Additionally, the number of life-years and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were analyzed. Deterministic and probabilistic sensitivity analyses were also performed.

Results: Oral BCAA treatment prevented 34% of HE recurrences and reduced the number of HE-related deaths by 18%. Although patients in the BCAA-treated group spent an additional 4086 USD on average compared with their counterparts in the non-treated group ($27088 vs. $23003), they experienced 0.34 more QALYs (2.77 vs. 2.43) over the 5-year period. The ICER for BCAA treatment was 12017 USD/QALY, indicating the high cost-effectiveness of the therapeutic option. Moreover, the sensitivity analyses showed that its economic feasibility was robust. With the willingness-to-pay threshold set at 1 GDP per capita, the probability of cost-effectiveness of BCAA treatment exceeded 80%.

Conclusion: Oral BCAAs for HE prevention may contribute positively to both the clinical status of the patient and the national healthcare budget.

Purpose: Endometriosis affects about 10% of reproductive-age women and can be managed through medical treatments, surgical intervention, or both. Approximately 40%-50% of patients experience recurrence within 5 years after surgery. Therefore, medical treatments, especially progestins, play a major role in the management of endometriosis. Dienogest has been used to treat endometriosis; however, its effects on endometriosis remain unclear. This study aimed to evaluate the molecular effects of dienogest on endometriosis.

Materials and methods: The enrolled patients were aged ≥20 years, premenopausal, and had pathologically confirmed endometriosis. The study participants consisted of four women who had received dienogest treatment before surgery and four women who had not received any medical treatment before surgery. This study compared the RNA profiles of the dienogest-treated and untreated groups before surgery.

Results: We identified 406 differentially expressed genes by comparing the dienogest-treated and untreated groups and conducted enrichment analysis with an adjusted p-value of <0.05. We identified pathways such as regulation of immune effector processes, leukocyte activation involved in the immune response, cell activation involved in the immune response, and leukocyte cell-cell adhesion.

Conclusion: Comparison of the dienogest-treated and untreated groups before endometriotic ovarian cyst surgery revealed pathways related to immune system function, inflammatory response, cell signaling and adhesion, and metabolic regulation. These findings suggest that dienogest may play a role in controlling inflammation and immune regulation, potentially alleviating endometriosis-related symptoms and delaying recurrence. Although further studies are required for validation, our preliminary findings suggest that dienogest may contribute to delaying the progression from endometriosis to carcinoma.

Purpose: This study aimed to evaluate the effects of functional games on attention in older adults with mild cognitive impairment (MCI), addressing the limited focus on specific cognitive domains in existing research. Additionally, it explored how functional games may stimulate multiple cognitive domains, contributing to overall cognitive improvement.

Materials and methods: This randomized controlled trial recruited 80 participants with MCI from April to June 2023 through outpatient visits at the Neurology Department of Incheon St. Mary's Hospital, Catholic Kwandong University, and public advertisements. Participants were randomly assigned to the treatment or control group. The treatment group engaged in functional games at least three times per week for 12 weeks. Measurements were conducted at baseline and after the intervention period.

Results: Among 71 participants, improvement in the attention domain of the Montreal cognitive assessment (MoCA) was more significant in the treatment group (42.11%) than in the control group (18.18%, p=0.003). Clinical dementia rating (CDR) analysis showed a slower cognitive decline in the treatment group (p=0.033), while no significant changes were observed in mini-mental state examination scores.

Conclusion: The intervention demonstrated a significant improvement in attention as measured by MoCA and a slower progression of cognitive decline as indicated by CDR, highlighting its potential effectiveness in enhancing cognitive function and mitigating cognitive decline in older adults. These findings support using such interventions as a viable strategy for cognitive improvement.

Purpose: AbnobaVISCUM^® F is an anti-malignant tumor agent derived from Viscum album, a mistletoe species parasitic to ash trees. It is known to exert anticancer effects by activating the patient's immune system without directly inducing tumor toxicity. We retrospectively investigated the anticancer effect of AbnobaVISCUM^® F in patients with resected pancreatic cancer.

Materials and methods: We reviewed a total of 985 patients who underwent radical resection for pancreatic cancer between January 2005 and August 2022 at Severance Hospital, Seoul, Korea. Patients were divided into two groups based on whether Abnoba VISCUM^® F was administered (Viscum group) or not (Control group), and clinicopathologic characteristics, disease-free survival (DFS) and overall survival (OS) were compared after propensity score matching (PSM).

Results: Of the 985 patients, 310 received Viscum therapy at least 12 times (Viscum group), while 590 did not receive it at all (Control group). After PSM, both groups showed similar DFS (p=0.518), whereas the Viscum group showed superior OS (p<0.001). Subgroup analyses revealed better OS for the Viscum group in T1 (p=0.014), T2 (p=0.012), N0 (p=0.010), N1 (p=0.001), R0 resection patients (p<0.001), and in patients who underwent no adjuvant chemotherapy or chemotherapy regimens other than FOLFIRINOX (p<0.001). Multivariable analysis identified Viscum therapy as an independent factor for improved OS (hazard ratio 0.601, p< 0.001), although it did not significantly impact DFS.

Conclusion: Viscum treatment significantly improved OS in patients with completely resected stage I and II pancreatic cancer, particularly among those unable to tolerate adjuvant chemotherapy. This anticancer effect, based on immune enhancement, should be further investigated, and large-scale randomized controlled study is warranted.

Purpose: We aimed to investigate the association between the results of color vision tests and simulation tests for police tasks among participants with color vision deficiencies (CVDs) and those with normal vision, and to assess the agreement between the results of various color vision tests.

Materials and methods: Participants with CVDs and healthy controls were recruited. Participants in the CVD group were classified into three subgroups (mild weakness, severe weakness, and color blindness). All participants performed simulation tests (bloodstain identification, traffic light test, and analysis of dashboard camera recordings) and clinical color vision tests. We statistically analyzed the association between color vision tests and simulation tests and quantitatively assessed the agreement between various color vision tests.

Results: We evaluated 25 participants with normal vision (92.0% male) and 21 with CVDs (95.2% male). Even in the mild CVD group, the scores for the traffic light test and dashboard camera recordings were lower than those of the control group (9.40±0.57 vs. 9.06±0.84, and 1.80±0.40 vs. 1.44±0.77, all p<0.05). However, no difference in the bloodstain identification test scores was observed between the control and CVD groups (p=0.190). Additionally, the association with anomaloscope results was strongest in the following order: Ishihara, Hardy-Rand-Rittler, Farnsworth-Munsell 100 hue, and Farnsworth D-15 tests.

Conclusion: This study demonstrated a correlation between the results of clinical color vision tests and police-related simulation tests. Particularly, the score for recognizing traffic signs or analyzing dashboard camera recordings was lower even in those with mild CVD than in those with normal vision.

Purpose: The Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were published in 2010 and revised in 2020 to improve the reporting of preclinical animal studies. The present study evaluated the reporting of animal stem cell research related to Parkinson's disease (PD).

Materials and methods: Articles on this topic published up to October 18, 2024, were systematically searched in relevant databases. For each individual study, we analyzed the proportion of subsets that were reported, partially reported, or unreported for each of the 38 ARRIVE 2.0 items. We compared reporting before and after the publication of the ARRIVE guidelines, and analyzed compliance score changes over time and by country.

Results: We analyzed 90 animal studies related to PD. None of the studies reported sample size calculations, adverse event reporting, or humane endpoints. Additionally, only about 20% or less of the studies reported on strategies to minimize potential confounders, inclusion or exclusion of animal conditions, limitations, allocation methods, and pre-protocol enrollment. We observed no substantial improvement in adherence after publication of the guidelines or over time.

Conclusion: The reporting of key design principles in animal stem cell research related to PD was insufficient both before and after the introduction of the ARRIVE guidelines in 2010. Both researchers and journal editors should pay more attention to the accurate, comprehensive reporting of animal studies.