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1.
Front Neurol ; 15: 1427142, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39022726

RESUMO

Background: Repetitive transcranial magnetic stimulation (rTMS) is widely used therapy to enhance motor deficit in stroke patients. To date, rTMS protocols used in stroke patients are relatively unified. However, as the pathophysiology of stroke is diverse and individual functional deficits are distinctive, more precise application of rTMS is warranted. Therefore, the objective of this study was to determine the effects of personalized protocols of rTMS therapy based on the functional reserve of each stroke patient in subacute phase. Methods: This study will recruit 120 patients with stroke in subacute phase suffering from the upper extremity motor impairment, from five different hospitals in Korea. The participants will be allocated into three different study conditions based on the functional reserve of each participant, measured by the results of TMS-induced motor evoked potentials (MEPs), and brain MRI with diffusion tensor imaging (DTI) evaluations. The participants of the intervention-group in the three study conditions will receive different protocols of rTMS intervention, a total of 10 sessions for 2 weeks: high-frequency rTMS on ipsilesional primary motor cortex (M1), high-frequency rTMS on ipsilesional ventral premotor cortex, and high-frequency rTMS on contralesional M1. The participants of the control-group in all three study conditions will receive the same rTMS protocol: low-frequency rTMS on contralesional M1. For outcome measures, the following assessments will be performed at baseline (T0), during-intervention (T1), post-intervention (T2), and follow-up (T3) periods: Fugl-Meyer Assessment (FMA), Box-and-block test, Action Research Arm Test, Jebsen-Taylor hand function test, hand grip strength, Functional Ambulatory Category, fractional anisotropy measured by the DTI, and brain network connectivity obtained from MRI. The primary outcome will be the difference of upper limb function, as measured by FMA from T0 to T2. The secondary outcomes will be the differences of other assessments. Discussion: This study will determine the effects of applying different protocols of rTMS therapy based on the functional reserve of each patient. In addition, this methodology may prove to be more efficient than conventional rTMS protocols. Therefore, effective personalized application of rTMS to stroke patients can be achieved based on their severity, predicted mechanism of motor recovery, or functional reserves. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT06270238.

2.
Adv Sci (Weinh) ; : e2400064, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38981007

RESUMO

Microglia play a crucial role in synaptic elimination by engulfing dystrophic neurons via triggering receptors expressed on myeloid cells 2 (TREM2). They are also involved in the clearance of beta-amyloid (Aß) plaques in Alzheimer's disease (AD); nonetheless, the driving force behind TREM2-mediated phagocytosis of beta-amyloid (Aß) plaques remains unknown. Here, using advanced 2D/3D/4D co-culture systems with loss-of-function mutations in TREM2 (a frameshift mutation engineered in exon 2) brain organoids/microglia/assembloids, it is identified that the clearance of Aß via TREM2 is accelerated by externalized phosphatidylserine (ePtdSer) generated from dystrophic neurons surrounding the Aß plaques. Moreover, it is investigated whether microglia from both sporadic (CRISPR-Cas9-based APOE4 lines) and familial (APPNL-G-F/MAPT double knock-in mice) AD models show reduced levels of TREM2 and lack of phagocytic activity toward ePtdSer-positive Aß plaques. Herein new insight is provided into TREM2-dependent microglial phagocytosis of Aß plaques in the context of the presence of ePtdSer during AD progression.

3.
Front Public Health ; 12: 1406514, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39035185

RESUMO

Objective: The study aims to investigate factors that prevent burnout (BO) and symptoms of posttraumatic stress disorder (PTSD) while facilitating posttraumatic growth (PTG) among nurses combating the coronavirus disease 2019 (COVID-19) pandemic, with the purpose of validating the mediating effects of PTG. Methods: A total of 247 nurses who provided patient care during the COVID-19 pandemic were enrolled, and a questionnaire was used to measure BO, PTSD, and PTG, data on deliberate rumination, emotional expression, adaptive cognitive emotion regulation (CER), maladaptive CER, and social support. The mediation path models for the effects of the predictors on BO and PS through the mediation of PTG were analyzed using the R Lavaan package. Results: The results showed that deliberate rumination, emotional expression, and adaptive CER significantly increased PTG, while PTG significantly reduced BO and PTSD symptoms (PSs). However, maladaptive CER did not have a significant effect on PTG and only had significant direct effects on BO and PS. Bootstrapping confirmed that PTG significantly mediated the effects of all predictors. It partially mediated the effects of deliberate rumination and adaptive CER and completely mediated the effects of emotional expression. Conclusion: Based on the results, it has been supported that deliberate rumination, emotional expression, and adaptive CER should be addressed as important variables in psychological interventions addressing nurses' adversities during the pandemic. These variables can prevent BO and PS by facilitating PTG.


Assuntos
Esgotamento Profissional , COVID-19 , Crescimento Psicológico Pós-Traumático , Transtornos de Estresse Pós-Traumáticos , Humanos , COVID-19/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Esgotamento Profissional/psicologia , Feminino , Adulto , Masculino , Inquéritos e Questionários , Enfermeiras e Enfermeiros/psicologia , SARS-CoV-2 , Apoio Social , Pandemias , Pessoa de Meia-Idade , Adaptação Psicológica
5.
Age Ageing ; 53(6)2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38880504

RESUMO

BACKGROUND: The risk of stroke increases with age, and although previous reports have suggested that infection risk may increase with antipsychotic use, relevant studies after stroke are scarce. We aimed to investigate whether antipsychotics increase post-stroke infection risk in the acute stroke period. METHODS: This propensity score matching study included adults diagnosed with first-ever stroke between 2011 and 2020 at five university hospitals. In-hospital antipsychotic exposure was defined as any administration during hospitalisation for stroke. The primary outcome was post-stroke infection after the first 2 days of hospitalisation, and the secondary outcome was the presence of pneumonia, bacteraemia and/or bacteriuria. RESULT: Among 23,885 first-ever stroke patients, 2,773 antipsychotic users (age 71.6 ± 12.4, male 54.6%) and 2,773 non-users (age 71.2 ± 13.2, male 54.6%) were selected as matched cohorts. After adjusting for propensity score, antipsychotics were not associated with an increased risk of post-stroke infection (odds ratio 0.99, 95% confidence interval 0.87-1.14). CONCLUSION: While our study did not find conclusive evidence linking antipsychotic medication to an increased risk of post-stroke infection, prescribing these medications should still be approached with prudence. Until further research can provide more definitive insights, clinicians should carefully weigh the potential infection risks when considering antipsychotic treatment during the acute stroke care period.


Assuntos
Antipsicóticos , Pontuação de Propensão , Acidente Vascular Cerebral , Humanos , Masculino , Idoso , Feminino , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Idoso de 80 Anos ou mais , Fatores de Risco , Pessoa de Meia-Idade , Medição de Risco
6.
Brain Behav ; 14(5): e3514, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38698593

RESUMO

BACKGROUND: There have been multiple reports about the occurrence of dysphagia after the contraction of coronavirus disease 2019 (COVID-19). However, a detailed pathology and epidemiologic relation between COVID-19 infection and dysphagia have yet to be established. Here, we report three cases of unexplained dysphagia after COVID-19 diagnosis, with atypical clinical presentations. CASE REPORT: All patients showed severe isolated lower cranial nerve involvement with dysphagia and aspiration, which required full tube feeding but showed no evidence of limb weakness or sensory symptoms. All tested positive for anti-ganglioside antibody tests, which all commonly (GD1b, GM1, and GQ1b) are known to have terminal NeuNAc(α2-3)Gal epitope. DISCUSSION: We report a series of cases featuring severe, isolated dysphagia post-COVID-19 infection, concomitant with positive anti-ganglioside antibodies. One potential etiology is a variant of Guillain-Barré syndrome. Because only isolated dysphagia with sparing of the facial and extraocular muscles was evident in these cases, we explore the association between anti-ganglioside antibodies specific to NeuNAc(α2-3)Gal, which has been frequently associated with the development of bulbar dysfunction. Given that NeuNAc(α2-3)Gal exhibits an affinity for the spike glycoprotein of SARS-CoV-2, a cross-reaction against NeuNAc(α2-3)Gal may possibly contribute to isolated dysphagia following COVID-19 infection.


Assuntos
COVID-19 , Transtornos de Deglutição , Gangliosídeos , Idoso , Feminino , Humanos , Masculino , Autoanticorpos/sangue , COVID-19/complicações , COVID-19/imunologia , Transtornos de Deglutição/etiologia , Gangliosídeos/imunologia , Síndrome de Guillain-Barré/imunologia , SARS-CoV-2/imunologia , Idoso de 80 Anos ou mais
7.
Cell Rep Med ; 5(5): 101567, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38744277

RESUMO

Bispecific T cell engagers (TCEs) show promising clinical efficacy in blood tumors, but their application to solid tumors remains challenging. Here, we show that Fc-fused IL-7 (rhIL-7-hyFc) changes the intratumoral CD8 T cell landscape, enhancing the efficacy of TCE immunotherapy. rhIL-7-hyFc induces a dramatic increase in CD8 tumor-infiltrating lymphocytes (TILs) in various solid tumors, but the majority of these cells are PD-1-negative tumor non-responsive bystander T cells. However, they are non-exhausted and central memory-phenotype CD8 T cells with high T cell receptor (TCR)-recall capacity that can be triggered by tumor antigen-specific TCEs to acquire tumoricidal activity. Single-cell transcriptome analysis reveals that rhIL-7-hyFc-induced bystander CD8 TILs transform into cycling transitional T cells by TCE redirection with decreased memory markers and increased cytotoxic molecules. Notably, TCE treatment has no major effect on tumor-reactive CD8 TILs. Our results suggest that rhIL-7-hyFc treatment promotes the antitumor efficacy of TCE immunotherapy by increasing TCE-sensitive bystander CD8 TILs in solid tumors.


Assuntos
Linfócitos T CD8-Positivos , Imunoterapia , Interleucina-7 , Linfócitos do Interstício Tumoral , Linfócitos do Interstício Tumoral/imunologia , Linfócitos do Interstício Tumoral/efeitos dos fármacos , Linfócitos T CD8-Positivos/imunologia , Interleucina-7/imunologia , Interleucina-7/metabolismo , Humanos , Animais , Imunoterapia/métodos , Camundongos , Neoplasias/imunologia , Neoplasias/terapia , Linhagem Celular Tumoral , Receptores de Antígenos de Linfócitos T/imunologia , Receptores de Antígenos de Linfócitos T/metabolismo , Efeito Espectador/imunologia
8.
Neurol Sci ; 45(7): 3513-3516, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38589770

RESUMO

BACKGROUND: Transcranial direct current stimulation (tDCS) has been used for the restoration of awareness in patients with a minimal consciousness state (MCS). Most brains of patients in MCS may structurally and electrophysiologically differ from un-damaged brains. Moreover, tDCS is currently contraindicated for patients with craniotomy or skull with metallic implants. CASE PRESENTATION: We present a case with prolonged MCS over 1 year, who had severe brain damage, ventriculoperitoneal shunt, and cranioplasty with a titanium mesh, which was treated with tDCS which optimized with the simulation of the electric field based on the patient's brain MRI. The patient was resulting in emergence from MCS. Six months later, she ate meals orally and started walking with assistance. DISCUSSION AND PERSPECTIVE: This personalized simulation based on MRI would make the treatment available even to patients with severe brain structural changes and metallic instrumentation.


Assuntos
Telas Cirúrgicas , Titânio , Estimulação Transcraniana por Corrente Contínua , Humanos , Feminino , Estimulação Transcraniana por Corrente Contínua/métodos , Estado Vegetativo Persistente/etiologia , Estado Vegetativo Persistente/terapia , Pessoa de Meia-Idade , Transtornos da Consciência/etiologia , Transtornos da Consciência/terapia
9.
Brain Neurorehabil ; 17(1): e6, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38585025

RESUMO

This case report introduces a novel type of shoulder prosthesis in 2 patients with hemiplegic shoulder subluxation. A unique reel traction device was incorporated to allow easy traction and accurate correction of joint subluxation. X-ray images taken before and after application showed immediate correction effects that were maintained up to 2 hours after application with no change of sling position. These 2 cases support the idea that this new type of shoulder sling could be applied for therapeutic and corrective purposes in hemiplegic stroke patients with shoulder subluxation.

10.
Life (Basel) ; 14(3)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38541657

RESUMO

BACKGROUND: We aimed to develop a consensus on the need for and priorities of exercise to treat preexisting sarcopenia with hemiplegic stroke. METHODS: A modified three-round Delphi study was conducted. The panelists responded to the questionnaire on a 7-point Likert scale. Responses were returned with descriptive statistics in the next round. Consensus was defined as >75% agreement (score of 5-7) with a median > 5. The percentage of strong agreement (score of 6-7) and Kendall's coefficient of concordance were calculated to demonstrate a more refined interpretation of the consensus. RESULTS: Fifteen panelists contributed to all rounds. The need for exercise was demonstrated. The consensus was reached on 53 of 58 items in the first round and all items in the second and final rounds. The percentage of strong agreement was high for all but eight items. CONCLUSIONS: This study is the first Delphi study to investigate the need for and priorities of exercise for treating preexisting sarcopenia in stroke hemiplegia. We present a standard recommendation including 57 priorities and a strong recommendation including 49 priorities. The eight items that were excluded reflected factors that are less important to hemiplegic patients with poor balance, cognitive decline, or mental vulnerability.

11.
Drug Saf ; 47(7): 673-686, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38512445

RESUMO

INTRODUCTION: Angiotensin receptor blockers are widely used antihypertensive drugs in South Korea. In 2021, the Korea Ministry of Food and Drug Safety acknowledged the need for national compensation for a drug-induced liver injury (DILI) after azilsartan use. However, little is known regarding the association between angiotensin receptor blockers and DILI. OBJECTIVE: We conducted a retrospective cohort study in incident users of angiotensin receptor blockers from a common data model database (1 January, 2017-31 December, 2021) to compare the risk of DILI among specific angiotensin receptor blockers against valsartan. METHODS: Patients were assigned to treatment groups at cohort entry based on prescribed angiotensin receptor blockers. Drug-induced liver injury was operationally defined using the International DILI Expert Working Group criteria. Cox regression analyses were conducted to derive hazard ratios and the inverse probability of treatment weighting method was applied. All analyses were performed using R. RESULTS: In total, 229,881 angiotensin receptor blocker users from 20 university hospitals were included. Crude DILI incidence ranged from 15.6 to 82.8 per 1000 person-years in treatment groups, most were cholestatic and of mild severity. Overall, the risk of DILI was significantly lower in olmesartan users than in valsartan users (hazard ratio: 0.73 [95% confidence interval 0.55-0.96]). In monotherapy patients, the risk was significantly higher in azilsartan users than in valsartan users (hazard ratio: 6.55 [95% confidence interval 5.28-8.12]). CONCLUSIONS: We found a significantly higher risk of suspected DILI in patients receiving azilsartan monotherapy compared with valsartan monotherapy. Our findings emphasize the utility of real-world evidence in advancing our understanding of adverse drug reactions in clinical practice.


Assuntos
Antagonistas de Receptores de Angiotensina , Doença Hepática Induzida por Substâncias e Drogas , Registros Eletrônicos de Saúde , Humanos , República da Coreia/epidemiologia , Estudos Retrospectivos , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Masculino , Feminino , Antagonistas de Receptores de Angiotensina/efeitos adversos , Pessoa de Meia-Idade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Idoso , Estudos de Coortes , Anti-Hipertensivos/efeitos adversos , Incidência , Adulto , Valsartana/efeitos adversos , Fatores de Risco , Benzimidazóis/efeitos adversos
12.
J Immunother Cancer ; 12(3)2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38471713

RESUMO

BACKGROUND: Recombinant human interleukin (rhIL)-7-hyFc (efineptakin alfa; NT-I7) is a potent T-cell amplifier, with two IL-7 molecules fused to IgD/IgG4 elements. rhIL-7-hyFc promotes extensive infiltration of CD8+ T cells into the tumor, concurrently increasing the numbers of intratumoral PD-1+CD8+ T cells. The hIL-2/TCB2 complex (SLC-3010) inhibits tumor growth by preferential activation of CD122 (IL-2Rß)high CD8+ T cells and natural killer cells, over regulatory T cells (Tregs). We investigated the underlying mechanisms of rhIL-7-hyFc and hIL-2/TCB2c antitumor activity and the potential synergistic efficacy, specifically focusing on tumor-specific CD8+ cells within the tumor and the tumor-draining lymph nodes (tdLN). METHODS: MC38 and CT26 tumor-bearing mice were administered with 10 mg/kg rhIL-7-hyFc intramuscularly and 0.9 mg/kg hIL-2/TCB2c intravenously. Anti-PD-1 monoclonal antibody was administered intraperitoneally three times at 3-day intervals at a dose of 5 mg/kg. Tumor volume was measured to assess efficacy. To compare the composition of immune cells between each monotherapy and the combination therapy, we analyzed tumors and tdLNs by flow cytometry. RESULTS: Our data demonstrate that the combination of rhIL-7-hyFc and hIL-2/TCB2c increases efficacy and generates an immune-stimulatory tumor microenvironment (TME). The TME is characterized by an increased infiltration of tumor-specific CD8+ T cells, and a decreased frequency of CD39highTIM-3+ Treg cells. Most importantly, rhIL-7-hyFc increases infiltration of a CD62L+Ly108+ early progenitor population of exhausted CD8+ T cells (TPEX), which may retain long-term proliferation capacity and replenish functional effector CD8+ T cells. hIL-2/TCB2c induces differentiation of CD62L+Ly108+ TPEX rapidly into CD101+ terminally differentiated subsets (terminally exhausted T cell (TEX term)). Our study also demonstrates that rhIL-7-hyFc significantly enhances the proliferation rate of TPEX in the tdLNs, positively correlating with their abundance within the tumor. Moreover, rhIL-7-hyFc and hIL-2/TCB2c can overcome the limited therapeutic effectiveness of PD-1 blockade, culminating in the complete regression of tumors. CONCLUSIONS: rhIL-7-hyFc can expand and maintain the progenitor pool of exhausted CD8+ T cells, whereas hIL-2/TCB2c promotes their differentiation into TEX term. Together, this induces an immune-stimulatory TME that improves the efficacy of checkpoint blockade.


Assuntos
Linfócitos T CD8-Positivos , Interleucina-7 , Neoplasias , Proteínas Recombinantes de Fusão , Humanos , Animais , Camundongos , Microambiente Tumoral , Receptor de Morte Celular Programada 1 , Fatores Imunológicos
13.
Sci Rep ; 14(1): 2850, 2024 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310134

RESUMO

Transcranial Direct Current Stimulation (tDCS) has benefits for motor rehabilitation in stroke patients, but its clinical application is limited due to inter-individual heterogeneous effects. Recently, optimized tDCS that considers individual brain structure has been proposed, but the utility thereof has not been studied in detail. We explored whether optimized tDCS provides unique electrode positions for each patient and creates a higher target electric field than the conventional approach. A comparative within-subject simulation study was conducted using data collected for a randomized controlled study evaluating the effect of optimized tDCS on upper extremity function in stroke patients. Using Neurophet tES LAB 3.0 software, individual brain models were created based on magnetic resonance images and tDCS simulations were performed for each of the conventional and optimized configurations. A comparison of electrode positions between conventional tDCS and optimized tDCS was quantified by calculation of Euclidean distances. A total of 21 stroke patients were studied. Optimized tDCS produced a higher electric field in the hand motor region than conventional tDCS, with an average improvement of 20% and a maximum of 52%. The electrode montage for optimized tDCS was unique to each patient and exhibited various configurations that differed from electrode placement of conventional tDCS. Optimized tDCS afforded a higher electric field in the target of a stroke patient compared to conventional tDCS, which was made possible by appropriately positioning the electrodes. Our findings may encourage further trials on optimized tDCS for motor rehabilitation after stroke.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Humanos , Estimulação Transcraniana por Corrente Contínua/métodos , Acidente Vascular Cerebral/terapia , Encéfalo/fisiologia , Simulação por Computador , Eletrodos
14.
Cell Rep Med ; 5(1): 101362, 2024 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-38232693

RESUMO

Repeated pandemics caused by the influenza virus and severe acute respiratory syndrome coronavirus (SARS-CoV) have resulted in serious problems in global public health, emphasizing the need for broad-spectrum antiviral therapeutics against respiratory virus infections. Here, we show the protective effects of long-acting recombinant human interleukin-7 fused with hybrid Fc (rhIL-7-hyFc) against major respiratory viruses, including influenza virus, SARS-CoV-2, and respiratory syncytial virus. Administration of rhIL-7-hyFc in a therapeutic or prophylactic regimen induces substantial antiviral effects. During an influenza A virus (IAV) infection, rhIL-7-hyFc treatment increases pulmonary T cells composed of blood-derived interferon γ (IFNγ)+ conventional T cells and locally expanded IL-17A+ innate-like T cells. Single-cell RNA transcriptomics reveals that rhIL-7-hyFc upregulates antiviral genes in pulmonary T cells and induces clonal expansion of type 17 innate-like T cells. rhIL-7-hyFc-mediated disease prevention is dependent on IL-17A in both IAV- and SARS-CoV-2-infected mice. Collectively, we suggest that rhIL-7-hyFc can be used as a broadly active therapeutic for future respiratory virus pandemic.


Assuntos
Influenza Humana , Interleucina-17 , Animais , Camundongos , Humanos , Interleucina-17/genética , Interleucina-7 , Linfócitos T , SARS-CoV-2 , Influenza Humana/tratamento farmacológico , Antivirais/farmacologia , Antivirais/uso terapêutico
16.
Cancers (Basel) ; 15(20)2023 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-37894294

RESUMO

BACKGROUND: The distinction between D3 lymph nodes and actual lymphatic pathways in primary tumors can be difficult during surgery, making it challenging to confirm the completeness of D3 lymph node dissection. Fluorescence lymph node mapping (FLNM) is a promising method for lymph node visualization. PURPOSE: This study aimed to assess whether FLNM enhances the effectiveness of D3 lymph node dissection in patients with right-sided colon cancer. METHODS: Endoscopic submucosal indocyanine green injection were performed on the distal margin of the colon cancer. In an FLNM group, the lymphatic drainage pathway and distribution of D3 lymph nodes were explored. Pathological evaluations were conducted for the fluorescent D3 and non-fluorescent D3 lymph nodes. RESULTS: The FLNM group showed a significantly higher number of harvested lymph nodes in the D3 area. In stage III patients, the proportion of D3 lymph node metastasis was significantly higher in the FLNM group. The harvested D3 lymph node count showed a proportional correlation with a metastatic lymph node count of up to 15. CONCLUSION: FLNM could be considered a promising new strategy to potentially increase harvested D3 lymph node counts in colon cancer surgery.

17.
Brain Neurorehabil ; 16(2): e18, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37554256

RESUMO

This clinical practice guideline (CPG) is the fourth edition of the Korean guideline for stroke rehabilitation, which was last updated in 2016. The development approach has been changed from a consensus-based approach to an evidence-based approach using the Grading of Recommendations Assessment Development and Evaluation (GRADE) method. This change ensures that the guidelines are based on the latest and strongest evidence available. The aim is to provide the most accurate and effective guidance to stroke rehabilitation teams, and to improve the outcomes for stroke patients in Korea. Fifty-five specialists in stroke rehabilitation and one CPG development methodology expert participated in this development. The scope of the previous clinical guidelines was very extensive, making it difficult to revise at once. Therefore, it was decided that the scope of this revised CPG would be limited to Part 1: Rehabilitation for Motor Function. The key questions were selected by considering the preferences of the target population and referring to foreign guidelines for stroke rehabilitation, and the recommendations were completed through systematic literature review and the GRADE method. The draft recommendations, which were agreed upon through an official consensus process, were refined after evaluation by a public hearing and external expert evaluation.

18.
Sci Adv ; 9(32): eadg6319, 2023 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-37556544

RESUMO

Underrepresentation of non-European (EUR) populations hinders growth of global precision medicine. Resources such as imputation reference panels that match the study population are necessary to find low-frequency variants with substantial effects. We created a reference panel consisting of 14,393 whole-genome sequences including more than 11,000 Asian individuals. Genome-wide association studies were conducted using the reference panel and a population-specific genotype array of 72,298 subjects for eight phenotypes. This panel yields improved imputation accuracy of rare and low-frequency variants within East Asian populations compared with the largest reference panel. Thirty-nine previously unidentified associations were found, and more than half of the variants were East Asian specific. We discovered genes with rare protein-altering variants, including LTBP1 for height and GPR75 for body mass index, as well as putative regulatory mechanisms for rare noncoding variants with cell type-specific effects. We suggest that this dataset will add to the potential value of Asian precision medicine.


Assuntos
População do Leste Asiático , Estudo de Associação Genômica Ampla , Humanos , Genoma Humano , Polimorfismo de Nucleotídeo Único , Genótipo , Receptores Acoplados a Proteínas G/genética
19.
Front Psychol ; 14: 1200570, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37546479

RESUMO

Introduction: In the context of the COVID-19 pandemic, which has led to complex psychological problems, it is important to examine the effect of coping flexibility and sense of community, because relying solely on specific coping strategies is ineffective, and the pandemic necessitates social cooperation. Methods: This study was divided into two parts. The first study used a quantitative research method(i.e., structural equation modeling) to test if coping flexibility and sense of community moderated the impact of COVID-19-related concerns on mental health (i.e., depression and anxiety) and posttraumatic growth among Korean college students. The second study used a qualitative research method for an in-depth examination of how Korean college students coped with the COVID-19 pandemic and if they achieved any positive change or growth. Given that the COVID-19 pandemic represents a situation distinct from what people have previously encountered, Study II was designed to examine the experiences of individuals during this exceptional period. Results: In the first study (Study I), coping flexibility was found to increase the impact of COVID-19-related concerns and difficulties on depression and anxiety. Conversely, a sense of community reduced the consequences of these overwhelming worries on depression and anxiety, while also expanding the impact of COVID-19-related disorders on posttraumatic growth. In the second study (Study II), the findings showed that the participants experienced various psychological consequences, including depression and anxiety, and distress in other aspects of their life, including disruptions in interpersonal relationships and college life. Nonetheless, the participants made efforts to cope with such difficulties and overcome the challenges together with the community. In fact, the pandemic improved their coping skills and expanded their value system and worldview. Conclusion: The study findings suggest that given the unique situation presented by the COVID-19 pandemic, a sense of community protected the mental well-being of Korean college students and facilitated their growth. This study emphasizes the necessity of promoting SOC to effectively cope with disaster situations.

20.
Biomedicines ; 11(7)2023 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-37509667

RESUMO

BACKGROUND: Safe values for quantitative perfusion parameters of indocyanine green (ICG) angiography have not been fully defined, and interpretation remains at the surgeon's discretion. This prospective observational study aimed to establish the safe values for the quantitative perfusion parameters by comparing tissue oxygenation levels from HSI images in laparoscopic colorectal surgery. METHODS: ICG angiography was performed using a laparoscopic near-infrared (NIR) camera system with ICG diluted in 10 mL of distilled water. For quantitative perfusion parameters, the changes in fluorescence intensity with perfusion times were analyzed to plot a time-fluorescence intensity graph. To assess real-time tissue oxygen saturation (StO2) in the colon, the TIVITA® Tissue System was utilized for hyperspectral imaging (HSI) acquisition. The StO2 levels were compared with the quantitative perfusion parameters derived from ICG angiography at corresponding points to define the safe range of ICG parameters reflecting good tissue oxygenation. RESULTS: In the regression analysis, T1/2MAX, TMAX, slope, and NIR perfusion index were correlated with tissue oxygen saturation. Using this regression model, the cutoff values of quantitative perfusion parameters were calculated as T1/2MAX ≤ 10 s, TMAX ≤ 30 s, slope ≥ 5, and NIR perfusion index ≥50, which best reflected colon StO2 higher than 60%. Diagnostic values were analyzed to predict colon StO2 of 60% or more, and the ICG perfusion parameters T1/2MAX, TMAX, and perfusion TR showed high sensitivity values of 97% or more, indicating their ability to correctly identify cases with acceptable StO2. CONCLUSION: The safe values for quantitative perfusion parameters derived from ICG angiography were T1/2MAX ≤ 10 s and TMAX ≤ 30 s, which were associated with colon tissue oxygenation levels higher than 60% in the laparoscopic colorectal surgery.

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