Objective: Tacrolimus intrapatient variability (Tac IPV) has been considered a marker for post-graft risk. We investigated pre-transplant psychometric testing to predict Tac IPV after living kidney transplantation. Methods: Minnesota Multiphasic Personality Inventory-2 (MMPI-2) examined during pre-transplant evaluation by 102 recipients were analyzed. Subjects were divided into two groups, low IPV (L-IPV) and high IPV (H-IPV), by cutoffs of Tac IPV: median of 24 and value of 30. T-scores of MMPI-2 scales were used to analyze difference between L-IPV and H-IPV using independent t-tests. Stepwise multiple logistic regression was used to test whether MMPI-2 scales affected Tac IPV. Confusion matrix of logistic regression was used to explain statistical power. Cutoff values of significant scales for H-IPV were analyzed by constructing receiver operating characteristic curves. Results: Hysteria (Hy) and depression (D) scale scores and Tac IPV were associated in IPV 24 (odds ratio [OR]: 1.08, p<0.01 for Hy; OR: 0.93, p<0.01 for D) and IPV 30 models (OR: 1.09, p<0.01 for Hy; OR: 0.92, p<0.01 for D). Paranoia (Pa) scale scores were associated with Tac IPV in IPV 24 model (OR=1.10, p<0.01) and were significantly higher in H-IPV 24 (p<0.01). F1 scores of confusion matrix in IPV 24 and 30 models were 0.70 and 0.71, respectively. Cutoffs of Hy, D, and Pa scales were 51, 57, and 47, respectively. Conclusion MMPI-2 profile is suggested as a predictor for high Tac IPV after living kidney transplantation.

Objective: Early detection and intervention of developmental disabilities (DDs) are critical to improving the long-term outcomes of afflicted children. In this study, our objective was to utilize facial landmark features from mobile application to distinguish between children with DDs and typically developing (TD) children. Methods: The present study recruited 89 children, including 33 diagnosed with DD, and 56 TD children. The aim was to examine the effectiveness of a deep learning classification model using facial video collected from children through mobile-based application. The study participants underwent comprehensive developmental assessments, which included the child completion of the Korean Psychoeducational Profile-Revised and caregiver completing the Korean versions of Vineland Adaptive Behavior Scale, Korean version of the Childhood Autism Rating Scale, Social Responsiveness Scale, and Child Behavior Checklist. We extracted facial landmarks from recorded videos using mobile application and performed DDs classification using long short-term memory with stratified 5-fold cross-validation. Results: The classification model shows an average accuracy of 0.88 (range: 0.78–1.00), an average precision of 0.91 (range: 0.75–1.00), and an average F1-score of 0.80 (range: 0.60–1.00). Upon interpreting prediction results using SHapley Additive exPlanations (SHAP), we verified that the most crucial variable was the nodding head angle variable, with a median SHAP score of 2.6. All the top 10 contributing variables exhibited significant differences in distribution between children with DD and TD (p<0.05). Conclusion The results of this study provide evidence that facial landmarks, utilizing readily available mobile-based video data, can be used to detect DD at an early stage.

Background: Enavogliflozin is a novel sodium-glucose cotransporter-2 inhibitor currently under clinical development. This study evaluated the efficacy and safety of enavogliflozin as an add-on to metformin in Korean patients with type 2 diabetes mellitus (T2DM) against dapagliflozin. Methods: In this multicenter, double-blind, randomized, phase 3 study, 200 patients were randomized to receive enavogliflozin 0.3 mg/day (n=101) or dapagliflozin 10 mg/day (n=99) in addition to ongoing metformin therapy for 24 weeks. The primary objective of the study was to prove the non-inferiority of enavogliflozin to dapagliflozin in glycosylated hemoglobin (HbA1c) change at week 24 (non-inferiority margin of 0.35%) (Clinical trial registration number: NCT04634500). Results: Adjusted mean change of HbA1c at week 24 was –0.80% with enavogliflozin and –0.75% with dapagliflozin (difference, –0.04%; 95% confidence interval, –0.21% to 0.12%). Percentages of patients achieving HbA1c <7.0% were 61% and 62%, respectively. Adjusted mean change of fasting plasma glucose at week 24 was –32.53 and –29.14 mg/dL. An increase in urine glucose-creatinine ratio (60.48 vs. 44.94, P<0.0001) and decrease in homeostasis model assessment of insulin resistance (–1.85 vs. –1.31, P=0.0041) were significantly greater with enavogliflozin than dapagliflozin at week 24. Beneficial effects of enavogliflozin on body weight (–3.77 kg vs. –3.58 kg) and blood pressure (systolic/diastolic, –5.93/–5.41 mm Hg vs. –6.57/–4.26 mm Hg) were comparable with those of dapagliflozin, and both drugs were safe and well-tolerated. Conclusion Enavogliflozin added to metformin significantly improved glycemic control in patients with T2DM and was non-inferior to dapagliflozin 10 mg, suggesting enavogliflozin as a viable treatment option for patients with inadequate glycemic control on metformin alone.

Purpose: This study examined the variations in nursing competence and job satisfaction across different career stages. Additionally, it explored the effect of nursing competence on job satisfaction within each career stages. Methods: Participants were 468 nurses working at a university hospital in B city. Data collection was conducted using self-report questionnaires from April 1 to 15, 2020. The data were analyzed descriptive statistics, one-way ANOVA, Scheffé test, and multiple regression analysis employing SPSS 23.0. Results: General nursing competence improved significantly after the proficiency stage. Care execution and critical thinking were improved as nurses progressed from the novice to the advanced beginner stage. Additionally, communication showed progress in the competent stage. Furthermore, responsibility and self-development were improved after the proficiency stage.Among the sub-competencies examined, self-development, care execution, and communication significantly influenced the job satisfaction of a nurse’s career. Moreover, self-development was influential at all stages. Conclusion This study shows that there was no substantial improvement in nursing competencies as they progressed through various career stages. Self-development was the most crucial sub-competence impacting job satisfaction, with the effects of the sub-competencies varying across career stages. These results will aid in planning clinical continuing education and formulating policies to enhance nurse competency.

In this study, the Search Your Mind (S.Y.M., 心) project aimed to collect prospective digital phenotypic data centered on mood and anxiety symptoms across psychiatric disorders through a smartphone application (app) platform while using both centralized and decentralized research designs: the centralized research design is a hybrid of a general prospective observational study and a digital platform-based study, and it includes face-to-face research such as informed written consent, clinical evaluation, and blood sampling. It also includes digital phenotypic assessment through an application-based platform using wearable devices. Meanwhile, the decentralized research design is a non-face-to-face study in which anonymous participants agree to electronic informed consent forms on the app. It also exclusively uses an application-based platform to acquire individualized digital phenotypic data. We expect to collect clinical, biological, and digital phenotypic data centered on mood and anxiety symptoms, and we propose a possible model of centralized and decentralized research design.

Purpose: We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods: Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results: Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Purpose: We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods: Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results: Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

PURPOSE: Oak is the dominant tree species in Korea. Oak pollen has the highest sensitivity rate among all allergenic tree species in Korea. A deep neural network (DNN)-based estimation model was developed to determine the concentration of oak pollen and overcome the shortcomings of conventional regression models. METHODS: The DNN model proposed in this study utilized weather factors as the input and provided pollen concentrations as the output. Weather and pollen concentration data were used from 2007 to 2016 obtained from the Korea Meteorological Administration pollen observation network. Because it is difficult to prevent over-fitting and underestimation by using a DNN model alone, we developed a bootstrap aggregating-type ensemble model. Each of the 30 ensemble members was trained with random sampling at a fixed rate according to the pollen risk grade. To verify the effectiveness of the proposed model, we compared its performance with those of models of regression and support vector regression (SVR) under the same conditions, with respect to the prediction of pollen concentrations, risk levels, and season length. RESULTS: The mean absolute percentage error in the estimated pollen concentrations was 11.18%, 10.37%, and 5.04% for the regression, SVR and DNN models, respectively. The start of the pollen season was estimated to be 20, 22, and 6 days earlier than that predicted by the regression, SVR and DNN models, respectively. Similarly, the end of the pollen season was estimated to be 33, 20, and 9 days later that predicted by the regression, SVR and DNN models, respectively. CONCLUSIONS: Overall, the DNN model performed better than the other models. However, the prediction of peak pollen concentrations needs improvement. Improved observation quality with optimization of the DNN model will resolve this issue.
Korea ; Pollen ; Quercus ; Rhinitis, Allergic ; Rhinitis, Allergic, Seasonal ; Seasons ; Trees ; Weather

PURPOSE: The pollen calendar is the simplest forecasting method for pollen concentrations. As pollen concentrations are liable to seasonal variations due to alterations in climate and land-use, it is necessary to update the pollen calendar using recent data. To attenuate the impact of considerable temporal and spatial variability in pollen concentrations on the pollen calendar, it is essential to employ a new methodology for its creation.METHODS: A pollen calendar was produced in Korea using data from recent observations, and a new method for creating the calendar was proposed, considering both risk levels and temporal resolution of pollen concentrations. A probability distribution was used for smoothing concentrations and determining risk levels. Airborne pollen grains were collected between 2007 and 2017 at 8 stations; 13 allergenic pollens, including those of alder, Japanese cedar, birch, hazelnut, oak, elm, pine, ginkgo, chestnut, grasses, ragweed, mugwort and Japanese hop, were identified from the collected grains.RESULTS: The concentrations of each pollen depend on locations and seasons due to large variability in species distribution and their environmental condition. In the descending order of concentration, pine, oak and Japanese hop pollens were found to be the most common in Korea. The pollen concentrations were high in spring and autumn, and those of oak and Japanese hop were probably the most common cause of allergy symptoms in spring and autumn, respectively. High Japanese cedar pollen counts were observed in Jeju, while moderate concentrations were in Jeonju, Gwangju and Busan.CONCLUSIONS: A new methodology for the creation of a pollen calendar was developed to attenuate the impact of large temporal and spatial variability in pollen concentrations. This revised calendar should be available to the public and allergic patients to prevent aggravation of pollen allergy.
Alnus ; Ambrosia ; Artemisia ; Asian Continental Ancestry Group ; Betula ; Busan ; Climate ; Corylus ; Cryptomeria ; Forecasting ; Ginkgo biloba ; Gwangju ; Humans ; Hypersensitivity ; Jeollabuk-do ; Korea ; Methods ; Poaceae ; Pollen ; Rhinitis, Allergic, Seasonal ; Seasons