Associations between the Type of Tobacco Products and Suicidal Behaviors: A Nationwide Population-Based Study among Korean Adolescents

The relationships between multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), and suicide-related behaviors among adolescents have not been extensively researched. This study examined the associations between the type of tobacco products used and suicidal thoughts, plans, and attempts among Korean adolescents. Data from the 2019 Korea Youth Risk Behavior Web-Based Survey were analyzed, and participants included 57,069 individuals aged 13-18 years. A multivariable logistic regression analysis was performed. Of the total participants, 13.0%, 4.0%, and 2.9% reported suicidal thoughts, suicidal plans, and suicidal attempts, respectively. After adjusting for confounding variables, all tobacco product users showed a greater likelihood of having suicidal behavior. However, compared with never users, dual users of CCs and HTPs were not significantly associated with having suicidal thoughts and attempts. Among tobacco product users, dual users of ECs and HTPs and triple users of CCs, ECs, and HTPs showed a greater likelihood of having suicidal behavior. Considering the prevalence of suicide and the increasing trend of using multiple tobacco products among Korean adolescents, tobacco control policies should monitor the effects of different products

Amphiphilic alpha-helical peptides that induces apoptosis through interacton with Bcl-2

학위논문 (석사)-- 서울대학교 대학원 : 과학교육과(화학전공), 2012. 2. 유재훈.Bcl-2 is one of the pro-survival factors of Bcl-xl family that inhibits apoptosis signaling by interacting with Bak or Bax protein. If it is over-expressed, pro-survival Bcl-2 proteins can lead to non-apoptotic cancerous cells. Thus, a blockage of interaction of Bcl-2 with counter-part proteins could reduce survival factors and finally induce apoptosis. Then, inhibitor of interaction with Bcl-2 might be pro-apoptotic and could be used as an anti-cancer agent. Analogues of Bak or Bax peptides and their mimetic synthetic substance and even small molecules have been intensively studied as pro-apoptotic cancer therapeutics. Structural studies reveal that Bak or Bax binds as an amphipathic and high alpha-helical peptide and makes extensive hydrophobic contacts with the protein. Therefore, we thought that a simple alpha-helical and amphiphilic peptide could bind to Bcl-2 as an anchoring molecule. Then, we could apply a strategy for selecting a tailor-made peptide against Bcl-2 by carrying out mutations in both hydrophilic and hydrophobic faces of the simple peptide, generating selective peptides. We designed and synthesized a library of amphiphilic peptides mainly composed of Arg and Leu, against an intra-cellular protein target, Bcl-2. For changes of hydrophilic and hydrophobic faces of the peptide, alpha-aminoadipic acid (Aad) and Trp were introduced to increase conformational stability and to induce more interactions with the target protein. A selected mutant in hydrophilic face, 13Aad, showed strong pro-apoptotic propensity (EC50 = 8.4 nM). There are several reasons why this peptide is so apoptotic. Firstly, position and carbon number of 13Aad was optimized to induce the highest alpha-helical propensity. Secondly, cellular concentration of peptides could be dependent on cell permeability that is correlated with alpha-helical propensity. Finally, the strongest binding affinity of the peptide against Bcl-2 is also a strong pro-apoptotic factor. The selected peptide could be used as a cancer therapeutic agent inducing apoptosis in its low nanomolar concentration.Maste

비파열성 뇌동맥류에 대한 혈관 내 색전술 시행 후 microemoblic event의 발생- Clopidogrel resistance와의 연관성

As the endovascular technique is developed, it's role in the treatment of intracranial aneurysms is gradually increasing. Although many of the advantages of the endovascular coiling is emerging, adverse event should also be taken into account .This study is design for reveal the relations between PRU(P2Y12 reaction unit) and microembolic event. We used our neurointerventional database to identify a total of 427 consecutive patients who had presented with a unruptured intracranial aneurysms (UIA) for endovascular treatment between July 2011 and June 2014. All patient underwent Diffusion weighted image (DWI) within 2 days after endovascular coiling. Diffusion positive lesions were counted in each patients. During the study period, our policy on antiplatelet agent premedication had changed. By the end of June 2013, when resistance was confirmed by P2Y12 inhibition assay, triple antiplatelet therapy with cilostazol was performed(period I) and then only dual antiplatelet therapy without P2Y12 inhibition assay (period II). There was no significant relations between the PRU value and microembolic event, analyzing cutoff PRU value was 240.(p=.073). However, some statistically significant results were obtained when the PRU value was re-analyzed with categorical unit and continuous variable. Also there was relations between PRU value and the number of microembolic lesions.(p=.010) Antiplatelet premedication was performed to reduce the risk of embolic infarction and adjuvant cilostazol medication was administered to patients whose resistance was confirmed by the p2y12 assay However, the clinical efficacy of cilostazol may be limited due to the inadequate clinical outcome of the cutoff value of resistance.Maste

Trends and Determinants in Breastfeeding among Korean Women: A Nationwide Population-Based Study

Many efforts have been launched to promote breastfeeding in Korea. However, breastfeeding trends and associated factors with breastfeeding in Korea remain unknown. This study aimed to examine trends and determinants in breastfeeding using the Korea National Health and Nutri-tion Examination Survey (KNHANES) (2010?2018). We analyzed data from the KNHANES V (2010?2012), VI (2013?2015), and VII (2016?2018). A total of 9232 women aged 19?49 years were included in this study. We performed multivariable logistic regression analyses to investigate breastfeeding prevalence trends and associated factors with breastfeeding. Compared to 2010?2012, the odds ratio associated with breastfeeding during 2013?2015 and 2016?2018 increased to 1.30 (95% confidence interval (CI): 1.11?1.51) and 1.40 (95% CI: 1.21?1.63), respectively. The breastfeeding rate was associated with 40?49 years (OR, 95% CI: 0.47, 0.34?0.64 compared to 19?29 years), richer and poorer income (1.20, 1.03?1.39 in richer group and 1.24, 1.05?1.46 in poorer group compared to richest group), education level (0.74, 0.65?0.86 in ≤ 12 years of education compared to ≥ 13 years of education), smoking status (1.77, 1.38?2.28 in non-smoking compared to smoking), and self-rated health (1.40, 1.14?1.70 in good and 1.20, 1.00?1.44 in average com-pared to bad). Education programs and policies such as the Baby-Friendly Hospital Initiative (BFHI) and mother-friendly workplaces are necessary to increase the rates of breastfeeding in these groups

Relationship between Perceived Stress and Weight Status in Korean Adults: Focusing Age and Gender Difference

Background: Weight status influences the emotional condition and perceived stress of individuals and may induce psychosocial problems. Recognition of weight status differs according to historical environment, culture, regional background, age, and gender. However, there is limited evidence on this among Koreans. This study aimed to investigate age and gender differences in the relationship between perceived stress and weight status. Methods: The study included 15,068 adults aged ≥19 years (6,306 males, 8,762 females) who participated in the Korea National Health and Nutrition Examination Survey between 2016 and 2018. Perceived stress was measured using a self-administered questionnaire. The odds ratios (ORs) and 95% confidence intervals (CIs) for perceived stress according to weight status stratified by age and gender were analyzed using multivariable logistic regression analysis adjusted for income, education, occupation, marital status, sleep, risky drinking, smoking, physical activity, energy intake, eatingout, dietary supplementation, and having breakfast. Results: Among males, the underweight group aged 19–39 years had a higher OR for perceived stress than the normal weight group (OR, 1.86; 95% CI, 1.04–3.32). However, in females, the obesity group had higher ORs for perceived stress among those aged 19–39 years (OR, 1.44; 95% CI, 1.02–2.04) and those aged 40–59 years (OR, 1.34; 95% CI, 1.03–1.75) compared to normal weight group. Conclusion: The results suggest that perceived stress according to weight status differs by age and gender. Acknowledging these different relationships is required for providing appropriate care for the psychosocial aspects of weight status, taking into account age and gender in Korean adults

Prevalence and Risk Factors of Elevated Alanine Aminotransferase in Korean Adolescents

Background: In developed countries, non-alcoholic fatty liver disease(NAFLD) is the predominant liver disease in adolescents. The main cause of elevated alanine aminotransferase (ALT) in adolescents is NAFLD. This study aimed to estimate the prevalence of elevated ALT in healthy Korean adolescents and to identify the prevalence of metabolic-related diseases and factors associated with elevated ALT. Methods: We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII. The sample comprised 1,417 adolescents (745 boys and 672 girls) aged 12 to 18 years. Logistic regression analysis was performed to identify risk factors for elevated ALT. Results: Out of the 1,417 adolescents, 3.95% were estimated to have elevated ALT. In the group with elevated ALT, the prevalence of hypertension, diabetes, high triglyceride (TG), and low high-density lipoprotein cholesterol (HDL-C) was 42.9%, 5.2%, 20.8%, and 44.0%, respectively. This was significantly higher than in the group without elevated ALT (P<0.001). Multiple logistic regression analysis revealed that elevated ALT was strongly associated with obesity (odds ratio, 15.41; 95% confidence interval [CI], 7.28–32.59) and overweight (odds ratio, 4.02; 95% CI, 1.44–11.23) compared to normal weight (P-value 0.008). Moreover, fasting blood glucose was associated with elevated ALT in adolescents. Conclusion: Elevated ALT was associated with obesity and obesity-related diseases such as hyperglycemia and low HDL-C. Therefore, it is important to manage adolescent obesity, which is a major risk factor for elevated ALT

Factors associated with successful smoking cessation in outpatient smokers after the inintiation of National smoking cessation support program

연구배경: 전세계적으로 흡연으로 인한 질병의 이환 및 사망을 예방하기 위해 담배 및 흡연에 대한 규제 및 관련 정책이 마련되고 있으며 효과적인 금연 성공을 위한 중재법 역시 필요한 상황이다. 이에 금연 성공과 관련된 요인을 파악하여 효과적인 금연 진료를 제공하고 정부의 금연 사업을 통한 흡연율을 낮추는 데 기여하고자하였다. 방법: 본 연구에서는 2015년 4월부터 2019년 12월까지 서울아산병원금연 클리닉에 12주 동안 최소 3회 이상 방문하여 국가 금연 지원사업을 통한 적절한 혜택을 입었다고 판단된 환자 202명의 의무기록을분석하였다. 인구사회학적 및 생활습관 관련 변수, 흡연 형태 관련변수, 금연 치료 관련 변수를 전자 의무기록을 통해 수집하였다. 금연 성공은 마지막 금연 진료 당시 작성된 외래 기록지상 자가 보고된 최근 1주일 동안 금연 상태로 파악하였다. 결과: 진료 사이 간격이 평균 30일 이상인 환자에서 평균 30일 미만인 환자에 비해 금연 성공할 가능성이 낮았다(≥30 days, odds ratio,0.35; 95% confidence interval, 0.18–0.67). 그 이외 연구대상자의 인구학적 특성 및 흡연관련 형태와 관련된 변수들은 성공과 유의한 관련성을 나타내지 않았다. 결론: 금연 진료 횟수 자체는 성공에 영향을 미치지 않았지만 총 금연 진료 횟수보다는 진료 사이의 간격을 30일 미만으로 방문할 때금연 성공률이 높아지는 것을 알 수 있었다. 진료 횟수보다는 단기간에 짧은 간격으로 금연 진료를 받도록 하는 게 금연 성공에 효과적임을 알 수 있었다. 비용-효과 측면에서도 금연 성공률을 높이기위해서는 금연 진료를 초반에 자주 보도록 장려하는 것을 고려해볼 수 있겠다. Background: The morbidity and mortality associated with tobacco use constitute a major health burden worldwide. International efforts are beingmade to legislate laws and policies for smoke-free environments and smoking cessation. We investigated the factors associated with successfulsmoking cessation and thereby contribute to lower smoking prevalence. Methods: We hypothesized that the effect of a smoking cessation treatment could be appropriately evaluated after at least three sessions. A total of 202patients who visited the smoking cessation clinic of Asan Medical Center from April 2015 to December 2019, were included in the analyses. Data onthe participants’ basic demographic characteristics, smoking patterns, and smoking cessation treatment were collected from electronic medicalrecords. Thereafter, smoking cessation was assessed using point prevalence abstinence data. Success was defined as a self-report of no smoking forseven days before a follow-up. Results: The patients who visited the clinic at intervals of 30 days or more had lower odds of succeeding at smoking cessation (odds ratio, 0.35; 95%confidence interval, 0.18–0.67). However, the variables related to demographic characteristics and past smoking patterns did not show a significantassociation with successful smoking cessation. Conclusion: When the interval between sessions was less than 30 days, the patients showed higher odds of smoking cessation success. Unlikenonmodifiable factors such as demographic characteristics, the interval between sessions is a modifiable variable that can be controlled duringsmoking cessation counseling. Thus, it is desirable for patients to have short term follow-ups in the early phase of treatment

Microsurgery Versus Endovascular Treatment - Which Is Adequate for Initial Treatment of Spinal Dural Arteriovenous Fistula: A Case Series

Objective: Considering the adverse natural history of spinal dural arteriovenous fistula (sDAVF), clinical outcomes may be worsened if the initial occlusive trial does not achieve complete fistula occlusion. We aimed to analyze the initial success rate of microsurgery and embolization and confirm the effects of initial treatment success on the clinical outcomes of sDAVF patients. In addition, we investigated the factors associated with initial treatment failure. Methods: A total of 38 patients treated for sDAVF at a single institution over a 14-year period were retrospectively reviewed. Clinical outcomes according to the initial treatment modality were quantitatively analyzed. Demographic characteristics and angioarchitecture data were evaluated to identify factors associated with initial treatment failure. Results: In the study population, 34 patients underwent embolization as the initial treatment, and complete occlusion of the fistula was achieved in 13 patients (38%). However, all patients who underwent microsurgery showed complete fistula occlusion. Among patients with initial treatment success, gait and micturition were improved with statistical significance (p&lt; 0.001 each). However, in cases of initial treatment failure, only mild improvements in gait and micturition were observed, which were not statistically significant (p= 0.097 and p= 0.375, respectively). A narrow feeding artery diameter (p= 0.007) and embolization of the artery only (p= 0.002) were identified as factors associated with initial treatment failure. Conclusion: To achieve symptomatic improvement and prevent neurological deterioration due to recurrence, the initial definite occlusion of the fistula is important. Despite advances in endovascular techniques, microsurgical occlusion is still superior in terms of initial complete obliteration

Longitudinal Changes of Body Weight According to Sex?Age and Metabolic Parameters in Korean Morbid Obese Patients after Sleeve Gastrectomy: 12-Month Retrospective Cohort Study

Background: Bariatric surgery has beneficial effects on weight loss and metabolic profiles in morbidly obese patients. A 12-month retrospective cohort study was performed to investigate changes in body weight according to sex, age, and metabolic parameters among Korean morbidly obese patients after undergoing sleeve gastrectomy. Methods: We included 58 patients with an initial body mass index (BMI) of 35 kg/m2 or more, or a BMI of 30 kg/m2 with metabolic comorbidities, who underwent laparoscopic sleeve gastrectomy. We collected body weight and biochemistry data pre- and post-surgery and analyzed longitudinal changes of body weight and metabolic parameters. Results: The mean preoperative and postoperative weights were 124.77 kg and 92.77 kg (pre- and at 12 months, respectively) in males and 99.21 kg and 75.29 kg in females, respectively (P<0.0001). The mean preoperative and postoperative BMIs were 39.57 kg/m2 and 29.39 kg/m2 in males, and 38.20 kg/m2 and 29.02 kg/m2 in females, respectively (P<0.0001). There was no difference in percent (%) BMI change between males and females. However, younger patients aged <40 years showed a higher % BMI change post-op at 2 weeks, 3 months, 6 months, 9 months, and 12 months than those aged ≥40 years. Metabolic parameters were significantly improved after sleeve gastrectomy. Conclusion: In Korean morbidly obese patients, approximately 25% weight reduction and metabolic improvement were achieved at 12 months after sleeve gastrectomy. Increased percentages of weight change were observed in younger patients. Large-scaled, prospective studies are needed to verify the long-term effectiveness of bariatric surgery in Korean morbidly obese patients