Statins and Clinical Outcomes in Patients With Low to Moderate Risk but With Non-obstructive Carotid Plaques: The SCOPE-CP Study

Background and objectives: Some individuals exhibit discrepancies between risk classifications assessed using clinical factors and those obtained by vascular imaging. We aimed to evaluate whether statins provide clinical outcome benefits in patients classified as having low to moderate cardiovascular risk but with carotid plaque. Methods: This was a retrospective propensity score matching study. A total of 12,158 consecutive patients undergoing carotid ultrasound between January 2012 to February 2020 were screened. Individuals with low to moderate cardiovascular risk who were not currently recommended for statin therapy but had carotid plaques were included. Among 1,611 enrolled individuals, 806 (statin group: 403, control group: 403) were analyzed. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs: cardiovascular death, myocardial infarction, coronary revascularization, and ischemic stroke or transient ischemic attack) and all-cause mortality. Results: During the median follow-up of 6.0 years, the incidence of MACCEs did not differ between the groups (6.1 and 5.7/1,000 person-years in the control and statin groups, respectively; adjusted hazard ratio [HR], 0.95; p=0.90). The incidence of all-cause mortality did not differ (3.9 and 3.9/1,000 person-years, respectively; adjusted HR, 1.02; p=0.97). Kaplan-Meier curves revealed similar rates of MACCEs (log-rank p=0.72) and all-cause mortality (log-rank p=0.99) in the 2 groups. Age and smoking were independent predictors of MACCEs. Subgroups exhibited no differences in clinical outcomes with statin use. Conclusions: Benefit of statin therapy was likely to be limited in low to moderate risk patients with carotid plaques. These results could guide physicians in clinical decision-making regarding cardiovascular prevention.ope

Erdheim-Chester disease presenting as an intracardiac mass and pericardial effusion confirmed by biopsy: a case report

Background: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that can affect the bones, heart, lungs, brain, and other organs. Cardiovascular involvement is common in ECD and is associated with a poor prognosis. Here, we report a case of ECD presenting as an intracardiac mass and pericardial effusion confirmed by biopsy with sternotomy. Case summary: A 54-year-old man was admitted because of dyspnoea. He was previously diagnosed with bilateral hydronephrosis and retroperitoneal fibrosis. Echocardiography revealed a large amount of pericardial effusion and echogenic mass on the right atrial (RA) side and atrioventricular (AV) groove. Cardiac magnetic resonance imaging and positron emission tomography-computed tomography (CT) revealed infiltrative mass-like lesions in the RA and AV groove. Pericardial window formation and pericardial biopsy were performed, and the pathologic results showed only pericardial fibrosis with no specific findings. Bone scan revealed increased uptake in the long bones. Considering the high probability of ECD based on the patient's manifestations and the imaging findings, we performed a cardiac biopsy with median sternotomy despite initial insufficient pathologic results in the pericardial biopsy. The surgical findings included multiple irregular and firm masses on the cardiac wall and large vessels; after obtaining a large amount of suspicious mass, ECD accompanied with CD68 (+) and BRAF V600E mutation was confirmed. Discussion: Erdheim-Chester disease can be associated with various forms of cardiovascular involvement. Considering the multi-systemic manifestations and difficulty in identifying this rare disease, a comprehensive and meticulous diagnostic work-up is crucial.ope

Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

Immunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16-14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.ope

Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis

Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with heart failure and reduced ejection fraction (HFrEF). However, patients often do not receive sacubitril/valsartan because of concerns about hypotension. We examined the feasibility of initiating sacubitril/valsartan at a very low dose (VLD) in potentially intolerant patients with HFrEF and subsequent dose up-titration, treatment persistence and outcomes. We analyzed 206 patients with HFrEF grouped according to starting sacubitril/valsartan dose. The VLD group (n = 106) commenced 25 mg twice daily, and the standard-dose (SD) group (n = 100) started on ≥ 50 mg twice daily. Baseline systolic blood pressure was 103 ± 12 mmHg vs. 119 ± 14 mmHg in the SD group (P < 0.001). The maximal target dose achievement rate was higher in the SD group (27.0% vs 9.4%, p = 0.001) and the VLD group experienced more dose up-titrations and fewer down-titrations than the SD group. The VLD group had a decrease in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) similar to the SD group and a similar increase in left ventricular ejection fraction. There were no significant differences in symptomatic hypotension, worsening renal function, hyperkalemia, cardiovascular mortality, and rehospitalization due to HF between the two groups during follow-up period. In patients considered by the treating physician likely to be intolerant of sacubitril/valsartan, initiation with 25 mg twice daily was generally possible and patients remained in therapy, with similar decreases in NT-proBNP and increases in left ventricular ejection fraction to those observed in patients receiving SD sacubitril/valsartan.ope

Association of Physical Activity Level With Risk of Dementia in a Nationwide Cohort in Korea

Importance: Current guidelines recommend 500 to 999 metabolic equivalent (MET)-minutes per week (MET-min/wk) of regular physical activity. However, evidence regarding the association between light-intensity physical activity (LPA) and dementia in older adults is inconsistent. Objective: To assess the association between physical activity and new-onset dementia, focusing on the dose-response association between physical activity and dementia and the association of LPA with the incidence of dementia. Design, setting, and participants: For this nationwide retrospective cohort study, we analyzed 62 286 participants aged 65 years or older without preexisting dementia who had available health checkup data from the Korean National Health Insurance Service database from January 2009 to December 2012. Participants were followed up until December 31, 2013, and data analysis was performed from July 2020 to January 2021. Exposures: Physical activity level was assessed using a standardized, self-reported questionnaire at baseline. Physical activity-related energy expenditure (in MET-min/wk) was calculated by summing the product of frequency, intensity, and duration. Main outcomes and measures: Incidence of dementia. Incidence rates were calculated by dividing the number of events by the person-time at risk (presented as the incidence per 1000 person-years). Hazard ratios (HRs) and 95% CIs for dementia were analyzed according to physical activity level. Competing risk regression was performed by using the Fine-Gray subdistribution hazard model, with mortality as the competing risk for dementia events. Multivariable regression models were constructed with adjustment for various patient characteristics. Incident dementia occurring 2 years after enrollment was assessed, and separate analyses included all follow-up periods. Restricted cubic spline curves were used to examine the association of continuous values of physical activity with dementia. Results: Among 62 286 participants, 60.4% were women, and the mean (SD) age was 73.2 (5.3) years. During a median follow-up of 42 months, 3757 participants (6.0%) developed dementia, and the overall incidence was 21.6 per 1000 person-years. Compared with inactive individuals (0 MET-min/wk), insufficiently active (1-499 MET-min/wk; mean, 284 MET-min/wk), active (500-999 MET-min/wk; mean, 675 MET-min/wk), and highly active participants (≥1000 MET-min/wk; mean, 1627 MET-min/wk) showed 10% (adjusted hazard ratio [HR], 0.90; 95% CI, 0.81-0.99), 20% (adjusted HR, 0.80; 95% CI, 0.71-0.92), and 28% (adjusted HR, 0.72; 95% CI, 0.60-0.83) reduced dementia risk, respectively. Thus, a progressive decrease in the adjusted HR of dementia was associated with increasing physical activity level, and a restricted cubic spline curve showed that this association started with a low amount of total physical activity. This association was consistent regardless of age, sex, and other comorbidities or after censoring for stroke. Compared with total sedentary behavior, even a low amount of LPA (1-299 MET-min/wk; mean, 189 MET-min/wk) was associated with reduced dementia risk (adjusted HR, 0.86; 95% CI, 0.74-0.99). Conclusions and relevance: In older adults, an increased physical activity level, including a low amount of LPA, was associated with a reduced risk of dementia. Promotion of LPA might reduce the risk of dementia in older adults.ope

Generation of a human induced pluripotent stem cell line YCMi004-A from a patient with dilated cardiomyopathy carrying a protein-truncating mutation of the Titin gene and its differentiation towards cardiomyocytes

Dilated cardiomyopathy (DCM) is a heart muscle disease that causes heart failure and is the leading cause for heart transplantation. It is a heart muscle disease resulted from a variety of genetics, toxic, metabolic, and infectious causes. One of the most prevalent genetic causes of DCM is a protein-truncating variant in the Titin gene (TTNtv). We have generated a human-induced pluripotent stem cell (hiPSC) line from patients who underwent heart transplantation due to DCM carrying a TTNtv mutation (c.70051C > T, p.Arg23351Ter) at the age of 20. The generated hiPSCs showed normal karyotype (46, XY) and expression of pluripotency markers, and were differentiated towards cardiomyocytes successfully.ope

A study on the income effects based on actors’ attitudes and mental accounting in consumption behavior : focused on smart devices, clothes, and leisure activities

본 연구에서는 소비 행동에 있어서 행동학적 요소를 반영함과 동시에, 소비 행동에 따라오는 하위 욕구가 지출 행동에 미치는 영향력에 대하여 탐색적인 조사를 목표로 하였다. 소득과 소비 간의 관계를 연구하는 기존 경제학에서는 항상 소득과 생애 주기 가설에 따라 소비 평탄화를 주장하고 항상 소득 가설에서 소비는 오로지 항상 소득에 따라 영향을 받는다는 주장은 자산과 소비 간 관계에 대한 실증 연구들에 의해 반론되어 왔다. 행동학적 생애주기 가설에 따르면 소득과 자산은 모두 소비의 원천이 되는 계정이 되고, 각 계정에 대한 심리적인 태도에 따라 한계 소비 성향이 달리 나타난다. 행동학적 생애주기 가설은 서로 다른 계정에서 오는 심리 효과를 명시적으로 고려한다는 점에서 그 차별점이 있다. 행동학적 요소에 더하여 소비자는 재화와 서비스를 구매할 때 얻고자 하는 욕구가 있다. 경제학적 관점에서는 이를 선호에 대한 가정을 통해 효용이라는 개념을 도출하지만 현대 사회가 점점 복잡해지면서 이러한 가정에 대해 재고할 필요가 있다. 한편, 경제학 연구에서는 헤도닉 가격 모형을 통해 개별 재화가 가지는 특성 또는 속성을 고려할 수 있다. 이를 통해 소비자가 개별 재화의 특성에 따라 얻고자 하는 욕구가 다르다고 유추할 수 있다고 하더라도 헤도닉 가격 모형은 재화의 가격을 결정하는 데에 장점이 있기 때문에 국내외 실증 연구에서는 가격 결정 모형으로 주로 이용되고 있다. 본 연구에 활용된 설문지는 행동학적 관점에서 한계 소비 성향의 차이 및 개별 재화의 특성에 대한 행위자의 하위 욕구 수준을 탐구하기 위해서 스마트 기기, 의류, 여가 활동에 대한 지출 항목과 태도 측정 항목, 그리고 인구통계학적 항목에 대한 응답을 조사하였고 이화여자대학교 재학생을 287명을 대상으로 설문지가 수집되었다. 행위자의 하위 욕구에 관하여는 기능적/쾌락적 욕구라는 이원적인 구분이 일반적이지만 본 연구에서는 소비 행동이 사회와의 의사소통 행위로서 사회적인 상징성을 별도로 고려하였다. 재화(스마트 기기, 의류)에서는 혁신성에 관한 태도를 측정하였고, 서비스(여가 활동)에서는 여가 관여 수준에 대한 태도를 측정하였다. 즉, 태도를 통해 하위 욕구 수준을 측정할 수 있다는 잠정적인 전제를 하고 있다. 연구 결과, 스마트 기기, 의류, 여가 활동에 지출하는 수준은 행위자 태도와 관련이 있다고 할 수 있으나 스마트 기기에서는 설명변수들의 설명력이 낮다. 본 연구에서는 소비에서 추가적으로 소비하고자 하는 행동 또한 욕구와 밀접하게 연관되었다는 가정 하에 분석을 시행하였지만, 한계 소비 성향에 대해서는 여가 활동에서만 행위자 태도와 양의 관계가 있는 것으로 나타났으며 이 또한 낮은 설명력을 가지고 있다. 추가로, 조사 대상자 집단에서 평균적으로 높은 소득 탄력성이 발견되었고 패널 데이터와 비교한 결과 상당히 높은 수치인 것으로 나타났다. 이는 일반적으로 미시경제 실험 연구와 거시경제 실증 연구에서 나타나는 차이와 유사한 양상이므로 조사 대상자의 대표성 문제이기 보다는 행위자가 소비를 하는 상황과 맥락 의존적인 차이에 대해 조사할 필요가 있다. 여가 활동에서는 설문 조사나 패널 데이터에서 모두 작은 설명력이 도출된 것으로 보아 다른 소비 활동과 구별되는 소비 대상으로 보인다.;The purpose of this study is to attempt to consider the effects of behavioral factors and sub-utilities on consumption behaviors at the same time. Traditional economics literatures, which studied the relation between income and consumption, contented consumption smoothing according to the Life cycle - Permanent Income Hypothesis, and argued that consumption is only affected by the permanent income. However, empirical studies have contradicted this model. Under the Behavioral Life-Cycle Hypothesis (BLCH), both the income and assets are the accounts, the sources of consumption, and the marginal propensity to consume differs by each account. The BLCH explicitly considers the psychological factors. In addition, consumers have desires when they buy goods and services. Traditional economic literatures derive the concept of utility by assuming the preference of actors, but these assumptions need reconsidering as modern societies are becoming more complex. On the other hand, economics studies examine attributes or characteristics of goods with the Hedonic Price Model. This model helps to figure out consumers&amp;apos; different desires from different goods, but empirical studies are done just to set the prices of goods. In the survey of this study, there are items about consumers&amp;apos; expenditures and attitudes toward smart devices, clothes, and leisure activities in order to examine the marginal propensity to consume and the desires of each good. There are also items about demographic characteristics and the participants are 287 undergraduate students in Ewha Womans University. It is general to divide the desires of actors into dual desires - utilitarian and hedonic desires, but this study additionally consider symbolic desire as consumption is a way to communicate with the society which actors belong to. Innovativeness was measured in smart divices and clothes, which are goods, and involvement level was measured in leisure activities, which are service. That is, this study has a basic premise that desires can be measured by attitudes. The survey found that expenditure levels are related to actors&amp;apos; attitudes, but the attitudes and control variables had a poor explanatory power with smart devices. This study was designed to examine the marginal behaviors, but the marginal propensity to consume is related to the attitudes only in leisure activities, which also had a poor explanatory power. On average, the participants showed high levels of income elasticity of consumption. This figure is quite high when comparing to the panel data, and this comparative aspect is similar with that of microeconomics experiments and macroeconomics empirical research, so the circumstance and contextual differences of consumption process need to be considered. In leisure activities, both the survey and the panel data showed low explanatory power, which suggests that leisure is a discriminating consumption target among consumption activities.I. 서론 1 A. 연구의 필요성 및 목적 1 B. 연구 문제 4 II. 이론적 배경 5 A. 행동학적 생애주기 가설 5 B. 소비 행동에 따른 효용의 하위 수준과 재화의 특성 8 1. 재화의 특성, 행위자의 동기와 욕구에 따른 소비 행동의 실현 8 2. 하이테크, 패션 의류, 그리고 여가 활동에서 효용의 하위 수준 11 III. 연구 방법 14 A. 연구 설계 14 B. 측정 도구의 구성 15 C. 측정 도구의 타당도 및 신뢰도 검정 19 1. 측정 도구의 타당도 및 신뢰도 검정 19 2. 세 가지 요인 점수 환산 방법 22 IV. 연구 결과 분석 및 논의 24 A. 조사 대상자의 일반적인 특성 24 1. 조사 대상자들의 인구통계학적 특성 24 2. 조사 대상자 특성별 스마트 기기, 의류, 여가 활동 지출 27 B. 행위자의 태도 및 심적 회계에 따른 영향력 31 1. 스마트 기기에서 나타나는 행위자의 태도와 소비 지출 31 2. 의류 재화에서 나타나는 행위자의 태도와 소비 지출 33 3. 여가 활동에서 나타나는 행위자의 태도와 소비 지출 36 C. 의류 및 여가 활동 지출에서 높은 소득 탄력성 조사 39 D. 과도한 소득 탄력성에 대한 논의: 패널 데이터와의 비교 43 1. 패널 데이터 분석을 위한 모형 설정 43 2. 회귀 분석 결과 44 V. 결론 및 논의 48 A. 연구 결과 요약 48 B. 연구의 한계 49 참고문헌 51 부록 1. 연구 참여 설명문 및 동의서 59 부록 2. 설문지 62 ABSTRACT 68석082

The Political-Sociological Study of Integration of the South Korea and the North Korea

남북한은 분단 이후 상이한 이념을 통해 이질적인 사회발전의 과정을 거졌으나 언어, 역사, 혈연, 문화 등의 요소를 지닌 민족주의를 지니고 있다. 이러한 민족주의 는 남북한 모두에 부정적인 영향을 주었고 남북한 통합에도 걸림돌로 작용할 수 있 다. 남북한통합을 위해서는 기존의 남북한의 민족주의에 대한 비판을 통하여 새로운 민족주의를 도출하려는 노력이 필요하다. 이러한 민족주의는 개방적 민족주의로 정 의될 수 있다. 개방적 민족주의는 남북통일공동체에서 성원들에게 새로운 정체성을 부여해줄 것이며 남북화해와 협력을 지향하며, 다원적인 정치질서를 추구하고 탈계 급적 탈냉전적인 사고를 지향한다. 이 민족주의를 통하여 기존 남북한이 보여준 위 로부터의 강압적인 민족주의를 극복할 수 있을 것이며, 서구에서 보여준 국민민족이 갖는 정치적 근대화의 긍정적인 측면들을 답보할 수 있을 것이다. 남북한의 민족주의는 혈연과 언어를 강조하는 종족적, 원초적인 성격이 강한 민 족주의였다. 특히 북한의 민족주의는 주체사상에 기반한 통치를 위하여 민족주의가 왜곡된 형태로 변형되었으며, 남한의 민족주의는 자유주의와 민주주의 이념과 결합 되지 않은 기형적인 형태로 전개되었다. 그렇기 때문에 서구의 민족주의가 가지고 있는 자유와 평등의 원칙을 남북한 모두 결여되었다고 할 수 있다. 이러한 문제가 있기 때문에 남북한통합에 과정에서는 새로운 민족주의가 요청되는 것이다. 개방적 민족주의는 통합의 과정에서 새로운 공동체의 창출에 맞는 정체성을 성원들에게 부 여해줄 것이고, 자본주의와 사회주의를 결합하는 정치적, 사회적, 경제적인 민주화의 과정을 추진할 것이다. 그것은 탈계급적, 탈냉전적 사고에 기초하여 시장과 효율 성을 강조하며, 다원주의적 정치제도를 제도화하고 남북한의 상호의존성을 높이는 이념적 좌표의 구실을 할 것이다. 단순히 정치적 통일만으로는 통합의 과정을 이룰 수 없기 때문에 남북한의 통일론에 대해 현실주의적인 접근방식이 필요하며, 새로운 국가의 창출이라는 장기적인 과정을 전망하면서 경제적, 정치적, 사회적인 측면의 제도화가 병행되어야 하는 것이다. 그렇기 때문에 개방적 민족주의에 대한 검토, 전 망이 필요한 것이다

A Study of the moderates` status in the making of Korean modern state, 1945-1950

학위논문(박사)--서울대학교 대학원 :사회학과,1999.Docto