Influence of Illness Uncertainty on Health Behavior in Individuals with Coronary Artery Disease: A Path Analysis.

PURPOSE: This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel's uncertainty in illness theory (UIT). METHODS: We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. RESULTS: The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. CONCLUSION: The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

Automated Personalized Self-care Program for Patients With Type 2 Diabetes Mellitus: A Pilot Trial.

PURPOSE: Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness. METHODS: A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40-69 years with type 2 diabetes and HbA1c ≥ 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group. RESULTS: A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria. Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes. CONCLUSION: Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness. TRIAL REGISTRATION: Clinical Research Information Service, KCT0008202 (registration date: 17 February 2023).

Low skull bone density is associated with poor motor prognosis in women with Parkinson's disease.

Parkinson's disease (PD) and osteoporosis are degenerative diseases that have shared pathomechanisms. To investigate the associations of skull bone density with nigrostriatal dopaminergic degeneration and longitudinal motor prognosis in female patients with PD. We analyzed the data of 260 drug-naïve female PD patients aged ≥50 years old who were followed-up for ≥3 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging. We measured skull bone density as a surrogate marker for systemic bone loss by calculating the Hounsfield unit (HU) in computed tomography scans. A Cox proportional hazard model was built to compare the rates of levodopa-induced dyskinesia (LID) or wearing-off according to skull HU. Longitudinal changes in levodopa-equivalent dose (LED) during a 3-year follow-up were assessed using a linear mixed model. A lower skull HU was associated with lower baseline DAT availability in striatal subregions; however, this relationship was not significant after adjusting for age, disease duration, body mass index, and white matter hyperintensities. After adjusting for confounding factors, a lower skull HU was significantly associated with an increased risk of LID development (hazard ratio = 1.660 per 1 standard deviation decrease, p = 0.007) and wearing-off (hazard ratio = 1.613, p = 0.016) in younger (<67 years) but not in older patients. Furthermore, a lower skull HU was associated with a steeper increase in LED during follow-up in younger patients only (ß = -21.99, p < 0.001). This study suggests that baseline skull bone density would be closely linked to motor prognosis in drug naïve women with PD.

Correction: Lee et al. Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel. Int. J. Environ. Res. Public Health 2020, 17, 2618.

The authors have noticed an inadvertent error in our article, ''Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel" [...].

Machine Learning Approaches to Predict Chronic Lower Back Pain in People Aged over 50 Years.

Background and Objectives: Chronic lower back pain (LBP) is a common clinical disorder. The early identification of patients who will develop chronic LBP would help develop preventive measures and treatment. We aimed to develop machine learning models that can accurately predict the risk of chronic LBP. Materials and Methods: Data from the Sixth Korea National Health and Nutrition Examination Survey conducted in 2014 and 2015 (KNHANES VI-2, 3) were screened for selecting patients with chronic LBP. LBP lasting >30 days in the past 3 months was defined as chronic LBP in the survey. The following classification models with machine learning algorithms were developed and validated to predict chronic LBP: logistic regression (LR), k-nearest neighbors (KNN), naïve Bayes (NB), decision tree (DT), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), and artificial neural network (ANN). The performance of these models was compared with respect to the area under the receiver operating characteristic curve (AUROC). Results: A total of 6119 patients were analyzed in this study, of which 1394 had LBP. The feature selected data consisted of 13 variables. The LR, KNN, NB, DT, RF, GBM, SVM, and ANN models showed performances (in terms of AUROCs) of 0.656, 0.656, 0.712, 0.671, 0.699, 0.660, 0.707, and 0.716, respectively, with ten-fold cross-validation. Conclusions: In this study, the ANN model was identified as the best machine learning classification model for predicting the occurrence of chronic LBP. Therefore, machine learning could be effectively applied in the identification of populations at high risk of chronic LBP.

Consoramides A-C, New Zwitterionic Alkaloids from the Fungus Irpex consors.

In our ongoing search for new secondary metabolites from fungi, a basidiomycete fungus Irpex consors was selected for mycochemical investigation, and three new zwitterionic alkaloids (1-3) and five known compounds (4-8) were isolated from the culture broth (16 l) of I. consors. The culture filtrate was fractionated by a series of column chromatography including Diaion HP-20, silica gel, and Sephadex LH-20, Sep-Pak C18 cartridge, medium pressure liquid chromatography (MPLC), and high pressure liquid chromatography (HPLC) to yield eight compounds (1-8). The structures of the isolated compounds were elucidated by the interpretation of nuclear magnetic resonance (NMR) spectra and high-resolution mass spectrometry (HR-MS). Their antioxidant and antibacterial activities were examined. The zwitterionic structures of three new sesquiterpene alkaloids (1-3) were determined together with five known compounds identified as stereumamide E (4), stereumamide G (5), stereumamide H (6), stereumamide D (7), and sterostrein H (8). This is the first report of the zwitterionic alkaloids in the culture broth of I. consors. Three new zwitterionic alkaloids were named as consoramides A-C (1-3).

A Cross-Sectional Study: What Contributes to Nursing Students' Clinical Reasoning Competence?

Clinical reasoning is a vital competence for nursing students, as it is required for solving problems arising in complex clinical situations. Identifying the factors that influence nursing students' clinical reasoning competence in the social context can help their implicit educational needs. Therefore, this study aimed to determine the factors associated with developing clinical reasoning competency among undergraduate nursing students. In total, 206 senior nursing students were included in this study. Self-reported measures were used to obtain data on participants' clinical reasoning competence, problem-solving abilities, academic self-efficacy, and level of clinical practicum stress. Relationships among continuous variables were analyzed using Pearson's correlation coefficients. A multiple linear regression analysis was conducted to identify factors related to clinical reasoning competence. Our findings show that participants with better problem-solving abilities and academic self-efficacy perceived themselves as having higher levels of clinical reasoning competence. Nursing students with lower clinical practicum stress reported higher clinical reasoning competence. Significant factors identified were younger age and subcategories of problem-solving ability such as problem clarification, alternative solution development, planning/implementation, and self-regulated efficacy. Our findings highlight essential factors necessary for developing a nursing curriculum that contributes to professional nurses' clinical reasoning competence.

[Comparison of the Prediction Model of Adolescents' Suicide Attempt Using Logistic Regression and Decision Tree: Secondary Data Analysis of the 2019 Youth Health Risk Behavior Web-Based Survey].

PURPOSE: The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis. METHODS: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0. RESULTS: A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model. CONCLUSION: Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.

Gender-specific effect of urate on white matter integrity in Parkinson's disease.

OBJECTIVES: To investigate the potential protective influence of serum uric acid (UA) level on white matter (WM) microstructural changes in de novo Parkinson's disease (PD). METHODS: We enrolled a total of 184 patients with drug-naïve de novo PD and 59 age and gender-matched controls that underwent diffusion tensor imaging (DTI). Based on the distribution, serum UA levels were stratified into tertiles in PD patients by gender. Using tract-based spatial statistics (TBSS) analysis, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were used to compare WM integrity between the groups. RESULTS: Interaction analysis showed that interaction effect on FA values between gender and UA levels in PD was significant in widespread WM areas, including frontal-parieto-temporal, corpus callosum, bilateral internal and external capsule, and thalamic regions. Multiple regression analysis revealed that FA values had a significantly positive correlation with UA levels across widespread WM areas in male patients. However, there was no significant correlation between DTI measures and UA levels in female patients. In a group comparison in male patients, PD with the lowest UA level (PD-L-UA) group showed significantly lower FA and higher MD and RD values in frontal-parieto-temporal WM regions than PD with the highest UA level (PD-H-UA) group. However, female patients did not show significant difference of DTI measures between PD-L-UA and PD-H-UA groups. CONCLUSIONS: The present study demonstrated that the serum UA levels may have the potentially gender-specific close relationship with WM integrity in the early stage of PD.

Areas of white matter hyperintensities and motor symptoms of Parkinson disease.

OBJECTIVE: To determine whether deep white matter and periventricular hyperintensities affect the motor symptoms of Parkinson disease (PD) differently, we analyzed MRI and dopamine transporter imaging. METHODS: We analyzed the medical records of patients with de novo PD who underwent dopamine transporter PET scanning and MRI at their first visit. Deep white matter and periventricular hyperintensities were scored with a visual rating scale, and motor symptoms were assessed by Unified Parkinson's Disease Rating Scale motor score and tremor, rigidity, bradykinesia, and axial symptom subscores. The influence of white matter hyperintensity on motor symptoms was explored using multivariable linear regression models. RESULTS: A total of 93 patients (mean age, 67.2 ± 9.9 years; 44 male) were included and the mean motor score was 25.0 ± 10.8. Subscores for bradykinesia and axial symptoms were correlated with both deep white matter and periventricular hyperintensities scores. Multivariable linear regression models revealed that deep white matter hyperintensities score was significantly associated with subscore for bradykinesia and periventricular hyperintensities score was associated with subscores for bradykinesia and axial symptoms after adjusting for putaminal dopamine transporter availability and clinical factors. CONCLUSIONS: These results demonstrate that deep white matter hyperintensities are associated with bradykinesia and periventricular hyperintensities are associated with bradykinesia and axial symptoms in patients with PD independently of the severity of dopaminergic depletion.

Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel.

This study aimed to identify the prevalence and patterns of multimorbidity among Korean adults. A descriptive study design was used. Of 11,232 adults aged 18 and older extracted from the 2014 Korean Health Panel Survey, 7118 had one or more chronic conditions. The chronic conditions code uses the Korean Standard Classification of Diseases. Association rule analysis and network analysis were conducted to identify patterns of multimorbidity among 4922 participants with multimorbidity. The prevalence of multimorbidity in the overall population was 34.8%, with a higher prevalence among women (40.8%) than men (28.6%). Hypertension had the highest prevalence in both men and women. In men, diabetes mellitus and hypertension yielded the highest probability of comorbidity (10.04%). In women, polyarthrosis and hypertension yielded the highest probability of comorbidity (12.51%). The results of the network analysis in four groups divided according to gender and age showed different characteristics for each group. Public health practitioners should adopt an integrated approach to manage multimorbidity rather than an individual disease-specific approach, along with different strategies according to age and gender groups.

Impaired functional connectivity of sensorimotor network predicts recovery in drug-induced parkinsonism.

OBJECTIVE: In a substantial portion of patients with drug-induced parkinsonism (DIP), parkinsonism may persist for long periods after discontinuation of offending drugs, suggesting subtle underlying neurodegeneration. We hypothesized that patients with DIP have impaired functional connectivity (FC) of brain networks, which may determine the reversibility of parkinsonism. METHODS: In this case-control study, we consecutively recruited 60 patients with DIP and 32 healthy controls. We used independent component analysis and dual regression of functional magnetic resonance imaging data to identify seven resting-state networks and compared FC of the networks between the DIP and control groups. Among regions where the two groups showed a significant difference in the FC with sensorimotor network, we compared the FC between patients who had completely recovered (n = 21) and those who had partially recovered (n = 39) within 3 months of cessation of the offending drugs. RESULTS: Patients with DIP had decreased FC between the sensorimotor network and widespread brain regions, when compared to healthy controls. FC in the prefrontal regions was negatively correlated with parkinsonian motor score. Patients who partially recovered had a significantly lower FC in the prefrontal and cerebellar regions than those who recovered completely, providing a useful predictor of recovery status. CONCLUSIONS: Patients with DIP had decreased FC of the sensorimotor network, which correlated with the severity of parkinsonism and predicted the recovery status after cessation of offending drugs. Impaired FC of the sensorimotor network can be used as a biomarker to evaluate the severity and prognosis of DIP.

Sex-Based Differences in the Quality of Life of Elderly Koreans with Chronic Musculoskeletal Pain.

In this study, we constructed a structural equation model (SEM) for predicting the quality of life (QOL) in elderly Koreans with chronic musculoskeletal pain (CMP) and examined the differences between sexes. Data were earlier collected in a prior study of 307 participants (101 men and 206 women) with CMP, aged 65 years and above, who used geriatric welfare centers located in two cities. The effects of pain, functional limitation, perceived health status, pain coping, and social support on the QOL were estimated with a multigroup SEM. For both men and women, the results show sequential causality from pain to functional limitation, perceived health status, and QOL. However, the relationships among pain, pain coping, functional limitation, and QOL differ between men and women. The multigroup SEM provides a better understanding of the sex differences in the QOL of elderly with CMP. The results suggest that in order to improve QOL among the elderly with CMP, a customized strategy should be applied that takes into account differences between the sexes.

Development of simulation education debriefing protocol with faculty guide for enhancement clinical reasoning.

BACKGROUND: The clinical environments are more complex, diverse and rapidly changing. Patients' conditions were chronic and complexed, healthcare providers require clinical reasoning for patient safety care. One of the learning methods to foster clinical reasoning is simulation education. The aim of this study was to develop a simulation education debriefing protocol that can improve clinical reasoning. METHODS: This study was conducted following steps. For the first step, the literature review was performed to constitute a preliminary debriefing protocol. Secondly, content validity was evaluated by five simulation learning experts. Thirdly, in-depth interview was conducted to re-examine content validity with education experts. Finally, the final debriefing protocol was applied to 7 undergraduate nursing students to examine feasibility of the protocol. RESULTS: The protocol consisted of debriefing steps, learning outcome, clinical reasoning attributes, core questions and guideline for instructor. Results of applicability of debriefing protocol represented that participants mentioned their reasoning competency was improved and understood the overall flow of reasoning. CONCLUSIONS: The debriefing protocol is important to educate healthcare providers 'clinical reasoning. It would be able to contribute to develop healthcare providers' clinical competencies.

The presence of depression in de novo Parkinson's disease reflects poor motor compensation.

Depression frequently accompanies Parkinson's disease and often precedes the onset of motor symptoms. This study aimed to evaluate the impact of depression on motor compensation in patients with de novo Parkinson's disease. This retrospective cohort study analyzed data from 474 non-demented patients with de novo Parkinson's disease (mean age, 64.6±9.8 years; 242 men) who underwent both dopamine transporter PET scan and depression assessment using the Beck Depression Inventory at baseline. Patients were classified into tertiles by Beck Depression Inventory score. At baseline, high-tertile group (Beck Depression Inventory score ≥15, n = 157) showed more severe motor deficits and lower cognitive function than low-tertile group (Beck Depression Inventory score ≤7, n = 158, P = 0.034 and P = 0.008, respectively). Greater motor deficits in high-tertile group than low-tertile group remained significant after controlling for dopamine transporter binding in the posterior putamen, as well as other confounding variables. During follow-up of a median duration of 47 months, high-tertile group received higher levodopa-equivalent doses for symptom control than did low-tertile group after controlling for age, gender, and initial motor deficit severity. These results demonstrate that depression in de novo Parkinson's disease is associated with motor deficit severity at baseline and dose of PD medications during follow-up, suggesting that the presence of depression in de novo Parkinson's disease represents poor motor compensation.

Identification of Lactic Acid Bacteria in Galchi- and Myeolchi-Jeotgal by 16S rRNA Gene Sequencing, MALDI-TOF Mass Spectrometry, and PCR-DGGE.

Jeotgal is a Korean traditional fermented seafood with a high concentration of salt. In this study, we isolated lactic acid bacteria (LAB) from galchi (Trichiurus lepturus, hairtail) and myeolchi (Engraulis japonicas, anchovy) jeotgal on MRS agar and MRS agar containing 5% NaCl (MRS agar+5% NaCl), and identified them by using 16S rRNA gene sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) as culture-dependent methods. We also performed polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) as a culture-independent method to identify bacterial communities. Five samples of galchi-jeotgal and seven samples of myeolchi-jeotgal were collected from different regions in Korea. A total of 327 and 395 colonies were isolated from the galchi- and myeolchi-jeotgal samples, respectively. 16S rRNA gene sequencing and MALDI-TOF MS revealed that the genus Pediococcus was predominant on MRS agar, and Tetragenococcus halophilus on MRS agar+5% NaCl. PCR-DGGE revealed that T. halophilus, Tetragenococcus muriaticus, and Lactobacillus sakei were predominant in both types of jeotgal. T. halophilus was detected in all samples. Even though the same species were identified by both culture-dependent and -independent methods, many species identified by the culture-dependent methods were not in the bacterial list identified by the culture-independent methods. The distribution of bacteria in galchi-jeotgal was more diverse than in myeolchi-jeotgal. The diverse LAB in galchi- and myeolchi-jeotgals can be further studied as candidates for starter cultures to produce fermented foods.

Effect of psychosocial interventions on the quality of life of patients with colorectal cancer: a systematic review and meta-analysis.

BACKGROUND: We conducted a systematic review and meta-analysis of randomized controlled trials examining the effect of psychosocial interventions on the quality of life of patients with colorectal cancer. METHODS: We searched the main health-related databases for relevant papers. Then, we examined the titles and abstracts of the retrieved papers, applying exclusion criteria to filter out irrelevant papers; a more in-depth filtering process was then conducted by reading the full texts. Eight studies remained at the end of this process. Next, we performed data extraction and assessed the methodological quality of the selected studies. This was followed by computation of effect sizes and the heterogeneity of the results, and then an assessment of the potential bias. RESULTS: The systematic review found that most of the interventions in these eight studies did not have a significant effect on quality of life. Meanwhile, the meta-analysis, the overall effect of psychosocial interventions at the post-intervention period was found to be statistically significant but small. CONCLUSIONS: This meta-analysis provides evidence for the beneficial effect of face-to-face psychosocial interventions on the quality of life of colorectal cancer patients. It is, however, suggested that further studies be conducted on this topic to assess the roles of physical functioning and severity of symptoms before utilizing such face-to-face interventions.

The cholinergic contribution to the resting-state functional network in non-demented Parkinson's disease.

The cholinergic system arising from the basal forebrain plays an important role in cognitive performance in Parkinson's disease (PD). Here, we analyzed cholinergic status-dependent cortical and subcortical resting-state functional connectivity in PD. A total of 61 drug-naïve PD patients were divided into tertiles based on normalized substantia innominata (SI) volumes. We compared the resting-state network from seed region of interest in the caudate, posterior cingulate cortex (PCC), and SI between the lowest (PD-L) and highest tertile (PD-H) groups. Correlation analysis of the functional networks was also performed in all subjects. The functional network analysis showed that PD-L subjects displayed decreased striato-cortical functional connectivity compared with PD-H subjects. Selecting the PCC as a seed, the PD-L patients displayed decreased functional connectivity compared to PD-H patients. Meanwhile, PD-L subjects had significantly increased cortical functional connectivity with the SI compared with PD-H subjects. Correlation analysis revealed that SI volume had a positive correlation with functional connectivity from the right caudate and PCC. The present study demonstrated that PD patients exhibited unique functional connectivity from the caudate and the PCC that may be closely associated with cholinergic status, suggesting an important role for the cholinergic system in PD-associated cognition.

Putaminal dopamine depletion in de novo Parkinson's disease predicts future development of wearing-off.

INTRODUCTION: The present study aimed to investigate whether the level of presynaptic dopamine neuronal loss predicts future development of wearing-off in de novo Parkinson's disease. METHODS: This retrospective cohort study included a total of 342 non-demented patients with de novo Parkinson's disease who underwent dopamine transporter positron emission tomography scans at their initial evaluation and received dopaminergic medications for 24 months or longer. Onset of wearing-off was determined based on patients' medical records at their outpatient clinic visits every 3-6 months. Predictive power of dopamine transporter activity in striatal subregions and other clinical factors for the development of wearing-off was evaluated by Cox proportional hazard models. RESULTS: During a median follow-up period of 50.2 ±â€¯18.9 months, 69 patients (20.2%) developed wearing-off. Patients with wearing-off exhibited less dopamine transporter activity in the putamen, particularly the anterior and posterior putamens, compared to those without wearing-off. Multivariate Cox proportional hazard models revealed that dopamine transporter activities of the anterior (hazard ratio 0.556; p = 0.008) and whole putamens (hazard ratio 0.504; p = 0.025) were significant predictors of development of wearing-off. In addition, younger age at onset of Parkinson's disease, lower body weight, and a motor phenotype of postural instability/gait disturbance were also significant predictors for development of wearing-off. CONCLUSION: The present results provide in vivo evidence to support the hypothesis that presynaptic dopamine neuronal loss, particularly in the anterior putamen, leads to development of wearing-off in Parkinson's disease.

Gender-specific effect of uric acid on resting-state functional networks in de novo Parkinson's disease.

INTRODUCTION: The pattern of resting-state networks is influenced by several factors besides the underlying pathological changes of Parkinson's disease (PD). Uric acid (UA), as an antioxidant, has a neuroprotective property against PD-related microenvironment; however, this effect would be gender-specific. We aimed to evaluate a gender-sensitive resting-state networks (RSN) according to the UA level in drug naïve de novo patients with PD to elucidate the role of antioxidant in cortical functional networks of PD. METHODS: This study enrolled 135 de novo patients with PD underwent functional magnetic resonance imaging (MRI). Based on the distribution, the serum UA level was stratified into tertiles in the PD patients by gender. With a seed-based approach, we investigated the pattern of RSN within the dorsal attention network (DAN), executive control network (ECN), and default mode network (DMN). RESULTS: Interaction analysis showed a significant interaction between the lowest (PD-L-UA) and the highest UA level (PD-H-UA) groups according to gender within the DAN, ECN, and DMN. Compared to the control subjects, male patients with PD-H-UA had higher cortical functional connectivity (FC), while female patients had lower cortical FC regardless of UA level within all seeds. In a direct comparison, male patients with PD-H-UA had increased FC than did those with PD-L-UA. However, there was no significant difference in FC between PD-L-UA and PD-H-UA in female PD patients. CONCLUSIONS: These data suggest that RSN might be closely and gender-specifically associated with the status of serum UA in de novo PD patients.