https://ir.ymlib.yonsei.ac.kr/handle/22282913/168982 2026-05-03T09:08:10Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211443 Title: Interplay of age-sensitive cortical vulnerability and dopaminergic degeneration in clinical manifestations of Parkinson's disease Authors: Kang, Sungwoo; Na, Han Kyu; Yoon, So Hoon; Kim, Han-Kyeol; Ryu, Young Hoon; Lee, Hye Sun; Yoo, Han Soo; Lyoo, Chul Hyoung; 유한수 Abstract: To identify the pattern of cortical atrophy variation in Parkinson's disease (PD) and its contribution to clinical manifestations beyond dopaminergic dysfunction, 45 healthy controls (HCs) underwent MRI, and 222 participants with PD additionally underwent dopamine transporter (DAT)-PET, Unified PD Rating Scale (UPDRS), and neuropsychological tests. Using principal component analysis in PD, a single pattern in cortical thickness (PC1PD) was identified. Linear regressions models were applied to investigate the effects of PC1PD and putaminal DAT (DAT-P) on parkinsonism, and PC1PD and caudate DAT (DAT-C) on cognition. PC1PD accounted for more than 80% of total cortical variance and showed a strong negative correlation with age. The spatial pattern of PC1PD was similar to that of PC1 derived from HCs, but its age-related association was more pronounced in PD. Independent of DAT-P, lower PC1PD was associated with higher UPDRS motor score and showed a synergistic significant interaction with DAT-P on the axial subscore. Independent of DAT-C, lower PC1PD was associated with worse performance in global cognition, language, and executive functions, with synergistic interaction with DATC on global cognition and executive function. The associations of PC1PD with UPDRS motor scores, general cognition, and executive function were stronger in older participants, indicating that aging amplifies the clinical effect of PC1PD. PC1PD represents an age-sensitive cortical vulnerability axis whose expression is amplified in PD, and its interplay with dopaminergic depletion and aging contributes to axial motor symptoms and executive dysfunction in PD. 2026-07-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211942 Title: Mechanisms underlying the effect of nurse-led enhanced supportive care for advanced cancer patients: A mediation analysis of randomized controlled trial data Authors: Hong, Bomi; Choi, Yun Young; Lee, Hye Sun; Lee, Jiyeon Abstract: Purpose: A nurse-led enhanced supportive care intervention integrating the Bandura's mastery enhancement and the acceptance and commitment therapy approach as an early primary palliative care was effective in improving coping, self-efficacy for coping with cancer, and role functioning. This study examined the mechanisms through which the intervention improved role functioning in patients with advanced cancer, focusing on the mediating roles of coping and self-efficacy for coping with cancer. Methods: A secondary analysis was conducted (N = 182). Active coping, self-efficacy for maintaining activity and independence, and role functioning were measured using the Brief COPE, the Cancer Behavior Inventory 3.0, and the EORTC QLQ-C30. Descriptive, correlation, and mediation analyses were conducted using IBM SPSS 27 and PROCESS macro Models 4 and 6. Results: In the serial mediation analysis, the intervention demonstrated statistically significant total effect on role functioning (effect = 8.89, SE = 3.21, 95% CI [2.54, 15.23]). The direct effect of the intervention remained significant after accounting for active coping and self-efficacy in maintaining activity and independence as mediators (effect = 6.19, SE = 3.08, 95% CI [0.12, 12.27]). The sequential pathway suggested by the conceptual model was statistically significant (effect = 0.78, SE = 0.46, 95% CI [0.11, 1.90]) and explained 8.8% of the total effect. Conclusion: The nurse-led enhanced supportive care improved role functioning via the serial mediation of active coping and self-efficacy for maintaining activity and independence. The results highlight the importance of coping and self-efficacy in enhancing role functioning and provide direction for future palliative care interventions. Trial registration: NCT04407013. 2026-06-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211617 Title: A practical and validated nomogram for predicting delirium in critically ill patients: A multicenter prospective observational study Authors: Chang, Sung Won; Lee, Hye Sun; Chung, Kyungsoo; Chung, Chi Rayng; Lee, Jongmin; Sim, Jae Kyeom; Moon, Jae Young; Chang, Youjin; Lee, Young Seok Abstract: Background: Delirium is a common condition in intensive care units (ICUs) that is associated with adverse clinical outcomes. Early identification and intervention are critical for improving the prognosis. This study aimed to develop a predictive model for identifying delirium in critically ill patients at the time of ICU admission. Methods: A multicenter prospective observational cohort study was conducted, enrolling patients aged >= 20 years who were admitted to the ICU for more than 24 h and had no pre-existing cognitive impairment. Two cohorts-development and validation-were recruited during separate periods. Delirium was assessed daily using the Confusion Assessment Method for the ICU and the Diagnostic and Statistical Manual of Mental Disorders, 5th. Results: Among the 462 patients included in the development cohort, 29.0% developed delirium during their ICU stay. A novel delirium prediction model was developed and presented as a nomogram incorporating only seven easily obtainable variables. This model demonstrated good predictive performance (area under the curve [AUC], 0.736; 95% confidence interval [CI], 0.684-0.787). External validation confirmed its robustness (AUC, 0.810; 95% CI, 0.733-0.887), with superior performance compared to the PRE-DELIRIC model in both cohorts. To facilitate clinical implementation, we developed a user-friendly calculator application (available at https ://avonlea76.shinyapps.io/shiny_delirium/) using shinyapps.io, which is compatible with both smartphones and computers. Conclusions: We developed and externally validated a nomogram-based model to predict ICU delirium in critically ill patients. The model outperformed existing delirium prediction tools and can be conveniently used at the bedside as part of standard ICU care bundles. 2026-04-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211832 Title: Adequacy Criteria for Thyroid Fine-Needle Aspiration in the Era of the Bethesda Reporting System Authors: Kwak, Jin Young; Cho, Sangwoo; Lee, Hye Sun; Yoon, Jung Hyun; Ali, Syed Z.; Hong, Soon Won Abstract: Purpose: There is a lack of consensus and data validating lower cell counts for sample adequacy of thyroid fine-needle aspiration (FNA). We investigated less stringent adequacy thresholds under the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and evaluated malignancy risks for "nondiagnostic" nodules by ultrasound features. Materials and Methods: A total of 2459 nodules with initial FNA were included. We built 11 new adequacy criteria based on the number of cell groups and total follicular epithelial cells. Diagnostic performance of each criterion was compared with the original criterion using the general estimating equation. Nondiagnostic nodules under each criterion were categorized by the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS), and malignancy rates of each ACR TIRADS category were compared. Results: Malignancy rates of nondiagnostic nodules were under 3.5% across all criteria, and showed no significant differences compared with the original. More than 40 cells, regardless of cell group, or more than three cell groups showed no significant difference in diagnostic accuracy and false negative rates compared with the original criterion. Malignancy rates of nondiagnostic nodules were above 28.6% for ACR TIRADS 5, and below 5% for ACR TIRADS 1 to 4, in all criteria. Conclusion: Less stringent thresholds for sample adequacy can show comparable diagnostic performances to the original criterion of the TBSRTC. Given their markedly higher malignancy rates, nondiagnostic ACR TIRADS 5 nodules may warrant more active management than lower category nodules. 2026-04-01T00:00:00Z