Yonsei Medical Journal最新文献

Purpose: Drug-coated balloons (DCBs) have demonstrated favorable outcomes in the treatment of femoropopliteal artery (FPA) disease. A variety of DCBs are currently available, with differing doses of antiproliferative agents and types of excipients. The objective of this study was to compare the efficacy and safety of high-dose versus low-dose paclitaxel DCBs for the treatment of FPA disease.

Materials and methods: We analyzed data from the multicenter the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) registry, focusing on patients treated with a high-dose paclitaxel DCB (IN.PACT™) or low-dose paclitaxel DCB (Lutonix™ or Ranger™) for native vessel FPA disease. We used inverse probability of treatment weighting to adjust for confounding factors and conducted subgroup analyses based on lesion characteristics.

Results: Among 820 target limbs, 626 were treated with a high-dose paclitaxel DCB, and 194 were treated with a low-dose paclitaxel DCB. At 12 months, there were no significant differences in rates of freedom from clinically driven target lesion revascularization (TLR; 91.7% vs. 89.4%, log-rank p=0.35), major adverse limb event (MALE; 91.4% vs. 89.0%, log-rank p=0.31), or all-cause mortality (93.1% vs. 93.8%, log-rank p=0.79) between high-dose and low-dose groups. On multivariable analysis, the presence of chronic heart failure and chronic kidney disease were the only independent predictors of clinically driven TLR after DCB treatment.

Conclusion: In this multicenter cohort study of patients with complex FPA disease, there were no significant differences between high-dose DCB and low-dose DCB with respect to freedom from clinically driven TLR, MALE, or all-cause mortality at 12-month follow-up.

Purpose: Children with precocious puberty undergo rapid physical changes that may lead to behavioral problems. Parenting style, along with parental stress and coping mechanisms, are important parental factors that affect the development of behavioral problems in children. Therefore, we examined the serial mediating effects of parenting style and parent's coping mechanisms on the relationship between parental stress and behavioral problems in girls with precocious puberty.

Materials and methods: This cross-sectional study analyzed a convenience sample of 200 mothers of girls with precocious puberty at a university hospital located in a metropolitan area of Korea. Mothers completed The Parental Stress Measurement, Parents as Social Context Questionnaire, Coping Inventory for Stress Situations, and Korean version of the Child Behavior Checklist 6-18. Descriptive statistics, t-tests, Pearson's correlations, and bootstrap analyses were used to analyze the collected data.

Results: Parental stress from family and personal roles triggers emotion-oriented coping, which reinforces negative parenting and contributes to children's behavioral issues. Conversely, stress from relationships promotes task-focused coping, which enhances positive parenting attitudes and reduces negative ones.

Conclusion: Interventions should be developed and applied to help mothers of children with precocious puberty use task-focused coping strategies in stressful situations to positively impact their children's behavioral problems.

Purpose: Depression is a major global public health concern. Diet and physical activity are major modifiable lifestyle factors associated with depression; however, their joint effects have not been fully addressed. This cross-sectional study aimed to quantitatively examine the interaction between physical activity and inflammatory nutrients in depression and utilized Bayesian kernel machine regression (BKMR) models to compare the effects of inflammatory nutrients on depression in individuals with and without physical activity.

Materials and methods: The inflammatory diet was assessed using the dietary inflammatory index (DII), while physical activity levels were measured using the Global Physical Activity Questionnaire, with sufficient physical activity defined as achieving 600 metabolic equivalent task minutes per week. Depression was defined as a 9-item Patient Health Questionnaire score of ≥10. We used multiple logistic regression and BKMR models to investigate the associations between the DII and depression, with all models adjusted for covariates.

Results: A total of 4110 participants from the 2020 Korea National Health and Nutrition Examination Survey were included in this study. Notably, participants with higher total DII scores were more likely to have depressive symptoms, and the additive interaction between insufficient physical activity and inflammatory nutrients was attributed to a 36% risk of depression. Moreover, BKMR analyses showed that individuals with insufficient physical activity exhibited a greater risk of depression posed by pro-inflammatory dietary patterns and did not benefit from anti-inflammatory dietary patterns with regard to the risk of depression.

Conclusion: Comprehensive plans for diet control and increased physical activity are essential to help prevent depression.

Purpose: Most studies have reported that the risk of coronary heart disease decreases when menopausal hormone therapy (MHT) is initiated before the age of 60 years or within 10 years of menopause. However, the findings regarding stroke risk remain conflicting. This study investigated the association between the risk of ischemic stroke and MHT, categorized by the type of MHT.

Materials and methods: This population-based, retrospective cohort study was based on the Korean National Health Insurance Service-National Sample Cohort (2004-2015). Participants were aged 45-60 years with no cardiovascular disease or preexisting stroke, classified as never, past, and current users of MHT.

Results: Among the study participants, 16915 (88.77%) women had never undergone MHT, 1437 (7.54%) had previously undergone MHT, and 703 (3.69%) were currently using MHT. During the study period, with a mean follow-up of 11.23±2.13 years, the risk of ischemic events was significantly higher among current users [hazard ratio (HR): 2.98, 95% confidence interval (CI): 1.95-4.57, p<0.001], particularly in those using estrogen-only MHT (HR: 3.49, 95% CI: 1.12-10.90, p=0.032) and tibolone (HR: 3.52, 95% CI: 2.05-6.03, p<0.001), compared to never users. Meanwhile, no significant difference in the risk of ischemic events was observed between past users and never users, even after analyses accounting for estrogen type and progestin co-administration.

Conclusion: Women currently receiving MHT without underlying cardiovascular disease exhibited an increased risk of ischemic stroke, particularly those treated with E-only MHT or tibolone. However, this increased risk returned to baseline after discontinuing MHT, indicating that past use of MHT was not associated with an increased risk of ischemic stroke.

Over 20 years of research on human pluripotent stem cell (hPSC)-based therapies for Parkinson's disease (PD) has recently culminated in clinical trials. The first clinical report on autologous transplantation of patient-derived hPSCs showed significant motor symptom improvement, validating the therapeutic promise of this approach. However, critical challenges remain, notably the limited engraftment and survival of donor cells. Cellular stress incurred during in vitro differentiation of hPSCs into midbrain dopaminergic progenitors and neurons contributes to the reduced survival of grafted mDA neurons. Additionally, the host brain environment at the injection sites becomes hostile to transplanted cells due to needle trauma, immune rejection, and alpha-synuclein pathology present in the brains of PD patients. This review discusses potential strategies to address both intrinsic donor cell stress and hostile host brain environment, aiming to enhance the long-term efficacy and engraftment of hPSC-based cell therapies for PD.

Purpose: Large language models (LLMs) have shown potential in medicine, transforming patient education, clinical decision support, and medical research. However, the effectiveness of LLMs in providing accurate medical information, particularly in non-English languages, remains underexplored. This study aimed to compare the quality of responses generated by ChatGPT and Naver's CLOVA X to cancer-related questions posed in Korean.

Materials and methods: The study involved selecting cancer-related questions from the National Cancer Institute and Korean National Cancer Information Center websites. Responses were generated using ChatGPT and CLOVA X, and three oncologists assessed their quality using the Global Quality Score (GQS). The readability of the responses generated by ChatGPT and CLOVA X was calculated using KReaD, an artificial intelligence-based tool designed to objectively assess the complexity of Korean texts and reader comprehension.

Results: The Wilcoxon test for the GQS score of answers using ChatGPT and CLOVA X showed that there is no statistically significant difference in quality between the two LLMs (p>0.05). The chi-square statistic for the variables "Good rating" and "Poor rating" showed no significant difference in the quality of responses between the two LLMs (p>0.05). KReaD scores were higher for CLOVA X than for ChatGPT (p=0.036). The categorical data analysis for the variables "Easy to read" and "Hard to read" revealed no significant difference (p>0.05).

Conclusion: Both ChatGPT and CLOVA X answered Korean-language cancer-related questions with no significant difference in overall quality.

Purpose: Geriatric trauma patients have unique risk factors for being undertriaged, which differ from those in young trauma patients. This study aimed to identify these risk factors and their implications for public health stakeholders and trauma surgeons to improve prehospital triage of geriatric trauma patients.

Materials and methods: Data were retrospectively reviewed from single level-1 trauma center database in patients aged ≥65 years, with Injury Severity Score (ISS) >15 between 2016 and 2020. Pre-hospital and hospital factors were compared between correctly triaged and undertriaged patients. The probabilities of survival and outcomes for correct and undertriage were calculated using the Trauma and Injury Severity Score (TRISS), observed (O):expected (E) ratio, z-score, and w-score.

Results: A total of 512 patients were included in the study; 401 (78%) were correctly triaged and 111 (22%) were undertriaged. Correct triage group presented significant z-score (correct triage: 4.29 vs. undertriage: -0.11), w-score (correct triage: 7.79 vs. undertriage: 4.29), and O:E ratio of mortality (correct triage: 0.73 vs. undertriage: 1.66). Undertriaged patients were older (77 [72-82] vs. 73 [68-80], p<0.001), had a higher women proportion (53% vs. 34%, p<0.001), had lower ISS (25 [17-25] vs. 27 [19-38], p<0.001), and had more head and neck injuries (89% vs. 65%, p<0.001). On multivariable logistic regression, female sex (odds ratio 2.55, 95% confidence interval [1.07-6.09], p=0.034), ground fall injury (5.82 [1.89-17.91], p=0.002), prehospital systolic blood pressure <110 mm Hg (0.13 [0.03-0.67], p=0.003), and presence of cerebrovascular disease (5.53 [1.35-22.68], p=0.018) were significantly associated with undertriage.

Conclusion: Geriatric trauma patients were undertriaged when they were women, sustained ground-level fall injuries, the more alert in the scene, and had cerebrovascular disease. Trauma surgeons and fire agency stakeholders should collaborate to create geriatric-specific triage guidelines and educate paramedics about these risk factors to prevent undertriage in this patient population.

Purpose: This retrospective cohort study aimed to investigate the association between the use of pain medications with varying cyclooxygenase-2 (COX-2) selectivity and the incidence of endometriosis (EMS) in women.

Materials and methods: Medical records from January 1, 1994, to December 31, 2022, were retrospectively analyzed. The cohort included 33406 patients diagnosed with any pain-related condition who were prescribed either selective COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients were followed for up to 5 years from the cohort entry date. The incidence of EMS was compared between the two medication groups using Cox proportional hazards models, adjusting for confounding factors such as age, past drug use, and prior diagnosis.

Results: The incidence rates of EMS were 3.00 per 1000 person-years in the COX-2 inhibitor group and 3.97 per 1000 person-years in the NSAIDs group. After adjustment for confounders, the hazard ratio for EMS incidence in the COX-2 inhibitor group compared to the NSAIDs group was 0.77 [95% confidence interval (CI), 0.63 to 0.93; p<0.01], indicating a significantly lower risk in the COX-2 inhibitor group. Subgroup analysis revealed that this association was particularly significant in younger women aged 20-44 years, with a hazard ratio of 0.71 (95% CI, 0.54 to 0.95; p<0.05) in this age group.

Conclusion: The findings suggest that COX-2 inhibitors may reduce the incidence of EMS compared to traditional NSAIDs, highlighting their potential as a strategic option for managing EMS, particularly among younger women. Further prospective studies are needed to confirm these findings.