Purpose: This study aimed to examine the mediating effects of posttraumatic stress and depression on the relationship between perceived stress and suicidality, and to explore the moderating and moderated mediating effects of resilience in this relationship. Methods: This secondary data analysis utilized data from the 2023 G metropolitan city mental health survey, which included 1,000 participants. The analysis was conducted using SPSS/WIN 25.0 and the PROCESS macro 4.3, with significant values of resilience identified using the Johnson- Neyman method. Results: Posttraumatic stress and depression were found to mediate the effect of perceived stress on suicidality. Additionally, resilience moderated the relationships between perceived stress and posttraumatic stress, as well as between posttraumatic stress and depression. Furthermore, resilience had a moderated mediating effect on the relationship between stress and suicidality. Specifically, when resilience levels were between 84.14 and 84.90, posttraumatic stress did not significantly affect depression, and the dual mediating effect of posttraumatic stress and depression on the relationship between stress and suicidality was not observed. Conclusion The findings suggest that developing resilience training programs may be essential for suicide prevention, even in contexts of severe stress or trauma.

Purpose: This study aimed to examine the mediating effects of posttraumatic stress and depression on the relationship between perceived stress and suicidality, and to explore the moderating and moderated mediating effects of resilience in this relationship. Methods: This secondary data analysis utilized data from the 2023 G metropolitan city mental health survey, which included 1,000 participants. The analysis was conducted using SPSS/WIN 25.0 and the PROCESS macro 4.3, with significant values of resilience identified using the Johnson- Neyman method. Results: Posttraumatic stress and depression were found to mediate the effect of perceived stress on suicidality. Additionally, resilience moderated the relationships between perceived stress and posttraumatic stress, as well as between posttraumatic stress and depression. Furthermore, resilience had a moderated mediating effect on the relationship between stress and suicidality. Specifically, when resilience levels were between 84.14 and 84.90, posttraumatic stress did not significantly affect depression, and the dual mediating effect of posttraumatic stress and depression on the relationship between stress and suicidality was not observed. Conclusion The findings suggest that developing resilience training programs may be essential for suicide prevention, even in contexts of severe stress or trauma.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Purpose: This study aimed to examine the mediating effects of posttraumatic stress and depression on the relationship between perceived stress and suicidality, and to explore the moderating and moderated mediating effects of resilience in this relationship. Methods: This secondary data analysis utilized data from the 2023 G metropolitan city mental health survey, which included 1,000 participants. The analysis was conducted using SPSS/WIN 25.0 and the PROCESS macro 4.3, with significant values of resilience identified using the Johnson- Neyman method. Results: Posttraumatic stress and depression were found to mediate the effect of perceived stress on suicidality. Additionally, resilience moderated the relationships between perceived stress and posttraumatic stress, as well as between posttraumatic stress and depression. Furthermore, resilience had a moderated mediating effect on the relationship between stress and suicidality. Specifically, when resilience levels were between 84.14 and 84.90, posttraumatic stress did not significantly affect depression, and the dual mediating effect of posttraumatic stress and depression on the relationship between stress and suicidality was not observed. Conclusion The findings suggest that developing resilience training programs may be essential for suicide prevention, even in contexts of severe stress or trauma.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Purpose: This study aimed to examine the mediating effects of posttraumatic stress and depression on the relationship between perceived stress and suicidality, and to explore the moderating and moderated mediating effects of resilience in this relationship. Methods: This secondary data analysis utilized data from the 2023 G metropolitan city mental health survey, which included 1,000 participants. The analysis was conducted using SPSS/WIN 25.0 and the PROCESS macro 4.3, with significant values of resilience identified using the Johnson- Neyman method. Results: Posttraumatic stress and depression were found to mediate the effect of perceived stress on suicidality. Additionally, resilience moderated the relationships between perceived stress and posttraumatic stress, as well as between posttraumatic stress and depression. Furthermore, resilience had a moderated mediating effect on the relationship between stress and suicidality. Specifically, when resilience levels were between 84.14 and 84.90, posttraumatic stress did not significantly affect depression, and the dual mediating effect of posttraumatic stress and depression on the relationship between stress and suicidality was not observed. Conclusion The findings suggest that developing resilience training programs may be essential for suicide prevention, even in contexts of severe stress or trauma.

Purpose: To investigate urine microbiome differences among healthy women, women with recurrent uncomplicated cystitis (rUC), and those with sporadic/single uncomplicated cystitis (sUC) to challenge traditional beliefs about origins of these infections. Materials and Methods: Patients who underwent both conventional urine culture and next-generation sequencing (NGS) of urine were retrospectively reviewed. Symptom-free women with normal urinalysis results as a control group were also studied. Samples were collected via transurethral catheterization. Results: In the control group, urine microbiome was detected on NGS in 83.3%, with Lactobacillus and Prevotella being the most abundant genera. The sensitivity of urine NGS was significantly higher than that of conventional urine culture in both the sUC group (91.2% vs. 32.4%) and the rUC group (82.4% vs. 16.4%). In urine NGS results, Enterobacterales, Prevotella, and Escherichia/ Shigella were additionally found in the sUC group, while the recurrent urinary tract infection (rUTI)/rUC group exhibited the presence of Lactobacillus, Prevotella, Enterobacterales, Escherichia/Shigella, and Propionibacterium. Moreover, distinct patterns of urine NGS were observed based on menopausal status and ingestion of antibiotics or probiotics prior to NGS test sampling. Conclusions Urine microbiomes in control, sUC, and rUTI/rUC groups exhibited distinct characteristics. Notably, sUC and rUC might represent entirely separate pathological processes, given their distinct urine microbiomes. Consequently, the use of urine NGS might be essential to enhancing sensitivity compared to conventional urine culture in both sUC and rUTI/rUC groups.

Objective: Multilevel posterior cervical fusion (PCF) and decompression surgery is a viable treatment option for multilevel ossification of posterior longitudinal ligament (OPLL) and spondylotic myelopathy. Since OPLL is known to affect bone formation, this study aimed to examine the effect of OPLL on the incidence of pseudarthrosis following PCF in a cohort study. Methods: We conducted a retrospective cohort study of patients with PCF and laminectomy at our institution. This study included patients who underwent C3 to C6 posterior fusion surgery involving lateral mass screw fixation without anterior surgery for OPLL or spondylotic myelopathy. Fusion status was evaluated 1 year postoperatively with computed tomography. Bone mineral density (BMD) and sagittal parameters were also evaluated as potential contributing factors to the fusion rate. Results: Eighty patients were included. Pseudarthrosis was observed in 22.5% (n=18) of patients. Pseudarthrosis incidence was lower in patients with OPLL (spondylosis vs. OPLL, 33.3% vs. 12.2%; p=0.003), and a higher BMD T-score (pseudarthrosis vs. fusion, -1.9 ± 0.7 vs. -0.6 ± 1.3; p<0.01), a larger preoperative range of motion (ROM) (26.7 ± 13.3 vs. 17.6 ± 10.9; p=0.01), and a greater preoperative-to-postoperative decrease in cervical lordosis (-8.1 ± 7.9 vs. -2.7 ± 7.9; p<0.01). Pseudarthrosis was associated with worsening neck pain after surgery. Conclusion The absence of OPLL, lower BMD, larger preoperative ROM, and a greater decrease in postoperative cervical lordosis were identified as risk factors for pseudarthrosis after multiple PCF.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.