Association of general and central obesity, and their changes with risk of knee osteoarthritis: a nationwide population-based cohort study.

In this study, we aimed to evaluate the association between general and central obesity, and their changes with risk of knee osteoarthritis (OA) using retrospective cohort data collected from the Korean National Health Insurance Service. We studied 1,139,463 people aged 50 and over who received a health examination in 2009. To evaluate the association between general and/or central obesity and knee OA risk, a Cox proportional hazard models were used. Additionally, we investigate knee OA risk according to the change in obesity status over 2 years for subjects who had undergone health examinations for 2 consecutive years. General obesity without central obesity (HR 1.281, 95% CI 1.270-1.292) and central obesity without general obesity (HR 1.167, 95% CI 1.150-1.184) were associated with increased knee OA risk than the comparison group. Individuals with both general with central obesity had the highest risk (HR 1.418, 95% CI 1.406-1.429). This association was more pronounced in women and younger age group. Remarkably, the remission of general or central obesity over two years was associated with decreased knee OA risk (HR 0.884; 95% CI 0.867-0.902; HR 0.900; 95% CI 0.884-0.916, respectively). The present study found that both general and central obesity were associated with increased risk of knee OA and the risk was highest when the two types of obesity were accompanied. Changes in obesity status have been confirmed to alter the risk of knee OA.

Effect of active airway warming with a heated-humidified breathing circuit on core body temperature in patients under general anesthesia: a systematic review and meta-analysis with trial sequential analysis / 대한마취과학회지

Background@#The application of a heated-humidified breathing circuit (HHBC) may reduce respiratory heat loss during mechanical ventilation, but its effect in preventing intraoperative hypothermia is controversial. This study aimed to investigate the effectiveness of HHBC in maintaining the core temperature of patients receiving mechanical ventilation under general anesthesia. @*Methods@#We searched MEDLINE, Embase, Cochrane library (CENTRAL), and Google Scholar to identify all randomized controlled trials (RCTs) up to February 2022 that compared the intraoperative core temperature in patients with heated humidifier (HH) and other circuit devices. The primary outcome was the intraoperative core temperature at the end of surgery. The weighted mean differences (WMDs) between the groups and their 95% CIs were calculated for each outcome. We performed a trial sequential analysis of the primary outcomes to assess whether our results were conclusive. @*Results@#Eighteen RCTs with 993 patients were included in the analysis. A significantly higher core temperature was observed at the end of surgery in patients with HH than those with no device (WMD = 0.734, 95% CI [0.443, 1.025]) or heat and moisture exchanger (WMD = 0.368, 95% CI [0.118, 0.618]), but with substantial heterogeneity. @*Conclusions@#Although HHBC did not absolutely prevent hypothermia, this meta-analysis suggests that it can be used as an effective supplemental device to maintain the intraoperative core temperature under general anesthesia. However, considering the substantial heterogeneity and limitations of this study, further well-designed studies are needed to clarify the effectiveness of HHBC.

Introduction to Umbrella Reviews as a Useful Evidence-Based Practice

The umbrella review (UR) is a novel methodological approach that has been established to address the ever-expanding research volume of published systematic reviews. In this study, we examined the rationale underlying URs, the concepts and goals of URs, and their applicability in clinical settings. Additionally, we briefly assessed the process of conducting URs and discussed the current challenges in this regard. URs are used to integrate, evaluate, and synthesize the findings of related systematic reviews. By organizing and summarizing the abundant information in accordance with the level of evidence, URs can serve as a useful methodological tool and provide appropriate entry points to clinicians or decision-makers in the medical field. Considering the availability of many suitable interventions for specific conditions in a broad field, URs can enable evidence-based decision-making and offer a broad perspective for the resolution of issues in healthcare by summarizing the evidence and providing directions on a variety of topics. URs are clearly contributing to the management of the deluge of evidence in evidence-based medicine. However, despite the availability of several directions for conducting URs, some points of confusion persist, especially when determining the certainty of evidence. Therefore, advanced guidelines for the appropriate performance of URs are required to provide more reliable evidence through URs.

The Role of Adjuvant Therapy Following Surgical Resection of Small Cell Lung Cancer: A Multi-Center Study / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This multi-center, retrospective study was conducted to evaluate the long-term survival in patients who underwent surgical resection for small cell lung cancer (SCLC) and to identify the benefit of adjuvant therapy following surgery. @*Materials and Methods@#The data of 213 patients who underwent surgical resection for SCLC at four institutions were retrospectively reviewed. Patients who received neoadjuvant therapy or an incomplete resection were excluded. @*Results@#The mean patient age was 65.29±8.93 years, and 184 patients (86.4%) were male. Lobectomies and pneumonectomies were performed in 173 patients (81.2%), and 198 (93%) underwent systematic mediastinal lymph node dissections. Overall, 170 patients (79.8%) underwent adjuvant chemotherapy, 42 (19.7%) underwent radiotherapy to the mediastinum, and 23 (10.8%) underwent prophylactic cranial irradiation. The median follow-up period was 31.08 months (interquartile range, 13.79 to 64.52 months). The 5-year overall survival (OS) and disease-free survival were 53.4% and 46.9%, respectively. The 5-year OS significantly improved after adjuvant chemotherapy in all patients (57.4% vs. 40.3%, p=0.007), and the survival benefit of adjuvant chemotherapy was significant in patients with negative node pathology (70.8% vs. 39.7%, p=0.004). Adjuvant radiotherapy did not affect the 5-year OS (54.6% vs. 48.5%, p=0.458). Age (hazard ratio [HR], 1.032; p=0.017), node metastasis (HR, 2.190; p < 0.001), and adjuvant chemotherapy (HR, 0.558; p=0.019) were associated with OS. @*Conclusion@#Adjuvant chemotherapy after surgical resection in patients with SCLC improved the OS, though adjuvant radiotherapy to the mediastinum did not improve the survival or decrease the locoregional recurrence rate.

Postoperative major bleeding risk in patients using oral antiplatelets and/or anticoagulants after laparoscopic gastric cancer surgery

Purpose@#The use of antiplatelet and/or anticoagulant therapies has become common. In rare cases, these therapies may increase the risk of dangerous postoperative bleeding. We investigated the association of antiplatelets and/or anticoagulants with postoperative major bleeding risk in laparoscopic gastric cancer surgery. @*Methods@#We retrospectively enrolled 3,663 gastric cancer patients (antiplatelet/anticoagulant group, 518; control group, 3,145) who had undergone laparoscopic surgery between January 2012 and December 2017. To minimize selection bias, 508 patients in each group were matched using propensity score matching (PSM) method. The primary outcome was postoperative major bleeding. Secondary outcomes were intraoperative, postoperative transfusion and early complications. @*Results@#After PSM, postoperative major bleeding occurred in 10 (2.0%) and 3 cases (0.6%) in the antiplatelets/ anticoagulants and control groups, respectively (P = 0.090). Intraoperative and postoperative transfusions were not significantly different between 2 groups (2.4% vs. 1.4%, P = 0.355 and 5.5% vs. 4.3%, P = 0.469). Early complications developed in 58 (11.4%) and 43 patients (8.5%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.142). The mean amounts of intraoperative and postoperative transfusions were not significantly different between the groups (366.67 ± 238.68 mL vs. 371.43 ± 138.01 mL, P = 0.962; 728.57 ± 642.25 mL vs. 508.09 ± 468.95 mL, P = 0.185). In multivariable analysis, male (P = 0.008) and advanced stage (III, IV) (P = 0.024) were independent significant risk factors for postoperative major bleeding. @*Conclusion@#Preoperative antiplatelets and/or anticoagulants administration did not significantly increase the risk of postoperative major bleeding after laparoscopic gastric cancer surgery.

Current concerns on journal article with preprint: Korean Journal of Internal Medicine perspectives

Preprints are preliminary research reports that have not yet been peer-reviewed. They have been widely adopted to promote the timely dissemination of research across many scientific fields. In August 1991, Paul Ginsparg launched an electronic bulletin board intended to serve a few hundred colleagues working in a subfield of theoretical high-energy physics, thus launching arXiv, the first and largest preprint platform. Additional preprint servers have since been implemented in different academic fields, such as BioRxiv (2013, Biology; www.biorxiv.org) and medRxiv (2019, Health Science; www.medrxiv.org). While preprint availability has made valuable research resources accessible to the general public, thus bridging the gap between academic and non-academic audiences, it has also facilitated the spread of unsupported conclusions through various media channels. Issues surrounding the preprint policies of a journal must be addressed, ultimately, by editors and include the acceptance of preprint manuscripts, allowing the citation of preprints, maintaining a double-blind peer review process, changes to the preprint’s content and authors’ list, scoop priorities, commenting on preprints, and preventing the influence of social media. Editors must be able to deal with these issues adequately, to maintain the scientific integrity of their journal. In this review, the history, current status, and strengths and weaknesses of preprints as well as ongoing concerns regarding journal articles with preprints are discussed. An optimal approach to preprints is suggested for editorial board members, authors, and researchers.

Comparison of the intubation performance of video laryngoscopes with and without a channel during the intubation training for EMT students wearing Level-D PPE

Objective@#The purpose of this study was to determine the type of video laryngoscope training that is appropriate for emergency medical technicians (EMT) familiar with direct laryngoscopes, to prepare them for tracheal intubation while they are wearing personal protective equipment (PPE). @*Methods@#Thirty-eight healthy EMTs were recruited. The participants underwent two tests with four different laryngoscopes: Macintosh, McGrath, Pentax Airway Scope (PENTAX-AWS), and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshops. The second test was conducted after a hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc., and asked all the participants to respond to a short questionnaire. @*Results@#The time to complete the insertion of the endotracheal tube with the Macintosh laryngoscope did not significantly change (P=0.098), but the rest of the outcomes significantly improved after the hands-on workshop (all P<0.05). Despite the unfamiliarity of the practitioners with video laryngoscopes and their wearing PPE, intubation-related performances were good with the two-channel type video laryngoscopes after the hands-on workshop (all P<0.05). @*Conclusion@#In preparation for an infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), it would be reasonable to train EMTs who would be wearing PPE on the procedure for intubating a trachea with a channeltype video laryngoscope.

Current concerns on journal article with preprint: Anesthesia and Pain Medicine perspectives

Preprints are preliminary research reports that have not yet been peer-reviewed. They have been widely adopted to promote the timely dissemination of research across many scientific fields. In August 1991, Paul Ginsparg launched an electronic bulletin board intended to serve a few hundred colleagues working in a subfield of theoretical high-energy physics, thus launching arXiv, the first and largest preprint platform. Additional preprint servers have since been implemented in different academic fields, such as BioRxiv (2013, Biology; www.biorxiv.org) and medRxiv (2019, Health Science; www.medrxiv.org). While preprint availability has made valuable research resources accessible to the general public, thus bridging the gap between academic and non-academic audiences, it has also facilitated the spread of unsupported conclusions through various media channels. Issues surrounding the preprint policies of a journal must be addressed, ultimately, by editors and include the acceptance of preprint manuscripts, allowing the citation of preprints, maintaining a double-blind peer review process, changes to the preprint’s content and authors’ list, scoop priorities, commenting on preprints, and preventing the influence of social media. Editors must be able to deal with these issues adequately, to maintain the scientific integrity of their journal. In this review, the history, current status, and strengths and weaknesses of preprints as well as ongoing concerns regarding journal articles with preprints are discussed. An optimal approach to preprints is suggested for editorial board members, authors, and researchers.

Bronchogenic Cyst Occurring at the Postauricular Area: A Case Report and Literature Review / 대한피부과학회지

Bronchogenic cysts develop from tracheal diverticula or abnormal budding of the anterior foregut during embryological development. The most common extrapulmonary site of such cysts is the mediastinum; however, remote locations such as the lingual, intra-abdominal, and cutaneous regions have also been reported. Moreover, the postauricular location is an uncommon site for this entity. An 11-year-old boy visited our hospital with a long-standing mass in the postauricular area. Ultrasonography revealed a well-circumscribed anechoic nodule measuring 1.02×1.03 cm in size with posterior enhancement. The lesion was then completely excised. Pathological examination revealed a cystic lesion lined with ciliated pseudostratified columnar epithelium, consistent with a bronchogenic cyst. The patient had no local recurrence at 6th month follow-up. Herein, we report the first case of a bronchogenic cyst that developed in the postauricular area, and provide a review of the literature on cutaneous bronchogenic cysts.

Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer

Purpose@#Cancer patients receiving various anti-cancer treatments commonly experience malnutrition, and many studies have reported that nutritional status is associated with survival and prognosis. Although standard neoadjuvant chemoradiotherapy (CRT) is commonly used in patients with locally advanced rectal cancer owing to its tumor-downsizing and downstaging effects, there is a lack of research on the impact of patients’ nutritional status on the efficacy of neoadjuvant CRT. @*Methods@#We investigated the immunonutritional markers before and after long-course neoadjuvant CRT in 131 patients diagnosed with locally advanced rectal cancer from March 2013 to March 2022. @*Results@#We divided the patients into two groups: a low prognostic nutritional index (PNI) with a cutoff value of 50.92, and a high PNI. In both groups, significant decreases in lymphocyte count and PNI and an increase in neutrophil-to-lymphocyte ratio (NLR) were observed before and after CRT (P<0.001). Furthermore, a higher proportion of patients experienced adverse effects in the low PNI group than in the high PNI group (76.6% in low PNI vs. 54.8% in high PNI, P=0.013). The most commonly reported CRT-induced adverse effect was lower gastrointestinal tract toxicity. @*Conclusion@#By measuring the PNI and NLR without additional tests prior to starting neoadjuvant CRT in patients with locally advanced rectal cancer, it is possible to predict the risk of acute adverse effects caused by CRT. Additionally, providing external nutritional support to reduce the immunonutritional changes that occur during CRT can decrease side effects and potentially increase treatment compliance.

Intention-to-treat versus as-treated versus per-protocol approaches to analysis / 대한마취과학회지

Randomized controlled trials (RCTs) are considered the most rigorous study design for testing hypotheses and the gold standard for evaluating intervention effectiveness. However, RCTs are often conducted under the assumption of ideal conditions that may differ from real-world scenarios in which various issues, such as loss to follow-up, mistakes in participant enrollment or intervention, and low subject compliance or adherence, may occur. There are various group-defining strategies for analyzing RCT data, including the intention-to-treat (ITT), as-treated, and per-protocol (PP) approaches. The ITT principle involves analyzing all participants according to their initial group assignments, regardless of study completion and compliance or adherence to treatment protocols. This approach aims to replicate real-world clinical settings in which several anticipated or unexpected conditions may occur with regard to the study protocol. For the PP approach, only participants who meet the inclusion criteria, complete the interventions according to the study protocols, and have primary outcome data available are included. This approach aims to confirm treatment effects under optimal conditions. In general, the ITT principle is preferred for superiority and inequality trials, whereas the PP approach is preferred for equivalence and non-inferiority trials. However, both analytical approaches should be conducted and their results compared to determine whether significant differences exist. Overall, using both the ITT and PP approaches can provide a more complete picture of the treatment effects and ensure the reliability of the trial results.

Systematic Diagnosis and Treatment Principles for Acute Fracture-Related Infections

Acute fracture-related infection (FRI) is a common and serious complication of fracture treatment. The clinical symptoms of the patient and the results of the serological, radiological, and histopathologi-cal examinations can be divided into ‘Confirmatory’ criteria and ‘Suggestive’ criteria, allowing for the diagnosis of FRI. Treatment principles can be broadly categorized into (1) the DAIR (Debridement, Antimicrobial therapy, Implant Retention) method and (2) the staged reconstruction method. The choice of treatment depends on factors such as the time elapsed after infection, stability of the internal fixation device, reduction status, host physiology, and virulence of the pathogens. Thorough surgical debridement and irrigation, ensuring stability at the fracture site, reconstruction of bone defects, and appropriate soft tissue coverage, along with antibiotic therapy, are essential to suppress or eradicate the infection. The restoration of limb function should be promoted through proper soft tissue coverage and bone union at the fracture site.

The Shorr Versus Modified Ultrafast Papanicolaou Method for Intraoperative Diagnosis of Peritoneal Washing Cytology in Advanced Gastric Cancer: A Phase II Study

Purpose@#According to the American Joint Committee on Cancer cancer staging system, positive peritoneal washing cytology (PWC) indicates stage IV gastric cancer. However, rapid intraoperative diagnosis of PWC has no established reliable method. This study evaluated and compared the diagnostic accuracy of the Shorr and the modified ultrafast Papanicolaou (MUFP) methods for intraoperative PWC. @*Materials and Methods@#This study included patients with gastric cancer who were clinically diagnosed with stage cT3 or higher. The Shorr and MUFP methods were performed on all PWC specimens, and the results were compared with those of conventional Papanicolaou (PAP) staining with carcinoembryonic antigen immunohistochemistry. Sensitivity, specificity, and partial likelihood tests were used to compare the 2 methods. @*Results@#Forty patients underwent intraoperative PWC between November 2019 and August 2021. The average time between specimen reception and slide preparation using Shorr and MUFP methods was 44.4±4.5 minutes, and the average time between specimen reception and pathologic diagnosis was 53.9±8.9 minutes. Eight patients (20.0%) had positive cytology in PAP staining. The Shorr method had a sensitivity of 75.0% and specificity of 93.8%; the MUFP method had 62.5% sensitivity and 100.0% specificity. The area under the curve was 0.844 for Shorr and 0.813 for MUFP. In comparing the C-indices of each method with overall survival, no difference was found among the Shorr, MUFP, and conventional PAP methods. @*Conclusions@#The Shorr and MUFP methods are acceptable for the intraoperative diagnosis of PWC in advanced gastric cancer.

Postoperative Segmental Motion up to 1 Year Following Single-Level Anterior Cervical Discectomy and Fusion: Plate versus Non-plate

Methods@#In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. @*Results@#In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. @*Conclusions@#Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.

Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension

Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.

Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension

The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

Efficacy and Safety of Subclinical Sensitization with Diphenylcyclopropenone in Children with Alopecia Areata: A Retrospective Study / 대한피부과학회지

Background@#Contact immunotherapy with diphenylcyclopropenone is one of the first-line treatments for extensive alopecia areata, despite its adverse effects (AEs). @*Objective@#This study aimed to investigate whether a modified contact immunotherapy treatment protocol can safely promote hair regrowth in children. @*Methods@#Children with alopecia areata who were treated with modified contact immunotherapy with diphenylcyclopropenone were retrospectively reviewed. All patients were sensitized with 0.1% diphenylcyclopropenone and began treatment at subsequent increasing concentrations. The efficacy, AEs, and demographic factors were evaluated. @*Results@#A total of 32 patients, aged 9 to 17 years (mean age, 14.6 years), were included in the study. The mean disease duration was 26.8 months. Ten (31.3%) and 11 patients (34.4%) showed complete and partial responses, respectively. No AEs were observed after the sensitization. During treatment, 13 patients (40.6%) did not experience any AEs. Sixteen patients (50.0%) showed mild to moderate pruritus, and only three patients (9.4%) had severe pruritus. However, all AEs were well controlled. @*Conclusion@#A modified diphenylcyclopropenone treatment protocol with subclinical sensitization could induce a favorable therapeutic response and fewer AEs in children.

Rectal NSAIDs-based combination modalities are superior to single modalities for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a network meta-analysis

Background/Aims@#Different modalities have been employed to reduce the risk and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, there has been a paucity of studies comparing the efficacy of various prophylactic modalities for preventing PEP. This network meta-analysis (NMA) aimed to determine the relative efficacy of pancreatic duct stents and pharmacological modalities for preventing PEP. @*Methods@#We performed a systematic and comprehensive search to identify and analyze all randomized controlled studies published until June 2020 that examined the effectiveness of pancreatic duct stents, rectal non-steroidal anti-inflammatory drugs (NSAIDs) based regimens, hydration, and their combinations for the prevention of PEP. The primary outcome was the frequency of PEP. An NMA was performed to combine direct and indirect comparisons of different prophylactic modalities. @*Results@#The NMA included 46 studies evaluating 18 regimens in 16,241 patients. Based on integral analysis of predictive interval plots, and expected mean ranking and surface under the cumulative ranking curve values, combination prophylaxis with indomethacin + lactated Ringer’s solution (LR), followed by diclofenac + nitrate and indomethacin + normal saline, was found to be the most efficacious modality for the overall prevention of PEP. Indomethacin + LR, followed by diclofenac and pancreatic duct stents, was the most efficacious modality for high-risk groups. @*Conclusions@#Rectal NSAIDs-based combination regimens with aggressive hydration or nitrate are superior to single modalities for the prevention of PEP.

Development of the Korea-Polyenvironmental Risk Score for Psychosis

Objective@#Comprehensive understanding of polyenvironmental risk factors for the development of psychosis is important. Based on a review of related evidence, we developed the Korea Polyenvironmental Risk Score (K-PERS) for psychosis. We investigated whether the K-PERS can differentiate patients with schizophrenia spectrum disorders (SSDs) from healthy controls (HCs). @*Methods@#We reviewed existing tools for measuring polyenvironmental risk factors for psychosis, including the Maudsley Environmental Risk Score (ERS), polyenviromic risk score (PERS), and Psychosis Polyrisk Score (PPS). Using odds ratios and relative risks for Western studies and the “population proportion” (PP) of risk factors for Korean data, we developed the K-PERS, and compared the scores thereon between patients with SSDs and HCs. In addition, correlation was performed between the K-PERS and Positive and Negative Syndrome Scale (PANSS). @*Results@#We first constructed the “K-PERS-I,” comprising five factors based on the PPS, and then the “K-PERS-II” comprising six factors based on the ERS. The instruments accurately predicted participants’ status (case vs. control). In addition, the K-PERS-I and -II scores exhibited significant negative correlations with the negative symptom factor score of the PANSS. @*Conclusion@#The K-PERS is the first comprehensive tool developed based on PP data obtained from Korean studies that measures polyenvironmental risk factors for psychosis. Using pilot data, the K-PERS predicted patient status (SSD vs. HC). Further research is warranted to examine the relationship of K-PERS scores with clinical outcomes of psychosis and schizophrenia.

Cognitive Behavioral Therapy for Psychosis / 대한정신분열병학회지

Cognitive behavioral therapy for psychosis (CBTp) is recommended by the National Treatment Guidelines in both the U.K. and the U.S. Consistent reports of moderate effect sizes have led to such interventions being suggested as part of routine clinical practice. However. Access to CBTp is poor due to a variety of factors, including training and resources. Therapeutic developments should be based on the theoretical understanding of cognitive models and psychological process associated with stress-vulnerability model. Cognitive models of psychosis incorporate the role of negative core beliefs, hypervigilance for threat, scanning for confirmatory evidence and safety behavior. The current evidence about CBTp is reviewed regarding various methods such as low-intensity of CBTp, different formats of therapy (e.g., individual or group), and phase of illness (e.g., acute or treatment-resistant) of subjects. This review suggests that that patients with psychosis with various disease phase need to be derived more benefit from appropriate adjunctive CBTp.