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Background/Aims@#Previous studies have revealed that glucagon-like peptide-1 receptor agonist (GLP-1RA) and thiazolidinedione (TZD) can improve nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH). However, comprehensive research comparing the effects of GLP-1RA and TZD is limited. Thus, this study aimed to compare the effects of GLP-1RA and TZD on NAFLD or NASH through a network meta-analysis. @*Methods@#The PubMed, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCTs) that explored the efficacy of GLP-1RAs or TZDs in adult patients with NAFLD or NASH. The outcomes were liver biopsy-based (NAFLD activity score [NAS], fibrosis stage, and NASH resolution), noninvasive technique-based (liver fat content on proton magnetic resonance spectroscopy [1H-MRS] and controlled attenuation parameter [CAP]), biological, and anthropometric indicators. A random effects model was used to calculate the mean difference (MD) and relative risk with 95% confidence interval (CI). @*Results@#Twenty-five RCTs with 2,237 overweight or obese patients were included. GLP-1RA was significantly superior in reducing liver fat content evaluated using 1H-MRS (MD –2.42, 95% CI –3.84 to –1.00), body mass index (MD –1.60, 95% CI –2.41 to –0.80), and waist circumference (MD –4.89, 95% CI –8.17 to –1.61) than TZD. In liver biopsy-based evaluation and liver fat content assessment using CAP, GLP-1RA tended to surpass TZD, albeit not significantly. Sensitivity analysis showed consistent results with the main results. @*Conclusions@#Compared with TZD, GLP-1RA had better effects on liver fat content, body mass index, and waist circumference in overweight or obese patients with NAFLD or NASH.
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Despite strenuous efforts to reduce cardiovascular disease (CVD) risk by improving cardiometabolic risk factors, such as glucose and cholesterol levels, and blood pressure, there is still residual risk even in patients reaching treatment targets. Recently, researchers have begun to focus on the variability of metabolic variables to remove residual risks. Several clinical trials and cohort studies have reported a relationship between the variability of metabolic parameters and CVDs. Herein, we review the literature regarding the effect of metabolic factor variability and CVD risk, and describe possible mechanisms and potential treatment perspectives for reducing cardiometabolic risk factor variability.
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Sestrin2, a well-known adenosine monophosphate-activated protein kinase (AMPK) regulator, plays a protective role against metabolic stress. The β3-adrenergic receptor (β3AR) induces fat browning and inhibits muscle atrophy in an AMPK-dependent manner. However, no prior research has examined the relationship of sestrin2 with β3AR in body composition changes. In this study, CL 316,243 (CL), a β3AR agonist, was administered to wild-type and sestrin2-knockout (KO) mice for 2 weeks, and fat and muscle tissues were harvested. CL induced AMPK phosphorylation, expression of brown-fat markers, and mitochondrial biogenesis, which resulted in the reduction of lipid droplet size in inguinal white adipose tissue (iWAT). These effects were not observed in sestrin2-KO mice. In CL-treated soleus muscle, sestrin2-KO was related to decreased myogenic gene expression and increased levels of muscle atrophy-related molecules. Our results suggest that sestrin2 is associated with beneficial β3AR-mediated changes in body composition, especially in iWAT and in the soleus.
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Purpose@#The purpose of this study was to analyze the influence of emotional labor, positive psychological capital, and rewards on the retention intention among coronavirus diseases 19 (COVID-19) ward nurses in regional public hospitals. @*Methods@#The subjects were nurses who directly participated in nursing while wearing protective gear (level D or higher) in a COVID-19 ward. Data were collected from March 15 to March 29, 2021, and a total of 187 questionnaires were analyzed. The data were analyzed with descriptive statistics, independent t-test, one-way analysis of variance, Pearson’s correlation coefficient, and multiple regression using SPSS for Windows version 27.0. @*Results@#The mean scores of emotional labor, positive psychological capital, and retention intention were 3.48, 3.74, 3.22, and 5.75. The factors influencing retention intension were positive psychological capital (β=.28, p<.001), and the explanatory power for retention intention was 20.0%. @*Conclusion@#These results indicate that in order to increase retention intention, it is necessary to foster nurses with high positive psychological capital who can make good use of positive emotions, and additional research is needed to clarify the factors influencing nurses’s retention intention to remain in the organization.
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Purpose@#The purpose of this study was to investigate the influencing factors on health-related quality of life according to body mass index (BMI) in middle age people. @*Methods@#Using the 2017 Korea Health Panel Data, a total of 4,711 subjects age 40–64 were selected and classified into four groups based on BMI levels (underweight, normal weight, overweight, obese). Influencing factors according to BMI in middle age people was analyzed using multiple regression. @*Results@#Activity limited was the most influential factor for health-related quality of life in middle age people. Walking and stress were factors influencing health-related quality of life in all weight groups. In the overweight and obese group, suicidal impulse was a significant influencing factor on health-related quality of life. @*Conclusion@#To improve the health-related quality of life of middle age people, effective walking and stress management for maintaining and managing health, as well as managing suicide risk in the overweight group and obese group are required.
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Background@#The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies. @*Methods@#The risk of diabetes in patients with Graves’ disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group. @*Results@#A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019). @*Conclusion@#The risk of diabetes was significantly higher in patients with long-standing Graves’ disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.
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Background@#Reference intervals defined for adults or children of other ethnicities cannot be applied in the evaluation of Korean pediatric patients. Pediatric reference intervals are difficult to establish because children are in their growing stage and their physiology changes continuously. We aimed to establish reference intervals for routine laboratory tests for Korean pediatric patients through retrospective multicenter data analysis. @*Methods@#Preoperative laboratory test results from 1,031 pediatric patients aged 0 month–18 years who underwent minor surgeries in four university hospitals were collected. Age- and sex-specific reference intervals for routine laboratory tests were defined based on the Clinical and Laboratory Standards Institute (CLSI) EP28-A3c guidelines. @*Results@#The pediatric reference intervals determined in this study were different from existing adult reference intervals and pediatric reference intervals for other ethnicities. Most tests required age-specific partitioning, and some of those required sex-specific partitioning for at least one age-partitioned subgroup. Erythrocyte sedimentation rate, monocyte percentage, basophil percentage, activated partial thromboplastin time, glucose, cholesterol, albumin, bilirubin, chloride, and C-reactive protein did not show any difference between age- or sex-partitioned subgroups. @*Conclusions@#We determined Korean pediatric reference intervals for hematology, coagulation, and chemistry tests by indirect sampling based on medical record data from multiple institutions. These reference intervals would be valuable for clinical evaluations in the Korean pediatric population.
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There is an urgent need for accurate and rapid diagnostic assays capable of identifying carbapenemase-producing Enterobacteriaceae (CPE). We assessed the performance of the RESIST-4 O.K.N.V. (OKNV) assay (Coris BioConcept, Gembloux, Belgium) for the identification of oxacillinase (OXA)-48-like-, Klebsiella pneumoniae carbapenemase (KPC)-, New Delhi metallo-β-lactamase (NDM)-, and Verona integron-encoded metallo-β-lactamase (VIM)-producing Enterobacteriaceae grown on sheep blood agar (SBA) and the CHROMagar KPC medium. Sixty-five carbapenem-resistant Enterobacteriaceae (CRE) isolates with characterized carbapenemase content were used to evaluate the OKNV assay. The assay correctly identified all 30 isolates that produced one of the four targeted carbapenemase families. Additionally, it correctly identified 15 isolates that co-produced KPC and NDM, VIM and NDM or OXA-48-like and NDM, but failed to identify an NDM-1 and OXA-232 co-producing Klebsiella pneumoniae isolate. All 16 non-carbapenemase-producing CRE and four CPE isolates exhibited negative results, and no cross-reaction was observed. Overall, the sensitivity and specificity of the assay were 97.8% and 100%, respectively. The OKNV assay is an accurate and rapid assay for identifying OXA-48-like, KPC, NDM, and VIM carbapenemases produced by Enterobacteriaceae isolates cultured on both SBA and the CHROMagar KPC media in the clinical microbiology laboratory.
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Humans , Agar , Enterobacteriaceae , Klebsiella pneumoniae , Sensitivity and Specificity , SheepABSTRACT
Serosurveillance studies reveal the actual disease burden and herd immunity level in the population. In Seoul, Korea, a cross-sectional investigation showed 0.07% anti-severe acute respiratory syndrome coronavirus-2 antibody seropositivity among 1,500 outpatients of the university hospitals. Low seroprevalence reflects well-implemented social distancing.Serosurveillance should be repeated as the pandemic progresses.
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Purpose@#The purpose of this study was to examine the mediating effect of self-esteem and social support on the relationship between anxiety and health-related quality of life (HRQoL) in the elderly. @*Methods@#The Korea adult psycho-social anxiety survey data were collected from August to September 2015 by the Korea Institute for Health. The subjects were 1,035 elderly people who were aged 65 or older at the time of the data survey. The data were analyzed by t-test, chi-square, Pearson correlation coefficient, and parallel redundant mediated model for PROCESS macro using SPSS 23.0. @*Results@#They scored an average of 37.93±7.58 for anxiety, 28.59±3.45 for self-esteem, 17.25±4.11 for social support, and 0.88±0.11 for HRQoL. The direct effect of anxiety on HRQoL and the indirect effect of anxiety mediated with self-esteem and social support about HRQoL were statistically significant. @*Conclusion@#These results indicate that in order to increase the HRQoL of the elderly, it is necessary to develop an intervention program that focuses not only on reducing anxiety but also on improving self-esteem and social support.
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Purpose@#The purpose of this study was to examine the mediating effect of self-esteem and social support on the relationship between anxiety and health-related quality of life (HRQoL) in the elderly. @*Methods@#The Korea adult psycho-social anxiety survey data were collected from August to September 2015 by the Korea Institute for Health. The subjects were 1,035 elderly people who were aged 65 or older at the time of the data survey. The data were analyzed by t-test, chi-square, Pearson correlation coefficient, and parallel redundant mediated model for PROCESS macro using SPSS 23.0. @*Results@#They scored an average of 37.93±7.58 for anxiety, 28.59±3.45 for self-esteem, 17.25±4.11 for social support, and 0.88±0.11 for HRQoL. The direct effect of anxiety on HRQoL and the indirect effect of anxiety mediated with self-esteem and social support about HRQoL were statistically significant. @*Conclusion@#These results indicate that in order to increase the HRQoL of the elderly, it is necessary to develop an intervention program that focuses not only on reducing anxiety but also on improving self-esteem and social support.
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PURPOSE: The purpose of this study isto identify the mediating effects of interpersonal problems in the relationship between Social Network Service (SNS) use tendency and depression among university students. METHODS: Data were collected from April 28 to May 7, 2018 and the participants included 222 university students, who responded to the question regarding SNS use tendency, interpersonal problems and depression. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression using the SPSS/WIN 23.0 program. RESULTS: A positive correlation is found between depression and SNS use tendency (r=.24, p<.001), and among interpersonal problems (r=.62, p<.001), SNS use tendency and interpersonal problems (r=.34, p<.001). Interpersonal problems have a full mediating effect on the relationship between SNS use tendency and depression (Sobel test: 5.24, p<.001). CONCLUSION: These results suggest that it is important to manage interpersonal problems to prevent depression caused by SNS use tendency.
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Humans , Depression , Interpersonal Relations , NegotiatingABSTRACT
BACKGROUND: Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes. METHODS: We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FE(γ-GT)) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined. RESULTS: We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08–4.19; P = 0.029). FE(γ-GT) was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP. CONCLUSION: Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FE(γ-GT) levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.
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Humans , Alkaline Phosphatase , gamma-Glutamyltransferase , Isoenzymes , Length of Stay , Liver , Multivariate Analysis , Pyelonephritis , TransferasesABSTRACT
BACKGROUND: Prothrombin time (PT) measurement is an important test for screening blood coagulation disorders and monitoring anticoagulant therapy. In this study, we evaluated the analytical performance of HemosIL ReadiPlasTin (Instrumentation Laboratory, USA), a liquid reagent for PT measurement. METHODS: The precision of HemosIL ReadiPlasTin was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) EP5-A3 guidelines. Further, comparison with HemosIL RecombiPlasTin 2G (Instrumentation Laboratory, USA) was made according to the CLSI EP9-A3 guidelines. The reference intervals were established according to the CLSI C28-A3 guidelines. RESULTS: The coefficient of variation values for repeatability and total imprecision at two levels of control materials were lower than 1.1% and 3.4%, respectively. The performance of HemosIL ReadiPlasTin was comparable to that of HemosIL RecombiPlasTin 2G, with a high correlation (r=0.996). The reference interval for normal subjects was 10.4–13.3 seconds. CONCLUSIONS: HemosIL ReadiPlasTin showed an acceptable degree of imprecision and its performance showed high correlation with that of a conventional reagent. Therefore, it is expected to be useful for PT measurement in clinical laboratories.
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Blood Coagulation Disorders , Blood Coagulation Tests , Mass Screening , Prothrombin Time , Prothrombin , ThromboplastinABSTRACT
BACKGROUND: Human adipose tissue is routinely discarded as medical waste. However, this tissue may have valuable clinical applications since methods have been devised to effectively isolate adipose-derived extracellular matrix (ECM), growth factors (GFs), and stem cells. In this review, we analyze the literature that devised these methods and then suggest an optimal method based on their characterization results. METHODS: Methods that we analyze in this article include: extraction of adipose tissue, decellularization, confirmation of decellularization, identification of residual active ingredients (ECM, GFs, and cells), removal of immunogens, and comparing structural/physiological/biochemical characteristics of active ingredients. RESULTS: Human adipose ECMs are composed of collagen type I–VII, laminin, fibronectin, elastin, and glycosaminoglycan (GAG). GFs immobilized in GAG include basic fibroblast growth factor (bFGF), transforming growth factor beta 1(TGF-b1), insulin like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), BMP4 (bone morphogenetic protein 4), nerve growth factor (NGF), hepatocyte growth factor (HGF), and epithermal growth factor (EGF). Stem cells in the stromal-vascular fraction display mesenchymal markers, self-renewal gene expression, and multi-differentiation potential. CONCLUSION: Depending on the preparation method, the volume, biological activity, and physical properties of ECM, GFs, and adipose tissue-derived cells can vary. Thus, the optimal preparation method is dependent on the intended application of the adipose tissue-derived products.
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Humans , Adipose Tissue , Collagen , Elastin , Extracellular Matrix , Fibroblast Growth Factor 2 , Fibronectins , Gene Expression , Hepatocyte Growth Factor , Insulin , Intercellular Signaling Peptides and Proteins , Laminin , Medical Waste , Methods , Nerve Growth Factor , Platelet-Derived Growth Factor , Stem Cells , Transforming Growth Factor beta , Vascular Endothelial Growth Factor AABSTRACT
BACKGROUND: The urinary albumin/creatinine ratio (ACR) is an important indicator of albuminuria. We aimed to estimate ACR uncertainty and its impact on test results and proposed imprecision quality goals based on the estimated uncertainty. METHODS: The combined ACR uncertainty was calculated using the individual uncertainties of urinary albumin and creatinine. ACR confidence intervals (CIs) were estimated based on the expanded uncertainty. When the CI contained the ACR category boundary (30 or 300 mg/g), the cases were considered ambiguous. Quality goals for ACR were suggested using the number of ambiguous cases among actual patient results. RESULTS: The number of ambiguous cases resulting from the combined ACR uncertainty was higher than expected based on biological variation (BV) quality goals. When the ACR met BV quality specifications, we estimated that 4.8–15.5% of the results may have been misclassified. To minimize the number of ambiguous results, the minimum, desirable, and optimum quality goals were set at 34.0%, 18.0%, and 4.5%, respectively. CONCLUSIONS: We expressed ACR uncertainty using the uncertainties of urinary albumin and creatinine and assessed the impact of this combined uncertainty on the test results. Subsequently, we proposed imprecision quality goals for ACR based on ambiguous results.
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Humans , Albuminuria , Creatinine , UncertaintyABSTRACT
PURPOSE: In people who have chronic diseases, disabilities, and rehabilitation needs, self-management education can improve health and health-related behavior, and it can reduce the utilization of healthcare services. The purpose of this research was to assess the long-term effects of chronic-disease self-management education in Japan. METHODS: This study included 184 adults living with various chronic medical conditions who participated in the Chronic Disease Self-Management Program (CDSMP) in Japan. Data were collected before the program began, and then collected 3 more times over 1 year. RESULTS: Healthcare-service utilization was low at baseline, and it did not change. Self-evaluated health status, health-related distress, coping with symptoms, communication with doctors, and self-efficacy to manage symptoms all improved after the program. However, there was backsliding in all of the outcomes that had improved. CONCLUSION: Some benefits of this program can last for at least 1 year, but interventions to prevent attenuation may be needed. For economic evaluations, research should focus on populations with higher baseline levels healthcare-service utilization, including use of rehabilitation services. Also, more attention should be focused on the longer-term decay or persistence of the program's benefits, particularly regarding on preventing and reducing disabilities and with regard to rehabilitation needs.
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Adult , Humans , Chronic Disease , Cohort Studies , Cost-Benefit Analysis , Delivery of Health Care , Education , Japan , Patient Education as Topic , Rehabilitation , Self CareABSTRACT
PURPOSE: This exploratory study aims to identify various factors influencing the rehabilitation nursing competencies (RNC) of nurses in various types of health institutes. METHODS: The researcher developed a questionnaire consisting of 45 items based on the ARN rehabilitation nursing competency model. Subjects were 434 nurses working at general hospitals, long-term care facilities, or community health centers. RESULTS: Nurses' RNC were significantly higher among those who have higher levels of education, receive continuing education in rehabilitation nursing, and practice more frequently in rehabilitation nursing. Age and duration of nursing career were significant only for interprofessional care domain. General hospital nurses scored highest in every domain while nurses working at long-term care facilities scored lowest in every domain. Multiple regression analysis showed that practicing daily or more than twice per week in rehabilitation nursing, achieving master's degree or higher, and working at long-term care facilities were statistically significant factors with RNC. These factors explained 31.1% of the total variability in RNC in this sample. CONCLUSION: Currently, there is no official certification program for rehabilitation nurse practitioners in South Korea. The results of this study would be useful in developing RNC training programs for Korean nurses, and provide strong evidence for necessity of certified rehabilitation nurse specialists.
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Humans , Academies and Institutes , Certification , Community Health Centers , Education , Education, Continuing , Hospitals, General , Korea , Long-Term Care , Nurse Practitioners , Nursing , Rehabilitation Nursing , Rehabilitation , SpecializationABSTRACT
PURPOSE: The purpose of this study is to measure health-related quality of life (HRQoL) and to investigate the affecting factors according to gender in older adults by using the 2012 Korea Health Panel data. METHODS: The Korea Health Panel data 2012 were collected from February to August 2012 by Korea Institute for Health and Social Affairs and National Health Insurance Corporation and the number of respondents were 1,921. The data were analyzed by t-test, chi-square, Pearson correlation coefficient and multiple regression using SPSS/WIN program. RESULTS: The limitation of activity was the most influential factor for health-related quality of life of both male and female. For male, the affecting factors on HRQoL were hearing problems and frustration. For female, the affecting factors on HRQoL were eating problems, depression and suicidal impulses. Drinking, moderate physical activities, vision problems and stress had a significant effect on HRQoL for both male and female. CONCLUSION: Health care providers should consider the differences between male and female when they design a program in order to improve HRQoL of older people.
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Adult , Female , Humans , Male , Depression , Drinking , Eating , Frustration , Health Behavior , Health Personnel , Hearing , Korea , Motor Activity , National Health Programs , Quality of Life , Surveys and QuestionnairesABSTRACT
Venous thromboembolism is well known as one of the rare but serious adverse effects of combined oral contraceptives (COCs). The COCs with third and fourth generation progestogens were found to have higher risk of venous thrombosis than those with second generation progestogens. We present a case of pulmonary embolism in a 23-year-old nulligravid woman who was using COCs containing the third generation progestogen (desogestrel). At the time of presentation of the adverse effect, she had been using the COCs for 4 months. She had no additional risk factors for thrombosis such as smoking, surgery, tumor as well as genetic factors. This case demonstrates even young women in otherwise good health may be at risk of venous thromboembolism from low-dose formulations of COCs as an over-the-counter drug. We describe this case with a brief review of literatures.