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Few large-scale studies have investigated factors associated with the development of hepatocellular carcinoma (HCC) in patients with autoimmune hepatitis (AIH). This study aimed to determine the risk of HCC in AIH patients and associated risk factors, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD). We analyzed the claims data from the Korean National Health Insurance Service from 2007 to 2020. The study included 7,382 patients with AIH and a control group of 58,538 age- and sex-matched individuals, at a ratio of 1:8. We compared the incidence rates of HCC between these groups and investigated the risk factors of HCC. During a median follow-up of 5.9 years, 160 AIH patients were diagnosed with HCC, resulting in an incidence rate of 3.60 per 1,000 person-years. The matched controls exhibited an incidence rate of 0.48 per 1,000 person-years. After adjustment, AIH patients had a 4.85-fold heightened risk of HCC compared to the control group. Within the AIH cohort, the presence of coexisting MASLD further elevated the risk of HCC, along with other factors such as older age, male sex, and decompensated liver cirrhosis, as observed in a two-year landmark analysis. The presence of concurrent extrahepatic autoimmune diseases did not affect the prognosis, while glucocorticoid treatment was associated with a decreased risk of HCC. Patients with AIH had an increased risk of HCC compared to matched controls, particularly those with coexisting MASLD. In addition to appropriate medical treatment, proactive interventions and lifestyle modifications for concurrent MASLD are recommended for these patients.

This study aims to create and validate a model explaining gestational weight gain and management behaviors using Ajzen’s Theory of Planned Behavior, assessing the model’s fit with actual data and examining the influences of various factors. Employing a correlational research design, data were collected and analyzed from 396 primigravida who were at least 36 weeks and agreed to participate in the study from April 15, 2022, to August 15, 2022, through an online questionnaire. SPSS 26.0 was used to analyze the general characteristics of participants, descriptive statistics of variables, reliability of tools, and correlation of variables. AMOS 28.0 was used to verify the hypothesis and to assess the fitness of hypothetical models. The modified model fitness was χ2/df = 3.29, goodness-of-fit index = .93, standardized root-mean-square residual = .06, root- mean -square error of approximation = .08, comparative fit index = .92, Tucker–Lewis index = .88, PNFI = .62. All hypotheses were statistically significant. The more positive attitude toward weight management behaviors (β = .52, p < .001), the higher perceived behavioral control (β = .21, p = .011) and subjective norms (β = .31, p = .034) were shown to have a significant effect on weight management behavioral intentions. They explained 77% of the variance in weight management behavioral intention. Weight management intentions (β = .63, p < .001) and perceived behavioral control (β = .52, p = .003) significantly influenced weight management behaviors, explaining 79% of the behavior variance. Enhanced weight management behaviors significantly reduced gestational weight gain accounting for 31% of the variance in gestational weight gain (β = −.56, p < .001). Establishing a nursing intervention strategy that addresses attitude, subjective norms, and perceived behavioral control is crucial as these factors enhance weight management intentions and behaviors, thereby facilitating appropriate gestational weight gain and reducing pregnancy complications.

The clinical utility of a type 2 diabetes mellitus (T2DM) polygenic risk score (PRS) in the East Asian population remains underexplored. We aimed to examine the potential prognostic value of a T2DM PRS and assess its viability as a clinical instrument. We first established a T2DM PRS for 5490 Korean individuals using East Asian Biobank data (269,487 samples). Subsequently, we assessed the predictive capability of this T2DM PRS in a prospective longitudinal study with baseline data and data from seven additional follow-ups. Our analysis showed that the T2DM PRS could predict the transition of glucose tolerance stages from normal glucose tolerance to prediabetes and from prediabetes to T2DM. Moreover, T2DM patients in the top-decile PRS group were more likely to be treated with insulin (hazard ratio = 1.69, p value = 2.31E−02) than were those in the remaining PRS groups. T2DM PRS values were significantly high in the severe diabetes subgroup, characterized by insulin resistance and β -cell dysfunction (p value = 0.0012). The prediction models with the T2DM PRS had significantly greater Harrel’s C-indices than did corresponding models without it. By utilizing prospective longitudinal study data and extensive clinical risk factor information, our analysis provides valuable insights into the multifaceted clinical utility of the T2DM PRS.

Diabetic patients have larger infarcts, worse neurological deficits, and higher mortality rate after an ischemic stroke. Evidence shows that in diabetes, the hypothalamic–pituitary–adrenal (HPA) axis was dysregulated and levels of cortisol increased. Based on the role of the HPA axis in immunity, we hypothesized that diabetes-dysregulated stress response exacerbates stroke outcomes via regulation of inflammation. To test this hypothesis, we assessed the regulation of the HPA axis in diabetic mice before and after stroke and determined its relevance in the regulation of post-stroke injury and inflammation. Diabetes was induced in C57BL/6 mice by feeding a high-fat diet and intraperitoneal injection of streptozotocin (STZ), and then the mice were subjected to 30 min of middle cerebral artery occlusion (MCAO). Infarct volume and neurological scores were measured in the ischemic mice. The inflammatory cytokine and chemokine levels were also determined in the ischemic brain. To assess the effect of diabetes on the stroke-modulated HPA axis, we measured the expression of components in the HPA axis including corticotropin-releasing hormone (CRH) in the hypothalamus, proopiomelanocortin (POMC) in the pituitary, and plasma adrenocorticotropic hormone (ACTH) and corticosterone. Diabetic mice had larger infarcts and worse neurological scores after stroke. The exacerbated stroke outcomes in diabetic mice were accompanied by the upregulated expression of inflammatory factors (including IL-1β, TNF-α, IL-6, CCR2, and MCP-1) in the ischemic brain. We also confirmed increased levels of hypothalamic CRH, pituitary POMC, and plasma corticosterone in diabetic mice before and after stroke, suggesting the hyper-activated HPA axis in diabetic conditions. Finally, we confirmed that post-stroke treatment of metyrapone (an inhibitor of glucocorticoid synthesis) reduced IL-6 expression and the infarct size in the ischemic brain of diabetic mice. These results elucidate the mechanisms in which the HPA axis in diabetes exacerbates ischemic stroke. Maintaining an optimal level of the stress response by regulating the HPA axis may be an effective approach to improving stroke outcomes in patients with diabetes.

Mammalian neurogenesis continues throughout adulthood in the subventricular zone of the lateral ventricle and in the subgranular zone of the dentate gyrus in the hippocampus. It is well known that hippocampal neurogenesis is essential in mediating hippocampus-dependent learning and memory. Ghrelin, a peptide hormone mainly synthesized in the stomach, has been shown to play a major role in the regulation of energy metabolism. A plethora of evidence indicates that ghrelin can also exert important effects on neurogenesis in the hippocampus of the adult brain. The aim of this review is to discuss the current role of ghrelin on the in vivo and in vitro regulation of neurogenesis in the adult hippocampus. We will also discuss the possible role of ghrelin in dietary restriction-induced hippocampal neurogenesis and the link between ghrelin-induced hippocampal neurogenesis and cognitive functions.

Unanticipated postural control measures may better identify mechanisms of ankle sprains in real-life situations. The purpose of this study was to identify directional deficits in reactive postural control during unanticipated horizontal perturbations among groups of chronic ankle instability (CAI), ankle sprain coper, and healthy control. Sixty-eight volunteers (24 CAI patients, 23 ankle sprain copers, and 21 healthy controls) participated in this study. The participants performed a single-leg stance with unanticipated horizontal perturbations in four random directions of anterior, posterior, medial, and lateral. Anterior-posterior time to stabilization (APTTS) and medial-lateral time to stabilization (MLTTS) were calculated as an indicator of reactive postural control during horizontal perturbations. A significant interaction effect of the group x perturbation directions (3 × 4) was found. Both CAI and ankle sprain coper groups showed longer APTTS and MLTTS during medial and lateral horizontal perturbations compared to the healthy control group. However, no difference was found in APTTS and MLTTS during anterior and posterior horizontal perturbations between three groups. Directional deficits in reactive postural control during medial and lateral perturbations could result from sensorimotor dysfunction as consequences of lateral ankle sprains in the CAI and ankle sprain groups.

Longitudinal data on perioperative opioid use for pediatric orthopedic fractures are sparse. This study evaluated 15-year trends in perioperative opioid use for pediatric distal humerus fractures in Korea. Population-based medical data from 51,638,809 subscribers to the Health Insurance Review and Assessment Service were analyzed to assess perioperative opioid use patterns. We reviewed patients aged 2–12 years who underwent closed reduction and percutaneous pinning between 2007 and 2021. A total of 33,770 cases were identified, including 17,945 cases of perioperative opioid use. Injectable opioids were administered in 17,665 cases, and oral opioids were administered in 642 cases. The two most commonly used opioids were injectable fentanyl (60.7%) and injectable tramadol (36.8%). The percentage of total opioid use increased from 40.7% in 2007 to 63.5% in 2018. While the use of injectable fentanyl has steadily increased, the use of injectable tramadol has decreased since 2017. More than half of the pediatric patients who underwent surgery for distal humerus fractures received opioids during the perioperative period. Most commonly used opioid was injectable fentanyl, and its usage continued to increase, representing almost all opioids used in surgeries by 2021. Further research is necessary to analyze the effect of this trend change in injectable fentanyl and tramadol use, offering with recommendations for reducing opioids.

Despite the substantial role of chest MRI for the diagnosis and follow-up of thymic cysts, information about inter-reader agreement and optimal MR sequences is still limited. We aimed to investigate the inter-reader agreement for diagnosing thymic cysts using various combinations of MR sequences and to assess the effect of the addition of CT on inter-reader agreement. A total of 76 anterior mediastinal lesions (≤ 30 mm) from two tertiary referral hospitals (55 from Institution A and 21 from Institution B) who underwent chest CT and contrast-enhanced chest MR were included. Internal and external reading sets consisted of different combinations of MR sequences (pre- and post-contrast T1-weighted, T2-weighted, subtracted images, and diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC] map) and CT. Four and three radiologists independently reviewed internal and external reading sets. The overall inter-reader agreement was moderate (κ = 0.50–0.57) for diagnosing cysts without significant differences between MR sequence combinations (all p -values > 0.05). The mean pairwise inter-reader agreement was the highest (κ = 0.65) when both the subtracted image and DWI/ADC map were provided. The addition of CT had no positive effect on the inter-reader agreement in the internal reading set (κ, from 0.57 to 0.50) but increased inter-reader agreement in the external reading set from moderate (κ = 0.48) to substantial (κ = 0.74). In conclusion, the overall inter-reader agreement for diagnosing thymic cysts on MRI was moderate. MR sequences including both the subtracted image and DWI/ADC map may be optimal in terms of inter-reader agreement.