Objectives: ：Somatic symptom disorder (SSD) is characterized by the manifestation of a variety of physical symptoms, but little is known about differences in autonomic nervous system activity according to symptom severity, especially within patient groups. In this study, we examined differences in heart rate variability (HRV) across symptom severity in a group of SSD patients to analyze a representative marker of autonomic nervous system changes by symptoms severity. Methods: ：Medical records were retrospectively reviewed for patients who were diagnosed with SSD based on DSM-5 from September 18, 2020 to October 29, 2021. We applied inverse probability of treatment weighting (IPTW) methods to generate more homogeneous comparisons in HRV parameters by correcting for selection biases due to sociodemographic and clinical characteristic differences between groups. Results: ：There were statistically significant correlations between the somatic symptom severity and LF (nu), HF (nu), LF/HF, as well as SD1/SD2 and Alpha1/Alpha2. After IPTW estimation, the mild to moderate group was corrected to 27 (53.0%) and the severe group to 24 (47.0%), and homogeneity was achieved as the differences in demographic and clinical characteristics were not significant. The analysis of inverse probability weighted regression adjustment model showed that the severe group was associated with significantly lower RMSSD (β=-0.70, p=0.003) and pNN20 (β=-1.04, p=0.019) in the time domain and higher LF (nu) (β=0.29, p<0.001), lower HF (nu) (β=-0.29, p<0.001), higher LF/HF (β=1.41, p=0.001), and in the nonlinear domain, significant differences were tested for SampEn15 (β=-0.35, p=0.014), SD1/SD2 (β=-0.68, p<0.001), and Alpha1/Alpha2 (ß=0.43,p=0.001). Conclusions ：These results suggest that differences in HRV parameters by SSD severity were showed in the time, frequency and nonlinear domains, specific parameters demonstrating significantly higher sympathetic nerve activity and reduced ability of the parasympathetic nervous system in SSD patients with severe symptoms.

Objective: The aim of this study was to investigate the association between the use of statins and the occurrence of delirium in a large cohort of patients in the intensive care unit (ICU), considering disease severity and statin properties. Methods: We obtained clinical and demographical information from 3,604 patients admitted to the ICU from January 2013 to April 2020. This included information on daily statin use and delirium state, as assessed by the Confusion Assessment Method for ICU. We used inverse probability of treatment weighting and categorized the patients into four groups based on the Acute Physiology and Chronic Health Evaluation II score (group 1: 0−10 - mild; group 2: 11−20 -mild to moderate; group 3: 21−30 - moderate to severe; group 4: ＞ 30 - severe). We analyzed the association between the use of statin and the occurrence of delirium in each group, while taking into account the properties of statins. Results: Comparisons between statin and non-statin patient groups revealed that only in group 2, patients who were administered statin showed significantly higher occurrence of delirium (p = 0.004, odds ratio [OR] = 1.58) compared to the patients who did not receive statin. Regardless of whether statins were lipophilic (p = 0.036, OR = 1.47) or hydrophilic (p = 0.032, OR = 1.84), the occurrence of delirium was higher only in patients from group 2. Conclusion The use of statins may be associated with the increases in the risk of delirium occurrence in patients with mild to moderate disease severity, irrespective of statin properties.

BACKGOUND: BK virus has emerged as a major cause of allograft loss in kidney transplant recipients over the past decade. The presence of BK virus in urine or blood indicates reactivation of the virus not necessarily accompanied by BK virus associated nephropathy. BK virus genotypes have been described based on the DNA sequence of VP1 region, and no data have been published on BK virus genotypes in Korea. In this study, we sought to determine BK virus genotypes and clinical characteristics associated with BK virus reactivation. METHODS: We isolated BK virus DNA from urine and blood of 103 kidney transplant recipients, and amplified VP1 region using polymerase chain reaction (PCR). The PCR products were sequenced and genotypes of BK virus (I-IV) were determined based on the nucleotide sequence 1744-1812 of the VP1 region. In addition, the clinical characteristics of the patients were analyzed to determine the risk factors of BK virus reactivation. RESULTS: Of 103 patients examined, 16 and 5 patients were shown to have BK viruria and viremia, respectively. Eight viral strains were demonstrated to be genotype I, but the other 8 strains neither matched with the genotypes from I to IV, nor did they fit into any other variants identified in the Western countries. Of note, 3 of these 8 unclassified strains were shown to have the same type of mutations. With respect to the risk factors of BK virus, tacrolimus and mycophenolate mofetil when combined with tacrolimus were found to be significantly associated with BK viruria and viremia. CONCLUSION: It appears that different variants of BK virus are prevalent in Korea compared with the Western countries, and that the reactivation of BK virus is significantly associated with tacrolimus.
Allografts ; Base Sequence ; BK Virus* ; DNA ; Genotype* ; Humans ; Kidney* ; Korea ; Polymerase Chain Reaction ; Risk Factors ; Tacrolimus ; Transplantation* ; Viremia