Publications by authors named "Yunmi Kim"

44 Publications

Photo-CIDNP in Solid State.

Appl Magn Reson 2021 Apr 6:1-17. Epub 2021 Apr 6.

Institut für Medizinische Physik und Biophysik, Universität Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany.

Photo-CIDNP (photo-chemically induced dynamic nuclear polarization) refers to nuclear polarization created by the spin-chemical evolution of spin-correlated radical pairs (SCRPs). This phenomenon occurs in gases, liquids and solids. Based on the solid-state photo-CIDNP effect observed under magic-angle spinning (MAS), photo-CIDNP MAS NMR has been developed as analytical method. Here we report the origin, the theory and the state of the art of this method.
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http://dx.doi.org/10.1007/s00723-021-01322-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021640PMC
April 2021

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet.

Yonsei Med J 2021 Apr;62(4):315-324

Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Purpose: To determine seasonal variations in serum potassium levels among hemodialysis patients.

Materials And Methods: This was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√{n/(n-1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis.

Results: The analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K, 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K, 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (<0.001) and spring (=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, =0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd-4th quartiles) were 2.8-4.2 fold more likely to be in the high potassium group.

Conclusion: Different seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.
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http://dx.doi.org/10.3349/ymj.2021.62.4.315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007431PMC
April 2021

Changes in renal function and predictors affecting renal outcome of living kidney donors: a nationwide prospective cohort study.

Nephrology (Carlton) 2021 Jun 15;26(6):541-548. Epub 2021 Apr 15.

Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea.

Aim: The safety of donors is an important issue in living donor kidney transplantation. We investigated serial changes in renal function and predictors affecting the renal outcome of living kidney donors.

Methods: We obtained the data of 456 kidney donors registered to the Korean Organ Transplantation Registry from 2014 to 2016. The estimated glomerular filtration rate (eGFR) changes according to the development of incident chronic kidney disease (CKD) and factors related to CKD were analysed. CKD was defined as an eGFR <60 ml/min/1.73 m or the presence of proteinuria or albuminuria. The change in eGFR over time was analysed using a linear mixed model.

Results: At 2 years after kidney donation, 21.7% of the donors (99/456) developed CKD. Annual eGFR changes after nephrectomy were 2.2 ml/min/1.73 m /year in donors without CKD, and - 0.4 ml/min/1.73 m /year in donors with CKD. Higher systolic blood pressure was associated with higher risk of CKD (odds ratio [OR] 1.322 per 10 mmHg increment, 95% confidence interval [CI] 1.036-1.686, p = .025). Higher pre-donation eGFR (OR 0.906 per 1 ml/min/1.73 m increment, 95% CI 0.876-0.936, p < .001) and higher ratio of eGFR at discharge to pre-donation (OR 0.603 per 0.1 increment, 95% CI 0.426-0.849, p = .004) were related to lower risk of CKD.

Conclusion: Kidney donors without incident CKD at 2 years after donation showed gradual increases in eGFR, whereas donors with CKD had relatively constant eGFR. A low ratio of eGFR at discharge after nephrectomy to baseline was a risk factor of CKD.
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http://dx.doi.org/10.1111/nep.13880DOI Listing
June 2021

Genetic identification of inherited cystic kidney diseases for implementing precision medicine: a study protocol for a 3-year prospective multicenter cohort study.

BMC Nephrol 2021 01 6;22(1). Epub 2021 Jan 6.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Background: Inherited cystic kidney disease is a spectrum of disorders in which clusters of renal cysts develop as the result of genetic mutation. The exact methods and pipelines for defining genetic mutations of inherited cystic kidney disease are not clear at this point. This 3-year, prospective, multicenter, cohort study was designed to set up a cohort of Korean patients with inherited cystic kidney disease, establish a customized genetic analysis pipeline for each disease subtype, and identify modifying genes associated with the severity of the disease phenotype.

Methods/design: From May 2020 to May 2022, we aim to recruit 800 patients and their family members to identify pathogenic mutations. Patients with more than 3 renal cysts in both kidneys are eligible to be enrolled. Cases of simple renal cysts and acquired cystic kidney disease that involve cyst formation as the result of renal failure will be excluded from this study. Demographic, laboratory, and imaging data as well as family pedigree will be collected at baseline. Renal function and changes in total kidney volume will be monitored during the follow-up period. Genetic identification of each case of inherited cystic kidney disease will be performed using a targeted gene panel of cystogenesis-related genes, whole exome sequencing (WES) and/or family segregation studies. Genotype-phenotype correlation analysis will be performed to elucidate the genetic effect on the severity of the disease phenotype.

Discussion: This is the first nationwide cohort study on patients with inherited cystic kidney disease in Korea. We will build a multicenter cohort to describe the clinical characteristics of Korean patients with inherited cystic kidney disease, elucidate the genotype of each disease, and demonstrate the genetic effects on the severity of the disease phenotype.

Trial Registration: This cohort study was retrospectively registered at the Clinical Research Information Service ( KCT0005580 ) operated by the Korean Center for Disease Control and Prevention on November 5th, 2020.
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http://dx.doi.org/10.1186/s12882-020-02207-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786983PMC
January 2021

Association between Dialysis Adequacy and Cognition in Patients with Peritoneal Dialysis.

Psychiatry Investig 2020 Nov 18;17(11):1143-1148. Epub 2020 Nov 18.

Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Objective: Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis.

Methods: Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck's depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function.

Results: RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V.

Conclusion: Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.
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http://dx.doi.org/10.30773/pi.2020.0279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711114PMC
November 2020

Effect of ambulatory blood pressure monitoring guided antihypertensive treatment on renal progression in patients with chronic kidney disease: a randomized comparative study.

J Hypertens 2021 Feb;39(2):325-332

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Objectives: Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear.

Methods: Patients with hypertension and CKD stage 3-4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months.

Results: A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was -5.5 [95% confidence interval (95% CI) -7.7 to  -3.4] ml/min per 1.73 m2 in the ABPM group and -5.0 (95% CI -6.9 to -3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120).

Conclusion: The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes.
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http://dx.doi.org/10.1097/HJH.0000000000002624DOI Listing
February 2021

Lyophilization Reveals a Multitude of Structural Conformations in the Chromophore of a Cph2-like Phytochrome.

J Phys Chem B 2020 08 6;124(33):7115-7127. Epub 2020 Aug 6.

Institut für Analytische Chemie, Universität Leipzig, Linnéstraße 3, 04103 Leipzig, Germany.

Cyanobacteria sense and respond to various colors of light employing a large number of bilin-based phytochrome-like photoreceptors. All2699 from 7120 has three consecutive GAF domains with GAF1 and GAF3 binding a phycocyanobilin chromophore. GAF1, even when expressed independently, can be photoconverted between red-absorbing Pr and far-red-absorbing Pfr states, while the nonphotosensory GAF2 domain is structurally and functionally homologous to the PHY domains in canonical and Cph2-like phytochromes. Here, we characterize possible bilin chromophore conformers using solid-state NMR spectroscopy on the two lyophilized All2699 samples (GAF1-only and GAF1-PHY constructs). On the basis of complete H, C, and N assignments for the chromophore obtained on the two Pr lyophilizates, multiple static conformations of the chromophore in both cases are identified. Moreover, most atoms of the chromophore in the bidomain sample show only subtle changes in the mean chemical shifts relative to those in frozen solution (FS), indicating an optimized interaction of the GAF2 domain with the GAF1-bound chromophore. Our results confirm the conservation of key chromophore-protein interactions and the photoreversibility in both All2699 lyophilizates, offering the possibility to investigate conformational distributions of the heterogeneous chromophore and its functional consequences in phytochromes and other bilin-dependent photoreceptors intractable by the solid-state NMR technique as FSs.
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http://dx.doi.org/10.1021/acs.jpcb.0c03431DOI Listing
August 2020

Role of Prior Split Renal Function for Living Kidney Transplantation in Recipients and Donors.

Transplant Proc 2020 Dec 27;52(10):3002-3008. Epub 2020 Jun 27.

Transplantation Center, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Korea. Electronic address:

Purpose: The purpose of this study was to determine the relationship between pre-operative donor split renal function (SRF) and the renal function outcome of donors and recipients after kidney transplantation (KT).

Methods: A total of 217 living KT cases were investigated. The estimated glomerular filtration rate (eGFR) change of recipients and donors, as well as graft survival, were analyzed based on the donor SRF. The difference in SRF (dSRF) in a donor was defined as follows: the SRF of the donated kidney minus the SRF of the remaining kidney determined by pre-operative Tc-diethylenetriaminepentaacetic acid in the donors. The dSRF was categorized into tertiles.

Results: The dSRF was not associated with the eGFR in recipients in any tertile at 6 or 12 months post-KT. The overall graft and patient survival did not differ significantly among tertiles. Donors in the high tertile, who donated kidneys with a higher SRF, showed a greater reduction in eGFR than did donors in the low and middle tertile after adjustment for function of the not-donated kidney (-34 ± 1.9 vs -28 ± 2.2, and -27 ± 1.3 mL/min/1.73 m, P < .05).

Conclusions: The dSRF did not affect the post-KT renal function or graft survival in recipients. However, the donors who donated the better functioning kidney had a poorer renal function after donation.
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http://dx.doi.org/10.1016/j.transproceed.2020.05.012DOI Listing
December 2020

In-Hospital Mortality in Patients Receiving Percutaneous Coronary Intervention According to Nurse Staffing Level: An Analysis of National Administrative Health Data.

Authors:
Yunmi Kim Jiyun Kim

Int J Environ Res Public Health 2020 05 27;17(11). Epub 2020 May 27.

School of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Korea.

The increasing incidence of ischemic heart disease is concomitantly increasing percutaneous coronary intervention (PCI) treatments. Adequate nurse staffing has enhanced quality of care and this study was conducted to determine the relationship between survival-related PCI treatment and the level of nursing staff who care for patients admitted to receive PCI. National Health Insurance claims data from 2014 to 2015 for 67,927 patients who underwent PCI in 43 tertiary hospitals were analyzed. The relationships of nurse staffing in intensive care units (ICUs) and general wards with survival after PCI were investigated using logistic regression analyses with a generalized estimation model. The in-hospital mortality rate in ICUs was lower in hospitals with first-grade nurse staffing {odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.23-0.48}, second-grade nurse staffing (OR = 0.55, 95% CI = 0.40-0.77), or third-grade nurse staffing (OR = 0.71, 95% CI = 0.53-0.95) than in hospitals with fifth-grade nurse staffing. Nurse staffing in general wards was not related to in-hospital mortality due to PCI treatment. This study found that nurse staffing in PCI patients requiring short-term intensive care significantly affected patient survival. An understanding of the importance of managing the ICU nursing workforce for PCI treatment is required.
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http://dx.doi.org/10.3390/ijerph17113799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313060PMC
May 2020

Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data.

BMC Nurs 2020 7;19:36. Epub 2020 May 7.

3Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.

Background: The level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs.

Methods: This study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio.

Results: The in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall.

Conclusions: Since the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.
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http://dx.doi.org/10.1186/s12912-020-00430-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206788PMC
May 2020

Activation of the alternative complement pathway predicts renal outcome in patients with lupus nephritis.

Lupus 2020 Jul 14;29(8):862-871. Epub 2020 May 14.

Division of Rheumatology, Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea.

Objectives: The aims of this study were to clarify the activation of complement pathways in patients with lupus nephritis (LN), and to elucidate the association between these complement activation types and clinical outcomes.

Methods: We enrolled 115 patients with biopsy-proven LN from 2003 to 2016 from the lupus cohort at the Busan Paik Hospital and the Jeju National University Hospital in Korea. The patients were divided into two groups based on the patterns of glomerular complements deposits. The presence of C1q, C4 and/or C3 deposits in the glomerulus was considered evidence for the activation of the classical pathway with or without alternative pathway activation (group 1,  = 93), and glomerular C3 deposition without C1q and C4 deposits was considered as a marker for the alternative pathway limited activation (group 2,  = 22). The study end point was progression of kidney disease defined as a ≥50% reduction in estimated glomerular filtration rate from baseline values or advancement to end-stage renal disease.

Results: The mean estimated glomerular filtration rate and median urine protein-to-creatinine ratio of the patients were 85.7 ± 32.4 mL/min/1.73 m and 3.1 g/g, respectively, at the time of kidney biopsy. Forty-nine patients (43%) had nephrotic range of proteinuria. Compared to group 1 patients, those in group 2 were older, were more likely to be males and were more hypertensive. In addition, plasma C3 and C4 levels were significantly lower in group 1 patients compared to those in group 2. Moreover, anti-dsDNA concentration was significantly higher in group 1 patients compared to those in group 2. The mean follow-up time was 5.4 ± 3.4 years. The rates of response to one-year immunosuppressive treatment were poorer in group 2 patients compared to those in group 1. During the follow-up time, the progression of kidney disease was significantly higher in group 2 than in group 1 patients.

Conclusion: This study showed that there was alternative complement pathway limited activation in the renal tissue in a small number of patients with LN, and these patients had worse renal outcomes compared to patients with glomerular classical complement pathway activation with or without alternative pathway activation.
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http://dx.doi.org/10.1177/0961203320925165DOI Listing
July 2020

Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data.

BMC Nurs 2020 17;19:17. Epub 2020 Mar 17.

3Department of Nursing, Dongseo University, 47 Jurye-ro, Saha-gu, Busan, 47011 Republic of Korea.

Background: The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. However, less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Therefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery using national administrative data.

Methods: The study analyzed data from 129,923 patients who underwent surgery between January 2014 and December 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5-3.4), level 3 (3.5-4.4), and level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the association between the bed-to-nurse ratio and 30-day post-discharge mortality.

Results: 1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in hospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8% in hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower at hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference.

Conclusion: The results of this study are highly meaningful in that they underscore the necessity of in-hospital discharge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk. Furthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need for a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea, and thereby to enhance patient outcomes.
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http://dx.doi.org/10.1186/s12912-020-0410-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076936PMC
March 2020

Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament.

J Pediatr Psychol 2020 03;45(2):203-217

Starship Children's Hospital.

Objective: Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep.

Method: Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old.

Results: Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07-1.73) but not postnatal (1.22, 0.88-1.68) or both antenatal and postnatal depression (0.89, 0.56-1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity.

Conclusion: Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.
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http://dx.doi.org/10.1093/jpepsy/jsaa001DOI Listing
March 2020

Real-world treatment patterns of renal anemia in hemodialysis patients: A multicenter cohort study performed using DialysisNet (RRAHD study).

Medicine (Baltimore) 2020 Jan;99(2):e18749

Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine.

A multicenter cohort study.The DialysisNet was previously developed for the management of hemodialysis (HD) patients based on the American Society for Testing and Materials Continuity of Care Records by metadata transformation. DialysisNet is a dialysis patient management program created by using the personal health record care platform to overcome the problems of registry studies, in real-time.Here, we aimed to investigate the pattern of treatment for renal anemia in HD patients using DialysisNet.We performed a multicenter cohort study among HD patients who were treated at one of the three Korean university-affiliated hospitals from January 2016 to December 2016. Subjects were divided into 4 hemoglobin variability groups by quartiles. The variable anemia treatment pattern was reviewed. To determine renal anemia treatment patterns, we automatically collected information on the practice of anemia treatment patterns such as erythropoietin stimulating agent (ESA) doses and administration frequencies, and targeted hemoglobin maintenance rate. Individual hemoglobin variabilities were expressed as (standard deviations)/(√(n/[n-1]).The records of 159 patients were analyzed (Hospital A: 35, Hospital B: 21, Hospital C: 103). Mean patients' age was 65.6 ± 12.8 years, and 61.6% were men. Overall, hemoglobin level was 10.5[7.43;13.93] g/dL. 158 (99.3%) patients were using ESA; and overall, the epoetin alfa dose was 33,000[4000;136,800] U per week. Hemoglobin levels (P = .206) and epoetin alfa doses were similar (P = .924) for patients with different hemoglobin variabilities. The hemoglobin target maintenance rate was lower in the highest hemoglobin variability group than in the lowest variability group (P = .045).In this study, detailed information on the actual anemia treatment patterns were obtained using the DialysisNet. We expect that DialysisNet will simplify and improve the renal anemia management for both dialysis patients and health care providers.
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http://dx.doi.org/10.1097/MD.0000000000018749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959890PMC
January 2020

Associations of obesity with osteoporosis and metabolic syndrome in Korean postmenopausal women: a cross-sectional study using national survey data.

Arch Osteoporos 2019 06 19;14(1):64. Epub 2019 Jun 19.

College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, 13135, Republic of Korea.

In a representative sample of 3058 Korean postmenopausal women, we studied which types of obesity were more or less desirable for developing concomitant osteoporosis and metabolic syndrome (MS), with the goal of helping clinicians identify steps to reduce patients' risk. Different definitions of obesity showed different relationships with osteoporosis and MS in this population.

Purpose: To examine sample characteristics, prevalence, and the risk of osteoporosis and metabolic syndrome among four groups of postmenopausal women classified by obesity.

Methods: Data from the Korea National Health and Nutrition Examination Survey were analyzed using the Rao-Scott chi-square test, analysis of variance, and multinomial logistic regression analysis. The four groups included body mass index (BMI)-based obese, waist circumference (WC)-based obese, BMI-, and WC-based obese, and non-obese women, using BMI and WC cutoffs for obesity of ≥ 25 kg/m and ≥ 80 cm, respectively.

Results: The prevalence of osteoporosis and MS was 40.8% and 48.5%, respectively. Age, socioeconomic status, smoking status, and hormone therapy use differed among the obese groups. The odds ratios of simultaneously having both osteoporosis and MS in the BMI- and WC-based obese, BMI-based obese, WC-based obese, and non-obese groups were 7.39 (95% confidence interval [CI] = 4.83-11.31), 0.74 (95% CI = 0.27-1.98), 7.07 (95% CI = 4.72-10.58), and 1, respectively.

Conclusions: The findings demonstrate the most and the least desirable types of obesity in terms of risk for both osteoporosis and MS. Public health practitioners may consider the type of obesity to reduce or prevent both conditions in postmenopausal women.
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http://dx.doi.org/10.1007/s11657-019-0615-0DOI Listing
June 2019

Factors and help-seeking behaviors associated with depression in Korean adults: Review of data from 2014 and 2016 Korea national health and nutrition examination surveys.

Psychiatry Res 2019 05 9;275:10-19. Epub 2019 Mar 9.

Red Cross College of Nursing, Chung-Ang University, 84, Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea.

As a health problem in Korea, the prevalence of depression is continuously increasing. This study examines factors and help-seeking behaviors associated with depression in Korean adults. Data was extracted from Korea National Health and Nutrition Examination Surveys (2014 and 2016) using the PHQ-9 depression screening instrument. Among 10,459 participants (weighted frequency = 36,418,292) over 19 years old, 7.2% were classified as having depression including depressive symptoms (PHQ-9 scores ≥ 10) or depressive disorders diagnosed by psychiatrists. Among those with depression, 58.6% responded that they had never sought help. Statistically high odds ratios for being at risk for depression include being female, aged 19-39, living alone, low household income, low level of education (middle school or lower), occupation (unemployed/inactive), an ex- or current smoker, having a chronic disease, and being underweight. Statistically low odds ratios for seeking counselling, age ≥ 60 and lower than high household income; for seeing doctor, age 19-39 or ≥60; and for treatment, age 19-39, lower than middle household income, and more than once per week drinking frequency. Overall, there is a need to find persons having these risk factors and to develop tailored strategies that will encourage help-seeking behavior with help-seeking intention.
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http://dx.doi.org/10.1016/j.psychres.2019.03.013DOI Listing
May 2019

Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea.

Kidney Res Clin Pract 2019 Mar;38(1):15-24

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term "renal disaster" suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.
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http://dx.doi.org/10.23876/j.krcp.18.0058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481979PMC
March 2019

The authors' reply.

Kidney Res Clin Pract 2018 Dec 31;37(4):421-422. Epub 2018 Dec 31.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.23876/j.krcp.18.0136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312767PMC
December 2018

Terminal lucidity in the teaching hospital setting.

Death Stud 2020 4;44(5):285-291. Epub 2018 Dec 4.

Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.

Terminal lucidity is an unpredictable end-of-life experience that has invaluable implications in preparation for death. We retrospectively evaluated terminal lucidity at a university teaching hospital. Of 338 deaths that occurred during the study period (187 in the ICU and 151 in general wards), terminal lucidity was identified in 6 cases in general wards. Periods of lucidity ranged from several hours to 4 days. After experiencing terminal lucidity, half of the patients died within a week, and the remainder died within 9 days. More attention should be directed toward understanding terminal lucidity to improve end-of-life care in a meaningful way.
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http://dx.doi.org/10.1080/07481187.2018.1541943DOI Listing
December 2018

Association Between Depression and Metabolic Syndrome in Korean Adults: Data From the 2014 and 2016 Korea National Health and Nutrition Examination Survey.

Asia Pac J Public Health 2019 01 23;31(1):18-29. Epub 2018 Nov 23.

2 Jeonju University, Jeonju-si, Republic of Korea.

This study aimed to examine the association of depression with metabolic syndrome and to investigate levels of awareness and treatment of depression in Korean adults. We analyzed data extracted from the Korea National Health and Nutrition Examination Survey (2014 and 2016) using the Patient Health Questionnaire-9 depression screening instrument. Among the survey participants, 10 459 were selected for data analysis. Of them, 7.2% had depression, 24.4% had metabolic syndrome, and 10.0% had both depression and metabolic syndrome. Among those with depression, 33.1% were aware of their condition and 25.7% received treatment, with significant differences found between those with and without metabolic syndrome. The mean Patient Health Questionnaire-9 scores significantly increased with the number of metabolic syndrome components ( F = 6.06, P = <.001). In logistic regression analysis, the odds ratio (OR) for depression with metabolic syndrome was 1.41 (95% confidence interval [CI] = 1.12-1.76). For the number of metabolic syndrome components, having 2 (OR = 1.37, 95% CI = 1.01-1.86), 3 (OR = 1.57, 95% CI = 1.12-2.21), 4 (OR = 1.95, 95% CI = 1.32-2.87), and 5 (OR = 2.18, 95% CI = 1.38-3.46) conditions significantly increased the OR for depression. Including depression in the management of metabolic syndrome could help make people with depression more aware of their condition.
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http://dx.doi.org/10.1177/1010539518813704DOI Listing
January 2019

Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea.

Kidney Int Rep 2018 Nov 4;3(6):1385-1393. Epub 2018 Aug 4.

Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Introduction: Conflicting results still exist regarding the benefit of renin-angiotensin-aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD).

Methods: Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event-free survival were estimated.

Results: Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.35-0.58,  < 0.0001). Major cardiovascular event-free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95% CI = 0.20-0.37,  < 0.0001), considering the cumulative duration of RAAS blockade use.

Conclusion: In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.
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http://dx.doi.org/10.1016/j.ekir.2018.07.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224622PMC
November 2018

Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests: An analysis of the standardized mortality ratio from the Korean Buddhist priests cohort.

Medicine (Baltimore) 2018 Nov;97(45):e13099

Department of Internal Medicine, Dongguk University College of Medicine.

Buddhist priests lead a unique lifestyle, practicing asceticism, with a vegetarian diet. Such behavior may have an impact on clinical outcomes. Hence, we explored the mortality among Korean Buddhist priests as compared with the general population.This study is a single-center, retrospective study. Among the 3867 Buddhist priests who visited Dongguk University Gyeongju Hospital between January 2000 and February 2016, 3639 subjects were available for mortality data from Statistics Korea. Standardized mortality ratio (SMR) was computed for all causes of death and compared with the general population using national statistics in Korea. Information regarding end-stage renal disease (ESRD) was investigated from the Korean Society of Nephrology registry. Among the 3639 patients, the baseline laboratory results were obtained in 724 patients. Chronic kidney disease (CKD) was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate <60 mL/min/1.73 m.The mean age was 50.0 ± 12.5 years, and 51.0% were men. During the follow-up period for 31.1 ± 35.6 months, 55 (7.6%) patients died. During the follow-up period, 3 (0.4%) and 23 (3.2%) patients developed ESRD and urinary stone, respectively. The SMR for all causes of death was 0.76 (95% confidence interval [CI] 0.57-0.99; men 0.91, 95% CI 0.65-1.23; women 0.52, 95% CI 0.28-0.87). Among 724 patients, 74 (10.2%) patients had CKD. The SMR for non-CKD patients (0.61, 95% CI 0.43-0.85) was significantly lower than the general population. Female and patients older than 50 years (0.74, 95% CI 0.55-0.98) had a significantly lower SMR. In the Cox proportional hazards model with adjustment, older age (adjusted HR 1.04, 95% CI 1.10-1.07) and presence of CKD (adjusted HR 2.55, 95% CI 1.07-6.06) were independently associated with increased all-cause mortality.Buddhist priests and especially Buddhist priests without CKD showed a significantly lower mortality compared with the general population.
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http://dx.doi.org/10.1097/MD.0000000000013099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250507PMC
November 2018

Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data.

Int J Nurs Stud 2019 Jan 1;89:104-111. Epub 2018 Oct 1.

Insurance Benefit Department, National Health Insurance Corporation, Republic of Korea.

Background: Nurses play crucial roles in cardiopulmonary resuscitation after perioperative cardiac arrest (PCA), and the level of nurse staffing is thought to influence the survival rate for cardiac arrest. However, no previous study has investigated the survival rate after PCA in Korea. In addition, nurse staffing levels in Korea are relatively low and their legal standard is not widely followed.

Objectives: This study investigated the relationships between nurse staffing level and survival after PCA in Korean hospitals using inpatient National Health Insurance (NHI) claim data.

Methods: The study used NHI claim data on patient and hospital characteristics for 2140 patients undergoing craniotomy or percutaneous angioplasty from January to December 2009. Because the information about nurse staffing in NHI claim data categorized nursing grade according to the nurse-to-bed ratio, the nurse staffing level was transformed from the nurse-to-patient ratio using the bed occupancy rate. The general ward and ICU nurse staffing levels were then categorized into major violation, violation, adherence, and major adherence according to the medical law standard. The association between nurse staffing level and survival after PCA was analyzed using logistic regression analyses with a generalized estimation model.

Results: The survival rate was higher for patients in hospitals with major adherence [odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.13-2.07] ICUs nurse staffing than for those in hospitals with adherence nurse staffing, and lower for patients in hospitals with violation (OR = 0.50, 95% CI = 0.26-0.93) or major violation (OR = 0.45, 95% CI = 0.21-0.97) general ward nurse staffing than for those in hospitals with adherence nurse staffing. Policies to ensure adherence to the medical law standard for nurse staffing levels is necessary to enhance the safety of patients experiencing PCA in Korea.
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http://dx.doi.org/10.1016/j.ijnurstu.2018.09.012DOI Listing
January 2019

Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry.

Kidney Res Clin Pract 2018 Sep 30;37(3):266-276. Epub 2018 Sep 30.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Background: We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.

Methods: Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.

Results: Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; = 0.003).

Conclusion: In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.
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http://dx.doi.org/10.23876/j.krcp.2018.37.3.266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147195PMC
September 2018

Effect of the Contents in Advance Directives on Individuals' Decision-Making.

Omega (Westport) 2020 Aug 13;81(3):436-453. Epub 2018 Jun 13.

Department of Nephrology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.

Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded "accept the special interventions" on the reference form. However, the majority (70%-90%) chose "refuse the interventions" on the negative form. With respect to the religious form, 70% to 80% chose "not decided yet." Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care.
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http://dx.doi.org/10.1177/0030222818782344DOI Listing
August 2020

Hexokinase 2 is a molecular bridge linking telomerase and autophagy.

PLoS One 2018 20;13(2):e0193182. Epub 2018 Feb 20.

Department of Biochemistry, College of Life Science and Biotechnology and Yonsei Laboratory Animal Research Center, Yonsei University, Seoul, Republic of Korea.

Autophagy is systematically regulated by upstream factors and nutrients. Recent studies reported that telomerase and hexokinase 2 [HK2) regulate autophagy through mTOR and that telomerase has the capacity to bind to the HK2 promoter. However, the molecular linkage among telomerase, HK2, and autophagy is not fully understood. Here, we show that HK2 connects telomerase to autophagy. HK2 inhibition in HepG2 cells suppressed TERT-induced autophagy activation and further enhancement by glucose deprivation. The HK2 downstream factor mTOR was responsible for the TERT-induced autophagy activation under glucose deprivation, implying that TERT promotes autophagy through an HK2-mTOR pathway. TERC played a role similar to that of TERT, and simultaneous expression of TERT and TERC synergistically enhanced HK2 expression and autophagy. At the gene level, TERT bound to the HK2 promoter at a specific region harboring the telomerase-responsive sequence 'TTGGG.' Mutagenesis of TERC and the TERT-responsive element in the HK2 promoter revealed that TERC is required for the binding of TERT to the HK2 promoter. We demonstrate the existence of a telomerase-HK2-mTOR-autophagy axis and suggest that inhibition of the interaction between telomerase and the HK2 promoter diminishes glucose starvation-induced autophagy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193182PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819818PMC
May 2018

[Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications].

J Korean Acad Nurs 2017 Dec;47(6):828-841

College of Nursing, Seoul National University, Seoul, Korea.

Purpose: This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014.

Methods: Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression.

Results: An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870).

Conclusion: To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future.
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http://dx.doi.org/10.4040/jkan.2017.47.6.828DOI Listing
December 2017

Cell Death-Associated Ribosomal RNA Cleavage in Postmortem Tissues and Its Forensic Applications.

Mol Cells 2017 Jun 15;40(6):410-417. Epub 2017 Jun 15.

Department of Legal Medicine, College of Medicine, Korea University, Seoul 02841, Korea.

Estimation of postmortem interval (PMI) is a key issue in the field of forensic pathology. With the availability of quantitative analysis of RNA levels in postmortem tissues, several studies have assessed the postmortem degradation of constitutively expressed RNA species to estimate PMI. However, conventional RNA quantification as well as biochemical and physiological changes employed thus far have limitations related to standardization or normalization. The present study focuses on an interesting feature of the subdomains of certain RNA species, in which they are site-specifically cleaved during apoptotic cell death. We found that the D8 divergent domain of ribosomal RNA (rRNA) bearing cell death-related cleavage sites was rapidly removed during postmortem RNA degradation. In contrast to the fragile domain, the 5' terminal region of 28S rRNA was remarkably stable during the postmortem period. Importantly, the differences in the degradation rates between the two domains in mammalian 28S rRNA were highly proportional to increasing PMI with a significant linear correlation observed in mice as well as human autopsy tissues. In conclusion, we demonstrate that comparison of the degradation rates between domains of a single RNA species provides quantitative information on postmortem degradation states, which can be applied for the estimation of PMI.
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http://dx.doi.org/10.14348/molcells.2017.0039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523017PMC
June 2017

Associations Between Reported Dietary Sodium Intake and Osteoporosis in Korean Postmenopausal Women: The 2008-2011 Korea National Health and Nutrition Examination Survey.

Asia Pac J Public Health 2017 Jul 5;29(5):430-439. Epub 2017 Jun 5.

3 Eulji Hospital, Nowon-gu, Seoul, Republic of Korea.

Osteoporosis is prevalent among postmenopausal women, and increasing evidence has linked salt intake with this disease. In this article, we explored the association between dietary sodium intake and osteoporosis in Korean postmenopausal women. We analyzed data for 3635 postmenopausal women extracted from the 2008-2011 Korea National Health and Nutrition Examination Survey. We found that 1542 participants (42.4%) have osteoporosis. The adjusted prevalence rates of osteoporosis at the lumbar spine were significantly higher in participants who consumed ≥4001 mg of salt than those who consumed ≤2000 mg. At the femoral neck, rates were significantly higher for those who consumed ≥5001 mg compared with those who consumed ≤4000 mg. Participants with a higher sodium intake showed a significantly higher odds ratio of developing lumbar and femoral neck osteoporosis, compared with those with a lower intake. Our results suggest that excessive daily sodium intake is associated with a higher osteoporosis prevalence in Korean postmenopausal women.
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http://dx.doi.org/10.1177/1010539517712759DOI Listing
July 2017
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